letmesleep

This NH sounds oh so familiar, how about we start off with a primary assessment up to and including some vs, BP/RR/HR/SAO2/ pupils, skin, d-stick. what does the vomit look like? send my partner to FIND A CARE GIVER of some kind to get some kind of paperwork on this Pt at a minimum, dispatch another ambulance in case this isn't the only Pt no matter how long of a response they might have at this point......I'll start there.

LMAO.........*points at FIREDOC laughing.........LMAO, old kind of codes.........hahah, wait, damnit! I know what a 10-50 is too!

DID THAT REALLY JUST HAPPEN? good one!

Now wait a minute, the OP seems a little upset at everybody for what 1 person (who may be a paramedic) said in a chat room/ forum. I can see where they might have gotten upset by what a reporter said was found on the internet because we all know that the creditability of journalism has NEVER been questioned, and everything on the internet is as equally reliable!!!!! I for one will start cleaning up my act, and self censoring as to maintain the professionalism of OUR field............roofing!

Another question about this topic......Why is it so easy to say never? This is EMS, do any absolutes truly exist? I guess my point of asking the inital question is: If you do have to transport a Pt in prone position, what steps would you take to monitor? Why is it an absolute NO NO? I will concede (for obvious reasons), and I think most of you feel the same that it is not the RECOMMENDED way of transporting. As FIREDOC just stated, not all combative Pts get transported this way, but is it never going to happen? what if it does, how are you going to handle it?

I worked a 3y/o struck by a vehicle one day. We had to quickly secure the Pt to a LBB, and leave the scene due to a major crowd who had become out of control (very emotionally charged). The driver of the vehicle (who also lived in the subdivision) also left before any emergency response had arrived due to fearing for his life (he was 18 ). The driver did call 911 and surrender to the Police who did not charge him with leaving the scene because of the above situation, and I do agree with that descion. Any ways, PD brought the Mother of my Pt to the LZ where we had retreated to. I did end up pronouncing her at that point in time due to her injuries, and in contact with Med control, of course. We did bring Mom to the ambulance to give her some time to hold her child. I wanted to give Mom some kind of closer, and we did stay with her during this time. The reason we stayed with her? In my opinion, she is now my second Pt and concern. She was obviously beside herself, and did become hysterical at one point. I called Med control, and administered PO Atiavn. We then released her to family once they arrived (they were en route by ground to the receiving facility, and had to return). approx 1 month later I ran into the oldest brother of my 3 y/o Pt. He was very grateful that we handled his Mother as well as we did, and also passed on a thank you from her as well. Obviously there is much more to the story (all the details), but my point was dealing with a hysterical Pt.

D-stick?

Richard, with all due respect, thank you for not wanting to get into a negative debate. Just for the record I have been on a truck for 15 years both in the rural setting and in a "big city". I have worked private sector and tax based. I agree that it isn't always reasonable to obtain VS, but I never said get a set or even a full set of VS. My statement is monitoring your Pt. VS are good, but even a partial set will do if that is all you can do. talking to your Pt, even if all it does is agitate them, to assure they have a patent airway. How many time have you seen people tie down the Pt then start writing their trip sheet/ report? there is no reason not to monitor your Pt some how, hell even if your actively struggling with them you can tell a lot about them like......they are still alive! respectfully, Letmesleep

I just had another thought.....any one who uses IN at their place of employment, would you mind letting me know were you work by means of a PM or here? My thought is to access protocols to assist us with our proposal, you help would be awesome. thanks in advance!

CBEMT, thank you for the article first of all. I do want to pull a single sentence from it tho, sorry my quoting ability sucks.... at the end of the second paragraph the sentence is: "At no time did the ambulance personnel or anyone else evaluate his vital signs during this process." A simple question for continued discussion........WHY? As I stated before I will certainly think twice before transporting in the prone position, but under NO circumstances is it acceptable (in my opinion, and I hope all of yours) to not monitor your Pt. Again restraints are not a substitute for Pt care!!!!!! thanks again CBEMT

LOL....ok, sorry, I should have clarified that statement. the device we found would fit on the syringe, but replace any needle. I guess it would be like teaching someone new to administer a drug rectally.......remind them that the needle gets REMOVED. Another drug we discussed this am was maybe ATIVAN OR HALDOL for the violent psychs that are such a hot topic right now, any input on IN sedation?

I'd have to agree that if a Pt is intubated, IN medication is a little ridiculous in my opinion. What we have found is a device that attaches to your lur-loc type syringe, and when injected it causes a misting action. We also have found that doses have to be condensed (for lack of a better word) into a 1cc (I believe, have to find it again)amount

We were sitting around the station this morning, and a conversation about IN (intranasal) administration came up. I'm wondering how many of you use this? Is it effective for you? What drugs do you administer this way? As well as, what are your thoughts? We have searched for info about this topic, and are going to write up a proposal to Med Control, but we were looking for some "first hand knowledge" on this issue. thanks!

sorry, but I just have too........It's not the size of the ship, but It takes a hell of a long time to get to England in a row boat......or so I've been told......LOL!

