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Bieber

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Everything posted by Bieber

  1. I don't know if EMS is racist or not. I do know that I really don't give a shit what race a paramedic or EMT is so long as they're competent, dedicated to patient care, and capable of doing the job--those are the only things I look at, and the only things any of us should be looking at.
  2. Thanks, guys. Yesterday was a tough day for me, but I'm gonna keep pushing forward.
  3. Update: I didn't get the job. They said they'd put me on the "immediate" list for the next time a position opens. So, yeah.
  4. First of all, you DO know that the 2 year old doesn't have to TELL you in order for you to assess for nuchal rigidity, right? Secondly, assuming those patients who were transferred without a spinal tap being done were coming from a doctor's office, I'm not surprised. I wouldn't think that they would do spinal taps all that often in the doctor's office. Indeed. And how many of them were left due to provider incompetence versus truly benign assessment findings? The question is not whether or not MIGHT die if we don't transport every last one of them, the question is, how many with truly benign assessment findings would die? The old overkill them with tests adage again, I see. You do know that physicians don't regularly do invasive tests for patients with minor complaints and benign or low acuity assessment findings, right? I can't tell you. But I bet you can't tell me why you won't acknowledge what I've already said multiple times now: that increased educational standards come first, then follows treat and release, and every other wonderful tool I feel we should implement. So, what you're saying is that if we COULD answer those questions (that is, if our educational standards were higher), you WOULD agree with treat and release? How about a little evidence to back up those numbers? Or are those numbers still brown from pulling them out of your ass? By that insane logic, nobody should ever be let out of the hospital after they've walked through the doorways. Because if even two die following discharge, that's too many. For the record, simply transporting everyone to the hospital "just cause" does not equal good patient care, it constitutes clinical incompetence.
  5. First of all, I've run far more than one hundred calls. Am I inexperienced? You bet your ass I am. Does that make what I have to say any less true on that basis alone? Not one bit. Secondly, you make that decision the same way a physician would: by performing a thorough assessment and obtaining a complete and accurate history. Do you seriously think physicians do a CBC and strep test on every kid who has a fever? If so, you need to go back and spend some time in the hospital. It is for this exact reason that I advocate narrowing the gap between EMS medicine and hospital medicine and putting our practices more in line with theirs. Finally, with a patient whose only complaint is a fever with no signs or symptoms indicating an emergent condition is present, exactly what benefit is there in transporting that patient by EMS as opposed to the family taking the child in to see their pediatrician?
  6. So, in your mind, clinical competence is simply provider laziness? There's your problem right there, but I assume that trying to get you to understand clinical excellence as opposed to TRUE laziness ("just transport 'em 'cause I can't be bothered to use my head") will be harder than trying to cut a tree down with a dead fish.
  7. The future is now, it's happening all the time, by the time you read this, it'll be the future. The one thing left standing still as time passes us by at such an alarming rate that many of us are looking in the mirror and wondering where in the hell all the time went is EMS. I was twenty-one what seemed like a few months ago, now I'm twenty-four, pretty soon I'll be fifty and I won't even have realized where all the time went. EMS is the same way, we've lost track of just how quickly time and medicine moves. Maybe it's because we've grown up outside of the mainstream medical system, we're not used to the way things really work in medicine. Maybe it's just because we've become so content with the way we do things, that by the time we're at that point in our careers where we could change things, we've either finally reached that golden position of administrator, but are too scared to rock the boat and risk returning to the streets, or maybe we just see retirement on the horizon and just want to put in our last few days in peace and move on to greener pastures. Either way, we seem to have our feet stuck in the mud and can't get them out. None of what I've proposed, either here or in any one of the many threads where I've shared my views about what I think paramedicine should become is ever going to happen until we increase our educational standards. At the same time, if there's one thing I've learned it's that nothing in this world--NOTHING--ever changes without some sort of motivating force. And whether that's the next generation of paramedics demanding more from EMS than what your generation saw, or the inevitable changes in the healthcare environment that are calling for more and more accountability and justification for payment, EMS is going to change. The way I see it, EMS has two paths in front it it. We have the option to continue the way we've been going, but you know what? I've said it before and yes, I'm going to say it again. We're not that good at what we do, and what we do is coming under a lot of scrutiny. Are we worth the money that's invested in us? Maybe not. Seriously, think about that. What if a cost-benefit study was done tomorrow on EMS systems. How sure are YOU that we're worth the buck? Because I'm not sure we could survive that kind of scrutiny. I'm really not. And if we continue down the path