AnthonyM83

Okay, so got into a pickle at work. One of the rules is that you report any vehicle contacts (like bumping into another car). Any at-fault accident gets you fired, even if minor minor damage (don't know another job like that). Lost best EMT I knew of at the company last month because he let the brake slip while stopped at a light and tapped the car in front of him. I love patient care, so I'm in the back almost exclusively. Yesterday, decided to be "driver" to switch things up a bit. I scraped the sidewalk curb at some point in the day. Didn't even think twice, no big bump or anything. Next morning (it's 24 hour shifts), the new shift points out a TINY dent in the outside of the tire rim. I could have said I had no idea where it came from, but I volunteered it might have been from bumping a curb yesterday. They mark it on their daily vehicle checkout sheet. Usually those sheets are never reviewed. Today the supervisor did. Reported it to management. Got a call later that day (yesterday) from a manager saying he was placing me on suspension for failing to report a vehicle contact. Said an investigation would have to be done. And I should come down to the office on Monday (next business day) to talk. I'm feeling pretty anxious about this. There's a good chance I could be let go, especially if they feel I was trying to cover up damage. I feel like honesty is one of my best traits and have always stayed out of trouble by always being honest. Even in HS when kids were trying to finish HW in class, I'd just tell the teacher at the beginning that I hadn't done it and would get extra days for honesty. I don't know if the firing decision will have been made already when I go in to talk to them or not (usually they have us fill out incident reports for these things first), but I'm not great with explaining myself on the spot. I'll take responsibility for having bad judgment on not reporting the dent...but might be too late. Any outside observer views on my situation? Maybe any other supervisors or managers out there with feedback? Except for getting PCR's kicked back I don't really have a bad history with them. No attitude type things. Thoughts? Thanks guys

Indirectly they are, as at least one of them will be in attendance.

Who would be the contact person if someone from the public wanted to give an opinion on the issue?

I'm curious as to the exact episode of trouble breathing. There has been correlation with transient breathing or gagging episode in very young children and sudden death afterwards... not that every provider would know that and be thinking that, though...

As far as I know, no. Just some alternative I thought of. I could go from reclined in gurney to out the doors in under 2 seconds. If it took a little longer to get out of the seatbelt, that'd be good "pull over the ambulance" time. And it wouldn't be quite as insulting/humiliating to willing psych patients.

Dust, a lot of these psych transfers we get are from ER's to psych hospitals. PD isn't involved at that point. It's left to private businesses (hospitals), who as part of their business, contract out transportation arrangements (private ambulance companies who accept this business). Though interfacility transports are more profitable here, I bet many companies would prefer to make all their money with 911 only. It'd be pretty much impossible to stay afloat and still be a strong company without IFTs. Thus, the psych transfers. Some of these patients are 100% passive and cooperative. In the system I work in, one must have a good reason to restrain (in the health department's eyes). If they're cooperative all around, that's why medics don't restrain them. For the high number of psych transfers done, very few cause problems. But there are a high number overall, so we keep hearing the stories of transports gone wrong. There's also a bit un-PC about restraining every single psych transfer, especially the A/O3 who seem completely grateful to be getting the help they need, then being treated like prisoners. One alternative method might be a partial restraint system. Gurney seat belts that require a key to unlock. The patient could still slip out of them, but it couldn't be done in a split second. This would allow the ambulance time to pull over and eliminate the 65 MPH factor. Dust, in response to some of the questions posted, as IFT ambulances we end up being part of the health system's transportation system.

Do you really know your EMS history? … Dr. Walter S. Graf, founder of the Daniel Freeman Paramedic Program, will be honored at the inaugural “Lifetime Achievement Award Ceremony” in Los Angeles on May 8, 2010, as one of the pioneers of paramedicine in the United States. The other honorees are fellow visionary paramedic program founders Dr. Eugene Nagel from Florida, Dr. Leonard Cobb from Washington, and Dr. John Michael Criley from Los Angeles. The County of Los Angeles Fire Museum Board of Directors is helping make possible this event to help fund the video that will memorialize their stories and historic contributions not only for our generation but for future ones. You can help support this historic event by attending the gala dinner and fundraiser. Mr. Randolph Mantooth, “JOHNNY GAGE” from television’s “Emergency!” will be the Master of Ceremonies. For more information visit: www.pioneersofparamedicine.org.

