DFIB

FNG You are a small, sad person. I feel sorry for you so I gave you an extre minus one. You are now a -15.

Congrats amigo, Mongolia should be a wonderful exparience. Kinda makes me a little giddy to think that you are headed over there. Will you be treating Mongolians or Americans? If you have time see if you can get into a mongolian wolf hunt. I have heard they are an experience different than any other. I wish you the very best!

We have touched on various approaches to the transport of morbidly obese patients. I would like to pitch a couple of different ideas into the mix. I was considering the discrimination angle as far as obese patients are concerned. Most morbidly obese patients know how much they weigh and how difficult it is to be transported. I mean everything about their health is specialty oriented. I am tossing around the idea that the real discrimination is cramming them in a unit not appropriate for their size. Kind of like a hospital with no wheelchair access. How would they view a provider that crams them in a unit that is too small? Expeditious or uncaring? Are they embarrassed when they are crammed into a unit that is not appropriate for their size? Could a patient successfully sue for being transported in a unit that is to small? Wouldn't they already know that transport requires specialty units as well? I wonder how the morbidly obese patient views a provider that would recommend a bariatric rig because of unsafe conditions in a standard ambulance? Would they take it as a sign of caring, laziness or something else? Do they appreciate the time and care demonstrated by the provision of equipment rated for the task or resent they need a specialty unit for transport? What happens if they develop a cardiac or respiratory emergency condition in route and there is no room in the truck to work them? Or get nausea from the ride?

I think the difference is that it is the other guys cert. on the line if he makes an unsafe desision. He/she can be responsible for their choices. I can only say what I would do and what I am willing to risk or not risk. I would rather risk my job than my certificate or my reputation.

I am wearing a pair of Bates that are 2 years old. They have held up very well through a lot of rough treatment.

As a private business owner (non EMS) I am always dismayed when an employee turns down revenue but am open to hear their reasons for doing so. When the company is the only person liable they can make you do what they want or else. When you share liability as a prvider you should have the freedom to make difficult descisions like this one. I think you did the right thing. Professionalism is king. The patient doesn't deserve a jerry-rigged transfer where they would be uncomfortable of possibly injured. The transfer from the bet to the truck would seem complicated and potentially dangerous for the patient and the people lifting. Exceeding the capabilities of our equipment is always a bad idea. It was not an emergency. If she was injured the company could face legal action. The hospital should remember you as the guy who considered all of the before mentioned aspects and made an unpopular decision that was best for all involved. So you protected the patient, the equipment, the company and you and your crews safety. Good call. Edited for spelling

In my area EMS is really new. The oldest EMT has been out of school 3 years, no EMT-I's or EMT- P's. There are some guys that aren't that good. There are others that arent that well kept but my crew has always been able to distinguish ourselves as professionals. I know and see some of tha Drs on a social level and they undoubtedly ask me when we will be working and appreciate the care we put into our patients and jobs. Dealing with sloppy, unprofessional, yahoos is embarrasing and dishartening. It makes me try harder, I try to think of myself as an agent for higher standards, Whether we notice it or not, other professionals notice.

Richard. I stop pretty much at every call I think I can help safely (there are a lot of narco shootings on the road here. I don't stop if the MVC looks suspicious). I carry a lot of gear. Same as you I call EMS services first (our emergency number here is 066). I also won't fault others that don't feel the conviction to stop. It is a personal decision that carries responsibility to self before others that I don't take lightly.

About 60% of my students are lazy. The worst are the ones that think that they know enough to be an EMT because they have spent a couple of volunteer shifts at the Fire station. We are able to bring about 20% up to speed. the other 40% either don't really want EMS bad enough or just dont have the muster to get it done. Being good is an individual choice.

In the third world we don’t have the luxury of sheets for the ambulance, (you know with socialized medicine) . We transport our patients on the mat and wipe it down after every patient. In the USA (with non socialized medicine) we would exchange our soiled sheet at the hospital for a clean one. Also there is a towel to go under the head. The ambulance carried 5 clean sheets, towels and 2 blankets. Stretcher gets cleaned after every patient. As far as the sheet flip, if it really bothered me I would mention it to the offender but wouldn’t consider going beyond there. Even that is debatable because I might end up working with him someday. It is likely he will not have fond memories of the day a new student was critical of his work. Like another poster already said, we can make our EMS work environment very inhospitable over small things.

