Just Plain Ruff

This is awesome that you are planning on doing this. Too bad you can't get us approved for CEU's on this.

Why don't we ask this question. How many of us have been involved in an accident in an ambulance? Of those, how many have been involved while the ambulance has been in emergence operations? I can answer yes to both questions. Of those questions, how many of those drivers had any sort of EVOC or emergency operations driving training other than "get behind the wheel and drive" training. I'll bet if you asked the general public what kind of training they thought the individual ambulance driver got the answer would be more than what the generic ambulance operator actually gets.

Any movie with Charlize Theron in it I've got to See. Maybe she'll get naked too.

BARBEQUE GRILL?????????????? JUST Kidding

MedicAR, I have so much to say to your situation that I just can't think of the words to say them right now. You are definatly working in a busted system. Unfortunately your management team knows that by what you wrote that your coworkers won't rise up and fight for better work conditions so they continue to keep you down. I'm not really a union guy but your service sounds like it's ripe for a union if I ever heard of one being ripe for the picking. Someone needs to be the leader of it but they have to be willing to take the ball and run with it. I'm not up on labor laws but I don't think you can be fired for trying to organize a union but the company can probably find some way around that. If you beat a dog long enough, well you've heard that proverb or saying. Let me talk to some guys who I know who have started unions at agencies with even more shit problems than what you listed and I'll get back to you.

These are the think outside the box kind of scenarios that until you actually live them, they feel more like ones that you only hope you never get. There is an instructor in Springfield MO who uses these types of cases in his refresher courses all the times. Outside the box thinking is incredibly useful in developing exceptional paramedics. Great share on this one. Much appreciated. OK< for those crews who do not have access to Ketamine in their drug boxes what other medications would have been a good alternative for snowing this guy? What are some alternatives to managing this airway? This scenario has so much more potential to be a teachable thread.

I'm just going by what the flight medics/nurses would probably do in my area. I'm quite concerned by that 2cm of tissue. I'm going to transport this guy to the nearest hospital with anesthesia capability.

Nah, my helicopter crews would paralyze this guy and aggresively manage his airway even before they would consider putting him in the bird. If they couldn't intubate him they would surgically manage his airway. But he Would NEVER get a ticket in the bird if he was suicidal alone.

Yeah, I didn't think about what Mobey said, what would the possibility of your friends offering you a per diem job with them. A part time casual job. You get your love of flying and taking care of patients as well as time to take care of your family. What I am deathly worried about is this and remember this comes from the heart and it's not meant in a negative tone at all CM But here goes and take it as you will but I'm worried that you have spent so much time helping and bailing out your family members from so many situations that I'm afraid that you in essence have become your families enabler. You keep helping them and not forcing them to face their bad decisions head on and it seems like the only one who is hurting in these situations is YOU. Maybe you need to step back, play the role of paramedic and look at the situation from a detached point of view and say "enoughs enough" It's time that I work on me. Take that advice however you will. It's ok if you think it's the wrong advice. I just dealt with that regarding one of my best friends, and he told me to F off and now he won't talk to me but in my heart, I know my advice to him was right. Either or, my prayer list got a little bit bigger since your original post.

Exactly, if the guy is not fully incapacitated then he doesn't go in the helicopters in our area. The way to complete a suicide successfully is to open the door of the helicopter and jump out. That will end his suicide plans quickly but I'm sure doc you already knew that hence the devils advocate play. or the worst case scenario is he gets loose and attacks the pilot thus bringing down the helicopter and taking the pilot, medic, nurse and patient. A foursome so to speak.

