# What are some things that you have been taught that is total BS?



## johnrsemt (Mar 27, 2011)

Such as:

   can't get a Radial pulse unless BP is over 80 S, Femoral pulse bp over 70, and carotid pulse with BP over 60 S.

   High Flow O2 for everyone
        but---
   too much O2 can shut off resp drive on COPD patients
     (I was taught both of the O2 ones in same EMT-B class)


----------



## usafmedic45 (Mar 27, 2011)

-That anything but CPR, defib and epinephrine has proven benefit in cardiac arrest
-That helicopters speed patients to trauma centers or offer any benefit to the average trauma patient
-That non-physiological mechanism of injury (damage to the car, injury to other persons, etc) can help predict severity of injury.


----------



## usalsfyre (Mar 27, 2011)

Endotracheal tubes prevent aspiration and are the "gold standard of airway management" 

Fluid boluses of 20ml/kg are needed for the hypotensive trauma patient. 

Norepinephrine is a pressor of last resort and people who get put on it always die.


----------



## Veneficus (Mar 27, 2011)

BLS before ALS


----------



## ffemt8978 (Mar 27, 2011)

Veneficus said:


> BLS before ALS



I was wondering how many posts it would take before that one showed up.


----------



## Veneficus (Mar 27, 2011)

ffemt8978 said:


> I was wondering how many posts it would take before that one showed up.



I didn't want to dissapoint.


----------



## LucidResq (Mar 27, 2011)

Everyone wants to sue you.


----------



## usalsfyre (Mar 27, 2011)

Narcan is a benign drug. 

CHF is caused by fluid overload. 

NPAs are a poor adjunct compared to OPAs


----------



## Zodiac (Mar 27, 2011)

Using the largest gauge possible when starting IVs on anybody "just in case"


----------



## JPINFV (Mar 27, 2011)

Oxygen is a benign drug that everyone should receive at 15 L/m via NRB mask.

Lights and sirens saves lives.

Seconds always count. 

Everything works out if the patient arrives at the hospital "alive."


----------



## usalsfyre (Mar 27, 2011)

JPINFV said:


> Lights and sirens saves lives.
> 
> Seconds always count.


Tell the guys over at elightbars.org these are lies .


----------



## 46Young (Mar 27, 2011)

The Golden Hour.

You can't diagnose a STEMI in a pt that has a LBBB or paced rhythm


----------



## Veneficus (Mar 27, 2011)

That diseases always present the textbook way and only one bothers a pt. at a time.


----------



## adamjh3 (Mar 27, 2011)

Transporting a suspected CVA to a stroke center is a no-no for BLS


----------



## ffemt8978 (Mar 27, 2011)

usalsfyre said:


> Tell the guys over at elightbars.org these are lies .



Just make sure it happens over there and not here...we want no part of that fight.


----------



## Veneficus (Mar 27, 2011)

adamjh3 said:


> Transporting a suspected CVA to a stroke center is a no-no for BLS



I just have to ask...

Who told you that?


----------



## katgrl2003 (Mar 27, 2011)

Veneficus said:


> I just have to ask...
> 
> Who told you that?



I've been told that all the time. BLS can only transport to the closest medical center, even if it's just a bandaid station. Baloney. If my patient has s/s of a stroke, I will go the extra 15 minutes to a stroke center. If a medic can meet up with me in that time fine, but if not I'm not diverting.


----------



## Veneficus (Mar 27, 2011)

katgrl2003 said:


> I've been told that all the time. BLS can only transport to the closest medical center, even if it's just a bandaid station. Baloney. If my patient has s/s of a stroke, I will go the extra 15 minutes to a stroke center. If a medic can meet up with me in that time fine, but if not I'm not diverting.



That is crazy, what the hell can a medic do for a stroke?


----------



## JPINFV (Mar 27, 2011)

Veneficus said:


> That is crazy, what the hell can a medic do for a stroke?



Rule out hypoglycemia...


----------



## katgrl2003 (Mar 27, 2011)

Veneficus said:


> That is crazy, what the hell can a medic do for a stroke?



Can you please come tell that to everyone here?! One of the dispatchers at an old job even tried to tell a medic that we couldn't transport to a stroke center, we had to go to the 'closest appropriate facility', which in her mind, was the hospital a block away. Nevermind the fact they have no neuro capabilities, and their CT scanner was down!

In this area, people seem to believe 'closest appropriate facility' means closest facility, even if the patient will have to be transferred out immediately for care somewhere else.  I've gotten in trouble several times for transporting BLS to a trauma center, cardiac, or another specialized facility without waiting on medics, or diverting to the closest facility to my location.


----------



## HotelCo (Mar 27, 2011)

JPINFV said:


> Rule out hypoglycemia...



Basics can do that here.


----------



## Veneficus (Mar 27, 2011)

JPINFV said:


> Rule out hypoglycemia...



Forgive me, blood glucose has been in the scope since I was an EMT-B, a long long time ago where I am from, but I see your point.

But I wonder about the thinking behind not being able to make the decision to a stroke center.

It would seem that it would be cheaper and more beneficial in places that don't have Basics with glucometers to get them rather than the delays, bills, and logistics of taking a suspected stroke to a nonneuro center.


----------



## Veneficus (Mar 27, 2011)

katgrl2003 said:


> if the patient will have to be *transferred out immediately* for care somewhere else..



That is an oxymoron in medicine.

Imediately transferred usually takes at least an hour usually 2 and that doesn't count the transport time.


----------



## katgrl2003 (Mar 27, 2011)

Veneficus said:


> That is an oxymoron in medicine.
> 
> Imediately transferred usually takes at least an hour usually 2 and that doesn't count the transport time.



True, I forgot about that.


