JJEDRN

+1 Good Work! Thanks for the advice and the offer. Stay Safe, JJ

Good Advice and Much Appreciated! Fire & Rescue do the majority of extrication here...based on your recommendations I've contacted them and our local Search & Rescue and will work from that perspective. Agreed! Any particular vacuum device for this? LOL...Pretty much what I get from S&R, as well as Fire. They say the handles are great for thru the roof extrication, but that's about it... Again, I agree. We tend to default to our level of training in times of stress. Given the opportunity, patient condition allowing, this is definitely my default plan. And I have discussed it with our primary EMS. Thanks again. JJ

Craig; I appreciate the input. Good points and I definitely plan on utilizing the resources at hand. My apologies for not being more clear in my original post. My primary interest is in current Hospital Protocols, Policies and Procedure that cover Nursing Personnel and out of "physical department" C-Spine Immobilization. Credentialing will be an integral portion of the process. I don't foresee much of an issue with the backing of our ED Medical staff...but this has got to pass muster with Risk Management. So I'm just putting out feelers as to how other ED's are dealing with the actual or potential problem of having someone arrive at their ED door requiring C-Spine Immobilization. I am in the process of contacting other area ED's to see how they deal with the situation. Thanks again Craig. And Thanks to all viewing this and giving your input. Later, JJ

"Torch". So guess where he got the nickname...:trout: He would frequently smoke while wearing his oxygen. He was a unit admit at least 3 times that I'm aware of... Slow learner... JJ

Protocols regarding extrication of potential spinal injury patients from POV’s showing up at your ED. I need some assist. I need to present a protocol to be established for our ED for extrication of injured patient’s from their POV’s (Privately Owned Vehicles) which show up at our ED Door. Obviously, the ideal situation would be for the driver to have simply phoned EMS and allow those with expertise in Pre-Hospital Management to work their magic. (We have an excellent and well trained EMS system in the county in which our hospital is located! There are generally at least a couple of trucks at the ED, but not when always…) We serve a 5-6 county region, and some patients, their family and friends, just simply load & go…it’s a mountainous area, and MVC’s & ATV injuries occur frequently. We are fortunate in that most of our ED Techs are EMT Basics, we have a couple of RNs that are also working Paramedics, and have a couple of Flight Paramedics that work in our ED. I am current in PHTLS and TNCC , as are a few of my co-workers. btw I personally feel that it would benefit all of us to be proficient in extrication skills. I am saying all of this, because I realize that having professional EMS to handle these situations would be ideal, but sometimes care simply cannot, nor should not, be delayed. We obviously have C-collars on hand, a backboard with appropriate straps, and Multigrip Head Immobilizer or CID’s on hand. I plan to add a KED, or Kendrick Extrication Device to our gear. Also in the planning is instruction related to the above. One of the Paramedics that work in the Ed was also my PHTLS Instructor. The bottom line is that we are trying to Proactive , not just Reactive . So please lend me a hand. If you have any insight, or any Protocols regarding extrication, or just your qualified opinions, I’d appreciate hearing them. Feel free to PM or e-mail me, if you’d like. Thanks in advance. Regards, JJ

Questions answered thanks to the "search" function.. Thanks to GilaRN and others. Good info. Thanks again, JJ

Thanks for bringing this topic up. The CEN is on my "to do" list. MY background is Critical Care. I've had my CCRN since '84. But I'm relatively new to ED...just 16 months. I've recently taken PHTLS, NRP, and TNCC in hopes this would improve my abilities and skills as they related to my work. (Current on my ACLS & PALS FWIW). I have the Gasparis tapes on CEN. Are still relevant? Do you guys have any recommended study materials? Review CD's or books for CEN? Are the review courses worth the price of admission? I don't mean to hijack the thread... I think my anxiety level is "fairly" normal regarding the CEN. But I think having the CEN improves marketability as well as demonstrates professionalism. Good going Craig! Later, JJ

I'm not currently a Traveler, but I worked as ICU Staff and did Agency for 18 years in N.O. prior to the storm. (I've since relocated...my Hospital, in N.O. East didn't float very well...). I still have friends that work Critical Care and ED at Tulane, East Jeff, and several hospitals along the North Shore (Slidell, Covington, Hammond). As I'm sure your friend told you, don't believe all the media hype. It's a great town and a cultural experience not to be missed. Heck, just the food is worth doing an assignment! But yeah...plan on hard work, sick folks (lots of mulitsystem issues), but generally good people around you. If you need any specific details and I'll try to be of assist. Later, JJ

I made the transition to full-time Ed about 18 months ago, after 24 years of Critical Care. It was the best move I ever made. The transition? The most challenging (for me) was developing the Mental Map of the Ed Flow, and the priorities as they relate to ED. This is not to say that the Critical thinking and prioritizing is any different for the Ed, but coming from a background of being totally responsible for every aspect of a patients care, to an atmosphere of shared responsibilities and trust in your team mates in constantly shifting priorities. (I did trust my co-workers in the units, this was just a "mind-shift" thing for me...) There is order in the chaos...embrace it! I am taking every class I can to improve and/or enhance my ED skills. The usual ACLS, Pals, NRP. But also PHTLS. I would highly recommend PHTLS to anyone working the ED. I feel it would really help all of us to better understand the Pre Hospital thinking skills, expectations based on those thinking skills and priorities, and improve the continuum of care based on those expectations. EMS is a great resource, BTW. I take my first TNCC Class this week. I think, like ACLS, it'll improve expectations and communication. Knowledge is never wasted. Late 40's? I'm in my 50's. We have better than 30 beds and run 160 patients/day. Only a Level 3, but run a high acuity. I'm tired when I finish a 12 or 16 hours shift, ibuprofen is my friend, but I look forward to each and every day as a positive learning experience. It's a challenge, but a commitment I wish I'd made years ago. You bring a lot to the table with your background and experience. Being positive, open to learning, and ready for a challenge will serve you well. Just my $.02 worth. Best of luck to you. JJ

I don't have any experience in this, but I am looking forward to the responses. My bride, an RN, just did an online BLS recert and was very impressed with the course. Our local ACLS Instr. accepted her BLS for recert. Is there a specific program or licensing company you'll be going with? Or is this a program you'll create? Thanks, JJ

I wouldn't think the Houston area would have significant slow down times, especially if you have some flexibility in meeting the staffing needs. I worked the New Orleans area for about 18 years, both as staff and agency. Initially there would be "summer slumps" in Critical Care. These slumps seem to have disappeared over the past several years. The patients seem to be more acutely ill with multiple health issues upon arrival, and of course they are discharged much sooner than in the past...possibly increasing the recidivism. Friends I have in the Houston area tell me it's usually pretty busy around there. I'm working ED now, in another area of the SE, and cancellation isn't usually an issue because of the core staffing required. Best of luck to you. Regards, JJ

ER/ED and Critical Care Perpetuating the Stereotype... JJ

Survey Done. JJ