Arctickat

We contact the coroner and ask the family which funeral home they want to come get the body.

I've been in EMS for 30 years.

It seems to me that those who would do it have some sort of military background from what I can tell.

Monday night's Daily Show with John Stewart dedicated the entire first half to canadian politics. It was quite hilarious.

Sorry Ruffems, somehow your quote from docharris didn't take and I missed it....I'd change it to reflect that it was a quote from Doc Harris, but I can't.

Mother's gonna be all over this one.

Shrug, I just lump it into the "Better than nothing" category. I mean really, what would be best? A paramedic on scene able to treat the ailment in 5 minutes, then transport in 15 minutes, or having to wait for the paramedic in the ambulance to show up in 15 minutes and have no preceding interventions?

See how it ended.

That's just poor documenting, not because of the type of vehicle used. Besides, the Pickup truck was an official El Paso FD vehicle from what I understand. Not someone's POV.

Isn't that just the same thing as a "fly car" or "rapid response unit", supervisor car, what ever you want to call it? I see them everywhere, I even used to have one. A medic driving around in a GMC Yukon or a pickup with a topper, some even in cars. They respond to the scene and treat the patient as they wait for the ambulance to arrive and transport.

This doesn't sound any different to me, they were forced to take the ambulance out of service, but they still had medics to respond and treat the patient until transport arrived. It's not like they were transporting in the pickup, even so, out here we are allowed to transport a patient in a properly equipped "Alternate Emergency Vehicle" but only to the nearest access point for an ambulance. I've had to use my Dodge Durango for that purpose a few times to access areas the ambulance could not. Heck, if I had to, I would transport in the pickup truck to an access point, what other option would there be?

Impressive posting Kaisu. You sound like a medic who learns exceptionally well from her experiences and is very much open to taking the advice of those whom are asked. A medic with a good head is a valuable one. It appears you have learned the most significant lesson...Be Assertive. If Dust hadn't already offered you a job, I would have.

Now on protocol. Correct me if I'm wrong. But my perception of protocol is that it lays out the minimum standard for autonomous care. The idea being that the protocol says what you can do without any contact with medical control or with minimal contact. Therefore if you're calling for Physician direction through the whole thing, that's naturally outside of protocol..

You're wrong. Although that may be the case in your area, In Saskatchewan the protocols are the maximum allowed procedures for the practitioner of the applicable level. Functioning beyond protocol is the same as beyond scope. Hope this might help avoid some misunderstanding.

It's a tough call and everyone screwed up. That is a rare occurrence but try to bounce back as best you can and learn from your mistake.

I will never push any med I did not prep myself or at the very least have the individual who did prep it show me the container the medication came in so I can verify it myself. remember the five rights of drug administration:

Right Drug

Right Dose

Right route

Right patient

Right Time

You can't verify that it was the right drug if you didn't see what it was.

Suppose your system gave you a one day long class in emergency c-sections,

I wouldn't go so far as to say a one day classroom experience would train you to competency. And I was not attempting to imply that.

OMFG!!! DUDE!!! You just said that in your previous post!! Is it a compulsion for you to argue, even with yourself??!! I am completely stunned!! I have never, ever seen someone turn on themself so quickly...even a delusional psych patient has the common sense to argue with a hallucination. Man, this is just too much.

There is cooking by the book, then there is thinking you can cook the turkey faster by cranking the oven up another 100 degrees. Geez, this thread has got to be the most analogies and what ifs per post ratio I have ever seen.

It's too much, I gotta go.

I guess I'm one of the cowboys but it would depend on the situation.

If I was a super medic with paragod syndrome I'd also perform brain surgery with a pocketknife and a cordless drill. "Thank God for Black and Decker"

Cool!! you watched Rescue 77's short lived run? I think that was on the final episode before it was canceled.

