crotchitymedic1986

Oh thanks, I get it, this is another combitube for those who cant intubate a patient the normal way.

arkticat, dont forget porcelain-reacting-rapidly-releasing S**t: this is where you hold back a BM for 8 hours, without any problem whatsoever, but the minute you step near the porcelain alter and start to fumble with your belt buckle, it becomes a race against time to keep from having to go commando. It is like the porcelain has a magnetic pull on your bowels.

When treating cancer, you often have to take chemo, which means you get weak and lose your hair (you suffer to get better). You need to give your mayor a little chemo treatment: transport every patient you can reasonably transport, and let the chips fall where they may.

I guess it could be either way. But even if it is transmitted wirelessly, I would make sure that it was transmitted in an encrypted fashion that couldnt be hacked. Like most things in this arena, the things it was purchased for would probably rarely be an issue, so you have to think about all the possibilities that it could be used for: For instance, you are working a pediatric arrest in which you had a long response time (because of your stupid managers or governing body). So during the transport you say something like, too bad we had a 20 minute response time, maybe this kid would have lived -- our director is such a **********, or I wish the mayor would shove that budget cut up his ***, cause he just killed this kid. And then the medic faces disciplinary action for making such comments.

Sorry, I will be the dumbass that asks the stupid question: How is this device superior to a regular stylette ?

Well I guess my perspective may be unique, but here is why I think everyone should participate more: As a manager, this is one of the "platforms or beliefs that I truly believed in". whenever I faced a tough decision, or for that matter even an easy decision that affected the whole company, I sought out the opinions and thoughts of everyone. And yes I mean everyone, the rookie, the old medic, the idiot, the lazy guy, the backstabber, the gossiper, the great and the not so great EMTs and medics. Even though I didnt need their advice or input 90% of the time, every once in awhile, someone who had a different life experience than me, would come up with a different angle on the solution. Mayber their solution wasnt the one we employed, but often times, their "way-out" suggestion sparked a conversation that led to a solution that we werent thinking about. I see the same possibility for an outcome in this forum. You never know when your opinion or thought will turn the whole discussion 180 degrees. Ninety percent of the time, it wont, and you may get bitchslapped by someone in the room, but I think that 10% where we break new ground is worth the repeated bitchslaps. But if you never share your thoughts, we may never make that breakthrough.

Relax, these things have a way of working themselves out, you just need to be ready to pounce when it does. I remember one city that shut down a fire station due to budget woes. There was some complaining about it, but not much. All the leaders, including the fire chief, said it would be OK, we have enough surrounding stations to cover this area. But guess what, 4 days after it was shut down, a cop was shot in that area, and had a 12 minute response from fire, and a 20 minute response from EMS. The media assault was not forgiving, and the city council found money to reopen the station. Just be prepared to show the difference in response times, mutual aid calls, and patient deaths, once you are furloughed. ** But if they choose to truly furlough the non-essential EMS employees: Lt's, Capts, Division Chiefs, billing clerks, and secretaries, I couldnt argue with that decision.

I dont think there has to be a "signal", as it could be recorded within the ambulance, with tapes/disks/memory stick changed out at shift change. Even if you transported 20 patients in 24 hours, and spent 30minutes in the box with each patient, you would have lots of disk space left over. Most services that do transmit patient reports wirelessly, from an onboard computer, have it encrypted so that it can not be hacked.

Take a look here, it explains it better than I can type it: http://forums.firehouse.com/showthread.php?t=75543

A dead body (thread shamelessly hijacked from the question about "bodies"). Two of mine from when I worked at a service that had to do the transports: 1. Elderly female found dead in a chair. Rookie cop on scene, when we moved her to the stretcher, air escaped from her lungs and vocal cords, making a faint moaning sound. Cop spun around to run, hit the wall -- as i bit a hole in my lip trying not to laugh too loud (family in other room), I said its OK, its just air escaping from her lungs -- He said, "dammit, make her stop that", he was almost in tears --- I laughed a good month on that one. 2. Had to transport A GSW to the head to the State Crime Lab at about 2am. Was in a van ambulance, and had that old style radio headset hanging from the overhead grip-bar (lights were out in the back of the truck as we made our way down the interstate). I was sitting sideways in the passenger's seat, facing my partner, trying to keep him awake. As we got into the city, the interstate had street lights, and as thise streetlights flashed through the side door windows, I caught a glimpse of the headset cord whiping around back and forth, and I thought the patient was alive and out of the body bag, I nearly had a code-brown.

