katbemeEMT-B

Sorry for misstating that. It isn't that I don't understand the, I do. Part of our training even as an EMT-B is to memorize and understand all protocols. The test we are given asks for the protocol in one section. The other gives scenarios and we must use our knowledge of the protocols in those scenarios. What I meant was that I don't know why they implemented these protocols. That is not part of understanding the protocol. I hope that this clears it up. Again, sorry for miswriting that sentence. My soggy brain from head cold is starting to get to me. The fact that spellcheck is writing more than me tells me I should maybe take some cold medicine and go to bed. :sad4:

I understand what you're saying and I'm not saying pain management is not our number one priority; as it is. What I am saying is that we have certain protocols we have to follow. Why they are there, I don't know but I do know that the surrounding hospitals also have them. I also know that seeking is not a huge problem in our area and maybe that's why. The woman in my example drove 120 miles one way twice in one week to obtain drugs from us. The only reason I know so much about this other than what she told us is she was arrested after the second time for possession and we were in court during her hearing to testify. She apparently had pot in her pocket that fell out in the hospital. We also depend on Med Control to help us out when we run out of options. We have limited resources for pain control but I have never heard a patient we transported come back and say you didn't do enough to control my pain. We are hospital based and the hospital sends out surveys to it's patients. From what I have seen 99% of the surveys coming back have excellent marks for the care they received from us. The 1% usually pertains to their rough ride and one joker thought it took too long to respond for his broken toe. We were 15 miles away and got there in about 14 minutes. Two lanes road, heavy traffic, bunch of retards that don't know what the siren is for. Call came in as unknown fracture, 68 y/o/m. We assumed it was probably a hip. Once on scene discovered it was a 58 y/o/m with a broken toe too drunk to take himself to the doctor. :violent1: So maybe it isn't perfect but at least we have some options on the ALS service. Some services around us have no options for pain control as they are BLS only (I happen to work on one of them in addition to the ALS service). Those are the patients I feel for. It comes down to this; educate me more (as I continue to educate myself) and give me the tools I need to make my patients as comfortable as possible. Sometimes it's not actually the pain but fear that is affecting the patient. It is our job to be able to differentiate between the two because both can be dealt with. An example: We had a 12y/o/m with a grossly deformed broken forearm. After giving him the max ped. dose of morphine for his weight he insisted he was getting no relief. We contacted MC and he had us administer an additional .2mg. He still insisted he was getting no relief. I was busy keeping the arm stabilized as there was really no good way to do that and my partner got "Timmy's" (not his real name) attention and distracted him. By distracting him my partner was able to keep him calm and not think about the pain while the morphine did it's job.

I agree with you AZCEP and I have seen this with a couple of medics that I worked with. Regardless of situation, get out a needle and admin. drugs or IV them. I'm not saying ALL medics are like that, just a couple that I know. They don't work for us any longer. As for this patient, he is alert and has a patent airway. Give him a soda and some peanut butter and jelly on something like bread or crackers. We've even put the peanut butter and jelly on a granola bar because there was nothing else to use in the house. That also worked. Patient said it wasn't bad either. EWWW :puke:

Hey thanks Urban. It may not have been in depth but it provided me with a little more information than what I have already found. As a basic I had never heard of this before and when we went on the call I started to hook the guy up to the leads and the medic told me "Um yeah you have to do everything in reverse on him." I didn't ask questions and did what she told me. I got a really concerned look on my face when I handed her the read. She was like, "Oh that's normal for him." Then he says' "yep, I'm just a backwards kind of guy but you'll grow to love me." It kind of took the edge off. At the hospital she was starting to explain his condition but we got paged out again. Thanks again!

Update: Passed the lift test and am now officially making decent money. I get paid some for the volunteer service but the paid service pays much better and learn a hell of a lot more.

I'm not the one labeling the seekers. If you read what I posted we call Med Control and they make the decision as to whether or not the pain meds can be administered. They have the records of these patients available to them. We give them patients name, birthdate, c/c, vitals, and any other information we have on them that we get from the patient or bystanders. Med Control makes the call. We treat them regardless to the best of our ability. If it's a major trauma such as a broken bone, severe lac., or to that effect we can give morphine after IV access has been obtained. If we are unable to obtain access we need to call Med Control for IM administration. I only used that one pt as an example of how obvious and stupid some seekers really are. Another example why this is important is the 48 y/o/m patient we transported for an obvious knee injury. He was in tremendous pain and allergic to morphine. Med. Control was contacted and we were unable to give him anything else except to put ice on it. I don't know why so I can't tell you that. His wife did tell us at the hospital that he is on some pretty heavy medications so I would assume it has to do with that but I can't be sure. I didn't ask because frankly, it's none of my business. I'm sure we have treated seekers. I know I'm not psychic and neither are the people I work with. We can't tell who they are all the time. It's just some times they are obvious. Even the obvious ones are still assessed and get treatment, just not drugs (which isn't our call to make) unless they have a major injury or are cleared by Med Control. By no means do we call and say, "Hey I think we got a seeker here, what should we do?" That would be ass-a-nine. We don't even give subtle hints that we suspect. But as I said, to my knowledge, it's not a big problem here. We are more of a rural area. It's a bigger problem in the metro area. Around here they would rather smoke weed. When I say weed sometimes it's really weeds.

