cosgrojo

Yeah.... you were 14...

Oh, I dunno...

Not you, of course.

:cyclops:

Someone who is rather daring, careless and desperate for an AMR job.

You are mostly accurate here... except the desperation was for "a" job. Any job would have done. :wink:

Just showing up - Although not the best way to go about things...It has happened. heh.

It has?!?!?! No way.... Not at AMR. Who would be daring enough to try such a silly stunt?

Most MD's don't spend thirty minutes with a patient in the ER. Is it fair to say that MD's have a higher education than ACP's? Knowledge is not the barometer for assessment time, so I reject the theory that Basics or PCP's don't stay on scene that long because they don't have the necessary knowledge to make it acceptable.

That being said, I have no problem sticking around scene if your patient is stable and you want to further your understanding of what happened. There is a lot of valuable information that tends to pop up after the primary survey. Also family, friends and bystanders tend to start to remember more after the initial shock of seeing all the pretty lights. I have no problem with 30 minutes on scene as long as you are not doddering around doing nothing. Although I prefer the sanctity of the truck so that nosy people stay away from my patient. Remember, every call has it's own circumstances, and every call needs to be treated differently based on those circumstances.

My question is... Is there a law in place that makes non-emergent, stable, medically clear, voluntary psych patients have to go into the back of an ambulance? Or is it just the way that it gets done? I'm curious what each state or hospital uses for criteria... anyone know?

Nobody has anything to add to this topic? I'm very surprised.... huh.

Some of you mistake "eating our young" for simple tough love. It's a test of their commitment to the profession. And I don't lose a moments sleep over those who fail that test. Unless they're hott.

Tough love is fine, as long as it is qualified with some level of personal respect. It's like teaching a child new things, when you discipline them you don't just hit them without explanation or without re-enforcing that you love them. Just berating new employees without letting them know that this is what they need to expect and that you are not doing it because you hate them or disrespect them, just that you need them to prove themselves in the field (as well as demonstrate knowledge).

And yes... if they're hott, we all have more patience... we're all sexist to some point.. men and women.

All references in my last post to the word: protocol, shall henceforth be understood to mean guideline, as I agree with the good sir moderator.

*walking down to ambulance to scratch "protocol" off all our books* 8)

I agree with you they should not be done blindly, I am simply commenting that many medics do that (don't get me started down that path again, been there, done that, ain't going there again). As far as the introduction of air to lungs-any unconscious we have automatically gets O2 15 LPM NRB if breathing, if not, they buy a bag and a tube if they don't perk up). So I would say that's kind of an automatic. Perhaps I'm not understanding what you are saying by that. If so, please clarify. Around here, alot of medics go by cookbook medicine and don't understand the rationale for doing what they do. Was just curious if this was situation everywhere. Also, if your assessment reveals an underlying cause, then it is not truly an unconscious/unknown and you divert to the appropriate protocol. Not trying to start a protocol fight, just tryin' to learn and be curious here.

First off, there are no automatics in EMS, every situation is deserving of it's own treatment. That being said, I believe that I was mostly agreeing with your premise. I am not interested in a protocol fight (especially since I know nothing of your protocol). The O2 comment was simply to add subtext to your statement. There are a lot of medics, and intermediates with intubation abilities that will go for the tube on an unresponsive patient before doing anything else. We've had multiple violators in our area. I was stating that unconscious protocol is not simply D50, Thiamine, Narcan... that their are assessments and clinical evaluations that need to be done in order to do these things right.

Again, since I don't know your protocols I can only go by what you said they were. I appreciate that you were being simplistic in order to post a readable and easily understood scenario. I'm not fighting, just trying to define some of the sub-texts of the question at hand.

So we are in agreement.... good assessment and clinical judgement combined with a proper treatment plan based on the spirit of the protocols, performed by adequately intelligent and competent personnel = good patient care. :wink:

I think we just solved all of the problems of the world of EMS. I think we deserve a pat on the back.

As to your original question... I don't know what everyone elses protocols are.... so chime in everyone!

