# "That BP is NOT possible"



## BloodNGlory02 (Mar 24, 2005)

Responded to a call today- 72 y/o male pt found lying in the garage by wife, unknown medical problem. It was by the rescue captains house so she was there right away. 71 y/o man found unresponsive in the garage by his wife. So Angie gets there, said the guy was prone, she rolled him over, he had vomit all over, had an insanely high blood pressure, barely breathing. So we get there, run up to the garage, Angie starts an IV, Marty tries to get an airway in, he wont open his jaw, so we load him up, get in the ambo, in the mean time the cops are trying to calm down his wife, so we try the nasal in the squad, we get it in with a little resistance. I must say thats the first time I've done a nasal. Its so much like stuffing it in the dummies nose! anyways, we get going, this guys pulse is all over the place and his heart rhythm wasnt really a rhythm. this guy was hairy so the leads were fallin off. Well the guy pretty much stops breathing so I suggest we  bag him. start that, get another BP, I call the hospital to let them know we're coming in. This is where it gets frustrating.
** me
&& dumb nurse I wanna kill

**St Lukes ER From TCFD 1451
&& Go ahead TC this is St Lukes
**Enroute to your facility with a 72 y/o male patient, unresponsive, assisted ventilations. pt was found by wife in garage, unknown down time. pt has hypertension and takes medication for that, upon EMS arrival pt. prone  in slight yellowish vomit. We currently have an IV established, nasal airway inserted and are assisting ventilations. Our vitals at this time are 224/126, pulse of 84 and fluctuating, 12 breaths a minute assisted and pulse ox of 98%, we'll be to you in 5 minutes.
&& TCFD that blood pressure is NOT POSSIBLE 
**That is what we've gotten 2 times.
&& Please revital as that blood pressure is NOT POSSIBLE
** Um.. yea 10-4 standby.....
...........
...........
...........
**St Lukes our repeat pressure is (somewhere near what I originally gave)
&& (sigh & snotty) tennnnnnnn four TCFD see you in 3 minutes.

How the hell is a nurse going to tell me my blood pressure IS NOT POSSIBLE? Im not lying. Thats what the screen said. Sure we get some interferance using the machine, but our VERY competant paramedic/RN/loads of experience Rescue Captain took a manual beforehand and also had something in the 200's. I was so pissed off at that. We got to the ER, I continued to bag until the doc was ready to intubate. We stood around for about 10 min before I went to do paper work. Mind you I was still fuming. They hooked him up to their BP cuff and got 230 something over 120 something. So i KNOW my BP wasnt off. So i finished the report and the tech that came into the room was very nice, I asked her who the nurse was that took report. She pointed her out and I told her what happened. She said she does that to a lot of squads. Im contemplating writing a letter to their ER director. There is no reason for her to be telling me that a perfectly obtainable BP is NOT POSSIBLE. I've seen BP's of 200's before it is VERY possible. 
The guy ended up having a head bleed. The doc didnt think he'd make it more than an hour. We went back in the room before leaving to hand over paperwork and the guy was bleeding out the nose and one of their IV lines came out and it was like he was on 200mg of coumadin. It was a faucet. So I guess ill find out in a few days if he made it.
So i have a question- im thinking about writting a letter to their ER director just because of the manner in which this occured. When does a nurse have the right to downright argue with an incoming squad with a critical patient? It was just 2 of us in the back so I didnt have time to talk on the radio and bag the pt. I had more things to attend to. Would it be a good idea to alert the ER to this nurses "practices"? Another emt said "you wont last long in EMS if you get all worked up over this" it is a big deal to me when im second guessed. Any thoughts??


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## Chimpie (Mar 24, 2005)

I would bring it up with your liason with the ED, meaning the person on YOUR department that channels info from your department/service to that ED.  You jumping over everyone, including your own, and going directly to the ER director may ruffle a few feathers.

If you feel that strongly about it I would let your liason know IN WRITING what happened.  Keep a copy for yourself of course.

And yes, things like this happens in every occupation.  It's the small stuff like that that sends me through the roof.  I have a hard time keeping my cool sometimes and someone challenging me like that, OVER THE AIR, would have... well, it would not have been pretty. 
h34r:


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## shorthairedpunk (Mar 24, 2005)

Your hospital likely records the radio and EMS line, I would request a copy of the tape within one week to be presented to your liason, if that has not been made available then bypass our liason and contact the hospital directly, if that doesnt bring results, the governing agency (in Illinois its the Dept of Public Health) that oversses things will have a policy for such an issue to be addressed at a state level.

