HERBIE1

Welcome to the city. So what did get you into this crazy business? What types of jobs did you used to do?

Well, someone needed to be a scapegoat. Problem is, this was a disaster type situation that taxed all the resources of the city. All the folks who call because they have an "owie" on their finger, or they needed a ride for a check up felt put out and will complain. They honestly don't care about anyone else or they would never abuse the system in the first place. Yes, I'm sure folks with serious problems also suffered, but come on. How many calls in a typical day could be seen as true emergencies? Boil it all down and see how many people actually NEEDED an ambulance vs how many were simply using it status quo- as an expensive taxi, and couldn't care less if the city was up for grabs? Sounds like they were also looking for an excuse to get rid of the guy and the snowstorm was simply a gift that gave them political cover.

Good advice so far. To clarify, the concern would be about exposure to the CHEMICALS used to manufacture the meth, not the drug itself. If the person ingested the drug, that's a different story. Many questions- If the person went into an enclosed area with those chemicals present in the air, then it could be an exposure. Look at the patient. Use your senses. I would be VERY cautious about such calls. Ask questions. I would not simply take their word that the scene is safe unless I knew they were trained responders. WHY was it that the LEO folks were not concerned about a Haz Mat situation? Are they trained in proper detection and handing of such things? Example: About a year ago, there was an ammonia leak in a local factory. Haz Mat crews on scene working on controlling the leak, and FSR finds one victim who self evacuated from the area. As is the case in many of these situations, there are TONS of people on scene- lots of chiefs and folks in positions of authority, and everyone talking at once on the radios. At some point, EMS is notified via radio that an exposure victim has been found and is being brought to crew in the cold zone. Their first question- has the victim been decontaminated. Yes, they are told. The crew suddenly finds the victim thrown into their rig, reeking of ammonia, and in some respiratory distress. The crew does a quick decon on the patient, but the smell is still overpowering. They treat and transport, notifying the ER that they need a decon station set up when they arrive. Bottom line- one of the crew spent some time in the ER with respiratory distress but nothing permanent. The chief who claimed the person was deconned ended up getting disciplined for endangering the crew. Apparently there was a communication problem- the person in charge of decon claimed he did not see the patient, nor did he even know there was a victim. The fire crew that found the patient notified their superior officer, who mistakenly thought the firemen had put the victim through decon. Nobody notified the incident commander. In other words, a total breakdown in communications and protocol. Moral of the story- do not assume what you are told is correct- especially if you have reason to question the source of the information.

Assuming you did not have a dedicated first aid kit, anything you can find would be suitable. Large sticks, vines, umbrellas, tent poles/stakes, rolled up newspapers or magazines, books, pieces of a frame on a backpack-in other words, whatever you could scrounge up. Think about what you are trying to accomplish, which body part needs to be immobilized, does the victim need to be mobile, is it simply about support, or also protection of an injury site. Obviously there are commercial, compact kits available, but I assume you are talking about improvisation here.

Exactly. Like was noted multiple times now, it's the fully competent patient's decision, not ours. Ensure they are aware of their options, and that's all we can do. Anyone who's been doing this for awhile has similar stories.such as yours. Not pretty, some situations may cause us a few restless nights, in the end, we help who we can and hope for the best for the rest.

I agree with you here, doc, but I will say in defense of the OP, I believe this is a relatively new provider. It takes time to step outside the rigid box of protocols and cook book procedures to realize there are gray areas. Medically, it's pretty easy to defend your position on something like patient care, but in cases such as these, you need to be able to take a step back and look at the big picture. Experience teaches you that the longer you are in this business, the more you see things that make you wonder about Darwin's theory. Do you lecture every 22 year old OB patient on welfare, who is G6P5, with a different daddy for each child- about the wisdom of spitting out yet another kid they cannot afford? What about lecturing the drunk who is slowly killing themself one drink at a time? You cannot help someone who does not want it, nor can you impose your moral code on someone else. Pick your battles, know your role, know the rules, and know your limitations. Realize it will be a short and very frustrating career if you cannot understand there will be times we simply cannot change someone's mind or keep them from making poor choices. It's called job security. A possible choice here is for the OP to propose a plan that their company can adopt in future situations such as this. Have an established protocol where the provider notifies management, who notifies the appropriate social service agency, and follows up with at risk people. I'm quite sure the hospital's social service folks are aware of the situation, and may have even offered possible home health solutions but in the end, it still means it's up to the patient to take advantage of the help being offered.

