Just Plain Ruff

I agree to a point. but tasteful tatts are to me ok. But I seriously don't think that a heart with a name through it is out of line. But the biker tats that I've seen, well if you have one and it's visible, well, there's probably not a job in EMS that you are gonna get over a more qualified applicant with no tatts.

Iowa, where are you saving your reports to in order to recall them? If you are saving them anywhere other than the company computer and it's accesible to anyone then you run the risk of patient confidentiality problems. Be careful is all I will say. Here is my format. Call type Chest pain call Called emergency to the scene of a man complaining of chest pain. On arrival found a 47 year old male patient sitting in the kitchen complaining of severe chest pain which started 20 minutes prior to EMS being called. Family states that patient has a history of heart disease and high cholesterol. Patient relates that his chest pain is substernal in nature and radiates to his left arm and into his jaw. Patient also relates that he has been under some pretty significant stress over the past week or so. Exam: Heent: head, ears, eyes, nose, throat Neck: any jvd, trachea ok?, exam of neck Chest: what is the chest exam like? EKG: whats the EKG look like (12 lead and 3 lead) Lungs: lung sounds Back: Back exam Abdomen: bowel sounds, abdomen exam Pelvis: pelvic rock, any trauma GI/GU: what’s the urine look like, any diarrhea? Does the patient have a foley? Vaginal bleeding? BABY? Extrem: fractures? Lacs? Etc, Skin: skin turgor, skin color, skin temp Neuro: What’s their neuro status? You can put pupil response here or put it up in the HEENT section I/I: Impression and Impact this is what you think is going on - This is not a diagnosis area. You can put something like “Suspect Fractured femur” or Suspect GI Bleed” or “Suspect CVA” NEVER NEVER put a diagnosis always preface with Suspect or Rule/Out Treatment: Number your treatments for example 1:Exam 2: Vitals 3: Monitor 4: 12 lead EKG 5: Oxygen 12 liters Non rebreather mask 6: IV NS 18 ga left AC 125ml per hour and so on and so on etc etc 34: transport emergency to Hospital Alpha 35: Radio report to Dr. Jones with no order requested or received 36: arrived at Hospital Alpha with no change in patient condition 37: care turned over to Nurse Ratchet 38: Report signed by Nurse Ratchet You can modify this report format as you wish or not use it. It’s up to you. This is my report format that was taught to me by a very good friend who is a paramedic and an attorney and I have only been to court one time in my career and it was not based on my documentation. There was a question based on the documentation but it was the circle the boxes of the state form and not the narrative section. Good luck with whatever format you choose. I would strongly urge you to find if you can, it will be difficult to do but if you can find it I urge you to buy it, the book called “The fourth protocol” by Kate Doernocour (spelling might be wrong) It’s based on documentation and how to write a legally defensible report. One of the best books on writing a report. IT doesn’t teach you how to write a report but what to put in your report to make it be nearly lawyer proof. Michael

I know many people with tattoos in EMS that are excellent providers, that would do nothing to sully the reputation of EMS, so why throw them under the bus by using generalizations that by getting a tattoo they somewhat make the profession less of a profession. That' argument is hogwash. I also know many bikers who are kind and courteous and have tattoos covering all of their arms and neck and they do nothing to sully or disgrace the reputation of bikers but unfortunately those who are more disreputable have done the job for them. So to paint the entire tattoo wearing populace with a brush as broad as a barn door by saying that anyone in EMS who has a tattoo is destroying or is hurting EMS is just idiotic and backwards thinking. How many of the Cities members girlfriends have tattoos? I'll bet that if those who were saying the same types of things about EMS with tattoos were saying the generalizations about those members female partners and I won't repeat the generalizations, we all know what they are, I'll bet those members would not get off so easy here. I would think that the boyfriends/husbands of the women with tatts/and the women themselves would be up in arms and ready to kick some ass on this site because I can guarantee that not all women who have tattoos are giving the female race a bad name. So come on and let's get real, seriously, do you really think that they are truly giving EMS a bad name? Do you really think they are putting our profession in a bad light? Come on.

One thing you should never ever do is lie on your reports and many IFT services sometimes require you to do that. They make you put something like "Granny requires ambulance transport because she cannot ambulate to cot" or "Granny required assistance from bed to cot" when in reality she moved herself to the cot. Medicare audits charts and when they see discrepancies in charts from one service saying that they had to assist granny to the cot while all the other services have her not being assisted then they will do a deeper audit and they may nail your service for medicare fraud. So be careful when your service starts to require you to vomit out the narratives that they are having you write out in your numbered items in your last post. That's a red flag that to me that they are trying to get their techs to possibly commit some type of fraud. I've been in those shoes before and it was not pretty.

