Stupid EMS Rules, Regulations, or Practices ................

[toutdoors]

This may be slightly off topic, and if it is, I apologize. The service I work for part-time finally allowed us to wear the "under armor" style polo shirt this summer, for the hot humid weather. The idea being that it would wick away the body moisture, and make us more comfortable working in the heat of summer. Great idea. The shirts are very nicely done, have the company name on back in nice big, bold, reflective lettering, and the star of life on the front of the shirt along with the small company logo. It is a professional looking shirt. So what is my issue? We can only wear it after 2100 hours. From the start of the day to 2100 you have to wear the same old light blue button up shirt with the company patch and your EMT level patch.

Isn't this kind of.......stupid? I mean seriously, we are not allowed to wear the shirt when it would benefit us the most; during the heat of the day. As I said, it is clean, neat, and professional looking. We do wear picture ID's that state our name and provider level, and it isn't as if we are that big of a service that the docs don't know what level we are. It just seems, well like "military intelligence". I have seen my share of that too.

Didn't mean to get off thread, just venting.

[firedoc5]

I hear you -- i dont need a watch/clock to count a pulse and i can usually guess a pulse ox reading within 2% points by just assessing the patient. Which reminds me do any of you play the "guess" the patient while enroute to the call game --- we had it down to a science as to what kind of clothing they would be in, whether they would be amputee or not, time of onset of symptoms, which hospital they went to -- we could even guess how many teeth they had based on the trailer park we were responding too.

We only bet on a pt's ETOH level once in the hosp.

Quote of VentMedic; The inattentiveness of some not to count was one of the reasons a few of the changes were made. Hyperventilating a patient to a dangerously high pH was as bad as the very low pH.

Throughout the years as more research became available or better methods to prove different concepts, medicine has changed its way of thinking may times.

The way we ventilate ARDS or a TBI patient has greatly changed throughout the years. Permissive hypercapnia is accepted in some situations as is the use of buffers now. Acceptable PaO2 levels have differed in acceptibility for ARDS, TBI, Sepsis and other disease processes. The limitations and benefits of the pulse oximeter has been defined and further understood as has the ETCO2 monitor. We now have many, many protocols driven by the disease and no longer make blanket statements. The use of oxygen in neonates has evolved into a different way of thinking for resuscitation in that population also. So many changes and some very exciting times to be more involved in medicine.

An interesting article about CPR and EMS:

http://www.jems.com/Images/CPR-Revived_tcm16-12259.pdf

I guess that's what I was needing to know. We did take pH into consideration, but hoped the higher the O2 the less reason to use Bicarb, or at least until they got to ICU/CCU.

[emtashelyb]

I think its stupid that here in nc inorder to restrain a pt you have to call the police to come do it while letting then tear your rear apart waiting. In md we could call medical direction and just tie them down with cravats. I can understand the legality but really I dont want to be torn a new one because someone drank too much and thinks Im a cop and I dont think it would be best to leave a rampaging pt in the back of the rig alone.

And the fact that until 09 I can only give oral glucose but come january 1st Im allowed to give narcan, use cpap (I got certified in abltimore so we werent taught how to use that there) and do a 12 led ekg..... Yeah that is out of my scope of pratice. Go onslow county for confusing the heck out of me. I know different places different protocols it just confuses me

Oh and why does baltimore city/county carry a thumper but here out in bumfuck they dont even know what it is? We have 2 hospitals here it would be beneficial to have the thumper here not in baltimore where you have 13 hospitals all within a few minutes of eachother

I know Im a newbie I just had to get out what doesnt make sense to people who understand

[spenac]

I know Im a newbie I just had to get out what doesnt make sense to people who understand

Nothing in EMS makes sense. Lack of any real required education is the biggest thing that makes no sense.

As to restraints never had to call anyone. If I needed them restrained I restrained them and documented reason in report. Those mother may I systems really suck.

[emtashelyb]

Nothing in EMS makes sense. Lack of any real required education is the biggest thing that makes no sense.

