Absolutely appalled

[medichopeful]

So I was reading the comments on an EMS1 article and I ran across this one:

I'm still kinda new to EMS and have only done a few of these. I think the best has to be "Super Morphine" where a EKG patch is placed on a drunk Pt's forehead and said drunk is told "to activate this brand new drug you have to smash this patch with your palm just as hard as you can." Watching drunks beat the crap out of themselves instead of swinging at me has had ER staffers rolling!

Is it just me, or is this one of the most reprehensible posts and admissions possible? I wish there was a way to find this poster and have his license or certification pulled. I have reported the comment, and hopefully they do something about it.

Thoughts?

 

[VentMedic]

Not much more appalling than some of the threads here about slamming narcan, arm drop on the face, alcohol in a syringe to shoot up the nose and stuffing ammonia snaps into NRB Masks or straight up the nose.

 

[Aidey]

Alcohol up the nose? That is a new one.

Honestly, at least some of time the people who do some the things Vent listed are just uneducated or were badly taught, they aren't necessarily being malicious. You get a newbie EMT who puts the ammonia in a NRB because that is what his officer taught him, and he's got no idea it is a bad thing.

 

[Don Gwinn]

You know, I must admit that bothered me when I saw it, and I didn't do anything about it.

 

[DrParasite]

While I wouldn't advocate the ekg sticker on the forehead thing, I need to ask:

slamming narcan, arm drop on the face, alcohol in a syringe to shoot up the nose and stuffing ammonia snaps into NRB Masks or straight up the nose.

What exactly is "slamming narcan"? is that giving the full does of narcan to an unconc person? or another method?

and the arm drop isn't done with malice, or for the express purpose of causing harm (unlike directing the drunk to hit himself to activate the morpine). it is used to help confirm responsiveness. not unlike checking to see if an unresponsive responds to painful stimuli.

alcohol up the nose is def a new one for me, as in ammonia in the NRB. and the only time I have used ammonia right up the nose method was to my little brother (when he was 14), when he was being extremely annoying, and wouldn't leave us alone as we were doing stuff around the FH. never did that to a patient.

some people in the field do some weird stuff. the ER can be just as bad. ever heard of the "3 F*cks get a tube" rule?

 

[VentMedic]

What exactly is "slamming narcan"? is that giving the full does of narcan to an unconc person? or another method?

Pushing the highest dose of Narcan allowed in your protocols.

and the arm drop isn't done with malice, or for the express purpose of causing harm (unlike directing the drunk to hit himself to activate the morpine). it is used to help confirm responsiveness. not unlike checking to see if an unresponsive responds to painful stimuli.

That's great if your patient is indeed faking being unconscious. However, if your patient is unconscious, you may have done damage to their nose or eyes and maybe even the teeth. Now you have a new set of problems to deal with as well as having just abused an unconscious patient. If you break the nose you now risk blood aspiration and have also lost a means of establishing an airway be it NPA or NTI.

alcohol up the nose is def a new one for me, as in ammonia in the NRB. and the only time I have used ammonia right up the nose method was to my little brother (when he was 14), when he was being extremely annoying, and wouldn't leave us alone as we were doing stuff around the FH. never did that to a patient.

When ammonia snaps were taken off most of the ambulances, some replaced these torture devices with alcohol. Some ambulances carried bottles of alcohol which could be used to draw up a little in a syringe. Others preferred the alcohol swabs to stuff up the nose.

some people in the field do some weird stuff. the ER can be just as bad. ever heard of the "3 F*cks get a tube" rule?

The doctor can threaten but to actually use a ventilator that might be needed for a critically ill patient on someone for "cussing" and to have that patient now in an ICU for 24 hours where bed space is very limited would have that doctor brought before his peers and possibly the state license review board as well as CMS. Every intubated patient starting in the ED gets tracked for the duration of their stay. If the doctor can justify chemical restraint in the form of sedation, pain management and maybe paralytics along with ETI for addiction withdrawal then that is not abusive and should never be stated with that intent. It is actually a very humane means of helping the patient deal with severe withdrawal by keeping them totally sedated for up to 4 days. One should not confuse that with blatant abuse.

