captainstandup

You know Cap, when you discuss medicine, you can be inspiring. When you discuss anything else you mostly come off as a dumb redneck.

You are exactly right I do come across that way sometimes, regardless of how I try not to. It just seems as though everyone seeks to excuse really bad behavior among an ever growing segment of society as not their fault.

The Democrats want to keep everyone dependant upon them for help to justify their existence. Social welfare programs have been an abysmal failure and only seem to enable those who, once dependant on the system, rarely escape.

The Republicans hate everyone for being sick or having mental illnesses. Being unkind, neglectful and blaming the sick for being sick then gaming the system to increase profits isn't helping anyone either.

I told a coworker today that regardless of which party wins there is a 100% chance that America will elect a scumbag for President this time. I have never felt so hopeless regarding political leadership and the future of our country as I do now.

Although this post isn't necessarily on topic I believe the political facet of the greater problem to have been worth discussing here.

Finally, I should have shut up a long time ago in this thread but as I too frequently do; I allowed passion to drag me to a much darker place than necessary, when attempting to make a point. The redneck comment was a bit of a "bitchslap" back to a more sane me and hopefully one that makes more sense. Forgive me in advance if I need one periodically.

I wonder if dustdevil or spenac would consider a bid for the Presidency? I'm sure there is a stool somewhere around the oval office where dust could elevate his injured leg.

At the end of the day only you can decide if you took unreasonable risks, well I suppose your supervisor may have some degree of input, but it sounds like it worked out ok. As I have said in other threads you have a responsibility to many different people to go home at shifts end.

As far as this forum is concerned you are the only one who was there, you assessed the situation and made a decision to act. Monday morning quarterbacking your decision is counterintuitive. We weren’t there..........

This brings up what is likely a much broader discussion regarding the risk vs benefit of many medications. Phenergan or promethazine has been on a very short list of nasty meds for a while now. I have been given this medication improperly and suffered with 8 months of phlebitis in my right arm. I have witnessed nurses and medics administer phenergan without diluting it then a half hearted attempt at flushing the line.

I personally NEVER, EVER administer this medication without first making darn sure the line is patent and there is no conceivable evidence of infiltration or "leaking" @ the IV site. I then thoroughly mix the promethazine in no less than 20 ml of .9% NaCL and administer slowly, followed by flushing with at least 20 ml of .9% NaCL.

With all this said I try to avoid promethazine and instead administer Zofran and if needed Ativan which seems to be much better tolerated and more effective on really sick patients.

Sooner or later it's all going to catch up to us and we won't be able to deal with it. Whether they're degenerate scum bags or not, the problem needs to be addressed. People aren't born gang bangers, it's directly related to them being raised by other gang bangers in neighborhoods where cops treat everyone like they're dirt rather then human beings.

It's a parenting thing, or absence thereof! Your inference that society is in some manner responsible for the reason these people are the criminal parasites they are is what is unbelievable. A dad that stays in the home and is a role model for the kids would be a good place to start. Coming to America legally would be another.

As for my comment regarding utilizing the military, gangbangers, drug dealers, thieves and murderers are the only ones in society that "wipe their ass" with the constitution daily. If a person is a hardworking, honest, taxpaying, law abiding citizen who winds up killing one of these vermin in self defense or in defense of his family all of the liberal elite rush to crucify the good guy in this equation.

As far as your being a disabled veteran, I meant you no disrespect as you are obviously an honorable person who served your country. It just seems contradictory for you to have the personal ability to serve in the most honorable role on earth yet at the same time not expect people to accept responsibility for their actions.

Another disgusting element is the default extension of the Bill of Rights to illegal aliens. As far as I'm concerned if you aren't here legally you should have only the right to leave and return legally.

Hey Dust, I would love to see you speak at the NCOEMS version of EMS Today in early October. There are usually around 1200 folks from varying levels of certification and fields of endeavor in attendance.

In any event, the call for abstracts is usually issued around July or August and who knows if you are interested and aren't back in the sandpile, perhaps some R&R in NC could be arranged? Just a thought........

However, the EMT had written on his paperwork that the patient had a GCS of 4/6/4. The medic lost his job.

