KAThomas

Let me tell you, the best ... Coming into a medical facility (in lieu of the term Hospital, right.) at.... shift change. Unless your patient is bleeding from the 3rd eyeball in their scalp... you are insignificant for the 27 minutes it takes folks to tell their counterparts what happened, is pending and to have a good shift. Completely ignored. Now, I understand that there are a wide range of things happening at that time, having worked in an ER myself... but every single person is not supposed to be so engaged that you are on the periphery... until they can get themselves in order. Wow! As you roll up to the bay and do a quick look at the watch for a "Destination" time for your paperwork, since that info is sometimes erroneous coming from dispatch, and you see you are close to the Witching Hour (yes, that'd be shift change not midnight)... you become completely awash with additional stress that is not needed based on the knowledge you just tacked on extra wait time. How much time does it add to the "wall" holding event? Enough to be significant. Makes me wonder how many folks from the Fire Authority and COBRA and Joint Comission and DHS and... actually make it out to see what's going on out there to the people they are suposed to be advocates for.

Everyone across the country should come to Los Angeles for a few ride-outs with any Private Ambo Service that provides trans for the 911 contracts and be sent BLS a few times. It'd make your hair fall out. The length of "wall time" varies tremendously. My personal longest was 6 hours. Yeah, it's a violation of the EMTLA policy but even when you complain who actually follows up and what is done about it? Even with that as a known fact, LA EMS is a Fire Department based system and as long as our Fire Department isn't transporting, most don't see a need to field triage appropriately. You call 911 and you've been tossing your lunch, or so you say, for a few hours... you're given the option to go in the Ambulance that's right here... you walk into the ER and they have a considerable amount of folks who have worse conditions and then you wait.... and more often than not you get triaged relatively quickly and then you wait... and wait... and wait and... you get the idea. A good charge nurse puts folks in the waiting room based on complaint and a quick assessment but that in itself is a roll of the dice. It makes most folks leave this field for anything else where they don't feel like their time is not worth much. The horror story I have is about transporting a "regular" and waiting 4 and 1/2 hours to be relieved by another crew who continued to hold the wall with him another 4 hours. Whoa!

Thank you... As I read the first few responses I couldn't recall the technical term but they cover this in most Pre-Hospital Trauma Life Support/ Advanced Trauma Life Support (PHTLS/ATLS) courses. And you're also taught never to dismiss this as Alz or Dementia even with a past Hx but to look at the kinematics foremost.

Just didn't feel like typing it all out... again.

Freeman and Crafton are good length is a year or less but no "work while you're studying" type things... ah, to dream.

Yeah. Was clearing from an ER I'm in the right seat and we had a ride-a-long in the back. We're in the 1 lane with a raised divider to the left and a 18 wheeler in the 2 lane starts trying to back intoa drive way... the guy behind the wheel of the ambo hits the brakes and then decides to gun past the guy... caught the whole right side and peeled a few things off. No injuries but it shook up the RAL pretty bad.

Thank you there is the answer I'm looking for but can you recall where is it cited directly? & the PMC was hot that there was no line whatsoever when we rolled in.

Did the child respond to any noxious stimuli, or any stimuli. Did he withdraw from the IV sticks?? I still think the child was most likely unconscious. To answer your question, unconscious patients can cry, moan, and grimace from pain...if the brain senses it. That would be negative response... I was monitoring for changes on each attempt and zero change there was unchanged grimace with eyes closed and the constant mewling without any tearing at all.

Alright guys... I give. I'm not a burnout... I just work in LA :evil: . (Seems like a good enough motto to me. )

Amazing... how the assumption is because you are a BLS unit you can't possibly know anything. I have a fistful of certs & college, military exp and the medics I deal with have seen me side by side in class with them... everyone screams only 110 hours... but who only has 110, if you dig what you do? Medic Prep, ACLS, PALS, PHTLS, and a ton of other stuff later... I think being an overstated/overpapered 1st responder is a bit of a low blow. I'm saying SoCal EMS will always stank to the heights as long as the B's cop out (fail to perform and fail to take a stance) and the other tiers of the system keep lobbing poop on them/us (and we seem to take it). I have held off from posting anything here for some time because I wanted it to have a modicum of substance. At present I train and assist in the hiring of EMT's... hard to do if their nose is going to be bloodied at every turn. This puts thenm out there to run for fire, nursing, ED Tech land or leave altogether as a means to get away from a system that says "EMT/BLS" like a dirty word.

:evil: With the closure of MLK... Now it's St Francis & Downey Reg as well :twisted:

I couldn't tell you how many calls come in as one thing and are more/less than reported. The SOB that's an anxiety pt, PC which is secondary to the nasty stab wounds to the chest, etc. The bleed that is a heightened paper cut. You get the idea. Boy Scout's motto... "Always be Prepared."

