ncmedic309

We get our share of rain, not like you guys out west though. We don't see much winter weather - a snow storm with 2" of the white stuff is a major event - it usually shuts down all the schools and sends everyone into a state of panic. They do event coverage as well, just depends on the venue. The OT as of late had dwindled due to budget cuts but here lately it has returned to normal meaning there is plenty of it to go around, especially for the parmedics. The mangement is better than it has been, but could still be better. I'll just leave it at that...

In regards to the state, I'm born and raised and lived here all my life. It's a great place to live but obviously I'm biased. I've got the mountains a couple hours to my west and the beach a few hours to my east. There's plenty to get into and lots of great places to live in and around Charlotte. It's typically hot and humid in the summer and cool and dry in the winters. We usually don't get much more in between, it's either one or the other and here lately is seems like we skip spring and fall all together. I can probably go on and on but if you want any specifics just ask and I'll see if I can answer your questions. In regards to the EMS agency, it's good place to work. It's extremely busy, they utilize system status management and you earn every penny. They do both 911 and non-emergent calls for the entire county of Mecklenburg. They are very aggressive in terms of education, they have probably one of the best, if not the best simulation center for EMS in the country. They have an on-site cadaver lab that provides some excellent training opportunities. They have an internal paramedic program that is the way to go if your an EMT looking to go through paramedic school. You get a great education and are paid to obtain it, you can't really beat that. The employees work 10.5, 12 and 14 hour shifts and there is typically a shift starting and ending every hour of the day. Again I can keep on going with it all. I hope this helps some...

Mecklenburg EMS Agency

NICE!

I initially thought it was BS that an incident was "staged" to catch somebody in the act but it would appear that this staging was not just a random occurence but part of a lengthy investigation on the EMT from previous complaints and suspicions. There isn't any room in this profession for these kind of people, we need them out and dealt with appropriately. I'm glad that they nabbed this guy before he got any further than he did. It would also seem that he was working with someone in the act, I'm wondering how things are going to turn out for this unnamed person?

I might be straying a little off topic here with this rant, but I believe it's related to the topic nonetheless... I don't feel that they should be completely seperate, but they should be organized within divisions in any EMS department that provides 911 services. You should have at least two seperate divisions, one that does strictly 911 and the other that does NET. It's fine with me for the crews that work one to work the other and vice versa, but we shouldn't be putting 911 trucks on non-emergent transfers. Our 911 systems are already overwhelmed these days and some areas struggle to get units out on emergency calls. I can speak from experience, that the non-emergent side has and continues to delay emergency care when those calls tie up 911 units. One of the services I work for does both, but it's still a common occurence that we reach a low system status (almost no trucks available) and you have multiple units busy doing non-emergent calls. This is one of our biggest failures and another reason you'll hear some providers calls for the complete seperation of the two. I agree it's beneficial for the provider to have experience doing both sides but to a degree they should be kept seperate.

I would really like to take the information we have now and compare it with the PCR from this incident. It seems that the biggest issue here is turning towards false and/or inaccurate documentation. It sounds like the decision was made to not attempt resusciation based on the finding that the patient was obviously deceased. I'm completely fine with that in pediatric patients but unless it's been declared a crime scene, it's usually best to at least transport the patient. I agree that we shouldn't be transporting dead bodies to the hospital, but in the case of a young child the circumstances are a little different. I've had similar calls in the past and made the call to go ahead and transport the child to the closest facility even after determination of death. I always call the receiving facility and speak with the attending in the ER and inform him/her of the same. They have always been very receptive to this and I've never once caught any grief from anyone for doing so. If the crew had done this, I imagine we would have never heard of the incident. I'm not citing the crew for the decision they made but calling medical control and documenting this call accurately based on their standing orders probably would have kept them out of hot water.

I've already READ the entire thread, we've already discussed this, I'm not going back to it AGAIN... How much do you want to bet? I'm game, you name the amount. It's my call on whether or not the arrest gets worked, regardless if it's medical or trauma. I'll throw this at you though, let's change the scenario - MEDICAL ARREST with you name the rhythm. The only thing I have to do if I decide to work it is perform ACLS measures for 20 minutes and with no ROSC and low EtCO2 readings the game is over. In that time frame, they've got an airway, vascular access and at least two rounds of ACLS drugs on board. What more do we need to prove at that point? The rest of your post isn't even worth taking the time to quote or respond to - if someone can give me something worthwhile I'll gladly respond - otherwise I'm done with this thread...

What outcome are you expecting with this intervention? If the patient has suffered a VFIB arrest secondary to a traumatic event, do you really expect to get ROSC after defibrillation. If the arrest is secondary to trauma, it's not cardiac in nature. We can't fix that with electricity, we can't fix that with ACLS medicatioins - there is no point in performing these useless interventions, it's been proven time and time again. It's likely that we can get a change in rhythm, likely PEA or asystole after defibrillation, but then what? There's nothing criminal about it, it's based on factual medicine and it's standing orders directly from our medical director. It's not something he just came up or decided to go with, everything in medicine is evidence based as is our standing orders for blunt traumatic arrest. Because death secondary to trauma is DEAD. I've been doing this job for well over 9 years and I've seen a ton of arrests both medical and traumatic in etiology. You can work the crap out of a traumatic arrest, load them up with fluids and cardiac drugs and eventually achieve ROSC. Does it sustain itself? I've never seen it last for long, every single blunt trauma arrest I've had in my career has the end result of death. If it makes you feel better, do it - it's your call to make. You can call me burned out, a horrible medic, whatever you like, I don't give two shits. I do what I do based on my knowledge and experience. I truly feel that I make the best decisions possible for each and everyone of my patients, even the ones that are beyond my reach. When and if you get to the point where you can make these same decisions on a daily basis as a medic, maybe you'll stop being so naive and see how things really work. I wish the best of luck to you, there's nothing easy or pleasant about it.

