HERBIE1

Not sure where you are, but in this area, NOBODY sleeps in EMS. The majority of the rigs do 6-7K calls/month. Do the math- that does not leave a whole lot of down time. As for privates taking over- they work in some areas, and fail miserably in others. Years ago AMR thought they could steal 911 response from the FD. They flooded the market with tons of rigs and pushed a bunch of privates out of business. They set their sites on taking over, but soon realized it is NOT a money maker with a 30-40% reimbursement rate. They lasted a couple years and promptly left the area.

Referring to the abortion issue- not to mention that as we noted, such a ban would never happen, I honestly don't think the social issues are going to be a big deal this time around. The economy is FUBAR'ed and that is job one for any POTUS- especially since the current one doesn't have a clue what to do. I want a leader who can solve problems, not blame everyone else for his inability to fix anything. That said, at this point, I do not want Romney. Why? Because he is the one the old guard GOP wants, which means more of the same. Paul, Perry- no way. It's still early, and while I do have some reservations about Cain, his lack of foreign policy experience is not one of them. How much foreign policy experience does any candidate have unless they are ambassadors or worked in that type of arena? A good leader does not know everything, but they do know how to surround themselves with people who do have the required knowledge and skill set. A good leader has a vision, and their job is to convince others to believe in that vision. They may not know all the details initially, but they do have a general idea of how they want to achieve their goals. Notice that after Cain put out his 9-9-9 plan and it was well received by the public, several candidates are now also pushing similar flat tax ideas. It didn't work for Steve Forbes when he tried it, but things are different now. I would not expect Cain's plan is fully vetted yet, and obviously it would need to be tweaked, but I think the country may be ready for a version of this now- or at least offer a choice. I believe Hong Kong actually offers a 16% flat rate if you so choose, or you can opt for the traditional, more complicated tax rates. I recently read a book about Cain- "I Am Herman Cain"- because I was interested in the guy and what makes him tick. Most of the book is how he got to where he is now, but it does list a few of his ideas. So far he is my choice- he has a history of solving problems and turning around failing companies. That is EXACTLY what we need in this country right now and I LIKE the fact that he is not a career politician. Let's put it this way-I want ANYONE but Obama in 2012. Our country cannot afford 4 more years of this guy.

Around here, choppers are used for IFT's. I simply do not have experience with utilizing them in the EMS setting.

I'm going to split hairs on this one, Dwayne. I will differentiate between medical and trauma patients. Normally you would never have 2 critical patients- someone may get the short end of the stick in terms of attention. If I MUST take 2 critical patients, I would feel a bit better if they were traumas vs an unstable medical or cardiac. Generally if a trauma patient crashes. it's not a problem you will fix with a cardiac medication. Has it happened to me? Yep. MCI's. Multiple critical patients, and a couple cases of poor triaging where patients go from green to red after we assess them. Is it rare? Also yep- the luxuries of having lots of help in an urban area. In terms of what you did- it's easy to play Monday morning QB, but as we all know, the best laid plan- and sometimes even a few "rules"- in EMS usually go out the window when things really go to shit. As long as you are trying to do what's best for your patient, to the best of your abilities, with the resources you have available, and notify medical control of the situation- we improvise. That is what we do. You are correct. Stopping enroute to a call or while you have another patient IS negligence. I know someone here who took a "long vacation" because they did just that. Call it in, give as many particulars as you can and move on.

Pros: Some of the smartest EMS providers I've ever dealt with. Learning there's more than one way to skin a cat Damn funny people, many of whom have the same sick sense of humor as I do Learning how folks across the pond- and all across the planet- do this job Cons: Frustrated at times when I realize how ancient our EMS system is compared to elsewhere Scared when I realize how much didactic stuff I've forgotten over the years Wishing I had the time and cash to pay a visit to many of the folks I deal with here

