There's a Mystery Here.. The average house fire burns around 1100 F for cremation to take place bones need to burn at 1400 to 1800 F for a several hours

 There's something very wrong about the recent fatal trailer fire in Dolan Springs on October 9th...

The average house fire burns around 1100 F, for cremation to take place the bones need to burn at 1400 to 1800 F for a several hours to turn them to ash. So how was the body almost completely destroyed,  burned so badly they can't use dental records or even DNA to identify the body?

So what's going on? How was the body almost completely destroyed? The family was told only the skull and some bone fragments survived the fire. 

From the radio traffic recorded by broadcastify.com it took around 30 minutes for firefighters to arrive on scene. 

So what happened? Was it arson? Was an accelerant used? What about the time line of minutes not hours? 

More to come as the investigation continues....

REPOST A Fire Districts primary obligation is to the residents who support the fire district through property taxes.

 A Fire Districts primary obligation is to the residents who support the fire district through property taxes. 

The Lake Mohave Ranchos Fire District, LMRFD only covers 144 square miles in the communities of Dolan Springs and Meadview, but not the parcels between the two communities.

In the past when the LMRFD had 6 ambulances and lots of volunteers the LMRFD ambulance CON was tasked to cover 2200 square miles. That's 2056 square miles larger than the 144 sm fire district. That's larger than all other fire district ambulances in the county, and even runs into parts of Coconino County.

 

The red line on the map below is the 2200 square mile area the LMRFD ambulance is required to cover. The blue squares are all the fire districts in Mohave County. The big blue square and the smaller one inside the red line are the areas covered by the Lake Mohave Ranchos Fire District Ambulance

As you can see the area covered by the LMRFD's one ambulance is larger than the area covered by all other fire district ambulances combined, it even runs up into Coconino County.

At one time the LMRFD had 6 ambulances, several quick response rigs and lots of volunteers. The economy and some bad choices left the LMRFD with two EMT firefighters and a few volunteers and one ambulance capable of transporting patients. 

No other fire chief with such limited resources would ever send his only ambulance outside their fire district if it left their district with nothing. Residents in White Hills and West of US-93 get the same fire and EMS service, yet never pay a dime unless they have a fire or medical emergency. 

With Meadview such a checkerboard of parcels inside and outside of the fire district, I wonder how many times someone really checks if a parcel was in or out of the district after a fire to even send a bill for services.

Who would voluntarily choose to pay hundreds to thousands of dollars in property tax when they get the same services for free now? 

What Can We Do??

Stop responding to fires outside the fire district. Advise residents in White Hills and West of US-93 they are not in the LMRFD. We need to offer a subscription service charging $60 to $100 a year. If you're not on the paid list, they don't respond. This would generate revenue to hire and train additional EMS personnel. 

Like other fire districts reduce the ambulance CON to the area covered by the fire district. If people in the 2056 square miles outside the fire district want EMS service, pay a subscription service, start a fire district or start your own ambulance service. 

We can’t abandon the taxpayers in the LMRFD to respond to areas that have been repeatedly told they have no service and have rebuffed attempts to provide their own fire or EMS service. 

Our first duty is to our citizens. We have no contractual liability to respond to fires outside the fire district. White Hills and west of US93 are not in a fire district, we can't have a mutual aid agreement because they have no aid to offer. 

One of these days someone important will die because our only ambulance was miles outside the fire district, only then will things change.

Two Die in Fatal Home Fire October 9th in Dolan Springs 30 Minutes for Fire to Respond So Why Can't More People Volunteer?

Correction only one person died in the fire... On October 9th two people died in a trailer fire on Jasper and 10th in Dolan Springs. You can literally see the fire station from the home, yet it took around 30 minutes for a lone volunteer firefighter to arrive on scene. The two firefighters we pay to be at the fire station were out on an ambulance run in Kingman and took a long time to respond.

Chances are without a smoke alarm these people couldn't have been saved. But the family is devastated by the deaths, but even more so because the bodies were burned beyond recognition and dental records were required to identify their loved ones.  

Every time the two firefighters we pay to be at the fire station and protect the fire district, they can be providing services for someone who pays no property tax to support the fire district. 

The arrows point to the area covered by the fire district 144 square miles, the red line is the area covered by the LMRFD ambulance 2200 square miles. The other blue area are all the fire districts in Mohave County. Our one ambulance covers more area than all the other ambulances in the county over 2000 square miles outside the fire district. 

I don't agree with the chief on many things, like letting Emergency Medical Responders assist by driving the ambulance. But a couple weeks ago I asked the chief to let me volunteer again. He fired me as a volunteer several years ago because I supported Mike Pettway for chief rather than him, but free speech is allowed last I checked. His personality conflicts with volunteers is a problem. To not allow someone to volunteer because he just doesn't like them is wrong and is not in the fire districts best interest

As you can see below, I have many hours of EMS and firefighting training. I'm too old to put on turnouts and rush into structure fires, but I can drive the brush truck and a tender to haul water. 

