Laura Anne

Sorry about the post. Was at work and got halfway through what I was trying to point out in reference to the above quote, but then those nasty lil bells went off and out the door I went. I guess it somehow was sent prior to my finishing. No biggie.... :roll:

The point I was trying to make was about the McCaffrey's Grocery store burning down; it was one of the listed jobs on that post that I was going to narrow down along with other articles.

Recap on the basic story: The grocery store aforementioned burnt to the ground from a simple cigarette igniting the mulch along side of the building. The irony and point I being made was that directly across the street is Station 80, an all volunteer fire house that couldn't get ANY members to respond and put out the small mulch fire along side the building. If there were a paid crew on, the building would have been saved. Instead, the entire store burnt to the ground because they had to wait so long for other staffed fire companies to respond into their local. To add insult to injury..... Jim McCaffrey, owner of the store that burnt to the ground, donates thousands of dollars to the all volunteer fire companies in the local area year after year. Thanks to his donations, stations 0, 71, and 80 all have top of the line equipment that couldn't roll out to save his property when in need. So you say Pennsylvania's fire houses will always have dedicated volunteers? Where were they the day Jim needed them....after everything he has done for the volleys?

Food for thought, no pun intended.

I agree with the person on top of me..hi CJ...lol. :shock: :wink:

Seriously, what ALS intervention do for this patient other than stabilize VS that per your assessment are already stable?

That being said, what was the Glucose reading on this patient? I didn't see it listed and therefore do not know if EMT's are capable of completing this skill out your way. Also, any new meds the patient may have been put on by his PCP lately? Perhaps over the counter yummies of any kind? 8) Patient seem febrile at all? Obviously something neuro is being altered and therefore needs an ER assessment. ALS intervention would only oversee and be capable of possibly stabilizing VS a bit more appropriately if they became unstable.

My two cents......

Ehhhhh.. Really, the only difference I've noticed is time. Hospitals, advanced care, etc, are farther away. People put themselves farther away, then blame everyone else when their house burns down, or their spouse dies before EMS arrives. The reason we're not paid, people are cheap. They want better roads and parks; and don't care about EMS till they need it personally. The fire depts here will always be volunteer, their call volume doesn't warrant any change. They have no problems getting out, their dedication and time spent on their organization have earned them modern and better equipment than most small cities.

EMS on the other hand, consolidation is what will make the difference. Consolidation and modernizing rural EMS systems would be better, for everyone, all around. There would be no downside, other than hurt feelings, and they'll get over it eventually.

If we didn't volunteer, they would have to provide EMS some way. It's the law. Every municipality in the United States must have a fire dept, an ambulance service and a police dept, to cover them. Whether it is by providing their own, contract or mutual aid. Someone, would have to do it. EMS is a necessity. It would be taken care of, no matter what. I'm not saying they could do a better job than you, but there would be some alternative on hand.

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Dear Sammy_Jane,

I am happy for you that you are a follower of whatever faith(Christian). Just be aware and respect the fact that others will not share your views, therefore please do not push any onto others, including patients. I had a partner who attempted to stop my ALS interventions and say a prayer for my patient who was in severe resp distress. Needless to say, it went over like a fart in Church, sorry for the pun~ :roll:

There's a time and place for your faith..... keeping in moderation and using it at the proper time is necessary in this field. 8)

" I am not mean, I am firm."

"Your Hiney STINKS!!!!"

his archenemies backside....

:shock: diffused the 'bomb'

pooped herself unconscious

Egamukayshun gows aye lonnnnnnnnj waiz.

One thing I picked up on this lovely thread was........

USE SPELL CHECK :roll:

*Whew!*

Thank you RuffEMS for putting the train back on track.....Khanek, same goes for me. I hope all get better soon, emotionally as well as physically. I'll keep them in my thoughts.

It's a shame that it takes something like this to happen to open ones' eyes. Hopefully with some time and wisdom we can all act a bit safer behind the wheel. I was an unfortunate one who learned the hard way and was thankful that no one else got hurt other than me. I don't know what I would have done if anyone got hurt, including my partner, the other driver, or the 5 young girls all under the age of 10yrs who were in the other car. The bruises and bones heal faster than the mental trauma of dealing with GOD FORBID hurting or killing someone due to ones' actions or lack of.

