HERBIE1

I'm not familiar with the area, but I assume it's in a poor part of town. I submit that what the community needs more than a hospital are a bunch of clinics that could handle the vast majority of medical complaints that present to an inner city ER.

Ever deliver a baby from a teen mom, and 15 or so years later deliver HER child? Talk about a strange moment.

For years, salvage covers worked well for these incidents. Now they have fancy large patient conveyance devices- essentially a salvage cover with handles and a prettier color. LOL

I wish we had one of those. Tried a prototype, liked it, but of course, the department won't spend the money.

Despite the fact that many ambulance services started out operating from a funeral home, thankfully EMS has moved away from those responsibilities. In many places, there is a private company that contracts with the city to remove dead bodies. Others have the coroners office take care of it if it's a coroner's case. Still others utilize the police department. Obviously if it's a natural cause death- DOA- at home the funeral home will take care of it. Simply removing the body doesn't require special training, but working FOR or AT a coroner's office does.

Totally agree with your comments except this one. Unfortunately college these days has gotten ridiculously expensive- even for state schools. The days of being a professional student, taking 6 years of philosophy classes and contemplating your navel are over. College students are a lot more focused in their studies, and basic liberal arts degrees are probably becoming less common. It makes sense- if I'm spending 30K, 40K, 50K or more for a degree, I want to be sure I end up with a marketable degree, if not a marketable skill. More than ever, students are taking advantage of junior colleges and transferring to a university to finish their degrees simply because it's the most economical way to do it. It's sad- when I finished college, my debt was 10K and I thought that was a fortune back then. It still took me 10 years to pay off that loan. What you said about entitlement is dead on, though. These kids simply cannot accept the fact that there are NO guarantees in this world- college degree or not. Based on what our president and his party have been pushing, I'm afraid they are doing nothing more than encouraging more of the same type of thinking. Not good...

Hey! As a male, I resemble that remark!

Bingo.

Been in the business for nearly 30 years and I have never heard the term "dart 'em". Flutter valve- yes. Then again, never heard the ambulance described as "bus" or "truck" either but clearly that's a term specific to certain areas. We use "rig" or "ambo" around here.

Like I said, half kidding. More of a comment on higher education in general than anything. Besides places like Oral Roberts, universities aren't exactly known for being conservative think tanks. There is a certain aura for someone who attends a school like Harvard, Yale, Northwestern, or University of Chicago. An education at places like this cost more than a family home. That is truly insane. If I was paying 120K+ for an undergrad degree, I think I would want a promise of a job too. LOL

I look at this in another way. Unfortunately, she got EXACTLY the education she should have expected from a small liberal(operative word here) arts college. She was apparently taught that whenever something goes wrong, blame someone else. (Only half kidding) Sorry, but even in this economy, IT is still one of the few professions that is still hiring- along with the health care industry. Someone else said it- she probably expected a 6 figure salary with a corner office, a company car, free medical, dental, and vision, and 6 weeks vacation- right out of college.

I understand your concern, but these handicapped people live like this every day. Their mobility/sight/hearing may be impaired, but they have ways to cope. I would certainly point out to a person who may have these issues of your concern. Say a person with diarrhea, who may need to make frequent trips to the bathroom, but ambulates with a cane, refuses transport. You see the potential for falls, etc, and point out these facts to the patient and make certain their refusal is indeed an informed consent.

I've had people tell me they were allergic to it, but never saw evidence of it.

Prayers and good thoughts your way. Hang in there.

Your boss is wrong. If the person was decompensating- poor sats, hypotension, decreased mentation- then needle decompression is appropriate. Tracheal deviation is also a late sign of a tension pneumo so I doubt that was accurate. The person would be in severe respiratory distress by that time. Possible reasons for the apparent lack of lung sounds- noisy scene, patient was hypoventilating- pain was keeping him from breathing deeply. Putting a needle in this patient would be like defibirllating a wide awake, normotensive patient for an apparent V-fib on the monitor. Something else is going on. Tough call as to how to proceed. If the boss pushes this, I would ask his clinical rationale for justifying what he wanted but I see no evidence he can support his claim. If he continues, you can have the treating MD speak to him, but then you may be burning your bridges, challenging his authority, and it's probably time to leave. I'd wait to see how this plays out and then you can decide how far you want to push this. Is there someone above this boss you can plead your case to? Good luck. Personally, I would confront the boss about his poor clinical and diagnostic skills and start looking for another job. He sounds dangerous. You do what you feel is right for you, but it's clear you have a major problem with this incident- and rightly so. That's also easy for me to say- it's your job to lose, not mine.

