Ridryder 911

There are places in the country that will always have to have a some form of a volunteer system. This is do to locality, population etc. But, these places are very few and rare. I am not upset of volunteers that give their time in this type of situation, it is neighbors taking care of each other, the best they can. Usually they will rendezvous with another EMS if possible. I recognize this system more of a first response system. In the same regards of small clinics that might keep a patient or treat until stabilized to go to a hospital. I would not call that clinic a hospital. What does upset me is for communities that uses volunteers in lieu of professional paid ALS/EMS. Any township over 15 to 20,000 people can afford a full time ALS/EMS units. It has been proven scientifically, and business wise there is enough tax base, population base for run volume etc. Those communities that deny having it, basically does not give a damn about their citizens well being .... short and simple. Those that volunteer in EMS for those communities, I believe are doing it for themselves definitely not for the citizens or the patients behalf. If those that did volunteer, would place as much time and work and interest in getting a full time department by researching on on how to funds, or contract a private EMS, then, I would honor them. I find it ironic, that we never see postings on local volunteer services becoming a paid one. Is this because volunteers enjoy the status quo ? I am sure the city does, again the cow and milk analogy comes in mind. As long as we have volunteers that make up a great portion of this job, it will never be considered a profession. It can't be. Volunteers are the death of this profession.. it has been seen and proven. But, I am not as worried as I used to be... With the population age increasing, it is predicted the run volume will triple within 5 years. Volunteers will be a thing of the past. Volunteer companies are already having hard time recruiting and maintaining rosters and education requirements. Most will not want to respond to 5 or 6 calls after midnight, every night, then go to work the next morning. The "warm and fuzzy" feelings tend to leave a lot faster. Cities might actually have to grow some testicles and take care of their citizens instead of having that golf course manicured. So now, how can expedite this..? Support increase State education requirements. Make re-certification levels more difficult by increasing education requirements. Increase Q/I requirements as well if they have not met such requirements then mandate remediation of skills in a local hospital(s) . Support professional EMS organizations by becoming very active in leadership in these organizations to focus on increasing professional level only. Suggest studies for cities and communities that are considering or should consider implementing professional EMS. This will not only help eliminate volunteers, but also cleanse a lot of dead wood in our professional level as well. Be safe, R/R 911

I agree Dust and part of this is probably true. We are fortunate that the local daytime ER staff is composed with about half of the nurses are former degree Paramedics with a history of > 12 years in the field. So, they are willing to teach, but like you described many are not prepared for clinicals as well. With the increasing number of patients and so much to do, it makes it very difficult to "teach" the student the basics sometimes. I can truly say most of this staff do remember what it was like to be a student, and are fortunate for that type of attitude. At one of our local technical schools, it is apparently hard for them to "fail" students. the policy is more related to attendance than testing. this is ludicrous. Ones who fail the test cannot sit on the registry, but can attend class. This is something they are attempting to change now. So yes, I believe many allow some students to attend to help "weed" them out. Although, this might not be the best ... I have decided to assist. I am not loaded for bear, but; I will not be as tolerate as I used to be. Like others I felt guilty marking poor clinical grades, but; if the do not perform I grade appropriately, I write suggestions, and if they change their grade will too. If they don't or drop out.... my feeling is they probably would not succeeded in the field. As I have posted earlier, on some things to be successful in clinicals, many do not present themselves appropriately. Either being lack of interest or apathetic. I am sure I will get a reputation (if I didn't already have one) of being a smart-ass and being hard on students. I don't care, if you want to learn then I will teach... but, if you want your packet signed off for that nighttime class ride with someone else. I was amused the other day when a Paramedic student arrived, and one of our newer aggressive Paramedics was going to precept. The student arrived ill prepared, without a stethoscope, ink pen, etc.. He asked the student where his "tools" were ? The student informed he had not purchased any as yet, because he did not know if he would finish the program and did not want to waste his money..... He was lectured on responsibility and how even plumbers come prepared and journeyman have an interest in their job albeit it will be a sh*tty day. I do think there is a major problem with EMS education as most know my opinions. Restructuring to a more traditional medical program with on site clinical professors, different attire when in hospital settings (other than police type uniform), pre-clinical classes on how to act, perform, appropriate professional behavior and communications should be emphasized. Clinical phase should be given more percentage of their final grade, since this is really where they demonstrate what they have learned and actually is the job they will be performing. Oh well, we have 4 fresh faces tomorrow... maybe one of these will pleasantly surprise me... R/R 911 Be safe, R/R

Oh great !.. Now we are going to get shot at everytime we have a paranoid cranker sees an ambulance coming down the road.... thanks guys!... You could had not used another approach huh..? R/R 911

