ERDoc

Not all of us who worked for transcare are bad people. I'm having trouble figuring out what they tried to tape. Trachs are pretty simple. There is a hole and that hole should not be blocked or your pt might die. If it isn't broke, don't touch it.

http://www.nytimes.com/2014/05/29/nyregion/jury-awards-172-million-in-verdict-against-city.html I have a hard time finding fault with the crew without more info. This is NYC and if you are up in an apt building, it can take a while to get out. Even if the hospital is right around to corner, just the trip down to the ambulance could take a while. Based on the limited info, I can't fault the crew. They started CPR and maintained coronary perfusion pressure (in theory) while waiting for a properly equipped unit. It might have taken less time for the ALS unit to respond than it would have to load the pt and head to the hospital. I think it was a judgement call and a damned-if-you-do-damned-if-you-don't situation. Dead and brain injured kids are guaranteed losses in court, regardless of how perfect the crew performed.

Seriously, WTF? I try to give EMS the benefit of the doubt but I can't make this any better when I try to think it out. http://www.emsvillage.com/articles/article.cfm?id=1779

Cleaning equipment, wow that is old school. I remember those days. The bloody cervical collar with the porous foam was good to go once you hit it with peroxide. My old VAC is building a new headquarters and found a bunch of old stuff laying around. They've been putting pics of the stuff online. http://shirleyambulance.smugmug.com/History/Equipment/37971131_Lgk3Pm#!i=3136145531&k=pBzdBWL

Why do you let the verbally abusive pts get to you? They are just words. The best thing to do is to ignore their tirades and just transport. As juvenile as it sounds, "Stick and stones may break my bones but words will never hurt me." Don't be that guy that feels he needs to one up the pt. That will never end well and usually leads to burnout. Try not to laugh when they are carrying on either. That tends to make them even more mad (yup, personal learning moment).

Agreed with the above. The cop may not have touched a weapon in 20+ years, but he has had more training that I have. Let's assume that we are on the scene with no cops in this situation. I'm not touching the gun regardless of what options we are given. I will move the pt out of the reach of the gun and have someone else watch it until LEO arrives. PS-Hey, we don't have supervisors on LI, just chiefs and they don't have any more medical authority than the rest of us.

I guess time will tell.

The way I understand it (and I very well could be wrong) is that the docs are considered govt employees and with sovereign immunity and therefore, the govt can decide if they can be sued or not.

We're talking civil law here so there is a lot more control by the govt. None of that pesky Constitution foolishness to deal with.

I can't really argue most of your points Island but I have heard that as far as the liability on the doc, they have been given soverign immunity. I don't know how true that is but I think it would be necessary if they want the program to succeed.

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Don't sweat it. Medicine is a new environment that takes some getting used to. You will always have those calls/patients that will stick with you forever but in time you will learn that it is not your emergency and you get to go home to your family, which is all that really matters. Make sure you have someone in the field you can talk to. You can talk to those on the outside but they will not fully understand it (sometimes all you need is someone who will listen and be sympathetic even if they don't have a clue what you are talking about). Your "partner" is a douche and should not be listened to. We all learn at different paces and all start with a different level of knowledge on which to build. I'm not sure how you judge someone as a "below average" EMT as there is not much to judge an EMT on. Generally the "below average EMT" is someone who does it for the glory, the action and the lights and sirens. If you are doing it to help people (as cliche as that is) they you are already above a large portion of your cohorts. If you want to survive in this field you will need tough skin and will need to learn to say, "Fuck them," even if it is just in your head. You sound like you have a good head on your shoulders and are doing it for the right reasons, just keep doing what you are doing.

The problem is with that is you are not dealing with the judicial system and constitution, you are dealing with a private enterprise. Fruit of the poisonous tree does not hold.

I wondered the same thing as you, Mikey. A friend of mine, who is really into sports and following this pretty closely explained it to me. We need to ignore the feelings on the actual act of making the recording as that is out of the hands of the NBA. The fact is, the recording was made and it was released. The NBA is a corporation whose brand depends on its image. All team owners are required to sign a code of conduct when they purchase the team that if they do anything that can be seen as hurting the image of the NBA brand than they may be banned and forced to sell the team. What was done to him was disgustingly underhanded but he signed the code and knew the potential ramifications. He is the one that made the decision to trust someone, that in the end he shouldn't have, not the NBA. As for him not being a bigot, to some people the color green means more than any skin color.

