ambodriver

We had to transport 7 ppl from a CO poisoning incident w/ two ambulances, quite a while ago. Hotter than the blazes of hell outside, late at night. Good night to sit outside, power went out. These folks put a generator in the bedroom closet to run an AC unit. Darwin Award. Two unresponsive went in one unit, and five in the unit I was with. Used an MCI Minilator and a second oxygen cylinder that we stuffed under the bench seat, strapped to a short board w/ blankets to keep it from moving. Tried to get more units, but nobody else responded.

I work in a very large city, this is crazy to me. i can't understand---I always have resources.

Sounds like you did the best with what you had. That's all we can ask. Strong work.

The point is that I am following your logic. If I agree with you that these patients should never be transported on the floor, I wonder why most 911 services transport them that way. I am sure in the larger cities there is "1" bariatric truck in every surrounding county, but I do not think that is the case in the rural areas and poorer states.

So to ensure patient safety, every ambulance should be mandated to be bariatric, as it would not make sense to make a critical obese patient to wait on the bariatric truck to come from the next county over. Right ?

Are you comparing your glorified taxi with real 911 transports? This patient was going to a rehab center. She could have waited for appropriate equipment to move her. You sound like your 22 years of experience comes from the privates....I'm impressed with your knowledge of billing, scamming medicare, and being a douchey manager.

I would have transported them both. Horrible spot to be in friend.

Google fu? ROFL +1 sir

I am the one being attacked here, as far as my management skills go, feel free to attack, but as a manager I have to enforce all policies fairly, and we have a policy that does not allow the medic to refuse a call. You can disagree with the company's stance, but that is our policy. And I disgree with most people's answer that a safety concern can be variable and open to interpretation. If you refuse to transport this patient due to MVC concerns, then I say you can not transport any patient, as no patient is safe in the back of an ambulance during an MVC, the stretcher will come loose from the floor, the plexiglass and all supplies will become airborn missles. You can't have it both ways.

So a pt. has to be stuffed in an ambulance on the floor for a taxi ride over to a rehab center? Why not just call appropriate resources and transport them in the safe and logical way.

No syst that was not directed at you. To the group, I do apologize for being rude, I was on the rag last week, and had some other stressors going on, I should not have been so rude with people who disagree.And yes I do understand the concept of risk versus reward and benefit analysis, but I just don't think the "risk" of performing a non-emergent transport a few miles is as great as many of you do, but everyone is welcome to disagree.About our policy, it was actually formed out of concern for our patients and our industry. We had a local busy 911 provider who created a policy where they would not transport any DNR patient for any reason; their logic was that using a 911 ambulance for a DNR patient was a waste of resources. This created a black eye for EMS for all bedridden patients who live at home and not in a nursing home. We had another 911 provider that refused to run nursing home calls, regardless of acuity of the call. And of course, as a private provider we frequently ran into the medic/nurse who would refuse to run a late call, long distance call, or a call because it was below their education (MICU Nurse doing a discharge to nursing home). We also terminate for any founded customer complaint (after investigation). All potential employees are made aware of all of our terminateable offenses before they are hired, so they know where the line is drawn. No one is forced to work for us. And for the record, I am probably a little too sensitive because I am obese, but it is also because we transport alot of these patients because they have been so mistreated by 911 services, that they refuese to call 911 anymore. We do have a wider bariatric stretcher to use, but we have encountered patients that are too large for it's weight rating. I am only aware of two services that have true bariatric ambulances, with wench and ramp. Most services use the tarp. We treat them like we would any other patient, and do not judge/abuse them, or make them feel bad for calling us. Yes, their predicament is of their own making, but most disease processes are of the person's making. Do you lecture people for smoking or having diabetes ?I googled "obese patient killed in ambulance wreck", in a variety of versions, and I did not see one news story regarding this risk. Which is not to say it has never happened, but it is obviously a rare occurence. I would argue that any call involving an MVC in a roadway or down a steep embankment is far more dangerous than this call.

I call BS. Big bad 911...the privates will save the day. Please. You sound way to immature and inexperienced to be a manager...but hey its the privates that doesn't matter does it

I am sorry, but I would have terminated you. First of all, the stretcher bar and antlers are easily removed from the floor. We do this type of transport frequently, we typically roll them to the truck on the hospital bed (fully raised), remove the head board and then just slide the mattress and patient into the back of the truck, then reverse the process at the receiving facility.

You probably pissed off every social worker and nurse in that facility, and showed them exactly how valuable your competitor is. There are very few services that have a bariatric wench and lift for an ambulance, so the other ambulance may not have been any better equiped than you. It is not your job to determine who you will and will not transport. Hopefully you will still have a job when you go back to work, but do not be surprised if you do not.

P.S. You have no idea what the next stage of treatment was, so you may well have delayed definitive care. She may have been scheduled for a procedure of some sort that day or the next day.

