cosgrojo

And for 14 cents a day... you can feed Sally Struthers.

Not only is this a fantastic idea... I'm curious if this is the norm anywhere? This is a completely foreign idea to the region I work in. Any truly good system would be clearly improved by a concept like this. I have often read people describe the tiered response system, and in all honesty I don't have many examples in the area I work in (primarily rural in nature). But in coming to an understanding of what it is, I feel that this system would also be appropriate for rural areas as well. Great post! Thank you! Very comprehensive in nature, I hope there are things people can add on to.

It could be serious... you have to ask, "Why did they stub their toe?" Was it near syncope? TIA? Early sign of Hypoglycemia? What's their H&H level? PH balance? Rare form of chronic sleep-walking? These are things that good providers need to ask right? (BTW, my partner is watching me write this and he just said "get the b!tch a bandaid")

This is not a gripe thread... this is not a thread meant to argue. My challenge to the people here at EMTCITY is to describe to me what the perfect EMS system is. I hear much on these boards about how this system sucks, and that system sucks, but very little in the way of solving this situation, or even quantifying why it sucks. I want a comprehensive post including everything that you need to provide the best care possible for your community. Be specific and realistic. To set the rules a bit further, I will give you the sample community (that way there can be no mis-understanding). This is municipal EMS of a large city with equal parts inner-city urban territories and outer-laying suburban sections. You live in a community that values their safety, and local government does not mind spending money on public safety. So you have money, and you have carte blanche. Have fun! Repeat... this is not meant to become a ALS vs BLs thing, and try to respect others opinion on this matter, it's easier to actually learn something then. I know many of you are involved in the administration of EMS so I am particularly anxious to read what you post.

Am I allowed to assault specific ALS personnel... or just the general populace? Nobody is actually taking this stuff seriously are they?

I think it's funny that everyone actually thinks they know what anybody else's true feelings are about anything. I thought the original post was rather specific about the terms and conditions that were hopefully going to be applied to this thread. I feel that the fact that I explained it so thoroughly, shows that I understand how things work around here. I knew that it was probably going to degenerate down to an all out moronathon, but I was hoping that enough people would have honored the concept and that I could have just ignored the off-topic ones. And BTW, Dustdeveel himself proposed that this thread be started, and I daresay noone is taking him to task about knowing where this was going to end up. So stop giving me the old "you obviously don't understand his views..." routine. I don't care, and I think that people should be speaking for themselves and not other people. I doubt that Dust appreciates anyone taking up the gauntlet for him, he likes to pick the thing up himself. ADMIN- thanks for the chuckle... maybe my schwartz isn't as big as yours...

And this is exactly what they do so that they don't have these long conversations about what "shall" means.

Unfortunately..... no, we can't. I know too many providers that don't really care, and I dare say if you think about it... so do you. This is so ridiculous anyway. This whole thread imploded in the exact manner that all other threads do... in a maelstrom of negativity -10 to all who went off topic -20 to all who tried to turn this into a BLS vs. ALS topic -50 to Dust for admonishing others for hijacking the thread... and then hijacking the thread. -100 to cosgrojo for proposing the subject in the first place Sometimes I wish ADMIN would swoop down on his white horse of glory and save us from ourselves.

