Vorenus

Exactly, I mean you wouldn`t divorce your wife only because you attended after she had an accident (awful scenario, but still). @flaming: What do you mean with HLPP? Looked that up, but couldn`t find any abbreviation that would fit into the context.

Why does she has to be nuts? It may only be the case that she likes his looks and thinks his sympathetic after chatting with him - what`s the difference between your scenario and them first meeting in a bar except the circumstances?

No rules concerning that in my service. I carry mine with me, with a "normal" ringtone. Since we don`t have a phone issued for duty, I quite often use it to communicate with dispatch.

Lol. Yeah, I do so like to interpret stuff in simple statements to make them sound magnificent. So, do I have to drive someone to a Burger place, just because he`s hungry(good blood sugar level/no history of diseases). I mean, he may sometime, at someplace get hypoglycaemic. Come on dude. I`m not talking about someone with hypothermia as a symptom of a pathological state. I feel cold sometimes, too. Believe it or not.

We obviously won`t agree on that topic. Just one question: Where do you see any indication for EMS in the first scenario that was pointed by the OP: I`m cold, 5 min walk from home?

What I consider as a BS call are those calls, that are freaking ovious just some kind of service action (I`m cold, , etc.) and in cases where the patient is able to identify that there`s no ambulance needed, but calls anyway ("It`s been hurting since 3 weeks", "I cut my finger" (not amputated), etc...)

Don`t know what you`re being told over there, but I would never have thought of calling an ambulance without heavy bleeding or something physically not looking like it used to be, as a child.

Nothing wrong there, as long as he`s not using information he got when he was being the responsible health care professional to get her round in any fool way.

Getting called out for "feeling" cold, in an otherwise healthy patient who just forgot his jacket, is definately BS. And no way would I have driven him home, @PCP.

If we stay in this scenario, where we have to transport 2 ALS pat. in one ALS and one BLS truck, there are not much alternatives. I don`t think starting ALS on one pat. (the one you transport) and doing nothing on the second (the one you don`t transport) sounds any better at the end of the day. Yes, it`s a pretty bad situation. I called out to transport Pat. 1 `cause he would get the most aggressive ALS treatment, while unless there`s some change of the situation, the predni and analgesia (I`m not talking about knocking him off) could be handled by BLS.

Man, that`s a real great discussion. Too many posts to answer to, so just the short version. Pat. 3 gets a blanket, as said. When it comes to the decision between 1 and 2, I`d propably say pat. 1 gets ALS, while 2 gets BLS. Pat. 1 needs to get intubated, since GCS is below 9 and the respiratory rate over 29 - both indicators for an intubation in Trauma. Maybe I read over it, but how is BP on Pat. 1? Osmotic diuresis is no option in a pre-hospital enviroment, we don`t even carry the drugs. HyperHaes might be an option, though. We want to have that Pat. normotensive, in a normocapnia and normoventilated. As for Pat. 2. He gets analgesia, predni, and fluids, then of with BLS as long as there`s no change in vitals. The two trucks stay together while en route to hospital, so medic can re-evaluate and possibly swap if a change of the situation occurs.

It was posted in another EMS forum that I`m in.

Should have made that clearer, they only get the Ketamine if we reposition. Otherwise, as with possible Fx Fenta or Piritramid. Of course it depends on the individuum, there are the one who walk to the ambulance with their dislocated Humerus dangling at the side. We don`t use Morphine for analgesia that often anymore, except for pain relief in ACS/AMI and don`t have Entonox (a shame).

With dislocated limbs we normally use Ketamin and Midazolam. I also find, that after the initial indication of analgesia to reposition and immobilize, most pat. don`t need extended analgesia anymore (at least not while keeping the limb still).

I`d love to have pool clothing, it`s imho the best way to provide clothes. Around here, I`ve also noticed that the volley service attached to our station is in many ways better equipped in contrast to us when it comes to clothing - on the one side, it`s nice for them to have all the fancy things, on the other side I see it as a little bit of a shame, that the career ems personell has to drive around in somewhat worse clothes. But that`s due to the fact, that our clothes/money is issued from another department.

I have to admit I don`t know for sure how we do it around here, `cause I don`t have anything to do with Intensive Care Transports - but, I do seem to remember (from school) that in the past, mainly nurses did intensive care tansports, or a paramedic that had to get an extra certification in nursing stuff. Now i see only paramedics on the intensive care tansport vehicle, some I know from sight and one was a teacher of mine in school. When it comes to air transport, I`d say that nurses wouldn`t be allowed to do that, at least not in the most cases, simply due to a lack of space. With the smaller machines, there`s only space for the pilot, the paramedic, the doc and the patient (I`m thinking Eurocopter) - but around here, a "Flight Paramedic" is really counted as part of the flying crew, rather than the medical (that`s on the ground), so they do a lot of navigating and stuff - I can`t see a nurse doing that. With the bigger machines, where there are more seating possibilites, a nurse might be around. I did a neonatal transfer a while ago, from the hospital to the helicopter landing space, and was accompanied by a doc and the neonatal nurse who both did the transfer in the heli, but that was a bigger machine.

Stabbing as a suicidal method? Pretty rare, I`d say, at least nowadays. In the past such a way was nothing that uncommon, though. "To fall on your own sword". Most common example may be Varus, or the ritual suicide of japanese Samurais. In Ancient Rome, to kill yourself with your own sword was deemed a honourable way to kill yourself.

LOL. One of the best is

German ICU nurses have in the most cases a broader knowledge about pharmacology than a medic, I`d say (at least a medic that is not doing any personal research), but Bernhard is right - the jobs not only about the clinical knowledge, but also about certain tactical aspects and the ability to work in some unfriendly enviroments.

Thanks for these interesting thoughts! I`m always a bit torn, when it comes to this subject. Surely, the most cases of suicide we see are the result of some sort of psychological disease/condition. Still, the concept of a "voluntary death" exists, but there`s always a debate about wether such a thing is really possible, or wether all suicide are the result of a mental condition. Personally, I guess there is such a thing, but it`s a tricky subject. Although, I`m also thinking that the concept spoken of, was mostly applied in the context of socially relevant necessities, mostly as a way of "keeping your honour" (i.e., I`m thinking Ancient Romans and Japanese Samurais) - so it propably wasn`t such a free decision, but at least they weren`t the result of a mental condition in the first place.

1. Around here, patients who still recieve CPR would be transported on the ground and the Heli-Doc would accompany the transport. But we have relatively short transport times (if I compare to some of yours). The major factor is, that it`s nearly impossible to do a sufficient CPR in a Heli, at least with ours. 2. Could be to get Pt., who are still in the timeframe for a Thrombolysis as fast as possible into the clinic, which would lift there chances. But these are only my thoughts, I can`t talk about your regional characteristics.

As long as that Palin woman is out of th way

LOL, sry, seems like I didn`t get the point.

Huh?

As someone who`s bearded, I just wanna point out, that there is no direct connection between facial hair and a lack of professionalism... But Mike, I hear you, I`ve been in this kind of position, too - there`s not much you can do about it, though.