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Hey all Once again, I am writing to purge my experiences over the last week or so. I live in Arizona - my mother lives in Thunder Bay in Northern Ontario. She is 80 years old and lives alone, but in a building full of people of her generation, and more importantly, ones that speak her language. After almost 50 years in Canada, she has never managed to learn English. Thunder Bay, at one time, had the largest concentration of Finns outside of Finland in the world. Her family physician speaks Finnish, as does her dentist, pharmacist, grocer, church, etc. etc. I was visiting her last June and noticed a clear cardiac problem. Mild exertion left her short of breath, diaphoretic and grey. She has always avoided doctors but I convinced her that if she was my patient, we would be heading for the hospital. She never spoke a word about the chest pressure that often accompanied these symptoms. She consented to make an appointment with her family physician. I wrote a letter to her family physician, who set her up with a cardiologist. At the beginning of December, my mother had an angiogram, which almost killed her. They had problems controlling the femoral bleeding, which necessitated a hospital stay as well as a return trip a couple of days after discharge due to pain, swelling and serious bruising. The angiograph confirmed mitral valve regurgitation and a minor blockage in one of the smaller branches of the right coronary artery. My mother is 80 years old, has been in controlled afib for about 5 years and with her decreasing cardiac capacity, has lost most of her muscle mass. She is malnourished (although obese), anemic (blood loss) with renal and hepatic insufficiency and relatively severe osteoporoses. Her measured ejection fraction was 38%. She has pulmonary hypertension and CHF. Just under a year ago, she almost died from an uncontrolled GI bleed, not calling for help until she just couldn't move anymore. On paper, she looked like a really bad surgical risk. In Ontario, the heart center is in Hamilton. The surgeon came up to Thunder Bay just before Christmas. He told me that he had decided against taking the case, but when he met her, he changed his mind. When I asked him later why, he couldn't articulate it. He said she had a "spark" and felt she deserved a shot. I was on the second half of a 48 (with about 3 hours of sleep) when I received a phone call that her mitral valve replacement was in 3 days. I did not have time to go home and get to the airport in Vegas. When I got off shift at 8:00am on Saturday morning, my husband had driven the hour from where I live with some clothes and other travel essentials. He had booked and paid for a flight from Vegas to Minneapolis to Thunder Bay. I drove to Vegas, where I discovered they would not let me on the plane because I did not have a passport. (Thank you Al Qaida) I am a Canadian citizen and a legal US resident for 12 years. My expired Canadian passport is in Wisconsin (where I have a second home). The would not allow me to fly to Minneapolis either. Apparently that is called "short-checking" and is against the rules. They did allow me to purchase a second full fare ticket from Vegas to Minneapolis but they had a heck of a time assigning me a seat on the full flight. I told them that they didn't need to assign me a seat as I would not ask myself to move from the seat I had been assigned to on the original ticket. The logic of this eluded them. Bottom line, I got on the plane. I was asleep in my seat before we even finished boarding. In Minneapolis, I rented a car and drove the 7 1/2 hours to Thunder Bay. The customs officials on the Canadian side were more than accommodating, waving me through and even wishing me luck. (My husband had called them and explained the predicament.) I slept for a few