So when your home is burning or you need an ambulance and it takes too long for anyone to arrive, please ask the chief why people are not allowed to volunteer, ask why a volunteer EMR and a paid EMT can't provide a second ambulance. 

PLEASE my post on A Fire Districts primary obligation is to the residents who support the fire district through property taxes. 

Yes chief I do have the same paramedic training you do, and I know I not a certified any longer so you don't need to remind me every time it comes up. 

My Training by Northern Arizona Consolidated Fire District 2018

Emergency Medical Responders 80 hours

EVOC Emergency Vehicle Operation 6 hours  

First Responder Orientation 16 hours

Emergency Communications NACFD Radio System Dispatch  

NACFD Safety Orientation 2 hours

Incident Rehab 2hours

 Water Tender Operations 2 hours 

Type 6 Engine Operations 6 hours  

Exterior Structural Firefighting 7 hours 

Hazmat First Responder Operations 16 hours  

Hazmat First Responder Operations-Decon 8 hours 

Fire Emergency Support Responder Training Phase I 22 hours 

L-180 Human Factors in the Wildland Fire Service 1 hour  

IS-100 Introduction to the Incident Command System 3 hours  

NWCGS-110 Basic Wildland Fire Orientation 2 hours 

S-130 Wildland Firefighter Training (Classroom) 

IS-130 Wildland Firefighter Field Exercise 8 hours 

RT-130 Refresher Wildland Firefighter Annual Classroom 16 hours 

IS-131 Type 1 Firefighter 16 hours 

S-190 Introduction to Wildland Fire Behavior 4 hours 

IS-200b Emergency Management Institute   

IS-200d Fundamentals of Emergency Management

NWCG S-110 Basic Wildland Orientation

NIMS 700 National Incident Management System 3 hours

EMS Training

Mobile Intensive Care Unit Paramedic Training Daniel Freeman Paramedic School 960-hour paramedic training program including training at USC Medical Center’s C-Booth, the birthplace of emergency medicine, so different than today This was c-booth when I trained at USC Medical Center Code Black the old days in Los Angeles County - special cut

 2016 CPR Adult, Pediatric, First Aid, AED Training

 2002 Arizona Crisis Response Crisis Team Training by Arizona State

 2003 40 Hour Crisis Intervention Basic Training Bullhead City Crisis Intervention Team

2003 Defensive Driver Training Course Bullhead City Police Department

 2018 American Heart Association Basic Life Support (CPR and AED) KRMC 

2018 Nationally Certified Emergency Medical Responder 80 hours Northern Arizona Consolidated Fire District

 2019 TIM Traffic Incident Management Arizona ADOT

2020 Train the Trainer Narcan Training to train EMTs and Law Enforcement on the use of Narcan

Industrial First aid with CPR 16-hour course taught by the American Red Cross, Spokane Washington

 Standard First Aid 8-hour course taught by the American Red Cross, Spokane Washington

 First Responder Montana 40-hour course taught by the Park County Sheriff Department, Livingston Montana

 CPR Instructor Spokane Washington American Red Cross CPR

 Basic Life Support for the Professional Rescuer

10-hour course taught by the Park County Sheriff Department at Livingston Montana

Advanced Cardiac Life Support 16-hour course taught by Daniel Freeman Paramedic School, Inglewood California 

Washington State Emergency Medical Technician 80-hour Basic EMT Training, Spokane Washington

 Rural Emergency Stabilization of Critical Patients 8-hour course taught by Sacred Heart Hospital, Spokane Washington 

American Red Cross Damage Assessment Assessing damage to buildings and structures, the number of people needing help

Emergency Medical Services has Grown So Why Not Use Volunteer Layperson

Emergency medicine has grown since the 70's. 

So have the lifesaving medications EMT's and paramedics can give in the field, so have the lifesaving medications a layperson can give.

EMS has grown over the years, in the past life-saving medications for true medical emergencies like anaphylactic shock, sudden cardiac or an opioid overdose could only be administered by physicians. 

Then came paramedic programs where trained  who could give these lifesaving medications by paramedics. But we learned that in these true medical emergencies where minutes really mean the difference between life and death, even the 8-minute average EMS response is too slow. 

Today in many states including Arizona a layperson with can give Epinephrin for the allergic reactions of anaphylactic shock. This is a true medical emergency where 8 minutes can be too long, let alone 30 minutes to an hour.  

Today in Arizona anyone can give Narcan for an opioid overdose, and with a couple of hours of training an EMT or law enforcement officer can give Naloxone (Narcan) for an opioid overdose. This is a true medical emergency where time matters, and a volunteer can save a life.

