fakingpatience

I have a question.. If you have NREMT, do you still need to meet the individual state's con-ed credits, or do you just meet one set for the NR? I had the option of taking NREMTB in '99, but it wasn't offered in our state, we'd have had to travel to Ohio in order to test. Just wasn't worth it, b/c I never plan on leaving. I do have an EMT cert in two states, though. Just a plus on a resume, for potential jobs, I figured.

The con-ed for state vs NR varies from state to state. In some states, all you need to do to recert your state card is submit a current NREMT card. In other states they have the exact same con-ed requirements as NR, but you need to submit your proof of con-ed (or just a list of the con-ed you have done) separately to NR and your state to recert both. Finally, I am sure there are some states out there that have completely different requirement for recerting their cards.

I will be in a similar position next year, with my NREMT-B card expiring 4 months before I finish medic school, and not needing the NR for my state. I agree with what was said above, just recert your NR. You should have enough CME to just input it into the website to renew your card, and it is better to have it and not need it than to need it and not have it.

I've asked very specifically over and over. This disabled person that can't live without their dog, what will this person perish from that the dog can provide and a human can't? I know we all feel good saying, "This dog is this person's link to a normal life!" But what makes that true in the hospital environment?

I feel good saying, "The Taliban are kind, but misunderstood souls. I believe that there is every sign that they will reverse their political/religious positions any day now!" That felt fucking awesome!! But don't you think that I should have some sort of examples to back that up? Even when dealing with those with special needs, shouldn't we have to be bothered to defend out points?

Why does the person with special needs need their animal in the hospital more than a cop needs his gun, or an elderly person needs the emotional support/comfort of their pet?

Dwayne

Dwayne

I have thought about different ways to phrase this (as you can see in my above answer), and then I saw your post about your kid w/ autism, and thought this might be relevant. As I am sure you know, they have service dogs for children with autism and various other disorders. One of the things that the dog can help with is calming the child and preventing self injurious behaviors. While another human may be able to provide the calming powers of the dog, it would require 1:1 support round the clock to be the equivalent of what the dog provides. The dog is attuned to the person's behavior, so they can sense when the self injurious behavior is coming, and step in to change the behavior pattern. Also, if the person is used to relying on the dog (especially for someone who functions best when routines are not broken), they will do much better with the dog there providing the support rather then a stand in. (note, I am not saying that it would not be important to also have the other humans at the hospital, just trying to point out the benefit of a service dog in a different light)

I tried to post this earlier, but I guess it didn't go through (darn you internet at work!)

Basically, a service dog provides the person with a disability a measure of independence equal to that of an 'able body' person. Yes, in the hospital there are staff who can help the disabled person with the task, but the act of needing to ask for help for everything lessens the independence of the person. If they have a dog there who can help them, they are enabled to be more independent, and 'equal.' While the task can get done either way, the self esteem of the person with the disability is much higher if they do not need to ask for help, but have a 'tool' (ie the dog) they can use to get the task done

Hope this helps explain some!

(Sorry for it being a bit rambley, I am just getting off a stand up 24...)

Anyone else find it slightly concerning battery powered portable suction is not part of more peoples first in equipment?

We don't carry any battery powered portable suction on our ambulances. We bring in a manual suction in our first in bags and rely on the fire department to bring their (usually better) suction

(I know this is not the best way/ how it should be, just saying how it works here)

We are supposed to have them, but as mentioned above, it often depends on their availability in the ER, for us to replace them. Lately we have been having trouble even replacing blankets in the ER, with the RNs there stashing them in hidden places so EMS can't get them. I actually had a nurse take one of two blankets off my stretcher the other day, telling me that we don't need them and they are running out...

