uglyEMT

Also it removes any external venom left behind from the bite. Don't need extra venom to enter the puncture site. Here is what we carry on our rigs (got to love rural EMS ) note:the link is to a camping supply website with an excellent discription of the product and photo. We ge ours from a different supplier but it is the same product. I have not been on a bite call so I can not comment on what to do but I would say have something in place for sure. Especially if it will be a trained handler during a show, he would know what he is bringing. Also I have heard (just word of mouth here) that some snake wranglers (what they call expo guys here) carry their own antivenom to the shows just in case. I know if its a wild call everything changes but it is something to find out for a control environment.

WOW What a nomination. Thanks Dwayne and everyone else behind the scene! That means alot to me to be voted best BLSer. I am truely amazed that with such a wealth of great BLS folks here I was even in the running. Thanks again and congradulations to everyone else that has been nominated, you all truely are well deserving of such titles.

Thanks Island! Yea it all just seemed to click and I didnt have that nervousness. I guess it is different for everyone and that was mine

Yea squint on initial PE no outward indication of a fracture, had strong distal PMS, no rotation, no bruising, no shortening of the leg. Just pain. Yes they just watched while I did the PE, taking history from the husband, getting the meds down but didnt actually PE. I wanted the KED but was talked out of it. I took their "experience" above my own (hell I still feel wet behind the ears sometimes). It was a FAIL, I get it. Nothing harsh about saying it, I need to own it to move on and be a better provider. Thanks guys and gals.

Hey folks, been away a little while. Have alot going on so I haven't been able to get on much. Well I wanted to tell of my recent shift that I finally felt comfortable with myself. I usually run with 2 in the back (my partner and myself) so I always looked over my shoulder to see if I was spot on. Well this last time it was different. We were at our building on my day off checking a demo rig out. More on that in a different thread. Well I got about 20 minutes of demo before the tones dropped. Normally we would have other members respond while a demo is going on (don't want to be rude) but this time it was a time critical call so I grabbed a partner and rolled. Unfortunatly it was already too late but it goes that way sometimes. Well we clear the scene and feel OK that we would be back i time to hear what the guy has to say. Not more then a block away we are called back for a second patient. Someone slipped and fell at the scene. Well now I have a patient and its just me in the back. So I don't have that "cushion" now, I have to do it myself. I run it step by step and all goes well. I have a smile on my face now because I did it. I didn't have to be reassured. Ok at this point we are usually done but another call comes out for mutual aid. Great time to step up again. Fire stand-by. Well we get there and its a fire in the woods, have to hump our gear to the staging area (our 4wd rig was in the shop). We no sooner get in there then we get diverted to another call. Well now this is the call that tested me. Wrestler (high school) that got slammed, had LOC, and was in real ditress upon arrival. Medics meet us and release (still can't believe they did that but thats another issue) so its me, the kid and a scared Mom. Well I run all my trauma protocols while watching his GCS (improving all the time) and trying to keep Mom calm as well. Get to the ED and transfer care. My partner was very impressed at my confidence in the back (he was listening all the time while I spoke with the Mom). Said I handled two patients at the same time well. Well thats about it, I finally had my confidence moment. Ok I know by now I should have had it, I sort of did, but this was my first time I knew I had it. Now I am not getting swelled head or anything I just am happy I found my confidence. I know too some of you are sitting there reading this and going "really? none of that was particularly trying" but to me it was my ah-ha moment. I think this is the first step of many to come now, little by little I will "get" it and become a better provider because of it. Thanks for listening.

Thanks guys. Thanks for the input Dwayne I appreciate it. I like that saying that without the fail I will never learn. Thanks for the heads up on geriatric patients. I knd of thought along that route but as stated I can only treat what I find. Without the break being evident intially I think the crew was complacent on not immobilizing. I will fight harder next time!

Sorry for not getting back sooner, been extremly busy. Thanks for the suggestion of talking to the local churches. I will let you know what comes of it.

HAHAHAHAHAHA OMFG Happiness Thats so classic.

Umm reread the first post we reassesed multiple times. It wasnt until the ED that the fracture became evident. Take the KED turn it upside down, wrap the hip with the lower (now upper) flaps, wrap the limb (in this case left leg) with the top half (now lower) of the KED and secure the straps in the same order as usual. Basically a real nice splint for hip and upper femur fractures.

