scratrat

We went on a chest pain so we needed to do a 12 lead. The women was old, in her sixties, but had a great sense of humor. She was screwing with me from the get go. I explained the 12 lead and told her where I'd be putting them and that I would need to move her breast (which were rather large and saggy). When I lifted her breast she looked right at me and said "Oh, you frisky little boy!". My partner about lost his damn mind! I couldn't think of what to say, so I purred at her. She laughed her ass off and my partner could no longer keep a straight face.

Try this rotation : 4 on 4 off 6 on 4 off 4 on 6 off THAT... sucks.. I miss night shift, but it is still slightly better than days. When I was on nights, I actually feel I got more time with my kids because I could wake up and have dinner or whatever then go to work. But my days off sucked. I had to get out of that mentality each time I had off, so my first day was spent being tired and miserable, then the remainder of my days off I could do things. Now I'm on days and aside from not having to get out of the swing of night shift, I'd rather be back on nights. The only shift available was 8a-8p so now when I get home, everyone is getting ready for bed so I see my kids less now then on nights.

Yes, the soft bags fold over on themselves. They make the same size bag only a little narrower, it a harder plastic bag. It takes more to fold it. I did read that about DEHP. That's where my question originated. I wasn't concerned with the adult population but it did have warnings about sending pediatrics into respiratory arrest. Although fixable, it's something I like to avoid.

The bad thing is if you don't have a signal, you're screwed. And hopefully not in trouble. The good thing is if it works, you can hear everyone so you're not stepping on anyone. I also found out (I don't know if this is just our particular system or what) that only a certain number of frequencies can be used at any given time. Like, even though fire, police, and EMS are on different channels, only 8 combined channels can be used at once. My radio will not work at all if I'm number 9. That means if 4 police officers are talking on different channels, and 4 firefighters are talking, I can't. I don't understand that since it's different channels. We used it in NJ and it was pretty good because it was less urban where I worked. You could talk to one end of the county to the other, unlike VHF.

That's all the same here. But my question is, do you mix it in a soft bag or a hard plastic bag? We carried both. One bag was stiffer than the other.

Question..... When we first starting using amiodarone in NJ, we were told to mix it in a hard bag of D5W. We were told that you were not allowed to use a soft bag because it caused the amiodarone to leach the PVC out of the bag and into that patients circulation. Here if FL, we used those same hard bags. For whatever reason the stock person got the soft bags, and was told thats all he could get because the others were on back order. I tried to find these answers on the internet but to no avail. The only thing I found states that this problem only occurs at doses higher than recommended or longer than recommended. I also found that this seems to be more of a problem with pediatrics. The only other thing of significance was that amiodarone loses the drug properties within 12 hours or so when in plastic, but not in glass. Anyway, my question is does anyone know if it's been proven safe to use soft bags of D5 or do you use hard bags/glass to administer a drip of amiodarone?

That's just funny...

Yes, I am sure. I came from snow land. Yellow is the first color seen in fog, rain, snow, etc. Blue is second. Line up three lights spaced about 2-3 feet apart and close your eyes. Open then and see which one gets focused attention first...

Actually, the first color the human eye can detect in all weather conditions, would be yellow/amber, hence the law that all ambulances have a rear amber light. Then blue, then red. Clear is just obnoxious. We have all LED lights and there are three red and two white on the front of the box. They are pretty obnoxious, but not as bad as standard incadescants.

That is so AWESOME! I love it!

Oh, I see mwhy I said that. A couple of people asked about the ECG and you must not have seen that so you didn't reply. I had thought you did. That's why I was surprised at the ECG. Two people asked about it but you must've missed that. Oh well. Thanks for the good scenario!!

