Just Plain Ruff

I cannot remember the poster who posted that they would like IFT work only, this is a prime example that that poster needs to read. You do indeed sound burned out but I would suspect that there is more to it than that. IFT work is BORING. Simple as that. You probably didn't get into the business to just take grandma Elliott back to her nursing home after a visit to the ER or the hospital. You also probably didn't get into EMS to continually not be challenged on a day to day basis. I suspect that you are smarter than that and you know that IFT work is so easy a cave man can do it. I have no love lost on transfers. As a matter of fact, I HATE IFT Transfers. There are some people who can do the job and love it but those are few and far between. I would bet that most of the knowledge that you had about emergency patients has gone south in the 5 years of doing IFT's. It's like anything else you do, if you don't do it on a regular basis, you forget stuff. It's good that you are seeing that you are burned out. 911 jobs are few and far between these days. You may have to look outside your area and consider moving. You may also need to consider that you may need to move to another state. ONe thing to remember, for every 1 911 job there are likely to be 100 or more applicants. AS a matter of fact, Lee's Summit Fire department had 1 opening for hire. They had 1100 or so applicants. Some departments have even more. If you are not a medic, this might be a tremendous opportunity to go back to medic school and get your degree/medic license. Fresh start, new knowledge and new faces. It's going to be tough. YOu are going to be up against many people who have 911 experience and will have that to their benefit while you will have IFT. Good luck this is a great sounding board for issues just such as yours. I was in your situation a long time ago. I was on the IFT truck for almost a year. I ended up just parking the truck, getting in my car and driving across country. I then took my medic class and the rest is history.

Thanks all, I had NO nails left after the pregnancy, I have none anyway cause I bite em but if it's as bad as last time I may have to move to the toenails (I know, bad images right) My wife is going to the ultrasound appointment today - as a matter of fact it's happening as we speak. I am in florida. so I'm kind of out of the loop.

That would be the most popular show in the nation at least among men.

For those of you who know my and my wife's saga with our daughter and the pregnancy of such, I have a new announcement WE ARE _PREGNANT AGAIN Keep us in your prayers

Today at the Winn Dixie I listened to a conversation between a customer and a cashier. Cashier "I don't have kids but I want some someday" Customer "I hate kids, if you want to know what they are like, borrow someone elses kids for a day" Cashier "I don't have any friends who have kids" Customer "Good for them, kids are a nuisance and a pain in the ass. I hate kids" Other customer to customer " do you have kids?" First customer "No I don't" Other customer "The shut the hell up. You don't know a f(*ing thing about kids" The other customer did indeed shut up!!!

all I can say is HOLY CHIT BATMAN!!!!!!! Am I the only one who is shocked at this? there is a good possiblity if the local ems agency hears of your self imposed policy that they might try to get your first responder agency certification removed. I know that you think you are doing the right thing and I am sure your heart is in the right place but....... you are saying that you purposely try not to have local ems transport the patient? What diagnostic tests do you have to make that determination that a patient can wait for the family to get there 30 minutes later? Do you have the education to make that decision? As a first responder certification or basic EMT I say you do not have the education to make that decision. DO NOT think I'm calling you stupid cause I'm not, Im saying that you more than likely do not have the education base to determine if a patient does not need to go to the ER by ambulance. There are some cases where no transport is obvious like ear aches or sprained ankles but most everything else is not obvious. In my area or neck of the woods the first responders are just that - first responders who have nothing more than blood pressure cuffs, stethoscopes, and Oxygen. Maybe the occasional blood glucose monitor but nothing more. You are advocating that you are taking this tremendous legal risk of not transporting someone based on what you have found. Many have said it here before but what legal defense can you offer a judge and jury if the patient indeed needed to go by ambulance but you decided that they could wait. Guys, this is just the mindset that is killing our reputations and keeping us from moving on to professional status. FSU I'm not focusing on you totally here. We have this attitude and other attitudes that say that I'm an EMT or a MEdic or a First Responder and this guy is not sick so I'm going to advocate that he go to the hospital by another means. FSU your thought process on this is totally wrong and this WILL come back and bite you in the ass one of these days. I know I ask patients why they didn't go by ambulance when the ambulance was called and if a patient told me that a first responder said I didn't need to go by ambulance then I'm going to be making some phone calls. Let's take the case of the medic who saw the high school football player and diagnosed him with dehydration and left the scene. When the parents got home they found their boy dead on the floor. That medic is getting sued and he's going to LOSE and lose BIG time. When you deny transport or try to move the patient in the direction of no transport then you get on a slippery slope. Your agency does not have any type of no transport arrangement does it? I'll bet there is nothing in your SOP's that allow you to push a patient to not go by ambulance. If you do not have that to back you up then you are in grave risk doing what you are doing. I'll bet your medical director would have a hissy fit if he read your post and remove you from your duties. I know I would. The legal liability of doing this as a first responder is too huge to ignore. Keep at your current status quo at your legal and financial risk. Your agency is not going to back you on this I guarantee it.

