JakeEMTP

Ruff, It is important to stay involved in the daily functioning of your employees. Find out what issues they may have a things that the like about the service, especially when you get settled in to your upcoming position . I would schedule a meeting with the employees either individually or in small groups if the service is bigger. Get to know them on a personal level. If they believe that you are genuinely interested in their ideas, moral should improve fairly quickly as this instills individual ownership and pride in the service. As stated above, a pat on the back for a job well done goes along way. It can be demoralizing to only hear from management when you mess up.

Double the rates? Wow. More for less. $800.00 and $16.00 per mile seems excessive. Not that it matters though. A good percentage of the HFD clientele aren't paying the bills anyway so whatever they charge is irrelevant. One of the women in the video has used and "amblance" many times. Many times? I replayed the video to make sure I heard that right. 'tis true, it is her only mode of transportation to the hospital when she's sick and of course, all her illnesses require treatment at the hospital, but I digress. Raising rates has some merit but shouldn't be quite so excessive. If they concentrated more on collection they could recoup the revenue they hope to gain for "maintenance". As Jon Lovitz used to say, "Yeah, That's the ticket"

Thanks Bro! That will give me something to do tomorrow after I recert in ITLS.

Ha! My wife who is an OR nurse always wondered how we could administer Lasix w/o a foley in place! Although we had to demonstrate our ability to place a foley annually, we didn't even have them on the ambulance.

WHACKER ALERT! If you want to provide further interventions than your current SOP permits, increase your education. If the State does not purge this guy from the ranks of our profession, they will be doing us all a great disservice. We as a profession cannot allow this to sort of thing to continue.

Sorry to hear that. What an excellent use of resources, or is it justification.

Fire apparatus doesn't respond to as many calls as EMS. It is the law of averages.

This is something however that does work. Your service and Medical Director should really look into acquiring it.

With that statement, I am in total agreement. We learn from each other constantly, one of the things that keeps me coming back here. Many threads I can't even enter, but I will always take something away from them.

I disagree. I don't think it for the reason you state at all. If it is of no benefit to the patient, then why are we giving it? Why do you give diuretics? Because you can? It is possible you are doing your patient's a disservice by it's administration. Just food for thought. No flame intended. Here is another article I found. http://www.jems.com/resources/supplements/eagles2009/meds_under_scrutiny.html

While we have Lasix available to us, just recently under the "new and improved" State wide protocols, we have to receive orders to administer it. Previously, we didn't require the orders. We consider ourselves fortunate as some services have had it removed from their bag of tricks. Now we are to, and rightfully so in my opinion, treat CHF, Pulmonary Edema with nitrates and CPAP. If the patient can't tolerate the CPAP, we can administer Versed or Valium to make it somewhat more tolerable. The thinking is, Furosemide is of no real benefit in the pre-hospital arena. Let me state that I am a firm believer in total pt. care and do not need to see a result of an intervention to think I benefited the pt. somehow. Now though, if Furosemide is not benefiting my patient and in fact, maybe doing harm, I will be hesitant to use it, or at least think about it. I can't seem to find but a few links to articles about Lasix and it's use in the pre-hospital setting which support it's non use. (if the truth be told, there are several, but they for the most part say the same thing) http://www.ncbi.nlm.nih.gov/pubmed/16531376 http://emergency-medicine.jwatch.org/cgi/content/full/2006/613/1 Because diuretic's work slowly as compared to nitrates, there really isn't a benefit to it's pre-hospital use according to the articles. In fact, pt. outcomes have not been shown to improve with the administration of diuretics in the field. As I stated earlier, we still have it due to the fact our Medical Director still want's it on the ambulance. In order for it to be approved though by the powers that be in Raleigh, we now have to obtain orders from Medical Direction to administer it. Got to love politics. Here is a link to the NC Pulmonary Edema Protocol. http://www.ncems.org/pdf/Pro28-PulmonaryEdema.pdf

According to the article it says allowing hose monkey's to drive ambulances would be situational. I can count on one hand the number of times that my partner or myself requested a driver so we could both attend the patient. In most of those situations we did recruit a knuckle dragger, but they don't now how to drive an ambulance. They drove it like a Firetruck. 70 mph was as fast as they drove with L & S, we were being passed on the highway by people in their POV's. On another occasion we had a LEO drive. These guys know how to drive emergency traffic! If I have the option, I'll always choose a LEO to drive me in over a Firefighter. If they let Fire in the door, it is over for the County EMS service. Might not be tomorrow, but it will happen.

Doh!

Yeah, I had a pt. once who became combative enroute to the hospital even after 5mg Haldol and 5mg Valium. I called dispatch and requested LEO meet us at said hospital. UOA the LEO opened the back doors with pepper spray in hand! Fortunately we were able to stop him before he contaminated the ambulance. I just asked for his handcuffs and some assistance in placing them on the pt. CYWG is the airport code for Winnipeg Manitoba.

Bryan, The only thing we have remotely close to what you're looking for is our "Police Custody" protocol. I know it's not much, but here it is anyway. http://www.ncems.org/pdf/Pro14-PoliceCustody.pdf I hope you can get something out of it.

I seem to recall a rather heated discussion here at the City a few years ago regarding this very thing. In fact, it may have been this very case but my old brain fails me currently. The general consensus of City dwellers was to never transport your pt. face down (prone position). I happen to subscribe to this theory. I'm not a huge fan of handcuffing the pt.'s hands behind their back either. Securing them to the stretcher or LSB by any other method ie: cloth restraints, hand cuffed to the board but in the supine position etc. Hey, how about a little Haldol? Regardless of the outcome of the lawsuit, this is an example of how NOT to transport combative patient's. Let it be an lesson to all.

Ruff, NC does not require NR. The reciprocity process is fairly uncomplicated. SC does require registry, however, according to their website, if you can get sponsorship from a EMS service there, you can get an SC license but must obtain NR within a year. Here are a few links to aid you. http://www.ncdhhs.gov/dhsr/EMS/resopros.htm http://www.scdhec.gov/health/ems/ReciprocityGuidelines.pdf Good luck Micheal. Keep you chin up friend. Jake

While not being there and admittedly unfamiliar with Abbott EMS, I would consider using restraints and possibly chemical sedation prior to getting into a physical confrontation with a pt. I've had seizure pt's before who have been combative. That is why we have standing orders for 2mg Valium IV or 5mg Versed IM if IV can not be established (we can give Versed IV also, but stated IM prior to the expected feedback). I know the article says the pt. wasn't responding to chemical sedation. I have found that securing the pt. with cloth restraint's ( although I don't know how effective they would have been with this pt.) or those ziplock handcuff thingys the cops have to secure the pt. to a backboard have been effective. I won't stand in judgment of the EMS provider in the article. I'm just saying there may have been other methods of restraint before fighting with the pt., especially with LEO's on scene.

Ha! Yeah Jeff, I knew you'd take it in the spirit it was intended!

Sort of an oxymoron don't you think? Almost like Army Intelligence.

Gotcha. Yeah, as long as you(generic you)are in control of the scene and the additional help who have arrived is kept at a distance, I am in agreement.

Anthony, are you saying you don't usually do a 12 Lead ECG in the person's residence before placing them in your ambulance? If we are dispatched to a CP call, we have made it a practice to bring in the ALS bag, O2 and the monitor. I would expect in L.A. there are always ample FF's to carry your equipment out.

Agreed. There is no substitute for a written narrative. Auto-generated narratives cannot possibly descibe the scene, the way the pt. presented, how they responded to treatment etc.

Just curious Herbie, we have the Zoll "Rescue Net" programme for our ePCR's. While obviously not the best programme on the market, the number one thing I like about it is the ability to write my own narrative. I was just wondering if the programme you use has that feature or is it a computer generated narrative. To the OP, I use the CHART method of writing a narrative. I just find it more comfortable for me. Which ever method you choose to use is fine as long as all pertinent information is included in it. Good advice from the other forum members!