Personally, the fear of potential future pt's with a dog allergy would not be a concern. That said, my response would depend largely on the situation. If the pt is ill, and the dog appears calm/ doesn't try and attack me (and the owner says the dog is fine with others), I would use the dog's leash and tie it to something by the jump seat (perhaps the seatbelt there), with a very small amount of slack. If we have time to wait on scene, I would try and talk to the patient about calling a friend to come watch the dog and bring it to the hospital, however if this does not work out, I would proceed as above. I don't know a lot about service dogs, but with most dogs, they are calmer around their owners, and trying to separate the dog from the patient, and have a different provider (such as a supervisor ) transport the dog may make for more problems. Now if the dog appears violent, I would refuse to transport the dog in my ambulance. The scene would not be safe.

Here is why I would not consider the allergy problem. First, after the call, I would ensure I decon the back of my ambulance, and try and air it out as much as possible. The ambulance is not a sterile environment. There are an infinite amount of things people are allergic to. I may be wrong, but I don't believe it is possible to have an anaphylactic allergy to dogs. Also, I will not stop eating food with peanut butter in the front of the ambulance for fear a future patient may have a nut allergy, and be exposed to trace elements of peanut butter on me, thus causing an allergic reaction. People are exposed to allergens every day, and our ambulance is no exception.

My company E-PCR software for documentation. Generally for BLS calls, much of what you do is covered in the check boxes, but I still write long narratives- If I am going to need to back it up in court, I would rather defend my own words than a box I checked. The format I use for my narratives is SaCHART:

SA: scene assessment: what we were called for, how the scene looked, anyone else present, immediate impressions

C: Chief Complaint

H: History of presenting illness, any other pertinent history. This is the section where I tell the story of why we were called for the patient. I will also sometimes include in this section what we did on scene, depending on how it is flowing

A: Assessment. Here is what I include for the most part: AAOx4 (if not, elaborate), pink warm and dry. Denies LOC, dizziness, headache, light headedness, nausea, vomiting, diarrhea, recent trauma/ illness. No signs of trauma noted. HEENT: PERRL (anything abnormal noted), CHEST: Equal chest rise and fall, breath sounds clear and equal (if pertinent to pt, I will elaborate on no signs of SOB, no accessory muscle use...). ABD: Soft, non-tender. PELVIS: Stable, able to bare weight w/out pain. EXT: Movement of extremities x 4 w/out pain (I don't check CMS on every pt, especially if it is a medical issue, so I document it this way instead). BACK: (if trauma) Denies spine pain on palpation, no trauma noted.

Anything else pertinent from the exam. This is the section I will put a more detailed description of injury if trauma (since I can view an injury, making it more objective... I prefer to keep objective info in assessment vs. subjective info in history section)

Rx: any treatment we did for the patient

T: Transport. I usually write how pt got to the stretcher, transported non emergent w/out incident to XYZ ER. Pt left in care of ERRN, handoff and paperwork given to ERRN, no pt valuables handled.

There is a separate section in my PCR software for vitals, otherwise I would put them in my narrative

When I first started, I carried a cheat sheet w/ this info in my notebook, so when I was spacing on my PCRs, I could go back and see what I needed to put in. My PCRs generally end up being fairly long- my coworkers make fun of me for doing such long PCRs, but as I said above, I would rather defend my own words then a bunch of check marks. Also, I rarely remember the patient after that day, so should I need information about them later, I would need to get it from my PCR

I hadn't really thought about what if the person gets hurt/ sick later, and someone tries to say the ambulance crew was negligent the first time we were there for a lift assist, and we have no paperwork to back up our story. Definitely makes me more strongly want to do correct refusal paperwork.

NYCEMS: My supervisors know that people leave lift assist calls without documenting names and such, everyone does it at my company, including many supervisors if they are working on the ambulance. You could say it is in the "culture" of the company to, for lift assists, simply document either "lift assist only, no info, no signature" or "no pt contact". I think part of this stems from calls that we run with the fire department that end up being refusals, the fd does all the paperwork, so my coworkers get very used to not doing refusal paperwork. It becomes an issue when it is an "ambulance only."