----------



## Veneficus (Mar 27, 2011)

katgrl2003 said:


> True, I forgot about that.



That also doesn't count the time when the original facility tries to do the $10 million workup for a dx that will be repeated at the stroke center any way because they need specific findings. 

the field of EM is really getting under my skin this week.


----------



## usalsfyre (Mar 27, 2011)

Veneficus said:


> That also doesn't count the time when the original facility tries to do the $10 million workup for a dx that will be repeated at the stroke center any way because they need specific findings.
> 
> the field of EM is really getting under my skin this week.



Usually I find this to be less EM docs and more "FM working in the ED". 

You know probably better than me EMTALA has more to to with taking an hour or more for transfer than EM specifically.


----------



## Veneficus (Mar 27, 2011)

usalsfyre said:


> Usually I find this to be less EM docs and more "FM working in the ED".
> 
> You know probably better than me EMTALA has more to to with taking an hour or more for transfer than EM specifically.



Very true, but it is usually the EM who is ordering all kinds of diagnostics that she can't do anything about no matter what the outcome of them.


----------



## johnrsemt (Mar 27, 2011)

I wish someone would tell the ED docs that flying is not faster than ground.

  Katgrrl and I were at a ED just hanging around outside, went in to use the facilities and raid the fridge;  was told by a nurse that they had a patient that they just called a bird for: trauma;  multiple fractures.   (11mile transport).
  we told them that we could get the patient there in under 15 minutes.    told no, the patient is too critical to ground transport.     They waited 28 minutes from call to helicopter landing;  10 min for crew to come in,  the crew took 26 minutes to eval patient, and 11 min for them to load patient on cot to go to bird  (they used our cot).    12 minute to take off.
  We left there when they took off, and drove to the Level I trauma center,  NO L/S;  19 min drive time  and was in the ED for 15 minutes when the patient came down off the pad to a bed.         
   121 minutes for helicopter to transport patient 11 miles (by road).    We got there in 19 min without running emergent.         But couldn't convince the doctor that we could do it faster


----------



## usalsfyre (Mar 27, 2011)

Veneficus said:


> Very true, but it is usually the EM who is ordering all kinds of diagnostics that she can't do anything about no matter what the outcome of them.



Billable units man, billable units...

Actually radiologist  at one health system put their foot down here, either the patient receives films done to their specs on compliant equipment, or they don want the studies done till they get to the big hospital in the system.


----------



## Veneficus (Mar 27, 2011)

usalsfyre said:


> Billable units man, billable units....




That says it all.


----------



## lightsandsirens5 (Mar 27, 2011)

katgrl2003 said:


> I've been told that all the time. BLS can only transport to the closest medical center, even if it's just a bandaid station. Baloney. If my patient has s/s of a stroke, I will go the extra 15 minutes to a stroke center. If a medic can meet up with me in that time fine, but if not I'm not diverting.



Hear! Hear! You have no idea how much I get yelled at for suggesting we transport a nasty trauma, (eg. a guy with an arm that got twisted around a tractor PTO) an hour south to a trauma center instead of 20 minutes to a little hole in the wall rural hospital. What the heck is a level IV trauma center going to do for a pt who needs reconstructive surgery on his entire arm. But perish the thought that I would bypass the all important "closest facility." 

Or how about when I see STE in two concurrent leads and am ridiculed for even thinking I can decide to head to the cath lab instead of the local ER. Back when I was newer and didn't know that I could do that, I was taught that everything I picked up HAD to go to the local ER. So one day we pick up a chest pain with STE in two leads (don't remember which). I called it, got the level one activated and took this pt to the local ER. Wish I had known that closest facility thing was actually false. I could have had the pt in a cath lab in 90 minutes. Instead, 20 minutes to the little ER, 20 minutes there while they come up with the same conclusion I did, an hour to get ground ALS up and an hour to the cath lab. Yea, somehow 2 hours and 20 minutes is better pt care than 90 minutes. Go figure. :-(


----------



## TransportJockey (Mar 27, 2011)

Lights, what sucks even more is if your protocols specifically tell you that you MUST transport to the local county facility, even if you're closer to a facility in another state or the Level II two counties over.


----------



## usafmedic45 (Mar 27, 2011)

> I wish someone would tell the ED docs that flying is not faster than ground.



We're trying.


----------



## usalsfyre (Mar 27, 2011)

jtpaintball70 said:


> Lights, what sucks even more is if your protocols specifically tell you that you MUST transport to the local county facility, even if you're closer to a facility in another state or the Level II two counties over.



Usually crap like this is born our of "getting the unit back in service" more than what's appropriate for the patient.


----------



## TransportJockey (Mar 27, 2011)

usalsfyre said:


> Usually crap like this is born our of "getting the unit back in service" more than what's appropriate for the patient.



I confronted the boss about it when I started (especially as I can legally transport into NM since I'm dual certed and my medical director will allow me to work in NM per NMDOH scope), and that's exactly the line I got.


----------



## Veneficus (Mar 27, 2011)

usalsfyre said:


> Usually crap like this is born our of "getting the unit back in service" more than what's appropriate for the patient.



Or a medical director with a financial interest in making sure patients are steered towards their EDs. 

I know of one specific instance where this is definately the case. If it happens once, it probably happens more.


----------



## usalsfyre (Mar 27, 2011)

You don't even really need to be dual certed. As long as the trip originates or ends in the state of licensure or your requested as mutual aid. 

This is why I'm glad I work for a larger service. Posting may be a pain in the balls, but having post trucks available does allow for things like transporting to appropriate facilities.


----------



## LucidResq (Mar 27, 2011)

katgrl2003 said:


> One of the dispatchers at an old job even tried to tell a medic that we couldn't transport to a stroke center, we had to go to the 'closest appropriate facility', which in her mind, was the hospital a block away.



