uglyEMT

I know what you mean LOL I think some of the equipment was designed by S&M folks. I should have clarified that statment to say what kind of pain a pelvic fracture patient would experience in a KED.

In my service we dont have vacum stretchers or splints so we use good old hard splints and now the KED for pelvic fractures. I agree about practicality, dont really know what kind of pain may be involved to the patient. I do know pelvics are extremely painful as it in. Might be the same as using traction on a femural fracture, could possibly relieve some of the pain until ALS arrives and administers meds.

In simple terms BLS is basic life support. Doing everything up to but NOT including internal interventions and medications. ALS is advavanced life support. Doing everything the basics cant. Advanced airways, meds, IVs, ect. If your lookign for the kind of calls each respond to it get harder. I feel ALS should be dispatched along with BLS to any call where IV or ECG will be necessary. Everything from broken bones (als for pain managment) to difficulty breathing (advanced airways if necessary) to MVAs (IV, meds) especially chest pain calls (ECG, meds, manual difib) BLS can go solo on your average transports for minor aches and pain, general malaise, ect. No advanced care would be likely needed in these cases but ALS should always be available to a BLS crew if required. As for billing I dunno that one, I dont handle billing so beats me. I know in my service ALS always gets paid and my BLS rig doesnt charge so I am at a loss there. If your looking for more indepth definitions please feel free to ask for them.

Fully trained with it. I have used in on afew occasions and both my services ambulances have them as standard equipment. How do I like them? They are a pain in the rear end to use in the field. Its a 3 person piece of equipment and most times there are only 2 of us. It is a good piece of equipment dont get me wrong. It fully secures the patient prior to transfering to the long spine board. We have also been training on using it now on pelvic fractures by turning it upside down. Haven't used it in the field in this manner but have been training with it.

Ok I want to preface this by saying I am making this up from my head. The included pic was just randomly picked off the net on a google search (wierd car accidents) and I am making up the scenario based soley on the photo. You are dispatched to a 2 vehicle MVA w/ entrapment unkown injuries at this time. You are on a BLS rig with ALS responding to scene. Fire and Heavy Rescue are also dispatched. At your disposal are 2 more BLS rigs one ALS unit. Air transport is available if requested. Nearest Level 1 is 30 minutes out by driving Nearest Burn Unit is 45 minutes by driving Nearest Hospital is 20 minutes by driving Im going to run this scenario step by step so everyone can follow. so without further ado.... heres the scene I have modified the photo to blurr the license plates 45 yr old Female in the truck unrestrained. 55 year old male driver in the car along with a 21year old female passenger both restrained. Airbags have deployed in the truck. Yes the scene is inside the residence's garage.

Herzlich willkommen in Die Stadt! Froh, Sie an Bord zu haben. Zunftsprache wartet, um über deutschen EMS zu hören. Sollte sehr interessant sein. Wieder Herzlich willkommen in Die Stadt! Welcome to The City! Glad to have you aboard. Cant wait to hear about German EMS. Should be very interesting. Again Welcome To The City!

Mena re like single celled organisms all they need is food liquid and reproduction women on the other hand are like supercomputers they just have to much going on. Thats why we never seem to see eye to eye LOL remember this is all in fun. I hope you see the humor

Load and go. Patient is already packaged. Lets get to difinitive care. Especially with no intubation allowed (RSI) get the GP involved due to airway comprimise still being a factor

Thanks for the heads up Mobey. I will check crotch seams from now on. I always figured if there was a wound(s) blood would be visable on the undies and as such be treated. But again thank you for the heads up

Glad to hear about the NIL makes me feel better. PD taking care of Dad good. Less on me. Lets get rolling to the hospital with the pad. At least a GP has more in a one bed ED then we have on a rig. Bird flying so looks like the next hour we will be assessing, reassessing, baggin and sweating.