The patient can request other Facilities... I have contacted my dispatcher to find out which hospitals have long BLS wait times to try to get my patients to a more appropriate facility. I wouldn't want a family member of mine going to a facility that everyone involved knows has a 5 hour wait time. I have dickered with fire about that... once they are deemed BLS they belong to us directly. Yes, we call report to hospitals (basic Age, gender, chief compl., ETA) and they tell us how long the wait is projected to be. Yes, we have taken people to their normal/regular facility or where we know their insurance will be honored (to save a later IFT due to insurance [and thus an additional bill and inconvenience for the pt]). If that helps.

My orginal question is being a little overshadowed Can a patient can be unconcious and crying/mewling at the same time? The medic stated he couldn't IO a conscious pt. presupposed by the crying.

Medic tries twice in the AC and once in the foot... no luck... Pt is a 2 y/o with no sig. medical hx (outstanding complications), found on scene hanging from curtain drawstring. Got the pt loaded, (BLS on scene/ ALS enroute) on the monitor... don't recall the numbers. Show up at the PMC w/o a line and they popped an IO and whisked the pt out to CT/MRI. Still mewling and posturing... Trauma nurse, monitor and Tech.

Whoa... You have it all wrong. :shock: What I'm saying is even if I had nothing (not that I would ever do that... fully stock Ambo, portable O2, Trauma Bag, AED, fully stocked Gurney... etc)... No true EMS professional is just a trained "observer", even in the worst of circumstance. That statement is a crock. :evil: I doubt we carry backboards and O2 in our car but we are more (considerably) than "trained observation" without it. As for 1st on equipment... portable O2, Trauma Bag, AED, & a fully stocked Gurney.

I can tell you that it has been my exp that the medics have to clear BLS units. I work the 911 for a large portion of LA. JP is right... I have seen some of the most unenthusiastic medics ever. Some are great but it's such a mixed bag. JP I had an exp that I brought to the "Company" (who asked me how it was my problem)... get this, we pull up on scene and there is a squad with a single medic in it. No matter what, we were going BLS and despite the fact the hospital is well within tolerance and there are no apparent life threats (there was never a plan on Fire's part to ALS the pt from the onset).

What about inline stabilization and bleed control... AVPU/MLOC & ABC's... my military medical training enforced adapting, improvising and accomplishing what needed to be done with things around us (no MacGuyver Jokes please) until you can get what you need. I'm not saying don't preplan and consider... but if you so happen to come on without it. trained observer... Wow! :shock:

Thank you. I saw a special on how many tons of exp. meds folks have at their homes... the work place would be even worse. Hmmm.

None of the above... but I didn't do it in the Military or for SAG either.

Anyone know of programs like this around LA?

I need some help here because I know I read it somewhere but not where or when.... A patient can be unconcious and crying/mewling at the same time... Pt. 2 y/o posturing decerebrate and crying/moaning... debate stemmed from getting a line IO (protocol being this is only an option if the pt is unc). Help guys. Title edited to reflect content...AK

I guess so... the idea here is that complacency breeds an environment that hurts all the good people to the point of forcing them away from what I consider to be an honorable and upstanding job & profession. First on shouldn't be first to wait... I gave oral glucose to a patient who had a BS of 27 by a family members Accucheck, pt meets the criteria... the Engine is waiting for the Squad... why? I did my job AVPU V/S ABC's O2 & Gluc... medics get a BS of 58... push D50 = b/s 157 package and were gone... How many of my "peers" would wait... along with the 5 EMT/FF from the engine and watch the coma? Here's a modified statement from the PHTLS book I provide to all my "new Hire trainees": Our patients did not choose us. Rather, they present to us because of some traumatic occurrence that has resulted in injury or illness requiring our assistance. We, however, have chosen to treat them. We could have chosen another profession, but we did not. We have accepted the responsibility for patient care in some of the worst situations: when patients are at their most stressed and anxious, when we are tired or cold, when it is rainy and dark, and often when conditions are unpredictable. We must either accept this responsibility or surrender it. We must give our patients the very best care that we can – not with unchecked equipment, not with incomplete supplies, not with yesterday's knowledge, and not with indifference. We cannot know what medical information is current, and we cannot claim to be ready to care for our patients, without reading and learning each day. At the end of each run, we should feel that the patient received nothing short of our very best. (NAEMT PHTL 6th Ed.)

We run Road Safety at my provider and it has a 68MPH Cap. And to be honest it is a good thing... it has the gyroscope limits for turns and hard braking as well... No expectation to be a perfect driver just a more aware and safe driver.

Nice response from an "Ambulance Driver" :!: