firemedic05

My standing orders for the intervention of an Intravenous line cover a pretty broad spectrum of patients and I quote "Make two attempt at IV access if the patient has reported volume loss, signs of shock, has any new mental or physical deficit, has a documented metabolic imbalance, has a new systemic complaint, has new or uncontrolled pain, or has a condition that may require emergency medication." I also know that every hospital in my area, draws blood to do a CBC on most all of the patients. So, they are going to get intravenous access, usually either way. Most nurses are glad that I have started a line because they can in turn, start a salinelok' and get their blood work. I have not in 5 years had to many patients that didn't fall in one of these categories in my standing orders. I know that most medics do nothing for psych evaluation patients but I will always do a blood sugar on a psych patient because they could be Bi-polar or Schizophrenic but be acting strange because their blood sugar is low. That is something that I can correct and stop their brain from starving for sugar. So, have I done ECG, IV, and Glucometer on every patient, probably not but for the most part if I am following my standing orders then most every patient should at least come in with a saline lock. BTW I have found some medics, when they don't think they can get the IV, they will justify that the patient doesn't need one and to that I say don't be lazy, do your job. There has been at least two times or more that I had a perfectly stable patient crash. One had a stroke and one on the printed out strips on scene showed nothing but NSR and had a MI en route. In those two cases, I was glad that I didn't second guess the "need" for Intravenous access. Brad AASP NREMT-P Certified Professional Firefighter

I haven't killed anyone yet in five years of being in EMS. So works for me, maybe not for everyone?

Paramedic Mike You are probably correct that I am annoyed. I can't help but be annoyed when someone is attacking the fire service. I don't like when people make blanket statements of ignorance. Ex: I saw a veteran from Iraq the other day who wasn't injured so the war over there must not be that bad? That is a pretty ridiculous statement, just like "Despite the daring hero image the fire service wants to portray, they don't even rate in the top ten most dangerous professions in America." So, your saying the fire service isn't dangerous? To me that is disrespectful to all the fireman, ecspecialy with the deaths in the fire service this year. I never said it was the most dangerous job. I do say it is a noble one and am proud to be a fireman. So, I apologize to you Dust. Dust, Firemen are my family and my brother is a firefighter and I take offense when attacked. You should never judge a whole group of people from a few bad examples within that group. To explain, getting paid when saying I am volunteer. In my town, we do not have a manned house and set firefighters only a Chief that is full time paid. So, we are called volunteer. Yes, I do make $10 a call but half the time I don't even pick up my check, my brother gives it to me. I don't do it to make money or as a "hobby" as indicated. I am trained as a firefighter and a paramedic, so why not? sure its exciting sometimes but other times it is a hazardous site or a basement fire and its scary as hell. If no one volunteered then yes maybe they would have a paid department but there are times we go a week without a call. So, for my particular little town, our system works and does save money for the taxpayers, of which I am one. I also have never heard of 60-90 day courses for Paramedic and that quite frankly ticks me off. I am paying back student loans for two years of school, so I apologize for saying that isn't true either- I find it hard to believe that is acceptable.

Well, I think you are right Dust. I have enjoyed your responses in other posts and you seem to know a lot. I do think you act like a bully on any given subject. I personally think being a Prick another way of saying bully is easy.The best teachers, firefighters, medics that I have ever encountered had humility and will tell you I don't know everything. Sorry, if I wasn't one of the compliant people that can only bow down to your opinion. There are two things I can't stand and that is Apathy and Arrogance. To me you fit in the arrogance category. I don't know of any fire departments that are allowing people to become medics in ninety days, ecspecially in my state with National Registry? That may be true but if it is I haven't heared of it and I do get out. I appreciate heated debate like the next guy and love being the devil's advocate myself because it brings out the passion in people but just to shoot down every thread that is put up, what is the point? BTW I am a firefighter on volunteer basis in my own town because if I don't do it then who will? Its just that simple.

