fireflymedic

I'm going to start a line of NS and one of LR and titrate to maintain a systolic BP of 80 - 90 I don't want it much higher than that to prevent more blood loss than I can compensate for causing him to bleed out faster. If we've got a respectable BP, then I'll give a little in the way of pain meds to keep him at bay until FD shows up. Do we have a reasonable airway? Can I please maintain that or what is he like? How shocky is he at the moment? If blood loss is out of control and still active, I'll consider tourniquets as this is one case where most likely he's going to lose those lower extremities anyway and with prolonged extrication, he may be a candidate. Lets hope that keeps him stable until we can get this guy out which hopefully is soon. I can deal with no helo, but if there were a candidate for one - this guys it.

"You get dispatched for a transfer of a 65 year old man" - just for you ruff was in initial report, but hey all good H and H - Hemoglobin - 10.1, Hematocrit - 30 Didn't want to throw those in there due to most not knowing normal values but there you guys go no chronic alcohol use, dark tarry stools, no bright blood in stool, pt states pain is relieved with antacids and acid inhibitors given in ER with positive results - you are going to a facility with GI capabilites which is an hour away by ground. ER is just a freestanding clinic with family practice doc staffing ER. Blood is not available at this facility and air med is not a possibilty due to weather. Ground CCT is an option though. What else would you like to do or know?

You get dispatched for a transfer of a 65 year old man who initially presented to the local podunk ER with a near syncopal episode upon standing. ER states when he came in, he stated he had blood in his stool and was nauseated. They dropped an NG tube which returned coffee ground like material. Pt also stated he had dark, tarry stools and has been tired and weak and also short of breath for last several days. ER states they administered ice water via NG tube and eventually return became clear. Pt states history of smoking for 30 years. Initial BP is 100/70, pulse is 110, but when you sit him up in the ambulance, it drops to 90/70 and pulse increases to 115. Pt also states he has epigastric pain. Pt states he regularly takes Tums, no other meds. No significant medical history except chronic bronchitis. Okay, what's going wrong with this guy, what will you do for him? You can cure or kill him, based on your treatment. More to follow - we aren't done yet !

Last night my mom was taken into the ER with chest pain, difficulty breathing and calf pain. I had been trying to convince her to go get it checked out for some time as she's been having problems and getting progressively worse, but of course, she wouldn't listen. She has a history of pulmonary embolism, which I suspected once again, and prelim ER reports say so. D dimmer is quite elevated and I just got home to quickly get some things before going back. I don't know if you pray or meditate or whatever, but please, send some well wishes and skilled physicians her way. They are greatly needed. Thanks.

all the EMS funerals I have attended that were solely EMS and not fire based or where the person was also a FF involved an ambulance transporting the casket. Most have had FD in attendance as well as some PD with a last call given and a ladder pass through out of respect that they were also public safety. The same applies to PD at least in this area. I can't speak for other areas, but thats how it works here.

Granted I come from a fire background - thus the user name, I am solely EMS now (though I run volly fire) and while my department has some of the nicest stuff in the area and I think overall some great stuff, it's a shame that fire can easily obtain new equipment whatever they need through the multiple homeland security grants and EMS is left to fend for itself. FF have lucrative pensions, as do PD - heck here there is incentive pay to be a FF, there is no incentive to get your medic - what gives? All their additional training is paid for - few EMS departments are able to offer this. Recerts in FD are totally paid for, few in EMS are. Fire schools are a chance for many to go and party for a weekend getting drunk in a hotel with things fully paid for - few EMS services can afford to send their people to quality con ed programs locally to improve knowledge. Saddest part is, fire uses EMS to boost their run volume to support their existance and while yes, both should have quality dependable equipment, I feel the priority should go to the service with the highest true run volume which in the majority of areas will always be EMS (and I'm not talking FD first response using that either). Perhaps the hospital based model really isn't that far off - we should really be grouped more with public health than with public safety but hey, what do I know, I'm just a lowly medic. Oh, and btw, I did give obama's website my two cents - not like it will be read but then I feel I can at least complain if I have given my opinion I have that right.

Kentucky baby ! Took alot to get this far, but we just went under technical college system and that put us with fire which automatically forced increased requirements. So plus one to fire for this one, but as I said, it's not been a dream boat and some actions as though mentioned earlier are being questioned...so we just have to ride it out. As was once told to me but oh so true - sometimes ya gotta spend money to make money.

hate to break it to ya'll but the names Eightball and East side are already used up as is ghetto gal. Hydraulic horses huh? that's all we need and drive by shootings? dear god, it would just be another day at hawthorne park in chicago - what's next on MTV? Pimp my pony ? Sadly enough, there really are weaves for those poor dear horses that don't have a tail (I know because I used to have a horse that required one - how sad is that? Had to have his tail amputated). As for the spinners, well, get harness racing involved and there ya go - just need to bling em out ! Thanks for the great laugh there !

