Just Plain Ruff

What gift are you giving yourself for christmas?

Let's not kill MikeEMt as he's really only doing what he's being told he is allowed to do which is truly unfortunate. I'd like to hear from other preceptors in Wasthington state about if it's just a Harborview thing or a Statewide thing where EMT students aren't allowed to practice skills. Mike, I would really be surprised if it is statewide that EMT students are unable to practice skills, and I'd bet it's specific to your system or area. I find it truly, truly sad that your area will not allow emt students to practice the skills that they have learned on patients and only cranks out observers in your educational system. That is truly a sad state of affairs that is based solely on the fact that one bad apple spoiled it for the entire system where you work. I think that someone was sued and lost HUGE and ended up putting a directive in place (as stupid as it sounds) that should be revisited and possibly rescinded. But I'm not in your system and I can only sit back and sort of chuckle that someone's paranoia at a repeat of the incident that might happen is guiding a system as progressive as Harborview is, especially if Harborview is such a pilot program. I mean if you let your students touch patients and do CPR during your research program wouldn't that be much more dangerous to your research if they did it wrong than a student splinting a patient wrong? Just asking? If you are doing research into CPR and are as truly as integral a part of the AHA and it's guidelines I'd be much more worried a EMT Student would mess up your research numbers than if a student were to put a 4x4 on a patient wrong. Do you see where I'm going with this?

Your law enforcement will play a different toon when one of their own get's hurt and needs you guys. But like Dwayne said, if law enforcement treats you guys like dirt, there has to be a underlying reason for that and that's something that you might want to look into and think about fixing.

Does it have to be East coast? I've got a couple contacts in services looking for PRN people that I might be able to pull some strings with to help you out. Sent you a PM

I still disagree with you but if thats the way things are done in your area thats the way its done. But I gotta say I think the way you guys do it up there is doing a huge disservice to your students. Sent from my SPH-D710 using Tapatalk 2

This is where you and I disagree. I fully believe that students should be involved in patient care to the extent (and this is the caveat) to the extent of the person watching over them or in charge of them felt comfortable with them doing what they allowed them to do. Let me ask you this, how do you think medic students get their skills checked off? They are students and by your reasoning they should not be involved in patient care so there is no way in your reasoning that they should be able to get their skills checked off. Right? So if they are not involved in patient care then how do you expect that medic student to get any of their skills or assessment skills checked off which is a critical part of their paramedic curriculum completed? Again, I'm just asking the question, not jumpin on you. I'm just trying to see how you expect for medic students to get their skills checked off????? I disagree with your premise but don't disagree with you having that premise.

The commercially available reference guides are excellent to have. The are NOT a waste of money. Mike, making a field guide on your own is a wonderful idea if you know what you want in a field guide but many people do not know what they want and the pre-made ones are good to get if you fall into this category. I purchased a new field guide every year and considered it 14.00 well spent. What if your company doesn't provide your providers with a field guide, where do you go from there? Do you put one together, that's a pretty big order and a lot of work finding all the info, printing it out on waterproof paper and tear proof paper, spiral binding it and all that. If you don't have the 14 or 16 dollars to spend then make your own but my opinion is to purchase one. The only thing that goes out of date really is the ACLS and PALS items and that's worth the price of a new one every year. My vote goes for the pre-made ones. So one vote for the pre-made one One vote for making one yourself.

So Mike did you get any hands on experience when you were doing you ride time? Why do you think that students are in class and doing ride time? You are there to evaluate them, you are there to help them on a real world patient. If you don't trust them then you should not have them on your truck. I'm having a little bit of a hard time understanding why you are precepting students. That's what preceptors do, they help students with their skills. I'm not bashing you because it's your prerogitive to not let them touch your patient but they have to learn it sometime. Does your service just put students with you and that's it. If so that's a shame. But I will tell you this.When and if you go to medic school you will be expected to perform skills and get them checked off, what happens if you get a medic preceptor who thinks like you "i'm not going to let them touch my patient because my name is attached to that patient so they can't touch them so all this medic student gets to do on this shift is sit back and observe" How are you going to feel? If you are truly observant of the student doing the skill on the patient and not just letting them do the skill then you can stop them when they begin to do it wrong. You also inform the patient that this is the student doing the skill and is it ok for the student to do it. The patient can say no or yes. Frankly Mike, I'm disappointed in your response. Every preceptor I had when I was going through both EMT rides and Medic rides allowed me to perform whatever skills I had been trained on in class. But you are entitled to your position and I'm not busting your balls about that position, just disappointed is all. I'm not saying that they be able to do all the skills that you do as an emt on a regular basis but come on, EMT skills are not rocket science in the knowledge it takes to do so. How much knowledge does it take to put a couple of 4x4's on a wound and then wrap it with some kling? But you should be showing them how to put on a splint and allowing them to help. Not just letting them observe. I'm sure they've done it dozens of times in the classroom setting. Putting on a hare traction splint, that takes two or more people to do, why not get them involved in putting it on. Not allowing them to get in and help and just making them observe is to me just tanatmount to a wasted 12 hour shift. If you need to have them prove to you that they can do the skill before they get to do it in the field under your supervision, that's great, but to refuse to let them touch your patient except for lung sounds or a second set of vitals, is just silly.

