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Old 03-04-2013, 13:47   #151
Gallium
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Quote:
Originally Posted by TX OMFS View Post
That was funny.

Does not for one second bother me. He is resorting to all sorts of insults because deep down, he knows I am making him sweat and nervous behind his keyboard.

And you know it too.
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Old 03-04-2013, 13:57   #152
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"Its messed up that STNAs arent required to be certified in some places"

Applicants for the Certified Nursing Assistant test in Virginia can complete the required classroom work in 6 weeks of full-time classes. They don't have time to cover everything - like CPR. It's enough of a job to teach them to read a thermometer and take a BP and write notes in the chart.

CNAs can make a little extra an hour by passing the med tech test so they can hand out medication.
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Old 03-04-2013, 14:17   #153
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I was ready to let it go until you insulted my ability to care for a pt based on what was no more than an assumption, which coincidentally appears to be the main basis of your argument against what I have stated.

I will concede the the protocols for transported deceased patients in my particular EMS system may be different that other systems. However, your argument that I cannot possibly speak for other areas in the country applies to yourself as well. This is the protocol I work under, believe it or not.

You inferred that you were a physician when you made a statement about putting on scrubs, a stethoscope and a tag that says Dr. Gallium. By all means, tell us what you really do.

I would love to have the opportunity to debate this with you in person. Obviously not going to happen. You're still trying to refute conjecture. That's not going to happen either. There are those that can teach, and those that can do.
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Old 03-04-2013, 14:24   #154
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Quote:
Originally Posted by Gallium View Post
If you have the experience then you know CPR is not done on folks with DNRs.
According to the newslink, there wasn't a DNR in place. Do you have any factual information or linkable data showing that the article was incorrect on this point?
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Old 03-04-2013, 14:24   #155
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Quote:
Originally Posted by Gallium View Post
'Flyer,

Good on you for having those skills and certifications. Unfortunately, money matters. Work CPR on a 1/2 dozen 87yr olds, resuscitate them, and have to deal with the aftermath of care...and it might jade your perspective.

Not saying right/wrong, just what it is. And yes, it is callous sounding as hell.

If you had very limited resources, and your choices were to work CPR on a 87 yr old, or a 27yr old, and none of them were related to you, and both present with the same symptoms in your presence at the very same time, and you have no help, who do you work?

87 vs a 17yr old?
87 vs a 37yr old?
87 vs a 47yr old?
87 vs a 57 or 67 yr old?

Essentially, this is the decision that many nursing homes and other health care providers are doing. They are saving the dollars for those folks who will benefit from the service.

There are no guarantees of anything - the 37yr old you save can come back to burn your house down, or die in the ER 2 days later...and the 87yr old could tack on another 10 years of decent living.

I don't advocate any of these things...just pointing out to you what "is".
Thoughtful, well reasoned response.
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Old 03-04-2013, 14:30   #156
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Quote:
Originally Posted by TX OMFS View Post
Uh, then why do we even do CPR or try to save lives?
For the same reason we try marriage despite the odds.

Some folks are optimists.
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Old 03-04-2013, 14:30   #157
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More on the non-existent DNR. The Bakersfield Fire Department has released a report confirming that there was not a DNR on hand in the deceased patient's files.

http://www.bakersfieldcalifornian.co...rdens-resident
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Old 03-04-2013, 14:50   #158
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Quote:
Originally Posted by countrygun View Post
For the same reason we try marriage despite the odds.

Some folks are optimists.
And it works sometimes I've got 3 of 6...
And I was either there within minutes or took over from somebody that was on scene when they stopped breathing.
posted using Outdoor Hub Campfire
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Old 03-04-2013, 14:54   #159
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Quote:
Originally Posted by tsmo1066 View Post
According to the newslink, there wasn't a DNR in place. Do you have any factual information or linkable data showing that the article was incorrect on this point?
Don't get your wires crossed.

  • Tx OMFS made a broad statement that had nothing to do with the article.
  • His response was, in turn to someone else who made a broad (and to Tx OMFS, a somewhat vague) statement.
  • My response to him - which you have quoted, was within the vein of that sidebar, and likewise is not addressing the existence/non existence of DNR.


Hope that clears it up for you.


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Old 03-04-2013, 14:57   #160
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Quote:
Originally Posted by Gallium View Post
Don't get your wires crossed.

  • Tx OMFS made a broad statement that had nothing to do with the article.
  • His response was, in turn to someone else who made a broad (and to Tx OMFS, a somewhat vague) statement.
  • My response to him - which you have quoted, was within the vein of that sidebar, and likewise is not addressing the existence/non existence of DNR.


Hope that clears it up for you.


- G
No problem.
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Old 03-04-2013, 14:57   #161
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Quote:
Originally Posted by tsmo1066 View Post
According to the newslink, there wasn't a DNR in place. Do you have any factual information or linkable data showing that the article was incorrect on this point?
No one has ever convinced Gallium he has ever made a mistake or been wrong. Don't try.
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Old 03-04-2013, 14:58   #162
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Quote:
Originally Posted by devildog2067 View Post
Medical care costs money.

If you don't have money and need medical care, one of two things can happen:

1) You don't get it.
2) You get it and someone else pays.

I agree that it's wrong for a first world nation to let people die who could be saved--morally wrong. But it's just as morally wrong to demand that someone else pay for something that you need.

Can't have it both ways. What's your solution?
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Old 03-04-2013, 15:00   #163
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Quote:
Originally Posted by TX OMFS View Post
No one has ever convinced Gallium he has ever made a mistake or been wrong. Don't try.
Well, if there was any doubt, the Bakersfield FD removed it this morning (see post #157).

There was no DNR.
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Old 03-04-2013, 15:18   #164
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Quote:
Originally Posted by slathrum View Post
I was ready to let it go until you insulted my ability to care for a pt based on what was no more than an assumption, which coincidentally appears to be the main basis of your argument against what I have stated.
No. I questioned your mindset, based on the SLEW of very poor assumptions you have made in this thread, then reversing yourself, then attempting to paper over them.

GO BACK AND READ YOUR STATEMENTS. PRETEND YOU WERE OFFERING TESTIMONY - see how much your statements SUCK.


Quote:
Originally Posted by slathrum View Post
I will concede the the protocols for transported deceased patients in my particular EMS system may be different that other systems. However, your argument that I cannot possibly speak for other areas in the country applies to yourself as well. This is the protocol I work under, believe it or not.
And as one person interested in the field of medicine to another, I have asked you repeatedly and pointedly to state where you are, so we can independently verify what you are saying. What you have said, and have continued to back up, even at this point contravenes what are generally accepted practices in the field of EMS.

I will use what you have said to relate to this thread, so we can all learn something from it:

You have said:
Quote:
Originally Posted by slathrum View Post
...

Also, EMS crews do not typically transport out of hospital cardiac arrests. Unless you obtain a return of spontaneous circulation or there is reason to believe a specialized higher level of care would be beneficial, then the deceased stays put.

I have pointed out to you that this (part in RED) is grossly inaccurate, for most of the country. You've only qualified your statement now to say it is done where you are, after my repeated hammering of your point. It is simply flat-out wrong, and everyone else here with a shred of training from even a BLS/1st Aid CPR level knows it is not true. IT is why I have pleaded with you to either post where you live, or post those protocols.

Visualize yourself on a bus, showing up to a patient as you are describing here, and declaring the person dead (MAYBE your protocols allow that in cases of non-obvious death).

Now the family sues, because everywhere else in the nation does not do this, and there is a chance their love one could have been saved.

What you should take from this is your locality is doing something very wrong if what you have stated is a part of your protocols.


Quote:
Originally Posted by slathrum View Post
...The reason, of course, is that quite frankly we are better at running codes. Period. Unless you are a trauma surgeon at a Level 1 facility, your care is either inferior or redundant, thus negating the need for transport.
You need to re-read this what you have wrote, look at the training required for paramedics in your locality, look at what minimum levels of gear is required, then compare and contrast to the minimum levels of training, staffing and equipment is needed for even a L3 facility...to see how weak & silly your statement is.

Quote:
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You inferred that you were a physician when you made a statement about putting on scrubs, a stethoscope and a tag that says Dr. Gallium. By all means, tell us what you really do.
I did not infer I was a doctor. No one else here made that inference. Someone here with a PhD in Physics (ie, someone who is reasonably adept at logic) pointed this out to you. The problem is not me, or everyone else, the problem (in this instance) is you.

I've already told you what I did - I post on Glocktalk.

Quote:
Originally Posted by slathrum View Post
I would love to have the opportunity to debate this with you in person. Obviously not going to happen. You're still trying to refute conjecture. That's not going to happen either. There are those that can teach, and those that can do.

I do not refute conjecture. For conjecture to be of help, it must be relevant, and usually narrow in focus, and applicable to the situation at hand. What you have done is almost the exact opposite. You created so many different scenarios and scopes, it would be difficult to use any scientific approach to what you have proposed.

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Old 03-04-2013, 15:20   #165
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I don't think it matters if there was a DNR posted or not - there apparently wasn't anybody there trained to perform CPR.

I suppose we'll get the facts of the matter sooner or later.
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Old 03-04-2013, 15:21   #166
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Quote:
Originally Posted by TX OMFS View Post
No one has ever convinced Gallium he has ever made a mistake or been wrong. Don't try.
Nor has anyone ever been able to make me accept garbage for fact, or to take claim for statements I did not make.

I have already explained to tsm1066 where the issue of no DNR came up. Quit grasping for straws and snide comments.
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Old 03-04-2013, 15:25   #167
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Quote:
Originally Posted by JohnBT View Post
I don't think it matters if there was a DNR posted or not - there apparently wasn't anybody there trained to perform CPR.

I suppose we'll get the facts of the matter sooner or later.
I have yet to meet a Nurse that isn't familiar with CPR, and I have worked with quite a few.

Setting that aside, the 911 operator in the recorded call makes it clear to the nurse who is refusing CPR that she can talk her, or anyone else present, through what to do and that anybody in the area can help. At one point, the 911 Operator even asks in desperation for the nurse to get ANYONE, even a passerby, and hand them the phone so she can talk them through how to start CPR on the dying victim.

The nurse refused to even ask if anyone else in the area was willing to assist.
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Old 03-04-2013, 15:28   #168
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Quote:
Originally Posted by tsmo1066 View Post
I have yet to meet a Nurse that isn't familiar with CPR, and I have worked with quite a few.

Setting that aside, the 911 operator in the recorded call makes it clear to the nurse who is refusing CPR that she can talk her, or anyone else present, through what to do and that anybody in the area can help. At one point, the 911 Operator even asks in desperation for the nurse to get ANYONE, even a passerby, and hand them the phone so she can talk them through how to start CPR on the dying victim.

The nurse refused to even ask if anyone else in the area was willing to assist.

Yes, and according to the article, it was the NURSE who said no CPR would be administered to the unconscious woman.

Quote:
The 911 dispatcher said, “We need to get CPR started” to which the nurse said, “They’re refusing CPR. They’re going to let her just die.


Also note the new article you posted gives a different age for the deceased woman.
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Old 03-04-2013, 15:30   #169
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Also note the new article you posted gives a different age for the deceased woman.
I saw that as well. Bakersfield FD puts her age at 80, not 87. I'm assuming the Bakersfield FD has better info than the local news since they have been reviewing this lady's medical files and data for the past day or so, but who knows?

For discussion purposes, I think we can just agree that she was "in her 80's".
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Old 03-04-2013, 15:33   #170
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Quote:
Originally Posted by tsmo1066 View Post
I saw that as well. Bakersfield FD puts her age at 80, not 87. I'm assuming the Bakersfield FD has better info than the local news since they have been reviewing this lady's medical files and data for the past day or so, but who knows?

For discussion purposes, I think we can just agree that she was "in her 80's".

I was not splitting hairs this time, but I obviously reserve the right to do so in the future.

(I kid )
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Old 03-04-2013, 15:36   #171
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Protocols for Alaska: http://dhss.alaska.gov/dph/Emergency...TprotoEMT1.pdf


(for Slathrum).

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Old 03-04-2013, 16:12   #172
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Gallium, you do not need to know where I work. It has no bearing on this discussion. I do not show up and pronounce patients dead. I work the code and if the patient does not respond to resuscitation then I call for a physician to make the call, understanding that the patient has received every intervention possible and is therefor not viable for resuscitation.

The grim reality is that by the time I get there, the patient has been down for at least 10 minutes, and sometimes as much as 40. I've got a fully neurologically intact code save on a patient that was down for 30 minutes. 100% LAD blockage was the etiology. I guess I must not have a clue what I'm doing.

Good grief, the ability to take a limited amount of information combined with training and experience and apply that is the bain of my existence as a paramedic. None of us can say exactly what happened because we were not there. It's amazing how these situations tend to play out though.

Can you imagine yourself a part of the responding crew to this call? What would be going through your mind based on the info that an 87 year old arrested in a dining hall of an assisted living facility? This level of critical thinking is important. The clues matter. Sure, she could have died of a massive MI, PE, aneurysm or whatever else our minds can conjure.

The fact that she did so in this particular setting is telling though. I mean, in a dining hall, what do you think the possibility was that nobody noticed she was going downhill until she was agonally breathing? She didn't die in bed to be found later, she did it in a public setting. We can reasonably assume she went downhill very quickly. We can also assume that based on her location, there's more than a slight probability that she could have had an airway obstruction.

Now, we don't become tunnel-visioned and narrow in on that, but you can be certain I'm going to make sure my EMT's getting good bag compliance and when I go to drop the tube I'll take a look for a foreign body at the same time. Meanwhile, I will also be considering every other cause of cardiac arrest that is treatable/reversible, all while operating a defibrillator, obtaining IV/IO access and administering medications.

I'm not perfect and like I said before, there will always be something for me to learn. I really don't get why you are so hell bent on attacking me. I believe that you are a very intelligent person, but based on your responses you are not particularly knowledgeable. You know enough to make points, but the basis of your arguments are attempting to refute others' points. That is not constructive, even if at times you are right.
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Old 03-04-2013, 16:33   #173
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I'm just a Fire fighter, not near as smart as Gallium. We have a number of assisted living facilities in the area that we cover. A couple of them won't provide lift assists to the residents. So they call us and we come over and pick them up off the ground at all hours of the day, as the staff watch us. It kind of leaves a bad taste in our mouths, but we answer when we are called. We never say no.
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Old 03-04-2013, 16:33   #174
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Quote:
Originally Posted by Gallium View Post
Protocols for Alaska: http://dhss.alaska.gov/dph/Emergency...TprotoEMT1.pdf


(for Slathrum).
I'm not in Alaska, but here's an excerpt from those protocols you posted. Apparently both Alaska and my service operate similarly in this respect.

II. TERMINATING RESUSCITATION:

A. When unable to establish voice communications with a physician, an EMT/MICP
with a certified EMS service may terminate efforts at resuscitation under the
conditions listed below:

1. 30 minutes of CPR was performed by the EMT/MICP on a patient who is
NOT hypothermic without a spontaneous return of respiration or pulse, and
ALS isn’t available.

2. 30 minutes of ALS has been provided to a patient who is NOT hypothermic
without spontaneous return of pulse or respiration.

3. Hypothermic patient has received at least 60 minutes of CPR in conjunction
with rewarming techniques (see Cold Emergencies guidelines) with no
spontaneous return of pulse or respiration.

4. Once evidence of enrollment in Comfort One or other DNR program is
established and the identity of the patient confirmed.
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Old 03-04-2013, 16:39   #175
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There was no DNR. Someone was in distress. There is a duty to act.

The staff were irresponsible, but thats the norm for assisted living.

Why are people jumping to the staffs aid? And Gallium, seriously dude, your wrong, i dont care how intellectual you think you are.
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