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Hey hows it going im new here even though ive had my membership for over a year just never really logged on. I am an emt basic at the moment but just passed my nremt medic practicals and will be taking my written test soon so hopefully ill be a medic within the next couple of months. WAHOO. Oh well just wanted to say hi.

1) career ladder involves many different positions in the EMS 'career' ladder. We have a position for the attendant which is ultimately responsible for the crew and writes reports. We have a paramedic commander who runs the shifts on there particular firehouse, and then regional EMS chiefs who supervise a region. We also have the option to cross over if one would like to be a medic on the engine (i have no interest in this) 2) We lag behind with some of the cutting edge equipment but we have what we need. Training is plentiful and required...we also get paid to do it. 3) We have lots of ambos on the street--some are super busy. They should be adding some more. We also have ALS engines. 4) EMS chiefs and officers get respect from the fire side. They are integral to each other. 5) Runs are increasing but we get the job done. They will have to add more units in the near future. Why not? EMS is a cash cow. 6) We have 2 medics....no threats of going 1 on 1. It's something we fight for in the contract and always will get. 7) Rules and regs are about the same. Money cannot buy happiness--you are right. But all medics should get what they deserve and be able to live comfortably and not have to work 90 hours weeks and have 2 jobs in orders to raise a family. Let me ask some questions now. 1) Would you rather have those ranger glidescopes and be living at the poverty line, or live comfortably and have the traditional tools? 2) Would you rather have have a unmatched 401k, work a private ambulance until you re 60 doing pysch. x-fers, or retire at 50-55 with a pension and be able to live out your old age with dignity? 3) Would you rather be at the whim of some owner of a private ambulance who cares about nothing but profits, or a municipal union gig that will give you representation and have your back to investigate issues? Is my primary motivation a paycheck? No. No one gets into this job to get paid. I make decent money but I'm sure I could have made a lot more doing something else non-related. However it is important to make a decent living, have good benefits and a retirement plan. Why not? We wade around in the $hit....impossible rescues, BS calls, dirty frustrating work. We are subjected to gruesome sights, we have to wrestle that crazy drunk, resuscitate babies in someones home with families tugging at you sleeves. The stress of this job is crazy and we deserve to do it for a livable wage. Is that a liberal and self serving viewpoint? Damn right, but I won't back down from it. Unions negotiate the contracts that allow us to get what we deserve. It's democratic process, we vote on our leadres in the union. IS it perfect???? OF COURSE not....but it is 100000000000000000000X better then the alternative.

I think there goal would be to eliminate those services in order to make them union jobs and increase the number of people in it. Honestly I can not see a drawback for me being in the IAFF, it should be noted that I am a single role paramedic. If I was not in the IAFF I would be making about 34k/year with lousy benefits and no pension. This year I grossed roughly 78k. I work 24 on and 72 off. So please tell me what the drawbacks are for me to be in the union? I don't want this to turn ugly so I mean no disrespect in my posts! I am interested to see what people are negotiating and getting paid while being a paramedic without unions and their fancy lawyers to sit down and make bargains. Thanks in advance for any info.

I never said anyone was an ass hole for attempting to correct it...all I said was that it's comical that every time there is a grammatical error on a post, ten people seem to feel the need to correct it. If everyone wanted to be an English teacher, then I guess they got lost on the way to class...Yes, it is extremely important to be able to communicate effectively in English (I actually JUST had this conversation on a job interview) so I'm not saying it's a bad thing to correct. Just saying that it's a little funny that EVERYONE has to comment on the terrible grammar of some people. If you look through some of the posts, the same thing is said over and over in regards to someone's terrible grammar. That is what is funny, the need for EVERYONE to comment on it, not the bad grammar itself. It irritates me that people come on websites like these and try to communicate with others in a way that either: 1. the post is so incomprehensible that no one has any idea what is being said or asked, or 2. that the post is understandable, but the way it is written is so unprofessional that no one wants to respond...I think it was you who actually responded in the "meet and greet" section to tvfdmedic. You gave him some great advice on how to actually communicate to everyone on here. And that's great, I am really happy you did that because I honestly had nothing positive to say to him because what he wrote was so grammatically incorrect. However, watch. Now that you have said something about it, I can pretty much guarantee that at least five others will now comment on the poorly written post. And that's what's funny, not the horrific English skills our public schools are teaching.

At the time of the shooting I wouldn't blame you for returning fire but afterward yeah that's what we do.

