azemt2007

I want to thank all of you for adding your perspective and insight on this topic. I appreciate that all the discussion was positive and I can tell you are passionate about what you do as I am. I have taken it upon myself to reach out to a friend of mine who is a network television anchor news reporter and we will be discussing this topic in great detail. I will be bringing a culmination of all of your insights with me to share so this will be the first step in the right direction....I hope. I am all for education but at the same token I think it has to be tempered with need. Does it make sense to require a bachelors degree for the EMT-Basic that has a scope of practice that is very limited as in Los Angeles County? Before we can make substantial changes in education requirements, we need to get every state, every county/burough/parish on the same page. Just an aside, did you know that in LA County, paramedics are not even taught how to read a 12-lead ECG in the county course? Did you know that the protocols don't allow the paramedic to interpret the 12-lead even if they are trained? We are told to just read what the machine determines...which we know 90% of the time is either totally incorrect or at least partially incorrect. Paramedics in LA County (and because I'm new to this system and appauled at the care given and the expectations of this system is why I keep referring to it), operate below the National Registry and DOT standard for rendering care because the county determined that the 10% of paramedics that were not able to meet national standards but had been allowed to work here, would require increased costs to bring their skills and knowledge to the national level, it was cheaper to just lower the scope of practice. So even in the areas where education is supposedly prized and mandated, those officials are working against us even though they don't realize it.

I'm finishing my Bachelor's of Science in Paramedicine in February 2013. Guess what that will get me? 0 pay increase, 0 respect increase from my employers, and only a handful of people know it's possible to get an undergraduate degree in that! I'm constantly staying up on new fronts in EMS and trying to stay ahead of the continuing education train. Unfortunately in the states, if you aren't part of a fire service that does EMS (here on the west coast), you won't receive the pay or the respect. I do know a very few areas of California that pay medics around $19/hour however there is typically an 800 person waiting list for 1 opening.

So I'm hoping for some positive involvement in this topic. This is not a hate thread as I love what I do and at the same time I hate going to work. The frustration stems from working in private ambulance for the past 5 years. I realize we are not all Rhode Scholars in EMS, (I have met many truly brilliant people in my career) but we are paid horribly and treated with even less respect by our employers. How many of you go to a station that the health department would condemn in any other situation yet our employers continue to allow to deteriorate? How many of you have supervisors that are not there to help you do a better job but are there to wait for you to make a mistake and discipline you? I know this sounds like venting but it's not really. I want to make a change in EMS. I still hold on to ideals that one person can start the ball rolling for change. So here are the issues that are important to me. See if you have the same or want to add some. Let's get together as a community and start to support one another. Issue #1: We may not spend 4 years going to school to be an EMT or Paramedic, however we do have to treat the sick, injured, and yes stupid with a smile and the best effort. Sometimes we even take part or are a major factor in saving someone's life. So why not pay us what we are worth? I mean I'm not talking $100k incomes but $8-9/hour for an EMT, $10-12/hour for a Paramedic...seriously? Issue #2: Public perception is a huge one. The west coast has glamorized being a firefighter...mostly after 9/11. Firefighters in the LA area often make more than $125k per year and rarely run fire calls. 90% of emergency calls with fire departments in the LA area are medical, yet private ambulance is who transports these patients and provides care are not acknowledged. I love my fire brotheren as I was also a reserve firefighter/paramedic. However, I will have to say this, not to be hateful, but the LA area has some of the poorest quality paramedics of any system I have ever worked in, yet the EMTs are some of the hardest working. So how do we change the public perception of us? How do we change how our employers perceive us?

just goes to show you, regardless of compression rates, early cpr/defib is still the best chance of survival. I'd rather have someone doing compressions a bit too slow than too fast as we all know it does not allow the heart to fill fully before the next compression. These guys were cool, collected and as Dwayne stated, communicated efficiently and effectively as a team. I've never seen a code run that smoothly in the hospitals I run to.

