island emt

Since it doesn't appear the wreckers are there to remove the vehicles and the FF's seem to have spread the kitty litter and done what needs to be done , pt's are packaged and transported. NO Problem at all. Whats the big deal. I think it is a very nice gesture for the neighbors to provide a cool drink and a snack for a job well done. Are your panties in a bunch because you were not offered to partake?

I guess that you have a degree in psychology or psychiatry that qualifies you to make those determinations??? Just because he is alleged to have jumped out of a vehicle by someone else means little in the present time. It is alleged to have happened two days earlier. In legal terms I believe that would be called hearsay . You need to make an evaluation of the Pt's current condition and evaluate based on what YOU see , hear and intuit from your questioning of the PT. He is not under protective custody or court order for eval, To force him against his wishes would be a big mistake on your part. If the Facility DR wants him evaluated then arrange for it to happen without placing the EMS crew in the middle of a legal conundrum that could potentially bite them in the arse. If you transport under a mental health professionals orders against a competent Pt's wishes then you are placing your service at risk. Without a bluepaper order from the court or protective custody from law enforcement we cannot force them to go. Yes I have transported folks that are making threats to harm themselves or others by using the law enforcement option of the law. They are taking the Pt into their protective custody, and offering them the opportunity to ride in comfort with us or handcuffed in the back of the cruiser. Sometimes they are handcuffed on the stretcher if the threat is serious enough, and the officer rides in with us.

Trevor: in a lot of places in the states there are 911 services provided by a sole provider while non emergent transfers are handled by multiple private services. A hospice pt transfer under most guidelines is not an emergent call. Our hospice programs prefers they not go to the emergency room unless their are issues outside the guidelines set up when the pt enters the program. Most care is provided by visiting nurses , care assistants, physical therapists and counselors at home.

Have I accepted a free coffee or other cold drink ? Hell YES. I've even come home and found a peck of freshly dug clams or some lobsters sitting in a cooler with a thank you note from a family member of my patients that we took care of. I neither asked for or expected them . At a former job we saved a gent from the Lions club who arrested whie he was working their food booth at a large venue. We usually bought meals from them . After the call we came back to work and found the other Lions club members very greatfull of our work in saving their member. For the next several days we could not stop them from suppling the entire crew of 40 with food. MMMMM fresh barbecue. They called it" leftovers" when they walked into the care center with a big tray full of sandwiches. Was it wrong to accept it from them as thanks? Or would it have seemed to be obnoxious to deny their wishes?

I'm with all of the above providers. If he's competent and not making threats to himself or others today, then have a great day and let someone else figure out how to get him a psyche exam. Way back in chapter 1 of the EMT Basic course book is the section of legal issues and definitions of assault & battery. To lay hands on him against his will and forcibly remove him from the nursing home is wrong and illegal. I will get you and your company brought up on charges. we can try to ask them or reason with them to allow transport. But unless they are blue papered by the court, then they have the right to refuse any care or treatment. PERIOD.

Always take a reading manually, then put the NIBP on for transport. It will take a reading Q-5 or whatever parameter you set. Allows you to get your other assessments / treatments and skills done. If you all of a sudden get an OFF reading then don't trust it without verifying manually.

Both the Zoll M series and Lifpack will get an accurate reading while moving if the tube is not flopping around. The Hospital service just got a new LP15 with the coiled hose and it has has a hard time with accuracy while bouncing down our roads.

dwayne: what you might have done or not done while working in a foreign country is different . You still had rules to follow , but were operating under a different type of ROE. when I worked at a private gig the rules were different than what is the normal outside the gate. The DR's we worked for allowed different things for different providers. Yes we have all made a conscious decision to push the limits of the law. It's how willing were we to take the consequences?

Welcome to the city from a really old timer. {started back in 71] The group here has a lot of different exposure to prehospital care from all over the world. Some are working in the ghettos of big cities and others are in places that are so rural as to be called desolate . Come on in and pull up a chair.

OK Wendy here's a challenge for you. Why don't you give a short lecture /training on Autonomic dysreflexia. Defib that was a pretty good scenario to make folks think.

AHHH the Empire strikes back

I was overlooking all the widow dressing such as barking dog ,newly mowed lawn hedges need trimming, etc. The weapons out in plain view are still a red flag to me. You don't forget the sound of high velocity lead hitting the walls a foot over your head , EVER. The redneck riviera scenario re-enforced the perception of possible dangers on entering the scene. It wasn't until the end that you gave the thoracic spinal injury and cause. Good on you Wendy!

