Lone Star

But then it came, a siren went off and a code blue up in the hospital happened, they wanted the students to run up there and do chest compressions for CPR. Immediately i was excited, but mostly scared $hit-Le$$ and kind of wanted to run away. We got up there and they had stabilized him with drugs and his vitals were normal, he was a vegetable, but still "alive" none the less. I was kinda of re leaved because, i am admitting this too you all so don't give me too much crap, i was scared to be around and touch a dead person. I know this job includes this a lot, im not naive, i was just scared, my adrenaline was going but i was scared, we sat in the room for a while, while the nurses worked on him (they were all joking with each other, laughing, talking about their plans for the weekend) which i felt was odd, THERE WAS A DEAD MAN IN FRONT OF THEM?!?!.

Ok, let's start by dropping the istant defensive attitude; no one is out to bust your balls because you've admitted how you were feeling during the code. What you felt was perfectly normal, and as you can tell, is almost expected. If anything, you may have already earmarked yourself as a compassionate provider

As far as the nurses reactions during the code, could it be that maybe you're unintentionally exaggerating this because you were so shocked by it? As you get more experience, you'll find that your sense of humor in stressful situations will become more 'dark/black'. It's nothing more than a coping mechanism (as tcripp pointed out). It's not that they've been through it so many times that they don't care, or they think it's a joking matter; it's how they deal with the stress of the situation so it doesn't drive them from the field because of 'burn out' or PTSD.

So what i am asking is, has any one else had these feelings before? Another EMT-B student was pissed because "he wanted to break ribs and get dirty". I was more stand off ish, interested, but also very nervous.

As far as the "...let's get in there and break some ribs!' guy....do NOT follow his lead! He'll be up on patient abuse chages in no time flat. To WILLFULLY and DELIBERATELY inflict paininjury to the patient simply for the amusement or humor of the provider is ABUSE! There is no 'grey area' here.

Just curious, and i am kind of worried that i should not be in this field now, but i will never quit i will keep pressing on.

There is nothing wrong with wanting to continue on this path, but if you find out that it's 'just not for you', then by all means, walk away. There is no shame in admitting that you have limitations. There IS shame in knowing that this is outside of your limitations, but staying in simply for the 'cool factor' or 'hero points'!

By no means am I suggesting that based on your original post that you get out of EMS, I'm only pointing out that if you DO stay in EMS, that it's for the right reasons.

I've got experience in moving a patient who's weight fluctuated from 1,020 pounds down to 860 pounds and then ballooned (no pun intended) to 1,685 pounds. I was part of moving this patient at least 120 times. Do you REALLY want to compare records here? I've also helped with patients who have ranged from 350 pounds to 800 pounds.

I'm 46 years old nd currently have more than 27 years of experience in Fire/EMS ( 15 years in the Fire service and 12 in EMS) under my belt. I've also worked in Metro Detroit. I've pulled as many as 38 calls in a 24 hour period.

Granted, I'm just moving into the ALS world, but that negates neither my experience or my credentials.

One must ask though.....if you're willing to misrepresent something as trivial as your age; what else have you misrepresented here?

First off, since the patient wasn't an emergent transport; there was NO reason (other than the sending facility trying to 'offload' the patient), there was no reason that they couldn't have taken the time to arrange APPROPRIATE transportation.

As for the contacted service, they should have made it clear that they didn't have the appropriate means to transport this patient.

In my opinion, the OP made the appropriate decision in refusing this call. It has NOTHING to do with discriminating against obese patients. It DID however, have EVERYTHING to do with being able to transport this patient safely.

While patient advocacy is paramount in EMS, there are other considerations that MUST be included when deciding patient transport. Not only the safety of the patient, the general public; but the safety of the providers.

It was stated that the patient was approximately 6" too wide for the floor space available. This means that the patient is crammed and cramped into the space available. In the event of a side impact, all of the energy that is transferred from the 'ramming venicle' to the ambulance body/chassis is directly absorbed by the patient's body.

Removing the safety equipment in order to take an IFT transfer only opens not only the responding crew, but the transporting company up for civil litigation. We know that we live in a highly litigatious society. As a memeber of the managerial echelon, one must balance the well-being of the employee against the liability of the company.

