paramedicmike

Gotta ask them. I don't know why. You'd think if they spoke english they'd be less likely to have INS called on them. -be safe

Another trick I've had minor success with is this. If you suspect your patient does speak english and is just playing dumb start asking your partner about the "wanted poster the police gave you this morning. Doesn't this guy look just like the picture? Same height, weight, build, he's also (insert ethnic group here). And didn't the cops say he would be wearing (insert type of shoes here)." Watch for their reaction. This doesn't always work but it's worth a shot. I can do ok with spanish speaking patients. I did have one patient who I suspected of being able to speak and understand english but was just playing dumb. I started in spanish with him. After several minutes of speaking with him in spanish, I said to him in plain english, "Hey, you dropped your wallet." Don't you know the guy stopped and looked? Busted! Good day! -be safe

If you know what language your patient speaks, follow these instructions: 1. Dial 911 from a landline. 2. Identify yourself and your unit to the dispatcher. 3. Ask for a patch through to the language line. 4. When the interpreter gets on the line, identify yourself as an EMS provider in need of translation for a patient you're trying to treat. It requires a bit of passing the phone back and forth but I have had some fair success it. Languages I've had to access included Russian, Chinese, Vietnamese among others. At the very least it can get you set up with information prior to transport. I have tried it with a cell phone but did not have much success. Part of that was I think it was a poor connection. Part of that, too, I think came from the fact that when I dialed 911 on my cell phone I got a call center in another state. If you can get a decent cellular connection you may be able to take it with you in the ambulance. That'll depend on your local coverage area. Hope this helps you. -be safe.

We have the choice. If their pressure doesn't support the use of morphine we can consider fentanyl. However, if their pressure is somewhat "normo-tensive" (please note the quotes) or elevated, I like to go with, and the docs seem to prefer use of, morphine. -be safe

Just to keep things in perspective, the youngest patient I've treated with an active MI was 11 years old. That's right, eleven! There were no known congenital problems with this kid prior to his MI. The last time I did any follow up on him, no congenital problems had been identified post MI. What's more, his presentation was similar to the original post. He was running through the yard playing tag with friends when he collapsed. (This kid, however, coded on the way to the ER and was successfully resuscitated.) Don't let age fool you or throw you off. Use your assessment to narrow down the problem. But don't exclude something from your differentials simply because you think the patient may be too young. Just food for thought. -be safe

This is the Funny Stuff forum. This is not funny. The original post did not include the warning. Admin was kind enough to add that after the fact (and after several replies had been posted). There's a difference between posting for educational purposes and posting for sheer sadistic pleasure. This was not presented as an educational opportunity as it was 1) posted in "Funny Stuff", 2) not prefaced with any type of lead in other than wondering if this really counted as snoring respirations and 3) the answer to the question posted is so blantantly obvious there could be no other reason to post it other than entertainment. :roll: Will we see this in the field? Yes. Is this an example of mechanism of injury and the resulting presentation of a head injury? Yes. Would it be appropriate for a classroom setting? Possibly. But no. The original poster presented this under false pretenses so as to elicit responses consistent with the gung-ho, "F' 'im up" attitude that most teenage testosterone laden boys carry with them. If he wants to continue to be a child with delusions of grandeur then do it somewhere else. If he wants to legitimately learn from this, post it in another forum. If he's looking to pass himself off as a tough guy thinking this kind of stuff is bad a$$ and cool then he needs to grow the @#$% up. Legitimate learning could be had from this, true. But this was presented only for shock value. And that deserves no respect at all. -be safe

This is so farking wrong it's ridiculous. What's wrong with you????? You find this amusing? Funny? Entertaining? Can we get this removed? Not cool. So very, very, very, not cool. :evil: :evil: :evil: :evil: :evil: :shock:

NREMT: Have you looked here? http://www.vidacare.com/Products/index_4_29.html There's a couple videos associated with the device there. As for discomfort, it is less painful than a regular IV stick. I've seen video of the developer having one started on his own leg and he didn't even flinch while speaking. Hope this helps. -be safe

+5 for Becksdad. That's a great post! Thank you for clearing up the confusion surrounding practice in Florida. -be safe.

