fallout

Be sure to ask about whether you should apply the monitor or not and if vital signs are indicated for the patient.

Personally, the majority of my IV starts are locks. I generally hang fluids on significant trauma or situations where the potential for using many meds in quick succession, e.g. RSI, cardiac arrest or when I think hypotension may develop, such as when administering nitroglycerin or narcotics. The only type I absolutely don't hang fluids is patients with pulmonary edema. It has too much potential for the line accidentally being turned on, resulting in bolusing someone already suffering from fluid overload.

He isn't listed on the disciplinary actions from the Texas department of health, so I don't think he is in jail over the incident. I imagine it would have been all over the local EMS community if he was, so I doubt that is the case.

I do not think overtreating is a good idea. For example, giving epinephrine to every allergic reaction would be a bad idea. The same goes for intubating respiratory distress or use of narcotics in chest pain. I could go on endlessly, but the point is overtreatment does not benefit the patient, when your treatment has the potential for deleterious side effects.

and pickles?

It's in my department's SOGs to secure the ambulance everywhere, including scenes, but...they only give us one set of keys. Do the math on how that works out.

I have refused stable patient hospital to SNF/nursing home patients transfers because of weather conditions before. Generally, it is because a massive storm complete with hail, etc. is blowing through. It will be gone in an hour or two and then the patient can go on to wherever they need to be. It is not worth the risk to your crew or the patient to be transported in very adverse conditions. The hospital will complain about having the bed still full. In the end, it is what ir right for the patient and the crew.

All CPAP uses a good bit of oxygen. I find the Whisperflow by Respironics burns through oxygen very quickly, to the point a D cylinder will last for 3-5 minutes before it is completely drained. The Port-O-vent CPAPos, I can't remember the manufacturer off the top of my head, I've seen have a D cylinder last 10-15 minutes. But, whatever the cost, CPAP is worth the price in reducing patient mortality, avoiding intubation and reducing or eliminating time spent in an ICU bed. Numerous studies are available that verify my statement regarding patient mortality. A google scholar search for non-invasive positive pressure support should return some of them. As far as logistically, I bring several spare D cylinders if I will have the patient for a long time, then run the CPAP off the D-cylinder, only switching to my main while I change the regulator to a full D-cylinder.

I would be of the remove the pinning object and go camp. Exsanguination is a major risk in this case. The femoral arteries and the femur can do a significant amount of bleeding. Might the bleeding prove fatal? Yes. Approximately an hour of developing anaerobic metabolic wastes as well as exposure to -35 degrees Celcius cannot be good for the critically injured patient. Add in extra flight time for the helo since I doubt weather conditions resulting in -35 deg C are ideal for flying. Then, add in time where the ALS crew has to stablize before the object is removed. Hypothermia and severe trauma have a much higher change of mortality for the patient. Either way, the patient is a bad position.

Heh, in middle school I was given a 3 day suspension for a butter knife. Zero tolerance is a terrible policy.

Given the quality of maintenance at some places I have worked, I would probably be presenting all my copies of the 15 or so equipment malfunction reports related to that specific ambulances back doors and stretcher mount.

The US government?

http://www.nfpa.org/assets/files/PDF/osfff.pdf A bit of firefighter related death statistics for 2006, since the topic has been brought up.

Most of my conflicts when on a dual medic truck result from a lack of professionalism on the part of my partner. I will preface this by saying that most of the time I have professional paramedic partners and we have some minor discussion on patient care, but is oriented toward whether we are providing the best care and making sure we aren't missing something glaringly obvious about the patient. Occasionally, I get the partner who has no interest in anything but dumping the patient as quickly as possible. I've had that nearly turn into an argument on scene, as he was wanting to start toward the hospital before I had even assessed and done any stabilizing treatment on the patient. For that matter, even knew if any stabilizing treatment was necessary. I got quite a bit of attitude from him when I told him to slow down, give me a few minutes and let me know what exactly is happening with this patient. We discussed it after the call and he told me that he believes we should be moving toward the hospital anytime the patient is sitting in the ambulance, for liability reasons. I felt there was greater liability in not thoroughly assessing and treating the patient where they are. We reached a state of detente where basically, if it was his turn to write the report, he made the call and if it was my turn, I made the call of when we left scene. I am a new paramedic and generally try and listen and learn from experienced paramedics, but some experienced paramedics are also burnt out paramedics, so I have stand up for my what I believe is correct patient care, at times.