Today in Arizona a layperson with a couple of hours of training can do CPR and use an AED (automatic defibrillator) in a sudden cardiac arrest. FACT Anything over 8-10 minutes and you're dead...

In these cases, 4 or 5 minutes can be too long, let alone 1-2 hours. 

Since EMT's and EMR's use BLS and don't do invasive procedures in the field, they obviously have less liability, not more. Sometimes the best patient care is simply rapid transport to definitive care.

In Arizona the law 36-2226 allows a layperson to give epinephrine in case of an allergic reaction known as anaphylactic shock. If you want to learn more about anaphylactic shock check out First Aid for Free's Anaphylactic Awareness page

Narcan also known as Naloxone can also be given by a layperson.
Under A.R.S. § 36-2267, any person may administer an opioid antagonist, like naloxone, to a person who is experiencing an opioid-related overdose. The statute further states, "A person who does this in good faith and without compensation is not liable for any civil or other damages as the result of the act.” 

For more information on the Arizona laws on obtaining or administering Narcan click HERE

Here's more information on How to Recognize an Opioid Overdose

Under ARS 36-2229 the Community Center in Dolan Springs and the Meadview Civic Association could have a couple people trained on how to give breathing treatments in case of respiratory distress.

Everybody needs to know First Aid and CPR... Who ya gonna call?
Learn for FREE at First Aid for Free 

Arizona EMS Laws

Emergency Administration of Epinephrine by good Samaritans 

36-2226 Emergency administration of epinephrine by good Samaritans; exemption from civil liability

A. Notwithstanding any other law, a person may administer epinephrine to another person who is suffering from a severe allergic reaction if the person acts in good faith and without compensation for the act of administering the epinephrine and a health professional who is qualified to administer epinephrine is not immediately available.

B. A person who administers epinephrine pursuant to subsection A is not subject to civil liability for any injury that results from that act unless the person acts with gross negligence, wilful misconduct or intentional wrongdoing.

36-2226.01 Emergency administration of epinephrine authorized entities prescriptions training immunity definitions

Physicians can prescribe epinephrine auto-injectors to an "authorized entity" That’s a school, restaurant, community center, camp, or place of employment where allergens capable of causing anaphylaxis may be present.

Emergency administration of inhalers

36-2229. Emergency administration of inhalers; authorized entities; training; immunity; definitions

A. A physician who is licensed pursuant to title 32, chapter 13 or 17 or a nurse practitioner who is licensed pursuant to title 32, chapter 15 may prescribe inhalers and spacers or holding chambers in the name of an authorized entity for use in accordance with this section, and pharmacists may dispense inhalers and spacers or holding chambers pursuant to a prescription issued in the name of an authorized entity. A prescription issued pursuant to this section is valid for two years.

B. An authorized entity may acquire and stock a supply of inhalers and spacers or holding chambers pursuant to a prescription issued in accordance with this section. The inhalers shall be stored in a location that is readily accessible in an emergency and in accordance with the inhaler's instructions for use. An authorized entity shall designate employees or agents who have completed the training required by subsection D of this section to be responsible for the storage, maintenance, control and general oversight of the inhalers and spacers or holding chambers acquired by the authorized entity.

C. If an employee or agent of an authorized entity or another individual who has completed the training required by subsection D of this section believes in good faith that an individual is experiencing respiratory distress, the employee, agent or other individual may provide and administer an inhaler to that individual or may provide an inhaler to the parent, guardian or caregiver of that individual, for immediate administration, regardless of whether the individual who is believed to be experiencing respiratory distress has a prescription for an inhaler and spacer or holding chamber or has previously been diagnosed with a condition requiring an inhaler.

D. An employee, agent or other individual described in subsection B or C of this section shall complete initial training for the use of inhalers and, at least every two years thereafter, shall complete subsequent training. The training shall be conducted by a nationally recognized organization that is experienced in training laypersons in emergency health treatment. Training may be conducted online or in person and, at a minimum, shall cover:

1. How to recognize signs and symptoms of respiratory distress.

2. Standards and procedures for the storage and administration of an inhaler.

3. Emergency follow-up procedures after the administration of an inhaler.

E. The organization that conducts the training required by subsection D of this section shall issue a certificate to each person who successfully completes the training.

F. The administration of an inhaler pursuant to this section is not the practice of medicine or any other profession that otherwise requires licensure.

G. Physicians licensed pursuant to title 32, chapter 13 or 17 and nurse practitioners licensed pursuant to title 32, chapter 15 who prescribe an inhaler and spacer or holding chamber in the name of an authorized entity, authorized entities and employees and agents of authorized entities that provide or administer inhalers and organizations that provide training pursuant to subsection D of this section are immune from civil liability with respect to all decisions made and actions or omissions taken that are based on good faith implementation of the requirements of this section, except in cases of gross negligence, wilful misconduct or intentional wrongdoing.

