lpndj6

Sadly these things happen more then we want to admit. I remember back in the 90s I was a tech geek who moonlighted EMS (reality I loved helping others but the tech jobs paid better) went through periods where I felt like a hired gun one job and then off to another.. I had been contracting in Washington DC for nearly 2 yrs when a Dot com offers me 50% pay raise with better benes. So Of course Im gonna take it (this was March 2000), besides honestly after the Y2K crap and dealing with DC paper pushers I was ready for a change... Things seemed great all was well Had a crew of 5 of us Network Engineers keeping 60+ servers up and running plus doing desktop support for well over 100 employees making well very good money.. First warning issues were coming was pay checks were late 2 pay periods in a row in November. Then without warning they terminated 20% of the staff 7 days before Christmas (talk about Scrooge City).. Only satisfaction was they went Chap 7 a few months later.. I wanted to add though on a side note where I live now same thing happened with an ambulance provider who did nearly all the interfacility transports within the largest county by area in the State of NC.. No warning no nothing.. They notified the county on Friday that as of Monday morning they would cease transports.. Now the Brunswick County where this happened has a hybrid system of sorts. There is Brunswick EMS which is paid county. Then there are individual Fire/Rescue and EMS only companies who have paid staff as well as volunteers. The problem was this dumped the transport issue square in Brunswick EMS' lap to fix because the individual depts were never supposed to nor could they handle such calls. Leading to BEMS having to shell out a buttload of OT while they tried to get new staff hired.. I havent heard anythingelse and dont know if the other private company who primarily covers the area of Wilmington NC and the county was going to assist at least on the North end or not its like the story just disappeared after 2 weeks just like the company did nearly overnight..

**It is highly likely the company shut down because about 2-3 months prior an ambulance of theres was involved in a fatal accident the driver was speeding and apparently many called into question how this person was even allowed to be driving with the previous driving record he had**

Youre family will be in my prayers.. I had issues as a teenager myself with what they then called PAT (this was back in the mid to late 80s) and I thought Id outgrown it until I had a reoccurance one night when i was really sick and run down and was running 208 (I was borderline septic come to find out as well) while in Nursing School and since then Ive had sporadic issues on and off even with a holter monitor they never caught anything. (I previous had had a bought of chest pain and such which landed me in the ER due to the rapid heart rate just below SVT level running int he 140s) got a full workup even had a nuke stress test (I was 36 at the time).. I hope for your sons sake they can identify for sure what the cause is and can treat it because believe me its no fun I used to have issues bout 3-4X a year (Scariest was one night I was in the basement of my house where my bedroom was and I went majorly SVT and was laying on the ground couldnt get up and couldnt call for help or anything I had to hope it stopped on its own and actually feared that here I was at 16yrs old I was gonna die right there on the floor without being able get any help before somebody found me because I just couldnt move or speak or anything)... SO I can understand the fear your son went through and probably still is and I Hope they can find it and treat him. WPW is pretty treatable as you know now adays a simple ablation procedure usually is able to resolve it without any long term issues (unless your a professional hockey goalie, poor guy has had ablations I think 3 times now in 2 yrs in Toronto and they sitll arent positive they got the right errant pacer site)

I had to take my 11 yr old son into the ER tonight. He was at a youth group and was sitting around about to have dinner when his heart rate suddenly jumped. After getting back over there myself, I found that his heart rate was almost impossible to get manually. I ended up taking him down to where our ambulances are housed, and his pulse showed around 246 when I put him on the pulse ox. There was another EMT there working on paperwork, and both of us had a hard time getting a B/P. He was complaining of headache, dizziness, nausea and starting to note chest/body pain. I walked him across the alley to the hospital and into the ER. They found the same for his heart rate and finally got a manual B/P of 84/P. We tried vagal maneuvers with him twice and they didn't work. They used adenosine on him after he'd been in SVT for just a bit over 2 hrs and cardioverted him. After the cardiovert, they found delta waves and started talking about WPW Syndrome. So, now we've been flown to Denver Children's and waiting to find out more.

Prayers would be greatly appreciated. (TIA!)

