RFDMedic3D

I was involved in an intersection MVC the other week while responding to CVA symptoms. The light had just gone red for my direction and I slowed to a crawl to ensure everyone in the opposing lane saw me, they had, or so I thought. As I proceded thru the intersection, a car came racing into the intersection and hit my ambulance right at the rear wheels. This caused us to tip up onto the passenger side wheels. As I looked out the windshield and driver's window, I thought to my self, "WOW! we're really high, wait a minute, this unit isn't that big!!!" We then returned to all our wheels with a "BANG!" After checking myself and my partner, we checked the other driver and called in to dispatch. We were both just shaken up and the other driver had a minor cut on the forehead, their car however wasn't as lucky.

I was just wondering if anyone else had crazy things go through their heads during stressful situations.

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Have a bit too much time on you hands???

Just for discussion.

If you knew you only had so much time left.... who would you tell and why? What would you say? Would you be glad for the chance for closure, and to say all the stuff we all think from time to time but never get around to saying. We all think there is time for that later.

Worst word there is. Regret.

Regret. We all have them. I'm sure that if I was told I had only a very limited time to live, I would die with many regrets. What would I do? Who would I tell? that would depend on the time frame. If it were days, my list of things would be shorter. My Family would be told no matter what. However, I would insist that they go on as if nothing was wrong. They must continue to live, hopefully a long time after I am gone, and hovering around me while I spend my last moments here will just hinder their future. I would like to spend free time with them.

It's only unprofessional, because it's not hawt female firefighters.. Who wants to see a bunch of bulgy, sweaty firemen..

They can't make an EMS calendar like that, can't find 12 super model looking people that work in EMS.

While I agreee that this entire incident may have been poorly conceived, it does fall into that area of "P.C. Behavior." Our country, and our world, has become so wrapped up in trying to make everyone happy that you can't tell a joke on duty these days wothout someone taking offense. If this picture offends, don't look! How about we STOP trying to police the morals of everyone else and accept some personal responsibility for our own behavior.

Do I think they should be fired? If there is specific policies that have been violated, yes. If no policies have been violated, then the issue should be left to fade into the background. I'm sure there are much more important issues facing this police department than a provocatively dressed waitress handling a firearm sitting on the trunk of a department vehicle.

By the way 4c6, I agree, you'd be hard pressed to find 12 total supermondel types, male or female, in my area as well.

Lastly, and most importantly, make sure that they understand that in the end, it is about the patient. These new skills and information will ultimately lead to better care for the community, and better patient outcomes. Better patient outcomes and improved patient care leads to an increase in respect from other medical professionals, and a better working relationship with complimentary services (PD, local Hospitals, and the med-flight crews).

I agree with everything Cos says, and most importantly I agree with the above. Getting vetrans of any field to accept new and "different" things is sometimes close to impossible. There are those time when you make headway with a few and can use their influence to sway more. One of the important things you need to have them understand is that you're not trying to redesign the wheel, so to speak. Remember to point out that ALL advanced care is based on GOOD basic skills and assessment.

I always point out to my basic classes, both EMT and CPR, that the first thing that is covered in AHA ACLS and PALS is BLS CPR! Without the basics, we can never move to the advanced.

No way is this discussion of a policy on what equipment to take in will hold or even be set up. Our service prides itself in allowing our medics to work autonomously and every one of them sans one takes at least a med bag or all three pieces of equipment (bag, monitor and oxy) in on EVERY call. It's just this one person.

I'm not going to go any further into this discusion on the "lazy" because of several aspects which I cannot discuss.

Thanks for everyone's input.

Ruff,

These type of providers are everywhere. Here are some opinions of my own.

1. What does the Medical Director think of these acusations? What do the PCR's reflect? Does this provider "fudge" evaluations, or do they actually document what they find? Ultimately, you come down to what you can prove as apposed to what is documented.

2. If patient families have witnessed this poor attitude, have them submit a formal letter of complaint to the squad. This will back up any discilpine you may take. Documentation is not just good for PCR's you know. Other crew members that have witnessed this may also submit incident reports.

