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The baby was at a hospital which offered a more stable environment for the birth than the back of an ambulance even if the hospital staff were not comfortable with it. As a hospital, they are still required to have a code cart with the necessary equipment and staff with at least the basic NRP cert as well as some expertise in their professions. The mother was in labor with a preterm infant. You have two patients with the potential need to resuscitate both of them depending on the cause of the preterm labor. The Paramedic knew this was a 25 week preterm infant about to be born and even in ideal situations that is a sick baby which requires special care. Just a little knowledge of NRP is not enough for the acceptance of this patient. Preparation for the birth of the infant must be given consideration for a 60 mile trip by ambulance or any mode of transportation. You are leaving a hospital that at least provides some of the necessary equipment and staff. The American Academy of Pediatrics has guidelines that suggests stabilization and transport should be done by a specialized team. In this area there are at least 2 teams that have OB/Neonatal teams who can also get access to a helicopter if needed and could probably reach the referring hospital in the same time it would take the ground ambulance to have been called and run real fast to Orlando. The specialty physicians at the receiving hospital who are involved with the transport teams can generally talk even the most freaked out general practice doctor in an ED or tiny ICU through some emergent steps to stabilize the mother and baby until the team arrives. However, the details concerning how much conversation was done with the hospital in Orlando are sketchy or if they were given a chance to send their team by EVAC already starting to roll. I believe the other hospital, Halifax, which was the first destination is still just a Level 2 NICU. AAP website with some good information: http://www.aap.org/ In this situation the mother and baby ended up at another little general hospital emergently because the ambulance diverted and the Children's hospital still had to come for the baby. The sending physician(s) should not have been the one making the decision as to what was best for this patient and her soon to be born baby for transport. The physician(s) may not have known the abilities of the Paramedics or were led to believe transport was no problem either due to greed, ego or lack of adequate training/education/experience to where they didn't know how little they know. Diesel can not be relied on to treat a preterm baby especially when you are accepting a known situation and taking a patient from what might already be a more stable environment. This is where lack of adequate education/training/experience will allow emotions to take over and poor judgement may come to play. This may also make for a very unsafe transport for the crew, patient, baby and the public with the use of L&S for 60 miles. And you know the legal ambulance speed may not be adhered to. Even some Flight and CCT transports must be aborted at the sending facility due to lack of appropriate equipment or expertise as well as a very unstable patient and no means to stabilize them for a safer transport. Neonatal/Pedi Specialty teams may spend hours at the sending facility doing what they would do in their own ICU with their protocols and guidelines to stabilize the baby before transport. They are in no hurry to move unless surgical intervention is needed because they are the higher level of care with the equipment and expertise. But, even for the cardiac babies that will require surgery, they will not go to the OR until certain other problems are stabilized. Here is the rewrite for the Florida statutes that was initiated after this incident. The accepting physician with specialty expertise will now determine how to transport and not the sending physician who just wants the patient to go some place fast or an overly eager ambulance service and crew. http://www.doh.state.fl.us/DEMO/EMS/RulesStatutes/RulesPDFS/NoticeChangePublishedFAW12112009.pdf This may have also come about from some of the several other incidents with poor outcomes due to a scoop and run mentality that is practiced by some ALS/CCT and even Flight teams which are not all created equal. In EMS some are quick to criticize the EMT-B who does not call for an ALS intercept but then these same people will accept a CCT to where even as a Paramedic they are little more than an EMT-B when it comes to the level of expertise and skills required to move that patient safely from point A to point B. This situation is also not much different than the scenario thread, "Threw up and can`t breathe", DartmouthDave started with the unstable airway. Disclaimer: I have no direct involvement in this particular case but it has initiated several conversations and changes in Florida as well as the OB/Neo/Pedi medical professions. The AAP has also been taking notes but then this is the type of situation they have tried to prevent from occurring for many years.

