Just Plain Ruff

Dang, I was going to move there and start to work as a medic there but the job I was going to want to get seems to be in the 890 that are going away. gonna be much harder to get a job over there now.

If this is the scenario as posted by crotchity, then that service is screwed already. Administration makes the list of who to call but the nurses are the ones who actually do the calling from the front lines. Unfortunately, if administration likes one service over the other then they will definately make it difficult for the front line workers to call the other service. If this is the scenario, I'll bet the hospital has an ethics hotline and you could call that ethics hotline putting forth a complaint. Be prepared to lose your job if you do that.

I am glad to see that the old dust is back. Hey LenyR Jobs are plentiful, they are easy to get and I'm sure you can find a job really really easy. Just get your license in hand and get your job. It seems like you already found the jobs, getting your license is going to be a piece of cake. Encouraging enough for you?

Hey Dwayne, get this. Since you brought up the appearances of the mexicans in Magnificent 7. Did you know that on a number of John wayne films and other westerns, the attention to detail wasn't really cared for. If you look at some of the scenes on the prarie, you will see Jet Contrails in the sky. If you look at some of the wrists of the actors, especially Wayne, occasionally you will see a nice watch on the wrist. they didn't have wristwatches back then. You will also see in the far background during some of the scenes on the praries, roads, and especially paved roads. Just some trivia - and I return you to the regularly scheduled thread - NO wait, this is my thread so I can go off topic if I want. ha ha

Thsi is one of those calls that make even the best medic cringe and turn white and have his asshole pucker up to near infinitely small in size. I am thinking the the amniotic sac had come loose and the baby was just a hare's breadth from being delivered. This is probably a fetal demise. When my wife miscarried at 17 weeks, the sac and the baby came out at the same time. This is exactly what we saw, the sac coming out and then the baby. It was HORRIBLE to watch and very very sad. But the baby came out nonetheless and your description sure sounds like what we went thru. Get the girl to the hospital but at 22 weeks it's very very early and a small survivability but kidlets at that gestation have been known to survive but with many many problems. Our perinatologist told us that a 22 weeker would probably not survive regardless of lifesaving measures done. There was a reason why this happened, I'm not one to guess.

When I'm using iodine or betadine for an IV start I'm going to swab the betadine and then alcohol. UNLESS I'm drawing blood for a BAC (blood alcohol) and then it's strict betadine. But I have always done betadine and then alcohol if i'm going to use betadine. No reason but it just seemed to be the right sequence.

Does the across the board pay cut involve management also? Or will management not take a hit. Don't ask me to sacrifice my livelihood if you are not going to sacrifice yours. That's what gets me about corporations today. The management rarely takes a cut, they expect the workers to do so but most CEO's will not make that cut. As long as management takes a pay cut then I'd be willing to take a pay cut but you can bet that I'm going to be looking for another job at the same pay rate unless the job I'm taking the cut for is the only game in town.

There is a special place in HELL that this woman will go to. This disgusts me. Just as much as the woman who dumped her car with her two kids in it in the river a couple of months ago. The same way that Susan Smith when she drowned her two little boys and accused a black man of the crime. Kill yourself but for god's sake don't Fricking kill your kids. That is selfish and cowardly. I HATE stories like that. What I'm going to go do now is call my wife and ask to talk to both my kids. What the hell.

I agree Why should I have to sacrifice and go to a 12 hour shift when I'm working a 2nd job? Sounds like taking something I worked hard for (seniority - I did get hired prior to everyone below me and I've put my time in) and giving it to someone who has not paid their dues or did not work as hard. Maybe even though I have a 2nd job, this is my full time job that I get benefits from. I'm not giving up my 24 hour shifts. If the place is anything like one of the places I used to work, 24 hour shifts are golden and the most sought after shifts. Where else can you work 2 days a week and pull in 40+ hours? If your service doesn't run lots of calls then 24 hour shifts are great to have. If the service is going to make me run 20 calls + per 24 hour shift - then I'm not good at that process. I do need my beauty sleep. Many people I know will tell me I need as much as I can get.

But wouldn't taking the 12 hour shift even if you had a 2nd job be a huge paycut also? What about the person who works for another service, they relied on the 24 hour shifts because that might be the only way they can work for the said service. If they gave up the 24's and then couldn't work the 12 hour shifts required, wouldn't they be in financial jeopardy. I'm sure this hasn't happened but I have no problem with the selfishness of the ones in question. If I was one of them, I'd be keeping the 24 hour shift. Gotta support me and my family first.

