emtannie

Certain calls do stay in your head. The very first call I went on in my career was a domestic dispute - no serious injuries, but I think I remember that one for two reasons a) my first call, and the entertainment value (long story). I don't think the child abuse cases that I have dealt with have truly affected me personally... I am who I am, and I do my best, and sometimes we see things that just are not nice or pretty. That is part of our job. Yeah, there are days I think there should be an exam and large fee to be able to have children, so that we can screen parents (for those who want to bash this, please insert sarcasm here). There are people in this world who are just evil, who have mental health issues, who have problems I can't begin to understand. I can't cure the world, but I can do what I can in my small corner of it, and that is to do my job to the best of my ability. Sometimes, some calls affect you more, and you have to be aware of that. The first "old lady with abdominal pain" call I had after my mom died was a little stressful for me. Did I let it affect my professionalism or my care? No. Was I worried that my personal feelings might have affected care? Yes. What did I do about it? I discussed the call with my partner after, and asked if he had seen anything I might have done differently because I was still mourning the loss of my mom. He said he thought I handled that call with the same care and efficiency I had any other call. If calls are affecting your performance, you have to look at whether you are effective in the field, or a hindrance. If you are a hindrance, you better get off the car until you can be sure that you have dealt with your own demons.

I have unfortunately, dealt with child abuse cases as well. The patient is your priority - you have to deal with them as best as you can. As Vent said, you HAVE to maintain your professionalism as best you can. NO making judgmental comments, or making any move that is anything less than absolutely professional. This can and is incredibly hard to do sometimes, as you just want to tell the "adults" exactly what you think. Document, document, document - absolutely everything... from the state of the scene that you entered, to EVERYTHING about the patient's condition, to anything that was said or how the "adults" acted in your presence. Ensure that you follow your area's protocols for informing the triage nurse, doc, and law enforcement, and document that as well. Be prepared to go to court over these calls. Sometimes they are hard to deal with, and you will be angry - your service should have people you can talk to about these calls, to vent your frustrations to. These calls are just part of the reason that we want to keep our skills and knowledge as sharp as possible - we always want to give the best care, but for some reason, those little ones who have been abused just tug at our emotions a little more.

Vent, I really liked your reply. My post wasn’t to offend, but to try to point out that collections isn’t the easy answer. Quote 4c6: “Large EMS systems need to have their own Collections Agency. Time to get what's owed.” It isn’t that simple. Quote Herbie “And then what? If someone does not pay their bill, does that mean we won't respond if they owe money on previous services?” Vent makes some very good points – there are those people who want to pay, but don’t have the means. There are those who don’t want to be a burden, and wait until the situation becomes critical. And, there are those who abuse the system by using ED’s as clinics, and taking up valuable emergency services time and resources. I don’t know how the system works in the areas where Vent, Herbie, and 4c6 are… Do hospitals have finance departments where repayment can be arranged over a period of time? Is this an option for some of those who cannot pay in a lump sum? Is this already in place? Does it work? Is there a mechanism in place to bill those who abuse the ED? Maybe a higher fee for using the ED for services that are non-critical and could have been taken care of at a clinic? I know the fee for service has been considered here, to try to lower the abuse of the ED by those who treat it as a walk in clinic, rather than an ER. It is still in discussion phase with our health region administration – it has its own issues. Are there social services programs where those that cannot pay can apply for partial funding? I don’t believe that collections is the entire answer. There have to be other alternatives as well.

Actually, I find Herbie's question legitimate. 4c6, I don't think that she was trying to put word into your mouth... Let's review.... Looking farther into the problem of non-payment, what is the option when people don't pay? As someone who doesn't live in the US, and who doesn't see the health care world in the same way as many in the US, I am curious as to how this would be handled. Someone doesn't pay their bill. I suspect that a majority of the people who don't pay are low income, on some form of social assistance, or have mental or physical health problems which prevent them from being productive members of society. I also suspect that most on this site will agree with that opinion. So, next step... they didn't pay, so now we want to collect... collect what? and from where? do we garnishee their social assistance cheque, so now they have even less for food and rent? Which we assume that they won't use for food and rent anyways, but rather for alcohol and street drugs. I know, stereotyping, but bear with me here. So, then next step.. we can't find any income to use for repayment.. do they have any assets? Hmm... let me think on that. NO - if they had assets, that would mean they used their income for something.. and we would have something to use as collateral for a loan, which brings us back to repayment, which we already said they don't have. Now what? In another thread, in a discussion on the New Obama health care, many said that health care is not a right, but a privelege, something that should be paid for, and that they are willing to take the responsibility. It is obvious that there are those in society who aren't... So again, then what? It appears that regardless of the system, there will always be those parasites who do not pay, and abuse the system. So, if they can't, or won't pay, reason follows that under the fee for service, if they don't pay, they don't get service. But, then we get back to the "well they called 911, so we have to go"... What a vicious circle...

