mstovall

code red G - immediate danger to all on scene gun involved code red K - " " " " " " knife " code yellow - verbal threats and escalation of tension on scene, send help immediately code green - need LE on scene, no immediate danger, usually used for drunks, druggies, and mentally challenged

I told him not to press the button............

Unions are suppose to make places of employment better. In a recent article I was reading (can't remember if it was EMS or JEMS) I remember that there was a high level of organized shops in fire-based EMS and little in comparison at other EMS-based operations (hospitals and third-party). We are a third party service and I hate to say it, but the union has done little to improve conditions. They have gotten a few extra days of vacation, but we have no sick leave, pay is lower than prevailing wage, and very little involvement in policy making. They do provide a lot of training which our company refuses to do, enough to keep your medic certs. Are associations or unions ever going to create enough pressure to improve things such as pay, retirement, and working conditions? Will we in EMS ever unite to cause change such as the teachers associations (mainly the NEA)? What other methods can we utilize to create a better work environment? Another recent post stated that only a handful of employees at one service were up to improving things. Is there even enough will in EMS to make our lives better? Are unions popular in other countries outside of the USA? Have they helped to improve conditions? Michael

The Molly Mcguires actually started in Ireland among the Catholic tenant farmers. They moved as the descendants to the PA mountains. They kept their organization in tact til in the late 1700's early 1800's they started popping up in the mines, organizing strikes, and trying to improve working conditions. The history channel had it close, but there are several more books on the Labor Movement that better tell the tale of woes these guys face. Long work days, inadequate equipment, lack of life sustaining pay, hazardous duties, lack of leadership in management, and inability to have a retirement option (basically you worked til you died). Man this is starting to sound like EMS. I will make a new thread for this, as I think this could develop into a good discussion.

This isn't really funny, but does anyone know where the term "red neck" originated from. It was from the Molly McGuires who was the fore runner of the United Mine Workers of America. It seems like the standard issue from the general store (aka loan shark shop) was blue. The McGuire's used the red handkerchief instead. This allowed them to know who the rats where underground and who was safe to talk around. They were more than a little rough, border lining on what would now be considered terrorism. They would where the neck scarf as a form of filtration mask underground so you can see how it would be hard sometimes to know who was working in the dim lights nearby and knowing their nature of business, how they wouldn't want company men to know what they were saying. FYI, Michael

try this out http://www.lmpd.com/arcade/index.php?actio...amp;gameid=1178

To answer the original question of how best to handle coming off a shift like this is to catch a two hour nap as soon as you get home (no longer than 4 hours). Then get up and carry on with a normal off duty day and go to bed about 2 hours prior to normal and resting then for atleast 8 hours. This is suppose to give you maximum recovery. I use this tactic often and it works good for me. If you have an EAP, try talking to them and see if they can provide some other alternatives. As for sleeping at a place that won't let you sleep (policy manual or direct order), just rember one word if you are caught "Amen!" Michael

What about this? About a month into my class (currently taking it and just finished Pharm with 95.5% kudos to me even if I say so myself), we are doing KED skill check offs. A guy was doing his on this girl and then she gets real red like. He checks his PMS and then says he can't find her pulse in either arm. She starts sweating real bad and then says she feels her heart fluttering. Sent to the ED from one of the ambulances from the station we are taking the class at. Then last week we ate at Arby's prior to the 45 min. drive to class. 5 minutes away I'm begging to pull over and puking my guts up. Touch of food poisoning I guess as I puked about 4 more times. Go in, stick a tube, hang an IV, do an IO, get checked off of skills, go back out and puke some more. I don't buy anyone who says they don't have time to study. I am working two jobs, 70-80 hours a week. I do my homework next to my kid or right before bed. I may only be getting 6 hours of sleep, but that is the commitment I made. I have cancelled cable, and log onto EMTcity only during study breaks, but I know it will pay off in the end. I have gotten some help from some of the medics around and that has helped greatly. The best things I have learned have been from a medic on the truck when I ask for the help I need. They have all been there and most will help you get there, although you do have to ask. I really like the quizzes while working a patient. The medic I work with mainly will let me verbalize through what I would do, but then go something like "nah lets get a monitor on first," or "let's get this line first then I can help." We discuss the why's after the call during the run report time or en route to a our next run if time permits, but he will always make sure we go over it after the shift is over if we haven't had an opportunity to do it. There is tons of experience and help around you, but you have to ask for it. Sometimes they legitimately can't help you, but there usually are more than one around to help. ER docs and MD's are also good assets to use. They especially like to shape the minds of those that will be working with them/ for them later. And also don't forget the nurses. helping out with that bed pan sometimes will open a very educating door. Don't be afraid to get your hands dirty as payment for a little extra help. Enough raving, got airway final on tues. and work 48-54 hours between now and then. good luck to all who are testing. My biggest thing is studying the objectives and then worrying about the rest. It seems if I can answer all of them, I do fine on the test. Thanks to all that have helped me if you are on this board under an alias. Michael

