VentMedic

But were prior arrangements made by with the center itself by JEMS to have a guided tour? If not, it is not necessarily the fault of the hospital. We also get many tour requests but can only accomondate X amount and with an escort of course. Some also show up because their conference included us in the "sight-seeing" program. There are also some areas we may not be able to show them once they are on the tour and we get disappointed complaints about that also. I am sorry your friends had a bad experience but with a center as popular as the Shock Trauma center in Baltimore, sometimes patient care must still take the priority.

Why do you take everything to the extreme? Basically the bills introduced are just asking for better equipment and more regulation for the proper dispatching of helicopters. If the state of Maryland can not effectively provide that, then open it up to others who can.

Although, as it was mentioned in the many investigations, the helicopters were called because they "could" and not because they "should". I believe in one of the reports published it mentioned how many patients walked out of the trauma center before the helicopter even got back to base.

A news update was just posted: Maryland May Lose 'Trooper' Medevac Program MARYLAND - 2/27/2009 On March 4, there will be a rally in Annapolis by Emergency Medical Service and Fire Department personnel from all across Maryland to protest the Senate Bill 650, which is being reviewed for approval. The bill, co-sponsored by Senators Picken and Astle, seeks to eliminate the current Maryland Emergency Medical Department helicopter program in favor of third party vendors. Upon review of SB 650, it would appear that the state is looking to do away with the expense of the helicopter medevac overhead including the maintenance and staff by bringing in a third party vendor to do the job. The use of third party vendors gives rise to a number of concerns, especially here in Southern Maryland where a medevac helicopter service is stationed in the area and the rapid response afforded by that close proximity has saved an incalculable number of lives. In any serious and life threatening accident or trauma situation it has long been established that the first 60 minutes, or ‘Golden Hour’ is the most critical difference between saving a threatened life or losing the battle. It has been proven time, and time again that critically injured patients who are treated within the first hour of trauma have an exponentially better chance at survival than patients who receive treatment after that first hour. Given the number of ‘Trooper’ fly-outs that occur in Southern Maryland, having a medical emergency response which has to be called in from miles away is sure to cost lives in the long run. However, there is more at stake than the number of lives placed in jeopardy by any prospective delay in treatment. There is a potential for a severe economic impact to patients and families as well. In the current system, Maryland’s Emergency Medical Department helicopters cost individuals nothing. The costs of private, emergency medevac helicopter services can be exorbitant – the average cost of a personal ride from Southern Maryland to PG Hospital is/was $7,500 - $8,000. These costs were experienced immediately after the Trooper medevac fleet was grounded after the Trooper 2 accident. However, SB 650 does not specifically address any real hard dollar costs. The bill does state that private contractors would be reimbursed by the state, but that is after any other form of reimbursement including insurance payments. While the bill does specifically prohibit billing patients directly; there is no language that prohibits third-party providers from billing insurance carriers for the costs of the transport. The two most prevalent concerns by EMS and Fire Department personnel across the state is first, the delay in coverage and second, the potential costs to Maryland’s citizens. As one EMS volunteer put it, “There is a huge potential for everyone’s health insurance premiums to be raised because of this cost to patients.” “The Troopers are available to us 24/7. [With] these private industries, we don't know how quick we could get one for a trauma transport. The troopers have been here much longer and we don't see where they have ever done us wrong,” said the EMS who wishes to remain anonymous. He continued, “Why fix something that isn't broken. This seems to have come up since the Trooper 2 accident. I realize it takes a long time to do the 100 hour inspections and the cost impacted to fix these vehicles. We need to fight to keep them here.” If the bill passes and becomes enabled, it is scheduled to take effect by Oct. 1. SENATE BILL 650 Introduced and read first time; February 6, 2009 A BILL ENTITLED: AN ACT concerning Medevac Helicopter Improvement Act of 2009 FOR the purpose of requiring the Department of Emergency Services, or the Department of General Services under certain circumstances, to issue a request for proposals under State procurement law to select an entity to operate the State's helicopter fleet for emergency medical services; requiring a certain number of fleets of helicopters to operate in the State; requiring the Maryland State Police and other appropriate law enforcement agencies to operate a certain fleet; requiring a certain fleet of helicopters to consist of a certain number of helicopters; requiring the Maryland State Police to submit a proposal in response to a certain request for proposals; requiring the consideration of a State-operated helicopter fleet for emergency medical services and certain options in the evaluation of requests for proposals; requiring the request for proposals to include certain requirements; requiring certain savings to be distributed to a certain fund; requiring the Secretary of Emergency Services, or the Secretary of General Services under certain circumstances, to adopt certain regulations; requiring the Secretary of Emergency Services or the Secretary of General Services to submit a certain report to the Governor and the General Assembly on or before a certain date and annually thereafter; making a certain section of this Act contingent on the taking effect of another Act; making a certain section of this Act contingent on the failure of certain legislation; defining certain terms; and generally relating to State helicopters.

