n5iln

Ouch. That's a touchy one. IMO, though, once you've given your verbal report and they've started their admissions process (including interviewing the pt), they've accepted responsibility for that pt. The problem is in how to document that transfer of care.

Our documentation standards call for an entry in the "disposition" section of the PCR, something like this: "Gave report to RN Smith and moved pt by two-person drawsheet lift onto gurney in ER Room 6." We have to say where we left the pt, how we got him off our stretcher, and who from the receiving facility was there to take our report. Once we've accomplished that, as the Lone Ranger would say, our work here is done.

The difficulty lies in whether a lawyer wants to view what's on the front of the PCR as any more or less important than a signature from an admissions clerk, RN or whatever. If your documentation supersedes the missing signature, you're in the clear. If not, you've committed abandonment.

My short answer (too late, I know) is to check with your supervisor. If they don't know, hound them until they talk either to corporate office or to the local attorney who handles your service's legal affairs. But if this is a common occurrence in your service, I'd say it's fairly important to find out exactly when the transfer of care takes place.

"ACE"

Thanks for the links to the studies. What I read in them is that 1 city of 46,000 population got the 43 seconds. One study. I am sure there is others out there that will show the same. The same goes for my service's informal study that found 2 minutes were saved (and the City's study that Chaz refers). Anyway I was not making a point that RLS was better or necessary. I just wanted to see the info to compare. As stated in others postings here - What does 2 minutes really save? Depends on the call. My service uses NAEMD Dispatch and we still run RLS to "real emergencies" and guess what? We still run RLS to calls that shouldn't be run RLS.

The 43-second item, believe it or not, is quoted in the National Safety Council CEVO-II course manual, which is the EVOC my employer has selected to put everyone through. I work in a city of somewhere around 90,000 covering something like 60 square miles (I'll admit I'm guessing here), so our mileage is going to vary a great deal, especially in winter when we get our typical snow loads on the streets. How much do we really save? I wouldn't care to hazard a guess.

The point, though, is that when I'm responding to a P1 call, I'm in a big moosy truck with a lot of lights and reflective tape and things on all sides. And I've been trained and qualified to drive it running RLS in adverse conditions. If a doc wants to do the same thing, he needs to go through the same qualifications, and do his responding in an "authorized emergency vehicle" and not just a POV that he's put a Gall's Special light on top of.

Mail men are given extra protections too, so don't let the courtesy that the legislature has extended to you go to your head. It just means they value your service enough to help protect you with legalities. That law didn't say anything about having "authority" or going to Guido's Wanker Supply in Manhattan and buying a badge.

Exactly so. Mailmen are Federal agents, but that doesn't mean they get to carry sidearms (other than dog-repellent sprays). Likewise, the public may view EMTs and paramedics as public-safety officials, and the laws of some states provide for punishment of those who assault us or interfere with us in the performance of our duties, but those laws only kick in after the fact...and if we're not vigilant, after the funeral. Me, I'd rather not give anyone any sort of reason, rational or otherwise, to want to ventilate me. So I keep an eye on what's going on around me, listen to my gut, and be ready to execute my personal RLH plan. And not wear any sort of badge (except the ID card that the state says I have to wear at all times while on duty...and it looks absolutely nothing like a shield).

I have spoken with EMSA of Tulsa, their lifting requirement is 80 lbs dead lift. They will be contacting me with the information in writing. The Ops Supervisor that I spoke with said they have only 80 lbs because "it's reasonable to assume that with 2 people it can be done", and if it's any heavier than that you can call for lift assist with FD. Work Comp has also told me to find 4 more to get national average. (Apparently they don't have it either). Up to this point I haven't wanted to contact an attorney to assist me with this injury, all I am wanting is medical bills taken care of, but since I am meeting a block everywhere I turn with WC and my PCP, I guess I am going to call a friend of mine that is a Labour Law attorney to see what he can find out for me also. I want to thank everyone that has responded, and if you know of any further information that will help, please continue to respond, all information has been helpful.

If you know of any companies out there that has a lifting requirement listed on their site, if you will let me know, I would really appreciate it.

Again thank you so very much.

Rural/Metro's corporate standards for field operations personnel require the ability to lift 125 pounds unassisted; as far as I know, that's at all their contracted locations coast to coast. When I first trained in Tulsa many years ago (and no, I won't say exactly when, because I don't like remembering that I'm starting to get older ) there was no such requirement; guess all the EMS back injuries started getting noticed.

Sidenote of personal opinion. Contacting FD for lifting assistance is an option, yes, but it's not always a workable one depending on what they already have going on. It has yet to happen to me personally, but I've heard dispatch answer a crew's request for FD response to assist in lifting "FD units unavailable at this time". Depending on the patient's condition I'd either wait a few and see if a mini gets freed up or I'll call for a second crew. If we're doing the pump-and-blow boogie, FD's always on scene with us, so that's a non-issue. YMMV.

