HERBIE1

Good luck getting that law changed, but if it happens, that would be more than half the battle in severely curtailing illegals crossing the border.

The only thing they should be "entitled to" is a one way ticket to jail, and then back over the border. Sorry- the "American dream" is for people who are here legally.

There is no perfect solution here. While I am not familiar with the various types of programs and/or systems that triage calls, I AM familiar with the people who call 911. The general public is the weak link in the chain here and why we have such difficulty in getting accurate info. Some are excited or nervous, some are 3rd party calls, some are pranks, and far too many are people who are intimately familiar with what to say in order to get the quickest response. In some areas, local "activists"/ministers actually coach their congregations as to what to say. Tell them you have chest pain or trouble breathing- regardless of what your complaint actually is- to get EMS. If you need the police, tell them you think you see a shiny object in someone's hand. Our system cannot track cell phone calls, they simply do not answer if the dispatcher calls them back, thus it's a purely anonymous act with no consequences. Yes, questions need to be asked, but my point is, don't take too much of the information you get prearrival to heart. Too often it has nothing to do with the current problem, so you deal with whatever you see. A call for a diabetic problem turns out to be someone who has had diabetes all their life but their current complaint is back pain. A call for left sided chest pain turns out to be 3 38 caliber bullets to the left chest. No matter how good a system is, there is always the "unknown" factor you simply cannot avoid. It's the fun part of the business- you never know what will happen. I do like the idea of EXPERIENCED medics or EMT's doing the dispatching- they know what questions to ask above and beyond any protocol. Nothing is perfect, but relying too much on a "system" or protocol is a dangerous road to take.

It sure makes sense to me to have 2 medics in the back-especially on a critical patient. There are times I wish I had 4 hands to get everything done enroute-especially if we have a short transport time. As with anything these days- $$$ is the issue.

3 crew members-that's a luxury we don't have here. We can request an EMT come with to drive during transport if we have a critical patient, but it's not automatic.

No rhyme or reason, but obviously a hot summer night does NOT make for a quiet night in the ghettos. The top 15 busiest rigs do 20-25 or more calls in 24 hours or about a 7100 run per year average. A better question would be "What percentage of your calls are actually emergencies in any sense of the word?" Busiest shift I ever had- 35 calls in 24 hours. Maybe 50% total BS, 50% horribly sick and/or injured. (There seems to be no "in between" in the ghetto.) Took 2 days to recover. LOL

I would take this on a case by case basis. First, as an employer, would this person disclose this information on their application or in an interview? If not, how would the HR person find out about it? Is this person's history common knowledge, or is it known because of a friendship or 3rd person? I would also be concerned about HIPAA issues as well. If I were made aware of the issue and I was doing the hiring, I would ask the person point blank, explain any concerns you have, and see how they respond. How long ago were these incidents? How do they feel? Are they still in counseling? Was there a single incident that precipitated the suicide attempt or is this an ongoing issue? the Personally, I don't think something like this should automatically disqualify the person from employment. As for the title on the thread- "questionable history", here's a quick story. Years ago, I was the operations manager for a fairly large private ambulance company and was responsible for hiring. I had an application from a guy who seemed like a pretty good candidate- fresh out of school, a bit older- (30ish), but literate and articulate on his application. The guy followed up his submission with a call, asked if he could get an interview and I agreed. During his interview, he was very impressive and told me that he had served a prison sentence for robbery, that he was a stupid kid who hung out with the wrong crowd and is ashamed and sorry for what he did. He said he was having a tough time getting a job because of his history. He seemed very eager, polite, genuine, and I appreciated the fact that he was honest with me. I was honest with him about my concerns, especially because of the nature of what we do and he said he understood. I spoke with the company owners about him, they were very reluctant, but after some arm twisting they agreed to let me hire the guy. I promised to keep an eye on him- nobody else knew of his history, and would ask discreet questions of his coworkers about his work ethic and skill. Turns out he was one of the most responsible, hardworking employees I ever hired. I never heard a bad thing about him, and he was well liked by our accounts, patients and coworkers. He lived quite a distance from work, took public transportation to get there, but was never late. I could always count on him to pick up an extra shift too. About once a month, he would thank me for giving him the chance nobody else would. When I left the company, I made it a point to tell him that anytime he needed a reference, he could call me and I would be happy to provide one for him. Later, I heard that he got married to a coworker, and that because he had finally established a work history he found a better job within the business with better pay and benefits, and was doing well. Does every situation turn out well? Of course not, but sometimes you need to trust your instincts, ask some questions, and give someone a chance.

