ncmedic309

I also find it important to determine the type of reaction that the patient had to the medication. I find that a lot of people will tell you that they are allergic to "x" drug and upon determining the reaction they had to that medication - it wasn't an allergic reaction. In these cases the patient labels it an allergic reaction when it was only a common side effect. I try to give everybody the benefit of the doubt, but if you have a pain complaint and tell me that your allergic to Tylenol, Ibuprofen, Aspirin, Naproxen, Toradol, (insert drug here that doesn't produce a "high") - you've just convinced me that your after pain meds and won't be receiving anything from me.

I see it the same way - something just doesn't add up. He's working outside and all the sudden his DKA progresses to the point that he loses consciousness and becomes near apneic? His BGL is concerning, but not to the point that it's going to be causing these symptoms. I would still be concerned about trauma (fall and / or electrocution, opiate OD, even though we never got pupillary size or response, etc.) I think there is more to the story than just new onset of DM.

Also, any evidence of drug use?

Pupils - size and response? Any medical alert jewelry or ID on the patient?

If it wasn't EMS - I would want to do something along the lines of climatology and / or meteorology. With either one, I would still be able to spend a lot of time in places other than the office and still have that freedom that EMS offers. I think weather fascinates me more than medicine.

The dancing doctor was great!

We just made the jump from the average low to mid 80's for a high temp up to near 100 degrees for the upcoming weekend - summer is here - no doubt about it. We still have to wear the same pants, uniform shirts and boots - and it's miserable.

We use the the LMA if we're unable to intubate. I've only used it a few times and only once did I feel like it was doing some good. The other times I felt I was better able to ventilate the patient just using a BVM and oral airway. It's also a skill that any provider can perform, basics, intermediates and paramedics.

I’ve got one to tell… I had just got my EMT certification and started volunteering with a local rescue squad. I was partnered up with a more experienced EMT for the shift who happened to also be a close friend that I went to high school with. We were BLS first responders and had just got cancelled off a lower priority call and re-assigned to a higher priority call in the area. My partner was driving and as we were in the process of making a u-turn to get started to the higher priority call, we were t-boned by an intoxicated motorcyclist with his sister on the back. I only remember hearing the engine of the bike revving up and then feeling the impact and watching two bodies fly over the hood of the truck. My partner was initially trapped in the driver’s seat due to the damage to the door on his side. It took me a few moments to get my bearings and then go to work. Neither my partner nor I were significantly injured but the male driver was unresponsive on the pavement and his sister was sitting upright on the pavement crying. Within minutes additional help was on the way and I was able to free my partner from the ambulance. We both went to work on the two patients that collided with our vehicle. The male had regained consciousness but was intoxicated and combative. The female patient was stable, just banged up pretty good from hitting the ground. Apparently the two patients lived only a few houses down the street and it wasn’t long before their intoxicated parents were at the scene. I remember the mother being very frantic and attempting to get to her son that was down on the pavement. I never saw the father until I turned around and saw an off-duty LEO taking him to the pavement. The intoxicated father had come up behind us with a large pocket knife in hand and appeared to be in attack mode by the description given by that officer. If he had not been there, I would have likely taken a knife to the back or elsewhere. I never saw him coming, never expected it. We were very fortunate that the officer was in the right place at the right time. We both kicked ourselves in the rear over and over again after that incident. The motorcyclist had apparently crossed a double-yellow line and passed several vehicles that had stopped behind us. He crossed into oncoming traffic and collided with us as we in the process of doing the u-turn. There wasn’t anything we could have done to see him coming or avoid the crash, if he had yielded to begin with as the other vehicles had – it wouldn’t have even happened. It was more upsetting that we both could have been killed in an act of violence and we weren’t prepared for it. I know our guards were down, we had just been in the accident and our emotions were already running high. I’ve had many other incidents in my career that have turned violent, I’ve been assaulted and had to fight more than one patient. This one sticks out though – it was a tough lesson for my first week on the streets.

I'm wondering if either one of the patients really needed an ambulance - it's just two patients either way. If they both are low priority - transport them both - what difference does it make?

Congrats!

In North Carolina... DNR = Do Not Resuscitate - if the patient is pulseless and / or apneic - it's a done deal. Any care at that point would be considered resuscitation. Up to that point, the DNR patient gets the same care that any other patient would receive. If it's cardioversion, dopamine or even endotracheal intubation - the DNR patient will still get that level of care unless they have advance directives in place that would otherwise outline the level of care they wish to receive. On topic, it sounds like the patient at some point decompensated to the point of no return and due to the legal paperwork in place - no further attempts at treatment were made. That's appropriate care in my opinion. However, once the patient has made it to the back of the truck, it's time to go to the hospital. I would follow the same routine that P3 outlined and let that be that. It's not against state law for us to transport a dead patient, but our medical control does frown up on it. I do feel that this particular case is one of the exceptions to the rule and I don't see anybody at the ED giving the crew a hard time about it.

We utilize a performance plan at our agency that scores you on your annual performance and determines your ARD (raise) percentage each year. It rates things such as your driving scores, your hospital turn around times, adhering to attendance policy, write-ups, internal and external commendations, meeting appropriate continuing education criteria, compliance with policy and procedure and a multitude of other things. If your a poor employee and your barely escape being fired on a daily basis, your lucky if you get a 1% increase in pay at the time of your ARD - if your top of the line and do it right - you get the maximum percentage allowed at the time of your ARD. There are some things that I don't agree with - such as the criteria for hospital turn arounds when it's just not possible due to uncontrollable factors (such as back up in triage, etc.) that in my opinion unfairly penalize you come raise time but it's not all bad either. It keeps the dumbasses that barely get by from getting the same raise as the person who goes above and beyond all year long. EDIT: I went back and read the initial post again - just for clarification - I DON'T work for AMR!

