Just Plain Ruff

anyone want to be a test subject to truly find out how much air a wood chuck breaths when a woodchuck well you get the idea. I do wonder how much it would take at times, especially those really annoying and special patients we all have.

I absolutely hate hot lz's they are rife with danger and the dangers are deadly. The NUMBER 1 question you have toask yourself is "Is my patient critical enough to require a hot load?" "is my patient going to benefit from this type of load and go situation?" If the answer to the two above questions are Yes then a hot lz is appropriate but I would say that 99% of all the patients you fly will not meet that criteria. I find that having a hot loading may be a crutch for inexperience. I have flown in my 16 years of EMS approximately 500 patients (80% were from the ER I worked at to a larger facility 50-80 miles away). I can honestly say I can't remember any of those patients who truly required a hot loading. Maybe 10 did but the others it was completely appropriate to shut the bird down and load safely. I'd say that Hot landing zones should be extremely limited to the patients where 7 minutes will mean the patients life or death. I also believe that hot landing zones should only be used in the most dire of circumstances.

I agree Wendy. A PM would have been better. Bad form EMSPROFESSIONAL

this has been the best thread of it's kind in months. Those who have posted have exceeded my skepticism.

for your 2nd Bravo. Nicely thought out and the like. I am afraid that the can of worms you opened here may not be all you wanted it to be. You will get those on here who hate volunteers with a passion. There responses will be typical Those who do not particularly like vollies but tolerate them and then those who like vollies. I fall into a I don't really care either way. Good luck.

[quote=" With that, there will always be a small number of patients who really will require invasive airway management modalities.

I've seen this happen, especially when the person has their own phone.

really he pm'd me the other day and asked me which type of penlight was better, he also asked me how many different items that he could put on his belt that wouldn't make him look to whackerish. But the best quesiton he asked me so far is should he go for the firemedic or vollie emt-p position at the local firehall.

There are several lines of defense 1. your partner - they have a mandate to report your screwups. I have reported enough of my own partners - if it endangered the life or hurt the patient then you have to report it. 2. QI/QA - review every run no matter how simple. I read a report on a cardiac arrest that was 9 sentences long. 9 sentences long. It got flagged and resulted in remediation of the medic. 3. The sup's - they are the next line of defense 4. Medical direction oversite - if a medical director isn't keeping tabs on his people then he should be.

let's take this example you are a medical director. Your medics under you have a intubation success rate of 45-55 percent and a 30 % success rate on RSI. How do you justify allowing them to intubate patients with success rates like that. I know of a medic out there who has a success rate of 25% for intubations. Do you honestly as amedical director want him tubing someone?

That is the crux of the issue - I believe that efficient, organized and lifesaving is not any where near what the government can do. That the term efficient and government are diametrically opposed to each other. I was reading somewhere that massachussetts government mandated program for health insurance would cost X number but it had ballooned to 3 times that much. I think the original number was 400 million and now it's 1.2 billion. So much for well run healthcare. I don't have a source but can find one if needed

take for example, Massachussetts, they have government mandated healthcare - it may not 100% be provided by Uncle Mass but they mandate that you have health insurance or I belive you get a fine. I'd be curious to see what EMS's call volume was before and after this was implemented.

Cons - potential loss of skills. I've found this to be true in my particular situation right now. This is a HUGE deal for me right now.

didn't take it as argumentative but fluids were this ladies best chance of survival and a BLS crew would not have been able to do that. But in the end, nah, she was a goner.

nope my son gets to rock for a full hour and I get to rock for a full hour. WE have to fill both the kindergarden slots and the 1st grade since they are in the same class together.

here is a prime example of a patient who had a superficial wound but it turned into a trauma code. 32 year old hooker, about 100 pounds, pissed her pimp off and he stabbed her in the thigh. She thought it was no big deal so she walked over to the local watering hole and sat down on the bar stool. The bartender called EMS because she was bleeding on his floor. WE get there, the woman is refusing to go to the ER. I decided to do orthostats and within 15 seconds she slumped to the ground. Her thigh was huge. We thought that was surprising. She was unresponsive and rapidly coded. 2 large bore IV's and cpr to the hospital (10 minutes away). She died. On autopsy, the knife had cut the femoral artey completely in two. She bled 3 units out into her thigh. The pimp couldn't believe he killed her but the knife he did use was a 1/4 inch stilleto style knife about 10 inches in length. her cut was about 1/4 inch in width. Kind of a holy crap batman moment. As for the criteria of the Fire guys on the original posters scenario, she'd have gone BLS.

sound like the fire guys need to go back to penetrating trauma 101.

What are the immigration requirements to go down under?

nah they put in a rectal tube and a foley catheter.

ROCK ON Zilla Care plans for EMS the wave of the future.

Thank you to those who purchased a book from my son's recent fund raiser. He was #3 seller overall for the entire school. You will not believe how excited he was to be featured in the kickoff for our next fundraiser. He got his picture taken and everything and also got 50 bucks in a target gift card. If anyone is willing to help out on his next fundraiser which is a Rock-a-thon where "Your's Truly" gets to sit in a rocking chair at 3am for an entire hour on a friday night please PM me with your name and address. I will get a flyer out to you and you can read it over. thanks for all the support from this community.

copy your protocols if you can't take them home. I'd be curious as to how many times that book has been looked at in the past 5 years. Probably 1 time per year by new employees. If they refuse to let you copy them then that is a HUGE HUGE HUGE red flag that reeks of "I'm scared, put me back in the box" to semi-quote Achmed. To re-iterate things - if there is another service you can work for, try getting on there. You may be forever harmed (mentally and careeer) by this service.

truly, 10-20 minutes extra on scene after a refusal is ok but 55 minutes and making sandwiches not this medic. but.... this sure sounds like some of the patients I took care of. When I approached their physician he agreed that this was a major issue and he ended up putting the ladies in the assisted living home(ALH). Every time I saw them they remarked how much happier they were at the ALH rather than at home. Not sure if this is what's happening to you and your crews but it might be a start to discuss this with their docs.

was told they needed a NIMS1 class. not sure what that really means. It was really only said in passing.

Anyone know where I can find a listing of the NIMS1 classes out there?