RatPack

We should recieve a dollar for having to read them

I voted yes, I'm not sold on the priority dispatching, I think the general public are poor predictors of whats a true emergency.

I do like the pre-arrival instruction and emergency medical dispatcher portion thats usually included with these programs.

CNA

LPN

RN

Nurse practitioner

Nurse anesthetist

You got em, sorry but there made of cement.

I wish I had a two more hands

I am in no way justifying this officers action. Their jobs is to uphold the law, this person ran a red light, what if one of your loved ones was t-boned by this guy?

Once at the hospital, the officer needs to be able to process the information. Which I dont think he accomplished.

As far as the person in the back seat of the car possibly having a weapon, that is a valid point. Maybe the recent shooting in Oakland played a part in his decision making.

Its a tough situation. Officers are put in situations everyday where decision making is crucial. One wrong decision could cost them or someone else their life. They have to be thorough. What if this guy walked into the ER guns blazing to finish off some gang banger and took 15 innocent people with him in the process?

Granted when the nurse came out to confirm the story. That should have been a indication that maybe this guy was telling the truth.

Just my opinion.

Here is a good article I think you need to be a member to view it though.

http://www.sciencedirect.com/science?_ob=A...62a83821351ee7a

"Siren addicted dorks" In my area police officers are required to hold a bachelors degree to even apply. Guess what, the siren addicts on power trips still exist.

I would bet they do more then the general public is aware of. As with EMS it only becomes public when there is ramifications from such behavior.

Education and responsibility does not eliminate stupidity. I hope thats not what your expecting.

Bitch'in and whining are not exclusive to EMS. In fact I would challenge you to find a field where it isn't present.

Why would we expect EMS to be different? Its human nature, if people if are involved, you can be sure that a minority of them will be unhappy for whatever reason.

There is no logic to it that I am aware of. As far as we can tell, it's merely to get the rig back in service quicker for the next run. Depending on time of day, location, and traffic, it could save a lot of time. Apparently this "need" outweighs the risk for running hot all the time.

Dispatch triages AND gives pre arrival instructions, but everyone also knows what to say to make dispatch "triage" essentially pointless.

Our policy states every ambulance summoned will use light and sirens to the scene. Transport priority is based on presentation of the patient and ultimately the crews decision.

I dont know where you get that notion that its about getting a unit back in service. A service requiring lights and sirens to and from the scene is a policy geared towards getting a unit back in service.

In my area extensive CQI usually curbs the enthusiasm to respond to the hospital when not warranted.

Here is a novel idea: Instead of trying to figure out how you can delay an ambulance to some patients, why not staff enough ambulances or first responders to give everyone a good response time ? Imagine the Pizza Hut employee who takes your order over the phone, and asks:

Cause money doesn't grow on trees. A city budget is a balancing act, sometimes difficult decisions need to be made, they are not always the most popular ones.

In the land of rainbows and gumdrops we would have an ambulance on every corner, a police department with enough manpower that people wouldn't have to wait, a fire truck around every corner just in case. Enough teachers etc,etc.

We dont live there, at least I dont. Things cost money and the cost is always rising.

I guess EMS isn't recession proof.

I'm afraid you are going to see these kind of decisions more frequently. Fire departments and police have taken a beaten in this economy, it was only a matter of time before EMS was affected.

Animal intuition always amazes me.

We only have one type of response- lights and siren, and only one type of transport- same. We do have a tiered dispatch- ALS or BLS-and that is a total failure, but that's fuel for another thread.

You transport everyone light and sirens?

What is the reasoning behind that?

We do use the Emergency medical dispatching, however we dont base response on it. Every call we respond to. Transport priority is based on pt condition. The majority are without lights and sirens.

As far as the dispatchng our system is geared more towards pre-arrival instructions then triaging calls. Bleeding control, CPR, Pt positioning, things of that nature. In my opinion it does work for us and would state that it has benefited more then one pt.

Pseudo seizures are physical manifestations as a opposed to neurological, there is no disruption of electrical activity in the brain. Which is what I think you are referring to here.

Granted in the field these can be difficult to differentiate from true neurological seizures, however this person was under the care of a MD, probably a psychologist who is completely familiar with her situation. I would defer to them.

You're preaching to the choir, Bro. But someone who is motivated to be the best they can be will take those foundation courses, whether their medic mill school requires them or not. That's what we hope to encourage here.

As for cost, I have found the opposite of what you have seen. The two-year programmes are usually community college based, with tuitions that are both cheaper than the non-collegiate schools, and allowing for payments by semester instead of a lump sum.

