under-dreaming

I'm beginning to think that the whole thing is a set-up. The OP's name is a little ridiculous (not that mine makes much sense), and he has given way too much information for a favorable outcome. It is almost like someone is trying to ruin his reputation.

Then again, he might just be confused...

That is an awful situation to be placed in.

First, I would like to thank you for sharing your story with everyone here. It is hard to relive these situations... then again, it's hard not to. They tend to stick in the mind for a little while.

You may find relief in another EMS system. Apparently, the common theme of the comments here are that you should get away from it. I personally couldn't disagree more. Places like that need you. The potential patients need you. You may not be in a position right now to have an overwhelming influence on the system you operate in, but eventually you will. The key is to allow positive growth within yourself as you operate in this system. Your presence will change things. Your positive and proper actions will change things. Believe in the power that you do have and hang in there. The hardest part will be keeping yourself pointing in the right direction. Often times, individuals will adopt the methods of their peers. In your case, that would be a negative thing to do. So keep that in mind as you carry on.

Not that you should think that leaving the system would be a form of quitting. I don't even know what your situation really is. Only you can know the reality of the situation, and how it is affecting you.

I have learned from your story. Your experience has made me more aware.

GVAC is where he currently volunteers, how is this offering him a new career?

I jokingly said I should apply based on my tremendous experience.

My mistake. I thought that you were informing people on ways to contact his co-workers to bring them into the topic. I apologize for the misunderstanding.

By the way GVAC is where jerillyn/beegers/whatever her name is now on here, volly's so one phone call to her and im sure she could enlighten us to exactly what the situation is ..

That is the line I was referring to. I was kind of trying to be funny too, in a way.

I've been an EMT about 2 years, I average about 10 calls per shift, 4 shifts a week ... that's about 2000 patients ...

Maybe I should apply !

By the way GVAC is where jerillyn/beegers/whatever her name is now on here, volly's so one phone call to her and im sure she could enlighten us to exactly what the situation is ..

http://gvacnj.org/

if anyone wants to browse around ..

The kids looking for advice, not a new career. But I guess it's hard to stop a boulder once it has started rolling down a hill though, eh?

There is no actual situation here besides the one that you are creating in your own mind. There is no doubt that you feel hurt. You are the root and the cause of those feelings.

"He who feels punctured must have once been a bubble... He who feels belittled must have been consequential, He who feels deprived must have had privilege..." - Lao Tzu

The good news is, you can overcome this. Once you are in the mix of things, it is easy to lose sight of why you were there in the first place. We enter into this profession because of the drive and passion to help others when they need us the most. We are here for others, not ourselves. Your situation is just one of the many lessons to be learned in life. Rock_shoes is right by saying that you are lucky to experience this at your age. I just hope you see it for what it is. You don't even need to respond to any of these posts here. The change has to happen within yourself, and nothing else matters. Set your heart in the right direction and you will not feel the tension of these situations like you have. You don't need to be a Lieutenant to practice the skills that can save lives. If you truly desire to pursue a career in this field, the opportunities will present themselves and you will climb up when the time comes. In the meantime, just be.

for BLS providers, who I think as a general rule should never just wait on scene for a patient to stop convulsing.

That's what I thought too. My BLS textbook says to remove surrounding objects, place something soft under the pt. head, monitor airway, possible O2 application, and then transport when the pt. stops convulsing.

It was an extremely vague section in the chapter regarding pt. with ALOC. I really just needed to see what the people in this business really do. You know how it goes. Thanks for your input.

Thanks, Dustdevil. The EMT was able to get an IV started when we parked at the hospital. The pt. convulsions range from moderate to severe... kind of like ocean waves. BP, P, SpO2: those could have been gotten easily in my opinion... glucose check too. You may be right, pertaining to interventions from the findings of the V/S. However, I don't like making a hospital radio report and/or face to face report when I can't even tell them any useful information. It might as well have been the family dropping him off in the ER. In a small town, reputations for cutting corners can develop quickly... you know what I mean?

Thanks, everybody.

Good story, Happiness. Thanks.

Waiting is not always the best thing to do. I once had a pediatric seizure patient, who didn't stop seizing the 7 minutes we were on scene, and the 20 minute ride to the hospital. At that point it was a carry him, strap him as best we can, and intercept with ALS. (This patient was also hot to the touch, and cooling didn't work to well.) ALS pushed a variety of drugs, but he didn't stop convulsing even in the Pediatric ER. This kid did had some type of disease (can't remember, was long ago), and the only thing he had going for him was the fact he had a trach stoma, making it easier for us to breath for him. Waiting would have had worse consequences, and we would have been on scene way too long. It all depends.

Thanks. Apparently we have to remain open to adaptation (as usual). And that's what I initially considered to be the case. It helps to hear stories of application. I appreciate your time.

