Happiness

We have a 40 something man here that has major seizures. His are from a brain injury he sustaned while dirt biking. (riding full gear and hit a tree. A branch went through his face mask, pushed his eye aside and right into the brain)

This particular event started with him swatting at a fly. It took us about 15 min to get there. When we got there he was in full grand mal and cyanotic. I somehow through the grace of god and some luck got an oral airway in and he went from 68% to 96 within minutes. Through out the call I did notice 2 things, the seizure seemed to be like a roller coaster in his symptoms, he never became postical but they did subside and then got worst. And his SP02 did flucuate through out the time with me it did go downward as the seizure got worse. In the end of this the guy seized everytime they brought him out of his drug induced coma for 7 days. The Drs were about to give up but the wife just asked for one more day to be with him. I saw him last week. It just goes to show that sometimes one more day is all you need

We have alot of ETOH seizures here. One of them woke up just as the pretty little red headed nurse came into the room and said "Hi beautiful I'm feeling much better now that your here" I just had to smile and walk away................

Nice work lol. Seriously though how do they get to the ambulance station ?

Shithead ;(

http://www.theprovince.com/news/Mike+Farnworth+recognized+helping+save+life/6906882/story.html

It is nice to have a happy ending even if a Politian is the saviour

I will do exactly the same things you did as in your assessment. I would say until your compfortable leaving the pt (this case is exceptional). Each case is different so, but I will normally spend between 15-20 minutes to try and convince the pt, but again there are those that I may only spend 5. hope that helps

Hope everyone is safe and has lots and lots of fun,,,,,,,,,,,,,,,

Do not ever say " holey shit what the hell happened to you" They tend to get a bit up tight after that

And yes I have said that once

Hi my name is Bob and this is my partner George. What seems to be the problem your having today

and always have a smile on your mug.

Funny had this same converstion with a nurse yesterday. First of all I agree that everyone has the right to end their own life and if it came down to it, I have always said the day I become a burden (as in a terminal illness not the old mom living in the basement to my family is day I want to leave this place. It is a personal choice and should be respected as that. As a person living in BC I have seen alot of this on the news.

This woman has all of her facalties and is at this time able to make this decision. She has seen what her life has instore for her and she wants to avoid that pain not only for herself but her family. Watching some one die is the most horrible thing on earth, we all know that.

I dont like the term Dr. Assisted myself, if someone wants to do this in a legal manner they should be the one to push the button and no one else. (yes I know that not all terminally ill people can but you get the idea) There are going to be times when someone has to make a decision on these things because the loved one may be unable to do so. In these cases they should have a process where the Drs and the courts make the decision and not the family members. And it should always be case to case.

http://www.health.go.../endoflife.html to be honest we already have a way to die with dignity in BC. If I go to a call and I am handed a piece of paper that states this person does not want any life saving things done I dont do it. There is obviously criteria for this but what is stopping someone from signing this and then taking their own life. Abosulitly nothing.

I get what your saying Wendy and please know I totally respect your opinion on the topic as I think this is not something you can't sit on the fence about its a yes or no agreement. I do have one question for you. As I read in your post you stated that it is acceptable to take those life saving measures away from someone and it made me think of http://www.nndb.com/.../435/000026357/. Terri was in a state of veggitation for 15 years and being kept alive with a feeding tube. They took it out and in 13 days she died basically from starvation. Now to me the family and Drs knew what the end result was going to be and if there was some sort of legislation to help her along to that end result it would not have taken 13 days to die. Yes I know there is alot of contriversy in this particular case but to me the ending of her life this way was cruel.

So if you have read my last post about being a part of saving my friends life, I have to say today I wish we didn't. That sounds kind of fucked up but now we have found out not only did he have a major heart attack but he also had a major stroke. They finally did a CAT scan on his brain and found out this is probably why he is not waking up. He is breathing on his own and his heart is pumping but his brain is screwed. This buddy of mine was a very vibrant man with a the most beautiful smile ever. He was a troller, siener and crab fisherman for his entire life. He went to the beach everyday with his family and taught them the way of land. I never once saw this man angry, or sad ever and I know that he does not want to be in the state that he is in, as Im sure none of us would be. Unless he has another stroke or heart attack he could be in that state for years, or if someone decides to take his feeding tube out and lets him die cruely. If something was in place today there could be an option for him to die peacefully and with dignity. Sometimes its very heart breaking to save the ones you love.

