HERBIE1

Some of the best advice I heard as a new provider... Keep your eyes open and your mouth shut- except when asking questions. Be a sponge- absorb all the knowledge and insights you can- from patients, family, partners, teachers, hospital staff, bosses- even bystanders. There is something to be learned from everyone- even if it may be what NOT to do. You are never too old/experienced to learn. Never step wanting to improve yourself professionally or personally.

Snoopy- You are quite welcome. I can't say that I can relate to what you are going through but again, all you can do is keep going and try not to be discouraged. Not to sound preachy, but your situation is an object lesson for kids- or anyone who makes bad choices- the consequences can last long after you have overcome the problem. The fact is, you beat a problem that ends up beating many folks. Nobody can take that away from you.

I told this story before but it bears repeating. Obviously laws vary from state to state, so you need to do your homework. Years ago I was a manager for a private provider. I had approximately 35 year old guy submit an application for an EMTB position, and he clearly stated that he had served time for theft as a younger guy. His application was well written, had good references(which I checked) and he seemed like a pretty good candidate. A day after I received the application, he called to ask if I received it, and if I had any questions. He also made sure to point out that he had indeed served prison time. I said we were reviewing his application and I would get back to him either way. Very impressed at his honesty and the fact that he followed up his application with a call. I checked the references, they spoke glowingly of the guy. There was no legal reason not to hire him. I went to the boss(the owner) and fought for the guy. It took a lot of convincing, I said I would bring him in for an interview, and we could put him on an extended probation period to cover our asses. The boss finally relented and agreed to let me interview the guy. I was impressed as hell- personable, very honest and contrite- he said he did something stupid as a kid and he was tired of the dead end jobs he had since then. He really wanted to make a difference and help folks and was frustrated that nobody would even give him an interview. I explained I would go to the boss and recommend he be hired, under certain conditions. He completely understood. Well, after a lot of begging(and putting my ass and reputation on the line), we hired him. I explained to him how hard I fought for him, that I was going out on a major limb, and that he had better not make me look foolish or regret my decision. Turned out he was the best employee I ever dealt with. Conscientious, hard worker, great attitude, and patients, contracts, and partners loved him, and I could always count on him. Never late- despite the fact he took 3 buses and a train to get to work(a 2 hour commute). He was so appreciative of the fact that we gave him a chance, he never let me down. He left after a couple years when he finally found a better paying job, closer to home, in part because of the glowing recommendation I gave his new boss and the opportunity we gave him to establish a work history in the field. I couldn't have been happier for the guy, but was really sorry to see him go. I also scored some major points with the boss- after that, he really trusted my instincts and I was given more responsibilities- and a nice raise. LOL Moral of the story- find someone who will give you a chance. It may be tough, don't get discouraged, but there are people out there willing to offer you a job. Be up front and HONEST about your past, answer questions directly and without evasion, accept any reasonable conditions an employer asks of you. Remember, to them, you are a potential liability and this is a business. Explain what happened to you, WHY it happened, WHY it won't happen again, and what steps you have taken to ensure you never go down that road again. Every job interview is about selling yourself, and the only difference here is that you have even more to sell and explain. Good luck. I wish you the best.

LS- I think one of the problems you will run into is that some of these Allied Health professions are certificate programs that may be 2 years long, but many of the classes are technical in nature, meaning they do no translate(or are accepted) as equivalent college classes. As an example, in the dark ages when I started the Radiological(XRAY) Technician program, I took things like Radiation Physics and biology, which were considered to be technical classes when I transferred to a university. They were certainly intensive enough classes, but also too narrow in focus to be accepted for transfer credit. I'm not sure a direct comparison between EMS and another field is appropriate- or even valuable. No offense to those in the Allied Health fields, but a quality paramedic program is far more advanced and comprehensive in scope and training than a surgical tech, OR tech, or ultrasound tech. I would simply provide a list of skills, medications, and procedures we are trained to perform and stress the importance of how we perform those skills-essentially autonomous. By requiring more general education classes and a degree, it only improves the quality, caliber, and professionalism of the providers, and let those facts stand on their own. I'm also afraid that making comparisons between unrelated fields we do ourselves a disservice. They only provide their service when a specific order is written by a doctor, usually in a hospital setting, while we do have standing protocols, we also are allowed to work independently. I think this independence does us a disservice, since others in the health field really have no idea what we are capable of doing. The fact is, we do our jobs outside a traditional hospital or health care setting. Ask a nurse who works on an OB/GYN floor, or Med Surg floor about our scope of practice. Many really do not have a clue. Just my nickel's worth...

