spenac

Have fun next shift. :twisted:

Ours have become transports for serious patients. Not enough ambulances or medics load up the critical and treat them enroute to hospital with limited supplys. We do not follow the one medic/ one patient rule so many adhere to. Now if you get the band aid bus one basic can easily handle that with no supplys. Just cut their clothes. Fold it and tell them to keep it held over the wound, or make a sling with it, etc. Improvise. Trauma bag needs to be with real patients if supplys are limited. As to duct tape just make sure its white and document it as medical tape used to secure whatever. :shock:

Good points but prefer Mobile ER (Emergency Room). In the USA everybody thinks medical when the hear ER. By adding ER they will think of it as a moving medical facility. Thus they will start thinking medical professional rather than taxi driver when they see us.

Thanks. Where did you find that at? I may pass this on to a couple or rural clinics that should have 12 lead.

No air because there is no air in my area, but that is changing. A fixed wing is opening this month about a 40 minute flight to our airport, then a helicopter is supposed to be put about an hour flight away from us, but not available yet. This is what I deal with. Patient can't stay still enough for the warm packs to stay in place. List of drugs available is on page 1 one. Patient screams "Don't let me die".

We actually do have agreements with schools already in place so that they will provide school busses for mass casualtys. Then we make them mobile hospitals. It requires improvisation as you are out of your comfort zone and limited supplys.

Original vitals were: Pulse: 114 reg Resp: 20 reg BP: 146/126 confirmed machine and auscultated both arms EKG 12 lead : Sinus Tach Skin warm, moist, and what you see with her sitting there normal in color. You decide to get a better BP and to examine the spot within out an embarrassing face plant to her vagina so you decide to stop the ambulance. You have to throw something thru the window to get your partners attention as he's to busy listening to his ipod. BP 158/138 Pulse 132 Reg equal all extremities. Resp 28 EKG Sinus Tach You explain to her that you need to look closer at the possible bite and check the rest of her body for any other possible sites. You gently open the vagina and look at and feel the area. It has the basic look of a black widow bite. No bites found anywhere else. You ask about possible drug use. She says no. BP is normal if not low normally. LOC normal but extremely anxious. No tearing sensation. Just intense pain and cramping. -5 to eyedawn for asking about resources that are not available per OP. But good try sneaking it in. Nearly 3 more hours to hospital if no problems. Patient screams at you "HELP ME".

We should run with it. Make it a murder mystery show on top of medical. Include a soap opera feel and vote people off of it each week and we would have the entire country trained within a very short time. 911 whats your emergency I need a Mobile ER to 1234 ABCD Lane my wife is having a baby.

"Is she hot?" She just was cover of swimsuit monthly. Does this change your treatment? :twisted: After you explain the need to rule in or out a bite she removes her panties. At first nothing is visible but as you palpate the area including lower abd it causes the labia to spread and you see a dark spot. Also noted that ABD is rigid. But is not tender to palpation. No problems noted on palpation of and percusion of back. Pain is now at 20 on 1 to 10 scale. She keeps laying down, sitting up. Rolling, etc. She can not stay still. She pukes on your new boots. She keeps asking if she is dieing? Skin is now drenched. Complains that the light is hurting her eyes and makes her head feel like it will explode. You are 30 minutes into the transport. Only 3 more hours to the hospital if we don't have ambulance problems. Vitals Pulse 140 BP 162/148 Resp 24

I do a quick triage on him. No immediate life threatening injurys and it will cause him no harm to go private car, I tell him no he will have to get someone else to drive him. I am even nice enough to suggest he go to another hospital as ours will be busy with the mass casualty event and he will have to wait forever if he shows up there. But I have that option based on my medical director. Even if not allowed to do this, I think I would risk disciplinary action by refusing in order to go help those that really need help.

Why is it always about race? Sorry could not resist. You are right need to get your self geared up. Hope you are wrong but err on side of caution and request outside resources based on worst case.

Had Mobile ER been enroute to get granny for a doctor appointment I would divert. But you were enroute to a 911 call, so you stay on course to original call. Do a load and go. Drop patient at hospital and roll to assist wreck scene. That is hard to do, but thats the way it goes. Now if I got to the first call and found a stubbed toe rather than the stated cardiac. I would tell them hell no and go to the wreck.

You tell her you need her to remove her clothes. She slaps you and calls you a pervert. So you explain to her the need to see if she is bitten. You also explain that anything restrictive could become an issue if she starts having problems later. She finally agrees and asks can I keep my pantys on? ( you decide? ) Exposed skin of upper inner thigh shows no signs of bites or stings. (Do we continue exploring?) You have IV established. No relief from Toradol or initial dose of morphine. Vitals unchanged. 15 minutes have expired.

Good job paying attn to the little details.

It was in original post. Learn to read . J/K. But it really was there from the beginning. You tell her you need to see the area she felt the unknown critter on her. She says it was on her upper inner thigh. Since you suspect maybe a bite do you leave her in her clothes? How closely do you want to look? Partner comes back from the outhouse. He whispers that he feels much better and says he saw no critters.

