VentMedic

The activation of EMS for a suicide attempt with verbal comfirmation and some physical evidence makes this situation very serious and puts question on the patient's intent and mental capacity for making a rational decision. With or without alcohol, this makes this person's decisions suspect and ground for professional evaluation. The alcohol compounds the issue but is not the sole bases for questioning a person's decision making capabilities. It can either mask or enhance what a person's real intentions are. It is also very possible that this person could sober up and get serious with their intent to kill themselves whereas in their drunken state, they couldn't get it right or other emotions were playing with them. Sometimes being intoxicated actually keeps people from facing reality and killing themselves.

I would have called for a PD officer with rank or tried to reason with the PD on scene as to why transporting this patient is a necessity. Regardless of phone record, the patient admitted to saying the same things that activated EMS/LE. LEOs are generally better trained than this and should have known that people recant their stories when they relize they are being thought of as crazy or know they are about to be held against their will. As well, the officer should be aware that people will lie about what they drugs took. Some patients may also not know what damage the drugs or combo of drugs/alcohol will do if they are altered by the substances and are feeling "good" at the moment. It is extremely important that you document your arguments to PD about your concerns from a medical professional's point of view as they may say they relied on YOUR professional expertise to make their decision. They may even be having this say conversation on the PD forums as "the Paramedics didn't seem overly concerned, should we have been more aggressive?" The refusal form he signed will also not relieve you of ANY liability because of the very nature of the call and the fact that the patient did admit to behavior that was potentially harmful. It would also be helpful if you got the LEOs signatures on the same form. But, even that still would probably be of little use. Due to activation of the EMS system for a suicide threat, his comments confirming the threat even if recanted and the physical evidence noticed around him definitely sets you up for legal consequences. If any harm or ill effects come due to what he did on that day, he has a great chance of legal action against you for not having his best interests in mind. As well, his family can come after you later if he is successful at suicide sometime in the future for not getting him help when you had the chance. You had better hope he lives a very long healthy life. Any threat on one's life should be taken seriously. This is not a grey area at all. The person needs to at least get an eval by a professional who is qualified to determine the extent of the intent since there is enough "reasonable cause" for placing a hold. If the mental health professional determines there is a need to keep the hold, that is their call to make. If they decide the patient is of no threat to their life or to others, that is also their decision and responsibility. In the meantime this is a patient that should be under close observation and possibly restrained in an ED.

This is relative to EMS providers and other healthcare workers. Anybody remember the issues with the hurricanes especially Katrina and getting license recognition for those who came to help? Opposing all of this Bill would not be that wise either. Without some of these policies and procedures in place, Emergency Services could be limited. While there are sections that one might not agree with or feel it impinges upon ones rights, one might have to be involved in a disaster situation to understand why some of these measures are needed. 9/11 could also be used as an example with some of the decontamination lines for the citizens of NYC that were in the immediate area as they passed into other areas. Katrina and other hurricanes also had situations where private property had be entered. This seems to be a very comprehensive Bill that covers many of the issues that have been concerns during the disasters of the past few years including 9/11 and Katrina. It also appears that it has left some room for consultation with the courts (emergency rulings) if needed.

The younger ones seem to be having a difficult time mastering peripheral IVs. Imagine if they had started in EMS several years ago when we had to maintain competency in all of the skills I listed and were even expected to be proficient at Endotracheal Intubation?

Yes, but you must remember the Subclavian was taught in the Paramedic text books for many years and central lines are still in some ground ALS protocols and not just for Flight or Specialty. Subclavian lines were no different than chest tubes, intracardiac epi and pericardiocentesis which were all part of the regular Paramedic curriculum not that long ago. Just 20 years ago we didn't have a helicopter and a trauma center on every corner.

Are subclavian CENTRAL lines still in your protocols? A femoral central line would present a few less risks but is still not a preferred route in the prehospital field setting. The EJ is a peripheral line and it used frequently both in the hospital for rapid access as well as by many EMS agencies. If someone or even all in agency can not get the EJ procedure done correctly, I don't think I would want them digging around for a subclavian or femoral central line.

