scratrat

At least Scatrat is on my side when it comes to the "New Jersey's EMS system SUCKS" debate.

Oh absolutely.

It's why I left. Why I still had some degree sanity.

I said some...

Ok here is my take on this all.

New Jersey actually has something good going on here. Hospital based ALS is the way to go. If you look at it closely, their main objective (besides the absurd bill) is to provide maximum patient care Some of these municipal run ALS programs have nothing but politics and tax money in mind. With hospitals you get quality training, quality assurance, top notch equipment, and less of the politics/tax BS going on. Why fix something if it isn't broke. Only about 10-20% of calls are TRULY ALS treats. I'm not talking ALS DISPATCH, but treat.

For example: BLS and ALS get dispatched to a residence for whatever reason, BLS arrives, does an assessment and decides ALS is NOT appropriate and to be recalled. This is the way the system is to work. BLS gets on location, does initial assessment, decides whether to keep ALS, if they aren't needed, they recall the medics and make them available for the next call. There are a lot of ALS dispatches, but only a few are legitimate treats. Where I live here in Camden County, I can have 3 different medic units at my house in about 6-7 minutes or less (provided they were all available). There is absolutely no need for every municipality in NJ to run an ALS program since it isn't tax effective and the quality of care is less than that of the current system. I know if I were the patient I'd feel more comfortable hearing "I'm one of the paramedics from the hospital" rather than XYZ fire department.

As for Intermediates, I have to disagree with everyone here. In New Jersey there is no need for Intermediate level. Once again, if the patient is in need of drugs, advanced airway management, and EKG monitoring, you should have Paramedics in the first place. The Basic provider level does just that, provide basic care. If they need more advanced care they call for paramedics. So you get a patient, its a legit BLS patient, you as an intermediate decide to start a line and hang some fluids. Did you do anything to immediately make that patient any better than what the Basic couldn't have done, after all, it was a legit BLS call. No. If they needed the more advanced care, get a medic.

These fire departments that want to start ALS care in NJ, its never ever ever going to happen. This would be a regress in standards. Cherry Hill lives in a fantasy world.

But what is interesting in NJ is that if a Medic is running on a BLS ambulance and they get a call with ALS, and they transport with ALS, as long as the Medic that staffs the BLS ambulance also works for the same hospital as a medic as the ALS crew, its up to the ALS crews discretion, but the Medic on the BLS truck is allowed to treat as a paramedic. This is because he/shee is covered by their medical director. Now if they were from a different hospital, it wouldn't be allowed. Pretty wild.

PLEASE tell me you are joking?

First of all you need to ride somewhere else other than New Jersey. That system is in the toilet and is only going to get worse.

Second, when all of those medic units are tied up on calls what then?

And how about when the EMTs can't figure out you are not required (which happens ALL the time) and then the caridac arrest goes out down the street with no medics available? Now the medics on your call are tied up for at least 10-15 minutes doing a SNR.

Yes, hospital based ALS up there does have more quality assurance. But if you think for one minute it's less political that way, you are sadly mistaken. Politics up there, as well as my above point, is why I left. Virtua and Atlanticare are both political and most of the medics are miserable and burned out because of unnecessary "since you're here you can evaluate".

And before you get all pissed of at me, I'm not saying all EMTs suck. Some EMTs I would trust my life with more than some medics. But then there's the ones who splint the non-fractured arm because they can't recognize deformity, inability to operate a BVM (yes, it's happened more than once), or the CHF'r on nasal @ 2 lpm whilst sucking on her last breath, the EMT would have noticed if the clipboard wasn't in hand.

The other problem with NJ is the fact that the FAC even exists. They don't have any requirements. They don't even require that an EMT show up on the call. How can a volunteer organization think that it's kosier to send a non-certified person to an EMS call? Or have 8 volunteers show up in personal vehicles but not one of them is an EMT, or they are too busy fighting over incident command to assist on the scene.

I'm sorry for venting, but NJ is a very screwed up system. Do it for a little while longer and you'll realize it.

And to whoever it was that was hired in AC EMS, good job and good luck. They've got some good people there. Learn from them. Also, if the medics give you a hard time UNJUSTIFIED, stand up for yourself and your decision. That's how you earn respect. Don't let them step all over you for no reason. A lot of them are great with educating, and you'll learn a lot from them. You'll figure out who those right quick. Keep a good head and all I can say is make a decision and stick by it!! Good luck.

