J306

First car was a '92 Buick Skylark man that car was awesome, drove it until it finally broke down on me, 2nd car was a 2002 Honda Civic which I traded in for my current vehicle, 2003 Jeep TJ Wrangler, Rubicon edition. I love my Jeep.

My hobbies apart from EMS include: working on my Jeep Rubicon and going on off road trails, hiking/camping/traveling (just got back from Peru a few days ago, me and a friend hiked the Salkantay trail to Machu Picchu), play a lot of sports, and read a lot of books on medicine, buddhism, and philosophy. I'm in the process of finishing my Human Resource Management Certificate, and I'll be going back to school in the summer to get my Advanced Care Paramedic then I plan to volunteer in South America for 3-6 months at remote clinics to gain some experience and work on my Spanish!

Funny you say that! Man, that post actually made me feel for the first time that I didn't waste my time doing this, but before I got accepted into the EMT program I had the foresight to complete my business certificate and then completed a semester of my Human Resource Management Diploma befoe taking off for the fall intake of the EMT course. Currently taking an online class and which ends April and another April til June which will then give me my HRM certificate! (only 3 classes shy of diploma)

Thank you everyone for your advice... I was feeling pretty overwhelmed for a while and I'm glad to be involved in a community where so many people are willing to offer such helpful input!

I've decided to stick it out rural and take some vacation time in March to volunteer at some hospitals and clinics in Nicaragua to gain a perspective on health care and hopefully pick up some Spanish. (Has anybody here been there and done this?)

As for school, I have considered venturing to other provinces to get my education; however, I looked at the cost/benefit of doing this, and since ACP is being offered at my hometown, I can stay with family and challenege the provincial exams if I choose to move.

Oh and my former employer up north has offered me a management position for when I complete my ACP, so it seems everything is falling into place!

Well, I guess I might just want to work their for the wrong reasons, possibly to satisfy my ego, but I guess the main reason is because a part of me really needs to be "kept on my toes" and challenged to keep me sharp, keep my skills fresh, and maintain my thirst for knowledge.

The thought that I had was that in the past I have worked in a very toxic isolated work environment and was able to block out the negativity and stay positive and proactive. Maintaining this attitude got me promoted to Senior Staff and be incharge of my own shift after only being there for 4 months.

Having said that, I was thinking that if I could take the same approach, that I would become a stronger EMT.

I want to work EMS for sure. In one year, I see myself either in school, or using the next year to save up and travel for a few months to Central/South America to volunteer at hospitals and clinics. Five years I see my self completed ACP and working for a proactive service which shares the same vision and values as I have. Ten years I would love to start working towards becoming a full time instructor or in a team leader/management position.

I feel as though the BLS level is not challenging me enough and that I am truly ready for a new challenge and to return to school.

You're right about that it left kind of a bad taste in my mouth.. I did my student time there and being on car again reminded me of all the "holier than thou" attitude.

Hello everybody,

I have a few tough decisions to make regarding my EMS career and I was hoping to get some advice for those of you who have been in some similar situations. Yesterday I decided on a whim that I would re-apply for the EMS service in my home town is a busy urban service.

The service I work for right now runs about 2-3 calls a day on average and I've been there 3 months. I've learned a lot here so far, but it's just not as busy as I'd like.

The last time I tried out for the urban service was 2 years ago, and I was competing with Medics and EMT's with much more experience than I had. That and I messed up one of the exams where they required you to use you're written and verbal multitasking skills from a dispatcher exam.. My ADHD got the best of me on that one and unfortunately I was unsuccessful.

This decision is difficult for a number of reasons.. At the rural service I currently work for, the general attitude is very positive and proactive and I'm starting to get settled in. If I stayed here I would probably stick it out until summer and possibly go back to school for the Advanced Care Paramedic course I got accepted to in the fall.

If I got on with the Urban EMS service in my home town, they would want me to defer school for atleast a year and start out as a casual position with the opportunity to get full time hours. One thing I noticed during my ride along was that the attitude was significantly different.. It seemed very tense and the crew I was with didn't seem interested in discussing calls afterwards and lacked the compassion and patience that I find to be so important to maintain in EMS.

