cynical_as_hell

spenec,

i changed the entire thing because you are right. I didn't know that my previous topic was already a discussion. Thanks for making me aware of that

In the very beginnign of my ems career, I was quickly tested on all levels. I had one bad pediatric call a week for the first three weeks I was in EMS. The first one, I thought maybe something was wrong with me because for the most part, the call didn't bother me. The second one, ok I was getting stressed and worked up, but was it because of the call, or not being use to the lack of sleep that sometimes comes with EMS?? Maybe it was a combination of both. But the third call is the one that sticks out most to me. I was three weeks into a brand new career, and tones went out at the station for a full code. That's the only information we were given besides address of course. When I got on scene, I saw the firefighters gathered around a table outside and I asked myself "Why are they demonstrating CPR outside?" I walked with my medic up to the group of providers and looked down to find them doing CPR on a four month old baby girl. She was so lacking in color that she had the tone of someone that had been dead for maybe a few days. I was so scared and I practicly froze. My medic went to the ambulance and I went over to her and told her that I needed her help. I didn't know what to do. She guided me and I followed her commands. We transported the child and as soon as we got her into the room and the doctor saw her, he pronounced her. He did the things that are done at that level of care in order to try and save a life, but stated the only reason why he did it was so that they can tell the mother that everything that could be done, was.

The child's only history was a current bronchitis infection that she was seen for the previous day of us being called. And she was premature by one month.

After a few hours my partner called over to the hospital to find out if anything had been discovered as to why the child died. She was informed that mom had accidently rolled over in bed onto the child while she was passed out from taking hydrocodone. The mother was never arrested and to the best of my knowledge, the DA never persued any charges.

My question is Do you think mom should have been charged with the death of her child and why?

This is to DwayneEMPT

I will take this one paragraph at a time, so that i don't loose my place, or anyone else's.

The way you chose to phrase things and the words you chose to use, your input did not come off as offensive or bashing at all. I thank you for that.

You are right in the fact that you cannot judge someone based off of posts. The only thing I will tell you is that I am actually more mature than most of my coworkers when it comes to life in general. I write poetry for a hobby and have been quite successful at it. The only reason why I mention that is because that is my normal way of communicating when it comes to writing or typing, anything that isn't verbal. My own partner, well semi-partner, kaisu has even admitted that I am wise beyond my years. She has had the oppertunity to actually work with me and see what I'm like. She can defend me in the fact that I am not anything less than professional to the patients I have to run on. One last thing, I know I kind of went off subject for a moment there....What does spelling have to do with anything? The posts here are not formal in any way and make no bit of difference in the real world in the event of rather we all still have jobs or not.

I truly do fail to understand why you believe that you must have compassion in order to be good at your job, regardless of level. Compassion is not a requirement, nor is it detrimental to you if you choose to not access that particular part of you. Some of the best paramedics we have in the area I work in, are the burnt out, here to collect a paycheck, im just doing my job, kind of perception. And yet, they still out perform the touchy feely paramedics. I do agree that some emotion needs to be felt for the patients, but to what extent? If you did everything you were taught to do, and your patient still dies on you, is it ultimately going to have a negative affect on you? Now here me out on this...Yes, it will have an affect on you. You will go over the entire event again and again and pick yourself apart, trying to figure out what you could have done different and what those outcomes could have been. In doing that, you learn, and you grow. In the end, you will be better for it. But are you retracing and reprocessing everything because you're upset and feel bad for your patient, or because your ultimant goal is to always learn and do better each time around?

You are right in the statement that you do have to talk differently to different patients. Not every patient is going to respond to the same verbal communications. Some patients require you to use a soft, non threatening voice. Some patients require you to be a drill sergant. Some patients flat out need you to show them who is in charge. Children, depending on age, need to be talked down to. There is no contest with your statement in regards to this.

Now in regards to a healthy patient being in the ambulance. What exactly dictates what's considered healthy and what's not. People run around all the time with medical problems and are still classified as healthy. Just because someone has slightly high blood pressure, does that make them unhealthy? Just because someone may have a medical condition, that does not make them unhealthy. Let's use me for an example...And please, give me your honest opinion....I am a 22 y/o female with a history of high blood pressure secondary to renal disease. We discovered the entire problem when I was 13, getting a physical for school so that I could run cross country. I never had any symptoms of any problems, I was very active as a child, and when I was taken to the ER, I had a blood pressure of 200/180. Almost ten years later, I'm doing fine. I don't take medication for my blood pressure and the one kidney I have works at about an 80%. Would you say that I am an unhealthy person?

