CoyoteMedic

now thats funny. The best part is, I have no clue when it comes to computer code. best part is, shes cute

Ok, I gotta admit, this one was good. The one about the hearing problems sucked tho

:kermit:

:brave: :bs: :glasses4: :glasses5:

I'm at work right now and just tried to read that outloud to my partner and couldn't I was laughing to hard

i read this and this picture just came to mind that I had bookmarked... http://www.emtcity.com/phpBB2/album_pic.php?pic_id=1680 hey dust, I even spell checked it for you!

((I am also curious about your agency medical director, why is he allowing this to go on???????)) Well, there are two medical directors. One for the county, I have no clue what is going on with him, and a second for the company, who has upteen thousand medics and EMTs working under him. Go figure. ((Coyote, who is in charge of hiring at your agency? Is it a typical Human Resources type setup? yes, typical human resources type setup. used to be corp hiring, now its done on the local level. as for running duel medic, its not going to happen. It costs to much. All I have to do is point ot the comment about the lowest bidder. This company is making money hand over fist, but its all going to the big bosses, nothing going to the field emp, even for training. Someone was telling me the other week that for bonuses last year the top 50 managers or something like that got a combined 25 million dollar bonus. Some might say the tthe title is missleading, but when you have people out there that do not know what they are doing, and you are doing nothing to educate ore remidate them because you claim there is no money only puts the public at risk. thats the sad part.

It all started after the contract was put in place. A mass hiring was done, about eight months before I got hired here, and from what I was told, those people who had gone in and done the interviews, and who had suggested that this person or that not be hired for one reason or another, that person ended up being hired. They didn't care if they got experiance or not, they just wanted the bodies to fill the rigs. And believe it or not, there is a person here who is the Clinical & Education Supervisor, but this person is to busy doing "invistigations" on this thing or that thing to do any kind of training, reviews, or whatever with medics. It should be called CES, it should be called CIS. What really sucks about it is I grew up in this city, I've spent all but two years of my life in this city. But its a hazard to my career to work in this city. I don't want to leave, but then if I don't, then who knows. Anyway, I'm done, thanks Dust for the fed back.