So my partner and I were talking about a call in our service where someone gave an amp of D50 b/c of a misread glucometer. They believed the pt. was hypoglcemic when in fact BGL was aprox. 150. (non-diabetic pt.) It was a CP pt. I didn't believe an amp of D50 would be too harmful, as I thought it would be absorbed pretty quickly. My partner stated if the pt. was having an MI the amp of D50 would worsen the MI by making the blood more viscous. Thoughts on this? I couldn't find anything to support his claim. I thought this mistake was pretty harmless.

Hyperglycemia itself is not immediately hazardous, but as Kiwi said, it's the dehydration that accompanies it from increased renal output that is problematic. Even DKA would fail to be that problematic if it weren't for the renal insufficiency that results from the severe dehydration (healthy, hydrated kidneys are very good at handling excess acids as well as excess glucose). For this reason, the first measure of treatment in DKA is always volume resuscitation. Insulin is a secondary concern, and I will usually wait until I have a potassium level back before starting the insulin drip in DKA. Asymptomatic hyperglycemia does not require any prehospital treatment, but anyone showing signs of dehydration (tachycardia, dry mucous membranes, nausea, poor urine output, sunken eyes) should be hydrated with IV fluid. This applies for the Type 1 diabetics in DKA as well as type 2 diabetics in a hyperosmolar nonketotic state. NS at KVO rate really won't help in any way, as it is a negligible amount of fluid. I start with fluid boluses, dose dependent on other comorbidities. If they have renal failure and are on dialysis, or are known brittle CHF patients, I'm pretty careful with the fluid, going 250-500cc at a time with reassessment each time. If not, I'll hit them with a liter of fluid. In children with DKA, overly aggressive fluid resuscitation is a risk factor for cerebral edema, so I'll hit them with 20cc/kg of NS IV bolus, followed by a maintenance rate + rehydration rate, which requires a bit of calculation. Remember that the dehydrated hyperglycemic patient didn't get that way overnight, so you shouldn't expect to fix it in a short period of time. Most people I plan to rehydrate over 48 hours. The initial bolus is helpful, but they will continue getting hydrated in the hospital over that time, or if sent home, will have instructions regarding aggressive hydration with PO fluids. 'zilla

One thing I hate about EMS forums and really EMS in general is that everyone is a know-it-all. And thanks Dart

let it be noted the pt. had a smell of etoh. i don't know most of the details as i was not there thanks for the feedback You act like you were there? Was this you on the call? I did not provide much details....and there is more to the story. You guys got way off topic and started spouting off your mouths without knowing the full story. This topic was meant to discuss what I had posted about it...no to bash the crew based on the little information I gave. From what I understand the pt. had smelled of ETOH and was acting intoxicated, but was AAO X 3 With that being said thanks for the inoformative stuff that was posted by you and others on this topic.

Oh I can't disagree more. I am so sick of this treating the patient not the machine thing that everyone is so hung up on. How bout an UnCx diabetic??... just intubate & transport? What about perfusing V-Tach? What about silent STEMI? How many diabetics have you seen that can go as low as 1 mmol without having any read symptoms? Your saying just wait till they become altered?? To be honest I think the crap that is spewed in this "treat the symptoms" is a catch-all for those who can't critically think for themselves. The machines are an assessment tool, they should be used to guide Tx. Reactive medicine treats symptoms. Proactive medicine treats signs. You decide. As for the bold text above; I would be interested to know if these same Dr's could diagnose without the "fancy tests". I gotta tell you though...... feel free to ultrasound, draw blood, or CT me anyday to ward off "exploratory surgery". Each to thier own though.

Actually hyperglycemia has been shown to contribute to morbidity and mortality in many acute conditions, MI and CVAs being 2 of them. Multiple studies have shown that it can reduce hospital survival rates and glucose levels are often looked at as predictors of outcomes. Pt's are started on insulin drips to strictly control the glucose levels even when they are only slightly elevated no matter what the cause of the hyperglycemia. There are plenty of studies out there and it the adverse effects of hyperglycemia with head injuries and sepsis is also well documented. Here are just a couple of article to get you started: Controlling hyperglycemia in the hospital. hyperglycemia and MI Just learn from this mistake and remember that none of the treatments we administer are completely benign and all have some degree of risk associated with them. Cheers!

So Like Totally you should take some English classes and learn proper grammar. So like I totally say No!