MontvilleFire39

Kiwi, You are hitting on what I am looking for. I work in a very high volume urban system but despite the high volume the acuity is quite low overall. This fact coupled with the plan to place paramedics on every street corner seems to create an environment where skills retention is an issue (or not building them at all). I am just looking for some facts to back me up before I voice the issue...

Hello, I am looking for any studies pertaining to the number of paramedics vs patient outcomes. Any assistance would be appreciated...

Tired of paying me to lift weights and sleep? Thats pretty funny... I am well aware that most fire departments run ems, I work on one of them. In fact the fire service played a pretty key part in the development of the modern American EMS system. As far as a debate goes, there is nothing to debate. Fwiw, I am quite familiar with Mr. Harris and your portrayal is dead wrong.

Predictable response....

These anti fire service threads are so lame and share one common underlying theme; jealousy. While I agree with some of the points made about sometimes, the root of these rants is jealousy. You will never admit it but thats ok. People like you are jealous that the fire service has evolved into a respected career while you are stuck in a little thought about stopping point known as ems. Across the board the fire service has better pay, benefits, working conditions, union representation, and respect. Because of this people like you have made it a mission to post every potentially negative article regarding a fireman. Take a look at these; this is why you should hate all EMS workers. http://www.wtkr.com/news/wtkr-paramedic-arrest,0,1856877.story http://www.newschannel5.com/story/14457388/paramedic-arrested-for-being-intoxicated-on-the-job http://prescription-drug-abuse.com/drug-abuse-articles/drug-crime-news/paramedic-arrested-for-siphoning-fentanyl/ You paint with a broad brush pal. While you make some valid points most are merely generalizations. I anxiously look forward to your reaction... http://prescription-drug-abuse.com/drug-abuse-articles/drug-crime-news/paramedic-arrested-for-siphoning-fentanyl/

We have been using Image Trend here in Memphis for about 2 years now on Panasonic Toughbooks. Initially there were some growing pains but all in all I am pretty pleased. I have used EMS Charts and currently use Zoll Rescue Net at my side job. The thing about image trend that will make or break it is the configuration of your agencies specific program. When we initially rolled it out report time were an hour or more cue to both operator learning curve and having to tweak the program to our needs. Our EMS administration placed and EMS Lieutenant in each of our receiving hospitals for the first week or so when we rolled it out to assist with any issues that arose and that helped tremendously. In addition to that they worked very closely with field staff, administration, billing, and Image Trend to tweak our specific program as we grew into it. I am now able to complete most reports in about 15-20 minutes. We have our Philips MrX monitors set up to transfer monitor data via bluetooth to the PCR and also to transmit 12 lead EKG's which works very well. Good Luck

To all the union haters, slap down the pay slips and talk about the benefits; I pull down $54,600 base salary along with $2300 in holiday money, roughly a grand or two in FLSA money, and 3$ job incentive bonus. On top of that very liveable salary I participate in a 25 year pension plan, am offered a deffered comp 403b accounty, and recieve top notch health insurance. I am allowed such perks as unlimited shift swap / sub time, 3 thirteen day vacations a year and recieve 24 hours of pay or comp time every 3 months that I don't call in sick. Lets just say the union dues are worth it...