And it sucks to hear people constantly tell me, 'its okay, Laura. It was an accident and not your fault.' Sorry, but hind site being 20/20.....there are a plenty of coulda, shoulda, woulda thoughts that bombard me every time I think of the crash. I do feel it was my fault and it is a horrible thing because I feel that if ever put in the same situation, I could have avoided a crash.

Please, please, PLEASE everyone be safe out there, slow down, and use common sense with due regard.

yes, it does sound harsh, and IT IS harsh. and yes it certainly is called life. but "life" is also the reason for patients dying because they cannot afford the surgery to cure it, and also the reason for massive employee layoffs and plants moving to foreign countries for cheaper labor in the unending search for the "bottom line". this is all called life but does that make it right? what is destroying the delivery of medical care in the united states is not the fault of the patient, nor the emergency caregiver. it lies in our legal system. to think that, in making a run where the patient states that they FULLY understand their situation and the risks they are taking, and still refuse care, the provider can be sued for negligence for not providing the medical care the patient did not want, and be held liable is a DISGRACE. that being said, we return to the question at hand. i am a human with frailties and medical conditions, the majority of which are beyond my control. i did not ask to be claustrophobic. it is just something that happened. before anyone asks, yes i have had extensive treatment in an attempt to rid myself of this condition, and for reasons unknown to the therapist or me, it has failed. so that leaves me the victim of a MVA with injuries for which emergency care is summoned. after all the physical examinations,histories, and investigations have taken place, the EMS makes the determination i must be transported to the emergency room. it has been recommended that i go, i do not refuse, i want to go, but because of a technacality of our laws, i cannot. i have never doubted the advantages which wearing seatbelts offer. i wish i could wear mine. i am not against mandatory usage laws nor primary enforcement, but all states i am aware of which have adopted mandatory safety belt usage laws contain EXEMPTIONS to cover people who cannot wear seatbelts for medical reasons. is there a reason why our EMS cannot offer these exemptions? this would save people like me tons of anguish and pain. i do not possess the knowledge to diagnose or treat myself, so therefore i refrain from so doing. i ask only that when deciding what is the best option for the patient, that this be done by making use of ALL pieces of the puzzle, including what the patient can tolerate. is it better to leave a patient at roadside to fend for himself than to treat/transport him? i hear most of you already saying that it is not the responder not offering care but the patient not accepting it. on the surface this is indeed hard to disagree with, but disagree i must, because your decision is based on flawed evidence that the patient is making a "choice" not to accept treatment. this cannot be farther from the truth. you must understand that it is NOT a choice when i refuse and resist restraint application, it is a fact of life. claustrophobia isn't something you can turn on and off depending on the situation. it is not something a person chooses to be. YOU JUST ARE. there is something very fundamentally wrong with a system that will not make exceptions in order to offer care to ALL individuals. it is true that it is not our fault, but it is also true that it is us who must fix it. thank you and may God bless you all.

i wish to say to laura anne, please tone down that attitude. you are not SUPERMAN, nor WONDER WOMAN either. and please do not be offended as this is constructive criticism. you come across as a "big know-it-all with a huge superority complex". and i wager that this is far from the truth, and a mistaken impression. i realize the laws are important and what you put at risk if you break them. i find it hard to disagree with your reasoning. what makes this an even more complicated issue is the realization that i know and accept the advantages seatbelts offer and agree that i should wear mine. this is very difficult for me, as i accept your premise and realize you are right. but i do not feel that you understand my problem and the reality resulting from it. understanding and compassion for people, not derision, will make you a far better medic than you obviously already are. finally, answer this question for yourself----------how many of your past actions and decisions made as an emergency care provider would have been different if you did not have the need to worry about the possibility of being sued?

mackeydad,

Let me start by saying once again I am sorry to hear that you have a condition that would interfere with properly transporting you in my care/vehicle. And no, I am not you, and I do not have your condition, and therefore cannot fully comprehend the horror you feel. I cannot truly understand the issue you face from in your shoes, but this doesn't mean that I am incapable of being compassionate. I actually get criticized by some co-workers for being a "hand-holder". Quite honestly, I am proud to be one and to show that I truly care for my patients. Unfortunately, this does not change the fact that the law is the law, and the safety of everyone in my care, including myself is in jeopardy the moment I decide I am above the law. And yes, I agree that it is a disgrace that one can be held liable for their actions or lack of in this situation. To think that it comes down to someone who is in need of medical assistance and not getting it due to legalities is a very, very sad part of the job. Once again though, at the end of the day, I will do what is best for myself, my patients, my co-workers, and above all my own family. This means abiding by the rules and regulations set forth by the government, which ever one it may be. This means properly restraining my clients for their best interest. Again, I know this is not what you consider to be in the best interest for your well being, but in my eyes and the eyes of the law, it is. I honestly cannot think of a less harsh way to state a fact, but the bottom line of our jobs as health care providers is to maintain the lives of all involved including our own above all. Isn't that what they teach us in EMT school? To protect ourselves and not to be placed in harms way because if we do, we are no good to anyone and may only become another patient on the scene?

