Happiness

No pics, no time. Our cell phone dosn't take pics or do texting. I cant really see the point as I am suppose to be able to tell the ER staff the condition of the scene and they should be treating the patient not the pictures.

Why not using the BLS ambulance for one of them (#1, as you said)? Just trying to understand the system.

I guess depending where the accident occurs, I will be the only one available at the time. The next station is approx 30-40 minutes away, most of the time they are out of service so then the next after that is 1.5 hrs away and by the sounds of it neither pt can wait that long. Our station has done training with other first responders, we work together and I am confident that if I have to take first responders with me they will follow my instructions, im very lucky. I tried to answer as if I had ALS available but I dont

No Hazing in our station, but as far as hazing goes Crab fishermen are the worst, Hubby out fishing with pals, Gets a bucket of water, throws on cousin in the top bunk, Yells the boat is sinking. Cousin falls out of bunk, gets on life jacket and goes to the deck to find the rest laughing at him. For next two days cousin collects all the red jelly fish from the crab traps with out anyone noticing, then just before bed takes jelly fish and puts in the bottom of sleeping bags. Crew get into sleeping bags feel slime they jump out and their feet are covered and stinging because red jelly fish can sting dead or alive...... after that they decided to build a potato gun and have wars against the other crab boats for fun.

^{I wanted to answer this without reading any response first. My Answer is}

^{#1 is going BLS as his vitals are stable, the airway is managed, he would still be going code 3 but with the snoring that is telling me there is probably severe ICP and his survival is going to be low. He will be c-spine packaged, bagged, O2 and monitored to the hospital}

^{#2 is ALS his viatals are unstable, with possible internal injuries and needs to get to the operating room. I picked him as he has a higher chance of survival. He will be c-spine packaged, O2 Non rebreather at 15 ltrs,.I will have all airway equip ready, and monitored.}

^{#3 toe tagged}

^{I am a PCP, And here is my reality they are both with me #1 on the bench and #2 on the strecher. Both of these pts are going to be going to the same hospital, will probably have the same medical team and possibly the same ER room. They will then be sent to the nearest operating room in rupert but Im not thinking #1 is going to make it. I luv rural EMS also but I am considered Isolated EMS.}

I dont answer any personal calls on my cell on a call and my ring tone is the one from the factory

Pro's

Learning from others

Others learning from me

Special friendships that will last

Con's

Trolls

Trollette's

I always have a problem with the words "could have" or "might have". There is no background on the medic to whether this is his first error, no information on what the mistake was and why.

If I make a mistake I will document it on my sheet, talk to the Dr. and my Unit Chief then a medical review will be conducted and if it is deemed the error is because of negligence Im pretty sure someone may talk to the family. Personally I havent had to go through the process. I am not the one that is to go to the family before anything is decided on the error. If I do make a mistake that is found to be negligent then I'm pretty sure that I could ask to tell the family or pt.

As for Flamming you can still go and tell your pt that you screwed up and lied about it if that will make you feel better. And the comment about IHLPP, it is an intentional act to put someone on the floor unrestrained when you make an error it is accidental, big difference.

http://www.bclocalnews.com/bc_north/interior-news/news/130160053.html this is the opposite of the topic but I thought it was worth making a comment on.

Personally I have no problems with nurses being in the ambulance as the have great skills, but were I have the problem is paramedicine is a skill set on its own and nurses are not trained in the things we do and vice versa. If a nurse wants to be in the back of an amublance why didnt they become a paramedic in the first place?

The artical above tells of the pilot program intergrating paramedics into the emergency hospital system, this has been mentioned through out BC for a few years and my comment was that if I wanted to be a nurse that is what I would have to school for. Now in our community about 10 years back Northen health hired a few of us paramedics to be available to go into the hospital if shit hit the fan, or if they couldnt man the hospital to full staff. It is a good idea in an emergency situation but I kind of think that the paramedics are going to get board as we all know that we are adrenaline junkies and when the pagers go off the heart rate goes up. Well just my two cents...........................

Right now if I had to

Most critical on the stretcher

Next on a #9 on the bench strapped in with bench seatbelts

If needed I can put a very stable pt in the captians seat and one up front with the driver.

