uglyEMT

Hi Herbie. I have ALOT of experience with this product and some of its variants. Everything you described sounds spot on to our experience. For some reason this crap puts folks on their ass and it gets scary for realitives and bystandards. I am assuming Naloxone is the same pharma as Narcan. I have seen the turn around after a push of Narcan and the hostility as well. I would love to hear the toxic screen, not because I suspect drug use but would love to see what "other" ingrediants are in Four Loko that are not listed.

No problem. If you need more info feel free to ask

AWSOME... Playing it for my crew tonight when we get on duty.

Thanks AK for that info. I did know a little but this clarified a few things for me. I guess what i was leaning twords with my statment wasn't so much as the cost of a medicine in general but more twords the charged cost in hospital care. I go to Walgreens and buy a bottle of Tylenol for 20 bucks and has 50 tablets in it. I go to the hospital and during my stay I am given 2 Tylenol and my bill shows 20 bucks. Thats what I was getting at, the markup. I know its all about profit margins and such. I just don't like it.

Sorry ERDoc for not getting back to here sooner. Was pulling duty. I understand the free enterprise side and "why should I expose myself when someone else does less but gets paid the same." It is understandable. Hell I see it everyday in my regular job, I make the same as the lump of crap sleeping in the chair next to me yet I do infinatly more than he does. Here is my one problem in this train of thought. Why does a Doc, specialist, ect NEED to charge hundreds if not thousands of dollars for a procedure? Why does a pill that costs pennies NEED to be charged hundreds of percent more because it was administered in a hospital? Admin costs?? Sorry I call BS. WHY does it NEED to be so expensive? Is it because most look at the medical industry and see dollar signs? "Hey I can get 5000 for reading an Xray so thats what I will contract it at, only took 5 minutes but hell I can get it." Sorry thats called greed. Let me put it this way.... If I hired you for my hospital at 250,000 a year salary. Would your care change if you have seen 10 patients a day or 30? No matter what you get that salary. Instead of charging thousands per patient you make X amount no matter what. Care is care, why should the dollar amount be a consideration? OK fine my ideas are Utopian and in my world everyone treats everyone equally. I get that. I just don't SEE where the costs come from. Why can I get on my rig day after day, deliver the best care I can all for nothing and not think twice about it yet the next town over charges 500 to 1000 (BLS/ALS dependent) for the exact same thing? NO I am not saying it should all be free and noone should make a living, what I am saying is why the disparity. When does the money become irrelevant? I don't know, I guess I am stuck in a tangent and have become warped. No my volunteer status has nothing to do with it, I don't want to get into that can of worms again. I just don't SEE the costs nowadays. Why does it take 100,000 dollars for a 3 day hospital stay? Why do labs cost 10 grand? Admin costs don't cut it as an answer. I think the bottom line is GREED. When I hear the loudest proponents of non standardized payment I usually see them in their Armania suits, coming to the meeting in their Porche after leaving thier McMantion saying why shouldn't I be allowed to charge that amount per patient. OK I will stop here, I am getting more and more worked up and probably will devolve further in this downward spiral of anger. I digress if I have offended anyone and all the previous statments are purely my personal beliefs not backed by any facts just questions.

ER Doc I guess what I envision (again my personal wishes or dreams) is to see a cost effective system. Why does the surgon have to charge thousands for that opperation sort of thinking. Like say you are an ER Doc you make X amount, the surgon makes X amount, ect. If every doc or nurse or specialist country wide was on the same pay scale my thinking would tell me prices charged wouldn't be so outrageous that hospitals or offices couldn't turn a profit while still being affordable to the masses. I guess I want to imagine when its doesn't cost 500 a ride for BLS, 1000 more if a medic gets on board, 3000 for that ER visit, another 5000 in lab work and xrays, then 8000 for that specialist that walked in for 5 minutes to do something. (prices for effect only here) I hope that made sense.

My service uses the Kendrick. The lack of force gauge doesn't seem to be an issue for us. Taking the slack out of the strap slowly and matching the force the second person is holding on the ankle is all that is required so communication is important. I have to look into the ITD unit.

