captainstandup

JCAHO doesnt freak out about anything except what the GD nursing associations and boards tell them to freak out about. They have kept the national "nursing shortage" going for ten years through terrorizing any discipline that encroached onto their turf.

There is a vast difference between the need for a seatbelt versus the need for body armor. I realize we are talking about worse case scenarios here and perhaps body armor is a good idea. The idea of going into what is essentially a combat zone unarmed is unacceptable silliness. I'm not going to take unacceptable risks for myself or my partner regardless of the number or severity of victims. Our families have a right to expect our safe return from work, even if this means we stage until the scene is secure, always, 100% of the time. If this means victims die, then so be it. Better them than me. Dead heroes are still dead, and can never take their kids fishing or enjoy the wonderful things life has to offer. I think the best case for body armor is for that percentage of calls where the violence is unknown, or at least the potential is unknown. Anthonym83 is correct in adding TC's to the discussion. I read, a long tome ago, an account of a ballistic vest saving a cops life from an MVA where there was intrusion of a foreign object into the vehicle and the breast plate deflected it away from penetrating the officers chest wall.

If societal decay has reached the point that we need body armor, perhaps it's time we arm paramedics with at least an airlight .38 with safety slugs. I agree that we probably would be safer with body armor but if I must routinely wear it to respond to help someone, perhaps I shouldnt be there in the first place. As a rule I'm staging until it's as safe as possible regardless of how many victims or their severity. The cops are the only group that is prepared to defend itself and I'm not bringing a jumpbag to a gun or knife fight. I think its interesting that during the most dangerous times in my life (on an ambulance) I have been disarmed by political correctness, liberal laws, and myopic policies. There are neighborhoods in America that are nearly as dangerous as Baghdad. Among the worst are South Miami, Washington DC, Houston TX, LA, Philadephia yet we expect non law enforcement personnel to rely on the fact that "we are there to help" and perhaps body armor to save us. This tune has a nice beat, but I think it may be hard to dance to........................

I tried a great number of stethoscopes and finally found that I really like my Littman Master Cardiology. Some providers don't like it due to it being a single head device but after reading the literature that came with it, and a great deal of use, I learned how to utilize the "adjustable diaphragm" and now prefer it over others even when treating pediatric patients. It's important to note that regardless of which stethoscope you purchase, it will be nothing more than a prop if you don't use it every chance you get. Listen to each patient you provide care for. This is especially true on routine calls. Turn every situation into a learning opportunity. Listen to your children, siblings, parents, grandparents. Listen to every healthy person you get a chance to assess. Having an excellent idea of what healthy breath sounds; sound like, enables you to recognize unhealthy breath sounds and develop clinical judgment about why they sound as they do. This is especially important in pediatric patients. You really don't need an expensive prop hanging around your neck. You would likely be well served to buy a "high end" stethoscope but you must treat it as the crucial information gathering device it is intended to be. OK I'm off my soapbox; I really enjoy preaching the "gospel" of standup pre-hospital care! Dust said it best, "go big or go home". I just wanted to add that it is important to be able to understand what you are hearing and how it correlates to your patient's situation.

Outstanding work!!!!!!!!!!!! Now "young grasshoppa" you can begin the process of learning how to take care of the sick and injured. Please, please, please please for the rest of your career in pre-hospital care always keep asking why! True knowledge lies in knowing "the why" Stay very close to EMT City and folks like Dust, Spenac, Ridryder911 and countless others, oh and of course me Throw the remote control at your EMS base in the garbage can and take a pick axe to the TV, its waiting to steal your mind and must be stopped. Now, go forth an heal young one and Godspeed! Don't just accept anything anyone tells you, and for damn sure always be suspicious of anything the American Heart Association tries to push as fact. They are for sale to the highest bidder and their science is suspect at best. They are motivated by the need to support the pharmaceutical companies that support the doctors that recommend the medications that support the pharmaceutical companies that contribute to the AHA, you get my point.......

AS a former EMS Director It wouldn't have kept you from being hired, however once you were assigned to a partner it would be your task to develop a rapport with them that permitted you to compensate for your color blindness. There are a few situations that absolutely require the ability to distinguish color, especially when transferring critical patients with hemodynamic lines, and in some respects interpreting some diagnostic tests are colorimetric based. I dont have a clear understanding as to how this may impair your ability to assess patients accurately because I really don't understand what exactly you see when others are seeing colors. That was terribly worded, but I think you get my point. I read a story in JEMS years ago about a deaf paramedic. I probably wouldn't have hired her. It is my opinion that as a medic you must be capable of seeing and hearing along with tactile feedback from hands on assessment. Furthermore I believe a visually or hearing impaired paramedic would create an unacceptable safety risk for themselves and others.

