benanzo

ok, was he supine when his tongue dropped out of his mouth and hung there? that might require some effort on his part.

ben was killed by: the original green goblin himself a falling condor broke his neck a gang of gypsies who wanted his bright red scarf in prague nobody knows what happened to ben, he just went away

I should have clarified that she did not continue seizing throughout the remainder of the transport. The seizure lasted about 30 seconds followed by extensive postictal state during which she was protecting her airway and vitals remained stable. But the point of my story was just to point out that it is common practice for this pt to be initially evaluated as BLS and during transport the situation changes and the initial presentation compounds by these kinds of complications. I have only ever complained to the queen bee about this once because my opinions and thoughts were severely discounted because I work for the private BLS ambulance which apparently doesn't have much insight to offer. Unfortunately it's going to take some codes that were cleared by medics in order to get anyone's attention.

it's the same thig, sometimes refered to as athetosis. his extremities were "posturing" in a way that closely resembled dystonia (dystonic posturing.) he had neurocystercicosis seen in CT. his ct was littered with calcified lesions....don't eat the pork in mexico. This is a CT similar to his. sorry this was kind of a dumb scenario, don't know where I was going with this.

I'm a basic and we're trained in the mechanics of intubation and IV start but not allowed to do it. I learned those skills in an area other than where I work currently but just the fact that we were taught but not tested shows a clear intention of eventual transition of those skills to the basic level.

yeah, I should have specified that one of the guys there was his half-brother who knew that he didn't have pmh. yes posturing was dystonic

I actually feel like I'm arguing with myself on this issue. This scenario is perfect for the examples that I've given in other posts as to what is fundamentally wrong with my EMS system (Seattle.) We were called to transport a 50ish lady to the hospital for sudden onset CVA symptoms (droop, unilateral deficit, a&ox3, stable vitals.) This is a BLS call here. I have taken many of these patients to all ERs in the area with no second thoughts even though I have always known the POTENTIAL for serious complications which could arise at the drop of a hat. There was a medic pulling some OT on the engine that day (so she was operating as BLS) and said: "yeah, she's good to go BLS." But even if she hadn't been a medic none of us would have thought differently because it's protocol. Anyway...the lady had a seizure half way to the ER (which was only 10 mins away total.) She never lost her airway/pulse, stable vits the whole time....we wheeled her in and transferred care....end of story. I understand that if a medic would have taken the call from the beginning, she would have had a line/monitor/advanced airway capabilities right away. But the argument I keep hearing is that those things are always imperative on all calls...which simply isn't true. I agree that King County protocol needs to reevealuate whether BLS should keep transporting people with clear CVA signs...but that doesn't change the fact that a stable CVA fares just as well for the 10 min trip in a BLS rig to the ER as they would in an ALS rig and if complications arise we simply treat what we see and wait a few minutes for the medics. Complications which require immediate ALS intervention are rare when the pt presents as stable cva. However, it must be known that deep down I believe medics should do all transports for all patients so as to minimize those risks.

it's not a matter of just being able to decide sick/not sick. There are way more factors than just knowing when to call medics. I am talking about knowing and understanding the specifics of transport and destination. They only ever see the first half of a call...nothing more, whether the pt went with medics or AMR, that is all they see. There is no transfer of care which is a huge part of field experience. Personally I think seattle has begun a slow transfer from BLS fire to BLS AMR as primary response. They just started a formal contract about 3 years ago and have had AMR respond to many calls instead of fire which I think is a clear example that the fire engine is being slowly phased out of EMS all together. It's inevitable given the rising operational costs and limited willingness for taxpayers to pay for what they don't use. I think every system will be privatized eventually.

I think that we've misunderstood my intentions on this. I was not bashing the medics here. They are excellent and probably the best trained in the country but that alone is not making the system here great or even good. Medic One is terrific once they get a chance to do what they do. The problem is simply that the system is overwhelmingly BLS. The fact that the ALS/BLS decision is being made by EMT-Bs (Seattle Fire) who never see a call all the way through to the ER makes their scope of experience to decide that minimal at best. It seems that the private AMB company here, AMR has more experience with pt care than fire does. Every patient they see is one on one up close and personal gathering info and exam and then transfer to ER. That kind of experience is not part what the ffs are getting because when they see a pt they're in groups of 3,4,5???? very few of them have any good experience with report writing and exams and interpreting the results because they're not always the ones doing it. If I have to tell one more FF that hmc doesn't deliver babies I'm going to scream. they never see the end result of not taking someone into the ER on a board even though the mechanism warranted it...the nurse/doc doesn't call their station, no they grill whoever brought them in. There is very little accountability involved. I usually know if I did something wrong or if there was more I should have done when the ER tells me so. FF never get that criticism. But I'm not saying that AMR should take over as primary BLS response like some people here think they shoud....I think MEDIC ONE should do all transports. The city needs to divert funding from running ALS/BLS/BS calls with engines/ladders to buying more medic rigs and training more medics.