Unfortunately once you break the integrity of the skin you will have a scar. Regardless of closure type I have seen it both ways, Dermabond if done right, can leave a very minimal scar, similar to a plastic surgeon scar. But done wrong or applied too liberally or not liberal enough it can leave a bigger scar than sutures do. Applying Dermabond on the face is a bad idea unless it's done by a competent physician. I hate to keep coming back to physician only skill but I think that allowing EMS to apply dermabond to a non-visible part of the body(clothes covered) or to a superficial lac on the extrems is not a good nor a bad idea, training training training, but leave the lacerations to the face alone and allow a physician to look at it. I think that dermabond should not even be considered on a child until a physician has a chance to look at the laceration and then the physician can decide to close it himself or refer the child to a plastic surgeon. Remember, we old guys, I'm 43, we don't really care about scarring, makes us look "heroic" and a scar to an adult is significantly less of an issue than a 3 year old who has many many years ahead of them, and they deserve to have the best suture repair that we can give them, especially around the face. I guess what I'm saying is that dermabond could be used by EMS but with pretty strict and tight restrictions. AS for the person who said that in the UK they have been doing this for many years, I'll bet if I remember right that the education for paramedics is much more stringent and in depth than it is for our medic mill medics out there who get their education in less than 6 months at some schools. Who are you going to trust to do more skills, a medic in the UK with several years of school and training or a medic in the US with a 6 month certificate? Consider if the laceration was on your face?

Some relationships between services and hospitals go way way way back. I'm sure you already know that. But since they are the new guys then they have to step up and start to be more visible. How many crews do they have working? They could have the crews that are on duty go buy bagels (stay away from doughnuts) and coffee and juice and deliver them to the ER or nursing unit where they are getting calls from. They need to cultivate a relationship with the dealmakers, the nurses and doctors who make the decision what service gets called. The facility management and administration are not the ones who deal with the services on a regular basis. Branching out and stationing a unit at the highest volume facility ensuring a very rapid response to their transfer will help them understand that you are committed to providing fast, competent and efficient service. Providing the nursing staff a report on how the patient did no matter how minor the transfer was will go a long way in telling the facility that you value their business. The more you can do to get your name out in front of the people who actually do the calling will do wonders. I am saying "you" but I am meaing your friend. Unfortunately, this all costs money so if your friends management is not willing to spend some dough and really get that service's name out and rely on word of mouth and hopefully getting a call then that service will continue to be on the bottom of the list in getting called. Wow them with competence and face time and the call volume will pick up.

I know of no one out there in the ems arena who could go all the way through school without working unless they had a really good scholarship or a bunch of student loans. Kind of hard to get a student loan if you are not going to a accredited university or trade school. The loans you might get from a non-accredited screwell of higher learning would most likely be high interest in the line of credit cards. So what is someone supposed to do if their program is not associated with a university or 2 year school. Associates degree or bachelors. So my opinion is that it is not bad to work as an EMT during your paramedic schooling. I did it and I turned out pretty darn well. If you have the financial means to not have to work so be it but I'll bet dollars to doughnuts that no one knows many of those types of people. Just don't get complacent in your learning, don't consider yourself a paramedic while you are in school. Do not practice outside of your scope no matter how much you trust your partner. Your patient will know the difference. Could get you kicked out of school and worse. I know of a lot of medics who did a lot of advanced skills with their partners while in medic school and some of them got in big trouble. I have a couple of examples but I will share only one if asked as I believe it is the one call that defines who I am. But in all reality, do what you have to do to support the family and better yourself. Sure as hell that no-one else will do it for you. Not your friends, not your mother and certainly not the government. Do it for yourself. Make a competent decision and stick with it. ASk the right questions and make the best informed decision y ou can.

Whoa, I didn't know that. I'm usually cleaning the site and then letting it air dry. Maybe that takes 2 minutes or so. who knows. But the 2 minute thing makes sense if you think about it. How fast does betadine work? I know that in order for the germ killing functions of Lysol spray to work that you have to spray the area and let it sit for 2-3 minutes and then wipe off.

We always use chloraprep. Seems to have a direct result of minimal site infections. I'm going off anectdotal evidence and not any true study. But I don't know of any iv site infections from our iv starts with the chloraprep but I do remember some nasty infections from alcohol alone and then you get the closet betadine allergic reactions = those who don't konw they are allergic but are. BAD mojo. But I only know my service and it's a small one.

http://blog.foreignpolicy.com/posts/2011/04/11/china_bans_time_travel No more Back to the Futures in China's Future. Bummer

Good luck wishes and prayers to you my friend. I have no doubt that you will get one of the full time jobs but if not then your management is goofy.

Our babies ultrasound. 13 weeks and counting. My link

My goodness, that was so funny that the soda I just took a swig of came out my nose and covered my papers on my desk. I'm still laughing.

