crotchitymedic1986

I had no doubt that you would transport those with lifethreatening symptoms, what i meant was that i would transport with a minimal illness or injury (flu or simple laceration) if they demanded transport. Because I have seen what happens when you dont and the patient files a complaint stating you didnt take them because you were racist or because they didnt have insurance ---blah, blah, blah. I found that i could either not transport 16 patients during my 24 hour shift, or i could transport 6-8. It was easier to just drive them the 8 miles to the hospital and be done with it, rather than argueing with them on the scene, having them call back later, then have them file a complaint. But i feel your pain -- we had a drugseeker who called 8-10/week, we would transport him to the ER, they wouldnt give him the narcs he wanted, he would get a friend to drive him home, and he would call 911 again to go to a different hospital. PD wouldnt touch it (as an abuse issue), so we had our medical director make an order that if he called 911, we would only transport to the hospital in our county, and he worked with that ER to insure they wouldnt prescribe him any pain meds -- so he started taking his own car to more distant places, and stopped calling 911.

WIthout all of the information, its hard to say. Were orthostatics taken -- the patient may have had a much lower b/p standing (especially with the H&H you stated --- which may be why the doctor was upset, because they did do orthos and found a much lower number). Was the patient average truck-driver size or a tiny fellow ? I probably would have bolused with 500-1000cc and then rechecked v/s. Either way, he needs a transfusion more than he needs fluid, so they should have been happy that he had 2 IV sites.

If they were filming your shift of calls for a tv show, what background songs would you want played for the calls you ran today: example GSW to the head -- another one bites the dust MI -- achey-breaky heart Psych -- insane in the membrane Seizure - shake, rattle, and roll sure you guys can do better

I am not aware of any law, but I am aware of: 1. If you are hospital owned, you fall under JCAHO. I am not aware if it was every clearly clarified if the hospital owned ambulance being called is the same as coming to hospital property. Meaning you can not refuse "care" - defined as stabilization - not transport. I have seen inerpretations of that rule in both directions. 2. While there may not be a law, I think it is a bad practice to refuse transport of someone who is REALLY ill or injured, as there is no defense for your actions in a court of law if you are wrong and the patient has a negative outcome. Just open up the checkbook and be prepared to write a big check. Ambulance crew refuses to take patient to the hospital, never sounds good on the 6pm news. 3. I knew of a 911 service that implemented a no transport for DNR patients, which was disasterous. Grandma dying, ambulance comes, refuses to take grandma -- family and nursing homes are upset.

1. Dress professionally -- not sexy. 2. Dont wear perfume -- you will probably be in a small office with the door closed, dont want to overpower them. 3. Be atleast 20-30 minutes early. 4. Be prepared to answer questions in detail with real life examples -- most employers have moved away from yes and no questions. Instead of do you work well with others, you are more likely to hear, "tell me about a time you had to deal with a difficult customer or coworker" or "tell me about the biggest professional mistake you have made in your life, and what you learned from it", or "tell me about a time when you went above and beyond at your last employer". The purpose of this type of questioning is to hear the "real you" not the "interview you" -- be careful how you respond, as honesty can trip you up -- for instance, "at my last job, i had this boss that was an asshole -- he was constantly writing me up, so i demanded a transfer to a different shift". 5. Smile 6. Be positive -- no negative answers to any questions 7. Be concise, do not get diarrhea of the mouth. 8. Ask a good follow up question like, "are there opportunites for advancement here, if i work hard", or "would i have the opportunity to work on special projects or committees". 9. Do not get too much into salary/benefits during first interview -- let the boss bring it up. 10. Get a business card from the boss/HR person and email them later that day to thank them for the interview.

