upgrade to code 3 or not?

[tniuqs]

OH, VITALS SIGNS BEFORE TRANSPORTING

BP 110/75 R-18 EASY P-72 REGULAR-SPO2 97 RA

NICE !

First off I am more upset with myself as I explained but I did not have a crystal ball at the time mine was out at the cleaners ... the title protection thing I get pissy about because it was in part my error and cannot be undone, Canadian governments have and will capitalize on this and that is my bone of contention with me don't take it personally.

Not really upset in the slightest man, but sometimes tough love is more productive, remember your on an international website, that can also be viewed by your fellow workers and your employer.

Back to your thread , don't hang your hat on the term "angina" as Dwayne commented as all chest pain is not cardiac related as you do know angina is relieved by rest, O2, and nitro.

.. but HEY now you know STEMI, Troponin, and have truly factored in your responsibilities working the gut wagons is not the most gentle of professions, sometimes best to learn on paper as opposed to a court room ... they are not forgiving.

Quoting Lone Star, kill them in the classroom so you can save them in the streets.

ps now here is a fun ecg deal ... http://www.skillstat.com/Flash/ACLS_Stat531.html on your way to become an ACP.

The biggest point I wish to make is excessive use of L+S, I receive a daily brief on frequency of MVC Ambulances world wide and in the USA its abyssal although I believe that media plays a very negative factor in reporting ... please don't make yourself a statistic that I have to read about especially on this type of non life non-threatening call.

You just learned a huge amount and unlike some others I did not have to hit you with a stick and cause a deadly bleed. PCP it does take a set of balls to come back from harsh pointed comments like that with a concise explanation to myself and Happy, exactly where you are in your career and were you want to go, the OFA is showing big time, you do have smarts to become a great PCP and then beyond but PCP set your sights way higher.

cheers

[Lone Star]

In every service I've been involved with, the higher license level is the one 'in charge' of the call. Ultimately, it's their decision on whether to upgrade the call or not.

As far as the equipment failures, that is on you and your partner. Shame on you both for not checking your equipment and supplies (extra batteries that are fully charged included).

Every service I've run with (even for my clinicals) the first order of the day was to take an inventory of what's on board. In every instance, the state has set a minimum level of supplies and equpiment that MUST be on the truck, otherwise the truck CANNOT be put 'in service'. If your equipment/supplies are not adequate, then YOU and YOUR PARTNER are at fault! There is NO EXCUSE for not checking your truck!

As an EMT-B, I wasn't educated in the different rhythms, but I knew enough to know how to apply a 5 lead and record a 'strip' if necessary.

The use of lights and siren should be used only in the situations where the risk of expedited transport has significant benefit to the patient. Not all calls require the use of lights and siren, and sometimes the use of these devices has a negative effect on the patient's well-being. The general public knows already that if they hear the sirens and see the flashy lights, something is seriously wrong somewhere; whether it's where the patient is or it's the patient on board. There are times where the patient hears the siren and figures that they're 'done for'....

OH, VITALS SIGNS BEFORE TRANSPORTING

BP 110/75 R-18 EASY P-72 REGULAR-SPO2 97 RA

I don't see anything in the vital signs you listed as particularly alarming. Yes, the patient was complaining of chest pain, but as has already been pointed out, not all chest pain is an MI/AMI. I would have looked at additional vital signs before becoming 'worried' and upgrading to 'code 3'. Skin condition, was the patient well hydrated? Lung sounds?

Well, I am sorry I posted this question as I was just curious to know if we should have upgraded to code 3 that was all. I am not sure where you took your PCP training, but where I took mine part time course we where not instructed how to read the different rythms or placement of leads, sure we read about it, but it is alot different when a person spends a two weeks just on cardiac stuff compared a few hours reading a section on Cardiac.

SORRY FOR MAKING YOU SOO UPSET THAT WAS NOT MY INTENTION AT ALL!!

If I had known that this post would have turned out like this I guess I would have mentioned as well that I did attempt to take a set of vitals while on route, but the attending nurse told me not to worry about at as she is stable and that the patient is in HER CARE.

Let's not start with the 'poor me' B/S...

EMS is known for "eating it's young". What it sounds like to me, is that you siezed on a couple key words and somehow twisted it into a 'dire situation'.

