WAS967

Dr. McGurty brought up an interesting case at the call audit at HVHC tonight. A man fell through the ice over near Roa Hook Road near the oil tanks. Guy was in full arrest on arrival (this was about 10 years ago) and core temp was in the low 70s (yikes). They had the Tumper on the guy and admitted him (yes, i said admitted) to the ICU with the Thumper going all night long. Basically it took all night for his temp to return to normal levels and was in the end declared dead. I thought this was interesting in the fact that they had the guy being "worked" all night long until his temp returned to normal.

This one I expect to garner some interesting comments. I'll hold mine for the moment and see what everyone else has to say first.

Do they dispatch themselves, or are they done by 60 control?

Yes, I am. And thanks for the site.

Yeah. I think a few things were missed in this case. I would have to wonder if any attempt was made at listening for heart sounds. And there was no mention of a monitor being applied and getting a three lead 6 second strip of Asystole. At least then they'd have something to back up thier documentation in cases like this.

Thats debatable. Medications have theraputic levels that need to be maintained. You can have cases where the patient has something underlying that causes thier levels to be thrown off dropping them into a subtheraputic range, thus making thier normal medication regimen ineffective/inadequate. You also can run into problems with resistance, but I'm not sure how applicable that is to psych meds. So if you get called to a person with a history of psych problems, they say they don't have any suicidal thoughts, but don't feel right in the head. Do you tell them "sorry, wo don't do transports?" Sure, we all hate BS calls. We've all had em. We've all been woken up for me. Stubbed toe, stuffy nose x5 days, patient fell at NH last week and started vomiting today, etc. But when it comes down to it, no matter how BS we think it is, it's the patient that matters. THEY are the one that feels the need to call for help, THEY are the ones that expect us to respond yesterday, treat them like kings, and give a crap about thier ailments. IT sucks but it's the nature of the beast. Now, if the patient states they "just want to go to the hospital" but don't give specifics, but state thier MD/Shrink is in Tarrytown instead of Peekskill, do you bring em to Peekskill? Well, thats dependant on local protocol and what not. And while I'm sure people will disagree with me, I think the patient should go where they want to go. If that means you call in a transport company because you "don't do transports" then so be it. Of course we take into consideration the stability of the patient. So back to the topic at hand (I'll get off my soap box). What does everyone consider to be "proper restraining measures". Technically, we are supposed to utilize only "humaine restraints". But what is humaine and what is not? (I know I was never taught the difference). How many people/corps utilize special made restrains (like velcro 4 points, etc). How many rely on the cravats and sheets method? Was anyone taught how to properly TIE a restraint? (Again, I know I wasn't...I had to learn it from experience). These are all things that I think need to be addressed in EMT classes, but are not. And lord knows I don't know many companies that have specific procedures on the books for dealing with EDP/Psychs, especially combative ones.

Actually, "EDP" can be a medical condition. Schitzophrenia and Bipolar disorder, just to name a couple are disorders in the brain which cause behavioral disorders. Also, the symptoms of an "EDP" can also be caused by a diabetic emergency, drug overdose, stroke, hypoxia, or other life-threatening medical condition. Although some psych patients can be transported by PD to the hospital for evaluation, and in some cases, should be (Depression/Suicidal Idealogy), most of the times an ambulance is warranted and the safe thing to do. There have been several cases where the patient had been handled as an "EDP" by PD, and later died due to the undetected medical condition. IMO, there needs to be more emphasis in the EMT and EMT-P curriculum in how to handle, communicate with, and restrain EDPs. This is a fairly common call, and many people just dont know how to deal with it. However, I do also think that succesfully dealing with EDP's comes with experience and tact. Though sometimes, no matter what you do, chemical restraint is the only way to fly. What he said. In a distant way you are kind of right. EDP is just a generalization. Anyone can be EDP. I'm an EDP when I get woken up at 3am for a BS call. But as Seth said, you have to consider, is someone is acting inapropriately, you HAVE TO rule out underlying causes. Speaking of underlying causes. FOLKS PLEASE. If you get called for an EDP, DO NOT take them directly to the psych ER at WMC. Any patient who is going to ANY non-medical psych facility (WMC-Psych, Four Winds, Stony Lodge, etc) HAS TO BE medically cleared. IT drives me nuts when I hear ambulances call 10-85 to the psych ER. Don't do it. You're just asking for trouble if you do. Ambulances must go to a MEDICAL ER first. Let them evaluate the patient, then let THEM make the decision to send them to crisis/rehab/psych/etc.

