chazmedic

April 9, 2006

Mag light.

For peds, Mini-Mag light.

Just kidding folks.

Mr. Haldol, Mr. Versed, Mr. Kerlix, Mr. Coban.

I got scratched by a head trauma patient once in the ER. Blood all over the place. Pinched and scratched, actually. Hurt. Nurse did not allow the patient to be restrained. When it was ordered, she loosened the restraints. See above scratch.

Now for the punch line... he had full blown-about-to-die-AIDS. None of that HIV ca ca. No sir, right to the front row we go. This was in '98, I was given the "3 drug cocktail" for "prophylactic precautions"... 'til those drugs tried to shut down my kidneys.....

Mag light.

April 9, 2006

I think it's the doctors responsibility to risk everyone's life and limb to respond to my emergency (ingrown toenail) lights and sirens and noone else's. Just me. And me alone.

April 9, 2006

I feel your pain. We have discussed for awhile about putting on a BLS transfer unit since 95% of our T-fers are BLS. However, if there is a glimmer of a possibility of a snowball's chance in the middle of July in Texas of even thinking about making the T-fer ALS so it can upgrade to ALS rates, we will have ALS trucks being dispatched to BLS transfers....what was I talking about?

April 9, 2006

Pet peeves:

1. Use of "umm" more than twice during the radio report.

2. A dispatch to "an unconscious patient, alert and orientated".

3. Comparing systems and declaring which is best. Face it, we all s&ck.

4. When my partner launches out of the bay, sirens screaming, lights flashing, tires squealing in protest, the swerve onto the blacktop, knuckles white on the steering wheel, and yells "YOU KNOW WHERE WE"RE GOING?!?"

5. Long, over dramatic, extended, and pointless descriptions to the point that you are making.

6. Volunteer departments

7. Career departments

8. Departments that consist solely of retired foreigners :wink:

9. Jessica Simpson

10. Humor in general.

April 9, 2006

TechMedic05

am going to have to continue to be feisty and correct something else...Medics are good for more than just pain management and cardiac. Something like...Airway?...hrmm...and a few other things.

Medicare ALS reimbursement.

What? You were thinking like..care? :shock:

April 9, 2006

paraloco wrote:

That is exactly what I'm talking about. The bean counters don't care about education. They want the cheapest they can get by with. Citizens demand public safety and essential services, but don't understand the costs involved. Municipal leagues will tell cities and counties to reduce fire and EMS back to a volunteer level, no matter the size of the city because it's cheaper. If on the books it's better to run intermediates or basics, they will try. Came up here in the PUM discussions. Remember, a city council member asked "Can't they just call a cab?" in reference to a 911 call for an ambulance. All they expect us to provide is in simple terms, they call, we haul to the hospital. Same as trash guys pick up trash, fire departments put out fire, cops shoot bad guys. Remember, when it comes to money, you have no allies. If the nurses think their jobs are in danger or paramedics are invading their turf, they'll gut use in a heartbeat.

Many will say EMS is not a public safety department. That may be true in some areas, but in all areas EMS is a part of the public trust. The public has an expectation that when they call for an ambulance, one responds. That's the public trust. We must confirm this.

April 8, 2006

Think about this: is there any new construction in your area? If so, there is a chance they are blasting. We just found out there is a construction site 1 mile from our station. They are blasting with ammonium nitrate-fuel oil mix explosives (AmFo for short). The explosives are stored on site in a bunker and hauled around the site in a trailer packed full. :shock: You should see how complacency makes you sling those bags around. Accidents happen. At any time.[/font:8c48d6d3f6]

April 8, 2006

They call, we haul. I have resigned myself to this. :?

April 8, 2006

I've worked with EMT's that I cannot believe they passed the NR test. I am positive their only goal is to drive. I divide my days on the ambulance as either having a partner or a driver. I recently have had major calls and was working with drivers. I'm working a critical trauma at the same talking the EMT though his job. The EMT I discussed earlier just realized we have pediatric kits and body bags on the units. You can scream at him that it's his responsibility to also check the truck and memorize where things are and to know what his job is until you're about to pass out. However, there is no telling where his head really is. He could be looking at the bag thinking about the new boat he's trying to buy. He's just going through the motions. He believes he's so good, he doesn't have to try. It's a product of high self-esteem teaching. Praise because you took the test and failed doesn't work. "Don't worry, Timmy. Even though you failed horribly, missed every question, and spelled your name wrong, you tried. And that's all that matters. Good job! Want some ice cream?"Praise has to come with accomplishment. Failing is still failing. In team sports, number two is still the losing side. In dealing with human life, failure should not be accepted. "Just getting by" isn't good enough.

Wouldn't you love to be my kids? Mm mm, just smell the therapy.

