Just Plain Ruff

Quoted here: But to do CPR for an hour, just to "let her know everything was done", that just doesn't cut it. Let's say that while you were doing your thing a call came in your coverage area for a 2 year old in anaphylaxis. Would it still be appropriate to tie up an ALS unit for the length of time if you knew there was no hope of succesful rescusitiation I did just that, was the only ambulance on at 6pm. cardiac arrest, worked him for 35 minutes. We got a call from dispatch saying for us to call in asap I did that, they said they have a 4 year old in anaphylaxis due to Peanuts 3 blocks away. What was our status? I said wait. Talked to the family of the code and they said go and save her, our loved one is gone. Got permission from the Doc in the ER to call the code. WE did Hauled butt to the house and were able to save the little boy. The boys family wanted to know how the other family was and we told them outright that the man died and the family told us to go save their little boy. This little boy's family was so grateful and at the same time sad for the family of the code that they have since become great friends. I also had a nursing home patient in the back of my ambulance who had a small laceration to her leg that needed sutures. A call came out on a choking infant. closest ambulance was 30 minutes away. We were about a mile away. Do you think we thought twice??? NOPE we drove to the childs house, found that the child had cleared his airway with instructions from dispatch and we transported both to the hospital. We operate definately in a mass casualty mode and we do what we can. Does anyone remember the ambulances where you could have hung the patients from the roof. Like a bunk bed.

I agree with the last post the criteria that we use is if a person has been down for an unknown period of time (or known even), and the drive to the scene is greater then 15 minutes (which is almost always is except for runs inside our little town) and that patient is in Asystole or a PEA rhythm then that person gets full ACLS protocols provided and if 20 minutes rolls around and the person has not responded then its a quick call the ed to get permission to call the code. I will then after speaking to my ED physician, I will discuss with the patients family about the decision to terminate the code. Of course this usually is met with relief by the family that we've done all we could but sometimes families get irate and if it's too much of a distressor to the family that we stop then we will continue and will transport. I'd say 85-90 percent of the time the family will understand that we did what we could and agree with the cessation of efforts. Now witnessed arrest, good cpr and v-fib on the monitor after no matter how long it took us to get there gets worked to the ER no ifs ands or butts. Others that don't fall under the treat and call mandate are kids and trauma codes and anyone that doesn't fall under the circumstances such as diabetic, seizures, overdoses etc etc. But with transport times exceeding 20-30 minutes routinely it's not practical to work the patient for that long. Especially when we sometimes run with only one unit on duty and another one on call. I have a Living will that is printed in small font in my wallet, my wife has one, my family has one. My grandparents have signed a DNR. When it is my time to go it is my time to go, please don't keep me from my glorious reward (my grandpa's quote)

Hello all, well Ditch sent me a pm last night via the trauma central boards. He didn't realize that there was still so much interest in his test. He's gonna start to write it again and said it would be a while for him to get the test written. So be patient my friends.

Race, I agree, he was guilty of a lot of things but the jist of the movie and it's underlying premise is that they were trying to prove, and they did in the movie, that it was possible to execute a man who didn't commit that crime. that was what their movement was all about, do away with the death penalty because this type of thing could happen. But he was guilty of a number of things, just not anything that warranted the death penalty. Can we execute innocent people? Sure we could but that is what the appeal process is for and that is why DNA is so important. I still am a staunch supporter of the Death penalty, even if the possibility of executing a person who might be innocent is out there.

Dust, I normally agree with you but you are wrong on the cost. I was putting all the costs together. It does indeed cost more to put someone to death than to house them. I don't have the references or links since I'm in Detroit and live in KC MO but my math is correct. Let me get those links and references when I get home and I'll show em to ya. And I'm not naive and I did not fall for them, I have the facts at home.

Racemedic, I have really thick skin, that's what happens after working in this field for 14 years. True the costs of the appeals stop after they get the juice but that might not happen for 20-25 years. So we are still talking huge amounts of money. I also think the government missed the boat by not limiting the amount of appeals but it's our justice system and it's flawed but the best one out there. I do believe that if someone is innocent then they should be given every opportunity and I mean every opportunity to prove their innocence and if that means a million appeals then so be it. I cannot fathom putting someone to death who was truly innocent. If you want to see a truly jaw dropping movie that made a hard nosed paramedic cry, go rent Life of David Gale.

well there's the crux of the issue. those are only my thoughts, my thoughts on what should happen. But if they are innocent then I'm not sure. No one failed math on the costs. you house someone in a prison for life and there are set costs - room, board, food, activities, job costs etc. But you put someone to death you have to account for all the tremendous amount of legal fees that will be spent on the appeals. some death row inmates have had upwards of 100 appeals, all paid for by you and me and our tax dollars. Consider the fact that an average appeal could run upwards of 100 thousand dollars in terms of hours spent by lawyers, investigators and the like. Someone has to pay those fees. Sure an attorney for the inmate could be working pro-bono but the state is not. So consider a small number of appeals 100 thousand times lets say 15 appeals = 1.5 million plus close to the same amount of money spent to house that inmate in a cell as a similar lifer. One appeal or two appeals for a lifer at 100K a pop and you get the math.

