toutdoors

Thanks for the input folks. Basically what I am looking for is general information. As I stated, I remember reading a short news brief in a trade magazine, I believe it was Fire House, in which a paramedic was terminated due to poor patient reports. I am looking for a few articles such as this simply to use as examples as to the consequences of poor documentation for a presentation I am tasked with. Once again, appreciate any input.

Not nearly long enough.

Would anyone be able to guide me into a direction in which I might be able to find some information regarding how poor pt documentation has resulted in termination of an EMT/Paramedic? I have been assigned Documentation as my instructional topic for my instructor class, and would like to include some case studies of how poor documentation has resulted in termination. I remember Firehouse Magazine reporting a few years back about a Florida EMT or Paramedic that was terminated due to poor pt care reports. Thanks, I appreciate any input on the subject.

I agree that a paramedic degree, or degree in some sort of emergency healthcare would be an asset to the medic, as well as to the pt. I would also agree that being a paramedic with a degree in geology probably will not make you a provider that has any "real" higher education in regards to pt care than a paramedic who has a high school diploma from 20 years ago. ( Way before "No child left behind") Yeah there will be arguements that any higher education is better than none, and this is true. My point being that if you want to build bridges, you get an engineering degree, not one in theatrical arts; the same should hold true for paramedics. Of course, you can get your master's degree if you want, but it still doesnot make you a better prehospital healthcare provider if you can not successfully utilize the education that you have obtained. The ability to study subject matter, and then bring it from the far reaches of that grayish, mushy brain of yours, and put it to work in the form of decsion making, prioritization, and actual skills performance, is what makes an "advanced educated" provider an asset, and not some dumb shmuck babbling on the radio, not knowing what he needs, nor what needs to be done next. Let me explain an example to you. The background for this engine company officer is that he has about 12 years on the FD, and has been a medic for about 15 years. The other night his company is dispatched to an MVC. Enroute, dispatch tells them that there is one pt who is receiving CPR. PD gets on scene and advised that there are 6 cars involved in this accident. The roadway is a divided 4 lane thoroughfare with posted speed limit in the 35-40 mph range. All of this information is provided to the company officer prior to his arrival on scene. He waits to arrive on scene, and then decide to ask for a second ambulance; I was working ambulance that night, and we had already sent 3 rigs to that incident after hearing all the updates. He focused on the cardiac arrest pt, who was not a trauma arrest, but had arrested because of his cardiac Hx, and this is how the accident came to be in the first place. It took 13 minutes for this officer to become aware that there was an entrapment, he then advised that they needed a rescue engine "just to pop a door" as he stated. This actually turned into a prolonged extrication, it was not a simple door pop. All in all, 3 pts were transported, the cardiac arrest, who survived and last I know was moved up to the floor out of the ER, and two trauma alerts. One of the trauma alerts..........you guessed it, spent over 20 minutes in the vehicle before the rescue engine even arrived. The person who actually asked for rescue was not the officer, but the "third firefighter". (He only has a high school diploma) So when you look at this situation, which is not the first time that this individual has exercised extreme discretion in regards to requesting additional help prior to or even at the time of arrival on scene, it becomes apparent that all of that education went right down the tubes when it should have come forward at such a critical moment. How is it that a person who "teaches" classes on mass casualty incidents (as well as other topics) does not recognize an entrapment for 13 minutes while on scene of an MCI? How is it that with all the information provided to you while responding, that you believe that your crew of 4 with an additional 2 medics, will be able to properly provide triage and treatment for at a minimum of 6 potential pts when you know one of them is in cardiac arrest with CPR being performed? I agree that if it was a traumatic arrest, you could probably maintain bystander CPR while you triaged the remaining pts but none the less, you know you have at least one critical pt, who may or may not be transported depending on circumstances. I am normally not one to "Monday morning quarterback" too quickly or too harshly, but I am sorry, this report card gets a great big "F". It was a huge failure, in my opinion, not to initially request an additional 2 engines, one of them being a rescue, as well as ask for the assistant chief to respond to assume command duties. If, after arrival, you discover that there is only one pt, and everyone else is standing around their cars with no injuries, then by all means you can cancel the other rigs. On the other hand, if you discover that this truly is a MCI, then your additional resources are already on their way, and will be there shortl. This is the way our system is set up, and when executed properly, it works quite well. My intent was not to point out what I consider a huge failure in one of our company officers, but to point out the huge failure of this individual's "EDUCATION" if it can indeed be considered as such. This person looks great on paper, but has not been able to perform to what I would consider even acceptable standards on this instance. I feel safe to say that I would imagine that for every service out there, an individual like this exists. So sometimes education is not the cure all to end all problems. Competency is also a huge factor in how well or poorly one performs their duties. I didn't mean to get off on a seperate tangent but I do feel this is supporting evidence that advanced education does not always pay off. Not saying it is a waste by any means, just that you can lead a horse to water, but you can't make him drink.

