EMT001

Yea, I'm not kidding. Do it. It will work, and they wont be mad for long once they realize you saved thier life.

HAHA - actually, I didn't read the entire thread and had no idea that someone else posted that. Yes, I know it works. But, I said don't do it because most people do not have protocols to do it.

Stick it up their butt, squeeze.

Just kidding, don't actually do that.

I would not lie about our protocols... I had one medic, who I did not get along with and he got orders to pronounce in the back of the rig, once that was done he made our crew pull over and take our rig out of service. A police officer had to take us back to HQ and a police officer had to wait on scene by the rig untill a coroner came. PD and BLS made a report and ive not seen him again on a call.

Not saying that you were were not telling the truth. I know NJ, trust me. Maybe we are talking about the same incident.

I would have the EMT "prepare to begin cpr". As you got doctors orders to to stop resusitiation.

and i would document it as pulseless and apneic, BLS/ALS started CPR- family doctor advised ALS/BLS to stop CPR @ date and time.

The only problem with having him pronounced dead in the back of your rig is that its now a crime scene and you have to wait for the coroner to come.. Per NJ guidelines.

HAHA - I think a former NJ medic who now posts on this board can tell you a story about pronouncing in the back of an ambulance enroute to the hospital.

A DNR not signed by a Doctor is INVALID and hence, is not to be followed. Now, like you said, you called your doctor, explained your situation and was told to not attempt resuscitation. THAT IS valid. A verbal order from a doctor is as good as any written order. If I were the EMT in this situation, since they do not have ONLINE medical command, I would begin resuscitation efforts, and when the medics arrived, they would contact their medical command and get orders to cease efforts. So you did the right. I would have done it the same way.

You can get online medical control in NJ. Just call either ARMC ED and ask to speak to a doc. This isn't done frequently, but it is an option. Chances are, and especially working in the city, that on a call where med control was needed, a medic unit would be on location also. Obviously, they could call control direct.

In New Jersey, you can drop off any infant at a hospital, firehouse, police station, or ambulance building and be free from prosecution. You actually have to leave it with somebody, you cannot just drop it off outside. I believe we call them "Safe Haven" laws.

You can have O2 and you can carry glucose. That said, why would you want too? Don't stop off-duty, ever.

There is no duty to act for off-duty personnel in New Jersey.

What beach were you on?

Just curious, how did he say he broke his femur?

"Noelle if you don't shut up I swear to God I won't kill you". -- That is my favorite line from the movie.

If you haven't already, you should watch the movie 'Hospital'. It is from the 1960's or 70's and is absolutely hilarious.

There is one line, when a patient is explaining what he did when he escaped, where he says, "I hit the nurses call button and then went into the hallway." When they ask why he hit the call button, he replies "To ensure a half hour of uninterrupted privacy". -- HAHAHA

I hope the nurses at his hospital bludgeon him in his sleep. I have a patient that will call 911 for a ride to the ED because she is scared to be home alone when her husband is at work at night.

Just to clarify, I did ask about previous knee injury and precipitating factors that would account for the knee swelling. She had a previous injury to the knee and stated that it was a little more swollen then normal, but not too bad. There was a decrease in pn. and a significant improvement in sensation. Also, I was having the same thoughts as Rid about quad-muscle spasms and free bone ends moving around. Saw the doc this morning, classic midshaft femur fx. with no patellar involvement. Thanks for all the input.

Wanted to run this by everyone to see what you think.

Had a run tonight where an elderly lady tripped and fell. She said her leg fell backwards and she heard a "pop". No LOC, No head, neck, or back pn. Only c/o (L) leg pn. When asked where the pn. is, she points midshaft femur. Good pedal pulses, decreased sensation. Obvious deformity midshaft femur, however the area around the lateral portion of the knee was also slightly swollen. No pn. to the hip or knee are on palpation however. The pt. stated that the only thing bothering her was the leg, which hurt a lot. I know injury to or around the knee cap is a contraindication for the traction splint, however I do not think this pt. had a injury to her knee. So, I applied the traction splint. Notable decrease in pn. and even an increase in sensation. Get to the ED, doc chews me out because the splint is on when there is swelling to the knee. I tried to explain everything that I stated above, but he wouldn't hear it. Just want to see what everyone else thinks/would have done. We are waiting on the X-rays to see if the knee was involved as well. No one is questioning that there was a femur fx.

