Dustdevil

At my last refresher, a firemonkey hooked up O[sub:bcdcb4b359]2[/sub:bcdcb4b359] to the seal inflation port of an EOA mask, thinking it was an oxygen inlet. Just about the time the instructor and I realised what he had done, it exploded like a firecracker.

"Money for nothing. Chicks for free." "My hobby is cooler than your hobby." "We don't need all that book learnin!'" "We don't need no stinking badges!" "I see dead people." "Show business!"

:shock: Great question! I remember doing that experiment in RT school over twenty-five years ago, but I sure can't remember the exact number. Without Googling, I can narrow it down from memory to something between 40 to 60 percent. It fluctuated with variations in the rate and sqeeze tecnhique.

I have never met a good female preceptor in my career. I've met some great female medics. But, unfortunately, the females frequently face the same kind of prejudice that she is giving you, and it colours their judgement in the long term. They end up with a chip on their shoulders for their entire career, and always feel like they have to prove something, as well as having to make sure that everybody else endures the same shyte they endured. The whole relationship becomes about them instead of the student, which is seriously counterproductive. No female preceptors in my system. Her job is to make sure you succeed. If you fail, SHE is a failure. Plain and simple, if she is worth a shit as a preceptor, then she should possess the ability to overcome any disadvantage she thinks you have from not having EMT experience. If she can't, then WTF is she doing precepting? While I do believe there is a time and place for "tough love," and pushing the student out of their comfort zone -- sometimes even by challenging them verbally -- it does not look like that is what she is doing. She's making this all about her instead of about you. Honestly, I am getting so pissed at this chick right now that firing is too good for her. She definitely needs to be on the carpet in front of her supervisor, her director, and your dean for incompetence and for creating a hostile environment that is counterproductive to her job and to your education. As for the whole zebra thing, it doesn't sound to me like you are really having a problem with it. They always have to be in the back of your mind. And you have to rule them out. But you do not have to focus on them primarily. I don't see that you are putting an unreasonable focus on them. In order to rule them out, or to even suspect them seriously, you have to have all the relevant information available to you. That means a THOROUGH assessment on every patient. NO patient gets just enough evaluation to arrive at a primary impression, no matter how good you think you are. You may start interventions after that cursory evaluation, but the total assessment continues until the moment you turn that patient over to the hospital. If that woman had been hypoxic from pneumonia or carbon monoxide -- neither of which are zebras -- how stupid would you have looked for failing to check her pulse ox? It's all part of doing a complete assessment, which is expected on each and every patient. With all that information available to you, you can then consider your zebra differentials as you go. Usually, when you have ALL the necessary information, something will stick out from the rest and make you think, "Hmmm... something more is going on here." A fever. Tachycardia. Widening pulse pressure. Red or pale skin. No previous history. Something that just doesn't usually go along with the diagnosis you are currently working with, even though everything else does. Example. Last month, I had a guy come in to me complaining of headache, dizziness, nausea & upset stomach, fever, chills, mild tachycardia, body aches, and just generally feeling like crapola. HEENT revealed an otitis media, which could by itself account for most all of those sx in extreme cases, but not usually in an adult. Chest was clear. No URI sx. He was well hydrated. I wrote the severity of the sx off to a combination of the OM and a viral illness, put him on antibiotics for the OM and sent him home. Twenty four hours later, he came in for a recheck feeling somewhat better, but now asking for something for his leg pain. What leg pain??? He hikes up his pant leg and there, bigger and hotter than hell, is a flaming cellulitis on his lower leg. That's where all those symptoms were coming from, not his ear! He had not said anything about leg pain the day before, but had I done a thorough assessment, I would have found it. No big deal though, right? Wrong. What if it had not been a cellulitis, but a DVT? The delay could have been catastrophic. I was lucky. EVERYBODY gets a THOROUGH assessment! DO NOT STOP just because you found a problem. There are frequently other problems still to be found, and sometimes they are more serious than the one you found already. This is very basic stuff, if you think about it. It's like treating an entry wound without ever looking for an exit wound. It's a horribly stupid, and potentially fatal mistake. You are absolutely on the right track in your thinking and your practice, my friend. Don't let this bimbo intimidate you into being as crummy a medic as she is. Your time with her is very definitely not wasted though. You are learning at least two very important lessons here. First, you are learning how NOT to be a crappy preceptor. But more important, you are learning how NOT to be a crappy medic. I am positive that you are going to be somebody’s Medic Of The Year early in your career. And, unlike her, you won’t need knee pads to do it.

