mobey

sorry meant to be a PM

so you really have three actual patients and 9 walking wounded

You have enough equipment then.

Put the young woman near the tear in the 2nd arriving ambulance - your first in ambulance is your triage ambulance

put the 2nd patietn who is moving his disorganizedly in the 3rd ambulance which just got there.

both those ambos go on to the hosptial

You are now responsible for the kid in the bus and the walking wounded. Since it's only a 10 minute run from the scene to the ER you can work on getting patient 3 out of the bus, packaged and initial treatment started while that first ambulance is on the way back to you. Once that ambulance gets there you put them in and they go

You then put the walking wounded on the bus that just arrived and you and any other emt's available can go with taht bus to the hospital.

You instruct the staff of unit #2 to grab the girl and load her up. Your EMT turns to you and says "she has no pulse, but some agonal resps" do you want us to transport?

You instruct the staff of unit #3 to package the male pt up and transport. he has obvious head trauma and moans to painful stimuli.

You jump in the bus to asses the 3rd patient who is complaning of leg pain.

Anyone wants to follow either of the patients in scenarioland feel free.

The helecopter will not leave thier pad.

Dammit!

BTW your ambulance that is now at the "code" tells you they will be transporting an active MI, not a code. They will drop thier pt. at the hospital and race back asap.

You are a BLS service with 2 full time ambulances, a third can be called in if enough staff are around to run it.

On a very foggy day you are dispatched to a Cardiac arrest. You and your partner respond with a third EMT to a rural residence. On the way out you hear a call come over the radio for a 3 vehicle MVC on the highway about 3 miles behind you. Gravel truck vs SUV vs school bus with 15 total potential patients.

Dispatch states there are at least 2 ejected, no other info.

Fire has been dispatched

You are about 7 min out from your code..... and 3 miles from the MVA (behind you).

12 kids, 3 drivers.

Driver of SUV, bus, and truck are out of thier vehicles and standing with 9 kids on the side of the road.

You can see a young womal lying on the side of the road beside the "Tear" in the bus, a young man directly behind the bus, moving his arms in a disorganized fasion, and one still on the bus sitting up.

Your 3rd ambulance and rescue truck are arriving staffed with 2 EMT's and 2 FF (first aid)

http://www.ctv.ca/servlet/ArticleNews/stor...0409?hub=Canada

I was just trying to post the pics... but anyhoo :roll:

this is what you roll up on.

Forget the media story, this is scenarioland.

(consider yourself on the 2nd car)

Great!

in our area it is up to us to tell dispatch what we want.

Police are now enroute (15 min responce)

Mutual aide ALS ambulances x2 enroute approx 45 min away

Heavy rescue 1.5 hrs away (local FD have power tools and are well versed in extrication)

Helicopters will not fly due to weather

School bus will respond asap.

Note: Accident occured about 10min from town. This will be a small town hospital not to used to trauma and 3 General docs.

can I keep my pantys on? ( you decide? )

(Do we continue exploring?)

Since you suspect maybe a bite do you leave her in her clothes? How closely do you want to look?

I would strip her and put a gown on her (If you carry gowns...we do). I am going to continue to observe the area of the bite, given I found one.

I also would like to spend some time calming her maybe coached breathing would help. This may allow her to better localize the pain.

You are a BLS service with 2 full time ambulances, a third can be called in if enough staff are around to run it.

On a very foggy day you are dispatched to a Cardiac arrest. You and your partner respond with a third EMT to a rural residence. On the way out you hear a call come over the radio for a 3 vehicle MVC on the highway about 3 miles behind you. Gravel truck vs SUV vs school bus with 15 total potential patients.

Dispatch states there are at least 2 ejected, no other info.

Fire has been dispatched

You are about 7 min out from your code..... and 3 miles from the MVA (behind you).

Ready, set, go....

(For those of you who know of this call, I will not be replicating the details for respect of the families involved. This is not a replay of the actual events, just a general overview with some omissions and additions)

[align=center]Hi,I'm Steve.Paramedic with a small rural ambulance and also an industrial site.Really find this site interesting,lots of good topics and discussion. Keep up the good work.

