DwayneEMTP

Asside from being able to point and say "Hey, look, it's an xray!", I really know nothing of xrays. I do know however that Vets have used a portable xray for quite a while (I've seen them perhaps for the last 10 years or so, though they are far from standard on most trucks). It's maybe 18" x 18", and they are able to carry it easily. It's set up on whatever is handy at the level needed, and then xraying seems to occur, and the Vet tells you his/her findings in a few minutes. I'm not sure of the quality, and I've only seen it used on the legs of horses...but I thought I'd mention it in case anyone found the info useful. Have a great day all! Dwayne

"18. Rectal examination revealed a normal size thyroid." Man, that's how the exam feels sometimes.... Dwayne

I found the make-up of the team interesting...What is the thinking behind having an MD,NP, and medic? Wouldn't the medic be redundant? Dwayne

I can pretty much guarantee Dust and AK are on their way to the UK as we speak... Dwayne

I was just wondering about this. It seems like a no-brainer good idea...but then I started wondering about dispatch based triage. Many medics/Docs/nurses here seem to think that basics, on site, deciding level of care (ALS v BLS) is often not a good idea. It would seem that dispatch (outside looking in, I have no idea of their qualifications) would be less capable to make this decision. Particularly in geriatric patients. This is not my judgment, just my train of thought... They mention the sprained ankle. Can they reliably determine if the sprain caused a fall, additional injuries from the fall, level of conscienceness, if the sprain was casued by a fall, that was possibly caused by a medical, medication, mentation issue, etc? If this really caught fire, would there be ramifications for the EMS job market? Can you see this moving outside of the geriatric population and becoming main stream? One of the many things you all have taught me is that things are seldom what they seem...I look forward to your thoughts. Dwayne http://www.emsresponder.com/article/articl...p;siteSection=1 New Tampa Dispatch System Reduces ER Trips TAMPA - Each day, emergency dispatchers field dozens of calls from people needing medical care, but not all of those calls require an ambulance ride and a trip to an emergency room. A twisted ankle, a minor spider bite or a backache don't have to be treated as quickly as, say, a heart attack or a gunshot wound. Now, a pilot program between Tampa Fire Rescue and a private home care company promises to send a doctor or nurse practitioner out to certain patients' homes to treat nonemergency medical troubles. "It's just such a wonderful concept," said Dr. Catherine Carrubba , a Tampa General Hospital emergency room doctor and the medical director for the Fire Rescue. "It will work well for patients." The two-year pilot program is the first in the state and will treat patients 65 and older, she said. It comes at no cost to the city, and there is no contract. AllianceCare , a for-profit company based in Boynton Beach, will send a medical team out to private homes. Because of the age restriction, most of the patients will be covered by Medicare. If a patient doesn't have insurance and is not covered by Medicare, they will be treated at no cost, said Greg Bellware , AllianceCare's senior vice president. "This is a very simple and a very small service but a very important one," Bellware said. Here's how it works: When someone calls 911, dispatch sorts the calls according to priority. If an elderly person calls in with a nonemergency problem, dispatch will contact AllianceCare. A company employee will call the patient within 10 minutes to set up a home visit appointment. Within two hours, a doctor or nurse practitioner and a paramedic will come to the patient's home. Once there, the team can prescribe medications, perform X-rays and handle other medical needs. The AllianceCare team works from 8 a.m. to 8 p.m., seven days a week. The company has started small, handling only three or four calls a day. "Taking care of patients' needs that can be best met in the home is not only better care but it's more economical for the entire health care community," Bellware said. Hillsborough Fire Rescue has no plans to get involved in the program, said spokesman Ray Yeakley.