Well said.

Alright. I'll take these one at a time. How can you be so sure? Maybe so. But be careful how you use that confidence. It's when you let your guard down that you get nailed. EDPs are sneaky. If they don't want something, they will do whatever they can to get out of there. My personal favorite is the "I'm gonna quietly take off my seatbelt and hope the EMT doesn't notice" move. I had that recently. Lady got the top two straps off and was about to bolt. Partner was a newbie and let himself get distracted by someone asking for direction. I told the lost people to ask elsewhere and got his mind back in the game (he was the tech on the call after all). I hope that confidence comes from a LOT of experience, in which case you know better than to be confident when it comes to EDPs. :wink:

PRVAC's new ambulance is already at thier quarters. I drove by on the way back from a call Thursday and it was sitting in the driveway. It has the yellow stripe but no lettering yet. The other ambulance was OOS at the mechanics shop on 172. It will be good for them to finally have a second rig. Nowadays it makes no sense to have no ambulance in town because the other one is down for mechanical reasons.

Since I'm usually on a fire scene in an EMS capacity, egress is a big thought in my mind. I always have to think of how many ways can I get out of the area in case one or more gets blocked by apparatus, operation, etc. If someone gets hurt, you don't have time to move cars or figure out what way is blocked and which needs to be used for egress to the hospital. I try not to stage to close because I know that at any minute the fire gound could expand and the next thing I know my vehicle could get blocked in by a 5" line running across the road. Sometimes with bigger fires you might have to call in more units because your first due ambulance will be surrounded by fire apparatus and being used for treatment/warmth and unable to get out. This is a good time for a good staging zone where you can place an ambulance that is able to jump in, grab patient and get out quick.

It will be interesting to see HOW they expand that building. I guess if they widen the building out the back, they could pull it off, otherwise if they make a new bay facing the street, they will have a heck of a time backing into there.

Hey yeah....we want details!

Anyone know if there is any significance in the name?

Aw man. You poor sucker. Here's to another free man lost! :twisted: (Seriosuly tho, congrats! Just wait until the future wife starts pestering you to have kids).

Probably the usual change over pains that people like to blow out of proportion in the name of bitching and moaning.

Towering Inferno. Now THERE's a great movie.

No Mylanta or M.O.M.? Man, I can hear those ulcers screaming now. =D> :twisted:

ah....thanks...sorry about the missed read. I try to log on as frequently as possible but due to the volume of posts some get missed. Problem is that PHPBB likes to reset your last read marker if you are inactive for an extended period of time. I've gotta see if we can find a fix for that. I can only read so much in one sitting, and this board is VERY active.

Impressive is the indicators that show an average response time of less than 8 minutes in all three segments.

What kind of ToxMeds do you guys carry? I'd imagine the usual Mark-1 kits and maybe extra valium. But do you carry anything like Methylene Blue, Amyl Nitrate, etc?

Backdraft was such crap., IMHO. Best movie ever made? No way. Was it a good buff film? Sure. Was it true to life, not really. I haven't seen Ladder 49 but from what I have heard, John Travolta is a VF in real life and mirrored my sentiment that Backdraft was a little too fake. That was supposedly his motivation behind making Ladder 49. (Is that out on DVD yet, I should pick it up.

What do people put a greater priority on, form or function? Yeah, I know you want it to look good in a parade and all, but I'd much rather have a kick butt, reliable, not-so pretty rig, than one that "looks good".

So when you call them on the air you won't call them "40 Control"? What will they be called? Putnam-911 kind of akin to Dutchess?

It actually sounds a lot better than the Hazmat Tech class. Usually HazMat Tech classes are 24 hours unless you do the EPA one (which is rare around here) which is around 40 hours. I think with all the medical additions you mentioned, I'd much rather take the HazTac class.