Asysin2leads

As a follow up to my own thread, I recognize that the federal government does establish provisions for bail bondsmen and their agents to pursue and detain fugitives, but that still does not give them any special authority towards medical care unless it is somehow stipulated in the bail agreement.

From a medico-legal stand point, this how it would play out. Let's say I arrive on a scene and find a person claiming to be a bail enforcement agent with a person who say, has a head laceration, in cuffs, who is requesting medical attention. From a legal stand point, I would see two civilians, one in need of medical attention, and one bystander that would be raising some red flags in terms of scene safety. I would request PD response immediately. While awaiting police response I would attempt to assess and treat the patient in the best manner I could. If the other civilian attempted to interfere in anyway, I would inform him that he was interfering with my patient care, which could result in criminal or civil liability on his part, and if he persists and the patient dies as a result of it, he can be charged with a crime in preventing the timely rendering of medical care. Hopefully by now the police have arrived. I would let them take it from there but request they escort the patient and myself to the hospital. If the bystander wishes to accompany us, as is our policy, he may, provided he does not interfere with patient care. If the patient does not wish the bystander to accompany us, than the bystander will need to find his own means of transport to the hospital. I operate in the realm of federal, state, and city laws. Bail bonds are a different entity. Bail bonds are a contract between two civil parties, which has nothing to do whatsoever with me. If a police officer wishes to place the patient under arrest for failure to appear, then he may, but if not, the cuffs come off, and the patient is a patient, because otherwise if I left the cuffs on, it could be a liability to myself and the police officer as well. In my mind, unless properly placed by a sworn, trained law enforcement agent, handcuffs are the same as a piece of rope, electrical cord, or tape, that may be binding my patient's hands. In other words, a bail bondsmen and his fugitive are no different in terms of approach and treatment then a dominatrix and the guy chained to the bed.

IF this what was really going on, and it wasn't a case of tweaking reality to suit our needs after the fact, then I'd say this person had good intentions, but went about it the wrong way. Unfortunately, its is an on going problem in EMS when directors and administrators turn a deaf ear to the concerns of their employees, particularly when it comes to a person with poor job skills. So long as the calls are getting done, they'll turn a deaf ear, no matter how unfair it is to the person who has to pull the slack.

Bail Enforcement agents are known by another name. Civilians. Treat them as you would any other civilian. Nothing more, nothing less.

911, first let me say that I think you performed very well in what sounds to be an emotionally charged situation. In addition, it is commendable that you focused on aggressive airway management in the pediatric patient. I'm not sure if this child ever truly was apneic or lost their pulse, it sounds like the child may have simply been postictal for a prolonged period... kids do a lot of strange stuff when they're posticital, turn blue, mauve, etc, but in any pediatric patient aggressive airway management and breathing support is key. Another tip for success in EMS: Don't say frothing at the mouth. Only rabid dogs to that. This is known as excessive secretions which you handled appropriately. Secretions. Not frothing. Kat, the reason the hospital probably didn't call for air support is that generally speaking, cardiac arrests don't get flown. They get pronounced. Many if not most air services will not fly in if its a confirmed cardiac arrest.

I know we've discussed this a few times, I believe I even may have asked this before, but after much researching and much printing out and phone calls, I was wondering if anyone on here can give me a simple direct answer about provinces in Canada (in particular British Columbia) using National Registry Paramedic as a basis for PCP or ACP certification. Can anyone on here just give me a simple yes or no answer? And if yes, where is the best place to start?

Mandate that all kids join the armed forces at age 2? And what if you don't want your kid to be a soldier? What if you want him to say, a farmer? And how did it go from kids getting their feet burnt to anti-depressants and the ever present "In my day, etc. etc. etc." I realize its an election year, but try to keep the flag waving and apple pie baking to a reasonable level, huh? I saw the pictures in the paper two. A toddler with second degree burns on his feet has nothing to do with hitchin' up yer belt and bein' a man. Especially when you're a kid.

If EMS is vain, what in the fuck does that make Fire then? Christ, sometime I think fire engines are powered by ego and machismo. Oh, and as for paragods? If it wasn't for paramedics EMT-B's wouldn't have a job in the first place. So quit your bitching.

Long. Very long. EMS is expensive to maintain, therefore EMS services will try to have the minimum amount of staff necessary, which makes for long shifts. In addition the fact that your co-worker's last job may have been emptying the dumpster's at Chuck E. Cheese's means many a person not coming into work. If frivolities like a house, a car, paid bills, and perhaps a dog are things you enjoy, making a decent living as an EMT is a pipe dream. If living with your parents or in a trailer next to the local meth dealer is okay with you, then you might be able to eke out a living. Given the amount of training, the level of responsibility, and the level of stress of a typical paramedic, the salary is no where near what should be paid. However, if you find the right service in the right area, you may be able to get the house, car, and dog setup, but don't be surprised if you have to move to an area of the country you have never heard of to get it. Surprisingly, the answer is no, which should say a lot about the profession in general. Most EMT courses include an 8 hour segment on driver training, which may or may not include cheesy videos from Driver's Ed which you can feel free to fall asleep during. If you don't have a few years of driving a car in normal conditions, driving a several ton vehicle in emergency mode probably isn't a very good idea. If you are going to do this as a real job, you should be able to lift and carry 50% of the weight of 90% of the population, which of course depends if you live in the heart of Double-Cheeseburger-Butt-Land or not. Most EMS systems run two people to a truck, and employers and patients generally don't like it if you are called to bring someone to the hospital and you are unable to do so. "It never hurts to help!" ---- Eek the Cat

