buckeyedoc

DNR's are a subject of massive confusion in Ohio. Keep in mind, the Ohio DNR laws were written by lawyers, not doctors. Yes, doctors had input, but the legal mumbo jumbo was written by lawyers. I have been threatened with lawsuits by family before because the pt. is a DNR (doesn't matter which one) and the facility could not produce a signed copy of the DNR order. Therefore, they're a full code. I had a grandson (who was an attorney) get in my face and wanted to fight when I worked his grandmother and had ROSC. He wanted to start a fight in the middle of the ER because she had a DNR, but the nursing home did not have a copy of the order (signed or unsigned). Ohio needs to re-write the current DNR law to clarify many things. medstudent, I just want to let you know that I was not attacking you. I hope you didn't take it that way. I was just disagreeing. Doc

Sorry, but you are mistaken. Ohio does recognize the Living Will and HCPOA. You can find a good bit of information here. Ohio Living Will and HCPOA Information

We have it in our protocols for dialysis pt.'s in arrest. I have yet to push it, though. I haven't read any articles on it usefulness in aystolic arrest. Doc

The FD I work on provides 3 t-shirts, 1 job shirt, 1 dress shirt, winter jacket, badge, pants (if you want) and if you're fire, bunker gear and helmet. I wear EMS pants for squad runs and at my full-time job and wear regular uniform pants when running fire. When I wear my EMS pants, I carry my pocket protocol book and 1 small pad of paper in one side pocket and my hospital ID (my company has the contract) in my other. I don't carry 14 pairs of scissors, hemostats, flashlight, and a bunch of other crap. I've come to realize that I really don't need all that stuff. It's handy enough in the bus if I need it. Doc

Our 2006 protocols have allowed us to access PICC, central lines and Dialysis Fistulas in codes.

I have to agree.

Ditto, except for the Dwayne part, of course. Doc

Woody, Hope this helps. Female Firefighter Calendar Oh, welcome back. Doc

Unfortunately, not uncommon at all.

I have to admit, this works (it wasn't in EMS for me, though). I sent a thank you letter to a large, nation-wide company after I interviewed, but didn't get the job. Turned out that I was 11 on a list for hiring 6. About a week later, I get a phone call from not only the HR manager, but the VP of HR and the director of the department I had applied for. They called to thank me for the letter and that they wanted me to come in for a second interview. The letter MADE the difference. Granted, I could have pissed and moaned about not getting the job, but companies notice the little things. Ok, now on to my tip for obtaining gainful employment (whether EMS or not)...TAKE OUT YOUR DAMN PIERCINGS (except ears, ladies) Who gives a crap you think it's cool or whatever, they DO NOT present a professional appearance. This will probably be a sore subject, but if you have tattoos all over your arms, for Pete's sake, wear a long sleeve shirt. Your prospective employer does not want to see them. Get the job first and then let them wear short sleeve shirts.

I currently work in the ED as a paramedic. Our hospital is a rarity in that paramedics are used as such. Other hospitals in the region (including several Level I trauma centers) use paramedics as Pt. Care Assistants (PCA, ED Techs or whatever the hell else you call them). We have PCA's in our ED that do (and only do) the following: 1. Draw blood ( NO IV's are permitted by PCA's 2. Foley Caths 3. Administer the 12-lead (and runs to the doc with it) 4. Transport patients As a medic in the ED, I work under a set of established protocols. There have been several times that someone comes in with c/p and the 12-lead shows an MI. We give the ASA and Nitro many times before a doctor even knows they are there. Now, let me make things clear, we are not treating the monitor, we are treating the patient's symptoms and use the 12-lead as a diagnostic tool. There are times that the nurses are busy with another patient and the medics are the only ones who check in the patient. Below is a list of of our scope of practice in the ED 1. IV's and blood draws 2. Foley caths 3. 12-lead (administration and some interpretation as mentioned above) 4. Medication administration (no IV antibiotics, Natrecor [or the like] or no blood products) 5. Intubation (like we ever beat the docs to this one, but we are permitted) We have several PCA's who are EMT's. Regardless of any certifications, the PCA's are required to be trained and tested on 12-lead administration, phlebot skills and foley caths. The medics in the ER are not there to replace the nurses, but to supplement staffing. PCA's don't even have Pixys access to obtain medications (that includes tylenol). thbarnes, as far as you pushing meds, interpreting 12-leads and starting IV's as an EMT-B, I have to raise the :bs: flag on this one. We, the people of EMT City, would be more than happy to view your standing orders for the ER. I have several friends who are paramedics (very seasoned ones at that) who work in a large Level I trauma center as an ER Tech who aren't permitted to push meds in the ER, with or without a physican's order.

Best of luck. Congrats on getting done what you already have. I, too, am in the process of setting up a third-service 911 provider so I know what you're going through. Here is a list of things that I can think of off the top of my head (at 02:00 hrs): 1. Staffing: volunteer, part-paid, full-time, basic, paramedic, mixed, shifts (8's, 12's, 24's) 2. Equipment: there are a ton of resources out there for grants for equipment (I've applied and got 2 totalling $35,000) 3. Benefits: medical insurance, training re-imbursement, free CEU's 4. Vehicles: type III's, type I medium duty (this I'm sure you've already scoped out) Good luck with this.

I'm not one to post other forums addresses elsewhere, but there is a lot of good information (as well as EMT-W instructors) here. I find the information very informative. Lightfighter.net Tactical Medicine Forum Mods/Admin, if you do not approve of me posting the link to the forum, please delete the post and let me know. If I offend anyone by doing this, I apologize. Doc

This has happened to 2 medics I know. They are 2 of the best medics I know. One made a medication error (the patient is just fine) and the other gave Nitro to someone w/ a sys. B/P of 110. His partner couldn't get the IV and the pt's B/P dropped. They had to do an EJ and the medical director climbed his arse because he was the senior medic. He was not permitted to operate under our dept.'s protocols. I worked with them at another dept and the medical director of that dept. knew of the situation and personally spoke with the medics, their supervisors and the other medical director. Their new medical director decided that it was a personal mission of the MD to get these guys fired. They are good guys and good medics. Doc

You'll be good to go. You have to teach 2 classes a year. My other advice to you is wait a couple of months. The new AHA curriculum was just officially released today. They will be teaching the new curriculum starting in June. Another bit of advice, make copies of EVERYTHING you do for AHA. I've had numerous rosters and tests get lost at the education agency (our local hospital). That way if something does get lost, you've got copies. Doc

In order to be able to provide certification cards to your participants, you MUST be an extension of an AHA approved education center (ie. local hospital). They will not let you instruct AHA without the instructor certification. Take the class, it's only 1 day long and costs about $90. Teaching CPR is fine, but if you want to teach to daycare centers, schools or anything like that, the state requires a card (at least in Ohio). My advice to you is to take the instructor course and then go out and teach. My wife and I are instructors from ACLS on down and teach several classes a month. Every place that we've taught has requested certification cards. Just my $0.02. Doc

Hey, what a coincidence, so do I. :wav: Let me put it this way, it would be hard for me to leave my current company and make more money (even at an FD).

That is my biggest pet peeve. I know people with high education (several doctors) who use this non-word. Drives me nuts.

I have to agree. You should take a little something from every call. Learn from your mistakes (and others' mistakes). That is how we become good at what we do.

I've always called them Ambu bags. I called an OPA a "J-tube" while teaching a class and no one knew what I was talking about. We called them J-tubes in the military. Apparantly, they're not called that elsewhere.

You'd have to admit, your question was a bit vague. I was just telling how it was done where I work. Everywhere is different. On every dept. that I have worked for, the "in charge", "senior paramedic", "paramedic in charge (PIC)" or whatever have in almost every case been by departmental seniority or how long you've been a medic. There usually isn't an exam that determines this.

I know you weren't being critical. I trust you, Dust. I'm actually a little torn. On the downside, we have a BRAND NEW medic (passed the 3rd time in December w/ a 71% BTW) who has been with the company for 9 years. He started out as a basic. We have a guy who started last May who has been a medic for about 4 years with a large 911 service in South Carolina. He was been a navy corpsman for about 13 years. By policy, the jackoff with his card for 1 month is Senior. I don't agree with that. NO ONE and I mean no one, including most management, listens to him. IMHO, I think that the person with the highest certification should be senior (which BTW isn't always the case). If there are 2 people with the same level of cert, then other things should be taken into consideration, such as... 1. Certification date 2. Time with dept./company I think that all things should be taken into consideration when determining PIC and not just bestowed on someone because they kiss someones a$$. Which happens a lot in this industry.

In that instance, the medic who has been a medic for 3 years and 3 years seniority w/ company would be Senior Medic. I never said it was a fool proof plan.

The fire dept that I run for has a "Crew Chief" on all runs. This is the most senior paramedic, regardless of rank (i.e. - Lt., Capt., etc.). My full-time job have PIC's (paramedic in charge). Obviously, because my partner is a basic, I am PIC by default. If we have multiple crews on a run (which happens every now and then, the most senior paramedic (in regards to company seniority) is the PIC.

Ditto