captainstandup

I recently transferred a 20 year old patient who was reported to be in a "Lupus crisis". Just like most other medics I know, we were only briefly exposed to this disease process in school and rarely see it in the field. The patient had the classic "butterfly rash" along with many other S/S. I, of course, have been searching / surfing the net ad reading books for more information and wanted to include my beloved emtcity in the process of learning more about this disease. So tell me more please, all information is pertinent but specifically implications that affect EMS or Interfacility transport ( very long distance) care are of specific interest.

We switched from M cylinders to dual H cylinders on each truck for both the oxygen and medical air. Our ventilators ( I-vents) are electrically powered (instead of oxygen or air powered) and have a great deal of adjustment in terms of FiO2 etc, which based on the clinical presentation of a given patient can be very helpful. I agree CPAP can be rather "O2 thirsty" but honestly oxygen is likely the cheapest drug you carry although wrestling those H tanks can be challenging. Hey how bad is blue anyway?

Surely you didn't allow her to start the IV? When she said I'm a Nurse, you should have replied "I'll bet your mom is really proud of you too" It's likely illegal for her to practice independently in pretty much any state. We have had State Troopers physically remove individuals claiming to be, or in truth, physicians, nurses, paramedics, EMT's and one veterinarian from our units in the past. Sometimes it's nice to have extra trained hands on scene. We have had medics and nurses approach us and politely ask if we needed assistance. If we need help we graciously accept, if not we decline. We always try to be as nice and professional as they will permit us to be. Oh and in the future, tell the nurse if she is attempting to establish credibility, she should consider not referring to her "ACLS acumen" Even a janitor can be "remediated to success" and get an ACLS card. 16 Hour ACLS Class: $55 unless you are fee exempt Remediation of a janitor to success in an ACLS Class: Free Shiny new ACLS Card: $2.50 - $5.00 Knowing what the hell you are doing: Priceless

Incompetence, cruelty to the patient and disrespect to you. I think you should have hit her in the mouth!! Document, document document and communicate IN WRITING with the service director and with the physician medical director. If this fails complain in writing with the city or county administrators / commissioners. If this fails communicate in writing with those funding the service assuming one of those earlier isn't the funding source. If all else fails involve the patients family. Make them aware of the fact this EMT may have worsened moms of grandmothers condition. Word of mouth is really powerful especially in smaller communities. You don't have to accept this level of arrogance and ineptitude from anyone! The public is conditioned, as they should , to expect good customer service.

I love this "place" and have really found a home here. Ill be contributing as soon as I finish paying the $8100 for my little boy's medical bills. Sorry for the double post :oops:

I agree.. forums do market themselves. It is all about the members. I am not sure if we are in trouble.. in fact' date=' just the opposite.[/quote'] Wow just trying to create a little loyalty for our beloved emtcity.com and it has escalated to this? In no way do I believe this site to "be in trouble". The subsequent posts have been wide ranging. From a guy with 75 posts that thinks he should be granted "MOD" status to those offended by my suggestion that we should support the site through either supporting the advertisers or contributing and finally those who actually understood what I was trying to say. Sometimes I'm bewildered by the simple thing that set people off.

Shayne

An equally sad fact is that the insurance companies were well aware where the insured properties were located. They happily accepted premiums and just when the worst happened they were able to fabricate some small print crap about wind driven flooding to deny payment for losses. Most anyone can tell I am strongly conservative in politics, but what the Bush administration perpetrated on our country during this disaster is unconscionable. Allowing their pals in the oil industry to rape our nation under the guise of damaged oil company infrastructure was preposterous. Exxon reported the highest fourth quarter profits in the history of the company following Katrina. Furthermore the Bush administration stood idly by as State Farm and the insurance industry abandoned those who had paid them in good faith for many years. I just wish there was a way to begin a national boycott of State Farm Insurance and let them know it was payback for taking advantage of the folks in New Orleans. I can only imagine the battery of excuses the bastard insurance companies already have cooked up and simmering for the next big earthquake. I just hope its not a wind driven earthquake!

I've simply got to do something to impress on you folks that I am really a nice guy, I am you know! You didn't make me mad and yes I will donate and yes I am putting the posters up at work and I too tell everyone I can about the site. Perhaps I shouldn't have used the term responsibility? I was merely trying to articulate the idea that as frequent users of the site it wouldn't hurt all of us to seriously support the vehicle for our desire to communicate. I've never met anyone on emtcity yet in a strange was I consider many of you friends. I have had discussions, arguments, spirited debate and a few people that seem to hate me on here. I've been put in my place more times than I can count but, you know, I never get mad because I know this makes me stronger, more articulate and results in tiny improvements in the person I am and the care I deliver. Prior to emtcity I did not have a medium that "worked for me" In my opinion there is far more intellectual content on emtcity than any other site. Hey I just don't want to be a squatter here that does nothing in return.......

I suppose I need to go to emtcity kindergarten, I seem to experience a great deal of trouble with the search functions here. At times I search and it will return several hundred matches. I want to be as responsible as possible on here but I don't have the time nor desire to read through 400 posts to ensure I haven't duplicated a topic or thread or copied another person's thoughts. Please forgive me as I learn how to communicate within the etiquette of "the city" I'm working on it, I promise.

As members of EMT City I feel we have a responsibility to "market" it. We enjoy an immense opportunity to share ideas from literally anywhere in the world and at no cost to us. One thing we can do is to make a concerted effort to patronize advertisers that support EMT City and I encourage everyone to do so. I think it would be great if we had pamphlets or some type of printed material available to distribute during national and individual state EMS conventions. Perhaps the administration could simply provide a standard form or flyer that we could download and print out. We all benefit from having EMT City available and just imagine how much better it will be with hundreds if not thousands of additional members.

Allstate cancelled my earthquake insurance last year! I hate Allstate anyway, they, just like those bastards at State Farm screwed people in New Orleans and the government allowed them to do it. It is incredible they were able to hurt the people in New Orleans, especialy those who paid their insurance premiums for years and years only to be ruined by their insurance company when they needed them. The basis for their not having to pay on flood insurance: " the flood was a result of wind driven water" instead of some other form of water. Is wind blown water less wet and destructive than say torrential rain? If there is a hell I sincerely hope the administrators that perpetrated this crime burn in the very hottest part! Another sad fact is that many of the folks they screwed were poor, working poor, minorities and those whom no government entity would have advocated for. Speaking of government officials, surely hell is big enough to throw in Ray Nagin and whomever was the governor, at the time.

Most services would know you had little driving experience. An NCIC or DMV/DOT (depending on state) search would only reveal infractions on a persons driving record. Once you are licensed to drive in the states your home free. I suppose an exception to this would be if the service has a driving skills assessment (most do).

You will likely see many more examples of mutts above you feeling threatened by excellence on your part. Its great that you are no longer employed by a worthless outfit that, not only wouldn't invest in your professional growth, sought to inhibit it through questionable employment practices. Apply your energies toward excellence and forget those fools. Don't even wast time suing them because it will distract your focus and its highly unlikely you will receive enough money to make it worth the fight. Finally, you certainly don't want to return to that "outfit", as employee, as it would always be a strained relationship and they would forever be lurking in the shadows waiting for you to mess up. Hard work will bring you good luck and now you're on; your way.......

We had a patient that based on the freight scales at the rear of the hospital weighed 923. He was at least 800 and honestly when you are this big who wants to quibble over a hundred pounds? Response to this guy's house was unbelievably bad. It took two fire departments, the rescue squad and two EMS units to manage him. He was always rude, never grateful and the smell was wicked. There were six other super obese patients in the county, all requiring far more than their share of community resources to manage them during frequent trips to the hospital and the many return trips to the residence. This speaks to the greater issue of the "massive" impact these type patients wreak on communities. They burden every aspect of public service, health care and most are recipients of public aid and do not contribute one cent in taxes. Hospitals are forced to lease or purchase bariatric equipment, EMS services are forced to purchase specialized equipment to handle these people and if not must risk placing them on equipment not rated for the load. This presents an increased risk of being sued if there is a collapse of the stretcher. The most important risk, in my opinion, is in the risk of injury to emergency services personnel. I realize there is a surplus of paramedics in America and no one has trouble recruiting and retaining them, NOT! An injured emergency worker is not only a loss to the community, but how many of their families can survive on 66 2/3% of their salary paid by workers comp for an extended period of time? It was understood in our service that we would take reasonable measures to care for the super obese but, we were not going to risk injuring personnel regardless of patient acuity. Scene safety extended to handling the patient in a manner that considered rescuer safety and risk of injury above the needs of the patient. This is the manner we should approach all calls. This topic has been covered, generally speaking, in a past thread, but I think it worth mentioning the issue of property damage that occurs during management of the super obese. Communities must take measures to ensure that EMS, Fire and Rescue Departments are held harmless in situations where structures are damaged in the process of removing obese patients from a residence. I have heard of cases where walls were breached and doorways enlarged with a rescue saw to aid in removal of these folks. We were taking a 450 man back to the residence (yes we had to do the returns back in the day) and this guy had the audacity to ask us not only to stop at McDonalds but to buy him three big macs. Neither one of us had any money that night and we didn't stop.