Hey, Cat. Good to see you back. But you don't have the experience to just get out there and risk the lives of others when you graduate EMT school either, yet you are talking about doing it. That makes no sense. If you are going to get out there and start risking lives with no experience, shouldn't you at least have the best possible education first? First things first. Yes. It's two years shorter. But you probably will not find an EMS job with an EMT certificate in Houston. There are very few jobs out there to begin with. Damn few of them are for EMTs. There simply is no use for an EMT in an area where nearly a dozen schools are cranking out hundreds of paramedics a year. If by some miracle you do find that elusive EMT job in Houston area EMS, it won't pay half of what you are currently making at your other job, and it will take double your time, which results in a huge distraction from your studies, less understanding, and less knowledge. There is absolutely nothing good about that plan. It's a reasonable theory, but it just doesn't work that way in medicine. Medicine is not first aid. Being an expert at first aid will not make you a better practitioner of medicine. Look at it this way: That is the exact same analogy as an EMT, except the Jiffy Lube guy works less hours and makes more money. It's all an illusion, Bro. The so-called "skills" you learn in EMT school are the very easiest part of EMS. A monkey can learn them in a weekend. And you will practise them many more times in Paramedic school anyhow. The only thing you're likely to pick up working as an EMT is bad habits. You won't even know they are bad habits, making them even more detrimental to your growth. It really just adds nothing of significant value to your growth. The very best new medics I have ever worked with -- every last one of them -- were guys with B.S. degrees, and fresh out of medic school with zero prior experience. Sound familiar? :wink: If you are a senior medic, would you rather mould a new medic the way you want him to be, or would you rather be stuck fixing somebody else's problems? It's all about a clean slate. Definitely the best way to go. Good luck!

Either that, or else you just really have a hard time communicating clearly.

But dammit... I wanna give bicarb! With normal saline! :twisted:

I love it! All fair points. But the ability to produce profit isn't what we were talking about, was it? I dunno, maybe it was what you were talking about and I misunderstood, lol. But it wasn't what I was talking about. What I thought we were talking about was the potential for a private, for profit entity to provide a quality public service. Anyhow, if we are talking about profits, then would you have a problem with a for-profit private running EMS if they were making a good profit? That seems to be what you are saying, in relation to the hospitals. You're saying they make a good profit, so it is okay. Does that mean that if a for-profit provider does not make a profit, it isn't okay? I guess I'm just trying to understand exactly what the problem is that you are talking about. Is it that they make a profit? Is it that they provide a bad service? Is it something completely different? I dunno, man... what I see a whole lot of in EMS is just a lot of wankers who are so eat up with the desire to be a civil service employee, like their heroes the firemen, that it becomes an overriding priority for them, regardless of anything else. I am just really hoping you are going to say something to reassure me that this isn't you, because I honestly have more faith in you than that.

Dayum! That was fast! Great job! When do you start working on your degree?

The question is, if the system were changed as I would like it to be changed -- that is, EMS is prohibited from running non-emergency, non-medical, horizontal taxi services, and vice versa -- and EMS were mandated to be stand-alone, would AMR stay in business? Would they still find a way to make it work, or would they immediately take their football and go home? Either way, I don't really care. I am the very last person here to be anti-free enterprise. I think if private industry can do the job well, that is wonderful, and I embrace them. But if the only way they can make it work is by robbing Peter to pay Paul, then that is simply not a sound business plan, and they need to GTF out. Yes, I will lament the day that only government provides EMS. We will all suffer horribly from that. But for the privates to cling to this combined-service nonsense in order to pay the bills is hurting the profession and the service as well.

