WolfmanHarris
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Everything posted by WolfmanHarris
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Reminds me of a few years back when I got the call my Grandpa had gone VSA at a job site. They'd gotten him back, but I was trying not to be mister doom and gloom thinking to myself: "He's had four previous MI's, he's obese and he arrested in public. His chances..." Anyways, thanks to an RN passing by, a Simcoe County PCP unit that had just cleared the Hospital and had a less than 60 second response time a York EMS ACP unit close behind and great post-ROSC care by Southlake Regional Health Centre (not to mention Central York Fire Services and YRP and the Ambulance Communications Officers at Georgian CACC) he was released neurologically intact 6 weeks later. I was still a student at the time, but when Spring came around and the Base Hospital hosted a Survivor's Day where Cardiac Arrest survivors could meet their rescuers I had the opportunity to attend, now in the uniform of the crews that had saved him. I met each and everyone involved in his care and thanked them personally. The fact that he was the Grandfather of a soon to be colleague really blew their minds and was a great experience for me and my entire family!
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EMS Crisis Response Teams
WolfmanHarris replied to EMS Crisis Response Team's topic in General EMS Discussion
Thanks for the review Bieber! From the thread title I expected something entirely different; so on that vein, anyone work in an area that has a specialized resource to respond to mental health in the community during crisis? Not necessarily EMS based. Here we have (or had, I haven't seen them in months) a team through the Police. A single plain clothes officer and a mental health worker (I don't know their individual credentials) respond in an unmarked Police car to crisis calls. The mental health worker takes the lead, but the officer is there to step in and if warranted provide the legal muscle to detain the patient under the Mental Health Act. They respond concurrently with a usual Paramedic/Police response, but will generally take over the call when they arrive. I've had great success with them taking patients off my hands who they've built a rapport with and who have consented to treatment (they transport). I've also had them detain and transport some MHA-holds but without the escalation to the patient that a marked police car or Ambulance seems to cause. I've also seen them work with patients, clear us from the scene and then clear with that patient referred for follow-up mental health care. Great resource I just wish they were 24/7 and across the entire region I work. -
It really comes down to two approaches: system based and on the fly. System based would be everything your service and area has in place for these calls and can tap into and will vary so much area to area. For us, even though we have large rural areas in our catchment, we have lots of units to call upon. In a really prolonged rescue we'd utilize our Rehab/Treatment trailer, assign a Special Response Unit medic and Supervisor and likely another unit to rotate personnel. I would have fire, since there's so many of them set up tarps to block the wind. I'm also fairly certain we have heater units for our inflatable shelters which could be utilized. Prolonged extrication is also a consideration for HEMS so we'd look at getting them tiered. The bigger problem is the time it takes to get these resources in place. Getting the trailer on scene and set up is just not going to happen on most extrications and the shelters are stored in HQ not on the units. On the fly I'd copy a lot of what's been said. Have fire tarp, tarp and tarp some more. Hopefully they have a rescue that can roll quicker than our stuff can since most trench/confined space rescue gear seems to include blowers for warm air. Raid all the heat packs and foil blankets and regular blankets from the truck and burrito that patient up. Call for a second unit for the hands, extra equipment (we don't carry dozens of heat packs) and rotating personnel as needed. Crank the heater in the truck and get the sauna going. Toss extra blankets on the seat of the truck and blast the vents on them as best you can. If done well and made a priority the patient can probably end up warmer than you. For me I'm tossing my splash pants on and the outer layer to my coat and putting winter gloves over my nitriles and my thinner work gloves (they're oversized and cheap so they can go right in the trash after if need be), toque on under my helmet and hopefully that's enough.
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In Julia's own words "Cancer update: latest MRI results The tumor is "stable". this means it has stayed the same size from the last MRI, (where it had come down some) and swelling has come down a small amount. Not the kind of results that have me dancing, but it certainly not bad! I'm keeping on with Chemo for now. I've been on Chemo for a year, and most aren't on this type of Chemo for more than 6 months, but i'v...e had no problem staying on it longer. Now we'll be deciding each month if I...
