NYCEMS9115

Take which ever course is best for you. You have to put in your best effort: be humble. Listen to others. As long as it has bee accredited by your governing body then feel confident that its a legitimate course. Be receptive to criticism. The course is just the start. They're so much to learn in Medicine; Paramedicine barely scratches the surface. All the best....

Call the Private Ambulances in NYC like TransCare, Citiwide, SeniorCare, & Midwood. They're always decomissioning Ambulances and maybe able to sell you guys one for cheap or donate it... Good luck... All the best...

Well, if you don't suspect something; you won't find it. Obviously, she was in pain and BLS treatment for pain; is immobilization. I don't know how the patient was really moved but your experienced EMTs aggrevated an incomplete fracture. Its very common among Geriatrics to have incomplete fractures and fractures from simple slips and falls. It is what it is. You have suspect it; in order to treat for it. All the best...

Well I'm just giving an example how as EMS Providers; were not held in the same regard. I'm not saying I'm right but we all casually speed; it is what it is. He got me; I'd identify myself; plus I used to work in the same Town as a Paramedic. But that's cool; I don't hold grudges; I still look out for all PD & FD, plus all Healthcare Providers. I'll do all I can for everyone; members of service get a little more. It is what it is. I don't think I'm special but I sure treat all my patients like they're special; so my professional courtesy goes a long way; I know I shouldn't expect it but I try... All the best...

Its nothing new. Its been going since MCR has been around. As long as there are a combination of: human greed, capitalistic beliefs, & lack of govt oversight; there will be this. Until we eliminate human greed, there's no fix. MCR, SSI, MK, & Welfare Programs will destroy us; unless there's govt oversight. Currently, there are none. On paper there is but in practical sense; there is none... All the best...

Each company is different. Expect anything. Study; they may give an exam: verbal &/or oral. Be loose, make sure you can lift & run; they may give a physical. Know how to read a map & be able to negotiate the serpentine: they may have a driving test. In other words; be prepared. NYS really hasn't... All the best...

I believe in it. Obviously, many don't. A cop pulled me over for going 70mph in a 65. He asked me why I was in a rush; I said its a long story but he wanted to know. I told him the truth, "I'm a Paramedic & a Manager. I had to go to another county to take a large amount of $ out of the bank; which there was no Capital One in my county. Head home; drop off $ to my wife and head to NYC; it was 8:30am & it was rush hour. I had something big that happened; one of my guys was hurt in a MVA." He said okay. He took my DL, Insurance Card & went his car. He came back to me in 5 minutes & wrote me a ticket. So I guess Professional Courtesy didn't mean anything to him. Granted I was SPEEDING but many of us do. I didn't think that going 5MPH over would get me one... I don't expect it but whatever...

http://www.google.com/search?hl=en&safe=off&client=ms-rim&channel=browser&ie=UTF-8&ei=O3ZQTe3BLoLogQfP-KH0Dw&q=cme+ems+online&start=10&sa=N Ruffems has the site... The link attached is a google page of a few... I thought I procrastinated. I'm due up at the end of April; my CMEs & Paperwork must be sent; post marked by 3/15/11. I still need some Peds, Geri, WMD, & OB. Just did 12hrs of CME Online through FuNCMEs; split among Cardio, Peds, & Geri. Heading to a 2hr WMD CME. Now for the OB.... Good luck... All the best....

Thanks... All the best... island emt, I honestly had a brain-farct which lasted all weekend. Thanks... island emt, I honestly had a brain-farct which lasted all weekend. Thanks...

If its mandated than we must carry and comply. If not, then the option to not have will be the option. I'm not saying I would; I'm not the owner. I was looking it at the owner's side. As for being a Paramedic; I want more training and all the skills possible but I do have to look at it financially. I don't work on the road. I would like to know the site which shows the price for Morphine & Fentanyl. Thanks...

In NYS, EMS needs to honor DNR, Living Wills, Power of Attorney, Heathcare Proxies, & MOLST. Enough is enough. No more confusion & ethical dilemnas...

Usmc_chris, sounds like that a lot of people. Wanting to take the easy way out. This and many other things I hate about EMS. It fustrates me that you get looked down on when you do the right thing. What you posted is so right. America was on the top of its game; key word is was. Were such a lazy society. I know this has nothing to do with why the USA is in a decline but if we stop and took a look at ourselves; we'll probably see many things we can change. If you're lazy about filling out the PCR on a possible call; then you maybe lazy for many other things...

