OT: How cold is Barrow?

Discussion in 'Digital Cameras' started by Dudley Hanks, Feb 19, 2014.

  1. Dudley Hanks

    Tony Cooper Guest

    Yes, my son is a certified EMT. He had that certification before
    advancing to a Paramedic certification.
    What you and Floyd don't seem to understand that "ER" (Emergency Room)
    is a term that is used in the US but not necessarily used in other
    countries. In the UK, the term is not used. In the UK, what we call
    the ER is "Casualty".

    There are web references to "ED"s (Emergency Departments) in NZ, but
    it's unclear (to me)in reading the material if they mean a designated
    area where patients are first seen as we have in the US with our ERs,
    or if it means the departmental structure.

    If Eric says he went directly to ICU, then I believe that Eric went
    directly to what is *called* the ICU in NZ, or was at the time he was
    admitted. The *function* of what he's calling the ICU may be what the
    *function* of we'd call the ER is here.

    In the US, the ICU (intensive care unit) is not - as you indicate -
    the first stop in a hospital for the patient. ICU is basically where
    the patient goes after receiving treatment or surgery in some other
    department. That doesn't mean that the term has the same meaning in
    NZ.

    I think it's rather bizarre for a person in California and a person in
    Alaska to tell someone in New Zealand that he didn't do what he
    insists he did when it's probably just a difference in terminology.

    And, you should know better. Both of you live in a country where
    terms and laws may be completely different if you step across a state
    line.
     
    Tony Cooper, Feb 28, 2014
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  2. Dudley Hanks

    Savageduck Guest

    True, <hanging head sheepishly> true.
     
    Savageduck, Feb 28, 2014
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  3. Dudley Hanks

    Eric Stevens Guest

    On Thu, 27 Feb 2014 21:35:12 -0800, Savageduck

    --- snip ---
    That site relates to 8 hospitals ranging from the mother hospital to
    which I referred you above, down to small town cottage hospitals.

    They all have 'emergency' departments of various sizes and
    capabilities. If you visit one of these you will find they are choked
    with colds, cuts, sprains and all kind of minor problems. That's not
    to say there are not more important problems there too but it is New
    Zealand tradition that people would rather attend a hospital emergency
    department than go to a local doctor.

    Patients arriving by ambulance come in through a special entrance.
    Their condition and their treatment are usually sorted out byradio
    telephone before they even get to the hospital.
    I too expect they will be sorted out in the cardiac unit before they
    go to whereever they are going. But that's a separate problem.
    Exactly. That's why I said (above) "unless it is urgent".
     
    Eric Stevens, Feb 28, 2014
  4. Dudley Hanks

    Tony Cooper Guest

    I should add to the above that a fire department emergency vehicle
    will have both an EMT and a Paramedic on board. Sometimes more than
    one EMT. There must be a Paramedic in the crew, though.
    This can vary by county within the state in the US. In most of the
    counties, the fire department is the first responder to motor vehicle
    and other trauma calls. However, a station will have a designated
    team and ambulance. The ambulances operated by the hospitals, and by
    the private ambulance services, are primarily for patient transport
    from one hospital facility to another. A patient may be admitted to
    one hospital, but transferred to another hospital because the second
    hospital has services that the first hospital doesn't have.
     
    Tony Cooper, Feb 28, 2014
  5. But I'll tell you one thing that is absolutely positive: If the
    ambulance that responded to that accident and transported Eric
    to a hospital *did have* the qualifications and equipement to
    start an IV, he had an IV running *before* the moved that ambulance
    even on foot from the scened.

    The only reason they would not start an IV is not being certified
    to do so.
     
    Floyd L. Davidson, Feb 28, 2014
  6. Their grestest concern was not "whip-lash". The put a C-collar on
    every and any patience that is place on a backboard. Not so much
    because they may have been injured as it is to *prevent* an injury.
    Are you still saying they did not start an IV???
     
    Floyd L. Davidson, Feb 28, 2014
  7. And I guarantee that no transport ever starts until an IV is in
    place, assuming they do have people qualified to start one.
    Most EMT's and certainly all Paramedics can start an IV without
    consulting a doctor.
     
    Floyd L. Davidson, Feb 28, 2014
  8. That is in fact quite reasonable.

    In the US X-Ray, CT Scan, and MRI are all distinctly separate
    from an ER, and also from an ICU. In the US an ICU is not a
    place for diagnosis, but for intensive *care*. There is no
    reason that NZ might not use the terminology slightly different,
    or even group the imaging devices and some functions of an ER
    into a "super ER" that could be called an "ICU".

    That is not common with the US health care system where an ER is
    not normally a place that people go to instead of making an
    appointment at a doctor's office.

