stcommodore

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.

Since we had our scheudled distaster called "new years eve night" yeasterday things ran a little different and almost better. Typically at night we have about 28 ALS/BLS squads in service and at times can run out of squads on a busy night. In NYE's past people died waiting for a squad and the bad press has led the powers that be to staff all 50 squads for the night now. In addition to that we had our ems batallion chief in the communications center keeping people from hiding out at the hospitals for to long. Needless to say when you have enough units to meet the demand it makes the night go better. In my part time suburban job where we are just starting to get MDT's that allow us to see our runs via computer it still takes alot longer to totally complete a call because of paper charting. The call volume isn't as high and money isn't as abundent so things are different. But obviously echarting, dispatching, interface between those two, as well as uploading EKG to the computer (which I can't get to work, ugh) makes life so much easier.

We are given "30min" before the dispatcher starts checking on you. Most don't use all the time and with echarting with the drs tatical computer (yes I love to preach its wonders) most of the chart can be done before arrival at the hospital. If the hospital is busy I'll just finish my narritive there, and our trucks are typically overstocked so resupply is usually not needed. Only once or twice have I had a string of critical patients and needed to return for supplies.

On going budget issues so no new ambulance for us. 4 years and 75,000 miles is alot of wear and tear in urban ems.

Sounds interesting, I wish my city had an extra 500k to throw around like that. I see where Dynamic deployment can be rough, but my system doesn't even have enough units to meet the demand let alone shift units around. Our day "peak" units just barly help meet the demand in the day as it is. I say take half that money and put it towards inventing a more comfortable seat in the cab, and the second for safer trucks.

I think regardless of setting you have to set a bench mark. In the urban setting where system abuse is so rampant they are the root cause of most of the systems dysfunction. Our responce times in the urban setting would be to standard if people didn't call for "testicle pain and ear pain", "pediatric flu symptoms", "headache x3 days" these are all calls I frequently have.

I want to know how he "refused" to respond? In my system a first responder company can place themselves on "fire duty only" typically after a fire or to do drill activities. Many "bad" medics to have found ways to avoid calls after being dispatched to one. Ie being "flagged down" for a "patient" on the way to the first call.

Any large city, or other services I know tell you where you'll work, when you'll work and will change that as necessary.

I believe that approx four of my missed tubes were sucessful intubations by my partner. Another was a field ROSC and the attempt was one attempt made en route to the hospital and later managed with RSI in the ED. If I remeber correctly one other miss was a code we intercepted a BLS unit on within 2 blocks of the ED, so the "well controlled" ETI attempt didn't really take place. I would argue that if you have no specific numbers/studies/etc to add where do you asume what sucessful % is the norm. Like it was said before each intubation sucessful or not is a learning expierence not only in putting the tube in the hole, but the flow of the incident, equipment you use, patient posistion, etc.

In regards to those I miss I keep a sort of running tally of each and I believe it was a early year slump for no specific reason. I have had great sucess with some really difficult intubations Ex. 500lb respiratory arrest, multisystem trauma, etc patient's but sometimes you can't get them all. I've used CPAP probaby 5-10 times this year the fact is I see more cardiac arrest patient's then CHF, severe Asthma, etc patient's. We can also expand this further into first time sucess, and at what point do you stop (three attemps total) and switch to a rescue airway? I've never personally used a rescue airway but feel that once I arrived at the hospital it would be pulled faster then anything so that 10 more people could make 10 more fruitless attempts.

Hey all, with less then a month to go this year how many ETI do you have as an ALS provider? To expand it further, how many do you average in a month? What do you think the average is for a full time ALS provider? What do you think the minimum standard should be before a provider is sent to an OR/training center to "keep there skills up." For the record I've had 22 sucessful intubations at a 82% sucess rate.

I work 8p-8a on a short week/long week scheudle of: Week 1-Monday, Tuesday, Friday, Saturday, Sunday Week 2-Wednesday, Thursday In addition to that I occasionally work 4-5 shifts at a part time job and 2-3 overtime shifts at my full time job. Besides all the advantages to nightwork vs.day like less traffic, no doctors offices, no school/work, 20 neighbors and bystanders on scene there is alot better about nights. I guess its a decision you and your girlfriend have to decide on. My girlfriend often says she would like days better but I then explain working 8a-8p would me I wouldn't be home til close to 9p and by then its just time to go to bed for the next shift. Working nights often allows chores to be done during the week, now allows me to advance my education with classes and on weekends fun "kid" activies with the family since I don't leave for work until 7p.

Are we talking "kkk" standards as law or some other source? Please include if possible.

Let me add that in a non-emergent transport situation the 5 point belts for the patient is nothing. But if we look at a 911 system with a zero to low serious collison percent, under 5 mi average transport. Where does "risk/cost vs. Benifit" fall there? I'm not personally against increased safety, but need a level of practicality to it.

sounds like a good idea. I wrote alot my first year as a medic, but find it harder to find the time to continue to write as frequently. Being that your setting is urban maybe you could highlight alot of the frustration that goes with that setting. System abuse, misuse, burn out and its effects on coworkers.

How about this situation...20s male sitting outside asumed intoxicated. Police called for "man screaming" they call us. Patient has a small abrasion to the forehead, but no other signs of injury. Patient being intoxicated isnt speaking clear but states no injuries. There are no signs of othet trauma, no cspine pain,etc... Thoughts

Stretcher shoulder straps may stop some movement in some accidents, but I having no expierence with them can't imagine treating a critical patient with them.

Lets all be honest here shoulder straps are far from practical.

I asked an high ranking officer once why we don't have a mount for the LP12 and they came up with a myriad of poor reasons. "We haven't respec'ed that area since the LP10", "we want people to bring the moniter to the patient on scene" etc, etc. It's a $200-400 mounting system that will actually be used vs. the improv seatbelt method I don't use. On the other end of the spectrum I'm facing a meeting with the "spcial investigations office" (deputy chief) for a extremely minor incident where I side swiped a college police car with my squad. The punishment for cosmetic damage to the other car could vary from losing some of my vaca time to a transfer. Now tell me how fair that is.

So my high volume urban ems service is removing valium come 12/1 and moving to Versed only for seizures. My medical director actually provided me the research for the choice. Anybody in similar circumstances?

I just finished doin' it in the back of a squad after a major mci. But really go trauma! You have shown steady improvement and will continue to watch.

Saw a few episodes and was rather impressed.