JPINFV

My company has a few non-dedicated units with isolette lifts for use as backup for our dedicated children's hospital units. I've heard that those lifts could be used as a gurney lift as well, but I've never seen it put into practice and the lifts look too small for a full size gurney.

Are we talking survival to discharge or ROSC? Not that it matters, because CPR is not exactly brain surgery. Heck, I might as well put that I've never lost a patient as an EMT in my resume.

^ That is, of course, dependent on local protocols. As far as ER notification, that is done through the company's dispatch center in my county. As long as EMS is goverened differently in each area/state/company, terms such as "never" or "always" to describe situations in other areas than the one you work in is a bit dangerous because each area is so different.

None, but really, what is there to ask for at the BLS level? Not knowing local procedures is not a reason to pass things up to medical control. If the patient is critical enough to warrent a base hospital consult then BLS should be doing 1 of 2 things, calling for medics or transporting.

While I can not speak for his location, but there is no online medical control locally to me for BLS. It's not so much a "not allowed" as 'there is no mechanism to do so BESIDES calling for paramedics.' Since the hospital is in a lot of cases closes then the paramedics anyways [since 911 is always an ALS response], there is no way to make base contact prior to making the transport/call ALS decision.

[/me remembers that we're supposed to be focusing on Hx] Has this happened before? If so, under similar conditions? Can he give any indication to what sort of neurological history that he has? Has he ever seen a mental health professional?

Hehe, advice? 1. Check your emotions at the door. While, yes, pinymayu's pictures are funny if you aren't on the wrong side of his posts, it does not help if you're all rallied up about them [i've been on that side before. cough CVA thread cough]. You WILL NOT be able to defend any argument you make if you're more emotional than Rosie O'Donald after being kicked out of a candy shop. 2. Understand that not all sick patients need a hospital. This is when entering into a professional conversation with other members of the patient care team [which, by providing transport, emergent or scheduled, you are a member of] is important. So your dialysis patient is bloated with crappy lung sounds [for example]. Well, maybe what the patient NEEDS is dialysis. By transporting the patient to a place other than the dialysis center, you are actually delaying the care that the patient actually needs. Another example could be a patient being discharged that is in obvious respiratory distress. Talk to the staff, the staff recommends a breathing treatment and calls RT. RT administers a breathing treatment [which can also be done in a nursing facility]. Patient is not breathing much easier. You transport without incident. Again, as my earlier post stated, it is not the responsibility of the transporting crew to determine if the patient is stable. That responsibility lies on the man or women with 8+ years of post secondary education and several years of on-the-job training [residency], not the person with 120 hours of advanced first aid training. [for the record, I'm an EMT-B]. 3. There are only 2 times that you should "refuse" transport. 1. Unsafe situation. Violent psych patient is not "unsafe," it's an accepted risk. Have staff sedate if need be, put patient in 4 point restraints, transport. I honestly believe that most EMS assaults, especially interfacility psych transports, happen because either the transport crew were assholes or stupid. If the patient might be anything approaching dangerous, talk to the staff. Furthermore, DO NOT TEASE THE PSYCH PATIENT. I like happy psych patients. They tend to be fun to transport. I do not like angry psych patients. I do not want, and will not, act in a manner that makes a happy psych patient into an angry psych patient [use of restraints, if deemed appropriate, is an exception. They can be as mad as they want in leathers]. EMTs that do that deserve what they get. 2. Patient requires an ongoing treatment that you can not provide. Other arrangements might need to be made, either with a member of the hospital staff riding with you [example from my company would be a CCT of a patient that requires a balloon pump. The hospital has to provide a tech to run the pump], or with a company that has a CCT program.

Err, nursing staff do not order discharges. I guess "unstable" depends on what your definition of "unstable" is. Hospice discharge of unstable patients is common. Some conditions can be cared for in lesser settings. It is not the job of the EMT to decide if a patient is "stable" enough for transport. Sure, make sure that there is no on-going treatments that is out of your scope of practice, but other than that, it is not your job to determin if the patient is "stable."

Just making an observation. Any other conclusion and you're reading way too far into my post.

^ Hmm, I wonder who the newbie that posts a lot of pictures is... 8)

Any medical history that he can tell us, especially cancer or neurological? Has he traveled outside of the country at all, either recently or not so recently?

What part of "involuntary hold" are we not understanding here? He was judged as being mentally unstable by a police officer, judge, or mental health professional and is being held AGAINST HIS WILL. It is a shame that they let people assist in the care of patients with mental disorders who do not understand that these patients will not act like everyone else. This is why it is called a MENTAL disorder. You wouldn't press charges against a violent trauma patient would you? There are 2 scenarios that I see as taking place. 1. The patient was mentally STABLE. The hold was unlawful and the patient is being falsely held against their will. You stand in his way out and are acting, regardless of legal liability, in conjunction with his captors. 2. The patient was mentally UNSTABLE. He was deemed to be, at least for the time being, unable to make his own decisions. If he was competent enough to make his own decisions, don't you think he wouldn't be under a hold than? 2.a. The patient was mentally unstable and has a long psychiatric history. He has been transported by your company before by some asshat EMT that thinks psychiatric patients are fun to screw with. You are a symbol of that company by wearing the uniform. You might not have screwed with the patient, but he probably doesn't care.] My advice, take your lumps and learn from it.

