the 100% directionless thread

Tigger

Dodges Pucks
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Anyone ever heard that Ativan doesn’t need to be locked up while stored on an ambulance? Citations for or against if possible...
 

Peak

ED/Prehospital Registered Nurse
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Anyone ever heard that Ativan doesn’t need to be locked up while stored on an ambulance? Citations for or against if possible...
Category III through V substances (Ativan being schedule IV) do have lower tracking requirements through the DEA than Schedule I or II.

All schedule I through V drugs do require a double lock of some form. Typically in EMS we consider a fixed safe and locking the doors or a locked box inside of a fixed safe to be sufficient.

Schedule II through V drugs can technically be signed out by someone who can legally posses the drugs and would not need to be double locked as they are not being ‘stored.’ I would think of this as when someone signs out drugs not typically carried by our crews (pentobarbital or methadone for example) for a specific transport. That individual is responsible for the drug though and should still be storing it securely. At some point the drug would need to be dispensed for administration, returned, or wasted.

Leaving Ativan (or any other controlled or high risk drug) unlocked in the bus is bad practice and does not fall in-line with DEA requirements.
 

Akulahawk

EMT-P/ED RN
Community Leader
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Anyone ever heard that Ativan doesn’t need to be locked up while stored on an ambulance? Citations for or against if possible...
What I've read over the past few minutes or so is that controlled substances do need to be secured. Just how secure seems to be more a function of the regulations an ambulance service works under than the DEA's requirements. Common requirements are a double lock (probably migrated to EMS via hospital/JCAHO regs) and witnessed counts.

As to certain Schedule V drugs, I could easily go to any store that has a pharmacy (and possibly ones that don't) and buy OTC Lomotil. That's a Schedule V drug, is available OTC and not secured physically while the store is open. I have never seen a Sched. IV drug that hasn't been required to be stored in a locked container of some sort when not physically being handled by someone authorized to administer it or during a count from one shift to another. One company I worked for issued me controlled substances in a locked container and I was required to store it in another locked container when not in my immediate possession while on shift. That was the exception, other companies required either a double lock when stored on ambulance or when stored in quarters and the meds were counted either at time of shift change if stored on an ambulance by ongoing and offgoing crew, or upon issuance, restock or return of the med to secured storage in quarters by two authorized personnel. Technically speaking, if I signed meds in and out daily from my supervisor (those places where this was done), I could have physical possession of the CS without locking them up on the ambulance itself.
 

GMCmedic

Forum Deputy Chief
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Ugh. Nationwide schedule change and i'm the low man on the totem pole at our base, this should be fun.

In other news, our respirators arrived, works good with comms but sounds like youre in a well. Still havent even seen a confirmed Covid patient.
 

DesertMedic66

Forum Troll
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Ugh. Nationwide schedule change and i'm the low man on the totem pole at our base, this should be fun.

In other news, our respirators arrived, works good with comms but sounds like youre in a well. Still havent even seen a confirmed Covid patient.
Come on down to SoCal and party it up with the COVID patients. Every single transport is considered a positive patient because the vast majority of our patients are testing positive.
 

Jim37F

Forum Deputy Chief
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Our EMS guys got issued half face respirators with filters that they can wear in place of N95s. Interesting idea, but the last time I was on a call with a crew wearing them, they practically had to be yelling to be heard, they were muffled so bad...

One of the stations in my Battalion is currently shorthanded, and since my crew is full staffed (we're at 5 guys, the other engine only 3 currently) so I'm being sent on "Long Term Relief" (essentially TDY lol).

Downside is this Engine is a 45min drive (vs my current 5 min drive).

The upside is this is the Sunset Beach station on the North Shore. Our backyard is literally the beach:
20200606_190700.jpg
 

Rano Pano

Forum Lieutenant
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Our EMS guys got issued half face respirators with filters that they can wear in place of N95s. Interesting idea, but the last time I was on a call with a crew wearing them, they practically had to be yelling to be heard, they were muffled so bad...

