Arachne

His POV has more lights than the ambulance, a siren, EMT license plates, bumper stickers, and stickers on it. He has responded to all of 2 calls in said POV, but has stories galore.

My service does not use "on-call" for EMTs, but they do for chair-car. I'm posting it because it may work for EMS as well, even if my company does not use it for that purpose. On some days of the week/holidays, they pay chair-car drivers a set amount to be "on-call", and stipulate that they live within a certain distance of the base. If they come in, they punch in and are paid by hour. If they don't come in, they just get the "on-call" stipend for the day.

One more for medics: He can be almighty ion accident scenes, brave in the face of chest pain patients, but wilt when confronted with a basic who asks advanced questions.

Personally, I do wear a helmet. If you find a decent one that fits you properly, it's really not that bad. At high speeds, it probably won't make a huge difference. I'll wear it on the "off-chance" that it will. At lower speeds, it is a nice hard surface between my face and the pavement. I'm a fan of not having road-rash on my face. I am always cautious about the government playing nanny, (See also: England) and for that reason I would hesitate to put laws in place that mandate helmet use. Perhaps insurance companies could give discounts to those wearing helmets as an incentive, or charge extra to those who do not wear them (which could be applied retrospectively after you've been caught in an accident without a helmet).

If I may chime in as the BLS such a patient may be triaged to... I would be perfectly content teching this patient, especially if ALS was driving. If something changes, ALS is there and probably was standing there through most my assessment prior to loading, so s/he already knows the story. S/he could start a NaCl lock if so motivated. If the ALS really wanted to tech, that's fine too - it saves me writing the report. If I came across this patient while working on a double basic truck, and she had absolutely no other symptoms and nothing was setting off my "ALS-radar", I would probably transport her BLS. She has no signs of instability (not physiological instability anyways). Depending on her demeanor, I'd consider that she might be a psychiatric patient whose medications have run out*, that there's something else that she doesn't want to tell us, or that she has some other motivation for wanting a ride to the hospital. Dizziness may just be -something- to tell the "ambulance drivers", especially if she felt the need to call 911 after 5 minutes of dizziness. This wouldn't change my treatment, but it's something I'd consider. *It's previously stated that she denied any PMH and medications, but there's no guarantee she's being honest. I don't like to presume dishonesty, but when things are just weird or don't add up, it's something to consider.

Wow. I work in a working class part of MA and they start BLS at $10-something, then pay for years of EMS experience. Don't you have really high gas prices out there too? I keep hearing rumors of regular costing upwards of $4/gallon, but never researched it...

Wow...I'll never get that 90 seconds of my life back.

There may be bad blood on a management level, but we get along with their crews just fine. I've seen them called when all the Trinity trucks were stuck in snow and many of HFD's trucks were stuck in snow (it was a good day for snow and a bad bad day for us), and I've seen them sent into Groveland to assist Trinity BLS when Trinity ALS was tied up.

Yup, they do. I kinda left that out for clarity. In Haverhill, there are 2 ALS trucks and 1 BLS truck committed to 911, and a number of transfer trucks that sometimes back them up. Haverhill FD dispatches the dedicated 911 trucks depending on how the call comes in. Haverhill also sometimes makes use of the AMR trucks in the city. Lowell has an ALS truck that gets pulled into 911 if all the BLS trucks are tied up or the Saints Memorial paramedics (a.k.a. Greater Lowell EMS) are tied up. Lawrence has a similar situation to Lowell.

In both areas where I work the FD is responsible for gaining access to the patient if not readily available - this can include MVAs with entrapment, patients in locked apartments, etc. We do butt heads sometimes - but as long as we all manage to stay calm and communicate, we generally get through things. Some cross-training and meetings have also been very helpful for each side to understand and facilitate the goals of the other. We do the best we can for the patient while allowing them to play with as many toys as possible, and they do the best they can to get us fast & safe access to the patient while not causing us to cringe in dismay. :tongue:

To address a couple things mentioned in the last 4 pages of commentary: - In MA, for an ALS truck to do 911 requires 2 paramedics. A P-B truck can only do 911 at the intermediate level, and transfers at a paramedic level.* In my region, the difference between a basic and an intermediate is IV (normal saline only), intubation for cardiac/respiratory arrest patients, and glucometers. - Trinity in Lowell & Chelmsford and Patriot in Lawrence run all BLS trucks. ALS is provided by hospital-based paramedics (out of Saints Memorial in Lowell and Lawrence General in Lawrence). I personally like the system - BLS goes to and transports all calls, but ALS is available for anyone who needs it. ALS is dispatched to anything that "sounds" ALS. If the call sounds ALS but turns out to be BLS, it's a simple matter to cancel ALS so as not to "waste" them as a resource. - Higher education doesn't go far in BLS. I have a B.Sc. in Physiology. It's very pretty on my wall, but it's not what makes me a decent EMT-B. It helps me to understand what is happening to my patients, and I can better explain to patients what is going on and why we treat them as we do, but understanding what a cardiomyocyte is doing during an MI really doesn't change my treatment of chest pain patients. Familiarity with osteocytes doesn't change treatment of a broken bone, nor does knowing the name of every bump, dent and angle of the bone. - Most of us who don't know how to use proper punctuation, capitalization and spelling don't brag about being able to write above the 7th grade level. The spell check button is located below the the window you type your replies in. *In certain areas/emergency circumstances there are waivers to this, but for most private services in higher volume areas this will be the case.