Ive long been a proponent of Public Access Defibrillators for a long time now. At one time I know they were more money but the price of portable AEDs anymore is well under 2k. It amazes me you see them in Malls in some cases but many other places you dont. Personally I think all multiunit housing facilites should have them accessible (1 per floor) same in high rise facilites. What really blows my mind is that healthcare facilites that arent acute care dont have them. After yrs in Pre hospital and now working as a nurse it blows me away that even Long Term Care or Asst Living Facilites dont have AEDs (but yet in many cases their crash carts include a suction machine) uhh ok. AED is standard training anymore in HCP CPR classes that are required for Health Care workers so its BEYOND me why they have yet to be mandated by law in such facilities. (Youd be surprised the lack of availablity even in multiclinical care clinics (large group practice health care groups which have many specialties under one roof) I mean somebody explain how a cardiac physicans office has a EKG machine but given the high risk of their own population they treat they dont even have a single AED.. Anyway Ill get off my soapbox now but to me the issue of PAD is the big weak link in the chain of survival now I believe. With the now push (no pun intended) for even hands only bystander CPR by anyone we still know that it still takes a kick start to break VFIB/Puseless VTach and reboot the heart and until PAD becomes much more common it will continue to be the weakest link in what truly is the chain of survival.

I gotta agree with Lonestar on this one. Whats funny is Ive run into the same situation myself but whats funny is once the crews find out that I have previous experience in EMS theyve tended to be a little more professional with me. Ive seen them give other co-workers of mine crap over 911 calls but when they find out Im the one that made the decision that the patient needed to go out they change their tune which I find weird.. I mean yes I spent 8 yrs in the field before going into Nursing that shouldnt make a difference in the end to my estimation we all have our roles we fill in the medical chain of care be it emergency, acute, sub acute, etc.. I mean no offense but any medic questioning a nurse who knows her patients and whats normal and not with them and knowing whats an issue.. Besides I know at least in my facility we always have to get the OK from the MD on call to send them out unless its a blantant medical emergency (IE Code, Unresponsive Diabetic (after TX X1 with Glucagon if Low),) The Charge nurse during shift usually makes the decision if the MD cant be contacted in time (which is me when Im working).. Now I did come across a situation one night which I did actually have an issue with the EMS crew and I did file a complaint. Patient fell down found face down semi-responsive with a previous DX of a spinal fracture (non displaced and non surgical intervention within the previous 2 weeks just prior to arrival at our facility). I had the Aide stay with the patient and hold Cspine while I called MD and then 911 and then took over CSpine after doing quick assessment of the resident awaiting EMS arrival.. They did NO immobilization of the resident just literally picked him up on the sheet he was in. his head was nearly hanging off the end of the cot. Granted fortunately he had no furtther exacerbation of his previous injuries but given his HX and a confirmed Fx I was blown away by their field TX of this patient and even a couple of my coworkers were aghast at what they witnessed.. (BTW no Id never had had an encounter with this particular crew before). But EMS is run by the Hospital System in the jurisdication where i work so getting word back to their MC wasnt too hard.. I dont know the final outcome but I do know that their Supervisor did appologize to us and the family (his wife had been in the room when it happened) for what happened and said it was definitely a deviation from acceptable policy.

PS I got my start under the old EMT-A standards in the early to mid 90s when it wasnt just a med and trauma station along with CPR/AED and you had to actually do random skills up in Virginia which apparenlty they are finally going back to that thank goodness.. IN fact I look forward to moving back to VA next year and returning to doing some field work again once I finish my next step in my nursing career (and after I fully recover from upcoming back surgery which is why I walked orginally from EMS due to back injury and went into Nursing but has finally caught up with me again and now going ot get things fixed for good and probably will finally feel better then I Have for years {Very Bad DDD L4-L5 and L5-S1)

First of all this is a vent post but I would really value your opinion.

I had a minor issue recently that I would like your opinion over, I stress minor issue here as nothing catastrophic resulted from it but it’s just been playing on my mind for a while.

