uglyEMT

See you learn something everyday. Here I thought they were progressive just from how many times they get mentioned and talked about. Well time for followed by BOHICA

Good thread Ruff! I was thinking the same thing after reading Herbie's post. I am currently in a position to shed a little ligth on this topic. My squad is currently facing a "change" right now. The young new EMTs are asking for all the newest stuff they have heard about or read about (equipment to protocols) (this is also a shift inside the State Cert Courses where more is being taught yet service protocols are not up to date) but some of the "old guards" like the status quoe(sp). Being I got certified under the old curriculum (the last class for it) I did not get the opportunity to get all the "new" teachings so I see things from the old gurad's perspective. But I also come here, do many CEU's, and read medical lit to keep up to date and progressive thus seeing the side of the new blood. I want to see my squad be progressive, have the latest protocols, have the newest tech at their finger tips. But at the same I see where some of our tried and true ways are sometimes the best ways. What I think we should tell our newest members to this great profession is patients. Learn the ropes, learn the medicine, learn the patients. Then as time goes on and you see an opportunity for a change bring it up, backed by scientific facts and or precidents, and go from there. Don't expect it to happen overnight but if you keep at it it may eventually happen. I know it has been mentioned here many many times, Wake County, I bet they didn't just start being progressive one day. I bet as the old guards retired and new bloods moved up the food chain things slowly began to change. Once the change happened and gained momentum it was an unstopable force and now boast one of the Countries most progressive services. So hopefully our new EMTs and Medics as they get farther along may help facilitate the changes to make their service progressive. Patients is the key and a virtue. edit to add responses to the direct questions I had no idea what Iwas getting into or wishing to accomplish. I was a wet behind the ears rookie and about the only thing I knew of EMS was the many transports I took in the back of one straped to a board with a funny thing around my neck. I want to see my squad be progressive. I want protocols that are scientific based. I want training to be undertaken to bring inline the veteran members with the newest class coming out and incorporating what they are allowed to do into our SOPs. As far as did these happen, I am working on it. I finally made it to a poistion where I can effect some changes and feel others are behind me so it may just get done. Yes I did just go with them when I first started but now I want to lead the charge.

heheheh yup We do it in a Horton Ok enough of a derail sorry about that!! It is amazing though to see a shift in thinking. It is a good sign at least

$100,000 for a rig !?! Can I please have that companies info I just paid $190,000 for my new rig. Seriously though, glad to see this is coming into the lime light so to speak. But I have to agree with Dust that the bone heads probably will do nothing. Hopefully the public becomes aware and maybe something will be done.

I know the feeling. I too am from a small community where it seems I run into past patients and family members in my off duty time. I recently had a "bad call" myself. It takes a while to get over it, sometimes longer then others. Being I occasionally run into the family members it brings the call back. One thing I try and do is not rehash it if possible even when asked. Talk to members in your squad, let folks on your crew know what you are going through. Sometimes by letting others know, you can find solice and healing because they themselves maybe feeling the same thing and just want to put on a strong persona. By talking about it it sometimes lets the emotions out and moves the healing process foward. Hell if worse comes to worse a good cry never hurts either. If all else fails please seek professional help, trying to live with a PTSD (which this can and will turn into if left untreated) can be hell. I have been there and if you search a few threads of mine about it you will see what I went through and how long I "put on the strong persona." Please don't suffer if you don't have to. The reason for the professional avenues of recovery is because we sometimes do need them. You are not weak, scared, a wimp ect for seeking help. You are human as we all are and sometimes the emotional stress we are put under is more then we can bare. We are the ones that everyone turns to in a crisis, yes even the 3am stubbed toe is a crisis to THAT person, we are the ones with the level heads the ones that bare the burdens of life and death at the worst times in someones life. Everyone thinks we are these immovable stone persons that look adversity in the face and laugh but unfortunatly no one sees what we deal with inside after the call. We are human so if the stress gets to much ( a few warning signs: reoccurent smells, nightmares, night terrors, insomnia, lack of motivation, lack of desire, sexual dysfunction) please seek the professonals out and get the help you need. Hope this helps you in some way. Know you do not suffer alone and at some point I think we have all been there.

