CBEMT

It was Marino I missed, since I don't know much about that system. All I knew is that there were two candidates from obvious fire-based systems and the rest weren't.

Meh. I stopped paying attention to Ludwig when he endorsed the "paramedics, paramedics everywhere" concept of EMS.

I've got two.... I can't see where your third is.

Large ones either. The after-action review of the Station nightclub fire noted that no EMS provider interviewed stated they used triage criteria for assessing patients, and not a single triage tag was placed on a patient. That said, 186 patients were transported by EMS. All reached a hospital alive, and only 4 died later (in some cases over a week later).

I didn't know a postictal state could be resolved with high flow oxygen. Read the OP again [hint- the patient presentation specifically] and come back and explain why this patient needs a non-rebreather.

Nah, I call bullshit. I'll bet anything most of that 67% is unnecessary/"just because" IVs.

Not to be Debbie Downer, but I have a hard time calling that a real flashmob. Way too choreographed, and there's NO WAY that could have been pulled off without the cooperation of whoever runs that station.

*Clap* *Clap* *Clap* Congratulations. That and 7 bucks will get you a cup of Starbucks. No wonder FDNY*EMS is "New York's Poorest." I wouldn't pay you as much as a firefighter either.

Run it through a copy machine section by section, and number them as they come out. Scan the copies (scanning actual strips rarely works well anyway, in my experience).

*Note- some details may have been changed to protect patient confidentiality. Dispatch: "Difficulty breathing." Initial impression: anxious-appearing male, weight being supported by friends. Patient's head is facing up and away from midline. Patient's legs are twisted in such a way as to not allow standing without support. HPI: Friends state they found the patient having difficulty walking, they grabbed him before he could fall. Patient states he began having trouble walking over the last several hours due to increasing muscle rigidity in his extremities and neck, and felt like he was unable to breath normally because of the neck stiffness. Denies pain per se but uncomfortable with stiffness. Denies LOC, headache, dizziness, n/v/d, incontinence, ETOH, or drugs of abuse. Admits to being transported last night for ETOH, released by the ED this morning (currently afternoon). Hx/Rx/Allergies- Depression/Zoloft/NKDA PE: Early 20's male, intact airway, adequate air movement, clear lung sounds, rapid radial pulse. No JVD, unable to determine tracheal shift at first due to position of head, later determined to be midline. Abdomen soft/non-tender. No incontinence. CSM/PMS intact in all extremities. Stroke scale negative. PERRL. Skin warm/dry/pink. BGL slightly elevated but not of concern. SPO2 98% at room air. Monitor- Sinus tach at 120 without ectopy, corresponds to radial pulse. BP 118/80, respirations 30. Once secured to stretcher, patient brings arms into chest as if posturing, states he feels as though this movement was involuntary. It was at this point that I was wracking my brain for differentials- stroke or bleed? Manifestation of a previously undiagnosed tumor? Some sort of seizure activity I hadn't seen before? Severe panic attack? What? Then, out of nowhere, it happened. I sh!t you not, a vision of an EMTCity thread page popped into my head, with one word in big bold enormous letters- DYSTONIC REACTION! I mention it to my partner (one of the few people I know who might know about dystonics), and his eyes go wide. "Yeah. Yeah!" Still, I hesitated. Everything I know about dystonic reactions I learned here, and I tried to picture explaining my pushing a drug in a way not covered under my protocols based off of knowledge that I got on an internet bulletin board. Or I could be completely offbase. I'd obviously never seen one, and don't know anyone who has. What were the chances I'd get one, but not my 20+ year veteran friends? So instead of tossing the Hail Mary and doing it anyway, or just punting and leaving it for the ER to sort out, I onside kicked. While obtaining IV access, my partner called Med Control at our destination hospital and explained the patient's presentation. First thing the doctor said was "That sounds like a dystonic reaction." My partner affirmed that this was our impression as well, but due to the protocol issue we wanted to clear our treatment plan with him. He approved 50mg of IV Benadryl, and we were off. The Benadryl didn't have as dramatic an effect as I'd hoped, but by the time we arrived at the ER the patient seemed to have an easier time holding his head midline and at a proper elevation, though he himself said he felt about the same as he had when we first arrived. I haven't read the full follow up yet, but was told later that the ER diagnosis was in fact a dystonic reaction, and they gave more Benadryl along with some Ativan. If the followup provides any further insight I'll post that when I get it. So thanks everybody. This one's for you.

Don't be gun-shy, just don't be a freaking idiot with the med.

We still haven't answered the man's question, beyond That's great. It still doesn't help him today/tomorrow/etc when he gets sent for a transfer involving a med that should be on a pump. He can refuse, and lose his job, or take the patient, do the best he can, and risk a lawsuit.

I think most of us are operating on the theory that the green patient doesn't need anybody at the moment, and in my personal opinion the yellow can wait for the next crew, allowing us to make an attempt on the last patient.

Truck belonging to the private I used to work for got pulled over on a highway once while responding emergency to an urgent care center in a more southerly town for chest pain. Trooper demanded to know why the crew hadn't stopped at the accident he had been at. The crew then had to explain, on the side of the road, the differences between private ambulances and fire departments in our area, and who goes to what and why. Far as I recall the story, the trooper stomped back to his car and roars back towards the crash scene he shouldn't have left in the first place.

Don't be concerned? Why worry? Yeah right. I'm watching this economy kill third service providers all around me, as cities with quality services decide saving a buck is more important and will score points with the IAFF after a layoff. Fixed that for ya.

Suctioning would be a start. And since at a BLS level there was nothing else to do enroute except more vitals, that BGL should have been done. Period. What did the tech spend the transport doing? Better not have been his paperwork.

Great. So not only should he be the stuck up EMT/medic student, he should be the whiny bitch that reported everybody to management. His clinical time is sure to go swimmingly now. Your students don't make beds. Fanfreakintastic. You get a cookie. In the rest of the world, it doesn't always work that way. Adapt, improvise, and overcome. If making some beds gets him a better clinical experience, that's called initiative in my book. The one thing I don't necessarily agree with is going on transports to the floors unless it's a critical patient ie learning opportunity. Don't risk missing something in the ED because you're taking Grandma Drippy Drawers up to her Med/Surg bed for an overnight observation.

Word.

I never understood the need to air dirty laundry in public. And the funniest thing is, it's always just barely English. And about "OMG teh drama" in a volunteer unit. And we only get one side of the story. And the side we get is always "right." Next.

So grab some from the hospital. When I was at the private, if I only used what the company put on the trucks I'd never have been prepared for the types of calls I was getting. Or keep patients warm, or decon the truck- minor details like that. We did what we had to do.

Traumatic arrest was a station on my final practical test day. I've seen people doing CPR inside of cars that still needed to be cut open. Time of extrication to transport was, oh, about 10 minutes or so. Transport time to Level 1 trauma center- approximately 3 minutes, give or take 30 seconds. Gotta get all that stuff done because the hospital expects it, y'know.

BRAVO ZULU. Now don't let this become the quickest route to a Paragod syndrome in history.

I'm happy the captain is safe. I'm NOT happy that the 4th pile of rotting horse shit will now get himself a public defender on my dime, be tried on my dime, and then be housed, fed, clothed, and provided better medical care than half the population for the rest of his natural life (which will now be generations longer than it would have been in Somalia) on MY DIME.

Medic would most likely be safe here, from a civil and licensure standpoint. 16 and over can make their own medical decisions; says so right in our very first protocol. He signs the refusal, it's on him. A service might still offload him to avoid the bad press, but they'd be handing him a wrongful termination suit.