Arizonaffcep

Ok...that makes sense. I'm fairly familiar with their hx (read some very interesting books and articles on them). I had just never heard of the level 0 thing.

Actually, if the dentist does any kind of conscious sedation stuff...look at pupils...they like to use narcs and benzos for sedation. My wife has run several of "these" calls from an office in south Scottsdale...and of course, they do it without a cardiac monitor... :shock:

It's not a matter of "authorization" to go to the trauma center. If it's a level one trauma, UMC must accept (unless its a PURELY "mechanism" style level 1 trauma, with no apparent injury AKA a "green" vs a "white" AKA a "yellow" or a "red," red being life threatening injuries). UMC is the only level 1 trauma center south of the Phoenix area...thus there is no option to "refuse" so to speak. Couple that with a "no divert/bypass" policy for southern arizona hospitals. The "patch" is to give them a heads up on what's coming in, vs. an "administrative order" which would be something like "Medic XX enroute with a level 1 trauma." That gives no info. What's the mechanism, where is the injury, etc. The patch isn't long...honestly it can consist of "I don't have time to do a full patch, XXyom shot in the chest. 1 big hole and unstable vitals, eta 5 min." Or, if you have a minute...give more info. Just something more than a nebulous nothing report.

It should be like that for almost everyone. Kids being the exception.

It all boils down to the medic's education. If they are taught the "2 blue, 1 yellow" style mentality, without the needed critical thinking skills you get a crappy medic. No thanks. This is why I opened my own place.

How was the surgery done? Was it local or general? Also, how long was he in the hospital for it? What are his current labs?

In Arizona, we can downgrade to BLS, but only with medical control's ok. It's not considered abandonment. Actually, depending on the crew you get in Tucson...it could be considered an upgrade

Commotio cordis is from R on T, so to speak, correct? Where the electrical activity is not generated by the heart itself, but rather the energy transferred from contact of the chest with an object. Same way a precordial thump is supposed to work. Vs. actual damage/contusion to the heart tissue itself. BTW, ERDoc, you need to be careful with your location. Here in Tucson, the 3 most dangerous things to do are: 1., eat a burrito, 2., walking home from church, 3., minding your own business. When done in combination...boy howdy watch out! GSW city! Safest things to do, be very nosy, don't go to church (or if you do, drive) and stay away from cheap mexican food!

Not sure what the manufacturer recommends, but my gut says its not necessarily about how you apply the straps, as long as the legs are immobilized for the transfer. Once the transfer is done, the Pt's legs are lowered anyway, to make it anatomically correct...so to speak.

As it played out, the ALS ambulance was on scene first...once they do the assessment, then they call for a BLS transport. The only reason for the patch in the first place (instead of just BLSing him) was it fell under level 1 criteria, which everyone is required to patch on. As it turns out...it was just the first few layers of skin without penetration to the pleural cavity. He was released in a couple of hours of obs, just to make sure he was ok. As an interesting addendum, they had a medic student with them...I pulled him aside and explained that we as prehospital providers don't have the training to be able to probe this type of wound, and must assume (for the Pt's sake) that it does penetrate into the chest cavity. I then told him this is why something like this is NEVER ok to BLS. What I didn't know was the medic captain was right behind me and heard me say this...boy did I get a glare! Not that I care...they are known for their mad "Pt. don't care" skills vs. "Pt. care" skills. Besides, I know their medical director and his co-director. I work with them and am friends with them...so I know they'd agree with me.

It did appear to be more of a slash vs stab, hence the quotes. It was relayed to us as a stab wound.

I don't remember seeing anyone respond who is a Basic provider. If there is, sorry about that, I'd be curious to see if any basics out there would be comfortable taking a patient like this. I'm looking for an honest opinion here, don't just "buy in" to the voiced thoughts.

Leave it...don't want to be charged with murder...a bottle of orange juice.