Now, as far as being 'WONDER WOMAN', only my boyfriend calls me that...ahem :oops:

Seriously though, you're constructive criticism, as you call it, stating that I come across as a "big know-it-all with a huge superiority complex" is far from the truth. I am, yet again, a compassionate person and I do understand to a point that you have a condition that makes this topic at hand very difficult for you. It will not change the bottom line when it comes to my patient care. If my opinion and professional conclusion makes me come across as stated above, then so be it. I only wish there were a better solution for you and others in your shoes. What would you do to better this type of an issue for persons such as yourself from a legal standpoint? Perhaps this is a subject that you should take up and fight for in the legal system?

I wish you the best of luck with your condition.

Having been oh so lucky to have been an ambulance accident, let me just state and reiterate Ridryder's point:

Seat belts and restraining the patient(s) properly = THE LAW.

You have a medical problem that you feel makes you special? Unless you're Superman, you're not being safe. If you feel that you cannot be properly treated by the EMS personnel, then I'd have you sign a refusal form stating why you will not allow yourself to be seatbelted/restrained for your safety. Because this is a legal form you'd be signing prior to the continuation of my ALS intervention, you can be assured my legal/professional status will be maintained over your refusal of care due to a medical condition. I am sorry to hear that you have this condition, but I have to do what's best for everyone, including myself. I will seatbelt in my patients properly for every transport while in my care. BTW, we only have two straps on our litters; one chest and one leg. I really like the Pedimate and will have to bring it up to my bosses. Thank you for that, medicmole. 8)

Just remember, at the end of the day, we all have families to go home to, to provide for, to care and be there for. If this means my patient(s) has delayed their own care due to whatever reason, I will make sure my own safety comes first...the safety of my job. Sounds harsh? It's not, it's called life.

:shock:

Yep, my three emotions for this video that i had already seen once before and still feel the same about.

:shock: ...for the fact that this guy was being such a selfish brat because he was obviously upset with the care being rendered in the lobby. This guy who got taken down by the FD is a text book definition of a jerk.

...more or less a look of disdain for the fact that this guy was held to the ground and not one of the providers turned their attention to the patient who made herself quite comfy on the couch after a while.

...is for the fact that the fireman stooped to the level of the guy being held down by kicking him after he was restrained. WTF? That just makes everyone in their field look so unprofessional and basically like.....a jerk.

I truly believe that a person can be restrained/taken down if one feels threatened or is threatened, but to kick him when he's being restrained properly? What an absolute ass. #-o

Were mom and baby okay?

I love it when these young girls deny that they are sexually active and turn up pregnant. I am a prepared chidlbirth instructor and have had a few of those come through my class. I asked them, "If you're not sexually active why are you in a class for expectant mothers?" Their response, "My doctor suggested it would help me." I would then ask, "So you have never had intercourse?" "Nope, we came close but he never put his thing in me." Hello little girls!!

Hmmm, something tells me the girls weren't the 'little' ones if they didn't know it was in there......lol :shock: :wink:

Sorry, had to go there :roll: :twisted:

On a more serious note, Akflightmedic.....you did as I think a lot of us would have done, so please don't beat yourself up for it. There's so many different types of illness that your partners S&S could have been diagnosed for. Plus, I have seen many different types of patients who all reacted differently to having an AP, myself included. My AP was pretty darn close to blowing, but my fever was low grade and I had no specific site of ABD pain and/or rebound tenderness, so they didn't think I had one either. My CBC showed a high WBC count and they kept me in the hospital for that reason on IV antibiotics due to my other Mhx. Later, they scheduled an ABD US and found my AP.