You have the Authority to provide a SAFE scene until law enforcement arrives so that you may render medical care. (I'm talking about the direction of bystanders, not gang bangers with guns)

(emphasis in original)

I'm terribly sorry, but this is 100% incorrect. Uniform or no, badge or no, armband or no, patches or no...an EMS provider has absolutely no more legal authority than an ordinary citizen at an emergency scene. Bystanders might listen to you...or they might choose to beat you senseless; you have no control over them. And EMS providers have absolutely no business attempting to render any scene "safe." In fact, it's just the opposite: EMS providers have a duty to stay clear of a scene until it has been rendered safe, by duly sworn and/or commissioned law-enforcement officers.

"Dead heroes save no lives." This was a truism when I first entered EMS some 18 years ago, and it's true now. How true? Ask yourself this: what's the first thing an examiner at an EMT practical exam (in the US, anyway) wants to hear out of your mouth when you're given a scenario, be it trauma assessment, medical assessment, CPR, or any of the other stations? "BSI, scene safety." In NYS it's a critical item; don't say it, you automatically fail the station. That tells me it's just as important as assessing the ABCs. Possibly even more so, since if you enter an unsafe scene, you're dead before you get to the A, and now the other half of your crew has to wait for the scene to be rendered safe before he/she can tend to two victims, instead of just the original one victim that the crew was responded to.

Back on the topic of badges...I think they add an immense amount of class to a Class A uniform. But I have absolutely no reason to wear a Class A uniform with my current employer. And where I work, badges == targets. Bullets don't care what the profession of the person they puncture might be. Nobody in the company carries a badge; in fact, I don't believe anyone in the company owns a badge, at least not in our operational area. And I truly believe that to be a Very Good Thing Indeed™. YMMV.

True 3-4 minutes is valuable , but if you don't arrive alive .. will it matter ? Again, speeding and endangering at double the speed in a residential or even high volume traffic .. how many lives are you jeopardizing other than your own?

Absolutely. As my EVO instructor was fond of saying (often!), "it does absolutely no good to get most of the way there quickly."

I have been witness to several instances where the AED would "interpret" the patient's rhythm to be VF/VT and it wasn't. I know this because I had my manual defibrillator applied after the BLS personnel had their AED attached.

AED's will deliver shocks to tachycardias, as well as ventricular rhythms. Tachycardias being over 130 beats/minute in most AED's algorithm, and ventricular rhythms being complexes wider than 0.14 sec. Good compressions are frequently misidentified by AED's as shockable. It is also possible for the AED to "identify" a shockable rhythm immediately following the stop of compressions.

If the patient has no pulse, there is very little danger of making the situation worse with an AED. Just understand what the device is/is not capable of doing.

Interesting sidenote...most AEDs (including the one I used last, the Lifepak 500) will shock one other rhythm other than VT and VF. And it's one I've only seen in textbooks. "What rhythm is that?", I hear someone in the back wonder out loud. It's...

...wait for it...

...Torsades de Pointes.

Just a little tidbit from the BEMT-D, former monitor tech and general collector of odd EMS trivia...

Seems a little silly for anybody to argue that volunteer fire wankers can run hot, but an emergency surgeon cannot. Reminds me of the 120 hour basics arguing how 40 hour first responders aren't trained well enough. Territorial more than logical.

Vollies can't run "hot" in my area unless they're in an authorized emergency vehicle. For their POVs, they get courtesy lights only, which entitles them to...wait for it...absolutely nothing. 'Nuff said on that, for now anyway.

Back to the question at hand...if an EMS system somewhere wants to put a physician in a fly car or something, so be it, and I have absolutely no problem with that. But do it the same way they set up regular crew rotations: provide EVO training, get the doc qualified, write a rotation schedule that works for all the docs that want to run in the field, and so forth. But don't say "sure, doc, just put a red light and a siren in your own car." It's a liability nightmare waiting to happen.

Just my two cents' worth...save up the change for a root beer or something...

I'm going to have to say this is a major problem waiting to happen. Studies (and I wish I could find the URLs) have shown that in a typical urban area, responding under lights & siren saves an average of 43 seconds. And it increases the risk of a motor vehicle collision by an order of magnitude. If I bend a rig because I didn't do the right thing while responding, well, that's a bad thing. But if a surgeon bends his POV while responding, that's incredibly, hugely bad, because now he not only can't help whoever he was on his way to help, but he can't help anyone in hospital either. And surgeons aren't exactly available for plucking from the nearest tree. (Okay, so neither are EMTs. But there are a lot more EMTs out there than there are surgeons.)

Just my two cents' worth...save up the change for a root beer or something...

FD does all extrications here, and they're very good at it whether they're volunteer or career. I volunteer with one of the local departments as well as ride with both a paid and volunteer ambulance, and the experience I gain from one, I find can be quickly applied with another.

Proper division of labor, that's the key.