WelshMedic

Correct, crews do not determine response urgency.

Having dispatched myself, YOU ASK...

Not everyone calling 9-1-1 is expecting lights and siren.

If it is a hang-nail, you ask and discern if it is a true emergency.

The mentality that every incident is a life-threatening emergency is what makes people so tired of responding EVs and perhaps makes some reluctant to yield to EVs.

There is a world of difference in a traffic mishap involving an ambulance driving routine compared to

a responding ambulance disrupting traffic, taking right-of-way from others, causing others to unexpectedly stop and get rear-ended, etc.

Why did that police officer not drive himself, or have another officer drive him, to a local ED?

Is it all the BS calls that are causing such delays?

So true, and also: most studies point to the fact that the time difference is so slight that it has no effect on mortality and morbidity. Thus making it another EMS myth that needs addressing in order to gain respect from the rest of the medical community.

WM

You could always come to Holland: if windmils and tulips are your thing....

WM

The decision to take away pediatric intubation, whilst being emotive, does appear to be evidence based. Pediatric intubations are thankfully rare, but the flipside is that maintaining the skill level required is difficult. Even with the best CE programs and OR rotations it is still very different to the actual practice. I consider myself to be reasonably well-educated, not to mention regularly trained. However, I still managed to miss a right stem intubation in a pediatric trauma a few years ago. We are not superheroes, we are just ordinary folk doing the best we can. OOH pediatric ETI may just be a little too much to ask of an EMS provider

WM

Hah, actually, I've never been to Baltimore. However, if I do run into you at some point, I'd be more than happy to buy you a beer. Thanks for the compliment on my English by the way, it's my second language.

Anyway - anyone with comments on the lesser of two evils? Volunteers vs. combined fire/EMS?

It's a deal!

Just to give my 2cents worth on this subject - I think that neither option is attrective, but if that I had to choose then I would go for professional. They are generally more accountable and have more time to train and hone their skills.

WM

I'm from Iceland. Sorry for the confusion, I'm not used to this new EMT City yet, the old one had the location below my screen name for every post...

By the way - I never did get used to the "old" EMT city, either. I miss the circa 2003 EMT City (ems-online.net, as it was called back then).

It's OK, I was just confused because your english is so good! I thought you were a native speaker (maybe you are...). Talking of 2003, were you in that group of Icelanders in Baltimore that we met at the meet and greet before the JEMS conference? If so, you still owe me a beer, haha!

WM

As far as I've seen this is the same cons to every Marketable Dispatch Protocol. Things AMPDS does offer is a structured system for dispatchers- people w/o any medical training or knowledge to send help. AMPDS was initially invented to ensure quality dispatch. Care given over the phone was brought in later.

There, in a nutshell, is the problem. Why are untrained personnel allocating resources on the basis of a computer analysis instead of actual need? It will all end in tears.

wm

Hello Kristo,

Where are you? Which country are you talking about?

WM

The problem with a politician is that every time they get a brain fart, they feel the need to share it with everyone!

Chill, chaps, this'll never make it through legislature.

WM

Hello All,

I didn't write the piece in French to show how wonderful I am at languages, I already know that .

I also thought twce about replying in French, as I was aware that it would seem rude to some. However, Natacha posed the question to me in French and it seemed even ruder to not answer it in the same language.

And to think i was telling her in french what a friendly bunch you are..........

WM

Hello,

Merci pour ce gentil message! Vous etes pompier ? Depuis que je vis aux Etats-Unis, etre pompier/paramedic me manque beaucoup donc j'ai decide de le faire ici. C'est complique, il faut que je refasse la formation mais je suis tres motivee.

J'espere que votre epouse changera d'avis.

a bientot.

Non, je ne suis pas pompier. Je suis infirmier graduee en Pays-Bas. Ici, la service d'urgences medicaux est charger des infirmieres, pas de paramedics. Nous n'avons pas aussi les medicins, comme La France.

M'èpouse ne sera pas s´advis comme elle est une femme! Desolée, cést une blague!!

Bon chance avec la formation, vous réussira!

