Bernhard

Speaking of uncreativity in screen names...if you want to know why I'm using this, you have to ask my parents. I used to use an abbrevation, then as people started calling me by it, it got painful and I now stick to my name. It's easier for real life communication. My avatar is the very unofficial patch of the EMS part of my organization. You won't see it on an official uniform, but I find it nice. And it's a cool trade item, people love it.

My first guess (but I didn't read the whole thread!) would be some kind of seizures/seizure aftermath, DD stroke and intoxication. Which may or may not be the real cause. A psychological diagnosis is often too fast and too easy for a hidden somatic background. Did the patient see a real psychiatrist? Often they come up with astounding obvious somatic diagnoses...(they like that!)

No, Vorenus, we over here just give our patients to real higher level of care...not to RN's. That may be a concept our U.S. collegues don't understand...

Really? Here, we would have the power to decide ourselves. Correct way here would be: Notifying dispatch about the request and getting their acknowledgement to handle the transport or giving the details to have them organize another ambulance in case they need mine for something else. In this case, the following would be the task of the other crew. See, if the patient is released by the hospital (paperwork/AMA signed). They have to, if the patient wishes. Making sure, that the receiving hospital is willing to take over the patient - that's the task of the family to organize, a call to the receiving facility to verify this is helpful. Making sure the transport costs are covered by insurance (here this will make a doctor's recipe needed) or by the family (signed cost agreement, we have some forms on the car). Getting information about the patient. Making very clear that the releasing hospital has the duty to give all needed information - they have at least here, even if the patient refuses their treatment they need to inform further care about the things happened. this by vocal instructions and by a (preliminary) letter. If patient needs care above the scope of my equipment, make sure I get it. A patient recovering from heart surgery is someone I want to have an ECG on and a defi ready plus an i.v. line running. On our BLS ambulances we have those possibilities, if not: get one who has. Transport. Just as any other patient. I know that some hospital staff may take an AMA personally and refuse to beeing friendly any more. Been there, experienced that, as well as with random patients and with family members. Such behaviour may proof that it was the better decision to leave this hospital. From an ambulance view, the process is not that uncommon and not complicated. In the given scenario there are at least five things that make me wonder: The ambulance had to do an hour drive around just to take over the patient from the same spot they were in the beginning. Why didn't they notify dispatch themself or stand by when family calls dispatch? May have things shortened a bit. The hospital does a lame job on passing the patient properly. I don't see any reason they can't give a proper report to a further caring medical crew. They have to document it anyway, the patient has a right to have this info and the ambulance crew needs it. So I see almost a violation of any medical care practise in NOT giving the needed info. Does the receiving facility know of the patient? What if they have no bed available, some important caring device defective or simply refuse to take the patient (because it's a known non-payer or else)? The ambulance crew would have a real bad time with this patient on board then...I for sure would have checked this before taking over the patient. Was it clear who pays for the transport? Here, insurances do pay only when a written receipt of a doctor is present (in emergencies the receiving hospital has to give one, but that is not the case here). If we are unsure if such a receipt is present, we are obliged to have the patient sign a cost agreement. Can't see this issue covered in the original post. If the crew thinks it should be an ALS transport, then why does dispatch think otherwise or why does the crew leader accepts this? If beeing uncomfortable then something is wrong, especially if higher level of care including more adequate equipment would be available: either I can handle it or I can't. Crossing fingers is not the only BLS option. Having sound arguments for getting ALS is. At least the argumentation "I need ALS because..." should be in the scope of BLS staff, not needing a supervisor...

You forgot the three standard arguments: "We (= I personally) never did this before!", "We (= I personally) don't need it!" and "We (= I personally) never needed it before!". Silently supported by "We (= I personally) don't understand it.". Thank you for learning another english slang term they never taught us in school! Yes, but there is a whole other issue on marriage in terms of religious views, which may be the main source for arguments from this corner. Thus ignoring the fact, that a marriage always was a kind of social security system, even before religion or such concepts as "love" stepped in.

