Rescue0ne

Talk about an age-old subject! It all comes down to the bottom line...what can you do about it?!?! You deal with it. You do your job and move on. If you work for a large municipality, or your smaller agency does it just because...yes, some places have you take an "oath". Whether it's ceremonial or not, it's very serious stuff. An EMS PRovider shall DO NO HARM...whether it's by action, or inaction. Above all else...DO NO HARM. I've seen it throught the years. You'll hear about it in the crew quarters, or elsewhere. "Bubba hittem with a 14 gauge, he swore the bitch wuzn't really unconcious." God...you just don't do that crap! If you have a problem with this...snail-mail me your EMS License/Certifications. I have a handy dandy brand new paper shredder I love playing with. Seriously...if you abuse patients in any way, for any reason, you need to get the !@#$ out of EMS. For Good. I don't give a rats' arse if they're abusing the system. Find other ways to deal with it. If it pisses you off to the point of patient abuse, go to your supervisor, or HR rep, and turn in your shield/uniforms/what have you. You're scum.

ParaGod: an individual with EMS certification/licensing at the EMT-Paramedic level. This individual more often than not considers him/herself to be the SH*T. Can do no wrong, has all the answers, makes sure their EMT-P patch is visible on everything they own. This person is always right, no matter what evidence exists to the contrary. :shock: NOTE: I know of a career EMT-I that reached EMT-P level not long ago. this person was always cocky, and full of bullsh*t...but it only got worse when Paramedic level was achieved. This person was "dared" to get "PARAGOD" on their license plate. Damn if the person didn't. :roll: They have since replaced the plate in question w/ a standard RS plate, which often obtained by Rescue & EMS providers in my state, after much razzing from fellow EMS providers. To me, the person that dared them is just as much of an A**HOLE as the person that the plate belonged to. ParaGods have no business in patient care. They're a malpractice/lawsuit waiting to happen. IMHO, that is.

ECC: 5710, that would be a negative. Please disregard & mark up as returned & in service. I'm assuming this is an original statement from cdemt5710? It wasn't shown as quoted, only italicized. Emergency Medical Services IS a profession. Unless someone almighty decrees that it's not allowed to be, then it will always be so. Volunteers aren't the death of the EMS profession. Volunteers don't do transfers...at least not in my area. That's absurd. Say this with me, "Volunteer EMS Agencies answer 911 calls." If you work for a career EMS agency, and both your career agency & your local volunteer agency both answer 911 calls...what are the options? It seems pretty cut & dry from my end. Possibly, it isn't like this in your locality. If I'm off-base with this, by all means, let me know. Well... I'm a life-long volunteer, and also career EMS. When I'm wearing my volunteer hat...spending $$ and time for EMS education is out of MY pocket. No one made me do it. I do it because I want to. If a career/paid system is put into place, and is able to provide patient care at the same level, or better, as the volunteer agency...you know what I'd do? I'd try to get a job with that agency. Not piss & moan about my woes. Don't get me wrong, volunteer EMS is an awesome thing. If it works in your area, and works well, in all aspects...there's no reason to go paid/career. There are those among us who will hate on Volunteer EMS for the rest of their lives, for whatever reasons. Just overlook these people. If you're of the mind that you should get paid for EMS services, then start your own ambulance service, or apply somewhere that does pay. Don't campaign to shut down a perfectly good, well-oiled machine. and one last thing... Dust...for crying out loud. Volunteer EMS is NOT a hobby! Stamp collecting is a hobby. RC Aviation is a hobby. Helping your fellow man in their time of need is not a hobby, in my book. Its an advocation. It's a calling. Just because one doesn't receive a paycheck/direct deposit, does not make them a hobbyist! That's my $1.99...spend it well.