Just a twit?

January 19, 2007

By MELISSA DiPANE

6 News Anchor/Reporter

SEVIER COUNTY (WATE) -- The Tennessee Highway Patrol is investigating whether a trooper went too far in forcing a firefighter answering a call to stop.

Michael Huskey was in the family minivan with his wife and kids when he heard a call from dispatch needing an emergency driver to help a nearby ambulance.

Huskey turned on his flashers and drove 85 in a 55 mile per hour zone when a state trooper tried to pull him over.

Huskey radioed dispatch to call off the trooper but he says the trooper swooped in front of him, causing an accident.

"Once he stopped my client, he found that out and yet he still handcuffed and arrested and investigated it further and took him to jail." says Jim Gass, Huskey's attorney.

Huskey got a speeding ticket and was charged with failure to yield to lights and sirens.

According to the report, the officer did not intend to crash into the minivan.

Huskey will go before a Sevier County judge in a few weeks.

Notice that it says "with kids and wife"? What was this guy thinking driving like that with his kids in the car? If he would have gotten into an accident and gotten killed they would have hailed him as a hero for answering the call in spite of family!!!!!!

God this drives me insane! I cannot believe some one would do this. His department should no longer allow him to be a member for this!

And what was the trooper thinking hitting a mini van with kids inside?

Tell me your thoughts.

If you're lifting, you should not be working past the 1st trimester probably.

It's a federal law for them to let you take family leave. It's called the Family Leave Act. It is required by law!!!! If they refuse, threaten lawsuit on a federal level. HOWEVER, they are within their rights to repost your position after (I think) 12 weeks. Which only means your job may or may not be available after your return from leave. And another note, if they are so hell bent on not allowing you time off, you should consider leaving for alternative work. That sounds to me like they don't care about their employees, so I would take this as my cue to leave.

OK, so once again, instead of educating providers and letting them practice, let's take the skills away. Not very progressive, is it?

First-time failures....something to consider is the condition we get the patient in while in the field. Case in point tonight, I had a cardiac arrest. Went in the first time, couldn't see crap. Suctioned, pre-oxygenated. Second-time in, I'm in without a problem, ventilating well with good EtCO2 waveform.

These are conditions that all these wonderful studies seem to forget about. Trust me, it's not an excuse. I've only missed 2 ET intubation attempts in the 5 years I've been a medic.

THANK YOU!!

The fire service and the EMS service never play well together...

Too many egos in one room

Screw you guys...I'm going home...as the beloved philospher Cartmen once said.

No kidding. What I'm saying is, if you can put 3 airways in someone, then they need to be tubed. A secure airway is one with an endotracheal tube in it. Not BLS airways. Yes, you ventilate with them prior to intubation, I never said to skip BLS procedures. I understand your passage, but what my point was, was that if they can tolerate the airways without a gag, intubation is in order. That's all I was getting at.

I can't wear mine for more than 12 hours or my eyes become instantly blood shot. I look like a drug addict. I bring my glasses. I also can't stand wearing them to bed then waking up with that cloudy vision like you're been swimming in a pool with your eyes open. I never sleep with mine in.

Black guy : Mav, what are you doing?

Maverick : I'm gonna bring him in closer..

Black Guy (can't remember his call sign) : You're gonna do WHAT??

Top Gun.

Sorry, I'm stuck in the 80's. That's my favorite movie.

Oh, and thanks for that post, I enjoyed reading that article. I don't hear much news from NJ anymore.

You are correct. There are two helo's. One operated by UMD and one by Virtua Health System. Both are piloted and owned by NJSP. The hospitals provide anf fund the flight medic and flight nurse.

Neither helo is worth a piss though because they never fly, unless it's for law enforcement purposes. And if they do fly, it takes them 20 minutes longer than any other bird, even ones further away. Go figure that one out.

All I can say is wow

2 nasals and an oral? Why not just intubate since obviously they no longer have an intact gag reflex?

And we don't need RSI. Just something better than Versed which sucks big time. It's a horrible drug c/ far too many side effects (hypotension being my favorite) and I've seen it not do anything to many many people.

