paraloco

On duty, I will not discuss religion, sex, or politics in any context. I have no religious beliefs, and will not pretend to just to please someone else, even a patient. I can't imagine a Muslim or a Christian denouncing his/her belief system by word or deed to please anyone. I am not a reptile however, and I assure my patients who have a prayer request (only 1 in 20 years), that I will have a chaplain summoned in the ER if they desire. I empathize with their desires, but I don't do so apologetically. My views are just as valid as theirs. I've had 1 partner who whated me to join him in a 'sinner's prayer' . I politely declined without elaboration.

It was 20 years ago. I think it was a transfer from a residence to a hyberbaric facility. My partner and I were in a Dodge Caravan high-top , we called it the pocket-rocket. The monitor was a huge, very heavy MRL. hmmm. single then, no kids. no health problems. I can remember a few calls from those first years. Bad trauma patients that we would take to the half-@ssed local ERs. Racing the competition to the calls, scanner-jumping. We only wore gloves if there was a gross amount of blood or body fluids. Needles went in to regular trash. We used sandbags on our backboards. We cleaned and re-used our BVM's. Spent way too much of my life cleaning those old Laerdal suction units. We used those APCOR radios(like the ones Johnny & Roy used) to call the ER, and transmitted our 3-lead strips from our new LP5's . We'd spend all the time in the world on scene with trauma patients, putting on MAST pants, starting IV's. We'd work trauma arrests. We'd laugh about the old load-n-go days, how little they could do. lol

Amen Dustdevil. Good thing God made ER nurses. And lab techs. and admitting clerks. and x-ray techs. and respiratory therapists.

it's not just the taxes, it's the exchange rate too. I have not calculated how much more I would need to make in Canada to equal my pay here. I went to websites that illustrated the differences in the tax rates. The really high taxes don't kick in until you get over 60K/year. It's the provincial taxes on top of that. It can be quite a bit. Now, having said that, I do prefer a cold climate to the hot swamp for so much of the year. Maybe if I lived in it all the time I'd change my tune. Now, about housing. I have a 4 bedroom, 2 bath, 2 car garage home in a decent neighborhood. How much would that set me back in Canada? I can build here for about 100 dollars per square foot. How much in Canada? A few folks have come here from California. They make more money here and are very pleased how much further their housing dollar goes here than in California. I pay property and school district taxes (deductible from my federal taxes) I pay about 80 dollars a pay period for 90/10 coverage on my family, with a drug card, dental and vision care. All this is moot really. A friend of mine goes up to Fort McMurray in Alberta to work for Air Liquide. Every time he goes through customs, they grill him with questions like " What job are you going to do that a Canadian could not do?" They do not like Americans coming in to work. The last time he went up there, Canadian Customs put him back on the plane. He got mouthy when they asked some of those questions.

How do the French and Germans do EMS? what is their model? I was told that physicians responded to calls in France.

VS-eh, I'd rather have an experienced medic of whatever level with the tools to save my life, if circumstances called for it. I won't care if he/she/it can quote Plato, or explicate a poem, or solve a differential equation, because that skill set would not be relevant to the task at hand. I recently made a differential diagnosis that a NP with a master's degree missed (because she did not do a complete assessment or HOI) She had been a flight nurse at one time. Tons of edumacation. It didn't benefit the patient that day. Tell us how your increased level of education changes your practice. Why are so many degreed people pursuing a job which requires a certification? If memory serves, you've posted similar threads before. It's starting to feel like you are looking at your popsicle, then at mine, and fear that mine tastes better. Come ride with us.

Depending on the offense, your record MAY be sealed when you turn 18, but don't count on it. You can hire an attorney and petition to have your record sealed, then you DON'T have to list it on an app. I checked into this stuff, my 14 year old son got into quite a bit of trouble. IMHO, that is your best alternative.

A well known EMS instructor who is also an attorney posted on this subject on another listserv. This issue was taken to court, and the ruling was that you must stop at the first emergency that you encounter. Notify dispatch of course, so that they can send another unit to your original call.

