strippel

Our county dispatchers (usually) give us decent information, so probably about 1/3 of or dispatches are non-emergent responses. (We do use Medical Priority dispatching). When we transport to the hospital, it is almost always non-emergent. I think I have used RLS twice in the last month, and one was yesterday with an unstable motorcycle accident patient. Another was an unstable IFT. We have a protocol (recently updated) that states in specific terms that the patient must be unstable. We are a city/suburban service, with most of our trucks less than 10 minutes from the hospital. Even our country truck (30+ minute transport time) must drive normal speed, unless the patient is unstable. In most instances, running RLS is more a liability than a benefit.

Dispatched yesterday for an unconscious person. We are immediately suspiscious, as this is a very high maintenance block. Arrived on location to be advised "caller being given CPR instructions". (This gives us our supervisor, and engine company, and PD). We go inside to see frequent flyers, man passed out on the floor, prescription drug overdose with alcohol. Same as previous MO. Cancel everyone except the supervisor. His son and wife state he had shoulder pain, and took some pain meds, and was drinking beer. Pain continued, so he took more pain meds (Oxycontin), nitro, and kept on drinking. After being unresponsive for some time while watching TV, his family combined brain cells, and became concerned. They called 911, and threw him to the floor. When confirming with his wife what happened, she stated that his shoulder hurt, he took pain pills, nitro, and was drinking beer. I said, "pain pills, nitro, and beer?" She states he took "pain pills, nitro, and beer". I told her that when he takes that all together, it's not so good. She states, "he didn't take any pain pills...he ain't got no description for them. The doctor didn't give him no description for pain pills". I then asked again what he took. She stated "pain pills, nitro, and beer". HMMM. Turns out he was having a major MI (nothing interesting showed on the monitor initially), and when he was fully awake, got pissed at the doctor. As the transporter was waiting to take him to the cath lab, he signed himself out AMA.

OK, so I am in paramedic school, trying to find time to study. Until the start of class, I actually had free time at work. I don't think I have had more than an hour total in the last 2 weeks. Between calls, charts, and mostly training new employees and EMT students, just no time. Here is my weekend, so far... [web:4126988d43]http://www.wgal.com/slideshow/news/9781421/detail.html[/web:4126988d43] about 5 decent medical calls, shooting, stabbing, MVA with entrapment (nice huge head lac), bunch more medical calls, Ending today with my regular who is going to really, really going to kill himself this time. Really, this time. Can you help me? Please? I'm gonna do it this time, really. And, since I left at 19, a 3 alarm structure fire. Hopefully tomorrow will be slightly more normal.

I have done some part time and PRN work for smaller, mostly volunteer ambulances. There were many times that the paid staff would stay in station, and the volunteer would be at home. Frequently, the vol tried staying at the building, but... they just had too many things to do. Most of the time, it was either a paid crew of 2, or all volunteers from home. Even the volunteers thought if they were paying someone to be there, they might as well pay 2 people, and the truck (bus) could get out faster. Our county requires a 6 minute response time, or you get covered. Paid crew obviously had to get out faster.

I usually cal it truck. As in, hey you frequent flier, "get in the truck". I guess I violated Asysin's law. Having grown up on the other side of the polluted waterway from Manhattan, and working with retired FDNY employees doesn't give me the right to use "bus".

PA was playing with photo state IDs last year. In the Eastern Region, they made several stops, and took lots of pictures, handing out EMT/Medic certification card Photo IDs. After the scheduled photo sessions stopped, I haven't heard anything about it. At my full time, we are required to wear our company AND hospital affiliate photo ID at all times. It is a JCAHO requirement.

You are very right, Rid. Example is my 15 year old son. He is a very hard right conservative Republican. I don't know why, because they did not take enough time with current events at his old school. I didn't teach him to be that way. When I ask him questions, he has a generic answer, but can't really say why he feels that way. I think it's the same with many other people I come across. Except they are usually on the other side. I no longer have political discussions with people at work, it's not worth it. Many get too angry very rapidly, and don't have a reason, it's just because they are on the other team, and don't like my team. Although, I was very pleased to find some new YOUNG co-workers who were very conservative, and willing to talk about it. All started with a conversation about the babes of country music. Other than politics, we all appear pretty tolerant of each other. We have a very representative diverse work force for the area we serve. Almost all of the providers play well with each other. And we have most areas covered, smokers, non-smokers, gay, straight, conservative, liberal, republican, democrat, male, female, blacks, Hispanics, Christians, and Jews.