To the OP : First let me say I am the only female within an all male department and have been for several years so I have seen and heard just about every discussion known to man. Some I really didn't care to hear, so guess what - I GOT UP AND LEFT ! Didn't take a genius to do that. I didn't care to know about some aspects of their lives, so yeah, I left it to them to discuss by themselves. Tactful way to handle it. No one was offended and all was taken care of. Second, HBO has a variety of shows on, not just porn, though I do admit some things are questionable at best. However, many of the movies that people state they are fond of have an R rating. They are for mature adults and again, if it offends you, just don't watch it. The language typically stated on any show on tv involves cursing (unless it's Little House On The Prairie okay?) though it varies to what extent. If people want to watch stuff at night, okay whatever, just in our station majority rules. We had a similar situation with two very religious coworkers that wanted it on the Jesus channel day and night - I think that presents just as much of a problem as anything else. Though I have yet to see a post about remove the Jesus channel on tv and what would your mama say if she walked into you watching Creflo Dollar (name alone lets ya know where his mind is)? We're pretty considerate of each other for the most part and we pass the remote around, so perhaps we are a little more progressed than other departments? I'm sorry if you are offended by what you coworkers have chosen to watch, but in an adult environment, there must be some give and take. And this isn't related to EMS only. I worked in other venues prior to my EMS employment and the guys there made the comment that when I was there they had to hide the porn (and yeah, we're talking real porn here). I made the comment if you feel the need to do so fine, but I appreciate the respect you showed by doing that, but when I'm not around feel free to have whatever you like. It was a give and take and ultimately in the end gained their respect more than had I walked in showing my disgust at everything. Sometimes a different approach gives you a better starting point ?

Okay, here's my piece of the pie I ride both sides of the fence. Full time EMS and PRN fire anymore. When the EMS board recently fell under the fire commission, I kept hearing gripes on all sides of the fence about how bad things were going to be. Well, it seems EMS was it's own worst enemy. Fire is pushing for higher education standards across the board, greater instructor requirements, and generalized improvements. However, there are a few concerning events which have happened recently regarding a new education push for an EMT advanced here so I'm not sure how that will play out. Was supposed to take effect the first of the year, and well now, it's all changing as the leader of the program was not reissued his seat on the board along with three others. Has solid EMS people crying foul and fire going WTF? Frankly I'm tired of the debate, can't we PLEASE just all get along? You know, if we didnt spend so much time pissing in each others yards, we might have a nice lawn instead just chunks of dead grass !

This statement is extremely concerning to me on a variety of levels. The first being that did we ever stop to consider that even a nasal tube can become dislodged? There is no way to monitor this if you dont have ETCO2 going as well ! Also, you have just placed a straw essentially into the patient's trachea - if they are unable to protect their airway to the point of needing intubation, well then they are needing to have PPV. As previously stated, if breathing, breathe with them. There is no reason to act this irresponsibly as a medic, and I am hoping this was addressed with the medic and if no satisfactory result, your employer. I wouldnt want them working on me ! I understand the need to protect the airway, that's fine. I'm okay with aggressive airway management, however, using just a NRB over the nasal tube, not cool. I dont know how many pt's you've seen nasally tubed, but putting blood in the airway (even if you use neosyn spray prior) as you are introducing something foreign and potentially causing trauma. I've seen many a patient have issues with bleeding and it's impossible to adequately suction with a NRB on. Period, end of story. Sounds like a recipe for disaster here.

I know cincinatti tried a brief trial of this thought of selective transport refusal based on pre established criteria. Great idea in theory, would have worked well until some monkey medics made the mistake of not transporting appropriate patients 'cause they didnt feel like it ruining the concept. I know a few other areas have given this a try or allowed transport to alternative clinics such as walk ins etc which I think could be a great resource if used appropriately. Would significantly cut down on ER visits and if we could selectively transport, fantastic, but as I said before, uneducated or lazy medics abuse it and you have deadly results. All well, guess we are stuck with what we have for now.

