Absolutely appalled

[reaper]

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.



Oh yeah...

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

I have had inhalants on the trucks, in the last 3 services I have worked for. Are they used that often anymore? No. But, they are still carried on the trucks.

I have seen many a EMT and Medic fired, for using an arm drop test. I have seen to many broken noses from this and a few black eyes!

 

[ExpatMedic0]

I was an EMT for 6 years before I was a medic AND last time i checked this was also an EMT-B method not a paramedic specific one. Yes I know first hand about the weight of a human arm, more than you probably since I took boxing for quite some time.
Your absolutely over reacting about this concept and its silly, all the education and paramedic training in the world cant teach some people common sense. Although in your mind I am sure common sense is a 101 level class that is taught only at the bachelors degree level.

PS:
I am the one that uses it so I HAVE MORE EXPERIENCE than you in this particular subject.

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.

 

[VentMedic]

I was an EMT for 6 years before I was a medic AND last time i checked this was also an EMT-B method not a paramedic specific one. Yes I know first hand about the weight of a human arm, more than you probably since I took boxing for quite some time.
Your absolutely over reacting about this concept and its silly, all the education and paramedic training in the world cant teach some people common sense. Although in your mind I am sure common sense is a 101 level class that is taught only at the bachelors degree level.

PS:
I am the one that uses it so I HAVE MORE EXPERIENCE than you in this particular subject.

Hopefully your patients aren't injured by your failure to grasp this very simple concept as to how you can harm them.

As a Paramedic, you should shake the bad habits you learned by being an EMT-B for 6 years. Yet another good example as to why it is important to get as much education as you can instead of all that "street medicine" so you can understand the difference between dangerous practice and the correct way of providing safe care for your patients.

 

[ExpatMedic0]

Its taught in college classrooms by EMS educators with at least bachelors degrees .... Where do you think I learned it? Did you think I thought one day "hey this may harm my patient lets give it a try?
your point is completely irrelevant and I will continue to listen to the EMS educators I had in college, and first hand experience instead of a forum troll on the internet.

 

[DrParasite]

Hopefully your patients aren't injured by your failure to grasp this very simple concept as to how you can harm them.

As a Paramedic, you should shake the bad habits you learned by being an EMT-B for 6 years. Yet another good example as to why it is important to get as much education as you can instead of all that "street medicine" so you can understand the difference between dangerous practice and the correct way of providing safe care for your patients.

ok, i'll bite..... what tests would you used to decide it a person is faking unconsciousness vs truly unresponsive? and lets assume the patient is hemodynamically stable

 

[VentMedic]

Its taught in college classrooms by EMS educators with at least bachelors degrees .... Where do you think I learned it? Did you think I thought one day "hey this may harm my patient lets give it a try?
your point is completely irrelevant and I will continue to listen to the EMS educators I had in college, and first hand experience instead of a forum troll on the internet.

It was taught in YOUR EMT class as you stated in an earlier post as a BLS skill in YOUR EMT class. That does not mean everyone advocates it nor is it taught everywhere.

I suppose you will have to learn the hard way by actually harming a patient and that is very unfortunate.

 

[VentMedic]

ok, i'll bite..... what tests would you used to decide it a person is faking unconsciousness vs truly unresponsive? and lets assume the patient is hemodynamically stable

Remember this thread?

http://www.emtlife.com/showthread.php?t=16100&highlight=faking+unconscious

 

[DrParasite]

actually no, i didn't. But after rereading it, you basically would send a person in the condition i just described to the ER, with ALS, and treat them as an unconscious/unresponsive right? I just want to make sure I understand your position.

 

[ZVNEMT]

if you're worried about the hand drop injuring the Pt, perhaps maybe you dont drop it from fully extended or shield their nose with your free hand. i could be wrong being that i don't have much experience outside of simple transport, so feel free to correct me if I am wrong.

and the "super morphine" thing is pretty bad... i'll leave it at that....

 

[firetender]

Humans is Humans

Thankfully, there are many of us who are appalled by such actions. Otherwise they would be much more widespread.

