EMDP2081

I work straight nights (8p-8a or 11p-7a) so my opinion is different since i dont have as much of that ball of fire to deal with but our service is a touch different. We function 100% SSM (ordinance says we must make it to scene within 10:59 of our comm ctr receiving the call 98% of the time or we lose our ALS license) but out of our 19 posting locations, we have 3 street corners that we post at. One is out SSM Level 1 location, one added when we reach SSM Level 18 and the last is a pretty common location, SSM Level 8 i think. Our physical locations vary from Fire Stations to Police Sub Stations to 2 EMS specific locations we have. At night, many of us dont like to awaken the firefighters sleeping in the station house by backing into their garage and waking up their FMO, so many of us choose to sit on the apron and roll the windows down and kill the engine. We dont kill the engine because of environmental concerns, but THE ENGINE MAKES IT THAT MUCH HARDER TO SLEEP. Even if i am not going to sleep, i still kill it because if i cna save my organization money, maybe that goodwill will translate into continued success of my organization and also a bigger pay raise next time our union negotiates... but that is just my 2 cents

Alright, I am going to Chime in on things here. I have worked in a couple different settings. My first full time paramedic job was in a PSA with about 250,000 residents and about 3,000 square miles that covered portions of 7 counties. Each county would receive the calls at their own respective PSAP and interrogate the caller on their own. Some agencies used the Medical Priority Dispatch System (MPDS) and some used a dispatcher asking aimless questions. Those counties would then land line our ECC and relay an address, Age, Sex and MPDS code and our ECC would then tone the call out to us and we would respond and no one complained about it. it is a working system by all reasonable accounts. The other model i have worked under is a system where the local PSAP forwards the call through the 911 system after they have triaged it and we run through the MPDS system via ProQA (computerized MPDS) and we assign the calls that way. we reduce alot of calls to a non-emergent response which is by all account safer for the crews and the public... The real kicker is that we get more dispatch complaints under this format because the crews are so used to getting all of the information that the occasional time that they don't have that information, they jump all over our ECC because of their fault... Personally, as both a Paramedic and a Dispatcher, i like both setups. I like being downgraded (as much fun as light and sirens are, they dangerous), but i like the simplicity of coming into a "clean" situation without other things to cloud my judgment. But if there is one thing, and maybe it is just the new paramedic in me, but i really don't have any yearning to listen in on that conversation...

All M3's and M4's are required to ride for 4 hours a year with us. All of the Emergency medicine residents have "EMS Month" where they are out of the hospital for a month and are in some sort of emergency response vehicle be it a Squad car, one of the Fire Engines , one of our Ambulances or flying with the flight program. We dont get nursing students very often. All of our Dispatchers are required to ride 24 hours a year. We also get the normal mix of Students be it EMT-B or EMT-P...

That is an awesome statement. Hear Hear!

here is my stance on the issue at hand. I am not an amazing paramedic. I've been doing this EMS stuff full time for 5 years, 3 years as a paramedic and i know i am still a very new paramedic. I do know what i am doing and I am proficient at what i do but I will be the first person to admit that i don't know everything in the world and that i have made mistakes. An education will teach you the be a paramedic, but a thorough education that goes above and beyond the standard curriculum theoretically makes you a professional who is able to understand the pathophysiology of patients in the out-of-hospital setting. you will not only understand what a medication does, but you should also know why it works the way it does. You should not only know why you should and how to obtain a 12 lead, but you should know in the first 5 seconds after a 12-lead is run if it is a STEMI or not and what you can best do to treat that patient. Patient advocacy is every providers responsibility and a personal charge. If you are comfortable with yourself as Dust is and know you protocols inside and out and have a thorough understanding of how the human body works, more power to you, but it should be a personal choice. I am not that kind of a provider. While reading this entire thread i did some thinking. I think i probably reference my SOG's every couple of months or so, but never in a life and death situation and it is only a double check of something I might be a bit foggy on. I know when to give what class of med, i know when BLS is a better option for a patient, i understand why i do the things i do. there is a method to the madness. Patient care is a dynamic thing that cannot be treated with a protocol. cookie cutter medicine is irresponsible and has no place in EMS.

Alright, here is my 2 cents (making my hourly wage even more menial and demeaning), Mental health is a pandemic. it is a burden because it is not profitable. if it were profitable and not operated primarily on reimbursements from government funded healthcare, every one would have all of the Mental Health care that they need and deserve, but that isn't really an option if you don't have a trust fund. EMS has inherited Mental health in alot of parts of the country because of the legal position it places Law Enforcement in. In MN, the law read something to the effect that PD is responsive for Mental health Transports unless there is no viable option for transporting the patients or they are unable to. Since most departments are understaffed, EMS is now a viable option and in most places, EMS is the policy. In stead of rebuking that "gift" we should instead focus on how we can do a better job of dealing with our responsibility. I don't necessarily think that restraining Mental health patients is a catch-all intervention applicable 100% of the time. I'm still a new medic, but in my 3 years of being a medic and 2 years working as an EMT, and having completed roughly 4,000 calls, i honestly think i can count on two hand the number of times that i have restrained a patient and i have never gotten thumped by a patient. Maybe i have been damn lucky, maybe I am just that good looking that patients don't want to injure my beautiful face, but either way, i believe that there is alot to be said about being civil with a mental health patient because they are still people and in their time of emergency, they could really use all of the dignity we can offer. What is the correct tool for the termination of Status Seizures? Restraints? they are shaking and moving uncontrollably, just like a patient experiencing a mental health emergency! Calmly talking with your patient and getting to know them and maybe listening to their life story (although often a can of worms) is probably my most effective tool. More effective than restraining, Haldol, Benadryl, Ativan, Versed or any other intervention is a empathetic (albeit still pathetic) Provider who is able to connect with their patient and genuinely try to make a connection with this patient. That is what i find effective and typically highly effective. Just like our mothers taught us, wear clean socks, don't put your finger in there and always remember the golden rule. You wont get anywhere with a Mental Health patient by being a douche to them.

