Just Plain Ruff

NOW that was funny

wow, that's sort of close to the line of appropriate versus innapropriate. Very close

Great Medical Ebook site. Have fun!!!!! Sharing what was shared to me from a friend. I make no disclaimers. http://www.medicalheaven.com/

Darwin award anyone, wait he had to die to get that award. So I'm just gonna give him his Sign. Here's your sign. I'm With Stupid, wait, I am stupid

http://www.emsresponder.com/article/articl...n=1&id=4724 Not only do we have crappy security which we've always known but now we've just truly broadcasted this to the terrorist masses out there. It's like saying - HEY come on over to the railyard, drop a dirty bomb on a unwatched unsecured train car and watch it go BOOM

http://www.emsresponder.com/article/articl...n=1&id=4723

If you are interested in the colorado springs area 50 minutes from Denver then drop me a PM.

Hospice - dying with dignity Good call not working that code. Good call calling the ER doc and explaining the situation. The family knew he was dying, the patient knew he was dying and they did the humane thing and brought hospice into the situation. Hospice is a great resource - my grandfather died comfortably in his sleep at a hospice care facility. One minute he was breathing and the next he was gone. This sounds like what your patient did. Patients go into hospice for mainly one thing - to die with dignity. -15 for the invalid DNR, bad bad mojo for the paper shufflers. +15 for not working the code. I would not have worked the code, I'd have called the ER and explained the situation. Sounds like you did a good and ethical job on this case.

Anthony, I went that route already and no-one can tell me the sources they just say- it's what we use. I guess we have to go a different route.

I did have one similar situation taking a child with a fractured left foot to the ER from a school. We were taking a slow boat to china drive to the ER and had a woman run out to the curb and flag us down. Her friend collapsed and was in cardiac arrest. She heard the ambulance go by earlier and when he collapsed she saw us coming. I put my emt driver with the kid, called dispatch to send a full response and got our equipment together and went inside. Started the code just like you would do so if you were in acls and did the first 11 minutes of mega code on the patient while waiting on the response of the FD and our other ambulance. Was able to get a return of circulation but the guy eventually died in the ICU after a couple of days due to massive heart damage caused by his MI. ONe other situation was we had a lady from the nursing home being brought into the ER for a peg tube replacement. Call for a choking child came out, we were 5 blocks away so we responded to that scene while the ambulance crew was scrounged up from the base. Long story short, child's airway was clear by the time I arrived. Mom and dad wanted child checked out so we packed that child up in our ambulance and put the 2nd ambulance in service. Transported two non-emergent patients in the ambulance. Parents were thankful that they didn't have to wait on the 2nd ambulance and the old woman got a little 3 year old to play with during the transport. A good outcome on this one. We do what we have to do, if you are rural you know what I mean. Not saying that urban is not as good but in an urban setting you usually have more ambulances available while in a rural setting you may wait 20 to 40 minutes for a 2nd ambulance to get to you. That's why I utilize helicopters so vigorously as they can transport the most serious of multi patient incidents and freeing you up to do more with the sometimes little that we have. If you take this post to be a urban versus rural post then you have too much time on your hands and that was not the intention.

I can almost guarantee that this age requirement is a insurance requirement. AMR in Independence used to have the requirement. Not sure if they have it now. But I'm almost 100% positive it's insurance. Are you committed to florida or would a different state be considered. I have quite a few contacts in Missouri

