Ridryder 911

Sorry wake up & smell the coffee... It happens everyday.. every ER, ICU, CCU, floor units etc.. physicians or even extenders.. make the call. Unless the family is really wanting the patient to be resuscitated with a hx. of long term illness (COPD/ Extensive Cardiac) with a terminal or pro-long hx. most resuscitation's efforts are little to none. I do not believe in them, but some hospitals have ... slow codes, or pharmacological efforts only where no compression & ventilation's, just meds pushed. I know, now when patients have been attempted in the field, very little to no effort is made in ER if there has been no prior response. Also, after the second round of ACLS medications the arrest is called. Decreasing prolong efforts & death with dignity has became more aware in emergency medicine. Be safe, Ridryder 911

How old was the patient ? Also neuro eval.. any deep brain function, lower limbic & mid brain function? The larger hospital may have consulted & informed them to check certain things, then make a decision. I know Down's syndrome have several congenital defects, which may leads them into a DNR category. Does sound a little harsh though..if I was attending I send & let them decide to pull after CT, etc. Unless you didn't think he make the trip. Be safe, Ridryder 911

No thanks.. If I am going to get into pain.. I can think of more enjoyable ways :evil: :twisted: Be safe, Ridryder 911

Well, lets put it this way Moses was my partner... & yes our protocols were written on stone tablets.... No I don;t piss rust & fart dust.. Be safe, Ridryder 911

Welcome to the insane asylum...LOL Be safe, Ridryder 911

It comes in waves. Last tour. was nice, not many calls like the set before, where it was hell. Now I am on my 4 day off, dreading the new tour.. probably will get whammed with calls. Be safe, Ridryder 911

Yeah, a student has the reversed jinks.. that is why I like them so much.. able to get some sleep then, but; boy after they leave.. the tones never stop. Be safe, Ridryder 911

If you really want a call; it is simple. obtain a full bladder, haven't not yet eaten in 6 hours..., need to study for a test, & say those those 3 magical words..... Be safe, Ridryder 911

As one who works an average of 120 to 140 hrs a week, I can attest to that. There is very few "medical careers" that are just 40 hrs a week. That is why, I highly suggest people who are considering this as an career, to stop & think about it seriously. As a healthcare member holidays, week-ends ,etc. are just another working day, and the "family" has to learn to adapt or celebrate on other days. It can make it very difficult on a lot of people. Good luck, Ridryder 911

Yeah, Budha .. that is why I am glad to see the Squad there to carry things ...LOL. I do believe, we are teaching new medics to fixate, & try to treat & cure before a real good assessment. After years of experience, most of us old-timers realize that there is not much you really need to stabilize a patient, until you can get them in your rig. Way too much stuff crammed in a kit, then it is too hard to find the appropriate equipment without loosing or cleaning out the bag. A pack should just include what you really need for the first few minutes to stabilize the patient. (unless you are SAR) My feeling is if you have to grunt.. when you pick it up.. there is to much stuff... Be safe, Ridryder 911

Too much crap ! Way over stocked.. All I need is a couple of 4 X 4's , airway kit, glucometer & meds. with 1-2 saline lockes, & a B/P cuff.. take the rest away. Be safe, Ridryder 911

I do agree John; however, so many medics wait until the patient is exacerbated. Many, try treating the pulse oximetry not the patient. If the patient is compromised, airway control is essential. Why make a patient suffer (V-Q shut-down, S/E acidosis, etc) when the patient is going to be on a vent anyway ? I try to teach ....think ahead & be the patient advocate & do no further harm to the patient. Be safe, Ridryder 911

In addition to the wisdom of Woody. As an older adult, I believe you can contribute more than you realize. This job really needs more mature, rationale people. You are actually at the median age of most professional medics. As far as gender, it depends (as in all professions) where your employed, I do know of some services with more women than men. Yes, the pay will probably be dramatically lower, I have hoped you investigated this prior to career change. Although, you can improve your salary, with more education, possible change in location & tenure. As far as lifting, work out at a gym, increasing leg muscles & have a professional, teach you how to properly lift (patients). Medics, who want to stay in this career, try to learn fast & prevent back injuries. You do not have to be a hulk in this profession. As far as education.. I highly suggest a collegiate level. If you want to pursue or increase your medical education, hopefully, you will not have to retake courses. Also, I believe, it will be required in the future (some services do have increased pay for degrees) & it might aid in promotions. Good Luck in your future, Ridryder 911

