fiznat

Gget them a leatherman tool ($30ish) or a stethoscope ($50+++ depending on model).

I know you don't want to hear it, but there is no reason you need a "cardiology" stethoscope on the ambulance. We are listening to blood pressures, lung sounds, and *maybe* heart/bowel sounds (probably not). What features attracted you to the STC that the Master Classic II (at half the price) doesn't have?

So, what have you got so far?

When you get your BS it will be EMS that is the waste, not the degree. Opportunities vary from location to location, but my impression is that advancement in EMS is pretty much a transition to management. Where I work, the "highest level" includes QA/QI coordinators, senior supervisors, safety managers. It seems that a BS is "loosely required" for some of these jobs. Some folks have the degree, others don't. The real advice is if you go to college, you're going to want to start looking for opportunities outside of this field.

It probably depends on where you are, but when I did my clinical time the staff always tried to get us hands-on as much as possible. We were required to get 100 IV starts and 15 intubations as I recall, along with some number of various kinds of assessments, med deliveries, etc etc.

As an ALS provider who works with EMTs for the most part, I have a few preferences as well. -If you don't know something, just tell me. Don't try to fake it. -Be active in what's going on. I will direct you if need be, but that doesn't mean put your hands in your pockets until you are told what to do. We've both done this stuff many times before, we both know what needs to get done, let's do it together. If I'm talking to the patient, talk to the family. If I'm talking to the family, talk to the patient. Get vital signs, or write down the meds, or think about how we're going to get the patient out of the house. Do stuff. We are a team. -Be familiar with the equipment. You should be extremely comfortable with the BLS side of things. I appreciate if you can help out with ALS stuff (spike bags, put on leads, whatever), but the BLS is far more important. I want to be able to rely on you for vital signs, excellent splinting technique, extrication, scene awareness, BLS airway management, etc etc. -Drive slow, and keep in mind every bump and turn is magnified in the back. Lights and sirens transport isn't an excuse to forget this, in fact usually it is even more important. -Always always be respectful to staff and family on scene. Don't make me apologize for your behavior. -Don't talk trash about other people, especially if we don't know each other. -Questions or concerns are fine, I like to talk about calls. ...But not in front of the patient. Wait till the call is over, and we can figure out how to do it better next time. (imminent safety concerns excluded, of course)

Yikes. I was surprised to see how quickly he went down. Scary. EDIT: Here's the MSDS-- http://www.wdserviceco.com/MSDSANHY.html

What was the cause of death?? How can we even guess about what you may have missed if we don't have that....

It looks like the charges will fall off of your record around the same time that you will be done with EMT school and looking for jobs. I think the above advice is good, get your DMV record yourself before you start applying so that you know where you stand. A DUI is an offense that a lot of ambulance companies take seriously (especially because of insurance concerns), but once it falls off of your record I don't think you should have anything to worry about.

Well they were all wrong. There is no criteria in any accepted c-spine clearance protocol that considers how long a person has been walking around. It doesn't matter if the injury was yesterday, we should be backboarding these patients in the field. If a physician tells you he took an x-ray of the spine and is recommending that the patient be secured to a long board for transport, just do it. I don't see what the issue is here.

About as often, I hope, as I actually transport lights and sirens...

You are forgetting about stop lights, busy intersections, and traffic. All of those things work together to slow down your average speed over the entire trip, which is the number you should be figuring into your math. This number is significantly slower than your top speed, especially in the city where there is a stop light on every block. You want to do some math? How about the ambulance that can hit a top speed of 20 mph over one mile, but stops at 4 intersections along the way for two minutes each. That means lights and sirens could potentially turn an 11 minute trip into a 3 minute trip (at 20 mph, nevermind the increased speed). That is significant, and we're only talking about a single city mile.

It seems to me that this would be confusing to other drivers on the road.

I work in a city with highways and I can say that lights and sirens saves a significant amount of time depending on the time of the day and the traffic. At rush hour, a 45 minute trip across town can turn into 10 minutes with the lights and sirens. I think that is a huge difference, and one that can be critical for a certain population of patients. I agree that as an industry we do tend to overuse the lights and sirens, but I would never advocate that they be entirely removed.

What was the response you got back last time you asked for more responsibility?

Good call. With acute hypotension in the absence of trauma you should be looking at "pump" and "tank" problems first. Sounds like your intuition was correct on this one, but there should definitely be a 12 lead ECG in your differential there somewhere!

Come on, give me a break. Not every person who dials 911 needs an ambulance. I had a dude the other day who called from the waiting room of one of our local EDs because he felt he was waiting too long and wanted to go to another hospital. The complaint? He had run out of his prescription meds. How about another one I ran last week for a bead stuck in the nostril, or the cold and flu symptoms x 5 hours, or the guy who just wanted a ride to the liquor store next to the hospital (not joking). I reserve the right to bitch about these calls, and I really don't think I need a job at a fast food restaurant.