We've seen this before in our area. Poor patients, not letting them abuse the system. lol A few years ago, my partner & I were walking out of one of our local hospitals. As we approached the ER entrance, I heard a man screaming into the payphone a few feet away, asking someone to come get him and take him to the other ER. We left, heading back to the station and pulled into a Stop & Rob, then continued. About a block from our station, a car passed us and pulled into the parking lot. When we got out , the driver indicated his friend was ill, and that the ER he had been in had done nothing for him. It was the same guy. Circling the drain. No air movement, turning blue, getting combative. We had to RSI him. We took him to the other ER in town. It was not a pleasant conversation that took place on the phone between the charge nurses of the two ER's. Just goes to show ya. Anybody ever get dispatched to a sick call and told to respond non-emergency(on the basis of what the caller told the dispatcher), then get there and the patient is in bad shape? I got caught like that once, and a good thing we had what we refer to as our BS kit, for just such happenings. Had an IV setup, and we were able to give a bolus fairly quickly.

My cousin works for Chicago FD. I'll call him up and ask him. If'n I can find his #

A retired long-time paramedic in our area just got busted for trying to solicit a minor on the internet. Not just any medic, the guy who was Obi Wan to many of us. he taught many of the paramedics in our area, and did a really good job of it too. Guys who were taught by him could come out ready to hit the streets running. I feel sorry for his wife, she's been an ER nurse for a million years. A local cardiologist also got busted for child molestation. What was he thinking? What a let down.

I carry nothing. I'll call 911 as needed. Unauthorized posession of medical supplies or equipment (that belongs to your employer) is grounds for decertification. There are devices which can only be purchased by or on order from a physician. True, you could, with little effort, jump through the hoops to possess this stuff legitimately. But why pay for it out of pocket, when all I have to do is call 911? If I lived in a sparsley populated area, I'd probably feel differently about the issue.

Do any of you use capnography frequently? Do you alter you treatment based on findings from it?

Had a near-miss recently. We got called for a fall, an elderly gentleman who fell while walking from his bed to the bathroom. A distance of about 8 feet. In his 80's, appropriate mentally, a retired prominent local businessman. All he wanted was assistance up, and he would be fine, he insisted. He denied injury, had no obvious injuries, was AAOx4, capable of self-evaluation, no alcohol or illicit substances. We helped him to his bed, and again asked him if he hurt. He finally admitted some lower back pain, which he had PRIOR to the fall. He allowed vitals, after his wife cajoled him. No radial pulses. weak carotid pulses. pulsating mass in the abdomen. " Oh yeah, I have an abdominal aneurysm, but just a small one." B*ll Sh*t ! It took 10 minutes of pleading to get him to consent to transport. Had a supervisor on the way, cuz I wasn't gonna go down alone if he crashed later. We grabbed him and scooted out fast, low & sideways. His aneurysm had grown up to be a big one, and had extended a fistula in to his vena cava. Don't know the final outcome. Oh, and he was also in a-fib with rapid vent. response. Good thing I stayed away from the diltiazem, the docs said I would have come in pumping on his chest if I had given that.

I visit a nurses' listserv on occasion. From the tone of a lot of the postings, you'd think you were here, lotsa the same issues. One message indicated that the physical therapists pushed for more education in their ranks, did it, and priced themselves out of jobs. Techs were hired in many instances. Think about how many calls an intermediate could handle just fine, with a short transport time. Education is good, I agree, but be careful what else you wish for....

How many of you relieve on scene, after the crew already made patient contact and initiated care? Does your service have a policy about it?

I carry a pager , cell phone, walkie, small LED flashlight, narc keys, station keys. in my right cargo pocket: field guide book, 2 good gel pens, 2 'throw down' pens, a small calculator, a calendar. In the left cargo pocket: a soft leather checkbook cover with my certs & DL Senior medic has a small case with some feel goods in it. Actually its a clamshell eyeglasses case. I hate it. hafta keep it closed with a tourniquet tied around it. I once carried a really nice Littman on duty. When it grew legs, I could understand people with suicidal ideation. I never wear a nice watch, only cheap ones. I've rooned 2 really nice watches. There are 2 large d-cell mag-lites in the door pockets of the truck, but more often than not, they don't work, and my LED is brighter anyway. We have multiple level redundancy of just about everything we might need. I do carry shears, mainly for cutting ECG strips (I've never had good luck tearing them over the edge of a counter top) I carry the radio, keys & such on a duty belt that I can shuck in an instant, like if I needed to bunker -up. I wear steel toe slip on shoes. Found em at Academy for 24 bucks.

I had a partner years ago who had surgery to remove a rod placed in his thigh after a wreck he had 20-some years before. The doc put him on zoloft, and when he came back to work, he stopped taking it cold-turkey. He later confided to me( months later, after he no longer worked with me) that while working an MVA, he heard voices telling him to step out into traffic. scary stuff.

