Finally ! Someone who cares about BLS and EMT's

[Chimpie]

Keep the thread clean and on topic or it will be closed.

 

[JPINFV]

I would argue that once he decided to man an ambulance that he is de facto on duty.

 

[VentMedic]

The EMT wasn't really on duty either - he stopped and picked up an ambulance from the Rescue Squad, without a partner, and went to the scene, rather than calling 911. That was part of the problem with the call. A fully manned ambulance, and probably ALS backup, should have been present.

From start to finish, the call was fouled up.

Yes, he bypassed the EMS system since he has access to an ambulance which he used as his own personal transport vehicle for his sister.

But. he assessed and determined the baby to be dead.

Can EMTs pronounce death in NJ?

He also did not know the significance of the placenta delivery or failed to clamp the cord.

In essence, he did not know what to do for the birth of a baby or the determination of death regardless of who else was with him. It appeared he was also doing most of the hands on.

He should also have known that some babies are born in hot tubs to be called a "natural water birth"...not that I compare a toilet bowl to a hot tub.

 

[rhan101277]

Yes, he bypassed the EMS system since he has access to an ambulance which he used as his own personal transport vehicle for his sister.

But. he assessed and determined the baby to be dead.

Can EMTs pronounce death in NJ?

He also did not know the significance of the placenta delivery or failed to clamp the cord.

In essence, he did not know what to do for the birth of a baby or the determination of death regardless of who else was with him. It appeared he was also doing most of the hands on.

He should also have known that some babies are born in hot tubs to be called a "natural water birth"...not that I compare a toilet bowl to a hot tub.

Yeah that toilet water will definitely be to cold for them. I think they can stay under for a 30 seconds to a minute as long as you don't stimulate them or cut the cord while they are under the water. I read through some of those revocations and some of the care rendered makes no since. I don't see how some of them got through class. I think any mother would get their baby out of the toilet, regardless of whether they thought it was dead or not especially since this baby was almost term.

 

[EMSLaw]

Yes, he bypassed the EMS system since he has access to an ambulance which he used as his own personal transport vehicle for his sister.

But. he assessed and determined the baby to be dead.

Can EMTs pronounce death in NJ?

He also did not know the significance of the placenta delivery or failed to clamp the cord.

In essence, he did not know what to do for the birth of a baby or the determination of death regardless of who else was with him. It appeared he was also doing most of the hands on.

He should also have known that some babies are born in hot tubs to be called a "natural water birth"...not that I compare a toilet bowl to a hot tub.

As I said, fouled up from start to finish.

And no, EMT-Bs cannot pronounce in NJ, which is yet another reason recussitative efforts should have been started. There was an amendment to the law introduced recently that would allow EMT pronouncements in certain limited cirumstances - basically the times you would not initiate CPR (obvious death, such as decapitation, lividity, rigor, decomposition). But that's not the law yet, and I'm not sure it should be.

Also, I would argue that when the child was born, there were then two patients, and even at that point, given the critical state of the baby, a second ambulance should have been called.

And finally, and no less important, I was taught in the cases of a potential miscarriage (which I don't think this was, but let's presume for a minute) if the fetus looks like a baby, it should be treated like a baby. That is, wrapped up in a blanket and taken to the hospital, not put in a garbage bag.

 

[VentMedic]

if the fetus looks like a baby, it should be treated like a baby. That is, wrapped up in a blanket and taken to the hospital, not put in a garbage bag.

That's at least commonsense out of respect for both the baby and the mother.

 

[medichopeful]

From start to finish, the call was fouled up.

The main problem was the HUGE conflict of interest. It was his sister after all. He should have been intelligent enough to get OUTSIDE help.

 

[Aidey]

Also I can't believe that people think most IFTs need a medic. When I was on the truck most of the IFTs we were doing were "80 yo man who is normally in a wheel chair needs to get to his doctor's appointment and back." Most of these patients medically stable, but for some reason they don't have the mobility to physically walk out and get in a cab.