H. The immunity from civil liability provided in subsection G of this section does not affect a manufacturer's product liability regarding the design, manufacturing or instructions for use of an inhaler and spacer or holding chamber.

I. An authorized entity may accept monetary donations to purchase inhalers and spacers or holding chambers and may accept donations of inhalers and spacers or holding chambers directly from the product manufacturer.

J. For the purposes of this section:

1. "Authorized entity" means any entity or organization in connection with or at which allergens capable of causing respiratory distress symptoms may be present, including recreation camps, day care facilities, youth sports leagues, amusement parks, restaurants and sports arenas.

2. "Bronchodilator" means albuterol or another short-acting bronchodilator that is approved by the United States food and drug administration for the treatment of respiratory distress.

3. "Inhaler" means a device that delivers a bronchodilator to alleviate symptoms of respiratory distress, that is manufactured in the form of a metered-dose inhaler or dry-powder inhaler and that includes a spacer or holding chamber that attaches to the inhaler to improve the delivery of the bronchodilator.

4. "Respiratory distress" includes the perceived or actual presence of coughing, wheezing or shortness of breath.

Combined Special Meeting for EMS Scope of Practice and Drug Tables Medical Direction Commission & Protocols, Medications and Devices Committee

May 1st there will be a meeting to update the  Scope of Practice for EMR's Emergency Medical Responders. an EMR costs $250 to train and can assist and drive the LMRFD ambulance. This would allow the Meadview ambulance to transport with an EMT/paramedic and a Volunteer EMR giving us a second ambulance. 

Information on the meeting and a link where you can give your opinion about using an EMR in Dolan Springs and Meadview.

PLEASE if you think Meadview needs an ambulance that can transport, NOW is the time to tell the EMS Bureau 

Combined Special Meeting for EMS Scope of Practice and Drug Tables Medical Direction Commission & Protocols, Medications and Devices Committee 

 Public Meeting Wednesday, May 1, 2024

10:00 a.m. - 2:00 p.m. PMD & MDC Special Meeting for EMS Scope of Practice and Drug Tables - Agenda

Date: May 1, 2024 Time: 10:00 a.m. - 2:00 p.m. (Doors open at 9:30 a.m.) In Person: 150 N. 18th Ave, 4th Floor ALS Training Room, Phoenix, AZ 85007 Online: (Chrome browser) meet.google.com/rip-ywhg-f

LINK to Meeting EMS Bureau Agenda with Link to Online Meeting

The law is pretty clear, EMR’s Emergency Medical Responders can drive the LMRFD ambulance and assist an EMT or paramedic as long as their primary responsibility is driving the ambulance.

I’m told over and over that we can’t use EMR’s on the ambulance that we have to have a paramedic and an EMT on the ambulance. Not True

 

Using volunteer EMR’s we could double our transport capability by reducing response times and improving patient care. 

 

ARS 36-2201 says "Ambulance Attendant" means any of the following:

A - An EMT, an advanced EMT, an EMT I-99 or a paramedic whose primary responsibility is the care of patients in an ambulance and who meets the standards and criteria adopted pursuant to section 36-2204.

 

B - An EMR emergency medical responder who is employed by an ambulance service operating under section 36-2202 and whose primary responsibility is the driving of an ambulance.

 

 

ARS 36-2202 - Duties of the director; qualifications of medical director

J. paragraph 5 of this section shall require that ambulance services serving a rural or wilderness certificate of necessity area with a population of less than ten thousand persons according to the most recent United States decennial census have at least one ambulance attendant as defined in section 36-2201, paragraph 6, subdivision A and one ambulance attendant as defined in section 36-2201, paragraph 6, subdivision B

 LAWS

36-2201 Definitions

In this chapter, unless the context otherwise requires:

5. "Ambulance" means any publicly or privately owned surface, water or air vehicle, including a helicopter, that contains a stretcher and necessary medical equipment and supplies pursuant to section 36-2202 and that is especially designed and constructed or modified and equipped to be used, maintained or operated primarily for the transportation of individuals who are sick, injured or wounded or who require medical monitoring or aid. Ambulance does not include a surface vehicle that is owned and operated by a private sole proprietor, partnership, private corporation or municipal corporation for the emergency transportation and in-transit care of its employees or a vehicle that is operated to accommodate an incapacitated person or person with a disability who does not require medical monitoring, care or treatment during transport and that is not advertised as having medical equipment and supplies or ambulance attendants.

6. "Ambulance attendant" means any of the following:

(a) An emergency medical technician, an advanced emergency medical technician, an emergency medical technician I-99 or a paramedic whose primary responsibility is the care of patients in an ambulance and who meets the standards and criteria adopted pursuant to section 36-2204.

