Just Plain Ruff

In my neck of the woods, she'd have been called no matter what due to the fact that the nearest trauma center is 1 hour away by air.

guys the horse we've been beating is now blue and on the verge of arrest. Let's give the horse a rest.

all I can say is WOW to that education comment and now I'm going to go bang my head into a wall. Me thinks he just doesn't get it. What can you do with that IV Khanek??? Can you give any of the medications that a medic can? by the way Khanek, who are you referring to in the post quoted above.

somehow I think the medics on the scene did something more in depth than just calling her dead. here is how I see it playing out patient on skewers patient removed from skewers patient placed on ground awaiting coroner Patient takes breath they work the patient and she survived

ok this is a toughie but here's what I'd do I'd determine how far out fire was for the tools to cut the poles. I'll ascertain if since shes a trauma code and you cannot kill her any deader, whether the group of us can lift her off the poles and begin cpr. If we can do that then I'll pull her off and start cpr and boogie to the hospital. If I cannot pull her off the poles and fire is more than 10 minutes away then see below - I'll call medical control and tell them what's up. I'm more than likely gonna call her right there because SHE'S DEAD! 0 pulse + 0 resp + a 10 minute response time from fire EQUALS a dead patient.

there are three in minnesota in the next 3 months there are 4 in North Dakota did you call the national registry? I'd do that. Phone: (614) 888-4484 "am looking for a place to take my EMT-P practicums. I have looked on the NREMT website and well there really isn't a whole lot of options here in Nebraska. Was wondering if anyone had a heads up on some practicum dates in either South Dakota, North Dakota, Neberaska, or Minnesota that are coming up... If so do you have the contact information. " no offense but did you even do a search on the states you were asking about?. As you can see I found several in the states you asked about. go to these pages for contact info for the practical testshttp://www.nremt.org/EMTServices/candidate_locate_exam.asp?secID=1 Do a search for the state of north dakota when you see the list of test sites choose the one you are interested in taking. then click on the binoculars and that will give you a lot more information on the exams

laura - +5 for the first part, I'm dang near almost up off the floor from laughing +20 for the rest of the post. Incredible You can take care of me anytime as can your emt-b's who have worked under you.

I think DUST As usual hit the nail right on the head. I have two friends who tried to start ambulance services in Missouri and Kansas and they lost everything when everything that dust said happened. One was a service who provided non-emergency services in our area and he was unable to help himself from being a jerk and divider in our community. The other tried his hardest to provide a quality service, hire quality people yet he didn't have enough money to pay more than 6 months of bills. My adivce is if you really are serious about doing this is three fold Whatever amount you think you need to start this service, triple it and then double it again. So if you think it you need one million to start this company then you will actually need 6 million. Don't buy used ambulances from services - they will more than likely have been run to death and will be maintenance nightmares. Start small, think big - don't try to tackle a service area that needs 20 ambulances to cover it well. Try a area where you would need 2 - 3 trucks to start. Work with the established service in the area. Try to get agreements with them for 911 back up and also calls that they don't want to transport such as long distance transfers - anything over 200 miles one way would be good to go after. that way the current 911 service can keep their trucks in district while you transfer the long ones. Hire a competent supervisor or manager to run the day to day things like personel matters, supplies and such and you can spend your time keeping the company afloat. have a million dollars in reserve just in case - your total now is 7 million if you are following my logic. Have another 500K in a expense account so you can have fluid cash to pay for a new ambulance when one of your crews total it in a wreck - you could go out and purchase the new rig the day the crash happens that way it will keep your service uninterrupted. Don't use consulting companies as a crutch- there is a saying in consulting "if you are not part of the solution there is plenty of money to be made in prolonging the problem" that is soooooooooooooo true. If the consulting company you use can't solve your problems they will have no issue in prolonging it and bleeding you dry. I've seen it happen. More money went to my friends consulting company he used than he paid out in salary, supplies and gas for the entire time he ran the service. don't hesitate to ask for help. Those are just a couple of the items that I found out by being close friends with two who tried to do what you are trying to do.

So Wink, tell em what they win so what did I win other than some really nice parting gifts.

EDP??????? what is an EDP? oh Emotionally disturbed person please don't use abbreviations that many of us don't readily know. Sort of like 10 codes. I transported Jesus I had one psych patient open the back doors of the ambulance and jump out - thankfully we were at a stop light.

I've worked with Gay partners. They kept their life to themselves and I kept mine to myself. It was our agreement. If you as a Gay person bring your personal life to work with you then you should be prepared to face some criticism. I don't care what anyone does in their bedroom or home but please leave it there and do not bring it to work. We work in too stressful of a business without having to worry about someone's sex or personal life. That's what the EAP programs are for. If you bring it to work then you have to accept the scrutiny either good or bad scrutiny. By the way, my two best friends are gay. These two friends are also my co-workers but I do not work in the same office or client site as they do. (just to point out my perspective.)

I'm not worried about someone catching the common sense part of my argument. I stand by what I say. It's all in the presentation of the patient. if the patient warrants being disrobed I will do that but if they don't then why open yourself to any type of liability or improper activities complaint. I've always used what I consider common sense in determining who should be disrobed and who shouldn't. It's a case by case basis, many patients do not need to be completely disrobed but many do.

well I believe that the hotter the patient the more clothes have to come off. NO I dont' believe the above OK But there are situations where the clothes have to come off. If you are transporting a 40 year old woman complaining of a headache are you gonna take all her clothes off? If you are transporting a 14 year old female or male with nausea and vomiting do the clothes need to come off? I vote no on the two above but someone will disagree with me I am sure but we have to use common sense here. There are many situations that require the clothes off but generic medical complaints are in my opininon not one of them. But there are times where the clothes should come off. Are you going to take off the clothes of a patient whose only complaint is abdominal pain or a headache? Hospital gowns are good if you have them but not every ambulance has access to them. I do believe that if an IV Is needed then at least take off the shirt and if there is one, the bra but make sure you cover them back up.

