djcokely

WHERE TO START? IN ORDER I GUESS...i DONT KNOW WHERE YOU WORK HAVE WORKED BUT THE ONLY THING THE PARAMEDIC HAS TO "PECK ON" IS THE EMT BECAUSE MOSTLY, WHERE I AM FROM M.D'S PECK ON US. IT IS NOT A GOD COMPLEX BY ANY MEANS WHAT SO EVER. I HATE THAT TERM. THE REASON IT IS THERE IS BECAUSE THE DIFF. BETWEEN AN EMT B AND AN EMT P IS SO BIG. I AM ALL FOR INCREASING THE AMOUNT OF CLASSROOM TIME FOR EMT B'S AND MAKING IV PLACEMENT WITH NS OR LR A NATIONAL STANDARD AS WELL AS GLUCAGON, NARCAN (ANY ROUTE), CHARCOAL (AFTER ONLINE MEDICAL DIRECTION), ALBUTEROL COMBIVENT VIA NEB, NITRO, AND HOLD ON TO YOUR SEATS.... PR VALIUM GEL FOR PEDS AND ADULTS. THESE MEDS ARE ESSENTIAL AND EASY TO REMEMBER THE INDICATIONS AND CONTRAINDICATIONS FOR...SIMPLY PUT. I THINK THE EMT CAN BE TRAINED VERY EASILY TO HAVE A LARGER SCOPE AND I THINK IT IS VERY POOR THAT THE NATIONAL STANDARD IS SO LOW. HOWEVER, THERE ARE SO MANY EMT'S WHO DONT CARE AND LEARN THE MINIMUM AND ONLY DO WHAT THEY ARE ASKED AND THE WILL NOT DO AN ASSESMENT PRIOR TO ALS ARRIVAL BUT JUST GET A CC AND A SET OF VITALS. THEY ACCEPT THAT THEY ARE THE LOWEST ON THE CHAIN. B.S. YOU WANT RESPECT FROM A MEDIC, EARN IT. ASK QUESTIONS AND SHOW HIM THAT YOU ARE TRYING TO LEARN ON YOUR OWN OR ARE TAKING ACLS, PALS, PHTLS, AND AMLS,. PROVE TO ME THAT IF I ASK YOU TO DO A TRACTION SPINT YOU CAN DO IT. AS FAR AS THE 12 LEAD... NO WAY...SORRY MOST MEDICS CANT FULLY READ A 12 LEAD. SIMPLY PUT. I USED TO SEE THIS BLS RIG AT UCLA (WHO WERE EMT D'S) BRING PATIENTS IN ATTACHED TO THE AED BECAUSE IT DISPLAYED THE RHYTHM ON THE AED....CRAZY. A LOT OF CHEST PAINS ARE BLS, CHEST WALL TENDERNESS IS A MUSCULAR PROBLEM, PNUEMONIA IN A YOUNG ADULT CAN CAUSE IT...THERE ARE A BILLION REASONS WHY CHEST PAIN IS NOT 100% ALS. COMPLAINING ABOUT A CODE IS A PERSONAL THING, MOST MEDICS USE "CODES" AS PRACTICE OR A TIME TO REALLY SHINE AND REALLY ACTUALLY SAVE A LIFE, SO THAT IS NOT A MEDIC THING, IT IS A PERSONAL THING. REGARDING THE "OVERSTOCKING OF THE RIG", YOU SAY THAT NOW BUT WHEN AN OLD MAN HITS THE GAS INSTEAD OF THE BRAKES AND PLOWS THROUGH A STREET FULL OF PEOPLE DURING A FARMERS MARKET IN SANTA MONICA AND YOUR UNIT IS STOCKED TO THE BRIM WITH EXTRA SUPPLIES, YOU WILL LOOK DAMN COMPETENT AND NOT INSECURE. STATE STANDARDS ARE B.S. AND ARE THE VERY BOTTOM LIMIT. A GOOD MEDIC WILL HAVE AT LEAST DOUBLE THE AMOUNT BUT HAVE THEM IN SEPERATE PLACES IN CASE YOU LOSE SOMETHING OR FORGET TO RESTOCK OR THERE IS A MCI ETC... IF IT IS A THUMB LAC ONLY THEN WHY IS THERE AN ASSEMSSMENT BEYOND "WHY DID YOU CAL 911". IF YOU WANT TO DO A FULL ASSESSMENT AND WORK THAT PT UP AND TRANS, GO RIGHT AHEAD. EMT'S ARE BELOW PARAMEDICS SIMPLE AS THAT. I FIRMLY AGREE THAT THEY SHOLD HAVE A BROADER SCOPE. HOWEVER, AS AN INSTRUCTOR YOU WOULD NOT BELIEVE SOME OF THE INCOMPETENCE I SEE DURING RE-CERTS. SO IF YOU DONT EVEN KNOW YOUR BASIC SHIT, HOW ARE YOU GOING TO GET THE RESPECT AND THE ABILITY TO EXPAND YOUR SCOPE? DONT BLAME THE MEDIC, LOOK AT YOUR SELF. YOU CAN NOT BE A GOOD EMT WITHOUT BEING A GOOD MEDIC. A GOOD EMT WILL ANTICIPATE THE MEDIC'S NEEDS AND WILL MAKE HISHER LIFE EASIER, AND THUS MAKE BETTER TX FOR THE PT. IT IS THAT SIMPLE.