It is not my responsibility to determine if someone is a drug seeker or not. I don't have a degree in psychology or sociology so I can't say for certain that they are a drug seeker. If the patient has pain, they get pain relief. We have liberal standing orders for pain relief. I use those liberal standing orders on all patients. If they say they are in pain, they get pain meds because I know that a ride in the back of an ambulance is going to intensify the pain. For fractures or traumatic injuries they get fentanyl. For chest pain they get Morphine For abdominal pain I'm going to call medical control but our docs are pretty good about giving pain meds to abdominal pain patients as it's come out in thep ast couple of years that EMS administration of pain meds does not truly mask the symptoms of abdominal pain for a good Surgeon. The worst feeling I have is a patient I know needs pain meds for abdominal pain and the doctor refuses to give orders for pain relief. That makes me, as dwayne says "batshit crazy". Kidney stone pain is another one that docs routinely refuse pain meds. Seriously, if there is pain, why not give meds? Does it take away from you as a person or medic? I transported a woman from a small hospital to a pain clinic 45 miles away over a very very bumpy 2 lane highway. NO pain meds were given to this patient prior to leaving the hospital. No IV either. 10 minutes out of the hospital she begins to complain of significant pain, crying and tearing up. I tried to call the ER via cell with no signal, radio in the truck was broke. I went on our standing orders and started the IV, gave zofran for her active nausea/vomiting and administered 50mcg of fentanyl. Made the drive much nicer. On arrival at the pain clinic the doctor refused to examine her because she had pain meds. The doctor said that she has a "rule" of No pain meds prior to the appointment. I told her it was a stupid rule and it was inhumae to make this patient ride in the ambulance for 45 minutes crying in pain just becuase she didn't want to give a patient pain meds. After a discussion with my medical director over giving meds without orders, my medical director backed me and said that I operated under the EMS Standing/protocol orders for pain control. I stand by my decision. It benefitted the patient not the doctor. The doctor did finally agree to see the patient and did what she said she would do for the patient. The ride back was much better for the patient because the procedure was done and it worked.

I've looked, found and called the number. ONCE only. NO other times required it. I also have a friend in the level 3 tech support at Sprint and there was one time when he helped me break the lock on a phone from a critical car accident victim. It took about 20 minutes but I had that time available as the patient was the only one in our ER and everyone else was working on helping the guy. We were able to successfully break the lock on the phone and get ahold of the persons family. Soon after he died of his injuries but being he was 1100 miles away from home it was good we got ahold of someone or he would ahve been just another john doe until fingerprints or dental records would have identified him. Why not put a ICE number in your wallet or purse? Wouldn't that be a better idea than a cell phone anyway. Most of the times when you are driving the phone is on the seat next to you or in a cup holder or somewhere and then when you get hit or hit something then that cell phone is going flying in the car. Can't say the same about wallets. They usually stay in the back pocket of the patient.

