paramedicmike

PR: If this were you and me on a truck I'd take it. Blood loss, a rate in the 70s, some BP changes on position all post dialysis would have me just slightly concerned. Even if this were a larger patient I'd still be concerned with the blood loss and lack of a tachy rhythm. Did I miss it? You mentioned a complete treatment. How long was she hooked up? And do I really have to guess with whom you were working on this call? I can guess, you know. In fact, I have a pretty good idea of who it might've been. And let me guess further, she had you take it. -be safe.

Why say any more than this??? Edit: If nothing else, stop threatening suspensions. This turns into the boy who cried wolf. If you're going to threaten it, make good on the threat. Otherwise, find a new job. Others below this post have made some excellent points. But I'm still on board with CHBARE on this one. -be safe.

Agreed, AZCEP. It's only going to take that one "undertriaged" patient who didn't get a helicopter ride when s/he really needed it to bring this crashing down (no pun intended) in a massive, flaming civil suit. I think another possibility that was not mentioned as to why so many patients are flown goes back to ER docs themselves. Speaking only for my current area of employment, many of the local ER docs "refuse" patients who might otherwise be appropriate for a local community hospital. Local medics and EMTs have gotten into the habit of calling the local doc, presenting a scenario only to have the local doc say they can't handle the patient and to refer to a trauma center. That brings in the helicopter. (I use the term "refuse" very loosely. The docs aren't saying "no" per se. They always fall back to the "this patient needs a trauma center" line and thereby wash their hands of further care.) Now, if, in most of these cases, the medics didn't cater to the local ER docs and just showed up with the patient, the patient would be cleared and sent home. If it turned out the patient really needed a trauma center, stabilization of injuries by the local ER could be completed then the patient could be transferred out. I realize and have seen first hand how HEMS has been overused and abused. But until they give us X-ray eyes I think it may be better to err on the side of caution on behalf of the patient. I'd rather fly someone who turns out not to have needed it than not fly someone only to have them die from unseen injuries. -be safe.

Oh no! There really is 250 feet of flight line. You just can't move it is all!

But wait a minute...didn't you say this earlier? So, which is it there, sparky? Do you have all these trauma centers close by or are you out in the boonies? You've just contradicted yourself. -be safe.

The Princess Bride. "Ah yes. A bear in his natural habitat...a Studebaker."

Yeah...but Jersey's just....shall we say...."special"!

Don't take an actual "sit at a desk with other people and listen to a lecture" course. Take it online. You can do it through the National Fire Academy. Follow this link to help you: http://www.usfa.dhs.gov/training/nfa/independent/ It'll give you the same training and certificate at the end. Plus it'll meet the Federal requirements to keep your employer/squad in compliance. Even more, it'll keep you from sleeping through what was otherwise a waste of time lecture. Seriously, do it online. You won't be sorry. But you will be if you sit through the class! Good luck. -be safe.

who screamed ecstatically

Hmmmmm...it's a possibility!

Easy everyone. For once this can be considered a valid question. Yes, it is true. The first was how they paid overtime. Then was how they resolved the overtime issue. The second was a claim of insider trading and having access to bids for service with the intent of underbidding the competition. The simple answer is I *DON'T* work there anymore. I quit and moved on to a much better opportunity. The not so simple answer is...well...not so simple. With that said, there is something to be said for PRPG's comment regarding being an adult. Sometimes the responsibility of taking care of my self with regards to having housing, food to eat etc...has to be considered. I will tell you, though, that once all this went down I started to look for a new job. I wasn't any more comfortable working for this guy than I was being in the same room with him. But sometimes you gotta do things or tolerate things you'd rather not. From my perspective, I wasn't compromising any of my principles by staying there. I wasn't doing anything wrong, immoral or illegal. My standing among my coworkers and patients was not affected. I was working to try and resolve the illegal practices taking place. And besides, I had a job to do. I could ignore the boss. I couldn't ignore my responsibilities. Does this answer your question? -be safe.

I'll second AZCEP's suggestion of a PDA. I use a Palm and it works very well. I don't currently have the cell phone/PDA that AZCEP mentions. However, it's something that I'm looking into as there is an awful lot to be said for consolidation of some electronic equipment. Yes, it's a little more costly. But I agree that you'll be better served in the long run. Good luck! -be safe.

