CPhT

Survey done, good luck.

Ok, I'm finally back. Here is the Good Samaritan law: http://legislature.m...x?mcl-333-20965 Now, the major court ruling for Duty to Act in Michigan is not a case of EMS/ Fire but a case of a woman who shacked up with a guy under the agreement that she could live with him provided she took care of him. She was not related to him, and he was disabled to the point where he could not sustain his own life independently. She was to use his money and goods to feed and care for him, in exchange for room and board for herself. She eventually stopped holding up her end of the bargain and he died from starvation/ neglect. She was eventually charged with Manslaughter because she basically let the man die in his basement and didn't attempt to call for help in any manner. The court's opinion on that situation: “If a person who sustains to another the legal relation of protector, as husband to wife, parent to child, master to seaman, etc., knowing such person to be in peril of life, willfully or negligently fails to make such reasonable and proper efforts to rescue him as he might have done without jeopardizing his own life or the lives of others, he is guilty of manslaughter at least, if by reason of his omission of duty the dependent person dies. 150 Mich.—14 “ So one who from domestic relationship, public duty, voluntary choice, or otherwise, has the custody and care of a human being, helpless either from imprisonment, infancy, sickness, age, imbecility, or other incapacity of mind or body, is bound to execute the charge with proper diligence and will be held guilty of manslaughter, if by culpable negligence he lets the helpless creature die.” 21 Am. & Eng. Enc. Law (2d Ed.), p. 197, notes and cases cited. Now that paints a pretty grim picture for EMS professionals, because of our Public Duty, and our Voluntary Choice. We also care for those in infancy, sickness, age, imbecility, and other incapacity of mind or body. However, unless we are being compensated for the work (paid/ career EMS), or unless we are voluntarily entering into an agreement to care for a person (volunteer EMS), we are not LEGALLY obliged to help. Morally, perhaps, but not legally. And that is where the Supreme Court ruling comes into play: Mr. Justice Field in United States v. Knowles, supra. “In the absence of such obligations, it is undoubtedly the moral duty of every person to extend to others assistance when in danger; and if such efforts should be omitted by any one when they could be made without imperiling his own life, he would, by his conduct, draw upon himself the just censure and reproach of good men; but this is the only punishment to which he would be subjected by society.” The People Vs Beardsley, 150 Mich 206 http://www.micourthi...s/beardsley.pdf

In Michigan, you only have a duty to act if you expect or accept compensation in any form for your services. That means if you accept money, goods, or even services in return, you are required to act. Good Samaritan law in Michigan also states that if you are providing help within your level of training, you are protected against litigation, unless they can prove gross negligence through act or omission. That includes EVERYONE, from lay-persons up to medical directors. Does having an Olde English D on your window make you a Detroit Tiger? Does wearing a jersey make you a Red Wing? Does having an IAFF license plate make you a firefighter? With a star of life sticker on my truck, would my wife (a teacher) have to stop if she was driving and saw an accident? It doesn't matter if you have stickers on your car/truck, or if you're in full uniform, in MI, you have no legal obligation to stop. Once I get to a full computer instead of my phone, I'll see if I can link you some actual laws.

Camp, LSTI and MAES both have payment plans. Sure, they requires 50% down payment, but at least you're looking at a reduced out-of-pocket per month, and up front, that way. Plus, if you get hired on to DMCE, Healthlink, or CEMS, you get the employee discount at LSTI (which is 10% off, or roughly $400). Or, any of the community colleges have financial aid, and they'll be starting in the next 10 weeks with their latest round of medic courses. Hell, hurry up and register at Wayne County and you'll be able to join me for medic training! As far as experiencing the road before jumping into medic; you'll probably know everything you need to know from working basic in a month. Any longer than that, and you'll just be putting yourself on the road to burnout, with working and school at the same time. Otherwise, to keep things relevant to work, here's what I would do (or rather what I've done, or plan on doing): 1. CEVO - Learn to drive a 16,000lb truck like it's a limo. 2. College stuffs (I've done these, but recommend them): Pharmacology, Anatomy + Physiology 1 and 2, Medical Terminology, Medical Math, Microbiology, Chemistry (through organic), Math through intermediate algebra, English Comp 1 + 2, Technical writing 3. ACLS - You'll need it for paramedic anyways, plus at the basic level, they'll teach you how to assist a paramedic on a call. Can you spike an IV bag and have it ready to connect to a lock? If not... take the course. 4. Sort sort of defensive tactics class, whether it's a weekend community center course, or a full blown martial arts class - You'll be working in, around, and near Detroit. Shit happens, and it happens frequently. You don't need to be Jackie Chan, you just need to know how to get yourself away from a situation and into your truck as fast as possible. Don't let ANYONE tell you that "if your scene isn't safe, you should have stayed in the truck" applies in Detroit. I have had several friends and coworkers called to a scene with PD, and as soon as the cops left, they were mugged. Yes, several. Other than that, use your head. If you're able to easily grasp new concepts at a fast pace, then your medic class may be all you need for education. If you need to slow down and study before things sink in, you might want to look into taking additional courses before you jump into medic class.

