BEorP

Thanks guys. It's always interesting to hear different ways of doing things.

Congratulations! That is wonderful. It is great when people in EMS are able to advance their education (in any field), especially if you might be able to use some downtime at work to do some uni work!

And I can see that there is a professional stamp at the bottom of your pic, so no worries about the gloves in the cab. Just as long as you know it's a terrible idea in real life.

Hey Dwayne... just curious since you and Mike both mentioned it, do you never wear gloves in the cab? Dirty gloves is obviously a no no, but what about on the way to the call? (with gloves that are hopefully new and clean) Or do you guys wait until you get there? Probably seems like a bit of a stupid question, but it seems like how we do it is one of those (many) things in EMS that is very strong in the various organizational cultures.

I don't know what it is like in the US, but in Canada and Australia you'll have a very difficult time renting a car under 21 so I'd imagine that that is somewhat of a magic number for insurance companies.

Welcome to the forum! From what we see on the forums, it certainly seems like regardless of age the job market in CA can be challenging. As the other responses mentioned, it may be that 21 is the magic number for insurance.

So I guess the question now is what you do if you're not able to find an EMT job. Do you want to have a career in EMS? If so, many people on the forum would recommend taking some college anatomy and physiology (if not a whole AS or even BS) and then going on to EMT-P. If you do some digging around on the forums, you should be able to find some of the past discussion on this type of thing (hopefully we don't need to rehash any of those debates in this thread).

If you're dead set against further education or it isn't feasible for you for whatever reason, then I guess it would be time to move. Even moving somewhere else though, it won't be a walk in the park to find an EMT-B job at your age.

The other option, of course, would be to find a job that isn't in EMS and wait it out. I don't know that that is really the best option.

Your ability to put together a polite and coherent post obviously shows that you're not like a lot of the people who show up on these forums so I'm sure that you will figure something out. Personally, I would strongly advocate for going the education route.

The other reason that education is important (aside from being a good provider) is that EMS careers do not usually last to retirement at 65. Many of us don't even last to 35! You need to enter EMS with a plan on what you will do if (when?) someday you can't do front-line EMS. If you want to transition into something like management, education, or research, having a college degree will be quite helpful.

Best of luck with the job searching and decision making! Feel free to ask any other questions that you might have.

I enjoyed the video. I especially liked how multiple times it was mentioned that doctors supported paramedics and taught then rather than just giving them a set of protocols.

We assume that it was gossip, and it likely was. But I would almost certainly have reported it, if I had any respect for my chain of command from a, "Hey, I just heard/saw this, you may want to try and get out in front of it." point of view.

Respect for your chain of command is one thing, but it could also be argued that respect for your colleagues should be equally important. It would seem that part of this respect would involve letting them being to take responsibility for their actions and be the ones to inform their superiors.

(Unless of course there is some specific reason not to, such as they were going to be showing up for a shift that night and had not gone through whatever proper channels exist to inform the employer or anything else like that.)

Holy crap, just saw the thread. Sorry about that, BEorP! Did you at least get to tour the facility? We would have hooked you up with some clinical experiences, as well as beer! Wait, are you old enough to drink?

I will monkey stomp you at the next CAP Lab for breezing through Dayton without dropping me a line.

I did get a tour and what a facility it is! It seems like you guys got lucky with getting the perfect site for all of the fun things you can run there. I went down to Cincinnati and Kentucky for the rest of the day, so it was not a wasted trip entirely. If you feel bad though, all I would ask for to make it up to me is a spot in your emergency medicine residency program in a few years.

Seeing how you are from small town nude hampster, I'd wager a guess that everyone in town knows that one of your members was arrested for assault within 8 hours.

[...]

It sounds like you did the correct thing in reporting the incident to your supervisor and now they want to spank you for doing the right thing.

Setting aside HIPAA because I know almost nothing about it, I don't think that the "hypothetical" actions of the crew were appropriate. Surely there must be some formal channel for the department to be informed of criminal issues of one of its members (even if it is that the member is to report it). I would consider even revealing the identity of a patient to a supervisor to be a breach of confidentiality (especially when that is someone who is known to the supervisor). The fact that they could look it up themselves in the patient report or that "everyone knows" since it is a small community has nothing to do with it.

Funny you say that! Man, that post actually made me feel for the first time that I didn't waste my time doing this, but before I got accepted into the EMT program I had the foresight to complete my business certificate and then completed a semester of my Human Resource Management Diploma befoe taking off for the fall intake of the EMT course. Currently taking an online class and which ends April and another April til June which will then give me my HRM certificate! (only 3 classes shy of diploma)

Well done! That is not a waste of time at all. We need managers who have been educated in management. If someone makes you feel like it was a waste of time, it is probably just because they wish that they had done it! Keep us updated on how your career progresses. Maybe I'll come work for you in a few years when you're a manager!

Good choice! It looks like you got good advice here and came in with a good perspective.