Dust, that has to be one of the most unfounded comments you have ever made. What the hell does that have to do with anything???? And where do you draw the line? Should we not let men into EMS, because they might see a pregnant woman and not be able to deal with it, or because they might joke about the nakedf breasts of the day? Do we not let fathers into EMS for the same reason that we don't want mothers in EMS? Do we not let people who are not parents into EMS because they haven't had children? How about those who have had a traumatic event in their lives? Maybe someone who has just broken up with their boyfriend/girlfriend shouldn't be allowed to respond to domestic dispute calls... How about someone who has spent time in Iraq or Afghanistan because they might have PTSD? That comment was unprofessional. I realize that it is your opinion only, and as your opinion, you are entitled to it, just as others are entitled to their opinion that you are completely out of line with that thinking. If someone can do the job well, they can do the job well. I don't care if they are a mother or not. Oh yeah - before anyone posts that I have my feathers ruffled because I am a mom... I'm not.

We discussed this story on the forum about a year ago. I used to work in Kern County. Don't remember all the details, but basically a medic showed up and the cop told him, "He's just drunk. He's going with us." The medic made patient contact but apparently also thought he was just drunk. He didn't do a proper assessment. One story I heard was that the medic claimed he could not do a proper neuro assessment because the patient was handcuffed. I'm not sure if this is really what he claimed or if that was the case then why he didn't just get the cop to uncuff him. Again, this is just what I heard and I'm not in on all the facts of the case. The medic took off, and sometime later a nurse from the hospital came by because she recognized the doctor. She realized he was having a stroke and had PD call for another ambulance. The lawyers will still have to prove that the delay in medical care would have made any difference in this guy's outcome. That doesn't seem very likely if he had a bleed, which is what I heard he had. Regardless, it's really tragic that this highly skilled doctor has become disabled. If I remember correctly, he was specialized surgeon of some kind.

And while he's looking for new employment, maybe the EMT will remember not to use an ambulance that doesn't belong to him to intentionally cause a vehicle crash during a dangerous law enforcement incident.

I can't agree. Although there is plenty of blame to go around -- and it should -- that does not mean that she herself should not also accept responsibility for her personal FAIL. I'm not of the theory that if everyone doesn't get punished, then no one should get punished. If you fail, your punishment is irregardless of other failures or their punishment. Two words: Personal Responsibility.

Horse Crap!!!!!!!!!!!!! She should not have been fired. She is the scape goat for an unprepared system. Start at the top not the bottom.

I thought that the episode wasn't bad. I agree with Dust, the acting is improveing. However I think that Trauma will be a one season wonder. I heard today that of the 20 episodes that NBC finally ordered, they have stopped production and are calling it done at 18. Season Finale (series?) is going to be at the end of April, two weeks earlier than initially announced. As far as backing your partner vs. your GF, it would depend on the situation, but I can see myself doing it in the right circumstances. It all depends. And I don't know if I'm dumb, or just someone who cares too much.....but I can see myself doing exactly what Rabbit did in that situation. Standing by his partner. At least if it was a partner I cared about.

There is no good option for an online A&P class. If there is one, it sucks. And most programmes won't accept one that did not include a lab component anyhow, so you will have wasted your time and money. I don't know who does an online pharm class, but I'm betting someone does. And I don't see any problem with taking it by distance. Just a fair warning, if you have never done distance learning before, don't try more than one class at a time. It turns out to not be for a LOT of people, and there are no refunds for figuring that out. Good luck!

