Altered Mental Status

As a medic (a new one at that) I like to think I am aggressive in my treatments. Being aggressive to me does not mean throwing a lot of drugs at the patient and seeing what works. It starts with the BLS level. If there is the possibility for an airway compromise I am going to protect the airway (NPA/OPA). Decreased BP trendelenburg right off the bat. I am not afraid to get into the drug bag when warranted. Lasix, Narcan, Nitro. We recently got CPAP on the trucks.  I was the first in the company to use it BECAUSE MY PATIENTS CONDITION WARRANTED THE USE.

A couple of weeks ago I was faced with my first unresponsive w/ hypogylcemia and no IV access. After double checking doasage in my handy dandy ALS version field guide Glucagon IM did the trick. I started with an unresponsive pt with a BS of 37 (on arrival) to an AOx4 (when did it become x4. It was x3 for years) joking laughing pt with a BS of 96 on arrival. I did get a little sideways glance from the ED nurse as if to say why did you bring him here.

I will admit the narcotics pouch not so much scared me as made me nervous. I have run a couple of chest pains where had we had a transport time greater the the 5-10 minutes that we had I probably would have gotten to morphine in the MONA mnemonic.

Last shift I was called out to a local ECF for a patient that had fallen from her WC CO hip pain. When we arrived pt was found on the floor obvious outward rotation of the right leg. I splinted the hip with a upside down KED board. Secured the pt to a LSB. Got to the squad. Went through the standard primary and secondary exam. vitals. sample Hx, monitor, o2 and IV. Pt rating the pain at a 10. Pt is also S/P femur fx x 4 days ago in the same extremity. I had a 7 minute transport time and had a pretty bumpy ride ahead of time. Sphincter  factor 10 started to kick in. This patient need pain control. I knew what the patient needed but had never pushed a narcotic before. By protocol I could have give MS with out an order but I covered my bases made a quick call to med control at the receiving hospital gave a quick assessment/report and added at the end “with your concurrence I would like to administer 4 of MS prior to transport/ Stand By ‘Big Potential EMS”. “Big Potential EMS” go ahead and administe 4mg MS prior to transport”

I grabbed the drug box. Broke the seal. Broke the other seal. Prepared my meds and then it started (The mental check list in my head)

1. Right Patient- Well I only have one so yes this is the right patient. (Did triple check allergies at this point)

2. Right Time- What better time than the present.

3. Right Dose- I think I checked and double checked my dosage 10 time in a matter of 30 seconds.

4. Right Route- Yep Got it

5. Right Drug- Checked this at least 10 time before administration

In the end I gave the med. The pain level decreased and all was well with the world. Well except the pt’s hip fx that is.

To: The Honorable Michael Bell, Mayor City of Toledo

From: A Concerned Citizen

Date: March 16th, 2010

Subject: WTF

Mr. Mayor,

I supported you. With your background in Public Safety I was sure that you could be counted on to keeps our streets safe. This is, after all, the main duty of a municipal government.

125 Police Officers received layoff notices this week. I know you consider this your “Plan B” if City Council does not pass the balanced budget as outlined by your administration. This type of strong arm tactic has no place in government. I honestly hope that you are not truly considering endangering the safety of every man, woman and child just because the Legislative Branch of our city government refuses to pass the mind numbing attempt at a budget you submitted.

Yes, the City of Toledo is facing a budget crisis. Yes, the previous administration dropped a major headache in your lap. We do need to tighten our fiscal belts and come out of this mess. WE CAN NOT DO THIS AT THE EXPENSE OF SAFETY.

Laying off Police Officers is not an option. Lets look outside the box and find solution to balancing the budget that will not have the citizens of this great city living in fear.

Granted I do not have access to the exact figures used in creating the budget. I would still like to offer some cost cutting ideas that should allow us to balance the budget without jeopardizing safety:

Police Department- Overtime for this Department needs to be ELIMINATED. The traditional 8 hours a day five days a week schedule is a thing of the past. We need to utilized System Status Management in scheduling our police force. We need to analyze the demands for police service and schedule Police Officers appropriately. We need to utilize non traditional schedules including split shifts to cover high demand hours and expanded shifts to cover  high demand days (weekends). Overtime needs to be eliminated by City Ordinance. Overtime to cover call offs and vacations is a luxury we can not afford right now. If we can not maintain minimum coverage for a given shift we need to put our Command Officers (Right up to the Chief of Police) and officers providing ancillary services (Impound lot, Dispatch, Property Room, Cold Case Detectives etc.) in a patrol car.

Eliminate the Training Division. In the future let’s require newly hired Police Officers to hold there OPOTA certification prior to applying. As for as on going training and continuing education, Owens Community College’s  Public Safety Training Center can provide these services in a more cost effective manner.

We need to focus our Law Enforcement efforts on Safety and Quality of life measures. During these hard financial times some services are going  need to be put on the back burner.

We need to practice cost control. How much money would we save annually if every police officer on the street was required to “Walk a Beat” an hour a day. Turn the car off, get out of the car and walk. I think the savings on fuel would be substantial. Do away with the annual uniform allowance. If a uniform items is damaged or worn and not serviceable the officers should be able to turn it in for replacement.  A preset yearly uniform allowances is contrary to good fiscal management.

Fire Department Overtime for this Department needs to be eliminated also. Scheduling of FD personnel needs to be based on a needs utilization assessment. The traditional 24/48  schedule needs to be eliminated. This schedule has built in overtime that needs to be avoided at all cost. Non Traditional scheduling needs to be utilized allowing higher staffing levels during historically peak service times.

As with the Police Department we need to eliminate the Training Division and require all newly hired Firefighters to be certified as Firefighters and Paramedics prior to applying for the department.

Other Cost Cutting Ideas

• During this fiscal emergency the City of Toledo needs to shutdown on Fridays. All non essential (safety) personnel will be scheduled Monday-Thursday 8 hours a day.
• Establish a City Volunteer Program. Volunteers can be used in a variety of positions. With a well run program we should be able to eliminate many positions outside of the Public Safety realm.
• Get out of the refuse business. Require residents to subscribe to a commercial refuse collection service. Charge a franchise fee for Refuse Collection services operating in the City.
• Lease the City Parks and pools to Community Organizations for $1 a year with the understanding that they will be required to maintain the parks as well as provide liability insurance for the parks. For those recreational facilities where no organization will step up and take responsibility close them
• Automate. Applications for licenses and permits. Filing of non emergent police reports. Record Requests and other services need to be automated and online.

Mr. Mayor these are just a handful of the options available to you to help balance the budget without putting our safety at risk. I am sure my fellow citizens could offer many more. We can no longer afford to do thisngs in this city just because that is the way they have always been. We need to think out side the box.

Sincerely,

Kyle D. Utz

Citizen