who cares? we are not going to fix the junkie and we are not going to make them one. give them the happy juice. In terms of just using narcs as a diservice to our patients? that is stupid. getting them to the hospital is fixing the pain, not usually anything we can do about it. besdies what do they do at the ER anyway, give pain control until they can find out or fix the cause. Pre hospital patients are under medicated? What a shock. The 1 - 10 scale is crap. Go online and look up some objective signs of pain. Hypertension, tachycardia, shivvering, bitting teeth. I know I am going to get the response that it could be a junkie just wanting his fix, well then give it to him so he doesnt puke on you and then snow him with so much MS that you get him into DETOX before he wakes up. All the opiates are safe because they are naturally occuring in our body and it is the only type of drug with no ceiling affect. Lets start treating the pain here people, because how often are we really going to save a life? I can count them on one hand, how many times can we decrease pain instantally instaead of 3 hours later after non emergency amb. ride, an ER eval by a nurse, an MD, the order for the drug, the IV line, then the drug....come on, lets do our jobs. I bet most of you can end suffering almost every day...until you have been in horrific pain that no one can see a reason why, dont talk. I have been there and I hate when EMS does not control pain. My motto is MS for everyone

I dont know what you are all arguing about. There is obviouslly a border line SVT ST AFIB that goes into a Bigeminy with it looks like Multifocal PVC's some sort of ectopy (cant tell because of the quality)....Whatever, this is clearly a case of treat the patient not the monitor. That is my 2 cents, we could sit here all day and say well maybe its a 1st degree Sinus tach. whatever those "junctional beats" are conversion beats subsequent to the PVC, the heart beat after a PVC pretty much has the right to be whatever it wants to be. Treat the Patient, not the monitor. Unless things changed, no drugs for this guy, unless you have other findings or complaints.

In most Large Urban EMS settings where an agency has a high call volume and has the ability to "ship" a patient through a BLS ambulance (e.g. LA COUNTY FIRE ALS SQUADS and BLS AMBULANCES...just like Jonny and Roy on EMERGENCY) I think you are going to have a total lack of pain control. If they are stable enough for Morphine (only pain rx LA county has) the medics are going to ship it with the BLS ambulance and not follow up. If it is a major enough trauma or meets "follow up criteria" then they are going to come but because we dont have fentanyl then there is gong to be no pain control. I did my internship with LACOFD and I can not tell you how many "hemodynamically stable" patients that had GSW's to their extremeties did not get an IV line and Morphine. It has a lot to do with having to call and ask for it, and burn out, lack of empathy and just being lazy, if they can send it via BLS then they will because as one medic told me "I am not going to follow up on some pain control pt." when there is another real ALS call out there in our district, and the next squad is coming from a distance". So the patients suffer because we are really going to save the Asystolic arrest if we get there in 4 minutes as opposed to 6 minutes.....Right. Especially when ALS assesment engines are being implemented left and right. Scary. But from what I hear from friends who work out in Riverside and S.B (less urban areas) they do not have Fentanyl (State thing of course) but they are rather liberal with M.S and they do not have to ask for it. Thye may, and show approve Fent for CA, but LA COUNTY will not take it, (at least not for a while)...we can not even Pace out here....scary stuff, scarry stuff

40mg of expired Lasix in a really a hole medics coffee while he wasnt looking... had no idea why he was peeing all day long. then there was the morbidly obese medic. this guy was so fat that the steering wheel would constantally rub against his belly when he drove and he had a permanent rash from it. we are talking 5 to 6 hundred pounds. nobody knew how he passed a medical. he was not a nice guy so...we took pictures of two of us standing in his pants (with room to spare I might add) and put them up in his locker and all over the station...the best part was he continued to make fun of fat people on television, at least he was a little bit nicer and started showering.

