Hillbilly Medic

I currently work as a Paramedic in WV, but my family and I have recently decided on relocating. We've chosen a few places we've been before on vacations, and narrowed down the list. I've researched a few agencies, and would like some advice, experiences, etc. I'm currently looking at Acadian Ambulance in Louisiana, Medic 911 in Charlotte NC, and Sunstar EMS in Pinellas Co FL. Does anyone here have any experiences with these agencies? Pay vs cost of living? General statements. All responses are welcome and most appreciated. I'd rather ask now than move my family hundreds of miles, THEN find out the agency or area isn't all it's cracked up to be. Thanks.

I'm with JWade on all of the above. Pacing is probably not going to work. Will it hurt to try? Probably not. Will it be effective? Probably not. Do I recommend it? No.

In an effort to understand the larger situation I do have a couple questions, though.

Why initiate transport on a cardiac arrest patient when you have a minimum 60-80 minute transport time? CPR is not effective in a moving vehicle just as it isn't effective when the person providing compressions is exhausted. You're not doing anything to help the patient at this point. What will it take to change your local culture to work a cardiac arrest on scene and transport only if you see ROSC?

Does your MCP not understand the time and distances involved? Since s/he wouldn't let you discontinue it would appear not. You need to make this point crystal clear to him/her when you call in your request.

Please think back to your CPR training, too. One of the endpoints of CPR is when the provider is too exhausted to continue. If one physically can't provide compressions are you really going to risk harming yourself for the benefit of a dead person who is going to stay dead?

Good luck.

Now I remember why it's not a good idea to post at 0300. Nowhere NEAR enough clarification. My fault. Ok, the pt was in severe resp distress upon transport, went into arrest approx 30 minutes into transport. He (the medic) was able to successfully defib twice, but was unable to convert the last cycle of v-fib. Continued epi and compressions. We both know that CPR is most effective, but that we're human and that, eventually, you get tired. As for changing the dynamic in our area? We've tried, but the only things the VFD is willing to roll on is trauma, or LZ setup, IF it's during reasonable hours. This was around 0240. The particular MCP referenced has done that several times. Why? I can't give you an answer. I know what I asked probably sounded stupid, but the discussion that lead to my post was if it was possible, physiologically, to gain any kind of contraction from pacing. My own opinion was/is that you'll merely be manufacturing PEA. However, I was willing to ask, more out of curiosity than anything. Strange things happen in the field, and I wondered if it had ever been tried, or if anyone had ever seen it work. That's all. I can completely see the reasoning behind it not working. Chalk it up to a "what if" type of scenario. But thanks for the replies, I appreciate it.

Well, Short answer, NO and it depends....

First, to answer your question accurately, please " qualify" arrest?

If the patient is in V-Fib or Pulseless V-tach, the answer is NO.

If your patient is in symptomatic bradycardia, refractory to medication , then obviously pacing and or CPR are indicated. ( This is also making the assumption one has figured out WHY the patient is in arrest and is instituting specific TX modalities.

Respectfully,

JW

Partner, and fellow new medic, was working an asystolic patient. Glucose WNL, 3 rounds of cardiac meds onboard, amp of bicarb. Minimal history of current condition. Went through the list of possible causes. MCP wouldn't let him DC resuscitation. he was just exhausted, and no available units to help, as none of the VFD's roll on medical patients, just MVC's etc. He was wondering if an attempt to pace would've been successful. I didn't think so, but it was an interesting discussion that just had me curious. I'm not afraid to say that I just didn't know, but I was willing to ask.

A few of us were discussing this, and I wanted some opinions. I work in a very rural setting, minimum transport time is 60-80 minutes to an ER. Sometimes, you can't get an extra hand onboard during bad calls. So....if you're working an arrest alone, and you're just to tired to do more compressions, is pacing a feasability? Isn't it still going to circulate, providing you get capture?

OK, I'm having problems with IV's. I can mainly get them in class and on people that let me use them as guinea pigs, but on my patients, I have a lot of problems. I got one on my first ride along day, but I have missed every one since, except the one I hit a valve on. It's really starting to irritate me. Maybe I just get nervous or something. Any advice?

I had this problem too. Check your angle, hold FIRM traction below the point of insertion, and above all else (in my opinion) DON'T take your time! Now, what I mean is, don't sloooowly insert because A: it causes undue discomfort, and B: Going slow tends to "push" the vein. Firm, steady pressure will penetrate skin and vein, then just advance slightly after you get flash, to ensure the catheter is in the vein.

I call BS on that you have nothing to add - your post above is one of the most intelligent and educated posts I have seen lately - and I hope you continue to lurk, and post as you see fit.

