cosgrojo

I find that the adjustable collars run a little smaller than the old "pick your size" collars. We carry both. A large person with a no-neck size... won't even try the adjustable, just get me the regular no-neck. When that don't work... like others have said, be creative. If it works, it works. Also, don't be afraid to re-adjust. if you get it on wrong the first time, go ahead and get it right. Just make sure someone still is holding it manually. :wink:

Pose, Congrats on it all working out! But I will caution you... right now it's working, next semester you may have a problem. When I was in school, I had the same situation as you. Paying for myself, living off campus, no family around... What I did, was focus on working, doing just enough to keep the grades where they needed to be for my financial aid, and try to get the bills paid. As a Economics guy, you will understand what I mean when I say this. Be careful of what you are giving up. There is an opportunity cost to everything you do. Try not and sacrifice too much school for work. That's what I did. In trying to keep myself out of debt, I didn't do an internship, or get any experience in the field I was studying for. So when all the work was done, and I got my diploma, I wasn't marketable. No internship= no experience= no job prospects in the field of choice. If I had it all over to do again, I would have taken out more loans, ratcheted back on the work hours, and focused on the future, and not the larger than life present. Good luck! Hope everything keeps falling into place for you.

Emergently, I think everyone has covered all the bases. But there are reasons as well in non-emergent transfers. Possible fluid restiriction secondary to CRF, critically low-sodium content, and (as noted with emergencies) aspiration precautions. When getting report from staff, they do not always inform you of these conditions, so best to not give at all. If a long transfer, it would be prudent to ask before transport, just in case they ask. CRF pt's are always trying to trick EMT's into giving them something to drink. Those who don't know what CRF is are sometimes fooled, some pt's can get a bit beligerant when they sense you might give in to their request. Rule of thumb, if the pt is very intent on having something, chances are they shouldn't have it. Be carefull.

Only time I've seen someone c-spined in prone position... psych call, guy was spitting at and biting anything he could get near. Cops were having a hard time controlling him, guy was jacked up in amphetamines. Boarded him face down with collar, cops restrained with cuffs, strapped him hard to board. Collar was only to keep him from spitting and biting. ER got a kick out of it. My partner thought of it... I thought it was quite ingenious. When he got calmed down, PD hauled him to the clink.

You would think that with the proliferation of hospital-borne illnesses (MRSA, C-Diff, VRE and the like) that hospitals would start taking the cause of the problem seriously. They tend to take the control of it seriously through decontamination and isolation precautions, but they are continuing to practice the same procedures that have caused the outbreaks. We bring in an elderly pt from a SNF to the ED for the suspected UTI/Sepsis. They take labs, do cultures, urine-dip, the whole nine. Everything comes back negative. What do they do? They prescribe an already immunodeficient pt a "preventative course" of anti-biotic, and send them back to a nursing home (cesspool of resistant nasties). They've just guaranteed that this person will acquire and eventually spread the malady further. Meanwhile, I brought my puppy to the vet because she has had some blood in her stool. Vet prescribed some anti-biotic like serum (Albon) that the dog eats to rid her of the nasty coccidia that has infested her gastric system. Then he also gives us something else to give her as soon as the course of Albon was completed. A gel form of Acidophilous. I begin to act as if a miracle has happened! Veterinarians are beginning to incorporate nautral/holistic medicines onto their plan of care? Where is the mainstream medical community on this. As we all know, anti-biotics kill indiscriminately, good and bad bacteria. When the bad bacteria outnumbers the good bacteria, there usually is a laundry list of issues that can arise. Why is it that Vets understand this more than MD's. I've never seen a hospital send information back with the pt about positive intestinal flora replenishment. Just a thought. What do you think?

I agree with you whole heartedly. If you can't communicate at all, your success in this industry will be minimal. What I was more concerned with and see as a trend, is that people are concerned with "exceptional" communication. This is much different than "effective" communication. I'm not trying to say that communication is of lower importance in EMS, I'm trying to say that it is unreasonable to expect EMT's and Paramedics to write and sound like Rhodes' scholars. If giving a simple, but effective report is a sin in this industry, then we are all sinners. If EMS gets a bum wrap from other segments of the medical community solely on the nervousness of the speaker, or lack of a thesaurus, then I think that's rediculous. As long as the care was appropriate. Again, I fell we are all in agreement that education is a wonderful thing, and that furthering it would be preferable; I'm just trying to say that it is not as simple as an idea. It's not as easy as just saying, "We're the industry! Here's the new rules, follow them or get out!" There's a lot more to it. UMSTUDENT hit it on the nose with some of his remarks, I appreciate the moderation.

Let's see if I can get this straight... I misinterpret you..... you misinterpret me..... and my hands go numb because my typing skills are below national standards. Essentially, we are arguing the same points (if we throw out some of our own egotistical bluster). It seems impossible to accurately display the nuances of our arguments, so I think I will consider us at an impasse. But your point about no-one in EMS not able to attain higher education... Up here, most EMT's are on volunteer (unpaid) EMS services, by making these educational changes, you essentially force them out of the field by making it economical suicide to pursue the field in any capacity. I don't know if they hand out free high-level education from where you're from, but they don't up here in cow-hampshire. And Dust.... not all of my comments were directed towards you.. I'm a technological blunder, just beginning to sift through the complexities of how to navigate and use the various functions of this web-site. I haven't figured out how to do the quotation thing that all of you are so adept at, so I wasn't able to properly direct my comments. And no, I'm not concerned with saving the MD's, I'm just don't really care about their opinions about people I work with. Those without sin may cast the ..... oh you know the rest. Regardless, I enjoyed the intellectual sparring, even if it was mostly in our own heads.