Err, what happens in your ambulance if the hospitce patient with a valid DNR crashes in route ?

[response is for both sets of quotes] Oh, I've transported a many psychatric patients. By far, the schizoaffective patients (SAD) seem to be the most interesting. It's always the SAD patients that have the interesting stories. Are mental health issues an illness? Sure. We're seeing more and more biological causes and effects from SAD, bipolar, schizophrenia, and a host of other disorders all the time. However, suffering from a mental illness does not always excuse one's actions. Since you cannot transport the mother against her will, you will need to contact the authorities to place her in custody. Scratch that. As I sad earlier, this is a case of child abuse [regardless of if it was psychotic in nature or malice in nature], at least in my state, and probably in most, you are mandated to file a report and contact the authorities. I was using it only as an example of a condition where a mother would be seen as unfit to care for her child. The fact that she ended up swinging her child I think pretty much omits that as a possibility.

Because, you know, ambulances transporting code 3 never get in any accidents. Nope, never. Unheard of. At least homeboy's homies probably aren't driving a heavy converted van AND the provider/local government isn't going to get sued when they get in an accident. Ambulance with any sort of government employee on board [cough fire based EMS] will.

^ I am not a psychiatrist. It is not my job to sit with the mother and ask her about her feelings and thoughts when the baby is my patient. Assuming it is depression, both the mother AND the baby will not both be in my ambulance. One or the other in a case like this. If it IS depression, then it still gets reported to local social services and the state. This way a proper evaluation is done and the proper actions are taken. There ARE mental illnesses that require children to be taken away from their parents for the childs protection. Munchausen Syndrome by Proxy is a very good example. Being psychotic [medical] and insane [legal] are two different things.

The problem is time. Look at it this way: [EMS] Person calls 911 Ambulance dispatch field treatment/packaging transport arrive at hospital Accident Homeboy's crew put's home boy in car transport Arrive at hospital [Homeboy Ambulance Company] Combine this with the numerous studies that show that code 3 transport on average saves very little time [statistically significant? yes. Clinically significant? Generally no] and homeboy's crew will win any race. They don't need to worry about onscene treatment, packaging, or anything else. It is a true "load and go" system.

AND Refutes that kids don't have super powers...

The only time I will ever "refuse" a patient that is not going to the ER is if the care required is out of my scope (of course we do have the ability to do RN or RT CCT units, so I will recommend that they contact for a follow up. Most of the time this happens is because of a communications mishap and the facility will cancel us (ex. Someone forgot to tell dispatch once that our discharge was a vent patient... they called back for a unit with an RT. They were only slightly amused when I offered to BVM the patient the 20 minutes to the destination ). Hospice DNR patients without proper DNR paperwork [yes, you need a physicians signature on that sheet. No, your face sheet that says DNR doesn't work. Hospice employees loves to take our DNRs with them or give it to the family] gets a stern warning that if ANYTHING changes, we will reroute to the nearest facility if needbe. This generally gets a copy the chart DNR real quickly. There has been once call that I should have "refused." I had a discharge out of a hospital once that was on lockdown due to a "bomb threat." They were supposed to bring the patient out to us [patient being discharged, not evacuated], but someone forgot to tell security that our patient would be waiting down in the lobby and was going to be brought out to us. Security outside couldn't find out patient in the lobby so they cleared us to go inside. The ER charge nurse was not happy that we were going to be passing through during a lockdown till the security guy walked over and cleared us. We got up to the patient's room to find it empty with the staff telling us that the patient was down in the lobby. :roll: In the end, the threat was fake, but you never know.

^ No! No Capes!

Treat the patient, then follow mandated reporter guidelines INCLUDING contacting local authorities, especially if there are other children in the parent's custody.

A few sayings come to mind: You can't please everyone all the time and you can't please some people any of the time. Don't put all of your eggs in one basket. 1. Are there really public places like schools in tornado county that does not have a basement? I don't live there, so I honestly don't know (I like earthquake country). 2. I am surprised that they don't have a system of waviers in place similar to lunch passes [passes allowing people with cars to leave campus and go home for lunch] for these events. 3. I am extremely surprised and concerned that they would deny a parent's request to pull a student out of school at ANY time. Unless the student is 18 or older, or an emancipated minor, the school should not have a choice.

When I came to the sad realization that I learnt over half the course as a boy scout. Hell, even in scouts we learnt a sorta of makeshift c-spine protection scheme if we had to leave a victim to go get help.

^ Just wondering, what level is Math 110? [100+ is upper division course work at my school]

^ That can generally be accomplished with a white board. 1 hospital (maybe 2) in my area (for the record, there are 20 hospitals in my area. We tend to find ourselves some more times than others. A few of them I've only been in once or twice in a year and a half.) has a fully digital ER bed tracking system. Most use some sort of white board system (one has a white board specifically for incoming patients. Another uses the main white board to track incoming patients). Bed assignments generally depend on conditions in the hospital and can change from day to day. For example, the hospital I used to volunteer in uses the main white board. Depending on who the "flow tech" is, the bed assignment might already be made prior to arrival (unit XYZ written in the slot for that bed) or the transport info (age, PMD, CC) might be just written on the board and circled in an open area [the system is neater than it sounds being described]. PM sent with the names of the specific hospitals...