mediccjh

Great!! I didn't get to see last year's issue.

PA now has a plastic certification card. Your cert info on one side, and a picture ID on the other.

I have only had positive experiences with MgSO4 for asthmatics. We are finally getting here in Eastern PA in July, when the [horrid] state protocols go online.

Yes, so far we have the "Dean" (Dean Martin) the "Duke" (John "The Duke" Wayne), and the "Princess" (Princess Leia) of EMT City. I am surprised that nobody has adopted these other titles:

• King of EMT City (Don King, Rodney King, or Elvis photo avatar)

Queen of EMT City (Queen Elizabeth, Freddy Mercury, or Liberace' photo avatar)

Prince of EMT City (Prince or Will Smith, or any royal prince photo avatar)

Don of EMT City (Don Ameche, Don Knotts, or Don Corleone photo avatar)

Dick of EMT City (Dick Van Dyke or Dick Van Patten photo avatar)

Captain of EMT City (Captain Kirk photo avatar)

Sargeant of EMT City (Dick Sargent photo avatar)

Sheikh of EMT City (anybody with a schmagh [checkered Arabic headscarf] photo avatar)

Shah Of EMT CIty (Shah Mohammad Reza Pahlavi of Iran [RIP] photo avatar)

Ayatollah of EMT City (Ruhollah Khomeini photo avatar)

• Anyhow, back to the topic at hand... those who keep trotting out the tired old argument of how individual volunteer providers can be just as good as individual paid providers are -- and I suspect intentionally so -- missing the point. This is not about individual providers. This is about THE PROFESSION! The fact is that the state of the profession itself is our prime concern here. If the profession fails to progress, so does care at the lowest level. And so long as the profession is viewed as nothing more than a hobby that is not worthy of your full-time devotion, then the profession will indeed continue to fail to progress. It simply does not matter that you, as a volunteer, are personally devote yourself fully to your education and personal professionalism. If you are giving your services away for free, further cheapening our services and our image, you may be helping your individual patients, one at a time, but you are hurting the profession as a whole. That harm affects those who are working full time to make this a respected profession (which benefits YOU TOO!), as well as hurting the citizens who deserve better a better service.

Spin it any way you like. But once you pull away the blinders and look at the big picture, not just your current patient, there is no way that an intelligent person cannot see that volunteerism is seriously detrimental to EMS. Period.

I want to be the Slum Lord. My avatar can be Joe Pesci from "The Super."

Brauns cost a little bit more, but the quality is superior.

MedTec is good, and so are Excellances.

It was a wiseass humorous post, people. That's all it was meant to be.

Get over it.

Relax...it is no more silly than you calling the rig a bus and saying you did 12 "jobs" instead of calls or runs.

Its a geographical thing that isn't ever going to change, so just accept it or ignore it, and move on.

Quite frankly, it seems only the people from the north east practice the silly name calling of bus and jobs.

Yes, and all the silly people from the rest of the nation call it a RIG.

I can get into the bus/job debate if you really, really want.

Relax Flyboy, it was in humor. You now owe me a Guinness, or I'll crash my bus into your rig. The bus wins.

NEW RULE FOR THIS THREAD:

There will no use of the word "RIG." This is supposed to be a professional thread on how to fix NJ's EMS problem, and the use of the word "RIG" is about as unprofessional as being called an ambulance driver.

Dean Asystole, you are in charge of enforcing the rule. And charging toll to leave this thread, since you have to pay to get out of NJ anyway.

9. Annual skill and equipment proficiency exams... so they know how to work the $4000.00 DeWalt powered electric "I'm a lazy-ass" cot that they put into their brand-new shiny "rig"... Not to mention so they know how to treat the patient strapped to that cordless drill on steriods once they finally get them into the "rig"

10. BAN THE WORD "RIG"!!!

I think I just fell in love with you, even though you're a volunteer.

You didn't piss me off, but I have a couple comments. I feel slightly entitiled since I worked there and had first hand knowledge. I'll reply to your numbers above.

3./ Partly agree. I like having a medic partner instead of an EMT. But the county thing has it's benefits too. I get to retire in 25 years with 75% of my best 5 year average. Can beat that. Jersey was, well, you're on your own.