So YOU made the decision to drink something YOU shouldn't have. YOU then got drunk off of it. YOU then tried to assault someone else who was trying to help you. Do you see the common thread in all of this (hint, it's capitalized). Personally, I am glad to hear that the EMT is pressing charges. Providers (EMT, Paramedic, RN, MD/DO, etc) have been putting up with this for too long. Getting assaulted is NOT in our job description, despite what the suits say. YOU made the decision to get drunk so you are responsible for the outcome, whether you remember it or not. I would consider yourself lucky. What do you think would have happened if you had done what you did to the cop instead? You're an adult, man up and act like it. Take your consequences and be happy they are not worse.

I'm with you. I think it is a good thing. It has been shown to save lives in the short term so I think we should continue and see what the long term outcomes are.

I don't think we have been doing it long enough to know about long term consequences.

I'm sorry for lumping all NH RNs together, because you are correct Kate. Not all are like that. The problem is that most are and it unfortunately creates a stereotype for the good ones. I totally understand when a doc says you have to send it also, that is totally out of your control. The problem for me is, that this particular NH is one of "those types" and they even have a vent unit. A large number of pts come in and we get told they couldn't get in touch with the doc so they had to send the pt. The ones that actually need to be in the ER they will call ahead about, the dumps they don't call ahead.

I don't know if things will ever get better. Physicians used to be seen by the general public as a respectable position. The last 1-2 decades have changed that. We are now seen the same as any service worker where the customer orders what they want and gets what they want. It is not going to get any better with the current movement to pt satisfaction over quality care. The same is going to happen with EMS.

I think we are missing the forest for the trees. There is more going on than just vent settings. Is anyone concerned with this red hole on the chest? Any chance a CT angio was done before we got there?

I would think about treating each side as a separate scene/event. It will be difficult for incident command on one side to manage/eval the other side. Just set up 2 separate incident commands if you have the resources. I would also have responding ambulances come from the opposite direction of travel, the road is already shut down due to the accident so it should be pretty easy access.

I hate to get into this pissing contest, but dude, seriously? There is a large difference between being called an arse and being called a cunt.

I'm a minimalist and a firm believer in the KISS principle. If you have the pt adequately sedated, there is no reason for paralytics. Every medication has side effects, why add more and more meds to increase the number and chance for unwanted side effects and interactions?

Wow, this one went downhill really quick. I can see where the miscommunications happened. Swamp, part of the issue is that it is hard for us to give you great advice without knowing more details. You are still young and inexperienced so I don't think you realize that the way EMS is done where you are is much different than it is done where I am. We were all there, including me. It took me a long time to realize that what happened in Suffolk County, NY didn't happen in the other 99.9% of the world. Some people can handle an accelerated course, some people can't. At the EMT level, it shouldn't be too difficult, especially if you have some back ground. Where I came from all courses were run by the vollies, whether it be a FD or a VAC. There were no EMT level college courses and only one ALS level college program (no degree, but got you the NYS EMT-CC certification). The only medic class in the county was run by the state university, but no degree again. Where I came from, all EMS classes were run by the gov't so I don't see it as a big deal, whereas others have issue. Again, it is the fractured nature of EMS in the US. Based on that, where I was, no employer cared where you took your class as long as you had a card. You will also find a lot of people here who have made EMS a career and have decades of experience. It tends to be a sore spot when people use the profession as a stepping stone to something else. Not everyone sees becoming a FF as a promotion and many see it as an insult. Just remember though, whatever course you decide to take it is not about you. EMS is a field of medicine, which is about the patient. Your patients are inviting you into their lives, seeing them on one of the worst days of their lives. You owe it to them to be at your best and bring your A-game very time. Unfortunately, most people who do EMS as a FD stepping stone could care less about the patients and just see them as part of that stone, nothing more than one more obstacle they need to get over to get what they really want. Don't be that provider.

Holy crap, Klutzy, that is a horrible story. I think we need a little palate cleanser right now. OP, some transports are complete BS as it sounds like this one was. Remember, it is not the pt that called and they should not be the target of your anger. Blame the people that called. We once had EMS bring in a guy from the local NH that was sent because he pinched a nurse. The complaint on the form from the NH was, "Aggressive behavior and altered mental status." When EMS brought him in he was laughing and making jokes. I asked him if he had any complaints which he denied. I asked him about the "aggressive behavior," and he said something like, "Hell yeah I pinched them. Those girls are bitches and deserved it. If they would just listen to me I would stop doing it." "Sir, do you want to be here?" "Nope, I want to go home and go to sleep." "Okay, have a good night." We got a call from the charge nurse from the NH who was pissed and told us that if he pinched anyone else that she would be sending him back.