When working the ambulance, we are dispatched and our response mode is determined by the medics. If we are going to a 911 call that has fire EMS dispatched as well, it is emergent. On the fire side of the issue, we are getting better at calling the medic unit and telling them they can slow down but continue because there will be a transport, but there is no immediate threat to life. Such as the broken arms, cuts that will need stitches, and they want to go by ambulance rather than have the wife drive them in type of deal. What I really love is when you get the transfer call from nursing home to hospital. So you get in the rig and go enroute, now when the dispatcher tells you you are going for chest pain, or lethargic/unresponsive hypotensive pt that has been this way for the past half hour, then we step it up and ask for fire EMS to be sent as well. There have been several snide remarks from the administrators at some of our beautiful (sarcasm) nursing homes that say we didn't need all these people here, but hey I don't mind putting a burr in some saddles so I don't care what they think. Then again, the whole nursing home scenarios could be dedicated to it's own post entirely. At one time, when dispatch for the ambulance was still done "in house" and there were EMT's or medics working the dispatch, then the response mode was given during dispatch, ie: respond code 3, or code 1 type of thing. Now the city/county comm center does the dispatch for the ambulance, so it is kind of up to us in the street to determine our response mode, to a certain extent.

My grandmother's Rx for an ingrown toenail is to soak a small piece of bread in milk, place bread on affected toe nail bed, wrap with bandage, put sock on and go to bed. Wake up in the morning and ingrown is gone. My mother did it to me once as a kid and it worked. I did it twice in the Corps also and it worked. Just don't try to make french toast out of the used bread for breakfast.

Ah, ya got me there on the scrubs Spenac. Can't say as I have seen the ones you are describing. I say if it works for you and it is clean, neat and "presentable" knock yourself out.

Fiznat, you know what may help is if you get the opportunity to be an evaluator at a MCI disaster drill. Even if you do not feel comfortable being an evaluator, ask if you can tag along with one and just watch what the responders do. It is amazing how much I learned from my first drill that I was an evaluator at. You actually get to see the big picture with no emotion or personal investment. You just sit back and watch the show unfold. You get a unique opportunity to see how easy it is for a responder to miss what seems to be a very simple yet important piece of the puzzle at times. We should all remember that drills are intended to be positive learning tools, and not a chance for some paragod or rescue randy to point out all the small things they witnessed, but rather a way to improve upon our current response and preplanning. I have been involved in numerous drills, as a firefighter, medic, US&R rescue specialist, I have even been the IC for a very large drill in our department a couple of years ago. The cool thing is that you learn alot more about a disaster everytime you drill, and hopefully get to "wear a different hat" at times. As the old saying goes "walk a mile in my shoes" This is when you get to really put the entire picture together and appreciate what exactly is going on at different levels of the command system and operations sector. Like I said earlier though, getting the chance to just watch a drill unfold allows you to just sit back, relax, and see how things get done, and answer to yourself how you may have handled certain aspects of the scenario. I still think you did a good job though.

Spenac, I see where you are coming from, but in my humble opinion, I would not be comfortable in a scrub top. I wore them when interning in the OR, and did not find them all that comfortable. Just a personal preference there, not slamming on ya. Now, as far as the wife wearing a pair at night, well that is for the personal side.

