the 100% directionless thread

RocketMedic said:
I drive an Insight and like weird things, like the Ambassador-class starship and Taurus pistols.

Last shift at current employer...if nothing else, this purgatory has smoke-checked my ego hard.
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What's a smoke check?
 
Aside from swapping the paper which usually causes a bunch of swearing and annoyance, I actually really like the x series. In a perfect world I'd blend the best features of the LP15 and X series and combine them, but all in all the x series is still good.

I've never really had issues with the pulse ox except for those thick, fake nails which happens often. Otherwise it's always been pretty spot on for both SpO2 and heart rate.
 
The X prints to the top of the monitor, the paper comes out between the bag and the monitor body. It's pretty crummy.

We were promised new bags by our soul rap. Those never materialized. There are some companies making replacement cases for the zoll x, but I am not going to pay for them. It's the principle of the thing.

the 12-lead on the Zoll is decent. It doesn't just show one complex per lead, I don't know where that came from. It's a lot better than the MRX ever was.

The nibp is extremely fast and accurate, the CPR feedback is fantastic, the see-through CPR algorithm is very nice. The battery life is exceptional. The weight is its major selling point.
 
NomadicMedic said:
I'm speaking at a conference for the first time tomorrow morning. Wish me luck.
(Gotta a little imposter syndrome happening here...)
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The ankle bone is connected to the... leg bone...
 
My sister 2 hours ago while chatting:
"You're still not packed and headed to the airport already?!?!"
Me: I'm only throwing a few clothes in a duffle bag....
*kills a couple more hours, finishes packing
*Ubers to airport, check in, go thru TSA, get a Starbucks and am at the gate all within an hour
*still has an hour before boarding starts, considering getting a burger lol
 
Akulahawk said:
You can learn to be a very good CLINICIAN by doing IFT and taking the time to hone your assessment skills, reading the chart (yes, you are allowed to!) and picking out a medication and medical problem to learn about.
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I find it's getting more difficult to get info about the pt. from the paper work they give you now days. All the interesting stuff is being sent to receiving hospital electronically.
 
Tigger said:
Do you have coiled or straight tubing to the BP cuff? The coiled variety is hot garbage.
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Coiled of course.


NomadicMedic said:
the 12-lead on the Zoll is decent. It doesn't just show one complex per lead, I don't know where that came from. It's a lot better than the MRX ever was.
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Maybe it's not an X? I just know it's a Zoll. It shows only one complex per lead. I haven't used it much, it's something on a certain fire department around here has, and that's how they give me their 12-leads. The paper is small and really long like the MRx, but it's white and just shows one complex per lead. I am trying to see if I can find an example on Google.

Edit: I cannot find an example. I wonder if the fire department over there changed the settings to make it show only one complex, if anyone has seen it before. I have a friend over there that I'll ask to do a 12-lead on himself or something to give you guys an example later.
 
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cruiseforever said:
I find it's getting more difficult to get info about the pt. from the paper work they give you now days. All the interesting stuff is being sent to receiving hospital electronically.
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Demand that you get the information that you need printed out before you leave. We have encountered the same on some of our flights within the system. Sending the records electronically or "they're in the system" are all fine and well, but we as clinicians still need a copy of important documents not only for our knowledge and charting purposes, but also in case you needed to divert to another facility etc.

Also under EMTALA law, which guides IFT a copy of the records must be transported with the patient. All I generally care about if we are time sensitive on a flight is the PCS form, a facesheet/demographics, and the most recent consult note or transfer/discharge summary. If they are coming from and ED then the sending MD should have dictated some form of an HPI somewhere, or at least a physician T sheet. Everything else is a luxury and we will not wait around for it or demand it if they don't have it ready, but stand up for yourself and your patient. If something changes enroute you are going to be expected to articulate the course of stay to someone who may not be familiar with the patient, and that is not always easy if you get a crappy report and no paperwork...
 
When I was on fire I also liked the MRX. I felt like it was durable enough, capable enough, and light enough.

I really liked the propaq MDs. I never really understood why the zoll products aren't more popular.

I don't love the lifepaks. They are function and do the job, but there are quirks I just don't like.

Most patients don't need a Masimo probe, and they are pretty expensive. I'd rather have a rad-57 with a reusable probe and a standard nellcor setup.

The coiled cord is annoying, granted this is a purchasing decision but they seem to be on a lot of the lifepaks I've seen.