HOLY CRAP!!! I thought you said earlier that the 12 lead was normal??? That would an inferior MI c/ lateral extension. Or, commonly called, you gonna die!

adding more tequilla

In New Jersey, you could not split. They eventually allowed it under extreme circumstances. IE, accident scene with 2 ALS patients and the second medic unit is 20 minutes away, while the helicopter is 10 minutes away. You cannot operate an ALS unit without two certified paramedics on board. If you did split, I guess technically, you were operating as two units, however, you could stop at another call and treat someone, or just take it upon yourself to start treating a second patient. Especially while enroute to the hospital. You requested a second unit. On the other note, ALS could in fact hand off a patient to BLS. We were allowed to evaluate the patient fully. We called medical control and informed them that we felt our services were not required. We gave them a full history and report. Either they agreed and BLS transported and we went available, or they disagreed and told us to treat with the IV of life. They called that Triaged to BLS or SNR. (Services not rendered.) Example would be when the local dispatcher calls us for a stroke and it turns out to be a 21 year old with a headache. We could evaluate and traige back to BLS provided everything came back okay during our assessment. If you were treating an ALS patient, you could only transfer to another medic unit or a registered nurse at the ED.

Now see, ERdoc, I was going with sepsis because of the recent pneumonia and slightly low temp. But you keep throwing that damn plavix out there, obviously as a hint. Now I have to go do some research....you bastard you...

That's how every place I've ever worked at operated. The only time we actually stopped was when my idiot partner nailed someone at an intersection. Any other time, you call it in and keep driving. I feel you are obligated to. But I guess thats just me. I never said ALS couldn't hand off a BLS pt. That was my point. Transfer to EQUAL or greater medical authority. You could certainly do that. In New Jersey, we weren't allowed to split, like someone else mentioned, I think from Texas. If we had two ALS pt's, you could begin treatment but you had to call a second ALS unit and transfer to them when they got on scene.

I was never taught that. We are rerouted all the time for other more priority calls. The dispatch someone else to the less severe call. But I still firmly believe it's abandonment if you do not continue to transport your patient to the hospital or at least transfer them to someone else of the same or higher certification.

I respectfully disagree. You already had a duty to respond to the first patient. Your duty to this first patient does not end until you transfer them to the hospital or to another ambulance of equal or greater level of care. You cannot abandon your initial patient. Once you initiate that care, you are bound to see it though. Unless you haven't made patient contact, you cannot leave. Some of you may say it's abandonment not to stop, but I don't see it that way, and I don't think the courts would either. If you already have a paitent, your only duty to act would involve calling it in to dispatch and advising them of the situation. The only time I could EVER see a deviation from this, would be an MCI. I am also curious to see if the family sues and what the outcome will be. If that were my kid, I certainly would have someone's arse on a platter. They directly put my kid into a line a gunfire. That is unacceptable.

In New Jersey : A paramedic may pronounce via telemetry to medical control. Pt must present with : Asystole in at least 3 leads. Although it also specifies ANY pulseless rhythm, most medical directors specify asystole. No spontaneous respirations. Any of the following : Prolonged down time (not usually specified but 20-30 minutes is fair game) Lividity Rigor Mortis Obvious decapitation or mortal wound Pupils fixed and dilated. It isn't specified but it also helped if the pt was under the direct care of a physician and had some sort of medical condition. You could also do a DOA - not pronounced. However, with the lazy arse medical examiners office, you would be called out later for the sole purposes of a pronouncement. These were cases where you walk in and find a head missing from a shotgun blast, or someone not seen you two weeks, and obviously died two weeks ago. Again, the medical examiners office would call you back anyway so it was easier to pronouce. I once had to pronounce someone who was missing half their head from a self inflicting shotgun to the head while the ME investigator was doing a liver temp. How screwed up is that? But that's for another forum I guess...... On the the original question It does sound like a lot of information is missing. Might I ask where you are from, roughly speaking. Depending on the MICU service, I'll reserve comment. If lividity was present, or rigor mortis, or pupils were fixed dilated and glazed over, I would have pronounced. But thats just me. I know some medics who never pronounced and worked everything regardless. I also knew some medics who pronounced no matter what. If the squad shocked three times as they were walking in and the pt was now asystolic, he would pronounce. Nothing in writing says you actually HAVE to stop CPR efforts. At least not in New Jersey, save for a DNR of course.

