Flasurfbum

How aggressive do you get when treating patients? This was brought on because of PALS today. I got a question wrong, which basically said the NRB was no longer sufficient for the pt. in question. As usual, 2 answers were wrong off the bat, but 2 were real possibilities, and, in my opinion, it really depends on the aggressiveness of the medic. One stated a BVM is sufficent. The other stated that intubating the pt was the right course of action. Being aggressive, and staying one step ahead of the problems is what I have been taught, and I went with. So, I choose intubation. I was wrong. So, not just pertaining to this question, but in general, how aggressive do you get with intubations, IOs, and med admins? I am a fan of pushing meds as a last resort, but when do you go straight to the drug box?

Good call Bro. I am glad I am down here. For those who are thinking of working AC EMS..... be aware, the pay sucks, you get treated like crap, but you DO get to see some cool stuff, and get excellent experience.

So I am at my clinical today (still there right now). I put my gear on the Ambulance as usual, and checked everything out. We run a call, and my preceptor tells me to take the pants and boots off (zip up Pro Warringtons) the truck, or I am going to be taken off, since "I wont be near any fire" :roll: . Aigh, the things I put up with for clinical hours....

[quote="mrsmall"To be honest, fire rescue is usually first on scene or right on top of us... any time I've been first on scene, I either didn't REALLY need the gear, or by the time I'm all suited up, fire already would have been doing their thing. The only time it is actually needed is like, hurricane/tornado stuff... as far as our service goes... yeah, a LOT of people are very upset... we have to reapply, go through probation again... we are not allowed to buy into FL retirement, so everyone gets their 403B cashed in, and has to start over... not to mention seniority is null, people are losing 1/3 or more of their pay, all of the supervisory positions that have the title "lieutenant, captain, cheif" require dual certification, none of our ranks are recognized. i could go on and on... they will have 100 open ff/ems positions and like 50 ems positions open.. to get in the single cert position, their physician has to declare you medically unable to attend fire school, (so unless you have a cardiac history worse than tachycardia, you'll be going)... only 7 people have applied, and the chief is getting ready to shit a brick...

Even on MVCs? I see you are form Ocala...my guess is that you are, or are about to become a FF, if you worked for Marion County EMS (that was a raw deal). is there not an SOP put in place for that? I know from mid March to late November is royally hot and humid, but sweating a tad to be safe is worth it, no?

Mandatory, no. It is merely an insurance policy I took to ensure, God forbid a flash fire occurs while I am attending to a pt in a wrecked vehicle, or a chemical is splashed on me, I have protection greater then my uniform would provide. Why wear a seatbelt? Why get health insurance? Cause ya never know! :wink:

Allow me to clarify, slightly. http://www.globefiresuits.com/lifeline/products/ems-gear/ MUCH lighter, easier to move in, and less expensive then true bunker gear.

Come on Dust, I am pretty sure you know what FD I am talking about here... high turnover, burnout among their "FireMedics" I assume that they were expecting the usual wide-eyed, fresh from EMT school, but not yet possessing a card, just outta the Fire Academy, and still doesn't have the first clue about anything Medic Student. Yet another reason I am in favor of actually working in the field prior to becoming a Medic. I was fortunate in the sense that my uncle is an officer on a PD in Jersey, and assisted me in locating :wink: a bullet resistant vest. It saw heavy use when I worked AC EMS, but I am lucky to not have put it on since I got back.

Does anyone else have a set of this? In Jersey, where by law, we were required to have a "bunker" type coat or jacket on the ambulance. I managed to bargain myself a good deal for a set of Globe EMS gear, non custom, off the shelf kinda stuff, but hey, its water proof, Nomex, and fits. What else can ya ask for? When I moved (back) to Florida, and I brought it on my clinicals, I was met by surprise, and somewhat of a Rescue Ricky response from the crew, who, incidently, wore bunker gear on all their MVCs. :roll: So, who else has it, and what are your opinions of it? There is potential for abuse by the wackers, but like anything else, it is a tool for us to protect our selves.

