captainstandup

While I do understand the OP's concern for their legal risk on both sides of this equation, I also would offer this opinion.

Drug abusers', whether wearing an EMS, Police, Fire, RN, MD, uniform or filthy rags of a homeless person are at their very core drug abusers. No more, no less.

Due to the "professional's" access to pain medicine, it makes for a very tempting environment to either steal or divert narcotics to themselves. News media of all forms are replete with seemingly countless examples of prescription med theft and instances of providers "diverting" or stealing narcotics through the practice of removing narcotic meds from vials and replacing it with 0.9% NaCL.

In the example offered by the author, it is apparently uncontested that the student has a drug problem.

From my perspective, the next time this person presents to class in an apparently intoxicated state, the instructor should contact security and have them removed from the class. Of course college policies must be adhered to implicitly. Once the student is removed from the classroom I would recommend insisting on a drug test to include hair analysis and a urine drug screen.

Be very careful in allowing someone you believe intoxicated to drive. You could be exposing yourself to liability. If they insist on driving, call law enforcement.

A policy containing the following would be helpful, along with requiring all students to sign a "Drug Free School" agreement.

If the students tests positive, they would then be required to produce a prescription validating the reason the substance was in their system. Those without a valid reason for being intoxicated with the substance would be given one opportunity to "come clean" about their drug use / abuse. Dishonest individuals must be discharged from the course for violation of the drug free school policy.

Honest students would be referred to the college version of he EAP for counseling and rehab services. Following completion of these services the student would be responsible for payment of periodic and unannounced drug screening to remain in the class. Any positive test would result in immediate dismissal from the program.

Remember, regardless of who they are, drug abusers are not rational when needing access to the substance of their desire. Normally professional individuals have and will do virtually anything to satisfy their desire for the substance they are addicted to. This includes stealing meds from cancer patients, stealing meds from anyone they can, including patients they encounter in the clinical environment. It is your job and your responsibility to protect the patients from these individuals at all costs.

Clinical Contracts / Agreements are precious to EMS Educators. If just one of your students is stupid enough or addicted enough to violate the trust afforded them by being allowed in this environment, it will be as if they opened Pandora's box. I promise you, if this happens, hell will pour out of it and your clinical agreements will vaporize overnight, and so will your career as an educator if you haven't shown "due diligence" in attempting to prevent the occurrence.

Was his cath done at a pediatric or adult facility ?

If it was done in an adult cath lab, they had better da*$#d well been certified to perform pediatric heart caths and immediate access to a CV surgeon capable of emergency pediatric surgery.

Sorry I've not been around much lately. This year has been crazy for me. This post comes from some of the stuff that I'm dealing with personally.

I have a 12 y/o son who was dx with WPW in April after running SVT for over 2 hrs and having to be given adenosine to stop the SVT. He had a cath ablation done May 10th. On May 22, he ended back in the ED with short runs that went as high as 306 bpm. Since then, he's not had any recorded events like that.

My son had to go to WY for the summer, so I wasn't able to check up on him like I would have liked and dad didn't take him in for the checkup that he needed over the summer with the cardiologist. He returned home on August 7th. Since then, he's complaining at least 2-3 times a week that he's having cp, h/a, SOB, nausea, and dizziness. We ended up with him in the ED on Sept 6, and the doc said he was in a NSR with ST elevation. On Sept 11, he got dizzy while taking a shower and ended up slipping and getting a concussion due to an episode.

Last night, he was with me at a football game where I was working on the ambulance when he started c/o "the normal". I could feel the irregularity in his pulse, so I got him on a monitor and had the ALS provider that I was able to get out there to take a look at the strip. He said it was a sinus arrythmia with the hr ranging between 54-88 bpm, and it didn't change with O2. With the hx and the fact that the kiddo was A&OX4 and tired, the ALS provider suggested I take him home and watch him. By this morning, he was back in a normal rhythm. He had an 11 am appt because of the concussion, and I took the strip in. The PA looked at the strip and listened to what's been going on. She then had a 12 lead done (NSR with ST elevation again) and a CT and chest x-ray (both normal).

It seems that his heart is showing the dysrhythmias more in the evening the closer to bedtime we get. He's getting extremely grouchy and acting depressed. It's making it almost impossible to get homework or chores done in the evening. He's even lying to me about having homework to the point of getting an F in math because he's just to tired to want to do it.

Besides getting him into the docs here, I have been in contact with the cardiology dept at Children's. The 1st available appt was Sept 21, so we'll be going up then. I also leaned on them about wires getting crossed and an event monitor not getting sent out at the end of May. We should have an event monitor Monday evening and be able to start tracking the episodes with that.