ok, great posts Lone and Dwayne as well as others. Let me put my career direction in to this mix and see if you can see some parallels. I'm a Emergency room computer consultant. I leave home monday morning at 0500 or earlier to catch a plane. I fly for 5-8 hours and then drive another hour to the site I work at. I then work till 9pm most nights. I stay in a hotel each night I'm on site. I do not see my family from 0500 monday morning until 11pm or later thursday nights. I am expected to put in 40 hours a week while on site. That makes the 9pm nights a requirement. I fly another 7-9 hours home on thursday. When all the work I do culminates with a go-live for the emergency department, I'm usually working 15-20 days straight from 0600 to about 11pm I'm sleeping either in the hotel room or on an ER gurney in an unused room. I make a lot of money, and I mean a lot. What they pay me they could pay 4 paramedics in my area. The money's great but the downside is listed above. Plus consider that I don't get to come home during the week so I'm away from the wife, daughter and son for those 4 days straight. My son hates my job, my wife misses her husband and my daughter, well she's only 1 so she doesn't really know I'm gone. I have other consultants who I work with who would sooner slit your throat than give you any education or knowledge transfer to help you do your job. Many consultants work in silos so you never truly know what they are doing or what they aren't doing. I have consultants who I've worked with who have told me to fix something and then just because they wanted to be assigned to this site, they made it look like what i did crashed the system. I have other consultants who want nothing more than to get you alone with them at dinner so they can tell you all their marital problems and then point blank ask you if you would stay the night in their hotel room with them. I have had other consultants who are so stressed that they just up and walk out of meetings or never come back. The infidelity rate is pretty high in the travelling consultant ranks because out of site, out of mind. Sort of the what happens in vegas stays in vegas type thinking. I love the job don't get me wrong, I never have to worry about medical care, most of the docs I work with are more than happy to write out a script for whatever you ask them for. I get seen in the ER much faster because I know most of them who work the ed. I also am in close contact wiht nurses, doctors, resp therapists and others and you see them at their worst in meetings. So compare that with EMS. Do the two compare - I beleive they do. My lifestyle (bills) are not too high but remember you spend what you make. Don't believe anyone who tells you differently. 95% of all people out there will spend every penny they make to pay bills and then pay fun stuff. Would I change my career back to EMS full time -0 Yes in a heartbeat but that EMS job would have to pay what my consulting job pays and no ems job does that. Maybe this makes no correlation to EMS but I think it does. Take the EMS job at its face value. Many of us have been doing the job for many years, some on this forum have 30 years in the service, I have off and on about 20. I was 20 when I started and I'm 42 now. I plan on doing the EMS thing for the next 20 years as a part time basis. You have to go into thejob without the rose colored glasses that many have, where they think they will be the hero and save the day. That is not the case, that will not happen. YOu have to understand the job and the complaints you are hearing here are complaints that everyone will eventually have. Can you make a living doing EMS work - yes you can but you have to really have two EMS jobs and your spouse needs to work. I'll bet that those who complain about EMS not paying the bills have many extras that they don't absolutely need to have but they think are necessities. That's fine but this is where the whining comes in. I have one friend who has two cell phones, one for his personal life and one for both his jobs to get ahold of him for shifts. He also has a pager. He has cable, internet, home phone, 2 cars, a boat, a jetski and a small cabin on the lake. He has 3 52 inch televisions, he has a 5K computer and a laptop he takes to work. He consistently complains to me about how he has to have a third EMS job to pay for all his stuff. I have no symptathy for him. But do you see where I'm coming from? But anyway. The job is what you make of it. you can survive on one paramedic wage if you are single but put a family into the mix and this is where things get tight. Well I'm done rambling. Be safe Ruff

Herbie my friend. I know not what you are going through but I can pray for you, your nephew, his buddy and everyone connected to them. I am forever grateful to the men/women in uniform for what they sacrifice for this country and their respective countries. All of them deserve our gratitude, not our scorn like so many have given them. Rest assured, the Ruff's in Missouri are saying a separate prayer for your nephew and his buddy. My son dressed up in a soldier costume this year and the only way I allowed him to do this was if he understood what that uniform stood for. How he was to wear it with pride and honor and believe me, he DID!!!!!!!! He knows the sacrifice that all the soldiers and their families make on a daily basis and he is stronger for knowing that. Your community of friends are here for you and ready to listen if you need it. Take care.