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Carter's eating habits constantly surprise me. Tried sautéed red peppers left over from dinner and he loved them. I was eating Korean short ribs and he wanted to try them. He ended up eating about a quarter of them. No bland kids food for him.
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So the floor in the family room had developed mysterious slippery spot. We couldn't figure out why we'd suddenly slip when walking in the room. Turns out my foam roller polishes the crap out of the floor.
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So busy today they needed me to leave CME to save the day! Well they needed volunteers or they'd choose lowest seniority to go, but that still counts. You're welcome.
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Good thing we rushed out and did groceries so we could come back to a house with no power and order in.
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We are issued the Cairns HP3 Commando helmet along with our reflective vests and jackets in our uniform/equipment issue. They are a little heavy and big but not bad. We wear them any roadside incident, fire scenes when we're out of the vehicle any time we're on a construction site and whenever we're on scene in the active area of a technical rescue. We're supposed to wear them into calls in the woods too, but that never happens.
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Went a little Thai crazy tonight. Made yellow currie w/ cauliflower "rice", chicken satay and almond chili sauce. All turned out really well!
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Trying something to curb procrastination. I'm deleting the Facebook app to see how it affects my time management. Not quitting FB, but I won't be on as much.
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Just learned the actor who played Stringer Bell on "The Wire" and Charles on "The Office" is English. Never would have guessed. BTW the BBC show "Luther" is really good.
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Curry is a surprisingly forgiving dish. Start off making an almond butter satay sauce and realize you're missing an ingredient? Cook up some chicken, sautée some veggies, dump the failed sauce on top and dinner is served. Curry paste and chili sauce cover all mistakes.
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Big cooking night around here. Julia made sausage, tomato, bean soup and I made a big pot of beef stew. Fridge well stocked.
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Just when I think I'm starting to get good at cooking... Tonight's disappointing dinner comes to knock me down a peg or two.
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It's been getting way better. At it's worst crews have spent the whole shift taking over the previous crew's patient and then handing off to the next crew at shift change. Now, leaving aside the last two awful weeks we usually don't see more than 30-45 minute offload delay. More at some hospitals way less at others. A few solutions have been implemented with some success. 1) Dedicated OLD RN. This nurse takes moderate and low acuity but requires a bed patients. They are assigned to these hall beds and aren't to be reassigned to other areas since their position is funded by the service and the province just for this. 2) improved patient flow and resource utilization by the hospital. The hospitals have gotten away from giving everyone a bed. Larger and larger section of emerg are putting patients in chairs and only moving them into exam rooms as needed. This keeps beds open for those that really need them. They have also started moving patients into arm chairs with telemetry where appropriate. (Resolved chest pain for example) 3) Show me the money. The Regional council has long given the hospitals money towards capital expenses each year. Starting two years ago they began clawing back that money proportional to amount of time spent over 30 minutes that crews wait on average. The loss of hundreds of thousands of dollars got some very good results as all levels of staff started taking the problem more seriously. Prior to this it was treated as primarily an EMS problem not a hospital one.
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2012 was simultaneously the best and worst year of my life thus far. I look back with mixed emotions and look forward with hope. May 2013 bury the ghosts of 2012.
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On a day I didn't pack a lunch I would get stuck on offload at the only hospital without a cafeteria.
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Mark and I went snowshoeing today. Had a blast, played with a pellet gun, now relaxing by the fire.
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By way of context I was considering a particular patient type when envisioning istat for sepsis coupled with a new program in development where I am. I was thinking of an elderly nursing home patient with advanced directives and patient's stated wishes that they did not wish transport to hospital unless absolutely necessary. They are generally in frail condition and the call if for "generally unwell - failure to thrive. " The new Community Paramedicine pilot envisions a partnership with the NP service that is currently available during business hours for Nursing Home patients. The goal of this partnership will be to identify 911 patients that can be better treated in their nursing home and can safely wait until the NP visits to continue care. We still know very little about how this will work yet but patients I've considered being ideal for this include skin tears, generally unwell. My thinking for the lactate and WBC was as part of a thorough sepsis screening to ensure that these patients are identified early. In this context is this a more reasonable test or am I reaching?