Not sure if its the kind of door you are talking about, but I saw a rural metro truck not too long ago when i was in the states, that had a back door that opened up with two shock absorbers (like you would find in an SUV), and the side box door slid open like a minivans -- looked neat, couldnt stop to ask the guys what they thought about it.

You really dont need a formula to run it over 10 minutes, you need a formula for running over an hour(s).

If this subject has been addressed already, I apologize, but I searched and I didnt see it pop-up. Obviously, ambulances have improved quite abit during our industry's short history. If you could design the perfect ambulance, what would you add, what would you take away. And please, lets not get into jacuzzis, wetbars, and a fold out bed for the tech, lets be serious. Some of the changes I would make: 1. Design it with the safety of the "tech" in mind. No sharp corners or cabinets to strike your head on. Padding behind the head on the jump seat, or change to individual captains chairs with 3 point seat belts. 2. A heated compartment or shelf for IV fluids. 3. LBB compartment on passenger side instead of street side. 4. Extended cab in the front if using van chassis. Premium seats, no carpet in the cab. 5. A flourescent light(s) that run directly above the patient, front to back, not one on each side running left to right. It seems the lights are always in the wrong space. 6. Heated LBB compartment -- always hated putting a naked trauma pt on 40 degree board (tried to keep one in the patient compartment when it was really cold out. 7. I would like to see an ambulance designed from the ground up, instead of just slapping a box on a truck chassis. 8. Design a box that wouldnt collapse during roll over (yes it has been done, but most companies still use the cheap, spot-welded boxes, that fall apart. What are your suggestions ?

I think they knew it was coming, but were only given one chance to pass. Now that several have failed, they are offering more training prior to the test, and more than one opportunity to pass the test (I think 3 times), which I can live with. If you cant pass the same test after taking it 3 times, you have issues. My problem is terminating an employee after failing any "one" written test"

The problem with left sided CHF is that it usually presents without edema to the lungs (unless the patient has waited too long). So it can be difficult to differentiate, Left CHF, COPD, or MI (depending on patient complaint). Most ER docs used to have to wait on the CXR to definitively know a diagnosis, now they have a lab test for it (BNP).

The complaint is: The people involved were fired because they failed one test. They had not been accused of any wrong-doing, did not have a patient complaint, and did not violate any policy. Just as if your chief walked in tomorrow, and threw down a NR quality test and said everyone who fails this is fired; I imagine a small percentage would fail, and complain. And I imagine 90% would complain prior to taking the test. Although "a written test" is one way to gauge knowledge, it shouldnt be the only way. When I put on my "patient advocate" hat, I want the medics to be tested alot, but I want it to be a combination of writtent tests and hands-on skill stations with scenarios, which was preceeded by some sort of training program. When I put on my "employee advocate" hat, I want the same thing, but if they fail, I want them to have a chance to be educated or re-educated, not immediately terminated. If they show that they can not learn and remember the job skills that they need, then they need to be terminated. I promise you, I could create a test that everyone in this room would fail ( I have done it before when challenged by 3 flightmedics who wanted a hard test).

Can lawyer ask for a copy without lawsuit ? My gut reaction would be NO, as HIPPAA would supercede "Open Records Act", unless the patient gave permission. So lets say the the patient is a fat cow, and in the course of doing a 12Lead, you pick up her 30lb breast to place leads under it, but in the grainy video, it looks like you held her breast "the wrong way" (whatever that is, maybe you lifted it by the nipple -- I dont know, or you held it too long). It might give a lawyer enough evidence to sue the county, hoping for a quick settlement by the county -- he makes $10k, she makes $3k, but all the community remembers is the headline, "Ambulance Video Shows Paramedic Holding Patients Breast", and the story is: Paramedic John Doe is accused of fondling a female patient in the back of his ambulance, a surveilence video shows Pmdc Doe, cupping the patient's breast. Pmdc Doe claims that he was merely moving the breast to do an ECG, but the patient claims he fondled her.