not much to do in the field.... but some seem to think we should dx cases like this so I'd like to here some people's ideas I should have said he was posturing from the get-go

You are called to a busy shopping mall to see a 35 y/o male unk medical. You arrive to find a man sitting on some stairs with two men sitting by him. He went to lunch 1 h 30 m ago. They say they called because when he didn't come back from his lunch break 30 min ago they came downstairs to find him. They found him sitting in his current position but wouldn't anwer any questions and had a distraught look on his face. His body was very rigid and was not appearing to comprehend any of their questions. You find him sitting upright alert but non-verbal. He gives no indication that he's comprehending anything around him. HEENT= PERRL, wont track, no droop, no signs of trauma neck/back=no jvd, no td chest=no dyspnea, clr = bilat, =rise and fall abd=soft, non distended, no masses VS= BP 154/80, RR 22, NSR @80, BS 110, O2S 98%RA NO PMH, NO Meds, NO Allergies After you lift him to your stretch he does a big seizure arch, big sound and lauches into 1 min grand mal. followed by 5 min postictal and then more seizures. Vitals stable throughout transport.

medics don't have the monopoly on doing a good pe and knowing how to interpret the results. I am merely saying that there aren't effective prehospital ALS rx that will serve to reduce the long term effects of a CVA. A fast bls tx is what is needed. I will grant that cva can quickly become very complicated by the onset of cardiac dysfunction, seizures etc, which would require als intervention, but in an urban environment with mult hosps in close proximity, a fast BLS tx does the job. I am not saying that ALS should be ignored even if the pt presents with those complications early on, far from it. Those are clear ALS indications which require medic rx. But if normal loc/vs are presented, a bls crew should begin fast tx.

"It is a reality check for all those people out there who think that training is more important than education, and that only skills separate basics from medics." But there were no ALS treatments that would have been necessary for that guy. I immediately suspected intracranial bleed...not surprising. fast trans to surg was what that guy needed, not a medic. That is why cva with normal LOC and VS is BLS run.

As for not basing decisions solely on protocol, I loosely disagree. But you have to understand that I am evaluating from BLS perspective which means that I am not using all the tools that the medics would. I can only treat from their vitals and what I see. We don't use glucometers or oxymeters (I use the facility's when possible.) If I see someone who is barely responsive with huge resp effort, it doesn't matter what I think is going on, I'm using protocol to base my decision to call medics. Now, if I see someone who is overly altered with diabetic history, I'm also using protocol to call medics, even if they find his BS to be fine and send him along with me. His lungs were probably clear except for all the gunk in his windpipe. I only used that example because I have seen it consistently as being an area where there are mult. ALS indicators but the patient wasn't necessarily critical. This can be a fairly complicated situation to evaluate from a BLS perspective. The fact that he is almost completely unresponsive with severely labored breathing should trigger some sort of ALS indication...right??? Another example is a CVA with decreased LOC. A CVA with a normal LOC is a BLS call here. A CVA with altered or decreased LOC is an ALS indicator here. BUT, the medics usually don't transport that. These are just examples of potentially unstable situations that should be referred to protocol given the inevitable liability if the pt were to crash, which has happened.

I am more than willing to have comfortable debate about this, in fact, I wouldn't have it any other way. I can understand how atheism can be seen as fanatical. But I'm not fanatical. I prefer to mind my own business when it comes to religious issues, especially involving work. If a patient specifically asks me to pray with them I will happily go through the motions. I would not discount their efforts to make their situation better, or be perceived to be better, in any way. My beef arises when the reverse is the case. I like the example of the pharmacist not giving contraceptives because it contradicted his religious beliefs. The last time I checked, pharmacists' licenses were awarded (as a priviledge) by the state authority requiring them to abide by the terms of that authority. That authority is funded by the state's tax-payers. I assume the seeker of that medication was a state tax-payer. If I were that tax-payer, I would confidently, and happily, sue the pants off that pharmacist, after buying my meds somewhere else. If I were that pharmacist, I would either fill the script and beg for forgiveness, or just spend the rest of my life in a cave with God.

I am not well informed as to the inner-workings of the Medic One program, but I can offer extensive critiques of the overall system here. It seems that there is a general conception that King County has a perfectly effecient and overwhelmingly effective EMS system, which is simply not true. Again, Seattle and it's surrounding areas suffers from too many ALS/BLS decisions being made by too many different people who aren't working very closely with each other. It seems to me that if the 911 dispatcher takes a call they believe to be BLS, then they should send a BLS AMBULANCE, not a fire engine, or worse, a ladder truck (what are they going to do that a transporting unit can't do?) I am not all for AMR taking over as primary BLS response. I am entirely unopinionated as to WHO does the response, just that it just needs to be a BLS AMBULANCE. The fire engine does nothing but add a layer that should be removed to maximize system efficiency. Frankly, it is only a matter of time before every system becomes privatized given the increasing operational costs and unwillingness of people to pay for services they don't use. If you need it you pay for it, just like anything else. That goes for here too. I was not surprised when I recently started seeing commercials about how the Medic One Foundation's funding is scarce and needs donations.

I don't feel like I save anybody. If they're going to die, they will die, if not, they don't. It's only a matter of applying science to various degrees in order to influence the outcome of an event. I shouldn't speak of God and Satan in such terms, sorry for that (isn't it reasons like that that the muslims are rioting nowadays???) The fact is I'm atheist now but have grown up in strict quaker setting, so i know the ideas and methods of religious people. Sometimes I have the tendancy to take on a religious tone in order to maximize the effect of bashing it. I often confuse people when I denounce God and the Devil by talking as if I actually believe in any of it (God, that is.) I do have a narrow belief which can and often does make me feel shallow and insecure but at the same time I am not willing to accept a system that makes no sense to me. I can't rationalize God's integration of our freewill and His omnipotence. If humans are free, that means they are free to beat and torchure children, which we all know happens all the time. And if God is all powerful, that means he could stop it anytime...why doesn't He? Well, you could say that that was God's Plan (for that child to be born to abusers???weird plan) or you could say that whatever happens happens happens and you'd better fess up by the time you die...or...we really don't have control and it's all a setup. I don't know...it doesn't make sense, therefore, I don't believe in any of it. Doesn't it say in the bible definitively that when the rapture comes there will be people who go against God??? How's that? I thought we had free will? If free will were possible that would mean that it's possible (but highly unlikely) for EVERYONE to side with God. The fact is, the Bible was written by scared humans who had to invent a dismal scenario for the end times to perpetuate the peoples' fear of going against God so as to gain more momentum in their religious movement, thus, more tithings. But even then, John didn't want money. He was just a little crazy. He was probably the craziest of all. I like Jesus' teachings though, they beat the heck out of any other doctrine around. But even he lost faith for a second and questioned God when his fate was sealed on the cross. I do respect religious implementations into family life. I think that when it's applied in moderation, people can grow up to be very good, wholesome citizens who wouldn't beat their kids or skip their taxes. I just don't like it when fanatical ideas extend their sticky hands toward mine.

I seem to have stirred up quite a debate here over Medic One. (No, you don't have to be cert. CPR to vote here.) The city of Seattle is contracted with AMR to do all BLS transports. AMR does not operate ALS ambulances in king county. (Besides Critical Care Transport rigs for ALS interfacility calls - when they respond to 911 calls, they operate as BLS.) When someone calls 911 in seattle, the first sick/not sick decision is made by the call taker-let's say they think the person is Not Sick. So, they dispatch 1 BLS Engine or AID car (which never transports). The Engine then makes the same determination of the pt when they arrive. Let's say they think the person is Sick. They call for ALS Medic 1 (Also part of the fire dept.) Medic 1 arrives and decides the person is not sick. The engine then calls for 1 AMR ambulance for transport. Then the AMR transports routine to the hospital. The theory is great... The problems arise in the fact that you have entirely too many people involved in a single call. What happens over time, and I have been witness to it mult. times, is that when a BLS crew (fire or AMR) sees the ALS unit make a not sick call in a grey area, that pushes the ALS indicators up further for those people. Example being a 2 y/o first time febrile seizure, status seizures. By King Co. protocol there are 2 ALS indicators there (first time seizure, status seizures) regardless of the fact that the seizure is febrile which is common in kids. In my experience, Medic One has never taken that pt. based solely on those two indicators, and fire sees this, so when they encounter that the next time, they don't call medics, they just call AMR, which puts AMR in a tight spot over whether or not they should call medics. AMR new-hires have a sit-down with the Seattle Fire liason when they start and are told never to question the Fire Dept. crews (ALS or BLS.) It is even worse when there are clear indications of a sick pt which has already been cleared for BLS by medics (who have since left the scene and can't give comment or rationale to the transporting AMR just arriving.) The BLS fire engines and aid cars are at a huge disadvantage to the AMR crews when it comes to EMS because they never see the end result of transfering care to the ED. They never see how that pt was received by the ED staff because they only saw them on scene. There is so much more to learn about the patients and their conditions once you get them to the ED than can be found on scene or during the medic's eval. This gives them less scope of experience to decide Sick/Not Sick unless you base those decisions purely off protocol, which I already said has gotten distorted over time. It is almost faux pas to request the Medic back for a second eval even if the pt's condition has changed during fire's transfer to AMR. This situation, though not acceptible, happens all the time and is purely caused by the fact that there are too many people involved. My opinion is that Medic One should do all transports, ALS or BLS, to minimize the risk of distorting the perception of Sick/Not Sick based entirely on what you have seen the medics transport in the past. Unfortunalely AMR crews and the fire dept crews are not in good communication with each other which makes second guessing and doubt about a transport decision off limits. So, to say that King County Medic One is stellar is true, especially in their training and innovation for ALS pts. However, the entire system is bogged down by the continuous sick/not sick decisions made by multiple parties for a single pt. Some may say that that only enhances the chances that the pt will have the right decision made about their condition, but I say that's not true simply because second guessing is taboo here. When AMR is called, they're called to transport, not question. Fire is very protective of their own, even if the BLS fire crew secretly disagrees with the medics, they'll never allow AMR to question the decision once they arrive. Another problem is that AMR, the transporting unit, is infinitely disadvantaged by the fact that they were not present during the entire eval of their pt. Fire does not have a good habit of divulging all necessary info to the transporting AMR crew, and quickly become impatient when they are "grilled" for info. They might only get a chief complaint and a general idea of what is going on, which leaves the AMR crew to start back at square with SAMPLE and OPQRST etc, all during the transport to the hospital which is no longer than 10 minutes anywhere here. This often leaves AMR with only the most basic info and nothing more, which can be frustrating. By the way, as for my scenario earlier, the medics have never taken that pt from me. I have been in that exact scenario multiple times with no change in transport decision. So, I began thinking that I was reading the pt all wrong...nope. I was right on the money each time based on protocol. There are SEVERAL ALS indicators (per King Co. protocol) given for that patient. I will continue to call the medics out each time simply because it is inappropriate for me to base my decision on what decisions I have seen the medics make in the past. Protocol is the only safe way to do business here, and anywhere really. ---- The first thing the ED does when they get that pt is deep suction to clear his airway (ALS skill) and ask me (with a surprised look) if he was eval'd by medics.

religion is soo strange to me. It baffles me to hear someone say that they "don't approve of someone's lifestyle...but they treat them like a human anyway" Who cares? Not me, not them. Ever think that satan's evil plan was to convince people he was good and holy so we'd turn against each other and fight over it for all time. Obviously God doesn't care, otherwise he'd correct it. And don't tell me that he doesn't want to because he doesn't want robots, we have freewill, yadayada. I can't believe in god because I can't rationalize the concept of an all-powerful god not intervening in tragedies because we have "free-will." Oh, but he does!! God works in mysterious ways!!! nope. For every one so-called miraculous intervention, 40 billion bite the dust and continue their awful awful existences because it was god's plan and they can look foreward to having a higher seat in heaven or whatever. Sounds strange... No pt should be treated bad for any reason. And if I ever go to the hosp in an AMB, the tech better not minister to me...it's just embarrassing. Someone said something about EMS as "doing God's work." I consider it defying God's work. Just a thought

Hi, I am new to this forum but have been active in other ems forums. I am an EMT-B in (I'll say the Greater Puget Sound Area (Seattle-ish) so as not to be pinned down by the locals I am bashing.) The system is set up so that city bls FD is primary resp on all 911 calls. If needed they request ALS, also city FD. After evals, if pt determined to be BLS tx, they call private AMB. But SNFs call private AMB directly most of the time without using 911. So, pretend you are the private BLS AMB called by SNF to tx pt to ER: 80 y/o male STH decreasing LOC/increasing SOB x 2 hrs. RN @ SNF states pt normally A&O x 3/3, active motor able to support self in wheelchair. Hx NIDDM, A-FIB, HTN, Arthritis, pneumonia 2 mo. ago Pt presents lying 45 degrees in bed, pale/hot/diaphoretic, barely responsive to px, very congested upper resp., RR 40 very labored, HR 90-120, BP 140/80, sats initially 79% RA, 88% after 5 min highflow NRB. There is no pedal edema, temp 102.0, glucose 160, full code. You call for the FD medics to come but will they take him? You decide. What is this guy's underlying problem and what ALS Rx could he benefit from? I already have my opinion but I want it to be confirmed un-biased first. Thanks a lot!!