Lone Star

First off: Richard, congratulations on appropriately using the word 'nefarious' successfully! I also noted that you used the word 'infamous' successfully; not once but TWICE! I own a 1989 Ford Thunderbird that I haven't seen in 2 years (it's sitting in storage in MI) I also have for my current 'transportation needs, a 1991 Kawasaki Voyager XII. Here in GA, I can ride almost all year long! I DO ride with a helmet! You'll also notice that there are no emergency lights, decals or stickers to identify me as either a Firefighter or EMT.....

I didn't relish the idea of having to quote 'the book' in this case. Until I can find legal statute to corroborate my point of view, I attempted to offer material (including legal definitions) of what constitutes abandonment as it is defined. Obviously, this is what has logically led to my position on this matter. Comparing EMS to nurses only serves to 'muddy the waters' and further confuse the issue at hand. Nurses aren't governed by the same policies and procedures as EMS, and to compare the two is moot. Until such time that I can find 'proof' of my position, I am withdrawing from this topic of discussion.

According to "Emergency Care: 11th Edition", abandonment is defined as: "leaving a patient after care has been initiated and before the patient has been transferred to someone with equal or greater medical training." (page 55) Since the paramedic cannot treat the patient through a closed door, he's left the patient unattended after initiating medical care. Since the medic was the 'highest medical license on scene', he cannot obviously 'hand down' to the EMT (who was not in the truck). Since neither medical provider was in the back of the truck with the patient, the patiet was not being attended to. Transferring patient care to a nurse or physician at the receiving facility releases the EMT/Paramedic from further obligation to treat the patient, as they're now in the care of someone of higher licensure. What happens with the patient after that, is no longer going to come along and bite ME in the ass! I don't see OEMS dictating protocols and rules for physicians and nurses....do you?

Because the patient's care has been transferred over to the receiving facility, (usually to a nurse, who's license is higher than a medic). This is why we get signatures as proof of the transfer of care. What happens after that takes place is no longer on our (EMS's) heads. As far as 'law in the real world', it's funny that the two places I've listed in my last post seem to corroborate my point.....

Before the dashcam video was released, the trooper stated that as he passed the ambulance, the driver stuck his left hand out the window and flipped him off. Now he states that as the ambulance passed him (as the trooper was going the other way), thats when the driver flipped him off. Amazingly enough, I've not been able to see the driver of the ambulance extend his hand outside of the vehicle. Now that the video has been released, the trooper claims that no one told him about having a patient on board. The video CLEARLY shows Paramedic White opening the rear door, stepping down from the truck, and informing the trooper that there WAS a patient on board. With the release of the video, it shows that Maurice White DID in fact, abandon his patient. By stepping out of the truck and closing the door, he terminated care of the patient at that point. In MI and GA, the termination of patient care without transferring patient care to someone of equal or higher licensure constitutes ABANDONMENT. By him stepping out of the vehicle and closing the door (whether for patient privacy, confidentiality or modesty), he effectively terminated patient care at that point. With the 'help' of the state trooper, he effectively left that patient unattended. West's Encyclopedia of American Law defines abandonment as it applies here as: Abandonment of a patient, in medicine, occurs when a health care professional (usually a physician, nurse, dentist or paramedic) has already begun emergency treatment of a patient and then suddenly walks away while the patient is still in need, without securing the services of an adequate substitute or giving the patient adequate opportunity to find one. It is a crime in many countries and can result in the loss of one's license to practice. Also, because of the public policy in favor of keeping people alive, the professional cannot defend himself or herself by pointing to the patient's inability to pay for services; this opens the medical professional to the possibility of exposure to malpractice liability beyond one's insurance coverage. http://www.answers.com/topic/abandonment Abandonment is sometimes defined as the unilateral termination of the provider/patient relationship at a time when continuing care is still needed. It is a form of negligence that involves termination of care without the patient’s consent. To prove abandonment, a plaintiff must show that a patient needs care — that a medical provider has entered into a relationship to provide care to that patient, and then either stops providing care or transfers care to a person of lesser training when the patient needs the higher level of training. http://www.jems.com/news_and_articles/colu...bandonment.html As far as the trooper committing a HIPAA violation, at no time did the trooper attempt to become involved in the patients care, or inquire to her condition or illness. Further, (at least as far as the video footage is concerned), the trooper didn't discuss the patients illness/condition with anyone that was not involved with her care. (Hell, he didn't even discuss her illness/condition with those that WERE involved with her care!) As far as the District Attorney not filing charges on the trooper, I personally think he 'screwed the pooch' on that one! The trooper was clearly the agressor, and laid hands on Mr. White while he was in the performance of his duties as a paramedic.