Your state will have to do better than this to beat Florida or California in the category of "Stupid EMS/FD Headlines". I think Florida has already had a couple of FFs admiring and/or photographing the boobs of patients when they shouldn't have been.

Maybe he thought it was okay since they were "fake" boobs? Demerol and Valium? I didn't see the initial complaint in the articles? Did I miss that part? I also don't understand the logic this mayor is using. Does he not understand there is a difference between fighting fires and patient care? The FDs are going to be their own worst enemy when it comes to EMS by protecting fools like this and for not maintaining competencies for the Paramedics.

I guess you are too young to remember lining up at age 5 for your smallpox and polio vaccinations. How about the MMR before college? If you work with kids, your varicella titer will need to be adequate or you will have to take the vaccine or find another place of employment. If you work in a hospital, you will be tested for TB if you are in patient care areas. I don't always agree with the flu vaccines especially those done in a rush and when there are many different strains. However, I do take the Hep B, MMR and have taken the Varicella as my titer disappeared when I turned 40. As for the quarantine, many public health laws on the books for many years have supported this for diseases such as smallpox and TB. I also don't believe this bill in MA is new but rather a rewrite of one from a few years ago. 9/11 did give many legislators a knee jerk reaction but would have thought terrorists would have hit the WTC and the Pentagon?

I believe this is the actual bill: http://www.mass.gov/legis/bills/senate/186/st02/st02028.htm

The best way to get the most accurate information is to contact the regional center in your area. EMS agencies have a way of seeing loopholes in the laws or falling through the cracks. This is both good and bad. While some may feel testing and various vaccines are unnecessary, it is good to know you employer has a plan established for occupational exposure of diseases that are infectious and what your rights are. This also includes Hep C. http://www.cdc.gov/tb/education/rtmc/default.htm'>http://www.cdc.gov/tb/education/rtmc/default.htm http://www.cdc.gov/tb/ Many different state health care licenses also require those getting a new license or renewing to have an least 1 CEU to update them on TB and/or HIV. That way you know what your rights are and if there were any changes in the laws. I don't always agree with forced vacination but I do see the point when exposure is highly possible but it is still based on "what if?". However, for TB, I know I see at least 1 - 4 patients per shift (at the hospital) who are being treated for active and sometimes Atypical TB. Even though I take precautions, many of these patients are dx'd after they have been in the system for a couple of days. The testing for TB determines if you have been exposed or converted to positive and should be treated. Early detection and treatment is the rationale here for the employee. Of course, the probability is low that TB is spread as easily as one thought although many healthcare workers have now converted to positive. Some have required aggressive treatment and some not. A few have been disabled. It all depends on your work environment, you awaremess of the risk factors and your own health situation.

Yes that could be scary but one must remember that these seniors were young and adventurous when the Beatles were around and "hippies" were just coming about. As well, the senior citizens of today in the U.S. partied with the Grateful Dead, Janis Joplin and were at Woodstock and the Summer Love. I sometimes have to remind myself of this when I enter a hospital or SNF room to hear rock & roll blasting or to hear the patients discussing the intricacies of "drug therapy" and I don't think they mean PCN.

Could it also be the reason why an EJ or central line was done? Usually if you establish a line, it should be for a reason like giving a med and yes there are some meds as well as medical conditions that may require the patient to be kept longer for monitoring. It would be a stretch to say that all patients with lines initiated, peripheral or otherwise, must stay in the hospital. Few EDs are going to tie up a bed for that and few are going to admit a patient to the hospital if that is the only reason. However, if your technique causes them concern to where they feel they must keep the patient, that should be addressed. As well, if you and your department (or Paramedic program) are weak in peripheral IV starts to where the IO is "just easier" that also needs to be addressed. One should be well versed in starting an EJ as there will be times where the IO could be done but probably shouldn't.

