Just Plain Ruff

Well it came today, another 5 years validity. maybe I should put it to use? maybe not. I do know that I'll be teaching a first aid class to my son's Trail Life troop in the next 2 months. Now if I could only find a service that wants an EMS Dinosaur who needs some TLC to get back into the field who can only work weekends and some nights.

oh, ok, that's better, Pasadena is a great area, good house prices and cost of living there is better than closer to balt/dc. Annapolis is a bit more expensive. Just remember, if something in your city takes you 20 minutes to get there in rush hour, add an hour up in the balt area.

Oh my god, just don't move to baltimore. You are too sweet and kind to live there.

damn, that's a crazy story. I did clinicals where we would get calls from the local funeral home across the street from the EMS station and we would go over and help them move larger bodies and help them do all different sorts of tasks. Sort of a public service for that funeral home.

Resolutions - Out with the old - In with the new What did you particularly not get to do in 2015 that you want to do in 2016? it can be EMS related or it doesn't have to be. I'll start off, I have several (I'll start with a couple here) I will be happy to hit 3 of these. 1. The first one is a threefer- lose weight(to shore up my back to keep from having surgery), spend more time with my kids, and love my wife better 2. Be a better employee- to learn a new skill each month bringing my marketability to a greater level than it's ever been by August of 2016 3. To have at least 30 short devotional style readings(secular and non-secular) written to share with my friends. 4. Complete the family bug-out bags and SHTF preparations 5. Paint my house and upgrade the storage areas in the house. 6. develop a 1yr, 3yr, and 10 year goal plan.

Now we just need someone with Publishing experience,,,,,,,,hmmmmmm who might that be?????? that could put their experience behind this and give guidance?????

I was semi-serious. I've been looking for a project and a writing project to boot. I've been doing a life lesson/partially religious/partially secular short story style writing when time allows over the past couple of weeks and I gotta say they are rough but pretty good. I need a project right now and maybe this might be something to think about doing. sort of a compilation of tips/tricks in short 1000 words or less from seasoned providers in the field who want to provide their expertise to new providers and old. Not a new intubation or EKG skills essay type but a "this happened to me" or a "what to do when this happens" ER doc, Dwayne, Mike, Scuba? Any thoughts?

just what do you want to end up doing? medic or RN? Whichever you decide, focus on that and let the other one slip to the side until you get the first one done. Don't try to do both as I have friends who have tried to do both at the same time and they failed miserably. You can do both but not at the same time. But that's my opinion only. Sounds like you have some A-holes in your county ems system if you ask me and I'll bet those same aholes get pissed when they have to transport a BLS patient when a bls unit could have done it just fine. Nothing pisses me off more than a bitchy provider.

and many times you can't kill em any deader.

hey Doc, let's you and I begin the negotiations with your publisher and write up a book on how to have those and other tough discussions for the new as well as the experienced provider.

Lots of oxygen during CPR I thought oxygen was bad!!!!!! (sprry, my sarcasm button didn't get turned off today)

ok, let me ask this question, for the one off patients, the ones who you work (hypothermic, drug overdoses, etc) and you get ROSC, should those examples be used to guide our overall treatment and transport of all Codes? There would be some in the field who would say that if the possibility to bring back even one code patient then the benefits outweigh the risks. Do we let anecdotal evidence trump otherwise valid evidence in this discussion? 9/10 or more outcomes are dismal at best, horrible at worst. We all have our stories of codes we've worked or know of worked and brought back and now we get to cart them back and forth to the hospital for their monthly admissions because they are alive but not, if that makes sense.

I absolutely think that many medics out there have a problem or aversion to doing what you are discussing. In my first year of working I was apprehensive to do it but after a close friend was killed when I was working and I had to call him in the field. I spent time with his family a couple of weeks after his death and they told me that my discussing what we were doing and stopping it when we did made it much easier for them to accept his death. I then began to push myself to be more "out there" in working with the families of patients who we worked who were dying or we were coding. After time, it got easier(it never gets easier but you know what I"m saying). After you do it for a couple of times you get a flow and process. I will also say that I had a great mentor in medic school who worked with me during the codes we worked to tell patients families of their impending deaths and non transports. I learned from a GREAT GREAT GREAT mentor. I tried to mentor with the same kindness that my mentor gave to me. If I was still actively doing this line of work, I'd write a book about it and other things. I think with all things, the more that you do it, the better (or more empathetic) you become.

Oh, I have no problem discussing calling someone in the field. As long as they meet the code pronouncement requirements. If I've worked them for the 20 minutes and couple rounds of acls and no return of circulation I'll spend some time with the family while others are doing cpr and discuss what's going. As a matter of fact, after the first round of ACLS with no return of circulation I'm going to start that discussion with the family to prepare them. I find that in my past experience, the family knows what's going on and as long as you are up front with them they usually go with what you talk to them about. I always review what I've done with a quick discussion with medical control (small town EMS you know) and then discuss options with family and families know their loved ones are usually gone. I never lie to the family, i never sugar coat it and I just tell em what we are doing. I've only had one issue so far and that was a 15 year old kid who hung himself and he was way far beyond saving but cpr was already in progress when we got there and we only continued CPR to get medical control sign off to stop CPR and call it in the field. Family wasn't ready to let him go and they were pretty adamant that we continue but after discussion of what was happening to him they agreed to our stopping and they got to say final goodbyes at the home rather than the ER. In the ER where I worked, I was the night shift designee to go in with the doctor to be with the family on death notification and if the doctor was busy, it usually fell on me to do the initial notification. Shoot, I even went(occasionally) with the local police and highway patrol on death notifications if it was a patient that I had worked to answer questions from the family if they had any. That often worked out very well. Our local protocols were quite broad in calling codes in the field.

