nypamedic43

I wouldnt elevate the legs unless you are sure the patient is hypotensive...that means checking a blood pressure. If the patient is breathing fine there is no reason to do a jaw thrust. Maintain c-spine and monitor until the ambulance gets there. Is the patient now awake? If so, get a SAMPLE history and ask them what happened. Think about WHY a person would have a syncopal episode. Do they have a cardiac or diabetic history. If it IS a simple syncopal episode, thier pressure should recover to normal fairly quickly. You will find that unresponsive patients are fairly uncommon and usually happen because of a medical condition. Diabetics, cardiac conditions, overdoses come to mind. Just remember to stay within your scope of practice.

You asked the question as a lay person who has stopped to help correct? If so, why are you carrying long board splints in your jump bag or even in your vehicle? Do you belong to a company that is transport capable? Just out of curiosity...how do you know that a hip fracture is at the femur head? The splinting technique that you describe for possible hip fracture sounds more like splinting for a femur fracture, if you dont have a traction splint available to you. It really does nothing to stabilize the hip itself. Some fractures need pain management before being manipulated. Femurs and hips are a couple of them and femurs bleed a lot internally as do pelvises. In the concept of how you presented your questions...as a lay person who has stopped to help, again, you should provide supportive care and wait for the ambulance to show up.

Hips are very painful when fractured and depending on where the fracture is ie: femur head or the socket itself...a SAM splint would be ineffective. Thats why I use an upside down KED. They support the hip and upper thigh very well.

I would leave the hip for the ambulance crew to be honest. As long as you have checked for a pulse before and after splinting of a wrist or an ankle and it looks like you have done a good job with it, the crew isnt going to unsplint it to check. They will recheck pulses and neuro though. I'm not a big fan of SAM splints. I like the boots for lower legs and ankles and board splints for wrists and arms. But that is me. SAM splints just seem....flimsy to me. They are good for knees in a bent position though but thats about all I have ever used them for.

materials available?? liiiike....sticks and the shirt that you've cut off them? or a board splint or a boot splint and ace wraps or cravats. Do you carry splints in your jump bag? Have you been taught how to splint a fractured bone? Have you been taught how to reduce a compound fracture or how to splint an angulated fracture in place? Have you been taught what to look for with a possible fractured hip? I usually use an upside down KED to stabilize a hip...I don't think you have one of those in your bag. My suggestion for this is make note of the possible fracture and make the ambulance crew aware of it. I once had a sports trainer tell me that one of the students that was playing basketball had fractured her tib/fib. I asked her how she knew that. Her answer was " I can see it and its swollen" I couldnt help myself and asked if she had x-ray vision. I splinted the leg anyway just because I was concerned that it was fractured and by the students description of what happened. It turned out to be a fractured ankle, in the joint. I still laugh when I think about the look on her face when I asked her that.

That's correct. If they've cut their arm, cut the sleeve until you can bandage the wound and control bleeding. Support thier airway and breathing. Whoever is on the ambulance, EMT or paramedic is going to do thier own assessments, regardless of your findings.

The only thing that is exposed on a cardiac arrest patient is thier chest. Just for the record I never expose a trauma patient outside in front of bystanders, especially if i have nothing to cover them with. They get exposed inside the ambulance. Trauma is going to be obvious....a car wreck, a fall off the roof or down a flight of stairs. If a medical condition caused the fall or the wreck, it's for higher trained providers to sort out. Sometimes bystanders an give you a clear picture of what happened ie: gramps clutched his chest before he fell down the basement steps. Abdominal pain isn't always going to be a dissecting AAA. It could be their gall bladder or thier appendix. Be careful of diagnosing someone. Supportive care at the first responder level is the best thing you can do for ANY patient, until the ambulance crew gets there.

And exposing patients as well. Why? Why would you expose an overdose patient? There's no reason too. There's also no reason to expose them if they have a medication patch on. Find it ( leaving clothes in place) and make note of the location for the ambulance crew. I'm a bit concerned about this unnecessary exposing of patients. Also some poisons need to be brushed away, depending on what they are. However, don't put yourself in harms way just to prove a point. A patient exposed to poisons, dry or otherwise, need to be decontaminated by people trained to do so and the source used to Devon them needs to be contained. Edited to add another thought

It depends on the situation. It the patient is an unconscious diabetic, there isn't anything you should do except call 911. Cooling a sweating patient with water is not a recommended practice...unless they are being decontaminated or have a heat stroke. General treatment of unconscious medical patients is maintain an open airway, make sure they are breathing and have a pulse. If you have an oxygen tank in that bag of yours, 100% o2 by NRM would help, IF as a first responder you are allowed to do so. If you are allowed to do so...cooling a heat stroke patient would be ideal but you should do it passively...like getting them into the shade or air conditioning and off the hot sidewalk or pavement. Be very careful that you stay within your scope of practice. Exposing a patient or active cooling just because you can or think you should may not work out so well for you.

If there's no sign of suspected trauma, why would you expose a patient? A syncopal episode that lasts a few seconds to a minute, that's was witnessed, and helped to the ground, rather than hit the ground like a sack of 'tators, doesn't need to be exposed. Another thing to consider is this. If you are acting in the capacity of a passerby but you are carrying your jump kit...with no identifying uniform or volly shirt or jacket..bystanders could question what your motives are, as to why you are cutting someone's clothes off. It is not unlikely for someone who has no medical training to put a "kit" together and pretend they know whAt they are doing. It's happened before. I am not saying to not help if you are able but I would use caution exposing someone if there is no need to. Just my 2 cents

I just remembered that I posted this thread and haven't revisited it to update everyone. I am very happy to tell everyone that Tim has been home for several weeks now and a couple of weeks ago, he started back to work. Thank you again everyone )

There is a transport company out of Paoli called Medtran. 911 in that area is covered by Washington Hose and West Wood Station 44.