Puh-lease... as a dispatcher, I can tell you I would probably slap a coworker if they tried to tell a crew where to go or not go. What right does an EMD-trained layperson miles from the patient have telling a paramedic what facility they need to take the patient in front of them to? 

Was that an IFT gig?


----------



## EMSrush (Mar 27, 2011)

johnrsemt said:


> I wish someone would tell the ED docs that flying is not faster than ground.
> 
> Katgrrl and I were at a ED just hanging around outside, went in to use the facilities and raid the fridge;  was told by a nurse that they had a patient that they just called a bird for: trauma;  multiple fractures.   (11mile transport).
> we told them that we could get the patient there in under 15 minutes.    told no, the patient is too critical to ground transport.     They waited 28 minutes from call to helicopter landing;  10 min for crew to come in,  the crew took 26 minutes to eval patient, and 11 min for them to load patient on cot to go to bird  (they used our cot).    12 minute to take off.
> ...



That's very, very interesting. I've always had my doubts about how much faster an air evac is... hmm....


----------



## ffemt8978 (Mar 27, 2011)

EMSrush said:


> That's very, very interesting. I've always had my doubts about how much faster an air evac is... hmm....



We're an hour from the nearest hospital here, and it is a 30 minute flight for the helo.  The only time the helo makes a difference for us is getting a patient to a level 2 trauma center which is 3 hours by ground, or 3.5 hours to a level 1.


----------



## usafmedic45 (Mar 27, 2011)

> That's very, very interesting. I've always had my doubts about how much faster an air evac is... hmm....


You're in luck....I happen to present on this subject at conferences.  

Most studies show that in most areas going by air roughly doubles the time involved be it a flight from a scene or from a hospital.  Outside of REALLY rural areas (where FFEMT8978 lives is a good example, although at 3.5 hrs hours by ground, you'd almost be better off with a fixed wing air ambulance because it's faster, easier to work in and a hell of a lot safer), offshore, combat, high rise rescue, etc you're better off going by ground.

Here's some of the science:
Snooks HA, Nicholl JP, Brazier JE, Lees-Mlanga S. The Costs and Benefits of Helicopter Emergency Services in England and Wales. J Pub Health Med. 1996;18:67
-Increase in scene times
-Increase in expenses to the patient/their insurer
-No improvement in response times
-Minimal benefit

Karanicolas PJ et al: The fastest route between two points is not always a straight line: an analysis of air and land transfer of non-penetrating trauma patients.  J Trauma 2006; 61: 396-403
-Longer transfer times (41.3 vs 89.7 minutes)
-Actual transport time shorter by air (58.4 vs 78.9)
-Distance of transport is not a good indicator of how long the transfer will take
-Other studies show similar delays with scene responses (Ringburg AN et al, 2007)

“They can do more in the back of the helicopter”
“Working a critical patient on board any medical aircraft- especially a helicopter- is a lot like trying to work a code in a bathroom stall at a Deep Purple concert.  You don’t have a lot of room to work, what little there is taken up by other people and you can’t hear anything over the din.”- Me
-Most advanced skills are done before departure
-Studies have shown that patients benefit from the availability of ALS not from the fact it came in the form of a helicopter (Hurola et al 2002)

“It’s in our dispatch criteria.” 
“Mechanism of injury!”

CALLING FOR A HELICOPTER BECAUSE OF NON-PHYSIOLOGICAL “SIGNS OF TRAUMA” IS JUST AS UNJUSTIFIABLE.
You’re basically being told you should fly someone to the hospital simply because the dent in their car is going to be expensive to repair.
A good example: The patients on board Maryland State Police Trooper 2 were both not critically injured and had been up walking around on scene talking on their cell phones prior to EMS arriving.  One is now dead and the other is permanently handicapped.


....and just in case you think that relying upon the local university HEMS operator means that it's not driven solely by profit:
Rosenberg BL et al:  Aeromedical service- how does it actually contribute to the mission?  J Trauma 2003; 54: 681-688
-University of Michigan Survival Flight
-Roughly $6,000,000 in operating costs
-Brought in roughly $62,000,000 and was the arrival route for patients accounting for 28% of ICU days
Those arriving by helicopter were twice as likely to have private health coverage as the patients not coming in by HEMS.
*“HAIL TO THE CONQUERING HEROES!”*


JUST IN CASE YOU HADN'T HEARD:  THERE IS NO EVIDENCE TO SUPPORT THE “GOLDEN HOUR”.  It was literally named the "golden hour" because that was what the happy hour at the bar Dr. Cowley and his colleagues were hanging out at when the idea was originally suggested (as a way of encouraging funeral home ambulance services to expedite transport).  Legend has it that the tenents of the "golden hour" were laid out on a cocktail napkin.    

There is some evidence that prehospital interval is a poor predictor of mortality (Lerner EB et al, 2003)


----------



## usalsfyre (Mar 27, 2011)

The real bonus in HEMS comes not from the aircraft, but the (theoretically) advanced and experienced crews that come with it. The aircraft is just an expensive, showy and dangerous way of getting there (especially in the US). So why can't we put these crews on the ground and have them run intercepts on critical calls? Because the reimbursement structure isn't built that way...


----------



## usafmedic45 (Mar 27, 2011)

> So why can't we put these crews on the ground and have them run intercepts on critical calls? Because the reimbursement structure isn't built that way...



Although the FAA is getting really fed up with the industry thumbing their nose at attempts to non-legislatively (or non-administratively, to be more correct) rectify the safety and operational issues.  Several of my friends work for the upper echelons of the FAA so I get to hear a lot of the internal rumblings related to safety (remember, that's my other "job"...I do safety research).  