Fla, as I stated, we cannot wear them as of yet, but with more research we may find that they will not be practical. I would think that they would be nice due to the wicking properties but have not had the opportunity to check with others in the fire side to see how these shirts perform while in a fire situation. Thanks for the input.

Professionalism, professionalism........we are constantly throwing this word around. If you truly want to look professional, put on a dang suit and tie. Didn't the "ambulance drivers" of years gone by start out wearing the all white uniform? Were they anymore professional than what we are today with 8 pocket dark blue pants and a short/long sleeve button up shirt? I doubt they were. Professionalism begins with attitude. You can walk in to a pt's home looking as professional as you want with a nice starched uniform, shiny badge, patches on each pocket and sleeve, and a crisp haircut; but open your mouth and start talking like an idiot and all of that appearance just got blown out the window. I am all for a good looking, neat and clean uniform. The button up shirt does look "dressier" than a polo, and a t-shirt. However, during the hot and humid months in the midwest, (which isn't as bad as some areas) I prefer a more comfortable uniform for being out on the street. On the fire side, we can wear t's on weekends and holidays, as well as after 1630, otherwise it is the button up shirt or a polo. Medic side, we are only allowed to wear the button up shirt unless it is after 2100 then we can wear the lightweight warm weather polo shirt. To me this is a little backwards, as we should be wearing the lightweight polo during the HOTTEST part of the day. Anyway, that is the way it is. How about the scrubs issue. It is my opinion, but I would dare say that most people are accustomed to seeing an ER doc or nurse in scrubs. To John Q. Public, if he sees you in scrubs, he thinks you are a medical professional. So why don't we wear scrubs in the field; wouldn't this make us look more like the "medical professionals" that we cry out to be? The simple answer is that scrubs would not hold up in the field. They are not practical, where would we put all of our patches, and hang all of our cool stuff from?(scrubs do not accomadate belts) As far as being in a standby status say at a large outdoor concert or parades, or some of the other stuff we do in the summer, the polo would be the ticket, as it is lighter in weight than a t shirt, but still looks somewhat "professional". Employee comfort must be given a consideration at some point, this is probably why we don't wear a suit and tie while working the ambulance. Christopher, the underarmor brand of clothing is awesome. The warm weather shirts are great for pulling the moisture off of you, and drying out quickly, while the cold weather attire is a true lifesaver in the cold. We are looking at trying to get our new uniform regs on the fire side to allow the use of these under armour shirts to be worn under our station uniform. Now, before Dust hits me with the safety issue, I agree with the problem while in flight status. Unless the flight suit has changed much since I discharged, there is some potential for the shirt to be exposed to the heat of fire. Now in the fire department scenario, we are going to be in turnout gear anyway if we are in a fire, so the real question would be that if your underarmour t shirt burned you because it was exposed to fire, don't you think you have a bigger problem than the undershirt? Just my opinion in that matter. Back to my original point. Professionalism is attitude. Appearance is just that, you can appear to look like a practioner in the medical profession, but you can't fake your competence or knowledge(isn't this what makes you more of a professional than the style of your clothing?) Now don't get me wrong, I do disagree with wearing a hooters t shirt or similar or beer slogan shirt while on a run, but fail to see how wearing a button up shirt vs a polo, or even a tshirt at times makes a person more "professional" than others. Just my thoughts

The only marital difficulties in EMS or fire, or police is the marriage itself. Just kidding. My first wife was way too insecure to feel comfortable with me working shift work. I never did work the ambulance side while married to her, that would have been way worse. On our dept, at that time, there were two women on the whole dept. (Now we are down to 1) She thought I would sleep with one or the other. Not even in my most drunken stupor would I have done such a thing, not to be a hard case here, but neither one of them are attractive in the least bit. My current wife is 180 degrees out of alignment than my first wife. She is fun to be around, has a good sense of humor, and trusts me. I also trust her. Fire, EMS, PD; all of these careers can bring out the best, or the worst in our spouses, it actually will show you their true character faster than the more "normal" work/business careers that others have. There are times that my wife and I hang out with some of the female medic partners I work with, as well as some of the male medics and other firefighters. This has helped her understand how we all interact, and that we kind of treat eachother like brothers and sisters, the nicknames, bringing up an embarassing moment type of thing. I feel truly lucky to have the woman that I have, sometimes she even lets me catch a power nap when I get home if she knows I was up all night on runs. Then again if the basement needs cleaning I am up a creek. I tried to read that Mars/Venus book after my divorce; it was some of the most painful reading I endured. Never even finished the book, I don't even remember what it talked about, but at the time it was making no sense to me. Maybe it was too touchy feely for me, who knows. Best of luck in your marriage though.

