Just Plain Ruff

ok, I've been watching the debate and this passage with interest. First, I have a pre-existing condition - Diabetes. I'm also overweight. Face it folks, we have already been rationing healthcare but no-one seems to understand that. The rationing is the inability of those who have pre-existing conditions to be covered. Also rationing in the form of Outpatient procedures or inpatient procedures that insurance denies. Remember Medicare is the number one denier of healthcare procedures and claims. (didn't knwo that did you? They denied 8.4% of all claims last year. Aetna was 2nd with 6.4%) I will provide figures as soon as I can find that website I read it on. I will believe all this hype of it costing less and other crap when it comes true. Remember, the massachussets plan was touted to save money yet it's now horribly in debt and not slated to get better anytime soon. I know that none of those congressmen/women will pay for this bill or it's associated costs. They don't have to because their healthcare is truly the best in the world. They get what they want but we peons don't. What frightens me the most is this, and you can agree to disagree with me but this is where it all boils down to. My son and daughters childrens children will still be paying for this. They will be paying for all the illegal aliens in this country to get healthcare. They will be paying for yours and my healthcare needs. Right now I owe nearly 25K to various doctors and clinics and hospitals. I do not have a full time job. I have no benefits for myself but I'm paying 600 bucks a month to cover my wife and two kids. Where am I getting that money, from my parents and my part time job. In my chosen field (consulting) I have not been able to find work for over 6 months. For the one who says that he pays 52% of his income in taxes, well when you make 36K a year you are left with 18K after taxes. Put a 1000 mortgage, 600-700 for other bills an you are left with about 2000 dollars A YEAR or 200 per month to spend on other things. I don't want to live that way. To have 200 per month cushion is absurd to expect a family of 4 to exist. What about the emergency rom co-pays, or the unexpected bill that comes in and wipes out that 200 for that month. There is no easy answer to this. I do not wish the congress's job on anyone. But I do know this, we do need change, was Obamacare the answer. NOPE I don't think so. Have you been following the big explosion thread I posted. There is some good information on how to survive disaster in there. I fear for this country, I see a lot of Babylonian empire in our country. If you need the biblical references just go to the book of Daniel and read chapters 1 through 7. I know many don't like bible references on this forum but you cannot discount the similarities in that book to our society.

There has been a lot of good discussion on what can and should be done. this Scenario is taken directly from (or close to it) the book called "ONe Second After" I forget the author. Didn't have a ground detonation in the book but the EMP was the big player. I highly recommend the book.

I should have mentioned, everything is out. There is no electricity, no phones, no NOTHING. You stumble around looking for something to begin to do and people start to arrive into town on foot, horses and whatever else they can get to the town with. They are all looking towards you and your fire house since you are the only medical and fire personnel in the 50 square mile radius. There were reports of a blinding flash as well as you can see multiple other large towers of smoke in the distance and on the horizon. You begin to suspect - "this aint gonna just blow over" What as an emergency management person are you going to do? Your closest big city in about 100 miles away = population 1.5 million The next city that you might be able to call on for resources in a town of 25K and about 30 miles away and from the looks of it there is a large cloud coming from it's vicinity. I'll bet you wish you had that Whacker EMS bag that was posted about here a little over 6-7 months ago. Remember that bag? What do you need to set up first? Triage or security? You do have a small 20 bed hospital in your town.

Yes Nuclear EMP destroyed all electronic circuitry

You attempt to contact dispatch but your radios do not seem to work. There are people standing around outside trying to get their Cell phones to work. You jump in your shiny red fire trucks and they don't start.

Or who Achmed would get A big fat hairy virgin with Meth teeth?

What no one wants to tackle this one?????

