CBEMT

I understand where he's coming from, but it'd be hard to justify legally in a situation like that. Yes, the next 5 years were hard on everybody and NO ONE deserves to live like that, but he could've lost everything for that decision . Our protocols pretty much put decapitation as the only criteria for not initiating resuscitation of a pedi.

Depends on the hospital, but some of them give out quite a few freebies. Some have a t-shirt day, the next day coffee mugs, etc. My current FT job doesn't transport much this time of year, so I didn't get to take advantage. When I was working for a private, we used to see several hospitals each day and got to partake much more.

If they are a quasi-vfd/rescue, there usually isn't a contract. They just exist, and their charter probably says they exist to serve community xyz. Unless they are "owned" by the town, they are almost certainly an independent organization that is free to disband in accordance with their bylaws.

First call was probably a dialysis, I don't remember. First emergency was an unwitnessed nursing home fall with +LOC, decreased mental status once conscious, and several deformed fingers. My partner felt that this was ok to go to the requested community hospital 10 minutes away instead of the trauma center 8 minutes away. Boarded, collard (by myself with the help of CNAs, he stood outside and collected paperwork), no vitals, no O2, no IV, and no state run report, just our company billing sheet.

I forget where, but another Cleveland news outlet had this story, I left my comment there. :wink:

Doesn't sound like they're actually an EMS service. I've seen some areas that have organizations separate from the fire department that do extrication, technical rescue, etc.

Don't have that option here- most medications are mandated by the state. For example, an ALS ambulance can't be licensed without Lasix- 240mg minimum. We do have optional meds though, and Cardizem is one of them since it's a paramedic-level drug.

That must be why whenever I see two cars waiting to turn at a red light with alternating turn signals, eventually they will ALWAYS synchronize. I thought I was nuts. :?

Well, Luka and Abbey are definitely moving away, and Pratt MAY have been blown to smithereens..... My bet is on whatshername though. Considering it was the first episode I've watched in months, I was somewhat surprised by all the movement. According to an article I saw the other day about the upcoming (and final) season, Abbey will make 2-3 appearances, Luka probably none, and Carter will be on for 4 episodes.

Good, you shouldn't be. Doctors pronounce. By our protocol, we can "make a determination of death" based on specific criteria, and at that point the body is the responsibility of the police until the arrival of the ME (PD makes that phonecall too). ME then pronounces the patient dead and assigns time of death.

The only time this situation was possible for me (post-cardiac arrest pedi and all), the doctor in charge of the transport told me to make a list of all the hospitals between our origin and destination, with their phone numbers. I always considered the doctors on our PICU and NICU transports to come under my state's "Medical Control at the Emergency Scene" protocol, basically covering what to do with a doctor at your scene. As with most, it says that if the physician is willing to accompany the EMS crew and document his/her interventions and orders, than the EMS crew is to defer to the physician's care. (If the crew feels there is a major conflict between the doctor's orders and standard care, on-line medical control is to be contacted and put in touch with the on-scene MD.) So, I always felt that I had my medical control in the back of the truck- with the caveat that everyone on board knew that the PICU nurse was really in charge anyway, since the MDs were residents.

We have the ability, just not the authority.

Well, given the endorsements, I will attempt to obtain this book. Not buy. Obtain. I will not put any of my money in that individual's pockets.

And a broken neck isn't? Fiznat is right about your protocol, and the Doc, as usual, reminds me of something I should have known right off.

Similar but different- apparently there's a private transport service in Boston that one of the major hospitals up there (Brigham?) contracts with to transport a harvest team to outlying hospitals with donors when they have a critical recipient in-house. I was talking to the crew of the truck one night as they were awaiting the team and organ. Basically a BLS unit responds to the facility, pick up the "team," and then it's lights and sirens off to the hospital where the donor is. They sit around for a few hours waiting for the patient to be unplugged, die, and be harvested (apparently there are occasions where that takes longer than you'd think, like this particular night). Then it's lights and sirens back to the recipient hospital. He said more often they did the same thing locally, but met the organ at Logan from a fixed-wing flight instead of traveling. As soon as we were finished talking, the resident who made the trip came out of the hospital, half-running. They all jumped back into the ambulance, the Igloo cooler was strapped to the stretcher, and off they went.

It sucked where I worked. Past tense (I know you didn't know that). "Problem" foleys and G-tubes made up easily a third of my runs after midnight. Apparently there isn't a nursing home medical director in the state that will allow their staff to put the g-tubes back in, and magically they "just couldn't manage to get that darn foley back in. Looks like the ER will have to do it. Do you mind taking them to [ER that we already know is backed up for hours but we want to get rid of the patient for the night]?"

Other than the screaming for lawyers, that was half my calls this week. :? I gave out more morphine this week than the last 4 months. Trauma centers are a little more liberal with orders apparently. :wink:

I never said dialysis. I said Foley and G-tube runs- the patients that "have" to go to the ER because the nurses refuse to put them back in. Nevermind, explaining it kills the effect.

There's one hospital in my area that uses badges, but I don't transport there anymore. When I did, the company kept the badge on the truck's keyring. Nothing to hang. Let's see.... One badge door, one security-activated door (OB/GYN hospital), three keypad doors, and the rest are nothing. One hospital's door code is their zipcode, which I found to be a far better idea than the usual "1234" or variations thereof that the others have.

I'd love to know that I'd be getting a guaranteed 5% a year for 4 years. While it's clearly better than a lot of people, my yearly raises are subjective. Some cubicle dweller in HR decides what I get year to year, and it will always be less than 5%. Something else I've been thinking about. People on this board and others have waxed poetic about the unity and political power of the police officers and career firefighters, wishing that somehow EMS could get to that point. And guess what they both have? Unions. I'm not a huge fan either, but two out of three unified, empowered emergency personnel fields having what we want is hard to argue with. Call me crazy but it's something that's been rattling around in my head.

My diagnosis is "Wishful Thinking."

It'd be nice if the system worked for the patients and citizens, but apparently that's too much to ask for.

Having fun on the Foley and G-tube runs? Now THERE'S quality use of an ALS unit. Considering what Canadian BLSers have to go through to get that license, you'd think they'd be allowed to make those kinds of transports. :roll: As for the signature issue, this is going to COMPLETELY dry up the billing incomes of most of the (FD) 911 services around here. I can only think of two of them that even have a form to get patient signatures on- our state EMS report doesn't.

Most of my area is stuck in "Take them to the closest hospital and let them worry about it." Which leads to things like a community hospital accepting a 2-hour ETA from a helicopter for a trip that could be made by ground in less than an hour.