Odessa? Isn't this the same department that is constantly begging for money to support their US program and sent some of their Paramedics to Paris for a conference after more begging for money from the citizens by telling them how it would improve their lives? If a department wants more gadgets, they need to work out the details of how to pay for them and continue to maintain them. I have not seen them publish their data in a reputable medical journal besides "JEMS". On the other hand, Germany and France a few studies but there is also distance/trauma center and training differences. The US has it's place if it is truly needed to determine your destination but then that also depends on whether you are ruling in or ruling out. It would be tragic if some thought everything was find and took a bleeder to a little community hospital in the opposite direction. If you see a reason to use the US, you probably already suspect something and may not need the technology to confirm that. Thus, hospital emergency teams can also be activated by a thorough assessment and well give report to doctors at the ED who have come to trust your skills and knowledge. If you are already transporting to a trauma center, they have emergency teams on standby. They may also do the same exam in the ED as few surgeons are going to cut based on a prehospital study. Thus, it is not going to change where the patient goes or what the hospital will do. Even if there was a negative finding with the US I would not likely change my destintation if the patient met trauma criteria or if the patient presented with symptoms such as dropping BP and abdominal rigidity. For this reason we decided not to carry the US after the intial trial. There were other pieces of equipment which are needed that could make a difference in the field.

Tips for longevity in EMS or any health care profession: 1. Befriend a Physical Therapist who specializes in sports medicine and loves to offer free advice. 2. Chat with the Rehab RNs and PTs when you do routine calls to these centers to see who is doing what in the world of ortho surgery. Check out the expertise of some doctors when you do your assessment on the patients you transport. 3. Hang out with the Athletic Trainers when you sit coverage at sporting events. Find out which Sports Medicine and Ortho Doctors are making a name for themselves both good and bad. 4. Start collecting the business cards of Sports Medicine/Ortho doctors you meet at Rehab/PT centers and sporting events. 5. Find a Massage Therapist that offers a discount for "frequent fliers". 6. Choose your health insurance by which one pays for Massage Therapy and has the better Sports Medicine/Ortho doctors on the plan.

Grade 2 for me over 25 years ago...ambulance wreck. I avoided surgery but went through 6 weeks of very painful physical therapy at a sports clinic which was started soon after the injury to minimize freezing. As well my Ortho doctor specialized in sports medicine so he knew I needed my shoulder as bad as an athlete. I dispatched for about 3 months until I was cleared to lift but I did have ligament involvement. In any exercise routine I have to concentrate on the shoulder for strength and to not do something stupid to create an injury to the rotator cuff. If you avoid surgery now, you may need it several years down the road as that shoulder will wear and tear easier unless you do get great advice on strengthening and maintaining the shoulder. My overall strength actually improved. I still have a Physical Therapist help with some serious stretching occasionally.

We are still trialing the Edwards FloTrac as it only provides calculated values off the A-line and not measured. In that respect it doesn't compare to a PA Catheter (formerly known as the Swan-Ganz). There are also some considerations for patients with other existing cardiac impairment. However, the trending data for the calculated CO can be very helpful when other lines are not available and the A-line is easier to place than a central line of some type. When choosing the pressors for either sepsis or cardiac failure, we have to also see the degree of renal failure. The pressor vacation may not always be an option although we might try to rotate for varied receptor response. But then we tend to favor norepinephrine for its alpha and beta-adrenergic actions. CVVH capability should also be available along with the cardiac assist devices. For sepsis we can usually manage with the numbers from an RA line (central venous line) to titrate fluids, pressors and ventilator management from the SvO2. When called to transport a patient from a local little general hospital, after viewing the patient's lab and hemodynamic/renal response to the treatment we may find the patient is headed down a path that will be out of the abilities of the initial destination. Just being a hospital with a cath lab may not be enough. We may request to divert to a facility that has more capabilities. These patients are a challenge to any IFT, either ground or flight, if the first hospital has limited capabilities. There are few things more frustrating than seeing a really sick patient get transported multiple times insearch of the right hospital or because of limited transport alternatives.

We still have obese health care workers that also smoke regardless of how many cardiac arrests, frequent flier COPD patients, diabetics or heavy carries from the 3rd floor that are seen.

