Just Plain Ruff

ok, I'm gonna piss some people off here but so be it could this patient not have been treated as agressively as they should have because he was being treated at a free clinic?? Not saying that free clinics are bad because they serve a significant and important purpose but since he was at the "FREE" clinic and more than likely in a lower income bracket with no insurance that he was treated less than someone who would have had insurance and at a PAY clinic? sorry for ruffling any feathers but don't ya think this might have been somewhat to blame?

Beck I agree with your thoughts. I usually will ask them point blank EMT or medic and if they say medic then they better be able to prove it either right there or after the call. If they say EMT then we're all good. Thankfully I've only had to ask that question about 5 times in 15 years. I've worked in mainly a rural environment my career and find that you get to know all the providers in your coverage area and I've never had to really ask that often. But I agree, clarification and proof after the fact is very much warranted. i will be the first to offer help if needed and the first to tell the person offering help that "We're good" or "Heck yes, get in here"

Coach, that was hilarious. what I have found is that the nurses aids who stop do this. Them "Hi, I'm a nurse can I help" Me "sure. what kind of nurse are you" Them "I'm a nurses aide" Me "Oh, ok sure you can help, stand over there" Them "but then I won't be able the help" Me "EXACTLY" I had that exact discussion with a nurses aid who followed us the hospital just in case the stable fractured ankle patient coded and we needed her help. She then asked me why I didn't let her help and I told her something to this effect "you misrepresented yourself therefore you don't get to help" Her "NO I didn't" Me "yes you did when you said you were a nurse and you aren't" Her "I said I was a nurses aid" Me "No you didn't. would you like me to get the nursing supervisor down here and discuss it with her" She worked on the 3rd floor skilled nursing unit in the hospital we took the patient to and we are based out of that hospital Her "Yes, get her down here" Me "Ok, I'll go get her" to make a long story short (some of you are saying TOOOOOO LATE!) She was reprimanded and ever since this incident I felt daggers in my back if I was ever on the same floor bringning up a patient when she was working. She has since gone on to bigger and better things - she works at the local chicken processing (tyson) plant. A step up for her if you ask me.

This is a great question NREMT - I'm glad you asked. And since it is covered in your emt book so thoroughly I'll give you a wonderful link on Coma a little further down in this post. First off this should never never never be performed on a patient until the c-spine has been ruled clear. If you use it on a patient without a c-spine that has been cleared then the possbility of paralyzing the patient is tremendous. this is a deep brain stem injury and is a very very ominous sign and very bad for the patient. this may indicate deep brain stem lesion. here is a wonderful site for this information. read the WHOLE thing. But if you do not wish to read the whole thing scroll down to Eye Movement section and you will see what Doll's eyes are. http://www.postgradmed.com/issues/2002/02_02/malik.htm Again DO NOT DO THIS MANEUVER ON A NON-CLEARED C-SPINE. To do so would possibly or more than LIKELY cause irreparable harm and injury to the patient and it would make your career in EMS very very very short.

JG that's a wonderful story. Sounds like you made a difference.

HOLY CRAPOLA BATMAN!!! Am I the only one who sees something wrong with this picture? Can anyone say Silent MI? I can. Wow hope you documented good on this one. what did the cardiac consult turn up? did your Brain Surgeon do any labs? If not I'd doubly get your documentation in order. (hint hint - suspect a visit from your local process server at your door sometime in the future if this guy had any negative effects of waiting for a cardiac consult.) I hope the guy did good. You are right to be concerned. You said it right - if you had seen him in the ambulance you would have worked him up for MI and transported to the hospital. I think your doc did a badddddddddddd thing.

exactly my point. If they cannot provide their credentials in the instant that they say I'm a medic then they get to do BLS Stuff only. I'll tell em that I don't have time to check their license and they get told BLS only. The legal issue for me is that if they cannot show me that they are a medic then I won't use them in a medic capacity because it will not come back and bite them on the ASS but it will come back and bite me if they do something they are not trained for. So in reference to my above post, they had better have their credentials ready or I better know them or all they get to do is BLS skills.

