medic53226

Whats going on is that we are using D50 to reverse insulin shock, and the pt not wanting to go to the hospital. So, we contact Medical Control, and they are not allowing the refusal. Causing the problem of patient refusing, and the doctor saying bring in the patient, but in Indiana that is kidnapping. So, our go is to make it better for the crew,patient and the doctor.

What is your policy on refusal of care, we are changing our protocols and just looking for ideals.

Trauma and OD's is the most common calls in my area, and meth abuse.

I would like for our basic emt's to be allowed to use glucometers prior to admin of oral glucose.

I would like some insight on how you fellow directors or supervisor would handle a problem that came about on a pt in my county. We had a crew respond to a accident, in which the pt was still alive and breathing on their own but shallow. The crew that found the pt decided to intubate, but pt was clinched. We don't have a protocol for RSI, but since he was combative they followed the that protocol and the respiratory distress protocol. However, 3 medics responded 2 on duty on off duty put on by the supervisor. The 1st paramedic on duty choose to have 1 medic give 10 mg of valium, which is in protocol but, the other two medics gave 10 mgs also so this pt got a total of 30 mg of valium. Due to the pts injuries the pt died at arrival to the trauma 1 hospital. My problem accures because as protocol medical control has reviewed, but 2 of the 3 medics have went to rival services, but use the same protocols. This is a vilation of protocol and the state has advised to inform the and we did, but little or no response. I would like your insight on how you may have or would handle this problem.

I'm sorry, It should read: Our narcs are checked at shift change and counted by offgoing and oncoming medics. Then logged in to our narc book. My question to all is how do you account for your wasted narcs, do you have your bls partner or does a nurse or doc have to witness. Thanks

Are narcs are checked every shift change and recorded, and counted in front on offgoing and oncoming medics. I have a question how do you was your narcs, when given and if they expire.

My system carries Fentanyl,Dilaudid,Morphine in our pain managament protocol. It is our choice on of which to give, except in chest pain only MS.

I would like your opions on this subject, and any info you might have. In our system one of the doctors, is saying that you should never use high flow O2 on anything. So, He wants the paramedics and emts to show him with medical documentation, that why high flow O2 is needed. Thank you for your time. Chad

All thank you for your replies and I'm sorry for the grammar, and this is my last topic and reply.

Shelbmedic, I thank you for your comments and I was not trying to say that the pt wasn't worth my time, and that I would check he out I had a new intermediate and that had had many runs since in our system medics take 90% of the run. The pt had no distress, and was AOX3, was evaluated by me before I got out of the ambulance and answer all my questions that I asked and at the present time of the run, I felt she had alot of issues, and that it would be a good run for him to learn on, and I at no time felt she needed monitor, with her intial assesment, because all of her vitals signs was stable and no distress, nothing, and also I don't consider ambulance runs taxi rides, I take pride in my work and I treat everyone with care and compassion, and as you said not to quote, and won't I check all my pts before anyone touchs them.

I was posting for a another unit that had a ldt, and was disp for a possible OD, Enroute as you all we try to asume what we a possible going to be faced with, and in this town meth is bad, and other illegal drugs. So upon arrival I was thinking that it was illegal or script OD. We found a 41 y/o male pt with a friend and she stated that he had taken 10 Lortab 10/500 with 30 Phenergan 25-50mg pills and chased them with ETOH. However, the pt was still AOX3, and said it had been 2 hours since he had taken these meds, so placed on the monitor, IV, O2 by N/C to start V/S stable, with no distress, just I getting back at my wife, so in the ambulance enroute to ER pt started to LOC, so I gave he a 1 mg of Narcan to start, and new full well what was to come, from my action and knowing that we don't have RSI, and have to have orders for intubation in this scenario, He got narcan just enough to keep him breathing, but also knowing that the phenergan is increasing the effects of the narcotic in Lortab. We as I though he woke up and proceed to kick my but while he was vomiting, what a thrill. So we get the pt to the hospital and have all his bottles, we find that he had just filled his lortab the day before and their was 180 lortab missing and with the phenergan, he also had vistaril, neurotin with the other meds so the drs figured that he had ingested the whole bottle he would have ingested 90,000 mgs of Acetamiphen, and 1800 mg of Hydrocodone with the phenergan, That has to be the most I think I have ever seen on pt take. I would like to know what you have seen and done for similar pts, and conditions. Thanks Chad

Thanks to everyone for you time and information, and I hope that this may help you someday, because I know that if you have been in this business for more than one day you have seen stuff that just puzzles the crap out of you. Another pt I had was checked by a EMS Director and passed to me as he is having a stroke he took no V/S, no BGL, just the FD told him the pt had a history of CVA's and that was all he needed. However the pt had a hx of diabetes and multiple other medical conditions, to say the least. By the way the pts BGL was 32 and after reversing the hypoglycemia, he started throwing couplets, and then VT, and he woke was complaing of chest pain. That at that time the wife stated he had been having chest pain all day before what she called his stroke episode. I wanted to drag my EMS Director out of his little office and ask did they teach you pt assement in you medic program, or you just to lazy to do that since you got you promotion. That is why I hope that I never turn into him, or anyone that just goes by what I'm told and not what I find. Thanks Chad

Sorry for the delay I have been swamped the last few days, But anyway This pt I was passing of to my Intermediate Partener and he was more than happy to take the pt, so he asked if he could put her on the monitor, he was a new intermediate and I said you dont have to ask my permission to put her on the monitor, and he did so as I was leaving the back of the ambulance. Because she was AOX3 no trauma, no problems, just stressed out over he family life. So as I was stepping out of the ambulance my partener said hey Chad take a look at the monitor and by the tone of his voice, I knew that I really didn't want to see what was on the monitor. So I looked anyway and found the pt to have Tombstone or Firehelment T waves with no distress so I checked the leads and they were right, so I went enroute with my partner driving, and did everything enroute, Pt is W/P/D and her only complaint is that her right elbow started hurting 2 days ago, and she had recently taken a nerve pill but that was all, so in this system we can do 12 Leads and when it printed it stated that she was having a Inferior MI, but she had no symptoms, so as I turned to call my report in I stated my findings and the pts condition and the Dr though I was a idoit, I for sure, but when I got done in the 1 min or less, I spent calling in my report she has went from W/P/D to PALE, DIAPHORETIC, PRESSURE ON THE in her right shoulder, N/V now I had already gave the asa, nitro per protocol but had to request MS if needed when I called, and her BP drop to 98/64 for 132/86. The pt was taken cath lab were on unblockage of the artery she went into VF was shocked and went hope 1 week later. To this day all I say is what I thought that day, were in the hell was that in the paramedic book.

Ok, This is the run, 60 y/o female that needs take to the hospital to talk to someone, and dosent want to drive herself, and would like a medic unit to come. You find a 60y/o female in the house with a dog that as big as cow and a dovermen pincker, and is helped to the back porch by the pt, before she opens the door. Pt intially says that she has been stressed since her husband had open heart surgery triple bypass, just 2 weeks ago, and her 40 y/o son moved back in and she just can't handle the stress. Ok, what would you like to know other than her V/S are stable, W/P/D.