crotchitymedic1986

Unfortunately there are financial realities in EMS, and reimbursement is a huge issue. The poor areas make up the majority of the call volume, but it's either self pay or state aid with pennies on the dollar for a return. Unless you get subsidies for providing that service, no company will operate in the red.

This is why it is so difficult to fight fire based EMS. It's not about level or quality of care, it's about doing more with less. Lets say an area uses a 3rd service provider. A municipality sees it can save money by sending a fire company on medical calls, who then determine if transport is needed and the type of care required, thus reducing the subsidy it provides the ambo service. Then the fire service realizes it can actually generate revenue if they take over transports, and voila- we get the problems we have.

So true Herbie, but as I understand it, the Fire Department can not take over this zone as long as there is a private provider who will do it. The rumor mill states two providers have volunteered to run it if they can get both zones. Looks like alot of Rural Metro staff are about to take a huge pay-cut, if they can find a job. My buddy states that the new services will probably hire off-duty firefighters (at a much lower wage), and not use ex-RM folks because they perceive that they will have attitude or will intentionally do things to mess up and make the new company look bad. At the same time, apparently the Burgerking has declared that any employee who applies for another job will be fired on the spot (sounds like lawsuit time to me, or maybe most of their employees should suddenly get back injuries). Looks like a bad time for alot of medics due to their incompetent managers, who let this happen. I can not believe that RM would hire a GM with no EMS experience to run one of their best zones, hopefully they will wake up and fire him and the whole management team this week.

Hearing rumors from friends in Atlanta, wonder if anyone knows the truth. Here are the rumors:

1. RM in Atlanta hired a manager who had no EMS experience, he formerly managed a burger chain. He was brought in to cut the budget and jobs by about 40%. RM had two thirds of the Atlanta 911 zones (a rich zone, and a poor zone). The plan was to pull out of the poor zone, fire the highest paid employees in the field and dispatch, and then rest comfortably on the profit from the rich zone.

2. Apparently when RM tried to get out of the zone, questions were raised as to why both zones should not be put up for bid. Now RM is faced with losing both 911 zones, and being totally out of business, thanks to the genius of the burgerking.

3. I also hear that 12 employees have filed harassment charges against the burgerking and one of his marketing reps through the corporate office. Kharma is a bitch !!!

Here is the only link I could find, is it really that bad down there ?

http://www.cbsatlanta.com/news/22536651/detail.html

Go to Paramedic School, then it wont be an issue. Your best chance is to apply at government agencies that are self insured if you choose to not go to medic school. The more rural and low-paying, the better your chances will be.

Hey doc, guess i missed your comments back when you made them originally, but I am not sure what you are referencing. I just asked a simple question regarding how long orientation is for most services ? I imagine it varies from one end of the spectrum to the other. I made no dire comments about the end of the earth, being blind, or why you should feel guilty. But being a "Doc", i assume you are familiar with the fact that JCAHO makes most hospitals prove (well, not prove, but create paperwork) that their staffs are competent, including part-time and contract employees. This is usually done through orientation check-lists and an annual credentialing process. I wonder how many EMS services could provide documentation regarding employee competence ? Or prove that any new employee is ready to start an IO or could pace a patient without hesitation ?

Here are a couple of thoughts:

1. I have a friend who works at a bank, and is required to wear a suit to work. He makes about $30k, and his suits are $200-500.00 each, and he has to have enough to make it through a 5 day week. His employer does not contribute towards his clothing.

2. I have a friend who is a Nurse, she makes over $40k/year and her employer mandates that she wears a certain color scrub uniform. Although she makes more than friend 1, she still is not reimbursed for clothing.

Be happy that someone buys your clothes for you. Better than that, be happy you have a job.

I seriously doubt that you will find to many "internet accessible" proof of firings for poor documentation. For one, personnel issues should be private, so you will not find the reasons for most people's terminations on the internet, unless they did something incredibly stupid (and poor documentation usually does not rise to that level). Two: Most departments have a progressive disciplinary process which means that for something like "poor documentation" the offender will be given the chance to improve, and most will improve before the point of termination. You might be better off talking with medics in your area to see if they will share some anecdotal stories of how poor documentation almost or did negatively affect them (in trouble with supervisor, sued, patient later died).

