Hi everyone! Most of you are already familiar with me but for those who are visiting for the first time, please allow me to introduce myself. I am a Firefighter/Medic with training and experience in the following areas; HCP-CPR, Advanced Cardiac Life Support, Prehospital Trauma Life Support, Pediatric Advanced Life Support, Firefighting Operations, Hazardous Materials, Technical Rescue, Water Rescue, Emergency Vehicle Operations, Prehospital Pharmacology, and Medical Terminology. I am here to provide technical support for those seeking to broaden their knowledge of Firefighting and Emergency Medical Services. This board has a wealth of resources to answer any and all questions that may come it's way, so if you need to know, ask and we will help in any way we can!
Drawing blood for lab work
by Cindy
Did the E! guys ever draw samples for lab work on route to the hospital? Thanks
I -think- I remember seeing this in at least one episode, but I can't remember well enough to be specific. If they did, minimum would be a red-topped tube (for chemistry studies) and a purple top tube (for a CBC) - the doctor might ask for more than that for other things as well, especially if they thought the patient might need a transfusion. Hope this helps!
Technically, it would be possible for Johnny and Roy to pick up LAPD communications but it would be impratical for the LACoFD to do that. Since the radio in the squad at the time could only receive one frequency at a time (without changing channels) they would need an additional radio to monitor LAPD while still being able to hear "LA Dispatch".
Also, since squad 51 covers the County of Los Angeles and the LAPD covers the City of Los Angeles there would be very little if any interaction between the two departments because of different jurisdictions.
If you want to know about the history of LAPD communications, check out this site. http://www.snowcrest.net/~marnells/kma367.htm At the bottom of the page, there is a link to let you listen to the actual transmissions of the "Hollywood Shootout" that happened a couple of years ago with the LAPD.
Could someone explain how backdraft occurs? I'm thinking that in a closed environment, the rapid consumption of the oxygen creates a vaccuum, so the flames explode out when a vent is made, with the rapid availability of air. Is this right? What would be the safe way to enter a building in this condition? Thanks!!
You have the how pretty good there... there will most likely be a rush of air into the room, and due to the extremely high temperature that everything in that room has been smouldering at, as soon as you add some oxygen rich air, EVERYTHING lights up and burns explosively fast and hot.
The safest way to enter an area with a possibility of a backdraft is to find a way to ventilate it before committing manpower. If it is in a house or other isolated kind of structure like that, cut a roof vent, and let the heat do what it does best, RISE out of the room. This will allow some fresh air into the space, and you may still get a backdraft effect in the space, but it should be more controlled, and reduced in strength due to the reduced heat in the space. After the space has had a chance to cool some, then you should be able to pretty safely attack the fire.
If vertical ventilation is not feasible, then find a point that you can reduce the exposures to other structures, and use horizontal ventilation to remove some of the heat
Hi Cindy, your question about backdrafts has a very interesting answer. A backdraft accrues in the third stage of a fire known as smoldering phase. The fire is burning quietly because it has consumed most of the available oxygen in the room the normal room oxygen is 21 percent in a backdraft condition it is 16 percent. When the room is opened the room is rapidly brought back up to 21 percent that causes the backdraft. The only safe why to enter to enter the building is buy ventilating it buy cutting a hole in the roof to let the air in and the explosion goes right up the ventilated hole. Then its safe to bring firefighters with attack line’s (2 1/2 inch hose line) to put out the fire. hope this helps
I promise it's almost done!!! Very soon! Okay--please tell me a blood pressure reading for a male who's lost a lot of blood from a gunshot wound in the arm that would be considered very low but not make him completely unconscious but a bit out of it. The sooner I get this answer the sooner the story is done! Thanks!
This one depends on the patient. Is he the athletic sort who runs a couple of miles every day, or a good ole boy who believes that the proper way to work off his steak dinner is to throw back a cold one just prior to hitting his sleep button for a nice mid-evening nap???
If the pt is in good shape, it would be possible for his pressure to be pretty low, like 80/50 for him to be still awake, but a bit off.
