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Not to be sacreligous, and I admit I am not a Trauma fan, but is it really that far off the mark than what "Emergency" was in it's day ? 1. Obviously Emergency used Gage and Dixie for their sex appeal. 2. I imagine the high-tech Emergency was ridiculed by emergency workers who were still riding in hearses without cardiac monitors and two way radios. 3. I imagine there were some mistakes in treatment on Emergency. But then again, maybe not, the treatment was the same no matter what was wrong with you -- some intracardiac epi and some D5W tko. 4. Bad acting ? you have to admit, the best actor on Emergency was Chet, everyone else was a horrible actor. You really didnt expect a tv show to realistically portray us ? After "The Shield" and "Rescue Me", you had to see this one coming.

Nick-Pics . . . - I think I figured out why they wear the DCs. It's so they can run code 3 with the windows rolled down. (Hey, it just looks cooler.) - It appeared they put the amputation Pt. into the rig all by himself. Blondie could have been going for the fwd side door, but who would leave that kind of Pt. alone even for a few seconds? - Fire medics entering a freshly put down fire scene sans turnout gear? The fire medics I see wear turn out gear on nursing home SOB calls. - Hope the S.F. fire guys didn't mind being portrayed as the department that can't clear a building properly. I could understand missing one whore, but a dozen? - Impaled arterial bleed Pt. on a cannula? (Probably couldn't say his lines under a RB.) - A surgical retraction instrument in a medic bag? (I gotta make a Galls run and get me one of those!) - Blondie's new found chastity. She only came within 15 minutes of adding to her interdepartmental bang score. - Wabbit's pre-planned rehabilitation from bad boy status. It started with the kid hanging onto his leg in a previous episode. (Kids are good judges of character, right.) Now he pukes and has PTSD. Big lovable lug syndrome can't be far off . . .

Well this place has changed a lot. It's probably been at least a year (maybe two) since I was last on here. Just wanted to pop in and say hi. Dustdevil reminded me of this place. -Nate

I check. The ambulance the back is checked as we approach it. The front is checked by the partner as he opens the garage door. If the door is already open the partner has to cross in front of the ambulance to get in. Personal I have checked all the way around mine every since an incident when I was a teenager decades ago. It takes no extra time. And even if it takes 15 seconds which is way more than it does 15 seconds will not make a difference in patient outcome. Why fire? Because this was a fire discussion, but yes everyone should check before rolling. Even if this guy was suicidal it would have been avoided had the FF's took a quick look rather than being lazy.

JW, you have listed all the classes and then some for at the very least an Associates degree in EMS and that is without your Business classes. I would just like to see half of those, which would be included in a quality Paramedic Associates degree. As you know from being in a business school, many of the students know they are not qualified for most jobs with just a Bachelor's degree and continue to a Masters for even an entry level position. The same is now happening in many of the health care professions. Some are finding that they must not do just the minimum required to stay competitive for a good ICU job or work in a progressive SCI/TBI Rehab. How many Flight Paramedics have you interviewed over the years who thought they were going to get the job by looking good in a flight suit? How many have showed up with just the bare minimum of certs that wouldn't impress even some of the worst ground trucks that only do basic ALS IFT? There are those who just talk and make excuses for themselves and EMS. Then there are those who believe they can make a difference by becoming a role model for education and patient care through obtaining the degrees whether they are required or not. I think you already know which category you fit into.

He did not get the Bachelor's degree in business to maitain a job as an EMT-B but rather to pursue other opportunities with the restaurant business. I believe once you have completed at least a satisfactory level of education in EMS, one can of course then continue higher eduation in whatever benefits their career or interest. However, I feel it is rather odd for someone to put in just a few hundred hours of training into a profession that deals with human lives but will put in several years of education to achieve a degree in something that is totally not related to medicine. While cosgrojo did see a value to education he was not always in agreement a degree is the way to go. Yet, there is probably no disagreement that the Bachelor's will help him in business. Also, many Fortune 500 companies want their mailroom clerks making a poverty level wage to have a minimum of a Bachelor's degree and few if any will put up any argument against that even though there is no cert or license requiring it. Rather, the employer just makes a recommendation. My Associates degree is EMS/Paramedic. My Bachelor's is in Cardiopulmonary and my Master's degree is in the college of education in Exercise Physiology. Most are related to medicine although some would argue the education classes in my Master's are a waste for EMS since only a few hours of training are needed to be certed as an EMS instructor. herbie, I do owe you an apology since I realize you probably did not know what my statements about Collier County meant. However, if you do a search for Collier County on this forum you will find several discussions that will get you up to speed. EMS has put much emphasis on skills and hours of training to where they have come to believe the education part can be side stepped. Thus when you have continued to measure EMS training in "hours" and emphasized "skills", I can see how you may actually not see a problem with this because that is the norm for you and much of EMS. Medical Directors should look at more than just a "skill" to measure his/her employees' competency. But then this is what Doctor Tobin did in Collier County and was greatly criticized by the FFs who thought is was just horrible that they had to know the hows and whys of their "ALS skills". I have posted that paragraph again now that you have a little history on Collier County. herbie, it is obvious that I or no one here will ever convince you that even the Associates degree will ever be of benefit to EMS. You seem firmly rooted in the skills aspect of the job. While they are important, knowing the hows and whys would be even better. Now back to the levels, if you were to read some of the posts on the forums that cater primarily to EMT-Bs, you might see where 120 hours of training is NOT enough and the AEMT might be some improvement although probably not near enough.

