Was I wrong?

[dahlio]

5. Your company and state sucks for letting people under the age of 18 ride on an ambulance and be the primary care giver for patients. I remember being 17 and thinking that I was hot Ca Ca for being 17 and knowing everything. I remember how it sucked not being able to do some things because some other punk 17 y/o couldn't get their life straight, so now I had to suffer for it [side note: Young male drivers who can't seem to drive correctly suck too. It's your fault my insurance costs so much], but that's life. Under 18 is a minor and thus should not be giving medical aid on an ambulance.

I'm a 17 year old, and I think your statement is complete garbage. First of all, how else are you going to learn? There are more mature 17 year olds out there then you think. Second off, he wasn't the senior EMT on that crew, and there was someone there to back him off if something did go wrong, but who says it will? He was trained and passed an exam that is far from easy. Don't think 17, not reliable.

On the issue of ALS, I know New Jersey has a guideline to follow about when to call ALS.

You can find that here http://www.state.nj.us/health/ems/adlttrig.htm I Personally think there was no need to call ALS on this call, just because he was out of it. There are other signs of a stroke.

One more thing I'd like to add, is that being young, and not being the most experienced, I take criticism well, and learn from it. I'm not cocky when it comes to that stuff, and you shouldn't be making generalizations.

[JPINFV]

I'm a 17 year old, and I think your statement is complete garbage. First of all, how else are you going to learn? There are more mature 17 year olds out there then you think. Second off, he wasn't the senior EMT on that crew, and there was someone there to back him off if something did go wrong, but who says it will? He was trained and passed an exam that is far from easy. Don't think 17, not reliable.

You learn by becoming educated while in high school. Take college prep courses (even better, go to college after you graduate). Getting good grades and developing a basic understanding of the sciences will help you out a lot more in the long run then an years experience as a basic. Remember, EMS is the only healthcare field where experience as a provider is needed to move up to the standard level. MDs aren't PAs first, RNs aren't LVNs or CNAs first, ophthalmologists (MD eye doctors) aren't optometrist first and optometrist aren't opticians, first and the list goes on.

Second, are you old enough to sign you're own permission slips for high school? Are you old enough to enter into legal contracts by yourself? As I said in my earlier post, mature teenagers get screwed because they are the exception, not the rule. It might suck, but I'm sure that there are a few of your fellow classmates that you'd rather sign AMA then have them transport you to the hospital in an ambulance (that said, there are some adults whom I'd rather sign AMA then let them transport me).

Third, please pick an argument. Either he is responsible for his actions or he is not. The fact that a more senior basic was with him means nothing. I've been working for about year and a half and I have noticed more then once that "more senior" does not equate to "more able" (nor does being a crew chief or an FTO for that matter). To claim that you are not responsible for a call that you are on because:

1. You're not 18.

2. You're not the "senior EMT" (as you're argueing)

3. You're on a single driver unit and you're the driver

4. Religion

5. The patient smells

6-xxx any other reason you can think of.

is stupid and doesn't work. As far as the test being "far from easy," that test is also 'far from hard' too.

Furthermore, he never actually stated that he was working with a "senior EMT," just that he got feedback after the call.

On the issue of ALS, I know New Jersey has a guideline to follow about when to call ALS.

You can find that here http://www.state.nj.us/health/ems/adlttrig.htm I Personally think there was no need to call ALS on this call, just because he was out of it. There are other signs of a stroke.

That's nice, but those are the protocols for a trauma. That said, I agree that a CVA is not enough reason to call for paramedics (Since I've had this argument with Ace a while ago, I'll state this here. Stroke=not a reason to call medics, not Stroke=don't call medics if your medics don't have anything to give a stroke patient. Remember that there are other problems that can cause stroke like symptoms that need to be ruled out that may require something that a paramedic can do that basics can't. Also remember that stroke patients have a good chance on presenting with other problems that can use a medic).

One more thing I'd like to add, [s:2a9b418849]is that being young, and not being the most experienced[/s:2a9b418849], I take criticism well, and learn from it. I'm not cocky when it comes to that stuff, and you shouldn't be making generalizations.

Keep that attitude and don't lose it when you become old and experienced.

[ffemt819]

as a medic i did not feel you did anything wrong

Do you have the option of finger stick to futher rule out hypoglycemia from fasting from previous night

was the oxygen improving the patients color, mentation was there a change in the SPO2(remember don't depend on the equiptment only do a good thorough assessment) looking for associated signs and symptoms other reasons for changes in mentation UTI,Fevers they affect the old very easily. were you able to follow up on pt diagnosis ?

[Dustdevil]

I agree that a CVA is not enough reason to call for paramedics (Since I've had this argument with Ace a while ago, I'll state this here. Stroke=not a reason to call medics, not Stroke=don't call medics if your medics don't have anything to give a stroke patient. Remember that there are other problems that can cause stroke like symptoms that need to be ruled out that may require something that a paramedic can do that basics can't. Also remember that stroke patients have a good chance on presenting with other problems that can use a medic).

Exactly. And any EMT out there who does not know or understand this concept is dangerous (and "cocky") and has no business in EMS.

