P_Instructor

Yes

Did you check to see if the NAEMSE course would suffice for the instructor in your state?

What is the size of your patient (ie. weight, frail, thin, etc...) All things need to be looked at and everyone has good ideas. Any history of prior lung problems that may indicate a small spontaneous pneumo that cannot be detected with lung auscultation??? Just wondering...

Ruff.......Are those Osborne wave's I see after the 1st, and 7th QRS's? Oh crap....sorry from the bottom of my heart......just realized you wanted this for students. My apologies.

There are P waves in the T waves. Accelerated 2nd degree Mobitz Type II (Classical). There are more P's than QRS's. Regularly irregular......

Quick look makes me think of a Mobitz Type II.

You didn't know that Amber is the southern Okie slang for Curt????????

There are many questions that one does need to consider. How long has this been going on, maybe between these two, whatever. The little puke got what he deserved as the initiator of this bullying event. I do give support to the larger kid who had restraint from pummeling the puke after the first punch to the head. My opinion is that yes, if the bigger kid punched the little one, more damage could have been done. True, a lot of damage could have been done with the body slam, but I still think restraint was used. Pisses me off that another 'big kid' stepped in after the little one got crunched, but realized that he had better not do anything. More support to the bullied kid as he walked away from the situation. I think the point was made. School policies on suspension for aggressive behavior differ from one area to another. Do I believe the larger kid should be suspended, no, but yet one must realize that he should have just walked away and reported the event. I still give him kudos for putting the little puke in his place. By the way, I was a skinny kid who got picked on through school, and eventually did defend myself which suprized my attacker. Haven't had any problems since that time with him and remain friends today.......many, many, years later.

I have to agree with with you on this one. Get is done 'face to face' and clear the air. It is probably some petty little thing that has snowballed out of control. He may still 'spread the word' but at least the OP would show some maturity in trying to deal with the situation.

Hey Disgruntled, welcome to the site. First thing, don't be disgruntled.....ha.....and you need to realize that all of us have been through the ranks from EMT to Paramedic. Whether your running the 911 or the IFT's, it doesn't matter. You are an EMT. Emergency blood, guts, gore.....hair, eyeballs, and teeth calls are at a very low percentage of calls encountered. Most are the transfer type. In my opinion, taking transfers and talking with your elderly patient who has seen it all is very rewarding. Some of my best calls were 2 hour transfers with WWII vets (I'm a WWII history buff). This made the transfer seem like 15 minutes. Being able to talk with a patient even on IFT's is an art that many people have lost.....so hang in there. Look forward to more questions and posts.

I was just chiding you anyhow.........to answer your question, full physical and mental exam, stroke screen, EKG, reassessments, questioning, talking with the son from out of state, the friend, entire history (which was limited as she hasn't seen a physician for some time, is on no meds, etc.), talking with DHS........all lasting approximately 45 minutes on scene. As for the latter question, I have yet to see an ER doc not do some type of test whether they agree with you or not. I am sure that blood work would have been done at a minimum. When we left after full explanation of our concerns, she was fully aware of the situation and still refused. This was one of those situations where she did not want to go and knew what she was talking about. Again, the premise for the post was to see if any other instructors actually create scenarios that are similar to this depicting geriatrics/morals/ethics, etc. I do, but again was wondering about others, so I could scratch their brains for more scenarios. Later...........

Let's discuss the issue presented in my original post. Are you an instructor, and do you instruct in great depth your classes, whether EMT or Paramedic, the geriatric model concerning morals/ethics/ and legal situations? Do you routinely give various examples, situations, and scenarios concerning the same? Trust me or not, I know what is happening or what can happen with the 'ground level falls in elderly'. After a full assessment, both trauma and medical, neurological and cardiovascular, decisions were made and based upon my knowledge and experiences. I will not just 'take em' for the sake of getting the dollar for the company. Taking someone against their wishes when they are fully cognitive can and will create more of a problem down the road. The patient has rights whether 20 years old or 200 years old if they can make their own decisions with sane mind. Here is a decent course for you: http://www.gemssite.com/ Otherwise, you might want to review and take this: http://paramedic.emszone.com/caroline/onlineChapterPretests.cfm?chapter=4&step=2 Don't take this as a bash, but a sensitive view on many geriatric calls that any EMS provider may, and will probably encounter.