Were they invited and did they have a personal escort? Chances are you might not even make it past the front door with very tight security in some trauma centers so they should consider themselves lucky they got as far as they did.

It is a hospital that is dedicated to trauma and actually can function independent of the rest of the hospital. It will have its own ORs, diagnostic services, personnel and ICU. Ryder Trauma Center in Miami is another example. Usually a trauma center is just an ED that has specific abilities and services with the patients becoming part of the regular hospital. As far as the HEMS and all medical helicopter situation, there have been numerous articles posted on this forum. Recent bill introduced: http://www.govtrack.us/congress/billtext.xpd?bill=h111-978 Recent statement from ACEP: http://www.acep.org/pressroom.aspx?id=44232 Differing opinions about costs: http://marketplace.publicradio.org/display...ue_helicopters/ NTSB hearings on HEMS (you'll find all 4 days here) http://www.verticalmag.com/control/news/te...?a=9911&z=5 You can also find out more info about each crash at: http://www.ntsb.gov/

Thank you. I can use your posts as more reasons why ALS should be the standard for 911. Again, if the patient knows more than you, presenting an effective and convincing argument will be difficult.

The combustion of sodium azide creates a fine alkali aerosol containing sodium hydroxide and sodium carbonate that is also, at least partly, released into the passenger compartment of the automobile. Sodium azide is a potentially deadly chemical that reacts with cytochrome oxidase to prevent cells from using oxygen. When it is mixed with water, sodium azide changes rapidly to a highly volatile irritant, hydroizoic acid. The above is from this article which has several more references at the end to read.: Lung injury after airbag deployment: Airbag lung http://www.sciencedirect.com/science?_ob=A...4bc07c98acb43b8 Airbag pneumonitis: a report and discussion of a new clinical entity http://caep.ca/template.asp?id=F698B5D1F30...F7C826E63E15F9C Search engines: http://scholar.google.com/ www.medscape.com

If he gets insulted so easily when someone suggests he could have more to learn and experience to gain, then any medical profession will be too much for him to handle. Pointing out things to learn is not insulting unless one is too insecure about their status to realize there might be more to learn. If one can not handle suggestions or criticisms on an anonymous forum, I hate to see what happens when a doctor or nurse says something to him in the ED.

Okay, I give up. My mistake because Education is horrible for EMS. Education is horrible for EMS. Education is horrible for EMS. Repeat. Is there truly something wrong with informing people that there are might more ways to approach something if they come across the same situation? Obiviously there is and education is horrible for EMS. There are more people reading these posts than the one EMT involved here. Some might actually see some value from a different approach that they hadn't thought of regardless of some of the closed minds here who know all there is with their EMT certification. Patients and situations will be different and there will be times so just the way this one scenario was handled does not mean it should be applied to all patients who present similarly. But for the sake of peace: Education is horrible and no one in EMS should be made to learn more.

Soapbox? Why is it that everytime the word "education" is brought up it is a "soapbox". This can be an example of where the patient probably has more medical knowledge than the EMT and knows it. What is so wrong with suggesting that one educates themselves about medicine a little better than the general public they serve? The education of an EMT is less than 200 hours and they can be easily manipulated by patients that know a little bit of pharmacology or buzz words they've picked up from the neighbors. Okay soapbox: education, education, education. Some U.S. EMS providers need to get over their fear and insecurities of education and the people who have made an effort to become educated.

