romneyfor2012

While thinking about the trauma patient call, I remembered this old topic about 66% of trauma patients arriving to the ER in a hypothermic state (not due to intentional hypothermia). I searched for it as a topic and did not find it, so if it has been discussed already I apologize. But think about it: We cut their clothes off, dump a bunch of cold IV fluid in them (at best your fluid is the same temperature as the ambient air in the truck, which is probably 60-70 degrees (probably worse in winter) after we lay them on a back board that is stored in an outside compartment (again could be really cold in winter months). Do you always cover them with a good blanket, or a thin sheet ?

I would be interested to know if the receiving facility even had a surgeon in the house, it was a non-trauma center in bad weather conditions. If not, 3-5 minutes would not have mattered (it would not have mattered anyway as 99% of trauma arrests die). With that being said, many years ago, our local trauma hosptial who also was the EMS provider for that area did a study and found that patients with penetrating trauma who were transported by car instead of ambulance arrived at the ER much faster (can not remember exact time difference, this was before we adopted "load and go" into our practices) and had better outcomes statistically. Which makes sense in that if everyone does their job perfectly, the car would at least have an 8-10 minute head start on you, and would probably transport at a higher speed than we would.

Research your state law, as laws should not change when the sheriff changes on something like this. Your state should have something that guides all jurisdictions on how mental health patients are admitted against their will. I understand the deputy not wanting to transport the patient 100 miles, but that is their (or your's) job when someone is homicidal or suicidal. A good lawyer would eat you alive if you had left this patient and he later did commit suicide, so even if your sheriff refuses to change policy, your service should have a policy that guides you if you do not already. My personal policy is to transport all drunks regardless of complaint, because the few times I have been burned, it was a drunk patient that did it.

Tired of hearing tax increase and at an impassioned and partisan politics

Actually ak it could nave happened to you. I changed the diagnosis to protect the medics. This patient had a rare ailment not seen by ems often and the only med that fixes it is prednisone, not other steroids or respiratory meds. When it happened the er doc had never dealt with it nor any medic I discussed it with. If I had listed the real disease it would have made the medics known. This patient was walking and talking in her home, all vitals normal, she went down very fast, with little warning, which is what generally happens when they have respiratory issues. ** Edited for typo created by autoword on my cellphone

In this real-life scenario, both were medics, the senior medic made the decision to transport to the ER and let his partner (the driver) return while he completed his report at the ER. He was suspended for 16 hours for doing so, but as he stated he would do it all again because if he got fired from this employer he could work elsewhere, if he lost his license, he could not work for anyone.

In one accounting, I read that she was not trapped, but it took them several minutes to get across the icey road and into the truck. It also claimed that the patient became combative at some point.

You are called to the residence of a 39 year old asthmatic at 3am, who is having respiratory distress that is unrelieved by her inhaler. You hear moderate wheezing, but nothing to be concerned about, seems to be your average every day asthma call. You get the patient to the truck and begin your first nebulizer treatment, and head to the hospital non-emergency (a 20 minute trip on backroads). Your patient starts to get more "tired", and sats are not improving, so you go to the next level in your protocol (whatever that is), about 2-3 miles from the hospital the patient goes into respiratory arrest, you pull over and intubate the patient, reassess vital signs, all is stable, and sats are improving. You know the closest engine company is a bout 5 miles away, and it is 3am, so you have to wait a little longer for them at this hour of the morning (in bed, got to throw on some turn-out gear, so you decide you will go to the ER instead of waiting on assistance from them. Your partner drives lights and siren, and as he is turning on to the road the hospital is on, he makes a right hand turn in front of a car he thought had stopped, but it had not, and plows in to the side of your box. Partner gets out, other driver is not injured (nor are anyone in the ambulance), it was low enough speed that the box is damaged but the truck is driveable, and you are literally 1/4-1/2 mile from the hospital. The patient's vitals are good except for respiratory rate, you do not believe the patient will go into cardiac arrest, but she is intubated. So do you: 1. Call radio and ask for PD, then instruct the other driver to sit tight, that you are going to take the patient to the ER, then your partner will immediately return to the scene to fill out paperwork. Realizing you are leaving the scene of an accident. 2. Or do you call for backup, wait there for the other ambulance to arrive, and let them transport (we will assume that ambulance is less than 10 minutes away). 3. Or do you do something totally different. This scenario is more about the risk benefit of leaving and getting the patient to a hospital, versus waiting and then being blamed because you delayed transport, so do not get bogged down in trying to figure out why the patient arrested, it happened, so now you have to make a quick decision, and for this exercise, your supervisor is not answering his/her radio or cell at 3am, so you have to make the call.

