HERBIE1

I think it depends on the service, the area you work in, AND the transport time. Most ER's around here do not have pillows. If someone needs one, a doubled up sheet roll, towel, or blanket works just fine- either in the ER or prehospital. Even if you had a pillow, the linen carts in the ER's do not have replacement pillowcases or pillows- those items are reserved for the in-patients up on the floors. It's not a sanitation thing, it's merely practicality and budget related. If a blanket or sheet get destroyed or stolen, they are cheaper- and easier- to replace than a pillow. That said, by state law we are supposed to stock pillows as part of our inventory. The required supplies are standardized statewide and not specific to any one area. Our employer provides them for us, but they are essentially one use, throw away, foam rubber mini pillows so if they get soiled, we need to order replacements and may get them in a couple days. In other words, not a high priority item in a high volume system. Most private providers here do have pillows, and most of them also have fancy linen- even quilted type sleeping bags for the winter. Then again, that is part of the service they provide, and they can exchange pillows, and pillow cases when they transport patients to and from the hospital floors. Also, unless you are talking about transporting for an IFT or contracted account, these providers charge well over 1K per patient, payable UP FRONT, so they better have nice linen and pillows for each patient. We may charge similar prices, but our bill comes in the mail, so the pain is delayed. LOL

Time for a 2nd opinion and an MRI. It sounds like you may have impingement on a nerve- either swelling or from a ruptured or bulging disc, in addition to your fracture. No fun- trust me. The spasms will eventually subside, but the pain takes a lot longer. When I sustained my back injury, I went through an entire course of physical therapy, but was still in pain. It was only then that the doctor authorized an MRI and found a bad disc at L5 S1. Not much I could do short of surgery- which wasn't happening until I can no longer walk. Steroid injections did not work. Lots of core work, strength training, etc. I have good days and bad days(mostly good), but this was 15 years ago and I am still working. You can get past this, but you first need to find our exactly what you are dealing with.

I agree with ERdoc here. Context is everything. In a university setting, professor and doctor are often used interchangeably, but often are inaccurate. When I teach, some of my new students call me professor, although I only have a Master's degree. I always explain I prefer my first name to be used. Should a PhD run around a hospital and refer to themselves as doctor? No, for obvious reasons. If someone on a plane calls for a doctor, do you think the guy with a PhD in communications should step up for the medical emergency? I always address MD's as doctors- unless I know them well, or have worked along side them. One of our medical directors always introduces himself as Bob to every new EMS worker, but until you get to know him, most folks do call him doctor. In mixed settings, ie with patients and/or family members present, regardless of how well I know them, I always use the title "doctor" out of respect to them and their position. I figure these folks earned the right to at least that level of respect.

'71 Chevy Nova '74 Chevy Vega(yes, a Vega- it was free, lol) '74 Pontiac Firebird-complete with an 8 track player, passed anything but a gas station '75 Audi(GREAT car) '66 VW Bug Convertible, stick- fun until the engine caught fire and it burned to a crisp '85 Cougar- nice ride but I had a lemon 92? Nissan Pulsar, t-tops- stick '95 Saturn, stick 2000 Dodge Grand Caravan 2007 Hyundai Entourage(current) 2012 Hyundai Elantra(current)

Always position of comfort for a dislocation, which means most ready-made splints probably won't work. It sometimes calls for creative splinting and the filling of voids, but pain management is key since we do not reduce in the field unless there is vascular compromise (never seen that happen with a dislocation). I've accidentally reduced a dislocated knee once. Attempting to make the patient comfortable and applying a splint, I think the patient had a muscle spasm and suddenly went from agony to screaming OH MY GOD, and let out a huge sigh- he was damn near orgasmic. LOL Scared the crap out of me. After undoing all my splinting handiwork, I saw the patella had indeed returned to it's normal position.

Thanks for the info. That's what I was afraid of. Just confirms the fact that our system is still stuck in the dark ages. The only glimmer of hope I have is that we have had a recent influx of young medical directors in the area, and they do seem to be open to more progressive/aggressive prehospital care, and seem to be more hands on, vs letting the nurses run the show. The old school medical directors delegated far too much authority and control to the nurse coordinators. Now if we only can get rid of some of the old school ER nurse coordinators who seem to still harbor animosity towards EMS workers, things may change.

It's times like this when I am truly disgusted at how backwards and out of date our EMS system is. Field reduction of a patellar disclocation, and then not transporting??? Wow. Maybe we'll see that here in 30 years-long after I'm worm food. May I ask how long your transport times are, Croaker?

After getting all of Pope Benedict's luggage loaded into the limo, (and he doesn't travel light), the driver notices the Pope is still standing on the curb. 'Excuse me, Your Holiness,' says the driver, 'Would you please take your seat so we can leave?' 'Well, to tell you the truth,' says the Pope, 'they never let me drive at the Vatican when I was a cardinal, and I'd really like to drive today.' 'I'm sorry, Your Holiness, but I cannot let you do that. I'd lose my job! What if something should happen' protests the driver, wishing he'd never gone to work that morning. 'Who's going to tell' says the Pope with a smile. Reluctantly, the driver gets in the back as the Pope climbs in behind the wheel. The driver quickly regrets his decision when, after exiting the airport, the Pontiff floors it, accelerating the limo to 205 kms. (Remember, the Pope is German.) 'Please slow down, Your Holiness' pleads the worried driver, but the Pope keeps the pedal to the metal until they hear sirens. 'Oh, dear God, I'm going to lose my license -- and my job!' moans the driver. The Pope pulls over and rolls down the window as the cop approaches, but the cop takes one look at him, goes back to his motorcycle, and gets on the radio. 'I need to talk to the Chief,' he says to the dispatcher. The Chief gets on the radio and the cop tells him that he's stopped a limo going 205 kph. 'So bust him,' says the Chief. 'I don't think we want to do that, he's really important,' said the cop. The Chief exclaimed, 'All the more reason!' 'No, I mean really important,' said the cop with a bit of persistence.. The Chief then asked, 'Who do you have there, the mayor?' Cop: 'Bigger.' Chief: ' A senator?' Cop: 'Bigger.' Chief: 'The Prime Minister?' Cop: 'Bigger.' 'Well,' said the Chief, 'who is it?' Cop: 'I think it's God!' The Chief is even more puzzled and curious, 'What makes you think it's God?' Cop: 'His chauffeur is the Pope!'

I took it as more of an FYI thing. They were not what I expected, but that's OK. LIke I said- the one story about the guy who turned to the bottle just seemed to be a cautionary tale- essentially be certain you have positive coping skills or you could be in big trouble later on...

RIP to those who made the ultimate sacrifice.

Did you see the videos he posted? They are simply about awareness and are not in any way trying to diagnose or treat any illness.

We have certainly beaten this horse to death around here, but anecdotally, I would say AT LEAST 75% of my saves with ROSC AND no neuro deficits have been without ET's. Obviously they were either witnessed arrests or ones where there was minimal downtime and/or someone was doing CPR prior to our arrival. Is there a place for ET's prehospitally? Sure- but then again in our system we do not do RSI's and use no paralytics, so in some cases where a protected airway would be optimal, we simply do not have that as an option. As the new AHA CPR guidelines indicate, it's now CAB- with an emphasis on quality CPR, rapid compressions, and minimal interruptions(we no longer look, listen and feel, or do multiple pulse checks). The decreased emphasis on ventilations also decreases the importance of advanced airways- at least in the initial resuscitation steps. Energy and medications- as needed- are the new paradigm. Even properly done, pausing CPR to insert an advanced airway is not desirable, and I happen to agree with that notion. I would love to see a study that compared and contrasted prehospital ROSC's based on advanced airways, or simple BLS techniques. I think those numbers would be interesting.

