cosgrojo

I've learned that I am a no good Basic that doesn't belong anywhere near an ambulance...

But really, I've learned a tremendous amount from these forums... despite my sporadic involvement. I've learned what EMS used to be, come to understand where it is in the present, and learned what people's hopes are for the future.

The most important aspects of learning in these forums as far as I am concerned is the vast perspective difference between providers of all ages and levels of experience. It always suits me to try and see things from someone else's point of view. I have learned about Medicine from MD's, RN', LPN's, Medics, and Basics. Some of the old time posters I always like to see on these forums when I make an appearance... spenac, RichardBtheEMT, AK, itku2er (I've always wondered what that stands for), Dust, ERdoc, LoneRider... and many others (chbare frightens me sometimes with the stuff he knows). I like to be challenged, and I like my own views and perspectives to be put through the ringer every once in a while. I never take it personally... but I do sometimes get nervous about what type of reaction I might get. Some of the people on this site have soooo much knowledge and experience that it is sometimes daunting for me to intellectually spar with them. I think that I sometimes hold my own though... mostly because of my awe-inspiring grasp of vocabulary, and less because of my actual medical knowledge.

I am glad that I have learned from the amazing providers in the City, and hope that in some way I have helped others in their own quest for learnedness... I totally made that word up... but I like it. I am a much better provider now than I was back in '05... and I owe that to all of you. Oh... and Admin helped a little bit too (don't go getting a big head over that Admin... you already can't wear hats).

One takes the Blame----- Statler Brothers

Why do you ask?

No reason why - Pennywise

Why do I hear the sound of collective sighing?

"Maybe Tonight" ---- The Knack

How your day going right now?

Painful - Staind

What should be the last thing said to end this thread?

Apolitical or not, my reasons stand. The pendulum will be stuck on the left for quite some time to come, and

in cases such as this, "right and wrong" is completely dependent on your political and social ideology.

As for John McCain, I could not get past some of his ideas like Immigration reform. Problem is, a pure liberal or conservative is hard to come by these days. Politicians hate to alienate even one voting bloc for fear of losing their chance to get elected. In many ways, this blended politician can be a good thing, but some of the hot button issues like abortion, immigration, and affirmative action are deal breakers for many people. They have such a strong opinion, they simply cannot get past that one issue.

Herbie- Not arguing with you... you may very well be right. I just felt like defining my comment so nobody thought I had some sort of partisan agenda. And nothing is dependent on political ideology (now I'm arguing with you). Politics is something that human kind invented. Intrigue and deception and promises not kept to gain advantage... those we created as a species. Social ideology on the other hand... you are correct about that one. Social classes exist in all live beings, have since the beginning of life itself. If the current state of politics actually affects your view of "right & wrong," then you are a very lost soul indeed. Those should be developed through personal contemplation and careful understanding of "social" norms, not political ones.

Oh, and I didn't mean to say that I agree with John McCain about his policies... I only meant to say that he is a bad-ass... and I like it.

Yes - Coldplay

How much longer will this go on?

Thy Will Be Done - Deborah Cox

There will be no more questions... or will there?

It's kinda like king of the hill only with a mouse

Dang it... Bobby.

Don't count on that-at least not for a long time. We have a Democratic president, a majority democratic Congresss, and Sotomayor

will soon be confirmed as a new justice. This will be the last ruling of this kind for quite some time.

My comment was completely apolitical in nature. Only social commentary on the vagaries of what is "right" and what is "wrong." I am neither Democrat, nor Republican.. I am not Independent, and I don't belong to the Green party. Libertarian I am not... and in case you were wondering, I have no love for the Tories or the Whigs. I dislike all politicians equally...If they had any honor or redeeming value, they wouldn't be politicians.

Except... well... I was watching C-span yesterday trying to fall asleep and they were re-airing the house committee on Health Care reform. John McCain was offering up his bill on foreign prescription drugs again... he forced a vote on it... basically told everyone in the room that if you don't vote yes, you are a shill for the pharmaceutical companies... and then he left before the vote... He did everything but give them the middle finger as he walked out. That man is a Bad-ass, and I think I might like him. Oh... it didn't pass... so you Canadians get to keep your cheap drugs to yourself for a while longer.

