Just Plain Ruff

a very good friend and excellent cardiologist one time told me the only reason that AHA recommended Amiodarone over Lidocaine is that in the studies Amiodarone helped a few more victims than Lidocaine. He said that the two were nearly the same in success rates.

Pt 1-Driver of the Civic, 20yo female, shoulder/lap restrained.

Pinned between the seat and the steering wheel. Vital signs fading. Responsive to painful stimuli.

Pt 2-Rear passenger of the Civic, 3yo female, appropriate child safety seat.

Severe trauma to the upper torso, head & neck. AMS, Vitals falling, Child is not responsive to any stimuli just staring into space.

Pt 3-Rear passenger of the Civic, 4yo female, appropriate restraint system.

Obvious deformity to R forearm. Vitals stable. Pt is screaming "bloody murder".

Pt 4-Driver of RV, 40yo male, ejected from the vehicle.

Noticeable road rash on posterior of the body, Vitals are weak, but maintaining for the moment. AMS, incoherent speech. Odor of ETOH suspected.

Pt 5-Front Passenger of RV, 35yo female found seated in passenger seat of RV. Unsure of restraint.

Pt AAOx4 c/o bilateral ankle pain. Obvious deformity to both ankles. Pt c/o no other pain. Vitals stable. Odor of ETOH suspected

Pt 6-Rear Passenger of RV, 41yo male, unsure of restraint. Pt found within rear compartment of RV.

Pt AAO x person & time. Pt. c/o pain all over. Deformities to L thigh & L forearm. ETOH suspected. Pt vitals stable with exception of Hypotension and a narrowing pulse pressure.

work on getting patient 1 out.

Rapidly remove patient 2 out and put on next in als truck, also put patient 5 in that same als truck

Put patient 3 and 6 in next als truck

get number 1 out, put in your ambulance and put number 4 in your truck.

unfortunately number 1 and 2 are gonna probably die unless they get to the trauma center right away.

Stephen, you admit to not reading the previous posts. I would do that before you make such inflammatory statements.

I've watched car racing and your drivers really are good drivers but I have to beg to differ with your statements. I'd put my emergency driving skill at the top of the pack and I've logged over 1 million miles.

Before you go and post this inflammatory post you should at least have the respect to read the previous posts and not just take the first post off the page.

actually that bls ambulance is run by the Fire Department so You are more than likely going to be getting two firemen irregardless of what department they come from.

I'm glad

Let me try to explain this a little better cause my previous posts were mis-read or I just did a bad job explaining

there are 5 different overall types of response vehicles. We are not talking LEO's here ok.

BLS Ambulances (2 emt ff's)

ALS Ambulances (2 medics or 1 medic/1 EMT)

Supervisor vehicles (1 Medic)

BLS Pumper

ALS Pumper

Call for a fall comes out

Dispatch sends a bls unit and a als unit. Whichever unit is closest goes L&S, the farther unit responds non-emergency

First unit arrives and triages the patient - if the patient is ALS or Life threat - then the further unit is upgraded. If the call is a bls call then the further unit is cancelled unless needed for lifting or other type of support.

At no times are two ambulances and a firetruck sent to a call unless it's determined by dispatch to be needed like a head on collision with significant injuries.

One other example - chest pain or cardiac arrest type call gets a Fire truck or BLS ambulance for manpower and An ALS Ambulance along with a supervisor.

I hope this straightened out the previous info.

What was great about it Dust is that it took in to consideration the type of call and the resources needed. Granted, if the call was bls then sometimes only a fire department bls ambulance responded, if it was in the gray area then a bls ambulance and a als ambulance would be called, usually the bls ambulance was closest so if it was deemed a bls call by the crew then the ALS ambulance would be cancelled.

If it was a bonafide life threat or need of ALS the first in unit could upgrade the ambulance. If the ambulance was first and didn't need help on scene they could cancel the Fire unit and vice versa.

Bear in mind, this county is not like any of the other many counties in this state, it has more money than it knows what to do with and can afford to send all these resources to calls. If they didn't have the resources then it would be a different story. But the money is there and they choose to spend part of it that way.

I agree when in doubt go L&S but when the call comes in as a injured right ankle or something like that then is LIghts and sirens warranted??

It all comes down to what information dispatch gets from the caller.

I worked for a service that would triage the call. If it was an emergency call but not determined a lifethreat, (eg chest pain, ejection, long fall, cardiac arrest etc etc etc) the closest unit would respond L&S and the farther unit would go non-emergency. Usually the differences in response times would be no more than 2-4 minutes. If the first in unit determined that it was a non-emergent patient then they would say continue non-emerg but if they needed us to upgrade we always could. I found that to be a great idea.

Any life threat call would have both units respond emergency.

Dust, I didn't think I made it sound like I diagnosed calls via dispatch, I never have and never will.