I'm not saying its wrong or right. Just something to think about. It will take for something bad to happen on these types of calls, for Protocols to change. It is, what it is. We are a reactive society. Something bad has to happen before we change. I'm okay with that. I'm just putting my opiniom out there and sharing what I do. All the best....

If that's the policy, so be it. Nothing can be done; if the service wants to delay the Ambulance response so the Fire Service can have 3minutes patient contact time; so be it. If that is how you better a provider's care; then so be it. Let the public know that and see how they feel. That policy is the most retarded thing I've ever heard. I am lying but it is pretty retarded. It's things like this, that hurts the profession. I am truly sick of all the stupid policies which hinder productivity and growth. This is definately one of them...

How did the patient ended up needing a lift assist? Did she try to go number one or two but lost her footing and she couldn't get up off the floor. I mean you're better off to document and have the patient sign the RMA. She may c/o pain later and no PCR or RMA was generated; the lawyers will have a field day with this. Its better to just secure the RMA than to mark it as an unnecessary for EMS. I'm not saying to document a book but document the events and findings with remarks of patient's adament refusal of going to ER; get them to sign and get a witness. What's the big deal? 5minutes added to your time. I'm just saying. Ex. U/A fd 50 y/o F with PD onscene, NAD, no complaints. Sts she's embarrassed that EMS was there. She sts she was sleeping; may have rolled over and hit her medic alert. Pt speaks full sentences; A/0x3; answers questions appropriately. Pt offered a transport to the ER but declined; sts she is fine & wants to go back to bed. Pt made aware to call 911; if any problems should arise. RMA signed by patient & witnessed by PO Smith, Daecy PD. 4c6 02 February 2011 - 11:35 PM "CC: Patient has no complaint, requested lift assist, etc., only." That doesn't make sense. The person technically has a complaint. Requested lift assist; isn't that a complaint? Well more like something went wrong for the person, called for 911, & the person needs your help to rectify it. I think that's what EMS Providers do for a living; I think that is so. If you just told me that the person; had no complaints and just needed you to pick them up; it was just a lift assist. I'm gonna ask you; how did the person end up on the floor? 5 years down the line with no paperwork; you're not going to remember any details to this call. So a RMA with a generated PCR will be your only protection. The person refused treatment & transport to the ER. Its not your problem. Any Lawyer will be able to litigate this case on the person's behalf. As in, they be-halfing some money from the company for negligence. Just throwing that out there to ponder on... All the best...

I'm just rationalizing what institutions, like Ambulance Services, will option for: the cheapest route. I don't blame them; if they don't have to do it; then they won't. Its about the dollar. My Private Service has Capnography because NYS mandated it; if they didn't we would be still using the Colored C02 Detector. If I was the owners, I would rather pay for CO2 Dectors than Capnography; its so much cheaper. Its not like the Protocol warrants ET Intubation; it states that if effective ventilations can be given with a BVM and a basic airway adjunct; intubation can be differed. In a discussion, I look at all sides: my side, your side, his side, her side, & their side. Right now I'm looking at their side. If I would look at stcommodore's side; I would look for the better one of the two & it would be for Fentanyl. But that would be too easy... All the best...

Well Tarascon goes with the $ notation for cost of per month or per course. It may cost nothing to make but the cost of the little hands in the sweatshops in Malaysia to make you Nike Jordans are pennies but you paid $100+ for them. That's capitalism for you. See Tarascon Pocket Pharmacopoeia 2011 Classic Shirt-Pocket Edition 25th Edition, ISSN 1945-9076, ISBN 977-0-7637-9305-0. Go to pages viii, 7 and 8... Email them at info@tarascon.com. I'm not making it up.