I can tell you that if you stopped at my scene and said you were a paramedic you'd better be able to prove it. I encountered a would be rescuer who said he was a medic. Our unit was the only one on scene of a 3 car mva with 2 criticals and 4 minors. I had 2 additional units and a helicopter in route. This guy comes up says I'm a medic can I help. I said sure take care of that critical patient till the ambulance gets here. He did and even though he did not cause any harm to the patient as he was able to keep the airway open and apply pressure on the brachial artery that was lacerated which was all he could do at the time since the guy was trapped in the car. It turns out that the guy was a EMT from a neighboring jurisdiction. I found out that he was an EMT by the 2nd responding unit. Needless to say I reamed him a new one for misrepresenting himself and vowed from here on out that I would never allow someone to help me out with any type of advanced skills unless they fit the following criteria 1. I had to personally know them and what level they were 2. OR - they had to show me their EMT-P or Nursing license before they could do any type of advanced skill Thank goodness it has never happened again but those are my ground rules I never stop at a scene unless I can tell there is a real pressing need. If the ambulance is already there then I don't stop. Now all this goes out the window if it's in my coverage area. All bets are off.

Turn it in to your supervisor and let them deal with it. the kid had too much to worry about from here on out so I would not have turned it in to the cops. I have too much to worry about in my daily duties of work to be worried about it so let the supervisor handle it. That's what they get paid for.

Congrats on the career change. I did the same and have not looked back. good luck.

Fair enough JP, I don't know the california way so I wasn't sure. I've never been in a service where there was no medical control like you described. thanks for the clarification. Kind of makes for some sphincter tightening moments.

If you don't have medical control then how are you operating a emergency vehicle or transport vehicle. there is always medical control. Just call the hospital you would have taken the code to and talk to the doc there. He would be getting the patient anyway so let him make the decision. are there really services out there who don't have any type of medical control. Maybe I've been spoiled all my ems life.

Cost=utilization You have a high cost item that is not used very often if ever and then management begins to wonder if the cost of purchasing the item was worth it just sitting on the truck. cost/utilization balance. If you have an item that is cheaper out there but not as good, do the pencil pushers take the more expensive item off the truck and put the cheaper alternative on? I don't have the answer to that.

Here is the text from the NAEMT site on how to become a flight medic. Maybe this should be in the knowledge base All credit goes to the NAEMT site. Give Your Career Wings: Making the Jump to Flight Medic For some EMTs and paramedics, flight EMS is an exciting, rewarding and challenging career path. These “angels in flight” play a life-saving role when a patient’s condition requires critical care during transport, or when distance, inaccessible locations or road conditions prevent timely care and transport. Trained to think on their feet, air medical crews are required to have extensive prehospital, emergency and intensive care experience, as well as extensive training in caring for critically ill patients in the airborne environment. A pilot, flight paramedic and flight nurse comprise the transport team on every patient flight to ensure safe, quality patient care. According to the National Flight Paramedics Association (NFPA), approximately 1,200 flight paramedics are working in 277 rotor-wing (helicopter) and fixed-wing (airplane) medical programs in the United States. Most of these are hospital-based. Rotor-wing aircraft are used for short flights (usually less than 300 nautical miles roundtrip) and often are used to land directly at the scene of a serious emergency or accident. Fixed-wing aircraft cover greater distances and may even fly patients across international borders. Since the inside of the aircraft contains a mini-intensive care unit to handle just about any crisis, most flight medics are required to have a minimum of five years critical care experience. Tom Walsh, a flight paramedic with Albany Med FLIGHT in New York, says that the most attractive candidates have experience in a progressive, high-volume EMS system. To obtain these credentials, some individuals may require relocation to gain the necessary pre-flight employment experience. According to Kerry Armentrout of Life-Guard 10 in Roanoke, VA, most flight programs also want a Nationally Registered Paramedic with the following base credentials: CPR-Basic Life Support, ACLS, BTLS or PHTLS, PALS and NALS. The base credentials must also include a state level paramedic certification. Instructor credentials are preferred but usually are not required. Base credentials usually preferred for a flight nurse are CPR-Basic Life Support, ACLS, BTLS or PHTLS or TNCC, PALS or ENPC and NALS. A new level of certification is sponsored by the NFPA called FP-C (flight paramedic-certified) is now available to all who are interested. “It is not a test to be taken lightly, and the NFPA recommends five years experience as a flight medic before challenging the exam,” Armentrout adds. Although candidates could have all the right credentials and necessary experience, poor interpersonal skills will seldom get them past an interview. “Flight crews have to be self-motivated and possess strong critical-care thinking and clinical-decision skills. They must also have excellent leadership and diplomatic skills,” Walsh recommends. “Flight program directors look for those EMTs who are in the top one percent.” Candidates should also be able to accept criticism. “To better assess a particular flight program, air medical crews have their calls reviewed all the time,” he adds. “You need thick skin because you will be scrutinized.” Another tip in preparing for the interview is to learn as much as you can about the flight system and the people who work there. Walsh and Armentrout both mention that flight paramedic jobs are competitive. For each flight paramedic opening, approximately 250 applications are received according to the NFPA Web site. Armentrout says that turnover in the industry is slow, and five to seven years is considered normal attrition. “When an opening does become available, most programs are now using behavioral interviews to screen candidates,” he says. His final recommendation is to read any books on behavioral interviews. “They’re a great help in preparation for the big day.” For more information on career opportunities in flight EMS, visit www.aams.org, www.flightweb.com or www.flightparamedic.org. Reprinted with permission from MERGINET.com, May 2004.