But the truth is, our profession is an extreme one. It is right up there with the most high-adrenaline of careers. Such careers attract people who are, let's just say, a bit on the edge between on and off kilter. Do you think everyone enters the arena where Life battles Death because they are sane?

There are a lot of people in the general population who have quiet little twists to their personalities that when given free reign can really get out there and become incredibly painful to others. No less a proportion of that population is part of EMS, and to be straight with you, I think it attracts a lot more people on the edge than does something like Accounting!

What EMS provides is OPPORTUNITY because, by definition, the population it serves is vulnerable. In high volume areas I have seen time and time again reprehensible actions toward human beings "just because" they are not the people who are deemed really in need. Donning layer after layer of emotional protection often leads to indifference to suffering; probably the most destructive of all behaviors a medic could display. And this, for the most part, is done subtly and secretly and not observed by others.

The actions themselves as described are of little importance to me. I, myself have taken many of them. And, yes, there were moments when I performed them with a touch of glee! This is the very thing that I deplore most because it is a weakness I have seen in myself. To me, then, it is not the actions as much as it is the attitude behind them. You can start an IV for spite if you want to, all you have to do is know how to call in for the orders.

And this is what I see as the BIG danger because there are those amongst us who, given the least amount of encouragement ("We'll teach him to waste our time!") or opportunity will de-humanize their patients. We get to see examples of this "slip in" to the threads here now and again.

My only point is, if we're going to be honest we'll have to admit even riding white horses will attract people who do weird stuff with their spurs.

 

[Lvillemedic]

http://theemtspot.com/2009/07/04/test-for-unconsciousness-the-hand-drop/

This is the correct way to do it and is the way I was taught in the mid 80's and again when I got my P cert. I still use it and will contiue to use it. I have never had a pt injuried by this in 26yrs doing ems. I don't consider myself lucky, I just do it correctly. If you do something remember 2 things:
1. Be able to justify it in a court of law.
2. Make sure you do it correctly and document it well.

Do these two things and you won't have any problems.

 

[emt_angel25]

Err...


Emphasis added.

ok unless you count the "hand drop" a cruel and unusual punishment on a consious pt. im talkin the big time stuff.

 

[rescuepoppy]

We have too many chances in the day to day interaction with our patients to accidently cause injury that we do not need to be doing the type of things too many use as a punishment. This type of thing is just another reason we as a whole are losing procedures that we could be using to help our patients. In my opinion every provider that is found guilty of using any procedure as a means of retaliation against a patient should be subject to disciplinary actions. Their is no place in any form of medicine for this type of behavior.

 

[ExpatMedic0]

Yes I have not had any problems with it either and found it interesting that it was even mentioned in this thread. Obviously like any procedure it must be done properly and used as part of an overall patient assessment to include other hands on assessments and diagnostic tools with pt. hx to reach a conclusion.
For those that do not like it, different strokes for different folks but its far from malfeasance, negligent or "appalling" Its a tool that can be used.

http://theemtspot.com/2009/07/04/test-for-unconsciousness-the-hand-drop/

This is the correct way to do it and is the way I was taught in the mid 80's and again when I got my P cert. I still use it and will contiue to use it. I have never had a pt injuried by this in 26yrs doing ems. I don't consider myself lucky, I just do it correctly. If you do something remember 2 things:
1. Be able to justify it in a court of law.
2. Make sure you do it correctly and document it well.

Do these two things and you won't have any problems.

 

[VentMedic]

http://theemtspot.com/2009/07/04/test-for-unconsciousness-the-hand-drop/

This is the correct way to do it and is the way I was taught in the mid 80's and again when I got my P cert. I still use it and will contiue to use it. I have never had a pt injuried by this in 26yrs doing ems. I don't consider myself lucky, I just do it correctly. If you do something remember 2 things:
1. Be able to justify it in a court of law.
2. Make sure you do it correctly and document it well.

Do these two things and you won't have any problems.