Whether they committed another crime is Irrelevant- being here illegally is a crime in itself. That's the only reason needed to apprehend them. As for them not stopping- totally agreed. Problem is, if they escape, they are home free. Now they hit the jackpot with free education and health care and enough people who will protect them and their "rights". It's well worth the risk for them to come here and then make every attempt possible to get away from police.

Yes, but without EMS, the future of FSR would be quite different. The only reason fire has reluctantly taken EMS into the fold is because it is a revenue generator and adds to their budget. In the minds of many of the fire big wigs, EMS is still only a necessary evil. Fire prevention, building codes, better construction materials all have reduced the number of fires. Firefighting will ALWAYS be necessary, but the industry is far different than it was even 15 years ago. In a perfect world, EMS would be a separate entity, and enjoy the same attention, funding, pay, respect, and benefits that most professional firefighters enjoy. Do I think that will happen- not likely in my lifetime, if ever. The problem is, because of budget contraints, funding, oversight, and politics, it means that those responsible for public safety are looking to get more bang for their buck. Blended fire and EMS systems mean they pay someone who can perform 2 roles vs hiring and funding 2 separate entities. That said, just because someone is a FF and a paramedic, it does not mean the EMS portion of their toolkit has to suffer. It is up to the provider to maintain professionalism and standards, and if they do not, I blame the provider, NOT the system. Yes, without organizational support, it is difficult to accomplish this, but we are the ones who must look in the mirror everyday and have the integrity to do the best job possible- regardless of what your job is. Hoping and wishing are fine, but you also need to realistically evaluate the climate we operate in. We have multiple levels of control- both medical and legal- and with this, often times what "we" want is almost irrelevant. We need to operate within our sphere of influence, push for change when possible, logical, and practical, and to also know when a battle should not be fought.

First, nobody wants these immigrants to be killed, and the crew must be in shock. I doubt they give a damn about the citizenship of this person as it relates to this incident- the crew accidentally took a life- not why they are in this business- and they will have to live with this the rest of their lives. I realize folks who live and work in the South and Southwest have a vested interest in the immigration issue, but it does affect everyone. It's like the old issue of whether police should engage in chases of criminals- especially in crowded urban areas. When someone is accidentally killed by the police or the fleeing suspect, every wants to know if that chase was really worth it. Police have severely curtailed these chases because of liability- courts have awarded millions to the families of these innocent victims and held the municipality liable for what happened. Is it right to be chasing someone simply because they are illegal? Personally, I think the concept of "illegal" is pretty clear. Either we abolish all border controls, or we enforce the laws we have, but you can't have both. Tragic incidents happen- illegals become lost and die in the middle of the desert, die because they are packed into a truck/train car/trunk like cargo, etc. Clearly to them, the risks to get here far outweigh the dangers they face on their journey- especially since they know that once here, the odds say that they will never get caught and returned home. I know- derailed a bit from original point, but I think still pertinent to the discussion...

