whit72

Well you wrong. Services can begin implementing the new guidlines as there personell are trained. Imagine that I didnt even have to quote anything.

Officially they went into effect on January 1st. The new material is out there being taught now. So if you had the refresher have at it. ACE wrote: T Hey man, they haven't...and even so 'He' isn't because the "PROTOCOL" hasn't changed ya see... I dont remeber asking you anything sir. Dont you have some journals or somthing to be reading, or quoting.

Here are a couple of the top of my head: I am having a cardiac arrest. More then once. I have had a severe headache for 2 days all of a sudden it went a way. I am hoping nothing is wrong. I haven't seen my(fill in your favorite furry animal here) could you please find him. I was wondering if you could give me directions to the hospital. My friend closed his hand in a car door, do you think he needs to go to the hospital. Where is he we will take a look at it. Ohhh he is not here he is at his house. That's all I can remember at this point. God I love the city.

Giddy up what a party starter.......or party stopper I guess. All I can say is 125 mcg can kill someone. That is equivalent by weight to 4 grains of table salt. The fact that it undetectable by sight or smell. Gonna be a fun summer......................... Maybe we should wait till next year to study the effects of the new CPR guidelines. They might be a little skewed

Thats big of you. Where did I state I knew everything? Thats your perrogative.

I'm sure we was smoking pot, I sure that's how he passes the time. I believe there were other topics covered in the article, including the levels of medics. Training aspects that suit the areas you work in. Yes I have moved on from the glucagon issue. However I am still awaiting my letter from the Dept. of Health. stating I am no longer allowed to administer Glucagon, albuterol, EPI, Tylenol, and ASA l due to the negative response from EMT city. Is this a discussion forum? I believe it is.

http://www.jems.com/Columnists/bledsoe/articles/13380/ I thought this was an interesting article. So maybe everyone does not share the same opinion on what should be in the EMT's scope of practise. Your thoughts?

EMS 49393 1. I don't believe I requested to ride with you. 2. I don't recall caring if you wanted to ride with me. I'm glad you understand your limitations. Treating hypoglycemia is not a limitation for me. So carry on and next time why don't you leave my name out of it. Thank you Whit

medic cgh wrote: And I'm only 25, and work in the biggest and busiest EMS systems in the nation. I am impressed. I dont recall asking if I could ride with you. I also dont recall caring what you think. Again sir call volume is based on resources not population.

EMS 4939 wrote: a million times over Whit Do I know you. I believe the question would be could you ride with me. Unlike yourself sir, I do not pass judgement on people I dont even know.

ERdoc wrote: Whit's comment about not identifying yourself, this too could lead to legal problems should someone recognize you and things go bad, not to mention that ethically you should not be lying to your patients. Why should he identify himself as an EMT? Should you identify yourself as a doctor? He doesn't have an ambulance, and you don't have an ER. I just cant see how you can be held responsible whether EMT, MEDIC, RN, MD if you don't have the tools to do your job. When we are sitting around at shift change and two calls come in and both trucks go out. If another call comes in we have to call for mutual aid we don't go out in our personal vehicles because we don't have the proper equipment to do are jobs effectively. I believe its a lose lose situation, I myself have been torn between acting and not acting. I mean where do you draw the line should you act absolutely. Do we most of the time? No. I don't believe you should be held to your standard of being a EMT or MEDIC when you do not have equipment needed to do your job effectively. So how can you be judged as an EMT or MEDIC in a court of law? I never understood that.

fireguard wrote: I produced badge, picture ID, and had a Fire Dept. T-Shirt on? OK a little advice for you and don't take it personal. If you want to save yourself some aggravation in the future. If you are not working don't produce badges or ID's or where fire dept T-shirts. If you see someone you want to help. Do your best for the pt. and if anyone asks, tell them you saw it on ER, or you stayed at a holiday inn last night. Don't offer information that could cause you a problem in the future. If the person dies they will remember you were the one with the badge and the ID. Just trying to save you some heartache down the line. Hope this helped.

Good Idea. lol

Actually two questions: hepatojugular reflex is this present in all CHF pt's or just in a acute crises? Removed the other I found the answer. Thanks

Interesting thanks for the information. I wasnt sure how that would be handled.

I am not sure if once the medical neccesity form is filled out by the nurse or MD, does that transfer the obligation to the hospital rather then the ambulance provider. My meaning: is the burden of proof now on the hospital to explain why the pt needed ambulance transportation or would it still fall back to the ambulance provider?

Not to mention, have you ever seen how oxygen reacts in the presence of heat and fire. God forbid if you were to get in a accident yourself. Im sure you dont want to be sitting on a bottle of oxygen.

