# Has anybody seen this? Family Blames Medics After Pregnant Woman Dies in Ambulance



## Trashtruck (Oct 6, 2012)

http://www.nbcphiladelphia.com/news...egnant-Woman-Dies-in-Ambulance-172373051.html


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## KellyBracket (Oct 6, 2012)

"Natural causes?" I don't think so...


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## Veneficus (Oct 6, 2012)

From the description, it sounded like a PE to me.


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## KellyBracket (Oct 6, 2012)

Yeah, so warfarin + DVT + fall down stairs + god knows what else ≠ "natural causes."

Man, the ER must have been an exciting place after the rig pulled up. Good day not to be working there.


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## Veneficus (Oct 6, 2012)

KellyBracket said:


> Yeah, so warfarin + DVT + fall down stairs + god knows what else ≠ "natural causes."



She had all of that and naturally she died 



KellyBracket said:


> Man, the ER must have been an exciting place after the rig pulled up. Good day not to be working there.



I was working as an ED tech when EMS brought in 2 seriously messed up pregnant women, both died in the ER with emergent c-sections done simultaneously in the trauma bay. One kid lived, the other was not viable due to gestational age.

That was an exciting day for sure. I live for stuff like that. (undoubtably I am a little off :unsure


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## VFlutter (Oct 6, 2012)

I think this call was not handled well by the medics and that the patient would have had a better chance if transported to the hospital sooner however it's crazy how people assume she would have lived if she got there 3 mins earlier and that the medics are 100% to blame. Not defending the medics, they obviously could have done much better, but the comments like "the medics should go to jail for murder" are just idiotic.


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## bigbaldguy (Oct 6, 2012)

Trashtruck said:


> http://www.nbcphiladelphia.com/news...egnant-Woman-Dies-in-Ambulance-172373051.html



Poorly handled. Would it have made a difference? Maybe maybe not but still very poorly handled.


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## DrankTheKoolaid (Oct 6, 2012)

Yeah if not a PE I would guess an amniotic embolus.  Had one long ago when she tossed it lying back for an exam.  Worked her for 45 before we got pulses back.  Even during the emergency section we were doing CPR.  Mom lived with some residual stroke signs and the daughter ended up with CP but is doing great 11 years later.


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## usalsfyre (Oct 6, 2012)

Don't know the medics, wasn't there, but...

It seems like they may not have realized the acuity of the patient presentation.


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## Aidey (Oct 6, 2012)

I will say that whenever I find grandma with pneumonia lying flat in bed the first thing I do is sit them up, so I don't really see anything wrong with that. 

I also don't think a 20 minute scene to hospital time is all that insane. But I agree with Kyle that it sounds like they didn't realize how sick the patient was.


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## akflightmedic (Oct 6, 2012)

Weird seeing a patient with respiratory distress....even PERCEIVED (by pt or crew) respiratory distress that they allow the patient to stay flat on her back. Then add in she is 9 months pregnant and again I ask at the most basic level, why is she flat on her back?


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## VFlutter (Oct 6, 2012)

If anything she should have been in left lateral recumbent. IVC syndrome anyone?


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## andyman0291 (Oct 6, 2012)

unreal...


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## Tigger (Oct 6, 2012)

Aidey said:


> I will say that whenever I find grandma with pneumonia lying flat in bed the first thing I do is sit them up, so I don't really see anything wrong with that.
> 
> I also don't think a 20 minute scene to hospital time is all that insane. But I agree with Kyle that it sounds like they didn't realize how sick the patient was.



Doesn't seem unreasonable to me either, that's probably better than most ALS scene times around here. I don't think that the public generally realizes that it's easy to get a patient worked up in the back of the ambulance on scene than anywhere else. For better or for worse, immediate transport to the hospital is often not the first thought, though in this case that may have been more appropriate.


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## Veneficus (Oct 6, 2012)

bigbaldguy said:


> Poorly handled. Would it have made a difference? Maybe maybe not but still very poorly handled.



I don't think it would have made a difference.