Buses are a good idea, they are on the way. What about the Red Cross? Would you like them on scene for food and warm drinks?

Someone mentioned setting up an efficient way to funnel transport units into and out of the scene without difficulty. The transportation officer (in the parking lot of the local mall) has a system that is working. He has a counterpart on the accident scene who radios him when treatment requests a rig. He sends the amount requested.

You are now working your way through the accident. The local PD is interviewing patients to see how the incident occured. You really haven't had time for this yourself, and assumed that the accident was simply a factor of the driver taking the turn too hard. One of the passengers mention that the driver had gone into the bathroom on the bus before they left, and, at the time of the accident, had passed out. An additional passenger also notes walking into the bathroom, smelling a strange odor, and he too feels like he is going to pass out. Slowly, but surely, numerous passengers begin showing symptoms of some kind of exposure to a foreign agent. You halt rescue operations in the bus and have all possibly infected personnel cordoned off, away from responders in the staging area who have not entered. The local Hazmat team, which already happens to be on scene, springs into action. No one called for them, but like all giant incidents the cavalry has come. They enter the bus and discover a suspicious package. What is you next move. You've already sent all of the P1 patients out and are in the process of removing the P2's.

(And no, this didn't actually happen. I had a boring shift the other day and tried to conjure up the worst incident I could imagine in my area.)

After your partner reports back, you realize the scope of the crap storm that you just walked into. You notify highway patrol that the ramp needs to be shut down. In addition to the EMS resources that you have responding, you request for the county task force to be activated. This will bring 35 BLS ambulances and 15 ALS ambulances. In addition, you ask your dispatch for medevac. Unfortunately, it is raining and all of the air services are grounded (welcome to my area). FD has arrived on scene and is determining extrication possibilities. The bus is unstable and will need to be cribbed before you can access the safety windows. The FD extrication team leader also suggests breaking the windshield so it will be easier to get people out of the bus, but it is your call. Local hospitals have been alerted. A level one trauma, 20 minutes away, can take 4 critical 15 minor; a level two trauma, 35 minutes away, can take 2 critical but 20 minor; a local ED, 10 minutes away, can handle no critical and 10 minor.

The FD has finally cribbed the vehicle and entry is now possible. Simultaneously to cribbing you had you originally dispatched ALS buses set up triage and treatment areas. You have a transportation area established in a local mall parking lot not far from the scene, and all resources are being asked to stage there. Highway patrol has closed the ramp. A safety officer has been established and you still retain overall incident command. (You happen to be supervisor for the tour, lucky you.) When your triage team makes entry to the vehicle they find the following: 10 P1 patients, 20 P2 patients, 15 P3 walking wounded, and the driver is DOA. How do you direct resources? You have more critical patients than the ED's say they can handle. Do you divert a significant number of minor patients from one facility so another can handle more critical? Oh, and by the way, it is 40 degrees outside, your patients are getting cold, fast.

That looks like a picture straight out of my basic textbook from years ago.

The bus is a tour bus, loaded to full capacity. You are currently unable to gain access due to the position of the bus. You have requested fire for a rescue assignment. Any other additional resources you might want? You partner has gone back to the bus and reports, from what he can see, that the driver is unconscious and atleast 15 people appear to be unconscious on the ground. Some of the passengers are moving around, but they are still too confused and scared to give you an accurate size-up.

We could always break out the Mark I kits. For dramatic purposes we could also inject them intracardiac (like they do in the movies).

"Inject the atropine into your heart". "You want me to stick this in my heart, are you freaking insane?"

