# Ask the Paramedic II **URL:** \ **Category:** Miscellaneous and Personal Stuff I Must Share\ **Created:** [January 28, 2009, 3:21am UTC](https://boards.straightdope.com/t/ask-the-paramedic-ii/483340 "2009-01-28T03:21:59Z")\ **Posts on this page:** 20\ **Page:** 2
**Author:** ![St.Urho](https://avatars.discourse-cdn.com/v4/letter/s/8e7dd6/32.png) [@St.Urho](https://boards.straightdope.com/u/St.Urho)\ **Post date:** [January 29, 2009, 12:51pm UTC](https://boards.straightdope.com/t/ask-the-paramedic-ii/483340/21 "2009-01-29T12:51:07Z")
> [@matt\_mcl](#): > > Here I sit in my typical second-floor Montreal apartment, [atop a flight of the typical narrow, contorted](http://www.urbanphoto.net/blog/wp-content/uploads/2007/03/staircase.jpg), [slippery-when-snowy, sometimes rickety, but](http://womensgardencycles.files.wordpress.com/2007/08/staircase3.jpg) [always picturesque outdoor stairs for which Montreal is famous](http://farm1.static.flickr.com/44/185576145_e5c4c9a606.jpg?v=0). > > And it occurred to me that second- and third-story walkups must account for, oh, about two thirds of the ambulance calls they must get in certain neighbourhoods. And for the life of me I can’t figure out how they do it. I can barely get my IKEA purchases in, to say nothing of the movers and my appliances, and that’s not such a big deal if it gets a little dinged. > > How do you deal with obstacles like difficult staircases, odd home layouts, hoarders’ troves, and the like? > > ETA: Huh, I see **drachillix** referred to this. So? Tell! Most places carry some variation on the [Stair Chair](http://www.galls.com/goid/style.html?assort=general_catalog&style=PT044&utm_source=froogle&utm_medium=datafeed&utm_campaign=Froogle-Datafeed& __skl_fd_skuid=PT044&__ skl_fd_uan=1). It’s still a pain in the butt, though. It generally takes a lot of time, effort, and people. Depending on the situation, we also use [scoop stretchers](http://store.gomed-tech.com/shared/StoreFront/default.asp?CS=medtech&StoreType=BtoC&Count1=720562160&Count2=637702584&ProductID=459&Target=products.asp&utm_medium=cse&utm_source=googlebase). Sometimes, we just have to pick somebody up and carry them, too. We also have things like [this](http://www.buyemp.com/product/1062103.html) for moving bariatric patients. The most popular is called the Man Sack (I’m not making this up) and is really fun to ask for on the radio. ---
**Author:** ![BiblioCat](https://avatars.discourse-cdn.com/v4/letter/b/ed8c4c/32.png) [@BiblioCat](https://boards.straightdope.com/u/BiblioCat)\ **Post date:** [January 29, 2009, 3:09pm UTC](https://boards.straightdope.com/t/ask-the-paramedic-ii/483340/22 "2009-01-29T15:09:32Z")
**St Urho** mentioned all the tools that I usually use at work. The Stair Chair is indispensible. We also have a dedicated bariatric unit for transporting patients over 300 pounds. It has an electric stretcher like [this](http://www.ferno.com/powerflexx/). My partner and I got to use it last week for a patient who weighed just over 500 pounds. We also had another crew helping us, because the guy could hardly move. Just for funsies, some pictures: [This one](http://i130.photobucket.com/albums/p241/Betsey38/work/pedsambo11.jpg) is the pediatric critical care ambulance that runs out of Johns Hopkins. It’s HUGE. [This one](http://i130.photobucket.com/albums/p241/Betsey38/work/airport1.jpg) and [this one](http://i130.photobucket.com/albums/p241/Betsey38/work/airport6.jpg) are from a call I did last fall. A woman had been in a car accident halfway across the country, and was being sent back home after eight weeks in rehab. Because of her injuries (broken hip and both legs), she was unable to ride home in a car or regular plane. The plane was a Cessna, outfitted inside pretty much just like an ambulance. We went to pick her up at the airport, and took her to a local rehab center for a few more weeks. We got to go right out on the tarmac. She said the plane ride cost $15,000, and she wasn’t sure her insurance was going to cover the full cost. [Me and a couple of coworkers](http://i130.photobucket.com/albums/p241/Betsey38/work/badass.jpg), hard at work, saving lives. 