# Heart Attack after Two Hours of Climbing



## Kanga (Sep 14, 2004)

During a ride last weekend, one of the riders in our club complained of chest pain and tingling in the arms, near the top of a two-hour climb. He was also short of breath and feeling very weak, considering he's a strong rider. I wasn't on the ride, and am just relaying information posted on our club forums to MTBR. But if I had been there, I'd have known immediately what these symptoms meant.

The group kept riding, with our friend still hurting and getting worse. After the group had to wait an unusually long time for him after a two-hour climb (he's usually right there, either with or just behind the fastest riders), he collapsed for a few moments, but then sat up and said he was OK, even though he could hardly breathe. The group turned back, riding downhill, our friend still riding, and went to the nearest ranger station from where they were able to summon paramedics. 

He'd had a heart attack, and doctors have since discovered severely clogged coronary arteries. Even though his fitness level was very high, there was still a great deal of blockage within his coronary arteries that had never been picked up on his physicals. I'm guessing that it may have been because he was so fit that they had missed the hidden heart problems, but I'm not a doctor. Had he not been so fit, the doctors tell him, he probably wouldn't have survived. 

Since the weekend, we've been doing a lot of discussion on our club forums and a few conclusions have come up that I wanted to share with all the MTBR crew....

First Aid and CPR training - Since mountain biking often takes us out of cell phone coverage and far away from vehicular access, this is one thing that everyone should consider. For those more seriously considering such training, a step up to Wilderness First Aid or even Wilderness First Responder would be even better, since that training spends more time dealing with situations in which we often find ourselves as mountain bikers.

Aspirin - Though some of our group routinely carry first aid kits, none on this particular ride had aspirin, which can lessen the severity of a heart attack or stroke, and even save a life. I'm not sure if any of them would have known what to do with the aspirin, since none had basic first aid or CPR training, and from the reports, it seemed that nobody in the group suspected a heart attack in such a fit individual who was so young (40's) and skinny as a rail.

ID - Keep essential paperwork in your camelback or toolbag: a copy of your ID and Insurance cards, and a list of emergency contacts, doctors, medications, allergies and medical conditions. I just printed mine on the computer and laminated it. 

Local Knowledge/GPS/Cell Phone/Radio - Though they had radios, GPS and cell phones, it was knowing the location of the nearest place to summon help (a ranger station) that ultimately determined the outcome of the incident. In other cases, a GPS might be used to give coordinates by radio or cell phone if the victim/patient is unable to be moved.

Solo riding - Had he been riding alone.... well we won't go there, since everyone knows to tell someone where you'll be and when you'll be back and/or take a riding buddy with you.

Our friend is now in the ICU, has undergone angioplasty, and will be off the bike for several months. But they tell us, with his newly opened coronary arteries, he might even come back a stronger and faster rider in the future. 

He was lucky, and we're all grateful for the outcome. But it shouldn't have taken such a potentially tragic event to give us all the wake up call we needed. 

I hope after reading this a few more riders take the initiative and get trained on the basics. The life you save may be one of your riding buddies.....


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## slocaus (Jul 21, 2005)

Kanga said:


> He'd had a heart attack, and doctors have since discovered three severely clogged coronary arteries. Even though his fitness level was very high, there was still a great deal of blockage within his coronary arteries that had never been picked up on his physicals. I'm guessing that it may have been because he was so fit that they had missed the hidden heart problems, but I'm not a doctor.


Some blockages do not show up al all. Mine was the LAD and if not for riding, I'd have never known it. It is termed the 'widow maker' with no warnings, just a massive myocardial infarction.


Kanga said:


> Our friend is now in the ICU, has undergone angioplasty, and will be off the bike for several months. But they tell us, with his newly opened coronary arteries, he might even come back a stronger and faster rider in the future.


Likely he will. I was restricted from lifting over 10 pounds for a week, then was given total freedom to do what I wanted. I had my warning a few months prior, but had not had any exercise for four months. When I went for a ride, I was stronger than before. (My story of the cath lab and stents is in my sig.)

Let your friend know that he has many "heart beats" and "pedal strokes" in his future!


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## Jisch (Jan 12, 2004)

I ride with a guy who is overweight. He does really well on the climbs and can flat out-ride me on the descents. We're somewhat competitive and I'll hammer up any hill to prove I can get to the top before him (its hardly ever a contest). 

Recently when riding with a third friend, he suggested that we need to lighten up so this guy can catch his breath and "not have a heart attack". It hit me that if this guy did have a heart attack, I don't know what I'd do. He weighs 240 lbs, most times, its just the two of us out there. No way I could move him any distance and I mean that literally. 

Something to think about I suppose, I should look into some training - I have taken various first aid and CPR classes over the years, but I need a refresher. 

John


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## Kanga (Sep 14, 2004)

Slocaus, he'll be glad to hear of your outcome. In retrospect, he'd been slowing down on the climbs over the past few months, but had put it down to stress and age, but now we know better.

Jisch - If you've had CPR classes over the years, the standard of care has been revised and has changed several times. What you learned years ago may be deemed inappropriate by current standards (which doesn't mean you shouldn't use whatever knowledge you have if the need arises). If you're comfortable with the actual administration of CPR, but are rusty on the timing, order, and other standards, there are now online classes that will help get you back up to speed. But IMO they're only appropriate as refreshers, not for first-time CPR classes, and even then, if you can take a real class you're much better off. There's nothing like hands-on practice. 

Our friend is in his 40's, 5'7" and less than 140 pounds. Not the size or type you'd expect to have blocked arteries. I spoke to him after posting above. He's been given a stint, and angioplasty, and the doctors were indeed amazed that he made it to the ER after continuing to ride with a heart attack in progress for more than an hour.


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## slocaus (Jul 21, 2005)

Kanga said:


> Our friend is in his 40's, 5'7" and less than 140 pounds. Not the size or type you'd expect to have blocked arteries.


It is all genetics. If you have the (bad) genetics predisposed for arteriosclerosis, there ain't much you can do. Sad, but true.

That is how my cardiologist explained it to me. Maybe being a vegetarian and taking all of the modern meds, but they will not be subscribed beforehand, and did not exist thirty years ago when my blockages began so subtlety.


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## Kanga (Sep 14, 2004)

Stripes, I used to be in Portland, but am in So Cal now. The only place I know of for WFR training is the Sierra Mountain Center, near Bishop/Mammoth. I did their avalanche 1 training program two winters ago. Their WFR training is a ten-day course that's very intense.


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## yfdcap (Apr 25, 2007)

This is a great thread. I would like to caution not to take aspirin if you suspect you are having a stroke though. If the stroke is a bleeding stroke(ruptured blood vessel)and not a clot it will make it more severe. For a reminder.
Heart attack warning signs are: 
Chest discomfort. Most heart attacks involve discomfort in the center of the chest that lasts more than a few minutes, or that goes away and comes back. It can feel like uncomfortable pressure, squeezing, fullness or pain. 
Discomfort in other areas of the upper body. Symptoms can include pain or discomfort in one or both arms, the back, neck, jaw or stomach. 
Shortness of breath with or without chest discomfort. 
Other signs may include breaking out in a cold sweat, nausea or lightheadedness 

Signs for Stroke are: Sudden numbness or weakness of the face, arm or leg, especially on one side of the body 
Sudden confusion, trouble speaking or understanding 
Sudden trouble seeing in one or both eyes 
Sudden trouble walking, dizziness, loss of balance or coordination 
Sudden, severe headache with no known cause


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## Christine (Feb 11, 2004)

It really is a great reminder to people, thanks! Especially in light of all the recent posts about stuff like this.


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## tahoedirtprincess (Jun 26, 2007)

*Asprin*

My husband had a heart attack a few months ago.

It's not so much about wilderness training or First Aid/CPR, it's about swallowing your pride if you are having symptoms or for the person with you to realize that it could be a heart attack. The WORST part of the heart attack is letting it continue and allow the heart to become oxygen deprived where the muscle starts to die off considerable (aka "damage"). When this happens, this lessens the effectiveness of your heart. One of the big signs? The person is as white as a sheet and they say "I have this discomfort in my chest...." OH BIG SIGN!

He now has a stent and is on a plethora of medications. However, he was able to get back on a bike within a month or so.

Also if you have anyone in your group that is diabetic, keep them in mind as well. Not only because of their sugar to insulin ratio, but because diabetics are more apt to have heart disease as well.

Even I forgot about the asprin. I will be putting that in my camelback tonight. You never know when you might need it and it's not like it's taking up a WHOLE lot of space!
Thanks for the reminder!


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## Kanga (Sep 14, 2004)

yfdcap said:


> This is a great thread. I would like to caution not to take aspirin if you suspect you are having a stroke though. If the stroke is a bleeding stroke(ruptured blood vessel)and not a clot it will make it more severe.


Thanks for that clarification... my understanding is that TIA or CVA's caused by a blood clot account for more than 80% of adult stroke victims (for children, it's typically 50% hemorrhagic).

But since there's no way to know for certain if a stroke is being caused by a blood clot or bleeding without a CT scan or other medical imaging, Aspirin shouldn't be administered in the field, especially if help is not too far away.

From what I've been reading, if the stroke symptoms (numbness, paralysis, etc, as listed above) have subsided and not returned for 1 hour, one can assume a TIA, and administer aspirin to prevent a re-occurrence until professional help arrives. Bleeding strokes generally don't subside on their own. I'm not an expert so do your own research and get proper training!

I should add that some people are allergic or sensitive to aspirin and should not be given any. That's why having the medical information, including allergies, as I listed in the first post, is also very important.


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## scheckler (Jan 25, 2005)

*Now I am scared...*



tahoedirtprincess said:


> My husband had a heart attack a few months ago.
> 
> It's not so much about wilderness training or First Aid/CPR, it's about swallowing your pride if you are having symptoms or for the person with you to realize that it could be a heart attack. The WORST part of the heart attack is letting it continue and allow the heart to become oxygen deprived where the muscle starts to die off considerable (aka "damage"). When this happens, this lessens the effectiveness of your heart. One of the big signs? The person is as white as a sheet and they say "I have this discomfort in my chest...." OH BIG SIGN!
> 
> ...


I have had diabetes for 38 years, insulin dependent. I have been riding for years now but do get these weird chest pains, like pressure and sometimes feel that something is just not right. It is very difficult for me to describe the feeling. I have told my doctor about this but she thinks it is something else, not heart related because I exercise every day. Now I am not so sure... thanks for this thread. Time to get a second opinion. Btw, what does one do when one is allergic to asprin?


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## Kanga (Sep 14, 2004)

Tahoedirtprincess, glad to hear your husband is back on the bike. My friend will be very encouraged to hear of other's stories of recovery.

While you're at it with the aspirin, remember some Benadryl. Bee sting allergies can also be fatal, and some people don't know they're allergic, or know, but don't have an epi-pen. The gel tabs are best, since someone with a rapidly closing airway may not be able to get down a pill, and you can break open the gel and absorb the liquid through the lining of the mouth.

You can also use an asthma inhaler to help open airways in the case of anaphylaxis (closing of the airways due to swelling from an allergic reaction). 

Let's get safe!


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## tahoedirtprincess (Jun 26, 2007)

I carry an epi-pen, I'm not sure that an asthma inhaler would work correctly, it dilates the bronchii not the throat or tongue that sometimes swells up during an allergic reaction. I always have Benadryl along for the ride as well.

The ER and cardiac rehab folks all have bashed into my head to give asprin. The chance someone is allergic usually is by rash, which is alot less harmless than prolonging the clot. There are all kinds of guidelines for it, the best place to go to is the American Heart Association website. Having been through it myself with my husband, it's still very scary, but the key part is to keep calm. He had chest pain for over 30 minutes before getting to the hospital with no damage to his heart. The short of it is to address it as SOON as they have pain. Which I know is hard, because no one wants to admit they are having a heart attack....


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## Kanga (Sep 14, 2004)

scheckler said:


> I have had diabetes for 38 years, insulin dependent. I have been riding for years now but do get these weird chest pains, like pressure and sometimes feel that something is just not right. It is very difficult for me to describe the feeling. I have told my doctor about this but she thinks it is something else, not heart related because I exercise every day. Now I am not so sure... thanks for this thread. Time to get a second opinion. Btw, what does one do when one is allergic to asprin?


If your doctor is not a heart specialist, then definitely get a second opinion. The best way to find coronary artery blockage or occlusion is with an angiogram, where dye is injected into the blood and an X-ray taken of your heart. My friend, the patient, is in his 40's with no history of any medical problems. He had a physical less than 6 months ago, and was given the thumbs up, so nobody would have thought to order an angiogram.... now he'll be getting them every year.


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## Kanga (Sep 14, 2004)

tahoedirtprincess said:


> I carry an epi-pen, I'm not sure that an asthma inhaler would work correctly, it dilates the bronchii not the throat or tongue that sometimes swells up during an allergic reaction. I always have Benadryl along for the ride as well.(


I believe that some countries the adrenalin inhaler is the standard of care for allergic anaphylaxis, though not in the U.S. where Epi-pens are the standard. If you don't have benadryl or an epi-pen, an asthma inhaler would be my next choice, and while not as effective as the first choices, it may just be enough to keep someone's airways open enough to breath on their own until help arrives. In one of my wilderness first aid training classes years ago, this did come up and was recommended, to the point where the company I worked for required them in all the first aid kits.


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## scheckler (Jan 25, 2005)

*Kanga, I really appreciate*



Kanga said:


> If your doctor is not a heart specialist, then definitely get a second opinion. The best way to find coronary artery blockage or occlusion is with an angiogram, where dye is injected into the blood and an X-ray taken of your heart. My friend, the patient, is in his 40's with no history of any medical problems. He had a physical less than 6 months ago, and was given the thumbs up, so nobody would have thought to order an angiogram.... now he'll be getting them every year.


your input  I am 43. This feeling does not always occur when I am riding, I am trying to figure out if there is a pattern(if there even is one). I have great insurance so cost should not be an issue. Now I know who to talk to and what to ask... thanks.


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## HarryCallahan (Nov 2, 2004)

*What he said!*



Kanga said:


> If your doctor is not a heart specialist, then definitely get a second opinion. The best way to find coronary artery blockage or occlusion is with an angiogram, where dye is injected into the blood and an X-ray taken of your heart. My friend, the patient, is in his 40's with no history of any medical problems. He had a physical less than 6 months ago, and was given the thumbs up, so nobody would have thought to order an angiogram.... now he'll be getting them every year.


Absolutely get another opinion. My dad had a triple bypass a couple years ago. The only symptoms he'd had were some mild tingling when he was lifting weights, and some shortness of breath at altitude when he skiied. My dad is 5'10 and 160 lbs, not a smoker, careful eater. His doctor chalked it up to age (my dad was 69 at the time, and how hard he works out, which is a lot!) My dad finally saw the heart specialist, had some pictures (angiogram) taken, and was not allowed to leave the hospital, as he had 90% blockage in 3 arteries, including a junction between two. He had bypass surgery 2 days later. Two years later, dad is fitter, and has less problems at altitude, though he also takes it a little easier.


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## AkDave (Jan 12, 2004)

*This subject hits too close to home....*



slocaus said:


> It is all genetics. If you have the (bad) genetics predisposed for arteriosclerosis, there ain't much you can do. Sad, but true.
> 
> That is how my cardiologist explained it to me. Maybe being a vegetarian and taking all of the modern meds, but they will not be subscribed beforehand, and did not exist thirty years ago when my blockages began so subtlety.


My dad died at 63 after many heart attacks.....I'm 61 almost......I've been riding mtbs for close to 20 yrs now. A year ago I had surgery on my back. After a reasonable amount of time I told the neurosurgon (sp) that I still had major pain in my leg. He sent me to a vascular doc and after the prescribed tests I am told I have "atreriosclerosis". I have had the artery opened twice now.....I still don't think it's right. Well, I don't ride off road anymore mostly to the back issues and loss of fitness but I'm putting more and more miles on the road to gain back my cycling fitness. As I ride and go about my daily activities I wonder which artery will clog next.....genitics.....who would of thought.
Dave


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## Steve030687 (Jan 7, 2007)

It is great to see everyone start to realize some of the medical emergencies that can arise while out on the bike. One thing that I do see people trying to do is a field diagnosis. Don't sit there and try to figure out if someone is having a stroke or heart attack; just get help ASAP. Carry a cell phone, if you are really out in the middle of nowhere, call first then move if you have to. Your position can be triangulated and help will come to you. Also, we move mighty fast on ATVs. There are tons of symptoms of a heart attack, but the main one is chest pain or tightness. This tightness can radiate to the neck, or especially the left arm. Dial 911 before giving any medication. Some pain may be attributed to Angina Pectoralis, which is more of a chronic condition where the heart cannot get blood fast enough due to smaller diameter arteries. A full blown heart attack is when a little clot gets stuck in the already small artery. Regardless, these two will show the same conditions and *CALL 911!!*

And as always, wear your helmet!


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## Steve030687 (Jan 7, 2007)

Kanga said:


> Jisch - If you've had CPR classes over the years, the standard of care has been revised and has changed several times. What you learned years ago may be deemed inappropriate by current standards (which doesn't mean you shouldn't use whatever knowledge you have if the need arises). If you're comfortable with the actual administration of CPR, but are rusty on the timing, order, and other standards, there are now online classes that will help get you back up to speed. But IMO they're only appropriate as refreshers, not for first-time CPR classes, and even then, if you can take a real class you're much better off. There's nothing like hands-on practice.


Yes, it is true that the standards have changed effective last June. Don't let your knowledge of the old standard stop you from doing something. Air goes in the mouth and pump on the chest; just don't do them at the same time. If you do that and CALL 911 then you have done your part. Leave the rest to me :thumbsup:


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## mrm1 (Apr 22, 2007)

Had my Heart Attack in early Nov 06. Age 43, no family history, no former problems, Cholesteral was 192 before HR, weight 180 lbs.

Had Classic warning signes, was at the hospital and hit with clot busting drugs within the hour. Took 2 overlaping stents to open the blockage and diesection. Have what was called "Single Vessel Coronary Artery Disease" Blockage was in the Major Obtuse Marginal Branch of the Circumflex - All other arteries wide open. ... back to riding now. I have no problems going out on 2 hr rides etc.

My Story

If it has not already been said, I would say to the asprine, crush it or have the person chew it. I also ride with nitro now. Perhaps that would be a good first aid kit item too?

I would also say ride and train with a Heart Rate Monitor. Know your limits and keep you HR within the physician/rehab suggested range if they will tell you. I got no such info and have had to discover my limits. I do really good up to 150 bpm. Go over 150 and have chest pain the next day. Also, my statistical max is 179 (220 - age), but i have lowered that to 170 in my HRM settings so that my training zones are lower.

If those of you who have had Heart Attacks have not found it, there is a forum dedicated to Riders With Heart Issues:

Keep Riding

Other sites of interests:
Angelopasty.org


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## HTR4EVR (Jun 15, 2007)

Two riders with heart attacks in less than a month is concerning me... I'm wondering how many mtb'ers die of H A during the year...


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## lidarman (Jan 12, 2004)

Steve030687 said:


> It is great to see everyone _start _to realize some of the medical emergencies that can arise while out on the bike.


LMAO....nobody here knows of this stuff until it gets posted on MTBR.

Good thing we have this place. This is more educational than sesame street.


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## JDO (Nov 18, 2004)

Hi guys.

Good to see the interest in this matter.

I´m a cardiac surgeon and a member of this forum. Any spelling mistake is due that english isn´t my 1st language. I usually don´t post threads about heart matters because partial info can do more damage than help (call 911 ASAP being the most important recommendation), but this time I feel obligated to give some facts about acute coronary syndromes (heart attacks).

As a biker (or as any other aerobic activitie) you have 20 folds less chance to have a Acute CS over a period of time, but if you are going to have one chances are that you are going to have it while riding. So be prepared, know what to do.

-Get CPR familiar. Is not that hard.

-An Aspirin can reduce the chance of fatal ACS by 30%, give it ASAP when you 
encounter a patient with oppressive chest pain, shortness of breath, coldness.

-The patient must rest, help should get to the patient, not the other way. Sometimes is impossible, but most of the time not.

-The patient must have an EKG ASAP and a well trained doctor or paramedic must read the EKG in less than 10 minutes, so the right therapy could be administered. This is crucial. Almost any facility have the capacity to make an EKG.