There is really no reason to backboard this patient, unless the fell and suffered trauma during the seizure, since this is a known seizure patient (it would be different if he had no history of seizures, or you had no idea what his history is). In this BLS scenario, with you knowing that this patient does tend to have seizures for greater than 20 minutes, I would load and go to the hospital (starting an IV, placing him on highflow O2, and maintaining his airway enroute).

It is a very simple algorithm to follow. Thats what bugs me about this other technician, laziness. The backboard has to do with the stairs we have to bring him down every time. Pretty much every house here has some type of elevation that we have to deal with.

**Right, I didn't realize I wrote in the question that it is normal to put the pt. on a backboard... my mistake.**

Read zzyzx's post about Washington medics in trouble --- bet they got that guy to sign a REFUSAL.

Already did. That was exactly what I had in mind when I was writing the comment. We can never be too careful, that's what I try to remember in those situations.

My reasoning is probably based on the fact that I haven't been in the system for very long at all, so perhaps I don't mind so much due to not as many ridiculous encounters... yet.

I don't think it is ever ever necessary to take it upon yourself to tell a pt. that they don't need an ambulance and then have them sign a paper releasing you of liability when in fact it is your words that created that situation. If a capable adult does not want to go to the hospital, even if they did not activate the EMS system, we have been trained to inform them of the implications and essentially release ourselves of liability. That is the only way that I want to do it. That is the only way EMS providers should do it.

If someone can give me an example of how these "unnecessary" pt. transports hinder and endanger the EMS system within your work area, I would like to see the evidence and then stand corrected accordingly. Also, we must remember that it is often these "unnecessary" pt. transports are the bread and butter of this business. Frequent fliers need to be dealt with after the fact. Try to talk to them en route about their habitual abuse and refer them to alternatives, if there are any. Perhaps the family or the hospital can also be of assistance in these matters.

We see the articles from time to time regarding mistakes involving pt. care (more appropriately the lack thereof). We mustn't allow ourselves to develop these dysfunctional habits. Eventually we will fail the patient if we take these situations lightly.

EMT-I is NREMT-B; EMT-II can initiate IV, intubate and push some drugs (NREMT-I '85); EMT-III pushes more drugs and higher level cardiac skills(NREMT-I '99). EMT-II and III are considered ALS.

The hospital is within two to five minutes drive from most areas. So yes, load and go is often a very wise decision. Usually additional resources are called upon for moving larger patients or for trauma incidents in colder weather.

That is such poor care! Wait, did I just say care? Why bother calling the ambulance? Just chuck him in the back of the family car and off we go.

Why is ALS not called? Seizures really don't warrant BLS.

Like I said, he is pretty much a bad example all around. The family doesn't know any different though! That's the saddest part.

This is a rural area, and we do not offer service above EMT-III in the fire department (and that has to do with who's on shift). During the day shift, there are two EMT's on duty; at night, only one. One of the off-duty staff or a volunteer answers up at night when there's an ambulance call. The EMT in question works nights at the beginning of the week, I work nights at the end of the week. I just happen to answer up to drive for him from time to time.

If I run on a pt. in cardiac arrest or a GSW or what have you, I can request ALS assistance if the hospitals flight medics are in town, and they can offer assistance. My chief is also a paramedic.

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Hello,

I would say 'load and go' if the patient had been seizing for 20 minutes. Any interesting history on this

patient?

D

Well, since you asked, I'll give you what I can.

Like I said, I've run on this pt. twice. I wasn't running the call, so I didn't get much Hx on scene.

30 y/o male pt.

Arrive on scene to find pt. supine on living room floor actively convulsing. Convulsions are mild to moderate. Airway is good.

The EMT running the call (EMT-II) had been there before, so he didn't gather any information whatsoever other than the duration of the seizure.

The pt. was loaded onto the backboard and we carried him out to the ambulance. No vitals on scene, no vitals in the rig (the hospital is just around the corner... not that it justifies cutting corners though). My partner told me to just go ahead and roll-out. When we got to the hospital he threw on a hep-lock just before we took the pt. out of the ambulance. and brought him in.

**Just for the record: I don't really look to this particular EMT as a good example of an effective EMT.**

This patient has a history of seizures. I don't know what is causing them... I don't even know if the hospital does. As you can see, the history is not interesting at all. My biggest concern is that this EMT is creating a habitual response to this patient. And the concern is not for the EMT, it's for the pt. and the family. Because if I find out that he has been dealing with this the wrong way every time, but the family is used to seeing him deal with the pt. in that manner, then they will think that I am doing something strange and wrong when I am the one making pt. contact without this other EMT. It is just something that I have been thinking about.

This is one of those situations where there is no one-size-fits-all right answer. If you are an ALS crew then stay on the scene and stop the seizure. For a BLS crew it may be more beneficial to the pt to get to the hospital as quickly as possible. However, if you can't move the pt safely while they are having a seizure then it may not be a good idea to do so. But, if they have been seizing too long you may be doing more harm. How is that for an answer?