One of the stations in my Battalion is currently shorthanded, and since my crew is full staffed (we're at 5 guys, the other engine only 3 currently) so I'm being sent on "Long Term Relief" (essentially TDY lol).

Downside is this Engine is a 45min drive (vs my current 5 min drive).

The upside is this is the Sunset Beach station on the North Shore. Our backyard is literally the beach:
View attachment 5017
Maybe I’d be fine functioning at the EMR level if that’s my work place.
 

RenegadeRiker

Forum Lieutenant
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Our EMS guys got issued half face respirators with filters that they can wear in place of N95s. Interesting idea, but the last time I was on a call with a crew wearing them, they practically had to be yelling to be heard, they were muffled so bad...

One of the stations in my Battalion is currently shorthanded, and since my crew is full staffed (we're at 5 guys, the other engine only 3 currently) so I'm being sent on "Long Term Relief" (essentially TDY lol).

Downside is this Engine is a 45min drive (vs my current 5 min drive).

The upside is this is the Sunset Beach station on the North Shore. Our backyard is literally the beach:
View attachment 5017
My grandpa is on Neepaapa place. I think that’s the service area for you here?
 

DragonClaw

Emergency Medical Texan
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So remember that lady in the Stokes that went on a spinning ride? She's suing as was imagined.

Facebook warriors cry that since she didn't die and she needed helping, she is just being a (insert not nice words here).

Some say a tag line was our was not used

Either way, I feel like even if you ask for help that doesn't dismiss the accountability and responsibility of the responders.

Does a victim of RI EMTCs gut tubing "deserve" it because they maybe indicated the need for intubation?

No

They messed up and now it's time for the chickens to come home to roost. That's my thoughts.

Anyone have anything to add or disagree?
 

DragonClaw

Emergency Medical Texan
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Oh and I was in the ED the other day and came across this scene.

80ish MVC pt. She's in full spinal precautions, abs is pretty small and skinny. It looks painful to be on that backboard.

FFs bring her in and she's crying in pain and pleading for help. They are getting her triaged but like completely ignore her. She's asking them questions she stuff and they ignore her

While they had to wait and after she was triaged they were ignoring her. It was semi busy so they were in triage for 30-45 minutes. The actual triaging took like 4.

She's bleeding from the head and ear and probably had other issues.

Her phone was ringing and she said it was her husband calling, looking for her. She's begging them to answer it, over and over. She can't see them well cause she's staring at the ceiling in a c collar and they're basically rolling their eyes at her, annoyed.

One of them says he will answer it, but doesn't and waits for it to stop ringing.

I mean again, tell me if this is DragonClaw being DragonClaw, but I feel like this is unacceptable.

Only one of them even answered the triage nurse's questions and the other just was standing by her.

Why didn't they even talk to her? Would you answer the phone? I'm sure that will be someone on the other end that is very worried and might ask a lot of questions but it seems very unprofessional to just have her like that, asking for help and being scared and they didn't even talk to her the whole time. It was like she was an inconvenience to their day.

They didn't tell her what was going on or where she was or assure her she would be taken care of. It was kind of sickening, their annoyed expressions and apathy.

Would they want their daughter, wife, girlfriend, mother to be treated like that?

Is it possible they had a good reason to not even talk to her? I could see an argument for not picking up the phone and getting into that mess (though I would have).

I had to hold back to not be like "Hey don't you care about your pt?"

I am not trying to cause any trouble but it was hard to watch. Our pt was chill and nice and was going to a higher level of care and it made him and others uncomfortable.

It just seemed wrong.

Am I making mountains out of molehills?
 

StCEMT

Forum Deputy Chief
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I dont typically go answering phones short of it being a minor, but there's something to be said about attempting to help reassure people.
 

VFlutter

Flight Nurse
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It was kind of sickening, their annoyed expressions and apathy.
I had to hold back to not be like "Hey don't you care about your pt?"

