flight-lp

And you would have potentially killed your patient thus further proving our point................. High flow O2 in a stroke pt. is contraindicated due to cerebral vasoconstriction potentially increasing the infarct and further occluding cerebral blood flow. In fact, most stroke pts. require NO OXYGEN! So tell me again why your EMT basic class qualifies you to treat pts. in an emergency response environment????

Spenac - You took the words right out of my mouth! 8) Broken - It is tragic that this chain of events has taken away from your livelihood and has altered your quality of life, but as previously mentioned, you DID refuse treatment. As the acceptable norms of spinal motion restriction were not placed due to this refusal, your acknowledgement of being conscious, alert, oriented, and of sound mind, and the non argued aspect of the incident itself, you really have no civil recourse, definitely no criminal recourse. The only recourse that is feasible would be throughout the EMS provider's company. Will the EMT be fired? Maybe. Decertified? No chance, you refused treatment plain and simple. I am sympathetic to your situation, but not of your actions. You are not an EMS professional, you do not know what care you need, we do. As far as the transport goes, I answered that one. Yes you should be able to go to hospital "c". Now if it wasn't a trauma center, then no, it would not have been appropriate. But just as you refused treatment from EMS, you could have very well refused treatment from the hospital and demanded a transfer. So, in essence, you can't have your cake and eat it too. You were not forced to receive substandard care, if that is in fact what you received. Again, as stated, if the crew was BLS then no pain meds for you. If this is not acceptable to you , then be proactive and involved. Tell your community leaders that this is substandard and that you deserve ALS responders who can adequately address your pain needs. Most of us know that ALS is a neccessity, but local communities are the ones who are not willing to pay for them. After being a patient, do you believe the cost is justified? I would hope so... Transport to the hospital with lights and sirens is clearly not indicated in your case. You were hemodynamically stable with no neuro deficits. Not worth the risk. I'll let you in on a little trade secret...............the safety of the crew will ALWAYS precede the care of a patient. Dead or injured crew members tend to greatly reduce the capabilities of any EMS system and are prone to cause bad patient outcomes......... My advise, as both a Paramedic and a legal consultant, rehabilitate yourself and enjoy your life. Legally, you are wasting your time based off of what we read here. If this is remotely complete or truthful, you'll never see the courtroom and I don't see too many insurance companies just handing you a check either......... Good luck! Flight

O.k. you are making this harder than it has to be. Go to "C", simple as that. Its only a couple more miles. Some folks have to do exactly as their protocols state. Others have the ability to use some autonomy and a little common sense. Varies by region.................... I hear you use terms like ethical and human. Over time you will learn that these traits have little to do with this industry. It sucks, but quite often these are overruled by such terms as legality and liability. Your compassion is admirable, but you must know exactly where you stand on all of your departmental policies and it would be advisible to follow them or seek other employment. Personal crusades in EMS can be quite destructive to one's career.

I was referring to responding to the scene. As far as transporting goes, call en route to the ER prior to leaving the scene. No other radio traffic should be required. Most ambulances have a hands free mode, this is a prime time to use it. Besides, very few actually require L/S to the hospital despite a very high overusage by EMS types...............

Not always visible??? Doesn't that defeat the purpose? If your going to put devices on your vehicle, then they need to be visible 360 degrees. As others have said, check with your insurance company first, many do not want an inexperienced 18 y/o driving with emergency warning devices. Plus in a rural area, why do you need one? Traffic isn't an issue, you could probably drive the speed limit without them (really no need to go any faster), and on a side note, you may also want to check with your vehicle manufacturer. Several will void your warranty if you add aftermarket equipment, especially anything electrical.....................

Yeah the driver needs to drive, and only drive. No talking on the radio, the cell phone, fumbling for the siren switch. The passenger needs to do all of that. And both sets of eyes need to be outside. You can start your report later................

hospital "c" by ground EMS.................... There, that wasn't hard............. "a" is out of the question as it isn't a trauma facility and possibly will not have orthopedic services. He doesn't want to go to "b" that fine, its his choice. But instead of having him refuse everything, including transport, why not just honor his request and go to another trauma center only two miles further away? No harm, no foul.................. Oh yeah, if your BLS, meet up with ALS and give this man some drugs, he'll need it for the transport!

