Riblett

Hello EMS friends, I will be traveling to the UK and Ireland in June 2019 (next month!) and I am hoping to learn more about the EMS systems in England, Wales, Scottland, and Ireland first hand. The process of cold contacting all these agencies seems overwhelming (although I will if needed). My excitement was dashed a bit when I read on their website that London Ambulance Service does not do ride alongs. But they will allow other healthcare providers to visit with the proper paperwork. To my colleagues across the pond: Can you give me any insight into how to approach this? Do you know of any 911 agencies that would allow an international ride along? Where should I start? A bit about me. I am a paramedic of over ten years and an EMS instructor. I am also a nurse practitioner specializing in emergency medicine and a former ER nurse. I can provide all manner of background checks and letters of introduction/recommendation from my employers and faculty. Is this realistic? Can it be done? Thank you in advance.

Thanks for the insight, Mike. To answer your question, the severe electrolyte deficiencies resulting in hospitalization has me very concerned.

Conflicted in this scenario so I am putting out for the masses to advise. I'll keep it fairly to the point. Scenario: You have a new EMT join your volunteer squad who is a non-insulin dependent diabetic. They take oral hypoglycemic agents. This EMT has experienced multiple incidents involving low blood sugar while on duty or otherwise present at the station. Incidents have been varied in severity, but all resulting in inability to function in a patient care role. This EMT is considerably overweight and is openly engaging in crash dieting and you think the two are obviously connected. They have also been treated at the ER for fluid/electrolyte issues. They have been mandated by the chief to check their blood sugar every two hours while on duty; seems compliant. Also been mandated to consume a meal BEFORE reporting for duty, since they may have a call right at shift change and be unable to eat. They habitually fail to eat prior to reporting for duty and seem very hesitant to eat unless they start to feel sick. As a squad officer, what do you do? 1. At what point do you suspend them from duty? Is there any possibility that doing so could be considered discriminatory? 2. What conditions would you put in place if you were to allow them to return? (written contract, perpetual third rider status, MD letter, etc) 3. At what point do you consider contacting family/parents, etc due to suspected life threatening eating disorder? Age 19. You also have some suspicions of histrionic/Munchausen type behaviors.

Hi Folks, Trying to help my little sister in law transition from North Carolina to Wisconsin. I am a paramedic here in NC and she is a cadet who has passed her EMT-Basic class and test; still waiting for the 18th birthday in a few weeks for her certification to be issued. Yes, I corrupted her with the dark world of EMS Unfortunately, my experience and contacts have fallen short of being any assistance in this move so far. Anyway, she is moving with the parents to Wisconsin at the end of August. They are moving to the Oshkosh area and living in the Neenah area. She is going to UW at Oshkosh in the fall, undecided with college major for now. She really wants to volunteer and eventually work as an EMT in WI. She would like to consider Paramedic or Intermediate education there as well, but we are not sure where to start. Being from NC and 17 she has no fire background and no experience besides cadet. Does anyone here know how the EMS systems there are structured and what her options might be? How is EMS education structured there? Any tips or advice you can offer one of our profession's young in this unknown land ? Thanks a bunch for any insight you have.

