flight-lp

One thing I can't stand is a student who fails to appropriately prepare for a practical skill and then places all blame with the threat of regulatory action on the instructor. Please tell us EXACTLY the nature of this "highly technical" skill that you feel was not presented to you. While you are at, please validate as to what part the strike played. I feel it to be completely irrelevant. Maybe then we can adequately have enough information to answer you appropriately.

You can also use non-selective beta blockers to decrease the overall cardiac output and splanchnic blood flow. We use IV Inderal in severe cases, along with a nitrate to keep the pressures down. We get Sandostatin from the sending facilities and will occasionally keep a spare dose or two on our CCT units. We also carry the SB tubes on these units for uncontrolled hemorrhages. These folks are definately a handful, gettting them tubed is a priority, trach / cric 'em if you cant pass the ETT or ventilate them due to blood obstructing the airway. Vasopressin is an alternative, however bear in mind that while the V1 receptor will increase venous BP through increased SVR, this can cause potential for cardiac ischemia. Risk vs. benefit has to be heavily weighed.

Any palpable abdominal masses? Varying BP between right and left sides? Back or chest pain?

Anyone else heading to San Antonio next month for CCTMC??

Yea, I'm calling BS on this one too............. The 82nd Airborne Division had several Batallions on site within 72 hours of the storm. As far as the jeans and t-shirt issue, those were not civilian air medical nurses. All civilian flight crews in the region were in their required duty attire. Perhaps you were seeing hospital based nurses flying on military aircraft? As previously stated, be thankful you have an employer that provides these items to you as most don't!

x2. I'm also curious how and more importantly who would be responsible for enforcement.

The three crew members on board were fatally injured. My prayers go out to the families of my co-workers, godspeed and rest peacefully my friends. You will be missed..............

Fortunately, our local PD agencies do psych transports in the case where a non-medical psych person has issues with safety. An uninjured person with no complaints who is competent is not a patient, regardless of the opinions of others. If someone is impeding on my personal safety and for some reason I was not able to manage that person, then they will not be in or remain if already in my ambulance. PERIOD. But again, chemical restraint and RSI are wonderful options to have........................ Tyson - Your local PD may refuse, but see what happens when you or one of your co-workers gets their ass whooped. You need to address this issue man.

While I firmly agree that this situation could have and definately should have been handled more diplomatically, I have a couple of questions. Were these two employees on an ambulance when they took this break? Or were they non-field employees working upstairs? They definately should have immediately called for medical resources and made contact with the patient, but before we are judge and jury, the question lies in whether they had the immediate capabilities to address the emergency. Even if they had assessed and interacted with the patient, would the outcome have changed? There is also the culpability of personal responsibility. Did the deceased have a history of asthma? If so, why did she not have her rescue inhaler with her? Was she compliant with her other medications? This absolutely was an atrocity by the hands of two lazy ass self centered EMT's. From an administrative standpoint, they should be held liable. I do however question the criminal liability.

Actually, no that is incorrect. As Dwayne pointed out, once they move onto becoming a threat to your personal safety, the bets are off. A combative individual can "decline" an IV all they want, if they are a danger to themselves and / or others, they are getting an IV providing it can be accomplished safely and efficiently. In many cases, asinine behavior can be predicted in the attention seeking population. Because of this and the very nature of psychological disease, I will usually establish an IV while on scene with adequate assistance available should the individual have a differing belief of the appropriate course of action. One that really sticks in my mind was an addict high on PCP. Dude was carrying 4 cops on his back. 10mg of Versed IM didn't phase him.....................But the 200mg of Anectine IM eventually did. Sometimes you just have to improvise to insure you go home safely at the end of your shift. Again, the OP needs either appropriate sedation options or a better transport policy.

Combative person + no chemical restraint protocol = person going with PD. It's 2010, time for your local EMS to catch up on the times and offer interventions appropriate to the patient population. Personally, I would have offered this kind individual a nice cocktail of Ativan or Haldol and Benadryl. Should he politely decline and continue his demonstration of low level Darwinism, he gets a consolation gift consisting of Anectine and an endotracheal tube. I am a firm believer in prophylactic RSI.

I get all of my flight, ground CCT, and FD 911 calls sent directly to my Blackberry. I like it as it is convenient and I don't have to lug around additional pagers or phones to lose.