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everymansaved

Any other skydiving EMT's/Paramedics?

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Hey all, I'm and EMT, and the other day, I was stiing at work, really bored and watching a skydiving movie. I got to thinking about how everyone at the DZ is always so "thankful" when someone gets a cut or some other mere flesh wound, when I started thinking about more serious injuries that could happen. My question to you is, what kind of preparedness do you have with you whilst out jumping for a serious emergency, and what are your thoughts about providing advanced care while off duty? Do you carry a few litres of NS, some drop sets and cathlons? What 'bout bigger needles for pleural decompression? Does your DZ have spinal gear? Would you spinal someone, or let the crew that gets there do it? I'm quite curious to see what everyone's thoughts are on this.

sean
God made firefighters so paramedics would have heroes...and someone can put out the trailer fires.

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I'm a volunteer EMT, and I usually carry my EMT bag to the dropzone with me. I do not carry an AED or oxygen with me since my bag usually sits in the car, and during the summer it can get quite warm. I usually have my rescue mask, bandages, gauze, splints, cervical collars, head wedges/straps, oral, and nasal airways, sterile water, shears, ice packs, glucose, etc... basically the typical stuff, of course BP, and stethoscope.

At the DZ if someone hits hard, I am usually prepared to help out if necessary. Although, there are usually a bunch of people who are qualified, and probably do more EMT services than I, so I just sorta stay back as a backup in case I'm needed. If I am needed, I'll stabilize someone, keep them as comfortable as possible, do vitals, and just do what I can until the ambulance comes.

If I don't have my bag on me, I always have my airmask just in case, and I will take care of vitals via manual pulse and such.

CReW Skies,
bubbles
"Women fake orgasms - men fake whole relationships" – Sharon Stone
"The world is my dropzone" (wise crewdog quote)
"The light dims, until full darkness pierces into the world."-KDM

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I keep some BLS stuff in my car and i usually have the equip to start at least 1-2 IV's. Although sometimes the IV supplies get used up to cure hangovers. ;)
As a general rule, the better it felt when you said it, the more trouble it's going to get you into.

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I jump at two local DZ's where there are a couple of nurses, doctors and several paramedics (like myself). Since I am only a paramedic I havent carried ALS supplies for some time. A few years ago a Paramedic had his license revoked due to the fact he had a small cache of ALS supplies. The revocation was supposedly based on him having the ALS supplies with intent to practice para-medicine without medical control.

So needless to say all I have is BLS supplies and a cell phone.


Fire Safety Tip: Don't fry bacon while naked

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I jump at two local DZ's where there are a couple of nurses, doctors and several paramedics (like myself). Since I am only a paramedic I havent carried ALS supplies for some time. A few years ago a Paramedic had his license revoked due to the fact he had a small cache of ALS supplies. The revocation was supposedly based on him having the ALS supplies with intent to practice para-medicine without medical control.

So needless to say all I have is BLS supplies and a cell phone.



This is the smartest way to go. A Para Medic without contact with a base station is an EMT and to take any treatment past that level in illegal in most states.
My idea of a fair fight is clubbing baby seals

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While I agree with you that using ALS skills (thoracostomy, etc...) may be going over the top, I'd rather get in a little trouble with the governing body and IV bolus my friend so he lives rather than save my skin and have him exanguinate. Plus, here in Alberta we have the "emergency medical aid act" that covers anyone trying to help someone else as long as they act in good faith.
God made firefighters so paramedics would have heroes...and someone can put out the trailer fires.

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Plus, here in Alberta we have the "emergency medical aid act" that covers anyone trying to help someone else as long as they act in good faith.



That sounds like the standard shield law and usually pertains to the layperson. With certified/licensed holders most of them state you must not exceed your level of training. In California that means if you administer ALS without contact with a base station you have lost the protection of the “shield law”.

While I would and have gone out on a limb for a friend in most places you have no protection and are exposing yourself to possible prosecution.

You might want to get a copy of the "emergency medical aid act" and read it in full yourself. Do not base you actions on what someone else has told you.
My idea of a fair fight is clubbing baby seals

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I just recently got into skydiving and find my self bringing my BLS bag with me most of the time. I'm currently a medic in training and agree with some of the others that I will only provide BLS services. In sue happy California the laws are not so forgiving. Running a bolus line is more then a hand slap, it will get your license revoked.
SUCK IT UP BUTTERCUP

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I have read the act, it's part of EMT school. When you're working as a EMT, you're governed by the health diciplines act, but not when you're off shift. The only time it's different is if you're a doctor.
God made firefighters so paramedics would have heroes...and someone can put out the trailer fires.

