GAmedic1506

No, just a simple question. Unfortunately many people assume that if you question something, that you are attacking them or their position. I have not attacked, unless i have been attacked. I think i have gone out of my way to allow people to say their piece, even when i disagree with them. But if you would prefer that I only ask simple questions that never cause any concern or thought, I will: What kind of wax do you guys use on your ambulance -- there is that safe enough ?

sounds like we touched a nerve -- if any of that is true, why do you still work there ? I would leave the industry before i would work for someone that is unethical.

Wonderful job PRPG, we need more leaders who will take the bull by the horns. LEADERSHIP IS ACTION, NOT TITLE --anyone can choose to be a leader.

AZCEP you are better than that, or atleast your post lead me to believe you are better than that. You have been in this long enough that you should be a leader at your workplace, even if you dont have the title (Leadership is about action, not title). And if that is not the case, you are obviously a leader on this site, and I am sure many of these rookies in here highly regard your opinion. Dont take the easy way out.

We are about to order our second, and have had good luck with the first. We have 25,000 miles on the first set of brakes and still have lots of life left in them. No transmission problems. Any one else tried one ?

Dont discount the opportunity you have on those long non-emergent transports. Those elderly patients can teach you alot, if you want to learn. I would recommend putting a Physican's Desk Reference (for prescription drugs) or other similar reference material on your truck. While you are riding, study that patient's chart, when you see a medical condition, prescription drug, or term that you do not know about, make a note and make sure you learn everything you can about that topic over the next week. Also note the overall appearance of the patient, in relation to whatever ailment they have been diagnosed with. Are there subtle differences ? Are their vital signs unusual ? Can you attribute that to a condition or medication ? If you are only a handful of calls into your career, i imagine you have a thousand questions -- email me anytime.

Sorry to hear that you have to go through the State for your medical protocols instead of your Medical Director, but none-the-less, I am sure there is something at your service that needs improvement. I didnt demand, I challenged ! You may turn the other cheek if you wish, but my hope is that you will return the slap with another slap (an accomplishment at your service). I will purchase some non-latex gloves for the sensitive ones in the group. This exercise will weed-out the whiners from the dedicated professionals. Whiners will give a million excuses, and all kinds of history about why they can't or haven't caused change at their workplace. The professionals will roll-up their sleeves and fix something. You are obviously a professional since you have risen to the challenge. "It had long since come to my attention that people of accomplishment rarely sat back and let things happen to them. They went out and happened to things." -- Elinor Smith

I posted a thread that asked what have you improved at your service ? After 100 views, there were only a handful of respondents who could cite any improvement. We are always quick to point fingers at everyone else in the world, when it comes to the failures in our industry, but in this area, we have only ourselves to blame. Therefore, I proclaim this challenge to each of you: [/font:eb9f1e0871] Between now and August 31st, I challenge you to accomplish ONE improvement at your service. Please inform of us of your success, through this thread. I do not care if you just retype the daily checklist so that it is more legible -- Do Something ! Test some equipment, revamp a protocol, clean that green crap out of the refrigerator, replace that "Bambi Does Dallas" porn video with a real Bambi video --- ANYTHING -- just make ONE Improvement. [/font:eb9f1e0871] Those who fail to accept this challenge, may no longer gripe about your service on this site.

You phrased your question as just being able to assess respirations while in back of the unit, not towards assessing respirations to make a treatment decision/diagnosis (yes i said diagnosis -- gasp). This is where you need to go a little old school. There was a time not to long ago when we didnt have pulse-oximetry, capnography, or fancy magnified stethoscopes. The question that you really need to answer is, "Is my patient in Respiratory distress or not ?" You should be able to determine this without any of the aforementioned equipment. If they are in distress, treat the symptoms. You should have done a good primary assessment before you took off, and you should be able to tell if the patient that is in distress is improving or worsening without hearing a single lung-sound. I am in no way saying you shouldnt use technology, or shouldnt reassess your patients frequently, but you should be able to make that assessment without expensive equipment. The use of accessory muscles, the presence of retracting / nasal flaring, and the patient's LOC are far more useful assessment tools than trying to figure out if that is a wheeze or a rhonchi in the lower left lobe of a 300lb patient.

Well unfortunately I have to agree with the above posts. But I still have faith that some smaller improvements have been made, maybe folks are just scared to admit their contribution because the feel it is too minimal. Obvioulsy, any step forward is a good one, so come on and brag about your service. Surely some of you have a community AED program, or you can brag that youve taught "x" number of citizens CPR. Maybe you used Homeland Security grants to make your community more prepared for a disaster. Maybe you changed your orientation/training process. Maybe you bought bigger/better equipment. Dont by shy, lets hightlight a positive, and spark ideas among other services.

Want to know what your stage-name would be if you became a stripper ? Your first name is the name of your very first pet, and your last name is your mother's maiden last name. What is your stripper name:

Come on guys and gals, 19 views and no one has made any improvements -- i find that hard to believe, dont be shy.

Fentanyl is a great drug for EMS pain management due to its short react time and short duration. They do not arrive at the ER unconscious -- but there pain is well managed during the 10-30 minutes you have them. I believe Nitrous to be the best, but the delivery system is expensive (compared to narcotics).

Sorry didnt notice you were an air-service. Check with Loyds of London Insurance Company. They are a large broke for finding air-med services for travelors that get sick or injured overseas --- I would send a roladex card to every hospital and rehab center in resort towns. Is your service in an area that desperately needs flight service, or is already covered up with it ? You might need to find a new base camp. But as stated earlier -- relationships equal business -- get out there and introduce yourself (in person) to as many people as you can.

