AnthonyM83

I think every EMS employee should receive that training. Definitely take it. Read your text before the class, so you have more context to understand everything they say in class and so you know what to do during the scenarios (not everything can be covered in class)

That night time thing was added later on, right? If chopper's not going to be able to transport, then you transporting takes precedence over getting ALS there. They can intercept us or whatever they'd like (could be useful for IVs to maintain permissive hypotension at a reasonable pressure?), but priority is fastest transport time by whatever level provider.

I can't say if it was the head tilt / chin lift, since I don't know how he was acting before and immediately after or even what the doctors said caused his death (something that could be caused by moving neck on a trauma?) or if there's other unspoken issues about why you think you might have been at fault..... BUT when it comes down to it, the mom was responsible for the baby's death. She committed the brutal crime and you came upon a situation that was realistically too far gone to fix no matter what you had done. That's the kind of situations you get with EMS. Don't displace that blame from her onto yourself and carry a burden you don't need to carry. ALSO, be aware that the episode probably affected/imprinted on you more because of your young age and being right out of EMT school, and while you've grown older with more experience, it still "got in" and is affecting you like it did back then. And yeah, visiting the grave might help...but probably once you're ready for closure...not sure if you are yet. PS, what's a "dh"?

This one's simple: Employee terminated for being unable to fulfill critical requirements of job. A police officer who's religion prevents him from shooting someone is unable to fulfill job critical requirements of job. It does not relate to image or other company-specific policy...it relates to basic requirements of job.

Reply: "I'm sorry. Unable to obtain due to limited personnel. If we stop CPR to check, his BP, pulse rate, respirations would all be zero, and we'd be liable for withholding CPR just to check that. Do you disagree?"

So, he never replied to me, did he . . . He seemed pretty adamant about what he was saying...

Right on!

FD: Hey, stop screwing around like a baby! You can move your arm. Do you want to go or not? No? You're going, anyway, we're here. -Guys, just load him up, BLS. We're going with general malaise.

I'm not sure if I missed something that's making this more complicated. If there's faster air transport (original scenario): Wait for air transport. If there's no air transport (added by AK): Immediate ground transport. What else? Leave him there indefinitely? Take off on ground just so you're technically transporting? Yeah, right. The only thing we have to decide on is: If waiting for air transport, do you wait until helicopter is nearby to remove object so patient packaging is finished as chopper is landing? Or you remove the object 20-30 minutes earlier, then continue to wait? I said wait off a bit, so if bleeding cannot be completely controlled, bleeding time is reduced (if it's totally uncontrollable, then he dies either way). If heat cannot be controlled, then that would take priority. Tourniquets either way, in case he IS bleeding out under the object.

All that transport theory doesn't matter, though, because transport wasn't yet available. Removing or not removing the object can't be based on transport, because your transport (the helicopter in original scenario) isn't there, yet. You still wouldn't be transporting if you freed him. Like I said, you're waiting for the chopper for transport, not for ALS. (Your only argument could be that you were going to intercept, but scenario didn't really tell us what direction they were coming from in relation to hospital and landing zones, etc.)

Actually, you just need to get your EMT cert in one county and that will make you certified to practice in any county in the state (just be careful if you live by county borders, know the differences in protocols). But like Dust said, there's no state certification/licensing.

That was very educational for me. That's kind of stuff I like learning about. I can make my flashcards and lookup the indications, contraindications, and mechanism of action online, but understanding the theory and process of how it works is what I'm really looking for.

We don't. I've never seen a protocol/procedure in the manual on removing or not or making decision to remove or not or anything similar. You'll tell the doctor we thought there was risk of exsanguination , so didn't remove it until we were ready to leave. I partially being swayed to removing him because of the cold factor if you can't keep him warm...but the above is what you would tell the doc (though I imagine even if object removed, circulation would not be regained...aka metabolic waste build up continues but at risk of further bleeding.

LOL I added that one myself RVR?

Transport

Pay for one of the hypnosis stop smoking programs (with a hypnotherapist, not a tape). Countless people have stopped that way. Usually people put it off as a last resort, but it ends up being the most effective. Usually takes one day.

I was told to save all abnormal emesis once...never do...

Is there that much of a distinction (for purposes of our decision making) between an actual air ambulance and a charter helicopter with ALS crew? Either way it seems like "air support" to me... I'm using them mainly for transport time, not primarily for ALS anyway. If I'm wrong, I welcome more info on difference (as it related to this scenario of course).

Did you see the movie, "There Will Be Blood"?

AK, I thought you were the one who added no air support into the scenario. We keep discussing air ambulance, because that consideration was part of the original scenario. Nearest hospital 2 hours by land. Nearest trauma center 3 1/2. I think most those who said to wait for ALS did so based on original premise that ALS chopper is 50 minutes out. After, the no-air support part was added, then I said, load and go. If ALS is on its way and it seems that his legs are crushed (based on ground hardness, equipment that fell on him, etc), I would hold off the 50 minutes. It's - 35, so I would imagine compartment syndrome would be slowed down. I would closely monitor for shock and would consider tourniquets if shock symptoms progressed. He could be bleeding out from injuries above where the object same to final rest.

Great one I was going to say smell breath, until we got the blood sugar. But smell the pee!!! I'll remember that on my next ALOC call...sniff sniff

equal grips? equal pupils? Describe the sz. Tx with whatever your local meds are...ex valium. Narcan? (yeah, not great assessment tool...esp after valium)

Is it well-water? Boiled?

Glad SOMEONE has an interest . . . after the freaking gigs and gigs of worth of discussions on EMS education and scope and advancement.

PD can cancel the request for EMS prior to our arrival, but once on-scene FD checks in with patients to make sure they don't have a complaint. Our ambulance itself can ONLY be canceled by FD, either on-scene or their dispatch calls our dispatch. I remember our EMT instructor telling us a story of an abandonment case (not sure if won or lost) where PD called FD for unconscious on park bench. As FD is rolling up, PD waves them away, "It's okay guys, he's just drunk." Pt ended up having some medical issue and FD got in trouble for it.