JPINFV

I don't think we can "diagnose" a lot of these patients. There's enough controversy in psychiatry already about some of the illnesses and how to diagnose. How can we be expected to differentiate between bipolar, schizoaffective, schizophrenia, etc including all of the subtypes. Is the patient manic or hypomanic (difference between bipolar 1 and 2)? Is this patient suffering from schizoaffective disorder: Bipolar type, or schizophrenia? In my research group, every patient has to see a doctor before testing, even if we've tested them before. They might have been diagnosed with one disease the last time we've seen them and now a few months later be diagnosed with something else. I don't think that there is no one way to treat psych patients. I have as much disdain for the "every psych patient gets restraints" method of treatment as for the "every patient gets O2" method of treatment. Restraints should be an option, but not an automatic. Just because they have a medical problem doesn't mean they lose all of their rights, even if they lose some (patients on holds, for example). I believe that basic education does a great disservice by not requiring clinicals in psych units and not really teaching the differences between the diseases. My EMT book covered psych illnesses in less then a page. There is a point where the medical provider has to move from being friendly and passive to being in control. Example: Psych transport from a local ER to a dedicated psych hospital. The patient (17 y/o male), diagnosed with schizoaffective disease is being accompanied by his mother. Personally, I don't mind family members riding in back with the patient most of the time (there are exceptions, though). The patient started changing from an apathetic mood to a more depressive mood with some hints of rage. The mother basically told him, in not so many words, to calm down and shut up. The kid calmed down. see above...

It's a unit that's on for 24 hour long shifts. My company schedules most shifts in 12 hour blocks, but we do have 3 24 hour shifts each day. The unit with the LBS boards is given calls like a normal 24 hour car but in the rare cases when the extra surface area is needed then this unit is dispatched.

One of our 3 24 hour cars (all 3 of the 24's are in type 3's) is equipted with a Ferno Large Body Surface (LBS) board that can be added to the gurney. Unfortunately we don't have the LBS mattress to go with it, so I imagine that the patient won't be very comfortable. We don't have any ramps or anything, but we do send lift assits if needed and will automatically send several crews for patients with scheduled calls (dialysis, wound care, etc). The 24's are also upgrading soon to power cots making it easier for the crew(s).

1. There is no reason to yell. Use some ATP and hit the caps lock button. 2. protocols!=differential diagnosis?

Depends... (damn 0.4 mile discharges... I still think they should just build a giant pneumatic patient tube system a la Futurama.

King/Drew= Martin Luther King, Jr./Charles R. Drew Medical Center (The latter half comes from the attached medical school). King/Drew is possible the worst, and if not it's near the top of the list, hospital in the country. The LA Times did a 5 part series n 2004 after the hospital was cited by JACHO for serious lapses. Due to numerous violations, the hospital was put on a provisional certification with JACHO visiting numerous times. The hospital failed a final "make or break' inspection and lost JACHO certification (they needed to get a perfect score, but failed in 9 categories). This put the residency programs in deep trouble and forced CMMS to withhold funding. Losing medicare/medicade [techinally Medi-Cal] funding costed the hospital about $200 million dollars [i failed to mention, the hospital is between two lovely areas known as Compton and Watts. This is kinda of your high cost-low pay customer base], about half of its funding, basically forcing the hospital to close. My limited understanding is that the hospital is firing everyone and forcing them to reapply for their jobs. Oh, and the hospital is going from 252 beds to 42 and management is being turned over to Harbor-UCLA medical center. Link to the LA Times article. http://www.latimes.com/news/local/la-kingd...51.storygallery

The only thing that will do that is a required internship akin to a medical residency. Not this 'do 1 or 2 ride alongs and basically observe the what the basics/paramedics do' crap. A "you will spend the next month or two working with certified basics being a basic (assessing, treating, documenting, etc) as an integral part of a team, not as an observer that will be there for 1, maybe 2 shifts."

Article on how tasers work. http://www.slate.com/id/2154253/ Difference between taser mode and drive mode: -Slate article linked above

^ A little background on that video. According to news reports, UCLA student Mostafa Tabatabainejad was at the university library after 11 pm. After 11 pm, the library closes to non-students and the community service officer (student volunteer) watching the library is supposed to do random checks for student IDs. Mr. Tabatabainejad either refused to show his ID or didn't have it on him (which, being a 5th year student at UCLA is a smidge stupid. He wasn't a freshman that was ignorant of the rules) and then refused to leave. The CSO contacted the police. There is some controversy on whether Mr. Tabatabainejad was leaving at the time the police arrived, but what is known is that he decided to smart off too the officers and "peacefully" resist. After refusing to follow police requests, the police decided to use the taser on "drive" mode to gain compliance. Basically the taser became like a cattle prod. In this mode the taser doesn't fire probes, but shocks the subject with a shorter and weaker shock then the mode used to subdue a subject. I will be more then happy to provide commentary on this subject if posted in the non-EMS section.

