New Thread (My Safety comes First)

[Guest guest]

Well stated Henry. Well stated. When I served as a combat medic in the

25th Inf Div (Light), not only were we trained how to protect your patient from

further harm, we were even evaluated as to how well we protected our

patients. After all, the medics were " Doc. " If my memory serves correct, a

large

portion of all Medal of Honor awards have been given to " Docs " for saving the

lives of their men--even if it meant sacrificing their own.

[Guest guest]

In a message dated 1/23/2007 10:25:23 AM Central Standard Time,

petsardlj@... writes:

I think we need to be more concerned about how much the violence has made

our job that much harder, and think about those issues. I do believe there

needs to be some kind of relevant instuction on what the company feels is the

way

to deal with a violent patient. This way the employee understands when the

company will stand behind you and when the company will stand behind you.

I agree. Grayson and I did a number of 'scene safety classes' for both

Basic and Paramedic students over the years...two of them got realistic

enough that there were students that ended up almost needing to change their

knickers....funny that no one from either of those classes forgot to actually

*check* for scene safety from that time forward...

ck

S. Krin, DO FAAFP

[Guest guest]

Lets talk about this subject for a few. Just how broad does that statement

extend?

Question: If your ambulance is in a wreck do you just jump out and leave your

patient strapped to the stretcher inside just in case it may catch fire or blow

up?

Question: Do you stop 5 blocks from a call just because the dispatcher stated

someone was hit in the face? How long do you wait for PD to get there?

Question: Do you refuse to transport a mental patient just because he may become

violent?

Question: Do you not respond to an industrial accident just because it is an

industrial plant and has hazardous chemicals.

Question: If someone attacks your patient while you are working on them do you

simply stand up, throw up your hands and state get after it just don't hit me.

Question: If your partner is getting his ass whupped do you run outside and

squeal for help?

Question: Do you not respond to the poor side of town just because their tends

to be more crime in that area?

Just how far do we extend our own safety at the expense of the folks we are out

their to assist and protect if need be? I think the answer is use of common

sense. Of course now days we may have to do some searching for common sense in

EMS. I really believe that now days medics take their personal safety to some

non common sense extremes. I almost equate it to the what's in it for me train

of thought. No one is saying jump out there and take a bullet for someone else.

I am saying take a reasonable approach. Get close enough to the scene or you

patient to make an assessment if their is danger or not. ( I don't know the

whole story about the guy jumping from the ambulance and am only using it as an

example. This is no reflection on the crew that was on the call.) At the very

least take a few lumps before allowing your patient take the big road rash

plunge. That may mean the difference between 70 mph and 5 mph. In the last 34

years I have never hit a patient but I surely have scared the hell out of a few

that thought they were going to whup my ass. Intimidation can be a last resort.

Size is not the only intimdator. I have had some small gals that worked for me

that could get the job done.

Sometimes it appears to me. I repeat appears to me, that todays medic looks for

any and every excuse to not do their jobs while crying how hard they have it. My

only advise is to just get in there and do your job. Be cautious but don't what

if it to death.

Flame on boys I have my teflon undies on.

Henry

[Guest guest]

Normally I like to argue with you a little Henry, but you are dead on the money

this time around.....well said

Hatfield FF/EMT-P

---------- Original Message ----------------------------------

Reply-To: texasems-l

Date: Tue, 23 Jan 2007 09:07:03 -0600

>Lets talk about this subject for a few. Just how broad does that statement

extend?

>

>Question: If your ambulance is in a wreck do you just jump out and leave your

patient strapped to the stretcher inside just in case it may catch fire or blow

up?

>

>Question: Do you stop 5 blocks from a call just because the dispatcher stated

someone was hit in the face? How long do you wait for PD to get there?

>

>Question: Do you refuse to transport a mental patient just because he may

become violent?

>

>Question: Do you not respond to an industrial accident just because it is an

industrial plant and has hazardous chemicals.

>

>Question: If someone attacks your patient while you are working on them do you

simply stand up, throw up your hands and state get after it just don't hit me.

>

>Question: If your partner is getting his ass whupped do you run outside and

squeal for help?

>

>Question: Do you not respond to the poor side of town just because their tends

to be more crime in that area?

>

>Just how far do we extend our own safety at the expense of the folks we are out

their to assist and protect if need be? I think the answer is use of common

sense. Of course now days we may have to do some searching for common sense in

EMS. I really believe that now days medics take their personal safety to some

non common sense extremes. I almost equate it to the what's in it for me train

of thought. No one is saying jump out there and take a bullet for someone else.

I am saying take a reasonable approach. Get close enough to the scene or you

patient to make an assessment if their is danger or not. ( I don't know the

whole story about the guy jumping from the ambulance and am only using it as an

example. This is no reflection on the crew that was on the call.) At the very

least take a few lumps before allowing your patient take the big road rash

plunge. That may mean the difference between 70 mph and 5 mph. In the last 34

years I have never hit a patient but I surely have scared the hell out of a few

that thought they were going to whup my ass. Intimidation can be a last resort.

Size is not the only intimdator. I have had some small gals that worked for me

that could get the job done.

>

>Sometimes it appears to me. I repeat appears to me, that todays medic looks for

any and every excuse to not do their jobs while crying how hard they have it. My

only advise is to just get in there and do your job. Be cautious but don't what

if it to death.

>

>Flame on boys I have my teflon undies on.

>

>

>Henry

>

>

[Guest guest]

Henry:

The last image I needed this morning was you in undies of any kind. LOL

However, you bring up a serious point that I'd like to expand on. Too many

medics I know want hard and fast rules for everything we do in EMS. If X, then

Y ALWAYS.

