mikeymedic1984

Because time is everything when it comes to saving lives (heart muscle and brain tissue). Just because your PROTOCOL says to go to the closest facility, does not make it right. It should be the most APPROPRIATE FACILITY (whether by ground or air). I would not take a pregnant woman who is having contractions at 20 weeks of pregnancy, to a hospital that does not have OB services. I would not take a critical or special needs pediatric patient to a band-aid station hospital that is going to have to transfer the patient later. Yes dumping them off our stretcher faster makes our lives easier, but it is not always easy to make a secondary transfer to the the most appropriate facitlity later in a timely fashion. You waste at least an hour of time for the patient by taking them somewhere that can not fix what it is wrong (maybe 6-12 hours). And NO, I am treating the patient, NOT the machine, by taking them to the place that can fix whatever is wrong. You don't take you car to the local "oil-change-only" shop, when you know you need a new transmission (by your logic, they have mechanics, tools, and a lift -- so they should be able to fix anything on a car). Why would you treat your car better than your patients ???

AMEN !

Thats fine, we can always agree to disagree, but I bet the school's attorney would think differently.

All ER's are set up to handle a stroke or brain trauma ??? Maybe in your neck of the woods. Not all hospitals in my area even have CT or MRI available, much less neurology, so yes they can throw a tube in his throat and transfer him 2 hours later, but thats about it. All hospitals can treat MI's, but are you argueing that it would be OK to transport an active STEMI to a hospital with no cath lab ???? If that is your only option, because you are in a remote location, then I guess it makes sense, but if there is a hospital within an hour away that has open heart capabilities, I think it would be better to go there, even if you have to use a helicopter to do it.

That is the point, none of us are politicians, we are health care providers. If we do not fight for what we know is right, then who will ???????? We can choose to hope that big-pharma gives us the silver bullet one day in the future, or we can work to do what we know works. It's funny fire departments, EMS departments, and Hospitals have no problem budgeting for a new ladder truck, a new ambulance, or a bond referendum to expand facilities, but we can't seem to find the money to do what we know will save the most lives. How many more lives would be saved by $500k of community defibrilators, versus a new ladder truck, some new ambulances, or a new outpatient center ??

There is a study out there somewhere that highlights the increased mortality rate of elderly patients with ground level falls; I will see if I can dig it up. But basically, as you age, your brain shrinks, leaving more room in your skull to bleed into. Therefore, elderly patients with a brain bleed may not show signs and symptoms for hours/days after their fall (and since it is only a ground level fall with a minor contusion/laceration on their head, and there are no signs or symptoms of anything worse, we (EMS) fail to transport, or the ER fails to scan them, and discharges them home). I wouldn't say you did anything wrong, if anything you overthought what you had, which may have steered you away from the most probably diagnosis (CVA/TIA or brain injury from the falls), which isnt necessarily a bad thing, I would rather you "THINK" about all possibilities (not necessarily ACT on all possibilities), rather than always assume the obvious; as long as you are not providing dangerous or unneeded treatments for the most unlikely cause versus the most obvious cause, there is nothing wrong with overthinking. You had too much artifact in your 12 lead to use for any diagnosis. Lots of elderly people have horrible looking EKGs every day of their life. Not to say that trigeminy or PVCs shouldn't grab your attention, but in the elderly who are asymptomatic of an acute cardiac event, and have a cardiac history, I wouldn't be reaching for the drug box immediately. We can argue about the use of a spine board, I probably would not have done it, but after four days of multiple falls, I can not fault you for doing it (until such time that we have x-ray/ct scanners on the ambulance). IF YOU DID ANYTHING WRONG, IT WOULD BE WHAT YOU DIDN'T MENTION: Hopefully you transported this patient to a Stroke Certified Hospital or a Trauma Center where a Neuro-Surgeon was available. If you transported this patient to "PODUNK COUNTY GENERAL HOSPITAL" with no neuro capabilities, that would have been a huge mistake. The reason I say this is that you noted the patient was released from the ER that same day for hypoxia after multiple days of falls/syncopal episodes (multiple falls/syncopal episodes in an elderly patient in a short span of time should have at least got him a 24hour Observation admission ---- not a good sign that this hospital discharged him --- unless the family refused to let him be admitted and sent him back to the NH); I am guessing you transported back to that same ER ??????

Oh I agree with that part of the arguement. There should be some type of bridge program like we have for Paramedic to RN, for all veterans (whether its medical, firefighting, police, driving 18-wheelers ---- they have shown the capacity to do a version of that work in the most horrible conditions --- there should be a way for them to transition to a civilian career over here, but it shouldn't be automatic, there has to be some instruction). I was responding to his earlier rants and raves, I missed the post where he apologized and mentioned his temper. Thank you for your service GHOST.

Actually I am saying she should call 911, simply because this is a "school/student" relationship, even though the student is an adult. Should the wost happen, which probably never will, the family's lawyer is going to ask why they chose not to call 911. Just as ER Docs have ordered unnecessary lab work, xrays, and CT Scans, that they knew were a waste of time, we have to protect ourselves from the lawyers. At a minimum, the school should be calling the emergency contact relative every time, on a recorded line, and asking them if they want to come get her or call 911.

