stcommodore

For those of you who have to stage, it will be interesting to see if the time comes when it is more cost effective to actually build proper stations for the Ambulances then it is to burn fuel from idling.

Thats probably the must uneducated thing you could say! Dynamic deployment is probably one of the most progressive means to respond to call volume and call location. Planning where you know the demand will be, covering large areas that are stripped of units with a unit in a central location and more are the best way to get care to a patient as quick as possible.

I typically spend about 30min checking the truck before a shift. That depends a lot on who was in the unit before me, did I work the shift before them, etc. Sometimes you put a little work into a unit and assuming your working with other good staff the truck should stay in shape for some time after that. If I'm working a 24, 36, etc on the same unit I'll only restock as the calls dictate. Typically after the truck check we'll wash it and get fuel if necessary.

Today I'm working a station I'm not typically at and is staff 4 nights a week but some volly staff when they decide to show up. So the career staff know to take a little extra time to make sure everything is where it should be.

I have a thing for a neat and minimally stocked IV tray so I have been known to spend a half hour on that alone on a bad day. I see no need for 5 22g's, 6 20g's, etc. We are not a very busy service and there is nothing worse then trying to pull an INT out of the tray and getting four other things all over the floor with it!

Like everything in EMS this is situation dependent but we should all be in the habit of checking the unit at the start of a tour, and teaching this habit to new providers.

I'm glad I don't leave anywhere near the departments like this! Plenty of the squads in southeast pa have slow days where you might get 1-3 calls, heck thats probaby the average for some departments but they are staffed. Long gone are the days of responding from home like some silly volly fire house.

For every person that says something about a fear of "hypoxic drive" in EMS there are then that says it shouldn't change your treatment. I got the "you have this copd'er on a nrb" face from the nurse but like I said he was in obvious distress and I had him for maybe 15min and not 2 hours.

Breath Sounds:I heard maybe a crackle in the right middle lobe, but nothing drastic or dramatic enough to want to dictate treatment over.

Needless to say the next sick respiratory call I had that shift got CPAP, etc. Maybe saying we learn from our mistakes is to harsh but we take away something from every call and patient and build on it for the next.

PT: 79 year old caucasian male

Hx:MI, COPD, HTN, CHF

Arrived to find the male perpherial cyanosis, resp distress, pt stated abdominal pain and diarrhea. FD on scene had the patient on NRB 15 LPM.

Put him on the liter and to the ambulance.

EKG-couldn't get a good tracing, looked sinus.

12 Lead-no luck with that either

SP02 99% B/G 134. 20g IV Right Hand.

Only other substantial physical findings:some crackles (nothing dramatic) in right lower lobe

Total transport time 10min, on scene 7min. Doc said he suspected Pneumonia, was going with Bipap when I left. Thinking through treatments after the only thing I could have done different was throw in a neb.

thoughts? comments? suggestions?

My ideal staffing if we are sticking to single tier response

P/P Units in high acuity/high volume areas

P/B Units in Lower Acuity/Lower volume areas

Also, guys we all go to school longer and learn more so we make the big calls to me it sounds like your all afraid to do it!

doesn't sound like this board is very pro-union. I don't know what they are striking over but if we can't stand together in this profession we are all screwed.

the paramedic shortage is a myth

LOL! So true. Of course, I say they can continue to call themselves ambulances, so long as they are staffed by at least two degreed paramedics at all times.

There we go. Just legislate that no vehicle with less than two degreed paramedics can be labelled as an ambulance, and that doing so is a federal felony offence. I'd settle for that. Every other profession protects their titles similarly. Why can't we?

we all know where you stand on this issue and staffing so get off your soap box and come up with something new

My preceptors were one of the two best mentors I'ver ever had.

In a county with over 25 parmamedic providers its not uncommon to see a medic work at 2-3 squads. Is that simply because they love to work and want something to do? Or is it that they need the 2-3 jobs to make a good wage? If this county had a unified system and paid its staff the 50-70,000 much of the rest of the working population made then you would get more medics, and alot more improvements.

I don't believe in such a thing as a paramedic shortage. I believe systems aren't set up to use the providers properly and services haven't moved into the future in the paramedics comming out of school.

I was given two in school, eventually had a third after one didn't work out and moved to another.

When I initally started preceptor A was nights and B was days so there platoon rotation worked well. By the end Preceptor A was back on rotating days/nights and Preceptor C switched platoons and ended up working oppsite of Preceptor A which made the end very intersting.

