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Californai Firefighter's Heart Attack Almost Got Him http://www.emsresponder.com/article/articl...p;siteSection=1 May 24--GRIDLEY -- Firefighter Tony Sonday said he remembers almost nothing about the massive heart attack that nearly took his life May 9. If not for artery graft scars on his legs, burns from defibrillator paddles, and the stories of heroism and near tragedy flying around his fire station in Gridley, he might not believe it happened at all. Three weeks after the attack, the Cal Fire-Butte County engineer is just starting to recall details, aided by relieved fellow crew members who are now anxious to fill in the blanks. One of them is his boss, Capt. Sean Norman, a veteran emergency medical technician and the man most responsible for saving his life. Sonday said the attack came on a Saturday morning as his crew was finishing up the second phase of a structure fire drill. He was about to start picking up hoses when he suddenly felt sick to his stomach and a little dizzy. Norman was right there and at first thought Sonday was suffering from heat exhaustion. When he threw up some water, Norman asked if he was having chest pains. Sonday said he was, but never recalled having that "elephant sitting on my chest" kind of pain other victims have described. Norman called for an ambulance. Within a few minutes, the stricken firefighter was being monitored for blood pressure. Norman, working with Enloe Medical Center paramedic Mark Walker, noticed signs of an irregular heartbeat, but figured that could be from heat. Norman left Walker with the patient and began working on staffing changes for the day, realizing Sonday would be at least temporarily out of commission. When he went back to check on Sonday, Norman said a 12-lead heart monitor Walker had hooked up showed some serious abnormalities. He said the firefighter began to get anxious. Sonday was responding to questions about what he was feeling, but doesn't remember any of it. As he deteriorated, complaining about numbness and stabbing pains in his legs, Norman and Walker decided a fast trip to Enloe was in order. Norman said he still wasn't convinced it was a heart attack, but hadn't completely ruled it out. Norman said Sonday at first asked him not to call his wife. Further down the road, near Biggs, Norman recalled Sonday saying, "I think you better call my wife." Norman said he eventually reached her and said he felt comfortable reassuring her it was a "minor situation." Within seconds, Norman said Sonday went into full cardiac arrest -- the first of four during the 17-minute race against time to the Chico hospital. Sonday said nearly all he remembers about the trip is the pain he felt while being defibrillated the first time. Norman said he screamed out and sat up. Sonday remembers a tremendous ringing in his ears. A powerful drug was administered to block pain from the defib procedure, which Norman and Walker had to do at least 14 more times before reaching Enloe. Norman said Sonday kept waking up in the ambulance, bouncing back and forth between full arrest and complete alertness. "Under those conditions it was really hard to manage the medications," Norman said. "I'm really glad there were two of us in the back." Enloe paramedic Buck Wilken drove the ambulance, and said later his foot was sore from trying to push the accelerator through the floorboard. Norman said he's dealt with an untold number of patients going into full cardiac arrest, but said it still feels "surreal" working on one of his own crew members. "When it happens to a member of your group, it just rocks you." Cher Sonday gathered up the couple's two children, 13 and 16, and beat the ambulance to Enloe. When it pulled in, Cher said her children could see Norman and Walker feverishly doing chest compressions and screaming at Sonday to get a response. One of her children asked, "Why are they yelling at dad, and how come he isn't answering?" Sonday was defibrillated 10 more times in the emergency room, and "coded" once for 11 minutes, Norman said. "Cardiologists gave him a very slim chance of surviving the night," Norman said. "We were told 20 to 30 percent," Cher Sonday recalled. When he returned to the fire house, Norman said he was unsure what to tell his crew. He answered what questions he could, then said he didn't want to talk about it anymore. Within a few days, Sonday was stabilized enough to receive triple bypass heart surgery. Following the procedure, Sonday recalls a nurse coming into his room. "You're proof. You're proof that miracles happen," she told him. "When I came to work today I was an agnostic; not now." His prognosis is good. Sonday said he could be back on light duty in three months, and eventually full duty. "I've been told I have a 100 percent chance of coming back," he said. Surrounded by his crew members at Gridley fire station 74 on Thursday, Sonday said he was getting most of the details about his heart attack for the first time. Thursday was also the first chance Sonday had to thank Norman and Walker for all they did to save his life, and to thank his crew and other Cal Fire members who looked after his family. "They did everything for us," he said. Sonday said he's feeling a little better every day, though he still suffers from extreme fatigue. "More than anything, this ordeal has really thrown off my sleeping pattern," he said. "But I think I'll be able to sleep tonight." Sonday has shed 30 pounds since the attack, but said he doesn't recommend it as a weight-loss procedure. Cher Sonday said she has no misgivings about Tony going back to work. "It's the job he loves; it's his passion," she said. Sonday never got a hint that his heart might fail. Being adopted, he has no idea what his family medical history might be. "All I know is I'm going to take better care of myself, and appreciate every day like I never have before," he said. "I wake up every day smiling, and I don't think you'll catch me ever complaining about anything again." Sonday is 42, going on 43.