I dunno about that. What I mostly see is medics whose only skill is in their hands, and they never had it in their heads.

I'd be willing to bet you that they did do research before hand. They researched among themselves, their supervisors, and a few of the field personnel who are lucky enough to be part of the "cool kids" in crowd at your service. And the overwhelming response they got was the same you get from people here when you bring it up; "I'm not wearing that thing. It's too hot. Besides, I don't need it unless it's dispatched as a shooting anyhow. Just get me something I can throw on over my uniform when I need to." Their "research" came from people who know nothing about body armour. They've never worn it. They haven't the slightest clue whether it is hot, or bulky, or uncomfortable, or how it rides or feels. And they don't posess the intelligence or common sense to think the issue through without just spouting off the first thing that pops into their head from their vast year of experience in EMS. Your agency wasn't attempting to protect you. Your agency was attempting to cover their arses. They don't care whether you wear it or not. Instead of evidence based research, they did democratic research. Majority rules, and you lose. But, when you die, your employer will be able to stand proud and say, "It wasn't our fault! We bought him a vest!" Your agency is administrated by idiots. Those vests are worse than useless, because as they will tell you themselves, any scene that raises the hair on your neck to the levels of throwing that big vest on, you shouldn't be entering in the first place. No agency will ever tell you to enter that kind of scene. And, if you do, they'll fire you for that kind of poor judgement. I would. Consequently, you will never, ever in your career be wearing a vest when you really need it.

I'm still curious as to why you give even a cursory glance at the billing implications of your runs. Is there a written agency policy directing you to biopsy these people's wallets? Was this something you spent a week on in paramedic school? Or is this just something you have taken upon yourself to do? Yes, I know there are some private companies out there -- usually non-ems -- that ask their employees to focus on these sorts of things, but I would seriously doubt that your new rural county agency does. If not, you're going out of your way to make trouble for yourself and your patients. Let it go.

You have bags on your nasal cannulae? :shock:

Ya know... this last two pages has almost made me completely change my mind about EMS running non-emergency transfers. :? It almost makes me think, 'hey, maybe everybody should have medical evaluation when being transported home from their doctor's appointment,' so that wankers won’t be making these kinds of mistakes. Then I realised, the problem isn't that this person needed medical evaluation or care. The problem is that she was being transported by people with no education whose big dream in life is to be EMS and run their siren, and they will jump on -- or manufacture -- any opportunity to do so, justified or not. It just reinforces my original position. Take the wannabes out of the horizontal taxi business altogether by completely separating it from EMS in every way.

The entire concept of defining therapeutic parameters by such nebulous terms as "high flow" and "low flow" is asinine. We should be hiding our faces in shame that this even exists in our so-called profession. Do you administer any other drugs simply on "high" or "low" dosage? Do you report your patient's BP as just high or low? What about their BGL? Do you just tell the doctor, "it's high," and leave it at that? Heartrate? Unless you are ventilating, "flow" is an almost completely irrelevant factor in oxygen therapy. It matters with a mask, because below a certain flow rate, CO[sub:3cf7eeec25]2[/sub:3cf7eeec25] has a potential to build up. It matters with a Venturi mask because it takes a very specific flow rate to function accurately. And it matters with a nasal cannula because, above a certain rate you will blow your patient's nose off their face. But none of those considerations are addressed by simply defining your flow as high or low. It's all about the fIO[sub:3cf7eeec25]2[/sub:3cf7eeec25]. That's the difference between a technician and a professional.