I can see the following happening Operator: "911 What Is Your Emergency?" Caller: "I am having chest pains!" Operator: "Do you have insurance?" Caller: "No." Operator: "Sorry then Sir, take an asprin." Caller: "Huh? What?" Operator: "Thank you for calling 911, Have a nice day." CLICK In all reality this will be a quagmire if it happens. IMPO I don't think anyone should be denied healthcare be it preventive or emergency based on wether or not you can pay. Maybe once we move from profit based to something else (like that will ever happen) things will change. I know my opinion is a pipe dream but it still is the way I feel.

Smokes, peeled unsalted pistachios, water. Thats about all I keep in the rig for "those" days. If I know I will be doing a long stand-by (SAR, fire scene, sporting event) I try and bring some protien bars, gatoraid (or equivelent), and sometimes popcorn. At sporting events its alot easier to come by cooked food so usually I pack light. I usually try and keep the snacks salt free and non messy. Hate trying to put gloves on over greasy hands or seeing grease smugs on the BDUs.

Happiness. I too wished for this yesterday. I did not attend any memorial services, I watched DVDs instead of the TV, I visited my parents and had a lovely dinner with my wife. The lead up to this day is always hard, it seems like the media wants to open up old wounds that alot of folks are trying to close and heal. It is very hard for some of us. Today I got up kissed my wife good morning and went to work just like any other day. I stopped on my way in on the shoulder of the highway and gazzed at the beautiful sun rise behind the NY skyline and the growing new Trade Center and in my own way gave rememberence to all those souls on that day.

Since I took the weekend off from the world and unplugged I missed this thread earlier. I glanced through most of the thread to get the jist of where it was heading so I think I can post and be part of the thread. 10 years ago on a bright sunny 68 degree Tuesday I watched my world fall apart before my eyes. I watched as 3000 people laost their lives and many many more were effected because of it. I watched as everyone turned grey, no creed, no color, no nationality, GREY. It was BEAUTIFUL!!! I watched as human beings became one. I worked 72 hours on a pile of steaming debris with my fellow humans. We as humans cried together, worked together, prayed together, felt pain together. I was on a bucket brigade and some folks on the same were Muslim. They cried the same tears as I did. Felt the same pain as I did. Had the same anger at 11 men that I did. I still talk to them today and they still feel what I feel today. 10 years later they hate the same 11 men that caused this atrocity. This wasn't a country that attacked us, this wasn't a religon that attacked us. This was 11 men that attacked us. I don't think 11 men represent an entire religon, country or community. Just as Oklahoma doesn't represent all Americans 9/11 doesn't represent all Muslims. It is the short sighted, fear mongering, nieve people that belive they do. I have never been to the Middle East or Indonesea but I would like tothink that if and when I do I would be looked at and treated as a fellow human being. I know I may be looking for rainbows but hopefully not. Hopefully this makes sense....

Thank you Dwayne for the honest response, especially that last line. I guess tonight I will be cracking open the books and refreshing my PMS skills, or at least seeing if I was missing anything. I don't think I did but figured I would through it out here just to see if it was me, the EMS Gods, or just a bad night. I will say I don't think I missed anything other then getting them to move said hurt appendage and my clincial thinking saying they probably couldn't. My clinical thinking might have been off, like you said, with my Captain looking over my shoulder. As for the meds, ALL THE FREAKIN TIME, especially up my way where prescription drug abuse is very prevelent. I had one where I asked all the right questions, ran through a list of possible meds that could be causing said s/s got No's across the board. Asked about illicet drugs and ETOH and got No's. ER Tech asks and gets Weed laced with Meth. I look at my partner and the medic riding with us like WTF and the ER Tech asks the medic why its not on the report said everything we did and the PT goes its just weed I grow it in my yard so its not illicet. Guess the Meth was home grown too But I do see what you are getting at that just because my patient said no he couldn't I stopped there and didn't try farther, which I stated, due to P and S being strong and I was splinting no matter what. I guess it was a disconnect between me and my patients. Could have seen the anxity in my eyes or face with my Cap behind me. Maybe the pt just liked the Captain better and looked at me like a noob. I don't know but I will reread my PMS chapter just to refresh a bit.

CPht I know your profession well. My father has several compounds made monthly. It is amazing what you guys come up with. ERDoc thanks for the heads up on "telling" my patient what to do. I guess I take the nice guy approach often and it is like second nature to ask them not tell them. I will give it a try next time. I will say sometimes I do demand things from my unstable patients just to keep them "with" me yet my stable ones are sometimes treated with kid gloves. BTW Captain's high horse is being put in the barn at years end due to retirement so I just have to hold out for 3 more months.

Ok this is a vent, a question, and asking for some advise. I had a run of calls the other night that I swear every patient did everything to make me look bad and I wanted to scream, "Really!?!" First one was a patient complaining of shoulder pain, I am working the patient up with my Captain observing so I am making sure I cross my Ts and dot my Is. When I ask the patient could he move his shoulder (after a quick assesment not finding deformation of clavical or scapula or possible dislocation of the shoulder joint) I get the no can't move it it hurts to much. I turn to my Captain (working as my partner) and ask for my sling and a crevat as I am going to immobilze in place (pt said it felt better in the position he was holdign it, tight to his chest slightly elevated and had good pulse and sensory but no motor so I agreed to the POC). As I am prepping my sling my Captain asks if the patient really couldn't move his arm. Like a miracle the simple laying of my Captain's hand on the arm and the patient has full range of motion WTF 2 minutes ago you said NO now you act like everything is fine. Needless to say an ice pack and an RMA later we are back on the rig. All the while I feel the daggers shooting from the Captain's eyes while traveling back to the satation. Call two, possible broken wrist / fore arm. Again I am teching the call with the Captain watching. Again, ask what happened and while taking in the history I am doing a quick visual exam. I go to check my PMS as I do see deformity in both the radius and the ulna proximal to the wrist. I feel a strong radial pulse and the patient says he feels my touch on his finger tips. OK on to the M, again patient states no movement. I am thinking possible tendon damage due to the broken forearm. Again as I prep my SAM and crevate Captain walks over and does another PMS check and BAM patient wiggles all his fingers and makes a fist but says it hurts. I get "the look" and we prep his arm for the break and transport. On our way back from this call my Captain asks did I even bother to check PMS on either of my patients. To which I replied of course, pt stated no movement, but had P and S and due to my assesment of the injuries felt loss of Motor was justified (pt one I felt was a sprained shoulder and movment hurt, pt 2 I thought was tendon and ligament damage due to the break). To which I was advised if I really did a thorough PMS I would have tried harder to get the patients to move their injuries. Look at what happened when I did. GRRRRRRRR UGGGGGGHHHHH I know darn well I did a good PMS and with my assesments and felt why put the patient in discomfort to try and get them to move their injuries when with pulse and sensory being strong the risk of comprimise wasn't high and immobilzation would be sufficent. Just to have them a few minutes later start moving said areas when asked by the Captain and make me feel like they were doing it on purpose just to make me look bad. What would you do in those situations? I felt like bitch slapping both of them to be honest then the Captain. But thankfully my adult brain worked and not my school yard brain and I just quietly mumbled under my breath probably every curse under the sun and then invented a few. I know this sounds like rambeling or whatever and I am sorry about that I just had to get it out. Any suggestions for next time I encounter this problem?

OK knowing this is third party speak I understand some answers can't be given. But here goes my take on this... Is it possible that before the supposed head lift and roatation the officer looked into the womens mouth, noticed the obstruction, and tilted the head to the side to clear it? Same as you would say and unconcious patient that vomited? Rotation to clear the sputem before suction applied. It could be the hymlic worked and the piece of lettuce was right at the back of the throat but still blocking the airway and the simple rotation of the head was enough to let the piece of lettuce fall away from the airway thus allowing the patient to breath? I know of a choking victim that had an ice cube lodged in the throat, hymlic did nothing to releave it but once the patient went unconsious and was layed flat, the natural heat of the throat, body position and probably a great deal of luck melted the ice enough to allow airflow, a few minutes later patient was consious and alert. As they say, all great stories have a nugget of truth.

