medic_texas

Watch out for the hill billies

The actions of the LEO in this incident shouldn't change anyone's opinion about other LEO's. We all work with other areas of public safety and we should all respect each other and their duty. My opinion, the LEO acted inappropriately and should be reprimanded. He delayed medical treatment (by a physician) to the patient, he took away the primary attendant from the patient who was being treated in the ambulance, and they did not handle the situation in a professional matter. They could have followed the ambulance to the hospital and then stated their case. IT WAS NOT AN EMERGENCY TO STOP THE AMBULANCE AND DELAY THE TRANSPORT OF THE PATIENT! The detention, restraining, and altercation with the paramedic was unjustified and I would believe will lead to the trooper's dismissal from the OHP. I believe the trooper(s) were acting on emotion, anger, and authority (which in this case is abuse of). The paramedic, also acting out of frustration (which I can't blame him for), did put his hands up to the trooper. True, the trooper was in his face and had him pushed against the ambulance (in an intimidating manner). Cooler heads will prevail. Honestly, I would have been pissed. I probably would have acted the same way as the medic. I hope we are updated on the outcome of this. Not to mention the civil suit that will probably be filed by the family.

Turns out, the driver of the other vehicle was intoxicated. I remember playing baseball against Dee on the playstation, he loved the Astro's. He leaves behind a wife and 2 boys.

http://www.kcbd.com/global/story.asp?s=10253380 Dee was a friend of mine who will be missed by many. Keep his family, friends, and the Lubbock County Sheriff's office in your thoughts and prayers.

It's all about money however Rid is right, if they use a pump you can charge the higher rate for specialty transport. A lot of hospitals may lend out a pump for your service to use for transfers but for 911, I'm guessing you would have to buy a pump. When I was the DO of a service I bought some refurbed AED's and LP 11's, they worked great, had a warranty, and it was way cheaper than most other places. My license/certifications is what keeps me eating so.... I'll protect them

To lower your potassium your body has to use it or get rid of it some way. I think your nurse friend is confused. It would suck to be 23 and on calcium channel blockers but reading about them might explain some of the effects on her blood pressure. The question you should be asking your patient is "do you normally have low blood pressure?" I see people talking about the MAP but what does the MAP tell us? Hrmm...

You should talk to your director and medical director about having pumps to accurately infuse your medications because that is the suggestion by the drug companies. The first thing that will be done when you get your patient to the hospital is drips changed and set up to infuse accurately. Why is this standard of care in the hospital but not in EMS? Like I said, if such a disaster happens, it will fall on you - the hanger of medication without a pump But do what you guys want.

Rid knows what's up. If it is your "standard of care" to infuse medications without a pump, then your standard sucks and YOUR CERT IS ON THE LINE every time you infuse a medication. Read your drug inserts because I'm willing to bet every one of them tell you to use a pump. Lidocaine, nitro, levophed, dopamine, cordarone, etc. I've seen medics bring a patient in, 2 separate incidents, where they were infusing dopamine without a pump. The second time the bag was EMPTY.. it somehow was wide open, either by the idiot medic or by accident, either way it's going to court. I'm just happy my name is nowhere on the charting because it's going to be ugly. I know you don't want that to be you. Being a 911 medic or a transfer medic does not make you immune to lawsuits, see above story.

You would be a fool to "titrate to effect" without a pump, 911 or a transfer. It's your certification tho..

Most paramedics under the age of 21 have a problem finding an employer's insurance that will cover them.

Both of them run the risk of osteomylitis, which is infection in the bone(s). It can take years to recover from or it will kill the patient. You should take extra precautions to cleanse the area properly to decrease the risk of infection. I'm waiting for the lawsuits to start coming out against BIG and EZ IO.

So, everyone who is bleeding does not get a fluid bolus? GI bleeds, stabbings, trauma, etc? Gotcha If you're so worried about hypothermia, place a couple hot packs on the patient along with a few blankets to cover them up. Then maybe turn the heater on. You still have some ability to warm a patient. I would still give 1L and a 2nd bag going at 100mL/hr.