Dwayne makes an interesting point- essentially about "helping" someone into impotence. This may be a bit of a tangent, but not too far off, I think. This is my general feeling about set asides, quotas, and special treatment for any group that has been marginalized in some way. It starts when groups decide they need to take a stand to shed light on a problem- sit ins, protests, boycotts, marches, rallies, etc. After laws are passed, eliminated, and/or changed to effect some wanted change, how much more "help" should be provided? I think- as Dwayne mentioned- when we try to show how compassionate/neutral/unbiased/helpful we are, too often we end up being condescending or patronizing. Folks ARE different- race, ethnicity, gender, socioeconomic levels, education... the list is endless. Yes, we have far more commonalities than differences, but to artificially enforce some utopian ideal that we all WANT to spend all our time in diverse environments is absurd. Sometimes women simply want to be women- with other women- without feeling the need to be "on their game" with men around. Same with men. Why is this so difficult to accept for so many people? Are scores of women clamoring to be admitted to Augusta National? I don't think so. Are there a few who would like to be members? I'm quite sure- maybe for the prestige, maybe for the networking possibilities, maybe simply because they have achieved such power and wealth that they can. I am quite sure many more men would like to be members but cannot, due to the exclusivity of the club's membership rules. Women have their own domains as well- spas, hair and nail salons, female health clubs, etc- where most men simply do not want to be or simply are not allowed. There they can network, socialize, and make deals with each other- to the exclusion of men. I think the only reason the issue with Augusta arose again is because one of the Master's major sponsors is IBM, who's current CEO happens to be a female. Certainly ironic, but I don't even know if she's the one who raised this issue. It seems to be yet another case of someone else deciding who should be offended and claiming to know what's best for someone else.

But there ARE plenty of clubs that exclude people now, so why no outrage about them? They DO allow women in this club, just not as members. I find it amusing that the biggest outrage over this seems to be from self appointed defenders of everything- the liberals, but the group directly affected by this-women-most of them couldn't care less. (Not directed at you since I have no idea about your political/ideological affiliation- this is based on reactions I have seen and heard elsewhere.)

I'm not saying I agree with Augusta's policy, but.. Define "right thing". Remember- this is a private club that gets to make their own rules. If Augusta is "forced" to accept female members, then how can you justify the existence of things like female only health clubs, or organizations/clubs/groups restricted to a particular race, ethnicity, religion, etc? Either it's right or it's wrong- you cannot have it both ways, split hairs, or make exceptions to justify deviations in how these things are handled.

LMAO Interesting possibility.