Just some unsolicited advice since it seems like you'd be receptive. Make sure that if you don't have formal management training, that you start to get some if you're going to be in a management position. ACP is clinical education, not management training, yet for some reason we often seem to require ACP as a prerequisite for management positions rather than formal training in management. There are a number of options for online diplomas and certificates, depending on how far you want to go with it. This may even be something that you could work towards online while working rural to help keep you busy at work.

Just to throw two options out there that were the first to come to mind:

http://xweb.algonquincollege.com/woodroffe/program.aspx?query=6040X07PWO

http://www.dal.ca/academics/programs/diploma/ehsm.html

According the Resuscitation Outcomes Consortium's "Completed Study" page, they ran a study in 2009 that was discontinued when there no improvement found when the hypertonic solution was used.

https://roc.uwctc.or...mpleted-studies

Yeah, they were using 7.5% and published their results in 2010:

http://jama.ama-assn.org/content/304/13/1455.long

Especially as a student, I do not think that you should be sharing your own personal beliefs on any topic with patients. If your friend understands this, then she can go on thinking whatever she wants as long as she sticks to science when speaking with patients. If she seems to think otherwise, then maybe it would to give her a tactful reminder if you are good friends and think that it will be in her best interests (and the reminder doesn't necessarily need to focus on religious beliefs).

They say that there's no such thing as a free lunch and that just may be true! I arrived at Calamityville this morning to find the parking lot strangely empty. Apparently the course was cancelled last week, but that message didn't quite make it to up to the Great White North. I got a nice tour of the facility at least and since I'm here I'm going to spend some time exploring this lovely state of Ohio. Thanks for the invite anyway, 'zilla. Too bad it didn't work out this time!

Thanks guys... at least it isn't just me who doesn't know what is going on!

I'm hoping that when it (if?) if does finally arrive then it will make things easier for me to get my foreign certification recognised since I can deal with the registration body and then try to get a casual position. I don't think QAS is eager to bring someone through their current equivalency process to just work casually!

While true that PA school requires "hands on" experience in order to be considered for acceptance, you'd be amazed at what constitutes "hands on experience". I know people who are in PA school now who volunteered in a nursery, worked as candy stripers, teched in a physical therapy setting, worked as trainers for one of their college athletic teams (something you might be able to do now), shadowed physicians and/or PAs for a summer, worked in a physician's office answering phones and taking blood pressures and more. When PA schools say they want hands on experience it doesn't necessarily mean they want you in the back of an ambulance making critical life or death decisions with regards to a patient. They're looking for exposure to health care and will take that exposure from a variety of settings.

Just to add to this or echo what you are saying... there are still some schools that value health care experience, but more and more the focus is just on a good undergrad GPA with some token volunteering in a hospital or shadowing a PA. If the OP volunteered in a hospital once a week during undergrad, that would probably make them eligible (in terms of HCE) for a number of PA programs.

It seems like it is some of the older programs that still value "high quality HCE" (e.g. EMT-P, RN, RT), but that is becoming more the exception than the rule.

The best resource for PA info online is: http://www.physicianassistantforum.com/

Be warned though that a lot of them are a bit old school in their view of the PA profession and they would rather not see people without real HCE entering the PA profession so this new breed of pre-PAs don't always get the warmest welcome. Even just to read though, there is lots of good info.

Hey guys,

I was just wondering whether anyone has any concrete information on when National Registration will be coming. There was a lot of talk about 2012 being the year, but I can't find a whole lot of information online and I haven't gotten much of a response from Paramedics Australasia.

Thanks!

Yes, you can come. As long as you speak English.

No doot aboot it, I do speak English!

And are taller than that little dog that holds up his paw saying, "You must be taller than me to ride....." I know how he haunts you...

Just trying to help you avoid wasting the trip Brother... :-)

Dwayne

I didn't have any trouble last summer at the amusement park!

...but even if I did, I'd just find an adult!

Hopefully the grant funding does not specify anything about nationality! If not, I would love to attend at the second offering. Can you confirm the dates? It looks like the website lists the 19th and 20th (Thursday and Friday). Are we able to register online or is there a different process for us?

Are foreigners allowed to come?

ACK.

It's another thing when threatened verbally with violence ("I will find you..." and such), THAT I would file as abuse or something like that, if there is the slightest probability for it to be meant serious. Rarely happens, though.

To me, even threats often aren't that serious. Yes, if someone who was coherent said that, I would address it appropriately. But if someone who is high as a kite tells me they will kill me, but makes no attempt to do so at the time, I'm not worried. They certainly aren't going to waste their valuable drug money finding time trying to hunt down a paramedic who they may or may not remember meeting.

I wonder how they defined "verbal abuse" because if it just being yelled or cursed at, I am surprised that only two thirds of paramedics reported this.