So he takes a low dose ASA for heart health. Viagra for ED and L-arginine for ??? L-arginine is used for heart and blood vessel conditions including congestive heart failure (CHF), chest pain, high blood pressure, and coronary artery disease. L-arginine is also used for recurrent pain in the legs due to blocked arteries (intermittent claudication), decreased mental capacity in the elderly (senile dementia), erectile dysfunction (ED), and male infertility. Some people use L-arginine for preventing the common cold, improving kidney function after a kidney transplant, high blood pressure during pregnancy (pre-eclampsia), improving athletic performance, boosting the immune system, and preventing inflammation of the digestive tract in premature infants. L-arginine is used in combination with a number of over-the-counter and prescriptionmedications for various conditions. For example, L-arginine is used along with ibuprofenfor migraineheadaches; with conventional chemotherapy drugs for treating breast cancer; with other amino acids for treating weight loss in people with AIDS; and with fish oil and other supplements for reducing infections, improving wound healing, and shortening recovery time after surgery. Some people apply L-arginine to the skin to speed wound healing and for increasing blood flow to cold hands and feet, especially in people with diabetes. It is also used as a cream for sexual problems in both men and women. How does it work? L-arginine is converted in the body into a chemical called nitric oxide. Nitric oxide causes blood vessels to open wider for improved blood flow. L-arginine also stimulates the release of growth hormone, insulin, and other substances in the body. Lets start with a little more hx of events leading up to tonights call. What started the problem? How long has he had the blotching / rashes? what percentage of Body surface? What health problems besides the amputation? Is he septic from recent surgery to limb? My brain says he probably took something else that is interacting with his viagra & the ETOH. How is he presenting chest pain SOB? Radiating? !2 lead shows? Lung sounds by auscultation? No pain meds prescribed for amputation? No anti depressants? No beta blockers ? No statins? Next up!

The woman was pulled from her semi submerged car by bystanders and police officers before the PFD arrived on scene. they did arrive to package and treat her injuries prior to the PFD Medcu ambulance arriving on scene. Not knocking the Fire folks in Portland at all: just the facts. They are 25 miles across Casco bay from us by water & 60 miles by land.

Early on in my career we were called to a third floor walk up railcar type apartment for a stabbing. It was located in the lower end of Holyoke Mass in what would be called a ghetto by most. PD was on scene and advised scene was safe and for us to come up. After toting our gear up 3 storied we entered through the kitchen door and started down the hallway towards the living room where the pt was lying on the floor. About halfway down the hallway a door at the end opened up & out popped the assailant with a tech 9 in his hands. As we turned to run the cop who was leading us in starting running and knocked my partner & I both over as he ran to clear the hallway. Shortly after the sound of a full auto 9mm was heard and bullets were spraying the walls & ceiling over our heads as we crawled into the kitchen. So much for PD clearing the scene. Luckily for us the drug dealer with the tech 9 was a lousy shot and emptied his magazine into the apt instead of us. The cops shot him and now we have two critical pt's and two scared shitless EMT's. Pt # 1 has a 8 inch kitchen knife sticking out of his chest and pt # 2 has four GSW's to the chest & abdomen. In the end both of them died by the time we got to the emergency room . Could have been us and the cops. That call made a believer out of me and even if law enforcement is on scene, I still trust my spidey sense of where I'm going to take a risk. Defibs call send my spidey sense running in the opposite direction for the moment.

systemet: Doesn't matter what his training is. In most states there is an established scope of practice , which is what we all have to follow. These rules are determined by a medical review committee at the state level and to venture outside of them puts your license to practice at risk. In this case the medic knowingly went outside the rules and knew he was doing so as witnessed by others on scene. He stated he was putting his license at risk according to the article & witness statements. Then he basically ignored the ER doctors repeated request to transport immediately to the ER a short distance away. This is a blatant failure to operate under the license parameters of his scope of practice. If the DR had advised him to do the procedure , then he might have a leg to stand on , as the battle would be between the state & the DR. for giving him those orders. Yes the pt may have been critically injured and to the best of the medics knowledge & judgement needed the pariocardicentesis done to relieve pressure on the heart. It doesn't matter if he was right or wrong on his diagnosis, what matters is the foray outside of protocols. Knowledge of a medical procedure can only go so far , before you cross over the line of whats legal for you to do. I truly believe the medic in question felt it was the correct thing to do and was willing to take the risk of both his license and his career in an attempt to save the patients life. After looking at the map: they were within 150 yards of the emergency room door. edit for spelling correction.