Thrombolytics are a temporary solution to a permanent problem. These pts. need a cath lab if one is reasonably available. An additional 10, 15, hell even twenty minutes to another hospital is of greater benefit to a patient than to go to the nearest ER that may or may not give lytics. Even if they do, you are lengthening the time to appropriate DEFINITIVE care. Sorry, but there is no reason in an urban environment to not go to a cath lab....... And to help add numbers to your study, our cath alert program has had only 2 "false activations" and they were both resulting from Brugada type syndrome and both were cathed anyway...........

We have a Cath Alert protocol for our AMI and acute onset LBB pts. They all, regardless of location, go to the same hospital for immediate cath. The protocol calls for the usual AMI stuff (i.e MONA as required), followed by a Heparin bolus and Lopressor if indicated. Upon our interpretation of the 12 lead, the ER charge nurse is notified that we have a "Cath Alert" and in turns activates the cath team. We bypass the ER and head straight to the cath lab (unless its at night and the team hasn't arrived yet, then we'll deliver to the ER until they arrive). We are hoping to add some other facilities to this program to further reduce our transport time, but as we stand now, our current time from 911 call until revascularization is around 85 minutes. The national standard from ER door time to revascularization is 90 minutes, so I guess we aren't doing too darn bad!

Interesting perspectives from all around. Personally, I believe that a Combitube is a great rescue airway, but should be limited to that use alone. Three unsuccessful attempts at definitive management would be an indication for use. However, what really surprises and in some ways disturbs me is the way that people see an indicated use at the BLS level. The very same people (general descriptive statement for several EMS forums) that always scream "BLS before ALS" are the ones suggesting misuse of a Combitube. What ever happened using a good 'ol BVM with a proper seal and appropriate ventilations? Need to keep an airway open, then place some pharyngeal airways. All of this, well what about if xxxxx happens, well, the reality is that definitive airway managment is not appropriately performed at a BLS level. You need ALS providers, period. People need to stop making excuses and justifications as to why some things are perceived as acceptable and start offering a level of care that could provide the minimal level of appropriate care. Sorry to rant, but I've seen more EMT's screw up things they shouldn't be doing in the first place than I have seen Paramedics not being proficient enough to perform at the ALS level. Thats my perspective, take it as you wish............ No apology needed Asys, great topic to bring up. Hopefully it will shed some new perspective on this topic and will help in closing a topic that has really been beaten to death........

Yup definite breakdown in communication, the way I see it you had an MVA with no patients as they were no longer on scene. In service, no patient............

Dust, you offer a very valid perspective on this particular tragedy. There was definitely a deficiency on the part of the triage nurse, but I still affirm that EMS should not get involved in most of these cases. My agency receives numerous calls from the ER waiting room, mostly impatient people who have a belief that their reason for visit supersedes all others. We call the ER and speak directly to the charge nurse who in turn goes to triage with the NP or PA and "evaluates" the situation. Based on that evaluation, I can say that we have NEVER had to respond to the ER. Now we have this case which is clearly gross negligence on the part of the ER staff. But I still fail to see why the shortcomings of the hospital need to be dumped into the lap of EMS. It sounds to me that even if EMS did arrive and proceed to the treatment area, the patient probably still would have received piss poor care. Just my .02 worth but I still say check with the hospital, if they deem everything o.k. then its their posterior, not mine..............................

So the fate of your job is in the hands of patients essentially? To think an employer would fire someone because of refusals, no patients, and patient by law enforcement type calls is absurd. Not where I would want to be, especially since probabaly half of my pts. do not need nor get transported to an ER....................

You really should care and you cannot properly actively rewarm a patient properly without a constant core measurement. If you are going to go as invasive as internal cavity lavage, then you ABSOLUTELY need a thermometer probe up their rear. Without it, how are you going to monitor for after warming drop, or worse hyperthermia? How will you (other than the obvious symptom of death) identify and stay ahead of such complications as rewarming shock? No we do not need to shove a thermometer up every pts. ass we come into contact with, but some do require it, hypothermics especially.....................

