stcommodore

In my department when they have to cover a call out they split up dual medics and "detail" someone to the empty spot.

among all the drama of a saturday night in the big city...

Call #1 possible stroke, unresponsive 88 yof, bvm near intubation

call #2 combative drug/alcohol overdose 45 yof, restrained and sedated

call #3 bar fight/assault, 29 yof shard of glass cuts upper arm w/arteral bleed, tourniqute (sp)

oh and my partner had a code tonight....

To: The General EMS Public

For your information and general lusting the Philadelphia Fire Department has begun to recieve its lifepack 15's. They will replace 35 Lifepack 12's used by its Paramedic units and be an exciting progressive change to america's sixth biggiest city.

My service will soon be recieving the Lifepack 15 which is equiped with the ability to moniter Carbon Monoxide. Now here is the problem! Pennsylvania has no protocal for monitering CO in a patient, go figure. We have such devices on our first in bags to moniter for them on calls but can't do the same on one specific patient.

Does anyone have research for or against the use of such in EMS? Does anyone actually do this on a regular basis or have a protocal there sevices uses.

Thanks!

I would ask we not "monday morning quarterback" this from news reports. There will be offical reports and the last thing this community needs is negitive comments.

This was very close to home, border of my part time job, just north of my fulltime job and a few miles from home. I dont know the medic personally but regardless we are all one family.

Lets boycott NBC.

glad to see its back!

How about I don't care about your silly non-american systems. In a big urban fire systems your emt's are firefighters and have very little but a fast ride to offer as patient care/skills. Paramedics are king here and minus burnout and laziness if you want advanced care you hope you get them.

Get over the terms they are not going to change.

Tell the "patient" all they are going to do at the hospital is wash out there eyes, which you can do at home and then you'll have a really expensive eye exam..maybe. So do you still want to go to the hospital?

I have heard of some newer radios with gos in them which helps. I also feel for the poster that can't get everyone a radio. Our dept has a radio for everyone on duty, bu I've worked places where thats not the case.

Oh, and to clarify we have a procedure for "civil disturbance" that includes what to do if you must abandon a station due to the area being unsafe.

Does any department have an operational procedure/sop/etc for "kidnapped/missing" crew? I work in a major urban system that has directives, procedures, etc for basically every situation including civil unrest/abandoning a fire station. We also have the typical "police assist" for situations when your in danger but does anyone have any expierence with this type of situation?

-How long would it take within your local to find an ambulance, then the crew if it was seperated from the truck?

-How long would it take depending on your status (on a run, at a hosp, etc) would it take for your communications center to determine something was wrong?

-Does your truck, radio, etc have gps or some other type of tracking system to find you?

I guess this is sort of a rare and unlikely event but it would be worth talking about.

"Running" a Cardiac Arrest isn't an easy feat and is dramatically harder if your the only Paramedic (advanced skills provider) in a room filled with basic providers. My partner and I (both paramedics) can typically run a code with the assistance of 3 EMT-B's pretty routly but take one of us out of the mix and its twice the trouble.

On the topic of intubation alone there is alot that goes into a sucessful intubation and if your still in training you don't know the stress of being the only Paramedic in the room yet. Obviously the important points of:

-patient posistion, airway assessment

-suction, preoxy, equip prep

-the actual attempt

-secure/etc02

Can take alot away from running the rest of the code...

Patient posistion can be easily overlooked if you don't know how much it helps! My partner and I always bring and have the port. suction set up prior to the blade ever going into the patient's mouth. In the last 10 intubations I think all have required minimal to heavy suction use. There is nothing worse then getting into the airway and then realizing you need something you don't have and you just wasted an attempt.

Bagging the patient and setting up the equipment along with an assessment of the airway can give you 30-60 seconds to take a deep breath, relax and prepare for the intubation. When you finally make your attempt have someone set aside as your "assistant" who can hand you equipment, move the patient, apply cric pressure, tell you to stop, etc. As your in the airway a few seconds to get the lay of the land is ok if you ask me. You may have to suction, readjust, and see your landmarks clear before you actually insert the tube. I even take a second with the tube as I pass it to make sure its going through and to try and not "burry" the tube in the patient. How long does that acutally take? I don't know but the point is make everything possible in your favor before making your attempt.

And now a story...

I recently had a trauma code which at the surface appeared like a car accident. But after removing the patient we discovered a gun and turned into a gsw to the head. So what factors do we have that make this intubation difficult? Blood in the airway that will require alot of suction, c-collar, drama of the moment, oh yea and the patient was a police officer (off duty/but in uniform.) To make the story short the intubation was sucessful but some won't so learn from each.

