Just Plain Ruff

Come on Scar, think bigger

well I spent the night outside microcenter for their 299 laptop, their 199 desktop and the 19 inch flat screen It's was based on commercialism but I got a great deal. By the way - It was fricking cold out there.

just so everyone knows -- Walmart is the 2nd most sued entity in the united states. does anyone know the most sued?

Irish kell what is your definition of code 3?

I know all that, but the question begs to be asked - what risk manager bright star thought to allow 16 year olds to drive emergency.

What I want to know is how did these 16 year olds get insured to drive?

Semi conscious blood loss > than 2 liters - the sand is soaked no pulses in left lower leg pulses in other leg and arm patient is breating but seems to be grunting and really working to breathe and miraculously your studious EMT/volunteer fireman thought to bring the mast pants - they are being lowered down.

The helicopter team came with all the bells and whistles but they forgot to put on a medically trained person. So they also have a nice hoist for you to swing this guy around in. You are hooked up to the hoist and along with two other rescue randy's from the helicopter you make it to the patient. Once there here is what you find. open fractures of both femurs and tib/fibs open fracture of the upper arm and radius and ulna. A large gash in the forehead and a gash with what feels like a fragmented area underneath the laceration - possibly indicative of a skull fracture What else do you want to know.

ok, what you do now is you send the rope certified guy to the edge. He makes 3 different descents to the edge before he sees the patient. the patient is about 100 feet from the edge at the bottom of the quarry the visual is like this. Straight down - sheer wall Patient is lying on his back with both legs angulated outward indicating fractures of both lower extremities. The right arm is at another unusual angle. The patient responds by moving his hand on his good arm but no verbal response It is now dawn and the gravity of the situation hits you. HOW do you get him up Another person arrives on scene just as your mutual aid radio crackles to life with this message Army rescue helicopter 301 to field operations. We are 10 minutes out of your position. What's your sitrep?

ok it's now 4am in the morning. You have reached the quarry and you call out to him. There is no answer. You find the remnants of the drinking festival, 2 bottles of empty jack daniels. Looking down the hill it appears to be a gradual drop and then an edge. you and your group has the following items at your disposal 500 feet of good quality rope assorted carabiners and other high angle ropes small cb style radios for communication a generator and several flood lights and other assorted items that you might need. ONe of your guys ties one rope to the tractor and drops about 250 feet of rope down the hill and over the edge. You have one person certified in rope rescue and another one who spent 8 hours rapelling in emt school SAR has been called in from Kansas City and they are 15 minutes out which there are people waiting to bring them to you What happens now? The storms referred to are a line of storms that should pass thru the area over about a two hour period starting about now. You have made contact with medical control who says to do whatever you need to stabilize the guy even if you have to cric and needle him. Just use your best judgement on what you are going to do. Now what?

I spent the night outside the local electronic store and she brought me dinner and hot chocolate and finally spent the rest of the night outside with me. NOw that's dedication. Got a killer laptop for 299.00

no one asked about the weather much except in passing. It's about 55 degrees, there is a huge weather front moving in with threats of tornados and high winds so the bird is now out of the question Your search and rescue people consist of the small volunteer fire department and your ems crew along with on duty deputies and a smattering of citizen volunteers. You have a local farmer who is willing to hook up his tractor to a flat bed trailer and get you as close as he can. With all those people in place it is now about 2 am in the morning. It's really dark, blustery and very windy. You have sent your partner and a fire fighter on ahead to go to the quarry that you suspect the guy is in. Radio's are useless out here especially since the terrain is pretty hilly. Once all of the extras are assembled you begin your treacherous and long journey into night. All of a sudden someone voices a concern - "Does anyone know how to rappel down to this guy if we find him?" what do you do now?

ok, I have not gone shopping yet - but leaving is imminent You know the area very very well you know that there is a quarry about 4 1/3 miles from the convenience store that has taken more lives in your short ems career than you can remember The drunk guy only said that after the bouncing and grinding down the hill and over the cliff ended, that he heard what he distinctively thought was "Ouch that hurt" come from the bottom There is an old service road that is sometimes passable and sometimes not leading up to the quarry but there is no way you will get the ambulance or any type of fire truck in where you want because the service road is about as wide as an old covered wagon is wide. You have a helicopter on standby but it's 45 minutes away at a outlying hospital. What else you all want to know. As for being whipped - yep I am. But it's a small price to pay for what my wife did for me last night -(get your heads out of the gutter guys - it's not anything like that)_

You are the only ambulance in a rural area of about 1500 square miles. You get a call of a man who has fallen over 200 feet down a cliff and hill. The scene is supposedly 4 miles into rough terrain and it's 11pm at night There is one person who meets you where he called you which is a convenience store about 4 miles from the scene but this person does not remember how he got to the store due to alcohol being involved. What do you do? I'll check back on this later today, I've got shopping to do with my wife (OH JOY)

Totally politically incorrect. Adults only http://www.youtube.com/watch?v=1uwOL4rB-go

Yeah good job on that. Had you not have turned him in you would have been as guilty as he is and you would have allowed a cheat to prosper. Way to go. I'm proud of ya!!!!