That nurse needs a good spanking if this is the first time, if it has been addressed more than once then she should be formally reprimanded by the regulating body, or terminated


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## BloodNGlory02 (Mar 24, 2005)

im not sure the line I called was taped. Its just the general ER line, aka- our med control line. Maybe ill check into that. The tech I was talking to said this isnt the first time she's heard of this nurse doing something like that. I think I might go to our rescue captain first, shes a paramedic instructor and does a lot of clinicals there, maybe she can get in touch with someone.


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## rescuecpt (Mar 24, 2005)

Our medical control lines are all recorded, however, our hospital transmissions are not (we call in by either low band or 800mhz to the hospital).


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## Jon (Mar 25, 2005)

> _Originally posted by BloodNGlory02_@Mar 24 2005, 10:29 AM
> * im not sure the line I called was taped. Its just the general ER line, aka- our med control line. Maybe ill check into that. The tech I was talking to said this isnt the first time she's heard of this nurse doing something like that. I think I might go to our rescue captain first, shes a paramedic instructor and does a lot of clinicals there, maybe she can get in touch with someone. *


 Med control is ALWAYS taped. It is a CYA for the doc to avoid the he said - she said if ever something goes to court.

Sometimes command radios are taped.


Jon


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## medic03 (Mar 25, 2005)

> _Originally posted by rescuecpt_@Mar 24 2005, 10:50 AM
> * Our medical control lines are all recorded, however, our hospital transmissions are not (we call in by either low band or 800mhz to the hospital). *


 800 is recorded......    :huh: 
When you switch to ALS1 on the 800 band, all that conversation is recorded. The county has it all.  Big brother is watching  :unsure:


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## rescuecpt (Mar 25, 2005)

> _Originally posted by medic03+Mar 25 2005, 05:42 PM--></div><table border='0' align='center' width='95%' cellpadding='3' cellspacing='1'><tr><td>*QUOTE* (medic03 @ Mar 25 2005, 05:42 PM)</td></tr><tr><td id='QUOTE'> <!--QuoteBegin-rescuecpt_@Mar 24 2005, 10:50 AM
> * Our medical control lines are all recorded, however, our hospital transmissions are not (we call in by either low band or 800mhz to the hospital). *


800 is recorded......    :huh: 
When you switch to ALS1 on the 800 band, all that conversation is recorded. The county has it all.  Big brother is watching  :unsure: [/b][/quote]
 Sorry, I didn't say it clearly - 800mhz is recorded when you call medical control, but not when you call the hospital.  Heck, they don't even pick up half the time at HH... damn NSLIJ.  UHSB is SO MUCH BETTER!


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## Jon (Mar 25, 2005)

> _Originally posted by rescuecpt_@Mar 25 2005, 05:55 PM
> * damn NSLIJ.  UHSB is SO MUCH BETTER!    *


 English, please.

Jon


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## TTLWHKR (Mar 25, 2005)

We only get recorded if we use telemetry, but sometimes I'd like to let some nurses hear how *****y they sound!


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## BloodNGlory02 (Mar 25, 2005)

thanks for all the feed back guys. Our radios are NOT taped. But I dont think its going to matter. The tech I talked to that day knows this nurse does stuff like this frequently so if anything she will let the director know.


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## SCEMT-B (Mar 26, 2005)

Don't fell bad about it, things happen, we a;; run into nurses who question what we give them. It could haev been like my situation tho. I got dispatched to a pt with a bp of over 500  :blink: course I figured the dispatcher ment BGL of over 500  :lol:

 I was correct of course


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## medic03 (Mar 26, 2005)

> _Originally posted by MedicStudentJon+Mar 25 2005, 07:13 PM--></div><table border='0' align='center' width='95%' cellpadding='3' cellspacing='1'><tr><td>*QUOTE* (MedicStudentJon @ Mar 25 2005, 07:13 PM)</td></tr><tr><td id='QUOTE'> <!--QuoteBegin-rescuecpt_@Mar 25 2005, 05:55 PM
> * damn NSLIJ. UHSB is SO MUCH BETTER!   *


English, please.

