ERDoc

Where are these places in the US where firetrucks are being replaced with a paramedic with an SUV?

Hey Kiwi, is this rash confined to the legs?

Even a broken clock is right twice a day, so be careful with that line of reasoning. Don't forget that not everyone needs a definitive airway. If you can oxygenate/ventilate with an NPA/BVM, then don't fix what ain't broke. Another question I have, is what was the cause of the code. Was this an OD? Would the pt have benefited from narcan? What do you mean by "code"? I've come to find that different people have different definitions.

If it comes down to a pt who really needs to go and you can accommodate them, then do so. In NY, the pt always had to go to the closest appropriate facility. We had a hospital that was not well liked and a large number of people preferred to go to one a little further away. Several times it came down to, "I'm going to Hospital B or I'm not going." It wasn't much of a burden on us and if it meant the pt got to the hospital and not left at home to die, then so be it.

I agree to some degree. The path of least resistance is always the best, but like you said, don't give into their craziness. We see plenty of pts in the ER who are in the process of suing us. As for my pelvic example, if there is a female ER provider I have no problems asking her to do it. Same with EMS. If there is an ambulance that is in a reasonable distance, then it might not be a problem. When I was a volley, we could barely scrape up a first crew, let alone trying to find a second. I sure as hell wasn't going to mutual aid a neighboring district for something like this. Then again, it was a volley system and you get what you pay for.

Ruff, the way I look at it is this. You are requesting an emergency service, you get what you get. The same thing happens in the ER. We get females of certain religions or persuasions who refuse to have a male do their pelvic exam. Sorry sweetie, I'm the only doc in house so you get what you get (I'm not calling in someone to do a pelvic exam. I can just imagine the laughing on the other end of the phone before it was abruptly slammed down). This isn't McDonald or the Sheraton. Now, I'm not that harsh with them face-to-face but I will try to explain the situation and why I feel the need to do xyz (much like you did). Sometimes it works, sometimes it doesn't. If not, here is your AMA paperwork.

If that is living, I think I'll take death. I know it is all in the head, but no thanks.

I was happy living in suburbia in complete ignorance. As far as I am concerned meat comes from the supermarket and comes in 4 varieties, beef, pork, chicken and fish.

Think of the pathophysiology behind a petechial/purpuric rash.

It has been a culture shock for me moving from the NY metro area to an area where there are lots of hunters. We have pot lucks at the hospital all the time. I never thought I would have to stop and ask what kind of meat was in the chili. I can't bring myself to eat venison, squirrel or anything other than cow or pig.

Such an open ended question. What kind of vacation are you looking for? Sit and relax, out and about, city, beach? How old are the kids? When is the vacation?

That is a good question that I have wondered about myself. We see plenty of studies comparing paramedics/ER docs/anestheisologist/etc. I'd be curious to see a study that evaluated the skills of providers that took time off to see if there is a difference. Is it the ongoing experince that makes the difference or is it the intital training?

I hate to say it but after living in the area I live in for the last 6 years, I could see it being difficult for someone with any form of "alternate" lifestyle getting hired. I, personally, would have no problem with it. As others have said, if they can do the job, I don't care what color, orientation you are or what planet you are from. If you can move the meat, you are more than welcome here.

I'm not trying to nitpick or go off topic here, but your reasoning is a little off. A perimortem c-section is done when the baby is above the belly button because the belly button represents 20 weeks and the baby is possibly viable at that point. The c-section is done to rescue a possibly viable baby. It does help the mother also by relieving intraabdomenal pressure.

Congratulations! Listen to what the others have said. Keep going and don't look back. Don't worry about what the others have to say, you are there to learn not to be popular. EMT classes usually have quite a few people who shouldn't be there and they get jealous of the people that succeed. Don't let them stop you.

A septic pt with a rash and melanotic stools. Doesn't sound good to me.

to win a lawyer has to prove 1) there was an obvious mistake made that someone of equal trainig and experience would not have made 2) you were solely responsible for this mistake ( ie varying from protocol or scope of practice ) and finally that 3) harm was done by you to the patient. 1)Name you in any lawsuit involving a dead or deformed baby regardless of how perfect your care was as long as you were within 2 miles of the ambulance that day. There, I fixed it for you.

But their surviving family members don't.

For those that are advocating forcing the pt to go against his wishes, how would you defend yourself in a court of law when it gets there?

Hey, what are you trying to say? We just conduct research so that we can be empathetic with our largest patient population. I think it is kinda funny how they describe paramedics as highly trained EMTs. I'm not sure why but it sounds funny.

Dude, how hard are you pushing that you are exacerbating a spinal injury? EDIT: And what does a long term relationship have to do with competing a proper exam?

Nurses and techs are salaried by the hospital so this will have no effect on their income. As for the hospital, it doesn't matter how it is coded when the pt arrives. There are certain requirements to bill certain levels of care and this depends on the physician. Billing is a complex entity and it does not matter if someone simply says, "Hey this is a trauma code." As for the ER physician, it depends on how they are employed. Some are hospital employed and salaried so it will not effect them. Those of us who are a part of a contract group get paid by what we bill. I'm not too worried about it because we can't keep up with the volume we have now, so losing a few people might not be a bad thing. Just because EMS doesn't bring them, doesn't mean they aren't coming to the ER anyway.

Holy overboard stupidity Batman!! I have to give this woman credit. I would be pissed and looking for heads.

Kiwi, in the US anyone under 18 is not considered competent, except when emancipated or a mother, so they cannot refuse to go. It is considered implied consent here.

Here is the other thread we had about this type of situation. http://www.emtcity.com/topic/22007-bystanders-with-cell-phones-and-taking-pictures/