whit72

My god two man stretchers. Thankfully those have gone by the wayside in my area. They were very light. I agree they went nice and low. We use that new ferno chair with the tracks, the only problem I have is it is a royal pain going up with it, if you have basement apartments ughhh. I swear every time i pull that thing out of the truck it gets heavier. Some days I think its made out of cast Iron. It will save your back though. Smooth going down.

This was a sign I used to see all the time on this guy's garage. "Screw the dog beware of the f#ck'n owner." I always liked that one.

Imagine wrote: I had the right to comment on my own personality I usually check with my other personalities before I comment on one. I don't want to offend anyone of my many.

I saw that tilt table test done in an EPS lab one day. Neat.

You strap a gun to your hip and go to another country to protect millions of people you don't know. You got my respect, I don't care what profession in. And if you don't hear it enough, thanks again. =D>

I just read over a few of the brochures. Interesting reading. I will try and read the rest of them. Sounds like this training would be very useful, especially in defusing situations. I dot claim to be a professional problem solver but I have been on scenes with some EMS personnel and frankly if they talked to me the way they talk to their pts. I would want to kick their ass also. I think a big problem is we are not sure how are attitudes or presentation is going to affect the possibly violent pt. Sometimes its like flicking a switch they go from co-operative to violent in a second, these are the ones I am most concerned with. I can handle the drunk, or the punk ass kid showing off in front of his buddies. The truly psychotic ones, you cant predict their actions. Good luck with these classes. I am sure they are very successful

Ruff wrote: ok, my 4 most memorable calls on new years eve 1. 8 year old who was playing with alcohol based lighter fluid and it spilled on his private area. he then lit a match in bed which is where he was playing with the lighter fluid to see where the alcohol spilled. It took him about 5 seconds to realize his winky was burning. Dad runs in the room and says what's wrong and the boy yells, "I'm burning" and dad says go to bed cause he can't see the fire. Dad then realizes after he see's the can of fluid that his son was telling the truth. He puts the fire out and we get called. 3rd degree burns on his you know whats. This got him a helicopter ride from his house in a very upscale neighborhood. 2. Call on a pedestrian struck injury accident, on arrival found a 29 year old man nearly cut in two with one leg amputated and the other connected only by some skin and the femoral artery. You could see in his pelvic cavity. That one was cool 3. 12 year old raided daddy's liquor cabinet, went out to the train trestle and proceeded to get drunk with his friend. He fell 35 feet face first on the rocks below. Near Trauma code but he survived. Alcohol, the greatest muscle relaxant of all. 4. 16 year old hit by a train - massive head trauma, local trauma center refused him even though we were 3 minutes away and said to take him to the childrens trauma center. Not withstanding the 16 year old was 230 pounds and alcohol. Called for a helicopter to land at the local trauma center's helipad and an ER nurse came out and told us that since we were on their property he was ours, I said NOPE NOT YOURS as I'm intubating him. Helicopter lands, ER doc of local trauma center is now outside of our ambulance and is PISSED. We put the patient in the helicopter and he goes to the childrens' hospital and survives with many residual problems. COBRA investigation ensues, COBRA sides with little ole ME and the doctor apoligized. He even said Happy New Year after it was all over. Those are my 4 most memorable calls on new years eve or day. I hope this was during your career and not all yesterday.

DT4ems wrote: I can assure you the litte "tap" (aka the DTP)would be the FIRST thing I would use against a 250lb person high on meth.....while I screramed to my partner to hit the brakes to let me out. The DTP was designed to help not take the pounding or wrestle with the guy that feels no pain. The Idea is to not be put in the situation where you have to defend yourself from that person. Entirely why if I feel threatened he doesn't ride or the PD comes with me. Side note to that that story, he picked up a refrigerator in the area they were holding him and threw it halfway across the room. So as much as I am sure that maneuver useful in most situations, I would rather wait for the guys with the badges in this instance.

Once I began to do a little reading on the subject, the statistics that were being thrown around were astonishing, however there were no facts to back up what Heimlich's findings were. That normal resuscitation efforts would not have produced the same statistics. I just found it some interesting reading.

I don't have extensive experience with drownings. However I have treated the few with normal resuscitation attempts. Thanks for the info provided. I have also found some articles online that have dismissed the use of the maneuver in the drowning pt. Thanks again.

I was just curious because I was talking with family member over the holidays he had taken a life guard training class a few years back in high school and was taught the Heimlich maneuver when resuscitation efforts were unsuccessful. I had remembered hearing about it but didn't have much info for him. I was just curious had anyone else heard of this method being used. Near drowning defines a person that has been successfully resuscitated. I believe.

I had just read an article about the use of the Heimlich maneuver in the near drowning victim. I understand the physiology of drowning. I was just wondering if anyone had any experience with this or had any information on the topic.