I always find it amusing to see the people that are put down as references. Ideally for a new candidate EMT or medic I'd like to see their instructor as a reference, preferably someone that precepted them, and also a former employer of any type ('cause we understand new in the field you haven't had a chance to show your EMS work history, but work history in general will give me a pretty good idea). Now for a proven EMS worker, I want two prior employers - one of them to be recent however current employer isn't required as I understand some people are looking, but don't want to rock the boat at their current job just in case it doesn't work out or they decide they don't think my service will be a good fit for them. However, don't give me a reference from a job four years ago unless you just left it ! Also, give me one personal reference - I want to know something about you and someone I can ask the tough questions to. Finally - I want someone related in EMS education - preceptor, instructor, etc so that I can see what your education motivation is. This gives me a pretty good place to start. You give me fake references, I'll check the numbers with you just in case you gave me a wrong number, but you falsify something on the app - I won't waste my time any further. If you'll lie about that what makes me believe you won't lie on other things? Also, letters of recommendation look very favorable for you, but I promise I will be contacting them for a reference as well !

I just read this - it was actually a comment that was made throughout my class as well as another one bites the dust - heaven forbid a pt realized that was what we were playing. LOL. I'm all for whatever works though, just not in front of the family - might cause a little problem there !

With the recent tragedies and the most recent being this morning of HEMS, I have been questioning hard whether the benefits really outweigh the risks to patients. Granted as I've said many times, I'm in a very rural area where I believe HEMS definitely has a benefit, but the more I look at it, the more I sit back and say how much will this patient truly benefit from going by air? If I couldn't justify sending them that way if there was a crash ie simply sitting down and saying they will die if they aren't with a surgeon in minutes, then they are going by ground. Period end of story. How many others here are questioning the validity of transports? As I understand it, the most recent was an interfacility due to seizures - could this REALLY not have been managed by ground? We need to allow flight crews to refuse flights and better educate sending facilities/ground crews as to what's appropriate to send by air. We need to sit back and ask ourselves what have we become?

Sadly yet another med helicopter accident - early this morning in aurora IL, just outside Chicago, a med helicopter crashes killing all four aboard - pilot, paramedic, nurse and 13 month old patient on interfacility transfer. Operated by Angel Air this was the third crash for the program with the other two being in 2003 (pilot fatality) and 2007 (no injuries). God speed to crew - prayers to families and coworkers. Sadly this is happening all too often.

What a tragedy - god speed.

Excuse me if I'm wrong, but nowhere in that article did I see them say docs are trying to take intubation away from us. Instead, I think they are addressing the importance of an issue which I discussed in a previous thread (be a kind medic) about the utilization of RSI and proper training and skill associated with it. I'm all in agreement with the author that the majority of services which have RSI protocols really don't need them. It is the new cool toy that everybody wants, but they don't want all the training and responsibility that goes along with it. That is nothing more than a recipe for disaster. I think if you can't do the con ed be it OR time or training on a sim man or als simulator to get the required intubations, plus a reasonable field number, then I think the service seriously needs to consider whether the procedure is warranted. It's just like any other skill - you don't use it, you lose it and I'm sorry but paralyzing and sedating and possibly not having and airway or not sedating someone is a problem I'm seeing frequently with service who don't have the call volume of serious patients to warrant it. The few I'm aware of that do have respectable training requirements in place to prevent this occurence. As far as what is carried within the drug box, ideally you should have a mixture of both types of paralytics and a myriad of sedation or induction choices. This one drug fits all mentality doesn't cut it with me. Each medic that performs the procedure should have demonstrated proficiency in the skill preferably before the med director before being allowed to practice on patients. It's not a matter of our own sitting there saying we need to take it away, but rather increase the training to maintain the skill. Frankly, if they aren't adequate in the skill, I don't want them doing it on me or my patients and would rather it be taken away and them forced to use an alternative airway or bag rather than causing harm. Just my two cents - keep the change.

around here the construction type vests that are reflective are required now on scene. Good move 'cause frankly I was tired of almost getting run over. I'm not convinced that the reflective stuff on pants is all that useful - kinda like the reflective badges who really notices 'em?

