Capman

I'm up for PHTLS in about 3 months, and this is interesting. They have always preached C-spine precautions for penetrating injuries. I'm not really sure about the rationale behind doing away with that. I would welcome any information on this as well. We know that they always change something everytime we take CPR, PHTLS, ACLS, Etc., but this one is a big change that could have serious consequences. Info' welcome.

98% of the time our patients go to a room. On occasion, you have a person who wants to go to the ER because they have had a cold or a minor ailment but have no way to get in there and they call the ambulance to get them there. Right or wrong, it happens. We are usually instructed to bring these patients to triage by the nurse during our radio call in. Of course, our report plays a major role in whether this happens or not.

All of our uniforms and boots come from Galls. We don't have a choice because our employer purchases our uniforms up to $315 a year. If we want to purchase our own items, such as belts and other duty equipment, we may do that on our own and purchase from any company that we wish. Galls I looked for duty belts at Galls.com and this is what I came up with. Hope it helps. Good luck. http://www.galls.com/category2.html?assort...og&cat=2944

It is kidnapping! If the patient meets criteria such as this... 1.) Patient must be legally able to consent. He/She must be of legal age, or an emancipated minor. 2.) Patient must be mentally competent and oriented. He must not be affected by any disease or condition that would impair judgement. These conditions include unstable vital signs, and altered mental status. 3.) Patient must be fully informed and understand the risks associated with refusing treatment and/or transport. 4.) Patient must sign a release form. Such a Form is designed to release the ambulance squad and individuals from liability arising from the patients informed refusal. ... then no doctor can force a patient to go to the ER. I myself have been in the same situation. Push the D50, patient comes around, then does not want to go to the ER, and the meets all of the sign off criteria... But then the doctor says, "I want to see him". I have no right at this point to force him to go to the ER. I can put him on the phone with the doctor and let them personally tell the doctor they are refusing, but it doesn't really do anything but take some of the heat off of me. I also have no right to have police place this patient in protective custody either. Keep in mind that you do not have to do everything a doctor tells you. I will tell you however, that before refusing the orders of a doctor, you had better know the difference between right and wrong. Also do not get into an argument with doctors about it after the call either. Let your service chief handle any fallout. It isn't like this is not a common occurrance. For the most part, most ER doctors will know that you can not just kidnap people they want to see who meet sign off criteria. If it continues to be a problem, have your service chief discuss this with who ever is in charge of Medical Control at that hospital. But like I said, most of the regular ER doctors are not a problem for us. It's the occasional traveler.

Sorry, not buying that one... Please give me an example of where med control orders protective custody of a patient then allows them to refuse care and leave the ER. I've been doing this for ten years, and I am yet to see that. The whole reason they were brought in by protective custody, is because they are incompetent.

You mentioned that you were changing protocols. I would be interested in knowing what your standard operating procedure/guidelines are now for your refusals. Was there something wrong with them, or are you just looking to enhance them? Please share some extra information. Now to respond... This takes us right back to to EMS classes about legalities. The only way you could truly "force" anyone to go to the hospital or accept care is to... A) ...act under an implied consent. ...have patient placed in protective custody. C) ...have a parent make that decision for a minor. D) ...have power of attorney make that decision. E) ... Well, you get the point. But, what if you do get one of those calls where care and transport is indicated and a patient within their right mind wants nothing to do with it? This is where your department/service should establish clear guidlines based on the laws in your location. And... How does your service chief know what those are so that he may know them and pass them along to his subordinates? The service has "lawyers working hard on their side making sure people don't get money they don't deserve". Here; up north, diabetics are the common patient who fit this category perfectly. The classic hypoglycemic, diabetic patient with a blood sugar of 25 mg/dL gets an IV and 25grams of D50. Very common. What's also very common is the refusal to go to the ER when they come around. After obtaining vitals, another blood glucose level, witnessing the patient eating food that will maintain adequate sugar levels, SAMPLE history, etc.... We call the doctor/med control and report off to him/her with all of the patients information and the patients desire to decline transport. The doctor/med control then approves the no transport with the command to give the usual sign off speech, that advises the patient that this is against our advice and of the risks involved with refusing our transport, and should the situation change, or if you feel that you need the ambulance to come back, do not hesitate to .... yada, yada, yada... The patient signs and if available, somebody witnesses it. We then indicate that patient is declining care and transport offered by our service and tick several boxes that indicate that patient is at least 18 years of age, able to make decisions for themselves, and a few others, then go on our way. In situations like this, and for that matter; all situations, be sure to document well on your run form. If you ever end up in court, good documentation will be your best friend. Remember more information will also be useful.