Call on-line medical control and discuss this case with the receiving doc.

I'll do my best to offer a little bit of the other side. EMS is filled with people who don't like their jobs. Everyone seems to have their own particular reasons why, but I will just touch on a few of the common themes so that you can be a little better prepared. These aren't necessarily my personal feelings, but I think they are all pretty accurate. 1. As an EMT, and even more so as a medic, eventually at some point you will realize that you are at the bottom of the totem pole in a system that revolves around hierarchy. Worse, you will realize that you belong there. Medical training for prehospital providers is like a crash course. There is very little of the background, of the science, of the rigorous study that characterizes most serious medical training. Because we lack this, we are constantly at the tip of the iceberg, knowing just enough to get by but not enough to really understand. Depending on your personality and your background, this may bother you every day or never at all. There is no real solution to this problem but to leave EMS and go back to school, which quickly becomes less and less of an option as people get older and more tied down by debt and family obligations. The result is a large population of dissatisfied EMS workers with no real way out. 2. The rest of the medical community, as well as many EMS employers, recognize the deficiencies detailed above and treat EMTs/Paramedics with a constant disrespect. This manifests itself in many ways both big and small, from relative job insecurity ("you are not special, you can be replaced tomorrow no sweat") to nurses/doctors/medical staff who refuse to acknowledge the vital role we play in the continuity of care. Some of this can be relieved on a personal level by maintaining a good reputation, but this takes years of work and at the end of the day when the chips are down, you are still "just" an EMT or paramedic. You will be reminded of this at the worst time and it will make you feel like shit. 3. There is the constant threat of injury. This is a dangerous job that requires repetitive physical motion. Back, knee, and shoulder injuries are extremely common and often career-ending. If that happens you can count only on a pittance from workers-comp for a short period of time, and then ending up jobless with very few marketable job skills. What are you going to do at age 40 with a busted back and a high school education? Not much. I realize you have a college degree, which is great, but this is the reality for an overwhelming proportion of EMS workers. Believe me, this weighs heavily on the mind of any career EMS worker, and it isn't a pleasant thought. 4. We rarely save lives, and a lot of the time it takes some creativity and imagination to even see that we "made a difference" for our patients. The majority of what you do on the ambulance will be needless transport for barely injured or sick people who have no business on an ambulance nevermind a hospital. The ratio will change depending on where you work, but I would (generously) estimate that 20% of the patients I see have a legitimate need for my services. This reality differs dramatically from the expectations of the newly hired. Even if you "know" it's not going to be all blood and guts, I don't think you can truly appreciate how ridiculous the day-to-day can be. Some people are better at handling this than others, as lots of people will certainty attest to on this forum. I can tell you though, if you take a look at people with 15 and 20 years in this business (a small population to begin with), you will find VERY few people who aren't frustrated with this on a daily basis. 5. The pay isn't great, and unless you work for a fire service or the occasional 3rd service municipality, you can forget about a pension or retirement benefits other than a 401-k. $20 an hour may seem like a decent salary to you now, but that money gets eaten up QUICK with a mortgage, school loan payments, and a family. Unless you are extremely good at managing your money (and most aren't), you will likely come to rely on overtime hours, which will be inconsistent and take you away from home for more time than you'd like. I work with a lot of people who routinely pull 60-hour work weeks just to pay the bills, and once you get caught up in that kind of situation it is very difficult to pull yourself out. There are others, but I think those are pretty much the "big 5." Education, respect, injury, B.S., and pay. You should know that this is, however, an extremely rewarding job. Working on an ambulance gives you opportunity to see things that you never would otherwise, and I think really gives you a perspective into life (and death) that very few people get. I don't think there is any other job out there like this, and those benefits shouldn't be ignored. I am very proud of my job and I am extremely glad that I decided to do it. That said, I'm working my butt off to get out.

It is worth mentioning that planning can go a long way with this kind of stuff. If you can avoid it, don't backboard someone on the floor. If they are already sitting on a couch or on a chair, or on a ledge of some sort, get them immobilized right where they are so that you minimize the amount of lifting you've got to do. Also, don't be afraid to call for help. Every town has police and fire, call them if need be. Don't get caught up in the macho "I can lift anything" BS, because nothing is worth risking an injury. Be safe out there!

I never have, but I've seen the hospital do it a few times. ...And those times it was only in the complete absence of any other form of identification. I don't feel it is all that important that I know about emergency contact information right away, especially if the patient is unresponsive/altered/otherwise sick enough that they can't just tell me outright. Priorities change once the patient is stabilized at the hospital, though.

That is the extent of the federal law. There may be additional restrictions based on state law. In my opinion, our ethical responsibilities to patient privacy go somewhat farther than the law does.

feel free to email me if you like. fiznat _at_ gmail.com

I thought it was amusing. Whats the problem here?