crotchitymedic1986

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.

Cant argue with that -- my point is that the culture of the company should push those who are pushable in that direction. If the culture is "my job is to sleep, watch tv, and gossip in betwen ambulance calls" then some who may have been teachable might take the path of least resistance, and join the herd of mediocrity. Maybe i am being polyanish, in hoping that i could capture another 1 or 2% from the darkside, but i always hold out hope.

I would also challenge the "leaders" in our company, which is not always the people with brass on their collars. Look around in the morning, the employee that has everyone gathered around him/her is a leader --- they may be a negative leader who is undermining the company, but they are a leader. TOo often, the bar is set too low, with the only expectation being "lets get through today's call volume". If the brassed and nonbrassed LEADERS set a higher expectation, most employees will rise to it. If you set a low expectation, they will settle to that as well.

Also, you have to realize that many instructors are used to talking TOO people and not WITH people, so sometimes it is they that have the communication issues with their subordinates. Anthony was also right in that all you know is your "book learning" right now. I am not trying to minimize that, but you need to get "experience" before you start questioning anyone on the scene. A better way to handle the situation for now, is at some point after the call is over, go to the instructor and supervisor and say, hey I want to ask you about that call -- i think i was under the impression that we were supposed to do "cde" but you choose to do "fgh", so please help me clarify what i should do in future calls. And remember, when presented with the option of being right OR being NICE, choose to be NICE.

First of all wendy, you should be commended for even stepping up and admitting, "I might have a problem". Some simple suggestions: 1. Smile. You can tell someone to go to hell as long as you are smiling. Conversely, you can say have a nice day with a smirk and piss someone off. So smile. 2. Ask yourself, do i listen to hear, or do i listen to formulate my response. Many people do not really listen to what is being said, but merely scan through hearing the catch words, to formulate their answer. Sounds silly, but try listening, and then repeating silently in your brain what the person said before you talk. 3. Dont add in your two cents every time you get the chance -- sometimes, especially when you are the new person, it is better to be silent for awhile. Many people have to add their two cents in during every conversation -- sometimes it is better to just listen and not talk. 4. Pick your battles -- you could wind up 100% right in every arguement you get into with your superiors, but wind up unemployed. I am not saying to compromise your values or morals, but ask yourself should i die on this hill, or live to fight another day ?

Amen to that, but i would shift the blame a little. In any business, 5-10% of employees are exceptional, 20% are just waiting to get fired, and the rest are somewhere in the middle. If you extend school to a 4 year program, you might be able to teach "everything" a medic might encounter in his/her career, but I am not sure you can guarantee it. I think a good bit of the blame falls on ems companies themselves and lawyers. The doctor kevorkians and drug abusers in our field just get passed from employer to employer instead of getting removed from the system all together. A better in-house orientation/training program would help those who are teachable, but many systems only have the most bare-boned and pencil whipped programs to educate their employees (I said many, not all).

I am learning that quickly through this forum, thought i had it pretty good -- guess you dont know how poor you are till you meet some rich people. You guys obviously work for some pretty cutting edge services.

I live in Canada, but i do not work in EMS any longer, my field experience was all US. We purchased the heaters you are discussing, but the problem was that they didnt last long, and as you stated the heated to over 90 degrees which was outside the range recommended by the fluid manufacturer (too hot is as bad as too cold). The heat/cool units with programmable thermostats were $300-1000 each, which was too costly for our budget. We then went to a heating "tray" (a heating pad on one of the ALS shelves, which also allowed us to heat linens) as part of all new vehicle purchases ($600) as it was easy to hide that in the overall purchase price.

I think you have to figure out what you can do to be DIFFERENT. If the only difference between you and the other employers is the color of your uniform, then why would someone jump ship for you ? How can you be different: Different schedule, higher pay rate (or same pay rate for less hours), better equipment, liberal or cutting edge protocols, you can be more employee driven (employees have a voice), be active in the community, do clinical studies that get published, have a real career ladder - EMT 1,2,3 -- Pmdc 1,2, FTO, LT, Capt, Colonel. Note that many of these suggestions do not cost $$$, some are just an expenditure of time and planning. Make your service "KNOWN" for something positive. If you do that, word of mouth will bring them in, because sadly, too many companies are different in color of uniform and ambulance only.

I think orientation should be flexible in time parameters -- some people may need weeks, more veteran employees may just need a day. At a minimum, they should prove that they can operate every piece of equipment on the truck, go through some driving training, soem territory training, and ride third until a senior medic gives them the OK, but even when on their own, I think there should be a thorough review of every call. I do not subscribe to the sink or swim philosophy, because when they sink, patients tend to die. This is where a good field training officer program can work wonders. I have a buddy that decided to be a CDL truck driver --- i was struck by the similarities and differences between his orientation and ours in EMS --- he had to go to school for 4 weeks and pass his CDL exam, that was administered by the state, and has a significant failure rate. The school was upfront in saying we only teach you to pass the CDL test, it is up to your employer to teach you to drive their truck (lots of differences in regular 18 wheeler, flatbed, and tanker -- not to mention hazardous materials). After passing the test, and getting hired, every employer required an 8-10 week orientation period where he was paid less than minimum wage. At the place he got employed, he spent 4 weeks in classroom and practice driving in their "yard", then drove the next 4-5 weeks in every condition imaginable -- mountains, city, urban, rural. He was not given his own truck until he passed every driving and written test. Out of the 19 that started his orientation class, only 2 received a job offer. And they start a new orientation every week, because they are so short. But unlike some EMS employers, they feel the "cost" of hiring someone who cant pass the rigors of this orientation period is too much of a risk (the average cost of an accident involving another vehicle is over $300k).

no otoscope -- should have said eardrums