Some are just missing the point...about education. If you only have a minimal knowledge about disease processes, the patient can state they have whatever to get anything out of your bag of medicine without you being the wiser. Patients can find out more about different diseases from the internet or from their neighbors than what you will find in many EMT or even Paramedic classes. If you can show the patient you might actually know a little about some things, they might listen. If you listen to some patients' statements "everyone has asthma" because their neighbors made the diagnosis based on some dear aunt told them about the wheezes. And the EMT has just confirmed this "diagnosis" without having proof of a history. "The nice EMTs have been treating me for Asthma and didn't tell me I had anything wrong with my heart or had cancer". "I trusted their diagnosis." Why are some so against exploring the bigger picture in the world of medicine than what is taught in an EMT book and a 110 hour EMT class?

You'll hear the term "dart" occasionally when PD asks for assistance with a combative patient. They usually mean chemical restraint where versed is sometimes used even though controversial.

Like the McSwain Dart? A dart also means any access to get a patient down or a little less combative. IV access may be difficult and probably not an option initially.

Depending on the size of your helicopter and patient positioning, you do NOT want any risk of a combative patient kicking or hitting your pilot as well as harming other personnel or equipment inside a cramped space.. If you have the opportunity to stabilize an airway before flight, take it. You may also be able to control the conditions for the increasing ICP if you control the airway.

Never used the word incompetent. However, as an EMT you might be under educated for complex situations. A thousand miles away? How many respiratory patients do you think I see in one 12 hour shift if I am working in a hospital? 30 - 40 might be a slow day. Granted, if I was working ground transport, I might only see 3 or 4 and for flight they'll probably be intubated. For goodness sakes! You are talking like there is NOTHING to do with an athma patient except give a neb or FORCE them to come to an ED. As an EMT how much do you know about pulmonary disease? You have used two little buzz words like COPD or asthma. How much time have you actually spent with these patients in you training or experience? How many extra classes or seminars have you taken to develop and understanding about these patients to use some other arguement rather than the usual "go or die"? Did you look at their medication list, the number of doctors they are seeing , nutrition and living conditions? When we enter a home regardless of title since RNs and RRTs also go to the homes and must get these patients to come in to the hospital, we look at the whole picture. That may come with experience for you but you may also have to put a little effort to understand how different things affect the respiratory patient's decision making. There are skills to be learned for dealing with patients of all types from the manipulative to the obnoxious. My advice if you want help: go back to school. Take A&P and Pathophysiology classes. Take CEU classes dealing with lung disease. Advance your education and knowledge. My apologies because I can now see how as an EMT you might have difficulties convincing a respiratory patient what might be the best choice for them since you may not have the knowledge base to use the same arguments those that work regularly with these patients. But when you replace you lack of knowledge with arrogance, it is the patient that suffers. If you perceive my statements that come from experience and education as arrogance, then you truly do not have enough education and experience to your credit.