The vest is not a stupid idea by any means. While working fire one day, we go to an unconscious party call. Upon arrival, we have a code, as usual, the family member is upset. We begin to work the code, and next thing you know, the code is abandoned, and we are in a free for all with the husband. He went completely nuts, first he is freaking out asking to help with his wife, as we begin our job, he flips. Did we do a bad job of scene sizeup? No, it was no different than any of the other codes we went on such as nervous/emotionally distraught family member standing there watching a loved one die, but something in this guy just bust loose, and he took his aggression out on us. PD was on scene very shortly because they were already enroute, but we never had time to hit our emergency button on the dang radio neither. Thankfully the mike got keyed up in the scuffle, and the dispatcher advised PD to step it up. This was a real eye opener. Would a vest have helped us out? Not that much in this case, he did get a couple lucky hits and kicks in, but no broken ribs by anyone; but if he had pulled a gun, or a knife, and the vest would (should) have been the same style to protect against penetration, then it may have been a life saver. I have been to shootings, stabbings and violent assualts in some dive bars, a vest would make me feel better; not safer. I think that by putting the vest on, it reminds you just how dangerous your job can be. As for carrying guns in the rig? I would say that during periods of civil unrest it is prudent to have some sort of added security with you, a police officer would be my choice. I have the training from my military days for self defense and the use of deadly force. With that being said, I will not shoot for your leg or the arm holding the weapon; I will aim center mass and fire. I also believe in the "bargain shopper attitude"; two for the price of one. You need one shot, you get two. I can understand that there may be times that are incredibly rare and extreme where the presence of a weapon on an EMS rig is warranted. Thankfully it seems that these times seem to be very few and far between. I also understand, and actually more freely accept the idea that there are some areas that a weapon would be beneficial to the protection of the medic and possibly patient in the far remote stretches of wilderness that some of our collegues find themselves working. The bear, mountain lion encounters I can understand, but then again you don't have to be able to outrun the bear, just the other guy. All kidding aside, I don't see it as an everyday occurance where a deadly weapon would be needed to be carried, not today anyway.

Fiz, I agree with pretty much everything that has been said. From the sounds of it, you did what you had to do. The most positive part that I read from your post is that you are rethinking the whole thing, and what could you have done different. Not that you should beat yourself up over it, but be honest with yourself, and your crew. This way you will learn, and be better prepared next time you get a call like this. As you are well aware, you can run a hundred calls with no problems or weird occurances, but then that next call comes in and it is one that leaves you asking questions. As you get onto more calls with multiple patients you will get better at being able to keep a bigger picture in front of you; but like someone else said, sometimes you just don't remember much of anything else other than what you are doing. You might be surprised at how much you subconsciously took in, and don't recall. Critiques are great for re-hashing a large scale incident like this, and for people to point out what went good, and what could have been done a little better. The funny thing I have noticed about critiques (both fire and medic side) is that they are rarely 100% honest. Most of the time we say "Yep, we dun did good huh", and walk away thinking that we really pulled something off. The reality of it being that there were things that could be improved upon. A critique should not be used to completely embarass someone, or point fingers, it should be an open forum in which all agencies and parties involved openly communicate what went great, and what needs work. Then come up with a practical solution to remedy the area(s) that need improvement. Otherwise don't waste the time with the critique.