(b) An emergency medical responder who is employed by an ambulance service operating under section 36-2202 and whose primary responsibility is the driving of an ambulance.

8. "Basic life support" means the level of assessment and care identified in the scope of practice approved by the director for the emergency medical responder and emergency medical technician.

13. "Department" means the department of health services.

14. "Director" means the director of the department of health services.

15. "Emergency medical care technician" means an individual who has been certified by the department as an emergency medical technician, an advanced emergency medical technician, an emergency medical technician I-99 or a paramedic.

16. "Emergency medical responder" as an ambulance attendant means a person who has been trained in an emergency medical responder program certified by the director or in an equivalent training program and who is certified by the director to render services pursuant to section 36-2205.

36-2201

17. "Emergency medical responder" as an ambulance attendant means a person who has been trained in an emergency medical responder  program certified by the director or in an equivalent training program and who is certified by the director to render services pursuant to section 36-2205.

18. "Emergency medical services provider" means any governmental entity, quasi-governmental entity or corporation whether public or private that renders emergency medical services in this state.

23. "National certification organization" means a national organization that tests and certifies the ability of an emergency medical care technician and whose tests are based on national education standards.

Fire Districts primary obligation is to the residents who support the fire district through property taxes.

 A Fire Districts primary obligation is to the residents who support the fire district through property taxes. 

The Lake Mohave Ranchos Fire District, LMRFD only covers 144 square miles in the communities of Dolan Springs and Meadview, but not the parcels between the two communities.

In the past when the LMRFD had 6 ambulances and lots of volunteers the LMRFD ambulance CON was tasked to cover 2200 square miles. That's 2056 square miles larger than the 144 sm fire district. That's larger than all other fire district ambulances in the county, and even runs into parts of Coconino County.

 

The red line on the map below is the 2200 square mile area the LMRFD ambulance is required to cover. The blue squares are all the fire districts in Mohave County. The big blue square and the smaller one inside the red line are the areas covered by the Lake Mohave Ranchos Fire District Ambulance

As you can see the area covered by the LMRFD's one ambulance is larger than the area covered by all other fire district ambulances combined, it even runs up into Coconino County.

At one time the LMRFD had 6 ambulances, several quick response rigs and lots of volunteers. The economy and some bad choices left the LMRFD with two EMT firefighters and a few volunteers and one ambulance capable of transporting patients. 

No other fire chief with such limited resources would ever send his only ambulance outside their fire district if it left their district with nothing. Residents in White Hills and West of US-93 get the same fire and EMS service, yet never pay a dime unless they have a fire or medical emergency. 

With Meadview such a checkerboard of parcels inside and outside of the fire district, I wonder how many times someone really checks if a parcel was in or out of the district after a fire to even send a bill for services.

Who would voluntarily choose to pay hundreds to thousands of dollars in property tax when they get the same services for free now? 

What Can We Do??

Stop responding to fires outside the fire district. Advise residents in White Hills and West of US-93 they are not in the LMRFD. We need to offer a subscription service charging $60 to $100 a year. If you're not on the paid list, they don't respond. This would generate revenue to hire and train additional EMS personnel. 

Like other fire districts reduce the ambulance CON to the area covered by the fire district. If people in the 2056 square miles outside the fire district want EMS service, pay a subscription service, start a fire district or start your own ambulance service. 

We can’t abandon the taxpayers in the LMRFD to respond to areas that have been repeatedly told they have no service and have rebuffed attempts to provide their own fire or EMS service. 

Our first duty is to our citizens. We have no contractual liability to respond to fires outside the fire district. White Hills and west of US93 are not in a fire district, we can't have a mutual aid agreement because they have no aid to offer. 

One of these days someone important will die because our only ambulance was miles outside the fire district, only then will things change.

Repost of 2017 Heat Stroke Call at My House....

Every EMT in Arizona should know the signs and symptoms and how to care for a heat stroke patient. 

The call at my home went very badly.... The Patient should always come first and rapid transport to definitive care should be the rule, not the exception...  The paramedic on this call was out current Chief Bonnee....

A friend was out in the heat too long and when her husband came in and told us his wife had vomited, she was confused, disoriented and was having problems walking.  We got her into the shower and removed most of her clothing to begin cooling her off. Her condition continued to deteriorate over the next few minutes so I called 911 to request the LMRFD ambulance. 

She stopped breathing several times after what looked like a seizure. I called 911 again and I was told the LMRFD ambulance was on the way. but the dispatcher refused to give me an ETA. 

After several more calls to 911 asking for an ETA finally an EMT from Meadview arrived on a fire truck. He brought in a heart monitor but no oxygen or suction even after we had told dispatch she had vomited and stopped breathing several times for as long as two minutes. 