hours, then accompanied my very ill mother on a flight from Thunder Bay to Toronto, where we spent the night, then drove to Hamilton, where my mother was admitted pending surgery the following afternoon. I contemplated the very good chance that she would not survive the surgery. A three hour surgery stretched to five and a half hours. The mitral valve was replaced. The tricuspid needed to be repaired and my mother's heart was so enlarged that her fossa ovalis was patent. Her measured ejection fraction of 38% was in reality a functional fraction of approximately 20%. The surgeon repaired the septal defect. Mother had no veins in her legs that could be harvested for the by-pass. The surgeon decided to close her up and take what he could get. I saw my mother an hour later in ICU. She had the ET tube, 4 chest tubes, a central line, a Foley, etc. etc. etc. I had her dentures in my purse and her tongue was lolling out of her mouth. I couldn't help myself - I burst into tears. I'm glad she was unconscious. (I told her the next day that she looked like a Chinese Crested Hairless) My mother has had a lifetime of defying expectations. Her ET tube came out around midnight and her chest tubes were removed the next morning. I finally got in to see her around noon. She looked at me and said "When are they doing the operation? I've been waiting an awful long time." I laughed and told her the surgery had been done the day before. She was amazed. "Well no wonder there is blood on my chest" she said. She told me that she had expected to wake up in heaven. I told her "so sorry - you are in Hamilton" (if you've ever been to Hamilton, especially where the hospital is, you will get the joke). That afternoon, I got news that a family member, 37 years old and the father of two young children, had been killed in a freak industrial accident. He is being buried today. I could only manage to briefly acknowledge my grief. I will deal with that when this mess is over. My husband, God bless him, is taking care of our responsibilities on that front. In sinus after the surgery, I observed my mother's rhythm deteriorate over the next day and a half. She went to 1st degree AV block, then a junctional rhythm of about 60. Amiodarone and Milnarone were discontinued to no avail. She finally had to be paced with an underlying ventricular escape rhythm under 20. I was in the room when I noticed the pacemaker malfunctioning with repeated non-captured spikes. I also saw spikes landing on the T wave. My mother became nauseous. I had to drag an ICU nurse over to look as she would not accept that a patient's relative actually had a clue. The pacemaker was replaced. Mom is throwing the odd multifocal non-perfusing PVC (and once in a while a couplet) which throws the pacemaker off but overall the pacing situation is in hand. There was the possibility that as her post surgical cardiac edema subsided, her AV tissues would recover. They have not. Mother will be having a pacemaker implanted tomorrow morning. I was looking over my mother's records. One of the nurses had noted positive for dementia. My mother is sharp as a tack. Just because she doesn't speak English and often misunderstands what is being asked of her does NOT mean she has dementia. When I challenged the nurse, she went crazy on me because I was not allowed to look at the records without a physician being present. I am bending over backwards to not challenge them and to make a small a nuisance of myself as possible. Some of the better RNs actually welcome my presence because I can translate and I help with her care. Others are threatened. If you are still reading - thank you! You have no idea how much it helps me to publish these meanderings and get your input and comments. It keeps me sane. (and no smart ass comments about my sanity or lack there-of thank you very much)

