MedicAR

All of the above, anything that poses a health risk to responders.

We won't even get into how I came to need this, it's a long, sad, and frightening story. Suffice it to say I need to create an infection control policy for my service. I've looked on the net and had some success, but there seems to be a lack of detail in the few that are available. Specifically, I need a post exposure policy/plan, as that's my weakest area. While a completed policy would be great, I don't expect to have my work done for me. Just point me in the right direction and once I complete this mess, I'll post it for inspection/critique. Thanks!

I negelected the Hot Springs area in my first post. You're right, they're good too!

Overseas......? My wife would hate me......

That's true. We're our own worst enemy. Legislation won't change anything, but having a voice to shape new legislation in the future might.

As disappointing as it is, it's also a bit of a relief to know we're not alone. Thanks!

I agree, this guy isn't helping us as a profession. People like him aren't the problem though, EMS is. Don't get defensive about those last two words, give me a second here to make my point. EMS is in trouble and not likely to change because Joe Q. Public has no idea what we are. What we are also varies state to state, so what is expected in one state is ignored in another. EMS is simply not well-defined enough nation-wide to stand on its own. Many big cities incorporate EMS into their fire departments rather than as a separate service so now we're not "Paramedics" but fire fighters in an ambulance. How often are we simply called "ambulance drivers" because that's all that people know we do. Not to get on the soap box here, but we need national standards. The National Registry is different in that it's not accepted by all states. We should use nursing as our example and make "Paramedic" as well defined to the public mind as "Nurse." I hate those Johnson and Johnson commercials that show nurses doing our jobs, but there's no unified voice for EMS to object loudly enough to make anyone pay attention and we need that voice, not just to object to a commercial, but to inform and educate the public and our leaders as to what we do and what we need to do it.

Yesterday. Now I don't know what to do. I'm too old to go to a fire department and have no other career paths open. I'm not wanted at my current job because my expectations are too high. I think most here would consider my expectations to be minimal at best. I'm off to Monster.com........

Where are you moving to in Arkansas? This is important because there are two Arkansas. There is metro Arkansas which is primarily Little Rock, Fort Smith and the Fayetteville-Springdale-Rogers-Bentonville area. Then there is the rest of Arkansas. EMS is an absolute mess in this state, no doubt about it. We are required to carry glass punches in our trucks because somewhere in this state someone couldn't figure out how to break a car window one time. They couldn't come up with a Mag Lite, a crow bar, a rock, or even the car's antenna. A big problem is that most of the state is very poor and very rural. There isn't a tax base to support solid EMS in most areas and isn't a call base to support a start up of a private company, so 95% of the regulations and requirements play to the absolute lowest common denominator. Medic skills are fair, but we're limited by our drugs. EMT and First Responder skills are essentially the same, nothing invasive and no medications. I used to work for a service that used to have a lot of lee-way with our med control. As the quality of new hires has declined, so has that lee-way. I've seen some incredibly good people leave for the surrounding fire departments because the pay, benefits, and even path of promotion was better or better defined. If you're serious about EMS and want to do it right, go with a fire department in Springdale, Rogers, or Bentonville. Fayetteville and the surrounding county use a private service with some governemental controls. Those controls don't appear to be working and the service looks like it simply wants "butts in the seats" rather than good quality people who are committed to quality care and are now turning into a monopoly for non-emergent transports which was met with a lot of resistance. If you'd like specifics, we can discuss it privately. Back on to Arkansas in general, yeah, it needs help. To my knowledge, we've never had anyone over the state's EMS board with more than an EMT certification. While there are some exceptional EMTs in the world, most can't comprehend what's going on above their level of training and that's evident in Arkansas' regulations. One example, we've begged for RSI, but because 95% of the state can't be trusted with it, we don't get it. It's sad and frustrating.

I hope no one takes this the wrong way, but why just accept it? I don't know what to do, but I'm up for anything now. We used to be a high quality service, so I know it can be done. I just need to figure out how......

Thank you all for the input! I'm going with the "black book" solution for now. Dates, times, names, places, run numbers. Nothing to violate HIPAA, but enough to prove anything I need to prove. I would leave, but where would I go? My wife is the real bread winner and she's staying put. I'm too old for the fire service (civil service) and there's not another EMS service close enough to be feasible. Also, most of family and friends are here and I want them and the rest of the fine folks in this county to have a quality system. Leaving it all behind is the obvious solution. Unfortunately, it's not an option.