Hey steve I am a Rural EMS-Addict (Hmm ...think I'll set that as my job)

Anyhoo.. are you in AB?

I work for a rural AB service that is going ALS very soon, maybe I can bounce some ideas off you in the future.

Is there a shortage of oxygen where you are? most people requiring an ambulance could benefit from a little O2 every once in a while. dont be sparing lads

Hmmm....

So in following the earlier posts, your saying just throw on an NRB because everyone requiring an ambulance could use a "little" oxygen.

In my experience throwing a mask with O2 whisling through it is hardly soothing. (Remember we are not talking cannulas here).

Patients requiring an ambulance that do not benefit high flow O2:

Isolated fracture of a limb

Hyperventolation d/t anxiety

Most abd pain

headache

I just don't feel well

My car ran out of gas, and I need to get to town

lower limb pain

I can't pee

I can't poo

My hemorroids hurt worse today

Anyone with SPO2 >90, Pink warm dry skin and RR < 30 & non-laboured

I dunno... I have a problem with all this pressure sore talk. I have heard all the mumbo jumbo about sores after 2 hours, and I am sure that holds true for little old ladies. But for the average adolesent/adult I have had very different experience.

I worked for a very remote service with a transport time of about 2.5 hours down some terrible roads (max speed 80-90km/hr). My patients would be on a board for around 3 hours by the time we got a room and god knows how long after we left them.

Ya they were definatly in discomfort/pain, but i never heard complaints of sores.

I always wondered... would it be that detrimental to put like a 1/4 inch of foam on top of the board?

I would tend to agree, but the friend in question thinks that the person is alive and has excellent self control......

In that case I don't want to know what the guy under the table was doing :shock:

It would surprise me if this was not a dead guy.

He dosent take a breath or twitch for 30 seconds, then even after the joke is over, he still continues to not breath or move... seems pretty dead to me.

This could be so many things, without a full assesment there is no way to give you any answers.

as for the HTN at the time of the call, he may be non-compliant with meds.

As for the agitation, it could be from < BGL, could be from anxiety, who knows.

There is no way for you or us to guess what was going on.

What about high bp makes you go with a NRB? Not saying it is wrong... just trying to follow your train of thought

The morning increase in thrombotic cardiovascular events has been attributed, in part, to the morning surge in platelet aggregability

*excerpt from American College of Cardiology study in 1996*

Thought it was interesting.

Our most common call times are early morning SOB, & transfers, and evening chest pains and "I don't feel good"

An ambulance.

I try keep my jump kit in my ambulance, i don't think it is big enough to fit the whole ambulance in

linked worked for me.

Very funny BTW.

Unless of course this person is looking for a personal vehicle.

Did you read the original post??

Every day I get more and more pissed off with how much I don't know in the medical field.

Saturday night palsy

Suspention trauma

Now this :roll:

Thanks for the post firedoc

We often use the speed splints. I am not much into all the fancy splints we carry in our unit, but i always stabilize fractures when time permits with one of these.

But if the machine can interpret the rhythm, then why do we need to train the providers to do it?

I wonder what the accuracy is on those machine diagnosis?

Just wondering how common NPA's are in other areas. I have never used one, never seen one used, and in fact we don't even carry them.

I know when and how to use them.

I am thinking they may be a thing of the past?

Or maybe the underdog of airway management that should be used more often?

OK maybe jump kit is not a universal term, but I mean the standard kit you grab on your way into every call. I will list what we carry, but I am considering recommending some changes and wanted to get some ideas.

1st kit (carried into every call that is not dispatched unresponsive/unconcious)

BP cuff & Stethoscope

SPO2 monitor

2x nasal cannula, 2x NRB, BVM

Med kit

Glucose monitor

Sharps container

IV kit

Manual suction

2nd kit (Only brought in to unCx unresponcive, or trauma)

All items as above plus:

OPA set

Non-visualized airway set (king right now)

Oxygen D tank

And a whole lot of dressings

I am thinking one all inclusive kit would be nice, makes my unit checks that much easier!