But nobody cares. They care how it looks.


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## Shishkabob (Oct 6, 2012)

Aidey said:


> I will say that whenever I find grandma with pneumonia lying flat in bed the first thing I do is sit them up, so I don't really see anything wrong with that.



Apparently it's bad, wrong, and lazy to tell the patient to do ANYTHING.  She was a big lady looking at the video.. I too would be telling her to do her part to sit on up.




> "If they would have came here better trained, with all their equipment, oxygen on time, yes, she would have been maybe in the hospital still, but alive," said Morales.


  If 3 minutes mean THAT much, then it was already too late, no matter how "better trained, with all their equipment and oxygen" sooner would have been.  





Having said that, the bag goes in with me on every call, no matter how BS sounding, just for such reason as we've all been sent to the toe-pain that became an arrest.  That is really the only part I fault the crews on without any further info.


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## Aidey (Oct 6, 2012)

I kind of wonder what the dispatch was for. There is a big difference between an bravo "Fall, possible lift assist" and a delta "difficulty breathing, ALOC".


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## NomadicMedic (Oct 6, 2012)

Although, not bringing anything into the house is a little strange. I don't know how you guys do it, but I bring an ALS bag (with oxygen) and a monitor in on EVERY call.


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## abckidsmom (Oct 6, 2012)

n7lxi said:


> Although, not bringing anything into the house is a little strange. I don't know how you guys do it, but I bring an ALS bag (with oxygen) and a monitor in on EVERY call.



I agree.  It's just lazy to go in without equipment.


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## DrParasite (Oct 7, 2012)

starting at the end and moving to the begining....

1) the door locks failed... they worked on scene (how else did they get the stretcher out), and failed for some reason.  can't blame the crew for that (but I am sure the family will try to).  it's just really really bad luck that they failed at that time.

2) 20 minutes from arrival on scene to arrival at the ER?  that's better than most places.

3) so everyone gets a NRB at 15lpm immediately.  regardless of if it's clinically indicated or not.  The commissioner said it himself, if someone says they have difficulty breathing, they should get oxygen.

4) it's downright lazy to not bring ANY equipment in with you.  even for a simple fall victim.

5) based on the article, and my experience as a dispatcher, this would be dispatched as a fall victim.  her history as an asthmatic or her being on meds for a blood clot wouldn't affect my dispatch.  the statement "she can't breathe" would absolutely upgrade it, but without listening to the tape, I don't know for sure. But knowing philly has an all ALS ambulance system (or used to, I heard they put on BLS trucks to handle the volume), i am assuming a paramedic crew showed up 3 minute after dispatch

Not for nothing, but this crew is being tried in the court of public opinion, just like the FDNY dispatchers were.  Not allowed to defend themselves, and the city/agency isn't standing up for them either.  The media is destroying their careers and they aren't even able to tell there side of the story.

And in my experience, when someone dies, and the family is looking for someone to blame, the story that they tell the press is rarely 100% accurate, and very often made without all the facts, and with a lot of angry emotions clouding their recollection.


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## Trashtruck (Oct 7, 2012)

DrParasite,
I'm confused about #3 above.
Are you saying everyone who says they can't breath should get 15lpm NRBM? 
Or are you being facetious?


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## Handsome Robb (Oct 7, 2012)

ZoMg ThE mEdIcS kIlLeD hEr! 

Maybe it's just me but if she coded en route I doubt there was much they could've done. I'm new and cautious but anyone complaining of SOB is an ALS call unless I have a VERY good reason to pass it off. Pregnant + fall down stairs and SOB she's getting a full ALS work-up. With that said, I'm not going to monday morning quarterback the crew, I wasn't there.  

I'm guessing he was being facetious.

They should've brought gear, I'm with n7 on this, I don't take my monitor in on every call but at minimum my first out bag comes but 90% + jobs get all our gear plus gurney brought as close as we can get it.


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## Veneficus (Oct 7, 2012)

*If you have not seen it in the field yet...*

When people have massive PEs they claim they cannot breath while they are yelling at the top of their lungs. 

