ERDoc

:glasses5: :glasses5: Mr. Ruff, please come with us. We need to talk to you. Some of these shifts are absurd. Even residents are protected in reguards of the number of hours they can work (though the limits are not always followed). A simple internet search would show these people how dangerous it is to work so many hours, especially when you are driving a several ton chunk of metal at 65-70mph. If there ever is a serious crash, I'm sure someone will be going after these people for the number of hours worked.

This could have been any of the things you mentioned. May have also been a pappilary muscle rupture which happens after an MI. From the sounds of things, there is really not much else you could have done. This guy was done by the time he called 911.

It would also seem that once he is called on something, he disappears. Sounds similar to another Firefighter that used to be around here, who I believe was from Chicago (though I could be wrong).

I'm glad I could meet your high standards. :roll:

If your pt is crunking, I doubt they need a medic. A good DJ with probably be enough. Scara, you can use shit as long as you do not refer to feces. You can say, "That was a pretty shitty thing to do," but not, "There is a huge pile of s*** over there." See, damn FCC does it every time.

That has to be the most naive statement ever made. Maybe you misunderstood what I was trying to say (I'll give you the benefit of the doubt for now). I am not knocking this guy for being a FF. I have a great deal of respect for him for being one. It's obvious that the medical field is just not meant for this guy. The FD may be getting rid of a guy who could be one hell of a FF because he cannot do the EMS part. Seems to me like they are cutting off their nose to spite their face. Not everyone is meant to be a medic and not everyone is meant to be a FF and by expecting someone to do both means you may be eliminating some awesome medics/FFs. The FD has no business running EMS. The only reason they keep it around is to make their numbers look better when its time to ask the politicians for more money. "Hey look, our volue was up by 25% last year and we need $1,000,000 more to keep up." Yeah, that 25% increase was in your EMS volume, too bad they will only see an extra $2.50. The rest is going to be spent on shiny new firetrucks. NREMT, I may not have as many letters after my name as you do but I think my 10 years in the field prior to medical school has taught me a few things. Fire chiefs have no idea what it takes to successfully run an EMS service. They don't have the first clue about practicing good medicine. The can't (or maybe chose not to) understand research and EBM. Medicine chages daily and they just can't keep up. Having been on the physician side of things for a few years I have seen the same thing. The services that are exclusively EMS are generally more progessive and want to stay current on the literature. It is the fire based services that still think MAST pants and spine traction are good things. They are the ones that say, "We've always done it this way, so why do we need to change?" As a supposed EMS professional why would you want someone else overseeing you profession, especially when that governing body has nothing to do with your field? Having the FD run EMS is akin to having CPAs run the PD or the FDA running NASA. I just cannot comprehend why you would want to have your profession run by someone else. Maybe you can explain it to me. You say that the vehicle doesn't matter. Are you serious? Are you going to run an arrest on the back of a ladder truck? Do you put your trauma pts in the stump jumper? If you are then that is the type of cowboy medicine that EMS does not need. A medical pt needs a medical vehicle with medical personel who can transport them to the hospital for medical attention. Do you see the common thread there? I'm sorry to hear that you have had to deal with bad medics in the past. Five attempts to get an IV sounds a little excessive, but it happens. Some people are hard sticks. But that being said, we all know of someone who did something. There are good and bad in every field and I am not arguing that point, so telling me that you know someone who took 5 tries to get an IV and got blood all over the place is really irrelevant. There are some FFs who make great medics and enjoy what they do. I would be willing to bet that in a FD where they are forced to become medics and they have no desire to care for pts that their pts are not getting the best care. Would you want to be treated by someone who wanted to care for you or someone who was being forced to? Who do you really think is going to provide better care? In the end, isn't EMS and medicinei n general about providing the best pt care?

Another example of why the FD should not be involved with EMS. People with a medical emergency need an ambulance not a fire truck.

ASA is often used in women who are pregnant and have a history of miscarriages from a hypercoagulable state. It is given in a low dose. In late pregnancy high dose ASA, as well as NSAIDS, can cause premature closure of the ductus arteriosus (Google it to get the revelant info). I think in this case it is a risk vs benefit issue. I would not fault you for giving one dose of ASA to someone who is actively infarcting, but it would seem that those where you took this pt disagree. Because this is such a rare event there is no good literature to support either side. Personally, I would rather save the mother and possibly lose the baby than lose both. I also don't think going to L&D is the best idea either. The ER doc and the ER nurses are much better at dealing with MIs than an OB is. Keep them in the ER and call for stat cardiology and OB consults. Any idea what the outcome of the case was?