It was only a matter of time before the pendulum began to swing back the other way. The world is round, and everything goes in cycles.

Which should clue you into their feelings about iagenic injuries vs. c-spine precaution.

Rare spelling misshap... iatrogenic... not iagenic.

-10 Called on myself. *I am very disappointed In myself... I hope the city can forgive me.*

Wait a minute... This strike is over not getting raises secondary to not having more education? The government is finally giving the paramedicine world the kick in the arse to make it a legitimate profession... and they are striking over it? Boy... doesn't this fly in the face of all the emtcity.com grandstanding about education is the only way? We get a chance to make the dream happen and we are not willing to step up?!?! Go get the degrees that the government is asking of you and lead the way for the rest of the world's desperate EMT's and Paramedic's need for substantiation.

This situation could be the tipping point for bringing EMS out of the bastard step-child role and prove to an entire nation that you are true educated professionals that need to be looked at the way Doctor's and Nurses are looked at... with similar pay strategies.

Lead the way Canada! Fine neighbors to the North... If you can pull this off... then in maybe 10-15 years we might see something come of it... or are you really just looking for the quick buck? If that's the case... STRIKE brothers and sisters! Strike!

Well this topic has brought back some old memories. I was once certified in the great State of Maine (and happened to grow up in vacation-land, until I was able to escape at the age of 18).

I remember when the c-spine rule out came out. Personally I was excited to have something progressive to do in the field that relied on my own assessment and ability to ferret out patient and scene specific information. At the same time I harbored more than a little bit of consternation over allowing some of my fellow co-workers the same amount of latitude. It seemed like a big deal to me. The service I worked for participated in the training and rolled out the protocol for the providers... but was less than enthusiastic about fully pushing the changes. It is not difficult to imagine that they were concerned with possible litigation and liability. Also the service in question is in a tri-state area with employees that are tri-state certified and work in all three systems. Only Maine had the protocol at the time, and the service was worried about people doing the wrong protocol in the wrong state. New Hampshire has since added it as a standard, and Massachusetts does not have an official c-spine rule out... but the ER docs in the area I work in are fine with it if you are able to support your decision appropriately.

FL-Medic - To your seemingly soul consuming quest to validate or invalidate cervical spine immobilization as a whole... I have not done any research at all on this subject and cannot give you any references at all for any of my statements. However... I have to believe that c-spine must be important/effective/beneficial on some level. I believe in pre-hospital c-spine rule out and am happy that I have the ability to practice it in the field. I work in a region that calls for me to quite frequently transport trauma patients to some of the World's best hospitals... Mass General, Brigham and Women's, Beth-Israel, New England Medical Center, Boston Medical Center... and any time that I have brought them a patient that the community hospital I transported from cleared c-spine and authorized transport without re-immobilizing... they have lost their ever-loving mind. Some of the best trauma teams in the country believe that we should have transported the patient on a board for the hour transport + however long they sat at the original ER. Which should clue you into their feelings about iagenic injuries vs. c-spine precaution.

So is my evidence circumstantial? Sure... is my conclusion Evidence or Fact Based? Depends on your definition. As smart as I like to think I am, and as much as I defend the role of Basics in the EMS community, and rail against ALS elitism, I must admit when I am being trumped. I am intimidated by those Doctor's in Boston... they are smart, they are educated, and they are aggressive. When you drop off a patient that to them meets trauma-team activation status... you are not handing care over to just one Doctor... you are continuing patient care onto a TEAM of Doctor's frothing at the mouth to ask the lowly EMT a bunch of questions that may or may not lead to that EMT's cardiac arrest.

It may sound simplistic, and in no way am I saying that your research is not a noble endeavor (I encourage all aspects and avenues of learning), but if c-spine is effective and important to a team of MD's who have the combined experience and education to make me change the color of my underoo's... then it is good enough for me.

Agreed. Back when Crotchity first joined the forums and him and I weren't getting along, one of the threads got quite heated and I suddenly found myself dwelling on it while I was doing other things. That was clue one to give my head a shake and do something else for a couple of days.

Heck, I practically took all of '08 off... so I know what you mean.

