Niftymedi911

LOL, sorry I got kinda off topic. The FD's here are trying to take our jobs..... our professions, our bread and butter away from us here...... I just have strong feelings bout that. I get kind of heated when I hear a FF trying to claim EMS is their thing..... when really it's not. We've been providing EMS for the county since 1972 and for the FD's to think they could "take over" as one fire chief put it, they're dead wrong.

I didn't mean to offend you or get you upset.

Welcome to the City!!!!

there they go making a case to justify their exsistance............ firemonkeys UNITE!!!!!!!

You guys put yourselves out of business with fire prevention and the like, don't you think you could of done it at a modest pace, so as still things could stay moderately busy? Pd/FD/EMS are all necessary services, but it doesn't mean, you should have a police officer/firefighter/paramedic on scene to work the crime scene, dose the little fire the perp started and give the mom some nitrous to make it all feel better? If your gonna try to take a position, why not take all of them...... of course your not out of convience. You don't want to be running all those you hit me and I want to sue BS..........

Do youself a favor, sit back in your lazy boy, ejnoy your nice salary, and SHUT UP!!!!!

I had just mentioned it, I didn't want to give someone something without consdiering Pro's and Con's.... that's why I picked that article.

I for one don't undertstand why we need them...... If we practice and hone our assessment skills like the article said, there would be no need for the Istat.

VentMedic- I was simply refering to the whole, hyperkalemia thing, I undertsand why and what but, I was just clearly trying to show, CB that it isn't just that, hyperactue T waves are definately a ominious sign, and warrant a 12 lead, I was just trying to show that it anit just the "save all attitude".

What you probably do not know, is Southwest Regional now owned by LHMS, will be shut down permantly once the new Gulf Coast hospital re-opens. And it is by far streamlined. The healthcare system here sucks a$$. Hell, even with our trauma center here, they still ship aortic trauma down to HealthPark, because they have no cardiovascular surgery at the trauma center. The system will be implementing the whole specialty care hospital BS once GCH opens, it will go something like this LMH- general medical, CCH- General, limited cardio/neuro capabilities GCH- All Trauma (Level 2 trauma center)/ Cardiology, Regional Women and Children Health center, Neurology (Stroke Center) HPK- Pediatrics PICU, Neonatal ICU, Cardiology, OB. And it will be nothing but transfer city. Why can't they get their head out of their a$$ and have everything at every hospital?? It makes sense but of course down here common sense isn't just that.

The project isn't going to get off the ground, and we have bigger fish to fry, like keeping the privates out of our county. Apparently AMR just went to county comission to bid on interfacility transfers in Lee County. Well, needless to say as of right now, it got shot down because we just ( As of 12/2007) implemented our very own transfer divison. We now have 2 ALS/ 2 BLS interfacility transfer trucks to supplement the ALS 9-1-1 response. Now, no more 9-1-1 trucks will be running transfers unless it's a type I (priority 1 L&S) transfer. Type II and III's will be handled by the divison. We now offically have a total of 39 trucks, 4 transfer trucks (Medic 34/35 BLS)(Medic 38/39 ALS) and 36 9-1-1 response units. 5; 12 hour and 29; 24 hr trucks.

To be honest, majority of our funds are actually from operational fees. Yes, our budget does come from the county in taxes, but we collect to offset that and last year in 2006 our re-coup rate for services rendered were close to 62%. Total budget for EMS was 22 million, we re-couped 14 million of that 22. This year, we're already at 18 million in re-coup. So techincally, we're acting and functioning like a private, but we're 3rd service.

http://www.segway.com/downloads/pdfs/Case_...ChicagoFire.pdf

Chicago FD/divison of EMS utilizes these for downtown response in congested areas as well as during crowded events and the like.........

Our agency was trying to get a set of these for a team to respond at our Major airport RSW. SouthWest International Airport. The idea was to have an ALS segway crew respond as first responders on calls and can advise if a transport truck woudl be needed. There are numeorus BLS calls everyday that are cancelled because RSW calls for stupid crap. Lac to finger, pedi vs. vehicle at .5 mph, I just want my blood pressure checked, burn in lap from coffee during flight, eyc. the list goes on and on. There have been 13 calls that have required ALS intervention since they opened the new terminal 3 years ago. Not very much really is worth sending a transport unit. Our County Commissioner's were on board, but because the Chief of Crash Fire/Rescue didn't like the idea, because they would be able to not justify they're budget and response, they decided against it. So now for every call Medic 25 gets sent wether its a cut finger or public assitance. BS!!!!!!!

The Dammned fire departments need to realize they have no business in EMS. You guys play with hoses and want to run into burning buidlings thats fine, but DO NOT tell me that EMS belongs with FD and I need to be fire certified, I will kick your ass.

Hyperkalemic? Absolutely, run that 12-lead with no pulse, let me know how it turns out. Or are we not just drawing labs now, but running the tests too?