I guess my next hurdle is going to be having the courage to tell my partners (not talking about one specific, I work with different people every shift, no permanent partner ) that I want to do the proper documentation on all those refusals...

It seems like it could be a continuity of care issue. As the transporting paramedic who is responsible for that patient and for providing the hospital report, I personally don't want to have to explain why treatments were given that I didn't give--especially if they're incorrect treatments (of course excluding CPR and AED use). Around here fire responds with us on all medical calls (unless we get there first and decide to call them off if we don't need them), and there are some FF/Paramedics but they can only act as basics.

In some of our coverage area we respond w/ ALS fire departments, both paid and volunteer. Some of them are the most incompetent providers I have ever encountered. I have had coworkers force the ALS first responder to ride in to the hospital in the ambulance w/ us to explain to the doctor why they gave what ever incorrect med/ treatment that they did... I personally much prefer responding with a BLS first responder than an ALS one

For me, though, where I work, we can document minimally on a no patient or "assist a citizen" with no signatures required. The crucial part is determining whether or not this is a patient. I won't say whether your partner was right or wrong, because I don't know your system and I don't know the full details, but you need to ask yourself: is this a patient? That is, do they have a medical complaint? If they're alert and oriented x3, competent to make their own decisions, and deny having any complaints, then I would call them a "non-patient". There was a really good video I watched during paramedic school by a paramedic turned lawyer about these kinds of things, that is, determining if someone is a patient or not. The gist of it was, if they have no complaints, no visible injuries, and they're competent to make their own decisions, they're not a patient. And perhaps that's what your partner is getting at, but again, I couldn't say. What are the protocols governing no patients in your service? Are you required to do a full assessment on everyone regardless of whether or not they have a complaint or not?

We don't have an official publicized policy on refusals like this, we don't have policies for many things. Our QA/QI person is not well respected, and is supposed to be reading all my PCRs since I am new, but has not said one word to me about any of them if they are OK or not...

I think many people do look at many of these refusals as a citizen assist, as you say. But say you are called for someone who fell and needs help back up into bed/ their walker, what determination do you use to determine if it is purely a citizen assist? What if they have dementia or don't speak english and there is no translator available? I have had all these circumstance (this is not coming from only one call), and it seems like a truly gray area.

(reposted from my question on life under the lights blog)

I have a question for you all about refusals. Let me start with a quick background. I am an EMT at a private EMS agency where we do both transfers and 911. I usually am working with a medic partner. I find that often on refusals, such as when we go to a house to help someone off the floor or similar situations, my partner won't fully assess the patient, and does not do any paperwork on them ("Lift assist only, no info, no signature"). These always make me nervous, because what if the patient does have something wrong with them that we missed by not assessing them, or by not documenting the assessment if we did one. Now as the basic on the truck, I am consoling myself by saying that if the shit hits the fan, it will fall onto my coworker, the medic, but I know that might not be true. Oh, and this isn't just one partner, as I have a different person every day, it is in the culture of the company to not do proper refusals.

Any ideas?

If the issues you have with your partner have already been brought up to management, then there is not a lot you can do about them. The only thing you can do is watch your own actions and make sure you are reflecting well on your company and your job. You can't trust your partner to have your back, so make sure you do things right the first time, and if you don't, then you should be filing an incident report on your self (It looks better if it comes from you then someone else).

Are you and your partner on the truck both the same level? If you are a higher level provider, then I would say don't let them tech any calls until you trust their standard of pt care.

I am in a situation now where I have "partner of the day" for every shift, since my permanent partners quit. Often times I do not trust the person I am working with. However, they are the senior medic, so at least I know that if they screw something up on a call, it won't come down on me. Also, if they ask me to tech a call which I am not comfortable with (or one that might be borderline ALS), I tell them that I am not comfortable with it.

As others have mentioned, if you don't get along with your partner, bring a book, a dvd player, anything to distract you through the downtime in your shift. Hopefully they won't be your partner for to long!