Picture of helicopter: http://www.thehawkeye.com/viewImage/Chopper-accident-090209-jpg More of the story but I think you have to be a naive of the area to follow the plot. Helicopter grounded Medforce rotor clipped at accident scene on U.S. 61. http://www.thehawkeye.com/story/Chopper-accident-090209

There are many EMS systems that still do not have 12-Lead EKG capability. But then, there are many parts of the United States that do not have any form of ALS and must rely solely on BLS. I guess Chicago should be thankful for what they do have.

That is my point. When I am on a Specialty team or IFT CCT or Flight, I will often pick up from a hospital that has very little specialty knowledge or resources to stabilize a neonate or serious trauma patient adequately. If asked directly "what could we have done differently", we may give a good brief reply or if it is something very simple like a little "tip" to secure or setup something appropriately we will make a brief "causal" comment. But, we will leave an information package full of instructions and tips to move the process along quicker when it comes to paperworks, labs and packaging. We will also leave the number and business card of our education department who arranges education classes even if it is just NRP, STABLE (including the cardiac module, TNCC and PALS for the employees. Some classes we may also extend to them free of charge. As well, our physicians are also available to the hospital's doctor while we are enroute to the facility. For the most part, the staff is just relieved we are there and will step back to allow us to work and move the patient quickly which for some neonatal transports that could mean 2 - 3 hours of stabilizing before we move. In other words, we are cautious not to offend especially if we know what resources they have and don't have. We also know that a thorough basic foundation may need to be developed before we just rattle off a bunch of treatment theories which could be mistaken for arrogance rather the assistance. Thus, we put the patient first and only educate if time allows or it is appropriate while on scene. We are not there to purposely find fault with that facility and its staff. If it was gross negligence (assumed or blatant), it will be brought out during the patient review and dealt with at a higher level. Florida has also been revising its statutes to where the rec'g facility determines the level of care need to move the patient safely and under whose medical director or what is required of the medical director and team. Thus, neonates, pedi and cardiac patients with VADs/IABPs with serious drips will not be tossed on just any BLS or even ALS truck to run real fast between facilities. Sometimes I believe this concept should be adopted by facilities that receive SNF patients so that the patient can get the appropriate care regardless of age and the nursing home stigma. It is often the EMS companies and the city/county that determine how the SNF/NH calls for transport and it is not always with appropriate patient care in mind. BLS trucks are not always the way to go but unfortunately due to contract situations, risk of penalties and cost containment, the patient care part is often missed. The RNs/LVNs know they do not have the resources available and know the many things that EMTs don't know that can go very wrong with an elderly or compromised patient. They may not have an exact diagnosis for you since they do not have the necessary diagnostics but know the patient just well enough to know they need a higher level of care. They also know they are taking a risk by sending the patient too late or even too early as the RN/LVN will be severely scrutinized by their management. If they dare to call 911 for what may be an emergency, they are scrutinized more so than you will ever know. The crap will run downhill to them as the SNF/NH takes a penalty from Medicare or whatever insurance and the county if the RN/LVN made a transport decision based on patient care appropriateness or erring on the side of caution but didn't have a crystal ball to see the acutal diagnosis. It just comes with the license and chosen place of employment which is why there is a turnover at these facilities. Having the physican make the determination for transport helps but the physician can also snap back when questioned by management why the patient was transported and say the nurse did not tell him/her "something" even if they did. Some EMT(P)s would run and cry if they had to go through the almost daily drillings those who work in SNF/nursing homes go through to answer for their actions. Most nurses that work in these facilities are darned if they do and darned if they don't.