Beaner = Caribeaner. The metal clip that the rope attaches to the harness with. Not Carlos Mancia

Um OK where did I say neighborhoods I said crime scenes? I am not stooping down to your level crochity as I see where you are coming from. I am not going to sling mud or get into a pissing match. Yes per call statstics of injured EMS vs call volume is low. Probably more injuries due to accidents then attacks. But isnt ONE death trajic? Isnt ONE death due to an unsafe scene enough? I know no matter what is said here I cant change your mind nor do I want to. As I said previously I dont want to get into the frey. I just want to keep the thread on topic, if thats even possible anymore, and keep to the OP topic and article, should EMS enter unsecured violent crime scenes? I will say this about "areas" you wrok your area day in and day out. You know where to go and where not to go. You know your area. I want to end my posting on this topic with this.... STAY SAFE OUT THERE EVERYONE

The 8 GCS has me worried but glad he came back from a 3. The posturing is a very bad sign, we have a spinal cord compromise. While he's breathing on his own lends me to believe it may be we are not dealing with a severed cord but one that may be in compression somewhere. Dad well, get the kid in the rig and cut away. At a GCS of 8 you are now under infered concent, we dont need Dad to tell us anything. I am not transporting without trauma naked. This kd has multiple severe trauma injuries I want to see it all. Leave the skivies I can palpate the pelvis to check for destablization. Helmet smashed, dialted pupil low GCS we have head trauma. Any CSF noted? Raccon eyes? Battles Signs? We have a head injury that needs immediate attention. Do we have a bird available? I want this kid on a table quickly. High BP and Pulse and shallow respirations we could be looking at a tension pnuemo. Do we have JVD? I would definatly keep an eye on the BP and Pulse as well as the breaths. This kid may need a chest tube placed. Being I am BLS I appologize if I am missing something ALS that should be done.

Hmmm Good question there. I am wondering, could the infection be in the blood stream? Hear is a question for the more knowledgeable folks as I dont really know. Could a comprimised circulatory system be the site of a infection? Like, if say the pericardial sac was weakened due to overworking could an infection take root there? And thus get spread through the circulitory system to other areas? Just a question thats all. You all got me thinking hard about this one. I dont want to google for answers, I want to use my brain to make the leaps from point to point.

OK while I dont want to get into the whole fray here I want to add this. The original article stated VIOLENT CRIME SCENE no where did it state bad area, gehto, trailer park, ect. Race was not mention it just said violent crime scene. Hell it could be Charlie Sheen's home in Malibu and if it comes over as a violent crime scene bet your ass I am waiting for PD to clear it before entering. Look at the newest article on EMS World about a California EMS Squad redoing their PD response due to a crew coming under attack with a gun from a women who ODed and just wanted to die. So my point is if its a crime scene or violent call you would be a fool and also less of a provider if you entered the scene unsecured. What good are you as a provider if you become a victim?

