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towheadedmule

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    Tired of crappy EMT-B EMSA wages

    in General EMS Discussion

    Posted

    Sorry you feel that is the "fullest assessment" or patients do not need a secure airway. Thus the reason some EMSA medics have to be re-trained. The reasons some employers "cringe" when they see EMSA as a past employer.

    Part of the problem is so many are installed into that the "EMSA" way is the only way. Many never realizing what emergency medicine is all about. I don't care if the patient was in the drive way of St. Francis they deserve an airway. Anything less is negligible.

    Again, they do have a lot of great medics, so that is why I try to avoid generalization. Unfortunately, many only think inside the box and the current protocols and methodology does not promote anything but to follow protocols and not think .

    I do wonder how one receives a call, performs any real assessment, follow a protocol of an IV, ECG, and then e-PCR that one has to complete before going back into service in less than 30 minutes? If one is running nearly two calls an hour. I know most in the Central area is allowed 20 minutes before going back into service to ensure medusa is complete and unit cleaned and the central area makes more responses. Even with this allotment there always remains a shortage, and they have placed sign on bonuses as well as now attempting to pay for EMT's to go to Paramedic school. Albeit, it is still controversial of the programs they maybe considering and the pay off or penalty is extreme if they choose to do so.

    Again, let me emphasize there is a lot of good but there is many areas to improve alike anywhere else. Part of the problem though is most assume "it is the best!" because they have never worked anywhere else or have came from a service that was worse. Many cities that are using EMSA are now beginning and planning to start their own EMS services. Tired of the costs, response time, and care provided. I do believe this will cause a problem as well. EMSA has continued to ask both cities (Tulsa & OKC) for millions of dollars to maintain costs. Hence the reason the thoughts and discussion of placing EMS into the FD.

    Personally, I would hate to see such a decision be made to place into the FD, in either cities. I would like to see better management techniques and better, broader education for the medics. Even if responding over one call per hour, it has scientifically demonstrated that mental stress and focused attention drastically drops and unsafe measures increases. Is this the best for the patient or staff? No.

    Personally, I recommend EMSA for those that want a lot of experience in a short period of time. I do always recommend one not to spend more than one to two years, for many reasons that I won't go into. Longevity is not one of their better aspects.

    R/r 911

    LMAO!!!

    Aphasic, pressure sky high, blown pupils, diaphorectic, family reports ongoing weakness and dizziness for one week, oh,,,,and unresponsive, good pulse ox and cap, ECG good. '

    maybe I should have sat onscene and done the CSS and MSS. Pulled a comprehensive HX from the family?

    Or Maybe take her the hospital.

    We find that transfer medics frequently have to be retrained to realize what an emergency is and what to do about it.

    Is EMSA the best. No. Could things be better. Yes. Our protocols generally work for us. And I have tubed in the bay at St John's and St Francis. If you read the literature beyond JEMS and EMSresponder you'll find that many physicians want to pull RSI from the scope of practice of paramedics due to atrocious intubation rates nationally. Our MD wants us to have rates similar to anesthesiologists in the OR before he will consider RSI.

    We ask for money because medicare and medicaid do not like to pay. And if you think those extra monies tack onto water bills are going to go away if Fire takes over, how laughable.

    The EMTs that want to goto paramedic school are screened and are volunteers, unlike many Fire medics that were ''forced'' to goto school. I'll take a volunteer any day over a draftee.

    Rant off

    Tired of crappy EMT-B EMSA wages

    in General EMS Discussion

    Posted

    I have had just over a thousand transports in the last year, and probably only 6 of those were pt who would have benefited from RSI. Three were within 3 minutes of the hospital and ODs. Two were OD with a transport of about 7 minutes. Both were nasally intubated with assistance from Versed. One was an CVA pt who I had in the hospital 18 minutes from the time of the CALL to 911. And just for you Rid, that was with a fullest assessment that needed to be done, 2 IVs and scoop and run.

    Would I like RSI, yes. We have some areas that have 25-30 minutes transports to the nearest hospital in perfect conditions. I don't know how many intubations we performed last month, but a banner month in transports by setting a record. Over 4000 transports. Successful intubation rate was 91% in the eastern division.

    Anecdotal evidence though.

