Just broke the seal on an airline jump kit

[MMiz]

Exciting! I too had the opportunity to use a Delta (Northwest Airlines) jump kit, and it was loaded.

Regarding the O2 tubing on the BVM, it was not made to hook up to airline O2 cylinders, and you're limited to using the masks they provide.

Regarding the use of drugs, they only unlocked it after contacting med control (Mayo Clinic service), and as an EMT-Basic I was only allowed to administer nitroglycerin.

Even though my patient was pretty out of it (suspected MI) he was secured in a seat for landing with my seated across the aisle with the O2. All other supplies were strapped into the seat next to me.

It was definitely an exciting experience, and it sounds like you did a great job. Did you get a certificate/brochure with 5,000 free miles? I still have mine.

 

[usafmedic45]

Did you get a certificate/brochure with 5,000 free miles? I still have mine.

Nice. I have a card somewhere that entitles me (and one person flying with me) to an upgrade to first class on Star Alliance flights because of the case I handled on a Lufthansa flight.

 

[clibb]

To be fair, I've seen some doctors who aren't very comfortable outside of a clinical setting. Maybe they practice in an unrelated specialty, maybe they want to observe before getting involved... it doesn't really matter. They know more, but they still might hang back at first. So I wouldn't call the OP a liar on that alone.

Agreeing with the rest, though. And the bit about staying in the aisle for landing strikes me as odd on a commercial airline.

One of my instructors told that she had a patient collapse on a football field during a game and an OBGYN doctor told her that he is in charge of the patient. She politely asked him to step away from her patient.
She is Nurse and a EMT, though.

This kind of damage is common, or as rare as hens teeth depending on who you talk too. Anyway you look at it, it does not appear to be the favoured method of painifying your patient. The consensus seems to be that if you use the sternal rub properly (rubbing hard for anywhere up to 30 seconds), you will do damage.

The painful stimuli of choice these days appears to be trap squeeze and supra-orbital pressure on account of the fact that they have a greatly reduced potential for causing nastiness.

I've never heard of the spinal injuries argument, though I've nothing for or against it. I have, however, always been a tad concerned about a pt's movement after a painful stimulus if I think they have a spinal injury.

Holy crap! Are we even talking about the same sternum rub? I mean using your knuckles and rubbing on their sternum. Not rubbing so hard that there would be damage. Also, I wouldn't rub for 30 seconds. If you're not going to get a response within the first 5-10 sec, then why would you at 30?

 

[mycrofft]

What was "pulling the oxygen mask" like?

They're very "exothermic", a unlabeled load of them started to light off in the cargo section and took down a cargo jet some years ago.

PS: I have had pt's who know how to withstand a humane sternal rub without flinching. I'm still a proponent of the prompt, reasoned, very transitory and unannounced delivery of an ammonia inhaler by the nose.

 

[JPINFV]

One of my instructors told that she had a patient collapse on a football field during a game and an OBGYN doctor told her that he is in charge of the patient. She politely asked him to step away from her patient.
She is Nurse and a EMT, though.

Was the nurse a bystander or employed/contracted by the school to provide a medical response?

 

[JPINFV]

They're very "exothermic", a unlabeled load of them started to light off in the cargo section and took down a cargo jet some years ago.

ValueJet in Florida...

 

[Veneficus]

One of my instructors told that she had a patient collapse on a football field during a game and an OBGYN doctor told her that he is in charge of the patient. She politely asked him to step away from her patient.
She is Nurse and a EMT, though.

Contracted or not, OB/GYN is still a physician, a surgical discipline at that.

It seems quite foolish to ask him to step away from the patient, much less tell him to. But I should come to expect such behavior from a nurse. Too much propaganda surrounding them.

 

[JPINFV]

Contracted or not, OB/GYN is still a physician, a surgical discipline at that.

It seems quite foolish to ask him to step away from the patient, much less tell him to. But I should come to expect such behavior from a nurse. Too much propaganda surrounding them.

The thing with being contracted is that if she is, then she has legitimacy to be there and in charge. To compare this to formal EMS, most EMS systems require online medical control before handing over a patient to a physician on scene, however a nurse cannot walk up and demand to care for a patient. However, if the RN was not contracted or on duty in any sense of the term, then the RN is a bystander whereas the physician, with an unrestricted license to practice medicine, is free to practice medicine whenever and wherever he feels fit to do so. That, alone, is a very serious technicality that is often overlooked in any physician on scene scenario since it's a major difference between physicians and other nursing or allied health providers.