I'm not trying to be snide here but my own co-workers, for the most part, wouldn't have been hired to work in EMS anywhere else. They're lazy and unprofessional. Now, if I were looking for tips on how to nap anywhere, respond unprepared, and generally live like a slob....these would be the right people! There is a small group or us that are looking to improve, but we feel hog-tied and don't know where or how to start. The suggestion about going to our board isn't going to do a whole lot, the board were selected for their "yes-man" abilities. As ridiculous as all this sounds, it is 100% true.

Hmmm.....you sound as though you've dealt with my system...... :-k No, FEMA is a well oiled machine by comparison.

I've hit on it in another thread, but let's just get right down to brass tacks. My service is in trouble and I want to fix it. The problem? I am not a member of management and those that are don't take input (constructive or otherwise) very well at all. This will have to be a grass roots change and even then, many employees may not be on board with it, at least initially. What we have is a group of 7-10 solid employees with a steady history with the company and a desire to get us back on track (seriously, I am not planning a mutiny). That leaves 43-46 full timers and another 30 or so part timers that may or may not fall in line. The problems: No recognizable training program. No standards for hiring, we'll take anyone off the street. No discipline, don't feel like checking the truck? No problem..... No organization. It's never clear who is in charge of anything, and even if it is clear, it may change without notice. No chain of command. It doesn't work in either direction. Problems going up may skip officers. Answers coming down will do the same. We have a chief, an assistant chief, 6 captains (including our maintenance captain/mechanic), a training officer/computer guru, a front office manager (she might be the 7th captain, I'm not sure rank is assigned), an accounting manager, and 3 lieutenants. That's 14 members of our "management team" to manage roughly 66 full time people. It seems excessive, but I could be wrong. Mis-management of funding. No common sense/planning when spending money. We waste more money patching holes that it would take to buy a new boat (it's figurative, we don't respond in boats). We're currently looking at spending $25,000-35,000 to make a rural fire station livable. This new location for us will improve response times to a very small segment of the population and will actually hurt the main city, as we're not adding a unit but moving one. No positive reinforcement. No consistency for anything. An example is that the front office gets one set of holidays. The wheelchair/transfer crews get a different set of holidays. Dispatch gets different holidays. The day time (12 hour) emergency crews get a different set of holidays. And finally the street crews get a different set of holidays. That's five different sets of time off/holiday pay. Waning support from outside agencies. The rural fire departments/first responders we work with don't support us like they used to. Of course we don't support them like we used to either with training or just common courtesy. Strong favoritism, bordering on discrimination.

My thinking is that the 23-27 age range is better for entering this field. More responsible, more settled, usually (but becoming less frequent) better educated. Knowing how to do the job is one thing. Many people have passed their certification exams but have no clue how to do the work itself or think that their job is only running calls. There is a lot more to it. There is public image to consider. I assume it's similar around the world, in that the majority of our patients are older (55 and up). These people have a certain standard that they expect public servants to hold to and that includes appearances and attitudes. Generally younger employees don't live up to these expectations. There is the ability to communicate effectively. It's a skill that comes with age. There is a level of confidence that has to be present and the ability to know that you've been understood. And of course, as mentioned before, insurance. Statistics show young people to be more reckless in a vehicle. Lights and sirens don't help that kind of attitude. I'm not entirely opposed to young people in this field, but it has to be very selective.

I got the impression it was a diamond carry. Still 1 person moving backwards, still not good. The pt I mentioned earlier wound up being 526 lbs per the ER. We moved him with three people on either side of the cot, two at the head and one at the feet until we loaded. Then we had the two at the feet and three on either side.

No biggie, I was just playing the part of the rookie that asserts himself!

There you have it. No matter how careful you are, how perfect your lifitng form is, sooner or later it just won't matter. Most of this job is creative problem solving!

Roughly 627 pounds.

I don't think most teenager are socially/psychologically ready for EMS. I'm 37, I've been in this job for seven years and have my fair share of "ghosts." Not disembodied spirits, but bad memories of bad calls. There is no way I was ready to handle them at 18. I've been on two calls that were career enders for two young crew members. I don't know their ages for certain, so let's just say 18-23 to be safe. There's more to this job than driving fast, CPR, and controlling bleeding. There's the ability to effectively communicate with people from divergent backgrounds. You can't explain everything to everyone in the same textbook manner, it has to be accessible to each individual and it's important for us as professionals to recognize when we are and are not getting through. It's important to recognize when able to ask for help and not be afraid to do it, both on and after a call. It may be even more important to recognize when a fellow crew member is in need of help and be the listener they need or send them to someone who is. Training is important in this field, but so is life experience. Teenagers generally don't have the latter.

Uhhh.....yeah. Did you even read the thread? :laughing6: We decided "hazing" was me mis-using the word awhile back. :wink:

Dwayne, thanks for the suggestions on the books, as well as your other post. I thought I touched on the earlier post yesterday, but if I did, I missed the "submit" button or something. I'll try to pick up the books after the mad holiday rush is over!