Another thought, and a few of us have mentioned "THE SPITTER". I have seen use of the NRB mask noted and the surgical mask, What are your thoughts on these two devices, and do you use anything else? I have heard of a pillow case being use in this situation, the trick is to keep turning it to a dry area through transport so you don't compromise the airway, Thoughts? By the way, sounds like most of the debate has been well stated about prone vs. supine, and honestly I will think differently about prone transport the next time I'm faced with that issue. Also let me throw out there that most of the practices (from the old days) that I and YOU all have mentioned are HUGE no no's these days like the LBB sandwich. Good debate, keep it going!!!!

Is this turning into online MEDIC class? Shane, what about the VS instead of a "dropping blood pressure"? your there, so take the blood pressure and tell us what YOU got, maybe some actual Hx? YOU were there right? So what did the Pt say before becoming unresponsive? Did she stay unresponsive? Hook us up!

LMAO.......I actually have one of my dispatchers sitting here this am. So in his honor I'm going with sick case.......kinda long story but thats what i'm going with.....................

I would hope that wanting to go home as intact as you came to work is the goal of all of us, but do you seriously NEVER deal with a violent Pt? It doesn't matter if they are psych or medical (and I do agree that both of these Pts fall under EMS care as stated above), again "what if" till your blue in the face, but realistically aren't you ever going to have to deal with a Pt that is combative and/or violent? I do agree that PD should be there to assist, as well as, just being a professional witness to protect EMS, but are we really going to just "dump" these Pts off on the men (and women) in blue because "they are to violent, and I'm not dealing with that"? Talk about picking and choosing your calls. Yes protect yourself and your partner, but handle your own business, now how are you going to restrain your Pt? As far as the positional asphyxia is concerned, I read the "lesson" about how the ribs expand and the muscles work, and yada yada. Let me ask you then, If the risk isn't worth it then why splint a spine on a LBB? How is the LBB any different other than typically your not "forcibly" strapping this Pt down? Do you not secure your Pts to the LBB snug to maintain spinal immobilization? Is it just supine position vs prone? What are your thoughts on this? As a disclaimer concerning people being offended......don't be, a little devil's advocate never hurt anybody. I'm just looking for your thoughts, and asking you to step outside your box, open your mind. We have multiple means of monitoring our Pts these days, and If your Pt's respiratory system becomes compromised common sense should tell you it's time for a change, restraints should NEVER NEVER be a substitute for monitoring your Pt. That would be like using playstation to baby-sit your kids. 1st and 10..........

So far some interesting and very professional responses. I will admit that i have done the LBB sandwich (back in the day), as well as prone/ tied/ and the head of the stretcher at a slight incline (that guy pissed me off), prone and supine both, at times i have even broke out the ATIVAN. so lets bump it up a notch, to those who DON'T believe that the prone position is worth the risk let me ask you this, How do you suffocate a Pt in this position? We have sooo many devices out there to assist us with monitoring CAPnagraphy/ SAO2/ EKG. besides the obvious ways to monitor the Pt like talking to them. Is it the belief that if a Pt is placed in the prone position that their face would be smashed into the stretcher there fore sealing their fate? wouldn't some common sense tell us to secure their head with their face to the side? For those of you who would simply defer to the PD, what if you have a medical Pt that is combative? PD isn't going to be the best thing for them now, you are! so tell me how you would restrain them, what are your "PROTOCOLS"? That word is so darn evil sometimes.............

How do you restrain a Pt that is combative to the point of wanting to kill you and possibly rape your partner? there is some discussion in FIREDOC'S thread (FREAK OUT) about this issue and I'm wondering what YOU do. I don't care what psych scenario you want to base your answer on ie: paranoid schizo, OD, pissed off/ spoiled brat teeny.....what ever you choose. Can you effectively restrain this Pt face down, or not? How often do you pull out the chemicals? do you carry leathers and/or soft restraints? play ball!!!

about 8 years ago I had something similar to this....."mary jane" (lol) was getting laced with meth on the street......Pt was speaking in his own language, diaphoretic, combative, spitting, yada yada. we had a few weeks of hell with this crap.

nope, we changed to yard darts....you didn't get the memo?

ok, I'm going to throw this out there. don't know if it's the right way to handle this or not, and credit to DAHLIO for posting this on the " GREAT PSA" thread......agin my apology if I didn't do this politically correct, but check out this link: http://youtube.com/watch?v=6ZafgFvHTTo just thought it fit!

oh, oh, and Ruffems....my answer to your question is YES, I might have done the same thing. As long as you slept well that night knowing that you did the right thing, then yes.

Good one, You made a choice to stay and help for sure. I would have to say that the 2 to 5 ratio is a little overwhelming for anyone. I would have to say that I agree with your decision here, but let me do my own back tracking for a second. You pulled up, did a quick size up, and decided to get out and help. There was NO real emergency medical help on scene ie: ambulance(s). even an ALS rescue truck can be a little under stocked for what you threw out on the table. I would be curious as to what the FF's were getting chewed for....would it be for not putting you to work, or for their attitudes? Maybe I didn't make my opinion clear.....Anyone of us who offers help, and then tries to take control is the whacker! With that all said, how did you handle things after EMS started to arrive, did you maintain control of the scene or turn it over? Again, if it was you showing up, and someone "off-duty" was there.....how would YOU expect them to handle themselves? It doesn't sound like we are on the 2 opposite ends of this discusion, and I'm sure we can go back and forth with "what if's", but it seems to me that with all that has been said so far the question in play is.....Where/ when have you (generic) crossed that line of professionalism? How about this question, and simply stated......Duty to act?