Yes, we do need higher standard. I just had this conversation c/ my partner tonight. If we don't tube x amount of people in a 6 month period, we should be given an OR rotation to do x amount of tubes in the OR setting before being allowed to continue working. But as the other guy mentioned, doing OR time as a medic is not fun. They don't want you there, and every tube is a 'difficult' one to them, so they want to do the tube. So how are we supposed to get our tubes when they won't let us? Their just pissed off that we can do their job c/ less training. That might not always be a good thing, but it still needs to be done whether they like it or not.

:shock: OMG :shock:

Nosobrite,

Even after I became a paramedic, I continued to run calls with my BLS squad for about a year. I couldn't take it any longer than that! You definately made the right choice. These are the type of people who can talk on the radio, play incident screwup (I mean command), and recognize all 50 different tones for all local agencies, but they can't tell you a thing about the pt after being on scene for 20 minutes. You're not missing anything. Run...quickly....don't turn around. And definately don't make eye contact....it angers them...

I use them but would rather not because of the bulk and because of the weight. I'd rather scoop them up and do it in the truck instead of routing around in those darn bags!! :x

And you're still allowing Tom Starr to be involved.......very brave.....

These are always fun

Darwinism :shock:

This sounds more like he walked up to the guy and was too lazy to do anything else "because he was a bum".

If he'd done his job correctly it would have been fine.

And I agree with the above statement. If I ever did this, I'd be fired on the spot. Why is he even allowed to protect the citizens of that town when he's too lazy to perform his duties?

Just another note. You shouldn't be using either one if the pt cannot follow commands (which everyone already knows) but you should NEVER be administering tablets of that size to ANY pt. Do you realize the litigation you just opened yourself up to when the pt chokes on that tablet? :shock:

Yes, I know the possibility of aspiration also comes with the gel, but I'd rather aspiration than choking to death!

Please correct me if I'm wrong, but I was always under the impression that, if a person codes @ home, in front of you, and the family wishes no resusication be done, then you don't work the code.......doesn't matter if there is a legal DNR in place or not? Same thing goes if there IS a legal DNR in place, and the family wishes you to work the code, then you work the code.

That's what I was always taught anyway.....maybe I was taught wrong???? The DNR, as far as I'm concerned, is only in place for me to make the decision to work the code(or not) if there is no family present....if family wants us to work it, then we work it, If they don't, then we don't.

Hmmm, maybe I should look that one up, for future reference, just incase.... sometimes family call 911 when a person arrests, even though they know they don't want us to work the arrest. :?: I could never quite figure that one out....call 911 for a person who's dead, but once we arrive, they don't want us to do anything to try and help the patient. In that case, why call 911???? Just to make sure they're dead???

Anyway, yes, you did the right thing.....the patient wished to die at home with dignity, and you allowed that to happen. Good job!

I have to agree with what the original poster did. I would have called and got the order too.

However I have to disagree c/ Connie slightly.

Now, just for talking, (because maybe I can learn something too), I was told by a laywer who was also a medic, if you HAVE a valid DNR, you must honor it. The only exception is if the family member who wants CPR done is the MEDICAL POA. Otherwise, their vote doesn't count. Same thing for stopping CPR, if the family tells you he wanted nothing done, too bad. You HAVE to work it unless you have a signed copy of a DNR or medical control tells you otherwise.

I don't want to sound like I'm being a prick, I wouldn't want to work someone who the family states didn't want anything done. But I'm going to start CPR and call my doctor and make damn sure he's okay with taking responsibility for not working the code. I know that doesn't clear me legally, but at least I'll know if he's going to back me up or not.

Your program sounds a lot like mine, actually it's one of the places I looked into before I moved down here. And that's all well and good. I work in FL too and our EMT's can do the same skills under our supervison, minus the LMA part.

What I'm referring to, is states like where I came from (NJ) where all BLS and ALS are seperate entities altogether. If an EMT deems it necessary for a medic to be there, they would call us and we met them to take care of the pt. They have no medical direction. And for some odd reason, the State has little control over them unless they kill someone, literally. In that kind of system, BLS should not be allowed to perform those skills. They don't have the skill set or the direction.

In your system, I think assisting c/ IV's and such is acceptable, but I'm ultimately responsible for that pt's outcome and I don't know if I could trust every single EMT here doing LMA's and more invasive, possibly harmful, skills. Some yes, some no.