It's requisite viewing similar to Emergency. If you haven't seen Mother Jugs and Speed then you need to go to your nearest video store or netflix and get it. The two classic scenes The large black woman on the stretcher The zipper scene Does anyone remember the series Code Red(I think thats it)???

If any one is awake right now - Mother Jugs and Speed is on AMC right now.

great response Spenac every place I've worked except for one said transport regardless of necessity. Keeps the legal eagles at bay. Plus one maybe just one will pay and it will offset some of the losses. two places I've worked it wasnt' really an issue since we were based at the hospital that they were going to go to anyway so either way we were going back to the hospital so no foul there, plus we always had a 2nd ambulance as well as sometimes a third available to go get the really sick ones. the one service where I worked that you could call medical control to get a refusal to transport authorized by the medical control doc and our refusing to transport happened so rarely that it was almost like a Holy cow you got the doc to do that kind of mentality when it happened. ON the flip side, for that particular service, if we had a patient refusal we had to call medical control to get permission to let the patient refuse. Many times medical control overrode the patient refusal when psych or mental deficiency came in to play. All the other services were - transport the patient no matter what the complaint because we are not doc's we are EMT's and Medics and we don't have the medical training and malpractice insurance and schooling to back up refusing to transport. That's the services I've worked for and their MO's Did that clarify my position.

well if he just says "take me to the hospital so I don't miss lunch" and has no medical complaint then I'm not gonna transport him, simple as that. If he starts to say he has a medical complaint then I'll transport. He has the right to refuse to allow you to touch him or examine him but I also have the right to attempt to get him to allow me to examine him. I've been on the end of this call before where the patient would not allow me to do anything to her and she only gave me her name. She came out of the house all gussied up and her hair was made up and her makeup was on quite nicely. She let us put her on the stretcher and that's all she allowed. She then went in to the ER with us and promptly refused treatment, signed AMA and walked out of the er. We last saw her as she walked into the bar across the street. I'd have been angry except we're hospital based so we were going back to the hospital anyway. I'm sorry but I think you are making a mountain out of a molehill with some of your scenarios. You deal with these situations as best you can. Good attempt at making all of us think but I'm not sure where the educational value is in some of the situations. You go with what you have to go on. No more no less. I have transported thousands of patients over the last 16 years and I can count on the number of fingers of one hand where the person only wanted a ambulance ride to either get lunch or go to the bar. Sure abuse like this must occur or we wouldn't be discussing this. I feel for your situation Spenac as to your limited resources but those I feel more sorry for are the ones who live in your area. Your resources are limited and you by your own admission say you only have one ambulance available and the next unit is 60 miles away. That my friend, no offense is the crux of your problems. Too few resources. The people who live in your area suffer because of so many variables. I'd hate to be in your administrators shoes when you are transporting a patient who only wants lunch when someone who really needs your ambulance has to wait 60 minutes to get the nearest ambulance to get them. Like I said, I truly feel for your situation. It is not a situation that I would want to be in on a regular basis. We could go on and on about this immigration debate or the abuse of ems which we have over and over time and time again but unfortunately there are no easy answers to your scenarios or your situation. Or the situations that countless others face daily.

I always will pack a bag of marshmallows for Smores and HOtdogs for those times that the fire may be going on during my lunch or dinner time. I'm never hungry nor am I very far from a potential victim. Seriously though - stay with the ambulance and wait till called. We don't need to be in the way but we do need to be near our equipment and the ketchup.

WEll first off I'll be calling the police for a possible dangerous subject in the ambulance. If he ever got past me and got in the ambulance without me in there first or me assisting him then my ambulance is no longer safe and I'll wait till the police get there to find out what this moron's hurry was. No matter if it was the blue light special. In my opinion, once you lose control of your unit and someone else is in there that you did not specifically put in there, then the ambulance becomes a potential crime scene or dangerous scene until ruled otherwise. the person in the ambulance now has the upper hand and is in control of the ambulance because you are not. This just emphasizes the LOCK YOUR DOORS way this thread has begin to go.

Yes it is. Wow, now I have to take some motrin cause it gave me a headache.

no, we can't do that. if we do start our own community we'd be accused of discrimination. See we can't win whatever we do.

What level of medical training do you have? Are you the first responder emt-b defib trained level? If so what are their though processes in not letting you get out of the car? What are their reasons for this? I agree that you have the danger of getting struck while in your car but you also have the danger of being struck if you are out helping. It's a catch 22 situation - hit if you get out or hit if you stay in the car. Honestly I'd rather take my chances in the car than being hit by a car - I think you might not die if you get hit while in your car. Just use common sense when you park. IF you are the last one there then you have the ability to make better decisions on where to park. One thought for you would be instead of parking at the back or end of the accident you could drop your doc off at the site of the wreck and then drive ahead to the area in front of the accident therefore providing a number of bigger vehicles as your protection. No scene is fully safe no matter where you park or walk - if it is your time to get hit then you can't do anything to bust fate.

Lone Star, the answer to your question is that if you are a White Christian with a minimum of values then you will never be accepted. In order to be accepted you have to have some sort of condition that is not in the mainstream. If you are a white christian male with middle class values then you should just go live in a cave somewhere which is where I am heading soon.

breathe for him, intubate if you have to but for god's sake breathe for him. ha ha . Transport and let the doctor gods take care of him.

Scope - If I remember right at least one or more of the 9/11 terrorists came through our border. Not sure if it was the canadian border or the mexican border. I could also be wrong but that's what I think I heard. So the concept of transporting a terrorist is not out of the realm of possibility.