Dust wrote: Oh, it absolutely will happen. There is no way that fire departments will want to have anything to do with EMS once their people are required to have a two year college diploma in order to work. Firemonkeys love EMS right now because it is something they can punish their rookies with. But once those guys have considerably more education than the fire officers, they won't want them around. But you miss the point of the article anyhow. This isn't about fire losing EMS. This is about fire losing fire! And don't get too caught up in your own hype about "dying for $10 dollars." Despite the daring hero image the fire service wants to portray, they don't even rate in the top ten most dangerous professions in America. And if you took EMS deaths out of the fire service statistics, their rating would drop even lower. Most Paramedics at Fire Departments have went through two years of school, me personally I have an Associates of Applied Science in Paramedic. So, to say "Oh, it absolutely will happen. There is no way that fire departments will want to have anything to do with EMS once their people are required to have a two year college diploma in order to work." is not relevant. You seem to say all Fire Departments do not have Paramedics that have had two years of schooling, when this statement is incorrect. How exactly is fire going to lose fire? Are you saying there won't be any fire departments anymore? Are there not going to be any need for fireman? This kind of mentality is ridiculous! You may not like the fact that fire is in EMS but there will always be a need for fireman. To try to put down the fire side to say that the EMS side is better really shows the ignorance and strife between the various assests of EMS. It would be like me putting down a flight medic because they make me insecure. Get over it! And for your information, I am not hyped about losing my life for $10 but it IS a reality. I wasn't trying to puff myself up like your portraying. Just simply stating a fact that is true, that at my volunteer fire department if Iwere killed, it would be for a $10 call. One would hope that if I used my training and safety procedures in place that it won't happen.

You are right Lone, not every one is making bank. What I am referring to is St. Louis County Fire Departents, who can make anywhere from $50k to $90k a year and many more benefits. They are being looked into by tax payers. I am like you, Lone, $10 a call on volunteer fire department, in other words, I could lose my life for $10.

Fire Departments losing EMS will NEVER happen. I am sorry to say that Fire was here first, way back when funeral homes were picking up patients for business. The reason that fire gets all the money over EMS is because, there are not enough lobbyist for EMS. For that reason, Fire will stay strong, its simple politics. This is not my personal view, for I work on a private ambulance and am not on a paid fire dept.. I just know the facts, it would be like trying to take Medicaid away, once you gave in to it - it will be next to impossible to reverse. I know around Missouri, they are cutting funds at Fire Departments because tax payers have found out the ridiculous amount of money they were making. The Fire Department could fall like big tobacco but I believe they are more like Alcohol, everyone knows its wrong but to much political clout.

Why not? What does it hurt?

I have encountered the "You think you're better than me because you are a medic" from the EMT B's and quite frankly it gets tiresome. I like, ak, was the "greatest EMT B the world has ever known", till I went through medic school and realized the huge leap from basic to paramedic. I like ak, also, have karma haunting me. I feel quite shameful of my cockiness and ignorance, now looking back. I have tried to reason with the EMT B, that I am currently working with but he takes every comment as a personal attack. Now, I am to the point of just telling him Get over it! I am tired of stroking your ego. I have told him, as smart as you are, why don't you sign up for Paramedic classes. Suprise, he doesn't want to take that responsibility on. I have worked with some lazy medics but also have never had a major conflict with one. I did have a new medic that used cold fluids and I told him to put them on the heater, of which he declined. The patient began to seize in the ER - coincidence ??? I do believe, though, he has learned a valuable lesson. I am also one who likes to D-stick, IV, and ECG on every patient. My core reason began out of being a scared sh*tless medic to having found on more than one occasion, more than one medical problem occuring at one time. Dust, I do think it is a shame, when you are being kept busy roping in a EMT B, when you should be totally focused on your patient care. Unforunately, we can't keep medics so EMT Bs is what you get.

Dust Devil hit the nail on the head. Nice response. I totally agree, I had students signing up for my shift due to me "being a nice guy". I am a nice guy but when I was presented with utterly incompetent students, I wasn't so nice anymore. I asked to have my name taken off the preceptor list because I realized that I do have a hard time explaining Why I do the things I do, sometimes. How do you explain things like: ex. why you like a certain music over another or why your favorite color is _____? I am trained like everyone else but use my gut instinct a lot and don't know how to instill that into others. Not everyone, automatically has common sense. I would like to teach and instruct but till I find a way to handle questions from students like " Do you think this person is going to die" in ambulance with patient listening or the student who told the motorcross patient " I guess this is a career ender, hugh?" while chuckling; I will have to work on my patience and self-control. To me the ultimate answer to your question will come when you finish medic school and have a few students yourself. Then you might see the other side of the coin, so to speak.