Hello and welcome

Trust is a very important thing to have in a partner but it seems each place has one person who does not quite fit in or has severe trust issue with their co workers. Such as Lying about things on incident reports, laziness in many forms on and off the truck, miss treating hospital staff/co-workers, inability to do ones job at when crap hits the fan or just having a very bad/loud mouth.

I know in EMS it's impossible to get along with everyone but I feel there is a unspoken rule of being able to trust your partner when the crap hits the fan even if you and your partner dont see eye to eye. Sadly some people just don't get it they piss off co-workers or make bad mistakes on the truck and then the feeling of mistrust grows to the point where no one at the company wants to work with them.

I have a person in my EMS Company who is like the above. This person has made a lot of mistakes and errors both personal and work wise. This person was also let go from another larger EMS company in the area for a very bad error in judgement and for a lot of the same things stated above. Now this person is creating problems where I work. Our management had been very quick to deal with the issues and the person is being carefully watched and supervised.

So I ask you all this since I have to work with this individual who I don't fully trust 100% on the truck to do the right thing or to help me when crap hits the fan. As my partner we had a very bad incident that I don't want to go into here since it's a personal matter and such things should not be posted here in my opinion.

The reason why I posted this is because I feel trust is a very big thing to have in a partner. While I may not like certain people for what every reason in EMS, I have to trust them to enough to have them be my partner on the truck. So how would one deal with a person like this when you have to work with them?

Cheers and thanks

Maybe you should look into programs that don't have a running requirement for admissions... I am all for companies having requirements to ensure their employees are in shape, but needing to run a certain distance under a certain arbitrary time is frustrating. I was in excellent shape (world level competitor for my sport) and I still couldn't run a mile under 9:30... Most programs do not have a requirement for fitness, if anything they make you pass a lifting test, but nothing else.

Richard, it is Rest Ice Compression Elevation

darn it, I just lost the game

Like most others, I carry a reference book, not because I necessarily need it, but because I feel more confident having it with me, to know that I can look at it if I blank.

A cool book one of my partners carries is http://www.amazon.com/Pocket-Drug-Guide-Patrick-Gomella/dp/0071664076/ref=sr_1_1?ie=UTF8&s=books&qid=1293252172&sr=8-1

It is useful for looking up some of the more obscure medication a pt. may be taking, and it has drug interactions, and overdose signs and symptoms, and what to watch for w/ an overdose. To me this is nice because, while you can learn a lot about a lot of medications, you cannot learn them all, and if a patient overdoses on a med you don't know, it is invaluable to be able look up what to expect

IMO, when a company has a lot of OT available, that should be a HUGE red flag for you. When they have a ton of OT, it is because they don't have enough people to staff it adequately. Since there is an overabundance of qualified EMT-Bs everywhere you look, this is usually because the company doesn't treat their employees well. When/ If you finish your EMT class, look for a company that doesn't have much OT for a full time job, and possibly pick up a second job for OT. But first you need to start the class, see if you are good at it and like it, and make sure EMS is really for you. I think you are putting the cart a little in front of the horse here...

There have already been many good, well throughout opinions here, but I will add my take on it.

First, IMO, your partner was being a jerk. Many people are saying you are wrong for having your partner tech the call. If your partner hadn't offered to tech it initially, would you have asked them to? Yes, I think that you should have teched it, but your partner seems like one of the "you call we hall thats all" folks. Were you having a bad day with him? It seems very extreme for them to write you up for one call, where you did end up taking the patient.

At the hospital, did you address your concerns to the ER staff? If you had, you might have found out what they had already talked to the pt about/ called for future services. As others have mentioned, if the guy is already signing out AMA back home, has already been talked to about this decision by a few other people, there probably isn't anything you can do to change his mind. Your only option is when you get the pt home, state your concern once again, and ask if he would like to go back to the hospital. Unfortunately, this probably wouldn't fly with your partner that day, and as dwayne mentioned, if this is complete bs, and the guy just wants to be in the hospital, the ER would probably be pretty ticked at you, but regardless of all that, once they patient gets home and sees how hard day to day life will be for him, he may change his mind.

