retired_medic61

My favorite EMS paid job was at a service that had both paid and vollies. The vollies stayed at the station. We typically ran dual Paramedic units but occasionally we would split and ride Paramedic/EMT with the vollies. Most of the vollies were EMTs at the service although there was one who was a fulltime nurse (RN/Paramedic) and rode out to keep up her Paramedic skills. The reason that it was my favorite job was not because it was a paid/vollie service but that we had a medical director who was excellent and knew his medics well, we enjoyed progressive protocols, had a great schedule, pay and benefits. We also had an in-house CE program as well.

I had been a vollie for over 5 years before I became a fulltime paid Paramedic. Some of the paid staff resented the vollies but I had no problem with them for obvious reasons.

I volunteered for 11 years for a service that started as a 100% volunteer service a little over 30 years ago and have had paid medics the last few years. It was still 100% volunteer when I started. Many times then my vollie partners and I would stay at my apartment with the ambulance and I would prepare a fantastic meal for the crew. I also ran every Thursday from work and my partner worked in the same building and we had permission from management to run on Thursdays. The initial meetings to start the service took place where I worked and many in that particular community who volunteered worked in the same place. Those were the days.

Later on I still vollied (less frequent when I chose EMS as a career) and ran with a paid partner who had been my regular partner at the nearby fully paid service. Interesting huh? I lived in an apartment complex located behind the building and had a response vehicle at my apartment. After I moved, I stayed at the station. The service is now almost 100% paid staff. The paid staff resented the vollies and most believed that vollies keep the pay scale down overall for EMS. I am thankful that I volunteered. I paid for my initial EMT but was reimbursed for it once I started volunteering after I received my certification. I was reimbursed for my EMT-I certification and the service paid for my Paramedic training as well. I received free ACLS, BTLS, PALS, PEPP and the Street Level Airway Management (SLAM) course. They were even willing to loan me a textbook for Paramedic so I would not have to buy one. I bought the book because I wanted one of my own to mark in. Total cost for my Paramedic education: $48.00 Experience...priceless.

Thanks for the stroll down memory lane

I think I would be looking elsewhere for employment.

I remember at the college I took my paramedic course we used the five volume series from Brady along with many other texts. The problem that my college faced was that a "private school" was offering the EMT-Basic in six weeks, the EMT-I in nine weeks, and the EMT-P class in three to six months. It is hard to attract new students when:

[*]your limited by the state at five semesters from EMT-B to EMT-P

[*]they strike really "cheap" deals with city services to send their personal there

[*]there is no one to answer too other then the DSHS

The college was limited in both hours, semesters, and budget. There are 5 major universities in the city of Houston (population 4,000,000); four very large community college chains (with 4 to 10 schools each); and countless small one campus community colleges. By far the best one has to be San Jacinto College, yet they have the lowest enrollment rate compared to the others. Why? Because HFD pays Houston Community College to teach it's paramedics because they just rent space, and HCC coordinates the whole thing. They also happen to have the lowest passing rate of them all. North Harris Montgomery Community College (NHMCD) has several campuses, and they have deals with most of the volunteer departments to provide "reduced" tuition to their programs. Their students do okay, but the minute they leave the safe haven of North Houston and walk into the low income South East Houston they are lost.

Paramedic education is a major problem, it is the reason why we are short staffed at my service. Simply put, we can't find any decent paramedics that can pass the test, make it through FTO, and not get weeded out once on the streets. You would think a paramedic would know better then to fake vitals, yet on his first day of FTO a new hire flat out lied. Why? We don't know.

I've given report to countless crews only to get that ghost look on the face of the crew after I just gave them a simple report. Have you ever noticed that EMS is the one field of medicine that doesn't really use all that much medical terminology? People like to say things like "we can't afford that," or "this is all we can afford out here," and my favorite one is "we just don't have the time to go back to school."

It is funny how almost every rural hospital seems to have RN's there, why can't they get educated paramedics? If so many people are still gung ho about volunteering, then why do they have such a problem conforming. Wouldn't they want to see these changes take place? You know education is an issue when you see a job discription that states the following: "ACLS, BTLS, PALS, preferred..."

I know which "private school" you are talking about and their pass rate is terrible. I know one quality Paramedic from that school.

I went to San Jacinto central campus and the education there was excellent and I know several quality Paramedics from there and several have gone on to nursing school and are now RNs as well. One in particular is a Flight Nurse and others are Critical Care Nurses.

"burn em and turn em"

When I started I had to give 100% of myself while I worked. The job demands it. Each day I went home I would leave 1% of me at work so I had 99% left to bring home. Add that up over 18 years. What do you have left, An empty wallet and an empty soul.

Yep, I agree 100%. I gave up a career as a software engineer to pursue EMS fulltime. I was stupid and young. I am now almost 45 years old, broke with a broken heart. I cannot even get a job as a software engineer now because the technology has changed so much. As far as relationships go, gone. Nothing here but financial worries and aches and pains.

I agree. That is why I try to keep people from making this a full time career.

Airway management is the most important skill we have. Unfortunately, from what I have seen, has the least amount of training in EMS Education programs and it is given very little time in company sponsored CE's from my last EMS employer who boasts what a great inhouse education program they have.

Texaco, I thought they only made motor oil and gas? :shock:

At Bay Star we have Valium, Versed, and Toradol. At City of South Houston we have Valium and Nubian as our only controlled substances. It would be nice to gain morphine at both services for the cardiac (chest paint/CHF) aspect as well as pain.

Now I have another question, since Nubian is a synthetic morphine, what is keeping it from being used in cardiac chest pain or CHF?

