HERBIE1

Refreshing? I guess, but there are plenty of folks who say stupid things without any fear of reproach. Then again, as you note, we all know how he feels now, but as a politician who has made it to the governor's mansion, you would think he would know better than to say something stupid like this. I have no idea if the guy has always been evangelical, or if this is something new, but down there, I suspect it's not necessarily a bad thing to many folks. If this guy truly is hard core, then yeah, he's inappropriate and has to go. These holy roller types let religion dictate every facet of their lives, and for an elected official who makes public policy, that's a no-no. A politician can erect and worship an Elvis shrine in their basement for all I care- just do not let it interfere with or dictate what you get paid to do.

Well Dwayne, I agree with your premise, but I would have to say that your statement could be amended to include making education a priority for ALL prehospital providers- from first responder to paramedic and beyond. We've discussed it many times here, but there are too many paramedic diploma mills that churn out folks who can pass a test, but may not truly grasp the big picture. When you finish any degree or certification, that diploma does not automatically make you an expert in your particular field, nor does it enable you to immediately function without some additional level of indoctrination/training/familiarity with your tasks. It does open doors and certifies that on some level, you have attained a proficiency in a particular subject or field of study. I submit that an education simply teaches someone how to learn, how to apply logic and reason to solve a problem, and how to find answers to something you may not know. As you advance in your studies-undergrad, grad school, post grad, professional school, etc, obviously you learn more about your subject, but you also sharpen your logic and reasoning skills, mature as a person, and essentially develop into an adult. The passage of time and the pursuit of higher education forces us to start basing our actions and personal choices on some developing moral or ethical code, vs seat of the pants, impetuous decision making. We all know that doctors spend a lot of time getting their education, so obviously their medical skills and knowledge are unsurpassed, but what I think they also have is a more refined sense of ethics and morality- at least in terms of patient care. For years, under the supervision of an attending, they treat patients, but are also exposed to a myriad of "grey area" situations that illustrate how complicated their profession can be. Yes, many of us have well defined and developed moral centers, but many younger folks are still figuring things out, and many times they have yet to experience enough life situations to force them to confront moral and ethical dilemmas. It can be hard to make a judgment call when you have little life experience confronting such difficult choices. I'm not at all saying that anyone without gray hair is immoral or unethical, but in terms of doing this job, at least getting an education slows things down and hopefully forces us to merge the didactic and book knowledge with our real life experiences. There are plenty of competent FF's who understand the gravity and nuances of what medical care is all about. The problem is, those are also NOT the guys running the show and making policy.

I've always loved that quote.

You are right about the household chairs, Richard. I've only used them in a pinch a couple times. Cannot recall the specific circumstances- probably just a move from one room to another, but there's also the issue of them simply not ergodynamically designed to be lifted by 2 people while someone is in the chair. Not comfortable to do at all.

Totally unfair.

I recall using those chairs-very low back rests. Horrible on your back and very unsteady for even an average sized patient. As often as possible and practical, I prefer using the full stretcher too- one less lift and patient transfer to worry about. Obviously it also depends on your location- if you have a lot of apartment buildings in your area, stair chairs are the only way to go.

Is that a typo? 30 calls a year? My gawd, there have been countless days I have done that in a single day. LOL I get what you are saying- there certainly are inequities in our priorities as well as our funding of services. Sadly, It's a never ending battle.

Lots of options available these days- such as the stair chairs with tracks or the oversized conveyance devices. When I was working for the privates- 30 years ago- our company frowned on the use of stair chairs(we owed them a cot ride because our service was so expensive, LOL), which meant we used the old 2 man Ferno/Washingtons in nearly every situation. Brutal, and one of the main reasons for my back problems today. You need to scout out the home and check for obstacles, tight corners, strange furniture configurations, etc, and assess what equipment and routes to take with the patient. I've used kitchen chairs, the patient's own wheel chair, or simply carried the patient via a bucket lift past an especially tight corner. It all depends on the patient, their size, and the configuration of the home. Sometimes a side or basement door- maybe seldom used by the family- is the best choice. Take a few minutes before you move the patient to develop a plan and it can really make a difference. Move any furniture and potential obstacles ahead of time. Brainstorm with your partner, and even ask the family how the patient was transferred on their last trip. In your example, the 5 steps are not the only issue. How wide are the hallways? Is it a regular sized door? Is the storm door an impediment? Are the interior doors wide enough? How many turns are there? Can you make the turns with the cot? Can the patient be sat up to get around a corner or do they need to lie flat? Can the cot make it all the way through the house and into the desired rooms? Any immovable objects that would impede the stretcher? Does their medical condition or injuries change how they must be handled or transferred?