 

[Veneficus]

The thing with being contracted is that if she is, then she has legitimacy to be there and in charge. To compare this to formal EMS, most EMS systems require online medical control before handing over a patient to a physician on scene, however a nurse cannot walk up and demand to care for a patient. However, if the RN was not contracted or on duty in any sense of the term, then the RN is a bystander whereas the physician, with an unrestricted license to practice medicine, is free to practice medicine whenever and wherever he feels fit to do so. That, alone, is a very serious technicality that is often overlooked in any physician on scene scenario since it's a major difference between physicians and other nursing or allied health providers.

I don't think it is a question of authority, but a question of turning away good help. Most physicians (even the ones I don't like) are rather reasonable. Pointing out you are the contracted responder will usually suffice. But to send a physisican packing because you want to clearly demontrate who is in charge, is not doing what is best for the patient.

 

[JPINFV]

But to send a physisican packing because you want to clearly demontrate who is in charge, is not doing what is best for the patient.

You mean that medicine is about the patient? Heck if there is a common theme between all physician on scene threads (including doctor's office calls), it's that everyone loves demonstrating how they can be superior to the dumb doctor.

 

[EMSLaw]

You mean that medicine is about the patient? Heck if there is a common theme between all physician on scene threads (including doctor's office calls), it's that everyone loves demonstrating how they can be superior to the dumb doctor.

I would say many things about the doctor's I've known. Like any population, they have a whole range of positive and negative personality traits. But I doubt any of them are dumb.

If anything, the problem I've seen with doctors at the scene of an emergency out of the hospital is that they know too much, and are paralyzed trying to sort through it all in a few seconds. EMTs have the benefit of their ignorance. Treat the symptoms, stabilize, and get to the hospital.

One course I've taken discussed clarity versus precision. At the EMS level, you need only clarity - you need to pick out which bucket of gross injury and illness types the patient falls into, and then act according to the protocol for that gross injury or illness type (difficulty breathing, trauma, possible cardiac, etc.) Physicians, who diagnose and treat in the long term, require precision - the determination of exactly what is wrong with the patient. You can't get precision on the side of a highway in dim light with no lab tests and traffic rushing by at fifty miles an hour.

Anyway, just my two cents.

 

[JPINFV]

I don't buy that argument because 10 miutes later you're going to be handing off to a physician who's going to be concerned about both the immediate (now), short term (next few hours), and long term (days/admission) needs. It's not like you hand off to a nurse or paramedic at the ER and the physician only comes when the lab results are back. This isn't to say that all phsyicians are capable at providing emergency care any more than all physicians can do open heart surgery, however I can point to numerous threads with chest beating about how the EMT or paramedic was "smarter" than the physician.

 

[clibb]

Contracted or not, OB/GYN is still a physician, a surgical discipline at that.

It seems quite foolish to ask him to step away from the patient, much less tell him to. But I should come to expect such behavior from a nurse. Too much propaganda surrounding them.

She did that so she could provide "on the field" care. After that the physician took care of it. Sorry for not providing that part.

But if it was me on a plane. I would ask the physician to provide the care for the patient while I'm there to assist him.

 

[EMSLaw]

I don't buy that argument because 10 miutes later you're going to be handing off to a physician who's going to be concerned about both the immediate (now), short term (next few hours), and long term (days/admission) needs. It's not like you hand off to a nurse or paramedic at the ER and the physician only comes when the lab results are back. This isn't to say that all phsyicians are capable at providing emergency care any more than all physicians can do open heart surgery, however I can point to numerous threads with chest beating about how the EMT or paramedic was "smarter" than the physician.

I see your point, though an emergency physician is something of a special case. Still, though, a hospital is a different environment than on scene.

 

[frdude1000]

Can you guys just chill out?!??!?! This guy was sharing his experience of HELPING somebody that he didn't have to. You don't have to bust his brains out over it. People don't follow rules they learned in kindergarten; if you don't have anything nice to say, don't say it at all!!! Some people on here need to be a bit nicer to others. There is a lot of Paramedic bullies, who think they are the sh*t because they have an associates degree from the local CC. Let the guy share his exciting experience; when I tried to share one of mine, everybody blew up on me too.

