paramedicmike

It's part of the proposed changes to Act 45. If the changes pass it'll mirror (for the most part) the proposed National Scope of Practice model. I think they're even calling it an "Advanced EMT" or "AEMT". It will also add a pre-hospital PA level.

I've read the proposed changes to the act. I'm not overly impressed. I've never been a big fan of the intermediate level so I may be a little biased in this respect.

We'll see what happens.

-be safe.

Come on Rid. Didn't you see The Incredibles?

Capes on your superhero outfit are bad. They get you sucked into jet engines and the like.

And that would be bad.

-be safe.

We had this discussion at work recently. The boss said that nationwide there seem to be an increase in the lawsuits filed against RNs. While the hospital will initially cover the employee for the suit, any loss incurred by the hospital will then be recouped in a counter suit against the RN (the employee). Rid and Dust, have you guys seen this in your experiences?

I asked the boss how this applied to us. Would the municipality would cover us in a suit? Yes. Would they then counter sue to get their money back...no answer.

Has anyone seen this in the EMS field?

It would not surprise me to see something like that happen. And the boss seems to be the vindictive type who'd do such a thing just to screw someone.

-be safe.

First off, congratulations! Now you get to really start learning. And don't ever stop learning, by the way.

From just a little below your original post you'll find this thread:

http://www.emtcity.com/phpBB2/viewtopic.php?t=3640

This should have some tips that could be beneficial to you in your quest to join the ranks of the underpaid and overworked.

The questions you have regarding the company would be good to save until your interview (although it is generally interview taboo to ask questions re: salary on the first interview). Do you know anyone who works there currently? Ask around to people you do know, people from class etc....

You're still new, and I'm sure you had no way of knowing this. But the search feature can be your friend. We have a variety of people here both new and grizzled vets. There have been many many pages worth of discussion held over more topics than you could possibly imagine. A quick search before you post questions could help you answer questions prior to re-posting something that has been raked over the coals.

No criticism. Just some friendly advice.

Welcome to EMS. Low pay and tons of work and all, I love this job. I can't imagine doing anything else. Any other questions you have think of posting here. This is a great resource with a variety of very knowledgeable people.

-be safe.

Through the roof state and local taxes AND a lottery and places like NY can't afford ALS? Puhleeze.

I would say that ninety percent of all jurisdictions that whine about a lack of money have plenty. It's not a lack of money. It is a lack of competent leadership.

Amen, brother!

The hours and pay suck but yet you're willing to sit through class and (presumably) waste your time in order to get a job you obviously don't want?

Tell us again why you're in class?

Maybe it's time to reevaluate your priorities.

Find something else to do. Go to plumbing school or something. The hours and pay are probably better. And you'll relieve the rest of us who really enjoy and love what we do of your whining.

Ditto what the others above me have said as well.

-be safe

3rd:

When your getting started, something to remember, NOT EVERYONE STARTS with great paying 911 jobs. Keep in mind, working your way through the world of inter-facility transports isn't always a bad thing (Dust shush)

You mean there *are* great paying 911 jobs out there?

Actually, Rid stole my thunder on the thank you note thing. Every job for which I have ever interviewed and wrote a thank you note has resulted in a job offer. That's over my whole life from bagging groceries in high school to my current job. It has never failed, if I didn't write a thank you note, I didn't get an offer. One man's experience but take it for what it's worth.

Also, when dressing, shower, shave etc as noted. Please wear a suit with a tie for men or a business suit for women. Make sure it fits you, is clean, pressed with appropriate footwear. A ratty or obviously worn or ill fitting suit will do you absolutely no good.

Turn off your cellphone, pagers or other electronic devices. Better yet, leave them at home. A sure fire way to remove yourself from further consideration is to have a cellphone/pager go off during the interview. "Thank you. Better luck next time." (I would end the interview immediately and send you packing.)

Good idea for a thread PRPG.

-be safe.

We've got the Stryker stair chairs with the tank treads. Can I just say that this device is one of the greatest inventions ever? I won't go back to using the old ones. Fortunately, all the places I work have the new ones so I've got that covered.

My current FT employer doesn't do much by way of keeping their employees happy...but they did an awful lot by listening to us and agreeing to buy this chair.

-be safe.

What a mess! Those medics would have been better off staying home. Poor guys try to help and wind up getting the shaft! I agree Rid, a investigation and possible criminal charges are definitely warranted! :x

SPELL CHECKED, no errors rported 8)

Try that spell check again, Jake.

-be safe.