There's only so much one can do w/o the proper resources. I would have no problems ever trusting your judgement and care as a provider from what I know of you here. Hope your partner feels better soon and recovers quickly from his ordeal.

SO, the point of this post is for everyone to fess up their tunnel vision call(s) of the past. MIND YOU, please do nt post anything criminal.....ugh. Be professional and use this as a learning tool, tool.

Once upon a time, I had a patient who was unconscious lying bent over backwards on a large pipe. He was power washing the floor in a closed little building that was part of the electrical company. He was agonal resps, soaking wet, and quite flushed in color. After finding out if the power was still or not, he was removed to the outside and given high flow O2 via BVM and immediately increased his LOC. By the time the medics got there, he was CAOX4 and C/O a severe H/A.

Yep...my thought process? He got electrocuted while standing in a puddle of water with this machine he was using to clean the place.

Real deal...the power washer was gas powered. CO. *sigh* :roll:

Moral of the story: everyone tunnel visions and makes mistakes, but it's how we learn from it that makes the difference.....oh and if we didn't kill someone in the process. :shock:

MY TURN, MY TURN!!!!! :twisted:

OK..... as professionals(most of us anyways), being able to determine if/what treatment is going to be rendered is part of our job. It's common friggin sense. If someone took my mother's clothes off for a twisted ankle and she had no other compaints/injuries/illness, I'd take part of their anatomy off, plain and simple. But hey, I am fair...I'd let the person who took the clothes off pick which part of their body(doesn't mean I'd agree, mind you).

When it comes to elderly and/or children, their modesty and/or fear plays a big role on how you assess someone. When it's kids, I normally want a parent or care provider there with me while I assess the ENTIRE patient. Now, here comes a big shocker.....I can do this WITH the clothes on! :shock: Yes, it's true. Just lift the shirt, pull down/up the pants, and check legs/buttocks for any other signs of injury/illness. Kids a lot of times won't tell you they're hurt due to not knowing you and/or fear of you or the care provider that may have caused the pain. Sometimes it's out of pure shame cause they got hurt doing something they're not allowed to IE: climbing the tree in the backyard, standing on a chair to reach the countertop, etc.

Elderly may be old fashioned/modest and/or have other reasons for not being capable of telling you every injury/illness they have had now or recently in the past IE: the bruises from recent falls, the pacemaker box in their chest, etc. PSST, this too can be assessed w/o the clothes needing to come off, just expose the body regions. 8)

So my answer is 'no'.

Of course we need EMT-B personnel!!!!! To think that I'd have to carry my ALS equipment up and down the steps all by myself, lift that darn heavy litter up and down, in and out of my truck, and lets not forget those darn fender-bender refusals we ALS providers love so much. Why heck! You-all EMT-B's are great for alotta things!! My personal favorite though is the gomer-mobiles aka BLS transport rigs....why if it weren't for you guys, the medics would have to do so much more work and quite frankly, I am too busy thinking up other sarcastic things to say....WOW!!!! How about just holding my clip board on scene and looking pretty??? No???? NOT what you expected?????? Well golly-gee wilakers.....I reckon I'll have to find a better reason for having my partner then....... notice I didn't say drive....lol :shock:

WHEW....*stepping out of the pile of smelly shi...ugh I mean oozing sarcasm......*:roll: :wink: :wink: :wink:

KIDDING SHEESH... I know someone will take this the wrong way and all I can say to playful sarcasm is...well, get over it.

I work on a truck with an EMT-B partner and I have never had a problem with the EDUCATED EMT-B's. For the most part, I allow the EMT I am working with run the call until/unless severe ALS intervention is required. I also try to have an EMT-B grasp the basic concept of assessment along with A&P when working with me. In doing so, I challenge their skills and drive them to think a bit more critically. This allows them to question, comprehend, and interpret cases later on down the line. This is how I was taught. I think it worked fairly well. It was from this approach that I became passionate about furthering my education to the level of EMT-P. Not only educating, but assisting in the descent of EMT-B's that seem to tunnel vision on certain injury/illnesses.....aka...... attempt to arrest the ignorant mind. 8)

It's the EMT-B's that don't want to further themselves in the educational aspect of EMS that I cannot stand. Mind you, there are PLENTY of medics who are the same way and we all have run into them from time to time. I just don't understand why someone who gets into this field feels that they are educated enough. EDUCATED ENOUGH?! :evil: There's no such thing, and if one is to portray themselves to be educated enough, well quite frankly, I don't want you anywhere near me, my family or friends, or even my patients because you are in my eyes dangerous. This I feel is the passion that drives this forum and the people on it; all here want to better, not only themselves, but the field as a whole.