3. From the attitude you report, it sounds like this provider needs to take a break from patient care. This sounds like typical burn out symptoms. It may be time to have this person take some time off, or change thier primary duties, if that is possible. It's all well and good to say that someone should be let go, but remember, it could be you some day. While we all think it won't happen to us, burn out is real and should be dealt with fairly and justly. We don't give second thoughts to providing CISD for large incidents, but mostly fail to see the result of the accumulation of weeks, months, or years of dealing with our chosen profession. Some of us handle it well, others do not.

My final thought is this, there is a small percentage of providers in this industry, that are only here for the paycheck. While I admit, the paycheck makes it easier to do what we do, there should also be an eagerness to help your fellow man.

This question is open to anyone who can provide a professional answer. This question involves a small department who utilitizes a paid on call crew with a volunteer back up crew. The situtation I am about give you in an ACTUAL situtation that occured here very recently and I just wanted some input from other medics and EMT's.

Our department was dispatched to a medical call this past week. The c/c from the patient was for CP. A BLS unit responded initially to the call. Upon their arrival they initated patient care in accordance with our protocols. O2 therapy was initated at 15L via NRB. The patient was also give (4) 81mg ASA as per protocol. The patient describe her pain as a dull crushing type pain which radiates into her left arm, left jaw, and back. Patient rated her pain 10/10. NTG gave minimal relief.

The lead EMT on the truck made the determination for ALS intercept. The medic who was scheduled to be on call was notified via cell phone of the situtation and informed that due to the patient's condition, the crew felt that ALS care was required. The medic informed the crew "I'm not responding, I'm spending time with my kids. Just take them to the hospital". When I heard this conversation after the call I was livid for one.

The lead EMT on the truck made the decision to have ALS intercept from a local fire department which operates ALS pumpers. When the medic from the FD got on board our unit, a 12 Lead EKG was obtained and showed elevation in Leads II, III, and AvF. An IV was established, the patient's vitals were WNL. Due to having minimal relief from the NTG, Morphine was administered at 4mg for pain. A copy of the 12 Lead was transmitted to the ER. On arrival of the patient at the facility, the patient was taken immediately to the Cath Lab for placement of a stent.

My opinion is this. The medic who initially refused to provide ALS care on this call even though he was requested is guilty of negligence and breach of duty. This medic was being paid by the department to be available for calls and refused to respond. This medic is also our Deputy Chief. The EMS Chief is investigating this matter internally for now, but the state has also be made aware as has the family of the patient.

The chief has asked for my opinion about this situtation and I informed him the best thing we could do is terminate the individual who refused the call above and hope our agency isn't sued by the family or sanctioned by the state authority. This is not the only call concerning this individual, but one of several. It in my opinion that this individual is a liability to this agency and those that we serve.

What are the opinions of my fellow EMS professionals.....

This is a very confusing and serious request. I havfe read the various responses from the other that have left their input, and would like to now leave mine.

First, you need to clarify, this Medic, was he on the clock, i.e., being paid to respond to calls? If so, under may civil laws he is negligent for not responding. If not then, as an officer of the company, does he have a duty to respond when requested? This again would make him negligent.

I am not sure of what the laws are where you are from, however, I am sure that your squad's legal advisor can give you a better understanding of what constitutes negligence when referring to failure to respond in your area.

Second, what is the certification level of the responding providers? EMT-B, or EMT-Advanced(Intermediate)? I'm assuming the former. If this is so, why wasn't ALS dispatched initially along with the BLS unit? You report the call was dispatched as Chest Pain. This is clearly a call for ALS response.

Finally, someone had mentioned that rapidly transporting the patient to definitive care is always an option. I both agree and disagree with this. If the transport time to the Hospital/ER would be less than the time to meet with an ALS rendezvous, then by all means apply the diesel. If the rendezvous will delay definitive care, transport direct to the ER. However if the rendezvous will not delay getting the patient to definitive care, by all means utilize this for the most positive patient outcome.

I have the greatest respect for the many volunteers out there in both the EMS and Fire Services. We must all remember that some places cannot financially afford to have paid crews around the clock, if at all. As both a career and volunteer provider of both Fire and EMS service, I say to ALL of my fellows, keep up the good work!