Personally, I appreciate a good, tasteful practical joke. In our department we do have the usual "written rules" in regards to what is considered "sacred" (rigs, PPE, personal harm...) and rightfully so. With this being said, I have to admit that the IV bag under the mattress and tubing secured to the headboard can be funny. When I was an engineer, I had a "floater" aka a "fill in guy" assigned to my rig one day. Well, during morning radio test, he is laying across the seat of the rig with a halloween mask on, and yells at me as I open the door for said radio test. I was unscathed, joke gone awry on my hopeful and now depressed coworker. However, later that evening, I see his mask in his locker, which was open, as are most of ours while at work. I "borrowed" it. His cubicle is down the hall from mine, so I wait patiently. Finally, with the lights off, he walks down the dark corridor, and I sneak up behind him, mask on, and say his name. He turns, sees the mask, and screams like a little girl. (NO OFFENSE LADIES) To me, and everyone else in the squad bay, it was priceless, as well as to my "victim". We were actually talking about it just the other night at work. Did a few guys get woke up? Sure, did any patients lose quality care? Nope. No response times were hampered, and no equipment or personal effects damaged or destroyed. I have had my bed short sheeted, it is funny. I have had my bed put on jack stands from the shop, it was funny. I have also done the same to others. We all laugh, we all help get the bed back down. Then there are a few pool balls placed under the sheets, or the CPR manikin put in someone's bed. I believe we see enough of the dark side or ugly side of life and human nature while at work. A little fun at work helps relieve stress, and lightens the day. I am not an advocate for causing harm to a fellow worker, or placing their personal property or health at risk, but a harmless prank can be a great stress relief. If this seems unprofessional to some, you are welcome to your opinions and beliefs. I shall remain with mine. On the off duty side of life, my former wife and I TP'd a couple that we were friends with. Not only did we get the tree, we did the van also. The next night we were over for a little while, and the husband was FURIOUS that some scoundrel neighborhood children had TP'd him. He was FUMING all night about it. As we left, he went outside and put his van in the single car garage, saying how this would keep the little heathens from messing with his van. I immediately drove to the discount store and bought a half dozen rolls of saran wrap. A couple of hours later, I woke up to my alarm, and walked the two blocks to his house, and proceeded to saran wrap the entire garage. His wife called mine the next morning to tell her what happened, we could hear him screaming in the background how he was going to kill who ever did this, he actually did call the cops though. His wife told us later that the cops told him to keep an eye out, and try to be nicer to the neighborhood kids, as it may prevent recurring events. I almost peed myself listening to him rant and rave. I am sorry, but I did find it funny. They never did know who did it.

I have only dealt with a couple of rape victims, and each of them were different. I think that it comes down to how you read your patient, and if they feel chatty or not. I agree with others on here in regards to the hugs. I have, and will steer clear of them, for the main reason that I would not want to contaminate her with any trace evidence I may leave on her such as a hair or fiber from my uniform. I would hate to think that I was doing the right thing, only to learn that my act of compassion may one day leave a trace that could be used to cast a shadow of doubt into a jury's mind. A little far fetched I know, but I would hate to take that risk. I think that by explaining everything to the pt, in regards to wrapping her up in a blanket, and even asking her not to pick at her fingers or toss her hair is hopefully part of her healing process that is sure to be long and arduous. I hope that by explaining these things to her, we are letting her know, that we are concerned about her and that we want her to be able to begin to cope with what has happened. For some of these people, it will help them to know that by taking some of these simple precautions, we (EMS, hospital, and even the pt) are helping to preserve evidence that may be collected and hopefully used to help the police identify the attacker, so that this may be one more stepping stone on her path to what some would name recovery.

In my area, the FD does the extrication, and the ambulance treats and transports. Bear in mind that all FF's are EMT's, so that at the very least, everyone on scene knows what C-spine immobilization means, and there is a good amount of common ground that we are all on. For the veteran medics, they know the difference between when a door just needs popping, and when everything needs to get moved. I am a firm believer in some amount of cross training. At least to the awareness levels. This way that brand new medic, who has never seen a fire engine, or rescue rig in person knows what the capabilities are of the extrication team, and what certain terms mean. ie, pop a door, or flap a roof. I also believe that anyone who is going to do extrication needs to be an EMT at a minimum. This only makes sense, well to me anyway. I mean really, if you are going to remove a bunch of mangled metal from around a patient, shouldn't you have a basic understanding of EMS? On the flip side of that coin; if you are going to treat and transport a patient that was entrapped in an MVC, shouldn't you have a understanding of what type of extrication evolutions would be of the best interest to your patient? I am not saying that all medics should be or need to be extrication techs, but they should have a basic understanding of how extrication is performed, and what evolutions will give them the best possible outcome for the pt. Why should we have two different agencies working toward the same goal, but not know what the other agency is doing, or why. The more I read here, the more I realize that where I work, we must truly be blessed, because the relationship between fire and medics is really good. (Most of the time) Of course we have some individual personality issues at times, but that will happen. The professional relationship, and respect goes both ways for us around here, I truly feel fortunate.