Ok, first off you have abbreviations and if you are using abbreviations does your service have an approved abbreviations list? That's important. I also do not see a head to toe assesment listed. My report format always will have a head to toe assessment. I will PM you my report format. My report format may work for you but may not work for others. I've used it for over 19 years with only a single trip to court.

Don't get me wrong, I am neither pro nor against tattoos but I think having visible tattoos that patient's see is unprofessional. Tattoos have a generally negative impression and that impression translates negatively over to those who have tattoos. That's unfortunately the impression that many people have of those with tattoos. And Wendy is right, remember that what you put on your body is there forever unless you spend oodles of cash to get rid of it in the future and even then it's still actually there, the removal techniques don't get the entire tatt. So if you want a tat, then by all means get one, I'm good with it, but make sure that you get it where it's not visible if you work in EMS, impressions count. I've worked at services that allow tat's to show and others that say you cannot work there if they show even a little bit and if you work for the second service and you get a tattoo and it shows and you can't cover it completely, then you are out, gone, finished, you don't even get to give a 2 week notice, they fire you. I actually think that tasteful tattoos on a woman are really sexy.

Ok, was on Facebook and saw a thread from a different forum and it had to do with EMS tattoos. I cannot find the actual threads but it showed a staff of life with a ECG tracing. It wasn't that well done but it got the message across. Most of the people were commenting that it was EPIC, and awesome and all that other rah rah rah that you would expect but there was some others who were saying that it was not so cool and really kind of stupid. I don't really care either way but I don't really care for tattoos on my body but other people can do what they want with their bodies. What is the CIties response to EMS Tat's in general? Like em or hate em? Do you think they portray your support of EMS or do they make you look like a Whacker? I'm curious as to what some of you all think.

Yeah, my last service, we usualy split crews. We had one ambulance initially. If we needed a 2nd ambulance it was at least 10-30 minutes away. So we had to split up. So one crew member went to one car and the other went to the other car or other area of the scene. So we normally split the crews. For services that have more than enough resources not splitting up crews it's not that big an issue. But I do see everyone's points on splitting crews. The pro's and the con's.

Well KIWI, that's what makes you guys bonkers about our education system right? But music you probably would not find a glucagon kit on a unconscious person unless they were a well prepared diabetic. I mean if I was found outside unconscious, you would more than likely not find a glucagon kit on me unless you found me with my computer bag which is where I carry my glucagon kit since I am usually pulling my computer bag behind me when I'm out and about, because I'm usually working. If I'm without my bag, my wife is usually with me. So a unconscious patient is probably not going to be carrying a glucagon kit on them unless they have a carrying kit or manpurse(if they are a man) or a purse if they are a woman.

I'm ok with this one. I would want my uncle or aunt to do the same for me since I'm a diabetic. Glucagon rescue kit is pretty idiot proof. You seem to have done the right thing. 911 was called. you gave the shot. You didn't give the glucose. You had permission from the aunt to give the shot. All's good. Other medics might not have been too happy but really it's not that big a deal. My diabetic doctor, He's a leader in KC MO in the diabetic medical field gave me a stack of glucagon admin instructions and told me to hand them out to whoever might have to give me a shot. He told me this. "Michael, glucagon can save your life if you need it. It won't kill you. It's not going to cause you to die of an overdose of sugar glucose entering your system. We can fix that. What we cannot have is you going too long without sugar in your system so if you go unconscious then by all means somone better give you the damn shot" So I don't have an issue with you giving the shot.

I don't split crews if they are going to be far apart but if there are two cars in a wreck, they are probalby close to gether. I was assuming they were close. So I have the medic go to the unconscious dude with the OP and the EMT or medic partner check the dead guy because they aren't really dead until someone higher on scene than a first responder says so in my olde system. You gotta get a strip on the dead guy. So that's the reason for splitting the crew. I do completely understand what you mean by splitting crews but there are still two patients on this call until patient 1 is determined dead by me or my partner. So I have to get one of the two of us on my ambulance to run a strip. And I'm not going to be that medic who relied on my first responder to tell me the guy was dead when he wasn't. I want me or my partner to make the determination. Let me ask this mike Let's say you are the first crew there. Do you and your partner go to the first car together and then to the 2nd car or do you stay split up and tackle one patent for each of you? That would be splitting up wouldn't it?

Face, it's not just for Dinner anymore.

After reading the article, I have to say, it didn't surprise me at all that this would happen.

patient 1 - dead - nothing you can do move on to next patient 2 - try to stop the bleeding - and wait for the ambulance. 15 minute ETA of ambulance just makes the 1st guy 15 minutes deader. And yes, the higher level of care should go check patient number 1 to evaluate deadness and then come see your patient. What should really happen is that the crew should split off and one check dead guy and the other begin on your patient.

