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I've thought a lot about how I want to present this. I'm kind of in a tough spot given my status as a grad student in this particular clinical setting. However, what took place today by EMS providers in the area where I'm doing this particular rotation made me so angry I couldn't see straight. The information I think I can share at this point is pretty generic and will be addressed anonymously to those in question. We can all learn from this experience, though. From a professionalism standpoint, appearance is hugely important. Scruff on your face may be fine if you're a Hollywood actor or a model for GQ or something. If you haven't shaved in a few days and look like you haven't bathed in a couple days it doesn't instill a lot of confidence. Even less so when your white uniform shirt is dirty and sloppily tucked (difficult to understand as it was still morning... not like you've been out running calls all night) over your belly that hangs to your knees. Reeking of cigarette smoke compounds all this. Couple this with one of your partners (and really, do you need 6 people to show up for a call that can be adequately managed by 2?) who tried to deny the access of a patient family member by raising your voice to a trauma surgeon by announcing "911 is for emergencies! How would you feel if we waited for the family only to have this patient have a head bleed? You'd feel pretty stupid now, wouldn't you?" First of all, the family member was not going to delay you. Second of all, raising your voice is by itself unprofessional. Thirdly, you have no ground to stand on as you didn't listen to the report from another physician present and you didn't even bother to assess the patient! Not even for lung sounds on an intubated patient! And you have the gall to raise your voice to two physicians and question/lecture them? Whiskey? Tango? Foxtrot? I have never been so embarrassed to be associated with EMS and other paramedics as I have been today. I have never been so disgusted and disheartened at the blatant demonstration of ignorance, incompetence and unprofessionalism as I was after witnessing events from today. I have never been so angry in a professional arena as I was today being forced to watch you make fools of yourself and give this industry and profession a black eye. So, way to go Kent County EMS. All the progress that some of us have fought for in tireless efforts to improve EMS was tossed out the window by the inability of you guys to demonstrate even the most basic of courtesies to other health care providers, patients and their family members. This isn't rocket surgery (my Dust-ism for the day). This is basic stuff. Every single one of you should be fired for how you handled yourself. AND you should be compelled to write letters of apology to all of the people your ignorance affected. You have disgraced yourselves, paramedics nationwide, and EMS as a whole. edit: corrected a few, minor grammatical issues. No content changes made.

Hi Folks, I've been lurking around the city for some time now, so I figured I'd join up and start engaging in the conversation. I'm Ross, a first year at the UNC School of the Arts in Winston-Salem, NC. Originally from Stamford, CT as I came of age to take advantage of the NREMT, I began studying for my EMT-B cert at Stamford Hospital in CT. I'd had an interest in prehospital care for a couple years, and I tore into the course, enjoyed every minute of it. I finished up my certification testing as the end of summer rolled around, and got it in time to get one ride-along with the local career service before I shipped out to NC. Down here at school, the campus has no options for student involvement with emergency medical response, so I've been sitting idle. You may notice my interests list "Film Lighting" next to EMS. My main career, aside from being a student, has been working as a motion picture lighting technician for the past three years. I've had the fortune of working on small student films to indie blockbusters to union television. It's a great industry not unlike EMS for the "lots of waiting and sheer moments of terror and awesomeness," but also is a very accident prone work environment between the steel rigging, high amperage and voltages of electricity and the conditions that actors and crew will submit themselves to in the name of film. I always bring my training and a small bit of PPE/dressings/mouth-to-mask in my back pocket to set, which I've had to pull out here. While this school takes safety seriously, the extent of the medical preparedness is carrying a first aid kit and throwing first aid procedures into a 100 page safety manual, containing other content on school safety regulation, electrical safety, etc, on which students are loosely tested every year. While it is a good precedent, the test does not specifically target the medical knowledge and the average joe college kid cannot realistically access that knowledge and act in a first responder capacity by reviewing a list of procedures once. It seems like there is merit to organize, equip, and manage a group of student volunteers, certified to the EMR or EMT-B standard, placing them on sets, at performances and in shop facilities. I'm currently doing some research on call volume and response time by the local services to our campus, and collecting data on location medical emergencies to statistically demonstrate need for this proposed solution. I've read some of the national collegiate ems foundation documentation, and intend to at least propose a quick response service on campus. It's a state school so it'll have to be a tight proposal in these tough financial times. Until I can create the campus service or build ties to the local service to start riding regularly, my greatest concern is the depreciation of my skills and knowledge. I did well in my course but I have very little practical experience that I feel would lock in that knowledge. I try to review my course textbook every once in a while, but I look forward to engaging in the scenarios as not to mindlessly memorize. I'm doing a writeup on the set emergency I encountered, hopefully to pose as a scenario, but the extent of my assessment was limited as I could not complete my vitals set with a BP reading. I don't have all the information as care was transferred with a Hx of the event and the baseline vitals I took when the ALS unit arrived, but I'd like to run it through as far as I can. i look forward to the discussions and knowledge to be gained ahead! Hopefully I can start working towards gaining some more experience in the near future. Regards, Ross Neugeboren