I don't know that your protocols mean for them to be done blindly. In our protocols it always states that you should consider those treatments based on your assessment. So if the stick shows you a BGL of 20... then D50. Pin-point pupils and reasonable evidence to suggest narcotic OD... Narcan. If your protocols for possible OD don't include the introduction of air into the lungs BEFORE Narcan, then your protocols need to be reviewed.

I'm not sure that protocols are meant to be followed blindly without assessment, that appears to me to be dangerous. You still need to have some rationale behind your treatment. Otherwise you are doing the EMS no-no of treating the dispatch reason and not the patient.

Patient and family rapport are, in my mind, the most important factor in EMS. I love the fact that this topic has been brought up, and only a little jealous that I haven't thought of it! :oops:

The human brain is the most influential and powerful organ in the body. Whatever the ailment (within physical reason) the mind can be utilised to dull the pain, relax the body, and make patient care easier. If you, as a provider, are able to break through the mental barrier that many patients erect and make a connection with them, then you have just enacted the single greatest intervention. A relaxed and trusting patient allows you assess the patient in a controlled manner. It also allows you greater scope because the patient trusts you enough to allow you to assess and treat to your full capacity.

Example:

3-4 years ago.... Myself and a Medic partner are responding in a very rural township for an 18 y/o female with shortness of breath. When we get there the volunteer fire monkeys are all ready there. The young lady is laying on the floor with her legs drawn up. There are 5 fire fighters in full bunker gear hovering over her, yelling at her all at the same time, and trying to shove 15 lpm o2 via non-rebreather. This is doing nothing but causing her to breath with short, shallow, rapid breaths with excessory muscle use.

My medic partner sizes up the situation immediately and orders all the fire-monkeys out of the room. I start talking to the patient and get some vitals and try and help her take deeper breaths. The medic gets the story from her parents..... boyfriend problems.... anxiety attack. Mind you I am a very green EMT without the complete understanding of these situations, and my rapport with patients so far has been during stable nursing home transfers. After the medic got the story, he immediately came over to the patient, removed the O2 and calmly and appropriately talked the patient off the proverbial ledge. Between the residence and the hospital the patient was breathing normally, having full conversations with my partner and feeling better about her situation just because the medic made a connection with her and was able to treat the patient without "treating" the patient. The fire guys were going by the Shortness of breath protocol without taking into account the patient.

This is the kind of call that rapport IS the treatment, not just a pleasant interaction that allows for better care, but it is the care. I think that we get too much tunnel vision. Treating the protocols and not the patients. Rapport and making a connection are paramount to good care.

Ways to get rapport:

1. Never lie to a patient. Even old demented patients can tell when you lie to them. Never get caught lying to them, you just ruined their trust, and you will never get it back.

2. Don't get tunnell vision. We get reports from family, staff, and patients to get an idea of what is going on. Big picture information, so you can treat the patient appropriately. Don't just treat the patient, treat the situation as well.

3. Be yourself. When it comes down to it, people know when you are being fake. People have a natural ability to sense this kind of stuff and it shows in their interaction. If you are not good and building rapport, try and work on it, but don't change your fundamental makeup, it is too telling.

4. Be empathetic. It may be trite, but it's true, unless you've walked a mile in another's shoes.... blah blah blah. We all know this.

Those were my thoughts.... again, great topic.

Jo, two people....recently leave for shifts.... Y'know firing isn't the same as leaving, right? ;-)

I didn't know you were fired? :shock: I thought you banished yourself to Vermont.

Deal with it... tired of coddling and trying to nurturing newbies. Tried it and never seen it work as of yet !

Which professor do you remember the most... the one that was easy, sweet, laid back or the one that was a hard-arss, and made you work for that A+?....

R/r 911

Well then I suggest that you are not doing it right, or you do not have the necessary patience and/or psychological makeup to train young, insecure providers who mask their insecurities with inappropriate bravado.

Personally I have seen it work dozens of times. Many young people who have been my partners came in without the knowledge or skills to survive. Together with other quality employees, we have successfully turned out many quality providers that may have not made it with another approach. The point is that everyone learns differently, and sometimes you need to personalize how you approach a new person. If you don't want to do it... there is nothing wrong with it, but don't say it can't work because you were unable to accomplish it. I have recently lost two partners who came into my shift without much experience or understanding. They leave me now for better shifts or new job opportunities. As they leave I watch their progress, and feel no little amount of pride knowing that I had at least something to do with their development. Nothing else I have ever done in EMS has made me feel better. And as sad as I am to lose some very good partners and some excellent providers, I look forward to helping out a new batch of people that need a little guidance.