http://www.pantagraph.com/articles/2009/02...98722215047.txt Short-staffed Heyworth ambulance service seeks waiver HEYWORTH — Short-staffed until tax money starts flowing, the Heyworth Ambulance Service has asked the Illinois Department of Public Health for a one-year waiver to run with fewer than the required emergency medical technicians. The waiver would allow the service to have only one EMT and a driver per run instead of two EMTs, as required by state law. It would tide the currently all-volunteer service over until it can use money from a new tax to pay salaries for the first time. “Having the waiver allows one EMT and a driver to respond, assess and start treatment without further delay in patient care,” said Judy Mowery, captain of the service. She said she expects to learn within two weeks whether the waiver has been granted. Voters in February 2008 approved creating an ambulance service tax through the Randolph Township Fire District. However, ambulance service officials do not expect to receive any tax money until mid- to late 2009. The tax rate, which cannot exceed 0.30 percent of the equalized assessed valuation of all property in the district, is expected to cost the owner of a $150,000 house about $150 per year. It previously was projected to bring in about $150,000 a year for the service. The IDPH granted a waiver that allowed the service to go with one EMT and a driver per run for 2008, and the village of Heyworth contributed $26,000 toward compensating the EMTs who respond on calls. Even with that financial incentive, it is hard to recruit EMTs to staff the service during daytime hours, Mowery said. That is a common problem for rural fire and ambulance services because residents often are out of town at work in nearby communities. “In a small rural community such as ours, the fire department and the ambulance service share volunteers,” she said. “In the event of a structure fire or a motor vehicle accident which requires both agencies to respond with the other, manning a second ambulance with two EMTs will sometimes become a potential problem.” The service uses 13 EMTs, eight drivers, a student EMT and two others. Mowery said the service often responds with two EMTs, meaning the service does not always have to rely on the waiver. However, if the waiver would help maintain the service’s compliance with state regulations, she said. In addition, mutual aid agreements are in place with neighboring communities that can respond to assist ambulance crews, Mowery said. Mowery said the service still needs volunteers. Anyone interested in more information can call (309) 473-2078.

Reedy Creek is Fire. Polk County EMS is doing Fire-Based EMS talks now.

I guess it is a good thing you don't carry other meds as an EMT that patients ask for. Next time try using the patient's air compressor and see if she feels fine afterwards. Some patients just want the O2 fix and not the albuterol.

Do you understand anything about riots? Do you even know what you are arguing about? Let me try to explain it to you simply. It was suggested the EMT(P)s could just carry guns on ambulances without their employer's knowledge since a conceal weapon's permit makes it "legal" according to a few. I thought you said you knew something about working in a city ED. Let me try to explain this to you simply. A patient might come in restrained by PD or EMS. They will NOT go to the triage area near the waiting room but will be placed in an area where they can be observed and continue to be restrained safely. Occasionally a patient will be extremely agitated by whatever happened from the time at the scene and during transport whether it be from an exchange between EMS or PD. Yes, occasionally the ED does get Christmas cards from a patient. But, it is usually not a patient we restrained. Did I explain this clear enough for you? You kept making remarks about me hiring morons and I am informing you that is not the case. I was referring to threads on another forum and not the people I hire. You also insist on insulting a company that I used to work for during a very volatile time in history. If you have no experience with street violence and riots, you can not criticize the job we were doing at that time. You seem hell bent on insulting all medical professionals that don't hold the same values as you even though this thread is about EMS providers. You started the remarks about RNs, RTs and MDs not knowing anything about violence not I but I will defend any and all healthcare professionals that do deal with combative patients regardless of the place. You have a very stereotyped attitude about nurses. Those that do work in the ED must put up with these combative patients for several hours and maybe have several patients like this to oversee at the same time. You can also have the luxury of a LEO escort and can dump the patient off after as little as 15 minutes.

mrmeaner, It seems you just have very limited experience with any other medical situations besides your own ambulance. That also goes for your understanding of hospital EDs and other medical professionals. No we do not restrain a patient to a chair in the triage area for a nurse to screen. Have you never been to a city ED? While it is tragic to have any loss of life on the job, we have had many more EMT(P)s killed this year by MVCs than firearms. Yet, few get upset about the lax driver training in the industry or look the other way when a co-worker has a substance abuse problem that is still allowed to drive. As far as the bullet holes in a truck, I already gave you the info. No my company was not a failure because we all managed to go home alive after the riots. You seem to have led a very sheltered life yet choose to talk big on an anonymous forum about things you may know very little about. Educate yourself to ways of preventing a confrontation with a patient and ensuring scene safety. Don't play the macho gun carrying EMT who must solve the problem all by himself. Let those in law enforcement do their job without a concealed weapon class graduate playing cop. BTW, I do not hire morons. Those I hire know they DO NOT carry any guns on the helicopter or fixed wing. Nor will we do any CCT or airport transfer with a gun toting EMT(P) even if and especially if it is concealed.