Likewise, if a physician, RN or whoever and whatever is on scene with other EMS workers, the EMS workers remain control of the scene and can ask the others not to interfere unless they are capable of accepting full responsibility for the patient. A Podiatrist probably would not be in any position to provide emergency care in any capacity higher than a Paramedic or even EMT.

I like this quote Vent, if only because I've been there, done that. Catamaran Snorkel tour in Mexico, one of the passengers collapses as I watch. From 10 feet away I can see he is pale, very diaphoretic, and out like a light as he falls back in his chair and against his wife. I scamper over three people and over to the patient...my first thought on the way was "Where's the AED" Then I recalled where I was. I got over to him and moved him to the floor of the boat and opened his airway. Three people came over to help me. Two were ward nurses and the third a urologist. All three of them told me that I was the one in my element, but they were there if I needed their help. The urologist kept the furthest distance...it was rather odd for me. It's not often that I have higher trained medical professionals on my scene, and to have them tell me I'm the boss and defer to me is a very strange experience.

Turns out our patient was just very ill from imbibing too much the night before, combined with using tap water to brush his teeth and finally a little motion sickness. We got him to shore and waited for the medico on the Marina golf cart to come get him.

Captain of the boat gave me all the free beer I wanted for helping his passenger out. Problem is, the trip was all inclusive.

What if I told you that a podiatrist and his LPN,

Another "What if" story...YAWN!!!

not everyone, there are atleast "3" of us "cowboys" who would do the right thing.

No need to wonder about your listed occupation in that case.

First of all, you are confusing the term "infant' for "fetus" It is not an infant and it is technically not alive until it is born. See the Born-Alive Infants Protection Act, P.L. 107-207. Although I suppose that is also debatable in your mind. I don't believe providers are too scared to perform the procedure, they are simply understanding the repercussions and weighing benefit vs risk. For some, the risk is simply to high for the benefit.

Doc also raises a good point..indirectly. Who's ass is going to be in a sling, when, after your medical control tells you to go ahead, his ass also ends up in a sling for telling you to do it? Now, he is in trouble and your defense of "He told me to do it." will be torn to shreds because he didn't have the authority to tell you that and you should have known better.

I had days of yore where I was a puppet medic, thinking my medical director could do no wrong, and that I was bound to do as he told. I quickly learned this was not the case, and it was my responsibility to keep him in check. There are limits to what Medical Control can approve, and they can not "have my back" After I almost ended up strung up before a disciplinary committee for functioning outside my scope of practise because my medical director told me to, I soon changed my ways.

Me, my wife, my kids, my parents, my instructors, my co-workers, and anyone else who has assisted/supported my careerchoice.

Not to mention the untold numbers of patients who would have benefited from your assistance and won't.

I don't see how a comparison can be made between the two. Regardless, people can throw "What if's' around until the cows come home all they want, I'm not gonna play that game.

Just to add to my post, BMW and Land Rover have this as a factory installed option on some models.

Like some have said, and I agree, this system is a waste of money, useless, and can be dangerous in an urban setting. Traveling for 150 or 200 miles over open road where dangers lurk just beyond the headlights? Completely applicable. Glance at the monitor every few seconds as a reference point and safety check and there is no issue. I'll agree it's a distraction, and that's a good thing, because I'll bet that as soon as you see that 700 pound moose you'll be distracted as hell.

I see, so when a driver glances down to the guages to make sure the vehicle is operating in the green that is also too dangerous? IFR rules are a replacement for VFR, but tell me a pilot who doesn't occasionally check his IFR instruments when flying VFR? What do you propose these ambulances do when they are 30 miles down the road with their patient and it's still another 30 miles to the nearest facility? Just stop were they are and wait for the fog bank or snow storm to pass? Turn around and head back home, even though, as you must be aware, the fog bank has also likely closed in behind them too?