[brock8024]

We are dispatched to a residence for an 80 year old male presenting with AMS. Arrive to find pt seated on bed, slightly disoriented. We get a brief history from his wife, stating that he had failed to turn off his alarm clock at the proper time, and he awoke in an awkward position, seeming confused. Last seen at baseline the previous night, seemed to sleep normally. History of CVD, nothing else, according to wife. We consider stroke, so we do some stroke tests, which find strong and equal hand grasp, equal smile, negative facial droop, negative slurred speech, and negative arm drift. Assessment of vitals finds bp of 130/84...pulse 68, skin warm dry and unremarkable, 12 resp/min, rales in lower left lung, SP02 93 on RA...NC on 4LPM based on o2 sats. Pupils PERL. These s/s were constant throughout transport. We didn't call ALS or transport to a stroke center due to the fact that he was requesting transport to his PCP's hospital., as he just seemed confused. He was unable to remember the year or who the president was, hwoever did answer personal questions well. Negative headache, neg chest pain, no SOB no discomfort/pain.

Would you have called ALS? Would you have transported to a stroke center?

I ask because I was told after the call by a senior EMT (i'm 17) that we made the wrong call, and I was wondering what you all thought?

From this information I would call this more than likely a ALS call. You have a 80yr male that awoke confussed. You said he was fine the night before per the wife. You said he only Hx is CVD. What is this? Cornary Vasculare Disease or Cerebral Vascular Disease. If it is the second the how can the wife say he never had a stroke but the pt said he did? You never said what meds he was on. His V/S are ok for now. The thing that would make this a ALS call for me is the fact that the guy was fine last night, awoke confused with rales in the left lung base, and he is old. I mean he could be having a AMI and not presenting in a "normal" fashion. And you said in another statement that it was a 30min transpor time. That and the other things I have stated would have made it a ALS truck. Now this is just me and I am still in paramedic school. One more semister to go, but it seems like something is going on with this guy, maybe not a stroke but something. He did not need to be ran in hot or code 3 but a 12 lead and monitor would have been nice with a IV. You also stated that if something would have happend you could have had ALS back up fast but if you are 30 mins from his hospital are there other stations along the way or another hospital.

Just my thoughts. Not saying you done anything wrong just that I might have done things different if I would have been there. That is what makes this great we all get to think for our selves.

[dzmohr]

I've seen new EMTs do that exam. I did that exam when I was a new EMT. I still do it. It takes a lot longer than what you are insinuating, especially when you are brand new and have not done it a million times before. Those tests and steps don't just pop right into your mind, rapid fire. You don't run through the sequence from memory. You sit there and think, and think, and think some more. You're like... "uhhh... okay, I did the grip test. Now what?" Then you fiddle with the blood pressure cuff for a few minutes while you think of some other test to give. Then as you're finally about to load them on a cot, you think of something else to check for. And, of course, all of that is only if you actually remember any of that stuff at all.

Yeah, in a perfect world, with a well seasoned and well educated medic, things run fast and smooth. Then there is the real world.

Actually we are teaching that test as part of the core curriculum for Red Cross, AHA and Medic First Aid now. And a NEW EMT finds themselves sitting and thinking a lot till they gain some confidence and experience, much like a new medic. I know a lot of seasoned and well educated medics who for any number of reasons still sit and think and waste too much time ( not sure if you meant it this way, but I do ...well educated does not mean they learned all that was taught ...just that they had the chance to.)

[emsbrian]

He was saying that since we can't diagnose, that confusion was reason enough...

Well theres your problem... AMS... run down the list, ruled out stroke its off it no probs there buddy. As long as you cya'd with hypoxia, spo2, hypothermia, blood glucose, ETC...

You did the right thing by realizing he was altered, this was your problem looked for the cause.

[arctic_myst]

I would have to say that I would have called ALS. Altered LOC with an unknow etiology...I'm callin in the big guns because there is potential for this to go downhill quick. However, based on your assessment and the fact that you are a basic, I would have to say that you did what you did based on the patient. However, always remember...treat the patient, not the monitor. And by monitor I mean, don't let the vital signs tell you things are ok if you are looking at someone that is not ok. You will find that women do not present with typical signs and symptoms of an MI like men do. Likewise, not everyone will have the same symptoms and signs for any given illness. Take it easy, you'll get better with more experience.

[sledogg1]

You are not wrong but you are liable for working on the rig as a medic..............what school put you through paramedic status? are you ding lines, ett's',MEDICATIONS and what State gave you a licence to work :? What is the name of your company as I am curious in a web site. For insurance reasons your employer must be paying out a crap load of money to be operating. Anywho, think of the ramifications if you mess up as u don't want to ruin your career before it starts.

[lewanda86]

We are dispatched to a residence for an 80 year old male presenting with AMS. Arrive to find pt seated on bed, slightly disoriented. We get a brief history from his wife, stating that he had failed to turn off his alarm clock at the proper time, and he awoke in an awkward position, seeming confused. Last seen at baseline the previous night, seemed to sleep normally. History of CVD, nothing else, according to wife. We consider stroke, so we do some stroke tests, which find strong and equal hand grasp, equal smile, negative facial droop, negative slurred speech, and negative arm drift. Assessment of vitals finds bp of 130/84...pulse 68, skin warm dry and unremarkable, 12 resp/min, rales in lower left lung, SP02 93 on RA...NC on 4LPM based on o2 sats. Pupils PERL. These s/s were constant throughout transport. We didn't call ALS or transport to a stroke center due to the fact that he was requesting transport to his PCP's hospital., as he just seemed confused. He was unable to remember the year or who the president was, hwoever did answer personal questions well. Negative headache, neg chest pain, no SOB no discomfort/pain.

Would you have called ALS? Would you have transported to a stroke center?

I ask because I was told after the call by a senior EMT (i'm 17) that we made the wrong call, and I was wondering what you all thought?

the pt doesn't sound like they are in any great distress. i wouldn't have done anything differently.