😃 ---
**Author:** ![muldoonthief](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/muldoonthief/32/3188_2.png) [@muldoonthief](https://boards.straightdope.com/u/muldoonthief)\ **Post date:** [January 29, 2009, 5:12pm UTC](https://boards.straightdope.com/t/ask-the-paramedic-ii/483340/23 "2009-01-29T17:12:58Z")
Have you ever been in a situation where a patient needed to be moved quickly, because of things like the building being on fire, but were in bad enough shape that you couldn’t move them quickly without causing significant further damage? How did you handle it? Are there protocols that specifically address such cases? ---
**Author:** ![outlierrn](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/outlierrn/32/3005_2.png) [@outlierrn](https://boards.straightdope.com/u/outlierrn)\ **Post date:** [January 29, 2009, 5:41pm UTC](https://boards.straightdope.com/t/ask-the-paramedic-ii/483340/24 "2009-01-29T17:41:31Z")
> [@St.Urho](#): > > We don’t do this anymore, it’s been out of the protocols for about 5 years, now. Our primary route is IM, since it provides significantly faster absorption than SQ and works better on patients who are shunting away from the skin. We also have protocols for IV epi, both bolus and drip, for patients who are truly in anaphylactic shock. Actually I was talking about subLINGUAL injection, not SQ, lift the tongue up and stick a needle in. It’s for people too shut down for IM or SQ gonna code in 2 min or less positive smurf sign pucker factor 9.5. ---
**Author:** ![Auntbeast](https://avatars.discourse-cdn.com/v4/letter/a/5f9b8f/32.png) [@Auntbeast](https://boards.straightdope.com/u/Auntbeast)\ **Post date:** [January 29, 2009, 5:58pm UTC](https://boards.straightdope.com/t/ask-the-paramedic-ii/483340/25 "2009-01-29T17:58:17Z")
Is there size limitations for Paramedics? I figure you guys crawling around ambulances and stuff that height or weight might be issues. That and most Paramedics I’ve known tend towards the small size. I’m 5’8" and I’ve been taller than 3 of them. ---
**Author:** ![Harmonious\_Discord](https://avatars.discourse-cdn.com/v4/letter/h/74df32/32.png) [@Harmonious\_Discord](https://boards.straightdope.com/u/Harmonious_Discord)\ **Post date:** [January 29, 2009, 6:43pm UTC](https://boards.straightdope.com/t/ask-the-paramedic-ii/483340/26 "2009-01-29T18:43:45Z")
What rough percentage of calls end with a DOA. No other details needed. ---
**Author:** ![St.Urho](https://avatars.discourse-cdn.com/v4/letter/s/8e7dd6/32.png) [@St.Urho](https://boards.straightdope.com/u/St.Urho)\ **Post date:** [January 29, 2009, 8:48pm UTC](https://boards.straightdope.com/t/ask-the-paramedic-ii/483340/27 "2009-01-29T20:48:01Z")
> [@outlierrn](#): > > Actually I was talking about subLINGUAL injection, not SQ, lift the tongue up and stick a needle in. It’s for people too shut down for IM or SQ gonna code in 2 min or less positive smurf sign pucker factor 9.5. Right- we still got rid of that, that’s where we’d use the IV epi. Sorry that wasn’t clear. ---
**Author:** ![St.Urho](https://avatars.discourse-cdn.com/v4/letter/s/8e7dd6/32.png) [@St.Urho](https://boards.straightdope.com/u/St.Urho)\ **Post date:** [January 29, 2009, 8:51pm UTC](https://boards.straightdope.com/t/ask-the-paramedic-ii/483340/28 "2009-01-29T20:51:14Z")
> [@muldoonthief](#): > > Have you ever been in a situation where a patient needed to be moved quickly, because of things like the building being on fire, but were in bad enough shape that you couldn’t move them quickly without causing significant further damage? How did you handle it? Are there protocols that specifically address such cases? I’ve rapidly extricated people from cars before. We do our best to handle them gently, but the important thing is getting them out of the unsafe environment. The theory they teach in school is “life over limb,” i.e. you’re better off outside the burning car with a spinal injury than you are cooking inside the car. Happily, it doesn’t come up much. ---