Just to clarify a few points: 1) Pyruvate is a product of glycolysis along with a net of 2 ATP via substrate level phosphorylation. In addition, two NADH are produced per glucose molecule. However, the pyruvate is turned into acetyl-CoA after entering the mitochondria. Lactate is produced in the TCA cycle. 2) The Krebs Cycle (TCA) is not the major ATP producing pathway. I believe only about two ATP are produced via substrate level phosphorylation in the TCA cycle. The major site of energy production is the ETC. Hydrogen ions and electrons help run ATP production in two ways. 1) The electrons give up energy as they cascade through the cycle. 2) Hydronium ions are utilised to make a gradient and by use of proton motive force (PMF) powers ADP to ATP conversion through a protein known as ATP synthase. The oxygen "scavenges" the hydronium ions and electrons at the cytochrome c oxidase protein complex. 3) Several things actually occur beyond cell death by acidosis. We have failure of multiple mechanisms including ion channels. Then, as cells die, inflammatory mediators are released opening a systemic bag of worms. This is part of why people with say a femur fracture can develop ARDS and MODS. Clearly, hypoperfusion related to hypovolemia can be another part of the puzzle. However, it is not uncommon for somebody to sustain a hypoxic insult or an episode of hypovolemia and end up developing MODS and so on. I am sure the Docs and JPINFV can go deeper, but I just wanted to clear a few thing up. Take care, chbare.

I don't entirely agree with this statement. In the GTA, you will definitely have an easier time finding work if you are a grad of Centennial, Humber, or Durham. This is, of course, not only because the reputation of the programs, but also because they have produced medics for these services for many years so they know what they are looking for (and many students will have precepted there). I do not have any evidence to support it, but I highly suspect that Centennial, Humber, Durham or even any of the other more established programs (Fandahswe, Conestoga, etc) grads would generally have an easier time finding employment than some of the smaller and newer programs (Lambton, St. Clair, St. Lawrence) since people know them to produce good medics (plus the person interviewing you might be alumni of your school or have other medics from your school who they like). Of course, the most important thing for getting hired on at a smaller service may be just making a good impression by precepting there and doing well, which you should be able to do even if you don't go to the school in their area (although it will be more challenging to coordinate, and if you go to a GTA school I would definitely recommend riding out there... that is too good an opportunity to pass up). Anyway, to the OP: If you hadn't mentioned that you already had a degree, I would have said to go to Centennial without even considering the other programs. The ability to fairly easily turn the paramedic diploma from Centennial into a strong university degree (that impresses potential employers) is a huge benefit of this school (yes, you can go and get a paramedicine degree from U of T after going to a different college, but it isn't as easy). Admittedly, I don't know much about Niagara and what Dust mentioned about all of those schools being good is true. That being said, I can say with confidence that Centennial will prepare you to be a good paramedic who can truly think critically (not just in the buzz word sense of the words). It will be an exhausting and frustrating experience at times as it seems to consume your life for two years, but you will likely look back on it and think that it was worth it. PM me if you have any further specific questions on the program.

Yeah I guess it is rather late...I'm curious and impatient and figured we all had to be creatures of the night like me.

wow...not even any views yet...

http://www.ems1.com/communications-dispatch/articles/782114-Pa-medic-fired-after-mans-snowstorm-death/ Pa. medic fired after man's snowstorm death Curtis Mitchell died waiting 30 hours for help during bad weather despite repeated calls to 911 The Associated Press PITTSBURGH — A Pittsburgh emergency medical worker has been fired following the death of a man who waited 30 hours for help during a snowstorm despite repeated calls to 911. Mayor Luke Ravenstahl's office says Josie Dimon was fired Thursday. Her dismissal stems from the death of 50-year-old Curtis Mitchell during a February storm that dropped nearly two feet of snow on the city. Mitchell had a history of pancreatic inflammation. He and his girlfriend called 911 10 times seeking help for his abdominal pain, but medics couldn't reach their home because of the snow. He was asked to walk four blocks to an ambulance but couldn't make it. Three other medics were suspended. The paramedics union has said they would fight the suspensions. A phone message left Friday for Dimon hasn't been returned.

Okay, let me then amend it to say that parents in general should not be in EMS. Not just mothers. All of my best partners have been single males with no children. I stick with what works best for me.

You have zero control over it. There is no "letting" it get to you. It just does. One of the many reasons that mothers shouldn't be in EMS.

LOL! My first negatives! Finally, I'm a member of the club! I'd like to thank all the little people...

Thread title changed to reflect content. "What would you do" is a specifically prohibited thread title in the rules. I don't handle them any different than any other run, and they don't bother me in the least. If they bother you, you should leave the profession, because there is no way to change that.