I expect my EMT to know his job, just as he/she and the patient expects me to know mine. Is that too much?

April 8, 2006

I fear a reduction of EMS services provided. Money is getting tight. Hard choices are being made in the medical field. Medicare is cutting back. Studies are coming out hitting ALS hard. Just look at this site: hits against CPR, intubation's in the field. JEMS and the Military channel both have had stories about prehospital care in Iraq. Both brag about aggressive basic care and rapid transport to the hospital as the life saver. Area hospitals still run commercials about if your having chest pain to "immediatly drive yourself to our hospital". Calling 911 is always the last ditch effort.

I remember a class the local hospital sponsored a while back taught by a nurse from Alabama. It was over neonatal transport. She popped a cork when she found out paramedics were invited. She bragged about how the nursing group she belonged too lobbied a reduction of skills a paramedic could perform. In fact, I can still remember her stating that we should stick to driving and "cot fetching" and leaving the real care to the nurses. I'm afraid the politicians and leaders will choose keeping hospital staff over EMS any day. Most still view us as simply a taxi ride and don't realize the good we can do. Money is always the final decision maker.

Damn, ain't I a downer?[/font:0306e1627e]

April 6, 2006

We have a guy working for us that claimed during his EMT course he had adult attention defect disorder or something like that. All his test questions had to be read to him, he got longer time to do his test, and the NREMT test had to be read to him. Only thing is there was no official diagnosis of his disorder, but the community college apparently fell over itself to help him. This came after he failed his first couple of tests during the course. "Of course, it can't be you, or the fact you don't study. It has to be an illness." He failed the national, but I don't know how many times. Nice guy, but immature. Finally passed and now he's here and he's a 2/20 EMT (less than 2 years in/over 20 years experience). We never hear about the "diagnosis" anymore.[/font:e18dc533f5]

April 4, 2006

We have heard that all supervisors would be let go if they took over. This seems to be a common trend when they take over. All other employees would take a pay cut.

Now, the thing to remember is, they were not invited in. The PUM board sees their presence as a destabilizing force of the existing system. The fear is that they are going to force the RFP on their terms. Efforts are occurring to lock them out of the region, see the article I posted above. The county judge has already indicated that all employees retain their jobs.

The other thing at issue is 3 counties in NW Arkansas (which we are a part of) operate under a common protocol system, the "Northwest Arkansas Protocols". This was put in place so that all 9 EMS systems operated on the same page. This was a collaboration between the systems and the area hospitals. The PUM is going to mandate adherence to this protocol system.

The main thing is the PUM, city mayors, and county judge appear that they are not going to let local "hands-on" control slip an "outside" company. The PUM board agrees that it's not an issue of substandard care, rather a funding issue.[/font:b0fe1c7574]

April 3, 2006

Here is an update with this. It appears the county and city are going to try to lock out AMR. I believe that the city and county do not want to give up "local control" of EMS. Since this meeting, we have heard that now AMR is reducing the amount of ambulances they are going to run and are focusing on the county north of us. They don't want to come across as the "bad guys".[/font:b1d1749b77]

Council to consider offering exclusive ambulance contract

BY MARSHA L. MELNICHAK Northwest Arkansas Times

Posted on Wednesday, March 29, 2006

URL: http://www.nwanews.com/nwat/News/38958/

The Fayetteville City Council will soon consider whether the city should have an "exclusive provider" for ambulance services beginning Jan. 1, 2007 or Jan. 1, 2008.

At the request of Mayor Dan Coody, a resolution to express the council’s intent to contract exclusively for emergency medical and ambulance services for the City of Fayetteville was added to the council’s agenda for April 4.

American Medical Response, also known as AMR, has indicated it expects to be in service in Washington and Benton counties by the end of April, which will put them in direct competition with Central Emergency Medical Services, the current provider of ambulance service to Washington County and the city.

According to Coody in a memo to council members, that competition "will have a potentially serious affect upon CEMS’s ability to remain financially viable."

And that, he indicated, would result in one of two scenarios: no emergency ambulance service or the city and county paying more money to fund the resulting cash shortfall for Central EMS. "The $300,000 budged for 2006 will not be sufficient to sustain the service even if there is only a marginal expense/revenue impact due to the loss of a portion of the non-emergency transfer market," Coody wrote.

A study paid for by the city and county recommends a public utility model to reduce taxpayer subsidies. The recommendation is for one exclusive provider so the fees from non-emergency transport help pay for emergency transports, which often go unpaid.

Washington County administrators would like the city to make Central EMS the exclusive provider immediately, then request bids for services beginning in 2008, explained Gary Dumas, director of operations for Fayetteville.

