MontvilleFire39

I am also for advancement of skills if found to be of a positive result as backed by legitimate research. Intubation is a skill that is poorly addressed in most paramedic programs. There seems to a preumption that you will get the tube without enough emphasis on backup airways. One should approach intubation expecting to suceed but prepared to fail. Education should include standardized techniques for assesing the ease or difficulty of seuring an ET tube. Skills such as Mallampati scoring should be standard. On top of this, nasotracheal intubation IMO should be emphasised as an option as well. I have utilized this on several occasions with positive outcomes. Use of bougie assisted intubation should be standard IMO as well. Deployment of King Airways, Combitubes, and emergency surgically invasive airways needs to be ingrained as a readily avaliable back up to safe, expeditious placement of an ETT. Mechanics have many different tools for performing the same repair with different surounding circumstances (different makes, models, and years of vehicles IE). Intubation is nothing more than a standardized procedure with different surrounding circumstances (body weight, airway anatomy, precipitating medical conditions). Increase the tools in your toolbox to ensure success.

Hospital waits are a a reoccuring problem in Memphis. The FD is taking measures to reduce wait times with the hospitals in the form of monthly meetings with all recieving facilites and having EMS lieutenants intervene in extreme circumstances but these fail to address the real issue IMO. In Memphis, we are unable to refuse transport if it is requested. Additionaly we "must" transport the destination of choice. This is compounded by a disturbing amount of "BS" calls. There is an extreme lack of primary care utilization thus the burden falls on the emergency rooms and in turn the EMS providers. It is routine to repond to a non acute complaintant and arrive to find multiple working vehicles with multiple family members present and then be followed to the ER. Add to this the ever long myth that patients will be seen quicker if arriving by ambulance. Hahahah.....not true if I can help it. This problem is worsened by hospitals refusing stable, low acuity patients without major injury but an sort of MOI. There is only one trauma center in Memphis. It only has two 2 bed "resucitation" rooms and 10 lower acuity beds. In addition to serving the greater Memphis region, they serve a good portion of Arkansas (who does not have a level 1 trauma center) and a large portion of Missippi. Needless to say they are slammed. Most of the other ED's tend to "recomend" a higher level of care for anybody involved in type of traumatic event. The solution is increased access to primary care which is difficult to implement with a high percentage of poverty level residents, increased education which is difficult to provide to a large percentage of low educated citizens, and paramedic initiated refusal which is a legal "no-no". My record for a hospital wait is 7 hours and 45 minutes to two hours is not uncommon. In fact on multiple occasions I have seen 10+ of our 33 ambulances waiting at one hospital.

Dust, i guess it depends on what your definition of good enough is. To me good enough is a service that allows me to practice my craft at a level that I find acceptable and that as a whole provides care at an acceptable level, provides me a livable wage, suitable benefits, stabel retirement, and will foster professional development. The "good enough" aspect comes into play due to the fact in a system with 400 plus practicing paramedics, some will be subpar, some will be medics only to get hose time, and some people will be complete douche bags but overall the negative aspects are the minority which is what I see in this case. To the poster(s) that criticized Memphis for not allowing single role providers; find somewhere else to work. It is their perogative. Is your third service going to allow me to provide fire suppression as well because I have a desire to? FWIW, the paramedic program is being spearheaded by individuals who began as single role providers before cross training began.In speaking with some of them, they have a strong commitment to "weed out" individuals who have no desire to provide prehospital care at an acceptable level. I share that belief and when and if I am place in a preceptor role (which I intend on pursuing), I will not sign off on anything less that professional, competent care. Unfortunately their are other factors that I feel will limit this ability that I don't feel are appropriate for discussion in public forum. Additionaly, upon completion of the program all new paramedics will be mandated to participate in an FTO program which adequately covers administrative and patient care aspects of performing in the field. I came through this program and found it to be quite impressive. I wholeheartedly agree on increasing education and entry requirements in the prehospital arena. I feel it is the only way to legitamize the profession. However until the overall industrywide compensation and working conditions improve, it would be difficult at best tom compete with other career fields such as nursing. On the flip side I don't see compensation and working conditions improve until training and entry requirements rise. It's a two head snake...see where Im heading with this?

