whit72

I would have to say he was probably at least 50ft in the air. Thats definitely gotta suck on the way down.

It isn't cool to come off the field on a board. That is what its all about to these guys, Im tough, that didn't hurt. It shows weakness and you don't want the other team seeing weakness, it gives the other guy a mental edge. These are adults and if thats their choice to walk you have to honor that. Most pro sports have doctors that come out on the field that assess the players, if they feel they need immobilization then it is applied. It just shows how truly few actually need full c-spine immobilization. In EMS its applied way to much at times to the detriment of the patient.

"Up too and including death." That is my favorite line, everyone gets that no matter what the complaint. I usually have a relative or someone on scene with them sign as a witness. Refusals are usually easy to discard in court due to the fact that they could have been signed under duress. So I explain to the pt. and someone with them so they understand the risks of refusing treatment. Then they both sign and I am on my way.

1. They have to make decisions based on your radio patch. If you call in a code they should have a medical team standing by. If you call in significant trauma they should have a trauma team standing by. I would fly anything lifethreatning if they don't have the ability to treat it there. Cost does not factor into me calling a helicopter, injury does. 2. Thats political bullshit, you should probably stand clear of that. I don't care if the presidents standing by, what they do after the patient is off my stretcher is their business. Sounds a little hinky though. The Feds will catch up to them if in fact they are fraudulantly charging people for services not rendered. It might take a while. 3. The ER should not be your concern, if the receiving hospital does not have the ability to treat the patients injuries. They get flown, end of story. If they want to somehow discipline me for that, they have that prerogative. I also have the prerogative of singing like a 500lb canary to all the sketchy behavior it seems like this hospital is up too. Just my opinion.

Maybe she s orthostatic? Was it hot out? Was she exerting herself? What was her pulse rate when you noted the falling BP? It could be anything. I guess. I am guessing the most likely cause to be the NTG.

I need one of them for rush hour traffic. Does it have guns on it? Guns are cool and work way better then lights and sirens for moving people out of the way.

Medic3326 wrote: The reason being I take care of my employees. That about sums it up. If you can stay true to your employees they will work hard for you, as I am sure you know. This could be and sounds like it is a win win situation for everyone involved. Congratulations on running a successful company that hasn't lost sight of the litlle people that make it go. =D>

I would agree with Ruff. Services that have response time limits are definitly asking for trouble. Out of chute times work better and dont put the public at risk.

I am not sure if you are confused. NTG can cause hypotensive periods. (low blood pressure) The dip in her systolic on your arrival was probably due to the NTG administration. Like rid stated. The effects had probably worn off by the time the medics arrived. Her systolic pressure would have returned to normal or slightly elevated like you explained.

Richard wrote: There are areas where that is the policy, but there are areas where whatever ambulance is the nearest, from that service, will handle whatever call comes in first, dependant as to the call's priority. Oh really. I guess that could be a problem then. I think you have to distinguish between the two 911 and transfer. When you start blurring the lines thats when the problems will arise.

Blood pressures are effected by everything. Alone you cant base a treatment on one pressure reading. There are to many factors which can effect them. Like dust said could be the use of different machines. The hospital cuffs and the bp cuffs attached to the monitors need calibration which they rarely or never receive. At least in our area. Nothing compares to a manual pressure, or if you cant get one, if a radial pulse is present she has a systolic of at least 80 or so. You can learn a lot from simply taking a radial pulse. The nitro is probably the most likely culprit. Always ask if there was a burning sensation under the tongue after the nitro is administered, that will be a good sign that it was still effective, and may be the reasoning behind the decrease in the systolic pressure.

I am not condemning anyone. I just think there are more useful roles for them to play. Just my opinion.

I don't know where you work, but the 911 trucks in most private companies I have experience don't do transfers, so them having a dialysis call over a choking kid is never going to happen. They are dedicated and all they do is 911.

Kristo I think you need to loosen up.

Because if nurses start manning ambulances the almighty paramedic wont be the highest level of care, A shot too the ego that some medics couldn't handle. When 90% of your call volume could walk to the hospital. It barely justifies a paramedic never mind a nurse with 6 years of education. I believe its wasted, keep them where they be beneficial to the most people. In EMS you treat one at a time. So if its a stubbed toe you own it. How long you think their going to hang around making 18hr transporting people that don't require their education, before they quit get a hospital job paying double that, in a safe controlled enviorment without the issues and political bullshit? Thats why I believe whole heartedly in the tiered system. The burnout ratio isn't as high, the medics get too use their skills, and stay sharp and the EMT gets to experience the emergency setting. Save the "No EMT should be on an emergency ambulance" crock of shit. I am sick of hearing that. Most EMTs with half a head on their shoulders can handle the majority of what they will encounter.

