fireflymedic

Sadly this situation isn't isolated to just that area. Two years ago there was a huge medicare crackdown on the renal roundup in this area and more than a few services lost a good majority of their patients because they had physician statements of neccessity, but in all reality didn't need an ambulance at all for transport. They just didn't want to pay the absurd gas prices so instead they planned for EMS to pick up the tab. It was overwhelming the systems and the patient load was incredible. Well, somehow someone gave medicare a whiff of what was going on and there was one area in particular that went from 40 patients to 7 patients. It still goes on around the area, but since that crackdown it's alot better. Amazing what people will do to fraud.

Around here the general rule with places you care to work is no more than 3 points on a license and no more than one wreck within the preceding 3 years. DUI and other serious infractions such as suspended driving, etc automatically disqualify you. Minor stuff like registration, etc tend to be overlooked especially if dismissed. Also, there are things here called "shelf tickets". These are a speeding ticket that you might receive but do not receive points for and if you have not had a ticket within the last two years and do not receive another within 6 months is dismissed and you pay nothing. Essentially it is as if you never got the ticket. If you do get another ticket, then you pay both tickets and get double the points on your license. Not all counties do this, but those that do, it's a handy little thing. My last service if an employee received a shelf ticket, they were put on probationary driving status during the period and if they received another they lost their driving privledges for 6 months. Any serious infraction and they were terminated. Also a consistent history of accidents etc was looked at on a time basis and record since. For example if you had two wrecks five years ago and no tickets or anything since you would probably still get hired if you were best qualified. If it was last year, you probably would not. Granted we also had a 25 to drive rule which eliminated the typical 21 and under stupidity. However, there are a variety of dump services around here that will hire anything including anything that is 18 and has a pulse regardless of whether it has a valid driver's license or not (yeah there's been more than a few pegged that were driving ambulances on suspensions). It just depends on what you are willing to work. Give it time and no serious infractions and you should be just fine. Around here checks run between 5 and 7 years back.

Hey there, Any of you that know Greg know what a great guy he is and I wish him a speedy recovery. He's somebody you could truly respect in his patient care and just as an all around person. Hopefully he'll be better soon and back to work. Here's a link to the story. http://www.wlextv.com/global/story.asp?s=10793813

Ruff - had you caught me a few months earlier, I might be up for a change, but I'm quite happy where I am right now, but I would have welcomed the chance to work with you. Best of luck in your search for a great person.

THanks to all who sent kind words and didn't act like I was playing a drama queen on here. I simply had my friend post here because it's easier than posting in mulitple places and a vast majority of my "real" and internet friends are on here. I'm back home and all is well. Will hopefully be back at work sooner than later, but have to have a meeting with the med director first. Thanks Again!

Hello, Fireflymedic asked me to post so I did not have to IM multiple people or keeping saying the same thing over and over. We both use the same compl and she was logged on permanent, so I didn't have to do so. I also know several she knows and workks with read the board. She is currently in serious condition at Atrium Medical Center in Ohio - in the CICU. Obviously she will not be at work for some time. If anyone would like additional information regarding the situation, they may contact the hosptital - I believe is is middletown, oh - and is atium medical center. If you want to know anymore PM on here as I will occasionally check and would prefer certain information unavailavle. Thank you for your prayers. Friend of Firefly

Spenac - Point well noted, which is why I phrased it as a concern. Some programs are better than others and as I said - I have noticed some places are better than others in my limited experience. As I stated above, I'm no expert on online programs by any means. I'm just curious to see how things works and I do see the biggest problem still being the lack of coordination between the host site and the clinical sites and who establishes the contracts for the sites? The students initiative? The school based on student request? How are preceptors monitored and how are problems addressed between them? That's just my thoughts though. Thing to remember is there is good and bad in everything ! There are some fantastic university programs and some that are sorely lacking.

Vent - The clinical portion is my concern and the lack of consistency in the preceptors. You may have one sight which has excellent preceptors and another site which is as you stated a sleepover with minimum contact. You also run the risk of lazy preceptors that will sign off without the students actually doing the skills. There is no opportunity really for the people to establish a monitoring system for every possible site and check the quality of the preceptors if this is an option. Also, I would imagine there is more difficulty in obtaining clinical sites. However, the one concern I do have with the online only classes is there is no lab aspect to them. The students first contact with a procedure comes during clinical time or ride alongs. That leads to a really steep learning curve, and while some students (especially those working within services that are fast paced or aggressive) are exposed to procedures, others in slower services are at a definite disadvantage. I couldn't imagine having never started an IV prior to clinicals, or having to think my way through a cric. It's tough enough to get good experience with great labs, but how do they tackle this issue? I'd be curious to hear. Also some states (ie here) it's difficult enough for established programs to get the required rotations. OR and Morgue are the two hardest due to liability. I wonder if students experience difficulty. There is one program that I think has a reasonable idea. It is texas based I believe. Started out as a fire academy, but has expanded to the EMS side. They do the online book work, then have students come for a period of time for a "boot camp" to teach the skills then do ride along experience. They end up with Texas certifications and have to request reciprocity from their home state. That itself is not a bad idea if the other online schools had a similar follow up, however FF skills can be taught much more quickly and easier to maintain than EMS skills IMHO. I'd be interested to see what their pass rate is for national registry. I'm completely against the accelerated program idea as I don't believe they cut it, even for students actively involved in EMS through the whole class period. You just can't do it. Granted I'm a product of one, but I felt lacking after graduation and pursued other education following. The only prospect I could see for an accelerated program is for those that had their license at one time and allowed it to lapse within about a 5 year period and were just trying to get it back. Longer than that, I would say completely retake the course like normal due to the constant changes. Just my thoughts for what they're worth.

While this is sad, there's long been the transitions from LPN to RN so I'm not overly suprised. It was just a matter of time. There are fully online medic classes waiting in the wings for approval (I'm not sure if there are any active right now or not) so I'm not sure if they will follow suit with this, but I certainly hope not. It's no longer about quality, it's about quantity. Who cares what kind of people we're putting out there when we can put a bunch of them out there and make our money quick while we can? Sad indeed.

Thanks for posting that, may we not forget it.

Whether working or just enjoying the day, please everyone stay safe !

well, dust does say he's from a special place in hell...just sayin' but hey you know we love cranky old men, otherwise he wouldn't still be around.

Maybe because he was tired of the crotch shots? You guys remember that after the first incident? I really feel pity for that photographer....

Good Riddance to the world's most famous pervert

Perhaps not exactly what you are looking for but addressing the idea of telling "war stories" as a method of coping with stress for paramedics. I think it's fairly well written, cited, and in general interesting. Might be something worth looking at. I've used it as a reference a few times. http://www.emc.eku.edu/docs/story_telling.pdf

Very true - I've seen that particularly with patients on initiating haldol as a treatment. It's not that uncommon. Also something to consider is to think about what happens when you give too much of a sedative - it has the opposite effect - it actually makes the person hyper. So if it truly was a benadryl overdose, depending upon his metabolism, it may not have entirely cleared his system and with the addition of other medications it may have enhanced or delayed metabolism and effects. CB - also thanks for the note on SSRI's. I've not experienced one causing a dystonic reaction and only dealt with my first case of seratonin syndrome not long ago so I'm relatively inexperienced on that. Appreciate it ! Be smart and stay safe.

I am fond of the intranasal delivery for anticonvulsants. I do have some questions about a few things and is why I would like input from other participating agencies. It is headed our way and I'd like to chat with some. I've spoken with the lead physician on it and some others, but I'd like to hear how it runs within other services specific to this.

Hey there, First off, poor kid bet he was absolutely miserable. It does sound quite a bit like a dystonic reaction. I've seen it with phenergan and other similar medications that were taken in excess. However, the typical resolution for a dystonic reaction is benadryl which in the case of a benadryl OD wouldn't help the situation, it would only add to the problem. Seratonin syndrome doesn't quite fit the picture here from my experience though if he was alert I don't think valium would have been out of the question (though with the difficulty in breathing I would have had some concern with that so would have definitely gotten med control on board with it prior). Thankfully you had a short transport so you minimized discomfort time with that aspect - have you had the chance to follow up on the patient? If not, I'd suggest doing so especially if you have docs that are good about discussing patients with you.

Good points have been made by all However, this question has been asked and answered multiple times - please use the search feature you can find alot of great resources and input there. Best wishes.

It's actually a study comparisson of IM auto injector midazolam comparable to the time it takes to establish and access an IV with ativan. http://rampart.umich.edu/rampart/welcome this is the actual study site, so perhaps more useful to than the you tube site. I understand LAFD is involved, but I'm not sure of all the other sites - any LAFD people out there?

We do utilize the humane socitey after hours number. Also, PD is used to address the issue of out of control pets (have even had the problem of a majorly overprotective service dog - situation was not pleasant for all involved). Typically though dispatch would ask if there were pets involved and if so have the person put them up if possible. As far as bites and "latched on animals" like your turtle friend here, I would consult med control or develop a relationship with a local vet that you can call after hours regarding sedation and separation. Hopefully that would assist you some. Oh and as far as PETA - it stands for a most appropriate thing - people eating tasty animals - enough said.

The idea for this is for the initial expansion of a epi pen type system for seizure patients to maintain at home just as patients that have a known severe allergy carry the epi pens or diabetics with glucagon. The only main issue with it is the problem of controlled substance and high potential for theft/abuse. My understanding is that it would be easier to carry than the current medication (diastat) gel which is very unstable in warm environments and also people are hesitant to give it considering it is a rectal medication (though considerably less likely to be abused/misused than an IM form). Hopefully it will move in that direction.

Only those associated with a participating department : Please PM me - I'd like to speak with others and hear their experiences if the trial is already underway in your area -

Depends on the day and my mood and whether I want to put up with the car's crap or not. 1994 3/4 ton Dodge Ram V10 Dually - dark blue and tan has over 280,000 miles on it with no major issues take that you little foreign cars ! Major issue, it sucks the gas bigtime, but I get the same hauling (I haven't ever really taxed it even with a 4 horse trailer with living quarters). But it handles the hills that I end up on heading to some of these farms lol. But yeah 10 mpg really sucked last year. 2002 Saturn LS - yeah has been brutalized poor little thing. It's my back and forth to work car so it unfortunately gets used and abused plus does all the local running. I've gotten it stuck in my driveway multiple times during ice storms, rains, etc and I retreat to get the beast to retrieve it lol. It's also dark blue with an absurd amount of miles (189,000) - can ya tell I drive just a little bit ? - He's getting cranky in his old age though, so yeah if I'm not in the mood to deal with it and it's cranky starting (it randomnly runs the battery down) I give it a rest and it works again. Laugh if you all want, but I'm not making a car payment and the little one gets 35 mpg - gotta love it ! Also, no whacker stuff noted - just EM plates on the car and a small department sticker like 3 inch diameter on back window. The truck has nothing as its primary job is hauling.