As you all know I volunteer some time doing first aid around the place. I was doing a first aid standby recently at the local motocross track, I had a 14 year old come off with pain to his right ankle, there was some localised swelling and 8/10 pain, I splinted it, gave him analgesia, loaded him into the ambulance and waited for the paramedics to arrive as were not allowed to transport from the event. Nothing wrong with the patient himself, the job ran with no problems, text book.

When the two young paramedics arrived I welcomed them into my ambulance and began to give hand over, the paramedic started talking over me so I just stopped talking and sat back. She then gave me the evil eye, stood over me and questioned why I hadn’t applied a collar, I explained there was no MOI, low speed MBA, helmet intact, no LOC, neurological and spinal assessment NAD, full safety equipment worn, no motor/sensory issues so I didn’t see the need for spinal precautions but was happy to put one on if they thought it was indicated. She laughed and made comment at my ‘expert assessment skills and she could only imagine were I got my qualifications from’. Needless to say they did not apply a collar or even do any spinal assessment so I guess they weren’t too worried. They weren’t interested in my neurovascular assessment of his foot so I just left it at that…

She then removed the air splint from his ankle, threw it at me, moved his foot around then told the patients father it wasn’t broken and not to worry. She then looked at me and told me never to waste there time like this again, I clearly had no idea what I was talking about. Anyway, they transported the kid end of story.

The next day I followed up with the hospital, turns out he had a # lateral malleolus, distal tibia and proximal metatarsal fractures which required surgical intervention.

I’m not a bitter person, I’m pretty easy going and what not but the option of writing a letter of complaint was raised. I’m a bit unsure of what to do so I just hand balled it to the patients father, it’s his son, he has the right to complain if he wanted, I’ve done all I can, did my job as best I could… Then I thought, well, if I stuffed up the paramedics are the first ones to jump down my throat on scene then follow it up with a letter of complaint then disjoint your reputation to shreds back at the station, so why can’t I complain?

I mean, just because I have first aid written on my uniform doesn’t exclude the fact that I’ve done a year of paramedics and three years of Nursing at University, I’ve done first responder training, spinal injury care, motorsports rescue training, I’m very familiar with the Hans Device, know the motocross gear like the back of my hand, do education sessions for motocross officials on incident management, talk to all the riders at briefing, they know us, we know them, I know how the motocross guys think and breath, we’ve had the joy of resusing a few kids out there and seeing them back up and riding the next year, I’ve done some riding with them back in my teen days so I know how they operate.

I’ve done over 300 motocross races so I didn’t come down in the last shower but 9 times out of 10 the paramedics will bring you down with some sarcastic comment and make you feel like a retarded Wally. It’s not just this call, they often pass stupid remarks to belittle you. I don’t know if it’s my age, if I look funny or what ever but I’ve really had enough, I shouldn’t have to put on my bullet proof jacket every time I call an ambulance, I do my job well, perform to my scope of practise and have never made any mistakes that would case further harm to the hundreds of riders I’ve cared for.

Sometimes I just think to myself… Why bother going to University full time, working 30 hours of nightshift, then staying up til 3am the morning before finishing assignments so I can volunteer to help the guys out, missing out on weekend work… Just busting my ass to be put down.

I don’t know what to do. I should really just have a cup of cement, harden up and move on I guess.

Yeah I got a couple questions and this based on my previous experiences to include working ER (as a tech) and Cardiac Stepdown (as a nurse). 1st did they draw blood to see if she had ETOH on board? If not Id also like to know when her last intake was.. Alchohol DTs aint no joke. Ive had patients on CIWA scale when I was working the hospital on our floor simply due to the possible withdrawal issues. Based on the answers Id have to potentially ask for some S.Os to include benzos to treat possible severe anxiety. It seems if shes already aggitated in the ER shes probably already showing issues so thats gotta be addressed I dont need a patient going bonkers in the back of my truck or worse having a Grand Mal due to withdrawal. If they've given her morphine for pain Im not too worried bout a head injury at this point obviously and of course some SO's for pain control would be nice given its a 3hr ride and lets be honest even in a perfect world shes not going to be comfortable. Ok Ive said my peice anybodyelse wanna tackle this?