Dwayne when I can figure out how to post multiple quotes like you I will answer that way but for now I will just go line for line. As for him AMA mid treatment. I know MRSA is a nasty bug. I dont think AMA will be enough. If memory serves me correctly, at 36hrs awake doubt it, but MRSA needs aggresive antibiotic cocktails. Cepro I believe is one of them along with some IV solutions and fluids. I cant see a ED ambulating this patient. Not saying he didnt volunterialy walk out but if he left mid treatment it could aggrevate the problem. Thus I am now thinking the bilat noduls could be a manifestation of the skin lesions associated with MRSA On a side note while commuting home I thought only abut this thread. I came to a conclusion that may or may not be on course but value your input. With the joint pain could we be looking at fibromialgia (sp) or ruhmitoid arthritis? Seems plausible in my opinion. As for the DVT question is it possible he has a filter in place? I have a frequent flyer that has a chronic history of DVT and has a filter in place, I forget the actual clinical name for it, but its a screen placed in the artery to help stop the clots. Being he has the history add to it the medications, without thinners I may be wrong here, I would think any condition will also have an underlying cardiac or pulminary condition that could be aggrevated. Thank you for the zebra note. I had it drummed into me during school by the medic instructors not to go looking for zebras. I had more than enough remediation essays because of it, yet it always seemed to prove my point than refute it. So who knows, maybe I have a little House in me after all. And if that causes me to catch something that benifits my patient then I know it cant be a bad thing. As for my finding to give my report as stated. Bare with me here I may make jumps but hopefully you can see what and where tey came from. I state it is an infection due to the low grade fever, general malaise, vomiting, diahrea, soreness, MERSA treatment. All point to some sort of infection be it viral or bacterial. Me I would hazard bacterial due to MERSA but wouldnt add that to my report (the bacterial part) Next my cardiopulminary conclusion due to history of DVT, his current medications, and the pale nail beds would lead me to believe profusion is lacking here (I my have missed an SpO2 assesment I appologize for that) thus an underlying condition being aggrevated by the infection. Thanks for the kudos Dwayne. It makes me feel good hearing an Paramedic liking my way of thinking even though I am a Basic. I know the titles dont really mean much when it comes to knowledge I only state it because I espect your opinion here as well as several others with much more knowledge and experience then me. By letting me know I am hitting the right questions it makes me more confident as a provider that I will ask these questions naturally in my course of the day and maybe just help a patient that much more then simply dropping them off at an ED with a shrug of the shoulders. As for my screen name you are not the first that said something about it. Maybe this will help shed light. Its an acronym actually (as well as what the ED calls my squad) it stands for Upper Greenwood Lake volly EMT Ok I know I could have done better but just fit me at the time. Again thanks for the kudos and you keep these coming, push me as a provider, I like the challenge.

considering fever weakness I would think systemic infection. Nods on the hands bilat are a puzzle to me. Being his amputation site is not infected I would rule out gangreen or related illness. MERSA infection could cause some sort of autoimmune reaction thus the general symptoms. Fever leads me to believe infection somewhere but without outward visable signs seems its an internal issue. Non of the meds listed sound like they treat MERSA or any kind of infection. Most except ibprofen sound cardiac related. One thing that has me scratching my head is you said fever but an oral temp of 97.8 which wouldn't be feverish. Is he sweating and saying he is hot (cold sweats) or is his skin warm to the touch thus the fever finding? Might be withdrawl? He has a DVT history so maybe something pulminary related. Could he be in late stage PE and the noduals are just a distractor? I know you said lung sounds were clear but is it a possiblity. The BP and pulse lead me to say no BUT.. stranger things have happened. I know I know dont see zebras through the horses. Well I will leave it at that for know. Based on my knowledge and not googling anything I would say to my ED personel that he is showing S&S of an infection with a high possiblity of a pulminary component to it. Let the higher medical authorities take this one. Restock my rig and 10-8 back in service Dwayne thanks for this. It is making me think more of how the whole body works together vs a single system. I cant wait to hear what this is and if I was in the right system. Thank you for making me think and not just load and go with a PCR stating general malaise (flu).

