stcommodore

So heres what happens when you "unoffically" tell a drug seeking system abuser your not taking himbto hospital x. He starts calling 911 in front of you. This is a perfect example of a pt with a primary care issue who called two nights in a row and no kind of "refusal of transport" or other protocal would have worked.

I'm a medic in PA for the reference. You gotta expect a certin degree of "problems" when you work for these fly by night transport companies. Even in the big city we have supply and apparatus issues that comes with trucks that average 8,000 calls a year and roughly 20,000 miles on the road each year. There are better ways to go about bringing change then calling the state, make sure you exaust all these options up to and including getting a different job before you call the state. Remeber EMS in any area is a small family and everyone knows everyone so the actions you do now could effect your career in the future.

Did someone honestly say its a good idea to canulate a patient's penis?! I can't imagien trying to document or tell the hospital that I put a 16g in the patient's ....um yea in his dick. Do you have to use bulky dressing to secure the shaft?! Dear god.

Usually unless the patient was on a backboard. I'd say half our patient's don't even get the stretcher.

Are there any published studies that support the ANSI vest? I think common sense, unit staging and common sense is better.

"I stop put on my vest so I make a big yellow target"

just kidding...

Not unless it's serious and I witness it. It's to dangerous to stop in most locations anyway.

Starting an IO to administer D50, dear god.

Are you kiding me? Threating somebody elses job/posistion over lights and siren useage? That's totally over the top! You have two people working as partners, working together on a shift/call/etc and they should be doing so as a team. But in the end it comes down to the highest trained provider. But really its lights and sirens, and not work a drag down fight.

When it comes to "provider initated refusal" you would need to have protocals with ALS and medical command support before ever doing something like that. I can't imagine that a BLS provider who hasn't even had basic anatomy could be expected to know everything necessary to tell someone they shouldn't go to the hospital.

I would define an IV as "invasive", an EJ as "moderatly invasive" and an IO as "highly invasive" when it comes to the EMS setting. To continue, why would we be placing an IO into any site if we can obtain an EJ? If a C-Collar, entrapment, etc prevent EJ use then maybe an IO can be placed. Lastly, I would pray that nobody is starting IO's simply for having access. We should only be using such means if we need to administer drugs, fluids, etc.

I've been released by Medical Command on several alcohol overdose/alcohol consumption relatd calls in the past. Obviously the circumstances varied from "friends called for ...." to other things. Other homeless/drunk related calls the person typically walks away, we imply they walk away or we just take them in. All bets are off when you include falls, trauma, etc with ETOH. Any MOI w/ETOH is a trauma patient in most of the trauma centers.

What are your current systems definition of a patient?

Sleeping in a vehicle on the road 3rd party caller?

3rd party call well fare check at residence?

Patient did not call ems someone else did?

If they are not a patient what sort of documentation do you use in your PCR? Cancelled call? No patient found?

Just curious

Thanks

Non-Patient Protocal Typically applies to MVC's where there was a third party caller and the person(s) presenting claim no injury and there is no MOI that would suguest one acquire a refusal.

In urban EMS "non-patient" is typically expanded to include the "homeless person sleeping" that someone calls in and on arrival the homeless person is actually sleeping and doesn't want EMS. We've used "Non-Patient" for lift assists, nonsense calls by a third party where the person has no need for EMS but you want to cover yourself with documentation.

We also expand this category to the area of "walked away", "gone on arrival", or "handled by police" for those drunks you wake up on the street and who then get up and leave. Or police related calls where there are no actual injuries.

Most of the comments to this article have covered anything I would say. One of the reasons there are still large amounts of fire apparatus in the cities is because it requires larger amounts of equipment and personel to do that job rather then most of our EMS incidents. Not to mention in a major city if you begin to have more then one large incident, and witness the removal of four engine's and two ladders from your department you'll see how thin fire protection can get.

The fluid bolus was given as the BP was below the "permissve hypotension" line which I believe per PA protocal is 90 systolic. My logic behind the Atropine was that even with the aiway addressed with OPA/BVM there was no increase and I saw the potential for it degenerating into an arrest situation en route. So how would you have explained in your report to the hospital that the patient was initally in Sinus Bradycardia and en route dereased until finally you decided to treat PEA/VFib/Vtach?

We had a very similar call a few weeks prior where a pedistrian was struck by a car at a high rate of speed, wasn't hypotensive but was bradycardic without adequate ventilations. This patient recieved ETI en route due to agonal respirations, blood in the airway, etc.

"Attention Medic XX respond 17th St and Skyline Blvd for a reported MVC, time out 0130"

Already on the road your responce time is under two minuets and you arrive to find a small crowd of bystanders on the sidewalk, an SUV approx 3/4th of the way down a city sized block and a female patient lying supine next to a sidewalk on the street. The patient per bystanders was struck by the SUV while riding her bicycle at a moderate rate of speed and bystanders report the suv "is messed up." The patient is a female in her twenties and appears to be approx 25-30ft from the inital impact and is also approx 10ft from both of her shoes. The patient has a standard bicycle helmet on and bicycle has been moved away from the patient.

You and your partner are both Paramedics, working in an urban setting where a Level I/University level trauma center is 5min away. On arrival your partner approaches the patient as you gather the equipment. The patient is rolled with assitance of bystanders onto a LSB, C-Spine, CIDS, etc packaging is preforming rapidly on scene. The patient is found have no purposeful movements, a small laceration next to her left eye, and dilated pupials, the paient's respirations are shallow, and radial pulse is weak. You request the Engine Company from your station (approx 5 blocks away) to respond for manpower as you move to the ambulance.

The patient's clothing is removed and abrasions are noted on the left arm and leg, the patient continuse to have no response to painful stimuli. 02 via NRB is placed, and vitals are as follows, BP 70/40, HR 38, Resp 10-12, EKG-Sinus Braycardia, Sp02 100% on 02. Bilateral 16g IV are established, and BVM ventilations w/OPA replace the NRB. On arrival of the Engine Company (approx 2min later) you instruct your officer "I just need a driver, lights and sirens, fast, go now." En route a approx 200cc NSS is admin for hypotension, 1mg Atropine is admin for Bradycadia, the heart rate increases to 90, the hospital is notified and you arrive within 3min.

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On arrival at the Trauma Center the patient is intubated after several attempts, assessed and found after scans to have serious brain injury.

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I'm looking for what you would have done/or do differently in this situation. Also any specific studies in regards to Braycardia and the use of Atopine in these patient's.

Congrats you were first in on a refusal, not a trauma patient.

If we are talking about important tidbits now, toss the traffic vest and focus on unit staging. Do whatever it takes with whatever you have to control traffic or close the roadway.

I would look into Philadelphia if you are seriously willing to move that far for a job. PM me if you want more info or check out the department's website.

Hey, does anyone have any info on the "220-age" rule in regards to Sinus Tachycardia and SVT.

Sorry to go off topic but I have to correct some comments made here.

Phila FD Paramedics or Fire Service Paramedics receive as stated some "Fire Orientation" when we attend the Academy but in no way are qualified as or are expected to serve in any "supression" activities. To expand on that the Fire Sevice Paramedics recently won a class action law suit against the city in regards to this topic. The city said that the FSP's were not elligible to recieve ovetime when they work over fourty hours a week because they are execpt from FSLA just as firefighters are. In the end the FSP's won because the jobs are totally seperate, paramedics do no supression activities and are not exempt from FSLA. In addtion to that the way the pay and rank structure works it is considered a pay cut and demotion when a FSP "crosses over" to the role of Firefighter.

To continue to correct comments made here, while there are not any well circulated plans to "run" another Fire Cadet class, the 28th Fire Service Paramedic class recently graduated and weeks ago finished there precepting and recieved there offical unit assignments. There are also well circulated rumors that the next Paramedic class will be hired and attend the Academy very soon. There are only approx 15 vacent paramedic slots at this point, and the system is on the up swing. It is busy, but with volume comes expierence. Talk to some of the people that work around here and ask how many codes they had in May, or how many Intubations they have for 09 and I bet I have them beat.

more importantly why do your memos end with "ems command" and mine "by orders of the fire commisioner"

Not really, you'd have to assume everyone is calculating the UHU with the same format and including/excluding the same variables. It's like stats for response times, cardiac arrest survival, etc.

Unit Hour Utilization-a measurement of productivity of a system calculated by diving the number of TRANSPORTS by number of UNIT HOURS produced.

So to get a acurate UHU by that definition you would have to remove: Recalls, Refusals, Standbys, Care Transferred, etc

Narrow it down to UHU. Unit Hour Utilization for your specific unit or system will give you a strait answer regardless of hours in service, units, etc.

In Pa your not permitted to "induce" intubation with anything but Etomidate, and very very few services carry the drug.

Philadelphia Fire Dept has the busiest Medic unit(s) in the US I'm sure. Medic 2 and Medic 22 are 8,500-9,000 calls a year and there UHU for 08 was over 100%. Granted recalls and other incidents that don't result in a patient transport are all counted but there is no hard and fast rule on that. My medic unit did 6,500 ish in 08 and we were 7th busiest of 50.

One of my mentors in EMS made a point once about "bringing care to the patient." At the ALS level if we are not doing that in situations that permit it then we need to readjust our thinking.

that emt village threat was total bs, how many people all suggested giving ATROPINE to a patient with a "high" AV Block. Either they are all Basics who think they read enough to be medics or medics that need to go back and read a pharm book. Dear God!