Here is an idea from a personal perspective I know all too well and you will see in the field. Epstein Bahr Ok I know what you are thinking, meh flu like syptoms, not shocking enough. Well I beg to differ. Here is why. I have this disease and if I am not careful when developing S/S and take a proactive approach you will get someone that looks like they are on deaths door step. If I catch it early and move quickly I present as a flu patient; fever, chills, general body ache, nausua, a nice pale grey skin tone. Usually catching it here requires bed rest, fluids, treatment of symptoms as needed. Now here is the spin... If I ignore my sypmtoms, just take a Dayquill or other OTC and push through it because its only a cold I deteriorate quickly usually within 12 to 18hrs. If you are called for me at this stage your pucker factor goes through the roof. I present with ash grey color, juandice in the eyes, cold sweat, high fever 103+, no muscle tone (I cant even lift my head), shallow rapid breathing, fast pulse, low bp, vomiting and ocassionally loss of bowl control, speaking is even hard and due to the fever confusion ensues. Picture walking into that scene when the loved one that finds you says just 12 to 18hrs prior you seemed fine just the sniffles or a cough. So we have sudden onset, unstable vitals, in need of supportive breathing, and juandice to boot. Care is usually bed rest, massive fluid infusions in the first day or so, meds are kind of hard due to the juandice (some Docs wait to see if it clears before meds go onboard others have pushed meds immediatly), high flow O2 via NRB until I stabilize and get it under control. FYI the breathing is due to the loss of muscle tone and nothing disease related as far as comprimise. Fever is usually brought down with ice packs until some ASA can get onboard. I spend a week or so in the hospital (depending on my response to treatment), another 3 to 4 weeks at home under bed rest orders, then about a week to two of light physical therapy to get my body back in shape. I hope this helps give you some ideas and if you would like more information from the patient's own mouth feel free to ask away.

Thanks for the heads up Ruff. Might be above my pay grade LOL being I we don't carry 12 leads it might be a more ALS thing in my area, but will pass it up the food chain. Might be able to carry it just not use it. Like our Saline chiller warmer. We can carry and swap out as necessary the Saline IV bags, tubes, ect but are strictly forbidden to use them without ALS on board. Wierd I know but hey thats what the MC wants. Yes this patient had 7 "shocks" that I witnessed all the while showing Afib (medics words not my interpritation). Even the attending at the ED, who knew the patient from discharge, agreed this was a "settings" issue. I have had experience with a pace maker this was my first internal defib unit so I just wanted to comfirm things. Hell I was even nervous at first about touching her, you know that whole "clear" thing during external defib, a quick call to MC confirmed no risk to us so it made transfer from initial position to stair chair to rig. One thing I don't think I will forget is the sound, I didn't think it would have been audiable. Hopefully others respond as well and keep this moving foward for all of us to learn.

Hey folks, figured I would bring this out to the masses to both bring light to the topic but also ask for advise for the future. Had a patient with a recently installed internal defib unit that was going berserk. I mean this thing was tasing this poor person. From 8 feet away you could hear the "snap" of the electronic stimulation. Every time the patient moved it would do this. Took me a minute to figure out a position of comfort that didn't shock her, kept my crew safe, and were able to move the patient to the rig. Settled on the stair chair and it worked. Once in the rig we took vitals and within a few minutes met ALS in route. Once they had the 12 lead on they said she was in continuous Afib. Vitals went from extremely high to bottoming out. Medics did there thing as far as patient comfort, blood work, ect. We transported w/o incident and transfered care. What I want to know is there anything outside the prehospital setting we can do other then what was stated? The defib was only 4 days old if that helps. Is this just a load and go, liberal diesl bolous, monitor patient kind of thing or is there something that could be done to correct, at least temporarily, outside a hospital?

Squint thanks brother. You are making me look up the studies about the humidified O2. I wa just going by my local protocols and standing orders. I will look into possible side effects. As far as your statement about EMT-Bs being allowed to administer said meds. Sorry not around here. We can't even give ASA for chest pain. Only meds we are allowed is O2 and Epi Pen. Being in a restrictive system has made me realize not to work too far outside my boundries. Will I turn a blind eye, yes. As stated about the wife "remembering" the Bayer commercials. Each situation is different, if this person was in distress and their parent was their with said parents inhaler I would probably "instruct" the parents. Would I use a strangers? I don't know, I haven't been presented the situation. I believe Ruf brought up the point that if you did administer the med from a stranger and the patient sucomes to the attack and dies you are in a shitstorm. Did the inhaler cause said death, I highly doubt it, but try explaining that to 12 people that couldn't think of a good enough excuse to avoid jury duty. Now if I contact OMC and they said yes go for it, then by all means I would be asking everyone to empty pockets and purses to find me an inhaler. This is an awsome topic, thank you Mathew for bringing it up!