Everyone has made very salient arguments, and I don't disagree with most of them. I would love for there to be an educational standard that promoted proper communicative and written skills, but the plain and simple fact that it is a long road to hoe. As some of you have pointed out, we are beginning to make those strides toward higher education and professionalism. My point is that until we reach that point, we need to not throw our co-workers and new EMT's with only a GED or HS diploma under the bus. In some cases these are people without the affluent background, or familial support needed to participate in "higher education." Many of these people have great potential, and if you encourage them to look forward rather than to stand still, and not throw them out with the bathwater so quickly when they haven't had the opportunity, then you may see some of the desired effect on the industry. Call me naive, call me inexperienced (although I don't know how you could garner that from a simple perspective difference, unless you are the omnipresent puller of the heavenly strings), but I vehemently disagree that it is the fault of the EMT that the hospital staff can't tell the difference between proper pt care, and someone with a social development issue. As someone (AZCEP) earlier on in this argument pointed out, it's not always the fault of the person (i.e. he of the Autistic son). I will not agree with any policy that discriminates against perspective personnel because of a speech impediment or a social aversion. If you think that that sort of policy is appropriate, then you might not be naive, but you may be a monster. This elitism is frightening, ZippyRN's response to part of my previous narrative questions the "critical thinking" of those who don't speak well. Since when has ability to speak have anything to do with critical thinking? Ever hear of a man by the name of Stephen Hawking. One of the great critical thinkers of our time, but I guess because of his affliction, not good enough to collaborate with... I wouldn't want him on my ambulance, but that's because of his complete lack of physical ability, but not for his critical thinking skills. Don't judge every book by its cover, remember, a cursory physical assessment doesn't always tell the story of your pt's condition, so don't do it with other people. I will also submit that we live in completely different communities and I will assume that the dynamic between hospital staff and EMS is probably different. I've seen MD's in the Northeast USA get away with dreadful mis-diagnoses and plans of care without the slightest recrimination. I live here, I work here, we hear everything. Dust Wrote: "It's the old chicken vs. the egg argument. Are we undereducated because the profession sucks? Or does the profession suck because we are undereducated? I submit the latter. And if you honestly believe the former, you are either blind, or you simply have not been around long enough" Again, I love how you generalize MY experience level and expertise from one post. So if I say "chicken", while you say "egg", that makes me blind or inexperienced. Frankly, I do believe that we are undereducated because the profession sucks. Our EMS education services that are charged with putting out these EMT's that you have a problem with are still putting them (EMT's) out!!!! That's not the EMT's fault for passing a rudimentary curriculum... it's the curriculum!!! How can you not see that? Your argument that it's the EMT's fault for not seeking further education is counterpointed by YOUR own argument that there needs to be higher educational requirements. If the profession was pulling its' own weight, then these people you believe are sub-standard would not be allowed to practice. Our educational system sucks, our recognition of the problem sucks, and the industries failure to fix the problem sucks. Not always the EMT's that suck (although sometimes that is the case). The simple fact of the matter is that the "profession" benefits from keeping us uneducated, we cost less as just "ambulance drivers." They don't want us to have the education that they need to eventually pay for. The problem is that WE are not in control. The companies, the services, the hospitals, the medical control, the municipalities.... everyone else dictates what our requirements are. Until you can get them to change the requirements, your pipe-dream will be just that. I am a believer that change comes from the people. We can't change the educational requirements, but we can change our attitudes and our respect levels. While I respect the combined experience of everyone in this community, I think that we become desensitized as we gain experience. It doesn't hurt to be tolerant of the new people, and maybe read a couple chapters before you pass judgment on the book.

Minimum SAT scores, Standardized testing required, college credits/diploma, all for an EMT-B who starts out at 10-12 dollars an hour? What's the draw to even get into the industry? You can't make EMS an exclusive country club. I agree in your Utopian views, have a Bachelor's degree in Business Administration, and did well on my SAT's, but I don't think that making them requirements is a feasible vision. If the starting pay in EMS was higher than your average burger flipper's pay, then maybe you could get away with those expectations. Some of the best partners and pt care givers I've ever worked with have fairly deficient verbal/written/communicative ability. But I'd rather have them on my truck when the big one tones out than some smarmy, stuck-up "college boy" with a superiority complex because he had a 1300+ SAT score. That's why we have partners, one to look after and correct deficiencies in the other. If we as an industry focused more on teamwork, collaboration, and tolerance, we might be more respected in the long run. Lastly, I don't give a vermin's pa-toot about what some Hospital MD/RN is saying about my partner who stuttered or repeated himself during a report. How was his patient care? Isn't that the important factor? When the Hospital staff makes mistakes, it gets covered up as an oversight, or an unforeseeable issue, when we make mistakes, we're stupid, uneducated rube's with a hero complex. I shudder when I see our own people prostrating themselves to the MD/RN and throwing their partners and Industry as a whole under the bus. Help your co-workers, don't berate them. Encourage them to improve themselves, don't impugn them if they haven't gotten to it yet. All we have is us... you... me... everyone.

Although spelling and grammar, in a perfect world, would be nice to have on all run reports, I think the quality of the report and accuracy of the details are of utmost importance. As an anal-retentive document scribe, I strive for perfect narratives and a consistent "story-like" flow. As an auditor for the service I am employed by, I look for completeness and substance. Too many people tend to stick with just the bare minimum. I don't think that poor documentation always equals poor care, but you can't prove it doesn't. If you didn't write it, you didn't do it, or you didn't see it. If it's not spelled correctly, it doesn't nullify it's efficacy. Poor spelling and grammar is not a sin, not documenting appropriately, is.