There are few things as brutal as the response when the FAA "blood quota" gets met.  This refers to the old adage that flight regulations are written in blood and that a certain number of dead people (or the death of someone high profile enough) to get the FARs amended.  It seems as though HEMS is getting pretty close to that and may G-d have mercy upon their souls when they finally blow off the FAA one too many times.  You will see the industry gutted like a salmon between the front paws of a grizzly.  Cheap, fly-by-night operators like AirEvac Lifeteam (sardonically know among my NTSB friends as "ScareEvac Deathsquad"; you've got a serious problem when you have the worst safety record of any operator in an industry best known for a poor safety record) will disappear faster than they sprang up when the medical reimbursement regulations were loosened.  The industry will wither away and all because they put profits before safety.


----------



## usalsfyre (Mar 27, 2011)

I count my blessings every day that I didn't end up splattered all over a cow pasture when a 206L proved yet again it wasn't up to the job. I may not have wanted to leave when I did, but it was probably the best thing that ever happened to me.


----------



## katgrl2003 (Mar 27, 2011)

LucidResq said:


> Puh-lease... as a dispatcher, I can tell you I would probably slap a coworker if they tried to tell a crew where to go or not go. What right does an EMD-trained layperson miles from the patient have telling a paramedic what facility they need to take the patient in front of them to?
> 
> Was that an IFT gig?



Yup. Dispatcher asked us to call when we were done with the run... I lasted 2 minutes with her berating me before I hung up on her.


----------



## rwik123 (Mar 27, 2011)

look at that mechanism of injury!

[YOUTUBE]http://www.youtube.com/watch?v=YzYxz_uvtSI[/YOUTUBE]


----------



## johnrsemt (Mar 27, 2011)

Where I am now, I am 45 min from a Level III,   and 90 from 2 Level I's and a Level II.   So we do use helicopters more here than I did while I was in Indy;  but they aren't needed as much as they are called for.  and we have some medics who sit on scene and wait for them to come to us, instead of meeting us 1/2 way.
  So while they are waiting if they find out that the bird can't come  then they are even more time from the Trauma Centers.


----------



## lightsandsirens5 (Mar 27, 2011)

ffemt8978 said:


> We're an hour from the nearest hospital here, and it is a 30 minute flight for the helo.  The only time the helo makes a difference for us is getting a patient to a level 2 trauma center which is 3 hours by ground, or 3.5 hours to a level 1.




You are only 3.5 from Harborview?


----------



## CAOX3 (Mar 27, 2011)

Nothing better then canceling a helicopter because some over zealous firefighter decided it was necessary to close a five lane highway and land the whirly bird without ever laying eyes on the patient.

The conversation went something like I don't tell you how to vent a roof, you don't tell me who needs to go by helicopter, we base treatment and transportation on assessment not your desire to get your rocks off.  He then stated well you wait until the medics get here, I said you will be waiting a while because I canceled them too.

He filed a complaint with my service, which didn't go anywhere because the kid was discharged an hour after arrival with a sprained ankle.


----------



## Hal9000 (Mar 27, 2011)

According to the three ALS services around here, "cold steel and flashing lights are what save a cardiac arrest—that's why we transport."  All three services transport *all* codes.  They're also convinced that CPR is as effective in the back of an ambulance zooming about code 3.  

I'd feel like Sisyphus if I were try to detail all the things I hear...the life-saving capabilities of the spineboard...driving code being 10 times as safe as driving one's personal vehicle in normal traffic...driving code "because that's what an ambulance is for."  

Too wearying to try.


----------



## usalsfyre (Mar 27, 2011)

What does cold steel do for non-traumatic arrest?!? More like "zappy defibrillators and muscular CPR save cardiac arrest". Heck, hot lights and cold steel are increasingly not indicated for trauma.

Some people are just morons. Glad to see you don't buy into the idiocy.


----------



## ffemt8978 (Mar 27, 2011)

lightsandsirens5 said:


> You are only 3.5 from Harborview?



Code 3 on the interstate, yeah.


----------



## usafmedic45 (Mar 27, 2011)

> Nothing better then canceling a helicopter because some over zealous firefighter decided it was necessary to close a five lane highway and land the whirly bird without ever laying eyes on the patient.











> He filed a complaint with my service, which didn't go anywhere because the kid was discharged an hour after arrival with a sprained ankle.



I had an air ambulance crew try that when I told them to get off my scene.  They contacted my medical director (or rather their PR/"education"/"quality control" department did) and said something about me depriving the patient of a higher standard of care.  I was present for the phone call and my medical director literally laughed out loud and then simply said "I won't say anything about you showing up without being called if you don't say anything about my EMS personnel being well educated.  Now kindly, **** off" and hung up.  



> The conversation went something like I don't tell you how to vent a roof, you don't tell me who needs to go by helicopter, we base treatment and transportation on assessment not your desire to get your rocks off. He then stated well you wait until the medics get here, I said you will be waiting a while because I canceled them too.










> According to the three ALS services around here, "cold steel and flashing lights are what save a cardiac arrest—that's why we transport." All three services transport all codes. They're also convinced that CPR is as effective in the back of an ambulance zooming about code 3.



I'm famous for asking people who fly aircraft with horrible safety records (such as the Cirrus line of aircraft) to sign releases authorizing me to have access to their autopsy reports for my research.  Turning that paperwork into a medical examiner or coroner is always fun:  "You have a what? How?"

Maybe I should start doing the same thing to EMS providers who work for services like the one you are describing.   



> Heck, hot lights and cold steel are increasingly not indicated for trauma


----------



## Hal9000 (Mar 27, 2011)

usalsfyre said:


> What does cold steel do for non-traumatic arrest?!? More like "zappy defibrillators and muscular CPR save cardiac arrest". Heck, hot lights and cold steel are increasingly not indicated for trauma.
> 
> Some people are just morons. Glad to see you don't buy into the idiocy.



