wrmedic82

Some great points. But the question I have for some is, if they are AOx4, at what point can you force someone to be transported to the hospital?

I can understand CYA and every possible situation that could happen as a result of ETOH intoxication. But at the same time what about the legal aspect?

Are these scheduled visits, random visits, or visits in lieu of an ambulance when the abuser calls 911?

Dust,

Its a little bit of all the above except for when the person actually calls 911. Then of course we roll to the person / patient's house with maybe a response with a CC responder or supervisor.

Only thing that scares me to a degree is that now they have a policy that if the lead medic doesnt think patient meets medical necessity, he/she can call the supervisor. If the supervisor gives his blessing after given the assessment done by the lead medic, he/she can refuse to transport a patient. Counterproductive in my opinion. Im sure it will reduce the load, but is it worth the liability?

You respond to a 45/m Man Down (3rd party caller). Upon arrival at patient's side you get a strong alcohol-like odor. You are able to arouse the patient easily. The patient admits to ETOH consumption and states he fell asleep. Patient denies any medical complaints, and refuses any treatment or transport.Patient is AOx4, GCS 14 How would you choose to clear the call?

LMAO

If hospital emergency rooms have to treat regardless if the patient can pay or not, what makes us any better? It is a known fact that in every system is a system abuser. Regardless, we have to treat that patient, even if we think nothing is wrong, as if that person is actually having a medical emergency. Why? Because they are going to probably be the one in the courtroom with you in a lawsuit if something actually was wrong, and your failure to treat caused harm to the patient.

In Ft Worth, TX, they have a program in which when a known system abusers get visited by CCEMT-P's in mobile units to check on them to make sure they are alright. Rhyme and reason is because system abusers most of the time just want attention. This actually has reduced the number of calls to these people who abuse the system. If the patient is not doing good, patient care is initiated on the spot, and a MICU is called to respond / transport.

This is just my opinions on the topic.

-Lets say he had a pulse when you arrived at his side. I would load and go.

-Lets say he DID NOT have a pulse when you arrived at his side. Give him 20 min of my best provided no obvious signs of death. Call medical control tell them what I got, and call it if the the MD is cool with it. I just feel that BCLS / ACLS is better done onscene if possible.

-Obvious signs of death with PEA or Asystole - DOS

I know everyone views this situation differently, and thats cool. I would go with your training / experience, medical direction, and gut instinct on this one. If your gut says lets go, then by all means. But the questions I would be asking is if its going to be worth saving a guy that more likely than not will live in a vegetative state for the rest of his life? Im sure there are many stories out there, and even here of people surviving and living life despite the odds. And I know some people will even say who are we to make that call. So your always going to have answers on both sides of the fence. I wasnt on the call so I didnt see what you did. But thats a generalized answer w/o variables factored in.

This topic reminds me of this comic

<!--quoteo(post=222455:date=Aug 29 2009, 01:06 PM:name=wrmedic82)--><div class='quotetop'>QUOTE (wrmedic82 @ Aug 29 2009, 01:06 PM) <a href="index.php?act=findpost&pid=222455"><{POST_SNAPBACK}></a></div><div class='quotemain'><!--quotec-->tamaith,

I hate to say this but this happens like everyone else says more often than not. To take the advocate of nurses for a second, a single nurse can have as many as 15 patients or more. Im sure chbare can attest to this. A good RN yes will be able to rattle off everything under the sun about a patient. Some things may be left out due to various reasons. It happens we all have to deal with it. LVN's especially at NH typically don't dive into their patient's hx as much as they should. So it should not really be a shock to anyone that they didn't know the patient's hx upon your arrival.

As a EMT you are a health care professional. More so, its your job to find out all you can about a patient. Sometimes this means you have to play detective. Sometimes the answers concerning PHx are within the notes, medication lists, etc. Although going based on a med list can at times be misleading, it does kind of give you a clue as to what is going on with your patient(s). This is not really a new challenge, but an old one that you do everyday. If the syncope happened within a residency, and to add a degree of difficulty it was a 3rd party call. You would try to find out what meds your patient is currently taking, and if he is unresponsive you would try to piece what possible hx the patient has based on medications they are currently taking. Most people don't have a sheet just laying around in the open the tells their PHx. At a NH its really no different. Thats why patient assessment is important for every patient encounter you have.

