tcripp

Taking this from another thread so that that one doesn't get hijacked...and thanks to flamingemt2011 for the segway. I am what the corporate industry would call a type a personality. After spending nearly 30 years in the corporate world, I am of the mindset that there are always better ways to do things, sharing of best practices is a good thing, and the only thing constant is change. I then enter the world of EMS. As a new hire (cadet) last year, I found myself always questioning why things were being done a particular way and making recommendations on how to change it to possibly make it better. LOL, this also included typos in our documentation, both internal and external. What I didn't know is that, as a cadet, my comments/suggestions would not only be met with deaf ears but much resistance. How does your service handle suggestions for improvement or questions of "why" without saying, "it's the way we've always done it."? Toni

Carl, Looks like they have an outdated revised textbook? My first (and only) google even speaks to permissive hypotension which references TNCC. http://www.nursingcenter.com/prodev/ce_article.asp?tid=1070098#P75 tlc

If you can find out who your local training sites are, go ask them. They may have something in mind, but just not official yet. I have one local for me who seems to only put on a class when they start hearing of interest. Interesting approach to setting up training...but it currently works for them.

...and now that I have coffee spurted all over my computer...

Walter, Your volunteering should be used as opportunities to network. The more you network, the better off you are. (See DwayneEMT's recent post about how he got to Mongolia.) Not sure if this is applicable to you and your area, but you may need to find a more rural service that is hurting for staff. Of the dozen or so people who graduated from my class in Dec '10, some are working for private services, 2 made it to the cities' large service (and one of them just recently was hired on), some moved on to something else and the rest of us are making a drive out to a rural service. I have up to a 2 hour drive for a 48/96 shift, but it turns out to have been a good decision. After I was hired in, I was told that there had been discussion on my lack of paramedic experience and the fear that I would only be hiring in to gain experience to only then move to another service. But, my professionalism during the interview (I was the only one of two wearing a suit) was a deciding factor. I'm guessing that was the first step to earning some trust... Another thing I would suggest is your contacting each service you wish to work and asking to do a ride out. This will be a KEY opportunity for you to start networking with is KEY to getting a job, in my opinion. Toni

I'd be interested in what that pledge reads...

I'm not sure what the TNCC doctrine is (please elaborate, I'd like to read up), but I can tell you what I remember learning in school. Establishing two large bore IVs in a trauma is indicated...whether or not you apply fluids or a lock. THEN, you determine fluid administration based on the needs of your patient. And, permissive hypotension is also maintained somewhere between 70 and 90 SBP, based on your protocols. Toni

Have you not ever gotten "backwards" in your thinking on a call or just simply had what I'd like to call a brain cramp. (Different than a brain fart as in nothing came out...). How many times have you called out "left" when you meant "right"? I believe what this medic now has is understanding the importance of getting the left/right spot on for this type of patient.

I am very sorry that I missed out on this thread when it first came around. I'm excited that you have the ability to travel and, as someone else said, the support system to do that. You have one very special family. I dropped the notion about remote travel to my husband...I think he's still dealing with my 48/96. ha ha Love the pictures and look forward to the stories!

Yes, but after 2 years of doing that...I have phantom buzzing in my left boob.

Ringtones...no. Calls in general, yes. I'm guessing common sense doesn't come in to play with some? Oh, Asysin - you already said that!

Interesting thread. Makes you say, "hmmm". The short answer to your question is, "I don't know". I'll have to ask when I go on shift next. However, should we as individuals be disclosing that information? I do not believe that is our place. That decision belongs to our Chief and Medical Director. What we should be doing is disclosing accurately in our reports what occurred. Let me repeat...accurately. Just curious in the example you have cited. Were you there (the partner) or is this hearsay? Other signs/symptoms that would lead the medic to believe coronary and not trauma related as the patient stated? Did the patient decide that he wanted to go POV and the team just jumped on it or did they encourage the refusal themselves? Regardless of which path, did they encourage the patient to go immediately and he delayed (you said 2.5 hours)? I'd really like to see more detail before we hang this crew... I've said it before and I will say it again. EMS is not an exact science and mistakes will be made. It's how we deal with those mistakes that defines us.

Bernhard, with all that "Octoberfest" experience...maybe you should come to Austin in June for our ROT Rally. Dwayne, you too. http://www.rotrally.com/ Of course, probably not as sophisticated as the Octoberfest.

Funny - I just recently heard another medic say, "We eat our own in EMS." Guess it is true...

Not exactly. I think the order suggested is Tintinalli, Harrison, Guyton's, DeGowins, Huszar, Phelan/Aehlert, Goldfrank.

