DFIB

In EMS I think we are privileged to serv the best and the worst of humainity, sometimes in the same day. It is kinda jaded that I am more surprised by peoples goodness than by their evil. Happy New Year Doc!

Prehospital BLS. Diagnosis: LRQ Rebound pain, Obturator sign (cope sign), psoas sign for differential diagnosis Transport in position of comfort with and emesis bag handy.

I think this protocol is complicated and long winded for an MCI situation. Vital signs during triage would take a awful long time although it appears to be simply directed at the single transport decision.

Welcome Derek jump in and enjoy!

On a cold November morning the elderly waitress at the local greasy spoon brings soup out to a customer. Noticing her thumb is in the soup the customer complains to which the waitress replies. “Oh, I have arthritis and slipping my thumb in the soup helps with the pain on these cold mornings” Offended by her nonchalance the patron responds “Why don’t you take your thumb and stick it your butt instead” “Oh, I do that while I’m in the kitchen” I am careful about BSI and keep up on my shots, but having grown up in the third world I have a Immune system that has been tempered in feces, human and animal. I had a microbiology teacher in the 80's that said "If feces were florecent the third world would not require public lighting, Every surface would glow in the dark". I guess I know there are people that are really careful about human contact but as a farm boy I simply don’t get it. I bet you would freak if you had to dig a clogged septic line or muck out behind the hogs.

You mean Mariachi Bands?

You know that entire birthing thing is pretty interesting. Recently the courts tossed out another birthing law suit on a technicality. They never even looked at the birth certificate. http://latimesblogs.latimes.com/lanow/2011/12/obama-birthers.html I have found it odd that the courts keep putting this thing off. I am not sure that It has ever been looked at in a serious manner by the courts. I think the implications scare them. What would happen if it was true that Obama is not a natural born citizen? I think it would be the destruction of the Democratic Party because they put forth a candidate that was not properly vetted. It would possibly change the political environment of America forever.

You mean you don't touch strangers with your bare skin? Ever? How long would you have to know someone before you will share a bathroom with them? I have to return to the fact that although moms and grannies have used this method since hands and kids have existed, it remains in the literature for EMT's and is probably the place we aquire the practice.

Welcome to the City. I looks like Dwayne knows you so it is good to have you in the forums.

True but if is addressed in the initial assessment and at any point they are or become unconscious it would mark a significant change in the patients state and be significant in the continued assessment. To be honest I am not sure exactly what he is getting at. .

During Patient Assessment the LOC is determined even before we evaluate and manage Airway and Circulation during the initial assessment. I use the AVPU or GCS. I consider the level of consciousness pretty important at my basic level because there is a reason I cannot see and probably will not be able to manage for a prolonged time. A rapidly diminishing LOC can be indicative of so many different conditions that information about the conditions of the loss of consciousness is pretty important. BSI SCENE SIZE UP Determines the scene is safe Determines the mechanism of injury Determines the number of patients Requests additional help if necessary Considers stabilization of spine INITIAL ASSESSMENT Verbalizes general impression of the patient Determines responsiveness / level of consciousness (Bold to mark place in assessment) Determines chief complaint / apparent life threats If you are talking about triage in the event of an MCI we use START triage. It evaluates AMS and LOC as a significant finding.

Chicken strips and coffee.

I think it is really cool that you are up for a challenge like EMS. It is a challenge for me and I can still hear pretty good out of one ear. Are you totally deaf or severely hearing impaired? I am in no way making slight of your condition but am truly interested at how you manage the job. I am sure it takes a lot of moxy to even try. If you have the time let us know what strategies you use and how they work out for you. Your question was not stupid but this is a tough forum with a lot of really smart people. I get my butt handed to me frequently .We kind of fall into the habit of questioning people a little to get to know them and kind of get a feel for their intentions. I like that you came out in defense of your intentions and ideas. I like that you want to help your community. If you had included the latter information information early on I bet the answers would have been different. If you are going to make a card I would only include pertinent Hx. Family HX of hereditary diseases, Sx, and current infirmities and meds. You might want leave some spaces so they can be updated or set it up to be renovated when updates are needed.. If you are going to do it as a community project that isn't for profit I would suggest talking to some local businesses and community clubs such as The Rotary or Lions Clubs to see if they would sponsor the cost. I bet someone will like your idea and get behind your project since you seem to have a good altruistic spirit. Stay around and participate in the threads. I think I will enjoy seeing you around. Best of luck to you. Let us know if you get your project off the ground.

