Eydawn

Don't you EVER ask for a discount. EVER. If it's freely given, you may accept, circumstances depending (thanks for your story Squinty). To ask, or to be offended because one previously given is not extended, is churlish in the extreme, and reflects poorly on our profession. Just what is it that makes you so god damn special that somewhere you ate is OBLIGED to give away part of their profits to you? We get prodeals through my SAR team. If they stop being offered, which companies occasionally do, we don't say a word except thanks for the previous years of prodeals. Do we *ever* go into a shop and ask for discounts? Absolutely not. That's actually grounds for dismissal from the team. In the rare instance that something is offered to us, we ask that the business make a tax deductible donation instead (which I know has happened). That way, it benefits the whole team and not just one or two of us who happened to be in uniform. Man, this kind of stuff REALLY chaps my ass. It's so stupid. Really. Just don't do it. Wendy CO EMT-B

Jesus, that camp pays well! Holy shit! Can't make that working for the BSA. I was lucky to get $350/week including room and board and being on call 24/7... AND I also worked as a shelter director and program director for the activities at the shelter!! Man... Wendy CO EMT-B

Holy crap, Bushy. I can totally relate. It's why I don't work prehospital transport EMS anymore. Much safer psychologically and emotionally to be working in an old folks place as a shift manager, learning to apply concepts from the nursing education I am now pursuing. I'm still kind of scared to get back on the truck (compounded by the fact that I don't have time right now with work and school and all that). I now only work as an EMT in the wilderness setting. What changed me? Working in a system where I was exposed to some poor medicine and ethical practices. Being told to withhold information from the police in a peds death taught me to *always* document exactly what happens and to report correctly. Holding my tongue cost me dearly in the form of mental anguish... I am not one who can easily lie. Your ethics are not worth compromising. Watching patient abuse taught me to stick up for providing compassionate care, even to those who piss you off or don't fit your model of "the kind of patient who deserves my sympathies." Seeing poor charting made me want to chart every day to the point where, if called to the stand in a courtroom, I could state "my documentation is complete as recorded and I have nothing further to add" and be confident in that statement. What really changed me first, though, and kept me from just falling into the trap of accepting that "this is how things are" in that crappy prehospital job? EMTCity. The amazing thinkers and providers in here have taught me more about medicine and ethical medical practice than I can possibly dissect out; I matured through a variety of life experiences over the last few years and the discussions I engaged with here in this forum. I learn from every mistake. I seldom make the same mistake twice. That, I think, is one of the biggest lessons I learned here on the City; to take every mistake and treat it as an opportunity to better my practices, rather than a simple failure over which to agonize or turn into a puddle of mush about. Dwayne. Dust. AK. ParamedicMike. Chbare. Squinty. MedicNorth. RidRyder. RichardB. Kaisu. Anthony. ErDoc. Doczilla. LoneStar. Matty. And others whose names escape me, because it's 3 in the morning. You have all helped to shape my thinking as a provider, and I am proud to count some of you as my friends as well as net-based professional mentors. When I started here, I was a naive kid in many ways... albeit one who could write well. Now, I feel that I am a much more mature medical provider, no matter WHAT particular job description I am working under at the moment... Dwayne, pass the tequila, wouldja? You named my favorite poison... (well, that and gin martinis...) Wendy CO EMT-B

I laughed so hard I started ROFLMAO (it's longer than three letters!) while reading this thread. WEMT is an upgrade from EMT-B. Take the WEMT course. Better yet, take anatomy and physiology and head for P-school! Wendy CO EMT-B

Top 10: Prescription medications (kids got into mom/dad's pills) Tylenol (whiner OD's) Heroin Cocaine Meth Alcohol Cleaning solutions (again, kids) Sleeping meds Drain cleaner Teh internetz, you know, those Twitterfiends... (sorry, couldn't really come up with 10!!) --Wendy

Wow! That looks so cool! It makes so much sense. Never seen it before... but may throw it towards my medical liason to see if we can get it in our SAR kits. Would be much easier to bag someone with one of those than a traditional, especially in a less-than-optimal transport mode... Wendy CO EMT-B

My Droid X rocks. Just sayin'. And Iphone doesn't own the market on apps... there's tons of Droid Apps and you don't have to buy all of them from the Apple source... And, like I told you earlier, RTFM on your blackberry already! You may have Wifi capability and not even know it. Wendy CO EMT-B

Ruh roh. I knew what woke me up earlier had to be a cat fight of some sort... Is this really worth snarling over, fellows? ;-) Just sayin'. Wendy CO EMT-B