Lastly, at every level of medicine there is ignorance due to lack of some type of education. There are really no exceptions to this. Thats why there is always room to learn, and to continue to learn. Where as some people do not take advantage of this, I encourage you to continue to learn all you can. Also encourage others to do the same. If a LVN doesn't know that atrial fibrillation is a cardiac condition, professionally educate them that this is cardiac. Maybe they knew it was cardiac but for whatever reason didn't feel it was pertinent even though it very well could have been. I don't know I wasn't there. But instead of being arrogant, we need to be professional, and help each other out. Just be tactful about it,and be ready to agree to disagree.<!--QuoteEnd--></div><!--QuoteEEnd-->

A good RN with 1 or 2 patients in the ICU will know everything about their patient.

The RN or LVN who has 20 - 40 patients to care for in one shift with 3 or 4 new patients per shift may not be able to memorize exactly everything in each patient's history. The LVN may know very well what A-Fib is and doesn't need an arrogant EMT-B trying to "educate" them about certain things that they themselves may not have a lot of education for. They have just enough time to get the necessary arrangements made, family notificed, paperwork for the ambulance and a brief report. Then it is back to the other 39 patients. Also what an EMT may believe to be a life threatening situation because it was mentioned in their text book in one sentence doesn't mean that is the condition causing the problem. Controlled A-Fib may not be an issue. Also, if a patient had a "hx" of it, that problem may have been resolved. Without a cardiac monitor you may not know what is the exact rhythm. In the meantime, while you are trying to show off what you learned in an EMT-B class, the patient is still not getting treated. The patient is going to a facility of higher care so that they can get the appropriate diagnostics and treatment. If the LVNs and RNs at the NHs could do or even had the time to do more diagnostics, they might be able to tell you what that patient's 12-lead EKG even showed. At a BLS level, it probably wouldn't make much difference. However, you still should be able to communicate with a ED when you have a drastic change in patient condition.

Since dialysis and NH calls are primarily medical, in a perfect world these transport trucks would have a Paramedic each truck who has a decent education in the many medical conditions of the elderly and chronically ill and not just first-aid training. Even many Paramedics are not adequately prepared for some illness and only know about the emergent. Thus, many things may be missed in an assessment. The LVN may have picked up these things but a Paramedic or EMT may not be aware of their importance. Example: "fever" in an elderly patient. Many EMT(P)s dismiss that as a bullshit call when it could turn life threatening very rapidly. The LVN, if he/she had time could probably educate the EMT(P) about a lot of things also if there was time. But, the EMT(P) would probably cop an attitude and be on one of these forums complaining that a "nurse" tried to tell them something about a "fever" or some BS "infection".

To the OP, continue to advance your education through college science and medicine courses such as A&P, Pathophysiology and Pharmacology.

Easy there vent. and your very right about a fib. as I was stating to the OP that it is possible. I know there are many reasons that cause a change in mental status. And yes most EMT-B's are clueless about the pathophys of a fib. But thats kinda getting off the path I was going with this. And I will say that anyone coming to reproach anyone with arrogance is not well accepted by anyone. If an opportunity presents itself to offer insight, experience or education I feel people should take advantage of these opportunities. Its not about one being smarter than the other. And well all cant "get it all". Im not advocating just thrust your nuts in a nurses face to show them how big they are. Like the old proverb says as iron sharpens iron we should sharpen not just ourselves, but others when appropriate.

My solution is to take the initiative and take everything in despite the request of the lead medic. no one is going to frown on you for doing so except maybe your partner. If it becomes a issue, bring a supervisor into the matter. I highly doubt you will be found at fault. Just remember to be tactful.

just an idea:

-boot the computer into safe mode

-Log in as Administrator NOT under your name

-Remove the acct

-Create another acct

-the restart the computer.