Wow... I go to work for 24 hours, make an unscheduled trip to the Cape to visit some family... and look what happens! Everyone has either lost their mind, or completely lost the point. I knew what I was doing when I made this thread, and I'm relatively sure that Dust knew what he was doing when he suggested it. Dust is a very thoughtful individual who is looking for a reason to advance EMS and improve the standards. I do not begrudge him this want, and frankly encourage any and all to sidle up beside him and help further the cause. Unfortunately he and others have made it clear that in their desire to re-vamp EMS, it is going to require the destruction and disbandment of the single largest group of EMS providers. They have all made it clear that they think the majority of BLS providers are bad. You know what? I agree. I think the majority of BLS providers are either in it for the wrong reasons... i.e. Fire Monkey add-on, or lack the in-depth knowledge and social skills (Dust: It IS about the Skills, just not the ones you mean) to perform at a high level. Most EMS personnel in general are people with very little accessory knowledge about life, classical regular educations, business, culture, literature, or even simple life skills like balancing a check-book or holding down a regular job. This is cumbersome for all of us who look to further the abilities of the industry and our systems. What I keep reading here is that even a good basic is more useless than a paramedic, to another paramedic. I believe this statement implies that all paramedics are adequate. I think the issues regarding why EMT-B's are useless applies even more dramatically to the paramedics. Bad Basics make bad paramedics. Regardless of where you started, if you don't have it in you to be a good basic, you cannot be a good paramedic. Most paramedics are just as woeful and sub-standard as all the Basics that run about. The problem here is that we are judging people based on the number of hours in a course. It's not about the course... it's not about the school... it is about the PERSON. The individual makes a good EMT or Paramedic. The schools and the hours and the education is ancillary in nature. If the quality of material being molded is deficient, so will be the final product. So, to answer my own question. A good EMT is similar to a good pharmacist, or a good construction worker, or a good engineer, or a good fighter pilot, or a good WHATEVER PROFESSION YOU CHOOSE. It is someone who tries hard, and thinks harder. Someone who is not satisfied with the education he received in class and didactic, and has taken it into their own hands to learn from their peers (the good and the bad... you can learn something from everyone). A good EMT has good peripheral vision, so that they can constantly watch their partners' back. A good EMT questions orders when appropriate to do so, and has a warning bell always ready to go off in his head when things are about to go wrong on a call. A good EMT knows every application of every piece of equipment in his truck. A good EMT know how to do exactly what his partner is not doing so that you can move with greater efficiency toward the ultimate goal... definitive care. A good EMT knows when his/her partner needs help before the partner needs help. A good EMT knows how to evaluate a patient in a controlled and detailed manner and know not only your own plan of care, but understand your higher level of care partners' plan of care. A good EMT knows how to organize a scene and knows how to utilize every person on that scene to make things run smoothly and efficiently. A good EMT knows how to communicate to a variety of people in a variety of circumstances in an intelligent and focused manner. A good EMT must give respect.. or expect none in return. The answer to everything is education (and the abolition of whackerism). But education alone is not sufficient if the beings getting the education are not capable of absorbing it. The one thing that is always overlooked on these forums is the QUALITY of the person doing the job. We are quick to nay-say the level of certification and all that hold it, but not break it down into fair and appropriate aggregates. One should not say that basics suck, they should say, "Hey! That basic sucks!" - or - "That paramedic sucks!" Because by classifying all basics or all medics together we verge on a new form of bigotry... One of which I will dub... EMS Apartheid. I could go on and on if I chose. But I got to go back to work. I believe I have gotten my point across, if not... then I will just tell everyone that what ever level of provider you are, that you suck. Cheers & Jeers Josh

At the behest of the revered Devil of EMT-city, I am going to give all EMT-B's a chance to let Dust know what a good BLS provider should know. Any and all users of this site have probably run into the attitude that Basics are sub-standard on some (if not all levels) of EMS. There have been multiple threads and comments on this very site that advocate the need for medics on every truck. My challenge to the perusers and users of this fine internet establishment is to quantitatively and qualitatively list what you think makes a good basic. Explain to the masses why Basics are not useless, and are more than drivers/taxi attendants. If you are to take part in this challenge... I implore you, think it through and try and post reasonable, intelligent responses. Also I think it might be useful to know from the advanced providers on this board to explain what they like to see in their basic partners (and no... a paramedic license is not an appropriate answer for this discussion). In the meantime, I will reflect and postulate my answers to this question and will not get another chance to respond for another 30-42 hours from now (duty as an under appreciated BLS provider calls). Happy posting, and I await the answers with unrepentant anticipation. In the immortal words of Rob & Big... time to do work.

*envisioning Dust surgically evaluating a tick burrowing into arm, while flipping through phone book for Red Cross number* Hilarious!

