croaker260

There is an awesome discussion on this topic on the NEMSMA google group...here are some highlights...I post them here because in many cases they say thoughts better than I could..... ANd here was my contribution to the discussion.... It was in reply to a comment that ETT as a gold standard and successful airway doest translate to a good airway for EMS...and the comment evolved from there...

Three comments: 1- We should really be titrating to a MAP , not systolic B/P 2- The "standard" is nothing more than consensus (read: he who argues longest or loudest, or is most stubborn ...wins) . 3- Differeng standards exist for general trauma and head Injury. Our guidelines verbally have been 80-90 for general trauma, 100-110 for CHI.

Well, I know we have not hired because of a driving record. As Gordan Graham says: "Past performance predicts future practice" If your reckless in your POV, why wouldnt you be in something you dont own. and if you wreck it, and you have a horrible record, even if it wasnt your fault, it looks very bad and enhances liability for the services end.

Airborn!

Well, about 3 years ago we purchased our own autoclave for our main station. Turn around on our blades is 1 day during the week, or the next buiseness day. Supervisors carry extra blades to restock units PRN, just like narcotics.

FInd the average cost of back injuries per employee, and the savings of a 50% reduction. Compare that to the cost of a power lift gurney AND a stairchair, preferably a tracked one. Theres your base argument. As a side note, identify some grants that may help as well. Thats our approach and we are planning to do a 100% replacemnt w/in 18 months if the grants work out. About 30 cots. We already have the stairchairs though.

Back on topic... I have two basic principles on these touchy subjects.... 1) As mentioned above, I document it objectively and specifically..slow or delayed speech, no eye contact, inability to relate person, place, or time, etc, just the same way I would if this was a patient I had never met before, or a child, and had no idea of their history. 2) If there is someone around who is familiar with the patient, then I include whether this mental status is a divination from their baseline (or is normal for them). Diagnosis of Developmental delay, mental retardation, cancer, OBS, or even PMS, go in the subjective portion of my document. AT most I will add a statement like : "..... consistent with the patients reported history of organic brain syndrome"

There is a difference between PUM and 3rd service. A PUM is a private with (heavy) government oversight and subsidy , like Sunstar, or MAST. A 3rd service is just an government run EMS thats not Fire Service, Law Enforcement , or hospital based.

Well Done my friend!

As silly as it sounds, "Grant writing for dummies" was an excellant investment for someone like me who knew nothing about grants. While the book is not EMS /Fire specific by anymeans, it has enough insider information on how to avoid common mistakes, it has helped a lot as a starting point. Of course from there, there is much to do and learn still....but its a great starting point.

Slightly off topic, but I think even Dust and I will agree adding Stats to paramedic curricula is a GOOD thing. Wish I had it with my original paramedic course.

Quoted for cutting to the chase

Dr. Eisenberg, Copass, and Cobb are legends as well as visonaries. Too bad we cant get many of the EMS systems antionally to adopt the lessons they have learned on EMS system design.

Well, I get around, "hear things" , and I hear a fair ammount of good and not a lot of bad....so anectdotally and overall its probably a top 10% agency, and third service, but again it is still in North Carolina... Did you look at Wake County EMS (NC), another very good EMS system.

Dust, It was in reference to your views on EMT's. Not wanting to hijack a thread, and having just come off an inadvertant 48....Im heading to bed. Didnt think my 1 comment on dust would generate so much rukkus, and my other comments (wich were on topic) nothing....

Well, mostly off topic, but how many people place a collar in non-traumatic intubated patients for tube maintance (to prevent tube dislodgement). For us its "strongly encouraged".

1) Dust, you are an angry man.... 2) Re: Preperation- College classess like A/P, basic EKG, and math. An intro to pharmacology (if offered) is useful too for any medical coursework. Knocking these out before actual paramedic school wil lenable you to focus on mastering the coursework instead of stressing about the A/P, EKG, or pharm while your classmates are giving themselves HTN and GERD. 3) RE: DUI/Reckless Driving, etc... I am heavily involved in our hiring process and I would consider us a reputable agency. We are a govermental agency. We have hired people with a single incident, including a DUI before. But we have a minimum time frame from the county HR of 7 years, and realistically its more like 10 years. I feel its important to add that this is a case by case evaluation, and what is more inportant is patterns of behaviour. If you have one single (non-felony) incident (that doesnt involve exploitation of ill, injured, children, or elderly).....even a DUI..10 years ago....and nothing else...we would give you serious consideration. If however, you have a series of traffic infractions ,non-payment of citations, or speeding tickets, even if its been a few years, we would be far less likely (read: snowballs chance) to hire you because it shows a pattern of behavior and irresponsibility, even if as individual incidents they are far less severe than a DUI. As Gordan Graham says , past patterns predict future practice. As for your immediate future, you are in a bad way for employment, even though you may still be able to get your EMT cert. That said, you can always try the fire service....... BTW, I got my start in the Middle TN area...Cheatham, Robertson, Montgomery and Davidson counties.