For me (BTW: and for the law here) a dog including a service dog is a valuable item. As with other valuable items of patinets I as a medic have to take care in (assumed) agreement with the patient. This opens a bunch of options: i can take it within the ambulance (other regulation steps in: as long as I can safely secure it), i can pass it to family members or friends in (assumed) consent with the patient, I can pass it to law enforcement, I can organize another trusted transport (command car, fire dept, other available aid services) or I can secure it on scene (well, this may not sufficiently working with a dog but maybe with a bycicle or else). I agree with Dwayne that a dog is no immedeate service for a man in the best care of EMS and hospital. I even agree with HLPP, if she is unsure about dogs in general or about securing it in the ambulance. In the given case, when the injury is minor, I most probably would have taken the time to call and wait for law enforcement to arrive. They will take care for the dog, in which way ever (lots of own options). In a more emergent setting, I may have choosen one of the other options - but mostly I would prefer the law enforcement option. The last option would be to take the dog in my ambulance, and I'm by no means scared by dogs and know how to handle them properly. We would even have the opportunity to have them secured in our ambulances, because we have special fixing places for bulky baggage as wheel chairs or other, a service dog with a harness (sp?) could be secured there pretty well. But I can't think of a reason to have a unknown dog in my ambulance - see above: I know how to handle them properly, this includes to not fully trust a strange dog. I even would not take relatives/friends in my ambulance other than in the co-drivers seat (exception: if needed for immedeate patient calming as with kids). A typical sized service dog can't be securly placed there. Anyhow, there would be no option to simply leave the dog on scene alone on it's own. As with all other situations in EMS: know your tools and evaluate "cost"/"risk".

Good Luck & welcome to the city!

Having filtering options sure drops the rate of BS calls, at least what EMS will see as such. Over here, we can: deny transport to obvious non-medical cases treat ambulatory (minor bruises and such) and don't transport assist helpless people (sitting back into chair or something) without need to transport call a General Practioner (they have duty to cover 24/7) on scene and may leave bring a patient to a General Practioners office (in some cities) pass a "just drunk" person to a special facility, where they can sleep under supervision pass non-medical but otherwise helpless people to law enforcement, who in turn have several options for sheltering or social work So, a real "BS" call (as in "thats not an emergency!") is reduced to a short on-scene time and not much additional load on the system. I tend to forget these calls as soon as I've documented them, unless they are very remarkable. Most remarkable (and, in retrospect, often funny) are those calls in the rare occasions, where above system doesn't work for a weird reason.

Quote of the month!

Too much alphabet soup! Give us non-native kiwi-speakers a chance understanding what all those abbrev. mean...

We had several tries over here to have such cars (example). Most of them I know resulted in heavy accidents...

I would find it unethical, trying on a patient having the phone number or address from the patient data set. I would find it unprofessional directly asking the patient or even accepting an offer from the patient during a call. [*] But I would find it romantic if true love makes it anyway. [*] Why? Because in both settings the provider has significant emotional advantages over the patient in a situation, where trust & reliability are two of the most significant factors. Playing out advantages simply is not a good base for ethics and professionalism. In rare, romantic situations it may work for both, but most probably it would be scary or at least a little upsetting for the (ex-)patient. Better try to "accidentally" step into her/his way in the supermarket. Don't tell anyone. Make a movie.

I absolutely would sign this. More terrible are doctors BTW. May I say that i don't like the co-notation of wanna-be-hero here? This statement is an invalid definition of both, "render first aid" as well as "hero". You (generally you) are definitely not a "hero" when "rendering first aid". I just don't like the misuse of words when people giving first aid are intentionally degraded as wanna-be-heroes or such. That may be the fact when they acting as such, but not by just giving first aid. What's a wanna-be-hero? The one doing all showing his heroism, but effectively doing nothing to really calm down a situation and getting things organized, even not checking that he adds more trouble than good. It's the one trying to get public awareness for his deeds just for pushing his own ego. Someone simply getting things done is not a wanna-be-hero and shouldn't be reduced as such, especially not by professional providers who should know the difference between show and effective help, even if it's just calming down scene and lending a helping hand. Thank you.

You're very honest to confess, Dwayne. I estimated only a 50% chance it was unintentional.

CPR can be so funny! Noone outside EMS will understand this.

Eveything is never spelled correctly. Welcome, Jamny!