So, I'm curious. I ran into a situation the other day that, while I have my own oppinions about it, I would like some varried thoughts, from BLS providers to ALS and above. Here's the situation (Admin, if this is in the wrong area, please feel free to do what you need to): The city FD, who has ALS engines/ladders and dual medic boxes-but they turf the BLS transports to a private company, responded to a stabbing the other night. A 60ish yom was "stabbed" in the back by his wife in the parking lot of the Circle K. The wound; on the laderal edge of the right scapula, around rib 5/6, which was about 1 inch in length. It didn't appear to go very deep. So...here's the question...to BLS or not. As per any level 1 trauma in Southern AZ, for transport to the trauma center (UMC), a "telemetry" must be done (AKA a "patch"). The RN who answered the radio said no for the BLS-ALS was needed. Upon arival at UMC, the medics were relatively indignant, frustrated that they weren't allowed to BLS this call (around 0300 hrs). Don't know HX, meds, alergies of the Pt (not really relevant for this discussion, as there was nothing major HX wise). Vitals, don't remember exactly, however I do remember they were WELL within normal limits. LS were clear = bilat, Pt talking in full sentences without difficulty. Unk how big the weapon was. So, how do you guys feel about the decision to ALS? Should the FD have even considered BLS as an appropriate measure? They are known for BLSing SICK pts. So, what would you guys/gals have done? What are your thoughts. Title changed to reflect content..AK

I'd be curious to see if the "lazy medic syndrome" played any part in the request for a chopper. In the fire district I used to work at, there was one medic who flew everything. Which was actually better for the Pt, as he is one of the worst medic's I know.

I fully support this. It's good to see someone who takes the initative to rock the boat. The only hesitation I have is, I'd be willing to bet that the FD's did more interventions than the numbers given. Only reason I say that is, everyone's familiar with how the FD transfer goes...they do some skills to do them, then when they write it down on the transfer of care form, they say "we came, we saw, we kicked some ass...transferred to XYZ unit." Usually it is one line, and usually never consists of an assessment. Their own fault...you don't write it, it never happened. Thus far (although I'm terribly familiar with him) I'm impressed. Collier county sounds like they landed a good one.

Sure...now they'll end up giving away free pencils at the schools. Next...we'll be teaching our 4th graders how to vote!

If you fail the NR written test, it does tell you what areas need work, but if you pass, it doesn't tell you what you got. I took it last year (as recert), and frankly it has the ability to make a seasoned person feel like they're an idiot. Also...in talking to people who have taken it as well, it varies from person to person, so there's no rhyme or reason to the questions you get. Mine were high in bio-chem stuff, very little OB/Peds. Others, just the opposite. Good luck!