Only in Denmark can you find something like this....

Us men hit our sexual peak around 18. and it only lasts for about 2 seconds. Women seem to hit their sexual peak between 30-40 and it lasts for several years. (hardly seems fair in my book!), but as a man, I have to say that as I've gotten older, my focus has shifted from 'quantity' to 'quality'..... Walter on marriage

In my EMT-B class in MI, we were taught that slow steady traction would be applied (only one attempt), and then when the pedal pulse had returned, you slowly release the traction, splint in place and transport. We were further taught that ortho only needs about a 75% overlay to consider the fracture 'properly reduced'. Anything above the 75% was just 'gravy'. I don't know what the 'rule' is here in GA, as we haven't covered that yet. While we're taught this information, it was explained that the muscles contracting is what has caused the fracture to become misaligned, and that by slowly providing traction, we get the muscle to lengthen, and thereby allow the bone ends to relatively 'fall back into place'. In 12 years, I've never had to perform this procedure, but I'm sure that it's gonna hurt like hell! As far as a pelvic fracture, we're taught that an inverted KED works well to stabilize the fracture long enough for transport. I was also taught that traction splints like the Sager and Hare were for simple femur fx, and that for simple tib/fib, we should use a long padded splint to stabilize the joint above (knee) and joint below (ankle).

Would it be more appropriate if I were to start rending garments, and wailing at the top of my lungs? Sobbing uncontrollably? With what little information is available at this point, the only thing I CAN do is feel bad for the family, but MY life will not suddenly stop because of this. I'll bet you were one of the millions of people that went around sobbing and calling all your friends after Dale Earnhard died by smashing into a wall at 185 mph.....

I would have thought that the Shaolin priests would have taught him against such 'deviations'.....

It has always been my understanding that stepping out of the truck with a patient on board, leaving the room before patient care has been PROPERLY transferred to the recieving facility and in general leaving your patient unattended after making initial contact (without proper transfer of care to someone of equal or higher licensure) constitutes abandonment. The medic in the back of the truck should have NEVER left the patient compartment, regardless of what transpired between the driver and the troopers! Thats how I've always viewed the abandonment criteria, Ruff. Dust, you of all people know that there are different rules and circumstances between people in the field and those in the hospital! How can you even compare the duties of a floor nurse to the field medics? You're comparing apples to tomatoes....-15 for you!

The article says 'he didn't mean to post it'....how do you 'accidently upload' something like that? Last time I uploaded something, it was a 'deliberate act' on my part......

It's not that you're 'too rough on the edge anymore', it IS a slap in the face to award someone for just 'doing their job' (and from what you've posted, not even the WHOLE job!). It's nice to recognize and reward outstanding performance, but to just hand out awards for the sake of 'bragging rights', or something to hang on your 'bragging wall'....well, it kind of cheapens the whole concept of awards.....

After I informed my instructor about this very topic, I was quickly told that OSHA's provisions more than make up for any provisions in the Ryan White Care Act. The only problem is that there are organizations that OSHA cannot dictate policy to. The problem with this and other provisions of the OSHA BBP Standard is that no further details are provided for employers. OSHA states this is a “performance-based” standard, which means that the standard identifies end results that are expected from employers, but doesn’t specifically identify the steps needed to reach those results. The emergency response provisions of the Ryan White law provided those missing steps. There was a requirement for a designated infection control officer (DICO) for every emergency response employer in the country to be the “go-to” person when exposures occurred. The DICO was responsible for obtaining the disease status of the source patient no later than 48 hours after the exposure. Although the OSHA BBP Standard doesn’t contain these provisions, these are the obvious steps needed to reach the end result expected by OSHA. Unfortunately, the standard is too ambiguous for some people. A municipal government employer in Kansas, for example, recently wanted proof that there was a legal requirement for them to have a DICO in light of the repeal of the emergency response provisions of the Ryan White law. This indicates that some managers need to see a law that states clearly what’s expected of them. The Ryan White law provided much more clarity than what we’re left with in the post-exposure provisions of the OSHA BBP Standard. What If OSHA Doesn’t Apply? Another problem with the OSHA BBP standard is that it doesn’t apply to state and local governmental employees in about half of the states. State and local governmental employees are covered by federal OSHA standards only in states with occupational safety and health plans that have been approved by federal OSHA. Federal OSHA has no jurisdiction over state and local government employees in the following states/territories—which don’t have OSHA-approved plans—Alabama, Arkansas, Colorado, Delaware, Florida, Georgia, Idaho, Illinois, Kansas. Louisiana, Maine, Massachusetts, Mississippi, Missouri, Montana, Nebraska, New Hampshire, New Jersey, North Dakota, Ohio, Oklahoma, Pennsylvania, Rhode Island, South Dakota, Texas, West Virginia, Wisconsin, Washington, D.C., and Guam. http://www.jems.com/news_and_articles/articles/jems/3309/now_what.html