And that is part of the reason why you will always be a better medic than they will ever be. YOU put the time and effort into learning the material so that once you were in the field, it was already there, not something you would have to look up, or depend on someone else for.

This guy is the perfect preceptor. THe point of clinicals is to test the knowledge you learned in the classroom, and apply it in the field. He allowed you to do that, and you learned from it, took constructive criticism (which many can't) and stepped up to the plate.

When I was in univ, we were in a dissection lab, and I remember my prof leaning over another student and saying "You know, always do something the wrong way first - then you will know to never do it again." That has always stuck in my head - when you make a mistake, you learn from it (or should learn from it)

Hillbilly, keep posting - I suspect you have a LOT to add to these forums.

Well, thank you very much for the compliment! I feel like a 3 y/o on Jeopardy after reading some of the posts on here, but I will take your advice under consideration! thanks

I've lurked this site for almost two years now, with maybe 1 or 2 posts tops. Being an EMT for a whopping 7 years (and a baby medic going on 3 months now), I honestly felt I had nothing to add. I see an enormous wealth of knowledge here, and it has both humbled and educated me. That being said, I couldn't help but chime in on this topic.

I came through medic class with a 3.95 GPA, more clinical hours than almost every other student, and passed my National Registry at 73 questions. I say all that to get to this: I had absolutely NO confidence. I was constantly being fingered out in class by other students, ie "Ask *****, HE knows", or "Well, once we are out in the field, we'll just call ***** if we can't figure it out"

You know what that did to me? It added an undue amount of needless pressure. They were just as capable of spending the time necessary to study as I was.

That all changed about 2/3 of the way through clinical rotations.

I had, in my opinion, the best preceptor one could ask for. Our first meeting, he reviewed my skillset, asked questions about my grades, class, experiences, etc. Then he sat me down and told me this :

"Right now, you have the basics. Nothing more. All the books in the world aren't gonna help if all that knowledge leaks out your elbows. You have to use that knowledge, and APPLY it. This isn't a classroom, and I'm not gonna tell you you've 'done your best', or 'good try'. If I see you doing something wrong, I'm gonna call you on it (In professional fashion I should add), and you're gonna have to explain to me WHY it was wrong. YOU are the medic on this truck, and I'm the safety net. The only way you'll gain confidence is by DOING IT. So you miss an IV? Don't blame the patients rolling veins, or the lighting, or the type of catheter. You missed it because you didn't hold proper traction, or you used an incorrect angle, or whatever. I will do my best to answer, explain, instruct, and guide, but I will not coddle, baby, or make you 'feel good'."

I thought this guy was a complete a$$. It's been 6 months now, and we're best friends. My point to the story? He made me WORK to gain my confidence. He was willing to let me fall flat on my face (making sure no harm came to the patient obviously), but would take the opportunity to educate me as to WHY I fell on my face. I wasn't held by the hand like so many I've seen. I was expected to take the leadership role from the onset, not slowly lead into it. It may seem like an odd approach to most, but I for one will be forever grateful for it.

I have this book also, it is wonderful. The best thing you can do is find people you know who have books, pick through them and find the best fit for you. Then get your hands on an ECG packet, we have one at work for new hires to do their ECG interpretation test with. I have a few from school and work, they have many different rhythms in them, and just practice. But understanding the way heart works is key, if that doesn't make sense nothing else will.

Another good place to go is HERE. Bob Page, the "12 Lead Medic", has some interesting stuff on his site as well. Just my 2 cents worth.

I notice this in every urban area I look at for openings. I lived in Miami for a year, and went back to electrical work while I was there because all services (except AMR) where fire based. Now, the question I have is this: I chose to become a Paramedic, and firefighters choose their trade. Why then must I have to do something I choose not too? I wouldn't ask a firefighter to become a Paramedic if that isn't what he/she wanted. Either way, you're gonna find that each person prefers one trade to the other. The end result is that they will excel in that which they love, and "slack off" in that which they don't.

If this really is in the best interest of the public, and not the money.....hell, let's combine police/fire/EMS and we can all do all three jobs.

I've been looking at various states to work in, and since I was born in Florida I looked around some there. It's evident that most EMS is Fire based, but I also found such places as Sunstar EMS, Lake Sumter EMS, and Lee County. Lee County isn't accepting apps at this time, but anyone know about the others? Florida isn't my only option, as I've been looking in South Carolina, North Carolina, and even as far as Texas and Nevada. I've just had my fill of rural EMS here in the hills of WV. Granted, the call volume is lower, but those 90-120 minute transport times, the cold weather, and the mountains of snow have done me in!

Any suggestions or info??

Thanks