We ask our patients to rate their pain on a scale of 1-10. If you run on the elderly often you will find that most have a very high pain tolerance and that is very much taken into consideration when we are treating them. We have had hip fractures with little pain and still admin. pain medications. But we also have to be careful what we give them as many of them are on so many other medications we run the risk of medication interactions. That is why we are often required to check with Med Control. You also don't want to give a pain med to a patient who is going to have an adverse reaction to it. As far patient privacy, I don't see how we even come close to violating that. Med Control is not giving us patient information. We call in and give patient reports on every patient we transport to the hospital. It's kind of like preregistering them. We give either the ER Doc or Nurse their name, birthdate, c/c vitals, allergies, medications, medical conditions, and any other pertinent information. If we need to talk to the doc regarding meds or what course of treatment we should be following how is that violating their privacy. He is not telling us they are seekers. He may be telling us to try some other treatment such as ice first. Depending on the c/c, he maybe telling us to adjust our IV. That's what he is there for.

No because they aren't actually telling us why we can't admin. the drug. There may be medical reasons such as allergy or contraindication with another medication or medical condition. It could also be what the doc feels is in the best interest of the patient at that time. One thing to keep in mind with my example is that when you have what appears to be a normally healthy 36y/o/f claiming to have just had a hip replacement two months prior followed by a fx tib/fib less then weeks old in a walking boot you automatically get suspicious. When we call Med Control we give them pt information, cc, vitals, and what we expect to be our course of treatment. What we get back is yes go ahead or a flat out no or sometimes an alternative treatment. It's not something that we have a very big problem with as most of the seekers in our area know that this is the routine not only with our service and hospital but also a couple of other services and hospitals close to us. So you see the only pt information shared is with the doc at the hospital to which we transport. No breach of the privacy laws.

I am looking for information on dextrocardia. Especially patients who also have a pacemaker. I have searched the internet and what I have found is very limited. I was on a call recently with a dextrocardia patient and found it quite interesting. It was a short transport and I was unable to ask him questions. Patient care comes first. I know that is when the heart sits in the chest in what is considered "mirror image" and everything is in reverse. It can also include the organs to be flipped in the abdomen. Putting leads on this patient is done differently as the medic I rode with taught me that. Does anyone have anymore info. they can share with me or suggestions for reading and research. Thanks! Kat

I would guess a seizure. While the different types of seizures have common denominators their symptoms can vary. I attended a recent conference in which a neuro doc from the Mayo Clinic in Rochester, MN spoke on seizures. He explained to us that sometimes their is no clear cut reason for the seizure and only extensive neurological testing can confirm that it was a seizure and even then if it was an isolated episode they may never be able to confirm it. We have had two such cases in my area. They didn't present as a normal seizure would have. One patient has not had another episode and it's been over a year. The other was diagnosed with adult onset epilepsy. He is a frequent patient of ours as he often develops resp distress following his seizure. Let us know what you find out if you do.

The ALS service I work for carries several different pain meds with Morphine being the most widely used. To prevent the seekers from abusing the service we can use these on obvious injuries; ie: broken bone, major lac, major trauma. You get the picture. Any other medical/trauma we call med control to confirm its use and dosage and they check for patient info at the hospital. An example of how this works is we had a patient reporting she had dislocated her hip after having a hip replacement. We arrived on scene and found her seated in her car. She had a walking boot on her right foot. :-k How can she drive with that on? Something didn't make sense. She claimed the boot got stuck under the brake pedal when she was getting out of her vehicle and that's when she heard a pop and felt the pain. She was crying to a point we could barely understand her. We made the decision to loosen the boot and try to remove it. While the medic attempted to obtain IV access (which was difficult) I worked on removing the boot. Well, she didn't even notice that I had moved her entire leg three inches to the left which should have left her screaming in pain. Her leg was free and we loaded her on the cot and into the rig. Med control confirmed that she was a seeker and no pain control should be given. She had been picked up by another one of our units earlier in the week. By working together, we kept her from duping us. Do we have adequate pain control, I believe we do even though we are sometimes required to contact Med Control.

