Just Plain Ruff

AK your point is sooooo true. If you have more than adequate notice that a Hurricane is coming and you choose to ride it out or expect someone to come get you to safety then stop whining when you don't get the response you expect. Those people who refused to leave their homes or their city when they had ample notice in regards to this monster hurricane coming should not expect that EMS or Fire crews will be there to respond during the incident. The fire crews and EMS crews along with the police departments I don't believe were given the choice to leave. They had to stay to protect life and property post hurricane. Those who chose to stay on their own can't say as much. Any service that forces it's crews out in that kind of weather situation should be flogged. Putting your crews lives at risk to save someone who refused to leave just leaves 3 people dead not just one. The same for blizzard conditions or during a tornado or any other natural disaster.

the 90% of EMS is linked with fire but only in his own little world.

Stop the burning process all the mnemonics that you have - do them cover with clean dry dressings oxygen - high flow for the 10 year old ALS to come get the 10 year old - Transport the two minor burns in the camp van. This can't be this simple can it?

Doc, conventional wisdom says c-spine cspine cspine. I'm gonna c-spine the guy unless I cannot see or gain access to his airway in a quick manner. I would seriously consider stabilizing the heck out of his body and head and forego the c-collar due to the fact that if we crich'ed him or tracheostomy'd him we'd need that access and visualization that a c-collar would cover. The underlying problem is just that we don't know where the bullet is. If the bullet is still in the neck and possibly resting against the cord then we don't want to move this guy much in terms of neck movement due to the distinct possiblity that the bullet would continue to place pressure or damage to the cord. When a bullet hits a body it often times will fragment and if those fragments are resting against the cord then we have the real possiblity of a cutting of that cord due to the jadded edges of the bullet. Even with an exit wound, we are not guaranteed the entire bullet left the neck. If it fragmented then the possiblity is very real that the bullet fragment is still hiding around that neck. So to make a long explanation short - I would secure the heck out of this patient. This would be a great case for paralysis to keep the patient from moving. If you can intubate the guy or crich or trach him then you will need to paralyze him anyway in order to keep him immobile. Being an armchair quarterback to this call is good and it sound's like all that was done for him was appropriate and he died despite the fact that he seemed to be getting better. He just didn't know he was dead yet.

treating them with kindness and being nice only goes so far. this mantra is spouted off in our government schools all in the guise of political correctness and the belief that if there are no winners there are no losers. Do you want to go thru life with that mindset? If you do, then you deserve everything you get because there are winners and there are losers. Most people are by definition "Losers" not the derigatory term Loser but we lose more times than we win. In every contest, phase of life there are people who win and then those who lose. football - one winner one loser politics - one winner one loser spelling bee - one winner many losers poker - one winner many losers car wrecks - one person comes out ahead, that does not make them a winner but if they are hurt less then sure they were the winner court cases - one winner one loser I see it on the sports field for my son, they don't keep score, they don't say who won or lost. They say "great game" or "you did a great job" no matter how sucky they really are. My son has been on the losing end of sports and games we play at home and he understands that he cannot win all the time but when he does it gives him a feeling of accomplishment. When he loses and he knows he played his hardest he knows that he lost anyway and he's a pretty good sport about it. AS for the killing the partner with kindness, that partner is not about to understand that approach. The partner is already too set in his ways to see anything other than his own situation. If you "kill him with kindness" he will not go away. He will continue and make your life worse. I've been there I know. I followed that mantra and then I grew up. Report this guy and let it go from there. He will not go away no matter how kind you are to him.

It's a shame you got there so quickly. But sounds like the nature of the call brought out the worst in that medic.

not funny enough Terri I'm sure someone out there has written their oscar acceptance speech in the guise of what I learned at EMT City Michael, you surely have one right?

Methinks it's getting really close to the Oscars. I love the responses so far but I'm still waiting to read that someone was thanking their mom and dad, and their agents for being there for them.

