MS Medic

When I worked in urban EMS, I did not realy hang any drips due to short transport times that did not allow you to get that far in the treatment protocols before sitting in the hospital. Since I have started working in a rural setting, I have hung or monitored drips that were set by a hospital and not set properly. Because it is such a touchy thing, I usually end up spending the entire transport monitoring and adjusting the flow.

That statement is not always the case, per state protocols. In MS, with the exeption of trauma, a pt has the right to ask to be transported to any hospital they want that is inside the services transport radius, reguardless of the appropriateness of the choice. If you for force a pt to go to a hospital they do not want to, you can be charged with kidnapping. The only way around this is to have online direction telling you to go to a particular hospital. As long as the pt is A/O, you typically won't get those orders though.

I'm still interested in getting answers to these questions. These are serious logistical issues with fire based ems. And seeing how many metro FD's have contract out to private services for 911 overflow, are you going to claim you have the answer to that problem?

Understanding Dr. Cowley's concept of the golden hour can better be accomplished if we look at the situation as historical researchers, rather scientific researchers, trying to understand the meaning of an ancient text. Look at the context of the times he wrote it in. He was THE pioneer in the modern field of trauma care establishing preceps w/o the benifit of the knowledge or medical technology we currently have the luxury of. Prior to Dr. Cowley's revolutionary changes, the basic tenents of trauma care were to take your time and allow the pt to stabilize before initiating treatment. A pt could sit in the hospital for hours before any real attempt to treat him was begun. At that time doctors did not have the bank of X-rays, CT, MRIs, etc. Significant exploritory surgery was required to find and fix the insult. Rather than letting a person sit for hours, he promoted rapidly initiating assesment and treatment of trauma pts. His concept of initiating it in 60 min or less was most likely based around the limited knowledge of trauma care and limited resources available. While the whole 60 min thing might not be as important as it use to be, just like dealing with a MI or CVA, time matters. The only true "cure" for sigificant truama is surgical intervention and the faster the time from the traumatic injury to appropriate intervention the better the chance of full recovery.

I did not shuffle through 5 pages of posts so if this has been covered, my appologies. If a city FD covers EMS, then who handles the county? The one fire based EMS system in this state picks and chooses when they respond to rural calls out side the city limits. In order to block competition (atleast I guess that is the motive), the FD fights tooth and nail to keep out private and volly EMS in the county. (Volly fire is all there is in the county thanks to same said FD). I had personel from that department in my paramedic class and noticed that the universal motive for fire personel to be medics was to "have one more cert" for promotion. In fact, that service requires the use of contract medics because the fire medics do the required 2 years on an ambulance to cover their obligation for a free ride through medic school then stay as far away from the ambulance as possible. At least with a private service, you know that when you know that barring MCI/state of emergency type situations you will get an ambulance and the crew will usually have a motivation other than getting a promotion

There is a valid point to the idea of pts knowing which hospitals have what services. When I was going through basic school, I was doing an ER clinical at a hospital that had a world class obstetrics dept. but didn't have anything else going for it. A crew brought a STEMI pt in because he wanted to go to that hospital and the crew could not talk him out of it and other than lvl 1 trauma we transport to pt choice here. Well down the road about a 10 min drive were 2 hospitals with campuses butted up against each other who both had cath labs. This dude would not even stop at the er in either one of those places but coded in the ER because he insisted on that hopsital.

Without knowing any details about the service you are applying for, the only thing anyone here can do is guess. But with that in mind, drug tests are not cheap as long as it is not a saliva test and if the company has made the investment of a drug test and a background check, you should be good as long as both of those come back clean. Congrats, good luck and enjoy the ride.

I have experienced this problem. I worked for a large corporate service (insert appropriate letters) Management only imposes the controls that were required when dispatch alsmost caused them to fail their last CAAS inspection. I have had dispatchers do everything from refuse to send fire for lift assist on bariatic pts to telling me that I did not need LEO on a psych pt and that they were not going to call and I was not to stage. When you logged a written complait with managment, it was filed in the shred box but only after the dispatch center learned you complained. When you coupled this with the fact that they ran modified system status management and you can imagine the fun of working there. (I am sorry for any misspelled words or typos. I am at work and the company firewall will not let me download the spell check.)

How can sitting in a nursing home doing CPR for 10 min just waiting to pronounce be justified when the pt can be in the ER by then?

I worked in Jackson, MS for years. We usually ran an average of 8 calls if all were transported (more if not) during 14 hrs of a 12 hr shift. I've had 2 knives pulled on me, fought with a guy trying to pull a gun on me and lost count of the number of psych pts who attacked me. A crew was robbed and shot at while staging at a gas station on a call. Units have been shot at while responding to call and there are certain areas that EMS does not go in w/o police escort for the safety of the crew. Unofficial common practice there is to treat life threats, move to the truck and do everything else en route. It is the personal safety of the crew that guides this practice and that might be the reason it occurs in other urban settings as well.

I just switched employers and went through class orientation the day after these posts. The timing was odd because we went into this during protocol review and the service demands we give vasopressin first because of the reasons chbare mentioned.

I apologize. I was referring to the replacement in the first or second round of meds. Could someone please link or list where you found this information. I would love to see all the right places I have not been looking in.