[web:afb2d9a416]http://www.wgal.com/slideshow/news/9716814/detail.html?qs=;s=1;w=320[/web:afb2d9a416] A crash today with a responding ambulance and a gas company dump truck. One person was injured, the article did not state who, or how bad. Hope all are well. This is York City, PA, and the ambulance belongs to White Rose. They are a private company, and are contracted ALS and BLS for the city. From what I have heard, a pretty decent operation. I don't know if they were responding L&S. We do have protocols for L&S and non-emergency response in our region.

We have the second largest nursing complex on the east coast. It is very expensive, and the care is usually great. More often than not, a nurse or other staff member is with the patient, and the charge nurse usually meets EMS at the elevator or desk. She then walks with you to the room, after handing over the paperwork, giving a short report, and answering questions. Most of the time, things are wonderful. And for the price the people are paying to be there, they should be. They also have a plan where independent residents (volunteers called "minute men") will stand at doors and elevators, let you in, and give you directions during emergencies. These old timers are great. But, sometimes the staff slips. We also have some of the crappiest places I have ever seen, and I wouldn't let my worst enemy's dead dog stay there. And they are part of national ECF chains. One place, has a nurse who can't speak English. Nothing. My partner and I can't understand her, the patient and their family can't understand her. How can her co-workers or 911? She arrives with the paperwork, and then leaves rapidly. Last time, luckily the family was with the patient, and gave me all the info I needed, and was very kind to us.

Well, today was the first day. Pretty mellow, no pressure. We are a small class (6) with a limited number of instructors. Except for the "FNG", we all have known each other and worked together for a few years. We all get along well. We had a lot of administrative duties this AM, but late morning, we started pretty hard on A&P. It is very amazing how much you can't remember, and never learned from EMT. On the same note, it comforting knowing how much I learned working with these people, and this service over the years. It will be tough. We already have a lot of reading, and homework assignments due. The part that sucks so far is official school paperwork. Since we are "at" a college of health sciences, we had physicals, drug testing, child abuse and criminal back round checks, and a bunch of other bureaucratic BS paperwork. I have never gotten so many phone calls and emails stating that I have paperwork missing. Got another one today, after being assured that everything was "OK" when I called to check. Also, there is no parking. Luckily we know people, and can park at their house. Otherwise, you have to park miles away, and take a hospital bus. it will be much worse in the spring when they close the employee parking garage, and everyone gets bussed.

My class starts on 8/22 also. I am not worried about class. We got our books a few weeks ago, and have already read the assignments. I am worried about keeping up reading and assignments.

One heck of a crash. To rip the body off the dump truck, and flip the ambulance.... All I can say is, the State Police staff medical helicopters in Maryland. And they use them.

One of the hospital services around here did that. I think they set part time regulars first, then full timers around that. From what i understand, it really used to suck for the full timers, but not so much anymore. Too many of them have kids and are back in school themselves.

All RNs and LPNs in our local nursing schools are required to do ride alongs with us during their last semester. It boils down to between 4 and six hours, and there are no "interesting" calls during that time. They usually get stuck watching us do IFTs, paperwork, or computerized con-ed. At least they try to enjoy the truck check. We ask them about the meds, uses and contra-indications. Most usually don't have any clue. Every now and again, a nurse will get to go on a "good" call (shooting, stabbing, OD, crash, assault). The ones who "enjoyed" that usually end up working in the EMD, but they wanted to anyway. All new EMD nurses are allowed to ride along with us, haven't had one willing in a long time. It takes a long time until they stop being "prissy". We had a doctor ride with us for as while. She was great, smart, funny, good looking. She is from Australia, and wanted EMS backround for when she returned. The bad part was that she is currently working in the clinic. She knew and had previously treated a large number of the patients we transported.

