mstovall

I was watching Bahgdad ER not long ago and have been wondering how they pick who becomes a flight medic? Are they 68W's? I can't find an MOS that is specific to this. Is there additional trainging that is more selective after AIT? I have scanned through the list and not seen anything that obviously answers my question, though soemthing might be hidden in a post. This is just a curiosity question. Thanks in advance for any answers. Michael

We caught a run for a transport from a doctor's office to the hospital for a direct admit. We were sent priority 4 which means no L&S. Upon arrival we called into dispatch to let them know we were on scene. When we get upstairs to the office, the waiting room is empty except for one excited nurse (Jane Doe RN) calling us to come on back. At the door to the room, we see another nurse (Jill Doe BSN) saying the patient is in here. As I guide the cot down the hallway, I look in the room for a general impression and see a guy slumped over, very cyanotic. I stop helping with the stretcher and lift the guys head to open the airway and he takes a deep breath and starts breathing again. The nurse (Jill Doe BSN) says, "He is just a dope head that was coming in to get off meth and start a methadone scheldule. He didn't want off that bad as he came back high as a kite." I am shocked at this point and don't really know what to say (except a few profanities which I try not to yell out). Then she gets the nerve to ask us if we are going to take that long, that the doctor had a few more patients coming in shortly. All I can think of is that I thought nursing home nurses were bad. How can these people call themselves professionals when they refused to take care of the ABC's. Sorry for the post, but I have needed somewhere to vent my frustration over this call. Michael

My first call was for an unknown medical. The phone was off the hook following a 911 call. LE got there before us and kicked the door in and had the scene secured. An older man had evidently had a heart attack and lost conciousness while dialing. The crew I was orienting with was eating and said, "They better be dead or close to it." Ever since then I have told Julie to just be quiet until we get to the scene. I rode in the back of the truck and couldn't really see where we were going. Arrived at a house that looked familiar. Had tunnel vision and took turns between CPR and bagging the patient while transporting. Kept thinking the guy looked familiar. Upon arrival to the ED, was met by family and realized it was a high school buddies dad we were working on. It kinda hit me hard, but the best thing said to me was by the medic, Jenny, "You know we did everything possible and when God calls you home, you go home." Whether you are religious or not, you will see some people walking away from things that no person should live through and other die from such little things. Just do your best and cause no additional harm. Hope your first night went well. Michael

Here in the big "O" population 60,000 the fire department responds on chest pains, possible CVAs, and MVCs. they always respond two rescue trucks with our ALS. Their theory is that if one is needed for a fire, that one can break off and still give EMS support. They touted a record run volume of approx. 600 calls last year. That was a mere 5% of our emergency run volume. The FD was talking about taking over EMS from the private contractor since it didn't take much of their man power to respond two trucks to these incidents. Then the paper joined in saying that EMS should go to fire. Then the numbers were released in a city council meeting and everything was dropped. FD still responds in the city, but you never know when or where they will show up. If it is a public place they will be there no matter how small the incident, but at the old lady's house around the corner from the station who has fallen from a swing and can't feel her fingers or toes they never show. Ok done griping about our city fire. The county fire is next to spectacular. They have a paramedic on every shift. Usually can beat us to the scene by several minutes. Will cancel us if we are not needed or step us down if needed for transport but is not immediately life threatening. They start the line, board a patient, or anything else that is needed. All of their gear is interchangeable with ours and we just let them get things off our truck and take theirs, no questions asked. They will drive us, loan a paramedic for the ride in, or help in any other way that we may need them. Our county guys deserve so much more than they get. If all fire acted as they did, everyone of us would want fire to run with us. They are the epitome of excellence. i wish I could give them more kudos. Daviess Co. FD Paid/Vol guys save lives with their quick responses. I guess what I am saying is if the dual response is handled right, it can be the best thing for the patient. There are no places for egos or non-professional attitudes. You work together including letting others know if you need to step it up or cancel them so they don't waste a trip, keep LS to a minimal, and develop trust between agencies. This is how it is ran in my town/county. Michael

I heard about a disturbing code and was at the hospital that this neo-nate was brought into. The Crew was sent to a city approximately 2.5 hrs away to transport back a baby that had just had surgery. They had an EMt-B, Paramedic, and Neo-natal doctor on board. The baby coded approximately 35 minutes on the way back. The hospital that they left was a pediatric hospital and next to (three blocks) a level I trauma center. The baby was in respiratory failure. The doctor made the decision to travel the remaining distance code III (lights and sirens) back to the small town hospital, which if I called a level III trauma center may be pushing it. My question is in this situation, shouldn't the decision on whether to turn back be up to the medic? The doctor was not part of medical direction for the service, but was in charge of the baby's care. He also passed a level II trauma center and a place that is in the process of certifying as level II. He also passed three level III hospitals. What is you legal responsibility as a medic on this truck in your eyes? What is the responsibility for the safety of the crew on the EMT that is driving? The good news in the baby is still alive, but the baby was bagged the remaining hour and a half in a truck, code III on an interstate. I would have thought it would have been best to have either stopped or returned to the children's hospital until the child was more stable for transport. Michael