I'm still pushing for the pizza thing cause I don't know about you guys but there are many days I don't get to eat when I'm working and it would be great to share a slice with my diabetic patient. :sign4: :occasion5: Damn! No pizza! Guess it's Spam and beers then. New protocol: All rigs must carry pizzas and pizza maker by order of Med Control.

I have never heard of the pizza trick before. I kind of like that one. We have a frequent flyer that we have standing orders to give orange Hi-C followed by a glass of Ensure. I'm thinking next time we'll stop by the pizza joint and grab a supreme and have dinner with him. I'm sure he would like it. He's pretty lonely most of the time. I have also heard of peanut butter and jelly on graham crackers (nursing home thing). Bread costs too much you know. Thanks for all the good ideas.

I would like to wish all my EMS brothers and sisters a happy and safe EMS week!!! :wav: Kat

Sorry it took so long to get back here. I talked to the patients daughter today and she is still saying the doctor said carbon monoxide. I'm thinking carbon dioxide would make more sense also. The patient did have a depressed resp. system as she was on 3L O2 via nasal. I believe she had emphyzema and COPD. I have not been able to talk to the actual doc that treated her as I haven't seen him. If I do I'll ask just to confirm that it was carbon dioxide. Thanks for bringing this to my attention. See, a person learns something new every day here, (or at least can confirm what they suspected).

You know, Dust has beat me up on other posts I have put out there, but he has definite validation for his statements here. In class I was a straight A student, top of my class. When I got out into the real world of EMS, I quickly learned just how dumb I was. I was able to take what I learned along with what my fellow co-workers were willing to teach me and am striving to be the best damn EMT I can be. The key is to continue learning by always having an open mind and thinking things through. You may get called out for fifteen diabetic reactions but you won't treat them the same because your patients aren't the same and neither are their symptoms. The other thing you have to keep in mind is when it comes to the legal end, if medical control tells you to stop CPR and you continue, the family can have you charged with battery for causing undue harm to their loved one. At the point that you continued CPR you began to work outside your scope of practice via orders of medical control. It's a lot to consider.

Wendy- Your theory amazes me. I think it delves into our very psyches. I like that and I don't think you're crazy. I also think part of it is that every person is intuitive and if they choose to develop that ability it becomes a real gift. Many times I have heard the phrase "womens intuition" but I firmly believe men have it too. It's just that most men choose not to allow themselves to follow it. In the EMS field they can't help but to follow their intuition because it helps to save the lives of many. While we have skills that tell us what we should be doing next, it's our intuition that guides us. I say this because have you ever been on a call, your pt is stable. BP, pulse, SAT, and RR are all within normal range. As you're transporting you start to prep everything you'll need for when he/she will crash. You step back and wonder to yourself why? Two minutes later for no reason at all the patient crashes but guess what? You're ready. It's intuition. You don't know why you had every thing ready because as stated your patient was stable. No signs or symptoms to tell you other wise. I think as EMS personnel we become more intuitive and that is why we are able to wake up before the pager tones or are able to say what the call is going to be, although some people may say it is from previous experience and trends. I think it would be awesome for one of the Universities to do a study on this in the EMS field. Well, at least you're not alone in the crazy wagon. I guess I'm sitting right next to you. Who knows, maybe I'm the driver

I agree with Shane that the doctor would have more authority over the medic. Let's not forget that whether we are basics or medics we are an extension of the doctors license so in reality if it is well documented that he ordered you to discontinue CPR your butt is just fine and his butt is on the line. Maybe it's better said that no doctor in your area will give the order unless there is a medic on scene.

I did not meet Ken personally. Nor did I have a conversation with him so I don't know what heis like and I have no opinion. I'm sorry to hear that your experience was not a good one. I do know however that the break-out session that he did was very informative. As you stated, Steve Berry is the bomb! I did get the chance to personally meet him and his vast knowlege amazes me. His cartoons are just what EMS needs. I missed his first book and am hoping they decide to reprint it.

Pretty humurous. I sent it on to the medics I work with. I'm sure they'll love it. Thanks!