I'm offended that you would equate my joke with this one. Everyone knows that Orthodox Alligators are not bent on converting everyone to carnivorism or killing them (course they do believe you should pay a tax if you want to be a vegetarian to live in their carnivoristic society). Michael

In a Maxim article a few years ago they mentioned the EMS segway. Check it out. It is in use overseas in Europe. http://www.defrance.org/artman/publish/article_1205.shtml Michael

I do the following; note where theme base neighborhoods are note street/ave layouts for your city (may change with lay of the land) know streets of high calls first (NH, bars, parks, etc.) and directional lineation streets (N vs S and E vs W) as stated in different posts above. I also would like to add that most cities have a numbering system that is the same. In ours it is even numbers on east/north side and odd on west/south side for the most part. I also have learned which streets are on the big divisions of numerics 500, 1000, 1500 etc. Then learn if they are through all the way or where they are broken up. This allows me to know that if I get a call at 1800 (a major street) I am going to be on Griffith Ave for the west half of the city. Then I can look for the name of the street as we intercept of my partner finds it in the book. This focus the streets you need to know to ones that you will navigate most. Learn the numerical division of your major streets. Is Main street on a 300 level division or an 1800 level. Is Cedar Ave 800 or 1000. This is the only things I would add to what others had mentioned. Michael

In many rural areas, if you want ALS intercept, it is the off duty paramedic that is jumping aboard. These off duty paramedics are all members of the volunteer departments. There are 4 medics out of the 20 that are volunteer medics in their areas. They can get there in under 10 minutes and it takes us 15-20 minutes. Our medical director gets many cudos. He will allow you to shadow him any time in the ER that you want to. He teaches CE classes, especially if he has changed a protocol. I haven't seen it personally, but they say that he even rides from time to time to see how things are going (and acts as a gopher at that, which means he knows about things on the truck). If you do something that can be improved on, he will not only tell you what to do to improve, he will show you how to do it and explain why to do things differently. He is approachable on professional level as well as on personal problems. He will know your name within weeks of hire (and that is for all the paid crews, city and county, volunteer crews, and ambulance service. That's about 400 +/- individuals that he may onlysee once in a 6 month place). I feel very lucky to have him as a medical director.

We have our problems with NHs also. Like today we (a BLS truck) was dispatched on a "schelduled call" for a transport for a direct admit. The patient was schelduled for 2 units of blood. Get patient in the back of the truck and when she is asked about hurting anywhere, she says she has had this chest pain all morning and nobody is listening to her. Arrived at ER in less than 2 minutes. They diagnoes STEMI and had her in cath lab within an hour of us getting her there. That being said, I have found one thing that has made my life at NHs a lot better. It has taken me about 9 mos, but now I get, "hey I'll be right there to help, I'm printing off a face sheet for you and be there to help you move X to the cot if you would like." Pray tell what is this secret I have discovered..............................I point out the vitals I have taken on every patient I bring back to them. This lets them know A) I care about the patient I have. I know you are busy and if you want the vitals I took less than 5 minutes ago for your records, here they are. C) We are part of a team. Karma is rampant...........What you do to others will come back to you. Maybe if we show others we care about X in the NH, they will catch a little bit of it. I take a few seconds and say hi to those I know I have transported that are in the halls. I will give the little old person a short wheel chair ride to clear a congested area (always moving them in the direction they were headed unless it is out the door). i hope someone might take the time for me later in life. I also like the relationships I have built in the different homes. Like the person posting above..........maybe we should look at how we are acting versus how others are acting. Michael

At work today I heard another term that would fit. "Ky Gold Card holders" The-my-kid-is-one-block-from-the-hospital-and-just-got-the-wind-knocked-out-of-him-and-I-want-him-checked-out-so-have-the-ALS-truck-punched-out-for-a-non-breathing-child-just-to-get-you-hear-quicker-and-then-get-you-to-take-him-so-I-don't-have-to-wait-in-the-triage-area-card. ok, not a good day today. Michael

