romneyfor2012 Posted December 20, 2011 Author Share Posted December 20, 2011 (edited) Actually ak it could nave happened to you. I changed the diagnosis to protect the medics. This patient had a rare ailment not seen by ems often and the only med that fixes it is prednisone, not other steroids or respiratory meds. When it happened the er doc had never dealt with it nor any medic I discussed it with. If I had listed the real disease it would have made the medics known. This patient was walking and talking in her home, all vitals normal, she went down very fast, with little warning, which is what generally happens when they have respiratory issues. ** Edited for typo created by autoword on my cellphone Edited December 20, 2011 by romneyfor2012 Link to comment Share on other sites More sharing options...
HERBIE1 Posted December 21, 2011 Share Posted December 21, 2011 Actually ak it could nave happened to you. I changed the diagnosis to protect the medics. This patient had a rare ailment not seen by ems often and the only med that fixes it is prednisone, not other steroids or respiratory meds. When it happened the er doc had never dealt with it nor any medic I discussed it with. If I had listed the real disease it would have made the medics known. This patient was walking and talking in her home, all vitals normal, she went down very fast, with little warning, which is what generally happens when they have respiratory issues. ** Edited for typo created by autoword on my cellphone Excellent scenario. It seems that local protocols differ as to what to do in such cases, and clearly it would depend on the specifics of the situation- vota;s of the patient, traffic, distance to ER, time to get more help, injuries or not at the traffic scene. In other words, yet another grey area for EMS. What reason was given for the suspension- leaving the scene of an accident? Which company/system protocols were violated? As I said, in my system, if there were no injuries, my first obligation would be to my patient, and a cursory evaluation(essentially a quick triage) would have told me that barring any life threats, the accident victims could wait until the next arriving unit could do a proper exam and refusal of service as warranted. So I assume the medic violated policy by leaving the scene? Bad, but I would have done the same damn thing and bought the 16 hour suspension. Then again, in our department, this would be viewed as unfair discipline and a party would have been held to recoup the losses incurred. Link to comment Share on other sites More sharing options...
akflightmedic Posted December 21, 2011 Share Posted December 21, 2011 Actually ak it could nave happened to you. I changed the diagnosis to protect the medics. This patient had a rare ailment not seen by ems often and the only med that fixes it is prednisone, not other steroids or respiratory meds. When it happened the er doc had never dealt with it nor any medic I discussed it with. If I had listed the real disease it would have made the medics known. This patient was walking and talking in her home, all vitals normal, she went down very fast, with little warning, which is what generally happens when they have respiratory issues. ** Edited for typo created by autoword on my cellphone The scenarios as presented could not have happened to me. Now that the facts have been changed, my response does not...I still would have called for resources the moment she dropped...if I have time to intubate, I have time to wait for the extra hands. Once the patient is intubated, there needs to be two sets of hands working on the patient and once the vent is hooked up and meds given to keep patient in sedated state (since she improved after intubation) there was more than enough time to wait on proper resources. If she dropped so suddenly, then they were not prepared or even thinking respiratory arrest was imminent. This means there was no prep on the intubation equipment, no prep on on the vent, no prep on the IV and meds...which again means call for assistance immediately and begin ALS interventions. Again, scenario is outside the normal, but if we are kicking this one around, then there was plenty overlooked which would have negated the big issue of what to do once a crash occurred. Would love to know what this hypothetical patient condition was.... Link to comment Share on other sites More sharing options...
DFIB Posted December 21, 2011 Share Posted December 21, 2011 I may be fixing to drive into the ditch here but I think that if my partner was a medic I would notify dispatch and request additional resources. Have my partner do a Rapid Trauma Assessment on the offending driver. package him with complete spinal immobilization, If additional resources arrive allow them to transport, if they do not arrive by this time, load the additional patient on the bench and transport both to ED for evaluation. So how much trouble did I just cause for myself? Link to comment Share on other sites More sharing options...
Just Plain Ruff Posted December 21, 2011 Share Posted December 21, 2011 I may be fixing to drive into the ditch here but I think that if my partner was a medic I would notify dispatch and request additional resources. Have my partner do a Rapid Trauma Assessment on the offending driver. package him with complete spinal immobilization, If additional resources arrive allow them to transport, if they do not arrive by this time, load the additional patient on the bench and transport both to ED for evaluation. So how much trouble did I just cause for myself? None, but I don't beleive the scenario said the driver was injured so why are you packaging the offending driver? And why are you offended at that driver, he didn't hit you!!!!! Link to comment Share on other sites More sharing options...
DFIB Posted December 21, 2011 Share Posted December 21, 2011 None, but I don't beleive the scenario said the driver was injured so why are you packaging the offending driver? And why are you offended at that driver, he didn't hit you!!!!! I called him offending to economize words. My driver was really the true offender. I was thinking of packaging him to cover all bases and be able to leave the scene promptly. What if I just loaded him in the ambulance and took him with me without packaging? Which do you think would work better? Link to comment Share on other sites More sharing options...
Just Plain Ruff Posted December 21, 2011 Share Posted December 21, 2011 I called him offending to economize words. My driver was really the true offender. I was thinking of packaging him to cover all bases and be able to leave the scene promptly. What if I just loaded him in the ambulance and took him with me without packaging? Which do you think would work better? Whatever will work would be the way that works for you. Link to comment Share on other sites More sharing options...
DwayneEMTP Posted December 21, 2011 Share Posted December 21, 2011 ...What if I just loaded him in the ambulance and took him with me without packaging? Which do you think would work better?... That depends on your priorities. You've got a critical patient in the back, that I've now abandoned if you send me out to triage the car accident, right? You go out and make sure that the ambulance is still in drivable condition, if everyone is claiming to be ok you put them in the front, if they'll go, or if more than one, one in the front and the other in the capt's chair, and go on your way. That seems to me to be the patient focused decision. In this scenario at the last service that I worked at I could expect, at night, about 10-15 mins before the next ALS ambulance will arrive. Fire would already be there, but I'm trying to work this out as a lone ambulance, worst case scenario. If you have fire assistance then you have the basic check the rig, do a quick triage, and then let fire take over until you get back. The most good for the most number...and then you get fired and sued...but, you know... :-) Dwayne Link to comment Share on other sites More sharing options...
Richard B the EMT Posted December 21, 2011 Share Posted December 21, 2011 "Offending Driver"? Was any guilt in the collision offered up, going either towards the ambulance or the other vehicle? If such was mentioned, I missed it. Simplification: State it as "The driver of the other vehicle..." Link to comment Share on other sites More sharing options...
craig Posted December 21, 2011 Share Posted December 21, 2011 I called him offending to economize words. My driver was really the true offender. I was thinking of packaging him to cover all bases and be able to leave the scene promptly. What if I just loaded him in the ambulance and took him with me without packaging? Which do you think would work better? DFIB just wondering as to how you would manage a fully packaged spinal patient and also a intubated patient in the rear of your ambulance alone enroute to hospital? Yes you have made some work for yourself with this..... Link to comment Share on other sites More sharing options...
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