Age old problem with EMS. Problem is, IAFF has the money and the clout to put out the propaganda, and as Beiber correctly puts it, this is about saving manning. The other issue is revenue. Besides things like inspection fees and fines, the fire service does not support itself and needs EMS to generate a funding stream. There are gold standards in fighting fires- manning, one in, one out, etc, but yes, this is STILL all about FF's and their needs. Fire companies are closing, lay offs are happening, and crews are running short handed. We need FF's, and we need to make sure they can do their jobs safely- meaning having enough personnel to get the job done. That said, this should NOT come at the expense of EMS. A half arsed attempt at providing EMS is also unacceptable. Again- we are such a diverse group, with various levels of training, so it's also difficult to unite under one umbrella. FF's are what they are, and their jobs are universal. They have decades of experience in politics, tens of millions in funding, and a major lobbying presence in DC and in every state legislature. We do not, and whether that changes remains to be seen. Yes, there are places that are very progressive, and have an integrated fire based EMS system which is top notch. Unfortunately, they are still the minority. As anyone who crunches numbers regularly can tell you, simple manipulation of data can change what those numbers say. Problem is, no amount of number crunching or tweaking changes the fact that fires are WAY DOWN, and have been for years now. That means the IAFF is desperate to stay relevant and keep the level of funding they have enjoyed for all this time. The only way to justify that funding is for them to adapt- which they are doing at the expense of 3rd service EMS providers. I hate to sound like a defeatist, but I simply do not see EMS being able to unite and build a strong and cohesive enough voice to combat the IAFF's machine. We have made some progress over the years, but are still in our infancy in terms of political muscle and funding. Are there cracks in their armor- absolutely. A few years ago, the thought of FF lay offs and closing firehouses would have been unfathomable. Not any more- it's happening as we speak. Public safety(police, fire, and EMS) is no longer the sacred cow nobody would dare touch. Cities are broke, and they are cutting EVERYWHERE, but the IAFF has some valid points such as the fire department's infrastructure and manpower is already in place, and from a politician's perspective, the more hats a worker can wear, the more cost effective they are as an asset to their area. I know many folks do not want to be a FF, and I think EMS will always exist, but it may be relegated to IFT's, and other nonemergent transports.If that's your bag, you should be fine, but I think most folks in the business eventually want more than that. Personally, I see the future of EMS being with the expanded scope of practice, but that means more education, more training, and a shift in our focus. Unless that extra training yields financial rewards, few people will invest time and money in something that may not pay off for their bottom lines but that education alone would separate us from the fire service where their training is very specialized. Medical education can translate into a slew of affiliated allied health possibilities, but there is little call for things like high angle rescue training or trench rescue in the private sector.

My pleasure. I get the idea of trying to flesh our possible alternatives in this forum, but it is exceedingly difficult to place yourself in that moment, in someone else's shoes, in a particular situation. So many variables- time of day, number of bystanders, traffic, weather, age, health, size of providers and partners, etc, that a blanket solution is impossible. Have I seen crazy folks wandering the streets? Of course, and depending on the location in our city, "crazy" is actually the norm. Sometimes you intervene, sometimes you simply call for police and give them the information, and sometimes you just shake your head. All depends on the situation.

I see no problem with what NYC did taking down the patient. His choice was to ignore this guy and see him or someone else possibly get hurt, or intervene. If you have the training, why not, if there is a better than average chance you are not in danger. Would this be a move for all- or even most folks? No. If he did not intervene, I see no problem either. It's a judgment call. Kudos to NYC for a job well done.

Your bio says you are in Baltimore. I do not know the area, but I would do my homework and see if other private services are organized. Call them and see how happy they are with their representation, and how their benefits/pay/working condition compare to yours. A couple suggestions from someone who has both organized a private company(got it unionized) as well as has been in management. -Make sure you go with a reputable union. Be careful of the smaller groups because too often the only thing they do is take your dues and provide little in return- think of some of the unions who represent folks who barely make minimum wage and have few benefits. -Make a list of your grievances from your current company and see how many could be addressed by a collective bargaining agreement(CBA, or contract), and how many are actually unreasonable- especially in today's economy.(You will need to talk to someone familiar with the process and/or a representative from a union. - Realize there are pros and cons of even a good strong union. Benefits to the employee include protection against unfair and unscrupulous employers, locked in wages, a defined discipline process which clearly spells out punishments, and established benefits packages. The cons would include locked in wages- meaning the worst employee in your company gets the exact same pay as the best employee with a comparable position and tenure. In other words, you can do the bare minimum and still make the same pay as the model employee. That can be hard to take for some people. The fact that the discipline process is usually long and drawn out means that same "worst" employee is also protected exactly the same as the best employee. That can seriously hurt morale. Other cons include the fact that someone needs to be point man on this- they need to start the ball rolling, and although it's illegal to punish someone for trying to organize a union, it can still happen, albeit in subtle ways. Trust me- I know. As one who spearheaded the organization of my company, my personnel file ended up the size of a NYC phone book thanks to write ups for the tiniest real and perceived infractions. There are rules and regulations that govern the process of starting a union company, and if you do not meet the minimum percentage of people interested in this process, the bid will fail. That also means anyone who was pro union ends up with a target on their heads from management. It can make for a very uncomfortable work environment later on. Generally- but not always- when a company gets unionized, it becomes a closed shop- you must all be union members. This also means that if at some point you do not think the union has helped your work environment, you are stuck, unless you change jobs. Decertifying a union is not an easy task. No company- especially the smaller, private or family run groups- likes to be told what to do by an outsider or cede control of their company in any way, which means they will almost always be very resistant to the idea of a union. Eventually though, they usually see the benefits. They do not have to worry about things like raises- they simply pay the wages specified in the CBA. If the company offered perks, bonuses, or incentives for extra work or a job well done, they usually disappear. There is a clearly defined process- albeit a drawn out one- they must follow for discipline, and the rules for punishment must be the same for everyone. There is generally a grievance process to appeal discipline and/or potential contract violations but resolution of problems can sometimes become laborious and protracted. Bottom line- you need to do some research. Good luck.

This whole religion and government thing is a slippery slope. For some time now, religion was an ugly thing when mentioned in the political arena, yet we are constantly bombarded with such references. Nearly every POTUS says at the end of many speeches- "God Bless America". "God" on our money. Businesses, and government offices close for major Christian holidays. Religious references are everywhere in government and the public arena, and have been since we were founded as a nation. In recent years, the blowback was to wish everyone Happy Holidays, because saying "Merry Christmas" may offend someone. Now, this past season, the tide seemed to be switching back. But, I will admit, this governor stepped way over the line. It's one thing for a politician to proclaim he is a Christian, or even make a religious reference or 2 in a speech, but to essentially condemn someone for not agreeing with his religious views? Stupid, and as was mentioned, it's also as "unChristian" as you can be.

Do the best you can. If you cannot safely subdue this person-without causing injury to yourselves or further the patient's problems, let him go. If you are in the boonies, where is he going to go? If someone else picks him up from the scene- fine, and advise them to get the person help. I've had violent patients who I simply let go. In my younger days I would have no problem going toe to toe, but it's a stupid idea. Try to convince the guy to allow transport- even for just a ride, even if it means no treatment. Undertreatment is better than no treatment at all. Of course you need to properly document all this to CYA. m lucky- in an urban area, police are usually just a few minutes away, although even 3 minutes, while you are dealing with a combative patient, can seem like an eternity. I cannot imagine having to wait for a cop to come from home.

All good points before me. I would add that putting out an acceptable list of abbreviations is a good idea to make sure everyone is on the same page. We just had a con ed on documentation and they put up a bunch of inappropriate abbreviations. I could not believe some of the ones I saw. Many I simply dd not have a clue what they actually meant. Here's one a couple I had to explain to the instructor- DIB=dead in bed. DRT= dead right there. Certainly I have heard phrases like these spoken among providers when talking with each other, but using them in a report- verbal or written? Unprofessional. I think there are a couple issues with the documentation problem. First, the younger folks grew up texting, and using odd abbreviations, and many simply do not realize there is a time and place for that. Second, I think some phrases, abbreviations, or vernacular may become common in a certain area, and it is assumed that 'everyone" knows what they mean. Not necessarily anything with malicious intent, just a false assumption.

LS- speaking of PC- Did you hear that someone has republished "Mark Twain" and removed every instance of the dreaded "N" word? Seems he felt it was no longer appropriate for our current times. Unflipping believable. Granted, the group/person that's doing it can only afford to put our a limited number of edited copies, but that's not the point. I told someone that they should have gotten one of the rappers to do an audio book version of Twain, since it's OK for them to use that word. It would probably sell millions of copies, too.

I'm sure there are plenty of reports generated, but not every joe schmo can get access to them. You either need to be a lawyer, part of a regulatory body, or directly involved in the case. The run report and hospital medical records are HIPAA protected medical/legal documents, as is the police report. The ambulance service may have a copy of the run report, but again, not just anyone can walk in and request to see it. If this is a car accident and if the persons involved file an insurance claim, then they would also have a record of the incident, but I'm quite sure they would restrict access to their records as well.

It happens- not to mention the occasional drunk or psych pt who decides to take the rig for a joy ride. When in the ghetto, we always made it a practice to lock the doors while we were doing patient care. Don't always do it now, but we should still continue that practice- too many loonies out there.

