Chief1C

This is PA's protocol, as I could not find the term service dog or service animal in MD's protocols. Purpose: The purpose of this policy is to provide guidance to EMS providers who encounter individuals who are assisted by service animals, including guide dogs for the visually impaired and other types of service animals. However, because of the nature of the services we provide it can sometimes be difficult to accommodate a patient and a service animal in an ambulance. EMS providers should be guided by this policy in determining whether service animals should be transported with the individual in the ambulance or wheelchair van, or whether alternate methods of transporting the service animal should be utilized. Criteria: A. Any call involving a patient with service animals. Exclusion Criteria: A. None. Procedure A. All Patients with Service Animals: 1. Service animals, for example, guide dogs utilized by visually impaired persons, shall be permitted to accompany the patient in the ambulance or wheelchair van unless the presence of the service animal will disrupt emergency or urgent patient care or there is some basis for the crew members to believe that the safety of the crew, the patient or others would be compromised by the presence of the service animal in the ambulance or wheelchair van 2. EMS providers should assess the level of care required to provide competent medical attention to the patient. 3. When the presence of a service animal in the ambulance might interfere with patient care, jeopardize the safety of the crew, the patient or others, or cause damage to the ambulance or equipment, providers should make other arrangements for simultaneous transport of the service animal to the receiving facility. Unless emergency conditions dictate otherwise, absolutely every effort must be made to reunite the patient with the service animal at the time of the patient’s arrival at the hospital or other destination. 4. Acceptable alternative methods of transporting a service animal to the receiving facility include, but are not necessarily limited to, family members, friends or neighbors of the patient, or a law enforcement official. Attempt to obtain and document the consent of the patient for transport of the service animal by such person. If no such individuals are available, contact the agency base or PSAP and request that additional manpower respond to transport the service animal. 5. Providers should document on the patient care report instances where the patient utilizes a service animal, and should document on the patient care report whether or not the service animal was transported with the patient. If the service animal is not transported with the patient, a separate incident report should be maintained by the EMS agency describing the reasons that the service animal was not transported with the patient. Notes: 1. EMS agencies in PA provide quality services to all individuals regardless of race, color, national origin, sex, disability, or creed, and comply with all applicable state and Federal laws regarding discrimination and access to public accommodations.

People that are easily offended piss me off. I'll judge for myself, what was the site?

I think it was the alcohol. It has nothing to do with EMS. I always say, if I were any calmer, I'd be in cardiac arrest.

Now today, I feel like a lost puppy. I don't know where I came from, how I got here or how to turn back. I guess I feel like I would describe a patient that's depressed. I may and/or may not have had a minor anxiety like episode. I don't know, b/c I don't really put myself ahead of anyone, or take "me" time. I took one of those non-diagnostic online tests, just for shits and giggles, and it suggested I call a crisis hot line. I don't feel that's necessary, maybe I put too much thought into the answers...or maybe it gives that response to everyone?

If a person, even well known, has a frame of mind where they consider an overdose to be acceptable. Then they aren't in a state where you can trust them. The other factors just bolster the idea that waiting is better. Yes, it's possible that going in, not waiting, and taking the patient could save their life. It's also possible that while waiting, the patient may die. Then, it's also possible they really want to die, and will kill you, to ensure nobody stops that plan. That's the only flaw in the plan of attempted suicide cases, the ones who really don't want to die; many times do die, because help didn't arrive in time. But who are we to judge, by dispatch info, whether a person was serious or not, or if they're dangerous? Had a case just after I became an EMT. A person shot themselves in the chest, and did not want to die. The spouse called 9-1-1, begging for help. Police arrived, ambulance, helicopter, paramedics all on hand. The patient wouldn't give the gun to police. The patient was conscious, alert, talking, highly intoxicated -- and holding a gun. Until [the pt.] passed out, [the pt.] was waiving the gun around. Maybe [the pt.] didn't understand what was happening, but was the patient able to be trusted? [the pt.] was drunk, and armed. Only one of which, IMO, is required to lose trust. The patient bled to death, with a gun in their hand. I wasn't going to lose my life to find out if [the pt.] was done shooting or not. According to the history, neither alcoholism nor depression were ever issues in the patients life, an apparent one bad day incident. Of course, who knows what the patients side of the story was.

But it'll take two weeks to order them. Don't listen to Kiwi, listen to spenac, and don't take anything personally.

I seen Redneck used, and I feel we must make a chart, because it seems to be a misused derogatory statement. I think you need to be schooled on how to properly insult rural white folks.

Maybe if you're demonstrating something from the Vietnam era. You could carry a key chain barrier device? Or a list of area funeral homes. I've seen plastic, disposable blades.

I've never killed a deer with a gun. But I've killed nine, and injured three with vehicles. I live in an area where they give school age kids five vacation days per year, for hunting. Deer Days. The whole school district closes, an acceptable absence, is hunting.

Just wanted to add... Thank you for abbreviating HIPAA correctly. Just sayin'.

<breaths out dramatically, drops head on desk>

I got this from EMA a couple weeks ago. I can't wait for the mass panic myself. What would really be clutch, would be like a grass fire at the same time, so the siren goes off. That would just fully exploit the situation!

I deleted my ring tone for the ambulance captain, which was a techno song clip that repeatedly said "I AM NOT A WHORE". Stemming from a party, an almost sobbing drunk said that. Heh.. It rang at the wrong time.