Jon [/b][/quote]
 NSLIJ = North Shore Long Island Jewish hospital
UHSB = University Hospital @ Stony Brook


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## Jon (Mar 26, 2005)

> _Originally posted by medic03+Mar 26 2005, 03:45 AM--></div><table border='0' align='center' width='95%' cellpadding='3' cellspacing='1'><tr><td>*QUOTE* (medic03 @ Mar 26 2005, 03:45 AM)</td></tr><tr><td id='QUOTE'>
> 
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> 
> ...


NSLIJ = North Shore Long Island Jewish hospital
UHSB = University Hospital @ Stony Brook [/b][/quote]
 Thanks.


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## rescuecpt (Mar 27, 2005)

Medic03 beat me to it.  I was kissing up to him, he works at University Hospital, as opposed to the other conglomerate in the area, North Shore LIJ... there's also Catholic Health Services.


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## emtal233 (Apr 15, 2005)

> _Originally posted by rescuecpt+Mar 25 2005, 05:55 PM--></div><table border='0' align='center' width='95%' cellpadding='3' cellspacing='1'><tr><td>*QUOTE* (rescuecpt @ Mar 25 2005, 05:55 PM)</td></tr><tr><td id='QUOTE'>
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> ...


Sorry, I didn't say it clearly - 800mhz is recorded when you call medical control, but not when you call the hospital.  Heck, they don't even pick up half the time at HH... damn NSLIJ.  UHSB is SO MUCH BETTER!    [/b][/quote]
 Thanks recuecpt.....


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## rescuecpt (Apr 16, 2005)

> _Originally posted by emtal233+Apr 15 2005, 10:08 PM--></div><table border='0' align='center' width='95%' cellpadding='3' cellspacing='1'><tr><td>*QUOTE* (emtal233 @ Apr 15 2005, 10:08 PM)</td></tr><tr><td id='QUOTE'>
> 
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> ...


Thanks recuecpt.....  [/b][/quote]
 Except for you, Alex of course.


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## emtal233 (Apr 16, 2005)

It's ok, that particular hospital give me a splitting headache when I walk in to the ED or the CCU or whereever I am removing someone from......


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## devist8me (Apr 17, 2005)

I've got tons of stories about run-ins with nurses like this. Luckily, only a small percentage of them exist. I never probably handle it correctly and tend to blow up without thinking it through.  I like the idea of a liason...those usually have good results.  

Also, she lacked professionalism plus disrespected you on the radio for all to hear who has that freq.  Makes the outfit she works for look bad too.


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## rescuecpt (Apr 17, 2005)

I had a pt yesterday, history of hypoglycemia, hypothyroid, endocarditis, and COPD, c/o difficulty breathing times 12 hours.  Picked her up at a clinic.  She stopped smoking one week ago and ever since has been week and had difficulty walking, etc.  We put her on 15L NRB, per protocol, and I discuss her options for nebulizer treatment (she does not use nebulizers or O2 at home).  Because she is over 70 and COPD I have to call for the treatment, we are less than 5 min from the hospital, so after talking to her a little bit she denies treatment as the O2 made her feel much better.  I monitor her vitals and keep a close eye on her O2 sats and respiratory rate.  Vitals all within normal limits, satting at 90% on room air, 99% on 15L NRB.

At the hospital, the PCA takes her off the O2 to get another baseline sat, and she immediately has difficulty breathing again.  After a few minutes, he puts her back on and she improves.  The nurse asks me about treatment, and I tell her O2 and monitoring vitals, pt denied other interventions.  The nurse asks how much O2, I tell her, and she says "why would you do that?"  I said, "that's my protocol."  She said "you don't give that much O2 to a COPD patient", so I replied "that's my protocol, regardless of COPD - I monitored for respiratory repression, O2 sats, and pain.  If something changed for the worse, I would have taken corrective measures."  She again said that that wasn't right, and I was like "well that's what I have to do"... and at that moment was when the PCA took her off the O2 and my originally quiet patient started gasping and wheezing.  I was pissed to be second guessed like that, I understand where she's coming from, but wasn't my explanation logical enough?


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## Jon (Apr 17, 2005)

I swear there is a class in RN school on how to be an a$$hole to EMS.


Jon


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## ffemt8978 (Apr 17, 2005)

I just love arguing with nurses on that one.

"You can't give 15lpm O2 to a COPD patient."

"Wanna bet?"

"You can kill them."