Driving around seemed to help me get used to towns when I first started. It is also good to utilize your partner when navigating to an unknown area. He reads and calls out the directions, crossroads, and such. Don't forget it's team work, so work together. However, when it comes to the occasional difficult partner. Let him/her drive. LOL

"Any time you have an obvious law suit you better go big or go home. You will be part of law suit. I would rather defend a little extra caution than not enough. " Amen to that. I like to cover my ass. Truth is, even after doing a spinal rule out, I always seem to get dirty looks from some nurses and doctors in the ER. I'm not sure if they want us to backboard the world or not. It almost seems like a catch 22. Lately I'm playing it safe though. I probably would have c-spined her, whether I really thought she needed it or not just based on the potential for problems. If she didn't want the C-spine protocol then, "sign here miss!". Then everybody is happy, and I know that my rear is covered. That Wal-Mart Blitz Cr@P is just a bit too much. These people are trampling each other just to purchase something for a few bucks less. Are they too simple to realize that if they wait about three weeks those items will be on the shelves for the same price? Hey, I saved $40 on this digital camera.... BTW, I spent $800 in the ER. Yeah! Sounds like a great deal.

](*,) Grrrrr.... Text Wrap people!!! Now the formatting is screwed!

Ahhh.... Sweet music to my ears... Though, wrong emoticon; and it just ruins the moment! Next time use this one please :arrow: Scaramedic... That's just wrong!!! Yet, I can't stop laughing.

Kind of contradicting Rid'... At least where I practice. The Maine EMS Instructor Coordinator course, which is a prerequisite to be even an adjunct faculty member at the college, teaches precisely what you just preached. It also contributes to the accreditation of the EMS degree itself.

Then read them this... LOL Seriously, it is difficult finding videos on some topics. I tried to find some things while teaching immunology earlier this semester. How do you keep the students attention while talking about immunoglobulins, T-cells, B-cells, and all those other fun and exciting aspects of the immune response??? Gotta' get creative buddy. I would offer you suggestions, but I have found, what works for one class does not necessarily work for another. Good luck. BTW I think spell check is on vacation. I almost got the Grammar police on my a$$ for spelling necessarily wrong. Caught it at the last minute. :oops:

Hmmm.... It is an interesting dilemma. If you move on to a bigger and better service, do not look at it as they win, but rather as; you win.

I can't do it with one word, but I can offer advice. Do not attempt that with buckshot.

I'm not quite sure what you are looking for Anthony', so I'll jump right to Dust's comment. He's dead on. The nationally established DOT standard is scene safety, BSI before anything else. Many believe that the patient is number one priority, however we know that the EMT/paramedic is the number one priority. If the scene is not safe (jumping into water without training fits into that description) then that patient must wait. In many locations, including up here in the styx, Violation of that standard will get you the opportunity to apply at Wal-Mart or at least some time off. John Q. Public will never understand this sort of thing. These black eyes will more than likely be a re-occuring incident.

I guess I'll be divorced and gay.

3 months and already wankin' about not being home??? :?: :roll: :?: I haven't been home in ten years. Let's see, how do I deal with working two 24's a week on the ambulance plus the extra day of overtime, coupled with the one 24 a week on the fire department, and the one Monday each week where I teach the Medical Emergencies portion of the EMS degree at the university. Then add that my wife is a full time, fourth year BSN Student who if isn't in class; is completing her 400 hours of externship and 300 + hours of clinical rotation. So, how do I handle it :?: :?: :?: I eat a York Peppermint Patty and forgeddabouddit all every once in while! :wink: Seriously man, If you are cracking already only working three 12's a week, you may want to re-evaluate whether this job is really for you and your love life. Any one will tell you that public service is not a family oriented profession. I wish you the best of luck however.

No Amio in Maine EMS at the time. At least I get to learn about it every two years in ACLS though.

Now that was funny! ***SPOILER*** ***SPOILER*** I knew Chuck Norris was going to kick that blenders a$$ all along.

Yeah, as I see it this profession is a catch 22! A few weeks ago I was reprimanded for excessive speed on a code 3 run as I was reported by a concerned citizen. Yesterday I got b!tched at for taking to long to arrive to a call. If an EMT actually had jumped into that water and drowned in the process, I'll bet there would still be complaints that no other EMT's had gone in to carry on where he had left off. Yeah, as I see it... It's a catch 22!

The station in the early 70's during the airing of emergency. The station as it is today. A little bit of trivia I just stumbled upon. I'm so ticked when I don't recognize an actor in a movie and find out about it later. Kevin Tighe played the bar owner in "Roadhouse". The tribute to Robert Cinader. I'm just waiting for this show to come to DVD.

Nice post scaramedic!!! Where on earth did you find those pictures? Good stuff!

If you have questions and there aren't any paramedics, you could ask the doctors or nurses in the ER. I can't see why they wouldn't offer you explanations pertaining to signs, symptoms, care, and such. I would help you, but you would have a hard time tracking me down as my Cell is either usually off while I'm on the ambulance or in the classroom teaching, and has a p!ss poor signal on my firefighting shift. I think it's all of that radio active cr@p at Loring AFB. LOL. Then again, you could always post your questions in here too.

Yep! What Richard B, the EMT said. LOL It was a great show. I believe it's Kevin Tighe http://www.imdb.com/title/tt0068067/

We exchange the drug box through the local hospital pharmacy any time we use any medications. They verify and count everything. The box and seal are checked and documented every day. Should the seal be broken to use an item, it is well documented and any waste must be signed off by a nurse or physician. In the 18 years the service has been in operation, there is yet to be any investigation or a discrepancy.