As I walked into the bathroom I told the EMT that the patient was decorticate posturing. He said I don't know, I’m sorry I’m just an EMT and pointed to his EMT patch. 

When I ask the EMT if I could see the rhythm or if he needed to use my AED? The EMT said he had pads on but wasn't authorized to use the heart monitor. The EMT was sitting on the floor holding the heart monitor the entire time my wife and her friend cared for the girl. The EMT kept saying I’m sorry I don't know what to do I’m just an EMT.

The EMT on the fire truck asked dispatch to have a helicopter put on standby, I asked him to please cancel the helicopter and start AMR, and he refused. I told the EMT to document on the chart that I had asked to cancel the helicopter and start AMR.

I called again and asked dispatch several times for an ETA for the ambulance and again she refused. I ask her to start AMR and again she refused. I know from monitoring the fire frequency that it’s standard practice when the LMRFD ambulance isn't available to start AMR ambulance from Kingman.

The EMT appeared to be very inexperienced and really not prepared to be on calls alone. Numerous times he said over and over I’m sorry I’m just an EMT and would point to his patch.

Paramedic

When the ambulance arrived I told them it wasn't possible to get the stretcher into the bathroom and asked if they had a transport chair, they said no and rolled out the stretcher. I told the EMT that we wanted her transported by ambulance and not by helicopter. The paramedic yelled at me from the bathroom saying “he doesn’t get to make that decision, I do”

I ask why if they were tied up they didn't call AMR, the EMT in the ambulance said "he had worked for AMR for 12 years and it always take 2 ½ hours to respond to Dolan". Why he would say something so untrue I'll never know. AMR responds to Dolan on a regular basis and it takes 45 minutes to an hour at most.

They couldn't get to the bathroom with the stretcher and carried her out on a tarp. Using a tarp to move the patient almost bending her in a U shape when she was already vomiting and having respiratory distress was a bad choice in my opinion. I've used someone's kitchen chair many times to move a patient from a difficult area or down stairs.

If she had vomited there's a good chance she could have aspirated, something that can cause severe complications.

AMR is called all the time to Dolan when the LMRFD ambulance isn't available. Why on this call when all of the LMRFD resources were tied up on another call didn't they call AMR as is usually done?

When the LMRFD left my home the helicopter hadn't launched yet, and gave a 30 minute ETA. Its only 37 miles from my home to Kingman Regional Medical Center. If it’s only 30 minutes or so running code to get the patient to Kingman Regional Hospital Emergency Department, why sit and wait a half-hour? The helicopter flight time was 30 minutes, 5 minutes to land, 5-10 minutes to load the patient, 30 minute flight time to the hospital, they were diverted to another hospital so 35 minute flight time? So 75+ minutes for helicopter transport rather than 45 minutes to the Kingman Regional Medical Center.

Was a $22,000 helicopter ride to a level one trauma center necessary when she was she released a couple hours later?

As an EMT I was taught that heat stroke is a true medical emergency with a 70% mortality rate. For an EMT in the Arizona desert to not know what decorticate posturing is, let alone that it’s a sign of heat stroke and a true medical emergency again shows the EMT lacks the experience to be on calls alone.

The paramedic on this call was Chief Bonnee before he was chief...

New Program Allows Paramedics to Treat and Refer Patients

We live in a medically underserved area with limited medical services, especially EMS and primary care. Many times the LMRFD ambulance is used for minor illness or injuries because someone simply doesn't have access to a vehicle. 

 Transporting patients whose illness or injury does not require ambulance transport to an emergency department puts our ambulance out of service for one to two hours. 

The Treat and Refer Program would give paramedics an opportunity to address non-emergency health needs and referral patients to a more appropriate level of care.

The Treat and Refer Program would better serve our community by allowing local non-emergency vehicles to transport patients that would otherwise take the LMRFD ambulance out of service leaving us with nothing. 

Today in Arizona we have the Treat and Refer Program for paramedics. This gives EMS providers an opportunity to assess patients and referral non-emergency to a more appropriate level of care (e.g. primary care doctor, urgent care or behavioral health office). 

The Treat and Refer Program would allow paramedics to respond and treat patients at home or refer patients to their primary care, urgent care, or crisis services.

Treat and Refer Questions and Answers 

Q: What is the Treat and Refer (T&R) program? A: A T&R interaction is defined as a healthcare event with an individual that has accessed 9-1-1 or a similar public emergency dispatch number, but whose illness or injury does not require ambulance transport to an emergency department based on the clinical information available at that time.

Q: Does the T&R program replace existing emergency services? A: No. Individuals who have an emergency and need transport to an emergency department will continue to receive those critical services. The T&R program is intended to give providers an opportunity to address non-emergent health needs through an assessment and referral to a more appropriate level of care (e.g. primary care doctor, urgent care or behavioral health office). The T&R program will provide better quality care and more opportunity for individuals to engage in their own health.

