PArescueEMT
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easy erika... I don't mess with any 14 y/o girls. That would be like you flirting with a 16 y/o boy. :wacko: ^_^ Don't I feel loved :wub:
Skate Medic???
- Thread starter Jon
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rescuecpt
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easy erika... I don't mess with any 14 y/o girls. That would be like you flirting with a 16 y/o boy. :wacko: ^_^ Don't I feel loved :wub: [/b][/quote]
Um, what's wrong with flirting with a 16 year old boy? It's so much fun to see them blush - look but don't touch, remember? HEHEHE... Just kidding. I don't deal well with younger men, they tend to get on my nerves. HEHE...
OP
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DAMN....THERE GO MY DREAMS
:lol: :lol: :lol:
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Yeah - as I tried to say, ALS was important, as no ED out my way would let you in the door (figurativly, so calm down before EMTALA is cited), with a confirmed LOC without an ALS assessment, unless you had a DARN good reason, like an arrest or unstable airway.
Here we all call the ED for "notification" at begining of transport, give quick report to RN or unit clerk to make sure the ED can accept the Pt.
occasionally the RN or PA who answers will tell you to get ALS, but thats real rare, and then the followup is, I'm finding the doc, otherwise they will throw the doc on the phone and have him take the report, and decide about upgrading
Long story short, if I had been riding as a Medic student (which will happen some day soon) I would have really thought about local ED vs. Trauma Ctr, and probably left it to the doc's discretion. that night, however, I got to pass the buck to someone with more letters after their name
:blink: :lol: Jon
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Yeah, 10-4 that, I guess I am just used to knowing all the local hospitals, who can/cannot handle closed head injuries, etc... But this is definately the time to shaft the person above you
h34r:PArescueEMT
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I am kind of suprised at how many ppl basically jumped in with the reasons for ALS. I know that I was at an advantage with reasons that Jon didn't post. but with what was posted, I enjoy seeing the different reasons caught.
rescuecpt
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My favorite is "because I can". My CC instructor made us recite that in class. I can do O2, IV, monitor on any patient I want. Why, "because I can". Say it with me now... (hehehehe)
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I had an ED nurse ask me why I brought a patient into her ER on O2. My answer was "because I can and my protocols say O2 is good, give lots"
OP
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I had an ED nurse ask me why I brought a patient into her ER on O2. My answer was "because I can and my protocols say O2 is good, give lots"
[/b][/quote]yeah. I LOVE getting into arguments with ED staff about using NRBM's on pt's in CHF/COPD with obvious, severe SOB. 1/2 hour O2 won't kill them, and it's all the drugs I as a basic can use on that patient. Yes, They need Lasix and a neb or 2, but I can't do that.
I had one patient myself and PARESCUEEMT picked up from a large, federally operated "medical center" in philly. pt. lived in a very nearby SNF, and had been fine when we dropped him off that AM, but when we got there to pick him up we barley got out of the elevator before we heard him gurgling, coughing, and wheezing. I listened to his lungs and myself and WhackerDude had the conclusion that this was VERY bad. Pt also stated he felt really bad, and having lots of trouble breathing.
Pt was a CHF/COPD'er on 2LPM by N/C, and we only had the strecher and o2 bottle - no NRBM. I cranked the o2 up to 6 and found the charge nurse, enjoying a glossy tabloid in the next room. her response - well, just drive him down the street to his nursing home (which has a close affiliation to the hospital). I said no, because then I get to come right back, becuase they won't take him. Either you do something about his condidtion RIGHT NOW, or tell me to take him to your 'ED' (a rather run down acute care clinic that city EMS does not recognize as an ED). WhackerDude called our dispatcher, and explained the situation, and he told us to drop the pt. at the ED and clear up for another run. the Nurse found a doc who brushed us off and told us that if we felt we needed to to take him to the ED.
We rolled into the ED and the charge nurse got all pissy that we intrupted his lunch. then he proceeded to tell us to take the patient to the SNF and let them decide to send him back. THEN he told us that he was on too much o2 and was a COPDer, ETC. The attending heard him berating us and came to our rescue. we told her what was happening and she personally worked up the patient, and we all agreed that he looked like crap and probably needed his meds. Given that these facilities are both very computer-based, they give transport units NO paperwork, just Pt's name Pickup and Dropoff, and maybe a SSN.