Well Legal said like Dwayne and Dust noted - yes it was abandonment and don't do it again. that's it I told them, I could not be sure what I'd do in the future but it did bring up the fact that there did need to be a new policy for this type of incident and that service is able to drop level of provider from als to bls if the patient is stable. In the end, nothing detrimental came of it towards me nor towards anyone on the call. There were three fatalities on the call, 2 people will never be the same. You know what I did find out about myself is that it's a different story when you happen on a call like this rather than get called out. when you get called out on a call like this when you know it's bad you can already call for extra help but to drive up on it just about minutes after it happens all that prep time is gone. There is no prep time. so in essence you become a bystander with skills because you didn't get to mentally prepare for the call. Granted, the training and my knowledge kicked in and we worked the call and it went pretty smoothly, we were able to extricate 2 of the victims (one of which died) prior to other units getting there. We had some pretty good bystanders to help us. I even taught one bystander to ventilate a patient with a bvm at 12 breaths per minute while I worked to get them stabilized. My emt partner worked on the 2nd patient the one who lived. On arrival of the first fire truck which we ended up having 3 fire trucks there, 4 ambulances and 3 helicopters, we were able to remove the 3rd and 4th patient from the wreckage. the 3rd got tubed and the 4th was a trauma code which we did not work. The 5th victim was the driver of the car and he was drt. So in the end, helicopter 1 took the 1st patient out (not the one who died) to trauma center 1, helicopter 2 took the 2nd patient(who died) we got out to a trauma center in a different city. The first unit in took patient number 3 out of the car who was class I to our hospital for stabilization and helicopter 2(they took a little longer to get to the scene) and took him from the er. Patient 4 and 5 died, but number 4 was transported to our hospital but died in the ER. Patient 5 was was dead in the car. Patient 6 (our wrist patient) was taken to our hospital by my unit and could not stop talking about what she saw. She is now a cop in a city about 200 miles from my old coverage area. We ended up having the 4th ambulance take the truck driver (NO INJURIES imagine that) to that ambulances hospital nearest their base for a check and mental health workup. All in all it worked out pretty smoothly yet it seemed like a cluster durning the incident. When you don't get to prepare for something like this you basically go by instinct until you know what you have. If this seemed a little disjointed remember it was 5 or so years ago.

Let me throw this wrench in you have just picked up a very very very stable patient from a fall. She has a hurt wrist only. You come up on a very very serious accident. You have a EMT Driver and a Medic in the back and a student(emt-p) who works for your service also. Your closest unit is 30 minutes away. Do you put the emt in back with the patient? Do you put your medic student in the back with the patient and you and your partner go out to the wreck You have 5 critical patients, 3 eventually die of their injuries(2 are children). You fly 3 of them out of the scene. (Car versus Semi Head on Highway speed) or do you the medic stay in the ambulance and let the emt's take care of the patients? I had this happen to me about 5 years ago. YOu have a duty to your patient in the back and they are definately BLS. Is it abandonment if you the medic leave that patient in the care of a bls provider? I was told by my supervisor at that time that it was considered abandonment to leave a patient this patient with an EMT becuase as a medic I initially took care of the patient and I dropped the patient down to a bls status. He said it was abandonment. I told him he was full of shit and told him to ask our legal department. What do you think his answer was? Heck I might just put this into a scenario for ya all. I'll include the pics that a bystander took of us working.

In the presence of Nausea and vomiting I would have to say that V-tach woudl be an ominous sign. I'd suspect and MI that has progressed to a very very irritated heart. sounds like the guy was about to code anyway but without more info it's hard to tell Just remember and I'm sure you know this, some patients die!!! No matter what you do, what you try to do and what others try to do they Die!!! It's just a fact of ems life. PM me if you need a good shoulder or ear to chat.