Somehow the adhesive defib pads seem flimsy, but it's hard to describe how.

Non-ems complaints: the external paddles have a oddly strong retention mechanism, it feels like I'm going to break the thing every time I use them, I guess it is to feel durable? The internal paddles are a nightmare to set up; there are separate paddles and handles, and then you still need to have another adapter cord to even make the thing work.

The charging cord/box is excessively large and cumbersome, added onto what already seems like a excessively large device.

I say this as a former firefighter and I don't mean it in a disparaging way. The lifepaks feel like a product that was built so the the stereotypical meathead firefighter doesn't break it; and so that it can survive the abuse of a cabinet on the engine with a bunch of wheel chocks, an extra gas can, and whatever else the reckless crew stuffed in there. It seems far bigger than it needs to be, almost like it can be dangled in front of a bunch of firefighters like a big ring of keys in front of a baby. Look, it's fancy and big, and now in color! Also you know it's quality because it's heavy, like a real halligan!

When the product rep came around to convince us how great it was he threw it 30 feet down the hall to show how tuff it is. One: not a selling point for any hospital or specialty transport team, know your market. Two: anyone who treats a piece of equipment with that kind of abuse doesn't belong in the medical profession (or on the fire service for that matter). I don't care if your are a volunteer EMR on a rural fire service or a critical care HEMS provider, or if the tool is a cardiac monitor or a 10 foot roof ladder.
 
CANMAN said:
Demand that you get the information that you need printed out before you leave. We have encountered the same on some of our flights within the system. Sending the records electronically or "they're in the system" are all fine and well, but we as clinicians still need a copy of important documents not only for our knowledge and charting purposes, but also in case you needed to divert to another facility etc.

Also under EMTALA law, which guides IFT a copy of the records must be transported with the patient. All I generally care about if we are time sensitive on a flight is the PCS form, a facesheet/demographics, and the most recent consult note or transfer/discharge summary. If they are coming from and ED then the sending MD should have dictated some form of an HPI somewhere, or at least a physician T sheet. Everything else is a luxury and we will not wait around for it or demand it if they don't have it ready, but stand up for yourself and your patient. If something changes enroute you are going to be expected to articulate the course of stay to someone who may not be familiar with the patient, and that is not always easy if you get a crappy report and no paperwork...
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A couple points of clarification:

EMTALA does not apply to stable transfer patients. There is not an EMTALA burden for patients being taken to home, a LTAC, SNF, et cetera. This makes up the bulk of BLS transfers.

While there is a requirement to send records, EMTALA does not dictate that these must be printed.

There is a requirement that the transporting party have an adequate knowledge of how to care for the patient en route to the destination hospital (whether it's parents or a caretaker going POV, BLS, ALS, CCT, HEMS, specialty transport, or whatever else). Under the guidance of HIPAA we should only be giving crews the information needed to perform patient care. Between EMTALA and HIPAA there is certainly no mandate to provide the EMS crew the entire medical chart.

There is no EMTALA paperwork obligation to a hospital other than between the sending and receiving facility.

If a patient is being transferred under EMTALA and deteriorates, it is unlikely that stopping somewhere in between is likely to help the patient. The patient should be transferred to the nearest appropriate specialty center, so for example stopping at another non-cath lab facility in the setting of MI is unlikely to benefit the patient. I'm certainly not advocating to blindly continuing to transfer a deteriorating patient, and certainly there is a lot that goes into this decision.

Hospitals should not be transporting things like psychs or insurance repatriations if they are not medically stable to do so. Transfer of the unstable insurance repatriation (when that service can be offered at the sending facility) is not a valid transfer under EMTALA. We often get push back on this specific issue from two specific insurers (who want us to send our patients to their designated hospitals), we win that fight every time.
 
Peak said:
When I was on fire I also liked the MRX. I felt like it was durable enough, capable enough, and light enough.

I really liked the propaq MDs. I never really understood why the zoll products aren't more popular.

I don't love the lifepaks. They are function and do the job, but there are quirks I just don't like.

Most patients don't need a Masimo probe, and they are pretty expensive. I'd rather have a rad-57 with a reusable probe and a standard nellcor setup.

The coiled cord is annoying, granted this is a purchasing decision but they seem to be on a lot of the lifepaks I've seen.

Somehow the adhesive defib pads seem flimsy, but it's hard to describe how.

