# Skate Medic???



## Jon (Dec 28, 2004)

Yesterday myself and WhackerDude <PARESCUEEMT - old partner> were out ice skating with my family - my dad is a ex-CPR instructor, and my brother is a Boy Scout First Aid Instructor. I was there to watch, as my balance isn't stellar, and I tend to FDGB on less slippery surfaces than Ice rinks. Well, maybe I'd have skated, but I can't find skates large enough  - I digress

So, I'm sitting there, watching the pre-teens make out on ice skates to bad Britney Spears Music (is there good Britney Spears Music??) when I notice a pile of people kneeling on the far end of the rink. I look around, and can't see PARESCUEEMT anywhere - he's got to be somewhere in the pile of people.

My dad skates over and says PARESCUEEMT needs me, and he's thinking transport. I get keys and go an get my little bag from the car. On my way, I let a rink employee know that I don't know whats going on, but my friend, an EMT is back there invsetigating, and I'll let them know if theres an "ecnalubma" on the way.

I go back to the back end of the rink and got the story:

14 year old Female. Fell, hit her head. Confirmed LOC by PARESCUEEMT - 30 seconds or less. Pt. insisted on standing and trying to walk it off, PARESCUEEMT didn't disagree, because he was seriously worried about a 2nd injury from another skater, as sevral seemed to think buzzing the group down on the ice was a cool idea. As soon as they got the Pt. off the ice she complained of loss of sight and hearing. I'm not sure if they were transient, or just partial, as the patient seemed to be able to see and hear me. PARESCUEEMT had one of her friends holding C-spine - poor kid was scared to death about screwing up.

Pt. complains of 7-9/10 pain in back of head. her neck hurts alot, as does her back.

Vitals - 132/84, pulse 100 S/R, resps 24-26 shallow (pt. very anxious and upset). Lungs CTA. After BLS arrived, pulse ox was good. On initial exam by PARESCDUE, R pupil was fixed and midposition, L reactive. on second exam, PEARLA. 

Anyway - we confer and agree that BLS and ALS are needed, and someone states they already called. I send my dad to be sure, and he gives loss of sight and hearing as current events.

BLS crew rolls in 5-10 minutes later, and are rather confused (they were hit for an injured subject - if I'd had a pager I would have called immediatly after dispatch and upgraded to ALS), but agree when I metion the 30-second LOC that ALS is VERY warrented, and is enroute 30 seconds later. Medic gets there, and he confers with his doc, who leaves the local hospital vs Trauma Center descion to the family's preferred hospital, where they sometimes act as a truama center, and sometimes as an acute care clinc when you talk of their "trauma acceptance." it all very much depends on which doc is working, and what sort of day they are having (Ya'all know how that is).

My worry was I did not want to put a bird on standby bexcause A: then the medic will think that I'm more of an *** than he thinks I am, and it dosent help that I seem to always try to fly my "simple" patients - as I've had my hands smacked by more than one ED attending for brining "that" patient in,

So, what do we all think.


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## rescuecpt (Dec 28, 2004)

How far by ground was the hospital?


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## MassMedic1052 (Dec 28, 2004)

Well.....My thoughts are....If you advocate on the patients behalf you will never be wrong and in your own thoughts should never be nervous about if you did the right thing or not.....Did she return to CAOx3?


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## Jon (Dec 28, 2004)

> _Originally posted by rescuecpt_@Dec 28 2004, 10:01 AM
> * How far by ground was the hospital? *


7 minutes to closest (where ALS came from - his command did not want patient)
12-15 minutes to Family Prefrence ED (Don't know if they accepted or not)
45+ to two closest trauma centers - Crozer in Chester City or U Penn in Philly

So, if the bird will fly, the patient gets a helicopter ride.

if the bird don't fly, you crash the party at the local ED until the patient is stable with ABC's, then you run downtown (I had a ParaGod friend have to explain this to his MedComm Doc, with a bad weather system halfway through the regoin, that he was taking his unstable trauma pt, unresponsive, posturing, with clenched teeth to the local ED. the doc said she didn't want the pt. and he said he wasn't going downtown without a patent <read ET tube> airway. We have some AMAZING docs out here - some are amaizingly good, and a few are amazingly silly)

My gut feeling is that the family prefrence accepted, because it was just starting to snow, andthey might not have been able to fly.