This came up at work this week, and much discussion has ensued – I am hoping to get some input from the members here. The discussion was regarding patient position while obtaining 12 lead. One staff member said that patient must be supine, as having the patient in Fowler’s position may affect axis deviation or other deviations. Another staff member said you can have the patient in Fowlers without having any change in the tracing. When obtaining a 12-lead ECG, how important is patient positioning? If you do serial 12-leads, if the patient is in a different position during a later reading, will that affect the reading? Does anyone have evidence-based references? I have looked through several texts I have, and have found the following: “Although it may not be immediately obvious, the position of the patient can affect the ECG. One reason for differences between tracings obtained in various positions is that although the electrode does not move when the patient changes position, the position of the heart does move relative to the electrode. Strictly speaking, a patient should be supine when the ECG is acquired. This makes comparison of serial ECGs more meaningful. However, this is not always possible or desirable in the chest-pain patient. If the patient is not supine when the tracing is obt5ained, simply note the patient’s position on the 12-lead.” - Phalen, T., & Aehlert, B. (2006). The 12-Lead ECG in Acute Coronary Syndromes (2nd ed., p. 50). Philadelphia: Elsevier Mosby. “Ideally, the patient should be lying down (supine). Often, however, this is not possible. A patient with acute onset of chest pain, for example, may not feel comfortable lying down. Therfore, the Fowler’s position (sitting up) is generally used for acute patients.” - Page, B. (2005). 12-Lead ECG for Acute and Critical Care Providers (p. 6). Upper Saddle River: Pearson Prentice Hall. The doc and the medic involved in this discussion said that patient positioning does make a difference, but the nurse said not. However, I have spoken with another medic who also said that since the leads are only reading electrical activity, patient positioning isn’t important. Your input is greatly appreciated.

I can see where occasionally, someone could miss an expired med, but it should be caught by the next crew coming on shift. To have a number of meds expired shows that the crews are not doing their due diligence in maintaining their truck. We do vehicle checks at the start of every shift, including drug checks. On the 25th of each month, the crews on duty do a specific drug check, and any drugs that will be expiring in the next month are ordered from pharmacy. A sheet is done for each truck, so when the drugs come in from pharmacy, on the 1st of each month, we then go and replace those drugs that will expire. Narcs have to be signed off every day, double signature. Are some people slack, and don't check their stuff? Of course. Even with control mechanisms in place, sh** happens - but we should be trying our best to minimize those events. Like Dwayne said, I want to look out for not only me and my partner, but I don't want to be the one who misses something and the crew that replaces me has to catch it, or worse, they find out something is missing when they are already on a call.

Hey firedoc - glad you are back! Love your choice of song today... My song today, only because I heard it on the way home from shift this morning, turned it loud, and can't get it out of my head... "Fat Bottomed Girls" by Queen

Phil, you have been a very bad boy.... you have been in my closet again.... very very bad boy.....