I smell poo poo......

Allow me to elaborate on whits post if I may : Abandonment and Negligence Terminating care of a patient without making sure the patient is in the hands of a provider at the same or higher level of training is considered abandonment. Negligence is deviation from the accepted standard of care that results in injury to a patient. There are four components to a successful negligence action or lawsuit: *The EMT-B had a duty to act. This means that the E M T-B was in a situation through employment, position in a volunteer squad, or other position in which the EMT-B is re q u i red to provide care and . . . HERE : The EMT/medic had a duty to respond to the seizure pt. They responded and had that pt on board the ambulance. This part they did correctly. * The EMT-B breached, or failed to perform, that duty and . . . HERE : The EMT now breached, or failed to perform. He was expected to transport someone's sick family member to the hospital. He was no longer doing so. * Injuries, which may be physical or psychological, or damages were inflicted and . . . HERE : Being shot at? I'm going to go out on a limb, and say this definately fits this criteria. * The actions or lack of action caused the injury or damage. HERE : Actions caused the injury. Um, yes. The driver stopped. He is directly responsible for the action that caused them to be shot at. Now on to the abandonment aspect of the issue. Abandonment of a patient, in medicine, is where a health care professional (usually a physician, nurse, dentist, or paramedic) has already begun emergency treatment of a patient and then suddenly walks away while the patient is still in need, without securing the services of an adequate substitute, or giving the patient adequate opportunity to find one. hmmmm...sounds like abandonment to me. You did not secure further treatment for this individual by taking them to a hospital. Services were no longer being rendered because you were no longer transporting that pt to definitive care. Sounds like a win-win situation in a court of law. On to your next comment. In California, violating protocols, would be against state law. Your protocols prohibit you from continuing patient care? Protocols are guidelines and nothing more. I realize that everyone is set against "what-ifs" but I have to do it in order to make my point. Same case, only this time you stop at the scene. The driver gets out and shoots your pediatric patient then takes his own life. You stopped because your protocols say you must stop at an accident scene, even if already treating a patient. Now the family sues you for wrongful death, and possibly negligent homicide (but I'm not sure about that one). You will definately be sued for the first one. Do you think a court is going to say, "Well, Mrs. Jones, we're sorry that they placed your child in harms way and as a DIRECT result, you're child was shot. However, their protocols say they are to stop and render aid." Let that one sink in for a minute. Then tell me, honestly, protocols or not, do you think for a minute the court will side with you or with the mother whose young child was shot? Sorry for the horrible scene description that I'd never wish on anyone, but this could have been a real possibility. As Dust says....if you protocols say that you are to stop no matter what, then your system sucks arse. I think I spelled that one right for you Dust.

Oh, I WANT one!! Here's why. I only want it if: 1./ It can be filled with Haldol and Benadryl 2./ It can be fired from 25 feet. Now that, in the words of Bill Engvall, would be AWESOME!

You never stop. That's abandonment. I don't what anyone says. That first pt was sick and requested transport to the hospital. They expect to be transported. If the ambulance was involved, then that'd be different. But in this case, they should have radioed it in and kept driving. The only time I've ever stopped, was on the way to the call. Never after a pt was on board.

My take: Do you want to go to the hospital? Yes? Good. Get in. Done.

I had it all. Lights, radios, lights..... I became an EMT when I was 17 so I went ape. Everyone in high school thought my EMT book was neat with all the pictures in it, so I fed off that. A couple years later, I went to medic school. I think the big difference for me, was this was more professional of a career than being an EMT in that state. There is no such thing as a volunteer paramedic where I went to school. Plus all the true whackers would piss me off to no end!! I hated it when they'd all show up on my duty night for the MVC. No one could help with the pt, because they were too busy listening to themselves on the radio. Then, those same ones would be no where to be found when the little old lady fell. And a few hours later, they'd show up at the next MVC. AAHHHHHHHHHHHHHH!!!!! That was my last day in a volunteer rescue squad.