Uhhh, so to answer your question? Yes, I do feel EMT-B providers are needed, but I would hope that they'd further their education and use EMT-B as a stepping stone towards becoming a paramedic.

::head hits desk as he starts sobbing quietly to himself::

1. For the sake of all that is good and holy, please proof read your post. While, yes, this is the internet, it is a forum for thoughtful and professional discussion. As with any other interaction, how you present yourself to those that are going to read and respond to your post is important. No one is expecting a post comparable to a graduate thesis, but the proper use of conjunctions [junction] can be expected.

.

:violent1:

THANK YOU! People want to be referred to as 'professional' in this forum, yet the majority of people lack the basic grammar skills of a second grader!!! Just push the wee little button called SpellCheck for the love of GAWD..... :roll: Also, throw in a few tid-bits of punctuation here and there, followed up by some capitalization and HEY....YOU TOO CAN BE ON THE NEW T.V. SHOW Are You Smarter Than a Fifth Grader?

OK *whew*, now that I am done my pointless rant, I'll toss in my two cents worth of an opinion....

I'd rather be safe than sorry with a basic crew calling for a rendezvous rather than have the BLS crew miss an important sign/symptom and cause further harm. I don't work in an area where there isn't an ALS squad on every corner. We/I am fortunate in that aspect because I know if there ever was a problem with a local BLS crew's patient crashing, they'd have some help around the corner, whether it be another crew or the ER itself. If I did get called to assess a potential ALS patient who is initially in the care of the BLS crew and found the Pt to be deemed stable for the continuation of BLS intervention, I'd be OK with it. The point I think being missed here is the need for ALS in a region that seems to call them frequently for back-up. Perhaps getting your county to provide ALS to it's people would be better for all involved? I am assuming you're squad is volunteer and doesn't feel the need for ALS, either volley or career?

Another point is the lack of knowledge and continuing education of the basic and medic providers is what chokes this entire field as a whole. Everyday I learn something new and I am happy/willing to do so. It's when the mind becomes stagnant and education lacks that we hurt not only ourselves, but the profession we all worked so hard to promote with sites such as this. Also, regardless of status (volley/career, basic/medic), there's always going to be a few bad apples that will ruin the bunch. Name calling only stoops you to their level of incompetence. Lord knows we all at one time or another have been there, just some of us learned from our mistakes........ :wink:

P.S. It is summertime now...is it ok to wear flip-flops yet? J/K!! sheesh.....

I had a woman who was a frequent flyer alcoholic. Her method of intoxication was to drink the tester bottles of perfume, followed by eating a lot of Rice Krispies to soak up the toxins/leftovers. She was at home with her 5 kids when one of them called 911. She didn't like me very much and asked why I was such 'a mean b*tch?'

I politely responded, "I am not mean....I am firm. Now, GET UP!"

It was the police who had dealt with her mutliple times before who filled me in on her little toilet drinking adventures. I normally wouldn't be 'firm' with people like this, but she was cursing and being quite rude in front of her kids and neighbors to me and the police. I personally don't start fights...I just finish them. :twisted:

On a more serious note...my concern is going to be when we come across one of these extreme alcoholics who is going to ingest something we didn't know about and end up hurting them in the process of trying to help them. Reasons for my concern is the large amount of alcoholics in my family. It is a hard habit to break, but it can be done with a little firmness from loved ones. KNowing the warning signs and ALL the possible highs these people can obtain is mind boggling.

That's actually really interesting....thank you very much for sharing that.

When I think of manual or mechanical chest compressions, I think of those CPR vests that came out a few years back that were going to do the CPR for you. Does anyone know what I am talking about? It would be nice to see this type of vest made for this type of medical situation. A few problems with this is

1. making it to correlate with patients' irregular breathing pattern

2. hypotension

3. size factor

4. actual usage of the device due to low number of actual patients in need of such a thing

Mind wandering now.... :roll: OK, back to my late night ice cream and coffee....! 8)

To all who replied.....thank you!