Most of the guys that work for us either shave their head, or crew cut. I am one of the few traditional style left, (trying to keep it ).. It took me a while to adjust.. (sorry no offense; most white guys look like chemo pt.s) all the Mr. Clean look.. I do understand it is cooler in nature & easier to take care of .. especially late night calls. Be safe, Ridryder 911

Here is web site; containing critical care paramedic protocols from Dr. Bledsoe. www.ssgfx.com/CP2020/medtech/procedures/proto_app.htm#rsi Be safe, Ridryder 911

I too have seen very tragic events from these vehicles. I don't think people (especially parents) are aware how unsafe & dangerous they are. Just last week in 1 day we had 4 separate incidences, ranging from fxr clavicle to neck & head contusion to an impaled foot peg. I have flown may c-spine fxr's & CHI from people not aware of the speed & instability these cycles produce. It was the 3 wheelers for years that killed several people before they were banned, I just hope we don't have to wait that long before some form of action to occur for these cycles. Be safe, Ridryder 911

They are considered an advanced airway here too. Be safe, Ridryder 911

Stroke victims are often taken to wrong hospital Monday, May 09, 2005 By Thomas M. Burton, The Wall Street Journal Christina Mei suffered a stroke just before noon on Sept. 2, 2001. Within eight minutes, an ambulance arrived. Her medical fate may have been sealed by where the ambulance took her. Ms. Mei's stroke, caused by a clot blocking blood flow to her brain, occurred while she was driving with her family south of San Francisco. Her car swerved, but she was able to pull over before slumping at the wheel. Paramedics saw the classic signs of a stroke: The 45-year-old driver couldn't speak or move the right side of her body. Had Ms. Mei's stroke occurred a few miles to the south, she probably would have been taken to Stanford University Medical Center, one of the world's top stroke hospitals. There, a neurologist almost certainly would have seen her quickly and administered an intravenous drug to dissolve the clot. Stanford was 17 miles away, across a county line. But paramedics, following county ambulance rules that stress proximity, took her 13 miles north, to Kaiser Permanente's South San Francisco Medical Center. There, despite her sudden inability to talk or walk and her facial droop, an emergency-room doctor concluded she was suffering from depression and stress. It was six hours before a neurologist saw her, and she never got the intravenous clot-dissolving drug. In a legal action brought against Kaiser on Ms. Mei's behalf, an arbitrator found that her care had been negligent, and in some aspects "incomprehensible." Today, Ms. Mei can't dress herself and walks unsteadily, says her lawyer, Richard C. Bennett. The fingers on her right hand are curled closed, and she has had to give up her main avocations: calligraphy, ceramics and other types of art. Kaiser declined to comment beyond saying that it settled the case under confidential terms "based on some concerns raised in the litigation." Stroke is the nation's No. 1 cause of disability and No. 3 cause of death, killing 164,000 people a year. But far too many stroke victims, like Ms. Mei, get inadequate care thanks to deficient medical training and outdated ambulance rules that don't send patients to the best stroke hospitals. Over the past decade, American medicine has learned how to save stroke patients' lives and keep them out of nursing homes. New techniques offer a better chance of complete recovery by dissolving blood clots and treating even more lethal strokes caused by burst blood vessels in the brain. But few patients receive this kind of treatment because most hospitals lack specialized staff and knowledge, stroke experts say. State and county rules generally require paramedics to take stroke patients to the nearest emergency room, regardless of that hospital's level of expertise with stroke. Stroke care is positioned roughly where trauma care was a quarter-century ago. By 1975, surgeons expert at treating victims of car crashes and other major accidents realized that taking severely injured patients to the nearest emergency room could mean death. So the surgeons led a push to make selected regional hospitals into specialized trauma centers and to overhaul ambulance protocols so that paramedics would speed the most severely injured to those centers. Now, in many areas of the U.S., accident victims go quickly to a trauma center, and trauma specialists say this change has saved lives and lessened disability. Eighty percent or more of the 700,000 strokes that Americans suffer annually are "ischemic," meaning they are caused by blockage of an artery feeding the brain, usually a blood clot. Most of the rest are "hemorrhagic" strokes, resulting from burst blood vessels in or near the brain. Although they have different causes, both result in brain tissue dying by the minute. Several factors have combined to prevent improvement in stroke care. In some areas, hospitals have resisted movement toward a system of specialized stroke centers because nondesignated institutions could lose business, according to neurologists who favor the changes. In addition, stroke treatment has lacked an organized lobby to galvanize popular and political interest in the ailment. A big reason for the backwardness of much stroke treatment is that many doctors know little about it. Even emergency physicians and internists likely