You might be an EMT or Fireman if you know more about the stories on the news at 5:00 than most the reporters reporting on them. You might be an EMT or Fireman if you have dreams, at night, of multiple traumas and not consider them nightmares.

One of the hardest concepts I had to tie my head around in medic school was not Pharmacology or Cardiology. It was that we don't diagnose but yet we have to diagnose in order to have a treatment plan. No medic would have this patient and come to the ER and tell the Doc this patient is having a dissecting Aortic aneurysm, they might say he/she is presenting with symptoms that mimic a AAA or dissecting aa and it needs to be ruled out. So, till we develop Xray vision, we are in essence guestimating what is wrong with the patient but using signs and symptoms to help. The main thing that I took from the case study is that the medic got the patient to the ER with a pulse. I and others, always want to expand our knowledge base but to get hung up on specific diagnosis is "futile". I had to find this out the hard way in the field. When I had a low blood sugar, decided to drive into tree but also decided to stroke and have a MI all at the same time. I looked at the Glucometer, the ECG, the Left sided facial drooping, had to trauma package --> I have to admit I was a little overwhelmed mentally. In the end, ABC's, spinal immobilization, treat shock, and the patient lived. No, pat on my back, the only thing I know I did right was turning a wheel and getting the patient to definitive care. So, in essence, what I am saying is it sounds like the treatment was appropriate and the learning the diagnosis let's the medic put it into his mental cue cards but next time it could be AAA. So suspicion was correct and best route if you ask me. Lovely debate and enjoy learning but no one is going to be correct all the time. Treat the patient, not the machines -->old saying but true.

Richard B - don't you love that its like the credit game - you need credit to get credit. My service has 911 contracts with certain municipalities but in general I don't think I get any credit for that because we also do transfers, vent calls, and the nursing home circuit. You would think they would want to hire someone who at least has a vague concept of the EMS system anything from how to talk on the radio or incident command, than the boss's nephew but everyday they hire the guy who has connections. Quite sad and to me they get what they deserve, when that guy shames their department or quits after lots of training.

I was just wanting to probe a touchy subject about the hiring processes of some EMS or Fire depts.. I am not talking about the places that will hire you if you have a wet inked license and a pulse (optional). I am talking after you are in EMS for a while (2 - 3 years or more), and you try to advance to a more elite working environment. I have found that due to not being willing to go drink till all hours at the local EMS hangout, that I am by default considered a snob or pretentious. What I want to tell people but presents uncomfortable, is that I have went through Alcoholics Anonymous and can't be in that environment anymore. I have made many contacts through several years of working in EMS and am by no way an ignorant or mean person. However, I have seen people hired in front of me due to everything from being the Chiefs neighbor to people that hang out at the union hall and drink all night. I have nothing against people who drink, I used to enjoy it, just a little too much. Has anyone else had a situation where it was hard to get hired, no matter how well you did on the testings? I know you have to market yourself but I can not market myself by hanging out in a bar.

What you are not understanding is they are probably "getting drunk" every day of the year. This day their house just so happened to burn at the same time.

Why is it that nurses are so ignorant to EMT's. Do they think we wander the streets to bring them in, just to ruin their coffee break?

I recently had an instance where a Paramedic student basically I felt was flirting with a drunk patient. She told me that she used to be a bartender and she could handle herself. I told her from my experience that you have to maintain a professional distance because if you go to far it will backfire on you. She became defensive but I know that this is right.

Per my standing orders, I try once on scene, if stable. Once en route and call for third attempts. When I first was working as a medic, I would really upset myself over a missed IV. Ecspecially when they really needed it shock, hypotension, hypoglycemia but as you go along you realize there are more important modalities sometimes. Airway, Breathing and to worry yourself can lead to second guessing, etc. To me the number one thing to do (my medical director agrees) is to turn a wheel. So many waste time on scene that counts. If you have an airway by simple maneuvers and got there in two minutes the doctor will not give you hell over an IV and if they do, tell them that you didn't want to waste time on scene when you could get the patient to definitive care.