"Cracked Actors"...Foo Fighters

Why should I care?

I Will Always Love You - Whitney Houston

How many times have you fallen in love?

I've always pictured Dust as a kind of Evil Santa Clause... always double checking the naughty list and leaving three times the amount of required coal.

And BTW... anyone that takes these forums seriously (i.e. personally) needs a vacation from the keyboard... and possibly some trazadone.

What am I getting for Christmas this year Santa Dust?

LOL! Maybe. I dunno. I just figured he must have confused me with Kiwimedic or something.

I may be an angry old bastard, but I just don't see how this thread brings it out!

My turn to laugh out loud... no one could confuse you with kiwimedic.

I hope you have many decades of happiness ahead of you. I have nothing funny or ironic to say... which makes me uncomfortable... Good Luck!

After the two pages of encouragement and advice I just gave this guy, you're going to say that?

WTF?

Are you sure you're talking to me?

Maybe he's just making a generalised (canadian spelling) statement about your level of cantankerousness, unrelated to this topic... Cuz' you were down right fatherly to this kid... for you.

I suspect ol' croak may have some unresolved frustration with you.

Tube steak boogie ZZTop

Are we there yet?

I Have No Clue - Terra Skye

What are you jealous of?

"Sunday Papers"...Joe Jackson

Who are you?

I am the Walrus - The Beatles

Where do babies come from?

I could have gone into the whole physiology stuff but I have been criticized for talking too technical to "show off".

Only by those incapable of showing off... please do not couch your expertise because some people are intimidated by it or jealous of it. If they do not want to read the technical aspect to your posts... they can skip it and read one of spenac's posts *hoping spenac has sense of humor... I do it for the comedy... *

To provide my opinion on the question you posed... I do not think that mechanism should be the sole deciding factor in calling a trauma alert. Where I work in Northeastern Mass. they have been trying to go away from this trauma/treatment modality. The problem with the system up here is that the state is is broken into regions that like to run things their own way, and that tends to wreak havoc with the providers that work in multiple regions. Also throw into the mix that not all providers keep up on what the region is requesting of you... and we run into many situations that the local EMS and the Local hospitals are at odds.

That being said, I think that mechanism should play a part in the algorithm, but maybe a slightly lesser role than the physiological and anatomical concerns. In the example you brought up of the death in the car, passenger trauma alert... I would probably err on the side of caution and call an alert. If the one patient is so dead that he's not being worked, I would play it safe... if the dead guy is being worked... heck, you already called an alert... throw another shrimp on the barby! But in most other situations, I would rely on what you see and what you find, as opposed to the suspected force involved in the mechanism. I know that is the direction the system I work in has been headed... and I'm on board with it.

Nice topic BTW.

Shouldn't your education teach you all this before you go out and attempt to learn it all while already working?

In many current systems becoming a well-rounded provider may require you to work many different levels and certifications to get the whole picture. But it just seems it is best to educate providers to that level before sending them to do their job, especially in this career. This is where we should concentrate our efforts towards changing EMS, don't you agree?

Sorry if I sent this thread down a different road.

Are you implying that the only way to learn is through the classroom? Or are you saying that learning is done better in the classroom than in the field? Either way... yes I disagree.

VentMedic- Kudos on the explanation (incredibly well stated)... and thank you for the support.

Slow ride

foghat

Which came first the chicken or the egg?

Surfin' Bird (Bird is the word) - The Trashmen

What is Black, White, and Red all over?

The problem with your premise is that you assume all ambulances, emts, paramedics, and systems are the same, and interchangeable. Are all cars the same; is a kia as good as a lexus ? both are cars that will get you from point a to point b, but if your life depended on it, which car would you choose ? So just because private company ABC has a closer ambulance, does that make it the best to send ? Do they have the same level of equipment as the local 911 provider, do they have the experience and expertise of the 911 provider, do they have the same level of investment, insurance, and employee training ?

Now if you took a geographic region or state, and said all ambulance services and 911 services will have the same type of vehicle, the same insurance, the same training program, the same equipment list, the same protocols, and staffed at the same level, I might agree that the closest ambulance should run the call.