I just got done speaking with someone that I knew several years ago that got into EMS from the fire side. Now let me start off by saying, this isn't a fire or basic bashing thread, but simply venting some frustration from a situation that I'm seeing over and over. My state recently enacted a program to push all EMS workers to go through an accredited program after Jan 1st, 2009. If they weren't graduates of an accredited program or grandfathered in then they were just out of luck. Grandfathering will be adopted for all current EMS workers. Well I asked if he planned on pursuing his medic and his exact words were, "hell no why should I? I can get paid 11.41 an hour for three months worth the school as a basic. I don't see the benefit." He also later stated he had no plans to continue a career in EMS (mind you he works for a local shuttle service, non 911). Also claimed that moving towards an accredited program with instructors being required to have degrees was ludacris and would serve no benefit to EMS personnel. We claim we want things better, better pay, benefits, equipment, whatever yet we constantly prove over and over again that we are our own worst enemies here. A sacrifice has to be made somewhere to get what we want but everyone is wanting something for nothing and people, hate to break it to ya, but it just don't work that way ! Perhaps the upgrade will reduce people coming into the field with this bull headed mentality. Sorry to go off on here, but I'm just tired of hearing the same old story every day but then when proposing plans to change things people are resistant 'cause "that's how it's always been". Dang it that excuse don't work anymore ! If that excuse worked, then why do we bother changing protocols and doing any sort of research? Let's just keep repeating our failures and never move forward. Yeah, that's how we'll get recognized as a profession !

You can walk a mile in someone else's shoes, then when you're done laugh because the only thing is that you've walked a mile and you're wearing their shoes Even if you could walk in that person's shoes for a day, you wouldn't understand or comprehend what the thought process behind them was. You didn't have all the contributing factors over a long period of time. Perhaps it was the job, perhaps it was the failed relationship partly from the job, maybe it was that they had some underlying issues that predisposed them to this - who knows and who am I to judge? I've dealt with many a psych patient, as I'm sure most of us have, and while there are those that are doing nothing more than attempting to manipulate the situation and the people within their lives, there are truly those that are just pained so deeply they don't see any feasible way out of the situation they are in. Consider the schizophrenic who is incredibly intelligent, used to hold a respectable job, then as his illness progressed, he deteriorated to the point he lost it, many treatments were tried with no success, he no longer has a family, a job, and to him he has lost his entire fulfillment of self worth. Charged by the voices in his head which have taken over, he commits suicide to release himself from the torment which he faces daily. Is that selfish? Hardly that is a mind driven to a point that neither you nor I can understand as we have not been there. It is easy to sit back and say well that was selfish, he just quit trying, but I hardly see it as such. I'm not sure in that situation any amount of counseling may have prevented the situation. It was indeed as it is called - mental illness and sadly just like any other illness sometimes people die from it. As far as the coworker suicide issue, I am very aware of some of the thoughts which go behind it. I think all of the opinions voiced here are really in a way just different variations of the stages of grieving. We like to think as healthcare providers that we are superman and that nothing we see ever gets to us. But I know better after several years in this field. I also know that not anywhere near enough time is spent on talking to students beforehand about what to truly expect when they enter this job, nor is there any form of support when they experience difficulty within the field. I know from a firsthand experience, that often times you may want to discuss something over simply to come to terms with it in your own way, but you're afraid to say anything because you know the negative impact it may hold on your job if they see you ever sought help for a psych issue - be it stress from the job or personal issues which may be affecting your job. It's sad that we have that thought process but truly good EMS jobs are hard to come by, and those that are usually involve a psych eval - admit yes to that answer and well, there went your chances at a job. It's yes or no, no explanations permitted at least in my experience. They are looking for the best and it's competitive and well, any negative mark on your history of any sort reduces your chances. Also, I know it goes through the minds of potential employers of well this was a problem before, will it be a problem again rather than okay this was a problem before, they got treatment, issue resolved/being managed. It is the narrow minded thoughts as expressed by some others on here that leads to this ignorant mentality further contributing to the problem. Mental healthcare is one of the worst fields overall as many are just swept under the rug and ignored - around here they are lumped in with mental retardation which is a stupid thing to do as really the two have nothing to do with each other. You are not retarded if you have depression - it is an illness which can be treated or managed. That's just my thoughts for discussion may be worth two cents or not. Take it as you will.

"Six people are in the hospital after an accident involving an ambulance. It happened Friday morning on Kentucky 114 in Floyd County, when police say the ambulance slammed into a pick up truck. Witnesses say the pick up truck was waiting to make a left turn off of Kentucky 114 when it was hit by the ambulance. All six of the people involved, including a patient in the ambulance, were injured. Three people in the pick up truck plus the driver of the ambulance were flown to a hospital for treatment. "At the time of the collision, DHP Ambulance was transporting a patient. That patient was not being transported due to any emergency situation, simply a transport from one location to another," said Scott Hopkins with Kentucky State Police. The crash closed Kentucky 114 for about two hours." Courtesy WYMT news - southeast KY I read this today and just shook my head. I've worked this area for quite a while and also know many of the people for which work for this service (though I do not) and though they have had their fair share of troubles and questionable things, I'm not posting this to condemn or blast the service as I don't know the circumstances behind everything and currently rumors are flying. The only reason I'm posting this is to open everybody's eyes to make sure you are safe. I'd hate to hear of one of us being in the news for this. Please everyone always be safe and drive/fly cautiously.