Great list of Pearls of Wisdom from many who are pioneers in this industry. Some of these are just exceptional mantras. Lead boldly—with kindness and a deep respect for others! This brings out the best in your organization and all you serve. —Jay Fitch, PhD, President & Founding Partner, Fitch & Associates The lesson of my life has been how much this giving profession actually gives back to us. You never have to hate that ambulance of yours, when you consider that everybody you meet there reminds you how lucky you are—to be breathing without effort, and living without fear or pain. Never forget the daily privilege of being there when people are born and when they die—private times, when no one else would be welcome, but you are so personally invited. —Thom Dick, EMT-P, Quality Care Coordinator, Platte Valley Ambulance Irrespective of your level of certification, type of agency you work for or area served, you’re here to provide the best care to each and every patient you contact. In a sense, they are your family and should be treated as such. —Chad Brocato, DHS, REMT-P, Assistant Chief of Operations, Deerfield Beach Fire-Rescue & Adjunct Professor of Anatomy & Physiology, Kaplan University Learn to recognize all the non-medical issues that may influence your medical decision-making, such as too many runs, 4 a.m. calls for "nonsense," annoying patients or families, or personal issues. Then work hard to set those aside, and make your patient-care decisions based on the medical concerns. A decision made in the best medical interest of the patient is the right way to go. —Kathleen Schrank, MD, FACEP, FACP, Professor of Medicine and Chief, Division of Emergency Medicine, University of Miami School of Medicine; Medical Director, City of Miami Fire Rescue; & Medical Director, Village of Key Biscayne Fire Rescue Share your dreams and visions of the future with those individuals (achievers) positioned to understand and move you toward your success. They will assist you greatly in your personal and professional achievements. You will find there are many individuals (maintainers) willing to tell you what you can’t accomplish. It’s of utmost importance to remember that most of these individuals are very successful at their mission of keeping you and others from achieving success. —Walt A. Stoy, PhD, EMT-P, CCEMTP, Professor & Director, Emergency Medicine, University of Pittsburgh & Director, Office of Education, Center for Emergency Medicine When assessing and treating patients, always remember that technical expertise in your skills is the basic expectation of the patient and people watching you work (all of whom are your customers). The public doesn’t want a minimally competent technician; they expect your EMS expertise and best care. Do whatever you have to do to be able to provide that highest level of care, consistently. It’s the mission of the true professional (paid or volunteer). After you can do that, adding an optimistic, genuinely caring, communicative manner will often be greatly appreciated and make your calls run that much smoother. —Richard Vance, EMT-P, Captain, Carlsbad Fire Department Keep it simple. Always go back to the basics when you’re not sure what’s going on. You can always come up with more esoteric answers after ensuring that the ABCs are intact. —Adam D. Fox, DPM, DO , Clinical Assistant Professor of Surgery, Division of Traumatology & Surgical Critical Care, University of Pennsylvania If there’s anything I wish I had known then, it’s this: Be a good listener. This one single character trait is the secret of success of those I most respect. As a provider, the ability to actively listen to your patients will reward you with unique insight into their lives and a better understanding of their needs. As a colleague, a good listener is your partner’s best friend because they know you respect their opinion before giving them advice. As an employee, the ability to listen first before criticizing the actions of management gives you the opportunity to measure your response and decide which issues are really worth fighting. And finally, as a husband or wife, a good listener puts their spouse’s concerns above theirs and help keep you from bringing too much of the "job" home with you, when the purpose of being home is to get away from the job. —Keith Wesley, MD, FACEP, Minnesota State EMS Medical Director & Medical Director, HealthEast Medical Transportation As EMS providers, we need to continue to learn medicine and search for better methods to achieve better outcomes, even if it’s at the most basic level. As mentors, we need to be able to teach and explain our craft so it can be understood at the most basic level. —Gregory R. Frailey, DO, FACOEP, EMT-P, Medical Director, Prehospital Services, Susquehanna Health & Tactical Physician, Williamsport Bureau of Police Special Response Team My lesson and direction came from Fess Parker, the actor, playing Davy Crockett on TV. He taught us a motto and it has been my guide: "Be sure you’re right, and then go ahead." —Katherine H. West, BSN, MED, CIC, Infection Control Consultant, Infection Control/Emerging Concepts Inc. Treat all patients in the EMS setting as if they were your mother, father, sister, brother, son, daughter or spouse. And after you have treated them in exemplary fashion, make sure to document this outstanding care on your run report without leaving out any pertinent and important details. —David P. Keseg, MD, Medical Director, Columbus Fire Department & Clinical Instructor, Ohio State University Don’t come to work each day expecting to save a life. Come to work expecting to provide care, to ease suffering and to provide comfort to those in need. It’s often those things we do in EMS that are impossible to quantify that have the greatest impact upon our patients and their families. —Marc Eckstein, MD, MPH, FACEP, Director of Prehospital Care, Los Angeles County/USC Medical Center; Medical Director, Los Angeles Fire Department; & Associate Professor, Emergency Medicine, University of Southern California My advice would be twofold: First, EMS providers are obligated to always perform their best in patient assessment and advocacy, providing therein the optimal response to those in need with the resources that we bring to bear. Second, always explain a tachycardia. —Ray Fowler, MD, FACEP, Associate Professor, University of Texas Southwestern SOM; Chief of EMS, University of Texas