If this is the goog ole boy, a pressure 95/60 would be bad news, his body has a hard enough time keeping up in optimal conditions, so you bleed him out quite a bit and he will be in trouble.
I just became a member of BBS.OneCenter.com. You can visit my BBS (discussion forum) at:
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It's a BBS message board community web program, but pays me money to use it! I'm really excited about this new Web program which helps keep my visitors happy and stay in my web site. Not like other free message board, I get paid for using their BBS message board. You can also place a BBS on your site and start making money too!
Talk about a good heeping steaming pile of all American Red, White and Blue, BS... A websight that pays you to use it? If you believe that, I have some good swamp land to build your next casino on...
Help!!! Pass the Bio-Phone, I'm sure Rampart would have the perfect cure for that load of crap.
What's the difference between a respirator and a ventilator? What happens if a person coughs up blood when they are on either machine? And how is a non-rebreather different from a resuscitation mask? Thanks!
The terms 'respirator' and 'ventilator' ('vent' for short) are used interchangably by laypeople (and some medical people) to refer to the same thing - a machine that helps someone breathe. There are many different kinds of ventilators - positive pressure, negative pressure, etc.
The term 'respirator' for this kind of machine is actually incorrect, as it actually refers to something else entirely. (for example, protective masks worn by hospital personnel around isolation patients and TB patients are called respirators, as are nebulizer machines.
A person on a ventilator cannot cough or speak because of the presence of the endotracheal tube, which passes through the vocal cords. A person on a vent may also sometimes be paralyzed with drugs to keep them from fighting the vent.
Patients on a vent with an endotracheal tube in place are frequently assessed to see if they need secretions suctioned from the lungs - this is done through the tube. (Because they can't cough them up themselves) The presence of blood in the secretions would probably be a cause for concern.
I hope this helps! I pulled out some of my old nursing books to make sure I was giving you the right answers - critical care isn't my area. Thanks for the chance for me to refresh my knowledge.
I have had such wonderful help from the people on this site! I hope I can write a story that justifies your advice. Okay---here goes! My last victim is a male who has been kicked in the head (actually the side of his face). He loses consciousness briefly, then awakes. He is coherent and oriented. Later he throws up, has slurred speech, and becomes semi-conscious. After a while he becomes unconsious. What type of head injury might he have (subdural hematoma, skull fracture, facial fracture, or just severe concussion, etc.)? What would his vitals be? How would the paramedics in the 70's treat him?
Well, others can (and most likely WILL) correct me if I am wrong, but I believe the kind of bleed you are looking for is an epidural hematoma. A sub-dural is basically a bleed in the brain cavity, so you have free blood in the head, where it doesn't belong. This,I do not believe, is conducive to consciousness.
Epi-dural hematomas, though, happen between the meninges (tough, fibrous membrane inside the skull, holds cushioning fluid, protects the brain) and the inside of the skull. It would be very possible to suffer a head trauma that initially causes unconciousness, as well as starting the bleed. They may be unconscious for some time, then have a 'lucid period' which basically means that the bleeding has stopped on it's own in the space. There is pressure on the brain at this point, but not necessarily enough to do serious damage or outwardly show signs/ symptoms yet. Some time later, however, if the bleeding continues, the pressure on the brain can increase, and the pt can again lose conciousness. That is why we ask if someone might have had a recent head injury if they present with an altered level of conciousness (LOC) of unknown origin.
Oh, and he might even have a skull fracture too...
Treatment is easy, 70's and today... lots of oxygen (20-24 resps/min usung a BVM to try to keep the intercranial pressure in check), immobilize (C-collar and backboard), and run...FAST but smoothly.
The paramedics don't get to the pt until more than two hours after the injury. Then ground transportation would take about 30 minutes since the scene is in a rural area. Should I call in the copter? Would they (at least in our favorite show) start an IV TKO? (D5W?)Thanks for the great answer! BTW, what would the pt's vitals be? Rapid pulse and respiration and low BP?
Given the trasport time, I would probably opt for a helo. An IV w/Normal Saline or Ringers is more likely than D5W. For vitals, given the length of time the bleed has had to progress, (and depending on how serious you want to make the patient) you may see what is called Cushings Triad.
