P_Instructor

If you are not watching this documentary on PBS, you are really missing something good (for those nature-lovers among us).

I agree. This is a very good program to watch whether your a nature lover or not!

Probably will be like all the other flu vaccines....get the vaccine and get the flu. Likewise, would like a little more study.

I'm sorry all, but is there anyone that can send me some phenegren or compazine, I don't feel so well after watching.

Gross incompetance. What's the term......Idiot I think. Good bye and stay out of the profession Jason.

There used to be a very low budgeted program produced by some Hollywood person who lost their daughter because of some accident, or she was saved, or whatever. This program was all 'real calls' whether EMS, Fire, Law, or Aeromedical. It was called "Emergency on Scene". I have a few video taped segments of it, all raw footage. This is what should be shown. Real stuff, not the 'ab-lib' dung that everyone thinks they want to see.

Go back to showing 'Mother, Jugs, & Speed' over and over on AMC.

IN Glucagon is within our protocal just as much as IN Versed, Valium, Fentanyl, etc.

Understand within your protocol. Just wondering how fast glucagon works given this route as compared to IM.

How do you get the ED a Eletronic Patient Care Record ?

Our service faxes the finished report to the respective ED's. I know it is probably best to complete the report prior to leaving the ED, but for some busy agencies, this is not practical due to call volume. Have your computer guru's set up a link from your computer to the ED's if possible, or finish your report at station, print it off (which you will have to do anyhow) and then fax it. If you gave a good radio and verbal handoff report, this should be OK. Use what is best for your service.

Sounds like you really weed our the whackers. Like most we just require a regular car license (not what you call a Class 4) and two days of driver training then 10 runs evaluated by a partner as being acceptable. The driver-training is inhouse so there is a good deal of scrutiny here as to "no whackers allowed".

Up until 1999 we required a CDL (passenger endorsement) to drive an ambulance but the volunteers killed that.

I hear you. I work in tristate region where the state policies are different concerning ambulance driving. Some require CDL and others don't. Unfortunately, even people that have been through the requirements of the CDL or whatever classifications, still operate the ambulances with the heads up the hole when it comes to L&S.

when i come across this problem i give glucagon intranasally.... works fast. then i can go back and see if i can find a i.v. site.

What is the therapeutic effect time? Aren't you afraid of any aspiration from this, or does it actually mistify enough to get it all in?

http://www.mysanantonio.com/news/62286107.html

Web Posted: 09/27/2009 9:26 CDT

Motorcyclist killed in collision with ambulance

By Michelle Mondo

- Express-News

A 46-year-old motorcyclist was killed Sunday afternoon when he failed to yield to an ambulance en route to a call and collided with it at a North Side intersection, authorities said.

The name of the man was not released because his family had not been notified, according to authorities.

Melissa Sparks, a spokeswoman for the San Antonio Fire Department, said the crash occurred around 4 p.m. at U.S. 281 and Evans Road.

Sparks said she did not know where the ambulance was going when the crash occurred.

Officials with the San Antonio Police Department said other traffic did yield to the ambulance.

Dead horse? This is a problem or disease that can be prevented. Isn't this what initial EMT programs were brought up for? Doesn't anyone teach about this problem anymore in their Ambulance Operations section of EMS classes? Get a used ambulance for your programs, not to drive L&S through town for practice, but to be aware of your vehicle. Employ driving simulators if available. Whether is was the motorcyclists fault or not, we as EMSers should by extra keen to the potential motorists that we are among. L&S are only requesting the right of way. This is an area that I believe many programs are complacent about. Could this be a reason insurance rates for ambulance services have skyrocketed?

Could his beligerance be onset of AMS? Tough call, probably should have been evaluated due to MOI, but looks like unsure of all the details.

ETOH is a commonly used and recognized abbreviation, and I've been using it for 30 years in my reports. What's the problem with the term? I use it in a description- such as "apparent ETOH on breath", or Pt admits to ETOH ingestion, etc. I've never heard anyone who claims there is ambiguity or a problem there. Everyone uses the term around here- from docs to nurses, to medics.

As for the PT- belligerence could be because of a head injury, but the only trauma mentioned was an abrasion to an arm. Could the belligerence be because the guy had just been in an argument with his girlfriend and beaten? Could it be because the guy is ALWAYS a jerk? No, we don't know how fast the car was going, but unless the patient was scraped up, dirty, and other signs of trauma, I wouldn't be too concerned about this refusal. Unless the person showed signs of being incompetent, I see no reason to force this issue.

