Just Plain Ruff

Whit, no those were calls from New Years eve/day over my career I think that one statement that would make me chuckle from a dive rescue guy would be "You're gonna need a bigger boat" I think that would be funny The other case I remember on christmas day about 8am was a minivan that got broadsided by a overweight semi-truck. We witnessed this accident. We called it in, got everyone rolling and got out and approached the vehicles and found both mom and her daughter pinned. I took the daughter and my partner took the mother. Mother died before the first fire truck arrived, the daughter clung on till we finally got her out after 40 minutes of extrication only to code on the removal of the car piece that was pinning her abdomen. We had 2 large bore iv's and she was intubated but she coded due to the crush syndrome when we released the pressure she just died. the truck driver after about 3 months of therapy i heard killed himself cause he couldn't live with the pain. He himself did not overload the truck, his company did, yet he paid the price. I had a friend who was a deputy sheriff in a small county along I-70 in Missouri. got a call from dispatch to call in. He called in and they told him to stop this specific truck(semi), to walk the driver behind the truck and then go check on the guy stuck to the front of the truck. apparantly this guy on the front of the truck at 11pm jumped in front of the truck and was struck. He basically stuck to the grill. So my friend, stopped the truck, moved the driver to the back. said wait here. my friend went to the front of the truck and indeed the dead guy was still there but most of him was on the highway back where he got hit. The truck driver ended up at the front of the truck and passed out. He quit driving trucks after that. the suicide was successful and it ended the career of a supposedly good trucker.

Like I said, I haven't had to take a test like this in about 12 years so I'm a little rusty on the skills sheets heck I don't really care at this point, but what I meant to ask is does everyone get 15lpm nrb or can you put them on less like 6lpm nc or something like that. I don't really have the desire to go to the nremt website to get the sheets as they don't benefit me either way. I was just curious. I also know that if you don't put them on O2 you fail but I was just wondering if it had to be 15 lpm

it's been so long since I had to do any of this but I'm curious Emilea(sorry for misspelling if I did), why did you put a generic apply 15 liters oxygen on the patient? Is this just how it's done in testing or is there another reason?

ok, my 4 most memorable calls on new years eve 1. 8 year old who was playing with alcohol based lighter fluid and it spilled on his private area. he then lit a match in bed which is where he was playing with the lighter fluid to see where the alcohol spilled. It took him about 5 seconds to realize his winky was burning. Dad runs in the room and says what's wrong and the boy yells, "I'm burning" and dad says go to bed cause he can't see the fire. Dad then realizes after he see's the can of fluid that his son was telling the truth. He puts the fire out and we get called. 3rd degree burns on his you know whats. This got him a helicopter ride from his house in a very upscale neighborhood. 2. Call on a pedestrian struck injury accident, on arrival found a 29 year old man nearly cut in two with one leg amputated and the other connected only by some skin and the femoral artery. You could see in his pelvic cavity. That one was cool 3. 12 year old raided daddy's liquor cabinet, went out to the train trestle and proceeded to get drunk with his friend. He fell 35 feet face first on the rocks below. Near Trauma code but he survived. Alcohol, the greatest muscle relaxant of all. 4. 16 year old hit by a train - massive head trauma, local trauma center refused him even though we were 3 minutes away and said to take him to the childrens trauma center. Not withstanding the 16 year old was 230 pounds and alcohol. Called for a helicopter to land at the local trauma center's helipad and an ER nurse came out and told us that since we were on their property he was ours, I said NOPE NOT YOURS as I'm intubating him. Helicopter lands, ER doc of local trauma center is now outside of our ambulance and is PISSED. We put the patient in the helicopter and he goes to the childrens' hospital and survives with many residual problems. COBRA investigation ensues, COBRA sides with little ole ME and the doctor apoligized. He even said Happy New Year after it was all over. Those are my 4 most memorable calls on new years eve or day.

i'm from the government and i'm here to help you. Can we meet somewhere private so we can discuss this error

I didn't go to this one as I've seen everyone of them but if this is the linda blair scary one please, thats' been around forever. It did scare the bejesus out of my wife though. That part was fun

DOH ouch that had to hurt. But stupid is as stupid does. But I agree the car really looks modified, almost like they were intending on hitting something. The dashboard is modified and there is no real dashboard - I didn't see a radio or heater control on this car. It's almost like this car was made to take the impact Plus they had a mounted camera showing the whole thing so I think it was staged - they still got hurt but I'd be certain that a non-modified car these idiots would have been hurt worse.

you gotta have two people in the chase car. Would you leave your fully stocked chase car unprotected at a scene in NEW JERSEY, I don't think so.

when the ambulance passes I just throw out the stop sticks and hope they make it through. Actually I've slapped partners for turning on the lights when another ambulance is coming. It just confuses the drivers out there who are already confused enough when they come in contact with an ambulance going L&S AS for bleeping or flashing lights when the ambulances pass is just plain stupid and I'm sure that each of the ambulances sees the other.

this was good. Very articulate person interviewed. Made me proud to hear what he had to say. Made it sound like each level of provider was as important as the next. I don't think this was like Bushy said, i don't think it was a jab at the certs just a overview. Good post thanks for posting this.