    However, the health care systems in bush Alaska are different,
    and operate under various Tribal Health Care organizations.
    Typically we just go to the "walkin clinic", which is in fact
    the ER area, rather that make an appointment with a particular
    doctor.
     
    Floyd L. Davidson, Feb 28, 2014
  9. Look, lets get it straight. You can say what you want about
    your condition at the time. You are not qualified to make such
    observations though! Not at *any* time, never mind right after
    having blacked out and driven off the road at 60 MPH.

    Everybody seems to know someone who has worked as an EMT or
    Paramedic here and has added to the conversation.

    I was the senior medic, and one of the founders, of an ambulance
    service. I served on the Board of Directors of the
    certifying/governing body, the Interior Region EMS Council, for
    State of Alaska's Emergency Medical Services in the area around
    Fairbanks Alaska.
    Patients get told a lot of things... :) Did she pat you on the
    head and squeeze your hand too?

    Once again, tell me they didn't put an IV in your arm at the
    scene... but they put you in ICU, did a CT Scan, etc etc...
     
    Floyd L. Davidson, Feb 28, 2014
  10. Dudley Hanks

    PeterN Guest

    Could be.
     
    PeterN, Feb 28, 2014
  11. Dudley Hanks

    PeterN Guest

    In NY while they have no need for triage, they are taken straight into
    the ER,, which has the equipment and variety of trained specialists to
    evaluate which ICU, if any to take the patient.
     
    PeterN, Feb 28, 2014
  12. Dudley Hanks

    PeterN Guest

    That is the ER.
     
    PeterN, Feb 28, 2014
  13. Dudley Hanks

    George Kerby Guest

    You guys are all bitching about nothing but *TERMINOLOGY* used in different
    parts of the world.

    Wanna get back to photography, maybe?
     
    George Kerby, Feb 28, 2014
  14. Dudley Hanks

    Tony Cooper Guest

    "Triage" means the assignment of the degree of urgency for treatment.
    It can be done anywhere. The paramedic can be participating in this
    en route to the hospital.

    In other posts here, it's implied that "triage" is an established
    procedure done in the ER. Well, it is and it isn't. It means "sort"
    (from the French), and came into use to describe sorting out which
    individuals need treatment first when dealing with many individuals
    needing treatment.

    If there's a major accident where several people have been injured,
    the triage process determines which need attention first. On the
    battlefield, the wounded are triaged to determine which will receive
    attention first. People who watched the television series M*A*S*H saw
    the doctors triaging the wounded as they were off-loaded from the
    helicopters.

    The ER triage process simply sorts out the people with minor problems
    like a stomach ache and the major problems like trauma and heart
    conditions. Stomach aches go to the waiting room and the people with
    more serious conditions are either treated first or placed under
    observation.

    If you go to the hospital and the ER nurse has you describe your
    condition, takes your temp and bp, visually examines you, and tells
    you to go back to the waiting room until called, you've been through
    triage.

    If the responding ambulance personnel call in to the hospital to say
    they are bringing in an accident victim, and describes the injuries
    and the vitals, that's part of the triage process. That person may
    skip the normal ER incoming process.



    Every year the hospitals in this area have a mock disaster drill. I've
    been a volunteer photographer for this, and will do so again next
    month when they have the 2014 drill.

    Last year, the mock disaster was a plane crash at Orlando
    International Airport. Triage was done in a tent in the hospital's
    parking lot. "Patients" were routed straight to the Operating Room,
    to CCU, and to other departments within the hospital.

    The hospitals do not know what the disaster will be. It could be a
    plane crash, a chemical spill, a large fire, a hurricane, or anything
    else that results in a large number of casualty victims.

    Here's where triage was done in last year's disaster drill.
    https://www.dropbox.com/s/n4nq013qi55z07d/2013-03-14-086.jpg
     
    Tony Cooper, Feb 28, 2014
  15. Dudley Hanks

    Savageduck Guest

    Our local hospital's emergency department is arranged to deal with
    *walk-in* emergency patients and ambulance/emergency vehicle
    transported patients.
    The actual ER has multiple treatment areas including a specialized
    trauma center which handles both physical trauma and cardiac
    emergencies.
    Patients are usually evaluated with any of the current diagnostic tools
    and are then stabilized in the ER.
    If immediate surgery is required, that can be performed in the ER
    trauma center, or one of the hospital's regular ORs. Only then would
    the patient be moved to the ICU or surgical recovery unit, which are
    completely separate from the ER.
    Usually all arriving cardiac crises are dealt with in the ER, with the
    stabilized patient moved to ICU or a regular bed based on need.

    I have had a fair amount of experience of treatment in ER and
    subsequently ICU, with my wife when she had her brain haemorrhage,
    subsequent surgery and 4 week ICU stay. I have had my own personal
    visits to the ER only one of which resulted in me being admitted for a
    longer than a patch up stay.

