strippel

I have seen where it is better to not use lights and siren on divided highways.

Now, that said, we don't have that many miles of them. Usually, we are trying to get to an incident on the highway, or are only going 1-2 exits.

If we are doing an emergent inter-facility transport (big hospital to bigger hospital, but doesn't warrant a flight), it's not worth using them on the highway.

I don't think mental health patients are difficult to deal with. As Rid stated, supportive care is the way to go.

First, ensure your safety, your crew, bystanders, and the patient.

After that, it is professionalism and respect. Ask appropriate questions, do an assessment.

Most mental health patients have legitimate medical problems. They need inpatient/outpatient, and pharmacological treatment from MDs, psychiatrists, psychologists, and social workers.

If they are anxious, reassure and calm. If they are depressed, talk to them if they are willing.

There are those that are just nuts, or criminal. Be careful with them.

The patient needs a specialist, EMS is there for the ride.

I am glad our 3 local hospitals are very supportive of mental health patients, especially in the emergency setting. There is another hospital nearby where the preferred treatment of involuntaries usually consists of 4 point restraints in the emergency room.

We have a bariatric truck. Obviously, it is not regularly staffed, but during the day we can get it on scene relatively rapidly. Nights and weekends slightly longer due to less staffing.

We use it pretty often, and it has assisted other agencies. It is accessable to any who need it (except our "competitors", whose supervisors won't allow it to be called). There are only 2 others in our region (6 county EMS district).

We will usually wait for it to arrive, as most bariatric patients are in ECFs. In a life threatening situation, the time factor would be considered.

We have a Ford F450 Type I. It has a ramp and winch, with a wide Ferno PowerFlex, which is rated more than 700lbs. There are also extra staps, and a wicked cloth-type slider. (Feels like it's made out of Teflon). We modeled the truck and equipment after Southwest Ambulance.

There is a replacement in the works. I don't know any details, there will be a lift mechanism which will lift the entire litter.

I can honestly only think of one time (recently) where I induced a refusal.

In this case, it was the 3rd 911 call to the residence in 24 hours. My partner was on one of them, and the previous crew told us about theirs at shift change. Bottom line, a female family member unwilling to properly take care of an older male with dementia. He was at the ER x2, and given prescriptions, which she refused to fill and give him. Also, the patient was to go to the county ECF, and administrators even arrived to pick him up. She refused, even though she set it up in the first place. Bottom line, she wouldn't get his money any more.

It is easier for me to transport, than not. I have to explain more (we have a long list of risks), and document more. I know a large number of calls are BS, and don't need an ER. I did not stay at a Holiday Inn Express. Hell, I'm only half way through Medic school.

Pretty uneventful day.

Got in at 0700, checked the truck, and harassed my partner.

Went to breakfast with one of our BLS crews. A very kind patron picked up the tab.

Got dispatched for an unknown problem. A patient with MS called 911 with her mouth dialer. Since the county dispatchers had a hard time understanding her, they feared the worst. Turns out the police broke her door down for nothing. She was fine. She was calling her sister, and the dialer defaulted to 911.

Assist volunteer BLS for an unconscious person at a Amish restaurant. She begrudginly allowed BLS to take her vitals, didn't want ALS to touch her, and refused. She looked pale, and my parter and I were uncomfortable. She and her family still refused.

Assisted our BLS with a hemorrhage. Dialysis patient had graft problems, was in ER on Friday, and signed out AMA during treatment. Woke up from nap bleeding like a stuck pig, lost at least 1500cc. Transient hotel, 4th floor, elevator broken, only one set of stairs. BLS had bleeding controlled and o2. FD helped carry the stairchair through blocked hallways and cluttered stairway. Patient not fully responsive. BP of 80/p trendeleburg on the litter.

Fire marshall's office will be busy on Monday.

I was at an EMS conference over the weekend. Ken Bouvier (past head of NAEMT, and head of New Orleans EMS) was the guest lecturer.

