cosgrojo

Oh Splenac... why do you have to promote such drivel? There are hundreds of thousands of successful "professionals" engaged in "professions" who have never received a diploma past high school. Your assessment of what a profession is, is simplistic at best, and ignorant at worst. Just because the vast majority of EMT's do not treat it like a profession and endeavor to make it a profession, does not mean that some of them do not do their best to enhance EMS... even at the Basic level. The disco patch infected you so quickely... it muddles your brain, sir. danderson- what Splenac should have said is... if you want to make a profession out of it, you have to work hard, continue to learn past your local protocol and licensure education. If you want to make more money, and have more responsibility, become a Paramedic. Being a Basic does not define your professionalism, or your knowledge base. I refuse to believe that a 52 year old adult who has been successful as an engineer could change jobs, and then as a product of his new license, considered to no longer be a professional. Your "profession" is what YOU make it, not others biased opinions of the median quality of other providers. Thank you, and good luck in your decision.

Don't you have a family Splenac? It's called transference... everybody's doing it.

Naked pillow fights... sometimes play cards... but mostly the pillow fights.

Martin - It sounds like you have a department with a median age of 17. The crew chief is too young to drive, you are too young to feel confident... what is going on in Maryland? I know that EMS is tending to skew young these days... but this is ridiculous. The solutions to your issues are knowledge and confidence. If you know what needs to be done because of your studying and protocol review, you must have the confidence in that knowledge to make the right decision. If you go into a call review situation armed with all the proper information and can tell everyone there all the mistakes that everyone else made... the question becomes, why did you let it happen? I would rather be charged with stepping on the toes of my 16 y/o crew chief then negligent patient care. If you noticed things going the wrong way on the call, you are just as guilty as everyone else is if you don't do something about it. I'm not trying to dump on you... I've been in similar situations, and made similar mistakes. Learn from your mistakes as well as the mistakes of others. I think it is important and healthy to judge your own actions as well as everyone else's. Anything that went wrong on that call was a product of every person on that scene. Nobody deserves all the blame, and everyone deserves a little.

I am writing a letter to the protocol committee right now.........

Scenario 1: She was wrong. Every chance you have to be in charge of the patients' movement, you take it. Walking a patient that is elderly, regardless of your confidence in their ambulatory prowess, is taking a risk. There is a reason why many hospitals employ policies that require everyone to be transported in their facilities via wheel chair or stretcher, even if they can walk. You are ensuring the patients' safety, as well as covering yourself liability wise. Her insistence on walking the patient is bred from laziness, not experience. It has been discussed on these forums many times, experienced providers often are the worst to work with because they cut corners and insist on bad habits that haven't "gotten me in trouble yet." That mentality is the epitome of laziness, and is poor patient care. Scenario 2: You had every right to ask for the medical history and PCS. It is your duty and responsibility to. If for some reason the staff does not want to give you a PCS, you document your efforts and call a company supervisor to alert them to this issue, and hopefully they will address it. Don't ever get into pissing matches with staff over PCS's... but you do not take over patient care and responsibility until you are satisfied that you have enough information to handle the patient in case of crisis. Providers that act with that dramatic sense of superiority are almost always the ones that are weak providers, and they know it. They try and distract you from their lack of ability through bluster and reprimands. Scenario 3: Who the hell cares enough about a traffic camera to belittle someone over it? That just sounds like she is an extremely self-centered, and unhappy person, trying to take some small observance as a prop to make her feel better than you. Now, these reactions that I have just posted are based solely on the content of your post, and while I don't doubt that this is how you feel about things... I will caution you that perspective being reality, it is possible that you yourself have over-reacted to her actions causing a heightened sense of de-edification (Odd choice of word... is somehow her actions regressing your want and need for knowledge or spiritual enlightenment? I would suggest using the term "belittle" or "denigrate".) *sorry about that... kind of a vocabulary Nazi* Whatever the actual reality is, if this is the way you feel, you need to address it. You say that generally you guys get along. If she truly respects you, she will allow you to speak your mind, and not hold it against you. Sometimes the "veteran" just needs to be stood up to. It is possible she is just waiting for you to assert yourself as a person and as a provider.... Also, if they are your calls, and she is just driving... then you are the boss on that call, and she does what you want. If she wants to control everything, make her tech. Be bold, leave the past in the past, and move forward with confidence. Just my thoughts.