Pretty close squints. Just add Bud cans and its all there. Herbie you are sometimes correct when in doubt Natie Ice life is never THAT short

All great posts. Now that you mentioned it (hindsight is 20/20) she did mention when I tried to move the leg a little it "felt better". Granted I don't actually remember how I moved the leg at this point but I did move it slightly. I think I moved it towards me, ala traction, to get closer to the patient. As for the number of transfers, unfortunately it couldn't be helped. Very small room she was in, 20 steep steps with ice on them, narrow alleyway. That's the option for the stair chair (not my call I felt a backboard with the patient spidered for the move would be perfect). I do know about the transfer board, my Mom uses it for my Dad (he is a quad) but alas we do not have it on the rigs, guess I could use a short board or a pedi board in the same way. We do have a scoop but what's funny is I am about the only one who knows how to "properly" use it. I know this because I work in an industry (my day job) where we use it a lot and way before medical teams arrive. Yes squints even in the States some folks call it the clam shell because it opens like a clam. In my industry it goes by Jacobs Box (from the term Jacobs Ladder) also have heard it called clam box, scoop box, scoop stretcher, grabber, and even dead lift cot. So from what I am gathering from the posts. I did a great assessment, the fracture wasn't enough to diagnosiin the field, the extended movements caused it to complete, should have tried some sort of stabilization, kick my team in the head for not listening to me, did not fail but learned a valuable lesson for the future. Can't wait to hear what Dwayne has to say on the subject

No worries squints Im a loyal follower of temple of Budwiser and I wasn't makign fun of them either. I was making a point of the area I am from. Honestly I wish HIPAA wouldn't stop me from taking photos on a call it was a really awsome looking chandlier. He used the antlers for the main support structure and the beer cans were shaped into twisting flames and he wires it with those flickering candle like bulbs. Was really awsome looking. Getting back to religous tolerence I would never disrespect someones faith or creed. Thats why I began this thread in the first place.

RE island: From the chair to the stair chair we did a complete lift never putting weight on the leg. The stair chair to the cot was to get her in the rig and again we supported her. Cot to hospital bed was a lift with the sheets and the cot. So basically never once did we allow weight to bear on the leg. Yes nothing on intial exam and nothing during reevaluation on the way to the ED. The ride over wasn't too bad as far as bumps and like I said she seemed comfortable and lacked additional pain. Even allowed us to lower her pants to do the visual. It was only at the ED after the final transfer did we see the ecchymosis, shortening and rotation. I just couldn't believe we went from unremarkable except continued pain, no change, to 10/10 pain and a femur fracture in just the time it took to transfer from cot to ED bed. Another thing after I made the post was that another reason I wanted to use the KED was she would be placed on a backboard, I was actually just going to secure the legs so she could sit up if necessary. I wanted the backboard that way it would have only been one move from the chair to the backboard. Once on the board she wouldn't be needing transfers except with us doing the lifting and her fully supported.

Herbie the boot cover is just for the people that are very anal. Like the ones that ask for shoes to be removed so instead of debating with them we just slip them on and go. I would say maybe 4 calls in 2 years we used them. I initially bought them as a joke for the rig crews but then we were asked once to remove boots and since then they have stood on the rig. Oh I know what you mean about the not standing still, critter calls. I was on one last night, I actually got back to the squad house switched clothing and through my gear in the washing machine. I wouldn't even dare bring my gear back into my house afterwards. Trust me Herbie we are a backwoods (literaly not figuratively) squad. Dirst and grime and salt doesn't bother us or for that matter the homes we are going too. Ever see a Budwiser Chandlier(sp) complete with deer rack candleabras(sp)? Yep dey made it dem selves.

Re AK: We did remove her pants down to her knees. Thus the visually unremarkable statement. I should have clarified better. But yes at the home we were able to lower the pants without cutting to check for deformity and skin discoloration. I agree with what you said about fractures w/ benign causation thus my wanting the KED ie high degree of suspition. It was at the ED we cut because of the pain she experienced when we tried just lowering the pants again. Re PCP: Yes on Friday she went to the Doc because of left leg pain that wouldn't go away and it was noted on the discharge sheet negative findings, unremarkable. Thus I believe our complacency in not using the KED because it was an aggrevation of a preexisting condition. So far everyone has it going to experience and "just one of those calls". Thats what my QA said as well but I would like to hear from more of you folks. I just want to make sure I didn't miss something or could have done something better. I guess its because it was the first time I had something like this happen and I am now second guessing myself.