I know this used to work, I have not played with it too much with Vista. But for XP and older OS programs it works really well.

ok 2 stories true stories that happen to me and my partner today. for anyone that doesn't know me i am an nremt b that works for a private company that 99.9% of the time just does dialysis transports. once in a while we ( the company) will get " emergency" calls to a nursing home we have a contract with to take the pt to the emergency room.

first nurse today . we get a call to go to a n.h. for an 82 yo male who is unresponsive.vitals are stable. no s.o.b. coa x 2 no jvd. no pain. no deformities/ abnormalities. my partner ( the tech) starts to ask the nurse what is going on ? nurse states pt was unresponsive for 60 seconds and now is sitting in the wheel chair on 2 lpm via nc. partner ask for the paper work and goes through it while getting info from nurse. nurse stated pt has a p.m.h. of heart problems but doesn't know what they are. my partner said wouldn't they be in your chart book on the pt. nurse: yeah i dont see them. partner: ok well what else can you tell me of the pt. nurse: pt has a history of a - fib. partner again ask nurse you don't know what cardiac problems pt has . nurse : no. partner: any other p m h we should know about ? nurse: no. as soon as we get on the elevator partner says to me: pt was sent here cuase of a history of syncope. i started laughing . partner says to me while the i was asking the nurse i was looking right at the big words primary diagnosis SYNCOPE.

wow. so the nurse couldn't figure out that a-fib is cardiac and maybe the reason ( not saying it was/ or is ) but maybe the pt had a syncope episode . maybe thats why the pt was unresponsive for 60 seconds. the nurse couldn't even tell us that the pt had a history of syncope. clueless or lazy?

2nd call

dispacted to dialysis unit for shortness of breathe. 63 yo female. had a full treatment. on 3lpm of compressed air via n.c. coax 1 nurse states pt is coughing up blood. resp 22. i appologize i forget pulse and b/p i do know they were both low. nurse stated that pt's i.n.r. is 6. and on the blood thinner coumadin. partner who i respect a lot and has done 9 11 for over 10 years and now doing transport ask what is i n r. the nurse looks at us starts to laugh and walks away. partner says no i really don't know what that is.please tell us. nurse doesn't answer. pt s condition is declining in the ambulance we pull up go to the er. where a nurse is on the phone. and a doc next to the nurse.. where i am ems has to wait for e.r. staff to acknowledge ems and pt. pt's eyes are closed. and now unresponsive in the e.r. partner asking for a nurse 4or 5 x each time voice is getting louder and louder. nurse on the phone says ohh the charge nurse will be right over. the doc looks at our pt and sits back down. partner now pretty much screaming hey can someone help over here who is better than me. finally another doc comes over feels for a pulse but doesn't feel one. so now after about 3 minutes goes by before we get help from staff . pt coded and was bleeding internal. er staff suctioned a lot of blood out of pt. my point here is why couldn't the nurse at dialysis tell us what inr was? lazy?

i can't blame to much on er. dialysis always says that they will call the e.r. for us since we don't have the e.r phone numbers in our radio's/ nextels since our boss has it so we can't dial reg phone numbers. ( why i don't know). er stated they( dialysis ) never called so they had no idea somebody was coming in. no i don't know 100% that the person on the phone was a nurse. i think so but not 100%. but why wouldn't the doc help us? why did another doc from across the other side come over to help when there was a doc right there?

anybody have experiences like this before?

tamaith,

I hate to say this but this happens like everyone else says more often than not. To take the advocate of nurses for a second, a single nurse can have as many as 15 patients or more. Im sure chbare can attest to this. A good RN yes will be able to rattle off everything under the sun about a patient. Some things may be left out due to various reasons. It happens we all have to deal with it. LVN's especially at NH typically don't dive into their patient's hx as much as they should. So it should not really be a shock to anyone that they didn't know the patient's hx upon your arrival.

As a EMT you are a health care professional. More so, its your job to find out all you can about a patient. Sometimes this means you have to play detective. Sometimes the answers concerning PHx are within the notes, medication lists, etc. Although going based on a med list can at times be misleading, it does kind of give you a clue as to what is going on with your patient(s). This is not really a new challenge, but an old one that you do everyday. If the syncope happened within a residency, and to add a degree of difficulty it was a 3rd party call. You would try to find out what meds your patient is currently taking, and if he is unresponsive you would try to piece what possible hx the patient has based on medications they are currently taking. Most people don't have a sheet just laying around in the open the tells their PHx. At a NH its really no different. Thats why patient assessment is important for every patient encounter you have.