We're not busting your chops to drive you from the field, or to make you look/feel bad. We've pointed out that there were a bunch of errors made here and hopefully are setting you in the right direction so that it doesn't happen again in the future. If you think this is a 'beating', you should surf the site and see where the true 'beatings' have taken place!

You're not the first one to have made these mistakes, and you certainly won't be the last one to make them. What's important here is that you pull yourself up, dust yourself off and LEARN from it.

[PCP]

tniuqs,

Thank you again for your comments on my post. In no way did I take them personally. I admit at first I was a little shocked, but then I took some time and read your comments again and it made sense to me. As to me coming back and explaining myself to where I am in my career I guess I was just trying to explain myself a little better as to my level of experience in the EMS system and that I do have the passion to learn and as well as very little experience when it came to doing a transfer with a nurse on board or doing a call period.

I honestly love the job and really want to be the best paramedic that I can, which I feel will make me a better patient advocate.

Any how, thank you again tniuqs for your comments and your advice

p.s. I am open for any advice anytime from anybody!

HAPPY NEW YEAR EVERYBODY!

Edited December 30, 2010 by PCP

[Happiness]

Happiness,

I now realize after reading your post and the one from Richard that there are things that should have been done and asked by me as the attending paramedic even when there is a nurse going on the tranport.

I am not sure why the patient was not on O2 from the beginning. It is my dumb mistake for not asking if and why the patient was not on O2 from the beginning and it was also my dumb mistake for not doing a better job at jumping in when the patient stated to the nurse she was having chest pain (angina). The nurse was taking care of the patient and I did what she asked me to do. I do know that giving Nitro is in my scope of practice and I would have administered it myself, but as mentioned the patient was being transfered with a nurse and she was in charge of the patient.

SO I THOUGHT!

I now know for next time that any time a nurse is along for the ride that I will do a better job of asking questions and making sure their equipment is in good working order, as well as if the patient develops any problems while in the back of the car I will not just let the nurse take care of it. I will do what I would normally do as if there was not a nurse escort.

I have only been working in a busier station now for 4 weeks and previous to the that I was in a station where I never did transfers and very little patient contact as I was a driver only for 2 half years and did only about 20 calls in that time.I am learning very quickly how things should be done.

You know I looked back at my post and I have to appolgise for my reply. My questions were ligit but I didnt need to sound so snotty, I'm on cold meds and thats the only excuse that I have. PCP just be aware that the Ambulance is your area and now matter who is in the back you the pt is just as much your responsibility as the nurses.

Enjoy learning about the job as there is much more to know and again sorry about the snotty reply

Happy

PS Squint is a good source of information even if he is alittle crast about it

[PCP]

Lone Star, Thanks for your post and I do agree we all need to check the truck before leaving the station and I do that every time. You must have missed the part of the post to as where I mentioned that the monitor is not part of our ambulance and belongs to the hospital. I did learn from the experience and from talking to yourself and the others what could have been done better. For example, next time I am doing a transport with a nurse I am going to ask and confirm that they have fully charged batteries.

I don't feel that I am being blasted here or being knocked down at all. I was just making a point that I feel as a new medic that I made some mistakes and that I need to learn from them. In now way do I feel I am or need to play the "Poor Me Card" that is not my style and it never will be. I appreciate your comments and suggestions as I take every comment and suggestion from everyone who posts on a subject that I may have posted and I feel it is a good point I try to incorporate it into my assessment or treatment, as well as I attempt to gain more knowledge by reading others posts or comments to me.

Please don't take this post as if I am upset or pissed that you said I need to stop my poor me attitude. It is hard to tell how a person is feeling by just reading a post they typed out.

Thanks again for you comments and encourgments!

Brian

[PCP]

You know I looked back at my post and I have to appolgise for my reply. My questions were ligit but I didnt need to sound so snotty, I'm on cold meds and thats the only excuse that I have. PCP just be aware that the Ambulance is your area and now matter who is in the back you the pt is just as much your responsibility as the nurses.

Enjoy learning about the job as there is much more to know and again sorry about the snotty reply

Happy

PS Squint is a good source of information even if he is alittle crast about it

Happiness, NO need to apologize for your post. I did not take it as being snotty at all. You were just pointing out a few facts that need to be addressed. Any comment or suggestion comming from a veteran like yourself especially from a fellow BCAS employee is alway welcomed by me.