WM

My intial guess would also be AFlutter. However, as we all know folks, treat the pt. and not the monitor. What did this pt. present with in terms of symptoms?

I'm not sure I'm even going to do much with this rhythm as long as my patient is haemodynamically stable.

We don't cure 'em, we just haul 'em in!

The above may sound fairly flippant, but I do firmly believe that doing no further harm is an important tennet in our work. The good clinician is not the one who takes every trick out of his bag just because he can, the good clinician is the one who weighs up the benefits for the patient. An so also knows when not to do something.

WM

Natacha,

Félicitations! Vouz avez suivi vos reves. Je voudrais aussi l'habiter en Etats-Unis dÁmérique, mais ma femme ne veut pas émigrer. Bienvenue aussi ici, on peut apprendre beaucoup. Les membres sont sympa!

Vos reves n'arret pas avec les pompiers-sapeurs, n'est pas? Nous essaierons changer votre avis, soins medicaux n'appartient pas avec les pompiers! Etudiez les postes ici, c'est une révélation.

Bon Chance!

WM

(sorry for my terrible french, but I tried!)

Hello all,

I know this topic has been done before, but I love it so much I decided te ressurrect it. I am currently in the process of writing a document on my time in nursing. This year it will be 20 years since I first sat in those chair/desk combination thingy's (you know what I mean, right?) in the lecture theater. In the meantime I have gathered lots of my own war stories, some of them sad. I don't want to focus on the bad side now though, I want to have some fun.

Here are a few of my favorite stories:

My first story is from 10 years ago, a dairy farmer collapsed in his milking shed, in full arrest. We pulled up as the second crew just in time to see all 2 tons of Daisy walking to the first crew, turning around and shitting all over their equipment and uniforms. I laughed so hard I couldn' t get my bag open to help.

The second one stems from my time as a Staff Nurse at the Whittington A+E (ER to the yankees). We had a bloke come in with a cucumber up his arse. My mate Eddie, one of the other nurses, decided to have a bit of fun. So he sent in the most junior of the student nurses on her own. She was the twin set and pearls type that had had little experience of life. After a moment, she comes back out, looking as white as a sheet. "Eddie, THAT man had a cucumber in his rectum. What do I do?" (at this point I was already crying). Eddie studies her for a moment and replies: " Well, darlin', if I was you I would fast-bleep the greengrocer, that might help".

She never said a word, she took it like a good 'un.

I have an EMT colleague that is a great bloke but, erm, how shall I put it? He's not the brightest bulb in the box. We went to pick up a hospital transfer the other day. When we got there, the pt appeared to be somewhat overweight. She gets on the stretcher herself and my crewmate looks at her and says: "You're in luck today love, this stretcher can take up to 245 kgs". She looks at me, bursts into tears and says: "but I'm only 108!" . Try not laughing when she's looking straight at you! And the worst thing is: my crewmate, to this day, still doesn't understand why she started crying.

WM

I'm not liking the sounds of this system at all.

Why am I not surprised?

No transport? So I'm assuming the medic will jump on the private/vollie transport ambulance. So does that mean they have to carry all their ALS equipt with them off the truck and onto the ambulance for every call? How do you get back to your truck after the call?

Do you ride solo or with an EMT/Medic on the non-transporting trucks?

Thanks again, I read the thread regarding which service to visit during your trip here. The banter gave me a headache.

You are largely right. NCC has double medics. Usually the second medic will drive behind the ambulance that is transporting. If there is a second call, however, the second medic gets diverted. You then have to arrange a rendez-vouz after you've both finished your calls. Don't worry though, this rarely happens.

WM

(And yes, they carry all the equipment with them, and all the trucks are double equipped as well as double paramedic crewed.)

oh oh oh can I come too?

Maybe I can arrange some ride time where I work if you are interested.

I feel an EMT city mini get-together coming on! Where do you work?

WM

Hi,

I know NCC as we have a ride-along programme going with them. The commute from Philly will take you about 45 mins, depending on traffic.

There is no SSM, as far as I'm aware.

The shifts are (or were last year, at least) )0700-1800 and 1800-0700.

