Just Plain Ruff

no ambulance is ever a comfortable ride for a patient. It's a combination of the stretcher and the shocks that makes the ride uncomfortable.

well if they go to the nursing home, pick up a sick person and perform skills on that person and then go to the ER then yes I think they could be considered EMS. I'm talking about the emt's on transfer cars that the closest thing to patient assessment they get to is doing a quick look at a patient and assessing whether they need a wheelchair van or a stretcher. And then put them in their ambulance and drive them to their bed in their nursing home or house.

well we didn't get into that. I assume that as emt's they only need to have a small number of CEU hours and keep their cpr current but I'm not sure.

I was eating lunch today when a couple of people from a local transfer service came in. I went to strike up a conversation with them all in the guise of getting somehow a florida state patch. I told them such. I then asked what they did all day when working and they said they do transfers. I asked you mean emergency transfers and they said no, only non-emergency transfers. I then asked when the last time they ran a emergency call and they said that they have not once in their 3 years working at this particular service ran hot or had a patient type other than a hospital to nursing home or hospital to home. They said they even go pick the patient up for their doctors appointment and then wait and then take them home. The question I have is this..... If your job description is transfer crew, you run zero nada zip in terms of calls that are considered emergency then can you consider yourself part of EMERGENCY medical Services? Just something that went thru my head as I was walking back from lunch. Not trying to start a pissing match or war here, I'm just curious.

It would even be funnier if it involved Al Sharpton, or Jesse Jackson or even Nancy Grace.

It's still funny but I heard it a long time ago and it was an insurance executive who was the one who did it.

so AK come clean, you were the actual complainant weren't ya? Come on confess.

I was going to say the same thing. There's not much more you can learn about being an EMT after 6 years. Sort of defeats your desire to go get your medic.

that cat thing is really really funny

Whoa, Captain, step away from the Kool Aid how can you sit there and say, he's molesting her? All you have are the facts that are laid out by the orignal poster. YOu are going too far in saying molestation when you know nothing more than what was posted by the original poster who says that he does not know if there is sex going on or not. I have several friends who waited until marriage to even kiss a guy let alone have sex with them. We all want to see the worst in this guy but let's at least keep the inflammatory accusations such as molestation away from this. In some states the age of consent is now 16 or even lower so if she's even 16 years old and the sex is consensual then it's not illegal. Of course, someone as old as he is dating a girl this young appears innapropriate but if she's of the age of consent there's not much you or anyone can do about it. So let's stop throwing these comments around like they are for fact because NO-ONE here, not even the original poster have a clue whether they are having sex or not.

lots of acronyms in there Zippy but I get your jist. It's like in the us We have emt schools spitting out emt's every week it seems. We have medic schools that are less prolific but they are similar. Fire fighters are just as prevalently spit out. We have an ambucab service for every community of about 1000 people or more. The area I worked at had two ALS services for our county. Granted we ran the majority of calls but this 2nd service ran 1/4 of the calls we ran. Add in the volunteer services and you see a huge jump. But then again, every thread here ends up with a volly versus paid slant or so it seems. I for one prefer the explanation "Global Warming" is the cause of this dilemma

so what happened to the kid? Reyes is a usually fatal disease if not caught early. Any bad outcome?

ok take DMAT out of the picture What do we do with the search and rescue teams that are strictly volunteer. Do we get rid of them?

True cmk but salicylates have been associated with Reyes for a long time if I remember reading that somewhere. So even though the salicylates in pepto are non-aspirin they still have the feasible possibility to cause Reyes. From EMED article I posted above Background: Salicylates are ubiquitous agents found in hundreds of over-the-counter (OTC) medications and in numerous prescription drugs. Salicylic acid and its derivatives are active ingredients in a wide variety of readily available topical preparations used for the treatment of pain, warts, and acne. Pepto-Bismol, a common antidiarrheal agent, contains 131 mg of salicylate per tablespoon. Salicylate ingestion continues to be a common cause of poisoning in children and adolescents. The prevalence of aspirin-containing analgesic products makes these agents, found in virtually every household, common sources of both accidental and suicidal ingestion So an overdose of aspirin or salycilates(I can't seem to get that spelling right) with a side order of possible reyes syndrome is entirely possible for this kid.

ok I'll take this argument on paid versus volly If all volunteer services have to go then what do we do with the volunteer Search and rescue teams out there? What do we do with the volunteer medical teams like DMAT? Don't these groups fall into the volunteer arena???????

Good god, if we would all mind our own houses and not others houses on situations like this a lot less bad things would happen than do now. This is miniscule compared to many things that are going on out there.

I agree with Asys. These guys need to be off the street and need to be off the street now. My wife was raped in college and it still stays with her. These guys are dirt plain and simple and the fewer days that they spend on the street from here on out are days that the public is at risk. Get counseling and press charges against them.