I'll concede the point, but is it because hindsight being what it is, with experiences gained you forget all the things you may have learned as a basic and assumed that you always knew them? I think maybe that you have just never had the benefit of working with a truly good basic. When you come back from playing pseudo-soldier over there, come to NH... maybe I can teach you a few things...

By the way, I hope nobody here thinks that I meant that Dust was really trying to run anyone off. It was meant as a comment with tongue firmly planted in cheek. I doubt there is too much confusion here, but since we are all following the rules now... I wanted to make sure there was no mis-understanding. 8)

I'm getting a bit tired of this all or nothing, go big or go home mentality. Not everything is black and white in this world. You just can't say that being a basic first is going to retard your ability to be a medic, no more than you can say that being a basic is invaluable. It is all about the individual attempting to be a medic. If you have the ability, the mental capacity, the drive, and the desire to become a good medic, then you will become one. Some people need the structure of knowing the job first. Some people need to get the jitters out of their system by being a basic and attempting to do EMS without a safety net. Others naturally have the ability to quantify what is going to happen and will be able to handle it as it comes. Overall, I disagree with Dust. I think that being a good basic is invaluable for the majority of EMS providers that want to become paramedics. Notice I did not say ALL providers. Let's face it, the mean age of EMS providers is ridiculously low. If you are over the age of 24 these days you are considered a veteran of EMS. Most of these kids coming into EMS have no practical experience in ANYTHING, let alone EMS. For a lot of these kids that found graduating high school a challenge, I want them to get some quality field experience first before they try and become a Medic. Dust, stop seething here, I do not mean that paramedicine is beholden to basic skills. I am fully aware that the level of understanding between the different levels of EMT's is immense. I know that in medic school they are trying to rip most of the things out of your head that they tried to put into your head as a basic. I am interested in the majority of people who want to become medics get a good foundation under their belts. If you can't do a quality basic assessment for a non-emergent transfer, and accurately portray that information to the receiving facility and staff, what chance do you have of being good at doing an advanced assessment and giving an emergency patch to a waiting trauma team that you just activated? The most important job of a basic (as I see it) is to ask every question you can (even stuff that you may not understand), and relay that information in a calm, organized, and efficient manner to staff members at medical facilities. This information may help further along a plan of care for a patient that may need it. By doing this on all calls a a basic you further your understanding about how things work. When you make it obvious to the staff that you are good at your job and you portray a bit of proficiency, they usually go out of their way to make sure that you are involved in things and teach you more. There should be no such thing as a taxi driver basic, and there is no shame in being a long-term basic if you continue to learn and get better. There are very few things in this world that saves tunnel-visioned medics more, than a competent basic with a lot of extra knowledge. If you think you have the ability to go straight to medic school without any experience as a basic, go for it. Quality and competency will always win out over EMS dogma. But lets stop saying that there is no possible benefit to these kids by learning how to be a good basic.

Kat- Dust's criticism's are valid, it was confusing and because of not knowing exactly what you were looking for I had to give a multi-purpose answer. Since you are new here, I'll give you a bit more advice. Dust's a cranky ol' buzzard. He likes to be cantankerous to try and frighten off new-comers. If you can get over his bluster and the hard edge in which he writes with, he makes a lot of sense and you can learn quite a bit from his lunacy. Keep at it, a post or two does not a reputation make.

This is BLS. Pt's probably having COPD exacerbation. Priority 3 transport to hospital. Get all the things previously mentioned and constantly assess lung sounds. Keep pt on O2. Most likely pt will be in same condition on arrival at ER. If things change, up the O2 and prepare yourself to call medics in if you are BLS. If you are ALS, Nebulizer in accordance to your local protocols. You probably would have already established a line because ALS loves needles. Simple call... as always prepare for the worst. This is the type of pt that if it goes bad, there is very little you could have done to prevent it, so you are just going to have to roll with it if you have to.