Since "iatrogenic injury" has been thrown into the mix, one must ask, "How long must the patient be left on the LSB before this becomes a serious risk issue?". It sounds alot like the whole "Don't put high flow oxygen on a COPD patient during a 10 minute transport, because you'll knock out his/her hypoxic drive." Another point was mentioned as well, and that being 'distracting injuries'. Since the body can only recognize one 'distracting injury' at a time, wouldn't that affect the patients ability to recognize even moderate to severe back pain in the first place? With all things being equal, we're brought back to a point I made earlier. If the patient doesn't recognize the back pain as 'significant, how can we 'clear the spine' based on the symptoms of the patient? Since we're not the ones feeling the pain of the injuries, logic would dictate that with the MOI considered, we already know what injuries are possible, and therefore should take the appropriate precautions to prevent further injury to the patient. We've all heard stories about patients involved in motor vehicle crashes getting out of the vehicle by themselves, walking around as we arrive on scene. The patient looks around and drops over dead because they moved their heads ....not knowing that they've fractured one or more cervical vertebrae. We know that blunt force will follow a certain pathway, and can affect parts of the skeleton not directly involved in the injury. For example, a patient with a colles fracture can also experience surgical neck fx.

You'll notice that in the paragraph prior to the one you've quoted speciffically dealt with the doctors determining the need for radiological imaging after palpating for deformities. In case you missed it, here it is again:

What a SHOCKING development that turned out to be!

I will concede that a LSB is an uncomfortable device, as well as K.E.D., and cervical collars. In the hospital setting, the spine is ultimately 'cleared' by radiological imaging, through the use of x-ray, CT scans or MRI's. There are techniques that the attending physicians have at their disposal, (from their far superior education), that allow them to determine the need for such an exam after palpating the spine. Until we start carrying portable x-ray machines, CT machines or MRI units on our trucks, we have no real 'tools' at our disposal in the field to be making the decision to remove or omit full spinal immobilization. Currently, the only real 'definitive criteria' that we have to make this decision is MOI, and the patient complaining of neck or back pain. Obviously, with the unconscious patient, we're not going to be hearing them complain about much of anything; leaving us with only the MOI to determine the need for spinal immobilization. Even if the patient ISN'T complaining of neck and back pain, that doesn't conclusively rule out cervical spine/spinal injury. Having been in a couple of pretty good 'fender benders', I can state with absolute certainty that the injuries I suffered in those collisions didn’t hurt nearly as bad at the time they were inflicted. A few hours later however, when the adrenaline finally wore off; you can bet that I felt them then! Since EMS usually shows up only minutes after the collision, how can we actually trust that the patient is ‘fine’ just because they said so? Could the pain of the spinal injury be masked by the adrenaline release due to the collision in the first place? Absence of notable deformity of the spine is NOT conclusive evidence that the patient’s spine is ‘injury free’, and since we cannot definitively and conclusively rule out the presence of a spinal injury; we have no business not using full spinal immobilization.

I picked up a whole set tof cordless power tools for under $200.00 Say what you will about Black & Decker, but the 24v Fire Storm line seems to be pretty much indestructable....

Like Clint Eastwood said in "Pale Rider": "There's nothing like a nice piece of hickory!"

The Fireman - George Strait Favorite place to party?

Blue Velvet - Bobby Vinton Where would you like to go on vacation?

As a veteran of the United States Air Force, I would like to extend a sincere 'thank you' to all vetrans of the United States miltary. They have stood ready and willing to defend the freedoms that are taken for granted on a daily basis. May they be remembered in our prayers, and may a special prayer be said for those that have made the ultimate sacrifice, or didn't make it back. Their selfless dedication should be remembered every day!

I"m using Course Compass, and haven't had any problems with it. From what I understand, with Course Compass, you (as an instructor) can even tell if your students are cheating on their tests, as its got some sort of 'keylogger' in it. My instructor told us that she can see every key stroke, and if we navigate to another site during testing, it will boot us out for cheating.

Judging from another thread, only blacks are allowed to use the term 'African American' these days. http://www.emtcity.com/index.php?showtopic=15165 Even the ACLU won't get involved in this one. Is it because this African American is actually white, and therefore doesn't deserve the same 'protections' that black America does? I mean when someone who was acutally BORN AND RAISED in Africa can't identify himself as an 'African American' because he's WHITE...now who's being 'oppressed'? Maybe we should look into some special 'set asides' just for him?