Oh we have learned something, and it has been elegantly stated in this forum. We have learned that changing what drugs we give every 4 years is a waste of time, and that if we could figure out a way to get help to people faster (like Seattle/King county) many more people would survive, But for some reason, we just can't seem to find the money to do that. We can find all kinds of money to build new sports stadiums though.

Well unfortunately the internet was not available in the 1980s, so I am sure you can request info from each university that did a study. But I would remind you that all ROSC rates have pretty much been stagnant for the past two decades, so before you write me off as an idiot, maybe you should look up the rosc rates over the past three decades, do some research, and show me that I am just a medic with alzhiemers. I hate to be the one to tell you, but in 70's-80's ems, there was not alot of controlled scientific studies. But as stated, this generation has not improved ROSC, no more than we did in the 60's, despite all your studies, so who is the fool ????

I am glad you think your are an adult triemal, but to discount real life experience versus what you read in a book, is not very mature. I read that Obama is an alien from mars, and that Bush was a puppet of the Luminatie. I also read that the earth is flat, and that the menstral cycle can be cured with leaches. Real life would suggest a different reality. I had far more ROSC under the ACLS protocols (not my protocols) of the 80s, versus what is offered today. If you practiced under those protocols, then please provide your real life accounts of why they were wrong.

HMMMM , YOU have a patient that is A&Ox 3, 4, 5 , 6 -- whatever you measure, and they have a glucose of 12 ----- do you give D50, or do you think that possibly because the glucometer and strips are kept in an ambulance where the factory prescribed temperatures are not maintained, that the glucometer could be wrong. Technology is a great thing, but it should be used to CONFIRM what you think the diagnosis is. not used to give you a diagnosis. I know this is crazy to all you new medics, but this is why youall give NTG to people with chest pain that have just been in an MVC and hit the steering wheel and have chest pain. Dont practice cook=book medicine, use your brain.

Did the patient die, or end up negatively impacted by what you perceive is a failure ? I worked with an ER Doc who started every shift by filling out several patient assessments that fit into the 5 most common ER diagnosis's ---- the paperwork is a required chore, just because he got a head start which allowed him more time to see all patients does not make him negligent or a failure. Did her lack of assessment skills cause the patient to become violent ?

yes i did.

People who fake seizures, do so to get the valium injection. Since your person does not want EMS (which means no meds) they are probably not faking. If they are faking it is for the attention, but you put yourself at risk should you fail to call 911 when this person if faking or not.

Patients do not die because Paramedics fail to intubate properly; PATIENTS DIE BECAUSE PARAMEDICS FAIL TO VENTILATE PROPERLY !!!!!!

Quote from the movie Tommy Boy: Tommy: I can get a good look at a T-bone by sticking my head up a bull's ass, but I'd rather take a butcher's word for it. Always go to the source with such questions, I am sure the State EMS office will be happy to give you the correct/accurate information you need.

All I can say is that we had a lot more Returns of Circulation (not necessarily discharges from hospital) when we started every arrest patient off with a round of bicarb, D50, and Epi.

Explain to me the basic concepts of 12 Lead EKG (How do you identify a STEMI), and how Dopamine and Dobutamine works, in as few words as possible. There is a big difference in treating mostly trauma, to having to treat everything a regular Paramedic has to treat in a non-combat role. I will be waiting for your quick and immediate response since you need no further training (Its 12/12/2014; about 7:30am EST in the USA).

The progressive disciplinary tool is always your friend, for volunteers or paid people. Write up each incident, and progress to the next level when he/she does not respond appropriately. Is this person driving county/city/municipal equipment, or just showing up (unpaid) in their own vehicle ??? You do not write up "john/jane doe had a low blood sugar", you write up that "john/jane doe showed up at a call, and was confused and unable to provide care to the patient" (doesnt matter if he/she was hypoglycemic, drunk, or on crack ==== you concentrate on the failure to perform, it is his/her job to correct the lack of performance). If you make it about diabetes, you open yourself up to all kinds of ADA type issues. I am sorry, you can not have a policy that says "No Diabetics" in patient care roles, unless you want to make that person a millionaire.

Been doing this over 30 years, never needed a tool ----- If you will look at the back doors of your ambulance, you will note the gap between the doors (in the center), is the perfect amount of space to slide your portable O2 tank in and twist, if you lost your key (as are most other door gaps).

First: Always treat the patient, not the machines. Second: What was your transport time ?

I'm guessing she had to perform a sex act that she did not like.

Agreed. time for new career, or at least different scenery in your EMS career (ER, ICU, mobile insurance exam giver, consulting, urgent care center, Prison, instructor, dispatcher, whatever). Your not making any money now, so dont let that be the decider of your new career. If you could do it all over again, WHAT WOULD YOU DO ? DO THAT, no matter the financial harm. As the old saying goes, do what you love, and you will never work a day in your life. Most folks these days are projected to work at least 7 different occupations in their career, maybe it is time for you to move on to #2. I had a supervisor who's health got so bad, he was diagnosed with MS, 3 months after retiring with a disability, he was perfectly healthy ---- no job is worth that.

sounds like an attorney to me........ respond at the risk of your agency.