We switched from 0800 to 0700 a few years ago, because of all the morning calls we were getting. My truck can bet on getting a call right before or after shift change, usually Maw Maw fell and can't get up. I try to get there 15 minutes before, to run a test strip on the LP12 for the daily report, check oil and fuel levels, etc. Actually I watch my trainee do all this stuff, same difference. Builds character. We get wake up tones at 0600, to finish what still needs doing. (taking out trash, getting times from dispatch if the MDC was down, face sheets faxed. etc.) I like 0700. would like 0600 better. Could get home & slip into bed with the Mrs. Paraloco before she has to get up, could see my kids in the mornings.

I've been dispatched to: decreased level of conscientiousness, decongestive heart failure, unusual low pulse, smoke coming from the vagina. I'm sure there's more. I was in the ER when a volunteer unit from an outlying area called in a report which started out: The patient was minding his own business when.... We busted out laughing, one of the nurses said "Positive for minding own business. check" Its funny to watch the ER staff listening to those really long reports, you know, the kind where the medic is reporting what color underwear the patient wore on groundhog's day 3 years ago, ate raisin bran yesterday morning, etc.

I hate it when the news media calls us 'Emergency Workers' . I would very much like the opportunity to call them 'Telemedia Workers' in a public forum.

I've dealt with lots of fakers, and can usually tell you when the call is dispatched what the demographic of the patient will be. If its fainting at a fast food establishment, it will be a teenage female trying to get out of work, has never had a job before and is unaccustomed to it. If its chest pain or dyspnea at Walmart, the mall, etc., it is usually a middle age female shoplifter that got caught. If its seizures at the side of the road, there will be a patrol car there, with someone who 'seized' after the handcuffs went on. The way I deal with simulated stridor, is to whisper in the pt's ear, that I know they are faking, that if they don't stop, me, my partner, and all the firemen will be doing it too to show that family that they are faking. They stop. I miraculously 'cure' them. I also promise to rat them out to the family members they were trying to buffalo if they ever do it again. On a different note, how many of you have run on a patient (with a real problem, ex. hypoglycemia,asthma attack) and a family member who had all the time in the world to get 'decent' is wearing something (or not wearing anything) skimpy? In the last year I've been to 2 different residences with a hypoglycemic patient, in which the patient's adult daughter answered the door in a T shirt and skimpy panties. One apparently expected the engine to arrive first and knew what shift was working, cuz she asked, "Is Jim working tonight?" "She was all prettied up, hair, nails, makeup. LOL OMG ROFPMP My partner told her, " We'll take care of your mother. You go put on some pants."

Up until the early 90's, it was a state requirement to have the capability to transmit a strip. In the mid 80's, we were using the Motorola Apcor, which had an effective range of less than 4 miles. We then went to a device that allowed us to transmit over our portable radios. Shortly thereafter, those big, huge Motorola consoles in the ER nurses stations ( which were down more often than not) just kinda died & disappeared with a whimper. It wasn't until recently that we began transmitting 12 leads to the ER (and only if OUR interpretation indicated it) . This was part of a new program to reduce door to cath table time. It requires too many people to be on the same page at the same time ( cath lab, cardiologists, everything). It requires ALL the technology to be in working order (how often does that happen?)

Can somebody help me? I just hired on part-time with Acadian for their venture across the Sabine River into Texas. Their protocols are what I'd call 'cookbook'. I noticed some of the supervisors wearing an EBR rocker close to their NREMT-P patch. They apparently have to pass a protocol test to work in East Baton Rouge Parish, and this is the source of pride (or an opportunity to add decoration to their Class B Army shirts). I'd like to compare these protocols with what I am using at my full time job. I suspect they are similar. Does anyone have them as an adobe document?

We (my partner and I) check several things as early as possible. We check the fuel and oil levels in the motor and generator, the mileage and hours (checking those against the stickers on the windshield),and the main O2 level. With the offgoing senior medic, I sign for the narcs and the narc keys. We also run a test strip on the LP 12 and attach that to our daily report, and adjust the time if it is off. (We've found that after we transmit a 12 Lead, our LP 12 frequently synchs itself with the hospital computer, which is usually several minutes off. We check the bags and cabinets as time permits, check to see how many backboards and sets of webbing we have. Glucometers and tympanic thermometers have a tendency to grow legs, I've concluded.