EmergencyMedicalTigger

Nurse Slutstein! Have you been to our local ER lately? :wink:

Unfortunately Asys's comments are all too true in many cases. Most instances I've seen of unprofessionalism were on scenes with volunteer agencies. I've seen several good, well-trained medics and firefighters leave volunteer departments b/c they expected professionalism from the other members. Sadly, they were crucified for standing up for professionalism against the 'good ol' boy' system.

Good attempt at the topic Eydawn, but I think your topic has digressed beyond saving at this point.

Like a mountain huh? No more excuses from the men...

EMS needs to be categorized as an essential service. There are many cities out there that can afford to pay for EMS, but they don't because there are volunteers. I know this because I used to volunteer for this type of department. I worry about my family and friends who still live in that city. I personally know the level of care and 'professionalism' they will receive if they ever have to call 911. These municipalities need to be forced into making EMS funding a priority in their budgets. "Oh no, you mean the city will only be able to have fireworks for July 4th and not Cinco de Mayo and the annual shrimp boil?" gasp! Many cities can easily cut things in their budgets to staff an ambulance. EMS needs to demand higher standards for education. This will be a difficult change to make, but it needs to be done to improve the future of EMS. EMTs and Paramedics should be required to have college hours. Many people have studied Brady or Mosby and have memorized enough information to pass the certification tests. However, those books don't teach critical thinking skills. It's important to realize that professionalism isn't attained by saying 'I've done this and this; I've reached this level, so now I'm professional.' An organization becomes professional when it sets goals, accomplishes those goals, and then says 'Now how can we be better?' There has to be constant quality improvement and training and most importantly people who care enough to make this happen. This is not going to happen while 6 week paramedic and subpar community college programs are considered acceptable

I'm having flashbacks to my last shift. Luckily the hospital we use most in our district has a good staff that doesn't blame us for bringing pts in at 3am. A couple big name hospitals have nurses that will literally bite our heads off every time we step in the door; one goes on diversion every time they get more than 5 pts. Do they really think we're that much happier about standing in their ER in the middle of the night listening to them gripe at us? We're not the ones who chose to get out of bed. :? sheesh

In one episode of 'Cheers', Cliff is seated at the bar describing the 'Buffalo Theory' to his buddy Norm. I don't think I've ever heard the concept explained any better than this... "Well you see, Norm, it's like this... A herd of buffalo can only move as fast as the slowest buffalo and when the herd is hunted, it is the slowest and weakest ones at the back that are killed first. This natural selection is good for the herd as a whole, because the general speed and health of the whole group keeps improving by the regular killing of the weakest members. In much the same way, the human brain can only operate as fast as the slowest brain cells. Now, as we know, excessive drinking of alcohol kills brain cells. But naturally, it attacks the slowest and weakest brain cells first. In this way, regular consumption of beer eliminates the weaker brain cells, making the brain a faster and more efficient machine. And that, Norm, is why you always feel smarter after you drink a few beers."

Unfortunately I wish the same could be said about some of the volunteer fire departments we respond with on calls. For the most part I haven't ran into many problems on scene, but I'm sure it's only a matter of time with the exploding call volume. No matter how small the department, I think they should all take drinking seriously, especially since they are our first responders and rescue crews.

What are the rules your services have for alcohol consumption? We're not supposed to drink at least 8 hours before our shift. We have random drug testing as well. If they find any in your system while you're on shift, you're gone.

I've seen a glove used before. I couldn't figure out why, at the time, he couldn't spend a couple extra seconds to grab a real tourniquet. But knowing most of the people and the mentality of that EMS I really wasn't surprised. I could see using one in a situation where you can't find your tourniquet and you needed a line asap, but usually a couple are carried on the truck as well as in trauma bags and IV start kits.

I've never heard of Lopressor being used in a prehospital setting. I've seen it used in the ER but don't recall the exact amount of time it took for the meds to take effect. Is it really worth it to carry this drug on the ambulance considering the possible side effects and the extensive list of common drugs it can interact? What are your thoughts are carrying/using Lopressor?

Awesome pics! Thanks again to all of you who are courageous enough to defend and represent our country. PS-Dust, nice gun

You get on scene w/FD first response already there and pt's mother says, "You're going to need more people than this." (We had to move same 800lb pt twice this weekend)

I saw in an article where Oxygent has a 2 year shelf life if refrigerated. Can it be kept unrefrigerated just resulting in a shorter shelf life? I voted for Polyheme, because there are services who run without mini-fridges. I think it would appeal to those services, so they wouldn't have to make changes to store it on their trucks. Although Oxygent seems like it might have fewer negatives overall. We will probably see both in the future being used in prehospital care.

Seeing that we are from the same city, are you really that shocked by the level of care these medics were giving? It is common knowledge that the most of the medics (not all) in that organization just want to play with a fire hose and are forced to go through an in-house paramedic fast track program to keep their jobs. Personally, I'm glad that I live in county jurisdiction where we have our own local EMS. But to get back towards the topic....I think it's best to keep it simple and not waste on-scene time overanalyzing. But it's also good to have as much knowledge as possible. It gives you a better understanding of what might be happening with the pt, and you might actually be able to use some of that knowledge from time to time to render a little bit better pt care. Everyone has had great points and information. We just need to remember to treat each pt on a case-by-case basis and not get too cook book with our care. Just my thoughts.