Thanks you two. It is still a hope for the best prepare for the worst. He was in the hypothermia state for 24 hours or so. Today they are going to try and wake him up. I seem to have a bit of a feeling of dread today, dont know why but do. No one in that room at the time figured he was going to come back and was destine to the cooler. He was shocked 11 times and that cant be good for the ole ticker, and I think it is having an effect with the heart pump that he is on. It is real hard to get info out of those that dont have any medical background, and I dont want to bother the family.

I am more worried about his step daughter as she for some reason went into the room after he was all hooked up to everything. I wasnt there at that time but walked in when she was about to have a break down and took her out. She is a very sensitive girl and I wish I could have stopped that vision for her at least not let her do it on her own. The step daughter is going to be graduating on Saturday and I hope that she dosnt have to deal with a funeral looming. It will all work out in the end as it suppose to.

The worst part for me on that day was when his cousin was all of a sudden at the door of the ambulance wondering if he was in the back . We were waiting for the crew to land. Apperently they had a big fight not long before and he was feeling pretty bad. I told him to go to the hospital (because we are so family orrientated here you will always have your chance to say goodbye) and say his peace that his cousin would hear him. He gave me a big hug and couldn't seem to let go and when he did I saw the big tears in his eyes. He hugged me so long that some guy came over to see if he was bothering me lol.

It will all work out in the end. If it hasn't worked out then it isn't the end, but always be ready for the ending not to be what you hoped it to be

so this is how my day went yesterday, I truely find it amazing how some times our universe just makes thinks work out in the end.

Just finished my first coffee and was about to get ready for work. At 7:45 my pager went of for a routine call. Called into dispatch and they said it was now a code 3 call.

On my way out the door looking like medusa and trying to get my hair in a pony tail, I say see you later to my husband and he says back " have a good friday". I said ya this is a good start to the day little did I know

Get to station and while waiting for my partner I call dispatch again to get more info. She says 52 yr old male was out at the beach picking up crab pots (they are about 100 lbs) felt chest pain, came home, sat down and said to wife you need to phone the ambulance. I asked if this pt has a cardiac hx and they didnt know at that point. Once I got the address I knew my answer. This is my friend for 25 years who taught me how to fish, took me in when I left my husband and my husbands cousin. 2 years ago while he was fishing he had a heart attack and suffered 30% damage as a result along with open heart surgery.

So the first part of the above subject line is the fact that I had a partner. We have a seconday medic that is here once a month and if she wasn't I would have been by myself and waiting for the other medics 40 mins away.

Got to the house met by wife and she says what happens, see the patient sitting on recliner, moaning, ashen and gasping for breath. My partner started her assessment. I went back to the car to get the cot, and AED. I grabbed the phone to call the hospital to let them know to get ahold of the Dr. and we will be there in five minutes, I never call them until Im on my way. Go in as my partner is looking at me like We need to leave now. Onto the cot, Airway in and in the car in 1 minute. He was swating at us at this point, then I hear her call his name, and I just knew I had to fly. The hospital is maybe 2 mins from the house. On my way I again call and say CPR is being performed so meet us at the doors.

So you might think that total chaos but everyone started to work as a team, setting up the AED, getting lines in, Bagging you know all that life saving stuff. In the end he was shocked 11 times had all the drugs and even the new ones that just came in the day before and 40 minutes of CPR, he came back. He never flat lined and always had a shockable rythm. The second part of the subject is that everyone (nurses and DR) in that room has worked in major trauma ER's and we all have experience, not one newbie to freeze or get in the way (Dont take offence to that)

The third part of the subject. A plane was called for and it happen to be 40 minutes away. This plane was a normal transfer plane that happen to have a CCT crew on board. They are never on those planes.

They land at 11:15 and off to the hospital we go, 4 hrs later getting his BP to a better level they left. The forth part.....The weather was picking up and as they left not 5 mins later the gusts start to get to 80k, any longer that plane would have been grounded.