I think you got the phrasing right on that—it did involve hot lights, not flashing ones.  It was the first time I'd heard such a nonsensical statement, so please forgive me for not recalling it correctly.

There seems to be a persistent miasma of medical folly around me.  I'm once again back to a paid ALS service that considers it appropriate to dash in to whatever scene immediately, then waste time having one person playing fetch from the ambulance.  Now that I have a college education, I only have a few more months that I have to stay in EMS, and I'll hopefully be done for good.  My current service is 9-1-1 almost exclusively and pays darn well for a private, so I'm willing to stick with it for now.  

The lack of education amongst "advanced" providers here really throws me off.  I was recently interacting with an ALS crew that hadn't even heard of CCR, and this happened to be with one of the services that transports dead people.  I suppose I'd not be inclined to rant, but when an ALS provider with zero collegiate medical knowledge tries to "educate" me on medicine, I become somewhat perturbed.

With some of the extremely messed up volunteer services I've taken part in, I could understand the amount of retardation.* With paid ALS services that interact constantly with hospital emergency departments, it's just strikingly inexcusable.  I hate hearing things like, "every patient gets an IV because the hospital says so," and the same reason for backboarding all trauma patients.  

The best one in the past couple of days was, "sores from backboards don't really hurt much and they should be the last concern for a person being backboarded anyway."  I quite literally had to stop my hand from striking my face. 







*(Proud to say that I corrected the most awful one, which is now a rural service offering paramedic service and critical care transports staffed by providers with bachelor's degrees, in lieu of having HEMS fly everything, starting with verdant rhinorrhea.)


----------



## shfd739 (Mar 28, 2011)

CAOX3 said:


> Nothing better then canceling a helicopter because some over zealous firefighter decided it was necessary to close a five lane highway and land the whirly bird without ever laying eyes on the patient.
> 
> The conversation went something like I don't tell you how to vent a roof, you don't tell me who needs to go by helicopter, we base treatment and transportation on assessment not your desire to get your rocks off.  He then stated well you wait until the medics get here, I said you will be waiting a while because I canceled them too.
> 
> He filed a complaint with my service, which didn't go anywhere because the kid was discharged an hour after arrival with a sprained ankle.



This is fun to do. Alot of our FDs always want to launch a helicopter even though we can go ground and save time or be just as quick. For the most if the helicopter isn't on the ground when we get onscene we are going ground. There have been a few times they were in sight or final and we still went ground as it was still quicker once load/unload times were factored in.


----------



## mycrofft (Mar 28, 2011)

*Lots of off thread reactionary stuff here.*

(Do I love a stomping or what?).
Not that the basic points are wrong, but some of the statements are wrong in some cases. In our local mountains, and across the more-remote areas of the Califorina Delta, and in times of flood around here, a helo can be a much better direct transport than a groundulance _*once they get there*_. They need to run helos with utmost professionalism, and use choppers which are up to the job, and staff and dispatch them in a manner which doesn't add delay. In the purely urban, or suburban, scenario the majority of calls cover and the majority of our fellow website users work in, yes, helos are an extravagance and sometimes a real danger.

Worthless advice or training I was given...

Nearly everything about snake bites.

Never apply a tourniquet except if the limb is torn off. (In fact, tearing off the limb is more likely to cause arteries to stretch then contract than cutting them does).

Carry a towel clamp to gain control of a pt by clamping onto the nasal septum. (I call that the "OhMoe" device):






Don't ready the AED while the pt is alert, it will scare them into a heart attack for sure.

Take everything the pt says at face value.





Oh, yeah. mastoid bruising and black eyes are a rapid sign of cranial fracture.


----------



## Hal9000 (Mar 28, 2011)

*Good point about HEMS in rural settings.*

Very needed in Montana in many cases...of course, one company has/had a HEMS activation policy for any MVC rollover outside the town limits.  Flying a patient 4.39 nautical miles is pretty silly.

Flying a patient from a skidder accident 50 nm is very reasonable.


----------



## usafmedic45 (Mar 28, 2011)

Hal9000 said:


> Flying a patient from a skidder accident 50 nm is very reasonable.



Depends on what those 50 miles consist of.  50 miles of highway is a totally different animal versus 50 miles on a one lane logging road.   The general rule I teach is that if you can get the patient to the hospital in under 90 minutes by ground, then you'll probably beat the helicopter.  Think in terms of time and not distance.


----------



## Hal9000 (Mar 28, 2011)

usafmedic45 said:


> Depends on what those 50 miles consist of.  50 miles of highway is a totally different animal versus 50 miles on a one lane logging road.   The general rule I teach is that if you can get the patient to the hospital in under 90 minutes by ground, then you'll probably beat the helicopter.  Think in terms of time and not distance.



Well, there aren't all that many skidder accidents in NW Montana that have 50 highway miles.  

This particular one would have been 50 logging road miles plus 50 highway miles.

EDIT: I should add that I've heard a helicopter launch for CPR in progress medical. I don't know why they'd do that, and it seemed so strange that I almost figured that they must have had some other reason for it.


----------



## usafmedic45 (Mar 28, 2011)

Hal9000 said:


> Well, there aren't all that many skidder accidents in NW Montana that have 50 highway miles.
> 
> This particular one would have been 50 logging road miles plus 50 highway miles.



That's what I figured you were getting at, but we have a lot of really stupid EMTs and medics on here who would think that just 50 highway miles is justification enough.  Therefore, I decided to inquire further.