This is a good point to ponder! Big fire departments can afford to be picky, and make their candidates jump through flaming hoops for two reasons: 1. Supply of candidates far outweighs the demand. 2. Rewards of the job make prerequisite education a sound investment We have number 1 going for us in EMS. Unfortunately, we're still a long ways away from number 2. And even more unfortunately, it's a Catch 22. The rewards won't catch up with the education until the education exceeds the rewards.

You know why I contribute money to EMT City? Because one day I realised, this is my professional journal, and it is worth paying for. I have gotten more quality education and entertainment -- not to mention a wife -- out of this website than I ever got out of JEMS, Emergency, EMS, or any other overpriced monthly rag during my career. Can I say "monthly rag" here? :shock:

I would agree that the charge of not having searched is tossed about a little liberally here. It's a fair charge in most cases, but sometimes not. It's a subjective call, and sometimes a difficult one to make. If it's difficult, as this one was, I think it's best to give the poster the benefit of the doubt. I would say that the big factor is not whether or not a topic has been previously discussed. The big factor is whether that topic has been OVERdiscussed, and frequently. When somebody comes here, registers an account, and then before even checking for their welcome letter starts a new topic asking, "Any advice for a newbie?" my first reaction is to answer, "Yes! Use the GD search function!" Topics like those are not just previously discussed. They are beaten to death. There is no excuse for failing to see that. People who do that are showing us that they aren't interested in our community. They just want their question answered so they can go away. That is no loss to us. If they aren't even bothering to click on our topics to read, you can bet they're not clicking on any ads. Just posting by itself does not establish credibility. Quality, not quantity. And part of the quality I look for is a real, demonstrated interest in the profession and the EMT City community. Those hit-and-run, one-topic posters contribute little to the community except chaos. Captainstandup is definitely not one of them, and I never suspected he was. Sure, we've talked about eating our young and the political drama that permeates EMS before, but it's not one of those definitive issues that is answered in black and white. And he presented it in a way that focused it better than previous discussions. I vote not-guilty.

Ya know... back in the 1970's and 1980's, I thought Cheech and Chong were the funniest shit ever. I practically pissed myself watching "Up In Smoke," "Nice Dreams," and "Next Movie." I watched them over and over and over, until I knew every line in the movie. And I STILL laughed! Last year, while sitting alone in a far away hotel room and flipping channels, I came across "Cheech & Chong's Next Movie" and got really excited. That had been one of my favourite movies ever! I sat there and watched the whole movie, giddy with anticipation that I was going to bust a gut and have a good ol time, just like every other time I had seen that movie. But I didn't. I didn't even chuckle. Not once. It just wasn't funny anymore. The movie hadn't changed. I had. JEMS hasn't changed. We have changed. We've just been around long enough that we've heard it all before, and have outgrown the nonsense that ninety-percent of the people who read JEMS are just now getting into. We've moved on to the mature, professional issues that really affect the profession, and lost interest in all the superficial "cool factor" issues that gave us wood twenty years ago. The sad thing is, while we have grown up, the profession has not grown with us. Unfortunately, JEMS is not a friend of the profession. JEMS is just entertainment for individuals. They know better than to tackle the serious issues of the profession on their pages. Their subscribership would drop to nothing, and they would go out of business. If they were to tackle the future of EMS in an intelligent manner, it would alienate the firemonkeys and the protocol monkeys who make up ninety-percent of EMS in this country, leaving only the serious few professionals, most of whom don't buy JEMS anyhow. The same thing that killed the Republican party is killing EMS. This "big tent" nonsense of trying to be all inclusive and not offend anybody with reality will continue to strangle us until a significant number of us has the guts to stand up and speak the truth without fear of offending anybody. Right now, there are damn few in that category. Everybody else is in it for themselves, just like JEMS. They could not care less about the future of EMS, so long as they get their little piece of the pie.

Sweet! To be sure that nobody misunderstands my position here, I am very definitely not saying that this is anything that EMS in general is ready for. In fact, even in Spenac's situation, if they do it -- even with protocols and training -- they will get sued. Right or wrong, that's the nature of OB these days. This not just another monkey skill to be thrown out there with an eight-hour merit badge. To set this thing up will require more than just huge educational changes in his system. It will require revolutionary changes in EMS educational changes as a nationwide standard to establish our jobs as a licensed, educated, professional practice with a legislated scope. It will require a complete and total change in how paramedics are perceived by the government, the medical community, the insurers, and of course, by the public we serve. I never said any of this was easy. I just said that, in order to provide optimum care under the conditions that Spenac describes, this would be part of the practice. Optimum care is what I am all about.

Closing their union shops, one by one, starting with the smaller ones and working their way up. The guys in Kalifornia ought to see this one coming from a continent away and react accordingly. Their days are numbered too.

O RLY? Then how do you explain the hospital phenomenon? How do you explain the difference in quality between the top private colleges and the top public colleges? Profit doesn't seem to be hurting their quality. Dude, I want some of whatever you are smoking! Find me more than a handful of cities that run a service like that. They all cater to the bottom line. That is why so many of them combine with the FD, simply to save money, regardless of the effect on quality. Obviously you have never worked for a government service. I have. I know the grass always looks greener on the other side, especially when you start comparing your single function salary to that of dual function firemonkeys, but that green is an illusion. And you know what? Those that cater to the bottom line best, pay their chief administrators major bank. It may not be about "profit," but it is still always about money. The only difference is who profits. Nice theory, but it doesn't pan out in practice, because even when you take away any focus on profit, the service they provide still sucks. Again, government generally proves itself to provide very poor healthcare, whether it be in EMS, or in hospitals, or in Medicare/Medicaid, etc... You don't have to be profit motivated to suck. In fact, profit motivation does much to prevent suckage, because nobody will buy your product if it sucks. When government provides the product, they have zero motivation to excel or provide a superior product, resulting in guaranteed suckage. At least with private enterprise you have a chance of excellence. Congratulations, you have just convinced me to add Economics 101 to the required course list for future EMS degrees.

Stick to EMS, Fiz. You're becoming a fine medic, but you have zero future as an economist. Find me one area of the United States where anybody with a choice would rather be admitted to the county hospital, military hospital, or VA hospital instead of the nice posh private hospital down the street. Most people would rather gnaw their arm off. But how can this be? How can government -- the lord and saviour of public health -- be running a facility that nobody with a choice would choose to go to? How is it that all these evil, for profit, private hospitals provide such a substantially a better product that even the uneducated general public knows it and chooses it? And even more relevant to you, why is it that most medical professionals would also rather work at those hospitals than the county/military/VA hospitals? Use your head, Bro. You could not be more wrong. This is not a symptom of placing public health in the hands of private industry. This is a symptom of a shyte EMS system. EMS sucks in this country, no matter who is running it. I know you guys up north are all about your benefits and your unions, and so long as you like your contract, the quality of the service provided is not a real concern to you. But that's not how all of us look at it in the real world. For every private service you show me that sucks, I'll show you two FD services that suck as bad or worse. The only difference is the pay and security, which matters nada to your patients. You're barking up the wrong tree. Government screwed up EMS in the first place. I certainly don't trust them to fix it.

Unless there were some critical medical implications that you haven't mentioned to us, I don't see the problem. I'm a medic, not a billing manager or system status manager. They get paid more. You call, I haul. Unless my patient's life is threatened by your choice of destination, I'm going where you (the physician) want me to go. Why wouldn't I? I just don't understand why you care. Were you in a hurry to get back to your recliner, or what? That's an urban attitude that will become a problem for you in rural practice, I assure you. I know I had to adjust my attitude when I went rural the first time. You (anybody going rural) have to chill out with all the Mr. Public Safety "I'm in charge" stuff and just serve your people. And no, I am not telling you what to think. I'm just asking if there is more information to this scenario because, regardless what you thought at the time of posting, this isn't a very complete scenario for us to evaluate.