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Your spelling, grammar, and attitude regarding each is why so many here have a severe dislike for fire based EMS. Congratulations on shooting for the very lowest level of achievements possible. Yeah you! Be glad that you've found yourself a fire based program that will baby you through, as you would be removed from any reputable educational institution in short order. If you look back through the history of the City you'll see that every now and then we have a rush of idiots that come trumpeting the idea that, "i ain't able to spell or talk good but that don't meen I cant be a really grate Heero!!" They all fall by the wayside, as will you if you should choose to continue to be proud your ignorance. I hope better for you.... Dwayne

Hey Tyson, welcome to the City. I'm going to take the less politically correct road here, as I have a feeling that's what you're really asking. How big is this guy? How big are you? This is what this situation says to me, that he started out being just sort of an ass, yet during transport this turned into an 'Oh Shit!' moment and you asking how to deal with it on your own? I get that... First off, for me, once he began to spit, all bets are off. Now he's gone from being an asshole to creating a significant bio hazard for me, and that just simply is not going to continue. Where I work it's pretty rural and PD is rarely on scene, often will not respond in a reasonable time if called, and when responding there are only a few officers that will be of any real help when they get there, so we tend to always think of resolving these types of problems without outside help. We have pretty progressive protocols so I'm allowed options for sedation, though if this isn't in my opinion a true psych, meaning that this is some spoiled kid acting like a weenie because it gets him attention, I may choose not to use them. I'm happy to use them to ease the situation for the truly mentally damaged, but not so quick for the spoiled idiot. Moot here I know as you don't have a chemical option. This just happened a few nights ago. I dropped the head of the cot, pt didn't have a shirt on or I would have pulled it up over his head, pushed his head to the side with my knee and put my full weight on that knee, mashing his head down into the cot. At this point I had complete control over him, not to mention eliminated the possibility for spitting and biting. I had my partner pull over, come to the back. While I kept his head mashed, all the while he's screaming about abuse and law suites, my partner pulled all of the straps as tight as they would go, tied each hand with Curlex to the Pt's thighs, pulled the chest and shoulder straps as tight as possible, to the point of restricting breathing even. This ended his options for any significant struggle. I put a surgical mask over his face, (this pt was a muscly 250 or so) and taped it in place with medical tape wrapped all the way around this head. None of this was done in anger, which I believe is a significant point. This guys was not happy, but he also understood that his dangerous behavior was not a game to me and was going to be neutralized. I'm not his mother or father, to be held hostage by such behavior, but I am a husband and a father who is going home without spreading disease to my family. Once he calmed a bit I loosened the chest strap so he could breath freely, chose a vein on the outside of his bicep and got an IV in case something else was going on here that I hadn't discovered yet, and we rode into the hospital. By the time we arrived he was calm and assisting me with his assessment like an honest to God human being. Now, you're probably going to see me get a beating for this answer, and my rating is likely to drop significantly, but that's OK, I'm wearing my big boy pants. And I do certainly see the need for this type of pt handling as a failure on my part. as there are many here that may be able to talk this pt into behaving without needing to resort to the above tactics as I most often can, but in my experience sometimes EMS simply becomes a contact sport. Now understand, had this been someone truly in mental pain I would have mashed his head into the mattress as described above but would have kept it there only so long as it would have taken for my partner to get me a line and some Versed from the lock box and life would have been peachy just the same. I simply don't like to be bullied or threatened into giving drugs by chronic assholes as opposed to those seriously ill. Bottom line is that you stay safe. If something like this works for you, go for it. If not, as mentioned above, get your ass out of the truck, call in PD, and get ready to eat some crow. :-) Dwayne

I hate to break the news to you but a high pass rate doesn't mean it's a good school or program. It means they can successfully teach the minimum required to pass the test. Given that the tests are incredibly easy, it's not a hard thing to do. Graduating competent providers is a better testament to a school. I'd also consider accreditation, entry requirements, class size, and education requirements when choosing a program. Anyone can establish a fly-by-night EMT school. You have to be really careful that you become a success instead of a victim. I hope that your spelling and writing skills improve. It's very sad to see how poorly the youth of today communicate, not only with the written word but verbally as well. I correct my son's grammar a dozen times a day and I'm left to wonder what he's really learning in school. Being able to communicate is important when you're trying to get your position across to other people. You might want to take it seriously instead of feeling that it's acceptable because you have an instructor that is also poor at spelling. It's not a badge of honor, it's actually rather sad when you consider that spell check has eliminated most of the work. Try firefox browser and it's built in spell check. It won't help you with grammar and punctuation, but it's a start. Good luck.

Hello to all, I decided to join this forum so I could warn any perspective emt or paramedic students about Florida Medical Training Institute. This school does alot of illegal stuff with student paper work and documentation. They also have high failure percentages on there classes. If you are a current student at one of there campuses or looking to attend there, and want more info about why you shouldnt just let me know.

Something else to think about is that if you are serious about the flight nursing, most will require a BSN any more. I know a lot of HEMS in Michigan have phased out the Medic/Nurse and are going to Nurse/Nurse. One, that I know of, is RN/MD..An ADN is not going to cut it in a very competitive market in the near future; certainly not a matriculation from medic to RN... Just some food for thought.....

