Things I Learned on the Ambulance . . . .

[bandaidsNhoses]

Never EVER cut a down coat in the back of the bus....otherwise you'll be breathing feathers for the next 2 months.... or MAKE your partner who cut it, clean it up...

The heavier you weigh, the higher the floor you live on.

It's ALWAYS "shift change" at the nursing home when they find the unresponsive patient....

"Don't throw out that BVM!" 'Why?' ask the medics "Cause we reuse it." reply the nursing home staff...

"Start your day with a D O A....doo dahh...doo dahh..." (or substitute M V A)

Drinking bleech won't kill you (quickly), but it'll give you a horrible case of GI distress

"So I drank a glass a water with 4 tablespoons of that stuff" (pointing to pure powdered charcoal). 'WHY?' "Cause I had chest pains."

"So i did some coke and I started getting palpitations, so then I took 40mg of valium (PO)" -'good job sez the ER doc, now i don't have to treat you'

more when i remember...

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[beanbean]

Thank you for the reminder on the down coats - I had forgotten about that one!

If you are a rich lady driving your BMW too fast while too drunk and crash, be sure to give all EMTs your bitchiest 'do you know who I am attitude'. When you puke all over your fur coat that probably cost more than my car, I will try to refrain from smiling.
Don't worry about the dry cleaning bill - we will just cut the coat right off with the trauma shears.

 

[bandaidsNhoses]

oh yeah! :

Don't play no: "My Neck, My Back, My Wallet" MVA injury with me... ur just gonna get the 2" tape right over your eyebrows..

 

[deleted6669]

if you are in a minor mva in which your driver door is pinned shut and you have mild neck pain do not piss off the medics and degrade them when they stopped playing a perfectly good game of ping pong at 3 am to come help you. they will probably have the fire dept tear your brand new jaguar apart to c-spine you.

 

[docB]

This is great! I didn't even know there was an EMS forum. I suppose my brain is too addled from breathing smoke back in the day.

Never allow a captain to start coding your patient because he was taking a radial pulse while you were taking a BP on the same arm. In fact if you have a captain in the back of your rig at all you've made an error somewhere along the way. One good way to get rid of them is to suggest that someone has cookies on the engine.

 

[aabobrov]

Here in Commerce City, a non-emergent response to a dog bite is actually a result of a police chase at 3am at 100+ mph, involving a rollover and taking out of a telephone pole. The dogbite part comes in when the carthief tries to run from PD after the above events and they have to send the K-9 after him to rip out a chunk of his arm.

btw, love this thread and this forum, good job guys keep it going.

 

[flighterdoc]

This is great! I didn't even know there was an EMS forum. I suppose my brain is too addled from breathing smoke back in the day.

Never allow a captain to start coding your patient because he was taking a radial pulse while you were taking a BP on the same arm. In fact if you have a captain in the back of your rig at all you've made an error somewhere along the way. One good way to get rid of them is to suggest that someone has cookies on the engine.

I usually save it for chiefs, but CHAOS works for captains too (Chief has arrived on scene). Have him go talk on the radio to dispatch, or something.

 

[raDiOnut]

dispatch for "patient not feeling well" = cpr soon to be in progress

I had a patient tell me at 0200 the other day that if I didn't transport her husband to Hospital X, instead of the usual Hospital Y, she'd take him by POV. Now why didn't she tell me that 20min before so I could've stayed in bed????

raDiOnut

 

[deleted6669]

"I had a patient tell me at 0200 the other day that if I didn't transport her husband to Hospital X, instead of the usual Hospital Y, she'd take him by POV. Now why didn't she tell me that 20min before so I could've stayed in bed????"