Why yes they are Dwayne... thanks for thinking of me... I myself have had the internal debates that are at times paralysing your ability to decide. In truth, they are issues that often go unresolved in my own mind. Currently (and I reserve the right to change my mind), I believe that trying to come to some sort of moral consensus is not something that will make you a better provider... just a more confused one. It is cliche, but one cannot compare apples to oranges. So while we torture ourselves because of the similarities between the Diabetic vs. Narcotic OD or the Diabetic vs. DNR, we are not accepting that they are situationally different. I think that it may be easier for you to accept your decisions if you realize that we need to treat every situation different. And while some situations may only differ by a micron or two... it is still different and may require a different decision. This is the greatest failure of the "protocol" system. Protocols do not do a good enough job of defining the duties and responsibilities of an EMS provider. This is why the best providers use them as guidelines as opposed to strict protocols. What I think may be happening to you Dwayne, is that you are trying to assign some sort of "Moral Protocol" to your treatment paradigm. This will never work for you because morals are not set in stone, they are fluid. Think of how much your personal morals have changed since you were a child, then young adult, then full fledged responsible adult. They have changed a lot, and so have everyone else's. Trying to make everything fit into one moral template will only lead to frustration. While my previous three paragraphs are chock full of wise generalizations... they often don't help when you are on the call. We are either devoid of appropriate information, or sometimes have that information being intentionally withheld from us, making it very difficult to make these decisions. We are all only able to do our best out there. Sometimes it is a swing and a miss, other times we hit a homer. When the call is over, we have to know we did our best... and acted as best we could under the circumstances. I wish I could tie it all into a nice neat bow... but a philosopher understands that there are no such things as an easy answer.

I contend that any attempt to "stay & play," with the desire to sign someone off, is a violation of your duty to the patient. If you encounter a patient that has some form of altered mentation level (especially ones that lead to airway compromise!), I believe you are obligated to transport them no matter what condition you improve them to. There are just so many things that can be wrong with them, and so many co-morbidities that the patient probably has, that it would be irresponsible to sign them off. More than the decision to transport against the will of the family, and sticking up for what you believe to be appropriate... I liked the part of the story where another co-worker called you to give you a heads-up about this patient. That is the type of information that is usually missing from our assessments that can make all the difference in the world. I have always appreciated it when people have done that for me in the past. Not only was it nice for your co-worker to do that, but it played a role in the decision to transport. It is rare that we get to peel more than a couple of layers off of the onion.

Looked it up... he sys "Abracadabra" Kind of fitting eh?

I agree whole heartedly. Came out around same time as "The Illusionist" with Edward Norton and Jessica Beal. The Prestige is way better... one of my favorites. Have you ever figured out what Christian Bale said just before he was hanged? I've played it over and over with the volume cranked, but can't seem to make it out.

While your ideas about sharpening each others education is commendable (and something I happen to agree with in theory), I think Vent is debating the appropriateness of doing so in an evaluation setting. When the consequences of delaying transport and definitive care are unknown. Also EMT-B's and P's alike are notoriously ill-equipped with the social skills needed to properly engage in said educational debates. Not to mention that no one likes having some one else walk into their sand-box and tell them how to patrol it. It would be nice if we all could "just get along" and respect each other enough to have these knowledge gaining conversations... but it is not feasible under most situations. If you happen to be one of the few that has the skill set to provide good patient care, and hold impromptu con-ed classes while getting report... then by all means... But don't assume that others have the same ability.

Morality judgments and law do not make good bed fellows. Like Church and State. People do things all the time that aren't illegal, but are immoral... we do not imprison them. No one has disputed your moral case LS, it is the legal one that we disagree with. You are obviously not married. Long-time married people can sometimes go weeks without actually communicating with each other. As a married man I can tell you that we mis communicate over things all the time. Things that we should have gotten down pat by now, and sometimes because one assumes that the other "will know what to do." Let me tell you that I find it highly probable that NO conversation was had at all. My wife does practically the same thing every morning before work... same routine, same order... occasionally she will do something different, I'll mention it, and she will tell me that this is always the way she does things. There are no absolutes... you cannot be sure of any statements you make about their behavior, and neither can I. We don't need to prove anything... burden of proof is on the prosecution... or have you forgotten the whole presumption of innocence bit? Don't worry LS... you are not alone... most have. First of all, let us be frank... you would not have gone to jail because you would have never been caught unless you turned yourself in, AND admitted that you did it on purpose OR that you knew the dog was in the car, but didn't think it was a big deal. Your assumptions do not hold any validity, unless the husband and wife change their stories, there won't be another witness, so no new evidence can be uncovered. If you take the story as the way it was presented, then it was an unfortunate accident without any intent. The Lady brought the Dog to two different clinics to try and save the dogs life. People who maliciously cause harm, rarely try and tend to the wounds. The fact that she feels bad isn't why she shouldn't be charged. She shouldn't be charged because there is no factual or legal base for any charges. Freak accidents occur, and the law usually knows when to accept it when there are no real victims but the "perpetrators" themselves. I don't mean to hurt the feelings of any dog lovers by my last statement and statements to come... but we are talking about the accidental death of an Old, Deaf, and Blind dog who was well cared for and had a spectacular life by any dog's estimation. It wasn't a human, it wasn't a baby, it's not that big a deal. LS, no one is saying you are not entitled to your views... just that our view is that your view is completely mental. And Dwayne... don't worry, we will be disagreeing and yelling at each other in no time... have no fear.