Does it really matter what uniform your wearing? If your private, civil or whatever your care should reflect competent professionalism. I have met fantastic providers in every type of system, and everybody's got meatheads. In the private system I worked in the company had no control over you. You were controlled totally by the fire dept. Dispatched and so on. If you had equipment failure or scheduling issue a transfer truck was downed immediately to put you back in service. They usually have unlimited resources also so you not scraping and stressing other nearby areas to satisfy your call volume. Your also not locked into the same area forever, they usually hold multiple contracts so transferring to different areas is possible. You can work in busy systems or quieter, urban or rural. You can get a variety if you so choose Their downfalls are many, but mostly on the transfer side. Not so much if your in a 911 system. The pay was pretty good and the benefits were better then some of the municipalities. 401k vs pension and so on. So I guess they all have the positives and negatives. Its what you make of it.

Seventeen years old? I am not knocking you, I am sure you our quite capable, but I am going to assume all seventeen year olds are idiots until proven otherwise. Then again I do that with every provider I don't know, regardless of age. Around here seventeen year olds cant even drive a car after a certain time. Never mind an ambulance. I do agree with your decision.

We have a zero tolerance policy. No drinking while on duty, as if you needed a law or rule to state this. It should be common sense. Our we that simple that we need to reference a a list of policies to figure out what isn't appropriate behavior.

They have their good and bad points like anything else.

Fiznat wrote: I dont think you did anything wrong, but I'd be interested to hear a little more of your defense as to why the seemingly CHF-sounding factors didn't sway you from your pneumonia diagnosis. I agree. It sounds like classic CHF to me. What besides the productive cough, pushed you to pneumonia? Everything else seems to point to CHF.

Is it me or does the sight of someone with a stethoscope wrapped around their neck in Dunkin Donuts make you want to punch them, even if it is a thousand dollar Littmann. I still to this day don't understand carrying a stethoscope around you neck. If anyone can clarify this behvior, I am all ears. I have been doing this for while and never once have I said shit, I wish I had a stethoscope, while I am getting my F'n coffee.

Transfer trucks are a great learning opportunities. I think everyone starting out needs to spend some time there. I used the time to assess everyone I came in contact with, you name it I assessed it, from blood pressures, to bowel sounds. I got some dirty looks, and I am sure I offended a few people . These people are truly Fk'ed up. Their missing body parts, organs, their on every medication known to man. They have medical histories as long as your arm. Their great learning tools. I used to talk to them about their symptoms when they came in, what they went through in their hospital stay. Its incredible how much you can learn from them. Sure its not flying by the seat of your pants emergency medicine. It however can be very useful to the new provider. Thirteen or so years later I work solely on a 911 truck. I transport drunks and fruit loops all day. Hmmm......Real interesting. My patients usually need taxis not ambulances and psychiatrist not EMS providers. I do get sick people it just seems like their few and far between lately. You know EMS. I am over due for a real bad spell and I am not looking forward to it.

Fireland wrote: That was 18 years ago since then I have never allowed a call to get in the way of my day I treat every patient with respect and give them my full attention no matter how small I may think their complaint is. I am full time now and we run a tremendous amount of calls and it does not matter if I am on duty or off and do a call-back the patient gets my full support. +1000 for remembering the true meaning of being in the helping field. I am positive you are an asset to your community. Keep up the good work. We need to all remember this as we go about our day. When I first began this field did a number on me emotionally, I couldn't forget, I always wondered if there was more I could have done. Every call felt like I was on this roller coaster of emotions. Today I am much more even keeled, I have a true understanding of EMS. I am not here to save the world just leave it little better then I found it. If thats just holding the hand of a scared patient, or just sitting with someone because their lonely. I realized a long time a go that this job has very little to do with saving lives.

Happiness wrote: ps of course once the car was removed we did a full assesment You did a full assessment on a flat person? Sorry could help myself. I have done a number of ejections. They very rarely have a positive outcome. I have done a few though that have made complete recoveries to my astonishment

So what makes everyone so sure that if the volunteers stopped showing up that would force their town to have paid providers? I have seen this before and they don't pay anyone, they just call mutual aid from another paid community. I agree if you have given it away for years, no ones going to want to pay for it. That does hurt the professional EMS provider. But you cant just stop showing up, that dose not benefit anyone. Just another issue to put on the list of things that need to be fixed in EMS. Pretty sad that in a profession that has been around for a while now that things that need to be fixed list is still infinitely larger then the things that work.