to see stroke victims tend to receive scant neurology training in their internships and residencies, according to stroke specialists. "Surprisingly, you could go through your entire internal-medicine rotation without training in neurology, and in emergency medicine it hasn't been emphasized," says James C. Grotta, director of the stroke program at the University of Texas Health Science Center at Houston. Many hospitals don't have a neurologist ready to deal with emergencies. As a result, strokes aren't treated urgently there, even though short delays increase chances of severe disability or death. Even if doctors do react quickly, recent research has shown that many aren't sure what treatment to provide. For example, a survey published in 2000 in the journal Stroke showed that 66 percent of hospitals in North Carolina lacked any protocol for treating stroke. About 82 percent couldn't rapidly identify patients with acute stroke. As with other life-threatening conditions, stroke patients are better off going where doctors have had a lot of practice addressing their ailment. A seven-year analysis of surgery in New York state in the 1990s showed that patients with ruptured blood vessels in the brain were more than twice as likely to die -- 16 percent versus 7 percent -- in hospitals doing few such operations, compared with those doing them regularly. A national study published last year in the Journal of Neurosurgery showed a similar disparity. Another major shortcoming of most stroke treatment, according to many neurologists, is the failure to use the genetically engineered clot-dissolving drug known as tPA. Short for tissue plasminogen activator, tPA, which is made by Genentech Inc., has been shown to be a powerful treatment that can lessen disability for many patients. A study published in 2004 in The Lancet, a prominent medical journal, showed that the chances of returning to normal are about three times greater among patients getting tPA in the first 90 minutes after suffering a stroke, even after accounting for tPA's potential side effect of cerebral bleeding that can cause death. But several recent medical-journal articles have found that nationally, only 2 percent to 3 percent of strokes caused by clots are treated with tPA, which has no competitor on the market. Some authors of studies supporting the use of tPA have had consultant or other financial relationships with Genentech. Skeptics of the drug point to these ties and stress tPA's side-effect danger. But among stroke neurologists, there is a strong consensus that the drug is effective. One reason why many patients don't receive tPA is that they arrive at the hospital more than three hours after a stroke, the time period during which intravenous tPA should be given. But many hospitals and doctors don't use tPA at all, even though it has been available in the U.S. since 1996. The dissolving agent's relatively high cost -- $2,000 or more per patient -- is a barrier. Medicare pays hospitals a flat reimbursement of about $5,700 for stroke treatment, regardless of whether tPA is used. Glender Shelton of Houston had an ischemic stroke caused by a clot at Los Angeles International Airport on Dec. 30, 2003. In full view of other holiday travelers, Ms. Shelton, then 66, slumped over, and an ambulance was called. It was 4:45 p.m. By 5:55 p.m., she arrived at what now is called Centinela Freeman Regional Medical Center, four miles away in Marina del Rey. Hospital records show that doctors thought Ms. Shelton had suffered an "acute stroke." But she didn't get a CT scan, a recommended initial step, until 9 p.m. By then, she was already outside the three-hour window for safely administering intravenous tPA. Records also say she didn't receive the drug "due to unavailability of a neurologist until after the patient had been outside the three-hour time window." Ms. Shelton's daughter, Sandi Shaw, was until recently nurse-manager of the prestigious stroke unit at the University of Texas Health Science Center at Houston. Ms. Shaw says that at her unit, her mother would have had a CT scan within five minutes of arriving, and tPA probably would have been administered 30 or 35 minutes after that. Today, according to her daughter. Ms. Shelton often can't come up with words or relatives' names, can't take care of her finances, and can't follow certain basic commands in neurological tests. Kent Shoji, an emergency-room doctor at Centinela Freeman who handled Ms. Shelton's case, says, "She was a possible candidate for tPA," but a CT scan was required first. "The order was put in for a CT scan," Dr. Shoji says. "I can't answer why it took so long." A Centinela Freeman spokeswoman says, "We did not have 24/7 coverage with our CT scan, and we had to call a technician to come in. That's pretty common with a community hospital." The hospital has since been acquired by a larger health system and now does have 24-hour CT capability. A hospital-accrediting group has begun designating hospitals as stroke centers, but that is only part of what is needed, stroke experts assert. They say hospitals typically have to come together to create local political momentum to change state or county rules so that ambulances actually take stroke patients to stroke centers, not the nearest ER. New York, Maryland and Massachusetts are moving toward creating stroke-care systems, and Florida recently passed a law creating stroke centers. But in many places, short-term economic interests impede change, some doctors