2 things to discuss here I will transmit the ekg if I'm at all uncertain as of the interpretation - I'm rarely uncertain enough to transmit it. But all MI's get one sent. 2nd thing - Transport time urban settings go from 10 mins to 20 or so minutes to the appropriate facility Rural setting - 20 minutes to 1 hour transport time and thats just to the closest facility which may or may not have a cath lab. Add on an additional 20-45 minutes to fly the patient to the appropriate cardiac facility. Urban responses have it easier since it seems like every hospital in an urban area has at least a cath lab. Rural hospitals may or may not have a cath lab and the three rural areas I've worked did not have cath labs - our patients had to go to a receiving facility 60 minutes away.

I think that I'd have called and discussed it with the receiving physician. The patietn seems stable right now so you can make the call. Tell the doc that you are leaning towards amio but it just doesn't look like v-tach to you. Ask if he wants lido or amio or does he want you to wait and let them look at the patient. I think most docs would be willing to discuss this with you. Remember, ACLS suggests expert consultation so you would be doing the expert consultation you know. The physician at the hospital might want to get the cardiologist who's on duty in on the case too right away. Then you have more expert consultations. Either or I'd have probably given amio and gone from there.

well I'd suspect that if the patient dies then that patient was going to die anyway no matter how fast you got them to the hospital. An extra two minutes is not going to make a whole hill of beans difference.

I've got a question - For those of you whose services have supervisors in suv's and or roving als intercept quick response vehicles - Let's say you intercept a bls crew workiing a code. You assume patient care and off you go to the hospital. What do you do with your vehicle? Where do you park it to keep it safe? If you have parked it, has it ever been broken into? What are your procedures in addressing the above questions?

Hey cullen, you give your own life and limb to save someone and let me keep mine. You should never give up your life or your health to save someone. That just isn't the way it's supposed to work. Remember the first one or two sessions in your emt class where they stressed Scene Safety. If you have to save life and limb at "All Costs" then you are going to have a very short career in EMS. Might want to re-think that though process. I know you are wanting to save the world, I was like that as an emt too until I realized that I'm not about to risk my life to save another. I have to get home to the Mrs. and the kids. And remember - a dead rescuer is one less rescuer to help.

I worked in a similar situation but our hospital was much smaller, 16 beds. I was given the same responsibilities as the nurse and was actually able to do more. I also worked the ambulance when a EMS call came out so it was the best of both worlds. I intubated, assisted in chest tube placement, pumped stomachs and put in foleys. I did a lot more than you think. If you can get into a hospital like mine or Fire911medic's you can learn so much plus your CEU's are free most of the time. If you are interested in moving to Missouri I can point you in the direction of the two hospitals I used to work at. Both had very similar setups. PM me and we can talk

Actually I don't have a problem responding with fire when they get a structure fire call. I can usually sit back and enjoy the view of a good structure fire. Sometimes I can get close enough to ward off the nights cold when it's really cold outside Plus sometimes, just sometimes you get to see the podunk fire department provide a brand new inground swimming pool to the family who didn't have one to begin with. Courtesy of Podunk volunteer fire department. A co-worker said it best "A new inground swimming pool courtesy of the Deepwater Volunteer Fire Department" (insert fire department name here)

Terri, this is a great idea and I'm surprised it didn't happen sooner but I don't think it's a new idea though. Churches have been doing this for years and years. Heck my church just finished a senior workday and in that day we had paramedics and firefighters who checked not only on what the seniors needed to have done in their homes but they also checked lighting, medications for expired drugs, and smoke detectors. It's a great concept but we need to get over our "It's all about me" attitude that so many providers exhibit these days. If it's not a code 3 or emergency call then it's not worth running. As soon as we can get over this attitude then I think many more services and fire departments will start to offer this.

It might be exactly like you said above about someone possibly getting hurt but............. It could also be your management trying to increase the call volume to look good for someone. The more calls you run the more money you get. hmmmmmmm That's my take on it.