Here are the guidelines and protocols specific to Florida. http://www.doh.state.fl.us/demo/Trauma/protocols.htm

It looks like it will be the usual night time soap. The producer,Jerry Bruckheimer, is the same as for Miami CSI. He also has another show about Miami on HBO, Cocaine Cowboys, which may have more realism since it is done in documentary format. That is the one I'll probaby be watching to reminisce my early years in EMS. Show Synopsis MIAMI TRAUMA is about a team of expert surgeons who work at one of the premiere trauma facilities in the country, where only patients with life threatening injuries are treated. Dr. Matthew Proctor (Jeremy Northam) is new to the trauma team, after a tour of duty in a MASH unit during the Gulf war. Dr. Eva Zambrano (Lana Parrilla) is a workaholic surgeon who is more comfortable in her scrubs than she is out in the real world. Dr. Christopher Deleo, "Dr. C.," is a playboy who thrives on the high-stakes of trauma medicine and is, by his own description, a genius redneck. Dr. Serena Warren (Elisabeth Harnois) is fresh out of medical school, and head nurse Tuck Brody (Omar Gooding) keeps the doctors on track and the patients' families updated in this chaotic corner of the medical profession. Together, this team of doctors excels in the "golden hour," the 60 minutes after being critically injured, when a patient's life hangs in the balance.

I watched a few clips and hopefully the whole show won't be as bad those few scenes. The helicopter crashes may also be a little detrimental to the battle SF General Hosptial (trauma center) has been in to get a helipad. At this time there in no hospital in SF that has helicopter access. The one scene definitely deplays the fear some community leaders and residents have discussed at great length. Some have tried at previous meetings to assure residents that crashes are rare and seldom that devastating but when it is now played out in HD, I'm sure their next meeting after the airing of this show will be interesting. The other side note is that the movie will now be allowed to be filmed in SF as a dispute was going to relocate "San Francisco" to Canada.

Put the protocols side by side and talk about the differences. Try to figure out by what you know about the MD and the area (transport times, available hospitals, where the MD trained or worked) to figure out how those protocols were derived. There may be some logic behind them that will help you to remember better. As you know from the headlines, some protocols are written to fit the abilities of the Paramedics. Some reflect the aggressiveness of the EMS system. (sidenote: this is why I wanted Diazepam618 to post his protocols. Sometimes I read protocols from other areas as it tells me alot about the system and sometimes it is just for entertainment. I sometimes have to stop, as spenac mentioned in his post, to remind myself that I am on the West coast. Again, when I am back on the East coast I have to get back into being in a more aggressive healthcare environment. I can also look at some orders written by doctors and tell almost exactly when and where that doctor trained. There is also nothing wrong with referring to the protocols or notes you have made.

Believe it or not but many others can sleep through CE classes just as well as you can. They are not a measurement of what you know. Do you understand the difference between CEs and a credentialing exam? Do you even understand the purpose of uniform testing? Florida does not use the NR either but has its own standardized test. It serves a purpose to allow someone to demonstrate they have at least some basic competency. They don't just rely on whatever the flavor of the day is handing out certs for the county who could be your cousin or mother. I'm sure in the future Florida will also use the NR since the EMT-B has gone that way. The state has just been holding out until it isn't so pitifully easy. Unfortunately it appears some in California still think the NR is too difficult. I seriously hope you are not bragging about California's scope of practice. Please post your protocols so the rest of the forum members can share in the joke.

