Just Plain Ruff

Elaborate - what kind of medication? Are you doing EMT clinicals or medic clinicals? If you are doing medic clinicals, I'm not sure what meds are out of your scope of practice except for the drugs given by Anesthitists.(sic). If you are an EMT clinical then no freakin way. let me elaborate - if you are unfamiliar with the medication then you should not be pushing it until you know what it does and what the side effects and cautionary items are. You just tell the nurse or physician that you are uncomfortable pushing that med and tell them why. then ask them to educate you on what the medication does and then as soon as you know what it does and what it can do to the patient then I say, go ahead and do it. But only if you are comfortable with doing it.

Holy crapola, how the heck did they get away with an entire cath lab. Didn't someone notice or was it done in one night? If it happened over a period of time then serves em right for not putting a camera or something in the lab to catch those creeps. I say Sux and a large dose of Niacin to cause the hot flash. paralyze them, breath for them but make em feel the flash.

happyness, those were some really good points and lessons. I'm glad it seems to have made you a better person and more understanding. Happiness check your pms

Here's your sign, err I mean Badge Here's Your sign

EMTALA and COBRA Once you have brought a patient on to the hospital grounds then that hospital is responsible for that patient. Period. At least that's what our COBRA/EMTALA rep told us. It's referred to as Anti-dumping. Once you are on hospital grounds and some COBRA/EMTALA reps have told us that if you are within sight of the hospital then you are on their grounds but that rarely sticks. What the hospital has to do to comply with EMTALA/COBRA is to perform a qualified medical screening of the patient, provide appropriate treatment to the patient and provide a appropriate transfer to a appropriate secondary facility. There must be Doctor to doctor communication and acceptance of the patient at a 2nd facility, Nurse to nurse contact to give report and then a qualified transport to that 2nd facility. You cannot leave that hospital until those items above are completed. Now if your patient says, I don't want to stay here and they are on your gurney then the hospital is still required by law to fulfill the parts of the above paragraph. If they just let the patient go then they can be fined up to 50K per occurrence and Administrators do not like to have to sign a 50 thousand dollar check to COBRA/EMTALA. It also looks bad and people equate that fine to that hospital dumping patients. Sooooo, to make a long story short, if you arrive on a hospital grounds and decide to take the patient elsewhere due to a long wait or the patient wishing to go elsewhere, in a nutshell, You Can't. If you do you will run the risk of alienating the hospital and also getting your tail in trouble. If the patient refuses to stay at that hospital then they can sign an AMA form and go to another hospital but more often than not the patients insurance will refuse to pay any of the bill because the patient refused medical advice. The bill might be paid but it will be after a long protracted battle with the insurance companies. Another wrench in the mix will be the 2nd recieving facility, if the steps to transfer are not taken and you just leave then that receiving facility will more than likely cry "COBRA" violation and report the first hospital to the reporting agency and a huge investigation will ensue, trust me I know this one as I or another co-worker have been invovled in at least 5 investigations in the past that I know of. So to make a long story short (too late), once you are on hospital property, you have effectively turned over care to that ER even if you have or have not given a report. The report has nothing to do with it. Once the ambulance turns onto the hospital property you are effectively wards of the hospital until they determine what happens to that patient. Special note: This also applies to helipads on hospital property you use for landing zones. COBRA/EMTALA have let us know that even though we use the helipad for landing zones to get the patient from the ambulance to a specialty center, if that helipad is on hospital property, you are effectively under the hospital's umbrella and that hospital has to abide by the transfer requirements set forth in my first paragraph or two. In all reality, COBRA/EMTALA are not going to cause a stink if it was in the patients best interest. The only time a cobra investigation really gets initiated is if someone reports a violation to COBRA. Then the investigation occurs, if no report then no investigation. They really do have better things to do than to investigate, than to go out and search instances where the best interest of the patient was taken into account. If a report is not made then no violation occurred is what the COBRA Rep told me. Sorry to ramble on but I hope I answerd your question. Oh One other thing - HUGE CAVEAT TO ALL THIS -- I was told by a COBRA rep that different reps look at things differently. One may be completely by the book and be a rules nazi while another one 300 miles away might have a completely different way of looking at things. It depends on the investigator on how stringent they apply the rules. they apparantly have quite a bit of leeway to look at things. So your investigator might look at things in a wholly by the book way and investigate every little complaint and suggest fines on every occurrence or your investigator might say, "how did it affect the patient" and go by that mindset.

sounds great, spend thousands of dollars on a medic license and then never get to use your skills. So what happens to those skills for those who have to sit out a year or more doing bls work. I can see how the draw for a bls person would be big in boston but I'm sure not many here on the city would want to regress back to bls for a chance(slim) to get to paramedic level in Boston. I wouldn't but then again that's just me. I do know that Boston is a happenin city though.

Let's blame the officers who wrote the tickets.

Are you interested in working in Missouri or kansas? A little clarification of where you are wanting to work. The US has a tremendous amount of area and just asking for places kind of will give you a million different answers. Maybe post your top 20 places you'd like to work? does quality of life outside of EMS matter to you or are you just wanting a place to get tons of experience and then get inevidently burned out?