Nope His was a crime, hers was an accident... a horribly preventable accident (like most accidents), but an accident.

Officer Lovejoy killed his Partner... a police department employee. This lady killed the old, blind, atrophied family pet. It was officer Lovejoy's JOB to keep that dog safe. He knew he had the dog in the car. She claims to not have known the dog was in the car, and the dog had no special training that made it important. There is a difference between accidental negligence and gross negligence. She will be scorned for sure... but she will not be successfully prosecuted unless they can prove that she knowingly locked her dog in an unventilated car. Based on the information provided, you can not come to that conclusion. Your hatred for this lady's hypocrisy is coloring your opinion. You have made it clear that you think she should be prosecuted BECAUSE of the fact that she works for the SPCA... and that is not fair or appropriate. If the door to your house inadvertently popped open and your dog ran out into the street and got run over, should you then be prosecuted? No, but it was negligent of you to ensure that your door would not pop open. But if you took your dog for a walk and kicked it into traffic when a car was coming by... then yes because it is gross negligence with intent to harm. You are trying to make the punishment worse than the crime.

If it can be proved that she did this on purpose, then she should be held to the full extent of the laws in her area. Since these laws vary greatly from state to state, I cannot intelligently debate what they are in her area. If there is no intent, there is no case. If your dog gets out and I accidentally run him over with my car, I do not get prosecuted. I will fell horrible about it, but I will not get any sanctions, and I will not go to jail, regardless of whether I have beat the drum for animal rights. If she truly intended on causing harm to this dog, then she should be held accountable under the laws of that area. If not... it was an accident and it was not a human, so let it go. She may have pushed for jail time for other individuals who were in the same situations. It is wrong for her to have done that, and it is wrong for us to do it now. If the full extent of the story is that an honest mis-communication caused the accidental death of a dog, then there is no jail time or punishment that needs to be given. Just because she has pushed for things herself, doesn't mean that we need to push harder the other way. Makes us just as wrong as she was. It appears to be a freak accident. If gross negligence is found, then it is not from the articles presented to us. Let's not make stuff up for the purpose of argument.

Two wrongs don't make a right. Just because that is how she would have reacted, doesn't make it appropriate to react that way ourselves. It's not OK that she contributed to the Dog's demise, but there was no intent, and it was a dog... a very old dog that had a nice life previously... and this is just the silliest conversation I have ever had. She is going to punish herself more than we can punish her. Karmic retribution for her zealousness has been mete out... let's let her suffer in peace. It is not OK to kill a human just because you feel bad about it... but an animal? We kill them all the time without feeling bad about it. Are you a meat eater? You can train a pig to do many of the same things that a dog can be trained to do... do you like bacon? Do you weep while eating your BLT? I know we all love our Dogs here...but they are animals... just like the ones you eat. So if you get all worked up over someone accidentally killing an animal.... then you should be enraged at the massive death that is caused on a daily basis to put meat on your table. Just because we have domesticated one species, doesn't mean that we have elevated it to human status... If we got bacon from a dog, we wouldn't cry as much over the dog's death.

On the contrary... never use the search button... and address all questions to Spleenac... he loves to repeat himself.

I don't understand what type of piper needs to be paid? Isn't the pain and humiliation of the situation enough? I mean is was a dog... not a human. If it truly just some sort of freak accident without intent, then let it be. She doesn't need to be prosecuted for neglect or brought up on doggie-slaughter charges. The fact that she is going to have to live with what she did to her dog is enough for me. It appears the dog had a wonderful life... far better than most. I love my dog, but I wouldn't trade any of your lives for it. I hope I never lose that perspective, 'cause I think these activists and Peta members have.

