P_Instructor

UPDATE: EMT Dead Following I-79 Accident in Lewis County

Posted: Jan 15, 2013 7:23 AM CST Updated: Jan 15, 2013 11:24 AM CST

By Stacy Moniot, Anchor/Reporter - bio | email

Courtesy: Jan-Care Ambulance Services

Local News

UPDATE: EMT Dead Following I-79 Accident in Lewis County

Jan-Care Ambulance Services confirmed Tuesday morning that a Jan-Care EMT died following an accident on Interstate 79 in Lewis County.

A Jan-Care ambulance was returning to the station from an EMS transport when it collided with a flat bed semi truck Tuesday morning, according to Paul Seamann, Director of Operations at Jan-Care Ambulance Services.

Jan-Care EMT, Mark Kinder, 26, was injured in the accident and later died as a result of those injuries at Stonewall Jackson Hospital, Seamann said.

Seamann said the paramedic on board was also injured in the accident but has since been treated and released from the hospital.

No patient was on-board the ambulance at the time of the accident, according to Seamann.

The Lewis County Sheriff's Department said the driver and passenger of the semi truck involved in the fatal crash were not injured.

There is no word on the cause of the accident.

The Lewis County Sheriff's Department and State Police are investigating the accident.

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Original Story

An ambulance and a flat bed semi truck collided on Interstate 79 south near Weston Tuesday morning and closed the highway for almost two hours.

The collision happened south of the Weston exit at mile marker 97.5. Lewis County Sheriff's Department and the Weston Fire Department were called to the scene. An accident reconstructionist was also called in to investigate.

Drivers on I-79 south of Weston were stuck for an hour and a half until crews opened the shoulder to allow them to pass through.

Crews on the scene and the Lewis County 911 officials were not able to confirm any injuries from the scene. Check back for updates.

How about a simple form letter stating that <insert name> has taken and successfully passed a CPR course as administered by <agency>. An official card will be forthcoming. Please accept this note from the instructor <insert contact information here> as proof of having taken the course until an official card arrives.

This has been done by instructors with whom I've worked. To my knowledge, it has never posed a problem.

We provide this type of document, only if requested for a specific purpose. Usually for nursing students that need it (HCP only) before going out to do clinicals. They're the main culprits.....and the requesting agency or whomever must be notified and will authorize an acceptance of the form letter.

We usually only provide a few of these. Less that 1% of the total thousands of people that go thru the HCP class.

Not the reason I retired from flying, but starting to think it was a good idea. Hits close to home as this program is a sister program to the one I flew for. Condolences for all the families of the crew, and also the co-workers. Sad, sad, sad......

Once, I repeat once, and never again.......Ipecac in the field. Can we say 'paint the walls with puke?"

I used the Procardia capsules way back when I was a LPN at a nursing home. It was not uncommon for us to puncture the capsules and administer SL. I shutter at how things were done.

Yeah, good ole times. Remember all the Verapamil that was given for SVT? Stuff actually worked good.

Glad your back!

The state of Iowa in it's infinite wisdom (ha) had all sorts of levels from FR (A)(D), etc., EMT A, B, Defib, etc, EMTI (85), EMTP (99I), Paramedic Specialist (PS), blah, blah, blah.

They finally decided to get things changed to be more in line with the National Standards.

Like other states whom are changing, the only levels will be EMR (all the old First Responder levels and endorsements), EMT (with all the other old endorsements), AEMT (new level above the old 85I and below the 99I), and Paramedic.

Iowa's 99I level was considered as an Iowa Paramedic in this state only. The Paramedic Specialist was anyone that completed the Paramedic level, so they had to delineate the levels.

If you are a current 85I, you will have to take further classes and con-ed, then take the NREMT AEMT test. If you opt not to go to this level, then you will drop to the EMT level.

If you are a current 99I, you will have to take other classes and con-ed, then take the NREMT Paramedic test. If you opt not to go to this level, then you will drop to the AEMT level.

In essence, Iowa is only cleaning up the mess of a numerous number of levels and endorsements to the now 4 levels of provider.

Of course, this should have been done years ago, but now there is still a delay and some providers have a couple of years to decide or transition.

Just a question out there.....how many of you 'old' medics ever have Physostigmine and Nifedipine in your drug boxes. Then, did you ever have the chance in using one or both of them before. This is purely a question in 'wondering'. Oh yeah, I'm talking prehospital, not in house.