As to restraints never had to call anyone. If I needed them restrained I restrained them and documented reason in report. Those mother may I systems really suck.

well some things do make sense like dont give a pt nitro if they have taken vigra that will end badly. But again other things dont. Again the thumper thing has me stumped I dont want to do cpr for an hour ride here in tractor/cow/horse crossing city. Here if you restrain them, you can get charged with battery.... yeah so I just let them beat the crap out of me right......

[JPINFV]

well some things do make sense like dont give a pt nitro if they have taken vigra that will end badly. But again other things dont. Again the thumper thing has me stumped I dont want to do cpr for an hour ride here in tractor/cow/horse crossing city. Here if you restrain them, you can get charged with battery.... yeah so I just let them beat the crap out of me right......

Of course why would you do CPR for an hour anyways? All you're doing is delivering a corpse to the hospital.

[spenac]

Again the thumper thing has me stumped I dont want to do cpr for an hour ride here in tractor/cow/horse crossing city. Here if you restrain them, you can get charged with battery.... yeah so I just let them beat the crap out of me right......

CPR for an hour enroute to the hospital. Bad protocols if that is what you do. You should not be picking up a code and rolling. If viable perform CPR, AED, ALS if available, on scene, if no return of pulse you let the funeral home come get them.

[Mateo_1387]

Here if you restrain them, you can get charged with battery.... yeah so I just let them beat the crap out of me right......

Any sources for this?

I saw another thread where you mentioned this, and stated that police must be called. Do you think the police may be there for your safety?

[crotchitymedic1986]

Ashley, here is a street medic axiom that you should get familiar with --- "It is better to be tried by 12 (meaning a jury), than to be carried by 6 (pallbearers). Never let an out of control patient put your's or their life in jeopardy. Sounds like your company needs to take a new look at their protocols for cardiac arrest and combative patients. Even if you dont have a protocol to stop CPR, you can always call the ER, paint the picture for the physician, and get an order to stop CPR. It is a waste of resources to tie up an ambulance performing CPR on a corpse (not to mention a safety issue for driving the corpse to the ER lights and sirens).

[Richard B the EMT]

On transporting a patient with a DNR, I just got the following information from the FDNY, sent to me from the New York State Volunteer Ambulance and Rescue Association. I now show it to youze guyz, for your perusal...

BUREAU OF OPERATIONS

EMS COMMAND ORDER 2008-191

November 20, 2008

TERMINATION OF CARDIOPULMONARY

RESUSCITATION (CPR) WHILE ENROUTE TO THE

HOSPITAL

1

1. GENERAL INFORMATION

1.1 Members are reminded that once cardiopulmonary resuscitation (CPR) has been initiated

it shall not be terminated except by the authority of the On-Line Medical Control

(OLMC) physician.

1.2 Members presented with a Do Not Resuscitate (DNR) order or Medical Orders for Life

Sustaining Treatment (MOLST) form after CPR or other treatment for cardiac or

respiratory arrest has been initiated shall contact OLMC, and if so directed by the OLMC

physician, discontinue CPR.

1.3 Members shall not contact OLMC to terminate CPR while enroute to the hospital except

if the patient has a valid DNR order or MOLST form.

1.3.1 If a patient with a valid DNR order or MOLST form goes into cardiac or

respiratory arrest while enroute to the hospital, members shall withhold CPR,

including chest compressions, ventilation, defibrillation, endotracheal intubation

and the administration of medications, and contact OLMC to inform them that a

DNR was honored while enroute to the hospital.

1.3.2 Members shall continue transport to the hospital in non-emergency mode and

present the deceased patient and the DNR order or MOLST form to the

Emergency Department (ED).

1.3.3 OLMC shall contact the receiving hospital to inform the ED that a patient in

cardiac or respiratory arrest with a valid DNR order or MOLST form will be

delivered to the ED without CPR in progress.

BY ORDER OF THE CHIEF OF EMS COMMAND