Just Plain Ruff

If the big one hits, no-one is going to be able to handle it. Bring in all the resources you need but the fact is, if you dont' have the infrastructure or facilities or equipment to handle it you will NOT handle it. You just do the best you can with what you have. it's a common theme in America to throw money at something and it will get better. That doesn't work. I wrote a paper on mass casualty situation with a WMD and got an A on it in my master's level health management class.. I'll try to post it here in a link. We need to look at the overall picture like a post earlier said, if you put all your resources into a MCI and then you have 1 or 2 people not involved needing an ambulance or a house catches on fire and you cannot respond then those people are not served well. larger cities are better prepared cause there are more resources there, more hospitals, more resources a shorter distance but take the small county I used to work in. We covered 800 square miles with 3 ambulances but only 2 crews, sure we could staff the other ambulance but it would be tough. get a incident with 30 patients or in my paper 400 patients and you see the problems.

ok, clarify something. do they have to accept all your treatment modalities or are they able to pick and choose. someone in a car wreck, they do not want a board but want transport, are you going to tell them they cannot go with you unless they consent to your full treatment? i don't understand your logic or maybe I'm missing someting or misreading you.

Thunder wrote: "If he had no pain, I can understand this one. However, if they have a significant mechanism of injury and they say "My necy/back/head hurts." they are going on the board. It's not thier choice any more." well you just opened yourself up to litigation for forcing treatment on someone who didn't want it. I can tell you that if you were treating me and I said no on a backboard and you took that line that it's not my choice then we'd have some significant problems and your boss and EMS agency as well as the state bureau of EMS would be hearing about it. You say it's not their choice anymore are you saying that if they need an IV and they refuse that they get one anyway? You are on a truly slippery slope if you believe what you wrote in your post. If someone refuses treatment be it an IV or a backboard and you force them becuase you say it's not their choice then you are way out of line. Please tell me you don't force these patients into things.

I have never been a fan of trying to diagnose a cardiac event from just 3 leads. Sort of makes it difficult to do unless the monitor is a diagnostic quality monitor. It's been a while since I've had a 3 lead monitor to use, usually it's the lifepak 12 4 leads. I have a great CD that if copyright allows, I will post in a rapidshare link for everyone to enjoy. I'll have to check the copyright and see if it's free to share and if it is I'll share.

i have a theory It's called Devolution for every sitcom, reality show, knockoff's of american idol, remake of old popular songs that comes out and the american people gobble up hook line and sinker we take one more step back on the monkeys/apes take one step forward. So far the apes are about 50 steps behind us.

I have found that staples work quite well.

Let me set the record straight here, IF you refuse to treat me due to your religious beliefs then when and if I get better I'm gonna come back and whop your ass right then and there. You have no business in the medical field if helping someone conflicts with your religious beliefs. That is not what you are there for, you are there to help everyone who needs the help and calls on it. Keep your religious beliefs out of the patient care arena. If your beliefs conflict with helping people then get the he(*)( out of the field and let the people who aren't offended do the work.

I have refused to transport only one person in the past 15 years and that patient beat both myself and my partner up. She went ballistic when I told her that her brother could not ride to the ER with her. She scratched my face, kicked my ribs(bruise the size of montana), and nearly kicked my knee cap off. My partner fared worse, broken nose, bloody lip and black eye. We had a BLS ambulance there and they ended up taking her because I now had 2 patients I had to take care of. Needless to say she didn't go with me. She actually ended up in the long run a resident of a long term facility with a date of release in 2006. But just to refuse a patient transport is not something I would ever do.

/Sarcasm Heck no don't fire em, promote em /sarcasm off If this was an isolated incident then just a verbal If consistent then more forceful reprimand But to fire em, well maybe not that far. Did the patient get taken care of in the end? Lot's of unanswered questions on this.

I agree There is so much in terms of personal safety that it just so wrong with letting a deaf person in. 1. Extrication scene - they need to be able to hear over the tools 2. Auto accident scene on highway - if they cannot hear the commander say move then they are dead. 3. Fire scene - they are near a wall that begins to collapse - can't hear the shouts to get the (*)(&)()* out of the way then they are dead. 4. Can't hear a blood pressure or listen to lung sounds - nope doesn't cut it. 5. How do they give a radio report So there are a lot of items that they need to be able to do but cannot. I for one do not want a partner who is deaf. No offense to the hearing impaired but they have to be able to do the same job I do and I don't want to be completely responsible for them.

I left the field to pursue a higher paying job. I was already having back problems and they have gotten worse not better since I left the field. My higher paying job was actually just a little more than 5k a year higher. I have since changed jobs and work in the consulting field going around to hospitals and helping them implement a ER tracking system that tracks patients from when they walk in the door to when they leave. It's challenging and puts me out of the house in a different city 4 days a week plus I increased my pay by 100% I am looking now to get off the road and have found that I've priced myself out of the local market for Hospital IT due to being paid consultant's wages. I'm gonna have to take a paycut. Not sure how much but It will be a big chunk, upwards of 10K or more. But the trade off is that I am home every night and not flying on a plane monday mornings and Thursday nights. That's a good trade off So yes I'd take a lower paying job but it's a case by case basis for me.

ok let's talk about this a little more. /Over the top example but You are driving in Washington Dc the president has snuck out of the white house and is jogging, you come tooling around and hit him. You leave the scene. Are we to understand that if we continue this line of reasoning that you should be charged with both leaving the scene, and assassination attempt??? /end of over the top example But its the same thought process There has to be intent to charge the person with attempted murder on this poor doggie. Actually I don't know why we(I) are gettin so worked up over this. I think I'm done

I'll give the failure to stop at an accident scene but to charge this guy with striking a police officer or attempted murder is absurd. Yes I am sure he heard a thump and all that but there is no way that he should be charged with anything other than leaving the scene. Attempted murder charges - no way.