I am blaming Albert Einstein for this… One of his famous quotes “never commit to your memory what you can find in a book.” I think too many students take this quote to heart, and do not try to learn, forgetting that in the field, taking the time to look things up is not always an option. I agree with the integrity issue as well. Albert had another quote on that, which is far more fitting for this situation “Anyone who doesn't take truth seriously in small matters cannot be trusted in large ones either.” I have seen students use the on-line question information for a number of classes, either for good or bad. I have seen students use these sites to develop quizzes to test each other; when used for this purpose, these sites show value. I have also seen these sites used just as tcripp and JakeEMTP described – as a way to try to shortcut learning. Like Jake, I see this in a number of refresher courses, including CPR and ITLS. Jake, I think you handled those students very well! I tend to give a lecture at the start of my classes: “In this class, you are required to have the mark of 80% to pass. Some of you are already giving me that ‘OMG 80% is awfully high’ look. I want you to think about it for a minute. If you were sick or injured, or a family member of yours was sick or injured, do you want the EMT or medic who just got 50%? Or even just got 80%? Or do you want the person who excelled? My bet is that you want the person who excelled.” (I usually see lots of nods here) “So, my challenge to you is, be the student who excels, not the one who just meets the bare minimum. When you are studying, ask yourself if you know enough to give the kind of care you would want.” I usually have to remind some of them of that short lecture during the course of the program, but it does have an effect on some of the students, and those students I am so proud of when they succeed. I don’t know how to break this cycle of entitlement, as beating it out of people isn’t an option….

Once again, news like this paints EMS with a bad brush. Unless there were significant extenuating circumstances (of which I cannot think of a single relevant one at this time), there is no excuse for this kind of a mistake. Do they not have protocols to follow before saying "yup he's dead"? Do they not have to confirm asytole with a monitor for a certain period of time? Or, do they not have to see obvious signs of death, like rigor, lividity, of the patient's brains separated from the body? Jake, I suspect you hit the nail on the head with the just checking carotid pulse. Articles like the one mobey posted make me want to take these two medics out behind the barn...

Well, Dwayne, for starters – you should have punched that Canadian nurse, and then kicked him in the tickets while he was down. I would be ok with that. (if you were Canadian, it would also be appropriate to pull his jersey over his head and beat him with a hockey stick…) Socialized medicine is not without its problems, and those who say it has no drawbacks are wrong. I could list pages of issues we have here with our medication system… oh wait… I think I have already been involved in some of those threads… Every system has its parasites and abusers, from the addicts we have all brought in to the ER, to those who call an ambulance because they don’t want to pay for a taxi, to the regular on the Jerry Springer show “Who the Baby Daddy” with 6 kids. I don’t think that will change regardless of the health care system provided – abusers will always find the loopholes. From what I have seen, and I am sure I have mentioned it before, the thing I truly like about socialized medicine is coverage for children. If I had a child here, who needed major surgery, there would be no question of “does my insurance cover” or “can I afford it.” I have seen, as I have a good friend in the US, who does not have that comfort. Although both parents work full time (and the husband works 2 jobs), their son who had heart surgery at a very young age, again needs heart surgery. Their insurance will cover 75% of it, but they will still have to come up with $50,000+ of their own funds. They are currently able to re-mortgage their home to cover this, but what if they weren’t yet in that financial situation? What if they were a younger couple just starting out? How do you not provide care for your child because you can’t afford it? Then what? I have talked to other US members on this site, one of whom explained it to me very well. The independence from government, and self-sufficiency is every important to US citizens, and “I had that child, it is my responsibility to care for it.” I get that, and I respect and understand that position. I just don’t think it is possible to be prepared for the worst possible scenario, and the costs involved. I just wish that people didn’t have to forego medical treatment for their child because of financial reasons, when the parents are middle-class employed individuals – I couldn’t imagine how that would feel.