I just had the opportunity to watch the "dash-cam" footage. That officer was driving excessively fast and came up on that unit real quick. I don't know how that car in front of the unit could have heard the siren at that quick of an approach. I would assume he must have seen the trooper approaching in his rear-view mirror, something the operator of the ambulance couldn't have seen. The video definitely doesn't help the trooper any, it still shows him being way out of line and initiating the assault. I never saw the paramedic make an aggressive move towards the trooper until after he was assaulted. I also doubt that he opted to take an administrative leave, I'm willing to bet that came down from the top. In the case of abandonment, it just didn't happen. The patient was still cared for and ultimately arrived at a higher level of care. The medic did his job and handled that situation the best he could in my opinion. The only thing that he could have done differently was place the driver in the back of the truck while he discussed the situation with the trooper, however I doubt the trooper would have allowed that to take place considering his aggressive attitude towards both of the crew members. I'm also not digging the whole blame his behavior on the fact that he just back from Iraq. I'm not saying that he didn't have PTSD or something else going on at the time, but if he knew he was in that frame of mind, he shouldn't have been at work - it's that simple. He puts himself and everyone else in a dangerous situation if he's not in the right frame of mind to do his job appropriately. I feel that they are just exploring every excuse that they can come up with but that's a big cop-out, no pun intended.

I also agree, it looks like a poor attempt to justify their inappropriate actions, just trying to cover their asses - I call BULLSHIT! I also wanted to comment on another situation being discussed in this thread, about the possible abandonment of the patient when the provider left the back of the ambulance. Does this really constitute abandonment? I know we've had similar discussions in previous threads but I don't feel that stepping out of the rig for a couple minutes is abandonment. I agree that we should make every attempt to reduce the amount of time, if any that the patient is without a provider at their side, but it happens from time to time. I'll give a brief example, it's only me and my partner on the truck and my partner is attempting to back out of a narrow driveway and needs a spotter. I jump out of the back to assist him out of the driveway and leave the patient alone while doing so - is that abandonment? I don't think so, and I really feel that it's completely irrelevant in this situation.

I understand your perspective on the situation and your right - we shouldn't be so quick to call for their heads based on an article from the media. I'm not attempting to judge the individual provider in this case, just the situation in a whole. It's obvious that somebody dropped the ball and somebody has to claim responsibility for it. I agree that the article is vague in nature, but it almost speaks for itself in this situation. It makes clear the biggest issue - the fact that somebody declared this patient dead and left them on scene for at least an hour without any care before somebody else realized that the patient was still alive and in need of care. It would be nice to have more details, but that gives us enough to jump to the conclusion that somebody didn't do their job. I understand that we are all human and we are prone to mistakes, but these aren't the kind of mistakes we need to be making. This has happened way to many times across the country and by now we all should have learned from the mistakes of our fellow providers. I wasn't there, I don't know exactly how it played out, but I imagine it was probably something like this: The initial EMS crew arrived on scene after first responders. They were likely overwhelmed after the initial size-up due to having multiple patients and at least one of them being a known priority patient. The first responders had likely already "assessed" the patient that was deemed to be deceased and relayed this information to the initial EMS crew. The initial EMS crew probably never did a thorough assessment on the "deemed to be deceased" patient and took the word of the first responder. The patient was declared dead and that was that - until the ME got on scene and did a better assessment than the initial responder and realized that they still had a viable patient. It could have went numerous different ways but I could see it playing out like that... I would hope that the crew would do a good assessment on the patient and realize that even though they can't palpate a pulse, the patient is actually still very much alive. I understand the situation with the VAD and how it could cause a different presentation. I don't know how many prehospital providers are familiar with VADs, but my initial education on VADs was in paramedic school and I've had more training since. I feel confident that I would immediately pick-up on the presence of one upon my initial assessment and understand the reason behind not having the typical findings, so in that situation it would be business as usual.

I'm not assuming anything - they obviously wouldn't have declared this patient dead had they done a thorough assessment. The ME on scene detected signs of life and I highly doubt he used a monitor or any other tool besides his own common sense. It's highly unlikely that the patient was ever pulseless or apneic. The article states that he was in the vehicle for at least an hour before it was realized that he was still alive and also that the accident occured over the weekend and he later died on a late Tuesday evening. This paints the picture to me that they had an obviously viable patient - just failed to recognize it. It doesn't take much effort to do a thorough assessment to determine death. It can be done rather rapidly if your effective and competent in your assessments. You attempt to palpate both radial and carotid pulses - you place the patient on the monitor (unless it's obvious death such as injuries incompatible with life), you do a thorough examination of the chest including observing for chest rise and fall, auscultating for lung sounds as well as heart sounds. It's also a good idea to do a quick pupillary exam as well. I know this can be done quickly and effectively because I do it on every patient before they get declared dead, regardless if it's medical or traumatic etiology (again providing the death is not completely obvious). I'll be judgmental on anything I choose to be with the information I'm provided with - it's not hard to realize that somebody really fucked up on this one.

If they had performed an adequate assessment on the patient, even during triage - they would have realized that this patient was an immediate priority and should have likely went before any of the others - providing care wasn't delayed by extrication. But even then, as soon as the patient is free, he's high-priority and off the scene. He definitely wouldn't have been last, not until he's really, truly, no doubt about it - DEAD!

I carefully read that statement and then looked at the entire situation again - it actually made sense and played out well with the video that we have all watched. I know statements can be altered to achieve a different outcome, but in this case it looks like the officer was well in the wrong. I hope the medic is successful with the assault charges and I hope that the officer in question loses his job. He deserves to be terminated at the least.