Kaisu

Great to see you! I know you will be a tremendous asset to this site. We could use some new blood around here to shake up some of the old timers... we all do get into our ruts you know. I am delighted to see you and some of the others that are migrating over. The more the merrier!

Well hello and welcome. Is this your first time at this forum? If so, let me offer some suggestions - freedom of speech is welcome be prepared to defend what you say with logic, reason and facts...... have a wonderful time and welcome again

A point from me big guy......

Being alone here in AZ with my husband, I am a goto girl for people who want the major holidays off. Thus, I wound up working Christmas day on another shift than my beloved A. Every Thanksgiving and Christmas, management provides the basics of a Christmas meal for those working on that day. It is normally augmented by home baked goodies, etc. from employees, their friends and family to give us some fellowship and consolation for being on shift when the rest of the world is celebrating. This is primarily organized by the field supervisor of the shift. For example, the crew that worked the 23 and 24, getting off at 0800 Christmas morning, was provided with prime rib. Very very nice. Like everyone else working Christmas, I did not pack food, expecting a ton of stuff at the station. After getting on shift, and running a call 2 minutes into it, I went looking for what was on the menu. Guess what? NOTHING! Not one cookie, nothing. The field supervisor was stunned and felt that an obvious over sight must have occurred. The supervisor responsible had taken the day off, was spending it with his family and not accessible. ADAPT, IMPROVISE and OVERCOME! The field supervisor had a ham in the freezer. His wife thawed it and brought it over. My partner and I hit a variety of drug stores and the one grocery store open on Christmas day. It personally cost me about 150 bucks on my credit cards and I know my partner kicked in too for pies. We put together a meal. Although we were busy running calls, and never were able to get all the crews to sit down together, everybody ate. The next morning, the supervisor showed up for the second half of the 48. I immediately asked him what had happened to the Christmas dinner. He looked at me and said "Well, did anyone ask for a holiday meal?" I was non-plussed and said "I really don't know". I was confused and that was the best I could come up with. "Check with the crews and the field supervisors" he continued "and see if anyone requested one." He then walked away. Rule change - with no notification. A lesson for us about how much the company does for us and how we take it for granted. My personal belief - we have gathered all the signatures we need for bringing in the union and although no notification has been made to us, I think this supervisor, who is in the management loop, is retaliating. Merry Christmas to the station that gets the crap kicked out of it on a regular basis, generates over half of the revenue for the entire operation, all for the grand rate of 10.68/hour for a two year medic with 1500+ calls under their belt. Comments appreciated. PS.. reimbursement for the meal is doubtful

Hyvää joulua ja onnellista uutta vuotta عيد ميلاد مجيد وسنة جديدة سعيدة ¡Feliz Navidad y feliz año nuevo Весела Коледа и щастлива нова година Frohe Weihnachten und guten Rutsch ins neue Jahr Buon Natale e felice anno nuovo Joyeux Noël et bonne année Feliz Natal e feliz ano novo 기쁜 성탄과 새해 복 많이 받으세요 Веселого Рождества и счастливого Нового Года Sretan Božić i sretna nova godina Vrolijk kerstfeest en gelukkig nieuwjaar Merry Christmas and happy new year