The thing is Dwayne, the way this "profession" currently stands, you really don't have to be very smart. Limited scope of practice, minimal educational standards etc. and very little required in the way of actual medicine makes a strong back and a thick skin way more important than smarts.

Geeze, Bro... I hope the worst is over, and that the page is turning on a new, and better year. I dunno if following your passion is a real substitute for being able to pay your bills, but it certainly is cause for hope and keeping you busy and focused on the future instead of the past. I wish you both the best in 2010!

While I agree to some extent that yes, not all psych patients are aggressive - the potential to be is much higher. They are obviously not thinking clearly at that point, thus why you were called in the first place and are transporting. There have been numerous times that a patient wasn't expected to be a problem and became one enroute for a variety of reasons. If I don't have PD I AM going to have an extra set of hands, I'm not doing this by myself. It's mine and my partner's safety above everyone else's. If you have been contacted for a psych patient (or even a suspected one) in this area, PD always goes first and evaluates the situation. My former partner was shot in the head and his partner killed because PD didn't go check it out first. Nobody thought it was going to be a problem. Now a good EMT is dead and a compassionate medic is out of EMS completely. Sad. Unfortunately, it took this to happen before this department chose to make corrections to their system (granted it wasn't for a psych call, but the man had an extensive psych history which now automatically flags in the system and PD is sent with). However, the reason you are being called is they are not thinking properly. If they are at the point they are willing to hurt themselves (even if just for attention) are they really thinking clearly enough to not want to hurt you in the process? I'm not entirely convinced. I'm with flight-lp - especially in that environment - it's not safe. If I'm expecting a problem, or you start to give me one, I'm going to take measures to ensure everyone's safety - including yours. Another good thing to pursue is a defensive tactics for EMS class - there's some people connected with Dayton that do a pretty decent one and I'm sure they are across the country. It's not how to legally beat the crap out of a patient, but rather if all crap hits the fan, how you can at least keep yourself reasonably safe until you get help from the guys with the guns. Bottom line - make sure you come home at the end of the shift 'cause you aren't effective if you are hurt or dead.

Lots of good ideas here, and as always because of differences in training, protocols, sizes of patients/ providers, transport times, back up availability- there is no one solution to a problem such as this. Experience will tell you what you need to do, and as has been mentioned many times, self preservation is the best policy- whatever it takes to stay safe. Also- listen to that little voice inside your head. He gets more and more brilliant, the longer you do this job. If you have a feeling someone may act up- BELIEVE IT, and be proactive. I'm always hesitant to use restraints for several reasons. First, in order to safely apply them, you need tons of help. Trying to tie up a combative patient with just 2 people is a recipe for disaster- someone is going to get hurt. Couple that with the confined space in the back of a rig and even if you have tons of help, you quickly run out of room, especially if you only have access to one side of the patient. Another reason- I have seen PCP ingestions where the patient treated leather restraints as if they were toys and snap the buckles. ideally you would apply them in a more controlled setting with plenty of space and assistance, but patients don't always present that way for you. Working in an ER, we would have at least 6-7 people to safely apply restraints. One for each limb, another to secure the torso, and 2 or more to actually apply and secure the restraints. Unless your rig is the size of an RV, that's too many people. My favorite restraint in a pinch- wide rolls of Kerlex. Yes, old school I know, but there's a reason it's so widely used- it works. It's readily available, quick to apply-especially if there's only 2 of you- and you don't need to fumble with keys, straps, and buckles. All you need is a couple quick slip knots and the job is done. Couple that with your seat belts and that person is not going anywhere. Yes, most places frown on this now, but I have yet to hear a hospital complain that a person has been restrained in this manner. They would much rather have a person present to them under control and be able to calmly assume care of the patient then to have them flailing and flopping as you roll through the doors. You simply need to ensure the gauze is wide enough as to not impair circulation or cause injury. It's also easy to remove- simply cut it off when you turn the patient over to the ER. A suggestion for new providers- talk to law enforcement people and/or a martial arts pro and get some tips for yourself or have an informal session for your people. I learned long ago from a partner who was a martial artist a couple simple techniques to control someone-- basic judo holds, pressure points, blocks, etc, and they have come in handy countless situations. They are also not for someone out of control- a novice use of martial arts moves will end up getting you hurt. These tips are very helpful for someone who is beginning to get squirrely- often times if the person feels you are in control of them- a simple arm lock, for example, gets their attention, shows that you will not tolerate them acting like a moron, and they tend to settle down. Unless someone is psychotic, even a drunk usually realizes when they are in a no win situation. The first time I saw the guy use a simple grasp of a person's thumb to render an idiot completely cooperative, I was a believer. No fighting, no wrestling, no injuries to anyone- problem solved.

Thank you. I just really need to learn to not want it now now now for once in my life! I think I am finally growing up and seeing the bigger picture.