Has anyone heard of kids having problems post ablation for reentrant tach problems like this? Anyone ever heard of this proceedure causing sinus arrythmias? Suggestions on ideas that I can use to weed out if this is an attempt to get out of homework and chores instead of actual cardiac problems? TIA!!!

As you are aware, WPW is to say the least elusive and requires extensive mapping to locate the aberrent focus. I agree with one of the other posts on here that RF ablation is about 90% effective in resolving this. Since it seems to be recurring it makes me wonder if there were additional pathways that were missed.

One question i have for you, is he on any anticoagulant medications? It seems prudent that he would need prophlactic meds to prevent the possibility of an episode creating an embolus. his of course carries its own set of challenges for a young person and especially an active young person but is manageable.

Nope don't stop, simple as that. Where I'm from the ambulance is little more than 5 minutes away. The backup ambulance is little more than 10 minutes away and I have no equipment on me, including gloves so I don't stop. What am I going to be able to do without any equipment. I can look pretty on scene though.

Of course, there are those on this site who have better equipped personal vehicles than many ambulance services.

Perhaps you would consider getting a few pairs of gloves and throw them in your "glovebox" I personally stopped at an MVA on I-40 one morning. A man driving a small pickup truck had been rear-ended at high speed and when I approached the vehicle he was unresponsive and gasping to breathe. All I had was a pair of gloves, but i was able to stabilize his c-spine and remove most of a McDonalds biscuit that had his airway occluded. He began to breathe easier, then normally and regained consciousness. This man did not have five minutes to wait for someone to clear his airway.

With this said, if I would have had my kids with me I likely would not have stopped due to the douchebags on the roadways these days. I cannot put my family at risk to go to the aid of others. I have had two trooper friends killed on this section of the interstate and realize there is nothing in the universe more stupid than a motorist.

Too much risk of cross contamination with an absolute host of "cooties" To mention a few, MRSA, CDIF, Flu, Hepatitis, HIV, Parasites such as Bed Bugs, Crabs, Scabies and who knows what else. If you are too lazy to sanitize the cot and change the sheets after each call, quit, find a new job. If by chance it were one of my family members and I caught them doing this, there would likely be an unpleasant parking lot discussion resulting in law enforcement response.

Just do the right thing, treat everyone the way you hope to be treated when you need assistance.

Its been a long time since I have posted to EMT City and must admit being provoked to once again join the action by Dr. Bledsoe's message announcing the passing of dustdevil. While I didn't know Rob personally, I did "meet" him through EMT City. Rob and I didn't necessarily see eye-to-eye at first, and continued to see things through our individual lenses. I did learn to respect and admire Rob.

We had several spirited discussions within the forums and outside their confines. Rob wielded his intellect as if he were King Arthur wielding Excalibur! Those of us who found ourselves in the way of it's sharpest edge learned not to play with fire or insult Rob with pettiness, but to bring our A game to his arenas of discussion.

I can tell you I am a better person for having met him through this utility and I am so very sad to learn of his suffering and his death. It is my most sincere prayer that he find peace, comfort and rest. I only wish I could have know him better and to have had the opportunity to learn more from him!

RIP My Friend

Randy Fugate, AKA Captainstandup

The whole special considerations of pedis aside, AHA has been de-emphasising intubation for years now in all scenarios. Even in a full arrest, they put it way down on the list of priorities. Just following that pattern of thinking along, it becomes pretty obvious where they are headed with that.

Virtually any story that starts with an AHA moniker included is usually troubling at best. I'm sure dust has seen the same trend in dealing with the AHA over this many years, in that they are literally for sale to the highest bidder. One only has to look at the ridiculous science behind the AHA touting of vasopressin and amiodarone over the years to see this clearly!

Then came the LMA and more suspect science but hey the equipment and medication manufacturers received a windfall every time AHA made big changes and ER's and EMS agencies ran out to purchase an entirely new bottle of snake oil.

Little if any verifiable proof ever supported the use of vasopressin and amiodarone and although the LMA is reasonably effective in the OR it's efficacy in a moving vehicle or aircraft is, in my opinion, unacceptable.

Students, especially those from a "patch factory" simply must be cautious in buying into any therapy being hailed as the newest and best thing since the discovery of fire.

There is simply no way to effectively challenge the AHA given the fact it is an organization designed to aid doctors, doctors that prescribe medications to patients, medications from companies that are publicly traded and whose largest shareholders are, of course, doctors. Nice arrangement isn’t it?

Educated providers, such as dust, supported by enlightened physicians make a great deal of difference every day in America and do the right thing for the right reason and based on solid science as opposed to greed or ignorance. Providers should admire and respect these folks and return to school to be worthy of joining their ranks, otherwise we are simply compressing syringes and pushing buttons because an "algorhythm or silly exam said we should"

I believe a lot of times providers make a scene worse. Of course there are armed situations and domestics where we simply must leave or delay response, but I have seen many Paramedics make a situation much worse.

