sevenball

I may be the only one here who doesn't think that AMR will shut it's doors. Downsize dramatically, yes, but close it's doors, I don't think so. First off I think that the northeast u.s. division is doomed, they have been from the start. Western division should be fine. If you remember, AMR is owned by Laidlaw. Laidlaw is a Canadian company. I know the Canadian economy is suffering as well, but it's my understanding that it is still doing better than ours. I could be wrong, maybe some of your Canadian members would like to chime in on that. If AMR REALLY wants to stay in this for the long haul, they will find finacial backers in Canada, and they will survive.

Do you taste the themometer to tell if it's oral or rectal first?

I have to go along with the thought that the pump is the way to go. Yes, it's good to know the formula, every good paramedic should, but the pump almost eliminates med errors. Of course, they can still happen, but certainly the frequency of more common errors are eliminated. As for starting care inside the house, shouldn't we be following our basics first before jumping right into dopamine? How about trendeleberg position? If you wanted to move into advanced care, why not try a saline bolus. From there, you've spent enough time inside the house and are probably moving towards the truck. If you want to look towards dopamine, you'll be in the right place to administer it safely.

Isn't that what we are in our regular EMS jobs?

Vent, I am aware that the DOT does not license us. That is why I said that the DOT governs us. On the same note, the national registry does not license us either. The National registry only certifies us. To be "licensed" you have to go through a state agency. Yes, a huge flaw in our system. Perhaps an argument for another post. My thought process on this was that the DOT sets the standards for the national registry. Those standards were origianlly set forth in the white papers, way back in the sixties. My opinion, and only MY opinion here, is that there has been little in the way of change set forth by the DOT to modify those standards. The government has allowed each state to stray from the National registry, create their own standards, and run wild. Until the DOT can put their foot down, require all states to conform, and set forth new, advanced standards by wich the National registry must adhere to, then we are doomed to waddle in our own staleness. My thoughts were only to create a higher, no, highest power to which we must all march to.

Everyone is talking about change needing to come from our home orginizations. Aren't we governed by the DOT? Don't they make the rules for us? Why should we be so content on changing our small orginizations? Why not push for the larger picture. Anything less seems like paint spatters on a building sized canvas to me. If I change what my orginization requires for pre requisites, what is your motivation to do the same? Do you really care what I do? I think not. You'll just take all my lazy run offs who refuse to rise up and conform to a new world of EMS. Change needs to be a requirement, not an option. Education must be forced onto providers. I cannot simply tell my medics to get one, just as I cannot tell you to get one. However, if the DOT tell us all to get one, we have no choice. Unless of course you look good in a headset and paper hat. "Would you like fries with that?"

The way I see it folks, you've got it all wrong. I think that all your educational shortfalls, gadget wizardry, better mousetrap problems can be solved with one change. Reimbursement! Unlike our economy, the "trickle down effect" would work here. If we get enough reimbursement for the calls we do, then we can afford to pay the medics what we are truly worth. If we get paid more, then there is incentive to enter the field, thus the nurse comment earlier. If there is an influx of medics into the market, then employers can become more finicky in picking who gets hired. In order to get hired, you need an edge. What better way to gain an edge, then get the most advanced degree you can. That will encourage every person looking to get into pre hospital medicine to push themselves to the limits of our educational boundaries. After that, we can all hold hands and sing Kumbaya!!! Rock ON!

My service just introduced the bougie, or BAM stick to our medics. I've had extensive training on these, and it is my understanding that in clinical trials, the bougie had a 99.9% sucess rate when used in accordance with the manufacturer. As my education coordinator plainly states "We should be able to secure an ETT every time we attempt one, there is no reason we should ever fail to introduce a secure and definative airway. If that means coming up with 10 different ways to tube, so be it." That being said, it is my impression that if we utilize the bougie after a failed attempt, then there would be no reason to resort to a secondary means of securing an airway, ever!