we're headed, you and I and every paramedic out there could be out of a job some day. Then there's the other path. The path where we stop holding ourselves back, we stop insisting that we can't and we won't, and we man up, grow some, get our educational standards where they ought to be, and start implementing these practices which have been shown in other EMS systems across the world to not only improve the cost-benefit ratio of EMS, but also elevate our profession and provide the best possible and the most competent care for our patients. And you all may think I get ahead of myself at times, and maybe I do, but you know what? If come tomorrow, it became national mandate for paramedics to have a Bachelor's degree, what would most paramedics say? "Fuck that, they're not paying me enough and it's not going to change what I do, anyway." So why in the hell is anyone going to further their education, when it's not going to do anything for them? You HAVE to have some sort of goals in mind, some sort of changes in care that having a higher education is going to grant people. Right now, people do it to get into admin. That's the incentive to get the degree. Until we start advocating a system that permits paramedics who have achieved higher degrees to expand their clinical skills, there is absolutely NO incentive for people to get that degree. A paramedic with a B.S., M.S., and PhD. is still just as restricted and paid just the same as the certificate mill paramedic. You have to have some bait to dangle in front of them to get them to jump. I'm not saying we should be doing these kinds of practices without degrees, I'm saying, "Hey, everyone, here are some things where we in EMS could do better, some things we could do that will really help our patients. But here's the catch... you gotta get your big boy degree first." I'm sorry, but the average paramedic in this country is not so enlightened that they're simply going to go out and get their four year degree out of the goodness in their heart and out of their deep, overwhelming desire to have more clinical knowledge. That's the reality of it. We have to not only advocate higher educational standards, but have some rewards waiting at the finish line for those who jump on board the boat. It's the same with changing medicare, you want to be paid like a healthcare professional, you've got to become a healthcare professional first. And thanks, Dwayne. I accept your edition to my statement and back it one hundred percent!
  8. Definitive care does not equal the ER in every scenario. The CURRENT EMS standard of care in the U.S. How about you show me where you got those numbers? And since when did every patient need (or actually get) labs and X-rays at the ER?
  9. Ah, so the solution is to ignore what's best for the patient and the healthcare system as a whole, and to simply hope nobody else notices that transportation of patients who don't NEED an ER is completely unnecessary. How much longer do you think that's going to last in our current "pay for performance" healthcare environment? It's time for EMS to evolve, because we're fast approaching an era when we're going to have to justify ourselves, and just like the fire department, we're going to be in for a rude awakening when the only thing we have to show for ourselves is groundless propaganda. Wake up and try using your head a little bit. We can't save anyone. At the end of the day, nobody, and I mean NOBODY in medicine is doing anything more than delaying the inevitable. Everyone is going to die. You, me, and every patient you or I ever save is destined for the grave. We can't make universal policies to try and prevent every single patient from dying, it's statistically unrealistic. We have to be implementing the BEST practices for the WHOLE, not to try and keep every single breadcrumb from falling to the ground. We're never going to have a system that prevents every possible bad scenario. What we CAN do, however, is provide reasonable, sensible, scientifically proven standards of care. And that does NOT include transporting everyone to the hospital. And you know what? If you do that, if you follow the standard of care as supported by scientific fact, you're not going to get sued. Do you think the hospital gets sued every time a patient who is released dies? No. You know why? Because the standard of care was followed and sometimes, believe it or not, people just die despite our best efforts. Nobody expects medicine to be perfect or to be able to save everyone from the inevitable. What IS expected is that competent treatment backed by research is followed and that every reasonable chance for life is given. That does NOT mean wantonly transporting everyone to the hospital, nor should it. How many times do I and the rest of the educated (see, non-US) EMS world have to tell you that not everyone needs to go to the ER before you'll start to consider that, hey, maybe, just MAYBE, these people might just be right? A predictable patient death is one that is, as stated by its title, PREDICTABLE. If you have a patient with a minor complaint, no significant signs noted on assessment, and stable vital signs, and there is no reason to suspect that the complaint is emergent or serious, and you release and refer that patient to a more appropriate level of care based on those findings, and they die, you do not have a predictable patient death. The only thing predictable about it is that we know that there are those exceptions which prove the rule, and that every now and then patients will simply die despite having only minor complaints, no significant assessment findings, and stable vital signs. Surely you don't think every patient who goes to the ER should or actually does receive labs, an ultrasound, an echo, a CT and an MRI, and a full workup by every specialty present? Because, you know, if you leave any stone unturned, that's a predictable death, right?