All Credit is to be given to Orlando Regional Healthcare, Education & Development. Document is an overview of interpreting ABG results. This is good basic background information. I learned some things or two from this. Enjoy Website http://orlandohealth.com/pdf%20folder/Inter%20of%20Arterial%20Blood%20Gas.pdf

ONe more article to add to ERDocs list http://www.jems.com/article/news/california-firefighter-faces-a this ones incident is recent - less than 2 months old.

oooh ooooh I know the answer. I know it. But I can't answer it because I read the entire scenario at medscape.

Maybe Crotchity is trying to be the EMTCITY Al Sharpton or Jesse Jackson!!!

I'm here to help patients. I did not create the unsafe scene, the unsafe neighborhood, the unsafe hood or the unsafe trailer park. Why am I being forced to enter an area that has notoriously been deemed as unsafe? Did we create that area? Do we have control over a neighborhood being unsafe? NOPE we do not. What we do have control over is this, we have the ability to use common sense and judgement and not enter any place that is considered unsafe. I remember a area in the past in Chicago I believe that had always been considered unsafe for people to be out wandering around but it was safe for fire and EMS to go in. One night that changed when a EMS crew came under fire and assault because they did not go into a violent scene. The truck took I believe I read over 40 bullets or something like that. An otherwise safe area became a very unsafe area for everyone involved. So now you have a neighborhood where EMS have been targeted. Do you just not go to that particular address and consider the other addresses as safe or is the whole neighborhood unsafe? I ask that rhetorically. Crotchity, I do admire your sticktuitness but I think that your continued use of the race card makes these discussions moot for all intents and purposes. You don't see it, I know you don't but when you bring up race in a thread that had nothing to do with race, yes yes yes, go back and read the original article, there was no mention of race issues except by you on this thread. I know you are a black man and you have been subject to racism, we've discussed this in the past, but it's not always about race you know. I'd hate for you to be seen here as the Al Sharpton or Jesse Jackson of EMT City.

All signs point to a very very bad outcome for this kid. Posturing, pupil problems. 1 hour for a helicopter and then who knows how long to definitive neurosurgical intervention BAD MOJO I would say that we will eventually need to discuss if his organ donation card is up to date and signed. As a medic I'll try ot get him paralyzed and intubated. Maybe the ER has a ct scan? too much to ask for a 1 bed ER. Smashed helmet - what does his skull feel like? This kids in major trouble and probably no matter what we do for him in the field, there are just some people who we cannot help. I've ran nearly this exact scenario before but we had a 30 minute ETA of helo and a 10 bed ER plus a good Nurse anesthatist to intubate this kid. (this was prior to us being able to use paralytics to facilitate intubation). The kid I ran ended up helping 15 other people with his organs and skin.

A well known quote "The needs of the many outweigh the needs of the few" spoken by Spock. We are already controversial but let's get a little further into controversy. EMS doesn't respond in to a neighborhood without the police department. This community is now in the spotlight and a well known councilman has thrown down the gauntlet to the EMS community and community at large that he feels that EMS should enter scenes safe or not with or without the police. It is now up to the EMS Agency to either follow through on his request or risk losing their contract if he has any say in the matter. How does EMS address this with the community? Do they put a public service campaign outlining which neighborhoods are dangerous and which ones are not. Does the EMS agency say "You can make your neighborhood safer by putting pressure on those who make the neighborhood unsafe" and outline what makes their neighborhood unsafe. Or does the EMS agency take a stand in support of it's employees and say even if they lose the contract, that they are not putting their people at risk? Please don't make this a racial issue. Make your arguments for or against the above cohesive and without personal or moral assumptions. If it takes the deaths of a few people in the community to bring community action and condemnation of those who make those neighborhoods unsafe to clean them up then maybe that is what needs to happen. Many neighborhoods, some of which were considered some of the most dangerous in some cities have been taken back by their citizens by saying, "We are not going to stand for this anymore" and "Your drugs, violence and other assorted crimes are no longer welcome here". A concerted effort and grass roots movement have made some of the most dangerous neighborhoods safe again. For many of these neighborhoods, ems did not respond without police to calls. They now do not have that delay in response.