Things aren't much better, if any, on our side of the border. Scumbags, drugdealers, murderers, child molesters, Rapists, etc have the ACLU and 98% of the democrats in legislative positions advocating for them. We are conditioning US society to avoid accepting responsibility for anything. Have no fear my chilly northern neighbor, we will implode soon enough and you folks can have a much warmer place to take summer vacations. Just remember there will remain small groups of us who are well armed and self reliant with a sense of right and wrong. Just be nice to us when you get here..............................

The dumbest thing I heard on the radio goes as follows: Dispatch: Attention EMS 5 respond to (*&&^^) road reference man down. US: EMS 5 responding (Thats actually me checking enroute) Dispatch: EOC to EMS 5 US: Go ahead EOC Dispatch: Caller now reports the patient is suffering GSW to abdomen Us:EMS 5 ok on that, ETA of law enforcement? Dispatch: Deputy advises 8-10 minutes. Us: OK EOC we will be staging at the EXXON Dispatch: EOC to EMS 5 US: EMS 5 Dispatch: Caller advises the patient is getting worse. US: Ok on that EOC, ETA of Deputy Dispatch: Still approx 6 minutes Us:OK we are standing by and will continue to scene one Deputy advises same is clear. Dispatch: EOC to EMS 5 US: EMS 5 Dispatch: Caller advises there is no danger and promises there is no risk, we recommend you procede ahead of Deputy, it sounds like the patient is critical. US: EMS 5 to EOC, be advised we appreciate the promise from the caller, but have you considered whether they were the shooter? Dispatch: Unable to advise EMS 5 Us: EMS 5 to EOC, per policy and common sense we will remain in staging until scene is secure. Dispatch: "Ok on that EMS 5"

No biggie, I get a little passionate (no pun intended) when it comes to children. We have horrible statistics in North Carolina regarding child abuse and the like and it's really frustrating. The reality is that given the fact this girl is perhaps within days of being "legal” it probably not necessarily an inappropriate relationship. In my mind there would be a significant difference in this discussion if the girl was a 17 turning eighteen as opposed to perhaps 15 turning 16. In any event, it’s her parent’s responsibility to act in what they believe to be their daughter’s best interest and my opinion really isn't relevant. Finally, I think in situations like this, the chief has an obligation to make the board of directors or "powers that be" aware of; the situation. This would allow them to be prepared to act in the organizations best interest and it would likely give a sense of credibility to the entire situation if there were no smoke and mirrors. This may be a stretch regarding personal relationships and privacy, but given the unusual sensitivity and risk of negative perception for the organization, I believe everyone involved would benefit from an honest open approach within reason.

The shame of it all! Oh wait, is that tones in the background? Ooooopppppsssss, I must go now............... Wait a minute, who are you working for, and why do you want to know? (He asks with a suspicious scowl). I'll bet my employer has hired another efficiency consultant. I know nothing, nothing at all!!!

mo·lest /məˈlɛst/ Pronunciation Key - Show Spelled Pronunciation[muh-lest] Pronunciation Key - Show IPA Pronunciation –verb (used with object) 1. to bother, interfere with, or annoy. 2. to make indecent sexual advances to. 3. to assault sexually. OK Perhaps he has just been bothering her, interfering with her maturation to adulthood and annoying the community. Bill Clinton "I did not have sexual relations with that woman" The point is; age difference, age of the child, person in a leadership role making bad choices. You could aske the question though, would it be as much of an issue if the guy wasn't in a public role?

No need to "concede". I've only been a member of EMT City for a few weeks and I am amazed by the level of expertise among the regular contributors to various threads. I've been in this business for quite a while and how I wish EMT City was available "back in the day". I find the threads, such as this one, inspire me to pull some of my dusty books down and wake up a few long dormant brain cells.