Long story short, a very nice doc saved the day, and the patient always loved me and WhackerDude, and the nurses on his floor knew it, so we would be walking by and they would ask us to go calm him down or have him keep his neb mask on. Great guy, one of my favriote patients I miss him
:angry: (I no longer work for that company and go to that Sh*thole of a facility) 
:angry: Jon
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Yeah, I wasn't a favorite of certain area ED nurses, but I was highly respected (I like to think) by Docs, who incidently let me do alot more than "protocol" but that's a different story. I was always the EMT who wouldn't take a transport that I deemed unstable, unless they were carrying DNR/No Code/Hospice paperwork, and not unsigned, photocopied BS, it had to be complete, and original, including crossing all i's and dotting all t's. I've gotten into verbal "disagreements" with discharge nurses, told them to call another company, over pt discharge conditions, and nearly got into a physical altercation over a DNR with a FF Lt. (not that we don't love Cpts, erika) who didn't feel it was appropriate to obtain a DNR from a pt who was CTD on a long txpt.
I don't know, I guess that even with my "all business" demeanor, when I was on the rigs, it was all about the pt, even if they didn't know what was in their best interest. They were going to get help if they needed it, and they were told they were full of BS when they were. I'm not going to get into the customer service BS that I think has taken over EMS, but I was told once that they call us because we're the professionals, and they don't know. I took that as gospel in my career, and once a patient was in my care, they were my responsibility until they declined care, or it was transferred, and for the time of my care, they were my only responsibility. I've caught flak for telling a patient they were full of $h!t, but behind the scenes, everyone was slapping me on the back, because everyone knew it was the truth.
I think that as an EMT, and when I was on the rigs, I was the patient's advocate, if something is going wrong, even if it is from "higher" authority, it's my job to protect the pt.
Thanks for reading my opinion,
Luke
I've gotten into verbal "disagreements" with discharge nurses, told them to call another company, over pt discharge conditions, and nearly got into a physical altercation over a DNR with a FF Lt. (not that we don't love Cpts, erika) who didn't feel it was appropriate to obtain a DNR from a pt who was CTD on a long txpt. I don't know, I guess that even with my "all business" demeanor, when I was on the rigs, it was all about the pt, even if they didn't know what was in their best interest. They were going to get help if they needed it, and they were told they were full of BS when they were. I'm not going to get into the customer service BS that I think has taken over EMS, but I was told once that they call us because we're the professionals, and they don't know. I took that as gospel in my career, and once a patient was in my care, they were my responsibility until they declined care, or it was transferred, and for the time of my care, they were my only responsibility. I've caught flak for telling a patient they were full of $h!t, but behind the scenes, everyone was slapping me on the back, because everyone knew it was the truth.
I think that as an EMT, and when I was on the rigs, I was the patient's advocate, if something is going wrong, even if it is from "higher" authority, it's my job to protect the pt.
Thanks for reading my opinion,
Luke
PArescueEMT
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Amen brother!!!
I totally agree. I have done the same with Discharges, and will continue to until I permanantly stabilize.
I totally agree. I have done the same with Discharges, and will continue to until I permanantly stabilize.
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Or suffer a TBI (Traumatic Brain Injury)
Jon
TTLWHKR
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You are joking right?
What EMS region are you in?
Our units can call for, or cancel the bird any time we see fit. That's a necessary tool up here in the boon docks. Local hospital is 30 miles, trauma center is 60-70 (Geisinger@Danville or CMC@Scranton).
In fact just called for one last week to medevac a critical medical patient. They don't make us call Medical Command. Maybe it's different around the state.
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Yeah - here we are 20 minutes from a local hospital, at the EDGES of the county.
where I run it is 5-10 minutes from one, and 10-20 from the other. none are trauma, though.
in delco only 2 people can "fly" the bird - Medic per Command, and Fire Chief, because he's the chief (VERY SILLY)
Here in Chesco there really isn't abuse of it, so if you as the BLS crew gets on the radio and screams for a bird, the county flies one. However, you don't fly without command unless you have a DARN good reason to. Worst case, all local docs are scared sh*tless of trauma, so a 30-second report over the whone will get you permissin to fly ANYONE with possible mecanism of injury....
Jon
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Ok - Talked with the medic last night - Pt. went to local ED, then to the city by Helo for a subdural bleed.
Don't know final outcome, though.
Jon
Don't know final outcome, though.
Jon
Around here, anyone can call for a helo - ranging from EMTP to PD. Everyone(PD and FD) is dispatched though the same dispatch center(at least in Harford County) so if anyone wants a helo, we just contact dispatch who in turn contacts SYSCOM. SYSCOM then contacts our state PD(our local helo tx) and they come to the decision of whether they are down due to weather or not.
So basically, if the weathers right and we request them, they're coming.
Now whether or not they transport is another story. Since out nearest Trauma Center is 45 minutes to an hour away, we are told to fly fly fly. Most of our providers understand the difference of when to fly and when not to. But if the helo gets there and they don't think it's warrented, they'll cancel themselves and have us tx. by land. That hardly ever happens, though. Like I said, most of our providers know when to fly and when not to.
Not to mention we have training on when to fly and when not to, so that helps out as well.