congrats on your save, and welcome to the city. couple of things to help you out. First off, when it comes to the emtcity, you'll find that the majority of people on here are very analytical, inquisitive, and intelligent. Explain yourself well, or you will be called out. (take this from someone who has been there...several times) Second, when posting, try to break up your post into paragraphs, it helps the rest of us blind folk read it better. Third, when it comes to EMS and code saves, savor this moment, it doesn't happen often. In fact, I would venture to say that it would be sometime before you save one again, but much like the other folks replying to your post, I offer the same advice. Don't give up, continue to fight on and become a better provider. Enjoy yourself in the field, think on your feet with your head, and get a thick skin, especially if you plan on showing up around here often.

tell her to get over it, clear with a signed refusal... Kidding... Certainly isn't that simple. You could be faced with a cardiac problem (all non traumatic chest pains are cardiac until proven otherwise), You could also be faced with a pleuritic pain from the sneeze, you could also be faced with an aortic separation (although rare and highly unlikely), but you never know. I worked with a guy that fractured a cervical vertebrae because he sneezed too hard. the body is funky like that.

It seems the harder the economic times, the increase in drug related deaths... funny how that happens...

be yourself - Audioslave

" I swear she looked like she was just faking it"

You pull your glucose reading from a capillary source. When you introduce glucose directly into the blood stream, you can measure it immediately (almost). After a few minutes, that sugar gets distributed to where it needs to go. Creb cycle uses it, cells use it, some gets used to replenish the sugar stores, ect... you get the point. That is where you can see your dropoff. There is actually a formula out there that you can use that will help you determine how much D50 you can give to prevent a drop, I just don't know what it is.

I'm with you, it doesn't stop here either, but that doesn't stop some companies from running 24's and such. I can attest, it really does make you feel drunk by the time you're done.

What about 24 - 38 hr. shifts, couldn't that have something to do with it as well. They say that every hour over 16hrs. is equivilent to drinking a beer. By time 24 hours roll around, technically, your tanked. Does our friends in the U.K. or Australia do 24's, are they allowed? When I was young and strong, I would pull 48's very often.

I think that hells bells makes a great point that no one has entertained yet. The media. Are the instances of ambulance related crashes greater in America, or do we have story thirsty media outlets hell bent on getting better ratings? Nothing makes a better story than irony. Goes the same for firefighters getting busted with trace amounts of marijuana in their system (see boston fire dept. new articles) Media may help to raise awareness of these things in America.

ruff, sounds to me like you're just arguing because you want to be right. Regardless of what your views on the topic are, you cannot sway my thoughts. I've been in EMS for 18 years. I've seen quite a bit. Again, if you think that there isn't any grey area in this world, then you need to find a desk job. Exceptions can be found for every rule. You seem to be one that will only focus on the exceptions in order to make an argument in your own favor. Let's stop the school yard antics, there is no place for it here. Big rigs, small rigs, small cars, yours, mine and ours ALL run red lights. As a whole, big rigs obey the traffic laws, and in most cases have far more training than you or I would ever dream of having behind the wheel. In most cases, accidents involving big rigs are our fault, not theirs. Anxiety is far more common when sirens are blaring behind you then if you see a tractor trailer driving behind you. Will it cause anxiety if a big rig gets on your fender, sure will. the same anxiety that will be caused if the geo metro is on your bumper. Noone likes to be tailgaited, big rig or not. We've all had experiences where things have gone bad with big rigs, but thats no reason to make a blanket statement that big rigs run red lights like ambulances do. Where are you're statistics that say the majority of bad accidents are caused by big rigs? I've responded to cessna plane crashes before. Does that mean I won't fly because all planes crash?

dougd, I can't buy into that argument either. Hauling freight is a completely different occupation. Big rig drivers don't blow through red lights, they don't create the anxiety that an ambulance does running with lights and sirens. I don't know that it has so much to do with the lights and sirens though. I think that most companies have adopted some form of emergency vehicle operators course that they employ. I would argue that there are a great number of us who are certified emergency vehcile operators, and have good insticts and reflexes. Unfortunately, the general public hasn't taken the same course we have. There is a section of the population that hasn't even taken a drivers education course in high school. That may also contribute to driver reaction. In the end, if we as operators cannot control our speeds, and cannot adapt to the unpredictable driving of the public, we will increase the chances of an accident.