Welcome to the city from another old timer- only you got me by a few years.

Welcome to the club. Just had it happen to me a couple weeks ago. I believe the problem was with facebook, linked to my email account. Sent every one of my contacts the "I'm stuck in Wales, UK was beaten up, the embassy won't help me..." No link to send money, though. My entire inbox was deleted as well as all of my email contacts. Pain in the arse, isn't it? Facebook is well aware of the problem, and even has a section in their FAQ's that addresses this specific issue.

I really like the idea of a code word for accidental trips of the "Oh shit" button. I'll have to run this one up the chain of command and see who salutes it. Our old MDC's had an emergency button that was flush with the housing of the unit-obviously designed by a management type with no street experience. Accidental trips happened multiple times each day. With the new terminals, the button is recessed and can only be activated on purpose. Our portables have always had a recessed alert button, so accidental trips were zero, to my knowledge.

If these are stable BLS patients, I see no medical reason why 2 patients cannot be transported via IFT at the same time. If you have the capability to handle 2 stretchers, then great. The only way we can handle 2 recombent patients in our rig at the same time is one is tied to a backboard and strapped to the bench. Happens all the time. If they are able to sit up, then it seems to me that a medical transport van, equipped for wheelchairs is the way to go. Besides, most insurance carriers- including Medicare- will not reimburse for an ambulance unless it's deemed medically necessary and a doctor certifies this fact. As for HIPAA issues, well, as was mentioned, in a crowded ER, those curtains are not sound proof, and if you are conscious and listening, you'll hear a person's entire medical history and far more than you ever wanted to know about them. It's the nature of the beast. In other words, asking medical questions in the presence of multiple patients is not optimum, but sometimes there is no other choice.

I hope I don't run out of things to say or I'm going to get really irritable...

Happy Birthday, Richard! You share the day with my 13 year old daughter. Must have been a good day...

Your assessment is spot(ting) on, but talking about these things sometimes cramps my style.

Great story. As I said many times to my students, it's great to know a million drugs, have lots of fancy equipment and techniques to help people, but that is not what they remember. It's the little gestures, the extra time you take with an elderly family member or patient, words of assurance that their father, mother, or grandpa will be OK. THAT is what it's all about- making a connection with people- however brief-because they don't care if you have taken PALS, ACLS, PHTLS, PEPP, or can intubate like an anesthesiologist.

Let's stay on topic here or the thread could bleed over into another area...

The physician has treated the patient, who is already under their care, they are aware of their PMH, their current condition, and the possible issues they may have. By calling EMS, they are giving tacit approval that the patient is stable enough to be transported without further intervention by the doctor and they are essentially ceding the fact they cannot do anything further for them in their office setting. Why would a speech be necessary in such a case? I have had patients from doctors offices who are critical, but in their offices, the docs are less equipped to handle them than we are. Most doctors do not have much in the way of ACLS drugs in their offices. I've had patients in CHF, for example, and as a courtesy, I've explained to the doc what we were planning to do per our protocols, and they have always agreed with our plan. I have had a couple old timers that were amazed we were able to provide so much care.

Reading the whole story, this is one screwed up department. A deputy chief being investigated for rape, his wife caught in uniform in the middle of a drug sting, and now this. Wow.

Not a bad idea, but is SE such a widespread problem? Honestly, I get maybe 2-3 status epilepticus patients a year and probably 95% of them respond to Valium. Maybe they have a higher rate of these calls in that area for some reason.

The fears and concerns our family has may not be rational, but they are very real to them. Yes, there are plenty of reasons to be concerned about what we do- and if they had any idea of how many more issues they DON'T know about, they'd really freak out. LOL My family is amazed at how completely desensitized I am to things like blood, guts, and gore. I'll never forget watching a show on the Discovery Channel which featured a very graphic surgical procedure, complete with plenty of gore. We were eating spaghetti for dinner and as I was getting up to change the channel, I became engrossed in the program as I was munching on my food. Everyone at the table was turning green before I realized they were getting grossed out.