----------



## Hal9000 (Mar 28, 2011)

usafmedic45 said:


> That's what I figured you were getting at, but we have a lot of really stupid EMTs and medics on here who would think that just 50 highway miles is justification enough.  Therefore, I decided to inquire further.




Oh, I can imagine that.  50 highway miles in MT takes less time than in more populated states, so I'd have even less reason.  

There are a couple of services in Montana that have launch criteria designed merely to increase revenue, but they're seen as heroic by most.  Bemusing...


----------



## usafmedic45 (Mar 28, 2011)

> There are a couple of services in Montana that have launch criteria designed merely to increase revenue, but they're seen as heroic by most. Bemusing...



This from the state that lost a medical helicopter because the crew thought it would be fun to chase mountain goats while returning to base.


----------



## Veneficus (Mar 28, 2011)

Hal9000 said:


> The lack of education amongst "advanced" providers here really throws me off.  I was recently interacting with an ALS crew that hadn't even heard of CCR, and this happened to be with one of the services that transports dead people.  I suppose I'd not be inclined to rant, but when an ALS provider with zero collegiate medical knowledge tries to "educate" me on medicine, I become somewhat perturbed.



Don't let it bug you, happens to me all the time.

If you really want to know how worthless and unnecessary education really is, just ask somebody who doesn't have one.


----------



## Smash (Mar 28, 2011)

usalsfyre said:


> Tell the guys over at elightbars.org these are lies .



Holy carp!  







That is some weapons-grade whackerism right there!


----------



## the_negro_puppy (Mar 28, 2011)

Lol a whole forum dedicated to fittingg out your car with lights?


----------



## CAOX3 (Mar 28, 2011)

The thing is I'm not a **** by nature, my post seemed to come off like that, but this firefighter made it confrontational, he took the focus off the patients in front of bystanders and the police it was unprofessional.

I admit when I was younger I flew some patients that probably didn't warrant it, I didn't understand, and I didn't want to make waves.  Today I'm a more informed provider and I'm not afraid to ruffle a few feathers if thats what needs to happen.  Sometimes it comes off like I'm an *** but that couldn't be further from the truth.


----------



## Emma (Mar 28, 2011)

Smash said:


> Holy carp!
> 
> 
> That is some weapons-grade whackerism right there!



So, I clicked through to see what that site was about.  The person who is the admin there has the same name as someone I went to high school with.  And it says his location is where we grew up.  I looked at the picture.

Yup.  Same dude.  He, ah, hasn't changed apparently. h34r:


----------



## Hal9000 (Mar 28, 2011)

usafmedic45 said:


> This from the state that lost a medical helicopter because the crew thought it would be fun to chase mountain goats while returning to base.



I knew about the powerline incident at a demonstration for a school, and the patient and paramedic hitting a tree during a haul operation (for which there was no legit training nor cert to perform), but I'd not heard of the one you mention. 

Sounds par for the course, though.  One scene had HEMS assistance (I advised against), and two of three outfits apparently turned it down.  The third didn't, landing in the mountains in SHSN low viz with variable gusts.  It was atrocious weather.  I asked why in the world they accepted, and the flight medic said proudly, "Our pilot was in Vietnam, he's not afraid of of the weather."    That was some years ago now, but I doubt it's much better.  They were always willing to hire whatever Tom, ****, or Harry showed up at the door.  

I took a critical transfer once for an trauma patient (helicopter came up at hospital request only to get trapped by inclement conditions, again), and the flight crew couldn't work their own vent, amidst other *ahem* "idiosyncrasies."  I'd describe more, but this one is unfortunately rather fresh, and it's probably going to truoc—releases have already been filed.  I sure as heck wish that I hadn't been the helping provider on that one, and that the crew had been competent. Mostly, I wish that they'd never showed at all, because now I'm associated with a mess that's not my of doing.  On  the other hand, I started documenting everything a while ago, right around the time that I realized that medical provider doesn't necessarily mean "competent professional," so I'm personally covered.

Still smarts. 



Veneficus said:


> Don't let it bug you, happens to me all the time.
> 
> If you really want to know how worthless and unnecessary education really is, just ask somebody who doesn't have one.



That's the truth, and it's also true that there aren't any walks in life where one can avoid such people.  However, it seems to be fairly common in this job—and job, I believe, is the right term for most of my associates, as opposed to "career."  But I don't want to sound like some obnoxious fool out to harsh on all the hominids, and I've met some of the best people in EMS.  

Returning to the topic of learning, I was lucky enough to have a CRNA as a coworker, who worked with a service PT, mainly out of a curiosity.  The overall outlook he had on medicine clearly differentiated him from those who remain in a skills-based arena.  I have a great respect for that nursing specialty, and I'd label it as being more than I have for the PA profession, overall.  I'm only friends with a few, but they've all been top-notch, and extremely well educated.


----------



## DesertMedic66 (Mar 28, 2011)

"there is always more to a call then what meets the eye" 
Sometimes a fractured leg is just a fractured leg.


----------



## usafmedic45 (Mar 28, 2011)

> I knew about the powerline incident at a demonstration for a school, and the patient and paramedic hitting a tree during a haul operation (for which there was no legit training nor cert to perform), but I'd not heard of the one you mention.