my point in saying what I said, was to state that we are not a universal healthcare country, which causes the poorest of folks to use the emergency services more. That in turn causes a higher response rate, which in turn makes us exposed to dangers more often. Nothing more, nothing less. Healthcare discussions aside, I was merely pointing out a contributing factor. To think that there isn't a grey area there is obsurd. Especially considering that we as medical providers live in the grey, thinking any other way would be far to narrow, and perhaps we should all become statisticians instead.

The only thing silly about the statement is that you believe that there aren't exceptions to every rule. Clearly, anyone who has worked in urban EMS would agree that we lump our poor into low income housing, you failed to mention my point being spot on there. Also, those who are lower on the socio-economic plane tend not to be able to afford to pay for his or her own doctors visits, and surely cannot afford to eat healthy. I too was once without health insurance. The difference was that I was employed making decent money and could afford to take care of myself. My "broad generalization" as you put it, wasn't broad at all. It actually was very specific. Targeted to those individuals on the lower end of the poverty scale. In the future, please be sure to read all postings completely before taking extreme exception to a comment, someone may call you on it and it will only make you look silly.

Dougd, If your post was meant to prove any type of point, I fail to see it. If your intentions were to give me some dose of reality, then you need to make some form of an argument. Was your post in favor of my discussion, or against it, it's pretty vague. The point that I was trying to get across was that if you have poor healthcare, then you tend to use emergency services more often. If you use services more often, then you increase the potential for tragedy by whatever percentage of usage that you have. Those folks in Australia don't need to worry about healthcare because it's all the same. Therefore, you can get regular preventative care, thus reducing the need for emergency services, decreasing the potential for tragedy.

I may be out of my league here, but I'll shoot off anyway. I don't claim to know much about australia, but here is what I do know to hold true. Australia has universal health care. So, regardless of you socio-econimical classification, you will recieve the same care as the president of your country (in theory). In America, there are millions of people out here that do not have health insurance, or any access to health care at all. We pack our poor into low income housing projects, shut off their heat and electricity at the first sight of financial trouble, and restrict their outside grilling to within 50 yards of their building. Unfortunately, that 50 yards is the street corner in which the crack dealer has set up his business, so thier options are limited. Why am I saying all of this. Simple. If you have no healthcare, you do not take care of yourself at all, no follow up care and no simple physicals for prevention. That leads to higher incidences of ambulance usage. Higher usage equals higher incidents of accidents and fatalities. If we shut their power off and their gas off, they cannot cook on their stoves, they use grills, indoors in many cases. Your just asking for trouble there. And since their domicile is run by a slum lord, their smoke alarms don't work, and there aren't any sprinklers to douse the flames. Harder times, higher the drug rates. More drugs equals more carelessness. It's all simple cause and effect, but that is simply my own opinion on the matter. I could be completely off base here and it may boil down to something as simple as statistics and population density.

For those of you who believe that we should be getting refusals from all pt. contacts: Should the same apply when you onsite an accident and the occupants tell you there are no injuries? Remeber this as well, in order to get into trouble, their lawyer needs to prove that you were negligent. Now I won't bring you back to basic school, but we all know how hard that is. Not only that, but the majority of us roll with fire and police, who also will be able to recall that the accident was minor, and that all occupants waived all services but the police. That may also be a good backup plan. That being said, nothing will EVER stop the foolishness that is the legal system. No matter what they sign, no matter what you've done, it is never enough. Some smarty pants will always accuse you of not explaining the risks and benefits good enough, and even if you documented well, some lawyer will always find a way to shoot a hole in your report.

What a horrible way for some poor family to start their summer. Just goes to show you that your whole life can change in an instant, and that the "won't happen to me" attitude just doesn't apply anymore.