Fire this guy, he is bad for business and really bad for the profession. This isn't simply a matter of minding our own business, this is a child and there is no excuse or explanation for this guy having become involved with her. Clearly if they are engaged, it has been going on for a while. I cringe at the thought of how young she was when he began molesting her. And to the comment that "this is miniscule compared to what's going on out there". Old timers used to have a saying that went " you can boil a frog, one degree at a time". This was based on the loosely held "fact" that a frog will not jump out of a pan if the temperature is gradually increased. By the time the frog senses enough pain to realize he is in trouble the damage is done. This was meant to serve as an example of the effect of declining morals "one degree at a time" If the community gives this guy a pass on this thing and simply writes it off as well she had a note from dad, or she was almost of legal age, or whatever excuse makes them feel good, or at least not bad, then what's next? This isnt a social service or counseling agency, its allegedly a professional organization responsible for a very important mission in providing EMS / Rescue services. Kick him out of the organization ASAP. You may be doing him and his little girl "friend" a favor. If he doesnt have agency responsibilites he will be free to take her to high school each morning, and if he's really good perhaps he can take her to; her senior prom.

I agree with doc, I have never heard of an MI that cant be seen in some manner by the 12 lead. Even old tissue damage usually results in some changes, albeit subtle in some cases. But hey, I never say never in health care and I certainly have a great deal more to learn.

OK three lines may be overkill, but two are a minimum. I'll agree there are a myriad of additional factors that impede efficient door to balloon time. The unfortunate reality is that hospitals are notorious for carrying forth their doctrine of heart or brain care and offer charts, graphs, a dump truck load of data allegedly supporting their plan and of course a new mnemonic to christen the new program. Unfortunately its entirely symbolism over substance. Physicians exercise their autonomy and either choose to participate in the various initiatives or not. It's very difficult to get them all on the same page and they essentially answer to no-one. Although not directly related to this thread, an example of what I am speaking of is diagnostic cath labs. These things are on every corner it seems. Patients, who already tend to minimize the severity of their situation, are easily deluded into believing a diagnostic heart cath is all they will need. Unfortunately, for a significant number this is not true. Once it's determined the patient has significant disease requiring at minimum stent or even CABG surgery, EMS or Critical Care Transport must then transfer the patient, sometimes many miles, to definitive care. This is no small issue by the way. Among the many risks associated with transfer are: Life threatening hemorrhage, air embolism, increased risk of clot formation and pulmonary embolism, and not to mention traffic accidents. If the patient has a swan-ganz in place the risk of catheter migration and spontaneous wedge are real possibilities. It is my opinion that diagnostic cath labs are at minimum unethical and probably should be considered criminal neglect, since the patient would have clearly been better served within an interventional lab with appropriate CVOR supporting services. Like Dennis Miller says "thats my opinion, but hey I could be wrong"

It really depends on whether the patient is right or left dominant in terms of coronary perfusion and absent a previous cath the waters are a bit muddy regarding the specific vessel. If for no other reason than a heightened degree of caution regarding increased incidence of catastrophic decrease in blood pressure associated with nitrate admin and RVI, I feel a V-4R should be standard in all chest pain patients. While I'm on the subject, please ensure students understand the need to initiate a minimum of two IV lines, three if possible, for anyone with suspected AMI. This will help expedite the patients "time to balloon inflation" time, should they go to the cath lab. It will also provide a backup should the patient require "fluid resuscitation" or multiple meds / drips. I applaud the fact that you are EDUCATING your students instead of teaching them. It sure is a shame your friend had to loose muscle due to an incompetent physician.

Spenac, ever the capitalist..............

I understand and no apology necessary. I'm hoping to get up there in the early summer to fly fish, and will certainly be visiting some EMS/Emergency Services agencies while I'm there.

I feel your pain friend. Sometimes it seems like time and progress are at a standstill, but dont give up! Get the media involved, show them how care can be better, but do so carefully. Remember who pays your salary and the power behind the throne, as it were. I'll be the first to agree that RSI isn't for everyone and as others have stated it's probably not best considered the standard of care without a tremendous array of supporting components. QA, QI, audit and review of each and every utilization of this skill. Someone in the industry simply must begin the task of "evidence based" data collection that includes a multitude of factors to determine if this is a useful procedure for the pre-hospital environment. This doesn't mean we need to stop using it, we need to honestly evaluate its usefulness. To reiterate my earlier statements, the focus must be on adequate airway management and specific patient dynamics and NOT on tally sheet measurement of successes and failures of specific skills. Again, we cant ignore the need for skill proficiency, but there must be a balance that encourages providers to focus on the patients need for proper airway management instead of fearing being perceived as incompetent by his/her peers simply based on a number on a skills sheet. This is not the time for cowboy recklessness. Our patients, our profession deserve an educated, articulate approach. Who knows, this may begin a process much larger than itself?

