Forum Replies Created
-
Posts
-
Health – Who were you quoting right here?
“Are you a Hatzolah guy? It sure sounds like it. Refusing to give information about the call, that doesn’t include private information is not a violation of HIPPA.
It sure sounds like you’re trying very hard to manipulate the public!”Once again you resort to name calling. This discussion has become very childish not what one would expect from a “medical professional”
Gamanit – What are the statistics that you are referring to? It would be nice if I can take a look at those numbers. To say that it is close to nill is very inaccurate, There are algorithms in place for this and these types of emergencies do occur. Not sure from where you take it that there need to be or these patients usually present with a prior indication. While some patients are at higher risk for abruptios and previas one does not need to have any prior indications to have an abruptio or significant post partum hemorrhage. In fact, every woman in the third trimester presenting with abdominal pain is considered to have an abruptio until proven otherwise.
I will ignore the personal attacks, It is irrelevant if I claim to even have any prehospital certification or not. Treating shock is beyond the EMT’s scope of practice. True, the EMTs can place the patient in shock position which might preserve the patients vital organs and even keep the patient warm, yet they cannot offer fluid replacement which is the first step in treating any hemorrhage or even transport to definitive care without an ambulance. Is that not so?
Health- “But the best defense is an offense.”
Is that why you very frequently try to offend other posters in many ways, by attacking what they wrote or trying to attack them personally?Health, just wondering why you spelled it HIPPA instead of HIPAA, is that because you are discussing this with ‘non-professionals’?
Health – I do not think I will respond to any of your posts if you continue to make it personal. For starters would you mind revealing what degree you have in medicine and in which area you practice? I know that you never revealed that despite many questioning your self-proclaimed ‘medical professional’ status. If you yourself mind on offering this information, then please do not ask others to do so, especially when I have never claimed to hold any training or that I even practice medicine. I tried to make my points without making the point that I am in medicine, for all I care think of me as a teenager hitting some buttons on a keyboard, but respond to the context of my posts.
You, on the other hand, use your online persona to validate your arguments. It would be reasonable to ask you to reveal your level of training and certification. If you do not want to reveal this information then fold your self-established personal of a ‘medical professional’ and start making some sense.
I respect everyone else’s opinion and I do not think that everyone else has to agree with what I wrote.
Health- very unprofessional for someone who claims to be a professional. This is noticeable by what you write, such as writing medical lingo, instead of calling it medical terminology and by your unsuccessful personal attacks instead of using contextual arguments.
Learned people with real positions do not go out of their way to defend their self made online persona, especially when no one is even challenging or cares about their proclaimed credentials and do not belittle other people that participate in the forum.
It would be greatly appreciated if you try to voice your opinion without degrading others that, just like yourself have a right to voice their own opinion. As a so called and self proclaimed ‘medical professional’ I am sure you would be able to comprehend this notion.
Why are you quoting what you posted earlier, what relevancy does that have to the discussion at hand?
You were the one that decided on what was done and that it was inappropriate intervention, after being questioned you now decided that the details and documented times be provided to you, probably so that you can see if there were any wrong doings. Is there any reason that this should be provided to you?
Gamanit – Chances are not as low as you make it sound, the risk of postpartum exsanguination is high on the list. There are many other causes that can put an OB at risk for hypovolemic shock (HS), true that most of them would not present with a ‘puddle of blood’ but some would. That is why they have the OR near the or in the LD unit, for these types of emergent situations. Are you saying stuff like abruptios do not occur, they surely do and higher class abruptios are true life threatening emergency’s?
If this were a medical review there would have been a lot of questions and added details, was this a trauma patient that is in shock? is the miscarriage secondary to anything else that is going on?
Regarding the terms used, this does not appear to have been written by a doctor or a lawyer, seems more like street terms were used. To some lay people miscarriage/still born/spontaneous abortion are one and the same.
Your other points are all situational and your own assumptions.
I am also sure that EN would have followed protocol, I also believe that did follow protocol which was to dial 911, what else can they do for the patient?
Health – your feelings are irrelevant, it is the facts that matter. So far there was nothing that would indicate that transport was delayed, I find it puzzling that you are bashing the personnel that handled that patient without even knowing if there were any wrong doings.
If indeed transport was delayed with no appropriate justification, your attacks would have been justified.Health – Not sure where it was stated that the ambulance was on scene prior to the paramedics, nothing that you have quoted seems to create that kind of timeline.
There are some instances in which resuscitation would be initiated on the scene, not just if transport was to be delayed for other reasons such as entrapment, this would be up to the providers to decide, the same is when the patient is presented to the ED, they would decide what if any intervention should be done for this patient before sending this patient to the unit that would care for the patient.
For example, if this were on the fourth floor with no elevator, would it be appropriate to delay transport for just two minutes to obtain access and begin fluid resuscitation if this patient indeed had a systolic pressure of 60? many would make the argument that it would be appropriate.