So I used more pain meds on my patients last month than any of our other Paramedics. But as primary job is within 10 minutes to the hospital the director of nurses and me had a not so polite discussion about me interfering with doctors assessments of patients because I do pain management. The nurse said unless more than 15 minutes out I should not give pain meds. I told her my patients health and comfort come first not the doctors convenience and that any doctor that knows their job can still properly assess a patient that has been given pain meds. Plus if it seems to be hindering they can reverse the affects. So was I wrong? Would you withhold pain management? Also I am fully in compliance with my medical directors pain management guidelines, so this is not me being a rogue medic.

Let me give a description of the events then I ask you for your thoughts. I received the call via our Control room asking me to do the inter-hospital transfer of a 2month old, premature (born 2months prem) baby from. We could not get more details as this child was laying at one of the local government hospitals. So off we go, ready to transfer this child to one of the private hospitals. The only thing we know for sure is that the father of the child wants us to transfer him. The current treating doctor sees no reason for the transfer. Normally we will not oblige something like this as it's against company policy to transfer a patient without the treating doctor doing the necessary paper work. Upon arrival at the paediatric ward, we are greeted by a somewhat uncaring nurse. I do the normal "Hello Sister, how are you?" bit only to be pointed in the direction of the doctor with a grunt. This is when I feel the air temperature, and decide it might be a good idea to zip up my jacket. The doctor walks me into a room filled with about 20 babies, I might as well have walked into a freaking freezer! I get to the side of the bed and find a small, blue skinned little boy on CPAP. The doctor start talking and explains the child was born two months prem, two months ago and admitted a week ago with pneumonia. I look at the IV and all I can see is a Saline on a dail-a-flow. No meds, no antibiotics. Just that one IV. Asking the Doctor if what meds the child had I am told the Saline. I ask again, just to make sure I ask specifically. "Has the patient received any medication?" To which I am told:"No, just the saline". I connect my monitor to check vitals and find the following: HR: 67 Sats: 56% (on CPAP) To this I ask the DR if the child has always been this brady. The reply will shock you:"He's sleeping, so it's normal". At this point I feel like killing this DR but, decide to rather do what I am paid to do. I sedated the child and tubed him, with the bagging the HR goes up to 120 and the stats increases to 93% where it sticks. I can't get it any higher, so we leave and transport to the receiving hospital. I inform the control centre to let them know that we are inbound and need an ICU bed and no longer a normal bed as arranged. At the receiving hospital, they take chest x-rays which reveals a complete collapsed left lung.... How would you deal with this?

For those missing emergency - amazing NBC put a link to it on the page to watch videos http://www.nbc.com/classic-tv/emergency/video/categories/season-1/32399/

From your post I respectfully contend that this is probably not the time or place for you to seek input on this tragedy. You obviously have not yet gained the perspective on this needed to discuss it with strangers (if there is such a thing). You have made this about the infidelity, not the brutal murder that occurred as a result. I feel like any attempt on mine or anyone else's part of minimize the temporary pain of cheating against the murder of two people and wide reaching permanent effects on their family and friends, not to mention the family and friends of the murderer (yourself included) would not be taken well, unfortunately that is the issue that is calling for attention. You have my sympathies, but I encourage you to seek help and solace from among your friends and family, not strangers online.

Please post news links so we can actually let this be a learning experience. Thanks.

I went back to school finished up a business degree (graduate in December). Other then that I have been working. I'm off the streets now, took a management gig (much nicer to sleep in my own bed every night). -Nate

There is more to this story for sure. But I did watch a documentry on affairs and it came to the conclusion that the male species really will concentrate on the issue of the physical contact and women will concintrate on the emotional contact. Its to bad if this story is true that 2 people had to loose their lives and the devistation is has caused with in the circle of family and friends. Monty you sound pretty upset and if this is in fact a true story you should also find councelling so that you dont take the tramp impression into your current or any future relationships you may have. Happiness PS I found out 10 years after that my ex husband had an affair while on a course. He never told her that he was married with 2 kids. She was confronted by people who knew he was married and she then ended the affair. The reason that I say this blurb is because yes there are times when the other partner really dosnt know.

Wonder if they used the dog to practice intubations after they killed it? Wonder how long before PETA demands they be killed for killing the dog?

Are you kidding me dude? It's one thing to be proud of your body image, etc. etc. but you are seriously expecting your employers, co-workers and others to make all these exceptions for you? It sounds like they have come a long way in making it possible for you to work. I don't hear any sense of gratitude for it from you. On the contrary, you come across pretty darn whacker. Perhaps an attitude adjustment? If you don't take care of the obesity, you will die. PS.. sit your fat ass on my face and I'll bite your nuts off....

Point for you dude... didn't watch, won't watch, good summary.

Happy birthday Ben !

Something tells me this was not a case of "adrenaline" bolus. If they were all jacked up responding to a "welfare check" type call, then they truly are the captains of whacker nation. This seems more of a product of laziness and oversight. Regrettable, unfortunate, and avoidable... but it happened. I'll let the powers that be decide the punishment, but I could see this happening to just about anyone. My observational powers are not always at peak levels... so I do have some (not a lot) of sympathy for these guys. Flasurfbum- I have to check every time I roll in and out of the bays. We don't have garage door openers in that majority of the stations I work at, and the ones that do are "open" only, so we have to be out of the truck to close the bay.

This is not exactly true... and it is not your fault for not knowing the specifics and intricacies of my life. So no points deducted for coming to that reasonable conclusion. I got the Bachelor's to try and become the next major captain of industry. Since that has failed... miserably I might add, I discovered a talent and passion for creating a menagerie of different food stuffs. It just so happens that the education in Business has given me an understanding on how to go forward with my goals. While I appreciate your comments, and even your compliments to my well-written posts... I too, fail to see the irony involved in this. It would certainly be ironic if I had set out to be the best, most well-educated EMS provider possible and while pursuing this goal I stumbled into a bakery one day as the current baker quit in a fit of rage, and I was offered a quick tutorial and offered a job... thus changing my goals and passion for medicine. Not exactly my position. I actually agreed with you that I would prefer a degree requirement, you simply considered my agreement to be invalid because I do not have a degree in the medical world. If the standards changed, and they told me that I had to get a degree within a certain time-frame, or become unemployed and my certification obsolete... I wouldn't be that upset. In fact I would applaud the changes and either comply, or wish the industry good luck in the future as I mosey into the EMS sunset. To ensure change, the standards must change. Vent, you correctly assess that EMS providers in general have an aversion to higher education (for various reasons, and many only get into the industry for a quick career, or to become a Fire Fighter), but then you say that the only way to improve is to all of these providers who will not pursue said education, to pursue that education. You are asking for the leopard to change its spots. My contention remains that in order to enact the type of progressive education you (and I) desire for EMS, it has to be REQUIRED. Make that education mandate, and people will be forced to comply, or seek other employment. As an example, see the Florida medical director who booted all those medic's for not complying with his regional requirements. If people at that level make the demands, then we will see change. If I do it, it benefits me and my patients, but not necessarily the industry as a whole (except incrementally). *edited for misplaced comma*

Well said Dust. Thy need to be made an exaple of, stupidity cannot be countered, this was negligent stupidity. Lets get them out of EMS, revoke their licences as well. If they havent got enough brains to operate a vehicle in the safety of themselves & the general community, why the hell should they be trusted to assist the sick & infirmed???????????

Tough call. This is clearly negligence, just like if you were driving in the fog unable to see, or shooting at a target unsure of what was behind it. While rolling heads may seem harsh, what is the alternative? You can't just let it go. It reminds me of every time some kid is ejected from a car wreck and killed, and people say the mother shouldn't be prosecuted for not having them in a car seat because "she's suffered enough". I can't buy that. Without personal responsibility being assigned, nothing will ever be corrected.