Sorry if this derailed the thread a little bit but felt it was pertenant enough to add. Never heard of it as Top Shelf Vertigo but will keep it in mind. Dwayne as an aside I will say this, as a sufferer myself, you did the guy a favor. Yea it probably sucked in that moment for both you and the patient BUT by helping diagnose it as BPPV you helped both the ED Doc and probably his GP give a better course of treatment. Being it is transient alot of times Docs have a hard time giving a good course of treatment (personal observation, maybe I have an asshat as a GP). Took mine 5 tries to get it right but now I am asymptomatic 4 years. To Lone's question, yes I would tone out ALS just incase. Hearing from others that they would still push meds makes me believe it IS an ALS call not just a BLS call. Just as Dwayne gave an example things can go south quickly and having the ALS option to push meds makes sense. As for what about rig motion, usually (in my case at least) side to side, back and forth did nothing to set it off. Looking up or tilting my head back is what set it off so I wouldn't think normal motion of the rig traveling down the road would do anything.

Thanks for the responses guys. Glad to see I knew what I was talking about and not just thinking out my ass. Guess this Basic knows a few things

Here is one for you. Benign Postional Vertigo also known as BPPV (I forget what the other P is, I think it is proximal) Not unlike regular vertigo with the spinning sensation and such BUT it is transiant depending on head position. Usually when tilting the head up or quickly moving it to the side. It can be a tough diagnosis to get in the field. It may present as unkown reason for vomiting, dizziness that comes and goes, confusion, and in severe cases dehydration. If the person has remained still and in a position of comfort the feeling usually subsides on its own (unlike "regular" vertigo that stays no matter the position). Now would the remidies be the same? (I ask because I truely don't know) Or would transport with finding a position of comfort that prevents the symptoms be enough and forego the meds?

OK I know this seems like an obvious answer, to me at least, but it sparked a heated debate last night. It was time for our liscense renewal class for Epi and a question came up on the test that asked the following: When Administering EpiPen or EpiPen Jr. You Are Giving A(n).... A) Subcutaneous Injection B )Intravenous Injection C) Intramuscular Injection D) Intraosseous Infusion naturally I chose C. A 1 to 1 1/2 inch needle is clearly an IM injection. Now here is where the debate started, the Medic running the class said well according to the answer key it is A. I, being the inquisitive type , asked why would it be SQ when clearly you are injecting into the thigh muscle. You are not putting it just below the skin between the dermus and muscle but into the muscle itself. I was told that because Epi is supposed to be administered SQ that the answer is SQ. Again I said EpiPen is pushed into the thigh muscle thus the correct answer is IM. Well you get the drift by now... this went on for a good 15 minutes. Was I totally off base with my thinking or was the instructors thinking flawed and just blindly following the answer key? side note: Yes I know Medic administered epi can be done a number of ways, I am not talking about drawing your own injection and administering, I am strictly talking about EpiPen Auto Injectors here. edited to change a stupid smiley where B should have been

It is a good reference yes. One thing I would like to mention for those that read it though... the patient had a head injury as well! In what we have discussed thus far we were talking strictly intoxicated no obvious injuries or suspected injuries. If it was me, having a head injury would have trumped the ETOH and you would be transported. It is a very good article though especially because it is a court case and its findings. Also it is in plain speak.

Questions, patient history, bystandards, family members, quick trauma assesment,ect. I see where you are coming from ERDoc, but it is subjective to the provider. Some are straight load and go and on the way get all the history and stuff. I myself would rather get that done on scene and decide if transport is necessary. I know we live in a suit happy world and anyone would be quick to make a buck but I still believe in personal freedoms too. If the patient doesn't want to leave, all vitals seem normal (minus the etoh), and is not a danger to themselves or others I do not see the need to take them out of their home and to an ED where they are just going to sleep it off on a cot somewhere.