Let me give you an example of a time when we did refuse to take a patient back from the hospital. This was at my old service, where we had a very good relationship with the hospital staff, and knew our supervisors would back us up. I was just shadowing on this call. An ambulance had brought in this pt to the hospital from his nursing home for a respiratory illness (don't remember all the details, but bad breath sounds, low pulse ox...) We get called to bring the patient back to the nursing home. In the ER, the patient looks like shit. Still has increased work of breathing, crap lung sounds, pulse oxing in the 80s on a nasal cannual, we know as soon as we get to the nursing home, the staff are going to turn around and send him back to the ER. My medic partner called the supervisor to give them a heads up on what he was going to do, then went and talked with the RN/ MD in charge of the patient. Turns out shift change had just happened and this MD had never seen the patient. MD came in and agreed the patient was not ready to go home.

I'm trying to find a website that will show what states have reciprocity with others. Specifically for EMT (or paramedic) but also for Minimum Standards (FF1 and FF2).

Is there such a thing out there on the internet?

Specific possible states are Georgia, California, Illinois, Texas, and Hawaii.

I'm in Florida by the way.

Thanks!

Here is a website with some info on state by state reciprocity

http://www.emt-resources.com/emt-reciprocity.html

I can't vouch for its accuracy though, as someone else mentioned, you will need to go to each states' website, and possibly call each one.

As far as Hawaii goes, I can tell you that the fire service is probably hard to get into. The whole community there operates based on who you know, and who you are related to, and many people there don't like mainlanders.

I think that this is a good topic to discuss. The old discussion looks over 3 years old, and I assume there are a ton of new members here since then, including myself.

At my service we have a different summer and winter uniform tops. In the summer we wear navy blue polos, and in the winter we wear white button downs, with a turtle neck underneath. Also, we have a pullover jacket we can wear, and if we are wearing it in the winter, we don't need to wear the white button down. We always wear black EMS pants, and black boots. In my opinion, our summer uniform looks much more professional. The white shirts are not tailored to fit each person (other agencies do this, but mine is to cheap...), so they usually end up fitting poorly, and it shows. Also, I think white is an awful colour for people in EMS. We are exposed to to much (not only pts, but being outside, leaning against a truck, eating...) to keep a white looking good. Our pullover sweaters are comfortable, but they also fit poorly. I am almost 6 feet tall, have the smallest size jacket, and it looks baggy and unprofessional on me. After only 3 months of use, the sleeves are starting to fall apart at all the seams. And this is normal, I am not especially hard on my uniform.

I think that a button down shirt (not white!) is professional looking, but to get it looking right, the company needs to be willing to shell out the money to get it tailored for all employees. When wearing a polo, it is not as evident if it is not fitted to the person, which makes it look more professional in that respect.

Does anyone have any advice for keeping your boots looking nice? I give them a good cleaning and polish them once a week, but the first day I wear them, they look awful again, with salt stains covering the boot from all the salt they use on the roads. I give them a quick once over with a cavi wipe, but they still don't look good.

Okay...I'm lost. Isn't a paramedic = ALS? If so, how can you have ALS experience in order to attend a school to become a paramedic?

No sarcasm here...

I don't know about Alberta EMT, but I am a basic working on an ALS ambulance. I get ALS experience watching my medic partner on ALS calls, and assisting them with ALS skills (putting the pt on the monitor, setting up the line...).