As this scenario is presented, I would not do the procedure. I would explain to the doc I was neither comfortable or properly equipped to handle the procedure in the ambulance. Fallout will land where it will. -be safe

I thought, "Nah...this isn't going to be any good." Once I managed to stop the tears flowing because I laughed so hard I changed my mind. HA! Nursemonkey. HA! Shut your fat mouth! That was pretty good. I do have to say though, did anyone else notice that the IV bag they were handing back and forth was upside down the whole time? Just made me laugh even harder. -be safe

I agree with what the others have said. If this person was detached enough from the situation to act professionally and you needed the help then why not? This serves a couple purposes. It gets you the help you needed. It gives the family a sense that everything that could have been done was done. Presumably, the family likes and trusts your friend. Seeing him partake in an attempted resuscitation could do a lot to relieve their stress and anxiety surrounding the death. As with everything else, document accordingly. Hope this worked out well for you. What happened? -be safe

Hmmm...short sighted and misinformed at best. There are no angles to spin this on. If you are a BLS provider, you treat at a BLS level. How is this difficult to understand? Need help? Want to do more for your patient? Call for that help. It's a pretty simple concept. That "means to an end" argument will not fly if you work outside your scope. After the incident is over you will be held to task for the actions you took. The "end" will be you losing your job and possibly your certification. The "means" to that end will be you having worked outside your scope and effectively broking the law. As to your plane crash scenario, I'd let it burn until the fire guys put it out. Call for lots of help. Once people start bringing me patients, treat them appropriately and within the limit of my scope. If I can't do something that the patient needs, I'd get them someplace where they could get what they need. If I can't do that, then it all falls back to EMS lesson number one which states, "People die. And sometimes there's nothing you can do about it." -be safe

They're dancing around it, Bushy, because so many people in American EMS thinks they should be able to do things and rules/education be damned. These are the people who are in it for themselves and not the patient. This is where much, but not all, of what has been brought up in this topic stems. It's the "ME ME ME" factor. Unfortunately, this is where American EMS gets hung up so many times. It's also a major reason why we here in the States aren't taken as seriously as some of us think we should be. You're spot on, though. It is black and white. It doesn't matter how you spin it. Unfortunately, people don't see it that way. -be safe

The answer is still no. They're still operating out of their scope. You're still delegating tasks that you shouldn't be. They're not your medic students. You're not their preceptor. If you allow it and then chart that you did it then you're falsifying your chart. Even if you don't write down that you did it or the EMT did it, the mere fact that an ALS procedure was done with you being the ALS provider on the ambulance means you did it. You have then falsified a chart. This doesn't bother you? -be safe

It seems the basic element of this discussion is this question that was recently restated, The very next sentence answered this question, If the legal answer is "no", then where's the problem? There may not have been any statement made as to actions of the medic save confirming the needed info for medication adminstration and instructing the EMT in question to push the drug. However, those of us who have been doing this for a while can see the different scenarios that have been outlined here. It didn't *need* to be said when it comes to the medic. The scenario, as initially presented, says this medic was out of line. If there's additional information that might be important to the scenario, now's the time to include it. The argument of "doing what needs to be done" only goes so far. You do what you need to do up to the limit of your training. If that's the case, that you "do what needs to be done", then basics should be allowed to do anything they want. And we all know this isn't a good idea. If a provider wants to do more than what's currently allowed then it's up to that person to go back to school and work his/her way up to the next level. That's the way it works. This isn't limited to basics. There are situations where I, as a paramedic, knew that certain things needed to be done. I also knew that some of those things were outside my scope and, subsequently, against the law for me to complete. So I didn't do them. And in at least one of those cases, the patient died. It happens. It's called life. The question has been asked and answered. I'm not sure where the problem lies. -be safe