- If Myocardial Infarction is diagnosed you as a patient have the right to receive:

-During the first hour after the start of the chest pain you should receive Trombolitycs (a medication that dissolves the trombous). This medication could be administered in the ambulance if the medical center is beyond the 1 hour period.

- After the first hour (if the patient couldn´t get the Trombolityc) you should get to a medical center with a CAT Lab. This CAT Lab should perform an Angioplasty in less than 90 minutes.

This is the ideal algorithm for an ACS patient. But is fundamental that you know that every minute counts. Aspirin have to be administered on site Right away. You have to get and EKG ASAP, and the possibility to get proper medical attention in less than a hour. after this period of time you have 5 hours to get to a CAT Lab capable center. After that there´s still chance to save cardiac muscle and limit the size of the infarction, but as you can imagine every minute counts (like the Lance book).

Don´t get scared. Get informed. The AHA/ACC is a good resource. 
Get CPR information, plan a training course at your local club 
Know the capabilities of the medical centers close to you.
Carry aspirin (if you know that you are allergic ask your Dr. for Clopidogrel or 
Ticlopidine as substitute).
Always carry a cell phone or radio
Visit your Dr for a checkup, is a well spended money
Stop Smoking

And ride, don´t ever stop riding. See you on the trails


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## Kanga (Sep 14, 2004)

Thanks for all that great info. It's nice to have "expert" opinions from both a cardiologist and an EMT on the boards.

As of today's ride, a few of us carried the chewable "baby" type aspirin in our packs. They're 81mg and very small, so carrying ten of them in a tiny 1" ziplock pouch is nothing. The question is how much aspirin should be given in such an incident? I remember reading 600mg, but haven't been able find the reference again.

Some members of our group are now planning to do the WMI two-day Wilderness First Aid course <http://www.nols.edu/wmi/courses/wildfirstaid.shtml>, as well as a red cross CPR class. I did the WFA course about 6 years ago, so I'm definitely due for a refresher. However, I wasn't on the ride when the incident happened, and nobody else on that particular ride was trained.

I spoke to our friend yesterday, and he is now out of the ICU and walking around. He's had a stint and an angioplasty, and will have another angioplasty in a month. He had a 100% blockage in one artery (now stinted) and 40% in a few others.

They expect he'll be off the bike for two months before easing back into cycling. Apparently the amount of cardiac muscle damage was relatively small, and the doctors were amazed at how little damage there was, considering he continued to ride for an hour with an MI in progress, then had to wait for paramedics.

The group had cell phones but no coverage, and FRS radios. I'm now encouraging people to get radios with a "scan" function, that allows one to quickly find other conversations on different frequencies and subchannels, and to learn how to use that function.

Does the forest service or any other agency monitor FRS or GMRS frequencies for emergencies? I've seen mention of FRS channel 1 as an emergency channel, but can't find an official designation, or any group or agency that says they monitor it. Is there a designated GMRS channel for emergencies?


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## JDO (Nov 18, 2004)

The 81 mg aspirin is enough for ACS.


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## Kanga (Sep 14, 2004)

JDO said:


> The 81 mg aspirin is enough for ACS.


It looks like the American College of Cardiology guidelines recommend 162 - 325mg (2 to 4 of the 81mg chewable aspirin):



> 6.3.1.4. Aspirin
> 
> Aspirin should be chewed by patients who have not taken aspirin before presentation with STEMI. The initial dose should be: 162 mg (Level of Evidence: A) to 325 mg (Level of Evidence: C). Although some trials have used enteric-coated aspirin for initial dosing, more rapid buccal absorption occurs with non-enteric-coated aspirin formulations.


<http://www.acc.org/qualityandscience/clinical/guidelines/stemi/Guideline1/InitRecognition.htm#6_3_1_4>

It is also important to record when and how much aspirin (or any other treatment or medicine) was given to a victim and report it to paramedics or doctors when they arrive so that they have an accurate history.


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## Steve030687 (Jan 7, 2007)

Don't get too caught up in the treatment of cardiac problems. *THE MOST IMPORTANT THING IS TO RECOGNIZE IT AND DIAL 911* If you have aspirin great. Nitroglycerin tablets that are prescribed to the person are even better. Keep them calm, try to lower their heart rate, CPR if you know it, if they go out - Zap them with the AED.

JDO also brings up a great point that I forgot about- no physical activity.

As a former CPR Instructor, I strongly urge people to take a 3-4 hr. course on CPR. Hopefully, you'll never use it and it will be the biggest waste of 4 hours that you could have spent mountain biking, but what if?


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## pinkheadedbug (Aug 16, 2006)

Wow. I'm the guy who always has the tools, tubes and patches. As of today I'll be carrying aspirin as well. I can't remember the time we rode and didn't have someone over 40 (including me) in the pack. I think I have the CPR thing down too but I'll refresh. This is important stuff.


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## JDO (Nov 18, 2004)

Kind of silly, but there´s a good deal of evidence that 100-200 mg dose aspinin is not better than <100mg. There´s a GUSTO Trial that prove it. That´s why I don´t ussualy get too medical in my posts, you can be lost in the details and don´t get the core of the idea. 

The important thing is that time is crucial for saving cardiac muscle in the process of ACS.
Get informed about the best center for treatment near you.


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## SlowSSer (Dec 19, 2003)

we just had a similar issue here in socal with my dad- it wasnt a heart attack but a bad enough wreck that he had to be air lifted to the nearest hospital. the worst parts are that he was riding in an area where i dont know where he is, so backtracking to find him isnt an option that and he was riding alone. 

he was found about 10 minutes after the crash by 4 fine people on horseback who made the call. my dad mentioned that he had tried his cell w/o luck, but one of the equestrians was sitting on her horse talking on one, so the 15-20 foot difference made the ability to make a call happen or not. 

so, dad's in the hospital with 6 cracked vertibrae, 5 cracked ribs, a cracked clavicle and a collapsed lung. the lung's on its way back to normal as we speak and he's out of the ICU.


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## oldbroad (Mar 19, 2004)

My husband has had 2 heart attacks,1st at age 46, and the 2nd last year at age 48.
Both happened on warm days right after a hilly ride. * 
After the 1st, he had a stint put in. After the 2nd, he had sextuple bypass. His family is full of heart disease, and he was not in very good shape, so it really was a matter of time.

He was back on the road bike doing easy rides 4 months after #2. He is now doing road rides & easy going mtb rides 3 -4 times a week and feels great. 

* Funny now story about the 1st one:
When we got home form the ride he was nauseous, sweaty, clammy and his shoulder hurt. We though maybe it was heat stroke, so he took a cool shower & lay down on the couch. When I came in and asked how he felt, he said not so good and his left arm hurt. I don't remember this, but he swears I said to him "You're having a heart attack you moron!" How loving & sensitive of me!


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## yfdcap (Apr 25, 2007)

JDO said:


> Hi guys.
> 
> Good to see the interest in this matter.
> 
> ...


More great stuff.
I will add a couple things.
I do not know of any(I am on Westcoast) medical direction that will allow us to carry or administer, Thrombolytics. So I would not expect to see any until arrival at a hospital. This may be reason for the medics to consider air-evac.
Our standing order for chest pain is 4 of the baby chewables 81mg each. I would not get hung-up on mg's or them being chewable or not. If you are going to buy them for this reason than by all means get the baby chewables. Most people out on the trail have non-chewable 325mg Aspirin. These will work(1). You can chew them also. I would also like to pass on a couple things I have seen over the years in the field. Do not put a aspirin in someones mouth that has already become unconscious. Do not try and give them anything if they are unconscious. Do not give someone Nitro that is not their's. As stated earlier, stop activity, rest them in the shade, call 911, Aspirin if you have it. 
You also may want to ask them some questions also. Allergies? Meds they are taking? Medical conditions if any? These questions will help the medics if the person becomes unconscious before they arrive.


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## Kanga (Sep 14, 2004)

yfdcap said:


> More great stuff.
> I will add a couple things.
> I do not know of any(I am on Westcoast) medical direction that will allow us to carry or administer, Thrombolytics. So I would not expect to see any until arrival at a hospital. This may be reason for the medics to consider air-evac.
> Our standing order for chest pain is 4 of the baby chewables 81mg each. I would not get hung-up on mg's or them being chewable or not. If you are going to buy them for this reason than by all means get the baby chewables. Most people out on the trail have non-chewable 325mg Aspirin. These will work(1). You can chew them also. I would also like to pass on a couple things I have seen over the years in the field. Do not put a aspirin in someones mouth that has already become unconscious. Do not try and give them anything if they are unconscious. Do not give someone Nitro that is not their's. As stated earlier, stop activity, rest them in the shade, call 911, Aspirin if you have it.
> You also may want to ask them some questions also. Allergies? Meds they are taking? Medical conditions if any? These questions will help the medics if the person becomes unconscious before they arrive.


Your standing order for 4 chewable 81mg is in keeping with the ACC guidelines. Everyone is correct in that getting professional help (by calling 911) should be a priority in any heart-related problem or serious injury, for that matter, and it can't be emphasized enough.

We encourage all of our riders to have a small printed 3x5 or business-card sized card with their insurance info, emergency contacts, medications, medical conditions, allergies, and primary doctor contact information. I printed mine from the computer, and had the card laminated. It just stays in my hydration pack at all times, along with a copy of insurance cards and ID. If the victim is unconscious or unable to talk, this information could be vital.

How many of us would know who to call (spouse or significant other) if one of our riding buddies was hurt?


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## racerzero (Jan 4, 2004)

Kanga said:


> . Even though his fitness level was very high, there was still a great deal of blockage within his coronary arteries that had never been picked up on his physicals. I'm guessing that it may have been because he was so fit that they had missed the hidden heart problems, but I'm not a doctor. Had he not been so fit, the doctors tell him, he probably wouldn't have survived. .....


There is a way to tell but it's expensive. My personal doctor recommended that I get a private MRI done. Health Insurance will not pay for this. His recommendation are based on his patients individual factors. In my case I'm over 40. My doctor has it done and discovered a problem with his kidneys. He would have never known about till it became serious. Ironically since it's a known problem his health insurance will pay for it so he can have his kidney monitored.

We have a private MRI facility in our city that's not affliated with any hospitals. They charge $400 for a cardio or upper body scan and $1,000 for a full body scan.

It's sort of a hit or miss thing. If they discover nothing wrong you blew $400 to $1,000 to know you're healthy. If they discover something you can immediately start treatment with your health insurance paying for it. My doctor has had some of his patients discover a hidden problem and started treatment right away.


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## yfdcap (Apr 25, 2007)

Kanga said:


> Your standing order for 4 chewable 81mg is in keeping with the ACC guidelines. Everyone is correct in that getting professional help (by calling 911) should be a priority in any heart-related problem or serious injury, for that matter, and it can't be emphasized enough.
> 
> We encourage all of our riders to have a small printed 3x5 or business-card sized card with their insurance info, emergency contacts, medications, medical conditions, allergies, and primary doctor contact information. I printed mine from the computer, and had the card laminated. It just stays in my hydration pack at all times, along with a copy of insurance cards and ID. If the victim is unconscious or unable to talk, this information could be vital.
> 
> How many of us would know who to call (spouse or significant other) if one of our riding buddies was hurt?


Info card. That is a real good idea. :thumbsup:


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## HTR4EVR (Jun 15, 2007)

Kanga said:


> We encourage all of our riders to have a small printed 3x5 or business-card sized card with their insurance info, emergency contacts, medications, medical conditions, allergies, and primary doctor contact information. I printed mine from the computer, and had the card laminated. It just stays in my hydration pack at all times, along with a copy of insurance cards and ID. If the victim is unconscious or unable to talk, this information could be vital.
> 
> How many of us would know who to call (spouse or significant other) if one of our riding buddies was hurt?


Very good idea indeed...:thumbsup: :thumbsup: :thumbsup: 
Online Army Stores can print that info for you in a Dog Tag, I have one that I use when I go deep in the back country on backpacking trips...


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## navymtbr (Feb 2, 2004)

*My story*

In Feb 2002 I turned 40 and had a full blown 5 year physical (Active Duty Military Requirement). I was given a clean bill of health and given a good to go for another 5 years. In July my nephew was visiting and we went for a ride around the neighborhood. I got home after the ride and felt winded. I attributed it to being out of shape, I was in between soccer seasons (I referee) and had not started training for the upcoming season. Two weeks later I went to a luncheon and developed heartburn after the lunch. As I rested at my desk the heartburn subsided. The next morning the heartburn woke me up around 04:30. As I lay there I noticed a tingling in both arms down to the elbows. I got up and went to work, on the drive in it mentally hit me. It was like an epiphany, I was having a heart attack. The mental battle lasted a few minutes; your having a heart attack, no I am too young; your having a heart attack, no, I just had a physical... Instead of work I went to the clinic. They performed an EKG and chest X-ray. Same Doc who did my physical was sure it was reflux but gave me an aspirin (325mg) and sent me to the local hospital for further tests just to be sure. The blood test was to check my Troponin levels. Troponin is an enzyme the heart produces when it is being damaged. Sure enough my Troponin levels were elevated, I was having a Myocardial Infarction (MI) and was airlifted to Bethesda. They stabilized and kept a close watch on me. Laying there I felt fine, no symptoms. So 24 hours later they did the angioplasty and inserted a 13mm stent into my Circumflex Artery which was 90% blocked. All the other arteries were clear and like some others here, genetics was blamed. Docs claimed my fitness helped mitigate the damage as I only had 10% muscle damage to the outside wall which had no impact on heart function. By the way, it completely healed itself within 2 years, only the stent remains as evidence of the MI. At the time my cholesterol was under 200, only risk factor aside from age.

Post MI: 
I am on several meds: Beta blocker, Ace Inhibitor, Aspirin (81mg) and Lipitor to keep my LDL's down (last count was 85 but new guidelines suggest <70). Beta Blocker and Ace Inhibitor keep my heart rate down making it work less. It keeps my resting heart rate at around 55 BPM. I also carry nitro everywhere as per the Doc. I train more as I have matured as a referee to the point of doing upper level games (17-19 Boys and Girls) and they are fast! I also ride as much as I can. A heart rate monitor has become an essential tool. I keep check to ensure I am working out to provide my heart optimum benefits. I carry a card in my wallet with the info on the stent and a list of meds as well as a list of POC's and how to contact them (my family). You never when you will be unable to communicate! Bottom line; listen to your Doc, take your meds, eat right and exercise and life is close to normal. The fact that you are now in a "club" that you never wanted to be in is unchangeable. You and your family will always be cognizant of the fact that you are at a greater risk then everyone else. Just stay tuned into your body and enjoy the ride!

One more, you will inevitably have a bad time somewhere on the trail and freak yourself out. I did just that, the key is to stay calm and relaxed and to assess what is really happening. I ride alone a lot. I was in New Jersey for business and riding at Clayton Park, a small but good loop for after work. Anyway, I sat in meetings all day and rushed to Clayton right after work, a 35 minute drive. I wanted to get at least one loop in before dark. I had not eaten lunch and grabbed something quick from a convenience store only a few minutes from the park. I finished the sandwich as I was pulling into the parking lot. I quickly got dressed and jumped on my bike to start the loop. Since this was the first ride at the park with my new bike I started feeling good and pushed hard. Three quarters of the way around I was huffing and puffing, dizzy and queasy. I stopped, thinking of my history and hoping it wasn't another MI - no chest or arm pain. I rested on a log and breathed slowly. After twenty minutes I felt well enough to continue although at a much slower pace. I determined I bonked in a big way.

Sorry for the long post, just passing along my experiences. 
Steve


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## Kanga (Sep 14, 2004)

Thanks for your story.... It's encouraging to hear that you're still active and that your heart muscle fully recovered. In our friend's case, as in yours, the fitness level seems to have allowed a much better outcome. 

I think it's good to get this information out there, and raise people's awareness and preparedness for any emergencies, not just heart-related ones.


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## JDZ (Jan 12, 2004)

slocaus said:


> It is all genetics. If you have the (bad) genetics predisposed for arteriosclerosis, there ain't much you can do. Sad, but true.


True that your fitness and diet may not prevent you from a having a heart attack, but they may make it possible to survive one.


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## Quasi (Jul 4, 2004)

SlowSSer said:


> so, dad's in the hospital with 6 cracked vertibrae, 5 cracked ribs, a cracked clavicle and a collapsed lung. the lung's on its way back to normal as we speak and he's out of the ICU.


Wow, he must have done something risky. When I am alone, I usually shy away from the risky spots and just walk it through. Good to hear he is out of ICU. He should get of morphine as soon as he can, nasty stuff, but it is wonderful when you need it.


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## bayareamtnbiker (Jan 2, 2006)

*Heart scan, aspirin allergy*

Re: aspirin, make sure the person isn't ALLERGIC, as I am - or you might kill the one you mean to help.

Everyone over 40, consider a HEART SCAN, which can detect early heart disease. Know if you are clean or showing signs - in a matter of minutes.

Survival rates aren't that great for first attacks. I saw a 44 year old collapse and die jogging right in front of his horrified young daughter and girl friend. Paramedics and a doctor were right there and couldn't help him. He might today be alive and raising his daughter, if he'd been scanned, as it turned out he was a walking TIME BOMB with 90+% occlusions. FIND OUT EARLY! Then you have a chance to take action.


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## MtbRN (Jun 8, 2006)

oldbroad said:


> he swears I said to him "You're having a heart attack you moron!" How loving & sensitive of me!


Hey Oldbroad (feel like I'm being rude using your screen name... LOL)

These days I am doing telephone triage for a cardiology office. You would not believe how many calls I get from wives saying "I'm calling for my husband, he's at work right now but for the last few days he's been having chest pain..." Denial is an amazing thing.

There's a reason why married men have a longer life expectancy... they live with someone who has some common sense!

So good for you. Hope hubby thanked you for it!


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## Sopranos (Aug 13, 2006)

bayareamtnbiker said:


> Re: aspirin, make sure the person isn't ALLERGIC, as I am - or you might kill the one you mean to help.
> 
> Everyone over 40, consider a HEART SCAN, which can detect early heart disease. Know if you are clean or showing signs - in a matter of minutes.
> 
> Survival rates aren't that great for first attacks. I saw a 44 year old collapse and die jogging right in front of his horrified young daughter and girl friend. Paramedics and a doctor were right there and couldn't help him. He might today be alive and raising his daughter, if he'd been scanned, as it turned out he was a walking TIME BOMB with 90+% occlusions. FIND OUT EARLY! Then you have a chance to take action.


Where do you get a heart scan? Is this something that you can ask for at the Dr. office or is it an outside agency? Do you know if any damage would show up on an echocardiogram or standard EKG? I have been experiencing chest pain if I try to jog/run for a few minutes straight but then it subsides once I stop. Also, my blood pressure has dropped significantly for no apparent reason as it used to always be high..... now it's 115/68. I know that seems normal but I am usually 140/85.... and I haven't changed anything in my lifestyle.


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## Sopranos (Aug 13, 2006)

Where do you get a heart scan? Is this something that you can ask for at the Dr. office or is it an outside agency? Do you know if any damage would show up on an echocardiogram or standard EKG? I have been experiencing chest pain if I try to jog/run for a few minutes straight but then it subsides once I stop. Also, my blood pressure has dropped significantly for no apparent reason as it used to always be high..... now it's 115/68. I know that seems normal but I am usually 140/85.... and I haven't changed anything in my lifestyle.

BTW - I am only 31!


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## MtbRN (Jun 8, 2006)

Sopranos said:


> Where do you get a heart scan? Is this something that you can ask for at the Dr. office or is it an outside agency? Do you know if any damage would show up on an echocardiogram or standard EKG? I have been experiencing chest pain if I try to jog/run for a few minutes straight but then it subsides once I stop. Also, my blood pressure has dropped significantly for no apparent reason as it used to always be high..... now it's 115/68. I know that seems normal but I am usually 140/85.... and I haven't changed anything in my lifestyle.
> 
> BTW - I am only 31!


Uh... have you discussed this with your doctor?? If not, go to your physician, tell him your symptoms and ask _him_ what appropriate testing would be. Why are you asking for advice on the internet????


