ERDoc

I don't think you will ever see ETTs fully removed off of the ambulance, but you will see less and less use for them. An OPA or King would be fine for a cardiac arrest situation. A code is a temporary situation, it will end one way or another in a short amount of time, so why not use a temporary airway, especially when an ETT takes away from the most important part of a code, the CPR. I don't start worrying about a definitive airway until the pt has been stabilized, relatively speaking.

Yes, I do know the author and worked with him when I was a resident. Although, I haven't found anyone who actually used his textbook.

Whatever. Show off.

Half.com is a good place too. I have a paramedic textbook which was signed by the author. It's too old for you, but I just wanted to gloat about having a textbook personally signed by the author.

It's also being used in the hospital for dysfunctional uterine bleeding and postpartum hemorrhage.

If you were going to design a patient satisfaction survey for EMS, what kind of questions would you want to ask? I guess this isn't limited to managers. As a field provider, what kind of info would you want to know?

Looking at the NYS trauma protocol, it looks like the ambulance was right in taking the pt to the local hospital. The protocol says to transport to the trauma center if the pt can get there in less than 1 hour after the injury. According to Google maps it is 81 miles from the high school to the nearest trauma center in Buffalo, over some hilly/mountainous roads. Even by air, it would probably take over an hour, so closest hospital seems appropriate based on protocol.

It makes me wonder if there was something on the tox screen the family doesn't want people to know about.

Here is a copy of the actual claim

http://download.gannett.edgesuite.net/wgrz/news/complaint_janes_chautauqua.pdf

I'm also curious why the actual cause of death hasn't been released.

Yeah, probably. It's NY so I wouldn't expect anything less. Seriously though, one of the complaints against the EMS crew was that they were refusing to drive the ambulance on the grass. Why would you need to do that? Keep the several ton hunk of metal on firm ground and use this little thing called the stretcher to move the pt to the ambulance. If they had driven the ambulance on the grass and it got stuck in the mud, the parents would be suing for that too. As for the hospital, a 3.5 hour turn around time, which I am assuming is arrival to departure, is not bad at all.

http://wivb.com/2014/11/03/football-death-lawsuit-could-have-big-implications/

Obviously we are only presented with bits and pieces, but WTF? Why are the responders, hospital and ER physician being sued?

You cannot force someone to go if they have the capacity to make their own decisions. They could be having a STEMI right in front of you, but if they say no, then it's no (assuming they have capacity).

Disregard.

Man, just had a rough one in the ER. Older patient fell down and sustained multiple fractures. Screaming in pain, couldn't get orders. It sucks seeing people needlessly suffer. Rather happy my hospital shifts are limited by educational duties these days. It can be a pretty nihilistic environment as far as providers are concerned. Some days are a constant fight against people who just don't care or are really good at making up reasons not to care. Even worse not having any power to facilitate comfort. Don't take the autonomy you have to make more independant decisions out in the field lightly folks.

Just remind your providers that pain medicine for long bone fractures is a core measure and JHACO is watching.

I think this highly depends on where you practice. Where I came from, 911 was run by vollies and most people who worked in the privates came from the vollies. I learned more doing the hospital d/cs and IFTs than I ever did on a 911 call. It also depends on what you mean by treatment skill.

We need to admit that there is a problem though. Hospital systems are starting to limit the use of narcotics to people who have frequent visits with no pathology. The US has something like 10% of the world's population but consume something like 90% of the world's supply of norco/vicodin. It is just as dangerous to give people unneeded opiates as it is to withhold them. There is more to this than just saying, "don't be a mean provider and give everyone opiates." Experienced providers can identify those who are seeking or dependent on opiates. Will we get it right every time? No, but do we get anything right every time in medicine?

Uh, what's convo?

2) When you are in pain, it is not uncommon for your pulse rate and your blood pressure to increase. You can use that as a barometer (with other factors) to determine if someone is really in pain or faking ----- "Doctor, my back pain is a 10/10, the worst pain I have ever had !!!!" (B/P 120/64, with a pulse of 62 ------ Not likely). So, if the pt has no hx of HTN, her B/P may have just been temporarily inflated by her current illness/pain.

http://www.ncbi.nlm.nih.gov/pubmed/20926627

Like the title says I have somethings that I need to get off my chest and get answers to. I am going to list them in numerical fashion so that they are easier for you guys to answer, and well..... here it goes.

1. For those that have done IFT and emergency calls, I have found that I feel more stress on the IFT side then I do on the emergency side have you guys found this as well?

2. A newer EMT asked me this and I was not really sure how to answer him without sounding like I have no soul LMAO! His question was "How do i give a conscious person a painful stimuli when I'm trying to establish there GCS on a IFT and not feel bad about it?"

3. When you work at a service like most others I assume, that has a shit ton of gossip flying around how do you go about making the best name for your self?

4. Over the years I was fortunate and unfortunate enough to work some jobs that have now turned me into an hour churning machine and a person not scared of hard work. I am use to doing a minimum of 60 hours a week and feel lazy when I don't, But have noticed i am getting a little tired of being one of the few that seems to being picking up extra shifts while others lounge. What should i do?

5. Why is it that my favorite food item when I'm working on the ambulance is ice cream and slushes?

6. When people asked me how I liked working my first code and I told them it was "exhilarating, made me feel alive, and I would be ready to do another code right then" they kind of looked at me like was crazy. So.... am I?

and finally my last.....

7. If your partner farts in the truck and its a SBD (silent but deadly) and he locked the windows so you couldn't get away from it. What would you do to get him back?

Well thanks for answering any of these questions or all of them and I look forward to seeing your answers.

1. My IFT was paid and my 911 was volley, so yeah, there was a little more pressure on you at the paid job.

2. Tell him his education sucks and he is not to touch any patients. He is to drive only and not touch the lights or sirens.

3. Gossip is for junior high school and should be ignored. You are not there to look cool to the other providers. You are there to take care of the pts.

4. You do what you need to do. Unless you are the owner/management, open shifts are not your problem.

5. Easy access. I can't count the number of slurpees I drank on the road.

6. No, you are not crazy but the terms whacker and/or buff are playing in the background (only kidding)

7. Not going to dignify this one with an answer

Is that the topic you chose or the one that was assigned to you? Right from the beginning it sounds like a pretty biased topic.

They are not going to pronounce someone that famous in the field short of decapitation. According to the link above, the paparazzi heard her talking to the responders, so who knows. Either way, her injury was not survivable but it makes you wonder what they were doing that took so long.

What interventions could they have been doing that would have taken that long?

My favorite will always be Eat It.

Say what you want, but Weird Al is American history. You know you have made it when he parodies you song. I love him growing up in the 80s and now my kids love him so I have an excuse to listen to him again.

Actually, I would say that Princess Diana's injuries were non-conducive to life so unless you had Jesus Christ there and Diana was going to be raised from the DEAD then her physician ambulance trip was pretty much doomed from the start. You just don't hit a bridge pillar at such a high rate of speed and expect to survive those types of injuries. Well not many do at least.

I'm curious as to what would have happened it this wasn't Princess Diana. Would they have still worked Joe Q Public in this situation?

Zippy, take a deep breath and read what I wrote again. We're making the same point.

All the best.

I think it's your accent systemet.