becksdad

"BATCHES?...... WE DON'T NEED NO STEENKING BATCHES!!!" .... you probably have to be kind of old to remember that movie line. Apropos nonetheless.

Wow - I wish that I had seen this thread earlier! I don't know anything about Washington state, but can tell you of my experience in a hospital E.D. in Florida. First, you will not be stripped of your certification in this environment, although your scope of practice may be different than in the field. You will see and use many types of equipment and materials never seen out on the road. You will learn many techniques of wound care not seen in the pre-hospital environment. You may or may not be able to initiate peripheral I.V.'s, but you will certainly perform lots of phlebotomy. You will become proficient at Foley placement (no ones favorite, but sometimes a necessity). If you choose, you will be assessing lots of patients, communicating your findings and impressions, and assisting with interventions. You will work codes, but be limited to compressions and ventilation. You will be watched closely and double checked initially, until Docs and Nurses feel they can trust you. Do not percieve this negatively, because it is the same as you would be in the reverse situation. More importantly, it is not really about what you can and cannot do, but what you can learn. As stated earlier in the thread, you will have access to Nurses, Radiologists, Respiratory Therapists, Physicians, etc. You will not only be intimately involved with patient care, but have opportunity to observe, ask questions, discuss. Most practitioners are very willing to teach and help you. The free Continuing Education available in the hospital environment is plentiful and varied. After one year of employment, the hospital I work in provides full tuition reimbursment towards any discipline that attracts you. Earlier, I made a statement that began: "If you choose...". Like anything else, you will recieve from a hospital experience as much as you put in to it. An E.R. Tech can probably meet minimum requirements and keep their position by just stocking, cleaning, transporting, recording vital signs, and performing basic procedures that fall within the scope of practice. If you just want the paycheck, there are easier and more lucrative ways to do that. But if you are assertive, you will be able to practice alongside other medical providers and become a valuable team member. And learn a lot in the process. I truly love working the trucks, and have had loads of fun and learned a lot on the street. But I can say the same for my own hospital experience, too. So good luck to you! If you do go the hospital route, I hope it is a good experience for you, too.

It is amazing that the state of Maryland still views itself as a "leader" in EMS based on "advances" made about 35 years ago. If I hear one more time that Dr. Cowley is the "father" of shock trauma I think my head will explode, just like in Dustdevil's infamous picture! I've spent the majority of my life in Maryland, and love it like anyone loves "home". My Dad was a Medic in Baltimore City through the 60's and 70's, when all these advances were occuring. Actually, I think the highest certification then was Cardiac Rescue Technician. Take note that Maryland still utilizes this cert. Maryland has some of the richest counties in the nation, several large metropolitan areas, surrounds our nations Capitol - yet remains mostly volunteer, using archaic certifications, and touting its world-famous University of Maryland Shock-Trauma Center and its 35 year old history. The "kingdom" hasn't changed much there in a long, long time. Rather than leadership, it seems to me that Maryland is a glaring example of what is wrong in EMS today, holding the profession back from true advancement. I know - way off topic, but I had to get this rant out of my system. But all the best threads evolve, right? :wink:

Pressed for time right now as I need to get ready for work, but look in any EMS text for the Glasgow Coma Scale, which addresses the very questions you ask concerning responsiveness/neurological status. Most useful for trauma, as medical scenarios must consider other factors such as prior CVA, as described above.

Occular thrush!!! You guys are just TOO funny!!!! And here I thought what happens in Vegas stays in Vegas!!! .... I'll never believe that crap again!! Two things, Dwayne, my friend - I already forewarned the forum that you had threatened to make up outlandish stories about me; and as far as "Lovin' Spoonful" is concerned, remember, Beauty is in the eyes of the beer-holder! Thanks for the laugh - it WAS pretty funny!!!