Giving fluid before surgery is very common. Making him hypothermic isn't an issue pre-hospital. The patient is obviously bleeding internally, giving him fluid won't hurt him. When the patient is at the ER then blood will be given, but until then you should be doing whatever you can (and pre-hospital that is FLUID REPLACEMENT) to help. Seriously, a Hgb of 8.2 (I had to reread the OP) and you people are yelling about giving him blood and actually considering not giving him fluid. Amazing.. "Salt water", wow.. It's more than just salt water but you should know that Bottom line, short transport time with 200mL of fluid replaced. I believe this patient to be "dry" and in a compensatory state of shock. Giving this patient a liter or 2 of fluid pre-hospital would not turn his blood into "kool-aid" nor would it drop his Hgb to 4. wow

I don't see how 1-2 liters of fluid is "a bunch". I also don't think a Hgb of 8.4 is very low (in ICU we usually don't transfuse unless they are under 8.0). Do you really think a couple liters of fluid would dilute him to a Hgb of 4? No. He has lost volume and needs it replaced, along with blood, to perfuse appropriately. Also, how come every thinks that because his SBP is 90 that his organs are perfusing? Does anyone know what a MAP is? That would be the best way to see if his kidney's are perfusing in this situation and it's on most monitors these days. I agree with the doctor in this case. Fluid would NOT hurt this guy and I would have bolused him with 1 liter and had a 2nd going at 100ml/hr for transport. Expand the volume, infuse the blood and get him into surgery where he probably would have gotten another 2-3k/L of LR and possibly some albumin (volume expander) on top of the blood.

We do cartizem drips and dig all of the time for patient's with a-fib who go into rapid a-fib (both ICU and ER). I'm just amazed at some of the responses people are giving here. My experience - education will outweigh an ego any day.

Texas rules, loser.

Thanks for the b-day wishes. I think dust is bitter about having too many birthdays under his belt already

Actually, we say do you have any questions or orders when giving radio report to a .... nurse. And we can give orders, just not medication orders. A lot of Nurses work under protocol too, not just medics. And it does sound like the nurse in this situation CAN give orders because they are able to by medical direction. If someone gives me attitude like "do you have any questions" that would be the last smart ass radio report they ever gave me. Our doctors don't put up with that crap from paramedics, and I know this from both sides of the fence. We are supposed to be a team in place for the patient.. Sorry your service sucks, there are others out there. Good post AK.. <tear>

I'd hit it for free.

They should have that job here, sounds like cake.

I think they should be taught more than to drive, CPR, and basic first aid..... First off, they need to be taught to cook. Because between calls I need someone who can cook a good meal, I'm tired of eating out or this slapping crap together casserole. Another thing, stretcher fetching. Very important. Might as well teach them how to work the cot too. Keeping their mouth shut. Massage therapy (females with nice boobies only). And finally, making my bed and cleaning the station. That's a damn good basic right there.

We just did a health screen at my job for our insurance. If we didn't do it, our insurance would go up automatically.

You have to be a patient advocate and do what's best for the patient, call the police to assist and as witnesses. Yes, sometimes you have to take someone against their will or the will of their caretaker/parent. This is all situational and I don't think it applies to this situation at all, obviously. Medics don't get reprimanded for doing what they are supposed to do. You are the medical professional not the parent (in most cases).

So why is the CEO of the Hospital "livid"? Why were the medics put on probation? You don't piss off the CEO of the hospital and get probation for doing nothing wrong. Obviously the facts are in and the story is just now hitting emtcity. I have also been on calls where they decided not to be transported but I have a line for this "we are already here, you called us, we might as well take you just in case". I've had people refuse, I've been upset at going to a house and transporting a toothache at 4am, and if they wanted to go I took them. You can't talk someone out of going POV when they have called 911. Do you realize what kind of liability that puts you in? It's your word against theirs, even if a refusal was signed. A good enough lawyer can argue temporary insanity due to the stress of a injured/sick loved one. You think the jury is going to side with a couple of "heartless" ambulance drivers? Better to be safe than sorry..

They screwed up big time. They should lose their job and be put on probation by the STATE at the very least. You call we haul.