CBEMT

Given the size of the state, EMS mutual aid is a daily, hourly in the city, occurance. It doesn't make much sense for City A's citizens to get a different level of care just because their own department ran out of ambulances. On a busy day the city here could have half a dozen or more out of town units running calls, plus their own. If they were all operating differently, it'd be a madhouse.

And if I was talking about Maryland, you'd have a point. Don't get so defensive.

In a typical ALS/BLS system I'd agree, but it's hard to argue with results- and Boston has them.

Statewide protocols are pretty essential if the state in question is not quite as large as some counties are in other states. :wink:

90 year-old non-verbal demented male, skilled nursing facility, called for hypotension. Staff report rectal bleeding for several days, they want him to go to the family's community hospital of choice (daughter is onscene, even at 3am). Their last BP was in the 80's. As per habit, my Basic partner took vitals while I set up the monitor and questioned the staff. He comes up with something like 70/30, and about that time I notice something hinky in leads II/II/AVf. Decided to run the 12-lead, comes back with significant elevations in II/III/AVf/V5/V6 with reciprocal changes. "Sorry, he can't go to _______ Hospital. He might have the GI bleed but it's not the biggest problem right now." Cath lab facility 1.25 miles up the road is diverting, so it's off for the 2-mile trip to the trauma center (community hospital is about 5 miles away). Zero IV access due to overall vein condition and arm flexion, patient is a G-tube feed so ASA is out. Come to find out he'd had an MI 12 weeks prior that nobody deemed important enough to tell me about. When we left they were discussing medical treatment as opposed to catheterization due to his age and overall condition, which the daughter seemed comfortable with.

All EMTs in my state are taught straight down the buttocks, under the legs, criss-crossing over the top to the buckles in patients with no groin injury, or straight down the buttocks, under the legs to the same side buckles if there is a groin injury. For testing purposes, there is NEVER a groin injury.

Not to be argumentative, but did ALS care change her outcome? Sounds like calling 911 instead of bellying up to the bar might've given her a chance at a different ending. Or not.

This isn't a stab, it barely qualifies as a slash. It's a laceration. If I can see where it ends, it's absolutely BLS. If I can't see it I'll probably ride in, maybe check lung sounds a few more times, but other than that I'm not doing much.

No, it's just that it's not MY money anymore! ROFL

Unfortunately next year's Stock will be too close to my wedding, meaning no money to play with....

At my former private service job we used to get similar patients, but they would always go. The reason we had them is because the local FD one day got fed up with taking them, and handed them the phone book open to the private ambulance pages and said "Pick one and call them from now on."

More places than you think. 12-leads were never mentioned in my state protocols until the summer of 2007. And even then, "If available." 12-lead machines are not required equipment, nor is the training to operate them. Hence, even the protocol that now contains the reference does not explicitly state that using it is required for chest pain or anything else. Now, does every 911 service in the state have 12s? Yes. Are they used? Irregularly. They are least likely to be found on private ambulances.

I'm whiter than white, it wouldn't help! :roll: :oops:

FTW!

Emergency call patient? absolutely, give em a good assessment and write it all. Four years of dialysis transports, I can't say I ever felt the need to shine lights in patient's eyes, or take q5 vitals on stable people. Basic school anybody? 95% of my dialysis patients were uncomfortable enough as it is. I don't think I need to be poking and prodding people going through an experience I wouldn't wish on anybody.

Not here either. But even the cheap-ass privates have them, though none of them spring for the ones with tracks. My old boss told me that the vast majority of a private service's stairchair carries are going UP, at which point the tracks are just excess weight.

I want to know who gave them clearance for a field amputation.

I have no problem walking out the door, after telling them tocall their private contract ambulance (most of our nursing homes are pretty good about doing that in the first place). Hell, I can even have my dispatcher do it if that's just too much work for them.

All the services in my state have a medical director, though they are not, technically, required to have one IIRC. With two exceptions that I know of, the function of a medical director in this area is to provide a signature for medication and equipment supply companies to keep on file.

Not me personally, but I do know somebody who, back in "the old days," saved a child's life while off-duty, operating out of scope but within training provided him by the military during his service there. The state yanked his license for a year. I don't believe EMS was his primary occupation at the time, if it ever was. But the kid lived, the mother was grateful, and he didn't lose his livelihood, so I think he considers it a good trade.

Hell, both of my medical directors are PCPs. I doubt either one of them could tell a backboard from an AED.

With that low of an acuity they should be refreshing all their skills every year.

And if it had been an EMT wielding the knife, the situation would have been dealt with as lightly? Riiiiight...

The fire department said investigators had termed the incident 'negligent horseplay'. According to the department, "[t]hough this resulted in a serious injury, it appears to have been the result of an accident." The fire department also called the behavior "not acceptable", and said it would "not be tolerated."