Jon


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## Jon (Dec 28, 2004)

> _Originally posted by MassMedic1052_@Dec 28 2004, 10:03 AM
> * Well.....My thoughts are....If you advocate on the patients behalf you will never be wrong and in your own thoughts should never be nervous about if you did the right thing or not.....Did she return to CAOx3? *


 what I was saying is more along the lines of well, they might need a bird, but that's ALS's call, and why not leave the bird to them, rather than risk a ParaGod Fit that I stole their thunder by placing a bird on standby.


Jon


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## rescuecpt (Dec 28, 2004)

Here, anyone can call for the bird (through the PD)...  usually it's highest ranking medical training.  But technically, if you don't have ALS on scene, can your BLS call for the bird?  Ours can.  They come fully stocked with a lovely very experienced medic.  Well, not always lovely.


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## PArescueEMT (Dec 28, 2004)

> _Originally posted by rescuecpt_@Dec 28 2004, 02:57 PM
> * But technically, if you don't have ALS on scene, can your BLS call for the bird?
> 
> They come fully stocked with a lovely very experienced medic.  Well, not always lovely. *


 keep yourself out of it...

Officially Neither BLS or ALS can call for a bird. In prder to get a bird, you have to talk with MedComm. They are the only ones officially alloud to call for a fly. I have heard of medics calling for a bird, then telling MedComm, but there is usually a damn good reason.


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## PArescueEMT (Dec 28, 2004)

> _Originally posted by MassMedic1052_@Dec 28 2004, 11:03 AM
> * Did she return to CAOx3? *


 She never really left that. She had everything correct except the month.

Name Correct
Location: "I know that I'm at the Ice Line"
Time of Day: Night Time
Day: Sunday
Month: November
Year: 2004
Last Holiday: Christmas
President: Bush

So I would've given her CAOx4 Since she got everything but the month Correct.


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## MedicPrincess (Dec 28, 2004)

> _Originally posted by rescuecpt_@Dec 28 2004, 01:57 PM
> *Here, anyone can call for the bird (through the PD)... usually it's highest ranking medical training. But technically, if you don't have ALS on scene, can your BLS call for the bird? Ours can. They come fully stocked with a lovely very experienced medic. Well, not always lovely.*


We have the same here.  Anybody can call for the helo if they feel it is needed.  This included any PM on down the the first Vol. FF on scene who determines a Trauma Alert needs to be called, or the medical is bad enough they need to go to the big hospital, thus the helo flys.

When the FF calls for it, dispatch will always contact the Med Unit and see what they want to do (annoying as crap...but they have protocols too) and what their reason for wanting a bird is.  And Always - with only ONE very notable exception and lets not get started about him- the PM will respond to dispatch with "Well what did the FF say?"  They all trust the FF to know how to recognize when the helo is needed.


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## Luno (Dec 28, 2004)

If I read your account right, I would disagree with everyone here, with pupils MERL (Mid Equal Reactive to Light) vitals stable, no change over time, the only reason that I would even recommend ALS is the length of the transfer, if the local hospitals couldn't deal with intercranial injuries.  If the transport was closer to 15 min to a trauma, this IMHO would be strictly BLS.  I don't see the reason to activate airlift.  But that's just my opinion.


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## rescuecpt (Dec 29, 2004)

> _Originally posted by Luno_@Dec 28 2004, 10:32 PM
> * If I read your account right, I would disagree with everyone here, with pupils MERL (Mid Equal Reactive to Light) vitals stable, no change over time, the only reason that I would even recommend ALS is the length of the transfer, if the local hospitals couldn't deal with intercranial injuries.  If the transport was closer to 15 min to a trauma, this IMHO would be strictly BLS.  I don't see the reason to activate airlift.  But that's just my opinion. *


 Potential for seizures secondary to head injury?  That would be the excuse I would use when asked why I called for ALS.  Although I'd already be on scene so calling for myself would be a little silly.  HAHAHAHAHA....  oh yeah, gotta love it 0404 with no sleep!


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## ffemt8978 (Dec 29, 2004)

The confirmed LOC is enough for us to consider the bird or ALS since it is one of the Big 4 that you can activate the Trauma System on.


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## PArescueEMT (Dec 29, 2004)

what about the Loss of Vision while on the ice, and the near loss of hearing throughout the incident. Oh yeah, 9/10 head pain, 8/10 neck pain, and 6/10 back pain? Is that not entering into consideration?

My first check, her Right pupil was fixed and dialated, her left was reactive and slightly sluggish.