Unfortunately, we're dealing with people. That means that what we do isn't

always a black/white situation, nor is it cut and dried. It means we have to use

common sense and judgement, whether it's " scene safety " or how we treat a

patient.

On a related note, how many of us have met a patient who presents with the

classic symptoms of a medical condition and who fits perfectly into our

treatment protocols and responds perfectly to those treatments? Let me know

when you have, because that patient seems as rare as a medic who doesn't

complain about their job. ;-)

If we want cookbook medicine, inviolate rules, and medics who parrot back the

policy manual without thinking, we should hire trained chimps. At least the

chimps wouldn't complain about system status management. Then again, there are

some places around here that seem to have parrots that repeat back the " company

line. " LOL

-Wes Ogilvie

P.S. -- I'm wearing Nomex undies. Slightly better flame protection than Teflon.

:-)

New Thread (My Safety comes First)

Lets talk about this subject for a few. Just how broad does that statement

extend?

Question: If your ambulance is in a wreck do you just jump out and leave your

patient strapped to the stretcher inside just in case it may catch fire or blow

up?

Question: Do you stop 5 blocks from a call just because the dispatcher stated

someone was hit in the face? How long do you wait for PD to get there?

Question: Do you refuse to transport a mental patient just because he may become

violent?

Question: Do you not respond to an industrial accident just because it is an

industrial plant and has hazardous chemicals.

Question: If someone attacks your patient while you are working on them do you

simply stand up, throw up your hands and state get after it just don't hit me.

Question: If your partner is getting his ass whupped do you run outside and

squeal for help?

Question: Do you not respond to the poor side of town just because their tends

to be more crime in that area?

Just how far do we extend our own safety at the expense of the folks we are out

their to assist and protect if need be? I think the answer is use of common

sense. Of course now days we may have to do some searching for common sense in

EMS. I really believe that now days medics take their personal safety to some

non common sense extremes. I almost equate it to the what's in it for me train

of thought. No one is saying jump out there and take a bullet for someone else.

I am saying take a reasonable approach. Get close enough to the scene or you

patient to make an assessment if their is danger or not. ( I don't know the

whole story about the guy jumping from the ambulance and am only using it as an

example. This is no reflection on the crew that was on the call.) At the very

least take a few lumps before allowing your patient take the big road rash

plunge. That may mean the difference between 70 mph and 5 mph. In the last 34

years I have never hit a patient but I surely have scared the hell out of a few

that thought they were going to whup my ass. Intimidation can be a last resort.

Size is not the only intimdator. I have had some small gals that worked for me

that could get the job done.

Sometimes it appears to me. I repeat appears to me, that todays medic looks for

any and every excuse to not do their jobs while crying how hard they have it. My

only advise is to just get in there and do your job. Be cautious but don't what

if it to death.

Flame on boys I have my teflon undies on.

Henry

[Guest guest]

Just when Henry starts to act all mellow, befitting his many years...he jumps up

and gets fired up long enough to restore our faith in his sometimes well placed

belligerence! Go get 'em big boy. PS. Is the Teflon coating on the inside or

the outside?

Vernon Gresham

New Thread (My Safety comes First)

Lets talk about this subject for a few. Just how broad does that statement

extend?

Question: If your ambulance is in a wreck do you just jump out and leave your

patient strapped to the stretcher inside just in case it may catch fire or blow

up?

Question: Do you stop 5 blocks from a call just because the dispatcher stated

someone was hit in the face? How long do you wait for PD to get there?

Question: Do you refuse to transport a mental patient just because he may

become violent?

Question: Do you not respond to an industrial accident just because it is an

industrial plant and has hazardous chemicals.

Question: If someone attacks your patient while you are working on them do you

simply stand up, throw up your hands and state get after it just don't hit me.

Question: If your partner is getting his ass whupped do you run outside and

squeal for help?

Question: Do you not respond to the poor side of town just because their tends

to be more crime in that area?

Just how far do we extend our own safety at the expense of the folks we are

out their to assist and protect if need be? I think the answer is use of common

sense. Of course now days we may have to do some searching for common sense in

EMS. I really believe that now days medics take their personal safety to some

non common sense extremes. I almost equate it to the what's in it for me train

of thought. No one is saying jump out there and take a bullet for someone else.

I am saying take a reasonable approach. Get close enough to the scene or you

patient to make an assessment if their is danger or not. ( I don't know the

whole story about the guy jumping from the ambulance and am only using it as an

example. This is no reflection on the crew that was on the call.) At the very

least take a few lumps before allowing your patient take the big road rash

plunge. That may mean the difference between 70 mph and 5 mph. In the last 34

years I have never hit a patient but I surely have scared the hell out of a few

that thought they were going to whup my ass. Intimidation can be a last resort.

Size is not the only intimdator. I have had some small gals that worked for me

that could get the job done.

Sometimes it appears to me. I repeat appears to me, that todays medic looks

for any and every excuse to not do their jobs while crying how hard they have

it. My only advise is to just get in there and do your job. Be cautious but

don't what if it to death.

Flame on boys I have my teflon undies on.

Henry

[Guest guest]

Personal safety is something we should all think about. Common sense is not as

common as we should like it to be.

I think that there may not be as much training on: YOU CAN'T HELP IF YOU CAN'T

GET TO YOUR PATIENT or YOU CAN'T HELP IF YOU ARE CONCERNED ABOUT YOUR OWN

SAFETY. " Scene safety " are just a couple of words and not a clear intentioned

thought process in teaching new EMS folk.

