HERBIE1

Oops- damn typo. My bad... I realize that most threads get derailed- and the longer they progress, the more off track they get. My point was that yes, after some qualifiers, that despite all the rhetoric to the contrary, most people WOULD work that patient.

We are starting a wellness initiative here- but it is only voluntary. Blood work, "heart scans", physicals, etc. It's a good thing- a good number of people have been found to have significant heart disease, HTN, or other illnesses and if it wasn't for these check ups, they might not have lived to collect their pensions. I agree with you, and I'm the same age as you are. I like the energy of new guys and sometimes it helped me when I would be dragging, but that energy does need to be focused and channeled. That's the job of a veteran partner. Now, I have a veteran partner, but we are of the same mind- we don't get riled up, BS is BS, but if you are sick, we do everything humanly possible to help you.

What I find humorous is that despite all the rancor and vitriol, according to the poll in this thread, 75% of respondents would NOT work this arrest. Methinks some folks argue just for the sake of arguing...

I stand by my earlier posts, and although most of those obits don't mention a cause of death, it merely supports my argument. This is a very demanding profession that takes a physical and psychological toll on people. Lifestyle choices, repetitive motion injuries, stress, odd hours, sleep deprivation, adrenaline ebbs and surges- it all takes a toll. As for younger people who suddenly pass away, we all know when your number is up- that's it- BUT in my department, I know of many people in their 40's who have had angioplasties, stents, and even a few with full blown bypass surgeries. That is NOT normal for this age group. I am willing to bet that once some comprehensive, multigenerational studies are done(we need enough data for a valid study and we're still pretty young), it will be shown that the life spans of EMS providers are significantly shorter than that of the general population. There's also a difference between being able to do something and whether or not someone should.

Good points. There is no shame in admitting you can't get a tube. Even ER docs occasionally ask for help from an anesthesiologist for a tough tube. Everyone has a bad day-and just like an IV- you can always ask your partner to try if you really need that tube. If I was having a bad IV day- blowing IV's that seemed easy- I'd call them "tape tearing days"- when all you are good for is tearing tape to secure the IV for your partner. It happens- we're all human. Proper bagging can be just as effective in oxygenating a person. Don't destroy the person's airway and make it tougher on the ER staff.

It's all about your local protocols. If you don't work someone, you had better be darn sure they meet your standards for a DOA and you document your arse off. In my system, agonal breathing is still technically alive- even with some grey matter protruding. Wrong- maybe, but I don't write the policies. Obviously agonal respirations are not a good sign and generally not compatible with life, but you also need to know their cause. Is this personal terminally ill with cancer, or do they have a potentially "fixable" problem? Is it an airway issue we can treat, or is it because their brain is herniating? It's not up to us to make calls like that unless, as you say, it's a multivictim triage situation. If you are presented with several critical patients and not enough resources, and one is agonally breathing, yes, that person is a black.

It's funny, when the airway/pharynx is clear- no emesis, no funky anatomy, no dinner, blood, or teeth- it almost seems wrong, doesn't it? LOL An intubation dummy is fine to demonstrate the steps in a simulation or a skills assessment- proper positioning of patient's head, cricoid pressure, oxygenate, bag, etc, but to not be able to intubate a real patient- to me, that's asking for trouble. It's too important of a skill not to be as prepared as possible.

Cancelled a surgery because of tobacco juice?? Obviously that was an elective surgery, but still... I'll never forget my first intubation, right out of school. I kept thinking- hey, this doesn't look anything like those patients in the OR!

Agreed on the education issue. I wasn't necessarily referring to teaching an EMT or paramedic class, but also in-service/inhouse training, or orientation for new hires. Yes, not everyone can teach, and people SHOULD have teaching credentials- although some are natural teachers. I also agree that there are a limited number of administrative spots too, but there are also other options- field supervisors, PR people for community outreach- we're a creative group, we can figure out something to use the talents of the "experienced" folks. A good, experienced preceptor impacts one student at a time. If you can use that person to impart knowledge to whole groups of people, isn't that a better use of such a valauble resource? As for our initial training- well we know this is an age old problem. My paramedic program was taught by 2 RN's who had never worked prehospital, but at the time, there were NO paramedics teaching paramedics around here. Like you said- ideally we should learn from the experts in a particular area- would you want to be taught how to intubate by a podiatrist?

Interesting comment about going to med school, doc. My wife is in administration at a local University and part of her job is advising preprofessionals looking at med school, pharm school, and dental school. She asked me some time ago about people who thought becoming an EMT or paramedic would help them to get into medical school. I told her the same thing you said- if your heart is already set on med school, go for it and forget EMS. The only caveat I made was to advise the youngest ones(still in high school) who were not sure about their career path to consider prehospital care to get their feet wet in the business. I suggested taking an EMT course as an elective(if offered) while you take the usual premed classes. I have a buddy who went the undergrad EMT route, and he used to ride along with me all the time. He loved prehospital medicine and EMS. He was always premed and knew he wanted his MD, only worked as an ER tech while in med school(never on the street) and he's now a surgeon, a partner in a physician group, making BIG bucks with 2 homes, a plane, and all the toys he can handle. That route worked well for him. He initially wanted to be a trauma surgeon but decided he wanted a "normal" life. He still tells a great story about when I taught him how to intubate. He says he now much prefers to have someone else intubate- when they are paralyzed, dry, and an empty belly. LOL

My point is that this is a young person's profession. If you are seeing any significant call volume, it takes a toll. Yes, one man stretchers are a God-send, but there is still a very large portion of the job that IS physically demanding. Obviously, there are exceptions to every rule and some 20 somethings can't perform physically, but let's look at the odds. An average 25 year old vs an average 70 year old- who will be in better shape? Could a 70 year old do basic transfers, in a controlled setting- I see no reason why not. Problem is, unless you are able to decide which calls a crew responds to(interesting wrinkle, I must say) you normally don't get to choose your situations or types of patients. It's not just about the person, it's about the patient and the person's partner. I've worked with many women(and yes, a couple men) who simply could not lift, and have hurt myself compensating for their lack of strength. It's nobody's fault, women simply don't have the upper body strength and that is what a significant portion of our job demands. I said it before- when someone reaches the age of 60 or 70, if they are still interested in EMS, I think their talents and experience would be more valuable as an instructor, a trainer, or mentor vs a field provider. Give back to the profession and utilize the experience they have to instruct new hires. I don't know about other places, but too many of our upper level administrators have had limited or no street experience. How can you effectively formulate and dictate policy when you are so far removed from the field? Let the people who have put in their time TEACH, give back to the profession, and mentor the next generation. We NEED good people to carry the torch and lead us forward from here. They can provide valuable insight, knowledge, and skills to those who are just starting out. I'm all for education, but what good is someone with a bunch of letters after their name if they have no practical experience to base their teaching on? You need both.

Depends on the software, I think. I use the narrative section to fill in details that aren't covered by the available options on the software pull down menus, and include any other pertinent scene info. No need to repeat things that are already included in the standard options- just fill in the missing data. Ask to see the reports of others and you eventually will develop your own style, based on an amalgam of everyone else.

Of all those shows, I briefly recall Chicago Hope, but that's it.

LMAO Pretty lame, wasn't it? You want reality- watch Trauma- Life in an ER. They show things like docs rocking out to Nirvana in their break room as they do their charting, and ducking outside to have a smoke in the ambulance bay. That's real life- not the depiction of some superhero.

Depending on where you come from, some engineers/pump operators do not leave their apparatus- regardless of the type of call, so anyone in that situation who is a paramedic won't provide any care. In that case, you would be correct. In other places, it's all hands on deck-even on a medical call, EVERYONE gets off the rig and does their thing. Many places do not have the luxury of having extra personnel and everyone is trained to the same level and can switch roles as needed. Here's the operative word. Of course, everyone wants to make a decent living, but for someone to volunteer to do a job that can be very difficult, stressful, and even hazardous (EMS or fire), I think it's damn noble to do it. In some areas, if it wasn't for volunteers, there would be NO EMS or fire protection. Would you be OK with that in your area? I fail to see why you think volunteers are threatening EMS. That's like saying if a doctor volunteers his/her time in a free clinic, somehow their salaries would be less in a traditional medical setting. Things like salary are determined by what the market/area/municipality can bear, based on tax base, cost of living, population, and demographics. A large area will nearly ALWAYS pay better than a small rural organization. It's simple economics.

This is all about show. It is a given that there are NEVER enough ambulances- especially in a busy urban system, so the powers that be make a show of force and send fire apparatus with varying levels of medical training to provide initial care until an ambulance arrives. Administration can say they are doing the best they can with their resources, but in the end, as we all know, you still need a transport vehicle. When EMS is fire based, it will ALWAYS be second on the list of their priorities, despite being the vast majority of the call volume and that is the age old problem. As for supervisors, it depends on their role. Is it strictly supervisory, or are they actually equipped to provide care? Here, our supervisors are only to handle administrative issues, conflicts, or coordinate large numbers of patients- they do NOT provide patient care. Yes, in an urban setting with 4th floor walk ups, subways or elevated train platforms, difficult access situations, providing protection on a highway scene, CPR- more bodies are needed, but I agree it looks silly when 10 people show up for a little old lady with a tummy ache.