Interesting, today as I worked in ER, I had a Basic (high school) EMT student. The staff had already warned him, that he would be assigned to me. Apparently all he did was play video games on his cell phone yesterday, when the staff would advise him of "might want to check out room # __) he refused. So today I forced him to actually touch a patient, observe etc. .. of course I quizzed on something basic knowledge.. i.e strain vs. sprain etc.. of course no clue... So now it comes time for evaluation... he smiles and even offers to buy me a coke... Unfortunately, I don't think he got the evaluation he wanted. I left note for his instructor to call me as well. The also had a Paramedic student riding EMS unit as well and apparently did the same thing....my partner threatened to sew his pockets shut... "all he did was put his hands in his pockets and watch us... never wanted to participate in care and helping.us !....... After a team huddle, we have decided enough is enough... we will now warn them once ... then after wards no further discussion ... Go home !... with unsatisfactory makes and to have a call to instructor. Sorry if you have to make them up...or get kicked out of the program ... get your ducks in a roll and your feces together... if you want to be a medic, you better be ready to learn......! R/R 911

The NREMT accepts the completion of the Paramedic program as CEU's NOT refresher though. Send a copy of your transcript or certificate, and mark te appropiate box in CEU section. Be safe, R/R 911

Sounds like he an infarct .. or fart while he had a B.M. and vagal down as well. The old "toilet" incidence. He then went into a brady sustained rythm.. block or not he gets a new pacer.... R/R 911

Dang ! R/R 911

I absolutely agree !........... Sorry, unless you have been on clinicals ove a period of time you are a guest. Please, do not make your self at home and recline back and sleep. Present yourself like you want to get a job. How do you think most employers get their new porspects ?... Yes, ask questions, but please try to ask intillegent ones... and if we ask you ones, don't be offended or dodge us..we expect you not to know. It is get to see some that do know.... I had a student with me yesterday .. it was great! He actually wanted to learn something... how odd ?... R/R 911

Welcome to the city.. I am sure the moderator will suggest this to go into a blog..... Sounds like it was his lucky day to survive. R/R 911

EMTPDIVER, I know there are several workman's comp attorneys that should have a list of services that have weight requirements. You might contact some that have represented some EMSA since the occurrence is probably higher. Your physician should not wait on that data, he should refer to your work men's comp case manager. He/She can give the information needed to give the range of lifting weigh approximations. If your physician is basing this solely based on 50 pounds, he is mistaken and he is aware of this as well. As usual you should get a private consultation with a recommendation of disability, then your employers/Workman's comp physician representative. They will average between. I realize you want to return to work, (which is very nice to see) BUT be very careful ! Be sure to get all settlements for your loss and medical treatment(s). I know many don't want to jeopardize their company etc..but, take care of yourself. Be sure you are totally healed first... if you you go back too soon, you will more than likely re-injure again. Realistically, a minimum of 125 -150 pounds is what most test for and should expect. By the time you add the cot weight and yes.. most of out patients are 300 lbs.. not 200. I would contact EMSA risk manager and ask what their requirements of lifting are, as well as workman's comp board to see if they have a lifting requirement for EMT on file. I wish you the best of luck.... R/R 911

We have had sevral medics out with "bad backs..etc" We have never had to have a exact number of pounds for return or release. It is part of the job requirement to be able to lift equipment and half of patients weight. Therefore physicians and even workmens comp are aware of the generalized weight requirements. My ex was a medic and she injured her shoulder and was out for a long period. All we had to describe that she was responsible for lifitng half the patients weight and "heavy equpment". Your case manager should had helped you in getting the requirements as well. The physician should also be aware that 50 pounds is an unrealistic number, for a job that requires lifting patients. Even more so is the repetitious lifting more than the extreme weight. Which area do you work in ? R/R 911

You can only count the class for one time. The same is true for any other class that you repeat, it called continuing education units for a reason... . R/R 911

I know several years ago, back when the EMS was called AMCARE in OKC, there was an incident that there was a family that was following an EMS unit too close and was involved in a MVC (not the EMS unit). It killed one of the family members when their vehicle ran through an intersection. I know the family attempted to sue the EMS for allowing occurrence etc... They lost because the the EVO had warned them not to follow... he radioed in to report to have LEO to stop them... and he was not exceeding the speed limits, and nor driving reckless. I am sorry, I don't have more info... this as more than 20 years ago as well. I know they changed their policy to stopping the unit and advising the family to "back off" and if they continue, the unit will go to the hospital in a non-emergency mode. I will try to get case .. etc. if I can find someone that might remember... A legend EVO safety instructor Gary McGraw used to have this in his course as a case. Be safe, R/R 911