Based on the information available, the responding crew made the appropriate decision, and the supervisor should be the one getting 'sacked'!

Those who support the transporting of the patient despite not having the proper equipment and vehicle need to go back to school and learn what 'patient advocacy' REALLY means!

Oh no! The kiwi's are getting as numerous as the ozzies!

Welcome to the City!

While we may not give the 'textbook answers', or answer them in the "feel good 'kumbaya' fashion", we will answer your questions in as much detail as you can possibly handle, (and in more cases than not) , more detail than you thought was possible.

Remember, EMS is a 'dog eat dog world', and anyone that gets into it is wearing 'Milk Bone knickers'!

LS

P.S.: As far as making friends in the Psychology Department, I'd start by getting cozy with the instructors (they know more than the students)!

As the day gets closer, you'll find SOMETHING that you've forgotten to attend to....(watches Scotty running around like a headless chicken).....

There is an 'up-side' to all of this......

Being a nurse, you won't have to make a trip to the ED when she beats you for stepping out of line.....you already know how to take care of the injuries

ROFLMAO

Congrats mate.......you should have run when you had the chance......now....resistance is futile....

I'll echo what the others have said, and will only add this: By the time you get out of your EMT class, you WILL know all of your classmates more intimately than you know most of your friends, because you WILL be putting your hands on their bodies, and they in turn will be putting theirs on you.

This is NOT the time to be 'shy', and be sure you've got clean underwear on!

Some options are:

Fire based EMS

Police based EMS

EMS based EMS (private carrier)

ER Technician (working in the ER)

Industrial EMS (manning a 'first-aid station, as say, in a factory/industrial setting)

Congratulations on the new Ruffle-ette!

I hope mom recovers quickly, and that the new addition is hale and healthy!

LS

I am glad I could help your egos feel better about yourselfs.

This isn't about making ourselves feel better, it's about answering your question with HONESTY!

now that avitar of FNG is going to offend many can anyone say why?

*Lone Star raises his hand and impersonates Horseshack from "Welcome Back, Kotter"*

I'm new but I figured I'll get right down to some of the questions I have. I'm active duty Navy right now but I should be back to civilian life by May and possibly looking at a future in EMS. That's where you all come in. I got some questions about the job, the schooling and stuff so I was hoping you could help me out. Here we go lets see if I can remember them all.

1). Is there a major difference between going and getting training at a community college vs. hospital? I know a lot of hospitals offer EMS training but so do some community colleges (they offer degrees too). I was thinking when it came to looking for a job it might look better to get training from a hospital but I'm not really sure. The issue I have with that is I don't think my GI Bill will pay for hospital training. I'd have to look that up though.

The hospital program is acceptable if you’re going only as far as EMT-B. If you’re going to go any higher, I would suggest that you look into the college program, simply because of all of the core classes you’ll need for your degree. They may seem unrelated, but trust me; they all will serve a purpose in making you a better medic in the long run.

2). The college I am looking into says it's about 3 semesters worth of school before I can apply for the medic core program. The medic program is another year long. So I guess I would be looking at around 2-3 years of schooling to become a medic. That sounds about right?

My program was 9 months: 6 months for EMT-B and an additional 3 months for EMT-I (they were combined into one program).

My Medic program is 15 months with 500 didactic (lecture) hours and a minimum of 360 clinical hours.

3). Some people told me before you can become a paramedic you have to do a certain amount of "911 calls" as an EMT. Is that covered in the training/schooling or do you have to go out and find an EMT job? I ask because I'm being told EMT jobs are tough to find these days. So some clarification on that would be nice.

In GA, I had to hold at minimum an EMT-B license, or the NREMT equivalent. Since I started medic class directly after EMT-I, I was ‘golden’. I’m going to have to apply for my state EMT-I license soon, so that I can continue in the class (the NREMT is going to expire before my medic program ends).

As far as the ‘experience’ part of your question, it IS a ‘hot topic’ with two schools of thought; the first advocating at least a year of experience before medic school, and the second advocating going directly to medic school.

The biggest problem with the ‘experience gathering hiatus’ is that it gives you time to build bad habits, which will have to be broken during your medic school. If you’re serious about becoming a medic, then by all means, go directly to medic school. This will keep the information learned in EMT school fresh and keep you in the ‘school mode’ of thinking.