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## Sopranos (Aug 13, 2006)

MtbRN said:


> Uh... have you discussed this with your doctor?? If not, go to your physician, tell him your symptoms and ask _him_ what appropriate testing would be. Why are you asking for advice on the internet????


My comments were 2 fold:

1. A gentleman mentioned a "heart scan" and I was simply wondering what/where this was.

2. I was checking to see if anyone has had these types of symptoms and if it really was necessary to go to the Dr. or if I was just worrying due to the nature of this thread.

I was not looking for a diagnosis if that's what you are all excited about....lol.


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## nonoy_d (Jun 27, 2005)

Heart attack is not isolated to MTB, it had been described among marathon runners and during the actual marathon...well, remember the running guru James Fix he even wrote a book and, then later sucummbed to heart attack. The killer in heart attacks is the electrical activity of the heart going awry (ventricular fibrillation). 
Just like tahoeprincess said swallowing your pride helps. But us males usually don't go for check ups unless pushed by significant others to do so. We don't talk about our medications around the drinking fountain, its proven in studies that this is a male attitude. True that the usuall stress test may not definitely determine coronary blockage, there are other modalities of diagnosing blockage if the suspicion is high. High resolution CT scan and MRI are the newer modalities. Angiogram is not a benign procedure and is only done to confirm if the above tests suggest blockage. Everytime you subject the person to the dye load the kidney is being pushed to failure. Nicking the artery(ies) and/or the aorta (big blood vessel inside the belly may result in profuse bleeding and shock. Some may also have dye allergy. 
What was noted among long distance runners who run the marathon race and get in to trouble is poor preparation, notably less than 35 miles of running per week. 
We are all vulnerable, it's a good thing that Kanga's club mate did not have the ventricular fibrillation otherwise without the defibrillator, really a poor chance of survival.


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## MtbRN (Jun 8, 2006)

Sopranos said:


> My comments were 2 fold:
> 
> 1. A gentleman mentioned a "heart scan" and I was simply wondering what/where this was.
> 
> ...


Yeh... again, if you are having symptoms that you are concerned about the appropriate person to ask is your doctor. The folks here are not going to be able to tell you, any more than I can, if it is "really necessary to go to the Dr."

Better to ask than to worry, right? Believe me, the folks at the doctors office aren't going to be upset with you for asking. A phone call takes a few minutes. And yes, people your age can have heart problems. These days, it seems to be showing up in younger and younger people.


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## bayareamtnbiker (Jan 2, 2006)

Wife and I had our CT heart scans at a place called HeartSavers in Cupertino, CA. Search the web for others. If there is heart disease in your family, your risk is elevated. Insurance covered about 1/2 the cost, but we felt this was cheap insurance to ward off a nasty surprise - my share was still several hundred $$$. MTB, as we all know, involves very high intensity extended heart loading, often pegging it for minutes which you should not do with a heart problem. Non-invasive CT scan resolution continues to improve. Full body scans are gaining acceptance w/i the medical community. Some people choose a scan over a colonoscopy, which, if you've had one, is appealing. Gastro physicians do not consider a scan to be a fully adequate substitute for the scope.


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## AA717driver (Aug 29, 2006)

I started biking and running this time last year at age 48. Now, mostly running (20-25 mpw) but I noticed around last November, I developed heart palpitations in the evening. To complicate matters, I found out a few years ago that I was adopted (thus trashing my "family medical history").

In March, I went to a family friend who is a cardiologist. He was kind enough to run an echocardiogram, stress ekg and do an ultrasound (free... THANKS!). He gave me a clean bill of health and explained what might be the culprit.

I was worried because recently, several experienced and well-trained marathoners have died from heart attacks.

Has anyone else experienced the palpitations as they got more fit? TC


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## No Brakes (Jan 24, 2004)

*Those carrying nitro...*

Just keep in mind nitro should be kept in a tightly capped, *dark glass* container to prevent exposure to air, light and heat...which might be hard considering this is an outdoor sport. If the container is not dated, date it and most should be discarded after 3 months. If it tingles when placed under the tongue, it's still potent otherwise it's not as effective as it should be.

Ride on!


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## Kanga (Sep 14, 2004)

AA717driver said:


> I started biking and running this time last year at age 48. Now, mostly running (20-25 mpw) but I noticed around last November, I developed heart palpitations in the evening. To complicate matters, I found out a few years ago that I was adopted (thus trashing my "family medical history").
> 
> In March, I went to a family friend who is a cardiologist. He was kind enough to run an echocardiogram, stress ekg and do an ultrasound (free... THANKS!). He gave me a clean bill of health and explained what might be the culprit.
> 
> ...


AA717, this probably isn't the best place to ask specific health-related questions, though a lot of that is being done.

That said, I'll tell you about a friend who was a roadie and had palpitations start happening for no apparent reason (but he'd been racing for many years before they started, so it wasn't because he was "getting fitter"). His doctors had a hard time isolating the cause. He was going though a long divorce, and interestingly, when it was over after two years, the palpitations stopped. It seemed to have been stress related in his case. What did your friend explain to you that might be the culprit?


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## Kanga (Sep 14, 2004)

Thanks everyone for sharing your stories and your concerns. Our friend is now at home and will be doing some "internet riding" for a few months, but is in good spirits. I haven't told him about this thread, but will send him here soon. 

My reason for starting this thread was to help raise the awareness of, and hopefully the preparedness for possible medical emergencies on the trail. Though it's rare to have an emergency on a ride, if we all ride long enough, the chances are pretty good that we'll eventually have to deal with some kind of medical emergency. 

In 21 years of riding off-road and working outdoors, I've seen many injuries, a few of them serious and a couple life-threatening. Heat stroke, broken bones, heart attacks...anything can happen out there, and knowing what to do and having a plan in case it does is important. 

But more importantly, keep on riding, living, and having fun!  If there wasn't at least some risk, would we all be so passionate about mountain biking?


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## Apteryx (Nov 27, 2005)

If you have symptoms see a cardiologist. I can't speak for this specialty. I am a radiologist though not practicing in the USA.

For the worried well you can consider non invasive imaging. CT coronary angiography will create images like an angiogram, but without the invasive nature of this test (arterial puncture and catheter into the coronary arteries with some attendant risk). The downsides are the radiation dose (low to medium and reducing all the time) and the contrast injection
(very low risk of allergic type reactions). The great thing with this test is it has great negative predictive value - if the test shows no coronary artery disease you don't have it. If there is significant disease you may need an angiogram to define the extent and go on to stenting or other definitive treatment. This test, CTA, is different to heart scans without contrast - so called calcium scoring where the amount of calcium in the cocrnary arteries is used to stratify risk of future acute coronary syndrome. The jury in the radiology world re whole body scans is still out - probably of no value.

cheers - lets hope it doesn't happen to us or ours


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## bingemtbr (Apr 1, 2004)

Imba's National Bike Patrol is an invaluable tool for Bike Clubs to use.

http://www.imba.com/nmbp/index.html

Check it out, the course includes getting certified for CPR and trail side emergencies. Well worth a day in the class room and on the trail.


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## AA717driver (Aug 29, 2006)

Kanga--I already did the cardiologist thing and he didn't find any specific issues. Coincidentally, I've been going through a lot of stress preceeding a job change. The Doc said stress could do it, too.

I'll be interested to see if it stops in the next few months as the change is complete. Take care. TC


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## BeaverTail (Aug 12, 2009)

I always carry multiple 325mg aspirin tablets with me wherever I go. Im only 24 but have always had chest pains, though usually not with exertion. Been to 4 cardiologists and all say I am fine. Though I still always worry.

may I suggest a portable CB radio or a GMRS radio. Try and find out what the local Ranger stations use for emergency use. This way if something like this happens again, you can try and call for help.


In my camelbak I always carry

Cell
FRS Radio
Knife
Iodine tabs
neosporin
alcohol wipes
some bandages
benydryl
Multi-Tool with plyers
Crank Bros Multi tool 17
Spare Tube
Patch Kit
Pump


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## PscyclePath (Aug 29, 2007)

bingemtbr said:


> Imba's National Bike Patrol is an invaluable tool for Bike Clubs to use.
> 
> http://www.imba.com/nmbp/index.html
> 
> Check it out, the course includes getting certified for CPR and trail side emergencies. Well worth a day in the class room and on the trail.


I did just that early last spring, and it's turned out (surprisingly) to be one of the best investments I've made in biking. I took the 8-hour Red Cross class on "Community First Aid" which covered adult/child/infant CPR and AED, plus another multi-hour block on dealing with problems such as stroke, diabetic reactions, fractures, wounds, etc. With geriatric parents, I wound up using those skills within the month, as well as on a number of club rides where folks got careless. These days I always ride with the first aid kit. I'm apparently the only Patroller in our community so far, but we're working to remedy that.

Tom


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## rabidchicken (Apr 16, 2009)

Don't depend on the 911 operator to know where you are. When i worked for 911 as a dispatcher, only a handful of cell phone carriers actually had GPS that worked, and it wasn't pinpoint accurate either. Know your location and be able to convey it to the dispatcher.

I have noticed that one of the trails in Ft. Lauderdale has numbered signs posted. This way you can tell 911 what sign you are near and they can know where you are instead of "I'm on the Red Clay Trail next to the orange rock." It probably wouldn't be hard to coordinate with the local 911 office to do this on your trails.


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## smilinsteve (Jul 21, 2009)

Don't have time to read the whole thread, but another thing to add to your list of things to carry in your camelback is nitroglycerin. 
If you have had an event, you probably already have some, but if not, a doctor should give you a scrip just by explaining you ride with a group and want some just in case anyone needs it.


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## rabidchicken (Apr 16, 2009)

smilinsteve said:


> Don't have time to read the whole thread, but another thing to add to your list of things to carry in your camelback is nitroglycerin.
> If you have had an event, you probably already have some, but if not, a doctor should give you a scrip just by explaining you ride with a group and want some just in case anyone needs it.


This is terrible advice. If YOU need nitro, then YOU should have it. I don't know of any doctor who will give you nitro so you can prescribe it to others.:nono:


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## smilinsteve (Jul 21, 2009)

rabidchicken said:


> This is terrible advice. If YOU need nitro, then YOU should have it. I don't know of any doctor who will give you nitro so you can prescribe it to others.:nono:


I had nitro prescribed to me a few years ago after what was either a very minor event, or a false alarm (doctors not sure). Anyway, I still carry that little bottle in my camelback, and always will.
When you are in the situation like in the OP, and someone has shortness of breath, tingling arm, chest pain etc, that person could be one second away from death. You never know. 
Even in this story, where the guy ends up ok, we don't know how much permanent damage was caused by the ischemia. That's permanent damage that might have been avoided with a nitro tab. 
I'm not saying you pass it out like candy. You might carry it around and never ever use it. But if you are at risk, or know older riders that might be at risk (and you might say that all older riders might be at risk), then I think it is a good idea to have it on hand. You might thank god you have it on hand some day. I stick by my recommendation.


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## canuckjgc (Jun 22, 2007)

This is a great thread. Considering the advice here, would a personal locator beacon be advisable? We ride well out of cell range. Not sure if it would be faster to ride to get help or simply use a PLB. Does anyone have experience on how fast help arrives with a PLB?

Not sure if the US system is the same as Canada's -- we have a central agency that coordinates response to PLB signals, but I have no idea how long it takes. 

I'd hate to rely on a PLB only to discover that riding back to get help would have been faster and saved someone's life. Any advice?


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## rabidchicken (Apr 16, 2009)

smilinsteve said:


> I had nitro prescribed to me a few years ago after what was either a very minor event, or a false alarm (doctors not sure). Anyway, I still carry that little bottle in my camelback, and always will.
> When you are in the situation like in the OP, and someone has shortness of breath, tingling arm, chest pain etc, that person could be one second away from death. You never know.
> Even in this story, where the guy ends up ok, we don't know how much permanent damage was caused by the ischemia. That's permanent damage that might have been avoided with a nitro tab.
> I'm not saying you pass it out like candy. You might carry it around and never ever use it. But if you are at risk, or know older riders that might be at risk (and you might say that all older riders might be at risk), then I think it is a good idea to have it on hand. You might thank god you have it on hand some day. I stick by my recommendation.


All is good until the guy dies and the lawyers find out you prescribed nitro. Even if he died of a heart attack and not the nitro your butt will be in trouble. Prescribing meds is not covered under the good samaritan act. Are you going to do a thorough assessment to make sure the guy isn't on any other meds which may have an adverse reaction with nitro? Playing doctor is not good advice unless you are a doctor. I stand by my recommendation.


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## osmarandsara (Jun 26, 2006)

I think there's a good lesson for all of us here.......I used to consider myself "fit" (mountain biker, not obsese, non-drinker, non-smoker, etc.) however, I never worried about what I stuffed down my throat (ice-cream, steak, hamburgers, etc.) because I figured I would burn it all on my bike rides and (I consistently can maintain a 32 inch waist size and 155 lb body weight)

But a year ago I went for a recent physical and the doc said I had very high cholesterol, border-line candidate for medication....I thought WTF, I'm a mountain biker, how can that be??? Next thing I know, the doc is sending me for an EKG to check out my heart.

So yeah the exercise is important, but we all need to cut back on the meat & dairy products.....I mean, I didn't turn into a vegeterian......but instead of having bacon and eggs I had oatmeat and toast and one slice of bacon, instead of the hamburger I started having the chicken sandwich, and instead of the double-scoop of ice-cream I only had one scoop, etc, etc,

So I recently went back to the Doc and my cholesterol went down, still a little above average but an improvement none-the-less.

It sucks cuz I really love steak, cheese, hot-dogs, and all that stuff, but its funny cutting back on the stuff actually made me crave it less.......


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## smilinsteve (Jul 21, 2009)

rabidchicken said:


> All is good until the guy dies and the lawyers find out you prescribed nitro. Even if he died of a heart attack and not the nitro your butt will be in trouble. Prescribing meds is not covered under the good samaritan act. Are you going to do a thorough assessment to make sure the guy isn't on any other meds which may have an adverse reaction with nitro? Playing doctor is not good advice unless you are a doctor. I stand by my recommendation.


So you wouldn't save someone's life for fear of the risk of being sued? 
That is your right. I would. 
It is also your right to say "no thanks" when you are laying on the ground clutching your chest and I ride by and offer you help.


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## axcxnj (Jun 23, 2008)

whenever i go into the wilderness, or somewhere that i konw there will be no cell phone reception, i bring this:










it works where cell phones dont, and will pinpoint your location...even if you are moving it will keep emergency workers updated with where you are.

its 150 to buy, 99 a year for the service, and $10 buys you 100k worth of search and rescue insurance.

it comes with me on my backpacking trips. definetly worth it IMO


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## rabidchicken (Apr 16, 2009)

smilinsteve said:


> So you wouldn't save someone's life for fear of the risk of being sued?
> That is your right. I would.
> It is also your right to say "no thanks" when you are laying on the ground clutching your chest and I ride by and offer you help.


Given my profession, I would not. There is a difference between doing what is right and doing something you are not qualified to do. How do you know you aren't causing more harm? I know how to do chest tubes, intubate, and perform other invasive procedures in the field, but that doesn't mean I am going to risk another person's life by doing them without the order of a physician. I support first aid and helping those in need as long as you are within your scope of practice.

My point is that you are not qualified to prescribe medication, bottom line.


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## sean salach (Sep 15, 2007)

i would definitely consider it irresponsible for someone who is not a doctor to give someone a strong prescription med without knowing for an absolute fact that ehy need that specific med and their body can handle it.


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## smilinsteve (Jul 21, 2009)

rabidchicken said:


> Given my profession, I would not. There is a difference between doing what is right and doing something you are not qualified to do. How do you know you aren't causing more harm? I know how to do chest tubes, intubate, and perform other invasive procedures in the field, but that doesn't mean I am going to risk another person's life by doing them without the order of a physician. I support first aid and helping those in need as long as you are within your scope of practice.
> 
> My point is that you are not qualified to prescribe medication, bottom line.


I respect your opinion rabidchicken, and I should have added that if you do decide to carry nitro, learn about it!
The thing is, lots of people carry it already, for their own use. Any of those people could be faced with a decision one day, when someone appears to be having a heart attack. Do you keep the nitro in your bag, or offer it? You talk about risking another person's life, but this is a situation where that person's life is already in extreme danger!

The risk of taking nitro is low. Hypotension is a possibility, but not a serious risk unless you are taking viagra or similar also. Anyone taking that should already know not to take nitro. And you should ask. 
It lasts about five minutes, makes your face flush and your head pound, might make you feel light headed, and then it goes away. It's not a major medical procedure like giving epinephine through the chest cavity or something like that. Again, you have to weight the risks. People with heart attacks are on the verge of death. I would bet that many people would say they wouldn't give nitro to a person, but when faced with the life and death situation, and a bottle of nitro on them, they would change their minds and do what they could to save the person. It just seems like the right thing to do.


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## Jim Z in VT (Sep 9, 2007)

smilinsteve said:


> I had nitro prescribed to me a few years ago.............Anyway, I still carry that little bottle in my camelback, and always will.


The _same_ bottle? I don't know if shelf life has improved in the 15 years since I quit the pharmacy profession (man, was that boring!), but the standard advice then was to replace the unopened bottle every 6 months, or 2 months after opening.

JZ

(interesting coincidence: there's a guy here in VT who owns several pharmacies who uses the name Smilin' Steve in his radio and TV ads :thumbsup: )


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## smilinsteve (Jul 21, 2009)

JimZinVT said:


> The _same_ bottle? I don't know if shelf life has improved in the 15 years since I quit the pharmacy profession (man, was that boring!), but the standard advice then was to replace the unopened bottle every 6 months, or 2 months after opening.
> 
> JZ
> 
> (interesting coincidence: there's a guy here in VT who owns several pharmacies who uses the name Smilin' Steve in his radio and TV ads :thumbsup: )


Yes I know about the shelf life. I know it is longer than what they advertize, as I have tested stuff that was open for probably 2 years. This thread reminded me I need to get new bottles.

I thought I was the only smilin steve....


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## Harold (Dec 23, 2003)

Good discussion (except smilinsteve). I don't care who you think you are, DO NOT give prescription meds to someone they're not prescribed to. If you need 'em, you carry 'em. And if I'm assisting, don't expect me to put them in your mouth, either. I'll get 'em out of your pack if you ask, but I'll hand the bottle over and leave it to you.

My wife is a medical professional and has versed me on a lot of these issues. She also happens to have a terrible family history of cholesterol/heart problems. Interesting mix, with her being at risk for heart attacks, and me recovering from leukemia. I got myself a roadID to put contact info on, and will probably get one for the wife. I like the idea of laminating an index card with additional allergy, drug, and health history information on it.

As an aside, one of my paddling buddies in Pittsburgh was kayaking down the middle Yough and happened across a group of folks tending to a guy who had a heart attack in his boat. The guy didn't make it. Really wore hard on my paddling buddy, even though he didn't arrive on the scene until it was too late to do anything.


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## smilinsteve (Jul 21, 2009)

NateHawk said:


> Good discussion (except smilinsteve). I don't care who you think you are, DO NOT give prescription meds to someone they're not prescribed to. If you need 'em, you carry 'em. And if I'm assisting, don't expect me to put them in your mouth, either. I'll get 'em out of your pack if you ask, but I'll hand the bottle over and leave it to you.


I knew a friend who went to the himalayas and got a few demerol from a doctor just in case someone on the trip was in extreme pain in an isolated place. Would you be against that also? 
If you go to the emergency room with chest pain, they will give you nitro first thing. And if you were out in the woods having a heart attack, and you knew I had nitro, I bet you would ask me for it as you were pissing your pants with the fear of death. And I would give it to you.

And two weeks later I would be eating dinner at your house and get a mushy card from you thanking me for saving your life.


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## Harold (Dec 23, 2003)

smilinsteve said:


> I knew a friend who went to the himalayas and got a few demerol from a doctor just in case someone on the trip was in extreme pain in an isolated place. Would you be against that also?
> If you go to the emergency room with chest pain, they will give you nitro first thing. And if you were out in the woods having a heart attack, and you knew I had nitro, I bet you would ask me for it as you were pissing your pants with the fear of death. And I would give it to you.
> 
> And two weeks later I would be eating dinner at your house and get a mushy card from you thanking me for saving your life.