Southwestern Medical Center; & Chief of Medical Operations, Dallas Metropolitan Area BioTel (EMS) System Caring for patients in the EMS environment is like riding a motorcycle: The moment you get comfortable and think you’ve seen everything, you become dangerous! —David Persse, MD, EMT-P, Physician Director, City of Houston Emergency Medical Services; Public Health Authority, City of Houston Department of Health & Human Services; Associate Professor, Emergency Medicine, University of Texas Health Science Center—Houston Doing what you know is best in adverse situations, or any situation, can be challenging and sometimes downright unpopular. But in the end, it’s what’s right and results in the respect of yourself. —Jerry Overton, MPA, CEO/President, Road Safety International Inc. Strive to be the best EMS professional you can be. Review every patient encounter and ask yourself if there’s any way you could have provided better care if faced with that same situation in the future—through more learning, better assessment or practicing your skills. —Jeffrey P. Salomone, MD, FACS, NREMT-P, Associate Professor of Surgery, Emory University School of Medicine; Deputy Chief of Surgery, Grady Memorial Hospital; & Assistant Medical Director, Grady EMS My biggest lesson is that there are multiple correct answers to most every problem. When I began my career, there was one way to do things—mine. Perhaps that was my experience level or lack of confidence working against me. As I grew in my career, I learned to leverage other people’s ideas to build better solutions on the street and in the office. —Allen Johnson, MPA, LP, Chief Administrative Officer & EMS Director, Montgomery County Hospital District Having a bad attitude or treating patients in a less than professional manner does not shorten your shift or reduce your call volume. And a bad attitude at work is likely to follow you home and spill over into your personal life. So, be selfless, make decisions based on family and have a great attitude. Every day, every shift is a choice. —Criss Brainard, Deputy Chief, San Diego Fire-Rescue Department and President, San Diego Medical Services Enterprises Regardless of a patient’s appearance or how poorly they may treat you, always strive to treat each and every patient as if they were your own family member. After all, everyone is somebody’s baby. If you practice this mantra with all of your patient encounters, you will be able to sleep each night with peace in your heart and be able to unequivocally look yourself in the eye in the mirror each morning without a glimmer of guilt or remorse. —Carol Cunningham, MD, State Medical Director, Ohio Department of Public Safety, Division of EMS; & EMS Medical Director & Emergency Physician, Lake Health Never stop asking, "What else could this be?" —W. Ann Maggiore, JD, NREMT-P, Associate Attorney, Butt, Thornton & Baehr PC; & Clinical Instructor, University of New Mexico, School of Medicine The "emergency" in emergency medical services is really a very small part of the job. When you feel under-utilized or frustrated for those not-so-emergent calls, think about how much you enjoyed the circus. Being in EMS is like having a free ticket to the circus: You get to marvel at the oddities and uniqueness of the human condition. —Bruce Evans, MPA, EMT-P, Assistant Chief, North Las Vegas Fire Department Keep your passion for EMS alive through quality continuing education. And be proud of the difference you make in your patients and their families, every day! —Linda M. Abrahamson, BA, RN, EMT-P, EMS Education Coordinator, Silver Cross Hospital; Board of Directors, National Association of EMS Educators; & Chair, Advanced Medical Life Support, National Association of EMTs Never stop thinking about new ways of doing things that can better serve your patient and your community. JEMS has always been at the forefront of presenting new ideas and innovations to EMS providers. —Stephen R. Wirth, Esq., Attorney, Page, Wolfberg & Wirth LLC; & Legal Commissioner & Chair, Panel of Commissioners, Commission on Accreditation of Ambulance Services (CAAS) Integrity in EMS is doing the right thing for the patient even when nobody is looking. —Bryan E. Bledsoe, DO, FACEP, EMT-P, EMS Textbook Author & Emergency Physician Faculty, University of Nevada Whether it’s policy-making, destination decision, judgment calls or direct patient interactions, we should always care for (not treat or manage, but care for) those we serve, as eagerly and as compassionately as we would want for one of our own family members. —Paul E. Pepe, MD, MPH, MACP, FACEP, FCCM, Professor of Surgery, University of Texas Southwestern Medical Center; Head, Emergency Services, Parkland Health & Hospital System; & Head, EMS Medical Direction Team, Dallas Area Biotel (EMS) System Take every opportunity to learn. Take every opportunity to teach. —Charlie Eisele, BS, NREMT-P, Flight Paramedic, State Trooper, EMS Instructor Our job is to serve, regardless of whether it looks like an emergency or not. —Corey M. Slovis, MD, FACP, FACEP, FAAEM, Professor & Chair, Emergency Medicine, Vanderbilt University Medical Center; Professor, Medicine, Vanderbilt University Medical Center; Medical Director, Metro Nashville Fire Department; & Medical Director, Nashville International Airport It may seem like "no good deed goes unpunished," but never stop doing good deeds! —Edward T. Dickinson, MD, NREMT-P, FACEP, Associate Professor & Director of EMS Field Operations, Department of Emergency Medicine, University of Pennsylvania; Medical Director, Berwyn Fire Company, Malvern Fire Company & Haverford Township Paramedics; & Medical Editor, JEMS Remember that for many conditions, kids are just little adults. It all starts with the ABCs, no matter the size of the patient. —Mark Meredith, MD, Assistant Professor, Emergency Medicine and Pediatrics, Vanderbilt Medical Center & Assistant EMS Medical Director for Pediatric Care, Nashville Fire Department It’s a small field. Be nice and respectful of everyone you come into contact with. You never know where a person is going to show up in your future. If you’re nice, respectful and courteous to everyone, you have no worries about meeting again. —James J. Augustine, MD, Medical Advisor, Washington Township Fire Department; Director of Clinical Operations, EMP Management; & Clinical Associate Professor, Department of Emergency Medicine, Wright State University

