# The Crackhead with Chest Pain



## JVEMT (Mar 12, 2009)

Trying to prove a fellow crew wrong. Dispatched for chest pain. You arrive to find one female patient A&Ox3 c/o chest pain & SOB. One can clearly see something more is at play. Patient admits to using cocaine, drinking alcohol and doing taking other medication such as percocet. Patient denies any history. Patient B/P is 150/120. No medics available. Crew responding said “even if there was ALS around the corner, he would cancel them because it’s a bull**** call”. Do you agree or disagree? Note* 1) Cocaine is proven for potential to cause M.I. due to arterial spasm, one of the symptoms being elevated B/P.


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## firecoins (Mar 12, 2009)

JVEMT said:


> Trying to prove a fellow crew wrong. Dispatched for chest pain. You arrive to find one female patient A&Ox3 c/o chest pain & SOB. One can clearly see something more is at play. Patient admits to using cocaine, drinking alcohol and doing taking other medication such as percocet. Patient denies any history. Patient B/P is 150/120. No medics available. Crew responding said “even if there was ALS around the corner, he would cancel them because it’s a bull**** call”. Do you agree or disagree? Note* 1) Cocaine is proven for potential to cause M.I. due to arterial spasm, one of the symptoms being elevated B/P.



disagree.  cocain causes MIs.  It was an ALS job.


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## VentMedic (Mar 12, 2009)

Since women and drug addicts don't always feel chest pain the same as the text book describes, this woman could already have had an MI previously and didn't know it as well as cardiomyopathy. This can be a very serious problem and some will already have an ejection fraction of 25% by the time they do get help. The fact that there are some in EMS who blows them off as bull**** doesn't help anyone or anything either. What could be an early diagnosis and treatment may now be an extensive ICU and hospital stay.


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## Scott33 (Mar 12, 2009)

It would take a very brave (I think that is the word) BLS crew to stand down ALS in a C/P patient who has a *diastolic* BP of 120.

Crew were wrong, and perhaps they should have a good look at why they are in EMS.


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## medic417 (Mar 12, 2009)

Another arguement for always having a Paramedic on every ambulance.  These BLS providers could have killed this lady by their inaction.


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## Sasha (Mar 12, 2009)

> It would take a very brave (I think that is the word) BLS crew to stand down ALS in a C/P patient who has a diastolic BP of 120.



I don't think brave is the word. I think ignorant, stupid, or foolish may be better alternatives!


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## firecoins (Mar 12, 2009)

I missed the ultra *high* diastolic.  I guess the diastolic was on drugs.:glare:


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## el Murpharino (Mar 12, 2009)

You should prove this crew wrong by bringing this case to the attention of your medical director...see what he/she has to say about it.


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## BossyCow (Mar 12, 2009)

medic417 said:


> Another arguement for always having a Paramedic on every ambulance.  These BLS providers could have killed this lady by their inaction.



I would say its an argument for not having stupid people on the ambulance. I'm BLS and this would have definitely been an ALS call for me.

Its not always the BLS making the mistake. I called ALS for support on an elderly female, ground level fall, she dragged herself to her waterbed where she lay for several hours on an unheated waterbed before calling 911. 

She's a familiar fixture in the area, though never called us before. Tough old broad in her late 70's, retired from a career in law enforcement. Drinks heavily, smokes constantly. We backboard her, called ALS and transported. I had an ALS crew respond and tell me to take  her in BLS. She was later diagnosed with a shattered sacrum and several fractured Lumbar Vertebra. 

It was several years ago and I can't remember the vitals etc. But she was in tremendous pain despite the liquor on board, and mildly hypothermic. I got reamed by the ALS crew for calling them out on B.S. in the middle of the night and accused of being overly cautious because I backboarded her.


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## medic417 (Mar 12, 2009)

BossyCow said:


> I would say its an argument for not having stupid people on the ambulance. I'm BLS and this would have definitely been an ALS call for me.
> 
> Its not always the BLS making the mistake.




I apologise I should have said properly educated Paramedics on every ambulance.


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## BossyCow (Mar 12, 2009)

medic417 said:


> I apologise I should have said properly educated Paramedics on every ambulance.



You can't educate away arrogance or personality defects.


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## medic417 (Mar 12, 2009)

BossyCow said:


> You can't educate away arrogance or personality defects.



But increased education would weed out more.  But as I've said before I do wish we could teach common sense.  That may be the only truly impossible dream in EMS.


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## firecoins (Mar 12, 2009)

There are MDs with arrogance and personality defects.


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## medic417 (Mar 12, 2009)

firecoins said:


> There are MDs with arrogance and personality defects.



Just think how many more there would be if they had lax education requirments like we do.


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## firecoins (Mar 12, 2009)

medic417 said:


> Just think how many more there would be if they had lax education requirments like we do.



