CBEMT

Ambulances have been getting in and out the entire time. Relax.

"Or imagine being magically whisked away to..." "Delaware." "Hi. I'm in Delaware." ~Wayne's World

I should add that I've read our trauma center's trauma activation criteria posted in ambulance triage, and it uses a mix of mechanism and anatomical/physiologic factors. For example, any trauma that comes in intubated is classed "Level 1A," while a fall from height without obvious signficant anatomical or physiologic will usually be a Level 2. Anecdotally, I've had a 30-foot fall with no obvious injuries but +LOC at the time of incident go level 1, and a restrained MVA with chest pain go level 2. Many times the decision on trauma activation is made at the time of arrival at Ambulance Triage except for obvious activations from pre-arrival reports. Most EMS services will not necessarily say the words "trauma activation," because we've gotten so used to the activations on arrival and also it's not really part of established local procedure, but enough of us have a general idea of the criteria they use that we know what to say during the phone call to get them moving. I've taken to starting my trauma calls with "Hi, this is __________ with a Level 1......"

I'm not trying to pretend I know everything about the special needs patients, vent patients, etc that are out there or even the ones I've dealt with. I've transported many to routine appointments from their own homes, and yes, the families were invaluable resources. I've also taken them back home from the hospital, where they were brought by the local 911 service, most of whom I wouldn't trust with anything more self-aware than a CPR mannequin. The families didn't know that. All they knew is that they're the guys who show up when they called 911 because the vent patient/baby on 24-7 SPO2 monitoring/etc was in trouble. As for VADs, I showed up on my day off for a CME on VAD patients at my old job, but the guest lecturer didn't. Haven't had the opportunity since, unfortunately.

Bullshit. I don't know about anybody else, but our trauma center functions just like a community hospital, except they get all the bad stuff too. They get the train wrecks and the bullshit "My neck/my back/my lawyer" MVAs; the STEMIs and the stuffy noses. If they didn't, our system would collapse in a day. Yeah, sometimes the less serious patients can be stacked 10 deep in Ambulance Triage on busy days or when one of the community facilities goes on divert. I guess you could call that overworked, but they can ultimately handle it better than the other ERs with their 10 or so total ER beds in some cases. I certainly don't think it justifies a policy that says trauma centers can only get "TRAUMA!"

This I simply refuse to believe. When I got my ALS license, the first thing our scheduling supervisor said to me was "Don't too anal, aight? I don't want to have to always be getting you a new partner." I took it as a compliment.

The larger issues aside, I'd love to know where these people are who think about the education of their 911 providers before deciding to call somebody else. In my experience from both IFT and 911, the only factor in the decision-making process of the local nursing facilities is "What's the ETA of our contract private? More than 20? Ok, call 911." Family members of special needs patients don't even spend that much time on it. If there's a problem they call 911, period.

Yes, I'm completely confident in the ability of LAFD's medic mill, "getting my license for a fire job" paramedic graduates to decide who needs a BLS taxi ride and who doesn't. Also, I plan on using a pack of komodo dragons to babysit my child. :rolleyes:

Uh huh. Anyway, thank you for making my point. If you're being unlawfully arrested, you'll get the last laugh in court. I'm saying that the side of the road is not the time to decide that you aren't going to submit to arrest because YOU think it's bogus. Extreme? Ever hear of a no-knock warrant, genius? There's no "negotiator" when they're forcing entry on a search. And your is neighbor sitting up at 3am watching your house for you? Wow, nice guy. Lol, wtf are you talking about?

Exactly what my protocol is. The only exceptions to treatment and transport of kids are "obvious signs of decomposition," bloating, green/black skin, skin slippage, etc.

Exactly the point I try to make whenever the "volunteer services must die" argument comes up. Sure, my department could be disbanded, and then they'd let the local private run the 911 calls. I wouldn't want to even get near the town if that happened. Just because the personnel are paid doesn't mean they actually have the medications, equipment, supplies, experience, and supervision necessary to provide adequate patient care. You'd think after all the discussions we've had about horrible agencies, companies, and providers, people would realize that the closest/fastest/paid/whatever doesn't necessarily mean anything.

Are you suggesting that I misinterpreted that statement?

I call 50% bullshit. The cops can get away with that stuff. Any one of those report card comments would get the teacher fired, union or no union.

You don't get to decide if the officer arresting you has probable cause, you don't get to decide if the arrest if lawful. You're being arrested, you submit. Period. Anything else is resisting arrest and there is a very fine line before you cross over into assaulting an officer. I know we often rant and rave here about the abuses of government and "Damn the Man!" and all that. This is one situation where deciding that you're going to wage a one-man crusade against the government is going to get you in a heap of trouble, just like opening fire on a SWAT team breaking your door down is going to get you blown into chunky salsa, whether they've got the right house or not. We aren't all going to be as lucky as Mr. White and get away with it.

Assistance to Firefighters Grants. Yeah, I know, you're EMS, but it doesn't matter. PPE is a big winner on those grants, so include every item of turnout gear you want and you've got a good shot at winning. Getting new extrication tools when you already have working equipment isn't as sure a bet, so make sure your narrative outlines why you're looking to upgrade.

Imagine? Most of us have done it. Hell, when I worked interfacility I'd grab lunch enroute to the facility, call onscene early, and eat enroute and in the parking lot if it came down to it. You learn to adapt and overcome, just like you do in clinical practice. You bring lunch from home (I've even stored a cooler in the truck during the summer), and hit the bathroom after you've transferred care but before you've called back in service. Life sucks, get a helmet. Yeah, so seriously that anybody who gets fired for any reason can drag the employer in front of an arbitration board and win 99 times out of 100. Must be great working (in any career field) with slags that can't be fired no matter what they do. . From what I've read, it's amazing that European countries have any GNP.

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I think this may be a situation where they EXPECTED him to resist, or try to run, or whatever, and they were so amped up from the chase and the officer down that they didn't really notice he wasn't moving. Doesn't forgive the shots to the head and the kicks, but I can totally see the initial tackles and whatnot. I also think that had he been conscious, it would have lasted a lot longer than 11 seconds.

Hmm. How often to seizure patients get 12-leads, anyway? Not something I can honestly say I'd be thinking of, especially in a young otherwise healthy person.

This is exactly why I lurk on or participate in a couple of firefighter forums. I've picked up LOADS of vehicle safety information there.

Anytime you guys want to come talk to the taxpayers about it, be my guest. We've been through this before, on this very board. LOL. Yeah, I bet they'll get right on it. What planet is that on?

Please. Town next door does almost 3,000 a year with the exact same situation as NJ- paid medic flycar 24/7, and the volunteer ambulance might get out. During the day, if the duty crew is out of town, they're probably calling us. We do a little under 2,000 paid-per-call.

One of them got a friend's company raided last year, but nothing ever came of it. Local media made a big deal out of the State PD, FBI, DOH, etc showing up, but of course they never broadcast the fact that nobody was ever charged with anything.

Edit: nevermind, I see it now.

Ok, somebody help me out. If you already know you're going to commit Medicare fraud with this transport, why are you DOCUMENTING that fact somewhere other than the paperwork you submit to Medicare? It'd be like murdering somebody, then writing down all the details of the crime and leaving it in your house.