Non-ems complaints: the external paddles have a oddly strong retention mechanism, it feels like I'm going to break the thing every time I use them, I guess it is to feel durable? The internal paddles are a nightmare to set up; there are separate paddles and handles, and then you still need to have another adapter cord to even make the thing work.

The charging cord/box is excessively large and cumbersome, added onto what already seems like a excessively large device.

I say this as a former firefighter and I don't mean it in a disparaging way. The lifepaks feel like a product that was built so the the stereotypical meathead firefighter doesn't break it; and so that it can survive the abuse of a cabinet on the engine with a bunch of wheel chocks, an extra gas can, and whatever else the reckless crew stuffed in there. It seems far bigger than it needs to be, almost like it can be dangled in front of a bunch of firefighters like a big ring of keys in front of a baby. Look, it's fancy and big, and now in color! Also you know it's quality because it's heavy, like a real halligan!

When the product rep came around to convince us how great it was he threw it 30 feet down the hall to show how tuff it is. One: not a selling point for any hospital or specialty transport team, know your market. Two: anyone who treats a piece of equipment with that kind of abuse doesn't belong in the medical profession (or on the fire service for that matter). I don't care if your are a volunteer EMR on a rural fire service or a critical care HEMS provider, or if the tool is a cardiac monitor or a 10 foot roof ladder.
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For us it’s the other way around, Fire is all on the Zoll X series while the ambulances are on the LP15. The zoll has pictures on the buttons instead of words so I think that is geared more towards the firefighters haha
 
DesertMedic66 said:
For us it’s the other way around, Fire is all on the Zoll X series while the ambulances are on the LP15. The zoll has pictures on the buttons instead of words so I think that is geared more towards the firefighters haha
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I would retort this but it’s 100% true... it’d be better if it were color coded in crayon too.
 
@Peak it depends on the Zoll product for me. Their PCR software is absolute ****, I'm so much happier with image trend. I'm kinda meh on the autopulse as well, I wish we had the Lucas with as much headache as the autopulse has given me. But the x series is where I give them props.
 
StCEMT said:
@Peak it depends on the Zoll product for me. Their PCR software is absolute ****, I'm so much happier with image trend. I'm kinda meh on the autopulse as well, I wish we had the Lucas with as much headache as the autopulse has given me. But the x series is where I give them props.
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In my head I meant that specific to their monitors. I've never used their charting software. I don't like the autopulse, although I've only seen it a couple of times; the Lucas seems to have most of the market here.
 
Peak said:
EMTALA does not apply to stable transfer patients. There is not an EMTALA burden for patients being taken to home, a LTAC, SNF, et cetera. This makes up the bulk of BLS transfers.
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I don't remember saying it did in my post.

Peak said:
While there is a requirement to send records, EMTALA does not dictate that these must be printed.
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It may not dictate, but certainly isn't an unreasonable request from a transport crew hauling a patient out of a facility to have a few pages of patient information. Some of this may be required for billing practices as well. Example: D.C. Medicaid requires a copy of a transfer or D/C summary to be attached for the maximum allowable allowance for the transport. Hard to do without any paperwork.

Peak said:
There is a requirement that the transporting party have an adequate knowledge of how to care for the patient en route to the destination hospital (whether it's parents or a caretaker going POV, BLS, ALS, CCT, HEMS, specialty transport, or whatever else). Under the guidance of HIPAA we should only be giving crews the information needed to perform patient care. Between EMTALA and HIPAA there is certainly no mandate to provide the EMS crew the entire medical chart.
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Again, I don't see where I said give the crew the entire chart. With that being said give the damn what they need to do their job and be in compliance with whatever their company practices are. HIPAA uses standards of reasonableness to address privacy & PHI, and PHI may only be shared for “treatment, payment or operational needs” EMS of agencies. So i don't know what information you would like to limit in this type of setting, but around my way general practice is to give the transport program what they need if it's a reasonable request and get the patient moving.

Also, having some paperwork helps to have "adequate knowledge" of how to care for the patient en route to the destination hospital. If I had a dollar for ever sub-par report I have gotten from a sending RN or MD, or heard the phrase "I just got this patient" or "we just came on" I would be rich and no longer flying. That being said toss me a chart with a solid HPI and I will not give you grief in front of the patient for not knowing information you should know, and we will comb through the info and figure it out. Tough to do without paperwork.

In an ideal world we would get copies of the important stuff AND a bang up good report.... I can personally deal with one or the other but not a lack of both, thus my point of get what you need to feel like you have a good grasp of what is going on.