You are dispatched to the entrance ramp for a major highway in your primary for a reported passenger bus rollover. Your dispatch has been getting numerous calls for this incident. They initially send out the three on-duty BLS trucks and two ALS trucks for the town. You are a fully equipped ALS unit that arrives first on scene. You observe that the bus has in fact rolled off an embankment while attempting to make the tight-turn onto the highway. The bus is at the bottom of a small hill, on its passenger-side. Damage to the bus appears minimal. You establish EMS command while you partner attempts to begin triage. Your partner comes back and says that he is unable to gain access to the bus, however he looked into the windshield and said it looks bad. What is your next move?

*** I intend this to be an evolving scenario. New information will be presented based on a general concensus of what the next move should be. ***

Good scenario! Kudos to those who picked up the possibility of OP poisioning; I thought that's where this was going when he mentioned severe lacrimation in his initial post. Now that we have identified the underlying cause of the symptoms, let's talk about tx. plans.

Extrication in my locale is handled by the fire department, however complete scene control is given to EMS incident command. A typical extrication scene will follow this sequence of events:

1) EMS determines the extent of patient injury to the best extent possible given the access limitations. This is to determine the neccesity of additional resources and if EMS is going to need to set-up in the car prior to the initiation of extrication. IF the pt.'s condition is so severe that immediate interventions are required, EMS personnel will enter the vehicle. If the only intervention required at the time is C-spine stabilization, a firefighter will enter, apply C-collar, and maintain stabilization. At all times during extrication, a safety officer is designated to watch the responder in the vehicle. If the responder signals for extrication to stop it is stopped immediately.

2) As this is occuring the FD extrication team-leader is determining the fastest and safest way to remove the patient from the vehicle (or, if your on a call similar to mine last night, remove the vehicle from the patient.) This is done in conjunction with EMS incident command. Once the extrication plan as been approved by EMS and FD command, it is initiated. All of this does not take as long as you might be imagining.

3) Extrication is complete.

Works great, we never have safety or staff issues.

All extrication assignments get an ALS crew, BLS crew, FD engine company, and FD rescue company.

EMT001 quote me if im wrong and I am sure your in the field already and know more than I but,

If your working 24's not all the time your on a call and your resting, but I am sure some nights are very hectic though. And say you work 3 '24' hour shifts a week? You still have 4 days off and thats twice as much as any other american?

Three twenty-four hour days lands you at 72 hours per week with 4 solid days of rest. That is the norm in a lot of systems and it works fine. However, you were talking about 80 to 90 hour weeks in a system where you probably won't be able to find anything less than a twenty-four hour shift. Try working four straight days of twenty-four hours shifts and then tell me that it isn't dangerous. I'm not trying to be an ass here, I've done it and can tell you from experience. EMS can be taxing, both physically and emotionally, on the body and, quite frankly, you need time to recuperate from that kind of abuse.

Repeating what someone posted earlier: Get as much experience as possible. Just because you are not comfortable with driving does not mean you cannot volunteer as a third rider to gain additional experience. Also, in the meantime, read as much as possible. Learn you A and P, pathophysiology, and GET YOU BASIC ASSESSMENT SKILLS down. The fact that there is not much more than you can do past a basic assessment at the BLS level does not underscore the importance of the assessment. In many circumstances, at least in my area, BLS is on scene long before an ALS truck arrives. A detailed and accurate BLS assessment can help the ALS providers detect any important changes in patient condition as time has continued. Also, take an ALS assistant course of some kind. There in no bigger help on scene than a BLS provider who is solid with their skills and who is familiar with ALS equipment.

I'm sorry, but working 80 to 90 hours a week is incredibly dangerous. You are putting yourself, your patient, and innocent bystanders at risk. Not to mention the fact that at 80 to 90 hours a week you can kiss any semblance of a social life away - and trust me, in this job you'll need one!

WOW!

Medic programs here range from 3 months to 1.5 yrs, and are supposidly among the toughest in the country!

But its all worth it.

How bout how much it costs? I want to be a medic liek nothing else, but the cash flow is limited

The cost is reasonable and I know a lot of guys who are in the medic program while working full-time as a basic.