He made it to Van, had surgery for two plugged stints and another one replaced, in a drug induced coma for 24 hrs and now its a hope for the best situation.

Thanks for listening.

Yep the strap will get caught it always does. No those are not head blocks they are rolled up towels, and third Im pretty sure the medic is suppose to be in charge of the airway, at least it is that way here, it dosn't matter what level the FF would be.

I always find it so rude for people taking pictures of what can be someone last moments on earth. Just my opinion.

Just thought I would post this out to our canadian friends Silver Not bad eh?

http://www.bcas.ca/EN/main/community/storiesArchive/2012-archive/2012-team-canada-bc.html?media=highContrast

Tell that to the guy in florida that had his face bitten off on Sunday

Any thing that makes me be in the back of our ambulance. Specifically if it involves me being drunk and stupid.

Funny guys :mobile:

Thanks Artic

Ok, you are the third member of a crew that is taking care of a patient who is a victim of a MVA, She's not hurt too badly but you and your crew have exposed her pretty fully.

There's this bystander snapping pictures of you working the scene and also of this naked woman.

You've asked him to stop taking pictures. There is one officer on scene and you've asked him to deal with the bystander yet he refuses to do so.

How do you deal with this pesky bystander and his cell phone?

I had just this situation on one of my last EMS calls before I hung up my shingle.

So Im not going through all the posts but the one thing I am going to point out is that first of all, Why is the 3rd exposing a pt fully in public if they are pretty okay. That is the problem. If the medic had put the pt in the ambulance where it is private then there would be no reason for the bystander to take pics.

I have not had to deal with this ever so I dont know what I would do. I would try to ask politely and hope for the best Im not wasting time that should be spent on my pt.

My husband who is a VFF had this come up when they got the call to attend a fire at the Propane outlet. Of course it was a Saturday so we were all at home, he called as they were getting ready and we left as this outlet is a block away from my home. All worked out for the best and I am here another day

I get a bit snippy when it comes to mental illnesses because I've seen how being needlessly agressive can negatively impact a patient, I've seen stupidty, both from system protocols, the people writing holds, and other EMTs, and I've seen how a patient can be completely different even a few hours and a couple of meds later. Not necessarilly enough to let them off of a hold 2 days early, but definitely in the right mind set to not require them to be strapped down in 4 point restraints. Similarly, my undergrad research project was in schizophrenic and bipolar patients looking at how well they filter stimuli. It's a big difference when mental illness is looked at as a neuro problem and not a mind problem.

OK JV just so you know I get the snippy part. Please understand I am trying to find a solution to a problem. I am starting to feel abit shreaded by you because of something that really I have no control of. I dont like this policy but I understand it from a flight crew point of view, as if they are not compfy with the pt they just dont go. It really is that simple. Be aware I have not refused any pt. I have been the advocate for them, also with this policy I dont let it run my call I make it work for me. The one thing that is not mentioned in this policy is required doses, so that in its self gives the Drs the ability to work outside the box.

In the field I use my body and velcro straps. In the hospital setting They will start with adivan and gravol and use haldol if required.

The stretcher itself has to be secured to the aircraft. What are the normal procedres briefed. for evacuating a stretcher patient? Would they be evacuated on the stretcher or removed from it? Perhaps that provides you with the answer. Again it will normally come back to the individual airline's policy in their adherence to the regulations.

My question was does the stretcher become a fixed part of the plane and this is the answer that I recieved.

Systemt that is a good artical but they got one very important discription wrong.

The guy who jumped was being transported by a seaplane not a heli from Masset to Prince Rupert with a guard. This guy on his way down the ramp to the plane was yelling at the top of his head he was going to jump and take the guard with him as he was hand cuffed to the guard. They get over the straights and he flipped out and lucky the guard (a 120 lb female) was able to get the key and unlock the cuff. After he got to the door and the grabbed her by the belt and she hung on for her life. The guy finally let go and hit the ocean. The hx on this guy is that he had held his GF hostage in a hotel room in Port Clements and repeatedly raped and assualted her. Not only was he depressed he showed alot of violent tendencies that not one person considered a red flag. Now remember this is RCMP not BCAS but it can happen. Also the plane had other people on the there and not one person helped. Oh just so you know I personally knew the guard and this is where my information comes from. The guys name is Donald Biggs.

yep we do, i guess i just have the vison of chunks and a bit of a brain fart I am going to contact transport cananda and directly ask if the Number 9 is cocidered a fixed part of the air craft. I reread the reply from them and it is just implied.