My first instinct when I read this was "where is the outcry from the insurance industry". Now I am no genius, and I can often oversimplify things, but to my way of thinking, true health reform would have resulted in massive arguments from the people making all the money with the present situation. No outcry from the insurance companies equals bad bill in my limited little mind. Then, what to my wondering eyes should appear but an article in one of the preeminent nursing mags which I quote in full - Nation’s Largest RN Organization Says Healthcare Bill Cedes Too Much to Insurance Industry By National Nurses United December 21, 2009 The 150,000 member National Nurses United, the nation’s largest union and professional organization of registered nurses in the U.S., today criticized the healthcare bill now advancing in the U.S. Senate saying it is deeply flawed and grants too much power to the giant insurers. “It is tragic to see the promise from Washington this year for genuine, comprehensive reform ground down to a seriously flawed bill that could actually exacerbate the healthcare crisis and financial insecurity for American families, and that cedes far too much additional power to the tyranny of a callous insurance industry,” said NNU co-president Karen Higgins, RN. NNU Co-president Deborah Burger, RN challenged arguments of legislation proponents that the bill should still be passed because of expanded coverage, new regulations on insurers, and the hope that it will be improved in the House-Senate conference committee or future years. “Those wishful statements ignore the reality that much of the expanded coverage is based on forced purchase of private insurance without effective controls on industry pricing practices or real competition and gaping loopholes in the insurance reforms,” said Burger. Further, said NNU Co-president Jean Ross, RN, “the bill seems more likely to be eroded, not improved, in future years due to the unchecked influence of the healthcare industry lobbyists and the lessons of this year in which all the compromises have been made to the right.” “Sadly, we have ended up with legislation that fails to meet the test of true healthcare reform, guaranteeing high quality, cost effective care for all Americans, and instead are further locking into place a system that entrenches the chokehold of the profit-making insurance giants on our health. If this bill passes, the industry will become more powerful and could be beyond the reach of reform for generations,” Higgins said. NNU cited ten significant problems in the legislation, noting many of the same flaws also exist in the House version and are likely to remain in the bill that emerges from the House-Senate reconciliation process: 1. The individual mandate forcing all those without coverage to buy private insurance, with insufficient cost controls on skyrocketing premiums and other insurance costs. 2. No challenge to insurance company monopolies, especially in the top 94 metropolitan areas where one or two companies dominate, severely limiting choice and competition. 3. An affordability mirage. Congressional Budget Office estimates say a family of four with a household income of $54,000 would be expected to pay 17 percent of their income, $9,000, on healthcare exposing too many families to grave financial risk. 4. The excise tax on comprehensive insurance plans which will encourage employers to reduce benefits, shift more costs to employees, promote proliferation of high-deductible plans, and lead to more self-rationing of care and medical bankruptcies, especially as more plans are subject to the tax every year due to the lack of adequate price controls. A Towers-Perrin survey in September found 30 percent of employers said they would reduce employment if their health costs go up, 86 percent said they’d pass the higher costs to their employees. 5. Major loopholes in the insurance reforms that promise bans on exclusion for pre-existing conditions, and no cancellations for sickness. The loopholes include: * Provisions permitting insurers and companies to more than double charges to employees who fail “wellness” programs because they have diabetes, high blood pressure, high cholesterol readings, or other medical conditions. * Insurers are permitted to sell policies “across state lines”, exempting patient protections passed in other states. Insurers will thus set up in the least regulated states in a race to the bottom threatening public protections won by consumers in various states. * Insurers can charge four times more based on age plus more for certain conditions, and continue to use marketing techniques to cherry-pick healthier, less costly enrollees. * Insurers may continue to rescind policies for “fraud or intentional misrepresentation” – the main pretext insurance companies now use to cancel coverage. 6. Minimal oversight on insurance denials of care; a report by the California Nurses Association/NNOC in September found that six of California’s largest insurers have rejected more than one-fifth of all claims since 2002. 7. Inadequate limits on drug prices, especially after Senate rejection of an amendment, to protect a White House deal with pharmaceutical giants, allowing pharmacies and wholesalers to import lower-cost drugs. 8. New burdens for our public safety net. With a shortage of primary care physicians and a continuing fiscal crisis at the state and local level, public hospitals and clinics will be a dumping ground for those the private system doesn’t want. 9. Reduced reproductive rights for women. 10. No single standard of care. Our multi-tiered system remains with access to care still determined by ability to pay. Nothing changes in basic structure of the system; healthcare remains a privilege, not a right. “Desperation to pass a bill, regardless of its flaws, has made the White House and Congress subject to the worst political extortion and new, crippling concessions every day,” Burger said. “NNU and nurses will continue to work with the thousands of grassroots activists across the nation to campaign for the best reform, which would be to expand Medicare to cover everyone, the same type of system working more effectively in every other industrial country. The day of that reform will come,” said Ross. We have been sold out by a president desperate to get something done fast. This is a huge disappointment.

I am in no way excusing the actions of these providers. It is my firm belief that the only way to mitigate these types of incidents is to try and gain some sort of lesson from it. This story immediately brings to mind the mid-level provider minimization of symptoms syndrome. I truly believe that if these EMTs had been cognizant of the seriousness of this woman's condition, they would have acted. Once the newbie excitement has been ground out of EMS personnel, and before the true wisdom of seasoned veterans begins to take hold, there is a "been there done that it's nothing" mentality that causes providers to make serious mistakes. It is something that we need to be aware of and guard against. My personal experience is that seizures are one of the most "faked" symptoms I come across. Of all the seizure calls I have responded on, perhaps 1 in 5 have been true seizures and non have been life threatening. (self limiting, requiring supportive care and a trip to the hospital). I actually studied the phenomena of pseudo seizures in my efforts to be of some use to these patients, to try and understand why they do it so that I would not just dismiss these patients as "nuts". In this particular case, the pregnancy was a great big red flag and should have warned these EMTs that this had the potential to go very bad very fast. I would hate to be them, and not just because of the public censure and loss of job, but I don't know that I could carry the burden of the deaths of a young mother and her child.