I have a person in mind for Mama Cass if we ever get a show like that. I agree with you Richard and I wasn't calling you out on my previous post. I think that efforts could be done to make a show that we would be proud of would be a good start but then again, having people sitting in an ambulance waiting for a call or sitting in recliners or working out in the weight room doesn't make good television. nor does going and picking up the 425 pounder off the floor - that makes compelling television if you ask me.

If the puppet fits he he he

Ok, I'm gonna stir the pot here. If this forum is getting so wound up in this stupid show, which does not matter to our lives in the least, how wound up can we get on some other topic. I know many from here have posted on the NBC forums about how bad the show is, many have told other people in the community how bad the show is and how it doesn't portray EMS in a good light. I even went to the Assistant chief of San Francisco and had a great dialog with him over this show. The question I have here is this and bear with me. We have fire departments who are going into the business of being patient care services now. We get news reports of this happening or at least we get information sometimes on which fire departments are planning on taking over EMS. Since many threads here go the way of IAFF versus EMS, why don't those who put all the energy into hating this show and even one of us is writing a line by line critique, why don't we put that effort into supporting those EMS Agencies where fire is coming in to take over. I'm sure that all that energy and support could go a long way. LIke I have said in the past, you can bitch and moan only so long before people either stop listening to you or you prove to them that you are more than just mouthwash.

