Just Plain Ruff

you bring up a interesting point. Anyone want to address that? Wouldn't getting a tip be considered some sort of payment for your services and be a bad thing?

Or the Natalie Holloway investigation. Seemed like that was all she talked about for a year. She's one woman I'd love to pay to shut up.

But even though the medic looks 50 the other guy has had 11 bypasses. WTF?? 11 bypasses? Seems like he was not needed in the afterlife, they spit him back. Kudos for the medic, these stories are what we don't hear enough of.

but don't you know, everything here eventually gets sucked into the basics versus medics thought process.

do you disagree ccmedoc?

The arsenal that an EMT has to use to treat patients is so much less than what paramedics have that many many times the only thing for the EMT crew to do is to get to the hospital where the patient can get to definitive treatment. If you have a limited scope of practice and a limited amount of tools of the trade, the allergic reaction or the MI patient has to suffer with only Oxygen and transport. Often to the detriment of the patient.

I just tell em "It sounds like Ebola or Marburg" and then tell them to go to their doc.

It's all about the SKILLZ JP the Skillz

Holy Crap batman, that partner sounds like a mass murderer in the making. He should have been arrested for the mace.

ok let's put this obviously rediculous concept of "Balls to the walls" to test here. You are the patient. You are having an MI. You are in the back of the ambulance. Your transport time is 12 minutes to the hospital. Your driver and attendent both decide that they need to get you to the hospital 12 minutes away at the fastest time possible. So they light em up. Rapid acceleration from the get go. At the stop sing or stop lights the ambulance applies it's brakes rather liberally and slows to a rolling stop hoping that the traffic clears. Then rapid acceleration again and repeat. You are bounced around in the back, you are looking outside the back of the ambulance and beginning to get a bit queasy. Is it the MI causing that or is it the drive. Your stress level begins to rise because of all the rapid acceleration and rapid slow downs and you begin to have an increase in pain. All of a sudden you hear your driver (who is supposed to be a professional) scream or yell some obscenity at a driver for not pulling over all the while slamming on the brakes to avoid hitting the recipient of his tirade. Now your chest is hurting more and more and you are only halfway to the ER. Out of the blue, in the intersection just minutes from the hospital you hear the sound we all dread to hear, HOLD ON and then WHAM your ambulance is it broadside by someone who was not paying attention to the road and didn't hear your siren. Your ambulance ends up on its side and you are hanging by two straps on the gurney. The cardiac monitor which was loose has struck y ou on the head and you feel woozy, is it the MI Or the head injury. You now have to wait an additional 8 minutes for additional assistance from the local fire department and the same ambulance service that you placed your trust in to begin with. They gently place you in c-spine precautions and move you to a backboard. You complain you cannot breath but because of the moronic driving of the professional driver they say you cannot sit up because you could have a spinal injury. The iv's that you had started need to be started again because they came out in the wreck. This ambulance crew that you are now transported by take the trip nice and easy and you arrive at the ER without more complications. Due to the wreck and stress of the drive your physician says that maybe your MI was made worse. Worst case scenario???? No, it happens all the time, not to this extent but it happens. We need to rethink our use of lights and sirens. Does it save time? does it save lives? What are the risks that are associated with lights and sirens? What level of training did your driver's receive? Do they all go to EVOC or similar training or do they just go to the largest parking lot they can find and practice driving? Do they spend time on the road in the ambulance without a patient in the ambulance until they are comfortable driving the ambulance? What is a safe speed? You see, there are so many more dynamics at work here than just getting the patient to the hospital in the fastest time possible. If you want to know what it feels like to be a patient in the ambulance, get your partner or your drivers training guy to take you out in the ambulance. Put yourself on the cot, strap yourself in. Ask the driver to drive like he would a normal non-emergency slow stopping and slow acceleration and easy turning. See how that feels to ride on the cot. Next, have the driver drive like they were driving emergency, fast acceleration, fast stopping and hard turns. See what the difference is. I guarantee you will never drive the same again.

you are soooooo correct - Medics save lives, emt's save medics and er docs save the world.

well if the bill is gonna be like 1000 bucks you should get at least 100 to 200 dollars for a tip. Any less from anyone makes em a cheapskate. Why don't we just put tip jars on the bench seats like the jars you see at starbucks for tips. and depending on the circumstances I don't tip. Like for instance, I was in baltimore Maryland and was in a cab going from the airport to downtown. They guy was going 25 miles per hour higher than the posted speed limit and drove right past a police officer. Well he got stopped, he refused to turn off the meter during the ticket and since I took the trip weekly I knew what the fare would be so that's what he got, 15.00 and nothing more. No tip nothing. He was not happy. So no I don't think we should accept tips from anyone. It's unprofessional. The patient is already being charged enough.

I fly every week and am on good terms with most flight attendants. There is no way that if you go into cardiac arrest on an airplane that you are going to survive to landing unless you have a shockable rhythm and even then it's no guarantee. There is also no probable way with even a cardiologist, a trauma surgeon and 12 paramedics and 15 nurses on board that you can survive a cardiac arrest. You are lucky to get a medical kit that will do much good. Don't expect to be able to run a code in a plane with what the medical kit's have in them. Plus there may be a maximum of 2 if not three oxygen bottles on board. I was on a plane at Detroit airport and a woman began to crash on us, it was myself, a physician(general practitioner) and the flight attendants. She was more than likely suffering from a PE and was rapidly going down the road to codes ville. Oxygen was applied and we got out the AED and I was informed that only the flight attendants could operate the AED per FAA Regulations. Not sure if that's true but it sounded legit. The med kit never got opened but when asked if they had epi and atropine in the kit the flight crew said they weren't sure. So a plane is the last place you want to code. There is no way that you can get to another airport to land in a resonable amount of time. It takes at least 20 minutes to prepare to land and to bring the plane down and that's IF you are 20 minutes from the nearest airport. Look more towards a 45 minute to 1 hour flight time to the nearest airport. We need to look at this story from a critical viewpoint - even with the oxygen would she have died anyway? With what sounds like she needed - High flow Oxygen, the two or three tanks would probably have been emptied out regardless. Just remember one of the cardinal rules in medicine - All patients eventually die. It was just this woman's time to go.