Well, this is a good one. I've been in EMS for 15 years now...took the EMT class when it was called EMT-A (Ambulance). In 1990, Virginia's EMT cirriculum was rated to be 2nd-year College Level. I was 16 then. Passed on the first try. Three years later, the cirriculum changed. EMT's no longer had to understand WHY that person was diaphoretic, or seizing...they were only required to know how to treat the signs/symptoms. To me, it seemed that EMT's became robots...or worse, like trained Monkeys. Hey monkey...do "such and such" when you see "such and such." You don't need to know why the person is doing that, only what to do when they're doing it. Am I missing something, or is that a reduction of medical knowlledge...equaling reduced quality patient care? Anyway, the cirriculum was changed again after a while, and EMT's were again required to know WHY, in addition to HOW. If the person is in it for only a job...well, McDonalds is almost alwys hiring. If you're just excited by the lights & sirens...be sure to email me your home address today before you log off...I'll send DustDevil over for an "attitude adjustment" session. I've met some people in the profession, ALS as well as BLS...but mostly BLS...that honestly don't GAF about pt care. They sure do like the patches, uniforms, blousing their trousers (lmao)...which is required sometimes for certain divisions in my agency, as well as the Batman Utility Belts with enough equipment onboard to perform most major surgical operations, in addition to finding the cure for cancer. TONES...bbl 2 finish

OH! Wait a second... Is he asking for input on rewriting his agency's SOP's...or is he just curious how ours compares to his? If he's looking for suggestions, then I hope he packs a lunch! This is gonna take a while.

In our SOP's, the main rule to remember is; WHEN THE EMS ADMINISTRATOR/CHIEF CROSSES YOUR PATH, YOU MUST GET ON YOUR KNEES AND BOW DOWN, ALL THE WHILE PROCLAIMING HOW UNWORTHY YOU ARE TO BE IN MY...OOPS...I MEAN HIS/HER PRESENCE. On a serious note... "n5iln" had a good point...although our protocols are nowhere near as "heavy" as his/hers are, there are way too many to list, and I'd not know where to begin. Here's a link to an agency that nearly mirrors ours though. We don't have ours online. http://rescue1.org/ops/default.asp (Their Standard Operating Guidlines page is under construction, but the other pages listed are very informational. This agency is top-notch...AND they're volunteers.)

No thanks. Saw that on ebay a couple of months ago. They're uglier than sin. Who makes these decisions anyway? :evil: I've got plenty of old-design patches (rocker beneath), and shall continue to use them until I pass away. Anyone remember the rocker-above AND below? I'm thinking the P patch had that, or was that just the I patch?

I know this topic has been talked to death, but I found a copy of my Regional EMS Council's Guidlines, and thought I'd share it with you. Scene Authority For Patient Care Scene authority and transition of patient care may occur on several levels within our system. With these protocols, each OMD has agreed to, and assigned each provider with a specific patient care level (CCEMT-P, EMT-P, EMT-CT, EMT-I, EMT-ST, EMT-J, EMT). Based on their proven medical knowledge and mastery of practical skills, the senior level patient care provider may assume responsibility of prehospital care. In the event of a multi-agency response (1st Responder agency, transport agency, etc.), the agency assigned with the task of transport shall obtain and maintain the senior level of provider care responding to the incident. If there are concerns regarding the care of the patient, Medical Control shall be consulted. Patient Care Transfer: 1. The 1st Responder responsible for patient care will provide a verbal report to the assuming transport provider. Once the report is received, the transport provider assumes patient care responsibilities. The transfer of care shall be noted on the call report and/or by radio communications. 2. The transport provider may request the assistance from the 1st Responder agency for manpower for those calls that are resource intensive (cardiac arrests, major illness/injury, etc). 3. Should disagreements arise between the 1st Responder responsible for initial patient care and the receiving transport provider, they should be resolved in a quiet, professional manner prior to transport. If a resolution cannot be reached prior to transport, either Medical Control may be contacted for further resolution or the 1st Responder responsible for initial patient care may be requested to accompany the patient to the receiving facility. Each agency's OMD (or designee) shall be notified of the incident within twenty-four (24) hours. 4. Once ALS level of care has been initiated (IV therapy, EKG monitoring, medication administration, etc), that same level of care must be maintained until transfer of care to the appropriate receiving facility. (This STILL means if an ALS provider has administered BLS care, that ALS provider has to accompany the BLS provider & patient to the hospital. This is that hazy area I mentioned in a previous post. Bottom line, you accompany the patient, no matter what.)