He talked about injuries in vehicle collisions, and did a very simple demo. He placed 4 chairs on the stage, and had 4 people sit in them. He then asked them to stand, and sit in every seat in a short amount of time, without going outsde the chairs. Of course everyone bumped into each other. That simple display is what happens during an unseatbelted roll over.

The only EMS supplies I have with me are what ever I forgot to take out of my pockets, and is now floating around the back seat of my truck.

I don't have any advertising on me, unless going to or from school or work. Nothing on my truck.

I used to have my Nextel with me so I could call 911, but since the bastards turned me off yesterday....

(My new Cingular arrives next week.)

I MIGHT consider stopping if I witnessed, or if I see stupid people making the situation drastically worse.

It all depends.

All of the obvious linen (sheet bath blanket, towel, pillow+case). Add blanket(s) when cold. All have a purpose.

(We usually don't have a pillow, they don't trust us with sharp objects.)

We run mostly ALS transport ambulances (some BLS depending on staffing), and calls are dispatched either ALS or BLS from the information given to the E911 dispatcher. We decide by the additional information given on response.

ALS sounding: Litter, ALS bag, monitor, o2 caddy.

BLS sounding: no litter, BP cuff. Or maybe BLS bag and o2.

Most of us follow the "proximity rule". Your comfort level on equipment is directly proportional to the distance you are away from your ambulance. BLS call in a row home, ambulance out front, BP cuff. BLS call to the 11th floor of the high rise, litter with all ALS gear.

We have Stryker Power litters, or Pro-Flexx with the "Catch-All" on the back. They get well used.

How about the old Smith and Wesson?

In our ER, it is usually very acceptable to watch trauma, as long as you are out of the way. If we have students or observers on, we usually stand them in the back, next to security. Also, the Chaplain is there, so they get to see what he has to get done.

Daytime, there are administrators there, so we are usually scarce.

As far as dealing with nurses, continued....

I find the male-female interaction very interesting. I am the old married guy, and most nurses know this. That does not mean I don't flirt, or joke with the good looking young nurses. Depending on the charge nurse, a chocolate bribe is not a bad thing.

At my part time, it is even more interesting at the two hospitals. The young, attractive under 30 female nurses will have very little to do with you, unless you are bringing in a trauma, or are a young, attractive, buff, under 30 Emergency Service worker. There are many badge bunnies, who run when a cop or hosemonkey arrives in the ER. It is funny to watch nurses look up from trauma to smile, or flip their hair.

At the other hospital, I don't think I have ever transferred care to a nurse under the age of 40 (except for the ones I am friends with). The young ones are always sitting, smiling, giggling. When a cop or a hosemonkey arrives, sometimes it looks like a meat market bar.

Some ER staff might never want anything to do with you. That is the way some people are, especially in a city.

In our main ER, there are staff members who don't like me, but they listen to me . They know the care I provide. There are others who smile and are glad to see me. Some are just anti-social, and don't give a rat's butt.

As far as you, treat your patients well, with competence and compassion. The way you would like to be treated. Show professionalism (look, act, speak). Be pleasant to staff (nursing, housekeeping, food service, other EMS) and family members. Some members of the ER staff will take note.

When you bring your patient in to the ER, help move your patient from your litter, hook the patient up to any monitoring devices needed. Cover the patient, put the side rails up, and lower the hospital litter.

Give a concise report, ask if they would like any more information. If the patient has paperwork (coming from an ECF), copy all papers, and hand them to the nurse.

Some people just don't handle emergencies well. Maybe they just isn't smart.

Maybe they didn't know how bad off he was, and didn't want to hurt him more.

Does your PSAP give pre-arrival and CPR instructions?

We have always had Broslow Tapes. They are a wonderful resource to have. Our ER even has Broslow carts.

We recently started using new peds bags. They are not Broslow, but are set up with some similarity. (We don't stock it with meds, because of the expense).