    R

    Tired of crappy EMT-B EMSA wages

    in General EMS Discussion

    Posted

    /Rant on

    We have 16 hours of overtime every pay period.

    We work on a truck for 12 hours, not all of it is sitting on post. I have run as many as 21 calls in a 13 hour period.

    No we do not have RSI. With a average 12 minute scene to ED time it is not really needed. Would I like to have it. Sometimes. But it is not needed.

    We have a complicated system, it takes time to learn. When we placed medics out on the streets without training we had a higher turnover. The academy helps our retention. It also gives us time to bring new paramedics up to speed educationally. It gives us time to get the basic to understand their role in the team. We often end up retraining some the paramedics. Everyone on leaving the academy is set on their refresher at their lever, BLS, ACLS, PEPP, PHTLS, AMLS, EVOC, NIMS 700, Hazmat awareness, and have received classes on Acute reperfusion therapy, capnography and learned that "weighty protocol book''. They are then tested on all of those.

    The new Medical Director is actually shortening the verbiage in the protocol book. Some have not been updated in quite a while. That is not the fault of EMSA. That is more on the OMD, Office of the Medical Director. It is a busy post. With over 800 EMT-P, EMT-I and EMT-B's working under his license spread out over the 2 largest cities in the state that are 100 miles apart, consists of EMSA east and west, OFD, TFD and numerous other fire departments, writing new protocols has been a challenge. Part of why the Old Medical Director is still on the job.

    As for the FD's taking over. Who knows. I think both cities would be worse off with uncaring hosemonkeys, looking for a fire fix, whose chiefs want to have a legacy, by getting rid of EMSA. IF the 522 districts are approved, it will be a moot point.

    Rant off/

    EMT CIty Book Club

    in General EMS Discussion

    Posted

    My second suggestion:

    Trauma Management: An Emergency Medicine Approach

    Author: Ferrera, et al

    Hardcover: 760 pages

    Publisher: Mosby

    ISBN:0-323-00210-2

    Copyright: 2001

    This book has been the base of knowledge for the last 2 paramedic classes that I've taught. It greatly expands on what is available in a standard issue paramedic text, and doesn't go so deep that the students get lost. It is written in a format for ER doctors, instead of the trauma surgeon, so much of the suggested treatments are available to prehospital providers. It also discusses some of the issues in dealing with EMS.

    My only complaint has been it is getting close to time to buy another edition, that has not been updated yet. If you like trauma, and want to better understand what your treatment will mean to your patients, this is the best book available. Take the PHTLS or BTLS textbooks and toss them. This one will easily replace both without burying you in minutiae.

    8/10 stars.

    Azcep, sorry for the necropost. I found this book online, cheapest was $160.00 While I am not completely adverse to paying this, given your change in status have you found anything as good or updated?

    Any other suggestions? Dust, might you have some?

    As for the Thread. On Killing and On Combat by LTC Grossman. Particularly On Combat. Will give you a good basis for communicating with veterans, both soldiers and public servants. Further the sections on stress innoculations will give you pause for thought, and wonder if training for paramedic should not have more stressful situations during lab time.

    R

    should we do away with EMT certification

    in General EMS Discussion

    Posted

    I am just amazed at what I am reading here. The medical community is a tiered system. Physicians, nurses, medics, techs, EMT's.

    I was wondering what was bothering me about this statement. First was the list, from physician to EMT. Seemed a bit odd (at least in my state). Techs here can be unlicensed and receive OJT, some are EMTs, some are patient care techs (read CNA with foley and pheblotomy skills). My course for Paramedic actually required the same about of didactic and a third more clinical hours as the RNs. But by this list I am under a RN? Wait, when I call for Medical Control, I get a physician, not a nurse. When I give report it is to a person of equal licensure, thus a nurse and myself, per my state, are equals.

    Then it struck me with what I really had a problem. Tiered? The medical community is tiered? I prefer a TEAM approach. It has fewer egos, and helps more patients. My job is to ensure the safe transport of patients and to deliver them to care in equal or better shape than in which I found. I do this for all my patients; the ankle sprains, headaches, CVA, AMI, the lonely person who just does not feel like living anymore. And has a team player, I have a duty to improve. To take refreshers and new classes, and later to teach those classes so that others may follow. I do not have that duty to my team, but to my end user, My patients.

    You owe it to your future patients to be the best you can be.

    R

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