Yes, CB we are doing tests, keep up with the times,..... Read this article on point of care testing for EMS:

http://www.jems.com/news_and_articles/colu...re_Testing.html

My agency is doing a six sigma project on wether we should invest in starting the point of care blood testing for our patients. With our hospital system (6 hospitals) within the next 3 years are cutting the duplication of servcies out and creating specialty hospitals, this would make sense.

BTW, you don't need to do a 12 lead on someone on diaylsis, they often have tall actue T waves in any lead if you hook em up.

As I thought, the "Paramedics Fix Everything" attitude wasn't far behind.

I'm glad your learning, we do try to fix everything, tell me exactly what you can identify as an EMT in the field and treat besides pain ( even then it's up to the medic for Morphine or Phentanyl) and trauma.

Hyperkalemic? Absolutely, run that 12-lead with no pulse, let me know how it turns out. Or are we not just drawing labs now, but running the tests too?

Yes, CB we are doing tests, keep up with the times,..... Read this article on point of care testing for EMS:

http://www.jems.com/news_and_articles/colu...re_Testing.html

My agency is doing a six sigma project on wether we should invest in starting the point of care blood testing for our patients. With our hospital system (6 hospitals) within the next 3 years are cutting the duplication of servcies out and creating specialty hospitals, this would make sense.

BTW, you don't need to do a 12 lead on someone on diaylsis, they often have tall actue T waves in any lead if you hook em up.

ok, so what as an EMT can you do for a dialysis patient who "Codes" on you?

By your reasoning, they actually should be transported by 2 Paramedics who can actually do something more than bag the patient and perform CPR.

Ruff,

You forgot to mention they could taze the Bro to with an AED.

There anit nothing like walking to a food fight with a shotgun.

And as far as the duel medic response, it is so true. The only way it could actually have a good outcome between an EMT and Medic working a code, is if the EMT is a little more advanced, but still cert at the EMT-B level. Reference: The agency I work for has a lot of training that would ordinarly be reserved for medics. Example: EMT's here can take a 10 hour course and work with an FTO for a shift to get 10 live sticks before our Medical dir. will allow the EMT to be IV certified. Another is the King tube is our friend. That is the definitive airway for cardiac arrests in Lee County, simple, fast, effective. Loop, swoop, and pull. The good thing about our county is that 17 of the 22 FD's in Lee county are ALS non-transport. So BTT we get there, they normally have CPR, Rhythm interpretation, and airway implementation (not in that order hopefully) in place. If it's just us, the EMT is in charge of CPR, IV's, monitor and pad placement, Fluid administration, prepare drugs for Medic (pull out syringes etc). No rugs in a code many one has certain jobs assinged but with my experience since our trucks are EMT/Medic, that is the general norm for a code. Not saying there are variations which of course there are.

Anyone thirsty?? Want some koolaid???

A couple ring to mind:

We were status Red (less then 25% of our fleet available) and our MDC's were down due to a CAD failure so everything was verbal. We had one dispatcher for 33 units on duty. It was crazy, everyone was talking over everyone else.

Medic XX: "Control, Medic XX 10-51 (enroute) DXX (one of the hospitals in Lee County, all the hospitals are in Delta codes.) ready to copy"

Control: "...... shut up".

Medic XX: "10-4, Do you want me to rub your feet too?"

I saw some paper on that.

@!@!@!@!@!!@!@!@!@!@!@!@!@!@!@!@!@!@!@!@!@!@!@@!!@!@!@!@!@@!@!!@!@!@

Control: "Medic X, Rescue X respond possible signal 4 (MVC) XXX & XXX, response on tac-3, XXXX hrs."

Control: "Medic X, Rescue X, off-duty ff advising one possible pin in, one ejaculation, MedStar on stand-by (laughing heard thorughout the channel).

You are the only ambulance in a rural area of about 1500 square miles.

You get a call of a man who has fallen over 200 feet down a cliff and hill.

The scene is supposedly 4 miles into rough terrain and it's 11pm at night

There is one person who meets you where he called you which is a convenience store about 4 miles from the scene but this person does not remember how he got to the store due to alcohol being involved.

What do you do?

I'll check back on this later today, I've got shopping to do with my wife (OH JOY)

Tell dispatch to clear the unit unable to locate, have FD advise EMS if the person has been located. Being the only unit within 1500 miles, you can't just go find a needle in a hay stack if you got someone else with chest pain, (a situation where treatment can have a good outcome). And if FD is able to locate some drunk and he is still alive, I would want to be his best friend.

Once in 3 yrs here. Had a Critcial Care transfer a AAA that was on the verge of exenguenating. Both helos were busy so we had SO block and leap frog the whole way for 20 min.