Well, let me first start off with some facts and to applogize, because I know there are some spelling errors that I missed. 1) The company I work for took over exclusive ambulance operations in two thirds of the county I live in almost two years ago 2) In 15 years, there was not one incident in a lack of pt care prior to the county awarding the contract to my ambulance service 3) In two years, there have been twelve documented cases of pt's either dieing or having some disability requiring extended stays in ICU's. Well, there it is. Layed out right infront of you. Before my company took over operations for two thirds of the county I live in, the crews took pride in the fact that they delivered above excelent patient care to the people they served. On average, I'm guessing they had a average of five years experiance, if not more, behind every medic. Training opportunities were there, there was a peer review. From what I've been told, the company actually gave a flying hoot about its employee's, supprisingly enough. Now, two years later, the work force has increased almost four fold. The ratio of people who have experiance to those who are right out of school is getting ever so smaller. The turn over is so high, the average amount of time that EMT-B's are spending on a BLS unit before getting a ALS upgrade is going from more then a year, to six months. Medic wise, there is a combo of people out there. Those who have been in the business for a while, that know what they are doing, that have the experiance to go along with the knowldge. Then there are those who are right out of school, that spent maybe a year on a BLS unit, with no ALS experiance, and all they are required to do is a five call (five ALS contacts), and ride duel medic for no more then ten shifts. Now that a little bit of a background is out of the way, I can get to the heart of the matter, but there is more of that to come later, I don't want to spoil it to soon. Last week, a email was sent out by my Union, it stated that the County EMS authority was setting out a new policy that prohibited paramedics from handing off BLS contacts, even a simple BLS transfer, to their EMT-B Partner. Why you ask? Eh, you must not of read #3 above. Since my company started running full time as the #1 provider to most of the county, there have been 12 cases, TWELVE, where the medic had screwed up, didn't do a assessment, missed something on his assessment, whatever the cause was, turned over the patient to his EMT-B partner, and took the pt in BLS. Those pts, later required extensive stays in the ICU, if not a trip to the morgue. Example #1; Please, before you read this, keep this in mind. What I am writing here is heard at best, second hand. I have not first line knowldge of what happened. A hypoglycemic pt was taken in code 2 to the hospital. The medic reportidly tried only a couple of times for a IV, and took the pt to the hospital, where the pt coded. Now, when we are unable to get a IV, after the second try, per protocol, we're to give the pt one unit of glucagon. What I was told was that this medic didn't give to the glucagon because "it was out of reach". Now we work in the type II ford van styles. Even my partner, whos not the tallest person in the world, could reach the glucagon on the shelf from the jump seat (not saying thats where this medic was). Anyway, long story short, this pt ended up passing. At this point, the county EMS was going to make it a county wide policy that all medics must tech the calls, that no EMT when working with a medic would have patient contact other then when the medic was doing the assessment on scene. But my company stepped up and said that they would make it a policy internally. Well, that went over about as well as giving a drowning man a glass of water. The union protested, and management gave in, going with the union that there would be change. Now after this, there was only one training session for medics, and it was with regards to advanced airways. Ok. I can see the use on this. A skill that some people don't get a lot of practice on. Plus we were given a new piece of equipment, a ETTI (please don't ask me to spell it out). So, yea, new piece of equipment, we need the training. So the latest incident, patient was attempting to shop lift from a store, well, security cought this person and beat the tar out of this person. Now I spoke with the medic today, and he stated that the pt presented with normal V/S, clear breath sounds, and no head/neck/back pain. Well, they took this patient in BLS. And that was the straw that broke the camels back with county EMS. Upon arrival at the hospital, the pt was c/o chest pain & SOB from the pnumo & the flailed chest, headache, light headed from the yellow/clear fluid coming from his ear as a result of the basilar skull fracture, and according to the EMT-B, the patient got the sub-q emphysemia from smoking. Ok, yea, those are two out of the twelve cases, so you can see why we not only have the County EMS looking at us so closely, but now from what I have been told we also have State EMS watching us like hawks. How is this happening? Why are these people still working? Why arn't they being punished? Are they being trained or remediated? They are all very good questions, that they were brought up in a recent metting with our union who has been meeting not only with EMS, but with our employeer. Some people have lost their jobs, others are on probation or investigation. As for the training part, it goes back to the title of this little rant. In the contract my company has with the county, its required to provide training for its employee's, but there is nothing in the contract time frame wise as to the requirements, I looked. Well, our union has been flat out told by management that there is no money left in the budget for any training of any kind. No mandated training, no Field Training Officer observation ride alongs that are supposed to happen every three months, no PCR review by FTO's, nothing. And the county isn't helping matters either. They have what they are calling a run review coming up in a few days, and I've been told that they are going to focus on Hazmat. Hazmat? Hazmat? At last check, that was not our main problem. So, instead of trying to work the problem to make it better, they are sitting back and letting it all go to hell. It might work out for them in the long run, it might not. They might lose the contract and all 400 people would be out of the job trying to get hired with whatever company comes in after us, they might not. Its all a waiting game, and I'm now done ranting.

well, one thing about that belt, is if you work at night, you're midsection would deffently be visable

I am printing this out and keeping a copy with me at work. Give the B(L)S pts a little light reading to keep them occupied on the way to the ER.

heh, I've got some memorizing to do before I run on three of the frequent fliers we have here... :twisted:

:banghead: :violent1: very nice.

oh man, I just played that for about three other crews while I was at the hospital, even a patient or two were laughing

now those are funny...

A couple people where I work started this shirt... People Are Retarted And My Education Didn't Include Careing.

ok, so who else failed at #1? Comon, I know your out there, speak up already. I know I'm not the only demented EMS person

I've heard it in story forum, but never seen a video of it. Always funny and a clasic.

I've seen that one before, its just been a while, and its always a classic.

"OAKLAND , (CA)-- Breaking news out of Oakland, California. Oakland Raiders football practice was delayed nearly two hours today after a player reported finding an unknown white powdery substance on the practice field. Head coach Art Shell immediately suspended practice and called the police and federal investigators. After a complete analysis, FBI forensic experts determined that the white substance unknown to players was the "GOAL LINE". Practice resumed after special agents decided the team was unlikely to encounter the substance again this season, it is sad but very true, thank you for your time, The Oakland Times."

