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It isn't that much of a zebra, WPW definitely happens and usually when you aren't looking for it. You only have to miss this once before you start thinking about it on every patient with wide and tachy rhythms. I've missed it before, and I promised myself I wouldn't again. As far as the OP: you really can't tell the difference between VT and SVT with abbarency on a 3 lead. Even with a 12 lead it can be very difficult. I would take extreme caution in diagnosing, and especially treating VT as this is an area where you can definitely do some significant harm with the wrong choice. It's been my personal observation that people tend to be a little quick to think they are dealing with VT when it is oftentimes not the case. You should have a high index of suspicion in regards to VT, and really only consider treating those patients who need it immediately.

I think in my mind it comes down to the fact the partner didnt want to enter for what ever reason. I have refused only once to go in a residence until RCMP have cleared the scene because like Herbie I know my community. The other fact that should be noted is the fact that the residence itself could have a potential hazard, alot of homes here have not been kept up and there are those I will not go into because I dont want to fall through a floor.

But how does a person who OD's a danger to you, or justify a delay in your response? Will they be upset and angry? Maybe, maybe not, but anyone who's been doing this job for more than a day knows what it's like to deal with someone who is under the influence. The point is, SOMEONE called for EMS- and most often it's the patient, after they had a change of heart. Obviously if a person has a weapon that is NOT a safe scene and until that person is disarmed- or dead- you have no business being anywhere near them. I think a little paranoia is a good thing, but it also should not paralyze you and prevent you from doing your job. I've had thousands of suicide gestures/attempts and not once did anyone want to take me with them. They may be angry that you are there, angry that their attempt was not successful, angry that someone called to foil their plan, but nobody has ever tried to harm me because I was their to foil their plans. I've had plenty of people beg me to let them die, but never have I been threatened by such a patient. As for trust- I don't trust ANYONE-sober, sane, drunk, young or old. Just like driving with lights and siren, you assume that your rig has a bulls eye on it and everyone is aiming for you. You assume that the person in front of you will do the exact opposite of what they should do. When carrying a little old lady out the door or down the stairs in a stair chair, you assume she will ignore your instructions and reach out and grab the doorframe or railings potentially injuring you.(I have a friend who's career was ended in exactly that manner- the elderly patient grabbed a doorframe as they were going through it, his neck was torqued, and he blew out 2 cervical vertebrae.) It's not intentional or malicious, it's just you cannot trust anyone to do what you instruct them to do. You take whatever information you can from dispatch, any prior knowledge you may have of the area, and take that into consideration when you arrive on the scene. You constantly assess the situation, monitor the potential hazards, and then if you see a credible threat to your safety, you back off and wait for help.

I know that scene safety is drilled into our heads since day one of EMT school. I will somewhat part company with folks here. When I was in the ghetto, if we waited for the police on every OD or call with the potential for violence, we would have rarely gotten out of the rig. Bottom line- you need to know your area, you need to know your capabilities, and maintain a situational awareness of your surroundings. If you are pulling up to a scene and notice dozens of angry people running around, then yes, it makes sense to wait until the scene is secure. It depends on how much prearrival information you receive, your knowledge of the area, and what the call is dispatched as. Maybe you are familiar with the address and know it's a drug house or gang hangout- then yes, wait for back up. Maybe you know a certain area is "hot"- meaning gang warfare is going on. Wait for back up. This is when experience comes in handy. If you decide to wait before making patient contact, you damn well had better be able to JUSTIFY your rationale because a lawyer will certainly want some proof later: active shooting, threatening bystanders, warnings from dispatch that the scene is not safe, etc. Simply saying that you did not feel safe is not good enough. In some areas, the whole neighborhood is "unsafe" by the standard definition of the word, but if that's your area, that's part of the deal. Prehospital care is by definition unpredictable, and that is exactly why most of us got into this business. If you want somewhat safe, secure, serene surroundings, a hospital is probably where you need to be. I'm no cowboy, I am never reckless, nor would I knowingly put myself or my partner in danger. I simply think folks sometimes overstate the dangers we face. The vast majority of times when I felt my safety in jeopardy was in cases that had nothing to do with a violent injury like a GSW or beating- they were from medical or cardiac calls when bystanders and/or family started acting up, or when a domestic dispute broke out while we were on scene. In my experience, in 99% of our calls, even the goofiest, most angry, violent folks do not direct their anger or ire towards us. As long as you make it clear you are there to do the job someone called you to do, generally they leave you alone. Remember- someone called YOU for help, and you are supposed to be the professional that is there to mitigate a problem.

I disagree. Nowhere was it indicated to wait for police arrival based on the information given in this scenario. There's a distinct difference between the cops are also coming and dispatch instructions not to enter until a scene is clear. Sounds like his partner wanted police clearance, not that there were dispatch instructions to that effect. Unless there's standing orders for PD to clear every drug OD, there's definitely grey areas here. It's a moot point anyway- it's the calls you never expect to be shitty that jump out and bite you in the ass... (elderly unwell, enter home, realize about 10 seconds into the living room that there's a pit bull sneaking out from behind the couch who looked PISSED that we're in there... that was a nice objective lesson in scene safety...) I stand by what I said- sounds like there's a different threshhold for comfort here, partner wanted cops, other partner didn't feel it necessary, waited for cops anyway, everyone's alive, time to go home... If you do notice, in my first post in this thread, I did say that you always err on the side of the little voice... whether it's in your head or your partner's head. Gut feelings can save your arse. Wendy CO EMT-B

What's the difference between a redneck boy and a hillbilly? The redneck raises livestock. The hillbilly gets emotionally involved. How can you tell if a redneck is married? There is tobacco spit stains on both sides of his pickup truck.

I am thinking that all these negative posts are because she didn't choose your ambulance crew. You guy's are just jealous that she choose mine. You don't think there will be a problem when she finds out we are a bunch of fat bald old guys with kegs rather than 6 packs?