Chbare,

I understand the concept behind the air trapping but figured if he wasn't too far along, it may have heled. You're right though. He was too far along and had absolutely no air movement complicated by his last bit of energy used up fighting us to have made any difference. After being intubated, my one EMT-B said it was really hard to bag and I informed him to bag small and quicker amounts, but not to attempt to over inflate.....a concept the other EMT-B who got clocked could not grasp(he is in his 3rd attempt through paramedic school...yeah...not the brightest lightbulb). Anyways, thank you for your response!

VentMedic,

High dose in line Albuterol....I guess if I had more time to be creative, I could have pulled out another neb set up and attempted to connect to the ETT/BVM ports? Other than that, is there a better set up? Thank you for your help....

AZCEP,

I am becoming a professional asthma killer! Grrrrr!!!!! :roll:

:wink:

Seriously though, I have heard of other meds being administered nasally, but Versed? Interesting, I'll look into that. And as far as Epi goes, I will have to think a little differently next time. It was one of those cases where everything happened so quickly that while I was setting up for one treatment, he presented in his next stage and didn't allow me to complete my first one.....how RUDE of him! ugh!! :roll: OHHH, Magnesium....yeah.......we don't carry that. Welcome to Montgomery County. Perhaps after these two past cases will make them consider it?? Thank you for your advice on this...food for thought, indeed!

Scope2776,

Once again, my county is a bit behind, but we're catching up...hence no RSI yet. As stated above, the time line of events inhibited my full thought process to ever properly evaluate the IM/SQ Epi. It did pass threw my mind, but I was more concerned with O2 admin and establishing/assisting with ventilation more than Epi....again hind site 20/20. I will be more aware of it for next time.....GOD FORBID.... :shock: Thank you for your response!!

mediccjh,

Thank you for your kind words. I will forever beat myself up on calls and push myself to obtain more knowledge every day so that I may perform better each time I am out there on the streets. Just the way I have always been...it's alllll good. :wink:

This guy was a well known 'frequent flier' and was well liked by everyone in the community, as well as the hospitals. Even though he was in the ER almost every other day or his asthma, he was always taken in and respectful to all who helped him, including the EMS teams in the local. This was the first time I ever saw him like this and it was unusual. This is when I knew the sh*t was going to hit the fan and just could not keep up with his decompsenatory state. No history of any drug abuse. Thank you for your kindness..... when are you coming to work with 'us' BTW???? :wink:

Medic26,

I appreciate your comment on the subject and will hopefully learn from the comments rom all on this event. Thanks!

fiznat,

As far as the Epi goes, I was assuming the peripheral shut down would have delayed and/or denoted any metabolic efforts at this time to help.....need to be more aware of it for next time. Racemic Epi would have been lovely, but we don't have it on board, although it was something I mentioned on scene. I wish we did carry it or the pedi asthmatics/croup cases we get. After my last "death by asthma" case, I asked one of the local ER doc's about it and he said it was worth a shot, but I was shot down at the ER via others due to it not being part of our protocols. Basically, I was told not to do it and to be a monkey medic which quite frankly pissed me off something FIERCE.....ER staff watched from the back doors of my truck while we coded him.....don't ask....bad situation all around.....hence my frustration with this ER from hell...........*rubbing ears and saying 'goose fava'*

OK, I am better....sorry for rant... :evil: Thank you for your help, though!! Your thoughts are always welcomed and well taken. I appreciate it very much! 8)

ERDoc,

RSI, as stated above would have been wonderful....cannot wait till we get it, although no line would make it a bit difficult. I am still pondering the Versed nasally.....I am going to have to seriously look into that!! Thank you for your comments!

vs-eh?,

Another point I will have to look into is the teachings of the chest wall compressions. Makes sense, so why the hell don't they teach it here?!?!!? Thank you for your response!

ALERTMedic,

ALl I can say is too little time, little too late......thank you anyways for your post!

sladey67,

'External Chest Compressions'.....can you send me or post the protocol for this, or perhaps something on it? I would greatly appreciate it! Thank you for your response on this topic! 8)

Basically.....give them Epi, try to sedate them if possible, and straddle them....to push on the chest! GAWD! :roll:

Thank you all again!!

This is my second cardiac arrest post resp arrest via COPD(asthmatic) in the past month or so.....

52yr old male C/C resp distress. Found him tripoding against a desk at relatives home. Only had Albuterol with him. Took 10tx prior to EMS intervention and w/o relief. Pt's severely hypoxic and uncooperative due to this current condition.