Lots of red flags here in that paragraph! From your description of the scene, you have just been dispatched to the redneck riviera I'm surprised there's not a stars & bars flag flying also. When the wife answers the door, What is her demeanor? Is she sober and clear headed , just worried about her man? Did she look you straight in the eyes when telling you her story? Weapons out in the open including a HUGE handgun and an assault rifle leaning against the wall would have stopped me right there. the reading material is another big red flag. Time to go back out to the truck and wait for the police to make contact. Stay behind your tuck out of sight of the home. Once the law shows up , clue them in to what you observed from the door and let them call you in when scene is secure. Once entry is made run your chest pain protocol: I'll stop here and let others play for a bit

2 Things will do him in. Operating outside the allowed Paramedic scope of practice Not acknowledging the DR's order to transport immediately to the nearby hospital ER where the procedure , if needed could be preformed by a licensed MD. Those two items are enough to deny relicensing in most states.

Maybe she just wanted to get to know you Mike. :-}

Like Chris said above: the older you get and watch folks your age start to go to meet their maker, then it becomes more personal. I never used to think about it much and have always managed to work through the bad calls. In the past year have lost several friends my age or younger and it makes ya wonder!

Your a lucky man Bieber: We rarely get the equipment out of the storage locker that has been cleaned or deconned. I've seen backboards coated with dried blood standing in the rack waiting to be retrieved by the services. They used to have a rubbermaid shed outside the ER doors that was so grossly disgusting as to make you wonder if you wanted to re-claim anything stuffed in there.. Certainly not without gloves and maybe a gown.

Sounds to me like there is a supervisor with WAAAY too much time on their hands writing stupid policies. OR the company is to cheap to have more than one of these items available for each truck. thats what happens when you have the bare minimum of equipment. Unless there is a high theft rate of said equipment in your area , then the hospitals need to have a more secure equipment storage area.

We are talking about the EVIL EMPIRE here. They will do whatever they wish and if the bean counters decide they aren't making enough profit just walk away, contract or not. They tend to want to keep the "HELP" under their thumb and don't really care about the well being of the employees. Lincoln freed the slave in 1864 unless they work for the empire.

I'm guessing that their thinking is in emergency situations it's better to get them breathing on their own" NOW" , & worry about the after effects when they get to the hospital. Without an understanding of the physiology behind opioid abuse then nasal narcan is a quick easy fix that even a layperson can try. If it doesn't work then they have to go back to the cookbook for arrest situations. Another assumption is that they are having a severe increase in opiate OD's that could be potentially reversed by first responders.

It is much more useful in areas with a high incidence of opioid abuse. these can include heroin or prescription derivatives or synthetic opoids. A few years ago there was rampant street abuse of the OXY family of prescription drugs. We were using a lot of narcan on a regular basis. Then the street availability of heroin became easy & cheap. Had an arrest call this year that was of unknown cause: 30 something just collapsed while eating a bagel. on arrival agonal resp and weak thready barely palpable carotid pulse @ 25 . cpr had been attempted prior to our arrival at the dock where pt was on a fishing boat . Only info we got from family present was asthma and allergic reaction to some kind of seeds. Worked CPR, ventilations with bvm showed irreg brady rythym on monitor. Every time compressions were stopped the pulse dropped off . Breathing was 3-4 & shallow. IV , epi given thinking anaphalaxis due to history given by family. While enroute to hospital nothing seemed to make sense as to the WHY. checked for track marks. checked pockets for drugs or evidence of pharaphenalia . nothing found Blood glucose normal . On a WAG we gave Narcan. two minutes later eyes opened , breathing normal @ 12-14, pulse irreg @ 60. confused as hell and still working off the prolonged effects of hypoxia. Come to find out pt had been spreading fentanyl patch gel on his bagel and having a really good breakfast snack. It never fails to amaze me the extent that some will go to to get high. Where he got the patches from remains a mystery. When in doubt give vitamin "N" One word of advice to those new to it. Don't give the max allowed dose at the beginning. titrate the effect to keep them breathing on their own and try not to completely reverse the high. Nothing worse than a wide awake addict who you just ruined their high. they tend to get violent or turn on the power chum machine. neither of which are good in the back of the bus.