Apparently I'm in the minority here, but can someone explain to me why so many feel threatened by volunteer prehospital providers? When I started as an EMT B nearly 30 years ago, for awhile I worked with the Red Cross as a volunteer in a rural area, providing medical care for special events as well as disaster assessment and even did some tornado spotting. The people I worked with were some of the most dedicated, hard working folks I have ever met in the business. They improvised, used their own time, resources, and money to get the job done and were well respected in the communities they served. People appreciated ANY help they could get. I simply fail to see what the problem is with volunteers. There's a time and place for them- in areas where paid personnel are simply not possible, isn't it better to have ANY provider vs none at all? There are just as many lousy full time professionals as volunteers so I reject the premise that because they are volunteers, their abilities or dedication is somehow suspect. Maybe I am missing something here, but if we're supposed to be about helping people, then limiting or putting restrictions on that help seems counter intuitive to me. Please educate me on this- I am honestly looking to understand this attitude.

From the report I read, she was NOT seen by a paramedic- the ALS crew was held up enroute and did not make patient contact because the patient did not want treatment. She signed a release and later developed symptoms. I wouldn't fault the original providers, assuming they gave the usual warnings.

The biggest obstacle in combining EMS and fire is within fire itself. The old guard- especially those who run the show at the national level- simply does not consider themselves anything but firefighters and EMS is a necessary evil to them. Yes, that attitude is changing, but at a snail's pace in many instances. We talk of education, and that is exactly what many in fire suppression is afraid of. EMS folks are used to studying and taking tests- it comes with the territory. Many of the old guard are afraid of being overrun by those "damned doctors". They know if EMS providers begin filling their ranks, they will outperform them on promotional exams and quickly "take over" what they consider to be their domain. For those who are interested, read up on the issue of organizational culture and it explains why old attitudes are hard to change. The fire service is a very old and well established tradition, which makes changing attitudes very difficult. What makes that profession great also makes it highly resistant to change. Look at it from a cost standpoint. Beyond the initial expense of medical equipment and training, once a city/state/county has a dual trained workforce, they realize a savings because one person can perform 2 jobs. As for volunteers- I simply don't see that as a threat to anyone. There will always be a need-just as for volunteer firefighters.

I hate to say it, but I don't envision a day any time soon where EMS will be on equal footing with fire for funding, recognition, or political actions groups. Fire NEEDS EMS to maintain their future. Even within a fire based EMS system, there are variations. Are the EMS providers all ALS? Are they simply a transport group and the FSR people provide initial care? Are the EMS providers single role or crossed trained as firefighters? Are they sworn members? Are they in the same union or do they have a separate union solely for EMS? Is there a pay disparity between the 2 groups? In any case, EMS is a minority member of these groups- especially when you are talking about single role and 3rd service providers. Thus, unless you can demonstrate a benefit to the controlling majority, anything that's simply an EMS issue will face an uphill battle. My point is, there are no simple solutions here and this is a complex issue, but I agree that education is a key, and not only just in the case of medical knowledge. The more you know about management, fire service, leadership, business, and politics, the better able you will be to offer integrated solutions to the problems we face. I think too many people think that because what we do is so important, the public and powers that be should automatically realize the problems we face. It doesn't work that way and the issues are way too complicated for that mentality. It's all about money, power, and being smart about what we are trying to accomplish. Folks need to look at the bigger picture- especially in these economic times.

I wouldn't call them deficits, I would call them growing pains. The thing is, the provision of prehospital care is so splintered, it's difficult, if not impossible to come up with a single pronged solution applicable to all areas. What is needed in a rural area served by volunteers is NOT what is needed in an urban area served by a 3rd service provider or a fire based EMS system. There is no panacea for these problems- they are too vaired in nature. The problems we are seeing are the results of these growing pains. The industry IS changing, and problems are revealing themselves when these changes occur. Think about the resistance we had not long ago from docs and especially RN's. No, it's not all hugs and kisses now, but it is far better than it used to be just a few years ago. When medics were first used in ER's to supplement the nursing shortages, think about all the grief we got. You're stealing our jobs, you don't belong here, etc. Hospital administrators realized they had at least a short term solution to their chronic nursing shortage and if a prehospital provider wanted to be a nurse and make RN pay, they still had to go to nursing school. Most nurses finally realized that medics don't want to be nurses or they would go to nursing school, so their feelings of being threatened also faded. Yes, there are still die hard EMS haters out there but those numbers are dwindling. We need to maintain our professionalism, push for education, and the recognition and rewards will come. We just have to remain vigilant.

