hatelilpeepees

OK, I feel a little better now, at least I know I am not alone.

So I was at a high school football game, off-duty, watching a relative play. Someone collapses in the stands about 40 yards from me. There is an ambulance on-site, but on the other side of the field. I did not immediately jump up and go to the patient, which shocked some of my family members (I have no equipment, no PPE). Sensing their disapproval, I went to the patients aid, it was just someone who got overheated and fainted. The ambulance crew got there about 5-6 minutes later and took over care. What would you have done if you were there, not in uniform, and no one knew what you did for a living ? And I ask the same question for when you are the first one that pulls up on a wreck (again no equipment). Do you stop only on serious wrecks, do you stop at all wrecks, do you not stop at any of them ?

And how much do you Canadians pay in taxes to receive that care ? And why is it Canadians come to the US for care, if that system is so great. I hear you guys have to wait 6months to a year for a CAT scan, or any "elective" procedures, is that true ? Nevermind, I found the tax rates: http://www.cra-arc.gc.ca/tx/ndvdls/fq/txrts-eng.html

http://statter911.com/2011/08/16/music-video-my-knee-hurts-now-calling-911-when-you-really-dont-need-it/

It allowed for proper funding so that we could buy disaster equipment, prior to 9/11 our only disaster supply was a set of triage tags. It also increased the training that we needed to take.

Fool me once, shame on you; fool me twice shame on me: Here is a list of terrorists attacks from the last 3 years, and granted it is not 100% "Muslim" generated, but they do seem to be mentioned alot: http://en.wikipedia.org/wiki/List_of_terrorist_incidents,_2009 http://en.wikipedia.org/wiki/List_of_terrorist_incidents,_2010 http://en.wikipedia.org/wiki/List_of_terrorist_incidents,_2011 I am in no way suggesting that we burn mosques or create some sort of genocide, but to ignore this problem is what allowed 9/11 to happen to begin with.

Topics and tempers seem to have been kind of hot in here last week, so I throw this topic out just to give us something to talk about that shouldn't turn into a war: Maybe this only applies to the obese people like me, but I keep some snacks in my bus, just in case we get slammed and I can't make it to a restaurant or back to the station at the time I would prefer. I usually try to keep stuff that does not require refrigeration, like those little cracker and cheese or peanut butter packs, trail mix, or slimjims. What do you guys eat ?

Herbie I have to disagree that forcing someone to listen to religion is a good thing, I believe this country was founded on that principle. I will give you an analogy, Do you think it would be appropriate for a group of 5 year olds to be forced to listen to a gay pride activist, that preached tolerance for homosexuality and was attempting to convert the 5 year olds at an early age (I am not saying there is anything wrong with homosexuality, just using it as a reference) ? Of course you would not, because the kids are too vulnerable at that age. Most homeless people either have an addiction or mental health problem, so you are taking advantage of that. The problem with religious people is that most of you believe "The Bible is the greatest book that I should read". If you are religious, that is great. Go to church 7 days per week, sell all your worldly posessions, shave your head, build a shrine, just stop trying to force your beliefs on others. If i wanted to know about your religion, I would come ask you questions. Now my question from the other thread? Is Muslim, Mormon, and Scientology real religions ?

I am not sure I agree Doc. Yes this is a small portion of the "Muslim Religion", but Muslims do have central voices. I would point to the political leaders of Afghanistan and Pakistan since both countries are primarily the same religion. I think we can also debate whether Muslim is a religion versus a philosophy but that is another thread. They have the capability to stop the Taliban and Alquida but choose not to. And not only do they let them operate right under their nose, they probably provide the financing.

I would agree with you vorenus if Muslims were actively speaking out against the bad element of their religion and doing something to stop it. I felt the same way about the Catholic religion because they turned their back on the pedophiles among their priests and paid people off to be quiet. Unlike crotch, I understand that this bad element of every religion or group is a small percentage, but it is the responsibility of the majority to fix the minority. If I had two Paramedics who killed a patient every week, it is my employer's responsibility to fix it or remove it. But if all the other employees in the organization just ignore it and offer an apology to the families, then we are wrong, even though 99% of us do a great job.

I have to agree with chbare on this one. This is why we have so much government intervention in our lives, because employers/employees are too lazy to do the right thing on their own. I can not imagine how horrible hospitals would be if it were not for the JCAHO boogie man. I guess we need to get the Federal Government to declare that every ambulance service must gain CAAS accreditation to collect Medicare payments, otherwise we will never improve.

I would say the fact that we have not had another huge attack on our soil, or that there have not been numerous smaller ones. That we have not been attacked today. I can't believe how far apart our political parties are. What happened with Anthrax attacks, I thought that would be our new norm with as many as we had right after 9/11 ? And I wonder how much our government spies on us without us knowing ?

I agree with both Tnuigs and Crotchity. Unconscious, diaphoretic, known diabetic, probably 90% chance of hypoglycemia. I think where you screwed up crotchity is that you should have made the patient have suppressed respirations and vital signs. When you say normotensive, I would consider the other possible causes, because it might just be someone faking. But once the patient started to tank, I would definitely throw some D50 at it, can't hurt. No different than throwing some atropine at EMD, cant hurt.

Crotchity must be a fan of the Neal Boortz Radio show, he is one of the loudest people on the subject that it is all a scam. I am with ER Doc, I think it is real, but I think some are just "bored" at school (versus their home environment with constant stimulation from video games, TV, music), and then are labeled hyper by teachers so they can get them on meds and get them to sit still for 50 minutes.