I have still to ascertain exactly what happened, but the AC EMS crew is at least half way competant. I have no doubt that they would have split the crew, and used the Engine that would have been responded for the MVC. There is no doubt in my mind that they would have ignored either patient. What I do suspect is that the underlying racial tensions, which have been boiling in this city for quite some time, have begun to boil over. And I hate to bring race, sex, or religion into ANY discussion, but there is a somewhat angry, undereducated segment of the population that is looking for an excuse to start trouble. They had Al "Who can I accuse of racism today" Sharpton in the city earlier this year to support a malfeasant "Firefighter" who has been disciplined multiple times for infractions ,and accused a Capt. of making racial comments/remarks, which were never proven. The way things are going, there will be a large event this summer....its just a matter of what triggers it.

Congratulations!!! I can only imagine how you feel right now, but I DO know the feeling of overwhelmingness. (I think I just made a word... 8) ) Double Congrats for the degree! I hope to start mine just as soon as I leap this hurdle known as Medic school....

Dwayne, yes and no. IMO, with crappy wages (10.50 an hour for an EMT to run 10+ calls in 12 hours), and retention of bad providers, coupled with the arrogance of "we are AC EMS, we can do this with no help from anyone else unless we REALLY need it, and the companies desire to turn a profit, and staffing the city, which has over 100,000 citizens, and visitors in it at times with the bare minimum of Ambulances, I think that there could have been a delay in the second ambulance getting there. Of course, with the absolute piece of crap VHF radios that can NOT be heard by another portable a block away, perhaps MedCom didn't hear the request for another one. :roll: :roll: And chances are, there were no Medics on scene. With only Medic 6, who is liable to get called to anywhere else in the County, and Medic 1 (the AtlantiCare SCTU for ACMC City Div), and the fact any Medic was probably recalled by the BLS crew, the chance that the pt got one of the few level headed, competant people there is slim. God help NJ EMS.....

I have actually never heard of anything other then a Firefighter staffed ambulance being referred to as a Rescue here in Fla, and I have traveled to many other areas outside my little area. Heavy Rescue, Squad, and Utility, but not just Rescue. Mateo, you are saying you would rather work a code by yourself, the accept help from the FD?? :roll: Yea, if I am down due to cardiac arrest, hold the FD, lets wait for EMS to get there. I mean, unless its a Paramedic doing CPR or Defibrilliation on me, its not good. :roll:

Dwayne; Most of the Car vs Ped MVCs are complete and utter BS. Some one walks into a moving car, takes a dive, and hopes for a payoff. Most are lower class, no job, no hope for income, and are willing to do almost anything. While I got my arse kicked a few times, and had a friend on another truck had a knife pulled on him, there were no riots, at least while I worked there. Atlantic City is a cesspool that is rapidly circling the drain. For a large city, they often times have just THREE ambulances available, 4 in the busy summer months, and certain other times, as per the contract with the city. Gotta love private EMS!! :twisted:

So happy that I don't work for AC EMS anymore...

NFPA is a joke. Really. But we don't know what calls are BS, and what are not. In my short career, I have responded to several "Activated Fire Alarms" that turned out to be multi alarm structure fires. But to justify the levels to be bean counters, we have to prove that we respond to xx amount of calls, so we need xxx amount of money for staffing the apparatus. Bassackward? Yup. But until common sense :roll: is used, we have to play their game.

I see alot of, what appears to me, as the usual, undereducated posts about the fire dept. YES, we need those big ol shiny trucks. YES, we need 4 on an Engine, and 5 on a Truck/Ladder/Tower Co, and 6 on a QUINT, in order for the unit to properly do its job on fire, and rescue (note, rescue, NOT EMS) scenes. NO, not every piece of apparatus needs to be ALS. Not on your life. ILS Engines, BLS Trucks and QUINTS should be the norm, coupled with ALS Ambulances. I do, however, see the necessity for an additional piece of fire apparatus on ALS calls. C/P, SOB, Cardiac Arrest, anything where an additional set or 4 of hands is needed. Not all Firemen want to be Medics. Not all Medics want to be Firemen. All of us grunts appreciate that fact. It is the upper echelons that order this. In order for us (firemen) to adequetly staff our apparatus to ensure that all the necessary fireground functions are done, we have to consistantly respond to these BS calls to justify it to the bean counters. So please, do not hold the line Firemen and Fire/Medics accountable for the policies of the administation.