Before we got the big box we had the van style (i sure miss it) and I did have a call that was 1 adult with 5 children, flip and land in a water filled ditch. Only service was us and one 1 hr away. the adult and two children went with me as follows due to injury severity

Adult on the stretcher full spinal internal injuries

One child on #9 on bench Full spinal internal injuries

One child on #9 chained to the roof (when you could do that stuff) this pt was the noisest and the least injured out of the 3. Still was a spinal and the reason he went with me (as 2 were pretty close in severity) is he has already developed seat belt bruising over sternum area, the other child had moved the shoulder strap so it wasnt over him. They all had great vitals through out the 1 hr transport and all turned out okay. The other 2 children stayed and waited for the other ambulance and they made it just as we were leaving.

All I can say about transporting pts is that we need to have the ability to work outside of the box and sometime the unconventional is the only option.

Thanks put it on my favorites

I am not 24, I made up a date when I created my profile, I am 40, and have 22 years of experience. your equipment.

as far as my age I guess I hit wrong button on phone during setup, will try to fix it didn't know it was wrong till you pointed it out, no lie intended

So which one is it, you cant have it both ways

IHLPP seems to be dodging my questions, but I'll try again:

IHLPP: Has your company discussed with your State EMS oversight department about transporting patients in the manner you described? I mean, that would end the argument right there.

None of mine have been answered but I didnt expect them to be, and with the admission that she has lied to us already on her profile, Im not to sure if I personally would even except the answer's as the truth.

Feeding children properly starts from day 1 of starting solid foods. When my boys were getting started on food I started with plain rice pablum, then when pureed food was introduced they started on veggies. Some one said to me "When you start feeding your boy make sure you do fruit and things like sweet potatoes last. I made my own baby food for them all and followed the advice. When they were young if you offered them an apple to a candy bar they picked the apple 90% of the time. Now the other fact is where I live there are no fast food outlets is a factor in that they ate healthy and when we traveled they wanted to eat at places that served meals not fast food.

It was my responsibility to make sure my kids ate healthy and no one elses. I was very lucky that they loved things like stuffed green peppers and escargo. They love to try new foods even today when we pick a restaruant (when i visit them) it is to try something new.

They also love to gather their own food. They now come home to get fish and deer, enough for the year. They have dinner parties and they serve good food. People need to understand if you eat out of a box it is going to taste like cardboard.

The other big factor in young parents feeding their kids is economics. It costs less to feed your kid junk over good healthy food, so I guess until good food is cheaper then food in a box it is just going to continue.

Somebody asked about the patients response to the situation. Can't find the question to quote it but here is the answer.

In the beginning she just wanted us to make it work. She even offered suggestions. After I made my desicion to not transport and explained my reasoning to her, she said she understood and she thanked me because nobody had ever thought about her well-being before. She said usually the private services just cram her in without any thought.

I know I made the right desicion for the patient. I just know that my supervisor doesn't see it like that. She lost $150 ya know!

I asked the question and you answered exactly how I figured it went. thanks

Well welcome home Cookie and I hope all is going well............

In the scenario I presented the patient didn't weigh 1000 pounds. She weighed a little over 600 which would easily fit on a bariatric stretcher rated for 750.

Can you tell us how the pt felt about it all. I asked earlier but I tend to carry on and sometimes things are missed

congrats again scotty you will do fine and you two make a beautiful couple..........................cant wait for the wedding pics

congrats again scotty you will do fine and you two make a beautiful couple..........................cant wait for the wedding pics

I remember my first dead one and it was ewwwwwww you want me to touch him, and touch him we did all the while I was going OMG why did I pick this job.. Everything you said about the scene sounds pretty normal and the guys that want to prime (break the ribs) the pt for CRP well let them do it because it is the most disturbing feeling under your hands you will ever feel. I had a young fire fighter trying to do CPR (he had never done it before) and wasn't doing the compressions hard enought so I put my hands over his and primed the pt. The look on his face was devistating and from that point on I will make sure that I am the one doing the priming.

