The general rule of thumb now is only go lights and sirens to a hospital if the hospital can do something for the patient that you can’t in the amount of time you would save going lights and sirens over flow of traffic that will make a difference in the patient’s outcome.

I tried to immobilize him. He wanted no part of it. I had two cops with me. Somehow they ended up wrestling with him to try to get him to submit to being immobilized. One cop had him in a head lock.

I can tell you this now, based on the medical literature, and on my experiences with the LMA and Combi-tube, I no longer hesitate to use an alternative airway as my first line airway.

“You’re just one crew?” the cop asks. “You have restraints?”

The first rule of medicine is “Do No Harm.” Lacking chest x-rays and the ability to do BNPs in the field, time and again, EMS (myself included) has done harm to our patients by giving patients we were certain were in CHF, Lasix when in truth they had sepsis or pneumonia.

When I tried to take the old Jamshidi needle out, it wouldn’t budge. I had bent it when I screwed it in. All the short four minutes to the hospital I spend trying to yank the dam thing out while a firefighter did CPR, and my rider squeezed the ambu-bag.

You slammed in two large bore IVs and had the fluid running fast and wide. Two 14’s was an A plus. A 14 and a 16 was good. Two 16’s was border line. Anything less was not worthy of the patch on your shoulder.

Things are very different today in 2012. You still need to be good at IVs, but there are more drug delievery options, which is better for the paramedic and, most importantly, better for the patient.

When I started we used narcan for opiate overdose and coma of unknown etiology. Today we use narcan for respiratory depression or inadequate ventilation associated with opiate overdose.