=D> =D> =D> =D> =D> =D> =D> Both of the previous posts...I couldn'thave said it better myself. We get into EMS originally to HELP people, not because the money is great...which it usually isn't. I personally feel that if helping others isn't your #1 reason for being in EMs...you need to find something else to do with your life. Yeah, money is a necessity...but if you're not here to help folks, drive a cab, or something.

When I was a new ALS provider, I already had 6 busy years as a BLS provider under my belt. There's no justification for me to automatically hand patient care over to the BLS provider and me only handling ALS intervention. (I know it's sounding like I'm contradicting what I said earlier in this thread, but I'm really not.) No matter if I'm allowing the BLS provider to handle most of the hands on pt. care...that patient is ultimately my responsibility, until I hand him/her off to an ER MD. If ALS intervention IS necessary, I'm taking the hands-on role anyway, the BLS provider is then my "assistant", for lack of a better word. I'd not let them take the lead, if I was performing ALS care...they wouldn't normally have a clue as to what I was looking for in re: vitals, scores, etc. What's the BLS provider really able to do for the patient while I'm performing ALS intervention, unless it's helping w/ 2-person CPR, or taking notes from me for the patients chart? Politics, egos, and infighting have no business ANYWHERE, let alone in the station...but of course, you're correct in that respect. Your EMS agency should already have, in place, an IC setup for major situations, etc. It really comes down to professionalism. Either you have it or you don't.

I was on the 1st page of this thread, with the intent of reading each post, before posting my own...but hell with it, I'm going to be late for work if I do. My father was 48 when he took the EMT-B (then EMT-A) course. This was in 1990. Today, he's an NREMT-P, and still as active as ever. He's a volunteer that answers more calls than most paid folks do. He retired from a Paid Agency just last year. Do the math. It's not for everybody, but it may just be for you.

In response to the abandonment issue...yes, you are correct. I was thinking along the lines of...if you left the rig, w/ the EMT in charge...and no one was the wiser...then you're guilty of abandonment, which is a really bad thing. you probably deserve to have your license or Certs pulled. Now, if you abandoned the patient to the BLS provider...and the patient coded, or seized...then you're REALLY screwed. Abandonment, plus lawsuits, possibly prison time, public humiliation, ridicule, everyone on this forum knowing that you're lower than whale@#$&. That's probably worst-case. Yes, leaving the patient w/o being relieved by a provider trained higher than yourself IS abandonment. I apologize, I should have clarified what I meant. As far as tying up 2 crews, often times, where I'm from (and I guess we're lucky in this aspect), the member driving the ambulance is sometimes not an EMT yet, or at all...allowing there to be two providers in the back w/ the patient. We're talking volunteer agency here, so it's really not uncommon. I'd agree with not tying up 2 crews, if that's indeed the case.

