JPINFV

Cliff notes version, if I read that correctly: Big Company: Pros: Pay, high volume, you like your current partner Cons: Mostly BLS transfer work (discharges... Do they do any ER calls from the SNFs?), they lie (my recomendation to everyone else. Pick your priorities before work. If they try to make you choose between work and school then stick with what your choice is and tell them to take a hike), no holiday bonus, further away, and posting at unsafe and random locations. Small company: Pro: Better rep, newer units, less BS, they will work with your schedule, your hubby works there, holiday bonus, closer, and posting at actual stations (or at least better spots) Con: Less pay, mostly ALS transfers (less play for the basic), longer transports. And there is a question about this?

^ Does anyone else say, "If it looks like a duck, quacks like a duck, then I'm going to call it a duck, and not a water fowl" when it comes down to the "we can't call it this or that" crud?

When ever a see the, "Hey, we're all paramedics over here" posts I just roll my eyes, nod my head, and say yes. Paramedic, just like doctor, nurse, and EMT, is just a title. Anyone who gets off on the title or the initials behind their name is a wacker. What you do with that education is more important then the title you get to claim.

Wasn't there a news article not too long ago that showed that intubation rates went up when not every fire engine was staffed with paramedics?

Well, based off of your first post, it does appear that some one is ventilating him (again, prone?). If someone is "using the BVM bag" prior to arrival, why isn't he already c-spined? You already stated that, at the very least, a secondary survey was partly done (DCAP-BTLS. /shudders at saying the letters). People were giving treatment options (medivac, NRB, large bore IVs x 2, chest decompression) for the first few posts. Then there was a few posts requesting information. Following that was the nemo posts (I think Dory would have tasted better. At least the taste wouldn't have been so funny...). Then there was a confusing post where you were asking us to confirm the patients signs and symptoms ("right???"). Next there is the "I can't intubate because he had esophageal surgery." This very confusing line since you intubate the trachea, not the esophagus. Then there was the lesson on compartment syndrome vs crush syndrome There was people trying to run the scenario at the begining, but the scenario was very hard to follow. Please do not be offended by this, but is English your primary or first language?

The article says it all...

Here's another neat little trick. Get two objects of the same size/shape, but different colors (ex dry erase markers, color pencils, etc.). Hold them behind your back and randomly move one so that its just in your peripheral vision. Now guess the color. Random fact of the day, the rods in your eyes releases neurotransmitters in the dark, not the light.

Heres the problem, though. How effective are YOU going to be once you get out of the water. Its not like you're going to be able to change clothes or that there is going to be a hot cup of coffee waiting for you when you get out.

The guy walking around has a strong enough pulse to walk. Thats good enough for me. Lets say we ignore the airfield and it happens to be open. We load up everyone and go to the community hospital that doesn't have a heliport. ER doc (who's last major trauma might have been during residency) manages to do chest tubes, RSI's, etc PRN. He still lackes the ability to operate, so the injured are still bleeding out and all. Now you've delayed significatly PCT to OR. The possibility to lose some more people then you should have is now running a lot higher.

It looks like they finally gave you crazy east coaster's something to call a "bus." Our politics might be crazy out here, but at least we know the difference between a "bus," a "rig," and our ambulance.

Google skill level up!

Painful Swollen Deformities? http://www.dsf.health.state.pa.us/health/l...kill_sheets.pdf page 57...

Of course, especially with your short transport time, you have to ask if you're doing your patients any favors. As a basic, I can take the time to educate myself and do a 30 minute physical as well. Sure, I can find tons wrong, but as a basic there is nothing that I can do about it other then give oxygen and get to the hospital. Ok, you're an ALS provider. You have 100 times the training, 100 times larger scope of practice then I do. I'm not going to argue that. Now, lets say, you find a crainial nerve that's damaged. Is there anything that you can do for it? As some point diminishing returns set in. Are you doing your patient any favors by delaying transport to an extent that you would be at the hospital by the time you're done with your assessment in order to find something that you can't do anything prehospital to fix? That said, I would rather take a prehospital provider that does too much of an assessment then one that doesn't do enough of an assessment.