EMS Week Education Membership plans Meet the medics sessions flyers sent to the members of the community Tricked out website Not much more that I can think of to market the ems system. providing impeccable service, arriving on time, matched uniforms, pleasant attitudes towards patient, family and especially the Idiot nursing home night nurses that we all know and love. Football, track, soccer, baseball standbys, providing pro-bono standby's for major events. Giving tours of the ambulance and demos at local daycares and elementary schools Vial of Life magnets to put on refridgerators Having a pleasant collection agency and not the dumbasses I'm working with (Non-ems related collection agency) Providing PR at local neighborhood block parties. Free CPR and Firstaid classes, Add to those classes a babysitting class or two. Just driving the ambulance around the neighborhood, stopping to meet the people in the community. Almost all the above is free or at very very little cost to the prospective service that decides to do any of the above.

I have liked most everyone that I've worked with in the past. Would I give up my family's livelihood to help them out, nope. My family comes first. If I have two jobs to make ends meet and I need both the jobs to do so then I'm not going to give anything up since jobs are so tight right now. It's not my responsibility to make sure that my colleagues or co-workers are making enough money to feed themselves or make a honest living. I have a hierarchy that I look at when I think about giving up financial or personal things. 1. Is it good for my families bottom line? Can we afford to do it? For this scenario - if it directly affected my financial security then I would NOT give it up. If we could afford the cut in pay, then yes I probably would. 2. Is this good for my families emotional or mental well being - again the above is used. If it directly affects my families emotional or physician well being then no I won't give it up. If it doesnt have a big effect then I'll consider it. 3. Does it go against my morals? same thing My current job, Non-ems, I'm making a pretty good living. I get a hourly bonus of 22.50 per hour of each time I'm on site with the client and it's tied to how many hours I bill. I get 22.50 per billable hour. If the client were to ask me to take a leave of absence so some of their people could get more hours, I'd be hard pressed to say "sure, I'll take a leave of absence" unless there were some assurances that I would get the bonus. But I would be very distressed as would my financial house be stressed if we lost that bonus. The bonus is about 30-35% of my yearly salary if you take it all into account. Is it my responsibility and my duty to help the clients people out? No it is not. Would I take a vacation instead, probably. I'm not sure if this relates to the original post but I tried to relate it to my current circumstances and look at it that way. But seriously, if I'm top in seniority and I can get a 24 hour shift, but I'm working a 2nd job to make ends meet then why should I have to sacrifice to allow for others to make more money? I don't see it as a equitable request.

We have Shagbark Road in our locality

Ill go on record here, there is no way that I'm ready to allow medics to do this procedure. No offense to anyone here but I personally do not think that we have any business closing wounds in the course of our jobs. This should be left to the doctors and NP's and PA's. I'm personally not comfortable with many if not all the medics I know enough to allow this. If my son or daughter cut themselves and an ambulance came and said that they could close the wound with dermabond, I'm not gonna allow it and Ill go to the ER to get it looked at. Again, no offense to anyone here but it just isn't gonna happen at least where my kids are concerned. Sent from my SPH-D700 using Tapatalk

I am not saying that we cannot do the dermabond thing, I'm saying that we really shouldn't. I'm also not saying we are not educated well enough or we can't get educated on this but previously in the past this has been a physician/NP/PA thing and I don't see that changing any time soon. I see a time issue here also. With our utilization being watched so closely by the bean counters, the time it takes to irrigate a wound and then dermabond it is not going to set well with the management of many services. Plus, many services will not want the liability for laceration repair. The added expense of the education on how to use dermabond will be a big issue with the services. I think that rules need to be in place to clearly define what lacerations can be repaired with Dermabond and I think that the first exclusion group would be children. Any child under 12 should not get dermabond until evaulated by an ER physician. Many times in the ER a physician will elect to send the child to a plastic surgeon due to the cosmetic issues of a laceration especially to the face. Dermabond does not work well on joints. Can a medic determine whether there is other damage underneath? I do not believe that they can. I used to work full time in an ER and was taught by some of the physicians to suture but I would never take it upon myself in the ambulance to dermabond a laceration as that is WAY beyond my scope of practice. If we are going to go down this road to put dermabond on lacerations we need training, education and hands on practice in the ER. I for one would not allow a medic to put dermabond on my child or on me to that matter. Others here might but not me. I don't have that much faith in the education levels of many of my co-workers. I'd rather spend the money on an ER visit.

The main question with using dermabond is this. Are paramedics currently educated well enough to know what kind of laceration would be a candidate for Dermabond? Have they been trained to correctly irrigate a wound? Are medical directors going to go for a paramedic or an EMT dermabonding a laceration that may need to be sutured yet didn't get a physician exam to determine depth, tissue damage and type of wound. In every ER I've ever worked in the physician was the one to dermabond the laceration. Sure I could have done it but the physician was the one who actually applied the dermabond. I think that this is beyond the current purveyance of the EMS systems in this country.