crotchitymedic1986

No, its indicative of our society today. Why should EMS be any different than any other industry ? As a young lad, I remember my grandfather driving 20 miles to the closest grocery store to return the $2.00 the cashier had mistakenly given him in change (they didnt count it out in front of you back in those days, he didnt realize it until he got home). How many of us would do that today ? When you violate policy at work or make a mistake, is your first reaction to admit your error or is it to try to cover up your error ? Do you follow all policies at work, or just the important ones (always use a backer ?). Do you always do the right thing, or just do the right thing when someone is looking ?

All those gigs sound fun, but its not like TV. Being on the swat team as a medic means you sit in your truck for 12 hours while the negotiators do their thing. Being on the boat or dive team means you freeze your ass of in nasty water retrieving bodies. For all the training involved, the calls are few and far between. But hey, if its your dream, go get it.

hmmmmmm, no response since last night ? The internets must have been down all night. Come-on, who is going to be the first to be adult enough to say OK, maybe I was wrong about that, I cant turn my back on my coworkers ? Therefore, I cant let the baby die either.

http://fems.dc.gov/fems/cwp/view,a,3,q,525773.asp NR required, no mention of any "state or district certification" listed as acceptable.

I have always been against unions, and I am still against the traditional union. I argued that they had outlived their usefullness, and had basically priced their employees out of jobs in almost every industry that was heavily unionized (steel, auto, textiles, manufacturing). But at the same time, when you look at what has happened to the average american worker over the past 20-30 years, you have to wonder if a "new union" would not be a good thing. Think about all the downsizing, mergers, bankruptsies, and buyouts over the past several decades that did nothing but get the CEOs and shareholders rich, while wages for the worker bees had remained relatively stagnant. I have no problem with CEOs making big money, but when they are paid 100's of times what the average employee is making, and they are making it while their company is losing money, that is wrong.

I was 17 when i started EMTI school, and had been 20 for about 2 months when I became a Paramedic. Age does not disqualify you or qualify you for being a good medic. The only downside is your lack of experience in the field, which all new medics have to some degree or another regardless of age (even if you were an EMT for years, Paramedic is a whole new ballgame). The problem is probably the shortcomings in his life, not you, and he is just taking it out on you. One thing you may not be aware of because of your age is that in our teens and 20s we tend to judge ourselves through other's eyes, because you have always measured your success by what your parents, teachers, and first fast-food employers said about us. Once you get a little older, you will care less and less about what crappy people like this think about you, and live your life through your eyes. If you havent noticed, this one person is controlling your day right now. He is contolling your mood and to some extent your actions. He has you so pissed that you were compelled to come vent in a public forum, which was basically like writing a letter. When was the last time you wrote a letter ? Now you have to make a decision, will you continue to give this one person this much control over your day ? Just because he pushes your buttons, doesnt mean you have to react. As we all know, if we were face to face and you wanted to fight me (as a teen or young man) all you would have to do is say something about my momma, and it would be on. But if I were standing in front of you today at my age, and you said something about my momma, I would let it roll of my back, because you dont know my momma, and I dont let other people control my actions. You will encounter miserable assholes like this throughout your life (patients, coworkers, and family); dont give them control of your day. SERINITY NOW !!

the problem is medics reading way too much into simple Atrial Fib.

Ok, I have said all I can to try to bring you around to the morally correct answer, but that obviously isnt going to work. This is my last and best effort to try to bring the message home, and then I give up, as this horse has been beaten to death and is now been made into jello: I know those who have stuck to their guns about not doing it probably will not admit if they change their mind with this last WHAT IF: What if it were your partner's wife ? What if it were someone in your family (not immediate, maybe a cousin or inlaw). Not moved ? Last chance: We put you in a plane crash in a remote area during a snowstorm. It will be hours before anyone finds you, or is able to get to you should they find you. You dont have to do a C-Section on anyone, but to save lives, you have to do some "non-approved" procedures like surgical airway, amputation, maybe decide who is not salvageable and who is (and let the ones who would take too many supplies and effort die) versus working everyone that codes, maybe removing some shrappnel, putting in some stitches ? Or do you just tell everyone, "sorry I have medical training, but I could lose my license if I save your life --- but hey, the guy that sells insurance that was sitting next to me, told me he was a boyscout, maybe he can remember some first aid." OOOOHHHHH OOOOHHHH OOOHHH Mr Kotter, scratch the plane crash, I got a better one: Instead of a plane crash, its either a helicopter ambulance crash with fire, or a structure fire with collapse, either way one of your brothers/sisters in EMS/Fire is trapped and will be burned alive if you dont do an immediate limb amputation to free them. Please tell me you wont turn your back on your co-workers, or is your license still the most important thing ? Somebody show some love, give me some props !!!!!

Go Kaisu go, you are correct. It is a Phenothiazine Reaction. Although the normal reaction involves dystonic and extrapyramidal reactions involving the tongue or facial muscles, it can also affect the neck muscles. Another common reaction is a psychosis where you find the patient with a "wild animal gaze" in their eyes, in a delusional state. Phenergan and Compazine are both phenothiazines, as well as many psych meds (that arent used as much anymore) like Stelazine. It can occur from normal dosage or overdosage. It can be treated with a single dose of Benadryl, but can often require several dosages to resolve all symptoms. If you were guessing Torticollis, that would also be a good guess, but the recent ingestion of a phenothiazine should point you to this diagnosis. http://emedicine.medscape.com/article/814632-overview

C-sections occur everyday in third world countries by people who have absolutely no medical training, or less than a Paramedic in the countries most of us are from. I do respect those who say damn the baby, my paycheck is all that is important in my life -- atleast you are being honest.

I said nationally registered medics, not paramedic, I am sure she was NR EMTB or I. No one has said these employees were incompetent or have been guilty of poor patient care, they simply failed a written test.

She normally only takes birth control pills and a multivitamin. When she went to the infirmary yesterday they gave her a 50mg IM injection of Phenergan, and she was prescribed: Phenergan 25mg tabs PO and Lomotil (her flu symptoms consisted of fever, N&V, general body aches, and diarrhea). She has taken her medications as directed. She denies taking any drug, alcohol, herbal medicines, or stimulants. She in not allergic to any medications.

Pretty easy to take a high and mighty position when it doesnt involve you. I think if you had a handicapped child or a spouse with health problems that disqualified you from getting health insurance individually, or if you were in your 15th year with a service making a great wage and were now forced to start at the bottom again in pay, and would lose a big chunk of your retirement (most fire departments do not offer "experience pay", most start everyone at the same level), I think you might be singing a different tune. And I would take the average 20 year medic who was state certified over the average new Nationally registered medic any day. Which isnt a negative comment about the NR medic, its just that they havent seen the things you only see a couple of times in your career yet. And I would be willing to bet a paycheck that both these highly publicized EMS mistakes that resulted in death in DC were handled by NR certified medics, not a 20 year medic who was grandfathered in. Anyone know the facts about the 4 medics involved ?

Has anyone else noticed a trend here ? It seems to me that the ones willing to do the procedure seem to all be old veteran medics, whereas the ones who are most vocal against the procedure seem to be fairly new to EMS (atleast less than 6-8 years of experience). Could this simply be due to the fact that we older medics know that for all the lecturing we have received about lawsuits if you make a mistake or fail to document something, the reality is that you will rarely be in a courtroom, and when you are it is usually about what you witnessed, not what you did. The new guys may not know that reality yet. So they may not be as comfortable to make such a quick decision. If you do not agree, what do you attribute this difference too ?

I am not so sure that you do have it Spenac. It is not that I doubt your skill or ability; the reason I am not sure is that the two questions that would lead you directly to the answer or atleast confirm your hunch, have not been asked yet. From what has been deciphered so far, there are at least two totally diagnosis that this patient could have (and probably one or two more that I never thought of, which I am sure the docs will point out at the end). P.S. This is rarely seen by EMS in the field. In my 20 years, I think I saw it 3 times in the field and 2 more times working part-time in the ER. So if you guys are having a hard time, dont feel bad.

Thats cool, enough said.

My guess is that it is a little A&B doc, and although I took on this arguement somewhat tongue in cheek, I dont think a single test (of any kind) should be used to fire someone. I agree that you should stay current, and should train as often as possible. I also believe that companies do have a responsibility to train their employees. But to take away someones income, their health insurance, their retirement on the basis of one test, while ignoring all other areas of job performance is criminal. Now if you want to administer a test to pre-hires, and not hire them based on thier failure to obtain a minimum score, I am fine with that. But firing a quality medic over one test score is not fair, and yes I believe you can be a quality medic without remembering every part of the "cell".

Just passed what spenac, what do you or your service do ?

Ok, in ten years i will plop down a diagram of a human cell and ask you to draw a cytoplasm, a mitochondrion, a vacuole, and describe its function --- or ask you indepth questions about cushings syndrome, and we will see how you do.

I guess I should be honest and also state that many of the checklists or training records were pencil-whipped or manufactured right before JCAHO arrived, so this process didnt actually "prove competency" but atleast the service had to take some effort. But then again, this was back when you knew JCAHO was coming, I think at some point in the last 3 years they have gone to truly surprise visits.

Read the article again. They all passed NR and got their certs, but because they killed someone, as part of the settlement of the lawsuit, all employees have to pass a NR test again, or be fired. I imagine many of their medics and EMTs were grandfathered in (dont know when DC adopted NR) and have never taken a NR test. I am all for training and testing, but some people do not test well, and to base your whole career on one test (that has a high failure rate) is not fair.

Combining alot of topics I have read on here in the past month, I have a question regarding Training at your department. One of the things that impressed me about hospital-based EMS, was that they fell under JCAHO (in the US). One of the things that JCAHO aggressively looked at a few years ago was "proving that all employees were competent to do their job". You had to have some proof that every employee (even part-timers) was trained on every piece of equipment in their department (or ambulance) and that they had some training regarding issues that were infrequent but were high risk or problem prone (like needle crich or IO), on a yearly basis at a minimum. So if JCAHO walked into your service tomorrow (or whatevery governing body that you choose) and asked you to provide proof that every employee (including that parttimer who just picks up a weekend shift once per month --- or the guy who usually rides the engine, but sometimes rides the bus, or the brand new medic that you hired 30 days ago) in your service was "competent" in all aspects of their duties, could you prove it ? And if I added the caveat that the inspectors could speak with any employee of their choosing and quiz them on their knowledge, would you still say yes ? If your answer is yes, what process does your service have that makes this possible ?

Thats fine if you want to put it on the NR exam, but this is an interdepartmental exam (as a result of that EMS killing someone again), that you are required to pass now that a lawsuit was settled to keep your job. You could be a 20 year medic, with a clean record, and lose your job and benefits because you cant pass one written test. And before all you whippersnappers start saying if you cant pass the test, you shouldnt do the job, I want you to look 10 years into the future, and say "sure i can pass any NR exam with a score of 90 or above" (also noting that it took several times for many of you to pass it right after school). If a medic is incompetent they should be reeducated and then fired if they do not progress, but to be called in one day after you have been a model employee for years, and to be told you will lose everything if you cant pass this test, is wrong. But this is typical EMS management; two sorry employees mess up one call, and the rest of the department (that didnt screw up) has to pay the price.

now that was funny doc.

I dont doubt you for a minute, there are many cultures that do not rely on a grocery sack full of pharmaceuticals to make it through the day.