fireflymedic

If you are let me know, would like to know if anybody off here is headed there (it's lexington this year - same time of year though - Sept 22-25). Lots of great topics on the table. It's in Lexington this year since the site in owensboro closed down. If you aren't check it out it's worth a look.

Top pay on the truck - $11.75 as a basic after 2 years and in medic class (this area tends to pay crap so that's good general starting pay at that time was between 6.50 and 7.00 - it hasn't progressed much past that except to federal minimum wage 'cause cost of living is so cheap. As a medic, one can do quite well if they have some time. In industrial running a clinic as a basic - $14.00 an hour and I did actually little more than put ice on sprains and wrap wrists. It was a cushy job and prolly would have kept it except company lost the contract and new company brought in all their own people. Medics could make a killing, almost $20 an hour plus overtime was always available. In hospital as ER tech - $16.00 an hour with shift and weekend differential. Yeah, the ER pays WELL here (if and BIG if you can manage to get past all the dang nursing students and actually get on). Now I make a nice living comparable to most nurses in a hospital in the area, so I don't complain. I didn't get in this to get rich, but I make a decent living and I like what I do. Decent paying jobs for basics are out there, you just have to look for them. Have a few friends that worked as techs for a cardiology office through paramedic school and they did quite well for themselves as well. But bottom line you want to make any money and have more options available to you, get your medic. Otherwise you probably can't afford to support yourself without working multiple jobs.

Defining moment in my life in EMS - I wasn't going to share, but I'm posting perhaps against better judgement, but I will anyway. Those that know me will instantly be aware of the story because I share it with people freely in person, and is much like AK's (by the way AK - glad you're still here with us !) But it definitely defined who I was a caregiver and gave me new eyes for my patients. There are a few things I will leave out as they are quite personal and have no place here, but this is the thing in general. Sept 11 is a day I'll never forget. It's the day I started my EMS career, the day the towers fell, and the day my life nearly came to an end. I had left that morning from my other job which was non ems related and was driving in a construction area which was very narrow as it had concrete barriers on both sides. I saw a semi coming the other way and didn't even think about it. The next thing I remember was waking up to a cop (who I've affectionately coined smokey the bear since then) and seeing how white his face was. He wasn't moving very fast and I realized I had just been involved in a wreck. My first thoughts were to see if I was stuck - I tried to pull my arms free (they were through the instrument panel of my car) and realized I was. The next thing that went through my head was "don't move your head or neck you know better". I just stayed put and as the cop walked back up to my car I can remember telling him "hey you mind getting me out of here smokey?" Usually I loved making fun of those hats, but this day, it was a site of comfort as were the sound of the sirens. It's amazing how comforting that sound can be when it's you that's in trouble. I realized I didn't hurt and kept wondering, why don't I hurt? I didn't understand why I didn't feel anything (real smart here didn't realize I was in shock eh?). The cop panicked realizing I was still alive (he seriously thought I was dead) and immediately called for a helicopter. First thing I said was "no way in hell you're flying me out, I'm fine just stuck, you can take me to the local hospital". Obviously he didn't comply - dang cops just don't listen well do they? I don't remember anything in between, but I was told I was in and out of consciousness as it took over an hour to remove me from the tangled mess of my car. They said when I was awake I kept telling them how to extricate me from my car (I didn't realize there was no front end to my car). I just knew I was pinned in there and wanted out, but I was told I never panicked, just insistent on how they should get me out. The next thing I remember was seeing a helicopter landing (dang cop) and continuing to argue with them that they weren't flying me out. I didn't win the arguement and I was loaded up. I looked into the flight medic's face and told him "just don't let me die". Evidently I became combative in flight and well we know what goes on when that happens. Evidently at some point the sedation wore off in the ER and I remember hearing them say that C5 and C6 looked funny. I can remember thinking that's why I didn't hurt and thinking through the stupid thing I learned in class about what injury correlated to what vertebrae and thinking where does that leave me? What will I still be able to do? My life is about to change. Evidently things went quite downhill after that because I was out for the next three weeks and unaware of anything. My sister later told me when she talked to my chief his first comment was "is she still alive?". My coworkers kept coming around and talking to me, telling me that everything would be okay, but I wasn't aware of it, but it was good to know they were there and cared about me. I remember the first day I was aware of anything looking around and realizing what had happened and looking down at my legs which were in casts and I willed my toes to move. I had to know if I was paralyzed or not. They moved and I thought, well at least I have function, the rest can be dealt with. The doc came in a little later and I asked him when I could go back to work and the hobbies that I loved so well. He told me it would probably never happen and I would be lucky to walk again with the damage to my legs. I had pretty much broken everything in my lower body, suffered a head injury, pulmonary embolisms, developed ARDS, and lacerated my liver and spleen. Yet somehow I had managed to live and had not damaged my spine (the cervical spine issues were just a minor abnormality in the vertebrae in my neck not a break as they originally thought). Everything hurt, but I was grateful to be alive, but I wouldn't accept not walking or returning to EMS or the other important things in my life. I loved them too much. I knew the wreck had been bad, and I needed to see the pictures for closure, so I could fully understand what had happened. Everyone except my partner at the time refused to let me see. I just kept getting the response "you don't need to see that, you don't want to". My partner went to the site where my wrecked car was and took pictures and brought them to me against everyone's advice. He was adamant though that I saw them how he showed them. The first ones looked like I expected the car would and then he showed my the side. I no longer had a front end to my car - it had literally been ripped in half. Then I saw the section of what was the driver's seat and I just couldn't take my eyes off of it. When I looked, there was no space for a person. The only reason I lived was my seat broke in the impact and when the car crumpled, I was pushed back and what was left of the front end of my car was pushed up on top of me. I went from the front seat to essentially the back seat. A few more inches and I wouldn't be here. They had to push the front end back over three feet just to get to me. To this day I look at it and wonder how anyone could survive. It took over 20 surgeries to restore my body to a functional state and I was stuck in a wheelchair unable to walk for over three months. I had to stay in a rehab facility and every day deal with extreme pain. The next obstacle was returning to work and everything I loved. My mind couldn't understand my body's limitations or accept them. I worked my butt off in therapy and a year almost to the date of the accident I got to return to work released to full duty. I have worked extremely hard since then never giving up on any of my dreams, finally completing the last phase of my recovery almost five years since the accident and celebrating it. The accident as horrible as it was made me appreciate everything I had. My friends, coworkers, family and everyone that stood by me during that time. Also, it made me appreciate what my trauma patients went through and the long road to recovery they faced. Before that I only thought of it as get them on the helicopter and to the trauma center (remember I work rural so a vast majority of severe trauma pts are flown) never once thinking of the long road to recovery they faced or the fact that their lives would be forever changed. I didn't care about that I just cared about saving their lives. Not that it was wrong, I just look at them with a different expression now, one of knowing the long road they will face ahead. I have more compassion to those in that situation and yes, it affects my work and I'm glad. If it didn't I would be concerned. For me, it took going from caregiver to the one cared for to develop that empathy for my patients, but it's made me a better person and a better caregiver. I wouldn't have it any other way. Thank you to all those that cared doesn't seem to be enough, but words will have to suffice as I don't know any other way to say it except to try to pass it on to everyone I care for. Stay safe out there.

