HERBIE1

Good to know that they paid attention to your opinions. The bottom line SHOULD be survival to discharge with the only exception I can think of being cases of possible organ donation. It's not really a "save" in my book unless the person is able to shake you hand later to thank you, although I agree that rarely happens. Anything else is prolonging the inevitable.

Sounds like after you finish your schooling, it's time to go. Trying to change an established culture- especially when many are volunteers, so you cannot hold their jobs over their heads- is an all but impossible task. It's also a tough sell for someone new to a company. I agree that the negativity WILL eventually affect you in some way. You will internalize the stress you are under, you will change your attitude, and you will not be happy. If you let it, your unhappiness may even end up souring you in the business. Sorry to say, but it's probably time to look elsewhere, and in the mean time, use that thought to keep your sanity.

Agreed about not letting the mrs hear a scanner. The best policy- Have her call and leave a message on your cell phone. Tell her you will get back to her as soon as you get a chance, but not to worry if you cannot return her call right away. Make it a point of checking your cell after every call. Reassure her that if something DOES happens to you- god forbid- that someone would notify her immediately. Ensure your service has such a policy, as well as emergency contact numbers on hand for such a situation. Inform her of this fact.

I know Richard- it wasn't a slam on you or FDNY EMS. I agree it's nice when your organization is proactive- and gawd knows mine is not. By the time we get "new" protocols, equipment, or medications, they are usually obsolete by industry standards. It just seems that in this case, the evidence was anything but overwhelming that this device was a good idea. No harm, no foul though, I guess.

A blog is not about clinical studies, it's about opinions from those with practical knowledge of a device, medication, or procedure. Depending on where you look for info, there may be quite different opinions on a device. I recall getting nothing but positive cheerleading from the department when presented with new devices or protocols, and if you took them at face value, there would be no question the new idea was the best thing since sliced bread. After doing some digging on my own- from things like scholarly literature AND blogs, I found that reality was much different than what we were told. Didn't matter, since I am not in a position to make such decisions, but it did open my eyes to a few things. Sadly, politics, money, and BS are all part of the process of getting a new idea implemented. Efficacy is not always the number one concern.

Well, it makes sense to me- especially with the latest CPR guidelines from AHA. The protocol de jour seems to now demphasize ventilations in lieu of more aggressive chest compressions. Besides, one of the studies I saw said that the end point was getting the person to an ICU bed post arrest, and the stats were essentially no different for a patient who had that device, vs one who did not. The study also did not address neurologic function, or survival rates, so I'm surprised NYC adopted the device as quickly as it did.

It's been a week since I was hacked and have yet to hear from FB on this. I'm thinking they have a potential lawsuit on their hands and are trying to figure out how to limit their liability. If someone can show that FB had inadequate security measures in place, they will be in big trouble. If you search their security FAQ's they have a section on this very issue, they have step by step directions on what to do if your account has been compromised, and even mention that your email account will also be affected, so it's clear they have been aware of the problem for some time now. Let me know if you hear anything, and I'll do the same for you.

Crapmagnet- Here's an article which may very well be the reason for our problems. A hacker from NZ seems to be responsible for this. I hope they catch the SOB and hang him by his gonads. I'll even provide the rope. http://www.nzherald.co.nz/connect/news/article.cfm?c_id=1501833&objectid=10640757 FB told me that they require proof of my identity, and MAYBE they can reinstate my account. I too am done with facebook unless they change their policies. Too bad, because FB allowed me to reconnect with some old friends. They clearly have been caught with their pants down on this.

I feel your pain. Cramagnet- I just dealt with this last week. Since I do not have your email, it must be a separate incident. Same message, same alleged location(Wales, UK)- but thankfully no link, phone number, or address to send cash to. I believe the vulnerability lies with the facebook account. The bot- or whatever- gains access to your email account, changes your default email, and send this message to every person in your contact list. It then deletes your entire inbox as well as every one of your contacts. That means any web site that is linked to the compromised email account can be vulnerable. Sucks, but it could be worse.

