fakingpatience

I work for a private company with a union. As a disclaimer, I should note that I've never worked for a different EMS company, so I can't compare it to anything but what I've heard.

Most of this is about the contract, which our union negotiated with the company. I believe having a union and a contract go hand in hand.

Pros: Management has to treat everyone equally. Equal rules. Everyone gets the same amount of call ins allowed before they get fired. Reduces favoritism. Your job is more protected, can't just be fired at will. Everyone is treated equally

Cons: Everyone is equal. Doesn't matter how much you put into your job, if you come in, do your job without issue, you will slide by. No rewards for outstanding performance. Management likes to pull the 'its in the contract' card. Silly rules, where you have to play with words or find loopholes in the contract to get things done. They have to treat everyone equally. For example, we are ridiculously short on medics, always are, but the company won't support basics going through medic school either by helping with scheduling of work to get to class, or monetarily. They say that to be equal, they would have to help everyone with any school, and they can't do that, so they don't do it at all.

I did hear that the union negotiated higher pay with this past contract, but we also lost a lot of freedom with it.

(Sorry if theres any spelling issues, I'm having issues with my spell check)

Hmm, just thinking perhaps the doctors in private practice are under the same illusion as some patients, the patient will be seen quicker if brought in by ambulance? Emergency Medicine is a specialty, after all, most MDs or DOs might not have that knowledge.

I had a doctor tell his patient that she would get seen in the ER faster if she went by ambulance vs private vehicle while we were standing right there. So yes, at least some doctors are under that impression. Personally when people tell me they took an ambulance to the ER simply because it would get them seen faster, I love walking them out to the waiting room to wait with everyone else (with triage nurse approval of course).

While not specifically doctors offices, I wish that more people would understand that there are more options then only going to the ER via ambulance or staying home (with going via personal vehicle or going to an urgent care being other ideas).

How often do you guys run into the situation that doctors fail to tell their patients that they are being sent via ambulance to the ER? We have a couple urgent care places in our area that are notorious for that, and the patients are always blind-sighted when we arrive.

She is in mild distress,

Mild distress as in she's anxious, or something else?

Other Cincinnati stroke scale signs? Any aphasia? How long ago did it start/ did someone notice it?

Any recent trauma?

Any family hx of seizures? Was someone with her when symptoms started to get a good story of what preceded the symptoms (was it slow, affecting only one area first, or all at once, any seizure activity seen?)

Are symptoms changing currently/ getting better/ worse?

i mean likei live in FL now andi wanna move back to ny when im done with school, i want to get a job as an emt there and finish school over there as well, im also wondering if anyone has transfered their license or if it has to be done even though i will be NREMT? i have so many questions and i looked all over online and nothing really answers it specific enough.

Thanks again!

NYS does not accept reciprocity from NREMT. They do however accept reciprocity from some states. I have no idea where FL stands in the eyes of the EMS council of NY; your best bet is to call the office and find out if they will accept a FL state EMT-B certificate to transfer over to NYS or if they will require you to redo some of your education.

OK, since your clearly not going too show us you're boobs, I'll answer your question.

The problem with going straight to medic school is the educational system is not set up for it. Let me explain.

When you leave EMT school, you are expected to be `barely competent``. It is expected that you will be heading out to the world to gain experience and get comfortable with the following skills:

History taking

Touching people

Talking too people

Dealing with vomit/blood/urine/feces

"out of the box" (or what we call "critical") thinking

Because these skills are expected to be obtained through experience (not on your practicum as there is not enough time). They are an unwritten prerequisite for Paramedic school.

That is the real problem, Paramedic schools are not designed to facilitate basic human interaction skills, those are expected to be there when you start.

So my REAL answer is, it is individual based. If you have worked customer service or interacted with the public on a personal level in the past then you may already have those skills. So my suggestion would be to go start school.

However, if you are like 90% of the students I have gotten lately, and have locked yourself in the basement for the last 10 yrs playing videogames and depriving yourself of public interaction, then chances are you have no human interaction skills and need to get out there to develop them. Paramedic practicum is not the place to develop those as your preceptor will fail you, and working as a medic is also a poor time too find out you are uncomfortable being in "personal" space.