Education higher requirements are good.  I don't think it has anything to do with arrogance or personality defects.  I think certain part of the job just attract such types.


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## medic417 (Mar 12, 2009)

firecoins said:


> Education higher requirements are good.  I don't think it has anything to do with arrogance or personality defects.  I think certain part of the job just attract such types.




True we even see that here.  Shockingly some here even claim I'm arrogant and have personality defects, of course thats nicer than the way they put it.


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## firecoins (Mar 12, 2009)

medic417 said:


> True we even see that here.  Shockingly some here even claim I'm arrogant and have personality defects, of course thats nicer than the way they put it.



I don't know you and can not intelligently assess your personality flaws.   

Several members claim to know my personalty traits simply based on this forum. They were grossly wrong in their characterizations. Anyone on this website who thinks they "know" people through the forum need to reassess that opinion.


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## MRE (Mar 12, 2009)

medic417 said:


> Another arguement for always having a Paramedic on every ambulance.  These BLS providers could have killed this lady by their inaction.



As a basic I don't know enough to determine that the call is not worthy of ALS, so they are definitely getting called if this was my pt.

It would be nice to have a medic on all ambulances, but not always possible, especially in my area.  Right now I would settle for basics with a decent head on their shoulders.


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## benkfd (Mar 12, 2009)

This is definitely an ALS run in my book.  Don't know what happened exactly but is there a protocol or standing order for a Paramedic intercept while they were enroute to the hospital?  It's hard to believe that there are services out there that don't have at least 1 Medic on each truck?  I would think that would be a liability issue?  We run at least 1 Medic on each truck and many times there are 2.


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## BossyCow (Mar 13, 2009)

And again, instead of addressing the OP's question, we deteriorate into the same old rhetoric.


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## VentMedic (Mar 13, 2009)

BossyCow said:


> And again, instead of addressing the OP's question, we deteriorate into the same old rhetoric.


 
Could it be because it is an issue? It is the root of many problems in EMS and ignoring it will not make it go away. 

It is an issue that we still even differentiate between ALS and BLS in a "profession" that is now over 40 years old. It does little to provide equal, efficient and effective patient care in 911 services. But, some just can not move forward to accept change and growth or see the limitations of their own title.


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## BossyCow (Mar 13, 2009)

VentMedic said:


> Could it be because it is an issue? It is the root of many problems in EMS and ignoring it will not make it go away.
> 
> It is an issue that we still even differentiate between ALS and BLS in a "profession" that is now over 40 years old. It does little to provide equal, efficient and effective patient care in 911 services. But, some just can not move forward to accept change and growth or see the limitations of their own title.



Sure, its a problem, so is global warming and the economy. But when every thread brings out the same tired old comments with no new information, no new possible solutions and no comment on what the OP was asking about.. it gets tired.. so I comment on the tiredness of it all.


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## Sasha (Mar 13, 2009)

BossyCow said:


> Sure, its a problem, so is global warming and the economy. But when every thread brings out the same tired old comments with no new information, no new possible solutions and no comment on what the OP was asking about.. it gets tired.. so I comment on the tiredness of it all.



If it's so tired, why even comment? All you are doing is further perpetuating the conversation that could have very well died off.

It's tired, but so is the "Should this have been ALS or BLS?", so instead of commenting about how tired it is, why not acknowledge the problem and try to fix it? Then the same old comments wont pop up again.


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## BossyCow (Mar 13, 2009)

Sasha said:


> If it's so tired, why even comment? All you are doing is further perpetuating the conversation that could have very well died off.
> 
> It's tired, but so is the "Should this have been ALS or BLS?", so instead of commenting about how tired it is, why not acknowledge the problem and try to fix it? Then the same old comments wont pop up again.



Yeah.. we've been there... and the comments continue.. check the forum.. how many threads turn into the same old crap? I have personally appointed myself the reminderer... address the question asked.. if you want to expound on the deficits in EMS education.. start a thread on it or contribute to one of the thousands here.


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## Sasha (Mar 13, 2009)

BossyCow said:


> Yeah.. we've been there... and the comments continue.. check the forum.. how many threads turn into the same old crap? I have personally appointed myself the reminderer... address the question asked.. if you want to expound on the deficits in EMS education.. start a thread on it or contribute to one of the thousands here.



Did you address the question asked in your post on this thread? Nope, all you succeeded in doing is possibly start an argument.

Pot meet Kettle. Hi Kettle!


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## VentMedic (Mar 13, 2009)

BossyCow said:


> Sure, its a problem, so is global warming and the economy. But when every thread brings out the same tired old comments with no new information, no new possible solutions and no comment on what the OP was asking about.. it gets tired.. so I comment on the tiredness of it all.


 
This is not a forum about global warming. It is about EMS.

It also gets tiring to hear the same justifications and excuses from those that perceive their education/training is more than it actually is.