Actually Ugly, they can prosecute the guy, they just have to prove that his thoughts were a hate crime. People have been charged for less. If they can assert that the guy was intent on hate then they can prosecute him. It's no different than prosecutors trying to charge pastors with preaching against homosexuality from their pulpits then they can prosecute this guy for promoting a black figure being hung by a klansman. Not saying that the charges will get to court but all they have to assert is that there was a hateful message intended to scare or frighten blacks in his neighborhood and they have a hate crime. What surprises me is Where is Crotchity on this one? I can't believe he's not all over this one?

I am a active member of Medscape. I have posted scenarios from there before. i have already read the entire article when it came to medscape and learned something, err I mean a lot. I had no idea what that lesion was but I do now and I had no idea that a disease process in the middle of the body can manifest itself in the hands,thumb joint. Dwayne, good post and I will not answer any of the questions as I've already read the article and know the end result.

herbie, you and I speak same language. I already posted that this would be considered a hate crime and prosecuted as such. But the first amendment applies here too. He can say whatever he likes but unfortunately the hate crime will do him in. One question for the group If we have hate crime legislation and prosecute for such, doesn't that go against the first amendment? I mean if you can say anything you like, no matter how offensive the message is, can a hate crime be charged? If it's speech we are talking about, and we do have a 1st amendment right to express our views, then do hate crimes apply on speech issues? Just asking

black councilman Black victims The ambulance crews must have been white Thus the race card. It took less than 1 page to get that card thrown down. And Yes, if the trailer park is composed of mainly low income white folks and theres a shooting or another violent incident then hell yes, I'm going to wait for PD. My waiting on PD to get there to make my scene safe knows no COLOR barrier. White, black, red, blue, purple or green people - I wait for PD if the scene is unsafe. I'm sorry but Crotchity you truly do play the race card too much.

black councilman Black victims The ambulance crews must have been white Thus the race card. It took less than 1 page to get that card thrown down. And Yes, if the trailer park is composed of mainly low income white folks and theres a shooting or another violent incident then hell yes, I'm going to wait for PD. My waiting on PD to get there to make my scene safe knows no COLOR barrier. White, black, red, blue, purple or green people - I wait for PD if the scene is unsafe. I'm sorry but Crotchity you truly do play the race card too much.

First amendment protection = Yes This is no different than the asshat Fred Phelps. Offensive, YES YOU BET YOUR ASS but protected - yes Should his house become a conflagration of fire and brimstone - one less scar on society And as racist as this appears, this still falls under the 1st amendment. He has every right to put this kind of crap up as I have to burn a cross or Burn the Koran, or put a black Lyncher and a white lynchee. I know this is truly offensive but he does have the right to do this. Here is the text of the 1st amendment if you don't already know it Congress shall make no law respecting an establishment of religion, or prohibiting the free exercise thereof; or abridging the freedom of speech, or of the press; or the right of the people peaceably to assemble, and to petition the Government for a redress of grievances Now, someone could argue that this is hate crime and the prosecuting attorney could go after him on that line. That is the most logical way for the county to go in my opinion.

IO as first line? No I'll try to find a vein first but if I cannot then I'll go IO I don't think that the drills are barbaric but the old center punch style ones are definately not for the squeamish. I do not have any issue dropping an IO as I have worked through the generic pitfalls with those I've already done and my last two were without issues. I also do know that if you don't get that Lidocaine in then you are going to have a angry or hurting patient. I have seen ED's give vicodin or percocets to patients who had IO's removed for the pain management aspects. Anyway, it's all good and all relative. The sicker the patient the more likely that I'll do an IO. Let me ask this question Do your protocols say you transport a patient who had an IO started?

For you Dwayne. Make sure you look at the nametag.