Yes, I would not give someone prescription meds that were given to me by a doctor. Because I don't know how another person might handle them. It's all about the good samaritan laws and what is and isn't covered. Giving someone prescription meds when you are wholly UNQUALIFIED to give them opens yourself up to an absolute $hitstorm if things don't go right.

I am currently not even allowed to take ANY OTC pain medications unless my doctor gives them to me. Nitroglycerin would probably kill me right now. So do you know enough about my medical history and the drugs I'm on to be able to say that giving me anything would be safe? No, you don't.

If I was going on a trip to the Himalayas, I'd talk to my OWN doctor about what medicines I could bring for MYSELF, and it would be a requirement for each group member to do the same. I would not be giving meds to someone else out of my own pack. And if you offered me something out of YOUR pack, I'd refuse and insist you use what's in mine.


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## VanHalen (Apr 1, 2009)

Wow I'm glad somebody pulled up this old thread, very useful info on here. I have heart disease running in my family (dad), and I try and stay on top of my diet and excersize. I will definitely start packing aspirin, and order some dog tags with my info on em (sometimes I don't bring my drivers license or insurance cards). Very scary to read how seemingly perfectly healthy people can turn out to have these kind of issues, makes me worried....


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## smilinsteve (Jul 21, 2009)

NateHawk said:


> Yes, I would not give someone prescription meds that were given to me by a doctor. Because I don't know how another person might handle them. It's all about the good samaritan laws and what is and isn't covered. Giving someone prescription meds when you are wholly UNQUALIFIED to give them opens yourself up to an absolute $hitstorm if things don't go right.
> 
> I am currently not even allowed to take ANY OTC pain medications unless my doctor gives them to me. Nitroglycerin would probably kill me right now. So do you know enough about my medical history and the drugs I'm on to be able to say that giving me anything would be safe? No, you don't.
> 
> If I was going on a trip to the Himalayas, I'd talk to my OWN doctor about what medicines I could bring for MYSELF, and it would be a requirement for each group member to do the same. I would not be giving meds to someone else out of my own pack. And if you offered me something out of YOUR pack, I'd refuse and insist you use what's in mine.


Ok, you are different than me. I am not so scared of drugs designed for the specific purpose I would use them for. And, I am not so enamored of the knowledge of doctors, or so lacking in confidence in my own ability to educate myself on these basic drugs.

Remember also, that we are not talking about forcing something down someone's throat. Taking any drug would be the individuals decision. I would offer them the opportunity to live, and they could decide if the risk is too high or not (which I doubt.)
You never really addressed my point. You said you would insist that I give what is in your pack, but what if you didn't have nitro in your pack? Again, if you were having a heart attack, I bet you would accept my offer. You would be crazy not to. But either way, you would be making the decision to take nitro, or not. I wouldn't be forcing it on you.


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## sean salach (Sep 15, 2007)

so you expect someone under the extreme duress of a heart attack to make a decision of sound mind on whether or not to take a prescription medication from a stranger??


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## hidesertbomber (Jun 16, 2009)

I ride alone a ton and wouldn't even think about heading out without my SPOT! 
http://www.findmespot.com/en/ 
I've been involved with 2 incidents, both severe off-road motorcycle accidents, where 911 phone service was not available. One was even 200 miles south in Baja! It worked flawlessly both times and lives were saved!
As Karl Malden use to say "Don't leave without it."


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## rabidchicken (Apr 16, 2009)

smilinsteve said:


> I knew a friend who went to the himalayas and got a few demerol from a doctor just in case someone on the trip was in extreme pain in an isolated place. Would you be against that also?
> If you go to the emergency room with chest pain, they will give you nitro first thing. And if you were out in the woods having a heart attack, and you knew I had nitro, I bet you would ask me for it as you were pissing your pants with the fear of death. And I would give it to you.
> 
> And two weeks later I would be eating dinner at your house and get a mushy card from you thanking me for saving your life.


Believe it or not there are people out there who get very upset and choose to pursue legal action over stupid things even if you did save their life. I am sure you have heard stories about lawsuits over broken ribs and liver lacerations resulting from properly performed CPR or the guy that wants compensation for the cost of his expensive jeans because you cut them off to save his leg. Luckily, the Good Samaritan Act protects you.

You may think giving nitro is a benign drug, but there is a reason it is a prescription drug. No matter how much moral weight you put on what is right, what you are doing is wrong, dangerous, and more than likely illegal.

When you go to get your expired drug refilled, tell your doctor what your intentions are.


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## smilinsteve (Jul 21, 2009)

sean salach said:


> so you expect someone under the extreme duress of a heart attack to make a decision of sound mind on whether or not to take a prescription medication from a stranger??


Yes because it is a simple decision. The answer should be yes. And we are not just talking about strangers, although it is one possibility. Friends, relatives, riding partners, etc. 
Look, this isn't some big giant decision. You know what the ER asks you before they give you nitro? The ask your symptoms, and if you are taking any other meds like Viagra. They would take your BP also. 
Then they give it to you. 
You know what a doctor will ask you if you ask him for a scrip? Why you need it, and if you are taking Viagra...
It's a drug that is meant to be self administered, and doctors will tell you if you are in doubt or even suspect you might be having an attack, take it. 90% of the time it is a false alarm, but better safe than sorry. 
Remember that most heart attacks could do less damage if the victim would not ignore symptoms and get medical help sooner. That medical help very often includes nitro.
In the case of the OP, the guy complained of symptoms at the top of the one climb, but kept riding. That was bad. He, like many people, probably didn't want to inconvenience anyone, or act like a wuss by being worried about himself, and was probably also in denial because the thought that you might be about to die is very hard to accept. 
I have walked into an emergency room with chest pain twice. Both times, I did not sit down, and I did not fill out paper work. They rushed me right past every other person sitting and waiting and they got the nitro in me. I think if there was a guy with his arm falling off, they would have pushed him out of the way. 
A heart attack is an immediately life threatening and critical situation. These discussions about the safety of giving people drugs are nice, but the priorities are a bit out of whack. I think if and when you are in that situation, you will see my point.


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## CrashCanipe (Jan 12, 2004)

I have no tie to the company at all, just a happy customer - check out http://www.roadid.com. This is an easy and cheap way to always have your vital information on you at all times. It's one of those simple "why didn't I think of that" kind of things.
Barry


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## smilinsteve (Jul 21, 2009)

rabidchicken said:


> Believe it or not there are people out there who get very upset and choose to pursue legal action over stupid things even if you did save their life. I am sure you have heard stories about lawsuits over broken ribs and liver lacerations resulting from properly performed CPR or the guy that wants compensation for the cost of his expensive jeans because you cut them off to save his leg. Luckily, the Good Samaritan Act protects you.
> 
> You may think giving nitro is a benign drug, but there is a reason it is a prescription drug. No matter how much moral weight you put on what is right, what you are doing is wrong, dangerous, and more than likely illegal.
> 
> When you go to get your expired drug refilled, tell your doctor what your intentions are.


I understand your point about lawsuits, but to me that is a crappy reason to not do something that could save a life. 
And I don't know what you think my intentions are, but they are not to skip around town throwing nitro tabs into everyone's mouth. My nitro is for me, to give me peace of mind if anything should happen to me. But if I could save someone elses life by having it on hand, I certainly would. 
Quick story about a time I watched a guy have a heart attack. He was a truck driver at a facility I worked at, who fell over honking his horn for help. We ran out there and it looked to me like he was having an attack. I offered him aspirin, and he said he was fine, just coming down with something (Denial). He started feeling better and I almost believed him. Then he went unconcious. We called an ambulance but he died on the way to the hospital. 
I still regret that I didn't convince him to take the aspirin, although it probably would not have been enough. 
If I watched something like that with nitro in my pocket, and didn't pull it out, I think that decision would haunt me. The nitro certainly wouldn't have made that outcome any worse.


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## whybotherme (Sep 12, 2008)

glad your friend got treatment and is on his way to recovery!

i work as an R&D engineer at a company that makes those products, every year we celebrate the impact we have on patient's lives with "Customer Appreciation Day".

hope things go well with recovery!


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## sxotty (Nov 4, 2005)

Personally I would rather smilinsteve was riding with me than someone who would just watch me die. That is all I have to say on the matter.


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## sean salach (Sep 15, 2007)

smilinsteve said:


> ........*You know what the ER asks you before they give you nitro?* ........
> *You know what a doctor will ask you if you ask him for a scrip?* ........*and doctors will tell you* ............ *They rushed me right past every other person sitting and waiting and they got the nitro in me. * ..........


what medical school did you graduate from? what state(country, whatever) are you liscenced to practice medicine in? if you are not any of the underlined words above, you are in no position and have no right to be dispensing prescription meds. it's irresponsible and dangerous. if you want to play doctor, become a doctor.:nono:


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## Harold (Dec 23, 2003)

sean salach said:


> what medical school did you graduate from? what state(country, whatever) are you liscenced to practice medicine in? if you are not any of the underlined words above, you are in no position and have no right to be dispensing prescription meds. it's irresponsible and dangerous. if you want to play doctor, become a doctor.:nono:


AMEN...giving prescription meds without a valid license is quite illegal whether those meds save the person's life or not.

I would NOT want smilinsteve on a ride with me, because he'd be apt to kill me with the wrong meds if I had a problem. If I don't bring something, there's a reason for it.

And yes, in duress, I would NOT expect someone to be able to appropriately make decisions about safe medications, or to point out that smilinsteve is an idiot for offering HIS nitro prescription to me.


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## smilinsteve (Jul 21, 2009)

sean salach said:


> what medical school did you graduate from? what state(country, whatever) are you liscenced to practice medicine in? if you are not any of the underlined words above, you are in no position and have no right to be dispensing prescription meds. it's irresponsible and dangerous. if you want to play doctor, become a doctor.:nono:


So I have "no right" to ask a dying person if he wants to take something that might save his life? No right to even ask? 
You still seem to imply that I would be prying someone's mouth open and forcing the drug on them. 
And you talk about dangerous but you seem to not understand, or underestimate, the danger of a heart attack.


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## Harold (Dec 23, 2003)

smilinsteve said:


> So I have "no right" to ask a dying person if he wants to take something that might save his life? No right to even ask?
> You still seem to imply that I would be prying someone's mouth open and forcing the drug on them.
> And you talk about dangerous but you seem to not understand, or underestimate, the danger of a heart attack.


You do not seem to understand the phrase, "practicing medicine without a license."

Doesn't matter what your intentions are. Providing someone a prescription drug that a DOCTOR did not okay FOR THAT PERSON is wrong. Hate for you to end up killing someone one day, but I feel that will have to happen before you understand. You'll have lots of time to think about it in jail.


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## smilinsteve (Jul 21, 2009)

NateHawk said:


> AMEN...giving prescription meds without a valid license is quite illegal whether those meds save the person's life or not.
> 
> I would NOT want smilinsteve on a ride with me, because he'd be apt to kill me with the wrong meds if I had a problem. If I don't bring something, there's a reason for it.
> 
> And yes, in duress, I would NOT expect someone to be able to appropriately make decisions about safe medications, or to point out that smilinsteve is an idiot for offering HIS nitro prescription to me.


Your ad hominim attack is a clear sign you are failing to make your point. And if you were having a heart attack, you wouldn't be calling me idiot, you would be calling me your savior. And even though I doubt you would refuse my help, if you did I would respect your decision, so there is no way I could "kill you".

I don't know if you believe in logic or statistics, but try looking at it this way:
I will bet you that there is less risk taking the nitro than not taking it. I bet it's not even close. This isn't some arbitrary opinion. Look at the % of people who die when having clear heart attack symptoms vs. the % of people who die from the adverse effects of nitroglycerin. 
You are talking one out of 10's of people vs. one out of hundreds of thousands of people. Orders of magnitude difference. Clearly the biggest risk is in NOT taking the nitro, even if the symptoms are a false alarm.
Put a pencil to it and get back to me. Thanks.


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## sean salach (Sep 15, 2007)

smilinsteve said:


> So I have "no right" to ask a dying person if he wants to take something that might save his life? No right to even ask?
> You still seem to imply that I would be prying someone's mouth open and forcing the drug on them.
> And you talk about dangerous but you seem to not understand, or underestimate, the danger of a heart attack.


someone who has never had a heart attack or had someone very close to them have a heart attack is likely to not know what the hell nitro is. i had no idea that such a medication existed before reading this thread. so no, i don't think you have a right to expect someone in an immense amount of pain and in a life threatening situation to trust your lack of training and hero complex to give them a prescription medication without putting their life at risk. it requires a prescription for probably several good reasons, not the least of which, i'm sure, is to discourage people who think they know what they're doing, but really don't, from dispensing it at will.


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## PscyclePath (Aug 29, 2007)

smilinsteve said:


> Ok, you are different than me. I am not so scared of drugs designed for the specific purpose I would use them for. And, I am not so enamored of the knowledge of doctors, or so lacking in confidence in my own ability to educate myself on these basic drugs.
> 
> Remember also, that we are not talking about forcing something down someone's throat. Taking any drug would be the individuals decision. I would offer them the opportunity to live, and they could decide if the risk is too high or not (which I doubt.)
> You never really addressed my point. You said you would insist that I give what is in your pack, but what if you didn't have nitro in your pack? Again, if you were having a heart attack, I bet you would accept my offer. You would be crazy not to. But either way, you would be making the decision to take nitro, or not. I wouldn't be forcing it on you.


Someone up above mentioned the NMBP... Patrollers are required to maintain current certification in CPR and first aid as a condition of maintaining good status in the Patrol. In my first aid kit I carry a variety of *non-prescription *meds that someone might need on the trail. If the affected rider is conscious or responsive, then I hand him the stuff, whether it's aspirin, Neosporin, sunscreen, or Deep Woods OFF!, and let him decide to take it or apply it to himself. That's NMBP policy.

If a victim is unconscious or non-responsive when you find him, then the rules under the Good Samaritan laws are different, and you follow the Check - Call - Care routine until competent medical responders arrive and take over from you. But if the rider is conscious and capable of making his/her own decisions, then you specifically ask for his/her consent before you try to help.

I don't carry prescription meds that aren't prescribed to me and intended for my personal use. Giving nitro or any prescription med is way beyond what I'm qualified or authorized to do.

Tom


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## Harold (Dec 23, 2003)

smilinsteve said:


> Your ad hominim attack is a clear sign you are failing to make your point. And if you were having a heart attack, you wouldn't be calling me idiot, you would be calling me your savior. And even though I doubt you would refuse my help, if you did I would respect your decision, so there is no way I could "kill you".
> 
> I don't know if you believe in logic or statistics, but try looking at it this way:
> I will bet you that there is less risk taking the nitro than not taking it. I bet it's not even close. This isn't some arbitrary opinion. Look at the % of people who die when having clear heart attack symptoms vs. the % of people who die from the adverse effects of nitroglycerin.
> ...


Look buddy, it is illegal to provide prescription medicine without a prescription. That medicine was prescribed to YOU. It is illegal to provide it to another. Period.

Are you a doctor carrying a script pad on the trail?
Are you a pharmacist?
Are you ANY kind of medical professional?
Do you have legal training?
Do you know what an idiot you are?


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## smilinsteve (Jul 21, 2009)

NateHawk said:


> Look buddy, it is illegal to provide prescription medicine without a prescription. That medicine was prescribed to YOU. It is illegal to provide it to another. Period.
> 
> Are you a doctor carrying a script pad on the trail?
> Are you a pharmacist?
> ...


Since you insist on calling me an idiot, I changed my mind. I'm not going to offer you my nitro, I'm going to watch you squirm and cry on the ground clutching your chest, and I'm going to laugh and watch you die. 
But I would help other people.
You are one of those people who was told a rule, so now you don't have to think or use any logic. 
Since you are so smart and I am an idiot, explain to me how the risk of giving a dying person nitro is greater than the risk of not giving it. There is a real and scientific answer, so I really don't feel like arguing about it any more unless you have the guts to look at real relative risk, as I posted above.



me said:


> I will bet you that there is less risk taking the nitro than not taking it. I bet it's not even close. This isn't some arbitrary opinion. Look at the % of people who die when having clear heart attack symptoms vs. the % of people who die from the adverse effects of nitroglycerin.
> You are talking one out of 10's of people vs. one out of hundreds of thousands of people. Orders of magnitude difference. Clearly the biggest risk is in NOT taking the nitro, even if the symptoms are a false alarm.
> Put a pencil to it and get back to me. Thanks.


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## sean salach (Sep 15, 2007)

smilinsteve said:


> Since you insist on calling me an idiot, I changed my mind. I'm not going to offer you my nitro, I'm going to watch you squirm and cry on the ground clutching your chest, and I'm going to laugh and watch you die.
> But I would help other people.
> You are one of those people who was told a rule, so now you don't have to think or use any logic.
> Since you are so smart and I am an idiot, explain to me how the risk of giving a dying person nitro is greater than the risk of not giving it. There is a real and scientific answer, so I really don't feel like arguing about it any more unless you have the guts to look at real relative risk, as I posted above.


i would quote all of the explosive results that came up for "nitroglycerin", but instead went ahead and clicked a link to the actual medicine "glyceryl trinitrate".

from: http://en.wikipedia.org/wiki/Glyceryl_trinitrate_(pharmacology)

*all emphasis added by me*

"Disadvantages
After long term use for chronic conditions, tolerance may develop in a patient, reducing its effectiveness. Nitrate tolerance was first described soon after the introduction of GTN in cardiovascular therapy as the loss of symptomatic and hemodynamic effects of GTN and/or the need for higher dosages of the drug in order to achieve the same effects. The mechanisms of nitrate tolerance have been thoroughly investigated in the last 30 years and several hypotheses have been proposed. These include:

Impaired biotransformation of GTN to its active principle - NO (or a NO-related species) 
Neurohormonal activation, causing sympathetic activation and release of vasoconstrictors such as endothelin and angiotensin II, which counteract the vasodilation induced by GTN 
Plasma volume expansion 
The oxidative stress hypothesis (proposed by Munzel et al. in 1995). 
Recent evidence suggests that the latter hypothesis might represent a unifying hypothesis, and a GTN-induced inappropriate production of oxygen free radicals might induce a number of abnormalities which include the ones described above. Furthermore, studies have shown that nitrate tolerance is associated with vascular abnormalities which have the potential to worsen patients prognosis (Nakamura et al.). These include endothelial and autonomic dysfunction (Gori et al.). *In the short run, glyceryl trinitrate can cause severe headaches, necessitating analgesic (very rarely up to morphine) administration for relief of pain, severe hypotension, and, in certain cases, bradycardia. This makes some physicians nervous and should prompt caution when starting nitrate administration. The painful nature of these adverse effects has a marked negative impact on patient compliance.*"

i'll repeat the key part of that: "*This makes some physicians nervous and should prompt caution when starting nitrate administration.*"

you're out of your league and out of line giving that stuff to anyone other than yourself.


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## Harold (Dec 23, 2003)

smilinsteve said:


> Since you insist on calling me an idiot, I changed my mind. I'm not going to offer you my nitro, I'm going to watch you squirm and cry on the ground clutching your chest, and I'm going to laugh and watch you die.
> But I would help other people.
> You are one of those people who was told a rule, so now you don't have to think or use any logic.
> Since you are so smart and I am an idiot, explain to me how the risk of giving a dying person nitro is greater than the risk of not giving it. There is a real and scientific answer, so I really don't feel like arguing about it any more unless you have the guts to look at real relative risk, as I posted above.


Good. I don't want your prescription meds. Hey, I'm being treated for leukemia. I guess you wouldn't mind if I thought you were in a bad sort and needed help, that my cocktail of medications would help you out, huh?

There is a reason it is illegal to provide prescription medicine without a prescription. You would do well to follow that one. I suspect that even if your 'help' did not kill a person, you could still be carted off to jail for giving nitro.

That's what this is about...you having some sort of hero/God complex thinking that if you have it, you should give it to others. That is NOT the correct answer. Have you even been through a single CPR/first aid training session? If you had, you'd know that you shouldn't provide treatment that you are not qualified to give. What makes you qualified to give prescription drugs to another person?


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## smilinsteve (Jul 21, 2009)

Hey Sean, I know about the stuff you pasted above. They are talking about chronic use. Nitro is prescribed to patients with angina (chest pain) to releive discomfort, and yes, there are downsides to doing that. 
It doesn't apply to what we are talking about, which would be one time use in an acute event. 

