History Nut

My experience was in Southern California. When I hired on a private ambulance company in the mid-70s, EMT-I wasn't required. The fact that I already had my Red Cross CPR and Advanced First Aid cards thrilled the personnel manager as he didn't have to fake a course to get me the cards. I had been instructing first aid and cpr for the Red Cross for years. During my three years on the the private company, I took an EMT-IA(about 80 hour course to qualify to work ambulance) which was basically First Aid and CPR with added tools of a BP cuff and Stethescope. We also had more modern traction splints. In 1978 I got on Los Angeles Fire Department as a "Paramedic Trainee". That was a Civil Service job title and had nothing to do with medical certification. I got another EMT-IA course("we're going to teach you how to do it our way") and worked an EMT-I ambulance(later known as a BLS ambulance) for several months until a slot opened in PM school. In early 1979 I was finally 'certified' as a Los Angeles County Paramedic. Over the next 24 years titles and designators evolved. We became 'EMT-P' while still referred to as Paramedics("are you Paramedics? No there is just one of me"). The State of California took over the testing and certification process from the Counties although each County could put their own tweeks on PM scope of practice. The State changed certification to licensure but it was just the name that was changed. They dropped recertification tests for those that had a lot of time on the job as long as you kept your Continuing Education up. They changed to National Certification just before I retired so I never took that test. Obviously, the terminology/requirements differ a lot throughout the country and between countries. One has to be mindful of the alphabet titles to work wherever you are employeed but the patients are the same wherever you are working. They are people in distress. Our job is to provide aid and comfort to the suddenly ill and/or injured. The rest is for people who shuffle paper for a living. Good luck on your time in what is either a job no one ever invented or the world's third oldest profession.

Congratulations on your retirement! When I retired in 2003, I didn't look back. I am proud of my years of service but am glad I don't do it anymore. On one of my last shifts, someone asked me if I would miss "IT". I told them that I wouldn't miss anything about the job except for the people I worked with and around. I had the honor to be associated with some of the finest people in the world and am humbled to have been afforded the privilage to do what I did for around 28 years. Let the bad times go if you can(it's hard) and remember the good times.

Being so concentrated on your ALS that you forget to apply BLS and the patient suffers. A "Paramedic" is an EMT-I with more tools and needs to remember that.

I have been retired for over ten years now but still remember the frustration of having to follow full protocol when I knew that the patient would best benefit from rapid transport. The study cited looks at end outcome which is the kind of study that is in fashion in medicine for the last 15-20 years. Results do speak for themselves but the conclusions drawn are flawed. The police unit that gets on scene first AND has the proper training/experience to recognize the need for rapid transport is the correct solution in those circumstances. However, the LEOs I worked with catagorically didn't want to be involved in patient care in any way. Granted, if a fellow officer was the patient, they thought nothing of scooping them into the police car and taking them to the hospital. Their problem was not understanding the Trauma system and they often took them to the ER that they 'liked' instead of the best for the patient. ALS units took longer times because they risked more in the form of censure/discipline if they didn't "check all the boxes" in their patient care. Sometimes we tried to scoop and run only to be met with demands for a full report by the base station while performing an emergency transport. Then when we arrived at the ER, we were met with a lot of questions like: "no I.V.?", "he should be in full c-spine?" and others. I tried to make the point at a tape review once that it took time to apply everything the base ordered in the field and then we still had to transport. Requiring base personnel to ride along more often would have helped the understanding of the different roles but it didn't happen enough. The study of outcomes only leaves out the most important part: why is there a difference?. I hope they are going to look into the why beyond the short-sighted idea that "ALS must not work because outcomes are poorer." There needs to be training not so much with the field personnel but with ER staff that just because the patient arrives by ALS unit they shouldn't demand full ALS treatment to have been applied and instead to rely on the good judgement of their trained and experienced medics.

Sorry to be "picky" but don't you mean the "Columbia", not "Discovery" as the shuttle that broke up on reentry?

I have watched both "Doomsday Preppers" and "Doomsday Bunkers". Some of the "preps" are good ideas. What most people should be considering is becoming a "Disaster Prepper". A couple of years ago, my Sister and her husband lost electricity for about a week in mid-winter. Their gas heater wouldn't run because there wasn't electricity for the forced air fan and the safety systems shut down the heater. Their stove was electric too. I made it through the '94 Northridge E-quake while on duty. We were without electricity for about 12+ hours. Several neighborhoods were without water service for some time. As a "Disaster Prepper" one should look at it as probably equivalent to a week-long camping trip. Supplies like food and TP can be built up over time by buying extra cases/packages during "sales" of the same food, etc. that you normally consume. It is also a good hedge against price inflation. Coordination with neighbors and friends of a like mind are key to a successful outcome. Defense against lawlessness could come into play if the disaster is long-term or widespread as in Katrina. If you do choose to be responsible for yourself and yours by obtaining a firearm, then please get proper training for yourself and any others in your group that may have to use one. All that being said, the most important tool to survival is the obvious one; your own mind is key. People have had every resource required to survive an event and have just 'given up' and died/killed themselves. I knew parents during the Cold War that said if Nuclear War came, they would take their children and go to Ground Zero to end it all. I was horrified by such thinking. God gave us life, we do not have the right to discard it without giving it a good try. As bad as things could get in a so-called TEOTWAWKI situation, if you are breathing and moving you should 'keep on trucking'. Remember that the worst case scenerio that most of us can conceive is no worse than a lot of the people in the World experience every day of their lives as their 'normal'.