Serenity now, Sernity Now ! Something you will learn through experience; no matter what you do, no matter what you say, no matter what plan you have, you will NEVER MAKE EVERYONE HAPPY IN YOUR LIFE. So rather than give any of these morons any control over your day (that is what you do when you let your B/P go up because of something someone else said or did = if they are controlling your mood, they are controlling you). You have to stand-up and decide what battles are worth fighting and which ones are not worth your time. As suggested earlier, smile (dont be rude), thank them for their input, tell them you will look into it, and go on with your day. Let the small stuff roll off your back, or you will soon have an ulcer. As for issues like the one with the track (where there is no doubt that you are on the logical/right side), just present them with the logic; you should have just said what you told us, "This is where the track owners want us, if you have an issue, please go see them". When you have a kook like the Ranger, where you have intruded on their authoritiiiii, you should have said, "I am sorry, I had no idea we broke the rules, maybe you can attend our next departmental meeting on such&such date and educate my staff to your rules and needs". You ran Barney's road block and hurt his ego, so just like Thelma Lou, you have to let him feel important.

This is a big problem in our industry, maybe because of the perceived shortage, but we spend way too much time with problem children in my opinion. Maybe this person is one of the few who will somehow see the light, but I doubt it. I am not saying we should not try to help everyone, and mentor them, but there becomes a point where you are spending 95% of your effort on 10% of the employees. And then what do we do with the GREAT employees ? We reward them by sticking with the worst partner, worst truck, and worst shift. When will we wake up ?

About two weeks before Obama won the presidency, a friend of mine shared a story of a mental patient who was being admitted against her will. She had freaked out about the possibility of Obama's election, was seeing apocalyptic visions, started reading her bible 24/7, and had contemplated murdering her kids to save them from the horrific future she saw. You can dedide with the knowledge you have now, whether or not she was crazy or visionary.

Realize the one of the most common causes of hallucinations is medication related, especially the phenothiazines.

Guess you never had a dying patient look you in the eye and ask, "Am I going to die ?" And what's the difference between lying to your boss (I am too sick to work today) or lying in your documentation to cover your butt versus lying to a patient. If you lie you lie.

Dear Johntown 2000 or whoever you really are, please let me assist you by asking a few questions:

1. In ths economy, with your present educaton, what higher paying job can you realistically go get tomorrow ?

2. If you can not afford to make it on an EMT salary then you need to live within your means (how many car payments do you have, how much is your house payment,how many times do you eat out per week ?

3. Who lied to you about EMT pay rates ? Its nt like it dramatically dropped while you were in school.

4. Yes,you may have to work 100 hours per week to make $100k, but what other job can you do that in ? If you were an accountant or whatever 40-hour week job you want to pick, most work 5 days/week, leaving you only 2 days to work extra (but if you live within you means, you shouldnt have to work two jobs).

5. Yes the test is difficult, and it shoul be. In most systems you are pretty much granted full reign to do as you please as a Paramedic, so someone needs to make sure you are up to snuff, even at the EMT level.

6. If you are a bad test taker, there are books and classes that will help you.

No there is not a breakdown. I read every accident posted on the emsnetwork's website (http://www.emsnetwork.org/artman2/publish/ambulance-crashes.shtml) and compiled the numbers myself. I can tell you that the death numbers are probably much higher, as many of the injured people were reported critical at the scene (often flown), but there was no follow-up if they died or recovered later, unless you were interested in searching for all of those stories, and knew everyone's name (occassionally you would see a follow up story if multiple people died from the same accident over a 2-3 day period, but you know that many probably died in ICU two weeks later, and the obituary is all that made it to the newspaper). The overall numbers are also low, because this data only represents the crashes that made the news (as you are aware, many do not). I did not categorize by L&S or by who was at fault; my recollection was that it was about 50/50 for L&S versus not, and about 75/25 the other driver's fault versus the medics (other driver did not yield or was drunk more often). When it was the medic's fault it was usually during a critical transport or enroute to a critical call, that the accidents occured, so you can surmize that they were probably driving emotionally and not defensively.

The numbers are actually lower than I thought they would be, but as I said throughout the year; most of these deaths were preventable, and just "1" death is too many.

Also, I did this month by month, not all at once, and it may have taken me a maximum of 20-30 minutes per month, so now that we are starting a new year, you might want to start keeping a runnin total for your department.