Imagine that...

An instructor friend of mine were just discussing the best "library" that could be built that didn't include a paramedic text book. Thought I'd share... 48.47 Huszar's Basic Dysrhythmias and Acute Coronary Syndromes: Interpretation and Management 72.14 Tintinalli's Emergency Medicine: A Comprehensie Study Guide 49.05 Harrison's Manual of Medicine, 17th Edition 30.59 DeGowin's Diagnostic Examination, Ninth Edition 106.38 Guyton and Hall Textbook of Medical Physiology Tim Phelan and Barb Aehlert's The 12-Lead ECG in Acute Coronary Syndromes The prices listed just happen to be Amazon.com pricing when I was doing my original research. Toni

Good point, Dwayne. Depending on where we are in the county, we could be looking at up to a 1.5 - 2 hour drive time to the closest appropriate facility by ground. That is in good weather with decent traffic. We have, technically, 2 air ambulances in our backyard. If they can be on scene by the time I'd be ready to move...then I'll set up an LZ and wait for them. If we have to wait any significant time, then we will meet them in the middle somewhere. With all the farm land, getting a good LZ usually isn't a problem. Good point about the cost. Another thing we take in to consideration when making the decision to drive or fly is quality of life. Sometimes it really sucks to be in that position, but it is what it is. Both of our air services have memberships. Cool idea I didn't know existed until I started on this rural service, but you can pay something like $50 or $100 per year. If you get a HEMS trip, they write off what insurance doesn't pay. Not a bad idea (Christmas gift anyone?) for someone in poor health out in the sticks.

Welsh, don't be surprised if I come and take you up on the offer...

If I make it over there...you buying dinner? Pros - getting to get insight to calls as other may have done it without being judged for the way I handled mine. - Dwayne, Kiwi, AK...et al - getting to help others... Cons - getting dinged for not being willing to sway my opinion from someone who's hell bent not to sway his/hers

1. Do you take a PT if they are still recieving CPR? They said something about it but i couldn't hear them. We only fly the patient in ROSC. There's not enough justification to fly a dead person. We will, however, drive a CPR patient to the local facility to be worked further or for the family. Small community, so that does occur. 2. They said something about pushing for transporting stroke PT's? We will fly to a designated stroke center if the onset of symptoms are < 8 hours otherwise we will take local or drive. Of course, the weather isn't always agreeable in Texas and we will drive those same patients because Air won't fly.

Obviously, I can't speak for your location. However, in my area, if you want to work as an EMT you will have to drive a bit to find a rural service that actually employs EMTs. My local service and, I believe, 2 counties over have dual paramedic trucks. But, there are paying jobs. Now, to your comment about needing experience. I got hired on with zero paramedic experience in a paramedic position. What experience I did have came from...as you...volunteering while working a full time job. And, that takes time. Additionally, I interviewed with confidence on what experience I do have and how it will relate to EMS along with the fact that I didn't hesitate when I said that I was looking for a full time position and this is what I want to do with my life. (Not to mention, I was the ONLY one in a suit and that just so happened to impress the hiring committee. Imagine that...I went in dressed as a professional. HA) Based on what you've written above, it sounds like you are still not too sure on what you want to do with your life. You will need to do that before you can confidently convince an interview board that this really is what you want. My recommendation is to continue in your current path (as I think I am seeing it). Continue volunteering and do it for different types of services and events. You may not get 911 experience but you will have patient contact experience. For the financial aspect...I'm going to suggest the following. Since you seem to be on the fence about the pay, take the difference between what an EMT makes and what you are currently making and put that in to a savings account. Do it before you do anything else with your check. Go for a few months on that salary to make sure that this REALLY is the path you want to take. This might hep you to decide you can indeed do it before you give up that salary for something you love. Toni

Disclaimer here - I was you. I'm a little older than most of the people at my service, by a few years. When I started here and would listen to the stories of the hazing, I would just cringe, mostly because I feel I am too old for these shenanigans. Now, I didn't come in saying "please don't do that to me", I did verbalize how childish I thought that was. Upside...at the same time I was a cadet, there was also a 20yo EMT going through the hiring process as well. And he gladly accepted the hazing. Downside...I'm a little on the outside of the "family" and he is right in the middle of it. I wish now I had kept my mouth shut and let whatever was to come, come. There's a bit of bonding that I have totally missed out on. So, be careful what you wish for...

Very glad to see you back. And, I will definitely let you know of any opportunities on this end. You still have them on your end? And, speaking of end... Giggle!