mshow00

I appreciate your point of view Dust, but I fail to fully grasp it. I guess that is because this is all I know, in the end I find myself surrendering to your wisdom. I have taken intro classes back in high school for Psych, Bio, Chem, and Algebra. I am an Eagle Scout who fell in love with first aid(being my start in this field) I have since taken Psych 101, Biology 101, Medical Term. The school I am going to is heavy in A&P and Pathophysiology. I fully intend on attaining my AAS, Critical Care status, and possibly a bachelors degree in business. I want to be able to do everything I can for my patients, all of them. Correct me if I am wrong but I believe Dust said no matter what happens on a call he sleeps well knowing he has the knowledge and wisdom to do everything in his power for that patient. I want that.

I think I miscommunicated my question, I have spent a year on a BLS truck (honing my paperwork and assessment skills on my own with impute from other medics I trust). I have been working on and off an ALS truck for three of four months, and spent the last two months or so working full time on an ALS truck. My paramedic class will start in May and my class is a year long. I have already started to pick up on several different things like basic reading of ECGs both 3 and 12 leads, further tweaking of my assessment and interacting skills and the such. My point was IF everyone went to dual medic trucks, I would be missing all the experience I have gained to this point. I hear one of my co-workers say "A good basic will always save a medic's a**" and he is a medic that has been in the field for years.

Just a couple of thoughts and questions from a basic on a basic/medic truck: As for if my partner wants/needs another opinion/advice on a particular PT thats what medical control is for, and our sups. I have made no secret to the fact that I work in for a private service, we run both basic/basic(mostly for transfers to and from SNF) and medic/basic trucks. My other question is what about people like me who have no interest in FF, where do I go to prep myself for medic school if everyone were to switch to dual medic trucks. I mean I have been working full time on an ALS truck for a couple of months and it is night and day different from BLS. I have just started to learn how to read 3 and 12 leads, learned and am learning a lot of little things I didn't know I didn't know.

thats funny i like that

Translation please for us non-Spanish speaking people

Are you Mo or IL? I am from the ILL side and just to point out one thing, this was Abbott's policy(before AMR) and supposedly AMR is looking to make this a national standard so to our fellow AMR "brothers and sisters"(as AMR is one big family) be on the look out. AMR saves thousands if not tens of thousands with this pay plan(the difference in pay is slightly higher than in MO b/c IL crew are required to have a MO licence) ours is $2 and $3 between "a" and "b" rates and another $2 to $3 between "b" and "c"

Another issue I see is that if this were to pass, many state and local laws and SOGs etc will have to be revised. My brother was 101 airborne and did the CLS course, when he came home for Iraq we talked about the differences in our training. It is like comparing apples and oranges. His skills and training are good for what he had over there, but by his own words he could not do my job, and I am a basic. In my state the military trained medics(by whatever name they are called) are nothing more than basics, and even then they have to do a refresher course. I love the sentiment of this proposal, I just believe it is impractical, and unfair to all involved EMS, military, and the public we serve.

Then you also have to consider the "needs" of your area. My company is split by a river that also is a state border. Our sister company (the other side) has had 15 medic and 20 to 25 basic slots open. We hire anybody with a pulse, regardless of their skills or knowledge (down side to working private)

I live in the Southwestern part of Illinois (15-20 mins from downtown St Louis) and work for a private service that requires new hires do 3 sifts ride-a-long paid. One one an ALS truck and two on a BLS truck. This is not really set in stone as I know I did only one ALS and then got thrown on the streets, and I am not the only one. Our competition in this area requires a lot (heard 6 months of ride-a-longs) unpaid to be hired. I think that is too much, however I think my company does not do enough. To put it bluntly we had one recent new hire that cant do paperwork, cant do BP(including palpation), and cops an attitude anytime anyone trys to help him(especially women). We have had others just like him, or worse(one of our EMT's killed a pt admitted it to family on scene and still works here) These people could have easily been weeded out had our company spent a little more time with them(or made sure they got the help they needed in the beginning)

We just received new SOG's in our region of Illinois and one of the big reasons is due to several medication changes. Our region took away lido and we now only have amio as an option, I don't really know the "Official" reason behind the change other than the two level one trauma hospitals in our area (St. Louis) use amio. Several of the medics I work with have made discontent statements about amio for the same reasons all ready listed... cost, unsuccessful use in the past, etc. Several medics either do or have worked for other companys with amio as an option, they also just gave us the SOG's to use glucagon those are the two big changes I know of

I have two involving the same medic 1. we got dispatched to a resp arrest the moment we come in service. we get there to find a woman laying in high folwers c and a&ox3 with a cpap going. My partner asked the SNF nurse why this came out as an arrest to which she replied with: her labs say she is crashing CO2 at 100% and O2 at 50-60% 2. the other he told me about yesterday, a guy's sister called 911 b/c he had a croche needle stuck in his rectum. accordingly it ended up poking out of his left check and had been that way for two weeks. needless to say it was very very infected. the pt states he "fell" on it... thing is this is the second time in a year that this has happened only last time it poked out of his right check...