And on your last point, I tend to remember the professors that took time to understand my view point and respect my views "irregardless" of whether they agreed with me or not. Professors who challenged my notions and ideas but also had a sense of respect for the students, AND made them work hard for that A+... that's who I liked. Not just a hard arse for the sake of being a hard arse.

I ask my wife (school teacher) to tell me how her day was. Sometimes it is easy to lose perspective on how regular people live, and if I'm not reminded frequently, I can be a bit of an ass. I find it fascinating that I have no real idea what it is that normal people fret about, so I like to listen to it. My wife likes to talk, I like to listen, it calms me down.

I also read... alot.

It's tough working with brand new basics who know everything...

Hey, I'm not new... and I know MOST everything.

1. When we are sitting in traffic, turn on our lights and sirens, then drive about 1/2 a mile and shut them off... it is not because we are bored and wanted to beat traffic, we were cancelled. (or our coffee needs to be re-filled).

2. *personal note* No I don't like lights and sirens, they give me a headache, not a woody.

3. *pedestrians* If we are driving in a parking lot, please do not break into a run to get out of our way (especially the geriatric crowd). We are in no hurry, and I don't feel like using the scoop-stretcher.

4. *restaurant personell* When you see the ambulance outside your window, and two people in uniforms are placing an order... please don't ask if this is "for here, or to go?" Assume the latter.

5. Trauma sheers = Chinese food bag opener. (This is for the amusement of Mr. Admin)

6. Yes, this is probably going to hurt.

7. Yes it is legal to work a 24 hour shift.

8. Yes we have to pay for tolls.

9. No it is not mandatory for the Fire department (volunteer) to wear full turn-out gear to a medical call, they do it just to increase your anxiety.

10. We are contractually obligated to tell you that you might die if you sign our refusal form, but I'm sure that hang-nail is not gonna' be the thing that does you in.

Medicine is tough.. short and simple 90% of what we do, is really irregardless, and really are not using our education, however; the remainder 10% is what really get paid for.

Rid.... Irregardless???? -10 Please tell me you don't say O2 stat as well...

Back to the thread... Take one cranky, slightly burnt out EMS person.... add one 18 y/o EMT with nuttin' for experience or education with an EGO to boot... and you get a thorough beat down, including eating of the young.

Neither side is right. It's the unfortunate combination of the two that is the problem. *Advice for youngsters* You are more likely to get the shaft end in an argument with a tenured guy... Show up, keep your mouth shut (except to ask questions (good ones)), your ears open, and the notepad in your brain ready to jot down information. If you do that, then chances are the razzing you receive will eventually turn into admiration and respect. Then soon YOU will be in the position to sprinkle salt and pepper on your young before dinner-time.

Maine, has their own way of things. Not 100% sure, but I believe they use their own exams, for their own State certificate. Licensure is the certificate itself. If you have NREMT, you only need to complete a paperwork shuffle that lasts about 2-3 months. Certificate shuffle: Free of charge

Paramedics and Basics who are nationally registered are given reciprocity in Maine. Intermediates who are nationally registered with the 1995 curriculum are not. Maine only accepts the 1999 Intermediate curriculum.

Everything else you said was more or less correct. :wink:

Just like every other question, problem, dilemma and quandary facing EMS, the answer to this one is one simple word:

• The whole "scope of practice" debate was and is a complete joke. It was destined to fail from the very beginning for one reason: again, education. Debating scope of practise is putting the cart before the horse. Until there is a nationwide standard of education (as opposed to training) that reflects a professionally educated workforce, the debate is headed nowhere. I damn sure know I would not vote for an advanced scope for US EMT's or medics with most of them being so pitifully trained and uneducated. And neither would most of the movers and shakers in this industry. It is one of the biggest reasons why, in the end, even staunch supporters like Dr. Bledsoe (author of the most popular paramedic textbook and a former paramedic) backed out of the push for a national scope of practise. Nobody was willing to raise their educational standards to a point where anybody with half a brain would advocate advanced practise.