I have even seen an 80 year old lady who could barely walk take 6 six rather burly firemen to hold her down on scene. 

Apparently the lack of oxygenation feels like not breathing. 

Some pregnant women suffer from DVT, especially if they are idle  and are put on warfarin. (though I would think LMWH better) 

If a clot dislodged, it could cause massive PE, which accounts for "not being able to breath." Nothing EMS has is going to change that, and I really don't forsee an emergent pulmonary clot removal in a pregnant patient prior to emergent c-section. Even then, it would probably be done only by the most aggresive of surgeons attempting very heroic measures in a facility that could actually do it.

Add the fall down the stairs, a potential disruption of part of the placenta and now you add the potential of massive occult hemorrhage in a patient on warfarin to the scenario.

Again, nothing EMS or probably even most hospitals will be able to deal with.

Oh, and she may have some trauma from falling down the stairs too, but that is basically a nonissue when you look at the more serious possibilities. 

This case seems to have little to do with poor medical care and everything to do with looking like a bunch of uncaring slackers.


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## abckidsmom (Oct 7, 2012)

Veneficus said:


> This case seems to have little to do with poor medical care and everything to do with looking like a bunch of uncaring slackers.



The PR person at the first big agency I got hired at had an hour of our orientation class.  

She said that she had been a medic, she understood how ghetto and painful our patients were, but the way to avoid complaints and problems was to always bring in the bag and never walk a patient.  If you look interested, caring and nice, people will not go randomly accusing you of not being so.

If you establish a track record of being interested, caring and nice to people, bringing your bag in, and bringing your cot to the door of the house, complaints of this nature, when they surface out of grief or other such issues will roll right off your back.


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## DrParasite (Oct 8, 2012)

Trashtruck said:


> DrParasite,
> I'm confused about #3 above.
> Are you saying everyone who says they can't breath should get 15lpm NRBM?
> Or are you being facetious?


yes, very facetious.  The commissioner made that stupid statement to the press, so the next memo that gets passed down is everyone who says they can't breath gets oxygen..... this is regardless of if it's clinically indicated or not.

so now the department is going to be doing something not because it's clinically indicated, but because it's bad PR or against an operational decree if they don't. 





abckidsmom said:


> The PR person at the first big agency I got hired at had an hour of our orientation class.


your agency had a PR person? that's awesome!!! most places don't understand how important a PR person is, and as a result try to avoid the press at all costs.





abckidsmom said:


> She said that she had been a medic, she understood how ghetto and painful our patients were, but the way to avoid complaints and problems was to always bring in the bag and never walk a patient.  If you look interested, caring and nice, people will not go randomly accusing you of not being so.
> 
> If you establish a track record of being interested, caring and nice to people, bringing your bag in, and bringing your cot to the door of the house, complaints of this nature, when they surface out of grief or other such issues will roll right off your back.


We will have to agree to disagree about the bringing the cot to the door, as well as the unnecessary back injuries that can occur due to the practice of never walking a patient and carrying everyone.

but always bring a bag with you, always bring a carrying device with you to the patient's side, and always look the part.  Sometimes the appearance of not caring will be enough to cause the agency negative PR, despite the reality of what was going on being completely different from what the uneducated witnesses were perceiving as uncaring.


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## Shishkabob (Oct 8, 2012)

DrParasite said:


> your agency had a PR person? that's awesome!!! most places don't understand how important a PR person is, and as a result try to avoid the press at all costs.


  We have a full time one.   Trying to combat FD getting all the credit for major calls.  We have news crews at our HQ atleast once a week.






> We will have to agree to disagree about the bringing the cot to the door, as well as the unnecessary back injuries that can occur due to the practice of never walking a patient and carrying everyone.



I agree.  I'm a huge opponent of lifting unnecessarily, almost to a fault.  If your complaint does not prohibit you from walking, you're going to walk. 


