whit72

I also assume when the elevator door opens their will be an elevator there. Maybe some day it wont be there, and technically it will be my fault cause I didn't check to see if it was there before I stepped in. I drive through intersections every day in an ambulance in my vehicle. I can only contol one persons behavior on this planet and that mine. If some knucklehead cant control his behavior, I cant help it or prevent it. No matter how prepared I am. You can take precautions to reduce the chance of being in an accident, you cant eliminate that chance. I wasn't arguing the fact about safe driving in EMS. I was arguing the fact that it was stated that all accidents are avoidable, and the actions of others can be predicted. I don't believe they can. I can do everything possible, and still die in a fiery wreck. Thats just the price you have to pay for living on a planet with 8 billion other people. You can assume that a percentage will not be prepared. Their decisions will effect you, through no fault of your own. If you do choose to stop at green lights at intersections to check if someone is going to blow off the red light be prepared for what is coming from your backside. Cause I am sure there is a chance that someone may run the red light. I can gaurentee that some knuclehead back there putting on her lipstick is going to assume you wont be stopping at the green light.

And how is slowing down at a green light not detrimental. Did I not state in my first post the precautions I take while driving. I was stopped at a red light a few years back and some drunk asshole rearended me doing fifty miles an hour. Is that avoidable? Is that controllable. Me making abrupt movements to avoid him, wouldn't have compounded the situation and caused more chaos, and undue injury to another unsuspecting motorist through NO FAULT of their own. You take those sentiments of every accident is avoidable and stick them where the sun don't shine. You know the truth. I am sure and your vast experience you have never started a sentence with "they were just driving along minding their own business and through no fault of their own, there all dead, or do you stand over their bodies and state every accident is avoidable you should have tried to better predict the actions of others? Sorry you couldn't, sorry your dead. You should have been more aware. Give me an f'n break.

Yes for those who cant detect sarcasm, I was kidding. Hence the first sentence in my following post "In all seriousness."

All accidents are avoidable. You sound like a claims adjuster or management. Have you not spent enough time in this field to know that no one has the control over the actions of others. I see it on a daily basis. People make decisions every day that affect others in a negative way. Its uncontrollable, its the reason why you and I and everyone else on this board has a job. I can only assure that I am doing what I can to ensure my safety and the safety of others. I can hope to be able to predict the actions of others while I am driving. That isn't always possible an never controlable. Akflight wrote: Possessing this kind of mentality is dangerous and does a great diservice to your personal safety as well as your partners, and the people on the road around you. Not as dangerous as believing you have the ability to control the actions of others.

In all seriousness this is a potentially harmful situation and you safety outweighs their need for medical attention. Sometimes decisions have to be made to ensure our safety. My partner and I are going home tonight, in the same condition we arrived. If that decision is detrimental to your health I apologize, however your medical needs don't trump the importance of our safety and my decisions will reflect that.

If law enforcement will not carry out the punishment for assaulting EMS personnel. You have the right to defend yourself its called GBBM treatmend modality. How its written in our protocols is Green bottle behavioral modification. You grasp said green bottle in dominant hand, extend arm, in a fluent motion direct said bottle to posterior of pts cranium. Repeat treatment until desired effect is achieved. Thoroughly clean and disinfect said bottle. This is not a considered a sterile procedure and green bottle can be used to treat more then one pt. Remeber to adhere to all positive protective equipment protocols as this procedure has been proven at times to produce an arterial squirting blood reaction. This is not the desired effect and should not be a deterrent in deciding if this a realistic treatment decision in certain situations. After treatment goals have been met, package pt, and transport to appropriate facility. It treatment is extremely successful level 1 trauma center is a preferable destination however isn't mandatory. This is considered both an ALS and BLS skill, no formal education is needed although at times this procedure can be invasive ALS providers need not be present. No medical control authorization is needed, and documentation of this treatment isn't necessary.

Am I missing something in this article? It never stated if there was a light or a stop sign. I don't stop at green lights in my personal vehicle do you? If he blew the light or a stop sign then its 100% his fault. Which I assume would have been mentioned in the article. Everyone jumps to the conclusion that this must be some whacker with no regard for personal safety, and disregard for traffic laws. I have been hit many time while responding to calls. Thank GOD no serious injuries have resulted. That however is the nature of the job. When you wok in an area where you cant get two miles in traffic without responding, it is a necessary evil. I use my lights and sirens to move people along, to alert them to the presence of an emergency vehicle approaching. I don't drive like a asshole that thinks he has a license to break every law in the book. Accidents happen, they are unavoidable. If this truly was an accident. If he was just knucklehead on a joyride then he has to deal with the consequences. I will reserve my opinion till the full story surfaces, if it does.