That all depends on the word "hit". Was it a case of clipping an overhanging sign with the box or catching a mirror? Or crunching one with the bumper or grill when pulling into a parking spot? I ask because usually signs are not sitting in the middle of an area where you drive. In other words clipping a sign can happen. Hitting a sign that was up on a sidewalk shows a lot more carelessness.

And if I give someone directions, maybe I'm aiding a kidnapper in finding an escape route? Or if I hold the door open at the ATM, maybe I'm aiding a mugger? We can quote hypothetical situations all day long here.

I'm a person of the "mistakes are preventable" school of thought. Of course, mistakes do happen, even to the most seasoned and skilled provider. Giving the wrong medication isn't like missing a line or missing a tube. There is a reason that someone drew up the wrong medication and gave the medication and while understandable, it still needs to be addressed. Obviously somewhere in the medication administration area, something broke down. Did the person who drew it up not hear the order correctly? Did they reach for the wrong vial? Did they misread the label? Why did the second person confirm the medication correctly? This is where remedial training comes in. I'm sure the provider knows how to identify, draw up, and administer a medication. However, when situations like this occur, reinforcing the procedure is sometimes what is needed to increase the diligence of the provider. If it is simply blown off, you don't learn from the experience, and if nothing else, the pain in the ass of going to remedial training maybe the positive punishment needed to modify the behavior, or at least that's what my friend BF Skinner told me.

I agree with Rich and the others. I heard the adage once, "In EMS, mistakes are tolerated, laziness and dishonesty are not." In other words, if you make an honest mistake, and you admit to it, it will be far better than if you lied or were doing something not on the up and up. I'm not saying there won't be consequences. But the consequences will be far less severe if you admit it and document properly, rather than try to cover it up. Almost without exception both medical directors and supervisors appreciate a crew that tries to do the right thing after a mistake occurs.

The really unfortunate thing about this incident, not that mediccjh fearing for his safety isn't bad enough, but also, the news report I saw stated that Northeastern University (which the students were from) would no longer be sending their students there. Up until this incident, Northeastern University had a great relationship with both UMDNJ, where the incident took place, and the FDNY, where I have personally precepted many of these students, who are almost without exception really top notch. So now future generations of Northeastern students will no longer the experience of working with the UMDNJ crews, and get some of the best EMS training in the country, along with three paramedics at UMDNJ losing their jobs, and the remaining ones like mediccjh now having to fear about harm coming to them. Stay safe, mediccjh, and if it gets too bad, take some sick time.

The problem is that people have no sense of context or setting anymore. The poster of that comment was saying something in jest that while it might elicit a laugh in the squad room or at the local watering whole, when held up to the light of day for all to see it is horrifying. I'm not sure what it is about Fire and EMS that gets people so sucked in to their own world that they forget what the rest of the world is like. Maybe its ego, maybe its stupidity, but if you're talking about your profession on the internet, don't write anything you wouldn't want your mother to see. Although I'm not one to talk, really. :-D

Chris, are you from New Jersey? Just curious.

Sedate, intubate, decompress, board, collar, transport, bilateral NS rapid infusion PRN. Get patient to surgery in quickest fashion possible.

Our standard operating procedure when being physically pushed by another agency is to say "Shove me again, asshole, and I'll stick that halligan up your ass sideways. Now give me back my gear and go pose for a photo." Or something like that.

Wow... HULK NO LIKE CAR ON WOMAN! HULK LIFT CAR! HULK GET BILLING INFORMATION! Hee hee. In all seriousness, my hat is off to the firefighter mentioned here. Good job, brother.

Do you work as a paramedic? Really, just asking. Show me the selective hiring process that can size up an individual's capabilities better than their overall academic and employment record and I'll get you an article in Forbes. I would like to talk to these PhD's and ask exactly how they finished their dissertation and multiple thesis paper if a coherent e-mail is beyond their reach. For a person with multiple backgrounds in different academic fields, you really seem to have missed the whole building block part of the sciences. Learning math is not about drug calculations. Learning math is about understanding at least pre-algebra, so you can understand chemistry, so you can understand Anatomy and Physiology, so you can understand pathology and pharmacology. There is this mythos about the doctors who maybe all good with that pointy headed stuff, but can't done do a math calculation, to which I reply, if you give me an attending physician, maybe in the middle of doing his multiple daily tasks he will have problems doing a drug calculation immediately in his head, but that doesn't by anyway mean he never learned basic math skills. Despite drug reps, pharmaceutical kickbacks, and Cialis commercials, medicine is supposed to be about doing right for the patient, not selling them something. Sure, I can be like many start an ambulance companies, buy some shiny looking ambulances, get some eager young and pretty people to put on them and throw some pieces of official looking paper at them to proudly display to anyone who asks, and then offer maybe a plasma screen TV or stereo give away to increase 911 calls, but at the end of the day, there would be a lot of people who did not get the care they needed, and a lot of people would suffer, because I'd have people getting the wrong care by pretty people in pretty ambulances, and they would suffer so that we could make a buck, which is definitely not why I ever got into this field. BTW, exactly where are you that your MD's can't do simple math and your PhD's can't write coherent sentences? I'd like to have a chat with your local colleges academic standards boards. See above. Some of us believe in actually helping people properly, rather than drawing the bigger check. BTW, I was thinking of toaster oven giveaways to each new admission at the ER. We could slap some stickers about healthy eating or some crap on the side and bill the hell out of Medicare for it. Whaddya say?