After my basic rotation, I probably spent 200-300 hours in this ER with terminal relatives in the next 18 months...so it got to feel pretty homey. Even so, I tried to make it clear that I felt there was a good chance I didn't understand all that was happening. Looking into someone else's world is kind of like looking into someone else's relationship, things are seldom how they appear. It wasn't my intention to judge, just put out something that I didn't understand so those smarter than I am could explain it. Sorry if I got you shaken up Rid. ERDoc, thanks for your response! It's truly is heartening to know that that is not the norm...You mention the Admin having to bend over backwards based on customer responses. Would you not perhaps benifit by having a professional evaluation based on rational, health care based, criteria (assuming that is what happens here) instead of a bunch of uneducated (medically, hospital operation) patients that have been angered by a long wait? As stated before, I haven't worked EMS or the ER with the exception of a few hours, so I have no idea what the answer is...I'm just interested in the question. I do see the resouce issue though. Murphy's Law would seem to dictate that these visits would happen at the worst possible time... Thanks for your thoughts... Dwayne EDIT: Yikes Ruff...somehow I jumped right over most of your post...Thanks for the great and thorough response...it makes a lot of sense!

I can see your point Ruff, but is 5 visits or so a year really that big of a drain? My opinion from the outside looking in... When I did my ER time for basic, I was very curious to see what went on in the ER. It seems, as a patient way too many times growing up, that as I sat there waiting while nothing much seemed to be happening behind the glass...I had a hard time believing that was very cost efficient, so tended to think I just didn't understand all that occurred, when it appeared nothing was occurring. So I was pretty shocked to find that pretty much nothing was going on while I was there!! The waiting room was packed full, a nurse would triage (allowing me to help) and then put someone in a room, or back out into the waiting area. Soon, the rooms were full...and I watched the Doc talking to the nurses...then he would hurry into a room...spend 10 mins or so dealing with an issue...then go back to the nurses station and visit for a half hour or so, then repeat the process. At first I though perhaps he needed to wait for an important phone call or something else that wasn't obvious...but as I paid attention I found that he was in fact just visiting. During this first 12 hours I found that even the nurses were disgusted with him. Though there were so many nurses, 6 I think, plus two Techs (paramedics) that they seemed to want to stay busy, but with so many, and no patients going anywhere any time soon, they were mostly bored as well. I am amazed at the wasted resources, and lack of motivation to actually move people through, as it seems that moving people through would provide the profit incentive for the hospital. I just wonder if the "mystery shopper" possibility wouldn't have been the motivation (partially) needed to operated at a more efficient level. Assuming that things happened in the ER the way I describe them it seems obvious that there are more issues here than can be solved via this method...but maybe it couldn't hurt. Also, I am still very open to the possibility that I have no idea what was going on...I would imagine there are much smarter people than I designing the ER staffing profiles, so I don't pretend to understand everything that I saw... Anyway...just my thoughts. Dwayne

