paramaximus

I tried so hard not to jump into this. I know my opinion won't be popular, it is held in very low regard in my own service, but I'm sorry. This soapbox is just too much for me to ignore. First things first. If you need a snazzy uniform to make you "look" professional, you probably aren't. Secondly, you have to decide the age old question... is it the man who makes the clothes, or the clothes who make the man? (or woman) I'm a practical kind of guy. The environment I work in changes daily, but the job I do is always the same. I'm a healthcare worker. I see nurses, doctors, surgeons, respiratory therapists, lab techs, surg techs, you name it... every day. Most of them are wearing scrubs. Do I look at them and think, "Oh my God, that person is wearing pajamas to work... how unprofessional!" No. I understand perfectly why they wear them. YET, I'm required to do much of the same job they do in a white button up shirt that is supposed to stay clean, pristine, and great looking for 24 hours at a time. This seems ridiculous to me. I wish beyond belief we (as EMSers) would embrace an EMS pant, a long sleeve t-shirt (if you want) with a scrub top. Cheap, comfortable and already accepted in the healthcare industry. But no. We go with navy blue mechanic button up shirts or some other ignorant button up uniform shirt. I hate it. We are allowed a company t-shirt from June to August, but frankly... I think the scrub top would be better. How about at least a bowling shirt. Why tuck it in? I want loose, flowing and free. Change the normal! Let's go another way!

Just have to weigh in here... I've been a paramedic for the last 16 years. I'm not a volunteer. I only mention the latter because I wonder where some of you get this concept that a service should be rendered without proper payment. The simple fact of the matter is I expect to be paid. Furthermore, everyone I work with wants paid for their time and effort too. I'm not independently wealthy, so this isn't a hobby for me. Therefore I want the service I work for to do all they can to collect money to make sure they stay in business, and that I get my paltry share. I'm confident enough in my ability to know what is an emergency and what is not. I would have no problem telling someone with a non-life threatening condition to pay up before we roll a tire. We don't currently do that here, but I'll be glad when the day comes. Just because they "feel" like they're having an emergency means nothing. They can "feel" like the earth is flat and it doesn't make it so. That's where we are supposed to come in. If you can't determine whether or not you're looking at something serious or something ridiculous, and then can't muster the testicular fortitude to tell it like it is... you probably have no business in this business. If they want a cabulance... let them pay one of the private service memberships... or me. Up front and cash is king.

A bit off topic I know, but have any of you looked at the data on Induced Hypothermia on post cardiac arrest patients? It's almost unbelievable. In my esteemed opinion, this will soon become the standard of care. Now when I say soon, it may be years for EMS, but the science is astounding. To answer your earlier questions 1. My service and those surrounding us are way behind the ball on many things. Running codes to the hospital is one such area. So pretty much, unless there are certain criteria, we transport them. 2. I don't want to transport anyone. In the perfect world they would all walk to the side of the ambulance and sign a No Transport without me even having to get out. But no, not usually. I don't enjoy in engaging in actions of futility. With that said, I have gotten pulses back on people I never would have expected it on. If the Induced Hypothermia data is accurate, those people now have a much better chance at survival without debilitation. 3. Gains? I don't know that there are any. There have been a few times in my career where they have gotten something back in the ER, usually short term perfusing rhythm, and then death. I think I'm with the consensus that if you don't get them back in the field, you're not getting them back down the line. 4. Risks? It is probably more physically demanding, but as far as potential accidents I don't think it's any greater than any other transport. 5. Call them all in the field? I'd like to see the broader data on it. Personally, I don't see a benefit. That is perhaps because I work in a rural area with just a couple small hospitals. If transport is working better elsewhere, then I'd love to know. Otherwise, I think it they're dead in the yard after X amount of time working it, they'll be dead in the ER.

It appears you have got some great, broad, ideas to begin. I would only add along the lines that have already been mentioned, it really depends on who you are a preceptor for. If it's a student, you will probably need to focus more on basics. If you have a new hire that perhaps worked elsewhere before, you want to focus more on your policies and procedures. The thing to remember is many services out there suffer what I call intellectual inbreeding. It might be something you and your co-workers don't even recognize... typically you don't in fact. But you continue to do something just because "that's the way everyone does it". Try to get out from under those paradigms and offer instruction in such a way that you never forget there are several ways to get a desired result, and the fastest isn't always the best. As for R-E-S-P-E-C-T... never lose sight of that. Dwayne made several great points. Use a mistake as a teachable moment. No reason to berate or belittle (although there is a time and place for that... think knuckle draggers who need to be policed and ran off). And finally... patience. It's hard for me to sit back and observe/assist but that is often what needs to be done when evaluating where someone is at. Get involved the second you need to, but allow them to grow. And growing is a process. Your humble Paramaximus wasn't born great... it took time.