Hey Mobey, care to post what the quick test your medic friend showed you. I am sure it will benefit most of those of us here.

Try looking at this. It took a little bit to load but it's pretty good. http://books.google.com/books?id=PKqXqB0W7...6k_6CM#PPA55,M1

On the subject of lines in movies and tv shows Remember the time on WKRP in Cincinnati when Jonny Fever, Venus and Andy were trying to get the photos of Jennifer(loni Anderson, whatever happened to her) from the photographers office. The night watchman was coming close and Johnny uttered that famous line "I was in a jail in Tijuana, Badges, We don't need no stinking badges" and they left the office without the photos.

Am I the only one who does that Spenac? I look at my rearview mirror every 2-3 seconds or so. In fact I was watching my rearview mirror tonight and saw a wreck happen. The girl was flying but the guy drove in front of her, no skid marks, no brake lights just Wham No one was hurt but boy was she pissed when they both got ticketed. Oh well, but yes, I check every 3-5 seconds all my mirrors it drives my wife bonkers.

this has at one time about 10 years ago been discussed in various forums. IT was deemed to expensive and was considered to only be a possible optional accessory to cars instead of standard equipment. What I"ve seen being done these days is to put the lightbar at the drivers height on the ambulance. What I mean is have the lightbar at the level of the other drivers. Currently the lightbars are placed on top of the ambulance cab and most people cannot see the bar due to their rearview mirrors being lower than the lightbar Another option which is in wide use in the KC MO area but not many other areas, correct me if I'm wrong, oscillating sirens, two separate sirens which makes it easier to hear but with the sound proofness(new word) of the cars these days it's amazing that you cannot hear the sirens. I heard an approaching ambulance but not until it was right behind me. I had the radio on at talk radio level, my windows up and I didn't hear them. another time I heard the siren, same car and volume of radio but this siren was the Fire Truck with it's Q style siren. I heard the truck about several blocks behind me.

There are two camps here. But I don't think that he is personally singling you out with his remarks, you don't really believe that he is singling you out alone do you?

oh my here we go. It's gonna be a bumpy ride. Buckle up.

yes I got them and the familiy really appreciated them. they say thanks to all who responded.

http://www.thekansascitychannel.com/health...970/detail.html Discuss:

Goodness, Yanni and Karunesh are getting to me Recently my grandfather passed away after a long battle with cancer. At his funeral were the ambulance crew that transported him to hospice as well as one of the hospice nurses. My question to the group is this: Have you attended a patients funeral and when do you think it is appropriate to go. I have been to 3 funerals because I just never felt comfortable to go to them but I know of other medics who go to every one of their patients funerals. Is there a common ground or rule of thumb that you go by in determining whether to go to a funeral of a former patient or not? Discuss

let me tell you a little story about a patient I transported one day She was an 18 year old who suffered a life threatening condition which required a liver transplant. When I transported her to the transplant center she was on deaths door and was number 1 in the nation on the liver wait list. She asked me in the ambulance if I believed in God and i said yes. She then asked me if I believed that she would go to heaven. I said, I couldn't tell her that because only God knew. she then said something that I will never never never in a hundred years say "That person at the end of the seat next to you says I will" I asked who she was referring to and she pointed to the end of the ambulance bench seat and said "The angel at the end of the seat, can't you see him?" I said I could not but I had felt some sort of presence or a feeling that there was someone in the ambulance and I had felt that presence since we had been toned out. Three days later she passed away waiting for the liver that she was needing. Her funeral was one of the only 3 funerals I've ever attended as a medic. I still get goosebumps and shivers when I think of her.

450 pounds is too heavy to lift with two people period, unless you only have the two to lift you have to get help. But lifting from the side is not good science either, it's a good way to get your feet crushed. There is no real good way to lift someone over 400 pounds without help But remember, you already have to lift 200 or so pounds just by keeping yourself upright. Then you add 400 pounds of patient and 100 pounds and we are up to nearly 1000 pounds. It's amazing aint it

One of my favorite sketches was the "Land Shark" with Chevy Chase. The land shark skit was about an intelligent shark that walked on land and murdered housewives in their homes by disguising itself. I found this piece to be brilliant. My favorite part in this sketch in the first Land Shark sketch was when the shark went after his second female victim. The lady replied to the knock with, " Who is it?" Landshark: "Plumber." Lady: I didn't hire a plumber. Who is it!?" Landshark: "Flowers." Lady: "What... for who" Landshark: "Plumber" Lady:"... you're.. that crazy shark aren't you?'' Landshark: " No maam, I am just a dolphin.. will you let me in please?" Lady: "A dolphin! Ok!"

wow what an incredible post. I've always thought that by doing what you said, keeping someone from smoking or everything else you said that I was doing something right but never thought about it in terms of a Save. That's food for thought and also great thinking outside the box. Vent, if you are interested in writing pm me and I'll talk to you about a proposition.

you don't know me very well then. I'm not a bible thumper and I like those types of movies.

I'm full of useful topics today. So when is it appropriate to pray with a patient? When they ask? Do you ask them if they would like to pray? Just when is it appropriate? Discuss

Cable guy