But yeah, you could look up aspirin and find a long list of adverse reactions and contraindications. All drug info is like that, and I agree it is important info. 

This is getting old. No one here has to give anyone nitro if they don't feel comfortable with it, and no one here has to accept nitro if they are offered it. 
I am talking about an EMERGENCY situation. In the woods, heart attack, no ambulance is going to come, etc.


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## smilinsteve (Jul 21, 2009)

NateHawk said:


> Good. I don't want your prescription meds. Hey, I'm being treated for leukemia. I guess you wouldn't mind if I thought you were in a bad sort and needed help, that my cocktail of medications would help you out, huh?
> QUOTE]
> 
> I wouldn't mind your offer one little bit. But I would decline. See how that works?


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## Biggie (Dec 11, 2004)

I agree with SmilinSteve. A great majotity of the world places medical professionals up on a pedestal. If I was out on a ride and started having bad chest pain I'd ask for nitro! Doctor or not, if anybody has some, I'm taking it! The US is different because you have the "sue everybody" mentality down there, but generally tough choices have to be made and taking a chance with nitro when you probably ARE already dying, is a small risk. I wouldn't hesitate to give it to someone with me either.

When you do a CPR course and someone's heart has stopped they tell you to give the person chest compressions like you are trying to hurt him! *They are already dead*! Shatter that breastbone? Can't hurt him any worse. Nitro is just like breaking the sternum, small risk with big reward.

Even in the US, I think good samaritan law would protect someone who is trying to save someone who is already dying! Even if it involved giving someone a prescription drug.

These people affected by the tsunamis in Asia, do you think they are waiting for MD's to give their loved ones pain killers, etc? Get over yourself and your lofty opinion of physicians. They make mistakes too! Decisions can still be made without them.


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## Hollis (Dec 19, 2003)

ok...Nate & Steve need to meet at the corner BP to solve this dispute
*Man Style*.


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## sean salach (Sep 15, 2007)

smilinsteve said:


> Hey Sean, I know about the stuff you pasted above. They are talking about chronic use.
> It doesn't apply to what we are talking about, which would be one time use in an acute event.


since bold, italics and underlining don't work for your attention span, i'll try enlarging.

"*This makes some physicians nervous and should prompt caution when starting nitrate administration.*"

you know that this thread alone could send you to prison right? asprin does not require a prescription. glyceryl trinitrate does.


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## emtnate (Feb 9, 2008)

Smilinsteve, you are not qualified to give someone nitro. Depending which artery is blocked and the type of heart attack the person is experiencing, you can / will kill them.

In any given day of work, I give more prescription meds than most people can remember. Rx and OTC meds are nothing to mess around with and even the best intended actions can have dire consequences. 

Call me paranoid, but I would never accept any meds from an un-professional stranger. I don't know what they are, where they've been, how old they are, and if they have been stored properly. 

Mods - please permanently delete these posts, the advice presented could kill someone.


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## Biggie (Dec 11, 2004)

sean salach said:


> you know that this thread alone could send you to prison right? asprin does not require a prescription. glyceryl trinitrate does.


Oh my God, did you just say that? How self-righteous of you. Read about the possible effects of alcohol; they are pretty scary as well.

P.S. You gonna rat out SmilinStevie?

I think you are in Alaska, Sean. If you were out miles in the back country, about to freeze to death, and find a dead guy with some of that stuff they take up on Everest. Wouldn't you take it? Maybe you really are that "by the book", but you have to allow for contingencies.

Another example, your in university, dating a hot narcoleptic. Need to do an all nighter. Would you sample some of her ritolin?


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## Biggie (Dec 11, 2004)

emtnate said:


> Mods - please permanently delete these posts, the advice presented could kill someone.


Then again, the tough decision to administer some on hand Nitro could save someone. All cases are different, but sometimes tough decisions have to be made, even without EMT, nurses or physicians present. I went to gradeschool with a kid who was given a trach. with a pen by his neighbor. He had crushed his larynx, or something, with a skateboard.


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## emtnate (Feb 9, 2008)

Biggie & Steve,

Could you kindly explain to the rest of us the mechanism of action of NTG. Expand on the damage being done to the heart during an infarction and why you experience chest pain. We need to understand the systemic effects of nitro on the human body as well as the scientific reasoning behind the risk / reward of the drug. What are the interactions with other medications, side effects of the drug and their reason, as well as explain why I mentioned NTG will kill you with a certain type of MI.

Thank You.


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## Biggie (Dec 11, 2004)

emtnate said:


> Biggie & Steve,
> 
> Could you kindly explain to the rest of us the mechanism of action of NTG. Expand on the damage being done to the heart during an infarction and why you experience chest pain. We need to understand the systemic effects of nitro on the human body as well as the scientific reasoning behind the risk / reward of the drug. What are the interactions with other medications, side effects of the drug and their reason, as well as explain why I mentioned NTG will kill you with a certain type of MI.
> 
> Thank You.


Nope. Just knowing that it might save someone who is nearly dead is enough for me. I wouldn't give it to someone on the doorstep of St. Mike's in Toronto. Or within minutes of medical care. However, in a particularly bad situation I'd give it in a heartbeat. Odd eh?

Your smartness is very impressive. You should audition for "House".


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## emtnate (Feb 9, 2008)

Well if you don't understand a drug, why you give a drug, expected side effects of a drug, and the risks of a drug, you have no right to administer it.

Saving lives is my job, it is a great responsibility that I take very seriously. If wanted to save someone and are so smart yourself, you would know certain precautions we take when administering nitro. You would also know that there are other things you can do to reduce the oxygen demand on the heart during an MI that do not involve Rx meds.


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## Biggie (Dec 11, 2004)

Nate, people find themselves, in life, in really crappy situations.

Look at the people involved IN the flights involved with 9/11.

One flight didn't wait for the police.

Enough said.

They may have saved thousands.

Up until that day, nobody would ever authorize resisting hijackers. Now we know.

Crappy situation, sometimes you have to do what "feels right".

If you're a programmed automaton, that's fine. There are leaders and followers.

Me, I like to act, do my best. If I fail. Fukk it. If I succeed, I may get some "I'm proud of you Booty". Your making this technical, its really not. Its about making decisions when they need to be made.


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## emtnate (Feb 9, 2008)

So I'm just an 'bambalance driver, I see how you are. I'm not programmed automaton, but you will blindly give ntg because someone has chest pain. That's being a follower. No knowledge of what you would do and why you would do it. Unfortunately it is not as simple as "it might save someone who is nearly dead" you might kill someone who is mildly uncomfortable. Medicine takes sound reasoning on why you do what you do. 

I'm not making this technical - it is about making decisions that need to be made, but it is about being informed to make the right ones. Giving prescription medication without the knowledge of why you are giving it and the risks / rewards of the situation is making the wrong decision. 

But I guess I can't impress the seriousness of playing doctor. You don't mess around when people's lives are at stake.


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## Biggie (Dec 11, 2004)

emtnate said:


> You don't mess around when people's lives are at stake.


You said it dude. I wouln't try to rebend the guy's aortic arch or anything, that would be messing around. Givin' someone a shot of nitro? I could handle that.

Like I said, if I was on a surgeon's retreat, or a gathering of gastroenterologists, I'd let them handle it. But in the right, particularly bad situation, I'd do it.

I'm not advocating "spike the punch with nitro" at the next party. I'm just saying sometimes, people need to act.


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## BeaverTail (Aug 12, 2009)

If somebody is incredibly hurt and there are no professionals around, then I will do just about anything. If the matter is life or death, id rather take a shot at saving somebody rather than simply letting them die.

I dont believe for one bit that just because somebody is not trained they should not do there best and try. I feel that is a pretty foolish to simply succeed like that. Sure I see some limitations, such as Id never do brain surgery. Though I would amputate a limb or do other surgery. There certainly is a chance that I will do damage, but if I am faced with certain death id rather take a shot.


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## Biggie (Dec 11, 2004)

emtnate said:


> So I'm just an 'bambalance driver, I see how you are.


At no point have I tried to belittle you or Sean. I'm just arguing a very, very rare case.

No offense meant or taken.


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## emtnate (Feb 9, 2008)

shot of nitro? Do you even know what form the med comes in? There are consequences to the drug beyond an interaction with other nitrates. This is what you don't understand. Just a report of "chest pain" with no further assessment can do more harm than good. 

It is entirely possible nothing will happen, it is possible that something good will happen, and it is possible you can kill someone. That's messing around. Can you handle watching someone die who would have lived because you made a mistake?


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## emtnate (Feb 9, 2008)

Biggie said:


> At no point have I tried to belittle you or Sean. I'm just arguing a very, very rare case.
> 
> No offense meant or taken.





> If you're a programmed automaton, that's fine. There are leaders and followers.
> 
> Me, I like to act, do my best. If I fail. Fukk it. If I succeed, I may get some "I'm proud of you Booty". Your making this technical, its really not. Its about making decisions when they need to be made.


probably the biggest insult I've received all day. And that includes the guy raising his fist saying get the **** out of here while reaching for a shotgun...


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## Biggie (Dec 11, 2004)

emtnate said:


> shot of nitro? Do you even know what form the med comes in?


Again, the technical.

Listen, I'd shoot it up someone's arse with a slingshot. What does it matter the form?

People in the world can use the medical advancements of the world when medical professionals are not present.

They put defibrilators, in Canada, in all hockey rinks. Sure, I don't want a zamboni driver zapping me when I've got indigestion, but if I'm dying I'll forgive the fact he has not got his 10 years of university authorizing him to zap me.


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## smilinsteve (Jul 21, 2009)

No this thread can't land anyone in jail. 
Some of you seem to be very very concerned about the whole legality of prescription drugs. But speeding is illegal too. If your wife was dying, would you refuse to go beyond the speed limit to get her to the hospital, since the almighty law is so important to you? 
My wife would be dying, and beating me over the head at the same time if I didn't put the pedal to the metal. 
emtnate, I actually could do pretty good job answering your technical questions. I won't waste my time right now, and besides, you wouldn't know that I didn't just cut and paste out of the Merck anyway. 
As technical and scary as those drug sheets look, the decision making process is straight forward. 
The risks of giving a drug can be weighed, and the patient can be evaluated out the ying yang to minimize the possile bad effects, if it is not an emergency. 
If it is an emergency, you don't let someone die. Period. 
That is not just my opinion, that is the logic used by doctors every day. Like I said about my own personal experience, when you go into the ER with chest pain, they can't move fast enough to get that nitro into your system. It's not ideal to start treatment without doing a 30 minute evaluation first, but in an emergency they do a simple risk vs. reward evaluation. It becomes clear that the risk of that person's heart stopping right NOW is the risk that matters at that point in time.


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## emtnate (Feb 9, 2008)

They do move fast to give NTG, in fact, it is one of the first drugs I give people for chest pain after making an informed assessment that it will do no harm. It is not a full or lengthy assessment, but rather ruling a few key things out. 30 seconds is about all I need. Should the drug have ill effects, I can also take actions to reverse them.

I try my damnedest to not let someone die in an emergency, but I do not want my actions or inactions to be the cause of their death. 

Speeding is against the law, but practising medicine without a license is a felony. Big difference.

Biggie, with NTG, the route of administration is pretty important for it work right. An AED is almost idiot proof. Fully automatic ones work themselves, although the machines can still be fooled into giving a shock when it is not indicated.


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## smilinsteve (Jul 21, 2009)

emtnate said:


> It is entirely possible nothing will happen, it is possible that something good will happen, and it is possible you can kill someone.


Yes I agree. Now, can you please quantify those risks? Especially the risk of killing someone. Then, compare that risk to the risk of them dying from the heart attack. Let me know what you come up with.


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## emtnate (Feb 9, 2008)

Not giving nitro, but taking other measure to reduce the oxygen demand of the heart will decrease the amount of damage to ischemic cells.

Giving nitro to a person with a "right sided" heart attack will cause irreversible hypovolemic shock, in other words, you've just killed them.


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## Biggie (Dec 11, 2004)

I don't think you are getting my point.

At some point decisions have to be made. If I was on a ride with you and there was a medical emergency I would defer to you. If however, you were to freeze, hypothetically, then someone else needs to act. Quickly.

Two of my favourite books: Ender's Game(Orson Scott Card) and Vengeance(George Jonas) are about the importance of decision makers. Sometimes even the finest specialists in the world, need a Team Leader to guide them. Intelligence, specialization are not necessarily the characteristics of great decision makers. Certainly, having available knowledge helps, but in the end, a decision has to be made.


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## smilinsteve (Jul 21, 2009)

emtnate said:


> They do move fast to give NTG, in fact, it is one of the first drugs I give people for chest pain after making an informed assessment that it will do no harm. It is not a full or lengthy assessment, but rather ruling a few key things out. 30 seconds is about all I need. Should the drug have ill effects, I can also take actions to reverse them.
> 
> I try my damnedest to not let someone die in an emergency, but I do not want my actions or inactions to be the cause of their death.


So you give people nitro for chest pain when you are working, but if you were off work you wouldn't?
Even if it looked like you could save them with it?


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## smilinsteve (Jul 21, 2009)

Biggie said:


> I don't think you are getting my point.
> 
> At some point decisions have to be made. If I was on a ride with you and there was a medical emergency I would defer to you. If however, you were to freeze, hypothetically, then someone else needs to act. Quickly.
> 
> Two of my favourite books: Ender's Game(Orson Scott Card) and Vengeance(George Jonas) are about the importance of decision makers. Sometimes even the finest specialists in the world, need a Team Leader to guide them. Intelligence, specialization are not necessarily the characteristics of great decision makers. Certainly, having available knowledge helps, but in the end, a decision has to be made.


Exactly Biggie!

I can just imagine a group of people standing around a guy in the dirt 10 miles from the nearest car, turning green, gripping his chest in pain. 
"What should we do?"
"I don't know!"
"I had a heart attack once and the doctor gave me this nitroglycerin to carry around"
"We can't do that! It's too risky!"
"Yeah, and it's against the law"!
"Pleeeeeeezzzz" he gasps his last breath.


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## emtnate (Feb 9, 2008)

You're not getting my point. It is dangerous, illegal, and irresponsible to administer Rx drugs to people and reasons that it is not prescribed to. Nobody should be advocating handing out dangerous drugs to your riding buddies on this forum. This is my biggest problem with this thread. 

I get your point that it is better to try than to not try, but it can be like playing russian roulette. You two act like there are no consequences and only benefits. You act like you would not hesitate hand out nitro to anyone with chest pain.

I applaud the intent though. We need more people who aren't concerned with legal action to help those in need. You just want to help your riding buddies, that is a good thing. But understand that you might not be helping at all. 

The first rule of medicine is "primum non nocere" meaning, first do no harm. Make sure you are doing no harm by your actions or inactions.


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## emtnate (Feb 9, 2008)

smilinsteve said:


> So you give people nitro for chest pain when you are working, but if you were off work you wouldn't?
> Even if it looked like you could save them with it?


Off work, giving ntg without a prescription would cause me to loose my job. Even then, the right thing to do would be to help someone in need.

I would make an informed assessment of the patient's condition and transport times to the hospital before administering a medication. I do not carry IV supplies and fluids with me wherever I go, so managing the resulting hypotension of NTG would be difficult at best.

If someone were having a heart attack that resulted in them gasping for their last breath, it is extremely unlikely that ntg would save them. It is primarily effective at relieving stable angina. There's other drugs we use to enhance the effects of ntg on the heart if it isn't immediately effective.

but the bottom line is, i would do what needs to be done so I can sleep at night. helping people is what i do.


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## Biggie (Dec 11, 2004)

Nate, I haven't seen the Hypocratic Oath in 20 years, but doesn't also say don't stand by and do nothing? Isn't that the basis of your country's, and mine's, Good Samaritan Laws?

SmilinStevie and I are advocating, sobering ourselves up and doing something, in remote emergencies. EMT's and surgeons, porn stars and nymphos are all great riding buddies. Unfortunately, I know none of the above. Dirty Balls, the welder, and Salicious, the pipe fitter are what I've got. If my fat ticker gives up the ghost and one of them can get me some NTG, I'll take it. Then I'll swab my taint with my hand and give them a taint Sanchez, because that would be a good way to go out.....


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## sean salach (Sep 15, 2007)

Biggie said:


> Oh my God, did you just say that? How self-righteous of you. Read about the possible effects of alcohol; they are pretty scary as well.
> 
> P.S. You gonna rat out SmilinStevie?
> 
> ...


i have no idea what they take on everest that would possibly prevent freezing to death, aside from appropriate clothing. if i were miles out in the backcountry, and freezing, i would keep moving and try my hardest to start a fire. and no, i would NOT (edited, forgot the not)take a girlfriends ritolin to do an all nighter.


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## sean salach (Sep 15, 2007)

smilinsteve said:


> No this thread can't land anyone in jail.
> Some of you seem to be very very concerned about the whole legality of prescription drugs. ............


this thread pretty clearly and blatantly establishes your intent to distribute prescription medication without a licence.


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## emtnate (Feb 9, 2008)

I'm not suggesting standing by and doing nothing. I am suggesting not giving prescription medications without being able to make an informed decision on if it is appropriate or not. 

Good Samaritain laws apply to you, but not me. On or off work I have to answer for my actions and inactions. At work I have a limited amount of protection from liability, off work, I have none. I would still help somone in need, even though I risk loosing my career and going to prison.


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## sean salach (Sep 15, 2007)

smilinsteve,
if you do happen to hit that "low risk" possibility and do kill someone by your administering of that prescription drug, how much are covered for with regards to liability? if that person happens to be the sole breadwinner for their family, and had a chance at survival had you not given them the hope that the drug you're not supposed to be giving them would save them, who's gonna pay the families bills after the fact? your malpractice insurance?


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## Biggie (Dec 11, 2004)

sean salach said:


> this thread pretty clearly and blatantly establishes your intent to distribute prescription medication without a licence.


Sean, I'm trying hard to follow you. But intent to distribute medication without a license in the one in a billionth chance of being in this situation? That doesn't show intent to distribute, it shows intent to save!


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## Biggie (Dec 11, 2004)

Sean, if you've got a friend who is dying and you're thinking about his electric bill and your own arse vs. malpractice suits then you've got issues. The emergency is THE emergency. Not the dudes credit rating.


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## emtnate (Feb 9, 2008)

the chance of harming someone with NTG is far greater (less?) than 1 in a billion. I don't think I'm going out on a limb to say that you have never seen someone pass out within seconds of 1 dose of nitro. 

you accuse me of acting automatically, yet you are the one suggesting "If chest pain, give nitro". Medicine is not that simple. If you endo and say your chest hurts, you do not want someone "shooting" you with a dose of NTG. Likewise, when I fight fire, I don't automatically put water on the fire.:eekster: The chances the fire is cause by oil or contains metals that react violently with water are slim, but the results can be devastating. 

This is what you both are failing to recognize. Devastating results, to cookie cutter type actions.

Something else, you're a welder? Ever had an acetylene tank blow up within 10 feet of you? If it vented did you just leave it the professionals, or did you attempt to shut if off and risk the consequences?


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## Biggie (Dec 11, 2004)

emtnate said:


> the chance of harming someone with NTG is far greater (less?) than 1 in a billion.
> 
> you accuse me of acting automatically, yet you are the one suggesting "If chest pain, give nitro".


First, the chance I would quickly weigh is chance of dying "as is" versus chance of ntg induced death.

You have actually misquoted me twice. I at no point said that ntg could kill 1/1000000000. I said the situation requiring action was 1 in a billion. Let's face it how are we away from our medical system? I had one ride this year where I wasn't in reach of quick medical care. Compound that with the odds of someone having a heart attack there.

Second, "If chest pain, give nitro". How about if chest pain see a doctor or call 911. But if you are remote enough in the woods things change. I keep looking for big Oak trees with telephones and internet, but they haven't got to Canada yet.


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## sean salach (Sep 15, 2007)

Biggie said:


> Sean, I'm trying hard to follow you. But intent to distribute medication without a license in the one in a billionth chance of being in this situation? That doesn't show intent to distribute, it shows intent to save!


no, actually, it shows intent to distribute, which is illegal for very good reasons.