Good luck. I think that clean car means clean ambulance is off. I have a super clean, orginized and stocked truck but my pov is far from it.

Just shows that the public sucks at identifying a seizure . But like someone elsw said this story has changed to many times for anyone not invloved to know.

Im not looking for a "urban vs others" I'm saying the female" hit with a 40" is't unique to my city and you all seem to be taking this the wrong way.

See also "what happens in the back of the ambulance"

Sorry if my late night ramblings didn't make sense. Basically I feel urban ems is so similar that it doesn't matter what city your in you could function. Along those lines there wouldn't be the same sucess in suburban or rural to urban.

I believe after working urban EMS for 1 1/2 yrs that besides the protocals, and logisics of the system you could do the job in any city. I think that in a disaster/nims sense its been tested and would love to see what you all think.

I may not know the radio lingo, streets of your city or hospitals but drop me in NYC with my partner, my truck, a good map/gps program, and field guide to the hospitals and we could go to work.

I work in a very "not" progressive urban service but we at the least have versed and a chemmical sedation protocal. If the patient is struggling against restraints and you can't explIn away the issue medically then put them to sleep. I work part time at a service that doesn't have restraints and each time I am on an incident where they were needed and I did't have them I write an incident report so there is a paper trail.

I think somebody misunderstood my previous post. On critical calls where everyone is busy Is the only type of calls I don't chart on the way to the call. I may quickly enter the name and demographics in the computer to start but go no further. Once the patient is in the hands of the hospital we complete the run and then go avail for another run. Your not allowed to leave any runs incomplete by the completion of your shift at my FT job. We have a wonderful and quick charting system as I said before and no need to carry charts over to the next day.

I will speak to limiting these crazy extended shifts. It's impossible to regulate it across different departments. But in my department medics can't work more then 12hrs in a row. FF's can work 24hr strait but the second shift can not be driving the squad.

In my rural county, 2010 will see the demise of volunteers-both fire and rescue-after over 50+ years in service.

We have a hot shot new fire chief from the big city, a new arrogant county administrator and a bunch of good old B.O.S. boys who jump every time a taxpayer whines.

We now have 24/7 career coverage most of who would rather get a PT refusal than transport to the closest hospital-40 miles away.

We have a bunch of paid EMT/FF who all pile on an engine and respond to calls, overwhelming most PT's.

http://www.emtcity.com/public/style_emoticons/default/rolleyes2.gif

Sounds like this town needs to build a closer hospital! Also, congrats to going paid.

I also enjoy the critical patient's where I have the "bunch of paid ff/emt's" that can do cpr, drive, carry, lift, retrieve equipment, secure the scene, etc.

I don't know what the issue is in charting en route. Most of my assessment is done and interventions complete before we even begin transport. Our charting system is very basic and designed to be quick as it is. On critical cases I may only enter demographics or nothing at all. I know what its like to be "in the hole" with multiple charts and its not ideal.

My cut off for waiting for a bed without starting to complain comes when I finish my chart and am still sitting with the patient on my stretcher. Which ment that its actually a patient in need of a bed and I just using the onscreen keyboard chicken pecked out an entire narritive.

When it comes to "stocking from the hospital" I think the places that have to do "hunt and steal" supplies

a)don't have a high enough call volume that hospital turn over time is important

b)don't have the money or want to spend the money to supply themselves

I'm thinking out loud here but say for your call volume you have 30 trucks overworked, constantly relocating or responding from a distance calls, etc and you add 20 trucks to make a total of 50. But in doing so a percent of those units are going to do dramatically less runs then others, thus cost more money, man hours, etc where is the middle ground?

We all know that call volume doesn't change when you add units its just spead out more. So from the prespective of you guys working dynamic deployment does the cost of "probably" having a unit closer to the next call worth the side effects? At my part time suburban job we run a fourth "bls float" truck in the day along with three als units. Between 07-2300 we are expected to operate in a SSM style to cover calls within the local and it appears to do so a majority of the time. But when your one squad in an entire county doing so its far from the norm. I think its a matter again of call volume and this department isn't busy and half the time you relocate you don't have another run.

When we transport a patient related to a fire incident either normal citizen or FD personel name, date of birth and something to the extend of "first aid and transport" are added into the incident histories notes. Other then that our dispatch center never sees any patient information. Our field supervisor (lieutient/captian) can't even pull runs without speaking with the CQI office/officer.