OzMedic

In my service years in position has no bearing on hourly rate. A newly graduated ACP earns the same amount as the 20 year veteran and both will earn the same increases every EBA (three years). The only way to earn more is to upgrade clinical education or go into management. This is fairly typical across Australia within professional employment. The problem with pay for years of service is that limits your transferability. Put yourself in a managers position, how can you attract senior medics from other services if they have to start on a lower level of pay than someone with less experience/qualifications than them. It does not promote our quest to be professionals with transferable qualifications. As for the nurse in my analogy, she should and would not be earning more money than the new graduate because she is practicing at a lower level regardless of her years in service which is how it should be.

Speaking from my personal experiences and observations over the years there seems to be a few different types of ego out there and they soon become obvious. The one I can most relate to is the "I know a bit about this, have been doing it for a while so don't try and tell me anything" ego. This is rife in EMS and will rear it's head in most people starting out in EMS at some stage. I was a shocker in my earlier days with the peak being about 4 years into the job. I don't really see it as a failing and think of it more as a process that most of us go through. The best news is there is a cure, knowledge is a great leveler. The more I study and learn about medicine, the more I realise how little I really do know and how misplaced my youthful ego really was. Yes you do come across the senior medics, Dr's, nurses etc who also display the same type of behavior. I feel that in this circumstance they are either a little insecure about their own abilities or the confirmed lifelong type A personalities that feel that no-one could ever do it as well as they do. To do our job well we need to be able to take control of crazy situations and direct personnel and by-standers in a way that is both assertive and considerate. It can be a fine line sometimes! Timmy, a lot of your comments remind me of what I was like when very new and green. A very senior and wise medic gave me some advice that turned out to be so true that I wished I had payed more attention at the time. He said "Son, the only difference between you and me is that you don't even know enough to know how little you really know!". I think I rolled my eyes at the time, probably just like you are reading this now

Sorry Shane, I could not disagree with you more on this issue. While longevity in a position does have some merit it should in no way override education and qualifications. Why should Joe the EMT basic who goes to work and comes home for 10 years without ever doing an ounce more study than his original course get more than someone who has been working and studying there arses off for the last 5 years so they can give a higher level of more appropriate care than good old Joe. Thinking like that is what is keeping the US EMS system in the dark ages and needs to change. By that logic the old enrolled nurse (or whatever the US equivalent is) that never bothered to up-skill deserves to earn more than a university educated registered nurse. Under that system there is never any incentive to continue with education because it will not receive any more recognition than if they just do nothing and wait for the years and pay-rises to tick by.

All the colleagues I have been involved with who don't drink are treated like gods because they can drive! It has never been my experience that they are excluded by the drinkers rather that they exclude themselves because who wants to be around a group of drunk people? I'm the same, I hate being around drunk people when I'm sober. We used to have an unwritten law when I worked out west for NSWAS that one of the people that was on-call went out with all the ambo's, coppers, nurses/Dr's etc in the "big white taxi" driving them from pub to pub. It's great fun early on when every one is just tipsy but later I used to dread it and wish for a case so I could escape, lol. Here's a quiz: How many drunk ambos/nurses/coppers etc fit in the back of an ambulance? Answer: you probably would not believe me if I told you

This does interest me as it seems to be something that is practiced according to the individual as opposed to any real evidence so if you could add a link to the evidence or post it on here it would be appreciated

Preferably female and with a pulse but it depends on the situation :wink:

Shutup you little do-gooder weasel, I bet I can drink more beer and shag more nurses than you before I puke! :occasion5: :bootyshake:

"don't worry little lady, I'll fix that wagon" John Wayne (I think). I love that line and always use a John Wayne accent to deliver it wether it was his line or not.

Just out of interest vs, how many paediatric intubations are you required to do in addition to your 20 intubations in hospital before you are allowed to practice?

My point exactly, bodies have no place in ambulances period (unless of course they weren't a body when they first got in there ).

Very interesting, I wonder what induction method was utilised as there seemed to be quite a bit of laryngospasm and gagging going on. Nice footage though!

I hope there were plenty of other resources available in your area while you guys were playing mister humanitarian. Sorry not trying to be harsh but the family of the kid who was knocked off their new bike that santa bought them while you were transporting a dead body would not be as appreciative I'm sure. I've seen this type of thing happen all to often, crews take themselves out of service playing Mr nice guy and Murphy steps in. There is always a way to handle these situations that maintains the ability to respond. Once again sorry, and if there were sufficient other resources available then I take my hat off to you for your kindness. Personally I think my back/knees have a finite number of lifts in them and I don't waste them on dead people.