If anyone has read this thread from beginning to end, they will know that he said it would take him quite a bit of time to get the test written. I think that with that said, we should stop posting on this because most people here want to take his test. Let's give him time to get the test written and disseminated out to the community.

About 8 years ago I had the opportunity to possibly sit on the jury in a death penalty case. A guy killed his wife for the insurance. I wanted out of jury duty so I said I was in the business of saving lives and not taking them. They excused me. I think I would hold to that belief today also. I'm all for the death penalty but I don't want to be the one to push the button. Heck I think that if someone gets sentenced to death, then their sentence should be carried out quickly. Convict in trial 1, retry immediately with a new jury and if they convict and recommend death, then a 3 judge appeals court reviews it for procedural errors, if none, then it is reviewed by the Supreme court one last time and if they don't issue a stay, then it goes to the governor and he either allows a stay/commute or he doesn't. If all those are completed and still the guy/gal is to die then take em out to the courthouse steps and tie the rope or put him either in the gas/electric or lethal injection room. None of this pussy footing around and appeals going on for years. Let the bleeding hearts pay for those. It cost more to put someone to death than it does to house them for life. Think about that.

Well I feel sorry for that guy's family and not to sound like a heartless ahole but this mandatory death penalty has been on the books for a very very long time. It has been published many times about the babarity of this sentence but this guy did the crime and even though 14 ounces of heroin sounds like a small amount, its just 2 ounces short of a pound. that's a lot of dope guys. He knew the penalty of getting caught yet he did the crime anyway. Ignorance of the law is no excuse according to our criminal justice code. So why should it be different there? Plus I believe he used to at least live in Singapore so he definately should have known the penalty. It's a harsh penalty but if you know what the penalty is for doing something then you have to accept that if you are caught you are screwed.

Goodness I thought that the xrays in the ambulance suggestions were a thing of the past. First off where are we going to put this new fancy piece of equipment. I've worked in Van ambulances that had less space than my studio apartment's bathroom, and that is small let me tell you. The fact that we have the ability to do this does not necessarily mean we should do it. We are reimbursed horribly by medicare and medicaid as well as private insurers yet we still want more and more and more bells and whistles. I agree with Dust, that we educate our ems personnel to be able to do their job and not require them to have to take x-rays. This means more hours spent in school and the way that licensure is in most states you would have to get licensed as a EMS provider and a radiology tech. Where are we going to put the developer also. Plus what is the quality of the image? I can just see this huge expenditure going into each ambulance and then the hospital saying the quality isn't good enough or a territorial battle over who takes xrays and the hospital just retakes the xrays. Let's get off the "I wish we had this cause it would be cool" and get on to the more practical aspects of patient care.

I'd like to see the test and as for ditch not posting here for a while, I k now for a fact that he posted on a topic I was watching within a week or so ago.

One time only and that was way before I was married.

guys guys guys, what do you expect with someone who only currently has 8 posts. . Stephen comes in saying these statements, never once saying he has driven an ambulance. Let's look at the safety record or road record of the high performance racing. you have a bunch of guys driving around a track and i don't watch car racing very much but I know for a fact that there are lots of crashes. If we take the number of crashes and the number of races run, multiply that by the miles or whatever formula you want to take, I am sure that in terms of miles driven that the high performance racing industry has more of a poor driving record than the EMS industry. Consider millions of miles driven by ems in their daily routine and a lot less than that in the high performance racing. But then again I don't know how many miles they actually drive but I'd think it's a lot less than that. I'd put my emergency driving skills up against this guys anyday. But I'd defer to him on the driving of the death highways of other countries. no desire to do that.

I might have put the child screaming bloody murder in with the ETOH smelling one to make them suffer if the etoh person is the driver of the offending vehicle. Make them think about what havoc they caused. So who was at fault?

Nate, I assume that if a plane crashed you wouldn't be working many codes at all. maybe a bus wreck or something like that

a very good friend and excellent cardiologist one time told me the only reason that AHA recommended Amiodarone over Lidocaine is that in the studies Amiodarone helped a few more victims than Lidocaine. He said that the two were nearly the same in success rates.