I'll just call John Logan. He's an EMS lawyer and for years was the CEO of Greater Valley EMS. He has a practice in Philadelphia. I'll send him an email since its Friday night and as soon as I get an answer, I'll post it here.

Im on camera all the time...are you kidding? this is Chemung County NY. I cant tell you how many times my friends have texted me to say "wow I just saw you on the news. was it a bad wreck? did the person die?" and I politely tell them I cant talk about it. We just had a HUGE drug bust in this city...on national news. I am so not worried about being filmed. The bystander has been asked nicely to stop...He wouldnt. The cop wouldnt do anything so I would. I would rather pay for a new phone for the asshole then live with the fact that I didnt stop him and this girls pictures end up all over youtube. Yeah...I'm real worried about being filmed...

Hmm...He's been asked to stop and the officer wont do anything about it. Depending on whether or not I let my bitch out of the box...here is what I would. Not letting the bitch out of the box = Sir please stop taking pictures. This woman needs some privacy and what if this was your wife, daughter, girlfriend or sister. Would you like strangers taking pictures of her in her most vulnerable state? I would then again go to the officer and ask him again to make the guy stop and if he cant then we will call his superior and see what happens. Letting my bitch out of the box= Sir may I see your phone? Wow thats a really nice phone...*insert breaking phone in half here* This is my boss's phone number...My name is blah blah blah...make sure you spell it right. And theres the officer for you to give your complaint too. Here's your phone sir..Have a nice day! Now get on the other side of the street! I've been called a bitch before on a scene...I dont care. When it comes to my patients privacy I will do what it takes to protect them. On a side note...I would have a couple people holding a blanket up so the people couldnt see, especially if I am going to cut somebody's clothes off outside of the ambulance. Just for the fact that people have cell phones and video cameras.

Allergies? Specifically to aspirin or nitro. Any cialis or Viagra in the last72 hours? Any nausea? Rate the pain on 10 scale. Let's get him on the stretcher and on some oxygen. I would also be moving toward the ambulance and get a line in him.

NYS Medicare only requires 1 set of vital signs. They require the following: HOW the patient was moved ie: walked to stretcher or if you state the patient is unable to ambulate, they were moved to the stretcher using bed linen, then at the receiving facility..they were moved from the stretcher using same linen or stretcher linen. They also want to WHY the patient is requiring an ambulance, ie: patient requires ambulance transport because of hx of right hip fracture and needs stretcher for positioning for pain, or patient has a hx of dementia and requires supervision during transport. We use the Zoll EPCR program. It's customizable to your services needs and helps shorten your narratives so you dont need to repeat v/s, medical history etc into your narrative. All our signatures are in the database so we don't need to sign them.

I use denies/ed all the time to cover my pertinent negatives and never had an issue. As for spelling, I had some co-workers whose spelling was so bad that a memo came out lol. Spell check is thier friend but it usually catches words that are spelled correctly, but doesnt recognize. If the QA person has an issue with the denies/ed word then I would worry about it. Write your charts like you always have.

Here in NY, a fatality is left where found. I would do what I can for the living patient. Depending on entrapment, I would assume c-spine control and talk to the patient. They may be unconscious but they may still hear you. Once the fire dept gets there, extrication can take place and the patient can be backboarded. Hopefully by then the ambulance will be there and can take responsibility for the patient and get them to definitive care.

I know a few EMT's that recerted this year and they were saying that this years EMT test was by far the hardest they have ever taken. They said it was asking questions about blood sugar and such...which was kind of strange to me because EMT's in NY cant ( well arent supposed to) check a blood glucose. The state has changed the test question pool and is requiring EMT's to know more...which isnt a bad thing really but in practice is giving them problems in testing. I'm sure you did fine

I dont think he needs the Lasix but its part of our protocol and I would have to ask to NOT give it. In this case I would tell the Doc whats going on, how the patient is presenting to me and ask if he wants me to give it. If not, I'm cool with that. A KVO rate on the IV will get him some fluid, however I dont want to make the problem worse by hosing in fluid just because I can, for which the ED will be giving triple the Lasix that I would to help get rid of it....

As chbare stated, we can inline the neb treatment. I would do the CPAP and a NTG sublingual and call med control about some Lasix. NTG and Lasix are in our protocol but with the absence of peripheral edema and still tight lung sounds I would ask the Doc about the Lasix. I would be still trying to get a line in him, but he doesnt need the fluid, so it will a KVO rate. Once I've gotten that done, I'll worry about the PSVT and see what happens with him as the CPAP starts to work. His work of breathing should greatly diminish once he stops fighting the machine. If this is pulmonary edema, and the wheezes being heard get to sounding like rales, the CPAP is whats gonna push the fluid out, and he SHOULD stabilize. Then again I could be off in the ditch too lol

The problem with "relocating" is you will have to deal with existing organizations in an area. Where are you? and where are you looking to try to relocate too? Without knowing the answers to these questions, maybe a merger would be an idea. Just a thought.

Since the daughter is so indecisive about what to do and is stating that she wants the minimal done....how about CPAP?? His problem is oxygenation. His SPO2 will dip a little more on the CPAP before it gets better however he will be getting more o2 with the CPAP. Its non invasive, which is what the daughter wants. It needs to be done like...5 minutes ago or he will be going into arrest. We've already thrown everything we can at him minus meds. If we can turn him around on CPAP...awesome. And we still have the option of intubating if it doesnt work.