VentMedic

Race car drivers have the same mentality.

Employers are concerned about the legal side of an off duty employee being injured while doing something that is similar to what that employee does for them. Many interpret their jobs as an implied "duty to act", even if there is no statute mandating it, as meaning 24/7. This can be true for some professions and some very specific agencies in a few states. But even if there is no such duty, employees may still try to sue their employers for workmen's comp. Florida had a FF killed off duty in 2002 while assisting at an accident. His death set case law and clarified a previous bill signed by Jeb Bush with a statute change for the off duty and workmen's comp situation. Now off duty employees of government agencies (FD, county or city EMS) can collect if injured while performing in a manner similar to their job.

Update and audio released. NTSB Releases Report On Medevac Crash http://wjz.com/local/medevac.crash.fog.2.852469.html Pilot Concerned About Weather Before Chopper Crashed, Tapes Reveal posted 11:20 pm Thu October 30, 2008 - DISTRICT HEIGHTS, Md. http://www.wjla.com/news/stories/1008/5658...l?ref=newsstory

What size was the tube? Small tubes and/or tight nasal passages = increased work of breathing which sets a pt up for failure or quick decompensation. Even a good sized tube has resistance that must be overcome and thus that is why we have all sorts of tube compensation modes on ICU ventilators. Any amount of secretions can further block the tube either partially or completely and pt can quickly decompensate without one knowing in the back of a noisy truck and the pt covered by clothing or sheet. Dramatic SpO2 change may be late and after pH has fallen with the rise of PaCO2 especially if the patient is in a hyperoxygenated environment like a NRBM. Was there an ETCO2 monitor in place? A pulse ox will tell nothing about the patients ability to clear CO2. Was the nare adequately prepped prior to intubation? Blood from the nasal intubation may also hampered effective gas exchange. If the patient was obtunded they may already have had impaired gas exchange. The respiratory effort once the airway was open may have been an attempt to decrease a possibly high PaCO2 level that had already accumulated and increase their pH out of the danger zone. Respiratory effort can be deceiving especially with impaired mental status. It is rare that we intubate anybody for alcohol unless they are apneic or a child with a toxic level. In the hospital, it is very rare to see a nasal intubation due to the high risk of infection and damage. If a patient is being weaned from a ventilator or post op, they may be on a T-Piece but the tube size is very adequate and ABGs give baseline while ETCO2 is monitored. Even that is rare due to safety issues and newer ventilatory modes on ICU ventilators to mimic a T-Piece which monitor the airway resistance with the appropriate alarms in place. Many, many years ago in the hospital, we used to leave the tubes in comfort care patients when we discontinued life support until it was ruled cruel and uncomfortable care by our medical ethics committee.

quote from article She also put a bystander at risk. That person's safety should have been of some concern. It would be interesting to know the workmens comp laws for that state concerning off duty EMS personnel. If Florida, you can be covered if you are an employee of a government EMS agency. Yes, it is difficult to watch someone burn, drown or fall to their death, but if your safety and the safety of others are at risk, it is a tough decision not to help but may be the correct one. If you and bystanders do not have the proper training or equipment, you may be ineffective or make the scene worst by now having more injured or dead people. Many lives, including families, can be ruined by some "heroic" acts involving off duty personnel and bystanders. Below is an incident that happened one year ago in Florida. http://www.heraldtribune.com/article/20080...5/1030/NEWS0103 Lingering Halloween nightmare Drowning revealed need for equipment, training Published: Thursday, January 3, 2008 at 2:24 a.m. Last Modified: Thursday, January 3, 2008 at 12:00 a.m. More articles on story: Boss defends EMS actions at drowning scene Updated: Nov 1, 2007 08:51 PM PDT http://www.wwsb.com/Global/story.asp?S=7300801 Manatee EMS staff training criticized Lack of a rescue attempt after a vehicle went into a pond draws attention Published: Monday, December 31, 2007 at 2:35 a.m. http://www.heraldtribune.com/apps/pbcs.dll.../NEWS/712310408