Living in Canada, and having access to health care without having to worry if I can afford the ambulance ride or the services I get at the hospital, I am a little confused about a few things regarding the events in the USA. I will admit, I am not well informed about it, and do not understand the complete ramifications of this, but some of the quotes really caught my eye. “The vote last night was the worst day in American History. It's the beginning of the end of America as we know it, unless we all do something to stop it!” - really? Worse than the shooting of JFK? Worse than the Vietnam war? Worse than the war of 1812 (which the US lost)? Why is this worse? “I am actually scared, scared for my family, and for my children.” - why? What is so scary about this? “No offense, but if our system, society, and health care is so lousy, why are people fighting to COME vs going elsewhere? Why do people come here from all over the world to get state of the art medical care? You can have "Decent" health care- I'd prefer to have the "best"- with all it's flaws. Instead of fixing the problems, we are blowing up the entire system. FAIL.” - no offense?…. People come from all over the world to the USA to PAY for health care. The priveleged, the rich and famous – that is a HUGE difference than average Joe coming to the USA for health care – that doesn’t happen. What about the average working class person coming to Canada for health care, or to Mexico? I live and work close to the US border – and if you think it isn’t happening, you are mistaken – I see a lot of US citizens that come to our hospitals and pay the out of country non-insured fees, because it is still cheaper, and faster, than getting health care in their own country. - I think it is offensive to the working class that they can’t afford health care in their own “richest country in the world.” “Shame on us for knowing that at the rate our current President and his cronies are going through the government coffers and giving it away…” - unfortunately, your own population spoke with their votes to get this person into power, for good or for bad.. “I see a lot of Babylonian empire in our country” - Ruff, I like this; I also think that we can look at our current countries and make comparisons to Babel. “Forcing American's to foot the bill for your problems doesn't hardly seem fair to me.” - again, is healthcare a right, or a privelege? - and, you are already paying for the parasites who prey on your health care, social services, and other government programs – how does this new bill make that worse? “Welsh, I think some were a little taken back with the "shame on you" remarks. Many Americans want health care reform and coverage and are not against these concepts. However, what just passed could be dangerous for the United States. We have no money, we are trillions in debt, we are already funding two battlefields and sending out billions in aide to other countries while we continue to take money from other countries such as China. Potentially adding trillions more to what we owe when our economy sucks could potentially bite us on the ass. We are doing this to extend coverage to 30 million or so people at the cost of potentially causing our country to go under. We should focus on conservative changes such as decreasing cost and tort reform instead of drastically changing everything with a concept we cannot afford. The US is in a bad way right now.” - THANK YOU, chbare, for explaining some of the reasoning – after 4 pages, I found very little up until your post to explain WHY you don’t like this bill passing. - “What the fuck is that supposed to mean? Could you BE any more European? (See how that feels, wise guy?)” - WTF? I saw the original comment, and didn’t find it offensive, but I find this one offensive… this appears that you think opinions coming from Europe MUST be wrong; when it was pointed out by the pervious poster who you replied to, that in America, health care is not considered a right, something that has been agreed to by many US posters.. so why the anger? I do not understand the part about fining someone who doesn’t have insurance – the theory behind that evades me; but is that the only reason people are against this? The US has tried to make health care private business for decades… is that any better? I see working people, with insurance, who still can’t pay their medical costs, who still have to mortgage their homes to cover surgeries for their children, and who lose everything to try to pay for life-saving medical treatments – is that better than what is being put into place now? Private health care as the US has is a “privelege, not a right” setup – is that really what citizens want? Do people only want health care for those who can afford it? I do see the concern with the debt this is going to incur; as a taxpayer, that is a valid concern; how is that any worse than bailing out the big businesses who showed to have incredibly poor fiscal management during the recession of the past few years? (I own my own small business – I didn’t get any bailout money) So, if I understand right, these are the reasons people don’t like this bill: - it costs a lot, and the USA is already in debt bigger than the average person can fathom - it will not insure those who truly need insurance - it won’t solve the problem of those who are parasites to the system - it was voted in without public support Am I understanding this right?

This came up for discussion when I was on shift yesterday, and one of the members I was working with used to work for APL. One of the reasons he left was because there were times when he worked 36 hours straight – not on call, but actually in a plane for 36 hours, and he knew he was a danger to patients due to fatigue. Others who I work with, who know some in this situation, said that gossip they heard was that the staff requested a mediator, and that is when they were locked out – granted, this is water cooler gossip – but if that is in fact the case, it does not look good for the employer to lock out staff when they have asked for a mediator and are trying to negotiate to a resolution. Quote from article link “The situation is truly unfortunate as the HSAA continues to drive the wedge between me and my staff as deeply as they can. The truth is, this union cannot make us do anything we are not willing to do nor will they. We cannot agree to anything that will put us in a jeopardizing position.” - if the staff were truly happy with their situation, they would not have voted to unionize – obviously there were problems before they took the vote to unionize, and the employer is not acknowledging that - putting the employer in a jeopardizing situation sounds more like “I will not spend more money, because profit is more important to me than crew or patient safety.” “Furthermore, the HSAA wants us to make impossible guarantees that we cannot commit to without doubling our air ambulance payroll. It would be irresponsible of us to agree to anything we cannot commit to.” - yes, doubling your ambulance payroll would mean that crews would not work the kind of hours they do now, and you would actually have to pay overtime – what a novel idea - again, I strongly suspect there was employee/employer issues before this, and the employees approached the union as they were unable to work with the employer