Doc, doesn't pepto have a derivative of Salycilates in it?

a good suggestion. We could be dealing with both. Good info here http://www.reyessyndrome.org/what.htm Both conditions Reye's and Aspirin overdose look similar.

ok now we need to assess for Aspriin and it's derivatives overdose. The following is taken directly from the website listed. It sure sounds like this kid has most of the signs and symptoms from this website for overdose of salycilates(sic) http://www.emedicine.com/ped/topic2031.htm Salicylates stimulate the respiratory center, leading to hyperventilation and respiratory alkalosis Salicylates cause both direct and indirect stimulation of respiration. A salicylate level of 35 mg/dL or higher causes increases in both rate (tachypnea) and depth (hyperpnea). Salicylate poisoning may cause noncardiogenic pulmonary edema (NCPE) in a few patients. Although the exact etiology is not known, hypoxia is considered a major factor. Increased cellular metabolic activity due to uncoupling of oxidative phosphorylation may produce clinical hypoglycemia, even though the serum glucose levels are within reference range. As intracellular glucose is depleted, the salicylate may produce discordance between levels of plasma and cerebrospinal fluid (CSF) glucose Salicylate poisoning may result in dehydration because of increased gastrointestinal tract losses (vomiting) and insensible fluid losses (hyperpnea and hyperthermia). All patients with serious poisoning are more than 5-10% dehydrated. Renal clearance of salicylate is decreased by dehydration. Hypokalemia and hypocalcemia can occur as a result of primary respiratory alkalosis. Central nervous system effects Salicylates are neurotoxic, which is manifested as tinnitus, and ingestion can lead to hearing loss at doses of 20-45 mg/dL or higher. CNS toxicity is related to the amount of drug bound to CNS tissue. Other signs and symptoms include nausea, vomiting, hyperpnea, and lethargy, which can progress to disorientation, seizures, cerebral edema, hyperthermia, coma, and, eventually, death. Gastrointestinal tract effects Nausea and vomiting are the most common effects. Pylorospasm and decreased GI tract motility can occur with large doses. Hepatic effects Hepatitis can occur in children ingesting doses at or above 30.9 mg/dL. Reye syndrome is another form of pediatric salicylate-induced hepatic disease characterized by nausea, vomiting, hypoglycemia, elevated levels of liver enzymes and ammonia, fatty infiltration of the liver, increased intracranial pressure, and coma. Hematologic effects Hypoprothrombinemia and platelet dysfunction are the most common effects. Bleeding may also be promoted either by inhibition of vitamin K–dependent enzymes or by the formation of thromboxane A2. Musculoskeletal effects Rhabdomyolysis can occur because of dissipation of heat and energy resulting from oxidative phosphorylation uncoupling. Clinical and laboratory manifestations Phase 1 of the toxicity is characterized by hyperventilation resulting from direct respiratory center stimulation, leading to respiratory alkalosis and compensatory alkaluria. Both potassium and sodium bicarbonate are excreted in the urine. This phase may last as long as 12 hours. In phase 2, paradoxic aciduria in the presence of continued respiratory alkalosis occurs when sufficient potassium has been lost from the kidneys. This phase may begin within hours and may last 12-24 hours. Phase 3 includes dehydration, hypokalemia, and progressive metabolic acidosis. This phase may begin 4-6 hours after ingestion in a young infant or 24 hours or more after ingestion in an adolescent. Nausea, vomiting, diaphoresis, and tinnitus are the earliest signs and symptoms of salicylate toxicity. Other early effects include vertigo, hyperventilation, hyperactivity, agitation, delirium, hallucination, convulsion, lethargy, and stupor. Hyperthermia is an indication of severe toxicity. Most telling --- from the website According to the Toxic Exposures Survey from the American Association of Poison Control Center, 24% of analgesic-related deaths are due to aspirin alone or aspirin in combination with other drugs. Early identification of salicylate poisoning can be lifesaving.

I'm not so concerned about how they count but rather how are they documenting it if the DEA comes in to check? How did your service get past the DEA inspections? I mean you have to have a controlled count of sign off and witnessing and periodic inspections happen. Does your company falsify the records? How do they get around it? I would think that your agency is a ticking time bomb when it comes to inspections. You are very right to push this issue. In the end the medical directors license is on the line but your's is too. I'd be pushing it also. Good luck if they don't shape up why don't you place an anonymous call to the DEA and say My service doesn't count our narcs every shift and I think there might be some shenanigans happening. That would take balls bigger than the ones many of us have here but it would prompt a more stringent record keeping for the future.

Off list if you will, I have a few friends there.

Hey, I have the book "Are you smarter than a 5th grader" and at least 1/2 of the quizzes in the book I can honestly say "I am not smarter than a 5th grader"

this guy in the tape is the reason why the rest of the world hates us.

contact me off list. I have a surefire way of getting you up and running on your reports. how many reports have you written for your instructor?