What I really want for Christmas is 21st century drug boxes. We still use those damn tackle boxes. I had to drill new holes in the last one I got from the hospital because although their little plastic seal would go through the new ones they had drilled into it, my padlock would not.

If you didn't have a tube/scope blade small enough, your medic may have tried a needle cric with a 12 or 14 gauge catheter. It still probably wouldn't have helped, but it would have given you the knowledge that you had in fact addressed the hypoxia.

First of all, thank you for posting. I was and am still interested. That has got to be one of the shittiest calls ever. No wonder you had some difficulty with it. The pediatric calls seem to affect most people the hardest, and you had two dead babies. Was not inspecting the placenta a mistake? yes. Would many of us have missed it? especially in the heat of battle over the 1st infant? yes Did it make a difference in outcome? probably not. The only consolation I have for you is that that is a pretty rare call. A woman with twins and no prenatal care is not something many medics ever run on. Birth at 7 months is usually typical for twins. The small size of the babies tells me that these infants may have been much younger and likely viability was in question even if they had been born in the best of circumstances. Have you discussed this with a pediatric/OB specialist? What is their opinion? Thanks again for posting. It says a lot that you are willing to open up this very sensitive call for the scrutiny of your peers. I hope you are doing better with all this.

Nothing smartass about it. We do not have a choice. Our shifts are 48 on, 96 off. If we don't like it, we can find another job. PS.. we have surreptitiously collected approx. 90% of the signatures we need to bring in a union

Appreciate the heads up. I'm pretty dumb when something comes in purporting to be from the CDC and dealing with H1N1. I've sent a copy to my friends too.