Culture is a relative term. The culture in your area may be totally different than mine which means many problems will be unique to a community. I do agree that we need to take control of our own destiny, which is far easier said than done. We need more people in positions of authority- not just in EMS, but as elected officials at the local and national levels. We are still very young and I think in time we will begin to assume more roles of policy makers, which is the only thing that will change the current climate. Most people have no idea the issues their local prehospital providers face, much less the problems that are national in scope. Things like public ed, PSA's, and again, legislative power will eventually help.

I never understood the notion of blasting an OD with so much Narcan that they go into instant withdrawal. Most of the time, these people DO get combative, AND many end up showing you what they had for dinner. Why would you want to deal with that? Yes, in recent years there was also a rash of Fentanyl/Heroin OD's that required 6-10 mg of Narcan- plus a Narcan drip at the ER just to keep them breathing. Are there bad medics- of course. Are some spiteful- yep, and I've worked with many. As with any profession, there are bad seeds. Not to excuse this behavior, but too many feel underpaid, underappreciated, and certainly overworked. Burnout is a real issue, especially for those practicing in busy urban areas. Such is also the nature of our profession, but as someone mentioned in another thread, we are STILL a young business. How many other professions can say they still have founding members working in the field? We are going through growing pains, and I would say we are in our adolescence. As with any "teen", guideance is needed, sometimes a firm hand, and the best and brightest of us need to be identified, nutured and mentored so they can lead us to adulthood and address issues like this.

The next step is a national standardization of classifications and it's coming. The new guidelines will have 4 categories of prehospital providers- emergency responder, EMTB, advanced EMT, and paramedic. Obviously this needs to be adopted across the board, but it will certainly lessen some of the confusion. Problem is, there are so many variables- volunteers, EMTB/EMTP crews, intermediates, first responders, and just as many types of organizations that provide the service. Counties, private providers, fire based, hospital based, 2 tiered responses,- and combinations of these and many more. Point is, many of the problems are very specific to each area, thus there could never be simple solutions. The vital issues facing one area may be nonexistant just a few miles away. A prime example and frustrating thing is that 2 people could have an identical background and training, but depending on where they work, their compensation is anything but standard. Everyone is held to the same standards but as we know, it's tough for a small town provider to make a living, but someone in a large urban area may be making double or triple their salary for providing the same care. In this economy, I would say this is probably the most important issue in that it cuts across all flavors of EMS.

There is no logic to it that I am aware of. As far as we can tell, it's merely to get the rig back in service quicker for the next run. Depending on time of day, location, and traffic, it could save a lot of time. Apparently this "need" outweighs the risk for running hot all the time. Dispatch triages AND gives pre arrival instructions, but everyone also knows what to say to make dispatch "triage" essentially pointless.

We only have one type of response- lights and siren, and only one type of transport- same. We do have a tiered dispatch- ALS or BLS-and that is a total failure, but that's fuel for another thread.

I'm thinking this guy needs a head CT ASAP. I'm calling it neurological until proven otherwise and treating it as such. His PMH of a DVT makes me suspicious of a cerebral vascular event of some type- aneurysm, bleed, AVM, clot, etc. Could be cardiac based which led to head problems- he's on Coumadin, so maybe threw a clot... Curious to see the outcome, here.