Just my 2-cents worth of knowledge - Be aware that, aside from what the others have stated concerning extreme differences in protocols, tempo and risk, hiring qualifications for most positions are very specific for all companies. I've looked at numerous positions and with 6-yrs experience as line medic with an infantry outfit with a tour under my belt, including a CMB and EFMB, I don't qualify for almost any position. They are looking for serious operational experience such as SpecOps medics. I've been blown-up, shot at and have fired back, but a straight-up 91/68W doesn't cut it. If you're really interested, Comprehensive Health Services seems to have the liberal requirements, with more positions behind the wire. At the very least, requirement or not, a good TEMS course would most definitely be in your best interest. Providing care in those conditions is an entirely different ball game. Good luck!

Vent, How do you qualify and quantify a satisfactory level of education in EMS? Who determines this? At what point did I achieve a satisfactory level of EMS education? EMT-Basic EMT- I EMT- P ( All university classes, with A&P, Pathophys, Micro, Organic / Inorganic Chem, Pharm I&II, Nutrition,) Physiology Degree Business Management Degree MBA MHA 17 years experience > 1000 flights CCEMTP, PNCCT, FP-C, ACLS / PALS instructor ..........and the blah blah blah goes on and on....Where is the end point? Am I a statistical Outlier? Again, I fully agree education is the key, and the people who don't have it, literally dont know what they dont know, but would be interesting to see your response.... Respectfully, JW

