HERBIE1

If his QRS was widening, I'd assume his device is ready to fire again. Check with medical control and see about a loading dose of the antiarrythmic of choice. Asymptomatic or not, if you can prevent his defibrillator from firing it seems prudent. Whether or not it may be effective-due to potential underlying problems- is another story. I'd increase fluids if you have reason to suspect hypovolemia. Wondering if the patient may be infarcting due to a thrombus affecting the conduction system- noted that Pt is on coumadin.

We don't have the option of chemical restraints. As for having PD with ANY psych patients- seems a bit excessive to me. "Psych patient" does not automatically mean combative or violent, but I guess it also depends on transport times and how far away back up may be. In my experience, with all the psych patients I've dealt with, very few are actually violent or even aggressive, for that matter. Again, a patient may also become violent or combative with no warning but I'm also pretty good at talking someone down from being aggressive.

Lots of 14 year olds do that around here. License? Insurance? Legal citizen? Why does someone need that stuff? LOL

I don't know what type of relationship you have with local PD, but use them judiciously. Obviously if you have cause to believe a patient is a threat, and express those reasons to an officer, they should be more than happy to help, BUT... I know a guy who has an adversarial relationship with police- he will claim he is always in danger. If a person says a cross word to him he calls for police back up. He is well known to them, has been around a long time, and is respected by NOBODY in EMS, hospitals, or police. Sad part is he is also an RN on his off days and from what I have been told(and seen) he's a lousy RN too. Point is, be safe, protect yourself and your partner, but don't be the boy who cried wolf.

If you or your partner are in imminent danger, get out of the rig and call for police. Let them trash the rig. If you have a minute or 2 transport left and you are not in immediate danger, if you have the capabilities, call dispatch/telemetry/or the ER directly and let them know what you have so they can prepare.

I read your posts, and you claimed that these laws do not pertain to EMS. I pointed out where you were incorrect. In every legal opinion and brief I have seen, "reasonable" is not about whether someone should place themselves in danger. Language specifically states that a rescuer- civilian or not- is not expected to put themselves in harms way. It's about what prudent or "reasonable" actions should be taken for a victim- care, treatment, or calling for help, etc.

No. This IS an EMS issue, and "Reasonable" has nothing to do with it. The case here is the FF was off duty, and in many areas because he is a trained responder, this means he is also not covered by the Good Samaritan Law either. Thus, he has no "duty to act" if he is not on the clock or working as a volunteer in the capacity of his job. Moral or ethical reasons whether to render aid or not are another story. Laws on this are vague, they vary from state to state, and they are also not federal. Only a couple states have language that compel an off duty responder to render aid, although as you note, NONE require a person to endanger themselves to do so. Again, in the context of EMS, duty to act is one of several determining factors as to whether or not a provider's actions are protected against a charge of negligence. If we are talking about reporting a crime, that's a different story. I have no idea for certain of the details, but I do know most LEO's are held to a different standard than EMS responders. I believe that in many places, a police officer is essentially always on duty, thus their "duty to act" is probably different than ours.

In the context of EMS, "Duty to act" is only one part of a legal nexus that determines whether a responder can be held liable for negligence/malpractice. I have never heard it applied to situations where the responder is off duty.

Lisa, don't let the stories scare you. The job can be summed up pretty easily- Very routine, with periods of absolute chaos. It may be a patient that suddenly becomes combative and violent, it may be a seemingly stable patient that suddenly goes south, or a call for abdominal pain turns into a gunshot wound. That's the beauty and curse of this business- you simply never know what will happen next. Most of us are in the business because obviously we enjoy- and WANT to help- people at the worst times of their lives. Many of us have tried other lines of work, and a 9-5 office job is simply not an option. It gets in your blood like an addiction.

Scene safety is about assessing any potential threats as you arrive on the scene-a no brainer. That's not the same as a patient going off on the crew during treatment or transport. Sometimes there is absolutely no warning, so vigilance is always a good idea.

Been there, done that many times. In my "younger" days (read STEWPID here) I used to enjoy an occasional wrestling match with an idiot. No more- it's not worth it. You simply never know what may happen. Been thrown down a flight of stairs, bitten, and punched, by folks on things like PCP(or they just had terminal stupidity). A few months ago, we had a guy-probably PCP- who cops had stopped for hassling pedestrians. The guy snapped and managed to injure 5 police officers- all despite being tazered twice and sprayed with pepper spray- before he was finally subdued. I don't own my rig- they are insured, and everything on it can easily be replaced.

If we spend more than 30 minutes in an ER for any reason, we need to notify dispatch. In 25 years, I can count on one hand how many times I have left an ER without giving a run sheet. (Mass casualties, major fires, etc, where we needed an immediate turn around) and then I notified the ER with a quick oral report on the patient, saying I would be back later with a hard copy if I could.) Always did the report later for our own records. Yes, sometimes there are bed issues, cleaning, supplies, extra documentation, etc, but for the vast majority of calls, even if I never entered a bit of info enroute to the ER, I can still easily complete an entire report in 30 minutes or less once I am there.

