paramedicmike

I thought of a VAD, too. But if this patient had one It would certainly be plainly obvious when looking at the patient with tubes sticking out of his chest. That would've been a crucial piece of the story and not omitted from the scenario presented to the students. There was no mention of CPR in the OP... just that the patient was worked. So it's conceivable that no CPR was done... which would be appropriate if there was a VAD in place. Most VADs I've seen, however, have not produced a pulse. I know producing a pulse with a VAD is a possibility. But my experience with them hasn't demonstrated one. I'm still a little skeptical that this was a real call, though.

I'm pretty sure I know what thread is being referenced and the idea of a lawsuit makes absolutely no sense for the very reason AK mentioned. The upside to this is that it should make it easier for Admin to avoid litigation should any papers related to any suit ever be served to him.

Here's the link.

Good. That's fine until you're told to take five and want to sit in that grass. Gross. Doesn't matter. It's still just as bad. You are both an EMT and a soldier. The soldiers in your squad/platoon will look to you, if they don't already, for advice on all things medical. As someone who may be the only medical resource immediately available for your soldiers it's up to you to lead by example. It doesn't matter if everyone is doing it. You know it's bad. You have seen the bad effects outlined here. As someone who's responsible for the medical welfare of your soldiers it would make sense to take point in making sure they at least know it's disgusting. That doesn't mean harp on them. But a well place statement on occasion ("Dude! What are you doing? I gotta sit on that grass that you just spat into." or perhaps starts a weekly mouth check in everyone who chews to determine mouth damage) can do wonders. To take this one step further, I fully understand the stresses placed on a combat unit. Some stress relief absolutely *must* take place. But you have to admit that a stress reliever that slowly eats away at your teeth, gums and jaw isn't really doing much for you or your soldiers. The Kingdom of Montgomery is a nice place. I don't miss it at all, though. Good on you for getting out to see the world. Much props.

I'm not sure why someone felt to mark this comment negatively. This is absolutely correct. EMT-Bs do not have adequate education to be making the decision whether or not someone really needs to be transported to the ER. Hell, a lot of paramedics don't have it, either. EMT-B is glorified first aid. I hate to break it to all of you who may think otherwise. But that's what it is. (And at this point I think it would be good to remind people, too, that making such comments is NOT a personal slam. So don't take it as such.) If you want to be able to make the determination as to who needs transport and who doesn't several things need to happen. First, we need to create an adequate educational process that will put providers on the street who have the educational foundation to function at a level higher than what we are now. Then, we'll need to demonstrate we can competently provide care at that higher level. Once that is done we'll be able to argue that we have the ability to refuse transports or direct people to alternative sites of care (e.g. urgent care clinics, primary care docs etc...). In the meantime, expand your education. Move up to paramedic by taking a full on degree awarding program. Take as many classes as you can in addition to this educational foundation. It will not be wasted effort. At times it may seem like it's simple to determine who needs transport and who doesn't. But it's not always that easy. And at this point it is simply an issue of not knowing what we don't know. edited to fix a couple pretty blatant spelling errors.

Condolences and peace to his family.

Your broad generalizations aren't very becoming. I agree with EMS49393 in that you may want to choose your words a little more carefully. You're talking to a lot of people with a wide variety of extensive patient care experience... some people have been doing this job since you were in diapers. Being a motivated soldier is one thing. Being a jerk is quite another. I get the impression that you're both young and still pretty new to the Army, yes?

Unless you have specific permission from your employer to use the items in question, regardless if the item is outdated or not, it is still theft as the items used do not belong to you. If your employer gives you permission then your employer assumes responsibility for the potential outcome. If your employer does not give you permission you're stealing. Out of all the places I've worked, both EMS and in my pre EMS life, none of my employers would allow it for fear of condoning what could potentially (however unlikely) become a hostile work environment complaint. Don't get me wrong. I'm all for a good joke so long as it's off duty and away from the station. But on duty and in the station or on the ambulance is not the place for it... especially if it involves stealing from one's employer in order to make it happen.

Well that's the kicker, isn't it? Some of the best laid plans seem to have a way of backfiring when we least expect, or want, them to. I, too, love a good gag. I love a good gag when it's done off duty and away from the station. I can't, and don't, tolerate this kind of stuff at work because no matter how innocent and harmless those planning may try to make it there will always be that one time when it will delay a response or compromise a patient/family member. And the one time it happens always happens to be the worst possible time. I agree with this, too. However, off duty and away from the station is safer for all involved. There is no chance at creating any kind of problem when it's done away from work. There's no damage to equipment, reduced chances of hostile work environment accusations, no chance of delaying a response, no chance of compromising patient care and/or embarrassing yourself and the organization in front of a patient or family member. Also, consider what's been posted. Several of the activities mentioned here will most likely involve theft (IV tubing and saline, lidocaine jelly, KY/surgilube) which is a sure fire way of getting oneself fired if caught. If company computers are used and passwords are stolen, this will most likely violate any computer/network usage policy that may exist for your organization (at least it has in every EMS and non-EMS organization with which I've been affiliated). Even if it's a personal computer, stealing passwords can lead to criminal charges. Termination of employment can quickly follow. By all means, have fun with your coworkers. Enjoy a good gag or joke or whatever. Just be smart about it and don't do it at work. It's not worth losing your job over.