say. "There are still very parochial interests by hospitals and physicians to keep patients locally even if they're not equipped to handle them," says neurosurgeon Robert A. Solomon of New York-Presbyterian Hospital/Columbia. "Hospitals don't want to give up patients." The University of California at San Diego runs one of the leading stroke hospitals in the country. It and others in the area that are well prepared to treat stroke patients have sought for a decade to set up a regional system, but there has been little progress, says Patrick D. Lyden, UCSD's chief of neurology. "Some hospitals are resisting losing stroke business," he says. "We have the same political crap as in most communities. Paramedics still take people to the local ER." Among the opponents of the stroke-center concept during the 1990s was Richard Stennes, then ER director at Paradise Valley Hospital south of San Diego. In various public debates, Dr. Stennes recalls, he argued that many apparent stroke patients would be siphoned away from community hospitals even if they didn't turn out to have strokes. Also, he argued that tPA might cause more injury than it prevents. And then there was the economic issue: "Those hospitals without all the equipment and stroke experts," he says, "would be concerned about all the patients going to a stroke center and taking the patients away from us." Dr. Stennes has since retired. "All hospitals and clinicians try to deliver the right care to patients, especially those with urgent medical needs," says Nancy E. Foster, vice president for quality of the American Hospital Association, which represents both large and small hospitals. "Community hospitals may be equally good at delivering stroke care, and it would be important for patients to know how well prepared their local hospital is." Stroke experts aren't proposing that every hospital needs to specialize in stroke care but instead that in every population center there should be at least one that does. In Atlanta, Emory University's neuro-intensive care unit illustrates the special skills that make for top care. Owen B. Samuels, director of the unit, estimates that 20 percent to 30 percent of patients it treats received poor initial medical care before arriving at Emory, jeopardizing their futures or even lives. Brain hemorrhages, for example, are commonly misdiagnosed, even in patients who repeatedly showed up at emergency rooms with unusually severe headaches, Dr. Samuels says. The Emory unit has 30 staff members, including two neuro-critical care doctors and five nurse practitioners. A team is on duty 24 hours a day. The unit handles about two dozen patients most days, keeping the staff busy. On the ward, nearly all patients are unconscious or sedated, so it's eerily silent. Patients generally need to rest their brains as they recover from stroke or surgery. After a hemorrhagic stroke, blood pressure in the cranium builds as blood continues to seep out of the ruptured vessel. Pressure can be deadly, cutting off oxygen to the brain. Or escaped blood can cause a "vasospasm," days after the original stroke, in which the brain reacts violently to seeped-out blood. In the worst case, the brain herniates, or squeezes out the base of the skull, causing death. To avoid this, nurses at Emory constantly monitor brain pressure and temperatures. They put in drain lines. They infuse medicines to dehydrate, depressurize and stop bleeding. Since Emory launched the neuro-intensive unit seven years ago, 42 percent of patients with hemorrhagic strokes have become well enough to go home, compared with 27 percent before. Fewer need rehabilitation -- 31 percent versus 40 percent -- and the death rate is down. Damica Townsend-Head, 33, gave the Emory team a scare. After surgery last fall for a hemorrhagic stroke, her brain swelling was "really out of control," Dr. Samuels says, raising questions about whether she would survive. The staff put a "cooling catheter" into a blood vessel, which allowed the circulation of ice water to bring down the temperature in her blood and brain. They intentionally dehydrated her brain to lower pressure. A month later, she woke up and recovered with minimal disability. She still walks with a cane and tires easily, but her speech is normal and she hopes to return soon to work. "I consider her what we're in business for," Dr. Samuels says. The public's low awareness of stroke symptoms -- and the need to respond immediately -- can also hinder proper care. Ischemic strokes, those caused by clots or other artery blockage, cause symptoms such as muscle weakness or paralysis on one side, slurred speech, facial droop, severe dizziness, unstable gait and vision loss. People with this kind of stroke are sometimes mistaken for being drunk. In addition to intense head pain, a hemorrhagic stroke often leads to nausea, vomiting or loss of balance or consciousness. Still, many people with some of these symptoms merely go to bed in hopes of improving overnight, doctors say. Instead, they should go immediately to a hospital and demand a CT scan as a first diagnostic step. The well-funded American Heart Association, established in 1924, has made many people aware of heart attack symptoms and thereby saved many lives. In contrast, the American Stroke Association was started only in 1998 as a subsidiary of the heart association. The stroke association spent $162 million last year out of the heart association's $561 million overall budget. Justin Zivin, another University of California