Okay I have decided to read up on this topic and am posting some of the sites for you all to comment on. I really do not like the responses that HLPP has made but have decided to look into what can be done about the problem of transporting obese pts, as in reality it is a growing problem in our health care system.

http://www.the-aaa.org/about/positionpapers/morbidlyobese.html

http://www.usfa.fema.gov/pdf/efop/efo39810.pdf

http://www.independentmail.com/news/2010/apr/30/heavy-lifting-medical-first-responders-pay-price-h/ I liked this one as it does mention a price of converting an ambulance, it mentions that the service is unable to refuse an obese pt. but most of all it states that if you invest in the converting you as a service will be able to save in insurance costs because your medics will have less injury

http://www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol142009/No1Jan09/Bariatric-Patient-Handling-Program-.aspx#USVA06 from nursing points of view

It is very apparent that the obesity is very much on the rise in our communities. So maybe the question should be posed to all ambulance services is Are you prepared for a bariatric patient, if no then maybe they should become that way. As I have been reading this and other information there are ways to deal with these patients without sliding them onto a floor in a non emergency setting. If as the OP says the other service does exactly what she refused the pt for then the transferring hospital should be the first line of pt advocacy and make sure that their pts are being transferred safely within an ambulance that is properly equip. Pretty much as far as I can see the OP should never have been put in the position of having to refuse the patient in the first place and her service should maybe refused the transfer saying that they were not properly equip.

I have to admit that I have been kind of forced to learn more about this topic and thanks MG for bringing it forward.

We have two options that I have seen used here for medivacing the obese here, one is to call in the Military Buffalo out of Nanaimo and the other is a special plane and crew from Alberta. In looking at all of the equipment that really is required to safely transport an obese pt I can now see why our Lear jet isn't used.

I am sorry, but I would have terminated you.

So lets put this in a way that even you can understand. Ya that statement is just rude

It is obvious that you have never handled this type of transport, so please withhold your opinion when you have no clue what you are talking about. Again rude you have no idea about the vast amounts of experience that travel through these forums

but I doubt that is the way it really happened. That is quite the assumption and you basically just called her a Liar, very bad form.

I would have assisted and techd the call, to alleviate any of the ridiculous fears that have been mentioned here. Well I guess YOU should have been there and because you were not how do you know those fears are rediculous. A patient ADVOCATE would have found a way to transport the patient, not abandon them in their time of need. So Im not to sure on how many Managers can be concidered pt ADVOCATE when they run by policy and not by common sense. Your position in the company is pulled by the all mighty buck there is no pt advocate in it.

Again, much like crotchity USA, you are refusing to answer my question: Well that could be said the same for you as I asked you to questions (hummm still waiting) and comparing long time members to the likes of Crotchity is just insulting

What other type of patients do you refuse to transport ? The poor, minorities, drunks ? Yep If I have a valid reason to not transport and if you must know 90 % of my call volume are the above.

No dwayne, i am not hiding, just have to work for a living every few days.

I admit I may be hypersensitive because I am obese and know what it feels like to get the look of shame from all the skinny people, but again, to me, being a patient advocate means we find a way to meet their needs versus refusing care. . This is were my question came in as I asked How do you want to be transported in you time of need Safely or not Safely, and again you bring up the advocate, again you are an advocate when you are there doing the deed and the OP did meet the needs by getting the proper ambulance to get the pt and it was above and beyond the call of duty. She made sure her pt was taken care of before she left and you seem to not see that.

Or to give another example. I think we can all agree that Dopamine would never be administered by a nurse in an ICU without it being on an IV pump, yet we do it all the time. Irrelevant to anything said we are not nurses in an ICU.

So does that mean if a 1000 lb patient presents to your ER, you will refuse care because your stretcher is only regulated for 750lbs ? So your telling us that I should put a 1000 lb pt on this stretcher so that it can collapse and create more injury?

