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It's 5am. You just got your truck all cleaned up from another run and are on your way back to the station for some much deserved sleep. Suddenly, the tones drop for your agency... "Respond to 1234 Main St for a 54 year old woman screaming in pain..." You arrive on scene and are greeted at the door of a rather large, clean house by the woman's husband. He tells you she has been sick for the past 2 days, and has urinated the bed twice which is unusual to say the least. He also says she has had a decreased LOC since last evening at about 6pm. He takes you upstairs to the bedroom, where the woman is lying on the bed....snoring. She appears to be sleeping. He says she awoke from her sleep about an hour ago, clutched her leg and screamed in pain. What do you want to do, what do you want to know? (This is a call I had recently, very interesting outcome, lets see if anyone gets it)

Unless it is a confirmed working structure fire or another incident requiring an ambulance, I believe it is unnecessary to take an ambulance out of service for every fire call. As has been said, by the logic that no matter what everyone can get hurt, we should have an ambulance standing by for all citizens 24/7. I've heard logic like this before when debating priority response with people. Some contend that we should respond priority to every call because "it could be bad and you can't trust dispatch information all the time..." Granted, sometimes dispatch information can't be trusted, but my safety and the safety of my crew comes first. If I get dispatched to a call for a child with a scraped knee, or granny stubbed her toe, better believe I'm not killing myself.

I'd never heard of this either, and probably would have reacted the same way you did. However after Googling (which I shouldn't do at work, someone may walk in) the topic of persistent ST elevation, I found the following article: http://www.incirculation.net/NewsItem/Pers...to-myocard.aspx Apparently some Italian fellas have found a correlation between persistent ST elevation post PCI and microvascular damage. This gentleman may have sustained some of that damage, and the end result is the persistent ST elevation. As for the elevated troponin...not sure on that one.

Lol nice site...I've found something else to occupy my time at work/school. Thanks!!

Had a situation like this. Mom had a seizure, so the kids called 911. We get there, mom is alert and oriented now, was going to BLS her, have LEO come and take care of the kids. Mom had another seizure right in front of me, turned into an alright we're going now type thing. So we load up the ambulance with mom and her 3 kids. My chief kinda disapproved of the situation, and I can see his point of view, taking kids in an ambulance is a liability. However, am I supposed to wait on scene for an LEO that may take their sweet time because it's a literal babysitting job? Or do I give my patient the expedient care she deserves?

A long night of drinking...I really don't remember what happened but I do remember my friend, who had been in the Navy at one point in his life, kept buying me drinks. I foolishly thought I could match him drink for drink, and after many many rounds of Bass Ale I decided to stumble home. I get to my front steps and can't find my keys...even though they were in my pocket...I call my fiancee (girlfriend at the time) and she comes over to my apartment to find me passed out on the front steps (in the middle of february) with puke all over the place. Her and my roommate drag me upstairs, and they start freaking out because I started dry heaving, no puking, and I was snoring. I was passed out was all, but they freaked anyway and called the ambulance. I knew everyone there of course, and they brought the stair chair up to take me downstairs...The funny part was that I put myself in the stair chair and had to show them how to work it. I get taken outside and immediately wake up when I hit the cold air, making my girlfriend and roommate extremely pissed off. Get to the ER, they hook me up to the auto bp cuff...and my bed gets pulled away slightly, causing the cuff to disconnect and an alarm to go off...I ask one of the nurses "Am I dead?" Anyway...discharged from the ER a few hours later...that night I go to my ALS class, with a HUGE hangover...and everyone that I went to the bar with was there, laughing away... Good times...

I tell my students that if they need to remember how fast to do compressions...either hum "Stayin Alive" by the BeeGees, or if you don't like that, "Another One Bites the Dust". Just...don't hum Another One Bites the Dust in front of the patient's family...may be ugly...

L&S are overused by many in my humble opinion. Either this patient was critical enough to get a full ride with L&S or she wasn't, you don't pick and choose when to use them and when not to during a ride just because you want to "Get a few cars out of the way..." It's plain ridiculous. It's a safety hazard, and it's irresponsible on the part of your driver. I'm trying to wean several members of my volly squad off them slowly. It seems to be a shock to their system that they can't have the flashy noisemakers going on every call. I did have an issue recently where our Asst. Chief ran priority to a 9 y.o. girl unable to urinate. That definitely belongs in the category "Things that make you go WTF?!"

I'd consider this a possible CVA or TIA until proven otherwise. No way to really r/o in the field, so she gets the full ALS tx and transport to the nearest hospital as many others have said. Good scenario.

Ditto on the crap medical necessity forms. I've seen my share of ER discharges to pt's residence that could have been carried out by the little yellow car with the sign on top. Instead the ER staff decides to call an ambulance, knowing they can get the patient out of their way that much faster. Most often we would get BS medical necessity forms, something along the lines of "Unable to ambulate". Then we watch as granny hops down from the stretcher and moseys out to the bus with her walker... Some people really know how to screw the system.