Biggie said:


> Sean, if you've got a friend who is dying and you're thinking about his electric bill and your own arse vs. malpractice suits then you've got issues. The emergency is THE emergency. Not the dudes credit rating.


agreed. 100%. only problem on your side is that most logical and intelligent people i know wouldn't think to administer their own prescription drugs to someone they don't know either.

i have asthma. i carry an albuterol inhaler. i know for a fact that there is a chance that it could make a persons attack worse. if i find a person collapsed, having a severe attack, and they have an empty albuterol inhaler in hand, i might think, ok, they have a prescription, maybe they ran out, mine could save them. or i could think about the possibility that they just took 30 puffs in the last five minutes in a panic, which WILL make an attack worse. now what? and if they don't have an empty albuterol inhaler? or have a different type of inhaler?

it's just not a road you go down.


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## emtnate (Feb 9, 2008)

Well the conversation was assuming medical care was not nearby, this is a real concern with this sport. Our trails are in a large city park, there are 3 large hospitals within 4 miles of the trailhead. 

You have been saying that if someone was having chest pain and in a remote area, you would not hesitate to give them nitro. 

I have been saying this is dangerous and you could do some serious harm. You have been arguing that the risk is worth it. I'm saying it may not be and you are not qualified to make the call if the risk is worth it or not.

I'm still saying that nobody should be advocating giving Rx drugs to anyone they are not prescribed for on the internet. This is just a bad idea.


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## slocaus (Jul 21, 2005)

Wow, crazy egos here. I am a guy with the stents that has been riding God's good earth for almost four years since I should have died (Halloween 2005 - I got the treat! :thumbsup: ), and not buried in the dirt. 

Easy to think it out in your skull, and justify your egos - you just have no idea what it is like on the other side, the one with the failing heart, and how your "offers" will be interpreted.

You guys scare me!


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## emtnate (Feb 9, 2008)

^^ I have a hunch your cardiologist would not suggest you use your medications on someone else, in any circumstance.


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## Biggie (Dec 11, 2004)

Nobody is promoting giving drugs to people they were not prescribed to. SS and I are promoting our choice as decision makers to react in the very specific case described above.

I would choose to act. Mild chest pain. I'd say "kick up your legs - drink some water".
Bad chest pain, very remote location, no aspirin, but a Camlebak of ntg. I'd say "Try some of this"....

Legality, morality, the majority choice of our people, would not even enter my mind. If my heart and mind make a decision, I go for it. This decision would not be taken lightly and with "intent to distribute".


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## emtnate (Feb 9, 2008)

By saying "try some of this" how is that not giving drugs to people they were not prescribed to?


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## Biggie (Dec 11, 2004)

emtnate said:


> ^^ I have a hunch your cardiologist would not suggest you use your medications on someone else, in any circumstance.


Yes, I could always phone him back at the trailhead...:skep: :skep: :skep:


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## sean salach (Sep 15, 2007)

biggie, steve, our logics differ. i disagree with yours and you disagree with mine. best of luck.


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## Biggie (Dec 11, 2004)

emtnate said:


> By saying "try some of this" how is that not giving drugs to people they were not prescribed to?


Again Nate, if you are worried about legality and being sued when you have a friend dying, I hope you are ok with that. Me I'm about doing my best in every situation. Considering we are talking about being away from mediacal care, I guess we won't have time to call our drs or our lawyers...


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## Biggie (Dec 11, 2004)

Take care guys.

Slocaus, we kept this very relevant thread bumped to the top all evening long. It just keeps people reading it.

Ciao.


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## emtnate (Feb 9, 2008)

I'm not too worried about being sued. I'm worried about people making misinformed decisions that could end someone's life. 

You picked a bad drug to start this argument with.

1. it is more effective in preventing chest pain than it is to reverse the causes of it.
2. it has the potential for some very negative side effects.

Had this conversation been about airway swelling from a bee sting and an epi-pen, I would have a slightly different attitude.


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## smilinsteve (Jul 21, 2009)

nate you seem to know a fair bit about this, so I'm sure you know how doctors prescribe nitroglycerin, not just in emergencies, but also for chronic angina. 
Old men with chest pain and cardiovascular disease carry these little bottles around with them and drop a tab under their tongues or whenever they feel like it to relieve their chest pain. 
the point is that this is not some super high risk super potent take it and die kind of drug except in very rare situations, or it wouldn't be prescribed that way. 
Doctors know that these guys will eventually have increasing pain. they will take the nitro, and it will not help, so they take more. They are having a heart attack so they will call the hospital, but hopefully their nitro and other meds buy them enough time to get to the hospital for the care they need. That's how it works. People are popping nitroglycerin all over the place right now. Let's not get over dramatic about the danger of giving to someone who is already in extreme danger anyway. 
Some people own guns. They have them for emergencies. they don't have to explain whether or not they intend to kill people, they just know that there is a small chance that some day they might be in an emergency where they would be glad they have a gun and they have to use it. Emergencies change the rules. Emergencies mean yo do what you wouldn't ordinarily do. I have continued to emphasize that this discussion is about emergencies.


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## emtnate (Feb 9, 2008)

People do have nitro, and do take it all the time. I see it almost every day. People that are prescribed nitro, have had complete assessments by a cardiologists, are instructed when to take it, when not to take it, and when to call us instead. They are also reasonably sure of the effects on the nitro and their body.

There is no way you can fully predict the effects of a drug you are giving a stranger. You have not done an assessment on them, you do not know if their blood pressure is even high enough to compensate for the drop caused by the meds. You are not prepared to deal with this drop when it happens and it may not be worth the risk.


This is where an informed decision comes into play.


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## emtnate (Feb 9, 2008)

You guys are making it sound like this particular drug is without risk in any situation. That's just wrong. Nitro works by dilating all of the vessels in the body. This is a good thing when one is clogged, because it opens it up, allowing more blood to flow to the heart. It also slows the heart down, this is another good thing because when the heart isn't working as hard, it doesn't need as much oxygen, therefore a lack of blood flow will do less damage.

These effects are also the dangers of the drug. It can drop the BP too low, so that there is poor oxygen exchange. It can slow the heart down too much so that not enough blood gets pumped round and round. There's groups of cells which control the heart rate, if the arteries which supply these cells are blocked doesn't work right and the heart can stop. 

Not common, but possible. I'm just trying to impress that handing out Rx drugs does not come without possible consequences. It's not a good idea to mess around with drugs that act on the heart.

Typically "right sided" MIs present with a slow heart rate and low bp already. This is one thing you need to check BEFORE administering NTG. Always and without fail.


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## Harold (Dec 23, 2003)

Such a good discussion taken down the drain by a couple of misinformed egomaniacs who think they know just as well as a paramedic or doctor. 

When it comes to rendering help in an emergency, you DO need to be concerned with legality and the potential for lawsuits. Have you not noticed how litigious people are, and how many laws govern our medical system? Good Samaritan Laws only go so far in protecting someone giving first aid. 

My wife is a veterinarian and has seen some truly awful cases. She knows how to handle all sorts of emergencies and she knows a great deal about many drugs. Yet she CANNOT use her veterinary knowledge to provide advanced care. She could lose her license and end up in prison for that. She is only permitted to offer basic first aid. No prescription drugs, either. That is how serious the laws governing this topic are. My wife has earned the title of DOCTOR and still cannot do a great deal of what she knows how to do because she does not have a license to work on people and hasn't gone through the specialized training to work on people. Many drugs she uses daily are not available for human use because of some very scary side effects.

In any emergency, get help. You will never be faulted for getting help. Be that with a cell phone, PLB, Spot, or hoofing it out to the ranger station. 

Certain OTC meds can be part of your first aid kit and could be helpful. Hopefully you have enough good sense to use them correctly.

Sometimes, certain prescription meds can be carried in your first aid kit for your own use in an emergency. You cannot give them to someone else. Even if that person doesn't sue, you can face criminal charges. If you don't tell medics what you gave the person, the person could die due to harmful interactions or overdose. 

If you're thinking about rendering care in an emergency, get the proper training. CPR/First Aid, Wilderness First Responder, etc.

I hope all this illegal and potentially deadly advice gets deleted when the mods get a hold of it.


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## slocaus (Jul 21, 2005)

Biggie said:


> when you have a friend dying


And what if you find later that he would have survived if you had not given him what you gave him?

In the 1970s, I did some extreme mountaineering. Cell phones, personal locater beacons?, ha! We, six close friends, who knew that our lives could be in each others hands, went to a doctor we knew for some training, and meds, just in case. We all knew the consequences, but we all had a word with the doc BEFORE we went out on these climbs. (This doctor was a world class kayaker who traveled the world, running rivers that had never been run; he died on one ot those rivers in the late 1970s, alone, and with total acceptance of the risks, and his fate.)

One time, one of our members came back two weeks later in a body bag. We did not have what was needed to get him out alive. Small consolation that the doctor who trained us stated that it would have taken years of training to learn the skills and diagnostics to save Peter, time we did not have as amateur mountaineers.

I would have been emotionally crushed to have given Peter the wrong meds, even though he had no chance, being 30 miles from the nearest road, at 11000 feet and 50 below zero. Sometimes, doing nothing is better than doing the wrong thing, believe me.


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## emtnate (Feb 9, 2008)

What NateHawk said, well put and thank you.

Edit: Slocaus too. My comment earlier, at first I thought you were eluding to treating random chest pain as you would your own. sorry bout that.


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## rabidchicken (Apr 16, 2009)

Biggie said:


> Nope. Just knowing that it might save someone who is nearly dead is enough for me. I wouldn't give it to someone on the doorstep of St. Mike's in Toronto. Or within minutes of medical care. However, in a particularly bad situation I'd give it in a heartbeat. Odd eh?
> 
> Your smartness is very impressive. You should audition for "House".


Administration of sublingual nitro will not save someone who is "nearly dead." Sorry but nitro is not the wonder drug. As mentioned and quoted it is a vasodilator which relieves discomfort. It is not a drug used to cure a heart attack.


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## PscyclePath (Aug 29, 2007)

smilinsteve said:


> I am talking about an EMERGENCY situation. In the woods, heart attack, no ambulance is going to come, etc.


Steve:

Got your first aid and CPR card up-to-date?

As first responders in an emergency situation, what we do is identify a problem, call for competent medical assistance (911), and care for and stabilize the victim until that competent medical authority arrives and takes over. Check - Call - Care.

Even in extreme cases where you have to perform CPR, you're simply trying to keep that person oxygenated until someone shows up with a defibrillator or AED. Let the professional medical folks make the decision whether prescription meds are appropriate. Make the wrong decision in a situation like that, and what you can very easily wind up with is a dead riding buddy and a pizzed-off next-of-kin who wants to sue your shorts off.

If you ride out in the boonies, be prepared. Take a Red Cross first aid/CPR class, keep your knowledge current. Know what your limits are, and stay within them. Hopefully everyone gets out alive at the end of the incident.


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## sxotty (Nov 4, 2005)

NateHawk said:


> You do not seem to understand the phrase, "practicing medicine without a license."
> 
> Doesn't matter what your intentions are. Providing someone a prescription drug that a DOCTOR did not okay FOR THAT PERSON is wrong. Hate for you to end up killing someone one day, but I feel that will have to happen before you understand. You'll have lots of time to think about it in jail.


Youguys are laughable.

There are so many drugs that are over the counter that are more dangerous than specific prescription drugs. I have no idea why people are so paranoid. You should learn a bit about the medications you take, and you should know about them before you take them. Whether a doctor prescribes them or not. Doctors screw up all the time. Prescriptions get filled incorrectly. You need to take responsibility for yourself not simply say a person needs some initials and then is infallible. Hell some vets know more about specific prescription drugs than doctors. I guess you would not let your wife stitch a cut up on you b/c she is only a vet. Well I would feel pretty damn happy if a vet came by and I was in need. Well except if it was your wife since according to you she would refuse to help me and let me die b/c she was so dogonned worried about a lawsuit. Then I guess I would have to haunt her.



emtnate said:


> Could you kindly explain to the rest of us the mechanism of action of NTG. Expand on the damage being done to the heart during an infarction and why you experience chest pain. We need to understand the systemic effects of nitro on the human body as well as the scientific reasoning behind the risk / reward of the drug. What are the interactions with other medications, side effects of the drug and their reason, as well as explain why I mentioned NTG will kill you with a certain type of MI.
> 
> Thank You.


OTC drugs are not magically safe. Many would never have been approved if they were not already grandfathered in, but no one runs around screaming how could you give him a nuprin, OMG he is going to die.

I have let someone use my inhaler before when they forgot theirs.

This is not about prescribing, it is about offering. Someone is having an asthma attack and I have an inhaler I sure as hell will see if they are ok and if they wanted to take a puff of mine I would not begrudge them. I hope a person would not begrudge me, but I guess some here would. They would rather I die then put themselves at any risk. Seems a tad self centered, but that is just how some people are.


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## Jayem (Jul 16, 2005)

sxotty said:


> Youguys are laughable.
> 
> There are so many drugs that are over the counter that are more dangerous than specific prescription drugs. I have no idea why people are so paranoid. You should learn a bit about the medications you take, and you should know about them before you take them. Whether a doctor prescribes them or not. Doctors screw up all the time. Prescriptions get filled incorrectly. You need to take responsibility for yourself not simply say a person needs some initials and then is infallible. Hell some vets know more about specific prescription drugs than doctors. I guess you would not let your wife stitch a cut up on you b/c she is only a vet. Well I would feel pretty damn happy if a vet came by and I was in need. Well except if it was your wife since according to you she would refuse to help me and let me die b/c she was so dogonned worried about a lawsuit. Then I guess I would have to haunt her.
> 
> ...


That is some of the most amazing rationalization I've ever seen.

Some drugs are more dangerous than others, so that must mean it's ok to use em all (no one said OTC drugs were safe)?

Some doctors mess up so doctors don't know what they're doing?

Some perscriptions don't get filled right so you'll be ok taking the wrong medicine?


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## emtnate (Feb 9, 2008)

Yeah, I never said OTC meds were safe. Most aren't, I think I even said that there is more than enough tylenol in a bottle to kill you. 

Some drugs, (OTC, RX, illicit) are safer than others. The drug in question, nitro, while extremely common, isn't a particularly safe drug. Giving it to people without a prescription, without knowledge of how their body will react, and without the ability to manage the intended and unintended effects of this drug is irresponsible. 

The people suggesting that they would hand it out without question were unaware of the risks, benefits, route of administration, and even the form the drug is in. They seem to be under the impression that it is a drug with very low risks and very high reward. This is not true. NTG alone will not cure a heart attack, it won't come close.

Doctors do screw up. I've made mistakes in my treatment, I'm sure I'll make mistakes again. This has nothing to do with handing out your rx drugs for other people. Again, some things have lower risks, albuterol inhalers have minimal risks, epi pens have minimal risks. NTG is a different story.

About rendering care, as a professional when not working, it is a touchy subject. I work under the license of medical doctor. It only applies when I'm working the ambulance service I work for. When not working, I have no legal right to practice anything beyond basic first aid. Sometimes the right thing to do isn't the legal thing. Would it be fair to my wife, my coworkers, and my future patients for me to be sitting in prison because I practiced medicine unlawfully? My family already sacrifices a lot due to my career, I will not ask them to sacrifice me all together. 

In a situation such as described, you can provide appropriate, timely care, without breaking the law, without illegally prescribing meds, and without risk of further harm to the patient.

You also say people need to be educated about the meds they take. Myself and a couple of other professionals have tried to educate the few on here about the meds they are taking, but they refuse to believe it. Feel free to research everything I have said about nitro. Look on the internet, call a pharmacist, ask your cardiologist. They won't have anything different to say.


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## canuckjgc (Jun 22, 2007)

Wow what a thread! 

It comes down to this: your are free to make whatever choice you wish, but you will have to deal with the consequences of that choice. 

Personally, I think the best advice to get help any way you can. Nobody -- not even the victim's family -- will fault you. 

If you are riding with a bunch of middle aged desk jockeys (like I do), why not have a 5minute discussion about what to do in an emergency? That way everyone is on the same page and nobody should feel guilty about making one decision over another.


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## sxotty (Nov 4, 2005)

emtnate said:


> Yeah, I never said OTC meds were safe. Most aren't, I think I even said that there is more than enough tylenol in a bottle to kill you.


Which is why they will likely start limiting tylenol sales in the near future. They want to change the dose, which is stupid IMO. If you reduce the mg then people just take more. If a kid gets a bottle and downs the whole thing they will be in trouble regardless of the mg/tablet. The only reason I brought it up is that people freaked out about something being a prescription. My point was just b/c something is a Rx doesn't necessarily mean it is more dangerous than an OTC medication.

They have ads now on TV trying to get patients to talk to doctors. Too many people are awed and think they are infallible so they don't mention important information. Doctors are busy and can easily overlook things or not ask questions. I am not saying doctors don't know what they are doing. I am simply advocating that people know something about their treatment. Get informed, get involved. You don't need to know everything about every medication you may ever need, but if people knew about the ones they take they would at least have some idea of how dangerous they are. And yes that gets to the crux of the original issue, which is, how much does the offerer know about what they are offering? I completely understand that you should not offer to give out Rx medications like candy, but I also take personal responsibility to read up on any medications I take and feel comfortable challenging a doctor if they are not prescribing the right dose, or medication. You never actually gave any information on the real risks of nitroglycerin as far as quantitative numbers go. I doubt you have them in your head and I would not expect you to, but that also means that you just said a bunch of qualitative things. I would not disagree with most of what you said myself, and I doubt anyone else would either.

As to the other liability issue I find it sad that a person would decide not to help another for fear of liability. And yes I can understand people being afraid and saying it isn't fair and so forth, but it is still an attitude of placing yourself, and your families well being before another person. They likely have a family too. You may risk prison, they risk a coffin. Anything you risk losing by helping you risk them losing by not helping. That doesn't make your stance wrong or right, but deciding not to act is still a decision.


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## sean salach (Sep 15, 2007)

sxotty said:


> ....
> I have let someone use my inhaler before when they forgot theirs.
> 
> This is not about prescribing, it is about offering. Someone is having an asthma attack and I have an inhaler I sure as hell will see if they are ok and if they wanted to take a puff of mine I would not begrudge them. I hope a person would not begrudge me, but I guess some here would. They would rather I die then put themselves at any risk. Seems a tad self centered, but that is just how some people are.


i'll address this one specific part of your post since i have ALOT of experience with what you're mentioning. i'm just going to post up a series of situations i have been in and how they relate.

* despite the concerns i mentioned earlier, i have given someone two puffs of my inhaler when he was collapsed on the sidewalk clutching an empty one. it was an old man, in nyc. he was beyond the ability to inhale, was not hyperventilating. was struggling to take about two very weak breaths per minute. people who knew him and had a cell phone(i didn't) arrived on the scene within five minutes, after he had regained the ability to inhale, and i told them i had let him use my inhaler but he needed to get into a climate controlled environment and get to a hospital or a clinic asap.

* i've had a severe attack that landed me in the hospital while out riding alone. it took me 3.5 hrs to go less than 5 miles once the attack started. i had to do most of it on foot in order to maintain my ability to breathe. the air was so thick with my triggers that i knew my inhaler wouldn't stop the attack. the last mile and a half i took at about 4 very short and weak steps per minute. i couldn't reach anyone on my cell phone. i pissed my pants. i couldn't devote the energy to holding it and i didn't know if i could spare the time to stop and take a leak. i limited my inhaler use to one puff every half hour during the march. it got me home, where i thought the ac and my nebulizer would stop the attack, they didn't.

during the attack, while i was trying to somehow divide my energy between breathing and moving forward, with the knowledge that overusing my inhaler wouldn't help; if i had encountered someone who offered me crack(it was NJ) with the promise that it would act just like an epipen and stop the attack long enough to get me home, i probably would have taken it. people in life threatening, painful situations can not be trusted to make accurate decisions about what will or wont work for them. they simply want the situation and the pain to end. that's why there are laws in place to protect their ability to trust the people that are supposed to be the ones offering them prescription meds.

*when i was young, i went through an entire albuterol inhaler in two days, one weekend, because i was having what should have been a manageable attack. the overuse of the inhaler landed me in a hospital. i've been very wary about overuse ever since.

*i've flatlined from an attack before.