Another reason privates have no business in EMS. I've seen this happen time and time again at a private company. She is the medical personnel on scene, its her ambulance and its her rules. IF she thought it was unsafe then thats her call. Kudos to you Medicgirl. Someone going to rehab can wait for appropriate transport. This isn't rocket science or even an emergency. It's a transfer service...it's not even EMS. The right move is to wait for appropriate resources. A private will not understand this, because all that matters to them is $$$$. As such, I despise private EMS, the 95% scam that transfer services provide.

Quote you a law ? Read your Bible. If you are atheist I guess you have no obligations except to your selfish self. The fact that you say "you used to stop all the time" tells me that you know you are wrong now. In your early years you did the right thing, now that you are old, lazy, and burned out, you choose to do the wrong thing.

Who cares about your bible? Who are you to be preaching here? Give me a break super medic, push your own values on your kids, not to us.

Hmmmm, making me think. I know this is crazy but hear me out. In my hood we have toll roads and are about to have toll lanes on another interstate, where most people by a transponder for your windshield so you do not have to stop and pay. So lets say there is an accident, which is visible by one of the traffic cameras, lets say the person has been ejected and is not breathing, and I just drive on by. Five minutes later, I pass through the toll booth, and my transponder is registered as going through the toll booth. A smart lawyer subpeonas all camera footage from that toll road, and you can see me on camera, looking at the wreck as I creep by, but I do not stop. What do you think a jury would say ? True, I had no supplies, but I could open an airway, or do CPR.

Or an easier scenario, I pass and do not stop, but call 911 and give a fake name. The investigators want to interview all of the witnesses to find out what happened, I am called in and it is learned that I am a medic. What then ?

I know that there is no written law about this, but that does not mean you will not be found negligent. Most corporations have been found negligent for something incredibly stupid, but they lost just the same "thats why Preparation H has a warning label that says "do not eat".

really? I'm not sure why I'm responding to this.....probably just to point out this is one of the stupidest things I've ever heard on this forum.

Well lets hope that if they black list them they are the ones punished. You cant make them socialize off hours or be best friends but I would hope that the guys are mature enough to work WITH them.

The job will always get done in Chicago regardless of whether we like each other or not!

sensitive subject for me

how do you think these guys will get treated at the firehouse? guys are already talking about black listing them at the houses

AC is pretty solid bet imo. In a true emergency situation with a critical patient, I've never seen anyone complain about placement of IV's. They should be happy we've taken care of everything for them. True the arm can bend impeding flow, I've placed a board like we do with peds to stop the bending.

That being said, I do follow the start low and go high, force of habit I guess. 18g is my standard goto for most patients, large bore =14 if I can.

EJ is a great spot for large bore IVs, especially on an unresponsive trauma.

On my FD pregnant medics or FFs get laid up to do light duty.

With the streets being so volatile I don't know how I'd feel about having a pregnant wife/GF/partner on the streets.

It is illegal to discriminate for pregnancy in my state.

Ughh.. corporate?

Despite despising privatized EMS I have some good advice for you.

1) next duty day show up an hour early. Go through the entire ambulance and know it inside and out. Yes your preceptor was a bitch, but the best way to deal with people that are so negative is outshine them in every possible way.

Good luck.

Perhaps a clot that resolved on its own. Id encourage a trip to the ER with a line in case the episode were to return. I'd grab the doc and make sure he knew what was going on and what I had observed.

And there, you self centered egotistical bullshit show you for what you really are. You cant be bothered using a piece of equipment because its to difficult for you

If your "whipping" the patient, fumbling, twisting and moving them to get it on you either havn't assessed weather the scene enables you to apply it effectively, or you just dont know how to aply it properly.

When applicable and used properly by a competent person, the KED IS part of the proper patient handling.

Your just a moron mate, who's own lazyness supercede those of a patient, and you show it time and time again. The old rep system would have shown how many people have taken exception to the benality of your posts

So you've just pointed out that using one piece of equipment is too damn hard, but at the same time want whoever "the man" is to let you clear c-spines in the field? Why should they let you, your too lazy to do a proper job now.

whoa whoa super medic. Let's not take this into a personal attack because you don't like my opinion of the KED? Use it if you like it, I could really give two shits what ya use or how ya use it. Truth is, you

have no idea how I operate, who I am, or what I think is important.

Funny...I'm on a 48er and just came back from some BS MVC. We threw the collar on him, put the board under his butt halfway on the cot and had someone behind him guide him down onto the backboard. Was lovely and went smooth. The guys complaint was "shoulder pain" near the seatbelt area. No damage to the car whatsoever. I wouldn't have even backboarded him after a more thorough back exam, but its so ingrained in these parts that its almost taboo to suggest anything against it.