How do you know she's not hypoxic? Your pulse oximeter tell you that? Did you get a CO2 or CO level? Normal vital signs for her or just by a textbook? Was the call for difficulty breathing or shortness of breath? If her living conditions are as you described, the first thing I would do is remove her from an irritating environment to an air conditioned ambulance. Once in the back of the truck, you will have the advantage and she might even enjoy the AC. Giving a nebulizer in a hot and smoky house is of no benefit. The only thing accomplished is maybe raising her PaO2 momentarily with the O2 running the neb giving her a "good feeling". You are also letting her known history dictate the treatment. Just because she has a hx of asthma does not mean it is the asthma causing her breathing problems. If she has a long smoking hx or any pulmonary hx, she may have a much more serious condition forming that should be diagnosed at a hospital. It is too bad that some EMS companies do not link themselves with social welfare agencies to get repeat patients assistance instead of just bitching about them.

I already stated that there are many medical professionals that do go where EMS goes but do not want to be seen as a threat or the aggressor by carrying a gun into someone's house on a medical call. Usually they are alone when they go on these calls. I also told you about doctors and other medical professionals working in other countries but want the people they will serve to know they come to them as medical professionals and not as aggressors carrying guns as the militia in their country. They too know the risks but understand avoidance of a scene that makes them uncomfortable until help arrives might be the best defense rather than shooting their way in or out of a scene. EMS is not all that different except that some prefer not identify themselves as healthcare providers or medical professionals. I don't get what you are talking about with the hiking thing. I meant it is possible to survive working all situations on a 911 ambulance and still live to talk about it. You do have the option to call for PD. Many dispatchers will automatically call PD for some parts of the city to escort the ambulance. All a gun is going to do is not only make someone look like the aggressor with both the patient and the community but also give some a false sense of security by thinking "we're armed and ready". Thus, some may put themselves into situations they shouldn't be in without PD. I can also see those that only have the training of a concealed weapons permit, as some suggest is adequate, having their weapon used against them or spending the rest of their life in prison. You might also check the statistics on the number of medical professionals that are assaulted within the walls of the hospital. Unfortunately, some of the assaults in the ED come from patients who have been thoroughly agitated by EMS prior to arrival. We had a thread on another forum about being mistaken for a LEO. Many posted that they have been and didn't correct the other person. They actually enjoyed being mistaken for a LEO and the authority it seemed to bring them. Imagine how some would probably act by having a gun but for the reason of completing the "uniform" and not for self defense. Wearing a gun can definitely change one's own perception of themselves. If you want to be viewed as a cop, you will have to take the same risks from the community as a cop and be expected to answer for you actions as a cop. There are alot more LEOs killed than EMT(P)s because some criminals feel threatened by them and make them a target. Now PD will have to worry about the EMT(P)s doing something stupid like showing their weapon at a scene and putting everyone at risk including them. Those that have worked inner cities without always having PD around either know when and how to approach a scene or presented themselves as medical professionals.

It's called homecare. Nurses and RTs do spend a great deal of time going into neighhoods where EMT(P)s only go with PD escort. I don't like to do homecare for that reason. I am much safer working as a Paramedic where I can call for backup and get it without any questions asked. Yet, I have not felt the need to carry a gun into a house through whatever mess to see a baby with a trach regardless of how heavily armed the uncles and their friends were. I posed no threat to them and went in as a healthcare provider or MEDICAL PROFESSIONAL. I was not in my FD uniform nor did I look like a cop by carrying a gun. Even during the riots, I was not armed with a gun. I let the LEOs and National Guard do their thing while I focused on caring for the injured. If you have ever worked in an area where you counted bullet holes in your truck as part of your morning inspection, you can compare EMS battle stories with me. Edit: However, what weapons I have in my own home and when off duty is my own business and I am not respresenting the company I work for or the profession.

Okay Dust, you put EMS back 25 years to being Public Safety Officers again and not medical professionals. EMS can't find a decent path to define itself in the medical field, it might as well just stay with a bunch of certs including "firearms".