Here, I'm a Rettungsassistent from the moment I get my certficate. 24/7, life long. If out of duty it's my decision what I do - but if I want, I can do all what I'm able to and have the equipment for (even, if this is given to me from a BLS ambulance). If I introduce me as medic, I would be accountable in a certain way for all things, but I have not exactly the same liability as on duty, circumstances would be taken into account. I'm publically insured as any other civilian if I get hurt during aid and can get replacement/money for damaged own posessions (i.e. bloody clothes). No med control here (not even on-duty), who could deny me something.

Happy Birthday!

Really? Do you have pictures? I googled for "type III ambulance", but got noone seeming to have more space than our standard EN 1789 Type C Mobile Intensive Care Unit (bavarian 2010 model). This also depends on the education and legal possibilities of the BLS crews. I would have no problem here (neither legal nor personally) to hand my patient over to a BLS crew if instructed to call me when something goes wrong. At least that whats they're able to (and have to do in everydays BLS business). EDIT: That's our recent standard BLS non-emergency transport unit: EN 1789 Type A2 Patient Transport Ambulance (EN is the european standard "euro norm"). Website in German, but click on the pictures zoom in.

From wikipedia: From the hacker's jargon file: Some people intend their trollish-behaviour for the reasons above, some only start troll-like and grow up to be a reasonable discussion partner, some (even experienced ones) degrade to a troll and some just don't get it. Sometimes an individual is mistaken for a troll, just because of misunderstandings and/or disagreement or wording in discussions. To get back to the topic: one of the PROs for EMTcity is the ability to get something senseful out even of real troll-postings. I saw this happen in other high-level discussion groups on emergency matters - so maybe it's just the high competency of the emergency (medical) services to professionally deal with strange people (colleagues, patients, ...).

To add an other angle of view: yes, I expect a "Thank you". I even expect respect for what I do and for me. But I'm old enough to be not surprised, when it doesn't come. I would expect the same, when I am a bank clerk or a fruit seller, and I myself spend a simple thank you more often than not. For me, a "thank you" and respecting others is an important part of social life. Even trying to teach this my kid. A little "thank you" doesn't hurt. Again: it's no way to be surprised, when there comes nothing back. In my career EMS department I really expect to be paid, this comes more or less from public sources. I even would expect to be better paid, so the real people who have to take a certain impression of us is the public in general. There i would consider all weapons are allowed. If they thank us with better wages (and in my volly service with better equipment, better funding for education and clothes), then I even would bear the burden of an hero image. But since there always is some kind of whining attached to getting a hero image ("please please consider me a hero, look how cool I am!"), I preferably leave this to the (then mostly volunteer) fire service. It would be better - in my eyes - to have the image of a professional provider (even when volunteer!), doing a professional work in the rear end of social risk-management, based on high-level education and certainly deserving a high-level pay (or, as a volunteer: the best equipment available). BTW, for my personal juvenile male hero ego it's enough to be summoned out, getting in my hero-suit (even if no phone boot available) and run the streets in my bat-car. Hooray! Thank you for reading!

First, it's mandatory for the organization/company here to issue protective clothing to staff, if career or volunteer. Disclaimer: In theory. In reality this varies greatly... Second: it took a long time. We started looking sloppy and totally scary - I somewhere have a photograph from 20 years ago, where every single provider has a totally different look, including a lot of private stuff Reaching a first real uniform level took almost 10 years, including fund raising. But it totally was worth the effort. And you (as a organization) simply have to take the first step... BTW, I can fully support the statement what effect proper clothing has on the public. Not on the most patients, they don't care. But bystanders and general public seem to care much. We gained a great reputation from the uniform looks, leading into significant donation raise and increase of booking for (paid) standby services (and therefore more money for training & equipment). Again: good looks have to be backed up by a high-level of emergency abilities, else it's worthless. But this really could be a circle. In our career service there is central laundry service (even state central for the whole EMS company, which is state wide). In our local vollie service I'm at the moment organizing this. Not easy, but the solution is near. main problem now is the space in our present station for realizing the workflow. Most probably has to wait until we get a new station (hopefully spring 2012, the landlord's offer just came in today - yippie!).