As was noted by others here, your job in that situation is to simply transport that patient home. I assume your service has a contract with the hospital, which stipulates they are the company who transports nonambulatory patients back home. I would assume it also includes IFT's as well. Your loyalty is to your company. There is no medical reason NOT to leave that patient, but certainly the social services issues need to be addressed as best you can, and as much as the patient is willing to agree to. Tough situation, dude.

Right or wrong, if a person is competent, they can do whatever they want. People choose to do all types of things they shouldn't- drink and drive, ingest drugs, eat unhealthy foods, refuse to be compliant with their medical care and/or medications- and even go home when you know they will have a difficult- if not impossible time caring for themselves. The OP stated there was a telephone nearby, so the person will probably realize at some point they DO need help, if it's not forthcoming via some social service agency, and they will reach out to someone. It's not our job to ensure that someone makes the right choices. We do the best we can, we educate them, we explain in the most graphic and blunt terms possible- the possible consequences of their actions, and then let them be. Provide alternative solutions if we can, provide them with It's no different than a refusal of service or transport. We may KNOW a person needs medical attention, but sometimes, despite our best intentions, they simply refuse. I should have also added that another action for the OP should have been to contact the employer for guidance. I would ask my supervisors exactly what the company policy would be in this situation, and what my- and the company's liability's are in such cases.

LOL The lengths some folks will go to in order to put their faces online. Tx? Get some crackers. Looks like Spam- or Alpo- to me. (Then again, I think the only difference between Spam and Alpo is the type of can...)

I see 2 issues here. First, your refusal to "tech" on the call. That's fine, but what exactly were you trying to accomplish? Either way, you would be present on the call- whether you were driving or teching. Second, leaving an immobile patient at home with no help. You mentioned that a home health nurse would be coming by, but it sounds like this person needed 24/7 assistance- bed pan, physical therapy, etc. Clearly the person did not want to go to a nursing home for rehab, which is their right- absurd as it may seem to you. I would notify the hospital's social service department of the situation, but I would hope they have already been made aware of it. Maybe they made plans you were not aware of. Reiterate the situation to them, tell them the person needs help, let them work out insurance issues for any aides, etc, and then I'm afraid there is probably not much more you can do. You could have refused to take the person home- which would probably resulted in the loss of your job. What did the person say when you asked how they would be able to feed themself, get to the bathroom, bathe, etc? Were they competent? Did they understand they NEEDED the help? I've had people flat out refuse our care and/or transport- even when we suspected a serious cardiac event was happening. Bad, and probably a bad outcome for them, but some things are also beyond our control. Make as many people aware of the situation as possible, ensure they understand exactly what you mentioned here, and hope for the best. Lots of gray areas in this business, Bieber and I can promise you one thing- it will happen again. One last thought- did this person sign out of the hospital AMA- against medical advice, or was it a formal discharge?

Welcome to the city, brother. Don't be shy- jump right in. Plenty of topics to choose from here, and there are plenty of us who are active and retired, FSR, privates, single role and cross trained, docs, and everything in between. Retired to the Florida Keys?? I'm jealous. Sounds like a great place to be. How many years did you put in the department before you pulled the pin?

I cannot sense sarcasm, so I hope you are kidding. Did you actually read the link? The median snowfall for NYC, from 1869-last year- was 27 inches. Yes, some years were much higher, some were much lower. Point is, I would not dismiss 20 inches of snow as insignificant.

chbare nailed it. We used to carry them in a plastic box- think a standard first aid kit. Personally, I never used them- they simply collected dust until they were finally removed from our system. I believe it was finally proven that they didn't actually work. Memories...