46Young- I hear you about the union issues and I also had no idea that NYC's PD starting pay was so low. I would hope that they have regular step raises as they gain seniority because I don't know how someone can survive in a city like NYC on that starting pay. Again, unions and EMS are going to be a tough sell. In my experience, many times the unions that do cover EMS groups are much smaller than the IAFF or AFL-CIO and do not have the same strength or numbers to get decent contracts. Like the SEIU(think hotel workers, hospitality workers, etc), often times the unions get far more out of their members than the other way around. Although those members do get a guaranteed pay rate, after they take out union dues, their take home pay is generally a pittance. The problem is, we are talking about so many different levels of licensure as well as types of service being provided, so a blanket EMS union would be a tough sell. Clearly we need to raise our standards- in school and in training, so we can demand better wages from employers. That will be a tough sell for someone who works in a small town or rural area. After a certain point, if we get enough training, we will approach the level of an RN or other allied health provider, and many will feel they might as well simply change professions to get better pay. Yes, EMS and in hospital work are different animals, but if I will be forced to get a 4 year degree or something similar for EMS, why not simply become a nurse or something else in order to get the better pay, better job security, and working conditions. The reasons most of us are drawn to EMS- the type of work environment, the variety of work, the excitement, the nontraditional hours, the autonomy- may not be enough to entice people to stay if you cannot make a decent living.

Salary is only a part of the equation. Think cost of living. The cost of living in a city like NY, LA, or Chicago is far different than in a smaller, more rural town. If you made 99K and lived in a small town in the middle of Kansas, you would be living large. In a big city, think ridiculous taxes, high cost of food and goods, gas prices, private schools(if the schools in your neighborhood are lousy), home prices, property taxes, etc, and that 99K doesn't go nearly as far as you might think. Yes, that IS a lot of money, but you need to put things in context. Salaries in larger towns NEED to be higher- especially for city workers mandated to live in the area- or people would never be able to afford to live and work there. Think about it- would you want to be a NYC or LA cop- with all the dangers they face- and try to live on 30K/yr? Yes, EMS salaries need to improve everywhere, but we also cannot directly compare our jobs to being a cop or firefighter in terms of job description. A firefighter or cop's basic job description is essentially the same wherever you go. There is no stereotypical EMS provider. Think of all the types of providers and the differences between their job responsibilities- from advanced to basic, private, special events, hospital based, fire based, county, etc. It's impossible to come up with a standard pay scale that would apply to the entire spectrum of what we do. That said, yes, we do need to be more organized politically, but for the above reasons and more, even with a major union affiliation or organization, it would be difficult to generate a cohesive national agenda that takes into account the various levels of training and/or job responsibilities.

Am I out of the loop here or do a lot of services use vasopressors(for any reason) in a prehospital setting? If so, how many times have they been used by someone here? Years ago we used to have inderal, but I never heard of it being used and it was finally pulled. I imagine in some systems- especially where there are long transport times, they can be of some use. As for varices, I understand the theory behind it, but like I said, if the person is shocky from hypovolemia, I still do not see the value of a pressor, especially when the vessels involved are far larger than an arteriole.

If they are hypotensive from hypovolemia, then a pressor is of little value- there is nothing in the tank. Largest IV's you can obtain, fluids under pressure- squeezing manually, BP cuff, or fancy pressure bag. Airway, CONSTANT SUCTION- in my experience, just use the suction tubing straight into the oral cavity- even the largest tonsilar catheter quickly gets clogged with all the blood clots and is useless. These are horrible calls- generally the back of the rig looks like a horror movie- blood everywhere. You simply cannot keep up with the emesis.