Right now in this country it takes only a *few* hundred hours to become a Paramedic. It takes less hours to become a Paramedic than it does a Beautician or Massage Therapist. Yet, when you look at the numbers, not that many in EMS are even willing to spend this little time to advance from EMT-B. Instead they continue to attempt to justify their level of patient care in providing *emergency* medical services. While their title may say Emergency Medical Technician, their training and education are obviously very limited. 

What does that say about this profession and the people it attracts when so few are willing to put forth enough effort to get a *few* hundred hours of education/training to be able to assess and provide care at an advanced level? And then, some want those who have gone on to advance their education to think in "BLS" terms even with many attempts to explain there is much more to medicine than what the EMT-B program teaches.

The excuses some make on these forums for not furthering their education sound like what you would hear in an AA or NA meeting. Actually, those in AA or NA may have more valid excuses for how they have chosen to live their lives and are taking the necessary steps to improve. However, when it comes to dealing with patient care and the lives of others, the excuses made by EMS agencies and some providers for not advancing should no longer be acceptable.


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## reaper (Mar 13, 2009)

Can I get an "Amen"!


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## ffemt8978 (Mar 13, 2009)

Knock it off and stay on topic.


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## medic417 (Mar 13, 2009)

JVEMT said:


> Trying to prove a fellow crew wrong. Dispatched for chest pain. You arrive to find one female patient A&Ox3 c/o chest pain & SOB. One can clearly see something more is at play. Patient admits to using cocaine, drinking alcohol and doing taking other medication such as percocet. Patient denies any history. Patient B/P is 150/120. No medics available. Crew responding said “even if there was ALS around the corner, he would cancel them because it’s a bull**** call”. Do you agree or disagree? Note* 1) Cocaine is proven for potential to cause M.I. due to arterial spasm, one of the symptoms being elevated B/P.



120 diastolic is alone enough to call ALS, but combined with chest pain should w/o question include ALS.


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## Ridryder911 (Mar 13, 2009)

There is nothing to answer. The poster decided to answer the question themselves. First, the most approppirate unit should had been dispatch. Better screening of calls.


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## Pudge40 (Mar 13, 2009)

benkfd said:


> This is definitely an ALS run in my book.  Don't know what happened exactly but is there a protocol or standing order for a Paramedic intercept while they were enroute to the hospital?  It's hard to believe that there are services out there that don't have at least 1 Medic on each truck?  I would think that would be a liability issue?  We run at least 1 Medic on each truck and many times there are 2.




Some places only offer BLS services there are 2 companies that I know of around me that are like this. There is no problem with not having a medic in my opinion. Yea sure you can't do IVs (at least not in pa) but at least there is some sort of amulance personnel.


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## firecoins (Mar 14, 2009)

Pudge40 said:


> Some places only offer BLS services there are 2 companies that I know of around me that are like this. There is no problem with not having a medic in my opinion. Yea sure you can't do IVs (at least not in pa) but at least there is some sort of amulance personnel.



the patient's condition indicates administering medications in a system where ALS is available with such meds.


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## Sasha (Mar 14, 2009)

> Yea sure you can't do IVs (at least not in pa) but at least there is some sort of amulance personnel.



Do you really think IVs are all medics do different from a basic?


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## MJordan2121 (Mar 14, 2009)

OMG! Where do all these dumb basics come from? I feel like my IQ gets higher each day. I would've had an ALS unit there pronto. I may be a basic myself, but I take my job seriously and treat every patient with the utmost respect and of the highest priority. Even if an ALS unit wasn't available, I would load the pt and get to the hospital stat. 
You know..the other day, we had a call for a pt w/ a severe headache and things did not seem right. Elevated B/P, sudden onset of severe head pain, hx of dormant aneurysm. We went Priority 1 to the hospital after my partner established the IV and I hooked her up to the monitor, etc..and turned her over to the staff at the hospital. We ended up going on another call and by the time we brought our next pt to the hospital, she coded in the ER and was being intubated..massive brain bleed. Just shows you, never take a call as being "not serious". Every pt deserves the best treatment available.


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## Pudge40 (Mar 14, 2009)

Sasha said:


> Do you really think IVs are all medics do different from a basic?



No, I don't think that is the only difference. I know there is a whole list of them but I couldn't think of the others off the top of my head. Another that I can think of rihgt now is being able to admister meds and also use the monitor to look at the heart rhythm.



firecoins said:


> the patient's condition indicates administering medications in a system where ALS is available with such meds.



I was just refering to the part that they said they think it is a liability to not have a medic on each truck. He also said that no medics were available at the time. But I do agree that if there was ALS available they should have called for them.


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## Jon (Mar 14, 2009)

As you said - "no medic availible". So BLS the call.... but that means O2 and diesel. You can't do anything else.

