cosgrojo

Surfin' Bird (Bird is the word) - The Trashmen What is Black, White, and Red all over?

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: 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

Either the subsidy being paid the Private service is not big enough to justify keeping ambulances at the optimum level... or you don't have a dedicated contract forcing them to stay. It costs a lot of money to run an ambulance service, and with Medicare constantly reducing compensation rates, many private companies are trying to spread themselves too thin to minimize losses. I'm not agreeing with these practices... just reporting it. Just when I thought we were getting along... I believe I will start a new thread on this topic...

The Basement Song - Bluetones What is the air-speed velocity of an unladen swallow?

220- patients age refers to the rate that an individuals heart can beat that epinephrine in the patients body is controlling. Our pulse can only go as fast as the Epinepherine in our bodies can make it go. In other words... that equation equals a Sinus rhythm, at a tachycardic rate. Anything above that number for the age of the patient indicates a conduction abnormality and then may be PSVT, A-fib, A flutter, or V-tach. *from the venerable Doctor Fowler*

Well... since you don't really have any strong feeling about this subject... I agree with you 100% If you are not willing to put up with being tormented by patients and co-workers alike... find other avenues of gainfull employment. Although... there has been one or two over the years that I soooooo would have liked to *self edited angry moment*

My question is, was the patient being carried WHILE the offending incident happened? Meaning... did the EMT calmly place the stair chair lovingly to the ground, and then start throwing bombs? If it was reflexive... then he would have dropped the patient. So either the perp did the offensive bit before/after being carried... or the EMT had time to decide if he was going to obliterate the guy. This bit would be very important if I was the lawyer for either side.

I believe that when he was talking about the quality of Police work he was talking about how they have improved greatly over the past year in a half since the incident, and that he didn't want the recent release of the tape to marr those improvements. Remember this has been in litigation for over a year... the tape is that old. Any illusions toward the quality of the police work on that actual incident were probably forced so as not to totally tick off the Police Union... which is a relatively powerfull union... at least in terms of any EMS union out there... *warning - OFF TOPIC* By the way... NEMSA sucks.

I would like to change many things about EMS... but if I had to narrow it down to just one I suppose it would be the attitude. Pervasive unprofessionalism both holds us back as providers, as well as monetary compensation. It has well been flushed out on these forums that education increases (nationalized or not) would be the best and fastest way to universal acceptance as professionals in the medical world. It worked for Nurses, and it would work for us... but I do not feel that our current "roster" of providers is professionally (i.e. containing the proper amount of core values and personal development) competent. Raising the personal standards that each of us has as individuals would go a long way to justifying our place in the expanding world of medicine. Act a certain way... get treated that way. We could have all the education in the world... but if we act like monkeys, we will continue to be perceived and treated like monkeys. Dust- Pol Pot, and eggy fruit salad... Hilarious. I agree by the way. I would whole heartedly vote for a complete dismantling of the system... but only if I got to be on the next planning committee.

It is good to have beliefs... I, for one, believe I can fly. *cue R. Kelly song*

Being one of the pseudo original posters on this lovely ever-changing web site... (seriously admin... take a technological vacation every once in a while) I thought it would be nice to celebrate my hard-earned long coming 200th post. I know what your thinking... 200 posts? Spenac and Dust combine for that amount before breakfast. And your assessment would be correct... but I call you all here to celebrate quality... not mind-numbing, life consuming, and sanity challenging quantity. You see... it is challenging for me to interact electronically. I type about as fast and with the same amount of accuracy as an illiterate Chicken who accidentally got into the Xanax bottle. I easily get distracted by loud jingly noises, and constantly find myself staring just beyond the computer screen with my head slightly cocked to the right, and my mouth slightly agape (I sometimes snap to 1-2 hours after starting a post... completely disoriented, and wondering whether this is what a really long focal seizure feels like). Yet despite these maladies and ineffectual disabilities... I occasionally soldier on and produce quality posts... resplendent with my transcendent acerbic wit, and liberally dotted with dots... ... ... I feel that maybe I should get an award or something for my travails. I mean I've done all of what I do for the kids... as you know... they are the future. I will now begin accepting gratitude from any and all members of EMTcity that wish to tell me about the many ways in which I have affected their lives in astoundingly positive ways. Please feel free to heap praise on me like you would the typical conquering hero... I will probably feign a little bit of modesty at first... but since I deserve it... it won't be for long. Thank you for your attention that I so rightfully deserve... cosgrojo Post...Script... For those who may not understand me or my post, I direct you to read the title of this forum... because that is all this is intended to be.

2004 F-150 Heritage edition... stripped down to the core. 5 speed manual transmission, decked out with human powered windows (which also serve as a top of the line air circulating device), Awesome sound system with not only AM and FM radio... but comes equipped with an actual tape deck. I also just recently purchased a BMW... for one dollar... it's a 1994... needs some work... but its a BMW, and now people will respect me.

Actually... I happen to see a kind of sneaky logic to the whole thing. I would rather have the fear of getting busted stop someone from climbing behind the wheel and possibly maiming or killing someone else, than to take the chance that they miraculously don't kill someone, just so I can ticket them. (that may be the worst sentence I have ever written in my life... Mrs. Lammers... if you are there... I apologize, it is of no reflection on your 3rd grade sentence structure instruction.) At least on that night, you know that you have probably influenced a couple of people to stay off the road... and in mine eyes, that is a victory.