EMD 420 -Alternative Patient Destinations 

This course provides EMTs and Paramedics the background knowledge to understand and implement community paramedicine and treat and refer programs across a variety of EMS response models and communities. Upon completion of the course, students will meet Arizona requirements for those students with a certification as a paramedic to function as a Community Paramedic in a treat-and-refer program

Additional Training Required for Treat and Refer 

 More Info HERE

 

Rethinking EMS: Don’t Knock ‘Homeboy Transport’ an article from Emergency Physicians Monthly

In some cases, the fastest way to get someone to the emergency room is by POV or Private Owned Vehicle. 

 

Apple pie and motherhood. That’s how EMS systems have come to be viewed in this country. While in some locations this is a well-deserved perception, in many others, local EMS systems have become out of step with medical evidence.

 

As the Associate Director of Paramedic Training for Los Angeles County several decades ago, I remember the extensive classroom and practical training provided to the students. If I recall correctly, the total number of hours of education was about 1,800. You can envision the level of detail that was achieved given this extensive amount of time. 

In retrospect we covered a huge amount of material that was essentially irrelevant to field care. But the goal was to ensure a comprehensive level of training. The esprit de corps was high and being selected for the training was considered an honor.

 

 It was generally assumed that paramedic-level care was the gold-standard for EMS. The huge popularity of the TV show, “Emergency!” which focused on three imaginary LA County paramedics in the 70s, catalyzed the nation’s interest in developing paramedic programs.

 

Yet, since those early days there has been a growing body of evidence suggesting we need to challenge many of our assumptions about the best ways to provide prehospital care. 

From issues like the decreasing need for prehospital drug therapy (especially in the setting of a cardiac arrest) to evidence that little is gained by lights and sirens transport (and that it is associated with about 12,000 ambulance collisions annually in the U.S. and Canada) to the demonstrable overutilization of helicopter transport, the list of EMS practices that are worthy of scrutiny continues to grow.

But a much more fundamental question is arising. Perhaps less is more. Perhaps in some settings EMT-based rapid transport can result in better outcomes than ALS care. The next four papers challenge EMS agencies to look careful at the status quo.

1. BLS trumps ALS in some cases...

ALS transport and care were associated with decreased survival in patients with penetrating injuries and ISS scores below 30, and provided no significant benefit for patients with more severe injuries. It appears that speed of transport (ie, BLS care) is more important than the level of care provided.

 2. Private Vehicle Transport Trumps EMS Transport

The authors acknowledge the methodologic limitations of their analysis, but note that these findings are consistent with a significant survival advantage of transport of GSW patients by private vehicle rather than EMS.

3. Cardiac Arrest better outcomes with BLS

In this large study, BLS care for prehospital cardiac arrest appeared to be associated with better outcomes than ALS care.

4. Endotracheal Intubation ETI vs Bag Valve Mask BVM

Rates of survival to hospital discharge were similar in the ETI and BVM groups (26% and 30%, respectively), as were rates of discharge with good neurologic outcome (20% and 23%).

Rethinking EMS: Don’t Knock ‘Homeboy Transport’

Truth is in some cases; patients have a better chance of survival with an EMT rather than a paramedic

Television and movies tell us that paramedics are the be all and do all of emergency medicine, and in some cases that's true. 

But in many cases the use of Basic Life Support, BLS skills like loading the patient and rapidly getting them to the definitive care of physicians have better survival rates than paramedics. 

Read the research links at bottom.

When I posted about using EMR's to respond to medical calls to give Dolan and Meadview a second ambulance, someone close to the fire district said, "Actually, there is less liability if nobody shows up than if somebody shows up and does something wrong". 

That is true.

It's also true that the more invasive procedures you do, the more chance for mistakes. So there's more chance that a paramedic will "do something wrong" because they do invasive procedures like endotracheal intubation or starting IV's. 

EMT's and EMR's use basic BLS skills like airway, breathing, and circulation. They secure an airway, give 02, support respirations, and rapidly transport the patient to the definitive care of a physician. 

My experience...

I was fortunate to take my paramedic training in Los Angeles during the 1984 Olympics. I trained as a Mobile Intensive Care Unit Paramedic at one of the first paramedic schools in the country, the Daniel Freeman Hospital Paramedic School. It was started by Dr. Walter Graf who's known today as one of the founding fathers of EMS.

We attended class 8 hours a day, 5 days a week for 8 weeks. Then 4 weeks rotating through various hospitals like Cedar Sinai, Martin Luther King, and the USC Medical Center. 

We didn't know it at the time, but we were training in the birthplace of emergency medicine as we know it today, the emergency department at the USC Medical Center's General Hospital. 

I spent time in C-Booth, and I really don't know how to describe C-Booth. It was a 10'x10' area with 4 beds, at least 2 always filled with someone who was about to die. It looked more like a MASH unit than today's emergency room.

An article by Intermountain Health Care described C-Booth this way, "the most critical, traumatic injured patients arrived in the trauma bay, called C-Booth, where “more people have died and more people have been saved than in any other square footage in the United States,” according to physician and director Dr. Ryan McGarry"

It was a teaching hospital; we were young paramedics, PA's, and physicians, it was an exciting place to learn, but one of the first things we learned was that mistakes happen, and patients die.

Back in Spokane

As part of my training, I spent 480 hours training with a Spokane Fire Department paramedic unit. On our first run, the first day of my training we got a shortness of breath call about two miles away at a bowling alley. 

A 40-year-old male who was bowling with his son was having an asthma attack. It only took us a few minutes; it was a straight shot down Division St from Station 10. 

He was in respiratory distress in the tripod position when we arrived using accessory muscles to breathe. 

I started an IV as another paramedic was assessing the patient. As he was assessing breath sounds the patient progressed into respiratory arrest. The paramedic intubated the patient using an endotracheal tube, I attached an ambu-bag to the ET tube bagged the patient as he auscultated each lung and saying he had breath sounds in both.

The patient quickly progressed into cardiac arrest as firefighters were bringing in equipment. I continued to bag the patient as firefighters started CPR. We loaded the patient and ran code to Sacred Heart Hospital a couple of miles away. 

One of the first things they do in the emergency room when you arrive with an intubated patient is do an x-ray to confirm the ET tube in the trachea and not the esophagus. As soon as they got the x-ray back, they called the code. 

The endotracheal tube had been placed in the patient's esophagus rather than the trachea and I had been bagging oxygen into his stomach rather than his lungs giving him no chance of survival.

The ER doc went out and told his family he was sorry that they did everything they could, but he had suffered a severe asthma attack.... 

He never said he was sorry, but the paramedic had accidentally placed the breathing tube in his esophagus rather than his trachea. If it had been placed in his trachea and he received lifesaving oxygen, he may not have progressed into cardiac arrest. 

Talk about a learning experience for a paramedic trainee, did I help kill a guy. I always made sure I could see the vocal cords when doing intubations. 

Truth is in some cases, patients have a better chance of survival with an EMT rather than a paramedic, because EMTs use basic life support with rapid transportation to get the patient to the definitive care of a physician.

These are excerpts from EMS articles about survival rates when being transported by a paramedic vs EMT. The results may surprise you..

I love this article Rethinking EMS: Don’t Knock ‘Homeboy Transport’ because in Dolan many times we transport friends or family in private vehicles (POV) because of long response times. 

Article; BLS is more than basic, it’s fundamental to good care

Advanced Life Support vs. Basic Life Support for Patients With Trauma in Prehospital Settings: A Systematic Review and Meta-Analysis "In prehospital settings, the present study showed no advantages of ALS on the outcomes in patients with trauma compared to BLS".

Article; Advanced ambulance care increases mortality

Patients suffering from trauma, heart attack or stroke have a better chance at survival if they are transported by a basic life support ambulance than by an advanced life support ambulance, according to a new study involving data from nearly 400,000 patients in non-rural counties nationwide. NOTE: Some will say this was done in non-rural areas but a nobody survives a cardiac arrest in Dolan Springs or Meadview. A paramedic and EMT alone cannot run an effective cardiac arrest and transport. It takes at least 4 people, someone needs to run the code, someone needs to drive, and you need at least two people to CPR. You can only do effective CPR for 10 minutes.

The study, published in the Oct. 13, 2015 issue of Annals of Internal Medicine, found that:

• For patients suffering from trauma, survival was 6.1 percentage points higher for those transported by a basic life support (BLS) ambulance than those who were transported by an advanced life support (ALS) ambulance. Patients with critical major trauma had a 12.5 percentage point greater chance of surviving for 90 days if transported by BLS.
• Patients with acute myocardial infarction (heart attack) were 5.9 percentage points more likely to survive for 90 days after their ambulance transport if they were transported in a BLS rather than ALS ambulance.
• Patients with stroke had a 4.3 percentage point greater chance of surviving for 90 days, when transported by a BLS ambulance.
• There was no survival difference between BLS and ALS ambulances for patients with respiratory failure.
• Greater use of BLS may also save money..

"But we found that basic life support patients were more likely to survive. They were also more likely to have better outcomes on measures such as neurological functioning."

LINKS USC Medical Center C-Booth

C-Booth Code Black

LA Times 1985 article, Tending to Broken Bodies : Heart of County-USC: the Emergency Room