Several years ago i was working with another medic, this guy was a real jerk, and was arrogant. He was unkind to his partners and certainly to the patients. We responded to a call for back pain at a local hotel. Upon arrival we find a construction worker who was VERY intoxicated. This fellow was jovial and wasn’t causing any trouble, but he kept trying to light a cigarette. I was trying to get him on the stretcher and he finally moved over to the cot. (The pain was non-traumatic)

This fellow put another cigarette in his mouth and I told him we had to get him on to the hospital and that he couldn’t smoke at the time. The guy was arguing with me but in a comedic manner and he was harmless and just drunk but my partner, who was trying to become a cop at the time, was so mad that he finally began cursing and actually reached over and snatched the cigarette out of the patient’s mouth. In a split second the patient open handed slapped the crap out of my partner against the left side of his head. I was laughing so hard I couldn’t do anything to help! The paramedic was so mad he turned the stretcher over and pinned the guy to the floor.

Law enforcement was called and felony assault charges filed against the patient. The sheriff’s deputy contacted me to testify and I refused. I told them to subpoena me, but reminded my idiot partner that if I came to court I was going to tell the truth. I never heard another word and the charges were eventually dropped.

This is but one example of how arrogance and self importance combined with poor character worsened a situation. This is the same Paramedic that wouldn’t stage for law enforcement when instructed to do so. He was finally fired a year or so later.

Drive only as fast as you are willing to crash!

The public's "right" to safety trumps ALL patient situations! Not to mention the priceless value of emergency services staff!

Rock the boat after you get hired and completely processed. Employers (good ones that is) invest significant money in making you a deployable member of their team. In most cases, you have to be a real pain in the a$$ or really stupid to get fired. Again, proceed with caution.

This is the reason I changed our probation period from 90 days to 1 year. Even an idiot can behave for the first 90 days, it's the other 275 days that usually reveal a new employee's character. Another advantage we had in NC was the fact that it's not a "right to work state" therefore provided the paper trail was created properly I could toss a ner do well employee regardless of tenure.

A few years ago some medics ran into a great deal of trouble for starting IV's on each other during our state EMS convention. They got trashed the night before and really really sick and one of them had brought fluids in preparation for the festivities. Somehow an OEMS official learned of this and they were brought before the state EMS disciplinary committee for practicing medicine without a license. I don't know what the outcome was.

Is there a lucid point associated with this egotistical rant?

Not really, I had simply decided to crawl into the gutter with Zippy for a bit. By the way dust, I already mentioned skilled nurses such as yourself in an earlier post. I have a very tame ego and am respectful of those deserving respect. An idiot with the misguided notion that a nursing license gives her/him superior clinical ability and especially outside the hospital is unworthy of my respect.

Its highly unlikely that zippy has more education and experience than many lowly paramedics she/he seeks to degrade. I was merely trying to illustrate that not only do many paramedics have a great deal of education, but also are cross-trained in technical rescue, search and rescue, vehicle extrication, collapse rescue, trench rescue, hazmat EMS, high and low angle rescue, swiftwater rescue not to mention virtually all of the silly alphabet classes the nurses are certified in. You, of all people, know this better than most. I suppose the point is not only can we deliver excellent care but we can deliver that care under very adverse conditions.

I am a bit suprised by the fact I was drawn into this silliness with someone who doesn't even live in the US, therefore her/his opinion and $4.99, (US) will get you the Big Mac Special at McDonalds.

If it wasn't going to be the Dolphins (though they were close) I am happy with the Giants.

I could feel the Dolphin loyalty! I would likely have pulled for the "taliban" over the Patriots as only a true Dolphins fan would! By the way where is Bob Greise these days, God knows we need him and hey, he's only 63!

Zippy,

she/he can "believe herself" to be catwoman, but this does not make it so. Semantics and whiny bullshit regarding position papers and the opinions or workings of the ANA are worth how much? Not a damned thing. We are talking about environment of care and the rule of law.

Most states have some form of Medical Practice Act that details the authority of various care providers in the pre-hospital or out of hospital environment. I am unaware of any state of the 50 that grants an off duty RN any authority whatsoever, in the pre hospital environment, and certainly none that would give them authority over Paramedics.

How many nurses (not including nurse/medics) have you seen 500 feet over an embankment or chest deep in the twisted remains of a semi lately? Hey I know, now that zippy has decided nursing is on such an elevated plane over Paramedics, perhaps they can now move into technical rescue, fire fighting, search and rescue who knows perhaps they can rule the world!

I would venture a guess that zippy has been about as close to real rescue situations or true field emergency medicine as her/his big screen tv and the last episode of Third Watch. Hey zippy, do you check with the ANA or the physician before giving Ms. Jones something to drink?