To me, if it's your patient, then Lt. @$#-face can do what you need him to do. If it is his patient, then you allow him do do what he thinks is appropriate. If it is his pt care, than all you can do is voice what you think is right, you can't force anything on him. Most people should respect the fact that if it's your call, it's your responsibility. But seriously... this guy wouldn't let you board and collar a Pt? If you are new, that's what people should want you to do. Make sure that their newbie has at least the basics of boarding and collaring under their belts. This guy is all wet Kat. My advise, either make sure that NOBODY stands in between you and quality pt care (which means aggressively managing Lt. bubble-head), or simply finding a new more progressive department to work for that won't cut corners on the well-fare of their pt's. If he has a real reason for doing what he did, he should have no problem enlightening one of his co-workers. The fact that he never explained his reasoning is suspect, and I wouldn't trust him.

OK...... I'm letting this post just wash over me for a minute................... I feel...confused... angry... slightly violent... Duuude... if it took you a year to finish your EMT-B (3-4 month class) then I think that maybe your career path should include lead trainer at the self check-out line at the supermarket. This industry will let anybody in!!! I mean I don't need Rhodes scholars, but some basic sentence structure please! Stay in school buddy, go get a better education, and find a job that doesn't allow you to take people's lives in your hands.

Dust... You are either incredibly random and cracked in the head, or that was the most subtle, yet awe-inspiring, attempt at explaining that my thread has been hi-jacked. Either way.. much respect. +50 for sheer originality.

In the state of Massachusetts? The money will never get to where it's supposed to go, the manufacturers of the plates will use substandard materials and keep the profits, and probably get drunk at lunch time causing a massive vanity plate spelling controversy. Then the state will launch a multi-million dollar investigation in which they will find out that their investigators are lazy and didn't find any information until the statute of limitations have already worn out on the violations. Then the State will have to pay the plate manufacturer for the legal fee's associated with the investigation. Great state... Massachusetts...

You had implicated on your post that you were going to be volunteering full-time. Now I don't know anything about your system out wherever you are, but it seemed a bit ridiculous to volunteer that much just to try and ingratiate yourself to a FD. Now I know that that wasn't the case. I applaud you for having a plan and trying to work toward it with as much haste as possible. You suggested that I implied that you should work, save, then school full time. That's not what I was going for, but it's better than your previous plan. Being new, you apparently have no idea what all this is about, and this is not a slam, it's impossible to have experience in something that you have no experience in. EMS is a physically dangerous profession, as well as fire-fighting. It is not out of the realm of possibility that you might get injured while you are working full-time and going to school. How easy is it going to be to try and afford school while you are injured and unable to work? The landscape of EMS is littered with people you over-extended themselves for the sake of speed and reaching their goals. I know many people who pushed too hard, and ignored their bodies and families, and relationships, and friends, and now they are not where they ever intended to be. When you push so hard in one direction, you open yourself up for a big fall. My official advice to you... you are young, so you are lucky. If at this time that you cannot comfortably afford to go to school because of financial and familial complications, I suggest that you work. Not just to get money (though that is a major plus), but to gain perspective and learn new skills. Please... do not pigeon-hole yourself into EMS and fire. You will not be the person you CAN be if you do this. Work somewhere else. Do you have any other interests? Even if it is using your EMT license to get an ED tech job, or become a CPR instructor and help kids and the general public learn CPR, or work at a grocery-store, or anything! Do some different things. You will learn more, make some more money, hopefully save a few years of hard labour on your body, and make you a better more reasonable person in general. If you are in this for the uniform and the so-called "glory." You are in this for the wrong reasons. If your perspective on life is out of sync this industry will chew you up the second it figures out how.