/quote in previous post Police K9s *are* officers. They are referred to as the handler's "partner". They work for, and in conjunction with, the police. I'm glad to hear that the K9 should pull through. I agree that, at a minimum, the driver should be charged with a hit and run. He hit an officer and left the scene. /end quote Above is my point. He hit an officer. Heck, I've hit a dog and never thought about it being an officer yet we are supposed to want to charge this guy with hitting an officer. No way.

/rant on whoa whoa whoa let's step back from the Kool Aid and think I'm an animal lover to the rafters but charging this guy for hitting a dog and leaving the scene is preposterous. Attempted Murder - Goodness what is that one smokin to make the person who hit the dog take the leap of faith that that dog might be a police dog is absurd even if there is police officers present. I hit a dog on the road the other day, damn thing darted out in front of me and I ran it over. I'm not about to swerve for any animal if it means that I may go off the road and either hit a tree, overturn or go down a ditch. My LIFE is much more important than an animals. To make the driver say, OH That dog I hit mi ght be a police dog so I should stop and go back - Heck no. I had not inkling that the dog I hit was a police dog nor do i think that anyone out there would put two and two together. Police presence on scene where the dog was hit, well how many times is there a police dog on a basic call. I think about 1% of the time. I'm all for taking care of the animals, I wish that cruelty laws were more strict. But to take this to the extreme and charge the guy with all these charges that are being leveled is absurd. Animals are animals, plain and simple. So to take this absurd argument that if we hit a dog we should possibly relate that that dog is a police dog to the next extreme, driving down a country road, I hit a horse and kill it and I do not stop. Am I to put a correlation that that horse might be a police horse because horses are often used by police departments? I think not. /OK rant off

State of Missouri If I remember right First Responder EMT-B EMT-P I like the KISS principle. Keep It Simple Stupid I never understood the need for multiple types of certifications. Seems like overkill to me. I mean come on Police First Responder?? Who thought of that silly thing. No offense to the police first responders out there but really.

My first 3 calls as an EMT were the following 1. Pediatric cardiac Arrest - SIDS 2. Adult cardiac arrest - save 3. Trauma code from pedestrian struck. Save Those were my first three calls as a new emt just out of orientation. My first 2 shifts were with a seasoned emt and then I was on my own for my 3rd shift.

Let's not forget the Amtrak Train that derails with a bunch of Nuns and Priests on board. After the train derails three planes in midair crash and fall on top of the building therby collapsing the building. You take your 4x4's and epipen and run to the nearest bar, get loaded and then run to the local church and confess all your sins and convert to buddhism and move to Tibet to be the next Dahli Lama But seriously - Triage, call for all the help you can get from 10 counties away and pray man, PRAY!!!!!

5 years out of ems? Thats a lot. I'd take the course again. I know Missouri requires full retraining after I believe 3 years.

Here is my take on this whole psych thing They are one of my most dreaded calls - I hate them due to their unpredictability BUT that being said I always transport the patient. The main reason is that you never know what that person has taken and not told you about. I'd hate to go out on a psych call and let them refuse or do a no transport and the patient actually have taken a overdose of a med that is making them act this way. The liabliity is just too great. I'm being paid to transfer or not to transfer, so I just go ahead and transfer. These patients are people too and deserve our care even if we don't like that type of call. Did I ever tell you the time I transported Jesus Christ? His family said he took no meds prior to the psych event, he denied taking any meds. It turns out he had taken a pharmacopea of meds that all interacted with one another causing an intense psychiatric episode. I had a feeling he took something and the ER did a drug/tox screen(it was one of those sendouts that comes back a week later) and it came back with over 20 meds that came up on it. The patient survived without deficits and once the drugs were out of the system he had no further episodes. We did a tad bit of praying together when we were on the drive to the hospital. Thank god he didn't think he could fly.

I agree and I apologize for my ranting. I hope I didn't make anyone too upset or so with my ranting. I had 1 hour of sleep and reading the responses to the post put me over the top. That was also after reading that story in USA today about the shortage of school nurses. The state of Missouri (misery) doesn't have any requirements for schools to have nurses at all.

/RANT ON Jeminy christmas - this was this guys first cardiac arrest in a rural setting. Give him some slack. Who cares if the frickin monitor was on too long, things get missed. If the family can't see it then there is no harm done. I can remember my first cardiac arrest in the field and it was a flustercluck and if any of you who are critiquing this guy can tell me that your first code, rural or urban went as smooth as glass then I'll bow down to you but if you can't then get off this guys back. It's amazing how people on this site or any other site can monday morning quarterback and say I'd do this or I'd do that but when it all comes down to it, you do what you can, you go with what you have and in the end the patient either lives or dies. It's not in our power to save everyone nor should it be. The only one who can make sure that it's not your time to go is whatever god you believe in. When it is your time to go it's your time, no if's and's or butts. So when the people who are critical of how this person ran the call become perfect then you can come here and second guess this guy but until then, cut him some slack. /RANT OFF Sorry guys but we were beating this guy up over piddlin things. Can you tell I've had a terrible night?

would frozen like a block of ice be a criteria?????

oh well then there is that

Jake, what do you mean take two steps between cpr and a breath?????