 

[emt_angel25]

uh i had a partner one time jam a 14g catheter in the back of some gals hand. do you wanna know why? "cause shes been ignorant, and shes drunk, and im the medic and i can do it just because i want to"

was it right? absolutely not but when your drunk and you have done nothing other than make caring for you a complete pain in the butt its a little bit easier to think....hmmmmmm.....they have tortured me so why cant i to them?


i dont think any of the above postings are right by any means but id be lying if i said i havent done and/or thought about some of them. (the hand drop test on a "unresponsive" pt who we were watching open her eyeballs) (( still not right, i know))

 

[JPINFV]

uh i had a partner one time jam a 14g catheter in the back of some gals hand. do you wanna know why? "cause shes been ignorant, and shes drunk, and im the medic and i can do it just because i want to"

was it right? absolutely not but when your drunk and you have done nothing other than make caring for you a complete pain in the butt its a little bit easier to think....hmmmmmm.....they have tortured me so why cant i to them?


i dont think any of the above postings are right by any means but id be lying if i said i havent done and/or thought about some of them. (the hand drop test on a "unresponsive" pt who we were watching open her eyeballs) (( still not right, i know))

Hopefully some paramedic tortures you just because they think that you're faking being altered or because they don't think that your complaint is worthy of their time. Just because a patient is being a pain doesn't justify even the thought of revenge.

 

[emt_angel25]

i never said revenge nor have i pulled such a stunt or would i ever just cause i was the medic on scene. its a disgusting abuse of power.

 

[Akulahawk]

Slamming Narcan? That's a GREAT way to get your opiate OD patient pissed off at you...

Yeah, go ahead and give that patient the full dose as a single bolus... and flush it as fast as you can... just as if it's Adenosine... You go right ahead... I'll be in the next county over while your patient proceeds to pummel you...

Even if your patient doesn't pummel you, slamming the Narcan can (and WILL) bring on some EXTREMELY strong withdrawl symptoms. It's about as unkind as you can be to an OD patient.

 

[VentMedic]

Slamming Narcan? That's a GREAT way to get your opiate OD patient pissed off at you...

It is often done just as the crew is about to enter the ED to get revenge on the ED staff or as a joke of some sick type that has gotten several RNs and Doctors injured.

 

[mycrofft]

Ammonia isn't a torture device any more than any other medical device.

It is its abuse that causes patient abuse, and it is a combination of abusive practitioners and abusive patient's complaints listened to by management that have made it off limits.

IF you clinically need to establish unconsciousness, ammonia inhalants have a long and safe history and can do the job IF you do not abuse them or the pt. In my experience sternal rubs are not always adequate and (speaking as a pt) they hurt and leave marks. Pinching earlobes, hyperextending joints over pens...bad juju.

There are things you can do with adhesive tape, alcohol wipes, sharps, elastic bandage or even just driving technique that will make you scream for Mommy.

NOT that I've ever done them.:glare:

On purpose.

 

[DrParasite]

uh i had a partner one time jam a 14g catheter in the back of some gals hand. do you wanna know why? "cause shes been ignorant, and shes drunk, and im the medic and i can do it just because i want to"

was it right? absolutely not but when your drunk and you have done nothing other than make caring for you a complete pain in the butt its a little bit easier to think....hmmmmmm.....they have tortured me so why cant i to them?

you know, this reminds of me something a police officer once told me: as long as there are no TV crews or cameras watching, a police officer can pretty much do whatever he or she wants without fear of reprisal.

is it right? in most cases, no. I will not defend any of such actions, including those that aren't nice, pleasant, and in the best interests of said person in custody. there are also "station house adjustments" which generally aren't exactly what the law specifies. But just like how in some EMS systems the non-critically ill people walk to the ambulance (regardless of condition), I will say things do happen, and they have happened before I got into this field, and will probably happen long after i retire.

 

[VentMedic]

IF you clinically need to establish unconsciousness, ammonia inhalants have a long and safe history and can do the job IF you do not abuse them or the pt.

I haven't seen them on any ambulance in the area since the 80s and we definitely do not keep them in the EDs. Too many people have reactive airway disease, including staff, that can be triggered to become a life threatening event.

