Dustdevil

Minus 5 for using unapproved abbreviations. DIB means "Dead In Bed" to me. Apparently you have made up something different, but I'm not sure what it is. :?

That brings up a good point that always bears reiteration. Hyperventilation is very, very frequently misdiagnosed in the field. Yeah, this probably belongs in the misdiagnosis thread, but seriously... I have seen a LOT of people treated as major medical patients when all that was wrong with them was simple hyperventilation. So, as somebody else already said, don't get so caught up in rare conditions that you forget to play the statistics and look for the more likely causes.

For those services carrying plasma, could you not cut the fence post with this? 8) Seriously, folks... that crew is getting a lot of back slapping congratulations now, but had this patient not lived, they may well have been strung up by their epaulettes for violating the prime directive from school, which is to never remove impaled objects. At least in the US, they would have been. They -- and the patient -- got lucky, in that by some fluke of nature, it all worked out. This is like the old, "well I once dated the cousin of a guy who knew a guy, who had a friend whose uncle survived a car crash only because he wasn't wearing his seat belt and was thrown clear of the car before it exploded underwater" story. Yes, freak things happen that violate the law of averages. But if you go breaking that law on a daily basis, thinking you are some sort of exception, you're going to lose.

I don't have enough information to opine one way or another. However I can definitely see just as much of a problem for a ground medic as a flight medic. It's not enough to notice that the patient's skin is changing colours. You need to know exactly what colour it is changing to in order to properly assess your patient. And if you cannot fully and properly assess your patient, I would have to say that pretty well leaves you being a half-arse provider, at best, for your entire career. Personally, I don't want any career that I cannot excel at. But that's just me. Apparently, a lot of people don't get all hung up on quality and professionalism like I do.

You encountered this in the field? And I know this isn't the misdiagnosis thread, but what was your working diagnosis before getting the labs?

Well, this thread has taken an interesting sidetrack. Nick, I have no idea what the "House" reference meant, since I don't watch TV, but the word that xselerate boldfaced in your quote was misspelled. Then you responded with an inappropriate, "Don't take my admitted lack of experience as a lack of knowledge" comment. He wasn't talking about your experience, unless you mean your experience with the English language. So now you have not only misspelled a very simple and common word (and obviously not by accident), but you have completely misunderstood a subtle hint about it and taken it to mean something completely different. Then Bushy comes along and makes a complimentary comment about you, and you go off on him as if he had attacked you, which is really perplexing. That is more than just a little defensive. It borders on the offensive. At least I am pretty sure that you won't have to worry about Bushy taking your side anymore, if that offends you. :? Nobody here has a problem with a lack of experience. We are especially impressed with those who come here seeking knowledge like you. Those are the people who tend to make the most of their experiences and do well. That is what Bushy was trying to say when you went off on him. Out here where I work, we call that "friendly fire." You pulled the trigger before you had clearly identified your target, and you shot the wrong guy. These are things that identify an immaturity that will slow down your professional progress. And, if you don't knock the chip off of your shoulder, you will find a partner to do it for you. Mellow out. You've already admitted your inexperience, and we all appreciate and respect that, because too many people are unwilling to do so. Just go with it. You do seem to be a smart guy. Don't let attitude sink your potential. And BTW, there are several Nicks here, one of which is a 17 year old, so it was a natural mistake, but again, Bushy was trying to compliment you, not trash you.

Size? :shock: You're either seeing smaller eggs or larger men than me. :?

Wow, dude. Tough break, but other than spending a couple of days miserable, he shouldn't be any the worse for wear. Abdo patients certainly give me the heebie jeebies out here. When the nearest CBC, abd film or sono means a trip through Indian country, it definitely makes you sit on things you wouldn't have otherwise sat on back in the states. That's just out of our hands. The physicians on this camp are in the same boat. I had a 24 hour GI virus burn through camp a couple weeks ago, and every one of them gave me concern. I kept asking myself every time, "Am I getting complacent from seeing all of these? Is this just another 24 hour SIQ, or is this the one guy who is really seriously sick?" I go make house calls on a lot of my abdo patients just because I am so worried that one will go bad on me. Given who your patient was and what he was telling you, I can't say for sure that I would have done much different. I probably would have become pretty adamant about a surgical consult after the 103 fever though. In both of the hot bellies I have caught out here, the fever was the one thing that sealed the deal for me. I have just been lucky so far. Very lucky.

