crotchitymedic1986

No, I do not believe that people with preexisting conditions (not their fault) should pay more. But people who CHOOSE to engage in dangerous activities should. Want to ride a motorcycle without a helmet, want to parachute out of planes, want to smoke tobacco or drugs, want to drink your liver to death, want to shoot up heroin, want to weigh 300+lbs ? Fine, just dont ask the taxpayers to subsidize your poor decisions.

I like scoobys answer, I would add that they more you see, the less shocking it becomes. You can google "trauma pics" or similar statements on the internet and get an eyefull of various gorey patients. The worst ones that you will see in the field will not be as shocking to you if you have seen some pics of those who have their insides on their outsides. For most people, it is the smells, not the sights that get to you. Of course, at the point you are totally callous to these scenes is probably when you should retire.

Here is the only problem with your pro-marijuana stance: Currently, the testing for this drug only proves that you have smoked it in the past 30 days, it is difficult to pinpoint exactly when you did it; two hours before your shift, or two weeks ago. So, do you want an EMT who is just barely buzzing to drive your rig ? How about your brain surgeon, is it Ok if fired one up 12 hours ago ? I agree, the war on drugs is as stupid as "prohibition" was in the last century. Legalize it, tax it, make those who indulge pay more for their health insurance premiums, and alot of our crime will go away.

Have not looked at it from that perspective doc, but I have to agree with you about making the employee stay home, but the problem is that you can be an asymptomatic carrier for two weeks. The good news is that I think most of us will be just that, the asymptomatic carrier; the bad news is that we will most likely be the carrier that takes it home to our families.

I think this is a symptom of the disease "greed". Throughout the 80's until now, this younger generation has watched corporations down-size, merge,be taken over hostily, and rape their employees just so the stockholders can make money, and the CEO can make 40 times what the average worker makes. I think they saw their dads get screwed over several times, and they said they heck with being loyal to a company, or taking pride in a company. The second thing is that to have pride, you have to have something to be proud of. Most management in EMS today is lacking the ability to produce companies that you can take pride in. You would hope that people would do the things you suggested out of "self-pride" but I believe that died somewhere around 1990.

LET THE RECORD BE CLEAR THAT IT WAS NOT I WHO INTRODUCED RACE INTO THIS TOPIC, but that was an interesting article tniugs. As far as "when" does the patient become a hospital patient, it was changed by EMTALA / JCAHO to include up to 75 feet off of the edge of the hospital's property, after someone who tried to ambulate to the hospital collapsed and died at the edge of the property, and the ER staff refused to go get him (thats the urban legend anyway). Once the patient enters that perimeter, regardless of how they got there, they have "came to that hospital seeking help", have become the responsibility of the hospital, and must be provided their medical screening exam (in the US). As to who is to blame for what happens if the patient arrests on your stretcher while awaiting an ER bed; you and the hospital should be in trouble -- just because you have entered the hospital's property does not mean that you should stop monitoring your patient, and the ER has a responsibility to provide atleast a timely and adequate triage for all patients, regardless of how busy they are.

Just a few facts to consider: 1. The experts fear a pandemic, this is not the "normal" flu. 2. We will probably double the number of flu deaths this year (if we are lucky) as the regular flu will kill it's regular numbers, and then H1N1 will wipe out some portion of the population (probably more pediatric). 3. The flu vaccine has been safely produced for over 60 years, with a change in the flu-shot almost every single year, as the strains change. 4. In 1976 there was an aberrance where alot of people died after receiving the flu shot, because something happened that triggered guilam-beret in those patients (experts argue if it was the flu or the flu shot, but if you want to blame the shot, then there was one year out of 60 when the flu shot was bad, but has not reoccurred in the 33 years that followed). 5. Had many of us taken the same opinion on smallpox or polio vaccines, it would never had been irradicated, and we would still be dealing with it. A coworker of mine caught the swine-flu from one of his children, as did everyone in his family. How would you feel if you learned it was you who was the carrier that brought home swine flu, which resulted in the death of one of your children ? I don't like the word MANDATORY any more than anyone else, but in some ways we are starting to sound like the dumb redneck that is always on the news before the Category 5 Hurricane is about to hit, who says "hell no i ain't evacuuuuaaatttin, i gots to protect my stuff".

I didnt mention anything concerning race, I was just pointing out that sickle cell/migraine/drug seekers are complaining of "PAIN". If we are all about relieving pain, shouldn't we relieve their pain too ?

Dixie was as sexy as 70's television would allow.

The answer is you treat them no matter how far you are from hospital, but you use the appropriate med. Fentanyl is very short acting, but works great, it is the perfect drug for your scenario. It knocks down the pain, but they are fairly alert 15-20 minutes later, when the Doc sees them. The Nurse was wrong, as LOC doesnt matter for an isolated extremity fracture. LOC is important in the multi-trauma patient where a head injury is possible (but they will get a CT either way, so maybe not). My point is that if you are giving Morphine for every patient that has pain, then that is a disservice to those patients. They should be treated with the appropriate drug. I say the same thing for Paragods that use Versed for RSI, it is the wrong drug for the scenario -- you should not overdose someone so that you can put in an ETT. If you are going to do RSI, use paralytics. Now the spinoff question, who are you, and who are you not managing pain for ? Are you medicating all sickle cell patients who claim to be in crisis ? Are you medicating your drug-seekers who are screaming in pain, but have absolutely normal vital signs ? How about severe abdominal pain ? Migraines ? Fractured finger/toe ?