TO be honest, I don't really give a flying leap how long it takes because I will never go that far, I was just guesstimating on the subject. Using the issue as an example, is one year when using it as an example a big difference??

The matter is they must maintain, educate, train, for however many more years then basics do. That was the point I was tyring to make.

So if you were just to dumb to see that fact and just try to pick apart my post to make yourself feel better, then be my guess, it's just too funny.

I thought you might like that.

I just take offense at your tendency to dismiss the lot of us basics as people who seemingly by definition, are idiots because their are barely nonexistent educational requirements to begin working as an EMT.

It's a generalization, yes. But think outside the bubble. There are roughly 410,000 EMT'S and paramedic's that are certified in America. You take that average further. In FL, there are roughly 25,000 licensed EMT's and Paramedics. That state mandated EMT-B course is a basic 3 month course. Yes, they train you, yes they show you. But think if it takes 7 years for a Med student just to reach residency and hopefully complete to get his doctorate, don't you think EMT's and Medic's, who operate like a "doc in a box" should have more then a 3 month course on how to wrap or splint an injury and give oxygen? Now, there are exceptions to everything and there is no exception here, just as you I took all of my pre req's for medic school while I went to EMT school, so I'm finishing my degree as we speak with my core medic classes. I didn't want to go into EMS with just basic knowledge and try to save the world. And it's those people who just get the course to wear a patch and think they're cool and not take EMS seriously. They'll be burnt out in 5 years and then have a mid-life crisis and then drop out and find something else to do. Don't blame Dust, because you always have 3 fingers pointing back when you point at someone. The people we should be blaming is oursleves because we all get that way when we start. It is just matter of when they decide to grow out of it and become a great provider. And it's those who don't grow up and realize, that Dust is generalizing about. And 99.9% of the time the only classification you normally find that in is EMT-B. Medics are usually headstrong, mature, and understand it's not just lights and sirens with shiny badges. Because they put forth the effort to understand and educate themselves, so when a lady drops in a near syncopal episode and after ABC's do a 12 lead to show elevation in II,III, AvF, they know exactly what to do, what's causing the problem, how can we fix the problem and minimize damage to the myocardium for this patient. If you don't have the knowledge to understand that 90% of the time syncopal episodes are either pump or volume related problems. Then you would be bringing a patient to the ED, who will have ultimately not the same quality of life before hand.

The reason we haul a-holes with minor emergencies from the ghetto and the trailer park is because we gets paid when we do.

Did you forget to mention if we don't transport they'll call back 20 min later saying the same thing.

:dontknow: here's what the NET's do when they actually get an emergent patient or they get the "light up" feeling. :headbang:

Dust, I'm in awe you slimply put everything into one single post.

We're being introduced to King tubes during our monthly inservice this week. Hope si to have them on the road for use by Dec 15. By the looks of it, way much easier. As soon as I learn more tomorrow I'll let y'all know.

I never "light up." The only two vehicles in my agency with lights and sirens are command vehicles. Im on call 24/7/365 with a pager waiting to grab my ruck sack and get on a C-130 waiting for an explosion or a hurricane. We have no ambulances since we dont tranport 911 or non-911 and on the rare occasions we do its with someone else's rig...like one of the Nat'l Guards. Im an NREMT, but since all of the above is true, does that mean we arent EMS? We have all the same toys and do the same procedures (except more advanced than most Critical Care teams). Is this the new Im a paramedic and youre a stupid EMT my schmeckle is bigger than your schmeckle argument? I vote with Dust on this one. The DOPH in most of the states I know of say those NET EMTs are licensed by the same EMS division as the trauma chasers. A general big old -25 for even having this conversation.

Whoa whoa whoa wait a minute. Who even mentioned stupid EMT vs. Paramedic in this post??? Obviously sir, you have some undealt with anger. No one even mentioned or even hinted at the whole paramedic vs. EMT arguement. This was based solely on whether or not we believe the NET's are a part of EMS.

Even going back further to a different topic, Dust said that all transfers should be completely eliminated from the EMS role. Which I agree wholeheartedly with. That would be the only way to get EMS from the dark ages.

Reguarding the lights, that is all they freaking are. Hell MPDS, even regulates the response so that we're not running to a knife fight with a nuclear bomb. Whether we run code or not, we're called, we assess, we transport. That is EMS.

Yes, CON stands for Certificate of Need in the state of Florida. And you guys took my post out of context. I've got quite much more than just lighting up. Perhaps, I mislead. I've been doing EMS for 3 years now. I guess it's just hard for me to see the other side of doing NET's etc. I've done nothing but 9-1-1. That's where my comment came from. (Which even then isn't 9-1-1 except maybe 1 call a month.)

Oral glucose is overrated. It takes forever and majority of the time, if it doesn't work fast enough you have to suction it out just to clear the airway. I have always been an advocate for BLS providers to do more. But the more I am around, the more uneducated BLS providers are based on a 3 month coarse I find. I'm thanking God, I took additional courses while in school.