1. I also agree with some of this... if they were using hospital computers and internet - that is a big no no... there are protocol and security policies in place with most employers regarding this, and I can see this being a firing issue depending on the severity of the incident. 2. Again, there are probably policies in place regarding use of hospital uniforms, posting pictures of work-related areas, and logo issues which may be in play here, and may also be firing offenses. 3. I carry my person cell phone at work; my employer allows it, and I do employer business on my personal cell phone. However, it is always on silent, so that it never interrupts my interaction with a patient, and I will not answer, check messages, or text if I am going to, on, or returning from a call, or if I have reports to do or any other work-related business. Same with my laptop - it comes with me on shift, but I use it for doing homework and referencing information. Facebook and game-playing is kept to short downtime breaks. There will always be those who try to blur that line, and push the personal use at work issue. Regarding the initial incident in this thread, I suspect there is more to the story, and if this was an employee's first "offense" is it a firing offense? Or is someone over-reacting? I can see far more serious things to dismiss an employee for, unless their chat was unprofessional in that it was rude, sexual in nature, or other obscenities, or presented the employer in a poor light.

So.... you are still a figment of my imagination.....

Boeing, rather than posting a purely emotional response, which was irrelevant to the original post and article, perhaps you could try to justify the actions of the firefighters in the article that Dust posted. Explain to me WHY the FD in this article want to “be exempt from any medical or emergency oversight when they're at a scene.” How does this improve care? How does this further EMS? Explain to me the justification of the following quote from the article: “the intent of the legislation is that we don't need the EMS board in on our discipline. A lot of the firefighters think they treat us like criminals, like we’re always wrong." IMHO, this quote shows the true reason for this legislation – pride, not quality of service, is the priority. So, if you can justify how this legislation in this article improves patient care and improves EMS as a profession, I will discuss this with you. If you want to post an emotional outburst of how “EMS is always hacking fire,” and how amalgamated services are working so well, I am certain that many on this site will be happy to argue that point, and provide statistics and recent articles on areas where it is not working at all. The gross generalization of “come down to the states where the service is combined” is incorrect, as there are many services that are EMS only in the USA. I may be mis-reading that, in that you may have meant “come down to individual states;” however, again, I am sure there are examples even in those states where combines services is not working well. “Those of us who care about our roles in this dual profession dont sit here and whine and complain and think of what negative thing to say to or about all of you who still work in single role depts, whose days are limited….” Wow. That is a completely arrogant and uneducated comment. Combining services does not improve EMS care, it does not improve EMS as a profession. It is a good way for fire departments to increase their call volume figures to justify budgets, as has been shown on numerous threads here. It is exactly comments like that which will draw fire, (no pun intended) because the reasoning for combining services has nothing to do with improving care. Ok, now that I have hijacked my own post, back to my original thoughts: boeing, stick to the thread. If you want to start a thread about how EMS are big meanies and like to hack fire departments, you are welcome to do that. In this thread, we are discussing a specific article, and the negative outcome of this legislation. So, refer to the OP, and post an argument in favor of the legislation if you agree that the FD in this situation is in the right. I will await your reply.

Good point, spenac.. and on seeing your post, I did...

Never mind, I FINALLY figured it out! I did get my Palm stuff to export to Outlook, and then was able to sync to BB... 342 Contacts successfully transferred! I was having visions of me retiring before getting all my contacts across.... Thanks tniuqs and speedy!

Turnip, I would do that, if I could get my Palm stuff to export properly to Outlook... I can't even get it moved to Outlook so I can go from Outlook to BB. Speedy, problem with using Google calendars is I am never at home - I depend on my phone to keep track of everything, which is why I need the software on my phone to be able to handle it all. And if I load everything onto Google, and it still doesn't sync to BB, I am still f***ed.

