paramedicmike

If these boneheads strike then every last one of them should be fired. And if I could deny them unemployment I would!

My understanding, from what my friend explained, was they had a 36 hour work week (3 x 12 hr shifts). They did work three shifts a week. Just that they (full timers) were scheduled around the part timers availability. Still trying to wrap my head around this. -be safe.

Ruff...that's horrible. Sorry you had to deal with that. I can't even imagine what that must've been like. -be safe.

Just who is AMR taking over in Montco, PA?

Here are my sources for the meds used: http://en.wikipedia.org/wiki/Lethal_injection (not authoritative but available none-the-less) http://www.deathpenaltyinfo.org/article.ph...d=8&did=479 http://www.statesman.com/news/content/news...6/13lethal.html (please note the line that says that Texas uses the same three drug combination that other states have adopted.) These are three among many. Please provide your sources saying that the procedure is something different.

No worries. Got it. Fair enough. Well, not really. Sure, if you look at the basic steps of sedate and paralyze then yes, it's similar. But these are the most commonly used meds used in lethal injection and are not available on standing orders to most (if any) services: Sodium thiopental: to induce a state of unconsciousness intended to last while the other two injections take effect. Not commonly used in prehospital RSI due to the lack of analgesia provided by this med. Pancuronium: to stop all muscle movement except the heart. This causes muscle paralysis, collapse of the diaphragm, and would eventually cause death by asphyxiation. This isn't used either due to it's long onset and long duration. Perhaps it might be used once tube placement is obtained as a long acting paralytic. But it's generally not the first choice nor am I aware of any service, ground or flight, who uses this medication in the field. Potassium chloride: to stop the heart from beating, and thus cause death. This is not in any way, shape or form in any paramedic level formulary. I'll agree to a certain extent that it mimics an RSI procedure in preparation only. I will disagree, and continue to argue, that these meds fall within the SOP of paramedics...certainly they're not part of any standing orders to most services out there. -be safe.

Actually, I think the drug most commonly used to actually kill the inmate is Potassium Chloride. And KCl is certainly outside the SOP of any medic out there. I've never heard of CaCl given to kill the inmate. And no matter how you spin this it is not included in any SOP out there. It can't be compared to an RSI as the drugs most commonly used aren't used in an RSI (with some exceptions for those that use Succs to paralyze) protocol. What's further is that we can't operate without the authority of a medical command physician. That means until a MCP gives us the authority (and accepts us under his/her license to do such) to start an IV on an inmate for the purpose of a lethal injection we can't do it. (This is why we can't just run around with IV stuff and meds in out POVs.) And it plays into the larger issue here being that they can't get a doc to sign on to do this. And I'll disagree with the idea that it's not that big a deal. Technically, no. Starting a line and pushing a button is not a big deal. But it's the end result that's important. Most of us can start lines with our eyes closed in a bouncing truck. But we're not doing it for the purpose of killing a patient. This is not an issue or attack on anyone who personally feels or believes that capital punishment is good, warranted and justified. This is an issue of medical ethics. And ethics is why this has become an issue. When we started working in EMS we allowed ourselves to be bound by certain ethical guidelines. We cannot, as a profession, excuse ourselves from that when it serves our personal beliefs. And I'd argue that if you do allow yourself to cloud the line between professional and personal ethics then you shouldn't be working in this industry. -be safe.

Just as a side note, Montgomery County PA is considering allowing etomidate. I think it's before the County EMS council now. Now back to your regularly scheduled discussion.

And yes, I searched and found nothing quite like this elsewhere in the forums. I was talking with a guy I know recently who works at a place that schedules their part timers first (based on their availability) and then schedules their full timers in the open spots. To a certain extent, I can kinda' understand this. Instead of trying to plug holes with part timers you tell the full timers that this is their schedule and go from there. I can see how this might make the scheduling easier. But on the other hand, it seems a bit hard on the full timers to not have anything set. Even more it would seem to create an environment of discontent in not having anything reliable from week to week and scheduling period to scheduling period. (To help clarify, schedules are done every six weeks for the next six weeks. So they never know more than six weeks in advance when they'll be working.). I know we have some managers here. Thoughts? From the rest of you line providers, what're your thoughts if this was how your scheduling was done? -be safe.

Someone mentioned to read the notice at the top of the forum but that doesn't help a bit. Can someone please explain what's going on here?

Well, no. Those medications are out of our scope of pracatice as well. It's not a matter of protocols. EMS based protocols don't come into play here. (Even if they did it would be an issue of going against protocols as no medical director would have a protocol on how to kill someone. Do you want to pay the insurance on that?) The meds that we push are described to be in our scope. All other meds are out of our scope which is why we don't use them. Don't confuse "scope of practice" with "protocols". They're two different concepts. -be safe.

Let's see, if doctors won't do it due to ethical standards (I seem to remember something about 'first do no harm...') then what would give an "I" or "P" the right to do it? Aren't we bound by the same ethical standards? If not, why not? If you aren't, then why are you working in this field? Don't we work for MDs...the same one's who are refusing to participate? If it makes sense to let us do it because it falls within the scope of our training, they why not let an RN do it? Isn't starting an IV within the scope of their training? But oh! Wait! They won't do it either because RNs maintain ethical standards, too! What a coincidence! Why is it that it is expected that MDs and RNs will be held to certain ethical standards but we won't? -be safe.