 

[JPINFV]

Can you guys just chill out?!??!?! This guy was sharing his experience of HELPING somebody that he didn't have to. You don't have to bust his brains out over it. People don't follow rules they learned in kindergarten; if you don't have anything nice to say, don't say it at all!!! Some people on here need to be a bit nicer to others.

You know, if I tell a story and I make a mistake, I want people to call me on it. You can't fix issues that you don't know is broken. Similarly, there should be back and forth over issues because depending on the information available, multiple people might have multiple views on what should have been done.

Also, I'll make sure to tell my attendings to be nice to me when I start clerkships. I'm sure that'll go over like a lead balloon.

 

[frdude1000]

Your absolutely right JPINFV. But do we need pages and pages of posts of this? I don;t think so. And was one positive thing said? I dont think so. A critique includes POSITIVES and deltas, things that should have changed.

 

[joeshmoe]

Can you guys just chill out?!??!?! This guy was sharing his experience of HELPING somebody that he didn't have to. You don't have to bust his brains out over it. People don't follow rules they learned in kindergarten; if you don't have anything nice to say, don't say it at all!!! Some people on here need to be a bit nicer to others. There is a lot of Paramedic bullies, who think they are the sh*t because they have an associates degree from the local CC. Let the guy share his exciting experience; when I tried to share one of mine, everybody blew up on me too.

Frdude....I dont think theres anything wrong with constructive criticism. The OP is (according to him) a professional EMS provider. It wasnt like he was just a good samaritan. Some things in the story seemed kind of immature and unprofessional, at least to me. It might just be the way he's retelling the incident, kind of embellishing his role. In reality he probably did an ok job.

Most EMT's are pretty aware of how little training and knowledge we have compared to other health care professionals, especially a physician. But there seem to be a few that arent completely aware, or maybe are in denial. This could potentially get themselves in trouble outside of work, maybe harm a patient, or at least make themselves look foolish.

Besides, thats just how forums like this work I think. Anyone who posts enough is eventually gonna get flamed by others, nature of the beast.

 

[Seaglass]

The only time I'd be comfortable with a lesser authority telling a physician to back off is if there's a really good reason. Like, the doctor's drunk.

Agreed, but they still hold (or will hold) clinical responsibility and should at least be asked if they mind.

I agree, but I'm giving the OP the benefit of the doubt on the details.

 

[Melclin]

I don't buy that argument because 10 miutes later you're going to be handing off to a physician who's going to be concerned about both the immediate (now), short term (next few hours), and long term (days/admission) needs. It's not like you hand off to a nurse or paramedic at the ER and the physician only comes when the lab results are back. This isn't to say that all phsyicians are capable at providing emergency care any more than all physicians can do open heart surgery, however I can point to numerous threads with chest beating about how the EMT or paramedic was "smarter" than the physician.

They do however, have the benefit of a controlled and familiar environment, with all the gear they need and plenty of nurses.

Certainly a lot of physicians would be perfectly capable in EMS, but I'm quite sure they would often have to take moments to absorb the differences. I'm always struck at how much clearer a pt's condition is when they have, plenty of light, a nice set of vitals appearing regularly and automatically on the screen above their bed, a proper 12 lead (instead of our stupid bloody ones all squeezed onto a rhythm strip), and history, meds, and working diagnosis laid out in front of you.

I also completely agree about being hamstrung by their knowledge. I tripped over the knowledge I had as a paramedic student when I started doing volly first aid. It wasn't rocket science to figure out but, it takes a minute to rearrange your mind to figure out your management, when you don't have say..blood pressure...or a monitor... or people don't answer your questions honestly because you're just a first aider and not a trustworthy figure like a paramedics, nurse or doctor. I imagine doctors would have to make similar simple but significant adjustments when all of a sudden they didn't have a ED to play with. Which could prove especially difficult if they were watching the footy one moment and then all of a sudden they have to deal with an unconscious head injured seizing footballer with unfamiliar gear, little or no support, and its been 10 years since they did that because they're a GP now and haven't dealt with a seriously ill person since St Kilda won the flag (a long time ago ;-) ). Better to let the paramedics do what they're supposed to and offer helpful advice and assistance where needed, I think. This is not a "dumb doctor" argument, its just a matter of adjusting to a new working environment.