We give Toradol for muscular pain, Fentanyl for fractures, Versed for sedation, and Morphine for mac-daddy pain (MI or Burns)

Contact AMR in Atlanta GA -- 770-428-8911. They put up a bariatric ambulance last year, complete with wench and heavy duty stretcher.

It occurs to me that the vast majority of improvements that have occured in our industry over the past 20 years have been technological or pharmacological, not necessarily by the hands of those who work in the profession. With that being said, I bet many of you have made major improvements to your service, even if it didnt impact your region or country. Could you please take a minute to list some of the great accomplishments of your service. My hope is that the good ideas may be circulated to other services, so that the improvements can reach more patients. So, what have you done to improve EMS ?

I was wondering how most of your services deal with those employees who have been found to have addiction problems. I am not talking about the ones who come forward and ask for help, I am talking about the ones who either come to work intoxicated, or have been caught with a hand in the cookie jar. Most services that I have been affiliated with have let these employees resign, instead of being terminated (although they would terminate if they dont resign), because it is easier to deal with legally. But then, most do not report this problem to the State or governing EMS body, so these people just find jobs at services that dont drug test, or they clean their act up long enough to get through the drug test of the next employer. 1. How does your state/ territory/employer handle this issue ? 2. What are your personal feelings on the issue, should they be reported and have their license revoked, or do you recommend another punishment ? 3. If you are for revocation, how long do you suggest it be revoked ? 4. Would your service hire someone who has successfully completed rehab, or are they tainted forever ?

In my state, the State is responsible for State Prisoners. Local and County jurisdictions are supposed to be responsible for their prisoners, but they routinely discharge them at the time of illness, so that they patient is responsible. Then have them return to serve the remainder of their sentence.

So does this mean patients abuse you more because it is cheap, or does it mean they dont have to call as much since their healthcare is free and they can go to the doctor instead of the ER ?

Thank you METRO39 -- I have taken quite a beating over this subject, and was shocked that people saw this as such a foreign concept.

Yes that does seem low, compared to the US. I wonder if due to Socialized Medicine, the Canadians may not abuse EMS and the ER for routine low-acuity medical problems as much as they do in the US ? Or if ambulance is covered by socialized medicine, is the expectation that the ambulance is supposed to transport everything. Can you comment as to what % of your calls are "ambulance was really necessary", they couldnt have went by other means ? Or could you comment on the differences that socialized medicine (sorry if i am calling it the wrong name) makes to EMS.

In a capitalist society, supply and demand determine wages. Most EMT-Is in Georgia start in the high 20s to low 30s, which is equivalent to what most people with four-year degrees start at.

Boy you guys jump to the wildest conclusions. Our department has yearly legal updates where lawyers discuss a variety of topics, so yes, I use the opportunity to pick their brains when they are here. I do not have a hidden agenda, I do not have an ax to grind, I love the EMS industry and my job, and I have been married to my wife for 20 years so I am not living the gay lifestyle to well -- although I realize that if I did turn gay, I might double my wardrobe, so who knows what the future holds. I am not any happier about this than you are, and I wish we didnt live in such a letigous society, but we do. And yes, I hate to tell you that if you are cursing at your partner, or calling him gay or ugly every day, you can be accused of creating a hostile work environment, if he ever tires of your comments. That is the problem with all of this, people say they are OK with whatever the behavior is, and then change their mind so that they can make the $$$$$. One of our local Fire Departments is currently settling a lawsuit secondary to the hazing rituals they put the rookie through - That case was same as what I warned about earlier. He was a sorry firefighter, they terminated him during his probationary period, and then suddenly he had been harassed. He didnt go through 1/10th the harassment I went through as a rookie, but the County lost the suit. Imagine having your hazing rituals as front-page and 6pm newscast headlines every day/night for a week. Dont blame me, I am just the messenger, hate the lawyers. And just because I have made you aware of the potential lawsuit, doesnt mean you have to change a thing in your station. Please feel free to watch porn, play grab-ass, insult your partners all you want. Just don't be shocked when your Chief comes to you and says this has to end.

Thanks for the percentage correction, yes that was a brain fart -- but anything over "1" is scary. As far as consistency, we did find some variances among staff, especially among diabetics. Some were telling the patient to use a sliding scale, some were telling them to recheck blood sugar every 30 minutes, every hour, every four hours -- some gave no instruction other than "let your doctor know what happened". Child with fever was also concerning in that this was the category where a patient was most often told they could see their personal physician versus going to the ER. Many medics felt it safe to assume that the patient had OM, but without the ability to look in the Ear, or run a CBC, or r/o pneumonia with a chest x-ray, we found that we needed to change this practice. About the statisics, in the south, for whatever reason, we tend to roll all no transports into the refusal category. I think we have a false sense of lawyer-proofing ourselves if everyone signs a refusal. I know of a few departments that have a "not needed" category for the minor stuff, but the vast majority have the patient sign a refusal. This might be why some are so confused over my 50% quote. Maybe I should have asked everyone to divide the total number of patients transported by the total number of calls, as it is obvious that we all categorzie the ones who were not transported differently. I seriously doubt that any 911 service is transporting 90-100% of patients seen, but maybe its different in Canada. Maybe we should start there: FOR YOUR SERVICE, WHAT PERCENTAGE OF 911 PATIENTS SEEN, ARE TRANSPORTED BY AMBULANCE TO THE ER ? If this formula doesnt work for you, what formula would you prefer to use, so that we are all comparing apples to apples ?