Pt 1-Driver of the Civic, 20yo female, shoulder/lap restrained. Pinned between the seat and the steering wheel. Vital signs fading. Responsive to painful stimuli. Pt 2-Rear passenger of the Civic, 3yo female, appropriate child safety seat. Severe trauma to the upper torso, head & neck. AMS, Vitals falling, Child is not responsive to any stimuli just staring into space. Pt 3-Rear passenger of the Civic, 4yo female, appropriate restraint system. Obvious deformity to R forearm. Vitals stable. Pt is screaming "bloody murder". Pt 4-Driver of RV, 40yo male, ejected from the vehicle. Noticeable road rash on posterior of the body, Vitals are weak, but maintaining for the moment. AMS, incoherent speech. Odor of ETOH suspected. Pt 5-Front Passenger of RV, 35yo female found seated in passenger seat of RV. Unsure of restraint. Pt AAOx4 c/o bilateral ankle pain. Obvious deformity to both ankles. Pt c/o no other pain. Vitals stable. Odor of ETOH suspected Pt 6-Rear Passenger of RV, 41yo male, unsure of restraint. Pt found within rear compartment of RV. Pt AAO x person & time. Pt. c/o pain all over. Deformities to L thigh & L forearm. ETOH suspected. Pt vitals stable with exception of Hypotension and a narrowing pulse pressure. work on getting patient 1 out. Rapidly remove patient 2 out and put on next in als truck, also put patient 5 in that same als truck Put patient 3 and 6 in next als truck get number 1 out, put in your ambulance and put number 4 in your truck. unfortunately number 1 and 2 are gonna probably die unless they get to the trauma center right away.

Stephen, you admit to not reading the previous posts. I would do that before you make such inflammatory statements. I've watched car racing and your drivers really are good drivers but I have to beg to differ with your statements. I'd put my emergency driving skill at the top of the pack and I've logged over 1 million miles. Before you go and post this inflammatory post you should at least have the respect to read the previous posts and not just take the first post off the page.

actually that bls ambulance is run by the Fire Department so You are more than likely going to be getting two firemen irregardless of what department they come from.

I'm glad

Let me try to explain this a little better cause my previous posts were mis-read or I just did a bad job explaining there are 5 different overall types of response vehicles. We are not talking LEO's here ok. BLS Ambulances (2 emt ff's) ALS Ambulances (2 medics or 1 medic/1 EMT) Supervisor vehicles (1 Medic) BLS Pumper ALS Pumper Call for a fall comes out Dispatch sends a bls unit and a als unit. Whichever unit is closest goes L&S, the farther unit responds non-emergency First unit arrives and triages the patient - if the patient is ALS or Life threat - then the further unit is upgraded. If the call is a bls call then the further unit is cancelled unless needed for lifting or other type of support. At no times are two ambulances and a firetruck sent to a call unless it's determined by dispatch to be needed like a head on collision with significant injuries. One other example - chest pain or cardiac arrest type call gets a Fire truck or BLS ambulance for manpower and An ALS Ambulance along with a supervisor. I hope this straightened out the previous info.

What was great about it Dust is that it took in to consideration the type of call and the resources needed. Granted, if the call was bls then sometimes only a fire department bls ambulance responded, if it was in the gray area then a bls ambulance and a als ambulance would be called, usually the bls ambulance was closest so if it was deemed a bls call by the crew then the ALS ambulance would be cancelled. If it was a bonafide life threat or need of ALS the first in unit could upgrade the ambulance. If the ambulance was first and didn't need help on scene they could cancel the Fire unit and vice versa. Bear in mind, this county is not like any of the other many counties in this state, it has more money than it knows what to do with and can afford to send all these resources to calls. If they didn't have the resources then it would be a different story. But the money is there and they choose to spend part of it that way.

I agree when in doubt go L&S but when the call comes in as a injured right ankle or something like that then is LIghts and sirens warranted?? It all comes down to what information dispatch gets from the caller. I worked for a service that would triage the call. If it was an emergency call but not determined a lifethreat, (eg chest pain, ejection, long fall, cardiac arrest etc etc etc) the closest unit would respond L&S and the farther unit would go non-emergency. Usually the differences in response times would be no more than 2-4 minutes. If the first in unit determined that it was a non-emergent patient then they would say continue non-emerg but if they needed us to upgrade we always could. I found that to be a great idea. Any life threat call would have both units respond emergency.

Dust, I didn't think I made it sound like I diagnosed calls via dispatch, I never have and never will. I completely agree with the dispatch info not being right. With constant short response time that I was experiencing being 3-4 minutes to get to anywhere in my city we seldom ran L&S. With longer times then heck yes, run hot. And I never said that I trusted what dispatch sent us on. Case in point, had a guy who fell off the roof, onto a cinder block, trauma code, ruptured esophagus and when we intubated the patient we kept getting chest rise and fall, visualized the cords and the tube goin in but with the rupture esophagus we were getting stomach rise also. The call came out as a fall. Heck when we got there we met the victims wife who was putting an ACE wrap on her ankle and we intially began to ask her questions as a patient until she said, I'm not the patient, it's my husband in the back yard. Well by then he was full trauma code. So NO I don't trust dispatch and what they give us, it's a rarity that I trust them and thats usually for calls from the ER to the nursing home only.