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## Margaritaville (Dec 29, 2004)

Sorry Luno gotta disagree,

Definitely ALS. Because of her pain issue and some of the other vague ss & sx - I'd send her to the "spinal center".

I work in an area that sees a very large amount of spinal injuries, and she is suspect. 

Better safe than sorry my friends. As far as using the helicopter - our criteria is different than most areas, so I have no opinion on that one.


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## Jon (Dec 29, 2004)

> _Originally posted by rescuecpt_@Dec 28 2004, 01:57 PM
> * Here, anyone can call for the bird (through the PD)...  usually it's highest ranking medical training.  But technically, if you don't have ALS on scene, can your BLS call for the bird?  Ours can.  They come fully stocked with a lovely very experienced medic.  Well, not always lovely. *


 My county will call for a bird if an incoming unit requests it. It is, however, a gray area. Our flight services trust that we only call when we needed a bird yesterday. I also know that some birds have jumped Medicals because they can beat the medics by 5-10 minutes on a code, or more. I also know of BLS calling for ALS via Helo when all other ALS is out and Pt. is starting to crap out, with at least 15+ min. transfer to the closest ED, which happens to have a bird on the roof.


The other thing is that ANYONE can ask for a standby, which varies by service as to what they get, from bird in the air towards scene (once in incoming bad Weather I had a helicopter show up without being upgraded "we were in the area, now give us the patient so we can get out before we are grounded  ) usually the pilot checks weather and then they go and start the preflight, so one the go is ordered, skids off deck in 60secs.


I have seen medics do EVERYTHING per written protocol, and when enroute back to the garage to restock call the doc and say, oh, by the way, I sort of just flew an unconscious head injury out from xxx and yyy and he's going to zzz ED via XYZ Helo. Just thought you'd like to know.


Long story short - if they were STILL unconscious when I got there, and hadn't been able to stand up and walk off the ice with assistance, I personally would have gone to the lobby where I had service, and called 911, and stated unconscious after fall w/Head injury, EMT onscene, Cert 1234567 I want ALS and a bird, yesterday.

I knew that the patient was "stable" I had a conscious Pt, who was conversing appropriately and I thought that the pt's current condition would likely remain the same for 5 or 10 minutes, and I'd let someone with the "-P" and Chutzpah call for the bird.


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## rescuecpt (Dec 29, 2004)

You know, the more I think about it, "Skate Medic" probably staged the accident so he could talk to the little teeny bopper and be the hero.   :lol:


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## Jon (Dec 29, 2004)

> _Originally posted by rescuecpt_@Dec 29 2004, 06:17 PM
> * You know, the more I think about it, "Skate Medic" probably staged the accident so he could talk to the little teeny bopper and be the hero.   :lol: *


 REMEBER. That would be PARESCUEEMT, NOT ME!!!! I was ON THE OTHER SIDE OF THE RINK WHEN IT HAPPENED.



Jon


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## rescuecpt (Dec 29, 2004)

> _Originally posted by MedicStudentJon_@Dec 29 2004, 06:26 PM
> * REMEBER. That would be PARESCUEEMT, NOT ME!!!! I was ON THE OTHER SIDE OF THE RINK WHEN IT HAPPENED.
> 
> 
> ...


 I know, that's exactly what I was saying.


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## Luno (Dec 29, 2004)

> *Potential for seizures secondary to head injury?*


 Rescuecpt, okay, I'll conceed that it could be a reason, it just wouldn't be mine


> *The confirmed LOC is enough for us to consider the bird or ALS since it is one of the Big 4 that you can activate the Trauma System on*


ffemt, true, + LOC is an indicator, I wouldn't given the pt quick recovery


> *what about the Loss of Vision while on the ice, and the near loss of hearing throughout the incident. Oh yeah, 9/10 head pain, 8/10 neck pain, and 6/10 back pain? My first check, her Right pupil was fixed and dialated, her left was reactive and slightly sluggish.*


 PArescue, of course it does, especially the 9/10 head px, but not enough is told, i.e. point tender, etc... px in reaction to light, sound, I differed my opinion due to pt quick recovery, and the symptoms subsiding quickly, no significant change of vitals over time, I assume pt was CMSx4, being someone who has been "knocked out" the symptoms you discuss were fairly typical of a less severe concussion, had there been residual amnesia, etc... I may have picked a different route, but don't let my monday morning quarterbacking (yes, that's all this is) get to you.


