EMS49393

There is a catch. If you're ALS, your employer has to set up your medical command status with PA before you can do any ALS procedures. It's been the hold-up of several of our newly graduated medics here lately. Also, you have to get on them (so to speak) about your stuff. They're giving out the excuse that they're overwhelmed with H1N1 stuff right now and they aren't processing any certifications unless you call them and ask them. It's ridiculous, and I hope it ceases when they don't have the flu as an excuse not to do their job. I had no problem, but I went in person, and it was during the summer, so no H1N1 to blame for all their problems.

Assuming they were just good Samaritans and perhaps were off duty with no gear, they did exactly what I would have done in that situation. I don't carry one piece of gear with me when I'm off duty. I also don't wear EMS or fire related clothing off duty, but that's another issue. What else could I do if someone was having an active seizure while I'm out slumming in my favorite fabric store except protect them from harming themselves and call 911? I can attempt to gather as much information as I can for the incoming EMS unit, but honestly my first priority is making sure the patient doesn't slam their head against the floor or other hard object during the event. Sounds to me that the good Samaritans, if they had no equipment accessible, did an appropriate job. As for the other people involved. I know how stories can be falsified or enhanced. From the information we have so far, they appear to be guilty as sin for negligence, but it's not for me to judge them, especially with such limited information from a newspaper. I'll be more interested to see how things pan our for them in the end. As for the lady involved, it was truly tragic. God Bless their family, and other child, during this time.

http://www.saems.com/ I don't know how to do the link thing, but there is the web address. Reciprocity in PA is easy if you have national registry. Although it's technically not a registry state, they'll take your registry, license from your home state, have you fill out an application, they'll make a call to your home state to make sure you're eligible to practice, and you'll have your PA card. When I moved from Arkansas to Pennsylvania, I went to the regional EMS council for my home region and had a card within 20 minutes. Good Luck.

We do it because it is our job. Very few people could or would do it. There is no shame in counseling sessions when you're at the breaking point. There is no shame in needing the occasional sleeping pill. There is no shame in needing a day off. There is no shame in asking for help. Figure out a fast way to deal with it. The more baggage you carry the heavier you are when you're trying to do your job and the less effective you become. You'll have to put these bad calls and shifts behind you and concentrate on continuing to do the very best job you can do. Good luck, and consider a vacation day or two to sharpen your blades.

If you would have understood the post you would have seen where I noted that the redness resembled his mesh undershirt. He had several layers of clothing on and I'm sure was a little chaffed in more than one area after sweating all day. Also, he never complained of pain, only of a "tired" feeling he noted was more than likely a result of riding his bicycle all day. I did palpate the entire spine. The medical director has since found that I did not err in my care of this patient. Nothing is "plain and simple." I wouldn't immobilize a nursing home patient with a compression fracture when it's been treated and I'm there for another reason such as a routine transport. Perhaps it's all cut and dry in your world, but in my world all my patient's are different, and I treat them all differently. Thanks to everyone who had valuable input.

I'm in my mid-thirties and back in school working on another degree, this time in history. I actually like school a lot more this time around. I'm older, it means more, and my drive to graduate with honors is much greater. Although I didn't do poorly when I went to college the first time in my teens, I didn't do as well as I could have because I wasn't mature enough to appreciate my classes. Unfortunately most young people think that a class that does not directly pertain to their course of study is useless, which is usually far from the case. I hear paramedic students talk about how they don't want to get a degree because they don't want to have to take any English, mathematics, or regular college level A&P. These are the same students that can't form a sentence in a narrative or calculate a drug dosage. Nearly everything in education may eventually come back to haunt you at a later date. You can get a degree in any subject your heart desires. I'd suggest that you research different employment requirements before you settle on a degree. You might find there isn't a snowballs chance in hell you'll ever use an Emergency Management degree. Pull up careerbuilder or monster, search jobs that may interest you down the road and read the requirements and preferred abilities for those jobs. They'll give you a much more accurate idea of what degree will actually land you a job. These older guys on here are correct about one thing... a business degree is a highly desirable commodity. It's specialized enough to get a good job, and generic enough to qualify for more obscure but interesting jobs. It's one of those not-so-interesting but highly useful degrees.