Sounds like she is just responding to your incompetence. No one can make you look stupid, only you can do that; dont blame her for noticing.

I just don't know.....I've had partners that tried rule the roost thinking that everyone else is incompetent because they were incompetent themselves. I agree with the statement 'No one can make you look stupid, only you can do that', but sometimes you just have to draw the line and if you partner is overboard. Confront them....clear the air and move on.

The moi is a bit scary, especially because you don't know how fast they were going. I've heard stats that as many as 75 percent of people that are tossed/jump from a car die. BUT...if he isn't ETOH (oh btw, what does ETOH stand for? i know what it means), is a and ox4, you can't take him.

Some Medics in our area stupidly use ETOH to mean the patient is intoxicated (ie. 'smell of ETOH on breath')

The patient's awfully beligerant......

Thoughts?

I thought it was mentioned that there are a number of cases like this, not many, but some. Does anyone know how they turned out, or what was the greatest age differential between fetuses that survived?

OK trying to think of defense for the fire chief. Perhaps patient is concerned that one of her breast implants have ruptured and that is what is making her sick so she asks him to see if he feels any difference?

Defense depends on if he was wide eyed and smiling, or purposely palpating for anomalies.

As many of you are aware, EMS in Ontario is almost entirely single role third service (some services are shared admin; none are dual role), but that doesn't mean there aren't Firefighters who are also Paramedics (second job). At my service we also have many combined bases and work a bit closer with the local FF's. In dealing with the Fire Service I've found myself drawing a few cultural comparisons between the two professions, and all ribbing or outright bashing aside, I think there is some room for discussion on lessons EMS could learn from the Fire Service.

1) Care for vehicles and equipment. I have a huge pet peeve with medics who don't check the truck at the beginning and clean the truck at the end of the shift (provided there's time), don't properly check and prepare their equipment and generally take a cavalier attitude to care for their vehicle and equipment. I think there's some modelling here to copy.

2) Health and Safety. It only takes a quick perusual of a scene watching a Fire crew working to see how much time and attention is paid to this. Every FF that shows up at a medical call (as First Responders) in my area has proper PPE. Vehicles always have a backer. This committment is far from universal in EMS, leading us to take unnecessary risks.

These are my two big observations for discussion; feel free to disagree or add your own. Obviously all departments are different, but let's try not to make this anecdotal about how "Fire in my area doesn't" or "My service does all that all the time." I talking about the prevailing culture in two professions as I've observed them.

Besides, the next topic I've been milling over is: "What do we need to copy from the hospital/clinical setting?"

Not saying the the fire service is the best, but one particular reason on how you view these items is 'manpower'. Fire services usually have 3-4 members for each rig where ambulance services typically have 2, and some 3. Most of the time for backing a rig, the ambulance team is understaffed and are providing their specialty, patient care. There is no excuse for not keeping your ambulance clean and stocked, but again, view this as a potential staffing versus time differential. Ambulance companies handle many more calls and this cuts the time down on cleaning. Just a couple of ideas. I do agree that when ever possible, your ambulance should maintain a clean appearance and should be stocked and ready to go. If at one point during your shift work, it becomes totally soiled (usually inside, but outside can count also for visibility), you should go out of service until this is taken care of.

I didn't take your reply overboard, what I was getting at was this. When you emphatically agree and put down AMEN BROTHER to someone's comment that gives the impression that you agree with their statement completely.

So the way I took your AMEN BROTHER was that you believed that resorting to an IO was because someone's IV skills sucked and an IO was the only way you were going to get the iv.

I have talked to several people on this forum who said that they got the same message from your post as I did.

Thanks, I will work on my reply skills (more CEU's!!...laugh). I again appreciate your reply.

P_Instructor. You can be our hero. Your statment should have offended most here. Your reference to those responding as is offensive. Most of these people have tremendous experience in dealing with trauma, medica & Mental Health issues. They do not however have their head in their ass thinking they are better than others because they are instructors.

The simple fact that this person has admitted to taking 20 tablets, regardless of what they were is indicitive they wanted to commit self harm. Further, the presense of ETOH, or any other drug for that matter, is a second factor & this patient needs a full mental health assessment & the threat should be taken seriously.