As far as the comment about not providing a history, I answered the questions asked. I did not treat the patient with K. This call occured in 1987, and was my first "treat the patient, not the monitor" call. There was no 12Lead back then. The rhythm was textbook VTach in 2 leads, and SVT in the other. The patient was A&O with stable V/S. I called the ER Doc (I could tell he didnt believe me, or thought I was stupid), I asked to just start an IV and transport (which he quickly concurred with) -- yes we had to call for IV orders. This call was in the wee hours of the morning, upon leaving the ER, no one had any clue what was wrong with him. We came back to the ER with another patient about 3 hours later, and found out the diagnosis and treatment. Today, a 12-Lead could help you come to that diagnosis.

I promised I wouldnt argue the matter anymore, so I wont. But to answer Dust's question about why not rescusitate the mom: I thought I read somewhere in these 14 pages that mom's head was squished to something along the size of a brick, so I assumed no chance at life and possibly a difficult airway to manage.

To tape is not a HIPPAA violation, but to release or show it to anyone else would be. Most hospital ICU's and Nurseries have moved to 24-hour surveilance tape in all rooms, to protect the patient from the things that have been brought to light. And yes, I was referring to a camera in the patient compartment, not a dash cam. My concern is that once the community found out that you had one, would lawyers start demanding access to the tapes to go fishing for a case ? Obvioulsy the audio should always be professional, but I think we have all said or heard some things in the back of the truck, during a critical call, that would not sound to great on myspace. But I also know a paramedic whose career was ended by this kind of allegation (not while on-duty), and I am pretty sure he was innocent. There are lots of crazy people in this world, and they love to make the easy buck through lawsuits. I can see the plusses and the minuses.

Sorry dust, if i knew you was gonna have my back, i wouldve toned it down abit. I think everyone should reread the post (yes i know its on its 13 page now) and count the number of times I have called someone a name, versus the number of times my name or character has been impuned. Up until this last page, I have only questioned your rationale for the decision, and then offered you a scenario where you might realize that there are no grey areas when it comes to morals --- there is right and wrong. When I finally found the two remaining brain cells I have left that prove this point --- using your partner as the patient --- then everyone realized they were wrong, and decided to take their ball and go home. This is my last message on this post, as I am sure I am about one name calling away from not staying professional, and then the thread will get shut down. My final question, to all of you who called me names, said I was a bully, please just answer the question: If it were your partner who needed the emergent life saving act, that was outside your scope, would you save your License or your Partner ? You had the guts to stand up for what you believe in, and to attack us cowboys. Are there still only 3 cowboys in the room ? And dont call someone a troll just because they disagree with you --- thats arrogant. Love you long time, GROUP HUG EVERYONE !!!! I am outta here, so please dont ask me for a reponse, if you need one PM me.

If you could hear my critics thinking right now: Oh my god, the potato disagreed with me, and had the nerve to type messages on the forum, how will I ever recooperate from the horrible bruises and fractures that this bully left me with ? I am just greatful that he didnt use "all caps" and scream at me, or I might of had to take an antidepressant. we could try to argue that an EMT/Paramedic license is more important than our partner's life; actually we have to since that is what we have said all througout this post. Nah, lets just get the thread shut down, that is easier.

Browbeating, bullying ?? Thats a stretch, or you guys have the thinnest skin in the world. I have been called everything but a child of god, by most everyone in this room for standing up for a moral belief. I have not gone off on anybody, cursed anyone out, sent a nasty PM to anyone, or talked about anyone's momma. Sounds like you guys have been cornered, and are taking the easy road out, because you know you are not going to come in this room and say your license is more important than your partner's life. So sayeth the potato (one of my many nicknames granted to me by my professional colleagues), so sayeth the flock.

I imagine most of these folks who have been charged for molestation are guilty, but if you were innocent, it would just be your word against theirs. Years ago, when the subject of placing video/audio recording cameras in the back of the truck to film you as you treated patients first came up, it was met with stiff opposition. What are your feelings now, would you still oppose such a device in the back of your bus ?

I have no idea when DC switched to NR, or if they have been NR all along. My guess is that since DC is not a "state", they would have never had a "state certification", and would have accepted NR or the certification of neighboring states, but that is just a guess. I am sure someone on here knows.