Lastly, at every level of medicine there is ignorance due to lack of some type of education. There are really no exceptions to this. Thats why there is always room to learn, and to continue to learn. Where as some people do not take advantage of this, I encourage you to continue to learn all you can. Also encourage others to do the same. If a LVN doesn't know that atrial fibrillation is a cardiac condition, professionally educate them that this is cardiac. Maybe they knew it was cardiac but for whatever reason didn't feel it was pertinent even though it very well could have been. I don't know I wasn't there. But instead of being arrogant, we need to be professional, and help each other out. Just be tactful about it,and be ready to agree to disagree.

As for communication to the emergency department. If you have a cell phone. It maybe helpful to ask the ER for a contact number so that you can communicate with the emergency department when you have a incoming patient. This can be really helpful if your bringing in a suspected stroke patient or a STEMI. If your employer wont open the lines of communication like they should, be proactive and do it yourself.

NIMS 300 & 400 is still an actual class room, there are classes online for 300 and 400 that will prepare you for the classes, but if you read the fine print, its not a substitute for the actual class.

As for volunteers. For volunteer FD's to get federal funding they must have all fireground personnel NIMS compliant. Otherwise I hope their wallet is big so to be self sufficient w/o federal funding.

Also the classes that are on the website that I put in my previous post are all grant funded courses by the DHS.

Correct me if I am wrong. When I was down in FL I was told that first responder was a prerequisite to EMT-B. I know that is not true in TX where I got my certification. But definitely get your EMT-B.

I agree that it is dry, but it is essential. Once you have worked a few disasters you will appreciate how much better it is when everyone is on the same page, versus just cowboying thier way through it. Sadly, since so few departments actually have disaster drills, most of this will be forgotten when the next disaster occurs. JCAHO mandates that hospitals have disaster drills, too bad there isnt an EMS authority that could mandate the same.

Couldn't have said it any better. When everyone is on the same page it not only puts everyone on the same page, but also helps to reduce emergency workers from unnecessary injury due to freelancing through accountability. Yes its about as boring as watching that long drawn out HIPPA video. But it does have a pay off during moderate (apartment complex fires or bus accidents) to severe ( MCI's ) incidents that you may encounter in your career. I do think that there should be more emphasis in the work place to ensure everyone knows what to do in these situations.

Just something to banter around the work place to help not just yourself, but anyone who reads this post. The Texas Engineering Extension Service has classes that can come to your place of employment to teach various things to prepare for such events, as well as the unthinkable. Here is the link. I hope this is helpful.

http://www.teex.com/teex.cfm?pageid=OGTpro...templateid=1658

One word. Only. You give one word to tell what comes to mind about the previous posters word.

Light

Blue

This is my take on the topic. Agree or disagree its all good with me.

We have the same problem in our system. Its very easy to become jaded after constant runs for the same guy over and over again. There are some people even that we know who it is before making the scene just based on CC.

We had a crew almost 6 months ago pick up a homeless guy that everyone in the company knew. A known alcoholic, and known 911 abuser who would get drunk, and call complaining of CP. Well this call started with the typical routine. Nothing appeared out of the ordinary, except for his 12-lead showing massive AMI. He ended up coding en route to the hospital, and pronounced dead at emergency room.

I like my partners stance on this which is treat each patient as if its the first time you have ever met them. I know that repeat abusers are as the little boy that cried wolf. But regardless we cannot let our guard down until we have the technology,and training, to actually R/O life threatening events. I understand some services do, while others don't. I don't like running on calls on people I see more times than my own family for the same complaint or lack there of. But I also like working towards being successful in my job. I would hate to loose what I have worked for, just to find myself trying to be successful somewhere else, or in a profession outside of EMS.

Point is we, as much as we would like to, cannot call a spade a spade just yet. I look forward to the day that it would be possible. However I see that day being far off, and not in the near future. I could be wrong.

Will keep him, a brother from another mother in my prayers. And if he is as stubborn as most people I know in EMS, giving up wont be a option, and hopefully he will be fine.

