hatelilpeepees

As The Rock would say, "Know Your Role". It is your role to give the best care possible to the patient that is in front of you, regardless what is going on in the rest of the world. It is your supervisor's role to ensure that there are enough ambulances to handle the call volume, to rotate those units to where they are needed, and to have a plan for when there are no ambulances available. When you start leaving "BS" patients (in your mind) at home, you will open yourself up to all kinds of problems. Let me ask you this question; right after 9/11 I bet everyone in this room called FEMA and volunteered to respond to NY if needed. What if instead of just volunteering, half the medics in your state dropped everything to go to NY, for what turned out to be a body recovery effort instead of a rescue. How many patients would have died because of the lack of ALS responders left in your state to handle the calls ? Their heart would be in the right place, but it would have been a poor choice. Abandoning a patient in front of you, to respond to a patient that has less than 1% chance of surviving is not a good choice.

You also have to remember that less than 10% of patients with major trauma have a C-Spine injury. If they patient had no C-Spine pain, I would opt for transporting them in a sitting position so that the airway stays intact. If the patient had C-Spine pain I would opt for immobilizing but putting the patient on their side as mentioned. I have never encountered this from a car accident, but have encountered it with GSWs where the tried to commit suicide by putting gun in mouth or under chin. 99% of the patients we immobilize do not need it.

You also have to remember that less than 10% of patients with major trauma have a C-Spine injury. If they patient had no C-Spine pain, I would opt for transporting them in a sitting position so that the airway stays intact. If the patient had C-Spine pain I would opt for immobilizing but putting the patient on their side as mentioned. I have never encountered this from a car accident, but have encountered it with GSWs where the tried to commit suicide by putting gun in mouth or under chin.

I am all for being a team player, but it is not my responsibility to run codes for an ER. All hospitals should have a "code team" that responds 24/7. I am guessing you gave them a radio or phone report that you were transporting a "code", so if the ER was not ready for your patient that is their problem. If I was the ER manager I would be quite upset if someone was recruiting people from the lobby to give patient care.

I would vote for a lockbox that has a combination front and key inside. Give every resident and the 911 Center the code. I imagine they are locking it to keep intruders out, which probably happens more frequently than an emergency on the beach, so be careful what you ask for; having a wide-open gate may be more dangerous to you than a locked one.

See if you can google or find the show on C-Span last night with Thomas Friedman (National Governor's Conference). He offerred a bleak job outlook for any career that is not specialized, basically saying if it can be outsourced or automated, the career is dead in the US. The reason I say that, is that you might consider some other medical careers that are connected to your skill set, or you may go back to school to gain more skills (Paramedic/Nurse). You could consider teaching EMS, becoming a dispatcher, or doing some industrial first-aid type duties. There are Paramedics who do insurance exams in patient's homes, I know of a Paramedic who worked in a law firm to assist them with medical malpractice cases. There are some options out there; same for nursing (school nurse, clinic nurse, doctor's office nurse, industrial nurse, nurse consultants for JCAHO, nurse consultants for insurance companies, Nurse advice phoneline type of jobs {poison control, refer to a doctor, refer to ER}). The door is only shut if you let it close.

On the back bottom there should be a "red" reset button (usually about middle of bottom, between house and unit). Try pushing that. If you do not have one, or pushing that does not work, take the cover off, and look for a round thingy, about the same size as the opening of a 32oz drinking cup, kind of frisbee like (on my unit, if you were standing in front of unit looking at house, it was on the back left side of the unit). It is some kind of capacitor or transistor, not sure what it is called but had to replace mine about 3 times, part cost under $50. If not that, open your wallet, and call the HVAC guy. In the meantime, you can buy a small window unit at walmart for around $125, is only big enough to really cool one room, but I lived in my bedroom for about a week with one, one summer when we were waiting on financing for a replacement AC unit. On the off chance you need a whole new unit, check with your power or gas company, as many of rebates and financing for replacing old systems. When I replaced mine I got like $1700 back, and my power company financed it at 0% for 36 months.

Where you are most likely to get burned is when first responder says oh, that one over there is dead, these two over here are critical. Then you found out after all the helicopters leave that your dead patient isnt quite dead. I think the dash sticker is a good idea, but i always used the same rule I used for itubation, I have to hold my breath until i get to first patient, then breath, have to hold my breath until I get to next patient, and so on down the line. I also like to send my partner to the opposite end, and let us both meet in the middle and add everything up. Getting the proper head count so that you can get enough resources and the right resources on the way is crucial.

welcome to EMS, if you have not realized yet, only about 4-5% of your calls are true, life-threatening emergencies.

Chemically, Amiodarone is supposed to be a better drug because of the receptor sites it interracts with, but in reality, we have been changing the drugs in the ACLS algorythms every 2-4 years of my career, and "OUT OF HOSPITAL ROSC or Discharge from hospital with viable life" has not improved at all. Without quick citizen CPR and ACLS intervention within 4 minutes, I doubt you will ever see a change. I think you would do just as well pushing a fluid bolus and an amp of bicarb, instead of following ACLS algorhythms, as statiscally the outcome will be the same. PS, I had more conversions back when we used bicarb as a first-line drug. With that being said, to quote the person that said each arrest is different, I remember an arrest where we had actually just stopped at the red-light in front of the fast-food restaurant where an arrest had just occurred, the patrons actually ran out and got us before 911 dispatched us. We had less than a one minute response time, the patient was a male in his 50s, had immediate good CPR by a nurse, was still in Vfib, got immediate shocks and treatments, never got him back. So he/she was right, no two arrests are the same.

You really want a Nurse to decide what you can and can not do ? Your State EMS Office and Medical Director should clearly define what you can and can not do, it is not the job of any ER or ER Nurse to be knowlegable about your scope of practice. Are you a practicing EMT ?

Your problem will not be the GED, it will be your age. Very few insurance companies will underwrite an 18 year old to drive an emergency vehicle. Keep your driving record spotless, go on to EMTI or Paramedic school.

You need to find out who is pushing for this behind the scenes; is it politicians who believe they will save money by combining departments, or is the Fire Department pushing for it so they can save their jobs ? The first thing you should do is suggest that EMS should take over the Fire Department, since the majority of calls of the new department will be EMS calls. You can also counter the money question by showing that you would take the traditional 24/48 hour schedule that the Fire Department is probably on, and put them on 12-hour shifts, and shut down some apparatus during the midnight to 8am hours when few calls occur. Instead of paying people to sleep, you can pay less to have them on call. All municipalities are looking to save money, and labor cost is usually 50-70% of any public safety budget. Someone in your public safety departments are about to lose their job, do what you can to make sure it isnt you.

I would consider shooting three videos: 1. Show how "bad ems" responds to patients. Show them being crass, short, body language that is poor, common ems phrases like "So you been sick for 36 hours, what made you call us at 3am"? 2. Or shoot a video where the EMS crew is on the receiving end of bad customer service, like they walk into a restaurant, and the staff treats them like they treat their patients. 3. Shoot a video where one of your medics has a bedridden family member at home/hospital, and the ambulance/hospital staff treat their family member like your guys treat their patients.

I do not think that I have ever been handed SOPs at the time the job was offerred, that usually has occured during orientation.

Some Advice from someone who has been doing this awhile: 1. Get the hell away from Dialysis, don't go back. 2. It's all about relationships, you need to make a friend at a facility. What have you offerred to date ? Are you offerring CPR classes to nursing homes ? 3. Don't shy away from the "hood". Medicare/Medicaid pay the same amount no matter where the patient comes from whether it be the nastiest nursing home, or the one that looks like a Ritz Carlton. 4. Go talk to the largest non-emergency provider and ask them if they will roll calls to you when they are busy ? Every service has days when they cannot handle the call volume no matter what size they are ? 5. Go to the local 911 service and ask them to roll the non-emergent calls or long distance transports that they do not want to run. 6. Visit THE NIGHT SHIFT. NO ONE EVER MARKETS THE NIGHT SHIFT. Take some $5.00 pizzas to the ER or nusing home around 11pm. 7. Move your station so that you are on-campus or nearly on-campus of a large facility, and let them know you are closest. 8. Post your ambulance at the ER bay, not at your station. I got hundreds more, PM me.

Probably belongs in another thread, but since it is a hypothetical scenario, I am putting it here. Your service hires a new employee who appears to be middle-eastern in descent. Obviously, you do not ask any questions about religion. He/she passes all your tests, so you give them a job. When he/she reports for orientation, he/she is in full muslim dress (head to toe). He/she refuses to where your uniform as their religion only allows for traditional muslim dress while in public. If this happened, could you fire them and not lose the lawsuit that will follow ?

You did not state your age and your family situation, but generally I would say yes if someone else is paying the bill for you, and you are sure with your limited experience that this is the career choice for you.

Here is how I always made the decision, I would say "if my entire interraction with this patient was video-recorded, would I be proud of how I looked when it was played in court". If I could not answer "yes" or know that I was completely covered, I transported.

cant speak for why flaming said what he said, but just a few years back, our local Pediatric hospital starting filing formal complaints with the State anytime an EMS crew brought in an unrestrained child, it didnt take long to get some rules and behaviors changed. Apathy can be just as dangerous as deliberate action. Letting mom hold the child on her lap should no longer be allowed, and although no one has voiced their desire to strap babies to the hood of the truck, you are already hearing excuses about how you can not assess or treat a child appropriately in a restraint device.

OK, you dont have to transport because the patient didnt call, how many 1 year olds call 911, how many illegal aliens call 911, how many passed out drunk college kids call 911 ? Cookbook medicine ---- how many 55 year olds with Chest Pain and dyspnea, but a normal EKG do you leave behind because you don't just treat symptoms ? Anyone who is altered, should be transported PERIOD.

OK guys, take the blinders off, you all missed an important point in what she said; either she is not telling the whole truth or something much worse occured here. She admits to drinking "1 shot" of strong liquor and then was unconscious/unresponsive. There is no liquor on earth that can do that to an adult, even a shot of rubbing alcohol won't do that. My guess, you got drugged and raped by your neighbor, chose better drinking partners, or your definition of a "shot" is much different than mine.

wow, thats pretty freaking scary !!!!

I am sorry I have to disagree with this one. I look at it from the patient's view, when you are a patient in the hospital now, you can not tell who is a housekeeper versus surgeon, as everyone is in scrubs, and doctors and nurses may or may not wear lab coats. In EMS/Fire, most people dress in BDUs and a t-shirt. I think you should have to be identified in someway, if you are scared, be like a striper or bill collector and have your employer make up fake work names that you will go by.

my guy won the Nobel Prize for Physics in 1991