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Just Plain Ruff

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Everything posted by Just Plain Ruff

  1. Hey Riblett, you might be better served to look to Facebook on this rather than here. this sites sort of dead now. No offense to this site but it it what it is.
  2. Well I'm not sure how my new job will want my narrative. It's been 9 years since I wrote one and I'm getting back into the swing of things starting May 15th. But my reports when I used to write them were hand written on a paper report form. yeah, it was before computers got in our way of writing reports and before we had to tick off all those legal mumbo jumbo boxes to make the bean counters happy. So I'll give you a idea of what my narrative was like. Remember this was a long time ago so I'm sure others have better ways of doing things now. But I can tell you, my narratives never pulled me into court. 1st paragraph - What happened - why you were called, what you found, what bystanders said, what patient said, what you observed. etc patient exam/assessment - the formatting of this site makes it hard to put it all down line by line but here goes Heent(head, ears, eyes, nose, throat); Neck; Chest; Lungs; Heart; Back; Abdomen; Pelvis; Gi/GU; Extrems; Neuro/GCS/RTS/ (all of these go on their own lines with what your exam findings are) What is your Impression/Impact - what did you really decide is wrong with this patient - they say we don't diagnose but we really do. So don't be afraid to say if they are having chest pain to say chest pain or if their 12 lead shows elevation in II, III and AVF to say that. What is your impression or suspicions. And now your treatment - Number them sequentially - from when you got there to when you dropped them off at the hospital - make sure you put down if they got better or if they got worse. Don't be afraid to say that if your treatment made them worse - say it because sometimes your treatments make them worse. Sometimes your treatment like Synchronize cardioversion causes them to go into v-fib. that makes them worse. Or you give them Lidocaine to a paced rhythm (honestly I didn't see the pacer spikes- really i didnt' and you nearly code them) put that in the report. (man I felt like crap on that one - but I was a brand new medic and I learn from my mistakes and teach from those mistakes). That's all I got. Oh yeah there's one more thing - there is a very obscure book out there, if you can find it, buy it and never let it go - I did and the person lost it. It's called "The Missing Protocol-A Legally Defensible Report" by Denise Graham It doesn't tell you how to write a report but it does tell you how to write a report that will keep you out of court if you do it correctly. It's out of print so I'm not sure if you can find it, I haven't been able to find it. May the person who lost my copy be crapped upon by a thousand camels with IBS and C-diff. I hope this helped.
  3. sorry you haven't gotten a response but this is my advice 1. do not allow him to retake the test until you speak directly with the registry. 2. Talk to them about what accomodations they can give him and what he qualifies for. 3. Ask them what kind of study guides or assistance they can offer for him to prep for the next attempt at the test. 4. DO NOT ALLOW HIM TO TAKE THE TEST AGAIN until you have done all 3 of the above. He only gets 2 more times before he has to I believe take a refresher course and you don't want him to do that. Just call the registry and talk to them. We can give you advice here but please go to the source and call them directly, they are the experts about their testing process and what accomodations that they can offer someone with a disability. That's my advice.
  4. Ok, heres what I purchased today from Amazon shears BONTIME Trauma Shears - Premium Quality EMT Shears, Stainless Steel Bandage Scissors for Medical, First Aid, ER, Nurse, Doctor, 7-Inch(2- Pack, boots - already have non-steel toed boots. I think I can wait a while to purchase those if ever. I never needed them when I was practicing prior to leaving so I'm hedging my bets that I won't need them now. pen light - https://www.amazon.com/gp/product/B07N1G7179/ref=ppx_yo_dt_b_asin_title_o02_s00?ie=UTF8&psc=1 Belt - going to purchase the belt when I get my pants Already have my field guide - have purchased already I think that's what a guy with a few years under his belt in the field actually needs. any other suggestions that won't make me look like a total dumbass???? One other thing, after digging through my storage boxes, I found my Littman Cardiology II stethoscope that I've had since 1992. The only thing I need to purchase is new earpieces as there is a hole in one of them The replacement earpieces will be here tomorrow.