+medic, the PCR shouldn't look the same. Patients are dynamic and every situation is different even though they appear similiar. I hate when my guys do that. Just a bunch of medical abbrev w/ postives and negatives but there are so much you can write for the HD patient(s). I assume the patient rec'd HD Tx. How long was the Tx, full HD or partial HD; if so, why? PMH should be reserved for the allocated boxes; unless it overwhelms the box. Does the patient have a Shunt/Graft/Fistula? If so, where? How does the site look? Did the bleeding stop in normal time? What was the pre and post HD Tx weight? Was a physical exam done? What were the findings? Is the abnormal finding, baseline for the patient? If not, why? Who said the abnormality is normal? What was the patient's mental status? A/Ox3, speaks full sentences, answers questions appropriately. Pt groomed or ungroomed? Good hygiene or poor hygiene? No major complaints but were there minor ones? Can the patient perform ADL (Activities of Daily Living)? Like brush teeth, use bathroom, bathe, cook, etc. Needs total AM/PM care? I know its just a BLS Transport but that's what I would add. My guys hate when I do their PCR reviews which is daily, weekly, & monthly. I read every PCR generated. I check for everything. I provide lectures on PCR Writing for the Non-Emergency and Emergency Calls. Lawyers are good at research. They know your job responsibilities, what your suppose to do, and what you should write . I'm not insulting your way or your Company's way; I'm adding my input to enhance the PCR writing skill you have. The 2 most important things the EMT does on a daily basis are not really covered in the EMT-B/I/P programs; PCR Writing and Ambulance Operations. All that are said is CYA; if you didn't write it, you didn't do it. Drive with due regard. There needs to be several sessions on documentation in the beginning and the end of the course: fundamentals and how would you document that. EVOC and Defensiving Driving Courses needs to be in the program. Is not done in NYS DOH EMS Programs; its not required. I'm just saying. All the best...

Tarascon Pharmacopoeia 2011 priced Morphine at $$$$ which is greater than $100 but less than $200. Fentanyl is $$$$$ which is greater than $200 but $$$$$ is the highest notation of cost in the book. Chemotherapy costs for one treatment is $$$$$ and it costs thousands of dollars. So Fentanyl is more expensive & in the Pr-Hospital setting; the service will not carry both; if there's an option. It just makes financial sense. Unfortunately, heathcare must make financial sense for the institutions and patients is foremost than the care. Well at least in America. All the best....

I've been in Pre-Hospital Care for 15+ years; 12 years as a Paramedic. In the Last Quarter of the Nursing Program. I've learned Human Autonomy. I've heard about it in Continuing Edu Lectures. I read it in Medical Articles. I believe in it. Do onto others as you would want then to do onto you. We've heard all the cliches. So why has these Protocols hinder the autonomy of others. Why in NYS can I only accept the DNR in the Pre-Hospital setting. Why are the Heathcare Proxies, DNI, Power of Attorney, Living Wills, & other recognize Advanced Directives ignored by EMS in NYS? Now we have another form NYS DOH EMS has accepted, MOLST. Its nice but a lot of others in the Heathcare field are "Huh?" about it. Are we trying to individualized this? Are we going to have patients fill out another form, sign it, notorized, MD review and signed. Another form. C'mon; they already have the DNR, Living Will, Power of Attorney, and Living Will. What more does one need? Dying is already expensive but we've made the process more difficult than ever. All the best...

Well the question was answered. To touch up on the intubation stuff. The reason that Paramedics can do somethings a RN can't, is because the field we are in: Pre-Hospital Care. We don't have (for the most part) other higher Medical Authority onscene, providing care. We learn all the ACLS & PALS stuff without taking these classes; its our Scope of Practice. The way Paramedic Training is; we have rotations in many areas like the ICU, ER, AMB, OR, etc. Many RN Prigrams only require Med-Surg clinicals. If a RN wants to work in the ER, CCU, PICU, or any specalty floor; they must take an internal Critical Care Course and many will require the RN to become a CCRN. Its the nature of the game. A RN fresh out of school can not work a code but a Paramedic can. Its just not the fundamental skillset of the RN. That being said, the RN has so much more movement than any EMS Provider can imagine (unless I get my way from NREMT, NAEMSE, NHTSA, etc for higher learning). The RN from the Crimean War days, has advanced so far. The Degrees like ASN, BSN, MSN, & PhDN. The Advance Licensed Titles like Clinical Nurse Specialist, Case Manager, Nurse Practitioner, Nurse Anesthetist, & Doctor of Nursing Practice. Its on a WOW factor. So much more movement for the RN, clinically and administratively. RN can work in so many settings. They can pursue further in the Nursing field. EMS must mirror what Nursing has achieved through the years but we won't due to Politics: skills w/o edu. Go and push yourself to the limit. Keep up the success. I respect the Nursing field. I'm in my last quarter of classes to get my ASN; hope that NCLEX is easier than preached about. So I can appreciate the difficulties. My theory is that EMS will remain stagnant because what it has evolved into: a hobby for most. A Volunteer Ambulance Service as the only means of EMS in areas is ridiculous. Nothing against the concept of Volunteering but in the most powerful country (Next to China), most suburban residents depend on Volunteer EMS for care & transport to the ER. At least Paramedics will always be a paid service. I've worked in a flycar ALS service and the longest I've waited for the Ambulance was for 45minutes because the VAC and the neighboring VACs didn't have members available. My company had to send one of our Ambulances (which was for Private Transport) to come to the scene. But Volunteering is great but it shouldn't be this way & in some areas the only way. I love being a Paramedic, the adrenalin rush was great when I was younger. Now I want something more stable and progressive. Bring on the replies; I know many will thrash me. Its my opinion based on fact. All the best...