I am sure someone has already stated this somewhere, but if not, we also have to realize that many EMS agencies are very limited in pain medicine that they carry. I am all for pain management, but that should include using the right drug. Morphine, Demerol, and Valium are usually all that is available; most services do not include Toradol, Versed, Fentanyl, or other alternatives. So you might want to see if your agency can use a drug that is more short-acting. If you continue to be the Paramedic who doles out the most narcs, you will be the Paramedic who gets the first pee test -- not sayin it is fair, just reality.

Not to be sacreligous, and I admit I am not a Trauma fan, but is it really that far off the mark than what "Emergency" was in it's day ? 1. Obviously Emergency used Gage and Dixie for their sex appeal. 2. I imagine the high-tech Emergency was ridiculed by emergency workers who were still riding in hearses without cardiac monitors and two way radios. 3. I imagine there were some mistakes in treatment on Emergency. But then again, maybe not, the treatment was the same no matter what was wrong with you -- some intracardiac epi and some D5W tko. 4. Bad acting ? you have to admit, the best actor on Emergency was Chet, everyone else was a horrible actor. You really didnt expect a tv show to realistically portray us ? After "The Shield" and "Rescue Me", you had to see this one coming.

Will be happy to answer any questions that you have. My two cents worth: Its not a bad thing if it is voluntary, and it is closed to everyone except those who were involved in the call (should offer invitation to dispatchers, they are often forgotten). I have found that sometimes you have people show up that want to be spectators, who had no involvment with the event. But I think it should just be used to "vent", if someone is really troubled by an event they should see a true mental health professional. I have found it to be more useful in rural areas where you may have volunteers who are part-time providers, and due to the low call volume, they are not used to dealing with these calls, and/or the patient may have been a friend/relative.

The schools financial aid office is the best source for what is available. In many areas, hospitals will pay your loans in exchange for signing a contract to work there "x" number of years.

I disagree with blaming the schools for this phenomenon. The schools are there to produce an entry-level employee, not a five-year veteran. As most of you know there is a big transition from book-learning to patient care. The problem is not with the school, it is with our substandard training and orientation programs for new hires and new medics. I think new employees should have to ride third or with a preceptor until they have been checked off (actually ran) every type of arrest (adult and pediatric) and other critical calls. Until the prove their worth on the most critical of calls, they should not be the lead provider on an ambulance. In a busy service, this means they would probably have a 6 month orientation, in a slow service, maybe a year. Do you honestly believe someone who just passed the Bar exam and became a lawyer gets assigned as lead counsel on the highest profile cases 2 months after they get out of school ? There is only so much that can be taught in the classroom with manequins.

New hires, and newly certified Paramedics ?

Rectal D50 is appropriate,you do not need a protocol in my opinion, but if you feel you do, by all means do so. The IO is to IV skills what the EGTA or Combitube is to Intubation skills. And I did not make any statements about literature, I believe that quote was attributed to me by mistake chbare

Cell Phone versus using radio, whats the difference: If you are driving an emergency vehicle, you should rarely have to talk on the radio: 1. Your partner can talk while enroute to the call. 2. You can call onscene after the vehicle has stopped. 3. You can call enroute to hospital or 10-8 before you put the vehicle in gear. 4. You can call out at facility after you have stopped. 5. You can call 10-8 before you put the vehicle in gear. If you absolutely have to talk enroute to the hospital, keying the mic does not require your eyes to leave the road -- texting does require your eyes to leave the road. Anyone who texts while driving an emergency vehicle should have their license (medic and driver's) pulled. If you have no more regard for human life or the maturity to realize the stupid (unneeded) risk that you are taking, then you do not belong in an emergency vehicle.

In researching one of the many ambulance crashes last month, I discovered one where the EMT admitted to being distracted and "looking down", and not at the road, just prior to his crash. The newspaper article did not clarify what he was distracted by, but there is no doubt in my mind that he was probably texting someone or reading a text message. This is probably the most dangerous epidemic facing our industry, not H1N1. Is there anyone who agrees with me, that this practice should be banned ?

Funny you should mention a park inside of New York, one of the great ironies that was expressed in this show, is how the MLK "I have a dream speech" brought the parks full-circle. As you know it was held at the Lincoln Memorial, which is a National Park, but what i had never realized was that the tall white police officer standing at MLKs left shoulder, was actually a Park Ranger and not a State Trooper or DC Officer.

google channing bette or laerdal

Also remember that D50 can be given orally, if conscious enough, and that your average 12oz canned soda has 39 grams of sugar versus the 25 in D50. As stated previously, there are a small percentage that do not have veins, but I will bet that if you followed up on all your diabetic IO patients, you would find that 99% of them had a peripheral IV started and the IO removed in the ER, shortly after you left. It is unethical to inflict that kind of wound on a diabetic unless they are in cardiac arrest, especially when it is not necessary. Quit being lazy, improve your skills.

If you are not watching this documentary on PBS, you are really missing something good (for those nature-lovers among us).

mobey is right, most companies have moved away from traditional yes or no questions, to questions that require you to think on the fly like: Tell us about a time you had to: work with a partner you couldnt stand you made a patient care mistake take charge to handle a difficult situation make an improvement at work break a policy or procedure at work so on and so on

No way to know unless you find someone who sat through it before, who is willing to share. Best advice possible, is to think of every question that you would dread answering, or would not have an answer for, and then find the answer. Be honest, and dont get diarrhea of the mouth. Smile, look professional, and dont ask any questions that are about how the department would benefit you (pay workhours benefits).