EMS Authors for Fire Engineering

Replies to This Discussion

Permalink Reply by Dennis E Sampson on May 20, 2008 at 7:03pm

Hi Mike,

Do you have or written anything on miscarriages or late term hemorrhage/bleeding and how to control the heavy bleeding that sometimes occur. In my area we have had an increase in late term bleeding/hemorrhaging and usually try to control bleeding, take vitals, High flow O2, gather history(onset,trouble pregnencies,how many,med history etc) as we load and go and have patient ready to transport as medics arrive or meet them in route to hospital due to the potential stress on the fetus/child and mother. And are there any areas to stay away from(questions, treatments, etc) as to not overly stress mon to add to the medical condition she and the family are dealing with.

Thanks!! Stay Safe !! Dennis

Permalink Reply by Mike McEvoy on May 20, 2008 at 10:35pm

There's not much that can be done to control the bleeding - it's pretty much all internal and not reachable. There are some drugs that will help, but they can injure the fetus. Two thoughts: (1) this categorizes in my dispatch protocols as a high risk OB case, requiring direct transport to a high risk OB center. We automatically launch a helicopter. (2) it's odd that there's an increase - this is a condition that should be known to the mother (if she has prenatal care). Is there an associated increase in mothers without any prenatal care? Or do you have a particular physician or group of docs who are not following these patients appropriately? I'd suspect one or the other. Not sure if that helps.... feel free to contact me off line (mcevoymike@aol.com) - Mike:)

Permalink Reply by Dennis E Sampson on May 21, 2008 at 12:49am

Mike ,

I brought this up due to in a local area of 4 towns in two weeks there have been five and we cover each other for mutual aid. Fly out is same time as transport to trama center or OB hospital, 20 min with medics on board when available. All are treated as high risk. Thanks for the reply !

Stay Safe !! Dennis

Permalink Reply by Richard Michitsch on June 7, 2008 at 7:58am

Mike,
This may or may not be appropriate for this blog, but it was during an EMS call.
I don’t know if there has ever been an article or if it’s worth an article on Police and EMS operations at an MVA. I know that for the most part that PD has control over MV’s since they are on the roadway, but I have had an experience in the past.
We had a T-Bone in the middle of an intersection with both vehicles were still in contact with each other. The occupant of the vehicle 1, who was removed, had its front end embedded in vehicle 2. Myself and two paramedics were working the patient up in the vehicle 2 when the PD decided to remove vehicle 1. The flat bed operator intended to place vehicle 1 on the flatbed and tow vehicle 2. As vehicle 1 was being pulled up the flatbed the cable failed sending vehicle down and back into vehicle 2. I was inside vehicle 2 along with one of the paramedics, when vehicle 1 made contact the window of vehicle 2 broke sending glass into vehicle 1 (luckily none of us were cut). The second paramedic was outside vehicle 1, when the vehicle made contact vehicle 1 shifted approx 2 feet sending all of the equipment (that was on the roof) across the roadway. (Let me know if this isn’t clear.)
The paramedic outside the vehicle lost it and after a minute of profanities to the flatbed operator, who indicated that the PD instructed him to remove the vehicle, the operation continued. In the vehicle and after the initial shock, we checked each other out and continued to package and remove the patient.
After the call, we wanted to discuss the issue with the PD, but there was no point. The PD sergeant indicated that all he was concerned with was clearing the roadway.
I have read of numerous confrontations between emergency services and police in firefighter close calls and other sites, where roadways are priorities over safety. All of the emergency providers were at risk of severe injuries, but that wasn’t a PD priority. Perhaps an article on How to understand and work with PD would be a benefit.
Just a thought!
DON’T be the next one, BE safe!
Richard

Permalink Reply by Mike McEvoy on June 7, 2008 at 9:32pm

Richard -

You cite an age old problem that maybe the time has come to confront. You probably have seen law enforcement reaching out to Fire and EMS for assistance with subjects under police restraint. The legal system has compelled them to do this. We're about to run a series of articles pertaining to the topic of combative patients, working with our law enforcement brothers and improving communications between Fire and Law Enforcement. The instance you cite is yet another (and probably just as common) instance where better preplanning and collaboration at the department leadership level would help to make life a heck of lot easier for those of us in the street every day.

Let me work on this a bit. I have a couple authors, myself included, who might be able to address this topic with a timely article in Fire Engineering. I appreciate the feedback.

Mike:)

Permalink Reply by Richard Michitsch on June 8, 2008 at 2:40pm

Mike,
Outstanding, I look forward to reading the articles and future collaboration with you.
DON’T be the next one, BE safe!
Richard

Permalink Reply by Koll Andersen on September 26, 2009 at 10:54pm

Hey Mike,

I love to write and would be happy to help write articles or items for Fire Engineering. It is a passion of mine to share what I have learned and experienced in all my years associated with the fire service.

Let me know if I can help.

Koll Andersen

Permalink Reply by Mike McEvoy on September 26, 2009 at 10:58pm

Koll - send me your email address or contact me at mine (mcevoymike@aol.com). Thanks, Mike:)

Koll Andersen said:

Hey Mike,

I love to write and would be happy to help write articles or items for Fire Engineering. It is a passion of mine to share what I have learned and experienced in all my years associated with the fire service.

Let me know if I can help.

Koll Andersen

Permalink Reply by Ralph L. Carr IV on May 10, 2010 at 4:01pm

Just a quick note as I read the group while getting ready for my shift tonight. A VERY hot topic locally and one that was touched on by JEMS last month or the month before.

Missuse or overuse of medevac agencies. We have had several issues locally to the point that each scene scramble and LZ event must be followed up by an incident report as well as the PCR. Some of the problems are as simple as an overly "gung-ho" medic calling for the bird or as sad as a medic totally wigging out on scene. Sitting on scene waiting for the medevac for say 45 minutes when the local ER is 10 minutes out and the pt is already in the back of the rig. I have been on a STEMI call, we had the pt to the local ER within 15 minutes of the initial 911 call. This ER is a small rural hospitol without a cath lab. The medevac agency was scrambled within 5 minutes of arriving at the ER. The ETA given was "20 minutes, they just lifted off", for a 20 minute flight time to our location. 55 minutes later, the bird went skids down. No explanation for the delay. The ER doc has gone to the local medical director and has initiated changes in our local protocol. Even as a ground unit that`s vehicles are limited to 70 MPH, we could have had that pt IN the cath lab before the bird landed.....

I don`t want to sound anti-medevac. Locally it just seems that the medevac agencies are out for business and pt care and / or actual need be dammned.