Nubain is a mixed narcotic agonist-antagonist with minimal hemodynamic effects, that is Nubain will activate some opiate receptors while blocking others. Morphine causes dilation of the venous system which decreases cardiac preload whereas Nubain does not have this effect.

I am with Dust, go to management. The one that gets to management first wins.

I left my handheld radio in the restroom at the emergency department. I realized it on the way back to the station and I had just mentioned that I had left my radio at the ER and he asked where in the ER I left it. About that time we heard a toilet flush over the radio and I told him "there it is!" I found out later that it was actually a dispatcher in the restroom with a handheld. She asked me if I had heard any additional background noise.

In these groups we need to remember how the drug is working, as to why it isn't giving the response we want.

If the Glucagon gives you a response (read: the patient wakes up, and can follow commands) a better subsequent action is to provide them with something to eat with more nutritional value than a pre-filled syringe of D50 has. The D50 follow up will work, but if the patient can eat something, it will give a longer duration of effect than straight sugar can.

And of course, re-check the BGL every few minutes to trend the changes.

True; however, many times during a transport the glucose level will drop and the patient will need to have D50 enroute. That is what I was trying to say. Yes, we do monitor glucose enroute and I have done so typically about 10 minutes after the med admin or if the patient starts to exhibit signs of hypoglycemia before that.

While we are on that subject I am going to say I have heard of medics who admin D50, obtain a refusal and back to the station. You pointed out a fact that D50 is also a tempoary fix and that the patients needs something to eat with nutritional value. So to all medics who slam their patients with D50 and go home, be careful, the patients glucose is apt to drop again soon unless they get something to eat.

I should have made myself clear that I was referring to a patient that is being transported. I don't have steak and baked potatoes on my unit.

Its like the American Express card...don't leave home without it :wink:

I have administered Glucagon in the past and none of the patients have vomited as a result. All medications have nausea and vomiting as a possible side effect. Glucagon is not really effective in someone who has liver damage such as an alcoholic or someone with liver disease.

Sometimes it is difficult to get a good IV line established in a hypoglycemic patient especially if they are combative. I have seen it work great in these situations. After you administer the glucagon, go ahead and start your IV and administer the Dextrose. The effects of the Glucagon will not last long at all and the glucose level will drop again pretty soon.

I am with Rid on this. In my state, basics are a dime a dozen as well. Also, I have seen many EMT's who pickup bad habits and carry these habits to the Paramedic level. Any good, reputable service is not going to cut you loose as a lead medic on the unit the day you receive your Paramedic certification or license.

I think an individual should take English Composition, Technical Writing, Algebra, Statistics, Medical Terminology, Psychology, Sociology, Geography, Anatomy&Physiology, Microbiology, Chemistry and a foreign language such as Spanish or French (depending on where you will work). I had all before I went to medic school except French.

In the service where I worked, we were contracted with the EMS program to have student riders. They were required to complete run reports (no patient names) for their class and they were evaluated and the crew as mentors were also evaluated by the students. We also were allowed to have observers provided they signed a release form.

Exactly. Even 911 experience generally only creates bad habits and attitudes. Who needs that?

Age? By the time you finish two years of medic school (the very minimum you should even consider taking), you'll be old enough.

Experience? Overrated. Doesn't matter how much time you spent as an ambulance driver. Once you get out of medic school, you'll still not be ready to work alone as a primary medic. Concentrate on education first and foremost. If you can get EMS work while in school, great. If not, no big deal. Best medics I have ever worked with were rookies right out of school with no prior experience. You can be one of them.

I'm with Dust on this one. I have seen many EMT's that have developed bad attitudes and habits and carried them over to Paramedic. I have known a few that went to work fresh out of paramedic school and they turned out to be excellent medics. I do not believe that you can throw the keys at a new paramedic and say ok its all yours, you are the primary medic. Unfortunately, that has happened and the results were not good.

I had a Paramedic instructor that used oral questioning. It was fun and really kept the students on their toes.

Also, check out some of Bob Page's techniques. He is an instructor in Missouri and speaks at EMS conferences frequently.

I have always used the LP12. I hear Zoll M Series is a pretty good monitor. I think its a matter of what you get used to.

I wear the Original SWAT boot. I have found that is the most comfortable boot that I have worn. In fact, I still wear them regularly even though I am no longer working on the ambulance. I work in a campus environment and do a significant amount of walking so they are more comfortable than regular shoes.

I have always been careful about ordering boots online. I will order online if it is a boot that I have worn before. I have been involved in EMS for 15 years. I feel I have no problems with my feet since I have always worn a good pair of boots.

I remember my first loss. I was on my second shift as a new EMT. One vehicle rollover with one patient ejected. The patient ejected was a beautiful 8 year old female who looked a lot like my sister at that age. I threw up after the call. It was tough but compelled me to move on. That was in early 1991. I have had several losses since then most I do not remember but there are a few that I do remember that had bothered me. If things never bother you then you are not human.

I was a shift supervisor on a 24 hour shift. Most of the shifts were sleepless. I allowed my crews to sleep as long as the trucks were checked off & cleaned and the station duties were done.

Early in my career I got off at 6am and most of the time I did not sleep during the day but rather went to bed early the following evening. Later in my EMS career I found it increasingly difficult to avoid taking a nap at some point the next day since as a supervisor I did not get to sleep much during my shift. The problem with sleeping the next day is that I could not get to sleep at night even on my four days off.

After 10 years, it really started to take a toll on me.

Aw heck, thats a lot of reading...I better call my shrink!!!

Now that is a term I haven't heard in a while.

Nate, that must be an oldtimers term. HFD used to put them through an 8 week acclerated program. Pretty freakin scary isn't it?