"Not in the relatively short time I have contact with them.  Besides, if they code, we have to give them 15lpm while we're bagging them.  If  you don't like it, contact my medical director and tell him you said he needs to change our protocols for COPD patients."

Never had one take me up on that yet.


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## usafmedic45 (Apr 17, 2005)

This is my first post here, and I feel I should state my qualification to make a comment here (I'm a respiratory therapist in addition to being an EMT-I).

The nurse is kind of right- under normal circumstances (stable patient) you can give too much O2 to a COPD'er, specifically those who are functioning off their hypoxia as a stimulus to breath (what's called hypoxic drive).   Simply put, you will knock out their signal to breath if you raise the SP02 too high.  

However- in an emergency, there is no such thing as too much O2....at least in the sense that it's better to give them the O2 and maybe have to bag them than for them to suffer deleterious effects of insufficient O2.

And remember that in a COPDer, their normal SPO2 may be 88-90% on several liters of O2.  Quite a few function (relatively speaking) with SpO2's in the low 80's or even high 70's as their norm.

Of course, there is a whole lot more that goes into this topic than just this, but I won't bore you with that info.  If anyone wants to know anythign further, please just ask.


BUT FOLLOW YOUR LOCAL PROTOCOLS (Just so you don't get in trouble  )


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## BloodNGlory02 (Apr 17, 2005)

I often wonder why we have so many CEU's and refreshers to attend, and nurses only have to renew ACLS and CPR. oh wait.. thats because they have a doctor on their @ss all over the hospital. They rarely have to think for themselves. *No offense*


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## Firechic (Apr 18, 2005)

> *I swear there is a class in RN school on how to be an a$$hole to EMS.*



Jon, I'm taking my last nursing class and I never saw that particular class in my curriculum!  They must learn that AFTER RN school!    



> *I often wonder why we have so many CEU's and refreshers to attend, and nurses only have to renew ACLS and CPR. oh wait.. thats because they have a doctor on their @ss all over the hospital. They rarely have to think for themselves. *No offense* *



I once thought the same way you do, but actually going through RN school has changed my point of view. Some states, not all, mandate RNs to fulfill CEU requirements in order to renew their certifications. If not mandated by state law, then their place of employment requires certain CEUs. 
Nurses do think - they are a patient's advocate, just like we are in the field. 
I've met plenty of a** nurses and plenty of a** medics. Lumping them all together is really not a fair statement.


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## CodeSurfer (Apr 18, 2005)

> _Originally posted by Firechic_@Apr 17 2005, 11:51 PM
> * I've met plenty of a** nurses and plenty of a** medics. Lumping them all together is really not a fair statement. *


 As with any profession there will be the a$$es and the cool ones (like me) but you just deal with it and move on.  If you do everything you are supposed to do it's their a$$ on the line, not yours.  Not saying I dont care if they are making decisions not in the patients best interest but getting all bent out of shape about it isnt going to solve it. We do our job and they do theirs.  When they dont do theirs we can report them, just like if we didnt do ours someone would report us.

Am I way too "go with the flow"? I swear it's what keeps me alive.


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## Jon (Apr 18, 2005)

> _Originally posted by usafmedic45_@Apr 17 2005, 06:13 PM
> * This is my first post here, and I feel I should state my qualification to make a comment here (I'm a respiratory therapist in addition to being an EMT-I).
> 
> The nurse is kind of right- under normal circumstances (stable patient) you can give too much O2 to a COPD'er, specifically those who are functioning off their hypoxia as a stimulus to breath (what's called hypoxic drive).   Simply put, you will knock out their signal to breath if you raise the SP02 too high.
> ...


 Steve, my lead medic class instructor is a Resp. Therapist and Paramedic.

Fun to hear him give this lecture.

If my patient is in respritory distress, I give them oxygen.

My favriote was the patient who the nursing home got in at 3pm, and sent out at 4:30pm for "low pulse ox" Pt. satting at 78-79% RA, then 86-88% on 4lpm. Pt is without cyanosis or any respiratory distress. If fact, pt. has no complaints at all.

Pt. transported to ED... ED staff looked at me like I had three heads saying that pt. must be cyanotic with that SpO2. Would have been nice to see the blood gasses.


Jon


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## Margaritaville (Apr 19, 2005)

USAFmedic45,

Let me give you my qualifications - I am a senior paramedic with 9 years career (21 years volunteer), and hold an A.A.S. degree.