I know what the science states about performing the hiemlich maneuver in near drownings before attempts or after attempts of resuscitation have failed. Do you attempt to empty the lungs first? Do you attempt resuc. efforts first? Do you just attempt resuc. efforts? I was just wondering what some of your experiences have been with this maneuver in the field. If any. I was just wondering if anyone has had success. Thanks

Ummmmm I think I stated removing the little old lady who pinches you or the assault caused by a pt with suspected injury or illness from the scenario, no other assault or attempt will be tolerated. I will let slide you personal attack again, sighting your obvious flaws in reading comprehension. Nremt basic wrote: I have been punched once and grabbed by the throat once and there was no available PD intervention in the back of the rig. Simple tap and escape maneuvers, and pulling over to the side of the road were what was required to regain control of the situation. Well you attempt your tap and escape maneuver on a 250lb mad man amped on meth. I will just wait for the the guys with the guns to arrive. Yes I will call PD if I feel threatened before the situation escalates to the point where someones safety is in serious jeopardy. I don't take the wait and see attitude.

OZ medic wrote: Backboards are extrication devices only and should not be utilised to transport spinal patients on! Taping/strapping the head only potentiates the problem and increases the risk of injury exacerbation and aspiration. Studies utilising CT imaging have demonstrated the inappropriateness of this approach not matter how much the patient is trussed to the board (this goes for KED type devices as well). The most efficient method of immobilisation is the full vacuum mattress, if this is not available then scoop/back board the patient onto your stretcher mattress and place 1 towel rolled from both sides under the patients head to minimise lateral movement. Do not tape the patients head in any circumstance!! Again these methods have been shown to be the most spinal friendly by the utilisation of CT imaging. Although I have read a few studies stating these exact facts, to state no-one should be secured to a spine board and their head not taped is dangerous. I am sure his medical control might have a different opinion of this. You area may be a little more progressive then most, but to throw out a blanket statement that no one should be placed on a long board could cause problems for all parties involved. Whether the findings are substantiated or not people have medical control to answer to. I suggest discussing it first with them before making any personal decisions about not using standard c-spine immobilization practices The whole idea of c-spinal immobilization is coming under fire, however it is in its infancy and should not be condoned until more studies have been conducted. I have read numerous articles condoning both sides of the argument. Whether I agree or disagree is a moot point. The fact is that proper c-spinal immobilization using standards that have been set forth is still recommended. Deviation from this could be problematic, even though its effectiveness is be questioned.

To accept abuse or assault because its part of your job. Violence is never accepted, in any field. Removing the little old lady that pinches or the assault due to injury or illness. It should never be accepted or dismissed. I am not here to be used as someones punching bag, I will and do defend myself to the extent needed to secure the safety of myself and partner. The safety of yourself and your partner should be of the utmost importance. You are in a very vulnerable state in the ambulance, close proximity and a difficult escape route can be hazardous to your health. So if the possibility of violence is even a remote possibility the PD is called, and we wait. No exceptions, no deviations. Myself and my partner will be going home in the morning.

Five-percent of your calls are true emergencies? I stated I would not take a person from a residence half naked. Anywhere in that statement did I make reference to you? I don't believe so. This thread was not about packing a wardrobe, it was about pt attire. Correct? Commanche wrote: If my patient calls me its because it is an emergency. There wont be time for them to get dressed and they shouldnt expect me to help do so. They call because they need immediate care and or treatment. Then you wrote this: whit perhaps you might want to check the link below. You say 30% are true emergencies?! waw, I'm going to relocate to where you are mate. Sounds much funner than where we are here...in EMS only about 5% of calls are true emergencies..... So yes I am a little confused, I however don't think it has anything to do with my reading comprehension. However if I was the source of the confusion I apologize.

Comanche wrote: If my patient calls me its because it is an emergency. There wont be time for them to get dressed and they shouldn't expect me to help do so. They call because they need immediate care and or treatment Hmmm.........Interesting thought. It would be nice if half the calls I went on there was a need for immediate care and treatment. I would take thirty-percent. However their definition of an emergency and my definition of an emergency seem to differ considerably. So I will usually find an article of clothing to put on them, or cover them with. I don't drag half naked people out of their houses, unless I have a reason to. I don't live in a climate thats sunny and seventy year round and the blankets we acquire from the hospitals I could spit through. Does it take a extended period of time to find something for them to throw on, so they don't freeze to death?