Does that include reruns of "Johnny and Roy" on "Emergency!"? I am one of untold thousands who got the idea to become EMTs, Paramedics, or Fire Fighters (separately or cross trained) by watching that show.

We should get every TV show that has EMT's, Medics, or even ambulances shown, taken off the air.

In many areas of New York state... Nassau County PD, Rotterdam Township PD, Albany County Sheriff, and Guilderland Township PD to name a few... the police or sheriff's department filled a need for ALS by cross training police officers that either worked on an ambulance or responded in a fly/chase car. All of these agencies have since staffed these divisions with civilian personnel who work for the police agencies, but some cross trained medics/LEOs still work for these agencies. There are a number of combined public safety departments I know of in the mid-west, where all personnel are cross trained LEOs, medics, and FFs. I have heard stories of a reckless driver cutting off the fire truck only to find himself pulled over and a ticket written. As for the SVU episode... well that's just television. EMSDoc

I'm not against cross training - there are areas where it works to their advantage. There are a few areas in ohio that I'm aware of that the cops also function as paramedics. Many of the troopers here are also cross trained with all being trained to a minimum of a first responder (certified) as well as all of fire being basic so they can perform their own rehab and an ambulance is no longer needed to stand by. Many have their own "fire buggy" which responds solely to the fire scenes for treatment. However - here's where the lines get blurred - when you are on a scene and both duties are required which one takes priority? If you are both a trooper and paramedic you don't treat the patient or have to leave the patient- that's abandonment, you don't keep the scene safe and you potentially get yourself killed. Needs to be a clear line as to when you are what. I'm not advocating against it, but I am playing devil's advocate. As to the SVU episode - I was referencing the fact it was overly dramatic. Most of the time, I'm actually quite the fan of the show as it's well written. Yes I understand real SVU cops probably hate it and sit and perform much of the same griping we did with "trauma", but it is well written and probably much of the reason it's lasted so long. I really just didn't see the justification for having her perform the skills when truthfully they could have. It might not have made such an interesting story line, but all well. Richard - I do stand corrected on the flight part - thank you. I was halfway listening while doing something else and heard the helicopter discussion and then looked up to see them delivering her baby and was like WTF ? Ironically though, I've not seen them drawing blood - every time I've seen the episode they have them at a clinic or the hospital getting it done. Perhaps I've just missed those episodes? Fair enough - just thought it rather absurd at the moment and fired something off. I'll return to putting my foot in my mouth and shut up now.

This kind of stuff just facinates me. And how can it not tug at heart strings? Link below pic Doomed Love

looks like a married couple strangled each other to death....

Hello, Picking on a long term care facilities is too easy. Mainly due to horrible patient-to-staff ratios and inadequate staffing mixes (RN/LPN/NA). They never can shine. Personally, working long term care is a horrible job. I couldn't do it. David

http://www.canada.com/news/national/Dying+officer+thanked+paramedic+rescuers/2426743/story.html

Holy crap, Batman! What happened to this thread?! First of all, I see no issue with Lisa O's comment. It does indeed seem like an attempt to empathize, and nothing more. Secondly, Siffalis, you really seem to be screwing the pooch on this one. You're implying all sorts of things that aren't present, and your tone is just atrociously antagonistic. Arctikat is right: If you wanted the thread to go a certain way, you should have given it some guidance and set-up first! You even seem to take issue with people discussing the actual content of the article... not sure what's up with that. Short on sleep lately? Thirdly: You said it yourself. This is an open forum. Nobody needs your permission to post what they like in this thread, whether it's the direction you wanted it to go or not... How'zabout everyone takes a step back for a little bit? Let's cool things off a touch and figure out what the real issue is here once the red fog clears... Wendy CO EMT-B

Well said. Not sure who Jaime is, but ok. The context of this post I assume is directed towards the original poster, which was me. Thanks for the input, I'll form my posts more to your liking next time. I am after all giving your opinions ... I originally made the post to share the information I had read; a simple story of a horribly sad incident. I was rather speechless (rarely happens), and the story almost brought tears to my eyes. Does that explain my "lack of effort" as you put it? A brother of ours had the strength in his DYING moments to say thank you to 4 of his own. Unfortunately some people didn't read the story in its entirety, and the posting just went off in a completely different direction. You I'm sure have started/been a part of similar threads that meander. Please take your own advice and keep things civil when in a main forum. If you want to blab at me in private message go right ahead, I really don't care. I don't want to read through useless bickering in a forum, and I'm sure others don't either. As for posting somewhere here, I will do so where I please as this is an open site and don't need an invitation to do so. Neither do you. I'm going to consider this matter

Facetious is my middle name Here is a link for those registered in another province interested in being registered in Alberta: http://collegeofparamedics.org/pages/Registration/AgreementonInternalTradeMutualRecognitionAgreement.aspx For those coming from a different country, it's more of an ordeal: http://collegeofparamedics.org/pages/Registration/IndividualSubstantialEquivalency.aspx

Uh huh ... and how can you properly diagnose an RVI in the field without a 12/15 lead? An EMT can go and obtain a 12 or 15 lead all they want ... they cannot however base any treatment they provide on those findings as interpreting those ECG's are not in scope.

