RaceMedic

Your welcome Beiber. Even with your response i would have Still help off with the tube. COPD exacerbation does not necessarily require intubation however if she was breathing and chewing on the tube i think she may be more than a clinical save. sounds like you arrived quickly with an almost immediate conversion from PEA to sinus tach with compressions and BVM alone, you had positive results. I agree with Dwayne's assessment of your partners wanting a field tube. But i still can not speak for the Capt's complete lack of basic compassion for the PT. As Dwayne said also, YOU need to stand firm and force the issue if you believe what they were doing was not in the best interest of the PT. Remember just because your new does not mean your wrong or will not be listened to. You will gain more respect from your colleagues. Do not follow the status quo !!! Trust will come in time.

Aside from what the others have offered i would have to say talk to you instructor if you know who it is, if not find out. They will lead you down the right road for how they will be teaching the course. Aside from that i agree. take the time before class and spend it doing what you want with family, wife, kids,friends, and/or girlfriend cause it will all be coming to an end soon for a year or two. Race

After reading your post ... WOW your captain refused sedation even AFTER SECURING THE AIRWAY ?????? In my opinion you are correct, I feel that with the way PT was coming around you would have been better served to maintain with BVM to support what respiration's she had. No need to force the tube down her throat. but i am still hung up on not giving sedation, especially before forcing it in the airway. Not to mention that it hurts to be intubated. I wonder if you went in to interview her if she would remember the event? you might be surprised. Unless she did not survive the entire event. I will refer to current and even the last update of ACLS. Intubation is well down the list of initial activities to be performed and again the way you present the case you would have been correct supporting the airway with the BVM. However with anything i was not there and hate to armchair the call. Still though, worried about knocking out the resp. drive of a PT that was just intubated and by force at that ... WOW ...

Flight for life is a great service !

Welcome!!! Sounds like you will fit, well back into place! I was in the same boat but happened to remember my old password.

All of the 911 units i currently work for are equipped like that AK. We do not have a rotor in my area right now but will be getting one soon, but thats a different story. In the description you gave Dwayne, I would have no choice but to transport both. One on the cot and one on the bench. However in that instance either an LEO or Fireman would be pressed in to service driving as myself and my partner would be in the box caring for the PT's. Race

ohhh well in that case ill take a smoked brisket with a side of sauce and potato salad...

we're still talking about this ?

love the mohawk ask all the questions you can,, read the answers with an open mind and remember that we will not always give the text book answer. welcome brother, looking forward to having you Race

There are some good private services out there. I do agree some are out for a quick buck, but not all. Again research and educate yourselves people.

I had mentioned that there are standards in place. I am not going to waste my time looking them up for someone that blindly follows policies that are extremely poorly thought out and implemented. However a transfer company that would place a 23 yr old with very little experience (5yrs if certified at 18) in a management position with firing ability is not on my list of places to work. If you going to let a couple videos on youtube be your guide to ambulance safety standards then stay where you are and have a great oblivious career. If you choose to educate yourself to the abilities and limitations of your ambulances. You will be much better off and prepared, not to mention a requirement of your position. It is not only your medics responsibility but yours as a manager. If you don't know you need to do the research. Additionally, look in to your ambulance inspection procedures. If the cot mounting hardware isn't included then it needs to be added. Not only does it need to be checked for visible wear and tear but also smooth operation and positive locking of the cot with no slack. This also includes the restraints for the PT. As i mentioned before i have worked an ambulance roll over on the highway. Bent the frame of the GMC 4500 chassis. The cot mounts and cot belts worked flawlessly. On arrival the PT was on the cot still in his belts and the cot was secure in it mounts as the ambulance is lying on the passenger side. After the unit rolled twice. Ohh and the only equipment "missiles" in the back from in the cabinets were some gauze bandages from the one door that was opened. the rest were still securely closed. Even the Lifepak 12 was hanging from the security straps and not flying around in the back of the unit. My shift partner was hurt but not by loose equipment, but rather she was unbelted suctioning the airway of her PT. There was no way to be belted and handle her PT to the level they needed while belted in either the CPR seat or the bench. So she was thrown around instead of equipment. Was not a good day. She did make a full recovery and is still working full time 911 service.

Z, thats nothing. As a retailer, WalMart tractor trailers are rolling bombs. Think about all of the hairspray cans, next to BBQ lighter fluid, on top of 1lb propane cylinders, next to cases of matches ect ...ect in the same truck rolling down the highway everyday all day long. It isnt even only WalMart but every general carrier on the road with out placards because they are not carrying "enough" of any one thing to require a HazMat placard. Placards are not required for a collection of materials like they carry, Only required for a certain amount of a single item. So long as they stay below the "set" limit of material they are free to load the truck and send it on its way. For example: For placarding you may need 20 cases of hairspray, or 20 cases of propane bottles, or 50 cases of lighter fluid. so i could load that same truck with 19 cases of hairspray, 19 cases of propane bottles and 49 cases of lighter fluid and NOT need a placard. That is scary ! I drove semi for 4 yrs while working my way through my paramedic degree prereqs

I do not refuse care, my hospital is a charity hospital. I will not work for a private... just a personal choice. Let me ask you this though... You would not put a PT on the floor of your ambulance, and by the way i do respect that decision. But by the way you asked that question just now, Would you honestly put that 1000lbs PT on your 750lbs rated stretcher? And if not and you had no other bed available How would you treat the PT ? On the floor ? You can not put the PT on something that will not and is not rated to support the weight. You will have to make adjustments. I believe my ER beds are rated for 1200lbs. they are considerably more stout than a standard ambulance cot.

