YOU, THE VIOLENT PSYCH, AND THE RESTRAINTS.......

[JPINFV]

What exactly is the point of CMEs and following changes in medicine if we don't change our standards? What was right 10-20 years ago might not be right today. Similarly, what was wrong 10-20 years ago might be right today. Just because someone was around 20 years ago doesn't mean that they should still be providing care the same as 20 years ago. Similarly, a provider who restrains a patient [s:c174a361fb]supine [/s:c174a361fb] prone is wrong because they are violating the standard of care (which is more than just a simple vote of current providers. There are way too many morons out there providing care to make me not care what an average EMT-B thinks) of today. Sure, it might have been the standard 20 years ago, but that was 20 years ago, not today. Otherwise we should be carrying leaches since they were the standard of care 100 years ago for just about everything.

Aye, thanks for the catch

[reaper]

Standard of care is not a OLD vs NEW idea. It is what all medical proffesionals adhere to.

A standard of care is a medical or psychological treatment guideline, and can be general or specific. It specifies appropriate treatment based on scientific evidence and collaboration between medical and/or psychological professionals involved in the treatment of a given condition.

In legal terms, the level at which the average, prudent provider in a given community would practice. It is how similarly qualified practitioners would have managed the patient's care under the same or similar circumstances. The medical malpractice plaintiff must establish the appropriate standard of care and demonstrate that the standard of care has been breached

[CBEMT]

Just trying to open the thought process' a bit after reading another thread and seeing many who stated (and this isn't a direct quote at all) that it's difficult as hell to monitor the Pt when they are thrashing around in restraints. Agree, but not impossible! I guess remembering the "old" days when we talked too, and observed our Pts without the neato little devices we have now is getting the best of me.

. When a Pt gets transported in the prone position, they should be evaluated more closely than a "typical" Pt in a supine position. Even if talking to your Pt pisses them off and aggitates them you know they have an airway (much like a baby crying in a peds scenario),

I'm not interested in how closely you monitor the patient!!! Your having a nice chat with them for the whole ride won't change the physiological process that is shutting down their respiratory drive!!! Yes, I know "But I'll see it happening!" Of course you will. Right before they go asystole, permanently.

Wouldn't it be nice if we could transport patients without having to worry about that?

Oh wait, we can- BY FOLLOWING THE STANDARD OF CARE, not winging it because "Nothing bad has ever happened on MY shifts."

See my topic of "Freak Out" and that is one instance for using prone. When it takes seven police and fire personnel to just get him to stop digging his finger nails into the asphalt, trying to kill anyone in his arm reach, and feeling no pain, yes, it's time to put him prone.

NO, IT IS TIME TO SEDATE AND TRANSPORT SUPINE IN ADEQUATE RESTRAINTS. These patients will be the first ones to go!

In that case he was prone for all of 7-10 minutes.

MORE THAN ENOUGH TIME TO DIE. You got lucky. Your patient, even luckier.

Nobody died from it in our care.

Be sure to tell the judge that. I'm sure s/he'll understand.

I've heard of instances where someone had died while being prone, but how much of it was from other influences, OD, alcohol toxicity, whatever was making them violent in the first place?

Those would be called "contributing factors" to a cause of death called POSITIONAL ASPHYXIA.

I'm still old school you might say, and through experience I've seen what works the best.

Do you still give sodium bicarb as your first-line cardiac arrest drug? That's old school.

Why not?

Because it is no longer the standard of care.

Do you still pace asystole? That's old school.

Why not?

Because it is no longer the standard of care.

Do you still infuse as much NS as you possibly can into hypotensive trauma patients? That's old school.

Why not?

Because it is no longer the standard of care.

Do you still use rotating tourniquets for CHF? That's old school.

Why not?

Because it is no longer the standard of care.

I can't believe I actually have to have this discussion with intelligent people. What part of "Your argument has no basis in medicine or case law" don't you all understand???

Every time I read a thread like this, it makes me want to be an expert witness when I grow up.

[letmesleep]

Sounds to me like a few people need to calm down and remember that this supposed to be a discussion not an argument. *Never* did I say that any of YOU should put face down transport in your "toolbox" of tricks, in fact quite the opposite, don't! *Never* did I state one way is better than another! *Never* did I state that I wouldn't reconsider the use of prone transport when placed in that position again!

It is hard to think straight when your "getting your butt whooped" wendy, but isn't that what we are trained to do? Aren't we trained to think straight in a time of crisis no matter what it may be? It's really cool how different quotes have been pulled from here and there, but did the whole statement get read or was it just a quick skim through?

I'm not just picking on wendy here either!

CBEMT, in your second quote from me about evaluation.....did you read the rest of it? where it states that a Pt should be rolled back over immediately after they have started calming down, or did you just pull out the part your needed to make you point? It would be the following sentence making reference to FIREDOC. You may not be interested in how closely i monitor my Pt, but the question was put on the table.

As far as the reference to leaches JPINFV, I'll have to look around a bit, but I'm very positive that some hospitals have been, at least, doing research on promotion of blood flow with the use of leaches in recent years, and believe it or not I think I have even seen some studies on the use of maggots as well.

Look, I have stated here that WE are not in disagreence over the topic of prone transport, and I will take a moment to also THANK YOU ALL, for teaching me some new information on this issue.