4). Do you guys enjoy your profession? I've been narrowing down my options for years and I finally have it down to xray technican and medic. I'm leaning towards medic because I think it's a much more rewarding field and I like working outdoors. I've always wanted to be a first responder (at first a police officer now medic). To have a job where I help people on daily basis sounds awesome. I know I would enjoy that.

The job definitely has its good points and its bad points. When you step into a bad situation and can actually do something to pluck the hapless soul from the jaws of death (ok, I’ve been watching too many of the ‘whacker shows’) it’s a feeling that compares to nothing else you’ll do. Make no mistake though, you’re not even going to come close to saving them all, and when you lose one despite doing everything right…it will crush you like a cigarette butt beneath someone’s heel. It’s a devastating blow; not only to your ego/spirit, but to your confidence.

5). I know every company is different but in general what is the EMS community's opinion on tattoos? Obviously, if they are concealable (chest, shoulders, back, etc) it's no big deal but what about visible tattoos (on the calf, lower arms)?

Many will tell you that tattoos should be ‘coverable’ while in uniform. The geriatric population of your patients aren’t always comfortable with the ‘colorful’ healthcare provider.

6). What is the job outlook like for medics? Is it tough to find jobs out there? All I hear is about how the medical field is expanding and there are jobs everywhere but that just seems hard to believe. I know it's a recession and even though it should be I bet EMS isn't exactly recession-proof. Are any of you having a hard time finding work or know of people trying to find a job?

With the ‘patch mills’ churning out mediocre providers, it DOES make it tough in some areas. Obtaining a degree will help set you apart from the masses of ‘cookbook providers’ being turned out by the ‘patch mills’

That's really all I can think of at the moment. It wasn't quite a million but it should keep you guys busy. Thanks in advance for your help. I'm looking forward to hearing some responses.

And by the way I'm going to be living/working in Minnesota (twin cities area) and I'm nearly 22 years old. If that helps at all. Thanks.

Good luck in your endeavors, and welcome to the City! You’ll find a wealth of experience and a few hundred folks that are willing to help you along the way.

Every patient gets new linens, blankets, pillow cases, towels, etc; every time, guaranteed!

Most hospitals in the areas that I've worked had a 1:1 swap policy. Normally, there was a rolling shelf unit that had linens and such just for EMS use.

I have been known to pull an 'extra set' from time to time, simply to have on the truck in case something goes wrong and I need them. I wasn't greedy about it (grabbing several sets of each at a time just to stock the truck), but it's reassuring to have a couple 'back up sets' just in case....

There's no reason to NOT change the linens and wipe down the stretcher (straps, mattress pad, side rails etc.). The ONLY reason it isn't done is out of pure laziness on the part of the on-duty crew. I mean, it's not like we're having to maintain 'military standards' on how we make up the stretcher between patients.

I'm sure that no one would willingly lay down on the cot after ANY of our patients, so WHY in the world would you force the patients to do what you would never consider?

Back before Admin changed the chatroom (back when we still had voice/video chat), and before the demise of my external hard drive, Dust and I spent many hours discussing music; and reliving all the ‘good tunes’ and the memories that they held for us. To say that his musical interests were eclectic at best is an understatement, (knowing Rob like a lot of us do, is this REALLY any great surprise?)

Doogs,

How DARE you come into OUR ‘house’ and start casting aspersions based on YOUR belief system! You condemn AK for his beliefs (or in your opinion, lack thereof), and insinuate that YOUR beliefs are the ONLY way to find peace and comfort in these sad times.

How can you say that AK’s beliefs aren’t the ‘right way’, and imply that he’s a heathen because he doesn’t believe in the same higher power that you do?

One can only conclude that since you’re so willing to castigate AK, that you are in fact, a religious person. That being said, let me provide a couple of bible verses that are extremely relevant and important at this point.

Philippians 2:12-15

¹² Wherefore, my beloved, as ye have always obeyed, not as in my presence only, but now much more in my absence, work out your own salvation with fear and trembling.

¹³ For it is God which worketh in you both to will and to do of [his] good pleasure.

¹⁴ Do all things without murmurings and disputings:

¹⁵ That ye may be blameless and harmless, the sons of God, without rebuke, in the midst of a crooked and perverse nation, among whom ye shine as lights in the world;

Matthew 7:1-3:

¹Judge not, that ye be not judged.