Once again, there is no indication from this article that transport was delayed at all.
Health –
a) I do not know what they did or did not do for that particular patient, I was just referring to what was written in the post. There is no point of delivering a patient that is beyond the point of saving when the patient could have been stabilized, so fluid resuscitation is a priority. If this should be done prior to transport or not depends on many details and dynamics of the situation.b) I did not use any lingo, just listed some of the devastating and fatal syndromes that may occur without aggressive fluid resuscitation.
c) Rapid transport is without question a high priority, yet there are scenarios in which transport should be delayed for a couple of minutes in order to stabilize the patient. What is also as important is early notification to the receiving facility and to the unit that will be receiving this patient so that the staff is all prepared.
d) Ambulances usually respond from a central or designated location, it also takes a couple of minutes to bring in the equipment needed from the ambulance to safely extract the patient. The Hatzalah EMTs and Paramedics have a grassroots response and are usually within close proximity of the call location, which normally means that initial basic and advanced care has been initiated before the ambulance is on location. So the patient gets treated prior to transport without any of the treatment delaying transport.
Health- If indeed the patients systolic blood pressure was below 60 with no distal pulses, this patient is entering irreversible shock and might have multi-organ failure, so yes bilateral IVs would be a vital priority and lifesaving for a positive outcome. Even without MODS there is the concern of metabolic acidosis, lactate acidemia and renal dysfunction, all of this can be prevented/delayed with aggressive fluid resuscitation.
Besides, having IV access would mean that the patient can be taken into the operating room and the required procedure can be done without delay.
This is standard stuff.
ubiquitin – I agree.
But I believe having same gender personal as a bridge is a really minor detail when someone really needs help. they would probably be more focused on getting a better facility, better doctors and people that are able to navigate the health care system and get things done. As I mentioned the higher the acuity is, the less people tend to focus on some details (such as gender) that would otherwise seem significant to another individual, this is probably true for male and female patients.
your question has a simple answer, I would want whoever I believe can better help me at the time of need. I have very rarely seen anyone being uncomfortable with a provider that is of opposite gender in time of an emergency. If this were not an emergency some might take minor details such as gender of the provider into consideration.
To answer the OPs questions.
You probably meant if the patient is experiencing symptoms of a heart attack, (as this can only be diagnosed either by paramedics or in a hospital).
I would say no, people usually care about themselves. When they believe they are experiencing what might be a health related emergency they usually seek help from whoever is better equipped and trained.
A patient experiencing signs or symptoms of what can possibly be a cardiac event really has three options to get diagnosis and treatment (in NYC), 911, Hatzalah or go by car. any other bridge service will help with measuring your blood pressure and even call 911 for you. Yet what this patient really requires is early diagnostics and transport.
ubiquitin – This is what I meant, due to it being a personal preference I do not think that I can make a blanket statement, everyone has their own personal preference. Some people prefer not to go to the hospital at all, or to call a cab. Yet I think its reasonable to say that people that deal with these situations on a regular basis are in a better position to respond to this than random people that do not have first hand knowledge.
Avram – Your missing basic facts, EN does not transport, they call 9-1-1 when they believe the patient would require transport or more advanced care, the vans that were mentioned are personal vehicles that are fully stickered in which they respond to the patients location.
Avram – Regarding Neonatal Resuscitation, true anyone can get a certification, all you really need to do in order to get the certification, is answer some questions on a test, although a class is recommended its a test that is required. the same goes for ACLS and PALS which doctors, some nurses and paramedics must have and remain current. The certification on its own does not allow anyone to actually do anything above their scope of practice or license.
On a Basic level, which is where EN operates, their scope of practice and license does not allow them to do any of the advanced procedures. The basic stuff, while life saving and important, is just basic.
In short, ALS and NRP are not the same, yet it is the ALS degree (Doctor, RN or paramedic) that allows the provider to follow the NRP guidelines.I agree with DWKL1, this thread has gone off topic. Lets keep it on topic.
Avram,
They do not offer Advanced Life Support, so how can they offer NR?
Did they just have some lectures on this topic, or are they certified?
They do not offer the complete standard of care that other patients get when calling and activating traditional EMS or Hatzalah. They only offer Basic Life Support with transport depending on them calling 911 as a 3rd party caller.
It is up to the patient to decide which services to contact or if to even call at all, yet it is important that the patient understands the options and limitations of any of the available services and make an informed decision.
Unfortunately, this story did happen in BP, I was aware of this story at the time, the neighbors that witnessed this were aware of this, the EMTs and Paramedics from Hatzalah that treated this patient were aware of this.
I do not think that posting randoms stories as such is appropriate, if the author wants to really do what is right as they noted in their post, they should share their name. Otherwise, it seems as if there are people with an agenda just producing stories.