Wow, I just stumbled upon this old thread while searching for something else. First and foremost, I am embarassed. Both sides in this argument are making claims to be in support of inreasing the professionalism in what they percieve as the best EMS delivery model. Trading insults and jeers back and forth is certainly not that. There are many methods of delivering pre hospital medical care. Different budgets, political climates, tax revenues, geographical constraints, demographic considerations, personel avaliability, and many other factor play into to determining what is the "best" method of delivery. Additional as a provider your financial needs, family constraints, professional desires, and personal prefference determine the type of system you fit into. I personally work for the Memphis Fire Department. I relocated hear about a year and a half ago. I previously worked out of state for a private ambulance service providing 911, interfacility, corpse removal, scheduled "renal roundup" service, and critical care transfers. To me, the private service as a whole is pretty dismal. I made a whopping $10.20 per hour, worked in equipment that would make Sanford and Son cringe, and was treated like crap. I was forced to work with coworkers who either A. wanted out so bad that they were miserable or B. were stuck there due to laziness, DUI's, credit scores in the single digits, or morbid obesity. That being said, not all private services are that poor. I am a paramedic, and truly enjoy being one. I became one to be one, not to assist with fire based employment. On top of being a paramedic I also really enjoy being a firefighter. To be honest it would be hard or me to choose; fire would probably get the edge simply from a career longevity standpoint. Thankfully I work for a system that allows me to work both disciplines to their fullest. I am assigned to one of the busisest ambulances and busiest truck companies in the city. I regularly get to fight fire and provide medical care at the ALS level. As a fringe benefit I am afforded IAFF representation and the assosciated liveable salary, good benefits, and an actual retirement. While there are some third services out there that provide this, I feel as a whole fire based trumps third service / private in terms of compensation and benefits. Although I will be scorned by many, I believe this is a cause of much of the discontent between third service and fire based. My (limited) experience as a paramedic / firefighter in Memphis has been nothing short of positive. We benefit from an experienced EMS command and field staff. At the daily operations level, their are 5 EMS lieutenants and 1 EMS battalion chief. They are responsible for narcotics restock, field replacement of medical equipment, "light" QA/QI on all run tickets, protocol compliance, serve as a resource for field paramedics, and act as a liason between field providers and hospital staff. Operationaly, they respond to working structure fires in a medical operations role, MCI's, multi-party MVA's, and any call with 3 or more responding ambulances. Theese lieutenant also give paramedics a dog in te fight IMO. This helps address the potential problem of having a supervisor who has a lessor medical certifiction. A paramedic directly reports to the firefighting lieutenant at his company, but is also supervised by an EMS lieutenant. Theoretically, EMS only issues should be handled by theese folks. People here are quick to bash Memphis without any firsthand knowledge. MFD has a host of quality paramedics. Of course as everyone else we have our bad apples. The system was set before my arrival and is firmly established. The basic structure is not going to change. However, administartion has commited to system wide improvment in every aspect. Their is a concerted effort to foster a culture of quality medical care. Our medical director is very involved. We operaste under fairly liberal protocols. They are nothing fancy but much of that is dictaated by our geography. Bottom line, MFD is providing service in a challenging environment with an emphasis on ever increasing quality. As far as Memphis running their own paramedic school goes, I had and still have some doubts. That being said, as time goes on and I get more exposure to the students in the program, Many of my concerns have been lessened. Thetraining center staff are mking a commendable effort to ensure a well rounded and real world applicable education is provided. I have had a few EMT-IV and a few paramedic student ride with me and to be honest I was impressed. This could be coincidence it could not, time will tell. None of theese people were FORCED to become paramedics. It was a requirement from the time they applied, which they voluntarily did. Unfortunately there will be some who are only doing this to be firemen which is ashame. They will be unhappy and their patient care will be adequate at best. From my personal observation this is not the majority. I could be wrong, we will see. I don't agree with everything the fire department does. I don't personally believe that we need to increase the number of paramedics to the levels planned. I don't agree with some of the dispatch procedures. I don't agree with all of the policies and procedures handed down from administration. But as a whole it is pretty good and getting better. Sometimes good enough is good enough. I have to many other interests in life that to fight the good fight working for a private or third service because it is "superior" with it's low pay, poor benefits, and no retirement. My first commitment is to my wife and kids whcih heavily influences my employment choices. If it ruffles a few feathers along the way the so be it. My family is fed, clothed, and sheltered in a pretty decent manor becuase of my job with Memphis Fire Department which is a big deal given the current economic climate. If you are so truely concerned with the inner-workings of the Memphis Fire Department, get your information from an official source not hear say. Got a question, contact me, contact Lt. Kramer, contact the Director if you so choose. I am sure they would be more than happy to provide you with a factual answer to your question. Lets be honest, there will never be one model for EMS. Accept it, move on, and attempt to foster positive relationships between different services and providers not online pissing matches and spewings of complete rumor with no basis rooted in fact. Ben Bindokas Firefighter / Paramedic Memphis Fire Department Truck 3 / Unit 3 C Shift benbindokas52@yahoo.com