  10. You're right, but our job isn't to rule out every possible outcome for our patients, and trying to do that is an impossible goal that makes it too easy to default to the "transport everyone 'cause y'never know" mentality. Yeah, patients will probably die as a result of being treated and released. That's just one of those unfortunate realities about medicine; sometimes people who get released from the hospital die as well. Not every patient should be treated and released, but not every patient needs to go to the hospital either. It's about finding a balance and keeping patient care in mind. Hopefully, with increased education and as more tools start to trickle down towards EMS, we'll be able to make more informed decisions about our patients and actually be able to treat and release competently in the future. Makes you wonder, what in the world would EMS do if medicare changed their billing schedule so that if it was later determined by the hospital that the patient hadn't needed EMS at all to begin with, they wouldn't pay the cost of transport.
  11. I tend to be rather conservative in my treatments (with the exception of pain management where I always try to make sure my patient is comfortable or as comfortable as they can be). Being a paramedic advocate is the same as being a patient advocate. Kiwi, can I come work with you?
  12. This post deserves an award. Since when was clinical excellence and competency deemed laziness? Oh, that's right. Ever since parawannabes decided that instead of increasing their education and becoming true clinicians, they'd rather remediate the whole profession to defaultist taxi drivers that have no common sense and no strength of conviction to elevate themselves and become the folks who can make these kinds of decisions on their own.
  13. I agree with Kiwi on principle. With regards to this case specifically, without knowing the specifics, I can neither condemn nor condone. Were they in the wrong? Maybe. Was this just one of those things that happen? Also maybe. Not having a PCR, though, that's going to be what damns them.
  14. Good to know! I hadn't ever heard that. I'll have to do some more reading later today. Thanks, Paramagic and JPINFV.
  15. I've always assumed it's due to the fact that you have a large volume of fluid in a tight, restrictive compartment. Similar to if you squeeze one end of an IV bag and the fluid moves to the opposing end and causes it to become rigid.
  16. It is a touchy subject, and please don't take it personal because I have nothing against you but to be honest paramedics in this country have appalling educational standards, and I say this even with regards to the few places like my state where it's a two year degree, and the idea that someone can start performing RSI or even doing half of the things paramedics do with only two semesters of education is just bad medicine, in my humble opinion. You're in school to become a paramedic, so I know that increasing your education is important to you--and I applaud you for it. I just can't believe the backwards systems that we have in this country, and trust me it's not unique to Virginia. It's all over, and it keeps our profession down in the gutters when we could be elevating ourselves to truly professional and truly noble heights. I only hope you will be a force for positive change in your system and be one of the few that demands higher standards, rather than one of the many who either calls for a reduction of EMTs and paramedics to mere skill monkeys, or one of those defeatists who call to simply strip EMS down because either "we can't learn" or "there'll always be idiots who aren't capable of treating a dog, let alone a person". Just the other day I encountered someone who was against selective spinal immobilization and C-spine clearance in the field for everyone, because there are too many folks who will screw it up. Educate them, and if they're still too stupid to do it correctly, fire them, is all I have to say on that matter. We need to quit holding ourselves down for the sake of fools and simply give those who are unwilling or incapable of learning or advancing beyond the status quo the boot.
