VentMedic

Did you happen to notice if transfer orders had already been written or some protocol to be initiated? Occasionally but not that often, CCU, PCU or tele orders will be written but unfortunately the patient may not get transferred to the floor or unit for a long time and the orders don't get started. The ED orders will continue. There may have been more aggressive orders waiting in the wings. That is what I meant earlier by becoming familiar with what the other units and floors do especiallly when certain protocols may have been initiated in those areas. Serial labs and diagnostics as well as additional meds may be started. A cardiologist will probably be consulted and additional tests or meds will be ordered. What may appear as a slow process to you may be for the reasons of caution with the patient's overall condition. And, what choices did the patient make if and when he himself was presented with the risks and benefits? The physician may have said something like we can offer you this treatment (could be cath lab) but this, this and that have a great possibility of happening. Or, we can treat you more conservatively with this treatment and monitor. All the information will be laid out and the patient can make an informed decision with the physician about the risks and benefits of each procedure. When patients present with numerous risk factors, it is usually very clearly presented to them as to what can happen with each option. crotchity Everything has to be about race or sex with you. While there are inequalities that do exist in any system since employees like you will be around, some healthcare professionals actually manage to function quite well above the discriminatory factors to provide quality health care.

No I didn't miss the point. Read my posts about bariatric patients and hospitals trying to accomondate the patients. Hospital professionals are not going to risk over extending their equipment either and will get the appropriate equipment if necessary. Elective surgeries are a little different than emergent procedures. Risks vs benefits must be considered for any invasive procedure.

It was a misunderstanding that has been taken care of without your help. This patient is having an MI. He doesn't need gastric bypass or PT at this time. Many hospitals are now capable of handling bariatric patients as I previously mentioned and do have some equipment inhouse. Whatever else is needed can be rented. Accomondations can be made if at all possible since this is becoming a growing population within the hospitals. His risk factors must be taken into consideration and the patient may also have made an informed decision based on the risks vs benefits presented to him. You are very quick to judge this person yet you know nothing about him. There are medical conditions as well as psychological reasons with both the patient and the enabler that may also need to be considered. Have you studied bariatric medicine enough to know the causes of morbid obesity besides just what you believe as their own fault by over eating? Do you even know at what age he started to gain weight? I don't believe that was mentioned so you are guessing and assuming which means you are making a personal judgement about this patient and not one that is based on science or medicine. And what is your fixation on the "N" word? Yes obesity can have some issues for different ethnic groups but there are other factors involved also.

Arizonaffcep No need to apologize. I have worked in healthcare long enough to know there are many inequalities and the haves or the have nots in a system. It just makes it a little easier when the healthcare professionals themselves can get on the same page or at least the same book (does not mean "cook book") to understand various resources and reasons. A little hospital stuff that goes on everyday: ED wants the patient up to the floors or CCU NOW. Which patient is the least critical to get turfed to the floor to make room? The floors and/or the CCU are moving patients around as fast as they can while also transferring a truck load of personal belongings. It is shift change. The ED or the CCU wants to unload before report. The doctors are busy and can't arrange the orders or do an acceptance consult. Too many patients here. Not enough staff there. Ambulances showing up, bringing and taking. Everyone wants attention now and those that don't say something probably deserve the most. And then, getting the right equipment for a bariatric patient? The problem does not lie in whether the hospital can handle bariatric patients, it is keeping enough supplies and equipment to handle the growing number of bariatric patients. It sometimes amazes me that anybody survives their hospital stay. But, it is organized despite its chaotic appearance.

You are being way too sensitive if my statement quoted below offended you. You are working inside a hospital, correct? For some patients you have standing orders to be initiated but the path may deviate when the diagnostic tests provide results correct? For some patients it is business as usual, correct? Have you never heard the terms "by the book" or "CCU protocols" or "tele protocols" or any disease or symptom protocols? These are all the usual recipes to be followed. Much of medicine is written in recipe form so it is organized and to avoid missing important data. From that, different pathways and guidelines are then initiated. You seem to be confusing with what is referred to as a Paramedic cookbook for prehospital. You stated you were working inside a hospital and that is what my references were to.

Why don't you start following the care ED patients get once they leave the ED? Learn the reasons why some therapies are done and not others. Learn the risks and benefits for different patients. The same cook book is not always followed for each paitient. Since there are known histories and values, there are more (or less) options. You should have been able to have asked your ED physician or the CCU physician that saw this patient some questions for a learning experience. Also, learn what the various units and floors can handle in terms technology and drips. Get to know more about medicine, the reasons behind the medicine and what really happens to a patient within the walls of a hospital. Don't be afraid to ask questions. This patient may get a cardiac cath but later. As I have already stated, not everyone with an MI happening at that moment gets a cardiac cath for a variety of reasons. You told us very little about this patient except he was obese and his troponin level was elevated. Other labs? Medical history? Overall health issues? Patient's acknowledgement of his health and disease processes as well as the risks? It is great that you are a patient advocate but learn more about what to advocate for and why with a sound point of view from medicine and not emotions because he was your age or an employee. You will eventually see young children come through your ED that already have their Living Wills and DNR/DNIs set up or where end of life may have to be discussed instead of intubation.

By the floor bed, the doctor probably meant tele which may have been appropriate for this patient. This is not that uncommon since progressive tele floors can monitor, do the necessary drips, can usually do CPAP and have a relatively low nurse to patient ratio. If there will not be more aggressive treatment or the need for a ventilator, the CCU bed may not be necessary. Also, not everyone with an MI goes to the cath lab.

Yes, some areas for concern. Another rather scary HEMS story: Review Probes California Bus Crash Response, Exposes Flaws http://www.emsresponder.com/article/articl...p;siteSection=1 Interesting reporting website: http://www.concern-network.org/

They still fill a need for something that is lacking for whatever reasons. The issues are still present whether it is not being able to have a paid ambulance service or medical facilities or the means to afford any of these services.

crotchitymedic1986 wrote: Even with what the stats say about survival for out of hospital survival, a cardiac arrest call probably gets the most adrenaline pumping next to the pedi calls. There is a preconceived excuse that driving a little faster than usual is more acceptable on these calls. It is also an excuse to drive faster with the L/S to the hospital while essentially working on a dead person. There are stats that have been published to show working a cardiac arrest in the back of a moving ambulance has resulted in many injuries to the providers even if the ambulance doesn't actually crash. And, the patient still remains dead or has their chances for survival diminished due to ineffective CPR in a moving vehicle.

We do a lot of volunteer bashing on this forum but the truth is there are other health care professionals that do volunteer their time due to the inequalities in our country's health care system. The article is nothing new but is a reminder that parts of our country and even areas of major cities do not look like what the American way of life should look like. I have volunteered as an RRT at clinics both in the U.S. and in the Honduras. It is really an eye opening experience to see such a total lack of quality medical access if any in some areas of the U.S

They had to have known something was coming. The terms of the settlement were made public. The Paramedics were supposed testedly for various "skills" last February. I don't hearing remember the results. But, I believe it was only for skills.

That term is used frequently in the hospitals. To sedate and to intubate are two very different things. The report should have given some indication of the patient requiring intubation. Perhaps the Paramedic was not clear about the patient's overall condtion.

Of course it was....do you think the medic would admit if it wasn't?

To "snow" a patient means to sedate. If the patient is unmanageable due to anxiety or pain, we will sedate enough where they will be out. If we have to intubate because we over sedated, it can be counted as a serious med error or an adverse event that was not the plan.

Not all serious mistakes make the headlines. If that was the case there would be a separate very thick book published weekly just for hospitals and EMS. Many of the "mistakes" don't kill especially if they are caught immediately. Unfortunately, in some EMS systems, we do not know exactly how many mistakes are made everyday unless they do cause serious harm. Poor medical oversight and QA/QI procedures not only make accountability difficult but also tracking those that provide less than adequate care. There are also those that believe "what happens in the truck, stays in the truck". If it is a serious mistake, the hospital, EMS agency, risk managers and attorneys will try to control the situation quickly. Many of those that mistakes are made on may have no patient advocate and thus no voice in what happened in their care or demise. Those are usually just shelved even if they are used for some statistic. You can put the elderly, handicapped and homeless into this category. During one of our lengthy Fire based education discussions on this forum, I linked to a review of the FD in question. It had incidents that resulted in the death of patients which were probably not published in the newspapers. You many find similar documentation in other FD or agencies protected by sovereign immunity laws or State protection statutes. The courts will protect government entities. However, a claim can still be made but liability damages are greatly limited. EDs have a reporting system but internally and externally for filing mistakes made by EMS. If the ED catches the right away, like a misplaced tube or grossly infiltrated line, it is pointed out in hopes the EMT(P)s will also do their own documentation. If the EMT-Ps admit to the wrong med, action can be taken quickly and there is an understanding mistakes to happen. It is all better than the ED finding out strange things on lab results. But, the proper paperwork must still be done. Hospitals have now put into place as many safequards as possible to prevent mistakes. Everything from computerized ID to med carts have tried to decrease errors. The technology I work with will keep a record of everything I do or don't do. If anything happens to a patient, the ventilator will be a witness with all of the data downloaded for all to see. Even the portable ventilators used on Flight or CCT have a memory chip which we will download for QA/QI. Some patients have had as many as 30 setting changes during a 15 minute transport. That speaks volumes about the "knobologists" managing that ventilator. Regardles of all the details to the Bakersfield patient, I'm sure the courts will sort it out eventually. Hopefully good documentation was done by the ambulance crews. The PD will also have their own documentation. There is a lesson to be learned from this regardless of where the largest percentage of blame lies. I'm sure everyone involved with this patient and with others have gone over and over all of the "should have", "could have" and "would have" scenarios in their mind...after the fact. It doesn't have to be a headline grabbing incident for some to have review sessions with their medical directors for situations that have gone very right and those that have gone very wrong.

That is definitely an improvement from this story out of Alaska. http://www.ktuu.com/Global/story.asp?S=9578696 EMT school abruptly closes, leaving students in limbo by Jason Moore Wednesday, December 24, 2008 ANCHORAGE, Alaska -- A school for emergency medical technicians and paramedics has closed its doors, and now a group of students are wondering if and when they'll get a refund for the hundreds of dollars they spent on tuition. The school was run by Guardian Flight, an air ambulance company operated out of Fairbanks. The move to close the school followed a new owner taking over the company. The Guardian EMS Academy operated out of the old Anchorage School District building. A week before it closed, EMT student Joni Andreasan saw the new owners of Guardian Flight come through the building. "They came by and walked through and we were in class and we all said, ‘Hi,' and they watched us do some training," Andreasan said. Guardian Flight also operates ambulances in Anchorage. Andreasan wanted to work for the company. "I was hoping to get -- after I got my EMT certification -- to try to get on board with Guardian, which our teacher told us they had full-time positions open and they were looking at hiring us straight out of class," she said. But Andreasan and other students wouldn't get their certificate. According to state business records, shortly after a Joseph Hunt purchased the company, the school abruptly closed. "We had class on Thursday and she gave us our work for the next Monday, and then the next day -- our instructors, they seemed to be in the dark about it and were just basically lost their jobs on a Friday afternoon were told that it's all going away," said Alex Sprague, a former student. That was more than a month ago, and despite repeated requests from the company the students have not received refunds -- $850 for the EMT class, much more for paramedic students. It appears they lost the time invested, and may be out the money as well. KTUU made repeated requests with Guardian Flight for a comment, but our calls were not returned. The new owner of the company appears to be the same Joseph Hunt who is based in Utah and owns other air ambulance companies in Hawaii and the Rocky Mountain states.

Sometimes there is not an understanding about the company's education policy especially when the company is going to be paying for the education and allowing the time off. The one year of employment may be a requirement to see if you are going to work out as an employee. If they send you to Paramedic school and you turn out to be a lousy employee regardless of your patch or you run off to join the FD, they have wasted time and money. However, if the company can at least get a year of work out of you and lead you to believe "it is for your own good and you'll get lots of experience", the company been the one to gain. Some also just go to RN or RRT school to get a degree instead of waiting to get a certificate. It is hard to hold ambitious people back who want to learn more about medicine. Many hospitals also have the one year wait before the education benfits kick in but no one says you must work as a CNA for one year before they ALLOW you to attend nursing school. You can do that whenever.

No. However, there may be a shortage of those applying for private ambulance jobs if the FD has EMS. One FD had over 6000 applicants recently. Since the Paramedic cert is required, almost all of those were Paramedics. Hard to believe, isn't it? We have close to 50 schools cranking out PDQ certs including the colleges that have streamlined their curriculum to resemble a medic mill. The problem is when those applicants are only going for the FD job and have no interest in the medical aspect. Thus, many will continue to flip burgers at Burger King until they get hired by the FD. Then, they can be that first-rate Paramedic on an ALS engine. Florida numbers for people holding a license although they may not be working as an EMT or Paramedic: As of October 2008, Florida has 34,638 certified EMTs and 22,196 certified paramedics.

Welcome to the world of Respiratory Therapy. Almost every department I have ever moonlighted in has been next door to the morgue. Usually this is because that part of the hosptial is the only place that has the room for all RT equipment. If is a litttle strange to have a body waiting for entry into the refrigerated unit parked between the life support equipment. We may have as many as 2 - 4 bodies parked in the hallway at one time waiting for their place in the cool, funeral homes or the M.E office. I find myself politely saying "excuse me" as I manipulate the stretchers to enter my office. Sometimes we will hear knocking on the wall which we share with the morgue. We just tell the new RRTs it is the patient who they blew off doing their last treatment.

MRI? Temperature? Lactate level?

What was the patient's temparture at the ED? A CT Scan is not always definitive. Even for a hypoxic insult, the patient may require a couple more CT Scans to see changes. If he was still relying heavily on pain killers 3 months post op and the family did not notice any other symptoms that would lead to a clue about his elevated WBCs, there may be a lesion or infection at the surgical site or just about anywhere in the CNS pathway including the head. Meningitis may also need to be ruled out. The pain killers may have masked some very important symptoms. A neurologist and an MRI would probably be appropriate.

Go directly to the source, UMBC CCEMTP (Critical Care Emergency Transport Program) http://ehs.umbc.edu/CE/CCEMT-P/ CCRN is not a course. It is a test that is taken after at least 1,750 hours of working in one specific patient care population. ex 1,750 hours in an adult ICU, another 1,750 hours for the Pedi CCRN, 1,750 hours for neonatal. There are review classes but it is expected that you already have a working knowledge of all the ICU applications for that age group as these classes are usually just a prep for the test. Here in the U.S. one can take a 3 month medic mill program for their Paramedic patch and then take a 2 - 4 hour class in the back room of an ambulance company who then grants them the title of CCEMT-P. If you noticed on the link I posted to UMBC, CCEMTP does not stand for Critical Care EMT-P. That is usually just a title some decide to use and represent it as such or their ambulance company has it as a job title. A few states do offer some form of CCP cert level. TN and Ohio are the two states I can remember.

Okay... But, do you see how easily your actions can make headlines? And, be careful with your treatment of prisoners. They have state and Federal laws to protect them against what can be construed as inhumane treatment.

Your overly cocky attitude has warranted most of my comments. That included your reply to my concern about the use of ammonia inhalants on an incarcerated patient. Here's at article that is from your area. I think it pertains to how some things can be dismissed as BS but later lead to not so pleasant consequesnces. State EMS probes student's death http://www.newsobserver.com/news/story/1217009.html Jesse James DeConto - Staff Writer Published: Sat, Sep. 13, 2008 12:30AMModified Sat, Sep. 13, 2008 01:52AM RALEIGH -- The state Office of Emergency Medical Services is investigating Orange County's handling of the Atlas Fraley case. Drexdal Pratt, EMS chief for North Carolina, said Friday that state investigators are determining whether the paramedic who responded to the Chapel Hill High School football player's home a few hours before his death followed protocol. "Any time a patient dies or suffers as a result of any action, it would definitely be a concern of ours," Pratt said. "I can't recall if we've had a situation like that where a patient has died after a paramedic assessed them." Fraley called 911 about 1:45 p.m. Aug. 12 after a morning scrimmage with the team. A paramedic responded a few minutes later and spent 22 minutes with Fraley before clearing the scene, according to emergency radio traffic released by the county. Fraley was dead within four hours. Fraley had requested an IV, complaining of dehydration, a condition he'd had in the past. It is not clear whether he received intravenous fluids. "We're unsure as to the facts of the case yet," Pratt said. Investigations Orange County EMS is conducting its own investigation, and officials there have not explained how the paramedic treated Fraley or why Fraley was not taken to a hospital. Pratt said the county notified his office of its investigation soon after Fraley's death, and the state opened its own investigation a couple of weeks later, at the end of August. "Since we issue the credential to the paramedic that may have been involved, we want to make sure that they followed the appropriate protocol," Pratt said. The state's investigation should be complete by mid-October, and a report will be made public at that time, Pratt said. Investigations are being conducted also by the Office of the Chief Medical Examiner, the Chapel Hill-Carrboro City Schools, and the Fraley family's attorney. Stricken Chapel Hill football player called 911 He was seen, not hospitalized Jesse James Deconto - Staff Writer Published: Fri, Aug. 15, 2008 12:30AM http://www.newsobserver.com/264/story/1178629.html CHAPEL HILL -- Atlas Fraley called 911 for help Tuesday afternoon, saying he hurt all over. An EMS crew came to the Chapel Hill High School football player's house but did not take the 17-year-old to the hospital. It is unclear how or whether the crew treated him, but by the time his parents got home that evening, their son was dead. Relatives want to know what happened, and the county's Emergency Services Department is investigating its response on a day that stretched resources to the breaking point. Even as Fraley's parents were arriving home, EMS crews were being called to a two-vehicle crash with four people injured in western Orange County and to East Chapel Hill High School, where another football player lay writhing in agony waiting for an ambulance. On Thursday, Capt. Dinah Jeffries of Orange County Emergency Services read a brief statement about the Fraley case but did not answer any questions. "A full review of the facts is in process so that we and the family may have a clear picture of the circumstances surrounding this tragic and extraordinary event," she said. "Our focus is on getting information to the family." And the family wants it. "They came here, and I guess they told him to take Gatorade and just left him," said Fraley's aunt, Melissa Edwards, mother of NFL defensive back Dovonte Edwards. "Why he didn't get help, we don't know." Fraley had played in a scrimmage against Middle Creek High School in Apex on Tuesday morning. During the game, he complained of a headache and coaches took him out until he felt better. The headache returned, and they took him out for good. About 2 p.m., he called 911 complaining of "full body cramps." "My body is hurting all over," he told the dispatcher. "I just came from football practice, and I think I need an IV or something. ... I think I'm just dehydrated and need an IV." Dr. John Butts, chief state medical examiner, who completed an autopsy on Fraley's body, is waiting for test results. "Dehydration may have played a role in his death, but this is not certain, nor even that he was dehydrated," Butts said. The death of the player came on a hectic day for the Emergency Services department. Between 5 and 7 p.m. Tuesday, Orange 911 received 11 calls for service. Officials would not say how busy crews were earlier that afternoon when Fraley called initially. In the evening, one call came from East Chapel Hill High School, where a running back for Carrboro High School, DeMarcus Powell, had injured his knee during a scrimmage. Powell, 16, lay on the field at least 23 minutes before a paramedic arrived in a sport utility vehicle. "He was biting my legs. He bit on his mouthpiece," said his mother, Patrice Powell. It was another 20 minutes before an ambulance arrived. Capt. Kim Woodward, operations manager for Orange County Emergency Services, said personnel could not respond more quickly because they were tied up on the other calls, including Fraley's death. Efforts to reach Woodward to discuss Fraley's call were unsuccessful. Barry Jacobs, chairman of the Orange County Board of Commissioners, said that he doesn't have any reason to think the medical response when Fraley first called wasn't adequate but that the incident raises questions that need to be answered. "Any time a 17-year-old who's apparently OK dies after they've been seen by some kind of medical personnel ... you wonder if anything could have been done differently," Jacobs said. "I think we owe that explanation to the family. And we owe it to people who call 911," he said. Jacobs said the county board had not yet been briefed by EMS directors.