crotchitymedic1986

Although it is possible for everyone to have been exposed to the flu at the same time, that is usually not the case. I would look for another cause, with the most obvious ones being food poisoning, carbon monoxide poisoning, or other poisoning.

It seems March was a much safer month. The totals for 2009 1/1-3/31 are: Ambulance Crashes: 57 EMS Personnel Injured: 57 Ems Personnel Killed: 0 Patient Injured: 13 Patient Killed: 2 Passenger in Amb killed: 1 Other Vehicle Injured: 36 Other Vehicle Killed: 7 Look at these pics: http://www.wrcbtv.com/Global/story.asp?S=10100799

I am sorry, I do not understand your question. Are you the only ALS provider or are you a BLS provider with no ALS backup ? I am not understanding why you would need ALS backup if you are an ALS provider ?

I agree with taking it away. An uncuffed tube does not protect the airway from aspiration, and I have seen too many medics (and flightmedics) spend too much time on the scene trying to complete a hard intubation. Patients do not die because you fail to intubate them, they die because you fail to ventilate them Next time you try to intubate a paitent, hold your breath the whole time the patient is not being bagged; which should clue you in when it is time to stop digging in their throat and give them a little ventilation.

I look at it like this: Lets say you are having abdominal surgery for appendicitis --- why not take out the gallbladder while you are in the neighborhood. Same thing for your car -- if you have to tear down the radiator and pulleys to replace your water pump, go ahead and replace the timing belt/chain while you are there. Taking an EMT test to get certified, take the national registry and give yourself 40-50 states to work in, instead of one ?

Hate to break the bad news to you, but it really doesnt matter in most areas. Due to our long response times, and an uneducated public that will not start CPR, you are basically working a corpse. Unless the percentage of cardiac arrests patients that walk out of a hospital has changed, the vast majority of these patients are dead, and will stay dead, but if you pump enough drugs in them over 20 minutes, you might get the heart beating again long enough to drive L&S to the ER so they can be pronounced there or in the ICU. So check a pulse every second, check one every 20 minutes -- doesnt matter. And dont worryabout AHA too much, as they change the rules every two years, solely for the purpose of making you buy a new text book.

Per AHA guidelines, you are to check before you start CPR and then after the 5th round of 30 compressions. Obviously a 2-3 member team could check more often than that, and guys please realize that the crew doing CPR could be BLS with an AED only, so pulse checks would be important.

Of course not, this guy was obviously guilty of DWB (Driving while Black), and should have known better. If he was white he would have been let go with a warning and a police escort to the hospital.

Your first policy should be to try not to have to restrain them at all. I always try talking to the patient first, and see if i can calm them down. Just because they are mad at to po-po doesnt necessarily mean that they can not be reasoned with. If that fails, then you should restrain them with soft or leather restraints as described in the article i linked: Restrain both ankles to stretcher, use stretcher straps as usual, restrain the dominant arm above the patients head to the t-connect at the back of the stretcher, and the other arm to the stretcher beside their leg. You should immediately do a full assessment, and do repeat assessments often. Once the patient arrests, it is like a trauma arrest, only a fraction of one percent live to walk out of the hospital. The article suggests moving the chest stretche strap to a higher position (under the armpits), but most have gone to the racing harness, so that may not be necessary for you depending on the straps you have. The key thing to know is that these patients will appear like hyperventilation patients, but they do not get better once they "pass out". P.S. When this article was first published it was titled : "Positional Asphyxia; Death by EMS"

I would change the "culture" of our industry. We are an industry full of whiners and bitchers who would rather moan about what is wrong, rather than roll up our sleeves and attempt to fix it. We have too many people with opinions about what is "wrong" with EMS, we need some "workers" who want to be part of the solution. Ask yourself this question: What have I done this week to improve my skills, my company, or my industry. If the answer is nothing, then you are part of the problem. Good question I2k.

Dddduuuuuuhhhhhhhh. But funny how they always have enough fire trucks, and usually enough cops. But you will note that I said "ambulance or first responder". First responders can handle your non-acute 911 calls.

Actually if you click on the link I provide, it is described in detail. The cause of death is excessive lactic acidosis and hyperventilation, brought on by positioning the patient so that the diaphragm and lungs can not work properly.

