My EMS service.

[911emt911]

Well, I am finally getting a little bit better navigating through the site here, the hardest thing is figuring out what forum to type your messages in, lol, and I hope I have chosen the right one for this one.

I'm not even really sure what to put for a subject on this one.......Anyways, ever since I can remember I have always wanted to work on an ambulance, not even knowing anything about the job......They have just always fascinated me, and wrecks too.....So, right out of high school I went through the emt course. I really enjoyed it and did really well in it, and also passed the NREMT-Alabama without any problems...... Shortly thereafter I got a job at my citys ambulance service. We have around 9 ambulances that are neither old or new, and around 35 employees with most being PRN. Our city has around roughly 20,000 people and we average about 15 calls per 24 hour shift. I have been working as an emt for about a year now. It is just so weird how you never use half the stuff you learned in college, and also how much more different things work such as the "book way" and the "field way", it's like night and day. I have learned so much more actually doing my job as learning how to in college.

We of course have our ''regulars'' also. I'm not talking about 1 or 2 home visits a month, im talking about 2 to 3 visits for some, DAILY. Within the last 4 to 5 months they have moved into nursing homes where they can get what they really need, which is love and attention. I was just curious if most ambulance services had people like this.........I wouldn't say that these people have ruined my job, but they have definetly gave me a different outlook on going through paramedic school. I'm not saying I don't like my job, it just gets aggrivating sometimes.

I go to so many houses and the patient/family thinks that all we are there for is just to put them in the ambulance and take them to the hospital.....The public just dosen't realize everything that we can actually do, and you might say we have everything an er has, just on wheels................It's also hard to find a partner that you can actually get along with......especially on life or death calls.

I plan on going through paramedic school, and then going through the 1 year crossover program that alabama offers to become an RN. But I hope you all can relate to what I said..

[Adam Swartz]

Well, I am finally getting a little bit better navigating through the site here, the hardest thing is figuring out what forum to type your messages in, lol, and I hope I have chosen the right one for this one.

I'm not even really sure what to put for a subject on this one.......Anyways, ever since I can remember I have always wanted to work on an ambulance, not even knowing anything about the job......They have just always fascinated me, and wrecks too.....So, right out of high school I went through the emt course. I really enjoyed it and did really well in it, and also passed the NREMT-Alabama without any problems...... Shortly thereafter I got a job at my citys ambulance service. We have around 9 ambulances that are neither old or new, and around 35 employees with most being PRN. Our city has around roughly 20,000 people and we average about 15 calls per 24 hour shift. I have been working as an emt for about a year now. It is just so weird how you never use half the stuff you learned in college, and also how much more different things work such as the "book way" and the "field way", it's like night and day. I have learned so much more actually doing my job as learning how to in college.

We of course have our ''regulars'' also. I'm not talking about 1 or 2 home visits a month, im talking about 2 to 3 visits for some, DAILY. Within the last 4 to 5 months they have moved into nursing homes where they can get what they really need, which is love and attention. I was just curious if most ambulance services had people like this.........I wouldn't say that these people have ruined my job, but they have definetly gave me a different outlook on going through paramedic school. I'm not saying I don't like my job, it just gets aggrivating sometimes.

I go to so many houses and the patient/family thinks that all we are there for is just to put them in the ambulance and take them to the hospital.....The public just dosen't realize everything that we can actually do, and you might say we have everything an er has, just on wheels................It's also hard to find a partner that you can actually get along with......especially on life or death calls.

I plan on going through paramedic school, and then going through the 1 year crossover program that alabama offers to become an RN. But I hope you all can relate to what I said..

Exactly. I rode with the EMS service in West Des Moines Iowa back in 2005. I new from that moment I wanted to do EMS. It is amazing how little that people know about EMS. Those calls where you really make a difference in someones life even if it is just a old person who is sick and lonely just for them to have somebody to talk to is a good thing. I know that that doesn't make any sense. But if they cannot find anyone to talk to and are sick you have accomplished something. I do not know what but something.

[Capman]

Well, welcome to EMS!

Every service has the regulars. Those who call several times a week and swear they are dying. Those who call for runny noses. Those who call because they can not sleep at 0300 in the morning. Those who want an ambulance because they are not eating well, or are feeling week, depressed, can't move their bowels................

You get the point.

The short of it is, it will never change. In fact it is getting worse. However, keep in mind that these people keep you employed. You either deal with it or move on.

As for the all the information you learn in school that you feel has no use for you in the EMS scene outside of school....

It is what separates us from trained monkeys.

When you get called to a patient who is suffering from a hypoglycemic episode, do you know why you push D50 or do you just know that you are supposed to push D50. If your answer is that you just know that your supposed to push D50 or any other procedure or med administration, then you may want to choose another profession.

I teach Medical Emergencies which is a paramedic level class for the EMS degree in Northern Maine. I can tell you, that the eyes roll as I lecture on the immunology, acid base balance, the nervous system, nephrology, Etc. The reason eyes roll from students, because they too feel that it is unimportant. By the time my semester ends, the students understand why this material is important, and they also understand why they do something not just that they are supposed to do something.

So, I will tell you that you will not get many people on your side when it comes to bashing knowledge base material.

I am sorry if I sound like I'm lecturing you, but I feel that you have got a bit to learn about EMS if you plan on advancing.

[Dustdevil]

Good post, Cap.