Would... no typo here. I honestly believe that the Mayor was completely disgusted by these actions and feels that his officers could have ended it faster and without much incident. If they get jobs again, it is without that man's approval. Just my read on it... God knows I've been wrong before... I once made a bet that "Krush Groove" was going to be a bigger hit than E.T. Boy did I get fleeced on that one.

What do you mean? I've been a member hear for only five years... and I'm already up to almost 200 posts!

I will gracelessly accept your absentminded compliment to my original post Dusty, and will pronounce myself vindicated.

It is not often that I am absolutely astounded by what I see... but I am right now. I can not believe that they unmercifully beat a prone person status post EJECTION from a vehicle. The Mayor was talking out of both sides of his mouth. He chastised them for their actions, but applauded their overall work... but also the way he said that the Police had exercised great restraint (far greater than he would have shown) in not aggressively ending the chase earlier, sounded like he thought that they should have ended it earlier, and none of this would have escalated to the level it did. Reading the Mayor's body language and reading between the lines, I would be shocked if any of these officers regained their employment.

"Cowgirl" - By Underworld What is your least favorite thing on your body?

Since I am still in EMS... I don't think that I qualify as a survivor... it might still finish me yet.

I cannot, and do not disagree with anything you said there. I would very much like to see all EMS have to go to a University system. That would provide credibility to our field, and some semblance of educational assurance. Alas, that is a dream with a very long pipe... and there are many reasons for it... but that would jack the thread completely... and piss off all the vollies. Fortunately many universities are beginning to cash in on this revenue stream of EMS-philes, and providing EMS degrees. If only the National Registry was a stronger organization that had the teeth to..... oh crap.... there I go.... I promised myself I wouldn't go off on a tangent. Sorry... end of reply.

Spenac- I am well aware of how Paramedic courses are structured... and I agree there is built in time for riding along and learning skills. But you will have to agree that most of your best learned lessons are when you are by yourself with nothing but your partner to rely on... not riding third watching someone who already made the mistakes that you need to make to better yourself. As for your last statement... you are obviously much more comfortable dealing in absolutes than I am. I still hold that everyone's experiences are different, and moreover, that every EMS system is different in composition. I am not familiar enough with the Floridian system that our Lone Rider friend intends to learn and work in, and not presumptuous enough to assume that all Basics are drivers there.

Being completely daft and unencumbered by intellectual thought, I was mortified that I had never pondered the hazards of the electric car. My younger cousin is blind, and she is constantly letting me know how absolutely stupid I am for not thinking of the mammoth inconveniences that someone with her disability must deal with. I just got off the phone with her after initially reading this article, and she confirmed that this is a topic of much discussion in her community. She said that it is a massive adjustment for her to make, and that it is nerve wracking to her when she leaves the house. According to her, most blind people don't trust the technology in place to help them in society. They are not comfortable crossing streets just because the crossing light started beeping at them. They rely mostly on their own instincts and their hearing to detect vehicles and other dangers. These quiet cars are not helpful. My ambulance service recently got one of the European style sprinters... and despite the fact that it has a diesel engine, it is incredibly quiet. I've been standing next to it and not known whether it was on or not. Just another hazard that we are unwittingly causing. It has been a long time since we came to understand that every action has an equal and opposite reaction... so why do we always forget?

While I have no wish to beat a horse which is already dead... I think that a reasonable person would agree that (in regards to experience at the Basic level) the truth is somewhere in between. It is not necessary to burden yourself with the idea that you have to spend 2-3 years on the road gaining BLS skills, but I would caution you about the mindset that completely disregarding the level altogether is appropriate. I myself have been a Basic for about 6 years now, and have learned a great many things that would benefit a prospective Paramedic or Nurse. My apparent lackadaisical career has been more a matter of incurable finances, lack of motivation, and a keen eye for other professional endeavors (and a wife that never STOPS going to school)... not because of some ill conceived notion of BLS experience. The benefits of extended BLS experience does not lie in the dogmatic arguments involving pre-hospital skill and ability accumulation, but in skills that are of a more intangible variety. Skills that include bedside manner, interaction with staff, commanding a scene, organizing chaos, learning how to work with medical people of both higher and lower skill and ability... and so on and so on. These skills are much easier to attain in a lower stress environment in which you are not the highest level of care and can make mistakes that are not going to hurt anyone. These skills are also much harder to accumulate when you are still trying to find your way on the road with SO much more on your mind... i.e. brandy-new-medic with no experience to rely on. While these attributes I mention are not in the curriculum, and not on the protocol exam... they do make a difference between a good medic and a great medic.

The system is broken because nobody actually knows what the system is or how to use it. It is obvious just from watching this discussion that everyone has a different idea of how things are supposed to be done. The overwhelming problem is that large companies and billing agencies all have similar disagreements. Everybody has a different interpretation, while most just continue to keep doing things the way they always have because they assume they are right. I work for a private service who is perpetually resigning corporate integrity agreements every year because we refuse to change our billing and auditing systems to keep up with Medicare guidelines. Instead of changing to their system, we just keep paying the fines and re-upping the bogus 1 hour con-ed class for Medicare. I've pointed out inconsistencies to my auditors/supervisors in the past in respect to Medicare billing rules... and they tell me I am wrong and they demand to know who told me that?!?!? I respond that no one told me that, I pulled it off of the Medicare website available to anyone with 15 minutes of research time to burn. They always tell me that they don't believe me because if that was true, we would be billing it this way. That makes me chuckle. People can be smacked in the face with truth, and still ignore it. This is the real problem with our system. Nobody knows what they are doing, but they all think they are doing it right. Unless someone knows of a way to cure egotism... our problems will persist.