Great point dustdevil, as i typed the line about "the driver only had to be trained in CPR", it immediately hit me that we have come full circle with EMTBs being allowed on the bus. And you are right about the trickle down effect, but i would say that is true in all of medicine. Everything "new" is usually driven by a new invention, gadget, or drug. What is really "new" in hospital care over the past 20 years ? Thrombolytics, heart caths, CABG, stroke treatment, implantible defibrillators/pacemakers -- we still cant cure the cold, blindness, diabetes, CRF, or met. cancer. For all of JCAHO's involvement in improving hospital care, I would say you have twice the likelyhood of being killed by a medical mistake or getting an infection during your hospital stay. They say if you arent part of the solution, you are part of the problem, so how do we solve this. I have read suggestions regarding "national standards", but what if the new national standard is set at the minimal level -- we would like to think it would be a higher standard, but typically government sets low thresholds. I have read suggestions about more education and four year degrees, but I am not sure that will improve EMS or its pay, because our pay is proportional to reimbursement. Medicaid typically pays a hospital the same amount for a child birth whether it is done by a midwife or a doctor. Medicare changed to a reimbursement rate for ems that was based on georgraphy a few years ago. Are we to assume that they will pay more for an ALS transport because the medics on the truck had a degree, especially when the current insurance model is to hold/reduce cost and payouts ? If there is no increase in reimbursement, can our employers afford to pay you more (my answer to that is yes -- just as we have seen with recent fuel prices, they found a way to pay it, but if you asked them 3 years ago what they would have done if fuel prices went above $4.00/gallon, their kneejerk response would have been, we would have to go out of business. So what is the answer ? How do we take EMS to the plateau that is talked about in this forum ?

or 2nd choice ....... leaving an original, still working, hand-held coleco football game machine.

take it --- leavin a pot of pinto beans and cornbread

not sure where we got off point -- but i did read the whole thread, so to save you the trouble: I think what the OP was trying to say was: 1. You can not watch nudity on tv in any other business, and in most businesses if you were caught doing so, you would receive disciplinary action. 2. Wathcing nudity in the workplace at best was unprofessional in his/her opinon, could be possible sexual harassment. 3. Most people who have replied thought there was nothing wrong with the practice and that the original poster was an idiot, religous zealot, or a virgin. I think that sums it up.

as doc said, we had them, but you had to make your own -- folding aluminum boards had hit the market, but were too expensive versus making your own -- I cant imagine bringing the wooden ones back; splinters in the hand, couldnt really get blood out of them once the polyurethane wore off -- and there was nothing like the pucker factor you experienced when you lifted a large patient and heard the board "crack". The last service i worked at before getting out had the hydraulic/battery powered stretchers -- god, what a difference there would be in my spinal cord if we had those back in the day.

you will be humming this one the rest of the night, sorry ................ They're creepy and they're kooky, Mysterious and spooky, They're all together ooky, The Addams Family. Their house is a museum Where people come to see 'em They really are a scream The Addams Family. (Neat) (Sweet) (Petite) So get a witches shawl on A broomstick you can crawl on We're gonna pay a call on The Addams Family.

take it, i need some sausage -- leave a copy of Mother, Jugs, and Speed on DVD (now i have really dated myself)

ok how about amiodarone versus lidocaine -- worth the price to keep amiodarone ? Use of steroids in acute spinal cord patients in the field pain management protocols in ems (narcotics for pain relief) the use of CPAP or dobutamine for CHF appropriateness of chemical sedation in the field proper restraining techniques -- google "death by EMS" on merginet Albuterol usage in CHF I remember reading a good debate on here (cant remember which forum) about why medics do not use charcoal very often -- it is on the truck, we transport OD patients everyday, but ask a medic when was the last time they administered charcoal -- answer is usually never --- why is it ok to allow the drugs to continue being absorbed in the body when there is an antidote (for some) sitting in the drug box.

my bad, forgot this is a multinational/state forum --- "10-13" is a term for those mental patients who are committed to psychaitric care against their will. So this is about transporting psych patients who are suicidal, homicidal, or drug abusers. In many areas this is a PD function, in others areas ambulances transport them to the psych hospital. The issue is whether or not it is safe in an ambulance, and is appropriate since medics do not have "police" powers

a few more popped in my head -- and that should have been "will" instead of "what" in the question about universal health care. Should ambulances transport 10-13 patients. Are medics really underpaid/overpaid for the amount of education they have and number of hours worked versus other occupations with similar educational requirements You want to approve RSI as a skill for all paramedics nationwide, it would be up to each individual state to set up rules/regulations and training standards -- is this a good thing or bad thing. Are helicopters overused in EMS You are a 911 provider who is struggling to meet budget cuts and your service may be privatized -- one proposal is to start running non-emergent/convalescent calls --- Pros, more revenue which may do away with the yearly privatization threat, more employees, more advancement --- cons: more calls, calls that take more time to run, employee morale/retention/recruitment.