Welcome to the forum, Bro. And welcome to EMS. It appears to me that you are the victim of the common small-town/small-system mentality that tends to give newcomers a terribly narrow and unprofessional EMS viewpoint. Not calling you unprofessional, or anything else, mind you. I don't know you. But I think there are a lot of issues that you haven't gotten the straight scoop on from your instructors or the people who have worked with you for the last year. It happens a lot, but it is easily overcome with intelligence, maturity, professionalism, and an open mind. Hopefully, your friends here at the City will help enlighten you without you taking offence to their advice.

Good luck!

[911emt911]

I didn't mean EVERYTHING, it's just every paramedic that you work with, and every emergency that you work is so different. I was taught by a licensed paramedic that works both ground, ER, and is a flight medic.........I mean, i've never seen a paramedic or emt do everything in perfect order like it's supposed to be done in the book. But, every paramedic that I have talked to says that things are different in the field as opposed to the book, not so much knowlege, as just the order and way that you work each call. I guess that's why serices prefer to hire ''EXPERIENCED" members.

[medibrat]

One of the first things that should be taught when you get out onto the road in this job is that most of our patients have not read the textbooks. They will do things you don't expect, and you will have to react differently. You will see your partner do things that you wouldn't necessarily do. Just remember, that when they do something differently, that doesn't always mean it's wrong. And even if you're working with someone you don't ~ahem~ get along with, when you get back to the station, and paperwork is finished, just ask them...don't challenge, just say something like 'hey, I was wondering why you did such and such in the order you did...maybe I missed something?' You'll be surprised. Some won't talk to you about it, but a lot will.

Different days, different calls, different partners. It's not all going to be good, it's not supposed to be. But that's what makes this job interesting! Remember that every shift is a new learning experience. You'll never be disappointed with that!

Brat :angel8:

[Dustdevil]

I mean, i've never seen a paramedic or emt do everything in perfect order like it's supposed to be done in the book. But, every paramedic that I have talked to says that things are different in the field as opposed to the book, not so much knowlege, as just the order and way that you work each call.

Well, I do wish those people were taking the time to properly explain that theory to you, instead of just dumping it on you to figure out for your self. That suggests they are either lazy, not interested in you personally, don't understand the concept themselves, or are just plain wrong. Either way, it is a sign that you are not entirely surrounded by stellar medics.

It has been my observation that most who spout that worn out old saying, "there's the book way, and there's the field way," are compensating for poor education and/or poor practices. They hope to convince the lesser experienced medics and students that it is medically acceptable to be lazy or incompetent so they don't look so bad. It's a lie.

You do, however, appear to be onto a bit of the reason why this gains so much acceptability. And Medibrat made the point well. In school, you are taught to deal with one problem at a time. And each of those problems is handled by following a flow-chart type protocol that you are tested on, and must not deviate from. Regardless of what these guys in the field tell you, that methodical flow is exactly how things should be done in the field too. If they are skipping over things, or putting them off til later, in an uncomplicated patient, chances are there is no valid reason for it. But as Medibrat said, our patients don't read our protocols. Consequently, quite often they present with more than one problem at a time. This requires prioritising your duties and being flexible in the process of evaluating and caring for them. That may well involve deviations from your NR flow chart.

For example, if you have an MVA victim with multiple injuries, who is in unstable condition, you are not going to bandage and splint every little injury on that person before getting them on the road to a trauma centre. Yes, that is different than the book. But remember, when the book talks about a broken arm, that broken arm is ALL they are talking about. It is up to you to put that broken arm into context within the big picture when you begin to practise. Of course, this is one of the biggest problems that makes the EMT-B curriculum so absolutely useless on an ambulance. It is taught as nothing more than a first aid course, focusing on individual "skills," and giving you no strong foundation of knowledge necessary to unerstand or function within the big picture. Consequently, it's common to see some EMT arguing with paramedics who are trying to rapidly transport a critically injured patient, just because they haven't splinted his wrist yet. And, because EMTs are sent to the field with so little knowledge and understanding, it results in a lot of prejudiced attitudes towards basics, and the conflict we constantly see here.

Anyhow, you will definitely do well to remain flexible in your approach to your patients. You do not want to get so rigidly locked into NR flowcharts and "protocols" that you fail to provide your patients what is needed to deal with their developing condition. But that is not a licence to just skip over those steps you were taught in school that you find inconvenient or time consuming. If somebody believes that it is more important to immediately transport the patient than to sit there and spend five minutes splinting their ankle, that is sometimes a legitimate call. But if if they are splinting that patient, and they decide to skip before or after pulse/motor/sensory exams because they just don't feel like it, that is not a legitimate call. Hopefully, that clears it up a little for you.

I guess that's why serices prefer to hire ''EXPERIENCED" members.

You'd actually be surprised how many better agencies would prefer to hire new graduates over so-called "experienced" providers. In fact, the topic you provided here is one reason why. Because so many with experience have developed poor practices and bad habits that will be difficult or impossible to break. And since they have gotten away with those poor practices for a year or two, good luck trying to convince them there is a better way to do things. The tide is changing in progressive EMS, and as people begin to enter the field with more and better educational foundations, it becomes a safer bet to hire those people and train them right from the beginning, rather than trying to change somebody.

[911emt911]

Well, thank you all for your replies.........I don't know, you just don't know what to expect out of a paramedic; such as how he is going to work any scene/call, which is to be expected since they are all different. Ex. Some would like to take their vitals right on scene, while others like to do their vitals/assessment in the ambulance. But anyway, regardless I still enjoy my job.

[Just Plain Ruff]

Cap, I tend to agree with Dust, your post here has been spot on. I could not have said it any better only differently.