Long story short here... Went to take someone to the hospital from an assisted living home. Pt fell 2 days ago, went to hospital and was told he has fx ribs. Now, he is still having right sided rib/chest pain and is having a hard time moving around. Staff knows next to nothing about his baseline or his history. The only thing that they have listed is HTN. I'm on a basic truck, and rib pain=chest pain in my book, so I can't rule out cardiac. Also... why did he fall 2 days ago? Did ER work him up or simply take x-rays? Pt has substantial left sided facial droop that the staff has never noticed before. Equal strength x4 positive CSM's. Favoring left side... could be CVA, Cardiac, or his fx'ed ribs. Pt is sweaty, warm to touch, with a slurred speech pattern. A&Ox2. We are very close to hospital, so ALS was not going to do anything for us, and since they were just here doing another call, I knew they were tied up. We go blowing over to the hospital. We give report, tell them about all our findings and how seemingly contradictory they all were. He's been to this hospital before, nurse looks into her computer and says he has bells palsy. She was here the other day when he came in and remembers him, and knows he looks a bit different. 12 lead showed 2nd degree heart block. Very complicated patient that would have been very easy to overlook certain things, and based on his presentation and lack of information on history, would have been very easy to scream CVA from the hilltops. I would love to sit here and rail against the Assisted living for not having a clue... but right now I feel more like making this a learning experience for EMT's. For all the brand new EMT's out there... and yes I remember when I was one as well... never stop asking questions. Find out everything you can about your patients and about the scene. Learn about other conditions that may mimic other one's. Stay away from getting tunnel vision on patients. It's too easy to be distracted by the 3 inch laceration on their scalp line that won't stop bleeding, and ignoring the fact that they had an MI causing the fall that made them whack their head on the table. You're never done learning. I learned things on this call. I've known what Bells Palsy is for a while, but I've never actually seen it in real life before. It can present itself VERY much like a CVA, but a lot of the times their are slight differences. I've read descriptions of the condition but never actually put that info into use yet. These patients can have MULTIPLE things that are threatening to kill them, not just one. Never take anything for granted, and stay diligent and work hard. OK. I'm off my soap-box now.

Well theres your problem.... No wonder you can't afford to go to school... you are volunteering your time when you could be WORKING and MAKING MONEY! I still simply do not understand the mind-set of a volunteer. Now if you are an established person in the community and have made some money and set up a career, I can see why you might want to give back to your community. But volunteering when you can't even provide for yourself!?!?!? This is sheer whackerism that has HERO-complex written all over it. How long are you going to volunteer and take classes before you get all of your school paid for by the dept and they start paying you? Go get a job, learn something new, make some money, pay for your own schooling, and (here's a new concept) EARN yourself a spot somewhere.

Despite Dust's incessant crankiness and dour attitude :roll: , I would agree that EMT'ing is not a career. Go to nursing school... much less lifting, and very little liability in comparison to paramedic career. It is rewarding in some ways, and when it makes you happy, you can't remember why you would ever want to do anything else. On the other hand, it can sap away what is remaining of your sanity... if you let it. It's an endless balancing act that you will inevitably lose, so go learn something else, and come be a weekend whacker for fun. You won't be respected by "full time" EMS people (sic... whackers)... but hey... at least your life expectancy will be much longer then theirs!

To reflect on the others' comments... 'Tis a noble profession indeed. Keep learning, keep your head on straight, learn to relate to humans of all walks of life to combat the seemingly inevitable burn-out/jadedness (made that word up), and always keep some friends from outside your profession to keep you level headed. Also try not to have a relationship with someone in your own field, it tends to muck up the relationship waters. Aside from all these things that will help you, if there is one piece of advice I can give you, it is to make sure that you respect your body. The human body is not built to accomplish many of the physical tasks set upon you as an EMS professional. It is hard, and if you don't treat yourself appropriately, you will pay for it. Trust me, I've messed up, and it sometimes takes me 20 minutes of stretching in the morning just to make it to my truck (and I'm only 29!). Luckily technology is coming up with new ways to make life a bit physically bearable... hydraulic stretchers, redesigned stair chairs, and ergonomic seating are steps in the right direction, but that can also be a double-edged sword. If you are not used to lifting and moving things, when you have to, you are more prone to hurt yourself. Good luck, Overall I've enjoyed my career so far. I hope you do as well.