JPINFV

No tenderness in the joints of the right hand. The patient isn't slurring his speech now [maybe last night], has no twitching, and does not have any trouble chewing. The paralysis came on sometime between when he started drinking last night and today when he woke up.

The ad bar is trying to tell you something...

At least I know I'll be accepted someplace... /as a pollock, I should have picked up on that sooner... [hr:3398313431]

Ah, but the Code of Hammurabi are also found in many court houses [along side the 10 Commandments many times], including the US Supreme Court Building. I highly doubt that a large number of Hammurabi's laws are currently in effect in US Law.

I've got a better one Dust. 70 y/o female with shortness of breath (reps around 40, A/Ox4) utterly refusing transport to the nearest ER [she wanted as far away from that nursing home as possible]. It's one of those obvious ALS calls, so since she's refusing the nearest hospital I end up going to call 911 to get an ALS response. I swear, I wanted to smack the 911 dispatcher. Hi, I'm with ___ Ambulance Company, and I have a patient that needs a paramedic escort [actual term used in the protocol is "paramedic escort"]. "Well, we don't do paramedic escorts, only responses." Durr, ok, give me one of those. "Is the patient breathing?" [resisting the urge to tell her that if she wasn't then I'd have better things to do than sit here talking to you] "Yes" "Is the patient turning blue?" [Ok lady, I know that EMT-B courses are easier than baking easy mac, but give me a friggin break here]. "No." "Ok, paramedics are on the way, will you be meeting them in your ambulance?" [standard question, no complaints] "Yes, can I get an ETA for paramedics?" "They're responding with their lights and sirens." [thanks for totally answering my question and have a nice day].

The hand is warm with a strong pulse of 90 beats/min[blood pressure is 130/76 mm/Hg with resperations at 20 ]. He's complains that he can't feel anything in the back of his hand and forearm. While he can move his arm, he can't seem to get his wrist to move. With significant effort, though, he is able to weakly extend his fingers. He doesn't really have a clear memory about what happened before he went to sleep, but he doesn't have any noticable bruising, tenderness, or deformaties. There is some reddness in the right axillary region. He denies taking any medication since waking up.

You and your partner are ALS. You find the patient sitting in a chair. His eyes are reactive, even if a tad sluggish, and bloodshot. A slight whiff of alcohol reaches you, but it's not strong. He appears on the outside to be in good health by having a normal build with no noticeable skin lesions. You do notice, though, that there is a decent splotch of half dried vomit behind the chair. His friend, the one who called 911, states that when he woke up he wasn't able to move his right arm below the elbow. "I'm not sure whats wrong, but I didn't wanna *hic* risk driving him to the hospital."

20y/o male complaining of sudden onset paralysis to right arm. Go. Edit: note: The EMT-City Super Ambulance is not in play, yet.

I fail to see how compartment and crush is mutually exclusive.

While not trying to be too nitpicky or too far off topic, I think the problem with the Ten Commandments is that it is both a religious symbol and a historical legal symbol. It is the latter which gives it credence to be in a court building. It would be different, for example, if someone was trying to put up a monument to the Beatitudes instead of the Ten Commandments in a judicial building.

Similar rules applied in California. There was no occupation exemption besides police officers (but you could freely reschedule once, twice if the jury managers are nice), but financial hardship, required to care for a family member, living out of state/county, etc all qualify for exemption. There is also a phone system, but your required to be 'free' for a week if you choose that option. Besides that, the rule is 1 day/1 trial. You can only be required to report once a year and a trial gets you off the hook for 3 years.

I've only served jury duty twice, and both of those were in Southern California. California doesn't pay for the first day. After the first day, you do get a rather small sum of reimbursement as well as a travel allowance. Both of those, though, still require you to be actually brought back after the first day. Both of my two summons ended with the majority of the jury pool being excused either before or at lunch time.

The problem with declaring it a "right" is that it's a "right" that demands work from someone else. Let's look at another right [at least under the US constitution] that people hate 99% of the time. Jury duty. How many people love getting that jury summons notice in the mail? Not many. In large part because people don't want to be sitting around not getting paid. Similarly, providers are not going to be happy providing uncompensated care and people, especially tax payers [top 50% of wage earners pay 95% of all federal tax revenue], are not going to be happy paying more taxes. As far as billing, who decides which procedures and treatments are deemed a necessity? If someone has money, shouldn't they be able to devote more of their money to healthcare and receive more services and bang for their buck then someone who places less of a priority on healthcare? What about people who engage in high risk activities ('extreme sports' or legal drugs like tobacco smoking)? Shouldn't they be expected to provide for their own care when that care is needed as a result of their activities? Alternatively, why should my tax dollars go to pay some smoker's COPD bills? Finally, why should we let the same government who can't control the borders or provide appropriate staffing for the Department of Motor Vehicles decide who gets what care when?

I guess another "option" would be to develop some sort of disposable gown top that they could wear on calls. This would be disposable and replaced after every call and should satisfy both the need for protection for the patient and modesty. The provider should cover the costs of this though.

Yea, I'm sorry here, but patient protection comes before any "rights" you have to free practice of your faith. If you don't want to bare your arms, then go work in psych or podiatry.

Too bad Captain Ramsey was completely out of line in the referenced situation.

Pass off responsibility :?:

Yes.

No air ambulance was included in the original post.

Ok, assuming worse case scenario, what are paramedics going to do? You can only infuse so much fluid before you flush out enough blood cells that the fluid level becomes meaningless. So, you've waited the 2 hours with him becoming hypothermic and bleeding out through any hole before the machine, and now you've still got a 2 hour drive to the hospital.

Same way whole communities get away with not providing paramedics. Money.

Transport immediately with bilateral tourniquets. Sure, saline would help keep his pressure up, but your going to disrupt clotting and dump his hematocrit at the same time. Also, wouldn't you be concerned about crush syndrome in a case like this?

Burn? She's a witch, BURN HER, BURN HER!

Thank you for that realization. Saying that the system is broken doesn't mean that the people who work under the system are necessarily broken.

Commercial ice packs and properly knoted ice bags shouldn't leak for the cardboard splints. I don't actually have a solution for air splints though.