But whatever you choose don't ever let anyone convince you that you need to master EMT skills prior to entering Medic school. You only have to master life skills.

Exactly! This is pretty much what I was attempting to say, but much more eloquent

In my experience, "practicum" time in basic school is a joke, only meant to show you what a day in EMS can be like, not actually teach you anything or provide an opportunity to utilize what you are learning in school.

I think the answer depends a lot on your self, and how long you take to get comfortable with your skills. Personally, I will have been an EMT for 2 years before I start medic school in the fall. By comfortable I don't just mean knowing your skills, I mean being confident in yourself that you can handle a call and be in charge of everyone else on scene.

I found a great volunteer place to start out with where I volunteered doing actual shifts (vs on call) w/ great people who were very experienced in EMS. I then moved and got a paid job at a different company. In both places I worked with medics, so in addition to using my BLS skills (both running BLS calls and assists on ALS calls) I got to see ALS calls being run, and ask questions of my partners afterwards. This exposure to ALS has helped me learn a lot more then what I simply learned in basic school, and is giving me a good foot up for medic school (I hope!). Also, when I started as an EMT, I was very nervous on calls and interacting with patients, now that is second nature, and one less thing I will need to worry about figuring out how to do when I am figuring out how to be a medic.

As someone (I think Dwane?) said, if you are going to be an EMT first, it is important to look at the place you plan on getting the experience to make sure it is the kind of base you will be wanting to build upon.

Try and find a phone number to contact someone in the NV office. Some states allow you to apply for reciprocity based on special circumstances, which sometimes includes applying for EMT jobs in the area.

Obviously English is not your first language.

Haitian is a national origin, not a race. Your racist assumptions have no place in this forum, so STFU.

Would you have been happier if I stated that the comment by the poster came off as ethnocentric, or derogatory towards Haitians? Either way, the point was made, and I would respect yours much more if you had not felt the need to take to insulting me in your post. Also, STFU, really? I thought this was a professional forum...

Very cool tattoo! Any special meaning behind it? The design looks very pacific islander...

On the occasions when we do get emergency calls and are stuck outside waiting for some lazy Haitian CNA to waddle down the hallway and let us in, its nice to be able to pop most doors we encounter.

-1 for your racist comment which has no place in this forum. (Really, do you feel your post benefited from giving the CNA a race?)

Hi there,

I'm going to become an EMT certified with my college which is recognized by the state and has been certifying EMT's for over 30 years. I was wondering if after successful completion of this course, if I'd need to take the NREMT. If so, would I be able to work as an EMT before taking the test, or would I have to do it before I even get hired?

I'm a bit nervous about the NREMT..

Oh and just a side note, are EMT B and EMT 1 the same?

Thanks for helping out the noob to the EMT world!

- John

It depends on what state you live in. In all states, you will have to pass at least a state test to become certified to be an EMT. Some states accept the NREMT test in place of a state test, some its in addition.

EMT-B and EMT-1 (number 1) are the same I believe. Can't remember which states use EMT-1 EMT-2 and EMT-3 as names for their levels

EMT-B is a lower level then EMT-I (letter).

In my two different systems we had different protocols

In my old system bleeding control was

1. Direct pressure

2. Tourniquet/ quick clot (depending on location of wound)

My new system:

1. Direct pressure

2. Pressure point

3. Tourniquet. BUT we don't carry and official tourniquets, so you have to make shift one...

I believe the new research showed that a tourniquet for a short (I believe w/ in 5 hours) amount of time is actually not as detrimental as once believed to the pt, and so you might as well skip to that vs. attempting a pressure point.

Sometimes volunteer departments can be ridiculous to get into, with how slow their application process is. Case and point, I applied to two volunteer EMS agencies (one ambulance corp, and one FD) and a month later when my cert. transferred to my new state I put in an application to two paid EMS agencies. I got offered a job at both paid agencies before I heard back from either volunteer opportunity...

I don't see why your foot pain would hold you back, this job is 90% boredom, with 5% excitement and 5% terror. You should be fine.