I see something being missed here. It seems we are all saying the same thing but missing the BIG picture. MEDICAL NEED All the statutes I have seen posted, read for myself, or found online all state "due to immediate medical need". Where is being intoxicated an immediate medical need? Yes if there is something out of wack, findings during your exam, then by all means go with implied consent and do your thing. I have stated what I would do back on page 1 so I wont rehash it again. Just keep in mind, MEDICAL need, not just implied consent.

Ok time for my take. I am in an area where this comes up ALOT both ETOH and other illicet drugs / chemicals. Here is my take on it. We have no standing protocols other then what is normally applied to consent laws thus it leaves us as providers to make the call. When I know ETOH is onboard, I do a set of vitals. If those are within "normal" limits OK check no immediate health risk. Then I check to see how "awake" they are. Are they likely to be passing out in the next few minutes in a pool of vomit and suffocate? OK if that doesn't seem like a possibility then I move on. I survey the scene, how many empties are floating around? What is the size and gender of my patient? What is the past history? Do we have friends and family? Do they make strange (suicidal) comments? Plus probably a hundred other minor thoughts in my head as I survey my patient. Then I think what does the consent law say. Implied consent means anyone that is not in a capacity to think for themselves do to AMS that would otherwise want medical attention. OK so now that is established what MEDICAL need does this patient have? Well beyond the ETOH and possible liver disease there is really no medical condition I am witnessing. Are they a danger to themselves or others? In your own home, sitting on the couch, watching TV, in an inebriated state but is not suicidial or showing signs of ETOH poisioning... NO MEDICAL NEED. Thus RMA, here sir / miss please sign here, have it witnessed, on my way. This goes for urban cowboys as well, just because a street corner or allyway isn't your home it isn't my place to say its not their home. This is of course dependant on weather conditions. If its going to be very cold, take them hypothermia is a medical condition that will only be exaserbated by the ETOH. Heat wave, again take them, hyperthermia again medical condition. Anything else leave them be. NOW.. illicet pharmacology..... This is a whole different ball of wax. I get there and someone called because so and so is acting strange. After some history taking I come to find out it is an illicet chemical. OK I check my little book to find out what exactly are the S&S and possible side effects. Ok with that information I go and check vitals. Now if the vitals are out of wack its now an immediate medical condition that needs treatment thus implied consent kicks in. Illicet pharmacology is a hard call sometimes but it depends on my survey and feelings. Usually it is a transport only because the vitals go haywire but sometimes they are not and so and so is not in immediate danger so RMA BUT I stipulate to the people who made the original call that if anything changes call us back immediatly. Ihave no problem going back but if I do come back they will definatly go for a ride. Again alot of my decision making process is from life experience and I really can't quantify it into words in a post. Its my decision and if I feel you need transport I will try my best to get you to go but if you as an adult do not want to go unless I have a legitimate medical reason to take you then nope you get to stay put, sign my RMA, and I will be on my way. Do others on my squad feel this way, no, most feel ETOH or illicet means AMS thus implied consent, then these folks get a ride to the hospital, sit in a bed ina hallway and sleep it off, get a huge bill for bed rest and think to themselves next time I wont call or if my friend tries to call I will just leave. Thus we now have a future patient that will be combative and unreasonable.

