Kaisu

Thank you for your service. Welcome home and welcome to the city.

Thanks Dfib. Keep an eye on the niece too. Just because she self extricated and feels "fine" doesn't mean she isn't seriously hurt. Her body was subjected to the same forces as her uncle and may start circling the drain in front of your eyes. She's younger and may be compensating well. That could change very quickly.

This is compensated shock. At that HR and and BP he is going to decomp fast. 1 hour extrication does not bode well for this patient. C-Spine, etc needs to be in the hands of the EMTs. Stop any obvious bleeding. Avoid positive pressure ventilations. Consider MAST trousers inflated in the lower extremities only.... Do NOTHING to delay transport. Forget the rural center. Nothing they can do that you can't (that matters). Get him to the 25 minute destination asap. As long as they have surgery, this patient's big issue is the abdominal bleed.

That's crazy. When I bring in one of those, in my radio patch I tell the hospital the patient is triagable. They meet me at the door, sign for the patient and walk the patient into the waiting room. (I make sure I don't start an IV.) No fuss no muss

The only thing I can think of is skin turgor, which is totally subjective.

Your gut feeling means a lot. To test it, I would check to see if his heart is in the right place. I know a lot of providers that vent in quarters, yet in the field they are empathetic and committed to patient care. I have seen the most callous provider treat a street drunk with tear inducing kindness. I have also known supervisors that have seen "something" in problematic individuals and protect them and mentor them for years. It was not good for anyone. The protectee is prevented from the reality checks that would make them or break them, and other crew members are resentful and contemptuous of the baby. Why do you want to do this? Does he remind you of yourself? There is no question that this young man is immature.. he's 16 years old for gosh sakes. He's supposed to be immature. Is there a place for him in EMS? Not on my squad. - not yet.

How much time and effort do you want to devote to child raising? How do your crews feel about participating in the child rearing. The youngster appears to have opportunities to mature on someone else's turf (the neighboring fire department). I would gently explain to him that there is not room currently on the team for him, but to keep in touch and offer to assist from time to time. edited because my thumbs hit the touch pad and posted before I was done

It ain't bragging if its true

Fie on that crew for not locking their ambo....

A lot of things that work great in the lab are unworkable on the street. A few years ago, our company added a glide scope to our airway arsenal. It was one of those visualization peer in things that easily showed a great view of the cords on the mannequin. Guess what? in the field they fogged up, obscuring the lens. Secretions and the malleability of the tissues made them useless. ETT is still the gold standard and there is a reason for that... and really, it's not that hard.

gag edit - and I have almost no gag reflex

I believe those outcomes are attributed to continuous quality compressions

I would suggest the CDC's plan for a zombie outbreak. I kid you not, look it up. edited to replace invasion with outbreak

hmmm.. response time discrepancies were a matter of seconds, not minutes.... sounds like a consultant looking for a job... or politicos trying to make hay....

These things are too difficult for people to think about for any sustained moment in time. It makes people uncomfortable. Until people are willing to bear the pain of dealing with this, progress will be extremely slow. It's the big black dog in the middle of the room that everyone would prefer to ignore. The person that points out that there is a big black dog in the middle of the room will be villianized.

You guys read cracked right? It's humor.....

gee I don't know.. sounded pretty accurate to me

Please do not feed the trolls... or others of their ilk....

I know this topic is dead, but I wanted to update you all. I found out that the gentleman did go to his doctor the next day. It was a malignant melanoma. The man had surgery and chemo. He is back at the gym and cancer free. It made me so happy! He credits me with saving his life. I can't tell you how awesome and humbled I feel. Makes everything seem worthwhile. I had to share it with you.

.. and who is qualified to make that call? Certainly not an EMS hero. Who better than the patient themself, hence advance directives, DNRs etc? In the absence of expressed wishes of the patient, then why not those that love the patient? I know that as an old person, the things I derive joy and satisfaction appear pretty boring and non-fulfilling to the twenty somethings I run with. I am pretty sure my perspective is not that of an 80 or 90 year old. My mother at 84 lives to see another sunrise - she loves them. Just because she is physically and mentally incapacitated, who am I to say she should go? She wants to stay- regardless of the indignities of incontinence and the pains of a failing body. Now if she codes, I would let her go, because she has told me she is ready anytime. Her cousin, 86 and in worse shape, says "do everything" otherwise how would God be able to demonstrate a miracle if that is what He has in mind?" Doesn't make any sense to me, but it is her life.

There is the law.. and the law states that without a VALID DNR and obvious signs of death the code is worked. We work within the parameters of the law.

Had an 88 year old witnessed arrest at a nursing home, family in the room, full code. Daughter screaming to save him save him. Protocols insist we worked him. We had been toned out for altered level of consciousness, downtime when I walked into the room of less than 2 minutes. Rolled him onto the floor, began compressions, rhythm check as soon as the pads were on. He was in asystole. All rational reason says do not work him but the loss of a father was too much for the family and they wanted "everything done". Lo and behold, after 2 rounds of drugs I have a perfusing wide complex bradycardia and a systolic of 120. Patient was tubed with 100% O2 and 34 ETCO2. Roll into the ED and the doc is pissed. He asks the daughter "do you want him to live forever?". The daughter asks me if it is possible that her father will recover from this. I state that "something made his heart stop and unless that can be fixed, survival to life with any kind of quality is unlikely. The patient died 3 hours later and they left him dead. So - asystole on the scene, the much balihoed ROSC and the end result was what? Huge transport and ED bills, the father's body subjected to all the indignities of a code, including broken ribs, I/O, intubation, etc etc. The only comfort I take from all that effort is that the family knew that everything that could be done had been done. Is it enough? Not for me to say. From my point of view no. From the family's? Only they can know. I don't believe we will ever educate the public to the extent that our point of view becomes shared.

My guess is that we are not. Dwayne - where are you? I hear zebras

I think you underestimate the skills of a good EMT. The ability to properly size up a scene, parking well (so we can get out - FAST if need be), patient assessment, knowing what needs to be done when, safe gurney handling, lifting, radio operations, etc. etc. etc. There is no doubt that timing and fine tuning of skills and abilities is adversely impacted when they are not being done on a regular basis.

ALS team - medic and emt. Unwitnessed arrest, unknown downtime, assuming no obvious signs of death (lividity, rigor, etc.) Is the guy warm? How's his skin? Be that as it may, my emt immediately begins chest compressions. I drop in an OPA, put on a NRB with high flow O2 and attach the cardiac monitor - paddles, remembering to plug in the patient cable. Quick femoral check to make sure compressions are producing pulse. I turn on the CPR feature on the LP 15 because EVERYBODY pushes too fast, even experienced providers. The metronome feature is much nicer than yelling at your partner to slow down. (It is helpful if the ventricles are actually filling during compressions.) I have time to open my drug box, get my IV setup and EZIO. By this time, 2 minutes are generally up and it is time for a rhythm check. What is on the monitor?