I know I was not hired for being fat at several municipal jobs, so I like the idea of basing the hiring on performance and not subjective criteria that changes from place to place.

OK, I know I am new here, but I detect crotchity isn't very popular here. Why is that ? I know lots of people who believe the same way he does. Are you a troll if you disagree with the majority opinion, or does he have a past here ?

maybe that is why i am so fat, I am carrying around a couple of calcified babies. Cool topic though, if this were my patient I would be thinking tumor, not baby.

Yes, I "woke up" at 4am one morning standing inside an overturned 18 wheeler (car had driven through it), had no recollection of how I got there.

I am sorry to break the bad news to you, but this is not a discrimination issue, unless like docharris said, they have let other employees with lifting restrictions do light-duty work in the recent past. They are not firing her, she is no longer able to do the job per her doctor's orders. This would be the same if someone had a back injury and was told they could not lift more than 45 pounds. I imagine the doctor put other restrictions on there too, such as can't stand for longer than "x", can't sit for longer than "y" (they usually do). But if the company's stated policy is "no light duty", then you have nothing you can sue for. P.S. It may be different in California, but she probably will not qualify for unemployment, as she was not terminated. She may be able to file FMLA which will hold her job without pay for 12 weeks, but they can terminate her after those 12 weeks are up if she is not able to return to work. Sorry just read where you said there are injured employees on light-duty. If that is the case, you do have a right to sue and should talk to an attorney (after filing a grievance or appeal with HR).

Another reason you do not start up high, is that you have to remember that patient may be in the hospital for days or weeks. By putting one in both arms, at the AC, you potentially ruin the chance to use the distal veins if one or both ACs get infected or infiltrate. If you have veins big enough for a 18 or 16 in the hand or forearm, that would be preferrable to start as low as you can, so that the next line will not have to be a central line. Most research no longer advocates dumping several liters of IV fluid in patients any more (In the old days we would put 6-8 bags in a trauma patient). If 2,000 cc's doesnt fix it, they are probably bleeding to death so all you are doing is turning their blood pinker.

I dont know why you would do orthostatics on someone whose B/P is 70, since the purpose of orthostatics is to find if there is a need for fluids. With that being said, it is even more uncommon that someone without an orthostatic change would benefit from trendelenburg, which is the only treatment rendered. Therefore, I say it must be an allergic reaction that was rectified by removing the patient from the thing that caused the allergy. No other disease process could be remedied by oxygen and trendelenburg alone. It would not shock me to find that the patient had tried a free sample of something that induced the reaction, or if it was a delayed reaction to the advil. Although this type of reaction is possible due to being close to something and breathing in a scent, it is more likely that something was ingested or held.

I agree with ambo driver, once you lay her on her side, you have lost all spinal immobilization, so why bother

He has asthma and just got the crap scared out of him. I would ask him if he felt like he needed a breathing treatment, since he knows his "asthma". If he said yes, I would let him use his inhaler or give him one treatment on the way. Its no different than asking someone who is always on oxygen if they feel like you need to bump them up another liter. If he had no history, I probably would not, but would report my findings to the ER staff so they could do a CXR and see whats going on.

1. That D50 can be given P.O. (by mouth). 2. Never get a refusal on a drunk, especially one that has endured any form of trauma (even minor). 3. That glucose machines are not always accurate. 4. That some drug ODs actually present as hyperventilation, until they quite breathing about 15 minutes later. 5. For every flight of stairs you are climbing, you can add another 100lbs to the patient, same for every foot of space-width that is lost in a mobile home hallway. 6. When patients say "I am dying", they are usually right. 7. Treat the patient, not the monitor, some folks have some ugly rhythms, but it is what they live with everyday. 8. Always check your truck completely, the day you dont will be the day you are missing a piece of equipment, at the worst possible moment. Especially if you work a busy 24, cant tell you how many times I have had to go to the last call location or ER to get equipment that was left by previous shift. 9. Never leave a patient that has called 911 more than once in a day, it is bad to have to explain why a patient called 3 times, was not transported, and died. 10. To combat the medication errors mentioned before, do not put medicine vials that look identical right next to each other in the drug box (albuterol and Atrovent), put medications that are potentially deadly (Heparin, Dopamine,) in its own separate ziplock bag and label with magic marker so you have to be a double dumbass to grab the wrong bag. If you have meds that are almost identical, switch the vendor on one so you get a different color box or size of ampule. Ideally, you should have a dial-a-flow or pump on medications that can be deadly. 11. Not all doctors graduated at the top of there class, and many ER Docs are not ER Specialist, but may be a dermatologists who is working part-time (especially the more rural you get), sometimes you have to step up and be a patient advocate. Thats a good starting list.

As The Rock would say, "Know Your Role". It is your role to give the best care possible to the patient that is in front of you, regardless what is going on in the rest of the world. It is your supervisor's role to ensure that there are enough ambulances to handle the call volume, to rotate those units to where they are needed, and to have a plan for when there are no ambulances available. When you start leaving "BS" patients (in your mind) at home, you will open yourself up to all kinds of problems. Let me ask you this question; right after 9/11 I bet everyone in this room called FEMA and volunteered to respond to NY if needed. What if instead of just volunteering, half the medics in your state dropped everything to go to NY, for what turned out to be a body recovery effort instead of a rescue. How many patients would have died because of the lack of ALS responders left in your state to handle the calls ? Their heart would be in the right place, but it would have been a poor choice. Abandoning a patient in front of you, to respond to a patient that has less than 1% chance of surviving is not a good choice.