Here's the one I was talking about: 
06/05/1987 CHOTEAU, MT Aircraft Reg No. N4999N Time (Local): 20:15 MDT
THE EMS HELICOPTER WAS RETURNING TO GREAT FALLS, MT, ON 6/5/87 WHEN IT CRASHED. ITS OCCUPANTS HAD EARLIER PARTICIPATED IN A RESCUE
SEMINAR AT MANY GLACIER, MT. THE WRECKAGE WAS NOT FOUND UNTIL 6/9/87. A VIDEO TAPE RECOVERED FROM THE WRECKAGE DISCLOSED THE HELICOPTER
TO BE FOLLOWING A HERD OF BIG HORN SHEEP UP A 7000-FT MOUNTAIN SLOPE AND FLYING SLOWLY AT TREE-TOP LEVEL WHEN IT SUDDENLY YAWED TO THE
RIGHT. TESTS MADE ON THE AUDIO PORTION OF THE VIDEO TAPE REVEALED MAIN/TAIL ROTOR RPM WAS AT 100% POWER UNTIL 3.5 SEC BEFORE END OF TAPE.
AT THAT TIME MAIN/TAIL ROTOR RPM DROPPED TO 94%. EVIDENCE ALSO DISCLOSED HELICOPTER TO BE FLYING AT HIGH GROSS WEIGHT, HIGH DENSITY
ALTITUDE, AND WITH A TAILWIND.

Occurrence #1: LOSS OF CONTROL - IN FLIGHT
Phase of Operation: MANEUVERING
Findings
1. (F) IN-FLIGHT PLANNING/DECISION - IMPROPER - PILOT IN COMMAND
2. (F) WEATHER CONDITION - TAILWIND
3. (F) COMPENSATION FOR WIND CONDITIONS - NOT PERFORMED - PILOT IN COMMAND
4. (F) DIVERTED ATTENTION - PILOT IN COMMAND
5. (F) WEATHER CONDITION - HIGH DENSITY ALTITUDE
6. (F) ALTITUDE - REDUCED - PILOT IN COMMAND
7. (F) AIRSPEED - REDUCED - PILOT IN COMMAND
8. (C) COLLECTIVE - EXCESSIVE - PILOT IN COMMAND
9. (C) AIRCRAFT PERFORMANCE,YAWING MANEUVERS - EXCEEDED
10. (C) ROTOR RPM - NOT MAINTAINED - PILOT IN COMMAND
----------
Occurrence #2: IN FLIGHT COLLISION WITH TERRAIN/WATER
Phase of Operation: DESCENT - UNCONTROLLED
Findings
11. (F) TERRAIN CONDITION - MOUNTAINOUS/HILLY
12. (F) TERRAIN CONDITION - UPHILL


> Here's another



NTSB Identification: DEN89MA130.
The docket is stored on NTSB microfiche number 39149.
Nonscheduled 14 CFR
Accident occurred Thursday, June 01, 1989 in BIG TIMBER, MT
Probable Cause Approval Date: 12/10/1990
Aircraft: BELL 206L-3, registration: N76KM
Injuries: 4 Fatal.

AT ABT 2158 MDT, THE EMERG MED SVC (EMS/MEDEVAC) HELICOPTER (HEL) PLT CTCD BILLINGS TWR & ADZD HE WOULD BE MAKING APCHS TO SAINT VINCENTS HOSP FOR (NGT) CURRENCY. APRX 9 MIN LATER, HE CTCD THE TWR AGAIN & ADZD HE WAS BEING DISPATCHED ON AN EMS FLT. THE EMS FLT WAS TO A RANCH (WNW OF BILLINGS). THE PLT HAD DIFFICULTY FINDING THE RANCH AT NGT, BUT ARRIVED AT 2238 MDT. THE PATIENT WAS LOADED & THE PLT WAS ADZD OF TRRN CONDS. A WITNESS SAID THE HEL LIFTED OFF FAST, THEN SWIVELEDARND QUICKLY (TOWARD EAST) & TOOK OFF W/O HESITATION. AFTER DEPG, THE HEL CROSSED A HILL & CRASHED AT HI SPD ON LWR TRRNIN A SLGT NOSE LOW, RGT BANK ATTITUDE, HDG 330 DEG. NO PREIMPACT MECH PRBLM WAS FND. THE PLT HAD BEEN RECENTLY HIRED BY THE OPERATOR; PREV EMPLOYMENT INVOLVED FLYING A DISSIMILAR HEL (BK-105) IN THE GULF OF MEXICO AREA, LIMITED TO DAY VFR. THE PLT'S LAST RECORDED NGT FLT WAS ON 6/16/87; HIS LAST RECORDED INST FLT WAS PRIOR TO JUNE 1984. NO RECORD WAS FND OF FAMILIARIZATION TRAINING FOR THE GEOGRAPHICAL AREA. RELATIVES OF THE PATIENT DESCRIBED THE ACDNT AREA AS A BLACK HOLE.

The National Transportation Safety Board determines the probable cause(s) of this ACC as follows:
FAILURE OF THE PILOT TO MAINTAIN CONTROL OF THE AIRCRAFT DURING TAKEOFF, DUE TO SPATIAL DISORIENTATION, WHICH RESULTED IN A COLLISION WITH THE TERRAIN. CONTRIBUTING FACTORS WERE: DARK NIGHT, PILOT'S VISUAL PERCEPTION, INADEQUATE INITIAL TRAINING OF THE PILOT BY THE OPERATOR, THE PILOT'S LACK OF FAMILIARITY WITH THE GEOGRAPHICAL AREA, AND THE COMPANY'S INSUFFICIENT STANDARDS/REQUIREMENTS.


----------



## usalsfyre (Mar 28, 2011)

What was the aircraft type in the sheep accident Steve?


----------



## usafmedic45 (Mar 28, 2011)

usalsfyre said:


> What was the aircraft type in the sheep accident Steve?



Bell 206


----------



## usalsfyre (Mar 28, 2011)

usafmedic45 said:


> Bell 206



It sounded like a Longranger accident. Why someone hasn't put their foot down about using them for EMS escapes me.


----------



## usafmedic45 (Mar 28, 2011)

usalsfyre said:


> It sounded like a Longranger accident. Why someone hasn't put their foot down about using them for EMS escapes me.