Yes, my mistake you are correct. The community college programs that I have read about are affordable. We dont have any that offer the paramedic program as of yet.

Do you think that todays economy is forcing students to lean more towards the training programs then the traditional education programs? I dont necessarily agree with that choice but I can definitely understand it. Just due to the fact that they can be done in six months versus two years.

We are not allowed to accept any gratuities.

However, I require at least 20%.

In all seriousness we graciously decline.

I do like the charity idea.

Its not something we encounter much. The majority of our population operates way below the poverty line.

Don't do it! You don't need training and experience to become a competent diagnostician. You need EDUCATION! You will get 100 times more benefit out of a semester of college Anatomy & Physiology than you would out of five years as an EMT-I. Your I training was a complete waste of time. I experience will be equally useless. Experience does not have optimum benefit on your practice until it has a theoretical foundation from which to grow. And the only place to get that theoretical foundation is back in school. The longer you wait to do that, the less of a medic you will ultimately be.

Right, the only problem is the majority of EMS programs have no education requirements at all. Its training not education.

So would you consider a paramedic TRAINING program a theoretical foundation? I'm not sure I would. The problem is there are few programs that educate and a million that train. Usually the educational programs are expensive, much more lengthy and in-depth, two things most people today are not interested in.

If you're waiting for changes in BP, HR and presentation, you're waiting too long...

Good Lord. All I stated was skin tempature is a poor indicator of internal blood loss.

Nobodys waiting for anything....

Thats it im done.

Actually skin gets warm before BP and puls changes show up. If not exposed and touched it will be missed.

If you say so.

I will base my findings on something a little more substantial. Like BP, HR and pt. presentation.

I agree skin tempature is a vital sign, however its a poor indicator in this example.

Im not arguing the point of exposure of the affected area. Just stating there are more reliable indicators then skin tempature.

Actually JessiR is right. By exposing they may see indications long before vitals tank.

I will have to disagree, internal bleeding is usually never visable to the naked eye, its a late sign.

I know here(in Virginia) if you do not expose on your states you fail automatically, regardless of what else you may do "perfectly". I haven't taken the NREMT-B(decided to keep going through school) but was lead to believe it was the same way. If that's so, then it leads me to believe it's pure out laziness. And to not expose when assessing a trauma? To me, that sounds like it could be edging on negligence. How can you do an appropriate trauma assessment without looking at the injury?? Ex- You have a fractured femur. You splint it, finish your "assessment" on scene, and go at a nice leisurely pace. But since you didn't look at it, you didn't know that it had severed the femoral artery was pouring blood into the closed injury. Your pt has serious complications(or even dies) because by the time you realized he was going into shock and prepared to treat it was too late. Maybe that's a little extreme an example, but it hopefully illustrates the damage that can be done by not taking those few extra seconds to cut away clothing.

Whatever level you operate at you need to be competent in recognition of life threatning injuries. In any event if there is enough force applied to the body to fx a femur then complete exposure is needed to address other possible injuries that are present and could be masked by the pain of the femur fx.

You can tell by looking at a fx femur that it has severed the femoral artery and is bleeding internally? This is where being able to assess all aspects of the pt to determine possible injuries. This example isnt that difficult, vital signs alone should tell you if internal bleeding is present. They will lose volume and usually quickly and that will be reflected in their vital signs.

You have to treat the whole person, injuries to specific systems will usually affect other systems.

So then you wouldn't mind if we bumped up EMT training to four years, while retaining the same skillset?

Thats fine. If the powers that be feel it neccesary.

Its not about skillset at my level. Its about recognition and assessment.

Im not confused about my place in this field. I dont need extended scopes or more skills to perform my job. That isnt how I justify my existance.

Regardless, 600 hours of EMT training is still not going to save the life of a heart attack or hip fracture victim any better than 120 hours would. Without ALS care, both are going to die. Being an overeducated EMT is like winning the Special Olympics.

I would have to disagree, I dont believe there can be too much education at any level.

My EMT class was 400 hours long it included anatomy, physiology, human body in health and disease, psychology and health law. All college credits that I put towards my degree.

The EMT portion of the class was 4 hours a night two nights a week and six hours on Saturdays. Altogether It took about a year. This was about fifteen years ago.

This class has gone by the wayside, they have removed the pre-reqs and dropped the Saturdays.

On a side note the pass rate of this class was about 40%. Whats funny is they removed the instructor who was a paramedic with about 20 years experience and a BS in biology, because the pass rate was to low and replaced him with an EMT with no college education and little experience. The pass rate a few years ago was about 100% . Its a joke.