To Medic's

[fireflymedic]

Eydawn,

If you can't stand EMS so much, then why do you continue to come here and focus on it? The vast majority of your posts seem to be just complaints about how this or that isn't good, but i have yet to see you post something truly educational that would benefit those of us practicing in the field or give a suggestion about how to improve the current situation. If you have those things I am all for hearing them.

Personally I got into this field because it did allow me to practice medicine without all the B.S. and paperwork that nursing deals with. If you think you will be doing more patient care as a nurse, you are sorely mistaken. You will be dealing with the same garbage that EMS deals with only in a different setting, with more paperwork, and little time to sit back and do the hand holding you are talking about. Nursing requires a different skill set than EMS and I don't think it's fair to compare one side of medicine to the other (unless it is emergency nursing and even then it is different). EMS offers one the opportunity to function almost completely independent, making decisions and yes DIAGNOSING in the field in order to treat a patient appropriately. Do the job right, you make patients better, do it wrong and you could kill them. Work in an isolated area and you could find yourself treating patients that may be quite critical for a good period of time with nobody to back you up. If you don't learn how to practice medicine in this arena, then it is you that is choosing not to learn.

Doctors do have a wider range of knowledge, however I've had more than a few residents tell me they wouldn't want to swap places and wondered how a crew has managed to get a patient to their ER alive. Knowing what a patient's injuries may be, having that index of suspicion, and being able to identify the problems and what it may lead to down the road is part of good medicine and good care ! One can never knock one for choosing to learn more. I don't regret getting a degree for one minute, and yes I started out in the same place as everyone else, but I worked to get to a point where I wasn't just seen as an ambulance driver. Talk to the docs and ask them what medics they respect and why and they will tell you it is because of their attitude and willingness to learn. Their knowledge of injuries and what to expect gives the docs a good picture of what may be to come. For example, you go to pick up granny that potentially had a CVA several hours ago and has been laying on the floor in the same position and hasn't moved. You may not be able to give thrombolytics, however, due to the fact she laid there so long you know that rhabdomylosis is a possibility and can be on the lookout for changes due to that and make docs aware of it as well rather than just walking in and saying yeah, we found her on the floor, don't know how long, whatever's done is done. Maybe it is, maybe it isn't. It is when you limit your knowledge and think you know it all is what causes you to lose the respect of doctors, not the fact that you are a technical school medic. I think you need to change your attitude and perhaps you wouldn't have the frustration you do with the profession. The good services are out there and education is there to be had and good medicine can be given if you are willing to pursue it, but it's not going to be given to you, it will have to be earned.

[Eydawn]

Firefly:

You haven't read many of my historical posts, I don't think.... I've had multiple posts over the years I've been here offering constructive solutions and discussing medicine in EMS. Hell, I came back from my honeymoon and posited the idea of an NP/medic hybrid as a solution for rural areas... take a look through my post history and see what I've had to say.

Perhaps in your area nurses don't actually provide care... but I know nurses in my area who are currently employed, and they provide a LOT more care than most of the medics I also know. There may be some geographical discrepancy here.

I've never had a problem with higher level health professionals (read: RN's, MD's, PA's, etc.) respecting me. I am very eager to learn, and gobble up knowledge whenever and wherever I get it. Do you know what that attitude got me when I actually had a position in paid EMS for four months? I got treated like dirt, because I actually wanted to think about the medicine and take a little bit of time to learn the EMS skill set in a way that made sense to me. It was bad that I wanted to learn things, instead of operating like a good little cookbook, racist, patient-abusing clone of my preceptors. I got burned by a bad service, and I am slightly bitter about it. I apologize for the bias this has caused in my posts lately.

That experience taught me one thing-- that Kiwi is right. For most services, it doesn't matter how much education you've got. The problem is that you have to win the approval of the entrenched ignorant in order to survive, let alone have the work environment be tolerable, and I'm just not willing to kiss the ass of bad medics in order to work my way up the chain. I've seen far less of this in nursing than in EMS, which is why nursing appeals to me. I also like the scope of nursing and the potential to move higher up (get one's NP, for example) which doesn't really exist in EMS.

I haven't given up on EMS. What has happened is that I've had my confidence shot by being jerked around, and by realizing how much I really don't know as a Basic.... but most programs have this asinine requirement of "1 year prehospital experience" to get in to get your paramedic degree.

It is extraordinarily frustrating to be told that I have to think like a medic without having the full mental toolbox (drugs be damned, I want the pathophysiology) to do so. I hate flying blind. And I hate being forced to fly blind and to be discriminated against because of my intelligence. I know that I don't know everything. I'm acutely aware of that fact. Double-checking my actions and trying to talk through my thought process with my medic on what was going on with patients got me labeled as "covering up incompetence with intelligence" and "lack of confidence in abilities." Figure that one out for me... I've been trying for a few months now to sort through that one.

