spenac

:headbang: :hello1: Yes, finally someone else that feels it is possible to think and deny transfer. I still feel that to be looked at as a Professional we have to be able to stop being taxi drivers. Thanks for great post. MY bothers and sisters in the USA about hung me for suggesting that we could deny transport, when I asked if they would transport someone wanting to go eat no medical problem many said yes. Different mind set I guess.

www.techproservices.net ECA (first responder), EMT-B, EMT-I, EMT-P primarily Texas, but students from all USA and world. Course's are tough and deep.

:banghead: :violent1:

Yup EMT 101.

He don't need no collar and board just put him back in the game another good hit will bring him around. Least thats what the coach always said. Never hurt me any never hurt me any, what were we talking about.

](*,) :banghead: :violent1: :love8: :occasion5: :wav:

mom fine baby no lived only few hours once at hospital, premature, those are the hard ones. I always love the little girls "it's not mine" statement when I've got a baby thats still attached to the undelivered placenta, makes me look under the sheet to make sure theres not another girl hiding under there.

see that beating Texas gave the yankees 14-2

"Can't we all just get along"

Sorry to leave the CO talk. Young young young small girl. Nausea, sharp pain abd. Didn't fully match any particular abd problem, could not fully dismiss several problems. Denied being sexually active when asked if she could be pregnant. Transported with unknown abd pain. In monitoring the pulse and respirations enroute to the hospital noticed reg pattern changes occurring. Had clothing removed, delivered a baby just seconds after removing clothing. Still denied sexual activity, miraculous conception I guess.

Man the original question has been long lost and forgotten. Why don't we just all agree we all need more education. As long as we fight amongst ourselves we'll all be looked at as taxi drivers rather than medical professionals.

FDNY hired amputee David Kruysman according to the May 2007 EMS Magazine. He according to the article wears prosthetic below his left knee. Hired jan 2007 sworn in march 15.

This sounds like a skill that should at least be discussed in more detail and then require to at least observe it being done by a Doctor while doing clinicals, probably be hard to get doctor to allow you to perform it. I know we would still not be skilled at it but we could at least make an educated attempt at salvaging the extremity. If close to hospital probably still better off loading and hauling butt to ER but not an option for all on the site. I have reestablished circulation on one fractured extremity, but probably only successful as had been able to observe doctors do it on several occasions, don't know if I did it completely right but person still walking on it, would have lost it otherwise. Thankfully all other fractures and dislocations have still had good circulation so just splinted and monitored for good circulation enroute to the hospital.

(spin off). How many can give pain meds for abd pain? What are some of the reasons for or against in your protocols? Thanks

Thanks for comment. Should have paid closer attn to question, my bad. I to see many docs and paramedics fail to give enough for relief. I also have seen medics because our protocols allow to titrate for pain relief stay on seen of broken leg forever it seems while titrating to pain relief rather than packaging and continuing pain management enroute to hospital. We don't get many seekers thankfully. Guess thats more of a big city problem or maybe it's just so easy to go across the border and get what you want. Heck torodol at the pharmacy no prescription required.

Before I started advanced education I thought I was using critical thinking. In reality I found I was just missing a lot of things that should have gotten me worried. In 2 years time as a basic I was the highest level available for 1 week out of 3, worked 2 weeks on 1 week off ( avg 2+ transports with 90 mile transport ). During 2 years I called for ALS less than 20 times. Within 2 months of starting advanced classes I started seeing things I had been missing and started calling for ALS more often or if could reach medical director would get authorization to perform ALS interventions I had already studied, while we rushed to meet the mutual aid enroute to the hospital. I to thought that I was doing wonders as a basic, man were my eyes opened. I can not see staying a basic if going to stay in this profession.

Do to an error all contest info is void and all gifts are sent to charity. Thank you for playing we appreciate your support. Catch ya'll next time on lost causes.

Thanks for all the replys. It is interesting the way each person looks at each question and the thoughts it brings out. Have a great day. And the winner is Keep the clothes on the majority of the time.

We are are dual certified ambulance BLS/MICU depending on the staffing ambulance may be bls or mobile intensive care unit. If running as a bls unit they are stuck with patient no matter how bad off at least 30 minutes as nearest mutual aid is 60 minutes out, if unavailable they have to go the whole 90 miles alone. No complaints have been made about the calls for a paramedic when the bls requests help, but they don't call for help often.

Morphine, Nubain, Toradol, Phenergan, Vistaril, Valium, etc.