One that knows how to do a good physical, take a good history, be able to use all of the tools provided to them, and improvise as needed, but also understands why the patient presents the way they do and how their treatment changes the patient's enviroment (internal and external) to bring about the desired affect.

I'll disagree with this one. Sometimes the only way to reconize and fix a problem is for an outsider to see it. A new person just has to pick their battles wisely or bide their time for a bit. While I agree with "if the trash needs to be emptied, take it out," I disagree with the notion that someone should ask someone else to do it unless they are engaged in something important (playing pool or watching TV doesn't count) or there is a set chore schedule. Talking on a cell phone is bad, how again, as long as it doesn't detract to reponding to calls, providing medical care, or doing chores?

Why not just write a standing order for D50? (I actually had a discharge to a SNF where they didn't remove the saline lock because of such an order. I was honestly shocked).

Simple, the federal government is very limited at what it can officially do. Most federal "laws" operate under the interstate commerce clause of the constitution [federal government can regulate trade between the states] or by using the "power of the purse." A non-medical example of the "power of the purse" would be the drinking age. Why is 21 the age to drink at in the US through out the nation? Because the federal government will withhold highway funds otherwise. How is HIPAA enforced? Simple, if you don't comply then you get fined. If you refuse to pay your fines then you don't get medicare/medicade payments. Lose medicare payments, you go out of business (example: King Drew Medical Center in LA finally lost its JACHO cert causing it to lose medicare payments, causing it to lose about half of it's operating budget, causing it to drastically downsize and be taken over by Harbor-UCLA medical center). Complying and paying fines is worth receiving medicare funding. If you don't believe that the federal government is very limited, then take a look at some of the laws that have been struck down as being "unconstitutional." A perfect example would be a federal law banning guns on school grounds (unconstitutional because the government can't regulate what pupils can bring on campus, not because of the second amendment).

^

Simple, most nursing home patients. In my experience, most nursing home patients who actually need a hospital should be a direct admit and only see the ER as they are being rolled from the ambulance bay to the door to the hallway.

Tax breaks for the company and tax write-offs for the donator. That said, Google is experimenting with a "for profit" charity so that they can get around some of the rules that limit non-profits.

Well, good thoughts won't pay for gas or supplies. Does anyone know why non-profit hospitals can bill for services but non-profit ambulance services can't? Just because something is non-profit doesn't mean it can't make money. A non-profit hospital by my house is firmly in the black, which is why it was able to build another 7 or 8 floor tower to expand services, already has plans to expand it's ICU with a third tower (the hospital already had a 10 floor tower), and expand its ER (which has one of the highest number of patients but one of the lowest number of hours on divert).

She would disagree...

Well, the youth in Asia were babies not too long ago, what's wrong with that... /going to hell //Window seat please

Hablo poco espanol, pero comprendo la frase arriba.

Learn to use your medial geniculate nucleus...

Because there's only one way to count reps?

The point about DNRs was in regard to being here "to save a life." No one should be here to "save a life" when the patient's wishes, via an advance directive or a surrogate requests otherwise. How about cases where the patient's surrogate makes the decision to withdraw lifesupport? Besides, this decision (life support for babies who did not achieve 22 weeks of gestation) isn't a decision made by the doctor but a recomendation provided by the doctor. Science should always trump emotion.

From what I read of this it does not seem like it is a unilateral decision of the physician to cease treatment. It is a joint decision between the parents and the physician with the recommendation that these patients who have a next to nill chance of recovery without major disabilities. It looks like it is similar to the recommendation to cease treatment of patients in a persistent vegetative state. In terms of saving a life, I am not here to save a life. I am hear to abide by my patient's wishes. Normally the idea of life saving and medicine goes hand in hand, but people do fill out a DNR for a reason.

Online medical control in my county has a tiered approach for online medical control. Paramedics make base hospital contact to Mobile Intesive Care nurses (MICN) at the base hospital. Some procedures/drugs can be approved by the MICN while others are passed by the MICN to the base hospital physican.