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For traumatic cardiac arrest, our protocol says something like this: .. Pronounce death without medical control if no signs of life and asystole .. consult physician for pronouncement of blunt trauma after 15 minutes of unsuccessful working with initial rythym other than asystole .. for...

Hello all, I've been offline for a while but now working 911/IFT on top of what I was doing before. I'm trying to wrap my head around the course our patients take once they reach a medical facility. 1. There are some public/charity hospitals that serve needs of the uninsured/underinsured...

From what I understand, EMTALA guarantees that a patient with an emergency medical condition will be evaluated and treated regardless of insurance and ability to pay. The way that this happens is as a condition of participating in Medicare. Does anyone know of any ERs that don't accept...

I did PHTLS over the weekend. It was good for me to see some trauma scenarios and transport decisions since I don't usually do that, but I will be in the future. I struggled a little bit with the thought process of deciding which hospital to go to in some of the scenarios. Can anyone give...

In a couple months I'll be moving from my current role as a volunteer event medic to a volunteer on a "real" 911 ambulance. One of the biggest things I'm nervous about is trauma -- most people seem to think medical is harder, and perhaps it is at the ALS level, but for me at the BLS level, I...

It's about 80 degrees out, and you're working a festival. You have some heat-related patients, but it's unusually cool, so you've been pretty quiet on that front. Called out to the scene for a 40 y.o. M "not feeling well," c/o N/V and dizziness, throwing up in the trash can. Skin is flush and...

I was obviously on the BLS side of this but want to better understand that the ALS practitioner does, and why. BLS: 40 y.o F (athlete) pt presents to aid station before race asking for a blood pressure check because she feels "unusual." The BP turns out to be 160/100. This reading concerns...

I heard a call dispatched for Fire Department X, mutual aid into remote area Y, for a 78 year old female not behaving right, possible CVA per EMD. The response time is 45 minutes emergent, and the transport time would be 1 hour. This probably sounds routine to some of you who work in rural...

I've been hunting around the internet but I'm somewhat confused. Can somebody explain this to me? As I understand, Diabetes Type I was the inability of the body to produce insulin, so insulin was needed to be injected. Diabetes Type II meant that the cells could not use the insulin to move...

A team was working a race when a 47 year old female presents with shortness of breath. She just ran the race, indicates chest tightness and arm tingles, and says she forgot her inhaler. As a team that is not directly involved, I respond for manpower, so I don't have the full history, vitals...

There was a thread that touched on this earlier, but I'd appreciate some help with giving on scene handoff reports. (Handoff from a BLS first response unit to an ALS transporting unit). I find that on scene I get a little rushed or flustered so I either omit something or my handoff report comes...

I put "EtOH" in quotes because it's a diagnosis of last resort, I know. Be suspicious of hypo/hyperthermia, stroke, hypo/hyperglycemia, and the whole kitchen sink. We were dealing with a special event this past weekend and "patients" tend to straddle that line between competent to refuse and...

In one of my earlier posts I asked about why EMT/Paramedic licensure is a thing, and it turns out that laws encourage organizations to hire an individual trained to a standard and vetted, rather than just some guy who would be trained by the medical director. Turning that around, in states...

COMA TOAST!!!!!!!!!!!!

Some topics in other discussions reminded me of this. When I did my ride along with the ALS 911 provider, most of our calls would follow the same general format: fire is on scene, we get the patient from them, load into the ambulance, spend 15-20 minutes doing an assessment in the ambulance...

I was talking to a friend who recently ran a CP call. He turned on the AED and put the pads on, with the logic that if the pt went into VT he would want to shock before the pt lost consciousness. I was surprised because we're told specifically not to do that in EMT class. But upon talking to...

I'm wandering in the wrong forum again, but curious about how ALS providers treat trauma. I was reading something about the recent trend not to bring trauma patients up to normal blood pressure, but rather to use intravenous fluids to keep the pressure around 80 mmHg. Presumably this is...

We are always told to call 911 instead of driving to the hospital, and I teach this as well. Does anyone know of any studies that compare survival rates on these things? Perhaps urban vs rural, etc? A quick search gave me a ton of websites but few research oriented ones. Thanks.

One of my old instructors sent me this article today. http://sciencelife.uchospitals.edu/2015/10/13/advanced-ambulance-care-increases-mortality/ I'm curious--what are your thoughts? The obvious concern is, since BLS and ALS ambulances don't respond to the exact same call, but rather, are part...

I'm curious, and was hoping that some of you ALS providers could fill me in on this. When/why do you intubate patients? My understanding is that concerns is the airway (duh) and of getting air into the lungs, not the stomach. Also to prevent the chance of vomit interfering with the airway...