I wouldn't say I think most IFTs need a medic, but that assuming none of them do isn't the way to go about it. In my system there is no dedicated transfer ambulance, we all run them, and we are an EMT/Paramedic crew.

The % of transfers that are called out as "BLS" and end up needing a medic is probably pretty low, but it does happen, and because of that I'm glad I was there. On the flip side, we have done transfers that don't meet the CMS ambulance transfer criteria, but because there is no wheel chair van available at night we do them.

I also think there is a difference between a regularly scheduled transfer for your 80 yo male and an unscheduled one for a 75 yo F who is suddenly needing 4lpm to maintain her sats instead of 3lpm. The 80 yo man who is being transferred to his GP and back may end up being the sicker patient overall, but he may be stably sick and doesn't need intervention, if that makes sense.

 

[MrBrown]

Come on folks, what is with the whole "BLS vs ALS patient" thing, wow, I mean it's just totally foreign to me.

If I was working with ALS and went to a patient who we examined and came up with "stubbed toe" for example, if we got on the radio and said "oh this patient doesn't need us, what is [the BLS vehicle] doing? Have them come transport as this is a BLS patient" I can guarentee you that I'd probably get fired.

Doesn't matter who turns up, if the ALS vehicle is the only one free and roll up to the job, the crew doesn't care how sick or hurt you are and if your condition is "compatible" with thier skillset or not.

Again I am hesitant to turn this into a pissing match about skills because skills are easy and require minimal education.

Understandably there are larger issues here than provider unwillingness like funding, tax and regulatory regimes. But let's immagine that those are fixed for a moment please, so why should the most developed nation on earth keep the least developed entry-to-practice standard?.

I'd be interested to hear what you think.

 

[CAOX3]

As I said, fouled up from start to finish.

And no, EMT-Bs cannot pronounce in NJ, which is yet another reason recussitative efforts should have been started. There was an amendment to the law introduced recently that would allow EMT pronouncements in certain limited cirumstances - basically the times you would not initiate CPR (obvious death, such as decapitation, lividity, rigor, decomposition). But that's not the law yet, and I'm not sure it should be.

Also, I would argue that when the child was born, there were then two patients, and even at that point, given the critical state of the baby, a second ambulance should have been called.

And finally, and no less important, I was taught in the cases of a potential miscarriage (which I don't think this was, but let's presume for a minute) if the fetus looks like a baby, it should be treated like a baby. That is, wrapped up in a blanket and taken to the hospital, not put in a garbage bag.

So your EMTs initiate CPR on decapitated pts? I hope not.

 

[Lifeguards For Life]

So your EMTs initiate CPR on decapitated pts? I hope not.

I think those were examples of conditions that warrant a death be pronounced on scene, hence CPR would not be warranted

 

[CAOX3]

As I said, fouled up from start to finish.

And no, EMT-Bs cannot pronounce in NJ, which is yet another reason recussitative efforts should have been started. There was an amendment to the law introduced recently that would allow EMT pronouncements in certain limited cirumstances - basically the times you would not initiate CPR (obvious death, such as decapitation, lividity, rigor, decomposition). But that's not the law yet, and I'm not sure it should be.
Also, I would argue that when the child was born, there were then two patients, and even at that point, given the critical state of the baby, a second ambulance should have been called.

And finally, and no less important, I was taught in the cases of a potential miscarriage (which I don't think this was, but let's presume for a minute) if the fetus looks like a baby, it should be treated like a baby. That is, wrapped up in a blanket and taken to the hospital, not put in a garbage bag.

Thats not how I read it.

 

[rescue99]

The main problem was the HUGE conflict of interest. It was his sister after all. He should have been intelligent enough to get OUTSIDE help.

The emotions often take over when loved ones are involved. Such a sad situation.

 

[EMSLaw]

Thats not how I read it.

Well, you read it wrong.

EMT's cannot pronounce. They can decide not to initiate resuscitation in cases of obvious death. So, no, we do not start CPR on decapitated victims, or on skeletons, or on persons with rigor mortis or fixed lividity. But that person is still not legally dead until a paramedic, RN, doctor, or other person authorized by statute arrives to pronounce.

The proposed change to the law here would allow EMTs to pronounce in situations where there is obvious death. To clarify what you had such a problem with - I'm not sure that EMTs should pronounce. Why? Honestly, because I'm pretty sure someone will screw up obvious death.

 

[CAOX3]

Well, you read it wrong.

EMT's cannot pronounce. They can decide not to initiate resuscitation in cases of obvious death. So, no, we do not start CPR on decapitated victims, or on skeletons, or on persons with rigor mortis or fixed lividity. But that person is still not legally dead until a paramedic, RN, doctor, or other person authorized by statute arrives to pronounce..

Maybe not legally. The fact they are allowed to withold CPR after assessment is a form of pronouncment.

The proposed change to the law here would allow EMTs to pronounce in situations where there is obvious death. To clarify what you had such a problem with - I'm not sure that EMTs should pronounce. Why? Honestly, because I'm pretty sure someone will screw up obvious death.

Yes and paramedics never screw this up? Shall I post some links?

 

[EMSLaw]

Yes and paramedics never screw this up? Shall I post some links?

I'm sure they do, but they have access to ECG and additional training. And at least here, paramedics only pronounce after a four lead shows asystole and they call medical control to obtain approval.

Are you just arguing for the sake of arguing, or do you support the idea of basics pronouncing?

 

[MrBrown]

i've heard of dead people getting a GCS of 6 so yeah I'd say somebody gonna screw it up somewhere ......

 

[18G]

I understand how EMT-B's feel having worked and volunteered as one for a FD and 911 EMS for a lot of years. However, I must admit that I felt helpless and very limited as an EMT-B many times. These feelings were a main motivating factor for wanting to become a Paramedic. And while there are many great EMT's out there that know far more than required, without the authorization and tools to use that knowledge, it doesnt do the patient any good.

I agree that Paramedics should be minimum staffing on all ambulances regardless of call type. If the crew consists of a Paramedic and an EMT, and the EMT can clearly handle than yes, allow the EMT to manage the call while providing oversight.

I don't have a big problem with using the terms BLS vs ALS to distinguish levels of care patients need. BLS and ALS are just descriptors. Perhaps it makes sense to just say "patient care", but I dont see what the big deal is.

 

[rescue99]

I understand how EMT-B's feel having worked and volunteered as one for a FD and 911 EMS for a lot of years. However, I must admit that I felt helpless and very limited as an EMT-B many times. These feelings were a main motivating factor for wanting to become a Paramedic. And while there are many great EMT's out there that know far more than required, without the authorization and tools to use that knowledge, it doesnt do the patient any good.

I agree that Paramedics should be minimum staffing on all ambulances regardless of call type. If the crew consists of a Paramedic and an EMT, and the EMT can clearly handle than yes, allow the EMT to manage the call while providing oversight.

I don't have a big problem with using the terms BLS vs ALS to distinguish levels of care patients need. BLS and ALS are just descriptors. Perhaps it makes sense to just say "patient care", but I dont see what the big deal is.

EMT/Medic rigs are common place. It is a good comprimise IMO. Provides what is needed and saves financial resources too. Now, if we could just get companies and FD to understand BLS assessment comes first, not as an after thought. Proper billing using mixed staffing and billing for only the service provided, lowers the overall cost of providing service while still providing both levels of care.

 

[Lifeguards For Life]

i've heard of dead people getting a GCS of 6 so yeah I'd say somebody gonna screw it up somewhere ......

I've heard deceased (and a living patient or two) recieve GCS of 0,1, or 2:unsure: