# Why are there so many of you?



## domepatrol

First off, I'm a firefighter finishing up my EMT certification. So, for now, all of my calls are going to be from the fire perspective.

There is a room in our local retirement home (we'll say room 104) that is inhabited by a 500-550 lb woman who likes to fall 2-3 times per month. Whenever room "104" is in need of attention, the dispatcher calls out our engine for manpower. Late one afternoon our engine gets called out to the retirement home for a lift assist. We all know exactly what it is. When we arrive on scene we're directed to room 104 by the secretary. So far, so good.

We make our way down the hall to room 104 and nobody is there. We hear EMT chatter in the room next door so our chief sticks his head in. The medics are working on a small elderly woman, probably 110lbs at the most. They clear us from the scene and say it was a mix up. As we turn around to leave, the 550lb woman rolls up on her motorized wheelchair thing (I don't know what it is, it's much more than a regular motorized wheelchair) and just looks at us, confused.

"Why are there so many of you?" She finally asks.

There was an awkward moment of silence before the guy in the front of the line says "Hey chief, the woman up here has a question for you."

We stepped around her single file, leaving the chief to deal with that conversation.

:rofl:


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## TB 3541




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## Flight-LP

Um.........Ok............


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## Handsome Robb

Some comment, whether it be a question or a statement, is made about the number if responders on a daily basis where I work. We get a 3 or 5 man engine or truck on every call, sometimes you'll get a 2 man rescue but that's rare.


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## STXmedic

It must have been very awkward for that chief.... :unsure:...


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## epipusher

404 Funny Not Found


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## akflightmedic

I am just amazed a Chief has enough free time to respond to a lift assist at a nursing home.


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## Household6

Is it common for woman like that to fall so frequently?


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## jeepdude911

One of the calls I ran for a sporting event. My partner and I had just brought our (seemed like) 19th slobbering drunk to the medical tent, when a nurse behind me tapped me on the shoulder and asked "does your monitor do 12 lead?" I swung around and told my partner "clear us from the drunk, and inform dispatch that we're committed to a possible MI." One look told me everything I as an EMT needed to know, diaphoretic as he**, the leads wouldn't stick, so while a second crew dried the pt.'s chest and got another set of leads ready, we started to move toward the rig. I lit it up and headed toward the closest ER. Upon our arrival, I got a strip from my medic, pulled the gurney and we headed in. Bad news, my partner got busy in back and forgot to call it in. the triage nurse tried to stop me. I just handed her the strip. We got a room within about 5 seconds.


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## chaz90

jeepdude911 said:


> One of the calls I ran for a sporting event. My partner and I had just brought our (seemed like) 19th slobbering drunk to the medical tent, when a nurse behind me tapped me on the shoulder and asked "does your monitor do 12 lead?" I swung around and told my partner "clear us from the drunk, and inform dispatch that we're committed to a possible MI." One look told me everything I as an EMT needed to know, diaphoretic as he**, the leads wouldn't stick, so while a second crew dried the pt.'s chest and got another set of leads ready, we started to move toward the rig. I lit it up and headed toward the closest ER. Upon our arrival, I got a strip from my medic, pulled the gurney and we headed in. Bad news, my partner got busy in back and forgot to call it in. the triage nurse tried to stop me. I just handed her the strip. We got a room within about 5 seconds.



Because every sweaty person in a hot outside environment who gets a 12 lead is automatically a STEMI...In particular, it's a darn good thing you guys started moving the patient so quickly that you didn't even get an EKG first.


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## jeepdude911

chaz90 said:


> Because every sweaty person in a hot outside environment who gets a 12 lead is automatically a STEMI...In particular, it's a darn good thing you guys started moving the patient so quickly that you didn't even get an EKG first.