I think we need to be more concerned about how much the violence has made our

job that much harder, and think about those issues. I do believe there needs to

be some kind of relevant instuction on what the company feels is the way to deal

with a violent patient. This way the employee understands when the company will

stand behind you and when the company will stand behind you.

Leadership doesn't start in the middle it starts at the top.

Henry Barber wrote:

Lets talk about this subject for a few. Just how broad does that

statement extend?

Question: If your ambulance is in a wreck do you just jump out and leave your

patient strapped to the stretcher inside just in case it may catch fire or blow

up?

Question: Do you stop 5 blocks from a call just because the dispatcher stated

someone was hit in the face? How long do you wait for PD to get there?

Question: Do you refuse to transport a mental patient just because he may become

violent?

Question: Do you not respond to an industrial accident just because it is an

industrial plant and has hazardous chemicals.

Question: If someone attacks your patient while you are working on them do you

simply stand up, throw up your hands and state get after it just don't hit me.

Question: If your partner is getting his ass whupped do you run outside and

squeal for help?

Question: Do you not respond to the poor side of town just because their tends

to be more crime in that area?

Just how far do we extend our own safety at the expense of the folks we are out

their to assist and protect if need be? I think the answer is use of common

sense. Of course now days we may have to do some searching for common sense in

EMS. I really believe that now days medics take their personal safety to some

non common sense extremes. I almost equate it to the what's in it for me train

of thought. No one is saying jump out there and take a bullet for someone else.

I am saying take a reasonable approach. Get close enough to the scene or you

patient to make an assessment if their is danger or not. ( I don't know the

whole story about the guy jumping from the ambulance and am only using it as an

example. This is no reflection on the crew that was on the call.) At the very

least take a few lumps before allowing your patient take the big road rash

plunge. That may mean the difference between 70 mph and 5 mph. In the last 34

years I have never hit a patient but I surely have

scared the hell out of a few that thought they were going to whup my ass.

Intimidation can be a last resort. Size is not the only intimdator. I have had

some small gals that worked for me that could get the job done.

Sometimes it appears to me. I repeat appears to me, that todays medic looks for

any and every excuse to not do their jobs while crying how hard they have it. My

only advise is to just get in there and do your job. Be cautious but don't what

if it to death.

Flame on boys I have my teflon undies on.

Henry

[Guest guest]

Being that my comment started this topic I must reply

as follows: And by the way Henry you are right,

however, we were taught that our safety comes first.

If dispatch says stage a block away, then I am staging

a block away till PD secures the scene. If family

members approach or the victim, then I will stage even

further. What if the perp is watching and them comes

and finishes the job? I am not standing in the way of

a knife or a gun. My days of serving my country are

over and I am not putting my likfe before anyone other

than my own family and my partner. And by the way,

you can't compare combat medics to street medics, way

different training and environment. When you sign the

dotted line, your butt belongs to Uncle Sam. And even

then it is up to the individual soldiers whether or

not they are willing to lay down their life for their

comrade. I have never heard of any soldier facing

punishment for not taking a bullet or grenade. Back

to the topic. If the pt is a psych pt, then

everything should be done on scene to control the

patient and ensure his safety and my safety enroute.

Do you go into an industrial call? Not until FD

arrives to control the scene if it is a fire. If it

is medical then of course you enter. If my ambulance

is in a wreck then the patient and me come out, if I

am conscious, if not then how can I help him. Of

course I believe the order is me, partner, and then

patient. Correct me if I am wrong. Do I intervene if

my partner is getting his ass whupped? Is he an ass

and probably deserves it? Is he a loud mouth and rude

to the patient? I can think of one medic that comes

to mind. He is very rude to patients. family, and

co-workers. I would not even take a bullet for this

guy. I remember on service where a scenario was given

about a crash with a patient in the back. The correct

answer was to help your partner first, patient last.

Scene safety above all, that is what we are taught.

Our safety first, then the patient. If he wants to

jump out of a moving ambulance at 70 mph, then sobeit.

Of course hopefully he was secured to the

stretcher/backboard, etc. Your partner should have

enough sense to slow down before he jumps out. Flame

on guys, I have no hard feelings. I love criticism.

It makes you think twice.

Sal Capuchino Jr

EMT-Paramedic

--- Danny wrote:

> Personal safety is something we should all think

> about. Common sense is not as common as we should

> like it to be.

>

> I think that there may not be as much training on:

> YOU CAN'T HELP IF YOU CAN'T GET TO YOUR PATIENT or

> YOU CAN'T HELP IF YOU ARE CONCERNED ABOUT YOUR OWN

> SAFETY. " Scene safety " are just a couple of words

> and not a clear intentioned thought process in

> teaching new EMS folk.

>

> I think we need to be more concerned about how

> much the violence has made our job that much harder,

> and think about those issues. I do believe there

> needs to be some kind of relevant instuction on what

> the company feels is the way to deal with a violent

> patient. This way the employee understands when the

> company will stand behind you and when the company

> will stand behind you.

>

> Leadership doesn't start in the middle it starts

> at the top.

>

> Henry Barber wrote:

> Lets talk about this subject for a few.

> Just how broad does that statement extend?

>

> Question: If your ambulance is in a wreck do you

> just jump out and leave your patient strapped to the

> stretcher inside just in case it may catch fire or

> blow up?

>

> Question: Do you stop 5 blocks from a call just

> because the dispatcher stated someone was hit in the

> face? How long do you wait for PD to get there?

>

> Question: Do you refuse to transport a mental

> patient just because he may become violent?