ha ha that was funny

ok let me try to explain this request to all of ya, since apparantly I wasn't clear from my initial post. We have a computer system called Cerner. Cerner has computer based forms on their system. ONe is a vital signs form. The forms have the following data items in them Systolic blood pressure diastolic blood pressure Heart rate Resp rate Pulse ox Temperature. There are other items that they track but let's just take the above. For each of these there are numbers(reference numbers that show up in different colors depending on what value is entered) behind them such as normal ranges, high ranges, critical highs and critical lows These numbers are pre-defined by Cerner. So lets say that for systolic blood pressure the nurse enters 180 Cerner defines this as a critical high. If the nurse enters 140 for systolic blood pressure it would register as in the High range. If the nurse puts in 40 for systolic bp then that is defined as critical low. All the nurses want is where Cerner got those numbers and what reference that Cerner used and Cerner cannot give them the reference where they got their values.. Bear in mind this is a big Six Sigma site. It's a very familiar site but due to confidentiality reasons I cannot say what hospital. they have their own ranges of critical highs and lows but they also do not have a reference for their ranges. What they are wanting is a reference to document back if anything comes of it that they can come back and say in "Steadman's book of medical factoids(fake book but an example)", the critical values which are the ones that we chose are as follows. Critical high systolic bp 180 or above Critical high diastolic bp 140 or above High systolic bp is 130 - 180 High diastolic bp is 110 - 140 normal bp 100-120/80-110 low bp 60-100/40-80 critical low bp <60/<40 Does that make sense??? In other words what manual or book did they use to get to their values. Cerner just tells them - those are the recognized values but we don't have the source of recognition. So I task you, and I actually wish Ace was still around, I need a verifiable source, either a textbook with values or a document with values. This is a huge six sigma site and they want sources.

Oz, the banana comment made me laugh somewhat as funny to me as the Banana in the tailpipe

the two places I've mainly worked at, we have 40-50 minutes of fast driving time to a trauma center. If a call comes in that sounds remotely bad then we will launch the bird. You can always turn em around. Trauma and peds got flown out a lot, most others we took to the er (local 106 bed hospital 12 bed ER) and stabilized and then either flew or transported. when I first started, we never flew anyone out, the medical director said all patients come to the er and then flown. He was a old time doc who was one of the first ATLS physicians educator in missouri so he thought he could heal them all.

Somedic, great response to Windsong's bash of the president and white house. it was truly funny.

I shouldnt have eaten that last helping of garbonzo beans.

of the hundreds of people I've known in EMS everyone of them says that they either cheated or know someone in their service that has. they sometimes say they know many many who cheat. I travel for a living now, part time EMS but as a traveller you would think it is extremely easy to cheat, you are away from home every week and such and yes I'd suspect that if you went out looking for it you would find it but I also know hundreds of people in travelling jobs and the response is the same as EMS, I know someone or I have done it. If you go looking for it, you will find it, if you dont look for it then you probably won't find it. As a brand new emt then medic, I admit I had a few flings but never with married partners and after I got married, I would never go looking for it and If it found me, I'd tell it to take a hike. Trust me from close friends, it will always find you out, and then you may lose much of what you hold dear.

showstorm = snowstorm surprised you didn't know that.

ok, the nurses are wanting ranges of critical, abnormal and normal values. They know what the numbers should be but they cannot find any documentation on what those numbers are. The product I work on has ranges but the nurses say that those numbers are a little off. The company that provided those numbers cannot give them the rationale as to where they got these numbers nor do they have documentation on what those numbers are and how they were decided I don't really care about their motivation behind wanting the numbers, it is physicians and nurses that are asking for these numbers. They do not want to take the numbers given at face value as the ranges are really wide. I will try to get the ranges that they have been given and I'm sure you'll see why they are questioning. The company that has provided the ranges often does things this way and does not have the documentation or rationale behind it. Heck, there are things that just aren't done right with the company at times. But to ask me the motivation behind the request, I cannot answer that other than they want verifiable data that they have the source for. Everyone on this site get's their panties in a bundle when others don't cite references and this is all that the nursing group I'm working with has asked. Seems that is motivation enough for me.

I've been tasked by a couple of nurses at the client I'm at to provide the following information and I'm at a loss I need sources if possible with the info. Normal vital sign values (hr, sys bp, dias bp, resp rate, pulse ox and the like) - I know these what I cannot find a good source on is critical vital sign numbers. I know what they should be but the nurses are adamant that I provide them a source for these numbers. preferably a scholarly source but a source none the less. I've searched google, google scholar and Pubmed etc. I can't find a good scholarly source. Anyone who can help me would be appreciative. thanks

i know just the person who will get my first letter.