I feel that letting the patient know that we have made a proper transfer of care is comforting to them and helps them feel more comfortable with their “new” caregivers at the hospital. In fact, I feel that the final words to the patient are integral parts of the transfer of care. It also is common courtesy to say goodbye to a person you have just shared intimate moments with. If I was able to comfort them during the transport I like to leave them with words of comfort at my departure. Common courtesy is always a nice thing to leave the patient with. I know they appreciate it and It makes me feel I completed my service. When circumstances do not permit a proper goodbye I feel like I walked out on an conversation mid stream and something was left unfinished even if it is simply a final hand squeeze and a smile.

Welcome to the City and congratulations on the new turn in life. What is a WOW player?

What percentage off calls turn out to agree with the dispatch order? One that comes to mind is getting toned out for a dialisis patient having sezures. Yes, he was seizing but the underlaying cause was V-tach. The only reliable information is your own assesment on the scene. Good call.

Here is one I like http://www.youtube.com/watch?v=XRGd0gD0QNE&feature=related

I don't know if 9Orange's intent was to be arrogant but I am pretty sure it was a disparaging remark against the other posters that do use alternative non technological measures to measure temperature. To speak of something as simple as checking skin temperature that is recommended in the AAOS literature, as voodoo medicine shows a disdain for providers that use that method. He is almost implying that they run around killing chickens and breaking eggs on people’s heads to heal their illness that are other voodoo practices. It may not have been arrogant but surely indicates certain haughtiness.

Very sad. My best wishes to all of our Aussie friends affected by this tragedy.

Peckerhead?? Are you sure you aren't a southern woman?? That is funny!

This is not to bust your chops but as a Basic EMT arriving on the scene what information do you think would be important to have on an unconscious patient? Let’s start there and see if we have anything to add.

As I look back at this year I am so very grateful for all the wonderful people I have met this year and who have been a part of my life and experience. I wish everyone a Merry Christmas, Happy Holidays and a Wonderful New Year.

There are many other jobs with equal or even less education requirements where better wages can be earned. You are right EMTB-B don't deserve minimum wage, of course not they deserve better than that. Not because of the level of their preparation but because of the value of the service rendered.

In the shooting incident the lady seems to be suing the Police for not securing the House. Notong about EMS. Were they staging outside? Did it seem like a hostage situation? There are too many variables me to consider this article as a serious point of reference to form an opinion. There is something missing in this story. I would not enter this scene until the scene is secured. You are welcome to risk getting shot if you want, I have a lot to live for. The girl with the seizure I would have asked bystanders to volunteer to help and carried her out but I work in a remote area and train and perform complicated environmental extractions. We would have needed to rig some safety lines and guide ropes but I would have taken her out. If it took them the same time to get out as it did to get to her you are looking at a two hour delay after the incident. The few minutes that the medics may have lost in the discussion probably would not have made a difference. The age and physical condition of the responders and equipment at their disposal would be critical points in the decision making process. I am going to suppose that the reporter took the coroners remarks out of context as well. As for the 85 year old man, the hospital should have a rapid response team to attend accidents on the premises. If they do not have the proper equipment and training to move this patient they would be accepting the responsibility for any legal liability. Not a bad call. The first rule after safety is to do no harm. Too bad the ambulance took so long to arrive. They could have tried to make them comfortable and monitored him in situo and I bet they did. As I say the reporter seems to have an ax to grind. Oh, and he mentions he died implying that it was the fall that killed him. I’m sure it had nothing to do with him being an 85 year old cancer patient. The rest of the article is hear say ”I heard of one case” And a shotgun approach of an apparently disgruntled reporter with no clue but a lot of opinions. I think these are the worst two examples ever to refute scene safety and what is ridiculous is your original post.

It is good to see you again doc! I have missed your comments. Here is the refernce I used to pose the question. I gues I interpreted it wrong. http://www.ncbi.nlm.nih.gov/pubmed/11070377