Just Plain Ruff

My first 3 calls as an EMT were the following

1. Pediatric cardiac Arrest - SIDS

2. Adult cardiac arrest - save

3. Trauma code from pedestrian struck. Save

Those were my first three calls as a new emt just out of orientation. My first 2 shifts were with a seasoned emt and then I was on my own for my 3rd shift.

Let's not forget the Amtrak Train that derails with a bunch of Nuns and Priests on board.

After the train derails three planes in midair crash and fall on top of the building therby collapsing the building.

You take your 4x4's and epipen and run to the nearest bar, get loaded and then run to the local church and confess all your sins and convert to buddhism and move to Tibet to be the next Dahli Lama

But seriously - Triage, call for all the help you can get from 10 counties away and pray man, PRAY!!!!!

5 years out of ems? Thats a lot. I'd take the course again. I know Missouri requires full retraining after I believe 3 years.

Here is my take on this whole psych thing

They are one of my most dreaded calls - I hate them due to their unpredictability BUT that being said

I always transport the patient. The main reason is that you never know what that person has taken and not told you about. I'd hate to go out on a psych call and let them refuse or do a no transport and the patient actually have taken a overdose of a med that is making them act this way. The liabliity is just too great.

I'm being paid to transfer or not to transfer, so I just go ahead and transfer.

These patients are people too and deserve our care even if we don't like that type of call.

Did I ever tell you the time I transported Jesus Christ? His family said he took no meds prior to the psych event, he denied taking any meds. It turns out he had taken a pharmacopea of meds that all interacted with one another causing an intense psychiatric episode. I had a feeling he took something and the ER did a drug/tox screen(it was one of those sendouts that comes back a week later) and it came back with over 20 meds that came up on it. The patient survived without deficits and once the drugs were out of the system he had no further episodes.

We did a tad bit of praying together when we were on the drive to the hospital. Thank god he didn't think he could fly.

I agree and I apologize for my ranting. I hope I didn't make anyone too upset or so with my ranting. I had 1 hour of sleep and reading the responses to the post put me over the top.

That was also after reading that story in USA today about the shortage of school nurses. The state of Missouri (misery) doesn't have any requirements for schools to have nurses at all.

/RANT ON

Jeminy christmas - this was this guys first cardiac arrest in a rural setting. Give him some slack. Who cares if the frickin monitor was on too long, things get missed. If the family can't see it then there is no harm done.

I can remember my first cardiac arrest in the field and it was a flustercluck and if any of you who are critiquing this guy can tell me that your first code, rural or urban went as smooth as glass then I'll bow down to you but if you can't then get off this guys back.

It's amazing how people on this site or any other site can monday morning quarterback and say I'd do this or I'd do that but when it all comes down to it, you do what you can, you go with what you have and in the end the patient either lives or dies.

It's not in our power to save everyone nor should it be. The only one who can make sure that it's not your time to go is whatever god you believe in. When it is your time to go it's your time, no if's and's or butts.

So when the people who are critical of how this person ran the call become perfect then you can come here and second guess this guy but until then, cut him some slack.

/RANT OFF

Sorry guys but we were beating this guy up over piddlin things.

Can you tell I've had a terrible night?

would frozen like a block of ice be a criteria?????

oh well then there is that

Jake, what do you mean take two steps between cpr and a breath?????

Quoted here: But to do CPR for an hour, just to "let her know everything was done", that just doesn't cut it. Let's say that while you were doing your thing a call came in your coverage area for a 2 year old in anaphylaxis. Would it still be appropriate to tie up an ALS unit for the length of time if you knew there was no hope of succesful rescusitiation

I did just that, was the only ambulance on at 6pm. cardiac arrest, worked him for 35 minutes. We got a call from dispatch saying for us to call in asap

I did that, they said they have a 4 year old in anaphylaxis due to Peanuts 3 blocks away. What was our status? I said wait.

Talked to the family of the code and they said go and save her, our loved one is gone. Got permission from the Doc in the ER to call the code. WE did

Hauled butt to the house and were able to save the little boy. The boys family wanted to know how the other family was and we told them outright that the man died and the family told us to go save their little boy. This little boy's family was so grateful and at the same time sad for the family of the code that they have since become great friends.