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I have read the act, it's part of EMT school. When you're working as a EMT, you're governed by the health diciplines act, but not when you're off shift. The only time it's different is if you're a doctor.



I would not bet my future on that. The light in a court room is sometimes blinding.
My idea of a fair fight is clubbing baby seals

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Here in VA if you do anything outside of your own county the you revert back to a BLS provider. In your county you can be off duty and preform ALS skills as long as you follow your protocals. But like the man said i would rather stand tall in front of my medical director for dropping a line and maybe saving or at least stabalizing someone then explain to family of a friend that i could have done something and didn't.
As a general rule, the better it felt when you said it, the more trouble it's going to get you into.

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See what happens? You become a Captain and you stop paying attention to protocols! Phil, we are now covered off duty as well as on. We can carry and forage for ALS supplies and operate within scope of practice off duty (we are never not under our medical control). That said, I have found (I have some experience) that the best thing you can do is assess and facilitate.
Faith in a holy cause is to a considerable extent a substitute for lost faith in ourselves.
-Eric Hoffer -
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Not in California!!! You are held to "Standard of Care" Another area people have confused is Duty to act. You only have a duty to act if you identify yourself...got that star of life sticker on you car?
Faith in a holy cause is to a considerable extent a substitute for lost faith in ourselves.
-Eric Hoffer -
Check out these Videos

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My husband and I are both Firefighter/Paramedics. We have had several worst case senerio discussions- they aren't fun, but we'd rather be prepared and hope that pushes the bad mojo away. We are working on getting everything we need to be able to help stabilize someone until flight medic or ambulance can show up, which could be at least 30 minutes at our DZ. We are looking into getting medical control established, but I can guarantee if I have the knowledge and skill to save a friend- I will.
I just hope I never have to!!

Blue skies to ya!

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I used to be NREMT-B, but it expired like 6 years ago. so I just watch them and let the profesional take care of them. I forgot everything so it is better to leave the person stationary, as long as they have clear air way, breathing, and a beating heart.
Bernie Sanders for President 2016

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Dude, it is better to let the person be staionary when you have no idea what you are doing. If he's airway is obstructed, not breathing I'll get it cleared away and do some CPR, now that I remember, but I don't wanna mess with compond fractured femur or pelvis.. I'm sorry but by me moving the guy I could make it worse now that I know....
Bernie Sanders for President 2016

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We can carry and forage for ALS supplies and operate within scope of practice off duty (we are never not under our medical control).



There are actually very clear definitions in the Sac County protocols of what you can and cannot carry while off duty, ALS wise...but that only counts in Sacramento county, for those of us certified there.

In Yolo county, you're under SSV. They have different protocols and different rules of engagement. You can't legally operate as ALS outside the county in which you're certified...mostly because you can only hold ALS certification if you are associated with an ALS agency in the county in which you are certified!

You can't freelance ALS like you can BLS.


"...and once you had tasted flight, you will walk the earth with your eyes turned skyward.
For there you have been, and there you long to return..."

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There's a reason EMS systems in the US (arguably the most advanced in the world) have gone to a "scoop and run" approach. Transport to a facility that has the resources to treat the patient is a priority. By treat I mean definitive treatment.
You do what you can on scene to stabilize or attend to the basic ABC's (airway/breathing/circulation) but not to the point where it will delay transport. Intubating someone seems very heroic, but in a majority of cases people can be ventilated with an ambu-bag just as effectively. It is a matter of balancing what can be done at the scene (limited) with the delay in transport to definitive care. It can be a judgement call and therefore all EMS systems have protocols in place to minimize having to make such decisions.
Realize that there is little that can be done immediately other than providing supportive care, eg clearing the airway, supporting breathing, applying pressure to stop bleeding, and immobilization. Keeping a cool head and providing comfort if the jumper is awake and preventing further injury is the best most of us can provide. I would resist the urge to be the hero unless there is an identifiable problem that you have the knowledge and experience to treat that cannot wait until EMS arrives.
Medico-legally, there are issues that need to be considered as well, and as far as I know, no one is covered by anything other than the Good Samaritan law when outside their realm of practice. Obtain the text of the law and study the language VERY carefully. It's not perfect by any means.
Just a word of caution for all medical folks out there. I know it's harder not to do anything than to do nothing at all. I'm not advocating doing nothing. I only advise restraint. If someone were hurt at my DZ, I would help them as I always do, but just be careful and think of the big picture and your place in it.

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AAhhhh young jedi...
Wrong.
Per Title 22 a paramedic out of county operates under the protocols established within his county where his medical control exists.

Per Sac county protocols: (E is the money shot)

III. POLICY – Off-Duty Provision of ALS Care:
A. Accredited Sacramento County Paramedics are explicitly authorized to provide Advanced Life Support (ALS) while off-duty. This includes the use of automatic and manual defibrillators where available.
B. Nothing in this policy shall require a Sacramento County Accredited Paramedic to provide ALS off-duty.
C. If an off-duty paramedic chooses to provide assistance to a patient already under the care of Sacramento County ALS personnel, it shall be at the request of, and coordinated by, the on-duty paramedic providing patient care. If only BLS Personnel are on scene, assistance may be provided only at the request of the incident commander.
D. Overall patient care will remain the responsibility of the on-duty ALS personnel except, at the specific request of the on-duty paramedic responsible for patient care and with the concurrence of the off-duty paramedic.
E. In the situation where no EMS personnel are in attendance, the off-duty paramedic may render BLS and ALS care within their capabilities and available equipment until arrival of on-duty ALS personnel. Transfer of patient care will then be made to the on-duty paramedic.

Edited to add: I do conceed that permission is required to carry drugs. If they are there...you can use them...
Faith in a holy cause is to a considerable extent a substitute for lost faith in ourselves.
-Eric Hoffer -
Check out these Videos

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There's a reason EMS systems in the US (arguably the most advanced in the world) have gone to a "scoop and run" approach. Transport to a facility that has the resources to treat the patient is a priority. By treat I mean definitive treatment.
You do what you can on scene to stabilize or attend to the basic ABC's (airway/breathing/circulation) but not to the point where it will delay transport. Intubating someone seems very heroic, but in a majority of cases people can be ventilated with an ambu-bag just as effectively. It is a matter of balancing what can be done at the scene (limited) with the delay in transport to definitive care. It can be a judgement call and therefore all EMS systems have protocols in place to minimize having to make such decisions.
Realize that there is little that can be done immediately other than providing supportive care, eg clearing the airway, supporting breathing, applying pressure to stop bleeding, and immobilization. Keeping a cool head and providing comfort if the jumper is awake and preventing further injury is the best most of us can provide. I would resist the urge to be the hero unless there is an identifiable problem that you have the knowledge and experience to treat that cannot wait until EMS arrives.
Medico-legally, there are issues that need to be considered as well, and as far as I know, no one is covered by anything other than the Good Samaritan law when outside their realm of practice. Obtain the text of the law and study the language VERY carefully. It's not perfect by any means.
Just a word of caution for all medical folks out there. I know it's harder not to do anything than to do nothing at all. I'm not advocating doing nothing. I only advise restraint. If someone were hurt at my DZ, I would help them as I always do, but just be careful and think of the big picture and your place in it.



All very good points. The most important thing you do is make sure 911 is called immediately to get the EMS wheels started. And as you said, us restraint. As Para Medics you are not Doctors, diagnosis and treatment are out of you realm period.

If you feel a line is called for, what solution will you use and at what rate? What is indicated for sever head injury with the possibility of brain swell? Do you go with Ringers, or NS? If the victim is conscious and in extreme pain do you push MS? Where do you draw the line? Are you going to help your friend or create more problems? Your few months of PM school are no substitute for the many years it takes to be called Doctor.

I have been there and done that. If you are emotionally involved with the victim you are more than likely a liability to those trying to help.
My idea of a fair fight is clubbing baby seals

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No where in you post does it say you can provide ALS care outside of Sac. County. Look in the State H & S code.

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Edited to add: I do conceed that permission is required to carry drugs. If they are there...you can use them...



If you do carry drugs and use them without the ability to contact a base station you are diagnosing and prescribing, both functions allowed by a Physician only. What besides Narcan and Dextrose for unconscious unknown do protocols allow you to administer before contact?
My idea of a fair fight is clubbing baby seals

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