*i've had litterally thousands of asthma attacks in my life. i've learned quite a bit about the disease and what's appropriate, innappropriate, dangerous and ok-but-dont-tell-everyone about treating accute attacks. noone in this thread has had thousands of heart attacks. noone in this thread has had hundreds or even tens of heart attacks. noone in this thread that isn't professionally trained to do so should be diagnosing and treating a heart attack with prescription meds.

*if someone is having a life threatening asthma attack in the middle of the woods, chances are the entire area is filled with the very triggers that are causing their attack. the only easy way to save them is to get them the hell out of that environment. if you are going to administer an albuterol inhaler, legally or illegally, to them to do so, you need to be very careful about the timeframe. otherwise it doesn't take long to go from one puff allowing a person to shuffle slowly and weakly down the trail to one puff too many and a limp and soon to be dead person on the side of the trail.


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## emtnate (Feb 9, 2008)

I have avoided some specific risks and talking about the action of nitro in the body because it is way beyond the scope and relevence of this thread. The problem with giving statistics of the risks, is that there times when nitro is not given for chest pain under ANY circumstances. So there are no statistics for what happens when you do something that you aren't supposed to do in the first place. The biggest risk is a sudden, irreversible drop in BP resulting in death. This risk is very real and you have to have high enough BP to give NTG in the first place. You also have to be able to compensate for this drop. We have other medications and techniques to do this. How common is this? The last time I saw nitro bottom out someone's BP immediately was 4 or 5 months ago. I gave one dose for chest pain, after assessing the patient and ruling out contraindications of the drug. 30 seconds later, she passed out. This may be a 1:100 event, how would the other two objecting to my opinion deal with a passed out pt with too low BP to maintain heart and brain perfusion because they gave her ntg. I have ways to deal with it and my patient suffered no complications. But we didn't give her nitro anymore and treated the chest pain a different way. Had these posters given her their nitro, they would have killed her. Again, they are not qualified to make these decisions.

Steve mentioned in a previous post that he saw someone die at a truck stop from a heart attack and would have given him nitro if he had it. I have been trying to say that may or may not have been the right thing to do. He says this person went unconscious, this is another situation where nitro would be detrimental.

Another red flag was that the nitro was prescribed several years ago and the bottle stays in the camelbak. So is it expired? Has it stayed out of sunlight? Nitro tends to become less effective with age. Does the poster know how to recognize the signs of the drug working? NTG can be effective, but not relieve the pain sensation. So then what do you do? 

Sxotty, you seem to understand the fallibility of practitioners as well as the risk / rewards of medications. If only everyone would sit down with their doc and pharmacist and fully understand the chemicals they are putting in their body. I don't expect everyone to memorize every single drug out there, but I think it is reasonable for people to expect someone in my profession to have an understanding of all of the drugs I give on a daily basis. I am not above double checking dosages and concentrations before I administer something. I believe my patients deserve nothing less. 

As I have said, ntg has tremendous benefits for someone with chest pain, but there are enough risks with it's administration that it should not be given to someone without a prescription unless you know what you are doing and are able to treat the reactions to the drug. (ie. EMS)


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## Harold (Dec 23, 2003)

sxotty said:


> Youguys are laughable.
> 
> There are so many drugs that are over the counter that are more dangerous than specific prescription drugs. I have no idea why people are so paranoid. You should learn a bit about the medications you take, and you should know about them before you take them. Whether a doctor prescribes them or not. Doctors screw up all the time. Prescriptions get filled incorrectly. You need to take responsibility for yourself not simply say a person needs some initials and then is infallible. Hell some vets know more about specific prescription drugs than doctors. I guess you would not let your wife stitch a cut up on you b/c she is only a vet. Well I would feel pretty damn happy if a vet came by and I was in need. Well except if it was your wife since according to you she would refuse to help me and let me die b/c she was so dogonned worried about a lawsuit. Then I guess I would have to haunt her.


Y'know what....my wife would refuse to treat ME with anything beyond basic first aid. (besides, backcountry suturing is also a bad idea) Doing so would be the end of our lifestyle. My earning potential isn't even half of hers, and she'd completely lose the ability to work as a veterinarian in the future. No more house. No more bikes. She'd be spending a lot of time in jail, too. That'd ruin our chances for sex, too.

Big diff between her and you is that she KNOWS what the laws are for her profession.


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## emtnate (Feb 9, 2008)

^^ That's the other thing to think about and is hard without sounding like a selfish prick. I love my job, I do not want to loose it but I cannot in good conscious put my family at risk. There are ways I can help people and stay within the laws for my profession. I would do that, but at the end of day I'm coming home from work.

I've walked away from people who were sick because the risk to myself was too great. Next time you go to work and find yourself staring down the wrong end of a gun, tell me you wouldn't walk away from the scene. I'm not good to anyone else if I'm in jail or if I'm dead. 

I've not made entry into a burning building, knowing there was a human trapped inside, because the flames were too heavy, I wouldn't make it out alive. Hard decision, yes. But I'm not going to jail or getting killed for this job.


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## sxotty (Nov 4, 2005)

emtnate said:


> Sxotty, you seem to understand the fallibility of practitioners as well as the risk / rewards of medications. If only everyone would sit down with their doc and pharmacist and fully understand the chemicals they are putting in their body. I don't expect everyone to memorize every single drug out there, but I think it is reasonable for people to expect someone in my profession to have an understanding of all of the drugs I give on a daily basis. I am not above double checking dosages and concentrations before I administer something. I believe my patients deserve nothing less.


Well that may be part of my problem. I expect others to know about the drugs they are using. Hence I don't have as much of a problem with someone offering something, but I guess people may not have that information.

BTW I always say my favorite doctors are the ones who will say "I don't know." I want them to look something up if they don't remember. It seems (and it could be wrong) that there is a professional disdain for admitting ignorance on a specific subject. So I appreciate that you are willing to double check.



NateHawk said:


> Y'know what....my wife would refuse to treat ME with anything beyond basic first aid. (besides, backcountry suturing is also a bad idea) Doing so would be the end of our lifestyle. My earning potential isn't even half of hers, and she'd completely lose the ability to work as a veterinarian in the future. No more house. No more bikes. She'd be spending a lot of time in jail, too. That'd ruin our chances for sex, too.
> 
> Big diff between her and you is that she KNOWS what the laws are for her profession.


Well I know plenty of vets. Vets who would help a person in need. Vets who have helped people in need. Suturing a dirty nasty wound is obviously a bad idea, but if you can clean it out there is nothing wrong with it. I have been with a vet on a trip who cut himself fairly badly. Just cleaned it out with betadine and then sutured it up himself. It healed perfectly.

If your wife would let you die when she could help for fear of losing her job I would think about a new wife.

Do you seriously think if your wife gave you a few stitches the secret veterinary gestapo would kick in your door and take her license? I don't think it is particularly likely. Now if she was buying drugs and then reselling them her license would be gone whenever someone finally found out no doubt.


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## emtnate (Feb 9, 2008)

It's not the secret veterinary gestapo that you need to worry about, rather the insurance companies that are supposed to represent you. When they find out something was done by an unqualified person, they will throw a fit, then the investigations will start. 

I'm not sure if I would treat my wife beyond basic first aid. I've thought about it a lot - I've never treated her for anything more severe than a moderate asthma attack - if it was life threatening, I would rather step aside and let my colleagues treat her. I've seen doctors make poor decisions because they weren't thinking clearly due to being preoccupied with the suffering of their loved one. I'm not sure how I'd react and I don't want to find out.


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## Harold (Dec 23, 2003)

sxotty said:


> Well that may be part of my problem. I expect others to know about the drugs they are using. Hence I don't have as much of a problem with someone offering something, but I guess people may not have that information.
> 
> BTW I always say my favorite doctors are the ones who will say "I don't know." I want them to look something up if they don't remember. It seems (and it could be wrong) that there is a professional disdain for admitting ignorance on a specific subject. So I appreciate that you are willing to double check.
> 
> ...


Backcountry suturing is a bad idea regardless. There are better options for wound care. It's not about the "secret gestapo" or whatever, either. Practicing medicine outside the bounds of your license is a CRIMINAL offense. That's not just a lawsuit. That's a go-to-jail-do-not-pass-go offense. Your vet friend who sutured himself is completely different than performing those things on someone else.

She would not let me die in an emergency, either. We're not going to be hauling a locker full of medical supplies for every contingency, so if something is serious enough, I'd die anyway (I've had enough close calls as it is..my 9lives will run out eventually). We carry enough supplies to conduct basic first aid. Let the people with the right equipment handle everything else.


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## emtnate (Feb 9, 2008)

I'd have to ride everywhere with a BOB if I had to pack a full set of first aid gear. If it's that bad, call a chopper. If it's not that bad, you can make do until you get to a road and get an ambulance.


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## rmac (Oct 26, 2004)

smilinsteve said:


> I understand your point about lawsuits, but to me that is a crappy reason to not do something that could save a life.
> And I don't know what you think my intentions are, but they are not to skip around town throwing nitro tabs into everyone's mouth. My nitro is for me, to give me peace of mind if anything should happen to me. But if I could save someone elses life by having it on hand, I certainly would.
> Quick story about a time I watched a guy have a heart attack. He was a truck driver at a facility I worked at, who fell over honking his horn for help. We ran out there and it looked to me like he was having an attack. I offered him aspirin, and he said he was fine, just coming down with something (Denial). He started feeling better and I almost believed him. Then he went unconcious. We called an ambulance but he died on the way to the hospital.
> I still regret that I didn't convince him to take the aspirin, although it probably would not have been enough.
> If I watched something like that with nitro in my pocket, and didn't pull it out, I think that decision would haunt me. The nitro certainly wouldn't have made that outcome any worse.


Steve - reading through your exchange with rabidchicken I see you wanting to do the best for other people but I don't think you are truely hearing what RC is saying. I doubt I will say it any better but your good intentions of possibly offering nitro to someone in pain and maybe experiencing an IC are WRONG. You would be essentially practicing illegal medicine and although clearly have the person's best interests in mind, you might heal them or you might kill them - you're simply not qualified to be making the decision.

02 cents.


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## sxotty (Nov 4, 2005)

Helicopters can only fly in specific conditions. Once again there are plenty of rules. I have had to call in choppers before, run out to get help, and haul people out before. Things happen. And jeez no one is suggesting you do this stuff for fun. Of course you would let someone else treat them if a more qualified individual is accessible, or an equally qualified one that doesn't have their wits gone b/c they are worried. No one was ever talking about such nonsense. 

The only thing in question is whether people are willing to help those in need, and whether it is truly helpful. And the answer is many people are too worried about possible repercussions to act. If someone was bleeding severely I would certainly rather have a doctor there, or a vet, or an EMT, but that doesn't mean I will just smile and walk on by b/c I am not qualified to put pressure on the wound. Yes there is plenty of worry now days and that is why they are so against telling people to use tourniquets in any situation. But if I had a serious cut to my artery I would certainly rather get a tourniquet than bleed out. Probably no days everyone would be too afraid to do it though so I would die needlessly so that a person would not be sued if a limb had to be amputated.


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## Harold (Dec 23, 2003)

It's not a misguided sense of worry people (including me) are expressing. There are limits to what one can do in a first aid situation. There are limits to what one SHOULD do in that same situation. I know what it's like for a lawsuit. That's a concern, but not a huge one. That's what Good Samaritan Laws are for. The concern here is doing something ILLEGAL. Whether you save the person's life or not, you're likely to be arrested, whether the patient wants you to be or not. This is not a simple lawsuit, and has repercussions far worse than monetary damages.

Furthermore, when dealing with prescription medications, they are a prescription for good reason. Many OTC meds should be on that list, too, but they aren't there for various reasons. Simply put, in a wilderness first aid situation you are NOT prepared to deal with side effects (or some primary effects even). You don't have the gear to run an IV drip. You don't have alternative drugs, or reveral agents, or any of that. Your primary objective is to get help. Anything else you can do is secondary and should be limited so the pros with the equipment can handle the serious care. I imagine one of the worst things a paramedic must do is clean up the mess from a well-meaning but unqualified first responder.


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## canuckjgc (Jun 22, 2007)

It is assumed in this thread that it is "illegal" to freely give some of your nitro to someone in an emergency situation.

To which law are you referring? It is illegal for someone to *prescribe* a drug who is not a doctor, but I somehow doubt that offering your meds to someone for free is "illegal" (maybe not smart, but I doubt illegal). 

Please post the statute so we can read it for ourselves.


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## sean salach (Sep 15, 2007)

"intent to distribute" "prescription medication" on google
http://www.google.com/search?q="int...s=org.mozilla:ga-IE:official&client=firefox-a

"sharing your prescription" illegal on google
http://www.google.com/search?hl=ga&...ing+your+prescription"+illegal&btnG=Cuardaigh

and here's one from wonderful canada, where everything is better and different. oh wait, it's illegal there too.
http://74.125.155.132/search?q=cach...ada&cd=2&hl=ga&ct=clnk&gl=us&client=firefox-a

.


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## Harold (Dec 23, 2003)

canuckjgc said:


> It is assumed in this thread that it is "illegal" to freely give some of your nitro to someone in an emergency situation.
> 
> To which law are you referring? It is illegal for someone to *prescribe* a drug who is not a doctor, but I somehow doubt that offering your meds to someone for free is "illegal" (maybe not smart, but I doubt illegal).
> 
> Please post the statute so we can read it for ourselves.


Each state has its own phrasing. Here's some relevant info for Texas, where I live. Doubt I can find it all.

Some laws
Some definitions
See #35 in the above link.
Lots more laws

Very lengthy legal codes governing prescription medications.


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## emtnate (Feb 9, 2008)

NateHawk said:


> I imagine one of the worst things a paramedic must do is clean up the mess from a well-meaning but unqualified first responder.


It happens all the time. It is very difficult to even figure out what some people have given my patients in an attempt to help. Then you have to figure out the dose given and if the drug was expired or not before reversing it.

I have seen people give an elderly woman 5 epi-pens because they were convinced she was having an allergic reaction and ended up putting the patient in a very dangerous heart rhythm.

I have seen people overdose others on seizure meds causing further problems for everyone down the road.

I have seen a home health aide do CPR on a person who's heart was beating. The aide only checked a radial pulse before starting compressions and apparently didn't think about it; since the person was breathing, their heart was beating. You might think this is uncommon, but I can think of 4 or 5 times in the last 6 months when CPR was started by a bystander when it wasn't needed. This list could go on and on - in a way it is job security.

Good intentions are one thing, but if you don't know what you are doing, your best action is doing nothing except for calling for help.

Like I have said repeatedly, nitro's intended result is a drop in blood pressure. I don't and can't carry IV supplies and other drugs to reverse this unless I'm working. This is not something you guys are prepared to handle in the backcountry.


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## Bob the Wheelbuilder (Sep 21, 2003)

Aspirin is an excellent thing to carry in a first aid kit. It has a great chance of helping in the case of a heart attack. You should give one regular tablet (325 mg.) as soon as possible for apparent cardic chest pain unless there is an aspirin allergy. Virtually all experts agree on the usefulness of aspirin in this situation. Of course if the person is dissecting their aorta, it could still kill them because it interferes with blood clotting, but dissection is a much more remote possibility than heart attack.

I would strongly recommend against giving nitroglycerin in the field to someone to whom it is not prescribed. This is especially true if you don't have training in its use or the ability to check blood pressure and start an IV. You literally could kill a person if they have a large blood pressure drop and you don't have the ability to give IV fluids. Being in the middle of a big ride increases the chance of dehydration which could make this type of reaction more likely. 

Rest is more important than nitro in treating chest pain. If a fellow rider is having significant chest pain, it would be best to make them as comfortable as possible and call for help or send someone for help. Judgement is needed to weigh the risks and benefits of waiting versus self-extrication. Things could go bad either way.

It's not just the legal issue here. Giving someone a prescription medicine that isn't prescribed for them can cause very serious problems. And yes, I'm a licensed and board certified emergency medicine doctor if that gives my opinion any more weight.


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## rabidchicken (Apr 16, 2009)

canuckjgc said:


> It is assumed in this thread that it is "illegal" to freely give some of your nitro to someone in an emergency situation.
> 
> To which law are you referring? It is illegal for someone to *prescribe* a drug who is not a doctor, but I somehow doubt that offering your meds to someone for free is "illegal" (maybe not smart, but I doubt illegal).
> 
> Please post the statute so we can read it for ourselves.


Of course your location can make a difference, but this is an interesting case. 
http://www.dayontorts.com/miscellaneous-those-who-share-prescription-drugs-owe-duty.html


> The Supreme Court of Arizona has ruled that persons who are prescribed drugs owe a duty of care, making them potentially liable for negligence, when they improperly give their drugs to others.


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## Harold (Dec 23, 2003)

Bob the Wheelbuilder said:


> It's not just the legal issue here. Giving someone a prescription medicine that isn't prescribed for them can cause very serious problems. And yes, I'm a licensed and board certified emergency medicine doctor if that gives my opinion any more weight.


Clearly that doesn't mean squat to the few idiot posters suggesting that everyone carry nitro in their camelbak for possible heart patients.


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## nOOky (May 13, 2008)

I carry aspirin with me at all times. I have atrial fibrillation and have had a heart failure before. Once you go through or are cognizant of an event like what is described above it hopefully makes you more aware. I don't carry much with me on a ride, but everyone's vehicle should have a nice first aid kit. Something to consider if you don't have one, I kicked down for a good one, and it comes in handy. CPR training is also great. It sux to have to use it, but nice to know what to do if the need arises.


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## Biggie (Dec 11, 2004)

NateHawk said:


> Clearly that doesn't mean squat to the few idiot posters suggesting that everyone carry nitro in their camelbak for possible heart patients.


Nate, you're just making stuff up.

I, certainly, never said anything about carrying nitro. I never would.

This is getting old. If in a remote emergency, I would(following advice found in this great thread): A) try to hydrate and B)give aspirin and C)insist on resting the victim.

However, without aspirin, without immediate chance of medical attention. If another rider said, "Hey, I got some nitro", I would would certainly offer it to the victim. I'd even say, "If I was in your shoes I'd be taking it".

If that makes me an egomaniac in your shoes, I accept that. Cheers dude.


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## emtnate (Feb 9, 2008)

It does not make you an egomanic, it makes you a ****ing dumbass. Listen to the good doctor who posted since you don't believe what the rest of us have posted.

Don't give prescription medicine to people it is not prescribed for. By your last statement, Natehawk is right - it doesn't mean squat to you.


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## Biggie (Dec 11, 2004)

emtnate said:


> It does not make you an egomanic, it makes you a ****ing dumbass. Listen to the good doctor who posted since you don't believe what the rest of us have posted.
> 
> Don't give prescription medicine to people it is not prescribed for. By your last statement, Natehawk is right - it doesn't mean squat to you.


EMT,

I just went and read through my Merck.

If I'm on a mountain, no medical care. Aspirin, rest and hydration aren't working. It says try nitro and even morphine(even any opiate). I'll give both. Yes, you heard it hear first.

If the patient obviously had difficulty relaxing, morphine would be perfect!


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## emtnate (Feb 9, 2008)

So now you are going to administer controlled narcotics without a medical license, there's a federal law against that and I'm pretty sure it's a big reason why our prisons are crowded.

I'm sure your Merck book mentions that you have to be able to provide cardiac monitoring, respiratory support, as well as stock an opiate antagonist before administering morphine.


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## Harold (Dec 23, 2003)

Biggie said:


> EMT,
> 
> I just went and read through my Merck.
> 
> ...


HAHAHAHA....see, one of the laws I posted mentions you need a DEA (THE DEA) number to give that stuff to someone. Do you have one of those? You storing your morphine according to law? IIRC, controlled substances like that have to be stored behind 3 locks here in TX.

If giving nitro was a bad idea, giving morphine is just flat retarded. So, you carry your Merck around with you? Wife's got one of those. Needless to say, 2305 pages of hardbound reference material is NOT lightweight.


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## emtnate (Feb 9, 2008)

Not to mention what happens when you combine nitro with morphine. You have to be real careful.


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## Biggie (Dec 11, 2004)

I think when you are in a remote medical emergency closing your options is just wrong. If you are in a remote medical emergency and somebody has a seat bag filled with prescription drugs you cannot rule out administering them due to the absence of a physician. That's ridiculous.

Closing your mind to choices and alternatives is flat out wrong!