There are things you can do with adhesive tape, alcohol wipes, sharps, elastic bandage or even just driving technique that will make you scream for Mommy.

NOT that I've ever done them.:glare:

On purpose.

Oh yeah...

Tape across the eyebrows. Reckless driving with just the "eyebrows" taped to the board. Stretcher drop.

 

[Akulahawk]

It is often done just as the crew is about to enter the ED to get revenge on the ED staff or as a joke of some sick type that has gotten several RNs and Doctors injured.

Indeed... This is not something I'd condone. If you want to get some kind of revenge or play a joke on an ED staff, there are better, less injurious ways to do it.

 

[ExpatMedic0]

I still do not see how extending the patients arm above there head and letting it go is considered "not appropriate.' I use this method along with a sternal rub and its not to mess with the pt. or be cruel. I was trained to do this in EMT-B, EMT-I, and EMT-P by instructors preceptors and even hospital staff. I can tell you I have never broke teeth or a someones nose by doing this and I think thats a pretty far fetched concept when you look at the MOI for such an injury, have you ever been gently slapped in the face by a limp hand? If so did it break your nose and teeth... come on!

 

[JPINFV]

i never said revenge nor have i pulled such a stunt or would i ever just cause i was the medic on scene. its a disgusting abuse of power.

Err...

i dont think any of the above postings are right by any means but id be lying if i said i havent done and/or thought about some of them. (the hand drop test on a "unresponsive" pt who we were watching open her eyeballs) (( still not right, i know))

Emphasis added.

 

[VentMedic]

I still do not see how extending the patients arm above there head and letting it go is considered "not appropriate.' I use this method along with a sternal rub and its not to mess with the pt. or be cruel. I was trained to do this in EMT-B, EMT-I, and EMT-P by instructors preceptors and even hospital staff. I can tell you I have never broke teeth or a someones nose by doing this and I think thats a pretty far fetched concept when you look at the MOI, have you ever been gently slapped in the face by a limp hand? If so did it break your nose and teeth... come on!

The human arm is actually quite heavy in an unconscious patient and if you ever had to restrain it to keep from falling off the stretcher, you would know this. Also, the patient might be wearing a bulky watch, bracelet or rings that can do even more damage. You are also still a new Paramedic that is still completing your education so consider yourself very lucky that you have not injured a patient yet.

Dropping the arm across the face is like doing the witch in the deep lake test. If the person lives, they are a witch. If they are innocent, they drown. Thus, if the patient is faking being unconscious, they pull the blow away from their face. If they are actually unconscious, they may be injured.

Keep doing this practice and I can guarantee you will eventually have to answer for your actions. Your medical director may also not be so quick to back you up unless he/she is stupid enough to put it in writing as an acceptable protocol. Of course when something adverse does happen, it wouldn't be too difficult to get an expert witness like Dr. B. Bledsoe who has written several articles on the subject or someone with similar qualifications.

 

[mycrofft]

How and when is it OK to adminster pain PRN?

Excuse me, noxious stimuli.

I wrote and created a powerpoint presentation in class aimed at teaching law officers about altered levels of consciousness and how/when it needs to be assessed. Street EMS has many of the same problems. Sometimes, often for your own safety as well as the pt assessment, you have to know if they are truly "out", and how deeply, and you don't want to get your hands near their mouths or allow them the opportunity to "accidentally" flail and take a cheap shot as they "awaken" or "have a seizure".

Needless to say there were jokes about using tasers, OC spray, and handcuffs to elicit responses. (Tapping the sole of the foot, or over the Achilles tendon with a baton without warning the subject works, but that doesn't look right and can cause bystander charges of assault).There are cultural biases to overcome but abuse is not conscionable.

And yeah the dropped arm thing is prone to causing pt injury.

 

[mycrofft]

PS: about NH3 in the ER..

My short career in the ER was in the late Eighties. SOmeone had gone and thoughtfully taped the "poppers" in each treatment bay. Being the newbie I went around and noticed some looked different.
They were amyl nitrate.


Follow your protocols, don't torture your patient, bottoms lines.