defib_wizard

This is an ALS pt. Especially in southern Az. Where med control can be pretty strict. The only way I could get away with giving this pt to a bls crew is if i had a critical trauma on the same call. I have had this happen almost simular except the pt I had was stabbed in the abdomen with evisceration. pt 2 was stabbed to the scapula. No SC air. I had a basic emt I trust assess the lung sounds and report to me. I would trust this emt with my life as she is my wife. She was an IEMT for 8 years until she had to downgrade or retire. ( long story that still ticks me off!) We got my pt loaded the bls crew left the scene right behind us and followed to the hospital with orders to notify me if the pt status changed. Transport time was <3 min. I agree not the best solution but this is how rural ems sometimes has to be done. The good news is an er nurse was there and hopped on. She rode to the ED with them and kept reassessing him. In a urban environment with a herd of medics this should not even be a option. IMHO they wanted to go back to bed because they probably moonlight as a construction crew on their days off. And they had a big job the next day.

i was just telling my wife about this event. She is interested for next year. If possible there may be a small clan from northern az warming up to the "campfire ".

If the pt arrests in front of you, a precordial thump can be done. This does work but not every time. the other down side to this is people see you hitting a pt. They don't understand your trying to help the person.

As a rural provider we use helicopters frequently. However the majority of the time we transport to the local ED. and they set up the flight. We also use multiple fixed wing services for air transport. They are cheaper and the cabin is pressurized. There are some circumstances that almost make calling for a helicopter mandatory. The other night while finishing my paper at the ED the doc. was getting upset about waiting for a CT report. The Radiology dept finally let him know the system that transmits the CTs to the radiologists is down. We were then dispatched to a rollover mva. The ED staff requested we fly the pt if it appears he would need a CT. Well he had s/s of a closed head injury so he got a helicopter ride to the trauma center. I agree it is much safer for everybody to use lit helipads, than a hot load on a dark interstate. But sometimes it is what is necessary in our area.

I would gladly take a test from you dustdevil.Even if i fail it would tell me what I don't know, and need to work on.

If only the taxi's accepted medicare assignment.

Congrats!

I agree with reaper, get the refusal and go in service on scene. Inform her from the beginning that you will leave if another call comes in. Another option is to get a local senior center involved. A lot of communities have volunteers that will go out a few days a week. To visit with them. Another option is find out if it is legal to bill for refusals in your state. If it is then get her billing info and have your co bill her base rate and stand-by. As far as I know medicare doesn't pay for refusals. This may sound cruel but the fuel and other cost to drive over there has to be considered. All non revenue producing calls keep me from getting a raise. She may think twice about calling if she has to write a check for someone to make her a sandwich. Good luck.

I just looked at the rate schedule at the dhs site and amr is not listed yet so they should be going with the rate river was charging. If so there is no difference in the rate from als to bls with no charge for supplies.

Well first things first I'm real glad you had a better shift. Second I got the date wrong saturday is the 4th. ( But I had just finished my last call and was lying down & the post before that I had to submit quickly because thats when the first call of 6 in a row came in 3 assaults 1 altered loc 1 drunk and a head & an injury rollover on I 40 ) 2 had to be picked up by the bls crew. I'll see if the other service has any openings if you want then I will pm you with the info and where it is at. If this is something you want to do let me know. i want to be upfront with you about it because there will be a definite culture shock from back east and it is different from kingman. Per Az rules the co has to charge for the highest level of care no matter what. The pt will get billed for als even if you didn't do an als procedure. But it is good form to put everyone on the monitor, emts can't do that so they have to bill for als. Again I'm glad you had a better day with a better fto .

I think guardian ground is testing om Oct 5 ( saturday ). they are in flagstaff. Williams is ran by lifeline out of prescott. Let me know I'll try to help.

Kaisu yes it is business as usual here. Part of the problem is there is a shortage of paramedics in the rural areas. I do agree that the other people on here that amr not giving you at least a shirt is total BS. Where I work is based with FMC. We have offline medical control and a very progressive medical director. ( for az) He is a former medic. We can give up to 14 mg of morphine without patching. If you are interested I can give you the phone number of the service 30 miles from here. ( we just filled our last 2 spots ) We have 12 leads and carry versed. Just pm me. But I'm warning you it is very rural you will transport primarily to the hospital in my town. I think they do 1400-1700 calls a year.