On NYE, for all those stuck working, there is an annual informal contest to see who could get the first shooting of the new year. Last year I was working and it was 015- we received a call for 2 people shot. I thought for sure we had the winner. Nope. 15 minutes into the new year and ours was already the 6th GSW victim. Gotta love the ghettos...

Phil, you are absolutely correct. Honestly though, I would say 99% of the people I work with are exactly like you and me. Life is way too short, and every day we see what horrible, unexpected things can happen to folks. Maybe it's because a few people here try to impress everyone with how smart they are, maybe it's all about creating some virtual persona, but a few laughs- especially the off color or irreverent ones are not only nice, I think they are vital. Keep it up, Phil!

LMAO Those are both damn funny! Thanks for both of them...

LMAO I gotta remember that one...

Interesting comment about the palpating pulses so the person must have a systolic BP of 70, 80, or 90, etc. It took awhile for me to learn that patients don't usually read our textbooks and if they CAN present in an unusual or nonstandard fashion, they WILL. I had to tell my students that a "rule of thumb" is highly dependent on the size of one's thumb. That always caused them to scratch their heads, but eventually they got it. As for mandating a paramedic level for FF's, it will never happen here. It is talked about occasionally, but the racial implications were staggering. I know many places that either require a paramedic license BEFORE you get hired as a FF, or as you said, within a year or 2 of hire, but not here. They can't even require EMTB as a prerequisite for the job because they cannot get the proper ratio of minorities with only a simple 6th grade level entrance exam. Requiring an EMTB license would be devastating to those numbers. Wrong- sure, but that's the political reality.

Well, as a supervisor, with all the ass chewings you can get from your superiors, it may be helpful to have a larger hind end...

Your comment about having the firemonkeys get out of ambulance duty may be true in some places. Around here, for any FF hired for the last 15 years, their EMTB license is a condition of employment, so if they screw up medically, they are out of a job. Problem is, they are never caught and/or disciplined for medical mistakes, although they do happen. Same with drivers licenses, so a DUI could cost you your job. When unions are involved, these things gets dicey. Someone can grieve the discipline, and it's usually reduced to a heavy suspension rather than a termination.

Will you be attending that rave, or working it? Raves seem to be losing popularity around here. Some years back they were pretty common- someone would rent out an abandoned building (always in a lousy area) and they'd throw these huge bashes. Surprisingly we never had any calls at these places, despite all the recreational drugs these parties are known for. Thankfully the only gunshots around my house are the occasional active and retired cops firing their service revolvers in the air at midnight. No biggie. A few die hards set off fireworks for about 15 minutes too. We stick to having the kids bang some pots and pans and pop some of those champagne bottle streamer things. LOL

Horrible. I wonder how long it really took after the address mix up. They will review the dispatch tapes and see who dropped the ball here.

So, it's the stroke of midnight on New Year Eve. I'm sure we all have good drunk stories to relate, but I'm referring to work. Where's the oddest place you found yourself at 000hrs? Me- Spent one year huddled with about 6 others in the tiny bathroom of a high rise housing project. (Safest place) Thankfully it was the usual nonemergent call there so we could easily delay transport. The shooting was so bad it was around 030 before the gunshots finally subsided enough to safely exit the apartment. Your turn...

Sadly, you are right about that Richard. Before I got into this business I was a cook, and believe it or not, that was a lousy eating schedule too. A bite here, a bite there when you get a chance. Now in EMS, along with that food trigger, there's also a secret switch that generates a call every time you hit the bathroom or lay your head down to sleep. After 25 years, I'm still looking for those damn switches... It's a horrible way to eat, but my eating habits are so programmed that I am always the first one done eating at home or in a restaurant.

Let's put it this way. Many times you will do things in front of your partner- make or female- you would never dream of doing at home. LOL

Yep. Variations include squad bench ass. I've heard it used for LEO's too. I realize that we all age in different ways, but at least in my area, women DO seem to develop this problem- moreso with their rear ends than anywhere else. Gawd knows I've packed on a few lb's over the years, but after some medical issues I was forced to change my ways. When I first started in the business, I worked out 3-4 times a week. Then I got married and all bets were off. "Too busy"(aka got lazy). After I had my wake up call, I started back at the club, dropped about 20 lbs and 4 inches off my waist. Not crazy about my diet, but when I cook, it's heart healthy. I have my occasional fast food, but working out is the key. The thing is, the more muscle you make, the more calories you burn. Obviously the older we get, the more our metabolism slows down and changes and we need to be more vigilant about eating and exercising. Women have the added issue of birthing babies, so they also need to rebound from that.