The director, while having a bachelors in "tall tales" and "lying through his teeth", was promoted from within. He really does have a college degree but it's worthless to him and his employees. At my other job it's hard to say. The main boss in an RN (hospital based service) but I'm not sure about the big boss. His bio doesn't talk about education at all. So I couldn't say.

So the victim doesn't remember who pulled her out? How did the press know it was him? Did he go about and say, "Hey! I pulled that lady from the car!"? Did people point him out and say, "He did it!"? I'm guessing then he stuck around long enough for the press to arrive? He did what I'd hope any reasonable person would do in terms of helping her out of the vehicle. However, the fact that she doesn't remember it and he's talking to the press leaves a bad taste in my mouth. My vote is "nice job but you're still a whacker". He'd have gotten the "hero" nod had he just slipped off into crowd without playing up what he did. -be safe.

Yep...I'm in.

Where in PA are you looking? Avoid Philly like the plague that it is. Besides, it's all FD based EMS and they currently...well...suck. Montgomery County isn't a bad place. Most places run EMT/Paramedic crews. Whether or not they'll hire you right out of basic school is another question. Given the glut of basics in the area it might be a tough sell. Check the other surrounding counties (Delaware, Chester, Bucks, Berks). Avoid the city. Try getting some experience at your local squad before you come over. That can only help you...even if it is Jersey. -be safe.

God is spelled G O D. Dog is spelled D O G. Same letters. Different arrangement. Coincidence? I think not! (My dog made me write this!) And you know what they say about agnostic insomniacs...they stay awake all night wondering if there really is a dog. -be safe.

No, no...he said "pretty quite". See? Here it is: Does he mean "quiet" or "quaint" or did he mean a "quite pretty" area? It's hard to say. I once knew a guy who used to be a Raleigh, NC cop. He told me a story about a raid on Chinese restaurant they did. Let's just say it wasn't chicken found in the freezer. And after the restaurant closed the rate of disappearance of neighborhood cats decreased dramatically. -be safe.

Your email most likely wound up in somebody's spam folder. The one to the State is most likely now part of a huge back log after the state was shut down for a week earlier this month. Try contacting the State EMS office by phone and talking to a real person. Or contact your old volly squad and talk to the training officer there. I'm sure both would have a better grasp on what the requirements are than what you would find from an anonymous poster on an anonymous internet forum. -be safe.

If you're planning on going to Seattle and want to work for Medic1 it doesn't matter if you have your paramedic or not. If you survive their hiring process they send you to their own paramedic school regardless if you have an ALS background or not. Getting hired, however, is the tough part. I believe, as far as BLS and transports go in the Seattle area it's AMR. If you're looking to move to Washington State I suggest on waiting until you move there to go to paramedic school. A friend of mine is not trying to go through the reciprocity process and it is, to say the least, unreasonably impossible. I suggest you do a search of these forums regarding EMT/Paramedic and the experience needed/desired/wanted between the two. Some people will say you need experience as a basic before P school. Others will say it's not needed. It's all been said before in these forums. Please do a search and find out what was said. -be safe.

Sarge: Yeah...now that you say that I remember. It's been a while since I've called for a helicopter in MD. Greenhat: You still haven't clarified anything. Your two statements still contradict each other and your explanation does nothing to satisfy the complaint. Patty: Your description of how long a ground transport versus a flight further supports the argument that you shouldn't wait to call for a Trooper. The longer you wait, the longer the patient has to wait and the longer the whole process of flying the patient becomes. The sooner you call the sooner the Trooper gets there and the sooner the patient in on his/her way to the hospital. If you think, based on the dispatch description, that you need a helicopter then call for it before you even get on scene. Why? Because they'll be there sooner than if you wait until you've done your assessments. If it turns out that you don't need them then cancel them. Don't worry about calling them out and not needing them. I guarantee they don't mind. They like to fly. And it's even better when they don't have to complete the trip sheet at the end (is the whole state using E-MAIS yet?). Also, and something I noticed in your initial posting on this topic (forgive me if this was already addressed. I didn't go back and re-read all five pages of responses to see if this came up), please don't document which vehicle is at fault for an accident. Don't document which is the "striking vehicle". If your patient says, "He ran the light and hit me" that's one thing. But if you document which vehicle was the "striking vehicle" and you call winds up in court the lawyers will rip you apart. Sure, you may be able to put together a pretty good idea of what happened during the accident. But you're not trained to make that kind of assumption in your legally binding PCR regarding what happened during the course of the collision. The lawyers know this and will have show no mercy as they eat you for lunch on the stand. -be safe.

That's what I was getting at. Chances are you're not going to get a mallampati score on any patient requiring emergent airway management. That's also why I mentioned the Ron Wall book on airway management in the City Book Group thread. It goes into great detail on airway assessments including the "LEMON" acronym as well as others. -be safe.

How do you assess a mallampati score on a patient who really needs RSI? Do you ask them to sit up and stick their tongue out? What about that immobilized patient? There are other ways of assessing an airway and determining the potential for a difficult airway. Assessing a mallampati score shouldn't be the *first* thing you do. Nor will it be feasible in just about every RSI scenario out there. Check the EMS Book Club thread in "EMS Discussions". There's an excellent airway manual listed there that should help you.

Dude! You flat out lied! And when you were called on it you continued with your story. Would you let it slide if someone lied to you? Unbelievable.

Can't say that I have...but we've got a couple of almost 20 year old BKs and a 10 year old (I think...it might be older) S-76. And we're the latter of the two! They do move fast, though. -fly safe