Sdowler

Working for my service I have seen some shady things with medicare and medicaid. The patient that has dementia and is traveling by EMS. Why is this patient going by ambulance? Well for safety and security of the patient and the driver. I will document what I see. On the pcs the patient is not ambulatory but when you enter the room that same person is walking around. Do patients traveling with hip precautions need ambulance how about knees. Non emergent evals are interesting. Read the FAQ for medicare just because 911 is called does not mean transport was indicated.

then fling at

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EMS should be EMS. No fire based or police based. Private service may be able to better cover Rural areas but I do not feel that hospital based EMS should be working in the hospital doing stuff other than EMS.

Cambridge has a tiered system where the city will transport mostly BLS and then PRO EMS will provide contract ALS. But the city has Medics and will transport ALS on their own. The engine is back up.

What I have noticed is the recent trend toward electronic run reporting and the questions being asked. The NH TEMSIS system is a copy of a model in use by many systems and one of the questions that will cause a "kick back" is the SSN. Several other questions arise with billing info beeing sent to people who have access at the admin companies or the IT guy at some large services such as AMR, Rural/Metro or whatever.

Secondly If you transport more than one pt is that a violation?

Third Hall beds have no privacy.

My service in the US just voted a strike on both the east and west coasts

OK my spelling went to the toilet sorry

The EKG licks possibly like a right sided MI with depressions and QRS widening in I,AVL, V3,V,V6, also maybe a BBB

OK RTA = Rapid Trauma Assessment

The H&H thing was just a joke for someone else on the forum disregard it

If her GCS is so low how does she have a gag relex or am i picking nits

sorry not my point. just an additional source.

Dust are you saying that cardiogenic shock saved the pt due to other complications?

I like exercise induced Rhabdo

TX is IV sodiumbicarb i think

Dust what is your opinion, nasal intubation or RSI if the NPA is not good enough and the pt is difficult to ventilate.

Side note what is her EtCO2?

what is her h&h

trendelenberg :twisted: :twisted: :twisted:

Ok lets see,

Pt is rapid transport

request ALS

C-spine protection

any other patients?

A) gurgling respirations - reposition airway with jaw thrust since we can't rule out trauma suction prn

8/min tolerates NPA gag reflex if the patient is pink and people are limited my questions are: will the NPA allow us to use a nrb or does my partner who is maintaining spinal precautions having to jaw thrust her still. If shallow resps BVM @ 10/ min

Question lung sounds

C) skin color temp and moisture Iv lock as noted above base line V/S

Monitor 12 lead BGL is fine

Seems no finding for RTA

Seems Initial GCS of 10

Secondary survey:

Review ABC changes and monitor therapies head to toe palpation inspection auscultation, meds allergies

any odors in the house any other feeling ill?

Are there any personnel from Calgary, Alberta EMS here? I believe that is a very progressive service with a very high save rate. I think JEMS did an article on them. Maybe they have some concrete definitions and science for what is a save?

I have to agree that it is all about timing to save a patient. If awards are being given then maybe no deficits is a tough requirement. We are limited in the amount that we contribute to the patient's neurological condition.

Last Friday I was asked to transfer a pt to snf. dispatch sent us to the wrong city and added 60 miles to the trip for the pt.

Good I like lies.

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while doing clinical time i saw a device that used fiberoptics and allowed venyilation through an lma while passing the tube through the lma

if you use a duo neb then the bronchodilator effects will be minimized and as long as there is no localised consolidation lasix may be in order.

I am not another basic asking for ALS skills. This is about education and if the ALS providers want to educate BLS providers then why don't they? Let's face it some areas NEED ALS available for their skills, but do we want BLS to call ALS just because or do we want them to know why they are calling them?

A very big part of my post describes some things that EMT Basics can do. Some states do not recognize the EMT I and those skills are divided down and as EMT HP only. I feel that if you work in a system and are unhappy with the care of your partner or the area providers, then maybe you should have more input.

The posts that are written here represent some very educated people, some of these people cannot use spell check appropriately and some are EMT Basics and some are EMT Paramedics. This is a basic skill and it should be mastered otherwise don't work on any body