>

> Question: Do you not respond to an industrial

> accident just because it is an industrial plant and

> has hazardous chemicals.

>

> Question: If someone attacks your patient while you

> are working on them do you simply stand up, throw up

> your hands and state get after it just don't hit me.

>

> Question: If your partner is getting his ass whupped

> do you run outside and squeal for help?

>

> Question: Do you not respond to the poor side of

> town just because their tends to be more crime in

> that area?

>

> Just how far do we extend our own safety at the

> expense of the folks we are out their to assist and

> protect if need be? I think the answer is use of

> common sense. Of course now days we may have to do

> some searching for common sense in EMS. I really

> believe that now days medics take their personal

> safety to some non common sense extremes. I almost

> equate it to the what's in it for me train of

> thought. No one is saying jump out there and take a

> bullet for someone else. I am saying take a

> reasonable approach. Get close enough to the scene

> or you patient to make an assessment if their is

> danger or not. ( I don't know the whole story about

> the guy jumping from the ambulance and am only using

> it as an example. This is no reflection on the crew

> that was on the call.) At the very least take a few

> lumps before allowing your patient take the big road

> rash plunge. That may mean the difference between 70

> mph and 5 mph. In the last 34 years I have never hit

> a patient but I surely have

> scared the hell out of a few that thought they were

> going to whup my ass. Intimidation can be a last

> resort. Size is not the only intimdator. I have had

> some small gals that worked for me that could get

> the job done.

>

> Sometimes it appears to me. I repeat appears to me,

> that todays medic looks for any and every excuse to

> not do their jobs while crying how hard they have

> it. My only advise is to just get in there and do

> your job. Be cautious but don't what if it to death.

>

> Flame on boys I have my teflon undies on.

>

> Henry

>

> [Non-text portions of this message have been

> removed]

>

>

>

>

>

>

> Danny L.

> Owner/NREMT-P

> PETSAR INC.

> (Panhandle Emergency Training Services And Response)

> Office

> Fax

>

> [Non-text portions of this message have been

> removed]

>

>

>

>

>

[Guest guest]

Thanks Henry.

Very well stated.

Jack Pitcock

_____

From: texasems-l [mailto:texasems-l ] On

Behalf Of Henry Barber

Sent: Tuesday, January 23, 2007 9:07 AM

To: texasems-l

Subject: New Thread (My Safety comes First)

Lets talk about this subject for a few. Just how broad does that statement

extend?

Question: If your ambulance is in a wreck do you just jump out and leave

your patient strapped to the stretcher inside just in case it may catch fire

or blow up?

Question: Do you stop 5 blocks from a call just because the dispatcher

stated someone was hit in the face? How long do you wait for PD to get

there?

Question: Do you refuse to transport a mental patient just because he may

become violent?

Question: Do you not respond to an industrial accident just because it is an

industrial plant and has hazardous chemicals.

Question: If someone attacks your patient while you are working on them do

you simply stand up, throw up your hands and state get after it just don't

hit me.

Question: If your partner is getting his ass whupped do you run outside and

squeal for help?

Question: Do you not respond to the poor side of town just because their

tends to be more crime in that area?

Just how far do we extend our own safety at the expense of the folks we are

out their to assist and protect if need be? I think the answer is use of

common sense. Of course now days we may have to do some searching for common

sense in EMS. I really believe that now days medics take their personal

safety to some non common sense extremes. I almost equate it to the what's

in it for me train of thought. No one is saying jump out there and take a

bullet for someone else. I am saying take a reasonable approach. Get close

enough to the scene or you patient to make an assessment if their is danger

or not. ( I don't know the whole story about the guy jumping from the

ambulance and am only using it as an example. This is no reflection on the

crew that was on the call.) At the very least take a few lumps before

allowing your patient take the big road rash plunge. That may mean the

difference between 70 mph and 5 mph. In the last 34 years I have never hit a

patient but I surely have scared the hell out of a few that thought they

were going to whup my ass. Intimidation can be a last resort. Size is not

the only intimdator. I have had some small gals that worked for me that

could get the job done.

Sometimes it appears to me. I repeat appears to me, that todays medic looks

for any and every excuse to not do their jobs while crying how hard they

have it. My only advise is to just get in there and do your job. Be cautious

but don't what if it to death.

Flame on boys I have my teflon undies on.

Henry

[Guest guest]

Hatfield FF/EMT-P

www.canyonlakefire-ems.org

>

>PS. Is the Teflon coating on the inside or the outside?

The outside, I really don't think you or I either one want to know what the

inside is coated with...

________________________________________________________________

Sent via the WebMail system at Neopolis.net

[Guest guest]

> If dispatch says stage a block away, then I am staging

> a block away till PD secures the scene. If family

> members approach or the victim, then I will stage even

> further.

Why? If you're safe a block away and they bring the patient to you,

what's the issue? Is the fact that you're staging somehow

interfering with your ability to determine scene safety? If they're

bringing the VIOLENCE and un-safeness to you then by all means

retreat. If they're approaching to get help, why not use that chance

to get the information you need to clarify your initial determination

in regards to scene safety?

> What if the perp is watching and them comes

> and finishes the job? I am not standing in the way of

> a knife or a gun. My days of serving my country are

> over and I am not putting my likfe before anyone other

> than my own family and my partner. And by the way,

> you can't compare combat medics to street medics, way

> different training and environment.