Health, as someone that keeps on saying your not PC, why dont you explain why Hatzalah is not the solution for the longer response times that EMS has.
If you want to be taken serious stop making such silly comments about you taking over the community EMS system, NYC Hatzalah is a very large operation only someone very skilled and knowledgeable can manage this on their own, people like that usually already have real jobs. just saying.
umiquitin – Your asking a question that has an opinionized response to it, It’s to each and their own to answer this.
But keep in mind, there are some that speculate and some that actually know, it’s those that deal with situations like these on a regular basis that have first hand regarding this matter.
apushatayi – I do not think that I made this comment, I did a quick scan over my comments yet was not able to find any such comment.
Not sure what you are trying to score with your question, what difference does it make if I am considerate or not with regards to someone else’s concerns, this discussion is not about myself. Everyone is entitled to their opinions and so am I, If you have anything reasonable to say, please do so.
health, it is exceptionally uncommon for a middle age frum woman to have advanced directives. other signs are usually associated with long downtime’s which does not seem to have been the case.
Not sure how this became a discussion about dispatchers, a lot of 911 call centers do not have EMDs answering the phones, yet they usually have some sort of training. Do you think that Hatzalah that has a significant call volume on a daily basis does not provide training for its dispatchers?
Each area is different, besides its the EMS that one wants not the police. Most out of NYC areas are having massive issues with basic coverage and heavily rely on mutual aide.
Its ones own choice to chose whichever available services they prefer. Yet its frustrating to see how random people just decide on whats an issue and what not.
In the presence of an emergency setting, most people will not care what gender the provider is, the greater the acuity the lesser ones focus or consideration on who the provider is, its the level of experience, expertise and scope of practice that matters to the patient.With regards to out of hospital births, there is the risk of complications to mother and baby that would require rapid lifesaving interventions. Its a statistical fact that some newborns will require aggressive resuscitation and some mothers will have life threatening complications.
It sounds nice when someone posts some nonsensical arguments of the responder being their husbands friend. for starters one would think that a friend or acquaintance of the patient or their family would let other personnel respond to this address, Hatzalah is a pretty large organization with lot of members there will always be someone else available for this call. Besides, an argument can easily be made that the patient would be uncomfortable with the same gender provider who is their acquaintance, not their husbands shull buddy, being involved in ANY of their emergencies.
Winnie, I am not familiar with that, but wonder how the author determined the reason behind their findings.
What Tznius issues? there is very little for EMS personal to do in the prehospital setting for gynecological emergencies other than take the patient quickly to the hospital, try to help the patient maintain decent vitals by administering advanced life support interventions. and most importantly if necessary having the hospital and the operating room on standby should there be a need for that, to save the patients life.
If that poses a Tznius issue, please point it out.
One would think that having a service that mainly responds to women related emergencies, with hard to miss stickering on their cars and vans parked in front of someones house, is a much greater Tznius issue.
Winnie, you mean areas that neglect health in general, which is not the frum community.
You obviously are not involved in the health care, the frum community in general is very aggressive and demanding when it comes to health care. You probably referring to some of the other communities that I am familiar with. that use the hospital as their primary health care providers.
Being cold is not a criteria for not doing CPR, I cannot post links but you can do a quick google, especially not under the New York State BLS protocols under which EN operate.
The other signs of certain death, take time to set in.
The saying goes, your not dead, until your warm and dead.
In fact, hospitals that were doing the hypothermia protocol for patients in cardiac arrest, had to work up the patient until they were warm, which would take a long time and made the staff go through many code carts.
Seems like the OP just copy/pasted one of the messages that were circulating on social media and chat groups, I do not think that the OP actually asked the CR any of those questions.
While I agree that some questions are not on target, there are many issues and unanswered questions.
For one, why do they call 911? weren’t they boasting in news articles and interviews about one year ago about their affiliation with East Midwood ambulance? what happened with the senior care relationship? do they call 911 instead of the patient or their family members??
If their only resource for transporting acutely ill patients and getting advanced life support to the patients location from FDNY (911), why don’t they explain this very important fact on their website, so that in case of a real emergency one should call 911 first and only if anyone wants their service, which seems like a bridge until EMS arrives, to contact EN. Otherwise precious time is wasted when the EN dispatcher has to collect vital information then pass it one as a 3rd party to the 911 call center.
To the poster that said that ten minutes is not a long time.
The fact that outside of the city it takes 30 minutes for EMS to arrive, does not mean that this patient needs to get this substandard ETA.
It takes much less than ten minutes for a patient that went into cardiac arrest to be beyond the point of resuscitation. even two minutes is to long.
Hatzalah is known for its very short response time, this was clearly a nature in which not only minutes can change the outcome of this patient its the seconds that matter.
