streethealer535

I was thinking as I read through this thread what about trying to vagal... it might not work but if it slowed the rythem enough to reconize something it my help. I guess running at 50mm might help but then I have never seen and EKG done like this is it easy to read and understand in relationship to the vertical lines on the tracing? ~street

Thanks for the great Information its nice to hear from someone who is actully in the system! I hope this lives up to the hype it could realy benifit everyone. ~Street

Your pretty close... there are still 2 states in the union that are "Duty to Act" states. Vermont is one the other is Alaska. It is unlawfully to pass someone in need if you are a licensed provider in the state. That being said If you have a duty to someone else IE pt in an ambulance or child in car you do not have to stop. I have never heard of anyone losing a license or even being warned for not stopping. Sadly this is not the first accident of the like in VT. I have personally been on four scenes were off duty police officers and FF have been injured due to vehicles hitting them or there vehicle on the side of the road. (luckily they all survived) This is a tough decision to make... I know you feel obligated to help but at the same time is your life or your family's worth the risk? ~Street

This seems quite interesting... My question of course is how well will this actually work... and what is the data that is used is it just location of calls from the past 4 years or does it take into account weather and other outside information? If this works like they seem to think it will I think we might be looking at a pretty useful tool!

Timmy, Please Let me Clarify for you... I was not talking about you wanting to know the child's O2 SATuration Level... I was talking about one of my pet peeves... Every time you say O2 STAT you sound like a moron! ITS SAT short for SATURATION... get it? ~street

REALY???? tell me please that this was a typo or a joke.... if its a joke I get it and yes you got me.... if not then well please just shoot me now... ~Street

O2, Bi lat B/Ps (femeral if poss or at least compare pulses), Injection of Diesel therapy back to the ED.

Seems to me the hardest part will be lifting and crawling around on the floor. If you will be early enough into your pregnacy that this is not a problem I don't see why you could not test. The biggest problems might come in the hands on part of the actual class (lifting, CPR on floor, ect...)but if they are willing to work with you it might not be a problem. Anyway good luck I have seen it done...

Yeah but the question is How many HOURS A week do you have to work to do that??? not just 40 for sure!! ~Street

fenwayfrankee From your name I am going to assume you are in the Boston area. If this is the case Two of the best Intercept "chase car" systems I know of are in your area. Lawrence and Lowell Mass both run BLS trucks for transport (privatly run) with dual paramedic intercept vehicals (Hospital based). These systems work very well and are very progressive with their protocols. Just out of curiosity what was your interest in this type of system?

I think p3medic said it best... who are we to decide what is quality of life for anyone but ourselves?? There is no way you can not work this patient. It is not right for us to try and push our own morals and belives on others. If this Pt did not want all efforts (real efforts not medicating her bed) She could easily have signed a DNR. You may be thinking mabey she just did not get to it, or someone else talked her into not signing a DNR but as EMS it is not our place to assume anything. WORK IT and work it RIGHT! JJ

Yeah the problem with the jepordy game is that its backwords... they are supose to give you the answer and let you guess the question... :roll: oh well ~street

Basicaly when all is said and done there is only one lower chamber and the IVC and SVC atatch directly to the pulmanary arteries and the Aorta is attatch to the RV Stay safe JJ

How about this? It does not get much more complicated then this... and if you think this is bad you should see the 3 stage surg done to corect it! stay safe. JJ

Mabey Im a little comfused but since when does RIGHT sided failure cause PE???? Its left sided failure causing PE then the elevated PA presure caused Elevated RV presure and then right sided failure!! Also we can get into the discusion of systolic or diastolic CHF, but I belive the question is a little easier to answer. Seems to me that most of our patients do not have simple one track disease processes. I might be wrong but it seems to me if there is PE then the Airway will become irritated and can be inflamed. So sometimes it takes albuterol to even hear rales instead of wheezes. Yes we can harm patients in CHF by giving them Albuterol, but in combination with everything else (C-pap, dieretics, baging, O2, Nitro if HTN) I think it is a good option as long as you continue to think about what you are doing to the patients. Just my thoughts... :wink: Street~