> *Definitely ALS. Because of her pain issue and some of the other vague ss & sx - I'd send her to the "spinal center".*


Margaritaville, okay, I'll bite, understand the px 2* to trauma, but if it was, she should of been kept on "ice" until proper c-spine precautions are met, there was no mention of point tenderness, lack of circulation/motor/sensation in extremities, etc...  And as far as I am familiar with, even spinal compromise is BLS, unless it affects Resp/Cardiac/Circulatory systems.  While we may differ on "field analysis" spinal precautions are always a safe bet.


> *I knew that the patient was "stable" I had a conscious Pt, who was conversing appropriately and I thought that the pt's current condition would likely remain the same for 5 or 10 minutes*


Medicstudjon (yes I shortened it, you can thank me later) I think this is the key here, as to why the bird wasn't needed, as well as ALS, pt was, if I am reading the account right, stable, i.e. BLS, but you were right to stay on the side of caution.
Luke


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## rescuecpt (Dec 29, 2004)

> _Originally posted by Luno_@Dec 29 2004, 08:39 PM
> *
> 
> 
> ...


 IMO, any head injury which include LOC and other neurologic defecits is ALS.  Seizures was just a backup bs answer if head injury with LOC and neurologic defecits isn't enough to get ALS.


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## PArescueEMT (Dec 29, 2004)

> _Originally posted by rescuecpt_@Dec 29 2004, 07:17 PM
> * You know, the more I think about it, "Skate Medic" probably staged the accident so he could talk to the little teeny bopper and be the hero.  :lol: *


easy erika... I don't mess with any 14 y/o girls. That would be like you flirting with a 16 y/o boy. :wacko:  ^_^  Don't I feel loved  :wub:


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## rescuecpt (Dec 30, 2004)

> _Originally posted by PArescueEMT+Dec 29 2004, 11:18 PM--></div><table border='0' align='center' width='95%' cellpadding='3' cellspacing='1'><tr><td>*QUOTE* (PArescueEMT @ Dec 29 2004, 11:18 PM)</td></tr><tr><td id='QUOTE'> <!--QuoteBegin-rescuecpt_@Dec 29 2004, 07:17 PM
> * You know, the more I think about it, "Skate Medic" probably staged the accident so he could talk to the little teeny bopper and be the hero.  :lol: *


easy erika... I don't mess with any 14 y/o girls. That would be like you flirting with a 16 y/o boy. :wacko:  ^_^  Don't I feel loved  :wub: [/b][/quote]
 Um, what's wrong with flirting with a 16 year old boy?  It's so much fun to see them blush - look but don't touch, remember?   HEHEHE... Just kidding.  I don't deal well with younger men, they tend to get on my nerves.  HEHE...


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## Jon (Dec 30, 2004)

> _Originally posted by rescuecpt_@Dec 30 2004, 09:44 AM
> * I don't deal well with younger men, they tend to get on my nerves.  HEHE... *


 DAMN....THERE GO MY DREAMS     :lol:  :lol:  :lol:


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## Jon (Dec 30, 2004)

> _Originally posted by Luno_@Dec 29 2004, 08:39 PM
> *
> 
> 
> ...


 
Yeah - as I tried to say, ALS was important, as no ED out my way would let you in the door (figurativly, so calm down before EMTALA is cited), with a confirmed LOC without an ALS assessment, unless you had a DARN good reason, like an arrest or unstable airway.

Here we all call the ED for "notification" at begining of transport, give quick report to RN or unit clerk to make sure the ED can accept the Pt.

occasionally the RN or PA who answers will tell you to get ALS, but thats real rare, and then the followup is, I'm finding the doc, otherwise they will throw the doc on the phone and have him take the report, and decide about upgrading

Long story short, if I had been riding as a Medic student (which will happen some day soon) I would have really thought about local ED vs. Trauma Ctr, and probably left it to the doc's discretion. that night, however, I got to pass the buck to someone with more letters after their name   :blink:  :lol: 

Jon


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## Luno (Dec 30, 2004)

> *I got to pass the buck to someone with more letters after their name*



Yeah, 10-4 that, I guess I am just used to knowing all the local hospitals, who can/cannot handle closed head injuries, etc...  But this is definately the time to shaft the person above you  h34r:


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## PArescueEMT (Dec 30, 2004)

I am kind of suprised at how many ppl basically jumped in with the reasons for ALS. I know that I was at an advantage with reasons that Jon didn't post. but with what was posted, I enjoy seeing the different reasons caught.