I wasn't commenting on my service. When the calls are split ALS to ALS providers and BLS to BLS providers. Nobody stays up all night for the most part. There are exceptions. I agree with you, at the point of 120 hours of training no one is ready or competent to handle anything. Let alone decipher what a pt needs ALS or BLS. Anyone who has been doing this for any amount of time, has a lot more then that, continuing ed, seminars. I have taken so many classes both in the college setting and work related training. I couldn't tell you what I learned in my EMT class. All are helpful. OK except for NIMS I cant speak to the level of all EMTs on this board. I can only speak to the level of myself and the ones I work with. I am required 28 hours of con-ed every two years, last year alone I had one-hundred and forty. So do the math. I wont even get into my whole college fiasco, however its safe to say I will be walking down an aisle sooner then later I hope. Do I jump up and down here stating I have more formal education them most? No. Am I more capapble? No. Why because they have the same amount of training that the state mandates to become an EMT. Does that training suck? Sure in the hands of someone who believes their done learning. I have never argued that point. I cant stop them from being shitty EMTs I can only prevent myself from being one. So think next time you make a comment that stereotypes everyone involved because you have had the misfortune of working with a couple meatheads. If you think eliminating will solve all your problems, I am afraid you are mistaken. The only point I am arguing is, I believe competent EMTs have a place in EMS. I believe that the tiered system is beneficial to all involved. You had a few medics here state they prefer that over the all ALS systems. Do I think you should come out of EMT school and be thrown on an emergency vehicle? No. You should have to prove your competence. Your ability to handle what is asked of you. When I run into an incompetent medic do I berate the whole field, throw generalizations around that medics suck, there education and training sucks? No. because every occupation has its idiots its incompetence, no matter the amount of training or education. You cant eliminate it its a trait in some people. So yes I believe education is important at all levels. If you replace the EMTs you are not going to remove the amount of incompetence you will just shine the light on a whole different set problem. I am really impressed that this discussion stayed somewhat civil. It just goes to show you there is hope for EMS and society in general.

Dust, I think your toothache argument is a stretch, but I get your drift. I would hope most providers BLS or ALS would be able to determine the probability of this being a cardiac event. A toothache alone does not constitue an ALS call. A toothache with other findings of your ASSESSMENT might determine it to be. An ache here or there, nausea, vomiting diaphoresis a cardiac history. Listen I stated many times the benefit of ALS providers. I am not questioning that fact. What I am arguing is the use of them for every call under the sun. Is useless and can be detrimental to the outcome of the pt. that truly needs their services. I will take two competent basics for a sick family member, then two overworked,underpaid, medics that have been up all night rounding up nonsense and frankly don't give a shit at this point and don't tell me it dosent happen often. So both play a role in EMS you can argue all day whos is more important. A competent educated and experienced EMT may not have all the bells and whistles you have, however don't underestimate their ability to do their job in a professional manner.

Dust wrote: What if the toothache or arm pain turns out to be an AMI? And how many ALS providers, would treat this as a cardiac complaint? No wonder medicare is broke. A two-thousand dollar ambulance ride for a toothache. If it walks like a duck and quacks like a duck. Usually it is a duck. Through assesment I could narrow it down and if I believe its cardiac related. You will get a call.

I am going with Ruff on this one, Hypoglycemic secondary to UTI. I am assuming the diaphoresis is caused by the sugar of 20. The temp of 99 orally really dosent concern me. I wouldn't even consider that a low grade temp. O2 high flow, monitor her airway, ALS intercept. So she was hypoglycemic, with a possible UTI, or pneumonia? Am I missing something or do we do this call 1000 times a year.

We are discussing a topic, nothing is personal, you shouldnt take it that way. There are many educational threads on this forum. If we all shared the same views these forums wouldnt be very interesting.

Why do you have titles like lieutenant, captain, corporal. This isn't the freak'n military.

Two and a half hours of unresponsivness before the ambulance was called. Sweet. Vitals? Normal LOC? Diaphoretic?