Scar-I thought the first thing you did was take care of immediate life threats....the ABC's. You do this prior to taking a history or focused assessment. Wouldn't fixing all immediate life threats then start with a BLS procedure? Skill-the ability to use one's knowledge effectively and readily in execution or performance. Webster A monkey mimics, it does not use skill. I agree with your description of a PP truck's relationship. Dust-Man you must have some very inept B's around you. I hear where you are coming from, but the mixed trucks work good around hear. I hope your B's could do more than just braun work. We are expected on our trucks to start interventions. We start bagging a patient while the P gets their airway kit ready. We start compressions while the Defib is being readied (maybe only a handful of compressions, but witness DNR arrests at the local teaching hospital has shown that it takes 6 seconds of compressions to get the BP up to facilitate perfusion). We set up lines, put on the O2, and can even help P's find veins on the other arm. While I will agree that a PP truck would be more effective, a good team of PB can handle just about anything. The best thing I think a PP truck has to offer is a mentor relationship for new medics to hone their skills. We are short in our area for paramedics. There is only one service in a 45 mile radius that I know has a fully staffed medic service. That is an area to include 16 services that handle emergency calls. If you have all the medics you can use, then PP trucks are the way to go. The pro's I listed were what I see in my service. While there are drawbacks that you listed, these are the advantages that we have with an PB truck over a BLS only truck. I was trying to answer the question that was originally posted for the pros of a truck that is PB. I can open an airway..............a BLS skill that should be utilized. I can place a simple adjunct....a BLS skill that should be utilized. I can perform chest compressions..........a BLS skill that should be utilized. I can check to see if a person is breathing..........BLS skill. I can control bleeding........BLS skill. These immediate life threats can be taken care of by a B while the medic is getting a line started, getting an airway kit out, reading an ECG strip that might be a little tricky ( I have even seen MD's measure out a strip on some borderline strips), get the narc box out, get drugs primed and ready, etc. I never said that a BP truck was better than a PP truck, but the question was posed as what are some advantages of having a PB truck. The tunnel vision many have in their responses on this board sometimes cause the original question to be left unanswered. Before crapping on someone's response in the future, we should all read the original post and see if the person being crapped on is answering the original post. That may alleviate some of the arrogant attitudes that hinder the original points from being answered. Course then we might have a broader spectrum of ideas floating around which may minimize the self-proclaimed superiority of certain individuals on this board. JMHO, Michael

I work for a service that has a run volume of about 12,000-13,000 clals per year. We are the 911 service provider, yet we are a third party contractor. We run alomost PB trucks. Here are the good things I see about it: 1)The EMT-B is able to get things set up and handle the BLS skills. You be come great at you ABC's. 2)As a PB team you can fill in the scheldule easier as we have a shortage of paramedics in our area. 3)The paramedic is left with the ALS parts of treatment while the basic handles the immediate life threats. Remember we are all EMT's first. We should thus be giving the BLS treatment first. If you don't control the basics, how can you move to your ALS skills. ALS is to handle situations that call for more than a BLS approach, but require a time period to set things up. Sure the person not breathing on the bed may need to be tubed, but what about opening the airway first and maybe try a breath or two while someone is getting the airway kit out. What about a few chest compressions prior to shocking an individual, it takes a while to get the leads on anyway. The one thing that medic school has taught me is how to be a better EMT-B first. While the additional skills help me take better care of a patient, we should all start with our basic skills. I have ridden on some PP trucks and I see a different attitude. There seems to always be the one to be more assertive on every scene. PB trucks are more role oriented. In our town, the B takes some vitals, takes care of transport (getting them to the truck), helps get history from the family/by-standers, and is not afraid to jump in and strat working the ABC's on really bad calls. I think the mixture would be great if the B's chose to hone their skills and care for the patient. If it was allowed to become a issue of "I get more pay than you" then you will self implode. Dusty, I have become a better care giver by practicing in the truck. However, I do agree that my education made me better prepared to give care. Until you get some true emergency back ground under your belt, it is hard to see the big picture. The 12 leads in the field are always a lot noisier than those in the text book. That is what is so great about exceptional preceptors. They take the book knowledge and tie the big picture together. If an individual has only worked granny shuffles started riding a emergency truck, they would then get to finally see how emergency medicine is applied on a daily basis. This is a good idea for every medic student. I don't believe every potential medic student should be on a truck prior to medic school, but I do think it is good to understand the pressures and demands at some point in your schooling. JMHO, Michael

