emTpromises

It would drive me crazy knowing that I had a misplaced apostrophe on my back for the rest of my life. Unless that was a mole...

Ditto... not enough information. "Seated" makes it sound like she was on a Ferno. I believe the lawsuit implies that she was on the medics' gurney, not the hospital's. Other than ALWAYS having one person with the patient, my partner and I lower the gurney if the patient is combative, hyperventilating, "writhing" in pain or any other such drama.

Hope you don't mind me jumping in--I'm only BLS, but... does the man have any med. tags? Blood sugar? Any other meds in the house?

Reddfrogg, I don't have any experience regarding an actual merger, but I work in a fire-based EMS system. Large numbers of people wanting to become firefighters here become paramedics in order to get hired with the department; however, these are people who want to be firefighters, not medics. Of course, there are some older medics in the system who are phenomenal and I love running calls with them and learning from them. Unfortunately, the majority of medics are just biding their time until they can get a spot on the engine. Their treatment is affected by this attitude. We have issues with medics BLSing ALS patients because they just don't care. For example, protocol states that systolic blood pressure over 200 and/or diastolic bp over 100 is ALS--can't tell you how many times I've gotten a reading like this and had the medic or another firefighter redo the bp and claim that I was wrong. Later, show up at the hospital, take vitals again and have a nurse upset that we just brought a patient in BLS with a bp of 210/120. Not sure how it will be in your area, but our ambulance company is contracted by fire, so it's in everyone's best interest to keep them happy. We are generally told not to question a medic's decisions; we are literally "gurney-jockies" here. If the dept. is unhappy with us, they can simply renew the ambulance contract with a different company. In order to win the contract, our company must also keep expenses low, which is why we work 24 hour shifts here at $8.00/hour. Bottom line: I don't recommend it.

Thank you, Mobey. That's exactly what I needed to hear. One point in response to "Pt. seemed slightly short of breath so I called for a transfer..." Our ambulance company is the county provider for 911 response in the area and also the main provider for IFTs--this was not a call for a transfer, but an emergency, code 3 response. But, seriously, you're correct. Probably not what I wanted to hear but I get it. :wink: P.S. Sorry, guys--haven't mastered quotations, yet. Working on it.

Thanks for the replies. I'm not upset about a locked door or a worker with a bad attitude. Sorry--my prior career was print advertising and I was trying to paint a picture in prose. What's bothering me is a Dr. who I feel actually put a pt.'s life in danger. Doug, as you pointed out, this Dr. had the common sense to call 911 but then left the (mobility-limited) pt. alone long enough to lose consciousness and fall into a position in which her airway was compromised. I can forgive a mistake and even understand a momentary lapse in judgement, but think of the process this Dr. had to go through in order to end up where we were: Step 1 - "Wow--something is seriously wrong enough here that I need to call 911." Step 2 - Go to phone, dial 911, explain situation and request help. Step 3? "Oh, yeah, I... left my lunch in the car/need a cigarette/really have to pee/(insert need here that was more important than a pt.'s status that you felt was serious enough to call 911 for)." That's what upsets me. This physician has not only taken an oath to "do no harm" but is also charging for the privelege to do so. So, in a way it's "nice" to know you've all dealt with it, too, but is that all we can do? Just vent amongst ourselves and let it go? In cases of child, elder or spousal abuse or abandonment we report it. Isn't this another form of that? Or am I putting too much responsibility on the physician?

Looking for some feedback... am I blowing hot air or is this a real ethical dilemma? Got called out to a Dr.'s office for a 68 y/o F difficulty breather. My partner and I were first on scene (we are both EMT-Bs... we run with the County Fire Dept., which brings the medic). Once inside the empty waiting room with our gurney, we had to wait for the receptionist to saunter over to unlock the door to the back. She pointed us down the hall, stating that she thought the pt. was "back there." My partner and I found the pt. in an exam room, sitting slumped over in a wheelchair, slow, agonal respirations, drooling, completely unresponsive. I called out into the hallway to the receptionist, trying to find out what status the pt. was in when 911 was called and where the Dr. was, amongst other pertinent pt. info. My partner and I had enough time to open the pt.'s airway, search her for any med. tags, put her on 15 lpm via NRB and obtain a thorough set of v/s before the Dr. came strolling in, looking annoyed, purse in hand (on a break?). I asked her if the pt. had been A&Ox3 when the Dr. called 911 and the Dr. went slack-jawed, dropped her purse and said, "Oh my god! Start CPR! Does she have a pulse?" (Yes... in that order.) Right then, FD showed up and took over, putting the Dr. to work gathering the pt.'s records (she couldn't give us any Hx, meds, etc., only that the pt. had been A&Ox3 when the Dr. called 911 because the pt. started breathing rapidly). Turns out, pt. was a diabetic and BS was 28. Everything worked out in the end. However, I was furious with the Dr. I asked around at the hospital and found out that this Dr. is a primary physician for a number of the con. homes in the area (at one of which this pt. is a resident). After voicing my concerns to a couple of ER nurses I respect and even my supervisor, I was told again and again that this is "typical" and part of the job (especially here in South Central L.A.--poor socio-economics = poor medical care). In only one year on this job I have seen a lot, including burnt-out workers with poor attitudes, but never a medical "professional" whose incompetence has so frightened me. Is this something any of you have dealt with? Do I learn and move on? Or do I take further steps to report this Dr.? Thanks in advance for your wisdom...