I understand. ACE wrote: I hear alot from nurses...just take them home, we don't care... That is definitely the attitude. I believe now you must have what they call a medicare necessity on every transfer. Stating exactly why the pt needs ambulance transportation. Does that curb fraud? I doubt it. Usually the hospitals just exacerbate the history of the pt. so they are allowed to receive transportation. I give your friend a lot of credit. I am sure if medicare is investigating the ambulance provider for fraud. They were probably cementing their case as far as evidence and witness's. Causing the delay. I believe these cases are probably slam dunks, you wouldn't have to look to hard to uncover fraud in some of these places. Hopefully he wont even have to testify. They maybe just getting their ducks in order in case of trial, contacting possible witness's an such. I would think they have some pretty strong evidence against this provider. I cant see a federal agency basing a whole investigation on one persons testimony. He probably precipitated the investigation, but I'm sure they have loads of evidence to go along with it now. Good luck let us know how he makes out.

Confused? He came forward against a ambulance provider? Medicare came to him stating his run forms were fraudulant?

pyro night wrote: If you want to have more authority over patient care, go to med school. Too many wanna-be-docs who get in a huff when you call them "wanna-be-docs" set up their little ALS camps on a scene and FAIL to do what EMS is supposed to do - stabilize the patient and quickly and safely transport the patient to definitive care (which, if you haven't been paying attention, AIN'T US). Get your hard hats out again boys its gonna get messy in here. For the most part I agree with what your stating. I dont believe sitting on scene does anyone any good ALS/BLS. Thats why they put wheels on those bad boys.

Yeah that did look a little funny when I posted it. Thanks Whit

1. Scene safety should be your first responsibility. Above all. Depending on your CC: When you ask them a question: Act like you care what the answer is, don't be fiddling around with equipment or writing down meds, My partner and I will switch off on calls. She will be focused completely on the pt. interview, history, assessment, vitals, initial tx, etc. While I am looking for medications, assessing the scene for possible contributing factors, getting a general big picture of what is going on. I believe this works better then two people asking different questions, interrupting the pt., not allowing them to fully answer the questions you have asked. Remember it is a conversation, not an interrogation. When we have both finished, after treatment is rendered there if needed. We will prepare for moving the pt. whether it be stair chair, long board, whatever When we have the pt. securely in the ambulance we will re asses everything that was assessed in the home. Noting changes both positive and negative. We will then treat again if need be. As a new EMT please don't rely on machines for your assessment. Manual BP, asses lung sounds. Learn to use the greatest tool you have at your disposal your head. Don't rely on machines to do the job for you. If you do someday those machines wont be available to you and you might be up the creek. The person who was focusing on the pt in the house is the one who rides to the hospital, they have built a rap ore with that pt and they can continue that to the hospital. Of course this is only an example. Things change. If it is a double shooting, or a three car flip on the highway, you wont have the benefit of doing some of the things stated above. You will be fine. You will find your own way of assessing pts, and scenes, etc. The only way that happens is doing calls. Hope this helped.

AZCP wrote: The hepatojugular reflex is a piece of cake to assess. Have the patient recline to about 45 degrees on the gurney, if they are able. Find the liver, palpate with moderate pressure, and watch the jugular veins. When they jump out at you, this is a positive. Excellent thank you. Is this present with all CHFers or just a percentage? ERDOC wrote: CHF will also cause dyspnea on exertion, paroxysmal nocturnal dyspnea and othropnea. Ask them how many pillows they sleep on. Ask if they able to walk as far as they used to with getting sob. Ask if there has been any weight gain.[/ A few more good questions to ask. Thanks appreciated. No we don't have one of those cool ambulances. I am thankful when I can keep it running for a whole 24, without having to tape something together or back on to it. Question for all: Have you had much experience with Pulses alternans or alternating pulses, and if so how frequent is it in CHFers? I have witnessed it maybe in 50% of the cases.

removed

Yes I have pretty simple policy on restraints. If you do not have a justified medical reason for your actions. then see below. 1. If your are a threat to me or my partner your arse gets restrained. Whatever it takes. soft restraints, 3 inch tape 2. If you see fit to dicipline me for that. By all means have at it. (with pay please) 3. I would rather take a 3 day rip then risk myself or my partner being injured or worse. 4. I like to get the police involved but I dont have the time to dodge and weave until they decide to show up. 5. If you swing at me and the results of your actions dont leave you unconscious you ride with them. Safety is my main priority fo my partner and me. If you deviate from that and you dont have a justified medical reason for it then see line 5