captainstandup

I just don't understand how the homosexual folks have the energy to raise hell about everything. Much like the revisionist historians they hope to create a new world of "equality". I submit that equality isn't the goal instead they ride the equality and disenfranchised train as far as it will go then fall on their swords (no pun intended) crying "poor pitiful gay me" They didn't hire me because I'm gay, they didn't promote me because I'm gay, they wrote me up because I'm gay and on and on............... If the homosexuals want to be treated fairly they should skip a few protest marches or sit ins and just do their part in society without making a big noise about it. This may come as a huge suprise to you but we DONT CARE about who you lay down with! We do care about your being to work on time, prepared to provide good customer service and to follow the policies that everyone else follows.

There is more to life than sitting around worrying about about how long it will take an ambulance to get to where you are. I have two kids and wouldn't dare consider moving nearer to a city. I realize response times are very important but the trade-off is often unacceptable. Why give up the beautiful places in the country in favor of getting an ambulance in 5 minutes when you have to live in fear of some jackass killing your kids. Robbery, gangs, drugs noise, filth present risks to your health too. We live in a rural area approx 40 miles from a small city and about 90 miles from a metropolitan area. Our county is roughly 550 square miles of mostly mountainous terrain. A great deal of national park land is in our county. The local EMS has 6 paramedic units and their average response time to 90% of the county is 6min 11 sec. There are, like a previous contributor mentioned, areas of our county that take over an hour to get to. As you would imagine there not many residents living in those areas. My point in all this, and I should have made it earlier, is that to apply a negative connotation to "rural EMS" isn't fair or accurate. The men and women in our EMS system are among the best trained clinicians in America. They are uniquely qualified to care for patients in an extended fashion and are quite successful in doing so.

RidRyder is spot on; on this one. I too don't believe homosexuality to be OK. From a religous perspective I disagree with the practice. From a political perspective I want to vomit each time I hear the liberal scumbag politicians pander to the "gay vote" From a personal perspective it troubles me greatly to be force fed the gay agenda by pretty much everyone in Hollywood. Im fed up with the gay pride marches and the poor pitiful gay me folks featured on talk shows and the nightly news. I don't give a damn who or what you lay down with at night, I just don't want to hear about it. It's not my fault the gay folks are "oppressed" and downtrodden. By the same token I don't care who you marry. For those with a frontal lobe I submit the entire gay marriage issue is about money. ITS ABOUT MONEY!!!!!!!!!! The very folks that hang out with you at your theme clubs, the insurance company execs that donate to every gay friendly cause known, the hospital officials that portray themselves as open minded are the ones stabbing you in the back. They realize that by allowing same sex partnerships they will be adding thousands of "dependants" to coverage and from a cost perspective this amounts to hundreds of millions of dollars annually. From a human perspective, noone should be able to treat homosexuals unfairly regardless of ones personal convictions on the matter we are a civilized society and as such everyone deserves respect until they no longer deserve it

The small virtually unnoticeable tatoo you described will likely be no big deal, but who knows? In my former life I was in administration and tried to remain as as open minded as possible. I must admit that myself and the entire admin staff would have been likely to have a negative perception of someone with "inappropriately placed" tatoos or those with content that opposed social norms. There is no way in hell we would have hired someone with facial tattoos or those that would have cast the agency in a negative light. I realize this may seem old school but I assure you there are sorely few professionals in health care management that will perceive "overdone" tatoos as a positive attribute. This isn't to imply you don't have a "right" to freedom of expression, just remember the powers that be also have a right to hire or promote someone else. In a service industry such as ours we have to remember that customer perception of quality is often based more on our appearance, demeanor and kindness, than clinical ability. Finally, who wants someone looking like Marilyn Manson taking care of their grandmother?

I agree with several others that checking for dilation is unnecessary in the field. Visual inspection and frequent reassessment of a patient with impending delivery is indicated. I agree with Rid that this "skill" would be fraught with error and I just don't see where it would be helpful. In treating OB patients with potential for field delivery we are going to break out the OB kit (God Forbid!), increase the temp in the unit to match that of hell's front porch and simply take care of mom while frequently reassessing. Man I hate OB Calls...................................