An entirely new "dimension" in scene safety.

No but these "tucks" had a really strange odor to them and for some reason my toothbrush was in a bottle of 151, oh and the Q-Tips are in a jar of homebrew and my bottle of afrin caught on fire. :twisted:

Instead of posting a third time just to apologize, why not just go back and edit them? :?

I tried and received a message that I couldn't delete the erroneous post because someone had already replied. I'm aware that this isn't the place for emtcity etiquette but honestly some of the idiosyncrasies are frustrating. Please try to overlook my errors and I'll continue to try to get better and if I cant I'll stop posting completely.

Thanks Doc, by the way can I, by virtue of your avatar, assume you were happy with the outcome of the superbowl?

I respectfully withdraw my offer!

By the way, I can assure you that Western NC is no better my friend. In fact did you know that in certain areas there is a statute that bans use of all blue jeans except Levis 501"s? ASK ME WHY!

OK I'm hurt that no one asked why.

The reason Levis 501's are required by law in WNC is that the sound of a zipper causes livestock to stampede

In reference to the Good Samaritan Law, just going to point out that I never said it keeps you from getting sued.

I wonder how many court cases are filed against EMS professionals on duty vs. off duty for providing medical treatment.

Law suits are avoided through the following:

* Education

* More education

* Even more education

* Training

* Kindness

* More Kindness

* Professional appearance

* Competence (yes I intended to place it here)

* Empathy

* NOT driving like a damned fool.

* Avoiding patient refusals as if they were a coiled cobra.

* Recurrent training & more education

* Recurrent "training & practice" on kindness and empathy. Refer to the Bible and

Christ's example on this. THIS ISN'T A RELIGIOUS STATEMENT BUT MERELY A GREAT

EXAMPLE OF SOMEONE WHO UNDERSTOOD KINDNESS AND EMPATHY! NOTHING MORE,

NOTHING LESS. Even non-christians can use the stories absent the religion. There are

a number of "deities" that can be interchanged here and please no religious fights.

given that paramedics in the US are not (Registered) Practitioners i think you might well just find that an RN is 'equal or higher' in the food chain ...

Gong!!!!!!!!!!!! In most states in the US the nurse can only practice in the hospital setting or in very confined out of hospital settings. An example would be air medical where the nurse is responding as part of an organized team in response to a specific incident, with established protocols and a medical director. It's true that often times the nurse is in charge of air medical if they are part of the crew configuration.

Contrary to what you assert (and a poorly veiled attempt at yet another nurse vs. medic pissing contest) nurses are not in any way licensed to practice medicine. They are licensed to nurse. Did you ever stop to think is this weren't true there would be nurses setting up clinics independent of physicians. Even FNP's operate within a limited scope of practice.

Instead of trying to start another argument, why not acknowledge its simply a different practice setting. Nurses such as dustdevil are educated and experienced providers in the out of hospital setting and understand operational considerations. An ER nurse with no prehospital experience or training, barking orders on an accident scene or other; prehospital setting is silliness.

I can assure you if this happened tonight in NC and the nurse refused to get out of the way she would instantly be arrested and removed from the scene.

Oh and by the way, if a physician was on scene, he would have to provide proof of NC Medical License and sign a form accepting responsibility for care and agree to accompany the patient to the hospital onboard the unit, even this would require approval from Medical Control. Absent these things the Physician would either get out of the way or would be arrested.

That hurts guys, really hurts.........................hey what was her number?

By the way, the reason Levis 501's are required, especially in southern Haywood County, is the sound of a zipper causes the livestock to stampede.

Unfortunately Captain, Eastern NC is home to the " Bojangles 3 x daily" crowd. [-X

I respectfully withdraw my offer!

By the way, I can assure you that Western NC is no better my friend. In fact did you know that in certain areas there is a statute that bans use of all blue jeans except Levis 501"s? ASK ME WHY!

How, exactly, are we going to check for the smell of ETOH? I know how spenac is going to do it, but what about the rest of you? j/k

If the patient happens to be Jennifer Anniston, Beyonce or Brittany Speers (on a good day) I'll take one "for" the team and volunteer folks! I'm your huckleberry!

Excellent info RidRyder and thanks for the effort. I must admit being ignorant of the parallel with carcinoma. I agree Lupus is a very complex disease and at this point it seems the effect on the kidneys and concomitant systemic impact could be the most significant.

I was also surprised by the similarities between this patient's symptoms and a patient we frequently transported who had severe sickle cell anemia, although I understand there is no relationship.

Sure there are downright nasty nurses. But really think about all the knuckleheads that you've worked with over the years and imagine that the nurse sees you as one in the same until you prove yourself otherwise.