However, my medical director recently sent out an email saying "No one walks", apparently due to a few idiots who walks people who shouldn't have been.  Many of us are trying to get that amended to only pertain those to medically necessary, IE SOB or chest pain.   There's no reason a person who just wants to go for meds, or who has a cut on their arm, can't, and should not, walk.  Not risking my back and my career for someone elses laziness.


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## Veneficus (Oct 8, 2012)

Linuss said:


> However, my medical director recently sent out an email saying "No one walks", apparently due to a few idiots who walks people who shouldn't have been.  Many of us are trying to get that amended to only pertain those to medically necessary, IE SOB or chest pain.   There's no reason a person who just wants to go for meds, or who has a cut on their arm, can't, and should not, walk.  Not risking my back and my career for someone elses laziness.



Since EMS medical directors are a dime a dozen I would just try to get rid of him. Especially since his out of touch directives can get somebody hurt.


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## usalsfyre (Oct 8, 2012)

Veneficus said:


> Since EMS medical directors are a dime a dozen I would just try to get rid of him. Especially since his out of touch directives can get somebody hurt.



Not to speak out of turn, but Linuss's medical director is generally the exception to the rule as far as being involved and up to date. I'm curious what spurred the "no one walks" directive.


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## Veneficus (Oct 8, 2012)

usalsfyre said:


> Not to speak out of turn, but Linuss's medical director is generally the exception to the rule as far as being involved and up to date. I'm curious what spurred the "no one walks" directive.



Even if there is a bunch of "maybe or definately shouldn't walk" on paper, I don't think itis worth the health and safety of everyone in the field. 

I will be the first to admit I have run across patients where no lift assist was possible and if that person didn't want to die there, they were going to have to walk though it was absolutely medically not indicated.

If a nurse in the hospital made somebody who shouldn't walk ambulate (double walk didn't look right) would a "nobody walks" directive hit the hospital?


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## Tigger (Oct 9, 2012)

If I had a dollar for the number of emails I have received from QA reminding us that "no one walks ever," I would be quite drunk right now.


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## Trashtruck (Oct 15, 2012)

It's amazing how we're forced to coddle people.


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## WuLabsWuTecH (Oct 15, 2012)

Aidey said:


> I will say that whenever I find grandma with pneumonia lying flat in bed the first thing I do is sit them up, so I don't really see anything wrong with that.
> 
> I also don't think a 20 minute scene to hospital time is all that insane. But I agree with Kyle that it sounds like they didn't realize how sick the patient was.





Tigger said:


> Doesn't seem unreasonable to me either, that's probably better than most ALS scene times around here. I don't think that the public generally realizes that it's easy to get a patient worked up in the back of the ambulance on scene than anywhere else. For better or for worse, immediate transport to the hospital is often not the first thought, though in this case that may have been more appropriate.



They had a 15 minute scene time (8 minutes in house and 7 minutes outside) which is in line with standards (at least around my area).  5 minute transport time is not that bad either.  The reporter makes a 20 minute time from on scene to at hospital sound like it's so long!  There are parts of my urban district where just getting through all of the side streets and back out would take a good 15 minutes!



Linuss said:


> Apparently it's bad, wrong, and lazy to tell the patient to do ANYTHING.  She was a big lady looking at the video.. I too would be telling her to do her part to sit on up.
> 
> If 3 minutes mean THAT much, then it was already too late, no matter how "better trained, with all their equipment and oxygen" sooner would have been.
> 
> Having said that, the bag goes in with me on every call, no matter how BS sounding, just for such reason as we've all been sent to the toe-pain that became an arrest.  That is really the only part I fault the crews on without any further info.





n7lxi said:


> Although, not bringing anything into the house is a little strange. I don't know how you guys do it, but I bring an ALS bag (with oxygen) and a monitor in on EVERY call.





abckidsmom said:


> I agree.  It's just lazy to go in without equipment.



One of my partners has the mentality of "I am an ALS provider.  I will enter the scene with the capability to provide ALS."  He interprets this to mean that jumpbag and monitor go in on every run.  If it's to a nursing home or to a more remote place (such as on a bike path or in a grocery store where it will take some time to walk to the patient after being on scene) the drug box also goes (we'll usually put everything on the cot to make it easier for us).

