whit72

Spenac wrote: Me keeping my job is never an excuse for allowing abuse of the system. You say it is not your problem to worry about if they pay. Well thats a pretty noble statement. So you never transported anyone that didn't require transport? Does your system allow you to deny transport? Whats the criteria or is just your opinion? I am sure you are quite capable but is every one you work with? Spenac wrote: if your service still stayed busy only transporting real emergencys which are easier to get funding from your service could afford more people and trucks again keeping you from exhaustion. We wouldn't, no system would without losing half your personnel. If your system does 100,000 calls annually, half of them require an ambulance, they don't staff on for only the ones that require it. They have to staff for everyone that calls. Thats the way it goes. Even if you don't transport you still have to go assess the patient and clear up, that takes time. Spenac wrote: To simplify it further will they die or become permanently worse if not taken by ambulance? Easily 90% if all paper work is done truthfully would be disqualified. So how many of your patients fit that criteria last week. Not many of mine did. So your service could still function with all its staff at ten percent of its volume? Thats why we run a tiered system, the ALS trucks are available for true emergencies while the BLS trucks handle everything else. It isn't a solution but its a start. We can gaurantee when your truly sick you receive the care you require.

We never deny transport, you call you go. Its pretty simple. They pay taxes, well some of them do To many meatheads in this field to allow crews to decide what is a true medical emergency and what isn't. How is it your problem if the insurance decides not to pay? That isn't my responsibility. I know and understand the facets of my job description deciphering what an insurance company will pay for isn't one of them. I have enough on my plate. If you use the excuse that you will take an ambulance away from a truly sick patient. Thats bullshit, we know the percentages of 911 calls that are trule emergencies. If you only staffed ambulances to handle truly sick patients you would have to drop half your trucks and lay off 75 percent of your field personnel. Its understood that half your calls you wont be reimbursed for, thats the nature of the beast. Educating the public as to what is an acceptable reason to initiate emergency medical services is what is needed if you believe your area has a problem. However that could persuade others that are truly sick not call because they don't believe they fit the criteria. Its a slippery slope. Be careful what you wish for because if only the truly sick called 911 half of us probably wouldn't have a job anymore.

One question. If your operating on a BLS ambulance. How exactly would you perform an ALS intervention without ALS equipment?

99.9% of deliveries are BLS, whether your ten minutes out or 3 hours. If your delivering ten kids a year in the field then I believe you may have the oppurtunity to experience more abnormal births and further education is probably needed. If Im thee hours out and I discover a limb pertruding, guess what I am doing? Calling the bird. I am not dicking around with a high risk delivery for three hours that I might end up elbow deep in, when we can fly her there in a half hour.

I dont know about you all. I think I looked under a pregnant womans dress once in my whole career, thats because there was a head sticking out. I note severity, contraction time, gravida/para and move along. Nothing good can come from looking up a pregnant womans dress.

Oh boy this topic is sure to start a firestorm

Nasogastric tubes. They empty the contents of the stomach. It lessens the likelihood of vomiting and aspiration.

ratel wrote: When I returned to base I found out that the ALS unit had put a complaint in against me for not waiting on scene for them. Waiting, fantastic.......I would have filed a complaint against the medics for being retards, you treat trauma with diesel.

I believe every area of a station is considered a working area if you are on the clock. If its posted that you are being monitored I believe you wouldn't have any legal standing.

after she allegedly slappped him in an effort to revive him Our we now slapping people in an attempt to revive them. Wow in my area where still using archaic efforts like defib and CPR. I would have punched her too, and probably followed it up with a body slam. I think we all know the limitations of assessing responsiveness in an unconscious patient. Slapping isn't one of them.

JPINFV wrote: But think of the income that could be generated by PPV and DVD sales of "EMTs Gone Wild" or "Code 3 Club: Medics on the Prowl" Ummm..our you wearing a blindfold to work. The woman I would choose to see naked our far and few between in this field. Nothing personal but this kind of work hardly attracts the beautiful people. Seeing a few that I work with naked would mandate immediate CISD. Not to mention the rest of my life being prescribed some type of sedative so I could sleep.

I would assume that if its their property and you are notified that the cameras our there. Then thats all they would need legally. A sign that stated this area is being recorded by closed circuit TV, behave yourself. Fist of all these people probably sleep in their clothes after being around sick people all day, with God knows what all over them that they cant see. You want to slap nasty s in a bed they just finished rolling around in? Not me. God knows what they would find in these stations if a lab came in and took some samples. Keep your clothes on, tend to your business while you are there, go home and take a shower then think about banging your partner in a somewhat less infected area.

Dustdevil wrote: With few exceptions, most agencies you find still doing 24s are either fire-based, or just plain stupid and unimaginative, with poor leadership. I think you forgot in your opinion those agencies are stupid, unimaginative, with poor leadership. I think every system has to be tailored to their specific needs. Everyone thinks you can use a cookie cutter to stamp out EMS systems around the country. You cant. They all have specific needs and should be designed with those needs in mind. As far as twenty-four hour shifts. I don't see a problem with it., as long as its monitored closely, you shouldn't be doing twenty calls a shift.

In Worcester there were reports of homeless being in the building. This job is dangerous, especially on the fire side. We all know the consequences when we get involved, we can take every precaution available to us and still fall victim. As far as the miners, Its a tough call, but safety has to be of the utmost importance, we shouldn't be risking lives if it is in fact a recovery effort. Does anyone know how long trapped miners have lived? Is it possible they could still be alive?

