paraloco

Uh, why not ems pants and a white scrub shirt with a blue star of life on the front?

a proven method for success in private service is to start out with 2-3 truck. Make some contacts at the facilities. Tell them that you don't want, or can't handle all the calls coming out of there. "Just give me some of them." Years ago, when a big private service bought up most of the mom&pop outfits in Houston, they made most of the admin type people sign no-competition clauses. There were a few low enough on the totem pole that they didn't have to sign one, but knew how to run an ambulance service. They started out small. They told the hospitals and nursing homes that when the big guy inevitably cut his number of units, and response times were affected predictably, that they could step in and provide timely, courteous service. And they did. You can get rich nipping at the big guys' heels.

What I like: They back us up. There are many of them to choose from for part-time work. They have less cumbersome procurement, (ie., if they need something, they go buy it. no political process, bidding process) They usually have nicer, cleaner equipment (because it usually is not used as rigorously) They have more flexible scheduling. They get to use profits to improve their system, rather than everything they bring in going to a general fund. They can aggressively go after dead-beats who won't pay ( looks bad for a taxing entity) We get to pick the cream of their crop for medics, we know ahead of time who the losers are. I'm talking about larger, well run privates here. What I don't like. I'm talking about a local level mom & pop operation now. The field employees are usually required to suck up whatever abuse anyone wants to splooge on them, especially nursing homes and dialysis facilities. They are staffed by youths, biding time until they get through school, hired on by PD or FD; by burn-outs (or f*ck-ups), or by long-term loyal employees who will never see the commitment they've made returned to them in any meaningful way. ; They (owners) put little emphasis on continuing training or QA/QI. As long as someone has a patch and a pulse, they can work. The crews know not to use the expensive meds because they'll get yelled at if they do. Then there's the 'golden child' phenomenon. A failed son of a local official/politician who got hired on as a favor, and who can basically do no wrong. Dispatchers who play favorites. The owner's family. All the owner's kids are supervisors, all have company vehicles & cell phones, no matter how little they work. Out-of-town transfers that come in just before shift change. Lousy (and very expensive) health insurance. Crappy (or non-existent) retirement. Some of the privates are a good deal if you are young, healthy, and single. Go to school, make your party money, truck & boat note & rent/house note. That's all some people want.

agrees with stick'em. the things going on where I am would not be taken quietly by IAFF if the firemen were running EMS

you left out 'gomer crumbs' and ILOC (increased level of consciousness. someone on acid, or mushrooms) There was a really bad one, would get me tracked down and fired.

I am an FTO and one of the first things I tell a rookie is that I better not beat them out of the house, to the truck, or to the patient's side. And they better not be empty-handed.

I also visit nurses' listservs. I see posts about the level of esteem and respect given to physicians, and why can't they be equal. It's their world, and I didn't burst their bubbles that physicians have far more education than they do. I look at the posts and see spelling and punctuation errors that mark them as true 'professionals' (<sarcasm) . The nurses have better unity than we do, but that's not saying a whole lot. BSRNs have little regard for the 2 year nurses ( They wanna protect the value of their degree) They'd like to see a BSRN be the mininum level. They have even less regard for distance-learning nurses. How many paramedics can you name who did an Excelsior-type paramedic program, with no ride-along time and a 1 day skill check-off? Not many I'd bet. There's a paramedic to rn bridge program not far from where I live. It takes 10 months, with no pre-reqs. I'm willing to bet they are light on the liberal education/critical thinking skill requirements. I'd also wager that these standards are far less stringent than in other countries, as it apparently is for EMS (from what I read here in EMTCITY). Rn's in here, am I right? If I wanted to do nurse-type work in a hospital, I'd become an rn and go work in a hospital. They make more per hour, but they work fewer hours (mostly 12 hour shifts now, right?) I bring home more than a rn who only works 36 hours/week. I also have much better benefits and retirement. I know more than 1 paramedic who got their rn license, then worked their butt off doing overtime just to make more money. They miss the autonomy of the street. Did they really improve their quality of life?

my point was that if my employers saw my post about dispatch, it would not be hard for them to figure out who I work for . might be harder for them to find ME, but ya never know.

I have no problem with nursing homes. The folks who work there have a thankless job.

This post will not bash nurses who are knowledgeable and diligent. It is aimed at the few who are slackers, who are barely competent. They exist, as the type does in any job field you could bring up. I have a problem with nurses who can't spell the names of common medications as I list them out when giving report. I have a bigger problem with nurses who can't carry their weight and rely on co-workers to do the 'hard stuff' for them, who take lunch instead of helping a co-worker who helped them. Regarding nursing homes, the only problem I have is when a nursing home staff member tries to tell me not to bring in equipment, or assess the patient. "Just take him to the hospital." Wait a gd minute. I'm in here because a private service didn't have a unit to send, and rolled the call to 911 rather than give it to one of their competitors. Unlike them, I am not beholden to you. I don't bring cookies,doughnuts, pens, or coffee mugs. When I ask for a report, everyone scatters. Nobody is doing CPR, but the NH wants the patient worked & transported so that they won't be pronounced dead on their property. I don't play those games. The PR people at XYZ Ambulance Service might have licked really hard to get business out of here. But that's not my problem.

