Kaisu

Fresh out of medic school - no time as an EMT - only experience is medic school clinicals and ride time... Guess what? I am on the streets after 2 weeks under a different preceptor each time - desperate for paramedics - I am doing my best.

12th call on a 24 hour shift - 3 hours of sleep - call came in 20 minutes before shift change. Transfer nursing home patient with dementia and an extremely painful perianal abscess. 3 minute transport time. Got vitals, got an IV established with a lock for meds. Put the sharp down by the disposal container intending to get BGL off of it. and realized we were at the hospital. Patched, disconnected the patient, moved her to the hospital. Completely forgot about the sharp. My EMT partner found it and told me he was going to have to write me up. I told him that I understood, that I had f----d up and he had to do what he had to do. What he did was go into the supervisors office and rant - didn't trust me and was not going to run with me. If scheduled with me he would go home. Pretty harsh - supervisors told me they would help me with my problem but if I didnt get it under control I was gonna be canned.... Not the best day for me. I am going to do everything I can to get it under control. As mentioned in another response, I trained with the retractable ones. When I try to explain this to the supervisors, they tell me that it is all excuses and they are not buying it. I keep reiterating that I am not trying to evade responsibility but I have 0 credibility in this place - I am not from here, I am a female and I did not do it the way they did (Basic for a year). As I said, tough gig. Good thing I am a tough broad. :wink:

The employer does NOT use the retractables... This is Arizona Dust - I have no 12 lead, no CPAP, the only med for pain is morphine (if my patient is allergic then he/she is sool) - no drugs for N and V, the cheapest possible catheters, and supervisors think they are being generous because they will allow me to use a portable sharps shuttle to help lick this sharps problem. I am the only one that uses a NS lock, both paramedics and EMTs are convinced that because I did not run a year as a basic that I cannot possibly be ready for the field... the list goes on and on... Its a tough gig and a big adjustment for me.

Root cause - in the area and system where I was trained, EVERYONE used retractable needles. After threading the catheter, there was a button that you pressed and the needle retracted and it was impossible to stick anyone with it. In class, the instructor retracted one and had us press it against each other - no way to get a stick. Disposal of sharps was part of the curriculum for national registries, but in those practicals, the damn container was right under your nose. You had to be stupid to not drop it in. So for root cause - that is it. My error occurred after 14 calls in 24 hours with less than 3 hours of sleep. That's when training kicks in cause the conscious brain is struggling. Good suggestions from you both. That is exactly what I will do. The people I am running with are convinced that the fact that I did not run as a basic is what gives me this trouble. They don't understand that there are different ways of doing things. I am going to go with the writing things out a million times, putting a piece of tape on the back of my hand and thinking of the sharp as a loaded gun. I do need to beat this thing and fast and I am very grateful for your responses.

I have hit a stupid snag in my paramedic career. I am brand new in the field and I have had 3 incidents in the last month where I have improperly disposed of my sharps. There are many reasons for this but obviously it is something I need to fix RIGHT NOW. I am looking for any tips, suggestions,etc that will help me remember to ALWAYS properly dispose of the sharp. Anything you can contribute will be much appreciated.

We will not transfer any patient with a psych diagnosis and history of aggression or violence without written orders for chemical restraints. Company policy is to refuse the transfer until orders are obtained.

I would definately wear it. I don't understand the controversy. With the high rate of rape in that area, the benefits for me far outweigh the risks.

geez spenac I am sorry to hear of your troubles. I hope you get well soon.

Did not know the man personally but he is from the neighborhood. My thoughts and prayers are with the family, friends and co-workers. Rest in peace.

Apparently the US is not the only place where there are problems with EMS. (Facetious I know but it does help put some things into perspective)

Suicide happens when the pressures to commit suicide outweigh the resources available to the individual to cope. I personally spent about 25 years struggling with the issue. I would be hit with a wave of depression that would last for months. Imagine a painful toenail - the first day its no big deal - by the end of the week you would want to cut the toe off. Depression and emotional pain wear a person down. Imagine waking up day after day feeling awful. Nothing gives pleasure - in fact, numbness would be an improvement over the aching, almost unimaginable pain. Now compound that with society's lack of understanding - people sick of dealing with your shit - others telling you to "get over it" - the feeling that you are fundamentally flawed - not right - and never will be. Can you imagine that? Try living it - over and over and over for many decades. What got me through one period would fail the next. One time it was thoughts of my kids - the next time my mind convinced me that they were better off without me. Another time it was fear of hell - the next, hell couldn't be as bad as this - at least there would be a reason for feeling this bad. The final time was radical acceptance - that if I felt like this forever well fine - be that as it may I was tough enough to cope. The next time? - who knows. I don't think there will ever be another next time but no one has that guaranty. The answer for me? fill my life with friends, support structures, sound nutrition, rest and exercise. Laugh every day, read and educate myself. Do meaningful and useful work. Go to church. Have things in place so that if I need to reach out I can. For anyone dealing with this, PM me - talk to me - I know a lot about this shit and so far I have beaten it. God bless

I used to teach adults - motivated students who paid to take the courses and wanted to learn the material. I never worked so hard in my life. It took so much energy. I would not do anything for the money. If you love the field work then don't leave it until you have to. (Just my opinion - I'm not you). All the best. PS - when I have a tough decision to make, I will often flip a coin. It's not what the coin tells me to do that is valuable, it is my reaction to what the toss decides.

My first thought is an endocrinal issue - hypothalamus or possibly thyroid problems.

Glad for you that its over. Rest up, take care and give yourself a pat on the back for taking care of your problem. OH and Get well soon.

First of all - scene safety! I don't know how firefighters is Aussie land do it, but that crowd was loud and raucous and I would have gotten out of Dodge. Secondly, that firefighter committed battery when he turned the hose on the youth. I'm not sure what he hoped to accomplish by doing it. He caused that scene to escalate.

Hey all. I had a better day yesterday. Another brand new preceptor, but this guy is a marine combat vet and a flight medic. He was called in to fill a spot. (I'm thinking one of the brighter bulbs that jumped ship when the sale came through). We got along like a house on fire. It was a quiet day and I personally wound up on only 4 calls - 2 refusals, 1 cancellation and 1 BS. The first thing I did was my rig check. Then I went through every item in the drug box (again) with indications, contraindications, side effects and adult and pediatric dosages. I got the station copy of the protocols and made a flash card for each one. (there are 61). Get this - the general manager came in on a surprise visit. He didn't know what protocols were. He looked at the book and said - o wow - somebody spent a lot of time on this. :shock: Guess what? In the protocols there are spots for 12 lead. If I don't do a 12 lead (and I can't), then I don't say I did a 12 lead. If we put a patient on a cardiac monitor, that qualifies as ALS. If we start an IV, that is ALS. This company is making money hand over fist - Also - the protocols allow administration of morphine prior to contacting med control in suspect ACS BUT verbally I have been told that we have to contact med control before ANYWAY. (I guess someone screwed up and now everyone is suspect.) I am going to Wisconsin on Sunday to pick up my husband and bring him here. (hopefully we will have a house to go to) That will take me a week. I will use the time for soul searching and decision making. Thank you again for your generous help. PS - a rural service with 1400 - 1700 calls per year sounds like heaven right about now. PPS - I did the PCR on the BS call in about 20 minutes and did NOT write my narrative on a draft. The preceptor made no changes to it - just said "why do I have to sign this - you're a paramedic?" DAMN STRAIGHT!! - no more draft narratives. 8)