Let's put it this way- I've been involved in a few of these cases, with various outcomes. The "best" case- was transporting someone who had an alleged seizure PTA. Pt now Awake, fully oriented, walking and talking, calm and cooperative. A friend walked with him to our rig as we arrived and said she witnessed his seizure. As we were assessing him and asking a couple questions, he went absolutely nuts- violent, kicking, swinging, punching, all over us, and even bit me on the hand. Finally restrained the guy- after it was an all out brawl and I was literally fighting for my and my partner's safety. Turns out he was on PCP- the "friend" with him was his girlfriend who was mad at him for fooling around and apparently spiked one of his joints to get even. We ended up transporting him with LEO's, and we all had injuries from our fight- including the patient. As we arrived at the hospital, the girlfriend was now upset that her poor, "innocent" boyfriend was hurt and she raised hell. She wanted our jobs, a lawsuit, etc. The police later explained what happened and apparently she backed off since I never heard anything more about that. Long story somewhat short, the states attorney refused to file felony charges, even though I had to go through the whole routine of testing and follow up bloodwork and the guy was let out on bond. Of course he never showed up for court. About six months later, he was picked up for a parole violation in another town and was shipped back here. Since my case was still open, I was called in, and I identified him in a line up, and I asked what he was being charged with, and whether he would be let out again. Not this time- he was now being charged in the murder of his "loyal" girlfriend, the who was upset with us for hurting her man. Apparently he beat her to death with a baseball bat. They asked if I still wanted to pursue my case, and I said only if his murder case somehow got thrown out or he was acquitted. We went to all the court dates, but never had to testify. I have never seen such open hate in anyone's eyes before- as if WE were responsible for his troubles. He was found guilty of murder, sentenced to life with no chance for parole. Extreme example? Maybe. Point is, you never know what might happen to you or when.

Being apprehensive is fine. It's pretty damn intimidating- especially when you are brand new. All I can say is just get in there- there's only one way to get over this fear. The good thing about compressions is that is ALL you need to worry about. Everyone else besides the doctor in charge is running around, doing multiple tasks. You have only one chore, and it's an important one. Just listen to what everyone is saying, because at some point they will tell you to stop CPR to do a pulse check, to intubate the patient, or to check the rhythm on the monitor. Just be ready to resume as soon as they tell you to. You will become so focused on the task at hand, you will quickly forget your initial fear. Think about proper rate and compression depth as you are doing it. Focus on doing the best damned job you can. Think about how many resprations should be given. If you are just observing, look around at what everyone is doing during the code, See if you can figure out the various jobs people have. You might not understand everything that is happening- what the medications are, what the energy levels for defibrillation are, or what you are seeing on the monitor- that's OK. Make a mental note to ask your preceptor about all the things you don't understand. The more you learn about what is happening around you in a code, the more comfortable you will become. Hang in there- you'll be fine.

Congrats on the baby, Ruff! My best to you and your wife. I wanted to take a peek at the pictures, but the site seems to be down right now. I'll check again later- can never get enough of babies!

It depends heavily on the state's attorney and whether or not they will pursue the case, and how they interpret what happened. Even in areas where assault on EMS folk IS a felony, the state's attorney has to approve the charges. In my experience, it's a 50/50 proposition. Either they don't think the injuries are severe enough, or you get a liberal judge with an agenda who protects who he/she perceives to be the "real" victims. Example: We just had 2 cases here- one is being held over for a Grand Jury, the other case was dismissed by the judge. Why? Because- you guys will love this- He said that those type of injuries (non lifethreatening) were part of our job. Even the other attorneys were amazed. We plan on organizing a petition to get this judge removed come time for his retention vote.

Best of luck on the blessed event. Let us know how it goes.

Stop acting like a petulant child. If this is all you got out of this, then you do have a lot to learn and not nearly mature enough to handle the responsibility that goes with the profession. You're dealing with people's lives here and if you screw up, it's not like a video game you can reset. You also need to learn the difference between arrogance/ego and confidence- one is about a false sense of self importance, and the other is about a self confidence that comes from education, training, and experience. In this context, one is dangerous, while the other is a valuable asset to have, but it is EARNED.