This seems like a good idea to me. Though I also thought testing teachers regularly was a good idea...so there you have it... Any thoughts? http://www.emsresponder.com/article/articl...p;siteSection=1 Mystery Shoppers Uncover ED Weaknesses AHC Newsletters via NewsEdge Corporation 'Mystery shoppers' can uncover ED weaknesses 'Patients' present unannounced, report findings "The next patient you see in your ED may be a "mystery shopper" — and you won't even know it. Companies, such as Devon Hill Associates in San Diego, are being retained by hospital CEOs to have individuals come to their facilities to be "treated" and to report back on their findings. The findings then are shared with the different departments in the hospital, with an eye toward improving patient safety and satisfaction. While the individual patient/mystery shopper will not be known, the ED manager probably will not be totally blindsided. "If I'm doing it, I insist they tell the entire hospital that mystery shopping will take place as part of their quality improvement or patient satisfaction plans," says Barbara Gerber, MPH, CHE, a former hospital administrator who is founder and president of 10-year-old Devon Hill. "Usually, all department managers will know." However, she adds, the ED manager would not now the "when" or the "who" of the visit. Gerber says a project solely involved the ED would cost between $7,000 and $10,000 and involve three to five mystery shoppers. "It's better with five," she asserts. There are a few other companies that provide similar services, she adds, including Dee Peterson & Associates in Houston, and Perception Strategies in Indianapolis. Bruce G. Jones, DO, medical director of the ED at Doctors Hospital in Columbus, OH, says, "As an ED director, I think this is a good thing. Anything that can provide valuable information to improve your process or the physical plant or interactions with patients is a valuable thing in your management role." Jones says there have been mystery shoppers in his department. As a physician, Jones reacts a bit differently to what he calls the "dishonesty" of the scenario. "As an ED doc, I may have seen one and not known it, and clinically thought it was really a patient," he shares. Gerber concedes that is a valid concern. "It always comes up in the ED. People ask why they should take care of three people who are not real patients when it takes time away from treating some very sick patients," she says. "While that's valid, the CEO will respond that out of thousands of visits a year, 70% to 80% may not be real emergencies; and if the ED can't take care of three patients out of the 15,000-20,000 nonemergent patients they might see, then they really have a problem." How it works Gerber, who says she has posed as an ED patient many times, says her company creates a variety of scenarios. She would not, however, provide much detail. "A lot depends on the area we are in, but in general we use scenarios where the illness or condition is such that no one will be able to pick the fact that we are not real patients," she says. Some pseudoconditions are minor, while others are more major, she continues. "We are able to do this because we have a number of mystery shoppers who have conditions that might make it necessary to go through certain processes or procedures," Gerber explains. There are certain issues that show up often in EDs, says Gerber. "We frequently find a lack of good communication — not letting people know how long they might expect to wait," she notes. "People are left alone in rooms with no communication for 40 or 50 minutes." Gerber says she often has been handed a form and not been told what it was that she was supposed to be signing. "A lot of that happens with a busy ED, and staff forgets they really need to communicate," she asserts. Discharge instructions are another area where EDs commonly fall short, she continues. "Instead of having them explained in a manner the patient understands, the provider is gone very quickly, and the patient leaves not knowing what they are supposed to do," she asserts. Gerber has also observed a lot of little things that she would correct. For example, patients often are not offered a pillow, asked which gurney position they prefer, or asked whether they want the TV turned on. "These things would make them feel they mean something to the caregiver," she notes. EDs take note Several EDs visited by Gerber or her staff have made important improvements following the visit. "Some EDs have developed systems where someone on the staff makes rounds on patients every 15-20 minutes — or they might have a patient advocate or volunteer responsible for making those visits," she shares. Her mystery shoppers frequently uncover safety issues, such staff not wearing gloves or not washing or sanitizing their hands in front of the patients. "Maybe they do it between patients, but the perception is that it is not happening," she explains. "When it has been brought to their attention, some EDs have had sanitizers installed in the rooms so the process is now more obvious." While Jones says he has not yet received any feedback from mystery shopper visits, he prefers to take a broader, more process-oriented approach. "We track productivity per doc every hour of every day, as well as a lot of other measures," he says." Dwayne

The post about the damaged hand reminded me of a comedian I saw once...I'll paraphrase best I can...(I can't remember his name) He said: "You know when you wake up in the morning, after sleeping all night on your arm and it's asleep?" "Well, I woke up one morning and my arm was just dead! I picked it up and dropped it...nothing" "So I pinched it to see if I could feel anything. I couldn't feel it...so I pinched harder...Still nothing!" "So I decided to see just how dead it was...and bit it, as hard as I could!" "That's when my wife woke up screaming!" Dwayne

I've trained somewhere in the neighborhood of 1,500 dogs to do just about everything including working with police, prisons etc...dogs are a tool I believe. It seems making the dog an officer would require intent on the dogs part to be an officer...and they just don't have that. That being said, any form of purposeful cruelty should be punished...running over a dog is cruel if intentional, but should not be equated to killing a human in my mind...Just my thoughts... Also, the guy that 'peppers' his dog is an idiot. He needs to quite being pissed at his dog for handler stupidity.... I was wondering though, can an officer use lethal force to defend his dog's life? Dwayne

Can she blame her behavior on the full moon? If she can't afford a lawer, does she get a pubic defender? Certainly she'll end up on paRollo after this....(Yeah..ok, so I suck at this) Dwayne

Fresh home from my final A&P practicum... So I'm kind of fried and can't figure out if this is a spanking or not...Either way, point taken...Perhaps I misunderstood the direction the thread was taking. (Missed the c8 reference...nerve maybe, but certainly not vertebrae) Have a good night all. Dwayne P.s. Dust, we were taught in basic academy to always remove the helmet unless damage prevented it...No idea what the rational is. They didn't say much about the underwear though...