I was reading some forums related to Jeff Dunham. Someone asked on those forums what Jeff's new puppet should be. Many suggested female versions of his current puppets. Let's put out some suggestions for his new puppet. I think the new puppet should definately be female. My idea is Walter's wife - a big busty terribly overweight Ukranian woman who keeps saying "I veel luv you forever Waltah" Any other ideas?

It's 11am and you are sitting around the station waiting for your first call. I know, not a busy service. You hear a huge explosion that rattles even your firestation/EMS station walls. Immediately your television goes out as well as the computer turns off. You exit the building to see what is going on and you see what appears to be a pillar like cloud coming from approximatly 5 miles away. All your services for your city are housed in the same building. Your resources are as follows 2 ambulances 2 pumpers 1 ladder truck 1 rescue truck and 1 tanker truck The police resources are 2-3 officers on per shift and your county officers and state patrol comprise 1-4 additional personnel per shift. You can see large amounts of smoke from where the pillar of smoke was. You notice that there is only one vehicle moving along the road your station is on. This road is the main drag of your town and it normally has many vehicles moving along at any time. The vehicle moving along is a 1960's era car. What do you do now? You have not been toned out and there are people standing around outside their places of business looking towards your station as they expect for you all to know what to do. Go with this.

I believe Roy told the guy "That's what protocols are for" or something like that.

Who was the bigger Bad Ass????? Johnny or Roy

I think it's mostly health care but there is a element of public safety in it but If pressed I'd say we are almost fully healthcare.

So maybe the reputation is deserved but be that as it may, what are we doing as a group or individuals about this supposed crisis? We can debate how good it is for Ems or how bad it is for EMS but we need to stop complaining here and start making it known publicly. No one wants to hear people complain unless they have a plan of action to accompany their complaining.

I was doing some thinking and I think many on this forum are correct. Vent, when you criticise us we don't get nasty and bent out of shape but when you are criticised you blow up.

Maybe some big conglomerate will come in and take over the ambulance service providing better working and wages. Wait, that won't happen. sorry now back to you regularly scheduled thread. Speaking of turmoil, our little ambulance service is going through some, not nearly as big as yours but it's pretty significant. I sort of feel your all's pain.

We read on this forum so much about how Fire is beginning to kill EMS. We rant and rave about how it's not fair or it's just wrong that Fire is coming in and taking over EMS. Everyone knows my feelings regarding fire medics and plain medics. Dual role medics and single role medics. Fire based ems versus private single duty ems and I'm not going to entertain any more bashing of either on this thread. Do so and this thread will be locked if admin will allow it. My question is this: There are those on this forum who are Absolutely against fire based ems. They are absolutely against Fire running EMS. My question is this. What are you currently doing to spread the word and helping people in the communities know which is a better fit for them? Are you just coming here and venting and bitching about this or are you actively doing something about this crisis? I don't want any bashing of any type of service, I don't want the standard over done lines about how bad fire based ems is. I want real solutions and real ideas.

This isn't rocket science. Just put one line on your report that says, daylight savings time change. That's what I did the night of the big change. And yes there was a 2am it just got downsized to 3am.

That Succinlycholine is a potent drug that may cause respiratory depression. I do know of a nurse who was told to give the medicine to facilitate intubation and she gave it in the X-ray department of the hospital and then went to get the intubation supplies from the ER. (NEW NURSE happened over 15 years ago) She got the intubation supplies but by the time she got back, the patient was Dead.

Was looking at a bottle of Succinylcholine. There was a warning on the bottle in Red letters. WARNING: Succinylcholine Chloride is a potent drug which may cause respiratory depression. Facilities must be immediately available for artificial respiration. Anyone see an issue with this?

I think that I have ran more people who got in wrecks while eating, sleeping, talking on the cell phone and what not. Let's legislate away the eating, the sleeping(no brainer) and the no talking on the cell phone and see how many of us young whippersnappers will throw a fit. I personally have run about 40 wrecks this year and of those I think I can count on one hand the number of elderly that have been at fault or involved. Most are people under the age of 50.

This does not bode well for this medic. She's off the street right?