Man do i have an invention for you, unfortunately I can not find a link to it, but this product is very similar: http://www.buckleboss.com/

It is a buckle guard that covers your stretcher belts/buckles, so that the patient can not unrestrain themselves. If you are using the over the shoulder harneses, along with abdominal and leg/knee belts properly, it would be difficult for a patient to come off of the stretcher during transport. Even if they do, it will take a few minutes of them trying, which gives you the chance to defend yourself or get out of the vehicle. I am not a proponent of abandoning the patient in the vehicle while you watch them tear up your rig, as when they escape into traffic and get hit by a car, you will have alot of explaining to do (not advocating you put your life in risk, but its kind of hard to garner public sympathy when the patient is dead, they had no weapon, and you are scratch/bruise free). You should also google the old Merginet article "Positional Asphyxia - Death By EMS", as it is a very good and indepth review on how to deal with these patients, proper restraint, and improper restraint.

P.S. There are several soft buckle guards used for children, I am recommending one that is solid steel, and very heavy duty. The one i am thinking of is simply a steel rectangle that encompases the seat belt female coupling, with a slit in the middle that is big enough for a car key to fit through (can use any key or straight/slender item to go through the slot and push the orange seatbelt release button).

The totals for the year are as follows:

There were 207 serious ambulance accidents reported to EMS Network

Those 207 accidents have produced the following:

EMS Personnel Injured: 191

EMS Personnel Killed: 5

Patient Injured: 39

Patient Killed: 9

Passenger in Amb injured 3

Passenger in Amb killed: 2

Other Vehicle Injured: 119

Other Vehicle Killed: 20

Pedestrian Injured: 3

Pedestrian Killed: 4

How in the hell did this get to be about Obama's vacation ? Anyway, lets redirect to the 800lb Muslim in the room. I hear this morning that Canada will no longer allow carry-on luggage due to this latest fiasco. On all the Sunday morning TV talk shows, I heard people ask why we are not profiling muslims ? As many of you have described, we are focusing on the wrong people due to political correctness. Not all muslims are terrorist, but it seems that 99.9% of all terrorists are muslims. Being of the african american persuasion, I know what it is like to be profiled for no other reason than my race (DWB, driving while black), so I can not be impartial on this subject. What say you guys, is it time to start profiling every muslim on a plane ? I heard another news story about some muslims on another flight who scared the other passengers by talking loud in a foreign language and watching explosions on their laptops. So they seem to think this is all a big joke.

Taking pictures of an accident scene is wrong on so many levels. "Hey Roy, can you turn the patient's head a little more to the left while you are holding C-Spine there, I cant get his other eyeball in the shot" ! If you feel the need to keep trophies, you need to get out of the business.

On or off shift does not matter, the facts of the call are this:

1. You did not cause the injury.

2. If the neurosurgeons could not save this person, then it is doubtful that a paramedic/emt could either.

3. You mention mistakes were made, but again, those were not made by you; they were made by others.

If you could magically go back in time and respond to the call, I am guessing that there is a 99.99% chance the outcome would still be the same. Maybe the call would have been smoother, maybe you would know that EMS did all that it could do, but massive head injuries rarely have a good outcome no matter what is done. There is only so much that we superheros can do. A famous quote can be borrowed from the TV show MASH that relates to this issue: "1. Young men die in wars. 2. Doctor's can't change rule # 1." The same is true of EMS, definitely go talk to a counselor.

What were the little cars called that were like a demolition derby; you ran them into each other and the fenders and hood would fly off ? Couldnt get that through today's safety standards (flying objects could cause eye damage), but atleast I am pretty sure that it didnt contain any toxins in the paint, as it was probably american made -- maybe ?

And who had the glow in the dark monster models (frankenstein, werewolf, dracula, swamp creatures, godzilla, kingkong) ?

This will sound like a smartas* comment, but it is not intended to be one: "Please stop working 48 hour shifts" ! I know you may feel as though you have to, but it is the quickest way to burn-out that there is. I have always told newbies that if you took a job that just required you to watch porn for 100 hours per week, it would not take too long before you would be tired of porn. It is no different in our job, and the long hours are just unhealthy. Please try to cut back, as there is a future full of people who will need you to respond in their hour of need; you may not be there if you continue to work this much ?