  17. Well, besides being new to the field, I've only ever given dextrose once throughout my entire internship and during the last several months as a paramedic. Never, ever given glucagon, so I don't know how quick I'll be to use it when the day comes I can't get an IV on a hypoglycemic patient.
  18. Nonexistent, though we used to be able to (before my time). Your agency is seriously allowing EMT-I's to perform RSI? Really? That's shocking, and not in a good way.
  19. With all due respect to the rights of other people, and the rights granted by the Constitution, NOBODY without a badge is bringing their gun into my ambulance under any circumstances. The right to bear arms doesn't allow you to carry wherever you go, and my safety comes first and foremost. I'd have to check, but I'd be willing to bet it's in the policy manual somewhere as well. I'm not saying they're a threat, I'm saying I don't know, and I'm not putting myself or my partner in the back of an ambulance with a dangerous weapon. We don't know our patients, we don't know whether they're law-abiding or criminal, and we don't know what their intentions are. They may be good, they may be bad. For my safety, the safety of my partner, and the safety of my patient, they're not bringing a weapon with us to the hospital. They can lock it up, give it to a family member, or turn it over to the police, but neither the ambulance nor the hospital is a place for people to bring their weapons. Be vigilant, be ready to run, and keep a very close eye on the patient. If they start acting like they mean to cause me or my partner harm, we take part in the time honored tradition of making a "strategic retreat". Otherwise known as running away like little the unarmed, unarmored folks we are.
  20. If I or my partner felt comfortable unloading the weapon, we would; otherwise, I would simply hold it by the handle, barrel always pointed in a safe direction, and place it in the lockbox. I go shooting from time to time, which hardly makes me an expert, but I take gun safety very seriously and wouldn't do anything I wasn't comfortable doing. If it discharged while in my custody, that would be disastrous. Beyond disastrous, even. It's not something I would ever want to have happen to me. I'm not sure, though, though, what other balance can be reached when it comes to not leaving a weapon unattended to on scene and taking care of my patient--which is my first and foremost priority. I don't feel comfortable leaving an unattended weapon on scene, but I absolutely cannot jeopardize my patient care for any other reason than for my own safety and the safety of others.
  21. If we were still on scene, and it wasn't a time sensitive injury, I'd call PD and hand the weapon off to them. If we needed to book it for the sake of the patient's wellbeing, or if we were already en route, I'd put it in the lockbox with our narcs and advise PD to meet us at the receiving facility. On a side note, towards the end of last year I took part in some EMT training where I played an armed patient. My goal was to get the gun into the back of the ambulance without them noticing, which I managed with only one group out of four. On the down side, all of the groups failed to properly take into account that it was nearly freezing out, and they all cut my shirt off for their assessment (which inexplicably took precedence over moving my hypothermic and hypovolemic ass into the truck), and had both extended scene times and a chronic failure to put a blanket on the spine board before they put me on it. I explained to them afterwards that if I, a perfectly healthy young guy whose body was NOT riddled with bullet holes, was growing ever closer to hypothermia due to their extended scene times and failure to take the environment into account, they could bet their ass that a patient who's bleeding internally would suffer even more serious consequences from that kind of error. Hopefully it was a learning experience for them! Returning to the topic, I'm grateful to have never had any kind of weapon drawn on me yet, and to have never found one on any patient either. The closest to violence I've ever come was getting kicked and punched by an ill patient--but never fear, I suffered only a bruise to my pride.
  22. Unfortunately, she is such a light sleeper that I can't even get up to go to the bathroom without stirring her. Seriously, I have never known anyone who can be awoken as easily as Des.
  23. I just use alcohol preps on my IV starts. I also make a habit of wiping down the finger I'm using to palpate the vein with, so I can double check the site location one last time after I've cleaned it without contaminating the site. Unfortunately, lately my IV skills have been crappy. I think the last time I worked I was two for five.
  24. Yep! But if I don't get the job, I'm switching back to that rabbit's foot.
  25. Back from the interview! I felt it went well, but I won't know till next Monday whether or not I got the job. It sounds like there's quite a few applicants for only a few jobs, so I'm keeping my fingers crossed. Thanks, everyone, for the good wishes. I'll be sure to let you know if I get the job or not.
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