The company that I used to work for had 2 divisions, EMS and Ambulette. The EMS division was responsible for handling 911 calls within the system, and the ambulette division would take grandma to her appointments. The people hired in the ambulette division had a CDL and CPR...that was it. Some people that had their EMT cert chose to work in the ambulette division because they were guaranteed hours for the same pay as an EMT. (which says alot about the company) For a while, on the weekend if there was a discharge from the hospital the 911 crew got stuck handling the discharge. Which caused a lot of commotion among our ranks because there were times when we would be unloading grandma at her house and we'd get a call for an ALS intercept with the nearby volly squad. On one occasion we weren't out until about 10 minutes after dispatch. We only ran 1 truck because of the call volume and service area, so it was hectic at times. Eventually they began to have an on call ambulette operator on the weekend that we could call to perform discharges and the like. In my opinion, the two divisions can run together, but they are not the same. Unfortunately because one company runs both, they are often seen as interchangeable and the same thing. They are not. If we want to be taken seriously as a profession, it is imperative that we separate the two.

Ack sorry Dust...I got so sidetracked with my ranting I forgot to answer your initial question... Yeah...I would wait for the 12 lead to come back...it's part of the assessment...

The current volly service I run with does not have 12 lead capability...In fact we just got 12 lead protocol in our region...to acquire them, not read them. However with a little extra research and time I've begun to pick up some tips on 12 lead interp...now im trying to convince the higher ups that we NEED 12 lead. But the cost issue always comes up. I believe at last check they said it would cost us around $5000-10000 a piece to upgrade our existing monitors. Just what I've been told. Instead of spending grant money on the upgrade, they decided to purchase new med bags and t-shirts for all the members...ya know...things that are really important and really effect patient care. The paid service I run with on the other hand, does have 12 lead capability...and I love every minute of it

My protocol says to not wait to administer nitro to gain IV access...However, I always ensure I have an IV before administering meds...If IV access can be gained that is, some people just don't cooperate

ABC is just a mnemonic used to get you through the initial phase of learning what to do. The practical sheets given out for you to run through are just for your state. Everything is different when you hit the street. After running the street for a while, things become second nature and you really don't need to sit there and think about what you are going to do. If you don't see an ALS provider talking about ABCs, it doesn't mean they aren't evaluating them. If you see an ALS provider not providing ventilations to an apneic patient...then it's time to worry.

As everyone else has said, if this patient was alert and oriented and did not want to go to the hospital, they have every legal right to say no. Just out of curiosity...what was the BGL on recheck? It does take sometime for BG to rise when given orally...just wondering. Enough procrastination, back to my paper!!

I am in the same boat as you Anna. I'm currently in my first semester of nursing school, and honestly I love it. I still love EMS, and am working 2 jobs while going to school, one in hospital and one in an ambulance... I love both worlds, and will probably take my initial focus into ED or ICU if I can. After that, I may do NP or CRNA, I haven't decided yet. Although one thing is for sure, I love my program, and I love spending time with my patients. Good luck to you, and I hope you're having as much fun as I am!!

Any meds that could have caused the hypotension? Didn't get a med list with the presentation so I'm just curious.

Random, but true...M

God I'm such a geek for understanding that...

Since I last posted in this topic, protocols have been updated. I now carry the following in addition to the last list... Reglan Metoprolol Amiodarone Haldol Acetaminophen elixir Benadryl elixir and tabs Solumedrol Thiamine I would have liked to have seen a few drugs on their, but what do I know? Incidentally, does anyone have experience with Vasopressin prehospitally? Any interesting articles out there? Think I've found one, but I'm really interested in it's use in place of or as an assist to epi in cardiac arrest.

I love this part of the article. Let's not mention the fact that there are countless other ways that ventilations can be delivered besides mouth-to-mouth ventilation. Let's make all the doc's and nurses look like selfish bastards for not wanting to contract Hep B. It's nice to see research is being done, but when I see things like this, it makes me wonder about the overall methodology used in the research itself. I wonder if this guy has ever taken a CPR course, and had his instructor tell him to use a barrier device.

The boogey man sleeps with a night light because he's afraid of Chuck Norris...

I was very bitter when I wasn't hired over the summer for a job I wanted. I was among the last applicants to have their application forwarded on for final selection. However in the end, they chose two brand new (ink still wet on their certs) AEMT-CCs over me. I have 1 year more ALS experience than them, and 3 years more EMS experience. But it didn't matter, because they knew people. Now, however, one was fired because she had to call for mutual aid from another department on a chest pain call. When the other department got there, she hadn't done anything. No vitals, no oxygen, no IV, no meds...she froze. They got exactly what they paid for...But I've moved on, have a nice cushy job in a hospital, and RN school. There is always a silver lining, don't get discouraged:-)