And I think your co-worker, if he/she/it really meant that, is a moron. Of course, it could have been bravado.... but that attitude is asking for trouble.


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## Sasha (Mar 14, 2009)

Pudge40 said:


> No, I don't think that is the only difference. I know there is a whole list of them but I couldn't think of the others off the top of my head. Another that I can think of rihgt now is being able to admister meds and also use the monitor to look at the heart rhythm.





> There is no problem with not having a medic in my opinion. Yea sure you can't do IVs (at least not in pa) but at least there is some sort of amulance personnel.



If you don't know the scope of a paramedic, how are you possibly able to determine if having them is no big deal or if they're not needed?


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## el Murpharino (Mar 15, 2009)

Pudge40 said:


> There is no problem with not having a medic in my opinion. Yea sure you can't do IVs (at least not in pa) but at least there is some sort of amulance personnel.



Please elaborate on this further; I am curious to hear why there is no problem with not having a medic on this call.  If possible, please collaborate this information with similar input from your medical director.

Secondly, your explanation as to the standard of care of a paramedic is so watered down and minimal that I pity your knowledge of EMS.  If you equate medicine to the amount of skills one can do, then you have plenty more to learn about medicine.


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## alphatrauma (Mar 15, 2009)

I'm beginning to think the OP may be a troll...

These threads are looking very formulaic


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## Pudge40 (Mar 15, 2009)

el Murpharino said:


> Please elaborate on this further; I am curious to hear why there is no problem with not having a medic on this call.  If possible, please collaborate this information with similar input from your medical director.
> 
> Secondly, your explanation as to the standard of care of a paramedic is so watered down and minimal that I pity your knowledge of EMS.  If you equate medicine to the amount of skills one can do, then you have plenty more to learn about medicine.



My bad I had worded that post wrong I meant to say "There is nothing wrong with not having a medic on every ambulance." Don't know if I was tired or what but I will go crawl in my corner for making such a stupid mistake. And I should say that I have alot to learn about EMS since I am fairly new to the field. So please feel free to corrent me and explain things.


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## Sasha (Mar 15, 2009)

Pudge40 said:


> My bad I had worded that post wrong I meant to say "There is nothing wrong with not having a medic on every ambulance." Don't know if I was tired or what but I will go crawl in my corner for making such a stupid mistake. And I should say that I have alot to learn about EMS since I am fairly new to the field. So please feel free to corrent me and explain things.



But how can you determine that? You have no idea what a paramedic is capable of doing or the (hopeful) education behind their license. So how are you to determine if it's appropriate to have a medic on every truck or not? Being so new to EMS, I'd like to hope that it's just your inexperience that has gotten you talking like that.


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## Pudge40 (Mar 16, 2009)

Ok maybe I am just bad at expressing my thoughts. My thoughts are that it is better to have a medic on the truck but if there is not it is still better than not having an ambulance at all. I hope this has clear it up. Also please send me a PM with all the things that medics can do that an EMT-B can't so I have it for future reference. Also that sentence was just in response to the person that said it would be a liabilaty to not have a medic on every truck. I don't see how it would be a liability. Please explain why it would be a liability as I don't see how it could be.


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## VentMedic (Mar 16, 2009)

Pudge40 said:


> Ok maybe I am just bad at expressing my thoughts. My thoughts are that it is better to have a medic on the truck but if there is not it is still better than not having an ambulance at all. I hope this has clear it up. *Also please send me a PM with all the things that medics can do that an EMT-B can't so I have it for future reference.* Also that sentence was just in response to the person that said it would be a liabilaty to not have a medic on every truck. I don't see how it would be a liability. Please explain why it would be a liability as I don't see how it could be.


 
You are in Pennsylvania, correct? If so, it is time you become familiar with your state laws and EMS code.

This if for the Paramedic.

If you want more specific detailed description:
http://www.dsf.health.state.pa.us/health/lib/health/ems/als_protocols-effective_07-01-07.pdf

For an overview:

http://www.pacode.com/secure/data/028/chapter1003/subchapBtoc.html


> (1) Perform pulmonary ventilation by the use of oral, nasal, endotracheal or tracheostomy intubation.
> (2) Insert, in peripheral veins, intravenous catheters, needles or other cannulae-IV lines.
> (3) Obtain venous blood samples for analysis, but only for diagnostic and treatment purposes.
> (4) Prepare and administer approved medication and solutions by intravenous, intramuscular, subcutaneous, intraosseous, oral, sublingual, topical, inhalation, rectal or endotracheal routes.
> ...


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## EMT-B2B (Mar 17, 2009)

Drugs or not....chest pain?......BP 150/120?.....SOB?.....bull**** call or not...pt may be lying.....who knows.... but with vitals.....it's still sugesting possible MI......ALS call one way or the other.....don't know about you....but I don't really want to be the one ending up in court just because my partner cries bull****


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