Thanks.

Very good observation, Vent Medic.

It comes down to personal devotion to expanded knowledge and actual understanding. The people that I am surrounded with in the EMS system are knowledgeable. And I believe that the system up here has facilitated their growth. I'm not trying to get too far out of line here and boast Alaska as being the ideal model for everyone to follow. Ultimately, I wouldn't know. So I really can't say too much. I am seeing a lot of opportunities for me to expand my knowledge and skills in the EMS system. And for that, I'm thankful. It's not just about the place and the policies, it's about the people.

Do you always wait for a seizure patient to stop convulsing before loading them on a spine board and putting them in the back of the ambulance? I was just looking it up in my BLS book, and it says that we are to wait until they are finished. Should we wait a long time? What is the wait limit?

I have run on a couple calls involving a seizure patient. The EMT in charge wanted to just load and go even though the patient was still convulsing. The patient had been convulsing for over twenty minutes by the time we arrived (both times, same patient), no harm was done to the patient. Was that the appropriate action?

Any and all information will be of great help. Thanks.

I'm not in EMS so I can act like a cop. I've never been called to a shaving rash/burn before, but like others have already stated above, we would be out of work without the abusers.

ok so i read and have found allot and it leaves me with more questions?

I found out TB can be managed by a few drugs but i don't know what they do? would albuterol do any thing to help?

also TB can sometimes be outside of the lungs and effect other organs would that be worse? what would they do for that?

Sounds like you need to buy a book or two to answer those questions.

Sounds interesting, how is Alaska EMS different from regular old US EMS ?

When I started working up here, I found out there are three levels of EMT in the state standard before paramedic. Everyone in the EMS system seems like they are committed to achieving all three stages before attempting paramedic school. Which is surprising. In California, everyone just operates at the basic level for a couple years, and then jumps into paramedic school. Up here, the stages gradually introduce advanced techniques while maintaining focus on BLS. It seems like it is far more productive for the human mind to undergo that kind of conditioning. Paramedics are on a far looser chain up here in terms of medical direction also. The MICP's are trained to be more off-line than in the lower 48, due to the isolated areas. All of the medics I have met up here are like walking medical encyclopedias... really very knowledgeable. I thing the state regulations have a lot to do with that.

The reason you make double in Alaska is the same as those who are making double in Iraq -- no one wants to go there, so they have to pay a premium. The same would happen everywhere if medics quit working 100 hours per week --- our pay is a supply and demand equation, we just wont let the true lack of supply be seen, so our pay stays stagnant.

Some want to be in Alaska. Some want to be in Iraq. The reasons are very different. I chose Alaska so I can escape the thoughtlessness and carelessness of the city lifestyle and the rat race that I was born into. Naturally, that is a different conversation entirely. However, their is a relationship here. It is the carelessness and thoughtlessness of city life that got most of these terrible EMS systems where they are today.

Perhaps an emphasis on public health instead of public safety would be beneficial (simple foundational language characteristics can make a huge difference in perception). Ultimately, we all want to be taken seriously, right?

Id just let it go dude... probably a joke, at least thats how I interprited it.

So it's one of those "insert laugh here" jokes. I'm afraid I just don't get it.

What was your interpretation? I'm not emotionally attached to the comment, I just want to know the intention behind the words typed.

It is apparent that the money seeking corporate EMS systems are the major problem holding us back. I wanted to work for an ambulance service that was all EMS, no fire. But when I realized the wages they pay Basics in the region I lived with AMR, I was disgusted. I could make that much flipping burgers, and I have a family to take care of. It is embarrassing. And the public doesn't even realize that their emergency responders are paid so little. Fortunately, I found a fire service that is primarily an ambulance service. Unfortunately, I had to move to a different state to find it. It truly is a great situation that I have with the city fire department. We are an EMS minded fire department who puts fires out sometimes, and we know it.

Federal programs are great. Federal control is not great... at all. But when a state gets the proper funding then the county/city can get the proper funding. Ideally, it all starts federal. Do I want a politician in D.C. telling me how to operate in a town that they have never even heard of? No way.

In Alaska, there is too much money circulating. This is due to the cultivation of natural resources. Because of this, city/state employees are able to budget in a fashion that is productive to growth. Therefore, the Alaskan model is going to be in a different category than the lower 48 states. But because of the existence of the Alaskan model, and the EMS system available here, the government can see the potential for other EMS systems when there is a little extra financing in the right department. I'm not trying to say that Alaska is a brilliant, spotless EMS system. But the fact remains that I am making more than twice as much to do the same job, and all training is paid for and highly encouraged.

There is such a thing as effective EMS without corporate attachment. I hope that whatever funding is available in the Obama administration is able to find a good home; and for those who need it most: speak up and speak loud, otherwise it may never find that home.