Did the folks that didn't want a specific Paramedic follow the steps to report the behavior that caused the animosity? Did they communicate with management about the crew member in writing? Fellow providers and the public can bitch about a myriad of things but until someone has the wherewithal to step up and address the situation in writing forget about it. Furthermore, how on earth would it be possible to allow anyone to be selective regarding the Paramedic or EMT since it is entirely possible that a person could be injured or become ill anywhere in the community? If there is a problem crew member it must be documented to provide management with the necessary data to cure the problem.

We are in fact on exactly the same page Dust, It nauseates me to see whats happening in the realm of "education" and thats certainly using that word loosely. I was referring to the rush to get them through school and on the truck with no consideration of knowledge or skill level and for damn sure no clinical judgment. Capt.

I would be curious if he has been in a really hot environment that led to sodium or potassium depletion. Beyond that exposure to spider bites or envenomation by a "creepy crawly" vector. Overuse of antacids or ASA or taking prescription meds not prescribed to him. I think pretty much else has been covered.........

I wonder how much of this problem lies in the educational system and how much lies in the fact that there exists an incredible shortage of Paramedics in the US? Many administrators I know are just happy to have a "warm body with a patch, and a pulse" on the truck as opposed to seeking quality professionals. A nearby county consistently operates with two or three units sitting unmanned due to staffing issues. The result of this has been to try fast tracking personnel from uncertified to paramedic in the fastest possible manner. One service has even taken the extraordinary step of advertising for persons interested in an EMS career, then teaching an EMT to Paramedic course in-house. The students are paid while in class provided they sign a contract to work for the agency for a period of time after becoming certified. I believe this is simply a symptom of a much broader problem in the EMS world that is multidimensional. 1)Pay 2)Danger vs Pay 3)Lack of advancement opportunity 4)Lack of respect from the health care community and on and on and on. Our industry has really only been an industry since roughly 1966 and we are neck deep in an identity crisis. Apart from airway, oxygen, epi in anaphylaxis, defibrillation and to an extent C-spine stabilization. there is really no SCIENTIFIC EVIDENCE proving that what we do is beneficial when compared to simply taking patients to the hospital. Before someone jumps on me about hemorrhage control, every civilian I know has enough sense to apply direct pressure. I really don't have the answers, but I assure you rushing people from EMT to Paramedic is not the answer. Whoring out the profession for the sake of staffing with no chance for students to develop precious clinical judgment and a "feel" for emergency services cheats the student, and cheats the patients out of the care they deserve. This is another chip out of our very foundation. How long before we become irrelevant as other disciplines take over our role?

One of the earlier posts had already mentioned the most important consideration for this patient is stability. Is the patient having chest pain, shortness of breath, pulmonary edema and the most importantly what is the patients LOC? If the LOC is normal the brain is being perfused and the patients condition is likely stable for the moment. As I eluded to in my earlier post in this thread, the specific cause for an aberrant BP is quite complex and can include poor heart valve function secondary to stenosis, a condition known as left ventricular hypertrophy, akinetic heart tissue in a specific portion of the heart following an MI. Anyway, most of this stuff is related to in hospital care and clearly requires a cath lab, echo and lab studies to diagnose. Having a high index of suspicion regarding potential for decompensation is crucial. This patient may only require BLS care during transport, but being prepared for the worst is always prudent. This is especially true when you have unusual vital signs or simply a "feeling" that something is wrong. I think it speaks highly of your your quality as a prehospital provider that you did not simply overlook or "blow off" this unusual blood pressure reading. I have two favorite sayings, 1)Chance favors the prepared mind 2)True knowledge lies in "knowing the why". Good job and keep on asking "the why"