Not anymore. Anymore, medics are encountering more and more violent

situations and have at least a threat of encountering situations that

would previously only been encountered in combat situations. If

you're not willing to place your life at risk (not NEEDLESSLY at

risk, but at risk nonetheless) then, respectfully, you need to find a

different profession. You risk your life for patients all the time

by running code to them, responding to their emergency, etc. Your

partner does the same and makes the same choice(s) you do. Given

that, the first priority is your patient, in a manner that is the

safest available for you and your partner (not just you - this is

where the partner concept comes in).

> If my ambulance

> is in a wreck then the patient and me come out, if I

> am conscious, if not then how can I help him. Of

> course I believe the order is me, partner, and then

> patient. Correct me if I am wrong.

I think you're wrong. If you're in the back with the patient, your

responsibility is to the patient. So, given that, it'd be me, my

patient, then my partner. My partner chose to accept the risk - my

patient didn't - and I owe initial safety to my patient. That sucks,

and the best thing is to do everything possible to avoid that type of

situational choice, but that's the reality of public service and

public safety. This isn't selling girl scout cookies - it's

EMERGENCY service.

> Do I intervene if

> my partner is getting his ass whupped? Is he an ass

> and probably deserves it? Is he a loud mouth and rude

> to the patient? I can think of one medic that comes

> to mind. He is very rude to patients. family, and

> co-workers.

IMHO, this is unacceptable. You either accept the responsibility to

help your partner or you don't. Caveat: this doesn't apply to a

situation that your partner CREATES/CREATED. You buy the ticket, you

take the ride.

> Our safety first, then the patient. If he wants to

> jump out of a moving ambulance at 70 mph, then sobeit.

> Of course hopefully he was secured to the

> stretcher/backboard, etc.

I really hope you don't mean this. Your responsibility to the

patient at this point is one of safekeeping. If you have to get

injured in the fight to keep the patient from getting dead while your

partner is stopping, pulling over and calling for help, so be it. If

you're not willing to accept that responsibility, don't get in the

back of an ambulance ever again.

The *better* alternative to to identify those patients likely to be

safety risks and take the appropriate precautions. Hospitals worry

about restraints because there's few risks and more oversight. I can

MUCH more easily justify tying someone to a stretcher when the

alternative is allowing them to choose to jump out the back of an 8x6

room moving at 70mph on a road with traffic.

Mike

[Guest guest]

Why? If you're safe a block away and they bring the

> patient to you,

> what's the issue? Is the fact that you're staging

> somehow

> interfering with your ability to determine scene

> safety? If they're

> bringing the VIOLENCE and un-safeness to you then by

> all means

> retreat. If they're approaching to get help, why

> not use that chance

> to get the information you need to clarify your

> initial determination

> in regards to scene safety?

The scene still has not been cleared by LE. If the

pere is till in the area, what's to keep him from

coming back? If you are also in LE that's great for

you, you have two roles to play. There maybe certain

instances where I may put others' life before mine,

but a scene like this is not one of them. Where in

any EMS book have you or anyone on this list (Dr. B

you may comment if I am wrong) read that we are

required to comprimise our safety. On the contrary

Mr. we are taught OUR SAFETY FIRST. I have never

read anywhere that depending on the situation or in

certain situations, we may be required to put the

patient's life before ours. You make it sound like it

is a TDSHS rule Mike. It is personal choice. If you

want to take a bullet or a stabbing for a patient then

more power to you. I for one am not.

Not anymore. Anymore, medics are encountering more

> and more violent

> situations and have at least a threat of

> encountering situations that

> would previously only been encountered in combat

> situations. If

> you're not willing to place your life at risk (not

> NEEDLESSLY at

> risk, but at risk nonetheless) then, respectfully,

> you need to find a

> different profession. You risk your life for

> patients all the time

> by running code to them, responding to their

> emergency, etc. Your

> partner does the same and makes the same choice(s)

> you do. Given

> that, the first priority is your patient, in a

> manner that is the

> safest available for you and your partner (not just

> you - this is

> where the partner concept comes in).

I have yet to encounter a combat scenario out here in

the streets. That is why there are tactical medics.

That is probably the closest to combat that our

profession will see. I think your point of view is

coming more from a LE perspective than from the EMS

side. Henry feel free to comment. How do you feel

about this?

> I think you're wrong. If you're in the back with

> the patient, your

> responsibility is to the patient. So, given that,

> it'd be me, my

> patient, then my partner. My partner chose to

> accept the risk - my

> patient didn't - and I owe initial safety to my

> patient. That sucks,

> and the best thing is to do everything possible to

> avoid that type of

> situational choice, but that's the reality of public

> service and

> public safety. This isn't selling girl scout

> cookies - it's

> EMERGENCY service.

This is a very touchy issue. Guys what do you think?

Do you save your partner first or the patient?

> IMHO, this is unacceptable. You either accept the

> responsibility to

> help your partner or you don't. Caveat: this

> doesn't apply to a

> situation that your partner CREATES/CREATED. You

> buy the ticket, you

> take the ride.

If he is a loud mouth and deserves the beat down,

guess what, have at him. I am not taking a beating

for a loud mouth, rude, and abnoxious partner. We

currently have a medic in this service that is rude to

patients, family, and co-workers. I know most

everyone here would not interfere if he was getting a

beat down after being rude.

> I really hope you don't mean this. Your

> responsibility to the

> patient at this point is one of safekeeping. If you

> have to get

> injured in the fight to keep the patient from

> getting dead while your

> partner is stopping, pulling over and calling for

> help, so be it. If

> you're not willing to accept that responsibility,

> don't get in the

> back of an ambulance ever again.

