Boston EMS TV Show

[RocketMedic]

Meanwhile, in a system that doesn't suck...

We have tylenol, toradol (awesome stuff), fentanyl and ketamine, plus Ativan and versed. Zofran and promethazine for vomiting.

Although I manage pain on a case-by-case basis, I try very hard to do right by our patients.5

 

[Fleury14]

Meanwhile, in a system that doesn't suck...

We have tylenol, toradol (awesome stuff), fentanyl and ketamine, plus Ativan and versed. Zofran and promethazine for vomiting.

Although I manage pain on a case-by-case basis, I try very hard to do right by our patients.5

Those are in your BLS protocols?

 

[NTXFF]

We carry nitrous but in five years I've never seen it used. We also carry Ketamine, versed, morphine, fentanyl, and dilaudid. Pain management is on a case by case basis but all the above are used quite frequently. Personally I'm a ketamine fan.

 

[chaz90]

Those are in your BLS protocols?

Nope, those were definitely ALS.

 

[CALEMT]

Those are in your BLS protocols?

Hahaha Texas is a progressive state, but if those are drugs a EMT can administer then I'm a neurosurgeon.

 

[NTXFF]

Deleted

 

[medichopeful]

Meanwhile, in a system that doesn't suck...

We have tylenol, toradol (awesome stuff), fentanyl and ketamine, plus Ativan and versed. Zofran and promethazine for vomiting.

Although I manage pain on a case-by-case basis, I try very hard to do right by our patients.5

I really, really wish that they would spread the use of Toradol more.

 

[Fleury14]

Hahaha Texas is a progressive state, but if those are drugs a EMT can administer then I'm a neurosurgeon.

That's my point. They were showing BLS calls for the most part.

 

[RocketMedic]

How is a knee dislocation BLS only?

 

[shfd739]

How is a knee dislocation BLS only?

Beat me to it.....or for god sakes a pediatric anaphylaxis..seriously how is a BLS crew supposed to manage that if they detoriate? They cant. God help them if that was my child.

 

[climberslacker]

It's from the other show (Save My Life) but did anyone notice this dude with his tacticool quick-draw belt-mounted OPA kit? Never before have I seen someone do that! Bottom left in this screen-grab.

 

[RocketMedic]

Beat me to it.....or for god sakes a pediatric anaphylaxis..seriously how is a BLS crew supposed to manage that if they detoriate? They cant. God help them if that was my child.

Don't question the tiered system.

 

[shfd739]

Don't question the tiered system.

Ha! Their tiered system looks horrible...

 

[RocketMedic]

But it's "high performance" lol

 

[medicsb]

As usual, talking heads talk... It's amazing that any EMSer would ever consent to being on a show since every EMS know-it-all will gladly step up on to their soap box to go on about how the subject EMS is awful and then go on about how great they are. As a doctor and former medic... BLS the patella dislocation. I've seen a number of them and they all were manageable for transport with immobilization. It's the reduction that will hurt. I typically don't give them anything because it will reduced in mere seconds and the pain will immediately begin to diminish, maybe a percocet afterwards.

As far as the 14 month old... sure, ALS would have been appropriate, but it's tough to tell whether or not the kid was actually BLS'd (probably got epi at some point, though it is not mentioned at any time) or if she was even brought in by Boston EMS (notice the EMT carrying the child into the room is NOT in BEMS uniform). Even if the pt. was BLS'd, epi-pens are required items on BLS ambulance and the state protocol allows EMTs to admin epi. Epi is, hands down, the most important med, so even if ALS didn't take the patient, she would have gotten standard of care if BLS'd. There is SO MUCH post-production in these shows, the scenes shown are often not in chronological order. They will play a recording of someone "saying A8" in a report to the hospital and show video of A14 and then show video of a person giving a report using a different radio identifier. That stuff is all over the show.

 

[triemal04]

As usual, talking heads talk... It's amazing that any EMSer would ever consent to being on a show since every EMS know-it-all will gladly step up on to their soap box to go on about how the subject EMS is awful and then go on about how great they are. As a doctor and former medic... BLS the patella dislocation. I've seen a number of them and they all were manageable for transport with immobilization. It's the reduction that will hurt. I typically don't give them anything because it will reduced in mere seconds and the pain will immediately begin to diminish, maybe a percocet afterwards.