Physiologically impossible to have a diaastolic BP of Zero. The coronary arteries are perfused during diastole. No coronary artery perfusion and the heart checks dies. Given the vitals of 142/36 and a heart rate of 56 I would be curious of a few things. 1)Does anyone know what the patients normal pressure and heart rate is? 2)What medications is the patient on, specifically beta blockers? 3) Is the patient on digoxin? 4) Is the patient on calan or verapamil and another biggie would be Tricyclic antidepressant meds? Depending on the patients physical build they could be quite dehydrated and if on "rate control" meds unable to speed the heart up. If both systolic and diastolic increaseldby 30 mmhg it it wouldn't result in an abnormal bp per se

There is virtually no HIPAA protection regarding information necessary to dispatch and respond to a call for assistance. Dispatchers are at full liberty to give a description of the chief complaint, your name and address when dispatching calls. The spirit of HIPAA is not to punish those trying to help you, its to prevent the intentional release for personal gain and or in an attempt to harm someone through the release of information,

http://www.mgh.org/mqtems/administative_Rules.pdf The real question is what is the National Standard regarding dispatch? I submit that in 98% of the country the closest unit is to be sent. This issue will be self correcting when you guys become aware of a death or worsened condition due to the closest unit having not been sent. Lawyers get involved then the County or City Council Members, County Manager, Comm Center Manager, Admin of the improperly dispatched agency, Crew that responded, and certainly the dispatcher(s) involved will be among those named in a massive civil lawsuit. Even if they aren't found responsible the cost of litigation for the government and the cost to the individuals involved could be incredible. Scanners and word of mouth go a long way toward providing oversight in a foolish situation such as the one you have described. Remember although not related to the topic, the murder formerly known as O.J. Simpson was found criminally innocent yet a civil jury found him at fault to the tune of $30 + million illustrating the power of a civil jury.

I forgot to mention the paid / volunteer combo departments. This is often a bridge to going paid for many agencies and perhaps an improvement over all volunteer. As I stated in my earlier post I really feel this is an issue of 1) Response times 2) Consistency of care combined with skill level and training. All things being equal, and I submit they rarely are, there should be no difference regarding the sole issue of pay vs. volunteer. Furthermore, if you were trapped in a burning house would you rather wait for the volunteer folks to go to the station to pick up the fire truck or would you prefer they simply get into the engine and immediately respond to help you? Finally, as to the issue of tax increase, you would be surprised as to what a community is willing to fund if you do the groundwork. Your community isn't going to miraculously up and say here is a check. It requires time, commitment and a willingness to get into the slimy business of politics to one extent or another, but I assure you high quality public service is expected by your community regardless of their place on a map.

You are exactly right spenac I overreacted. I absolutely love this EMT City thing! Ill do better in the future.

Hypothetical situation: A) Your non EMS family members who live four miles from the nearest rescue / fire station are eating dinner when one becomes unresponsive and pulseless. 911 is called and they wait for help. Volunteer squad members rush to their building to retrieve a vehicle with defibrillator then rush to the scene. Elapsed time likely to be 8 to 15 minutes in the best of circumstances. B)Your non EMS family members who live four miles from the nearest rescue / fire station are eating dinner when one becomes unresponsive and pulseless. Crew on duty gets call for service, gets in the ambulance drives to the scene defibrillates the patient. Elapsed time 5 1/2 minutes. This could be altered to be a fire call or any other emergency situation. It is generally accepted that a person in V-Fib or pulseless V-tach has a reduction in survivability of roughly 10% per minute until defibrillation is delivered. (10 min = 100% dead) Furthermore it is generally accepted that a person in respiratory arrest has approx 6 min in the best case before irreversible brain damage / brain death occurs. I haven't mentioned anything about paid or non-paid up to this point. I believe that in America most volunteer services consist of unmanned stations. This is no fault of their own, its simply the nature of being a volunteer service. Volunteer services rely on the goodness of their personnel to donate precious time away from family to provide a service to the community. It would be asking a great deal from a volunteer to consistently donate 12 consecutive hours during the week when they have already worked 40 or more hours on their job. This is especially hard on those with small children or elderly parents needing assistance. Furthermore it would be virtually impossible to staff the agency on weekday days as this is when most volunteer folks work on their jobs. Training and experience are also issues worthy of discussion. Paid personnel are often more available to attend training and inservice opportunities and simply by nature of their being paid to be on duty 2080 hours per year or more they have many more opportunities to practice skills than the volunteer provider. Furthermore administration can more effectively require compliance to training policies when it pertains to the individuals livelihood. I personally know volunteers who are among the best prehospital providers in the nation, but these folks are dedicated beyond the norm. The sacrifices they make in order to remain current on ALS topics and skills are very high, sometimes at a huge cost to their families. On the other hand I also personally know paid providers who are lazy and consistently do the very minimum to keep their job. These folks treat trade journals and text books like superman reacting to kryptonite and must be forced to attend training sessions. These are among the worst pre-hospital folks, choosing reruns of south park or sleeping in a recliner at base over a learning opportunity. Finally, and i'm sure you are glad I arrived at finally, I don't believe professionalism and ability are entirely related to whether a person is paid or not. I believe if we are going to continue relying on volunteers in America they must be available to respond immediately from the station and must be held to the same standards of the best paid personnel. As for the worst paid personnel, they have a way of thinning themselves out over time and are hopefully replaced by higher quality providers.