**Author:** ![St.Urho](https://avatars.discourse-cdn.com/v4/letter/s/8e7dd6/32.png) [@St.Urho](https://boards.straightdope.com/u/St.Urho)\ **Post date:** [January 29, 2009, 8:53pm UTC](https://boards.straightdope.com/t/ask-the-paramedic-ii/483340/29 "2009-01-29T20:53:12Z")
> [@Auntbeast](#): > > Is there size limitations for Paramedics? I figure you guys crawling around ambulances and stuff that height or weight might be issues. That and most Paramedics I’ve known tend towards the small size. I’m 5’8" and I’ve been taller than 3 of them. The only size limitations I know of are with air medical services- you have to keep your weight below x so the helicopter can take off and you have to be able to fit inside said helicopter. It’s pretty common to have a lifting test be part of a pre-hire screening process, so as long as you can lift the stretcher, it doesn’t matter. ---
**Author:** ![St.Urho](https://avatars.discourse-cdn.com/v4/letter/s/8e7dd6/32.png) [@St.Urho](https://boards.straightdope.com/u/St.Urho)\ **Post date:** [January 29, 2009, 8:54pm UTC](https://boards.straightdope.com/t/ask-the-paramedic-ii/483340/30 "2009-01-29T20:54:23Z")
> [@Harmonious\_Discord](#): > > What rough percentage of calls end with a DOA. No other details needed. Dead on scene or dead at the hospital? I’d guess 3-5% dead on scene, with another ~5% that die in the ER within a few hours of arrival. ---
**Author:** ![the\_Lady](https://avatars.discourse-cdn.com/v4/letter/t/bb73d2/32.png) [@the\_Lady](https://boards.straightdope.com/u/the_Lady)\ **Post date:** [January 29, 2009, 9:57pm UTC](https://boards.straightdope.com/t/ask-the-paramedic-ii/483340/31 "2009-01-29T21:57:08Z")
> [@St.Urho](#): > > The only size limitations I know of are with air medical services- you have to keep your weight below x so the helicopter can take off and you have to be able to fit inside said helicopter. > > It’s pretty common to have a lifting test be part of a pre-hire screening process, so as long as you can lift the stretcher, it doesn’t matter. My sister, at 5’1 on a tall day and approximately 110 pounds is a paramedic in Vancouver, BC. She definitely needed to hit the gym to pass the lifting requirements, but hasn’t had much trouble since. ---
**Author:** ![drachillix](https://avatars.discourse-cdn.com/v4/letter/d/48db29/32.png) [@drachillix](https://boards.straightdope.com/u/drachillix)\ **Post date:** [January 30, 2009, 3:00am UTC](https://boards.straightdope.com/t/ask-the-paramedic-ii/483340/32 "2009-01-30T03:00:38Z")
> [@matt\_mcl](#): > > ETA: Huh, I see **drachillix** referred to this. So? Tell! I ran into about a dozen odd tough home extractions, sometimes its just furniture, a little shoving and its all good. The worst one, we just kinda made a big sling out of his blankets and told him it might be a little bumpy (it was a 26"-28" wide spiral staircase. > [@](#): > > Originally Posted by muldoonthief Have you ever been in a situation where a patient needed to be moved quickly, because of things like the building being on fire, but were in bad enough shape that you couldn’t move them quickly without causing significant further damage? How did you handle it? Are there protocols that specifically address such cases? You can immobilize someone on a backboard in a minute, its not going to be fun for them. I never had a yank from the flaming car situaition but I had a couple quick load and go moments. Big one was 8mo pregnant woman, no seatbelt, in passenger seat , ejected through the windsheild and hit the side of the van they ran into. She was laying crumpled up on the hood of the car when we got there, conscious but not trying to move because she knew she was hurt bad. Mom and baby were both alive when we dropped them off, dunno what the final outcome was, it was a busy week and never got to come back and ask. Nobody else was injured beyond a couple nasty cuts. You load them just like you would any other serious injured patient just in her case we started loading her before any significant examination since we knew she had alot of injuries so we grabbed a scoop stretcher and got her