The Paramedic was too stupid to work anyway, why was an EMT attending to and documenting the patient care report for a patient with an altered LOC? In a manner of speaking the Medic abandoned the patient or was, at minimum, negligent by failing to attend during transport. Of course i suppose it is possible it was a three person crew or perhaps the medic "just let the EMT document the call"

There is a project near here where several black gentlemen and ladies, if you will, summon an ambulance for emergency conditions. Upon arrival @ the ER they instantly refuse further treatment and leave the ER AMA. This is done to secure a free ride across town since the hospital is near the baseball field, liquor store and local drug dealer hangout. I have personally witnessed individuals on more than one occasion being transported only to see them at the ball park not 20 minutes after arriving at the hospital.

Before someone starts yelling about this being racist, it is merely fact and to date no other race has pulled this %^&*()$#@. The next time it happens to me I'm going to get a warrant for felony misuse of 911 and summoning an ambulance without intention to pay for services.

Ruffems said: "Actually Cap, no offense intended but maybe you should have taken your own advice that you gave wendy regarding your response to the turd watch episode.

Again no offense intended at all."

No offense taken ruff, and you are exactly right, i was tyring to illustrate in words how ridiculous I was that night.

WANTNYU is correct, it was Rescue 77 instead of third watch. If I remember correctly there was a huge outcry against Rescue 77 among the EMS community. If I recall correctly they only aired three or four episodes before it was cancelled.

dust said: "Yeah, and you can tell it's nurse, and not a paramedic, because her arse isn't four feet wide"

Wouldn't you like to see one that wide do the handstand defib trick, ok perhaps not?

Both pressures are important as is mean arterial pressure since this is essentially the constant force applied to the vessel. Size doesn't necessarily decide whether they operate or not. Location and exact type of aneurysm are determining factors as are age, history and overall health status of the patient. Prehospital therapy, since an aneurysm in the field is a best a guess' will include high flow O2 two large bore trauma lines at very minimal KVO rates, gentle handling with no exertion. If it a known aneurysm such as an interfacility transfer Nipride may be utilized to keep the systolic BP @ or below 90mmhg. Clear communication to physician and the need for surgical intervention is a must.

On a couple of other topics I was just surprised at how hands and eyes off people are in treating their patients. I was taught in all 4 levels of EMS school I have taken or taking that to do a good exam requires all our senses except taste, and sometimes taste comes into play as odor is so strong you taste it. What do you see, feel, smell, hear? I was taught that if a person complains of something say stomach pain you expose and see if anything visible, then you palpate starting on the areas w/o pain moving to the painful area, finally you auscultate the area. During this you may note various odors. Even in clinicals a the hospital I was asked to do all the above and even had Docs bring to my attention some of what I was feeling or hearing.

So my question is am I the only one taught this way? While it may not affect our immediate care of the patient do you feel it is still part of a proper EMS exam? What are your thoughts?

Only posers & mutts "assess" without touching the patient and utilizing all of the senses spenac mentioned. Although it may look good in a report to list all of the crap one allegedly does for a patient, there is no substitute for actually utilizing our education & training to the benefit of our patients. Who knows, we just may become better at it!

yeah turd watch It was that episode that kept me from watching it.

I was literally standing up yelling at my TV (momentary psychosis) and instantly changed channels never to watch it again! My family was bewildered by my behavior as was I later. There are just some things so ridiculous the human mind cant easily process them. Although I understand this was supposed to be entertainment to me it was the Paramedical equivalent of WWF or whatever that "Pro-Wrestling" show is.

Poor pay for privates...sometimes, but not always. So you're wrong there.

24 hour shifts being better...sure, if the call volume isn't to high. But if you run 10 calls in a 12-hour shift then you run how many in a 24? Wrong again.

Ambulance ride paid for by taxes...holy hopping crap on toast, what kind of fantasy land do you live in? In 2 states there is one fire department that I know of that does not charge residents for transports. And this is in an area that is mostly fire-based EMS. Once again...wrong.

Nice post. Pretty much entirely wrong, but nice reading just the same. About the only thing that was accurate was that it does come down to patient care and patient care only.

I issued a challenge a while back for someone to provide an example of just one private company that offers good pay, good working hours, good retirement, good equipment, and interestingly, to date no one accepted the challenge. I have never, NEVER, seen a private company that could remotely compare to most local government or fire based services. Given that you feel empowered to state that xgldcrossemt's post was "entirely wrong" I figure you are up to the challenge.