A lot of the problems with lack of professionalism, I believe, stem from the root of this profession as an offshoot of paramilitary public safety as opposed to medicine. Gungho git 'er done attitudes are fine and good when axing structures and/or tearing apart cars; not so appropriate for medicine. The same old lack of formal education, easy entry into the field and poor wages and shitty hours discourage the professional minded and medically driven from either entering or staying in the field. It makes me crazy. I have noted that one individual can make a big difference in the culture of a place. Lead by example. Express dismay in a non-confrontational manner at anything you see in the field that reeks of whacker. A dedicated professional, especially as the leader of your crew, can make your crew, then your shift, then the entire organization better. Believe it or not, most management wants the same thing. Those that don't really have no leg to stand on in this day and age.

Mike: I can understand the frustration with dealing with these type of providers. Some folks can be just punched in on the clock & look that way. I worked with a few pigs over the years and have even turned the garden hose on one that really really needed a bath. BO that brought tears to my eyes. Of course he went whining to the boss! Boss said it was about time somebody cleaned him up. := The fact that a mere PAramedic had the audacity to raise his/her voice and question the attending's in the hospital says a lot about their system and how well they are respected. Our mission is to be a leader in meeting the present and future health care needs of the citizens and visitors in out community through a network of high quality advanced life support services, education and prevention programs which share common goals and values. Service: We are committed to help the sick and injured by providing superior service to our patients and our community with skill, concern and compassion. Quality: Because our patients are our primary concern, we will strive to achieve excellence in everything we do. People: The men and women who are our paramedics, and those associated volunteers, physicians, nurses and students are the source of our strength. They will create our success and determine our reputation. We will treat all of them with respect, dignity and courtesy. We will endeavor to create an environment in which all of us can work and learn together. Stewardship: Fulfilling our mission requires that we use our resources wisely and with accountability to our publics. Integrity: We will be honest and fair in our relationships with those who are associated with us, and other health care workers as well.

FNG, I'm glad you came back and hope you'll stick around. I think you need a word of caution about this site. This site is fairly unique in that it has a high level of standards for EMS. Its really a collection of prehospital professionals, and we like to try and keep it that way. Our friend and colleague who recently passed helped to set that high standard. You can Google a million and one EMS sites and find the same old pat on the back war stories that everyone has heard and everyone is sick of. They'll be the ones with the cool gear and the latest patches. This isn't that site and its why its the only EMS site I belong to. I even canceled my subscription to JEMS because I got tired of the nonsense on that site. I read back the responses to your post and I really didn't see any name calling. Yes the responses were a bit harsh, but this real life. Every single profession in the world treats its subject matter with the same degree. If you don't believe me, go try arguing a point about structural steel with a group of ironworkers. It won't go well. So you won't find anyone here who will tell you everything is okay when it isn't. But if you have a question, you'll get it answered. It may not be the answer you wanted, but I can tell you it will be right answer. So good luck and again I hope you'll stay.

Stand easy and stand down, DustDevil, we'll continue from here what you started.