No adult person likes to be emasculated... or whatever the feminine equivalent is. This guy was a fireman, as he stated several times. Think of this guy's life up to this point. Not only does he honestly believe he is in some sort of hero role, but the other people around him, particularly his family, believe the same thing. So what happens when all of a sudden there is an emergency, someone needs help, and he can't do anything about it? Is he going to sit back and just tell everyone up until this point the limits of his training and capabilities? Not by a long shot. The big fireman was panicking and it was how he was expressing himself. Don't take it anymore personally than the dog who bites you while you're trying to help its puppy. These whole scenarios are why I think its important to emphasis Fire/EMS as a career rather than a lifestyle role, but 1,000 T-shirts from Galls are working against me on this.

Any good course should give you some good preparation for the field. Any instructor who says something to the effect of "Throw everything I just said out the window... etc. etc." taught a lousy class and you should get your money back. In scenario testing there needs to be a standardized way of making sure key points are hit, skills are performed properly, and appropriate questions are asked. Unfortunately, at the EMT level, since understanding of concept is not able to be adequately taught, rote memorization is strictly enforced. Since a scene is dynamic and changing, so too does a provider's approach to a patient. The real problem is that there is a big difference between a provider who adapts his assessment and treatment procedure to the needs of his patient, and one who believes that there is some kind of mystical street skill set that takes precedence over proper education and practice, and the two can be very hard to differentiate between. Case in point. Today we had a call for through Lifealert for a person with a known diabetic history who sounded disoriented on the phone. Upon arrival we found him extremely lethargic and nodding off but able to answer questions. He responded to verbal stimuli and I placed an NRB on him. I asked him if he was a diabetic. He answered yes. I asked him if he took his insulin. He answered yes. I asked him if he felt like his blood sugar was low to which he answered yes. I then directed one partner to take a blood pressure and attach the EKG while I set up for an IV and prepped the D50. After administering the D50 he became much more active, his skin color returned to normal and he was his old self. Everything else was normal on him. If I had run a call this way in testing I would have failed, and failed badly. But it was the appropriate thing to do for this patient. I hope this helps with your question.

I guess the big question in my mind is if she is experiencing anaphylaxis or not. A big heap of cinnamon could set off a reaction even in someone who had no previous incidents. So her heart rate is up, and her saturation is down. If she aspirated, I would treat as any other aspiration pneumonia, High flow 02, monitor airway, transport. Her behavior, heart rate, and Sat don't quite match. If she was tachying out in the 140's with a sat of 90, I think she'd be looking like crap at that point. Rule out possibility of drug use, search house, use bright lights and telephone book if necessary. Just kidding. The differential here for me would be aspiration vs. anaphylaxis. Other than she is just stupid and deserves to be stuck in the ER for a few hours with an IV in her arm. And if the the local FD needs some press they can feel free to dramatically rush her out the front door with an NRB on, and the local press could do a good scare the parents what YOUR teen is doing the latest craze thing on next.

Wait, so, the FF/Medic wanted to try pacing but couldn't remember how to do it? Cardiac pacing isn't just something we try for the hell of it. ACLS has pretty clear guidelines as to when to reach for the pacer and when not to, and most regional EMS protocols also spell out when to do it or not, and I was under the impression that using the cardiac pacer was a standard skill set in most paramedic services. Is the LAFD rockin' the ganja again, or what? Hee hee. Anyway, cardiac pacing is easy and fun. First you need a patient who is unstable and bradycardic, and you should probably already have gotten in your first line drugs. 0.5 of atropine, and a dopamine or epinephrine drip if you're feeling frisky. Next, you should attach the pacer pads, which conveniently enough should also be the defib pads. I am not sure what the exact technicalities of the Zoll's monitor is, but the medic should have known, but basically you set the rate of pacing, we pace at 80 bpm but you can set it at what you want to, then you dial of the voltage until you get capture, which should look on the EKG like a pacer spike with a corresponding QRS complex, and more importantly, improvement in hemodynamic function. Our standing orders are to dial it down until you lose capture, then fine tune it to the lowest voltage setting, but so long as you have capture you should be GTG. Oh and its also good to sedate the patient before zapping them through the skin repeatedly.

For every inch of a step we take forward, guys like KSEMT send us back back three yards. Thanks, buddy.