If you want to do 911 you may have to put time in doing transports or something. Alot of places want experience.

__________________

watch online movies

Troll? Post copied from one earlier in the thread...

Thanks everyone. It is nice to know just that other people have 'been there' and gotten through it staying in EMS. After much searching (because they don't have anything about it online) I found a sports team here that I will love practicing with, and that is sure to help me distress! I also am going to talk to the HR person at my work about a few of the personnel issues I've been having, because some people are making it miserable for me at work, and I am hoping that we can actually get it resolved (I have tried talking to the people and it got worse ) So hopefully things will be on the upswing here soon!

Well first of all you are not going to like everybody you meet and not everyone is going to like you, so in the beginning of your career deal with it, thats life. The other point is and I may be wrong but you didnt mention when you ask your questions. When Im doing my stuff with new people I dont mind them asking ANY question but I do perfer it at the end of the call not while Im with the patient, but it does depend on the sercumstances. I hope you tough it out and carry on in your education as this can be a very rewarding career and when you find the right place you will be fine.

happy

I thought I asked the questions after the calls, but according to what they told my friends (no one will say things to people's face here) I asked a few during calls. I know in my head that I'm not supposed to ask the questions on scene of a call/ around others, and as I said, that is one of the things I am making a conscious effort now about. Also, it has been more of the new medics, who are less sure of themselves that I have been annoying with it then the ones who have been medics for a while.

Lonestar, I agree that I need to make friends outside of work, I am just having trouble doing that. I guess before now I was always in school, and my friends were either from school, a sports team, or one of my jobs. Now all I have is work, no sports teams or school, which are nice easy places to meet people, I need to figure out how other 'adults' find friends.

I'm not quite sure where to start this.

Right now I am worried because I'm not sure if I am actually depressed, or if this will pass soon. Let me start at sorta the beginning.

About 7 months ago I moved across country, the main reason was to get a paid EMS job. I have been working at my current EMS company as an EMT for about 6 months now. I love being an EMT, and EMS is something I really think I am passionate about and want to make my career, but not here. My current job is just that, a job, not a career. However, it is a really good set up to be able to go to medic school in the fall and finish next year, then move on. My trouble now is coming from my coworkers. I have a couple people I work with who I consider friends, but I have also managed to get people here who don't like working with me, and a few who strongly dislike me, and are consistently rude. My friends at work asked other people what their problem with me is, and basically it boils down to me being too assertive and asking to many questions. I ask questions so I can learn more, but I guess I am coming off wrong, and it sounds like I am questioning people's judgement on calls. I am making a conscious effort to change that, thinking even more before I speak, but I don't know how well it is working- it is difficult to change people's minds when they are already made up about you. Honestly, right now, while I know I need to hear constructive criticism, and what I can change, I need to hear what I am doing right. I am getting so frustrated being around people who dislike me, it is making me dislike my job (I am a person who seeks the approval of others...). I go out of my way to pick up overtime with people who I get along well with so I can have a good shift and remember why I like my job. But for the day to day, I constantly feel 'down' at work, and not as happy as I used to be.

I think another problem is I really don't have a life outside of work here. I don't know anyone else (it is hard to meet new people outside of work when you just randomly move to another place!) so I am more invested in my job then most people here are.

I guess I don't really know what kind of advise I am looking for, just wanted to get this out there to see if anyone had any words of wisdom

There is another city that I know of that does this. They go off of a point scale, and you automatically receive extra points right off the bat if you are a minority of any sort. Female? Extra points! Learning disability? Extra points! Mexican? Lesbian? Oriental? Other disability? Missing a limb? Extra points! Drives me nuts....

Off topic, but as I pointed out before, please please please use the correct term. It is Asian, NOT oriental!

(sorry, it just always irks me when I see the term oriental used, I know it is not used in malice, but still...)

So, trying to get slightly back on topic, Wendy I also would have been uncomfortable with the skits. I doubt that your instructor had bad intensions, but acting out the skit as you said, reinforces the stereotypes. While it is important to point out some cultural norms, such as "religious muslims" (not, not all middle easterners) are typically very modest, or how many cultural groups have a different concept of time, different then our American idea of everything being at an exact time and punctuality essential. Perhaps they could have given you suggestion for how to deal with different issues that may come up while dealing with people of different ethnicities.