Alright my esteemed colleagues in Canada, lighten up it was a damn joke, it was a joke! I live in North Carolina for God's sake. Deliverance was filmed 120 miles from here, just across the GA line and we certainly cant point fingers. Mexico, on the other hand, can piss off. Spenac, if anyone bothers you daughter I'll bring a chainsaw, shovel and a couple bags of lime my friend. Just tell me where to meet you, God forbid that ever happens! This discussion was regarding the leader of an EMS / Rescue organization. If the folks in that community are willing to accept the minimum stanard in ethics, then they deserve the fallout when things go badly

Which is likely to kill the patient first, relative hypovolemia or a failed airway? I dont believe anyone would argue the fact that we are now discussing semantics. In a patient with an inadequate airway I submit their blood pressure is virtually inconsequential. We must correct airway compromise immediately and completely. This is in a manner of speaking like waiting for extrication to be completed before decompressing a tension pneumothorax. The patients are often far too injured to wait for this life saving therapy and I feel the ones meeting RSI criteria are as well. (NO I DONT MEAN RSI SHOULD BE ATTEMPTED PRIOR TO EXTRICATION) This isn't to imply that hemodynamics are of no importance, but what good does it do to perfuse a brain with a soup of 50% or less sao2 blood and lactic acid? Of course we all work in areas with different protocols and vastly different scope of practice settings and we must work within those limitations, but if you are so restricted that you cant provide care to the minimum standard, I recommend moving to another town for the sake of those you love and for your mental health or at least carefully begin the political process of firing the medical director.

Canada and Mexico should be very proud! How do they define virgin, an ugly third grader? Nothing and I mean nothing good can come of this looser dating an underage girl. Leadership must establish ethics and demonstrate behavior that exemplifies the values of the organization he represents. This shouldn’t require a note from a girl's parents or infinitesimally specific interpretation of the law. This guy is a looser and a child predator and he is excused. Hey, based on spenac's chart he should consider Canada and Mexico, I understand it to be a "target rich" environment for a fellow like him.

Should this squad or any squad permit leadership to exist that, in any manner; has even the remote appearance of impropriety regarding a child? If she is under the age of eighteen, this guy should be fired, voted out or perhaps stoned to death! He should at minimum be charged. Not only does it make him look like a parasite and a fraud, it discredits the good work of others in the organization. Parental permission is legally meaningless. Unless this girl has been emancipated by the court or has given birth to a child, she is still a minor in the eyes of the law. As I understand it, If this guy has been, or is having sex with her, consensual or not, he is guilty of a felony in all 50 states. Mom and dad can't simply giver her a permission slip to sleep with the rescue chief. I am forever amazed at the level of low-life’s we will tolerate in emergency services. Perhaps we are simply reflective of the communities where we live and their value systems. I suppose we should be thankful this guy didn’t have a fetish for barnyard animals; otherwise he would have needed a permission slip from farmer brown. Finally, let’s say your squad was called to treat a girl of the same age as this girl for a medical complaint, perhaps a severe UTI. Because she is underage the ER calls the girls parents for permission to provide treatment. The man involved is the same age of your chief, but the parents haven’t given "permission" and this guy is charged. Fast forward to the court proceedings where the slick defense attorney delves into your chief's lifestyle in an effort to illustrate to the jury that his client's actions were the social norm. How will this play out in the media for your agency? God help you if you are donation supported!

I wasn't aware of that article either. Fools on the highways are likely the greatest threat to Paramedics. Reckless ambulance driving, drunks on the roadways, and the worst is collisions between dumbass drivers half asleep, drunk or on the cellphone crashing into Emergency services folks working on the roadside. After loosing two LE personnel we started staging the biggest fire apparatus, preferably a large tanker or ladder approx 50 yards behind the accident scene at a left facing angle to deflect a vehicle away from personnel. One department sends their 3000 gallon freightliner tandem axle tanker for this purpose. This is a new tanker and the chief said he wasn't worried about it being damaged, adding they would sue the estate of whomever hit it and if that was enough the FD has it insured.

Interventional cath lab is likely their only hope of salvaging muscle and this would require early action by the patient, good diagnostics by paramedics with transport to the nearest APPROPRIATE facility.