Under no circumstances am I advocating blowing up whatever response paradigm your system has in place just to satisfy experience for transfer medics. I'm actually intimating that primarily 911 medics and techs should get transfer experience to help them be more well rounded. I'm not saying that 911 trucks should be running transfers, they should be covering the community, but if the medic is experienced on both end, I believe them to have an advantage over techs with only having experienced one side of the world.

But to address your point... when a system does go down to zero level and a truck primarily responsible to provide non-emergent transfers gets called into 911 action... it would be nice to expect that they will be able to perform at the same high level of care as the same level of medic on the 911 truck. A medic should be a medic, regardless of the shift they happen to inhabit at the time.

I make no assumptions about EMS's interchangeability... I am spouting off about my own personal vision of EMS utopia. My utopia is obviously going to be different from yours. But your points about staffing levels and insurance and training etc... are valid and an appropriate concern for many systems that have multiple levels and agencies running calls in them. I cannot argue those points (and I can argue most everything). Well done.

cosgrojo

I just might get killed on this one... but I haven't taken a good beating in while, and I think it's time to shake off the rust.

It was said in a previous thread:

You could accomplish the same thing, without the negative effects, by simply separating the EMS and non-emergency transport industries once and for all. No crossover. Neither has any business doing the other.

I happen to disagree with this statement thoroughly. Now everyone reading this remember that my lowly Basic certificate keeps me from understanding the complexities of EMS the way that a medic/RN/or MD does... but I'll try nevertheless.

It is my contention that the integration of non-emergent and emergent calls into ones career and into a system is vital to competent personnel, quality EMS, and a well-rounded industry. Transfers and 911 is not akin to church and state... there is no fundamental reason to separate them. There is a lot of tangible knowledge and skill to be learned on transfers, and those skills and knowledge translate to better 911 care and ability. Having experience in both realms gives the provider a great advantage over those that just do one or the other. It allows you to see the whole picture. By doing the transfers and getting reports from Nurses and MD's, reading discharge summaries, H&P's, emergency room reports, and reviewing med lists... you increase your knowledge of the patients condition, and you get to add depth to your understanding of an illness. You get to increase your knowledge in patho-physiology, pharmacology, and fill in the blanks that you were unable to fill in when you responded to the original 911 call.

All of this information translates to a better 911 provider. When responding to calls you are able to pull from your experience to know what is likely going to happen to this patient once they get to definitive care. You will have an idea of what happens to them in the hospital, what the plans for discharge is and even follow-up with rehab. It will allow you to make smarter decisions for the patient as well as allow you to have the confidence of knowing what the future may hold for this patient. Receiving reports during transfers from different points of view and levels of care will also give you a better understanding of how they think, and will ultimately allow you to have better communication skills within the medical community.

Some of the sickest people I have met have been on transfers. Without having done transfers, I would have never heard of Esophageal atresia, would never have transported a patient with Menky Kenky syndrome, and wouldn't know that Shy-Drager syndrome means orthostatic hypotension. Those with experience in both worlds are able to have more interesting medical discussions, and are more likely to make a positive impression on others in the medical community.

Separation of these two sides of EMS is stupid for other reasons as well... it promotes segregation between ourselves and breaks us up into factions, causing back-stabbing, in-fighting and professional hatred. Instead we should be striving for a sense of community so that we can overcome our history of the red-headed bastards.

Non- emergent, or emergent, they are all in the same industry. What happens to a transfer medic who has never had 911 experience when during a long distance transfer the patient crumps on them? Under a separated system, the medic will be over their head, and the patient will suffer. What if a piece of information on a discharge summary one day led to you figuring out how to save someones life on a 911 call?

It is asinine to believe that these sides of the same world should be separated. ALL of the good medics that I have seen and worked with, were proficient in both worlds (and don't give me the crap of "a Basic can't possibly know or understand what Medics understand," I know when I see good EMS, and I can recognize quality when I see it). If we purposefully brought transfer and emergency together you would build a superior kind of EMT. One that has acute understanding of the medical community and can seamlessly transition from scenario to scenario while slowly gaining the acceptance and respect of the professional medical community, and general public et al.

Thank you for your time... I will appreciate any and all debate on this subject.

cosgrojo