Just Plain Ruff

I'm not talking about charging the poor schlep who takes all the precautions and finds themselvess in need of rescue. I'm talking about the person or persons who think they are above the requirements or recommendations given to them by the park service and they disregard those said recommendations. Then they get hurt and the SAR members have to go find them. Those are the ones I'm talking about. Same with the water rescues when someone's boat flounders and they don't have the survival gear or equipment to help themselves. They should also be charged. Thsi guy and I on the plane did not part as friends, he was vehemently attacking my stance on making people pay. He seemed like a nice guy but I think that his priorities were misplaced. He seemed to me to have the hero attitude not the helping attitude.

I have also gone this route. I have seen enough whited out chest x-rays and then finding out that 1-3 liters of fluids have run in over the course of a code that I have limited my fluids to keeping the vein open and flushing the medication through the system. I will open the iV to flush the meds, and then turn it down. Pink frothy sputum seems to make me think that this is a bad outcome especially if the patient was walking around the local mall or ball park and collapsed in arrest. I tend to think that pulmonary edema was not the root cause of the arrest. Especially when the guy was a 44 year old very very active coach of his little league team.

Should the organizers of search and rescue operations charge those rescued? Should the organizers charge fees from rescued people if those people did not take reasonable precautions to make their rescue easier? I ask this because I had a great conversation with someone from Montana on a airplane over the billing question. He adamately said that those rescues should be free I disagree'd especially if that person did not take reasonable precautions like bring a Cell phone, a signalling device or some other way to be found. There are certain recommendations to all hikers and explorers that are universal and I think if those reasonable precautions were not followed then they should foot at least part of their bill of the rescue. For those who are separated from their equipment and signalling devices due to a fall or injury then they should not get billed. I'm sure all the SAR members of this forum will have opinions so chime away. Listen, we bill for ambulance transport, we bill for extrication and we bill sometimes for even no-servicing patients, why not bill for the rescues of future darwin award recipients?

I think that my main concern with fluids adminstration during arrest is after 2-3 liters (yes I've seen that much) infused into a very compromised patient, do we do them harm? I think that we do but unfortunately, the empirical evidence just isnt there but I have seen patients post code who's chest x-ray looks like a white sheet of X-ray film where their lungs are supposed to be and I'm suctioning copious amounts of pink frothy sputum from their ET tubes. Did the pulmonary edema come before the arrest and that's what caused the arrest or did it come after with the overinfusing of Saline in the code? That's where I'm coming from? I'd like to see the AHA Come out with some sort of definitive recommendation on this very point.

I just completed a Non-internet/non-texting weekend. Kind of clearing of the head weekend. I did check my work email but not much of anything else. I agree with the majority of those here in their opinions. ALS intercepts if done correctly can provide compromised patients who are receiving BLS care to get advance care. Correctly done I mean by saying is the BLS Crews recognize the need for ALS and call early. Don't call me 10 minutes outside the hospital when you've had the patient for 20 minutes already. By then it's a piss in the bucket of what I can do for the patient. Once the BLS Crews realize they need ALS the ball is already circling the proverbial toilet and there are many factors that help this ball get where it is. 1. The caller themself - what did they tell dispatch 2. Dispatch - what did dispatch ask of the caller or patient. Did they take it seriously or not 3. The BLS crew on scene - do they recognize the need for ALS quickly? I would consider any patient with the following signs and symptoms as needing ALS intercept if you are a BLS provider 1. chest pain 2. shortness of breath 3. Altered level of consciousness 4. trauma that fits in the class 2 or 1 category 5. stroke symptoms 6. intractible pain 7. any pediatric patient with resp distress, chest pain or many other assorted problems. 8. Pregnant patients who are due within 1 -2 days having contractions or other assorted symptoms or if they are premature and in labor There are others but getting some of the BLS Crews I've worked with in the past to think critically is like spitting at fish. BLS providers seriously can handle most generic emergencies but the GOOD BLS providers recognize when they may need help and call for it early. My 2 cents worth, maybe not worth 2 cents but my thoughts.