Don't know if this will help, but maybe a good place to start (your state PROBABLY varies from this list to some degree). This is what the State of Arizona requires for an ALS program. Department of Health Services – Emergency Medical Services December 31, 2007 Page 23 Supp. 07-4 Exhibit A. Equipment Minimum Standards for the Arizona EMT-I Course, EMT-P Course, ALS Refresher, and EMTI( 99)-to-EMT-P Transition Course Historical Note New Exhibit made by final rulemaking at 9 A.A.R. 5372, Quantity Equipment 1 Moulage or Casualty Simulation Equipment 6 Trauma Dressings 1 per student Pen Lights (or provided by the student) 1 per student Scissors (or provided by the student) 4 Stethoscopes (or provided by the student) 4 Blood pressure cuffs - adult sizes 4 Blood pressure cuffs - child size 4 Bag-valve-mask devices - adult size 4 Bag-valve-mask devices - pediatric size 2 Oxygen tank with regulator and key (Must be operational and maintain a minimum of 500psi.) 4 Oxygen masks non-rebreather - adult 4 Oxygen masks non-rebreather - child 4 Nasal cannulas 2 boxes Alcohol preps One box per student Gloves - (small, medium, large, and extra large, non-latex) (each student has one box of an appropriate size available during the course) 6 packages 4x4 sponges (non sterile) 5 boxes 5x9 sponges (non sterile) 36 rolls Rolled gauze (non sterile) 5 Occlusive dressings 2 Traction splint devices 2 Cervical-thoracic spinal immobilization device for extrication, with straps 2 Long spine boards with securing devices 3 of each size Cervical collars (small, regular, medium, large, and extra large) NOTE: may substitute 6 adjustable devices NOTE: Soft collars and foam types are not acceptable 2 Head immobilization materials/devices 1 Ambulance stretcher 2 Blood glucose monitoring devices 2 Portable suction devices 3 Rigid suction catheters 3 Flexible suction catheters 2 of each size Oropharyngeal airways 2 of each size Nasopharyngeal airways 2 of each size Rigid splints (6 inch, 12 inch, 18 inch, 24 inch, and 36 inch) 2 Burn sheets 2 OB kits 2 CPR Manikins - adult 2 CPR Manikins - child 2 CPR Manikins - infant 1 per student CPR face shields or similar barrier device (or provided by the student) 1 per student Pocket mask (or provided by the student) 1 Semi-Automatic Defibrillator or AED training device 1 box IV Catheter - Butterfly 1 box IV Catheter - 24 Gauge 1 box IV Catheter - 22 Gauge 1 box IV Catheter - 20 Gauge 1 box IV Catheter - 18 Gauge 1 box IV Catheter - 16 Gauge 1 box IV Catheters central line catheter or intra-cath 1 unit Monitor/Defibrillator 1 unit Arrhythmia Simulator 1 box Electrodes 2 unit Intubation Manikin-adult 2 unit Intubation Manikin - pediatrics 1 set each type Laryngoscope Handle and Blades - one complete set curved and straight, sizes 0 through 4 1 set Endotracheal Tubes - 3.0, 3.5, 4.0, 4.5, 5.0, 5.5, 6.0, 6.5, 7.0, 7.5, 8.0, 8.5, and 9.0 1 Esophageal Tracheal Double Lumen Airway Device 2 each Stylet - adult and pediatric 1 box 1 cc Syringes 1 box 3 cc Syringes 1 box 5 cc Syringes 1 box 10-12 cc Syringes 1 box 20 cc Syringes 2 IV Infusion Arm 5 bags each IV Fluids: 100cc, 250cc, 500cc, 1000cc 5 sets each IV Tubing - 10gtt and 60gtt 5 sets Blood tubing 2 Sharps containers 1 for each skill Invasive Skills Manikin – Cricothyrotomy, Central Line, Tension Pneumothorax NOTE: A single manikin equipped for all skills, or a combination of manikins to cover all skills, is acceptable. 1 for each skill Training Devices for intraosseous and sternal intraosseous, adult and pediatric NOTE: A single device equipped for all skills, or a combination of devices to cover all skills, is acceptable. 2 Magill forceps 2 Hemostat forceps 3 IV tourniquets 3 Scalpels 1 Simulated Drug Box

That's what the Vic's is for...

These are available on the NIMS website...Homeland Security, something like that...all are on-line and "at your own pace."

There are 2 ways this (in my book) can play out. As you said there are only 2 cars for the county, being in-service on a BS call is a high priority. So...are the medics in question staying on scene and are not in-service once they determine this to be a refusal? I can see staying...if its agreeable between you and your partner, but ONLY if its done IN SERVICE, available for calls. Anything else is unacceptable, and a huge liability. The other way to play it out...get APS (adult protective services) involved (you did say you've tried this), or if it gets "bad" enough...involve PD. Calling 911 repeatedly with no complaint (at least here in AZ) is a crime, and PD will get involved. For this to happen though, usually they need to be calling MULTIPLE times A DAY. The last person I got PD involved in was calling 911 4-6 times a day saying she was too drunk to drive and need to go to the grocery store (presumably to get more ETOH, but who knows...). Of course, a creative 3rd way would be...if she's a regular caller, eat nothing but chilli the day before a shift, and fart your brains out, loud and smelly like. Negative reinforcement, AND she'll get disgusted (hopefully she's not into poo stuff).

What the hell fun is that? :shock:

In AZ, we can contact medical control, and let the doctor "rule" that they, the Pt is not able to make a decision to refuse treatment. This has happened to me once (she wasn't combative, but belligerent), I contacted my base hospital, and they Dr. made the decision that she was not able to make that decision on her own (due to ETOH and being in a rollover, not to mention that she wasn't A&O X 4). PD on scene stated they weren't going to force her, but with the Dr.'s order of not being competent to make her own decision, the Dr. can then order PD to place the Pt. in custody. It's not used very often, but in AZ if even if the Pt is A&O x 4, but EMS belives they are not able to make a rational decision about medical care, you can contact the base hospital and get the doc to say they aren't mentally able to make the decision. They are usually pretty good about going along with it (the docs, not necessarily the Pts).