courageheartx

I work in a Large Urban area, 1 million plus residents in the city with about 45 ambulance running at peak hours.

We operate under a flexible deployment strategy, where we have certain stations that must be manned at all times. (ie. a call goes out from a demand post, the nearest non-demand unit will be called in to cover the area). For me, working from a non-demand post it seems like we're forever driving back and forth between stations in between calls. It get particularly annoying during nights, when I just want to catch a few hours sleep.

So... My question to all you guys in the big citys, does this sound similar to where you work? Are there any deployment strategies out there that work better? Does anyone work in systems that practices curbside deployment? I'd really like to hear what works, or doesn't work for all y'all.

sounds like Calgary

This is pretty cut and dry. No, someone with a communicable disease or (even congenital or heriditary)*some conditions* should not be allowed in the industry. as mentioned before, first do no harm. also refer to hippocrates oath. anything in society can be looked at as discrimination,but when it boils down to it, a patient's safety and wealth shouldn't be jeopardized even more because of a providers current illness or disease. the public utilizes the EMS system when they are ill or an emergency has arisen. as providers as a whole we need to be in shape,healthy and able to preform our duties. if were not,what are we really doing for our patients?

good topic brett.

If you get to pick where you go for practicum then you're pretty lucky. From what i've been told you go whereever there's a spot

weather,at times can be a scene safety issue and in this case @-35 it would be. you need to get that pt out of there and loaded in whatever get to the nearest hospital. load,go,stabilize. my question is why isn't there a paramedic or nurse onsite? in this case,every ounce of chance is critical...

I wouldnt suggest that, It would be WW3 for some people.

i just had a huge glass of LMAONADE

sounds like a waste of money to me.

I don't know how this yahoo got through the cracks of the system,but it happend and it's not good.

Man pretended to be a nurse at Winnipeg hospital for two years

By THE CANADIAN PRESS

WINNIPEG — Health officials in Manitoba are investigating the case of a man who did not have the proper credentials but worked as a nurse worked for two years at a Winnipeg hospital.

Seven Oaks General Hospital discovered the situation in December during an annual review of nurses’ licences.

Cathy Rippin-Sisler, chief nursing officer for Seven Oaks, says the documents the man gave to the hospital were not original copies, and when human resources staff followed up with the nurses’ registering body, the man did not have a licence to work in Manitoba.

Sisler says he no longer works at the hospital.

The College of Registered Nurses of Manitoba is reviewing the incident.

A spokesman for Winnipeg police says they are waiting for the results of the health system review to see if criminal charges are warranted.

[email=http://calsun.canoe.ca/News/National/2008/01/23/4789455.html]http://calsun.canoe.ca/News/National/2008/01/23/4789455.html

your body will always be your best weapon.

Another USA cost saving measure. Tell people they are in healthcare and doing an important job but pay them crap.

that sounds about right.

CNA???

nurses aide????WTF? never heard....

Calgary last year,pushed approx 120,000 calls during 2007.

say hi to Dave for me plz.

student or bank loans.

EMTCITY will not pay your tuition.

kthnxbai.

TOO BAD ITS A FORD.

It's probably in the patients best interest you use your valuble BLS skills and work this patient.....or sh it just might hit the fan in the long run.....You will never be penilized for working a patient whom you are unsure of working.....

sure,now change the rules lol

So, courgeheart, What did you end up doing for this patient?

Well?what would you do for this pt?

hmmmmm... systematically,like it should be.

scene assesment

1)Personal protective equipment

2)MOI?significant?

3)fire,wire,glass,wire?hazards?

4)Will i require back up?additional resources?

4)how many pt's?

5)do you have all the right equipment stocked,sterile,ready to go,ready to use

6)weather conditions?

7)rapid pt access...

As you approach the pt.....

general impression..

a)Pt's level of distress?

b)skin?color?condition?

c)are their any visible angulated fx?

d)incontinence?

e)can you see blood pooling?is blood visible?cerbrospinal fluid?

f)emesis?

g)bystanders

So the MOI is obviously great,just from the description given. So I would introduce myself and my partner as EMR's from whatever EMS department and say If you could please not move while my partner stabilizes your neck....So at this point is the pt concious?What is the pt's level of conciousness?Alert?Only responds to verbal?Responds only to pain such as a sternum rub or trapezius squeeze? After assesing the need for stabilization of the neck,assessing the LOC,then I would asses the airway for patency?clear of fluids?clear of emesis?Assess breathing by listening to apices and bases. What is the pt's rate?rythm?quality?stridor?rales?wheezing?etc...next I would do a deadly bleed check to see if there are any severe bleeding as that is a part of the PRIMARY....and lastly expose anything that is bleeding or injured if you can. Load and go situation?Does the pt fit the load and go criteria?

update EMS dispatch...

next...

DCAP-BLS-TIC....

deformities,contusions,abrasions,penetrations,burns,lacerations,swelling. you are always using the method palpation(feel) for tenderness,instability and crepitus. Visually you are also looking for racoon eyes,battle's signs,csf fluid leakage. After assesing the head,you move to the neck...

DCAP-BLS-TIC....

You are feeling for any irregularities..etc..If trauma is ruled out you may release manual stabilization but in this case,this dude gets a fresh collar.Trachea midline?deviated?JVD?

chest

DCAP-BLS-TIC....

same as above...this is a rapid trauma assesment folks....can you feel and here subcutaneous emphysema?EXPOSE the chest. Scars?pacemakers?id necklace?

DCAP-BLS-TRD......

thats right. tenderness,ridgity. soft upon palpation?tender?bruising??

pelvis..

DCAP-BLS-TIC...

unstable?incontinence?priaprism?

Extremities: legs

DCAP BLS TIC...

neurological response in the lower ext?

DCAP BLS TIC..

neurological response in the upper ext?

RAPID EXTRICATION....

im not going through each individual step of extrication because i am tired as hell but assess the back when you are doing the move.....

I will finish this scenario when I get LOC,ABCDE,resps,pulse from you Anthony.....

sorry its short. im tired

Nothing. I just posed this question to see what other providers would do if a situation like this were to occur.

Have some one maintain manual traction on femur, have sam sling on board, roll patient onto board. Secure pelvis with sam sling and place hare traction. Total time: < 2min. Take pt woo hoo to hospital calling trauma alert. Drop off pt, do paperwork. Finish 12" Subway Meatball Sandwich. Clear from hospital.

LOL

You can provide manual stabilization on the femur fx while you look at the back and simultaneously place the backboard. Don't spend too much time immobilizing the leg. You need to scoop and scoot.

'zilla

thanks. so then you would load and go,stabilize while en route?

so you would just not asses the back for injury?