ABSOLUTELY You cannot drive safely at high high rates of speed. As a matter of fact, many emt's and medics cannot drive safely at any speed. this has been discussed over and over again.

another person here saying you can't get good money unless you are a fireman and a medic. I know of at least two if not more places in the Kansas city area(within 60 miles) that pay upwards of 50K for a medic and you do not have to be a firemedic to make that. Blanket statements are just that, blankets.

Let me ask this question. Do you know what her eventual diagnosis was? Could she have been suffering from some infection of some sort which in diabetics causes sugars to go all hinky at times. There is a definate cause for concern when the blood sugars do not stabilize after everything you did for that patient.

Actually incog you shouldn't have to take a beating for wanting to stay the level you are. What I think gets us all inflamed is those emt's who state why can't I push this drug, why can't I do an advanced skill if all I have to do is go to an additional class. If you like the level you are and are happy there then by all means stay there but those who want to do more as emt's and think they should get to play with the fancy medic tools then those are the ones we have problems with. Those who do not know their limitations nor admit that there should be additional schooling or education to actually perform the skills are the ones who are causing one of the biggest disservices to the profession.

Excellent further post The way you go about addressing a possible treatment error by a medic or an emt or a nurse is to get the facts straight first. You can't go to a gunfight with only a knife. You need to confirm or try to confirm that the incorrect treatment was rendered. For example, Giving nitro to a patient with a blood pressure of 60/40 c/o chest pain. That would be a bad error. The correct way to question the medic is to repeat the blood pressure to them. Hopefully it will make the medics brain click and say, Holy crapola batman, I can't give that medicine to the patient. That's bad karma. Then you can discuss after the call why the medic thought the way he/she did. If the medic still gives the nitro then you have to address it with their immediate supervisor or the physician taking care of the patient. By no means did I mean to say in my previous post that you have no right to question the medic but what I meant to imply is that there may be something more directly going on with the MI patient than meets the eye. There is nothing wrong with questioning any type of medical treatment. Believe me the patient will thank you and most times the medic will thank you that you helped divert them from making a bad decision. it's great that you are going to medic school. You will be able to more neatly assess and understand why the medics do what they do and what their thought processes are. But one word of caution, just because you are in medic school does not a medic make. Don't come off as a know it all and you will succeed in your endeavors.

An article written by Dr. Carlos Frederico Arend in 2000 for the Brazil Cardiology Association states “Since the first medical use of mouth-to-mouth ventilation in 1744, only the transmission of tuberculosis, Neisseria meningitidis, Herpes simplex, Helicobacter pylori, Shigella sonnei and Salmonella infantis have been documented. No case of hepatitis or HIV transmission has been described over these 254 years so HIV has been around for 254years? plus, why are they using data from 1993 and 2000? Isn't there any more recent studies to use?

Congratulations - you just overdosed your child with twice the dosage of tylenol. According to this website http://www.rxlist.com/cgi/generic/apap_ids.htm the dosage of tylenol for a 10 year old is 400mgs. How are you going to explain this overdosage to the physician?

Ok, I'm about to either kill myself here or not. This post will more than likely piss a lot of people off but I'm gonna say it anyway. Here I go. If you thought that the medic giving the wrong drug to a patient why didn't you question them right then. If by your counts the medic was giving the wrong drug why didn't you SPEAK up. We all know what happens when the wrong drug is given. The best scenario by giving the wrong drug is a minor drug event but it could be catastrophic for the patient. You feel that you can question their judgement but you don't question them on scene. I would be grateful for a partner who questioned my giving something that they felt was wrong. It has to be done on a practical basis and not directly in front of the patient. You can bring this up to me in numerous ways. To be blunt here, an EMT can question a medic only so far. The emt has not been thru ACLS, has not been thru a pharmacology class and barely has enough A&P and assessment education to really question things. Sure you may have a lot of experience but like Doc said, there is a lot of underlying causes and issues to critical patients and without the A&P and pharmacology to the level that medics get doesn't really give this person the right to criticise the care given. I'm sorry if this is blunt but an emt does not have the education to question the medic. Im sure that this will open a shiite storm with the above comment but I think that there will be a lot of people here that will agree with me. Just as a caveat, I have known emt's who were very educated and knowledgeable and I trusted them with my own life but for all intents and purposes, the treatment of the patient is my responsibility and mine alone. If I make a mistake it's on no-one's head other than mine. The arrogant attitude of the original posters topic title and her post is what set me off.

www.despair.com look up perseverance and others they are hilarious

This is a really good article on antiemetics. http://www.emsresponder.com/features/artic...n=0&id=6550

ok inside you can panic that this patient has just arrested on you when the signs all pointed to pre-eclampsia devolving into eclampsia. You can panic now that you realize that you didn't get a line in and you have a patient in arrest. You can panic now that you have two lives who are coding and not just one. You can panic because your medical director and the legal eagles are going to ask you why you waited on scene for so long considering hypoglycemia and not transporting when the signs of pre-eclampsia are there. once the seizure started you got wayyyyyyyyyy behind the eightball. this is a learning experience for everyone. Pregnancy emergencies are not taught very much at all and continuing education courses are few and far between. maybe we all need to go back and review pregnancy related emergencies.

Good sum up Wendy but in the scenario there's no ALS Air transport. You have an ambulance coming but no heligoflopter available.