Forget the excitement over the fact is has a pathophysiology chapter - that will be short lived as I'm sure it was. Any respecting medic class will have a dedicated section to pathophysiology equivalent to a class PRIOR to the start of the actual book. Anything you get in there should be nothing more than a review. Ideal is two college semesters of such, however, I know that department is lacking therefore, I'll settle for the alternative until we progress to that point. Glad to see we've finally managed to agree on something here !

I learned early on, don't dismiss your patient, because they are the one that will kick your butt and make you lose everything you've worked for. My second shift on the job, sparky new EMT riding a BLS only service. We get a call from a frequent flying lady who always complained of not feeling well and difficulty breathing. Everybody groaned and well, being the newbie, I got the run. Went out to her house and first thing she said is I don't feel good and I'm having a hard time breathing. We put her on the stretcher, took her out to the truck, I hooked her up to O2 and started doing a decent assessment. My partner hands me a slip of paper with the words "she just wants attention" written on it. It made me angry. I did the best I could and treated her with dignity and respect. We got her to the hospital who also knew her well and fortunately she landed under a new doc in the ER. He did a 12 lead and boom an MI - boy was I glad I had treated her as I did. It was a learning experience. My partner quit EMS altogether shortly after. We see patients of every type and fashion in EMS, some needing acute help, some needing long term help, some needing help beyond our expertise. FOr each you do the best you can, refer them to the proper sources, encourage them to get help, and pray the next time you pick them up it's not going to be their last. I'm not a "bleeding heart" and I'll be the first to say there are a good chunk that frustrate me to death some days with their frequent calls. I just keep reminding myself, we may be the only help they can get and they don't know how to ask any other way. They just might be looking to you to help them get what they need, and then again they may be hardened abusers of the system that don't care. Either way, treat with respect and you'll always be fine. Lose that and you need to walk away from this field, it's no longer for you.