I understand the point being made by those of you who say it's a mechanical act and, when supervised by the medic, should not be problematic. And, to a certain extent, I agree. It's merely mechanical in that you push the plunger and give the medication. But there is a problem. If the medic is too busy to do it him/herself then the basic is administering a medication unsupervised. Supervision implies that the medic is watching what's happening (and can intervene immediately should something go wrong). How can that happen if s/he's too busy to do it personally (i.e. tied up with other interventions)? Also, while pushing a plunger may, in fact, be a mechanical act, do you (a general you, not to anyone in particular) know how fast to push? Or does this med (depending on the med and the situation) get pushed slowly? This ties in to the supervision aspect, too. If the medic is so busy that s/he can't personally push the medication, how can it be expected that the supervision will be provided by that medic to ensure the drug is given effectively? Morphine given too quickly will cause a patient to puke. Unfortunately for me and a patient I had as a brand new medic, I learned that the hard way. Hell, I've been given morphine before and the brand new RN who gave it to me learned the same lesson. There are many things I will trust a basic partner to do. This isn't one of them. -be safe edit: VS and (I can hardly believe I'm saying this :wink: ) Whit, well said. You posted while I was writing. Spot on. Both of you.

Dude: You *really* need to do a search of these forums. -be safe

Should it happen? No. Does it happen? Yes. Do I allow it to happen if I'm working with an EMT partner? No. Does your friend have a right to be nervous about this? Yes. Especially now that it's posted on the internet for all to see. (Don't think for a second any of this is anonymous.) Did both of these providers do something wrong? Yes. The EMT worked outside his scope. The medic falsified a legal document. Both are grounds for termination and cert/licensure revocation (depending on location). -be safe

So if Dust can do it under those conditions, why can't it be expected that others do it as well? If you blame your poor spelling and grammar on lack of sleep that tells me a few things. Chief among those things is that you didn't pay attention in school well enough to have the habit of writing properly. If you cared enough in school to make it a habit then it wouldn't show through when under stress. What's more, if you didn't care enough about it then to make it a habit, what does that say of your other so-called "educational experience"? It tells me that you don't care about your schooling. Which tells me that I don't want you taking care of me or my family. I know of no other profession that uses "Oh, I was tired" as an excuse. It's not accepted anywhere else. It shouldn't be accepted here. If we're talking about being professional, this is one of the first places at which it needs to start. Stop making excuses. If it's worth doing, it's worth doing right. If it's worth doing right, it's worth doing right the first time. And you people wonder why we aren't viewed as a profession. I don't have to wonder. I just have to read some of the posts here to this forum. :roll: Unfortunately, that tells me more than I really want to think about when it comes to my coworkers. :shock: -be safe

I'm familiar with the Army terminology. However, according to every single soldier I know, every single piece of Army referenced material I've seen, the spelling is "Hooah". Hooha is slang for a certain part of the female anatomy. Further evidence that the poster in question fit's number 2 of Dust's possible scenarios. That's just funny! -be safe

Hooha? What are you? Some sort of hooker? :roll:

Any partner I have has to demonstrate to me that s/he know what s/he's doing before I trust them enough to let him/her go. This goes for a basic or medic partner. It matters not which of the two it is. Now, I don't think a partner should have to explain why they're doing things or even ask permission first. But that person should be ready to answer accordingly when I say, "What in the world are you doing?" For some partners this takes longer than others. To be fair, I expect my partner, basic or medic, to treat me in the same manner in a given situation. From a medic's perspective, anything that happens on the ambulance is ultimately my responsibility. So I feel that I need to make sure I know what's happening. And that's why I might ask why my partner is doing something. Once we trust each other, however, it becomes more a matter of "grab me if you need something". Again, some people get there faster than others. Hope this helps. -be safe

I've done this before...push D50 through a 22g IV cath before. Was it ideal? Not really. Did the patient need it? You bet. Did the patient have any other access besides this tiny vein in her hand? Not on your life. It was a very slow push. I kept an eye on the IV site for the duration of the push. The vein did not blow. If you're careful and watch what you're doing it's not a big deal. If you can continue, then continue. If you have to stop, since you're watching closely, you stop. -be safe

...when you wash your hands *before* you go to the bathroom. -be safe