Fun little story about Nitro, that I think illustrates a point. A paramedic in Ontario was attending to a patient with cardiac chest pain, and was going to admisiter a Nitro spray, to use a Nitro spray properly you spray it once to prime the pump to ensure a proper dose is admisitered to the patient, the paramedic primed the spray off to the side away from himself and the patient. Unfortunately the patients large dog came around the corner with its tongue hanging out of its mouth as the medic sprayed. The dog dropped. Disclaimer: no animals were harmed in the making of this post, the dogs blood pressure recovered by the time they left, unfortunately the medics shorts may never be the same. I understand being excited (the scanner and supplies) No holding c-spine is not rocket science, but without proof of proper training, that patient could turn around and say you were the reason he cant feel his legs (lawsuits suck). If you were properly holding C-spine, how did you get him is pills? I can forgive you giving the nitro, was it the right thing to give, no, did he ask for it yeah, did you know any better, no The only thing that really irks me is that you ran from the scene when asked to stay, and I wonder why you would do that? Did you realize you did something wrong and wanted to avoid punishment? Was it lack of respect for the responding crews? Personally if I was one of the fire fighters you ran off on, and I saw you working a call even as a licensed EMT, I would have a chat with your supervisor. I dont think being a cowboy and then ducking responsibility for it would sound great for a future boss. Everyone here has learned to take a spanking for doing (or saying) something less than bright, usually by one member in particular. Learnign to accept critique, even when harsh, is an important skill in EMS. Listen and learn well young grasshopper Dan EMT

So what are your findings of the EMS system's response to your college campus? Forsyth County EMS is one of the more highly regarded one's in NC. You sure there is no reinvention of the wheel? With the system and local hospital, its a good place to get hurt. Besides, how often are there injuries necessitating EMS services? Not trying to bust your bubble, as you seem to be intelligent, trying to write proper proposals with financial constraints and statistical analysis included, but, I get the impression that you are looking for an outlet to play EMT, so those skillz won't depreciate and become stale. With such an obvious intelligence about yourself, as well as your interest in EMS, are you sure set lighting is your calling?

Its been a long time since I have posted to EMT City and must admit being provoked to once again join the action by Dr. Bledsoe's message announcing the passing of dustdevil. While I didn't know Rob personally, I did "meet" him through EMT City. Rob and I didn't necessarily see eye-to-eye at first, and continued to see things through our individual lenses. I did learn to respect and admire Rob. We had several spirited discussions within the forums and outside their confines. Rob wielded his intellect as if he were King Arthur wielding Excalibur! Those of us who found ourselves in the way of it's sharpest edge learned not to play with fire or insult Rob with pettiness, but to bring our A game to his arenas of discussion. I can tell you I am a better person for having met him through this utility and I am so very sad to learn of his suffering and his death. It is my most sincere prayer that he find peace, comfort and rest. I only wish I could have know him better and to have had the opportunity to learn more from him! RIP My Friend Randy Fugate, AKA Captainstandup

Narrow minded and bigoted answer.

Brother, let me break this down for you, and I'm not being shitty, as it can be hard to understand where people are coming from if you don't live/work in this field. You believe that you helped, that you showed that you care by leaving your home and showing up. Many others do the same, and like you, most often they harm people with their ignorance. Now, don't confuse the words ignorant and stupid. You can fix ignorance... The bent steering wheel is a huge deal to most of us here as it tells us that the pt, in one way or another, transferred a ton of energy from his body to the stearing wheel, and that almost never comes without significant injury. Almost every injury that can happen from that mechanism is going to be life threatening, and most of them will cause the medics to have a battle to control and maintain the patients perfusion. (blood pressure) Now the body will fight to keep that blood pressure up, to keep the organs fed. But by giving him the Nitro you gave him a medicine chemically designed to fight against the body's efforts to save itself. You claimed that his 'vitals were fine' but not a single paramedic in this conversation, no matter how many years they've been practicing would make that statement on this patient without taking them again and again over a period of time. If this patient had any of the injuries common with this type of accident there is a very good chance that you killed him with your treatment. It is likely a good thing that you ran away, as there is also a good chance that you would be in jail now if you hadn't. It looks, from the outside looking in, like people are doing a bunch of mindless bullshit when you watch them on scene. But most of the important stuff is happening in their heads, not in their hands. You hurt a man. You claim you wanted to help, but all here are telling you that you almost certainly harmed him instead, yet your response remains, "Well at least I did something!" This is a professional forum full of people that have payed their dues for the right to go behind the yellow tape. Most have payed with years of their lives. They are intelligent, and have the ability to help people. You should really, really not kid yourself into believing that just by running to an accident and being willing to get bloody makes you a good guy. As in this case, it doesn't. Stop pretending that you want to help by buying bandages and hanging out with the local volly squad and actually get committed to doing some good and get the education necessary to do so. In this case, this man would have been better off if you had never shown up. He would have been healthier and safer if he has sat there alone until professional responders showed up. That's not your fault, because you didn't know better. But now you do. So what are you going to do? Continue to cry about it, or get the education to Do good, instead of Pretending to do good? Not running away, and continuing to participate in the forums is a good start. If you have the balls for it. Dwayne

