Just Plain Ruff

The problem I see is this We are functioning under the control of a doctor or medical control. Since we do not have a doctor on board the ambulance who is the final authority as to whether there is a emergency medical condition occurring then we cannot in our right minds expect that we will be granted carte blanche to say "No transport for you" Couple that with the image that EMS is not a profession but a job that most people in America have and we are already behind the eight ball. Since we don't have the title MD Or DO or NP we cannot justifiably in our own defense tell a patient that they do not have a condition that requires ambulance transport. If we had the initials behind our names then that would be a different story, but plain and simple we do not. We can bitch and moan on this forum all we want about Sally the ambulance abuser and Marty the trauma junkie, but we need to begin to think outside the box and ask the question "Why does America expect us to transport everyone?" The simple answer is that since we are NOT doctors, we cannot with any certainty tell someone that they are not suffering from a Emergency and tell them we are not going to transport them. Unfortunately hindsight is 20/20 and if we knew then what is painfully obvious today, that the state of EMS is in trouble and part of that trouble is the mentality that we transport anyone and everyone no questions asked, we could have been better prepared as well as been able to better prepare the public that EMS is for emergencies and not a quick trip to the hospital. If more and more people were educated via a media campaign and flyers sent to their houses what constitutes a emergency then I believe that our number of transports would decrease. This then brings me to another point - payments to the ambulance services. If every service pursued collections of people who use their services instead of writing their bills off then maybe the public would stop and think, do I really need to call a ambulance to take me to the hospital. I'm gonna get a 450 dollar bill from the ambulance service that they are going to want to be paid. Maybe I don't need to go by ambulance when Virgil next door is perfectly able to drive me to the hospital. If insurance companies would pay more than a piddly little amount and if Medicare paid more for our services then maybe we would be able to put more ambulances on the streets to combat the epidemic of running out of ambulances in a city. I can count on everyones hands here the number of times when the places I've worked have been out of ambulances and calls were backed up. Finally, if we as americans didn't expect that their medical care be free or nearly free with insurance and if American's didn't expect to be seen in an ER within 30 minutes (those er's know who they are and they are bad for Emergency care In my opinion) then we would not be in the crisis we are in right now. WE have to re-set expectations of the general public in a way that fosters caring and firmness. To do nothing is tantamount to not being able to bitch about this subject.

What else was she doing while on the couch. Now before you all get your knickers in a bunch and think deviantly, was she eating prior to this episode? Did she take a larger drink than normal. Did she feel something catch in her throat when she swallowed? I suspect a couple of things 1. separation of a rib or two from the sternum 2. Esophageal tear 3. Vaso vagal 4. regurg or GERD Or her husband got pissed at her and popped her in the chest.

Well until we have politicians who favor the law over votes then we will never have even adequate enforcement of the border. Rant on -I can almost guarantee that if a illegal killed or seriously injured a member of congress or his/her family that the enforcement would go up. But until we have congressmen with rubber backbones we will never have enforcement of the border. It might hurt the illegals feelings if enforcement is increased. I'm darn sick of politicians saying one thing and then voting completely different. It's all politics I know but don't they know that there are lives affected by this issue. Same as the war in Iraq, same as many many other issues. Until the politicians vote with their heads and not the number of votes they can get then nothing of note will get done in this country. Rant off.

Spenac, what's the possibility that you could have your partner while driving call in an anonymous tip that an illegal is riding in the ambulance? Make it a private tip to the INS.

Spenac, what's the possibility that you could have your partner while driving call in an anonymous tip that an illegal is riding in the ambulance? Make it a private tip to the INS.

But the question Doc, did you save her?

I would not transport this child. The crux of the issue is that there is no medical complaint. Take out the mother's being here illegally. She sees an easy way around the border patrol. Why dont' you tell her that the ambulance will be stopped and checked and if she's on board both she and all of you could go to jail and she'd be deported back to Mexico and her precious little angel would be left here. I feel for your pain spenac, you have a very difficult job to do down there on the border. I applaud your working there. But I still would not transport her.

I too am disgusted and frightened by the way that people cry foul and racism and other epithets for perceived wrongs committed against them. I refuse to go further as I might get sued.

Holy crap - I think I see the light. AAA I think I'm awake now.

Here is what I find funny The only time Firefighter523 comes out and posts something is to try to prove all of us wrong. Eydawn- Firefighter523 has never once told any of us who have asked him and there are many, how many years of experience he has yet he demanded at one time to know how much experience I and other had. The only time he comes out to post is when he has some insulting to do and there is no surprise that he doesn't like me. He's so much as said so. And in a previous post he said that the fun on this forum was no longer there. He also in a pm to me said he didnt' give a crap(this is the watered down words) about anyone on this group yet he still comes here and posts. It almost makes me wonder if he comes to post after he's had a bad day. I fully expect a diatribe and insults to come from Firefighter523 on this post - I've come to expect no less.