Yes and we all know what an outstanding example of EMS California is. Read the newswire for your state lately? Do you not see a problem with allowing all the individual counties and departments make up their own rules? Just because your deparment has lower standards doesn't mean everyone else must. Why should testing standards be lowered because your department leaders don't believe their EMT(P)s can meet them? That is the real issue here isn't it? If they were to retest of your department EMT(P)s it would probably have a much larger scandal than Washington D.C. How long have you been an EMT(P ?) and/or a FF? It just amazes me when some are supposedly in this professon and yet know so little about it. The volunteers take the same tests as everyone else in their state. So try again to justify your point about the NR.

It has also been due to the OT abuse that some areas are mandating no more than 80 hours per week. In SF, one FF pulled 19 straight shifts. It concerned the public that this guy was either paid to sleep or too tired to safely perform and thus putting the public in danger. In just 2 months during 2008 two FFs racked up over 900 hours of OT in just 6 months. However, the Sheriff's Deputies still came out ahead in salary earned for the year as did the RNs. It is unfortunate that CA remains so fragmented in their oversight for that state and allow the bubbas in the county to run the show. I just saw another headline for CA where a baby killer was allowed to get his cert in your state. Real nice system you got there. Why do you believe the Paramedic should be different than other professions when it comes to test taking? Do you believe they should have the testing standards lowered because of the poor education/training some receive or that the quality of people the profession attracts is so low that one could not expect them to pass a test without help?

Others have medical directors that have trust in their Paramedics' abilities. You must do some serious OT or math isn't your strong point. You do realize that 100k is the equivalent to 50K with the cost of living adjustment? It is actually a lot less than what others make in your area.

If the patient deteriorated at the local hospital, he would definitely be SOL with no place to go for definitive treatment. If this is an ALS crew and he deteriorated in their truck, hopefully they would be able to establish at least an airway enroute to the trauma center and he would be on his way to a higher level of care. There is nothing more frustrating than to work at a little local hospital having a patient that you know needs a higher level of care but can do nothing but try to maintain until the patient dies if he can not get transferred out. Often a helicopter may not be able to fly due to weather and the distance can be over 2 hours by ground...just to get the CCT to the hospital and another 2 hours back. That is of course, once all the other testing, calling and paperwork is in order. I've flown many patients out of little local hospitals that I know didn't have a chance due to the time that had passed. Sometimes they have been stuck in the ED for up to 12 hours and other times they have been in the ICU with limited services for days. It is sometimes all we can do to keep them alive for the hour flight.

A 17 y/o is invincible. This is also one of the reasons I am not an advocate of someone driving an ambulance until the age of 21. Not all lawsuits are about the money but that seems to be the way some must go about it before attention is drawn to a situation or the way policy has been set. This may make this EMS system and others examine their own protocols and see if there is room for improvement. Something can be learned from each of these cases. It could be just a reminder to check your documentation. The death of the New York Times reporter David E. Rosenbaum is a good example of a family whose lawsuit was initially about money but declined to take the settlement if the Washington D.C. Fire and EMS reviewed their training practices. Of course we have seen what happened to that and the Rosenbaum probably should have just taken the money. In Florida, it took the death of an off duty Paramedic over 25 years ago for some counties to realize a trauma center might not be a bad idea. He too was initially alert and oriented but bled out from internal injuries while waiting for a surgeon to come in for a consult. By the time the surgeon arrived and the decision to operate was made, the OR team had to be called in. It was too late by the time everyone was in place. In rural regions like this and without knowing the ability of the EMS service or their protocols, I can see where it is a tough call. However, when this happens in areas where some still take to the closest facility when a more appropriate facility is just a few more blocks, I do take issue with that especially for stroke, cardiac, burns and trauma that fits the criteria.