NateHawk, what amateur athelete does not have a closet filled with old prescription drugs. I'm sure in mine at any moment there are mult. anti-inflammatories(prescription, plus ASA, ibuprofin and acetominophen), mult. pain killers(I think I even have some toradol(sp?) left). I'm sure I have old anti virals, etc.

The only think I don't keep are antibiotics; I try to avoid those...


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## Harold (Dec 23, 2003)

Biggie said:


> I think when you are in a remote medical emergency closing your options is just wrong. If you are in a remote medical emergency and somebody has a seat bag filled with prescription drugs you cannot rule out administering them due to the absence of a physician. That's ridiculous.
> 
> Closing your mind to choices and alternatives is flat out wrong!
> 
> ...


  

The idiocy here is astounding. A seat bag full of prescription drugs? What might be in there? Sure, if I find some prescription drugs in a seat bag or med kit, I'll take one of each and hand 'em to the person to take.

I don't keep prescription drugs, to be honest. Antibacterials, antivirals, and antifungals (I'm currently on all 3) get taken until they're gone. Other stuff gets tossed when I don't need it for the original problem anymore. I've got a bottle of Darvon at the moment. Don't use it much, but I gotta keep it around until my docs tell me I'm allowed to take OTC pain meds again. See, I can't take the OTC stuff since it can mask a fever. Masking a fever is BAD news for me, since ANY infection can kill me.

However, the hospital has given me Tylenol a few times specifically to lower a dangerous fever (105 anyone?).

Oh, hey, do you know if the person you're treating without a license takes any herbals? Some herbals have VERY bad reactions with pharmaceuticals. Many of these reactions are unknown since herbals aren't tested by the FDA. So what're you going to do if you combine a drug with an herbal that causes a severe reaction? Got the equipment and the training to handle that?

You act like a doctor's knowledge is some trivial thing. There's a reason they spend so many years in school and training to get where they are.


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## emtnate (Feb 9, 2008)

I wouldn't trust a seatbag full of prescription or OTC drugs. I like to know exactly what I put in my body. I like to see stuff sealed up and labeled, so I know when it was prepared. If I'm prescribed something I'm not familiar with, I always ask my pharmacist about it. 

What you still fail to understand, is that in an emergency, your "seatbag full of prescription drugs" might do more harm than good. You don't know what you're doing, you don't know how the drugs work on the body, and you don't know the risks. You assume drug A will treat condition B because that is what it is commonly prescribed for. You are ignoring variables and advice from professionals. This mindset will hurt someone else. 

You have not answered how you would react if your good intentions killed someone who would not have died from the condition you were trying to treat. You have been warned by several other people than myself of some very real dangers of these drugs, but continue to insist they are safe. We're not making this stuff up.


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## Biggie (Dec 11, 2004)

emtnate said:


> your "seatbag full of prescription drugs" might do more harm than good.
> .


I never said my seatbag full of drugs - I said I don't carry any.



emtnate said:


> You don't know what you're doing, you don't know how the drugs work on the body, and you don't know the risks. You assume drug A will treat condition B because that is what it is commonly prescribed for. You are ignoring variables and advice from professionals.


You are ignoring variables! Your logic based purely on EMT programming is refusing to understand that crap happens. What will happen if you are in an emergency and no doctor is coming? You have to be able to act outside of your education.

For me to make any hazardous decision would require a substantially more hazardous situation.



emtnate said:


> You have not answered how you would react if your good intentions killed someone who would not have died from the condition you were trying to treat. You have been warned by several other people than myself of some very real dangers of these drugs, but continue to insist they are safe. We're not making this stuff up.


I have the greatest duty of responsibility in the world, that even greater a doctor's duty to patient. I'm a parent. Recently, my 9 year old was vomiting up way more blood than a 9 year should have in his stomach. I didn't look for old prescription drugs. I immediately called 9-1-1. Turn out that he had two bowls of frozen berries before bed.:madman: :madman:

You and the other Nate are grandstanding like SmilinSteve and I already have a private practice opened. We are just preparing for a day when we may have to make decisions outside of our normal day. The situation in Southwest Asia comes to mind.

To the two Nates, enjoy the comfort of your American medical care system. Although not free, great medical care is available. Natehawk, you are living proof! Someday, all of us may find ourselves without the luxury of physicians or surgeons. At that time, maybe tough decisions will have to be made.


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## emtnate (Feb 9, 2008)

You obviously have no idea what I do as a paramedic. If you understood my job, you would know that we work in the field, independently, and without the ability of specialized exam equipment. You would know I work in a constantly changing environment treating people with no knowledge of their history and sometimes with no knowledge of what happened prior to being called. Depending on the situation (read dire emergency, no chance to make it to the hospital) we can do whatever is in the best interest of the patient. One recent example from my medical director was a paramedic that amputated a leg with a hacksaw and opiates and benzos because the guy was trapped on a tower 100 feet in the air. The crush injury to his leg would have released a build up of waste from the dying cells that would kill him when the pressure was released.



I'm not purely programmed, I am highly educated and highly skilled to do what I do. I have to make split second, life and death decisions constantly. Rarely things happen "by the book", the variables are what I deal with. If everything went by the book then I would simply dispense a drug for a condition. Instead I have to do my best to look at the big picture with limited time and decide what I need to do. 

I fully understand that **** happens, I see it every day. 

You are still skirting my questions.

So you see someone on the top of a mountain who is complaining of chest pain. Someone in your group carries NTG, so you give it to the person with the pain as you said you would in your post. 

This person is dehydrated from the climb, it is hot, they feel weak and sweaty. You give them the nitro as offered by your buddy. All the sudden they turn white as sheet and collapse on the ground. What are you going to do? 

5 mins later you have a dead person laying on the trail. An autopsy proves they were not having a major heart attack, but have recently had a respiratory infection resulting in pleurisy. The nitro you gave them caused all of the blood vessels to dilate, combined with the fluid loss from dehydration, there is not enough blood flow to sustain perfusion to the brain, so they died. 

Had you done nothing, they would have survived the trip down the mountain with no complications. You, and you alone are responsible for their death.

This is not an unusual scenario, and is an extremely common cause of chest pain. But you wouldn't know that because you are not trained.

Would you be able to sleep at night knowing you just killed someone? You left kids without a parent and a spouse without their best friend. But you were only trying to help...


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## emtnate (Feb 9, 2008)

And an aside about the american health system - big shocker here, my employer does not provide me with health insurance. I can't afford my own services. How much do you think I get paid? Can you believe that in a 24 hour shift, I only get paid for 16 of it. I also volunteer my services for a rural BLS ambulance. That's how much I believe in what I do, I'm willing to do it for free because I think helping people in need is the right thing to do. Would you do your job for free?


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## ssinglesspeed (Apr 17, 2006)

I'm asthmatic. I've pretty much gotten conditioned to some discomfort, at one level or another. Especially as a SS'r. A little over a year ago, while riding with my 13 yo son, I felt an intense burning sensation in my center chest. This went on for a week or so, on 3 or 4 rides. A lot like my bronchials complaining. Anyway, I rode thru it, with a lot of discomfort. A couple of days later, covering a co-workers shift about 4:00 am, my heart decided it had had enough, and I sat down, went home, and after a few hours, off to the ER. Then off to the cardiac ward. My right coronary artery was 95% blocked, no heart attack, but so close. A stent in place now, and riding , and racing, harder than ever. The moral of the story: If you are having chest pain, no matter if you think you know the reason, Go To The Hospital. Don't wait.The life you save may be your own. Happy Trails!


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## Harold (Dec 23, 2003)

Biggie said:


> You and the other Nate are grandstanding like SmilinSteve and I already have a private practice opened. We are just preparing for a day when we may have to make decisions outside of our normal day. The situation in Southwest Asia comes to mind.
> 
> To the two Nates, enjoy the comfort of your American medical care system. Although not free, great medical care is available. Natehawk, you are living proof! Someday, all of us may find ourselves without the luxury of physicians or surgeons. At that time, maybe tough decisions will have to be made.


You two are behaving as though you could open a private practice! You act like you know far, far more than you do. There are times when acting outside your education is the irresponsible thing to do. This is one of them. If your suspension blows 100 miles from nowhere, that's a good time to act outside your education and figure something out. Figuring something out when it pertains to the human body gets people killed.

In the early days of medicine, a lot of that happened. Grave robbing, human experimentation, etc, etc. We've moved past that garbage now. But medicine is a very dangerous field to be "figuring it out" with. If I break the fork on my bike, I can buy a new one. Won't be cheap, but possible. If I break someone's heart or lungs, I can't just go buy a new one.

Some of the requested legal information was provided. That shows that it really is illegal to be handing out prescription meds. My wife told me today that she doesn't even think that morphine can be given to patients to take home because it's so addictive. So even if you wanted to carry it, you'd probably be guilty of a few felonies before you even had the chance to give it out.

Several professionals have pointed out that what you suggest is wrong. I guess we should all ignore the ER doc and the EMT's and the other doctors and medical professionals, right? After all, they only give the advice they do because they want to pad their own pocketbooks, right?

Thanks, I am quite happy with the quality of care I have received. That's why I would prefer such things to remain in the hands of trained and educated professionals rather than Average Joe on the trails who thinks he's helping by handing me some nitro he carries for his own heart issues.

You want to be able to provide more advanced care in an emergency? Do it right. Get yourself the education and the training to do it right. Otherwise, you're selling people short.


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## Biggie (Dec 11, 2004)

emtnate said:


> And an aside about the american health system - big shocker here, my employer does not provide me with health insurance. I can't afford my own services. How much do you think I get paid? Can you believe that in a 24 hour shift, I only get paid for 16 of it. I also volunteer my services for a rural BLS ambulance. That's how much I believe in what I do, I'm willing to do it for free because I think helping people in need is the right thing to do. Would you do your job for free?


Nate, I think EMT's in Canada are similar. I do not know for sure but I am led to believe they get paid less than our firemen. They are probably busier than firemen(answering more calls), often work out of the same stations, but get remunerated less than their peers. Its an odd system. I do believe health care is something Canadians do better than Americans and that Obama's health care sytem really seems like a step in the Canadian direction. I hope, and believe that, EMT's and emergency response people should all be remunerated equally.

However, there are parts of our "free" system that don't work. Many of our doctors head your way for higher(private) pay, neglecting home for a few extra dollars. Now that our dollar is close to par this is changing a bit. Also, Canadian hospitals and medical schools are now competing with American job offers by offering signing bonuses and paying off student debt to lure top professionals/residents.

My community is now recruiting volunteer firemen. When I told my wife it was something I wanted to do I was met with a lot of resistance. I'm an out of work autoworker and my wife was not happy with me looking for "volunteer" work. That is life.

Again, this thread has been heated but I think its a great thread. A lot of good info. Despite the fact I look like Dr. Doug Ross and have followed his career closely, I have no plans of practicing medicine.

You and the other Nate, take care.

Other Nate, I recently have a great "cancer story". Well, no cancer stories are great, but of my Aunt really giving it a great fight. If I get some time I'll post it in your thread soon.

Ed


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## emtnate (Feb 9, 2008)

I can understand the resistance, several years ago I took one of our volunteers to the burn center. Even volunteering, it's a huge commitment and nothing to take lightly. The educational requirements are the same if you get paid or not.

I do fire and ems at one job and only ems at the other. 80% of our calls our ambulance requests. Us medics get less respect than our firefighter counterparts, it doesn't make sense to me. As for healthcare, I've seen both sides, a good friend of my wife is Canadian and did her residency at a hospital in our city. She gave me good insight, both positive and negative. I think the biggest difference (other than the payee part of it) is cultural and that is something my President wont' be able to change.


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## slocaus (Jul 21, 2005)

Biggie said:


> I think when you are in a remote medical emergency closing your options is just wrong. If you are in a remote medical emergency and somebody has a seat bag filled with prescription drugs you cannot rule out administering them due to the absence of a physician. That's ridiculous.
> 
> Closing your mind to choices and alternatives is flat out wrong!


I agree, administer everything. Kill em quick, so you can get on with your ride and make the great escape from the legal consequences. The family will give you a few million for the family fortune for putting the old goat out of his misery. Get the girl and have a wonderful Hollywood ending. You will be the hero, at least in your fantasy world....


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## sxotty (Nov 4, 2005)

emtnate said:


> And an aside about the american health system - big shocker here, my employer does not provide me with health insurance. I can't afford my own services. How much do you think I get paid? Can you believe that in a 24 hour shift, I only get paid for 16 of it. I also volunteer my services for a rural BLS ambulance. That's how much I believe in what I do, I'm willing to do it for free because I think helping people in need is the right thing to do. Would you do your job for free?


Lots of people do their job for free more or less since they work far more than 40hrs/week.

BTW why is it ambulance have unusually high accident rates and a large number of the fatalities are the drivers who wont wear seatbelts? For a supposedly trained and intelligent group I never understood that.


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## sean salach (Sep 15, 2007)

you really can't figure out on your own why ambulances would have a higher than usual accident rate?!?!? i'm talking the real reason, not whatever you're suggesting with your pathetic attempt at degrading EMT's.


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## slocaus (Jul 21, 2005)

sxotty said:


> ambulance have unusually high accident rates


Because they are not mountain bikes and should not be in the dirt trying to get to mountain bikers in critical condition after someone gave them nitroglycerin for heart burn..... 

This is more appropriate for dirt and just bringing out a body.........









Whoa, quantum shift, from riders who have survived heart problems while biking (me included) to prescribing drugs to others without a license to ambulance accident rates - *that* is a faster direction change at high speed than a UFO is capable of performing!

And this is my contribution to the absurdity of this thread......


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## JPark (Aug 12, 2009)

sean salach said:


> you really can't figure out on your own why ambulances would have a higher than usual accident rate?!?!? i'm talking the real reason, not whatever you're suggesting with your pathetic attempt at degrading EMT's.


Maybe I misunderstood the post, but I thought he was refering to fatalities due to not using seat belts from a group who should know better.


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## Sometimes (Jun 21, 2009)

HTR4EVR said:


> Two riders with heart attacks in less than a month is concerning me... I'm wondering how many mtb'ers die of H A during the year...


I can't answer that but we had someone die of a heart attack/stroke on the race course when I was racing ATBs. Ready access to EMTs did him no good. It was kinda of surreal to continue racing by him lying just off the course with the ambulance nearby.

I definitely second getting a more complete physical, angiogram or whatever annually. Money well spent.


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## Biggie (Dec 11, 2004)

slocaus said:


> And this is my contribution to the absurdity of this thread......


Slocaus, the "absurdity" of this thread has kept in pinned to the top for nearly two days. I'm sure most readers can seperate the wheat from the chaff included here, although the thread has changed topics several times.

Included with the "absurdity" is a good description of the symptoms of heart attack and a very effective way of treating a person at risk - rest, hydration and 320mg of aspirin.

I find it strange that a heart attack victim would want it buried in the archives as it really seems educational to me.


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## emtnate (Feb 9, 2008)

Sxotty, are you talking about ambulance accidents, or fatalities caused by drivers not wearing their seatbelts getting killed?

Accidents are high, we're on the road constantly in large, fast, vehicles. We do have special driving training, but we also have to deal with people who don't react to us like they should. The concept of pulling over to the right and stopping seems foreign to the majority of drivers on the road, this causes problems for us.

I was involved in an accident while I was in training - lights in sirens to the hospital, a car passed us on the right, and pulled a hard left right in front of the rig. The driver swerved to avoid a t-bone collision. I was standing up in the back setting up IV meds, was tossed around and broke my wrist trying to catch myself. 

Accidents involving police cars are higher than ambulances.

If you're talking about ambulance drivers getting killed because they aren't wearing seatbelts, it happens. People break the rules in every job, even people that know better. I wear a seatbelt 100% of the time while in the front seats of our truck. I do this even though we have tattler boxes that let the boss know everything we do. Some don't. 

You can't single us out because some people choose not to follow the rules. I think you would find similar things in every industry. A lot of doctors smoke while telling their patients to quit.


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## sxotty (Nov 4, 2005)

It is interesting that you think police accidents are higher. I just did a report on this last year and GEMS had higher accident rates than fire (in terms of fatalities vs. VMT).

I am speaking of fatalities to ambulance drivers who don't wear seatbelts. That was the statistic that surprised me. I figured the guy in the back would be the one getting hurt since ambulances in the US have no crash testing to speak of (they lay a weight on the side to ensure the compartment doesn't crush, but there is no dynamic testing whatsoever). Ambulances in other developed countries are far safer and they do dynamic crash testing. I just wondered if there was a good reason to not wear seatbelts, or if it was just people being dumb. I could understand for example why a UPS guy might not buckle up to drive 5 feet and get out (that is hyperbole obviously).



emtnate said:


> Sxotty, are you talking about ambulance accidents, or fatalities caused by drivers not wearing their seatbelts getting killed?
> 
> Accidents are high, we're on the road constantly in large, fast, vehicles. We do have special driving training, but we also have to deal with people who don't react to us like they should. The concept of pulling over to the right and stopping seems foreign to the majority of drivers on the road, this causes problems for us.
> 
> ...


To sean: Chill dude, although if you want to call people on the internets names and insult them knock yourself out.

edit: Here is a good paper on the subject btw title: Relative risk of injury and death in ambulances and other emergency vehicles
http://www.ncbi.nlm.nih.gov/pubmed/12971929


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## emtnate (Feb 9, 2008)

There's no reason not to buckle up in the front. There's still no good way to wear a seatbelt while working in the back. Many companies make it a policy, but it makes it very difficult to do your job. 

There's a new restraint system that involves a 5 point harness and a retractable tether to your seat. I'm not sure how this is a good idea, but it is an idea. It seems like if you were in an accident, you wouldn't want to be immediately drawn back to your seat, especially if you were drawn across the patient. 

AMR has several prototypes of safer ambulance designs, it will be interesting to see where the industry goes. 

I haven't looked much into fatal ambulance accidents compared to fire and police. I know in my city, squad cars have the highest accident rate compared to hours on the road than ambulances and fire trucks. This is counting all accidents, PD and PI.


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## sxotty (Nov 4, 2005)

I was actually specifically looking at info about helicopter EMS, but comparing it to Ground EMS fatalities so I don't remember all the stats perfectly. I seem to remember that the seat belts in the back would not do much good anyway (if you could actually use them) b/c many times they aligned sideways to the vehicle so if you got in an accident it would break you in half practically. I mean it could be better than being tossed around into all the things in the compartment, but it seemed pretty bad either way. I did see a picture of a 5 point restrain system, but the user has to wear a full body harness and clip in repeatedly, that surely would be a little beyond my expectation for anyone to do. The inside of the back compartment could be made less deadly for someone getting knocked around in there though even if they were unrestrained. I can certainly see why you would want freedom of movement if you are doing something in the back instead of just ferrying someone who is already stabilized.

The only reason I brought this up, was like I said the driver thing really surprised me simply b/c I thought that EMS people would see the effects of not wearing seatbelts and thus be more likely not less to wear them while driving. I figured you might know if there was a reason for the low rates of use (in comparison to passenger cars). I wasn't even sure for example if the driver gets out when you get to the scene and helps or his job is only driving and thus he doesn't get involved (i.e. stays in the cab the whole time).


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## emtnate (Feb 9, 2008)

we all take turns driving, i generally have an EMT driver, we alternate every other patient unless someone needs my advanced skills, if i am working with another paramedic, we alternate every call.

not wearing a seatbelt in the front is just dumb. i dont know why people still do it. on my dept it is a policy violation, and can get you fired or suspended. 

air and ground ambulances are different animals and cannot be compared. the faa has been changing regulations about them due to fatalities.


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## sxotty (Nov 4, 2005)

The media representation of HEMS fatalities is somewhat exaggerated. I found data for helicopter fatalities and they were the same as for HEMS. In otherwords helicopters are dangerous in general whether flying news persons, sick people, or any other civilian use. The EMS crews in the choppers do as good of a job as other people in choppers. There was just a spate of accidents the triggered a media response. Those new FAA regs I understand will affect all helicopters not just HEMS though. (there was one abnormally high fatality year though).


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## ProfGumby (Feb 27, 2008)

axcxnj said:


> whenever i go into the wilderness, or somewhere that i konw there will be no cell phone reception, i bring this:
> 
> 
> 
> ...


This is the post of the year! Not only good idea for this thread and heart scenarios, but all manner of things that can go bonk outdoors! Thank you!
:thumbsup:


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