I'll start it out with the 22 year old psych pt... She arrived via our bus to the local ED. I told her "ok, you just need to change into a hospital gown" and before I could finish my sentence, she flopped her sundress to the floor. Nothing on underneath, and she was definitely not bad looking. Took me a minute to regain my professionalism, but I threw the gown over her and tied it closed before the rest of the room got a show too. Then, transporting a 99 year old lady back to a nursing home. She was completely non-verbal, non-responsive, and ignored basically everyone in the room. We sheeted her to the cot, strapped her in, and headed for the elevator. As soon as the doors closed, she went AOx3 and said "thank god you guys showed up, that bitch in the next bed wouldn't leave me alone. I had to play dumb to get her to shut up". Finally, had an older lady call 911 for chest pain at 0-dark-30. Showed up to a lady on her front porch with suitcases packed, who stood up and started towards us with a "what took you so long?". When asked about her chest pain, she said, "oh, my chest is fine. I have a headache though, and they always give me vicodin at the hospital". I said, "ok, we're on the way to the hospital, we just need to make a quick stop off at the police station so you can talk to them about the proper use of 911".

Well, did you get the job? Send me a pm and let me know who you applied for. Also, send an app in for Healthlink. They just lost a couple of basics, so they'll be hiring again shortly.

Last night we had a transfer out of the hospital where we took this patient. Just for curiosity sake, I stopped at registration and asked about her. They said she was transferred up to ICU later in the night that we brought her in. I slipped up to ICU as we still had a couple of minutes before our call was scheduled. The nurse at the ICU desk said the pt was take off feeding tube and ventilator at family request earlier in the morning and died shortly thereafter. Apparently, the pt had pretty significant neurological deficit, shown by some tests done by the neurologist. She never regained consciousness. Plus, the pt kept slipping into pulseless electrical activity. Temporary victories. The way I see it, at least the family got to say goodbye to a living relative, rather than a cold corpse. I'm not gonna lie though, I hugged my wife a little harder last night than normal, and may have been choking back a tear or two.

We have a contract to provide mutual aid to a local municipal echo (non-transporting paramedic) company. Typically, they are supported by a dedicated ALS unit, but when they go out on a call, they can be supported by first available. As it turns out, we were the third call. My unit (BLS) was enroute to a transfer at a hospital when we got the call to flip it around for active choking at an elderly group home. To follow is my edited narrative: B*** dispatched priority one to group home in ******** for reported choking, RFD on scene. B*** responded emergent (lights and siren), with no incidents. ATF pt of unknown age unresponsive on the floor of her bedroom, CPR in progress by RFD FF/EMTs. PT currently apneic, no radial or carotid pulse, pt appears cyanotic, skin cool. Pt has white frothy sputum and pink liquid coming out of mouth and nose. Staff at group home indicates pt started choking while eating lunch, staff called 911, then pt lost consciousness shortly thereafter. Pt airway suctioned with portable unit, assisted RFD with hooking up the AED, allowed to analyze, no shock advised. CPR continued. Pt prepared for transport. CPR halted, pt log rolled, placed onto backboard, then rolled back into place. AED allowed to analyze, no shock advised. Pt carried via backboard to stretcher, CPR resumed. Pt secured and taken to ambulance. Pt loaded, CPR continued in back of ambulance. Pt airway suctioned again. RFD EMT readied combitube. AED analyzed again, no shock advised. Combitube inserted, inflated, placement confirmed with auscultation over stomach and both lungs. Combitube secured with tape. CPR continued, AED allowed to analyze as appropriate en route to hospital, no shocks administered. Pt transported to ** hospital priority one (lights and siren) with RFD EMT driving **** ambulance, both **** EMTs in the pt compartment performing CPR. ** hospital contacted via HEMS radio patch. Upon arrival, pt unloaded and taken to resuscitation room, code team waiting. Report given to code team, who assumed care of the pt. B*** cleared of scene and returned to service after decon and restock. So... I walked out the resusc room basically shaking and barely able to walk, as this was my first working code. I was fairly confident that the pt was dead in the truck, and taking her in for resusc was basically a formality. I was finishing typing my report and kind of calming my nerves when I was approached by one of the company paramedic field trainers. He came up and said "I heard you give report on the radio, and heard you bring the pt in, and I had to stop in and see it. You did an incredible job on the road, and looking at the patient, you gave her every chance to live". It helped to get feedback like that, and I really needed it at that point. He walked away and went into the resusc room. He came back out, pulled me outside into the parking lot, and said "Are you ok? You don't look good. You just need to take a minute. Oh... by the way... she has a pulse". I didn't believe him, so I went back into her room, and sure enough, she was in NSR on the hospital monitor, pumping away at 78. They had her on a vent, but she was beating. I'll flat out admit that I pretty much broke down. The doc saw me standing there and said "Are you one of the ones who brought her in?". I nodded. He said "You guys did good. She's alive. Not sure for how long, but you did everything right and did a good job getting her to us". I went back to that hospital later in the shift for a transfer. I peaked in the resusc room, and it was empty. I asked one of the nurses where the pt was, and they said they had moved her up to the floor about 2 hours ago. That sure made the rest of my shift go by easy.