We have our own billing, logistics, mechanic shop, operations, etc. We're self sufficient.

I believe your billing department may be largely responsible for the "powers that be" wanting out. A 57% collection rate is terrible, unless you are talking about collecting 57% of your total operating costs which is then supported by a subsidy of some type.

57% of billed is completely unacceptable. If they would reconsider I could provide information on a solution for improving your collection rates, hell I would even drive to Florida if it would save your job!

Not that it matters now but who does your billing for EMSA?

At least its not as stupid as the nurse in the J&J commercial working in the ambulance.

Spenac, what is the J&J commercial and do you remember the name of the show where the "paramedic" performed a handstand and defibrillated the patient who was traped and lying in water?

Wow that was a good deal, what were the motivating factors for the change again? I assume you "guys" were providing excellent care and reasonable response times. Could this simply be a money grab by a Fire Department trying to justify its existence?

Wendy! Please go out to the ambulance and spend some quality time with the nitrous oxide and some McDonald's french fries. ITS A JOKE! ITS SUPPOSED TO BE FUNNY THROUGH ABSURDITY! Life is too short to be this serious and hey, after most of us lived through the "handstand defibrillation" on one of those stupid prime time soap opera rescue shows, everything else is pretty much childs play.

Although I don't like the "Fire Hybrid" solution you will probably be much better off in the end as opposed to remaining with a private company. Hopefully there will be some manner the Fire Department can honor your seniority, retirement and accrued leave time, assuming you even have those benefits with the private company. Best of luck to you whatever happens

Joe Rambo's a joke term the military uses.

For example, if some one were to ask:

"Who would win in a fight consisting of 1 Navy Seal against a Platoon of Marines?"

The answer is Joe Rambo.

When people ask ridiculous questions, the all around American Hero Joe Rambo will always prevail.

In terms of society being set back, you're nuts. This day and age is the first where we've actually had a steady flow of medical personell in this sense. Society is so far evolved from what it used to be, especially since electricity came around, that it's just wishful thinking to say "Is this what we've come to?". It implies that we used to be better then we are.

Targetting violent offenders is an entirely new debate, which goes more towards the way that we just throw people in prison, rather then providing the psychiatric support they likely need.

We don't live in a society that tries to reform it's criminals, we simply throw them off to the side and discard them. How would that make you feel?

Everyone reacts differently to adrenaline, people with drug addictions can be going through completely uncontrollable thought patterns - especially on drugs like crystal meth where they become sleep deprived or PCP.

The key to avoiding confrontation is having absolute empathy. Don't ignore some one on a scene because you think they're a degenerate ect.

Are you Hillary's campaign manager or what?

This liberal excrement is exactly why society is rotten to the core! No personal responsibility and no accountability for one's actions. There have been a myriad of threads on EMTcity that have included elements of this type discussion. If we could just speak to little Gary Leon Ridgway's inner child perhaps his nasty habit of killing people wouldnt have reared its ugly head.

Gang bangers and thugs regardless of color or race are the parasites of modern society. The people are rarely rehabilitated and continue taking and taking from society until someone kills them. Hopefully its their scumbag friends that kill them and then get charged with the murder (a two for one special) The best scenario is they both die in a shootout that doesnt involve anyone else. EMS brings out the handy dandy ziplock disaster pouch and for a moment in time things are better, but only until another looser takes their place.

I think we should suspend the Posse Comitatus act for a week or so and send the military to kill as many of these people as possible. It would be good practice for the military and urban renewal for the country. Who is doing more harm to American anyway, al-qaeda or the drug dealers and gangs? Try the fools for treason and execute them.....

Although I always advocate for standup (no pun intended) it would have been career suicide for you to get in the middle of this thing on day one. The problem you must remember is that in situations like this you are the one at greatest risk of being "thrown under the bus". Two seasoned and "tenured" employees could accuse you of making the error, then you would have no experience or credibility with the agency to defend yourself with.

Now that I work in the backstabbing equivalent of hell ( a hospital) I record about two thirds, or more, of the calls I respond to on a digital recorder and make notes in MS Outlook every single day regarding the days events. If anything out of the ordinary occurs I type up an incident report and keep it on file. I back all of this up once a week on a flash drive then on an external hard drive that isn't kept at home. I am especially diligent in recording and documenting when i respond to or transport a patient to an area, department or facility where I have had trouble in the past.