I don't feel well is a statement I hate to hear. It means either of two things. I will be cleaning up puke or doing CPR, neither of which sounds real appealing to me.

Ummm I don't feel well is a pretty vague complaint, you mind narrowing it down a little. Like I am going to die" I don't feel well" or "I am a pansy and I have a stomach ache don't feel well"?

Eydawn wrote: A LITTLE WHACKING IS FUN, TRY IT SOMETIME!!! Hmm....

It has everything to do with demand, the field is flooded, both ALS and BLS. Until they do something to limit the number of people allowed to enter this field, then you can increase the education requirements. This will always be a young persons enviorment. They are usually the only ones who can survive on the measly pay. Education has little to do with compensation. Take a look in the newspaper to see what people with BS degrees are being paid at various jobs. Demand is what increases compensation. An entry level business course will tell you that. It is the only reason nurses with associates degrees are making fifty-dollars an hour. Once the field levels out you wont see the compensation increases you are seeing now.

I have begun to witness this trend in EMS. More and more I hear from new EMTs and medics: Well our protocols state this, and we are not allowed to do this, without this. Its like the human decision making element is being weeded out of EMS. No more assessment, if you find this, then do this. If you see that, then give that. Its quite scary. Its almost like they would rather have you follow a flow chart. Then assess a patient and make a treatment decision based on your findings. Now I am no brain surgeon, but most of my EMT class if I remember was geared towards assessment, Its like their pumping out non decision making robots. Like they dont want these people to think for themselves cause their afraid of what they might come up with. I always prided myself on being able to assess a patient and most of my college education was also directed towards classes that would help improve that. Although my degree will probably take me out of the patient care field. I have learned things in just about every class that I have taken that I can in one way or another use to help me better assess my patients. The new trucks we have just put in service have electronic BP cuffs, a fancy pulse ox. all this French equipment that allows the provider to just plug the patient in and two minutes later the machines spit out whats wrong with the patient. Its bullshit. When I started we had a twenty year old BP cuff and stethoscope, thats what we relied on. Now these new riders they just want to plug the patient in sit in the tech seat and tell me about all the lives they have saved. I have a cabinet in my truck thats designated just for batteries, everyday I come in and see that cabinet it makes me cringe at what we have become. Don't get me wrong I like technology and the advances we have made, but when some meathead has to take his truck out of service because the batteries in the pulse ox are dead, and he cant confidently assess someones breathing without the flashing red numbers, I get a little pissed off. I just hope that somewhere down the line we can refocus our attention on the importance of recognition and assessment. Its the best tool we have. It also can never be replaced by something that runs on batteries. Yes we all have fancy little toys, some more then others. However if you cant assess your patient, which I have witnessed is becoming a lost art, then all that equipment isn't worth jack shit. Whit72<----------- Gets off his soap box, and smashes it into a million pieces. Sorry for the rant, my regular partner was out yesterday and I had to work with another guy who cant get to an address without plugging in his five-thousand dollar GPS system, it took him longer to plug int the coordinates then it did for me to find it on the good ole ten dollar map. You should have seen this thing you would have thought we were piloting an un-manned space shuttle. I was thinking to myself what this guys reaction would be if I took his overpriced map book and launched it into the bay. I think I just need sleep, night-night. Sorry for hijacking the thread.

Dust wrote: You're not an untapped resource. It sounds to me like you are being used for exactly what you are good for: performing mundane skills-based tasks so that licensed professionals can be freed to focus on more important things. Dust, you better be careful this chick might kung-fu your ass.

Sorry Ruff, now I get it. Wow. That could get expensive.

I am assuming a physical test. Heart and lung test, if your fit to perform your duties. Just guessing.

Hey Stick'em, where you going all in a huff? When it gets a little hairy you run off. Not a great quality for EMS professional. What did you think everyone would agree with you? This isn't Mayberry. Now get your butt back here and stick up for yourself and your opinions. Show a little freak'n guts man.

Ruff wrote: Death of same car occupant Passenger compartment intrusion of greater than 20 inches and so forth and so on etc etc. I understand transporting these people to trauma center. Would you fly them without significant or life threatening injuries? This is where assessment comes in. I don't fly hemodynamically stable patients without significant injury. We have that same criteria in our protocols. This is an excerpt: The following should be considered in deciding whether to request air medical transport, but are not automatic or absolute criteria. Mechanism of Injury: Motor Vehicle Crash - High speed MVC - Prolonged extrication > 20 minutes - Fatality within the same vehicle - Ejection from vehicle Pedestrian struck by vehicle and thrown more than 15 feet, or run over by a vehicle. Mechanism alone wont get you flown by me. If mechanism along with significant complaint, noted injury or hemodynamically unstable vital signs, will buy you the bird. I don't concern myself with cost or the political bullshit. If I think its warranted that thats how you go. I haven't had a problem in over ten years. If a flight isn't beneficial to the patient then they don't get one.

Who the hell flies a patient based on mechanism alone? The introduction of seatbelt and airbags allows for the occupant to at times escape even the most serious of crashes. If you cant assess a patient as to injuries they have suffered and base a helicopter ride on MOI alone then thats a problem. People are not severly injured without any signs at all. You may miss interpert them. Thats your fault. The signs do exist and its your job to be able to detect and differentiate them. If your flying based solely on mechanism then you either lack the ability or confidence to be able to detect a life threatning emergency.