Ok folks had a weird call last night. Well the call itself wasn't weird the outcome was and I need to know if I could have done something else. Quick backstory... regular duty crew was off I was with replacements, folks with many more years experience then me. Dispatched to an 84yr Female w/ possible broken hip. Arrive on scene and find an elderly lady sitting in a chair. Husband states she fell while getting up, screamed, and he helped her back into the chair. We ask a quick history and find out she was recently at the doctor for Xrays of her left hip and leg due to constant pain and everything was negative and unremarkable. Palpate the hips, nothing unstable felt, no crepitus, patient states no pain. Palpate the left leg and feel nothing remarakable, visual everything appears normal. Patient states pain from about 2 inches (pointed to region) below the hip to her toes. Thinking back, this is why she was at the docs to begin with last week. Right leg is unremarkable no pain. Take PMS and have strong results bilat. Both extremities are same length. I suggest a reverse KED due to a high index of suspition (treat for the worst thinking here). My crew looks at me like I am nuts. They suggest that due to the findings, which they concur with, that it doesnt appear to be a fracture. After a breif back and forth I digress twords the more experienced folks. We stair chair the patient to the cot, cot to rig, and begin transport. Reevaluate in route, no change other then she feels more comfortable now with her legs straight. Again palpate, visual, PMS no change. On the way to the ED get caught by a train. Delays transport 8 to 10 minutes (we were freakin two blocks away). Get to the ED and transfer from cot to bed. Patient states pain is now more severe then before and she "feels swelling" nurse palpates and feels something. She looks down the leg and it is now rotated slightly outward and now shorter then the other. We cut the pant leg open and there is remarkable bruising and deformity. ER Doc comes over and gets her to Xray stat. Find out later it was a femur fracture. OK WHAT THE HELL DID WE MISS???? How do we go from nothing remarkable to femur fracture in a split second? I am wondering if it was fractured all along but not broken through thus my KED idea would have been the right call or that some how it fractured during the final transfer from cot to bed thus being an underlying ailment (remember the history) and it was just exaserbated by the fall, the ride, and the transfers. I don't know folks, it had the ER nurse and Doc stratching their heads after reading the PCR, it had my experienced crew scratching their heads at what we missed if anything, and has me wondering if I should have pushed my idea harder and thus this is my first official FAIL that I must own and learn from it. Anything will help folks, anything.

Great example Richard. I haven't had that yet but I can see it happening. As for the slip covers I get them from online vendors a box of 50 for 20 bucks sometimes cheaper. It is not something we do all the time but having them on the rig for "that" time is well worth it. We usually know the calls that "require" them as we approach. PD usually tells us to grab them, a set for them too LOL Some people are just strange

Dennis Leary said it the best on his No Cure For Cancer Tour "Life's A Bitch Get A Fuckin Helmet!" Thats the problem with kids today, they all want to be popularl; folks tell them they are special,pretty, athletic, ect; no one can tell them what to do. What ever happened to the days when kids weren't popular (you made friends with other kids), you were not the prettiest (you excepted yourself and moved on) you didnt make the athletic team (wow shocking you are not good, better hit the books and yea not everyone got a "feel good" trophy) and a whole other list of things that have turned into mambe pambe land. I see nothing wrong with what this teacher did. Plus her lawyer has a huge precident case to go by. That EMT that spout off aboit her boss and was terminated but was reinstated after a judge agreed it falls under workers rights laws and free and protected speech laws. Hopefully everything turns out well.

Thanks for the info Herbie. I didn't know how "strict" these "rules" were adheared to. As I compile my info I will keep that in mind and teach the rookie properly. As for the boots off thing, we actually carry slip covers on our rigs just for that purpose LOL Just slide them over the sole of the boot and no worries, once back on the rig or out the door (depending on patient status) just take them off and throw them away.