We did a lot of things in the 80s that are no longer done in the year 2010. You seem to want to live in the past. Medicine moves forward even if some in EMS try not to. Try to get up to speed and stay current. There are reasons why some things are no longer done or considered acceptable. It also makes some in EMS look rather stupid to continue doing things that others have stopped long ago because they understood the reasons "why".

Even the "blog" page you posted states this:

And while this last part should go without saying, I’m going to put it in here anyway. No test is completely accurate regarding level of consciousness. People presenting with altered mental states and verbal unresponsiveness need to be treated as unconscious regardless of our suspicions based on tests such as these.​

If you develop the habit of blowing off your patients because they fail tests like the hand drop and the face flick, you’re bound to get caught with your proverbial clinical pants down sooner or later. A bad day indeed.​

If the test may not be accurate anyway, why do something that could potentially do harm? It is also ironic that the top of the page states: Medicine moves fast....keep up. Yet, it advocates stuff done in the 80s and for most, stayed in the 80s.​

Yes I have not had any problems with it either and found it interesting that it was even mentioned in this thread. Obviously like any procedure it must be done properly and used as part of an overall patient assessment to include other hands on assessments and diagnostic tools with pt. hx to reach a conclusion.
For those that do not like it, different strokes for different folks but its far from malfeasance, negligent or "appalling" Its a tool that can be used.

You haven't even finished what is required of you to be a Paramedic in OR yet which I also find appalling that a state which lays claim to requiring a 2 year degree when it actually doesn't. You are young and once you injure a few patients because you fail to understand what it is that you are doing, hopefully you can return to your EMT-B status permanently. Doing something "just because" or "that is how it has always been done" just shows how far you still have to go with your education. If you can not understand why something like the arm drop is harmful, I seriously wouldn't want you around medications especially narcan. This thread has probably given you way too many ideas of how you can abuse or torture the patients you don't like.

 

[JPINFV]

ok unless you count the "hand drop" a cruel and unusual punishment on a consious pt. im talkin the big time stuff.

It's ambiguous whether you meant just the hand drop, or the hand drop as an example. However, then if that's all you meant, then ok...

 

[EMSLaw]

I've heard the stories about shoving ammonia inhalents up the noses of OD patients and pinching... but that was back in the 70s. I'd have thought that after 35-40 years, EMS would have advanced.

I won't play holier than thou - I've had patients go beyond testing the limits of my empathy. But ultimately, we're supposed to be there to help, not cause further injury if we can help it.

 

[Aidey]

Honestly, it's hard to get really worked up about ammonia and the hand drop when there are ER docs who still use both. Not ammonia up the nose or in a NRB, but ammonia in general.

Yes, I understand there are complications to both, and I personally can't be around ammonia, so I won't let it be used in my ambulance. However, I can't condemn another paramedic for doing them when the medical community can't make up it's mind one way or the other.

 

[VentMedic]

However, I can't condemn another paramedic for doing them when the medical community can't make up it's mind one way or the other.

There are also some ambulances that carry the MAST because their medical director still has faith in it.

Actually some states have made up their mind about ammonia snaps. NY is one that no longer allows them. Canada also does not allow them throughout much of the country.

While in some controlled environments, it may be acceptable. However for a medical director to accept responsibility with some procedures that have been identified as a high potential for harm and/or abuse for EMT(P)s that include some of the attitudes that are displayed just on a few EMS forums, they would be a fool.

Those that are agruing the strongest for their right to do something and denying any chance of harm can be done to a patient would be the ones that should not be doing that procedure. One should know that every procedure done has the potential to do harm as well as be of benefit. If the complications, side effects and potential consequences are not taught along with the benefits of a procedure, then that instructor has failed at his/her job.

 

[rescue99]

Honestly, it's hard to get really worked up about ammonia and the hand drop when there are ER docs who still use both. Not ammonia up the nose or in a NRB, but ammonia in general.

Yes, I understand there are complications to both, and I personally can't be around ammonia, so I won't let it be used in my ambulance. However, I can't condemn another paramedic for doing them when the medical community can't make up it's mind one way or the other.

A patient's death is why ammonia inhalents are banned here.