Have you seen them do this in front of you? Why aren't you attaching these to the hard copy of your report as part of the patient record? Do you do your own 12-lead EKG interpretation or do you take the machine's word? It is sometimes very difficult to get a good EKG in the back of a truck with artifact and other factors that can interfere with tracing. This has been a problem with some EMS agencies that rely on the machine and are calling in a lot of false STEMI alerts. Now, back to the topic. http://scholar.google.com/ Since this has been a major topic on news and talk shows, it might be good to know what they are telling the public. Five ways to get ambulance workers to take you seriously http://www.cnn.com/2009/HEALTH/01/21/ep.91...cnnSTCText?iref Panic Attack or Heart Attack? http://www.womensheart.org/content/HeartDisease/panic_attack_or_heart_attack.asp

It didn't state his other injuries or give vital signs. MOI (ejection or bent steering wheel) and usually one other criteria can get a trauma center in FL. MOI and the paramedic's judgement by assessment of the patient and scene can get the patient to a trauma center directly from scene also. Florida's Trauma Alert criteria: http://www.doh.state.fl.us/demo/Trauma/PDF...riaMeth1202.pdf Criteria for an IFT of a trauma patient. Again, the burden of proof is on the sending facility and all criteria must be met to the trauma center's satisfaction. http://www.doh.state.fl.us/demo/Trauma/PDF...cGuidelines.pdf The guidelines for EMTALA must also be met which includes the appropriate transport personnel must be provided.

For the RRT, the clinical simulations are now computer based and consist of 10 patient scenarios. If you screw up, it is doubtful you will see the same scenarios again. You just study as much as you can for all age groups from neonatal to geriatric. The fees for testing are also considerably higher than the NR. Initial test is $390. Each redo for just the simulation part is $200 and $150 for the written. RT's credentialing agency, the National Board of Respiratory Care, also has a Continuing Competency Program. This is in addition to the state requirements to ensure standardized national requirements for continuing education and recredentialing. The requirement also exists for each specialty credential obtained through the NBRC such as Neo/Pedi Specialist, Pulmonary Function Testing and Sleep Disorders.

Let me tell you a little about interfacility transfer Hell. Once a patient is taken to a hospital that does not offer alot of services that hospital will now have a greater burden of proof that a higher level of care is need than what would be expected of a Paramedic on scene to have. There will be various procedures and acceptance protocols that must be completed before the call is even made to a trauma center. That could take up to 2 - 4 hours. A flight team or qualified CCT might be put on alert that they have a call pending but usually can not leave the ground until acceptance is made. Also if a confirmed call comes in before that hospital is confirmed, we fly on the confirmed and they will have to find an alternative service...or wait until we are clear from the other transport. Our IFT flight transports can be lengthy due to the preparations to make the patient flight ready. We don't like to do a code in a helicopter. Once confirmed they may then have a 30 minute to an hour and 30 minute travel time to just reach the patient. By that time it may be decided that the patient is now deteriorating to where intubation and other meds will be needed before transport. That can take more time. Finally, they go enroute for the 30 minute to 1 hour and 30 minute transport. If the transfer from an ED can not be made in a timely manner, say 24 hours, the patient may have to be admitted to the ICU at the local hospital. That is where the transfer now gets very difficult. There have been trauma patients trapped in small hospital ICUs for days that didn't quite meet the requirements for an ED to ED transfer to a trauma center and had difficulty getting a physician at another hospital to accept them for whatever reasons from insurance to just not wanting to take what will probably be a train wreck patient who will die from the time lost for serious intervention. If the patient is too unstable at the local hospital, the transfer will be aborted and the transport team leaves. That patient will remain at the local hospital usually to die. If the local hospital has something that resembles a Pedi ICU, this can also happen to children. However, children's hospitals are often more accepting then others and will have their own transport teams under the direction of a pedi intensivist. That can make a big difference in their abilities. Another issue faced in some regions is the licensing of the helicopters. Some that can do scene response for HEMS at the local level may not be able to do interfacility transport. Once the patient touches the hospital, another service must then be called. That then starts the whole process I described at the beginning of my post. The abilities of the CCTs can vary. Some CCTs are just the local ALS. So, a lot of it will be dependent on how their local services are certified and the agreements made with the trauma center or other hospitals. Every region is different which is why I am extremely careful in some parts of my state and others not to have my first MI or be a trauma in some counties or cities. BTW, on some islands it can take less time to get transfer acceptance and be in the U.S. at a trauma center than it does within this country.