3a./ Can't agree at all. I came to an all ALS system, but we treat everything including BLS, which can suck. BUT I cannot tell you the number of times I had to hold BLS's hand because of some stupid crap, that because of some stupid reason (age, history, etc), I couldn't leave, but the pt would have been fine to go BLS. Then the MI or cardiac arrest goes out down the street and the closest medic unit is 25 minutes away, if they are even available. So I can't see your logic there. Here, every ambulance is ALS, with one medic and an EMT. Every call is guarenteed a medic unit. A little over effective, but effective. At least if something goes wrong, you don't have to call a medic unit. Can't see your logic on that one. Sorry bud.

4./ THANK YOU!!!!!!!!!!!!! That state could literally care less if you kill someone. You MIGHT lose your job, but the state never investigates. This partly lies in the problem that ER's and squads never report them. Like medics who can't operate equipment and effectively watch a pt die. Someone got fired, but why was this never brought to the States attention by the employers or the ER? Why was this person still allowed to practice as a medic? No intervention at all by the state. That's insane.

4a./ Again, 100%. If they can finance police and a mayor who make more money then we do most of the time, they can finance EMS. Everything down here in Florida is either county or city based. Barely any volunteers. And, I think (but don't quote me), every county has paud 24 hour EMS. Maybe remote in some places, but it's there.

5./ Again, 100%. You worked in Jersey once too right? So you performed a SNR (services not rendered) or triage to BLS or whatever you called it when you evaluate and release the pt back to BLS? I think that when they say, "WE were going to recall you but since you're here...", their squad should get a bill for $250.00 for an ALS exam. Not the pt. When I left, I believe they were toying with the idea of billing pt's for these calls. They didn't request us, BLS did. If BLS can't figure it out, charge them a fee. That'll curb it. Probably create another firestorm where they'll be afraid to call, but at least they will only do it when they know it's warranted.

I'm done now. I just had to comment. Sorry dude.

No need to apologize. I came from the EMT-Medic system in PA, and it has its pros and cons. I currently work f/t in Jersey, and I like having a dual-medic truck. I also worked NYC which was dual-medic, and I enjoyed it. Don't get me wrong, I didn't mind having an EMT as long as he/she was smart and could keep up with me (my last 2 f/t partners were able to and are now both medics), but I hated having some stupid EMT with me where I was basically working by myself on a crictical patient.

As far as number 3, I do have a state pension (crap, I just gave away where I work). The reason I prefer hospital-based systems is because if it's a good system with good medical control, the possibilities of paramedicine are limitless, with progressive "protocols" and more importantly, accountability for crappy providers.

Yes, I still had to go to work during the shutdown, and I still got a paycheck during the shutdown.

On to more important things.

1. Abolish the First Grade Council. They are useless, and full of stupid volly hoopies who only care about how shiny their red lights are to feel good about themselves.

2. All EMS agencies, paid and volunteer, MUST be licensed under OEMS. Yeah, the sticker's ugly, but it's worth it.

3. Keep the ALS Hospital-Based, with dual-medics. With how corrupt county governments in NJ are, I really don't wanna work for them.

3.a Keep the two-tiered system. Frees up ALS for ALS patients.

4. Hold the crappy EMTs and Paramedics accountable for their actions.

4a. Hold the EMS organizations accountable for not keeping the ambulances staffed 24-7. NJ is the most densely populated state in the nation; there is no reason that this can't be done. If it means regionalization of BLS units and providing paid staff, oh well. There are other hobbies out there.

5. Teach the EMTs not to be ALS-dependent for everything. This requires education. If anyone pulls the "well, I'm a volunteer card," take their EMT card away.

Now I wanna see how many people I pissed off.

Would that be Tussin? It's the only T I can think of that looks like a gel.

Hi-flow O2, BVM, ETT if needed

IV or IO, blood sugar

Narcan 0.1 mg/kg

Dextrose if blood sugar <60 mg/dL

Next time, take that pill that says W for Water, or P for Placebo.

While we are on the topic, is the short spine board a safe tool for the extrication of a time critical patient?

I was instructed to use one once during my early days as an EMT student, and it seemed an effective compromise between the KED, which takes time, and nothing.

If you have a time-critical patient, that is what the rapid extrication is for - removing a critical patient expeditiously.

CBEMT... I agree to an extent. Only in a truly Utopian society could one be guaranteed the availability of a transport capable BLS unit. Your most advanced providers should have the most basic tools of the profession at their disposal, i.e. a rolling ambulance cot and an ambulance to put it in!!