We do refer to it as an ambulance around here. We call it a rig most of the time, but if you're doing a radio report, one's more likely to use the word ambulance. There's no way this was an actual call-in, though. IF ANYTHING, it might be a chief doing a separate secondary call-in to the hospital. But I kind of doubt that, too. The actual call-in would be very easy to find. It's on record.

Not even close to how they'd answer the phone, how the medic would reply, and how he would start off his report, or how he would give his report, including speed. Also, don't hear any sirens in the background (guess they could have still been parked on-scene...but with the commotion going on outside the ambulance, I'd think they'd want to get out of there). And while LA does give super detailed reports (supposedly because they don't trust the medics, with good reason for most) to the point that it'd detrimental to the patient because you're waiting on-scene, if the report was actually 3-minutes, it would be rapid fire talking from both ends. Maybe this was a report given by someone else on-scene to a specific doctor rather than the official call-in, though doubt that too. There's no background noise whatsoever...whether in ambulance or outside, based on the video, there should be a lot of it. The phrases used...just wouldn't be used in a base report. AND there's one easy way to confirm. Just pull the tapes of the actual call-in...which I imagine would have already been done...

Wow, it's kind of embarrassing as a citizen that they'd be giving the fire department grief over this. They work 24-72 shifts sometimes. Give them some time to grab some food, get a little fresh air, and interact with the community. Growing up we always saw the fire truck outside the supermarket and everyone loved it. Kids got to see the truck. Parents got to interact with the FD for a bit. They were a community presence. Also, moral goes a LONG way as to how well they service the community. Let them freaking interact with the people they're putting their lives on the line for!

I'm trying to figure out what you're getting at. What exactly was never reported to the Coroner's Office? That she had told someone about the headache? Are you saying the death was never reported or that it wasn't made a Coroner's investigation case? I don't know what "the safety authority" is and don't know what the company's safety committee handles. Are you trying to find out if a supervisor was being negligent by not calling 911 when she told him of her headache? If so, gotta be honest. If I wasn't in EMS and someone told me they had a headache, I wouldn't know what to do any better than the person telling me. In fact, I'd probably know less, since I rarely get headaches. Before I got into EMS, headache was never something I imagine one would call 911 for, so probably wouldn't encourage her to get medical attention.

That's just silly to have as a rule. I've had some good doctors that provided great CPR coaching to my trainees in the ER as they helped out with compressions. In general, rules like this are silly, as they can be made for all positions (medics about EMTs, RN's about medics, medics about RN's, RN's about MD's, etc etc)

Good replies, everyone. I've often heard of people using a towel around a person's neck when a collar won't fit (or perhaps not tolerated). How is the towel actually applied? Wrap it like a scarf? Does it stay? Does it have to be a certain length or do those smaller hospital towels work? Or is it just put laterally under the patient's neck and then rolled up on each end (in addition to the lateral head immobilization device, still, right?)?

Is it that that alcoholic energy drinks don't mix with teens, specifically? Or just alcohol in general with teens? The site just seems to be saying: Hey, btw, some energy drinks have alcohol in them. And teens drink them (probably less than other alcohol products).

So much to question about this study as it relates to changing field procedures that I can't even start... Well maybe start, yes... which kinds of collars did they use, what was their training on the collars, what positions where cadavers in, what percentage of patients have the specific types of spinal injuries that caused injuries in the lab, what was the rest of their immobilization like (head wedges, "cheese blocks", towels, none?). And yes, using a lateral head immobilization device is still standard of care. Haven't heard of a place that doesn't use them.

Thanks Kiwi...Gotten face time on a few medical TV dramas already, though.