I've heard that a partially inflated cuff will help. I didn't think to try it the last time. But it'll definitely be something to keep in mind the next time around. I heard somewhere, too, that the manufacturers don't recommend insertion like that. But I haven't seen it in print yet so I don't know for sure. But if it works and I don't flip the tip around I'm happy. Thanks for the reinforcement of that tip!!! Nice to know it's worked for others out there. -be safe.

I told the boss that he was breaking the law in several areas, presented evidence of said infractions, then almost lost my job because of it. The good news is that he changed the practices so as not to violate those particular laws. The bad news is that he just arranged it so he broke the same laws in a different way (harder to detect) and threatened me that if I ever spoke up again I'd get fired for my trouble and sense of fair play. That and our employee rep told me to keep quiet about it because it would affect other jobs within the municipality. You know one of the biggest problems in EMS today? Managers. Especially overzealous managers, and wanna bes who think they need a soapbox. Otherwise, I echo AZCEP's words. GA, you need to lighten up. You've come into this sight as a whirlwind of arrogance and self importance. Maybe if you slowed down a bit you might see things for how they really are. AZCEP is a leader. He's also got a pretty funny sarcastic streak, too. -be safe.

Ummm...so if you have that many trauma centers that close why do you bother putting a helicopter on standby? There's no need for it. Especially if you decide to wait until you've done an assessment before requesting a fly. If you do that now you have to wait for the helicopter to take off, get to you, land, complete their assessment, load, take off and fly to the hospital. Congratulations! You've just wasted an unacceptable amount of time when you could otherwise have already been en route to, and possibly have arrived at one of those trauma centers before the helicopter would have even landed at the scene. Your situation isn't limited to Oregon. I've seen it other places, too. In Maryland where this call originally took place (and where I used to work). In Pennsylvania where I currently work. In Virginia and West Virginia, too. I'm not quite sure why people wait so long but for some odd reason they do. The only time this might be acceptable practice in an urban area is during rush hour where traffic is so bad that even a trauma center three miles away would take you an hour to get to. But there are only a handful of places in the country where that might be a consideration. Otherwise, thanks for raising an important issue with regards to HEMS. -be safe.

I can't speak for anyone else, but the proposed revision of PA's protocols suck. It will, in fact, be a step up for some and a step back for others. What's worse, as was noted, each region will have to decide to adopt them so the idea of COMMONWEALTH (PA's not a state ) wide protocols is really a non issue. And if one particular region decides they don't want it then that pretty much kills the idea of consistent care across the Commonwealth. (And several regions reportedly have already said they won't adopt them.) Dust, be glad you don't live in the NE. (Except for Maine. From people I've spoken with Maine seems to be ok.) But back to the issue at hand. My full time job uses the LMA as a back up (yes, in PA...but it's with a flight service). I used it in the field for the first time recently on what turned out to be a difficult airway. It was easily placed and worked well. In fact, it saved this guy from coding on me! :shock: (He was not a fun patient.) My biggest problem with the LMA is that the tips can fold back on insertion. I've had this happen a couple of times in the OR. I'm not quite sure if it's something I'm doing or not. I've worked with a couple CRNAs and anesthesiologists on this problem and they've all said it's not my technique. Maybe, as Spock noted, I'm just a slow learner and need to drop a few more to work the bugs out. The two ground services for whom I work use the combitube. I've never had to use a combitube in the field. I've played with it on mannequins but that's it. So I can't speak with any kind of authority on how well it actually works. For what it's worth, hope this helps. -be safe.

got nailed by

My sister married a Canuck. But that's ok. We love her anyway. (And he's a good guy, too!) -be safe.

First you said, Then you said: Now finally, this: It works fine to call it that because that's what you're doing. So you're not doing the c-spine clearance after all (not that it's a surprise to us)! It's the doc who's doing it. And suddenly now no mention of any kind of radiographical study? What happened to the need to wait on a board for a CT? Or, as Rid pointed out, the more appropriate x-ray? And then there's this little gem: You mean by exhibiting qualities like honesty, integrity and accountability for our actions? I agree we need these qualities just as much as the rest of the medical profession. Too bad you're having a hard time following them yourself. Please, stop digging this hole for yourself. It's only getting deeper. -be safe.