Dale brings up a good point. The thought process of cost-benefit analysis should be done here. What is the cost of a refit remount? What is the cost of a new unit. Just how many more miles does the old unit have on it? Is there rust around the body of the ambulance? What is the general condition of the ambulance pre-remount? If the condition is poor and you are remounting because of that then I move for you to think about purchasing a new ambulance. Chances are you will be speccing(sic) out a new ambulance within 1-2 years and by then that ambulance you remounted will be coughing and sputtering it's last legs. I worked for a service who remounted a 1988 ambulance because it cost more to get a new ambulance than remounting. The rig was so top heavy and boxy that it took many a minute to get to 65 miles per hour and was in the shop more than it was on the road. AS a matter of fact it broke down one time on the way to a call and another time on the way to the hospital with a patient on board. NOT A GOOD THING The money spend in the shop on this piece of crap could have been better spent on a new unit. But the management wouldn't see it that way. They were proud that they saved a couple thousand dollars.

my suspicions if they are correct is that this patient was a goner from the get go. Massive neck trauma, tracheal insult, bubbles from the wound all line up this guys stars in a way that whatever you do will be window dressing. Oh what I would give for a fully equipped OR in my ambulance for this guy. So what was his outcome? I'm gonna bet my next paycheck that this guy didn't make it.

i bet if that trooper had his say, he'd want to take a bull dozer and push the damaged car's, patient and all and push them onto the grassy shoulder. Then he can open all the lanes of traffic.

do we really need to go so far as to have an ice breaker? I have found in 15 years that "I'm Mike, did you call 911" or "Hi I'm Mike, how can I help you today" works good every single time. I do say that you need to have different types of greetings for different age populations.

WAIT WAIT WAIT - you are gonna put an ace wrap on a neck gsw??? Please explain your rationale for putting a constrictive dressing on a neck wound?

just because you cannot get financial aid such as scholarships an pell grants, but there is such a thing as student loans. they are not based on need as I got 37K in student loans and I made 93k a year when I got them. So all financial aid is not the same.

think of how good this would have been for a contest.

I just heard about a new call predicting software system out there, being tested somewhere, I'm not sure where but it's supposed to be able to predict 95% of all calls that come out. It tells you exactly where you should put a unit in a 4-6 block area. I'm skeptical about this, actually more than skeptical.

yes it would have been a god contest, but someone might have said it was too much like work

Well at least they didn't lose 500K social security numbers like another governmental agency did. will the administrator get reprimanded for not following procedure and policy, you can bet your but that a lowly employee would get reprimanded or fired but the administrator - no freakin way. I'd be a little upset.

Well Dust, this is a secret that I'm going to have to keep to myself. I have ton's of other stuff that I'll give to the group in a scattered time period.

classic drug seeking behaviour Nurse "I'm gonna give you some Ketorolac" patient "no way, didn't you read my chart, I'm allergic to Toradol" or Nurse "I'm gonna give you some tramadol" patient "I'm allergic to Ultram" Nurse, well why don't we just give you some Hydromorphone for your pain Patient "I can take dilaudid" ha ha

I heard a crew member (might have been me) say after our 15th transfer from the hospital to the nursing home and an occasional real emergency, "thank you ma'am, can we have another"

I know it happens. So what as providers can we do to help the districts with this issue? I think these pens are just as beneficial as AED's in the schools plus they are cheaper.

let's put this in personal terms your child, playing on the playground. Gets stung by a bee. Been stung two or three times previously with no problems. Now he's having short of breath, hives, urticaria, sweating and decreased LOC. Your school thought about getting a epi pen and then due to liability or whatever dynamics came up decided against it. ALS is 20 minutes away or even 8 minutes away. You do have an AED but no epi-pen. Your child goes into resp arrest and then codes all while the teachers and the nurse even watch in horror as two teachers do cpr on your child but in the end your child died due to the decision made by the administration of the school system were either too scared of liability or they assumed EMS would be there in time. What would you do in that situation? I had the unfortunate circumstance to be involved in trying to save that said child. No epi pen due to a districts inability to decide to have this life saving intervention. You cannot say it doesn't or has not happened.

This website has archives of many different lectures at the following colleges: Actual lectures from very well known colleges. Go get as many of them as you want. They are free. http://oedb.org/library/beginning-online-l...es-in-the-world Stanford UC Berkley MIT Duke Harvard Queen's University UCLA University of California San Francisco School of Medicine University of Glasgow Yale And Oxford I have not tested all these lectures or even some of them. The biology course from UC Berkely is able to be downloaded both the audio and video versions. This would be an incredible advantage to all of us to get more out of biology. There is a physiology course too. I hope this helps.

that was a good explanation on explaining what you meant. I understand your thoughts now. one funny story that happened to me we had a MI patient who had Eminase ordered for them. This cost 3200 per dose. I mixed it up and at the last moment the receiving doc in the heart center said HOLD the eminase and get him to the cath lab first. Well I just put the vial of eminase in the sharps box. I found out that the vial cost 3200 and I would have to pay for it. ha ha ha joke was on me. The hospital ate the 3200 dollars.