Final results: We transported her to the hospital, and they treated her as they saw fit, regardless of her refusing they started an IV(b/c my partner did not) and fed her fluid and flat out ignored her protesting(ED Doc. said she was AMS) dispatch called us 10 8 b/c of a 10 50 roll over 15 to 20 miles north of us(status 0 and no one closer) so how it went after that.... dunno

Thats just it... medical control ditched us... told us we were on our own... my partner is a push over sometimes and let them off the hook with that..

The major point here, aside from the 'unusual' religious comments made by her, she would not give us enough to assess her mental status. So it boils down to what do you do if you can not prove if she is A&OX3 or 4 or not. We made our decision based upon the fact that she was making said statements about God, refusing meds for at least 3 months, and refusing all food and drink for 2 weeks save for what little family basically forced down her. Medical control was no help, and her Dr. just wanted her to go and thats where he ended it. So when you have minimal information with which to judge you do the best you can, in the end I do believe we did what was right medically for the pt, however the question remains was it legal? Given only what was in this post alone not one person could say she was mentally fit to make her own choices.

I wish it was, beleive me I really do

PS the DON at the SNF was highly upset we did not just come in throw her on our strecher and leave regardless of her mental status. I personally feel as though I could not trust what she was saying due to the fact that she was hell bent on the pt leaving. The nursing home is not a 'nice' one and has a hx of bending/breaking rules.

done three different times, once by me, once by my partner, and once with her son in the room and her Dr on the phone. all to no avail. The only part I left out was that in between answering "It is my right not to answer your questions" she would call out to Jesus. She would utter phrase like "the Lord will take care of me" and "the Lord watches out for me" so on and so forth. After attempting to talk her into going with the family and her Dr, her son stood up and started to shout for the devil to leave his mom. (funnest part of the call in a messed up way). We were on scene for well over two and half hours working with her. After her son's little episode my partner the medic took him out to the hallway and i sat next to her and started talking about how God only helps those willing to help themselves and Jesus was not going to call her 'home' until he was ready, and that with her being the way she was she was interfering with God's work. She finally broke down and said, "Do what is best, do what you have to" and she did not say another word to anyone until we got to the hospital and said "I forgive you, I know you are just doing your job, and may the Lord bless you for it" POA is power of attorney

the history was relativity unknown and the staff says she had dementia, but there was no offical Dx and in our SOPs POA has ultimate say i such situations

I have a question about a situation my partner and I came across the other day. It starts with us being called to a local SNF for a non-emergent transfer to a hospital for dehydration. When we get there we are notified that the pt came to them in January weighing in at about 86 lbs. She has refused all meds, and more and more frequently refused to eat or drink. She currently weighs in about 70 lbs. When we walk into the room she states she does not want or have to go to the hospital. When we try to ascertain her mental status by asking her age she replied with "look in my chart." and then every time from that point on when we asked her a question she would reply "it is my right not to answer". My partner went and called medical control, while on the phone with them the SNF reverend came into the room to talk to her. She told him to leave so she would not have to get mad at him. Medical control told my partner what ever we do, document very very well. So my question is what would you do in this situation? Recap: refuse to answer questions, refuse to sign DNR, has her own POA, refuses to go, failure to thrive, Dr staff and family want her to go to ED After contacting our sups, talking with her Dr and family, and a second call into medical control(which ended with the same results) we decided to take her. In my opinion we did what was medically best for the pt, but was it legal? Did we in-fact "kidnap" our pt?

I am just a basic so don't take what I am about to say as gold, but I believe as it stands now in our SOPs we are only allowed to start EJs in arrest pts. And as of this moment (new SOGs coming soon) our SOPs also do not allow for us to carry or use glucagon. We carry d50 and oral glucose. And even though the new SOGs will allow is to carry it it will be a system specific carry. So we in the private sector still will not carry it.

I'm already getting a feel for that. We have had to do two or three otc and yes it sucks.

It all goes back to Basic class 101.... saftey first

I understand Ruff and Dust comments and I agree I am not comfortable using or carrying a teaser, but there are areas in our coverage that regardless of the call the police will not show up. And if they even do show up, they are terrible at clearing a scene, case in point: older teenager shot in local gang violence, police come and clear the scene, victims younger brother about 10 to 12 yo was in the room with the victim and two of our crews. That young kid pulled a gun and told our crews that if he died they would die. Only the quick thinking and fast talking of one of the medics got the young kid out. Case point number 2: Same town similar situation... gang sponsored shooting police on scene... victim loaded into the back of the rig... bystander tells the EMT that if the victim survives they will not. Case in point number 3: again shooting victim loaded into the back of the rig, cop opens back door gets hit in the back of the head knocked out second man jumps on the bumper reaches in and puts three more in the victims chest and this is the same town that it took police five hours to respond to a murder.... my companys medical control Dr is looking into ways our crews can protect themselves since in some areas the police are less than reliable. I, like I'm sure most of you, have reasons not to die tomorrow on the streets, so I will take and do whatever is necessary for that not to happen, including staging for extended amount of time, until police are on scene.

apparently not so little anymore... they said they are huge and growing

I am trying to get a fix on this company AMR. They recently bought out my private company and ever since we have received all kinds of promises (rumors to be truthful) about changes that are going to be made. So far the only changes I have noticed are the change in company letter head, and some extra on line training. I just want to know if or what kind of changes may be coming down the pipeline. Thanks for your help.