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## rescuecpt (Dec 31, 2004)

> _Originally posted by PArescueEMT_@Dec 30 2004, 10:40 PM
> * I am kind of suprised at how many ppl basically jumped in with the reasons for ALS. I know that I was at an advantage with reasons that Jon didn't post. but with what was posted, I enjoy seeing the different reasons caught. *


 My favorite is "because I can".  My CC instructor made us recite that in class.  I can do O2, IV, monitor on any patient I want.  Why, "because I can".  Say it with me now...   (hehehehe)


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## ffemt8978 (Dec 31, 2004)

> _Originally posted by rescuecpt_@Dec 31 2004, 08:07 AM
> * My favorite is "because I can".  My CC instructor made us recite that in class.  I can do O2, IV, monitor on any patient I want.  Why, "because I can".  Say it with me now...   (hehehehe) *


 I had an ED nurse ask me why I brought a patient into her ER on O2.  My answer was "because I can and my protocols say O2 is good, give lots"


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## Jon (Dec 31, 2004)

> _Originally posted by ffemt8978+Dec 31 2004, 12:33 PM--></div><table border='0' align='center' width='95%' cellpadding='3' cellspacing='1'><tr><td>*QUOTE* (ffemt8978 @ Dec 31 2004, 12:33 PM)</td></tr><tr><td id='QUOTE'><!--QuoteBegin-rescuecpt_@Dec 31 2004, 08:07 AM
> * My favorite is "because I can". My CC instructor made us recite that in class. I can do O2, IV, monitor on any patient I want. Why, "because I can". Say it with me now...  (hehehehe) *


I had an ED nurse ask me why I brought a patient into her ER on O2.  My answer was "because I can and my protocols say O2 is good, give lots"   [/b][/quote]
yeah. I LOVE getting into arguments with ED staff about using NRBM's on pt's in CHF/COPD with obvious, severe SOB. 1/2 hour O2 won't kill them, and it's all the drugs I as a basic can use on that patient. Yes, They need Lasix and a neb or 2, but I can't do that.

I had one patient myself and PARESCUEEMT picked up from a large, federally operated "medical center" in philly. pt. lived in a very nearby SNF, and had been fine when we dropped him off that AM, but when we got there to pick him up we barley got out of the elevator before we heard him gurgling, coughing, and wheezing. I listened to his lungs and myself and WhackerDude had the conclusion that this was VERY bad. Pt also stated he felt really bad, and having lots of trouble breathing.

Pt was a CHF/COPD'er on 2LPM by N/C, and we only had the strecher and o2 bottle - no NRBM. I cranked the o2 up to 6 and found the charge nurse, enjoying a glossy tabloid in the next room. her response - well, just drive him down the street to his nursing home (which has a close affiliation to the hospital). I said no, because then I get to come right back, becuase they won't take him. Either you do something about his condidtion RIGHT NOW, or tell me to take him to your 'ED' (a rather run down acute care clinic that city EMS does not recognize as an ED). WhackerDude called our dispatcher, and explained the situation, and he told us to drop the pt. at the ED and clear up for another run. the Nurse found a doc who brushed us off and told us that if we felt we needed to to take him to the ED.

We rolled into the ED and the charge nurse got all pissy that we intrupted his lunch. then he proceeded to tell us to take the patient to the SNF and let them decide to send him back. THEN he told us that he was on too much o2 and was a COPDer, ETC. The attending heard him berating us and came to our rescue. we told her what was happening and she personally worked up the patient, and we all agreed that he looked like crap and probably needed his meds. Given that these facilities are both very computer-based, they give transport units NO paperwork, just Pt's name Pickup and Dropoff, and maybe a SSN.

Long story short, a very nice doc saved the day, and the patient always loved me and WhackerDude, and the nurses on his floor knew it, so we would be walking by and they would ask us to go calm him down or have him keep his neb mask on. Great guy, one of my favriote patients I miss him    :angry:    (I no longer work for that company and go to that Sh*thole of a facility)    :angry: 

Jon


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## Luno (Dec 31, 2004)

Yeah, I wasn't a favorite of certain area ED nurses, but I was highly respected (I like to think) by Docs, who incidently let me do alot more than "protocol" but that's a different story.  I was always the EMT who wouldn't take a transport that I deemed unstable, unless they were carrying DNR/No Code/Hospice paperwork, and not unsigned, photocopied BS, it had to be complete, and original, including crossing all i's and dotting all t's.     I've gotten into verbal "disagreements" with discharge nurses, told them to call another company, over pt discharge conditions, and nearly got into a physical altercation over a DNR with a FF Lt. (not that we don't love Cpts, erika) who didn't feel it was appropriate to obtain a DNR from a pt who was CTD on a long txpt.  