10 minutes per patient for both documenting and giving medications per shift? It takes some EMTs and Paramedics 30 - 45 minutes to document one page on just one patient. The RN also does wound assessment documentation and still must do other written assessments as well as charting for phone calls to the MD and family. NH and SNF patients are usually incapacitated and can not line up at the medicine cart. Many of their medications must be crushed or mixed into some "takeable" form. They can't just force feed 10 - 15 pills down a patient's throat even if the patient is able to swallow fairly well. Even an MD inhaler if done correctly can take 5 minutes. If they have 3 that may take 6 - 10 minutes with just the respiratory meds. Meds also include those for wounds. Dressing changes can take awhile. Vitals are also required and must be documented before giving a med. Some RNs may take their own vitals especially if more than one hour has lapsed since the CNA did rounds. Then, there are IV checks and starts. The list goes on. Even if we used your example of 10 minutes per patient for just meds, at 20 patients, that is 200 minutes. There must still be dressing changes and assessments. Then, you have the constant flow of interruptions by family and transports/transfers with all demanding information RIGHT NOW! Often the RN will play nurse, family counselor, secretary, ward clerk and still must find time to stroke the egos of EMS or the nurse will be greeted with a stream of verbal abuse that would get any other professional (excluding MDs) fired. If they complain to the EMS company, often they are told how stressful these routine transfers are for the EMTs and Paramedics. I would hate to see some of these EMT(P)s handle a real emergency if the NH calls stress them. Oh wait, I have seen these same EMT(P)s muck up emergency calls and stress out on them also. Again, the nurses do not have a full lab or a crystal ball to tell all about the patient. If the nurse doesn't send the patient and the patient decompensates rapidly, the family, MD, ED staff and EMS will bitch about not sending sooner. If the patient is sent early the only ones that might bitch are the ED staff and EMS. Yes, the ED staff gets annoyed because many there may feel they are Trauma surgeons and Trauma nurses just like those in EMS. This "clinic" calls are beneath them. Geriatric medicine is not for everyone. And, some ED doctors and RNs enjoy doing their jobs and giving the patient a thorough assessment. Some (EMS and ED) get hung up on the DNR status and forget it doesn't mean Do Not Treat. Ever wonder why there are not more DNRs on patients in NHs? The admitting MDs feel their patients will never get treated or treated as well as a patient that is full code. But, they may have made a notation to be called if death is imminent or before life support is initiated. defib_wizard Patients are the ones caught in the middle. How does it affect YOUR life one way or another as to what happens to this patient? You are paid by the hour. You probably won't remember the patient's name even after riding with the patient to the hospital and must look at the paper work to introduce the patient at the ED. Often, a name is never given. All you're going to remember about the patient is "some stupid nurse BS call". Some people have a choice and can shop for a NH or SNF. Usually it is dictated by insurance and availability. Unfortunately people can not determine who their ambulance or EMS EMT(P)s will be. It is unfortunate in some areas of crappy EMS/ambulance and bad attitudes, usually go hand in hand, that there aren't better alternatives for transport for the disabled and elderly. It would be nice to have a company staffed by healthcare professionals that understood medicine and the American healthcare system. Unless you have proof there is blatant fraud, neglect or negligence occuring at these facilities and then have the ambition to follow through, there is not point in bitching about it. Just be professional. Too much bitching just makes you look unprofessional and uneducated. Your crappy attitude will be reflected in your work whether you believe it or not. The same can be said for some ED staff when they no longer feel sick old and disabled people should be cluttering up their hallways. Their preference may be for the SNF RNs not to do their job or be concerned so the patient will just be a quick code and off to the morgue. No remembrance of the name or even the code later.

Doesn't EMS stand for Earn Money Sleeping? Or EMTs: Earn Money To Sleep? Don't go there when you know there are some in EMS who consider 1 call in 24 hours too many and complain about it the whole time. I've read several of your other posts on this forum and you attitude toward nursing displays you have a sincere dislike for the profession. Unless your own backyard is perfect, careful what you say. The blunders and laziness of some in EMS could fill the memory on the best computers. Sorry spenac. Just read too many of his posts.

Nick! The Godfather of reality TV. Yeah, I remember when Alligator Alley was still an alley. We owned a half-track and a swamp buggy for our fun times on weekends when I was much younger. Broward EMS went through some transitions in the 80s and 90s but overall they weren't too bad. The ambulance services........ (must be gentler and kinder like spenac)

The happenings in Florida have more comedy, drama and tradegy than anything on TV. I can't say I'm too surprised. Broward County has had an identity crisis over the past few years with many consolidations and mergers. Everything finally landed under the Sheriff. Taxes are at an all time high in an area of retired people with fixed incomes, there is alot of frustration. We had many volunteer services prior to 1985 but we also had sand roads, half the population and not as many high rises. Broward Sheriff's Office (BSO) http://www.sheriff.org/ http://www.sun-sentinel.com/community/news...0,4906105.story Switch to volunteer fire department a hot topic in Lauderdale-by-the-Sea Switch from the Sheriff's Office to volunteer fire department has some concerned about safety By Linda Trischitta | South Florida Sun-Sentinel October 29, 2008 LAUDERDALE-BY-THE-SEA - By switching to a volunteer fire department, town officials hoped to save millions of tax dollars while keeping service on par with what the Broward Sheriff's Office provided over the past four years. But some residents and commissioners are concerned the move, which took effect Oct. 1, could jeopardize safety because the VFD's contract allows nine minutes to respond to a blaze. In its final year, the sheriff reported average response times of 3:56 minutes for 18 fire calls. "Nine minutes is totally unacceptable," said John Toohey, a retired assistant chief of the New York Fire Department and vice president of the 15-story Ocean Colony condominium. For example, he said, if someone had a few cocktails and fell asleep holding a lit cigarette, "if the fire department arrives nine minutes later from then, forget that person." Fire Chief Robert Perkins isn't worried. He said in its first two weeks, the VFD responded "within between four and seven minutes" to 14 minor fire calls and 30 practice runs with new EMS vendor American Medical Response. We've had 15 to 17 firefighters responding per call," he said, adding the VFD has drilled twice weekly for seven months, held classes and visited condo towers to map water supplies and climb stairs in full tanks and gear. "These guys have worked very hard. At least give them an opportunity to show you," said Vice Mayor Jerome McIntee, who is also a VFD member. Fire protection is a combustible issue for this 2-mile-long barrier island town's 6,300 residents, a number that grows to 11,350 in winter. The 2000 U.S. Census said 23.9 percent of the population had disability status, a statistic captured before the town's 2001 annexation of a northern mile of A1A. "I know what a wonderful job BSO did and the training they had as firefighters and paramedics," said homeowner Virginia Holder. "I live in a house, and would be a whole lot more concerned if I lived in a [condo] tower." The National Fire Protection Association sets different response times for professionals and volunteers: six minutes is the career force standard; for volunteers it's nine minutes. Fire departments report their own response times to their communities. The town averages five fires that require use of water to be extinguished per year. McIntee says the town's 68 buildings that are higher than two stories are not a concern. "The buildings are 99 percent fire-resistant," he said. But Toohey said, "apartment contents are flammable. Fire could spread along a public hallway, from a basement Dumpster through trash chutes; along wiring paths or through exploded windows. That's how you could have a high-rise fire." The town expects to save $1.3 million a year by hiring the VFD through 2013. In the final year of the sheriff's fire and EMS contract, the town paid $3.3 million, $2.3 million of it for fire alone. But since March the town has spent $2 million for fire service. That money covered fire and beach patrol vehicles, the EMS vendor's agreement, and VFD contracts that cost at least $850,000 annually. "There are obviously startup costs," said Commissioner Stuart Dodd. To ensure public safety, Mayor Roseann Minnet and Commissioners Birute Clottey and Dodd have discussed setting up a citizens' committeeto review the VFD's training and performance. "If an oversight committee prevents one incident, then it will achieve its purpose," Dodd said. Perkins said it's unnecessary, and Commissioners McIntee and James Silverstone, also a firefighter, have resisted. "I feel that there is a movement on this dais by a couple of people to attack the volunteer fire department," said McIntee, who added he would support oversight, if it's also applied to police and ambulance performance. The VFD reported to the state fire marshal that of its 76 firefighters, 57 have firefighter II certification, or 360 hours of training. The rest, including the chief, deputy chief and three captains, have firefighter I status with 160 hours' instruction, or are trainees. Most have not yet passed medical exams, something Perkins said will happen within the year. Some live in town and many are new fire academy graduates who train with the VFD while awaiting permanent jobs elsewhere. Clottey said she received "numerous complaints" from residents about the Sheriff's Office's firefighting abilities and the VFD deserved the contract. "Unless you are from here, you don't understand what the volunteers mean to the community," she said. http://www.sun-sentinel.com/community/news...0,4906105.story

I know I am sounding pretty critical in my posts but remember your professionalism or lack of also reflects your company. Contracts for routine transport for hospitals and LTC facilities, whether ALS or BLS, are the bread and butter for some companies. In larger cities, this can be a very competitive process. Whether you realize it or not, your attitude and professional conduct are being noted. If you yell at other health care professionals regardless of the setting, it will be noted. Your supervisor may or may not be notified but regardless, the day, time and patient will be noted with your identification. Those who say things about ED overcrowding must also remember we have to wait for transport to move patients out of the floors and ED to make room for more. If an ambulance is late, and yes you do have your very good reasons, it backs up the process. We just have to respect the fact that no one and no system is perfect. However, the bigger professional will try to understand the situation the other is in. Inquire if the information is being gathered or if the RN can come over to give some info. The RN may be torn between getting the paperwork quickly (which is not always possible) and talking to you. He/she will be sure to catch an attitude if they make the wrong decision either way. Until then, you can do a great assessment and get your own paperwork started while waiting for the RN to cover his/her formalities for the transfer. If the patient is truly BLS, you will have a few minutes to catch your breath. If the patient is coding, you're not going anywhere anyway. If the patient is ALS, take the few minutes to get your ducks in a row. Do your assessment and then when the history arrives, you may already have figured out alot of it. Not all nurses are bad and the nursing profession probably covers for many of the blunders of EMS more times than you realize. Nursing also has a way of floating those ED RNs that complain too much about LTC facilities to a med-surg floor or attached SNF for an attitude adjustment. Just practice patience and good patient care. At the present, it is difficult to change how we warehouse our elderly and disabled.

Do you think nurses just sit on their arses awaiting the paramedic? Rarely does anyone have time to just sit at the nurses' station. Nor, are they going to leave the patient care area if there are other patients besides the one you are there for. And, how long does it take some EMT(P)s to complete their paperwork? Some sit around our ED for 30+ minutes working on one report. These RNs must gather up enough pertinent paperwork to avoid any mistakes from an extensive history. As far as the ventilator patient, maybe your dispatcher and service should know what facilities are in their area. If we get a call from X facility, we know it will at least have a trach. Any EMS service should already have this information about certain facilities in their area for disaster planning. It should not be a surprise. And yes, you can bag a vent dependent patient to the ED if no ventilator is available. Many ATVs that EMS Paramedics carry are of little use anyway on these patients if there is another respiratory issue.

Through fear. Florida citizens defeated one bad tax move earlier this year because the FFs didn't count on the public being educated enough to read a financial sheet. But, the majority of Florida already has FDs with all Paramedic FFs on ALS engines and ALS ladders. California is also a huge state for these tactics. Here's some of their ads they are are running for this election: Berkeley: Vote for a medic on every fire engine. http://yesongg.org/index.cfm?Section=10&PageNum=78 Alameda: small island - They usually spend their day grocery shopping and hanging at the coffee houses or just driving their equipment around town. Yes, they do get the occasional fire and medical call but it is still a small town. http://www.savealamedafirehouses.com/ Let's not forget the power of the unions on a city government. Vallejo, CA was a great example of that. http://www.sfgate.com/webdb/vallejo/?appSe...n=7441898916846 Put Fire Dept in the box and come up with almost 100 names that earned well over $100,000, some over $200,000. And, this is not even San Francisco.

Our med-surg RNs in an acute hospital may have up to 15 patients. Some days they might even be lucky enough to get a CNA. One of the few things California did right was enact the nurse to patient ratio but that only only applies to hospitals. The SNF and NH RNs are still left out. However, many SNFs try to limit it to 15 or less. Unfortunately most of those patients are total care. Read the post I did earlier about hospital safety for some amazingly mind blowing facts about our healthcare system. Again, those of us who work in LTC facilities and hospitals are trying the best we can with the resources we have.

One bad apple? In EMS? When I was a field officer, I was actually dispatched to nursing homes by the PD who wanted to arrest our guys for becoming verbally and to the point of being physically abusive to the nursing staff. The reason; the nurses weren't quick enough in getting them the paperwork. You have no idea how many people out of the many patients the RN is in charge of is pulling that RN in many directions. They have to be very careful and cautious about everything or unlike EMS which is protected by state immunity laws, they are no. Unless you want to and can do their job it is not for you as an EMT-B with 110 hours of training to 2nd guess RNs and MDs. And no, there usually is not a secretary around to copy paperwork for you. And, the RN must also get the call into the MD. And, not leave another patient hanging in the middle of some treatment in an unsafe condition. You get a lot of sick and medically needy patients under the same roof and it can be overwhelming. It is also diffcult to crique nursing home equally because not all have the same staffing ratios or reserve staff if someone calls in sick. Many run very lean. Many LTCs facilities have different acuities and handle sicker patients. I probably had it easy as an RRT moonlighting in a subacute with only 40 patients total compared to some RNs that work NHs. All had trachs and 20 were on ventilators. The entire staff for the shift was 1 RN, 1 RRT and 2 CNAs for 40 total care patients. When something did happen, I couldn't just run to get copies of paperwork and stand by the door until help arrived. Nor could everybody just drop the patient they were working with and run to my assistance either. Of course, that would be the time someone would decannulate themselves just to make my night even more fun. I realized then how easy I had it in all of my 30 year career as a Paramedic even on the slave trucks of Miami in the early 80s. I have yet to read many posts on RN and RT forums that waste as much time as those in EMS do bashing other professions. I can't even remember seeing an EMS bashing post in the RT forum but I know RTs get bashed regularly on some EMS and Flight forums. RNs and RTs also know that some in their professions actually look down on that sort of thing and will police themselves accordingly. It has something to do with professionalism. It is a good thing too since EMS has so many fragile egos. EMS has alienated itself for so long, it doesn't know how to interact with other health care professionals. EMS has its own special career schools and rarely venture into the college world when they might co-mingle with other students of various professions. Hopefully, if EMS ever raises its educational standards some of its insecurities will disappear and they will not feel the need to constantly find fault with others to make themselves feel good.

Unfortunately that is not the issue for some of these flights. It seems they fly because they can. And some commonsense. http://www.ems1.com/ems-products/consultin...itical-patients Study: Many Medevac crashes were for non-critical patients October 23, 2008 By Robert Little The Baltimore Sun PRINCE GEORGE'S COUNTY, Md. — The medical helicopter crash in Prince George's County that killed four people last month was one of more than a dozen fatal crashes nationally during the past six years that raise doubts about whether the victims ever needed to leave the ground. A review by The Baltimore Sun of crash records and other documents on the 26 fatal medevac crashes in the United States since 2003 shows that many did not involve urgent, minutes-from-death missions. At least eight involved patients who waited longer for a helicopter than a ground ambulance might have needed to drive them to a hospital. And at least six were for patients discharged soon after a helicopter dropped them off at a hospital, or who survived a lengthy ambulance ride after the helicopter sent to get them went down. The recent history of medevac crashes also includes heroic accounts of late-night flights to retrieve critically ill or injured people in foul weather and urgent missions such as transferring a sick woman from an underequipped hospital in rural Alaska or plucking a young hiker with heat stroke off a mountain in Utah. In the wake of last month's deaths, Maryland officials have repeatedly defended the state's 4,500 annual flights as safe and necessary for saving lives, even if some flights appear unnecessary in hindsight. But one patient who died after an accident in Arkansas had waited in an ambulance for more than an hour for a helicopter that was to fly him 35 miles. Another victim with a broken leg waited while three helicopters tried to fly through fog, even as ambulance drivers offered to take her to a hospital. In four cases, including the Sept. 28 incident in Forestville, patients survived not only their initial condition but a subsequent helicopter crash. Half of the 26 fatal medevac accidents occurred during missions to transfer patients between hospitals — one for a distance of 10 miles — and many of the transferred patients waited hours from the time a helicopter was called until it arrived and was ready to take off again, records show. Officials at the state agency that oversees emergency medical care in Maryland plan to convene a panel of national specialists to review the state's medevac system and recommend potential improvements. The National Transportation Safety Board will hold a public hearing next year to explore the potential causes of a sharp increase in fatal medevac crashes, including eight this year. But a growing list of medical specialists are planning their own national dialogue. While regulators such as the NTSB and the Federal Aviation Administration focus on issues of maintenance and safety each time a helicopter crashes, some doctors say that a critical review of helicopter flights from the medical perspective is overdue. "I'm all for heroes — for the firefighters who climbed up the stairs while the World Trade Center was falling down or anyone else who risks their life to help people," said Dr. Jeffrey P. Salomone, deputy chief of surgery at Grady Memorial Hospital in Atlanta, and chairman of an American College of Surgeons committee that considers guidelines for pre-hospital emergency care. "But it's a real tragedy to think someone could die trying to help a patient who didn't have a life-threatening injury to begin with." "I remember a patient, an 11-year-old boy, who flew in from a motor vehicle accident and was just standing there, and I asked him, 'Are you hurt?' and he looked at me and said no," said Dr. Marc R. Matthews, trauma director of the Maricopa Medical Center in Phoenix. "It's that kind of laxity that can get people killed," Matthews added. "It's unintentional, of course, but it's dangerous and it needs to stop." The records of helicopter crashes do not always include detailed medical information, and doctors caution that the complexities of each case often are not apparent from the paperwork. Police accounts of the fatal collision of two helicopters in Flagstaff, Ariz., in June, for instance, do not reveal that one of the patients onboard, a firefighter bitten by a spider, was apparently in anaphylactic shock, a condition that can be quickly fatal without advanced care. But the records do show that patients sometimes are not in such dire medical condition that a few minutes — or even a few hours — would make a difference. For example, a 71-year-old man injured in a vehicle rollover in Arkansas last year waited with an ambulance crew for more than an hour before a helicopter came to fly him 35 miles. He died from injuries received when the aircraft crashed soon after takeoff. In June, a 58-year-old in Huntsville, Texas, with a ruptured aortic aneurysm waited more than two hours for a helicopter to take him to a Houston hospital, 72 miles away. He and three crew members died when the helicopter crashed into the woods two minutes into the flight. In the case of Alicia May Goodwin, 27, who was hit by a truck on South Carolina's Interstate 26 in 2004, ambulance crews offered over the radio to drive her to a trauma center 48 miles away, according to records from the Newberry County Sheriff's Department. They were told to wait for a helicopter — the third to attempt the flight on a foggy July morning. More than an hour later, Goodwin and three medevac crewmembers died in a crash less than a mile away. Before the helicopter crash, Goodwin had suffered what medics and her family's attorney described as a serious leg injury but was not in any immediate danger. "All the medical experts we could find said she was stable and coherent," said Jeffrey R. Harris, a Georgia attorney who won Goodwin's family an undisclosed settlement from the helicopter's operator. "Getting her into an ambulance and to a trauma center would have been easier." Some advocates of helicopter transport say a simple assessment ignores one of the key benefits of a medevac system - minimizing the amount of time that patients spend in transit. Because providing medical care can be difficult inside an ambulance or inside a helicopter, limiting the duration of the trip can be the most important concern. "Think of a hospital as a safe zone," said Jonathan Godfrey, transport coordinator for the Children's National Medical Center in Washington. "When a patient leaves the hospital to go to another hospital, whether by ambulance or by air, the resources available to the medical crew are greatly diminished." Godfrey, a registered nurse, was the sole survivor of a 2005 crash into the Potomac River, which happened after he and his crew delivered a cardiac patient from Frederick to Washington. The patient, Godfrey said, benefited from the helicopter trip's speed and advanced care, and even the crash has not caused him to question the medical value of flying. Some recent crashes illustrate the kinds of cases that Godfrey describes. A flight that crashed in 2004, killing four people, was ferrying a 3-month-old child with pneumonia about 300 miles across rural Texas. The child was in respiratory distress, according to news accounts, and the 1 1/2 hour flight to advanced care might have taken more than four hours by ground. The flight of a 60-year-old woman with an infection and low blood pressure across Alaska, which crashed last December on the way to a hospital in Anchorage, would have required a ground ambulance to take either a ferry or a 400-mile detour around Prince William Sound. But the potential medical benefits are not always so apparent. In Falkner, Miss., a helicopter responding to a traffic accident crashed after experiencing mechanical trouble. The patient, who had what the local fire chief described as "a pretty bad leg injury," was driven 57 miles to a trauma center in Tupelo without incident. Maryland has implemented a change since last month's crash that is designed to limit the number of flights that are not medically necessary. Patients with obvious severe injuries are flown whenever helicopters offer a "clinically significant reduction in transport time," but more questionable cases now require consultation with doctors at the receiving hospital. But specialists outside Maryland say they will pursue a broader re-evaluation of helicopters for medical transport, particularly as examples mount of flights that might not have benefited the patients onboard. "Every time a helicopter crashes, there's always this emotive, knee-jerk reflex from the community that everything's OK," said Matthews. "I could understand if a crash was an infrequent event, but it seems like there's a new one every few weeks."

How many EMTs and Paramedics are also able to memorize all the details of 30 - 50 patients and their meds? They give you misinformation and you'll go off on him/her for that. That nurse will hand out over 400 meds in her shift. He/She is responsible for every patient on his/her watch. It would really be nice if the RN could just sit at the bedside of a patient like the EMTs do but it is not possible. The minute you turn your back something is happening with another patient. Or, if they take too long a patient suffers the consequences of not getting their meds on time. As I said before, you don't know how many paitents you haven't been called far. But, they did call you for assistance with JUST THAT ONE PATIENT. Try to take care of that ONE patient without showing your very superior attitude and taking your frustration out on everyone you meet including the patient. Some EMTS need to sit at any hospital or NH nursing station and listen to their own co-workers. Not all are glowing representatives of the EMS profession either and that is with JUST ONE PATIENT. Get your RN license and work in a LTC facility for awhile if you can do better. I've been there, done that and it ain't as easy as it seems. No sleep or TV time at all. My comments are not nessarily directed at AMESEMT. It is meant for those who bring a pt to the ED from a NH and don't bother doing their own vitals or assessment but fill the ED staff's ears full of "what lousy care" at the NH.

http://www.nbc-2.com/Newslinks/CCEMS-Fire%...02008%20(2).doc The Scathing Letter October 26, 2008 Dear Commissioners of Collier County and County Manager, I find myself compelled to write to you reference the newly created Office of The Medical Director and its role in formulating a safe and responsible oversight of pre-hospital clinical activities by Police, Fire and EMS. I find myself continually challenged by fire administration in the clinical activities that I permit their fire medics to engage in and/or the training and experience mandates that I demand in exchange for those privileges. The current road we are heading down increasingly is becoming a battle ground of what privileges we are going to grant to fire-based paramedics and, based on those privileges, what training they must receive. This is a critical and potentially high-risk area because these fire-based medics are just never going to receive the clinical experience of a CCEMS-based medic. Of even greater haunting relevance is my conviction that if the fire departments did only basic life support (BLS) with the addition of epinephrine, benadryl, atropine and amiodarone as preliminary advanced life support (ALS) drugs, the community would be served equally well and probably with a safer level of oversight. I have plans, one day, to arm the police with epinephrine and benadryl for acute allergic reactions because these are such time-sensitive, life-threatening events. You have all witnessed the raging politics associated with any attempts on my part to responsibly adjust medications on fire-based apparatus based on evidence and my own medical experience as well as that of Dr. Douglas Lee. These arguments are 100% political and have nothing to do with prudent prehospital medical care. None of the contested drugs were ever used by the engines and, of the 15 drug dosages actually administered last year, one of these was administered inappropriately. (Note: in the same time period, CCMES administered 7547 dosages of drugs) I recently copied your commission on training and ride-time guidelines for the fire departments to achieve Intermediate or ALS Engine Certification Status. I am already hearing that these guidelines are too expensive and too time-consuming for them to comply with. Instead, they want me to form yet more committee’s to “discuss” these demands and negotiate something that is easier for the fire departments to live with. Such negotiations are not only time consuming, but are again heading down political roads that put risk ahead of responsible medical judgment. It has also been brought to my attention that IF all fire departments and EMS were consolidated, “things would be different”. That also is quite untrue. If all departments were consolidated under medical direction, the BEST medics would be matched to the toughest calls; the next best to the daily grind of challenging medical calls and the least experienced medics (most of whom ride on fire engines) would be our BLS safety net along with the police. This is close to what we have today and I am working towards improving this and, we are far from consolidated. I lost some of my best and most experienced medics to the fire departments a few years ago. These medics would be offered re-training and re-assignment to the first or second category of rescue medics (should they volunteer for reassignment), once their clinical skills were refreshed and re-challenged. Regardless of whether or not the fire departments consolidate among themselves as ONE FIRE DEPARTMENT alongside ONE EMS DEPARMENT, or consolidate with EMS under ONE EMS/FIRE DEPARTMENT, or each entity closes ranks under the county’s watch or the sheriff’s department, medical reality and commons sense must still prevail without the intrusion of turf, power, money and politics. Regardless of the formula of consolidation or its continued absence, medical skills, competence and evidence-based medicine must guide our decisions as a community. The Office of The Medical Director will eventually require a bit more form and structure to function effectively. It will require an expert medical training department (which I already have a good foundation) and enough administrative personnel to accomplish its tasks of overseeing medical care in the streets prior to hospital delivery of patients by all agencies concerned. I am happy to have input from fire and police, but this is first and last a physician-determined and directed program. This is not up for debate as far as I or the medical community at large is concerned. In the meantime, I must ask for direction from your commission about continuing down a road that has little basis in fact, experience, evidence or medical common sense. These are not just my opinions; they are standard of care issues that must be fulfilled to protect my license and our county and county commission from excess liability. I can not comfortably continue to make compromises or acquiesce to demands that run counter to my intuition or sound medical judgment and that is exactly what I am doing at this time. It is about the right time to ask for the following: 1. Cease and desist with any further attempts to put ALS in the hands of the fire departments. It is the wrong direction and puts my license and the county at much higher risk. The past 12-15 months have not supported this direction. 2. Reassign primary BLS responsibilities to the fire departments with the addition of 4 additional drugs named above. I need unequivocal support from you to do this. 3. Continue to work towards an enhancement of prehospital medical care thru a structured first-aid course for the police departments. 4. Provide the Office of Medical Direction with a statement of public support that preempts any further debate over what the fire departments will and will not carry on their engines. We have ample evidence that they do essentially nothing beyond BLS and a few rudimentary ALS procedures over more than an entire year. 5. I have, like it or not, been given the responsibility of 4 additional fire departments and 102 paramedics that work for them. I am asking for an additional $48,000 per year to pay an assistant medical director in the name of Dr. Douglas Lee, M.D., FAAEM. An alternative to this would be to employ both myself and Dr. Lee directly under the county. Although this will be of little benefit to me, Dr. Lee is a much younger man and could benefit from the retirement etc. afforded by being a county employee. I reiterate to all of you that the above is heart-felt and my conviction. I also have the unanimous support of the Collier County Medical Society and Collier County Dental Society comprised of physicians and oral surgeons who recognize the obvious standard of care issues alluded to here. . None of these medical issues and principles is up for debate or negotiation. They are fundamental rules followed by people who provide medical care to a wide variety of people and must prevail in the most difficult environment of prehospital care. Sincerely, Robert Boyd Tober, M.D., FACEP Medical Director CCEMS Medical Director NCH Healthcare Wound Healing Centers Medical Director Neighborhood Health Clinic http://www.nbc-2.com/Newslinks/CCEMS-Fire%...02008%20(2).doc

http://www.nbc-2.com/articles/readarticle....=22588&z=13 Video included. Battle between firefighters, medical director heating up Originally posted on: Tuesday, October 28, 2008 by Kara Kenney Last updated on: 10/28/2008 6:35:21 PM COLLIER COUNTY: The war of words between firefighters in Collier County and their medical director got nastier. Both sides are locked in a heated battle over how many life-saving medications should be allowed on the fire trucks. The battle heated up with what some call a scathing letter from Collier County Medical Director, Bob Tober, to county commissioners. Dr. Tober is saying firefighters should be less involved with saving lives - a notion that has firefighters fired up. Firefighters no longer just fight fires. These days, they're also ready to give you medicines that could save your life. But the letter sent to commissioners could change how firefighters do their jobs. Collier's medical director told the county commissioners to, "Cease and desist any further attempts to put advanced life support in the hands of fire departments." That has firefighters like Deputy Chief Jorge Aguilera furious. "I think he just said we don't do anything of value when it comes to providing first response medicine," said Aguilera. "I don't know which graphs he's looking at, but he's sure not looking at the graphs we are." Aguilera says arming firefighters with advanced life-saving drugs improves response times and allows for more people than can save your life. "You want more or less?" asked Aguilera. NBC2 asked Tober if he thought it would make more sense to have more people and more drugs out there to save lives. He answered, "Actually, that's not the case. Do you want the surgeon that did your operation five years ago or five times last week?" A month ago, firefighters had more than 20 medications on their trucks. At Dr. Tober's request, they knocked that down to 15 and if he gets his way it will go down to just four drugs. "The more drugs they carry, the greater the opportunity there is to not only help, but harm somebody if the drug is misused," Tober said. Dr. Tober wouldn't say if he's planning to cut advanced life support from fire departments altogether, but says firefighters should stick with firefighting and basic life support. Collier Commissioner Tom Henning says the long standing feud needs a break. "I'm disappointed he took the stance he did," said Henning. "But cooler heads need to prevail here. We just need to cool down for a while and regroup and solve this problem." The North Naples Fire Department is hoping to have a public workshop with commissioners and Dr. Tober to sort through some of the issues in the letter. http://www.nbc-2.com/articles/readarticle....=22588&z=13

Pts with dementia can ALSO have a change from their baseline mental status. Nurses are required to contact the physician for ALL transfers be it routine or 911. Hopefully if it is a really acute incident they activate 911 first. But, of course, that will vary from facility to facility depending on what agreement they have with your agency and the physicians. You might also consider the number of times you ARE NOT called because the RN called the doctor and after a call to the family, the code status was changed to comfort care. Or, they may have been able to treat something at the SNF/NH/SA. Considering the number of patients in LTC facilities, you should be thankful that they do have certain protocols they must follow. These patients are not healthy and they have multiple symptoms that are routines treated without transfer. You only see those that they are not sure about or they (RN & MD) are just playing it safe.