Dependant on the extent of impact as previously questioned (how deep of ravine, etc.) you have the initial cardiac symptoms to think about, the traumatic event and possible injuries sustained from this, and with the seat belt marks, this would indicate enough impact to cause any structural chest injury. Another concern would be cardiac contusion.

Now the real hard part starts.....con-ed, puke, blood, guts, gore; hair, eyeballs, and teeth. Good job and don't kill anyone

I am sorry and sympathetic towards my New York bretheren in EMS. I am not usually political, but your mayor is an idiot. They should have cancelled immediately and not have the publicity.

If they run it, why don't they have the runners 'run' the provisions up the 20+ flight of steps to the elderly that can't get it for themselves......

With the chest pain and the adequate perfusion, anyone interested in trying Cardizem?

We're expected to be able to use our brains when we assess a client, not just disregard a vital sign because we don't like what it tells us and getting a patient history is just common sense..

Thank you!!!

Respirations are useful for reporting your vital signs. However, the point that should be looked at is if the respirations are adequate for survival of the cells. This along with cardiac perfusion should be monitored much more than the number of breaths per minute. Waveform capnography is cool, but in the initial stages of patient assessment, are the respirations, whatever they may be, adequate enough?

Otherwise, to answer your inquiry, all previous posters have garnered through experience how to count respirations by different techniques, All are good, so try them out and figure what best works for you.

Knee jerk reaction and thought.....any increased respiratory difficulty and or neck swelling due to sq air in tissues? (will go on from there)

Sorry for any 'intent' on my last post. Don't sue me . The post has generated ideas of how to handle a call like this. One must realize that legal matters can differentiate state to state, etc.

The main purpose is do you really have that obligation to take the patient legally against their wishes, alibeit orders, ethics, morality, etc.

To identify, try to adapt to, and also try to institute ways to transport, or get the patient to go can vary. What else can you think of?

OK Mike, grab him, strap him, sedate him, take him......get to the psych consult and find out the guy is sane. There goes your so-called pension.

Welcome to the world of emtcity.

Maybe the nurse can drive him on her way home.

Ha....love it, except the nurse would probably shove him out of the car.

Court order was another option thought of, but according to RN, these unavailable in that county????? Again, was thought of, but no go. The best option would have been the staff getting the resident for a psych consult the day he jumped out of the van.....not two days later. Duh!

Assessed patient, full mental capacities. Patient does have POA for medical affairs. Called POA who only has authority when patient unresponsive. POA out. Medical control contacted, agrees cannot transport for patient wishes. Family physician contacted and will come speak with patient. Arrives, assesses, and realizes patient requests not to go. Cannot force him.

Patient due for dialysis, decides to take day off. Now two day without treatment. Sugars fine. Lab work unobtainable. Options:

1. Patient decides to go....NOT

2. Med control authorizes...NO

3. Patient out to lunch....NO

4. Physician authorizes...WILL NOT

5. POA authorizes....NO

6. Call law enforcement?....WHY

7. Sedate patient and take him?.....I THINK NOT

Best option......leave him there. Wait a couple of days when his bloodwork is out of whack (four days of no dialysis), reassess and take him.

A lot of moral/ethical/legal crap in this scenario. Need to think of all options.

Your ALS service is dispatched to respond to area nursing home (30 miles away) to pick up a patient to be returned back to your city for a psychological consult. You respond and while enroute, your supervisor radio's you and lets you know that you might have to sedate the patient prior to transport.

No further information is obtained.

You arrive at the care facility and enter where met by staff RN. She states the patient has doctor's orders to be sent for the consult. Prior history is that patient jumped from the facilities van two days earlier nearly getting self run over. Also, patient apparently in brittle diabetic where glucose reading can "go from 800 to 30 within seconds". Patient is also on dialysis, next treatment is due today.

You enter the patient's room and find him sitting in chair watching TV. You address the patient whom is conscioius and awake, alert, etc. After telling him you are there to take him to the hospital, he politely states " I'm not going to go with you".

You assess the patient where all findings are normal in vitals, blood sugar, mentation,.....everything. He is refusing to go.

You advise the RN that the patient is refusing and you cannot take him as he has all mental faculties intact. This sets the RN off stating that he is a danger to himself, etc.

For scenario purposes, what are some options you can think of for this type of call.

(I will address each option provided with response in what I did. I will also acknowledge any new idea concerning the case)

Just being the smartass here........cause of death.........the heart stopped beating. Reasons to be announced later.

Hiya from Iowa. Great to see someone with a developed passion for the profession. Are you looking ahead to getting into a Paramedic program? If not, you should.

Welcome from just up the road a piece.