Do we see a trend ? .... Do you see part of the problem... I, I, me ...me... Hmm where is the patient ? ... So many communities that could afford EMS or at least develop an ALS -EMS, but don't secondary to egos. Sorry, there are so many volly EMS is because of tradition not necessity. Yes, there are areas in EMS that thank-God have dedicated EMS volunteers, but there are plenty out there do it because of the self need in themselves. I feel this is gross negligence on the community leaders that allow it to continue and those that think of their need to "give" before patient care. If you are really concerned about people, then develop funding from tax revenue, bonds, grants, contract out private business . gasp !for a full time ALS - EMS ! So do you really think you doing the best for your patent?..After you are not able to administer the analgesics for that severe burn, or when you your patient has aspirated.. do you still go to sleep with that "warm fuzzy feeling ?"... Keep telling yourself, how wonderful and such humanitarian you are ... you might be able to convince yourself...because professional medical caregivers don't buy it! EMS has been harmed and retarded in growth because of the concern for the volunteer. It is well documented that curriculum and the National Scope of Training was diluted in fear of "not getting enough volunteers " to be active or having to have volunteers to go back to school. Sorry patients... hate to inconvenience those wonderful caring human beings!...remember what is important.... put medicine on hold and so some can "feel good" about themselves. Again, there are areas that will have to have volunteers, but those are rare.... professional EMS is sometimes prohibited from being introduced into communities because of egos and concern of themselves..... not the patients best behalf. R/R 911

Nothing against volunteers....but; okay. Really are you doing the "best" ? If they are senior citizens then they are probably the best to have a funded EMS. Again, I believe most of the volunteer systems are in place for the EMS to feel good about themselves, not for the "good" of the community. (Nothing personal .. general summation) Have you checked into private contract EMS so ALS could provide EMS care ? Partially paid full time roving Paramedic, with BLS response for ALS transport ?.. There are many other options.... Until the patient receives prompt BLS with followed immediate ALS care.. then really "the best" has not been provided. Even after 40+ years of active EMS in the U.S. , we still allow and make excuses for communities. The priorities of communities are skewed on what is important. R/R 911

I believe that the EMS gods.... sometimes gives that have some time under our belt a "shake up call" to make us be on our toes once in a while... kinda rattles our expectations and gives a little more experience. Of course we have grown to know this is what makes us better.....and learn off them. I too have been more than once have the unexpected routine turn into terror... enough now, to know that it will occur .. just don't know when. R/R 911

Check the NHTSA jobe description. It is posted on the forum somewhere. It might have lifting requirements. R/R 911

Be sure to clarrify courses (college) NOT all health or even EMS courses will be credited. They must be within the scope of the National Curriculum or have been approved by state or NREMT prior to attempt for credit. There is a listing of what is standard approved on the web site : www.nremt.org Be safe, R/R 911

Simple I call P.D. for lift assist. they can determine then, what they want to do. They know when I call there is a reason. Done it before , will do it again. Sorry Ak have to disagree with if some had rectal bleeding due to anal sex...YES I chart mechanism of injury. Sorry, that is the part of the history of the patient. The same if he has an impaled object, or lacerated penis etc... Rectal bleeding non-traumatic would be examined and possibly tx differently, not searching for tears, etc. but medical in nature. Be safe, R/R 911

Doc the $ 20 is usually the hospital costs... the patient may get charged up to >$300. ... We too use Zofran like candy, I too like it for pre-meds.. not the cost for the patients ...wow ! My wife was getting chemo last year and the usual costs for her Zofran 4mg was $200.00..and Zofran readi-tabs p.o. was $1200 for a box of 14. I about fainted... thank god for inusurance... R/R 911

LOL.. That was I was thinking too Doc.. but, the door is so open... R/R 911

First welcome to the City ! From the information you given sounds like the gentleman may have multiple medical problems. Definitely as you described liver/hepatic problems. He might have associated electrolyte and ammonia levels as well, causing other problems, or may even have onset of dementia. These type of patients are getting to become more common as the mean population increases. We (EMS) will see more & more multiple medical scenarios. We usually call them "train wrecks" due to complexity of the case. I am sure he was treated for more than one diagnosis. I truly believe that EMS needs to start focusing on medical emergencies (diversified) as the as run volume increases with these type of calls. As the population ages, these type of calls will be the norm. Be safe, R/R 911

Don't suggest tatt's to diabetic's ... I have seen many on them ans some that have problems healing after they get them.. better off getting a necklace... R/R 911

Wasn't there a song .."playing with a Queen of Hearts....you know it is not very smart ?"... R/R 911

Your right Ak.. just off a busy 24. There was questions in what the "whole story" was so many open holes. Another wacker that wants attention ....seems like this site is gathering a lot of different personalities these days, than it used to. I hope this is not what EMS is really becoming. R/R 911