I haven't checked in for awhile and just saw this topic. In 1978, I joined Los Angeles City Fire Department to become a Paramedic. At that time, it had been only a few years that the City Ambulance Service had been transferred from LAPD administration to LAFD control. It definitely was not a happy "marriage". I am highly biased on this subject because of things that happened on the job so I don't think I should be a good source. Hopefully you can find some published sources that can tell the story. During the 1990s (I can't remember the year) events occured that eliminated the seperate job classes of "Paramedic" and the older "Ambulance Driver" and "Ambulance Attendant". All personnel became "Firefighters" by decree. I was one of the old dogs who didn't take the Fire Suppression course that was offered to the former Paramdics and EMTs. It is an emotional subject for me. I retired in 2003 and am glad I did. Some of the medics still on the job say quality has gone down. I don't know. While still working, I had occasion to work with FF that had become PMs because they wanted to and they did a great job. I also knew medics that I wouldn't let get near me if I was hurt/sick. Now that anyone that wants to be a Paramedic on LAFD has to be qualified as a FF first, some folks are locked out of the job. Mostly it is women and small statured men that can't pass the FF PAT no matter how good a medic they would become/are. No matter what form the service takes, it really comes down to the quality and professionalism of the people. Good quality people will do a good job even if it is one they didn't seek. Even the most irascable FFs I worked alongside would put out a tremendous effort to help someone that they realized the patient really needed help. If I don't stop now, I will probably 'write a book' so I hope this brief post helps. Hang in there.

I have watched this show from the first episode. I was prejudiced against it from the start as far as reality comparisons. I too groan when something ridiculous is shown. What has surprised me is that I am beginning to like the show! I agree with others that it has so many technical errors that it would almost qualify as a training film in how not to do the job on that basis. In some ways it makes me think of "Police Story" back in the 70s or 80s. Joseph Wambaugh commented that he was trying to get the producers to show more of the "emotional violence" that a police officer endured rather than the emphasis on Hollywood 'sex and violence' that dominated the writing. "Trauma" seems to mirror that description only for EMS. A medic endures a tremendous amount of emotional stress in their work. Not all of it is directly 'case' related but ties into the work environment. "Trauma" is hitting that nail on the head in a highly dramatized fashion. Because it is getting that part 'right' I am beginning to like it while being able to let the technical errors pass. Perhaps I am just mellowing in my old age or have been retired long enough that I don't care about the details so much anymore. Of course it doesn't hurt that the blond is HOT and I am definitely a DOM. Regarding Richard's item 18: I don't know about current policy but in the 60s, the FAA and DOD had a joint policy that civilian airliners with landing gear problems could be diverted to military airfields due to the better crash rescue/firefighting equipment and personnel available on military fields at the time. Civilian fields have upgraded their standards since then so I suspect that has changed. I remember working some shifts during the '84 Olympics at LAX on some part-time RAs and was up close with the Crash apparatus. To describe them as 'impressive' is an understatement. I also remember in the mid to late 50s hanging out at Joplin Airport where the only 'crash' apparatus was a 40s/50s era pick-up, painted red with a couple of large CO2 bottles in it and some hand tools. I am not sure who was supposed to 'staff' it other than the CAA people or the airline ticket agents. Joplin Fire would of course respond with structure equipment but there was nothing based at the field. Of course the largest airliner using the field was American Airlines Convair 240s and Ozark Airlines and Central Airlines DC-3s so the number of potential casualties was limited. Oh well, perhaps I am getting soft in my old age.

This is also why, if you see a friend at the airport and his name is "Jack", you never greet him with the phrase: "Hi Jack"! :wink:

I have had three years private ambulance work followed by 25 years working a paramedic ambulance for a public first-responder agency. I never had to go off duty with a back injury. I did feel injury many times but nothing that prevented working. I attribute my 'luck' to learning proper lifting techniques before working in the field. Learn 'body mechanics' well and you will have a better chance of avoiding serious injury. NEVER hesitate to ask for assistance no matter how much someone whines about having to help you. Always refer to it as a "safety" matter and it will shut most supervisors up. Since you have a documented back problem/injury, many companies/agencies will disqualify you. Workman's compensation being what it is, they don't want to pay for a previous injury when it is aggrivated on in their employment. Sometimes it isn't fair but then life isn't fair. I do notice that in retirement, I pretty much have a 'background' level of discomfort in my back. Part of that may be due to letting myself get 'out of shape' now that I am not working in the field. Good luck.