Our rig is staffed with three two EMT-Bs and a driver or three EMT-Bs. As basics we carry variances that allow us to admin. albuterol neb., oral glucose, glucagon, Epi-pen, baby aspirin, nitro SL, normal saline via IV access, and activated charcoal. We must be cerified through our MD. What scares me is that often times we are paged out for SOB when it is a cardiac issue or stroke. You know how that goes. What we were told the chase car will respond to the for instances stated above. We can request them if we arrive on scene and discover it is one of those but then do we sit there and wait for their arrival? I'm thinking not unless they are some place close buy. We can be to the hospital in 6 minutes max. By the way, pain management wasn't a good enough reason to request them as they are servicing several communities and have to concentrate on the life threatening calls. They figure we've been doing the broken bone thing this long we can continue. I agree more ALS does not equal better ALS. I would love to see us forget this chase car thing and sign a mutual aid agreement with the ALS service stationed in the neighboring town. They are a great bunch of medics that strive to be the best. They are constantly challenging each other to learn more. I have recently started with this service part-time and am loving it. I am learning so much. I also agree that putting a chase car in every community would be a financial burden. I know there has to be a solution to this problem that is why I am asking for insight and ideas from people who have chase cars in place and how do they work. I would love to be able to bring these ideas to the board. I would also love to see ALS support in our area.

Steve Berry's cartoons definitely show the ligher side of EMS. I had the opportunity to hear Steve Berry speak at a recent conference where he used these and many of his other cartoons in his presentations. He is great and makes a conference interesting. I learned so much from him and Ken Bouvier, New Orleans EMS Administrative Liason

In my neck of the woods, one of the major ALS services is in the process of implementing an "ALS Chase Car" to assist the BLS services in 5 communities (actually 6 because we cover a very small neighboring community). I think this is fruitless and I will explain. Their plan: They will station the chase car at the northern end of this combined area as this is where the vast majority of the calls are (makes sense). The chase care will only respond to cardiac, stroke, and mva/major MOI calls (By the way, when asked, SOB does not constitute a cardiac call). When they arrive on scene they will board our rig and take over pt care and some one from our rig will drive their vehicle to the hospital. Additional patient care will consist of ALS drug admin if needed, pacing, and cardiac monitoring (helpful, especially with those cardiac as we have no way to tell what's going on other than they are having chest pain). They will continue patient care with the assistance of a basic until care is transferred to the receiving hospital. They will then bill out there services with ours doubling the cost. Sounds good on paper. Now the reality of things: First off, by stationing the car where they have chosen to gain the most calls, they have put themselves 30+ miles away from us and over 40 to the small community we service. We are 7 miles away from a hospital to the north and 15 to the south. The hospital we transfer to depends on where we respond to. Now, if we have a stroke or cardiac patient (along with several others) we aren't going to putz around on the scene waiting for this chase car to show up some 20 minutes later. We are going to load and go and be to the hospital probably about the same time or close to it that they reach the town it's in. Where is our benefit? If the call is to our south the chase car would spend the entire time chasing us. I don't understand how they expect this plan to work. If the call is for an MVA/major MOI yes they have a chance of making it on scene before we are en-route as it takes time to extricate and/or package a patient for transfer. This one was thought out although we usually call for air support as the patient will more than likely be flown to a Metro hospital anyway. As for the billing aspect, I agree with sending one bill but I don't see a lot of our patients being able to pay the additional cost as most are elderly and on a fixed income or non-English speaking. Our plan: If they want to give us the added service of an ALS chase car, then place one in each of the communities they are offering the service to. I would have no problem with that as long as they responded with us or rode on the rig with us. As for the types of calls they are willing to respond to they shouldn't get to pick and choose, I think if they were here we would use them more often. I also don't believe we would over use them as we are used to being a self sufficient service with apparently many more variances that other services don't have. It may even take some time for us to get used to the idea that we have extra help available but I think most of us would come around. Oh wait, there are those few old timers who think they know it all and need no one. Well, they'll retire soon, (I hope). When would we use them other than stated above you ask? Well, for example; for the child who fell and broke her tib/fib and was in tremendous pain. Having some one there to admin a pain med would have been great. The really sad thing is that there is an ALS rig stationed 10 miles away from another service that would be more than willing to offer mutual aid when needed. The billing issue, I don't know how that would be resolved as there is no real solution in my eyes. You can't bleed a turnip. Unfortunately, we get paid what we get paid. Maybe we leave it up to the pateint if they want the ALS service and that would put them in a binding contract. Hahaha. By the way, they didn't like our plan and said no. So far they are going with their plan although I have heard some talk that they may change the location of where the car would be stationed. Anyone else have some good ideas or insight? What works in your area?

This was said to a medic that I work with by a patient. Repsnded to a call for an 80 y/o/m with chest pain. Loaded the patient and took vitals. She asked him if he is on any meds. He said no. She asked him if he is on Viagra or the like. He said, "no but I would still like to make love to you. With a rack that nice you gotta be great in bed." Dirty old men.

Don't know. I'm not a doctor. That's what he said. I can see if I can find some info for you but it will take some time as I am working the next several days.