I am the driver of an ambulance. I never have patient care. I'm there on scene with my medic and I put the patient in the back of the ambulance, and outside of that, I dont know a whole lot that goes on. My company runs an EMT/Paramedic unit, so the paramedics get all the patient care. All they really need us for is to drive. Sure, I do listen in while Im driving, but that's not enough. So when it comes to finding out all the particulars you were asking in this paragraph, that's not my place. Now before you get mad that I said that, understand that we are taught that only one person at a time should speak to the patient so that you dont confuse that patient. With 3 paramedics on scene(including ones from the fire department) at what point do I realisticly take an active role with this patient?

I am appearantly lost in the fact that you think you are more important than me and that you are better than me. I could be misunderstanding what you're saying here, however, as far as I'm concerned, no one is better than anyone else here. I'm thinking that I'm lost on this one.

I completely agree that with you being a paramedic, you have seen more and done more than me. Again, there is no contest there either. But I continue to fail to understand why it is that all of you guys on here truly feel that I am wrong in the way I think. Compassion is not a requirement of the job, and if you do your job as you are taught to do, then where is the problem? Most of the time, what we do, is only comforting the patient for the time they are with us. What we do doesnt mean anything to the hospital because they do all of their own stuff. At least, that's how it is here. The hospital doesnt trust anything our medics do, and the medical director is severly holding back our medics. And by no means is any of this a result of rather our medics know what they are doing or not.

i must say, this particular group of people are a damned if you, damned if you don't attitude. And dont think for one second that im the only one that feels that way. I was serious in my last post about getting input for the fact that you all dont agree with me, but nowhere i there does it say "Please go ahead and continue to bash me for not thinking like you" You may not agree with how i think, and im not asking you to, but at least i was willing to hear all of yours perspective, and i havent bad mouthed you for it. in some areas, i do agree with you guys, but in others, i dont.

As far as the who am i to judge who gets compassion and who doesnt.....answer me this? Are you going to show the same amount of compassion on some frequent flyer that calls you every shift at the same time and always has the same complaint? can you sit there and say that you would show them the same amount of compassion as you perhaps did the first time you met them?

I do understand that although every call may not be life threatening it may very well require a 911 response. For example, someone that is ALOC because their sugar is a little lower than normal, is not an emergency. And it is something that most of the time we can fix before getting to the hospital.

I personally believe that all of you put EMS and your positions within it on a peda-stool

Everyone in EMS can be replaced and we are no different than those who will come after us and take our place

thats awsome

that is just horrible!!!! I am definetly un-educated with this procedure, but i thought that in order to RSI someone, not only did you have to paralyze them, but isnt there a medication given that pretty much wipes their memory? It must be a very scary feeling to be paralyzed, and be harmed, and theres nothing you can do.

I have been watching all of your comments since my post and im well aware of the emotions held within them. Now i will not apologize for what has been said cuz im truly not sorry about it, however, most of you are right in the fact that it could have been worded better to say the least. My motto has always been "Show me a person who TRULY needs EMS, and I will show you TRUE compassion towards that patient." I dont believe in shelling out compassion to those who dont need/deserve it. By doing that, all your doing is inhibiting those patients to continue to abuse the 911 system.

Having stated that, I am here because I do want input on a question I have in regards to the whole suicide thing:

Why do you feel it's neccessary to show compassion to a person that wants to commit such a selfish act? Now, im serious on this question, as it's very obvious that all of you dont share my ideas. I do agree that the family should be shown compassion, especially if the victim actually follows through with their intent, but does the patient really deserve to have their hand held and told eeverything will be ok? Why not try a different aproach and inform them of all the consequences and suffering they will cause, should they follow through? Now i do understand that these people do have some wiring problems in their head, for whatever reason it may be, but that does not mean that you cant reason with them without kissing their ass.

Please feel free to input, as I'm looking to see what others' perspectives are.

WOW, that's interesting. Given the fact that it was known that she was having a violent nightmare, i'd think for sure that something would have shown up on the autopsy. I dont even want to try and imagine the sorrow surrounding you, her family, and the coworkers that knew her well. Best of luck to all involved

Hurray for him. he actually went through with it instead of calling 911 crying about how he wants to but truly doesnt have enough balls to like most of our patients. Its just ashame that he felt that he needed an audience. Considering he did it for everyone to see, sounds like he just wanted his 15 minutes of fame. Maybe all the other suiciders can learn something from him.

being a bls provider i would ALS this patient. Although he is stable and presents no serious problem, the ems provider on scene still needs to take into consideration the possibilty of all potential risks given what the injury is. its always better to side on what's best for the patient.