² For with what judgment ye judge, ye shall be judged: and with what measure ye mete, it shall be measured to you again.

Revelation 22:18-19:

¹⁸For I testify unto every man that heareth the words of the prophecy of this book, If any man shall add unto these things, God shall add unto him the plagues that are written in this book:

¹⁹ And if any man shall take away from the words of the book of this prophecy, God shall take away his part out of the book of life, and out of the holy city, and [from] the things which are written in this book.

Yeah LS but in a Samuel Jackson voice my 'verse' is way cooler <grin>

In my best Will Smith voice:

The difference between you and me, is that I make this shit look GOOD!

At 46, I'm still working on my medic degree. I was an EMT for 12 years. As long as I'm still able to do the job and provide the care that my patients need, I'll be 'in the field'.

When I can no longer do the job at hand, I'll either teach or simply leave the field.

Most of your patients will trust and respect the 'older medic'. Kind of the same way they relate to the older docs. They automatically figure that you've been in the field longer than you really have, and therefore must know a great deal more than you think you do....

So sad, I really wasnt here long enough to meet him. Is it possible to find his "last post" on here ?

http://www.emtcity.com/topic/20732-littmann-cardiology-stethoscopes/page__p__265446#entry265446

There used to be a couple of interviews that Rob took part in, one being at EMStock...(a couple others were webcasts); does anyone have the links to these?

I offer my sincere condolences to his family and his friends.

I know that I've probably done more than my share of driving him absolutely 'bat shit crazy' at times, but I have to admit that through some of the absolutely knock-down, drag-out' battles we've had, I was honored to call him 'friend'.

It is because of Rob that I've not only changed my view on becoming a 'degreed medic' or 'collegiate medic', but has made me the vociferous advocate I am on trying to increase the educational requirements for entry-level EMS. I will continue the fight, and can only pray that I can bring even half of the passion and tenacity that my friend had!

Rob Davis was one of those 'love him/hate him' kind of guys. There was no 'in between' with him.

Like many of you 'old timers', I've spent many hours simply chatting with him in voice/video chat and in text. I can't help feeling 'cheated' that I never got to meet him in 'real time'.

Because of Rob, I've gone through miles of Hell to get back where I am today. Every time I thought about just throwing in the towel, Rob would somehow intuititively know, and would magically appear and put a boot in my ass to get me moving in the right direction. For that, I will aways be in his debt.

Rob never allowed any of his friends to 'half-step' along, you either marched full bore or you didn't join the formation. One of his favorite (and most used) expressions was, "Go big, or go home!"...a creedo that I've adopted along the way.

Rest easy my friend, your job is done. It's now time to pass the torch, and let someone else continue the fight you and a handful of others have started. I will proudly carry that torch and light the way along the path that you have laid out!

Susan,

First off, welcome back to the City!

I'm impressed that you would share your story with us like that, and I'm even more impressed that you've taken the initiative to stand your ground and actually DO something about your problem! We've all seen many that fall into the whole drug use/abuse cycle, and never do anything to break it. Your courage and strength are to be an inspiration to those that are where you were.

The fact that you voluntarily surrendered your license before something 'bad' happened was an intelligent move on your part, and I can only hope that in doing so, it will be viewed in your favor if you attempt relicensure in the future.

I can only imagine the difficult road you're facing, and can only offer the words of encouragement to stay strong in your quest.

Best wishes

LS

Why not just marry the correct person and be happy. Or do not get married and play the field as much as you want.

Unfortunately, prospective spouses don't come with a 'compatibility list' to ensure that it's a perfect fit.

I was married once, and found out within the first 18 months that she was a lot like Will Rogers (Never met a man she didn't like; the problem was, she 'liked' them better when I wasn't home!).

Sincethen, I seem to find women who either want to make me 'pay' for the sins of their exes, or who can't stop playing their stupid school girl games .....(stupid 'tests' to see how faithful the guy is by having their friend make a pass, sleeping with someone else out of 'curiosity'...you get the idea)...

Hell, I've been dumped because they thought I wasn't 'emotional enough'.....