Union are a very mixed bag and the pros and cons must be carefuly considered. I have worked for a union private provider represented by the IAEP (Intl. Assoc. of EMTs& Paramedics) and currently for for a fire department represented by the IAFF. The private service I worked for was in its infancy both with being a union shop and being represented by the IAEP. That is a huge factor to understand as a union will take a significant period of time as condtions won't improve over night and will take several contract periods to really improve conditions. We also were a fairly small local with a small budget which forces you to be selective in which you pursue. The IAEP itself is a solid orginization and intends well in its honest effort to assist its locals. That being said they are a fairly small group therfore there resources are limited. You will be assigned a regional represenative who will be your point of contact for assistance. The regional rep who worked with our local was good but the timliness wil vary as they are spread thin. The IAEP will assist you in organizing and ratifying a contract. While the contract I worked under din't procide massive changes, it provided a minimum standard. It kept management from making sweeping changes on the fly and prevented management harrasment. It also provided a means for resolution in the event of the forementioned events. The IAEP also offers some union discounts, scholarship funds, and such. I currently work for an IAFF represented fire department. (Lets keep the opionions of fire based ems and the IAFF out of this discussion) The IAFF is simply put a very powerful labor union. There political action fund is one of the largest in the nation and their resources at the international level are tremendous. We are a very large local (2600ish members) which gives a large budget to work with. Because of this we can more aggresively purse issues that arise and take them further. This budget also allows us to have our 3 principal officers work full time at the union hall versus having your officers working for the union "on the side". Representing the membership is their full time job. We also have an attorney on retainer and provide him with enough work to be very dedicated to our local. The IAFF has enabled to negotiate a very generous but not perfect memorandum of understanding with good pay and solid benefits. If you go forward with your decision to begin a union the selection of who to organize under is eesential. I personally am not a fan of the "catch all" unions such as the IBT. I prefer a union that is dedicated to your profession entirely and not split amongst multiple. I don't believe a trade union fully understands the issues of fire or ems providers. I would look at the IAEP and talk with them. Something to be relaized is that the IAFF has organized several EMS only organizations but firefighters are their primary focus. A major consideration is the labor status of your state. A labor state makes for a much stronger union and the employer must recognize your union as long as it is legally organized. In a right to work state they don;t have to deal with you whatsoever. Understand that if you go union you are legally required to provide representation to ALL dues paying members regardless of your personall opinions. There have been several lawsuits filed against union locals who did not provide equitable representation. This means that you must allow a good standing member the process they are entitled to even if you disagree with their actions pursuant to your defined grievance process. If a member gets popped for a DUI; guess what you must represent them. this doesn't sit well with many folks. Also keep in mind that past precedent is a huge factor in settling grievances which means that you sometimes must defend questionable actions for future benefit; it can be a tough pill to swallow at times. Another manjor factor is local involvment. If your membership won't be actively involved your union will be weak. The union is controlled by the membership and no the officers. If you have any further questions don't hesitate to contact me.

Hello, I am looking for a little information on Wake County EMS from the employee prespective. 1. What can a first year paramedic expect to make their first year? 2. Is overtime avaliable? 3. What are the benefits like? 4. How is the retirement? 5. What is the call volume like? 6. Are you assigned to a base or do you rotate? 7. Is the turnover high? 8. How is the equipment? Thanks, Ben

In Memphis, our EMS dispatch protocols our approved by our medical director. Abuse of the 911 system is a serious problem however call triage and paramedic initiared refusals are not the answer. The potentil for incorrect "triage" over the phone is huge. The quality of the decision is based highly upon the inteligence of the caller, make your own determination on this one. Paramedic initiated refusals will always ultimately fail at the hands of an inevitable lazy paramedic, "mam thats not realy chest pain" type of scenario. FWIW, my first call in Memphis was a call for a sick party called in as that by his wife. She wasn't lying, pulseless and apneic is quite sick.

I am looking at OH, PA, MA, ME, MD, RI

Thanks for the replies. I am not wanting to come off "entitled" by any means, but I am not willing to step backwards to relocate. Thankfully I am happy where I am at now so I can be choosy...

Hello and Happy Holdays to All, I am currently working in the Mid South for a large urban fire department. I am looking to possibly relocate closer to home, somewhere in the Northeast. Any leads on avaliable jobs meeting the following criteria; 1. Fire based or third service; due to the contract nature of private services and the inherent instability I am not interested in a private service. 2. While it's not all about money, I currently bring in about $63,000 annualy at my full time gig. I would need to be somewhat close to that. 3. Primarily 911; I am ok with some ALS hospital transfers but my days of renal roundup are over. 4. The service must be progressive in nature with an emphasis on quality care and employee well being. If anybody has any leads, they would be appreciated.

