paramedicmike

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.

There were two valuable lessons in this post:

1. Ambulance services that can afford a brand new ambulance in a "pretty quiet" area should look toward throwing their personnel a bone in terms of payment...if only pay per response.

2. That cats are white meat. I did not know this and it expands my dietary horizons.

Please note: no animals were harmed during the creation of this post.

No, no...he said "pretty quite". See? Here it is:

'm a volunteer at a rescue company in a pretty quite area.

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.

The first thing you need to do is look at a patients airway and determine the class of airway based on the Mallampati class 1-4....

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.

So for future reference I will never be offended by being corrected on a point but think its really unprofessional to harp on someones error as you did.

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.

Tell me the last time you saw an EC-145 sitting in the middle of farmer Joe's field in rural america? Or a worn out Bell 206-L1 sitting on top of a prestigious hospital based system's pad? It just doesn't happen that way.

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

PR:

If this were you and me on a truck I'd take it. Blood loss, a rate in the 70s, some BP changes on position all post dialysis would have me just slightly concerned. Even if this were a larger patient I'd still be concerned with the blood loss and lack of a tachy rhythm.

Did I miss it? You mentioned a complete treatment. How long was she hooked up?

And do I really have to guess with whom you were working on this call? I can guess, you know. In fact, I have a pretty good idea of who it might've been.

And let me guess further, she had you take it.

-be safe.

Janmarie3, you may want to think about working for another employer if you think your current employer is so pathetic that they must hire and retain people who are unprofessional. It also sounds like there are other things going on as well?

Take care,

chbare.

Why say any more than this???

Edit: If nothing else, stop threatening suspensions. This turns into the boy who cried wolf. If you're going to threaten it, make good on the threat.

Otherwise, find a new job. Others below this post have made some excellent points. But I'm still on board with CHBARE on this one.

-be safe.

Agreed, AZCEP.

It's only going to take that one "undertriaged" patient who didn't get a helicopter ride when s/he really needed it to bring this crashing down (no pun intended) in a massive, flaming civil suit.

I think another possibility that was not mentioned as to why so many patients are flown goes back to ER docs themselves. Speaking only for my current area of employment, many of the local ER docs "refuse" patients who might otherwise be appropriate for a local community hospital. Local medics and EMTs have gotten into the habit of calling the local doc, presenting a scenario only to have the local doc say they can't handle the patient and to refer to a trauma center. That brings in the helicopter. (I use the term "refuse" very loosely. The docs aren't saying "no" per se. They always fall back to the "this patient needs a trauma center" line and thereby wash their hands of further care.)

Now, if, in most of these cases, the medics didn't cater to the local ER docs and just showed up with the patient, the patient would be cleared and sent home. If it turned out the patient really needed a trauma center, stabilization of injuries by the local ER could be completed then the patient could be transferred out.

I realize and have seen first hand how HEMS has been overused and abused. But until they give us X-ray eyes I think it may be better to err on the side of caution on behalf of the patient. I'd rather fly someone who turns out not to have needed it than not fly someone only to have them die from unseen injuries.

-be safe.

Yeah right, next thing you'll try to tell is there no such thing as 250ft of flight line.

Peace,

Marty

:joker:

Oh no! There really is 250 feet of flight line. You just can't move it is all!

That is very true and we normally only use life flight during rush hour in urban areas, but it is important to remember that Clackamas county, our largest county area wise that has EMS service has no level one trauma centers and only 3 Er's (where I would not allow myself to be taken, by the way) to service more land. Much of this area is classified as frontier and our response time is 4 hours or whenever we make it. In these areas, we tend to activate life flight more often, and also to transfer from other states as the next closest trauma center is 5 hours away to the north, 14 hours to the south, not sure on the east, but we do take several flights in from states to the east of us, and nothing on the west side. We have 2 mountain ranges that are more than an hour from any hospital code three after you make it to The freeway, and several other rural areas that have need of our life flight. We only put them on standby until we have assessed the patient (that is EMS or fire as all of our fire crews are paramedic crews) due to the plethora of false calls where life flight went to a scene where the 911 caller was panicked and said the call was much worse than it was in actuality. It is an imperfect system, but it works in our area, especially since flight craft are only ever about 10 minutes away from any of our urban calls. Again, not perfect, but it works... Also, it puts health care decisions in the hands of *gasp* health care professionals, not Joe public.

But wait a minute...didn't you say this earlier?

of course, we have two level one trauma centers within 5 miles of each other and a 3 level two's within 10 miles, so we really have plenty of hospitals to take people to

So, which is it there, sparky? Do you have all these trauma centers close by or are you out in the boonies? You've just contradicted yourself.

-be safe.

#1-"This is your last chance! Surrender now!"

#2- "DEATH FIRST!"

The Princess Bride.

"Ah yes. A bear in his natural habitat...a Studebaker."