I am the one being attacked here yep agreed and I have pointed out a few reasons why above, as far as my management skills go, feel free to attack, but as a manager I have to enforce all policies fairly Well in this case you jumped the gun and probably just fired someone that had great skills as a medic without hearing the whole thing through, How is that fairl, and we have a policy that does not allow the medic to refuse a call Just because you have it dosnt mean it is right. You can disagree with the company's stance, but that is our policy. And I disgree with most people's answer that a safety concern can be variable and open to interpretation You know I thought about this for awhile and yep I do sort of agree with this statement but at the end of the thought process it came to me, You are not the one that is putting Your safety at risk, so therefore why should you give a dam again the all mighty buck rules. If you refuse to transport this patient due to MVC concerns, then I say you can not transport any patient, as no patient is safe in the back of an ambulance during an MVC, the stretcher will come loose from the floor, the plexiglass and all supplies will become airborn missles. You can't have it both ways. You have missed the whole point of every thing that was said.

I have read each and every response to this thread and Im sorry HLPP you brought alot of this on yourself. Lets take a look at this whole thing. So first you have made good comments on other threads but like others have said this one has made you snap a bit. You have said your obese and a bit hypersensitive to this topic.

Ok lets look at your profile pic if that is you, Your a pretty blond girl that looks a bit chubby and you have big boobs which make women look even chubbier than they really are. So by being chubby is it fair to say that really if you had a choice to go to an appointment safely and compfortable you wouldn't take it. I dont think that is true and I think you would probably wait. The other thing is that I am sure the OP did go back and talk to this pt and explain everthing to them. Maybe MG can comment on that What did the pt feel about this whole thing because really that is the bottome line. You are a 23 year old Manager well that is not a real good time line of experience and you will learn in life that policy is not always right. There is a ole addage that says After Me you come first and that is so true in this profession. My safety comes before the pts and the pts safety comes befor the greenback. I agree with the others in saying there is something that has happened to you to make this type of response.

She is prettyawsome I like the second to last pic, thats her early warning signal for teenagehood

MG you did the right thing as far as I can tell. In my community there are more obese people than non. We have 5 ambulances on our little island and the one in the middle has the bariatric stretcher. When medivacs are for the obese they take the call. Your safety is first and then you pts is second.

Now like I said we live in small communities here and in 15 years I have seen one call where they used the Manta mat for a 400 lb pt in medical distress. They did yes put him on the floor and they had a fire truck in front and back for the transport of 3 minutes to the hospital. The risk was worth the benifit in that case the pt one need to go to the hospital and that pt lived. This senerio seems to be a non emergency that was able to wait the extra 12 hrs for transport and if the other company did it that way it dosn't make it right

On the topic of refusing pts I have the ability to say there is no way I am taking that pt if I feel unsafe . I personally have never refused and I rarely take the RCMP with me as they just aggravate them. I want my pts to trust me and I have had the biggest nut bar in the back. Phyc calls are the ones here I do well (yes there may be a reason for that and if I had to do my assessment in the back of the cop car, follow them to the ER then that is what I would do. As we fly out phyc's here we are the conection from the hospital to the plane. If I feel a pt hasn't been sedated enough then I go to the dr and explain why and we deal with it together as I am not going to waste anyone's time to have my pt refused by the air crew they are busy enough. Thank god I dont have people above threatning to fire me because I did my job.

HLPP first of all MG was really the mature one in this forum and just basically said thank you for your input. She has come here for help in a dessision that she had to make and then you say she should be fired without really reading the post. You then try to make the senerio change to try and prove your point what fairness is in that? Ok and on a bit of a little topic but come on do you honestly think with the screen name you have picked any one respects what you have to say, as they cant stop laughing, myself included. When I look at your profile your what 23 oooohhhhhh the experience you must have in those years and you put that you are a paramedic but since your in the states exactly what level re you. So before you carry on with your little tantrum that others have pointed out, you as a person that is heavy HOW the hell do you want to be transported safely or unsafely.

As a medic I have never been had any of the above, but that might be because they are more afraid of me then I am of them. As a bar manager it all happened to me and they weren't always drunk but they only did it once I dont know the laws in your area but it would be a good thing to find out and take some self defence classes and always remember your PPE.

Good luck

now that avitar of FNG is going to offend many can anyone say why?

congradulations