Dwayne, I don't think this guy needs a transport out of there. By the way, where is this guy from? Is he local or is he a travel in? That might give us a idea of what patho's he might be carrying. But I do think that he does need observation. He's doing pretty good sitting and tolerating the oxygen. My sats were running in the upper 80's. They had me in the springs ER for 11 hours, breathing treatments for most of that time. then they admitted me for 24 hours and after that they sent me packing after my sats picked up to low 90s. I'm thinking I'd be a bit more concerned with this guy with his sats at low 70s though. I'd be cautious. Can you observe him for more than 48 hours or do you need the space? But you then have to decide, can you really take care of him if it's really something worse? I think you need to get him to a place where you can get a chest x-ray on him. That is going to tell you the most about him lung wise I think. Can you run a sputum culture? If you can then you can probably get an idea of what he's got growing in there, or at least a basic idea. He hasn't been on the antibiotic long enough I don't think to really see the benefit, what did your nurse put him on?

Dwayne, before we go down the road of microscope and stains and all that peripheral stuff, why don't you let us know what you do have available for us to use. That might keep us from going down the primrose path of nowheresville. I mean if he doesn't have cannulas, I'll bet he doesn't have microscopes and stains, but stranger things have happened in this type of place, right Dwayne?

It's the evil spirits stealing some of his oxygen but maybe his body hasn't acclimated to the altitude and the low oxygen content at 6600 feet. how long did you say he's been there? Maybe he needs some more time to acclimate to the high altitude. When I went to colorado springs for my first week on site at Memorial hospital Dwayne, I spent the first day at the ER on low flow oxygen due to a low pulse ox. It took 2 days for me to really get acclimated to the altitude. After the 4th day I was fine. Got a couple of breathing treatments and then discharged with a couple inhalers. My 2nd trip I had no issues and I was able to fly in and out with no issues. I tend to think that this guy might be just like me. I say watch him a couple of days and he should be fine. So he's been on the antibiotic for 24 hours now, any change?

Yeah, write your reports like you always have. If the company you are working for has a specific format then you will need to adapt but unless they do then do not and I REPEAT do NOT DO NOT DO NOT DO NOT DO NOT adapt to(I can't recognize correctly spelled words) guys format. If your report format has been working for you then don't change a thing. Your FTO or trainer has his way of writing reports and you have yours. if he has a issue with how you write your reports then by all means get with your departments QI/QA people and have it out RIGHT NOW and have it out soon. If you adapt to this guys way of writing and he's telling you that you have multiple spelling errors then you are the one who will be screwed not him when your new format get's called into court. So you better nip that in the bud. So if he is telling you to change your report writing to fit his style, that's a big red flag and you should take care of it quickly. I went through 5 EMS systems with the same report format and each one the FTO tried to make me adapt to his format and each time I fought it tooth and nail because my report format was taught by a attorney who told us what report writing should look like. Each QA/QI team at the services in question approved my format. So you better cut that off at the pass before it gets out of hand. Unless it's not an issue.

CHbare who? did he respond on this one?

Island speaks truth. You are the bottom of the bottom feeders right now. Don't rock the boat or as per Han Solo "you might bounce to close to a supernova, and that would end your trip real quick" Bide your time, bite your tongue. Remember that nothing lasts forever and being a probie doesn't either. Wait till you get off your probation and then you can start complaining at the company publicly. Hopefully no-one on this forum works at your company and is smart enough to put two and two together from your post. It could happen from your cryptic post, maybe not though. also remember not to treat your future evaluee like you are being treated. But what you have to do is just grin and bear it but if it gets too out of hand and the guy is too much of an Asshat then go to his supervisor but don't do it until you have things documented in a journal. Dates and times are key as is witnesses. But remember this(I speak from experience on this one) when you do this, you will probably burn any support that you have at that agency you have. You will be deemed the one who is classified as the "tattler" or Asshole. just my two cents

NO LIGHTS AND SIRENS. NO NO NO I got in late on this one from my last post and of course the best of the best were treating him. Continue as is, keep on trucking, drive methodically to the er and treat as you have been. Don't screw up what has been working. Oh yeah, does he have a foley? If so, you might want to empty the foley to gauge what his urine output is from when you begin treatment to arrival at the hospital. A full bag on arrival at the hospital doesn't help the nurses but if you empty the bag when you start to treat the guy and then bring a guy with a bag that has 200cc or 0cc into the er and tell them that you emptied the bag when you started treatment, that can tell the nurses some good info, especially if you decided to go with lasix at any time in the treatment regimen, which I don't believe we did. But sounds like the EMT City EMS Service is well on it's way to saving another one. Rock on.