crotchitymedic1986

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 ?

I agree, but once the employee is yours, he/she is yours. You have to make reasonable accomodations, and what is reasonable to a buracrat may differ from us -- generally, being moody and sleepy arent grounds for dismissal. We are not talking about crazy/crazy here, where they are a danger --we are talking about those who are depressed. And many smaller departments do not have light-duty options -- I am not saying you cant get rid of them, just pointing out they have legitimate avenues of regress (especially since they are about to lose their job and health insurance, they have nothing to lose in fighting you). Especially, if they claim the depression is job related.

Let me play devils advocate ---- we have been bitchin about education for as long as i can remember, and it hasnt improved. Conversely, in my humble opinion, just about every major improvement that has occured in EMS has been an intoduction of a new technology or has been driven by a new technology. The discussion of the ability or inability to read 12 lead, were it not for 12 leads making their way into ambulances. I am not sure if succesful field intubations percentatges are worse or better than they were 15 years ago (depending on what you read), but pulse oxs, followed by portable vents, and then capnography, and RSI have pushed the issue further than education has. Not to mention pacing, glucometers, computers, and iv pumps.

Not so fast spenac ---- a person with a mental disorder falls under the Americans with Disabilities Act -- plus there is a good chance their lawyer can make the case that it is the job that caused the problem --- in your system, how would you define slowed reaction times (especially if its an EMT) --- and once you do find they are 30 seconds slower to get to a call --- do you remember the crew that slept through the first tone one time, that you didnt fire ----- or the medics who wrecked a truck that you didnt fire.

Good points, but i didnt say the person on psych drugs wasnt able to perform-- i am sure you have seen this guy or gal somewhere -- sunglasses on in the station, asleep by 10am, up all night --- not friendly, not very talkative, very moody --- when the bell rings they go, but if you get on to them about sleeping or being lazy, its "i am sorry, its these drugs i am on".

The answer to all of your questions is NO --- his exam is totally unremarkable except for the leg weakness and the possible VTACH -- remember one lead shows SVT. As far as treatment, i dont want to give the answer away until a few others have chimed in, but feel free to ask questions, or better yet -- why dont you and everyone else post your best three diagnosis' for this patient, before we move into treatment.

Do you know what the difference is between penn state and cheerios cereal is ?

Cheerios belongs in a BOWL

well actually that is not limited to fire unions -- most private companies will not report to future employers or licensing bureaus out of fear of litigation (either because employee discipline is supposed to be confidential or because their addiction is a disease and reporting it to outside people could be a hippa violation). Let me throw this one at you, as this is common. An employee is on three different psych drugs that have been prescribed by their doctor. They are obviously altered by the meds (more drowsy, more zoned out, more moody), but they have a prescription. What do you do with them ?

I can still catch em --- just cant remember what to do with them when i do.

No they dont, which is the problem. Most people can mask their addiction for a long time and still function. Once the start to screwup on the job, they are usually way over the edge, and are putting their patients and coworkers at risk. I wish more services did random testing, and forwarded the results to licenising agencies so they can be removed permanantly, instead of bouncing from service to service.

i dont think that is a scenario --- but no, whenever i see her, my penis disappears for 3 days.

Here is one for the rookies -- too easy for the veterans (and it was a real call). You are called to "weakness" at 3am. You find a healthy looking 30 year old male lying in bed, who claims his legs arent working right. He just feels weak all over. He denies any trauma to his body, no recent illness or fever, no headache or CVA symptoms. He has no previous history other than starting a new exercise routine in the past few weeks. His B/P is 130/80 supine, pulse is rapid at 130-150 (a little fast to count at 3am). His primary and secondary BLS survey are normal. D-Stick is normal. You ask him to sit up for an orthostatic b/p, and you note that he drags his legs off of the bed with his arms, and the legs flop to the floor like that of a paralyzed pt. Now realizing this may be more than the flu -- you question again about trauma, falls, exposure to anyone sick, anything you can think of --- you get nothing. He has sensation in his feet, legs, and rest of body, but just cant move his legs. He doesnt have a fever, no rash, you cant find anything unusual. So you backboard him and move him to the truck --- you decide to put him on the monitor to verify that heart rate --- and i be dadgummed, you are looking at Vtach in lead II (this was before twelve leads and pulse oxs). You check his b/p --still 130/80, A&OX3, no pain. You check lead 1, still Vtach -- you check lead III, which shows SVT - but the other two leads are still textbook Vtach. What is wrong with this patient ???????????

My problem with pot versus alcohol is there isnt an adequate test for pot. You can test someone for alcohol and get a reasonable result as to whether they were under the influence at the time the test was performed. All you can gather from marijuana is that they have smoked it in the past 30 days -- could have been this morning, could have been 3 weeks ago, which is why i am against the legalization of pot. I want to know if my medic, my neurosurgeon, or my airline pilot is high while i am in their care. And I would argue that if presecription meds have not surpassed alcohol addiction, it is well on its way to doing so.

I would never advice you to compromise patient care. My point was that there are people in this world who HAVE TO BE RIGHT in every conversation, and thus tend to dominate conversations and refuse to see that there may be another way of doing things, or godforbid, they may actually be wrong for once. My point about being nice was for general conversation, not life and death patient care situations. Glad to hear things are getting better for you

Congratulations, I hope you succeed -- here are my thoughts, and i am not trying to disuade you, but coming from the same time period, I have these opinions:

This may not apply at the BLS level, but a big difference from the days when you were here last (depending on region) is that

1. medics now have a much greater level of autonomy, which means your skills have to be sharp. I remember when you had to ask for IV orders and were denied 70% of the time, now you pretty much do your job by protocol, and not through direct physician orders. A dumbass back in the day could fake his way through what he didnt know and just say, hey I wanted to do that, but the doc refused me --- now you cant hide behind that, you have to be able to walk the walk.

2. Most services are or have already transitioned to computers versus pen and paper -- which may be an issue.

3. The younger work force does not have the work ethic that your generation had (in general). You will have to interract and work with the "lets do the absolute minimum necessary to get by" generation every day.

4. You will most likely have a younger boss. The good news is that most of today's EMS managers are better than what you started out with, but they are still whippersnappers to you.

5. With the advent of oneman stretchers and the new hydraulic stretchers, we are far better off than you were with the old twoman stretchers, but our patients have gotten much heavier. I can remember when transporting someone over 300lbs was a rare event --- now 300 is a daily event and 700-1000lbs occurs a few times per year -- and obviously there are many more two story homes and businesses.

I too think the OP could have done a better job framing this discussion -- after about 10minutes of google searches, i turned these links up, which doesnt really defend the position, but it makes me wonder about the sorry employee that you finally get to fire, and then they come back at you using sexual harassment or hostile work environment to save their sorry hyde:

http://career-advice.monster.com/conflict-...-Work/home.aspx

http://www.emsresponder.com/web/online/Top...rminated/1$1473

within that link read: The investigation also found that Moynihan fostered a work environment where off-color jokes, teasing and innuendo were common occurrences.

http://cms.firehouse.com/web/online/News/D...t-Suit/46$55100

and from a construction company education site: A contractor is also liable, however, if the contractor merely knew or should have known, that sexual comments or conduct make its working environment hostile to women. Most sexual harassment claims are such "hostile environment" claims.

Examples of conduct that may create a hostile working environment are as follows:

Unwelcome sexual touching.

Sexually explicit or abusive language.

Sexually suggestive or degrading remarks about a person's body or clothing.

Display of sexually explicit or suggestive literature, pictures or objects.