I offer my sincere condolences to his family and his friends. I know that I've probably done more than my share of driving him absolutely 'bat shit crazy' at times, but I have to admit that through some of the absolutely knock-down, drag-out' battles we've had, I was honored to call him 'friend'. It is because of Rob that I've not only changed my view on becoming a 'degreed medic' or 'collegiate medic', but has made me the vociferous advocate I am on trying to increase the educational requirements for entry-level EMS. I will continue the fight, and can only pray that I can bring even half of the passion and tenacity that my friend had! Rob Davis was one of those 'love him/hate him' kind of guys. There was no 'in between' with him. Like many of you 'old timers', I've spent many hours simply chatting with him in voice/video chat and in text. I can't help feeling 'cheated' that I never got to meet him in 'real time'. Because of Rob, I've gone through miles of Hell to get back where I am today. Every time I thought about just throwing in the towel, Rob would somehow intuititively know, and would magically appear and put a boot in my ass to get me moving in the right direction. For that, I will aways be in his debt. Rob never allowed any of his friends to 'half-step' along, you either marched full bore or you didn't join the formation. One of his favorite (and most used) expressions was, "Go big, or go home!"...a creedo that I've adopted along the way. Rest easy my friend, your job is done. It's now time to pass the torch, and let someone else continue the fight you and a handful of others have started. I will proudly carry that torch and light the way along the path that you have laid out!

Go ahead and complain to the politicians, who will call the Chief to answer the complaint. I am sure he will pick up the phone and call you for employment the very next day. NOT !!! That is like saying I would love to come to your superbowl party and eat chicken wings and drink all your booze, but I will not come because you asked me to bring some ice and a 2 liter. I imagine many employers will start employing this tactic, as it is expensive to send these folks to school. Every fire department has about 400 applicants for every vacant position, so I do not blame them for saying, "you pay for your own school". The reason they want you to be fire/ems is so that they do not have to pay you overtime. Again, the Chief sounds like he is running his department on a tight budget, like most are, and is making wise decisions.

I am sorry, but in a situation like the football game, you have a DUTY TO ACT. If you are so burned out that you no longer feel compassion towards your fellow man, then it is time to get a new profession. For all you know the person could have been choking on some food, and could have been saved by a simple maneuver. You should stop at all wrecks too (unless everyone is out walking around), if for no other reason to keep some untrained idiot (or a trained idiot like a Dermatologist) who stopped from doing something dumb (dragging them out of the car before it explodes like they do on TV).

Whhhhhooooaaaaa, get off your high horse. We have several volunteers in the area that have no EMS training, and it is not rocket science to put on a c-collar and hold a head up straight, would you prefer for his neck to be flopping around for another 10 minutes ? And I have reviewed my EMT book which clearly states that it is legal to assist a patient in taking their medication. The difference between me and some of you: I care enough to respond on my time off to people in need, according to another thread, most of you wouldn't even consider stopping on the side of the road to help someone.

Who cares about your bible? Who are you to be preaching here? Give me a break super medic, push your own values on your kids, not to us. really? I'm not sure why I'm responding to this.....probably just to point out this is one of the stupidest things I've ever heard on this forum.