Terminate. As an off thread (I think there are some), did or does the FDNY actually perform background checks and/or psychological testing prior to employment on the EMS side? Most FD's do, but just wondering on the EMS side.......even though I know some go 'bad' at times...

Down time short period. Patient stated had been up and down thru morning, latest event about 30 minutes. Denies unconsciousness at any period of time. Yes the non-auscultated BP did 'alarm', but further investigation due to cooler extremities, age, size, etc, carotid pulses were present and regular with adequate strength. Not all 100's have a pressure above 100. Further assessments of vitals were obtained during the course of the call, did leave patient with pressure in 108 systolic range, no neuro deficits, no complaints either from patient or family. Hairdresser actually remained with the patient for rest of day and thru evening per our/family/her request and patient approval.

The problem is when you cannot get ahold of MC, then what are you to do. You need to be able to use your resourcefullness to do the right thing. By the way, MC couldn't give me much info in this situation.

OK, not many replies. Situations like this are more frequent than most realize. As instructors, open the suggestions and lead them to do what is best for the patient, or be that patient advocate, whether they want the help or not. I ended up speaking directly with the son in another state, the State DHS, and got those entities hooked up. Also asked if the friend could stay and watch over the patient (which she was very glad to do and even would stay through the evening and night, with approval from the patient and son). All this is made aware to the patient. EMSer's must realize that we are not there only for the physical patient care, but for the needs of the patient/family, whatever it may be. This goes along with the moral/ethical aspects which should be stressed even more in the classroom instruction. Comfort and compassion and the wanting to do what is right goes a long way. I have been in the business over 30 years, and this was the first time that I was thanked by all parties involved. Even received hugs from the patient and friend.

True, but we nibble a whole lot!!!!!

Complacency can kill a cat........more should have been done for her even though the complaint was only back pain. Be the patient advocate and work her needs whether complaint or not in certain circumstance. My opinion only.

How many of you instructors deal in instruction in what is really best for the patient in odd situations. Example: I was working a shift with a newer inexperienced paramedic the other day. His rotation as the attendant. Dispatched out for possible injured party. Arrived scene and FD EMS meets us outside residence stating just to bring clipboard as patient is refusing transport. We still took the cot and jump kit, etc near the door and entered the home. Found near 100 year old female supine on bedroom floor with lower legs under bed frame. She was only dressed in nightgown, typically weighed only 90 lbs. She was conscious and alert without complaint other than having to go to the bathroom. Apparantly, has been up and down this morning, very unsteady on feet, needs assistance by way of grasping furniture to be mobile. She was found by friend/hairdresser because neighbor called friend to check on patient after not noticing any lights on in the home from across the street which is atypical. Friend activated 911 response. Assessment was unremarkable for the patient except for slight pressure bruising to elbow and shoulder point from lying on hard floor. Skin was cool and dry. Partner could not obtain auscultated BP, but patient has good carotid pulses and regular apical heart beat/tones in 60's. The patient only wanted help off the floor to go to bathroom. I jumped in and took over as partner seemed a little perplexed and after letting patient know that we would remove her from the supine situation, that if there were any changes (which we thought there would be) that we would take her to hospital for evaluation. Ahhh, this is the point that the ole gal stated 'no you will not' in loud/firm/demanding tone. Long story short, got her up without changes and assisted her to commode, then to sofa in living room where she wanted to go. The problem at hand is that the patient could not ambulate sufficiently enough in my opinion to be by herself, however, she stated otherwise. Have you, or do you ever instruct students on what you could do in these type of situations? It is the inevitable identify/adapt/overcome type of scenario. Give some opinions or ideas. I will let you know what I ended up doing in leter posts.