SOUNDS LIKE AN AMA, MY FAVORITE 3 AM COMPLAINT.
AMA= ADIOS MUTHA F***HA

 

[docB]

Nurses, just like any other HCP or anyone period, come in good, bad and dangerous flavors. I responded to a floor code not too long ago and I started to intubate the patient when the nurse told me to stop. She said we had to move the patient to ICU before we intubated. I laughed politely because I thought she was kidding. When I kept going she yelled at me to stop. I said that I was not going to wait and that I was running the code and she said that if I did not "follow procedure" she was going to have all of her nurses stop assisting with the code. She also said that I, as a doc, was not allow to push drugs so I couldn't continue the code by my self. At this point I have intubated the patient and I asked the nurse, "Are you ------- crazy?" Fortunately the other nurses did what I said, not what she said and we resuscitated the patient and moved her to ICU (intubated). I walk out of the unit and meet up with the nurse and the nursing sup. The nurse is fuming and tells the whole story to the sup. The sup just stares at her for a second and looks at me and says, "Why don't you head back to the ER." As I wald away the sup says to the nurse, "Are you ------- crazy?"

 

[HNS]

This is the best thread I have read for a long time! I have been doing this for a few days and have to say, it is all true....

Another bad thing to do....

DISP nursing home for CP. Arrive to find 4 people in the room, all stating they have chest pain. Only one had it since this morning. The staff, as suaual have no idea about her, "The RN is getting everything together, she is normally really healthy", thanks.

Go though the questions, pt reports no allergies/history/some unk meds, monitor, line, drugs.

Start to leave and the RN come up and said "You know she is allergic to NTG"

As normal, the reaction the pt has is a HA and lower BP.

The appropriate statement to the pt is not "We are going to take you out of here before the nurses can do anyhhting else to try to kill you."

 

[Mavrick]

The sign at McDonlads Drive Thru doesn't actually mean "Drive Thru"! Stopping at the window usually does the trick and there is no need to plough your car into the checkout wall!

If I am going to hang myself by jumping out of the top of the barn, I am going to make sure the rope isn't so long that my feet hit the ground breaking both femurs and putting me in hospital for months!

Its a good idea to make sure you dont run out of fuel when trying to commit suicide by locking yourself in the garage with the vehicle running.

A&E staff dont take too kindly to me filling in a Patient report form for each personality of a schizophrenic!

 

[beanbean]

Bumping this thread up!

Somebody has to have learned something on the ambulance these past couple of weeks.

I haven't learned anything on the rig because I haven't done any calls lately, but I have learned something in the ED on my elective:

If you are 95 yo, fall out of your wheelchair and get a small lac above your eye it is not necessary to prove to us that you are ok by doing wheelies in the ED hallway with your wheelchair. Actually, it will probably contribute to buying you a trip to the CAT scanner.

 

[NontradICUdoc]

To the nursing home staff:
If a wheelchairbound patient has been missing for several hours, start searching the bottom of every stairwekk, they will be there.

To the ER doctor:
Asking a patient who is boarded and collard if his neck and back hurtsprior to your removal of such devices, 2 minutes after we drop them off, gets placed in my report to protect MY ASS, not yours.

To the charge nurse:
We know you are very busy, who the hell do you think brings them in?

To the Lumberjack who just lost his leg:
Cutting down a tree that is 5ft in diameter at 9pm with no light, is not smart. There are clues to this: #1 the chain to your chainsaw breaks, #2 you have to cut in multiple places, #3 you light tiki torches to see what you are doing.

To the ASS who just exposed me to your blood by spitting at me:
Cops will beat the crap out of you for that too, at least in my town. Then when I have to clean your bloody face, I will make sure that it not only burns but is a little rough around the edges too.

To the idiot who refused to pull over for me while approaching the accident scene:
Uh, accident scene with injuries=lots of cops present. But you knew that since the cop walked up to your window and told you in a not so nice way to pull over because he wants to test his new pen and see how many tickets he can write for you.

 

[aabobrov]

If you're sitting in the ambulance at the drive through at Taco Hell at 1am on a Friday night and the dude in the truck in front of you doesn't move for over 15min, get pissed, turn on the siren a few times, and when there's no response walk outside and tap on the window. If you discover him passed out and slouched over with his foot on the brake and his truck in drive, call Fire to unlock the doors (aka smash the windows) and call PD so they can take him to the slammer for drunk driving. If you're still dumb enough to attempt to get some food at the Taco Hell after that (it being your fourth attemp that night), you're plain stupid and should probably just have your EMT drive you to the mental hospital down the street.