Lyme Disease? I'm so tired it's all I could have come up with.

thanks chbare. I was leaning actually after reading and thinking more into starting at least a lock. Not sure if I'd go fluids yet. But more and more of doc's scenarios eventually need the big guns so I'll go with a lock for now. I am also following your thought process of the submandibular swelling and such.

Exactly Shane, like I said, some times less is better. There is such a thing as TMI

Chbare - I'm not sure I'd start an iv on this guy. Can you elaborate on why you would get IV access on him? I'm treating this right now as either a simple testicular pain or epididimitis. I might get an iv just to have access and if that's where you are going with it then cool but if not please tell me more of your thought process. we can do this in PM's if you want.

ok, I'll ask what's the "Pickle Test?"

when I give narcan I usually also restrain the patient that way he doesn't harm himself or others. If the patient is known to me then I will usually not restrain them but that's on a case by case basis. I do have several instances where the patient I gave narcan to became very combative and pissed due to my taking away their 5 dollar high but those have been few and far between. Overall if I'm going to give Narcan I'm going to at least have the patient secured to the cot really well.

Doc what happens on scene stays on scene 6. Has not had any of these symptoms but has not had sex since the pain started. Do you want to have sex with him to find out? (OK, that may be a little overboard, but I commend your dedication to pt care) But seriously - I have to go and review what your reply to my reply was and then I'll be back.

Only report it if they ask specifically about accidents in the past 3 years. That's all I would do. No elaboration just that I was involved in one minor car accident in the past 3 years. There is something to be said for giving too little info rather than too much sometimes.

this has the hallmarks of a really funny ending. There is just so much wrong with this one that I'm trying to keep it in check. The requisite questions abc's scene safe environmental hazards such as organophosphates? anyone else there to help explain the pain or history Differentials: trauma - any? Epididimytis- most common cause of testicle pain in men ages 18 and higher Torsion - well this is a bad thing if he's got it as it's been goin on longer than the testicle can survive with torsion. He'll most likely lose his nut but since this has been gradually coming on and getting worse I'll put this down as last on my list. Hernia - when's the last time he's been checked by a doc for a hernia? Low on list of suspicions though. Orchitis - anyhistory of mumps??? Tumor - not probable but could be hematocele/rupture - low on probability though Ruptured Testicle - that just hurts me thinking about it. Are any of these signs or symptoms present???? 1. Swelling: The testicle or the scrotum may become inflamed, red, and swollen. 2. Prior incidents: A history of similar episodes suggests that the pain may be due to torsion. 3. Nausea/vomiting: With severe pain, these symptoms could be torsion. 4. Fever: You may see fever (or chills) with epididymitis but less frequently with torsion. 5. Pain on urination or a penile discharge: These symptoms also are common with epididymitis and less frequent with torsion. 6. Pain with intercourse, pain with ejaculation, blood in the semen Even if any of the above are present - take him to the ER. There is no way we can diagnose this in the field. Just supportive treatment to the ER and go from there.

I have a friend who used to call his parents all the time on friday and saturday nights to come get him cause he had too much to drink. Last weekend his parents went out and had too much to drink and they called him at 11 or so and asked him to come get them. He was in the middle of a date but he and his date went to get them. His parents always did threaten paybacks.

No CBEMT I put succinylcholine down the ET tube, motor oil in the Iv and I'm drilling holes in the heads of non-trauma nosebleeds. No I don't have a 2 or a 4 year EMS Degree, not sure what you meant in your post.

My cutoff has always been a systolic of 90 or higher but there are times when I've given nitro (in the ED) at pressures near 80 remember in your textbooks that what you are learning are the Classic all the time presentations. You read about the illnesses classic presentations yet no book out there presents you with patients who really fall outside of the classic guidelines. The books do not present material on patients who do not fit the pretty little outlines of a specific illness. The presentations are cookbook in nature and it is up to you to gain the experience or learn more than what is in the books. Yes the shortness of breath material shows the major illnesses yet not many cover those diagnosis or cases where it could be one thing yet might be another. That is what differential diagnosis and thinking outside the box is for. You get adverse reaction to medications material in one book yet no where does it cover what a dystonic reaction looks like nor what it's treatment is. So it takes someone who is dedicated to learning to really delve into learning more about specific illnesses and disease processes. A good anatomy and physiology book would come in real handy as an adjunct to learning.

The ambient light is where it got me thinking. how bright is the light. Does it provide any better viewing of the veins in sunlight or flourescent light? I would probably have to guess no. Now in darkness maybe

Nice device, streamlined and compact but can't see the cost benefit analysis for EMS. I think that money could be spent better elsewhere. It might be a good thing on a supervisors vehicle when they respond with you to a cardiac arrest or major trauma. I think it might require that extra set of hands taht could be doing something else. I like the product though.

I have a video of the top 100 deadliest karate moves but I don't think I need to show them to ya! Might get me in trouble.