Gotcha. Sorry, you know how those things come across on the internet. However, if you feel the CVA is hemorhagic then ASA would be contraindicated. A pt with MI and a bleed is screwed however you want to look at it.

Please explain.

Does anyone else have a problem with a scale that gives a 2 week old corpse 3 points? I know it is totally irrelevant, but it is just a pet peeve.

I've gotta agree with others. There is not much you can do in this situation, especially since you are dealing with the feds. Your best bet is to know what the other services can and cannot do and make the best of it. PS-If you think Dusts remarks were malicious, you have not read too many of his posts. He was just giving you his opinion.

I respectfully throw down the gauntlet and ask that you site a source.

Here is some info for from the FAA: http://www.airweb.faa.gov/Regulatory_and_G...E/AC121-34B.pdf http://www.airweb.faa.gov/Regulatory_and_G...E/AC121-33B.pdf Here is a discussion from a pilot website: http://forums.jetcareers.com/general-topic...-aa-flight.html

He never had a first name. In one episode they showed a business card that read R. Quincy. Even when he got married he was referred to as Quincy. The woman that he married played his dead wife in a flashback in an earlier episode (coincidence?). Jack Klugman was asked what Quicny's first name was and he always replied, "Doctor."

Putting aside this case, since we don't have all of the details I'd have to say that there is a preamble to the first rule. Do not get yourself harmed. We are supposed to be an advocate for the pt but we also have the right to protect ourselves. I think most are sticking up for the medic because we have all been there and know that things can go bad real quick if you don't take control of the situation. Again, I'm not saying it was the proper thing to do in this case since we don't know much about the facts.

I also believe that the oxygen from the drop downs are not guaranteed to be medical quality. I also don't know if they can release the drop downs. I recently read an FAA release (though I don't remember where it was) that said the meds supplied in the kits are for medical personel that may be on the the plane to use.

I got dibs on Quincy.

No, but I'm sure if you were interested you could look through the articles cited in the info. Coyote, the correct treatment depends on what caused the seizure. I'll be honest, I haven't read this case over in a while so I don't remember what the final answer was, but if she was hypoglycemic she needs glucose and if she was eclamptic she needs magnesium.

I think anyone with a medical/psychiatric issue deserves the minimum amount of force necessary. Unfortunetly that will occasionall result in them getting hurt. As for someone that has created their own problem, ie drugs, sometimes they need to be quickly put in their place by a show over force, sometimes you need to use that force on them. Better someone strung out on something get hurt than someone who is providing care. I did take care of a kid with Asperger's Syndrome (kind of a mild form of Austism for those who don't know) recently. He had fallen and split his nose. This kid was 15 y/o, 6'4" and 250lbs and deathly afraid of needles. The only way we were going to get his nose closed was with sedation. I tried to give the kid oral versed. It usually works pretty well, but of course Murphy was looking over the ER that day. This kid had a paradoxical effect and became aggressive. He ran out of the room pushing all of the nurses to the floor. He went running down the hall with 3 large security guards hanging off of him. Looking back on it, the whole scene was pretty hilarious seeing these huge security guards hanging on to this 15y/o kid and they couldn't bring him down. It took 6 or 7 people to finally get him down. Luckily we were able to do it without hurting him. He ended up with a needle in his arm for procedural sedation and he sucked up the ketamine like candy.

When you are put in a violent situation by a pt you need to make sure you are well protected. This means using force greater than or equal to that which the pt has. That is why we call so many people in when there is a problem in the ER. In the field you don't have the luxury of calling everyone and their mother, so additional force may be needed. I can't say whether it was justified or not in this case based on what was given here, but crews should have every right to do what they need to do in order to protect themselves. Eydawn, I don't think your clients come under the same umbrella as this guy. Your clients have issues that they did not ask for or bring upon themselves. I don't think anyone would consider using such force on them. The same should go for people with head injuries. If you are drunk or high and become violent, you have no one to blame but yourself for the force used against you.

Dwayne, I think you handled the pt just fine. I think your case makes a great point of education vs training. EMTs are trained to do ABCs then secondary survey. There is no deviation from that. Medics are taught to think ahead, which is what it sounds like you did. If I remember my ATLS also, IV access is part of the C in your ABCs. Maybe you should let the American College of Surgeons know that they are teaching trauma care wrong and hook them up with this guys phone number so he can set them straight.

Wow, there is a man who is just not meant to die yet.

I believe that the medical kit and AED are no-go items. If they are not onboard, the plane doesn't go.

You are missing one critical things in all of these cases that would have meant the difference between life and death. An ERDoc!