So I have not been on EMT City for a while now, but I guess I might find some like minds or at least some folks with similar experiences here. A little background, I am currently a paramedic and an EMS instructor. I have been in EMS for eight years, five at the paramedic level, two as an Intermediate, and one as a Basic. I have an AAS in EMS and a BS in Health Science with a concentration in health care provider education. After several years of prerequisites and applications, this past year I finally got into nursing school with the hopes of being a nurse practitioner. Yay for me...or so I thought. Accelerated BSN program was where I ended up. I am currently in my second semester out of five and frankly I WANT OUT! I am so incredibly frustrated with the whole experience. My grades are good enough, usually top 25% of my class for nearly everything, but they are driving me crazy. These nursing instructors defy the laws of physics by simply getting their heads through the classroom doors in the morning. They are rude, condescending, unorganized, and frankly treat the students like something they scraped off the bottom of their shoe. They make the cockiest brattiest new medic seem as humble and gracious as a saint. They seem to pride themselves on being so incredibly esoteric and complicating even the simplest of information to the point of exasperation And to make it worse, they don't even seem to have the knowledge to back it up. They make blatant and irreconcilable errors in the information they present. Examples: A-fib is a shock-able rhythm. Narcotic antagonists are a class of pain medicines. Hemorrhoids are weak muscles. Give aspirin to stroke patients. These are just some examples I have recalled in the last thirty seconds. And if I pick up on these I wonder how many more there are that I simply don't know any better than what they are saying. I should say that I have actually had two awesome professors, who exceeded my expectations in their teaching abilities and clinical knowledge. But the rest of the instructors, I can't even describe. Their lectures are God awful. It seems that none of what I study is on the exams. I have tried the textbook, the lectures, study groups and everything. But the tests come around and it seems like the test was taken from another class or another school. And when everyone fails, the instructor are oblivious to the fact that they might need to do something a little different. There also seems to be complete and total lack of consistency in practical skills evaluations. Clinical skills evaluations are something I have done as an instructor for many years, and I find it very disturbing to see one student pass a station and the next student failed for doing the exact same thing. The entire profession seems to have chip on their shoulder bigger than the US deficit. They are more concerned about teaching students nursing theory and how nurses are "professionals in their own right." etc. I wish they spent half as much time and effort actually teaching factual information and skills. And "nursing diagnosis" OMG. A collection of esoteric BS which does nothing other than satisfy some inferiority complex nurses have against the MDs. Google it if you haven't ever heard of it. I would NEVER treat any of my students the way we are treated. We are talked down to, screamed at, made to feel stupid in front of patients, family members, and class mates. And to make the process way more degrading, we have to wear see through white scrubs. That is right, see through clothes. And an apron. ​ And being on a geriatric floor in that outfit means basically having a sign on your back that says "free adult diaper changes." I have spent so much time and money to get here, but frankly I am so stressed I don't know if it is worth it. I dread getting out of bed in the mornings. Anyone else take the RN path? How did it go? How did you cope with any issues you had? Am I just at a bad school? What should I do differently? On the first day of class we had to go around the room and tell our names, backgrounds, and previous education. After myself and the military corpsman did ours, the instructor went on a ten minute rampage about how inferior medics are and how they shouldn't be allowed to do anything other than take people to the hospital, etc. (My paramedic education was six semesters, full time, no cook book medicine. I don't get frustrated with having to learn theory. In fact, I value an appropriate amount of theoretical education. All my EMT Basic students walk into their state exam able to describe in their own words the pathophysiology behind every major emergency condition we see, the ins and outs of every drug they give, and how and why to do every skill in their scope, but I digress )

I am back guys, got stuck at a station with no wifi for 24 hours (deplorable, I know!) So most of my students are under 25 years old, mostly young volunteer firefighters. Maturity level has certainly not been the highest with this group, but I do have some very good ones. After the behavior seemed to make a female student I was using as a patient uncomfortable I changed it to where I was acting as the patient. I made them conduct the physical assessment on me. Which, on a side note, is a whole different outlook on grading your student performance. I think I may put myself in the patient role more often and have a student or assistant instructor calling the scenario. It was a double edged sword in that it stopped all giggling and immature behavior, but it made the ones who were uncomfortable touching female 'patients' even more nervous. Taking your advice I cracked down and reset the tone of their scenarios. During end of chapter skills check off I told them point blank that if they laughed or did anything inappropriate their scenario stops, they receive an automatic fail, and will have to remediate outside normal class hours. I was the patient and had an assistant instructor calling the scenario. We evaluated them as a team.

I am having some difficulty getting my EMT students to conduct assessments appropriately, particularly on opposite gender 'patients.' The female students don't seem to have an issue with it. Some of the male students don't take it seriously and laugh the whole time. Others are so uncomfortable that the stammer through the whole thing and don't do an accurate assessment because they are too scared to actually touch their classmate. I am not talking about ob/gyn type stuff here, just your typical secondary survey (head to toe) on a fully clothed fellow student. Obviously this involves assessing the chest area to assess the clavicles, ribs, and sternum, but I (a female instructor) am always present when they are doing opposite gender practice assessments. I try to make sure they can practice assessing patients of both genders, but now I am reconsidering. Should we not be making our students peform assessments on opposite gender during their class? Should we allow them to opt out? How will this effect their ability to perform them in the field?

