ERDoc

Welcome back. It looks like the changes are starting to bring back all of us.

Ma'am, I found your TV remote. I have a feel this thread is heading in a downward trajectory very quickly,

Welcome fellow Michigander. Curious about your user name.

Has it always looked like that? Just because the rest of the world is wrong and doesn't call an ambulance a bus, don't give those of us from the east coast a hard time.

Cough cough cough, the pt is taking a little longer to wake up than planned and it's getting close to closing time, cough cough cough.

We seem to have lost the OP.

It all depends on who your target audience is, ie who makes the call to get the ambulance. If it is anyone in the ER, a steady stream of pizza would give you a huge ROI.

Welcome to the City. I'm guessing that if you just became and EMT and are looking to get into medical school that you are probably in your early 20s. My guess is that is the reason you cannot be insured as a driver. You also seem to be confusing the different types of insurance companies so I'll break them down and talk about each one. You can be as offended as you want and you can be the best driver who has ever lived but insurance companies base their decisions on risk and risk is determined from statistics and actuarial tables. As a male in your young twenties your cohort has the worst driving record out of everyone. That is why rates are so high and some ambulance companies may not want to pay that much when they can hire someone a bit older and save a shit-ton of money. It just makes good business sense (which is what these EMS agencies are, a business). Now, the other kind of insurance company you have to deal with in medicine is the health insurer. These people are life sucking leaches whose only job is to make their shareholders money (but I may be a bit biased). They will become the source of most of your displeasure in life if you become a physician. They don't care about the physicians or the patients, only the shareholders (again, they are a business). Sure there is medicare and medicaid but they only care about paying as little as possible, which is why most physicians won't accept them and some states are considering forcing physicians to see these pts as a requirement to keep you license. It is in the health insurer that determines how much they will pay the EMS agency for a transport. If you think dealing with them now is a pain, wait until you have to deal with things such as ICD-10 and core measures. As others have said, EMT pay is low because they are a dime a dozen. It's simple supply and demand. Why would a business pay someone $10/hr when someone is willing to do the job for $8/hr (or free in the case of vollies but more on that later)? No one is paid based on their value to society. If this were the case, our military would be the richest people in the world and there would be no millionaire athletes and rap stars. When you are in a position that requires less training than it takes to become a beautician, don't expect to make more than they do. As for the vollies, your assumptions are completely wrong. There are plenty of places that could afford a paid service but chose to stay volley (Long Island, NY is the one I am most familiar with, which is not even close to being a poor or rural area). This is just my opinion, but having "professional" drivers is just a bad idea. First, how do we define what a professional driver is? I would much rather have someone driving who knows what it is like to ride in the back of the bus while trying to take care of someone. It is also helpful to have another set of skilled hands at times, which you won't have with someone who is only a driver. As for unions, they are a double edged sword. If you want to understand the comment Mike made about a union holding EMS back, read up on what the IAFF has done to "advance" EMS. It's great that you want to bring about change but you need to see where things are and what the impediments are before you jump in. EDIT: I just reread your last post and saw that you are not, in fact, in your early 20s. It makes me think that there is something in your background that you are not being honest about otherwise there would be no reason to not be insurable as a driver.

I wouldn't necessarily say that they are bona fide emergencies, at least not all of them. Do you have a specific question or concern? Otherwise, treat them like any other pt, but listen to what the docs have to say since they may have some important piece of information. Mike, I think we would all like to hear that story.

I always have the residents do DL first, except in trauma. The glidescope is always at the bedside if needed.

And what does the team taking care of the unconscious kid have to say? Will we be able to get the drunk kids down under their own power? Do we see anything else at the scene such as drugs? What do these two have to say about the unconscious kid?