i dont know what the rules are in other states but here in AZ if someone says "I want to go to the hospital" we have to take them no matter what. and i have never felt that was right. i would love to see a system where we can deny patients a ride to the hospital IF its obvious that there is no emergency. i know that's taking on alot of liability for EMS workers, but i think if ems started refusing transport on bullshit calls, maybe we could see some change. the medical director i have tells our frequent flyers that never have a true complaint and always get discharged with nothing found wrong with them that if they come back to the hospital and nothing is wrong with them he will have them arrested for trespassing. suprisingly it has worked on some of these patients. most people dont agree with this kind of practice, but something has got to give.

the police in our area i feel abuse the system just as much. since when does a drunk person become an emergency and need to be taken to the hospital? i mean seriously!!!! they are so lazy and instead of taking them to jail or holding them overnight til they sober up, they would rather just call us.

and those stupid wannabe suicides....dont call us unless you've actually attempted. or the oh so favorite, i've been in pain for four days now and its 2 am and ive decided that now its an emergency....

perhaps if we didnt have to be so professional to these idiots and we could actually speak our minds and tell them "Hey fuck head, this isnt an emergency and you need to drive yourself to the hospital" maybe we would see a decrease in that as well.

at what point did EMS become all about customer service??? we dont need the money from every patient that calls us.....

Unfortunately that is not the issue for some of these flights. It seems they fly because they can.

And some commonsense.

http://www.ems1.com/ems-products/consultin...itical-patients

Study: Many Medevac crashes were for non-critical patients

October 23, 2008

By Robert Little

The Baltimore Sun

PRINCE GEORGE'S COUNTY, Md. — The medical helicopter crash in Prince George's County that killed four people last month was one of more than a dozen fatal crashes nationally during the past six years that raise doubts about whether the victims ever needed to leave the ground.

A review by The Baltimore Sun of crash records and other documents on the 26 fatal medevac crashes in the United States since 2003 shows that many did not involve urgent, minutes-from-death missions. At least eight involved patients who waited longer for a helicopter than a ground ambulance might have needed to drive them to a hospital. And at least six were for patients discharged soon after a helicopter dropped them off at a hospital, or who survived a lengthy ambulance ride after the helicopter sent to get them went down.

The recent history of medevac crashes also includes heroic accounts of late-night flights to retrieve critically ill or injured people in foul weather and urgent missions such as transferring a sick woman from an underequipped hospital in rural Alaska or plucking a young hiker with heat stroke off a mountain in Utah. In the wake of last month's deaths, Maryland officials have repeatedly defended the state's 4,500 annual flights as safe and necessary for saving lives, even if some flights appear unnecessary in hindsight.

But one patient who died after an accident in Arkansas had waited in an ambulance for more than an hour for a helicopter that was to fly him 35 miles. Another victim with a broken leg waited while three helicopters tried to fly through fog, even as ambulance drivers offered to take her to a hospital.

In four cases, including the Sept. 28 incident in Forestville, patients survived not only their initial condition but a subsequent helicopter crash.

Half of the 26 fatal medevac accidents occurred during missions to transfer patients between hospitals — one for a distance of 10 miles — and many of the transferred patients waited hours from the time a helicopter was called until it arrived and was ready to take off again, records show.

Officials at the state agency that oversees emergency medical care in Maryland plan to convene a panel of national specialists to review the state's medevac system and recommend potential improvements. The National Transportation Safety Board will hold a public hearing next year to explore the potential causes of a sharp increase in fatal medevac crashes, including eight this year.

But a growing list of medical specialists are planning their own national dialogue. While regulators such as the NTSB and the Federal Aviation Administration focus on issues of maintenance and safety each time a helicopter crashes, some doctors say that a critical review of helicopter flights from the medical perspective is overdue.

"I'm all for heroes — for the firefighters who climbed up the stairs while the World Trade Center was falling down or anyone else who risks their life to help people," said Dr. Jeffrey P. Salomone, deputy chief of surgery at Grady Memorial Hospital in Atlanta, and chairman of an American College of Surgeons committee that considers guidelines for pre-hospital emergency care. "But it's a real tragedy to think someone could die trying to help a patient who didn't have a life-threatening injury to begin with."

"I remember a patient, an 11-year-old boy, who flew in from a motor vehicle accident and was just standing there, and I asked him, 'Are you hurt?' and he looked at me and said no," said Dr. Marc R. Matthews, trauma director of the Maricopa Medical Center in Phoenix.

"It's that kind of laxity that can get people killed," Matthews added. "It's unintentional, of course, but it's dangerous and it needs to stop."

The records of helicopter crashes do not always include detailed medical information, and doctors caution that the complexities of each case often are not apparent from the paperwork. Police accounts of the fatal collision of two helicopters in Flagstaff, Ariz., in June, for instance, do not reveal that one of the patients onboard, a firefighter bitten by a spider, was apparently in anaphylactic shock, a condition that can be quickly fatal without advanced care.