Forgive the late entry here, folks, but becksdad has been on a bit of a hiatus, and DwayneEMT-B has threatened to spread vicious lies about me if I did not post something soon. . So just to clarify, I am not in jail (anymore), I haven't drastically changed my lifestyle, and the cult is now disbanded :wink: Anyway, I will echo what I see others saying here - most far more experienced and qualified than myself. Re-focus on what you want to present to a potential employer. I don't think anyone would be impressed with discussions of skills, "saves" (I'll leave that one alone), or anything else "dramatic". Besides, after you've done it a few times, CPR is one of the most undramatic things I can think of. If the prospective employer is worth working for, there will be some kind of testing or scenarios. That is the place to demonstrate knowledge/skills. The interview is the place to demonstrate who you are - qualities you possess that are desirable in the field of EMS. Look the interviewer in the eye. Be honest, be yourself. There will most likely be opportunities in the interview for discussion that will give clues as to your initiative, common sense, critical thinking, compassion, ethics, maturity, honesty, and humility. Communicating a desire to learn and experience more sends a powerful message. Because the truth is that there is far, far more that we don't know as opposed to what we do know. Finally, a little thing that I have noticed in different interviews over the years (both in and out of EMS). Instead of approaching the interview with the state of mind that I really need or want this job, and I must impress them, approach with the attitude of being interested in becoming a colleague. It changes the entire atmosphere of the encounter. You are both interested in each other then, and the discussion tends to flow easily, spontaneously. And then, the outcome of the interview becomes secondary to the encounter itself - each of you getting a "feel" for the other. Quite Zen, eh? Anyway, good luck to you in your endeavors. I hope you become associated with an employer worth working for.

Show off.

MedicNorth wrote: Your foam system is a keg of beer on a paint shaker. That would be alcohol abuse. A retneck would never abuse alcohol. Pretty funny though!!!

So shortly before I had a medical problem that took me off the road back in October, I was kicking this idea around in my head about a "mentoring" or field training program for new EMT's. The Dept. I worked for has an FTO program in place with the philosophy that FTO's aren't there to teach anyone how to be a Paramedic or an EMT, but to teach how to work within this particular system (i.e., specific SOP's, protocols, CAD programs, etc.). This may be OK for people with experience and demonstrated competency, but I think it short-changes people new to the field in several ways. While it is desirable to be competent at operating within specific guidelines and using specific equipment and programs, so many people are put on the road without a clue as to operating in the real world of running calls, dealing with scene safety, being patient advocates, supporting ALS partners in an effective manner, etc. In other words, being a professional, effective member of the team, with some basis set in place for success. I think you can teach what to do and what not to do, attitudes to adopt, pitfalls to avoid. I think it is possible to better prepare new people for being out on the road, alone with a Paramedic partner. And I think Paramedics would appreciate having a new partner who they could maybe count on more so than they can expect now from a new EMT. While I have not really developed a proposal fully, I do have some questions and doubts about such an idea. Is this even a realistic proposal? Given that Administrations are so budget conscious, what company or agency would be willing to make such an investment? Further, is such an idea even a good thing for EMS as a profession? Would this encourage a status quo mentality of maintaining minimal BLS/ALS response teams, or could it encourage enthusiasm and a desire to learn more from individuals coming out of EMT programs and ultimately lead to increasing professionalism and education of providers? And in the best of all possible worlds, could this increasing desire for knowledge and professionalism come from within individuals, leading to a higher level of commitment of providers rather than mandating requirements? I don't know. So I am asking you for your thoughts on this idea. The more I think about it, the more questions enter my mind. So do you think that this could be a realistic thing? Or is it a Utopian idea that will never work and ultimately be bad for the profession? Please let me know your thoughts. Whether you may think something like this could be good or bad, why? Thanks in advance to anyone who might have any input.

Dwayne, I guess it's not quite fair to call BS, then not define what you mean, But besides those already pointed out by others, there are other obvious holes in the story. For instance, stating doing assessment on scene, and then stating typing narrative enroute to hospital for the PCR. Of course assessments are done on scene. Starting with scene size-up, initial impression of patient, ABC's, secondary survey. But if you're typing on a computer in the back of the truck, you're quite literally abandoning your patient. Where's monitoring the patients condition - ongoing assessments, reassessments with every intervention. Even if it's just O2 administration? If you decide a patient needs O2, aren't you going to reassess that intervention, decide if it is adequate, what changes now present? If you are running an ALS call with I.V, fluids, drugs, cardiac monitoring, etc., etc., and your transport time averages 15 minutes - how the hell are you going to type up your narrative and then just print it at the hospital? Even if you had all that in place prior to transport, if you are focusing your attention on a computer, you have abandoned your patient. I would stay busy continually monitoring the condition of my patient and the effectiveness (or lack thereof) of interventions, and any complications that might arise. But maybe I'm just too slow. Beyond stating what has already been publicly printed, to call BS on anything else would just be mean-spirited, I think. I'm trying not to do that. I'm not mad when I cut my grass.