Skills and procedures vary from agency to agency.

EMT-B's at LCEMS:

Start IV's under medic supervision

Admin NTG, ASA, MD prescribed meds

Oxygen

Watch and supervise patients during transfers with saline locks, NS or LR hanging no further meds.

I would agree with the MD in this case only because of the high suspicion of stenosis or regurg simply because of his age + Hx. He has a previous event in the past which could have affected the intropric ability of the heart. The ECG readings are borderline, but if you put his hx, age, and presentation. I would be 95% sure it's just regurg because of the past event.

BTW, (I'm not putting you down in any way I'm just curious) why would you be treating the monitor and not the patient? I would definately not make him a BLS patient just because he can't talk, but his just his presentation isn't very indicative of an MI and he didn't complain of it in your presence. As you've said in description, he would verbalize chest pain or shortness of breath if it occured. Again, I'm just curious, it's kinda easy to be the monday morning quarterback.

Yeah those are pics from the truck being completed in Columbus, Ohio by Horton. That pic was taken in Feb. of 07.

Ruff, where these crew members from Ambitrans Transport Service??? Sounds a lot like them. We hold the only CON for 9-1-1 and Ambitrans runs all of the NET's to MD's office and nursing home vists. I have never seen them run code in the 3 years I've been round EMS. Most of them fill postions there because they cannot pass our new hire testing or credentialing. We really don't think down on them. Most of the time we strik up good conversations about things on the road etc. But I just couldn't imagine never lighting up in 3 yrs. I would do everything it would take to find a job where my skills could be used in more of a manner that they're intended.

We have a couple of Sprinters, they're like sardine cans inside. I'm not quiet sure which model your talking about but the walls slop inwards about 2 feet from the frame upwards. I'm 6' and I have trouble even walking around to reach things. Not to mention my knees are the in patient's face because of the bench seat and position of the stretcher. I've done long diatnce transfers in them (which is what we use them for). I spent 3 hours in the back one way and will never do it again. My legs fell asleep even sitting in the captains chair. Not enough room. Give me a Type I Mod anyday. Our Medium duty trucks by ALF are a complete waste of money. They come with all the bells and whistles including Federal EQ2B sirens so they are nice, but ideally not applicable.

I love these and wish my agency would switch all of them instead of just the island trucks:

These are the monsters we have now:

I work for a 3rd service and there are obvious problems and there is also very good feedbacks from people. Most of the fire-based agencies in the county are ALS non-transport. With tax cuts here in Fla. everyone's trying to justify their budget. The FD's want to take over transport. They argue that it's their due right to transport. But in reality, they want, want, want but never can justify the want. They all view EMS as a cash cow. Just as much as 3rd services do inter facility transfers, there cash cows and easy, guaranteed money. There is 1 private service, where all the medics and EMT's who cannot get hired on with us go. They do the NET's (non emergency transfers) to MD's offices etc. We do all of the ALS/BLS hospital to hospital, long distance or within Lee County transfers.

A majority of (78%) the fire/medics who work for the 17 ALS FD's have actually come from the county run service. They're all skilled, highly trained. We do get along with everyone fine with the exception of Cape Coral Fire/Rescue. They build fire stations and raise the rent for EMS to house a truck (close to 5k more just because) just because they know that the response is needed in that area. They continually try to stir problems with us. They have they're own dispatch center, separate from the county's so delay in dispatching an ambulance relies on if the communication dispatcher forgets to call our dispatch for an ambulance. ( It has happened many times before and we get the blame for not responding fast enough).

We're the sole 9-1-1 ALS transport provider of Lee County with a population of 650,000 full time residents and over 3 million during snowbird season. Call volume for 2006 was 74,996 and in 2007 we're getting close to be around 80,000. Average call volume per 24 hour truck is anywhere from 5-10 per shift. Busiest units run from 10-20 calls per shift. We have at this time 28, 24 hour trucks and 6 12 hour peak load trucks. Bene's are second to none, I'm in for 25 years and retire from the FRS with 85% for the rest of my life. Which by the way I'll be retiring at 43 with 3 retirement funds . Medical, dental, vision 100% paid for with prescription drug coverage, 12 paid holidays, PTO, sick and vacation leave etc. Salaries are nothing to sneeze at either.

The big problem with our agency are the old timers who do not like change and want to hold our agency back. There are not a lot of ways to promote besides the typical ladder from EMT>Medic>FTO>Lt.>Captain>Chief>Director. Our shift captains continually are biased who they give OT assignments to. Admin is always looking for new ways to try and show the road crews that they're not doing a good enough job. example: Performance indicators ( offload times, response times, PCR uploading and compliance, Skill evals). they spend too much time running on tax payers expense everywhere else in the country for "new ideas", without fixing the ones already arising.