 

[Oats]

Funny things I've seen/heard:

1) Monk sets himself on fire. When the medics show up, with fire dept. on scene, monk is still engulfed in flames. Medic asks fire dept. to please put fire out. They respond no-can-do until police get here. Medic finally gets fire extinguisher out of ambulance and puts out monk herself. Pt. pronounced DOA by Medics.

2) Attn NH staff: If pt. has rigor mortis or lividity, please do not attempt CPR. And don't get mad at us when we pronounce the pt. dead.

3) Stepping on a toothpick does not qualify you for any type of medical attn. Especially mine.

4) Attn pregnant pts. You have 9 months to prepare for a ride to the hospital when labor begins. Unless the head is crowning or your water has broken, remember that cabs and buses also go to the hospital.

5) When the area is in the midst of the worst snow/ice storm in 50 years, please try and see if you can hold off on calling 911 for the abdominal pain you've had for 2 weeks.

6) Don't EVER play chicken with an ambulance. You will lose everytime. Also, after you've been shot or stabbed and are circling the drain, it is not the best time to give us a hard time. We didn't put you in the situation and are your only lifeline for the next 10-20 mins. And frankly, we still get paid no matter what your outcome is.

7) To all of you dispatchers who love to screw with the crews you don't like. We sometimes fantasize about you wrecking and it being our call. While we would never hurt you, it could make for a very rough day.

8) First responders: Please avoid bandaging and wrapping the wound before we get there. Control the bleeding and let us deal with the bandaging. If not, we've have to take it off to look at it, then re-bandage it. Aaaggghhh!!

Thanks for letting me vent.

 

[47534]

hey everyone,

i'm new to these forums and i thought i'd just introduce myself...here's my little contribution to this thread.

DON'T beat up your pregnant girlfriend, then go to the ER to get treatment for the hand you hurt while beating her up, and when we roll into the ER with your girlfriend in the back of the rig, DON'T pester the ER staff with questions about why she gets to be treated first.

 

[aabobrov]

...have gone to the P.D. booking or to jail for some dumb arse who has chest pain, is passed out, or can't breathe? Yeah, I have. In 5 years of doing it, I've NEVER had a prisoner with a legitimate medical problem. What do you know, you're getting booked for the crime you committed and all the sudden you get chest pain? You got arrested for shoplifting and now you're dizzy? Do you think going to the hospital will get you out of going to jail? Is the Pope muslim?
Last time I embarked on such adventure to the county jail for a 24 yo dyspneic male (held a knife to his mother's throat), I found a prisoner in a cell coughing and hacking, screaming for his asthma medications. The tipoff to his "legitimate" medical condition was that while I listened to him scream for a minute, he forgot that he was short of breath in all his rage. The rest was all downhill: clear and equal breath sounds, SpO2 98% room air, pink warm and dry, equal insp. and exp. phases, etc etc. To stop this guy from spitting all over the ambulance and screaming (my EMT and I both had a headache) I decided to try some of that experimental asthma medication on this dude and let my EMT attend. It's funny, nebulized Obecalp works wanders on bs'ers. Too bad Obecalp is nebulized normal saline. My physician advisor, on duty at the ER that night, chuckled on that one forawhile before he was finally able to tell me that this is unethical and I should probably hold off on Obecalp until it passes some more trials.
Obecalp, btw = Placebo backwards

 

[beanbean]

I have actually responded to a legit call at the PD for a guest who had 'passed out'. This 18 yo kid had been taken in for suspicion of DUI. When he was walked over to the breathalyzer he passed out. The cops initially this kid was trying to get out of taking the test and they were pretty annoyed. Honestly, the kid's BP was something like 60/40. He was so completely freaked out about getting arrested he had a vasovagal reaction and hit the floor. He was white as a ghost, very diaphoretic and his pulse was thready and rapid. He wasn't even drunk, but being under 21 any alcohol in your system puts you over the legal limit.

 

[GeneGoddess]

Four years in rural Texas taught me:

1. If you are planning to run down your significant other, you might not want to drive your brand new car into your new mobile home: consider driving your old beater car instead - and avoid your house.