If he was properly secured and he managed to unsecure

himself and probably push me out of the way or

threaten me in some way, then guess what? Hopefully

by this time my partner has slowed down, he can jump

out if he wants. I am not going to get in his way

again only to get hurt worse.

If you

> have to get

> injured in the fight to keep the patient from

> getting dead while your

> partner is stopping, pulling over and calling for

> help, so be it.

Can you please tell me what TDH rule or what book you

read this in? And don't tell me that it is not

ethical not to because I think alot of people would

tend to disagree on this one. Henry?

If

> you're not willing to accept that responsibility,

> don't get in the

> back of an ambulance ever again.

I am willing to accept certain responsibility that

comes with the job such as responding to scenes, etc.

But no where have I ever read that you will sometimes

have to jump in front of a person who is suicidal,

take a bullet for a patient, get stabbed trying to

help a patient, etc. If anything you are a liability

to you and your partner, but like I have said before,

it is peersonal choice. If you want to play the HERO,

then hey wait for your plaque from the city or maybe

post-humously. I for one choose to stay alive for my

family. We are in enough danger, as you say, as it is

without having to add to it by taking these actions.

Sal Capuchino Jr

EMT-Paramedic

--- Mike wrote:

> On Jan 23, 2007, at 11:13 AM, salvador capuchino

> wrote:

>

> > If dispatch says stage a block away, then I am

> staging

> > a block away till PD secures the scene. If family

> > members approach or the victim, then I will stage

> even

> > further.

>

> Why? If you're safe a block away and they bring the

> patient to you,

> what's the issue? Is the fact that you're staging

> somehow

> interfering with your ability to determine scene

> safety? If they're

> bringing the VIOLENCE and un-safeness to you then by

> all means

> retreat. If they're approaching to get help, why

> not use that chance

> to get the information you need to clarify your

> initial determination

> in regards to scene safety?

>

> > What if the perp is watching and them comes

> > and finishes the job? I am not standing in the way

> of

> > a knife or a gun. My days of serving my country

> are

> > over and I am not putting my likfe before anyone

> other

> > than my own family and my partner. And by the way,

> > you can't compare combat medics to street medics,

> way

> > different training and environment.

>

> Not anymore. Anymore, medics are encountering more

> and more violent

> situations and have at least a threat of

> encountering situations that

> would previously only been encountered in combat

> situations. If

> you're not willing to place your life at risk (not

> NEEDLESSLY at

> risk, but at risk nonetheless) then, respectfully,

> you need to find a

> different profession. You risk your life for

> patients all the time

> by running code to them, responding to their

> emergency, etc. Your

> partner does the same and makes the same choice(s)

> you do. Given

> that, the first priority is your patient, in a

> manner that is the

> safest available for you and your partner (not just

> you - this is

> where the partner concept comes in).

>

> > If my ambulance

> > is in a wreck then the patient and me come out, if

> I

> > am conscious, if not then how can I help him. Of

> > course I believe the order is me, partner, and

> then

> > patient. Correct me if I am wrong.

>

> I think you're wrong. If you're in the back with

> the patient, your

> responsibility is to the patient. So, given that,

> it'd be me, my

> patient, then my partner. My partner chose to

> accept the risk - my

> patient didn't - and I owe initial safety to my

> patient. That sucks,

> and the best thing is to do everything possible to

> avoid that type of

> situational choice, but that's the reality of public

> service and

> public safety. This isn't selling girl scout

> cookies - it's

> EMERGENCY service.

>

> > Do I intervene if

> > my partner is getting his ass whupped? Is he an

> ass

> > and probably deserves it? Is he a loud mouth and

> rude

> > to the patient? I can think of one medic that

> comes

> > to mind. He is very rude to patients. family, and

> > co-workers.

>

> IMHO, this is unacceptable. You either accept the

> responsibility to

> help your partner or you don't. Caveat: this

> doesn't apply to a

> situation that your partner CREATES/CREATED. You

> buy the ticket, you

> take the ride.

>

> > Our safety first, then the patient. If he wants to

> > jump out of a moving ambulance at 70 mph, then

> sobeit.

> > Of course hopefully he was secured to the

> > stretcher/backboard, etc.

>

> I really hope you don't mean this. Your

> responsibility to the

> patient at this point is one of safekeeping. If you

> have to get

> injured in the fight to keep the patient from

> getting dead while your

> partner is stopping, pulling over and calling for

> help, so be it. If

> you're not willing to accept that responsibility,

> don't get in the

> back of an ambulance ever again.

>

> The *better* alternative to to identify those

> patients likely to be

> safety risks and take the appropriate precautions.

> Hospitals worry

> about restraints because there's few risks and more

> oversight. I can

> MUCH more easily justify tying someone to a

> stretcher when the

> alternative is allowing them to choose to jump out

> the back of an 8x6

> room moving at 70mph on a road with traffic.

>

> Mike

>

>

>

>

[Guest guest]

> The scene still has not been cleared by LE. If the

> pere is till in the area, what's to keep him from

> coming back? If you are also in LE that's great for

> you, you have two roles to play. There maybe certain

> instances where I may put others' life before mine,

> but a scene like this is not one of them. Where in

> any EMS book have you or anyone on this list (Dr. B

> you may comment if I am wrong) read that we are

> required to comprimise our safety. On the contrary

> Mr. we are taught OUR SAFETY FIRST. I have never

> read anywhere that depending on the situation or in

> certain situations, we may be required to put the

> patient's life before ours. You make it sound like it

> is a TDSHS rule Mike. It is personal choice. If you

> want to take a bullet or a stabbing for a patient then

> more power to you. I for one am not.

