Just Plain Ruff

I know the legal answer to the question in the topic is NO we cannot but I'd like to hear honest responses to the question. Can we as medics or EMT's diagnose in the field and if your answer is yes please explain. I guess what I'm asking was prompted by a previous post about coercing a refusal. I know that I've in the past told a patient it was probably a vagal reaction or a simple laceration that could wait to be transported to the ER in a private vehicle but............ can we ethically promote a diagnosis in the field? I know we've all done it but I'm just curious if anyone here will admit to being able to diagnose in the field and what the rationale is behind that thought process?

yeah the only patients who don't require a transport are the ones who are warm and dead. As for the partner who coerced(possibly just swayed) a refusal - as a supervisor and I had heard that, I'd have suspended him. Let me ask everyone on this board a question - but I'll do it in a different post

This might be your ideal choice. Paramedic refresher dates are February 9, 10, 11, 16, 17, 18 of 2007 Held in sunny cleveland Ohio http://www.emsacademy.us/EMS/ems+continuin...+refresher.aspx I hope this helps. If you need anyone to make phone calls for you pm me and I will help you out. Michael

Here is a place that has ems refresher courses and they are top notch. Not sure if it is what you are looking for but I'll give em a call for you since you are a long way away. http://www.stjohns.com/foundation/education.aspx St. John's EMS Education Programs (does not appear to have a web site) 1235 E. Cherokee Springfield, MO 65804 417- 820-5450

when did she have her pacer adjusted. You stated in your opening line that you were called for intermittent chest pain. Did you say she had any type of fever? If a fever is present I would begin to suspect pneumonia or bronchitis. This is why I suspect pneumonia or bronchitis from your post "Chest - Decreased Breath Sounds/+ Wheezes/ Intermittent Right Sided Chest Discomfort ( Non burning & Non radiating )"

The point of this whole post is that the original poster cannot deal with the stress of the exams. OH boy here we go again. If you cannot deal with the stress of the exams which is a guarantee that you will not kill anyone during the tests then how will they deal with the stress of a patient who is crashing or coding or god forbid taking violence out on the original poster. I also second the motion that if you cannot handle it then another career ladder is more appropriate. AS for somedics responses - albeit their being a little harsh I find nothing wrong with his posts. Nothing like driving home the point. Bow please do not use all caps in your posts again and also please use correct pronunciations and grammar. No one here wants to read in all caps. It's just plain irritating For what it's worth, I was a very very bad test taker in school, would freeze up but you get over it and go on. good luck with whatever career path you choose if you do not choose to stay in ems.

you betcha we called it the HEAR radio Hospital Emergency Area Radio or something like that. in order to get to a specific hospital you had to dial in their number. consider it one of the first rotary dial cell phones. When they worked they worked well, if you didn't get the dialing right then you did it again and again till you got it right.

Well that my friend is what they call inducing a patient refusal and that is plainly WRONG but then again I wasn't there so I don't know the whole story. Still I'd reflect on the fact that you think you might have pushed her towards a refusal and not do that again. You had no idea what was wrong with the patient yet you pushed her and downplayed her symptoms. So what would have happened if 2 hours later you responded back to her home and she was significantly worse or in arrest. I always found it distasteful that many medics that I know gloat as to how many refusals they get. I for one at one time was guilty of it until I was called into a deposition involving a refusal of care. It was a real eye opener. I'm not preaching here (maybe I am but) but we need to remember that we DO NOT diagnose and inducing a refusal by saying that it's the meds acting up or your symptoms are normal for your complaint we begin to get on that slope. This is something to think about. One other thing - what would your services management view be if you told them you swayed the refusal? I'm sure it would not be a good view and would probably have elicited a significantly negative response towards you and your partner. I know that all the services that I have worked at they take a really really dim view on this and it is sometimes punishable by remedial training, suspension or termination.

just when the plane was banking to the left, all the seatbelts undid themselves and those on the right side of the plane landed on those on the left side and then......

maybe this is one of those complete my thoughts threads So after the pilot said "LET ME SHOW YOU" the plane took a tremendous bank to the left and continue everyone please.

HUH?? What makes this post funny? OP please expand thanks

I agree, there was nothing inappropriate about cutting and pasting as many many here do the same. Citing the source would have been nice but jeesh, I learned something. As a standard, I don't ever think it's the poster's original work if they put a huge amount of information in a post. Unless the poster says it's their own work. I have cut and pasted stuff here too and have never been chastised like Timmy was. And Phil, no offense intended but maybe you didn't need all that information but I for one found it very informative and I am glad he posted it. The fact that you knew this information doesn't negate the fact that many others probably learned from his post. First cast no stones

ok ok ok AS a part time EMS'r and a full time travelling consultant - EMS life is cake. Sure 24 hour shifts take you away from your family or girlfriend for 24 hours but here's my situation I leave monday morning at 0400 to catch a plane to go to my client site. I then spend 3 glorious nights in a homewood suites away from my son and wife. I arrive back home thursday night between 8pm and 11pm depending on the flight schedule. I do this in addition to occasional shifts on the ambulance. I do not see my wife or son for 4 days so if your lifestyle is crimped by 24 hours away from each other I say do as others have said to do - get away from this girl and find one less "high" maintenance. You will be happier Find someone closer to your line of work, nursing, dispatcher or what not. 3 years and just starting to get serious - you both sound young. Take a break from dating and work and build up a nest egg and then come back to gettign serious. Trust me, you will thank me for it in the future.

I also hope you did not induce the refusal for the liposuction patient. Any time we as medics or emt's begin to play doctor and say oh it's only your pain meds causing this or something along that line we get on a true slippery slope. post surgery, liposuction patient, nausea and vomiting - can you or your partner diagnose what is going on in that patients body? I do not think so. Any time we start to pressure someone to not go with us then we begin to be our own worst enemies. Can anyone here tell us what many women with MI's present with as initial symptoms????? I belive that n&v is one of those classic signs in a woman. Not saying this was the case but go by this rule and you will never fail - if the patient wants to go take them - simple as that. Who are we to go around telling patients or pushing them to refuse. If they want to go take em. What harm is there in taking these people? Remember - many medics have been bit in the ASS by refusals and this lady had she have deteriorated you would have been more than likely found negligent or liable for her demise. I like to look at it this way - it isnt' gonna take all day to get her to the ER and get your truck back in service. If you get angry at the patient because you miss the big call because you are taking care of the little call then you are in the wrong business. Their complaint is important to them and they don't call 911 with the expectation that they are not going to be taken to the ER, they call us because in their eyes and mindset, they needed an ambulance. It only takes one patient to refuse on you and then crash before your career is over.

http://www.msnbc.msn.com/id/15730874/wid/11915773?GT1=8717 I don't know what to think. Sounds like good science behind it but I'm not sure if I agree. discuss

Pumpernickel how long have you been in EMS? If this is your first and only job then maybe before leaving ems all together you should try a different service. There are bad people in all areas of all jobs. I've worked in many different fields and every field has it's bad arseholes. Good luck in whatever you end up doing. So what did your medical director say that the issues were? You need to take a look at those issues that were brought up and think about them. If they were vague then you may have gotten on one person's bad side and if that is the case, it could be a he said she said situation Go back and think about what was said and I'm sure you'll find some semblence of the truth. Or you can take the easy way out and quit. I'd fight this if I were you.

Rid, unless the ownere of the ez IO drill doesnt' have a patent on this device will competition be there. I think other companies would be worried about patent infringement. What do you think?

I was at a system which was a trial site for the FAST 1, I've used it and seen it used. It's a medieval torture device. Has anyone seen the video of the device being used. OUCH. I witnessed a liter of fluid dumped in a critical patient in less than 2 minutes on this device. Great device. Woudl I want it used on me? HECK no

Somedic, 2 of your points were good points. But I also believe that you have to protect yourself at all costs. You are the one who is supporting your family and if it means to go on the offensive then by all means do it. I've been on both sides of the coin. I've been the prey and also been the predator and by all means being the predator is preferable than being the prey. Being the prey usually means your butt is on the way out the door. This doesn't mean to be an arsehole but it does mean to protect yourself.

the answer to your question is not burnout. Burnout is different than what you are describing. you feel betrayed by the people you trusted and you are angry. You have every right to be angry unless you deserved the write up You will find that in this field as well as any other field that many people do not come right out and say that you screwed up or you did something wrong, they go behind your back as you call it and write you up. It's happened to me many times. I find it the cowards way of dealing with things but hey, to each their own. So it's not burnout that you are feeling, it's a feeling of anger, distrust. I'd get over those feelings, obviously someone felt strongly enough to write you up and your medical director felt strongly enough that the write up was warranted so look there first on why you were written up. Remedial training is good sometimes. you now know who you can trust to be honest with you on things and those y ou cannot trust. This my friend is not burnout just a natural reaction to a stressor that you were put under. At least your medical director felt remedial training was an option and they just didn't fire you. Some services I've worked for would have fired you rather than made you go thru remedial training. The only other question I have for you is this. just what skills were they concerned with? A lot of times someone will say everyone won't work with you to make it more dramatic and seem more urgent. I agree with some of what Somedic posted - the main thing is to re-assess yourself and take a good long look in the mirror and say, do I really know what I'm doing on scene? it's one thing to pass with flying colors on a sit down chat but the devil is in the details and your skills in a sit down chat session may be top notch but your on scene skills may be lacking.

If you don't take Dust's advice and want to study pharmacology here is a site that might just fit your requirements. http://www.geocities.com/doctor_uae/pharm1.htm

Dang Dust that was the best reply I've read in a long time. Are you sure you are the same dust we all know or did you get caught up in that mass kidnapping yesterday and they cloned you. My prayers for those who were kidnapped. Did you get my pm?

I study as often as I can but I don't consider it studying. I'm usually reading or looking up something on the net in order to get a better grasp on things. I also believe that even though as a medic you should keep on top of your game you should also provide for learning something apart from EMS. If you have wanted to know about underwater basket weaving and wanted to learn it then I'd study that. If you want to know how to make a alarm clock work then learn about that. There is no reason you should only focus on your job for studying. I for one during work as a medic started to take classes in project management at the graduate level and now I work in consulting doing EMS part time. I see all I want of the ER while working as that is what kind of consulting I do. So I don't believe that you should completely focus on EMS education but the more knowledgable you are the better Cliff Claven you can be.

Sounds like a rough couple of days. Go home monday, take a day away from the Pager and the scanner if you listen to it. spend some time with friends, family or just in a hobby you enjoy. My first day as an emt, brandnew on the streets emt, pedi code, adult code, mva with 3 class I trauma patients. They were so busy that I did not have a field training officer to ride with me and coach me. I was alone with my partner. All in all it went well but it was mentally draining. Everyone has weeks like you had and in the end it does all work out. Keep your spirits up and by all means, spend some time with the ones you love. We dont' get to see them all that often in this line of work.

how about "What would your former employee say about your past performance?" Or "Tell us about a time when you had to work as a team to get something done? what happened, was it successful? And if it was successful tell us why and if it was not tell us why?" Or this one - a long time ago about 15 years ago I was interviewing for an office position you know filing and filling papers out etc etc. The interviewer asked, Are you gay and if you are not how do you feel working in an office with 5 gay people and one straight person? (Honest, real life interview question)