First of all, I'm not a newbie to the forum as I haven't posted in a while (especially after the start of charging for the chat), if you noticed, I joined in april 2007. Secondly, I never referenced the surgery she had when i stated she had lost her atrial kick from the afib, which would cause a lower ejection fraction by itself. Third, I did read the post hence when I said, "...degraded ejection fraction is not surprising, especially as time from surgical repair increases," basing that statement on the fact that she did have surgery and just quite possibly, she has a recurrence of the original problem. Fourth, yes she is 82 years old and it is not uncommon for someone of 80 y/o to have transplant or vad, one in particular, Carrol Shelby (of the car fame) had his done late 70's or early in his 80's. Fifth, I never suggested treating this patient in the field, merely speculating since brainstorming is always fun and educational. I never claim to know all the answers, hence I used the terms I suspect, not I know. Finally, as an elite member of the forum and fellow arizonan, I would have figured you would be more polite in posting rather than mocking someone who took an interest in your post, albeit dead (whatever the hell that means since the prior post was 10 days previous to mine).

after looking at everyone's great considerations and your patien'ts family member's awesome history, I would conclude this: First you identified the patient's underlying rhythm as A-Fib. That being said, ami is not a med i would choose since the side effects to this patient are by far greater risk than the benefits. I would consider cardizem or verapamil if there was witnessed runs of vtach/sinus tach. Again that is making you read the ekg a bit closer as you stated the qRs complexes are wide. Keep in mind, this patient has lost her atrial kick so having a degraded ejection fraction is not surprising, especially as time from surgical repair increases. Furthermore, palpatations are often mimicked by abarencies within the A-Fib, often from re-entry type pathways. Additionally, her heart failure is in both ventricles, so she probably has an enlarged heart creating a much larger surface area for the conduction, slowing conduction volicity, resulting in wider than normal qRs complexes. My suspicion is that she has mitral regurgitation to the degree that she can actually feel it. In combination with her A-Fib, this will definitely allow the myocardial cells to become irritable. I would suspect this lady is toward the point of needing a VAD or transplant.

This is one topic I can weigh in on with some experience. I have been in EMS for 5 years. Before that I ran a successful architectural firm in AZ. After career burnout, the only option was to pursue my first childhood dream...becoming a paramedic. I never took into account the financial aspect and how substantially lower the pay would be. Until the industry is recognized for it's merit rather than it's perception, we will continue to be underpaid. EMT's are a dime a dozen as said already because for every town, there is a college that holds EMT classes. The same type of situation with medical assistants. The demand for EMT's and Paramedics has dropped since most private ambulance services have been a stepping stone for people trying to get into the fire service (where fire and ems are combined). With the schools still turning out the EMTs and Paramedics, but the municipal services cutting back on hiring, there has for the first time in 40 years been a surplus of EMTs and Paramedics. How I got my foot in the door? I drove 500 miles one way to work for a friend's ambulance company where my folks live. The more rural services are willing to take a chance on a green newbie because they don't have the option of picking among 200 applicants for one job. My advice as already stated in the thread is to look in the rural areas. Make the sacrifice if you can afford it to drive and get the 1 year experience under your belt. You will be much more marketable to the urban services once you do.

Here in the west, we have very few if any volly services. As such, the state has divided into areas of response and awarded them to private or municipal ems agencies. Those specific agencies each have their own medical director that oversees the area. State law does not protect nor grant a paramedic that does not work under that medical director to provide ALS care off duty unless there is already a prior arrangement with that particular medical director. Each base station has a base medical physician, then there is a medical director above them. So there wouldn't be any stepping on toes per sei as there is one director for each response area.

when I worked in the greater phoenix area, helos were way over-utilized. Even in rush hour traffic, I could usually beat a helo to the hospital running code 3. There is always the argument that running code 3 is more dangerous and potentially more expensive if causing an accident than just flying the patient. In the end, it's really based upon the severity of the patient. If that patient is going to expire if it takes just one more minute to go via ground, then the medic stating that as his reasons should buy a crystal ball. flights aren't cheap. in my area, they cost $17,000 to the patient or insurance just to transport...more if the flight medic/rn touches them. So we need to be more aware of what we are doing to our patients, during and after the call.

with my cardiology III I can hear a nhat fart from 1000 yards

This may anger some of you and may ring true with others but my opinion is this: First, if you have enough time to take pictures of the patient while on scene, you need to go to journalism school and forget ems since you are not there doing what you are supposed to be doing. Second, I've never met an ER doc that asked to see pics of the scene or the patient's condition. Even if it was an extended transport, neither he nor I have time to mess around with taking pics and sending them. Third, do you think it's respectful to the patient aside from all the HIPPA bullshit and would you want some EMT/medic photographing you or your family when they are injured? Aside from all that, once the scene has been wrapped up and all that's left is the vehicles or the charred out house, pictures are ok to show severity of the scene as reference for later education or information for litigation/insurance. Most scenes require too much focus to be taking away from it by worrying about picture taking.