You tell us! We don't know you from Adam. You might make it up to sound important. You might make it up because you're not smart enough to know any better. But what's worse, you *did* make it up and now you're being called on your false information (because Herbie, who initially called you on it, and I know better). I'll let you in on a little secret though. The PA BLS protocols are available with a five second google search! :shock: You have internet access to get here. It stands to reason you'd have it for that, too. This bugs me. Only the hospital will call it a level one or level two trauma. As far as EMS in PA (or anywhere else for that matter) is concerned it's a Class one or two trauma alert/transport or a class three patient (or insert your priority listing there). Designation of a trauma "level" doesn't take place in the field. Tell the hospital what you have and let them decide their response. How long have you ever had a patient wait to come off a board? What is what so hard to believe? That you do c-spine clearance in the field? It's hard to believe because you don't do it! Read on... Every patient we come across does not need spinal immobilization. That's why we practice selective spinal immobilization. We conduct our complete assessment and then determine based on our findings if that patient needs to be immobilized. You said you cleared c-spine in the field. I'm telling you that you do NOT clear c-spine in the field. As Ridryder pointed out only the doc can clear a c-spine after his/her exam. Care to cite an example? Bet you can't do that either! I suggest you follow Ace's suggestion and search the forums for this particular topic. What you find will astound you. :shock: Also, as you are finding out, this is a pretty rough crowd that demands excellence among all participants. We expect that if you post something you have the ability to back it up. When you fail to do so you're called on it. Basic high school writing teaches that if you claim something you'd better cite a source. If you haven't been to high school yet that would be one thing. But I'm inclined to think you've already been down that road. And one last little piece of advice. When you realize you're in a hole you can do one of two things. You can keep digging or you can put the shovel down and step out of the hole. I suggest you follow the latter of the two. -be safe.

You are not clearing C-spine. What you're doing is called selective spinal immobilization. There is a difference between the two. If you don't know what that is there have been some excellent discussions on this forum about that very topic. ...to what? Did you mean to add another thought there? But wait, in your previous post you said: So which is it? Does the trauma team remove the patient from the backboard to conduct their assessment? Or does the patient stay on the backboard from an unknown amount of time while waiting in a mysterious line for a CAT scan? It seems that you've completely flip flopped your position. Can you please pick one and clarify your stance? Thanks -be safe.

You can? Not the PA in which I live and work. Care to reference your source? And please don't say PA BLS protocols...I'm looking for specifics here. Can you please post these guidelines for us to see? Not in any hospital in three states to which I've transported patients. They'll get there, the doc will do his assessment. While the collar may stay, the patient is removed from the LSB fairly quickly. Sometimes I can even take the same board back with me before I leave the ER. So, please enlighten us as to the source of your information. Please post that information here. Herbie's called you on it. I'm calling you on it. There are several other PA providers here who may just do the same. -be safe.

SHAMELESS PLUG ALERT! SHAMELESS PLUG ALERT!!! Oh come on! You knew I had to give you a hard time about it!

I hope you had these boneheads brought up on charges. At the very least it's assault. At best it's attempted murder as chances are you would've died had you not been taken to the ER. That's just outright moronic! WTF were they thinking? Glad you're ok. -be safe.

I think I see what you're saying. But let me make sure so I don't go and mess anything up down the road. What I think you're saying is that so long as the intent of their action was good then it's ok to proceed. So if they gave something obscene like 5mg of fentanyl for sedation to keep the patient's mind off the heat, humidity, trouble breathing, pain, or whatever, but not to kill them, then it's ok. Even if the patient "accidentally" wound up dead because we all know that respiratory depression is a side effect of that much of the drug. But if they specifically went out with the intent to terminate the life of the patient by administering that much fentanyl (or morphine or whatever) then it's not ok and should be punished. Am I reading you correctly? If not, let me know. Just trying to get a better handle on your line of thinking. And again, I'm not agreeing or disagreeing with anyone on this. There's more information to this story that none of us have. I'm withholding a decision on a position until all the facts come to light and we're able to better assess what went on in such dire circumstances. -be safe.