Dwayne- safe travels, my friend. I have to admit, I am envious to a fault. I have always wondered what it would be like to travel to such far away places- especially in the name of making a buck or two. I cannot imagine the learning opportunities and personal enrichment you have enjoyed so far. My present situation will not allow such adventures, but after things get sorted out in my personal life, who knows what the future may bring.

All sound advice so far. Be confident- make the company feel that you are someone they NEED to hire. Make eye contact with the interviewer, try not to fidget in your seat. A good trick is to keep your hands folded in your lap. If you aren't sure of a question, have them repeat it. If it's a complicated or multiple part/follow up question, don't be afraid to pause for a moment to collect/organize your answer. There is nothing worse than someone saying "er and "Um" with every sentence. Keep your language and demeanor professional- do not cuss(may sound stupid, but you would be surprised how many folks do it). Overall, be yourself. Promote your skill set, your personality, and your desire to get the job. Convince them you are motivated to apply what you have learned in school. Do not slander/bad mouth prior employers or even instructors. In many areas, EMS is a small community and you never know that your interviewer may be best friends/a former student/colleague of your instructors. They may try to ask your odd/off the wall questions and scenarios to see how you react under pressure or when you are faced with something unexpected. After all, in order to succeed in the business, you need to be quick on your feet. Good luck and let us know how it goes...

Dan- damn funny story about the dog! I'm also glad the pooch is OK. I think I would have needed to change my drawers after that too. LMAO

When I worked on the privates- 25+ years ago, we would use hospital sheets and change them on every call. BUT- in the winter time, about a year before I left, our company purchased what were essentially sleeping bags for winter use. We obviously would wrap the patient in a sheet and usually bath or chain blankets before we put them in these "sleeping bags" but it always grossed me out thinking about reusing those things. As a result, I rarely used it myself. If we had a patient with hygiene and/or fluids/emesis/blood, we would simply use regular blankets and forgo the bag, but still- yuck. The company would impose discipline if we were caught NOT using the bags, but I didn't care. Now- yes, sheets are changed on every call- unless of course they only sit on the squad bench for a "taxi ride".

Our Narcan doses per protocol here used to be 0.4mg here. Over the years, it was found this is not nearly enough and the starting dose has increased. The high potency narcotics we have on the streets makes 0.4mg completely ineffectual at even improving respiratory effort, much less level of consciousness. The vast majority of OD's we get are agonally breathing. I agree a smaller dose can be a good diagnostic tool, but to restore respirations, minimum doses here are around1.2mg- more if we know a load of bad(strong) dope is going around. We used to only stock vials of 0.4mg- not any more. Most hospitals now have 2mg vials or preloads as replacements for us. A few years back we had a period where the drug dealers were cutting heroin with Fentanyl, and we could easily push 6-8 mg just to get the person's respiratory rate above 2. We actually had to get special deliveries where each apparatus would get a bag full of Naloxone to supplement our supplies. Often times these folks would even be put on Narcan drips once in the ER. NASTY stuff. We also had many OD's during that time where we were too late and could not revive the patients. Since we do not have a benzo antagonist, it's use is not an issue with us anyway. Supportive care- that's it.

That was not stupid at all. Sound advice.

Actually, we DID need to hit you over the head because you instantly became defensive- even after you allegedly asked what you did wrong. There's no way to sugar coat the potential trouble you may have caused yourself. Your EMS career could easily be over before it even starts. Just hope that crew does not wish to pursue this issue and the authorities start looking for you. Hopefully the patient was OK and all will be forgotten. No, a trained, educated responder would NOT have done the same thing. That's the whole point of this. We won't split hairs about WHO gave the NTG, but if you had the proper education and training, you would have been able to explain to the PT why taking that NTG would be a bad idea. If the patient goes against your advice, fine, but do you know what to do after that? How would you prove that what the patient did was against your medical advice? Here's a hint- it does not involve sneaking away from the scene. A little knowledge can be a very dangerous thing- especially in this case, and the ironic thing about medicine is that the more you know, the more you realize how much you DON'T know. The fact that you had to look up WHY this was such a bad thing perfectly illustrates why folks were all over you. As Doc alluded to, read up on some horror stories, or ask folks who have been in the business for awhile about legal issues they find themselves involved in. Did you know that many providers actually have their own malpractice insurance- just like physicians? Even folks who work for major companies or municipalities and are covered under a blanket policy. Why? Because even with the best of intentions, bad things can and do happen even to providers with years of experience and training. Someone has a bad outcome from a situation- whether or not you were in any way culpable- and they SUE everyone possible. Can you afford the legal fees, court costs, potential monetary damages, or even jail time if you are found criminally liable? You are young and have a lot to learn about life. You will also need to develop a much thicker skin because this type of criticism- and a lot worse- comes with the territory.

The thing that got to me was the arrogance of this kid. Yes, he was acting like a "typical" 18 year old- they have all the answers and nobody can tell them anything. Problem is, in this case his attitude could get himself or someone else injured or even killed- not to mention his ass thrown in jail. His intentions are irrelevant. There was no contrition, no mea culpa on his part. Yes, he did ask what he did wrong, but apparently it was supposed to be a rhetorical question since he really did not like the answers he received. Hopefully this WAS a learning experience, and he moves on to get proper training and guidance. Personal opinion- I do not think this guy has the right mindset for this job, and certainly not the maturity- at least not yet. Hopefully he'll channel his energies properly and prove me wrong.

After reading the tributes to Dust, it's clear he touched a lot of lives. It was fun battling with him here- always a challenge, and he kept me on my toes. Sometimes we simply agreed to disagree, but that's OK. This makes me realize that although we verbally joust about damn near every topic known to man, it's good to remember there are faces and stories behind the pseudonyms here. There are many folks I would love to go out and have a beer with, and others I want to throttle by the neck, but regardless of our viewpoints, I think we all have far more in common than we care to admit. As we all know, our health is the one thing we cannot control. For those of us who have dealt with serious medical issues, after you couple that with what we see every day, and we realize just how fleeting and fragile life can be. Sadly, I count myself as someone who- even after a near miss with the grim reaper, who still too often sweats the small stuff. STUPID, and I wish I could stop. I guess once a Type A, always a Type A, although I am better than I used to be... Let's all honor Rob's memory by striving to be better providers, and better people. Don't take life for granted- you never know when it will be snatched away from you.

The scary part of this is you don't even have enough knowledge to understand how wrong you were. It's clear you have quite a bit of growing up to do- at 18, many kids think they have all the answers and don't take kindly to criticism. I know my son was the same way when he was your age. The problem is, you are messing with people's lives here, and it's no joke. Knock it off before you get yourself or someone else badly hurt or even killed. Go to school, you will realize how badly you screwed up, and consider this a lesson learned. You also better hope that crew doesn't find you and report you to the authorities.

I was wondering how he was doing-I knew his was sick, but was not aware of the ALS diagnosis. Damn shame. RIP, brother.

Update: Our patient was discharged home, but that's all I know. I need to speak with the folks who were working that day and I have not seen any of them since that day for updates on her condition and what they found with the toxicology screen, etc. edit for spelling

Welcome to the city, sutures.

"does not take it due to financial constraints" Noncompliance with medications is probably the biggest reason we get called for seizure patients, followed closely by folks drinking alcohol, taking their medications, and then wondering why they still have their seizures. Very rarely do we see new onset epilepsy- but febrile seizures are incredibly common- generally at least one patient per day. Here it is. Now it's time to get tough with the family and ask how much they love their family member. Ask them if they would enjoy having to care for a brain damaged 23 year old brother/son/etc. I realize there are financial constraints but more often than not, the issue is not the money. Apathy, screwed up priorities are generally the real reason why someone does not take their medications. Nasty as it may sound, I have asked families of repeat customers- and patients after they wake up- if their beer/flat screen TV/ designer clothes are more important than taking their medication and possibly preventing their deaths or severe mental disabilities. Sorry, but sometimes tough love is warranted. Does it work? Sometimes, and I figure if it gets just one person to do what they should, its worth it.