streetsmart

My service, which is an ambulance district (public - tax supported) has an age requirement of 25 (insurance company requirement), but several surrounding services accept 18 y/o who are licensed. These include public and private services.

The service I work for in Missouri requires all of us to pull 24 hours first out duty and 24 hours 2nd out duty (call) each week. For both shifts we are paid 18 hours minimum and the full 24 if we don't get 5 hours of uninterrupted sleep between midnight and 5:00 a.m (sleep time). We get the six additional hours on both shifts even if the phone rings whether we are actually called out or not. On our 2nd out day (call Shift) we have to be available within 15 minutes and only have to report in if the 1st out crew is called out. If you are fortunate enough to live in the town our base is located in, you can stay at home on your 2nd shift day. Actually it is a pretty nice work schedule.

I work for a small service in Missouri - we work 2 - 24 shifts per week. Even though it is a small service we average 2000+ calls a year, or just over 6 calls a day. Most of the time we end up working the majority of the 24 hours with very little sleep. So every time we get off we usually spend our first day off at home sleeping to recuperate. I thought everyone in EMS or that has been around it very long - knew that it is a low paying, thankless job! Isn't that part of the reason we love it!

AnatomyChick is 100% correct, the Missouri Unit of EMS is presently drafting the EMT-I scope of practice. Although there is presently not a requirement by the Missouri Unit of EMS, several colleges in Missouri are placing an emphasis on obtaining your AAS.

AHA ACLS Protocols are nationally accepted guidelines. However, ultimately you are under the control of your medical director. If he is suggesting giving a medication that is not consistent with those guidelines you have every right to question them to determine what rationale they are using to deviate from the accepted standard. Calcium choride is used to treat hyperkalemia, one of the frequent causes of PEA, in addition to treating hypocalcemia and calcium channel blocker toxicity. Unless it's a total act of negligence in following your medical director's standing or voice orders, that's the stance I would take. Your medical director is responsible for reviewing any of their standing orders and making changes as necessary, usually on an annual basis. It will always be a question of how, when or what we can be sued for. Did we administer Atropine exactly 5 minutes after the first dose or was it 5 minutes and 10 seconds, either way this is not negligence. If we administered 5 mg of Atropine however it would probably be considered negligence since it is 5 times or more the appropriate dose. If you didn't have standing orders and had to use the radio to get an order for epinephrine in VF and your medical director denied the order where do you stand? Do you give it anyway since it is an accepted guideline or do you follow medical direction? Of course you follow medical direction and chart appropriately.