I've had a relatively crappy day and I think I'm going cynical in my old age but here goes. the first paragraph is sarcasm but there is a lot of truth in it. A long time ago, it used to be, I believe a badge of honor, to work the patient till you were blue in the face at the house and then load the patient up in the ambulance(hearse) and drive balls to the walls to the hospital all the while working them in the back of the ambulance and then arriving with a warm dead body just to follow your local out of date protocols (and count how many pink boxes and blue boxes and grey boxes and brown boxes you used on them) which those out of date local protocols would NOT allow you to call the patient in the field. I absolutely abhored doing that knowing that we would hardly EVER EVER EVER(read NEVER) bring them back and if we did, they would never ever make it out of the hospital and it they did make it out of the hospital, they were heading for a life of luxury in a nursing home near you to be cared for an unknown number of years until you got called to the nursing home to work them again and finally break the cycle of senseless CPR and giving them drugs just to fulfill your local out of date protocols. And in between these life events, we would be called to the nursing home to transport Elmer to the hospital for his weekly blood work or Pneumonia check and probably admit to the hospital so we could prolong their life yet again when they should never have been transported in the very first place because they were DEAD the first time you coded them and you could have called them if you have an updated set of protocols that allowed you to call dead people in the field. Amazing how far we've come. The last service I worked for had a liberal do not transport dead people protocol and I took it one step further and truly believed that if you drive 8-15 minutes to a non-breather and arrive to find the patient without CPR in progress and you have no witnesses to downtime and they show Asystole then they are dead and you reach for your cell phone immediately to call medical control to discuss deadness rather than start to work the patient. Let you partner put the electrodes on the patient and check for breathing and heartbeat but get the orders to not start CPR if they have been down for a while. But I'm jaded from having worked too many people who should never have been worked. But don't get me wrong, if my protocols force me to work them, I'll do it, but I'm going to try to not have to do so if it's in the patients best interest. But to start CPR on someone who has been down for more than 15 minutes with no cpr started, is beating a dead horse, especially if they are asystolic........V-fib or v-tach or other reversible cause rhythm's fall under a different umbrella alltogether. And DONT even get me started on this BS I hear about "compassion codes"

I haven't seen this many thread resurrections in I don't know how many years. Maybe it will spark some good discussion.

Yeah, and no i don't have NR. I've always been grandfathered in for Missouri and only Missouri. had no plans to use my medic outside of missouri so didnt' forward think to keep registry(which I did have at one time) in an inactive status. But bygones be bygones. But hopefully the packet has arrived or is due to arrive in jefferson City MO today or tomorrow. Since I lived outside of missouri for a 2 year period during my last licensure I needed to get fingerprinted so I'm not expecting my license back until around February. I don't have any plans on using it before then anyway. I guess it's more the "I spent so long having it that I don't want to give it up" kind of mentality.

Well the day job is what pays the bills, EMS hasn't in several years so it really isn't a matter of not being on the ambulance, it's more a matter of if I let the license fully expire, then I lost a part of me that has been me for 25+ years and that doesn't feel too good. So I'll keep it for 5 more years, if I use it great, if not, well I haven't used in for a couple years so it's sort of status quo. Maybe I'll write a book, who knows.

I just sent in my relicensure packet for the last and final time. What I will get back will be my final license good for another 5 years. Will I ever use it again, maybe but more than likely No. Facing back surgery which the end result will likely make it impossible to get back on a ambulance based on what the pain doc tells me. Not like I've actually practiced on an ambulance much in the past 3 years anyway. So it's not like I will miss it but it's good to have as a fall back, now that's a plattitude I hate to use. Would you want a 48 year old, hasnt' been in the ambulance for at least 3 years working on your loved one having a heart attack? didn't think so. But anywho, there's always, teaching, or selling insurance. I promise not to quit my day job, which is keeping my hospitals medical record system running smoothly, which I can say I'm pretty damn good at.

to start you out http://www.eagleambulanceservice.com/ and lo and behold they are hiring in Billings https://www.amr.net/Locations/Operations/Montana/Billings (and AMR is there - where are they not?????) http://ci.billings.mt.us/index.aspx?NID=692 and to keep from doing your work for you - call Lindy at (406) 670-5021 or email lyndy.gurchiek@amr.net, I'm sure she'd love to chat with you. Now go make some calls, talk to Lindy, come back and tell us what you find out.

What fire house would not be complete without the requisite recliners. but a very nicely done firehouse. I've been up to the vineyard a couple of times in my life, all before my life in EMS, but if I were to retire a rich man, I'd be likely to move there or somewhere similar.

have you done a search on EMS AgenciesFire departments in Billings Montana and given them a call and just chatted with someone?

I've heard bad things about LSU fans, I'm thinking we may have to hold a vote about allowing an LSU fan to stay. Just kidding, welcome to the site.

go here and do a comparison http://swz.salary.com/CostOfLivingWizard/Layoutscripts/Coll_Result.aspx

how'd the presentations go?