Ah! I saw something in your post... you mentioned transporting folks to doctor's appointments. It's much easier to get certified as an agency providing non-skilled assistance to the home-bound/elderly/non-car possessing. If I am understanding your intent correctly, it is to provide service to your community... let me tell you, as someone who works in an assisted living facility, there are SO MANY people who could use even just some companionship or a ride to the grocery store, who cannot afford to pay privately for said services. Something to consider, eh? There's really no place for another first response agency, especially somewhere like Oregon where paramedicine is pretty well established, on most scenes. Usually it's too much with the fire department AND the EMS crew, especially if they're separate agencies. Add in another "first response" group, and boy do you have too many cooks. I know you want to be helpful, but unless you're the only thing around, you really are only going to get in the way and make people angry. I'm not saying this to be mean, honest to God. I get your intentions. I'm saying this based on my experience with different first responder groups in both urban and rural settings. The reason we're talking about billing and payment is because you *will* need resources to cover your overhead expenses. Your basic first aid supplies may be tax deductible, but insurance for your practice isn't (and you don't want to practice without some form of liability coverage, trust me on this.) If you're an official agency, Good Samaritan type laws no longer apply to you as you have a perceived duty to act. Liability in medical practice of any kind is HUGE. I'm an EMT-B, have been for 6 years. I'm also now a nursing student. I started as a First Responder. When I was a First Responder, I thought I was cool as all hell, and super useful (I was also 16). Then I became an EMT, and realized just how little I knew other than physical skills. My assessments sucked, and I couldn't give any useful info to higher levels of care. As an EMT, I thought I was cool as hell. I voluntarily, without pay, dutifully helped the RA's at my college take care of drunken, vomiting undergrads. Then I started getting into the pathophysiology of injury and disease processes, and realized just how little I knew as an EMT. I could do more than I could as a First Responder, and had some basic semblance of what was really going on with patients, but it seriously wasn't enough. I realized that some of my decisions, based on how little I knew, could actually endanger my patients. It's not an ego thing from many of the higher level providers here on this forum- if anything, it's embarrassment and humility, because most of us have been where you sit right now, and realize that we also once spoke from positions of ignorance (note- ignorance does not equal stupidity, please don't take this statement that way.) We're trying to let you in on it, but some of us are harsher than others with the approach. Don't let that rebuff you or think it's personal- it's not. We're not trying to shit on your parade, honest. We're trying, as the people you will potentially be interfacing with in the field, to give you our honest assessment of the plan. Your honest to goodness best bet is what Tcripp just said- go talk to the local EMS agencies, as they already know all the rules governing practice, and pitch your idea to them. See how it is received. You will need their support, since you are not planning to compete with them, but rather be "another resource" in the field. If they don't like you or support you, they will block you at the levels you need to be certified at. Just honestly the way the world works. Good luck to you... hope this post was helpful in some way. Wendy CO EMT-B

Nope. Good old coffee and tea (mostly tea) and water do it for me, and I regularly work 10 hour overnight shifts with a sleep cycle that I switch back to "normal" on my off days. Energy drinks scare me. Had a gal riding a mountain bike race over several passes here in CO who came up from Utah, decided to chug a 5 hour energy that she'd never had before, and boy she was a mess. Altitude + dehydration + 5 hour energy = whoops! All that taurine and stuff is rough on your kidneys. My brother loves Red Bull, he digs the taste- I tolerate it but don't much care for them, so I don't seek them out. Wendy CO EMT-B

Nobody's being crucified. Rather, people are intimating that professional communication lends one more credibility in this particular setting (what setting *doesn't* that apply to, however...) and providing good reassurance that more experience will help one become smoother and more proficient at handling emergency calls. Nobody jumped on this n00b and said dude, get out now, you done screwed up your entire career from this call and ya ain't got what it takes... that would be crucifying the n00b. Wendy CO EMT-B

Hey y'all, I'm working on recerting by CE this time (don't have time to take a refresher this year) and I found some absolutely rockin' CE's from a health system in my area. HealthOne EMS I'm trying to get a plugin to work for one of the lectures, but the Burn unit has a killer podcast that was super interesting, mostly from a burn surgeon's point of view. Easily one of the best online lectures I've ever heard. Check it out! You get to print your own certificate after you get 70% or greater on the after unit quizzes, and each section is worth 1 CE. I think, but am not positive, that they work for NREMT recerts- I'm working on a state only recert, as I decided to quit paying the bastids at the NREMT the $70 (farking seriously?!) because it didn't get me anything good except a shiny patch and lots of junk mail. Wendy CO EMT-B