Batjka wrote" Such as intubations and saline IV's, as well as glucose injections and needle decompressions. Why in the world would you allow a BLS provider to perform a skill that is practised in the field about as many times as Dust agrees with me on a subject. As far as ETI, that is even being questioned at the ALS level, if there isn't enough tubes to go around for the ALS providers what makes you think when the basic has to performed he will be successful? Come on I am advocate for BLS providers in the field however, you cant be serious about these two procedures. The facts of the matter is we are having a hard time proving the that pre-hospital ALS interventions are beneficial to the patient, in certain circumstances. Why would we broaden the scope of practise for the EMT when we cant prove that interventions the ALS provider is practising are beneficial. As far as Dust I love you too. I bet you got beat up a lot when you were growing up I don't question the essential need for ALS providers in the field, never have. To assume one is needed on every truck is sticking your head in the sand. I see how an educated competent medic can improve a pts condition in a certain situation drastically. I have also been witness to the competency of the EMT being able to handle the majority of EMS calls successfully. See the difference, I comment on things I have witnessed or have experienced. I don't make sweeping generalizations about a whole level of provider on the actions of a few. To state I don't have the tools, education,experience, or ability to determine if a pt. requires a intervention I cant provide is bullshit. I understand the capabilities and limitation of my profession. Assessment isn't one of them. I am sorry you haven't had the benefit of working with any competent EMTs. I have also had the pleasure of working with some highly incompetent medics. Good thing for you I don't I don't assign guilt by association. I am sure Dust is a very competent provider, I don't question your capabilities. I don't feel compelled to, I don't judge you or ridicule you. I truly don't care what you opinion of me is, one way or another. I would however enjoy the pleasure of working with you some time. I will reserve my opinions of you till then. See I believe nothing of what I hear and only half of what I see. So although you talk a good game. I am not so sure you could get your self out of a paper bag without assistance until I witness it with my own two eyes. EMS has made me skeptical, so my apologies, I will withhold my opinions of your competency and abilities. As far as the post, I am sorry I go off topic. When 75% to 80% of all EMS calls are BLS. I think the paramedics should be justifying their role in EMS. Not the other way around. . I can handle 7 out of 10 calls on my own. I think my existence is justified. I do believe the EMT needs more education. A&P, chemistry, biology, psychology amongst others. Two semesters would be sufficient, ER rotations and ride time. I had pre-reqs to apply to my EMT class. Why shouldn't they now? We are not educating doctors here, we are educating pre-hospital providers. Recognition is our most important trait. Not how many meds I can push, or tubes I can put in you.

Here is an article. http://pdm.medicine.wisc.edu/20-4%20PDFs/Isenberg.pdf The benefits of ALS in certain situations is immeasurable. I have been witness to these on a daily basis. However the thought that the EMT has out lived his welcome is asinine. Studies have proven time and time again the small percentage of pts that benefit from pre-hospital ALS. There is no reason to have a ALS provider on every ambulance. If you have paramedics available when they are needed that is sufficient. Who do you believe to be the more capable ALS provider: The paramedic that responds to 20 calls a day, 5 maybe which are true ALS where an intervention is warranted. The paramedic that responds to 20 calls a day, All which require an ALS intervention. There is a place in EMS for both the paramedic and the EMT.

Just for shits and giggles if I had to defend myself or my position on a 911 BLS truck it would go something like this: My co workers and I are completely capable, more then competent enought to respond to, treat, recognize the need for a higher level of care, maintain that pt till they arrive and help in the effort to care for and transport that patient. We dont have to justify or defend ourselves to anyone. If you dont think are training or education is sufficient, write a congressman or somthing I dont have to sit here and whine about how I am not respected or included in the real EMS world because I am not a medic, or what I can do to make my medic co-workers more confident in my abilities, my job is not to impress, seek your approval or justify my existence to you. I know the responsabilities, capabilities and limitations of my proffesion. If the pt requires an ALS intercept just make sure you know the responsabilities, capabilities and limitations of yours. If you want to spend our time together evaluating what I have done thats fine. I dont want a crash course in the metabolic process of CHF on the cellular level, or negative effects of high flow oxygen on the copd pt that resides above seal level. Neither does the pt. that cant breath. If I have a question about somthing I will ask you. I dont want to hear why you wish you had this drug or that drug or CPAP or BIPAP or RSI. I wish I had a million dollars. I dont so lets just move on with what we do have. My actions speak loud enough. If we were not competent enought to tend to our duties we would be removed, by our medical director the one with the MD on his coat. The decision to run BLS units was not a financial one. We could be replaced by ALS units tomorrow. However I am sure if you would like to contact them and voice your opinions on what you believe with your vast knowledge and education would be a better way to run the system across the country I am sure they could use a good chuckle. If not concentrate on being the best provider you can be at the level of your choice, find you niche, and do your part at making this proffesion a little better then you found it. Stop bellyaching about what you wish it could be and concern yourselves with making the one we have as capable and efficient as possible. By the way, when you guys do achieve the elite nationwide paramedic only standard, dont forget to inform me so I dont have to set my alarm.

They explained it to me as a rotation of the cervical spine. Where the cervical vertebra lay normally in line, hers looked slipped, they didnt line up correctly, it looked as if it was putting pressure on the spinal column. I was wondering if that could be a congenital issue. Maybe were not getting the complete story as to what happened from the parents. We were waiting on word of her outcome. Usually if there is even a question I immobilize just out of precaution. I do believe we immobilize way to many pts, but we dont have any clearance protocol as of yet.