Vent, Just to play devils advocate with you for a minute, I am confused as to your statement above, Why is is so IRONIC that Cosgrojo chose to get a BS in a non-ems related field....? I have been in EMS since 1992, moved up through the ranks from EMT-Basic, EMT-I, EMT-P, FP-C blah blah blah, I am 36 now, and just finishing a Double Masters Degree in NON-EMS related fields. MBA / MHA . I have always loved saving lives just as much as the next person, but honestly, we have to truly look at the statistics I think to understand we are rarely saving lives anymore, and have become for the most part expensive taxi rides, and primary care providers. I always teach and preach having to understand the " WHY" your doing something as opposed to knowing you have to do something, just yesterday in my ACLS class, I had to sit down and explain Cerebral Perfusion Pressure and why a CPP of 42 is bad in an adult. I am PRO education for paramedics, and I agree with 99% of what you say, I just don't see why it is so IRONIC for people such as Cosgrojo and Myself to pursue advanced degrees regardless if they are EMS related or not...... One last thing, CAREER versus JOB debate, these lines are becoming more and more blurred today, society has changed dramatically over the past 50 years and people are no longer willing to be subject to society dictating they MUST pick a career and work it for 30 years, retire, and move to Florida....:-) I read a recent study that showed, todays teenagers will likely have 3 different substantial " Careers" during their adult working life.....I personally regress against the thought that someone must stay in a chosen career field just because they like to do something.....I have multiple passions in life, HEMS, Aviation, Fishing, Cars, and I would be happy to be working in any of them..... Respectfully, JW Just in case anyone was wondering about Fallacies.......... Logical Fallacies An Encyclopedia of Errors of Reasoning The ability to identify logical fallacies in the arguments of others, and to avoid them in one’s own arguments, is both valuable and increasingly rare. Fallacious reasoning keeps us from knowing the truth, and the inability to think critically makes us vulnerable to manipulation by those skilled in the art of rhetoric. What is a Logical Fallacy? A logical fallacy is, roughly speaking, an error of reasoning. When someone adopts a position, or tries to persuade someone else to adopt a position, based on a bad piece of reasoning, they commit a fallacy. I say “roughly speaking” because this definition has a few problems, the most important of which are outlined below. Some logical fallacies are more common than others, and so have been named and defined. When people speak of logical fallacies they often mean to refer to this collection of well-known errors of reasoning, rather than to fallacies in the broader, more technical sense given above. Formal and Informal Fallacies There are several different ways in which fallacies may be categorised. It’s possible, for instance, to distinguish between formal fallacies and informal fallacies. Formal Fallacies (Deductive Fallacies) Philosophers distinguish between two types of argument: deductive and inductive. For each type of argument, there is a different understanding of what counts as a fallacy. Deductive arguments are supposed to be water-tight. For a deductive argument to be a good one (to be “valid”) it must be absolutely impossible for both its premises to be true and its conclusion to be false. With a good deductive argument, that simply cannot happen; the truth of the premises entails the truth of the conclusion. The classic example of a deductively valid argument is: (1) All men are mortal. (2) Socrates is a man. Therefore: (3) Socrates is mortal. It is simply not possible that both (1) and (2) are true and (3) is false, so this argument is deductively valid. Any deductive argument that fails to meet this (very high) standard commits a logical error, and so, technically, is fallacious. This includes many arguments that we would usually accept as good arguments, arguments that make their conclusions highly probable, but not certain. Arguments of this kind, arguments that aren’t deductively valid, are said to commit a “formal fallacy”. Informal Fallacies Inductive arguments needn’t be as rigorous as deductive arguments in order to be good arguments. Good inductive arguments lend support to their conclusions, but even if their premises are true then that doesn’t establish with 100% certainty that their conclusions are true. Even a good inductive argument with true premises might have a false conclusion; that the argument is a good one and that its premises are true only establishes that its conclusion is probably true. All inductive arguments, even good ones, are therefore deductively invalid, and so “fallacious” in the strictest sense. The premises of an inductive argument do not, and are not intended to, entail the truth of the argument’s conclusion, and so even the best inductive argument falls short of deductive validity. Because all inductive arguments are technically invalid, different terminology is needed to distinguish good and bad inductive arguments than is used to distinguish good and bad deductive arguments (else every inductive argument would be given the bad label: “invalid”). The terms most often used to distinguish good and bad inductive arguments are “strong” and “weak”. An example of a strong inductive argument would be: (1) Every day to date the law of gravity has held. Therefore: (2) The law of gravity will hold tomorrow. Arguments that fail to meet the standards required of inductive arguments commit fallacies in addition to formal fallacies. It is these “informal fallacies” that are most often described by guides to good thinking, and that are the primary concern of most critical thinking courses and of this site. Logical and Factual Errors Arguments consist of premises, inferences, and conclusions. Arguments containing bad inferences, i.e. inferences where the premises don’t give adequate support for the conclusion drawn, can certainly be called fallacious. What is less clear is whether arguments containing false premises but which are otherwise fine should be called fallacious. If a fallacy is an error of reasoning, then strictly speaking such arguments are not fallacious; their reasoning, their logic, is sound. However, many of the traditional fallacies are of just this kind. It’s therefore best to define fallacy in a way that includes them; this site will therefore use the word fallacy in a broad sense, including both formal and informal fallacies, and both logical and factual errors. Taxonomy of Fallacies Once it has been decided what is to count as a logical fallacy, the question remains as to how the various fallacies are to be categorised. The most common classification of fallacies groups fallacies of relevance, of ambiguity, and of presumption. Arguments that commit fallacies of relevance rely on premises that aren’t relevant to the truth of the conclusion. The various irrelevant appeals are all fallacies of relevance, as are ad hominems. Arguments that commit fallacies of ambiguity, such as equivocation or the straw man fallacy, manipulate language in misleading ways. Arguments that commit fallacies of presumption contain false premises, and so fail to establish their conclusion. For example, arguments based on a false dilemma or circular arguments both commit fallacies of presumption. These categories have to be treated quite loosely. Some fallacies are difficult to place in any category; others belong in two or three. The ‘No True Scotsman’ fallacy, for example, could be classified either as a fallacy of ambiguity (an attempt to switch definitions of “Scotsman”) or as a fallacy of presumption (it begs the question, reinterpreting the evidence to fit its conclusion rather than forming its conclusion on the basis of the evidence).

Hey Im canadian and Im hot (well does menopause count)

I don't know what points you are missing. I have given many examples of how nursing and other allied health professions encouraged those entering and already in their profession to get a degree long before it was required because they KNEW that was their ultimate goal. They didn't wait for some union to say it was okay or wait for someone to MAKE them get a degree. Most saw the need themselves. Once the educated become the norm or increase in numbers enough to show a difference between the grads from a medic mill and a degree program, those with legislative powers will get the message. Thus, it is up to those in EMS to start controlling their OWN destiny and that of their profession. The other thing, as I have also mentioned many times in this thread, is to raise the educational standards for the instructors and make them true educators. That could within reach more realistically but at this time since there are few with even a 2 year degree, it will take a while to implement that. Once the instructors become educated, they can be role models for education rather than relying on "fish" tales to prove their value in the classroom. Honestly this is not a difficult concept but if those who are providing the patient care fail to see the importance of an A&P class, what hope is there. Unfortunately too many are like you who just want to wait and be made to get a degree instead of taking the initiative yourself to set an example. If you already have a degree as you say, why do you think a mere 2 year degree is so unrealistic? Once there are more educated people to speak for education, the IAFF and private ambulance complanies would be foolish to point out education is a waste if it puts them in a bad light with the tax payers. But, you can just sit back and continue to make excuses so you and the herbies of EMS can complain about the FDs. But, I think this speaks volumes for your stance. You are an EMT and not even a Paramedic but yet you are trying to tell us about a degree as a Paramedic. This would be like a CNA telling an RN that his/her BSN shouldn't be obtained until they are made to get that degree. But, you are not even pursuing the Paramedic or even EMT as a career. After 30 years I still have hope that the Paramedic will become a recognized professional health care provider but that is only if we stop catering to the weakest links and listening to the excuses or blaming someone (or the FD) for our failures in EMS. I have been around to see first hand the many changes in medicine and that includes the many professions which are a lot younger than EMS. Medicine is not fantasy. It is a very much a reality which is based in the sciences. If a profession doesn't understand a few simple sciences, it becomes stagnated. That being said, thank you for the compliments and good luck with the restaurant. I wouldn't mind having a wine bar and bistro for my retirement hobby. But, I am not oblivious to the fact it would take considerable education and dedication just as EMS should.