You need to be careful in these situations, being a family member alone does not give people the right to make life and death decisions about a person. Think about the possibilities!!! Are you going to make this kind of critical decision within a few minutes based upon what someone who you have no idea about their real identity or motives has told you? What if they murdered the patient? What if they stand to benefit from the will? What if the patient had changed their mind about the will prior to the person who is telling you not to resus placed a pillow over their head? Family members have not legal right to make these decisions unless they are enabled to do so by the patient via the appropriate legal documentation even then they still have to abide by the patients wishes contained within that documentation (ie. patient requests no resus then the medical attorney must abide by this and cannot request resus be commenced). In my state I am not expected to verify if a person is the actual health attorney if they state they are. If someone identifies themselves as the health attorney and give me directions and it turns out they were not then they will be dealt with by the law and there is no comeback on me (by the way, I always point this out to people when they make these claims. It's tends to sort out the do-gooders from the real thing). While I'm on this how many people out there have family members that they would not want making medical decisions on their behalf? .............I rest my case

I hate it when that happens!

Sorry, not sure what n/v means. Just a query, are you sure it was a VT and not a SVT with aberrant conduction? The only reason I ask is that 250 is pretty quick for a VT especially in a conscious patient. If I see rates that fast with a wide QRS in a patient that is still perfusing ok I start to get a bit suspicious. If it was in fact a SVT then a lot of other possibilities come up. A bit more information would probably help. PM me if you like, I'm in Australia so there is not much chance of there being a conflict if that is what you are worried about.

I also support what Dust has said although it can be a bit daunting to pick up an A&P text and not know where to start. Trying to put myself into your position I would probably focus on the Cardiovascular, Respiratory and Autonomic nervous systems as a start. The reason I suggest these is that they are the systems you are most likely to come across that your interventions have a direct effect on in which you may make a difference. Don't get me wrong it's all important and you will need to cover it all in time if you want to do this stuff for real but upon reflection I thing those 3 are a good place to start for extra study. What do other people think? All you switched on people out there, try and imagine you know nothing and had a choice where to start out to get back on track in the easiest way and post your suggestions. Try and keep it as brief as possible that will give the most benefit. It's actually quite hard trying to imagine not knowing anything, lol How about this for and exercise, You can pick 3 broadish subjects to suggest. What are they?

Great Post and I agree with all that you say. I think that we need to look at this issue from a couple of perspectives. In reality, should every EMS provider that has access to a SpO2 monitor be educated to the above level before they use it?........ I think so yes, however, to understand the above and interpret SpO2 readings in the context of each patients presenting condition is another matter. From what I understand about the sad state of EMS education in the US there is not much point in learning the above info if the EMT/Medic does not have the background anatomy/physiology/pathophysiology knowledge to put it to use. Does this mean SpO2 should be reserved for clinicians that can interpret the values?........ Maybe not. The fact is that EMS providers of all levels are performing all kinds of advanced interventions (rightly of wrongly) on these patients before they reach hospital or are backed up by ALS of a higher level. As we all can testify at times, the patient that we wheel into an ED may as well be a completely different person to the one that we were first presented with. The ED nurse then rolls her eyes and makes some comment like I thought you said this person was sick, in extremis etc. Then the poor ER doc has to come along and make sense of the whole issue and try and decipher the clinical picture that he is presented with compared with the handover/runsheet from the EMT's (which let's face it can be worthless depending on who gave it and who took it). An initial room air SpO2 value on the runsheet may assist the ER doc in some way to interpret what is going on with the patient and what to do with them now. I guess the point of what I am saying is yes SpO2 can be dangerous when wrongly interpreted by poorly educated EMS personnel. However, it is an easy, safe, non-invasive measurement of a value that MAY be of value to a clinician when they interpret it later on. By the way Vent, you say "you can always take oxygen off" and once again I agree with you as I do it all the time, but how often do you see it done in EMS and how often do you see it used inappropriately?

Dust, Plus 5 for s instead of z Plus 5 for not being British, at least South Africa can sort of play cricket and are ok at rugby. I love the english language even though I display a poor grasp of it at times. Here is one of my favourites...... "Time flies like an arrow, fruit flies like a banana"!

I agree with you, anyone who makes a post like this should not have it! :roll:

This may be a stupid question but why do you need speed if you are working a code? Why do you even need to be moving? Unless there has been some kind of return of output but then it's not really a code anymore. How is it possible to work a code safely and effectively under L&S transport? The only patient I am transporting under L&S regularly are those that need a surgeon and I am sitting in my seat with seatbelt on doing not much in the way of interventions as a result. If I wanted to risk my life/health for a living then I would have joined the army or FD. I will make a bigger difference by looking after my health and being around longer to attend more patients.