I have been a patient on an ambulance twice. When I consider all the moving of clothes up down, sideways etc while having lung, heart, abd sounds, and ECG hooked up I personally think I as the patient would have found it easier to have just removed my shirt. So do I feel it would maybe better to have all patients remove clothing at least pants and shirts yes I do. I feel it would allow me to be sure I am not missing a clue that could lead to better treatment of the patient. I personally feel that if I can improve the outcome for one patient w/o harming the other patients I see makes a method worth while. Are there legal issues to consider probably. Could you forcefully remove nope. I do not feel a lone medic could decide to make it the standard to have all patients asked to remove clothing while the rest of the medics leave the clothes on. If it were implemented it would require in my opinion the medical director deciding it was the way it should be done. So for now will keep doing as always have the clothes that I deem needed removed to treat each individual patient. I am a firm believer in the look, listen, and feel method of patient care, my equipment is used as a means assist evaluation. I do not treat the machine I treat the patient. Just a little of my thinking probably not even worth $0.02 in somes mind but oh well.

Nope, in 90 minutes person can go from bad to worse even die if not properly treated. One poster said only treat CC. CC may only be a symptom of something more serious, as I asked so just give aspirin for the headache let the doctor figure out it was a CVA?. Doing that could be very harmful for the patient. Can most make it to the hospital with nothing being done, yes just like in your system, but when something dramatic is happening missing something literally can lead to death. In the field we have very limited ways to examine a patient, the key ways are our eyes, ears, and fingers, if you rely only on the machines you can not be a very good medic. In my part of the world there is no golden hour they are still with me way past that hour. Ten minutes to hospital missing something probably will not drastically change the outcome, missing something serious 90 minutes out you may have just let your patient die. While I have said I think having all patients change into a gown could be beneficial I have never said force them. We do not require them to do it. One great thing about the USA is all compentent patients have the right to refuse any and all medical care, so if patient says no when we need to look we do not force it we just document their refusal for that part of the treatment. As you mention we to only remove what is needed to take care of that patient. To properly assess any OB patient in labor requires visual exam failure to expose that patient would be neglecting your patient. Sense none of us are doctors we all have to work with the idea that there is potential of something and proceed accordingly. Again can we get back to the question should we have all patients in hospital gowns, maybe you can include criteria of when you would feel this is good and when you feel it is bad. Let's forget about any of the above scenarios and discuss possible times we should consider it, or if we feel all patients discuss why. I am sure there are many lines of thinking based on the types of areas you work in. Thanks for input.

As far as removing clothes previously mentioned in most cases if done would be done in ambulance, not in public. As far as personally taking clothes off someone only ones I could see would be trauma patients when we cut off clothes. The other patients would be asked to remove clothing and put on gown much like at the hospital. Do we strip every patient, NO. Should we is what I am asking? Just trying to see peoples thoughts about it. I do not put people in gowns just for headache or abd pain. Doc I mentioned in my area probably would be OB related, of our actual need an ambulance patients at least a third maybe more are OB, if theres any chance they could deliver they are disrobed and hospital gown put on. We transport 90 miles at least, we have areas that take more than an hour to reach and from there around 2.5 hours to the hospital. I have had several deliverys where the woman never even grunted, no real change in vitals, and had we not been doing regular visual exams we would not have been aware they were delivering and had they started delivering in there jeans could have caused more problems. I have raised the sheet and gown on more than one occasion to find a head almost delivered. One thing that amazes me is how quite and still most illegals are during labor. Many have heard stories of babys being taken from them etc and they do not want to upset anybody. I am almost 100% in guessing legal status based on how they act during active labor. Woman here legally usually get loud, want pain meds, cry, etc only to get to hospital and only be dilated at a 1. Illegals usually deny pain, often our only clue is changes on monitor and the changes that are seen during visual exam. But the point of all this is we have have to far to travel and have to be prepared to deliver on all OB's, some take days but others go from 20 minutes apart to delivered in less than a hour, even the doctors can't say how quickly a natural delivery will take. As far as humerus break my years tell me there is potential for more injurys and should treat as if there are until ruled out. But again my opinion based on my experience and common sense. Again my way of thinking is based upon knowing I have to stay ahead of my patients condition because I am alone no hospital nearby, no helicopter, no one to take over, IF I MISS SOMETHING PEOPLE DIE, IF I WERE CLOSE TO HOSPITAL MAYBE I COULD LET THE DOCTORS WORRY ABOUT IT BUT NOT AN OPTION HERE. I had a very good EMS professor at a large university here in Texas mention he wishes all his students could ride out with us so they could see the need to think, and realize how what they do can affect a patient. In 10 minutes time many have not even seen the benefit or lack of the treatment they have chosen. As he put it if they screw up or just don't know what to do they are just 10 minutes to hospital and know the doctors will take care of the patient, so not as much pressure. I am not saying we are better, just have a different attitude, different mindset, always looking ahead so if the worst happens ready to take care of it. Again I realize the things I deal with are different that is why I respond differently than others here. I hope by sharing what I deal with will get others thinking out of their box. I know comments made by city medics have given me lots of things to think about, I have actually started trying some things I have read here, that I had not even given a thought to. If I were 10 minutes to the hospital I see how many things we have to do may not be needed. But I also see things city medics say they do that would not be good to do here.

humor doc humor

Definitly keep going. Your used to studying, you are thinking about what you have learned, so easier to start now. The longer you lay off the harder it is to gear up again. git-r-done