P_Instructor

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.

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?

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?

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.

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.

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?

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

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.

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

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'.

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.

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......

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

Sounds as if he was conjuring up his own real scenario for con ed since he was on leave...

Bonus points to you my EMS brother!

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.

They're paying for the facility.....let them use it for their own desires. They may be soggy in body, but crisp in mind! These are the type of patients that are fun to have.

Any action, whether deliberate or not, attention getting or suicidal, where there was an attempt to harm self needs evaluation. Force the PD to put them in protective custody and transport him. Let MC know the circumstances also.

Sorry, I guess I didn't read what I was supposed too........I guess I was traveling to fast thru the message board and tipped....

Data is data.....It can be utilized for the purposes to better the system without compromising patient information.

It would be interesting to find out the specific instances on how the accident occurred. This is another reason the insurance companies are refusing to back ambulance services. If it was the driver's fault.....ouch. You can teach everything about handling an ambulance, but there is always the inevitable mistake in judgement or how to handle these big/heavy, overfilled, top-heavy, boxes on a cattle truck frame. There should be more education on handling these vehicles. Find training programs that actually have real ambulances as well as simulators that can be utilized in the training process.

Cool. I agree with you and Spenac. RESEARCH!!!! There are many resources that you can draw from. There is program individuality on information that is requested. I ask of my students: Name of Drug (Generic and trade), Type of drug, Indications for use, Major Contraindications (all that apply), Side Effects, How the drug is supplied, Dosages (adult and peds) as well as how delivered for all specific instances, and also have the students list any other special considerations if there are any.

I believe it is all relative dependant on your protocols and your assessment and decision making skills based on what you have. CP patient's with true cardiac problems may also benefit with ASA, and NTG/MS admin dependant on clincal findings. We have had good success in relieving CP with administering NTG followed by immediate MS, creating less demand on the myocardium. (this is all relative again to hemodynamic stability)