They have come in very handy over the last few weeks, and especially this past Monday. I think they will be adding to them in the near future. Hopefully some protocol changes will come as well.

Nate, where are you?

Around here, we have fire fighters waiting years for jobs, but not paramedics.

If you have applied at a paid union fire department that provides ALS, you may have to wait until they decide to accept applications, and run their civil service testing. It is dependant on population growth, but mostly retirements. Some cities/counties are constantly hiring/testing, others don't for years. Many city and county departments in Maryland and Virginia are always accepting, and run scheduled testing every year.

Here in PA, most EMS is not provided by union fire departments, it is provided by hospitals, or non-profit organizations, who hire frequently.

We have a regular, who calls for no apparent reason. She likes going to the hospital, especially when it is hot outside. She called 3 times in one 12 hour shift, the same truck picked her up each time. She fakes seizures, among other complaints.

She was convicted of setting her house on fire (that is a story in itself), and stealing from the hospital gift shop, then sent to prison. Our call volume dropped.

She knows enough to open the side door, sit on the bench seat, and seat belt herself before the provider gets out of the front seat. Unfortunately, she has cooties.

OK.

First, that you Asysin2leads.

The patient was sitting on the toilet in a small bathroom. We did not have the monitor on him during his first "event". We had just arrived on the second floor, when he slumped over. He was a large, muscular, sweaty man, and it took a lot of effort for 2 providers to move him from the commode to the floor. He was unresponsive, but came to slightly when he was "thrown" to the floor.

He was in Vtach on and off. In the hospital, I watched the monitor (after our next call), and he was in coarseVfib/asystole, and was shocked multiple times.

To put the AED thing to rest.....

It is computer aided dispatch terminology for any EMS call where a person my be in cardiac or respiratory arrest. The dispatch provides ALS ambulance (BLS ambulance if it is their district), and police. Some fire departments also respond. In our city, we get police officers, our supervisor, and a fire truck.

The idea is simple. All police cars in the county were donated AEDs by a cardiologists office. It was decided they will be used, and police MUST respond, and have been trained to use it. We have 2 stations, with 3 (2ALS/1BLS) ambulances located in the city (plus others outside). There are 3 fire stations, with five pieces staffed, all with AEDs. There are 30+ police cars, all driving around, with AEDs. When a call comes in, all are dispatched, someone can reach the patient in less than 2 minutes. That is it. No more.

We have LP12, full function with fax.

He coded in the ER, shortly after arrival.

"AED Response" is our CAD terminology. It means possible cardiac arrest, and gives us police officers with AEDs, our Paramedic supervisor, and an AED equiped fire engine to the scene. It is for manpower.

We have AEDs in all police cars in the county, and they MUST respond on all "AED" calls.

Yesterday, my partner and I got dispatched for an unconscious person. Our additional information reports a 47 year old male now conscious, having trouble breathing.

Arrived to find family at the door, they direct us to the upstairs bathroom of a beautiful row home. There is a large, muscular Black man sitting on the toilet, screaming with chest pain and difficulty breathing. Within a second of my partner getting into the bathroom, the patient becomes unresponsive, and slumps over. He is the whitest black man I have seen in quite a while, profusely diaphoretic. I squeeze in, and bounce him to the floor, trashing the well decorated bathroom. (Probably V-tach). We drag and bounce him a few inches to the doorway, struggling to get the monitor and O2 on him. He is struggling to breathe.

The police arrive, officer walks to the top of the steps, and asks; "did you get any of that Narcan stuff in him yet?".

The patient is now on the monitor (located in the bathtub behind me), with huge ST elevation. The cop was a little confused when my partner yelled, "call county, upgrade to an AED response". (That gives us our supervisor and an engine).

We rapdily had enough help, and got him downstairs, and into the ambulance. Called the ER, and they were ready, even though the Nextel amazingly was unable to fax the 12 lead. After multiple bouts of V-tach, he was pronounced about 45 minutes later.

Since we are quasi hospital based, we follow all the same rules as do the inside employees.