Have you seen him since 1991? Do you know him more than just a causal "hi" at the ED? Are you a FF under his command? Sometimes personal feelings can skew one's judgement to critique someone's professional abilities. I thought the article tried to put him in a favorable light. Much of it did consist of quotes from Norman. Street smart? That is not exactly a compliment towards him. Did he not continue his education as a Paramedic or was he busy advancing his career as a FF? Perhaps if he had not been relying on street smart analysis of the situation and approached it as a well educated/trained medical professional, this article would have read differently. We critique articles on forums for a learning experience as it helps others to think of ways not to make the same mistakes and become a bad headline in the news. It just seems that a few parts of this country give the forums an abundance of articles to comment on and California just happens to be one of those areas. And, I am impressed you found this year old article buried in the past that only a few people found worthy to comment on probably just because it was in California, again. However, hopefully Firefighter Tony Sonday did make a full recovery.

Update: NTSB Identification: ERA09LA464 http://www.ntsb.gov/ntsb/brief.asp?ev_id=20090817X80103&key=1 Details of medical copter crash shows autopilot confusion http://www.naplesnews.com/news/2009/aug/26/details-medical-copter-crash-shows-autopilot-confu/ Expert: Night vision goggles may have prevented MEDSTAR crash http://www.nbc-2.com/global/story.asp?s=11003640

A good RN with 1 or 2 patients in the ICU will know everything about their patient. The RN or LVN who has 20 - 40 patients to care for in one shift with 3 or 4 new patients per shift may not be able to memorize exactly everything in each patient's history. The LVN may know very well what A-Fib is and doesn't need an arrogant EMT-B trying to "educate" them about certain things that they themselves may not have a lot of education for. They have just enough time to get the necessary arrangements made, family notificed, paperwork for the ambulance and a brief report. Then it is back to the other 39 patients. Also what an EMT may believe to be a life threatening situation because it was mentioned in their text book in one sentence doesn't mean that is the condition causing the problem. Controlled A-Fib may not be an issue. Also, if a patient had a "hx" of it, that problem may have been resolved. Without a cardiac monitor you may not know what is the exact rhythm. In the meantime, while you are trying to show off what you learned in an EMT-B class, the patient is still not getting treated. The patient is going to a facility of higher care so that they can get the appropriate diagnostics and treatment. If the LVNs and RNs at the NHs could do or even had the time to do more diagnostics, they might be able to tell you what that patient's 12-lead EKG even showed. At a BLS level, it probably wouldn't make much difference. However, you still should be able to communicate with a ED when you have a drastic change in patient condition. Since dialysis and NH calls are primarily medical, in a perfect world these transport trucks would have a Paramedic each truck who has a decent education in the many medical conditions of the elderly and chronically ill and not just first-aid training. Even many Paramedics are not adequately prepared for some illness and only know about the emergent. Thus, many things may be missed in an assessment. The LVN may have picked up these things but a Paramedic or EMT may not be aware of their importance. Example: "fever" in an elderly patient. Many EMT(P)s dismiss that as a bullshit call when it could turn life threatening very rapidly. The LVN, if he/she had time could probably educate the EMT(P) about a lot of things also if there was time. But, the EMT(P) would probably cop an attitude and be on one of these forums complaining that a "nurse" tried to tell them something about a "fever" or some BS "infection". To the OP, continue to advance your education through college science and medicine courses such as A&P, Pathophysiology and Pharmacology.

Actually they are presenting the toned down version in the newspaper. I have had the displeasure of attending a couple of meetings in that area last Fall and earlier this year because I have an interest in the Golden Gate situation. I can tell you that not all what was said in those meetings was printable. I can also tell you the comments made by members of the FDs towards those who openly supported Dr. Tober was not printable. Also, if you dig up some of the earlier articles and read the public comments, you will find that some of the fools writing at the end of this article even blasted the taxpayer and regular citizen who dared to comment or ask questions. This has truly been a bad presentation of professionalism on the part of a few. Again those who do not understand what responsibility comes when working as a Paramedic or who believe their medical director is their fire chief need to give back that extra pay they receive as a Paramedic. Some may even be defying medical authority in hopes of not running medical calls. The departments need to make it clear that just having a Paramedic patch to get hired is not enough. One must be able to function as one. There are many others holding a Paramedic patch while working at Burger King just waiting to get hired on at one of these FDs for the benefits.