In the meantime, what are you doing about the situation at hand? You are now too far out for prophylactic treatment if that was the route you would choose. However, you could still get a baseline HIV and Hepatitis at the county health department at minimal charge. Then, you may also need to get a followup in a few months as the CDC and OSHA guidelines recommend. This may give you some piece of mind and provide you with additional documentation for the future. While HIV testing is not always required, I still recommend some to get tested depending on exposure level in both professional and personal environments. We are getting too many newly diagnosed cases from those that missed all the good education provided in the 80s and 90s because they had not been born yet.

The comments at the end of the news article are hysterical. It is also embarrassing that this feud continues to be aired in the community paper with the "us against them" crap. Whatever happened to "patient care" and providing quality medical services? It seems some are just out for their own agenda and could care less about the people of Collier County. This whole county has been an embarrassment to FFs and those who are good Paramedics. Collier EMS leader accuses firefighters of cheating on medication tests By LIZ FREEMAN (Contact) Originally published 8:24 p.m., Friday, May 15, 2009 Updated 8:24 p.m., Friday, May 15, 2009 http://www.naplesnews.com/news/2009/may/15...ers-cheating-m/ NAPLES — State Emergency Medical Services officials have been contacted concerning Collier County firefighters and paramedics possibly cheating on tests about the medications carried on advanced life support trucks, the county’s EMS medical chief says. “I notified them as to the exploitation of the testing process so now they are opening an official investigation,” said Dr. Robert Tober, who is in charge of the medications and protocols on the ALS fire trucks. Tober said he sent an e-mail Friday to the state EMS office and got a call an hour later from the head of the state EMS Bureau, Chief John Bixler, saying a probe would be opened. State EMS officials couldn’t be reached Friday to confirm that a query is being launched. Tober said he also sent e-mails to the County Manager’s Office and Collier commissioners raising his concern about the integrity of the test results. Leo Ochs, deputy county manager, said Friday that he has received such an e-mail. The testing concerning the medications and usage protocols started about three weeks ago and about 70 firefighters/paramedics have taken the tests at different times because of work schedules. Tober said he noticed that the results were improving over time. He believes people were coming out of the tests and writing down every question they could remember to pass on to others taking the test later and he said cheat-sheets were used. “It was obvious to me the questions had been passed around and a training officer was collecting the questions,” he said. “We didn’t expect anywhere near this degree of nonsense. It was a travesty.” Tober said he used eight different test versions but originally developed four versions. He hasn’t finished grading all the tests. The medications on the ALS trucks are for stabilizing the heart, to treat people with seizures, for asthma attacks, high blood potassium, low blood sugar and other medical calls. Tober, as medical director of EMS, developed the advanced life support protocols. County officials and the fire departments have been at odds in recent years over possible consolidation and the experience level of cross-trained firefighters to offer advanced life support treatment. Firefighters/paramedics with the cities of Naples and Marco Island were the first to take the tests and nothing stood out with their results. “My recollection is Marco and (Naples) had fairly standard scores and failure rates,” he said. “I suspect their tests were pretty forthright and honest.” When firefighters/paramedics with East Naples and North Naples fire departments took the tests, that’s when the results were noticeably different, he said. “As the tests went on with later groups, the passing rate instead of 66 percent it went up to 80 or 90 percent,” he said. “It was an abrupt change in week two. I suspected a lot of the people had already gotten a lot of the questions.” Officials with both the North Naples and East Naples fire departments said Friday that Tober hadn’t brought his concerns to them. “That was the first we’ve heard about it,” North Naples Acting Chief Orly Stolts said. “Dr. Tober certainly didn’t give us a call ahead about anything.” Stolts said he wasn’t surprised by Tober’s allegation and said his crew members were leery about the test in the first place, after his training officer and those from the other fire departments weren’t allowed to have input on how the tests would be developed. “He gave us the protocol and we spent six weeks preparing for the test. We dissected it,” Stolts said, adding that his firefighters/paramedics studied hard. “We were not just going to pass it, we were going to pass it real well,” he said. “Our guys were well-prepared. “Dr. Tober has been against the ALS program and he has been looking at a way to get rid if it,” he added. “I don’t know. I don’t know what all the allegations are. I don’t know what he is claiming.” Stolts said he welcomes a state probe. “If we had anybody who did something wrong, we don’t tolerate that. I think the state needs to be examining him,” Stolts said. East Naples Fire Chief Doug Dyer said Tober hadn’t come to him with his concerns about the tests. “It is not true. We did not cheat. We studied our butts off,” Dyer said. “We borrowed the training room at Physicians Regional (hospital) for three days to study with each of the three shifts and there was some shorter sessions.” Dyer also said some of EMS personnel were intimidating and harassing some of his firefighters while they were taking the tests and he suppressed it. He said his crew studied hard for the test because they knew something would be used against them, that they would be accused of cheating if they did well or not caring if they did poorly, he said. “(Our training officer) just grilled us and grilled us and I doubt very seriously North Naples cheated as well,” he said.