In my years as an EMS provider, it's been acceptable if the ALS provider allows the BLS provider to maintain scene control, as long as the ALS provider accompanies the BLS provider all the way to the ER, ready to assume control if the patient requires any type of ALS intervention. Usually, this takes place if the patient isn't in any real distress...simple O2 administration, monitoring of vitals, you know the drill. If the patient, in any way, requires skills that the BLS provider can not provide, the ALS provider is required (by the laws in my state) to assume the primary role in patient care. There are some lines that become a bit hazy, in certain situations...but if the ALS provider makes his/her credentials known, and gives any type of care to the patient, or assistance to the BLS provider, then that ALS tech is responsible for patient care until relieved by someone of higher training...this usually being the doctor at the ER. If the ALS tech doesn't accompany the patient during transport, after rendering ANY type of assistance..then its the ALS tech's arse if something goes wrong, and the patient requires ALS care en route to the ER. You get what I'm saying. I know this to be true for the EMS Agencies under the purview of my OMD. It's true across the whole state of Virginia, if I'm not mistaken. Anyone else who responds to this thread will probably agree, to some extent, if not all. As for the first part of the question...do it professionally...if for example, you're relieving someone at the scene of an MVA, in front of the FD, Police/Sheriff, the rubberneckers that you'd love to shoot, and God himself. Proper way is for the "higher level EMT" to ask for/be given a thorough briefing of patient history & treatment. Make sure everything is documented, including both your names when you note xfer of pt. care. Remember: IF IT'S NOT WRITTEN DOWN ON THE PATIENT CARE REPORT, IT DID NOT HAPPEN. EDIT X MYSELF: What Medic393 states about it being your ass on the line is so dearly true. If your the ALS tech, and the junior tech isn't someone you'd trust with YOUR life, I'd definitely check behind them. Discreetly if possible, blatantly if necessary. Also, in the event of an MVA/MVC...in my area, highest trained EMS provider of the agency with primary responsibility for the area that the accident took place in is Incident Commander. I don't know how it's set up in your neck o' the woods.

Opinions please: Given what we know, as far as how long it takes for emergencies to go from serious to critical to dead, heart attack, CVA's, cardio-pulmonary arrest, seizures, car accident victims, etc. How long is too long to wait for an Ambulance? From the time of tones going off...over 8 isn't good. Over 10 is wrong. How far is too far for populations to be from an Ambulance? In my opinion...8-10 miles. Urban areas, much less. Majority of my experience is with Suburban & Rural. How far is too far for populations to be from a receiving hospital with a certified ER? Considering there are some grossly rural areas in this country, I'd say 20 miles, maximum. I know, it's wishful thinking...but whatcha gonna do. What can be done to free up units from BS calls? Having the Senior EMS Provider on scene be authorized to release his/her rig from the scene, if the situation does not warrant an EMS transport. Medical Control may be called if necessary. NOTE: Of the several agencies I've been a member of, all of them allow AIC's to make that call, with AIC's instructed to call Medical control if necessary. If it's a true non-emergency, we'd ask them, if possible, to go by POV. If not possible, we'd offer to have an Ambulance Service respond. If they refused that, then we'd offer to take the patient to the CLOSEST hospital ER...which usually isn't even a Level 3 Trauma Center. If they refuse that, then Medical Control was contacted, situation explained to the Doc. 9 times out of 10, they'd release us from the scene. Now...if you're talking about EOC not even toning the EMS agency out for the call to begin with if it's a BS call...that's a really good question. If I were the EMS director of my state...I'd put in place a directive that any prospective patient not requiring EMERGENCY care and transport...be routed automatically to a non-emergency Ambulance Service. Have something worked out between the municipailty and the A.S. where they'd respond, and bill whatever insurance the patient might have...and if no insurance...A.S. bills the patient. I Don't Know. This is a truly magnificent, and quite common dilemma. I'm paid to think about issues like this. I'll get back to ya if ever a viable solution revelas itself. What can be done to prevent patients from being put on waiting lists, excluding times of disaster? Unsure what you mean by this. A waiting list for Emergency Care & Transportation to an appropriate Medical Facility?

Nope, he wasn't in this case, and that's what REALLY set me off in the first place. Really appreciate you sharing your experience / lnowledge.