"zaps Kiwi" be nice, he's new to the ranks. Welcome Anton, hope you enjoy your new career and make a positive difference.

Having read through the entire thread, thought I would add from my few years of experience. I worked in a rural area of CA, rare to find that now but I digress. Often times when off duty, I was closer by 10-15 min. than the fastest responding ambulance. As such when I would visit family (I was one of those weird people that would commute 500 miles one way to work for a friend's ambulance company in my hometown), I would be on call and be paid for any call i was dispatched to. My boss made sure I had a full ALS jump bag and monitor and I would respond POV, stabilize the patient if necessary and ride in with the ambo. I would get $50 per call. Aside from that, I never used that jump bag for anything off duty. I'm not sure how it works back east or in the midwest, but where I am licensed/certified (Arizona, California, Nevada), Paramedics cannot freelance (meaning cannot operate at an ALS level if not on duty) unless specifically directed to in advance by the medical director for that region/area. That being said, I would stop at serious MVA's to make sure everyone was ok and offer BLS care only if necessary. If people were up and walking around and the damage to the vehicles was not significant, I would keep driving, notify the highway patrol dispatch and continue on my trip. One of the contentious arguments in Paramedic school was if you stopped, someone obviously needed ALS treatment and you had the supplies/equipment, would you do it? My answer is NO. I would like to but I wouldn't since the Good Samaritan Law does not cover you in that sense. And in most cases, especially trauma, there isn't much ALS procedures can do to change the outcome of the patient. I respect anyone that has the conviction to try and save the world. Most of the people like that are very good hearted and caring people. Now if you have multiple scanners, decorate your car like an ambulance, and stop at every accident scene and put on your EMS jacket, you might be a whacker and a bit creepy. I don't work for that small service anymore and have been primarily in the big city working. Not much reason to stop unless someone is under a car or it's on fire. Response times are usually less than 6 min. and transport times are usually even less. If I stop, I'm usually just in the way since each crew has a process by which they run a call. Besides, who am I to piss in their pool?

My only advice on this subject, having been through the hiring process as of late (with budget cuts and job cuts), is your first impression. Having a resume that dresses up what your qualifications are will make the difference between having it sent to the round file or the recruitment file. Salesmanship is the way in these days to any job. Example; "spent 3 months volunteer time on rural fire rescue." Change that to "provided ALS and BLS care to emergent and inter-facility patients within state and county guidelines with a rural ambulance service." My grandpa used to say, "if you can't dazzle em with brilliance, baffle em with bullshit!" He was right. How you word your credentials and experience in a resume can change the perception of how good of a candidate you are. Make good use of your experiences during your field rotations and play them up. If you only got 3 intubations, make them sound good. My rule of thumb is write it down as good as you would embelish it when you tell your friends! Good luck on the hunt.

From what I see, anytime you have someone willing to do anything it takes to make money, they'll find a way. Our current society seems to produce laziness and the hunt for a fast buck. Yes the taxpayers are being burdened beyond belief with the corruption but what about the poor patients that are being shuffled around to places that are unnecessary for reasons they can't comprehend? I got into this whacky business to help people and in the houston area, it seems they have lost sight of that. I realize it's a grossly huge example of corruption in EMS but in same ways I think it's very indictive of the business model most private/for-profit ambulance services operate on...the bottom line. As I stated in another thread, most private EMS services will run their people ragged and push the burn out envelope to squeeze out a bit more money, then only update systems/equipment when almost forced by the government regulators. I don't think we need more regulations in the Houston situation, but we need more medicare enforcement. Clearly from the article, 2 enforcement/investigators for the Houston area is not enough when you have over 300 services operating.