Anthony, I never never never ask for free drinks. I was only relaying on the free drinks after assisting in an incident that someone told me. If you accept any sort of renumeration for assisting be it free drinks or free flights you in essence have accepted payment for what you have done with assisting that a court could consider you an employee of the airline therefore opening up some really bad places we never want to go. The medical kit on a plane in nothing close to your jump kit and has a fraction of what you have. As for identifying myself as a paramedic - I should have clarified, I fly so much that I only identify myself as a medic to the flight attendants that I know and let me tell you I know quite a few from Delta and Southwest. I also do not identify myself to get in the mile high club as I don't have any aspirations of becoming a member without my wife gaining membership with me. I have taken overseas flights and identified myself only if I've seen people who might require assistance such as people on oxygen or someone with a large pill bag. Sorry for the miscommunication.

Firemedic - your 1st post is quite surprising As far as responding when I am "off duty" or "off call", if I see someone that needs help I will help them only if there is no medical help there already (First Responder Unit or Ambulance), or if I see just a couple people I will approach them and see if they need anymore help. Also I dial 911 to confirm that assistance is on its way, then I help. I have been told a thousand stories about people dying because a "off duty" or returning ambulance did not stop to assist them. How many stories have you been told - a thousand -- That's amazing that you know enough people to have been told a thousand stories. I'm really very very skeptical at that statement. Off duty or returning ambulance if it is in their coverage area should stop and render assistance. if it is out of their coverage area they should stop to confirm that help is on the way and then render assistance if they get permission from the county or city that they are stopping in. But I truly do not believe that you have been told a thousand stories. That's a tall tale.

FUUUUUUUUUUUUUUUUUUNNNNNNNNNNNNNNNNNNNNNNNYYYYYYYYYYYYYYYYYYYYYYYYYYYYyy

Nothing much to do differently. I travel every week for work and have been involved in at least 4 different instances. From the very minor diabetic who needed some sugar in their orange juice all the way to a patient with a pulse of 24 and getting ready to code. Which she did a little after they got her in the back of the ambulance. What you do not ever do is interfere with the flight attendants - no matter how right you think you are. They are always in CONTROL. Many airlines policies require that the flight attendants operate the AED and you can assist but they operate the aed. If there is a physician on board - defer to them unless they have no clue which most of them on the airplanes do not or do not want to have a clue as this makes them liable and responsible. One other thing, do not ever take any monetary or extra perks from the airline such as a free ticket or free drinks or whatever because in effect you have just become an employee of the airline (per a attorney who was on the flight that the lady coded on). Once you take any recompense from the airline then you become an employee of the airline and are no longer subject to the Good Samaritan allowances. So my advice to you is this -- do what you feel comfortable doing and no more. Remember you are actually not practicing under anyone's license and thus you need to follow accepted treatment guidelines. When in doubt, the airlines have in place communication plans that allow you to discuss the patients condition with physicians on the ground. they will make the determination if the patient can make it to their original destination or if an emergency landing needs to be done. I've been on transconinental flights and always identify my self to the flight attendants that' I'm a medic so if something happens they can always call on me to help, it doesn't hurt and sometimes the flight attendants give me more soda and peanuts if they know I'm willing to help out.

I have had the opportunity to refuse a doctors order but only when the patient has refused. for example Morphine for pain when the patient refused it I let the physician know so I really didn't refuse the order. There has been one time when I refused an order by a base station physician. I was told by a physician to transport a patient(pediatric overdose). I told the physician that this patients parents were refusing to be transported by ambulance but they would go to the hospital on their own. The physician told me "NO, I said transport the patient, do you have a problem with that" and I said, "No I do not but they are refusing to go by ambulance and I will not take them" She then replied "I am giving you a direct order to transport the patient to the ER by ambulance and if you do not then I will have your license" I then replied "Well I'm not transporting the patient against the families wishes" and I did not. The phsyician made a huge stink, she went to my ambulance management and filed a complaint. In the end I was vindicated by our medical director and my management due to refusing this order. The child was taken by her parents to the nearest er, she checked out without issue and was discharged from the ED 3 hours after she got there. I'm sure if the outcome was different then it would have been a different story but it all was well. I felt totally in the right on this one and would do it again if I felt the order was wrong. Even though they are doctor's doesn't mean they are not always right.

We see enough of this junk that we shouldn't have to watch it while perusing a web site. You got a lot of complaints because this is a disturbing video and one that doesn't need to be shared. Good to know that you have seen it all and are desensitized to it but some of us don't like to watch this.

I too would not hesitate to do this. I've done at two in the past with a ER Trauma Surgeon watching over me and standing right next to me. So I would feel comfortable doing this. I've also relocated a dislocation in the field due to a 2 hour egress and transport time I was the first in one of my services to peform a needle cric and several other things. All at the doctors orders and direction. So no I would not have any problem doing this. It's already been said - you cannot kill them any deader.