I reread you post, previous to the one you mention and didn't find anywhere that you asked to lock the thread. So your ASSumption was foolish. As I said in my post...it was said "over and over", sorry you took offense. I believed if you, or anyone else had asked to lock the thread then it would be obvious whom I was referring to, as well as my general opinion on the matter for anyone reading. You have so much to offer if you ever get passed the 5th grade "I have the right to do this" stuff...You seem to feel the need to pretend I demanded that you ask for my permission...not so. I believe my point was pretty clear, I refuse to wrap in in velvet so that you are not able to blow it out of proportion. The rest of your post was awsome! I thank you for it...And will make a stronger attempt to heed that wisdom in the future... Have a great day all! Dwayne

Good Lord, one of the most childish and unproductive statements made over and over here is "I hope they lock this thread" If you don't want to participate, don't, but quite hoping Admin will lock the thread after your latest 'one-up' attempt. Say your piece, or choose not to...but quite trying to decide that your last post was so brilliant that the rest of us don't need to hear any more on the matter. We're all pretty much full grown. When Admin is tired they will lock the thread. When the rest of us are tired we'll click passed it. OK? Dwayne

I'm thinking this may be a terminology issue... It seems when Timmy says 'sports trainer' he means 'coach' in American speak. (Coach = clipboard, yelling, CPR card) He doesn't seem to be speaking of someone specifically trained in athletic injury care and prevention as we would be here. Maybe this will help... Dwayne

Yeah...I think this shows you all aren't really reading these posts!! :wink: http://www.nlm.nih.gov/medlineplus/ency/article/003420.htm Thoracentesis is a procedure to remove fluid from the space between the lining of the outside of the lungs (pleura) and the wall of the chest. Normally, very little fluid is present in this space. An accumulation of excess fluid between the layers of the pleura is called a pleural effusion. Dwayne

Wow Doc, thanks for taking the time to present both (more?) sides of the issue...pretty dang cool. This kind of information is what makes posts from the 'the counsel of elders' such a gift. Dwayne

Not me. Posting pretty much uses all of my techinical resouces. Do you know what the fomatt is? (The file extension) My wife is pretty clever with these things..I might be able to get her to help me out....I'm not sure if she's as savvy as Michael...(She's quieter) And yeah, I was wondering why Michael had been so quiet...I hope all is well with all of you! Have a good one! Dwayne

Some of you may have seen this. I have an instructor friend that send these sometimes and this one struck me. http://www.nothingtoxic.com/media/11649526..._Smashing_a_Car What got me thinking was that if I had happened on this accident, I would have found two people, that from the little we see don't seem obviously badly injured, sitting upright in their seats, airbag deployment, ( I can't tell if they are restrained or not) and no severe intrusion into the passenger compartment. I noticed the starred windshield, deformed steering wheel, and it appears she damaged the dash with her knees... I know many of you with experience will know what that all that means as it applies to an index of suspicion. You might be saying "Well, they were in a high speed collision, of course they bounced off the airbags, bashed their heads together, traded seats, smashed into the windshield and then sat up like nothing happened...What did you expect?" But it just didn't go down the way I have pictured it in my head...I never imagined such interaction between the bodies. That they could cover so much territory, hit so many things, and then appear that very little had happened! I can't imagine the damage caused simply by the impacting bodies...before you even factor in the other objects and levels of impact... Hell, I guess I'm just trying to say I feel like an idiot. People that have been put through a blender should appear to have been put through a blender...they should not seem to be sitting as if nothing exciting has happened. As becksdad once said..."I'm not sure why I'm posting this, I don't really know anything about it" (Paraphrase)...Perhaps those of you smarter than I am will be able to figure out what I'm talking about... Have a great day all! Dwayne