Thanks to all. Honestly, I look at this as being in the right place at the right time. Simple BLS stuff more often than not makes all the difference and anyone here would have done the same thing. It's just nice to have a good outcome- so many times we're either too late, or our efforts are simply not enough.

20 inches of snow isn't catastrophic? By who's standards? Unless you are talking about Colorado or Wyoming, that's most of NYC's average annual snowfall in one day. http://www.climatestations.com/images/stories/new-york/nysnow.gif As for the job action- if this is what these guys did, it's despicable.

Believe me- getting those LP10's was a huge coup for us. Told you we aren't exactly progressive. We had the old 2 man Ferno/Washington cots until around 5 or 6 years ago and I have the bad back to prove it. LOL

Well, I learned that our service has a LONG way to go to be even considered on the curve, much less ahead of it. (Hardly news since we're not exactly the most progressive, and ANY change occurs at a glacial pace) We had inservices early in the year on 12 lead EKG's, CPAPS, and just a couple months ago, we finally received the CPAP set ups. No word when the 12 lead capabilities will happen, but since we have LP10's, it's simply a matter of adding a module. We did finally receive an EZ IO gun- that's a good thing. Our intubation success rates have improved dramatically- not sure why. Complaints are way down. The take home lesson I learned(or more accurately, had reinforced for the umpteenth time) is that true change for us will not happen until I am residing on the south side of the sod. It's frustrating, but for a large system, getting something changed is a matter of patience, persistence, and most importantly, politics and money. BTW- Good question, crochity...

The last time I had to worry about whether or not to use lights and siren was 25 years ago on the privates. We always transport and respond with lights and siren- with the occasional special case transport at our discretion. Archaic? Maybe, but as I have noted before, if we get in a crash, that is the first question our safety officer asks: Were the emergency devices activated? I sense a major reluctance on the part of many to run with emergency lights and siren, and so many seem to be looking for any reason to justify NOT using them. We can debate all day the amount of time saved vs risk to a crew, the public, and the patient, but in the end, certain truisms are at work here- at least in our case. We are a busy system, and there is always another call waiting. In heavy traffic, in my case, running silent would probably add an average of 10-15 minutes to each transport, and in some areas, that number would be much higher. Now add those numbers up city wide, and see what impact there would be on an already overtaxed system which is short on units. Now factor in delays in obtaining an ER bed, longer transports because of hospital diversions, and those numbers would quickly add up. There is a bigger picture to consider than simply the benefit for one particular patient. For our call volume, it is also worth mentioning that our rate of any type of accidents is incredibly low- despite the fact that we always respond and transport in emergency mode.

Well, I guess this is about semantics but the question is what untoward event happened. Was it negligence, working outside scope of practice, failure to follow protocols, etc? Does this involve a civil suit, is it an internal investigation/complaint, a criminal charge, etc? Certain rules and legal standards apply based on the situation, and accountability/liability depends on specifics of the case. Certain standards need to be met to prove things like negligence, and as such, various folks would be held complicit. Other standards are system specific and involve specific internal rules- above and beyond legal statutes. Respondeat superior is a legal standard that holds the employer accountable for the actions of a worker- unsatisfactory training./oversight, etc. Depending on the outcome, the medical director, employer, AND the employee can be charged. If a medical director received evidence- either direct, a 3rd party complaint, or an internal investigation- that a provider is incompetent, that director can suspend the license, pending the outcome of some established review board. As such, we DO work under their license- or at the very least their authority- if they are able to initiate such proceedings against us. We cannot finish paramedic school, set up a jump bag and start free lancing. We need to work within the confines of some established medical control- whether it be in a hospital setting, or withing the rules of some municipality. Our ability to practice is not autonomous.

Definitely upgrade. Clearly this person was decompensating and/or having a cardiac event, so if the person needed to be defibrillated or paced, you need that battery juice.