Tamaith- It is important to have calls like these in the beginning. It is important because it shows you that you are in over your head. Hopefully you realize that, and you no longer take these calls for granted. I am not going to defend bad patient care, or laziness... but think about providing care to 20-40 patients at one time... We typically provide care to one patient at a time and can engross ourselves in the history of that one patient. SNF (Skilled Nursing Facility) staff have to provide care for the whole facility. It can be overwhelming. Not an excuse... just think about it. One thing that has always bothered me is when EMS providers say "Oh, I only ever run dialysis transfers, never get really sick patients." WTF!?!?!?!? These are some of the sickest people on our planet. They have to get their blood taken out of their body, filtered, and stuffed back in 3 times a week just to live! These patients often have several co-morbidities that make them liable to crump on you at any moment. A good set of vitals is imperative for the treatment and care of a Dialysis patient. Never think that you can just mail it in on dialysis calls... they will bite you in the ass. I suggest doing a little research on Dialysis, it may just blow your mind what is actually going on with these patients. P.S. tamaith, if you hit the shift button and then a regular letter key... it produces an UPPER CASE letter... just saying.

Starting any interventions upstairs is probably going to make things more complicated for you. The patient is not presenting in a "Not gonna make it to the bus" way, So I would vote for immediate removal to the truck. Stair chair and a few hearty souls. If I was there with my normal Saturday partner... We do it ourselves (we are big boys). With anyone else... get two people on one end, and me on the other. I don't like 4 point lifts. It causes more movement, and is a communication nightmare. If we all happen to be different heights.... well it can be disastrous. As few people as it takes to get the job done safely. When you start intervention up stairs you are adding variables to egress that may complicate things. IV lines need to be secured, O2 bottles and lines as well. Why add more things that can go wrong when the patient will make it to the rig without it? If you determine these interventions will save their lives before we are able to get them down-stairs... then by all means. This one doesn't appear that way. Get 'em in the truck, and work 'em up on the way to the hospital.

That many complaints, and no discipline!?! Must have staffing problems up in AMR NorthWest...

As usual the few bring down the many... and the the public just doesn't have the base knowledge to understand the situation. Being a private EMS guy with no Fire experience at all, I can not help you with your request, but I support you and Dr. Tober's efforts in keeping up and raising the standards for Fire/EMS in Florida. If more would take these progressive stances, we may some day hold some respect in the hearts and minds of the public that knows us not. Thank you for your post, and good luck! I hope that the members of the City with experience in these fields will be able to help you. But don't ask the Admin... he doesn't like fire either... (it's scary!)

I am not advocating a policy as much as some re-education for your one derelict employee. Make sure he knows what is expected of him... and I would frighten him more with what he says and does on scene that is reported by the family and the patients, rather than the equipment issue. I'm sure that there is a policy about professionalism and courtesy to tax-payers and town's people, and that is where I would reprimand him the most.

Squint- Never have watched NCIS, so the reference is lost on me... but the commentary was hilarious regardless... good work! Ruff - I agree with Dust to a certain extent. The old adage "one bad apple to ruin the bunch," comes to mind. If this guy gets away with this type of activity without some sort of meeting with your local EMS Lords, then you set a nasty sub-conscious precedent. The rest of your crew members may start to think to themselves... if this guy can do it... then so can I. Or more problematic, if you get any new employees that don't have the experience or work ethic of your other crews, you run the risk of this guy infecting them. So it's not quite an organisational failure yet... but it has potential. And as a career street guy who has never graced the Ivory offices, these types of behaviors are usually more prevalent than they think. So be careful about throwing out absolutes about the rest of your crews... it's better not to be so surprised when the "S" hits the "F."

Once again, Unions do exactly the opposite of what they were intended to do when they were originally organized. The "good" Medics/FF's/EMT's are going to be lumped in together with the ones that didn't do what they were supposed to do to keep skills sharp and continue their education. Why is it that unions only pander to the lowest common denominator? Why protect the dead beats and laze-abouts? I would think that a Union would be better if it's members were thought of to be professional and proficient... not lazy, whiny pieces of poo. The union that I am forced to be in does the same thing. If you are an upstanding member who never gets in trouble, and keeps your nose clean, you never get represented when things are brought against you. It is sad that your situation has to be "sexy" to the union for them to help you. I've read through the training book for union stewards for my union, and it clearly states that if a member comes to the steward with a complaint, the steward must either fix it under normal supervisor channels, or decide if it is a subject that the Union can "organize" around. If it is not sexy enough to "organize" around, then tough luck to the union employee with the problem. If mal-content employee "A" who has been on the brink of termination before gets in trouble again, defend him because it makes it look like we did the impossible. If above average employee "B" who rarely gets in trouble is dicked with by management and wants his problems looked into... tough luck, try being a worse employee, then we'll talk. Unions of today are reprehensible.