I don't claim to be an expert, nor have I read all of the posts here so far, but I can pull from my 25+ years of experience and give MY OPINION on this subject. While I see alcohol use widely accepted and on the increase, I am also aware of some providers that do smoke weed occasionally. I would like to say, however, those that I know who smoke weed would do it even if they didn't work prehospital EMS. This just gives them a convienent excuse. I also think that "burn out" is used by many to explain their substance abuse. I personally work a moderately high volume ALS squad in an urban setting, and while I'll admit that I look at life from a distortedly dark point of view, that many in this field share, I do not drink, or do illegal drugs. I do take antidepressants, more to spare my family from the backlash of my psyche dealing with the things I witness. I however do not have trouble sleeping.

Substance abuse for any reason, or due to any cause, has it's complications and will take it's toll eventually. I am becoming aware of an increase in emergency responders being prosecuted for DUI. Law enforcement agencies seem to be putting a halt to the old practice of giving "professional courtesy."

Again, this is me and my opinions.

The new standard is CCR - cardio cerebral resuscitation as opposed to CPR - cardio pulmonary resuscitation. It is our new protocol. Some salient features -

1 - used for adults only

2 - used for Vfib or non-perfusing Vtach only (PEA, asystole protocol remains the same)

3 - used only in non-respiratory driven arrest ( ie. not for near drowning, positional asphyxia, etc)

The protocol says - 200 uninterrupted chest compressions. Do not stop for ventilations. Pop in an OPA and attach a NRB mask with high flow O2. Check rhythm after 200 chest compressions. Shock if Vfib or or Vtach.

Repeat for a total of 4 rounds. IV/IO access asap and administer epi. No antiarrhythmics.

After 4 rounds, revert to standard CPR, think about airway, antiarrhythmics, etc.

If arrest is witnessed and EFFECTIVE CPR/CCR performed PTA, then shock immediately. (if rhythm is shockable)

On some short transport times, we have delivered patients without ET tubes. Before the nurses in the ED got onto the new protocols, we got flack for it. Everybody is on the same page now.

Sorry, but I don't quite follow. Who's protocol is this, it is NOT AHA BLS or ACLS as far as I'm aware.

I am in Schuylkill.. I understand your pain in their ignorance. I have been trying to get info on a BLS instructor course from them for awhile.

I believe Exeter Ambulance is holding an AHA Core Class and BLS instructor class. 610-779-7687. I'm not sure when.

Tim,

I'm a bit confused. In your original post, you state that he attends, or should I say, appears at station, for training courses, but does not participate in the training, and when he does he is disruptive. I also believe you stated he "passes the training because he's a volunteer." I hope that doesn't mean he is given a passing grade due to his volunteer status! This is EMERGENCY MEDICINE we are talking about. If he is not truely qualified, he should not be given a pass because he's a volunteer. Volunteer or paid status should not be a consideration when talking training. If you can't get management to understand that, ask them if they'd let him work on them or their family.

Institute mandatory training levels and if he does not complete the classes successfully, he doesn't get the qualification.

If he's not qualified he can't run on the units. Problem solved.

I have the opportunity to read Patient Care Reports (PCR) with narratives written by various people. Some providers chart a cardiac arrest with a brief paragraph and extensive flowsheet of treatment, others write novellas for a case of the sniffles. Personally, I like to chart the positive findings, touch on pertinent negatives, and chart any changes due to treatment rendered.

I recently had a discussion with several providers about their habit of charting, "trachea is midline and there is no notable JVD." My point was that if the trachea WASN'T midline, or if there WAS JVD, you should have been charting some other notable findings way before you got that far.

I have also found that your medical director may have some input as to what he would like to see in a narrative. One of mine likes to see that we chart "CAOX4" on refusals, even though the GCS is part of the recorded vital signs.

Sorry gang, I'm coming in late in this discussion. I am an AHA Instructor on both BLS and ACLS levels. My understanding of the intended audience for the hands, or compressions, only CPR is that it is only intended for heneral public, or lay person, Heartsaver CPR. It is being shown to HCP students so that if we come across someone doing it, we understand that it is not incorrect CPR. I also tell my students, that if they are off duty, like walking in a mall, and someone collapses, they can do it, but MUST do proper BLS CPR when on duty.

If someone has already said all this, I'm sorry. Like I said, i'm coming in late.

I am looking for any assistance in this issue. My TCC is requiring all BLS Instructors to also carry a provider card. This is not a problem for me, however some of the older instructors seem to be disturbed about it. I am trying to determine if this is a TCC requirement or an AHA requirement. Can anyone help???