I am not sure if you are aware and please don't take this as to being rude, but where I ride the information concerning COPD patients and hypoxic drive is taught at the very basic level. Not only do we give O2, but we know why we are doing it!

The point that was being made in this post was that yet again, a nurse was attempting to point out what an EMS provider did wrong in his/her opinion. According to my protocols, I answer only to the Dr. at Medical control - not the nurse on the radio or in the ED. God bless our nurses for the job that they do, but if they will stay out of our sandbox, then we'll stay out of thiers!

Any questions about that, please feel free to ask and I'll be happy to explain!


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## rescuecpt (Apr 19, 2005)

> _Originally posted by Margaritaville_@Apr 19 2005, 01:55 PM
> * USAFmedic45,
> 
> Let me give you my qualifications - I am a senior paramedic with 9 years career (21 years volunteer), and hold an A.A.S. degree.
> ...


 Just like I didn't question the nurse tonight who unwrapped my bandaging on a head lac that took me 20 minutes to get under control... then she was surprised when the patient started gushing blood again... all I said was "huh... must be a bleeder".

LOL!!!   :lol:


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## Summit (Apr 20, 2005)

I had a pt that was satting at 69% on the monitor (the transferring clinic didn't have her on O2, no order for O2) and looked terrrrible. A little O2 and she looked muuuuuch better back in the 90s and said she felt much better. No history of COPD. I told the receiving RN about this. I went off to the ED EMS lounge to write my report. I forgot to get a pt signature on the HIPPA form so I went back to the Pt. The RN had removed her from O2, she was now @ 82% (lower altitude) and looked like crap again. I mentioned this to the nurse as I handed her my report. "Oh, she'll be fine."  <_<


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## Wingnut (Apr 20, 2005)

> _Originally posted by Summit_@Apr 19 2005, 11:44 PM
> * The RN had removed her from O2, she was now @ 82% (lower altitude) and looked like crap again. I mentioned this to the nurse as I handed her my report. "Oh, she'll be fine."  <_< *


 Why??? Why do they do that???


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## AJemt (Apr 20, 2005)

> _Originally posted by Wingnut+Apr 20 2005, 08:10 AM--></div><table border='0' align='center' width='95%' cellpadding='3' cellspacing='1'><tr><td>*QUOTE* (Wingnut @ Apr 20 2005, 08:10 AM)</td></tr><tr><td id='QUOTE'> <!--QuoteBegin-Summit_@Apr 19 2005, 11:44 PM
> * The RN had removed her from O2, she was now @ 82% (lower altitude) and looked like crap again. I mentioned this to the nurse as I handed her my report. "Oh, she'll be fine." <_< *


Why??? Why do they do that??? [/b][/quote]
 RN = Registered Nitwit  - at least the ones that call us Empty-Minded Twits


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## rescuejew (May 6, 2005)

man I wouldnt sweat it...and no offense to any decent nurses reading the posts, but just cause they have RN after their names, doesnt meant hey are the authority on pt care.  Ive seen BPs as high as +300 systolic with the pt bleeding from every orifice, and Ive seen nurses doing chest compressions while the patient was screaming at them to stop because it hurt.  People are still stupid regardless of their credentials...

Dont let the red tape get you down...


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## emt3225 (May 6, 2005)

> _Originally posted by rescuejew_@May 6 2005, 12:47 AM
> * People are still stupid regardless of their credentials...
> 
> *


You are soooo right about that...I have also seen some stuff and it amazes me that these people are still certified to treat people..Actually it's scarey...I see it everyday in the nursing home where i work..We had a resident in respiratory failure and i walked into the room to see if i could help and there i see a RN trying to sunction the PT with a oxyen tube while the LPN  is putting a nebulizer mask on the resident  instead of a non rebreather....They looked at me and asked for me to help them...Have you to know that i'm a recreation therapist and i ended up doing the care, plus having to speak to the doctor about the treatment that was giving to the pt...I'm sure not all RN'S and LPN'S are like that but it still amazes me today how some of these people got a  license to care for people.. :blink:


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## rescuecpt (May 6, 2005)

emt3225 - you don't work at Gurwin, do you???


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## emt3225 (May 6, 2005)

> _Originally posted by rescuecpt_@May 6 2005, 09:05 AM
> * emt3225 - you don't work at Gurwin, do you??? *


 Nope...I never even heard of that place....   :blink: Rescuecpt will u be going to the wake for the 2 emt's that died on Wednesday?