2. If you are using a box-cutter to open boxes, be sure to CLOSE it when you put it back into your apron pocket.

3. If you have driven your car into the ditch on your way out of the bar parking lot (on your way to another bar), do NOT ask the medics if they will get you a beer while waiting for the cops.

4. It is always appropriate to carry "special" shears on prom night and homecoming night. These decorated shears are only used to remove formal dresses from drunk high school girls in MVAs.

5. Swearing at the medics will result in overusage of tape in very delicate, hairy areas.

6. Do not complain about the bruise caused by your seatbelt when you are covered in the blood of the dead people in the car who weren't wearing a seatbelt.

7. All cases of priapism should be investigated, as it could be a symptom of spinal injury. But there really is a twenty-something kid out there who makes Dirk Diggler look like a mouse.

8. The correct answer for, "How much have you had tonight?" is ALWAYS "Two beers."

 

[aabobrov]

...before starting medical school...and I'm a bit nostalgic. 5 years in EMS have been good to me, teaching me lessons most 25 years olds don't have to learn. EMS has been my life during this time, and just as it has convinced me of my passion for medicine, it has also convinced me of my need to go on, pursue further education. As great as pre-hospital medicine is, it certainly has issues and limitations; however, I know that I'm a much better person for having been a paramedic, just as I will be a better physician because of my paramedic background.
Thank you to this awesome field, and thank you to all of you dedicated EMS folks out there. All the best to all of you

-alex

 

[Sweet Tea]

I was an EMT for 4 years in NC before med school. It was an interesting county to work in...half of the county was affluent and intellectual (being the home of UNC), the other half was very, very rural. I loved it, and I really missed it in med school. So here's some of what I learned.

If your 98-year old momma fell down and didn't get up 5 days ago, stopped "taking water" 4 days ago, got really cold 3 days ago (no matter how many electric blankets you put on her, or however many space heaters you put in the room. In August.), and now has roaches under said electric blankets, your momma does not need EMS care.

If your 89 year old, 92-lb husband fell in the middle of the night and has an obvious hip fracture, don't give him 3 percoset and then get mad at us when we pronounce him with altered mental status.

"Some dude" has got to be brought to justice. He keeps attacking people who were walking around, minding their own business in alleyways at 3am.

If you get a call to an 18 year old, drunk out of her mind college freshman, you will inevitably be working with someone who is a sympathetic puker.

I was also on the Swiftwater Rescue Team...here's something I learned from there:
Say there's been lots of rainfall in the past 2 months, meaning the rivers are all up, and now a hurricane is coming through. THIS IS NOT THE TIME TO TAKE THE CANOE OUT AND GO FISHING.

 

[PluckyDuk8]

Repost of what I added to EM's thread...It actually belongs here more.
If you are a 450 pound female with shortness of breath and chest pain and a hx. of COPD and asthma it is best to decide not to take an ambulance because it is too expensive for you. The taxi driver you decide to take instead will like appreciate you collapsing while attempting to enter his taxi

This resulted in us arriving and finding her in asystole.

 

[beanbean]

Well, at least she was street-level and not on the 5th floor of a walk-up.

Its sad when people don't realize how sick they really are. We had a 55yo guy code last night in my town - he hadn't been feeling well for a week but never went to get checked out.

 

[medic8m]

Repost of what I added to EM's thread...It actually belongs here more.
If you are a 450 pound female with shortness of breath and chest pain and a hx. of COPD and asthma it is best to decide not to take an ambulance because it is too expensive for you. The taxi driver you decide to take instead will like appreciate you collapsing while attempting to enter his taxi

This resulted in us arriving and finding her in asystole.

I know everyone has a little gallows humor in this field, but damn -- the cab driver wont "appreciate you collapsing" and dying. The poor woman couldn't afford an ambuance and died. It isn't the first time. Sorry, this post just struck me as mean and pointless.

 

[Oats]

Long time no see Sweet Tea! It was great seeing you on THIS forum tonight! Thanks for all the back-up to 'J & A' on the other one. I checked the internet on A's screenname and found it disturbing to say the least.
I work in NC too (EMS). Sounds like the same county too. Hmmmm.... Anyway, good luck to you in med. school and take care!

