AnthonyM83

Sure, but we have precedent set for this. In an emergency, seatbelt can't always be your first priority. I guess you weight things out. For example, GSW's are commonly altered and slightly combative. We could waste a lot time time properly securing with all seatbelts before leaving, but we just take off and try to secure (restrain) en-route. For young peds, medics would rather have them semi-relaxed in mother's arms in gurney, than thrashing about crying on gurney, while he attempts IV access. Sometimes we sacrifice seatbelt risk, b/c patient's current medical condition is seen as a bigger risk. If the claustrophobic person who posted earlier were truly emergent, we would see it as a bigger risk not to transport. Each patient is different. One crew has a 600+ lb. patient and they had to use a sheet to slide him onto the floor in the back of the ambulance (For once they were glad to have 7 FFs on-scene.) Patient's condition was emergent enough.

Nice

That's how it is here for both the private companies and FD...though FD-EMTs don't wear an EMT patch b/c it's understood all are EMTs. It's nice being able to get on-scene and look at the patches to immediatley know if you have ALS on-scene or not.

If a patient's condition were serious enough that they really required transport and they were claustrophobic to the degree you describe, we could remove the seatbelts for the patient's own good. The alternative would be not treating the patient which would also put us in a bind. We don't do chemical restraint and it'd take a lot to get a thrashing person restrained, so I think best bet would be to just transport and treat it as part of the emergency. Same way emergent young children go in parent's laps on the gurney...code 2 young children require carseat. (generally)

Here here

I was talking to a guy in medic school right now. Apparently, his school switched to Mosby's b/c Brady's had too many contradictions. That's what he said anyway...it's going to be the one I'll be using if I go to the medic school I'm planning on...But I guess that's for another thread.

Alternatively....

I know a few people who have worked there. None would ever do it again, though they did make some good friendships there. The ones who did it AND are good EMTs now worked there b/c they weren't old enough to work for a 911 provider (b/c of insurance reasons). Rise above the rest, then move on.

And THAT'S why I support studies that support obvious points or things that make people say "duh, we all knew that already". 1 in 100 (or whatever) ends up showing us the obvious truth wasn't actually the truth.

So, exactly, you have no evidence other than "that's the way we do things here". The POINT of the thread from the start was to FIND evidence for procedures we're already using. So, you're evidence can't be "well, it's the procedure we're already using". The point is that we're questioning the procedure. It's part of critical thinking (another idea why a bachelor's degree would be good for EMS, IMO...to develop those skills). PS You lose. You made an assumption about ERDoc. You aggressively asked a question about him you didn't already know the answer to and got owned.

If you're talking specifically about recommending medication over the phone, then I agree. But EMD can provide other simple info, such as CPR instruction, choking procedures, and how to position patients. For more than that, you'd want to do a live assessment first on-scene. I do disagree with the logic that if it worked, there would be no need for ambulance drivers. Even if someone came up with he closest to perfect algorithym for EMD, we (responders) would still be needed. The point of giving advice over the phone, even if system worked perfectly, wouldn't be (and was never meant to be) to replace responding units. It's to help increase survival and prepare for EMS arrival.

Fair enough. Just remember that getting life experience is one of the greatest learning opportunities of all. You can think of your post college jobs as your field internship for stuff you learned in college, then go back school when you've settled a bit. Both routes work!

I'm assuming that if the dispatcher told the patient to take ASA, it was part of some bigger protocol or EMD or such, in which case the dispatcher was doing exactly what they should have been and there was either a miscommunication between dispatcher and patient or there was a flaw in the flow sheet that tells them what to recommend to patient based on their chief complaint.

Public Health is always a good one. If you're going for a PhD, though, I would just go for the PhD. You don't need to get a masters, THEN a doctorate, unless there's specific masters work you want to complete to have in your background for your doctorate.

Dust, I rarely miss a beat when people say even the most extreme things, but you definitely get the price for most "Oh, sh**, did he really just post that!?" outbursts from readers.

Right, it makes great sense in theory...but he's saying AHA apparently believes there's been no evidence to support nitro reducing mortality. So, anyone have evidence?

He's looking for evidence for use of nitro...not stents or what helps MIs survive....

Checked mine during my EMT school ride-along...I was in the 30s. Definitely light-headed and tired, but I routinely feel like that when I'm on the go and have never gotten low enough to have any problems. Non diabetic. As far as doing something to every patient, there's no real harm to that patient, but it's embracing the idea that we do things just because. It's an outlook type of thing. The way your approach medicine.

Weird. Looks like our quotes got switched for each others.

At first responder level, I can see us becoming severely understaffed. EMT companies here are already dying for EMTs and they get most of their EMTs from pool of people who want to go into Firefighting. If we lost out on that group, too, we'd be in some big trouble. I'm just trying to consider other not so obvious implications.

The difference is that the guy who is only hungry wants to go. We wouldn't refuse him transport, either. But I guess I'm lucky in my system, b/c we'd be tied up for hours each day if we needed parental signatures without exceptions. It's about the only good thing in our county...

I don't know if I agree with Basics having an Associates. We need a basic first responder level that needs to be easy enough to fill in all the positions even in rural Anywhere, USA. Definitely harder than it is now, but don't think Associates is necessary if it's still going to be a position people might leave at high rate. I don't know. Medics definitely Bachelor's, though, b/c these would be career medics and can invest the time and money into it.

We don't carry thermometers in the field. They'd be nice to have available, though, for some cases...such as fevers to know urgency of transport (febrile seizure at 103.5 versus 106.7 and rising)

Sorry, I might not have connected my post with the discussion at hand well enough. I was taking the logic that an AMA is needed for any release after tx to an extreme to see if you guys felt the logic still held, since logic used needs to hold for all situations. The scenario of me walking through a shopping mall and being approached by someone for a bandaid with a SUPER minor papercut (or as extremely minor thing you can think of in your head...) popped to mind. We were trained in Santa Clara County not to require AMA for minor things that we didn't think any transport was necessary and in Los Angeles County where I now work, it's also the system we use (so giving you examples of two places, not geographically close to each other, that use the same system). It's not assumed that the 17yro's parents would want their daughter transported for an already bandaided papercut when we don't have medical justification for such transport. We assume it with small children because 1) They can't decide on simple decisions for themselves and 2) They need a guardian to be released to, but if we feel this is a decision this 17yro is capable of, then we can allow her to make it. At least how I was taught. But if you're in a system like DustDevil described, then I guess my scenario doesn't make the point I wanted, because you guys need AMA for literally everything, no exceptions, if a minor.

What would that 17yro be refusing exactly? AMA is usually refusing to transport or refusing treatment. The reason being that we as "medical professionals" believe they need medical tx. If they have no medical problem, what medical treatment or evaluation are you trying to get them to accept? What medical advice are they going against? If a 17yro had a papercut approached you while on shift and asked you for a bandaid and showed you her finger, would you need her to sign out AMA?