Running lights and sirens versus nonemergency Running double medic trucks versus 2 Medic/EMT I trucks The use of EMTBs on 911 trucks Getting a refusal on drunk/altered patients -- how drunk is too drunk, can they sign for themselves Why arent cardiac arrest survival rates improving Is there anything wrong with a 30 minute response time to non-urgent calls Should 911 ambulances be able to REFUSE to transport non-lifethreatening illnesses or injuries or DNR patients Should medics with substance abuse problems be fired or helped -- and should they be allowed to return to EMS -- how many strikes before they are out Is it appropriate to talk someone out of transport, and then ask them to sign a refusal form that releases you from liability Solution to the diversion problem - strictly from the EMS side (do you ignore diversionary status -- put up more ambulances What universal health care be a positive or negative for ems You are a director who has to implement a budget cut -- you can either opt to cancel your purchase order for new cardiac monitors with all the bells and whistles (replacing LP10s) for your whole service, or you can opt to shut down one ambulance from your fleet (firing 6 employees) and not filling 2 vacant positions. You are a new employee at a service (first week on the job) and you witness a supervisor doing something unethical or something that compromises patient care. Do you report him to the top brass or keep your mouth shut (keep your job) that should spark some ideas

Probably a realistic fear, but it could easily be solved if the state legislature would just add a clause to their good samaritan law that stated that schools/businesses/residences would not be held liable for the use of a defibrilator (or the failure to be able to use it -- not charged, device failure, location to far away, locked up after hours and no one has a key, or patient or user are registered democrats -- LOL).

Veterans Day - the Ballad of the Green Beret: http://www.youtube.com/watch?v=LH4-tOqLH94 God bless the USA: http://www.youtube.com/watch?v=RssIN3ustUw And the greatest military song/video of our time:

Take it, i can offend muslim taxi drivers with them (any chance of skid marks ?). I will leave your some hot boiled peanuts and a coca cola in the small glass bottle.

Also, no PPE except the sterile gloves in your OB kit, no safety vests, no safety needles or sharps containers on the truck.

Moving a conversation from another post: In my "if you could wish for one thing post" the conversation morphed into a commentary of how little EMS has changed in its 40+ year history --- pay is low, need for more education, need for better national standards. And while I can not refute some of the negative views about the state of EMS today, I would like to add a little sunnier historical view (realize that many items that were new or non-existant to me at the time, may have been available in other parts of the country -- I can only speak about my experience). . I got into EMS in the early 80's, went to medic school in 85, became a medic in 01/1986. Here are the changes I have noted, most of which were technological changes, but were improvements none the less. In 1986, you only had to have one certified person on the ambulance, the driver could be certified in CPR only. There were few women or minorities in the field (EMS & Fire). We had two man stretchers that had to be lowered to the ground and lifted up into the ambulance. Our cardiac monitor was a LP3, with no pacing or 12 lead capability, and was the size of a 20" tv set -- guessing 40-50lbs. We did not have glucometers or pulse oximetry -- much less capnography -- some services had Byrd respirators, but there were no ventilators. We had NO pediatric equipment at all, unless you count the wooden short back board we used for extrication that doubled as a pediatric LBB. Speaking of that, there were no KEDs, and back boards were made of 3/4 inch plywood, that each company made for themselves. We used sand bags and 2 inch cloth tape (no 1/4, 1/2 inch tape or transpore tape - you tore the size you needed) for immobilization, there were no CIDs or foam blocks (and ccollars were one size fits all). Oxygen tanks were M and E cylinders, and the M cylinder was housed under the squad bench in your van ambulance or suburban (Type 1s were around, but not used as much); it was alot of fun to change out your cylinder back then. You had to choose between using your federal Q siren, or having lights in the back of the truck when patient loaded, you couldnt have both. Emergency lighting consisted of beacon lights only, no strobes, no LEDs, no wigwags, no lightbars. Air conditioning in an ambulance was a luxury, not a necessity. Ambulances were gasoline powered. There was no 911, and everyone operated off of the HEAR system for radio traffic (pagers were the new, most incredible technology). A drug box consisted of Epi, atropine, bicarb, calcium, Lidocaine, NTG, and D50 --- there were no respiratory meds (aminophylline was in the more advanced providers box), no pressors, no medication drips, no antiemetics, and no narcotics. You had to call a doctor for all orders including IVs, and you would be denied over 50% of the time. The average EMT made about $12k per year, with the average medic making $14-16k, there were no health benefits or 401ks at most private companies, and you pretty much had to do a year of convalescent at a mom&pop before a 911 provider would hire you (then you got benefits). PLS was the new class to take, PALS, BTLS, PHTLS were not around yet. EMT was a 120 hour course, Pmdc was 200 hours. If you had any kind of critical care transport, a nurse from the hospital had to accompany you. And the thing that most company's advertised in the phone book was "Oxygen equipped and Radio Dispatched" -- that was what we were most proud of ! Have we come as far as we could have in 40 years, probably not ? But we have come a long way baby !