Here's a question - how far up must one be in the medical establishment to be a force for change? Are there doctors who would be allies in working to mandate increased educational standards? Or would Paramedics and EMTs who wish for prehospital care to become a respected profession need to leave the field behind and go to medical school in order to be in a position with sufficient leverage? Are medical directors able to require that all Paramedics working under their license have an AAS? And VentMedic's reputation meter keeps going up because people recognize that she is saying what needs to be said. We're dealing with people's lives here - no room for mollycoddling. I may be a rookie, but I can tell when someone is speaking from a place of experience. Like I said upthread, I came into my EMT/Paramedic program expecting the people in it to be the best of the best. While it's too early to tell in the Paramedic program, I was appalled at the lax attitude of many of my fellow students in the first year. I can also say with confidence that I would have learned more if those students had been washed out early in the program. Their presence was a constant drain on those of us who took the course seriously. Getting an AAS really is not that hard - most of my classmates have families, and there are several single mothers who also work full time in slave wage positions. They are some of the most organized and dedicated students. If they can do it, anyone can. The biggest obstacle people have is in their own mindset of "can't".

Now for personal attacks... You are the one who has stated you do not have a degree because it is not required. I have not used the words "undereducated fool" in any of my posts when speaking of you. Those are your words and if that is how you think of yourself, you might consider getting at least a 2 year degree. Having the letters of a degree behind your name is not a bad thing and should not be viewed so negatively. Do you care to point out the spelling mistakes in post #94? Those are abbreviations for the associations and not misspelled words. In the other post I used Dustdevil's spelling for ass which is arse. Could it be others agree that education is important and one shouldn't wait to be told or made to get it if they want a better understanding of medicine to provide quality care to their patients? Of course it would be nice to have the 2 year degree as a requirement for Paramedics.

You realise of course that there isn't a level of provider called CCEMT-P. CCEMTP is another alphabet course, albeit an excellent one. I plan on attending one in the very near future. Anyone who claims to be a CCEMT-Paramedic is just doing so to make themselves sound more important. In reality, they took the initiative to upgrade their education. Kudos for that! http://ehs.umbc.edu/CE/CCEMT-P/

They were lazy. This is another reason there should be no remote controlled doors at fire, ems, police stations. Make someone stand there hit button, watch ambulance, truck, car pull out then hit close, jump in and then go. This ensures people see what is in front before moving. It also delays less than 15 seconds and 15 seconds in the field will not change patient outcome.

There's less room for advancement because there is no demand for it. We increase the pay, benefits, etc of the EMS profession with the improved education standards there will be more options out there. People are more willing to stay if things are good rather than using it as a stepping stone to get out to a better job. As previously said, it's going to be painful, I don't minimize that, and you are stuck in the comment of well what do you do with the people that already have significant time in but no degree? Do you start bringing in degreed medics at a higher pay? Or do you raise their pay with the caveat of having their degree within a certain amount of time? Do you keep them at the same level of pay until they are degreed? Personally I go for the second option, but that's just me. As long as they are progressing towards it, I think that should be rewarded. If they stop though, they are reduced to their prior level of pay until classes resume or they find employment elsewhere. That would soften the blow and encourage them to further their education until we have a fully educated group in place to move forward with. Then you can start demanding the benefits PD and FD have. I think with the improved education, there will be an expansion of EMS possiblities within patient care and we will see better benefits. I'm not cruel and heartless to those already in and I think those who previously chose to go the easy way out should have the option of degree completion. I'm not saying get rid of them - just bring them up to the education level within a reasonable time frame (ie two years or so) to equate with the rest of the medics graduating. We can sit here and debate all day, but until we decide to agree on something we'll not ever get anywhere. Fire and PD learned a long time ago - unite and we get what we want. We're too busy bickering with each other to get what we need ! Oh and guys - you say well I never got that college level a/p class - why don't you go get it now? It's sure not going to hurt you and most schools will let you just sign up for a class or two without pursuing a degree. Why not give it a try and see how much it will help?

Sorry Dust - I was referencing the gentleman that squint talked about. Though I think it would still be hard, it wouldn't be as hard in the situation you describe as the one squint described.

I would really struggle with that one - knowing they are conscious and talking to you and as soon as you stop they will be dead. How do you explain that to them? "I'm sorry but we're going to stop because we can't continue this forever, and you will die." I believe that would be even more difficult for the family as they know if you continued that the person would be alive and push you to keep going. I know we speak many time of the cruelty of doing CPR to certain populations (the very old, end stages of terminal disease, etc) but would you react differently if they were able to communicate with you? I can deal with open eyes during CPR as I know there is no one there, but to experience someone literally "coming back to life" and then dying again would be troubling. Very few calls in my career have haunted me, but that is one that I will be the first to say would. Interesting topic we got started.

My apologies - the book is called Emergency by Mark Brown M.D. It is a collection of stories from physicians and nurses in the ER from across the country, so I would say it was pretty easy for someone to take the work and call it their own. The actual story was written by Jerome Hoffman M.D. To be fair to whoever posted this comment as you say, it's possible they were the medic caring for the patient as they state the paramedics brought him in like that in the middle of life and death, not choosing which side he wanted to be on. Persistent V-Fib was his rhythm never changing and a two hour code when they finally called it quits and let the man die. As far as how common that phenomenon is - the doctor stated in the story he had been a physician 20 years in a busy urban ER and had never seen it before. I've never heard of it, but that doesn't mean it's not happened elsewhere. This is the only case I've ever heard of. I guess theoretically if you were perfusing the brain well enough via CPR you could improve level of consciousness. I am only guessing at this point though. Would definitely be an eerie position to be in. As far as how common is it for someone to take a story and turn it to their own - dust stated best - extremely frequently. I've seen it more than a few times on this board and others.

In urban areas, yes I think there is a definite overusage of HEMS - unless you are in excess of 30 min from the scene which is really rare I do not see the neccessity of using them. As previously stated by the time call comes in, lift off, landing, report, take off, transport, landing and transport into ER you could have usually already had your patient in and evaluated. However, for rural areas that are an excessive distance from a trauma or definitive care facility (yes I'm lumping some medical things in here ie STEMI, suspected CVA, etc) I would rather see a service call for HEMS than sit and wait, the patient wait around then finally get transferred out (usually by air med due to distance and also the oh crap factor of the physician in the ER). Average time for a significantly injured patient from injury to evaluation at a trauma center is around 4-5 hours if diverted to another facility. There's alot of patients that can't wait that long. So yes, I don't mind someone calling based on mechanism of injury due to that. Easier to treat it earlier than later with better chance of recovery. I think it is entirely dependent on distance, local department's capabilities (and their availability - if they have one medic in the county it changes the position about than if they have one on every truck), mechanism of injury/nature of illness, what the patient's complaints are, and the potential for injury, and current status. If anything makes it high risk, then I wouldn't object to a helicopter being called for transport. If the indications aren't there or within 30 min of evaluation then go on by ground.

makes me think of the story in the book "EMERGENCY" by jerome hoffman of the guy that they claimed came back to "life" everytime they started CPR and "died" everytime they stopped. Evidently he would open his eyes and blink everytime they started CPR back up, then revert to the partial closed of death. He stated everybody in the ER thought he was looking at them...was there awareness there? Who knows, but freaky indeed. BTW - if you haven't read the book it's a decent read. True incidents that are funny, sad, etc but best because all are true.

Was it something like this mike ?

haha - makes me think of when I worked back in university a few years ago with a brand new CNA in the ER (for some reason she got floated down there was interesting as she hated it). Had a pt pass away and we had to relocate him. Got the stuff together to move him and the cart. He was nicely already packaged to move. Unfortunately, we ended up with the cart that didn't like to lock, so you had to do the foot stop thing which under most circumstances wasn't a big deal. I told I would be nice and take the head and she could take the foot to transfer (we both were short and reaching across was a challenge for both so dead people got moved head to foot). I had my foot down, and did the okay, 1,2,3, move. She picked up feet and had them about halfway on the cart. I had the head and was right between the two beds (she moved a little quicker than I) when that "moan" you get happens. Poor thing turned pale white, dropped the guy and went OH SHEAT ! HE'S ALIVE ! Well, I now had 200+ pounds of dead weight just dropped on me and I couldn't help it and dropped the guy right on the floor. Woops Anyhow, if the fact that the girl ran out, I dropped the dead guy and he is now laying on the trauma room floor wasn't bad enough - tack in the fact that two FF from the local fire/ems were sitting there completing their run report and are now laughing their butts off. Yes, somethings people just never live down (even 3 years late I still haven't). Fortunately they were nice and helped me get the guy off the floor, but not without a few red faces and a good laugh. Yeah, that brought back bad memories there herbie - thanks

Yes again a very down to earth advice ... its sad really but it is now the way of the PC world. cheers

Agreed. Yes again agreed, I have never been reprimanded by an MD although with RNs there can be a component of professional jealousy underlying and axes to grind very dependent on the RN, in vast majority of cases have to be approved by an MD first as we on occasions can be considered renegades thing is you just can't please everyone, so take care of the patient's needs first is my mantra. Point in fact and a wee diversion,I had 2 patients both chewed on by a Grizzly Bear ... landed @ with helo and had to be grounded into a less than stellar rural ER and being well aware of the delays in assessment, quite typical for that less than stellar facility. I did not push that extra top up for break through pain (later became waste) this before a 12 minute ground transport ... well yeah know I will always regret that as once through the hospital door I was not "allowed" to use my own meds ... The MD kinda pissed me off too and the patient and because despite my suggestion of top up with my own meds and soaking off with N/S the now clotted and dried dressing (a major avulsion) and against the patients request too, he ripped it off causing more pain in his haste to "assess" ... live and learn I guess. spenac: On another note, I would be cautious as one operation I worked for did evaluate the high narcotic usage of one fellow Medic ...to find that he was having some personal issues with controlled substances and got caught red handed umm how can I put this .... pocketing the waste so watch your back and document very well with a independent and trusted co signer. ps Billy Smack is no longer on the streets, thank you very much. cheers

Ditto to the above responses. I too have administered analgesics upon arriving at the ER and have also given them while waiting for a bed while extended at the ER. Most local facilities around here do not complain as they are aware their personal perceptual opinions are irrelevant to our treatment and that we will stand behind our argument that any competent physician can appropriately assess a patient with analgesia on board. Most of the decent agencies around Houston have very liberal (i.e. unlimited) pain protocols. My current guidelines allow for analgesia prn for as long as the patient can maintain consciousness and their own airway. If your patient reports pain, it needs to be addressed in the appropriate fashion. Personally, I wouldn't concern myself with comparison statistics to other medics nor the impulsive concerns from a receiving RN. Beneficence can and should go a long way!

If only when leaving the apparatus bays, I'd suggest you look back to posting #6 of this string. Other than that, does anybody have, on their ambulance, engine, or truck vehicles, one of those mirrors mounted on the front, that shows what is directly in the "blind spot" in front of that vehicle, as is required here in New York City, for Yellow School Buses? They became required after a school bus driver accidentally drove over a small student that had just gotten off her bus. (Please note that I am calling a bus a "Bus", and not calling an ambulance a "Bus")

Funniest and saddest thing I’ve seen in at least a week, lol, too bad it wasn’t the station chief…

At our bases someone has to close the door behind the truck. Between that and not trying to scream out of the bay like a bat out of hell I've never given it much thought. I can honestly say, that if we could open the door from the truck, I'm not sure I would have thought to look directly in front of the truck. I will now.

You mean you don't exit the station with your eyes closed?

Shhhhh !!!!

London Beat them to it

Sadly if such a cavalier practice was introduced into the civilised world it may indeed result in the embarrassing and untimely deaths of a few Paramedics. However, this would be a small price to pay if response times were improved substantialy.

Ponder upon this my dear chums. Why do those silly sods who attempt to kill themselves by driving their cars into a tree or another inanimate object always invariably wear a safety belt ? And you have to cut the bloody thing off before you extricate them. Also, when you pick up some wailing cretin who has taken a paracetamol overdose, why do they always insist upon you putting a safety belt around them before you head off to Hospital ? Suicide attempts my arse !

And if you are going to do it....WHY CALL 9-1-1?????? JUST DO IT!