I want to say a big "thank you" to everyone participating here! You've got me thinking, to say the least. I couldn't find the comment, but it came down to "lead by example" which is as simple as it gets. I'm questioning everything I do now. Is it a good example? Is this how it should always be done? Is this what I would expect to see another employee do? The answer is "yes" the overwhelming majority of the time. When the answer is "no" I make adjustments, regardless of whether anyone is around or will ever know any different. I don't think it will fix things here, but I can easily hold my head up and say I'm doing the absolute best I know how.

I'm sure I will continue to shock and awe this board with my response to this question. We do have "preceptors" I used to do it a lot. There were no real qualifications, only that the preceptor was a solid employee with two years or so under their belt. Then hiring went to pot. We took (and still take) every loser that comes through the door. Once we preceptors realized that the new hires would be released to work on their own whether we gave them glowing reviews or recommended remedial training, we went to management and made our case. We were assured that this wasn't the case. I personally took on one recruit and never had a positive evaluation on him. He was released anyway. Once this trend was made clear, the preceptors started to refuse to take on trainees. Now, we have preceptors that have been here as short as three months and that barely function on their own. Most of the senior staff that were preceptors are gone, and those that are left refuse to take trainees because we don't want to be held accountable when the trainees are released and do real harm. Our training officer does double duty as our computer IS (or IT or whatever) person and is so preoccupied with the computers that there is no real training at all. As far as compensation for preceptors, there was absolutely none. Continuing education? Well, we used to offer partial reimbursement for college classes that would pertain to some area of our job. This has stopped because it got to the point that employees would get the classes they needed for another career path paid for, then leave. We offer two paramedic scholarships annually for EMTs that want to attend medic school. There is no careful selection of the EMTs that apply, and generally they pay the way for anyone that will go. This year, we only have one in school and the prospects for next year are not good. There is no "path to leadership" and promotions go to the finest kiss-asses and family members of the current management team. Dissent is not tolerated, even if said dissent is not only warranted, but follows all the proper procedures. Once you voice an opinion contrary to management's you're branded a troublemaker and treated as such. Our retention plan is non-existent. Come, go, do as you will, it's okay by us. In fact, it's better not to stay past 3-5 years because you'll start to cost too much and just be disgruntled. I know I'm making my organization sound terrible, and I don't like that. But I sincerely want to make things better and I think that in order to do that, I have to tell it like it is to seek solid advice. I do not believe my management team is on board with the idea to make things better. They've had the opportunities and let one after another slip past, so this needs to be a grass roots start. The vast majority of my family lives within our coverage area as well as most of my friends and I want to do the right thing by them as well as everyone else that relies on us.

There's differences between "slipping up" and bringing in an X-Box or a hangover and thinking it's alright to take it easy all day without checking the truck or doing any side work. Again, I think I've painted this far too broadly. It's not unusual to have a new hire come in and go straight to bed. This is not an exaggeration. They do it. And their partner is stuck because there is no supervision. Seniority does not equal superiority, and the odds of an actual supervisor coming out to get them our of bed are slim. When complaints are made we're told to do our own work and not worry about it. In my opinion, making sure my partner does their job is part of my work because if they don't I have to take up the slack to be sure everything is there and in working order. Everybody seems to have grabbed on to the recliner thing. It's not a point of cruelty and it was rarely abused by senior members. Every organization will have a bad apple from time to time, and in a good situation it would be taken care of as you all have mentioned here. It's not about sitting around and doing nothing. It was done to keep the new hire awake, alert and learning. There is always something to do and removing a luxury like that will help them to find it. I am more than willing to show them anything they want to know about. I'll gladly give the hows, whens, and whys behind absolutely anything. But I can't force it on them, and the recliner was just a tool to nudge them along. I also think it weeded out the lazy new hires in that they weren't patient enough to wait that year and went elsewhere to become known as a mediocre EMT/medic. Now we're the place the mediocre recruits come to, and I think it has to do with the lack of discipline. Ultimately, my organization is in sharp decline. For nearly 20 years we were the place to be. We took part in national and worldwide drug trials. We had a waiting list for new employees. We were able to select the cream of the crop every time. But as leadership has eroded, so has training. And as training went so did the prestige. And as that went, so did the prime employees. I desperately want to fix it. I have strong roots in this area and both want to stay and want my organization to succeed. What I'm doing here is looking at what's different for new hires now compared to when I started. Maybe a return to the old ways isn't a good thing, but then that's why I posted. I'm looking for some new ideas!