I had to think about this alot before posting. I see we are all basically in agreement that we would take the service dog but not "Fluffy". In regards to what Dwayne has asked. Dwayne I see the point your making about what can the dog do that a nurse can't do but have to say, ever been in a hospital for more than an hour? I know in my father's case (he is a quad) they have left him sitting in his own "mess" even after multiple pushes of the call button, have placed the water glass just out of reach of the straw, the TV remote to far for his tool to touch it, the voice button for the phone way out of reach, ect. Now understandable he doesn't have a service dog but do you see where I am going? Say the person has the dog and the nurses do what I mentioned above, minus the mess, the dog would be able to provide for them. Thus removing the animal from the equation dibilitates them. I am not speaking of emotional ties just what the service animal can provide while in a hospital situation. Yes granted as others have mentioned if it will be a detriment to my actions or a threat to my crew then I would leave the animal and make arrangements to get the animal taken care of either by a family member or transported to the hospital by another crew, LEO, or even animal control. I think when you look at it unemotionally you can see where the service animal is actually a help not a hinderence. I think it all depends on the situation and one blanket statment will not cover everything but I do think that it would be a good idea to bring the animal along.

Thanks for the replies guys. It is what I figured but wanted others opinions before giving the rookie the wrong answers. I know sometimes we have to go against the grain to get the job done. You are right I would rather stand in front of a judge and explain why i took an article of clothing off to help my patient then explain why my patient died because I didn't. (now I have to check my malpractice policy to see if it covers that LOL) Dwayne thanks for the in theater input, I figured you, Dust, AK, others would have a good example. Yes I know we are in America and they should follow "our" rules but I had to ask. I know with gang colors and biker colors I wouldn't cut until I asked and was given permission so I wondered with religous observance is it the same. BTW the reason for lack of posts is double shifts, purchasing a new rig for the squad, keeping our current rigs on the road, ordering supplies, and my normal day job LOL Just doing a whole hell of a lot brother, I post when I can. I know this is a touchy subject and I am trying to be respectful to bring out the discussion. As was mentioned by Beiber that other religons do refuse certain medical procedures based on customs, no matter how rediculous it seems to us personally. Also like the example of the Hindu temple not wanting the female on the male side, with some explination it was allowed but it took time away from the code. I did ask around to a few other folks in my area and one person did state it would be up to the husband or father to allow it, if not and we did, it would be concidered adultry and she would be banished from the community (stoned in her country not ours) and I was surprised by this but this is why I am asking. I know our biggest tenet as EMTs is do no harm and by removing clothing or disrespecting wishes of others we may be doing harm after the fact. I still don't have an opinion yet and I would hope others will contribute to the thread and hopefully we all can gain some insight.

Hey all. I know the thread title sounds like a joke or something but I have some serious questions about devout religous observances pratices in our field. Not talking about holidays but in practices. Im trying to find out what, if any, observanes should we follow. A question was posed to me by a rookie and I didn't have an answer so I figured I can come here and you guys and gals could help. The question posed was as follows: If we have a devout Islamic patient such as in traditional garb ie Burqa or similiar is it allowed to remove or cut it to gain access for patient care? I took a course on religious practices and traditions and tolerance but it never touched on this aspect. So I did a little research on my own and found out the practice is for modesty in public and it is concidered an "offense" to the husband or father for another man to "see" the women or her body. I also believe, from my understanding, that a women could be concidered an adulteress if another man sees her body. So I am stumped, would we be breaking some moral, ethical, religous code by removing the clothing? Im thinking something along the lines of a trauma here where in any other instance we would cut clothing without hesitation. I guess even medical calls too, say to gain access to the arm for a BP or the wrist for a pulse. Lung sounds? I tried looking through my protocols and about the only thing I found was a sentence stating to try and maintain the wishes of the patient and/or family whenever practical. I went a little farther and checked with a local ED Doc and he told me, nothing in writing just verbal, that usually for Orthodox Jewish people an autopsy wont be preformed due to religous observance and also the body would be released as soon as possible so as to be buried by the next sundown. He also stated there are special observances for Muslims as well but he would have to look them up. So I figured I would ask you all the question and see your replies. I know some have worked in theater in the Middle East and would probably have a good handle on this situation, I may be wrong though. Thanks Everyone For Your Help

Thanks EMS. Yes we just started the process and its already pulling me in every direction. We are following our steps and hopefully that will help keep us organized. Just wish the other companies would keep appointments. Its bad enough to get the other people together on their days off only to get a call that the dealer can't show. If ti keeps up PL will win just by customer service alone.

We carry hand powered suction in the O2 bags. Battery powered is available if call demands it. Plus we have stand alone suction onboard. 4c6 said it the best. Nothing wrong with the recovery position. Just turn the person on their side. Most folks that vomit know before hand they will so you get them on their side. If they are under full spinal and you are sure of your strapping (as you should be) just turn the whole board on its side.