Teri, Teri, Teri,

Greetings from the uncivilized part of the country. It was another one of those killer shifts. Three crews of 1 EMT and 1 medic each ran 37 calls in the first 24 of our 48. I finally got 5 hours of sleep at 9:30 the following morning when a supervisor called in a crew from the substation to get each of us some down time on the second day. The second half of the 48 was almost as bad. We went through 4 rotations after midnight. The angel of death rode with us this shift. I personally had 2 die on me, and one (details to follow) lived despite our efforts to kill him. This is the one that bothers me this morning, a full three days later, so as is my wont, I am writing to expunge it and appreciate comments from all. I had just returned from a call to the state prison, where a 25 year old inmate had shot himself up with a lot of heroin. CPR had been in progress. Long transport time, but this one is going to live. We get toned out for a gunshot wound in BF nowhere. This location is 40 minutes from our station down I-40, locale for desert rats and lean-tos. In this area, I have seen garbage piles that pass for residences, ran on patients with maggots infesting open wounds and 14 year olds beating up their grandmothers. Dispatch states “gunshot wound to the neck - the weapon has been secured.” That’s it - that’s all I get. We go enroute and I launch a rotor. 15 minutes into the run, I get an update from the BLS volunteer squad on the scene. There are a couple of new EMTs out there, which is a positive development because at least they still remember what they need to do, and are green enough to want to do it. I get “he’s got no nose, no tongue, and we can’t stop the bleeding.” I co-ordinate with DPS and BLS for landing the chopper, and it gets on scene about 10 minutes before I do. My EMT partner is tearing up the dirt road, he turns to me and says “I’m only doing this for you.” He knows I want to get there, and he is driving faster than he normally does. The dust from these dirt roads is infiltrating every nook and cranny in the cab and the patient compartment, and he is going to have hours of work to clean this thing up, if we ever get enough downtime to eat, let alone decon a rig. (Our “management”, 60 miles away, is based at a station that never runs on anything but pavement with half our call volume and 1 more rig, and writes us up when we turn over dirty rigs.) I get on scene. The flight crew has moved the patient on a gurney into the BLS rig. The patient is a 77 year old man. He is in tripod on the gurney. I see accessory muscle use, and labored breathing. There is a seeping clot where half his face used to be. I immediately flash to that infamous picture in the Brady Paramedic text of the patient with a shotgun blast to the face and whom my esteemed instructor referred to as the walrus. I also immediately recall his first rule of wing walking: “Never let go of one thing before getting a hold of something else.” This patient cannot be bagged because it’s pretty hard to get a seal on hamburger. I also figure that if I see no identifiable external landmarks, my odds of identifying internal landmarks are pretty slim. If it was my scene, I would hit the guy with some Versed and crice him. The flight crew is getting their RSI drugs ready. The flight crews around here are infamous for knocking down patients and then not being able to get tubes. I also note that there are no ACLS drugs in the rig (recall that it‘s a BLS rig). I turn around, go to my rig and get my drug box. On my way back, I note the patient’s son and granddaughter standing outside the rig. When I get back to the patient, they have given up on the tube and are cricing him. They get the tube in through a very nice hole in his throat and begin ventilations. The patient arrests. He is in a brady PEA. CPR begins and the flight RN is yelling at someone to get her ACLS drugs from the chopper. I draw up epi and pass it to her. As she is pushing that, I draw up the atropine. I hand that to her and she pushes it. I take over chest compressions. I get about 50 in and ask her to verify that she is getting a pulse with the compressions. She is. After about 2 minutes, we do a rhythm check. Patient has a pulse of 135 (um.. That would be the atropine) and a BP of 220/140 - um, that would be the epi. The Hs and Ts folks - when you cause hypoxia in a patient, if you correct that, you actually have a chance for ROSC from a brady PEA. I take over ventilations (and custody of the tube) from the flight medic. He is pumped because he just got his first field cric. My supervisor is on the scene. (He had come out in the supe vehicle) and he secures the tube. Does a fine job of it too. Patient is now stable. The EMTs and the flight medic begin organizing the move onto a spine board (why he wasn’t on it when they put him on the gurney is anybody’s guess). My supervisor grabs the yankauer and begins to suction the hole in the guys face. “leave that alone” I tell him - “it’s the clot”. He grins sheepishly and stops. A few minutes later, the RN picks up the suction and heads for the hole in the guy’s face. “leave that alone” I tell her - “it’s the clot”. Bottom line, the patient is loaded onto the chopper and off they go. They had debated taking him into Kingman and I chime in with “no - get him into definitive care in Vegas. That’s where he will need to be anyway”. They contact med control and get the OK to take the patient to Vegas. I am left on scene with my rig covered inside and out with dust, the BLS rig knee deep in trash and gore, and the patient’s family staring at me and my blood covered gloves, jacket and uniform. I remove the gloves and the jacket and go over to the family. “Is he gonna be OK?” I tell him the patient has done a lot of damage to himself. He wont’ be able to talk (no tongue), and I prepare them for the fact that he may lose one of his eyes and he has no nose. The son says “I wish I had known - if only… “ I stop him and say “It’s not your fault - there is nothing you could have done or not done.” The son collapses weeping into my arms. OK - so that’s the story. Now I’m going to tell you what had me up this morning thinking about it. This patient has shit for a life. He got to the point where he put a .38 under his chin and pulled the trigger. If he makes it, and I’m pretty sure he will, now he’s got shit for a life and no face. Tell me again why we do what we do. Thank you for listening.

Dear Santa, I would like a hungry hungy hippos game, some silly putty, and because I've been really really good, a Schwinn stingray with a banana seat and cissy bars. (I never got the Schwinn

Do not screw with a scandinavian..,

Did I miss it in the original posting about 15lpm via NRR? I never intended to imply that I would put hurricane force O2 on the patient. With no symptoms of SOB, they would get 2/3 LPM via NC... and yes, before anything else.

f we ever get 12 leads on our rigs, and if we ever convince the ED docs to pay the slightest attention to our interpretations, then I can start to think about doing a 12 lead before O2. Like many things, what we do is so much based on where we run. I am still dealing with idiots that say a 12 lead on the rig would be a bad thing because then these stupid medics would delay transport to get a 12 lead that would be done at the hospital anyway... I gotta get the f*** outta here...

Nope - O2 first. If it is ischemic chest pain, then as much O2 that we can get (both attached to hemoglobin and dissolved in the plasma) the better.

thanks for the posting. Rest in Peace Ms. Foster.

what a way to go - in the traces. Rest in peace chief.