at San Diego stroke expert, says the stroke association "is a terribly ineffective bunch. When it comes to actual public education, I haven't seen anything." The stroke association counters that it is buying television and radio ads promoting awareness, similar to ones produced in 2003 and 2004. The group also sponsors research and education, including an annual international stroke-medicine conference. It's not just the general public that fails to recognize stroke symptoms. Often, emergency-room doctors and nurses don't, either. Gretchen Thiele of suburban Detroit began having horrible headaches last May, for the first time in her life. "She wasn't one to complain, but she said, 'I can't even lift my head off the pillow,' " recalls her daughter, Erika Mazero. Ms. Thiele, 57, nearly passed out from the pain one night and suffered blurred vision. When the pain recurred in the morning, she went to the emergency room at nearby St. Joseph's Mercy of Macomb Hospital. Ms. Mazero says that during the six hours her mother spent there, she was given a CT scan, but not a spinal tap, which could definitively have shown she had a leaking brain aneurysm, meaning a ballooned and weakened artery in her brain. After the CT, Ms. Thiele was given a muscle relaxant and pain medicine and sent home, her daughter says. Two months later, the blood vessel burst. Neurosurgeons at William Beaumont Hospital in Royal Oak, Mich., did emergency surgery, but Ms. Thiele suffered massive bleeding and died. Ali Bydon, one of the neurosurgeons at Beaumont, says a CT scan often is inadequate and that her condition could have been detected earlier with a spinal tap, also called a lumbar puncture. "Had she had a lumbar puncture and perhaps an operation earlier, it might have saved her life," says Dr. Bydon. "In general, a person who tells you, 'I usually don't get headaches, and this is the worst headache of my life,' is something that should alarm you." In addition, he says Ms. Thiele "absolutely" was experiencing smaller-scale bleeding in May that foreshadowed a more serious rupture. If doctors identify this kind of bleeding early, he says, chances of death are "minimal." But when a rupture occurs, he says, "25 percent of patients never make it to the hospital, 25 percent die in the hospital and 25 percent are severely disabled." A St. Joseph's hospital spokeswoman says the hospital has "very aggressive standards for treatment, and we met this standard," declining to elaborate. Paramedics did the right thing after Chuck Toeniskoetter's stroke, but only because of some extraordinary intervention. Mr. Toeniskoetter, then 55, was on a ski trip Dec. 23, 2000, at Bear Valley, near Los Angeles. He had just finished a run at 3:30 p.m. when, in the snowmobile shop, he began slurring his words and nearly fell over. Kathy Snyder, the nurse in the ski area's first-aid room, quickly diagnosed stroke. She called a helicopter and an ambulance. Ms. Snyder says she knew the closest hospital with a stroke team was Sutter Roseville Medical Center in Roseville, Calif. The helicopter pilot was planning to take Mr. Toeniskoetter to a closer ER, but Ms. Snyder says she stood on the helicopter runners, demanding the patient go to Sutter. The pilot eventually relented. Mr. Toeniskoetter went to Sutter, where he promptly received tPA. Today, he has no disability and is back running a real estate-development business in the San Jose area. "Trauma patients go to trauma centers, not the nearest hospital," he says. "Stroke victims, too, require a real specialized sort of care." One-third of all strokes are suffered by people under 60, and hemorrhagic strokes in particular often strike young adults and children. Vance Bowers of Orlando, Fla., was 9 when he woke up screaming that his eyes hurt, shortly after 1 a.m. on Jan. 8, 2001. Malformed blood vessels in his brain were bleeding. He was in a coma by the time an ambulance delivered him at 1:57 a.m. to the nearest emergency room, at Florida Hospital East Orlando. Emergency-room doctors soon realized Vance had a hemorrhagic stroke. But neurosurgery isn't performed at that hospital. A sister hospital-- minutes away by ambulance, Florida Hospital Orlando, did have neurosurgical capability. But in part because of administrative tangles, Vance didn't get to the second hospital until 4:37 a.m., more than two hours after his arrival. Surgery began at 6:18 a.m. "This delay may have cost this young man the possibility of a functional survival," Paul D. Sawin, the neurosurgeon who operated on Vance, said in a letter to the hospitals' joint administration. Florida Hospital, an emergency-medicine group and an ER doctor recently agreed to settle a lawsuit filed against them in Orange County, Fla., Circuit Court by the Bowers family. The defendants agreed to pay a total of $800,000, court records show. Monica Reed, senior medical officer of the hospital, says the care Vance received was "stellar" and that any delays weren't medically significant. Vance's stroke, not the care he received, caused his injuries, she said. Vance, now 13, survived but is mentally handicapped and suffers daily seizures, his mother, Brenda Bowers, says. Once a star baseball player, he goes by wheelchair to a class for disabled children. He speaks very slowly but not in a way that many people can understand. "He remembers playing baseball with all of his friends," his mother says, but they rarely come around any more. "He really misses all that." Food for thought, Ridryder 911