Age is sometimes nothing more than a number. It is the ability of an individual to gain the education, learn the strategies, and tactics, know their medical protocols, maintain an open view of the big picture, determine what you have, what you will do (or not do), and what resources you have, and what resources you will need. Then you need to pull all or some of this together, deliver the orders to those assigned to your command, and be right. Some of the deciscion making can be taught in the class room with power points, and "roundtable" discussions on presented scenarios in still photos or better yet, video. When your abilities to draw upon all of your assets, (education, training, experience) allow you to effectively, and efficiently make quick and rational deciscions with little or limited immediate knowledge of the entire situation without you "freezing" up, then you are ready to be the leader of a small group of people that will be put into some sort of harm's way. This is more the fire side of me speaking out here, for the simple reason I feel that being the officer of a fire company is of great responsiblity to my crew, department, and the citizens that we serve. Don't get me wrong, I am not taking anything away from the non fire medics out there, or the field supervisors in medical services. Doug I agree with you in the aspect of what the Corps taught us about fire teams and young leaders working with a small group of individuals. The one thing you need to remember is that the way you train combat Marines is different than the way you train firefighters or medics today. Sadly, it is a kinder, gentler arena that we must work in. Cfaulk, I don't question your ability as a paramedic. If your service is worth a darn, and they trust your abilities, than good for you. I think that what we are talking about is more along the lines of a leader in this sense is a person who is responsible for a crew of 3-4 people, such is the scenario you will find on your fire rigs, not really on the ambulance. If you are working in a busy ALS service, you may very likely have more experience with small MCI's (3-6 pt MVC's) than a 35 year old medic with 10 years of service in a slower service. In this sense, if the two of you were to roll up on a school bus of 20 kids vs an SUV MVC, than you may be a more competent medical branch officer who can initiate the triage, and determine the treatment staging area, set up for vehicle staging, and ingress/egress routes of the scene as well as think of what additional resources are needed. Where the older medic would not have had as many opportunities to develop these skills by working in a slower service where there were very little if any incidents that could not easily be handled by his rig and maybe one additional crew. This is where you would have the experience advantage over the other medic, but he would the age and "time in service" upper edge on you. Now if you want to ask who would be a better supervisor if there was a 22 y/o and a 42 y/o medic, with both of them having only two years on the street; I would say that in this instance the 42 y/o SHOULD be the more qualified person. (providing they are not a nitwit) The simple reason is that here the age issue might come into play for the simple reason the older medic has more "life experience". Sometimes this goes a long way into being a good leader or supervisor, other times it does not make a difference at all. So I say again, sometimes age is just a number.

I gotta admit, that was funny.

Yeah, we wear the reflective stripe on all of our pants that were purchased after this summer. Adds a considerable expense to the pants, with what I feel, is of little value. Honestly, if the doorknob driver has not seen the flashing and blinking lights of the squad cars, fire apparatus, and ambulance, along with some of the scene illumination lighting, this one inch reflective stripe down my leg won't really help me much. The upside of this is that I am helping the uniform shop owner make a few extra bucks everytime I buy new pants. Just doing my part to share the wealth.