Ugly They give love a bad name Good post

I agree that fast food is inherently unhealthy and that they are masterful at marketing but I think you also hit the "nail on the head" when you said you choose not to eat fast food. Life is about choices. I am pretty sure that you were not implying that you were smarter than the people that speak "urban vernacular". But you are better informed and more disciplined. Unless a person has a medical condition that contributes to their obesity it is about choices and personal responsibility. It takes a lot of discipline to eat healthy, reduce your caloric intake, and especially hard to wean off sugar and fatty foods. Our obesity rate would not speak so much to bad eating habits but to people’s desire for immediate gratification, be it food, sex, drugs. I think it speaks to not having the will and desire to deny the pleasure of eating for the greater good. Aristotle seems to believe that pleasures compete with each other, so that the enjoyment of one kind of activity impedes other activities that cannot be carried out at the same time. He states that although some pleasures may be good, they are not worth indulging when there are other pleasures that are far better. The pleasure of eating VS the pleasure of being healthy. I cannot blame fast food advertisement for the obese. For me it is all about choices. I'm picking up what you are throwing down bro.

I heard a kid burn to death about 25 years ago. We pulled the driver out but the passenger burned to death. He was only 17. It was the most horrible thing I have ever experienced.

Hot Dang!! Your posts get more intelligent every time. You really just don't get it do you? You are privileged to have medics and Drs with years of combined experience give you pointers and advice. A smart person wouldn’t piss it away with ignorant generalizing remarks.

Thank you Wes. It seems that we often end up with questions about the legal aspects of EMS and you court room experience definitely brings perspective to the forum. Your knowledge of the legal system will be very valuable to many of us. Great first post. Welcome.

Your post would be funny if it were not so sad. Why would anyone think that their personal fantasy about a "duty to act" would hold true for others other than what is clearly defined by law. That just seems a little arrogant and naive to me.

Welcome Wes, I am sure we will all benefit prom your particular skillset. There is a open thread about writing better PCR's that I would like to hear your opinion on. http://www.emtcity.com/topic/20771-learning-how-to-do-a-good-pcr/ Enjoy, Edited to insert link.

After reading the thread I concurr with others that we are possibly talking about two different aspects of the reporting procedure. On one hand the need to communicate pertinent information in a quick and consise way and on the other writing a report that will be defensible in a lawsuit, I will continue to invest the additional 15 min to write the deatils because I consider it a smart investment to the future. Also beacuse when the lawsuit occurs 3 or more years latter I will need those notes to remember the call and be able to be a credible witness on the stand. I would hate to have to give sworn testimony on a three year old memory. There are some calls from last month I couldn't describe adecuately to defend. In court if I say anything different from my report the lawyer will hang me with it. I continue to be in favor of complete narratives.

Direct pressure, tourniquet only to be removed in the presence of the Dr.

The impact of the billboards in my opinion will only breed negative results. If a fit kid that sees this billboard on the way to school he will arrive with the idea it is ok to publicly criticize fat kids. Why not? There is a sign on the road so it must be ok. If a fat kid sees it he would probably immediately want tp skip school because he has just received public disapproval for a condition that is his parents fault. This is wrong in so many ways.

My condolences to Rob's family and friends that mourn his passing.

I have to concur with pretty much everyone that has posted a response. And do not want to repeat all of it. You seem to allude that some of us are uncaring because we make a reasoned decision to stop or not stop at the scene of an accident. This is not true. Any real EMS person knows the limitations of stopping without having the proper gear to work with. We also understand that depending on the area the patient is much better off waiting the extra minute or two for the ambulance. The truth is that on your own you really can’t help that much. Providing your own equipment is not in your best interest either. You would have to work three jobs to provide your own equipment to patients on the road. The most important thing you can learn from this thread is that if you REALLY have EMS in your blood you will NEVER do anything like this again. If you are found guilty of all of the things you committed the possibility of ever being a practicing EMS provider are very, very slim. You need to understand that the FF “Looked at you like you were crazy” and left you to deal with later because they had to go see if THEIR patient was dying because of your actions. You are young, so take the time to go to school, train properly and THEN you can help many more.

What a waste of money. They are already cheating with him.

I am surprised no one carries chewing tobacco. Or was it ommited from the list.