I have worked as a basic on an EMT/ medic ambulance, and also as a third rider on dual medic or medic/ EMT ambulances (company used both, depending on staffing). In my experience (and this is from the outside looking in, as I am not the medic), the true difference is how well the partners work together, regardless of their levels. BLS saves ALS is bull, IMO, a good partner saves their partner. I noticed my partner putting limb leads on the pt's fake legs and pointed it out to him that this was why the monitor wasn't getting a good reading. This had nothing to do with my being a basic, but being comfortable enough w/ my partner and our routine to tell him. Personally, I think that when I become a medic, I would like to have a medic partner, just to make sure I don't make any stupid mistakes. However, I have coworkers who think that a new medic needs to be "thrown into the fire" and having a dual medic truck will only hinder them. In the long run though, I would rather work with a partner I trust, regardless of their skill level.

I think that there are two separate issues being looked at here. We have the title issue, of paramedics teaching EMT classes. Then, as someone mentioned, the idea of paramedics being instructors to patients. A competent paramedic should be able to educate the public on certain issues pertaining to their health, and perhaps there should be a section of paramedic education focused on this, as they have for RNs. However, I don't think that paramedic students should be forced to teach BLS. As others have mentioned, it takes a lot more then knowledge of the information to be a good teacher. In some aspects, teaching is one of those things where you either have it or you don't. You need to be enthusiastic, and invested in teaching, and the enthusiasm will rub off on your students. Some people just aren't that good at making speeches in front of large groups (think a class of 25+), and as a paramedic, that isn't necessarily a skill that you need to possess. Likewise, the ability to reframe a concept, and explain it in a few different ways so more people will understand is also necessary for an effective teacher. There should be a certification/ degree separate from the initial paramedic cert/ degree necessary to teach any BLS or ALS class.

That is interesting. Since the trucks are washed at the end of each shift, if we are on a late night/early morning call - it is expected that the unit will still be washed (weather permitting). HOWEVER, I'd say that 98% of the time, the oncoming crew will step up and either help to get it done or offer to do it completely. Command doesn't want to have to pay the additional $ for operational when there is another crew on shift capable of getting it done. In 9 months, I've only had one crew NOT offer to do take the truck as is (as well as the station).

Change of topic a bit...incoming crew will also find out where a call is happening to relieve the offgoing crew, if possible, to help them get off shift in a timely manner.

And, yet, another reason why I like my service...

Good coworkers make all the difference! Most of the trucks I am on are called "peak cars", and they go out of service at night, so no one to relieve us.

I heard of people's relief going to the hospital if they are stuck there waiting for a bed for a pt, and trading there, and that sounds pretty ideal, if you can't clear the hospital.

Why can't you wash the trucks if the weather is bad? Do you do it outside?

Our rigs are supposed to get washed before end of shift every night/ morning. Our supervisors even expect us to stay late if we had a late call to wash the truck... There is no rule how often the inside gets cleaned. I have never seen anyone at my new company mop down the floor inside, but we do get a towel and wipe the floor down (it is really snowy/ slushy outside, so the floors get really wet and dirty). Equipment gets cleaned when ever the crew feels like it. Usually when I am starting my shift, I wipe down the grab bar at the ceiling, the door handles, the bench seat, monitor, the steering wheel, and the siren controls, and anything else that looks dirty.

I agree that the trucks should be cleaned, but I get annoyed that we are expected to stay late to wash them.

The only issue that I MIGHT have with gays in the military is if someone decides to undergo gender reassignment surgery, especially if they expect the government to pick up the tab. I'm NOT suggesting that this is why the gay community wants to serve... The only reason it was even mentioned is because we know that there ARE elements of society that DO try to abuse the 'system' when they get the opportunity.

I understand what you are getting at here, but wanted to point out a couple things. First and foremost, gender identity has nothing to do w/ sexuality! A person who is born biologically male can feel as though he is meant to be female regardless of his sexual orientation. Regardless, I doubt the military would cover such a surgery, as it is not deemed "medically necessary."

As an aside, sorry I have been so absent from the other discussions I have been involved in, I have been really caught up w/ work lately.