There should be a minimum age to be a paramedic- what, exactly, I don't know. Life experience and maturity are vital to this business. Think about the responsibilities were have- we literally hold someone's life in our hands. That's pretty heady stuff for the average 18 year old. ANYONE can be trained in the nuts and bolts and book knowledge needed to perform skills, but knowing how and when to apply that knowledge comes from maturity and experience. I remember precepting students who came from an accelerated paramedic program who were supposed to have experience at the EMT B level before they started their advanced training.(That wasn't always enforced- as long as they had their tuition check) It was a very rigorous program and their drop out rate was high. I recall one girl- mid 20's- very book smart, but literally could not operate a stretcher or even turn on or change an O2 regulator when she came to me a a newly minted paramedic. She had a license(or certification at that time) but had zero street experience at any level. I had to teach her the very basics before we could even begin to address her clinical skills. Her maturity wasn't the issue, but her lack of experience was. She had no experience in speaking to patients, their families, bystanders, or hospital staff and this was probably her biggest problem. This girl did realize her limitations and ended up being a pretty good medic. She said that the reason she took the accelerated course was because she was a single mom and needed to finish quickly for the sake of her kid so she could make money. She would have preferred to take her time and gain more experience before jumping in to ALS care but her situation prevented her from doing that. Young EMT's and paramedics need proper guidance, teachers, and preceptors. Think about how much we change from age 18 to even 21 or 22. You need to have a good handle on yourself before you should be entrusted with someone's life. Partnering young and inexperienced people with senior members is vital, but I have also seen 2 relatively new people working together because of manpower issues. To me, that is a recipe for disaster, and not fair to the providers or the people they are serving. Obviously there are exceptions to any rule, but let's go with common sense here.

Edgerton Wisconsin has a local chili fest- big for the town, but not all that big. I had some of the spiciest chili I could ever imagine there- all homemade, obviously. Having a full beer at all times is a MUST at these events. Tons of fun, but I could have done without the GI issues later...

Many places have very strict rules on gifts. In these political times, anything you take could be viewed by someone as being unethical and by "catching" a public servant acting unethically, they may try to make a statement and put you in the trick bag. I've had many offers of gifts- come by my diner and I'll buy you dinner, free hair cuts, discounts on products, etc. I've never taken someone up on that. Taking cash is another matter- especially if you work for a public agency. Be very careful. On a few occasions, I've accepted a couple dollars at the repeated insistence of a very grateful patient/family member or a gift card from Starbucks and see no real harm in that. As was noted, common sense should dictate your actions. Often during holiday season, people are in a "giving" mood. If you work in a residential area, you tend to know the neighbors and they often bring by food, fruit, cookies, and cakes. Some people feel the need to express their gratitude by more than just a thank you and in many cultures, it is considered offensive and very rude to refuse a gift. A good rule to live by here-trust your inner voice. We use that voice all the time when treating patients and trying to figure out whether the person is ready to code. If the offer makes you feel odd, or you think you would have a hard time justifying it to a boss, politely decline the offer. I'm with Richard- I always make a joke about on offer and say an "atta boy" letter to the mayor or bosses would be sufficient and to tell them we're not as bad as they think we are. If they write the letter- great. If not, that's fine too. We all know that people are far more willing to register complaints than they are compliments. It's sad to think someone would try to poison or drug you, but you just never know. I seem to recall an incident where a plate of pot laced brownies, left as an alleged thank-you, were ingested by an entire fire house. Possible- yeah. Likely- probably not. I'd still be careful, especially with homemade treats.

Well Richard, considering the overcrowding of ER's and the issue of proper allocation of resources, the idea of a medically supervised drunk tank might need to be revisited. As any provider who works in a busy urban setting knows, a significant portion of ER beds are filled with folks "sleeping it off", especially on a hot summer night. The thing is, not every one of these people are homeless regulars- many are weekend warriors who were "over served". Maybe spending a night lying in a room full of ripe old homeless guys would be a good object lesson for them. I've always felt that a bed, a banana bag and fluids is far too kind for someone who was dumb enough to drink themselves into oblivion- the "penalty" for their behavior is greatly diminished. Then again, maybe I've been doing this too long...