Peak said:
If a patient is being transferred under EMTALA and deteriorates, it is unlikely that stopping somewhere in between is likely to help the patient. The patient should be transferred to the nearest appropriate specialty center, so for example stopping at another non-cath lab facility in the setting of MI is unlikely to benefit the patient. I'm certainly not advocating to blindly continuing to transfer a deteriorating patient, and certainly there is a lot that goes into this decision.
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Again, you're preaching to the choir here I'm sure for the majority of people on the forum that do IFT, and it was never said that stopping somewhere is likely going to help that patient. That being said I'm sure they're are plenty of people on the forum that do extended distance IFT's, and operate as a solo provider in the back. Although not ideal, and not regular practice, there are certainly plenty of scenarios that could create the need to diver to a facility that was not the intended destination (regardless of capabilities they may or may not have and based on the level of care of the transport service and/or provider). That being said should said situation arise, it's nice to have some paperwork to share upon arrival to an un-expecting facility.

The bottom line for my post to the OP or any provider for that matter was to get the information they feel like they needed to feel comfortable and complete the transport, and go along your way. Sending provider's for IFT's want the patient's gone, in my experience in a timely fashion. Fighting over paperwork is just dumb, not needed, and causes delays for the patient.
 
CANMAN said:
I don't remember saying it did in my post.



It may not dictate, but certainly isn't an unreasonable request from a transport crew hauling a patient out of a facility to have a few pages of patient information. Some of this may be required for billing practices as well. Example: D.C. Medicaid requires a copy of a transfer or D/C summary to be attached for the maximum allowable allowance for the transport. Hard to do without any paperwork.



Again, I don't see where I said give the crew the entire chart. With that being said give the damn what they need to do their job and be in compliance with whatever their company practices are. HIPAA uses standards of reasonableness to address privacy & PHI, and PHI may only be shared for “treatment, payment or operational needs” EMS of agencies. So i don't know what information you would like to limit in this type of setting, but around my way general practice is to give the transport program what they need if it's a reasonable request and get the patient moving.

Also, having some paperwork helps to have "adequate knowledge" of how to care for the patient en route to the destination hospital. If I had a dollar for ever sub-par report I have gotten from a sending RN or MD, or heard the phrase "I just got this patient" or "we just came on" I would be rich and no longer flying. That being said toss me a chart with a solid HPI and I will not give you grief in front of the patient for not knowing information you should know, and we will comb through the info and figure it out. Tough to do without paperwork.

In an ideal world we would get copies of the important stuff AND a bang up good report.... I can personally deal with one or the other but not a lack of both, thus my point of get what you need to feel like you have a good grasp of what is going on.



Again, you're preaching to the choir here I'm sure for the majority of people on the forum that do IFT, and it was never said that stopping somewhere is likely going to help that patient. That being said I'm sure they're are plenty of people on the forum that do extended distance IFT's, and operate as a solo provider in the back. Although not ideal, and not regular practice, there are certainly plenty of scenarios that could create the need to diver to a facility that was not the intended destination (regardless of capabilities they may or may not have and based on the level of care of the transport service and/or provider). That being said should said situation arise, it's nice to have some paperwork to share upon arrival to an un-expecting facility.

The bottom line for my post to the OP or any provider for that matter was to get the information they feel like they needed to feel comfortable and complete the transport, and go along your way. Sending provider's for IFT's want the patient's gone, in my experience in a timely fashion. Fighting over paperwork is just dumb, not needed, and causes delays for the patient.
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The reason that I specifically addressed what does not need to be provided is because bls IFTs were stated to be a good learning opportunity for a new EMTs.

Typically the information needed is minimal, and certainly not an amount that is going to provide a whole lot of learning after a while.

I'd also take statements around demanding information carefully. Most transport crews (BLS, ALS, HEMS, or otherwise) are reliant on their contracts with hospitals, and worry about their image quite a bit. Arguing with ED or other staff is probably going to get you in trouble with your own company. If you really don't feel like you have enough information and the hospital staff are unable or unwilling to provide it then you should be contacting the supervisor on your service.

I'm sorry that you have gotten poor reports from sending facilities. I get the same thing on the phone from them. My fire service didn't do IFTs, and I've always worked in specialty centers. Chances are when you are getting a poor report from a sending facility they don't have a clue what they are doing though, so it's often best to just take what you can get and move the patient to better care as soon as you can.
 
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