As far as I can tell, most psych transports in my area is done BLS (be it IFT or to be cleared medically). Grant it, we aren't hurting for ambulances (7 private companies, most with mix 911/IFT services. ALS provided only by the hose draggers) where I live, so we don't run into the undercoverage problem. Me thinks that you need another BLS unit on at nights to cover the transports then. Average transports run anywhere from 5-30 minutes depending on where to where. We have 3 dedicated psych hospitals, a dedicated evaluation and treatment center (ETS), and most of the hospitals have a psych unit. Really? Not all psych patients really need handcuffs. I would expect the restraints to do more harm then anything for most people. An involuntary admit due to grave disability isn't really a danger to anyone. If I ever have a family member transported to a hospital in restrains only because it was "standard procedure," then people would be fired. While JCAHO might not be responsible for the prehospital enviroment, they do highly advocate for consideration and implementation of non-restrictive measures first and restraints as an option of last resort. I'm sure that JCAHO isn't the only group saying this, either. Grant it (not directed at anyone in particular), EMT-B education in psych disorders and dealing with psych patients is just as sad as the rest of the basic "education." The public preception of psych patients doesn't help very much, either.

Well, if those are his ovaries then I want to see his flower...

Here's something I remember from Trauma. One of the doctor's has a pair of really dark sunglasses that he wears home following the night shift. No light means no stimulation of the hypothalamus means its easy to get to sleep because its still "night time.'

Well, if they aim it just right, and you land just past the top of the arch, it just might work. That said, I'm not volunteering to be the first one.

Blah, work IFT and you won't have this problem...

Its understandable. The truth is that no matter how powerful that lunch box of life is, no matter how hard you push, and no matter how fast you drive, that code that was last seen alive 30 minutes ago and is now sitting there in asystole is dead. 99/100 patients won't respond and survive to discharge is even worse. You might as well get improve you're skills for a patient that you can help. Inncidently, this is the same reason why you don't want to go to a teaching hospital in July...

^ True, but the student also has some responsibility in the matter. What you do outside of class is just as important, if not more, then what you do inside. Yes, class should be longer, but what is stopping the EMT-B from picking up a H&P or neurobio book? Nothing but themselves.

Just wondering, is most people's PCR a narrative? The PCR's at my company only devotes less then 1/6th of the space to the narrative. I would think that a lot of what other people are putting in their narrative would be found elsewhere. For example the subjective part would be in the hx, allergies, meds boxes. The assessment would go, respectively, in the V/S, picture, primary survey (ABC, skins, LOC, pupils, and lung sounds each have their respective area with choices to check) and the secondary survey? I would, though, like more space for my narratives...

At the risk of highjacking this thread... Of course enough A&P, pharm, and cell biology should also be added so that we actually understand what the frack those drugs do, right? Hell, I don't even think we went over why you need oxygen in my basic class. I know that it isn't in my basic text book. It honestly might not be a bad idea to remove oxygen from the basic's scope of practice. Or do you believe that just knowing how and when to push a drug is enough?

I wouldn't work off the clock. I was talking the other night with an ex-EMT from another company in my area. He meantioned that his company didn't give them the choice of being in units that worked (lights in the patient compartment working, for example). I agreed with him. The company doesn't have a choice. I'm not going to work with a half-stocked, half-working unit. I don't care how many dialysis calls are stacking up or how long I've been/will be in the bay. I'm not going to work for free, either.

Of course a head ache could be something more serious, like a stroke. "While the severity of migraine attacks often causes patients to fear they are having a stroke the likelihood of a migraine attack causing a stroke is very remote. That is not to say that migraine sufferers cannot have a stroke associated with their migraines. In persons under age 40 the most common associated factor for stroke is migraine headache." http://www.headaches.org/consumer/topicsheets/stroke.html Would you tell a person with chest pain that it's probably just acid reflux and that they shouldn't have called 911? Probably not, right? The truth is that the majority of the public have no clue as to what a stroke even is till its too late. They don't know what the signs and symptoms are till they are laying on the ground half dead. Anything less then that and they will wait to let it pass instead of causing an inconvenience to someone who is paid to come when people perceive an emergent medical condition exists.