Coody prefers to start sooner.

He suggests the city immediately begin the process of soliciting proposals for an exclusive provider for all ambulance services through a public utility model to be operational by Jan. 1, 2007.

City Attorney Kit Williams explained that the city must comply with state statutes to limit itself to one provider for emergency and non-emergency services. "We can’t just do that. … There’s no way just to write an ordinance immediately and immediately let CEMS have it. That’s not allowed," he said.

The proposed resolution would just express the intent that the city wants to limit to a single provider, whoever the best provider will be, Williams explained.

Hugh Earnest, facilitator of the study, said AMR’s focus will be non-emergency service. He said the company is positioning itself to be in the market when bids are requested.

He said the Jan. 1, 2007, target date could be met. The county wants to continue a regional service, such as is provided now by Central EMS, he said.

According to Earnest, Fayetteville’s interest in being part of a regional public utility model is crucial. "Sixty-five to 70 percent of the business for emergency comes out of Fayetteville," he said.

Russ Kelly, president of the Central EMS board, said they are concerned about the financials with AMR coming into the area, but they are also concerned about losing qualified people to other providers. "It looks like without an exclusive contract, we’re going to lose most of that (nonemergency) business," Kelly said.

At Tuesday’s agenda session, Alderman Bobby Ferrell asked other council members to "remember what happens when we rush into things."

March 31, 2006

76% dixie....ya'll.

Here's one for ya. What does "Losing your religion mean"?

March 31, 2006

I was in EMS full time until age 31. That was 10 years of service. I then went over the FD full time and keep doing EMS part time. I left EMS full time because I felt I had gone as high up as I was going to go, no more promotions, no more raises except COLA. In Arkansas, the cut off age for civil service fire is 32. After that, your too old. I didn't leave because I was burned out or tired of it. I did because of financial reasons (I brought home $350.00 more a check as a "probie" FF than I did as a "veteran" medic, step raises, state funded retirement program) and because I figured I would always say "I wished I did that when I had the chance" if I didn't. I work at least 100 hours a month with the ambulance service for the extra money and because I truly like it. If you want to do EMS, you can. Just realize the pays not great. Promotions are rare. You can get hurt suddenly and severely. Plan ahead with your retirement. Always remember there is no cut off age for mercenaries in South America. You will see really bad sh#t. EMS is what you make of it. My wife always says that "being a paramedic is who you are." If you get into the biz, wear that uniform with pride. (cue the patriot music) :brave: [/font:9a3c2f885e]

March 31, 2006

"Chaz was killed by his own troops for being obnoxious" :shock: Leadership s$cks

Also found:

"killed by mistake."

"killed by 8 bullets after being mistaken for a terrorist." :?

and finally:

"killed by pirates on the Mississippi River" :shock:

March 31, 2006

It's going to be either a PUM or Fire Department. Our county Department of Homeland Security and Emergency Management director is drooling at the chance to establish a county wide paid department no matter what it takes. As long as he and his buddies are in control. The mayor of Fayetteville (pop 70,000, daytime swell to 100,000) and the county judge want control of EMS. Bear in mind, the company brought this on with bad management decisions (routinely sending 4 of 7 on duty trucks on long distance transfers then saying he wasn't doing it, saying he was a private company so f--- off, refusing to answer any questions the city and county had).

Actually, our new fire chief in Fayetteville does not want EMS. He has gone out of his way to show our taking over is a financially bad idea. He has told the council this.

I'll get the name of the consultant. I know he is a former paramedic. The funny thing about the 2 studies, both showed the FD taking over is a bad idea. A council member then asked "so let's do a study to see if the FD should take over."

March 30, 2006

After my ordeal I should still be wearing them, but history teaches us nothing, right? The steel toes I wore was a pair of Red Wings that I still have and are still in great shape.

The kind of boot to stay away from are the 8 inch fire service turnout boots that look like duty boots. There are companies that will sell these to your service as the "greatest thing since sliced bread and the wheel". Water proof and great protection on MVA's. Remember, they are turnout boots, meant for fighting fire, not walking in all day :walk: . Very heavy, very hot (did I mention VERY heavy). My fire department (job #1) bought everyone a pair of these as "duty boots" for around the station and EMS calls since the company said they were "perfect" for that. Blood can't soak through. We bought 110 pairs. I think 10 people wore them. Mine are still in the back of my locker. The EMS company (job #2. Come on, I got 3 kids that eat like locusts!) had dealings with the same company but fortunately didn't fall for it. :walk:

March 30, 2006

I have attached an article in todays paper about our service, the public utility model idea, and the sudden appearance of American Medical Response and how this is effecting the process. The service and and the county judge, who is the main supporter of the idea, are in a panic about AMR.