[align=center:fa12208751]http://www.kfsm.com/Global/story.asp?S=6817214[/align:fa12208751] Not a great deal of background information, but sounds unfortunate.

I too have lived this scenario. The Set-up: We were transporting a child with an open skull fracture and t-spine fx from a small rural hospital to the Childrens Hospital about 2 and half hours away (less than optimal weather, helicopters would not fly). I instructed my EMT to "get there" as I am not fond of seizing children even when they are strapped to a backboard. In a little Podunk town known for being a speed trap, we found ourselves being pursued by a very anxious law man. My first thought was "screw em", but he wasn't giving up. I told my EMT to stop, right there in the road. Before the law man could even get out of his car I bailed out the back (with both doors wide open) and requested his name so I would know who to transfer the pt over to. When he looked in and saw the angelic face of a child with bilateral periorbital ecchymosis you could literally see the color drain from his face. He said since he only saw one person in the cab of the ambulance, he thought a mechanic was taking it for a joy ride... strange, I know. At any rate, he felt compelled to provide an escort from there on. Needless to say, we didn't get a ticket and I think he probably got a lesson he will never forget.

Thank you for the info thus far. While yes, I did say "Clearance of C-spine" I was under no delusions that we actually clear the cervical spine. Thank you for pointing out my poor choice of words. I suppose it's one of those things like RSI, people in the know realize it isn't Rapid Sequence Intubation but rather Induction. Mistakenly spoken, paramaximus

While the EMS service I work for is fairly progressive compared to many, one area we are behind in is field clearance of c-spine. Hence the smallest "crash" or fall brings about a needless cocktail of hard spine boards, straps, clips, head blocks, back pain... and the patient doesn't like it either. So... do any of you out there have a specific protocol you utilize for field clearance of the spine? I would imagine mechanism would be a large part of it, what else? I would love to hear from you, if you'd rather... send me your protocol via the email address provided. I would love to join the 50 plus percent of services (according to JEMS) that do this. Thanks, paramaximus

Initially I thought you were joking when you were seeking advice from attorneys on how to improve the image of EMS. Why not a used car salesman or a real estate agent? At any rate, the problem is far deeper than you can possibly imagine. As a paramedic, I don't think of myself as a public servant. I'm a healthcare professional. My career cousin isn't a fireman or cop, it's a nurse, RT and physician. The biggest negative trend in EMS is the absorption into public service sectors such as fire and police. It has been done for purely economic reasons, but it is costing us (EMSer's) dearly. This particular case that you cited in the article seems to be more of a problem with California certification/licensure laws. This guy is probably part of a union to boot. Here where I am, we are a right to work state. You can be terminated (that's fired) for any reason at any time. It works well. We have moral turpitude stipulations, and once we had a medic that got a little slap happy with his wife. Our EMS director was going to let it slide since she decided not to press charges, but our medical director refused to let the individual work under his license thus ending his job at our service. Proving there are plenty of ways to get rid of an idiot or a sociopath. Finally, several have hit the nail on the head as it were. Before we go parading before the public, perhaps we need to do a little internal policing. If you have an idiot or sociopath working in your service, begin the process to drive them out. I prefer psychological warfare. A well placed criticism here, an insult there... pretty soon they get the picture. Worse case scenario they get tranferred away to another station or service and you aren't embarassed running down to the one stop anymore. Cordially, paramaximus[align=left]

[/font:3691c885b1] As has been mentioned, once you've worked an adolescent who's had an MI, it tends to open up a nightmaric cornucopia of possibilities. Given the presenting set of signs, symptoms and circumstances, I would concur with your treatment. I give you a big smile and a cheesy MENTOS thumbs up! paramaximus

[/font:e9620ab853] Is hot, good-looking and employed negotiable at all? Would you consider warm, good-eyesite and employed? I've learned in life that if you lower your standards, you seldom endure disappointment. nuff said, paramaximus

[/font:0e6338e1c1] Perhaps I'm simply desensitized to this sort of thing. Or maybe I'm just not easily offended. Two guys go mono e mono, and one loses. A great example of snoring respirations with a touch of decorticate posturing. It should be shown in every EMT class across the world. Always, paramaximus