Also important is learning politically correct terms for 'labeling' different groups. People don't typically mean badly, they are just ignorant of correct terms. Now that I have said that, I am pretty sure I have pointed this out before, but Oriental is NOT the term you want to be using, it is Asian.

As other people have said, one of the most important things you can do is to not be afraid/ to proud to ask questions! Find the person who likes their job, is competent, treats others well, and wants to teach, and stick to them. It might not be your FTO (hopefully you should have an FTO time), but having a good mentor when you start this job is essential.

Look at it this way, there always has to be a youngest at the company. In your post it seems you recognize that you will be lacking some of the life skills others have, simply from experience, and honestly I would rather work with someone who recognizes their short comings than someone who thinks they know everything and are Gods gift to the world. I am the youngest at my company, but no one usually believes me when I tell them my age, because I don't behave irresponsibly like many 21 year olds. If you do go and party and such, don't brag about it at work, it will not get you respect from your coworkers.

Someone said that your coworkers will be like a large family. In some companies they are, but honestly in some they are not. People can be mean, especially when you work together in a stressful environment like EMS. There will be people who have nothing better to do then hate you because you are new/ young. There is not much you can do about it, just try not to take it personally. Always take the high road if someone is being petty. Remember if you say something about someone else, chances are it will get back to them, so watch what you are saying and whom you are saying it to.

One last thing. If you ever get that "gut feeling" on a call, trust it. It could be telling you the call isn't safe to go in without police backup, you need ALS even though nothing obvious is off, anything. Although you may not have a concrete reason for what your gut is telling you, you need to be aware of it, as it will keep you from getting into a bad situation more then once.

Sorry for such a long comment.

Good Luck! Let us know how your first week is going

Sometimes the OLMC will accept the RMA when the onscene crew feels the patient should go, or deny it, when the crew feels the patient is good to be left home. the main thing is, over 65 and wanting an RMA, OLMC MUST be contacted, per our protocols.

So what happens when OLMC denies the RMA? Do they issue paperwork to put the patient on a medical hold? Who carries out the paperwork if the patient adamantly refuses? Do you do everything necessary including taking the pt using force into the ambulance? Do police get involved at place the patient in their custody? Not saying you are wrong here, just honestly trying to understand what happens if the OLMC says the pt cannot refuse.

(sorry to hijack the thread)

Called to a Rural hospital.

No physician available.

82 y/o male presented last night after syncopal episode.

Found hypotensive, with hx of 2 day coffee goround emesis, and hematochezia.

HGB 47

Pt on coumadin, but has not had it in 2 days INR 3.2

Pt was talking GCS 15/15 this morning, but has passed 700ml measured blood per rectum within the last hr, and dramatically decreased in conciousness.

It is now 1400 hrs.

The pt has a DNR, however asked to be transfered to the city (2hrs away) for surgery. This was at 1300, shortly therafter his vital signs changed, he became lethargic/confused and eventually losing conciousness.

Daughter agrees with plan, and wants him transfered. Physician calls you, and washes his hands of the pt.

You have the hospital at your disposal.

You enter the room to find: Appropriate size for age elderly male, lying supine with loud snoring resps.

RN in room for report and monitoring him.

He is GCS 3. (the pt, not the nurse)

Nasal cannula in place with 2lt 02 running

IV in place x2, both 18 G. One Nacl 250ml/hr. One locked.

BP via machine: 74/32, HR 132 reg (no radial), Resp 22 deep reg. Temp 36.7, BGL 10.4mmol

Pt has had 500ml Nacl

Vit K

1000ml Pentaspant

All within the last 2 hrs

Nurse sts, "Dr. says he would like you to stabalize him and get him to the city ASAP."

I am a BLS provider, so most of my questions are out of my scope, but here are my initial thoughts

1st, I thought that definitive care is very different from a DNR order. I don't think there is any conflict with the patient saying that he wants to be transported for definitive care, while still maintaining the DNR.