I've done it before, not often, but a few times. I've had damaged cables before, and they had to have been damaged on the interior, because they looked just fine, meaning without fraying, etc. I wanted something remotely close to diagnostic so I could finish the call and get a set of cables that actually worked. The other times I've done it have been while waiting for patient prep. If I have a patient that requires a good shave to get the pre-cordial leads attached, I often hit the button while I'm doing other patient care procedures and waiting on my patient to be prepped. I certainly don't stand there and stare at it until it spits out or worry if it's a little wonky, since I plan on getting a decent tracing as soon as the patient has had his shave. It's the ADD in me, I have to have several things going on at one time to be happy.

Although not related to EMS but still related to medicine, Dr. Ben Carson wrote a book many years ago called Gifted Hands. For anyone unfamiliar with him, he is the head (nice pun) of pediatric neurosurgery at Johns Hopkins Hospital.

This is a joke, correct? What is an antect? Good, I hope they never try to make another TV show or movie about EMS, it would be better than putting for this garbage.

I'm not mistaken, I work more than 60 hours a week in this system. Management is well aware of the concerns from the BLS providers about these hospital based ALS chase medics. In fact, I have made them aware of numerous problems I personally witnessed the few weeks before my MICU went in service. Perhaps your QA system is different or better, or perhaps there are some ALS providers here that aren't exactly forthcoming in their documentation. I'd be interested to see if BLS reports in any way match ALS reports on some of the calls I've worked before the MICU went available. I'm actually only interested in one report in particular. I don't have any bones to pick. I was posting my opinion on the chase car system, as many have done before me. I could care less about any ALS chase provider here because I rarely have to deal with them. MY company is not bad, although the county-wide system itself is flawed, and I am not the first person to admit that fact. It is a waste of resources, as I said in my original post. I do not make the rules here, the fire chiefs do. I was told there is little the EMS departments can do about box areas, assignments, or anything relating to response because the VOLUNTEER fire chiefs make all the decisions. Unless you directly work in my system, I suggest you refrain from telling me how wrong I am.

It must not be working out so well in South-Central PA because they've had two ambulance services start MICU services in the past year. From what I understand, my company was a little sick and tired of having the hospital-based ALS chase cars show up on scene and say one of the following phrases to them (on nearly every call they were duel dispatched on): "Why didn't you cancel me?" "You can't handle this call?" "So, what am I doing here?" "What do you think I'm going to do for this patient that you can't do?" They would then go out of their way to berate the BLS crew throughout the duration of the call. I really thought they were exaggerating how poorly they were treated, and that perhaps their perception was a little skewed, but I had to work strictly BLS for the first three weeks I worked until our inspection and paperwork was finalized with the federation. Now I'm spending time trying to instill in them that if they are uncomfortable, if they have a patient that needs pain management, if they have any patient that makes them uncomfortable at their level, that they are to call me out and I'll transport in my MICU. It's still far from a perfect system here, really unbelievably far from perfect, but it's better then it was before the MICU was placed in service. The biggest problem I see with ALS chase cars that are not a part of your specific employee pool is accountability. These guys could treat people any way they felt because there were no repercussions. It's not as though my boss could reprimand them for attitudes or laziness. There is also a question of Q/A. They could do nothing on a patient that really does require ALS intervention (I've seen it here first-hand) and no one has any idea what they are documenting. They didn't see our reports, and we didn't see theirs. Now that I'm a paramedic that actually works for the service to which I provide ALS coverage, I am held to a standard regarding how I treat my fellow employees, and how I take care of patients, because everything I do can be traced though the company. Wait, there's more. I'm classified a second-due BLS ambulance in a large service area that has first-due ALS coverage via hospital-based chase car. So I will be dual dispatched as a paramedic unit along with a chase car that can conceivably have two other paramedics on board. A complete waste of resources, but it's "how the fire chiefs do things here." Which is ironic considering a few of us aren't even associated with the fire department. Thumbs down for ALS chase cars.

Well, I'm lucking out this month. We are having a lecture in a few weeks from one of our ER residents on c-spine immobilization criteria, techniques, etc., at our monthly audit review meeting. There has been a lot of discussion and change in the thought process behind this skill, and it will be nice to have a review of what we've learned so far and where we're going. I plan on taking some fantastic notes (of course I always do) and I might be willing to post the information gained from this Doctor's research for discussion.