One of the reasons behind my OP was an incident that occurred many years ago which received a great deal of "rumor coverage" but no media coverage. Let me begin by saying I wasn't working the day this happened. A local paramedic was treating a patient in severe congestive failure with profound pulmonary edema. Normal treatment would have, in that day, been High flow oxygen, SL NTG, 100 mg lasix and if indicated intubation.

Important note: We carried "mega dose" vials of 1:1000 epi (30 ml). I'm sure you can already see where this is going...

The medic applied NRB @ 100% , gave the patient 0.4 mg SL NTG, Initiated IV and administered 10 ml of 1:1000 epi instead of the 10 ml of lasix he believed he was administering. Almost instantly the medic caught his mistake and according to his partner began losing his mind!

The medic admitted his mistake and his paramedic certification was suspended for a year, by the medical director, but he didn't loose his job. The service actually permitted this guy to work as an EMT-I. The best part of the story is that the patient survived and the service didn't get sued. Good news is the error never had any media attention.

Lessons Learned by this guy, at least I hope he learned them! Just because its in a large brown vial, it's not necessiarily lasix, although i must mention the epi vial was significantly taller than the lasix vial. Oh! I failed to mention the epi vial had Epinephrine 1:1000 on the label and the Lasix vial had, ahhh errrrr, well it had Furosemide on its label. Apart from these three things they were identical, similar, ok they were nothing alike and this guy is a dumbass..........

What were those five patient rights pertaining to medication administration again, hmmmmm........................................................................

What are the worst patient care errors, mistakes, screw-ups you are aware of?

BEAR IN MIND THERE ARE LIKELY OTHERS ON EMTCITY THAT MAY BE ABLE TO LINK A SPECIFIC CASE BACK TO YOU IF YOU PROVIDE IDENTIFYING INFO SUCH AS COUNTY, CITY, TOWN, SERVICE NAME ETC. BE CAREFUL NOT TO INCLUDE ANYTHING THAT COULD BE A HIPAA VIOLATION AND NEVER MENTION ANOTHER PROVIDER OR SERVICE BY NAME. DONT SAY ANYTHING THAT COULD COME BACK TO HAUNT YOU!

My intent is to have a discussion of errors that happen in EMS or a related discipline. Through this discussion perhaps we can all learn, or at least pause for a second a remind ourselves, to be very diligent in the accuracy and appropriateness of the care we deliver.

Why dust, one you get past the odor, drainage, bug infestation and sores they are just like every other female, aren't they?

I didn't put mine in there either, but it did illustrate my need for better understanding of the procedure.

In your crunching, have you been able to come up with a transport time of an hour or more, yet? If so, then this should be pretty self-explanatory, considering all that has already been said. If not, then please continue crunching. Many medical questions cannot be answered in "several minutes," once you begin to think above the DOT level.

To lead you in the right direction, ask yourself this; how could this information be so absolutely vital to the hospital staff, yet worthless to us? What are they getting from it that we would not, and why would it not benefit us?

If you are thoroughly educated and experienced in the L&D process, and aware of the significance of all that is learned from vaginal checks in both the full-term and pre-term pregnancy, but still don't think this is appropriate for EMS on any level, then we have a legitimate discussion on our hands. But if this is simply your way of saying, "I don't need to know all that" without even knowing what it is that you do not know, then we're wasting our time here.

I thought you would like to know I was wrong on this dilation issue! I had a patient last month, interfacility transfer for OB emergency, 32 weeks, ruptured membranes, dilated and effaced, anyway we made the 98 minute transport without delivery. I was a very happy boy too. Extremely complicated maternal history including pre eclampsia, GDM, Pregnancy induced hypertension and a history of meth and marijuana use. Anyway my friends in L&D and an OB specialist are assisting me with a better understanding of the technique and assessment pearls. Just though you might want to know.

since Dust has not spoken up on this one

Your service sucks if they let you play cop while on duty.

your service sucks if they wrote you up over letting a ff use a urinal

your partner is a whacked out psychopath who should be the one who got the discipline since she was the lead crew member.

Any time you are the lead crew member then most of the crap rolls downhill and strikes you first.

all in all, your service sucks

What she said, twice!