:shock: Wow! I wouldn't have seen that one coming! How did they pull that off? Who bankrolled the opposition, AMR? What were some of the issues that got the public's attention? Was this really a vote for AMR, or was it more of a "screw the bastards for trying to slip one past us" sort of revolt? Regardless, score one for the good guys! =D>

Yeah, this is pretty much a northeastern concept, from what I can tell. It's almost unheard of in the south and midwest, except for scattered, really rural areas. You're not really going to find it in Texas, where just the opposite is true. First responders run around in mixed vehicles, while the medics are the ones staffing the ambos. This, of course, makes one hell of a lot more sense. That's why they don't do it up north. Of course, you will learn when you get here that every frostback from Pennsylvania west calls themselves "midwestern," because they are ashamed to be a Yankee. Consequently, the term has lost a lot of its specificity with misuse. :?

If this is indeed true, it is still the very last bit of information that I would even think of giving any thought to. If your skills suck, it is because you suck, not your school (unless they simply gave you no tube time, or the like). And skills will always get better with practice. Always. But your book smarts pretty well stop the moment you leave school, for most people. They get so caught up in their so-called skills and trying to fit into the "EMS lifestyle" that they never pick up a book again. And damn little of those silly CEU classes really cover those foundational basics. Ever see any CE classes on anatomy and physiology, pharmacology, or pathyphysiology? Nope. It's all centred around skills, assessment, and field treatment. You have your whole career to build on your skills, and you will. But you only get one chance to lay a foundation. There is no going back. Make that your number one priority in education.

This is, without a doubt, among the top 5 mantras commonly repeated in medicine. We hear it all the time. We see it all the time. Yet, I am just appalled by the frequency with which it still occurrs! And not just in EMS, but in clinical and hospital practice too. I've lost respect for so many providers over the years as I watched them get tunnel vision on the monitor and totally lose sight of their patient's actual condition. When will this madness stop? :?

And... here's your sign. :sign3: Ya know, it's almost sad to laugh at this. After all, as Asys said, it is so very scary and deadly serious that it is really no laughing matter. But stupidity is now, always has been, and always will be friggin' hilarious! What's funnier is that the professionals here don't even have to post intelligent arguments. Everything these two type only serves to further illustrate our point for us!

There have been quite a few patients over the years who left me wondering WTF was going on with them. However, I can only recall one specific incident of actual misdiagnosis, and that was just a few months ago. Early thirties foreign male who spoke essentially no English, except for a few words, making history taking difficult at best. Presents complaining of severe facial pain in the maxillary region. No individual teeth were loose or tender to tap, nor were there any obvious cavities or other dental problems. He had headache, nausea, spiking fever, loss of energy and appetite. Sinuses were inflamed and mucous was green and purulent. Sinus x-ray clearly showed a consolidation in the Lt maxillary sinus region. No brainer, right? So I put him on Augmentin and Vicodin and sent him on his way. Two days later I get a report that he was taken to dental, where they cut him wide open for a maxillary dental abscess. :shock: Yeah, I know that was an easy mistake to make. And I'm not the last person who will make that one either. But damn, that is embarrassing! :?

Jake, is that you messing around with fake screen names again? :? Seriously dude, adjust that attitude or do us and yourself a favour by quitting now. We don't need any more "the minimum needed to get a cert" losers in the field. Serious, educated professionals only need apply. If you are truly serious about becoming a medical professional (not an ambulance driver), then I highly recommend you read DwayneEMTBs excellent post at the top of this page ---> http://www.emtcity.com/phpBB2/viewtopic.ph...60&start=30 I wish you the best of luck and a change of heart

Sweet! Now comes the celebration! Sell all your textbooks and go buy yourself a badge! Seriously, dude... congratulations! Best of luck to you! I hope you can find something better than Boston EMS.

Clearly (no pun intended), that box is opaque on five sides. Either that, or she simply chooses to exercise her vision in only one direction.

Harry Fishbine cared more about his employees than most every boss I've ever had in EMS. I can think of only two exceptions in thirty years. Hey, you laugh, but I assure you, it's not as easy as you think!