I don't think that anybody is getting the entire story with this. Of course I have all the same questions that have already been asked, but even more so is Why was a second ambulance called? Firefighters have the same training that ambulance crews do and most fire departmants staff a minimal of 2 employees on their units. Why couldn't one of the firefighters ride in the back with the ambulance crew member that had patient care and be on their way? I also understand about not allowing non-employee people driving other company vehicles....however, it is a child in arrest so why are you going to wait? I would rather have to face my boss and explain why a non-employee drove my ambulance than face the family of a child who thinks that my delay in getting their child to the hospital was a possible cause in the death.

One should not be able to give nitro without the ability to first, initiate and monitor/maintain an IV line, and secondly they need to be able to obtain and interpret a 12 lead and 15 lead ECG. The risk is too great of harm to your patient without being able to do these things. In Alberta us EMT's can give nitro (whether or not the medical director allows this in protocols is individual to the service). My service is urban ALS, so EMT's have a great potential for learning and assisting with these things. When I was still in my rural days and had the chance to admin nitro, I withheld as I could not rule out RVI. This was good, as upon arrival at hospital and completion of 15 lead ECG's it was shown in (from what I can recall) 24/30'ish patients that there was right sided involvement. So I could have potentially harmed or killed a couple dozen people if I would have said "oh, chest pain, cardiac, let's give nitro". IV, O2, ASA (if no contraindications), maybe a little Entonox ... I did my thing and never hurt anyone. Hopefully most people aren't jumping the gun and giving something "just because they can".

Still wondering what they were thinking, but was watching an episode and they had one of the cops climb in completely unprotected into a smashed up car and the EMT who is in the window right next to her and tosses her the IV bag and says here I'll walk you through it. Then uses a police helicopter to fly the woman magically to the hospital who is in active labor - wow I guess it's rubbing off on NBC.

Almost every county in the state of Michigan has a Paramedic Division of the County Sheriff's Department. They're automatically toned out on 'Tier I' calls (cardiac, respiratory, CVA, etc) http://www.co.genesee.mi.us/sheriff/paramedic_division.htm

If you recorded that episode of SVU, play it back, and review for the following:. Olivia, after declining medical attention for herself, climbed BACK into her wrecked car to attempt stabilization of Elliot's pregnant wife during extrication/disentanglement, and yes, she was guided by the paramedics in starting an IV. Mrs. Stabler delivered her baby, with the paramedics assisted by Olivia in the ambulance, and then went into cardiac arrest, to be defibbed while the ambulance was still enroute to the ER. She would be revived in the hospital, off screen. As for the helicopter, it had been sent to bring Elliot back from making an arrest of a murder suspect somewhere in Suffolk County. Elliot's wife was never in a helicopter in that episode, and as such, never met Rabbit, from the medical error filled "Trauma". Olivia, Elliot, Fin, and Munch must have had some medical training, as they almost always seem to be the ones drawing blood for DNA samples. Let's keep the two shows separate.

This is not a new trend for emergency services. Many county services both down south and out west use a three tiered system with Police that work as Medics and in some cases as firefighters. They are sworn officers that have also completed fire and EMS training and are required to change hats on a call to call basis. This is primarily done when the counties run Police Fire EMS. I think it is a great idea to be able to change hats at a drop of a dime because it keeps the job interesting and utilizes its employees the best possible way for each situation. Many Virginia State Troopers are also paramedics and dual role as well as many SWAT team country wide. In my home town the entire town highway department crew are trained as firefighters and are automatically dispatched to extrications and structure fires so help with staffing issues. They are covered under the same town insurance, lowers the ISO for the town residents, and really reduces response times. I think if more towns got on board with cross training it would help the budgets, prevent layoffs and better our comunities. .....Just my two cents

+ 1

Oh sure.. cause it only takes about 120 hours to provide emergency medical care and we all know getting cross trained fire/police dudes there in 5 minutes is much better than getting ACLS there in 8. I mean, all those guys do is start IVs right? And as police and fire stuff requires ongoing education, training and practice, its a good thing that EMS crap is so easy.