This may be a bit of a rant and generalization, but here goes anyway... We all know the stats- about how many of our calls are not genuine emergencies and how many of these folks COULD get themselves to a doctor on their own, but instead call 911. So the question becomes- WHY don't they? Simple answer: Because they can. Paring this down to a root issue, I think that those of us in EMS are fortunate that we as a society have become far too helpless and dependent- at least when compared to how our forefathers were. Most EMS systems are bursting at the seams and call volumes are though the roof. Yes, obviously many of these changes are positive and have made us a more "civilized" society, but I think they have also made us lazy. Essentially we have become so "civilized" that we have caused concepts like common sense and personal responsibility to be placed on the endangered species list. Do you think it ever occurred to folks a generation or so ago to rush to a hospital because their child had a sore throat, or because they had a couple episodes of diarrhea? People have now accepted the fact that in many instances, we willingly cede power/control/authority to others on things that used to be considered the responsibility of the individual. Protection, livelyhoods, settling disputes- generally taken care of between parties with no governmental involvement. We've taken that responsibility away from folks. Same with health care. EMS has evolved because instead of folks being responsible for getting themselves or a family member to medical care, we arrive on the scene making lots of noise with our rigs, filled with fancy toys, to whisk someone to a hospital, while hopefully being able to alleviate some of their problems before we deposit them at the ER. Yes, obviously sometimes we do make a difference, but as anyone who works in an ER can tell you, much of what we deal with is nonacute. As a result, expensive resources with highly trained people stand ready 24/7, when in many cases, the patients we/they see need no more care than what a primary care provider could give them. Yes, some folks simply do not have the ability to transport themselves to the hospital, but how many times has a family member (or 2, or 3...) told you they would drive to the ER on their own, as you give their 30 year old healthy relative a $1000 taxi ride for their tummy ache? Job security- the more helpless folks become, the busier we get, but the more broken the system becomes. We can preach proper use of emergency services all day long-speaking engagements, posters, PSA's, radio and TV ads, print ads, etc- but unless there is a downside for opting to remain helpless aka-abusing the system- nothing will change. As anyone with medical insurance knows, there are serious financial consequences for not following proper procedures when seeking care, yet the very folks who abuse the system have no such rules imposed on them. In fact, the government has passed laws that essentially protect their right to continue to abuse the system and punish a hospital/clinic/entity for refusing to provide them the services the seek. Think about our documentation- sure, it's a record of any care we provide, but more importantly it's to CYA from potential future litigation. Sadly, that has become the overarching concern for anyone in the health care field these days. We've been through all this before but it bears repeating- we need to look beyond today and see what exactly we want EMS to become in their future. We need to realistically examine our priorities, strengths, and weaknesses. We'll see what changes are coming with Obamacare and how it affects EMS, but my guess is we will only get busier since the focus is still centered on the government taking responsibility from the hands of consumers. Based on those changes, we can then adjust how EMS will move forward, and in what capacity we will provide our services. I am, however, dead set against the concept of more governmental controls, mandates, regulations, and/or intervention in our lives- ESPECIALLY with health care, so most of the changes coming seem to go against the grain of what our ancestors stood for. For the life of me, I will never understand how someone can think an enormous, inefficient, corrupt, bloated entity like the government can do ANYTHING better than the private sector. We'll forget for a moment the notion that most things the government does these days should NOT be their responsibility anyway. Have the services available for those who truly need them, but require folks to follow very specific guidelines- ie "have some skin in the game". Just like someone with an HMO who must get their PCP's approval before seeking care, everyone who has their care subsidized needs to jump through a few hoops as well. It certainly won't completely eliminate the problem of sky high health care costs but it is a good start, it will improve efficiency within the system, and it eases the burden on the rest of us who pay for that assistance with our tax dollars. end rant

Someone already mentioned about women-only health clubs, which is exactly the point. If this is a PRIVATE entity that takes no government money, then let them make their own rules. Archaic and stupid to some, "tradition" to others. As for the club that doesn't even allow women on it's grounds except for special occasions? Well, that's more than a bit creepy to me, but again- their club, their rules. I would question any male who was a member there and has a wife and kids. What type of message does that send when he chooses to be a member of a group that is so against having women anywhere near them? Why so secretive? Why would a wife put up with such a thing?

Uh oh- this could take a nasty turn... LOL Accomodate every patient? Isn't that a bit impossible? I'm all for being able to converse with your patients, but what if you live in a large area where you could run into a dozen or so different languages in the course of your tour of duty? If you know you have a large population of a certain ethnic group in your primary response area, then it would certainly behoove you to at least learn some key phrases in their language. Problem is, many folks have large areas to cover and it would be impossible to be familiar with every language you may encounter. I'm of the opinion that if you are a citizen here- even naturalized or on a visa- you SHOULD be speaking English. I think it's arrogant to assume that your host country should adapt to YOUR language, but that's just me. When visiting Mexico, I always brush up on my Spanish, since even though it's only a vacation, I make the attempt to converse in the native language- as horribly butchered as it may be.