Man...I have nothing but respect for you AK, but it's way passed time someone calls bullshit on this thread. This could have been posited as a hypothetical, but instead you chose to allow all the regular members of the board to know who this is. And if we're wrong, there is a kid on this board taking an amazing beating for nothing. And now you call him out as a coward for not running into the lions den to defend himself? He has no defense! And the main reason he can't explain his actions and repent is because every other person here that has done shameful, CHILDISH things aren't required to reveal them before getting their chance to tell him what a dirtbag he is. This is out of control! If we're here to learn and educate then I have to wonder how, after he's exposed, attacked and humiliated, possibly chased from the board, everyone is going to be able to sit around and pat themselves on the back and talk about what a good thing they did. Pick one year from my life between 15 and 20 and you will find enough broken laws, shameful behavior and things I wish I could change that not a single one of you would have another word to say to me (maybe you won't now anyhow). We're kids! We lied to the guys about our drinking and whoring. We made up great adventures where we vanquished the dragon. Yeah, some of us even drank, did drugs and stole. But if people believed in us, we grew to make different decisions, and even make a difference in our families and communities. The absolute worse thing that could happen is that this young man believes that he is as vile and worthless as you all have told him he is. He's not...He's a kid. What pisses me off even more is that in another thread Dust implied that he maybe would have taken (hypothetical)drug money to pay his mothers mortgage. ( I'll trust Dust to take this in the spirit intended) and not one single person in this thread had the balls to call him out and make him explain his post! But there is no lack of volunteers to beat up a kid. So everyone is right. Good for you. Who has been productive? Ok. That's it...I've broken my 'don't post while your pissed rule'..but there you have it. Dwayne

I just saw this in the news section. I know there is another post something like this but I can't find it... http://www.whig.com/287615789481108.php "Those medics being paid as EMTs are mandated by law to perform all skills, duties and responsibilities at the paramedic level," Mercurio said." What's up with this? I noticed in the other thread that some ambulances are stocked at the basic level (If I understood correctly) This seems to fly in the face of logic if paramedics are riding and expected to perform at the level of their certs. Are these Paramedics just so hungry for jobs that they will allow this? Is this common? Maybe Mercurio is just full of soup...? I don't get it.... Just interested in your thought... Dwayne

Taking off my pants....

1. Yourself: Comfortable 2. Your boyfriend/girlfriend?: Yummy 3. Your hair: Brown 4. Your mother? Gone 5. Your Father? Complicated 6. Your Favorite Item: Flashcards 7. Your dream last night: Anatomy 8. Your favorite drink: Grapefruit 9. Your dream car: Jeep 10. The room you are in: Office 11. Your Ex: N/A 12. Your Fears: Parenting 13. What do you want to be in 10 years: Smarter 14. Who you hung out with tonight? Family 15. What You're Not? Arrogant 16. Muffins: Homemade 17: One of Your Wish List Items: Twins 18. Time: 0758 19. Last thing you did? Bus 20. What You Are Wearing? Jeans 21. Your Favorite Weather: Thunder 22. Your Favorite Book: DeMille 23. The last thing you ate: Tomato 24. Your Life: Undeserved 25. Your Mood: Happy 26. Your friends: Blessings 27.What are you thinking about right now? Studying 28.Your car: Pickup 29.What are you doing at the moment?: Procrastinating 30. Your summer: Hot 31. Your relationship status: Married 32. What is on your tv? SpongeBob 33. When is the last time you laughed? Minutes 34. last time you cried? Private 35. School? Challenging