I'll stand by my original comments and also did not "dis" the company- except for the snide waste hauler joke. My point was, and still remains- that large businesses are all about profit- even ones tasked with providing a health care service. A business puts out feelers and attempts to expand and take over an area. AMR is no different than Starbucks, McDonalds, or any other large chain in that regard. That's how it works. As long as the quality of their service or product isn't an issue, they have every right to do so. If the company cannot deliver on their promise to uphold standards, provide a quality service, then they are gone. Similarly, if they cannot generate enough profit to justify their presence in an area, they are also gone. Simple business. This story was about a screw up by the crew. In order to learn exactly what happened, and how to keep it from happening again, some questions need to be asked and honestly answered. What was the company's policy regarding responses to shootings and other potentially violent scenes? What was the experience, training of the crew? Where exactly was the ambo supposed to stage? How would the crew know who to contact to ensure the scene was secure? Ultimately, the company is responsible for their employees- for training and their actions. In a civil suit, the company is held liable under the legal concept of "respondeat superior". Even if the company does have an established policy for such situations, it's still their responsibility to ensure all employees are aware of it and comply with it. The problem is, situations like these are fluid, and Richard B alluded to another issue- secondary incidents are very likely. Often times- especially when the responses are short, a supposedly "secure" scene is anything but. The shooter is still in the area, another situation develops, retaliation occurs- anything is possible and the crew needs to be acutely aware of their surroundings, the possibility of a sudden change in the scenario, and be able to react appropriately.

Sounds to me like the city is positioning itself to justify possible lay offs, pay cuts, and budget slashing. Nothing new- politics.

I think it's rather amusing that AMR's parent company-Laidlaw- is also known for it's waste hauling business. (I'll refrain from using a too easy joke here...)

While I've never worked for AMR, I do have peripheral knowledge of how they operate. Some years ago they came in to this area, and scared the hell out of the established privates here. With the mere hint they were coming, companies folded and consolidated. AMR saturated the market, took over some contracts, and made it clear their next target was the fire based EMS 911 service. AMR clearly did not do their homework because it wasn't too long before they realized they could never turn a profit here- reimbursement is around 30% thanks to a significant number of self payers and those on entitlements who abuse the system. They completely bailed out of the area, leaving the remaining private operators to pick up the pieces and for many of them to start over. Does it make AMR a bad company? Like I said, I've never worked for them, and I have heard people in other areas that have no problem with them. The bottom line is they are merely one of many businesses owned by Laidlaw, a huge multinational company that is only interested in the bottom line. If something does not turn a big enough profit, then they are not interested. That's simple business, and personally, I don't think that prehospital health care is the business that should be putting profit ahead of everything else.

I think I need to look over my protocols. I had no idea that "collapsed lungs" was an indication for IO injections.

Based on what the story said, the medics WERE wrong. If the patient was brought to the rig, then I see no reason why they refused to treat him. That was stupid. Unless the person was strapped with explosives, the patient is not a threat. If they felt the crowd was a threat to them, grab the patient and relocate to a safer location. If they were staged in an allegedly safe area, then how did the bystanders find the ambulance? If they were only a block away from the scene, clearly it was close enough for the family and/or bystanders to see them so they were already too close to a scene they thought was unsafe. Sorry, I'm the first to advocate for scene safety, but once presented with a patient, I see no reason why they did not treat the patient. Nowhere did it say there was active gunfire or the crowd was hostile to the crew. Were there police on the scene? I realize second guessing is difficult, but anyone who has dealt with these situations should know how to properly handle them.

As we have discussed ad nauseum, each city has different needs and there are many variables which make direct comparisons between systems difficult at best. What works(or does not work) in a city like Flagstaff may not work in a larger city or in a rural area. A hospital based service may work well, but if they are owned and operated by the hospital, they are also not as dependent on turning a profit as a free standing entity. The hospital, for example, can absorb costs within their overall operating budget so their stated profits/losses/costs/expenses can be misleading.