The bigger issue I think is whether this verbal "abuse" even matters. As the Windsor manager rightly points out, we deal with people who are in stressful situations or often have some underlying mental health or substance issues. Does anyone really get truly hurt by things patients say to them? I would certainly hope not.

I expect that I will ruffle some feathers with this comment, but I think that this verbal "abuse" should just be an accepted part of the job. If a patient isn't physically attacking me, I'm not really concerned. Sticks and stones may break my bones but words will never hurt me.

Agreed about delaying transport for an IV being flat out wrong- unless there were extenuating circumstances as I mentioned above, but I find it impossible to believe that this in any way contributed to the death of this patient. The docs even agreed this patient's outcome was not affected by their actions.

I agree as well that this patient's outcome wasn't likely affected (going to have to trust the docs on that...), but if you had a large number of similar patients and delayed transport to start an IV, less of them would survive. So I would say that it wouldn't have saved this girl to get to the hospital three minutes earlier, but it would have saved some.

Agreed about delaying transport for an IV being flat out wrong- unless there were extenuating circumstances as I mentioned above, but I find it impossible to believe that this in any way contributed to the death of this patient. The docs even agreed this patient's outcome was not affected by their actions.

I agree as well that this patient's outcome wasn't likely affected (going to have to trust the docs on that...), but if you had a large number of similar patients and delayed transport to start an IV, less of them would survive. So I would say that it wouldn't have saved this girl to get to the hospital three minutes earlier, but it would have saved some.

So are you suggesting then that fighting with and sitting on this combative patient until the ambulance was rolling, instead of sedating, (Theoretical case of course, and assuming worst case, no IN drugs.) is a more realistic approach? As she soon died from her injuries I have a hard time believing that this could be considered 'doing no harm', right?

Actually I think we need to define 'delaying transport' as I don't believe that transport would be delayed if it was not realistic to actually get the patient into the ambulance. An extremely combative trauma patient is not so different from one that's entrapped as I doubt that you will do much less damage by continuing fight with them then you would by simply ripping many traumas out of their entrapments.

It's not your general argument that I have an issue with but the absolute statement. I've heard of that study, but haven't read it on my own, which I would need to do as most every study of it's type that I have ever been exposed to has been heavily flawed.

But even so I'm willing to bet, and you can help me out as it seems that you have read it, that their conclusion wasn't 'There is never a need to begin an IV prior to transport as no trauma patient has ever been helped via that intervention."

We need to put the 'never start an IV before rolling' with the Golden Hour and the Platinum 10 as absolutes that have no real place in intelligent patient care. In my opinion of course.

Dwayne

Thanks for bringing up the important point of defining, "delaying transport." To me, this means that you're ready to go, but you sit on scene to start the line (likely with the patient already loaded in the truck). If the patient is trapped and you start a line, then transport was not delayed. If the patient was so combative you could not transport them without sedation, then you did not delay transport either.

Certainly there may be a subset of trauma patients who could benefit from an IV even if it delays transport, while the majority would not. It would be silly to think that we're able to pick out the ones who can benefit though. It surely can't be as easy as picking out the hypotensive ones. (Unless you are so confident in your skills that you know someones BP, SpO2, and ICP just by looking at them... see other thread.)

So without knowing who might benefit if there is this small subset of patients, I wouldn't delay on scene for an IV in a serious trauma patient.

I've personally never started an IV (still 8 months out of starting my medic courses) but I can imagine they have SOME justification for starting it on-scene rather than waiting to get in the back of the truck. If it's a big enough deal that they mention it as a deviance from the standard, then (Devil's advocate) they MUST have had a reason.

If they delayed transport to start an IV on a trauma patient, they were wrong. I don't mean to seem like I'm not open to a discussion, but I really don't see how there is much more to say on this. Prehospital IVs in trauma patients don't save lives. This type of patient is why the OPALS study showed that severe trauma patients treated by ACPs (likely getting IVs) had worse outcomes than patients treated by providers not certified in IV therapy.

If the patient was trapped and they popped a line in then, it would not have been mentioned as a deviation from accepted practice since it would not have delayed them on scene.

Despite her chances of survival being incredibly low, this girl needed a doctor, not an IV.

It does not specifically say what the charges are here- negligence, malpractice, etc. It also says that this seems to have started with the coroners request that the ER doc review the case in regards to the fact that the closest ER was not available and whether or not that played a role in the outcome of this case. It seems that the lawyers are using the shotgun approach- dissect every aspect of the case and see if they can assign blame/fault/culpability- which in essence means they are looking for the ones with the deepest pockets.

This is not a lawsuit, it is a coroner's inquest. The jury is mainly trying to answer basic questions about the death and is also likely to make non-binding recommendations to prevent future deaths. More information here.

I can also tell you the patient's B/P within a few points of margin just by feeling the radial pulse.

If you're saying this just to get a rise out of us, congratulations.

If you're saying this because you believe it, please stop working in EMS.