I would like to address your "lesson" to me about standard of care/ medicine as a science/ and case study in regards to being "old school". I find it interesting how easy it is to forget where the career came from. Your all right, there have been multiple changes in medicine over the past 15 years of my career (personally) that make a lot of my inital education "out dated". JPINFV, you made a good point, and I have also stated something like that in another thread, about changing OUR standards. Does that mean that YOU as the newer generation have NOTHING to learn from those of us who have been here since you started kindergarten? You, as a newer generation of medic have more knowledge base than my generation ever did comming out of school. You have the ability to find information at your finger tips right out of the gate. Study after study is available here on the internet, but read it. Yes, all of this is here for me too, but I'm not discussing me right now, you'll get a chance to do that when I post this. All I have been asking YOU to do in the past few pages of this thread is to open your mind, and get away from the "Nevers" because there is not absolutes in medicine. You can find a study to justify whipping front to back vs. back to front, but use the information to guide you through your career not dictate you through, otherwise you get stuck on the "cookbook" medicine that is so very much loved here in the city (that was sarcasm). I hope to have further discussions in the future with you, because you are all very intelignet as well, but remember that those of us who have built this career for you to carry in to the future and especially those before me, still have plenty to offer. There is always going to be a situation arise that you or I have never seen or even thought we'd run in too (science), WE are going to handle it as best as we can as to not harm, but to help the Pt (standard of care), and hopefully that situation will help teach the next person what to look forward too (case study).

Thanks!

[firedoc5]

I'm not here to discuss things as "point-counterpoint" with anyone. CB, are you always so "by the book"? What if a situation came up, not necessarily one that you have to restrain someone, but you just could think of what to do next and a veteran Medic is there and remembers that, "Hey I've had this happen before and we did such an such'. Are you going to look in your book and it's not there, are you going to say, "Nope can't do it, it's not in the standard of care. Haven't you ever heard of having to improvise? What about coming up with a new idea and trying it? Listen to us "old timers". Not only do we have the education, but the experiences that anyone can fall back on when need be. And don't be so ludicrous and asking about something like rotating tourniquets. It is immature. When you do that you are insulting those who have helped you in getting to where you are today. Who do you think writes and advises the books that you study so hard to be able to do what you do? Us "Old Schoolers" with 20+ years of service.

And I'm not meaning this for just CBEMT. We all have something to contribute. Let's all be civil and professional. I'm sorry that I've got this personal which I rarely do and try not to do.

[JPINFV]

As far as the reference to leaches JPINFV, I'll have to look around a bit, but I'm very positive that some hospitals have been, at least, doing research on promotion of blood flow with the use of leaches in recent years, and believe it or not I think I have even seen some studies on the use of maggots as well.

Yes, leeches are used to increase blood flow in some cases and maggots are used to clean up some wounds. That said, the use of maggorts and leeches are not used nearly as much as they were 100 years ago, which was my point (used "for just about everything."). That doesn't negate the point that the standard of care has changed and the use of maggots and leeches are not even close to being as wide spread as they used to be.

Does that mean that YOU as the newer generation have NOTHING to learn from those of us who have been here since you started kindergarten?

There is something to learned from seasoned providers. That said, if a lesson begins along the lines of "back in the day" or "when I first started," then it's generally a bad lesson. If that trick or tip was still relevent to current practice then there wouldn't be a need for a chronological qualifier like those. Not all tips, tricks, or lessons are created equally, and some do change or die out.

[CBEMT]

I improvise frequently- within the bounds of medical science and established legal precedent!

Experience is wonderful- but not bad habits!

[Just Plain Ruff]

I improvise frequently- within the bounds of medical science and established legal precedent!

Experience is wonderful- but not bad habits!

Remember, experience is a wonderful teacher

And Necessity is not always the mother of all invention.

But sometimes the back in my day tip does ring true. Back in my day we used to use two tow trucks to pull apart the car to get the patient out but now we use the fancy hurst tool. That lesson is a valuable lesson.

[firedoc5]

I rarely start out a lesson with "Back in the day..." Most of the time I am comparing to what is taught today with how it use to be. I don't teach that any given way is better than another. Given the scenario of being able to now use a Hurst Tool to extricate someone instead of using two tow trucks is great. But what if the Hurst Tool goes down or one not available? Would you know how to extricate someone with two tow trucks? This is only an example. That's why I like to teach what is current and what has been done in the past. The more ways you learn to skin a kat, the better.

[Eydawn]

Hmm...

It is hard to think straight when your "getting your butt whooped" wendy, but isn't that what we are trained to do? Aren't we trained to think straight in a time of crisis no matter what it may be? It's really cool how different quotes have been pulled from here and there, but did the whole statement get read or was it just a quick skim through?

My point, which you seem to have missed, exactly. It is hard to think straight when someone is beating the ever living hell out of you. And we ARE trained to think straight. Which is why I have a hard time condoning the idea of prone transport, but decided to toss it out there that perhaps as flawed human beings in difficult situations, we could be faced with prone restraint or no restraint.

I did read all of your posts, in their entirety. The luxury of the forum is that I don't have to formulate a lengthy response to every word you say, but rather can focus my time on the snippets I feel to be pertinent to the discussion, from my point of view.

If we are not disagreeing on the appropriateness of prone transport, then why are we having this discussion, and why didn't we branch off on some of the other treatments? If this is about reconciling experience (which you have plenty of, no doubt about it and my hat is off to you for remaining in this field) with the newer educational standards, then why did we get so hung up on prone restraint as the only subject for discussion?

If that's what you really want to discuss, let's create a new thread... because it didn't seem very clear to me that you wanted a devil's advocate situation and a philosophical exploration of old-school techniques vs. new education and protocol. It seemed to me that you were advocating the use of prone restraint should the situation warrant it, and many of us disagreed based on our knowledge base and protocols...

And I didn't see this as an argument, I saw it as an impassioned discussion. Because the premise of the discussion wasn't quite as clear as it could have been, people got derailed a little bit by the implication that you could actually be advocating something that most of us feel is harmful to patient welfare. Now that I know you weren't actually advocating that, things change a little bit.

Wendy

CO EMT-B