Here is a novel idea: Instead of trying to figure out how you can delay an ambulance to some patients, why not staff enough ambulances or first responders to give everyone a good response time ? Imagine the Pizza Hut employee who takes your order over the phone, and asks: 1. Sir when was the last time you ate ? You: 3 hours ago 2. When was the last time you ate Pizza ? You: 2 days ago 3. How much do you weigh ? You: 275lbs 4. Could you rate your hunger on the 1-10 scale for me, with "1" being equal to just finishing a buffet meal, and "10" being an ethiopian child ? You: I would say about a "3" Pizza Hut: Okay sir, I am making you a priority 4 response, your pizza will be there in 6 hours, and it will be delivered by our lowest trained personnel. We are saving our best employees for customers who really need a pizza.

Do alot of research before you leap. I had a friend from Mississippi who also worked in Tennessee, and claims the pay is way below average there. He had to move to Georgia to find real money. Then again, the cost of living is much cheaper there.

Thats good policy. The patient won't do what we want so lets paralyze him and make him ventilator dependent.

I think there are several factors at play here, some from the industry side, some from the individual. Here is my take: 1. EMS is still a young industry, somewhere around 40-50 years old, as compared with many other industries that have been around for over 150 years (teaching, firefighter, cop, attorney, nurse, etc..). Therefore our industry is still going through growth pains. We have come a long ways since the early days, but for the most part, we are still an industry that is a subset of another industry (fire or hospital) and there are few, successful, stand-alone EMS providers. This means we still have issues with pay-equity and benefits, and we also still have issues with having a true career ladder. 2. Most of our leaders do not have a formal education. They were just the best paramedics or emts in the company, and were promoted. This creates poor management policies. Many of our organizations tend to lean towards a paramilitary style of leadership, which is the wrong model for the "type-A" people that EMS attracts. Due to this lack of leadership, the leaders are the bitchers and whiners, by default. When you go into work tomorrow see who everyone is gathered around ? Is it the white shirt with a title, or the loudmouth with an attitude ? Whoever they are gathered around is your leader. Who gets the most attention where you work; the employee who does his job well, or the screw-up ? 3. Individually, when we were in high school, we all thought we would be millionaires by the time we were 30. Then you get close to age 30 and realize, damn I am going to be stuck working two jobs for the rest of my life, and I will not be a millionaire. Rather than blame ourselves for managing our finances so poorly that we had to work two jobs, we blame the employer for not paying us enough money to afford two new cars, a $300k mortgage, the boat/ATV/RV payment, and our $100.00 week Starbucks habit. 4. For whatever reason, our industry does attract the back-stabbers and gossipers. Add all that up, and you get the type of performance you see.

Although a good topic, you only touch on half of the issue, and actually the more important lesson to learn is that no patient should ever be restrained in the "prone" position. Read this article for a more detailed discussion on the topic and instruction on the proper way to restrain the patient that was described in this article: http://www.charlydmiller.com/RA/restrasphyx01.html

But if you punish when they report, many people will just not report the error. The Five R's is a good thing, and has been around a long time, but it is not stopped all errors. Just google Heparin and read all the mishaps from nurses giving the wrong concentration and killing patients, because the bottles used to be almost identical in size and labeling.

I am not asking whether or not your service has a policy, but I am just wondering if our culture has changed from covering-up these errors, to a position of reporting every single medication error. Obviously, if you were to give a lethal dose of medicine, I believe everyone in this forum would report it to protect the patient's life, but what do you do if it is a simple error without a negative outcome. What if you gave a patient atrovent instead of xopenex or other respiratory aerosol treatment ? So my questions are: 1. Have you reported or do you report every medication error that you know of ? 2. What does your service do to minimize the possibility of medication errors ? 3. If you do report such errors, are you punished by your service (most hospitals have moved to a non-punishment policy because they want the errors reported so that they can find ways to minimize the reoccurence of that error by someone else) ?

Sinus tach with BBB, probably another pt on digoxin.

What are you smoking ? AFIB ? hope you were joking. Regular Rhythm, p waves before every complex.

It is not uncommon for tires to explode while the vehicle is on fire, but rarely a vehicle. Vehicle fires do occur from accidents, but it is rare. They are more likely to catch on fire from an electrical short, as you will see more vehicles burning on the side of the road from that, than you will see from collisions. With that being said, there is no such thing as a "safe" vehicle fire.

actually work comp is very easy to obtain. Did you know you can file work comp claim for having an asthma attack while on duty ? And dont get me started on ADA.

Sinus Tach, pt is probably on digoxin -- no biggie

Barring him from work because he has a mental disability and has to take medication could be an issue. But to make it even more difficult, the employee decides that it is his "job" that has created the depression and anxiety in his life, and wants to file workers comp