    I have also had to deal with baby sitting various miscreants, who for
    whatever reason required help/treatment in an ER. Sometimes those would
    end up in the hospital's ICU, a regular hospital bed, or transported to
    the local county jail infirmary.

    All of this is probably done a little bit differently in Waikato.
     
    Savageduck, Feb 28, 2014
  16. Dudley Hanks

    Savageduck Guest

    Umm. thanks for all that research work on *Triage* Tony, but I have
    been well aware of the various uses and subtleties of the word in
    different medical emergency situations for well over 45 years now. I
    have seen it used in combat medicine, for sorting out ER priorities,
    and for evaluating disaster victims.
    At one stage of my multi-faceted working life I was a lab tech at
    Faxton Hospital in Utica, NY, and even in the lab we were subject to
    different triage protocols (there is that pesky word protocol again)
    based on circumstances and need.
     
    Savageduck, Feb 28, 2014
  17. Dudley Hanks

    Tony Cooper Guest

    No research was involved. What was involved was decades of experience
    dealing with hospitals through my business.

    While you may have an understanding of what "triage" means, a post is
    often read by many people, and some of them may not understand what it
    means. This is not email that goes from one person just to another
    person.

    Some may not understand that the nurse that spends a few minutes with
    them when they come into the ER asking a few questions and taking the
    vitals is doing triage. It's not always a full-blown procedure as
    it's presented on television and in the movies.

    One of the reasons that "triage" is seen so much is that hospitals
    like to use this term to make that initial contact with the ER patient
    seem important. A patient who comes in with a stomach ache, and is
    told they just have a gas bubble and not an appendix about to rupture
    feels better about the whomping bill they'll get from the hospital if
    they think that the hospital is doing something important and
    technical like triage and not just sorting out the stomach aches from
    the surgery-required problems.

    Our professional backgrounds sometimes make watching television shows
    painful. I'm sure when you see a police-type show like "Southland"
    (which I like), you sometimes jump out of your chair and say "We don't
    do that!". I do the same when watching a show like "Grey's Anatomy"
    when I see the surgical staff out on the apron meeting an ambulance
    bringing in a vehicle crash victim or doing something in the OR that I
    know is not done in a real OR.

    Many in this group have that kind of reaction when some video image is
    enhanced impossibly on shows like "NCIS" (which I don't watch).

    Drifting a bit in the discussion, in "Grey's Anatomy", every broom
    closet in "Seattle Grace" seems to have a couple of surgeons in it
    banging away like rabbits. If that went on in the hospitals I called
    on, I was never aware of it. Nor was my wife - a former OR scrub
    nurse - aware of it anywhere she worked.
     
    Tony Cooper, Feb 28, 2014
  18. Dudley Hanks

    Tony Cooper Guest

    There are several hospitals in the Orlando area, but they are not all
    equal. Some are satellite hospitals. Several years ago, when I "felt
    funny" and went to Florida Hospital North's ER, I was examined there
    and then transported by ambulance to Florida Hospital's main location
    where extended facilities were available. That's where I had bypass
    surgery the next day.

    I was perfectly capable of driving to Florida Hospital's main
    location, but once you are considered to be a patient it's wheelchairs
    and ambulances for all future movement.
     
    Tony Cooper, Feb 28, 2014
  19. Dudley Hanks

    Eric Stevens Guest

    I do remember that once I was settled on my back in the ambulance a
    needle was inserted in my right arm - but it was not used. I was told
    that they expected further instruction over the RT about its later
    use. No instruction came and nothing was done until I got to hospital.
    My normal medication includes warfarin for atrial fibrilation and I
    wear a MedicAlert bracelet to that effect. I think the ambulance crew
    were expecting instruction to start me on vitamin K to help control
    possible internal bleeding.
     
    Eric Stevens, Feb 28, 2014
  20. Dudley Hanks

    Eric Stevens Guest

    As far as I know, we have no private ambulance services in NZ.
    Ambulances are operated by St John's and funded by the government.
    Initially, all emergency calls are handled by the 111 emergency
    service. On this occasion they had an ambulance which was on it's way
    back home from a patient transfer. Once they arrived the crew decided
    that Waikato was the most appropriate hospital for me and medical
    control was handed over to that hospital by the emergency service.
    From then on the ambulance crew were in contact with the emergency
    team in the hospital and were under their control.

    The fact that I was delivered to the IC department seems to stem from
    the fact that that was where the CAT scan was. Since then that part of
    the hospital has been entirely reconstructed and things may now be
    different. The URLs that Savageduck gave yesterday deal with the new
    department. That was not the place to which I was taken.
     
    Eric Stevens, Feb 28, 2014
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