I've seen exit wounds smaller than entry. I've seen entry wounds smaller than exit. Unless you are trained to identify such injuries, you should not, under ANY circumstances, make any effort to identify what is an entry or exit wound. As was noted, if you misidentify what type of wound it is, you could throw an entire case against a suspect off. What's worse, you could be responsible for letting the guilty party get away with murder.

Please do not make any attempt to identify or document which is the entry or exit wound in a patient with a GSW. You're not trained to do it. As such, you don't know how to do it. In other words, don't do it!

ERDoc presents a good way to document the noted injuries.

Yeah...don't do it.

-be safe.

I was thinking Chaney was trying to get a new heart... now, finding out the attorney had a MI .. he blew it !.

Be safe,

R/R 911

Looking for a new heart?? And he shot a lawyer? What was he thinking??? :shock:

Oops! Was that out loud? My bad.

Is that certified or certifiable? I've had many people tell me I'm certifiable. Fortunately, I manage to keep a step or two ahead of those guys who want me to try on this coat with really long sleeves! :shock:

I am, as indicated by my screen name, both certified and licensed (depending on which state/commonwealth you want) as a paramedic. Registry, licensed in one state, certified in two commonwealths.

-be safe.

Any particular agency in mind? There are quite a few in NYC.

-be safe.

Be careful when you Google. There are many EMS organizations in Washington who call themselves Medic1. It's all a play off the original which is King County Medic One. When you Google it, make sure you include the "King County" as part of your search criteria.

King County Medic One has one of the best EMS systems in the US. They have a very progressive and involved medical director. They are ALS only which means their paramedics only do ALS calls. If it's BLS the local BLS truck takes the call. While their system won't work everywhere, I think they do an awful lot from which the rest of us could learn.

Hope that helps.

-be safe.

I'd like to see him argue against gun control after this. He can't even use the "gun control is hitting at what you're aiming" line anymore.

Not taking a stand on gun control. Just making an observation.

-be safe.

Further, you were advocating the use of a hot response to the hospital and you don't even know what you're transporting! How scary is that?! :shock:

There are two types of students. There are students who ask questions in the hope that everything will be explained to them. Then there are students who make the effort to look up information first and then ask questions on concepts that aren't yet understood or are confusing.

One is certainly more well received than the other.

Any type of search feature is your friend. It usually helps to check before asking questions.

-be safe.

I think this article discusses an important aspect of EMS. However, I don't like the premise on which it was written.

From the article:

This article explores the inherent dangers of "no transport" situations and addresses incidents when EMS providers decide that transport is not needed or encourage a patient to sign a refusal form.

It sounds to me like the author is maligning the very people for whom she writes. Or she's misinformed at best.

Why are EMS providers deciding that transport is not needed? Further, anyone who would *encourage* a patient to sign a refusal shouldn't be working in EMS to begin with.

Refusals are a touchy situation to start. Any refusal taken should not be taken lightly. All the paperwork should be filled out. Documentation of a refusal should be even more detailed than a normal PCR might otherwise be.

We should not be deciding someone doesn't need transport. Further, we shouldn't be encouraging refusals. If you're going to take a refusal, make sure that everyone knows the potential for harm by not seeking care. And do a complete and thorough documentation of the call.

I agree with Rid, too. Damned if you do. Damned if you don't. There's so much potential for harm to come out of not transporting someone. I realize we can't force them. But it's just so much easier if they go with us than if we let them stay home.

-be safe.

To go further than what Dust noted (in my opinion correctly), if you or your partner present yourself as a less than effective communicator (whether in speech, writing or both), do you really think the doc is going to approve requests for orders when you call?

The doc won't deny the request for orders simply because s/he doesn't think the request is appropriate. If the doc thinks you're a bumbling, uneducated idiot, why should you be trusted? And if you present yourself in a manner such that you stutter and bumble your way through a report and follow it up with a poorly written PCR (complete with spelling and grammatical mistakes) then you've demonstrated yourself not to be worthy of the trust with regards to extra patient care.

And in the end, it's not the doc who suffers. It's the patient. Patient care suffers because you've demonstrated yourself, through your presentation in person and in writing, incapable of the trust to properly handle the care of the patient outside the realm of protocol. With that, you prevent the rest of us from being able to provide prudent care because now the doc thinks the rest of us are just as bumbling as you. And it's not the doc's fault. That comes back to you.