Its kind of like owning a three-legged dog. You dont love him cause he has three legs, you love him cause he is yours. So stop talking about my three-legged dog. Its a touchy subject

Lady firfighter wrote: Nurse at the hospital questioned us for quite some time about WHY, and did it in front of the patient's parent. Parent commented that they were glad we took the extra precautions, than not. Nurse was irate that we had her on a backboard for a very minor isolated injury. The nurse is a knuclehead. Dont sweat it. Shes probably been a knuclehead long before you came along. She gets a board on mechanism alone. If she dosent need it oh well you just got a little more practise immobilizing someone. No biggie. What if her elbow was not the first to hit the ground? What if she landed on her head going 30mph, still enough energy to smash the elbow as a secondary injury. We just had a two year old fall off a bed maybe 10 inches off the ground. When the crew arrived language barrier, kid acting appropriatley, no neck back point tenderness. No defecit noted No distracting injury. Sitting their playing with a doll. They decide to immobilize on the language barrier alone. Come to find out the kids got a c2, c3 circumflexion (not sure if i am spelling that correctly), and a bleed. Fifteen minutes later she is in a helicopteron on the way to a childrens hospital. Thats probably one in a million. Now that kid wont be sitting in a chair for ever, having someone feed her breakfast. I allways err on the side of caution. HOw often does a kid fall off their bed and it just gets blown off by the parents. Scary.

The thing is you cant deny pt's transportation. We live in a world where everyone is looking for a "get rich quick" way out. So it is safer both health wise and liability wise to just transport. I also dont have very long transport times, so its easy for me to say just get in the truck we will have your stubbed toe looked at in the emergency room, you sally. It is a slippery slope though. If the public was educated on the proper use of the EMS system. Some would wait to long to call, some wouldnt call at all. I much rather take a person now with some shortness of breath then to have them wait till their completely full and not moving any air, to decide its time for an ambulance ride. I am sure the ER would too. So we try not to deter anyone from calling, no matter the complaint. The knucleheads that calls at 3am because they slammed their finger in a door two days ago and now they want an x-ray, are just what you have to deal with. Whatever, its not a big deal everything has its downfalls. Nature of the beast.

Well dust as the self proclaimed director of EMS for EMT city. I stated most EMS systems suck. Not always due to the educational standards. People in general are lazy, miserable, inconsiderate, and really just dont give a shit. This is not soley an EMS problem, but since this is an EMS forum it relates to EMS as well. I believe that is more of a problem with EMS then ALS vs. BLS. As far as education goes,and the level at which you operate in your systems. I have worked in both and prefer the tiered system better. Thats my opinion. I am entitled to it and you to yours. Lets face it I know most would disagree with this however being in EMS for over a decade. 75% of the people I transport need a ride not an EMT never mind a medic. Most of them would fair just fine in a personal vehicle. ALS providers ahould be left to ALS complaints. BLS providers to BLS complaints. It has been proven over and over in studies. You guys like studies. Als providers that for the most part tend to ALS emergencies have far better succes rates when an ALS intervention is warrented. Most here discard those studies because having a medic on every ambulance must equal better care. We are seeing now it dosent. A properly educated and competent BLS provider can handle the majority of calls that arise. When a more educated provider is needed one can be summoned. Of course ever system has its own unique needs, and should be devised to cater to them.

Dust wrote: Whit, you could have just simply said, "my system sucks," and saved yourself three paragraphs of typing. I agree in general most EMS systems suck. However it has nothing to do for the most part with education or training. Usually it has alot to do with the lazy ass atitude of people in general. EMS not withstanding. You are under the assumption that education breeds competence.

Umm......Not every EMT class is 120 hours. That is whats mandated, the class can be more in depth and run much longer then 120 hours. My EMT class was almost four hundred hours, with A&P as a pre-reqs it was longer. The EMT in the state I took my class is comparable to an EMT I. They administer medications and can place airways ETT tubes and such. As far as it being dangerous, at times it can be. Some situations are uncontrollable and the actions of others can not be controlled nor can they be predicted. I know many providers who have been injured, assaulted, shot at, run over. To assume they were injured through fault of their own is asinine, and insulting. As far as not being able to make a living, thats arguable. Many of my co-workers live comfortably. Their not driving Bentleys but their families don't go with out. By the way a top step EMT where I work makes about four-dollars more an hour then a fairly new medic. Medics make only 2.50 an hour more when their both topped out. Their are many career EMTs in my service, we run tiered systems, and no medic truck is more important to the system then the BLS units. These are seasoned providers both ALS and BLS. We both play important roles that keep us very busy. We work together and provide excellent care to the residents of our communities.

Do I get a gun?