You are right- the problem with being a manager is knowing when to step in when you "hear" something 3rd party. On the one hand, you need to be proactive about problems, and even if you don't do anything officially, an overheard comment could present an opportunity to nip something in the bud. Bring the parties in, counsel them, remind them of possible repercussions of offensive/derogatory remarks to the employees as well as the company. No discipline imposed, just a talk to stop a small problem from becoming a bigger one. What you must do is at least document that meeting in a general way- "discussed proper workplace conduct, definitions for harassment, etc" in order to protect yourself as a manager. If things DO escalate, everyone involved will be questioned, and your actions/inactions as a supervisor could make you liable as well. I've seen it happen. The other option is to wait, but you need to be sure this is not a pattern that will repeated, and for that you need to be damn sure of your employees. Dangerous option, to be sure, and that puts your arse on the line. The problem with a harassment/hostile workplace type issue is that it can escalate well beyond the boundaries of the company. That is why management needs to keep a lid on it BEFORE it gets out of hand. Is it wrong that a 3rd person comment can set a process into motion like this- yep, but such is the way in our litigious society. In the end, this is a human resources problem, and depending on the size of the company, there may be a single person responsible for hiring, firing, and issues such as this, or it may be an entire department. A simple personality conflict rarely escalates beyond the company and can be handled in house, but as soon as you inject race, ethnicity, religion, gender, sexual orientation, the organization loses control and ultimate responsibility for the course of events that can follow. In the OP, I would suggest there is an ulterior motive from the person who was allegedly offended by the overheard remark- designs on a promotion, protecting their job, an unknown conflict with one or more of the people involved. Who knows. I would also suggest the person who committed suicide had other issues as well, and this incident was merely the last straw.

Interesting. He could have also included the widespread and long standing scandals of the Catholic church, their cover up, and response to it, but I'm not surprised he didn't. I think it presents an interesting problem for those who rely on organized religion- the very group they have sought guidance and counsel from has been accused of heinous crimes. I've drifted away from the church for a long time now- for many reasons, and it seems every other week there's another scandal that reinforces my belief. I believe in a higher power, but have come to believe a person's relationship with a deity is their own personal business. Whatever. We certainly need something these days-a moral center, faith, strength- whatever your tool happens to be. So many issues, so many people feel powerless to change things they do not like, but in the end, it's our future and we need to decide what need to do to make it happen.

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I feel your pain. I've dealt with this issue from the management and employee side of the fence. As a manager, you are supposed to enforce rules and trying to shield the organization from potential liability. In cases such as these, there are huge stakes because if someone files with the EEOC or other agency or watchdog group outside the company, they can result in large fines. Add possible media coverage and those numbers go even higher, and also resulting in bad publicity for the organization. These things also go beyond any collective bargaining agreement and in my experience, any discipline imposed is not likely to be reversed or even diminished. Stupid- yes. Childish. Yes. PC run amok- ABSOLUTELY. I feel your pain. I've dealt with this issue from the management and employee side of the fence. As a manager, you are supposed to enforce rules and trying to shield the organization from potential liability. In cases such as these, there are huge stakes because if someone files with the EEOC or other agency or watchdog group outside the company, they can result in large fines. Add possible media coverage and those numbers go even higher, and also resulting in bad publicity for the organization. These things also go beyond any collective bargaining agreement and in my experience, any discipline imposed is not likely to be reversed or even diminished. Stupid- yes. Childish. Yes. PC run amok- ABSOLUTELY.

I understand the need for harassment laws and regulations, but was as mentioned, and is the case with most things, the pendulum has swung wildly in the opposite direction. We know the problems that have caused these laws to be enacted, but we have now gone from someone having no recourse while working in a offensive and hostile workplace to being completely void of any common sense when dealing with these things. Should this guy have been reprimanded- sure. Give the guy a reminder that anything he says can and will be used against him. Reeducate him about appropriate decorum in a work place. Maybe that was all the company was planning to do. In our area, hundreds of thousands of dollars have been awarded to people claiming harassment/hostile workplace, racism, etc. Some of the complaints were questionable as were the motives of the "victims", and yes, some were legitimate issues that needed to be addressed. We've heard stories like this before- someone overhears a comment, takes offense, and even though the remark was not directed at the person, by most of these laws, they can still claim harm. To me, the complainant should need to prove a pattern of abuse or offensive behavior, not just a single instance or remark. I'm guessing there is more to the story- maybe the company has had recent problems with such incidences, maybe they have paid out settlements, so this employee may have been afraid of the company's possible response to the allegations. Who knows? Tragic for sure. Maybe the guy was overcome with guilt. It's a fine line we walk- especially in our business. Most of us engage in gallows humor to deal with the stresses of what we see, and most of us would not be considered to be easily offended or have thin skin, but some do. Inappropriate- to some, horrendous- sometimes. Take a look at any humor, joke, or funny stories about EMS and the medical field. Some outsiders must think we are nuts, but I think many understand it. Be careful of what you say, folks.