Thanks, Wendy. Nobody in my family has anything to do with public safety. That said, I consider many folks I work with 'family' as well. I still keep in regular contact with nurses, docs, and techs I last worked with in a hospital from 20 years ago. Some have moved across the country, some are still here, some have moved into affiliated professions(medical companies), and such, and some are even retired. Every year or so we have a reunion for folks who worked there and there is always a huge turnout- even though the last time we may have seen each other was at the previous party. Unique situation? Probably, but it was an incredible group of people. One of the guys who was a tech like me is now a surgeon, and flies in on his own plane just for this party. As we know, there is a bond among folks in this business- few can truly comprehend what our jobs are really like. We all find our ways of coping, and yes, sometimes they aren't the healthiest. To last any period of time in the business with some semblance of your sanity means to have figured out some way of dealing with the stress. It certainly does take a toll on those around us, and we all figure out exactly how much information we tell our families. I tend to rehash the funny/strange/bizarre incidents and leave the bad stuff out.

I'm taking this as a question- and it is a critical one. This is the million dollar question for those in this business for any length of time. It goes to the heart of what make a good provider- empathy, not synpathy. It is a very fine line to go from being able to relate to the emotions of those we deal with(and being able to adjust our thinking and/or treatment PRN) and to letting our emotions dictate how we do our jobs. As such, we either erect barriers, or bleed over some of the emotions onto our home lives, and sadly, folks in this business-and police and hospital workers- do not have the best track record when it comes to relationships and marriages. To answer your question- we all cope differently. As someone mentioned, find someone in the business- preferably someone with some experience to confide in, or your significant other if they can handle it. Some people think we should seek out the company- spouses and friends- of folks in the business because they understand the pressures we are under, and you don't need to explain as much. Others think it's good to have someone who offers us a respite from what we do. Personal choice- everyone's different. The key to coping is to realize this is NOT your emergency, YOU did not cause the problem but instead tried to make it better somehow, and try to move on from there. Yes, some calls haunt us sometimes years later, but honestly those are very few. In 30 years there are relatively few calls I can remember with any vivid detail- which is why I am OCD about my documentation. Frustrating for a lawyer maybe, but good for me. LOL Try to figure out WHAT is bothering you so much about the call and address it. Is it the fact that the kids won't have a father? Certainly calls involving kids are the worst, which always causes us to hug our kids- or other young relatives- a bit tighter the next time we see them. Critique yourself and the call, but don't belabor it. Move on. As long as you did the best you could, that is all anyone can ask of you.

I am too cynical for my own good sometimes. As I'm sure you are aware, in order for survey to be valid, certain criteria need to be met. If not, the results will be skewed towards a particular type of response- sometimes planned, sometimes not. The problem I have with things like this are the absolutes we must assume when considering the scenario, the question and answers, since there is never a black and white patient-meaning even 2 folks with the same disease process often manifest differently. As a result, for many it's too easy to "what if", and read too much into the question. Example- the only options listed for treatment are using memory or using a written protocol. What about using online medical control if someone is unsure of a treatment? I often contact pediatric medical control station when dealing with peds patients to confirm doses after using a Broselow tape. I realize that additional option throws a whole new variable into this, but it would also be more accurate. Not trying to be a pain in the arse, just noting one of the possible reasons you are getting a bit of push back here.

For the hands, try used coffee grounds. Works wonders for onion and garlic smells. Immerse your hands in the grounds, let a coating sit on it for awhile, then wash. Also-try "Fresh Wave". It's a commercial sanitizer/deodorizer made from natural oils and extracts, and comes in many forms- powders, gels, beds, etc. You can use it in laundry, in carpets, rugs, and hands. It's safe for humans and pets and is nontoxic. Worked wonders for a nasty smelling basement after a flood.

Welcome. 26 years in the business? You are certainly no rookie, so your experience and perspective will certainly be appreciated here. Jump in.

I honestly think you need to nail down exactly what your learning objectives need to be. Examples: organizational culture issues, training issues, personnel issues, employee retention, management vs leadership, budget, compliance, motivation, etc. If this is to only be a 2 day class, I would identify a few particular needs and have the speaker focus on them. Poll the stakeholder agencies and ask them for a wish list of topics they would like to be covered. I wrote and teach an EMS administration class and it's designed for an entire semester. Depending on the topics chosen, you need to have enough time for group exercises to reinforce the teaching points. Hope this helps. Good luck.