Very old school, and only brought up with the "you would never believe what we used to do.....High dose Epi, rapid Bicarb, Isoprell, and percussion pacing, oh yes, rotating TQ's and Alcohol down the tube in CHF..." type of discussions, IMHO. Not saying it isnt a last distch tool, but your more likely to see it on ER, Emergency, or MASH than you are for real.

Any chance of one on the western half of the US?

Im heavily involved in our testing of new employees...PM me if you have specific questions I can answer. I do not anticipate a hiring test until Fall (Sept) at the earliest, but if you are interested at all, get your packet together now. I too am a father of two, and family wise this is great place to be.

Well, my first civilian gig as a paramedic involved 1 day with a supervisor, then the next shift I was running 911 calls with an EMT who got his card int he mail a week after I got my medic card in the mail! That was in 1995. Now...The service I run ( www.adaparamedics.org )with uses the Kaminsky model for FTEP. The following is off the top of my head Phase 1- Academy- currently 3 weeks orientation broken down as follows: -Administrative- 20 hours: P/P. H/R, etc -History of the Department 2 hours -Orientation to FTEP 1 hour -Customer Service 2 hours -Expectations of the Department (Taught by one of the Directors) 1 hour Field Operations -Communications- MDT/Radios about 8 hours -Mapping 30 hours with frequent reinforcement and reassessment and practical -CEVO II with driving course - Vehicle Orientation- 4 hours initially with 1 hour reinformcemnt every day of class Vehicle check out) - Dispatch Procedures 1 hour EMD overview with 4 hours with dispatch - 8 hour supervisor ride -Safelifting, using gurney, stair chair, etc -NIMS /ICS 100, 200, 700, 800 - Non clinical (as in daily operational) paperwork Clinical Operations: - SWO review, discussion, and testing 8-12 hours -12 leads w/ STEMI systems 8 hours -SSI training 2 hours and test -RSI/MAI lecture 2 hours -Clinical Day (practical day with sim lab, reinforcing what was covered) 8-10 hours - Charting/ePCR documentation (ESO solutions) Phase II 3-6 months with at least 3 different FTO's, training and evaluation using the "San Jose" model of evaluation Phase III 4 shifts, evaluation only, pass/fail Phase IV- cleared to "general population" but followed still by the education department and subject to review. Exit review with MD when done with total probation, about 1 year.

Speaking of Fire Departments.... Police: man had sex with teenage cousin Updated: Thursday, 28 May 2009, 9:17 AM EDT Published : Thursday, 28 May 2009, 8:50 AM EDT SARASOTA - A Sarasota man is facing charges of lewd and lascivious battery and incest after police say he had sex with his 15-year-old cousin. Police arrested Christopher Kilduff, 28, Wednesday night. According to the arrest affidavit, the victim said Kilduff offered her Oxycodone and marijuana, which she declined, and then he asked her to have sex with him. Arrest records show Kilduff, who listed his occupation as an [b]EMT with the Sarasota County Fire Department, is being held in the county jail in $10,000 bond. Sorry ...couldnt resist.

Far from it. Landing at scenes, with the variables, are one of the factors in increased accidents in Air Medical. Where I came from in Tennessee and also here in Idaho , Pilots prefer to land at pre-established landing zones. Locations they have plugged into the GPS, that have been inspected by a pilot in the past for grade/hazards/etc, and if they are used enough are well known to all. This is especially important in winter as snow drifts can obscure actual slope, fence lines, etc. Not as good as an improved and lighted landing pad, but nice anyway.

The Chassis is Medium Duty, thus the term. Heavby duty would be in the range of the 18 wheelers. Light duty are the E150-450 chassis Dont know where the 550 chassis falls.

Cant say I disagree at all.