Follow your heart, like the commercial says, if you do what you love you will never "WORK" a day in your life. Dont worry about money as your decision driver. But if you are getting into EMS, you really need to go for EMT-I, then Paramedic. Nursing and EMS are getting more aligned:

CNA = EMT B

LPN = EMT I

RN = Paramedic.

Please bring me a "SWAT" lunch box, a Stretch Armstrong, and a Big-Wheel. My brother would like a Coleco-Vision hand held football game, a huffy bicycle,and a "pong" game for our Tandy computer (these computers dont do much Santa, not sure they will last long, if computers are just a passing fad, he would like a Farrah Fawcett poster).

Try being an over-the-road truck driver, gone for 21 days, home for 3-4. Or try being in the Military stationed overseas. We got it easy, quit your bitching. And Paramedics and Firefighters do not get divorced because of their job, they get divorced because they have sex with other people (usually at their job).

I have heard of several of these companies, and saw a show on TV that highlighted one, but not sure if it was the A&E show that people referenced. From what I can tell, it would be very difficult to be profitable, as it did require more work than I envisioned. As mentioned, you have to be capable of removing whole sections of carpet and drywall while in a hazmat suit, and then replacing it. Then you have to find some place that will accept the hazards you removed (the local landfill apparently isnt thrilled about accepting your king size, blood soaked, mattress). I have no idea what they do to get the smells out of some of these dwellings. Although I can see the demand, I am not sure the typical homeowner could afford such a service, and I doubt the manager at your local hotel would be willing to spend that kind of money or file an insurance claim when he could just get the maintenance man/maid staff to do it.

No, I'm dead serious.

Yes I would and routinely do. You (and others) are making assumptions, I said withold the treatment (O2) until a baseline 12 lead is established and proven to be clear and readable (no artifact, intererence, etc). Once that is done, continue on with standard of care. O2 as appropriate, IV, ASA, Nitro, Morphine, etc.

The diagnostic test is the standard of care in nearly our whole Province as is early physician intervention (consultation) to triage to either PTCI (proimity, availability of cath lab, which cath lab, etc) or prehospital thrombolysis (tNk) , if warranted. This followed with Plavix and Enoxaparin (low molecular weight heparin).

I'm sorry, but this is one of the few definitive times where you do actually treat the monitor (12 lead/15 lead) with more importance than the patient.

And tniuqs, the Wellens discussion comes from a Cardiologist and 2 residents at UAH. Not specifically O2 alone, but our global treatment for cardiac ischemia (MONA if you will) has evidenced many occasions resolution of 12 lead indicators but our early 12 lead establishes evidence of the pathology. Hence why Cardiology loves EMS 12 leads.

I know there are semantics and generalities in your statement, but you should always treat the patient before you treat the equipment. When I started out, we did not have glucometers, pulse oximeters, or 12 Lead, and it amazes me to see how many Paramedics trust the equipment over patient presentation, history, and signs and symptoms. The first thing I did for any new Paramedic on my truck was to take all of that equipment away, so that he had to assess the patient first.

Care to explain this? Specifically the bolded section.

Yes, in my humble opinion, the 12Lead in the field is useless unless you carry thrombolytics on your truck, and use them. My rationale is that it rarely changes out-of-hospital or in-hospital treatment, WHY:

1. 99% of patients will be treated the same way in the field regardless of what the 12 Lead shows; do you withold NTG, O2, and MS because of a negative 12 Lead ? NO Do you not transport due to a negative 12 Lead ? NO Does it change where you transport the patient to ? In rare circumstances yes, but I hope that you do not transport chest pain patients to hospitals that do not have cath labs, regardless of what the 12 lead says.

2. As we all know, 12 Lead changes may not occur until many hours after the onset of symptoms, so a negative 12lead 20 minutes after the onset of symptoms means nothing.

3. Positive 12-Leads in the field do not speed-up door to needle times or door to cath lab times in most facilities. Most facilities already have time parameters for these patients regardless of how they arrive. The hospital will still redo the 12-lead, and will not call the Cath Lab team until the hospital 12-Lead has been read.

4. But rather than me blather on and on, please provide any scientific proof that you have that shows that 12-Leads done in the field increase survivability or muscle. Who knows, maybe I am wrong, but I doubt it.

5. If you want to invest in something useful, ditch your 12leads and buy Istat machines so that you can do a cardiac lab panel on the truck. But even those levels may not rise right away.