Hello all, I am an NREMT-I in the Dallas Texas area. I have been an NREMT-I for almost 5 years. I am in Fire school at the North Texas Fire Academy and should be finished with that within the next month or two. I am 40 years old and have a great wife and a 2 year old son. I was previously a paid firefighter/EMT in south Georgia before my wifes employer moved their headquarters out to Texas. Prior to that I lived in the Atlanta area for about 18 years. Grew up in coastal NC.

I currently work for a county EMS (911) provider in N.Texas and have been there for about 2 years. Looking forward to meeting new folks on this site and hopefully keeping up with the never ending changes that grace our profession.

Welcome to emtcity for start. I would have thought since Georgia is a IFSAC state you would get reciprocity. Chalk it up to politics. I'm not too far from your neck of the woods, just on the otherside of the metroplex in fort worth. good luck to ya.

Hello all, I am an NREMT-I in the Dallas Texas area. I have been an NREMT-I for almost 5 years. I am in Fire school at the North Texas Fire Academy and should be finished with that within the next month or two. I am 40 years old and have a great wife and a 2 year old son. I was previously a paid firefighter/EMT in south Georgia before my wifes employer moved their headquarters out to Texas. Prior to that I lived in the Atlanta area for about 18 years. Grew up in coastal NC.

I currently work for a county EMS (911) provider in N.Texas and have been there for about 2 years. Looking forward to meeting new folks on this site and hopefully keeping up with the never ending changes that grace our profession.

Welcome to emtcity for start. I would have thought since Georgia is a IFSAC state you would get reciprocity. Chalk it up to politics. I'm not too far from your neck of the woods, just on the otherside of the metroplex in fort worth. good luck to ya.

Well it all makes sense.

When Farrah Fawcett died, God said to her, you had a good career, lived a good life, and did wonderful things to help others. I want to grant you one wish. And she said that she wished all the children of the world would be safe.

R.I.P. MJ

too true spenac. Ive had alot of friends leave just for that reason.. its a quick career killer

If we are still on the basic level. There is nothing more basic about a good diesel bolus. Unless you drive like someone in a demolition derby.

The only reputable on ( or close to reputable ) that I know of is AMR. There are alot of mom and pop places. I think there is a way to look up what providers are in your area on the TXDSHS website. www.dshs.st.tx.us.

I was just looking into a RN program online (cuz I dont have time for formal classes otherwise Id be all over it) And now unless you are a RN you cannot get a nursing degree. So that part of my career ambition is put on hold. Probably for the best. I prefer learning from experienced pro's vs on my own any day of the week. Good Post.

Ok I want to know if this has ever happened to anyone else.

We were sitting underneath a bridge at 820 and Marine Creek in Ft Worth where we normally post. All the sudden a SUV pulls up and the front seat passenger looks like he is having a SZ. I got out and began to do an initial assessment. The patient had agonal respirations, no radial pulses, but had a faint carotid pulse. As my partner approached the vehicle, I went to get our equipment. As soon as I got into the back I hear my partner yell "get a backboard he is in full arrest. So I grabbed the backboard and assisted my partner in getting the patient out of the vehicle. As soon as he was on the backboard, I began CPR. We had a Trainee on the truck, so I had him BVM the patient as I'm pumping chest. We then got the pads on him, to find the patient in coarse Vfib. We delivered 1 shock to the patient which converted the patient into Sinus Tach. My partner then tried for a line, which was unsuccessful. Then he went for the tube. As soon as he was about to intubate, the patient comes to and says "what the hell is going on?" We get him loaded up inside the ambulance. My partner makes a second attempt at a line, then pushes .5 of lidocaine and we transported code 3 to the hospital. The entire time we were transporting, the patient was slightly confused as to what was going on, but answering questions appropriately. Patient was dropped off at the hospital AOx4 and unremarkable. Only thing I wish we did is get a 12-lead, we only did 3-lead don't ask me why, that was my partner's call. I personally would have. As we left I got to shake the man's hand that only a few minutes prior I was pumping on his chest.

Has anyone else seen this happen? Thoughts?

Take Care

Will