This is our way of doing things.

Yeah...but Jersey's just....shall we say...."special"!

Don't take an actual "sit at a desk with other people and listen to a lecture" course. Take it online. You can do it through the National Fire Academy. Follow this link to help you:

http://www.usfa.dhs.gov/training/nfa/independent/

It'll give you the same training and certificate at the end. Plus it'll meet the Federal requirements to keep your employer/squad in compliance. Even more, it'll keep you from sleeping through what was otherwise a waste of time lecture.

Seriously, do it online. You won't be sorry. But you will be if you sit through the class!

Good luck.

-be safe.

who screamed ecstatically

.

This is simple. You work to live. Regardless of situation. Im sure Medic Mike was there because of the wonderful staff, good municipal benefits, and attractive civil service compensation for retirement?

Just a THOUGHT, NOT THAT I WOULD KNOW FOR SURE OR ANYTHING.

Hmmmmm...it's a possibility!

sounds like we touched a nerve -- if any of that is true, why do you still work there ? I would leave the industry before i would work for someone that is unethical.

Easy everyone. For once this can be considered a valid question.

Yes, it is true. The first was how they paid overtime. Then was how they resolved the overtime issue. The second was a claim of insider trading and having access to bids for service with the intent of underbidding the competition.

The simple answer is I *DON'T* work there anymore. I quit and moved on to a much better opportunity.

The not so simple answer is...well...not so simple. With that said, there is something to be said for PRPG's comment regarding being an adult. Sometimes the responsibility of taking care of my self with regards to having housing, food to eat etc...has to be considered. I will tell you, though, that once all this went down I started to look for a new job. I wasn't any more comfortable working for this guy than I was being in the same room with him. But sometimes you gotta do things or tolerate things you'd rather not.

From my perspective, I wasn't compromising any of my principles by staying there. I wasn't doing anything wrong, immoral or illegal. My standing among my coworkers and patients was not affected. I was working to try and resolve the illegal practices taking place. And besides, I had a job to do. I could ignore the boss. I couldn't ignore my responsibilities.

Does this answer your question?

-be safe.

I'll second AZCEP's suggestion of a PDA. I use a Palm and it works very well.

I don't currently have the cell phone/PDA that AZCEP mentions. However, it's something that I'm looking into as there is an awful lot to be said for consolidation of some electronic equipment.

Yes, it's a little more costly. But I agree that you'll be better served in the long run.

Good luck!

-be safe.

I've heard that a partially inflated cuff will help. I didn't think to try it the last time. But it'll definitely be something to keep in mind the next time around.

I heard somewhere, too, that the manufacturers don't recommend insertion like that. But I haven't seen it in print yet so I don't know for sure.

But if it works and I don't flip the tip around I'm happy. Thanks for the reinforcement of that tip!!! Nice to know it's worked for others out there.

-be safe.

I told the boss that he was breaking the law in several areas, presented evidence of said infractions, then almost lost my job because of it.

The good news is that he changed the practices so as not to violate those particular laws. The bad news is that he just arranged it so he broke the same laws in a different way (harder to detect) and threatened me that if I ever spoke up again I'd get fired for my trouble and sense of fair play. That and our employee rep told me to keep quiet about it because it would affect other jobs within the municipality.

You know one of the biggest problems in EMS today? Managers. Especially overzealous managers, and wanna bes who think they need a soapbox.

Otherwise, I echo AZCEP's words. GA, you need to lighten up. You've come into this sight as a whirlwind of arrogance and self importance. Maybe if you slowed down a bit you might see things for how they really are. AZCEP is a leader. He's also got a pretty funny sarcastic streak, too.

-be safe.

What we do here in Oregon is put them on standby until we arrive on scene then activate after we have done an assessment, but conscious patients almost never require life flight... of course, we have two level one trauma centers within 5 miles of each other and a 3 level two's within 10 miles, so we really have plenty of hospitals to take people to.

Ummm...so if you have that many trauma centers that close why do you bother putting a helicopter on standby? There's no need for it. Especially if you decide to wait until you've done an assessment before requesting a fly. If you do that now you have to wait for the helicopter to take off, get to you, land, complete their assessment, load, take off and fly to the hospital. Congratulations! You've just wasted an unacceptable amount of time when you could otherwise have already been en route to, and possibly have arrived at one of those trauma centers before the helicopter would have even landed at the scene.

Your situation isn't limited to Oregon. I've seen it other places, too. In Maryland where this call originally took place (and where I used to work). In Pennsylvania where I currently work. In Virginia and West Virginia, too. I'm not quite sure why people wait so long but for some odd reason they do.

The only time this might be acceptable practice in an urban area is during rush hour where traffic is so bad that even a trauma center three miles away would take you an hour to get to. But there are only a handful of places in the country where that might be a consideration.

Otherwise, thanks for raising an important issue with regards to HEMS.

-be safe.