Yeah, we had this lady that kept calling in with chest pains and was "allergic" to nitro. It would give her a headache. Funniest thing about it was, while taking her in one night we noticed she had an elevated ST. Next thing she is unconcious for real.......................Well she got to heart cath in time, I just wonder how many we miss due to the "crying wolf" syndrome. After this may not be so funny, Michael

I like the pepid program also. It is great for drug calculations, especially when you have pedi calcs. to do that you haven't done in a while. I also like the fact that you can get the most up to date drug facts if you do your regular downloads. This is about the only time I use it, but it is a lot handier than trying to thumb through a couple of drug books to check that one calc., especially when it takes the wt. and age into the mix. JMHO, Michael

I think you have run into the problem that will face true accreditation of EMS programs. Since there are very few people that have masters, let alone doctorates in EMS, there are few to meet the requirements set forth by many collegiate accreditation conferences. There is only one such program in all of KY. The theory is that you have a more structured learning environment that will ensure that you receive all the classroom skills needed. The only problem is that the individuals needed to actually get these programs accredited are lacking in numbers. Many MSN's don't have the background either to achieve accreditation. The strongest program around my area is taught through a hospital and is overseen by an ER Doc that is actually into teaching you. the next best program is only open to career FF's. Both programs are extensive hands-on programs and offer a great education. If you want the only accredited program that I know about in KY, you would have to drive about 6 hrs one way. Hope this helps on why the accredited programs are lacking in numbers, even at accredited schools. Michael

There are many different organizations that use search dogs. In our rural county we have four canine officers, 1 state police canine unit, one fish and game, and a neighboring SAR team with k-9 resources. We also have three dogs in training. I have a GSP and my friend has two GSD. The dogs are certified by NASAR, FEMA, USPCA, and several other groups. They also have different jobs. Mine is an air scenter, while my friend and most k-9 officers are trackers. We also have access to cadaver and water search k-9's. I train with the local PD and SO as they want decoys and I need experience and bodies to find. Even trade in my opinion. I do know of a started dog (she needs about another 6-9 mos of hard training) to a SAR individual. She is an air center. This dog is only available to an acitve SAR member, but they do not have to have k-9 experience if they have a training group to participate with. Anyone interested can PM me and I can get you details. Other resources are the rescue dog foundation and FEMA if you are looking for specific results of dog finds, although they are going to be somewhat incomplete. Michael

Then one I use at my ambulance service the most comes from Shooter ........"I've got the feet."

I was told something similar in my class, but a further explanation was given. There is several portions that are advances based on what is being learned in combat. They are saving more lives today than in any other war/conflict I was told. These innovations are now being taught in PHTLS and to a certain degree ITLS. The only problem is the delay in new life saving methods and getting the test updated for national registry. The same problem happen a few years ago when AHA changed the guidelines for treating cardiac emergencies. The problem is not that it is effective, it is that the test has not caught up with the new information. We were further told that if you tested after Sept. you had better answer your questions based on the new information as it is suppose to be fully integrated by then. (disclaimer: This is just what was said in my class and really don't know if it is true or not, but it makes sense as most of the paramedic classes around here are saying the same thing, just different time frames for initiation.) Hope this helps, Michael

My paramedic class medical director is a DO. He is great for trauma and medical assessments. He has helped me in not getting tunnel vision. Now I have only worked under one MD and he was more of a get them here now and treat what you can. The DO is more of learn everything you can if it is not a immediate life threat and then transport. It is more of a different approach to the same end in tactics. The DO though does seem to care more about patient care. In the end though I am not really qualified to give an expert opinion as it is hard when you only have worked under two Medical Directors Michael

Or get the first four years worth from Best Buy...............