Aussie, I am not comprehending your statement. What is this 'hero' dung? This was a simple message to offer tomtom differences of opinions, from a variety of background in EMS, to his initial question. There was no, and I still can't see what offenses you are referring too. Why refer to me as 'hero' when really it probably is 'ignoramas'.

P-instructor

do you successfully start IV's on all your pediatric codes or do you use IO's?

Are you 100% successful in all your IV starts?

Blanket statements like if you have to resort to an IO your IV skills suck have a tendency to come back and bite you in the butt.

If you can say that 100% of all your IV's are started successfully then I'll bow down to your IV prowess but IO's do have their place.

Never would I state that I am 100% in IVs, anyone that does state this are morons. Look for IV site first, and if you have one, try once. If successful, great, if not, don't screw around and get the IO. If you need it now and don't want to bother getting the IV, get the IO. Of course, this is me and everyone does it their own way. This became deeper than the original question. Stick the IV for the D50, or give the Glucagon. I wouldn't give the D50 IO personally, but would go with the Glucagon. I never stated anything about resorting to IO because IV skills suck. The statement I agreed to was from Crotchity - "If you have to use an IO......". It was his statement and I guess my reply was taken a little overboard.

Did someone honestly say its a good idea to canulate a patient's penis?! I can't imagien trying to document or tell the hospital that I put a 16g in the patient's ....um yea in his dick. Do you have to use bulky dressing to secure the shaft?! Dear god.

Hey, I can honestly state I've started a Boob vein with an 18 short. Circumstances beyond my control led to this, but it worked perfectly, even when the patient coded. We brought the patient back through it.........what works, works I guess......

Dispatched to a suicide attempt at a local motel, dispatch tells us pt called a hospital and told them he had taken 200 aspirin and was "tired of living." We arrive and talk to pd briefly. Apparently his story has fluctuated between 2 and 200 aspirin and he is now saying he took 20, "just for attention," and has now thrown them all up. We enter the room, and while my other two partners assess the pt, I look around the room and in the bathroom for any pills, pill bottles, vomit, etc. Nearly empty Aspirin bottle and half full vodka bottle found, I re-enter the main room to assist. Pt's vitals are well withing normal limits (I don't recall exact numbers) and stable. He says he never said he was tired of living, but that he said he was "tired of living in this particular place." Pd contacts the hospital to confirm and hospital states that they cannot as there was no recording. I recall distinctly that when the subject of transport was brought up, pt was adamant about not going, and threw the word "lawyer" around quite a bit. We asked him what he was going to do if we left him, and he said he planned on going to work and was not, and never had been suicidal. He did admit to taking 20 aspirin with vodka however, but didn't see that as a suicide attempt, just a try for attention. Crew leader has him sign a refusal and we leave.

I personally consider that a suicide attempt, and was not comfortable leaving this guy alone. The crew was split half and half on taking him in when we talked later. Crew leader says that because there was no hard evidence of suicide on-scene, pt denied, and pd wouldn't take custody, there was nothing we could do. From reviewing my book it seems that this is one of those gray areas where there is no real answer. If we feel he is a threat to himself, we can take him in, although I'm sure this opens us up to lawsuits? Any thoughts?

funkytomtom - - using this for a class project. Got responses from ex and inexperienced B's and I's, some volunteer, some part-time, some full-time, from rural to urban areas. If you send me a private message with email address, I can and been authorized by the individuals to send you their responses. Might be fun to see the differences. P_Instructor

The activation of EMS for a suicide attempt with verbal comfirmation and some physical evidence makes this situation very serious and puts question on the patient's intent and mental capacity for making a rational decision. With or without alcohol, this makes this person's decisions suspect and ground for professional evaluation.

The alcohol compounds the issue but is not the sole bases for questioning a person's decision making capabilities. It can either mask or enhance what a person's real intentions are. It is also very possible that this person could sober up and get serious with their intent to kill themselves whereas in their drunken state, they couldn't get it right or other emotions were playing with them. Sometimes being intoxicated actually keeps people from facing reality and killing themselves.

Bonus points to you my EMS brother!

Your protocols don't apply everywhere. Not all areas require Medical Control contact for refusals.

I stand corrected. However, what are the protocols for this area. The base of what I stated is true, unless there is a protocol written by medical direction for this scenario.

Problem of unique preportions. Whether you think it right or wrong, the Medics identified, adapted, and overcome the situation. I believe they did the best for all. If the admins want discipline the Medics, slap their hands and then leave it alone. My opinion is that both parties were served with the upmost care. Good Job.