It is being discussed by some with the FAA as part of what they have planned for HEMS if the BS and cutting corners does not stop in the near future.  Part of what is being discussed would require HEMS to be dual pilot which would pretty much put the 206 out of the running because of weight restrictions.   Kiss AirEvac Lifeteam goodbye when that happens.


----------



## usalsfyre (Mar 28, 2011)

usafmedic45 said:


> It is being discussed by some with the FAA as part of what they have planned for HEMS if the BS and cutting corners does not stop in the near future.  Part of what is being discussed would require HEMS to be dual pilot which would pretty much put the 206 out of the running because of weight restrictions.   Kiss AirEvac Lifeteam goodbye when that happens.



Pretty much all of the smaller airframes would be out the window, all the small Bells and A Stars  I've seen run the patient down the full length of the left side of the cabin. 

Not that knocking these coff...err, I mean airframes out is a bad thing...


----------



## MrBrown (Mar 28, 2011)

Let Brown think ..... 

- Shoving oxygen down everybodies gob at 15LPM
- Strapping everybody to a spine board
- This hilariously ridiculous notion of "ALS" and "BLS"
- Crappy lungs = CHF = frusemide
- Tachydysrhythmias need to be cardioverted or given amiodarone
- Bradydysrhythmias need atropine and pacing
- Everybody needs an IV
- Everybody who gets an IV must have fluid hung
- Obtaining and/or reading a 12 lead is not important
- TKO saline is appropriate for a pulmonary edema
- Blood pressure is an adequate indicator of severity of shock
- Assisted ventilations are a good thing
- RSI is a bad thing
- Trauma is a surgical disease
- "We're not doctors!"
- Lights and sirens are important
- Response times are important
- All that education is not important,

and lastly ..... 

- That this Brown fellow has some sort of medical education


----------



## beandip4all (Mar 29, 2011)

LucidResq said:


> Everyone wants to sue you.



^^ this!! 

and that every pcr you write will be scrutinized in court.  LIVE IN FEAR because lawyers will rake every single notation over the coals.


----------



## johatan25 (Mar 29, 2011)

Paramedics save lives, basics save paramedics.


----------



## adamjh3 (Mar 29, 2011)

Veneficus said:


> I just have to ask...
> 
> Who told you that?



Guy I work with. He just finished Medic school at a local mill and thinks he's better than all of us.


----------



## johatan25 (Mar 29, 2011)

adamjh3 said:


> Guy I work with. He just finished Medic school at a local mill and thinks he's better than all of us.



He'll eventually learn that he's not IT man, the worse you can encounter is worn out Medics that give you all their BS... just after you mentioned you want to go to medic school. Who cares if you are tired of EMS? Just give me useful info and keep your complaints to yourself. I look forward in encouraging future medics, that's your best medic right there.


----------



## usalsfyre (Mar 29, 2011)

johatan25 said:


> He'll eventually learn that he's not IT man, the worse you can encounter is worn out Medics that give you all their BS... just after you mentioned you want to go to medic school. Who cares if you are tired of EMS? Just give me useful info and keep your complaints to yourself. I look forward in encouraging future medics, that's your best medic right there.



The "tired of EMS BS" as you call it is TRYING to keep people from stepping off into the same mistakes many of us have made. They're not complaints, very often they're realistic views. Being a medic is far, far from lives saved, rainbows and unicorns, especially once you figure out how little your doing in a lot of cases.


----------



## johatan25 (Mar 29, 2011)

usalsfyre said:


> The "tired of EMS BS" as you call it is TRYING to keep people from stepping off into the same mistakes many of us have made. They're not complaints, very often they're realistic views. Being a medic is far, far from lives saved, rainbows and unicorns, especially once you figure out how little your doing in a lot of cases.



There's a big difference between Realistic Views and Complaints. This is not something new to me, as I've been interested and involved in patient care about 9 years. You can tell when there's a medic who loves what they do be it calm or be it storm, and there are others that can't stand taking a simple call. You never do 'little' in the medical field. As far as keeping other people in making the same mistakes, that is done with advice and tips.


----------



## cappello91 (Mar 29, 2011)

interesting thraed


----------



## lampnyter (Mar 29, 2011)

johatan25 said:


> Paramedics save lives, basics save paramedics.



Whatcu talking about. That is the most true thing i have ever learned.


----------



## Veneficus (Mar 29, 2011)

lampnyter said:


> Whatcu talking about. That is the most true thing i have ever learned.



You are being sarcstic?

I hope anyway.


----------



## JPINFV (Mar 29, 2011)

lampnyter said:


> Whatcu talking about. That is the most true thing i have ever learned.


----------



## lampnyter (Mar 29, 2011)

Veneficus said:


> You are being sarcstic?
> 
> I hope anyway.



Well the basics saving paramedics part i was serious about.


----------



## johnrsemt (Mar 29, 2011)

Basics ARE good at remembering BLS stuff that medics sometimes forget when we get busy thinking ALS stuff that we need to keep track of.

  Good Basic partner is better than a Medic partner in alot of cases.


----------



## STXmedic (Mar 29, 2011)

johnrsemt said:


> Basics ARE good at remembering BLS stuff that medics sometimes forget when we get busy thinking ALS stuff that we need to keep track of.
> 
> Good Basic partner is better than a Medic partner in alot of cases.



Not to bash Basics, because I've worked with some great ones, but a good paramedic thinks of appropriate patient care regardless of the labeling of BLS and ALS. If a good paramedic doesn't perform a "BLS" intervention that his partner thinks should have been performed, a lot of times there's a good reason for it.

Basic partners are especially better when the medic wants to stay up and proficient on his skills and doesn't have another medic partner to have to share them with >=[


----------