ERDoc excellent post there. He should have helped, I also believe it was offered, by the hospital staff. When I talked about transfer of care I was thinking along the abandoment lines, yes hospital staff was on scene first but because he initiated patient contact he, in my own opinion, would still need to stay with the patient until triaged. Not in the rig mind you but stay with everyone while they wheel him in. edited to finish a fragmented thought

Hmmmm interesting thread. I see all three sides (now with Lones observations) My 2 cents for whatever they are worth... I see the confusion of the OP, he had made pt contact, was doing his interview and was told to just put the person on the cot and wheel them to the ED by staff. What staff that was is unkown by us as the OP did not state and as Dwayne said could be two orderlies, ER Techs, security guards, ect. so in those situations the OP was correct in wanting to keep his patient. As for just handing over even to trained hospital staff, what is to say she would recieve care once in the ED? Reading into the abondonment issue just giving her to a nurse and not finding out if she will at least be seen is in my mind still abandonment. I already have a thread started on this http://www.emtcity.c...-triage-nurses/ so I wont go deeper in this thread and derail it. As to the our world their world thing. This isn't high school we don't have cliques. We are all professionals here and are all part of the chain. We need to remember that. As to what Lone has brought up. Spot on! The "missed my point got back in the rig and left." line is where it went wrong. OP should have went to the ED and got the information and made a proper transfer to a higher medical authority. Again wont derail the thread here I referenced the other thread. I guess without more information on as to exactly the who and where it is speculation at this point. I do want to thank Dwayne for playing devil's advocate and opening up the discussion from a different perspective which hopefully we can all learn from. edited for spelling

In the imortal words of Bill Angvale Heres your sign...........

For the naysayers about scene safety or to the rookies especially and even some of the veterans. Here is a perfect example of never turn your back..... Dispatched to a domestic violence call. PD is on scene (3 officers) plus their Sargent. Husband is in another room being "interviewed". Wife is on the floor in the kitchen with head and neck trauma. My two partners are working the patient while I assist. "Gut feeling" or "hairs on the back of the neck" or "street sense" whatever you want to call it says keep an eye on the other room. My partners are so involved with the patient a pink elephant could walk in the room and they wouldn't know. A second (well seemed like it) later here comes hubby mad ass all hell charging my partners screaming "I'll kill the B----" PD is doing there best but he is still coming. In my best hockey style manner (I played in college) I checked him to the wall. PD did there thing and he was restrained, cuffed and placed in a squad car. When I brought it to the attention of my crew they were astonished it happened because they had no idea. After the call the QA basically went down the road of feeling too secure at a scene because PD was there, having blinders on, glad we have someone watching our back..... Folks seem to get complacent when PD is on scene and don't keep situational awareness. Hopefully with this call and the others previously mentioned we get a dose of reality and remember situational awareness, scene safety, and keeping an eye on your partner(s)

Awsome post. I totally missed on the partner dynamic. That is one of the biggest influences we have to go through. Once the "unit" gells then its like watching a masterpiece.

It is for identification during a scene. Makes it easier for crew chiefs and captains from different companies to call out someone by name instead of hey you in which everyone would turn around. It is funny though when you have several memebers of the same family on a scene.

Very true Dwayne. It was more tongue in cheek then anything. I was trying to take the Hollywood version of us and shed light on our reality. I can picture a producer and editor watching 9000 hrs of 3am hang nail transport footage for 20 minutes of OMG MVA footage and trying to stretch it out for a 30 min episode. Of course they would try and make it a Trauma episode with creative camera angles and such.

Come on?!?! THATS not how it really is. Thats it I quit!! LOL That was a great article. It is amazing that that is the perception folks have of us, not the 3am water bed version. What we really need is a show like Cops to really shed light on who we are and what we do. But then again who would want to watch a show with a bunch of folks in the puke mud and blood, dirty and sweaty, no glamourous lights or uniforms doing what we do some for free. Then again when I watch World's Dumbest I think I recognize some patients of mine LOL

Everything you said is true to my area as well chris. It is a crutch they use and we accomidate as best as possible but untimatly it is up to the patient and the patients needs. If I need a stroke center, divert or no divert (minus fire or natural disaster) I am going there. Same goes for cath labs ect. The divert thing is used mainly for the 3am stubbed toe want meds kind of calls where we could use other local resources. I guess its just the verbage in my area the way we use it. Its not really set in stone but is fround upon unless it is medically necessary.