Howdy all, I figured I'd try to get ahead of the game over the summer and do some self study on interpreting EKGs so it's one less thing to try to cram in during my crazy 2nd semester of nursing school (Med Surg first half, OB/Peds second half). Anyone used Mosby's Basic Arrhythmias? Did you like it? Anything you particularly found helpful? I won a copy at an EMS conference I was at in my area (got to meet Steve Berry, too! it was a good day) and have just barely started to work with it to keep m'self awake during my night shifts. It's got a nice online interface too which I haven't had a chance to mess with yet... right now, cardiac is one of my weakest areas. I understand some of the patho behind it, but I can't correlate it to strip changes, and I would like to know what I'm seeing as I try to sneak a peek at the strips the local EMS crews end up running on my residents when I send them out... Wendy CO EMT-B

I also want to know what the issue is. If it's unsafe practices, that are blatantly visible as unsafe, even to someone who is still a "novice," I would speak up, but I would take Dusty's route. If it's a matter of differing clinical judgments, then you may be on shaky ground challenging the instructor unless they did something that totally violated protocol. If that's what it is, I would most likely just tuck it away in my brain for future "I will NOT be doing this when I'm on my own" type deal. Wendy CO EMT-B

You'll get it back. It takes a while to get your chops back when you've had an absence from something. They're still in there, just a little rusty. Give yourself some time- don't expect to be 100% on top of everything when you've been out of the groove for a while. Gotta let your brain re-learn the work patterns. Are you feeling off about it because you expected to be totally on your game, or are you finding it just hard to find the same joy in what you were doing before? Not a bad question to ponder with a counselor- may be time to find new motivations to love the job you're doing. I used to love my job because I loved some of my coworkers and one of my nurses. They have all since moved on. So now, I take joy in making the mental connections between why certain things are happening with certain residents and their overall plan of care, disease pathophys, etc. In other words, I'm looking at the "nursing picture" that I'm learning in school and applying it at work, even though my job description doesn't require me to do that. In any case, it's very soon that you're back after a fairly significant absence... just be patient with yourself! Hang in there! Wendy CO EMT-B

I also vote for AED availability and think it would be feasible. Real crux is, are you going to be providing or advocating community responder training in these buildings? If there's nobody around who knows what an AED is, let alone where to find it or a general gist of how to use it... I know they're designed to be idiot proof, but lack of confidence deters many from stepping in to help, especially in our lawsuit-happy society. ***Mini thread hijack...**** On the assisted living note, look at it this way-- the people working in independent living and assisted living settings are often given no-to-minimal training in proper lifting technique or medical assessment. Do you really want high school Suzie, whose job is mostly to help put shoes on and fetch things, trying to lift your loved one off the ground? She could definitely do more harm than good, especially if there's one of those hip fractures that doesn't manifest itself until grandma tries to bear weight... you definitely want someone to know how to gently get them back to the ground or into a chair at that point... As far as the CPR goes, many "non-skilled" facilities have been sued because the care providers did CPR and grandma died anyway or survived, but with broken ribs. Why were the suits successful? Because a facility that provides CPR should also be able to provide assessment by a nurse in order to provide proper care... so the logic goes... It's all a game of dodge the lawyer. Everyone living in said facilities signs a waiver stating that they understand that staff do not provide CPR and that community emergency response times may be long enough that even if you are full code it may do no good. I've yet to hear someone freaking out about it, and it took me a LONG TIME to get used to the idea in my building (I work in a no-CPR, minimal lift assisted living... we can get 'em off the floor but only if nobody lifts more than 50 pounds and the person is helping you to get them off the floor in some way.) We have LPNs during the day... and to be honest, I'm not sure if they do CPR either. We certainly don't have any suction, and can't initiate any O2 on anyone (or change the setting on their concentrator) without a direct doctor's order... so the fastest way to get any of that is usually to call 911. What really chaps me, is that I'm considered an "unskilled" provider and therefore, not supposed to take vitals, yet I'm a night shift manager. (It's just my assisted living that feels this way, others in my area allow non-nursing staff to do vitals). I have no nurse at night. Therefore, when I call EMS, I end up having to explain to them "no, folks... I have no vitals for you, it's technically out of my scope." I am allowed (wink wink, nod nod) to use the pulse oximeter, so that's usually the only thing I have. If it's something iffy enough that I'm having trouble making up my mind on whether the person needs to go out, I take a full set of vitals protocols be damned, but you bet I don't chart them... Boy, that's a fun grey zone to be playing in... **returning thread from hijack** Wendy CO EMT-B