But the records do show that patients sometimes are not in such dire medical condition that a few minutes — or even a few hours — would make a difference.

For example, a 71-year-old man injured in a vehicle rollover in Arkansas last year waited with an ambulance crew for more than an hour before a helicopter came to fly him 35 miles. He died from injuries received when the aircraft crashed soon after takeoff.

In June, a 58-year-old in Huntsville, Texas, with a ruptured aortic aneurysm waited more than two hours for a helicopter to take him to a Houston hospital, 72 miles away. He and three crew members died when the helicopter crashed into the woods two minutes into the flight.

In the case of Alicia May Goodwin, 27, who was hit by a truck on South Carolina's Interstate 26 in 2004, ambulance crews offered over the radio to drive her to a trauma center 48 miles away, according to records from the Newberry County Sheriff's Department. They were told to wait for a helicopter — the third to attempt the flight on a foggy July morning. More than an hour later, Goodwin and three medevac crewmembers died in a crash less than a mile away. Before the helicopter crash, Goodwin had suffered what medics and her family's attorney described as a serious leg injury but was not in any immediate danger.

"All the medical experts we could find said she was stable and coherent," said Jeffrey R. Harris, a Georgia attorney who won Goodwin's family an undisclosed settlement from the helicopter's operator. "Getting her into an ambulance and to a trauma center would have been easier."

Some advocates of helicopter transport say a simple assessment ignores one of the key benefits of a medevac system - minimizing the amount of time that patients spend in transit. Because providing medical care can be difficult inside an ambulance or inside a helicopter, limiting the duration of the trip can be the most important concern.

"Think of a hospital as a safe zone," said Jonathan Godfrey, transport coordinator for the Children's National Medical Center in Washington. "When a patient leaves the hospital to go to another hospital, whether by ambulance or by air, the resources available to the medical crew are greatly diminished."

Godfrey, a registered nurse, was the sole survivor of a 2005 crash into the Potomac River, which happened after he and his crew delivered a cardiac patient from Frederick to Washington. The patient, Godfrey said, benefited from the helicopter trip's speed and advanced care, and even the crash has not caused him to question the medical value of flying.

Some recent crashes illustrate the kinds of cases that Godfrey describes.

A flight that crashed in 2004, killing four people, was ferrying a 3-month-old child with pneumonia about 300 miles across rural Texas. The child was in respiratory distress, according to news accounts, and the 1 1/2 hour flight to advanced care might have taken more than four hours by ground.

The flight of a 60-year-old woman with an infection and low blood pressure across Alaska, which crashed last December on the way to a hospital in Anchorage, would have required a ground ambulance to take either a ferry or a 400-mile detour around Prince William Sound.

But the potential medical benefits are not always so apparent. In Falkner, Miss., a helicopter responding to a traffic accident crashed after experiencing mechanical trouble. The patient, who had what the local fire chief described as "a pretty bad leg injury," was driven 57 miles to a trauma center in Tupelo without incident.

Maryland has implemented a change since last month's crash that is designed to limit the number of flights that are not medically necessary. Patients with obvious severe injuries are flown whenever helicopters offer a "clinically significant reduction in transport time," but more questionable cases now require consultation with doctors at the receiving hospital.

But specialists outside Maryland say they will pursue a broader re-evaluation of helicopters for medical transport, particularly as examples mount of flights that might not have benefited the patients onboard.

"Every time a helicopter crashes, there's always this emotive, knee-jerk reflex from the community that everything's OK," said Matthews. "I could understand if a crash was an infrequent event, but it seems like there's a new one every few weeks."

based on this article and the bold statements contained in it, there was no need for these patients to go by air to hopsitals that were within reasonable miles. some of these patients could have been taken by ground and at the next facility long before the helicopter crew could get to them. some of my questions would be, why are the doctors insisting these patients go by air? why is this practice being allowed to go on? in the area i work in, when a patient has to go by air, they are going to another hospital that is minimum 110 miles away for "needs higher care" or "needs a specialist" and the doctor feels its not safe for them to endure the 2 hour at least drive that it would take to get them to the next place. i've also had issues though of patients needing to be flown and the doctor refusing. i guess everyone does their own things and have their reasons for doing so.

i agree that the causes for these crashes need to be looked into and corrected immediately. i also feel that the doctors that sent these patients on these choppers, need to be evaluated for the decisions they have made. like i said before, in some of these cases, there was no need for a helicoper, or for the patient to have to wait as long as they did, when they can go by ground and still get there sooner.

i guess the more common sense you lack, the higher paid you are.