Dwayne not being versed in Autism at all I don't want to say be construed in any way shape or form as knowledge of said disorder, if any. I am still the way you describe your son. Barely any chest, arm pit hair. Minimal arm hair, spotty facial hair. Legs that would make a gorilla jelous LOL. To this day I never really gave it much thought other then clothing I may wear, If you look at my legs, due to wearing high socks constantly I have no hair around that area. Hopefully this is just the case with your son. As Ruff said maybe an edocrinonolgist to rule things out and maybe ask his GP. Good luck brother!

Ruff I like this statement. This AM I wasn't even thinking along the lines of On-Line MedCon. Perfect way to CYA and still get the job done. I will say if your in my area the Director will say NO let one of my Medics handle it. I was denied ASA for chest pain when we didn't have ALS available. Thankfully the wife remembered the Bayer commercials wink wink

Sorry Matthew remember your Rs Right Name Right Experation Right Perscription Right Dose I would never give someone someone else's perscription. The only exception to that rule is Epi Pen, we carry our own in the lock box incase of anaphalaxsis. Look at it this way, do you want to lose your liscense over a mistake that could have been prevented? Just because it is the same medication that the patient takes doesn't mean everything is the same. One thing you could do while waiting for the rig is add water to the O2. Sometimes moisting the O2 will realive some of the symptoms of the attack. Yes its not medication and no it won't completely fix the situation but it will buy you time and releave the patient discomfort to a degree. Your best bet is to put a rush on the rig, have ALS respond as well, and keep an eye on your patient because an asthma attack could decompansate into respitory failure if it goes to long.

Ruff I agree ONE HUNDERED PERCENT. Some rescues are just too dangerous. But the flip side of the coin is in the public eye we should rescue everyone. I will play somewhat of a devil's advocate here. Some of us have gone through certain training disiplines be it swift water rescue, confined space rescue, tactical EMS, ect where the danger level is raised above that of the "average" first responder. It is in those instances the judgment of the responding crew comes in. I wouldn't expect the day to day EMT to jump into flood waters and rescue a person but I would expect a SWR team equiped properly to do so. Do tragities happen even to those folks YES. Sometimes we have to look at all the reasons for the bad to happen not just the situation. A good example are rescue swimmers, we all know the story of the crew that lost one man during the "Perfect Storm". They did what they were trained to do but through a series of unfortunate events it all went wrong. Yet when one of these crews does make a save its not always in the news but to those that were helped angles were sent their way. If my team feels the risk outways the reward (ie the "save") we will stand by and watch helplessly. We will pound our fists, curse, damn all to hell, ect but in the end sometimes we go from rescue to recovery. Will we push the envolpe of our training, sometimes we do, thats the nature of the beast BUT we always weigh the risk vs reward. Unfortunatly Mother Nature usually has a way of teaching us She is more powerful then any one of us when we decide we can "beat" Her. One of my scarest moments actually came during training in SWR. We trained at a local water park, yea thats right a water park. Controlled conditions and all that stuff. I was tethered on the drag line crossing the "Lazy River" in which we had simulated debris (basically rafts and other objects including lounge chairs). My footing slipped and I went under but when i tried coming to the surface my drag line actually piled up the debris and I was held under. The force of the water plus the weight on my line made it difficult to get footing or clear my debris. Finally realizing I was my own worst enemy I just sank to the bottom and let the current take me after what seemed like an eternity enough debris cleared and I wound up in an eddy that allowed me to surface. So here in this instance in controled conditions it almost all went wrong, now picture it in a raging torrent in the middle of the malstrome with an actual life on the line. It can quickly go south. Yet when the tones go out I will answer the call but in the end I want to go home and see my family. Yes there are some we can not save but we will try won't we?