PMHx asthma, cardiomyopathy, HTN.

I put him on high flow O2 immediately, flowed by another Albuterol. Needles to say, it wasn't working. Pulsox on high flow reading 73%, poor reading via cool/diaphoretic exts. Pt became combative, punched co-worker in face and could not sit still with O2 in place. We attempted to restrain him and place the mask back on his face, but he wouldn't sit still. I couldn't get an IV yet because he was fighting us. He was now doing the 'guppy mouth' breathing so I grabbed the BVM and went to nasally intubate him. He went into resp arrest, vagalled down into his 30's, then went into cardiac arrest. 8.0ETT, 14g Lt EJ, 1mg Epi and 1mg Atropine IVP and CPR. I never got him back.

No in-line nebs at this job.

No CPAP due to short transport times in city(approx <5mins, entire calls approx <15mins).

No Solu Medrol.....took it away for now.

No 1:1000 epi SQ due to peripheral circulation shut down.

This call from Pt contact to ER doors and care transferred to ER team was 12 minutes.

I felt I could have done more, but not sure what. Hands tied due to lack of meds/equipment. What could have been done differently? :?

Oh dear......

Spenac,

I do feel your pain due to the fact that I, too had lived temporarily on a border town over in Southern California. I do not think we had established a protocol stating the denial of care due to no need for EMS intervention....at least not while I was there(5yrs prior). Perhaps things have changed and if so, I apologize. I am only going to comment on what we did as EMS providers when I was out west. Also, where I was, we had a hospital approx <10miles from the border town checkpoint.

***El Centro Regional Medical Center, Cali.***Gold Cross Ambulance, Imperial Co., Cali.***

There were certain situations where EMS was called to the Customs check point on the border for transfer of care from the Mexican EMS ambulance. In this case, there was no issue that I was aware of in reference to the status of the patients' nationality or their parents' if the patient was a minor. If the BPA found them and they claimed an injury/illness(which happened often as a scapegoat from detention), then we took them without question due to the verbal complaint noted and/or obvious injury/illness presented.

Now, if a patient was already in town/US soil and wanted medical care, then I see no reason for denying transport. Unfortunately, in this scenario, the parent has to make the medical decision for her child. Perhaps she's using her child to help her own personal situation, but I would not want to be the EMS provider who attempted to state this in a court room. Err on the side of what is best for the patient......that's what I would do.

Are we aiding the illegal immigrant into the states? Technically, she is already here approx 50miles, correct? And the child is an American citizen, therefore giving the mother the right as the legal guardian to accompany her. It's kinda like the pregnant illegal mothers who walk to the check points fully in labor, water broke and all, just to give birth over in the states, making their child an American and also giving them the legal right to stay. :roll: This is where the legalities come in and quite frankly, I just don't know how it is done since I left...again...apology. :wink:

Basically I'd transport the patient and mother. If BPA has an issue with the passing of the mother thru their check point, let them make the legal decision. Let her state to them what she stated to you. OBVIOUSLY, this won't go over well with her and she'll either lie or admit her wrong actions. As a medical provider though, I am not sure if can deny. This statement about being unable to refuse transport is due to what the standing protocols I go by up here in Pa. I think it's great that you all have the capability to , under your medical command, inform a person(s) that your services are not being rendered in the best interest of everyone involved and that, quite possibly, abuse if the emergency unit is taking place. If there is an alternative you can give the mother, such as a taxi voucher, a phone call to another relative/friend/etc.....let her do this so you can stay in the local for your community and any other 911 calls.

One side note: I personally do not have any problems tieing my boots prior to going on a call, nor am I incompetent in my job. Please do not let your judgement of providers where I work be tarnished because there are a few who may spoil the bunch. My understanding is that no one service, state, etc is perfect......but I do NOT like being portrayed as 'lacking' in my profession.

.....when the MOTHER of the 5 month pregnant, 18yr old drunk, cigarette smoking ditzy female gets arrested (along with her ENTIRE family) for DC. In between all this lovely PD action, she attempts to attack your partner on the way to the ER. She needed to get checked out because the cops put the handcuffs on too tight when they restrained her uncooperative as* ((BS lawsuit)). Each PD cited her then let her go cause they didn't want to deal with her.

*note to self: try not to brake so hard next time when she unrestrains herself in order to attempt plant her fist in my partners' face. OOPS :wink:

GAME ON