On a side note.. I had different thoughts when I seen sexy and c-collar. Not bad ones, just... Anyhoo.. So I was on eBay selling some things to clean out my closet. People that are into fetishes, sell like oxygen masks, BVM's, collars... at prices five or six times their actual value. Hell, I could make more selling EMS equipment to sick bastards, than to EMS providers!

Talking to many firefighter-paramedics, at least those who have gone to the FFII level. Their dream is to leave PA as soon as possible and seek employment in one of the big departments that have become career in North and Eastern Maryland. Right around DC seems to be a hot spot. In fact, most ppl I know have gone down to tag along with departments that are big on College Student live-in programs. The places that really put the term WANKER to the level.

Beached?

Actually, with only one term misused, and one word misspelled coupled with a few minor grammatical errors..... (like me using ......) It was a very good 1st post. Welcome to the 'city! In fact, I find it worthy of a +1.

You can't have an ambulance available to arrive in front of every tax payers home with in two minutes. It's not possible. When I first started reading that article, after JEMS posted it to their facebook account, I figured it was another "my child died, so I have to blame someone" case. To a point, if someone is to triage to determine need for an ambulance, you could cut down on unnecessary transports. If you say it aloud in a conversation anyway, it sounds like a good idea. No matter what your extent of service or training, one of the first routine things you learn is dispatch info is NOT absolute. The information is only as good as the caller's credibility, which can't be determined in thirty seconds. Can't go by frantic callers either. I've taken seven digit "911" calls from people screaming and crying - over grass fires. It seems like a genuine and practical idea - how would it work? I have no clue, nor would I want to be the one to decide the protocol for waiting to dispatch EMS, or just sending them as well. Somewhere, it's doomed to fail. damn errors

I always enjoyed watching his bit at the end of 60 Minutes... A true icon of American Television! http://www.washingtonpost.com/local/obituaries/former-60-minutes-commentator-andy-rooney-known-for-his-wry-musings-dies-at-92/2011/11/05/gIQAnMI5oM_story.html

They still get billed for transports, as they would anywhere else. But on personal terms, the only thing I've ever accepted was cards and baked goods..

Time to start thinking about drying out the fall out shelter, I guess...

It's the exact same way here. The only time I don't know the patient, usually anyway, is either a wilderness rescue or a vehicle accident on the state road. In this day in age, everyone has cell phones, so I don't even use the home phone. But I leave it connected, because I know every time it rings, someone is avoiding the call to 9-1-1. I handle it just like a dispatched call, I notify the com center where I'm going and what for; they start a card, and I get a refusal (that they didn't require or need an ambulance). If they're in a bad way, I use the medical command option to try and talk them into going. There's places that it takes an hour to get to, so if it sounds bad, I at least want an ambulance on the way. Whether it's just a first aid run, or an inhalator call; or someone needs an oxygen tank filled; I still like to cover my ass. Some nurses will go out and field suture, I won't go that in depth. I won't apply ointments, etc, if it's bad, I'll drive them in to the urgi care. Have to be very careful, because it's EMS care, not a Good Samaritan act. It's one thing if I'm treating a fellow fireman, or someone shows up at the door. But calling the party line is the same as 9-1-1, it's activating EMS. But there's a lot of minor first aid stuff. I feel very proud to be trusted enough to be called, but I don't know where the hell these people get my phone number b/c it ain't listed. You could go back to the to do or not to do of treating people "off duty". But I guess I'm always on duty, or on call. I guess the only time I'm off duty is when I go into the tavern for a drink. Folks around here are poverty stricken, they can't pay, they don't have insurance. They don't call till the last minute, that's taken a lot of lives, for illnesses that can be treated. The protocols support not transporting non-viable patients, eg, no shock on the first try and 15min from an ER. Most of our arrests are an hour from an ER. That is by far the hardest part, because they look at it as if you're giving up.

About 800 in the combined municipality. However, it's only at 426 this year.

On personnel taking pictures, we strictly forbid it for personal means. That policy was instated over two years ago, among several nationally publicized lawsuits. However, every EMS unit in the county was given a digital camera from a fund established after one of our buddies and long time EMS leaders died of cancer. A pink, digital camera. We also have several older model Polaroid cameras on board; and our rescue-engine carries one. The best way to learn from what you do, is to document it, in writing and visualization. Like cribbing an awkwardly found vehicle, or use of air bags (lift bags) or stabilization struts; we also take pictures of fluid in streams, and barrier methods (damming, diking, rerouting, booms, etc.) But these pictures never go any farther than a lap top that isn't connected to the internet, and is locked up 99% of the time. The ambulance camera is a great way to be an extension of your mind, an advocate for the patient, if you will. Why paint a picture, just in words, when you can provide an actual picture. I've found that most HEMS crews, Trauma Center staff appreciate being able to see a MOI.. Also, it looks less like you're freelancing, if you're using a "crime scene" looking camera, than just pulling out your cell phone and snapping a picture. We don't take pictures of bodies, etc; unless of course there was a survivor, and one still entangled. Then we would sheet the other victim, and try to avoid taking obvious pictures of the decedent. This is all my opinion of course, and what we practice. It used to be quite common to snap a few shots of the vehicle, interior and from a distance to leave with the ER's copy of the PCR to show what exactly the patient went through to get to that point. *** I typed it, but then it kept deleting when I tried to space it, so it was only edited to the extent of spacing.

Damn... Because I COULD REALLY USE A VALIUM.