Why does this patient not have bloods running?

Does his DNR specify for intubation/ artificial ventilation? With snoring respirations, it seems it is going that way fast. How does the patient look in regards to his respiratory condition? Does he appear cyanotic? Do we have a SP02/ capnography?

I would want to talk with the MD in person. Does the MD feel the pt has a chance of surviving a 2 hour transport in his current condition? Does the daughter know the chances of her father dying in the back of the ambulance? Has the admitting hospital been notified of pt's worsened status? What are our provisions for transporting a dead body if/ when he codes in the back?

Not specifically to this scenario, but I have to disagree with what has been said by a few people here. I do not think I would necessarily call medical control for this patient unless something in her presentation made me uncomfortable leaving her alone. Crochity, you say that anyone over 70 with a medical complaint should be transported. What are you defining as a medical complaint? I don't know to many people over 70 who don't have a medical condition that they live with day in and day out, that sometimes flares up.

Here is what I would do/ want to know were I in a similar situation

First, instructor, you say carotid pulses are present. What about radial pulses? I assume they were as later you state a pressure with 108 systolic. If I am having trouble ascultating a pressure, I attempt to get one by palpation, then either have my partner, or the monitor try. After obtaining baseline vitals with the pt on the floor/ how we found her, and doing a basic assessment, I would then assist her to sitting. At this time I would reassess vitals, check how she is feeling, and do a more detailed exam. If nothing is hurting and vital stay the same, I would then assist her to standing. How does she normally walk? Independently or with a walker? Does she use a wheelchair for distances? If she is is able to ambulate around her house (get to and from bathroom/ kitchen), I would be comfortable letting her refuse, while encouraging her to call her doctor for an evaluation for frequent falls, and having a plan for friends/ family to come over to stay with her for a while. (NOTE, this is based upon her earlier statement that falls are due to feeling unsteady on her feet/ increased weakness, NOT dizziness...). If she does not have a walker, she probably needs an evaluation for one, which they will not do in the ER.

If I get pt to standing and she is unable to ambulate independently/ with her walker, I would have her sit back down and we would have a discussion. I would tell her I don't feel safe leaving her at home alone when she can't get around. What if she needs to use the bathroom again, how will she get there? I will try and point out realistic problems that she can/ will have if she is unable to walk. I will encourage her to call her family/ friend, and if it is OK with her, explain to them what is going on, and try and have them convince her to be transported. If pt is adamant she will not go by ambulance, I will bring up the option of having family/ friends drive her to the ER. If she is still refusing transport, I would document and have her sign a refusal, and have someone else present sign as a witness. In this scenario, I would consider calling med control, but unless she has a physical complaint other than increased weakness, I doubt they are going to want anything to do with it.

As far as how to teach your student/ new person this, sometimes the best thing to do in these situations is watch. I am still a relatively new provider, and I am thankful that I had the opportunity to watch different EMTs and medics with much more experience then I deal with these types of scenarios, so I got to pick out parts that each one of them used, and put them together in my own style. Then when I became more comfortable, I started running the entire call on my own, with them watching (actually they said "we will not do anything including getting vitals unless you specifically ask us to") only jumping in if I was going to miss something major.

I know some fire departments here give out house numbers to people so they can ensure they have a visible number on their house. If numbers on houses would make it easier, perhaps team up with one of the local school, and explain to the kids how important it is to have the numbers present on their house, hand out numbers and the magnets someone mentioned, and then they can bug their parents about it

I just saw this video

Short clip about why you should know how to spell your street address!

If you're looking for quality EMS education, you need to look into the full EMT class; not an accelerated one. Shortcut yourself, shortcut your patient.

Have a good day.

I technically took an accelerated EMT-B program. It was 10 credits, offered through the local CC. It was a summer course, and we met 4 days a week about 4 hours a day, for 2.5 months. IMO the program was an excellent educational base, especially compared to some of the 2 year HS programs I am seeing where I live now. It depends on the person, if they can learn quickly, and how the teacher teaches and structures the course. Don't knock all accelerated programs. Some probably are awful, but not all of them.