I must have stepped on spenact toes or hit a bit to close to home for him / her. First off I seriously doubt you have the education, training or experience to imply that I am a moron. Furthermore if you would pay attention to the profile you would have noticed that I am a newbie to EMT City therefore unaware of the fact this subject has been beat to death on here. Finally, if I said something that offended you I certainly didn't intend to but its kind of like a television show or radio program that offends a person. If you don't like the content change the damned station.

How many of you are allowing the patient to be transported in "hobble restraints" or "hog tied" in a face down position?

Anyone notice an inherently backstabbing nature to the EMS industry? I have worked in a variety of other arenas and have never witnessed the degree of faultfinding, hateful, slimy one "upsmanship" than in EMS. I haven't personally been a victim of this however I have witnessed a multitude of examples of EMTS and Paramedics living to cut another's throat. My experience has been that many pre-hospital providers seek to second guess, monday morning quarterback and critique the work of others even given the fact they were not responsible for doing so. Is it just me or are affairs and cheating more common in public service than other jobs?. I am curious if anyone has similar opinions and if so why this phenomenon seems more pervasive in EMS than other professions. Ill offer a theory to get this started. Perhaps the psychological makeup that enables humans to witness the worst life has to offer comes with these other characteristics. I KNOW, NOT ALL PREHOSPITAL FOLKS ARE LIKE THIS BUT I ALSO KNOW WHAT I HAVE WITNESSED OVER 16 YEARS IN EMS.

Thats a really insightful description of EMS. How long has it really been not much more than a club? So how can an industry fraught with a multitude of dangers (infectious diseases, back injuries, the risk of being killed by stupid ass motorists talking on the cellphone and crashing into our accident scene, low pay and lack or respect from pretty much everyone you deal with and finally virtually no conceivable hope of any meaningful advancement) attract and retain quality individuals? Beats me

Fire folks would do well to investigate the history of the effects on fire protection when they decide to get into the EMS business. One common occurrence when fire gets into EMS is that city, county, parrish, commonwealth bean counters typically screw the fire service in favor of supplying, equiping and staffing the revenue producing EMS. This isnt to imply the activtes of fire or ems are of more importance than the other.

Problem is there is no formal way to gain this respect. Like most of the folks that have responded to this thread I have a veritable alphabet after my name with exception of the sacred RN. Perhaps one day RP will mean something too......until then I suppose we will remain ambulance drivers and will be paid as such.

Since I started this post my greatest fear was that someone would bring up the point of your last post ridryder 911. To this I have no meaningful response. I don't want us to be licensed or registered just because the nurses are, but I really wish we could somehow gain the recognition they enjoy regardless of their skill level or clinical ability; or lack thereof.

Excellent point Ridryder 911. Perhaps this whole national "scope of practice" has blinded us to the fact that prehopsital therapies offered in metropolitan areas may not be the best therapies to offer in rural mountains and vice versa. Your point regarding geography etc is right on and especially considering transport times, community demographics and common disease patterns.

By the way what is a "Nexis"