This is the kind of airway and patient that makes many medics anus's pucker really really tight. The airway is unstable potentially but for the time being it's stable. But with a suicide patient he's already proven that he's willing to try to kill himself and he had the plan and the action to do so, so he's more than able to try to finish the job if you don't preclude him from trying to attempt it again. so you better darn well restrain this guy and make sure he can't reach his airway. To put this guy in a helicopter is a huge NO NO in my part of the woods. Probably any where else too. If we are going to intubate this patient you better have the most experienced airway manager available. You do not want a medic who may have intubated one or two patients in the past year trying to intubate this guy. That's a recipe for disaster because how are you gonna bag this guy when the first intubation attempt fails and he's paralyzed? I would try to wait until you get him to a very controlled environment such as the nearest ER or surgical suite with an anethesiologist or comparable level of airway support. Somehow I suspect that this patient realized that he truly wasn't ready to die and recognized that he made a truly monumental stupid mistake and he won't do this again but maybe not. But what you need to fully realize when you are transporting this patient is that this can go from bad(currently) to amazingly worse in a very short time so you better have all your equipment laid out, your medications drawn up at the doses appropriate for this guys weight, the tubes appropriate for his size (one size bigger and one size smaller et al), you should have at least two if not three or four additional sets of hands in order to help restrain this guy prior to paralyzing and intubating him because I am absolutely sure that you don't want to transport this guy by yourself in the back of the ambulance. This is one scenario that I would hope to not have to face alone with just my partner and myself.

I keep forgetting that your flight terminology also may include fixed wing which would allow him to walk to the plane where my flight terminology exclusively would focus on helicopter. good scenario

But the fact that this patient was flown out makes me think that this patient crumped in the ER at sometime. Thinking about it, I suspect (thinking out loud) that he developed a chemical pneumonia that degenerated into a pneumothorax thus requiring a chest tube and intubation. Without knowing what else happened and only having spotty info I'm also waiting for more. Mobey, you have damn good scenarios.

Crapmagnet, I truly cannot know what you are going through. But here is what I would do with your two friends on the helicopter service. Sit down with them, they obviously know what you are going through. There are some times when you just have to sit down to a come to jesus meeting and this might be it and talk to them. Tell them your story, tell them you might not be available till sept. See what they say. Ask them if they will hold the job? If they want you bad enough they will hire someone for this current position and then keep the next one open for you. If the job is meant for you the job will be yours just not on a timeline that is right this instant. On a alteranate note, Maybe it's time to put yourself first for once. I'm an outsider looking in, having read y our posts here, I only see your side but as an outside looking in you've provided many many chances to your family and you've been there for them and maybe like the mother robin, it's time to help them to help themselves. I have no idea how you will do that or if you can even make yourself do it but there comes a time when your pitcher becomes empty and you have to fill it back up before you can begin to pour it out again. But that's all I really have to help you on this journey as I don't have the same common frame of reference as you. I'm sure others can help you more. All I can offer you is a kind word and a few short sentences in a prayer said a couple of times a week. Michael

I think that if the local yokal hospital has no capability to deliver or take care of the newborn then they would be high on the list of facilitles who would be saying, BYPASS US PLEASE. But if they aren't then you have to assume that it's a dollars decision only and that is terrible medicine and downright dangerous medicine.

How deep was the bin of oats? Was he on top of the oats and if so could he have gone down into the oats and had to force his way back up out of the oats after being under the oats, a drowning in the oats. That would account for the sudden onset of the short of breath. It could also account for the pain, as he may have pulled something on his fighting to get out of the oat bin. The quiet lung sounds could be that their might be a clog of oats in one of his airway tubes. Probably not but who knows. I'd think he'd be a lot sicker if the above scenario happened but this could be the early onset of a soon to be very very sick kid. I'm anxious to hear the answers to questoins already raised.

Ah yes, young lieutenant bieber, I did not read the rapidity of the symptoms and I would still not take this kid to the doc in the box 5 bed ER but I would still defer transport to the big hospital with the peds ICU because of the rodent droppings, mold and other crap and the cornucopea of symptoms and other crap that is going on with him. Plus the kids' more than likely going to be transferred out anyway if he's taken to the small facility and well that would be me anyway so why put me on the road twice in one day so I'll opt for one trip and one set of bills for this kid. Worst case scenario is that the kid gets to go home from the big city hospital. Plus he probably gets' to go to a retaurant that he normally wouldn't get to go to as well. Plus I get to eat at my favorite BBQ restaurant in the city too. But if my index of suspicion is correct, and it might be in this case then I've saved the world once again.

EMLA cream also works wonders on the prep for removing suspicious lesions for biopsys. Numbs the area really well for the introduction of lido. But it's been said before, One stick of Lidocaine and then a stick with a needle for the IV. I'll take the single stick of the IV.