While I've met some very attractive women in my travels (school, work, etc)....I'm not usually in a position to cheat because I keep getting that look from females that says in no uncertain terms "I can do SOOO much better than you!"

Even if I DID find a 'willing partner', I'm know I'm too stupid to do it without getting caught. Since getting caught would cause WAYYY more problems that I really don't need, I find it very easy to not put myself in that position.

Before anyone comes up with the conclusion that I would do it if I thought I could get away with it, think again. I don't do it because it's not the "right thing to do, and it's not the right way to do it." (Thank you Wilford Brimley!)

I've been on the other side of this equation, and I didn't like how it felt, so WHY would I be willing to subject someone else to that kind of hurt?

When I had to do drug profiles, I figured out how to adjust the settings in Microsoft Word so that I could type them out. I then printed them off in (my printer didn't like me much after that!).

All that needs to be done is load the cards (5x8 inch) correctly (I used cards that were blank on both sides ). Just load the cards into the printer so that the 5" side is your 'top' and 'bottom' and then slide your paper guide all the way to the side, just like you would do for a stack of 'regular paper'....

The cards are set up for drug name (centered across the top of the card), Classification, theraputic action, indications, contraindications, precautions, and both adult and pediatric dosages.

Some drugs took two cards to complete. I researched the drugs online, n my books and even went to the pharmacist at the local Walgreens and CVS to get drug information. I've got enough paper on drugs to make a document that completely maxes out the extra large binder clips. The pharmacists thought I was some sort of nut case asking for all these profiles.....lol

The drug name is in 16 point bold, each category is 14 point bold and the text is in 12 point.

Each drug card looks something like this:

CLASS: Sympathomimetic bronchodilator

THERAPUTIC ACTIONS: Relaxation of smooth muscle of bronchial tree. Decreases airway resistance, facilitates mucous drainage, inhibits histamine release from MAST cells; reduces mucous secretions, capillary leaking and mucosal edema caused by an allergic response in the lungs.

INDICATIONS: Relieve bronchospasm in patients with reversible obstructive airway disease (asthma, COPD, emphysema)

CONTRAINDICATIONS: known hypersensitivity to drug, tachydysrhythmias

PRECAUTIONS: Blood pressure, pulse and EKG should be monitored. Use caution in patients with known heart disease (Due to B1 effects)

SIDE EFFECTS: Bronchospasm, chest pain, tachycardia/palpitations, tremor/nervousness, hyperkalemia, hypertension, headache/vertigo, nervousness, insomnia, cough/hoarseness, sore throat, rhinorrhea, stuffy nose, dry mouth/throat, muscle pain, diarrhea

DOSAGE: 0.5ml (2.5mg in 2.5ml normal saline over 5-15 minutes), repeat PRN as needed (2.5-5mg)

PEDIATRIC: 0.15mg/kg in 2.5-3.0ml normal saline, repeat as needed.

Detroit EMS as it is currently is a mess. I work at one of the recieving hospitals where the vast majority of our ambulance traffic comes from Detroit EMS.

Essentially they are in the process of converting to a BLS system from an ALS system. The idea is that their transports are generally short and Detroit has many hospitals. However, this is very frustrating in situations where having a medic would make a big difference. Probably the most common situation is a hypoglycemic diabetic where they are powerless to do anything about it. Often the know the sugar is "lo" based on the patients own glucometer but even then our EMS has not way to give glucose or recheck the sugar unless it is one of the two or three remaining "alpha" advanced units. I suspect that these few remaining units will be phased out as paramedics quit.

When I was working for a private carrier in Detroit (in the mid 90’s), one had to be an EMT-S or EMT-P in order to be considered ‘eligible for hire’ by Detroit EMS. The reasoning behind this was because Detroit EMS was converting to an ILS-ALS only system.