Hey give 'em credit, at least they picked someone with a legitimate medical problem which is better than the vast majority of B.S. runs that we pick up. There's more than a few I've picked up that had nothing wrong with them, they just wanted a ride to town to the ER for some B.S. complaint so they could go to the liquor store and get a cab voucher home. The stopping of the hospital issuing cab vouchers helped, but unfortunately also hurt those who truly needed it - someone always has to pay for others stupidity sadly. Too bad they don't have the option of diverting to an urgent care clinic or the health clinic. You call we haul will kill us all.

I had two thoughts initially though I'm late in on the scenario - sepsis - had a patient not long ago that resembled this so it was fresh in my mind had both gram negative and positive bacteria going on - self contamination of picc line. My other thought was rocky mountain spotted fever - I know not prevalent in your area kiwi, but who knows where you dug the scenario up from? Could have been around here. This area is prevalent with ticks so lyme disease and rocky mountain spotted fever produces a very similar rash with comparable symptoms. It's been seen more than a few times. But it's a great scenario. There have been a few cases I've heard of pts having meningitis and having very little symptoms, but this guy is certainly in trouble at this point. As far as the reference to nancy caroline's book - much of it is outdated or flat wrong. Be careful what you follow within that book. Brady is a much better resource.

In this state, they require EVOC every two years. If not provided by the employer, there are various opportunities at fire schools to obtain it. I'm not sure where you are located (sorry didn't get a chance to look), but if you are around indiana, ky, ohio, or tn I can give you some great resources. There is also a college in the area that has an excellent EVOC course that I truly believe no service wide program can compare to and many services utilize them as they have a skid path and full course associated with the state police program. They offer it specific to POV, fire apparatus, or EMS vehicles. That's another common problem is finding something that has the driving portion done within POVs and not emergency vehicles. I agree the first portion could be done online, but if it does not require a driving lab, then forget it. My biggest issue with EMT basic classes - they don't involve a driving aspect (at least in this area). Many are cut loose without EVOC and may not receive it until they are employed for up to a year, the whole time driving ! Are other states like this or is this isolated to just this area?

I'd hate to know what some think of me. I'm all up for a good challenge and to learn and actually like when someone forces me to expand on something or give references to it (though I certainly try to when possible). Though some have dismissed me probably as secretive and full of crap because I refuse to tell particular things at times or state if you want to know more, to PM me as opposed to having things in open forum out of respect for those that give me that nice thing that pays the bills called a paycheck. I also tend to be quite animated and say what I think and well, if you don't like it I'm sorry. I can appreciate DwayneEMTP for that - he's a straight shooter and I like it. Vent and Dust - feel free to challenge me all day long. It is people like you that make me want to learn more (so I can argue more intelligently ! ) To even a few of the mods that I initially thought to be grumpy, I've learned over time that they really aren't. You just have to be willing to listen and learn sometimes (thanks happy feet !) and I've grown to respect them. I can't say there are many on here that I would care to work with because as one is on here and what one is to work with may be two very different things, but I think in general all try to give the best care they can. I'm in agreement with us all trying to be respectful of each other whatever the location or level. The best to you and be safe to all.

I make no arguement there squint. When the snow drifts are higher than I am tall (hell the snow fall is almost as much as I am tall !) then yeah maybe you can't see us !

You are sick lone, so very, very sick. By the way, how did this get moved to non ems discussion? It started off as one !

hey squint, only one problem I'm already married, but let me know when white is the flavor of the month ! But dang you for telling - I was going to tell them I was purple and claim color persecution ! Or why not blue since that seems to be the color of interest this month....

Squint - man I wish it was easy to get immigrant status ! When I was looking at applying for citizenship when I was going to stay there due to a great job (still wish I had to a point but all well) they wanted proof I had a job already lined up, could support myself, etc...was a major pain. School eventually ended up calling me back so I came back to the USA, but I'm still quite fond of canada eh?

Well noted chris, and it can have as many arms, legs, and heads as you desire.....

Man have we wandered off topic here. Now we have blue mice juvenile delinquents OH DEAR !

When I speak of ignorance I am referring to a lack of knowledge in how to deflate properly not stupidity. Ignorance in that aspect can be fixed by education on how to properly deflate. Stupidity unfortunately can't be fixed. It was not meant as an insult, it was only meant to show that there is a lack of knowledge there. One could say we all start out ignorant in EMS but that is corrected by education. The stupid ones that start off are the ones that don't pass or drop out or unfortunately pass and make it on the streets as the partner you want to kill daily....