The best way to fight the cold is to stay inside, other than that you are up a creek at times. I swear by underarmor undergarmets. The ones designed for cold weather that is. A good coat, a "beanie" hat and some decent gloves. I also carry a pack of the chemical heat packs for my hands in my coat, and carry a few extra in my bag, they are cheap, and easy to use, although I have not had to use many of them due to the fact that most of your scene time is pretty short when outside. I have danner boots, and love them, I have not had much problem with traction, but had a horrible time with my rocky's. I also put an extra pair of insoles in my boots, helps keep the feet warm, and my boots are a 1/2 size too big so I can wear the thin polyester liner sock and a thinner wool sock. I do through in a pair of insulated bib overalls in the rig with me on the really cold days. If we get out on a fire standby, and I want to walk the scene a little, I can slip them on really easily, and they are a huge insurance policy if we are on an out of town transfer and have problems on the road. Dressing in layers is a great way to stay warm and be able to regulate your temperature, but in all honesty, I wear just my underarmor, and uniform with my coat and this is adequate 95-99% of the time. My gloves are the cheap white liner type of glove you can find that meat packing plant workers wear. They are dirt cheap, and will allow me to wear XL exam gloves with no problem if working outside. Once we are in the rig, rip off the outer exam gloves, put the liners in my pocket if clean, and slip on my regular large exam gloves I use. Normally works pretty good for me. I also like to keep the heat in the back of the rig on at least medium, so that the back of the rig is warm enough to get a pt into, and then adjust from there. I get cold fast, and this works well for me. There are a lot of good tips on here, you should do just fine. Have fun in the cold, and never, never hesitate to initiate a good old fashioned snow ball fight. Don't forget the sunglasses, the sun is bright on snow.

Fallout, I feel for you. We carry etomidate as our frontline sedation for RSI, and have versed for the maintenance side of it, if needed. I would have to agree with you on how tough of a deciscion that would have been, but I agree with you in that you were truly between a rock and a hard place. The thing of it is, there were basically two choices to make here: one, paralyze the pt, and intubate, while possibly causing some possible fear in the pt, if there truly is any awareness, OR, let the pt completely quit breathing, and then intubate. I think that in the context of your situation, you acted in the best interest of the pt, and protected the airway when you did. Maybe the pt did experience some memory of the event, and was mentally traumatized by the event. The question is simple. Are you the one personally responsible for how this situation transpired? No, you are not. You are not the one who made the suicidal pt overdose on a hypnotic, and a narcotic. You are not the one who personally selected your protocols, and the drugs available to you for RSI. So, you need to work with what you have. Here again, I think you acted in the pt's best interest. Now, if this person did suffer some memory of the event, that is truly too bad. But look at it in a slightly positive aspect, it just may be enough for them to reconsider a second suicide attempt due to whatever memory they may have of the event. (If any at all) So, in a sense, you may have saved this person's life 6 months from now, when they reconsider taking all them dang meds at once again.

This may be slightly off topic, and if it is, I apologize. The service I work for part-time finally allowed us to wear the "under armor" style polo shirt this summer, for the hot humid weather. The idea being that it would wick away the body moisture, and make us more comfortable working in the heat of summer. Great idea. The shirts are very nicely done, have the company name on back in nice big, bold, reflective lettering, and the star of life on the front of the shirt along with the small company logo. It is a professional looking shirt. So what is my issue? We can only wear it after 2100 hours. From the start of the day to 2100 you have to wear the same old light blue button up shirt with the company patch and your EMT level patch. Isn't this kind of.......stupid? I mean seriously, we are not allowed to wear the shirt when it would benefit us the most; during the heat of the day. As I said, it is clean, neat, and professional looking. We do wear picture ID's that state our name and provider level, and it isn't as if we are that big of a service that the docs don't know what level we are. It just seems, well like "military intelligence". I have seen my share of that too. Didn't mean to get off thread, just venting.

ALS due to mechanism of injury. Too many unknowns at this time, unless you have CT and Xray on board the rig (we don't). Stable pt's do deteriorate.

Spen, I could not agree more with what you highlighted in my post. While doing my ride time, I witnessed the medics conferring with each other at times. No big deal as far as I am concerned. I think it provides both parties involved the opportunity to put in their two cents, and make sure everyone is on the same team. When I was orientating to the medic position from my intermediate position after my testing was done, we ran a heck of a trauma where the pt needed RSI. The two medics working were both trying to get the tube, but to no avail, in went the King LT. Even with dual medics on board, sometimes things get BLS treatment out of neccessity. It is what it is. I still think at least one seasoned medic is preferred.