I still do not understand where they get the figure of 160K for these Emt's full time salary? First it was one emt full time at 160K which I said I'd move there and work full time 24 hours a day 365 a year for that much money. Now they are saying it's 3 emt's at 160K. That's 53K a year which is a better number but they are going to have thousands of applicants after those three jobs for that rate. But maybe that's with benefits making up the 160K. who knows. But it seems awful high pay for EMT's.

Don't go out and buy it quite yet. There has to be a way to get it cheaper. These prices are insane and they are for an out of print book. I'm trying to get in touch with the author to see if there's a project in my future with her!!!!! Report writing was my passion and I need a project. Methinks this book needs a bit of updating to fit the EPcr's like Craig alluded to.

well if there's no narrative then the book will still help you out but I can tell you it's been a while since I've read it so I'm not sure if it's been updated to include the electronic report writing capability. The book is specifically geared towards writing narratives. But don't electronic report writing tools all have narrative pieces to them? I'm not familiar with all of them out there so I don't honestly know Craig, I would think there would have to be a place to write a narrative otherwise I would be very very leary of using that report writing system because to me that is where the meat and potatoes of what you saw, heard, felt and did come into play. A bunch of boxes and check marks doesn't even come close to making a narrative for me. If I can find the book at a good price, I'll be sure to post it here at that price. I still think that if your electronic report writing system doesn't let you do a narrative the book would still be a valuable tool in your arsenal of educational tools. But I do understand your question.

Ahhh that sheds more light on the situation. I suggest that you just let them know you are willing to do whatever they allow you to do. If there is a skill that they are going to perform ask them if you can do it, as long as it's in your scope. All you can do is ask. It they don't allow it, document it on your evaluation sheet that you turn into your instructor. If you don't have one of those, make sure you let your instructor know that you had skills that you could have done but the crews wouldn't let you do them. You are there to learn and if the people you are riding with aren't letting you do them, then they really don't need to have students ride with them. You are being robbed of valuable skills time that some other crew might let you practice. But maybe all the crews are like that, I don't know. good luck and just be available to the crew.

Well go to the 2nd link, shell out the $XXX,XX for the book I referenced and read it. You will be a better medic for it. But make sure you can afford the book. It's pretty expensive. But please go look at the link. It'll save you a butt chewin

Make sure you rule out the latex allergy if they have a couple of rubber chickens lying around. And be extra careful if you see some pretty torn up apple pies.

Really, That sounds like they use you as glorified eye candy and part time help. No splinting, no bandaging? How the heck do they expect to help you learn skills that you should learn? Any chance you can get with a better more progressive learning environment? Have you had a discussion with your instructor about the limitations that you are under at the EMS Agency you are riding with? Could it be that someone at the class you are in ruined it for the rest of you by screwing up royally or does that service just not trust you students. When I had students they were allowed to do whatever their scope of learning (to that point of their class) allowed them to do. If they had learned bandaging and splinting then they did that, if they hadn't gotten to that point, then they didn't get to do it. Sounds like your ride service is behind the times.

Did you even look at the links that I posted? I'm not going to give you everything. The link to the first one gives you a direct link to the description of the book and the price The 2nd link doesn't give much. The 2nd book is how to write a EMS Report that is legally defensible. Write the report based on a legally defensible frame of mind. What tips and tricks to use. Write the report from a defense attorneys mind set since you will be the defendant rather than the plaintiff. And I know you didn't click on the link because you would not be asking the price because it's right there in plain sight. I'm working on trying to find a better price. You have to do some of the legwork.