I completely agree with the dispatch info not being right. With constant short response time that I was experiencing being 3-4 minutes to get to anywhere in my city we seldom ran L&S.

With longer times then heck yes, run hot.

And I never said that I trusted what dispatch sent us on. Case in point, had a guy who fell off the roof, onto a cinder block, trauma code, ruptured esophagus and when we intubated the patient we kept getting chest rise and fall, visualized the cords and the tube goin in but with the rupture esophagus we were getting stomach rise also.

The call came out as a fall. Heck when we got there we met the victims wife who was putting an ACE wrap on her ankle and we intially began to ask her questions as a patient until she said, I'm not the patient, it's my husband in the back yard. Well by then he was full trauma code. So NO I don't trust dispatch and what they give us, it's a rarity that I trust them and thats usually for calls from the ER to the nursing home only.

agreed, here's your coke.

Challenge now - what other calls will a 1-2 minute faster response make a huge difference?

I also have worked in all types of services. Rural or urban. I have found that in the rural areas I can get there just as fast running without L&S as I can with em. In urban settings it just depends.

In fact, I had a boss who didn't want us running in town hot due to the short drive to anywhere in town. less than 3 minutes. Heck our average response times in our small town of 5500 was about 4-5 minutes.

Out in the county it was 20-40 mintues.

Urban our response times were 10-12 minutes virtually anywhere. so we ran hot a lot.

I prefer a non-emergency response to non life threat calls but who is to say what dispatch gives us is non-lifethreat.

So the schools of thought are complete opposites at times.

But if someone can prove to me that getting there one or two minutes earlier can make the difference in life and death I'll buy you a coke. The only time is when you can get there and deliver a shock. There may be others but I've been doing this for 15 years, have seen countless patients and can count on my left hand how many people I've saved where the minute or two made the difference.

but for those who do not know this, the po form has not produced the cardiac events that the injectible form has. It's a slightly different formula.

I would be very careful when getting this injectible. The PO form is fine to take but the injectible has quite a few risks.

For those of you who do not know the dangers of Imitrex for migraines, people with cardiac history should not take this drug.

Sounds like shannen had a pre-cardiac event that may have been related to the imitrex. I advised in a pm not to take that drug again.

I had a patient who said they had a slight cardiac family history and I was ordered to give imitrex for his migraine, we ended up coding him and bringing him back but it was a really bad scene.

How are you going to pay for the three person rigs as well as staff them???

Your goals are lofty and I applaud you for them.

I'd get a little experience as a physician before you start to change EMS in your area because you will need to get a good reputation to make changes you are postulating. Not many people in ems will take you seriously when you are fresh out of medical school.

This post content might change as soon as I can read the pdf files that were linked to the post but until then from the information presented here is my take:

forgive me for ignorance but who is going to truly benefit from these devices. From a purely financial statement how will the services recoup the cost of one of these devices? I mean, if one costs even a fraction of the quoted price of 25K such as something in the area of 5K and these are used only a fraction of the time then how much will the patient be charged.

Also how much is insurance going to cover?

I know it is probably too early to talk cost but that has to be a significant factor in determining the need for these devices.

Are they going to tell a medic in the field anything new or more important. I for one know that I care very little what the patients ejection fraction is. You can rest assured that if the patient fits into the criteria for putting one of these on them then they probably have a crappy EF anyway so will this information be of any real calculable use for medics in the field when a large percentage of transport times are 30 mins or less.

This is a good idea but I don't really see the efficacy of putting something like this machine on every ambulance. Maybe helicopters or rigs that have a routinely long and I mean greater than 1 hour transport time.

I agree, the last time I took out the mast from one of my rigs I found a horrendous smell emanating from the box. Nearly knocked me over.

I found a bunch of dried blood and some tissue pieces.

We cultured the stuff in the lab for an experiment and it grew some really nasty organisms. I can't remember what they were.

We went back in the reports and found the two crew members who used a pair of mast last and they got the job of cleaning the mast. unfortunately our infection control said NOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOO don't put those nasty things back in service, so it was a object lesson on cleaning that the crew recieved. They were really pissed when I threw the pants away in front of them. They said that I did it on purpose which I actually did but they did at least from then on out clean their stuff prior to putting it away.

After a terribly long shift working with the worlds crabbiest nurses and the worlds best paragod I misspoke and said hip fracture when I indeed was talking about pelvic fractures.

I have placed the mast on one patient with a pelvic fracture but that placement was well received. It did turn out that aside from a pelvic fracture the patient also had the head of the femur broken off too.

So I guess in a nutshell I have put the mast on a patient with both a pelvic and hip fracture.

There was no fall out for putting them on the patient even with the hip fracture. This did stablize the patients fractures and made the patient comfortable so no harm done.