There was an article on the EMS Professional email that I get. It's about ALS intercepts and a study that was done. Here's the link http://www.jems.com/article/administration-and-leadership/paramedic-intercepts-bls-study?utm_source=Go+Forward+Media+eMail%2C+Powered+by+Bronto&utm_medium=email&utm_term=Paramedic+Intercepts+with+BLS+Study&utm_content=ruffems%40gmail.com&utm_campaign=JEMS+eNews+07-08-10 I hope that works. What are your thoughts on ALS intercepts? Do they do more harm than good? My opinion is fractured if you ask me. Often times the BLS crew calling realize they are going down the road to the patient gettting sicker and they call. Other times they call because they think the patient needs ALS. Both reasons I do not disagree with. What my fractured thinking is how long did this ALS intercept delay definitive care? The reason why I ask this is that my experience in ALS intercepts are the bls crew calls me less than 10 minutes outside the hospital I've been based at. We get in route and we pick a location where we can safely get off the road and get me into their ambulance. This costs valuable time for the patient. By the time we are back on the road, it's been 2-5 minutes or more because I like to get my own exam done and that takes time. I like to hear lung sounds and heart tones and all that. I like to get a non-bumpy ride twelve lead. If I need to intubate I prefer to be sitting still rather than moving down our counties roads. This all takes time. By the time all that is done, that BLS ambulance could have been at my hospital with the patient. The really good EMT crews I've worked with realize when they are out of their depth and call when they depart the scene. Others don't. What are some of this groups experiences with ALS intercepts. Does it waste valuable time or is it beneficial? The study showed that 76% of the time the patient got a monitor and an IV. 24% of the time the patient got more advanced stuff. Not sure what the outcomes for these aptients were, they didn't say. Of the past 10 ALS intercepts and that's over the period of a year, I think I've done more invasive and Higher level care than an IV and Monitor in maybe 2 of those intercepts, both of those patients had very poor outcomes due to one having a huge MI and the other in cardiac arrest. My experiences may differ from yours. Discuss

I have the unique opportunity to join a Homeschool Co-op education group that meets on Fridays every week starting in Mid-August. I have offered my services and they have tentatively accepted. I am planning on providing a general EMS/healthcare education class weekly titled "What to do in an Emergency" I am looking to gear it on the kid's level. I think that the class will be broken up into elementary school age, junior high school age and High school age. I am under no disillusion that it will have to be very very basic for the elementary age students especially the kindergartner thru third grade level. I am looking for ideas on what to cover each week. I am looking for insight from whoever may have done something like this in the past. Any suggestions are helpful.

Suggestion If a BLS truck, a volunteer ambulance, a ALS truck and a fire based medic all started from Point A, B, C, and D and had to travel 20 miles to get to the call which unit would get there first. Never mind, I got nothin.

Spin off topic from my "What's WRong with America" topic. What is right about america? What are we doing right? We are bombarded on the news every single day about what is wrong with America. What do you see is right with America?

Again, the solving an argument with a weapon rears it's ugly head. Never break up a fight, no matter if you are bigger than the two dudes fighting. Just call the cops. What was to gain for stopping this fight? We all know what there was to lose.

I was listening to a radio show this morning and the speaker asked this question. What is wrong with America? He gave his answer later in the lecture but I'd like to hear some of your responses before I reveal what he said his answer was. I for one think that America isn't broken, it's just got a few screws loose. We can sit here and debate big versus small government and what is worse We can debate immigration reform, healthcare reform, credit card and banking reform and also mortgage reform. Autobailout and wall street bailouts. It's a combination of all the above as well as We ourselves are part of what it wrong with America. We as a collective people I don't see us as really caring about the country. Sure we say we are patriotic and all that but I was reading a list of questions for citizenship. I didn't know the answers to some of the questions and these are questions that I should have known. That disappointed me and sort of made me sad. When the average person on the street in many big cities cannot tell you who the vice president is, what happened on 09/11 or even what year 09/11 happened, when they cannot tell you who many of the political leaders in this country are but those same people can tell you both of the Pitt's babies names, who Sandra Bullock kissed at the grammies or whatever show she was on, who won the last 5 years american Idol competitions, this is where I say we are what's wrong with America. I am what is wrong with america as well as everyone else. What am I doing to make America a great place to be? What am I doing to make sure that America is remembered not for it's invasion of Afghanistan and Iraq but it's overall legacy. What can I do to make America better and try to fix it. I'd appreciate your response. This is a NDA topic.