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## rescuecpt (May 6, 2005)

Yes, I am going to Heidi's firematic services tonight, then I think as a group we might head over to the end of Bill's wake.  I'm riding tomorrow so I can't go to his prayer service.


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## Chimpie (May 6, 2005)

How's Alex doing?


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## rescuecpt (May 6, 2005)

> _Originally posted by Chimpie_@May 6 2005, 11:20 AM
> * How's Alex doing? *


 He sounds ok, I've talked to him everyday - we are over 1hrs drive apart so I haven't seen him yet - but I will see him tonight.  I know he's going crazy right now, but he's putting up a pretty good front.  I can't wait to see him tonight and give him a huge hug.

Thanks for asking, I know he appreciates the concern.


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## emt3225 (May 6, 2005)

> _Originally posted by rescuecpt_@May 6 2005, 10:59 AM
> * Yes, I am going to Heidi's firematic services tonight, then I think as a group we might head over to the end of Bill's wake.  I'm riding tomorrow so I can't go to his prayer service. *


 I will also be there tonight with Mineola..We are going as a group..Soo sad..Life is too short..


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## rescuecpt (May 6, 2005)

> _Originally posted by emt3225+May 6 2005, 12:11 PM--></div><table border='0' align='center' width='95%' cellpadding='3' cellspacing='1'><tr><td>*QUOTE* (emt3225 @ May 6 2005, 12:11 PM)</td></tr><tr><td id='QUOTE'> <!--QuoteBegin-rescuecpt_@May 6 2005, 10:59 AM
> * Yes, I am going to Heidi's firematic services tonight, then I think as a group we might head over to the end of Bill's wake. I'm riding tomorrow so I can't go to his prayer service. *


I will also be there tonight with Mineola..We are going as a group..Soo sad..Life is too short..  [/b][/quote]
 I'll be with Commack Ambulance - I'm 5'5, blonde hair, blue eyes, Advanced EMT patch on my right arm, if you spot me come say hi.


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## emt3225 (May 6, 2005)

> _Originally posted by rescuecpt_@May 6 2005, 01:37 PM
> *
> I'll be with Commack Ambulance - I'm 5'5, blonde hair, blue eyes, Advanced EMT patch on my right arm, if you spot me come say hi. *


 I will keep my eyes open for you.   .I'm 5'3, brown hair, brown eyes and i also wear eye glasses..Hopefully i will see you tonight..


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## coloradoemt (May 6, 2005)

> _Originally posted by BloodNGlory02_@Mar 23 2005, 11:29 PM
> * I was so pissed off at that. We got to the ER, I continued to bag until the doc was ready to intubate. We stood around for about 10 min before I went to do paper work. Mind you I was still fuming. They hooked him up to their BP cuff and got 230 something over 120 something. So i KNOW my BP wasnt off. So i finished the report and the tech that came into the room was very nice, I asked her who the nurse was that took report. She pointed her out and I told her what happened. She said she does that to a lot of squads. Im contemplating writing a letter to their ER director. There is no reason for her to be telling me that a perfectly obtainable BP is NOT POSSIBLE. I've seen BP's of 200's before it is VERY possible.
> *


 Ok back to the original topic as it looks like I skipped over this topic a time or two. About all I can say is, with all of the things that can be said and done to me that may irritate me, a nurse telling me she does not believe my BP is not going to be one of them. It is also my opinion that if something this minor actually gets you pissed off and fuming maybe you need a different life path...... or classes.   As far as writing a letter, I am sure you will do what you feel you must but I believe it to be an act of a small minded child seeking retribution.


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## Jon (May 6, 2005)

> _Originally posted by coloradoemt+May 6 2005, 05:29 PM--></div><table border='0' align='center' width='95%' cellpadding='3' cellspacing='1'><tr><td>*QUOTE* (coloradoemt @ May 6 2005, 05:29 PM)</td></tr><tr><td id='QUOTE'> <!--QuoteBegin-BloodNGlory02_@Mar 23 2005, 11:29 PM
> * I was so pissed off at that. We got to the ER, I continued to bag until the doc was ready to intubate. We stood around for about 10 min before I went to do paper work. Mind you I was still fuming. They hooked him up to their BP cuff and got 230 something over 120 something. So i KNOW my BP wasnt off. So i finished the report and the tech that came into the room was very nice, I asked her who the nurse was that took report. She pointed her out and I told her what happened. She said she does that to a lot of squads. Im contemplating writing a letter to their ER director. There is no reason for her to be telling me that a perfectly obtainable BP is NOT POSSIBLE. I've seen BP's of 200's before it is VERY possible.
> *