 

[Sweet Tea]

Oetzi, you have a PM coming your way.

 

[PluckyDuk8]

I know everyone has a little gallows humor in this field, but damn -- the cab driver wont "appreciate you collapsing" and dying. The poor woman couldn't afford an ambuance and died. It isn't the first time. Sorry, this post just struck me as mean and pointless.

I promise I meant no harm and I apologize. This call was in a country not in the u.s. where pretty much all ambulance calls are paid back by your insurance, and everyone is insured (and even so the ambulance ride is very cheap in comparison to america). She really wouldn't be paying a thing. I am sorry for the misunderstanding, I reread my post and truthfully I didn't mean it that way. I just meant to convey the irony in the call and that people should really listen to their bodies.

 

[SMW83]

BUMP up this thread...I know SOMEONE has learned SOMETHING on the Ambulance in the past Week!!!!!

 

[Emergency!]

well - its not in the past week, but I learned that if a psycho gets kicked off the greyhound at the local bus stop, and the cops get called to deal with them, the cops with somehow ALWAYS manage to convince them that they have some kind of medical problem, so they can call the EMS to haul them.

Officer - "Oh gee, I was SURE she said she was having chest pain. That's odd that she says she's not having any now."

 

[Siggy]

Sorry for the bump, but:

Heres one from my ride along (I'm about 3/4th of the way through my EMT-B class).

If you are dispatched to a Bike vs Car with a ridealong, then the bike will win and the patient will sign out AMA.

If you are a police office at said accident, then it is not a good idea to badger the EMT that is TRANSLATING for you to the pt. that doesn't speak English about whether or not the pt is going to file a police report every 5 seconds in a not so nice voice.

This action will result in the EMTs (EMT-Ps from the engine to be specific) getting the AMA signed in record time which will result in you losing your translator. The traslator will also kindly inform the patient that and question involving the word "report" deserves a "No, I just want to go home" answer.

 

[v-tach]

I don't see how CO2 and sodium hypochlorite can react that badly? CO2 is already in its oxidative state, and sodium hypochlorite is an oxidizing agent. Maybe there were other unknowns chemicals (such as NH3) inside the vehicle that reacted to the bleach. Or maybe the concentration was a little too strong, and the vehicle wasn't properly ventilated, since the fumes from bleach is pretty powerful

sorry for the tangent - gotta defend chem majors

Maybe it was an ammonium phosphate dry-chemical extinguisher.

 

[v-tach]

This is the best thread I have read for a long time! I have been doing this for a few days and have to say, it is all true....

Another bad thing to do....

DISP nursing home for CP. Arrive to find 4 people in the room, all stating they have chest pain. Only one had it since this morning. The staff, as suaual have no idea about her, "The RN is getting everything together, she is normally really healthy", thanks.

Go though the questions, pt reports no allergies/history/some unk meds, monitor, line, drugs.

Start to leave and the RN come up and said "You know she is allergic to NTG"

As normal, the reaction the pt has is a HA and lower BP.

The appropriate statement to the pt is not "We are going to take you out of here before the nurses can do anyhhting else to try to kill you."

Wow. Don't they know it's not even POSSIBLE to be allergic to nitro?

 

[leviathan]

Sorry man, I just take issue with this post. Some of the things you said were a little funny. BUT, you dont sound like the type that should be criticizing any other health care professionals.

No person should criticize any health care profession, regardless of their credentials or competence. Period.

I bet most people getting off that boat from the Carribbean can spell PIECE, CARRIBBEAN, not to mention STETHOSCOPE.

I just love it when people correct the spelling of other people with their own incorrect spelling. It's spelled caribbean.

 

[Tas]

More as a hint to patients...

If you call us saying you have a migraine, yet have the audacity to have 10 dresses on a hanger and 2 suitcases packed when we arrive, we will NOT take you to a 'bandaid' station hospital 1.5 hours away as opposed to one of the 2 nearest hospitals < 15 mins away.


As a corollary, we won't do it the second time you call (1 hr later) either.


This isn't much of a bump, but this thread needs life!

 

[trauma_junky]

More as a hint to patients...