I also had a nursing home patient in the back of my ambulance who had a small laceration to her leg that needed sutures. A call came out on a choking infant. closest ambulance was 30 minutes away. We were about a mile away. Do you think we thought twice??? NOPE we drove to the childs house, found that the child had cleared his airway with instructions from dispatch and we transported both to the hospital. We operate definately in a mass casualty mode and we do what we can.

Does anyone remember the ambulances where you could have hung the patients from the roof. Like a bunk bed.

I agree with the last post

the criteria that we use is if a person has been down for an unknown period of time (or known even), and the drive to the scene is greater then 15 minutes (which is almost always is except for runs inside our little town) and that patient is in Asystole or a PEA rhythm then that person gets full ACLS protocols provided and if 20 minutes rolls around and the person has not responded then its a quick call the ed to get permission to call the code.

I will then after speaking to my ED physician, I will discuss with the patients family about the decision to terminate the code. Of course this usually is met with relief by the family that we've done all we could but sometimes families get irate and if it's too much of a distressor to the family that we stop then we will continue and will transport. I'd say 85-90 percent of the time the family will understand that we did what we could and agree with the cessation of efforts.

Now witnessed arrest, good cpr and v-fib on the monitor after no matter how long it took us to get there gets worked to the ER no ifs ands or butts.

Others that don't fall under the treat and call mandate are kids and trauma codes and anyone that doesn't fall under the circumstances such as diabetic, seizures, overdoses etc etc.

But with transport times exceeding 20-30 minutes routinely it's not practical to work the patient for that long. Especially when we sometimes run with only one unit on duty and another one on call.

I have a Living will that is printed in small font in my wallet, my wife has one, my family has one. My grandparents have signed a DNR. When it is my time to go it is my time to go, please don't keep me from my glorious reward (my grandpa's quote)

Hello all, well Ditch sent me a pm last night via the trauma central boards. He didn't realize that there was still so much interest in his test. He's gonna start to write it again and said it would be a while for him to get the test written. So be patient my friends.

Race, I agree, he was guilty of a lot of things but the jist of the movie and it's underlying premise is that they were trying to prove, and they did in the movie, that it was possible to execute a man who didn't commit that crime. that was what their movement was all about, do away with the death penalty because this type of thing could happen.

But he was guilty of a number of things, just not anything that warranted the death penalty.

Can we execute innocent people? Sure we could but that is what the appeal process is for and that is why DNA is so important. I still am a staunch supporter of the Death penalty, even if the possibility of executing a person who might be innocent is out there.

Dust, I normally agree with you but you are wrong on the cost. I was putting all the costs together.

It does indeed cost more to put someone to death than to house them. I don't have the references or links since I'm in Detroit and live in KC MO but my math is correct. Let me get those links and references when I get home and I'll show em to ya.

And I'm not naive and I did not fall for them, I have the facts at home.

Racemedic, I have really thick skin, that's what happens after working in this field for 14 years.

True the costs of the appeals stop after they get the juice but that might not happen for 20-25 years. So we are still talking huge amounts of money.

I also think the government missed the boat by not limiting the amount of appeals but it's our justice system and it's flawed but the best one out there.

I do believe that if someone is innocent then they should be given every opportunity and I mean every opportunity to prove their innocence and if that means a million appeals then so be it. I cannot fathom putting someone to death who was truly innocent.

If you want to see a truly jaw dropping movie that made a hard nosed paramedic cry, go rent Life of David Gale.

well there's the crux of the issue. those are only my thoughts, my thoughts on what should happen. But if they are innocent then I'm not sure.

No one failed math on the costs.

you house someone in a prison for life and there are set costs - room, board, food, activities, job costs etc.

But you put someone to death you have to account for all the tremendous amount of legal fees that will be spent on the appeals. some death row inmates have had upwards of 100 appeals, all paid for by you and me and our tax dollars. Consider the fact that an average appeal could run upwards of 100 thousand dollars in terms of hours spent by lawyers, investigators and the like. Someone has to pay those fees. Sure an attorney for the inmate could be working pro-bono but the state is not. So consider a small number of appeals 100 thousand times lets say 15 appeals = 1.5 million plus close to the same amount of money spent to house that inmate in a cell as a similar lifer.