Call your base hospital prehospital coordinator for them. If you don't have their number you can get it on the dhs web site. It is an optional drug in Az we don't carry it here because it won't work if it ever gets hotter than 77 degrees. You are right but 12 lead is not a requirement here, yet!

:shock: What? You start a new career in a new place and your overwhelmed? ( Just giving you a hard time) Ok I am going to try to help you. Before you decide to quit, if it doesn't get better PM me and I will try to contact a few friends that are medics in kingman. The good news is you will use your skills and be a paramedic not just a gurney jockey. It just takes some time to get used to ems shift work and its nuances. Kingman is a unique area, it is small enough that it is a rural system with a large area to cover. But it is busy enough at times it is like working in a large city. Stick with it you will hit your stride and be just fine. If not let me know and I'll see if we have a place for you here. ( I'm 200 miles east of you on I40 ). Now for my opinion of why they are being hard on you. 1. you not from there. ( nobody trusts outsiders ) 2. You are female. ( yes this is BS but true ) 3.The don't trust you because you didn't do the "normal" thing and pay your dues as an emt basic. The emts think you were never one of them so why should I respect you. You probably intimidate the hell out of the other medics that stayed through the sale. Some of them can't go anywhere else. A lot of the bright ones jumped ship and moved on. So here is my advice to you; When you get on duty get with your emt and go over your rig. Try to instill a team approach with them. I realize some of the opinions of basic emts on here can be pretty harsh. But they are a part of the system here and can help you especially the ones that are good at what they do. You will also earn their respect if you will show them that you can help stock and clean your ambulance. Remember they are the worker bees in the colony. As far as your FTO's are concerned, be a paramedic, assess the situation and act on it! If one likes short narratives try to include "just the facts" and make him happy. In other words you have a bunch of people that do things in their own way and each believes it is right. Also they are a preceptor sometimes not by choice but by being forced into it. "Wouldn't you rather be back at quarters relaxing than babysitting this person that takes forever to do thier paperwork"? They will also try to push you out because without you being there then they can get more overtime. You are taking that away just by being there. Above all be patient, you are in a new environment for you. Plus the environment that your coworkers are in has recently changed. This has caused a lot of waves in the pool you just dove into. So fight to the surface catch your breath while treading water, then start swimming with the current to a place you feel confident in. You can do this ok! End of lecture.

Dustdevil wrote; If he does I bet the tie isn't a clip-on! :shock:

change of address card rhythm.

Hello everyone from the state of Arizona. I joined this site a few months ago and have actually enjoyed a lot of the discussions here. I've been a paramedic for 13+ years and was an IEMT for a year before that. Lately I've been discouraged with my life so I recently downgraded back to a basic emt. I figure my life would be much easier with less accountability and resposibility. JUST KIDDING! I didn't downgrade, I just wanted to make DustDevil drop a brass twinkie! LOL

take a look at these guys. www.Medic-CE.com

Do you still have national registry? How about the link that says Earn Paramedic CE Online at the top of the page here?

I don't understand all of the arguing. Some people sound like they watch too much Judge Judy on duty. Experience is something that will come in time. It is up to you to decide whether the experience will help you be a better provider. If you go on every call with the attitude that you can learn something from the pt, it doesn't matter what level you are. While getting this experience you have to ask "why?" Develop a learning and helping team type relationship with the hospital staff. Most of the time the Docs and RNs will share their knowledge. If you think that experience is not important, then should we call BS on the "heavyweights " of this site when they describe theirs. It is education and experience that assist you in critical decision making. A new medic that has limited clinical experience may miss some of the finer points of pt assessment. This could keep them from giving a patient something that could make them better. On the flip side a medic that has been "just running calls" with lots of call experience and a limited education can be just as detrimental to the pt. Hey at least I waited until 20 posts to wade into the fray.

I agree with the argument about no transport on people with cpr in progress OK. However here is a situation that we have to deal with in our area. If a person dies in the residence, it is either abandoned or burned by the surviving family. So there are a few cases that to prevent the family from having to do this. We will transport the pt with cpr that would normally be pronounced in the field. This is a cultural / spiritual belief. If it is an obvious DOA then we will pronounce on scene of course. Does anyone else have issues like this in their response area?

Ok what happened to the medic?

leave it I prefer to make my own bottles empty. 4 bottles of pale ale. Full and unopened.

fire_911medic wrote I believe the toxidrome doc was mentioning is for anticholinergic overdose. Which X would definitely fall into.