Devil, I agree completely, in regards to the physical fitness, medical knowledge, and standards or professionalism. Really, if they weren't in shape, and weren't professional, they have no business in a Career EMS position to begin with, in my opinion. ESPECIALLY not, if they aren't up to par on medical knowledge equal to their level of training. Now sure, if the individual is a Basic, and AMR/whomever only wants EMT-I & EMT-P...then of course, they're a no go. If the provider is 300 lbs and 5' 4" tall...then yeah, they'd have to be passed over. My deal with it all, is that if you're going to have Career EMS in place, then don't outsource individual employees from jumpstreet. Existing providers need to be given ample opportunity for employment. If they don't meet criteria, then great. Keep on looking. I know of one instance when AMR was contracted to run a municipal EMS service. They're still in place today. A Nationally Registered Critical Care Paramedic, who I am familiar with, was a supervisor with the existing system. When AMR took over, they brought with them a whole management team, and fired the previously mentioned CCEMT-P. Now, if the guy had been shady, or out of shape, of unknowledgable, or an inept supervisor, then fine. Can his butt. However, this Medic has his act together, he's a great leader, supervisor, preceptor, and all around excellent provider. AMR wanted their people in place, and to hell with everyone else. they didn't even offer him a regular Paramedic's position. Just "Don't let the door hitya..." Really quick, I'll state that the medic in question is/was not me. The medic in question was not my friend, coworker, or supervisor. This wasn't even someone I personally liked...but they were a helluva Paramedic & Supervisor. Turns out, there Is justice in the world. The Medic in question is now the Operations Officer/Senior Flight Paramedic with a kick-@#& Level One Trauma Center-based Medevac System. That's my only problem with AMR & outfits like it. To me, it's like we're outsourcing MEDICAL CARE just like our country outsources everything else these days. I've always considered those outfits to be mercenary in nature. No disprespect to anyone who may work for AMR, etc. You may be a kick@$& provider yourself, but your company's policies just really suck a big ol' uvula.

Chaz, I poked through AMR's website, and found their corporate policy page, where you may view them in PDF format, if you have not done so already. I didn't see anything related to how they'll treat existing providers already in place...but maybe it's in there somewhere, and I missed it. Here's the link--> http://www.amr.net/CorpCompliance/Corporat...ll_policies.htm I personally have nothing against paid EMS. I worked for a few Ambulance Services in my time, Metro and rural alike. What I do have a problem with is a municipality outsourcing their EMS to a company like AMR...and not providing a clause that AMR or whomever must allow existing employees a position w/ comparable benifits, etc. Like Chris Rock said when he was running for President, "THAT @#$& AIN'T RIGHT!"

Heck yes he does! Was it John Burruss maybe? I need to qualify something though. I'm not a CARS member, I was a member of a squad in the county south of them. We were in the same EMS Council, same protocols, same OMD, same everything, just about. Visited them often, they just really impress me...and I'm not easily impressed. Now, actually...I'm in Southwestern virginia, like yourself.

Glad to see some good websites out there. I'm a Web Developer, in addition to an EMS administrator, and I design & host websites for non-profit Fire/Rescue/EMS in Virginia. I won't go into my educator mode in the thread, but there are a few small bits of advice that I feel are important. Some things to keep in mind when designing FIRE/EMS websites. [*]Sounds - Don't have audio files automatically open when a user visits your site. If you so desire, offer a link or button where they may listen, but NEVER force it upon them. [*]Menus - As it was said in a previous post, left side menus are best. Don't try to get TOO terribly fancy, unless you're an experienced developer. It's often not worth all the trouble. [*]Images - If you plan on having many images on the same page, always have a thumbnail present on the page, and link it to a larger image that will open up on a different full-sized page, or same browser window. Try not to use pop-up windows, as many folks have pop-up blockers, and may not feel like adding your site to their safe-list, or turning it off just to view your picture. [*]Email addresses - If you post contact email addresses on your site, ALWAYS make them spam/robot/etc safe. Use images, or ascii coding to allow them to display, don't just type them into the website builder, or the html scripting. Your officers & members will definitely appreciate the effort to keep them spam-free. [*]Sounds - Did I already mention this? Well, it's important. If someone has their speakers ALL THE WAY UP...and all o' a sudden, your dispatch tones, or theme song, or what-have-you start blaring at them from their desktop, it will definitely not leave them with a warm, fuzzy feeling. Take it from someone who has viewed thousands of Fire/Rescue pages. I really really despise that, and I know most feel the same way. God forbid, if your state Fire or EMS association has a Website Contest, that will definitely make your Dept's. site FAIL Having said all this...GOOD LUCK! Look forward to seeing you on the web!

