SDMedic

So, I just read this on the JEMS website (I work as an Editorial Intern for them) and I thought it was a pretty thought-provoking article - especially to hear some responses from the people who may actually be riding in them. Who do you want developing new ambulance design standards for apparatus to be bought by the federal government: the National Fire Protection Association, who has a history of setting design standards, or the American Ambulance Association, who deal strictly with ambulances? http://www.jems.com/news_and_articles/arti...w_standard.html

I've seen a lot of people have viewed this topic by next to no one has replied. I'm really interested in hearing how other services run. I hope some more people will honestly answer these questions.

Hello, 29yo, work as a paramedic in san diego, and a some-time volunteer for la cruz roja (red cross) tijuana. Also work one-day a week as an editorial intern for JEMS. Looking forward to reading/hearing about anything going on elsewhere and putting in a word or two myself from here.

SDEMSE is a public-private partnership between the CITY of San Diego and Rural-Metro Corporation (as well as a couple of other incorporated cities). The COUNTY of San Diego has perhaps 30+ different agencies for each of the cities, as well as areas run by an "Authority"-like FD, and CAL FIRE (which used to be California Dept. of Forestry). Likewise, AMR has it's share of presence here, working with non-transporting FDs. So, to pin down how San Diego's history is difficult would take more time than you're probably willing to read, and more time than I'm definitely willing to write. That fact in itself should help paint a picture of how muddled the system is. However, the long and short of it is that in the early to mid-90s San Diego City and County made budgetary and other administrative plans for a future they did not foresee: population explosion beyond anyone's wildest dreams. The resultant lack in public safety resources left them scrambling to fill positions, and therefore standards were arguably eased, especially when it came to recruitment. The idea of the MICN, according to some, was to supervise the haphazard practices of medics coming from all parts of the state and country, and to try and promote a standard of care throughout the county. However, it seems their necessity is less prevalent than it once was. That's the crux of the argument i'm trying to find out: has anyone else had the same experience? What came of it? So, reading SDEMSE's website might not be the best place to find out about a controversial history - it is an official website. Likewise, MICN's are employed by hospitals, not EMS agencies.

thank you, sir, for seeing the question as it was intended. rest assured, i'm not a threat, just a medic trying to find out information that is PUBLIC - large gatherings, and the logistical nightmare they present, are learning experiences. i don't think this would be my first stop in trying to find out government secrets.

"Mother-May-I" INDEED! :oops: Here's how your (our) typical call would run: We arrive on scene, assess Pt and treat Pt (if necessary) based on protocols. We have 3 types of orders in SD, and must treat based on the treatments classification: Standing Order (self-explanatory) Base Hospital Order: issued by MICN, and based on pre-existing protocols we ALREADY know, i.e. wanting to give NTG to a STEMI with a blood pressure , 100SBP Base Hospital Physician Order: issued by MD only, i.e. giving Epi SC to an asthma Pt >65yrs or w/Cardiac Hx Then we proceed with the remainder of the radio report (whatever's left: age, weight, c/c, story, vitals, Hx, allergies, meds, treatment rendered, eta). Unless it is an acute call, the MICN does little more than start Pt registration in the hospital system and perhaps advise the charge RN of our arrival. Needless to say, there is a great deal of "us vs. them" on both sides of the radio, and medics who don't please MICN's are often subject to an inability to receive much-needed orders because of ego. While arguments are made that MICNs protect Pt's from careless medics (and I know they exist in ALL systems nation-wide), the assumption that there aren't any careless MICN's is just as uninformed. I'm getting the impression that this whole MICN-thing is unique to SD. San Diego EMS has a ... "difficult", yet interesting history which warranted the implementation of the MICN as an overseer. However, the comment that because they have a BS means they are able to "see" the Pt better than the medic on-scene is a faulty premise - especially if the Medic is only guilty of giving a poor radio report (which is mandatory for every call, regardless of acuity) ... how much more is there to pick up on scene vs. simply hearing the re-hashed story while sitting in a closed room at the hospital? I have both a BS and a medic license, and truth be told, the BS wasn't nearly as demanding as Medic school. Again, it is a mother-may-I system, and the debate is growing as to the necessity of this role; which is why I was wondering if anyone else had experience with this type of system, and how it resolved itself - I'm really only looking for the effectiveness or inefficiency of this role as played-out in other systems. And yes, while CA has perhaps the best laws to protect hospitals, clinicians and other Allied-Health care professionals from outrageous settlements, the reason we have these laws is because of the outrageous number of lawsuits here, hence the "Sue Me State" nickname.

MICN - Mobile Intensive Care Nurse (Radio Nurse): takes incoming reports from units on-scene/en route, issues orders (if required by local protocols), informs as to availability of hospitals (bypass)

I work as a medic in San Diego and for every call we run we have to give a full report to an MICN en route. I'm not aware of any other system that uses the MICN to the extent that we do, so I'm wondering if anyone could tell me if they work(ed) in a system that also utilizes MICNs and is in the process of eliminating them, or already has, and what it took to do so. There is a movement going on here to try and eliminate them since they're seen as little more than an unnecessary middle-man(woman), but the problem is that they rule the system, and basically developed it, so the goal is to prove how the system can be just as successful without them. in short, i'm looking for any similar experience out there. likewise, i'd be more than willing to hear from anyone who thinks their system could benefit from them. thanks!

I was hoping to find out if anyone's involved in the EMS effort at the Inauguration and whatever they might know about it, i.e., pre-planning, logistics, inter-agency coordination (with the Secret Service, FBI, D.C. Fire/EMS, etc.). Who's running the show, in short, and what kind of preparations have they made in case of ... anything unexpected? All i've found so far was this article taken from the Orlando Sentinel, but I'm definitely looking for more. http://www.jems.com:80/news_and_articles/n...auguration.html Thanks if you can help!!