What do you have to work with? Etomidate only? No other drugs? What could stop this seizure and possibly help you better secure the airway? If the jaw is clenched then the patient is already suffering from trismus. Do you want to give them something that will only perpetuate the condition? Or move straight to the backup plan? Or try something that make make your primary plan a little easier? Are you sure? Is etomidate really going to relax the jaw when the patient is actively seizing? I understand what you're thinking. And you're on the right track. I just think there's a better way to go about this than what you've outlined so far. I should add my apologies to Kiwi. I'm not trying to hijack his scenario.

Do you really want to give a medication that can cause trismus to a patient with a clenched jaw and is actively seizing?

I put in "Negotiable", too. Then, when the offer is made and they start talking compensation, I start with a number/proposal that is much more generous than I reasonably expect to earn. I'm willing to bargain down to what I really want.

This. Take the class as well. Find one and sign up and go. It will be well worth your while. If, for whatever, reason, you can't take the class, this is the book you need (same as what's referenced above).

Somehow, I'd expected that he'd have better peripheral vision. Here's the story. I was going to post this in funny stuff. But someone getting hit by a car isn't really that funny.

Hey JayEMTP, I suggest you spend a little more time perusing the forums and getting to know the people here before bashing a rather established and respected member of this community with your own demonstrated ignorance. It might save you some trouble in the long run.

I'm with JWade on all of the above. Pacing is probably not going to work. Will it hurt to try? Probably not. Will it be effective? Probably not. Do I recommend it? No. In an effort to understand the larger situation I do have a couple questions, though. Why initiate transport on a cardiac arrest patient when you have a minimum 60-80 minute transport time? CPR is not effective in a moving vehicle just as it isn't effective when the person providing compressions is exhausted. You're not doing anything to help the patient at this point. What will it take to change your local culture to work a cardiac arrest on scene and transport only if you see ROSC? Does your MCP not understand the time and distances involved? Since s/he wouldn't let you discontinue it would appear not. You need to make this point crystal clear to him/her when you call in your request. Please think back to your CPR training, too. One of the endpoints of CPR is when the provider is too exhausted to continue. If one physically can't provide compressions are you really going to risk harming yourself for the benefit of a dead person who is going to stay dead? Good luck.

Because too many moronic EMS providers arrive on scene, say the person is dead after little more than a cursory glance, only to be called back to the morgue when the "dead" person wakes up. These stories hit the news every once in a while. It's generally bad press for all involved. So, EMS docs have to dictate protocol to the lowest common denominator.

Pretty funny. And since I can't seem to get the page to display in this window, here's the link.

Couldn't this have been handled in a private message? Just curious.

Ok, it's not much. But every little bit of good publicity helps. Kudos to the bystanders willing to get involved. Kudos to the EMS crews there and ready to go. Good luck to the runner who was treated. Here's the story.

This is exactly what is wrong with EMS, and NJ EMS in particular. First, the EMTs are exactly what is wrong. Their insistence on volly squads only fuels the FAC which pretty much, almost single handedly in fact, keeps NJ EMS in the dark ages. The idea that "we just follow protocol" demonstrates that you (volly EMS, not you individually) are not smart enough to think independently. Not being able to think independently is a pretty significant problem in itself never mind how it binds you to blindly do things without understanding or knowing why you're doing them. As for the first part of your post and not understanding why people would put down vollies, there are *MANY* discussions in these forums detailing why volly EMS is a plague upon this industry. Please look around and see what you can find. You have a lot of reading and learning to do.

They must've been removed. Someone came through and posted a bunch of negative marks on anyone with even a remotely disparaging comment about volunteers.

Too bad Billy Graham never said it.

It's better to add onto an existing thread than create a duplicate, yes. In fact, it is entirely appropriate to do so. It is also entirely appropriate for anyone reviewing an old thread to read the thread in its entirety to gain an understanding of what's already been said before adding new comments. Lately, there seems to be a rash of really old threads being bumped with no new or useful information added. I'm all for increasing participation in ongoing discussions. But many threads that go years without new posts usually go that long for a reason. Random posts by someone who obviously hasn't read the whole discussion do little to promote ongoing discussion or understanding. Unfortunately, for the newcomer, that is often times a disservice to their learning and understanding of the topic at hand. The tough part is finding a way to get them to read the entire discussion before posting... -be safe

If anyone thinks the OP got a hostile response here, wait to see the replies he'd get over at JustHelicopters. This place is tame by comparison.