MikeJ

I carry two guides - one is the pocket version of my regional protocols, the other is comprised of two, double-sided pages of that I wrote up myself. The guide I wrote for myself has stuff like pediatric vitals, indications and contraindications for the few meds we give, summary of our major trauma and stroke protocols, documentation reminders, and anything else that I'm afraid I might forget in the field. When it wears out I just print another from my computer. The pocket version of my regional protocols has everything else I'm going to need, but I find that I seldom have to refer to it.

The modification was no big deal, just grind off the metal rivets and the plastic comes right off. I don't break a lot of windshields but I'm guessing it will still work OK in a pinch.

I took the plastic guards off the blades (dremel tool) and can now carry mine in the cargo pocket of my pants. I like it a lot. I am not at all comfotable with that small-of-the-back holster - it looks like a spine injury waiting to happen if you somehow get knocked to the ground.

I carry a cell phone, gloves and a pocket face shield. Won't leave home without them. I'm betting that there is not one of us here would wouldn't help somebody who collapsed in front of them, even when they are off-duty. If you know you are going to do it, you might as well be prepared to protect yourself.

Good post. My opinion is that you were sort of screwed from the beginning - this really wasn't a BLS transport. Old guy, SOB like that, he could have been in the midst of heart failure, and he really needed ALS care from the outset. (I'm guessing that your boss may have frowned on you calling for ALS support for a call like this, and it's up to you to decide what you want to do about that). When his respirations became inadequate during transport, you supported them successfully. Other than calling for ALS intercept or preparing for CPR, there isn't much more you can do at a BLS level. I would have told my driver to light up and go at that point, too - once you are bagging somebody, you have every right to hurry to the ER. I've learned not to expect much from nursing home staff. Sometimes they can be quite good, but they often make poor patient care decisions. You are probably correct when you say you should be more assertive, but it's hard to be assertive when you are new to the job and unsure what to do, especially when your opinion differs from that of more experienced people. The really important thing was noticing the life threat as it developed, and correctly addressing it. I think you did all right, considering your situation, and I applaud your effort to learn as much from this experience as you can. That's the right way to get good at this job.

Interesting: Virgin Atlantic today announced that it will be introducing Tempus, the telemedicine device designed for use by non-medical experts during a remote medical emergency, onto its aircraft. The airline has signed a deal up until 2009 which means that all Virgin Atlantic aircraft in the fleet will be fitted with the equipment. Tempus uses the satellite technology that operates Virgin Atlantic’s onboard telephone system to transmit medical information such as pulse rate and blood pressure readings as well as video images to medical experts at the MedAire Centre in Phoenix, Arizona. The ground-based doctors can then diagnose the problem and advise the crew on the next course of action, enabling crew to use their medical training to assist the passenger. Steve Ridgway, chief executive of Virgin Atlantic, welcomed the introduction of the technology; “The safety and welfare of our passenger is of paramount importance. Virgin Atlantic has used the original telemedicine system, MedLink, for many years, but Tempus’ advanced technology significantly increases the airline’s onboard medical provision.” Graham Murphy, Managing Director of RDT, said; “We are really pleased to be installing Tempus across Virgin Atlantic’s fleet of aircraft, and are delighted that the contract covers fleet expansion.” Virgin Atlantic was the first airline to introduce defibrillators across its fleet and has used the MedLink remote doctor service, for many years. But Tempus’ advanced technology significantly increases the airline’s onboard medical provision. Cabin Crew will have expert help to differentiate between serious and non-serious incidents and do not have to make crucial medical decisions nor interpret medical information themselves. As with defibrillators, it is expected that this technology will soon be adopted as industry standard. (Originally found here)

In my district, psych transports are BLS, even if there are no other medical issues involved. I never understood this. We almost always insist on bring the police along (either with us in the rig, or following behind), so it's not like we are freeing up law enforcement resources here. The police, not us, are the experts at transporting potentially unruly people, and they, not us, are the ones best equipped to handle an outburst of violence. Maybe they figure that BLS crews are better at calming people down... maybe they will start dispatching us to defuse bar fights and domestics, too.

I was looking for the same thing a while back, and I found very little that was of any use. I then asked my department's QC staff what they wanted to see on the PCRs, and that helped a bit.

What do you think of malpractice insurance? If you carry it, do you recommend your insurance company? As a student EMT here in NY, insurance was required before we could do our required ride-along. It's just expired, and I'm thinking of getting a regular policy now that I have graduated. On a related note... any thoughts on additional automobile insurance for those who drive the rig? (I serve as both a medic and driver on a local volunteer squad).