Ok, depends on what you are wanting but I've found that an ER based (hosptial based) EMS System gives you a very good grounding on your career. But that service should provide you the opportunity to work in the ER. My first paramedic service I worked at was a ER based EMS system where you worked the ER one night and then the ambulance the other. You were the primary EMS crew one night (you were assisting in the ED but available for calls) but the next night you worked you were the secondary crew who was assigned to work in the ED and when the 2nd ambulance was needed you went out on the call. It worked out really well. I learned a LOT. You can go to work for a ER and just do the ER work but that will get old real quick if field work is what you are dying to do. So if you don't have a hospital based ambulance service in your area and you really want to do field work then don't do the hospital route unless that's the only job you can find. I second Tylers notion as to getting some pre-requisites out of the way as your DEGREE GRANTING paramedic program will require you to have these pre-requisites anyway. Get them done, you will be ahead of the game from those who are struggling to take the classes while in paramedic class. I would also make sure you take at least one if not two english composition classes in your quest for EMS higher learning because you need to learn to write reports and having a good basis in how to WRITE correctly will keep your butt out of court more often than your treatment of a patient. If you write a terrible report a lawyer will sieze that terrible report as a means to question your skills and treatment of the patient and add your name to the list of defendants in a court case and you don't want that. Here are two books I recommend When Violence Erupts - by Dennis Krebs - the best keep your ASS safe book ever written. Get it, spend the 33 bucks and it will save your life. http://www.amazon.com/When-Violence-Erupts-Responders-Continuing/dp/0763720704/ref=sr_1_1?ie=UTF8&qid=1354123510&sr=8-1&keywords=When+violence+erupts The Missing Protocol - how to write a legally defensible report This is a very expensive book but it's out there in a cheaper form somewhere. I used to have it but it's gone now. If you can find this book cheaper BUY IT!!! I guarantee it will save your ass just as often if not more often than book one above. http://www.amazon.com/missing-protocol-legally-defensible-report/dp/0967129613/ref=sr_1_1?s=books&ie=UTF8&qid=1354123675&sr=1-1&keywords=The+missing+protocol

480 calls a month and your city cannot provide even BLS EMS services to it's residents, you have to rely on a outside service or make a cop drive your ambulance. JEMINY christmas. What a clusterfu#$$.

Well unfortunately the EMS gods will either shine on you or say "nope aint gonna give you shit" and let you just sit around and watch TV in a recliner at the firehouse. Just do what you did last shift and observe and be there to do what they need you to do. Tell the medic or the emt in charge that you are willing to do whatever they need you to do. Remember it is their job to keep you safe, but your job as well so keep your head on your shoulder. Don't be an idiot like one of my students and go off into the basement of one of the houses we were at looking for the overdose victim and nearly become a victim themself. That was a bad scene. STICK WITH YOUR PRECEPTOR. GOT IT!!!!!!!!!!!!!!!!!!! But in all seriousness, do what they tell you to do, perform what you have been taught and soak up the learning atmosphere because one day soon you will not be in the learning sphere anymore, but in the patient care in charge sphere and what you learn on your ride time is that important.

no but make sure you get it on youtube

So true, barfing will make you feel better but the toxin is still in your system hence the continued barfing. What I was trying to say is that if you think it might be food poisoning make sure you keep some of what you puke up for legal purposes if you want your medical bills paid for if it's determined to be the food vendors fault.

ok, how's momma B?

Study hard, stay in school, don't do drugs, keep your nose clean. all that crap. Get in a degree granting medic program Don't freak too much out in emt class as there are thousands of EMT's out there who have done the same thing you are doing or have done. So in essence, there will be 36 or so other guys/gals like you in your emt class wanting the same thing. EMT is NOT Rocket science. Don't put to much pressure on yourself with the class. Good luck and have some fun.

This was a friend of mine's glucose - 1540 along with a Potassium of 6.9 He's a pretty sick guy. edited to fix my dyslexia on the potassium

oh hell, no wonder why the amiodarone didn't work the last time I used it on a arrest, the guy had just drank a glass of grapefruit juice. But seriously, advice is to stay away from Grapefruit juice if you are taking any of the drugs listed and for those of you who don't go to the website listed here's the list of meds that are affected A-C Alfentanil (oral) Amiodarone Apixaban Atorvastatin Buspirone Clopidogrel Crizotinib Cyclosporine D-F Darifenacin Dasatinib Dextromethorphan Domperidone Dronedarone Eplerenone Erlotinib Erythromycin Everolimus Felodipine Fentanyl (oral) Fesoterodine H-P Halofantrine Ketamine (oral) Latatinib Lovastatin Lurasidone Maraviroc Nifedipine Nilotinib Oxycodone P-Z Pazopanib Pimozide Primaquine Quinine Quetiapine Quinidine Rilpivirine Rivaroxaban Silodosin Simvastatin Sirolimus Solifenacin Sunitinib Tacrolimus Tamsulosin Ticagrelor Triazolam Vandetanib Venurafenib Verapamil Ziprasidone