  5. I want to add to my post Fentanyl is a great drug. It can be used on most anyone. I've used it from 2 year olds to 80 year olds and probably older but I can't remember. I don't remember a patient ask me personally to give them fentanyl, but remember I've been out of the field full time for 9 years, (part time for several), but I've been asked to give patients dilaupid(yeah I know it's spelled wrong) more times than I have fingers and toes. There is abuse potential in a lot of stuff we give. Hell there's abuse potential in flexeril as well, that's what a friend of mine was hooked on and what eventually killed him in an over dose when he took an entire bottle (90) pills because he was just tired of livin and wanted out. So I do not believe we should get rid of fentanyl just because it's the soup du jour of the addicts this year and last. 10 years ago, I believe diluadid was the soup du jour of addicts in my emergency room. It's what they asked for by name. Who knows what will be on the menu in 3-5 years from now. But for goodness sake, don't take a tool out of our arsenal because a small subset of the population have made it their drug of choice to abuse and kill themselves with. That would be I believe foolish and a knee jerk reaction, but then again, it's what we in america are known for, knee jerk reactions to a problem without finding a solution first.
  6. Ok, so I can make it official. I got the call with the offer. I will find out my start date Friday when I go down and pee in a cup and sign the forms for my background check. I'm clean as a whistle though so that shouldn't be a problem. Now I gotta figure out how to pay for all the gear(I'm not a noob so I won't go overboard) that I need. 2 - 3 pairs of ems pants stethoscope shears boots They provide the shirts but I have to buy them(they order them for me) pen light Belt Already have my field guide I think that's what a guy with a few years under his belt in the field actually needs. any other suggestions that won't make me look like a total dumbass????
  7. Yes we do have alternatives but I say keep it. A great mentor one time told me this, if a person is going to get hooked off one single EMS administration of a drug we give them, then they are probably hooked on something already.
  8. Yes I agree that this sounds like a real situation. And yes there is a lot missing. Would like the original poster to return to give more information. If this is his loved one that would be very helpful to know. If he's searching for answers to why paramedics or emt's did this or that and this might go to court for malpractice, he's not really going to get any information from us to possibly hang those medics out to dry as that is what the court system is for and that's what the expert witnesses get paid big bucks to do. I don't expect the OP to return but I would like him/her to do so in order for us to understand more of what they are wanting us to answer.
  9. Oh my goodness Mike, you hit the nail on the head. There have been more jobs lost, more marriages ruined, more relationships destroyed and more homes ruined by facebook than any other electronic medium every before. I personally know of at least 20 couples who have divorced because of facebook. I personally know of 30 people who have lost their jobs due to inappropriate facebook postings. I have multiple friends at work, church, and outside church who's children have sent Dickpics/naked pics to their girlfriends/boyfriends that have then gone viral over other media and it has ruined their childrens lives. I actually counsel and do small group lectures/sessions around my area on how to address it when this does happen to your family. Facebook is not the only culpret. There are other social media sites that are just as bad, some are even worse, some MUCH MUCH MUCH worse. I am putting together a teaching slideshow that I will be using with my small groups and hopefully be able to get this citywide/statewide someday. If I can get a non-profit put together and a sponsor group to back me I would love to take it nationwide because I feel so strongly about it. Guys/gals - I have 2 daughters 7 and 9 years old, and a 16 year old son. it's out there and ready and waiting for them. My son is a good kid, he's already been hit with some of the garbage that is out there. I weep for those who have been hit harder than we have. I set up my son's facebook account when he hit age 14. It has all the privacy filters and such. I have his password, I am his friend on facebook, his mother is his friend on facebook. We see every post he posts, he posts maybe 1-2 times every week. he knows the risks and dangers but he still got caught up in the cesspool of the other dangerous social media sites. I won't go into it here. It was not as bad as it could have been and we got through it. I have Police officer friends who work in Kansas City's Sex trafficking undercover world and I've been on their raids, and I watched them arrest a shit bag who was getting ready to have sex with a 3 year old. I cried my eyes out for 2 days. But she is safe and in foster care. I wanted to kill the guy and so did the officers but he is spending the rest of his life amongst the worst of the worst. It's awful and terrible. These are the officers that I've worked with to build some of my material. I've also worked with officers who work cyber crimes and crimes against minors division. it's out there, and our job to keep our kids safe. Sorry that this got off the rails but it's on us to keep our families safe, especially our daughters. and our son's. More to come
  10. I've been here for many years. I've seen it when we had dozens of new posts a day, the chat room was jumpin and we had active members who checked this site on a daily basis. Now, it's lucky to see a new post once every two to three weeks. I still check this site about every 3-5 days or whenever the site decides to notify me of a new post which is hit or miss. Honestly I do not believe this site is relevant to a new provider as there just are not enough active members here to be a good site to come to. Can that change - yes I believe it could but there are so many facebook groups that honestly are just as good as we Used to be. We used to be the site of choice prior to Facebook becoming the place to be. Now Facebook is the place and with Facebook's instant responsiveness, this site unfortunately cannot hold a candle to Facebook. Good discussion can be had here but there has to be people to discuss things with and I don't see that here. There was a time a couple of months back that I wrote a post pointing out we had X number of members but in a period of X number of months there were only 2 new posts and a small number of replies to existing posts. I was needless to say Dismayed but it is what it is. I'd love for this site to return to it's prominence it once had but I fear that it is never to be again. Maybe but maybe not. Who knows, maybe someone else has a different take. EMT City, Dinosaur still holding on? Prove me wrong!!!