It isn't that I can't stand EMS; it's that I lament the shambles that our system seems to be in. I hate that the good old boys, fire based or not, have a stranglehold on the system and are preventing us from raising educational standards so that all medics would be like YOU: well educated, and actually giving half a damn about patients. Most people go into EMS not to avoid the paperwork, but to avoid having to actually challenge themselves to learn. It's easy to coast in EMS, and that's what I can't stand.

I want to help change EMS and raise the standards, because our patients deserve better. I just don't have the resilience right now to go back into the broken system. So I'm getting my RN, and probably re-entering the EMS field AFTER having acquired that education...

Hope this clears things up for you.

Wendy

CO EMT-B

[under-dreaming]

Interesting story, Wendy.

I'm going to be starting RN school soon myself (for different reasons though). I've only been working BLS for a little over a year now, but I remember when I was four months in. My attitude then was way different than my attitude is now. And I'm positive my attitude will be different with each coming year. I don't have the same problems that you seem to have had (with paragods). The difference in this region is that we a rural. And when I'm on a call, I run the call. I am BLS and limited to those means, but I have handled quite a variety of patients in my first year.

It is interesting for me to notice that you have so much to say about EMS (good things) yet have so little real time experience. I hope you find yourself in the pre hospital setting again, you will probably do many patients a good service. I would suggest you find yourself an ambulance company that runs BLS calls. If it's your confidence that is shot, this will surely clean that up in a hurry. And if not, you will no that pre hospital isn't for you.

[Eydawn]

Under dreaming--

I have no issues when I'm practicing wilderness EMS. The majority of my experience since acquiring my cert in 2005 has been in the wilderness setting... where I get to think things through and be in charge of how I want to run things. And I learn something new with every patient I encounter in that setting. I think the major problem for me was the urban service I was hired on with and their emphasis on speed before thought. My confidence in the urban setting is shot because I got turned six ways to Sunday trying to please several different preceptors, all of whom wanted to mold me into their own personal mini-me-EMT. I'm still good to go in the wilderness setting... I guess I need to just suck it up and give urban another try, but again, the dilemma of having enough education to be comfortable in that setting and to know when to assert myself against potentially harmful preceptors is what scares me a little bit.

I'm also not just pursuing RN because I want the education to become a better EMS provider; I really like nursing ethics and the nursing approach to care. I hope to be able to do both sides- in hospital and pre-hospital. They're different kinds of care, and there are advantages and disadvantages to both. I love my current job in an assisted living facility as a care provider... and the nuances of continuing care are fascinating to me.

Sorry if I derailed this thread... and sorry for whining. I'm still frustrated with the way things turned out with the service I was with... it looked great, the pay was great, and I got inside and found myself in the middle of a mess I had no prayer of changing. My biggest shame is that I shut my mouth and let these paramedics do stuff that I knew was wrong (both medically and ethically)... and I didn't speak up because I wanted to keep my job and not make waves until I had been there long enough to build some credit... and that didn't work either.

This was supposed to be one of the better services... and seeing just how broken it really was bothered me.

Again... sorry for any incidental rantage.... no offense was intended.

Wendy

CO EMT-B

[firefighter_nremtp]

Not really. Rapid a-fib is frequently misdiagnosed as SVT or vice versa, which is why even the AHA recommends the use of Adenosine as a "trial maneuver" in such cases.

Agree I guess, but this is really a kindof masturbatory way of summing things up. I don't believe that our knowledge is really all that exhaustive. We get a cursory training that covers a very small slice of medicine, and I think it is much more important to recognize our limitations than it is to trump up this quasi doctor vision of paramedicine. Work hard, yes, but also know where your understanding falls off (a lot earlier than you think).

To the OP, my answer would be to brush up on your A+P, and otherwise simply prepare yourself to pay attention in class. That's all.

Absolutely agree 100%. I have been off this site for a very long time, and furthered my interest in law enforcement. I have actually found being a Police Officer very rewarding. I have crossed all thresholds now, being an IFSAC FF, NREMT-P, and Police Officer. Each entity has it's rewards and short comings. But the point is, do not make more of any profession than what it is. Being a Paramedic barely, and I do say barely scratches the surface of medicine. I wish you good luck and best wishes with your studies.

[fiznat]

...the dilemma of having enough education to be comfortable in that setting and to know when to assert myself against potentially harmful preceptors is what scares me a little bit.

I don't know that EMS is all that different from any other profession in that when you are new (like you are), you need to have the discipline to suck it up, do things the way people tell you, and relegate yourself to the understanding that independence is a byproduct of experience, not a right. I understand that your preceptors probably did some things differently than you would have liked, but with only a few months experience you really are not in a position to question their judgment. With experience will come a more thorough understanding not only of the medicine, but also of the environment in which you practice (equally important!). Only then should you be able to start making some independent decisions and begin molding yourself as your own kind of provider. There is a LOT to learn - usually more than you think - before you reach that point.