AussiePhil, Your incredible hatred for the fire service and fire based EMS clouds your judgement and makes you look ignorant. Fire based EMS can be debated adnausem but bottom line is being "fire based" (even though theese two are NOT firefighters) does not automatically make your actions inappropriate. The comment regarding the union sweeping it under the rug was a pathetic attempt at a shot towards the IAFF; funny that FDNY EMS as well as communications staff are in their own union seperate from the IAFF. If you hate the fire service so much that is your perrogative, but as professionals let's try to judge individual events based upon their own unique circumstances not our own individual prejudice toward a particular service delivery method. Frankly, it makes you look like you have a week argument.

I actually attempt to keep a running log af all of my intubations...year to date here are my numbers; 26 attempted oral intubations 20 succesfully placed oral endotracheal tubes 5 succesfully placed King Airways following attempted intubation 1 patient unable to secure ett or backup airway due to massive facial trauma 1 attempted nasal intubation 1 successfully placed oral endotracheal tube Oral ETT Success Rate =81% Comined ETT / backup airway success rate =97% Oral Intubation Success Rate=100% (above numbers are a combination of my full time gig working in the inner city, my part time suburban ems job, and my part time rural ems job w/ RSI capabilities) While I feel my endotracheal tube success rate is a bit low, I am pleased with my overall success rate of ett/backup device. My reasons for placing the King vary; 1. If I am running without a first responder on a critical call and after one attempt I deem it to be a difficult or lengthy intubation I will place the King as I feel a rapidly secured King Airway frees me up to acomplish other ALS procedures as well. 2. I feel a rapidly placed King Airway is better than multiple lengthy attempts at ETT. My one call in which I was unable to secure neither an ETT or backup device ended up being carefully bagged to a nearby local facility and recieved a surgical airway prior to air transport to a Level I trauma center with a successful outcome. In my system we run 33 ALS ambulances with greatly varying call volume. I know some medics who will get 20 plus tubes a year and some who are lucky to get one or two. We don't curently have OR practice sessions avaliable, but have a full time training academy with several different dummys avaliable as well as a decent training staff; additionaly training is avaliable with our very pro ems medical director. It's not a perfect setup but pretty decent IMO.

First and foremost, a good preceptor / FTO is someone who wants to be one, not who was told to be one. IMO, a good FTO program links a candidate / probationary employee / student with a set FTO allowing a relationship to be established. This allows the FTO to make an investment and then see the reward. Second, I feel a good FTO program has an established agenda while allowing for flexibility based upon the person being FTO'd. I promise I am not shamelessly plugging the agency I work for; the Memphis Fire Dept. began a new FTO program about two years ago. It really has worked well to weed out some bad apples as well as enhance the abilites and confidence of some folks "on the fence". If you want more information, send me an email benbindokas52@yahoo.com. Back to your original question, above all a good FTO must take great pride in his profession, delivery of his/her skill set, be of sound moral standing, and be able to identify when to let a candiate learn from his own mistakes vs. step in when warranted.

I am going to try to do a medline search when I get off shift.... Something I have really made an effort to do is get my first BP be it manual or NIBP before we move the patient, similar to getting a good baseline EKG. Also, out of curiosity I began to atempt to "combine" the two. Our new monitors (Philips MrX) show the pressure as it is being counted down. I try to palp the systolic BP as it is taking the NIBP. I found that my reading is alays 5-15mmHg or so different than the NIBP reading. Perhaps the NIBP is more sensitive than my delicate hands. When we had our inservice with the sales rep, he described some sort of complex algorithm of taking multiple readings, averages, etc..I would like to learn the interacacies (sp?) of the technology before I feel I can make an educated opinion...

Dust, I have exhaustively searched but was unable to find an article discussing a study of NIBP vs. Manual BP vs. IBP in the hospital setting. I don't remember specifcs, but the article claimed that NIBP in the hospital setting to be more acurate than manual BP. Something to think about...

65k.....highly doughbtful Fayette County is not hospital based, but nonetheless a great service. Good people, equipment, and protocols; unfortunately quite small with little turnover. West Tennessee Healthcare runs hospital based EMS out of Jackson, TN.