How is it that the people most upset at your response time are the ones who: a) waited 3 days to call you? have no number on their house, mailbox, end of driveway, and no lights on? c) have 6 family members nearby, but no one went to the end of the driveway to wave you in? Why is it that the people who are uninsured and will not pay their bill are most likely to complain about the service they're receiving?

I don't know about Boston, but in Region III of MA c-spine clearance is decidedly not in protocols. Even most of the services physically located in Region III that have withdrawn from the region's control don't allow it.

Does your country have some form of provincial or national safety organization, either general or fire/EMS focused? It might be worth investigating if these problems are in violation of laws/regulations - if they are you may be able to get help from outside your company.

There are a couple factors that can be missing in Hemophilia - I'm not sure if they have synthesized a replacement for all of them. I would guess that anything given would be a very long shot. A female patient is exceedingly unlikely to have hemophilia - it's an X-linked genetic disease that can be carried by females but is rarely expressed in females (if ever) - so anything that is usually given to help hemophiliacs isn't likely to help her enough to save her. As Dust Devil mentioned, giving clotting agents like that would be an invitation to get emboli in undesirable places. If they were giving something like vitamin K and EPO, they'd be encouraging the body to make more blood on its own, although neither of those would specifically help clotting. EPO (erythropoietin - naturally occurring chemical that increases red blood cell production) takes a few days to kick in, so that might be given if they think she'll live that long. Again, though - it would be a long shot.

And if you use it on psych. patients, the bulb makes a convenient leash.

No EMS show will ever accurately portray the profession - we don't show as much cleavage as CSI and there isn't enough drama and blantant heroism in accurately finding and treating most medical problems (or an expertly executed dialysis transfer :tongue:).

I'd just like to applaud those of you who make the effort. I've got a few partners who could take a lesson from you (one of them is so obese that he's out of breath just climbing into the driver's seat). On a similar topic, do any of your employers/services provide fitness equipment or gym memberships? I've heard of it, but not within EMS.

Hey, as long as it's not going to shock me, it seems easy enough to deal with: Put them on the stretcher, manage the airway/give them oxygen if they seem to need it, monitor vital signs and take them to the hospital. Extra points if you can intercept with ALS. Personally, I'd not want to delay transport waiting for medics*: If the patient needs it to go off that often, they're very sick and need to go now, and if it's malfunctioning, it could interrupt normal function and cause them to become very sick. *Unless you're in very rural EMS and have the choice between doctor in an hour or medic in 15 minutes...where I work we can often get to the hospital before the medics can get to us, so we try to intercept and don't sweat it if they can't catch us.

As BLS, I'd be calling ALS to intercept due to the high blood pressure and general appearance, especially if further assessment can't rule out cardiac origin of the chest pain. Because of the limited assessment and treatment available to BLS, I wouldn't want to mess around onscene. Recent trauma? Tender on palpation? Is the pain seem more like chest-wall pain or is it deeper? Localized or generalized pain? Do any bystanders say that he's taken something that he's not admitting to?

How about when people say, "Not to mention X", then go on to discuss it?

Well, we have over-sized wheelchairs/beds/stretchers/coffins, seat belt extenders, bariatric ambulances, and nursing homes specializing in morbid obesity...maybe "plus size" c-collars are next. :tongue:

While this doesn't sound like it happened in this specific case, but if your blood pressures don't seem to make sense for what you see when you're looking at your patient, make sure you were using the correct size blood pressure cuff. If your patient is obese and you're using a normal cuff, your readings can be off.

I worked in a rural/volunteer setting for 5 years before starting in more urban, full time EMS about a year ago. It's a bit of a beating to your ego to find out that those years don't amount to much. I found that I was frequently relying on my partners to guide/train me in situations that were beyond my previous experiences. It was almost like being completely new. Having been out of my EMT class for 5 years didn't help either. Like everyone else has said, it's about call volume.

I tend to value being happy and feeling safe at your job over money (presuming, of course, that you can pay your rent and eat). Partners are just a matter of luck. You might find that you like your partner at the smaller company as much as you liked the one at the bigger company.