I don't know, I guess that even with my "all business" demeanor, when I was on the rigs, it was all about the pt, even if they didn't know what was in their best interest.  They were going to get help if they needed it, and they were told they were full of BS when they were.  I'm not going to get into the customer service BS that I think has taken over EMS, but I was told once that they call us because we're the professionals, and they don't know.  I took that as gospel in my career, and once a patient was in my care, they were my responsibility until they declined care, or it was transferred, and for the time of my care, they were my only responsibility.  I've caught flak for telling a patient they were full of $h!t, but behind the scenes, everyone was slapping me on the back, because everyone knew it was the truth.  

I think that as an EMT, and when I was on the rigs, I was the patient's advocate, if something is going wrong, even if it is from "higher" authority, it's my job to protect the pt.  

Thanks for reading my opinion,
Luke


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## PArescueEMT (Dec 31, 2004)

Amen brother!!!
I totally agree. I have done the same with Discharges, and will continue to until I permanantly stabilize.


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## Jon (Jan 2, 2005)

> _Originally posted by PArescueEMT_@Dec 31 2004, 11:02 PM
> * Amen brother!!!
> I totally agree. I have done the same with Discharges, and will continue to until I permanantly stabilize. *


 Or suffer a TBI (Traumatic Brain Injury)

Jon


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## TTLWHKR (Feb 6, 2005)

> *Officially Neither BLS or ALS can call for a bird. In prder to get a bird, you have to talk with MedComm. They are the only ones officially alloud to call for a fly.*



You are joking right?

What EMS region are you in?

Our units can call for, or cancel the bird any time we see fit. That's a necessary tool up here in the boon docks. Local hospital is 30 miles, trauma center is 60-70 (Geisinger@Danville or CMC@Scranton).

In fact just called for one last week to medevac a critical medical patient. They don't make us call Medical Command. Maybe it's different around the state.


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## Jon (Feb 6, 2005)

> _Originally posted by Blueeighty8_@Feb 6 2005, 06:38 PM
> *
> 
> 
> ...


 Yeah - here we are 20 minutes from a local hospital, at the EDGES of the county.

where I run it is 5-10 minutes from one, and 10-20 from the other. none are trauma, though.

in delco only 2 people can "fly" the bird - Medic per Command, and Fire Chief, because he's the chief (VERY SILLY)

Here in Chesco there really isn't abuse of it, so if you as the BLS crew gets on the radio and screams for a bird, the county flies one. However, you don't fly without command unless you have a DARN good reason to. Worst case, all local docs are scared sh*tless of trauma, so a 30-second report over the whone will get you permissin to fly ANYONE with possible mecanism of injury....

Jon


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## Jon (Mar 6, 2005)

Ok - Talked with the medic last night - Pt. went to local ED, then to the city by Helo for a subdural bleed.

Don't know final outcome, though.


Jon


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## Ray1129 (Mar 15, 2005)

> _Originally posted by rescuecpt_@Dec 28 2004, 01:57 PM
> * But technically, if you don't have ALS on scene, can your BLS call for the bird? *


 Around here, anyone can call for a helo - ranging from EMTP to PD.  Everyone(PD and FD) is dispatched though the same dispatch center(at least in Harford County) so if anyone wants a helo, we just contact dispatch who in turn contacts SYSCOM.  SYSCOM then contacts our state PD(our local helo tx) and they come to the decision of whether they are down due to weather or not.

So basically, if the weathers right and we request them, they're coming.  

Now whether or not they transport is another story.  Since out nearest Trauma Center is 45 minutes to an hour away, we are told to fly fly fly.  Most of our providers understand the difference of when to fly and when not to.  But if the helo gets there and they don't think it's warrented, they'll cancel themselves and have us tx. by land.  That hardly ever happens, though.  Like I said, most of our providers know when to fly and when not to.

Not to mention we have training on when to fly and when not to, so that helps out as well.


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