onto a backboard strapped her down and loaded her up. We rolled for the hospital about 4 min from arrival including a quick check on other patients. > **[Scoop stretcher](https://en.wikipedia.org/wiki/Scoop_stretcher)** > > The scoop stretcher (or clamshell, Roberson orthopedic stretcher, or just scoop) is a device used specifically for moving injured people. It is ideal for carrying casualties with possible spinal injuries. > A scoop stretcher has a structure that can be split vertically into two parts, with shaped 'blades' towards the centre which can be brought together underneath a patient. The two halves are placed separately either side of the patient, and then brought together until securing clips at the top ... Scoops allow you to pick someone up without having to move them around alot or lift with hands. ---
**Author:** ![drachillix](https://avatars.discourse-cdn.com/v4/letter/d/48db29/32.png) [@drachillix](https://boards.straightdope.com/u/drachillix)\ **Post date:** [January 30, 2009, 3:06am UTC](https://boards.straightdope.com/t/ask-the-paramedic-ii/483340/33 "2009-01-30T03:06:44Z")
> [@outlierrn](#): > > Aren’t you just an ambulance driver with a stethoscope? D&R Excuse me…could I get another pillow over here…and another diet pepsi. Why can’t I get HBO, sex in the city is on tonight. The girls at Applebees are so much more helpful, maybe we should pay nurses minimum wage plus tips that will get them moving. Duck, run fast, still get hit in the back of the head with a flying can of diet pepsi. 😃 ---
**Author:** ![Ranchoth](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/ranchoth/32/1066_2.png) [@Ranchoth](https://boards.straightdope.com/u/Ranchoth)\ **Post date:** [January 30, 2009, 9:50am UTC](https://boards.straightdope.com/t/ask-the-paramedic-ii/483340/34 "2009-01-30T09:50:16Z")
At the risk of sounding callous or crass…how dead does a person have to be when you show up for you not to even bother trying to treat them? I mean, people have been revived from cardiac arrests, or from after being drowned and near frozen for hours; but there’d obviously be no point in performing CPR on a severed head or something. But where’s the cutoff, officially? ---
**Author:** ![VunderBob](https://avatars.discourse-cdn.com/v4/letter/v/839c29/32.png) [@VunderBob](https://boards.straightdope.com/u/VunderBob)\ **Post date:** [January 30, 2009, 12:34pm UTC](https://boards.straightdope.com/t/ask-the-paramedic-ii/483340/35 "2009-01-30T12:34:03Z")
> [@Ranchoth](#): > > At the risk of sounding callous or crass…how dead does a person have to be when you show up for you not to even bother trying to treat them? > > I mean, people have been revived from cardiac arrests, or from after being drowned and near frozen for hours; but there’d obviously be no point in performing CPR on a severed head or something. But where’s the cutoff, officially? Jumping in; under North Carolina law and the medical protocols my squad uses, an EMT -B or -I can declare death when the patient is decapitated; is cold and has obvious lividity (blood pooling) and rigor mortis; or is decomposing. Otherwise, we can’t call it. We can, however, contact our medical director who can make the call over the phone and we stop treatment. I’ve done CPR twice in my 2 years on someone colder than a frozen fishstick because none of the first 3 points were met, and the Medical Director would not let us off the hook. The other rule we have with hypothermia cases is, “they’re not dead until they’re warm and dead.” ---
**Author:** ![St.Urho](https://avatars.discourse-cdn.com/v4/letter/s/8e7dd6/32.png) [@St.Urho](https://boards.straightdope.com/u/St.Urho)\ **Post date:** [January 30, 2009, 5:48pm UTC](https://boards.straightdope.com/t/ask-the-paramedic-ii/483340/36 "2009-01-30T17:48:12Z")
> [@Ranchoth](#): > > At the risk of sounding callous or crass…how dead does a person have to be when you show up for you not to even bother trying to treat them? > > I mean, people have been revived from cardiac arrests, or from after being drowned and near frozen for hours; but there’d obviously be no point in performing CPR on a severed head or something. But where’s the cutoff, officially? Obvious signs of death include rigor mortis, dependent lividity, and 3rd-degree burns over greater than 90% body surface area. In addition, a pulseless patient with massive blunt head, chest, or abdominal trauma is going to be pronounced. ---