After the first attepmt at hiring a bell ringer, the preacher puts another ad in the paper. In comes an identical man as before. When asked, the man states, "that was my twin brother and I have come to see if I can take his place." The Preacher a little nervous agrees. The man again takes off and hits the bell just like his brother. Amazed at him being willing to do this the preacher says if you can ring it 11 more times, the job is yours. On the tenth try, the guy is a little disoriented, misses the bell, and plunges to his death. Again a crowd gathers around and starts asking who this guy was. When the preacher is asked, he simply states, "I don't know, but he is a dead ringer for his brother"

I don't have a problem as long as the route of infection is minimized. How many people are out there that are infected and don't know it? Are we going to require testing of every individual like we do TB test (yearly basis in KY)? Are we going to dictate that services, which are already struggling financially go through the means of testing everyone multiple times a year? Are we going then to award worker's comp claims as individuals have been exposed on ocassion and not know it? While we may think initially that we would want rules, how are we going to actively enforce said rules and what are we going to do in the mean time between test? What about those that have been exposed, are we going to take them off the streets until their test come back? And what about things like HIV that may not be detectable for several years, do we continue to pay individuals to sit on the side line for their window to clase? It would take much then for people to use this to their advantage. While we may wish to do something about this, not only are their legally recousre for infected individuals, but there is just the impractibility of enforcement of the issue. JMHO, Michael

Being that you said you were sitting in for union negotiations, I think you mean that you are bargaining a contract. If this is the case, I suggest getting your hands on as many good contracts prior to sitting down with the company. You need to have an idea what you would like vs. what you are prepared to accept. You need to also not tie yourself down to set raises, instead tie your cost of living raise in with the consumer price index. That way if inflation rises tremendously, you are not locked into a wage that you can't make a living with. The biggest thing I think in negotiations is solidarity. If you do not have it going into negotiations, good luck in getting half of what you want. If you are prepared to stay together, you can get so much more. Don't forget the company must bargain in good faith, but you must also. Ask for the moon, but be prepared to reach just the treetops. If this is your first contract, let me know and I will send you a sample contract you can base one off of. Also be prepared to take a while to get the first contract worked out. Our ambulance service is represented by the Boilermakers. They have a great network in other fields, but they have not giving us the national support to get things done on the local level. They did not do a good job in bargaining. I have filed complaints all the way up to the president of the national and not gotten any response. The local was divided and not willing to stick it out for a good contract. Basically it was a divided we failed. Other places of work we stuck tight and got everything we needed to have a great work environment. Unions are only successful if you stick together. If your workplace won't do this, don't waste your time with an negotiations and start looking for a different place to work. Michael

Boundtree has a great grant writing assistance program. That might be a good place to start. They have helped several local fire depts. get the things they wanted on the first try. There is a cost, but it might be worth the cost not to have to deal with it for several years prior to being awarded a grant. Michael

Here is a link to the response of several local agencies, how they worked together, and the problems that came up. After reading a recent thread on how by-standers cars can inhibit response times, consider the limitations we faced. This is on a web-site and I do believe they have a DVD that can be shipped to you also for educational use. Enjoy. http://www.deaconess.com/body.cfm?id=2127 Michael

I live near a little (and for most of you it is definitely little) ski slope. I go several times each year to here and a few times to the Appalachians to ski. My skis are strong for the local slopes, but poor for the bigger slopes. What I was wondering is if any of you know how to get involved with a class. I have left messages and tried to get info off their web page to no avail. They have sent me info on becoming a ski instructor, but I am not interested in that. I would volunteer my time if I got free lift tags. i also would be available at times throughout the week, as I work shift work. I guess this is a little more of a rant than you could ever help, but what things can I do to position myself to be a better candidate for next year? Michael

Hancock County Ky has a great set up. They make a few more calls than you, around 1500 I have been told. They have an ALS intercept vehicle that is in there central dispatch. The medic will respond to every call. Then, they will do an ALS assessment. If it is an easy BLS run, they go back to station. If it is an ALS run, they jump the truck and a vol. fire will run his chase vehicle to the main station. It works great for them and they would be a good contact for ideas on how to do this. PM me and I will get their info if you want it. Michael

The best service in our area is Scott Township. They are given the equipment to do the job, the support through training to stay well educated, and they have a great support network with the volunteer fire department on runs (I have been told they have 2-5 individuals show up on county (rural) runs and city runs. I have made a call with them during a ride time and they had everything we needed on scene and then some. As I was talking to the guys on the way back in, they said it was always like that when they made runs with Scott. This is in southern IN, just north of Evansville. I also know several extremely good medics that are on a waiting list to work part time there. It is that desirable. EMT's need not apply unless you are with their fire service as they only fill from within I've been told (which gives them very local geographic estute individuals on each truck. They also are a combination service so you get several vols. help out at the scene after you start the initial response. They are small, but they seem to be the best around here I would say. http://scottfire.org/ Michael

Doc, You raise an interesting question. If states license Paramedics (as some states do I am told while others move that way, at least Ky is), would this constitute practicing without a license if it was done on scene? I think it would. What about impersonating emergency response personnel?

yikes