So that's the answer. Education. Improve it drastically and our profession will improve drastically in every conceivable way. Scope of practise. Pay. Respect. Recruiting. Conditions. You name it. This really isn't hard to fix at all. The problem is, as is clearly shown by this particular thread, more than half the people in EMS don't want no more of that book learnin'. They just want more drugs, more skills, more respect, and more money for the 120 hours of training they already have. :roll:

Dust-

I agree with your premise, and have agreed to this rant a number of times. But I don't see that this is feasible. It would be wonderful if the educational requirements were to a level where we could attain universal respect for our professionalism, but it is not such an easy road to hoe. It would take a concerted effort and dedication to the "vision" by all in EMS, plus the "movers and shakers" that you referred to.

What is required here is an entire industry to adopt a paradigm shift. This is not easy (I ask you to refer to any thread that discusses the nature of Fire Services controlling EMS). This revolution cannot be attained through minor improvements such as Rid has suggested. Getting together with your locals and improving the education of your particular area and people are commendable, but without the thrust from the industry, it will not catch on.

In order for us to improve ourselves on a global scale, we would need to make a few things happen first:

1. Unify as a collective, have everyone from the top down agree with and move toward increased educational requirements.

2. Stop working for free, nobody can take us seriously if we have 80% of our workforce agreeing to respond from our homes (and without pay).

3. Wrest our industry away from the fire services and stand on our own feet.

4. Recognition from the government that we are an essential service and offer to fund the enhancement of EMS through grants and financial aide (which would happen easily if we stopped working for free).

There are probably more things that need to be done in order to facilitate wide-spread change in EMS (and feel free to add), but I believe these to be most important.

Those are my thoughts on the subject...

Peace out.

Dust- -5 for making my eyes hurt...

Well said though...

I can see that this discussion went right where I thought it was destined to go.... right in the piss-pot.

What if you are a darn good basic who enjoys his job and is working to better himself through school and experience in OTHER fields? Trying to do the job as best as you can while you are there but trying to further yourself in another area. See PRPG starting up his own ambulance service... Does he need to be a Paragod to do that? We have such tunnel vision in this industry. Open up your eyes, your minds, and your hearts. Respect someone for what they are because you cannot know their intentions or their focus. To pigeonhole all EMS people as ONLY EMS people and only respectable if they continue up the EMS educational tree is assinine.

There are good providers and bad providers, just like in every industry. With all due respect to the life-long EMS people, and quality providers in this forum... give it a break.

What those of you who have issues need to do is get off your fat, lazy butt and start freaking talking to your paramedics/EMTs and opening up those channels for communications. I'll be the first one to say my service has it's downfalls too, but after hitting rock bottom a few of us paramedics and EMTs said screw this, we can do better then this. So in the end we have what we have, but that isn't possible if we don't trust each other, talk to each other, and respect each other.

Grow the hell up or go find another career path to follow, this field is to damn important to have a bunch of babies who can't get along.

Nate- Thank you... Thank you for bringing in a little sanity to the subject. The whole premise of this thread is infantile. "BOO-HOO why can't we get along? What do you hate about your paramedic? Now let's discuss the possible solutions...."

Here's a solution.... Why don't we grow up and start treating eachother like adults? We are an industry full of people with tremendous skill. Unfortunately we haven't developed the ability to manage our skills in regards to playing with others. We are a bunch of catty adolescents that need to be the one who is right. You are wrong, I'm right... na-nee na-nee noo-noo!

We all have our roles, we all have our strengths. Why we have to complain about each-other's roles is beyond me.

I've been staying away from this thread, but I had to back Nate up on this.

Yes, but does she have....

Oh, nevermind. 8)

:shock: How dare you ask such a personal question!!!!!! But the answer is yes.....

We'd make great partners. We wouldn't ever have to worry about competing for the same women!

I married a blonde, but dream about the Brunettes... :thumbup: I wouldn't mind pulling a shift with ya' Dust.... But I'm only a Basic...

I used to dream about work constantly.... I've effectively blocked out night-time references to my daily life.

Now I only dream of large-breasted brunettes.... Excellent trade off. 8)