Pretty much unlimited supply of the following drugs kept in ambulance: Activated Charcoal with Sorbitol, Acetaminophen, Adenosine, Albuterol, Amiodarone, Chewable Aspirin, Atropine Sulfate, Brethine, Calcium chloride, Calcium gluconate, Clonidine, Dextrose 50%, Diphenhydramine liquid oral and injectable, Dopamine, Duo Neb (0.5mg ipratropium, 2.5mg albuterol in 3cc saline), Epineprhine 1:1000, Epinephrine 1:10,000, Furosemide, Gluctose, Haldol, Ipecac, Lidocaine drip, Lidocaine HCL 2%, Magnesium Sulfate 10%, Morphine Sulfate, Naloxone, Nitroglycerin, Nubain, Oxytocin, Oxygen, Procainamide, Promethazine, Racemic Epinephrine, Regular Insulin, Romazicon, Sodium Bicarbonate 8.4%, Succinylcholine, Toradol, Vasopressin, Verapimil, Versed, Vistaril, 0.9% Sodium Chloride: 1000cc bags, Lactated Ringers: 1000cc bags Right now thats what I recall from our drugs. I think I missed some and may have duplicated sorry. If you need something else ask and I'll see if it is available to you.

Are you pregnant? Don't think so. ( Do ya'll really believe thats all we get out here? ) Are you allergic to anything? Just seasonal allergies. Any health problems/meds? No. Did you use any chemicals recently? No. Has anything bitten you? Not that I am aware of but did feel something on me in the outhouse, just brushed it off so don't know what it was. Basic Vitals Pulse: 114 reg Resp: 20 reg BP: 146/126 confirmed machine and auscultated both arms EKG 12 lead : Sinus Tach Skin warm, moist, and what you see with her sitting there normal in color.

But how much is it? :?:

We were way passed that comment why bring it back up unless you want to debate it again?

In a remote part of the world you find yourself with a call. You get a 911 call to an area that is almost a 2 hour drive to reach. That means once you reach your patient you are 3 and half hours from nearest hospital. You have no air support. Just you and your basic partner. Welcome to my world. Dispatched to XYZ for woman in severe pain and extremely anxious. You ask if trauma. No trauma. Unknown cause of pain. You ask if anyone can drive her to meet ambulance. No one is available to drive her. So off you go bouncing down the rough roads at a top speed of 45mph which is to fast especially once patient is on board. Finally after you are extremely sore and tired from the road you get on scene. Patient is seen pacing one hand holding her low back other keeps grabbing at her crotch, then up to her chest. She appears other than that to be a healthy in shape 20 - 30 year old female. You walk up to her and ask what happened? Patient in complete sentences says she does not know. She had driven out to check on the familys ranch. She stopped and went to the bathroom at the outhouse near the entrance then continued on back into the ranch. She started having a little low back discomfort and figured it was because of the long bouncy ride out. Then discomfort after an hour or so became unbearable pain low back, thighs and now she is having chest discomfort. She says she can not stay still. She had attempted to drive down to ranch entrance and almost wrecked. "Am I going to die?" The entire time talking to you she continues pacing and moving arms. You patients name, age (26), address, insurance, are on paper she has with her. Alright lets let you guys get involved. Again it is just you and your partner for the next 3 and half hours to the hospital. Don't request flight, additional ambulance, med control as radios and phones don't work until 10 minutes to hospital.

The general public would need us to spell out really everything. Except maybe Mobile ER (Emergency Room). This would be something the public would understand as something medical rather than just transportation. Just almost everyone has been to the ER or watched ER, so they would expect us to provide medical care if we were called Mobile ER. Just another thought.

Ruff but as an ex-ems "professional" told me as to why we do it that way "it don't hurt me". Yes he really did. That statement did help me get past being so timid when I first started learning IV's. But I never understood that for administering meds. That attitude seems very prevalent sadly. Myself I always think what would my reaction be if I was the patient. Yes I know that is hard to believe that I care about patients feelings but I do.

Well I used to respect you opinion. :shock: Alright you sci-fi guys. I bet one of you will be able to find where to buy it and for how much. Will it be someone from star wars or star trek or perhaps another show. May the farce be with you.

Glad I was wrong. I was really worried your were complaining about CE's. I agree many of those company policy trainings are boring but at least when they get sued they now can blame it all on you. Why? Because you knew better as you watched the training. Well enjoy.

I agree with you hellsbells. Now I have been bored at work and said bored, slow, quite, etc. I have described all sorts of calls and gotten none. Then other days it is funny how you say it and it happens. Would it have happened had you not said it? Yes. But still funny. It's just like when asleep and you wake up go pee and then the tones drop. Many claim you sensed something and got yourself ready. Of course I don't buy that. More often tones wake me up and I have to go with a bladder that one wrong bump is going to make it explode. Life is full of coincidence. Enjoy it, have fun with it.