I don't think auscultation of the abdomen is regularly practiced in EMT class, and treating it as a BLS call, that might be why that wasn't done first. Correct. Reading through the "Suggested Readings" list at the end of some prehospital care books, you'll find books that list inspection and palpation of aortic pulsations as part of the physical exam. Not that this means you should or need to, but it is something quite regular to find in most healthy people.

Do not judge an EMT class on how far the spread the EMT hours out (over a matter of weeks or months). I went to community college EMT. Two quarters. Instructors were great people. CRAP education and preparation. Cookbook to core. Waste of time spreading that out. One only studied right before the exams, anyway (or not at all and still passed), because cookbook is easy. I continuously get ride-along students from a local accelerated program here with students who have really impressed me. I can pick out the ones who went to that school. They can explain nitro in terms of basic pre-load and do basic critical thinking better than most EMTs. They know their academics and their skills. It's still basic, since it's EMT, but it's a 3-week program, and if I had to choose, I would prefer to be treated by students from that program, whether traumatic or medical (if it had to be at EMT level). This might be the exception, not the rule. But even then, recognize there are exceptions. Also, told they have much much higher NREMT pass rates. So, that's increased academics, field performance, and testing rates (whereas some only have quality in one of them). Before knowing about this program, I was against shorter programs.

Half an hour seems to be a general time when they ask us if we're still on-scene (but not always). If we didn't reply, though, I feel like it'd be another half hour until someone came by to check on us (and we're in an urban setting).

I guess it's half and half (I'm still working as an EMT, so it's never up to me), but if it's done inside the house, it's usually in a smaller room with no other family around and the rest of the firefighters step away unless critical (same privacy effect as if in a closed ambulance). Either way, there's minimal cleavage showing and IF there is some momentary exposure mid-hand movement, it's in a pretty private contained environment.

I keep hearing mention of using a towel or sheet to cover the patient while you do it. I've very rarely done this, not because I didn't care about maintaining privacy, rather it usually isn't necessary in order to keep patient covered. Do people remove the patients entire top or do you work around it? V1 and V2 are usually fine. Then V3-V6 can be easily accessed from most tops, by either lifting and/or unbuttoning. Except for split second flashes while you move the shirt around, the actual breast usually is never exposed and it's done in the ambulance with doors closed, anyway. Are we talking about draping the towel over her chest or holding it up in front of her? I feel the towel would fall off and make it harder to maneuver your hands, slowing down the whole process when breasts wouldn't be exposed in the first place. The exceptions would be when the patient is wearing a tight 1-piece, like a dress where it needs to be rolled up from knees to the chest area, then we use a sheet. But then again, this is LA, for all I know I've been doing 12-leads wrong all this time. Wouldn't be surprised.

There's no official rightness or wrongness to checking it, but one can gather much of the same information by percussing the abdomen and possibly causing less pain.

Hit me up when you settle into California. We're not that far away...

I'll have to disagree with the assessing to things we do not fully understand (as even a paramedic doesn't fully understand every finding he has). In high volume hospitals with wait times up to several hours at time, the information we present to the triage nurse can greatly influence whether patient is sent to the primary ER, the secondary ER without monitored beds, or the outside waiting room or lobby. The nurses do not have the time to perform a full assessment on each patient. It's not uncommon to have 2 codes going on at a time, STEMI patients waiting for a few minutes in a hallway, SEVERE respiratory distress, and so on (you get the picture, sure you've seen it more than I have), so incoming patients get a quick report from us and frighteningly if we don't give any indications that there's something urgently wrong, then they don't necessarily ask.

Just follow PHTLS recommendations. If they have good neuros (sensory/motor to extremities) and are unstable in anyway, don't waste time on-scene immobilizing them. Remember that urban study from USC showing that trauma victims who are driven private auto (provided they by chanced went to a trauma center) had a higher survival than ambulance transports for similar severity of injuries. Less time wasted on-scene. I've also seen GSW victims with severe shortness of breath forced to lie supine so they can maintain immobilization on the backboard. This is not good for them...