Thanks for posting the entire story. I'm not tech-savvy enough to figure out why my links never work. It's time for me to just post stories and forget trying to insert links. Unfortunately, it's been a bad weekend all around. I knew Johnny from school, but I also know the man that was driving the ambulance that struck him. Things are much easier to deal with if you have at least one anonymous party. On top of that, I had the one of my worst shifts in a few years Halloween night, so it's looking like this holiday is going to go down in my "never celebrate again" column.

Johnny Dollar was one of the most vibrant professors at his college. He was a teacher of World Religions and several history classes. He would come into my US History class every morning to chat with that instructor and with us. His death is devastating. I used to work for MEMS. They have a reputation for forcing EMT's to work consecutive days in a row without a break upon penalty of being written up or terminated for "dereliction of duty" should they say they are too tired. I personally know the man that stuck and killed Johnny. I have to wonder if they pushed this man to that limit. I always said it wouldn't be a question of "if" they had a major accident, it was a question of "when." Unfortunately, MEMS also has some great propaganda people and I see this being cleanly swept under the rug quickly. My heart is breaking over the loss of Johnny. My sympathy goes out to his wonderful wife Susan, to the history department at Pulaski Tech, and to all the people that Johnny's life touched. Ambulance strikes and kills professor

I got a negative, I wonder who that was from?

The entire thread is directed at me. Thanks for chiming in. I'll give you the reason why a seasoned practitioner with steady hands that did pull it off without damage in a pinch had to try it... Necessity. I was in a situation with nothing else at hand at a complicated delivery with multiple equipment failures. I absolutely had to suction meconium, which requires intubation, and I had two successive blade failures, one a bulb and the other broken by an overly anxious EMT. Scooby didn't get the entire story before she began to flame me and call me a baby killer. You can Monday-morning quarterback all you want, but when you're knee deep in a big pile of suck, you make do and improvise. I might be stupid, but that kid is alive.

I'm working on a baccalaureate degree in history. Although I fall in the 2-year degree paramedic category, I don't love EMS like I love studying history. I'm sure that will offend hard-core EMSer's but at least I'm honest.

I'm never going to get it 100% correct, but that doesn't mean I'm going to stop striving for that 100%. It was an odd little call that really got me second guessing myself. Even after knowing the outcome, I'm still unsure I did the right thing. What I feel I have learned is that the general consensus is to immobilize no matter how "insignificant" a collision like that may seem. Next time I'll be more on my game because of what happened last night. I really appreciate the fact that you guys did not beat me up over this. I wondered if I should have posted it at all, and now I'm glad I did.

The patient believed the sensation he was feeling in his back was a result of his riding. He was one week into a 3 month bike ride from one end of the US to the other. He is riding about 60 miles a day. He felt he might have just been physically fatigued because he was near his stopping point for the day. He had no fractures. He was diagnosed with the ever generic sprain/strain to the back in the low thoracic/high lumbar area. He was discharged a few hours after arriving to the ER. Thanks to those that replied.

The car hit the bike tire and did no damage. If the patient would have fallen off to the right he would have hit the ground, he fell off to the left landing on the car. He did have protective equipment, but I understand the 3000 lb car vs any protective gear will win. The way the patient described the accident, he wasn't directly struck, his bike was, but he did fall off the bike. Forgive my jumbled mess. I'm a night-shifter that is having trouble sleeping right now, so I'm not as eloquent as I like to be. I'll PM you with the outcome. I really want to see more feedback before I post it. I'm really attempting to use this call to improve my assessment and comfort level with trauma patients. A person can't improve if they can't recognize that they may need to do something better.

I made it 2:45 minutes into the 3rd episode, right up to the eyeball popping back into to place part. I admit, it's 45 seconds longer than I made it into the 2nd episode. What a load of garbage. I have to go vomit now.