The pt. was not in a hot environment, cool, pale, diaphoretic, too much so to get an EKG on scene, and already seen by an RN. There is an "E" in EMS,  but I digress. You must be truly gifted to critique a straight forward STEMI ( which it was) at Candlestick Park from Delaware. I can only hope to be that good someday. Pity, I've only been doing this for 19 years. It is possible to start interventions based on presentation. but that would mean BLS before ALS. Oh, wait, I'm an EMT, that's what I do!


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## chaz90

jeepdude911 said:


> The pt. was not in a hot environment, cool, pale, diaphoretic, too much so to get an EKG on scene, and already seen by an RN. There is an "E" in EMS,  but I digress. You must be truly gifted to critique a straight forward STEMI ( which it was) at Candlestick Park from Delaware. I can only hope to be that good someday. Pity, I've only been doing this for 19 years. It is possible to start interventions based on presentation. but that would mean BLS before ALS. Oh, wait, I'm an EMT, that's what I do!



I wasn't criticizing the straightforward STEMI diagnosis. That sounds like it went fine. I simply made a comment regarding the assumption that one can take a single look at a patient and glean everything you need to know. I'm quite happy that you're able to hear someone ask if a monitor can acquire a 12 lead and instantly recognize the scent of a STEMI. I typically find it better to dry off a diaphoretic patient's chest and get an accurate EKG before deciding I need to run L&S to the nearest ED, but I wasn't there and have no concept of how sick this patient initially presented. 

BTW, I have no problems with EMTs or interventions based on presentation. I do have a strong dislike of presumptuous medicine, non-critical interventions performed prior to proper assessments, and trite sayings like "BLS before ALS." Also, I usually define interventions as something done to/for the patient, not just moving them to the ambulance.


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## RocketMedic

chaz90 said:


> Because every sweaty person in a hot outside environment who gets a 12 lead is automatically a STEMI...In particular, it's a darn good thing you guys started moving the patient so quickly that you didn't even get an EKG first.



Wind resuscitation.


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## jeepdude911

chaz90 said:


> I wasn't criticizing the straightforward STEMI diagnosis. That sounds like it went fine. I simply made a comment regarding the assumption that one can take a single look at a patient and glean everything you need to know. I'm quite happy that you're able to hear someone ask if a monitor can acquire a 12 lead and instantly recognize the scent of a STEMI. I typically find it better to dry off a diaphoretic patient's chest and get an accurate EKG before deciding I need to run L&S to the nearest ED, but I wasn't there and have no concept of how sick this patient initially presented.
> 
> BTW, I have no problems with EMTs or interventions based on presentation. I do have a strong dislike of presumptuous medicine, non-critical interventions performed prior to proper assessments, and trite sayings like "BLS before ALS." Also, I usually define interventions as something done to/for the patient, not just moving them to the ambulance.



I understand, but being BLS the term "BLS before ALS" isn't trite, it's a way of life. After the number of STEMI's I've run, yes I can look at a pt., see enough to know urgent from emergent, and start intervening. I always move the pt. as soon as possible, getting him or her into "my house" so we have the option of "stay and play" or "load and go" or calling it in and letting the base station call our next play.  San Francisco is a congested city, and a 49er game, with its traffic challenges and general busy atmosphere, is not the place for a STEMI pt. The object there is to get the pt. away from the stadium and to the receiving hospital ASAP regardless of the nature of the call. BTW, I really respect the opportunity to have a spirited debate with a medic. Some forget what being an EMT-B is all about. I love the challenge of BLS in a big city, and I respect what medics do, it's just that sometimes a veteran EMT like myself can save a green medic's tail on a hot call. Thank you.


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## emtdansby

Very true that an old basic can make the difference on a call with a green medic. I do understand and agree with the other commenter about the dangers of being presumptuous with medicine. Nearly every protocol my company has starts with 12-lead prior to departure. In Texas, the BLS we would do prior to ALS is a quick assessment and set of vitals, thus no interventions or meds would be given prior to an assessment.


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## jeepdude911

emtdansby said:


> Very true that an old basic can make the difference on a call with a green medic. I do understand and agree with the other commenter about the dangers of being presumptuous with medicine. Nearly every protocol my company has starts with 12-lead prior to departure. In Texas, the BLS we would do prior to ALS is a quick assessment and set of vitals, thus no interventions or meds would be given prior to an assessment.



I hear you. In this particular case, an RN had already done an initial assessment with the 4 lead they had in the medical tent. She couldn't keep the leads on. There was nothing presumptive about this call. The way it works in CA, initial assessment is usually done by the EMT. The second the EMT sees anything elevating that pt. to ALS (in this case pt. meeting ACLS protocol) we hand off to the medic. Because of where we were, egress was going to be time consuming, so a big part of the treatment was transport ASAP. I love the armchair quarterbacks. The best part was, I saw that pt. the next Sunday at the next game.


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## Aidey

I think it is important to point out that something like a pulmonary embolism can very closely mimic a MI. A 4 lead is not diagnostic, and the waveform morphology can vary widely between a 4 lead and 12 lead taken on the same machine if it uses different filters for 4 and 12 leads. A good physical assessment is important, but you really shouldn't get too locked in on one diagnosis.


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## jeepdude911

Aidey said:


> I think it is important to point out that something like a pulmonary embolism can very closely mimic a MI. A 4 lead is not diagnostic, and the waveform morphology can vary widely between a 4 lead and 12 lead taken on the same machine if it uses different filters for 4 and 12 leads. A good physical assessment is important, but you really shouldn't get too locked in on one diagnosis.



absolutely, however in this instance, you have an EMT, not a medic, doing a rapid primary assessment and beginning interventions based on presentation, not an EKG. The diagnosis could wait for an ER MD. All that was known at that time is that the pt. needed to go stat.


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## lissa304

domepatrol said:


> First off, I'm a firefighter finishing up my EMT certification. So, for now, all of my calls are going to be from the fire perspective.
> 
> There is a room in our local retirement home (we'll say room 104) that is inhabited by a 500-550 lb woman who likes to fall 2-3 times per month. Whenever room "104" is in need of attention, the dispatcher calls out our engine for manpower. Late one afternoon our engine gets called out to the retirement home for a lift assist. We all know exactly what it is. When we arrive on scene we're directed to room 104 by the secretary. So far, so good.
> 
> We make our way down the hall to room 104 and nobody is there. We hear EMT chatter in the room next door so our chief sticks his head in. The medics are working on a small elderly woman, probably 110lbs at the most. They clear us from the scene and say it was a mix up. As we turn around to leave, the 550lb woman rolls up on her motorized wheelchair thing (I don't know what it is, it's much more than a regular motorized wheelchair) and just looks at us, confused.
> 
> "Why are there so many of you?" She finally asks.
> 
> There was an awkward moment of silence before the guy in the front of the line says "Hey chief, the woman up here has a question for you."
> 
> We stepped around her single file, leaving the chief to deal with that conversation.
> 
> :rofl:



hahaha :rofl:


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## Handsome Robb

jeepdude911 said:


> The pt. was not in a hot environment, cool, pale, diaphoretic, too much so to get an EKG on scene, and already seen by an RN. There is an "E" in EMS,  but I digress. You must be truly gifted to critique a straight forward STEMI ( which it was) at Candlestick Park from Delaware. I can only hope to be that good someday. Pity, I've only been doing this for 19 years. It is possible to start interventions based on presentation. but that would mean BLS before ALS. Oh, wait, I'm an EMT, that's what I do!




This is the EXACT dogma we're trying to get away from. Yes there is an "E" in EMS and this call may have been an emergency but the treatment described was a disservice to the patients spend the extra couple of minutes to dry him, use some iodine or chlorhexidine to make the area tacky and capture the 12-lead. If egress was so long why not do it while you're idling through the event on the way out?

I'd be torn to shreds by QI/CQI here for not obtaining a 12-lead and activating the STEMI protocol. Showing up and handing the nurse the 12-lead may have gotten them the appropriate treatment but it was delayed even though you had a emergency and transported without assessing.


We spin the lab on our STEMI alert on scene then call a full report em route. Consistently pull 30 minute door-to-balloon times. 

Not trying to Monday morning QB you, I wasn't there but if that's the standard there it needs adjusting. 

"BLS before ALS" is one of the dumbest things I've ever heard when it comes to medical care from medical providers. We provide appropriate treatments at the appropriate level. If I show up to an anaphylaxis with massive laryngeoedma, facial swelling, stridorous, and hypotensive I'm goin to give epi and albuterol then without a quick change they're getting criched. I'm not gonna :censored::censored::censored::censored: around with BLS interventions because "BLS vs ALS".

Sorry, you struck a nerve, friend.


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## chaz90

Fell for the necro thread there Robb...That's okay, you echoed my opinion from last year.


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## Handsome Robb

Whoopsies haha

Great minds think alike.


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## mfshorepatrol

Handsome Robb said:


> This is the EXACT dogma we're trying to get away from. Yes there is an "E" in EMS and this call may have been an emergency but the treatment described was a disservice to the patients spend the extra couple of minutes to dry him, use some iodine or chlorhexidine to make the area tacky and capture the 12-lead. If egress was so long why not do it while you're idling through the event on the way out?
> 
> I'd be torn to shreds by QI/CQI here for not obtaining a 12-lead and activating the STEMI protocol. Showing up and handing the nurse the 12-lead may have gotten them the appropriate treatment but it was delayed even though you had a emergency and transported without assessing.
> 
> 
> We spin the lab on our STEMI alert on scene then call a full report em route. Consistently pull 30 minute door-to-balloon times.
> 
> Not trying to Monday morning QB you, I wasn't there but if that's the standard there it needs adjusting.
> 
> "BLS before ALS" is one of the dumbest things I've ever heard when it comes to medical care from medical providers. We provide appropriate treatments at the appropriate level. If I show up to an anaphylaxis with massive laryngeoedma, facial swelling, stridorous, and hypotensive I'm goin to give epi and albuterol then without a quick change they're getting criched. I'm not gonna :censored::censored::censored::censored: around with BLS interventions because "BLS vs ALS".
> 
> Sorry, you struck a nerve, friend.


??? What state are you in??? Thats some BLS $!#& in CT


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## Alan L Serve

Good call. You did the right thing and I'm proud of you.


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## Giant81

Handsome Robb said:


> [...]
> "BLS before ALS" is one of the dumbest things I've ever heard when it comes to medical care from medical providers. We provide appropriate treatments at the appropriate level. If I show up to an anaphylaxis with massive laryngeoedma, facial swelling, stridorous, and hypotensive I'm goin to give epi and albuterol then without a quick change they're getting criched. I'm not gonna :censored::censored::censored::censored: around with BLS interventions because "BLS vs ALS".
> 
> Sorry, you struck a nerve, friend.



In my system albuteral and epi are administered by basics so giving them before a crich is BLS before ALS.  I get where your coming from though, you do need to accelerate your interventions in relation to the patients condition.  Though BLS before ALS to me just means try the least invasive interventions first and move up from there if needed.


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## akflightmedic

But that is the point....there are times where the least invasive thing is to be skipped and the MOST invasive thing should be first. But again, medicine is not a step by step cookbook although many teach it that way, learn it that way and practice it that way. It is more like a ghoulash....throw it all in the bowl and savor the many flavors. But you cannot do any of the above without a solid foundation rooted in education...


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## mrhunt

One time, there was a big lady. and she broke a wheel on her barriatric bed. And was all like.......Is it cause im fat?

And we were all akwardly silent......And finally one of us was like ......."nooooooooooooooooooooooo dear! Its just a defective wheel! happens all the time!"

yeah. True story. It happened.


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