Damn, I must be lucky. I have two rides. First is a 2005 Chevy Silverado, dark blue 4 door. It is pimped out with AM FM CD tape AC, a tool box in the back, heavy duty hitch and transmission cooler. I never counted the lights on it, but it's whack. Headlights, fog lights, DRLs. The turn signal blink on and off when I change directions. I love it, especially when I can afford to drive it. I mostly use a 1996 Toyota Camry, which has really great mileage. The back seat is full of health care text books, uniform shirts, and turnout gear. It only has a cassette deck, and it's pretty lame, but it gets twice the mileage of the pickup. We like enthusiasm, when used wisely. I was young once, but a long time ago, I can understand the energy and excitement. I do believe all of those lights in NJ are illegal, they were when I did EMS there. I think you need squad approval, along with Mayor/Police Chief. I'd check on that. Welcome to The City.

With a large part of Pennsylvania being rural, the age for EMT is 16 (by the day of testing). There have been paramedics that are 18 year old. Generally, that is too young. But, I have been very impressed by some of the young medics and EMTs. Have a friend who was a medic at 18, is now a flight nurse. He turned out well. Another is a cop. When I was volunteering, we tried to have an explorer post, for high school kids over 16. Big failure. They expected everything, including crew chiefing and driving. It was a struggle the whole time. Years later, one of them currently works in the billing office, but does not ride, another two are still EMTs and firefighters, and darn good. If it were up to me, would not try it again. Currently, we have volunteers in our system. One who rides with me is 17, and home schooled. She is very smart with good skills, but not well socialized. Another is 16, and wants to be doctor. Very book smart, but can't do skills, and gets very upset with constructive criticism, and cries. He already knows everything, and doesn't listen. We have quite a few observers, many still in high school. Most come from the health care track from Vo-Tech. We have explained to them what we see, and offer them the option to stay in the truck, or in the station during "interesting" calls. Only a very few have asked for the supervisor to take them home, or to stay outside with fire or police. Luckily, we have not had any problems.

At my full time, there is no issue. We only have basic cable. Some people bring in videos, some "unrated", some "R". We have never had a problem. Usually, there are just 2 people in the station, and they discuss amongst themselves. What makes it less of a problem is that we are so darn busy. We don't usually have time to watch. Also, we have many volunteers ) some under 18), students (medic and EMT), and observers (RN, LPN, and young people thinking about careers). Most study, or review with preceptors. The tapes don't come out. At my part time, we have full digital cable, with On Demand and PPV. Many watch whatever they want, and there has been no problem. At the main station, office people are there during the day, so TV is usually boring. We have watched On Demand HBO and Showtime, and the boss doesn't mind. No uninvited people are upstairs. And when a sales/insurance rep is there, the TV is off. Our one station is out in the country, and is not open to the public. As long as no one watched PPV with out paying the company back, what is watched is between the crew members. Never been a problem. Our 3rd station is inside a volunteer fire department. Since we pay the cable bill, EMS gets control of the remote. There are many teenage firefighters, and the station is owned by the municipality, nothing questionable is on when ANYONE is there. During the day, firefighters stop in, as will police officers and DPW employees. Teenage firefighters have been yelled at late in the evening. They have watched "hard R" On Demand when EMS is out running calls, and no senior firefighters are with them. There are members who are only allowed in the station for calls, drills, and meetings, as they cannot be trusted. EMS has not had a problem.

We have a Toughbook mounted in our supervisor vehicle. They have been running email, Verizon paging, and the county dispatching program. (Our dispatching in addition to radio, is also web based.) Due to Nextel's desire to keep limiting our unlimited mobile internet, that is as far as we have gone. Now, we have just gotten a bunch of laptops. They are not Toughbooks, but should work well enough. We are looking for the right locking mounts for them. We may just load Word on them, so crews can type their narratives. The plan is to have the PCR program loaded, but it is web based (Emstat). Back to the limited unlimited internet from Nextel. A service near here has Emstat loaded on a laptop in their ambulance, no internet connection. The crew can type the chart on the way home (minimum of 1/2 travel time to hospitals), then upload the whole PCR, including state data fields. We hope to be doing the same soon.