Wow, you guys and gals are amazing with your recommendations. I'm on the road right now riding shotgun for the return trip of a long distance transport, so I have to keep it short. Fat fingers, lots of caffeine, and a tiny keyboard... In any case, I'm going to play around with some ideas when I get back to the station and maybe post an updated report. Most of the stuff I include in the narrative is more for the legal/ cover-your-ass aspect. Things like pt secured, stretcher secures, etc. The ePCR software (Zoll RescueNet) we use has sections for subjective and objective assessment, vitals, PMH, meds, allergies, and interventions. All the goodies. I like the software. I kinda want to print a fake paper report just to see what all comes out. In any case, I'll check back when I get home or to station. Thanks again! EVO using Tapatalk 2 - "I should be working"

Oh yeah, I should have mentioned that. All of the abbreviations I used are approved by our med control authority, and we have about 5-6 pages of TLAs (three-letter-acronyms) we can pick from. That's pretty much what I'm looking for, is a bullet-proof narrative that I'm not afraid to take to the Quality Control group, or to a courtroom. Thanks! Thank you for the insight. It definitely took me a while to get used to using SOB for shortness of breath, as opposed to... well, you know. We basically have 2 things that my service requires in our IFT narratives: 1. Why they require ambulance transport (rather than non-emergency van "wheelchair van", or even POV) 2. What services are available at hospital X that aren't available at hospital Y To my understanding, it has something to do with insurance coverage, and getting medicare to pay for the ride. Thankfully, if it's an emergency, all bets are off and we don't have to spell those things out. I agree with overcharting vs undercharting too, I'd rather have too much info than not enough, in the event that my quality of care ever comes into question.