When I went to the basic academy they just pounded on it...We must have heard 30 stories similar to: “Your treating a gunshot victim. While loading him into the ambulance he says 'Joe did it' just before becoming unconscious, A cop asks 'did he say anything?'. You say, he said 'Joe did it.' At which point you are pulled from the back of the ambulance, stripped naked in the snow, and flogged publicly. Your naked picks (complete with shrinkage from the cold, which may be the worst part) are posted to the internet. You are fined $8,000,000 dollars. They tattoo HIPAA Violator onto the foreheads of your wife and children...which causes them to dislike you...Friends, coworkers and strangers alike, spit at you on the street and they send your name to every known telemarketer in the U.S., causing you to be approved for 6,000 low interest loans if you'll just refinance the mortgage on the property you are renting, TODAY. We never really got into the language in class... and I haven't done it after since as it seems like you just don't talk to anyone not directly related to patient care, about anything. But since then I've come to see that at times it might even be more complicated than that... For example, I'm not sure if their valid...but stories I've heard. You tell your partner that you picked up a violent, spitting, biting AIDS patient. You tell your partner to be careful if they have to pick him up because he bites and has AIDS. Your partner tells the people at the hospital...and you're immediately pulled from your warm bed, and stripped naked....Yeah...you get the point. I guess bottom line is I'm going to have to read it for myself... Have a great day all! Dwayne

I'm going to make a lot of assumptions for the sake of argument... Assume that the rescuer in this story was called by a newspaper for his comments. He did not identify the patient, simply responded to questions, without permission, about a person identified by the reporter...Did he violate HIPAA? http://www.emsresponder.com/article/articl...p;siteSection=1 Florida Partial Decapitation Victim Meets Lifesaver BILLY TOWNSEND Tampa Tribune (Florida) LAKELAND - It was a gruesome way to start a friendship. A paint truck and a dump truck collided on West Pipkin Road in Lakeland on the morning of Oct. 24. Jason Dougherty, an off-duty Tampa firefighter and paramedic who lives in Lakeland, happened onto the aftermath. Dressed in shorts, T-shirt, flip-flops and a baseball cap, Dougherty approached the driver of the paint truck, who was walking around in a daze. Dougherty saw blood, but couldn't tell where it was coming from. "Look up at me," he said to the man, 24-year-old Paul Wadleigh, of Brandon. What Dougherty saw was shocking: The glass of Wadleigh's windshield had sliced deeply into his throat, cutting his jugular veins and trachea. "It was a partial decapitation," Dougherty said. In an instant, Dougherty called for onlookers to bring towels he could use to slow the bleeding until emergency responders arrived. "I basically put a tourniquet around his neck," Dougherty said. Then he shared a very hard truth with this stranger. It would be a struggle for Wadleigh to survive long enough to reach the hospital. "I told him the only way he would make it through was with sheer will," Dougherty said. "And he showed me he understood." Wadleigh did make it to the hospital with Dougherty by his side in the back of a Polk County ambulance, exhorting him to stay conscious. "I gave him a little slap on the cheek and told him, 'Look at me. Don't give up on yourself,'" Dougherty said. Wadleigh never did. He survived emergency surgery and is expected to recover fully from his injuries. His voice is garbled, but improving. He's able to walk on his own. And his parents say he suffered no neurological damage. They hope he will come home by Thanksgiving. On Thursday, about three weeks after the crash, Wadleigh and his family got to thank and embrace the man they say saved his life. "I feel like he gave me my son back," said Judy Wadleigh, who is a nurse at St. Joseph's Hospital in Tampa and set up the meeting. "How you doin,' brother?" Dougherty said, walking into the hospital room. "You look a lot better than the last time I saw you." The men spent about 30 minutes together. They talked of having a beer together or going fishing when Wadleigh fully recovers. They reflected a bit on the accident. Wadleigh's memories are fleeting. But he recalls touching his throat and thinking: "Oh, God." Now, other than a narrow scar running beneath his chin and some fading facial scratches, Wadleigh's labored voice is the only obvious fallout from the crash. Dougherty, 30, lives near the crash site in Lakeland. But he works at Fire Station 18 in East Tampa. "He just epitomizes a good work ethic," said Nick LoCicero, the department's rescue chief. "He's willing to assist in any way he can. That's evident in how he responded in this case." Dougherty, who credited Wadleigh's survival to Lakeland Regional Medical Center's trauma surgeons and Wadleigh's own will, said he was proud to have helped but was a little embarrassed by the attention. "I had a little bit of training and was able to help," he said. "Anybody else would have done the same thing." Reporter Billy Townsend can be reached at (863) 284-1409 . Have a great day all... Dwayne