I see two sides to this argument. Yes it was unfortunate the way this case went down, however, the service involved knowing the these particular meal awards were in place was negligent in not having extra crews in the area available to respond. Yes we can go without food and reheat our cheeseburger however is that the way we want to value ourselves and our long term health? Irregular and poor quality meals are going to kill us just as much as what ever killed the bloke who arrested in this particular case the difference being that he probably had a choice when and what to eat. I think a lot of the time our organisations and Joe Public play on our good will too often to our ultimate detriment. We seem to have a problem with pushing for any condition that carries the risk of costing a life if it is poorly managed by our organisation instead of hold them to account for not being prepared. Unfortunately like most things in this world not much happens until someone dies. A classic example is a service I worked for years ago got by understaffed for years by calling the guys before their shifts and from home despite the pleas from staff that they could not keep it up. Staff got together and decided they were not going to answer a call unless they were on shift, management still done nothing for a few weeks until one day guess what? Yep, cardiac arrest and nobody to send! All of a sudden staff goes from 7 full time to 12 full time overnight. It sucks but it's not our fault! I bet in this case management steps up and sorts something out as well, after the horse has bolted of course! The main message is that we should not be made to feel guilty about being awarded better work conditions, it is the duty of management to implement strategies to deal with these developments as they arise.

I agree with most of this however my understanding was that increase in ph from the sodium bicarb caused the TCA to become bound to circulating albumin and therefore inactive until it is excreted or ph drops. I think this is why hyperventilation is also thought to be beneficial in TCA OD's. It has been a while though!

I still have not found the CT studies that I first refered to, however the following are still relavent to the subject. Spinal boards or vacuum mattresses for immobilisation http://www.tripdatabase.com/spider.html?itemid=138620 Comparison of a long spinal board and vacuum mattress for spinal immobilisation M D Luscombe and J L Williams Emerg. Med. J. 2003;20;476-478 doi:10.1136/emj.20.5.476 http://emj.bmj.com/cgi/reprint/20/5/476.pdf Effects of Prehospital Spinal Immobilization: A Systematic Review of Randomized Trials on Healthy Subjects http://pdm.medicine.wisc.edu/20-1%20PDFs/Kwan.pdf This study demonstrates the problem of movement of the body when the head is strapped rigid. Spine. 1999 Sep 1;24(17):1839-44. The efficacy of head immobilization techniques during simulated vehicle motion. Perry SD, McLellan B, McIlroy WE, Maki BE, Schwartz M, Fernie GR. STUDY DESIGN: Laboratory experiment. OBJECTIVE: To compare the efficacy of different head immobilization techniques during motion simulating ambulance transport. BACKGROUND: A significant number of neurologic injuries associated with cervical spine fractures arise or are aggravated during emergency extrication or patient transport. Previous studies have not addressed the effect of head immobilization on the passive motion that could occur across the neck during transport. METHODS: Three different head-immobilization methods were compared in six healthy young adults by using a computer-controlled moving platform to simulate the swaying and jarring movements that can occur during ambulance transport. In all tests, the trunk was secured by means of a commonly used "criss-cross" strapping technique. Efficacy of head immobilization was evaluated using measures of head motion and neck rotation. RESULTS: None of the three immobilization techniques was successful in eliminating head motion or neck rotation. Movement of the trunk contributed substantially to the lateral bending that occurred across the neck. A new product involving the placement of wedges underneath the head provided some small, but statistically significant improvements in fixation of the head to the fracture board; however, there was no improvement in terms of the relative motion occurring across the neck. CONCLUSIONS: Somewhat improved fixation of the head to the fracture board can be achieved by placing wedges under the head; however, the benefits of any fixation method, in terms of cervical spine immobilization, are likely to be limited unless the motion of the trunk is also controlled effectively. Future research and development should address techniques to better control head and trunk motion.

LOL, did you mean to write that Asys? even funnier if you didn't . I concur with your sentiment, we have lost 6 staff and 3 patients in the last 5 years in my service alone due to helo crashes. Things have changed as far as safety goes but I avoid getting on them at all costs. There is always some other mug busting to get on so I let them do it (having survived an engine-out helo landing I cannot recommend it). Remember the old saying people "Helicopters do not fly, they beat the air into submission" (problem is, sometimes the air fights back!)