Interesting ECG and why you should use a 12 lead


I just wanted to quickly post up an interesting ECG, in the past this ECG would probably have been missed by ambulance 3 lead monitors, in a pt without chest pain nothing would have been though of it. This is why, almost every in almost critically ill patient I will attempt a 12 lead, not only to try and give me a full picture of what may be occurring with my patient but to avoid delivering the wrong pt to the wrong hospital and bringing a delay in treatment.
We love sexy pelvic binders, CT6s and exciting trauma procedures. But I think the 12 lead needs to be treated with the same reverence. The more information we can gain about our pt the better we stand to be in the handover.

Pre Hospital Pelvic Binding and Femur Traction Survey (Directors Cut)

Head over to survey monkey and take my quick 6 question survey on Prehospital Pelvic Binding, I got a feel for the topic with a limited one question survey 2 months ago, It had 38 Respondents, I’m looking for more!

Please get this out around the world. I’ll be doing something exciting with the results, more to come on that.

Thanks for your time

Mitchell Thomas
@jrparamed on Twitter previous post can be found here

Training Podcast show notes

The podcast really speaks for its self, most of the items we used were from the local hardware store or peoples sheds

The Cannula trainer, easily made from items at your ED or ambulance station.

You can find the podcast over on Itunes at the link below.
If your not already a subscriber add me and leave a comment, make the show easier to find.

Paramedic & Emergency Pharmacology Guidelines

Recently I was back at the Education center for my Ambulance Service, I had a quick look at the store while I was there, thankfully I didn’t have to make as many purchases as last time I attended!


But one thing I did pick up was this




I’ll start by saying I’ve been looking for a book like this for a while, its nice to know what everyone else out there does. Especially when talking to the wider world on twitter and facebook.

I wish we had a book like this when I was a student at uni, we used to have to borrow the drug cards from the Paramedics on placement and try and make photo copies for our practical classes, or get a ACLS/PHTLS themed book.
This little pocket guide is the size of a thick note pad and covers a large amount of common Australian Prehospital medications in a tabled format.


The lay out of each medication is simple, easy and basic, exactly what you need for quick reference. Each medication has entries for description, indications, mechanism of action, pharmacokinetics, contraindications, adverse effects, precautions, preparation (common ones available), dosage.

The book is made of coated paper so it should survive a trip to the bottom of a pocket or bag, being sat or stepped on or other things paramedic students are liable to subject it to.
Going to uni in a time when table’s were a thing of the future and if you wanted info you had to haul a text book or a computer to class, or just plain remember it, I would have loved to have this as a quick reference for question time, practical scenarios and study. I’m really quite impressed by this amalgamation of references into one easy to use pocket book. If your looking for an inexpensive, useful gift for your self or someone you know this makes a great one. Now that I’m pushing myself into study again I find myself looking to it more and more.

For those of you that prefer to access your information on phones (and who doesn’t) there is now a phone app of this book.

In addition to this and for those now casting the printed word aside there is an Iphone/ Android app (I’ve only played with the Android version, for some reason people aren’t trusting with their phones)
Same idea as the pocket guide but it now inhabits a place next to all your other pocket guides on your phone, for a little over 5 dollars you get a searchable reference that is update-able. In addition to having medications it also arranges them by use.
Screenshot_2014-08-30-06-52-22 Screenshot_2014-08-30-06-52-24 Screenshot_2014-08-30-06-52-28 Screenshot_2014-08-30-06-52-48

The book retails for around $30 and the App will set you back $5

It all depends on what you like, I prefer the phone app as it I would give the book a 4/5 as its a great bit of kit that I would have loved as a student and the app a 4.5/5 as it takes the book to the next level.


Resus Room Feng Shui by Tim Leeuwenburg

Thank you Tim for producing this inspiring talk, while speaking to your experience in the remote resus room I think you also cover off a number of points that affect pre hospital providers. Issues of controlling our space, while our resus room always looks different and there’s rarely maximum access we really do need to ensure we train maximizing Feng Shui of the pre hospital scene.