Throwing the KED on this guy would have required much more pt. movement then simply c-collaring him and moving him to the backboard from inside the car, or even /gasp letting him self extricate, stand, then sit onto the backboard to be guided down. Don't take it from me though, you clearly know-it-all and will get pissy if I voice my opinion.

The KED might be nice if the only way to get him out was from above, lets say if we cut the roof off.

Don't take it from me though. I'm just a lazy incompetent ambulance driver who doesn't know how to use a ked

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2691505/

http://ukpmc.ac.uk/abstract/MED/9523928/reload=0;jsessionid=4CB35A3D4ADDBC204DDF09C8D6A1AD34

Sensitive, sensitive! Think I care about some negative points on my profile here? Sorry, not in it to win a popularity contest. Bite me.

back on to topic.....................

I've used to KED ONCE. Our local trauma center called our firehouse to goto a church for a pastor that was released earlier in the day. They said he had a cervical fx. s/p fall that they missed on the X-Ray. He was sitting up and as a super precaution we used the KED to immobilized him and move to a backboard.

I see the KED as a waste of time. You can accomplish the task far easier and less whippish if you apply a c-collar, hold manual stabilzation and jam a backboard into the car and guide the patient down. Fumbling around with that KED how much are you twisting, and moving that patient around. Proper handling of the pt. will work much better in this situation.

The real problem, is the ridic. notion in EMS that everyone in any sort of fall/MVC must be backboarded. How about allowing a more thorough exam and letting us clear C-Spine in the field instead of these ridic. backboards, that quite frankly probably do more harm then good in a cervical injury.

p.s. i've heard the KED is good for immobilizing little kids. We have a seperate device for that, and again it does more harm then good to wrestle a kid into those things, don't ya think?

earth to common sense?

people use KEDS?

Patients don't cause EMS abuse. EMS causes EMS abuse by giving the public one number to dial, and no options.

Don't blame the public for the failure of YOUR system. Especially if you are doing nothing to fix it.

yea its called 1 800 taxicab, or public trans!

And this is another case for an IO drill in every protocol. That way your not screwing around trying to get an IV for ten minutes when there's probably more pertinent issues at hand.

Again, my humble opinion.

Yea I would have 'boarded, get to ambo, look for a quick airway and go. Everything else done in route. 10 mins fishing for an IV seems a bit much. I wasn't there though.

...dustdevil shut up already with hating on FDs, its getting old quick.

There are retards in the FD and private services.

and yes lock your doors

alright, quit picking on him.

shock you can be my friend.

Isn't a bus a large awkward vehicle to respond in ?

yea, those crazy NYers don't know WTF a rig is eh?

I work in one of the top 10 busiest ambulances in the nation. In a horrible part of town.

If people are going buckwild on the ambo you know what I do? Call the cops and drive away. Or throw the body in the ambo and drive away.

I wouldnt even waste time with pepper spray. I carry a knife....mainly as a tool, but for a last resort self defense.

Yes, my partner and I have had to tussle. It's a fact. Carrying all that shit just gets in the way.

99.999999999% of the time they love seeing us on scene. Even the retard ghetto thugs will carry a jump bag for me if I ask.

100 hours of combat training. Would love to see you get dropped off in my ambo with this attitude.

However---whatever you like to do right? Your preference bro. More power to ya.

Take it easy guys he is SAVING LIVES and has 100+ hours of COMBAT TRAINING.

On my person:

Pocket knife.

Wallet

Wedding ring.

In my vehicle:

Spare water

Extra windshield washer fluid

Spare tire

Dwayne

Yes. +1 sir. I'm with you on this post brother.

I carry on my person at all times:

a full jump bag

heart balloon machine

a mini promed cath lab that comes with a pocket nurse

a 6 pack of nihi grape

a big belt buckle with a star of life

3 pairs of trauma shear

a fire dept/ems shirt

a pocket EKG book

a badge

Really though:

"Dude you're a freaking whacker .... WTF

On my belt I carry ... nothing

When not crewing I carry .... nothing "

taxi it up bro. Welcome to EMS.

Can't recall how many times I've transported some drunk dumbass or toe ache and missed a deserving call. Like the child vs vehicle. Great.

detach yourself emotionally, it'll do wonders for ya.

Well I should add that the reality I speak of exists only in my area. I am not sure how privates do elsewhere. I am ignorant on that. I am glad others have found good jobs that they can support families on w/o being union. That is great, and I further advocate more pay and benefits to my paramedic and/or firefighter brothers union or not union.

However, in the Chicago area, unions have paved the way for the middle class.

Would I prefer to not have to pay union dues and receive all the bennies the unions helps provide us with? You betcha! However in my area that is not a possibility.

I am blinded by how it works in the Chicago land area.

There are only two options in this area for EMS personnel

Non-union positions: poverty wages

Union positions excellent pay and bennies.

If other people in the country make it w/o unions and make respectable wages I am happy for them and would even say they don't need union representation.

Nothing personal friend