I have worked on both sides. In Eastern Tn I was a member of a rescue team (actually only probationary and moved before a slot opened up for me). They used the EMT and Medics to the fullest. Whoever was the strongest in an area was the team leader and then the best medical person was next up. This was done due to the large amounts of backcountry they covered, including lakes, caves and high angle. The guys would all be at a minimal competency, then they usually specialized in one area. In Ky, EMS is responsible for all extrications. Many services have chosen to contract this out to the local fire departments, but other services have retained this. In Ky, the local FD is listed as the basic for everything other than extrication (except if they have a contract giving them this responsibility). Then there are regional teams for SAR, Hazmat, Dive teams, and soon to come the high angle, trench rescue, and confined space. This is usually a core group of guys that specialize in this one area. They try to get at minimal one person from each county in the region of coverage. They also use medical people trained specifically for the problems that could be seen from the rescuers and the patients. This gets a medical officer or two that knows about the specific health risks involved with these special rescues. I hope this is clear as I just finished a reverse double and my mind is a little cloudy. If there are any specific questions you have, feel free to pm me or post and I will answer ASAP. Michael

Vital signs..................no, but we do take American Express.

An alligator walks into a bar. The alligator says, "Bartender, give me a beer!" The Bartender replies, "Sorry, but FL laws doesn't allow us to serve alligators." Alligator, "I said give me a beer!" Bartender, "Sorry, its against state law." Alligator, "Bartender if you don't give me a beer, I am going to swallow that lady over there whole!" Bartender, "Sorry, state law you know." The alligator goes over to the lady and swallows the lady whole. The crowd was shocked as the alligaotr went back over to the bartender and said, "Bartender give me a beer or your next!" Bartender said, "Sorry, can't serve druggies in here." Alligator, "What do you mean, I'm no druggie." Bartender, "Yes you are, that was a barbitchyouate."

Frequent Flyer is some one who is always calling. Transport Tommy is someone who is using you for a desired result. Named after an individual that was once noted as a frequent flyer, but would bend the system to the uptmost. He would get kicked out of a homeless shelter or motel or resident program and then use us to either get another place or just shuffled through a system that would have to take care of him. Feel free to use this as I think it is kinda catchy. Michael

I am frustrated by some of the misuse of our service, but in the end it is us training the individuals that they can misuse the system. We had a regular drunk who would be transported across town from wherever he ended up to the ER on a 2-3 times a week cycle. Then he would refuse treatment in the ER and walk the half-block to his house. He was on disability and was utilizing us as his private taxi. This stopped when a newer medic to our service called LE to have the guy arrested and pressed charges for false reporting of an emergency. The guy was jailed on a misdemeanor. Another tactic we use is triage. Many people were using us to jump the line of the ER. Once they realized they would go to triage anyway, we reduced our run volume on other calls. My only suggestion is to do a thorough assessment if you are going to refuse transport. Too many times we are so frustrated by being called out 3 times in one night by a transport Tom that we don't adequately assess the individual. True professionalism is defined when you give the person the same level of treatment when you know it is BS to rule out any possibility of a health issue instead of just dismissing something cause of who it is. One final thought; At least most of your services are right beside the main taxi cab service in your town. Yellow Ambulance Yellow Taxi Cab I already see the eyes rolling as you feel my pain.

I guess I am lucky. We are allowed to walk at our own discretion, hence many of the runs we make on ky gold cards that are not life threatening are walked. Like a previous person stated, we have to transport a person to the hospital regardless of neccessity or ability to pay if the patient requests it. A prime example of this is the lady that had an uncontrollable nose bleed, sent to respond priority 1 for uncontrolled bleeding (new dispatcher) to find the lady sitting on the curb waiting for us. She jumps in the ambulance as we are trying to get to her apartment. Wondering what this lady is doing, my partner asks whats up. She says she needs a ride to the ER for her nose bleeds. She had the bleeding controlled and still wanted to go because she had no vehicle and no primary care physician (by the way, her disability she had was alcoholism and she was on medicare and medicaid, our tax dollars at work). Our volunteer FD's are more help than the paid crews. We are lucky that they will do anything they can to help and turn out in numbers no matter time of day or night. It is not uncommon for them to have a line established, path cleared, primary strip ran, and ready for meds if needed upon our arrival. I think that until the government dedicates another form of medical service to those who have no transportation means or limited means, we will forever have those bs runs. There simply is no accountability. Likewise on these runs, it is up to our on judgement as to whether we ambulate or carry. I try to treat everyone like it is a true emergency for the simple fact that the little boy who called wolf too many times wasn't fibbing in the end. I don't want to be the one bringing in a person, assuming it is another bs run, only to find a lifethreatening issue was overlooked.