Ok so you refused a call based on PT advocacy. Great give yourself a pat on the back. I also work as a Medic/RN for a small IFT fixed wing and Ambulance service. I have refused calls based on PT condition and size as well. That is our job as medics to know our limitations and the limitations of our services we work for. We do not have a bariatric unit nor does the 911 service i work part time for. but i have transported an 1100lbs PT in the back of my ambulance in the manner your speak of before. However i did not ask for permission to remove the mounts i just did it. No that being said there is no local bariatric unit with in 300 miles so we had no choice. It was either transport him or deny him access to health care. Or worse yet he be transported by the neighbor in the back of a pickup. So it does happen. And to address your comment about a hospital refusing treatment, the short answer is yes private hospitals can refuse treatment and regularly do. They can not refuse to stabilize if they have an ER. Then the PT is generally immaculately transferred to a county or charity hospital. Just the facts, i do that very thing on a regular basis. One more thing, about the mounts for the cot in the back. I have worked an ambulance roll over (my own service, on my shift. My partners) and guess what ? The mounts held through the roll over at an estimated 85mph ( highway patrol estimate) the PT was being held securely by the straps on the cot while hanging sideways. If the mounts are regularly checked and tightened as needed they should hold through a 35mph MVC. They are tested. If the video in question shows them failing then i would ask about the inspection process in place for that service and how old were those mounts. Every time i get in to my ambulance i check my mounts for wear and tightness of the mounting hardware. My service replaces the locking arm in the back at least every 6 months just due to wear. the horns at the front are replaced yearly. I know we are not the norm, and not all services are like this but if you do not trust your companies equipment based on a video on the net then maybe you need to read the manufacturers literature and find out the limitations and expected life of the equipment. Also look up your major Ambulance builders and see the testing that the ambulance actually goes through to when being designed, They so have standards to follow. And if you still do not trust your companies equipment after that then maybe it is time to find another company. Just my two cents from my experiences, Regards Roman

I do not have personal experience with this beyond the dementia and mentally disabled, however i worked with a medic that did file charges when his shirt and chest were shredded by a woman that had no real reason for that behavior. she was found guilty and was ordered to write a formal apology, community service, and probation for 2 yrs.

Congrats on the new rufflet !!!

Sounds like a great gig and lots to learn. I am also one of the envious crowd as i have been reading and learning about Eastern Medicine. There is so much we can learn from the ancients and the natural medicines that can enhance our western medicine ... im sorry i am babbling on cause i would love to assist you on the site... you are on an incredible journey and i wish you the best of luck !!! Roman

I have found that Throughgood boots have a "trooper" boot that is great ( to me anyway ) they do run close to 150.00 but a polishable, durable and come in a non steel safety toe. Kyle, i would not recommend a "non-boot" Boot. Boots are usually required by most services for your protection just due to the nature of the job. we are in various injury producing situations that shoes would not last in nor would they protect you from injury should something get dropped or you kick something ... ect.

I have to agree with Asys.... As per my local protocols ( i would do this regardless of local protocol) All peds codes are worked and transported to the ED. Even if it is obvious. I do work in a rural not as busy as many places service so we do have the time and availability generally. We do this for several reasons: 1. shows that EVERYTHING is being done for their child. 2. removes you and your crew from what could easily turn in to a dangerous and violent situation. 3. The hospital has a Chaplin, grief counselors, social workers, ect... that are better educated and paid for this situation. 4. police aren't always called and do not always make it to the call on time. see reason #2 I have worked several SIDS and baby codes and have always applied these reasons to why i have never left a child on scene and have never been questioned. Even when i worked in the larger city with staffing problems and black out periods i was never questioned or reprimanded for my efforts. I am not saying that this is the right way to handle these calls but this is how i learned and continue to practice. Race

I just bought and upgraded the Viewsonic Veiwpad 10. It is a dual boot tablet with android and windows 7 op systems. I do really like it and the touch screen is very good. they have a new one out now already that has windows 7 pro w/3g also. While mine does not have 3g yet i did upgrade from a 16gb SSHD to a 64gb SSHD will be upgrading to 2gb ram as well soon. while i was at it i also upgraded to android 3.2 (comes with 1.6 or 2.2) so far has been great with the upgrades. i have added a 3g card in it but have not activated it yet. If this op system combination was available on the viewpad 7 ( 7" android only like samsung) i would have it instead. and the roll up keyboard is an awesome addition

I know i been out for a long long time but i would love to attend as well if you all would have me, I know of at least one other "old Timer" that would definitely be willing to go should time and schedules allow. Rob and I had continued to email out of city until about 2 yrs ago... You are definitely not alone Asys. as we can all see and feel. I missed several invites to go and hang out with Rob and have been beating myself up for it. I am easing back in to the site and will be involved more as time and schedules allow... hoping i can assist in keeping the pot stirred . Dust, You wielded a massive spoon my brother... we all need to help keep it moving !!! Race

Ok I know i am a day late getting the news ... This F(*&K'N SUCKS ASS!!! ... Im sorry but we all have our things. Bryan, Thank you for your posts. They explained a lot. Rob and i spoke for a long time and eventually even then lost contact and this explains it.. Rob, My friend, My Brother... thank you for all you have done for me and everyone that knew you.... Godspeed and look over us all... I will continue to stir the pot in your honor brother!!! RaceMedic