As I'm sure is normal our diverson policy says that during "Code Yellow" or "Code Red" status in the county that no diverson will be accepted.

"Code Yellow" is used due to weather conditions or any abnormal increase in volume and is a recommendation to squads to prepare to bring in more crews, as well as arrangments to staff the 4 county MCI units.

"Code Red" is used when the above or other large scale incident happens. The code status can be specific to North, Central, South or county wide. Additonal units should be staffed and squads should expect units to be relocated to cover the effected areas.

I've been working on the EMS responce to terrorism program on LMS and it makes you think what our local hospitals surge capiblities are. Also, do we have secondary areas that can be used to treat, relocate, manage a massive amount of patient influx. On top of that do we have a system in place for mass population and or mass patient relocation?

The hell with diverson, say due to weather related damage one of your hospitals must be evacuated have you thought at all the amount of resources it would take, where you would take people and how long it would take to do such a thing?

Good topic...

I've been trying to teach EMT students that your inital notification should be short as in within 30 seconds the RN taking the call should know what they need because anything longer they really don't listen to.

EX. Who you are, what you found, what you did, when you'll be there

Calls to Medical Command you should introduce who you are/cert level and be clear as to what you want, and also find out who they are.

Tell us about yourself

Where do you see yourself in 5 years

What are your short term/long term goals

What do you know about us

Why did you apply to our department

What would you do if you got in an argument with your partner

What would you do if your partner did X wrong and wouldn't report it

What are your strengths and weaknessess

Tell us about your best/worst call

Any questions for us...

This has pretty much been the norm in what I've seen in recent interviews

It's called EMTALA, they can't close the front door so they try and block the back. Until society and abuse of Emergency services changes or EMTALA changes then this is our reality.

County is divided into "North", "Central" and "South" clusters. " Each has three hospitals, execpt "South" who has four including two trauma centers. No more then 50% of hospitals in each cluster can be on divert, one trauma center is in "south" and "central". Divert is for I believe 2 hours with 2 hours off before you can divert again, if more then the 50% try and divert then everybody is "forced open." We also have 'trauma only' which is what the busier trauma center(s) end up doing around the end of day shift when we hit them with 2-3 traumas to add to there day long back up.

I think this thread goes back to my "what do you bring into a call" thread. I did my paramedic field time in the area that the orignal poster is working in. They had an "A Box" and a "B Box" and for the clearly BS calls you would carry in your oxygen and the small box but for everything ALS you would bring the larger. Then for long and deep runs you take everything, the same applies for medics that ride calls in on BLS units.

I don't run 20 calls a day, heck I'd love to run half that so I can't put myself in that place. But regardless of the system I hope we do the right thing for the patient.

Then tell me how you define or provide a text source that defines SSM.

What a load of shyte.

The "ideal" way to handle any call volume takes all effects into consideration and weights the benefits against the drawbacks. SSM does not do that. There is nothing ideal about SSM. Just like every other method, it either ends up costing you too much or leaving you inadequately staffed. The only difference is it causes more problems for your agency in the long run than the other methods.

You don't seem to agree with anything! SSM by having more units on during noted busier times is taking things 'into consideration' and the benefit is covering your local, getting units to patients and sometimes like in all business you don't make money.

For the love of god the restaurant world uses SSM because it works.

Somebody said something here about a "negitive" skin test and chest xray, but from what I'm told once you have a positive test be it from an exposure (common in health care) or from active TB your not to have a skin test again because you'll always be positive.

System Status Mgt and Dynamic Deployment are not one and the same. SSM is the ideal way to handle peak time call volume, and a dynamic deployment a way to place units best for the call volume.

I think if we are going to take any aspect of EMS and use it in fire it would be tired deployment. Why do we need 4-5 staffed pumpers going to calls when 80% of calls are false? Two FF's on minipumpers can take care of resetting alarm systems and assisting EMS units.

Without reading the entire thread this is my view of it all...Suicide and mental illness is a very real issue in Emergency Services. It isn't a chapter in our text books and education for no reason, we need to watch ourselves and our co-workers for issues and look out for each other in the early phases of a problem. I would wonder the legality of termination in this type of situation because in many cases when a health provider is found to have a drug problem there are requirments that you seek help for the provider before termination.

On a more basic level I would hope that a "brotherhood" willing to look out for each other on the street would look out of each other back at the station.