Most providers can do a better job of communicating with patients. Some in EMS have poor social skills in general let alone when trying to interact with a patient in distress. It is not appropriate to ignore a patient and a little reassurance can go a long way. However, it sounds like you were on the outside looking in and I would caution against passing judgment. It seems to be a theme that if a provider does not act in the way which you would then they de facto do not care. I am curious if your indignation or views on apathy will change with a few years of experience.

Regardless of how justified you may feel, I probably wouldn't walk up to a provider and say "Hey don't you care about your pt?"
 

DragonClaw

Emergency Medical Texan
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Most providers can do a better job of communicating with patients. Some in EMS have poor social skills in general let alone when trying to interact with a patient in distress. It is not appropriate to ignore a patient and a little reassurance can go a long way.
Yeah. Me myself, sometimes I have no idea what to say. And I'm just sitting there awkwardly. But not if they're in pain calling out. I try and update them and inform them. Let them know what I'm doing in my power to help them. That I'm here to help and whoever I'm handing over care to will take great care of them.

I saw a flyer at a nurse's station talking about a study on how two things that really builds pt confidence in their care team is when everyone is introduced to them, including trainees, and that reassuring them you'll take great care of them or wherever you go will take great care of them.

However, it sounds like you were on the outside looking in and I would caution against passing judgment. It seems to be a theme that if a provider does not act in the way which you would then they de facto do not care. I am curious if your indignation or views on apathy will change with a few years of experience.
I know I'm on the outside looking in. Which is why I've given pause and thought to myself maybe there's something I'm missing. Maybe I'm too quick to judge.

It is just very hard, given what little time I saw, to see anything else but indifference and apathy.

Maybe because I've encountered it so much growing up. Parents who didn't really care if you were bruised and bleeding. Parents who never cared why your grades slipped or why you were so stressed. Parents who would themselves injure, insult, and blame you even if you'd done nothing deservedly so.

I'm surely biased and I recognize that.

My views on things have already changed a bit. As experience lends me a new view or idea, I adapt. I've changed a lot so far. For the better. There's things I look back on and cringe at. 😅

We'll see.

Regardless of how justified you may feel, I probably wouldn't walk up to a provider and say "Hey don't you care about your pt?"
Yeah, which is why even though I was pretty dang sure they were just not caring, I didn't think it was my place to say. I don't think they were causing her to die or anything. It's not like they were beating her up or anything.

It was just hard to watch. Am I too emotionally invested in a random stranger that isn't my pt? Maybe. But it was right in my face and hard to ignore.
 

GMCmedic

Forum Deputy Chief
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So remember that lady in the Stokes that went on a spinning ride? She's suing as was imagined.

Facebook warriors cry that since she didn't die and she needed helping, she is just being a (insert not nice words here).

Some say a tag line was our was not used

Either way, I feel like even if you ask for help that doesn't dismiss the accountability and responsibility of the responders.

Does a victim of RI EMTCs gut tubing "deserve" it because they maybe indicated the need for intubation?

No

They messed up and now it's time for the chickens to come home to roost. That's my thoughts.

Anyone have anything to add or disagree?
To the extent of my knowledge of the situation, the tag line broke. Not my place to determine if the lawsuit is frivilous or not, this is America and suing someone is about the most American thing you can do.

I will say though, the version of the video set you "you spin me round", is the best thing to happen to the internet since Al Gore.
 

CALEMT

The Other Guy/ Paramaybe?
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To the extent of my knowledge of the situation, the tag line broke. Not my place to determine if the lawsuit is frivilous or not, this is America and suing someone is about the most American thing you can do.
IIRC thats what happened. Unfortunately they'll probably settle for a payout vs litigation even though there weren't at fault.
 

DragonClaw

Emergency Medical Texan
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IIRC thats what happened. Unfortunately they'll probably settle for a payout vs litigation even though there weren't at fault.
Are there logs to show they regularly check equipment for safety and fraying? Or is there an expiration date for a tag line?

If they used one and did it right, I say they're "not guilty"
 

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