As far as not being able to give glucose to the hypoglycemic patient, Oakland and Wayne county protocols allowed for this, so explain to me how they weren’t able to treat the hypoglycemic patient appropriately. Granted, the EMT-B couldn’t perform a ‘finger stick’ because it was considered an ‘invasive procedure’, if hypoglycemia was confirmed by ‘assisting’ the patient to check their own BGL levels with their own equipment, there was no reason they couldn’t treat the patient appropriately

Its not the EMTs themselves that are the problem but the system as a whole in Detroit that is a mess. Detroit EMS is essentially the largest system in Michigan yet they are the only system that is not doing reporting of electronic run data as mandated several years ago by the State. They can get away with this because they are so large and the state knows that if they take any regulatory action to shut them down a huge number of people will be without EMS service. Other issues relate to ambulance availability where over half of the fleet is in for repairs at any one time. Further complicating this is the abuse of the system in Detroit where patients call an ambulance for nearly any complaint, no matter how minor. Worsening this, until recently Detroit EMS did not prioritize their dispatches. This mean that that the my finger hurts cases got the ambulance before the GSW because they called in 1 min earlier. We still recieve transports of patients by police because no ambulance was available, although i'm told its less than in the past.

I personally know of more than a few incidents where the Detroit EMS crews were ‘milking the clock’ by dropping off patients and hanging around the hospital (either in the ED or sitting outside in their trucks, putzing around so they didn’t have to take that next call waiting. Another factor in Detroit EMS being such a mess was the transporting crews ending up being investigated for theft from the patients.

Unlike fire based EMS at placed I have been in the past, our medics do not rotate with the firefighters and are not dispatched with fire. Meaning that when they go to a cardiac arrest or other complicated care the only folks on scene to help with transport and treatment are the two EMTs on the ambulance who have to do CPR, place the combitube, ventilate the patient, load the patient and then drive while the other takes care of the patient. Other places would send firefighters who are otherwise just sitting around to help with CPR and moving the paitent.

How is this different from what a crew from any other private carrier faces? If a crew from Universal, Community EMS, or any of the others can do it, why should Detroit EMS be any different?

I like most of the folks I've met that work Detroit EMS and they generally seem competent at what they do but they are in a tough situation. I feel bad that my hospital is perhaps their least favorite hospital to bring patients to because of the very small number of patients we bring to the resuscitation room on the basis of the EMS call.

You must be in the DMC. Hutzel, Detroit Receiving and a couple other hospitals are usually inundated by ‘walk ins’ that they are ‘Status C’ more often than they’re not on diversion.

Ultimately I think the best solution would be to dissolve the Detroit EMS organization and contract with a private company. There are several operating in Detroit and every once in awhile they end up getting a 911 type call of some sort of another. They tend to be paramedic based and very competent. Which is odd that most of the medics in Detroit are doing interfacility transports and not 911 runs.

If Detroit EMS is going to do IFT’s, then they need to utilize their resources better. In private carriers in Detroit (like Community EMS and some of the other smaller services), the EMT-B crews are the primary source of the IFT crews.

I grew up at Fenkell and Lahser... I know the area a bit too well. Everyone who knew me when I was living in the area, hoodlum, "straight up", or otherwise, at least acknowledged that we were all in the same situation. Mutual respect, if you know what I'm saying. Granted, that was 15-20 years ago, and you probably wouldn't know that unless I mentioned it. Usually the mention of my old address raises eyebrows with people who are familiar with the area.

In any case, thanks for the advice and the knowledge. That's a really good idea about distinguishing ourselves as EMT, NOT police. I'd rather not get shot/stabbed/punched by some crackhead who sees a badge and freaks out. On the flip side, I'll really take the respect and treatment aspect to heart. People don't live in the ghetto for it's appeal and resale value, but they still need to be treated with the same level of respect and dignity as if we were pulling a CEO out of his high rise office.

Thanks!

Well said!

Respect isn't all that terribly difficult to give, and it means worlds to the person on the recieving end.

There is no real reason that our patients (despite their geographical location, socio-economic class, etc) shouldn't receive respect, especially if it's being withheld based on those criteria.

The bad thing of "The Bad Parts Of Town", is that the bad folks get all the press, and the nice folks get painted with the same brush as also being evil.

I worked the worst drug infested projects in New York City, and really met the nicest of people. Unfortunately, I also met some of the nastiest.

If using stairwells, I learned to yell, "EMS in the stairwell! If doing something you shouldn't, better stop for a bit!" The "Bangers" used to comment that I was crazy, but they seemed to like me for doing that.

Definately saves on the 'surprize factor'!

When you come around the corner unannounced and wearing a badge...in a uniform that looks a LOT like law enforcement, you tend to get an unwanted reception....