...Just my opinion of course, but I think others here would likely agree and it is probably something you should keep in mind.

[DwayneEMTP]

Now ole' Paramedic Jim Jim just knows to reduce and split as best as can be done and maybe get some pain relief onboard, none of that fancy big worded junk. I would say most of what Sparky can tell you ain't gonna change jack shit about how we splint this kids arm.

This is the most idiotic, self serving, backwards bullshit I've seen on here in quite a while. And there's been a bunch on here to compare against of late.

If you're uneducated, ignorant, or simply lazy, then yeah, a broken arm is a broken arm. Though you have no idea what the "best" way to splint the arm is without some knowledge of anatomy and physiology. "Reduce it and get pain meds on board"...Holy shit.... Is pain control the only reason to administer pain medication? I hope you're answer is no.

If Paramedic Jim Jim wants to spend his life working at a basic level, then yeah, this should be his plan. What type of fracture does it appear to be? Can I do more than simply verify pulses and splint? Of course I can. And Jim Jim can kiss my ass while he focuses on splinting the arm as he forgets to check for the possible pathologies that may have caused the fall, the co morbidities related to such a fall, etc. You espouse the ignorant cowboy medicine of days gone by, while parroting the idea of better education. It's transparent to anyone reading the post quoted above. Purposeful ignorance should no longer go unchallenged in EMS, or on a board that claims to be a source of education.

I am by all means an advocate for more education and strongly believe that you can never know too much nor that we should simply educate "skill monkeys" but I was warned that knowing a lot can be dangerous as you can dig yourself into a hole and get "tunnel vision" practicing diagnoistics when the best thing for the patient is for you to take them to the hospital.

Digging yourself into a hole with tunnel vision is another symptom of ignorance, not an over abundance of education. I get so sick of hearing the 'old time' medics talk about the "college educated medics that run around on scene like idiots...they just ain't got no common sense!" I didn't run around anywhere like an idiot during an emergency when I was lacking a college education, and at no point was I required to turn in my balls and/or common sense during or after.

Overheard a coworker talking about her fire medic brother on my last shift. She relates the story about his run on a severe ped asthma attack. She said, "He had Albuterol on board, they were just a couple of minutes from the hospital and he'd just asked the kid, ' are you feeling better?' to which he replied, 'yes' and then he just coded! Nothing he could do....they lost him." I wanted to give her a swift kick in the throat. I asked, "what about Epi or Mag Sulfate?" She said, "There just wasn't time after he got worse. He was getting better and then just died!" I'm guessing you've seen ped asthma? Do you believe he 'got better' just before he died?

Do you suppose her brother was blinded by his education? That he got tunnel vision from too much knowledge? He was either an idiot, that didn't see the physiological signs that told him his pt was incorrect in his self evaluation of his condition, or a coward that didn't want to push drugs. How would being less educated have with helped that? Right, it wouldn't.

Just sayin'....

Firefly, I'm surprised by your evaluation of Wendy's posting history. It it seems you've been here long enough to know that a few grumpy posts don't define a person's posting history, right? She is easily in the same category with ak, Dustdevil, Fiznat and many others where A&P is concerned, and the vast majority of what's important is A&P right? I'm surprised to hear you devalue her opinion because she hasn't worked on a truck for very long. That's a weak argument and I've come to expect more from you.

Experience has it's place, but very little of what I do every day involves experience. It involves confidence, organization, delegation, investigation, and a solid application of physiology/pathophysiology. Was my 30th breathing difficulty less stressful than my first? Sure. Did I examine it very much differently, or reuse the same decisions from my previous cases on this one? Not really...new person, possibly about to get run over by a different zebra..it all starts anew.

I can't figure out why, exactly, that you were offended by her post and then spent paragraphs reexplaining all of the things she had already stated in a few sentences?

Review her older posts and I think you're going to feel a little silly about asking her what she's doing here.

Fiznat, you're my hero, but I very much disagree with your feeling that you have to do things the way others do them, or simply do what you're told until you've reached a point where you've earned the right to practice in a way that you feel is morally and ethically sound. (If I understand your post).

I entered medic school with very definite opinions of right and wrong. I was gifted with many new opinions of pt care and advocacy while there. I refuse, and yes my life is sometimes made more difficult because of it, to work at a level below my moral/ethical/intellectual ability simply because I've chosen to enter a field where sub standard practice is often accepted as the norm.

In no way am I a superior medic, but hopefully some here can attest to the fact that I've become a decent medic, and perhaps one day will be good, but I can not justify in myself, or suggest to others, that they degrade themselves and the field by feining 'less competence' simply to fit in. We make changes in the industry by elevating ourselves, and hopefully in the process giving others a helping hand to become better, not lowering ourselves to get by. My two cents...

Have a great day all.

Dwayne

[fireflymedic]

I can and have been caught on a bad day before and occasionally do take a post at face value. I am a bit tired of hearing people complain and say they are getting out of the field I have chosen as my career. Yes I said it - I chose this field as my career. I'm fortunate enough to have worked in some places that pushed education and had an actively involved medical director. I realize not everyone is this lucky and that can lead to frustration and you feel like you really are getting nowhere and it's a dead end road. However, in this area, more opportunities are opening for medics that are good paying and you can make a career out of this job. I enjoy what I do and love it as much today as I did the day I started. I am content with what I do, and I've seen a wide scope of opportunities for medics from the truck, to ER, to industrial, to workmans comp, to flight. The good places are out there, you just have to put your time in at the lower places and work your way up. They're not going to be handed to you straight out of class. It's like any place - start at the bottom, put your time in, and work your way up. You do that, your possibilities are out there.

I do get frustrated with people saying they are getting out of this field rather than saying I'm working to change this. Frankly if I don't like something, I'm going to speak up until someone hears me. Remember, it's the squeaky wheel, not the quiet one that gets the grease. I may be squeaking a long time, but I'll keep it up as long as I need to. If we push one state at a time and joined together instead of fighting with each other, we might get somewhere. Nursing learned that a long time ago, as did the fire service and they got what they wanted - when are we going to learn? When we do, we'll see the changes we desire. Instead we're sitting back going well I want this, and you want that and billy bob is happy being the backyard country bumpkin volunteer first responder. Until we DEMAND further education, we're not going to have professionals and people are going to keep using EMS as a vehicle to get to other careers instead of making it theirs. Just a little food for thought.

[DwayneEMTP]

Firefly,

Thanks for your response. I I certainly hear you when you say that you're tired of people bailing instead of digging in to fix problems. But surly you see that that is going to be a decades long solution. At least.

Wendy is terribly over educated for the certification she carries, she simply digs EMS. Unfortunately her first foray into working the streets landed her in a backwards redneck service that still allows medics to get their rocks off by proving their superiority over basics. Idiotic.

And yeah, when I see a post like Kiwi's I begin to wonder why I keep bothering with this shit too. He's a somewhat respected member here despite the fact that he spews that crap. We have 'respected' members here that preach higher education but are not able to do so in proper sentences. Sometimes it seems that the lazy and ignorant have used hugs and high five's to take over, and at times it's simply heartbreaking. You belonged on this board a few years ago when Dust and ak ruled the day and stupidity never went unchallenged. It's a different world now. I posted a month or two ago asking people to please explain their post edits. It was deleted. I can't imagine editing a post without explaining what I changed, even to mention that it was for spelling only, to be fair to those that may have come after me. I can't remember the last time that professional courtesy was offered here.

Am I starting to sound like Wendy? Grin..yeah, I know, but I keep coming back too. Why? Because if no one speaks up, nothing changes.

Not so long ago my response to Kiwi, you and Fiz would have started a 10 page debate..but now it's a thread killer. No one has the balls to debate and take a chance on being wrong or getting their feelings hurt, at least very few are willing to do so. I find it ironic that the biggest balls left on here come from our female posters...perhaps we need to change the saying to, "Yeah, they just don't have the boobs to run with this crowd." :-)

I'm with you on change. I fight for it every day at my service, and it's one of the most progressive, well paying services in CO. Our medical director rides with us regularly, operating as our "basic" third rider, every single PCR is reviewed and commented on, we have a wide scope of practice, yet still we have the 'good ol' boys' and some firemen that think this is a game, or a hobby.

Keep at it lady. Things do change. Probably not in my career, or perhaps yours, but at least being a pain in the ass gives us something to do during our down time... :-)

Thanks again for your response.

Dwayne

[spenac]

Not so long ago my response to Kiwi, you and Fiz would have started a 10 page debate..but now it's a thread killer. No one has the balls to debate and take a chance on being wrong or getting their feelings hurt, at least very few are willing to do so. I find it ironic that the biggest balls left on here come from our female posters...perhaps we need to change the saying to, "Yeah, they just don't have the boobs to run with this crowd." :-)

Dwayne

I disagree Dwayne. Most of us are just sick and tired of having to type the same facts day after day. And then the same idiots fighting despite facts presented. This ans other EMS sites seem to be having the same problem those of us that fought hard are just tired of the online crap.

I am making my focus on the area I am in. Hopefully starting at the local I can spread my desire to see EMS improve because no improvement has been seen by mine and others efforts online.

And yes Wendy does work hard to promote EMS improvement. To bad most have no desire to see improvement.