Okay, I'll give you all that don't know me very well off the board the benefit of the doubt, but I was being a bit of a smart one here. I found it hysterically funny that they even considered injecting blue dye into mice - I mean come on, what did they expect to happen? And what are they proposing - we turn our patients into smurfs? Speaking of which, the smurfs were full of that stuff, bet they never had issues with spinal cord injuries. I was just sitting back thinking wow, just when I thought I heard it all we are turning mice blue in the name of science. It didn't give specifics as to the type of injury, how the injury occurred, etc so obviously as someone said it is off the hand reporting, but hey, I'll take one blue mouse !

Not to be cruel or sound extremely harsh, but that is a chance that they took. They understood when they got on that boat or made that trek that they stood a chance of being caught and if so being deported back. I understand that they are trying to make a better life for themselves, but do so legally please. If you come to this country legally and are working, paying taxes, like the remainder of americans I am all for doing everything in my power to help you. If not, I believe provide the stabilizing care and send you back to face the consequences of your actions. America is a very inviting country, unlike some other countries, we do not require you to prove that you can support yourself when you come here, some are "married" just to get here, among other things. If you want to come legally, chances are we will let you in. I believe in people's right to pursue a better life and I know at some point the vast majority of us came from immigrants. However, they did so legally. If you are an illegal immigrant decendant, I seriously pray at some point they pursued becoming legal. Having worked within a career outside of EMS which is predominantly run by illegal immigrants (to the point that immigration buses are brought through every few months to deport the illegals) I found frustration. I will be the first to say, many were excellent workers and worked hard because they were trying to provide for their families back home. However, I felt frustration in that I was working just as hard and receiving less money as I was being taxed and had to work almost double the hours to make the same amount of money as they did illegally. From the EMS perspective, I see they are receiving free medical care and it angers me, not that we provide the care, but it is at an increasing cost to legal americans and we cannot provide the same coverage to our own. I see some leaving AMA that desperately need treatment or not going to the hospital until they are nearly dead because they know they will not be able to pay the hospital bills. Collections are pursued on those that do try to obtain care and they are gone after for everything they have. Illegals on the other hand are not gone after because the places know that they will be unable to collect as they leave no paper trail. I experienced a severe car wreck nearly five years ago and went through a vast amount of medical bills. I am still paying them off even with very good insurance coverage. I know many others like myself. Yet an illegal receives the same care and will not have to pay for it. How fair is that to us? I am not coming down on you vent as you know I respect your opinions, but what do you propose as a suggestion to solve the problem from both sides? I'm all for hearing an idea to serve both communities in a fair manner.

Indeed mobey - but my thoughts are at what point do we decide the patient with decreased or altered mental status is suffering that due to a head injury or lack of brain perfusion? Certain times we are able determine CPP and maintaining the ideal MAP of 50-60 depending upon which text and physician you decide to follow though I have found 60 to be the general accepted number. Within the critical care community you may occasionally transport patients with ICP monitors and thus be able to determine CPP, otherwise as you stated at this point you cannot determine it within the field. Unfortunately I think at this point, despite the positive evidence that was out for some blood product alternatives the research into that area has been postponed for a good bit. The one area I am curious of is the trial which is using albumin for stroke patients...the military currently to my understanding from a military medic friend of mine is that they are using the very thing which we do not carry for patients with extensive blood loss within the field - dextran seems to be a big choice. They have higher survival rates as it is a volume expander, not replacement as current options we are using (ie LR or NS). Most of our advances have come from military medicine, so perhaps this is the new frontier for us to follow and trucks will begin carrying these within the near future especially as research on blood substitutes such as polyheme are halted for the moment. Though understand the polyheme trial one of the excluding criteria was head injury.... I'm interested to see where this research takes us. Hopefully to great improvements in patient care !

You don't believe it? Here you go http://www.cnn.com/2009/HEALTH/07/28/spina...eref=rss_health

Frankee - that is similar to our mentality, however we are discussing unconscious patients or those on the brink, not conscious mentating patients - that's a whole nother ballgame. Obviously consciousness is the biggest determining factor in how well the brain is being perfused. Thanks !

Recently while at a conference a respected trauma surgeon in our area made the comment that the accepted permissive hypotension level of 90 systolic while acceptable actual was not the optimal level at which patients survived. Based on the data he showed us (which is far to extensive to link here if you wish for it, please PM me and I will attach) the optimal level of survival was at 110 systolic. Now I know this is still an area of gray and great debate as the arguement still lies between trauma surgeons and neurosurgeons as to the level at which survival is optimal and produces a functional patient in the end. The argument is that we are saving patients but at an increased risk to brain function. With what was informed to us at this conference, the level of 110 does not significantly increase the risk of bleeding out much more than 90, still adequately perfuses the brain, producing not only an alive patient, but a patient with the greatest chance of recovering function and not having injury due to ischemia. Granted this was his first go around with this but the information shared was interesting and is really making some of us wonder. This physician is well respected within this area for research so it's posing a question to us is the acceptable level of permissive hypotension really correct or should it be a bit higher? I'm not trying to throw current research to the wind but the current level has both neuros and trauma docs in a debate over who wins - perhaps we raise the level a bit it may reach an agreement between the two and improve patient care? Thoughts?

I have mixed feelings on this. While I think we have a responsibility to provide appropriate stabilizing care to the illegal immigrants (per emtla) we do to everyone. However, as far as long term care, I think we are under no responsibility if american citizens are required to pay for the care. If they are paying privately for this care, by all means allow it to continue. My problem here lies in the fact that we can barely take care of our own. I see seniors taking their dogs medication because it is cheaper to purchase through the vet than through the pharmacy. Children that have things that could be fixed being refused because their parents do not have medication. People who worked hard all their life being denied care outside of the ER because they don't have insurance. It's not because they are lazy, it's because they just happen to land in that unfortunate bit of not poor enough to get charity and too poor to afford it on their own. That's why the ER is becoming the primary care clinic of the new century and that "specialty" is dwindling in students pursuing it. If we are providing a service to an illegal immigrant, we should be willing to provide it to an american citizen, the same way, free of charge. I'm not saying let the illegals die, I'm saying stabilize them, then deport for their own country to care for. Any other country would most likely do so to an american citizen that could not cover costs in some form or another. We have physicians who are all gung ho on going to "underprivledged" countries to take care of the poor little children. And yes, I feel bad for them, but heaven forbid an american child walk in their office that their parents can't afford to pay for an operation and can't get insurance despite their best attempts. They certainly aren't going to volunteer the great majority of the time. Yet we praise them for their good efforts overseas. My theory always has been and always will be - take care of your own first, and once they are all cared for, take care of someone else. America would do good to follow this thought.

Here over my career I went from seeing them still being written within protocols and being used in circumstances when I think they were beneficial to not even existing on a truck or being so covered in dust and not maintained you wondered about the integrity of them. They are no longer taught in class and students are basically ignorant about them. Granted most of my work has been in primarily extremely rural areas (over 30 min transport at best as long as 2 hours at worst) though I did do some urban time for about a year for a change in pace. I never saw them on a truck during my city time. You can still find them occasionally on a rural truck depending upon the service and their director. The biggest problem faced (at least here) wasn't so much picking the appropriate patient for them as many were and respectable results were seen (remember our transport time and general level of care when I started was one medic per shift in whole county so call it BLS). The problem was ignorant hospital personnel that did not know how to properly deflate them as they had not been trained to deal with them or ignored that giant thing on them that says "do not cut" *sigh*. I think that and the amount of time it took to apply them along with the eventual upgrading of the vast majority of the services to ALS trucks opposed to one ALS truck or a medic on call if you were lucky sealed their fate and they were dismissed. Given the right circumstances, I think they may still have a place, but the ignorance on the part of hospital staff now and fair amount of new EMS personnel make them pointless.

Here with the exception of meds (ie glucose, asprin, etc) there is very very little difference in the first responder course and emt basic. Don't waste your time with a piddly FR course - go ahead and do an accelerated emt b course especially for what you are doing. We're not talking rocket science here. It's basic common sense (of course I know many are lacking in that and therefore cannot pass the class *sigh*). Have to admit, I like the proper name for bodyguard... Best luck to you. I can't help you as of FL specifics other than to say contact the state board as alot of times they will maintain a list of educational facilities that you can call and ask for assistance. In my area, the first responder is basically been phased out to the level of basic even within PD and FD. Any paid FD requires you to be a minimum of a basic in order to work there (ie to do their own rehab state wouldn't allow just a FR to do so they were required to have a buggy at each scene which was a pain). Even within most of the volunteer depts they are upgrading. Also we'll be adopting the new classifications shortly and I think that pretty much makes a first responder useless. Best wishes to you and stay safe.