I have so much trouble not responding to posts that concern the area I live in. Specifically Lee County, Fl. Kind of for the same reason that when the grass gets too tall in your own yard, you cut it. BS, BS, BS, BS!!!!! I won't go into the rant I planned because I have neither the energy or inclination to do it.

Why didn't he need C-Spine precautions?

I want to thank everyone for their advice posted here, and in another thread that was active before I actually started work in the ER. It has all been helpful. It's been about 3 months now, and I can say that so far it has been a very good experience! I am coming to love what I do there as much as what I did on the street. It is certainly busier than on the truck in the sense of dealing with 20 patients at a time instead of one at a time. Anyway, folks have offered their thoughts on hospital work (both positive and negative), and I would like to offer some of my own observations, and maybe others can comment further. First, what some have presented as the down side. Cleaning beds, changing linens, placing Foleys, running labs, transporting patients, rectal temps, cleaning patients covered in feces or blood or vomit or dirt, swabbing noses and butts, or whatever else you might think of. Yep, Techs do it. But guess what? So do nurses. At least in the hospital where I work they do. It's too busy not to work as a team, and so far it is the extremely rare nurse who feels that any job is beneath them. If the charge nurse can empty trash, change linens and clean patients, so can I. Another thought on the "negative" stuff. I have found that the quickest way to be accepted as a valuable member of the team is when some patient comes in from an ALF covered in urine and feces, be the first one there to start cleaning them up, and assessing them as you're cleaning. I find if you do that consistently, there will be no lack of help to do it with you. They almost rush to help you out! Of course, that is just one example. I guess what I'm getting at is being ready to jump right in and do the stuff nobody likes to do, but everybody ends up having to do at some point. But for anybody new, be assured that this is not all that Techs do. We are involved in patient care and assessment also. All the stuff that's done on the trucks is done in the hospital. Vital signs, cardiac monitoring, histories, ongoing reassessments, blood draws, O2 administration, etc. Any Tech will have to prove themselves as competent in patient assessment and basic skills before Doc's and Nurses will really trust you, and this is where experience on the truck helped me so much. I decided quite awhile ago that since I am an EMT-B, and have very limited ability to initiate therapies in the field, I should concentrate on assessment skills and become as good and accurate as I can at this. After awhile of dealing with the same Docs and Nurses, if you're pretty good at assessments and communicating with other clinicians, they begin to trust your judgement. And the learning that's available! My God - it's everywhere! All the time! I get to ask questions of Physicians, Nurses, Respiratory Therapists, Radiologists, you name it. We have discussions about differential diagnoses, pharmacological mechanisms of drugs, contraindications, the list is endless! Sometimes I feel like a pest to the Docs, but I think they like it. They have always been willing to discuss in depth anything I ask about. You just have to pick the right time to try to discuss stuff. I've had the opportunity to sit and talk to a Radiologist during a head CT about the anatomy and physiology of the brain and observe abnormal pathology and how it presents radiologically. Docs have included me while discussing X-Ray interpretation. What more could anyone who considers themselves a student of medicine ask for? So now I have some funds together to start back to school, and then after a year of employment, the hospital will pay for the rest of my school tuition. Again, what more could anyone ask for? I figure to get the prerequisite stuff done, which seems to be similar for any medical discipline, and see which particular direction I want to go in. Already have some of the pre-req stuff that's needed for any degree, but need to brush up on math for sure. Then I think A&P would come next, and by then I will qualify for tuition coverage. From what I've seen so far in 3 short months, I think I agree with Dustdevil that RT's are the closest thing to what is most attractive about Emergency Medicine. Every patient they respond to actually needs medical attention, and they seem to be very educated and must meet very strict standards. But we'll see where it all leads. Anyway, I didn't really mean to take up so much space here. But I did want to offer some perspectives from an EMSer in a hospital atmosphere. Maybe someone can benefit from it, and hopefully others will post some other stuff that will be helpful to us all....