Unlike replacing VFR flight with IFR, this system is an ENHANCEMENT to driver and passenger safety. It is an enhancement that requires no more attention paid to it than an occasional glance every few seconds. It is an enhancement that allows the driver to see beyond his visual range so that dangers are more easily recognised and avoided. Visibility at night is less than an 1/8 of a mile too, healights only shine 500 feet, shall we prohibit all ambulances from doing transports then as well and wait until daylight?

The reason that health clinics up North have to wait, sometimes for days, is not because the aircraft has to fly VFR, it's because landing an aircraft in such poor visibility while traveling approximately double the speed of a land vehicle does not give the pilot time to react if he misses the runway. An ambulance can slow down for poor weather and the worst case is that the patient arrives at the destination in three hours rather than two. If an aircraft slows down for poor visibility it falls out of the sky.

If you are so easily distracted by television screens that they pose a hazard to you, god help anyone walking near a television store when you drive past the display window.

90 degrees from what I understand.

Something that seems to have been missed in this discussion is the little matter of the infant's survivability. Unless you are working on mom prior to her arresting, and are able to determine precisely when she does, there is no way that you will have a viable patient once you get done talking through the procedure and performing it.

The pathology demands that the infant is removed at the first sign of maternal distress, not after she has checked out. Once that happens how long has junior been without oxygen, or adequate perfusion for that matter?

Maybe they'll listen to you...I'm starting to talk in circles which is my cue to give up.

Again, are you actually saying you believe yourself incapable of competently performing the manoeuvre?

Or are you simply saying that you still would not do so, due to legal or philosophical concerns?

Let me put it this way. There are dozens if not hundreds of very impressionable young medics out there who read our words and take our words of experienced knowledge to heart, as erroneous as some of it is. Something like this is not as clear cut as it seems, and the last thing I want to find out in the news is that a maternity patient had a bradycardic episode that became asystole, and rather than treating the mother, these impressionable rookies recalled our conversation and grabbed the scalpel instead of the atropine because they heard somewhere that some medics think it is best for the mother to be dissected to save the baby.

Now, to your question, do I feel competent to do it? Yes.

Would I do it? Perhaps under the following conditions.

I know exactly when the mother went into cardiac arrest,

I know I have the approval of the next of kin in writing,

I know that the mother has sustained injuries that will prevent her resuscitation of any sort,

I know that the mother is unable to be transported immediately with CPR enroute,

I know that my transport time will be a death sentence for this fetus

I know that the fetus is still viable

I know that my medical control is on board, and

I know that I am comfortable with the possibility that after this call I will never be permitted to perform even a blood pressure on a person ever again and that I will likely be spending the next 20 years in court defending my actions, and likely penniless because my malpractice insurance will not cover me for working outside my scope of practice, regardless if the child lived or died. BTW, the 20 years? Not an exaggeration. The child will also have the right to sue me once he turns 18.

There is the reality of it, If all those conditions were met, I would be happy in knowing that this child was actually around to sue me, even if he is trying to ruin my life for saving his.

The fact that the mother is dead is irrelevant to the situation. If we had nothing in our arsenal and training to reverse this condition, then it might. The fact that we can actually reverse death means that the adage "She's dead, so it doesn't matter what you do it can't get any worse." is not applicable. First, we have to ensure that we tried to fix a fixable condition, otherwise why bother taking ACLS training? It's not over for our patient when our patient is dead, regardless how pregnant she may be otherwise we might as well just start using every code patient we treat for cadaver training instead. Even a patient with a head crushed to 3 inches thick may have enough lower brainstem function to be able to maintain adequate perfusion to the fetus until such time as it can properly be extracted.

Yup.

... firstly, the average goth type is above average intelligence, just a trendy thing to do (as Ventmedic commented) like grow your hair long and protest in anti (whatevers) but they do suffer from lower esteem but because of association with others they (as most teenagers) need to find a sence of belonging, like bot scouts, football teams but the crap in the face I can do without , I must be getting old .

Snicker, I had a goth period in my history too, then I learned actual social skills. It does explain my IQ in the 150s though.