We feed our friends a lot... here's some of our rotations... Easy pasta- cook pasta, saute in a pan with olive oil, frozen peas/other veggies, canned chicken or tuna, then pour in a lot of balsalmic vinegar and toss thoroughly to coat. Breakfast for dinner- giant scrambles full of veggies and cheese (most often onion and bell peppers), toast, and turkey bacon/real bacon. Fritatta- Saute 2 zucchini, 1-2 onions and 4-5 thinly sliced potatoes in olive oil in a large oven-safe saute pan. Mix in about 8-10 scrambled eggs and cook halfway through. Put the pan in the oven at 425 for about 15 minutes to finish cooking; about 5 minutes before removing, sprinkle cheese of choice over the top (I've done this with non-dairy rice cheddar shreds, mozzarella, fiesta mix... you name it, it works). Cut into wedges, serve with bowls of tomato soup on the side- basic Campbell's or your favorite generic that you fix stovetop after putting the fritatta in the oven. Feeds 6-7 people. White Folks Pad Thai (aka non-authentic)- Stir fry veggies and meat of choice (I usually use frozen veggies, onions and chicken but you can also use shrimp, tofu, etc.) Cook a package of wide rice noodles, drain, and toss in with veggies and meat. Add in about half a bottle of teriyaki sauce that you've pre-mixed with some cornstarch (only takes a tablespoon or so). Cook until sauce thickens and noodle mixture is thoroughly coated. Scramble some egg and crush peanuts for topping. Another good one is Ratatouille, but that's not so station friendly... lots of steps, but feeds a crowd! I do mine by slicing my veggies in a food processor (1 medium to large eggplant, 6 zucchini, 3 bell peppers, 2-3 onions, 4 yellow squash) and coating them in olive oil and roasting on pans at 425 degrees for about 9 minutes. This takes several rotations of trays and takes a while. Then I end up layering the roasted veggies alternately with canned diced tomatoes and basil, salt and pepper in a glass baking dish. Once the dish is full, cover the top with mozzarella and bake at 375 degrees for 30-40 minutes, or until the mozzarella is nice and brown and bubbly. Serve with crusty french bread. Wendy CO EMT-B

Come on, Bieber... do you really have to ask? Why would you monitor for infection- same reason you'd monitor any other sutured wound. High risk for anaerobic bacterial growth and tissue damage. Doesn't matter if you stitched it together with surgical sutures or sealed it over with dermabond/medical superglue, you've still got the same risk. I think the risk in the field would actually be higher, as you might not have irrigated or disinfected properly... less access to topical anesthetics to improve pt. compliance with irrigation, etc. Hence, why I watched the two lacs I superglued like a hawk. My terms were actually that I would only do it for him if he agreed to go to the ER at any signs of infection, which he readily agreed to. Which brings me back to my original point... if we're going to start treating minor things in the field and releasing, we need to develop a community health interface with protocols for assessment by home health nurses or specially trained paramedics for a prescribed period of days post-treatment. It would be also great if we could field stabilize and then refer to a community based in-home care for things like asthma exacerbations, flu/cold, etc... Wishful thinking, I know... Wendy CO EMT-B

Got a friend with no health insurance. Works on cars. Patched together 2 different deep lacs for him with superglue (after irrigating and disinfecting). Watched them EVERY DAY for signs of infection- he was headed for the ER if I saw even a hint of it. Something I'd advocate for paramedicine? No. Too risky. Something I'll use on a friend, who asks me to do it, who I know won't sue me? Occasionally, and only if I feel comfortable with it. We've been lucky that he HASN'T had any infection from those injuries, and without someone to monitor it daily I wouldn't have done it. So, a treat and release is not an option, really... unless you're wanting to come back for daily follow up care. This is why we need public health interface roles... then it would be viable... Wendy CO EMT-B

I had a migraine in reaction to Macrobid that I took recently. Won't take Macrobid again- I thought I was going to die. I never get migraines, is part of it. My lesson there was a shot of phenergan and a shot of NSAIDs in the butt. Lucky me! I really hope it goes away soon and you feel better!!! Really hoping! Poor fella. --Wendy

None taken your point is absolutely valid hence why I just challenged the epithet. You are smart as always!!

Ok. The gloves come off now. NOW, I am calling into question your status as a martial artist. The people I know who bear that title have a lot more restraint and discipline than to rocket off with massive amounts of vulgarity after someone responds to them with civil posts. You've been reported to admin. Methinks there be an odor of troll floating here. Either delete the post and do something to redeem yourself, or off you go... By the by, we don't hold well with ageism here. Yes, I'm 24- but if you ask those who have been around longer than a week and a half, most refused to believe my age when I was 19 based on my intellectual presentation. The median guess was 38. Wendy CO EMT-B