Having spent the greater portion of the past ten years involved in emergency management I can assure you there is no way the country is prepared for something of this scale. Most civilians are under the misguided notion that the government, through the auspices of EM, will be there to save them when the worst happens. The biggest misconception I have seen through the years is the notion that FEMA will build people a new home if a disaster destroys theirs. The second biggest misconception is that the government (local, state, federal or military) will be there to keep them safe. Its a real shock for many to learn the most money an individual homeowner is usually "entitled" to is approx $5400. The second and sometimes more painful reality is the government will not be there to help you for a minimum of 72 hours and realistically it could be weeks depending on the scale of the disaster. The police and sheriffs office can keep you safe from looters and opportunistic parasites. Where we live in NC we have a well protected water supply that isn't dependant upon the benevolence of other communities or their infrastructure. There is fairly limited means of access to the communities and a very low minority population and no housing projects or slum areas. I say this not from a racist or separatist perspective but only to highlight the undeniable truths of differences in cultural reaction to catastrophe. citizens already heavily dependant on public assistance REGARDLESS OF COLOR are far more likely to need help early in a disaster. If the disasters impact is primarily in an area of heavy minority or poor population, as they often are, incidence of looting, murder and for some reason rape are common and become an operational and planning consideration for managers and responders. Citizens and responders must properly arm and equip themselves for response during disasters and ensure their families are either evacuated or well defended and supplied before they can be effective responders. A disaster on the scale discussed in this thread will span virtually all socioeconomic groups and will tax national resources for months. Politicians and the wealthy will be a huge impediment to response since they feel the privileged should get the best service.

Firedoc wrote: (edited for content)

Incredibly true! There is an old saying that goes "The devil lies in the details" As paramedics we are often totally engrossed in one aspect (usually critical skills or med admin) of a given patient situation and fail to pay attention to the details. By details I mean small things that individually aren't life threatening but, combined with three other "small things" could be much more significant.

Perhaps you should be selecting better candidates for ventilating your patients or secure your tubes better. I recommend an entire roll of silk tape if necessary. At the end of the day, its still your fault if the tube comes out, but you already knew that...................

Is the State Police the only providers of air evac there? That saves the patients about $7000 based rates for flight services here in NC.

Or forgetting to remove the vent circuit exhalation valve test cap, attempting to ventilate the patient, then wondering why it doesn't work. :oops: :oops: :oops: :oops: :oops:

There was a story on Rescue 911 or it may have been in a trade journal several years ago that featured an EMS service that was a part of the Sheriff's Office. The Paramedics were sworn, armed officers who performed regular patrol duties when not on EMS calls. According to the story the medics simply patrolled in their ambulance which was equipped with red and blue lights and a traffic radar. I really wish I could remember where I saw this story.

I'll help with the East coast one too. If you guys decide Vegas for the West please let everyone know as soon as possible. It will be a bit more of a logistical challenge than St Louis but, hopefully I can get a reasonable flight. Whats the name of that new really cheap airline? I believe its Skybus.com. Of course one must be willing to ride on surplus North Carolina school buses converted into airliners. Just kidding! A colleague of mine actually flew somewhere in the midwest for $10. Its a promotional gag that the first ten seats on each flight sell for $10. Parachute not included.

I'll behave, I promise! Dust is buying the first round isn't he, since he gets all that tax free war zone money?

I help by staying out of the way and not bringing any additional potential victims to the scene.