I think the ability to look at a physical map is a major problem with many dispatchers. At the company I worked at before this one, even our good dispatchers had no concept of where hospitals were and how long it would take to get to them. There was times were I would spend an hour and a half getting to the transfer call, only to learn they had given them a half hour eta.. to drive across the entire city...during rush hour? I agree about the role swap thing. I think it would benefit everyone, a bit.

We respond to scene and determine if the patient presents with the common criteria for withholding resuscitation. If so, we release the scene to PD and go back in service.

I've seen a few people on Salvia and they generally come around fairly quickly. But, like any substance used to "get high," the imbiber or the producer is likely to mix it with something else to enhance the effect, resulting in poly-substance interactions, etc.

Somehow I have a feeling that if they had called it in and kept going, we would be reading the article talking about how there was a MVC at that location and the FDNY ambulance just kept driving, nevermind the gun wielding driver and all that. We would also be hearing "OMG THEY SHOULD BE FIRED FOR NOT RENDERING AID." I think a few of you have forgotten what it is like to be new in this profession. Every day that I come to work, I have an experienced partner telling me to do the complete opposite of the last guy. I do my best to do what I believe is the right thing, and yet somebody, somewhere, will choose to lambaste me for it. EMS needs leadership, and frankly, feeding people to the wolves for their mistakes is not leadership, it is destruction of our profession.

Congratulations. And regarding state offices being shut, Texas had to go flood their entire health department building. I think that takes the cake.

PID is pelvic inflammatory disease, which describes infections of the female reproductive system. The treatment is two large bore IVs wide open, a femoral and sub-clavian line, RSI, bilateral chest decompression and emergency transport to an LZ for flight to a level 1 trauma center, if my forum cliche recollection is correct. The flight crew is also expected to perform a hysterectomy prior to reaching the hospital.

I think EMTBASIC_911_911 is a bored forum member.

I worked for roughly a year in a system that required posting. It wasn't so bad when you only had to be within a few miles of your post, leaving open the option of hitting the local convience store, restaraunt, grocery store, etc. The operations manager, who is incidentally out of a job now, decided to make the policy you had to physically be at your post and went around looking to see if you were there. Then, some genius made some of our post locations in the middle of the friday night gangland's fight area and there was a revolt among the field crews, with many of them leaving over that and other issues. I guess I don't really see the point of posting, it may make me closer to one call, but further from another. I do support the idea of having multiple stations set up, that aren't always manned and that have crews placed in them when the call volume in a given area starts increasing.

I think the solution is to enforce two concepts above all. 1.) Always yield to the other driver. You are the trained professional, they are not. You are supposed to be educated in driving safely, and a better driver. 2.) Arriving to the scene one minute later is acceptable, if it gets you there in one piece. Driver training is a good idea and should be done in any company. I am not so sure on the concept of minimum ages for driving. Approximately half of my current company are under 25 years of age, and we have had two vehicle accidents this year. Neither were associated with driving emergency traffic. One accident was a drunk driver going in excess of 50 broadsiding an ambulance. The other was someone clipping the side of a toll booth. I think the best way to handle is emergency driving (and driving in general) is to mentor your employees in it and hold them accountable. The rest will work itself out.

While we are on the topic, is the short spine board a safe tool for the extrication of a time critical patient? I was instructed to use one once during my early days as an EMT student, and it seemed an effective compromise between the KED, which takes time, and nothing.

It has everything to do with a few factors, namely 1.) Most transfer services are Medicare fraud mills. 2.) You will be asked to do unethical or illegal things in the name of profit. 3.) The management of these companies do not want EMTs, they want wheelchair van drivers who use oxygen and and take a blood pressure. 4.) Most transfer service protocols are very conservative, in the "please don't sue us" kind of way. 5.) You are basically dumped on by everyone, 911 crews hate you, nursing homes hate you and other medical professionals hate you. I work transfer, and try damned hard to treat my patients and be a true EMS professional;But, at the end of the day, you go home and no one respects you for anything you did that day, it definitely affects your morale toward the job and willingness to continue. As far as your resume, if you did something wonderfully amazing, say so. Otherwise, a brief synopsis of your position and a rough idea of the responsibilities you had in your position, will suffice.