Studies have shown that running to the hospital code 3 (L&S for your northern folks ), it increases the chance of a MVA involving that unit 10 fold. When your pt has a clear airway, is breathing on his own, has a good pulse, and is not complaining of any serious signs or has any serious symptoms (Hypotension, Chest Pain, SOB, Altered Mental status), where is the point in endangering yourself, your partner, the pt, or the general public? The entire point of EMS is to do whats good for the Pt. Granted N/V is a s/s of a MI, but there are alot of other factors out there that even a EMT-B can use to find out if the pt is actully having a MI. If your partner is this unsure of himself with regards to field clinical impression, then whats best for the pt is for him to find another job. Everyone else on here has given some sort of example, so why not... this weekend I was working as a 3rd person on a rig. Two medics and a EMT-B, I was the secondary medic. We were called out for a ALOC at a apartment complex with about a 25 min travel time to the nearest hospital. We get there, its a pt who hasn't been responding all day (its late afternoon), and has had snoring resp per the wife. She put him on her bi-pap last night because he had been having trouble breathing at night. On assessment his BP was WNL, but his pulse was elevated. Fire already had him on O2 by the time we got there, we get him loaded up, sinus on the monitor, shallow resp at 24, L/S congested. He wouldn't talk, but followed very simple basic commands. Get'em in the elevator to down to the rig, and I noticed his pupils were pinpoint. The gent had a cardiac hx, and his meds confirmed this, but no narcs were noted in his meds. Well, he really didn't meet our local protocol for narcan, so the primary medic instructed the EMT-B to start to the hospital code 3. We got a line in him, and after talking it over, the primary gave him a mg of wake up juice because we desided his resp were not adiquate. Go figure. His pupils go from about 1 mm to about 4 mm within seconds, and he starts talking to us. Had the narcan not worked, you bet we would have kept going code 3 because we have a altered mental status with a unknown cause. But since he came around and stabalized respitory wise, where need is there to continue code 3? There's not. So we down graded, and coasted in. My 2.8725165761 cents EDIT: BTW, accu check was WNL

Or you can take Asys's idea and expand on it. Get the local FD's involved, and do a combo EMS/hazmat training. You said you work in a rual area, I'm going to assum there are alot of farms and crops out there. Do something Organophosphate related. Full hazmat, with the hot warm and cold zones, decon procedures, treatment policies for a OGP (or OPP as some call it) exposure. Signs, symptoms, etc. .

Its not a shirt, but there are a bunch of licence plate frames out there. One I've seen reads "Paramedics save lives, EMT's save paramedics"

Don't get my wrong, gents, I'm not bad mouthing unions. When I worked for CDF as a firefighter for the 2002 fire season, they helped me in getting my COBRA pay that the unit I worked for never included into my check. But I've also had a experiance with NEMSA in the past. I won't go into to much detail, but long story short, they tried to come into the company I worked for, and it was a one sided mud slinging fight. NEMSA doing the mud slinging. Then two days prior to the voting, they pulled out of the process. As for people losing their jobs for little stuff, keep in mind, what I'm saying here is hear say. I do not personally know anyone that this has happened to.

#1: They can still move, on command, any extremity, then its a 5. What you seam to be talking about is a CVA, and thats a different scale. #2: Going by the book, you have to give them a 1. Best thing you can do is question the caretaker. They know the pt best, and can tell you if there is anything abnormal about the presentation. I have heard of modified GCS scales out there, but have not actully seen one. #3: If they don't move, its a 1. If they don't open their eyes, its a 1, if they just moan, its a 2 for incomprehensible #4: Depending on where the lac is. if its in a spot where the bandage can be removed for assessment of the eyes, then yes you need to. Especially if the pt is altered in anyway. Did they fall and smack their head? Did someone try to play baseball with their head and hit a homerun? Or did someone just mistake their head as a carving board. If the lac is on the eyes tho, then no, your not going to be able to determin, and you relay that to the hospital in yoru call in and your report at the hospital. Hope that helps any.