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Army To Civlian Flight Medic


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#61 Foxfire001

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Posted 06 May 2014 - 05:49 AM

I dont really mean to change the subject but I do have a burning question. I find the pictures posted by Foreverlearning very interesting. I assumed that many of you transfer patients that present in this very fasion. I was curious to ask why hospitals are transfering such patients? When we do transfers it is normally because a sending facility does not have to capibility to manage the patient. It just seems that if a facility can place a balloon pump, VAD, 12 drips, ECMO, etc then for what reason would they need to transfer? Just a question. I only get to see what my service does and am therefore interested in learning what other services are doing.

Thank!
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#62 ForeverLearning

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Posted 06 May 2014 - 07:03 AM

I dont really mean to change the subject but I do have a burning question. I find the pictures posted by Foreverlearning very interesting. I assumed that many of you transfer patients that present in this very fasion. I was curious to ask why hospitals are transfering such patients? When we do transfers it is normally because a sending facility does not have to capibility to manage the patient. It just seems that if a facility can place a balloon pump, VAD, 12 drips, ECMO, etc then for what reason would they need to transfer? Just a question. I only get to see what my service does and am therefore interested in learning what other services are doing.

Thank!


Transfers occur for multifactorial reasons

1-Patient can be in a tertiary care center with all the capabilities. However patient family adamantly requested, they have a miracle doctor in another state who is like House/Jesus and can perform miracles. All is asked of you the ambulance driver is just get that 86 y/o nursing home patient on max life support without DNR with max dose pressors there alive only 200 miles and miracle doctor in the new magic place will cure the patient.

2-The Hospitalists thought they could manage the patient in non tertiary care center ICU. The process was long and tedious, drawing ABGs from every orifice and increasing that levo to a dose I didn't even know existed and Plats were so damn high that we switched the patient to Pressure assist control mode. Only a few more days the hospitalist said and bed ridden ARDS patient get discharged back to SNF, he will walk too. 2 weeks pass and the weary attending somehow gets lost and stumbles into ICU and "well well well this guy needs tertiary care!". When you arrive you are greeted by the clerk/administrator and all the doctors are gone. Why would a doctor be in a hospital out of all places? "Thank god you are here!!! We been waiting for sooooo long" an echo from a nurse who got this patient today 2 hours ago as a float even though the guy been there for past 3 weeks. No one knows much about anything except that "YOU HAVE TO TAKE HIM NOW! IS WHAT WE WERE TOLD"

3- We got a new shiny cath lab with all the flurscopeee, and stuff and this IABP is so cool. Does it really matter that we cannot do CABG here? Why should that stop us from exploring the cath possibilities in a cardiogenic shock patient with very good possibility of multivessel CAD. Worst comes to worst will just place this guy on IABP with a really short cord, call the ambulance drivers and leave before they come.


All in a weeks work


On a side note, I have experienced some new radical double standards? When I bring someone as emergency to the ER, I am the idiot driver and that is how I get approached regardless of the hospital, some even have signs "AMBULANCE DRIVERS REPORT TO TRIAGE NURSE!" on the doors. I am not making this up.

When I come to any ICU all of a sudden? You mean to tell me you a PARAMEDIC and EMT partner cannot by yourself handle IABP with 6 drips and you need my assistance?

In a class (with hospital staff mostly physicians, nurses) during small group scenario. What? A paramedic does not know doses of antibiotics and which are needed for gram pos or gram neg cultures? What specific nosocomials are present here? What medic school did you attend?
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#63 Foxfire001

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Posted 07 May 2014 - 05:08 PM

That does not sound fun at all.
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#64 Medic09

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Posted 07 May 2014 - 09:39 PM

When we do transfers it is normally because a sending facility does not have to capibility to manage the patient. It just seems that if a facility can place a balloon pump, VAD, 12 drips, ECMO, etc then for what reason would they need to transfer? Just a question. I only get to see what my service does and am therefore interested in learning what other services are doing.

Thank!

Any number of reasons. Pt. may be going for transplant. Sending may not have beds for post surgery. Sending may not have surgeon for particular surgery. I'm sure we could add a few.
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Mordechai Y. Scher
NRP, FP-C, RN

It's all about kind, competent patient care; and getting home safely to tell about it.


#65 Foxfire001

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Posted 08 May 2014 - 04:36 AM

Any number of reasons. Pt. may be going for transplant. Sending may not have beds for post surgery. Sending may not have surgeon for particular surgery. I'm sure we could add a few.


Thats pretty cool. Facilities in this region do not have any of those capibilities. We generally transport patients from very small hospitals to facilities that do have these capibilities.
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