BEST FREAKING VIDEO EVAH I loved it. WOW how fun but then again illegal. disclaimer - I didn't know dynamite could do that officer.

Those tests are geared to make you feel you failed when in reality you didn't. It's the same as the computer based testing for LPN's that my wife took a number of years ago. I sometimes think that the National registry has decided to make this as stressful as they can so everyone gets driven crazy.

1150 Boy am I sooooo going to hell and a handbasket. If we did something twice do we count the fine twice, if that's the case then I'm burning right now.

I read something in this that I hit on right away. You ahve not been performing skills for over 7 months. That is a long time to be expected to retain the information and skills. Everyone loses skill ability if they are away from performing the skills for long enough. The advice above is good - you are human, we practice medicine we are not perfect. I would suggest this - Get a group at your service together and work on skills stations. OR Take a refresher course on your days off. You will be back in the full swing of things in no time. But stop kicking yourself in the arse and stop drinking the Kool-aid in the belief that you should be flawless and polished. As a new emt there is no way that I would expect you to be polished and not a little bit rusty. Any FTO worth his salt would be sitting down with you prior to the shift start and asking you -- what do you want to learn today or what do you want to go over today that you feel you need help with. If your fto doesn't ask you then go to him before shift and say, can we work on this or whatever. You should be taking as many blood pressures and pulses and whatever else you can think of. The only way you get better is to do it over and over. Here are some other things to do 1. read your book - it helps to review things 2. listen to lung sounds 3. listen to the heart 4. take many many many bp/pulses 5. Review the equipment so you understand it's use 6. ask ask ask questions - your fto might begin to hate all the questions you have but if you don't ask you don't learn. Good luck, you will do fine but it does take practice practice practice.

and every house fire you have been to the owners received a thank you card with this motto on them. "Another quality inground Swimming pool courtesy of XYZ Volunteer Fire Department"

Please try to use common english from here on out. If your question is are we a taxi service, well those at a service I used to work for called their ambulances big red taxi cabs with lights and sirens. Do we transport emergently, occasionally but some medics more than others. Do we save lives or are we just taxi's I would say that we do save lives but remember this old adage - Patients die and we do not save everyone contrary to public belief secondary to Rescue 911. Please rephrase your question in the form of a question or query please. Now I can try to put direct pressure on everyones eyes who are bleeding.

I've got to get one. This entire week I spent smashing the snooze button and finally the clock rebelled and didn't even go off today. I'm ordering one this morning.

I agree with you Dust. News media and reporters have long since put their lives at risk. Just look at the reporters from the media in wartime. Many of them don't make it home. The chopper pilot is one of the best, he can get pictures that no-one else can even come close to getting. I was just wondering what the fines might be or if there were any.

JP You must be talking about that infamous post from GAMedic. Oh I remember that one well.

Anthony you hit the nail on the head - Get your education - you can always fall back on education - you can't fall back on "I can't get a job mentality" and then move back in with mom and dad The advice given is good. If you don't heed the advice then you have nobody else to blame except yourself. If you don't at least heed this advice and take it into consideration then you have no right to complain to anyone about your predicament which we have all seen before.

ok, there is a huge fire in kansas city with a chemical plant explosion. Black black smoke with a smoke plume extending about 5 - 10 miles southwest. The channel 9 news chopper is flying all around the incident. the Fire department has issued a warning to stay 1 mile away. The head of the emergency operations center said while he was talking to the news company that runs the helicopter. The pilot said he was going to fly through the smoke and the cheif said "Tell your helicopter pilot to stay a mile away from the smoke. We're watching him" I wonder what kind of fines this pilot can incur. Any ideas? New Info:: And now they have done another silly thing. The saw some black substances falling from the sky from the smoke. The pieces are as small as quarters to as large as loaves of bread. One of the newscrews picked a couple of these things up and brought them to the news room. They now get a call from the fire department telling the news people and the citizens to NOT pick this stuff up cause they do not Know what this stuff is. This just gets better and better.