Equipment? Well they are an ALS service that does not transport so they utilizie custom built Ford Explorers instead of ambulances. In the city the private-contract BLS unit transports, out of town it is largely vollie Fire.

They are largely based at Firehouses throughout the region.

Career opportunities? Not really sure. What I do know is that you couldn't wish to meet a better bunch of people!

Say hello to everyone when you get there. Especially Lt. Mark Allston, my buddy down there.

We will be visiting again in september from Holland, so I'll be organizing a get-together. Hope you'll find time to join us!

WM

If you are a single, male flight medic or know someone who is, contact itku2er/Terri immediately. Her sanity (and ours) could depend on it!!!

Why, does she want to be taken to new heights?

WM

Is this an option:

Set a baseline of care at federal level that everyone is entitled to. Authorize a (limited) number of insurance companies to cover this baseline level of care through premiums. Then make health insurance mandatory for everyone. But make it income -indexed. Those who can pay, do pay. Those who can't get helped out in the form of premium subsidies or tax rebates.

Simple really, isn't it!

WM

(well, it works here anyway)

The best time to visit Jim's is a summer evening. After eating the culinary equivalent of Nirvana you then walk it off by sauntering through South Street whilst people watching and visiting all the quaint boutique stores. You can finish up by visiting any one of the bars or restaurants on the street, although this is a personal favorite of mine: http://www.gethappypub.com/

WM

I was reading an article in the newspaper last week. It was about Mr. Obama's planned heathcare reforms. There was a lot of detail that I can't recall now, but one fact stuck out: The US spends more on healthcare per head of the population than any european country and yet something like 48% of the population is underinsured or not insured at all.

That fact alone tells me that the system is broken and needs fixing.

WM

I was thinking heat stroke.

Whilst heat stroke is a plausible diagnosis, it does not sit well with me that they are both suffering from it. It's too much of a coincidence.

One of the other possibllities is an (?accidental) overdose of XTC or GHB. Both of these drugs are connected with hyperthermia and, if untreated, DIC (Disseminated intravascular coagulation).

Read all about it here

WM

Thanks Dust for the links.

First of all let me say that I am not denying that any of this is true. However, I would like to nuance one or two areas, particularly in relation to the first article. First of all, in the current climate of polarization of the migrancy debate, it has to be noted that the comments were made by a politician. What will you hear from a politician? The vox populi, of course! That's how he gets elected for each term. The fact remains that it is a very small minority of immigrants that refuse to integrate and are intent upon being "a leach" on society. You may wonder why this subject is close to my heart? Well, that's simple: I have the same skin color, am completely assimilated into dutch society. However, I am and always will be a migrant.

I am aware of the fact that there is a difference in work culture between the US and Europe. Note that I avoid the term "work ethic". To me, the term "ethics" is irrevocably intertwined with a set of personal beliefs and values. That is why I am so vehemenently opposed to any generalizing comparison.

One of the reasons that we enjoy better pay and benefits in Europe is that we have a long and rich tradition of trade unionism. We have had a system of collective responsibility and representation for more than 200 years, something which I passionately believe in. Of course, there is a price to pay for all of this: taxation. However, this is a relatively small price to pay in camparison to the benefits we enjoy. In any society there will be opportunities to milk the system, one may also argue that it would be easier in Europe. It still, as I already stated, is a very small minority.

Furthermore, it could also be argued (and has been for a long time) that when one looks at productivity levels, things are a much more even playing field. Take EMS, you yourself are a fervent opponent of the 24-48-72 hour shift patterns that are commonplace in some quarters of our profession. Working a 36 hr week and then closing the door to spend time with your family is of irreplaceable value. I, for one, do not intend giving it up.

WM

The silly assumption was that the U.S. work ethic can be found in Europe.

Obviously not.

That sweeping generalization is not worthy of you, my friend.

WM

Were they invited and did they have a personal escort? Chances are you might not even make it past the front door with very tight security in some trauma centers so they should consider themselves lucky they got as far as they did.

They were invited as part of the JEMS conference programme. They are both very experienced ER and pre-hospital RN's. That's why it was a shame.

WM