The topic came up between my partner and I today that our narratives are vastly different, and she seems to think that I'm including a lot of extra words and info, when it isn't needed. I have only been doing this for 4 months now, but I've been doing process documentation for the better part of 2 decades, so I thought I had a decent grasp on what was needed. So... for your entertainment and critique, here is a sample of a completely fictional narrative. I'm a Basic EMT, but I'll be starting medic classes in August, so I'm sure my narrative will be evolving even further after that. Feel free to pick it apart as needed. Typical transport: B582 dispatched non-emergent to (hospital) for pre-scheduled transport of pt to (other hospital) for rehabilitation services not available at (hospital). PT was admitted to (hospital) for rt knee replacement surgery, treated, and cleared for transport to (other hospital). PT requires ambulance transport due to unsteady gait, and pt is at risk for falling off stretcher. ATF 70 yo female pt laying semi-fowlers in hospital bed. Pt assessed, found to be AOX3. Pt denies cp, denies sob/dib. Pt states she currently has pain in her rt knee at the incision, which she rates 7/10. Nursing staff administered pain control medications approximately one hour ago. Pt denies any other pain at this time. Pt vitals checked (tech initials): BP120/70, P70, RR16, SPO2 99%RA. Pt is unable to stand due to surgery, pt moved from hospital bed to ambulance cot via draw sheet, secured to cot railsx2, strapsx5. Pt moved to ambulance, loaded, secured to floor rail. Pt transported to (other hospital) non-emergent, monitored for safety en route and vitals rechecked prn. Upon arrival at (other hospital), pt unloaded from ambulance, taken inside to rehab wing, and taken to her room. Pt moved from ambulance cot to hospital bed via draw sheet, positioned for comfort, and rails raised. Report and paperwork given to nursing staff. Care transferred to receiving facility. B582 cleared without incident. (tech signature) Typical Emergency: B582 dispatched priority one to (city) residence for chief complaint of altered mental status, possible diabetic emergency. B582 responded emergent to scene without incident. ATF 30 yo male pt seated on city easement with (city) PD on-scene and at the pt side. Pt appears AOx1, conscious and alert, but disoriented. Pt responds to his name, but answers questions incoherently. (tech initials) retrieved glucometer, checked level, BGL 20mg/dl. Pt given one tube of insta-glucose orally, pt condition immediately improved. Pt LOC increased to AOx3. Pt denies pain, denies sob/dib. Pt denies alcohol or drug usage. Pt states he is a diabetic and took his insulin without eating lunch. Pt agrees to examination by EMTs. Assisted pt in standing and walking to ambulance, helped into pt compartment, and seated on squad bench. Pt vitals checked (tech initials): BP100/50, P100, RR20. Pt agrees to go to (hospital). Pt moved to stretcher, positioned for comfort and secured railsx2, strapsx5. Pt transported priority 2 to (hospital). (Hospital) contacted via HEMS radio patch. Upon arrival, pt unloaded and taken to ER Pod C. Report given to nursing staff. Care transferred to receiving facility. B582 cleared without incident. (tech signature)

Well at least your name will be easy to remember. I'm Eric as well, but I've gone by Doc, Willy, Ninja (don't ask), and a handful of other less-than-friendly nicknames. I doubt that I've seen you around though, I didn't start at HLNK until January. Prior to that, I was a drug dealer (aka Pharm Tech).

I'm here. I work for Healthlink EMS, a non-profit private company based out of Taylor and covering the downriver area. 911 contracts with Taylor, River Rouge, Ecorse, Romulus, and Lincoln Park. Great company with great employees.

I know this isn't really what you're asking, but perhaps it will give you an idea of what to look for. My service stocks our ambulances on a nightly basis, even thought we still do pre-shift checks. I work full time for a local private service at the BLS level. On my person (during shift): shears (German shears, cost me $12 from Amazon and I have cut turnout gear with them already) roll of 2" tape on a carabiner 2 ballpoint pens 1 disposable penlight 1 Stethoscope (littman master cardiology 3, DO NOT BUY THIS ONE!!! Mine was a gift, and the only reason I carry it is so I know where it is 24/7, rather than making it's way to someone else's pockets) 1 pager (work provided) 1 cell phone (I provided, work uses) 4 pairs of gloves 1 pocket notepad In my pack, usually on the truck in the cabinet: Glucometer (for some reason, our service doesn't provide these to BLS trucks yet, so most of us bought our own) protocol book field guide chewing gum Mio drink mixes Thermos full of coffee Jack Links snack packs Cell phone charger Extra pens Extra penlights Extra notepads Rescue knife (seatbelt cutter, oxygen wrench, window breaker) Extra shears Extra Gloves So, you can see what I've provided is mostly the stuff that I like to have on hand at any given moment. Most of it, the service provides in one form or another, but it's just easier to have my own. Plus, who really likes using "public" stethoscopes? Eww...

I work for a service who provides IFT and rescue services at both the basic and advanced levels. I have noticed that most of our trucks have a pillow and a couple of blankets under the squad bench, as well as the one we typically exchange out on a one-for-one basis with every patient. To me, it's important to make sure a pt is comfortable, even if you're only going a mile, because the discomfort from our stretcher could cause false feedback from the patient. Your 60yo female pt with DIB and right arm pain is now complaining of back pain during the transport... is it because she's uncomfortable, or is she experiencing referred cardiac pain? Now having said that, in a true life and death situation, I could care less if the patient is comfortable. If I'm doing CPR, I'm not going to stop to make sure that the pt has a pillow. I can see the attitude of "if they call 911, they don't need a pillow", and I can even agree with that sentiment. However, how often do you get calls where you are truly the difference between life and death, versus how many calls do you drop an IV just to KVO, take history, and run a slow priority 3? The minor calls, I'd call it laziness for not concerning themselves with pt comfort.