Crochity, I am not saying that payment was an issue in this case. I was saying that your description of the ER was not accurate. They are more than capable of treating pediatric patients, and do so quite often. What they lack is the ability to admit those requiring ICU care. I think that this case has everything to do with EMTALA. Its sole purpose is to ensure equal care for all and prevent hospitals from transferring patients inappropriately. If we routinely circumvent it by transferring patients from the waiting room that have not been screened, stabilized, and certified for transport we open ourselves up to huge liability. If we take part in these transfers, what is to stop them from being performed in the future based on a persons ability to pay, etc? As I said, if the hospitals know we'll bypass the laws and just transfer them then why not just leave the ones they don't want to treat in the waiting room?

Crochity, I am the OP. And that was not the case.

And does you opinion change based on the level of your emergency? I mean, toe pain versus crushing chest pain for example.

This hospital typically does not admit peds, but if the child was truly unstable we would have taken them to that hospital to be stabilized anyway. It is the only hospital in our county and sees plenty of pediatric walk-ins. All other hospitals, those with specializations or admissions area minimum of 45 minutes away. It seems almost counterintuitive, because if it was enough of an emergency to need an emergency ambulance then it was enough of an emergency for them to need stabilization. If it wasn't enough of an emergency to really need the ambulance, then sit down and wait your turn. I respectfully disagree with the assessment of an emergency is an emergency no matter where it is. That is why they are in an EMERGENCY department. As much as we try to think of ourselves as high level care givers we need to realize that our ultimate goal is transportation to definitive care, which may include stabilization at an intermediary facility. If the patient is in the ER already then EMS should not be responding. Quality of care at the hospital, ED and ward, is beyond our level of responsibility. If we allow this sort of thing to take place, then what is to stop anyone is a minor ailment from getting annoyed with waiting too long and calling 911 from the waiting room? ER's do triage for a reason. Also, EMTALA is in place for a reason. If we start transferring patients out of the waiting room, not only to do we open ourselves up to liability, but provide an avenue to EMTALA to be circumvented by hospitals. A patient doesn't have insurance? Well if we leave them in the waiting room long enough they'll call 911 and get taken to another hospital. Skip evaluating them, skip stabilization, and skip facility acceptance or transfer paperwork! Just my $.02.

And before someone takes away my special points, I am aware of previous discussions of the topic from 2007.

A few nights ago, one of our County units was dispatched to the waiting room of the local community hospital. I was at another station, so I don't have a lot of details. Apparently someone called 911 from the waiting room and it came through EMD as "breathing problems." The patient was a two month old male according to dispatch. This community hospital is does not really do high acuity pediatrics, cath lab, OB, etc. But they do stabilize and transfer. This was not a transfer orchestrated by ED staff, those are paged out differently and usually go through a contracted agency. This person apparently called from the waiting room and demanded they and their baby be taken to a hospital in a neighboring county approximately 45 minutes away. The kid must not have been in that bad of shape because they crew marked en route to the other hospital "routine traffic." I don't really understand why dispatch sent an ambulance to begin with without contacting the charge nurse or something. They were already in the ER. If an emergency transfer was needed, the staff would have called for it. Should the crew have even transported this patient? It seem to me that unless they patient's guardian signed out AMA this would be an EMTALA violation and open the EMS crew up to liability. But even if they did, suppose the kid really was in bad shape or became that way and died en route to the other hospital? We have rules in place to keep unstable patients from being shifted between hospitals for just this reason. And to be sure if this child had suffered a negative outcome the lawyers would be coming after that EMS crew for negligence.

I am pretty sure it was the amniotic sac. I have seen the placenta a couple times before and it didn't look like that. This girl was visiting her boyfriend at college and lives in another part of the state. So she had no relationship with any OB in the area. There was no doc in the ward when we got there. They paged the on-call OB when we brought her in. The nurses were really not helpful. I still don't know the outcome. The only thing I was sure of on this call was that my partner was experiencing an acute Zofran deficiency