Ok back to the original topic as it looks like I skipped over this topic a time or two. About all I can say is, with all of the things that can be said and done to me that may irritate me, a nurse telling me she does not believe my BP is not going to be one of them. It is also my opinion that if something this minor actually gets you pissed off and fuming maybe you need a different life path...... or classes.   As far as writing a letter, I am sure you will do what you feel you must but I believe it to be an act of a small minded child seeking retribution. [/b][/quote]
 Yeah.... But on the same token, my looking like an a$$ because I trusted my partner to take a B/P, and he is hearing his OWN amke me look bad :angry: , and hurt deep down inside   (ya hear that, PaRescue? Ya remeber 2 weeks ago?)

Jon


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## rescuejew (May 8, 2005)

agree with colorado...to h*ll with them.  You can be friends with nurses, or not friends with nurses.  We are NOT techs, and we are not subordinates to NSG staff.  We are our own profession with our own interventions.  Nurses cant do anything without a doctors order, we can intubate, defibrillate, hang drips, push all sorts of meds (including MS), we field-diagnose and treat.  

Some of my best friends are nurses, but understand the difference, we will always have the autonomy and required critical-thinking in our job, and the nurse can/will always have to walk down the hall and find the doc for orders.  they are 2 vastly different careers, EMS was never intended to be a subset of nursing.


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## emtbuff (May 8, 2005)

I agree with you rescuejaw.  And yes it is kinda hard for me to always remember when testing  or even quizing others in my nursing class that little part of getting orders and other little things.  I am going straight on for my RN but have had a tough time with remember as an LPN you can't touch an IV for the most part where as an EMT if I need to I can change it.  

You are right that nurses need to work under a doctor and can't do anything with out their permission.  Which kinda stinks.

They will always be a separt profession for me.


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## Jon (May 9, 2005)

> _Originally posted by emtbuff_@May 8 2005, 02:22 PM
> * I agree with you rescuejaw.  And yes it is kinda hard for me to always remember when testing  or even quizing others in my nursing class that little part of getting orders and other little things.  I am going straight on for my RN but have had a tough time with remember as an LPN you can't touch an IV for the most part where as an EMT if I need to I can change it.
> 
> You are right that nurses need to work under a doctor and can't do anything with out their permission.  Which kinda stinks.
> ...


 Paramedics can't do advanced procedures without having a doctor's order, either - we just do a lot under "standing orders"

Jon


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## rescuejew (May 10, 2005)

But "standing orders" are defined as using discretionary judgement.  Our protocols here are the same way, they use words like "APPROPRIATE airway management" or "CONSIDER Narcan".

We call for very little.  There is a county southeast of us that has to call to d/c a line.  I can count the number of times on one hand that I've run a call in 3 years that I've had to call for orders.  We are a very autonomous system, and we've had to do some nursing education here as well: ie the whole "paramedics are worthless" attitude.  We have things on standing order that nurses will never be allowed to do PERIOD.  

I'm not downing nursing, it has its place, its place just isnt prehospital medicine.


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## Jon (May 10, 2005)

> _Originally posted by rescuejew_@May 10 2005, 01:31 PM
> * But "standing orders" are defined as using discretionary judgement.  Our protocols here are the same way, they use words like "APPROPRIATE airway management" or "CONSIDER Narcan".
> 
> We call for very little.  There is a county southeast of us that has to call to d/c a line.  I can count the number of times on one hand that I've run a call in 3 years that I've had to call for orders.  We are a very autonomous system, and we've had to do some nursing education here as well: ie the whole "paramedics are worthless" attitude.  We have things on standing order that nurses will never be allowed to do PERIOD.
> ...


 in PA, my understanding is that you have to call command for any time you do an ALS-level skill, even as a "gee, we just gave narcan to the Heroin OD...."


Jon


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## rescuecpt (May 10, 2005)

In NY, you have to do a post-call 34 (call medical control) anytime you enter the ALS system.  Usually takes less than 5 minutes, it's just information gathering on their part.