Let me take a crack at it (BLS here so bear with me if I stop beyond my SOP) 16yr Male. High Speed ejection. Unresponsive First I would be looking for paralysis signs. Are his arms curled up to his chest? Are they bent away from him? This can be done while walking up to the patient. So no loss of time for interventions but can guide you in your next steps. Check for pulse? If there is one proceed to next step. If not skip step and proceed to Airway. Next chin thrust to open airway followed by a quick RTA for s&s of trauma. Helmet, note scratches, dents, deformity. Is it going to imped airway adjuncts or interventions. If so it will need to be removed. Quickly but carefully. Secure airway if needed. Gag reflex? NPA or no gag then OPA. (like I said Im BLS so I stop at PAs if I was a medic tube him probably). By this time I would be assesing the need for medivac. I would at least have had the bird on standby due to MOI. Once airway is secured is Pt breathing on his own? Yes but shallow bag him w/ BVM on 15lpm O2. If breathing on his own NRB w/ 15lpm O2. Circulation. What color are the nail beds, lips, gums. Is he profusing OK or are we looking at a cardiopulminary issue? BP / Pulse? OK now we have our ABCs out of the way time to go trauma naked here. Cut everything away to his skivies while taking note of scratches, tears, rips. All can lead to conclusions of internal injuries. Keep gear together including helmet for transport with Pt to ED for Docs to inspect as well. The helmet is especially important. What kind of injuries are we looking at now that his gear is removed? Broken bones, chest injuries, head injuries? Concusion or closed head trauma? Bleeding from ears, nose, mouth? Any CSF leakage? Full spinal procautions with this patient so collar and board as quickly as possible and prepare for transport. Depending on findings and mode of transportation is he being flown or driven. I will stop here as depending on the answers will dictate my course of action. Right now his main priorities are ABC and immobilization. Findings will dictate future interventions. If I was to hazard a guess, just a guess, might be looking at some sort of chest injury from impact with the bars of the bike or impact with the track. Depending on if he slide into anything or not possible broken bones in the arms, ribs, pelvis, legs. Could be looking at a closed head injury if he impacted from a fall of height or if his head impacted the track with force. Spinal injury is a high suspision in my book. Hopefully not showing signs of paralysis upon initial observation. If he is alot of what happens next will be dependant on where the SCI is and to what systems they will effect. Good scenario, can't wait to hear some answers to get moving along with this patient. Even from a BLS level its a very good training scenario.

Sorry Dwayne missed the bilat part. I thought it was only on the hand in the picture. Then you would be right and it isnt a spider bite. Ok now I am totally out of my element with this one. Time to call the ALS boys...

Well maybe I can shed a little light here. I mean no where as great as Lone Star or Dwayne but some personal insight. I have only been in this industry 2 years and been at this site even less BUT I will say this. When I first got on a rig I was all stars and sparkles, couldnt wait for that trauma call or the arrest. Well guess what its not like that LOL I love what I do and I do it for free as a vollie. This brings me to this site. When i joined here I hated all the vollie bashing. Check my posts I would fight tooth and nail till I was blue in the face defending my vollie experience. Then a few folks here explained to me the reasoning behind posts and such. Its based on THEIR experiences and as such they are entitled to their OPINIONS. So I digressed and realized that I can coexist with everyone here if I let alot of the negativity to fall by the way side and focus on the meat and potatos of the discussions. Your experiences will be just that YOUR experiences, some will be good. Some will be bad. Good and bad days. Just realize what we really do and try to enjoy the profession. ok some of this is probably incoherent babble as I am pushing 20hrs awake and am looking at another 14 before sleep so I appologize if it doesnt make sense.

Wow alot of responses and all the same. Yup I agree I wouldnt be going through a cell for ICE. Like everyone has said, if the situation is that critical where I cant get the info directly from the patient then let the ED handle it. Richard, the question I posed was related to the CNN article where a EMS director is telling people to do the ICE in the phone thing. I wasnt posing a hypothetical just trying to find out if others feel that way thats all. I agree that let the PD check wallets, info, ect ect. Let us just handle the call. Maybe I should send this director a link to this thread LOL and let her know its not prudent telling folks to ICE their phones. If anything put that on a card in a wallet so PD knows what to do.

here is a link to the article in question http://www.cnn.com/2010/HEALTH/11/04/cell.phone.save.you/index.html?eref=mrss_igoogle_cnn Ok here is the question... would you look in a patient's phone for their ICE information? According to the article they are telling folks EMT's (their wording not mine) will look in your phone for information. I dont know about you but I never have. I have had PD check a wallet for ID and of course we all look for MedAlert bracelts and necklaces. But I dont know about going through someones phone. Now adays with everyones Blackberries, Iphones and pads, ect holding alot of personal information I don't know the legal ramifications of searching one. I was wondering if anyone else has or would. Kind of a grey area I guess. Well lets here your opinions