  11. Yeah, I'm taking a video refresher course by Jon Puryear - learning a lot - I guess that's why they call it a refresher right. Just took ACLS last week - learned some good stuff Taking PHTLS wed and thusday of this week PALS soon Start date would be May 15th as that's the next orientation date. I should be all certed up by then. It also gives me time to keep working my part time consulting project and get some money to buy my EMS Gear that I'm going to need. nervous but ready.
  12. I had to respond, I think it's a record in thread resurrections. And Shitty advice to begin with from the original Necromancer.
  13. Well, I got a tentative job offer same day, but he wanted to talk to the crews and also see what HR had to say. I was hoping for a phone call today. I'm patient. We shall see.
  14. You are kidding me, she walks around in her underwear around you and no-one has said anything to her? Honestly she is sexually harassing you and should be reported to HR for this. I may be old fashioned but you just don't do that. Does anyone else walk around in their underwear when they are working? I bet not. This is one step away from a harassment complaint and I'll bet it won't come from any of those who are fully clothed, it will come from her saying that you guys keep looking at her partly naked body. You better nip that immature behaviour in the bud and if it doesn't stop, request a transfer to a station where crewmembers are more mature than 3 year olds. Man, Dust would have a hey day with this one.
  15. Well this sort of sounds like some of the other situations we have encountered in this forum. Stillnotcharlie, we have been presented these questions before on a hypothetical basis and they have actually been family members looking for evidence to sue EMS providers or Hospital employees or just bystanders for doing things that should or should not have been done. You probably won't get an answer to your question here hence the "Hypothetical" comment by Paramedicmike nor a response to me unless you give us more background on the call or scenario. Could this have been your grandfather?
  16. So today, after being out of the field for a very long time - I'm interviewing for a field medic job with a local company at 230 today. Nervous but confident in my ability to do the job. Wish me luck.
  17. I agree. I was flabbergasted at what my pain management doctor did an how he treated this patient I brought to him. that is why I reported him with his refusal to treat the patient initially. thank goodness he relented and treated her appropriately in the end and I have to admit that she was treated very very appropriately and tolerated a very rough ride back to our facility with minimal pain as he wrote orders for pain relief on the trip. If she began to exhibit any pain on the trip back she had orders for meds.
  18. I second Dusts comment - from the grave But couldn't you call the receiving facility and ask them for orders? Tell them that the wussy doc sending the patient won't give orders and the patient needs them I'll tell a little story had a patient, history of brittle bone disease, going on a 2 hour transfer for a pain management consult. 2 lane roads all the way, terribly kept up roads. Was given a 10mg toradol PO pill and 15mg demerol prior to leaving the sending facility(it was the facility I worked at as a hospital based EMS medic). 1 hour prior to leaving she was given this huge dose of meds 20 minutes into the transfer, the roads get the best of her and she starts to cry out in pain. we are now out in the boonies, no cell service, we are also in the ambulance with the broken antenna so no radio service. So I go ahead and work via our standing orders for pain, start an IV, give her 25mcg's of fentanyl and some zofran. that does the trick for about an hour. I then dose her again. All the while trying to make contact with the receiving and the sending hospital with NO luck. When we get there, the pain management doc goes nuts, he says I specifically said no pain meds on the transfer so I could evaluate her pain when she got here. I told him the road condition and how much she was in pain. He in front of the patient said He didn't care and refused to see her. I told him that he would have to discuss that with her physician and that I would be making a complaint to the Missouri Medical Licensing board for his neglecting to treat the patients pain as well as making a complaint to the STATE. (I did this by the way). He did agree to treat her now that the pain meds were on board for 2 hours and he said he guesses that he could go ahead and see her since she was here. The patients family was really pissed off at the doctor, and myself and my partner were thanked by the family for making the patient as pain free as possible during the drive. We transferred her back to our hospital with new pain orders from the pain doctor after he saw what this patient had going on, I wrote all this up in my patient care report. Let my EMS medical director know what happened. Our director of nursing reported me to the State bureau of EMS for prescribing medications without a license (I gave med's based on standing orders - he(nursing director) didn't like that we had standing orders for anything). the state came in, investigated, found me without fault since my medical director backed me and my ED nurse manager and EMS supervisor backed me as well due to radio failure and cellular failure. I told the director that I could have easily have reported this to the State as well due to the poor medication orders given for this patient as we all know that JCAHO and Nursing care everywhere feels that pain control is the new 5th vital sign. 6 months down the road, there were mass layoff's (firings of 8 ER nurses and 6 paramedics - and I was the first to go on the day of the purge). I know why, but hey, it sometimes sucks to be a patient advocate against such shitty nursing/physician care. Tje state did find out about the failure to treat pain but it was a fall out of the complaint I made against the receiving pain physician and hospital she was transferred to, not the place I worked at but I don't believe my hospital was cited for this situation. I do k now that I had to sit with an investigator and my supervisor for about 2 hours going over my run report and the entire transfer. but the investigator was a nice lady and it wasn't too bad.