I really don't think kids are suddenly discovering that sex feels good. What I do think is their attitudes towards it have become far more cavalier about it than in previous generations. It used to be a small segment of the population, but now thanks to music videos, TV, movies, and ads, sex is the number one thing that sells damn near every product. Instead of it being used sparingly, in very specific circumstances, sex is everywhere. As prehistoric as it may sound, in some ways I think it was a good thing when being young, single and pregnant was not something to be proud of or something to aspire to.

Well, here's an opposing opinion. Sort of. As was mentioned, teachers are already overwhelmed, and I really do think this is an instance where the parent should be taking the lead. That said, I realize that for religious, cultural, and personal reasons- and yes, simply being uncomfortable about the subject), many parents do NOT give enough information. So- what happens when your beliefs conflict with what the school is teaching? IE-abortion, premarital sex, birth control, masturbation, etc? If you let the kid opt out of this at school, then who is the one who suffers? The kid does not get the information they need, and they are marginalized. Of the kids who "get into trouble", I would love to see numbers on how much and what they learned in their sex education classes. I submit that the sex ed information- or lack thereof- too often is not the problem, but a lack of parental involvement/supervision is. I think these days, kids are much more aware of the consequences of unprotected sex- far more than when I was growing up. We were given very rudimentary info, yet I can think of only 1 student in my 4 years of high school who became pregnant, and this was in a school of several thousand. These days kids are exposed to so much- TV, movies, etc, and there are countless instances of teen moms and their problems, STD's, and now we even have HIV and AIDS etc. We NEVER had movies or TV shows that discussed these things on a regular basis. I think the attitudes of today's society towards sex is FAR more of a problem than a lack of available information and options, but that's just my opinion.

Try a test. See how much water a pad can absorb before it becomes saturated.

I know what you mean about worried family members. The wife is pretty good now after 14 years of wedded bliss(and nearly 30 years in the business), but since we live in a big city, if anything nasty is going on, it will usually be on the news, and she always wonders if I was there. Problem is, I am also a crap magnet and she knows it- meaning damn near anything horrible and/or sensational and I somehow seem to end up in the middle of it. LOL We talk, she knows there are inherent hazards of the job, but she also knows I am damned careful and have been doing this a long time. I tell her just enough to satisfy her curiosity but leave out the bad stuff. She may know I am holding back, but she also knows I won't budge on giving her too much info. You are doing the right thing by being proactive on this. Do NOT underestimate the stress this can put on a relationship. No matter how understanding she may claim to be- she may have been putting on a brave front- her concerns may be coming to the surface. Have a sit down and I'll bet she expresses concerns you never knew she had. Talk it out and I'm sure you'll come to an understanding. Good luck, bud.

Bring your phone with you, put it on silent or vibrate so you don't get distracted during the call, and as soon as you drop off the patient or clear a scene, check it, and call home if needed. When you leave, if it's portable, maybe you need to grab the scanner too.

Nothing much to add except that with that high pitched cry- stridor?- it sure sounds like it could be a partial blockage and the grape is lodged in the right mainstem bronchus. Check the sats, give some O2 via a blow by if that's all the kid tolerates, and transport. Sounds like the doc may need to go fishing...

I agree with you- too many variables here. Is it bright red, dark, tissue, is there cramping, tenderness, pain, other signs or symptoms? PMH? I've even had women SWEAR they were having vaginal bleeding when it fact it was a nasty urinary infection with gross hematuria, so what about urinary symptoms? I would say that if she is normally regular, then she could be having a miscarriage, become irregular for some reason, or has something else going on. Personally I wouldn't be too concerned about that amount of blood in terms of hypovolemia, but clearly something needs to be checked. Ultrasound, pregnancy test, labs, urinalysis would clearly be indicated.

It's naive to think you will change an established culture- especially if you are new. In order to effect change you need either an actual position of authority or at least be an unofficial leader. It seems that she is neither. I agree with you that the director is not doing their job if they he/she allows attitudes like this to exist. This is the person who should be either setting an example or leading the change within their organization.