Once a year, nurses from the hospital's Occupational Medicine Department show up, and give out/read PPDs. If you don't work those days, you must go into the office to get it done. If you don't get it done by a certain date, don't expect to work. Since I am in the hospital's college, I recently got boostered and/or checked for 'everything'.

At my part-time, they don't know what PPD means.

Rid hit it head on.

It is especially hard when you are trying to take your blood covered litter out of the trauma room. You can see into the family room, and the chaplain talking with the family. And they can see you.

As far as the worst, a few come to mind. To keep it simple, a light plane crash, didn't get any altitude on takeoff, took out electric wires along the road at the end of the runway. Then hit cars that were driving by, spewing burning fuel everywhere. Plane then crashed into a large farm market. I had my young son, and was driving home from work, just missed seeing the fireball. Occupants of the now flaming cars ok, market heavily involved, stupid people too busy buying vegies to exit. Got them out, as the self extricated pilot walked out of the smoke. He was burned over most of his body, and looked very pale gray/blue. Kinda like Casper the ghost cartoon, almost transparent.

PRPG, was that Route 1?

At least she was minty fresh.

I haven't noticed that problem here, our few urban outdoorspersons still drink real alcohol.

When I was young (before I got rich working EMS), I worked security at a mall. Many times we caught, or took reports on people stealing Nyquil.

Our county dispatchers (usually) give us decent information, so probably about 1/3 of or dispatches are non-emergent responses. (We do use Medical Priority dispatching).

When we transport to the hospital, it is almost always non-emergent. I think I have used RLS twice in the last month, and one was yesterday with an unstable motorcycle accident patient. Another was an unstable IFT. We have a protocol (recently updated) that states in specific terms that the patient must be unstable.

We are a city/suburban service, with most of our trucks less than 10 minutes from the hospital. Even our country truck (30+ minute transport time) must drive normal speed, unless the patient is unstable.

In most instances, running RLS is more a liability than a benefit.

Dispatched yesterday for an unconscious person. We are immediately suspiscious, as this is a very high maintenance block.

Arrived on location to be advised "caller being given CPR instructions". (This gives us our supervisor, and engine company, and PD).

We go inside to see frequent flyers, man passed out on the floor, prescription drug overdose with alcohol. Same as previous MO. Cancel everyone except the supervisor. His son and wife state he had shoulder pain, and took some pain meds, and was drinking beer. Pain continued, so he took more pain meds (Oxycontin), nitro, and kept on drinking. After being unresponsive for some time while watching TV, his family combined brain cells, and became concerned. They called 911, and threw him to the floor.

When confirming with his wife what happened, she stated that his shoulder hurt, he took pain pills, nitro, and was drinking beer. I said, "pain pills, nitro, and beer?" She states he took "pain pills, nitro, and beer". I told her that when he takes that all together, it's not so good. She states, "he didn't take any pain pills...he ain't got no description for them. The doctor didn't give him no description for pain pills".

I then asked again what he took. She stated "pain pills, nitro, and beer". HMMM.

Turns out he was having a major MI (nothing interesting showed on the monitor initially), and when he was fully awake, got pissed at the doctor. As the transporter was waiting to take him to the cath lab, he signed himself out AMA.

OK, so I am in paramedic school, trying to find time to study. Until the start of class, I actually had free time at work. I don't think I have had more than an hour total in the last 2 weeks. Between calls, charts, and mostly training new employees and EMT students, just no time.

Here is my weekend, so far...

[web:4126988d43]http://www.wgal.com/slideshow/news/9781421/detail.html[/web:4126988d43]

about 5 decent medical calls,

shooting,

stabbing,

MVA with entrapment (nice huge head lac),

bunch more medical calls,

Ending today with my regular who is going to really, really going to kill himself this time. Really, this time. Can you help me? Please? I'm gonna do it this time, really.

And, since I left at 19, a 3 alarm structure fire.

Hopefully tomorrow will be slightly more normal.