Here's another one for you all. How in the heck did they not hear this baby crying. These are definately two who should never breed again. http://www.msnbc.msn.com/id/16312314/

off subject a little, did the end result require the Norwood Procedure? What did his feet look like? ARe they normal color or cyanotic also? The other thing that I thought was maybe a late finding of coarctation of the aorta but that's usually a toddler/2-3 year old issue Maybe Abernethy Malformation or Hepatopulmonary Syndrome And could it be so simple as blue food coloring - like he maybe drank blue food coloring thinking it would be good to drink. Or had he baked cookies with mom and used blue food coloring? That sure would make the skin appear cyanotic and it would be on his fingers via the palmar aspect? It is around the holidays that we do a lot of baking. Here's a neat article on blue coloring in parenteral nutrition - http://www.theannals.com/cgi/content/abstract/34/7/868

so have we asked all the history questions? If so what does the exam list that I put out in a previous post reveal? I'm still kind of leaning towards raynauds due to the presentation of the hands with the cyanosis.

This is a toughie what was the Sample PQRST?

my faves are the Bozone layer ... Hipatitis ... and the Dopeler effect Here is the Washington Post's Mensa Invitational which once again asked readers to take any word from the dictionary,alter it by adding, subtracting, or changing one letter, and supply a new definition. The 2005 winners are: 1. Cashtration (n.): The act of buying (or building) a house, which renders the subject financially impotent for an indefinite period of time. 2. Ignoranus: A person who's both stupid and an asshole. 3 Intaxication: Euphoria at getting a tax refund, which lasts until you realize that it was your money to start with. 4. Reintarnation: Coming back to life as a hillbilly. 5. Bozone (n.): The substance surrounding stupid people that stops bright ideas from penetrating. The bozone layer, unfortunately, shows little sign of breaking down in the near future. 6. Foreploy: Any misrepresentation about yourself for the purpose of getting laid. 7. Giraffiti: Vandalism spray-painted very, very high 8. Sarchasm: The gulf between the author of sarcastic wit and the person who doesn't get it. 9. Inoculatte: To take coffee intravenously when you are running late. 10. Hipatitis: Terminal coolness. 11. Osteopornosis: A degenerate disease. (This one got extra credit.) 12. Karmageddon: It's when everybody is sending off all these really bad vibes, and then the Earth explodes and it's a serious bummer. 13. Decafalon (n.): The grueling event of getting through the day consuming only things that are good for you 14. Glibido: All talk and no action. 15. Dopeler effect: The tendency of stupid ideas to seem smarter when they come at you rapidly. 16. Arachnoleptic fit (n.): The frantic dance performed just after you've accidentally walked through a spider web. 17. Beelzebug (n.): Satan in the form of a mosquito, that gets into your bedroom at three in the morning and cannot be cast out. 18. Caterpallor (n.): The color you turn after finding half a worm in the fruit you're eating.

Ok, I am sort of asking this in a new thread but not sure where it will lead. It was stated in a previous thread and I'm quoting from the earlier thread credit goes to FFEMT4100 Adapt,improvise and overcome.Let's face it , this happens all the time and everyone knows it.Bid deal, who cares and yes it is what was best for the pt.With that said i have seen alot, right or wrong the pt. is my priority!!!! Here is my question: If it is what is best for the patient, right or wrong the patient being my priority(paraphrasing above) what would you as medics/emt/flight crews and doctors do that might cross the line. If I read the quote from FFEMT right, and forgive me if I'm putting words in his/her mouth but it sure sounds like you would do anything for the patient be it right or wrong. So,,, to this community I ask, where do we draw the line? We have an EMT pushing meds on request of the medic in a previous thread by NREMT I witnessed a EMT - Nursing Student run a full cardiac arrest from starting the iv to giving the meds to intubating and shocking the patient. The Medic just stood there and took orders from this emt/nursing student. (background on this call - medic and emt partner were long time partners and the emt was going to nursing school. I was the new hire EMT so I just went along with things cause I was too new to understand at the time that what they were doing was wrong - I'm older now and know better) I know that this sort of thing happens all the time according to the thread and this disturbs me in the greatest sense. Not only does it put our licenses on the line when we do something like this it puts your career and the reputation of the service you work for on the line. If word gets out that people for a certain service are practicing outside their scope of practice then litigation begins and a service can be ruined for this. Well off the soap box - Where do we draw the line at acceptable behaviour? Just questions that have been going around in my mind. Dust, come knock some sense into me mkay

FFEMT you are quoted here FFEMT4100 wrote: Adapt,improvise and overcome.Let's face it , this happens all the time and everyone knows it.Bid deal, who cares and yes it is what was best for the pt.With that said i have seen alot, right or wrong the pt. is my priority!!!! So you are saying that whatever is in the best interest of your patient you are gonna do it no matter what the cost? I'm curious as to why you say that? Elaborate please. I do agree, the patient is your priority but some times you can take things a little too far when it comes to the best interest of the patient. I have another train of thought starting in my head but I'll let you elaborate on the Right or wrong the patient is your priority statement before I get into what I am thinking or better yet I'll probably post it in a different thread.

FFEMT I don't know about Bushy's experience but he's spot on, it shouldn't happen and it's not right. End of story. 3rd post and your already making waves. Get ready for a bumpy ride.