I am the senior man on day shift, and I still have to work Christmas. Have for the last 3 years, with my partner Dave. That is just the way our template falls. You have to work the holidays that fall on your rotation, there is no taking holidays off. If you are lucky enough to switch, or find a part-timer... It sucks, we both have families. My wife and I schedule Christmas according to our free time anyway. She works in health care, and has to take OR call. Sometimes on holidays. Until my parents moved nearby, Christmas would have been celebrated either a month early, or late. It is usually celebrated on my weekend off. On Christmas, my wife and son usually go to her parents. The next weekend, to mine. Please don't feel like you are insecure, or bothering us. We will gladly attempt to help, or at least, reassure. If you have child care, have you ever considered riding an observation shift with you husband?

It's all about the drama. My partner and I have been fooled, too. No big. I first look for the incontinence. To be willing to fake that, you need to be good. I have seen fakers do that, though. What gives it away is what is what you see when you are on scene. All family members, SOs, etc, will deny that there was stress prior to the seizure. But about 1/2 the time, the tension is so thick you can cut it with a knife. It's like walking into the set of a bad Mexican soap opera, or the Jerry Springer show. The thing that makes me aware of fakers is that we have so many regulars with real seizures. Most are urban outdoorsman, domicile challenged. We have one who seizes, and drops to the ground. He has a huge head, so he is always injured, then flops around for a few minutes. He has a long, violent post-ictal state, which involves many members of the law enforcement community, and sometimes an extra ambulance or engine company to keep him and bystanders apart. He is very dangerous. Usually, when he becomes alert, he runs away. I have learned from watching during the seizure, and post-ictal phase. i know everyone is different, but it's still good learning. If only they would take their prescriptions, and not sell them.

Here, fire and EMS are unrelated. (Except for two combined volunteer stations). We like it separate. EMS is way too busy doing patient care and handle rescue extrication. We have a 2 person crew (maybe 4 on a good day with a volunteer and a supervisor), there is no time for any extra curricular activities. We tell fire what needs to get done, and they do it. We both extricate the patient together. (Yes, they can be trained for simple tasks). They help put the patient in the back of the ambulance. We leave, they clean up their tools.

I don't know where the grant money came from. Like everyone else, we are trying to tap every source of money. I just know that management is trying to figure out how not to loose the money. We will not be getting them, but will keep one for the bariatric truck.

That's too many people. On our serious calls (like cardiac arrest) we get a 2 person ALS ambulance, and a 3 person engine, or 2 person truck. Most of the time, our supervisor won't show up, unless requested. Here's the thing. Our cops and FD have AEDs, and are required to show up on any call where it may be used. Initially, we may have an engine crew, and a dozen cops, but unless it is a crime scene, all but one leave....rapidly. He just hangs out to make sure all is safe. We have them trained well, they then get us info. That said, yesterday we had a cardiac arrest. We were on scene, and had the airway and IV before two cops showed. They attempted to ID the patient, but were unable, and stepped back. Within about 5 minutes, we had volunteer fire there, with a duty vehicle and engine, crew of 10. We let them have fun. The chief drove, one FF did compressions, and another BVM. Ended up being a good team-building session. Normally, this dept has more testosterone than water, but they did a good job.

To make Ace happy.... I don't go anywhere I'm not dispatched. I do not assist the police, unless requested, and it must be related to our patient. (We have a very good working relationship with the police, and I don't ruin that by being a wacker.) I've been doing this long enough, I don't need to create my own excitement.

I know some of you big city people can beat me, but this was new to me. Today my partner and I got shot at. Luckily it was only paint balls, but we thought it was a BB gun. It was no big deal, until they hit the ambulance when we were trying to load a CHF patient. (She was very swollen, ready to burst, and had a pulse ox of 81% on room air). We took the patient to cover, and the family and neighbor called 911. Within a minute, the Po was on the scene, arrested 2, and confiscated 5 paint ball guns. Now, I have been to shootings and stabbings before. I have been to non-secure scenes, and have heard and seen shots fired before. I have helped the Po chase and subdue perps. But I have never been "shot at" before.