There is a nutshell is part of my dilemma. Defib is an Arizona paramedic. This is business as usual in this state. Coming from NY as Asys or in my case NE Wisconsin (where you can't beat a bush without flushing out medics) I am appalled. It is a huge shock. I know how things are run in my state. This is not how things are run in my state. It makes the adjustment even more difficult. I am NOT looking for people to tell me it will be OK. The insight I have gained from your comments is invaluable to me. I have been very careful to not appear as an out of state know it all. That also has been a difficult balance to strike because now I am being treated (by some) as a target cause I take s**t. I am going in in about an hour for my first shift after 2 days off. At least my stomach has stopped churning and I can actually walk in there and give it another whirl. BTW - I have been told that I need to get my driving in. I have been in this city for 2 weeks today. They will have to get someone else to drive. PS.. I don't know if I mentioned, but my family and friends are 2000 miles away. I am living in a motel room until I get into a house on the 6th of October. You people here are my lifeline because there certainly is no-one at the station that I know well enough to trust. PPS - When I mentioned to my supervisor about the 12 lead thing he sneered and said we don't have that luxury. You can always run a modified 12 lead. So then I asked about the monitor vs. diagnostic mode and he ignored me and walked away. During the chastisement I got for something else, he asked me if I was comfortable with the operation of the LifePak. I said NO - He gave me this long speech about how he would be happy to break out a set of pads and let me play with it. I guess I have to add this to my list of things to do - after my rig checks, after writing out the protocols (or obtaining a set) etc etc etc etc. That's the overwhelmed part I was referring to earlier. PPS - I didn't know that about amiodarone and the temperature. See - now stuff like that is super to know. When I asked people why they didnt like it, they told me "it doesn't work". One said "it's onset of action is too long". The second was something I researched, the first didn't help me at all. So thanks for that too... (as long as its true - I will have to check it out.) :wink:

I am certainly not taking offense P3medic. I appreciate the point of view. I misspoke when I said 15 calls. I have been on 7 shifts for 12 hours each. The 15 calls were ALS calls. I have not had the same preceptor for any of those shifts. I've had 3 really good ones (but each had a different way of doing things), 2 that were ok and 2 that were awful. This is all subjective of course...

I am getting so much valuable information and insight from you folks I can't believe. You all are my secret weapon :wink: OK - so I have some more questions - I have no uniform - they told me I don't get one until after I am off probation. I bought some navy pants and white polos and show up on scene with nothing IDing me as a paramedic or EMT or anything. I asked for a fanny pack (which is issued to all paramedics) got a bunch of double talk. I carry my ears around my neck and my pens in my pockets - 1 credit card, my motel key and a bit of cash. No place assigned to put my stuff. My probie book is out on the desk for all to see. My car keys too - unless I stuff those in my pocket too. I asked for the protocols. Was told that there is only one per station - cannot take it home - cannot carry it on the rig - and SOPs do not match the protocols which are poorly written (old flowchart style). Paramedics make remarks like - amiodarone is crap - we are taking it off the rigs. The main O2 is turned on and off each call - and the regulators and lines are NEVER purged - uses too much O2. We have no SPO2 on the Lifepak and the portables often are missing or dont work. We have no 12 lead capability - people call ST elevation on only one lead - which is crap.. as far as I know it has to be 2 continuous leads. We have one option for pain control - morphine - and even in MI we have to get permission to give it. The catheters are awful - they are a pain in the ass to use. Everybody gets a bag hung unless we pick up saline locks from the hospital - which everyone looks at me like I am speaking martian because here they are still hep locks..... OK OK.. I guess I am coming across as a whining crybaby - but I have not said a word about any of this to anyone - I figure as a newbie on probation I have way too much on my plate to ask these kind of questions. It doesnt make me feel good tho. It undermines my confidence in the system and in myself. I dont want to learn the wrong way to do things. Now I've gone and gotten myself all upset again. big breaths - deep, cleansing, big breaths... goes away muttering - maybe something mindless on tv....

5 days into my first paying gig with a private. I thought I would be practicing medicine. I thought that at the very least, I would be able to make personal connections with my patients and help them through a difficult day. (I can hear you all laughing). I am going to nursing school.

P3medic.. for the most part you are correct. However, my charts are BETTER than those written by the others. I have comments from the hospital and one of the supervisors that they are excellent. One of the FTOs has a style that he prefers. He fills in all the blanks and little check boxes thoroughly and then limits his narrative to one or two lines. He told me he's had to defend his charts in court many times and has never been nailed. :? I didnt see him for 3 shifts. I had other preceptors. His turn came around to precept me and he didnt even look at my narrative. He crossed it out on my draft sheet, wrote his own and said "this is all you need". What was I going to do? get in a pi**ing match with him or just shut my mouth and do what I was told? I shut my mouth and did what I was told. *** edit - PS he marked on my evaluation sheet for the run that my report writing needed improvement - ](*,) I figured out what was going on. These people are firmly in the camp that you MUST be an EMTB before you become a paramedic - so for me, that is strike 1. A lot of people are willing to give me the benefit of the doubt, but there is this one shift - all hoary old veterans - ALL MALE - that are going to make me earn everything I get. Every error I make, and I've made many already is just justification for the way they see things. Do not get me wrong. There are wonderful people that work at this company. This used to be a mom and pop organization that was bought out by a big one in the spring of this year. People are still adjusting. Its not the greatest time to be a newbie in the company. There are those people (and you know this is true) that are trying to advance their own positions over the bodies of others. I appreciate everything people have written. I am getting a little more perspective on this situation. After a full days rest I already feel better. I am putting my head down and plowing on through. Don't be surprised if I appear on here crying in my beer many more times. Thanks for everything.

I am the most afraid of doing something really stupid and hurting someone. The biggest problem is that I don't trust these people. (They don't trust me either). There is a lot of corporate crap going on. My preceptor had a problem with something I did and he did not say a single word to me about it. He ran into the supervisor's office and closed the door. Several hours later I was called in and chastised. I took it because yes - I had made a mistake. I had a situation on scene where stuff was not where it was supposed to be. I was essentially told that I probably didnt know where to look. I brought the bag out and actually showed a co-worker that it was lacking before I filled it, but I still wasnt believed by the supervisor. I had FTO's make me write my narratives on a piece of blank paper for approval before transcribing it onto the PCR. I was off at 8:00pm last night. At 7:30 I took my narrative to the FTO to approve. He told me he was busy and leave it. He would be in in the morning. I was off today. At 8:15am I get a call telling me that I didnt finish my paperwork and I had to get in and do it. I tried to explain what happened. I was told that's your paperwork and it is your responsibility - I had to go in an complete it. That particular FTO says "it was a misunderstanding. Don't get me wrong - some of the people are really good. A few of the women have been awesome. I just get this gut churning feeling in my stomach that this is a meat grinder and I am going to be run off my feet. It scares me because what I see tells me that patient care has got to suffer. There is no way to deliver proper care if people are exhausted, undersupplied and ill equipped. I am too green to say anything about what I see around me but I can't pretend to myself that I don't notice. Thank you Wendy for your kind words.

OK - so I've had about 15 calls with my new job and I am getting creamed. This is my first job after paramedic school and I am feeling overwhelmed. The company is extremely busy, with an average of 30 calls per shift (run by 3 crews of 1 paramedic and 1 EMT each). I have had a different preceptor each day. They give contradictory advice and when I change my methods to adapt to one, the next one slaps me for it. The rigs are not always stocked properly and the people are overworked. I am sick to my stomach. I feel like I have been thrown to the wolves. I am supposed to be cut loose on my own in two weeks with an EMT. This is a station where it is not unusual to be the only team 50 miles out and ride back with THREE patients in the rig. I know I am not a stupid person, but these people act like because I have no EMT B experience that I am a complete loser and not up to snuff. My medical knowledge is better than theirs, but I freely admit that school is different from life and I am NOT equipped to do what they expect of me. What do I do? I am really looking for help here.

We run both. I prefer the big box, especially as a previous poster mentioned, for patient access on the right. I have figured out that sometimes I have to straddle the patient on the stretcher to get to a difficult stick on the only good vein I can see. The van sure is nimble in tight spots, and while my job is not to worry about economics, the more efficient our business unit is, the nicer corporate is with new toys and raises. In the immortal words of Tim Gunn, we make it work.

What about the step test? Did you have to do that one?