Combative person + no chemical restraint protocol = person going with PD. It's 2010, time for your local EMS to catch up on the times and offer interventions appropriate to the patient population. Personally, I would have offered this kind individual a nice cocktail of Ativan or Haldol and Benadryl. Should he politely decline and continue his demonstration of low level Darwinism, he gets a consolation gift consisting of Anectine and an endotracheal tube. I am a firm believer in prophylactic RSI.

Screw medic school. Total waste of time, and very possibly counterproductive to your educational development. Go straight to nursing school. Get a few years of critical care (not ER) experience. Then either do a paramedic quicky school, or challenge out.

The question might also be if you are serious about doing Flight, is the Paramedic worth it? However, many Flight RNs are expected to have a BSN which shouldn't be much of an issue since you already have a degree. Their experience should consist of no less than 3 years with 5 preferable of critical care experience and some in the ED. To be really valuable, you should also have a year in PICU and a year in NICU. Now of course, for Paramedic, you can get a quick cert and a couple years on a decent ALS 911 service and probably land some job on Flight even with about 200 other candidates applying. But, to land a competitive job on a decent flight team that just isn't looking for warm bodies, you should have the degree with the same prerequisite sciences as nursing. While you may be able to get all the additional weekend certs that look nice on a resume, the interview will determine whether you actually know what you are doing and not just collecting the alphabet soup. You will have to obtain a strong knowledge of critical care medicine which unfortunately the Paramedic is rather limited at obtaining experience. And, the interview will probably be done by a flight RN with extensive critical care experience. If you just want to do HEMS with a FD and not do critical care IFT flight, then just the Paramedic and FF cert may be all you need. It just depends on how hard you want to challenge yourself in medicine and critical patient care of the very sick patient.

You say your a medic.... Why not chemically restrain him? A second choice is to stop the ambulance and have police take over restraint. Did he really even need an ambulance? Why not pull over and have the police continue transport? Just a thought, if he was of sound mind, didn't he have the right to refuse care?

Guys, that's not the 3rd party bill for the transport, the way I'm reading this. That's the bill to the department receiving the mutual aid because they can't get out the door, issued by the department picking up the slack. Services rendered, as they say.

Or- don't shoot the messenger- it could have something to do with the fact that they know you spent more time with your paperwork than the patient. Sounds like you work at a private. Guess how many competent EMTs working at privates the triage nurse has seen in his or here time? I'll give you a hint- it's very likely a small, small number. You could be the best EMT at your company, but if one of your colleges was a moron earlier that day, the nurses are probably going to treat you the same as they'll treat him. Guilt by association. It sucks, but that's life. Just some advice from me to you. As far as the original question, it takes us whatever it takes us. We restock from the ER, including meds. If it takes the supply guy a while to get to us, and it takes me awhile to find a nurse with enough free time to resupply my meds, I could be there 45 minutes sometimes. And that doesn't always include report time (I tend to write more than most people I see). We're required to leave a completed run report copy before leaving, so no matter what dispatch wants, I can't leave until at least then. Nowhere I work has a set policy. One dispatch might start calling if they're busy and running out of trucks in service, or if they have another one for us. They can't order me to clear, but the supervisors might become more interested if I make a habit of very long OOS times.

When the Cambridge PD arrested his dumbass buddy, he couldn't get in front of a camera fast enough. A Muslim whackjob tries to kill 300 Americans on Thursday, and it's three days before we hear from anybody at the Cabinet level, never mind the President.

It'd be a valid point if he'd actually done anything this year.

Save yourself some grief next time and use the "search" function. Just about every EMS forum has had a couple discussions about his school. Also, few are going to listen to advice when a school offers such convenient classes and easy financing (that one will pay dearly for many years. Let's not forget the cool commercials and the great sales pitch that promises a rewarding career full of excitement. And, you don't have to take all that education stuff where in some colleges one might even have to take A&P. Schools like this are an easy way for someone who lacks motivation or has no interest in medicine to get a medic cert. They get their hours and are taught how to pass a test all for $12k and 6 months of training. Of course you can get a package deal for just under $20k if you take the EMT class with them.

http://www.nydailynews.com/news/2010/01/05/2010-01-05_he_got_the_boots___it_cost_his_career.html

The failure is in sending EMTs to do a paramedic's job in the first place. Exactly

He would've been RSI'd at my hospital. I brought in a very similar patient, fought so hard I never even got a collar on him. Trauma staff gave him enough ativan and haldol to kill a herd of elephants before he shut up, then realized they should have just tubed him to begin with because now his airway was questionable. So they did.

i dunno to be honest the school i go to has a paramedic program as well so i could go there or i could take the 2yrs and spend 24k on schooling at the major college here which i don't have. are your talking about right now or for paramedic right now after doing this course i get nothing but the knowledge that shows im good enough to do my job and proficient enough to save life's which in the end is the only real thing that matters anyways. after im done with this program then i can go take the NREMT test WHEN i pass it i will then become an EMT-B. and after that if i wish i can go and take my EMT-C and EMT-P course

I wasnt looking for sympathy you genius. It was a simple warning. If you didnt care so much why waste your precious last brain cells on making a reply. Its funny how the only person from FL that replied knew what I was talking about.

Richard, is there a link for that? I'd love to disseminate that through my agencies.

He didn't say the kid legally drove his car into the hospital.