stcommodore

Obviously a solution that only worked on papar...

I've seen a mandation system at the service I did my paramedic time at and probaby only saw one or two people ever get 'mandated.' Usually someone picked up the shift or someone on that night took the day to be off for the next shift. But clearly the goverment can find ways (good or bad) to pay for and expand Emergency Services when needed.

I'll repeat a previous comment about 'if nobody did it for free...' Those are the situations where volly FD/EMS systems collapse and the goverment steps in and finds a way to then pay for the service. I would rather we not have to reach the 'bad event' that makes the public realize a need for change and adapt to the changing tides instead.

Townships, Boro's, etc find a way to pay for a Police Department, Trash Service, and Utilities right? Then as part of the drive for a professional image why should we be viewed as anything less? Granted not every service is run by the goverment and most recieve tax money from the local they serve this is a larger argument then just the sides we are presenting.

-Just playing devil's advocate

I volly as an EMT-B and a firefighter and really sit in the middle of the issue. It's very clear that if the powers that be can find people to do the job for free why would they go and pay people for it? So in a larger picture having a group (often the majority) that does it for free will in turn drag down the pay for those who are paid for the profession.

I in no way want to compare the skill levels, training or dedication of volly vs. paid but focus more on the advancement of the profession. Are departments becomming paid because vollies left and the system came close to or collapsed? I hope not, I hope that goverments or whatever body reconized the need to have a dedicated service and moved to creating combonation or paid services.

I was able to read it fine, don't let the grammer gods get you. I know a medic that has a theory that rural type roads create alot worse accidents then others, so wouldn't be surprised if that holds true in overall rual systems. But like everyone said find someone to take over (if possible) otherwise realize what it is and get past it. While I didn't have it for my test there is a very common registry scinereo for the a station where there is a graphic injury, but that injury isn't a life threat and it often distracts people from the actual assessment and treamtment.

I don't know if I would go that far but it does have alot to do with lobbist and political support. One of the biggest problems with US EMS is that we don't speak up and educate the public about what we do. We allow the media to create a pseudo-image of EMS and then complain when we don't like it.

tired responce fire department....2-3 FF's in a minipumper that cover 80% of calls and fully staffed Engine, Ladder, Rescue Co's further spread out to respond to actual emergencies.

11/12, need to retest 'supine spine board'...of all the stations!

Wow, 950mi round trip from the Philly area and back. My friend and I spent more time driving back and forth then actual time in Concord for the exam. The fire acadamy, lodging and entire staff was great just waiting now for test results. I think I messed up one station but if thats it 11/12 isn't terrible.

My view on 'calling for a medic'

Recently was doing a stand by on a BLS unit at a football game. We get flagged to 'a sick person in the stands.' Arrive half way up the home stands to find a 80's yr old male, pale, vomiting and calmmy. Without even taking a blood pressure, my hand was on the radio calling for a medic. As the call progresses and we extricate him from the stands and to the ambulance after an assessment, 02, Hx from the wife by the time we were loaded the medic arrived and was able to get on the unit and go.

If the medic hadn't arrived or was futher away I wasn't going to wait. Just like a medic shouldn't way for the helicopter on the scene with a loaded patient.

If your closest ALS is the hospital, go and if they catch you great.

If your patient is sick, go and if they catch you even better.

As was said before the University/College base model of Paramedic education needs to be the future. Where the middle ground is gone and paramedics recieve the medical model of education and treat job like the profession they want it to be thought of.

What study books did you guy find the most helpful? Were the wording of the questions similar to the books?

I think the patient just ALS'ed himself..."I was going to turf this cal until the guy ate the back of the unit" is probaby what the medic is thinking at that point...

thats really really wild

Thats really what I'm going for...I haven't been in this type of situation but doubt I would have done much different. How many of us would be able to act with enough sense to secure a scene with an active shooter? How many of us would be able to be smart enough to exit the bus and find better coverage? I hope most of us...How many of us as paramedic students have been in active shooter calls? Hopefully not many, but dare I say this guy got a hell of a shift that day.

Sounds like alot is missing in the story, 3 failed attempts with big/ez-io sounds impossible.

I think the crew did a great job in making sure that no bystanders were injured during the shooting. I think the crew did what they thought was necessary at the time they were at the MVC. The patient from the two lines we know about them sounded rather stable and at no time was ever left alone. I doubt half of you know what it is like to opperate in urban EMS service where this type of thing happens so simply on that have no right to comment. We all make choices on the information we have at that moment and they did, lives were saved by the actions of this crew and no they should not be fired.

Are you ALS or BLS? If your speaking at a BLS level and are sitting 3-5min from an ED and the ED is the closest ALS then thats fine. But if your ALS and decided not to fix something you could have on scene, then thats simply crap.

Back on topic....Do we know how busy the ED was at the hospital at the time? I've been at the ED many of times where there are really no beds and to be putting patients in the hall is overstretching the nurses and staff and is just a damn bad idea. If there really was no room for this patient, then until she presented as critical they probaby were doing the right thing.

On the 911/EMTALA/EMS end...No EMS should have been sent to the ED, nor should it ever. Plenty of calls for EMS could and in places do not recieve an ambulance. Other places have EMS, and EMS deems that no transport is needed and refuse calls. In the future its not hard to see EMS also going, treating and not transporting minor cases. Thesse situations are the future of EMS. EMTALA states that a patient presenting to the ED in the way this patient did would create a violation for EMS to take her to another facility. To step out of the ED and stand outside to be transported is just as bad. If your really well enough to call, stand outside and get on another ambulance then your not sick enough.

911 is the biggest social experiment by the goverment to ever work. People call because they get bad service at taco bell, because there is a scary black man wandering around in the burbs, or because they need someone to cook them dinner. All for plenty of reasons that emergency serives should not be activated But america is generally dumb and any attempt so far to educate them when not to call really doesn't work.

I don't know if it was said but a featured study by JEMS showed no difference in intubation with Etomidate vs. Versed.

20 intubations?

I saw the glide scope at JEMS and thought it was a cool toy and this was a great video.

as a precepting medic student he can....

Not at all...Everyone understands the laws but the situations we end up in often fall outside both natural laws, understanding any everything under the sun. Also, there are plenty of angles to spin this on, have you been through a shift and every call ran the exact same? All things being equal here I think people are using situations where they wanted to do more for the benifit of the patient. Many times like I said they weigh the "ends vs means" in there head and choose to act or not. So just like in that disaster situation with all bets off and logic be damned you tell me what you would do with an 747 into a 15 story highrise?

(please note i have a flare for playing devils advocate)

The college holds a graduation for thos of us who will finish with an associates, and the program(hospital) holds a small event as well.

Let's just put it this way then. Somethings happen in the back of an ambulance that are not totally "legal". Sometimes paramedic students acting as EMT-B's can "assist" simply on knowing what is going on, what is and will be needed and by that do things from 12 lead placement to "other things" in the back of an ambulance. Issue then is if the crew opperates this way are they willing to live with the consequences of there actions? Situations happen from time to tim where we make that call and we are left to live with it good or bad.

Here is a spin...

You are a medic student riding with your school's/services preceptor and respond to a mass casuality event. You are seperated from your preceptor for whatever reason and need to treat a patient you have ALS. Do you do it, or consider yourself a basic again since you are without your preceptor?

...We can say in a disaster all bets are off but beyond that what would you do?

screw all the debate...would 5mg of morphine really do crap for this patient anyway?