It's standing orders here - our medical director and other doctors don't like us bringing dead patients into the ED. If you can work a code on scene with appropriate ACLS and your not getting a response from your treatment - they don't need to be transported to the hospital. How is that going to change the outcome? Why risk your lives and others around you to haul ass to the hospital with a dead person that's going to stay dead? It makes no sense at all - field termination should be standing practice in all "ALS" systems.

It's quite simple - the majority of calls that any fire service will run are EMS calls. It's EMS runs that keep the numbers up and the ability to justify the new stations, new apparatus and continuing increases in manpower. I work part-time for a fire-based EMS system - and everyone there knows that the majority of the call volume / responsibility is EMS related - almost 70% of the call volume. They are also getting ready to hire multiple new employees due to the increased call volume - almost 70% of those new employees being paramedics. Also, I'm not knocking the fire service - just telling it how it is - I actually enjoy working at the fire-based system more than I do the private EMS system.

I've seen similar circumstances in the hospital and more so in the field. It's usually due to a lack of leadership / control by the person running the code and an overall lack of communication from the group. I'll tell you from personal experience - once you lose control of a situation like that - you don't get it back - it's a cluster from that point on. The key is to establish that control and communication early on and keep it going.

If more law-abiding citizens would arm themselves - we would have a lot less victims of violent crimes and less repeat offenders on the streets. I'm not trying to knock the police, but the "to protect and serve" slogan is a false sense of security. The police do the best that they can but are too limited these days when it comes to available resources and the ability to get garbage off the street. The criminals always have the upper hand with the police having to justify everything they do - they can't just do their jobs. If you want protection, your going to have to provide it for yourself. The police are seldomly in the right place at the right time. The crime rate in our area is sky rocketing and the citizens are finally realizing that the only way they can keep from becoming victims is to protect themselves. The CCW courses in this area two years ago only had an average of about 15 people per class, this year the average is over 40 per class. We shouldn't restrict the abilities of students to protect themselves on campus. I'm not for everybody going out and buying a gun, but if you can obtain a weapon through the legal process that includes the extensive medical and criminal background checks and take the appropriate courses that go along with - I'm all for it! It again comes back down to being in the right place at the right time - but again - the police obviously couldn't stop the majority of these school shootings as evidenced by 30+ deaths before the gunman takes his own life. We should never have such a thing happen. I have a CCW and I carry everywhere that law allows me to do so. My handgun is as common as my wallet, when my wallet goes in my pocket, my gun goes on my hip. If your a business that restricts the ability for me to legally carry my weapon - you've lost my business. If it's a property or institution that restricts me from carrying - I try to avoid that facility at all costs. If I can't be armed - I don't want to be there. I don't rely on anyone to protect me and my family but yet that still doesn't give me any certainty of absolute security and safety. I know that I have less of a chance at becoming a "victim" and having a better chance and stopping a violent crime against me and / or my family.

It might be done different elsewhere, but here the lead medic on scene is in charge of the patient, even with flight services on the ground. It's obvious if flight services is on scene, the intent to transfer care is present, but it's still the lead medics responsibility until there has been a formal transfer of care. In some situations, we might not utilize their services even when present on scene but more times than none, if they are there, we're giving them care. It's fairly simple and easily understood and we don't have any issues with it. We work well as a team and get the job done, that's the most important aspect of it all.

I don't like to transport patients "in custody" without an officer in the back of the unit. I will do it on occasion, but... 1. The officer must follow my unit to the hospital and 2. I must have a cuff key in case I need to remove them to provide care I have my own personal key I keep with me, but I usually just request one from PD and explain the reason I'm doing so - it's typically not an issue...

We also use the Emergent PortO2Vent CPAP device. I feel that it's probably the best CPAP device on the market for prehospital providers, for the same reasons that have already been mentioned. Our last device used a downs flow generator and we couldn't adjust PEEP settings, thus greatly limiting the use of the device to just treating pulmonary edema. We are now able to use CPAP to treat asthma, COPD, reactive airway diseases and in cases of toxic inhalation and near-drownings.

Jake: Where are you taking the test?

Zoll makes a couple clips that keep your limb and precoridal leads in order and keeps them from getting tangled - they are easy to remove and put back on and simple to keep clean. I'm not sure where they are sold - but you might be able to find something on a site that sells Zoll products.

Well, this I can agree on - we're not getting anywhere with this - I've shared my opinions - the rest of you can battle it out. I'll catch the rest from the sidelines...

I don't know the stats on the urban vs. rural poplulation on here - but I do agree that these type things do happen very often in the urban setting. It's not often that weapons are involved or that it ends in a shootout - but us folks that do urban EMS are much more likely to encounter these type situations where we come across another incident while in transport or enroute to another call - it happens quite often here. Either way, for you folks that seem to think it's quite easy to just wave and smile as you drive by another incident that needs your assistance - I just can't understand how you do it? If I'm enroute to another call (regardless of priority) and I come across bystanders waving me down from the sidewalk as they huddle around a male patient that appears unresponsive - I'm supposed to just keep on driving when I'm already there? Or the same scenario where your transporting a minor illness such as a 9 month old who likely had a febrile seizure - that warrants you just passing an incident that looks much more critical just because you have a patient on board? Your there - yet you just keep on going? That's just pure stupid...