HERBIE1

I used to work in a busy ER in a predominantly gay area. I've seen my share of foreign objects inserted in various orifices, but I have NEVER seen it as it was happening. I took the initial warning as a challenge, but now I cannot shake that image. All I can say is- oh my gawd. The physical damage caused here would be far easier to fix than the psychological issues this guy clearly had to attempt this in the first place. I can only imagine the similar stunts he has tried in the past...

That's some funny stuff. I had to stop reading for a moment to wipe the tears!

Don't forget the famous Ford Pintos and their exploding gas tanks! In 25 years, and thousands of car crashes, I have never seen an exploding gas tank. Cars on fire, yes, and even those are pretty rare for simple crashes. We all know about calls for auto fires and they turn out to be powder from air bags or steaming radiators. Like was mentioned above, the movies have conditioned people to think that every time someone has a fender bender, their car is a ticking time bomb and the street surgeons need to drag them out to save them. Remember, public stupidity means job security... I had a 66 VW convertible bug, and that era of VW engines was famous for going up in flames- don't know why. I let my sister use it while I was away in college and received a phone call one day, saying it caught fire while she was on the highway and burned to a crisp. (She was fine) Came home and saw what looked like a rather large charcoal briquette sitting in my driveway. Damn shame.

Well, in technical terms, fractals are actually used when determining optimum response times and goals. As we can see here, different systems are structured differently, meaning when determining analysis of benchmarks and needs, I think the info has to be tailored to each situation. Fractals are on objective way to do that.

I have found that well written reports- with names and PHI redacted of course- are a powerful tool to go with any power point presentation. Present a scenario, based on the info contained in the report, and have the students construct a good report from it. Compare/contrast the report generated by the student with the selected model report. Contrast that with a poorly written report- same process. Explain why each report is good and bad, and what are important items than need to be included. I have found that powerpoints- even the best ones- can have a mesmerizing effect and often times the student tends to miss important points. Dissecting both good and bad points in a report keep the students(and even those who are there for con-ed) focused on the pitfalls and problems of report writing. Explain personal experiences with the legal system if you have them and how a lawyer looks at a report differently than we do. Anyone who has had to testify in court or give a deposition can give first hand knowledge of how vital a well written and accurate report can be and is a great object lesson.

From the EMS side, it seems to me transports are simply a system policy issue. In our city, we try to accommodate a patient's hospital request- within reason. Obviously patient condition, time difference between closest and desired locations, capabilities of the receiving hospital, diversion status, time of day(traffic), call volume, and more- are all considerations. There are established guidelines that deal with taking OB or pediatric patients to capable facilities, trauma patients to trauma centers, but in general a comprehensive ER should be able to handle anything- at least in the short term. Now, with the advent of specialized stroke centers and cardiac centers to handle MI's, the problem is only compounded and although a stroke center is best for a patient having those symptoms, it can leave a void in your coverage area when you are gone. There are pro's and cons of trying to honor a request, and as far as the police is concerned, often times they prefer a patient be brought to a closer hospital, in or near their assigned district- especially if there are multiple victims and may need to take statements and make reports from everyone involved. When a rig takes a patient far from their assigned area, in a busy system, it has a snowball effect which causes vacancies in areas, response times increase, and things can quickly get out of hand. Obviously when hospitals are so full they can no longer accept ambulance patients, these extended transports cannot be helped, but any efforts to "please" the patient, their doctor, or law enforcement must be tempered with common sense. In these cases, the impact on the entire system has to be taken into account. These days, patients are considered customers and it's all about customer service in both the prehospital and hospital settings. Clearly there are many factors involved here and I think the more you know about your system, it's capabilities, and shortcomings, the better you will be able to make the best decision for your patient and for the rest of the system. You need to seriously consider the consequences of any transport decisions and how they impact everyone around you. Also, the amount of latitude a system gives it's crews to make these decisions varies quite a bit from city to city.

Difficult question to answer. So many variables, different types of services, different schedules(24/8/10/16 hr shifts), multi-tiered responses, etc. If we could find out what you want to do with the info, maybe we can narrow it down.

The old days of drunk tanks worked out just fine- until an occasional one died from complications due to a secondary medical problem and people became upset. Now nobody wants that liability. Maybe there needs to be some type of medically supervised drunk tank so they can sleep it off without tying up an ER bed. As for shelters, most around here refuse to admit someone who is intoxicated. They simply don't want the hassle. The police here used to take drunks in transport wagons, as well as folks who had minor problems- to the ER. Again- liability(and the fear of infectious diseases)- has them now call EMS for anyone with a boo-boo.

In general, any state statute would supercede anything your organization might have. I would check those and any applicable municipal ordinances as well as your insurance carriers and medical control and pattern your ideas accordingly. I agree that we should be held to a higher standard than the general public and our conduct should reflect than off duty or on, so think more strict. Good point. In our locale, the Secretary of State's Office regularly sends a list of any suspended licenses to the department- regardless of the reason for the suspension- failed emissions tests, proof of insurance, expired, revoked, DUI's, etc.

Depends on far more details than you are providing. What were the scenes like? Safe? Tons of bystanders? Unruly? Potential for problems? Surroundings? How much assistance did you have? Irate/upset/interfering family or friends? Yes, some of it is burnout, some of it is things you may not be aware of- previous problems in these areas, who knows. If it's simply trying to get back in service for the next call- that's silly. You can only treat one at a time- except for MCI's of course. The point is, we have a lot of toys to use, but time and place. Good post. May I also add that in certain cases- bad trauma- load and go is the only way. You do whatever you can enroute, but they need an OR- that large bore IV will probably do little for them. For a sick cardiac, we can definitely make a difference and at least in the first few moments, we do exactly what an ER does. Obviously they have more help, MD's, more toys, and more meds, but our first line, immediate care is ACLS and the same as an ER. In this case, extended scene time is OK and I've been told this by every doc I've spoken with. Depending on transport times, the acuity of the patient, and the level of skill of the provider, what can be done enroute to the ER also varies widely.