:cheers: :hello1: :cheers: Best post in a while! Well spoken!

As I stated before, you don't have to agree with my beliefs, I could care less. I did utilize tact in my previous posts, perhaps you should reread my last post. Honestly though, if a tactful written statement on an online forum actually bothers you, then you have other issues that you may wish to look into.............. @khanek - Thanks for the insightful response. Although a rarity, it sounds like your organization really tries with what they have. Although I still believe ALS is a better option, at least you have the capabilities to utilize them if needed, again its better than just being out there with your stuff in the wind. Good luck to you....

I once transported a physician diagnosed nympho to our regional psych hospital.............. Longest damn 3 and 1/2 hours of my life. Played with herself the whole way there............

I'm confused by this statement, wouldn't the MVA be the one that you would "load 'n go"??? What about ACS patients? They would definately benefit from ALS therapies............... Your dedication and pride is admirable, but volunteerism is a dying breed in this country. Come on, your community deserves a higher level of care. You have an agency that is willing to provide it, many communities would kill to have it. Sometimes you have to consider the best needs of everyone, not just the volunteers in your service. Besides, this could open new doors for your volunteers (paid positions, advanced educational opportunities, etc.) Please expand on how this would "hurt" you (other than putting your organization out of business). Can you provide your cardiac arrest survival statistics? Does your "discharged neurologically intact" percentage exceed 5%? What are your mortality rates on your urgent / critical medical patients (i.e. how many COPD'rs and CHF'rs died within 24 hours of arriving at the hospital or passed while in your care)? How many of your 75% falls resulted in a fracture? I am interested in hearing your response..........................Thanks!

Actually, that is predominately not the case. As previously stated, a trained monkey could do the job of an EMT-B, but an educated person can utilize a thought process that combines knowledge and skills to provide the best care possible for each individual patient. That does not equate to putting a C-collar on everyone who tests Newton theories or a NRB on everyone who believes that the 21% oxygen content in the environment is insufficient. Please take a moment to read over some threads, you will find a wealth of knowledge concerning this very subject. Nope, had nothing to do with it. I have absolutely nothing against EMT's. I work with some of the best on a daily basis. There role in the care of our patients is invaluable. But it is not equal. A quality EMT can identify the difference. Do you think there is a reason why? Could it be perhaps that administrators and medical directors recognize the need for advanced life support? Perhaps a level of care that cannot be feasibly performed by an EMT-B? It is not a personal attack, it is about what constitutes the best for our patients. These are my beliefs, I respect that you do not agree with them. That is fine, but perceptive assumptions are never a way to introduce yourselves to a new online family. On that note, welcome to the family.........

~groan~ Here we go again................ No, you do not need to train the BLS crews, you need to educate them. Nowhere in these posts did anyone tell you that you can't do your job nor need supervision. However, it is a FACT, not opinion, not a "paragod" complex, but a FACT, that having a Paramedic on an ambulance is far superior to a BLS unit in the 911 environment, especially in the rural environment where critical thinking abilities rarely possessed by an EMT-B are essential. Call it what you want and I'm sorry that this hits a nerve with you, but reality speaks louder than an impulsive exclamation by a young EMT. My personal opinion (take it however you wish) is that ALS intercepts are a "barely treading water" level of pre-hospital care. Yes it is a huge step above volunteer BLS units running 911, but it is no where near optimal.................

+5........ =D> :shock: :shock: WTF :shock: :shock: Doesn't sound like much of a service to me :scratch:

Exactly as it should be! And they will let you give basic analgesia................Just become a Paramedic.

Sux to be in Jersey! Fortunately, pain management is one of our medical directors top priorities. Fentanyl 2mcg/Kg. PRN or Morphine 2-5mg PRN, no max on either (unless they are drooling on themselves), and Nitrous Oxide PRN. I usually have happy patients upon arriving at the ER..........

?? :? ??

40 hour work week in EMS? Now that's funny!