Good points. Being a nurse is also an entirely different mentality than being a prehospital provider, but an RN definitely opens more doors and provides more career opportunities.

Working in a hospital setting as an ER tech is good for seeing a wide variety of patients, but what you are allowed to do skills-wise varies greatly, depending on where you work. You also work directly under nurses and doctors- not the autonomy most of us like being on the streets. There are a couple private providers in the area that do 911 calls for a few smaller suburbs in the area, but most 911 responses are handled by Fire based EMS. As for working on IFT's, don't knock it. You learn the basics, how to handle patients, talk to people, learn the system. Many people around here who move on to 911 services started on the privates and they are better providers for it. Besides, most paramedic programs want some experience at the EMTB level before they admit you- and for good reason, IMO. Most privates work via contracts- with nursing homes, MRI facilities, staff special events and festivals, and you do get an occasional "house call". You are just starting, you need to walk before you run.

Nothing there. Forgot the link?

It's all about the drama. I'll probably tune in to see what it's like, but I doubt I'll be a regular viewer. As for how it portrays EMS, think of "Bringing out the Dead", with Nicholas Cage. I enjoyed that movie even though(or because of maybe, LOL) it was pretty dark, but was it really an honest depiction of most EMS providers? Unless something is done as a documentary, it will always use embellishments and creative license to make it appeal to the masses. Doc is right- most of the job is routine and does not make for good TV. Where's the excitement of a 90 year old with general weakness for 2 weeks, a nursing home patient with decubitus ulcers, or a 20 year old with a toothache? People want sex, blood, and gore. We'll see how the show does with the ratings...

-What are the best agencies to work for in that area (especially in terms of salary, flexibility, types of calls, ect..)? -Are there any Hospital-based agencies in the area? Or what are the non-private services (especially that hire EMT-Bs)? (I had my clinicals with Poudre Valley Hospital which had it's own ambulance service that co-oped with the local Fire Dept and I really liked the way that system worked.) I'm considering even skipping the job search and just volunteering with Americorps for a year.. Would that be a good idea in your opinion? The pay is a stipend of about 800-1100 a month and I would probably work in an emergency preparedness program (for terrorism and disaster events) Would it be beneficial (directly) at all for my EMS career? -I'm not yet EKG or IV certified, can I and where are places I can certify at? -How does it work becoming ACLS and/or ATLS certified? Is it a class or course like IV? Where can I find one? -One thing I really want to do is become a flight medic. What is the best path to accomplish this? -Long-ways down the road I'm considering the possibility of becoming a nurse or even going on to medical school, again what's the best route to get there? -Any advice for a fresh green eager-beaver EMT-B? -Oh yeah, For those that are EMT-B or P with a fire service, how does it work, what is the structure? DO you ride in the truck or on a bus? Are you a Fire Fighter or 'just' an EMT or Medic? Hope this helps. Welcome, and good luck in the business. Also- listen to the previous advice. Lots of info available here, but hopefully you don't have thin skin- some folks get pretty testy here.

Richard, I sincerely mean it. I now I even have a vested interest myself- the first relative since Viet Nam who is in the military. My 20 year old nephew/godson is in the Army, completing his training at Fort Campbell, KY and since his interests lie with linguistics/intel/and or the Rangers, he will deployed sometime in the near future. It all depends how much more training he will need. Let's put it this way- the military was essentially a last resort for him, but he has embraced it and thrived. He was not major trouble, but could not find his way. Very bright kid, but no focus. Thus, I'm scared/proud/happy for him. Whatever reasons someone chooses to serve, it is a calling not everyone can answer.

Agreed. All it takes is one mistake from dispatch. Not worth the risk.

LMAO I LOVED those old Q sirens- nothing like them, although the new ones are a pretty good imitation. I especially loved it when those old Q's were winding down. BTW-You are showing your age, Richard. Similar story- Years ago, the former head of our department lived in the middle of the city, in a highrise apartment. Someone in dispatch got their hands on a memo, not meant for wide circulation, that the chief wanted his subordinates to tell the crews to limit siren use in the downtown area after a certain hour. Apparently he was a light sleeper and was constantly being awakened by the noise. As you might imagine, when news of this memo spread, every crew within a 5 mile radius of this guy's building made it a point to do a "drive by", blaring the siren and air horn, regardless of the level of traffic. Crews made it a point to plan as many of their responses and transports past this building as humanly possible. We heard through the grapevine that he got the message. LOL

While we are enjoying our friends, family, or our patients if we must work, let us remember what this holiday is all about. A big thank you to all veterans and their families, and a heartfelt thanks for those who made the ultimate sacrifice. These folks served to defend our ability to do things like engage in this forum- our most cherished right- free speech. Happy Memorial Day to ALL!