What happened to interviewing the patient while on scene?

I'd imagine this is a common threadamong every EMS, but i've seen about 15 variations on Fentanyl come out of my dispatchers. Antibiotics and Antineoplastics are even better... Dave NREMT-P EMD

Forgive me for bringing life back to an old thread, but i am going to share my thoughts on Opticom, because nearly every city in Minnesota has since it is a 3M (Minnesota Mining & Manufacturing) Product . Opticom is a tool, just like a cardiac monitor. You treat the patient not the monitor. Opticom is a dangerous tool when applied incorrectly. it doesnt allow you any special privileges or permissions except to have the light cycle once the receiver activates. It is commonly thought that when you get a solid white light back from the intersection that you "own" it, but a feature of Opticom is Priority levels. I know in MN, state troopers have the highest level of priority, then cops then newtons laws come into play meaning that fire trucks have a lot more inertia so they will get priority over an ambulance. This could result in you "losing" control of that intersection, so you are taught to continue to clear the intersection just like you would if you didnt have a preemption device. In Rochester, we use a newer version of the opticom system called TOMAR which gives every vehicle in the city a different flash pattern that is registered and recognized by a central database owned by the City. This is beneficial in that the administrators know who went through what intersection, which direction and at what time. It also is a safety net in that if a squad car gets stolen and is running through the city code 3, they can track where the car is. The city also has the ability to lock a vehicle of of the system. Overall, i think it is a good tool that does reduce response times slightly, but you needs to be more vigilant of your emergent driving practices if you work in an area with Opticom...

We have the entire Zoll Rescue Net / RightCAD / Sanitas / Nomad / EMSPro / ZDC system and have been using it for over 4 years. I Have have never used another dispatch platform, but this one has its bugs and the SSM module inst all that well built, Candidate Ranking only operates "as the crow flies" but overall, it is a good dispatch suite and was easy for me to pickup and it interfaces with ProQA very well. Nomad is a love it when it works, hate it when we don't have it thing and i think alot of it is the result of our hardware, not the program. We have NEC PocketPC's that were old technology when we got them 5 years ago. they take alot of abuse as they have cables coming off of them in every direction. end of next month we are getting a new piece of hardware that is the official hardware device for nomad and from the dealings i have had with the device so far, seems robust enough to hammer in nails and probably about 72% EMS-proof. EMSPro is an excellent program and is very easy to learn how to use and i absolutely love the ZDC module where we upload all information from our Zoll's directly into the monitor and saves a ton of time in the documentation process... We have the system deployed in about 75 ambulances, 3 rotor wing sites and 1 fixed wing site along with our emergency response teams at the Mayo Clinic. I guess i would recommend the Zoll RescueNet suite to other agencies, but make sure you have adequate IT support as it will require at least 1 FTE to support a medium sized agency.

What kind of scope of practice is one looking at as an ALS provider out there? I guess i had never considered NZ, but i had a coworker tell me about how awesome a trip she took there was and that i needed to go there... Also, i noticed that the only position that they have open is one EMD position... is it worth applying for that position in the hopes that a vacancy will occur on the paramedic roster?

i also want to agree with inccognitogirl. I also work 0.3FTE as an EMD and 0.75FTE as an EMT-P and i find that the codes that i go on where the family member has already began CPR, i will often treat them as another First responder and allow them to do things, even if it is a menial task like holding an IV bag or handing me a supply i need. I honestly agree that if you have involved the family member, they feel a sense of ownership in making what are probably the last moments of this persons life, much more dignified. I believe in the EMD process and i think that it is a useful tool when used appropriately and early CPR is what truly saves patients where as all of this ALS stuff we throw at them doesn't have much statistical proven decrease in M&M. On the other hand, I work in a city of 100,000 people. We are home to the Mayo Clinic. 30,000 of those people work for Mayo. about 8,000 of them are nurses and we have over 1,500 physicians. This can be a blessing and a curse, but is completely reliant on teh mindset of the family members. i would hope that many of them have enough sense to remember that they are probably the world's foremost expert on the metabolic functions of some fungus that grown in a patients right ear lobe and not a broad based emergency care specific provider like we are. i find that 50% of the time that you have other medically trained folks at the scene that if becomes a Charlie Foxtrot and the other portion of that, you have folks who can keep their heads on or are benign. So in conclusion of this glob of random thoughts, i think it takes a experienced provider to properly utilize a family member during the course of an attempted resuscitation... Dave NREMT-P EMD

Alright, Heres my story. I am a Paramedic in the US for the past 2.5 years and lately i have been toying with the idea of dropping everything and taking a leap and dropping everything i have here and doing something completely random with my life as the only leash i have to the states is a home mortgage. My top choice so far is to take a leap to Australia and try my hand at EMS in Australia. My question being, Is this a reasonable idea and what are my best avenues for seriously pursuing a career in EMS over there? What kind of education am i looking at, what is the cost of living over there, what patient care is like over there compared to what i get to do in the states? What are some good areas to look at? That Kinda stuff.... Right now i have the National Registry Paramedic certification and my associates (2 year) degree along with my advanced EMD certification and ACLS, PALS, PEPP, ITLS, PHTLS and some Critical care courses... Any help would be very much appreciated... Dave NREMT-P EMD