Todays standard of care is to have pit crew non-stop CPR, you need a full crew and you need it early for successful resuscitation.
Yes, people die even with short response times, long response times just makes sure they do not even have a chance. This is one of the perils people living outside of larger cities have to deal with.
Unfortunately the story is very true. not because of the many photos of the scene that clearly show the EN van, but because of the many members that were on this call.
EN clearly cannot be held liable from a legal standpoint, they have a protocol and they followed it. its not their fault that the patients family member did not call Hatzalah. But there are major issues with their behavior last night.
They put their protocol or agenda before patient care. its an undisputed fact that Hatzalah had resources that are adequately equipped and experienced just down the block from this address and can be at the patients side within one or two minutes. yet they clearly ignored this very important fact which possibly resulted in the negative outcome.
Is their agenda against Hatzalah that big that they place it before a human life??
Second, from what the people on scene are saying, the two EN responders were not administering CPR they were just standing there shocked not knowing what to do. all of this when there were EMTs and Paramedics within very close proximity.
If not for EN, the family would have clearly called Hatzalah, in fact I doubt that any person would care which service responds for their loved one when they are in cardiac arrest, they would clearly chose the one that is not only closer and faster, but much more trained and heavily equipped to deal with critical patients and deal with these types of emergencies on a regular basis. No doubt that the caller clearly made a mistake. EN dispatcher and responders clearly knew that they were called in error as they are never called for a nature of such, yet they still followed protocol.
So all of this is for the tiny number of 100 or so people that want to enter the USA?
All of this for extra few hours of detaining and questioning these few people with possible ties to terrorism or actually being terrorists?
All of this for people that come from countries that would murder you and myself just for who we are?
So what gets done? protests that gets thousands of people delayed for hours..
Does moving the embassy really help Israel?
I believe that Trump is making this into a bargaining chip. So now he can sit down with the Palestinians and have them settle down if they want the embassy to remain where it now is.
I have not read many articles on this however, from what I understand, here are the facts.
These countries have been marked by Obama and Congress as the seven countries that harbor terrorists.
They can still come in to our country, only will be taken aside for further questioning and comprehensive screening.
They will be moved through the process as quick as possible, either to be released or to sent back.
109 people from these countries were taken aside, most of them were processed through the system already.
Not sure how accurate all of this is, however supposedly this is the plan.
By the way, I am sure that Israel probably has much more comprehensive screening and questioning for people coming in from these countries. Even I was taken aside and asked which shabboss my Bar Mitzva was, and in which hall it was.. and i was coming from the USA.
Did not read the article, however, prior to the orthodox expansion, no one walked on the streets at night, especially in spring valley.
Now Ramapo PD mainly deals with medical emergencies, traffic issues and other minor stuff, it is very safe to walk in most areas any time of the day or night. this is a huge difference of how it was just a couple of years ago.
YWN has a good clip of this in their news section, how Joel P bites into the CNN reporter and others about this.
facts are, cop is jewish. the fine was a slap on the wrist for what they did.
Some are still here yet are readers not posters.
Is it a crime to delete emails (33,000 of them) after getting a subpoena?
Wow, no response and its already been over 6 hours..
Health,
That’s not a source, it’s not even a complete sentence!
You can just copy paste a few words without the context, this does not warrant a response. You fail to respond with any logic or sources to your claims, you put in so much time and effort in your foolish posts, yet whenever asked for a follow up logic to back your claims, your response is that you will do it for money.. Not even funny anymore.
Should I take the time and effort to respond to your copy/paste??
would it satisfy you if I can kneel down to your level and explain it to you while providing real literature, not just copy paste tidbits of information from a website?
health, you make me laugh!
All the name callings can easily be redirected at you, in fact you prove to be the uneducated and childish silly posts.
As proven numerous times, you would be paid NOT to teach or share your thoughts.
That’s subjective.
Being sad is OK, just do not keep inside yourself, find people that are willing to listen to you, not sure the advice was given above that you should distract yourself is a good thing, maybe in the long run but running away from the fact will hurt more in the long run.
Deal with the unfortunate situation, and I hope that you believe that Hashem has had this all planned out and in the bigger picture this is for your and your siblings good.
Health, you really need help.
Putting the rules aside for a moment, most or some of us were already in the position be being in the know of something that went public, yet the intimate details were not known to the public.
With just two seconds of thinking, (if that at all..) posters submit their opinions, which at times can be very hurtful and non-deserving to the people involved.
Thank you mods for editing and closing threads according to what they see as appropriate.
Hey, I am not interested in going back, but to be honest, I was asked for sources, I responded with the sources, the response to that was personal something about having gone down and spoken to JP while he was incarcerated making me feel like it wasn’t due to the lack of sources (didn’t know that posters are required to have sources for what they write here..) only because of personal beliefs.
Either case, I prefer not to go back, I moved on.