Oh God please don't....it is really gonna hurt

Patient care can't and should not be defined as rural vs urban but based upon the situation at hand which are dynamic and not black and white. Per SOP, at a minimum I am required to take a jump bag, o2, and monitor into all EMS calls. Some do, some don't but it is a punishable offense and the potential to get in a ringer is there. As far as treatment on scene goes, I often prefer to treat the patient on scene but inthe ambulance for crew safety reasons. If somehing goes negative on scene you can quikly take off. In questionale at best neighborhoods scenes can change rapidly. In the upstairs bedroom of a house with a patient on the monitor and 02, you can rapidly exit the scene. It is a judgement call and depends on the neighborhood, amount of people on scene, and amount of personel on scene. If we are on scene with a first responder company it prvides more eyes to be looking at the overall scene which is hard to do as a treating paramedic. One of the biggest traits of a high quality paramedic is being able to rapidly and appropriately decide if they can effectively initialy manage a patient on scene or if the patient is in need of a higher level of care than afforded by the EMS crew thus prompting them to rapidly transport and treat as much as possible enroute.

WTF are you talking about? I was unaware you could send a bleed....gimee your address and I'll send you one in the mail...Priority Mail flat rate $4.99...who wants one? You sound like so many of the patients I pick up who refuse to go to a certain hospital because they "killed" mama... Sorry to be harsh but try to post in a more inteligible form to invoke a more warm, fuzzy response.

Ya, really. While not able to be done in all situations it s plausible . Elelevate strethcer to 90 degrees, place patient into sniffing position. That was just one example. Thyromental distance and Mentum-Hyoid distance canbe assesed and provide some insight into the difficulty or ease of an intubation. Like you said, much of the ETT failire rate is due to educational shortcomings. On top of entry level education, may providers fail to coninually educate themselves as well. Their is a wealth of continuing ed opportunities out there; classroom sessions, structured on line con ed, online information, intentional educational dialog and debate with other providers etc....While no one method is best a combination of all is essential for maintaining competence and staying abreast of changes in practice.

Had one a little while back, humbling to say the least. Dispatch Notes Dispatched for male in 50s, assault victim wiht police on scene. No further information provided. Upon Arrival UA, found ambulatory male being interviewed by PD. Multiple bystanders around. Patient states he was involved in "encounter" with another male party and was struck in head with brick. Patient Presentation Patient has a small abrasion above right eye with slight non active bleeding. Patient and bystanders deny LOC, patient alert and oriented to person, place, time, and events. Patient obviously and admittedly intoxicated, drug use denied. Patient adamant about not being transported and intermittently beligerent. Patient vitals assesed, WNL. BP normal, HR normal, Resps normal, SPO2 99%. For whatever reason I was insistent on transporting patient to which he finally agreed. In unit, secured IV access. At the point of assesing lung sound, patient became increasingly beligerent. The quick listen I got sounded clear and equal. Patient has no other obvious signs of trauma, no visible bleeding. At this point I deemed patient stable and conceited to a hands off transport. Tranported without incident, patient ambulated to ED due to patients refusal of stretcher transport. Hospital Course Once inside ED, patient triaged by nurse without incident. After an apporx. 30 minute wait, patient was put in fast track room. Upon turning in trip ticket to nurse, I was informed by treating nurse that patient was now being moved to a major side room and was having a chest tube placed d/t pneumothorax. While placing patient in hospital gown (sp?), it was discovered that patient had a small puncture wound under his right breast. There was no bleeding. Upon furher interview patient recalled being stabbed with an awl. Fortunately there was no negative outcome in this case. I was incredibly humbled and glad that for whatever reason I was insistent on transport. I learned to not be complacent, to better expose trauma patients, and attempt to uild a better raport with patients to allow for a more complete assesment. Truly a learning case for me...

Spenac, Im not quite sure what your getting at with this. Agencies don't have a responsibility to provide individuals with a career that suits their individual needs, but rather a responsibilty to employ people who fit into their decided method of delivery. Where you / are you from the Memphis area desiring to work as a single role provider? If so their are several other agencies surrounding that allow for this type of work. In fact I am on duty at one right now where I work part time.