Like they said, you sound like you are in the right place right now. The first thing I would say would be to not respond to scenes on your own even though your chief is encouraging you to. If you are not comfortable with it, don't do it. Medicine is something that you become more comfortable with as time goes on. Experience will make you feel more comfortable just give it time (think years not weeks). Like Ruff said it's their emergency not yours. Deep breath and think about what needs to be done. Codes are the easiest pts to take care of. They are dead and you can't make them deader. It's the pt that is circling the drain that is sphincter tightening. At the EMT level, there is very little you can do in most cases. Mistakes happen, we all make them. Luckily most are no big deal since people are hard to kill. You sound like you have a good head on your shoulders so just keep learning and getting experience and you should do well. EDIT: Be careful of those "best" medics and EMTs. You would be surprised how often the "best" people turn out to be complete idiots. You just don't realize they are idiots because they are so confident in their position. I'm not saying that is the case with you but just something that I have seen over the years.

Welcome and a very interesting first time scenario. Just a few quick comments. We have people from all over the world here, so try not to use local abbreviations. What does RP mean? There is no such thing as a standard trauma bag, everyone's is going to be different. Maybe just say you have a trauma bag with BLS supplies. On to the scenario. This scene is a little concerning. You have an unconscious kid at the bottom of a tree and two others who don't seem to care. I would have the medic and one EMT go to the unconscious kid. The other EMT and a first responder should check on the kid in the tree and I'll take the other two first responders and check on the kid that is walking around. Let's get the helicopter headed our way since there is the potential for a very serious trauma pt. What information can we obtain from the two conscious kids?

I've used the first and second generation McGraths and the GlideScope but only in the hospital. I like the Glidescope much better due to the large screen size and the fact that you don't rely on batteries which crap out on you at the worst possible time. I think it is a bit bulky for the field though.

You plan is definitely doable but it just depends on your level of effort. There are plenty of people who start medical school later in life. Actually, 23 or 24 is about average if you figure the average person graduates HS at 18, and college at 22 give or take a year or two. In my residency we had a guy that retired from the WV State Troopers after 20 years before he started his premed. He did just fine. He was a little strange but most state troopers are. There is no reason to expect not to get in on the first go around, plenty of people do it. The only thing I see wrong with your plan is your "Pre-med" degree. There is no such thing. Premed classes are just a group of classes that are required in order to get into med school (Bio, Gen Chem, Orgo, and Physics. Math and English might be required now but I'm not sure). Get a Bachelors in whatever interests you or you would be happy doing as a backup if you were not to get in.

I have no idea, I just know what I have heard. That is probably a question is ask CMS or maybe google. I also know that there is a reward (I think it is a certain percent) for any fraud that is turned in.

Don't mess with CMS. They will screw you and are looking for fraud. It may take them a while, but they will find it. A CMS audit is no joke. CYA, get this stuff in writting and think about whistle blower protection. As an aside, if you brought this thumb fx into the ER with an IV and monitor I would have something to say about it.

There is no reason it can't be done. If you can get a good seal supine, you can get a good seal sitting upright. I've done it a few times.

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I wrote my reply to this thread when I was still a second year resident and under 30 years old.

I can pretty much do it whenever I want, but I don't have to follow any protocols. Maybe @EMT City Administrator can make a sticky in one of the forums where everyone can post a link to their protocols? Here is a link to the current protocols from where I started. They are much different than they were in my days. http://www.suffolkremsco.com/main/protocols/

Hey MedComRadio. Which part of NY are you from? As for the topic of community medicine, it all is going to depend on the system where you are. Volley systems are not set up to properly handle something like that given the education requirements.

EMS in America is a fractured hell hole, to put it nicely. Even in the same state, there are different protocols. I think there is a place on this website where people can provide links to their protocols. Try checking there to see the differences. When you say 'resuscitation' if you are strictly referring to running a cardiac arrest, most places have pretty similar protocols that follow ACLS algorithms. CPR in a moving vehicle is generally frowned upon but there are some places where all cardiac arrests must be transported to the hospital, so it happens.

Sorry I haven't responded sooner, Ruff. I would be more than happy to add some advice to your writing efforts.

No, because if we did that we would be working/transporting all arrests. Every so often we hear a story on the news where someone was down for some unreasonable amount of time but gets resuscitated and makes a full recovery. It makes the news because it is so rare. I think the biggest reason that codes make it to the ER that shouldn't have is because providers don't feel comfortable having the talk. I doubt there are many classes that teach this, especially at the EMT level.