Uh.... By posting to this forum...you're not boycotting EMT CITY. Think about what you're doing before you act. EDITED BY MYSELF: Previous poster had posted something extremely "anti-volunteer", and Mod deleted it. Ty to our quickacting Mods. FYI: The same poster also posted same message in other threads within the EMTCITY forum. People like that do not need to be in the EMS Profession. PERIOD.

It's been said earlier in this thread that Volunteers do not deliver a quality of care that is equal to that of a Paid EMS provider Can you honestly make the qualified statement that "non-paid EMS providers do not deliver as good a quality of care as a paid provider does?" If someone does only get 1 or 2 calls a week w/ a rural EMS agency, then sure, it's possible they may fall through the cracks. However...I'm from Virginia (yes, Virginia, for all you who'd wish us to move to Canada ), and firstly, our State Office of EMS (referred to as OEMS hereafter) is a heckuva watchdog, as far as state enforcement goes. They're very easy to work with, and genuinely give-a-crap about quality of training/care. Our state also has the Virginia Association of Volunteer Rescue Squads (hereafter VAVRS), and the folks there go the extra mile, when it comes to offering extensive training programs, usually for free, that you'd otherwise have to pay outsourced instructors for. Virginia is divided into (Non-Profit) Regional EMS Councils, who take the training one step further, offering MORE extensive assistance and guidance to our providers, in whichever region the provider "runs" in. Many Virginia Community Colleges now have EMT-B and EMT-I as part of their course offerings. Some even have the NREMT-P program. There's no limit on how far a provider can go, only the limits they set upon themselves. The BLS/ALS Pre-hospital coordinators for the Regional EMS councils also review the "calls" for each agency monthly, and offers advice guidance...then enforces change if necessary, in regard to an agency, and or individual provider. Virginia, overall, does not suffer from a lack of qualified Emergency Medical Care, be it from Paid, or Non-Paid Providers. you will always have the one or two that just say "!@#$ IT", and go their own way, doing it however they want. Those types of people don't last long. There are some folks out there who will debate the issue until it's dead...but as long as there are people who "GIVE A !@#$", and are willing to volunteer their time & energy, in every aspect of PreHospital Emergency Care, then in the end...the quality of EMS care provided by volunteers will never suffer. I realize that demographics have alot to do with it, and what I've said may not necessarily hold true in all localities throughout the nation, but some of what has been said, against volunteer EMS, is just NOT TRUE as a whole, even though alot of comments made in the thread often group all volunteers together. If anyone cares to take a look...here's a prime example of an ALL Volunteer EMS Agency that really has it's act together. They're located in central virginia, and serve a divided population...Urban & Rural...and when I say rural, I mean really rural. Go here --> http://www.rescue1.org

66% Dixie. Just under the Mason-Dixon Line Man...Virginia's my home state, and is where I live now. Isn't the M/D Line rather north of here? Just want to qualify something...I'm a SOUTHERNER, not some redneck rebel. My beltbuckle isn't embossed with the Confederate "Southern Cross". :roll:

"Guest" posted Kickstart My Heart by Motley Crue already, but I had to bring it up again. I can't believe no one else mentioned it before he/she did. It's the first song that popped in my head when I read the thread topic. I guess some of us are just showing our age :oops: I'm only 31, btw. God I feel old. FYI: Years ago there was a "Say No To Drugs" commercial on TV where it showed some teenagers doing illegal drugs in a park, sitting on a picnic table.. Next thing you know, Paramedics are rushing around, defibbing & doing compressions...and what song is playing in the background? Kickstart My Heart - Motley Crue (from the Dr. Feelgood album) If anyone cares, u can check out the lyrics here --> http://www.elyrics4u.com/k/kickstart_my_he...motley_crue.htm

Um... I have died and/or will die many different ways, according to Gooooooogle, but here's my favorite. " ...Tyler was killed by outlaws while leading a posse."

Here's a first for the thread... DIRT DEVIL :twisted: Wtf is up with that? 'Splain that please.