Who told you this? If it was someone at TC I would suggest getting a second opinion.

http://www.tc.gc.ca/...ction11-231.htm

http://www.tc.gc.ca/.../551/acsi32.htm

Therefore, if your Number 9 cot can be removed from your aircraft, it is not a fixed part of the craft, the mounting brackets are. The only requirement that I can see regarding a patient restraint is that it must have a quick release mechanism, like a belt buckle, or, in our case, a velcro strap. There is no reason that the patient can't be restrained to the cot.

However, you're asking the wrong people in this forum, Transport Canada would be the proper authority here. Also, the pilot would be the one responsible for ensuring the CARS are followed.

I did ask transport canada qne got an email back

Next issue with restraints is the what if, if your pt is strapped to the stretcher and they start to vomit, if you cant roll them over then the you will have a whole new set of problems. This whole thing is just a dammed if you do and dammed if you don't.

If what is being said is true, and anyone with a mental health disorder, including simple depression, are being knocked out, then it's stupid, dangerous, and the "but our safety" people are idiots who can't assess patients. It's everything that's bad with "zero tolerance" or "always do ___" policies or rules.

No not everyone is being sedated and someone who has simple depression is not being sedated nor are children. And I will disagree about the safety because I am one of them and I assure you I have a very good ability of assessing phyc pts out in the field or in a controlled setting. We do have a zero tolerance the same as the hospital but we don’t do the "always do" not in our station anyways

There's a time and place for chemical restraints, but just as the indication for a non-rebreather mask isn't "ambulance," the indication for chemical restraints should not and cannot be "history of any mental illness."

Agreed

You never know how anyone is going to act, ergo everyone should be knocked out. Not everyone being committed is being committed because they are a danger to themselves or a danger to others. Furthermore, since this sounds like middle of nowhere frontier rural, just because someone is being admitted doesn't mean that they are being committed.

And when I am referring to this topic they are not being admitted they are being committed and normally on their own accord. The last guy I had to sedate was paranoid schizophrenic; he came to hospital on his own accord because the TV was telling him to kill himself and other violent acts.

If psychotropic medication is the sign of, to use your term, lazy physicians, then making every patient with a history of any mental illness unconscious is the sign of a lazy flight crew.

No you took that the wrong way. I feel that people who are like the above need intensive phyc care which does not include 2 weeks in a phyc ward and a bottle of pills. They need to be in a controlled hospital setting for much more than that. By the way the day after this guy came home he did committe suicide and it was very violent. That is what I mean by lazy. As for the flight crew they are going on by what has been told to them. Even though the policy says certain things if the pt is going for an ultrasound and there is no mention of their, let’s say prior suicide attempts they are NOT sedated. It is a tricky situation all around and I do a case by case assessment but if dispatch has said violent tendencies or psychosis I am required to follow the policy

Is that for patients who actually need sedation, or the insanity of "any patient with a history of mental illness, regardless of how slight, gets to go to lala land because... well... because we said so, regardless of if the patient actually presents a danger to... well... anyone"?

So as I see it, it is not everyone that has a hx of mental illness, we would be sedating everyone. It is there for those that actually have been diagnosed with a medical condition (they are listed in the policy) also for those that have been deemed violent (the case I keep mentioning is a drug addict that in the past year has stabbed 3 people and the last person was stabbed 8 times) Most of the people that are sedated are going to a phyc ward and not because they want to, they have been committed.

Or is it because the medical community views putting patients under heavy sedation for no better reason than "because" to be malpractice? Alternatively, is it a combination of HEMS induced malpractice and a misunderstanding on the appropriate uses of chemical sedation?

I really don’t disagree with that statement but I have to say exactly what is the appropriate uses. Now please remember this topic is on Flighing people out. We cannot drive because it would an 8-52 hr ferry ride. I don’t believe that people going by car should be sedated to the same level by any means, because you can physically restrain them to the stretcher or pull over and jump out, you don’t have that luxury in a plane.