Dang Dust, you beat me to it. Where in Fla are ya?

gaelicfirefighter; That was one of the most well articulated, and thoughtful posts on this subject that I have read. Thank you for your insight to your cit and its workings. I have much for CFD Jakes. We have a former CFD FF on my dept, and he is an incredible asset to draw information from. I have worked in a cit (Atlantic City) where, for the most part, all 3 services (ACPD, ACFD, and Exceptional Medical Transportation who had AC EMS Contract) got along well. ACFD responded to ALS calls outside of casinos, and their FFs had a good grasp of BLS skills. We could arrive to an Engine Co. who had (accurate!) vitals, and they were working on a pt hx, and meds by the time we arrived. The system I am a Medic student in is well, a mess. Fire has pwned EMS. Hardcore. The County F/R is the only ones who can transport prehospital pts, and lawsuits have been filed to stop that. They also have all ALS Engines, and FORCE all new hires to become Medics within a year, or be terminated. I was in class with their latest group, and they b*tched, whined, complained, and some days just slept through class. They scrape by the skin of their teeth, and one day, will be riding the Rescue that MY family could be requesting. I ended up switching classes just so I could escape their amateurism. We never can really get along until we fully understand each others jobs, and appreciate what we do. Sure, you may work where the FD is a bunch of beer swilling, redneck slobs who have more blinkys in their POV then the latest Galls rag has, but don't ASSume that all Firemen are like that. We are, for the most part, a hardworking group, who trains constantly. On shift, during conferences, and across the country. Your perception of us may be a lazy bunch who sits in recliners, or sleeps all day. That is usually the "retirement house", where the Crusties spend their last few years on da job. They have earned not waking up 7 times after midnight. They are the ones who have served their time on the line, and are passing what they know to us young bucks. I took a leave of absence from this board. I came back a different person, with more respect for my fellow EMS providers. All I ask is that you respect my fellow firemen in the manner that you wish to be treated. We truly are a Brotherhood, and will come to the defense of one another at a moments notice, no questions asked.

Great stuff! Sounds like a Mega Code I had today. It is pretty cool to be able to understand a code from an ALS pov. Thanks again for the info, and the strips!! And good job!

A certain resident of Atlantic City would call 911 to Arctic and New York Aves, or in front of the old unemployement office, just off NY Ave. Sometimes 3x a day. All for "seizures". Usually for a sammich. Sad thing is....he actually has/had a seizure condition, and did occasionally suffer from a real seizure. Last I heard, he was doing time for something....

Amen Brother. As a soon to be Medic, I am "shopping" around the agencies for a job. Hmm, well, i could use this new patch and work on and ambulance, and make 13.22/hr. Or I can go be a lifeguard for a city, and make roughly the same amount. Hmm, decisions, decisions.

Hmm. Interesting. Between teaching surfing, being a surfer, and doing my clinicals on beachside Rescues, this is something to take into consideration.

Humor really is the best medicine. If you can incorparate a joke, a lighthearted moment into a medical procedure, then it makes it that much easier to perform. Of course, it all depends on the Medic, pt, and situation. Since I started, I have tried to bring a sense of calm to a situation, and I have found that humor truly is the best medicine. Often times, I have arrived at the Ambulance Bay with my patient, my preceptor, and I in stitches from laughing, all the meanwhile, getting my assessments, and treatments completed. If you can take their mind off their ailment, from stubbed to, to amputated arm, for just a moment, then you have done well.