I think Wendy is spot on for early stages of hantavirus or mold exposure. Need to be really early suspicion on that. Pediatric critical care facility. A rural general care facility will more than likely not be this kids best friend if it turns out the be hanta or airborn fungus amongus illness. Remember the four corners virus outrbreak, I believe that the killer of the people was not the virus(well it was in the end) but it was really the slow to realizaton care that they received initially at the smaller low acuity care facilities they were seen at initially if I remember reading about those cases right. So having a high index of suspicion in this type of case and err on the side of caution.

Quoting Dwayne here "I want everyone to be able to excel and find happiness in whatever way that they choose. I just don't see where infringing on one person's right to pursue their happiness with whomever they choose impinges on another persons right to find happiness as well. " Damnit Dwayne, if everyone cannot be happy and even if one person is not happy then we all have to be miserable and if you won't let me in your house then I'm not happy thus you must also not be allowed to be happy ergo, I must be allowed into your house. See how this works. It's in the constitution, you my friend are going against the constitutional clause of the pursuit of happYness and I won't have that Dwayne, I'm therefore drawing up a constitutional amendment that makes it a federal crime to not be happy.

Miss Stephanie Speaks truth and she hasn't even run a single call. Even if every call you run and stage on turns out to in the end be safe, There is that one that will not be safe and that one you will end up waking up DEAD! How will you explain that to whoever your maker is?

There is one thing I've learned over the years is that there is one policy that I will follow to the letter and that is the staging policy. If dispatch tells me to stage then I stage. The policy is there for a reason. The law enforcement has determined that there at the time is a clear and present danger in the type of call that came in and they advised that EMS and Fire is to stage until they clear the scene. I'm good with that. If the OP decides to over-rule the orders of dispatch and law enforcement to stage and not go in until the scene is cleared then they need to be aware that they take all the risks if the scene were to go bad and something were to happen. I have a question to the OP. Are you willing to look your partners spouse and children in the eyes and tell them that it was you that made the decision to go against the dispatch and law enforcements statements to stage. Are you willing to tell your partners family that you felt that it was safe to go in? If you can say that you felt that since you knew the people involved or "your spidey sense" (insert sarcasm here) that you felt it just OKEY DOKEY. They have staging rules for a reason. This is sometimes the reason why medics get shot and killed. Ultimately the decision to enter the scene is yours, but remember when the shit hits the fan and law enforcement is still 20 minutes out, it was your decision to enter the scene and you better have some way of getting out of the scene by yourself until they get there. And when you can't get out of the scene, just remember that many of us here told you that you were taking a HUGE risk doing it. Not that I think really think you will listen to reason though.

Beer Fridays!!! Seriously, one of my previous employers honestly did this and the beer was free. But seriously, not many employers I've worked with have done much on keeping morale up. It was left to the individual employee. I'm not currently working in EMS right now but my current employer has a once a year company meeting where employees and spouses (kids are allowed but are supposed to be not seen) trip is paid for all expenses. Here is where they are sending us this october. www.paradisepoint.com WE are taking the entire family for three days prior and three days post meeting. It's our first family vacation in 5 years that we've actually been able to get off work with no client responsibilities of mine. Staying in a bungalow. Other than this company meeting, my company provides no other morale boosting items either.

I wish I had listened to what my father had told me when I was your age. Don't listen to the jones's or the miller's and don't try to keep up them. Just keep working on trying to keep up with yourself. In the long run who are you really competing with? YOU!!!! In 20 years, are you still going to be competing with the same jones family or will there be different Joneses and Millers? You have to deal with you and you only, keep looking out for yourself, make sure you have a roof over your head, food on your table, make sure you provide a stable family life and give to the poor if you can. NObody is going to bend over backwards to help you out so give if you can but remember, in a crisis situation you are responsible for you and yours so remember to take care of you and your family first as that is what your responsibility is first and foremost. Bieber, you have a great head on your shoulders, keep doing what you are doing and I can't imagine you going off on the wrong path. The advice is free it's what you do with it that comes with a price.

Yeah, I had the same experience AK. I actually refused the lidocaine. They nearly refused to do the surgery without the lidocaine for the IV first. I told them they were being stupid and obstinate. They finally relented and got the iv. The nurses were pretty pissed and upset I refused the lidocaine. They sort of were amazed that I was able to take the 20 gauge needle pain without the lido. I told them that I started hundreds of IV's over the past year without lidocaine and could count on one or two hands the times that a person had an issue with the pain of an iv needle.