Mediccjh... Agreed... But now who do we hold accountable and press for change?? We are all intimately familiar with the problem, the system is broken, there's no two ways about it. Where do we go from here? I don't know. I do know one thing though, if WE, as EMS professionals, don't have input in this, we're just going to get another system doomed for failure. Any ideas?

All in all, I still think ALS Intercept could be improved upon by adding the fail-safe of putting your Paramedics into something as cheap and readily available as a non-custom mini-mod ambulance. That would be an excellent safety-net for the system. Don't throw the "it's too expensive" argument at me... the gas-powered SUVs common here can and do EASILY meet or exceed the cost of a diesel mini-mod. The costs draw very close, especially when one factors in maintenance costs, longer PM intervals for a diesel engine, etc.

However, once you put your Paramedics in your cheap ambulance, and they are dispatched with BLS for an ALS assigment that ends up being BLS, with no BLS responding, your medics now must dispatched the stubbed toe while the AMI 2 miles away has to wait an extra 20 minutes for the paramedics.

This debate can go around and round. My Utopian society is professional BLS providers in a transport-capable ambulance w/ ALS chase fly cars, this way ALS is kept for more serious emergencies, which is what the original concept was.

ALS Intercept vehicles are one of those concepts that looks GREAT on paper but, TOTALLY SUCK in reality!!!

It sucks because the volleys can't/won't get out during the day for grandma having the CVA, but if an MVA w/ entrapment come in, they come out of the woodwork.

It's that simple.

Pick the brains of your preceptors. Your brain should become a sponge.

Treat your patients not because you need the skills, but because the patient needs them.

Go in as if you know nothing, ie, don't tell war stories or brag. Preceptors look at this as fresh meat and will jump on you if you fail.

Easier solution : Don't live in New Jersey. Guaranteed to extend your life !

That's why I just use them for their tax-payer money that pays my salary.

The video subjectifies a debate in this country that has been raging since the Bill of Rights was signed: Freedom of the Press vs. Right to Privacy.

As public health professionals, it is our job to enforce the right to privacy. That being said, there is nothing that can be done when the videographer has a really good zoom lens.

There are no right answers. Either way, there would have been death.

If he woulda let the kids out at 1300, they woulda been on the roads when the twister hit, and more would be dead.

You're damned if you do, damned if you don't, and damned when it's done.

Very well stated as per your norm mediccjh, for well for a guy that wears a skirt (Just busting Your chops, bro).

.... :twisted:

Could someone please explain this... frankly I am confused.... how does more educated providers cause death?

Or is this the very old fire/paramedic argument.......am I missing something here ?

It's all in the numbers, bro, which I pulled out from under my kilt.

A study was done, I belive in LA County, that showed oversaturating an area with ALS units caused higher mortality rates.

The belief is simple: oversaturate an area, the number of patients an individual sees goes down, and more importantly, the number of skills the provider does, ie endotracheal intubation.

This is why I fully support a two-tiered system of educated BLS and ALS. You don't need ALS for a toothache.

Rid,

With the Wang numbers, there are a lot of flaws:

1. The condition of the airway when a medic first intubates. How many times does it take 2 attempts since you have to suction the oropharynx, find the cords, etc?

2. The numbers, I believe, stem from the fact that most of Pennsylvania is rural. The highest population in PA is east of the I-81 corridor, due to these things we have here that you don't in OK called mountains (Just busting your chops, bro).

Looking at my part-time job's statistics, there were only 6 endotracheal intubations last year, company-wide. This is a service that does about 2600 911 jobs a year, with a huge coverage area. In comparison, the company that I used to work full-time for, does 40000 jobs a year (both emergency and non-emergency), and I had 10 intubations there (14 total for the year including Newark). Sometimes, the numbers are just not there, and it's not due to oversaturation of ALS (though you know I agree with you that the oversaturation of ALS kills patients).

One must remember, as with all studies, numbers are skewed.

As a closing statement, I truly believe that education is the key. Being that I live and work in PA, I can't wait to get my hands on Etomidate. It'll be nice to have more tools to help take care of my patients in the boonies.

Yes, I also own the Special Edition DVD of Monty Python and the Holy Grail.

It is also the day the welfare and social security checks arrive. Coincidentally, it also seems to be the day in which a higher number of heroine overdoses occur. Hmmmmmmm......

Which leads to a busy weekend in the ghetto......

I'm disappointed in all of you.

I would think you woulda picked up the sarcasm when I asked what a RIG was.

RIGS dig oil out of the ocean, or have 18 wheels.

Tsk, tsk, tsk.

What's a rig?