And kudos to you for taking your education further than necessary (at the time of being an EMT).

You guys all need to go back to your roots with the attiudes about EMT's, where did every single medic come from? An EMT.

Now, I'm not much for supporting EMT's to do ALS care, BLS is EMT's and ALS is Medics, No questions asked, but the bashing of EMT's is getting kind of worn out. Yes, we might not have the higher education levels that you guys might have, thats plain and simple. But EMT's wether you work for BLS or ALS provider are your partners, the people who should be watching your back, I cannot tell you how many times I've saved a medic's ass from write up or even worse injury resulting in loss of work. The EZ IO is ALS, I personally, believe the LMA should be BLS. If we can insert a Combitube which does more damage to an airway then a LMA does, then why not an LMA? Our medical director for my agency allows EMT's to insert LMA's with supervision in the field if the medic cannot intubate. He also allows us to start IV's in the field under medic supervision. The LMA is simply a slide into until it stops not forcing into the trachea. It's a secondary device, I though secondary device's were BLS? If you would like an updated copy of our medical protocol's let me know, the ones on our website are 2 years old, we are unveiling a revised protocol guidlines book, which includes the LMA, and administration of Lopressor we now carry on our trucks.

I've also read on here some members' generalizing all EMT's. THAT IS BS!!! Just bc you have some really crappy EMT's does not mean they are all the f***ing same. Who knows, I might just be one of those anomalies who's actually an educated EMT and can do the skills efficently, apprioriately, and safe. I don't know.......

Not to beat a dead horse but....

You obviously missed a lot of what people were saying.

No one said EVERY EMT sucks or anything like that. I came from an EMT job too. I would NEVER have felt comfortable as an EMT c/ something like an IO or LMA. I would have left that up to the medic. Maybe that's a bad thing on my part, but I was raised in a system where I knew my limits. Advanced care belongs to a advanced provider. I can't say I know your area, but my EMT school was 3 months long, 1 night a week. That was 10 years ago. Maybe it's gotten better, but I left that EMT program and learned nothing except a few anatomy things. I learned everything from experience and mostly from medic school. Medic school was actually a wake up call for my brain.

You also mentioned the Combitube which I also think shouldn't belong to BLS, but if your medical director is comfortable with it., great! On that note, I think the reason most people are saying no to BLS being afforded these skills, is because BLS agencies USUALLY do not have a medical director, or rather not one who actually involves himself. Unless you work in a BLS/ALS joint system. I never had a medical director as a BLS provider. It was all State Protocols.

I think what most people are saying is, not to discredit BLS, but how often are you going to be using these skills and tested on these skills? As a medic, at least where I am, you have to have x amount of successful tubes, otherwise you get remediation, x amount of successful IV's, x amount of IO's, ETC. Is your medical director going to update training at least yearly for all EMT's practicing these skills? Is every other BLS agency going to do the same? That's the point. Back in NJ where I came from, EMT's could basically kill somebody before the State actually stepped in and did something. EMT's could be dumb as a box of hair, but answered to NO ONE! They had no medical directors to answer if they screwed up, and only rarely did some BLS agencies investigate negligence on the EMT's part. I can't trust a program like that to give EMT's more to do harm to a pt with.

Perhaps she's related to the 9 year old who set his genitals on fire with the lighter fluid?

I voted on. I know I started out too at one time, but not with invasive procedures. After 6 years of being a medic and 5 at a basic level, i would never trust enough EMT's to allow it's use. Don't get me wrong, I've have worked with many EMT's who do a better job than my paramedic cohorts, but I've also seen too many blatant, stupid errors. Not knowing how to ventilate properly with a BVM (how can you use an LMa if you can't even use a BVM), not recognizing resp failure in the CHF'er who's on a nasal @ 4 lpm, not recognizing that the reason they can't hear the BP is because they're asystolic and probably have been for quite some time....

This stuff really happened. How can I trust that EVERY EMT is getting enough training AND retraining to ensure adequate skill levels? Especially when stuff like the above happens? On a paid squad handling a lot of calls too, not a small volunteer organization that doesn't get out much.

Oh, and splinting the non-fractured arm! I swear to g**! That was my favorite.