Did your A&Ps include a lab or was it part of the Paramedic program? Some college programs here have the overview A&P dumbed down for the Paramedic course which is ridiculous because it transfers nowhere. Broward Community College has a good RN program. It is also an easy transition to the BSN programs. You are right about not taking too many short cuts when it comes to nursing theory. It may make the other classes a little more difficult. It is easier for LVNs since they already have some the care planning and theory background. The women's prison? BCI?

There are a couple of private ambulance services that utilize Paramedics for IFT and sometimes CCT. For 911, yes you will need to be a FF in South Florida. Except, I believe AMR in Key West which is 3.5 hours away still do 911 with 48 hour shifts. Collier County EMS is 1.5 -2 hours away on the west coast. The EDs may be your best bet especially with your CNA and Paramedic certs. However, don't get too discouraged if you can not find the job of your dream right now. We are just going into the off season and jobs are scarce when the snowbirds leave. In the Fall, our population will triple and the jobs will be back. If you did take a CNA or tele/monitor tech job in the hospital that also uses ED techs, you would have a great opportunity to get first chance at the next opening. You might even try the cath labs if you like cardiac well enough. You could also get yourself known by taking classes in the education department and meeting the staff to let them know you are around. Managers will usually ask staff if they know you. BTW, Florida also uses PCTs and you might be able to quallify for that cert. At least you will be doing more skills and have the opportunity to work in several different areas. It is also interesting that their education/training in hours is sometimes longer then the Paramedics especially when taught at the same "career school" And, learn some Spanish. Good luck! One more thing: Wait until your cat sees the Palmetto bugs.

Since the article states "restarting" chemo, that indicates the parents and the child had allowed conventional medicine into their lives. Now the question comes into how well conventional medicine supported them or not which made them turn totally to the religious alternatives? Children should definitely be part of the decision making process regardless of age and learning abilities. If this child is under the care of a children's hospital, they should have the resources to explain things in terms a child and even the parents will understand. This should not be approached in a way where the child may perceive his treatment as punishment by not being kept informed. Did the child and family know what to expect with the first chemo treatment? To see a child, especially your own, get totally ill after a treatment can be very frightening. Did they have adequate staff support to get them through this? Too often orders are written and carried out without an adequate care plan although I would expect better from a children's hospital but not all are the same nor are the attendings. Sometimes egos and the hospital or doctor's own personal views about alternative medicine can even push patients to seek other options. We now openly discuss alternative medicine and do allow some different treatments into our hospital. Massage, accupuncture, Reiki and nutrition are just a few of the things we support. It is explained as a team effort for the patient with everyone keeping an open mind. I myself have seen patients who defied all odds or the medical statistics and got well enough to live a long life when conventional medicine gave up. Sometimes even in the adult world something like this plays out: "Yes Mr. Smith, the biopsy we did is positive for cancer. I've written the orders for you to get some additional tests and we'll start your chemo. We won't know how effective it'll be but just take the treatments and we'll followup later. Any questions you can call my receptionist for an appointment although I won't be available for a couple of weeks but maybe one of my colleagues may be able to help." I also believe any woman on this forum who has had a breast cancer scare or actually been through it will identify with how conventional medicine sometimes forgets the person and just treats the disease. When the patient and family's questions are not answered, it is very easy for them to find someone who will listen and yes, even take advantage of them for a profit. To remove the family from the picture and tie the child down is not the best option and regardless as to what the statistics say, if the child feels punished, the best medicine in the world will not help his healing process. This is not just a one time deal like an acute illness or injury which can be easily treated with sedation and a couple of days on a ventilator. The support must be there for days, weeks, months and years to come. The child must also believe in the treatment being given. Since this family did allow conventional treatment initially and did seek help from conventional doctors to get to this point, I believe some where something could have been done differently to prevent them from losing faith in conventional medicine. Communication is often the key and if the child was treated as if he didn't understand what was happening to him and by doing so, he was also not keep in the information loop, I can see where a lot of fear and confusion can arise. I also don't always agree with the legal system or the legislators on every issue since many have their on religious and personal beliefs. It's not like we haven't seen this happen many times before with George and Jeb Bush being a couple of examples of where their beliefs have been pushed onto the public. Stem Cell research is something that could benefit a disease like lymphoma. And Jeb's opinion on quality of life and the rights of the patients and families was a little on the fanatical side. Of course it is very easy to criticize others when it is not your own child or family member and you are not the one living with the consequences. We can all say "if it was my child I would..." but until you have experienced something of this magnitude, it is hard to know if you will always be rational. You too may be scanning the internet looking for a miracle cure. I've also had co-workers talk about not wanting heroic measures done to save a loved one but yet a few have gone as far as reversing the DNR on their elderly parents at the last minute and have them placed on a ventilator. I can also give many examples where conventional medicine does not always agree on the best treatment. Sometimes the best will be the most expensive and there are hospitals/doctors who will not acknowledge that treatment due to the cost factor. So, there can be many factors that may be specific to one area and their options to form an opinion when presented to a judge.