If you call us saying you have a migraine, yet have the audacity to have 10 dresses on a hanger and 2 suitcases packed when we arrive, we will NOT take you to a 'bandaid' station hospital 1.5 hours away as opposed to one of the 2 nearest hospitals < 15 mins away.


As a corollary, we won't do it the second time you call (1 hr later) either.


This isn't much of a bump, but this thread needs life!

esp when the second call is from the ED payphone. fuking system leeches!

 

[Tas]

esp when the second call is from the ED payphone. fuking system leeches!

You've had these patients too then I never believed it to be true, until they hopped onto my rig.

 

[deleted6669]

along the same lines I have seen people call 911 from the er waiting room stating they have a medical emergency and aren't being seen fast enough and want a ride to hospital x instead.....
as a medic in a busy system I have called for orders from the hospitals ambulance bay.....
"we have xyz and need orders for bretylium...what is our eta? zero...we have been here for 5 minutes and you haven't found us a space for the pt yet. yes I know you are on divert, everyone is on divert, so guess what , this is your pt....."

 

[Parscope]

If I'm stripping paint off the floor, open a window.

This man was found by wife after an entire day of work in the basement with no ventilation. This person probably had the most chemically damaged brain I have ever seen. He never said a word, was a little combative and was slowly looking around the whole time in the ambulance.

 

[trauma_junky]

along the same lines I have seen people call 911 from the er waiting room stating they have a medical emergency and aren't being seen fast enough and want a ride to hospital x instead.....
as a medic in a busy system I have called for orders from the hospitals ambulance bay.....
"we have xyz and need orders for bretylium...what is our eta? zero...we have been here for 5 minutes and you haven't found us a space for the pt yet. yes I know you are on divert, everyone is on divert, so guess what , this is your pt....."

The hospitals abuse the courtisies that EMS provides by holding the patient in Triage. We started a 20 min policy due to simple liability. Have a bed in 20 min or the patient goes on the floor. They hate us! It's sad how lawyers have killed patient care and compassion.

 

[pushinepi2]

1. Patients die with or without you and in spite of expert paramedic assistance.

2. Elvis has indeed left the building when the patient sucking on a nebulizer simply dangles it from the corner of an open, drooling mouth.

3. Please check the patient prior to pressing the, "silence alarm" button when the sp02 probe reads 80% AND correlates with a reasonable heart rate.

4. Yelling at patients who speak a foreign language doesn't make them understand you better.

5. Securing obese patients to a stretcher will make it harder for them to be ejected from your cot once it buckles under the force of gravity.

6. Projectile emesis into a NRB set to "flush" makes for interesting facepaint.

7. Circle of death: An entire truck company rendering assistance to a critically ill patient.

8. When you're behind the eight ball and patients are actively trying to die, remember that it is not YOUR emergency. Also remember that asystole is much easier to remedy than hypotensive cardiogenic shock.. unless you're emedpa.

9. Aggressive masturbation is a proximate cause of flash pulmonary edema in the aged, infirm, and bed-ridden nursing home patients.

10. Sending paramedics to fire school does not cause them to appreciate engine companies even more. As a matter of fact, paramedics who complete fire college are 10x more likely to suffer from chili stirrer's elbow, recliner tendonitis, play-station thumb, and sacral pressure sores.

Why go through the trouble of selecting an obstetrician when a mobile field delivery unit is available 24/7? You'll never wait for your next appointment! God keep us poor EMS workers,


-Push

 

[Jambi]

Since there has been a lot on NTG...
When you take three (yes, 3) doses of NTG all at once for your dizziness then call 911 via your "life alert," don't becomes angry because we cannot get into your house because you are laying prone in front of the locked door and every time you reach up to unlock it you nearly have a syncopal episode. When we finally do get into your house please do not try to convince me that your physician told you to take your NTG when you became dizzy. Then don't go on to tell me that the same physician told you to take all three doses at once. Also, don't become demanding when we are not able to mystically fix your dizziness in an instant, "just like on TV."

more NTG goodness,
Don't walk over to your neighbors house when you have chest pain and don't let that neighbor put one of his NTG patches on you. When you do begin to feel better don't go for a walk into the forest, collapse, and have your family expect you to survive when you have managed to get two miles back in undrivable terrain.

