Management of a potentially aggressive patient on PCP.

[NYMedic828]

Smart move. If you always tell the truth, you'll never contradict yourself.

Luckily, the docs here trust us... When we call for orders, they almost always grant them.

Thats one of the problems I immediately realized as a new medic here in NYC.

we have like 20 medical directors, so for starters none of them know you, and we really have a diverse standard of competency amongst providers which leaves little to trust from the doctors.

 

[NomadicMedic]

Thats one of the problems I immediately realized as a new medic here in NYC.

we have like 20 medical directors, so for starters none of them know you, and we really have a diverse standard of competency amongst providers which leaves little to trust from the doctors.

Yeah, that's a problem. Luckily, here in DE, it's small enough that our docs know all the medics by name. If you can paint a clear picture of why you need what you're asking for, you'll seldom get denied.

I envy you working in NYC, but I'm sure the call volume must just wear you down. :/

 

[NYMedic828]

Yeah, that's a problem. Luckily, here in DE, it's small enough that our docs know all the medics by name. If you can paint a clear picture of why you need what you're asking for, you'll seldom get denied.

I envy you working in NYC, but I'm sure the call volume must just wear you down. :/

Its actually not that stressful as ALS.

As BLS i would get hammered on a daily basis probably 4-8 jobs a day.

As ALS, I do 2-4, and i actually enjoy my job now that I can legitimately treat people's ailments.

 

[Maine iac]

4-8 runs a day? How long are your shifts??

2-4 calls in a single shift?

Wow.

So NYMedic where you work BLS is called to the scene first, then if they determine ALS is required you get called in? If so, I have always wondered how your cardiac calls work.... Is ALS getting called out for all chest pains?

 

[Youngin]

Possibly a dumb question: What's EDP stand for?

 

[Ramis46]

LOL.. in our Service, we RSI people like that.. We don't really like to take their High away... just make them mot so Combative!

 

[SliceOfLife]

Agreed. These PTs need to be sedated early to decease whatever is causing the erratic behavior, whether its chemical or phsycological or a mix of the two.

Also, The guy was naked except for a pair of boxers and was about 150 lbs ... and I wear a Kevlar vest on the job. FWIW, I don't feel I need to justify my actions to anyone here. I simply related an experience that I had recently, using nasal versed to sedate a PT with excited delirium. If you chose to wait for PD, that is your decision. I have waited for PD in the past, and I'm sure I will again when confronted with a situation that I am not comfortable with.

But, I do appreciate your concern.

Vests don't protect you from knives unless it is a stab vest, which most aren't. Unless you are in the UK.

 

[Maine iac]

Possibly a dumb question: What's EDP stand for?

Emotionally Disturbed Person

 

[Aidey]

Vests don't protect you from knives unless it is a stab vest, which most aren't. Unless you are in the UK.

There are combination vests.

 

[SliceOfLife]

There are combination vests.

I have never seen one used. Have you? Adding stab protection to a vest is awesome but it requires rigid plates which are expensive and stiff. Unlike a ballistic plate, these encompass the entire vest.

Some how I doubt that is what he had on.

 

[Aidey]

Yup, at least several of the police around here have them.

 

[SliceOfLife]

Who knows maybe it was Class IV armor and he had a ballistic shield in front of him. We can only speculate.

 

[NomadicMedic]

Who knows maybe it was Class IV armor and he had a ballistic shield in front of him. We can only speculate.

Or, you could just ask.

Our vests are Kevlar and are not stab vests. However, as I mentioned, the guy was naked, except for some shorts and was not armed.

I don't want to beat this dead horse, but the fact remains, the patient I was treating needed to be sedated for his safety and the safety of the crew treating him. The two EMTs and I were able to accomplish this without much difficulty. If the situation was different, my plan of attack would have been different. Every situation is different and needs to be fluid.

What I did may not be recommended for you. My actions on scene are my own. Let's move on.

 

[NYMedic828]

4-8 runs a day? How long are your shifts??

2-4 calls in a single shift?

Wow.

So NYMedic where you work BLS is called to the scene first, then if they determine ALS is required you get called in? If so, I have always wondered how your cardiac calls work.... Is ALS getting called out for all chest pains?

8 hour shifts.

Depends on the call type. Injuries, Trauma, CVA, abdominal pain, non-copd asthma, sick jobs all go direct to BLS.

Substantial medical calls like cardiacs, AMS, hypotensives, Diff Breathers, inbleeds all go to ALS directly.

Jobs like cardiac arrests get a BLS an ALS a CFR fire engine and an ems supervisor.

Jobs that the ALS are extended to, get a bls backup if they are closer for a high priority job.

Jobs that are high priority bls with no BLS available get an ALS bus but thats rare.

We have a priority 1-8 system. A 1 being an arrest or something, 3 being chest pain and whatnot. Anything 3 or under is considered high priority. Abd pains are a 5, edps are a 7. Standbys are 8. Anything 7 or higher is a non emergent response.