If you haven't figured it out yet, EMS is a dangerous (okay,

hazardous) business (okay, profession). By putting on the uniform

and accepting the public trust, you accept that there may come a time

when you are asked to place yourself at risk for the public. That's

the PUBLIC part of public service (without even getting into the

PUBLIC safety vs PUBLIC health argument). While the best course of

action is to act in such a manner that you and your partner are well

protected, the bottom line is that it comes down to a personal

willingness to accept risk - the risk of running Code 3 through

traffic, the risk of starting IV's on patients with bloodborne

diseases, the risk of being the one that treats the first guy off the

plane from central Africa that has Ebola and being infected and dying

from a contagious disease... the list goes on and on. EMS is *not* a

safe profession, but advances in training, education and equipment

are such that it is made /safer/. Even so, just like in the fire

service and police work, there may come a time when you are asked to

place yourself in personal jeopardy for a patient or group of

patients. Obviously I'm not talking about a suicidal action (one

that you KNOW you won't come out of), but one in which the risk of

death is real. Rappelling down to a high angle incident. Strapping

into a helicopter with a rainstorm coming. Everything has mitigated

risks - and so does EMS.

There doesn't need to be a TDSHS rule, or a line in a book. The

" rule " is the acceptance of public trust, something most EMS folks

have either forgotten or continually disregard. Like it or not, the

flashy lights, loud siren, distinctive graphics and the ability to

(as Phil so eloquently puts it) " occasionally give death the finger "

sets a certain expectation in the public that you exist, and they

allow you to exist in a public capacity, to provide them safety, and

in so doing accept the risks of doing just that.

Again, I'm not talking about the Hollywood image of a secret service

agent diving in front of a bullet for a president - I'm talking about

the simple choice of accepting risks that carry potentially deadly

consequences.

> I have yet to encounter a combat scenario out here in

> the streets. That is why there are tactical medics.

> That is probably the closest to combat that our

> profession will see. I think your point of view is

> coming more from a LE perspective than from the EMS

> side. Henry feel free to comment. How do you feel

> about this?

Tactical medics aren't going to be a SINGLE bit of help when the fit

hits the shan and bullets are flying. Did you listen to the State of

the Union? Did you notice the attacks that were claimed to have been

averted? Assuming you believe the claims, realize that those are the

DECLASSIFIED ones. Our nation is at war with an ideology that fully

intends to bring a war zone to our streets. And our populace is

such, when combined with our freedoms, that a certain, small

percentage of us will bring that war zone on our own through drug

wars, gang wars, turf wars, school shootings, office shootings,

generalized violent crime, accepting alcohol and drug abuse,

tolerating spousal abuse, etc. If you are not prepared for the fact

that you could end up in a " combat zone, " the I'd assert that you're

simply not prepared. Does that mean mounting .50-cal machine guns on

the ambulance (no matter HOW much that would help with traffic

<grin>)? Of course not. Does it mean medics carrying handguns? I

certainly hope not. Does it mean understanding the dynamics of

violent situations in such a manner that you can avoid them, but at

the same time not being the ostrich with it's head stuck in the

sand? I think so. I think that as providers who have signed up to

uphold the public trust in providing them with life safety services,

that we have a responsibility to recognize, train for, and

potentially equip (not necessarily ARM, though) for " combat

situations, " simply because it's become an issue. Front-burner? Not

hardly. We still lose more people to drunk drivers and chronic big-

mac overdoses than we do to " urban combat, " and it makes sense to

focus our efforts on those areas we can help control - but it doesn't

mean that we should do so to the exclusion of other, serious,

dangerous issues (problems).

> > This isn't selling girl scout

> > cookies - it's

> > EMERGENCY service.

> This is a very touchy issue. Guys what do you think?

> Do you save your partner first or the patient?

If I'm in the back with the patient, my priority is the patient

first. If I'm in the front driving, my priority becomes saving

both. It's not an easy call, and not one you can make beforehand...

but there is certainly a possibility that, given your own Kobiyashi

Maru, you may be called to choose. If that time comes, it will

suck... but you have to at least be willing to consider your

responsibility to the patient in contrast to your ability to save

either/or. Then again, this is pretty much just mental

masturbation... but something that should be discussed, seriously, at

the partner level.

> > IMHO, this is unacceptable. You either accept the

> > responsibility to

> > help your partner or you don't. Caveat: this

> > doesn't apply to a

> > situation that your partner CREATES/CREATED. You

> > buy the ticket, you

> > take the ride.

> If he is a loud mouth and deserves the beat down,

> guess what, have at him. I am not taking a beating

> for a loud mouth, rude, and abnoxious partner. We

> currently have a medic in this service that is rude to

> patients, family, and co-workers. I know most

> everyone here would not interfere if he was getting a

> beat down after being rude.

It's your responsibility to stop it before it happens - long term OR

short term. If that means constantly writing the guy up and narc'ing

on him, so be it - he's certainly not considering your safety at that

point. Either way, when it comes to fisticuffs, I'd certainly expect

you to jump in and help him regardless of any personal issues you

had. He is, after all, your partner. And if he's as bad as you say,

he should have been fired LONG ago, and every medic on your roster

should DEMAND that management do so. That's leadership from the

ground up.

> > I really hope you don't mean this. Your

> > responsibility to the

> > patient at this point is one of safekeeping. If you

> > have to get

> > injured in the fight to keep the patient from

> > getting dead while your

> > partner is stopping, pulling over and calling for

> > help, so be it. If

> > you're not willing to accept that responsibility,

> > don't get in the

> > back of an ambulance ever again.