I am not against more education, but i do not think it automatically produces more income. Look at nursing for instance, it has pretty much been a four year degree profession since the late 70's, but wages were not driven up until a shortage of employees occured. This was a generational shift, when my generation of women started taking new jobs other than teacher, mommy, or nurse. We have the same shortage in EMS right now, but it isnt apparant because we all work two jobs. If you could get all medics to stop working two jobs for a 6 month period in a large region or nationally (will never happen) our pay would rise dramatically. How many positions were staffed by a part-timer from the fire department or someone working overtime at your provider today ?

Well again, to play devils advocate solely, and not intending to put down anyones arguement -- a common problem that i see with EMS folks is this career path: you graduate high school with the dream of being a millionaire by age 30. you drop out of college, get into ems, work it a few years. as the age of 30 gets closer, some medics become bitter (to quote obama --lol) and lash out at their EMS job, because they dont make as much money as they think they should. My question was very specific, when i asked what profession could you earn more money at with the education you have now --IN THIS ECONOMY. many of the jobs that were listed require skills that you may have, but most medics do not. Many of the sectors that you described are laying off people left and right and are not paying the rates they did years ago (construction, sales, retail). I didnt ask what profession you could jump into with some extra training. Your point about per hour pay is valid, but you knew that when you signed up --- its not like anyone changed the rules mdstream on any of us. And things have vastly improved since when i got started. I made less than $12k/year to work 24 on 24 off without any benefits-- and thought i was rich when i got my first 911 job that paid 19k/year with benefits (as a medic). You have to remember that our profession, and yes i do call it a profession, is only some 40+ years old. It is still in its infancy. Unless you have a different definition of "profession" than I do, which is entirely possible: pro⋅fes⋅sion   /prəˈfɛʃən/ Show Spelled Pronunciation [pruh-fesh-uhn] Show IPA Pronunciation –noun 1. a vocation requiring knowledge of some department of learning or science: the profession of teaching. Compare learned profession. 2. any vocation or business. 3. the body of persons engaged in an occupation or calling: to be respected by the medical profession. 4. the act of professing; avowal; a declaration, whether true or false: professions of dedication. 5. the declaration of belief in or acceptance of religion or a faith: the profession of Christianity. 6. a religion or faith professed. 7. the declaration made on entering into membership of a church or

I am not trying to judge you here, so dont take it the wrong way. But I think the question to ask is what is it you really want to be ? You are in school, and have obviously set aside time in the next several months to continue school. The reason I ask is that it sounds like you have left EMS atleast once before, which isnt a bad thing, as many people leave for greener pastures, only to find that EMS wasnt so bad afterall -- but before i would commit that much time to this profession again, i would really think about this career choice, and make sure it is the one you want. If you are settling back into it for financial reasons only, and werent happy with EMS before, you wont be happy this time around. If you are taking the time to do a do-over, make sure it is the do-over that you really want.

OK, but how many other professions (right now) can you earn a 40-60k base with no college degree -- not to mention the fact that you can work 2 jobs and earn more --- if you are an accountant or bank teller working mon-fri -- it is hard to make a sizeable second income. Or to put it another way, with the education you have right now, what other profession could you do and make more money -- realistically ?