Carl, I'm not bearded. That was Vorenus - the other German guy here. Speaking of look: I know people in this profession who always look fresh from dressing cabin, others who instantly look like 48hrs straight forward disaster medicine in their first 10 minutes in service. Nothing of that compares to their competence in work. So, look alone doesn't count - I myself am somewhere in the middle... Said this, I'm always behind having my people in vollie department look well dressed. Cleaned shoes, washed clothes, tucked in shirts, collars right outside (my mother would be proud of me). A lot of this requires organizational coordination: issuing of enough parts (costs real money!), opportunity to store the pieces properly, access to proper shoe care products, cleaning workflow and so on. Some things are still on my todo list. It's my third year in leading this vollie group, introduced new set/organizing of clothes two years ago and we're already recognized by the public as "professional aid group", even compared to neighbouring squads. This in return gives the members a good feeling. But doesn't save them from high-level ongoing education, though. In my career EMS department, they switched to pool clothing, which in my eyes was the best decision ever. That means there is a stock of every size of clothes (sweat shirts, polo shirts, jackets, trousers), the only personal thing is the belt, the velcro name tag and the pair of safety shoes (latter issued by the department). Now the appearance is uniform instead of dependent on which year's clothings design you entered the department. The clothes are clean and hygienic (changed each shift or if severe dirty/infected, whatever comes first). It took some time to organize things the way, that always enough clothes are available in all needed sizes. Just some under- and oversized colleagues were issued their own set of clothes. Negative is, that helmets (we rarely need one) and working gloves (same) are not issued but stocked in number of staff on the ambulance - if you need one, it's always too large or too small, which is bad for the protection level ( I seem to be the only one to make it fit before shift starts). And in career EMS we don't have any sufficient rain/sun or cold protection for the head, only the sloppy hood from the jacket. So in winter there is a variety of head cover. However, management doesn't seem to really care, they rant about own personal items brought in and once hung a paper on the blackboard, but it doesn't have consequences. Just in my vollie service even belts, helmets, sun caps, fleece bonnet, working gloves are issued personally - but there the staff is a finite number. And it has consequences if someone shows up without proper personal equipment. So, I think it's a mix of personal will with good organizational support and a management that really cares. If any of this doesn't work, you get a sloppy medic/EMT soon. BTW, next thing I have in mind to improve personal appearance is a simple but large mirror in the changing rooms.

Isn't there any concept in your country (as I recall we have at least USA, Canada, Australia, NZ, UK, Netherlands and Mexico here) to occasionally add transport capacity for non-regular emergencies in your area despite mutual aid? We have rapid response squads specialised in transport, prepared for multi casualty scenarios. Two ambulances per squad can be sent out in 10-30 minutes, volunteer based (mostly EMT level). In our little district we have two of those squads, so I can easily double transport capacity within short time. Additionally we have two volunteer treatment units that each may buffer 25 patients until transport could be set up. All of them have a call volume of about 2 per year (the vollies serve in regular EMS to keep in shape). That is even where we have a lot of ambulances (ground and air) available on mutual aid basis. Wonder if such things exists and/or are commonly used in your country. If not, and if you encounter such scenarios often, it may be a good idea...what does you hinder? EDIT: typo

Fully packed ALS ambulance and the BLS unit is left standing alone on scene? Okaaaay...(see below) No need to, we have automatic respirators on our ALS units. Yes, I'm aware. I grew up in a time in EMS, where hospitals could deny patients. So all the fancy high level trauma centers 30-60 minutes away just closed their doors and let us drive hours to the next big city. Night choppers weren't available then as well. I'm very glad the law has changed and every trauma center now is obliged to take just one more even if fully occupied (assisted by several organizational aids) plus we have usually at least one night flight available, if really needed. However, I wouldn't let the BLS unit just park on the scene without staff, because they're all in the ALS unit working on two patients in confined space. That sounds like a waste of ressources, in my eyes the BLS ambulance would be perfectly able to transport one of the patients. But I understand, that legal restrictions may arise, if BLS staff is not allowed to work under expanded authorization with rendering/supervising ALS treatments as i.v. drops and else. That's what I asked for to understand. Thank you for explanation! Again, I'm glad to not have those restrictions here (which makes it not better here, just may be easier in this special case).