Interesting article although her injuries were obtained from those committing a crime. I believe the family of the young EMT who was killed recently by a gunshot while on duty is also suing everyone they can on the behalf of his estate. However, I still don't believe those that call EMS for help with no intent to harm the EMT(P)s should have to worry about being sued.

Infants are slightly different and those that do get defibrillation or cardioversion will have a known CHD problem or will be in the care of a physician in the ED or ICU. More often than not, the rhythm will be too fast (for reasons other than cardiac), too slow or non existent (unshockable). Specialized pedi and neo transport teams do have guidelines and protocols for those special situations. Here is an interesting article that may be a little off topic but one shouldn't be too surprised if they hear of an infant or child with an implantable defibrillator or pacemaker. I'll post the abstract incase some can not find the full article: Pacemaker and Defibrillator Therapy in Pediatrics and Congenital Heart Disease 10/01/2008 Terrence Chun Future Cardiology Abstract Pacemakers and defibrillators have a growing use in pediatrics and in patients with congenital heart disease, but they present unique problems and implications for their implantation and follow-up. Congenital and surgically acquired rhythm disturbances are common, but the efficacy of device therapy is not well established in these patient groups. The diversity and complexity of pediatric patients and congenital heart disease make device management a highly individualized art. There are technical issues related to device implantation that have necessitated novel approaches to using leads and device that were not designed with children specifically in mind. The current guidelines and indications for implantable device therapy for children and congenital heart disease are reviewed, as well as some of the specific limitations and problems encountered.

That was my initial thought also. Does this service not offer any type of OSHA blood pathogen training or is this not required by your state for certification or recertification? What about all the other infection control aspects of the job and disease exposure accountability? Exactly what is the purpose of the Infection Control Officer if he does not know the P&P to initiate advisement, testing and treatment options as required within your state or local laws? The clock is ticking on your options if you so choose to follow through.

The EMS crew can NOT deny transport. Only a physician can deny transport according to this opinion in this state. Thus, any EMS protocols will be written as such.

Not totally true. There have been several interpretations of EMTALA which have be applied to various state laws. This not only includes transport but also who has the ability to a screening exam. The ownership of the ambulance must also be taken into consideration and whether the patient is on hospital property. Thus, a blanket statment can not accurately be made for all situations. Here is an example of one opinion that allows it under direct medical control. http://www.ag.state.nd.us/opinions/2001/Formal/01-f-06.pdf House Bill 1282 therefore permits an ambulance service to refuse to transport an individual to a hospital only after it has been determined by a physician who is providing direct medical control that the transportation of the individual to a hospital is not medically necessary. This implies that the individual desiring transport must be examined by the ambulance crew and a physician must be consulted before the individual is refused transport.