Present yourself as an idiot and it's only the patient who suffers. Not the doc. You do to the extent that people think you're an uneducated buffoon. But ultimately it's the patient who gets less than reasonable care simply because your professional image presents someone who isn't trustworthy of the responsibility of patient care. Which makes you a taxi driver. Which makes the rest of us look bad.

See the circle that's forming?

Do us all a favor. Speak well. Write well. It'll help you and your patient in the long run.

-be safe.

I do QA at work. I have returned, and will continue to return, PCRs with multiple spelling/grammatical errors. It is something that bugs me to no end. It gives the impression of an uneducated nimrod (sometimes not far from the truth) and puts the provider, and ultimately the service, in a bad way when that chart is presented in court.

And the last thing I want is to be associated with some dumb ass who's too lazy to spell/grammar check the PCR being written for errors. Not because it makes them look bad. They can do that all on their own. It's because it makes *ME* look bad. If I'm going to be regarded in a negative light, let it be for something I did. Not something my lazy coworkers did.

In an online forum I can see mistakes here and there. Free thinking and typing can lead to errors. I know I've missed a letter here and there, too. But I will agree with Dust that there's no excuse for it as there is a spell check feature on this site.

(Spell checked for your convenience. )

"What do you mean I can't debate this (insert topic/procedure/drug administration). I've been *TRAINED* how to do it. Therefor, I'm qualified to discuss it in great detail!"

Puh-lease!

-be safe.

I'm going to disagree slightly with medic001918's post. Lead II does nothing more than tell you rate and rhythm. That's it. It is commonly used to see what's going on but it doesn't tell you anything other than how fast and the origin of the impulse.

If you want to see what's really happening with the heart, you need a 12 lead (or, for a more complete diagnostic view, go for a 15 lead). The more you can see the better idea you will have as to what's going on in the heart.

If you don't have access to a 12 lead you can do what's called a modified 12 lead. Place your monitor in lead III. Take the red lead and move it to the various positions on the chest where leads would go if you had the 12 lead capability (R then L 4th intercostal space etc...). Make sure you label each one so you know what you're looking at later. This can help provide a better picture with a three lead monitor without the enhancement of 12 lead capabilities.

To answer your question directly, yes. You should be flipping through all three lead readings. If you think you need a better view of what's going on, obtain a 12 lead. If you don't have 12 lead capabilities, use the above to help obtain a modified 12 lead.

Hope this helps.

-be safe.

Pennsylvania has as well. While my squad doesn't currently carry it we are in talks with our MD to add it to what we already carry.

-be safe.

Placing an endotracheal (ET) tube is not a matter of "hit or miss". It is a process of directly visualizing the epiglottic opening and watching as you actually place the ET tube through the vocal cords and into the trachea itself. Once in place with the cuff inflated and the tube secured you have direct access through the tube into the trachea and lungs.

Placing a combitube is a matter of opening the patients mouth and sliding it in (blind insertion). Once in place and secured, there is still the risk of losing the airway due to some form of tracheal or epiglottic injury as air from ventilations still has to pass these anatomic structures. It is not as direct a route to the trachea and the lungs as is the ET tube. Since it's not as direct a route, the airway is not as secure as it might possibly be with an ET tube in place.

Further, a properly placed and secured ET tube offers access to certain medications in certain situations. While this isn't strongly recommended, it is still an option. You just can't push medications down a combitube.

Lastly, please do a search on the subject. There have been many discussions here regarding this very topic. Some of these discussions have gone into quite a bit of depth regarding many aspects of the use of either airway management device. The search function is your friend. Please use it accordingly.

-be safe.

We obviously don't because I have no idea to what you're referring.

Can you help me out with some info on what you mean?

-be safe.

It will somehow get turned on ME being the bad one in the situation.

We have tried marriage counseling before and it didn't really help.

You know, you'll forgive my being blunt, but this sounds like a relationship that has already fallen apart. It's just that noone's told you yet. Like Rid said, you did nothing wrong. He can't turn this around on you because you've done nothing wrong. If he tries to pin this on you, you have the advantage of knowing he's going to try to plus he made the choice to fool around.

I am just petrified as to what is going to come of this. I Love him and don't want to lose him.

This may just be the pessimist in me, but it sounds like he's already gone. He's actively cheating on you. He's having virutal sex. The mere fact that you know he's going to be defensive and try to say it's your fault indicates he's guilty. This sounds like he's already checked out and just hasn't had the common decency to tell you.

Please follow up with some professional (marriage) counseling. You can only benefit from it.

Be strong. You can and will get through this. It's not your fault. You did nothing wrong. He's the scumbag. You are not!

Good luck.

-be safe.