Do make sure that the little spray nozzle on that NTG spray is pointed at the Pt's mouth and not your face, arm, hand, eyes, partner, ect...

Don't play around with the NTG spray and say, "look its empty!" as you spray it into your mouth (not me I swear) The rest of the EMS crew on that day will laugh at you.

Do call 911 for Pt's that need us, instead of driving, calling a taxi, taking a bus, ect.

Don't call us for Pt's that don't need us.

Don't be surprised when the paramedic/emt admits to not having a magic wand, or that the magic wand batteries are dead

Don't seem surprised when the EMS crew does not appreciate it when you call them ambulance drivers.

if you are a BLS fire crew and you are on scene with my partner and me (the last ALS crew in the valley. It was a busy day) for the old guy can't pee for 2 days call. Please don't leave when the 2 year old drowning victim one block down the street call comes. Then transport the 2 year old in the back of a PD vehicle while trying to do BLS CPR while passing us (the ALS crew) while we load the can't pee guy into our rig because we can't leave now that you left. Then please don't have your chief call and complain because there were not enough ambulances. We were not the ones that left us on scene.

and

It is okay to cry...

 

[Mr. Freeze]

Always wear clean underwear...

If you going to shoot yourself in the face, don't miss. Anything worth doing should be done right...

If you're going to drive around naked with some girl that isn't your significant other who may or may not have her boobs taped down (WTF?), don't do it drunk...

If the same significant other pisses you off one night, don't reach in the sink and throw the first utensil you grab; it will invariably be something long and sharp...

Don't let the foley bag get covered with a sheet. They will open if you step on 'em and I guarantee you'll be going down a hill when it does...

Don't eat the biggest meal of your young life and then drink yourself 3 times the limit...

If the lady at the front desk of the nursing home laughs and says I think they might be doing CPR, when you were dispatched nonemergency, she doesn't have a f'n clue and they are indeed thumpin' away down hall 2...

 

[pianoman511]

We get a call for a 77 y/o female with chest pain. Upon getting there we see said female in bed on top of towels which were placed there to absorb all the sweat. This patient had all the classic signs of AMI. Chest pain with referral to left shoulder, nausea, sweating profusely. BP 80/40, first 12 lead showed ST elevation in V1-V3 and depression in II, III, and aVf. We advised the patient to go to a hospital with cardiac cath capability. The response was....NO.. I want to go somewhere else. Furthermore all we can do is give her ASA, which she REALLY doesn't want to take because of her GERD. We bring her to that somewhere else. On the way we repeat the 12 lead...elevation now V1-V4 and more pronounced depression in I, II, III and aVf. Still, the patient doesnt want to go somewhere else. Finally, we get to the hospital and immediately the ED attending calls the hospital where we wanted to bring her to arrange a transport. We go to that hospital later that day and find out that the patient coded in the ambulance bay and barely made it to the cath lab. Moral of the story....listen to the EMT's (we know what we're doing).



Damn that adrenaline rush...gotta love EMS

 

[beanbean]

At least with Trauma regulations you can make a patient go to a trauma center. I am all for patient autonomy, but sometimes I think there should be CVA and AMI regs as well. It is not like the old days when every hospital did the same thing. Many patients, esp the older ones don't realize that.

Could you have tried calling med control at the hospital she wanted to go to.... maybe they would have redirected you based on her presentation?

Frustrating call!

 

[pushinepi2]

We get a call for a 77 y/o female with chest pain. Upon getting there we see said female in bed on top of towels which were placed there to absorb all the sweat. This patient had all the classic signs of AMI. Chest pain with referral to left shoulder, nausea, sweating profusely. BP 80/40, first 12 lead showed ST elevation in V1-V3 and depression in II, III, and aVf. We advised the patient to go to a hospital with cardiac cath capability. The response was....NO.. I want to go somewhere else. Furthermore all we can do is give her ASA, which she REALLY doesn't want to take because of her GERD. We bring her to that somewhere else. On the way we repeat the 12 lead...elevation now V1-V4 and more pronounced depression in I, II, III and aVf. Still, the patient doesnt want to go somewhere else. Finally, we get to the hospital and immediately the ED attending calls the hospital where we wanted to bring her to arrange a transport. We go to that hospital later that day and find out that the patient coded in the ambulance bay and barely made it to the cath lab. Moral of the story....listen to the EMT's (we know what we're doing).