Depends .. emergencies average about $ 700-1000. We also have a transfer van.. they can buy memberships, but average about $ 150 Special event charges.. football games, etc not sure Be safe, Ridryder 911

Never seen a facial burns, head trauma with the patient clamped down ? CHF compensating ? Remember the old saying Glasgow < than 8 : intubate ? Versed is only a sedative, it does not prevent laryngeospams, movement, etc.. Be safe, Ridryder 911

As a professional educator, we are taught each adult learner receives & able to retain information by different teaching methods. Some by lecture, some by hands-on, some by combination of both. (has the highest retention) Of course this all depends upon the topic & skill need to taught. Yes, incorporate hands on & be sure students should be familiar on performing the skill & understands the rationale for each of the skill & procedures. Be safe, Ridryder 911

I worked with a physician who worked at a migraine center on research. She as most physicians I work with no longer prescribe narcotics for migraine tx. Since basically, you are sedating the patient, hoping they will sleep It off. I am not familiar with all the neuro involving cluster H/A vs. storms etc. & do not claim to be specialized in this area.. She used a mixture of Decadron & Compazine I.V. I seen this provide analgesic approx. 90% of the time, including people who had been on M.S. pumps. I was very impressed with the results. You might talk to your neurologist & see his opinion on the use of this. I know this can be dilapidating & very painful. I wish you the best of luck. Ridryder 911

This topic is on several post here... there has been several discussion on this.... please refer to : http://www.emtcity.com/phpBB2/viewtopic.php?t=728 Be safe, Ridryder 911

We are going to electronic, supposed to start soon, this has been a heated debate between medics & management. The larger metro service has electronic & had to hire 4 full time computer tech's for 24 hr coverage, when the system crashes. Some of our medics works there part-time & describes all the down time, with them. You do get less denials on claims, since everything is checked before system can clear. So the management is looking for increase $$$. However; we should look at the over all costs. Be safe, Ridryder 911

There has been tons of research on this & actually shows there is NO correlations. Not non-scientifically, it always appear more freaks are out. I had a psychiatrist tell me once that :" when the full moon is out, the gravitational pull slightly alters the sodium level" patients that are on heavy salts such as Lithium, can have some mood swing. I don't know how accurate this information was though.. Be safe, Ridryder 911