Excellent point, although this almost starts a new thread entirely. The burnout factor is not so much the result of running BS calls as it is the result of poor management and poor education. Poor management is at fault because any employer who knows this is how his medics shifts are running is just plain neglegent to even schedule them on 24 hour shifts to begin with! But, you know why he does it? First, because there are enough wankers who are so desperate to play with the siren that they will work any shift and take any abuse just to get to wear that uniform and make that $7 dollars an hour. Second, because these employers WANT you to burn out! People who stay with the company more than a couple of years demand too much money in raises and benefits. Heaven forbid that they stay long enough for the company to have to pay retirement benefits. How many people have you ever heard of retiring from AMR or Rural Metro, even though they have been around for around thirty years? *crickets chirping* Education is at fault because EMT schools feed into this big lie about how you are going to be a highly educated and valued professional lifesaver, when they know that you're actually going to be just a glorified taxi driver, who makes less money than the un-glorified ones. They set you up for burn-out. They get your engine all revved up with excitement, only to watch you crash into a wall of disappointment, the moment you let out the clutch. And they don't care anymore than the employers do, because high burn out equals high turnover. And high turnover ensures that classes stay full of suckers ready to plop down $250 to $2500 dollars for a three week first aid course that offers them the pipe dream of being a "medical professional" in less time than it takes to learn to drive a truck. If both of those entities would get their houses in order, burnout would not be a significant side effect of the increased workload of non-emergent transports.

Better yet, just be a professional and leave your personal life at home. Don't use your professional life to push an agenda. EMS is not a pulpit for you to preach societal change. Come to work, do your job, then go home and take it up whichever orifice you choose. But leave your co-workers and your patients out of it, gay, straight, or otherwise.

What I was getting at was, why two separate radios of completely separate makes and models? Especially if all you have is a couple of conventional channels? Is one a dispatch radio and the other a car-to-hospital radio? Them being so different, they must come from two different sources for two different reasons. What specifically is in EACH radio individually?

I definitely agree there! They are not qualified to drive. Not sure where in all that bandaging and splinting training they acquired the belief that they were qualfied to take my life in their hands behind the wheel, but that is another delusion. Even if they had a whole weekend [sarcasm] of EVOC thrown in there to boot, you've got to show me a lot more than a 120 hour first aid course before you are going to chauffeur me around the city streets with lights and sirens and adrenaline pumping through your veins. So yeah, EMT-Bs definitely are not driver material. So, what are they good for? First responders. That is exactly and completely what they are good for. That is all their training is appropriate for. Immediate stabilisation of life threatening conditions. They aren't educated to thoroughly assess and diagnose medical conditions and/or determine appropriate intervention. And because of that, they are not qualified to even determine when a higher level of care is or is not indicated. Consequently, first responding is the only appropriate function for a person of EMT-B level training. Is that a bad thing? No. Is it demeaning? Of course not. First responders are an extremely important element of the EMS system. It is the very core of the military medical system, from which modern EMS was developed. No military medics or corpsmen take offense at being utilised at an appropriate level. You don't ever hear them blowharding about how they are qualified to perform a nurse, PA, or physician's job. Take a clue from them. Accept your lot in life, be proud of it, and do it to the very best of your ability, or move up. Those are your choices. Whining is not an option. It's a cop out. And an annoying one at that. Please find me one single quote from here where anybody said anything even remotely approaching that silly statement. It hasn't happened. And your failure to see and think this through rationally does nothing to make anybody feel more comfortable that you are a critical thinker, qualfied to assume responsibility for the lives of our most vulnerable citizens. Right there is the very crux of your failure to understand the issue. You do not yet have the education or experience in EMS to understand that THIS IS NOT ABOUT SKILLS! All our silly little skills -- yours AND mine -- are absolutely worthless without the educational foundation necessary to intelligently and competently assess your patient's condition and needs. Physicians come out of their fourth year of medical school still scared to death that they cannot competently do this. I came out of medic and nursing school scared to death that I couldn't competently do it. And after thirty years of practice, I STILL see about one patient a week that leaves me wondering WTF is going on, and if I am doing the right thing for him. You're only fooling yourself if you are honestly asserting that your EMT-B training prepared you to competently assess the condition and needs of your patients. I can assure you, no matter WHAT EMT school you went to, it did not. In fact, it was never intended to. Look at your curriculum. It very clearly was designed to teach you only one thing: to recognise and stabilise immediately life threatening conditions until definitive care can be obtained. Period. I don't care if your silly little school taught you how to do CABGs and heart transplants, those skills are worthless to you when you don't have the education necessary to diagnose the conditions you are treating. And, take away the skills training from EMT school and what is left? About 40 hours of theory, tops, of which about 8 hours is anatomy and physiology. Puhleeze. The guy who puts freon in my air conditioner every summer has two years of college education. And you want to call yourself a qualified medical professional? As has already been pointed out, this statement only serves to illustrate just how unable you really are to determine the appropriate use of ALS resources, which was the point of this thread. You see it wrong. EMS only needs EMT-Bs if the ambulance resources are stretched so thin that first responders are necessary. But EMT-Bs are never needed on an ambulance crew. Let's quit puffing our chests and patting ourselves on the back for completing a three week first aid course and acting like we are something of indisposable value to society. It's a joke, and since we have all been through it, you aren't fooling anybody except those who choose to be fooled.