We have our own license, but we still must work under our medical director's license as well, who is the one that sets up the protocols we follow. We cannot set up shop somewhere and work on our own.

What you say is true, but even in Canada, don't paramedics still need to operate under a physician's license? EMS is evolving, and when started, EMS was about PREHOSPITAL care, and very few of us worked inside a traditional hospital setting. Now, with changes in scope of practice and staffing shortages, our paths are indeed crossing. Here's a question for our resident MD's and DO's here- do they really feel threatened with the advent of PA's or advanced nurse practitioners? Seems to me it's simply another allied/adjunct health provider that helps a doctor, and ultimately the patient.

I realize this is an older thread, but I do have something to add. First, in my area, we do not have hospital based EMS service- it's either private or municipal/ fire based. When paramedics started working in ER's as techs here, there happened to be a severe nursing shortage(a cyclic thing around here). Nurses welcomed the help for 2 reasons- first, we were paid far less than an RN so we were not initially perceived as a threat, and because they simply needed another warm body. The skills we were allowed to use varied wildly- depending on the hospital, the charge nurse and/or doctors. The usual rancor between the groups was generally not an issue because we were in their domain, and under their control. Ironically, at the same time, the turf wars between prehospital EMS and RN's was in full blown crisis mode. Open hostility often existed, but I think the fact that so many ER's employed medics and EMTB's, the barriers eventually began to break down. The nurses began to see and really understand who and what EMS folks are, what they can do, and that we are not the enemy. Nurses are finally understanding that as a side job, working in an ER is fine, but not many EMS folks want to switch roles and become a nurse. Now, for career longevity and physical well being, more EMS folks ARE switching to a hospital based setting, but that's a relatively new trend. Is it perfect now- hardly, but it is MUCH better. Yes, there are still a few miserable, old-timer RNs who will not give up the "war" but they are few and far between. An example of how far we have come in this area: Recently we learned about a personnel change in a local ER, which is well known for it's hostility towards prehospital EMS folks. The ER received a new director- who was basically a private sector efficiency manager with no medical experience. He was initially hired to streamline the hospital as a whole,. but decided to fill the open spot in the ER. On his to-do list- getting rid of or demoting many of the RNs with attitude problems, and hire younger, eager nurses with good attitudes. Another shocker- he promoted an ER tech- a paramedic- to EMS manager. I asked about the reaction from the staff- he said overwhelmingly positive. He's a sharp guy, a hard worker, good skills, and well respected by the staff so everyone apparently supports the decision. Incredible, and certainly good news for our profession. To sum up- Not sure what will happen in your case- especially since health care is in flux right now, but you never know how things may turn out.

Yes it is one of our most basic urges, and from an evolutionary and survival of the species point of view, by default that sexual urge MUST be heterosexual or the species will not survive. Until relatively recently, you simply could not reproduce in any other way. I am not decrying homosexual relationships, just the notion of gay marriage. I look at homosexuality not as a lifestyle, but as something that is NOT the norm. See above- it simply cannot be "normal" if the species is to survive. OK. I will also sit back and wonder why there aren't any short white guys in the NBA, why some kids are born with horrible diseases like cancer, why some people think it's OK to kill women and children in the name of a god,. and I will also wonder why some people can have the mind of a Pope John Paul, and others have the mind of a John Wayne Gacy. Sits with me fine, since I look at the idea of homosexuality differently. It's not a choice for someone who is truly homosexual. It also CANNOT be "normal" or the human race would never survive. It is a mutation, somewhere in our genetic code- just like if someone is born with diabetes, a congenital heart defect, or they develop lung cancer when they never smoked a cigarette in their life. It is not a mental illness, it is not something that should be used as a weapon against someone, nor should it entitle them to "special" treatment or protection such as from a hate crime law. Let's be clear here, Wendy. I am not suggesting or encouraging discrimination in any way, but I also do not believe that marriage is some basic human right that should be conferred on anyone.

LOL Wow. I'll let everyone else worry about semantics since I don't worry too much about such things. Potatoe, potAto,