I could write a long essay on the subject of dispatchers. I'll refrain, remembering the emt that got fired for her post here. But I'm thinking the thoughts.

at my full-time job, we use the FAST-ONE. at my part time, the EZ-IO. I prefer the EZ IO, several things can prevent proper placement of the FAST-ONE

Our dispatch would have notified the shift commander, who would have called the charge nurse about it, or gone inside himself to assess the situation. I agree that the hospital was negligent. But. It looks really bad for the dispatcher to do what they did, and public perception is the reality. I'll bet the dispatcher gets fired, so the city can offer up some fresh bleeding meat to the media and the family of the victim. Policies will change, and we'll be caught in the middle. I can see people approaching a crew who has dropped off a patient and are on the way out, past the waiting area. Or putting their truck back in order out in the sally port, and being asked to take somebody to another facility. Has disaster written all over it.

Ok, those of you with more hospital experience than myself, how prevalent is rectal temperature taking in the hospital environment (not just pediatrics)? Where I am, it used to be done on unconscious patients, but if they have a foley they just use the criticore temp instead. I'm old enough to remember when it was the norm, especially for kids. Looking back at it now, I can see one reason why. Those old glass thermometers had mercury in them. What better way to ensure that a kid didn't bite down on it than to stick it up his butt, however demoralizing it might be. It was kind of a Kafkaesque aspect of being a kid. Go to the doctor. No matter your complaint, nurse in white stockings and a funny hat comes in, shaking down a thermometer. " uh, I feel much better now. Really."

Because I've found more than a few people who turned out to be hypoglycemic. 1 or 2 hyperglycemic, with no prior history. What's the harm?

for our purposes in the field, tympanic does the trick.. we do have an electronic thermometer in the pedi bag for those rare instances that we might need to do a rectal temp. I've used it orally on people whose ear canal was too small for the tympanic. However, on another subject I can state I always do this: a blood glucose level. on all patients regardless of complaint or presentation.

Dust, maybe if our level of education won't improve rapidly enough, EMS in the U.S. should be limited to the basic level, maybe a few intermediate skills. Wouldn't hurt my feelings. just don't cut my pay. It would take a big effort, but might be worth it.

I've had more than one hypoglycemic patient who was also profoundly hypothermic. Anyone else seen this?

I've had 3 patients in 20 years with a dissecting aortic aneursym. I've had 2 with a dissecting splenic artery aneurysm ( an ER doc told me that the typical ER physician sees 2 of those his/her entire career. It presents similar to AAA, just not as severe). I've had 1 guy bleeding out thru esophageal varices ( place looked like something out of a splatter film) I've seen 1 guy blown up like the Michelin man with sub-q emphysema. In all the wrecks I've worked, 1 man had a blow-out hip fracture. 1 LeFort III fracture. 2 V-tach with a pulse that I had to cardiovert in the field. I've seen 1 or two of Almost everything. no presenting limbs or cord yet

I sometimes use mathematical expressions in my documentation. ex. 2pack/day smoker x 25 years straight out of algebra 1 at the very least, you need to be able to manipulate fractions. How many of you chart with mathematical symbols, like less than, greater than, greater than or equal to, etc. I use them also on the mechanical checklist, ie., diesel > 1/2 tank, main O2 <500psi Do you chart pain as 2/10, 10/10 ?

A police officer was struck and killed a few days ago. A drunk driver sped through the motorcycle wreck scene at high speed, knocking her over an overpass. The next day, PD started shutting down the highways. Kinda late.

My EMT-B class was about 120 dollars in 1982. My paramedic was about 240, I think.

I learned to deal with the frustration that BS frequent-flyers cause by realizing years ago that it's no skin off my nose to take these folks to the hospital if they want to go. If one of Somebody's (prominent politician, dignitary) loved ones died as a result of a unit/units being tied up on these calls, THEN we'll see some kind of change, probably not before. Don't get me started on the police. PM me if you want some details about what I've seen them do (or not do)

Unless my life or the life of one of my children ( and maybe my wife) is in danger ,I'm unlikely to shoot anyone. BUT. I will stand in plain view of a perp, using my cell phone to desciribe him down to the color of his eyes, and too bad if he doesn't like it.

check out Beaumont EMS. 3rd city service under the health dept. 2 for 1 matching funds in the retirement system, ins, cafeteria plan. very busy & progressive. you'd use all your skills, frequently. close to houston, about 4 hours from Austin & San Antonio.