This is when the blood pressure increases and the pt is bardycardic. The respiratory pattern also changes. Often in a predictable fashion Chezne-Stokes, a toxic respiration, etc.)
By the way, I am glad this information is coming. I posted a question about head injuries on Apr. 1 and NO ONE said so much as "boo" to me! This is going to be very helpful for my story too! Hope you don't mind sharing, Leslie.
Real simply bardycardia is when the heart rate is below 60 beats per muinutes. There are several flavors of this and if you need to get to that level you may need to look at a reference book (Dubbins). The variations occur based on where the electrical impulse of the heart is starting.
As for the respiratory questions, Cheyne Stokes is a respiration pattern where the rate is rythmic and picks up in speed. Sometimes, before the cycle starts again, there is a pause. Sort of long, longer, longest, pause and reset. The other types of respirations are most likely not what you are interested in but this site may help: http://www.ohsu.edu/cliniweb/C8/C8.618.html
I think I can finish my story now. At least medically speaking. I'll be back if anything comes up. Hope you will still be available. Just for grins, can you (or anyone else who's interested) tell me what fire vehicles would be sent to a barn that is on fire? It is in a rural area. There is an end to my story somewhere. I just haven't found it yet!
Sorry I didn't get back to you on the other questions...but everyone else seemed to pick up for me very well.
As far as the truck response, it would depend on the department protocol, but if memory serves, E! first alarm response on a structure fire would be 3 pumps, an Aerial, a chief, and considering the fact it is rural, a tanker or two wouldn't be a bad idea.
I'll just ask you another question! What's an Ariel--a helicopter? All that for a barn? When Sam calls the alarm, would he say Tanker (number) along with the engines?
I will let you know when it is up. I have another story up now on the Emergency! Shelter site if you are in the mood for a laugh. Thanks, Brian!
All an aerial is is the ladder truck, standard dispatch for a structure fir, it is usually the truck with the gear for search and rescue, and the main truck for the overhaul work when the fire is out.
I imagine Sam would dispatch it as Tanker #... Don't know for sure.
Will be sure to look up your other story!!
I wrote the ending of my story today. Now I have to go back and finish all the details I have learned from everyone here. Just a few more weeks (I sincerely hope NOT) and I'll be done. I think after this I'll just stick to humorous stories. :-P
Just for reference, in Calif. the main types of fire apparatus are: engine (=pumper), truck (= ladder, platform/Snorkel), water tender (=tanker), copter (=helicopter), dozer, patrol (=brush truck), utility (=pickup truck). In many areas, a rescue is a paramedic unit (LAFD calls it a rescue-ambulance or RA). Occasionally, it refers to a heavy rescue unit (extrication equipment, ropes, winches, etc.) And tanker refers to an air tanker (airplane that drops fire retardant or water).
I have often heard it said on E! and maybe in reality, that no pain meds can be given with head or spinal injuries, because it can mask more serious symptoms, that might develop later on. Is this true? In a story I'm currently working on, not online, but in MS Works, Chet Kelly is cold-cocked by a errant fire hose, he helmet is cracked in half, and he has a bad gash, and it's a big bleeder. I check his pupils for reaction to light, though, in the story, I'm only a Jr. Parmaedic(I pretend that Gage and DeSoto started a Jr.Paramedic program to teach kids first-aid in the home), I learned about pulse, respiration, and
B/P, and how to check pupil reaction, but mostly,
how to bandage wounds, do CPR and the Heimlich Manuver, and spint broken limbs, within the limits of my abilities, they take care of the rest, because they are more advanced in their training, and better equipped to handle emergencies. What do you think of that story? Are you an E! fan? and do you remember the Jr. paramedic kits. It just had information about the Paramedic Program, and about the people who played on E, and how to
do CPR and artificial respiration. It was so interesting. I used to have a Jr. Paramedic kit, with the pictures, but I had to give it up. It was fun while it lasted. Oh, did I mention in the story, that Chet was in pain, and aking for pain meds, but I chided him ,and said "I wish I could, but you need to have your head examined (no pun intended) by Brackett or Early? I know there are reasons, and I'm sure that a medics heart goes out to the patient, but the pain is used as a means of determining how severe the injury is. Am I right?"
I've heard that people with head trauma aren't allowed to sleep? What happens if they try to go to sleep?
I'm just curious, because I have Chet Kelly getting his helmet cracked in two by a wayward fire hose, and he's drowsy, and wants to sleep, or else, he's losing consciousness. I hope you can answer this for me.
I read on the main page about the license aspect of KMG-365,but do the letters and numbers have a code meaning?For instance BBC TV stands for Brittish Broadcasting Corperation.NBC TV stands for National Broadcasting Corperation,etc.etc.etc.
K seams to represent the country or area,such as K for KLAX,an ident for the Los Angeles Airport.The letter K stands for American in terms of airports.Does the K have the same aplication for the K in KMG,and of the other letters&numbers?
Unlike broadcast radio stations, licence call signs are issued randomly by the FCC. The call sign for my fire deparment here in New York is KJD-401. I don't belive the letters have any meaning, other than most licences will start with a K or a W. It seems that 3 letters indicate base stations, 4 letters in a call sign are for mobile licences. I don't claim to be any expert, but i've been around this stuff to figure it out on my own. I hope this answers your question.
I'm not sure about the three and four-letter thing. Where I ride here in NY, our dispatch terminal is WNPH543. Although all of the other terminals around here are three letters, and all K (KEA511, KEE398, KEA323, KAF548).
I'm kinda stuck in my story until I get some more details. Can anyone answer the questions I had posted previously about infection and psychogenic shock? It would help a lot! Thanks!
I have not been following the thread but...pyschogenic shock is basically a fainting spell where the blood pressure drops due to a stimuli and the person either goes out or feels lighted headed and dizzy. Treatment is calm them down, removing the stimuli, lying them down with the feet elevated. It normally clears up in a couple of minutes. You are probably going to a low BP, heart rate and respirations can vary.
If the infection is in the hospital and the patient is already receiving antibiotics a infection can still set in. HELP ME HERE.. I believe antibiotics are only effective against bacterial infections and viral infections can be caught in the hospital setting the open wound could have been exposed. Also, some bacteria are resistent to some antibiotics and they one of these could be the culprit.
Check this site out for some info... http://www.healthsci.tufts.edu/apua/apua.html
The doctors would be giving prophylactic/preventative antibiotics right from the start - probably from the time the patient arrived in the ER. This is pretty standard for all 'dirty' wounds, as is a tetnus booster. Wound infections do take some time to develop. They could develop even in spite of the antibiotics, at which point the wound drainage (the most noticable sign of infection) would be cultured for what is called a 'culture and sensitivity' or 'C&S' for short. This determines what kind of bacteria is growing in the wound and which antibiotics it is most sensitive to for treatment. At that point the doctor would order new antibiotics. As a C&S takes several days to show results, the doctor might switch to a different antibiotic before getting the results back, using his personal experience to guide him on what the most likely type of infection would be.
Viruses do not grow in wounds; they are systemic rather than local.
The most common symptoms of a wound infection are - redness, warmth, swelling and tenderness around the wound, foul smelling/looking drainage, and elevated temperature. Clear or slightly bloody drainage is OK and even normal; pussy cloudy drainage is not. Greenish drainage is also bad - it's a sign of a specific infection called pseudomonas.
Hope this helps -
MVM
An infection most probably wouldn't show up for at least a day, more likely two or even three. They take time to develop. If it's a local infection (like in a wound) the patient might or might not have a temperature, and it might be only slightly elevated (99 or 100 degrees F). A lot of times people don't develop general temperatures from localized infections unless/until they're pretty well advanced. If it's someone already in the hospital, it's going to be caught pretty quickly.
The risk with wound infections always is that if they're not caught and treated, they get larger and more nasty and extensive until they spread through the body - this is called 'sepsis'. (What they used to call 'blood poisoning' a long time ago) But this takes quite some time to happen. Prompt treatment with antibiotics and it will never get beyond being a local infection.