Not trying to win any arguments, just trying to point out where a little more medical education might be needed since you are the one who said you didn't know anything about lab values. Did you read any of my posts particularly the part where those "awful corporate people" lose money if the the bed is not occupied but are obligated to hold it? You would also have read about how many LTC patients we do get in our ED in just one shift. Patients in long term care are very fragile, get sick and sometimes it is hard to know just how sick they are. Even ER docs and RNs that complain at first may end up eating their words later when the lab results are done. What's with the name calling? Nobody called or suggested you to be a total moron? Get your skin thicker and do some more studying.

Point made but I'm still .

Granted this may sound pretty gross but look at what we reuse in the U.S. and some of the "lack of sterilization oops" scares this country has had with the potential for several thousand being infected. Recent outbreak of a nasty bacteria in a nursery due to improper cleaning of intubation equipment. Contaminated Endoscopy scopes due to bad cleaning. Resistant bacteria outbreak in several ORs due to bad cleaning of non-disposable equipment. Metal trachs can be recycled in this country. Many prosthetic hips and knees can be removed after death and see to who knows where. Non-disposable BVMs are still used in many places...they just sterilize the vomit. :shock: Contaminated transport ventilators from CCTs that don't know enough to protect the machine or themselves from whatever bug the patient has in his/her lungs. And, anybody read the white papers position statement on CPAP when it comes to use with a virus or bacteria outbreak? quote by tniuqs Lets talk even about the simplest form of infection control...hand washing. At the nurses' station we have to clean off the counter each time an ambulance crew uses it for charting while still wearing their dirty gloves. Humidifier bottle?

spenac, I'm sure he appreciates your support. But, have you ever been on the other side to hear the dumb arse comments that continuously escape from some that do drag down EMS professionals? We may see easily 75 ambulances with NH/SNF/SA transports in one 12 hour shift. Majority of them are minor BUT THE PATIENTS STILL NEED CARE THAT CAN NOT BE PROVIDED AT THE NH OR SNF. BS comments are not always warranted if you do not have the whole picture or can even carefully evaluate a small part of the picture. As someone who can be involved in sending patients and receiving patients by way of EMT(P), I would also like to vent my frustrations and that of the RNs who work with me who must take crap from EMT(P)s at least 10 of those 75 NH/SNF/SA transports every shift. I am embarrassed for the EMS profession when they come up with excuses and comments that have NO PLACE as a medical professional and are just showing how little education/training they have in many cases. Yes, a foley catheter change might seem like bullsh&* to you but it is definitely not BS to the welfare of the patient. Yes, a temp of 38 may seem meaningless to you but may not be in the broader spectrum of things. Altered mental status may seem like BS to an EMT(P) but it can mean something else needs to be examined. If the EMT has never met this patient before, how do they know what their mentation is like yet they continuously argue with RNs who have been with the patient every shift and maybe for several years. Yes, I know there are lousy care givers in all professions but that doesn't mean we give people the license to bash other professionals especially if their own knowledge of medicine is incredibly limited to just a few hours of "training". Even if I'm wearing another patch in the hospital, I still have a vested interest in this profession. The next day I may see these same doctors and RNs when I'm wearing my Paramedic patch and do not want them to think all of us in EMS are going to display the same lack of manners and intelligence. From the posts, John_Boston seems to be just starting his career and is too new to start with the BS crap and sound so frustrated. It makes me wonder what type of "postive" mentoring he has had. Maybe when he is your age :wink: he might have a little more experience and knowledge to his credit. Until then, he should be focused on learning as much as he can, including lab values, and not waste so much effort finding fault. As always I do respect your opinion spenac and I will try to play nice in the future.

I guess you don't have much experience yet with elderly or confused patients. If you know nothing about lab values or if the patient has altered mental status, how are you the one to determine it is BS? Also, did you know that many facilities may be obligated to hold a bed for 7 days for a patient AND NOT get paid during that time. It is not always in their best interest to ship patients out unless it is necessary AND ordered by the physician. Again, if you want to file a complaint, go ahead. But, as stated before, you better have your ducks in a row. Lab values will also be part of the file that will be in question. Hopefully your extensive understanding of medicine from your 110 hours of EMT-B training will be of use in court against the orders and education of a physician. BTW, my previous long post would probably have been better under the crowded ED and pts in the the hallway thread but that article had not been published when I wrote that post. I just know that it is a problem we have been trying to cope with for a long time. I also know it doesn't help matters when some hospital staff keep going on strike, in union country, for as long as 10 days which delays many procedures and further extending the patients' hospital stay.

I didn't know they had IKEA stores in Canada. That is even better then the term Knobologist which I use occasionally. However, this guy didn't come close to even qualifying for that title.