Niftymedi911

He doesn't have to Akroeze. He doesn't work for the FD's, he is a county employee in a supervisiory position. Just like if your Lt. suspected you of cheating.... There would be a investigation. Why warn the suspected cheater of an investigation, if in fact they would be able to get rid of the evidence prior to the inevestigation starting? I say investigate the crap out of every ALS FD department, strip them of their ALS cert and leave it to the professionals who actually provide patient care and transport.

Just like I hope residents in our slice of pie just to the north realize what Lehigh Acres FD is doing. Their budget being cut? Guess what the first thing to go is? EMS goes bye-bye. Their dumping their 5 truck ALS transport system because they will have a deficit. Then with the same mouth, bad mouth our agency as if we're DC EMS, bc we have to pick up their slack. It's time the public realizes just how much the FD's treat EMS as a red-headed step-child.

Unfortunately we according to SOP respond to all 80,000 calls/yr, lights and sirens. It's one of those areas where "We've always done it this way, why change?" But, times are changing. Our dispatch center just became Nationally Certified (NAEMD), they're also Nationally certified to use the Pro Q/A software with MPDS. We're starting to do pilot programs with certain areas within our county to send BLS trucks to BLS calls non-emergent. It's a month program which at the end of the program will guide the rest of the responses to the 9-1-1 system. Hopefully, by September of 2009 we will have a full complete response matrix of what to respond lights and sirens to and what not and what recourses need to be sent.

It's reinventing the wheel pretty much, but for a county as big (750,000 full time residents / 3 million seasonal respidents) and busy we are its a MIRACLE!!

Another thing my clinical educator / Medical Director said to us is simple: Even though you can see em, we don't transport dead people. Funny saying but its catchy and sticks.

No obivious injuries not compatible with life > Work it til a doc says no

Signs or Injuries not Compatible with life>> Signal 7 (DOA)

Plain as simple

It's split three ways.

It's sent to the EMSSTARS server, We also keep it in-house on secured servers, and it also sent to our billing agency. We have full-time IT guys who oversee and maintain the computers, CAD communication, and Servers.

We also used Image Trend EMS field Birdge v3.8 soon to be v.40.

Image Trend is EMSSTARS (The FL state EMS EPCR database) Complaint, which currently it is not a requirement, but legistation coming through the house and senate will make electronic reporting law. The toughbook 19's can handle the program without a hitch. It can integrate itself within your CAD system so when it comes time to upload your times and call numbers, you don't have to manually input them. Customer Service is well planned out and acceptable. It is desgined for wireless internet, so if you have air cards in your trucks which you can connect your 19 to, your never without a connection. Look to your neighbors to your south in Lee County, we don't bite...

The big seller with Image Trend, is it reduces lost revenue and also generates more revenue. We're up close to 24% more in revenue this year so far over last year with our old PCR system.

Trust me, if it meant making a dollar or not, that Lawyer will try every stop and trick in the book to throw at you. Anyone or anything can become unpredictable when money is behind it.

Reguardless of what condition the patient is in, you were invloved in a MVC. According to the law no matter what PD says you are bound by DOT/ State regulations to stop and request additional rescources. You leave the scene, you are liable and will more then likely be charged with leaving the scene. 1-800-Ask-Gary lawyers will have a hay day with you and your stunt.

And most of all, it's not your emergency. Understand that you not only have a responsibility to your current patient, you also now have an obligation to the public. Yes, you are dealing with a critical patient, but ultimately isn't that what you want to deal with? Is it not a lot better then dealing with a priority 3 stubbed toe? Even if it is a respiratory arrest patient, learn to use your skills and rely on them. You adapt, change, and overcome. You make the best of it and move on.

Hey, Hey, Hey now, just because we're from the south doesn't mean we're all stupid and can't wright............

I too have a CPAP machine at home for the evening as well.

I run a ResMed Elite II EPR with a HumidAire3i humidifier and a Mirage Liberty partial mask. I have the one were it covers the mouth and has nasal pillows for the nose. I'm running @ 11 of PEEP at night. In a way its kinda scary. The most we can use prehospital of PEEP is 10 unless we have MD's orders to go higher, at the very least at night I need 11.

The only down side to it, even with my humidifier on and set to almost max, I have frequnet nose bleeds.... roughly 2 times a week I'll wake up with dried blood in the nasal pillows or in my nose.

The CPAP machine at night for me was hands down one of the absolute best decisions in my life. I used to fall asleep all the time during the day, even after having a full 8 hrs of "sleep". It got to were work got invloved and threatened to take me off the road bc of the of complications. Found out after the sleep study I stopped breathing roughly 58-60 times an hour. My doctor said, it wasn't just some problem, it was life-threatening. And ever since the RT came to my home and set the machine up. I think more clearer, I act more appropriate, I have energy to do things I use to not be able to, and I actually wake up feeling completely refreshed in the morning.

12 lead shows

Anteriolateral Wall AMI with poss borderline RBBB

Thanks for the compliment Adam, I've only learned from the best...... I too are not settling for just the basics, I tend to wanna know more and study more......

And don't give Fentanyl to them (MS is contraindicated) without MD's orders... like me and get QA'd........ Bad Fred.... (slaps hand for thinking outside of the box).

I'm gonna have to go with Acute Pericarditis Adam.

The lack of consistent and consecutive T wave inversions in the inferior leads don't really indicate true mycocardial injury.

The ST changes in all pericordial leads would indicate early repol.