**Author:** ![muldoonthief](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/muldoonthief/32/3188_2.png) [@muldoonthief](https://boards.straightdope.com/u/muldoonthief)\ **Post date:** [January 30, 2009, 6:29pm UTC](https://boards.straightdope.com/t/ask-the-paramedic-ii/483340/37 "2009-01-30T18:29:57Z")
> [@drachillix](#): > > You can immobilize someone on a backboard in a minute, its not going to be fun for them. I never had a yank from the flaming car situaition but I had a couple quick load and go moments. Big one was 8mo pregnant woman, no seatbelt, in passenger seat , ejected through the windsheild and hit the side of the van they ran into. She was laying crumpled up on the hood of the car when we got there, conscious but not trying to move because she knew she was hurt bad. Mom and baby were both alive when we dropped them off, dunno what the final outcome was, it was a busy week and never got to come back and ask. Wow. Which leads to another question - how militant do you become about seat belts, or other basic safety procedures, in your personal life due to what you’ve seen? As in, will you refuse to start the car until everyone’s got their seatbelt on, things like that? ---
**Author:** ![outlierrn](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/outlierrn/32/3005_2.png) [@outlierrn](https://boards.straightdope.com/u/outlierrn)\ **Post date:** [January 30, 2009, 8:54pm UTC](https://boards.straightdope.com/t/ask-the-paramedic-ii/483340/38 "2009-01-30T20:54:18Z")
> [@muldoonthief](#): > > Wow. Which leads to another question - how militant do you become about seat belts, or other basic safety procedures, in your personal life due to what you’ve seen? As in, will you refuse to start the car until everyone’s got their seatbelt on, things like that? I won’t ride in a car with an unrestrained child, it can take days to calm down after you work one of those cases. ETA. I’m not at war with death, I’m not on a mission from god, I know that in the end all my patients die, but that kind of shit is seriously fucked up, please don’t put us through it. ---
**Author:** ![St.Urho](https://avatars.discourse-cdn.com/v4/letter/s/8e7dd6/32.png) [@St.Urho](https://boards.straightdope.com/u/St.Urho)\ **Post date:** [January 30, 2009, 11:48pm UTC](https://boards.straightdope.com/t/ask-the-paramedic-ii/483340/39 "2009-01-30T23:48:10Z")
> [@muldoonthief](#): > > Wow. Which leads to another question - how militant do you become about seat belts, or other basic safety procedures, in your personal life due to what you’ve seen? As in, will you refuse to start the car until everyone’s got their seatbelt on, things like that? More than a few of my patients have gotten a speech that ends with “So you’re going to wear your seatbelt/helmet next time, right?” ---
**Author:** ![drachillix](https://avatars.discourse-cdn.com/v4/letter/d/48db29/32.png) [@drachillix](https://boards.straightdope.com/u/drachillix)\ **Post date:** [January 31, 2009, 3:06am UTC](https://boards.straightdope.com/t/ask-the-paramedic-ii/483340/40 "2009-01-31T03:06:26Z")
> [@St.Urho](#): > > Obvious signs of death include rigor mortis, dependent lividity, and 3rd-degree burns over greater than 90% body surface area. In addition, a pulseless patient with massive blunt head, chest, or abdominal trauma is going to be pronounced. Heh, our EMT teacher called it the “don’t worry about it” lecture. If there are obvious signs of decay…don’t worry about it. If the head is not attached to the body …don’t worry about it. If they are frozen solid …don’t worry about it. [Previous page](https://boards.straightdope.com/t/ask-the-paramedic-ii/483340.md?page=1) [Next page](https://boards.straightdope.com/t/ask-the-paramedic-ii/483340.md?page=3)