Your post brings up some very interesting points. First of all, please don't see my reply as a critique. I've been in very similar situations and it is unfortunate that EMT's are placed in the often precarious position of patient advocate.

Remember that a competent patient, despite harrowingly unstable vital signs, has the right to refuse treatment AND determine their own destination. I can think of no emergency physician, especially considering today's EMTALA laws, that would willingly refuse such a patient. The 'refusing' physician would have to take responsibility for your patient during transport to a definitive care facility. From your post, it seems that your patient was aware of the risks in transport to whichever hospital. The patient, therefore, is responsible for the consequences despite whatever lawsuit she may try to arrange. Wouldn't it have sucked if you'd have saved her life, transported her to a cath-capable hospital, and then you were slapped with a false-imprisonment lawsuit? LOL! As health care providers, we can only suggest the best course of action to our competent patients. It is up to them to carefully consider the risks and benefits of any resulting choices. The only exceptions are for minors, individuals in policy custody (Baker act), or individuals under the influence (Marchman)... etc..

The good news is that current guidelines and studies (recent issue of Annals/AHA ECC guidelines 2004) support paramedic directed triage. Since the door to drug and door to balloon times are increasingly unforgiving, it is imperative for people to be routed to appropriate facilities. Ideally, transport protocols for AMI, stroke, and trauma patients will one day exist side by side. EMTs, as you say, DO KNOW what they're doing.. but their decisions must be supported by corresponding legislative and medical authority. Perhaps you could talk the case over with your medical director. I doubt that s/he will REQUIRE that you MUST bring a particular patient to a specific facility.

Finally, there exist other options for the treatment of hypotensive cardiac patients. You mentioned that you could only give ASA? GERD is in no way a contraindication for class I aspirin therapy. Furthermore, it sounds like the massive anterior wall MI was causing some fairly severe systolic dysfunction / backup. Sometimes, these hypotensive MI patients benefit from judicious (100-150 mL) fluid boluses in order to increase cardiac output. With such crappy pressures, the vicious cycle of ischemia/infarction/failure/catecholamine release can only devolve into cardiac collapse.

Great case.

 

[SMW83]

If I decide to kill myself I will not try

....mixing ant poison and beer

....drinking liquid potpourii

....to chop my own hands off with a knife

.... to set myself on fire

..... to hang myself over a door the same height that I am including the length of the rope

.....to take ibuprofen, aceteminophen or any other over the counter medicine.

....by taking a handful of antibiotics


....or laxatives

GOOD LORD!!!!!!!!!!!!!!!

hell if it werent for stupid ppl, we'd be out of business.....

 

[LDutch]

Speaking of NRB masks... kind of a random question I've always wondered:

On airplanes they always give the "if cabin pressure should drop oxygen masks will fall" speech before the flight. The flight attendant always says that the reservoir bags will not inflate but that oxygen is flowing. So these bags must serve some other purpose than in NRB masks. Does anybody know what function the airplane mask reservoir serves?

Something to do with containing the oxygen in case of fire?? (seems far fetched but its all I can think of)

I have a pilot friend of whom I asked a similar question-

Me: So, why the masks and no reservior inflation?
Him: Haha they're simply to muffle the screams.


Morbid, but probably true. The great thing about plane crashes- the great equalizer- everyone goes!

 

[southerndoc]

I have a pilot friend of whom I asked a similar question-

Me: So, why the masks and no reservior inflation?
Him: Haha they're simply to muffle the screams.


Morbid, but probably true. The great thing about plane crashes- the great equalizer- everyone goes!

Oh now that's classic! I'll have to remember that.

 

[ISU_Steve]

The bags were put on there to give the impression of something working- but only later did they realize that they don't always inflate. At least this is what was told to me by an aviation mechanic friend of mine who works on Boeing 767 and 777 life support systems for a major airline.