I ran a call last night in which a bicyclist and a car collided at an intersection at a low rate of speed. By low, I mean the car had traveled three feet from a dead stop before coming in contact with the bicyclist. The speed would have likely been well below 5 mph. The patient was alert, oriented, and had a complaint of "a tired feeling" in his lower thoracic spine area. He had some minor redness to this area that resembled his mesh undershirt. He was ambulatory at the scene and initially wanted to refuse treatment and transport. He had no distracting injuries, no c-spine tenderness, no neurological deficits, no loss of consciousness, and was wearing a helmet as well as a few layers of protective clothing. He states he more or less tipped onto the hood of the car landing on his back. He was NOT thrown into the air, and had contact with the car that probably had less impact than if he would have fallen to the ground from a standing position. No damage to the car or the bike. His vital signs remained well within his normal limits throughout transport. We did not immobilize the patient. My third rider felt the patient didn't require spinal precautions and I agreed based on all the information I gathered. When we got to the ER and gave report to one of the residents, he ordered spinal precautions on the patient. The nurse also decided to give my third rider a hard time over not taking precautions. I'm telling this story because I started researching c-spine clearance criteria when I got home this morning in an attempt to figure out if I had mis-managed my patient. I'm familiar with the NEXUS criteria, and honestly, that his the criteria I cited in my rational for not taking precautions. This morning I came across a few abstracts about the Canadian c-spine rule and how it is superior to NEXUS criteria. In turn, I researched the Canadian c-spine rule and reclassified my patient based on that criteria while doing a little call review with myself. After all of that, here is my question (finally ): Would this particular case be consistent with the "bicycle struck or collision" part of the dangerous mechanism? I understand it technically was a bicycle collision, but this man probably would have hurt himself more falling to the ground. The car hood likely broke his fall from the bike and probably kept him from more significant injuries. Secondly, how many of you would or would not have immobilized the above patient and why? I know the outcome of the patient, and I'll post it after some feedback. Thank you all for your help.

Let's discuss American providers exclusively for a moment. The average basic class is 120 hours, intermediate can be as little as 300 (like in Maryland), and paramedic can be as little as 800 hours. You can't honestly expect anyone with that little amount of education to know very much when they start clinicals. Since most clinical rotations in paramedic school start the second month, they really don't know anything. For that reason, I have to agree with Dust, they don't know anything, teach them everything. I'm in favor of raising the education bar, I'm also in favor of extensive internships. I had an extensive internship and it was more valuable then my classroom time. I had good preceptors that were there to teach, not to belittle. When I precept I take the same approach. A lot of these students probably know the answers or know what they're doing. It's hard to get out there and try to take care of a patient when you've got the big, bad preceptor standing over you pointing out all your flaws. I can guarantee they aren't perfect, no matter how long they've been doing this. It's a lot easier to function as a new person in a more relaxed atmosphere, not one where you are being yelled at or berated. Don't get me wrong, there are people that try to get into this profession that are just not cut out to do it. You can encourage and teach all you want, and there are going to be people that fail regardless. The thing is, as preceptors we should be giving them every chance to prove they can, not every chance to prove they can't.

That's exactly why most of the basics I work around will not call for any sort of ALS upgrade. I'm sure it's hard to hear a medic tear you apart because you felt their services would be necessary and were rude enough to drag them away from their movie, nap, or internet time. How dare you presume to think they should do their job. I took a job with a company that was transitioning from BLS to ALS a few months ago. It's the lazy medics they've had to deal with that are making my transition so difficult. I tell these guys over and over to call me if the need me. I tell them I don't mind coming out and taking a call if they are the slightest bit unsure about anything. I also tell them to call me when they know they have a patient that needs pain medication. Most of the basics here are so used to splinting in place and listening to the patient scream all the way to the ER. They're simply afraid to call a medic here because they will more often then not berate them for calling and proceed to provide no additional care. I don't really care how burned out someone is either. If they're burned out and crusty, they need to go find a nice janitorial or food services job somewhere. If you know you have the ability to make a patient more comfortable, you should be doing it. It's about the best interest and best treatment for the patient, period.

I gave fentanyl last night and I was 8 minutes from the ER. Although the doc ignored me for a good five minutes while I was attempting to provide them with a story, she did come up to me later and in her round about way give me some kudos for providing pain management. I will confess, and I could care less who blasts me, that I have delayed transport before to give pain meds. I refuse to listen to someone scream in agony with an isolated extremity injury because I don't want to take five minutes to control their pain before I manipulate them. It's simply inhumane to allow a patient to suffer when we have the ability to make them more comfortable. If it's not life-threatening, it won't kill us to take that extra few minutes to provide comfort. If it is life-threatening, it still won't kill us to provide comfort en route if possible. By the way, JCAHO apparently has huge pain control criteria for their accredited hospitals. It doesn't pertain to us, but it's an interesting little side note. You keep advocating for you patients and providing them with comfort. I don't mean to sound unprofessional, but to hell with that nurse, you're doing the right thing by your patients and you know it. Don't worry about giving more pain control than other medics either, I'm the same way. Document, have witnesses, and you'll be fine. These crusty old cowboy-up and take the pain people have got to go.