Interesting points. A few things... I agree with your assessment of the studies. The results of any poll, study, etc are only as good as the questions that are asked. Numbers can be skewed, sample sizes may be insufficient, differing results may be statistically insufficient, the group conducting the research and asking the questions may have ulterior motives, etc. Who is sponsoring the study or stands to gain from the results? In other words, yes, simply reading an abstract or executive summary may not give you all the facts. Hospitals need to meet certain criteria in order to keep their various accreditations. A Trauma center must do a certain volume to maintain their status. Why is it such a stretch to think that unless you practice a certain skill on a regular basis, you may not automatically be allowed to use it? I guess the problem becomes, in some areas, which is better, a person who's skills may be a bit rusty vs having someone who's not even able to do any advanced techniques? Tough call.

More strawmen. Never once did I say, imply, or insinuate that I had no respect for RN's or MD's- I simply stated a fact. I always knew my role in a hospital setting, and did it to the best of my ability. As a result, I was able to earn the trust and respect of my coworkers and take part in many procedures and situations normally reserved for more highly trained providers. I have done open cardiac massage, inserted chest tubes and central lines. I was like a sponge-I couldn't stop learning, loved every minute of my time with those people, and am forever grateful for their patience and assistance. One of my major shortcomings is a lack of tolerance for people who have inflated opinions of themselves and the depth and breadth of their knowledge. I would also never presume to lecture you about your area of expertise. Sorry bud-it takes much more than you have to intimidate or bully me.

Obviously our first job is to follow the law and our own protocols, then follow any advanced directives the patient may have. As was pointed out in the article- and we all know- it's not always that simple. Even with a terminally ill hospice patient, family members panic when the time comes and change their minds. Fair to the soon to be deceased- nope- but that is also not the best time to debate someone's final wishes with the family. I really wish that we could promote the idea of dying with dignity here. When the time comes and hope is essentially nil, I have instructed my family to let me go- or I'll come back to haunt them. (Only half kidding) I think I've told enough horror stories of people in vegetative states, what they go through, and who can linger for years in a nursing home. That is NOT going to be me. It's not fair to me- or my family. I don't want them to remember me that way or be a burden to them.

Interesting point. I agree. I think the new normal is indeed around 200lb now. The other day we had a cardiac arrest who was right about 200 and he almost seemed "small". LOL Good call- an ACLS Mega code station from hell-he went through just about every rhythm possible multiple times and then some. Lots of drugs, lots of CPR, pacing, lots of electricity. It was a save too. Interestingly enough, because of a dispatch mix up, a lack of manpower and his constantly changing EKG, I didn't intubate him until about 15 minutes after we started the code. Good BVM= good oxygenation and no gastric distension. Return of pulses, a good BP, and spontaneous resps. Made it to the cath lab and then to ICU. Will see what his deficits are tomorrow- if any.

Either you are new to this game or your area is far more progressive than mine. I've worked in hospitals for 20+ years and have been in EMS for around 30. I assure you what I said is true for this area and every area I have been involved with. Again, that adverserial attitude is MUCH better than it was, but is not completely gone yet. Strawman. Read what I said above. Again. Read what I said instead of pontificating. Evidence based QA and QI is vital to the future of EMS. Never said they were not. Right back at ya. If you have something constructive to say, by all means say it, but lose the attitude. It does not help your argument. Bullying and intimidation may work with the young ones, but not with me.

Are you hard-wired to be a d**k or is it something you need to practice? I was agreeing with you. Yes, CRITICS. Like some nurses who still live in the past and resent us for our autonomy. Like old school docs who went to medical school in the 1800's. They are certainly not as abundant as they used to be, but they are not gone yet. You can't change someone's opinion, but you can certainly keep from giving them ammunition by doing your job professionally. Do it right, do it by the numbers, and do what's best for the patient.

Well, the oversight in hospitals is clearly better. They have infection control nurses who patrol and do QA's. With the advent of things like MRSA, it's simply not something they can play around with. Prehospital, we have no such watchful eyes- just our own integrity to do it right. If you say the stats show not much difference between the 2, then like many things in our business, it's incumbent on us to prove our critics wrong.

Many hospitals as a matter of procedure, routinely disconnect and restart field IV's because they feel the conditions in which they were started were probably less than optimal. It's a CYA thing- regardless of patency or size, they are worried about infection, thus lawsuits. Same for ET's. If a doc signs off on a tube or procedure, they are agreeing that all procedures done to that point are satisfactory.

As with anything in this business, there are so many variables, it's difficult to make a profession wide declaration like 'The Prehospital recognition of X disease is lacking." Call volumes, demographics, training, dispatch protocols, level of training of providers, etc- it's hard to make a direct comparison of anything.

Looking at the first few studies, it was clear the sample sizes were exceedingly small- statistically insignificant if someone was trying to suggest that prehospital triage is large scale problem. Certainly these studies cite a problem within those particular systems, but I fail to see proof it is a widespread issue. As for trauma- much of what we do(treatment, proper mode of transport, appropriate facility, etc) is supposition based on MOI, not necessarily direct evidence. We assume the worst and let the hospital and their advanced training and diagnostics rule everything out- as it should be. If there was a nationwide study, with an appropriate sample, that bridged all types of EMS provider systems, I would be more apt to believe the results.