I agree CH but I've always been curious as to the efficacy of large amounts of fluid given to Arrest patients. I've always thought it in the end made for a more difficult recovery and have attempted to limit my fluids in cardiac arrest only to the amount required to flush the medications and also to keep the vein open. I've always wondered how many patients we throw into chf or pulmonary edema post code and am dismayed at the amount of evidence based studies that look at this.

I've been sitting here thinking something and I'm going to ask the collective for their thoughts (the collective is EMTCity) I've been watching at various ER's across the country and also in my own practice and place of employment. I see these cardiac arrests come into the ED with Fluids running wide open, often with at least one bag of fluid already infused and a 2nd bag hanging. These codes of course come in all shapes and sizes of patients. We've already realized that using multiple medications on patients often provides a detriment based on the medications all working on different actions or different parts of the body and by staying in the circulation this hodgepodge of medicines post code can be problematic to say the least. I have seen multiple code saves or even codes in progress with the IV's running full bore and flowing into the body often times with pressure infusers going especially if the access is an IO device. My question is this - are we helping or hindering patient outcomes when we do things like this?

ok, first thing first, STop do not pass go and do not ask for medical advice here on this forum or any other. You are asking for trouble. If you continue to ask for medical advice and coming here makes me think you are not truly talking to your doctor, then I will not feel sorry for you when something does go wrong that your doctor could have fixed or at least been aware of. Now if you have exhausted all your steps with your doctor, then I take back the above. But seriously, have you been to a general practitioner or have you been to a cardiologist. I used to work for a hospital who did treadmills all the time, adenosine stress tests all the time and we didn't have a cardiologist on staff, just a physician who knew a crap load about cardiology but sent any patient with chest pain to the city even though that doctor could have treated his condition at our hospital. So, get your rear in gear and go see a different cardiologist or go see an actual cardiologist. The fluttering feeling is telling you something. It might be benign or it could be the death of you with the fluttering signalling the beginning of a irreversable cardiac event. You never know what is going on and the services of a qualified medical professional is so much more valuable then a bunch of guys and gals from a website that you know nothing about their qualifications, their knowledge base or their motives. You could get someone with the best intentions and then again, you could get someone to PM you with some nasty intentions to lead you astray. If you choose to rely on what our collective knowledge gives you, then you make your own bed and choose to lie in it. So what I'm trying to tell you is, Don't listen to us, go to a cardioligist and get your information from them. Remember a lawyer who defends himself has a fool for a client and a patient who treats themselves with this type of illness has a undertaker in their future.

I might just call him today and catch up.

I sent an email to the director of the mass ems division. I gave him kudos for sticking to his guns in what was probably a very difficult time. I bet that the IAFF was up in arms there and giving him hell. I told him RIGHT ON BROTHER in sticking to his guns.

Your community just got on the top 5 of the communities that I would look into relocating after the situation regarding my other post comes in. But.... and theres always a but.

I think that since it's directly related to this guys care that you can talk to anyone with a need to know the info. Social work would fall into that category. Next time you haul him into the ER during the day, go to a ER phone and dial the operator and then ask for social work. Explain who you are and then tell them what the issue is. They will take it from there. I got this advice directly from a social worker at one of the busiest hospitals in Central Florida. Remember, if you don't think anything has been done for this guy then you are probably right. Good way to take the iniative. One other thing, I'll bet your service will tell you that as long as you tell the ER nurse then your butt is covered. I say go the extra mile like I think you will.