I’d point any curious paramedic students or newer clinicians like myself in the direction of this talk. Of course as part of a rounded SMACC and #FOAMed diet


The one question that remains where is Penny’s podcast!!!!!





Resus Room Feng Shui by Tim Leeuwenburg.

Intranasal Medications Podcast


Inspired by a recent twitter conversation with a UK Paramedic I’m talking this afternoon about IN medications and their use, encompassing a case study.
A few people have been talking about IN Fentanyl on Twitter, I’ve been using it now for quite a while. So I thought I would jump in front of a microphone and have a quick chat about it.
Just a quick one here for the podcast, haven’t been able to talk about as much as I want to, a big period of study coming up in the next few weeks.

Podcast is locatated at

Or you can find it on Itunes please subscribe and rate making it easier for he next person to find.

Effectiveness of morphine, fentanyl, and methoxyflurane in the prehospital setting.

A great website covering all things Intranasal

Methoxyflurane (known as Methoxy)









Prehospital Pelvic Binding and Femoral Traction Poll

I’d like to hear about your service and Femoral Traction in the Presence of a Pelvic injury, do you have a SOP, Protocol, Guideline on the application of Femoral Traction Splints in the Presence of Pelvic injury?

This is out of Twitter, does your service have a formal recommendation on the use of Traction in pelvic fracture, if so I’d like you to enter an answer on the poll!

I’d like to see as many responses as possible!

Feel free to comment on the blog, at twitter or in the current discussion on G+

Fatigue in our workplace


While my girlfriend was looking through some resources for work she found a Fatigue Risk Assessment and Hazard wall chart presumably developed for Mines NSW, So she sent it over to me to have a read of. She’s been working on her workplace policy for fatigue and avoidance of excessive overtime. Being the wonderful person she is and knowing I spend good deals of time on twitter and here talking about various things she occasionally provides some resources.

Here’s the where you can find it

This got me thinking about what we do, a lot of the risks identified are iatrogenic to our 24/7 365 best care out there model (IE. not readily modifiable) The points on the table where you as an individual have the most ability to affect change are the individual and non work factors

A few weeks ago I was involved in a chat on twitter about how best to do night shift.
The question from a Paramedic student, presumably in reference to up coming clinical shifts generated a number of tweets about different strategies

What I find work for me is, take as much time for my self in the preceding day as possible. As tempting as it is to go out, hang out with friends or have a bbq its going to hurt later (I have most friends well tuned into my 9 day roster).
I try to limit my caffeine intake in the AM and early PM to allow me to have a nap if the mood strikes. I try to avoid stocking up on sugar for nightshift, I find pushing back my dinner until 11 usually tides me over until the morning (this will of course be different) I try and avoid relying on the various brands of energy drink.
I find some light exercise, helps to wake me up for the shift a jog or some light cycling try to avoid muscle fatigue that won’t help.

After a shift I like to have breakfast, usually something light and wander off to bed, if its days off then I’ll have my girlfriend call around 1 or 2 so I don’t sleep through the day and wreck my sleep cycle.

Now for a Airline industry mnemonic! Because Twitter loves Aviation (and why shouldn’t we) Used by pilots to assess fitness to fly.


Now why did I start this with a story about how I found this via way of my wonderful girlfriend, because that’s what I think about when I think about fatigue, moving away from the patient safely issue we all like to talk about and bringing it back to a more personal point. The consequence of driving tired not only affects you, but loved ones, mates and other road users.
Don’t be afraid to have a nap after night shift, my lounge is often offered to paramedic students and everyone who’s a close friend knows how to get into the house where to find blankets and that they are always welcome to a kip on the lounge.
Fatigue its a huge killer on the roads. We have to operate through it by virtue of our employment. Watch this ad from Transport NSW and think about the message.

Stay safe out there

The featured photo was taken after I was coming back from a night shift that involved a long drive, after realising I was struggling I diverted to a friends house and took a nap under my jacket on the lounge, thankfully the 3 year old allowed Uncle Mitch some much needed sleep!

Are you OK?

Originally posted on PHARM:

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