But, even he has his exceptions.  If we're being told we're going for something that's not medical--"lift assist, non injury" comes to mind or "well being check" nothing goes in with us.  Sure, the family told the dispatcher that the lady was having difficulty breathing, but it doesn't mean that the dispatcher entered it in as a something else.  Or, because it was a larger woman, perhaps the dispatcher entered in another line: "Larger person, lift assist" to note that help might be needed but whoever put out the call accidentally dispatched it as a lift assist.  The investigation will delve in deeper into these issues and until then, all we can do is speculate.

The reporter that asked whether a truck check was done had a point--but i bet records will show that a truck check was done.  We would get chewed out so hard here if we ever skipped a truck check.  Even so, they had to get the stretcher out, and back in again.  So the door was working.  Even if they did a truck check, issues can develop between the truck check and a run on the same day!

Also, when the commissioner was asked whether or not it's protocol for medics not to take in equipment, he stated that normally they do, but also hinted that sometimes they might not.  It looks, from the surveillance tape, that the medic was parked very close to where the woman was (within a few feet) as they are lifting her to her feet and putting her on the stretcher right there on the sidewalk.  I have to wonder if these were exterior stairs she slipped on, and the medics didn't grab anything because their truck was 20 feet away.  If so, how many other scenarios can you see where a family says, "They pulled up 20 feet away, and then spent a full minute getting their equipment before even coming over to check on her!"


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## Melclin (Oct 22, 2012)

*Wow*

"We wanna give people oxygen if they're having trouble breathing, immediately". So they're against people breathing immediately and apparently oxygen is the cure for that. Holy dangling modifier batman!

20 mins from arrival to drop off. I can safely say I have never once delivered a pt to hospital with such incredible times. I takes me longer than that to remember the pts name after introducing myself.

On a more serious note, the O2 has been mentioned, but what about* collaring/boarding her*? I thought you guys loved that stuff and she did fall down some steps. Even I'd have considered it at least. There is obviously some missing info about this job. I'd love to hear the real story. 

I can't imagine how this pt would have been dispatched without any indication that they might need some gear. Again, I love to know the full story. I trust so little of what the media report about us here but this article is a special piece of work that would be bad even for our worst papers. 



n7lxi said:


> Although, not bringing anything into the house is a little strange. I don't know how you guys do it, but I bring an ALS bag (with oxygen) and a monitor in on EVERY call.





Linuss said:


> Having said that, the bag goes in with me on every call, no matter how BS sounding, just for such reason as we've all been sent to the toe-pain that became an arrest.  That is really the only part I fault the crews on without any further info.



Do you guys hate your backs? For every toe pain that becomes an arrest there must be thousands of metres walked carrying tons of back breaking gear. You must be a lot tougher than me (although thats no great achievement  ). Not worth it in my opinion. A resp or cardiac arrest are basically the only pts I can think of that can't wait for my partner to scoot back out to the truck. If Mrs Blogs hits the deck dead and nobody tells me its anything more than a sore toe, then either the caller didn't didn't say yes to any of several easy and obvious red flag questions or there has been some kind of colossal systemic balls-up that severely _under_ rather than _over_ triaged. Both are rare (never happened to me or anyone I know) and neither are my fault or worth my back and shoulders.   

When you do turn up to a "28yr old traumatic back pain, non recent", that turns out to be a 86 yr old hypotensive rapid A-fib, its pretty clear from the first sight of the pt that they will need more than I'm carrying, so my partner is generally coming back with the necessaries while I'm still doing the basics. There is little if any delay, its pretty rare (happened to me about 3 times in the past year) and again is neither my fault or worth my back. 

If you ring the police and tell them that someone wrote you an letter full of grammatical errors and they turn up 4 hrs later to find you being held at gun point by your pissed off misus, the fact that they didn't bring a SWAT team is not their fault.



Veneficus said:


> Some pregnant women suffer from DVT, especially if they are idle  and are put on warfarin. (though I would think LMWH better)



You mean its likely they had a DVT if they were on warfarin, notmore likely to develop a DVT on warfarin right? Am I missing something massive?

While I've got you hear. I had a pt the other night whose hx and initial presentation screamed PE but he was warfarinised with an INR of 4.7. Is it still possible to develop DVTs and PEs in that circumstance? I would have thought not...._emphatically_, but I was unable to produce from my mind a figure explaining exactly how effective warfarin is at preventing such things. Whats the go?


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## Melclin (Oct 22, 2012)

SOMEONE IS WRONG ON THE INTERNET!

As for the comments, those that I can decipher amongst the mess that may once have been English really sum up the increasingly common reaction of certain scummy parts of the public to stories like this: 

"ZOMG. I'm outraged. This story, and the ever important yet unreported context, about which I know absolutely nothing, has suddenly and inexplicably filled me with such incandescent rage and ill-informed opinion, that I must take to facebook to share with the public my mess of grunts and moans. My thoughts are important. I matter. ME!.... Swag"

With people like that breathing, its amazing we made it this far. I suppose reactions like this aren't new. But there is something about modern mass media, and maybe social media as well, that magnifies and lends more power to these people's opinions while authority figures and experts submit to the overwhelming torrent of stupid people who vote.


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## systemet (Oct 23, 2012)

Melclin said:


> "We wanna give people oxygen if they're having trouble breathing, immediately". So they're against people breathing immediately and apparently oxygen is the cure for that. Holy dangling modifier batman!



and



> "ZOMG. I'm outraged. This story, and the ever important yet unreported context, about which I know absolutely nothing, has suddenly and inexplicably filled me with such incandescent rage and ill-informed opinion, that I must take to facebook to share with the public my mess of grunts and moans. My thoughts are important. I matter. ME!.... Swag"



Sir, I take my hat off to you.  Not just once, but twice.  Well played.


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## Melclin (Oct 24, 2012)

systemet said:


> Sir, I take my hat off to you.  Not just once, but twice.  Well played.



I live to give.


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## Jon (Oct 26, 2012)

KellyBracket said:


> Yeah, so warfarin + DVT + fall down stairs + god knows what else ≠ "natural causes."
> 
> Man, the ER must have been an exciting place after the rig pulled up. Good day not to be working there.



Eh. It's Temple. Doesn't actually sound overly bad. Bad is when PD pulls up with a trauma code... or two. 



ChaseZ33 said:


> I think this call was not handled well by the medics...


Think that says it best.



n7lxi said:


> Although, not bringing anything into the house is a little strange. I don't know how you guys do it, but I bring an ALS bag (with oxygen) and a monitor in on EVERY call.



I know of plenty of medics that don't always bring gear in, especially when they are in a system where they are responsible for BLS as well as ALS calls. Not saying it's right, but it happens.


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## mycrofft (Oct 26, 2012)

We lost a fetus once, the pregnant mom neglected to tell us she was a heroin addict. Her husband (not in custody) said he was going to come shoot one or mre of the medical staff, and we didn't have a perimeter fence. They caught them on a traffic violation before he came by.


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## Veneficus (Oct 26, 2012)

Melclin said:


> You mean *its likely they had a DVT if they were on warfarin*,



Sorry, this is what I meant. 

Probably another multitasking fail on my part.



Melclin said:


> while I've got you hear. I had a pt the other night whose hx and initial presentation screamed PE but he was warfarinised with an INR of 4.7. Is it still possible to develop DVTs and PEs in that circumstance? I would have thought not...._emphatically_, but I was unable to produce from my mind a figure explaining exactly how effective warfarin is at preventing such things. Whats the go?



I would think it impossible for them to form new clots, but not break up and old one and launch part of it into circulation.

I have seen it happen in IR where a vascular filter was placed but a piece of clot just broke off from the larger one. (saw it happen in real time, it was cool for me, but the patient died) That patient was on LMWH at home and was brought in emergently by EMS.


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