Okay, time for me to join in the playground here. Can't help but wonder a couple things. One what's this kid's build like? Are we tall and skinny or stocky or what? Have we had some involvement with steroids possibly? Other issue is underlying cardiac that wasn't diagnosed. Have had several instances of that within the last year here of cardiomegaly that wasn't diagnosed until these seemingly perfectly healthy players were randomnly hitting the ground. Two basketball players, a soccer player, and a runner. What do his pupils look like? Any indications of head trauma of any sort? What do I want as far as treatment in ER? Since this sounds alot like recent episodes we've had I'm gonna push for a Chest x-ray, echo as I want to know if his heart is enlarged, and if so how is it functioning now? Can I have a 12 lead as well? Just for kicks and giggles run labs to see if his lytes are off balance. This guy may have been out in toasty weather, not taking in enough water, got dehydrated, and that caused cardiac abnormalities. Plausible for sure. As far as the bicarb, I'm with CB on not giving it with 3 min of down time and immediate CPR after witnessed arrest. Bicarb really only plays a role when you've had long down times with no CPR. That's when the acidosis factor starts kicking in and you may see benefit there. Our general rule is 15 or more, then bicarb, but less than that, we'll work 'em otherwise. Other services may work differently, but that's how we roll. Thanks CB for the good scenarios - you make me work there ! My brain gets tired !

Dust, while I agree with you on the state of many rural services having the mentality you state, there are some which provide a quality service to the area. Where I work is one such service. However, many surrounding us are only basic level services and yes, HEMS is a huge crutch to them, and if they can't get a bird they go into a full panic. My main arguement with having basic level only services for this reason. However, when time is a factor, and you are the distance I am from trauma/cardiac/specialty centers, it's definitely a plus to have that added benefit of quicker transport if and when appropriate. Key thing being said appropriate. After having worked in an ER and for several rural services, I'm quite aware of the practice of helicopter shopping when one service turns the flight down, they just keep calling or even will call same service two or three times pleading them to take it until they finally relent. It's not a safe practice. If we get one service telling us no, we may call a different base that will avoid bad weather which may have hit the other base, but if they say no as well we're done. That's the only time we may call another service. I'm not looking to kill anybody out there and I make pretty dang sure my patient will benefit from risking those crew's lives before I put a bird in the air. Alot of other people are flight happy - I do utilize choppers when appropriate and I see a definite benefit to my patient, but I have one of the lowest call rates as we function as ground CCT as well, so I really don't see the need to call as often. Many times less is more. I think issue of calling a chopper is also a matter of convenience for rural crews - they don't want to keep more crews on to simply take transfers so they call the birds to avoid having a crew out of service for three hours or so. In addition they won't know how to manage a very critical patient for that long, nor have the resources, training, or meds required to maintain that patient. It is just as Dust said, a crutch for them, and heaven forbid we should take it away from them. I will not insult the memory of this crew by trying to say what was right or wrong, because as I know most flight crews (at least in this area) don't have the capability to refuse a flight once on scene unless for safety reasons. Them thinking the patient doesn't need it doesn't allow them to say no. This in and of itself is a shame because I definitely think there needs to be a greater education placed on what really deserves a flight and trauma call as opposed to what is going to get a pretty chopper to appear. Let's take a deep look at the current flight criteria. If you look at it truly, just about any patient could be made to fit into the criteria. Heck, if that's the case, let's just call a chopper for everybody, not even bother transporting ourselves ! And sadly the HEMS industry feeds this by providing nice little posters and talks saying call us for this this and this. Never once have I heard nor seen anything saying this doesn't warrant a flight. Perhaps it has been said behind closed doors (I work with several flight medics on the ground and have heard the comments) but never is it said within the confines of their flight job for fear of losing it. And heaven forbid they do that because there is a multitude of those waiting to fill the seats. And in reality, with medicare/medicaid it is easier to get a helicopter trip reimbursed than an ambulance trip, even when ground transport would have been more appropriate and cheaper ! It's an industry fueled by money like any other, but one where safety should surpass that greed and sadly in it's current state isn't. Some things need to have a hard looking at and education on both sides from when to and not to fly for ground perspective and the flight persepctive to have the right to refuse inappropriate flights. Then I see things possibly changing, until then, it will be all talk with no benefit.