One appeal or two appeals for a lifer at 100K a pop and you get the math.

If anyone has read this thread from beginning to end, they will know that he said it would take him quite a bit of time to get the test written.

I think that with that said, we should stop posting on this because most people here want to take his test. Let's give him time to get the test written and disseminated out to the community.

About 8 years ago I had the opportunity to possibly sit on the jury in a death penalty case. A guy killed his wife for the insurance.

I wanted out of jury duty so I said I was in the business of saving lives and not taking them. They excused me. I think I would hold to that belief today also.

I'm all for the death penalty but I don't want to be the one to push the button. Heck I think that if someone gets sentenced to death, then their sentence should be carried out quickly. Convict in trial 1, retry immediately with a new jury and if they convict and recommend death, then a 3 judge appeals court reviews it for procedural errors, if none, then it is reviewed by the Supreme court one last time and if they don't issue a stay, then it goes to the governor and he either allows a stay/commute or he doesn't. If all those are completed and still the guy/gal is to die then take em out to the courthouse steps and tie the rope or put him either in the gas/electric or lethal injection room. None of this pussy footing around and appeals going on for years. Let the bleeding hearts pay for those.

It cost more to put someone to death than it does to house them for life. Think about that.

Well I feel sorry for that guy's family and not to sound like a heartless ahole but this mandatory death penalty has been on the books for a very very long time. It has been published many times about the babarity of this sentence but this guy did the crime and even though 14 ounces of heroin sounds like a small amount, its just 2 ounces short of a pound. that's a lot of dope guys.

He knew the penalty of getting caught yet he did the crime anyway.

Ignorance of the law is no excuse according to our criminal justice code. So why should it be different there?

Plus I believe he used to at least live in Singapore so he definately should have known the penalty.

It's a harsh penalty but if you know what the penalty is for doing something then you have to accept that if you are caught you are screwed.

Goodness I thought that the xrays in the ambulance suggestions were a thing of the past. First off where are we going to put this new fancy piece of equipment. I've worked in Van ambulances that had less space than my studio apartment's bathroom, and that is small let me tell you.

The fact that we have the ability to do this does not necessarily mean we should do it. We are reimbursed horribly by medicare and medicaid as well as private insurers yet we still want more and more and more bells and whistles.

I agree with Dust, that we educate our ems personnel to be able to do their job and not require them to have to take x-rays. This means more hours spent in school and the way that licensure is in most states you would have to get licensed as a EMS provider and a radiology tech.

Where are we going to put the developer also.

Plus what is the quality of the image? I can just see this huge expenditure going into each ambulance and then the hospital saying the quality isn't good enough or a territorial battle over who takes xrays and the hospital just retakes the xrays.

Let's get off the "I wish we had this cause it would be cool" and get on to the more practical aspects of patient care.

I'd like to see the test and as for ditch not posting here for a while, I k now for a fact that he posted on a topic I was watching within a week or so ago.

One time only and that was way before I was married.

guys guys guys, what do you expect with someone who only currently has 8 posts. . Stephen comes in saying these statements, never once saying he has driven an ambulance. Let's look at the safety record or road record of the high performance racing.

you have a bunch of guys driving around a track and i don't watch car racing very much but I know for a fact that there are lots of crashes. If we take the number of crashes and the number of races run, multiply that by the miles or whatever formula you want to take, I am sure that in terms of miles driven that the high performance racing industry has more of a poor driving record than the EMS industry. Consider millions of miles driven by ems in their daily routine and a lot less than that in the high performance racing.

But then again I don't know how many miles they actually drive but I'd think it's a lot less than that.

I'd put my emergency driving skills up against this guys anyday.

But I'd defer to him on the driving of the death highways of other countries. no desire to do that.

I might have put the child screaming bloody murder in with the ETOH smelling one to make them suffer if the etoh person is the driver of the offending vehicle. Make them think about what havoc they caused.

So who was at fault?

Nate, I assume that if a plane crashed you wouldn't be working many codes at all. maybe a bus wreck or something like that