> If he was properly secured and he managed to unsecure

> himself and probably push me out of the way or

> threaten me in some way, then guess what? Hopefully

> by this time my partner has slowed down, he can jump

> out if he wants. I am not going to get in his way

> again only to get hurt worse.

You're telling me that you wouldn't risk a minor physical injury to

prevent a patient from jumping out of an ambulance and killing

themselves? I'm not talking about him pulling a gun on you and

jumping out - I'm talking about getting up and grabbing for the

door. Big or small, short or tall, you can believe the fight had

better be on until the rig can get stopped. Then let him go... but

to simply say you'd sit back and allow someone to kill themselves is

either callousness or cowardice, IMHO. I'm sure I'll take heat for

that... but so be it. I certainly couldn't think about stepping in

the back of an ambulance with a patient if I could be content with

sitting idly by while they kill themselves because I'm afraid of a

comparatively minor physical injury (and a potential one at that).

> > If you

> > have to get

> > injured in the fight to keep the patient from

> > getting dead while your

> > partner is stopping, pulling over and calling for

> > help, so be it.

> Can you please tell me what TDH rule or what book you

> read this in? And don't tell me that it is not

> ethical not to because I think alot of people would

> tend to disagree on this one. Henry?

See above. And stop asking for " TDH rules " on this and that - it

makes you sound whiny. It is very much an ethics question - and

ethics is something that's SORELY lacking in today's EMS curriculum

and testing.

> If

> > you're not willing to accept that responsibility,

> > don't get in the

> > back of an ambulance ever again.

> I am willing to accept certain responsibility that

> comes with the job such as responding to scenes, etc.

> But no where have I ever read that you will sometimes

> have to jump in front of a person who is suicidal,

> take a bullet for a patient, get stabbed trying to

> help a patient, etc. If anything you are a liability

> to you and your partner, but like I have said before,

> it is peersonal choice. If you want to play the HERO,

> then hey wait for your plaque from the city or maybe

> post-humously. I for one choose to stay alive for my

> family. We are in enough danger, as you say, as it is

> without having to add to it by taking these actions.

Now you're just being a drama queen. We're not talking about being

the super-hero and stopping bullets or trains or knives. We're

talking about, specifically, physical intervention that could

possibly lead to injury when dealing with a patient who is attempting

to get up and jump out of an ambulance at 70 mph; or sitting 2 blocks

away from the scene and RUNNING AWAY if the patient approaches

because the assailant MIGHT follow, rather than evaluating what's

coming at you, where you are, and what you can reasonably do to

protect not only yourself but your approaching patient, and just as

importantly, the public trust you represent to uphold. That's what

this is about.

Respecftully,

Mike

[Guest guest]

I feel that even when in the back of the ambulance my safety is my first

priority cause if I get hurt or are killed then I can't help anyone, myself, my

partner, or the patient. If the patient is adamant about getting out of the

ambulance then we pull over and let him (or her) out. Then we completely and

thoroughly document exactly what happened. I have done that in the past but we

did not open the doors, the patient did. That is why if I even THINK there is a

potential for violence or the patient is a violent patient I will NOT get in the

back with him (or her) alone. I always insist on Law Enforcement or at least a

Firefighter, the bigger the better to go with me. It has been proven ther is

safety in numbers.

Anita

NREMTP/LP

[Guest guest]

> I feel that even when in the back of the ambulance my safety is my

> first priority cause if I get hurt or are killed then I can't help

> anyone, myself, my partner, or the patient. If the patient is

> adamant about getting out of the ambulance then we pull over and

> let him (or her) out.

Which is QUITE different from " allowing them to jump out at 70 mph, "

as other providers have said they'd do. Hopefully, you'd be among

those who would at LEAST attempt SOME form of additional restraint

until you could get the unit slowed down and let them jump out safely...

> That is why if I even THINK there is a potential for violence or

> the patient is a violent patient I will NOT get in the back with

> him (or her) alone. I always insist on Law Enforcement or at least

> a Firefighter, the bigger the better to go with me. It has been

> proven ther is safety in numbers.

This is what needs to happen, and why we should look at both EMS

staffing and training with regards to violent subjects. Either

broader restraint policies, stricter " escort " policies or three-

person crews like Miami/Metro-Dade.

Mike

[Guest guest]

>

> > I feel that even when in the back of the ambulance my safety is

my

> > first priority cause if I get hurt or are killed then I can't

help

> > anyone, myself, my partner, or the patient. If the patient is

> > adamant about getting out of the ambulance then we pull over

and

> > let him (or her) out.

>

> Which is QUITE different from " allowing them to jump out at 70

mph, "

> as other providers have said they'd do. Hopefully, you'd be

among

> those who would at LEAST attempt SOME form of additional

restraint

> until you could get the unit slowed down and let them jump out

safely...

>

> > That is why if I even THINK there is a potential for violence

or

> > the patient is a violent patient I will NOT get in the back

with

> > him (or her) alone. I always insist on Law Enforcement or at

least

> > a Firefighter, the bigger the better to go with me. It has been

> > proven ther is safety in numbers.

>

> This is what needs to happen, and why we should look at both EMS

> staffing and training with regards to violent subjects. Either

> broader restraint policies, stricter " escort " policies or three-

> person crews like Miami/Metro-Dade.

>

> Mike

>

Thanks Mike, it's nice to know that someone agrees with an extra set

of hands in the back if the patient is or has to potential to be

violent. I also teach the same thing to my students. I hope I am not

misunderstanding the message.

Anita