Lone Star

Remember pal, I'm the monster you helped create! So in your own wise words, "Suck it up, cupcake!" In all seriousness though...back to post #5: Granted the guy's girlfriend called us, and she was pretty intoxicated herself, I'm not comfortable with the idea of just giving the guy that many chances to guess the right answer (or make the questions easier) in order to be able to say "Yep, he was alert and oriented enough to leave him here!"; but by the same token, I realize that there was a bare minimum that we could actually do for the drunk in the field. He wasn't in distress, he wasn't complaining of chest pain or shortness of breath; in fact he wasn't really complaining of anything except the fact that she called us and we obviously woke him up! I don't know what benefit he would have had by being transported to the E.R. either... Would he have benefitted from being arrested so that we could cart him to the hospital simply because he was the only call we had that shift? Again, probably not... Ultimately, I wasn't in the position to have to make that call, and I'm really not educated enough to try to sit back and 'armchair quarterback' my preceptor's thought process or mentality concerning that call. I'm not trying to be 'intentionally obtuse', nor am I out to bust someone's chops because they don't agree with me; I'm simply trying to learn where certain lines are drawn so that I can define the box I have to play in....

Same thread, post #5 (OMG! It's my post! ) I guess that makes me guilty of laying the groundwork for this thread to end up going straight to Hell in a hand basket....50 lashes with a wet shoelace! That is possibly one of the nicest things you've said to me, buddy! Where do we draw the line with the intoxicated patient? How do we ascertain the patient who is just 'buzzed off his ass' or a patient suffering from alcohol poisoning? Herein lies the crux of the issue... If they're too drunk to be considered compos mentis, does their refusal actually carry any weight? After all, if they are not competent to make such legal decisions, how can we actually abide by their decisions in the first place?

The issue I'm having with this response Dwayne is this: When I got whacked on my motorcycle, I didn't call for help...I was unconcious. Since I only remember waking up in the ambulance as we turned into the hospital, does this mean that I can sue the ambulance company and the attending crew for kidnapping because I didn't call and therefore didn't consent to be treated? Or was treatment rendered under implied consent? As far as being awake on scene, one of the guys in my Paramedic class was one of the fire department first responders; and has since ripped on me for telling him over and over "Don't cut the leather, man!", which implies that I was alert and oriented enough (even though I don't remeber it) to know what was going on. Since he indeed cut my leather and treated me against my wishes, does this give me grounds to sue? Was I ACTUALLY 'alert and oriented', or did I still qualify for 'altered mental status'? Just because the OP isn't the one that called the ambulance ISN'T sufficient grounds to negate 'implied consent'.

If telling the OP to lay off the 'energy drinks' is a crucifixion, then I guess we're all guilty. Considering that we've only been supportive of him; I don't see how that's even remotely considered 'crucifying' him. We've all explained that the feelings he went through were understandable and expected for that first 'hot call'....and we found no fault with his treatments. However, judging from the number of negatives you've gotten on that one post, it looks like YOU might be in line for the next available cross.....would you prefer nails or simple rope?

Following your own logic, you've created a couple other issues: 1. Since you felt you had an 'obligation to assess her', by speaking to her had established 'patient contact' 2. By simply walking off, you abandoned your patient (you established patient contact, and didn't properly transfer her care to an equal or higher licensure). 3. Proper transfer of patient care includes a written report and a verbal report to be given to the recieving facility, neither of which were done (by your own admission, you simply got back in your truck and left the scene). Brady's "Intermediate Emergency Care: 1985 Curriculum", (Pg 66) defines 'abandonment' as follows: 4. Since you stated that you had an obligation to assess the patient, and then just got back in your truck and left, by your own admission have breeched your duty to act, which constitutes negligence as well...

Even if this was only for a 1 week period, where do you draw the line between 'accetpable collateral damage' and 'one too many'? Those 5 calls may be only the ones highlighted, but how many never made the news, or weren't reported by the local police departments? The point is that even if it were only ONE call that went awry, there may have been some warning sign, or something that could have been done to prevent the headline in the first place. Scene safety is stressed in class, simply because it's a VERY important factor out on the streets!