I've been reading quite a bit of forums and posts since I've started and decided to express my opinion on only a few occasions. I've seen a collection of very experienced and intelligent people on this site and I'd love to hear some thoughts and suggestions!

That is how it should be though, a case by case basis. If you are generalizing treatment of your patients, you are behind the 8-ball.

Well, I generally believe that patients should be treated/transported in a way which will preserve their dignity and reduce the risk of further injury or unnecessary exertion which could worsen their condition. I would agree that anybody in EMS who has a generalized tx plan before even assessing their patient has a long way to go.

I'm curious as to how long you've been in EMS. If you've mentioned it previously I either missed it of have since forgotten.

While I appreciate the position you're taking, you're going to find that you're going to encounter many patients who don't either need or deserve to be transported on the stretcher. This doesn't imply a lack of professionalism on your part. It represents a fact of life and will become a practical part of your life in EMS.

This isn't coming from a disgruntled, back injured old timer. This is from someone who has seen too many back injuries from people who do everything right in terms of lifting yet wind up flat on their back with debilitating back injuries.

I've been in EMS for about two and a half years and just got accepted into school for ACP starting in September.

On my first year of my career I worked in a northern reserve community where the terrain was very challenging and houses had missing stairs and endless amounts of obstacles in the yards. We had no stair chair, scoop stretcher, FD, or backup unit to help lift for the more difficult and barriatric pt's. I found myself having a lot more of my patients walk if possible than I would now in my city job with FD responding to all of our code 4 calls and with a stairchair on our main unit.

The point was made that your geography has a lot to do on how frequent and to what extent you lift patients and with that in mind it makes a lot of sense why there would be such a contrast of opinions on this topic.

Oh J306..... I see myself 10years ago

If you had a drunk girl who could stand up on her own, she likely could have walked WITH ASSISTANCE on her own. "Assistance fail"

One person under each arm, and away we go.

Not to get hung up on one case.....

I once too held the parinoia of patients falling, and had it drilled into me "If they call 911, they deserve a stretcher". This is just so untrue.

You need to be more concerned about you're longevity in this profession if you are considering EMS as a career. There are actually very few patients in areas like ours that cannot ambulate themselves to the cot, if the cot is lowered just outside the back of the ambulance, or use the side door for the lower step. You may be changing the words from you're original post, but your tone remains the same.

I like the patient advocacy you are displaying, but remember, you and your partner come before the patient.

You mention professionalism in your post above... here is a thought for you. Carrying patients unnessesarily holds back progression of our profession.

As for power cots, in the hands of non-progressive practitioners who insist on carrying cots around like in the 80's, they are dangerous and should not be used.

I have been using one for 2 years now and have never lifted it. Most practitioners just refuse to change thier traditions. Lemme run a call by you:

Pick up a 65 y/o 250lb with influenza like illness. Coughing, fever, SOB, weak, dehydrated. Single level home.

Walk the pt to the front door with assistance to where the cot is sitting. (or use a stair chair if you like)

Have the patient sit on the cot.

Push the "up button on your 125lb elec cot. Weight lifted = 0

Hook the cot onto ambulance and have your partner grab the handles with you and lift. Weight lifted = 125+250=375. 375/2=187lb. 187lb/2 people lifting=93lb each

Now while your waiting in the hall and the patient has to go pee? Push the down....

Now the cot needs adjusted to unload into hospital bed..... push the buttons.

Seems to me technology, when used properly, is taking away alot of the manual part of our jobs.

I agree with the two person assist; however, not making excuses, but the call and decisions on how the patient would be ambulated to the unit was no longer my decision once the senior staff took it over, made the pt walk and sit on the crew bench which is one of the reasons I find it so frusterating.

If my tone was interpretted as believing that "everyone who phones 911 deserves the stretcher to be brought right to them" well that is simply not true. I believe that every patient deserves to be transported on the stretcher in the position of comfort and should not be discriminated against or carefully chosen who or who doesn't get the stretcher based on personal bias or laziness.

I don't consider any of the patients who I choose to lift "unnessesary" I think it's an intregral part of patient care and is a more proactive approach when done with proper form.

Power cots are useful, but for the place I did my practicum with, it was against policy to lift them into houses because of their extra weight, and in my experience, with the uncx pt's, the majority of the difficult lifting and moving is done in the house and to the stretcher outside.

Okay I've read several posts in response to mine, and I'd like to start off by stating that perhaps I should have explained myself more clearly.. I absolutely agree that in which circumstances you decide to use your stretcher depends on your geography and patient status.

However, I'll lay out a call for you I did the other night which has made me have a strong opinion on this particular topic.

At around 0230 on my last night shift, my partner and I were sent to a local nightclub for a

"27 year old female patient, possible overdose".

Now anyone who's been involved in EMS for longer than 15 minutes knows what that dispatch info can possibly mean, anything from a drunk girl who had one sourpuss shot too many, to a party gal who has been drugged and sexually assaulted, driving to the call I had my pre-conceived notions but I kept them to myself like I always do.

We arrived to find a young girl slumped over against the wall outside the bar. The police were on scene as were hundreds of party animals in various stages of alcohol induced debauchery. I walked up to the girl and asked her what was going on, she promptly puked all over her self and then told me she thought she had been drugged.

A quick primary assessment revealed a drunk girl with an slightly altered LOC and no obvious signs of trauma or injury. The girl was literally covered in emesis and her clothes were all askew providing myself and anyone within a quarter mile a view of way too much skin. I asked my partner (first time working with this particular guy) to grab the stretcher and he said something that literally made the hairs on the back of my neck stand up with anger.

"Hey, HEY!! Can you walk? Stand up and walk to our ambulance"

Where do I start?

I have lots of things that drive me nuts in this business, but making patients walk to the ambulance when they are unable to safely do so is right up near the top of my list.

I had a brief little "professional discussion" with my partner about the issue, with him ultimately "pulling rank" and forcing my patient to stand up and stumble to the ambulance.

What happened next? You guessed it, the patient fell to her knees several times, vomited again, and then fell stepping into the ambulance causing herself to become sufficiently wedged between the stretcher mount and the adjacent wall. As I crouched there with my partner, straining and stretching trying to free this drunk pukey woman from her confines, I couldn't help but fume as drunk after drunk after drunk walked by our unit and stared/laughed/heckled.

It was wrong. We looked like idiots and our patients dignity was compromised.

If a patient meets you at their door with a lacerated hand....ok they can probably walk to the unit, but with my aforementioned case, walking the patient is unprofessional, rude and incompetent.

As for EMS being perceived as a low status job...I think that mainly has to do with your attitude, I am all for the "work smarter, not harder" mentality but the fact remains that our job will always have an element of manual procedures which will not be replaced by new technology such as power cots (which add an additional 50-60 pounds to your load)

As EMT's/Medics our backs are one our most important tools!!

I've just come back to work post a nasty back injury and I'm far more choosy about which patients I carry to the vehicle now.

You have to consider a number of factors I suppose - Complaint, Status, Weight, Extrication Difficulties, Distance to Ambulance......

I can think of examples where I've seen patients who are relatively sick being walked to the vehicle due to their weight or hazards in their home......

I don't think I've ever seen a written procedure here in New Zealand (Kiwi please point it out if I've missed it!!!) but I think anyone who's been around for a while knows who needs carrying and who doesn't!!

Yes yes I've heard the excuses before,

"I'm not using my back and lifting a patient unless I absolutely have to".

How about this, if your THAT concerned about your back, get in the gym, drop some weight, do some core exercises, improve your health and conditioning to the point that your obvious physical limitations DONT affect patient care. If your too old/fat/stubborn to do something proactive, how about you go find a nice relaxing 9-5 job that's not going to stress your back too much.

How hard is it to just grab the stretcher? Its right there, it takes ten seconds, and that's what its designed for so why not use it?