As far as the 14 month old... sure, ALS would have been appropriate, but it's tough to tell whether or not the kid was actually BLS'd (probably got epi at some point, though it is not mentioned at any time) or if she was even brought in by Boston EMS (notice the EMT carrying the child into the room is NOT in BEMS uniform). Even if the pt. was BLS'd, epi-pens are required items on BLS ambulance and the state protocol allows EMTs to admin epi. Epi is, hands down, the most important med, so even if ALS didn't take the patient, she would have gotten standard of care if BLS'd. There is SO MUCH post-production in these shows, the scenes shown are often not in chronological order. They will play a recording of someone "saying A8" in a report to the hospital and show video of A14 and then show video of a person giving a report using a different radio identifier. That stuff is all over the show.

How dare you bring logic and actual medical knowledge to this discussion? How dare you sir!? Don't you understand how this goes? The panic has begun, next comes the chants of "burn the witch! burn the witch!" and the mob stocked with torches and pitchforks. Why oh why would you want to head that off? Wait...it's obvious; you must be a collaborator of the witch! Ah...of course you know that this means that now the mob will come for you...

Slightly facetious, but does anyone want to bet that I'm wrong?

 

[RocketMedic]

I know I certainly don't want medicsb taking care of me or my family if that's their expressed standard. #itllbuffout

 

[RocketMedic]

As usual, talking heads talk... It's amazing that any EMSer would ever consent to being on a show since every EMS know-it-all will gladly step up on to their soap box to go on about how the subject EMS is awful and then go on about how great they are. As a doctor and former medic... BLS the patella dislocation. I've seen a number of them and they all were manageable for transport with immobilization. It's the reduction that will hurt. I typically don't give them anything because it will reduced in mere seconds and the pain will immediately begin to diminish, maybe a percocet afterwards.

As far as the 14 month old... sure, ALS would have been appropriate, but it's tough to tell whether or not the kid was actually BLS'd (probably got epi at some point, though it is not mentioned at any time) or if she was even brought in by Boston EMS (notice the EMT carrying the child into the room is NOT in BEMS uniform). Even if the pt. was BLS'd, epi-pens are required items on BLS ambulance and the state protocol allows EMTs to admin epi. Epi is, hands down, the most important med, so even if ALS didn't take the patient, she would have gotten standard of care if BLS'd. There is SO MUCH post-production in these shows, the scenes shown are often not in chronological order. They will play a recording of someone "saying A8" in a report to the hospital and show video of A14 and then show video of a person giving a report using a different radio identifier. That stuff is all over the show.

I'm sorry, but that is a pretty mediocre standard of care for patients. Sure, you may be a doctor and all, but seriously, that reeks of arrogance and callousness. It's entirely possible to do most of what we do with no analgesia whatsoever, but unless you meet crews at the door, you're still leaving folks in considerable pain for prolonged periods of time until you get your magic doctor mittens on their dislocated patellas and reduce them. So much for reducing incidents of PTSD amongst our patients, or providing even minimal compassion...

Quite frankly, if you treated me (as a patient) like that as a medical provider, I would make it my business to make trouble for you. Certainly you could trot out your expertise and discretion and knowledge as a physician in denying effective pre-reduction analgesia, and you would not necessarily be incorrect- but you certainly would not be right. You certainly would not be receiving payment if I could help it.

 

[Tigger]

How is a knee dislocation BLS only?

A patellar dislocation is not a significant dislocation and is not even likely to be a difficult/painful reduction. My system trains its EMTs to reduce patellar dislocations for what it's worth.

 

[medicsb]

I'm sorry, but that is a pretty mediocre standard of care for patients. Sure, you may be a doctor and all, but seriously, that reeks of arrogance and callousness. It's entirely possible to do most of what we do with no analgesia whatsoever, but unless you meet crews at the door, you're still leaving folks in considerable pain for prolonged periods of time until you get your magic doctor mittens on their dislocated patellas and reduce them. So much for reducing incidents of PTSD amongst our patients, or providing even minimal compassion...

Quite frankly, if you treated me (as a patient) like that as a medical provider, I would make it my business to make trouble for you. Certainly you could trot out your expertise and discretion and knowledge as a physician in denying effective pre-reduction analgesia, and you would not necessarily be incorrect- but you certainly would not be right. You certainly would not be receiving payment if I could help it.

Immobilization and positioning goes a long way for controlling pain. I see all sort of injuries that can have pain managed with basic measures at certain times, which are very much a part of the continuum of pain control. Pain control does not equal meds all the time. Most patients with patellar dislocation are happy with out waiting for an IV and meds to kick in when I can reduce it, have it immobilized, get them crutch training, and have them out the door with ortho follow-up in less than 15 minutes from time of arrival. Now, if it seems they may not tolerate the reduction or are in serious pain at rest, then yes an IV, morphine or dilaudid, and x-rays before we touch it.