dzmohr wrote: Let me ask you this, I am driving near your house, you and your family have just been in a MAJOR MVA right in front of me! You appear unconscious but your wife and three kids are trapped in the car trying to get out, obviously panicked and there is smoke and flame showing under the hood, do I follow your advise call 911, stay in my car and keep driving or stop, use my extinguisher and see what I can do to help your wife and kids ( leaving you alone to wait 20 minutes for the delayed response due to traffic, since that is your expressed wish from this post.)? First, I am sorry if you find my post judgmental. As I stated MOST are not prepared or equipped to handle the situation. I have been driving for almost twenty-years and in that time I have never come across a situation in which you describe. Yes, I would be thrilled if you stopped to assist my family from a burning vehicle. Would I expect you to? No. What I don't want is innocent people being injured tending to injured parties without the equipment necessary to do it safely and effectively. I might have two trucks responding for the three reported injuries then you are injured in the process. I now need additional resources which in turn delays the care and transportation of the originally injured. Not to mention your vehicle is probably parked in an area and does not have the proper notification system to properly alert passing motorists to its position, they are to busy watching, and taking pictures of the bystander rendering care. SMASH, CRASH, BOOM, more injuries, more resources, now although your intentions were good you have completely stripped my area of available units that could be handling other emergencies. If you think this is far fetched it isn't I have had motorists smash into fire trucks, my ambulance, the guy in front of them, the crowd that has gathered to watch the show. This was not a personal attack on people who stop to render care in life threating situations as you described. Yes, put the fire out, now you notice one is critical do you have the resources to handle c-spine stabilization, and airway maintenance simultaneously? Which do you neglect. Yes your original intentions were true, however now you find yourself in a situation you can not possibly handle alone. So you do the best you can, re align and clear the airway and spontaneous respirations return, however your actions may not have directly caused a cervical spine fx, however there is one present. Do you think people will just let that slide and just thank you for saving their loved ones life? No. Because the lawyer everyone has on retainer will place the blame solely on you. You should have known, you are trained, oh your educated even better, then you should have definitely known. That lawyer will have a field day with you. Its sad but its the world we live in, you have to take that into account.

I just do not understand the reasoning behind stopping at MVAs when you are off duty. Yes we all have an obligation, and its nice to read of the stories in the paper about the off duty EMS professional that saved a life. Its not so nice to read about of same off-duty person with a wife and three kids being killed or injured while he was attempting to render care in a situation he was not prepared or equipped to handle. I have been nearly killed a few times at MVAs while on duty and thats with a ambulance with flashing lights, two or three engines with flashing lights, local police, state police, all with flashing lights. I cant understand the reasoning behind it. I might have an obligation, I also have an obligation to my family, not to be killed in a roadside accident that I have no business being at. I don't take risks on duty, why would I ever take them while off duty. I am not driven by the fear of litigation, however when you are not equipped and prepared as you are while on duty. You will mis-step and when every Tom, Dick and Harry with a cell phone equipped with a video camera is looking for the money shot, you should tread lightly. You might have the best interest of the pt at hand, however I can assure you the twelve-person jury of your peers in the civil suit also will, and they probably wont be driven by what your initial interests were. So do yourself a favor stay in your car in the traffic and let the pt wait the five minutes for the on duty crew to arrive, just like everyone else has to. I have paid accidental death and dismemberment premiums to long to let my insurance company off the hook by being killed while off-duty.

You said she was African American, how about acute chest syndrome caused by an undiagnosed sickle cell disease. Probably a reach but I thought I would throw it out there. Although the symptoms seem to relate. Just a thought.

Thanks for all the replies, I will look for the language line.

I have heard of these studies also read a few myself. I believe that stating the paramedic does not effect the outcome of trauma pts is a little empty headed. I believe the information just points to the fact that the human body is not meant to sustain traumatic injuries. It dosent have anything to do with the level of responding providers. Time is the most crucial aspect. So maybe they don't affect the outcome of these pts, I don't believe anyone would. I did read one study as to the effectiveness of ALS in trauma situations, with short response times in which the receiving hospital was a level one trauma center, there was no definitive difference between survival rates in the ALS pt as opposed to BLS pts or delivery by personal vehicle. I again think this only points to the fact that time is the mitigating factor. Trauma is multi system damage done internally. The only way to correct that is surgery, if it can be corrected at all. So Although there are a few paramedics I would like to throw off a bridge at times, to state the paramedic is useless in the treatment of traumatic injuries, I believe is incorrect, a more fitting statement would be that everyone, except the surgeon is pretty much useless.

I got it........Although I have fell for it before. They don't bury survivors.

I was just wondering, with the increase of non English speaking population soaring in the United States. How do you handle the different problems that present themselves. This has been a growing problem for me over the past few years, with what seems like the majority of my pts being non English speaking. I worry at times that I can not completely understand or decipher the needs of the pt. Not so much in the critical category, as with those you can usually decipher through assessment or the context clues. Its more the non-life threatening issues that arise that at times I cant seem to get a handle on due to the fact that I can not converse with these pts, in other words finding and otherwise healthy individual seated at home, with no visual clues to injury or illness. I find these the most difficult situations. When I am trying to communicate with these people I am weary that I am not able to get the gist of their complaint and worry at times that when I drop my note to the ER that I may be leading hospital staff in the wrong direction. ( I have attached an article for you to see what I mean) http://content.nejm.org/cgi/content/full/355/3/229 I have tried the english to"______ " guides. (Fill in any of the twenty different languages you may come in contact with on a daily basis.) It seems as if the different dialects of spoken languages the words or phrases often have different meanings. We don't have adequate translation services although there seems to be a new phone system coming on line soon in which you can request an interpreter if you are able to identify the language. Just wondering how you handle these issues.