Its people like us or not like us: who've messed this Country & World up. Ex. Words are used to name, describe, and/or explain an action or something. There are words like: Murderer, Arsonist, Rapist, Burglar, Robber, Mugger, Molester, Adulterer, Sexist, Rascist, Biggot, & I can go on & on. It describes an action(s) by people. The sins of the World are caused by people & only people. It will never change. Something that goes wrong; is always caused by people. It will always hold true. Like the basic saying in Philosophy; no act is selfless. It will always be true; ALWAYS. Unless we realize this; things will NOT get better. Like an Alcoholic or a Gambler; they can't recover until they realize their problem. Same holds true for the Human Race; we will continue to spiral downwards, into the endless depth of the abyss. I'm okay with that because most don't see what I'm saying. When we suffocate from our daily disregard of the environment or get poisoned from ingesting recycled waste because our resources are depleted; it won't be "I told you so" but a time for reflecting on our last days. Most say, "I will be dead by then." That is the reason why, people have and will destroy this planet. Is it too late? Only time will tell but we will all be long gone when that happens.

Most of our ancestors didn't come here legally unless you're Native American. My ancestry traces back to the Middle Kingdom. So I need to head back to China. I got my spoon; gotta get my DIG on...

No Policy regarding RMA? That doesn't make sense. Ask your boss; ask the EMS Regional Council. You have to let your Supervisor(s) know about this. Your revealing that its been on several occasions your partner leaves the scene w/o documenting or assessing. I know its a State violation; I don't need to know your State. Every State has Protocols regarding RMAs. An assessment and interview must be done at the minimum; signatures with a witness are a must . This doesn't make any sense. Your company has Policies and your EMS Region has Protocols. Ask someone. You obviously need postive leadership. Someone(s) must guide you. Don't be insulted; you don't know. This forum really can't help; go to your bosses and the EMS Region... Good luck. All the best... FireMedic65 31 January 2011 at 11:37 PM; Posted "This is why you document everything in detail. I used to write at least a page for a narrative for basic IFT calls. The same for lift assist and being canceled. I was "spoken with" a few times from the higher ups that it was not needed and to stop doing it. I disagreed and eventually quit that job because they seemed like they didn't care." I'm all for documentation but cancellation prior to arrival; need for thorough documentation. What else can you write? Other than, "cancelled by dispatcher enroute to location." You can write no patient contact made; if you like. Is there anything else you can write for the cancelled call before making patient contact? Thanks. All the best... Just remember. Its easier to defend a fully documented PCR than to defend no paperwork generated. When and if the law process comes into picture; you'll have aged several years & you'll never remember this call. My rule is and it goes above and beyond any State Protocol. If I make patient or person contact and the person/patient doesn't want to go to the Hospital; I'll document the findings, the events of the call, and get the person/patient to sign the refusal. Regardless of why I'm there (Medic Alert accidental trip, unable to use equipment, changed mind, wanted someone to come to make something to eat, etc). It will protect you in the long run. Lawyers are very go at manipulating the true; they know your profession better than you; & they are very good researchers. Good luck. All the best...