So the solution to me is for Northern Health to have a Psychiatrist on the islands. The money that is saved by not transporting them would pay for that. Now with that being said we are not rural we are isolated and you really have to love living here to stay here. Our system just sucks all around in the north and then being isolated makes it 100% worse.

I think you have a fairly unique situation there, as some of your flights are crewed BLS, right? The article seems to suggest that "paramedics" can't give sedation, but you're EMA-3 / ACP medics must have some sort of standing orders for benzos or haldol right? The flight ACPs have an expanded scope, don't they?

I am a PCP and I have 2 other PCPs in the station. I also have EMRs (Basics) I am pretty sure the ACPs have those standing orders but again some of the Flight crews (Transfer) are also PCP so they would not.

From what I get reading the news story, it sounds like there's a blanket policy that any psych transfer requires a fairly heavy degree of sedation, regardless of the perceived risk? And also that this is being applied in some situations where the patient's being transferred for another complaint but has a history of a psychiatric disorder? Am I reading that correctly?

Yes

If this is the case, I'd suggest that the policy is dysfunctional and needs to be changed to allow the transporting paramedics the discretion to decide what degree of sedation is required, and which patients should receive it? It might be worth re-designating psychiatric transfers that are judged by a PCP crew to require sedation to go ALS. Or continuing the existing policy of allowing any crew (BLS or ALS) to refuse to transport any patient they feel is not adequately sedated.

The Policy is in the works of being revamped. Our medics here have the ability to refuse a pt if they feel unsafe tranporting them. Personally no one in our station has ever refused but in other ones on the island have. In 15 years I have had 2 crews do the iffy thing but took them on my personal knowledge of the pt. My rule of thumb with sedation is , if I am having a normal conversation in the room and the patient wakes up and participates in the conversation they are not sedated enough, if they open their eyes and go back to sleep I am happy. I also have a discussion with the drs on how much is given. Many years ago there was a girl that took 3 days of drugs to be able to be sedated enough for transport. Now she was a definent extreme phyc pt.

Now to be honest there are those that have made this into a pissing match and since the Drs do want their pts to go they just give in. I dont feel this is appropriate and really would just like to find a common ground on this one. I have worked in the hospital where the nurses have really just thought of us as taxi drivers, and I have worked many years to get rid of that thought. We have a good relationship right now and Im trying to keep it that way.

But any attempt to demand that all patients with a psychiatric diagnosis, or being transferred for a psych referral be sedated into a danger zone for losing airway control, would be grossly unethical.

I agree with this statement but again as I mentioned before there are those that have the ability to be very violent at any given time and if they are being transported by air I do request sedation. In 15 years I have done this once. When I did this, the nurse thought I was being unethical but in my mind I was keeping the crew safe from an unpredicable patient that was withdrawing from street drugs.

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Also, regarding the argument that benzos/antipsychotics can interfere with the receiving physicians assessment, it should be remembered that the use of chemical restraint is also to protect the patient, so that the transport is less distressing for them, and to prevent them from harming themselves!

It is not always seen this way by the medical community

While these patients may be manageable in a clinic environment without medication, the flight environment provides a bunch of additional stressors must be anticipated.

See above

Some of the problem with longer acting agents, e.g. valium, can be mitigated by choosing agents with a shorter half-life, such as midazolam. But even accepting that this is a problem, any inconvenience to the receiving physicians should be outweighed by the risk of a catastrophe if a high risk patient is flown without proper precautions.

Agreed but again not seen this way by the medical community

I don't want to seem like I'm doing an about turn on my previous statements, I'm not. The crew has to have the ability to refuse a potentially dangerous transport, and the tools to mitigate any risk that is judged acceptable. But any blanket policy that removes that choice from them, and results in overaggressive sedation of low-risk patients is a problem.

Agreed, so you know the pilots also have the abilty to refuse as per transport canada.

Thanks for your comment. The only thing i didnt like about the artical is the mentioning of kids. I have had two pts at the age of 16 be sedated because of violent suicide attemps.

thanks again