True Story from Santa Monica, California: Small medium sized city 5 engine companies, 1 truck and rescue, 1 BC. 2 ALS Squads. There are also 1 ALS Ambulance and 2 BLS ambulance, provided by AMR. One of the BLS units (Rescue 74) was out on a BLS run and then a reported structure fire was dispatched to basically all of the Fire Units as the caller said there was smoke pushing through the top floors: Engine 3: "Engine 3 is on-scene at 2835 Santa Monica, with a size - up". Dispathc: "Roger Engine 3 go ahead". Engine 3: - out of breath - "Engine 3 on scene 2835 SM, 2 story commercial building, vacant, thick black smoke pushing through all 2nd story windows. We have several structures nearby possibly threatened, continue all units code three and I need... Rescue 74: "74 transporting one patient non-emergency to SM" Dispatch: "74 youre stepping on E3, go to channel 2" Engine 3: - upset - "Echo 3 continuing, I need an ALS ambulance dispatched to our scene we have a male victim who was aparently in the building and is suffering from... Rescue 74: "74 did you copy us transporting?" Dispatch: - 30 second series of tones (emergency traffic only tones). 74!!!EMERGENCY TRAFFIC ONLY, ALL UNITS WITH TRAFFIC SWITCH TO CHANNEL 2. Batallion 1: " BC to SM IC...why havent I got a size up yet? The EMT on 74 was new and had never worked that that unit or in that city, but you would think that she would know enough not to step on a Captian giving his size up.

I realize that speaking from the point of view from someone who has a B.S. in Psychobiology it is easy for me to say that I think Paramedicine should be a 4 year degree. I recognize that is simply not possible right now. The sad fact is that we need medics desperately and one way to keep them as a source of cheap labor is to not require any type of degree. While one can go to nursing school and just get an R.N, they can make so much more by getting thier BSN. Their really is not that option for Paramedics. A paramedic can get a BS or a BA but not in Paramedicine and therefore the pay scale will be the same. I work in LA County and we have not progressed since we started the whole concept! Too many doctors who witness bad paramedicine regulate our protocols by stating that "you are always within 10 minutes of a hospital in L.A. Although we all know that time to ER is not time to treatment. They recently got rid of our ability to do Needle Crichs. They stated that of the 20 or so that have been done in the past couple of years, not one was done correctly. Bull. My friend did one correctly. But realy a needle crich is not going to do much of anything, a surgical crich is the only thing worth a damn. But honestly I would not trust most paramedics in LA to do one. The sad fact is that, especially in urban areas, the need for EMS is so high that we can not impose a 2 year degree restriction on Paramedics because not many people would want to do it. In LA we already have tons of firefighters forced to go to paramedic school that do not want to. Fire based EMS is very much part of the problem. In LA it seems as though the EMS agency and fire departments (and even some of the medics) want to do as little as possible. This dumbing down is insulting. The root of the problem is the fact that in large urban areas like LA 75% of the calls are B.S., 10% are true BLS emergencies and only 15% are true ALS emergencies. Another part of the problem is medics not trusting thier assessment skills and just wanting to transport everything. It increases the amount of runs and decreases the availability of ALS care and thus reduces the scope because medics "have to get available"... Pain management for M.S. Trauma is un-heard of out here because it is not listed as a mandatory ALS skill transport...The ironic part of all of these issues is rooted in this horrible catch 22 ciclical problem... So I fully agree that Paramedics should need a 2 year degree nation wide and that EMT-B's should have to go to school for 1 year and get to start I'V's and Defibrilate. Paramedics should have the ability to do more procedures and to have an endless list of medications. You can not give a paramedic these powers without teaching him first and that will not happen in one year. I remember distinctly when most of my class realized that they did not have to pay attention during the GI GU (non-traumatic abdominal pain) because they realized it was very similar treatment - IV access, fluid challenge PRN, O2, monitor, vitals, pain management PRN and transport. No one cared enough to learn about Chrone's Disease or Nephrittis. Another part of the dumbing down lies in how paramedic school is taught and how the class is structured. In my school passing was 80%. There was a slogan 80=100. Personally I feel that 80% is not adequate if we as paramedics want to advance our knowledge and standing in the allied health field. I think 90% is more realisitic, I mean we are dealing with lives, not someones pay-roll. How would you feel if a medic gave your mother a drug that was contraindicated and he said, "sorry that was part of the 20% I didnt remember". So while yes Paramedicine should be a 2 year degree, we should start to think of it in terms of it being a 4 year degree because only then will the profession start to gain some respect from doctors and the medical community and once we gain that our self-image will improve and I think a lot of the paramedics who like to dumb things down will either lieave or get forced out by the new group of "educated medics" who will hold their brothers to higher standards than we do now.