OK, I know this isn't EMS related... I need technology help, so please, if you are going to post, provide help, not just "google it" or "go to crackberry.com." I have been those routes already. I have a Palm Treo 755p, and just purchased a Blackberry curve 8530. As this phone holds all my scheduling and contacts for my employment with 3 ambulance services, a college, a hospital, and my personal company, as well as personal contacts, I really do not want to re-key all my contacts and my calendar. When I installed the Blackberry Desktop, there is a section on migrating stuff from Palm, but it doesn't allow me to select Palm or get into the actual setup to do this - the options are greyed out. I googled it, and went to Crackberry, and found several posts that said I could export my data to Outlook, then from Outlook to BB. I tried that... when I import my data from Palm to Outlook, it imports the names in my address book, but nothing else. I tried it as a comma deliniated file, and as an Excel data file - neither worked. I am trying to refrain from throwing my BB as far as I possibly can.... Can someone provide step-by-step instructions on how to get my data from my Palm to my BB? I would really appreciate it.

Reading this article was just painful. Dust, you should have been handing out ativan to all readers when you posted this one…. And now, after reading it, my BP is so high I may need Labetalol… What are they thinking? OK, the first line got me “Every day across Louisiana, firefighters are busy battling blazes and, in some cases, saving lives.” What dramatic effect – maybe the writer should have started the article with “it was a dark and stormy night…” This “proposed House Bill 1030, written by state Rep. Karen St. Germain from the Baton Rouge area, makes all firefighters exempt from any medical or emergency oversight when they're at a scene,” is very very scary. No medical direction? What will the scope of practice be? Who will ensure that firefighters maintain that scope of practice? In the event of negligence, is this the loophole that allows firefighters to say “we are not medics, we are firefighters, and we were just doing what we thought was right.. sorry someone died..” “the intent of the legislation is that we don't need the EMS board in on our discipline. A lot of the firefighters think they treat us like criminals, like we’re always wrong." Ahhh – so you want EMS as part of fire, but you don’t want to play by EMS rules. You don’t want to be regulated, you don’t want to follow direction, and you want to just play with drugs and shiny objects without having to report to anyone. Maybe there is a reason “we’re always wrong,” and maybe that reason is exactly because the firefighters involved in pushing this legislation through are more concerned about their bruised egos than the reason EMS is in place – to provide quality care. These same people should ask themselves if they would like to be treated by an unregulated doctor or dentist, or if they would like their child to have surgery by someone who doesn't have to answer to anyone else. The theory is the same. Very very scary…

I am glad that these workers were cleared. Not because they didn't do something wrong, but because by not clearing them, the city can't use them as the scapegoats for a far bigger issue. It wasn't just these EMS staff who were wrong... it was everyone involved... from the dispatchers to the doc that talked to the patient over the phone, to the city workers who weren't there to assist the EMS crew in getting to the scene, to the earlier crews that turned back... to the disaster management staff who didn't have their sh** together to have the equipment and staff available to handle this kind of situation. By only laying blame at this EMS crew's feet, they would just be the sacrificial lambs, and the excuse the city could use to wipe the incident under the carpet. I do hope that the city looks at this more seriously and make some changes... but, I'm not holding my breath...

For clarification – Dixie and Dr Early were married – not on the show, but in real life. Emergency was a completely different genre than Trauma. Emergency was a public service announcement worked into a 1 hour television show. Trauma is just nighttime soap opera with no basis in reality. Emergency touched on topics of “drinking and driving is bad,” “drugs are bad,” and the politics of hospital and EMS/Fire. Emergency was based a lot on James O Page, one of the pioneers of EMS, and who the Johnny Gage character was supposedly patterned after. It was also based on actual events of the time, including touching how medics were trained, the legislation in California which allowed the paramedic program to be developed and implemented, and the hurdles they faced. In comparison, Emergency and Trauma are two completely different creatures.

I don't know where you can get second hand defibs, but I will give you a word of caution - if you intend to buy second-hand, make sure that the company that made the defib will still stand behind their product (Zoll, PhysioControl, Philips, whoever..). I know here (Alberta, Canada) there are purchase retrictions and there are situations where they will not honor warranties if it is purchased second hand - make sure you do your homework before spending any money!

Well said, Lone and Spenac. This will continue until there are significant consequences to employers for not checking certifications. Huge fines are a deterrent, and publicity is also (hopefully) something that the employer does not want. This is clearly a lack of due diligence on the employer's part - there is no excuse for things like this happening, yet they happen too often.