I thought it was funny. Of course, I would have added that the dealers were off-duty firemen moonlighting at the casino. :wink:

I take keyboard under fingers somewhat hesitantly on this subject because I know I am going to come across as a grumpy old dinosaur but so be it. I reserve the right to express my opinion based on my experience. After all, I wasn't 'brain dead' during most of those 25,000 plus EMS runs I did in my career. First off, I am not citing any 'studies', just my experience so those of you in love with 'studies' in the medical field will be frustrated. Although I worked in a disciplined agency so I followed all the protocols that were required, my opinion of most medical 'studies' is that their greatest value is that they are printed on paper so they might help start a fire in an appropriate situation. A case in point is the study cited in the original post. Some doctors did chart reviews and came to conclusions about spinal immobilization using spine boards based on hospital outcomes. I am glad they got to publish so they could make a few extra bucks and brag. I am not impressed. They drew a conclusion about one aspect of patient care from cases that have too many variables to make a single conclusion valid. What were the mechanisms of injury in each case? At what point was spinal immobilization begun and was it properly maintained throughout? Was the board padded in the lumbar and cervical region to maintain the natural curve of the spine? Was the body padded properly so the strapping system kept the patient still? What kind of strapping system was used? Upon hospital arrival was the patient kept properly secured or like most cases completely unsecured and left on the board? When sent to X-ray, was the patient escorted so enough people were available to keep the patient immobile during the X-rays? The last originated from a student in one of my first aid classes who was an X-ray tech. He told of patients being brought to him on a backboard and everyone would leave for him to do the X-rays. He had no idea what a long back board was so he would just ask the patient to 'scoot' over onto the X-ray table! He was taking first aid so he could better understand the apparatus that was often on his patients. The popular thing these days are "statistical blind studies" if I remember the term correctly. They sound neat as they assume (!) that repetition in numbers eliminates errors. That works great in land survey. We would 'tape' a line over and over at the same pull on the 'tape', the same side of the stake, noting temperature for its affect on the 'tape' and after doing it a certain number of times, calculate the accuracy based on 'error canceling error'. It works well because by applying the "scientific method" there is only one variable. For those that have forgotten high school science, "scientific method" allows only one variable in any experiment. Dealing with real humans in multi-caregiver and facility situations involves way too many variables to validate even 'statistical blind studies'. If one wanted to do a real study involving the benefit or lack of benefit of long back board spinal immobilization, it would have to include careful study of all variables. First a study monitor would have to ride with the prehospital unit to score each variable. The monitor would then have to continue into the hospital setting to validate any variations and findings. Hospital charting is far from error proof both accidentally and deliberately. After all the separate records are collected they then can be categorized for variables and only those cases used that have only the LSB, properly used, applied to the experiment. Of course to be ethical, the study monitor would have to get patient consent of those that were not going to get boarded after explaining all the risks. Good chance of that happening! Medical studies, especially in the pre-hospital setting are often applied to a patient without their knowledge or consent. I am surprised that some really sharp lawyers haven't made a fortune off this simple fact. As far as my experience with using LBBs for spinal immobilization, I believe that they are a useful tool when properly used. The flaws are in standard application of the tool and use protocols dictated more by the latest lawsuit results than true medical needs. While I was still working, we didn't have any protocols for field clearing of C-spine. As far as application protocols, that varied with each facility that received the patient. One thing about medicine, is that there is no consistency between facilities and schools. It is very dogmatic and not very analytical anymore. Thanks to liability, protocols triumph over analysis. I would like to hear the experience of those of you that do work with clearance protocols. I would believe your 'anecdotes' over all the 'medical studies' in the world. Now that you all have concluded that it is good that I am retired as I am no longer a threat to the human race, I hope you take a moment to think about what I have posted. I believe that 'medical studies' do have some use. They should be used to give us a direction for true analysis and careful experimentation long before changes in the standard of care are made. Unfortunately, the medical profession seems to jump to conclusions based on the latest 'study' and that rolls downhill to land in EMS's lap. In case you are interested, I have seen 'standards of care' totally reverse themselves and some come full circle regarding some procedures/meds in my time on the job. I am just saying we should all remember our anatomy and physiology and use our brains before swallowing whole someones 'paper'. Regardless, since EMTs and Paramedics are at the bottom of the patient-care ladder, you can only follow what your area's protocols require. Maybe someday EMS will be so dogmatic that they can train monkeys to do our work (oh, wait, firemen already work ambulances don't they? :twisted: ) but until then, we should keep using what we know and what we learn through experience to do the best for our patients.