Imagine if Teddy was an airline pilot....

By my first name, I'm a MAD SCIENTIST!!!!!!!! MWUHAAAHAAA.........

Sled, I don't quite understand part of your last post. Even if you died right now, there's still oxygen in the blood. The other drugs mentioned don't depend on the presence of O2, but rather the action of circulation. Maybe its just being picky with semantics, but in cardiac arrest, we supply not only the oxygen, but the circulation, too. Anyway, no big deal. The original question about does O2 by itself save lives? I don't know.... but I think in certain circumstances (like whenever severe hypoxia exists), it is certainly a required first step for improvement in order to survive long enough for complete definitive treatment. So I think at the least it is often a neccessary piece of the puzzle.

I'm not sure of the off-label use, but judging from all the fish I fail to catch, they must be smarter than some people!

On the back of a package of plastic worms for bass fishing - "Not for Human Consumption"

Laura Anne - Nobody wants you to go away and not post again. Other threads that you have posted in demonstrate that you are intelligent, professional, thoughtful, with the best interests of EMS as a profession at heart. There are quite a few of us who have been argued with, ridiculed, beaten and eaten here at the City. We disagree, sometimes vehemently, with each other. For some reason, those of us within EMS seem to have cannabalistic tendencies. That is for each individual to examine and decide how far to take it or how much to control it. Nobody wants Shira to go away, either. Look, as with all the other degenerative arguments here, we got angry, we hurt some feelings, we offer some olive branches. Then we have a little fun, and just move past it. Fuggedabout it!!! EVERYBODY! K?

Jumbo shrimp. .....Just wanted to throw another one in.

Professional Firefighter/Paramedic.... oxymoron....Hahahaha!!

Yes, that's true occifer.... We were actually in Chappadiqui..... Chippaquadi..... *burp..., ahhhh,.... some li'l town.... I remember a bridge.....burp... and Michael was driving. Yeah, that's it... Michael was driving (burp)!

I'm with Dustdevil. It sounds like a good plan to start working in the field, get experience, and work on Paramedic education while still doing what you love to do. But the real logistics of that plan very often don't work. Let's say you do go into EMS now. You're out on your own, increasing your debt, and making a little less money to boot. But you love what you're doing, so it's no big deal to work some overtime shifts for the extra money you need. Now, where I have worked, shifts are 24 hrs, with 48 off between. Each O.T. shift means you work for 48 straight hours, with only 1 day off to catch up on sleep, do your laundry, run errands, anything else you might need to do. Of course, you can't do this pace all the time, but do it enough and it starts to take its toll. Maybe you'll have a wife and kids, maybe not. We all have family, friends, other obligations - a life. How are you going to schedule school at least 2 days a week, do all the clinicals and ride time required, too? Each ride time is another 24 hour commitment, clinical 12's, and you have to do a lot of them. See where it becomes an extremely difficult task? Now, let's look at staying with Mom & Dad. You've got a whole lot less debt, you continue to make enough income, your job is a regular 40 hour a week gig, and you've got plenty of leeway to make the commitment necessary to do well in school. In 2 years, you're now a Paramedic with a far more marketable set of skills and education, you will be in more demand than an EMT-B, and you'll make more money. Dust said it much more succintly than me..... a no-brainer. I'm all for independence, becoming your own person, paying your own way. But if you have the opportunity to set the odds in your favor for success, why not take advantage of that?

Now that's funny right there! I don't care who ya are! Right up there with hittin' on them purty plastic women they got in dee-partment stores!

You know, I've been thinking about a post I put in this thread yesterday, and I owe an apology. I can understand how Shira would take Laura Anne's post personally. And while I agree with the basic concepts behind Laura Anne's post, what I subsequently printed encouraged in a mean spirited manner the personal aspect of this. It is not about personal things. This thread is about professionalism, and for me to place a post that could be interpreted as personally vicious is just plain wrong. It was not professional of me, and for that, I apologize to all the members here. To Shira, I apologize for taking a thread meant to address professional issues, and turning the focus towards a more personal level. What I posted did nothing to promote professionalism within EMS, but ended up being the main catalyst for what could reasonably be termed character assassination. I hope you forgive that, and stick around on board here.