The patient in turn about 8 weeks later walked in to the ER with the help of a walker and gave me and my partner (not the paragod) a hug and said that the 40 minute ride to the hospital was so comfortable and made the pain so much easier to deal with. I don't know if the patient would have said that to me if we didn't use the mast.

So I stand corrected on the single statement of hip fracture, thanks for pointing out my errata.

I think the most appropriate place to get answers other than this group is front line EMS workers in your area.

The mast has fallen out of favor over the years and I don't recall the last time I've put one on except for a hip fracture and it did a wonderful job.

I'm not sure if using hemostats is a good idea but I'll leave that to the trauma junkies who have had more experience with using them than I.

I've only had one experience where we could not stop the bleeding from an artery and that person exsanguinated (bled out) with us prior to leaving the scene.

I hope I've helped but maybe a more seasoned trauma junkie would have some better answers.

Good luck in your investigation/research.

To Vs-eh, are you saying that none of your medics up there would give a report like the one cited, if no one would then kudos for your system but I know that there are some that might.

Why are we doing the Canada versus the US EMS systems are better than each other.

I did a lot of work in London Ontario in the ER's doing computer consulting and I heard some medics up there give crappy radio reports and crappy ER reports.

I've heard crappy radio reports and hospital reports in the US.

I have been on scene in london ontario as the first one to witness an injury and was treated terribly by the responding crew and was basically told to leave the scene they are there now.

I've been treated the same way in the us.

So why are all the posts a US is better than canada or vice versa from some?

I'd have raised holy h*&*ll that their security said they searched the kid and it was obvious that they did not. I'm sure the conversation went like this

officer "hey, you got anything in your pockets?"

Kid: "why no officer, I sure don't"

Officer to nurse "he's good to go I searched him, now back to my coffee"

I'd have raised holy you know what in regards to the quality search that the officer did.

Bottom line is, no one is watching out for you except yourself. I am glad that it turned out like it did and not the alternative. We never want to read here about another EMS death.

But to me this is a black and white issue. My safety comes first. If I don't feel comfortable then I'm going to do something to remedy my feeling uncomfortable. No one but myself guarantees my safety. Remember what I've said in a previous post, even though there are two officers on scene this just means that there are also 2 guns on scene.

If something doesn't feel right and it sure sounds like you didn't feel right taking this kid without being searched and look what you found.

Frankly I don't care if there is a complaint lodged against me, if my safety is jeopardized and god forbid I'm injured or even killed then who is going to help my family out? Certainly not any work place I've ever worked at.

So bottom line to me is that if you think someone needs to be searched the by golly do it. The life you save may be your own.

As for the poster who says they would get a trip to the unemployment line if you searched too many patients or something like that.

My question is this --- do you really want to be working for a service who puts the safety of their employee behind that of the inconvenience of a search of a patient.

It's all about safety people, Trust your instincts and search em I say. If the cop was going to be transporting them in his car he would definately do a search.

The service you work for would take a different tune if had you not have searched the guy and he injured you with the knife/razor he took out.

Or then again they might have fired you for not searching the patient. It's a double edged sword.

Good job on your instincts.

Had a partner one time that was working a shooting scene, guy shot 4 times in the chest. Distraught wife on scene sitting on the sofa. She asked my partner if he was dead and my partner said "Not yet" and then the lady pulled a gun out of her pants and shot him 3 more times. He was dead after that. Cops crapped their pants and got in a whole mess of trouble.

Important to remember that for every cop on scene there is at least one gun per cop and sometimes two if they have a back up weapon.

NO SCENE IS EVER SAFE

Let me tell a story about the lasix in the coffee prank

I was just that person who got the lasix in my drink but it was 120 milligrams of lasix. It was a horrible day, could not figure out why I was peeing so much, I did not eat at all that day, did not drink any fluids that day either but boy did I find every bathroom that was out there, even patients homes. (nice people)

well to make a long story short, after a 12 hour shift, I got off the ambulance and began to feel faint and lightheaded, chest pain and short of breath and the next thing I know, I'm on the same ambulances gurney that I drove to the station, bp of 80/40 pulse ox of 70% and irregular heart rate. being transported code 3 to the nearest cardiac center.

I was diagnosed with a severe electrolyte balance due to unknown causes. My sodium was critically low, my potassium was critically low. found out 3 days later that a paramedic playing a joke on the new guy put the lasix in the soda.

He was fired, he also lost his medic license and was charged with assault/battery on me.

so the lasix in the coffee is definately NOT FUNNY EVER!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! It nearly killed me.

I agree with CDN here.

If the state is already on to him then let them at him

As for your reputation, more than likely what this guy says about you won't mean jack to many. There may be some who listen to him but if his reputation precedes him then you should be ok.

Your reputation is your bond. You work to make a great rep and someone bad mouths you it hurts. Once people see you for who you are their perceptions are usually changed if your rep is good.

just my opinion