All good points. Your other option would be to bypass miss I'm not gonna do anything but nod at you Nurse, and go to the social work office of the hospital you transport him to. They are the best people you can go to in my opinion. They can evaluate his placement possibility and go further than the nurse in the ER. I'll be what you tell that nurse goes in one ear and out the other and she may mention it to the ER doctor but seriously, the ER is ill equipped at times to effect a nursing home placement or even a assisted living arrangement. The Social work is where to go. If he's elderly then you could hotline him to the elder hotline. It's not an abuse case but he is not getting the care he needs so they can also get the ball rolling. To many medics and EMT's this patient would be a burden to them, taking them away from either their recliner or the "Good calls" and I applaud you for not being a butthead about this guy. Besides, isn't transporting patients of all makes and models part of our job?

Lone, I don't believe your experience was an isolated incident in the realm of online courses. The instructor has to be committed to online education. They do not have a pulpit or platform to deliver a personal lecture but they have to rely on the intricacies of online delivery. Life events that can be addressed such as deaths and personal issues in person or in a classroom session often get extended in an online environment. I had one course where the instructor just vanished for two weeks. By the time that she returned she was so far behind that the rest of the course was a hodge podge of minimalistic lessons. It was by far the worst class online or off line that I've ever had. The students gravitated away from the class and in the end, the class was counted but it was offered to the students at no charge a second time. Unfortunately had the same experience in a in class course yet the instructor was able to appoint a substitute instructor. The class suffered for only two weeks and it was back to normal.

I worked with the oldest paramedic in Missouri at one time. She was around 84 or so. She forgot more about EMS than our entire system knew. She could do anything us young 24 year old whippersnappers could do. I do not know what happened to her after I left the service but if she was able I'm sure that she would still be working a rig 18 years later. That would make her nearly 100. I'm sure she's dead now but who knows, maybe she's providing EMS for those in heaven?

So true on the routine statement. But the same thing goes with our jobs where there is no such thing as a routine call. Something may go wrong. But as far as the two officers were concerned, I'll bet that they were doing their routine and it went terribly wrong. Supposedly they caught the driver (female). She is not considered a suspect at this time. I think probably is that she was driving this dirt bag around, they got stopped, she was cleared by the officers and the dirt bag was being arrested and he killed the officers. I suspect that the girl panicked and ran when the suspect ran. She may have been involved but my thoughts are that she wasn't and was just in the wrong place at the wrong time. I am not sure whether she turned herself in or they caught her. Either or she is the star witness.

I was hoping that someone had firsthand experience with this school While I took 3/4 of my master's degree courses online and only a few in class I felt that online was a great way to learn but it just wasn't for me. Expediency and personal financial situations required me to take the online version of the school. I think I grasped or gained about 50% of the knowledge that they were trying to give me via online courses. If I had more time on my hands and more time to devote to studying the course materials, I am sure that I would have learned a great deal more. It all is based on how much you apply yourself. I applied myself to the learning but probably not as much as I should have. IN the classroom courses, I felt that I learned so much more. After 2 years of classes ONline and off line, 36000 in tuition and books, I have a masters degree in project management. Could I have learned more, sure, but with my time constraints I did not. before anyone gets all hot and bothered about the time constraints statement, these were 10 week courses (classroom or internet), I was working 70 hour weeks and the few spare hours a week I had with the family left me with a small amount of hours each week to devote to class. I did not take the courses from this college as a get the education quick scheme.

Out of death comes life. The 2nd officer who passed away this morning will be kept on life support until his organs can be harvested. Out of death comes life. It appears that the suspect(s) shot the officers and then ran them over with the car when the female drove away. The male suspect took off on foot. they know who did this because the officers already ran the guy and girl for warrants and found a outstanding bench warrant on the guy. I wouldn't be surprised if the suspect doesn't make it to the police station. The entire state of Florida is looking for these two pillars of society.

Ok, while perusing these great forums of ours I came across the College Network advertisement. It says "Paramedic to RN No classroom attendance required" or something lke that. Just what kind of nurse can you be if you have no classroom time and a limited amount of clinical time? Aren't these degree or non-degree programs just as bad as our Paramedic mills and 12 week medic classes?