Easier said than done. Especially with politicians and other VIP's. These guys usually have current and former LEO's as bodyguards, and too many of these guys become self important political creatures, just like the VIP's they protect.. Are you going to argue with a guy who has a gun and a badge? Go ahead, take a stand and see how far that gets you. Civilians vs high profile-like it or not, there is a HUGE difference- not in treatment, but all the associated crap you need to deal with. My policy is to load the PT, lock the doors before anyone else gets in the way, and do what needs to be done. .Nice- in theory, but does not always work out that way/.

Clearly you have never been involved in a high profile case, with tons of media and VIP's around. It quickly becomes a major cluster... I wish I could find the picture, but when a former mayor had an MI and died, there was a famous photo that showed the ambulance pulling away from the scene, with so many people in the patient compartment, they could not close the rear doors. It looked like a friggin clown car. Every one of those people claimed to be the mayor's best friend, closest/,most important aide, bodyguard, chief of staff, etc and the crew had 2 choices- argue or simply pull away.

Yep. I am guilty as charged. Their choice. In high profile and VIP cases, often times there are tons of law enforcement, aides, etc who want to ride along. Sometimes it cannot be helped, but if I had my way, other than the guys with the badges and guns, NOBODY should be back there. Agreed. Maybe, maybe not. Unless it's pertinent to my care, it would simply fall into the "nice to know" category. For the purposes of discussion here, anything is possible.

My reasons for not wanting riders in the back are mostly selfish ones. I'm more worried about distractions to me and my patient care. My partner is a good driver, and can usually ignore a distracting rider. He becomes pretty focused on the task at hand- so much so that sometimes I need to throw things at him from the back to get his attention. LOL(not really) Simply asking demographic information, much less providing treatment enroute- can be a major hassle with someone else back there. I usually suggest family and friends take their own vehicles and meet us at the hospital- especially when I know the patient will be treated and released- so they have a way to get back home and not need to call for a ride or pay for a taxi.

In my EMT wilderness training- in the early 80's- we improvised a traction splint. I can't recall all the details but I think it involved tent poles, torn up shirts as cravats for support and the ankle hitch, and a stick to apply the traction to . Surprisingly, it worked pretty well..

Theoretically possible, but not likely. Also not very smart if it did happen. I can see allowing a family member to ride in the back if you know this person may die to say a final good bye, but an aide? No way. It sounds like this woman had a through and through GSW to the head, so I'm thinking the crew might be a bit busy with patient care, and this aide would be certainly be in the way. I figure this aide is embellishing his role and taking advantage of an opportunity to score points- politically and personally. Disgusting, but it happens all the time. My MO- Unless it's something like a minor or young female or a sexual assault victim who should have another woman present(friend, female cop, family, etc) all riders sit up front. I agree with the OP on this- I call BS on this story.

All good ideas. I will reiterate some of them. You do not mention the type of call- I assume the scene was safe. Prioritize. Simple questions need to be answered first: What exactly do I have? ie Nature of call? Does it match up with what I was told? How many victims do I have? How much assistance and what type do I need- LEO's, more ambos, ALS vs BLS? Do I need a fixed wing or helo? Will any of the bystanders cause me enough trouble, be disruptive, or cause a danger that it may interfere with my job? Asking someone to help is crucial- pick the ones who are most agitated. Giving someone a task- notify family, get their medications, if Pt is a minor, find a parent, etc. It gets them out of your hair, and keeps them from spreading more panic. It is difficult to get control of the scene with nutty bystanders and street doctors. Ask a disrupter- especially a loudmouth tough guy- to act as a bouncer. Say "listen- I need some help. I''m trying to take care of this person but unless you help keep these people back, I cannot do my job." Ask a calmer female to take a hysterical female away. Generally these folks end up recruiting friends to help them accomplish whatever task you ask of them. Be polite, but above all, be FIRM. You need to project an air of confidence and show that you are in charge. That's why they called for help- they wanted someone to take over. There is no magic formula to this, each scene is different, each area you respond to presents challenges that may be unique to that area. This is a situation that requires experience. You need to be confident in your abilities and be able to project that confidence to others. We are called because someone cannot handle the situation they are in. If they do not think that you can handle the problem, you simply add to the chaos, and depending on the situation, may also jeopardize your safety. Forget medical control until you have a handle on the situation. You have far more important things to worry about. They will be of zero help in such cases, and often times they can make things worse. Many hospital based folks have no idea what these situations are like. As you say, they make a call, hit a button, and have all the assistance they could want. Their focus and expertise is on MEDICAL issues, not scene safety and control or utilization of assets. Sadly, you need to experience a few of these before you start to get confidence in your abilities to handle such things. It will happen, just analyze later what went wrong, what went right, and how you could do things better next time.