Once did 7 medevacs in a 24 hour period...We only had a single BLS unit with two staff covering three reserves with no relief until tour was up.

Your on the right track with a healthy thirst for knowledge, welcome!

Update: Got accepted into the fall 2012 intake for the ACP program at SIAST. I recently moved from a very busy northern reserve community which ran a single BLS unit to a rural community with lots of very great experienced coworkers and bosses, but very few challenging calls so far. My concern is that my skills and knowledge have become "rusty" over the past couple months and that I won't be as sharp and prepared for ACP school as I otherwise would have been when I was using those skills on a daily basis.

I'd like to quickly comment on what is referred to as "black humour" which I'm sure we have all either experienced or even taken part in. I've noticed it's fairly common in EMS/Police and to a certain point I think it can be helpful to certain people in dealing with the stress of the profession.

Where this "humour" becomes an issue is when it negitively affects the entire organizational culture and creates an uncomfortable work environment. One instance in paritular was around a year ago when I was 3 months into my EMS career working in a northern reserve community and had my first code which was a 10 month old with an hour from the hospital with both parents present. The black humour was introduced by group of police officers who some terrible things which made it much just that much harder to get over the incident.

Dwayne, I really enjoyed your "test" idea in the supermarket. I do agree that for the most part people are truly kind and loving but have created a protective default towards strangers until you reach out and show a bit of vulnerability.

Kind of strayed away from the original topic, still slightly jaded by that particular incident early in my career and I suppose I also felt a bit introspective with the new year only 11 hours away!

If you have something on your mind I think the majority of people would be more receptive to reading about it in a forum as opposed to through a PM. If you want an opinion on something I'd suggest to post what it is and get a few different opinions and views on how to handle it.

Aha! Now I know where you work too! EMS truly is a small world.

Not to mention the NOCP's !!

No school should be teaching to protocol!

BTW: Take the new MFI course at SCEMTS, I helped develop the program and made the ppt.

Ah you must know Sh Cr then, small world, he did a couple years in Pelican and recently did some recerts for the nurses.

I hit the gym 5 days a week. Here's a breakdown of my routine which has been giving me very positive results so far!

Day 1: Chest/Abs 16 minutes cycling for cardio

Day 2: Bi/Triceps 20 minutes on treadmill

Day 3: Back/Hamstrings/Glutes 12 minutes cycling

Day 4: Shoulders/Abs 20 minutes treadmill

Day 5: Quadriceps/calves 20 minutes cycling

I'm always sure to take my preworkout formula which includes various combinations of amino acids and post workout protein shake within an hour of completing workout.

I have a vegetarian diet so sometimes it can be tough to find whole foods with sufficient protein, but you just have to know where to look!

Ah, going to have to find myself a pair

Damn I'm good!

Back in the day I was a PCP student there, Had a blast with D.D., N.P., Bob & the gang.

That ACP made a real impression on me in those days, and she tought me alot about how to critical think rather than follow flowcharts.

I hope D.D. still says "Big poke from a little prick" prior to starting every I.V.

I do with my nervous patients.

Too bad they are not ALS, I still have my Sk reg and would come casual fo sho

I can't remember who let me spinal the Diabetic so I could get my final competency and not have to extend my practicum, but it was a pretty hilarious last call. Especially once the d50 was pushed....

Yeah they run a really good service here thats for sure. I've only worked here a month and came from working in Pelican Narrows... Have to say quite a change in atmosphere and work environment!

The main reason I came to this service was because I had heard from classmates that they had a lot of great mentors and that's exactly what I need at this point of my career. Glad to hear that you enjoyed your rural tours in Swift and in the near future it looks like they will be getting ACP's... But who knows entirely when that may be! Which college are you taking your medic through?

You would't happen to have 1 ACP working as a ICP would you?

....haha sounds like you figured out where I work! Are you a former employee?

Welcome mate

If you're considering Saskatchewan give me a shout!

Where do I find myself a pair of these.. "rock shoes?"