ffemt, remember not to take interactions with patients and their family/friends too seriously. Did this guy even knew you where volly, rather than paid? I've had plenty of patients' family members and friends "get in my face" simply because it was their loved one, not because they had any higher medical authority than me. Remember, in "emergencies" we are the ones with the training to keep our cool, especially because most of those around us will be panicking. Sometimes that includes brushing off the attitudes and harsh words of "outsiders." Frankly, if my relative or friend needed medical assistance and I were present, you can bet I would let the emergency medical personnel know that I had some experience so that 1) proper care would be given, "I'm watching you" and 2) I could assist if needed, "Hey, I actually know what's going on here." In the long run, feel free to vent, but understand that this was just some guy losing his cool in the heat of the moment. If he, for any reason, takes this incidence further--as long as you did the right thing--you have nothing to worry about.

Thanks for the reminder, Gaelic! My thoughts and prayers are with this firefighter and his family. It's easy to get complacent when, thankfully, these incidences are rare. This past weekend, my partner and I were sitting in our rig whining about how long it took for PD to arrive on scene. (It was a suicidal ideation 911 call and we must stage out until PD clears the scene on any call that may involve violence). We made our self-righteous points about how someone could have been bleeding to death inside but, as we are all taught, we are no good to our patients unless we, ourselves, are safe and healthy. Luckily, PD arrived and cleared the scene, finding nothing apparently threatening, but it's important to remember why we take that time and go through the proper process. Which leads me to my mantra here in South/South Central Los Angeles: thank a police officer--they are compensated much less than they risk! I am so glad that Chicago will be changing their policy and sending the investigators out in teams. I am very familiar with South Chicago and am surprised that this is a new policy. Stay safe out there!

Yes, Scaramedic, Abu Dhabi is where Garfield threatened to send Odie... Saturday morning cartoons just aren't the same these days. Abu Dhabi is pretty bad for pedestrians, but not nearly as terrible as Delhi. At least most of the UAE urban areas have sidewalks. In India, I got my foot run over once by a crazy rickshaw driver and refused to walk anywhere else--woulda been suicide by traffic.

I agree with Phil regarding the treatment of mental illness in ems and I also agree that one's patience can be completely depleted by the time that spitting, biting, 5150 patient has been restrained to the gurney. However, I think the biggest point here is for freedome--it sounds like this is a field in which you are no longer working. It also sounds like you have had some difficulty in ems, as you mentioned that you are currently suffering from PTSD. This forum is great for learning more about the field and venting to fellow ems workers, but I think you really need to seek professional help. A lot of good-natured teasing takes place here, but I don't think that's what you need. Please consider finding someone to talk to face to face, specifically a professional. Only you can help yourself. Once you've helped yourself, you can go back to helping others. And Dust, most people in this industry are truly kind and caring, even if it's hidden deep below a tough exterior... :wink:

For us, California state policy is 15 mph or less when breaking a traffic rule. Our company policy is COMPLETE STOP when breaking a traffic rule. Our district has red-light cameras at most of our intersections and if we go through the intersection at 1 mph+, the camera takes a picture and sends it to our company. This picture also documents how fast our vehicle was going through the red light. Yes, it's a little Big Brother-ish, but honestly, what's more important, our on-scene time or whether we even arrive on scene? How can a smashed-up emt/medic help anyone? And on the way to the hospital, we often have patient's children/family with us. Who wants to be charged with involuntary manslaughter? Again, if we come to a complete stop before running a red light, the camera will not even snap a picture. I feel that these stops are well worth the safety of our crews and patients. By the way, this is in an urban area--we don't have miles of road in which to see upcoming cars. And, even if we did, most of the cars in our way don't yield to ems vehicles. Why risk the 2-3 second eta on other people's stupidity?

You know you're in Urban EMS in Los Angeles when: -County fire has you transport a 21 year old female BLS for cramps--Hx, she just started her mens. cycle and the Ibuprofen wasn't helping -A young, buxom mother approaches your ambulance with children in tow and requests some cold packs because her new breast implants are sore

Los Angeles is divided into "L.A. City" and "L.A. County" fire areas. City responds with their own ambulances; county contracts with ambulance companies to arrive on scene with them. I work for one of the companies that runs with county--if the transport is deemed ALS, the county medic rides with us in the ambulance and the squad follows us to the hospital. Both city and county show up on scene with at least one medic. The ambulance companies that run with county are usually staffed by two EMTs. Our company also employs a few paramedics. They are mostly on board to facilitate ALS IFTs. If a medic rig shows up on a 911 call, they are usually still treated as BLS. In L.A., if one wants to truly practice as a medic in emergency situations, one's main goal must be the fire department. L.A.'s EMS system is fire-based and they run the show, including determining whether a patient is ALS criteria or not. The short answer to your question--it depends on which area of Los Angeles from which you call 911 as to whether you will be transported by the ALS responders or if it will be a private, contracted ambulance.