For the life of me, I cannot imagine why anybody would want to do this. Do you have significant business management experience? Do you have endless funding to get you through start-up and the lean times that will plague you from the beginning? Those are the very first things you will need before you even think of doing this. Anyhow, unfortunately, if there is any place that a fly-by-night, mom & pop operation can get a 911 contract, it is Texas. :? That's a good location to smoke this pipe dream of yours. The market is VERY competetive in most places. Although, there are a lot of rural places where they can't seem to keep a provider. But when you find those places, you can't get too excited, because if you look hard enough, you will see WHY nobody wants to provide service there. The local government is run by idiots or cheapskates or both. Basically, if you can find a market where neither the big boys (AMR, Rural Metro) nor the local government are providing the service, there is a good reason for it, so be scared. Be very scared. But yeah, you can find some place to get a contract there if you have enough start-up capital and the gift of BS. They won't pay you enough to run a quality service, and they'll nit pick the hell out of you over every little thing, as if they are experts on EMS and you are just there to kiss their arses. The people you transport won't pay their bills because rural people have no insurance and can't afford a $500 taxi bill. Medicare will take six months to pay you maybe 40 percent of what you bill them. People will complain to the city council that you take too long to respond, that your sirens disturb their horses, that your ambulance station devalues their property, that your drivers are rude, that you charge too much, that your ambulances drive business away from their restaurant, etc... And then there are the multitude of complaints that will actually be earned by your people because you are forced to hire nimrods just to keep the trucks staffed. You will have to go back to the city/county government at least twice a year asking for more money, and they will rightfully tell you that you should run your business better so you don't have to keep nickle-and-diming the taxpayers. And all the volunteers, whose hobby you took away, will band together to tell the city/county how they provided the citizens a better service for 30 years for only half the money you are charging. Then you'll be on your arse, still owing the money you borrowed to start this abortion in the first place. Best of luck! :wink:

That is the standard cot mount for most ambos in North America. The Y shaped yoke on the floor, up by the Captain's seat, cradles the front wheels of the stretcher, while the c-clamp on the rail along the wall clamps on the rear wheel area. As for how "secure" it is, meh... I wouldn't bet my life on it. The one first hand experience I can relate is from my own accident. We had the same mounting system. We broadsided another vehicle at approximately 60 mph and came to a very abrupt stop. My patient was lying on the cot with the head elevated at about 45 degrees. The mounting yoke held okay, and the cot remained in place. However, the tubular bar that holds the head of the cot elevated was snapped in two from the force of the patient's weight moving forward after impact. When I regained consciousness, the patient was supine instead of sitting up, as he had been before impact. From head to shoulders, he was in the Captains chair. His upper torso was suspended between the chair and the head of the cot, and the rest of his body was still lying on the cot. Had he been lying supine when we hit, he probably would have gone head-first into the captains chair, full force, and broken his neck (like I did). But he also would have been better off if that cot bar hadn't broken too! Anyhow, that floor mount yoke is only held down by a couple of really thick steel bolts to the floor. I dunno how much force they will take, but apparently a good bit. Now, if it had been a side impact or rollover, it could have been a very different story. Yeah, that patient compartment is pretty cramped. The choice to stick the backboards inside takes up prime interior real estate. Consequently you end up with really deep cabinets that aren't necessary and just waste space. Definitely a poorly planned interior layout. Plus 5 for buying anything but Motorola radios! :thumbright: Who can you communicate with on each of them, and what bands do they utilise? How often do you find you need the 4wd? Are all of your ambos 4wd?

I wasn't going to mention the whole "Superior" thing. I didn't want to embarrass him, since they misspelled Superiour. :wink: