Contents of Crash Cart for Dr. office

[Guest guest]

Disregard my last post... it sent before it was ready.

Check this link:

_http://www.statkit.com/index.cfm?fuseaction=stat_

(http://www.statkit.com/index.cfm?fuseaction=stat)

-Wes

In a message dated 9/8/2006 5:42:13 PM Central Daylight Time,

paramedic1@... writes:

Of course, those are good questions! The practice is listed as Pain

Management and Aneshesiology.

=Steve=

_ExLngHrn@..._ (mailto:ExLngHrn@...) wrote:

> Steve:

>

> What kind of physician? What is his/her patient population?

>

> Seems to me that those questions need to be developed before you can fully

answer the request. For example, I can't think of too many geriatricians

who'd need a Broselow tape in their crash kit.

>

> -Wes Ogilvie, MPA, JD, EMT-B

> Austin, Texas

>

>

> Contents of Crash Cart for Dr. office

>

>

> I had a request from one of our local physicians to help them get a

> crash cart together. The don't know what the crash cart consists of.

>

> I have some idea what an ER puts on the crash cart, but for a

> physician's office? I'd think it would depend on what they're prepared

> to do, and maintain. We've had others that didn't want to stock a cart

> and keep everything current when they might rarely need it. So I'd

> think somewhere between an AED alone and a full crash cart is the answer.

>

> BUT, I don't know the answer, so I'm askin'! Any thoughts?

>

> =Steve , LP=

> AlertCPR Emergency Training

>

>

>

> ____________ ____ ____ ____ ____ ____

> Check out AOL.com today. Breaking news, video search, pictures, email and

IM. All on demand. Always Free.

>

>

> [Non-text portions of this message have been removed]

>

>

>

>

> Yahoo! Groups Links

>

>

>

>

>

>

>

>

>

>

>

[Guest guest]

A good place to start might be here:

In a message dated 9/8/2006 5:42:13 PM Central Daylight Time,

paramedic1@... writes:

Of course, those are good questions! The practice is listed as Pain

Management and Aneshesiology.

=Steve=

_ExLngHrn@..._ (mailto:ExLngHrn@...) wrote:

> Steve:

>

> What kind of physician? What is his/her patient population?

>

> Seems to me that those questions need to be developed before you can fully

answer the request. For example, I can't think of too many geriatricians

who'd need a Broselow tape in their crash kit.

>

> -Wes Ogilvie, MPA, JD, EMT-B

> Austin, Texas

>

>

> Contents of Crash Cart for Dr. office

>

>

> I had a request from one of our local physicians to help them get a

> crash cart together. The don't know what the crash cart consists of.

>

> I have some idea what an ER puts on the crash cart, but for a

> physician's office? I'd think it would depend on what they're prepared

> to do, and maintain. We've had others that didn't want to stock a cart

> and keep everything current when they might rarely need it. So I'd

> think somewhere between an AED alone and a full crash cart is the answer.

>

> BUT, I don't know the answer, so I'm askin'! Any thoughts?

>

> =Steve , LP=

> AlertCPR Emergency Training

>

>

>

> ____________ ____ ____ ____ ____ ____

> Check out AOL.com today. Breaking news, video search, pictures, email and

IM. All on demand. Always Free.

>

>

> [Non-text portions of this message have been removed]

>

>

>

>

> Yahoo! Groups Links

>

>

>

>

>

>

>

>

>

>

>

[Guest guest]

I would have the AED, an airway set, with OPAs and NPAs, Combitube and LMA

(and make sure they know how and when to use them), and that's it for the basic

stuff. No laryngoscope. They should go straight to the Combitube for

adults and LMAs for pedis.

I would also demand that the doc and his staff go through an orientation

course given by an EMS educator, pointed toward showing them what they need to

do

while waiting on EMS. CPR and airway would be the main things, with CPR

being the No. 1 emphasis.

I would add, depending upon how short or long EMS response is, IV fluids and

setups, and a couple of amps of epi 1:10000, and an amp of epi 1:1000. Maybe

an amp of atropine and one of vasopressin.

That should do it.

Gene G.

[Guest guest]

I'd go ahead and though in some jumper cables and maybe some WD-40. Sears

sometimes has sales on tool boxes that can double as a crash cart.

[Guest guest]

Don't forget balin wahr and duck tape.

GG

>

> I'd go ahead and though in some jumper cables and maybe some WD-40. Sears

> sometimes has sales on tool boxes that can double as a crash cart.

>

>

[Guest guest]

I had a request from one of our local physicians to help them get a

crash cart together. The don't know what the crash cart consists of.

I have some idea what an ER puts on the crash cart, but for a

physician's office? I'd think it would depend on what they're prepared

to do, and maintain. We've had others that didn't want to stock a cart

and keep everything current when they might rarely need it. So I'd

think somewhere between an AED alone and a full crash cart is the answer.

BUT, I don't know the answer, so I'm askin'! Any thoughts?

=Steve , LP=

AlertCPR Emergency Training

[Guest guest]

Steve:

What kind of physician? What is his/her patient population?

Seems to me that those questions need to be developed before you can fully

answer the request. For example, I can't think of too many geriatricians who'd

need a Broselow tape in their crash kit.

-Wes Ogilvie, MPA, JD, EMT-B

Austin, Texas

Contents of Crash Cart for Dr. office

I had a request from one of our local physicians to help them get a

crash cart together. The don't know what the crash cart consists of.

I have some idea what an ER puts on the crash cart, but for a

physician's office? I'd think it would depend on what they're prepared

to do, and maintain. We've had others that didn't want to stock a cart

and keep everything current when they might rarely need it. So I'd

think somewhere between an AED alone and a full crash cart is the answer.

BUT, I don't know the answer, so I'm askin'! Any thoughts?

=Steve , LP=

AlertCPR Emergency Training

________________________________________________________________________

Check out AOL.com today. Breaking news, video search, pictures, email and IM.

All on demand. Always Free.

[Guest guest]

Of course, those are good questions! The practice is listed as Pain

Management and Aneshesiology.

=Steve=

ExLngHrn@... wrote:

> Steve:

>

> What kind of physician? What is his/her patient population?

>

> Seems to me that those questions need to be developed before you can fully

answer the request. For example, I can't think of too many geriatricians who'd

need a Broselow tape in their crash kit.

>

> -Wes Ogilvie, MPA, JD, EMT-B

> Austin, Texas

>

>

> Contents of Crash Cart for Dr. office

>

>

> I had a request from one of our local physicians to help them get a

> crash cart together. The don't know what the crash cart consists of.

>

> I have some idea what an ER puts on the crash cart, but for a

> physician's office? I'd think it would depend on what they're prepared

> to do, and maintain. We've had others that didn't want to stock a cart

> and keep everything current when they might rarely need it. So I'd

> think somewhere between an AED alone and a full crash cart is the answer.

>

> BUT, I don't know the answer, so I'm askin'! Any thoughts?

>

> =Steve , LP=

> AlertCPR Emergency Training

>

>

>

> ________________________________________________________________________

> Check out AOL.com today. Breaking news, video search, pictures, email and IM.

All on demand. Always Free.

>

>

>

[Guest guest]

In a message dated 9/8/2006 3:24:30 PM Central Standard Time,

paramedic1@... writes:

I had a request from one of our local physicians to help them get a

crash cart together. The don't know what the crash cart consists of.

I have some idea what an ER puts on the crash cart, but for a

physician's office? I'd think it would depend on what they're prepared

to do, and maintain. We've had others that didn't want to stock a cart

and keep everything current when they might rarely need it. So I'd

think somewhere between an AED alone and a full crash cart is the answer.

BUT, I don't know the answer, so I'm askin'! Any thoughts?

=Steve , LP=

AlertCPR Emergency Training

Simplest solution: a Banyan Stat Kit...

_http://www.statkit.com/index.cfm?fuseaction=product & itemnum=700_

(http://www.statkit.com/index.cfm?fuseaction=product & itemnum=700)

Banyan also supplies AEDs...and sends monthly reminders to the offices to

check and replace meds.

I've used them before, and a number of airlines have purchased these kits

for in flight use on International flights.

ck

S. Krin, DO FAAFP

[Guest guest]

The reason that I didn't include the Banyon kit or a similar one in my

recommendations is that most office physicians have no business running a code,

and

if you give them enough stuff, believe me, they'll delay calling 911 and

getting the folks there who do know how to do it.

I have had plenty of interactions with office docs who tried to tell me what

to do for their coded patient, such things as push two amps of sodium bicarb

before you do anything else, or the most usual one, " I don't want you to do

anything to him but take him to the hospital. "

I've always wanted to have one of those a******s as a patient. " Sorry, doc,

but we can't do anything for you but take you to the hospital. Yeah, I know

the pain in your ankle is excruciating. Here, bite on this triangular

bandage while we take the speed bumps. Yeah, I have fentanyl, but you don't

want

a PARAMEDIC giving it to you do you? Just tough it out. We'll be there in

about 45 minutes. "

Gene G.

>

>

> In a message dated 9/8/2006 3:24:30 PM Central Standard Time,

> paramedic1@... writes:

>

> I had a request from one of our local physicians to help them get a

> crash cart together. The don't know what the crash cart consists of.

>

> I have some idea what an ER puts on the crash cart, but for a

> physician's office? I'd think it would depend on what they're prepared

> to do, and maintain. We've had others that didn't want to stock a cart

> and keep everything current when they might rarely need it. So I'd

> think somewhere between an AED alone and a full crash cart is the answer.

>

> BUT, I don't know the answer, so I'm askin'! Any thoughts?

>

> =Steve , LP=

> AlertCPR Emergency Training

>

> Simplest solution: a Banyan Stat Kit...

>

> _http://www.statkit.http://wwwhttp://www.stathttp:// & itemnum=item

> (http://www.statkit.http://wwwhttp://www.stathttp:// & itemnum=ite)

>

> Banyan also supplies AEDs...and sends monthly reminders to the offices to

> check and replace meds.

>

> I've used them before, and a number of airlines have purchased these kits

> for in flight use on International flights.

>

> ck

> S. Krin, DO FAAFP

>

>

[Guest guest]

In a message dated 9/8/2006 10:56:44 PM Central Standard Time,

wegandy1938@... writes:

The reason that I didn't include the Banyon kit or a similar one in my

recommendations is that most office physicians have no business running a

code, and

if you give them enough stuff, believe me, they'll delay calling 911 and

getting the folks there who do know how to do it.

Gene, I believe that you will find that it's actually a recommended item for

any facility doing conscious sedation (like many dental offices and rural

health centers)....

And at the very least, the ADA, the AAFP and Banyan Corp recommend that the

office staff (and the docs) be up to date on the use of the drugs and

equipment in the kit.

ck

[Guest guest]

Aren't MD's *supposed* to have ACLS? I have had a few docs in class with me

before...

Oh, and I once ran a code at an MD office where they had helpfully hooked

the patient up to a 12-lead and recorded her V-Tach to V-fib conversion

before calling 911. The pt. had been sitting in the waiting room, waiting

for her husband to be finished with his appointment, when she complained of

severe pain and then collapsed. The Family Practice MD said something like

" Uh, I'll be back in a few minutes, you guys can just do what you do. "

I also recently had a code in a nursing / rehab facility with the facility

attending MD present, who, with a look of panic on her face stated,

" Whatever you guys want to do, go ahead, I'll sign whatever you want when

you're done. " heh heh heh....

-Meris NREMT-P

FTO MetroCare Services EMS

Austin, TX

[Guest guest]

Loved this response. My feelings excatly on more than 1

occasion.

On Fri, 8 Sep 2006 23:50:17 EDT

wegandy1938@... wrote:

> The reason that I didn't include the Banyon kit or a

>similar one in my

> recommendations is that most office physicians have no

>business running a code, and

> if you give them enough stuff, believe me, they'll delay

>calling 911 and

> getting the folks there who do know how to do it.

>

> I have had plenty of interactions with office docs who

>tried to tell me what

> to do for their coded patient, such things as push two

>amps of sodium bicarb

> before you do anything else, or the most usual one, " I

>don't want you to do

> anything to him but take him to the hospital. "

>

> I've always wanted to have one of those a******s as a

>patient. " Sorry, doc,

> but we can't do anything for you but take you to the

>hospital. Yeah, I know

> the pain in your ankle is excruciating. Here, bite on

>this triangular

> bandage while we take the speed bumps. Yeah, I have

>fentanyl, but you don't want

> a PARAMEDIC giving it to you do you? Just tough it

>out. We'll be there in

> about 45 minutes. "

>

> Gene G.

>

> In a message dated 9/8/06 9:44:33 PM, krin135@...

>writes:

>

>

>>

>>

>> In a message dated 9/8/2006 3:24:30 PM Central Standard

>>Time,

>> paramedic1@... writes:

>>

>> I had a request from one of our local physicians to help

>>them get a

>> crash cart together. The don't know what the crash cart

>>consists of.

>>

>> I have some idea what an ER puts on the crash cart, but

>>for a

>> physician's office? I'd think it would depend on what

>>they're prepared

>> to do, and maintain. We've had others that didn't want

>>to stock a cart

>> and keep everything current when they might rarely need

>>it. So I'd

>> think somewhere between an AED alone and a full crash

>>cart is the answer.

>>

>> BUT, I don't know the answer, so I'm askin'! Any

>>thoughts?

>>

>> =Steve , LP=

>> AlertCPR Emergency Training

>>

>> Simplest solution: a Banyan Stat Kit...

>>

>> _http://www.statkit.http://wwwhttp://www.stathttp:// & itemnum=item

>> (http://www.statkit.http://wwwhttp://www.stathttp:// & itemnum=ite)

>>

>> Banyan also supplies AEDs...and sends monthly reminders

>>to the offices to

>> check and replace meds.

>>

>> I've used them before, and a number of airlines have

>>purchased these kits

>> for in flight use on International flights.

>>

>> ck

>> S. Krin, DO FAAFP

>>

>>

[Guest guest]

not every doctor, mid level or even office nurse keeps up on such

things...remember, we do best what we do often and get feed back on....and many

hospitals do not require docs outside of the critical care teams, (ICU, CCU, ED

and OR) to maintain certification.

ck

S. Krin, DO FAAFP

Re: Contents of Crash Cart for Dr. office

Aren't MD's *supposed* to have ACLS? I have had a few docs in class with me

before...

Oh, and I once ran a code at an MD office where they had helpfully hooked

the patient up to a 12-lead and recorded her V-Tach to V-fib conversion

before calling 911. The pt. had been sitting in the waiting room, waiting

for her husband to be finished with his appointment, when she complained of

severe pain and then collapsed. The Family Practice MD said something like

" Uh, I'll be back in a few minutes, you guys can just do what you do. "

I also recently had a code in a nursing / rehab facility with the facility

attending MD present, who, with a look of panic on her face stated,

" Whatever you guys want to do, go ahead, I'll sign whatever you want when

you're done. " heh heh heh....

-Meris NREMT-P

FTO MetroCare Services EMS

Austin, TX

[Guest guest]

Ain't life GRAND at times?

GG

>

> Aren't MD's *supposed* to have ACLS? I have had a few docs in class with me

> before...

>

> Oh, and I once ran a code at an MD office where they had helpfully hooked

> the patient up to a 12-lead and recorded her V-Tach to V-fib conversion

> before calling 911. The pt. had been sitting in the waiting room, waiting

> for her husband to be finished with his appointment, when she complained of

> severe pain and then collapsed. The Family Practice MD said something like

> " Uh, I'll be back in a few minutes, you guys can just do what you do. "

>

> I also recently had a code in a nursing / rehab facility with the facility

> attending MD present, who, with a look of panic on her face stated,

> " Whatever you guys want to do, go ahead, I'll sign whatever you want when

> you're done. " heh heh heh....

>

> -Meris NREMT-P

> FTO MetroCare Services EMS

> Austin, TX

>

>

[Guest guest]

Yes, and that's all I meant. I didn't mean to insult office docs and

nurses. But it makes sense to me that if you haven't run a code in 10 years,

you

probably won't be very good at it, even if you maintain ACLS status, which

most private physicians do not. It's interesting that Dentists are better at

that than doctors, but I digress.

Why would a dermatologist or an endocrinologist spend much time staying at

Level One in cardiac resuscitation? She probably wouldn't unless she had an

interest in emergency medicine as a sort of a hobby.

So when a physician gets a kit with all sorts of pharmacological toys in it,

he or she needs to be current in cardiac emergency care. That's all. If he

or she doesn't want to live up to that standard, then he or she is better off

doing the AED and airway with a Combitube and doing GOOD CPR till the

paramedics get there. But perhaps he or she should post a notice on the wall

that

informs the patients of what level of emergency cardiac care to expect. Truth

in advertising?

On standard of care, the poor physician is damned if he does and damned if he

doesn't. If he doesn't have a kit, then the experts who favor everybody on

the planet being capable of emergency cardiac care will say he was negligent

in failure to have the necessary tools to care for a coded patient. If he

does have the kit, then he's expected to know book and page how to do everything

that it permits him to do. And if he makes a mistake, he's screwed.

But that's no different from the standard for paramedics. If, for example,

our service chooses not to spend the money for waveform capnography, which is

relatively cheap, and a patient is esophageally intubated and it's not di

scovered until brain damage has occurred, then the experts are going to crucify

the

service for failing to follow what they will testify is now the standard of

care. (BTW, I think it IS now standard of care--ignore it at your peril).

That will provoke a battle over standard of care which the jury will decide,

and I wouldn't bet a nickel on what a jury would find.

No matter what you do, somebody will say that it didn't satisfy the standard

of care.

So what should one do? Have the kit? Don't have the kit?

My own personal feeling is that every physician should maintain proficiency

in emergency cardiac care and have the necessary equipment, drugs, and supplies

in her office in order to handle an emergency on the spot, and train her

staff to run a code. The public thinks that all physicians are basically the

same and that they can all save you from a cardiac arrest. I know that's

simplistic, but I think that's the public's perception. They have been taught

to

revere doctors, and therefore, they expect miracles from all of them. After

all, on TV they always save their patients.

My philosophy is to do the very best you can for your patients at all times,

and if your efforts fail, the family and the jury will forgive you. But you

must do your absolute best. That means keeping up with standards and

practicing for emergencies and having the right stuff available.

I like to use a sports analogy when I talk to students about preparing for

emergencies. Consider that you're a player on a professional sports team, like

the Green Bay Packers. They have a play book that the players are expected

to study and learn. Then they practice, practice, and practice some more

running those plays. But football is only a game, and the losers don't die.

Contrast that with a medical team whose game is cardiac arrest resuscitation.

They have a playbook, the ACLS guidelines or their protocols. They are

expected to know them, and they may have to take a protocol test before they're

hired. But after that, do they practice?

How many EMS crews practice scenarios daily?

Now, if the professional sports team followed EMS practices, they would study

their playbook, take a multiple choice test, maybe run a couple of random

plays, and be certified for two years.

So, on Monday the team would show up and the coach would say, OK, guys, this

week we have a game next Sunday, so I want you to study your playbook and

we'll see you a couple of hours before the game.

That's completely absurd, isn't it? Yet, that's what medical professionals

do. They seldom ever practice. You'd better believe that the sports team

is going to spend the week running plays and practicing to hone their skills to

the finest possible point.

We don't do that in EMS or medicine. But our patients DIE when we fail.

Why don't we practice our " plays " in the same way that sports teams practice.

After all, our game is about life and death.

Think about it!

Your mileage may vary.

Gene G.

Believe those who seek the truth. Doubt those who find it.

--Andre Gide

>

> not every doctor, mid level or even office nurse keeps up on such

> things...remember, we do best what we do often and get feed back on....and

many

> hospitals do not require docs outside of the critical care teams, (ICU, CCU,

ED and

> OR) to maintain certification.

>

> ck

> S. Krin, DO FAAFP

>

>

> Re: Contents of Crash Cart for Dr. office

>

> Aren't MD's *supposed* to have ACLS? I have had a few docs in class with me

> before...

>

> Oh, and I once ran a code at an MD office where they had helpfully hooked

> the patient up to a 12-lead and recorded her V-Tach to V-fib conversion

> before calling 911. The pt. had been sitting in the waiting room, waiting

> for her husband to be finished with his appointment, when she complained of

> severe pain and then collapsed. The Family Practice MD said something like

> " Uh, I'll be back in a few minutes, you guys can just do what you do. "

>

> I also recently had a code in a nursing / rehab facility with the facility

> attending MD present, who, with a look of panic on her face stated,

> " Whatever you guys want to do, go ahead, I'll sign whatever you want when

> you're done. " heh heh heh....

>

> -Meris NREMT-P

> FTO MetroCare Services EMS

> Austin, TX

>

>

[Guest guest]

I think that's a great idea! We should practice, practice, practice. We should

start having a scenario of the day. It would make us start thinking every

morning and help us all improve our skills. By the way, I'm fairly new here and

I have caught your last two scenarios. I really enjoyed trying to figure out

the answer.

Jo NREMT-P

wegandy1938@... wrote:

Yes, and that's all I meant. I didn't mean to insult office docs and

nurses. But it makes sense to me that if you haven't run a code in 10 years, you

probably won't be very good at it, even if you maintain ACLS status, which

most private physicians do not. It's interesting that Dentists are better at

that than doctors, but I digress.

Why would a dermatologist or an endocrinologist spend much time staying at

Level One in cardiac resuscitation? She probably wouldn't unless she had an

interest in emergency medicine as a sort of a hobby.

So when a physician gets a kit with all sorts of pharmacological toys in it,

he or she needs to be current in cardiac emergency care. That's all. If he

or she doesn't want to live up to that standard, then he or she is better off

doing the AED and airway with a Combitube and doing GOOD CPR till the

paramedics get there. But perhaps he or she should post a notice on the wall

that

informs the patients of what level of emergency cardiac care to expect. Truth

in advertising?

On standard of care, the poor physician is damned if he does and damned if he

doesn't. If he doesn't have a kit, then the experts who favor everybody on

the planet being capable of emergency cardiac care will say he was negligent

in failure to have the necessary tools to care for a coded patient. If he

does have the kit, then he's expected to know book and page how to do everything

that it permits him to do. And if he makes a mistake, he's screwed.

But that's no different from the standard for paramedics. If, for example,

our service chooses not to spend the money for waveform capnography, which is

relatively cheap, and a patient is esophageally intubated and it's not di

scovered until brain damage has occurred, then the experts are going to crucify

the

service for failing to follow what they will testify is now the standard of

care. (BTW, I think it IS now standard of care--ignore it at your peril).

That will provoke a battle over standard of care which the jury will decide,

and I wouldn't bet a nickel on what a jury would find.

No matter what you do, somebody will say that it didn't satisfy the standard

of care.

So what should one do? Have the kit? Don't have the kit?

My own personal feeling is that every physician should maintain proficiency

in emergency cardiac care and have the necessary equipment, drugs, and supplies

in her office in order to handle an emergency on the spot, and train her

staff to run a code. The public thinks that all physicians are basically the

same and that they can all save you from a cardiac arrest. I know that's

simplistic, but I think that's the public's perception. They have been taught to

revere doctors, and therefore, they expect miracles from all of them. After

all, on TV they always save their patients.

My philosophy is to do the very best you can for your patients at all times,

and if your efforts fail, the family and the jury will forgive you. But you

must do your absolute best. That means keeping up with standards and

practicing for emergencies and having the right stuff available.

I like to use a sports analogy when I talk to students about preparing for

emergencies. Consider that you're a player on a professional sports team, like

the Green Bay Packers. They have a play book that the players are expected

to study and learn. Then they practice, practice, and practice some more

running those plays. But football is only a game, and the losers don't die.

Contrast that with a medical team whose game is cardiac arrest resuscitation.

They have a playbook, the ACLS guidelines or their protocols. They are

expected to know them, and they may have to take a protocol test before they're

hired. But after that, do they practice?

How many EMS crews practice scenarios daily?

Now, if the professional sports team followed EMS practices, they would study

their playbook, take a multiple choice test, maybe run a couple of random

plays, and be certified for two years.

So, on Monday the team would show up and the coach would say, OK, guys, this

week we have a game next Sunday, so I want you to study your playbook and

we'll see you a couple of hours before the game.

That's completely absurd, isn't it? Yet, that's what medical professionals

do. They seldom ever practice. You'd better believe that the sports team

is going to spend the week running plays and practicing to hone their skills to

the finest possible point.

We don't do that in EMS or medicine. But our patients DIE when we fail.

Why don't we practice our " plays " in the same way that sports teams practice.

After all, our game is about life and death.

Think about it!

Your mileage may vary.

Gene G.

Believe those who seek the truth. Doubt those who find it.

--Andre Gide

>

> not every doctor, mid level or even office nurse keeps up on such

> things...remember, we do best what we do often and get feed back on....and

many

> hospitals do not require docs outside of the critical care teams, (ICU, CCU,

ED and

> OR) to maintain certification.

>

> ck

> S. Krin, DO FAAFP

>

>

> Re: Contents of Crash Cart for Dr. office

>

> Aren't MD's *supposed* to have ACLS? I have had a few docs in class with me

> before...

>

> Oh, and I once ran a code at an MD office where they had helpfully hooked

> the patient up to a 12-lead and recorded her V-Tach to V-fib conversion

> before calling 911. The pt. had been sitting in the waiting room, waiting

> for her husband to be finished with his appointment, when she complained of

> severe pain and then collapsed. The Family Practice MD said something like

> " Uh, I'll be back in a few minutes, you guys can just do what you do. "

>

> I also recently had a code in a nursing / rehab facility with the facility

> attending MD present, who, with a look of panic on her face stated,

> " Whatever you guys want to do, go ahead, I'll sign whatever you want when

> you're done. " heh heh heh....

>

> -Meris NREMT-P

> FTO MetroCare Services EMS

> Austin, TX

>

>

[Guest guest]

With a background of EMS and managing Physicians offices, I feel the

urge to comment on this subject. I have credentialed multiple

physicians with many insurance companies, and hospitals; every

contract has a different set of " requirements " first and foremost

was that the MD/DO be current in ACLS, and an additional office

persons be currently trained in Emergency Life Saving Algorithms. I

agree this is a scary thought, but it was what the commercial

insurance companies required to allow the physician to be a

contracted provider.

Michele L. Poche'

EMS Director CERT Emergency Services

Dispatch

Cell

Fax

> > The reason that I didn't include the Banyon kit or a

> >similar one in my

> > recommendations is that most office physicians have no

> >business running a code, and

> > if you give them enough stuff, believe me, they'll delay

> >calling 911 and

> > getting the folks there who do know how to do it.

> >

> > I have had plenty of interactions with office docs who

> >tried to tell me what

> > to do for their coded patient, such things as push two

> >amps of sodium bicarb

> > before you do anything else, or the most usual one, " I

> >don't want you to do

> > anything to him but take him to the hospital. "

> >

> > I've always wanted to have one of those a******s as a

> >patient. " Sorry, doc,

> > but we can't do anything for you but take you to the

> >hospital. Yeah, I know

> > the pain in your ankle is excruciating. Here, bite on

> >this triangular

> > bandage while we take the speed bumps. Yeah, I have

> >fentanyl, but you don't want

> > a PARAMEDIC giving it to you do you? Just tough it

> >out. We'll be there in

> > about 45 minutes. "

> >

> > Gene G.

> >

> > In a message dated 9/8/06 9:44:33 PM, krin135@...

> >writes:

> >

> >

> >>

> >>

> >> In a message dated 9/8/2006 3:24:30 PM Central Standard

> >>Time,

> >> paramedic1@... writes:

> >>

> >> I had a request from one of our local physicians to help

> >>them get a

> >> crash cart together. The don't know what the crash cart

> >>consists of.

> >>

> >> I have some idea what an ER puts on the crash cart, but

> >>for a

> >> physician's office? I'd think it would depend on what

> >>they're prepared

> >> to do, and maintain. We've had others that didn't want

> >>to stock a cart

> >> and keep everything current when they might rarely need

> >>it. So I'd

> >> think somewhere between an AED alone and a full crash

> >>cart is the answer.

> >>

> >> BUT, I don't know the answer, so I'm askin'! Any

> >>thoughts?

> >>

> >> =Steve , LP=

> >> AlertCPR Emergency Training

> >>

> >> Simplest solution: a Banyan Stat Kit...

> >>

> >>

_http://www.statkit.http://wwwhttp://www.stathttp:// & itemnum=item

> >>

(http://www.statkit.http://wwwhttp://www.stathttp:// & itemnum=ite)

> >>

> >> Banyan also supplies AEDs...and sends monthly reminders

> >>to the offices to

> >> check and replace meds.

> >>

> >> I've used them before, and a number of airlines have

> >>purchased these kits

> >> for in flight use on International flights.

> >>

> >> ck

> >> S. Krin, DO FAAFP

> >>

> >>

[Guest guest]

Michele,

Good points. I agree with Gene mostly, I'm afraid of most physicians

being equipped for ACLS. But I don't know what the rules are. So I'll

do some digging.

And my largest client is a health insurance company, so I'll tap their

network development folks too.

=Steve=

mlpoche wrote:

> With a background of EMS and managing Physicians offices, I feel the

> urge to comment on this subject. I have credentialed multiple

> physicians with many insurance companies, and hospitals; every

> contract has a different set of " requirements " first and foremost

> was that the MD/DO be current in ACLS, and an additional office

> persons be currently trained in Emergency Life Saving Algorithms. I

> agree this is a scary thought, but it was what the commercial

> insurance companies required to allow the physician to be a

> contracted provider.

>

> Michele L. Poche'

> EMS Director CERT Emergency Services

> Dispatch

> Cell

> Fax

>

>

>

>>

>>> The reason that I didn't include the Banyon kit or a

>>> similar one in my

>>> recommendations is that most office physicians have no

>>> business running a code, and

>>> if you give them enough stuff, believe me, they'll delay

>>> calling 911 and

>>> getting the folks there who do know how to do it.

>>>

>>> I have had plenty of interactions with office docs who

>>> tried to tell me what

>>> to do for their coded patient, such things as push two

>>> amps of sodium bicarb

>>> before you do anything else, or the most usual one, " I

>>> don't want you to do

>>> anything to him but take him to the hospital. "

>>>

>>> I've always wanted to have one of those a******s as a

>>> patient. " Sorry, doc,

>>> but we can't do anything for you but take you to the

>>> hospital. Yeah, I know

>>> the pain in your ankle is excruciating. Here, bite on

>>> this triangular

>>> bandage while we take the speed bumps. Yeah, I have

>>> fentanyl, but you don't want

>>> a PARAMEDIC giving it to you do you? Just tough it

>>> out. We'll be there in

>>> about 45 minutes. "

>>>

>>> Gene G.

>>>

>>> In a message dated 9/8/06 9:44:33 PM, krin135@...

>>> writes:

>>>

>>>

>>>

>>>> In a message dated 9/8/2006 3:24:30 PM Central Standard

>>>> Time,

>>>> paramedic1@... writes:

>>>>

>>>> I had a request from one of our local physicians to help

>>>> them get a

>>>> crash cart together. The don't know what the crash cart

>>>> consists of.

>>>>

>>>> I have some idea what an ER puts on the crash cart, but

>>>> for a

>>>> physician's office? I'd think it would depend on what

>>>> they're prepared

>>>> to do, and maintain. We've had others that didn't want

>>>> to stock a cart

>>>> and keep everything current when they might rarely need

>>>> it. So I'd

>>>> think somewhere between an AED alone and a full crash

>>>> cart is the answer.

>>>>

>>>> BUT, I don't know the answer, so I'm askin'! Any

>>>> thoughts?

>>>>

>>>> =Steve , LP=

>>>> AlertCPR Emergency Training

>>>>

>>>> Simplest solution: a Banyan Stat Kit...

>>>>

>>>>

>>>>

> _http://www.statkit.http://wwwhttp://www.stathttp:// & itemnum=item

>

> (http://www.statkit.http://wwwhttp://www.stathttp:// & itemnum=ite)

>

>>>> Banyan also supplies AEDs...and sends monthly reminders

>>>> to the offices to

>>>> check and replace meds.

>>>>

>>>> I've used them before, and a number of airlines have

>>>> purchased these kits

>>>> for in flight use on International flights.

>>>>

>>>> ck

>>>> S. Krin, DO FAAFP

>>>>

>>>>

[Guest guest]

I work in a busy ER and can tell you exactly what we have in our carts, but as

stated before, a physican's office wouldnt need all of the stuff we do, BUT

being that it is pain management and aneshesiology office, and patients are

going to be sedated weather it is as much as concious sedation or not, the doc

and all nurses & techs NEED to have ACLS certs. i also think that an AED is NOT

enough, i think they should have an PL12 or somethin comperable, i full airway

tray with ETTs and an assortment of mac & miller blades, BVMs, EtCO2 detectors,

suction, and a full array of cardiac drugs (epi, lido, atropine, and some dope),

as well as IV supplies. also some narcan would ne a good idea as well since its

pain management office.

that being said, it should be stressed to the office that yes, they might have

equipment to carry on a code for a few mins, but they should call 911 anytime

they use the cart, to expidite transport to a difinitive care facility.

and again, the office faculity should be well versed on when, and how to use the

cart, and maintain the proper certs as well.

this has got me thinking, i wonder if there would be a client base to start a

company, and go to doctor's offices, teach everyone CPR & ACLS and run them

through scenarios, and then keep their crash carts uo to date & restock them

when they've been used. possibly even provide the carts to them for rent or

sale.

Contents of Crash Cart for Dr. office

I had a request from one of our local physicians to help them get a

crash cart together. The don't know what the crash cart consists of.

I have some idea what an ER puts on the crash cart, but for a

physician's office? I'd think it would depend on what they're prepared

to do, and maintain. We've had others that didn't want to stock a cart

and keep everything current when they might rarely need it. So I'd

think somewhere between an AED alone and a full crash cart is the answer.

BUT, I don't know the answer, so I'm askin'! Any thoughts?

=Steve , LP=

AlertCPR Emergency Training