You arrived on scene to find the hospital staff already treating the patient, and you STILL think that the patient is yours? It would appear that since they were already on scene, the patient was already 'theirs' to begin with. This would be no diffferent than you working a call, and having an EMT-B or EMT-I trying to take control of the scene; it wouldn't fly on that scene, and it can't fly here. Ultimately, its YOU that "missed the point"...

This brings up an interesting point... Per my medical/legal/ethics class, I'm to honor the wishes of a competent adult when they refuse transport/treatment. Since acohol is known to cloud judgement, which leaves me to ask: Can an intoxicated individual REALLY be competent enough to refuse transport/treatment? One of the calls during my last clinical rotation set, we got called to a motel room for a suspected cardiac arrest. Turns out that the man and woman in the room were drunk, he was drunker than she was. He also admitted to smoking marijuana in addition to the alcohol. He was extremely intoxicated and when asked if he knew what city he was in, he failed to answer correctly; in addition to not knowing that he was in a motel room. To me, this is considered a 'failure' in the grand scheme of things when assessing orientation. The attending medic gave the guy 6 different opportunities to name the city he was in, and all 6 times, he failed. To my shock, they allowed the guy to sign the RMA (Refused Medical Attention) form and simply left him there. Am I the only one who sees an issue here? When querying an intoxicated patient, how many attempts do you let them have to guess the right answers before you ultimately consider the patient not 'competent' enough to make the decisions to refuse transport/treatment?

This is probably true, but I wrote that in response to flaming talking about getting your ass kicked by violent patients, and if you haven't...you must be a rookie. When your truck is rolling along the ground, and not on it's wheels; it's a little difficult to talk an inanimate object out of following the laws of inerita and pure physics....

Or we have good enough communication skills to be able to diffuse a potentially ugly scene. The biggest part of scene safety is paying attention to your surroundings at all times. By paying attention, you can pick up on tell-tale signs that should tip you off that things are going 'south', and you can either diffuse them, or get out. I've worked some of the roughest neighborhoods in Detroit without a vest, (not because I didn't think I needed one, but because I couldn't afford one), and I seem to have survived unscathed. I've run a fair mix between IFT and 9-1-1, although the nature of the dispatch doesn't preclude you from potentially violent patients. It's amazing how far a little bit of respect and empathy goes toward calming down your patients... Will it work in all situations? Not at all, but it DOES help in trying to diffuse the situation before it gets further out of control.

Whether you agree with his stance or not, you have to admire his conviction and dedication to those that were suffering from terminal illness!

I've seen patients refuse treatment by a crew member for less than that...

Considering I only offered my personal view on the definition, and not trying to establish a formal definition, who are you to tell me that my view on things is wrong? By the formal definition, only those healthcare providers that are employed by a municipality, a fire department or law enforcement department can be considered 'public servants' while those employed by private carriers are not. Secondly, you're comparing apples to pine cones. In view of the tiny little fact that the 'services' provided by your examples aren't even LEGAL.... Furthermore, employees of the local power company, gas company, phone company and cable provider are normally considered by the general public as 'public servants' because they serve the general public. Methinks you're being confrontational just for the sake of being confrontational... *Edited for content and structure*

Harold Camping made the prediction for 1994. George Orwell made his predictions in the book, "1984". I'm kind of glad that his prediction was wrong, as this would have been my first Rapture, and I had no idea what I should wear... Man! People are making 'rapture jokes' like there's no tomorrow! *Edited to fix grammatical errors*

As arrogant as this may sound, I've held the idea for a while that we need to raise the bar for the 'lowest common denominator' in EMS. I've seen far too many 'cook book providers' in the field that don't know enough to be able to distinguish their ass from a hole in the ground! Even at the EMT-B level, mistakes can be made that can potentially cost our patients their lives. Not every 'hero wanna-be' is qualified to break into EMS, no matter how in love with the flashy lights and loud noisemakers (sirens) they may be. If other medical professions can weed out the slackers, the hobbyists and the glory seekers, why shouldn't EMS do the same simply to purify the gene pool? Don’t get me wrong here, I’ve met some fantastic people in this field, but not all of them were cut out to be in EMS. I’ve also met some people that are adequate or better providers, but have no business in EMS because of their jacked up attitudes. The bottom line though, is that in order to start looking to become recognized as a healthcare profession, we have GOT to stop allowing just anyone with an 8th grade equivalent education into the field, where the only way that they can render care is “because the book says so”! I'm not saying that everyone in EMS needs to be a Rhodes Scholar, but the current arrangement isn't working out so well as it is...

Well, yesterday was our finals for the quarter. Unfortunately, our regular instructor wasn't there because he had some classes he had to attend. The 'substitute teacher' that took his place was a Paramedic with 21 years of EMS experience. Her job was to administer the written exam, and then fill in for one of the 'hands on' testing stations. When the adjunct instructor that I've been talking about showed up, there were several of us staning in the hallway while the remainder of the class was finishing the written portioin of the exam. Instead of saying 'hello' or any other form of greeting, he looked at us with sadistic glee and simply stated "It's time to cull the herd!". I don't know if this was just an evil plot to play on our nervousness, or because he was actually looking forward to eliminating some of us. Knowing how I've been treated by him, (not only during clinicals, but during 'lab time' as well), I opted to do the practicals portion of the exam with the 'substitute teacher'. Going into the practicals, I knew that I could end up with either a trauma patient or a medical patient, so I had to be prepared for anything... As it turns out, I ended up with a medical patient. My scenario was "You are dispatched to the local school for difficulty breathing. On arrival, you find a 17 year old male in the nurse's office, in respiratory distress. The patient is allergic to nuts and at lunch time began to experience difficulty breathing. You see that the patient has visible urticaria as well. The nurse has administered oral Benedryl about 20-25 minutes prior to your arrival with no relief." This was a fairly straightforward scenario, but since we haven't covered pharmacology yet, it kind of complicates things because I don't know the dosages yet. Long story short, I started an IV, administered epi, albuterol and benedryl "per protocol", and explained that on arrival I got a 'poor impression of my patient's condition' and that this would be a 'rapid transport' situation. The instructor called me this morning and advised me that I earned a grade of 88% on the written and received an overall grade of 4.0 for the quarter!

LOS ANGELES — The state medical board has revoked the license of the fertility doctor who helped "Octomom" Nadya Suleman become the mother of 14 children through repeated in vitro treatments, according to a decision made public Wednesday. Read the full story here:

With all the great responses, I don’t know if there’s anything of substance I can add; but let’s give it a shot anyway…. First step: Put down the energy/power drinks and back away slowly! Second step: Put down the strap and stop beating yourself over this… Ok, now that we’re calming down, let’s look at what you had and what you did: 90 year old female slip and fall… First things you should be considering is: 1. Possible hip fracture/dislocation 2. Did she hit anything on the way down? 3. How long has she been down? 4. Any secondary injuries from the fall (sprained/broken wrist, dislocated shoulder, ulnar/radial fractures)? What was your MOI? Did she slip on one of those crocheted/hand braided rugs that grannies are notorious for, or did she take a nose-dive off the ladder where she was painting the ceiling? Since she was screaming in pain, she obviously had a patent airway; so there’s no real need to sweat that at the moment. That’s one checked off the list. Did you notice any major bleeding when you made patient contact? Check another off the list…. Were peripheral pulses present? Capillary refill < 2 seconds? Check that off the list as well.. Now that we’ve covered the ABC’s, it’s time to look at the ‘D’ … what was her disability? Was she complaining of any other pain besides her neck? Did she strike anything (like the table, counter or coffee table) on her express ride to the floor? Since she WAS complaining of neck pain, the C-collar would be a wise choice, since you don’t have x-ray vision and can’t tell if anything is subluxed or fractured. Since you’re immobilizing the cervical spine, then a LSB is in order. Your initial patient survey usually runs from ‘nose to navel’, and your secondary is ‘nose to toes’. Complete each stage before moving on to the next, that way it becomes a systematic and complete process. This WILL take time! As far as report writing, this too will take time to master, and develop your own style of reporting. The main thing to remember is that you should be able to pick up a PCR and by the time you’re done reading it, be ‘caught up’ with the situation at hand. Critiquing your call is one thing, but using it as ammunition to beat yourself up is a horse of a different color all together! Look at it objectively and ask “What could I have done better?”, not “Oh look how I completely screwed EVERYTHING up!”. You’ve had your first EMERGENCY! call, now it’s time to stop with the rookie nerves and start thinking about the possible injuries based on your dispatch information on the way to the call…this will help you ditch the ‘tunnel vision’ and start looking for zebras when you hear hoof beats… Like the others, I can’t really see where you ‘screwed up’ anything. I see someone who let their nerves take control, not controlling your nerves. We were all ‘green’ at one time or another (and for some of us, we’re ‘green’ on several levels in our careers). We DO understand the reactions to that first ‘hot call’, and we’re here to lend whatever assistance we can to help you through it. This ain’t the end of the world, and you WILL get through it and get better at what you’re doing as you get more experience/exposure… Ultimately, the best time to panic is when it's all over with; until then, just keep your head in the game and you'll do fine!

I'm going to have to disagree with this definition. I don't think that 'public service' is defined by your employer, but rather by your client base. We stand at the ready to come to the aid of the general public. We cannot refuse to help people because they're not a card carrying member, nor can we refuse to help someone based on their ability to pay; nor can we refuse service because they don't have the 'right kind of insurance'... Unlike a doctor's office, we cannot selectively pick and choose our patients like say a doctors office (private practice), nor can we refuse to treat them because they don't listen to us and follow our medical advice. Even private fire departments (like Rural Metro) who serves a 'members only' client base (they sell 'subscriptions' to raise money and have been known to stand and watch while a 'non-members' house burns) are known as 'public servants'. As far as name tags/plates are concerned, it is my opinion that they're part of the professional apparel/uniform. I prefer those that show either 'last name only' or first initial and last name. Have you noticed that Doctors have their names embroidered on their lab coats (you didn't actually think it was there because its a 'vanity thing' did you?)? If you happen to encounter a 'badge bunny', 'EMS groupie' etc that is engaging in stalking/threatening behaviors or putting you and/or your family in a precarious position, that's when you call a different 'public servant'....the police, and let them deal with it.

I have to agree here. Just because I don't think that the two steel clips in my skull have anything to do with my broken ankle doesn't mean that it won't change treatment options...I'm not getting any closer to an MRI machine than I absolutely have to! Because certain races have a higher susceptibility to certain disease processes, it's important to document the patient's race in the narrative section. Additionally, you cannot guarantee that the receiving facility staff is going to even look at the demographic and personal information fields on your PCR. Remember, your PCR is supposed to 'paint a picture' to the receiving staff. How can you give a complete image if you don't document all known information? That's like presuming that based on the current meds, the staff will automatically know the patient's past medical history....

The only 'conclusion' I can foresee coming from this little 'social experiment' is to see how many will attach labels and how fast they can do it. At the end, I fully expect 'flaming' to show us the errors of our ways by revealing just how WRONG we really are for judging and labeling people based on nothing more than appearance. Once this has been done, I fully expect a scathing lecture on how we're so wrong about labeling the GLBT crowd based on appearances. There's a difference between advocacy and just looking for somthing to fight about, and it looks like this is just looking for trouble. He can tell me that there's no 'hidden agenda' till he's blue in the face, but I'm not buying it. A 'social experiment' like this only serves to bait the participants into a big knock down drag out fight because 'flaming' had to stir the pot one too many times... I fail to see how asking the participants to 'label' someone based on appearances only, will serve any productive purpose; and for that reason, I will refrain from playing. From where I sit, this smacks of nothing more than a game of "I Told You So" combined with an opportunity to throw words like 'prejudice, bigotry and discrimination (in all of its variations)' around.

First off, let’s consider the relevance of a criminology course for nurses. Unless the nurse is going to be also working in an investigative capacity, or even in the capacity as a prison administrator, I can’t see the relevance of the criminology course being even remotely tied to the education and duties of a prison nurse. Wouldn’t the nurse be better served by focusing on the medical aspect of the nursing education, after all; that’s why he/she would be in the prison in the first place…? I think this is a poor example at best, and shouldn’t have been used to illustrate your point. One of my core classes was ‘Computer Concepts and Applications’, which focused on knowing the difference between system software and program software, and the applications of Microsoft Office. Does this have a direct bearing or influence on the medical aspects of what I’ll be doing as a Paramedic? Not in the slightest! I’ve had people tell me that the course is required because I MIGHT be using a computer to complete an ‘e-PCR’, and it might malfunction. My thought process is this: If the device that I’m using to complete the ‘e-PCR’ malfunctions, it’s not my place to attempt to repair it; that would be a task better suited to those with the IT or computer repair education. If the device malfunctions, then the next logical step would be to complete an ‘old fashioned’ hard copy PCR. All of the other courses I’ve taken to date can be justified as being beneficial to what any Paramedic does or will experience in the field. If I read the thread right, the OP hasn’t balked at increased education, rather; it’s certain members that feel that it would be a ‘waste of time for the EMT-B level’. This is doubly significant, simply because it not only highlights the importance of education, but it also illustrates my original statement that EMT-B is the basic foundation upon which the higher EMS license levels are built upon. The concepts of patient care, medical/legal/ethical and other facets of EMS start in the EMT-B classes, and are enhanced and expanded in each subsequent class you take as you advance ‘up the food chain’. As one’s scope of practice and responsibility increases, it’s tied back to the basic concepts that were taught in the EMT-B class. Do you have proof this is where the EMT-B license level originated from? Not all of the failings within the EMS system and its structure can be attributed to the Fire Service…

You know, when I was taking the position that a college educated Paramedic wasn’t any better than one who learned to be a Paramedic in a hospital based program…you, Dust, AK and a whole host of others busted my chops over it. Now that I’ve actually reversed my original stance, and have taken the courses that will make me a better provider; you want to bust my chops again for advocating your original stance! You can’t have it both ways! As an EMT-B, I thought I had EMS at that level by the balls; simply because when my then Medical Director came in to do a ‘guest lecture’, every scenario he threw at me, I was able to hand back with all the right treatments in the right places. Did this make me a ‘super provider’ because I knew what to do and when to do it because the ‘book said so’? Hardly! Now that I’ve actually taken the very classes that you and others have said were needed, I’ve come to realize how horribly WRONG I was to ever think that I was an ‘outstanding provider’. I’ve not only cheated myself but I’ve done a great disservice to every patient I’ve treated in all those years! You busted my chops for resisting higher educational levels, you DON’T get to bust ‘em again because I’m actually advocating higher educational requirements! You and I have had conversations about how inadequate the EMS educational requirements really are, so why attempt to beat me down because I’ve changed my stance and become an activist for the advancement of EMS from simply a ‘job’ to a ‘profession’? You want me to come out and say it? Here’s goes: When I was an arrogant EMT-B and thought that I knew all I needed to know, I WAS WRONG! Just because I was wrong in my thinking, doesn't mean that I haven't learned the errors of my ways and amended my thought process along the way....

And still people wonder why I fervently advocate higher educational requirements for entry level EMS...and go absolutely rabid when someone suggests that more education isn't necessaary, because EMT-B training is more than 'adequate'...