Well based on your assumptions it might be a HIPPA violation. It's true that he wasn't on duty when he responded, but he rode in the back of the ambulance, so did he assume pt care? If so, then technically it might be a violation, especially if he didn't get permission to release information. Just b/c a newspaper knows the name of the pt doesn't mean he had the right to say anythinig other than basically "Yes I was there and assisted in care of pts at the scene." The way it was written, you really can't tell entirely what information was supplied by the medic other than the quotes.

Sorry for not responding Dust, I was doing a search for something and saw someone actually replied to my post! It's going great. There seems to be typical BS politics-it is a county system-but so far everything's good. I work in the poorer area of the county, so most calls are BS and sick calls. We do occasionally get a good call every now and then (like the CVA we got yelled at for flying). My partner is awesome and most of the paramedics are more than willing to answer questions to help me learn. Overall I love my job and am excited about starting Paramedic next year.

Sometimes they're less disgusting than the live ones.

Thanks to everyone for the responses. The only time people get away w/flying medical is if the call is way out in boonies or if you can somehow incorporate trauma into it. Alot of medics who have serious medical pts have slapped c-collars on the pts who may have fallen to the ground so they get away w/flying the pt. I think it is ridiculous they would have to go to such lengths just to not get reprimanded. As far as the "critical medical" thing, our Deputy Chief states that only 5% of our transports should be code 3 traffic to the hospital and the remaining code 1 (non emergency) according to some national studies. So, basically we're supposed to ground transport every medical call and just drive code 3 to the hospital if necessary. It made me feel good about the decision seeing people on emtcity support it. I'm fairly new to EMS (about 1 year), so it gets discouraging to have your supervisors tell you a choice wasn't correct. I really feel we went by our gut and chose the best form of care for this pt.

Dust, good points. My partner and I try to keep our work areas as clean as possible, so we wipe down our computer at the beginning of our shift-I don't know about the other crews. We usually print code summaries off the LifePak for our vitals, times, etc. I prefer to write stuff on a small notebook I keep w/me, such as pt info or manual vitals and just refer to it later. Most of the time I have them sign a separate acknowledgement/refusal card instead of trying to get them to electronically sign on the computer correctly. I'm not perfect w/it comes to keeping everything germ free, but I'm better than most. I'm a big proponent of hand washing even if gloves were worn.

There's nothing wrong w/having different pens. When I worked for a service that still required handwritten reports, I carried a pen to use on calls for pts to sign forms and a pen that I didn't let anyone else touch for finishing reports after calls.

Soooo, if you get your "romantic" meeting with Asys, will you be wearing gloves? :twisted:

This call happened a couple weeks ago. I decided to post here for your comments, b/c the disagreements and discussion at work hasn't faded. Our protocols state you are not allowed to fly critical medical, only trauma. However, our MD has stated that you can fly the pt if you’re not w/in 15 mins of an “appropriate facility.” So here goes: We were dispatched to possible stroke w/PD and FD on scene. Go into this house and are directed up two sets of stairs w/a 90 degree turn and impossibly small landing (I'm starting to figure out the pt is always on the second floor, especially if they weigh over 125 kgs). The bedroom is a mess, clothes and stuff covering the entire wooden floor, and no, there's no "path" like you see in some messy houses. Pt is 49 y.o./f sitting slumped on the bed w/her 17 y.o. son trying to hold her up. The family just got home from son's bday dinner when pt began c/o of really bad headache. She has no pertinent PMH. Pt's got left sided weakness and aphasia. I get her on O2 and start getting her vitals. My paramedic partner asks her to squeeze her hands and blink for yes/no. Pt starts having trouble blinking and begins repeatedly squeezing my partner’s one hand repeatedly as hard as she can. I’m looking at my partner like “this isn’t good.” We can’t use the stair chair b/c of several factors. We’re 20 mins from a Level 2 stroke facility by ground or 10 mins from one of the top Level 1 stroke facilities in the nation by air. My partner calls for air medical and by this time our Lt. is on scene. We have a 20 min scene time b/c of the extrication from the house. Pt starts decorticate posturing and vomiting coming out of the house. Pt’s mental status is decreasing rapidly. I’m assisting ventilations w/an NPA and suctioning, while my Lt. and partner are trying to get a line on her en route to the LZ. My partner finally gets a line as the flight crew arrives. The flight medic RSI’s her, I intubate, and she’s off for air transport. Even though our Lt. agreed w/my partner’s decision on this call, she’s catching a lot of disapproving criticism from others, including officers. We caught up w/the flight crew later that night and found out pt was prepping for OR 75 mins from onset. The head nurse of the stroke team said pt had a “massive bleed.” The next day a doc from the stroke team calls and compliments the decision to fly the pt saying that she would have died if she went to any ER. Last we heard she was in ICU. I understand why management would discourage flying some medical b/c then medics might abuse it. However, I think it was warranted in this instance.

I think a tough question is "How would you feel about working for a supervisor with less [industry/field] experience than you?"

It's important too have good BSI habits, but I think you might be going a little overboard. Use gloves when working w/the pt. Try to prepare ahead of time like AK said if you're going to be dealing w/alot of exposure. If you drive take your gloves off before getting in the front cab. That drives me nuts to see people do that, not to mention it's gross. Wash your hands frequently. Wipe down the equipment you used on the call and do detailed unit decons once a week. If you use pens for written reports, wipe them off every once in awhile and don't stick them in your mouth :shock: (yes, some people do this).