  19. I totally agree with you PM - (paramedicMike). it takes saving, possibly a company match or tuition assistance or assistance from family or a student loan. My example was extreme on the +30K that I'm still paying back after 10 years or so but the ROI for my investment has not been returned. My parents paid for my paramedic course which was 2400 total but I did not get a degree out of it but I already had one - it was a BA in Admin of Justice, or I was just finishing it up, can't remember that far back. Hell I cannot remember yesterday let alone 20+ years ago how things went. But I do remember the lifepack 5 and mast pants and how to put them on. I'm all for paramedic degree's be they associates or bachelors. I think for a run of the mill field medic an associates degree is appropriate but for someone who wants to be a supervisor/FTO/higher up manager then a Bachelors degree is essential. Just my .000000002 cents as my opinion be that I no longer truly practice is really worth just that. .0000002 cents. I wonder what dust would say on this thread.
  20. This I can't help but agree with but the thing I have to call into question is this, our pay already sucks big donkey balls and putting a loan payment on top of our responders already meager living(wages) could put some of them into deeper hock or debt. Do you also then embrace the programs that offer loan forgiveness (which almost no-one can qualify for - I know, I've tried to qualify for them) and saddle these providers for the next 20 years with payments that never ever ever ever ever seem to go away just so we as a profession can spout those hallowed words "our profession is a degreed profession" there is a great meme out there that shows two men side by side one guy it shows that he has student debt, a degree where it's hard to find a job and is in debt up to his eyeballs the other guy went to trade school, has no debt or minimal debt, got a trade, and just turned off the guy in the above sentences power. I know not a great analogy but I have 27K in student loans still after 12 years for a Masters in project management that I was given this really polished song and dance from Keller Graduate school of management that it would help me become a higher paid consultant but honestly it has not, I'm just paying 232.00 for the next 15 years.
  21. So question, what are the true benefits of having a degree? Not sniping but do medics truly need american history and other similar courses or can we build a EMS bachelors or Associates degree that focuses specifically on what medics(not talking about EMT's here) need to be successful. I cannot cut and paste the screenshots here but here is the Johnson county community college paramedic curriculum for AAS in Paramedic. here's the link - http://catalog.jccc.edu/degreecertificates/emergencymedicalscience/emergency-med-science-aas/ If this was the norm - then this might not be a bad framework but to add all the extra's such as history, and sociology courses - it sort of loses it's luster. just my 2 cents which is often worth less than 2 cents.
  22. Oh here we go on this site. It's all over facebook - truly strong feelings about this subject. Let's keep it civil and factually appropriate - no emotions please. That's what has derailed most of the facebook threads - emotions and emotions don't make facts.
  23. who is the keeper of the tapes? who is the keeper of the privacy of these patients? Who has access to these tapes, does the legislature address this in the bill? I've known some truly shady providers and there are some douchebag shit heads out there and it's a shame that we now have to have this type of protection out there for the patient but I'm more a proponent of this bill for the provider's in case they get a accusation lodged against them that isn't true. It has always been the patients word against the medic/provider and on this site as well, we've always crucified the medic before the true facts have been known in some cases, that in essence the patient made it up. then the providers life is ruined. So as long as the tapes are kept private until needed, only authorized people can see the tapes and the media can't get them until the investigation is in full swing, then I'm for this legistation.
  24. No when I clicked on the words design ideas it linked me out to the crate and barrel site. see below screenshot This is what I get when I click the words design ideas - it sends me to crate and barrel's site. Me thinks that wasn't the purpose but maybe again it was.
  25. did you mean to link out to the crate and barrel site? if so, I cannot see how the crate and barrel site would translate to a EMS forum shell but I suspect you have an idea how it would. Go on and do your magic.
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