If it was not for this website and the discussions I have had and the few friends I have made by joining this site, I would not have learned what I have learned in the past month which has helped me in my career as a BCAS employee, as well as helping me become a better paramedic which will help me give my patient the best patient care they deserve. So, as mentioned NO need to apologize for your reply. I understand what you have said about the back of the ambulance is my work space, and for now on I am going to treat it as so when doing transfers with a nurse escort or any time I am attending.

Hope you are feeling better soon

P.S. I received an email from my UC the other day, explaining that the local fire dept. and the wife of the patient I had last week that had a cardiac arrest contacted him and expressed how good of a job my partner and I did and that how respectful I was, and how I showed great empathy for her and how I showed great dignity towards her husband. The fire dept. said they were happy the way my partner and handled the call and they were impressed how I handled myself for doing my first cardiac arrest.

For me that made me feel proud to be part of the BCAS and that helped me know that I did everything that I could for my patient. As well as when I took some time to talk to the wife while at the hospital that my words did mean so much more than one can imagine to a loved one that was going through what she had to go through.

HAPPY NEW YEAR and STAY SAFE!

[CSAR_MEDIC]

Not enough information to say but I probably would NOT have upgraded.

What is the past medical hx? What were the vitals?

Does the pt have hx of CP? If so, the nurse was managing it appropriately.

Would turning on the lights and sirens actually benefit the patient's situation? No.

Would the time saved be of benefit? No.

Would the risk for all involved be increased significantly for no major benefit? Yes.

I agree with AK,

If the the reason to upgrade to Code 3 is because of failing equipment then equipment is the issue. The Pt had a 1st degree, not an immediate life threat so no need to risk you or yours partners lives. Code 3 Light is in my opinion for response and response to mitigate an Immediate life threat. If your nurse is squared away she should be able to handle this patient no problem.

[CSAR_MEDIC]

Funny i always thought PCP was something you did when you were young and made poor judgement calls, live and learn lol

[PCP]

Funny i always thought PCP was something you did when you were young and made poor judgement calls, live and learn lol

[/quote

LOL, After I picked that name, I did laugh at myself once I thought about the name as the drug. Guess I could have changed it, but oh well.

At least I did not call myself "crackhead" that could have turned out really bad!

cheers

[Lone Star]

Lone Star, Thanks for your post and I do agree we all need to check the truck before leaving the station and I do that every time. You must have missed the part of the post to as where I mentioned that the monitor is not part of our ambulance and belongs to the hospital. I did learn from the experience and from talking to yourself and the others what could have been done better. For example, next time I am doing a transport with a nurse I am going to ask and confirm that they have fully charged batteries.

I don't feel that I am being blasted here or being knocked down at all. I was just making a point that I feel as a new medic that I made some mistakes and that I need to learn from them. In now way do I feel I am or need to play the "Poor Me Card" that is not my style and it never will be. I appreciate your comments and suggestions as I take every comment and suggestion from everyone who posts on a subject that I may have posted and I feel it is a good point I try to incorporate it into my assessment or treatment, as well as I attempt to gain more knowledge by reading others posts or comments to me.

Please don't take this post as if I am upset or pissed that you said I need to stop my poor me attitude. It is hard to tell how a person is feeling by just reading a post they typed out.

Thanks again for you comments and encourgments!

Brian

Brian,

I have to say that I am impressed with your attitude throughout this thread!

You've posted a question, provided possibly damning information; and throughout it all, you accepted the criticism as well as the encouragement without copping an attitude and resorting to personal attacks.

You've owned your mistakes, and apparently have learned something from them. I see great potential here! I can see that you've got great empathy for your patients, and you're concerned about learning more. This is the precise attitude that is needed for EMS. There are far too many that become complacent after they get out in the field, because they mistakenly think that they now know it all. This is not the case with you.

EMS is known for its ‘tough love’ attitude, and there are many of us that strive to not only be the best that we can be; but work hard to advance EMS as a whole.

Being new on the trucks (regardless of your level of licensure) is a tough spot to be in! We’ve all been there and some of us will ‘be there’ again. Ultimately, it’s what you do with it that decides if you’re going to make it or not. I’ve seen people excel under the pressures, and I’ve seen people fold and quit. I don’t see you as one to throw in the towel and walk away.

This site is a great learning tool, if you let it. There is quite possibly hundreds (if not thousands) of years of experience that is available to you. You’ve already shown that you’re willing to speak up and ask questions.

Good fortune to you, sir!

LS