But, the prominant ST elevation in V1-V6, with the distance of the ST segement divided by the tallest T-wave (ST/T Wave ratio) in V6 value is greater then 0.25, (0.33) ruling out Early repolarization and indicating possible Actue Pericarditis.

That's my crack at it.

Ditto with above...................

We have 2 seperate computer systems in our truck.

1) Toughbook for use of CAD and Mapping..... We have Premier MDC by Motorola (CAD) and Premier ATM Moblie Mapping both about 10 yrs old and in need of being replaced... as the need for this poll.

2) DRT Technologies HH3 "Hammerhead" Tablet computers for ePCR's.

3) We're currently awaiting for the new toughbooks (the swivel / touchscreen ones) to be realsed to the road crews to replace the hammerheads.

Our ePCR program is Image Trend v 3.8 EMS Field Bridge. Great program if you got the hardware to handle it. The program itself takes a gig of RAM to run, if windows takes approx 30% of a gig and there is only one gig available, the program runs at about 70% and crashes constantly.

I'm just curious to see how many agencies are embracing the different types of technology available to road crews.

If you answer the poll, please post any pro's / con's you have. Also, if you know what software your runnning put it here.

I'll be waiting for the protocol to come out Adam, I know you do great job keeping abreast of what's out there. I'm just a little weary in that I think we're getting a little too big for our britches.

Your right about the medical direction. I've called them about 3-4 times since I've credentialed.... I'm not afraid to ask or use the radio. It is amazing how too many people here have too much pride to admit they need help.

Why not just get the order from d7 on the radio Adam??? If that type of call presents itself, I'll be touching base with the doc at least once or twice.... might be easier just to bounce it off him and see what he thinks. Bc in all honesty how many pre-elcamptic patients do you respond to in a year, even if there was a protocol, how effective would it be?

I like the idea of putting patient's in traige....... but for us it's not just an idea, we are expected to triage accordingly and notifty the recieving hospital on telemetry, that the patient is canidate for triage. Most of the time they just annouce, transport to triage, but every once and while the charge will come, meet us at the door and ask what we got. If its something that cannot go out to the waiting room, we wait..... and wait...... and wait...... and wait..... It's gotten so bad I've even put in a request in to the hospital to install a 12" plasma TV with cable, some chairs and a radio in the EMS hallway at one said hospital bc almost every time I transport, it's a gaurrenteed 1 hr or more wait. The only response I got back was a very rude letter??? I don't know I was just thinking..... maybe a bit too much???? I kid you not I've waited for a bed in the hall 13 min with a STEMI alert......

Anyone got any ideas?? The triage one is an easy answer and like I said we're already doing it as much as we can.

No lie that's sitting on the wall of my station......

That's the thing the hospitals here are also not allowed to divert. The only that stops us from going to said place is an internal disatser. We still have an issue. My record this year (09) is 2 hrs 48 minutes and that was last week.

This season (snowbirds) in our county we have seen an extreme jump in call volume and the number of sick patients. Most of the time we would expect it due to season but this year as by far been the worst in the past 5 yrs. We've done in excess of over 11,000 EMS calls this past month. Now, the biggest problem we keep running into which I know everyone has experienced a time or two was the long offload (wait) time in the ED. I'm interested to see or find out if anyone has been part of a CQI or a committe of some sort to better the situation for EMS personel at the ED's with offload times. Our agency has done some ( as in calling into a transportation officer before transport to request a specific hospital, and based on offload times and the like are directed to that facility or must go to another destination. The ED's also update their status to better inform us on a computer program so we can see the offload issues. But in a day where close to 350-400 9-1-1 calls for help come in and maybe a total of 100 ED beds county/system wide, its kinda hard to balance things.

Just wondering if anyone has advice or a situation where a study was done to help things along. FYI my average offload time this past week was 1 hr 9 mins. We're at times getting close to running out of units (status Red) bc of the ED crowding of EMS units. And we have 37 trucks.

Better Info to help understand:

5 County Hospitals (All owned by health system) / 1 120 bed Private hospital owned by HMA

Biggest ER is 25 beds, smallest ER is 10 beds

Approx 2000 beds total county wide

Out of season population: 550k-600k

In Season: Approx 1-3 million

Offload time is defined as time of arrival @ ED to RN taking report

Offload is defined as being assigned a bed, moving the patient to the bed, RN walk in, give verbal written report to RN, Rn takes over pt care

Any and all information is helpful and apprieciated!

CBVEMT... that would be me.....

And to answer your question, the safest (in job security wise) currently in the state of Florida to run not private or Fire is: Lee County EMS or Lake-Sumter EMS.

I work for one of the aformentioned agencies and I'm not going anywhere. We're the highest paid 3rd service, the most progressive medically with state of the art equip and trucks. We ran 78,000 calls (2008) last year. 24/48 with 12 hr optional. 9-1-1 Division / IFT Divison / Critical Care / Aeromedical (2 helos)

But regretfully due to Amendment One and the economic down turn.... we're in an indefinate hiring freeze.

Any truck reguardless of 24 or 12 hr status is eligible to stand-by at another station. there are a few trucks that jump from one station to another, but usually if your sent on stand-by your normally getting bagged with a call. But it's the luck of the draw.... and it's that chance that SIREN can determine wether or not to send a unit, based on wether or not a call will drop in that zone. If no call....no truck placed on standby= more station time

Ambo,

Is the double dose an effort to decrease the ICP in head injury patient's??