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## rescuejew (May 10, 2005)

WOW!  I had no idea...its just not like that down here in redneckville.  Thanks for the edu-ma-cation.  We dont hire EMT-Bs here, strictly an ALS system, with intermediate-paramedic or paramedic-paramedic trucks.  EVERYTHING is on standing orders except for things like CaCl and Bicarb.  We can 10-22, that is, cancel calls, if they dont need an ALS truck, then they just dont get one, plain and simple.  (That cuts out a lot of BS)


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## Jon (May 10, 2005)

> _Originally posted by rescuejew_@May 10 2005, 05:21 PM
> * WOW!  I had no idea...its just not like that down here in redneckville.  Thanks for the edu-ma-cation.  We dont hire EMT-Bs here, strictly an ALS system, with intermediate-paramedic or paramedic-paramedic trucks.  EVERYTHING is on standing orders except for things like CaCl and Bicarb.  We can 10-22, that is, cancel calls, if they dont need an ALS truck, then they just dont get one, plain and simple.  (That cuts out a lot of BS) *


 what happens if they need a BLS truck?

Jon


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## Jon (May 10, 2005)

> _Originally posted by rescuecpt_@May 10 2005, 02:42 PM
> * In NY, you have to do a post-call 34 (call medical control) anytime you enter the ALS system.  Usually takes less than 5 minutes, it's just information gathering on their part. *


 I think around here, they want it done ASAP... I love the times when the medics call up with a "hey, we just flew someone out..."

jon


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## rescuecpt (May 11, 2005)

> _Originally posted by MedicStudentJon+May 10 2005, 06:13 PM--></div><table border='0' align='center' width='95%' cellpadding='3' cellspacing='1'><tr><td>*QUOTE* (MedicStudentJon @ May 10 2005, 06:13 PM)</td></tr><tr><td id='QUOTE'> <!--QuoteBegin-rescuecpt_@May 10 2005, 02:42 PM
> * In NY, you have to do a post-call 34 (call medical control) anytime you enter the ALS system. Usually takes less than 5 minutes, it's just information gathering on their part. *


I think around here, they want it done ASAP... I love the times when the medics call up with a "hey, we just flew someone out..."

jon [/b][/quote]
 If you run totally within standing orders, you don't have to call until afterwards.  If you finish your standing orders, or within 20 minutes of pt contact if not at the hospital, you need to contact medical control.


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## rescuejew (May 11, 2005)

JON: 
If we need a BLS truck, which happens a lot in the nursing home industry, then we have a private service (Johnston Ambulance) that handles it.  We'll just give em a buzz from our cell phones, state that we have evaluated the pt and feel s/he would be safe riding in BLS.  It works out well.  If we get a BLS call and the person has a legitimate complaint, most of the time we'll give them a ride, but lots of times there too we have to try and find the most suitable transportation for the pt, be it a friend, family member or taxi.


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## Jon (May 11, 2005)

> _Originally posted by rescuejew_@May 11 2005, 06:18 AM
> * JON:
> If we need a BLS truck, which happens a lot in the nursing home industry, then we have a private service (Johnston Ambulance) that handles it.  We'll just give em a buzz from our cell phones, state that we have evaluated the pt and feel s/he would be safe riding in BLS.  It works out well.  If we get a BLS call and the person has a legitimate complaint, most of the time we'll give them a ride, but lots of times there too we have to try and find the most suitable transportation for the pt, be it a friend, family member or taxi. *


 Does the BLS service arrive while you are still onscene or do you "abandon" the pt. to wait for a taxi ride??

Jon


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## rescuejew (May 11, 2005)

I have never left a patient alone to wait for a BLS truck, there has always been a family member or RN there.  JAS is usually used with nursing homes, NOT out in the community.  Some nursing homes here just downright suck and they call 911 for every hangnail they find to dump patients because they dont feel like taking care of them.  Calling JAS is education: select the appropriate ride, the patient is paying for it, maybe they dont need a $500 ALS ride.  But Yes, I do leave befroe they get there, our call volume is high and I cant always wait for them to arrive.  Its not abandonment, the patient will get to the hospital, just not by ALS.  We are allowed to refuse EMS services to patients here, that isnt abandonment either.  If we have evaluated them and determine they dont need it, then they dont get it.  Its not like I leave some LOL sitting desolate and alone in a dark room while I check t8 to go run errands.


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## Jon (May 12, 2005)

Ok... That is actually really cool, and I wish PA could be so progressive!

Jon


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