No agenda no gotcha just thought the stats seemed high

Your logic is sound mike, but with the current approval rating in the teens I will take a chance on losing the good 15% that someone thinks is doing a good job

I read another report that showed it took almost an hour to get to the hospital after arriving on-scene, it does not say how much time they spent on-scene or how many miles away the hospital was, so that could be a problem.

http://www.niagarafallsreview.ca/ArticleDisplay.aspx?e=3408114

Please join me in a new cause, I want to bring all of the Tea Party and Occupy Movement people into something we can all support: V ote E veryone T he-hell O ut 2012. Let's send a clear message to all politicians, that the status quo is not working, and it is time for a change. Vote out every incumbent office holder in the Federal Government, and no I do not care which party the replacement person represents.

I have not used this one where it pulls the stretcher into the truck, but I have used the power lift stretchers. I am a big fan, especially if you are an IFT service that has to lift a lot of bedridden patients all day, but here are a few of the problem areas: 1. Very expensive. 2. Very heavy if the battery fails or you have to lift the stretcher with patient up or down stairs, or over rough patch of earth. 3. You need to have a battery charger in every truck so that the batteries can recharge, I think they also have a charging stretcher bar now, so that the stretcher is charging all of the time. At first your batteries will have long life, but just like any other rechargeable battery, it will lose capacity over time. So make sure you have some way to charge in the field. 4. Have a few spares for when breakdowns occur, it does not happen often, but you usually can not fix these with a pair of pliers and a hammer, a service tech will have to come out, which could be days/weeks depending upon where you are located. 5. We did not see a significant reduction in back injuries with this purchase, but we may be unique.

I can't believe u went there but it is true

My way works on all concentrations, and yes I have a pump, if I did not I would demand dial-a-flows. We should not administer dopamine without one.

Been thinking about it dwayne, what if we define it as genitalia or breasts (female breast) being touched by some part of someone elses body against your will. We will not count slaps on the butt or accidental touches. Does that work?

Admin, I need some help, got a PM that said the poll makes you have to answer both questions, can you please tell me how to fix it so that you can answer either, but not both ? I do not see any way for me to fix it.

New study shows that nearly 1 in 4 women have been sexually assaulted or raped, and 1 in 70 men have too. I do not expect you to talk about it, but the poll results could be interesting. Please vote. http://www.cdc.gov/media/releases/2011/p1214_sexual_violence.html http://goodmenproject.com/good-feed-blog/new-cdc-study-on-sexual-assault/

Well first of all the gay thing is pretty year round in the keys and Palm Beach, just at a lesser level. Last time I was in Palm Beach I had to move to a different beach spot, as two gay men were making out pretty hot and heavy on the beach in broad daylight, wearing just speedos. The answer is much like what is going on with the Occupy movement, Police often choose not to enforce the law. To most of them, gays make them feel "icky", and they would rather not have to deal with them (especially half naked and in masses), just like they are not enforcing the laws in many cities to remove protesters from public parks. Imagine having to deal with 100 half naked men like flamingemt all day long after you lock them up ? Same could be said for homeless people, they are vagrants and there is a law against that, but if you arrest them, you have to deal with them (and smell them). In EMS it is like when you put a ccollar on a patient, once you do it, you pretty much have to do a full immobilization, so sometimes we choose not to do that.

Although there is nothing wrong with doing the above, I prefer to be exact, because I used to work on a neonatal transport team, where we would frequently make the concentration of drugs much higher to reduce the amount of drops that had to be delivered, in that situation you could not "spit-ball" the dosages, so here is an easy way to be exact: Multiply everything together and divide by the concentration: Mcgs you want to deliver x Patient KG x 60 / concentration So if you want to deliver 10mcg to a 50kg patient, 10x50x60= 30,000 / 1600 = 18.75 This formula works for all dosages and all concentrations, and you will amaze everyone as most charts round up 1-2 drops.

It is just one of those things that we need to change that we never have because we are lazy in EMS. It is rare that we fix anything in our industry unless a government agency/regulator demands it, or an insurance company decides to pay for it or quit paying for it.

I have to disagree a little crapmagnet. Yes, we all know of the studies that state "size does not matter", but that is not true for all women. Just like there are men who need to see 44DDD boobs, there are women who like to see an anaconda on their man. Although this is not a scientific study, if you just go to any of the websites where people are performing booty calls, 90% of the women's ads say "Searching for BBC or BWC", I will let you figure out what that stands for, but I have yet to see one that says Searching for SBC or SWC (lol).

I am going with Endocarditis.

I vote that you do not do anything, if you do not know it by now, you have no hope of passing, cramming will confuse you.