I think it sounds like we are all coming to the same conclustion... My only question is what was the final outcome??? Did the patient continue to refuse treatment in the ED? Was there a Mental change due to dehydration or mental defisency? was the patient released back to the SNF? Just wondering how it all worked out... JJ

VS... Why are you putting so much faith in the "DOCTOR" who was not there but on the phone.. A medical doctor (PCP) I am assuming would have no more a right to as you put it "form" a patient then we do as EMS... with out proper legal criteria met they have no ability to even touch a patient without consent. If the criteria is met as EMS professionals we could transport the patient with out the doc saying so anyway. I think we need to give this crew some credit for taking a difficult call and making the best out of a tough situation. I will be the first person to walk away from someone who does not want to be treated. I refuse to push medical help on a competent pt who wants to be left alone. However sometimes making the distinction between who is competent and who is not can be very difficult. Although it may be nieve I tend to belive if you have a good heart, make the best decision you can with as much knowledge as possible, and document the crap out of the call you should be able to defend it to anyone. I think MSDeltaFit got it right just cause someone is AOx4 does not mean they are competent. they need to understand the consequences of their decision. mshow00 good job.. JJ

In all my many years in EMS... (ok, ok, just 10 yeah I know Im just a pup.. but it makes me sound almost regal... :wink:) I would have to say Dust's comments have been the only possitive thing I have ever heard about AMR... of course I am from New England and have see first hand what Doug is talking about with AMR in Mass... Just my 2 cents JJ

:shock: ummmmm uhhhhh yeah ok??

At least in NH it would have to do with pay period... if you work more than 40hrs in a pay period you must me compansated with time and a half... this might even be a weekly thing not just a pay period... JJ

Dust your infinite wisdom shows again!!! I spent 8 years as a EMT-B and EMT-I and until I started my Paramedic program (AS degree with A&P 1 & 2) I had no Idea what I did not know or did not truly understand. Now my most used statement to all my partners and students is this. "You don't know what you don't know until you learn it!!" I belive this goes for everything in life not just EMS. As for A&P being mandatory I like to link it to other professions... Mechanics don't learn to fix problems they learn how a car works and how to trouble shoot to find the problem... same thought process just a different patient. We need to know the human body inside and out if we ever hope to trouble shoot patient complaints and use CRITICAL THINKING!!!

I understand what your saying but think about this... three years ago I read a study conducted on ambulances. Any Crash over 35mph and anyone sitting on the bench had a 98% chance of not living through it seat belted or not. just some food for thought JJ

Its called Gallows humor its a coping mechanism... so lay off the guy huh.. its dam funny... if you don't take life soo serious. Death is enevitable, life ends, its about what we do to make a difference when we are here... So light'n up and smile!!! JJ PS evilmedic13 ... thats some funny stuff right there...

My though is this... sounds like the patient has some Pulmonary adema from CHF.. (no lung sounds stated) The treatment for CHF: Lasix, Nitro, C-Pap Lasix is not going to do much if your only 4 min down the road and the medics were unavailable right? not your fault last time I checked Nitro is going to help but only if you can assist. pt might not have had there own and agin not your fault medics not available. As for C-Pap... what is it really but a little pressure to assist in ventilation... get were I am going with this... Bagging can do the same thing... I have had CHF Patients actually bag themselves. (I prefer to do the bagging but sometimes patients need this) Hold the mask and tell them to squeeze as they breath in. sound crazy right... well trust me it works... exspecialy when you don't have C-Pap. Now if the patient is breathing fast cause they are scared (they tend to get that way when we can't breath) then helping them will slow their resps. As for the RN YELLING at you I have a pet peeve with higher level providers Yelling instead of educating... its kind of useless to yell at someone for doing something "wrong" and not telling them what is "right". JJ

I am not sure what a fire/medic makes in Tempe now. But I would tend to belive that even thought the company is sending 94K to the fire dept its not the firefighter that is seeing all that money... that seems a little shady to me... JJ