Dustdevil

Oh yeah, I have one of those. Here's a pic of Vivi and I at our last MCI drill with it.

You can't say "coxsackie" here.

Be glad you were at an AF hospital instead of out here with the Marines. I get told everyday by the Marines, "You're not military! You're Air Force!"

Definitely one of the better, more eye-opening case studies ever posted here. :thumbright:

Those surprised me too, the first time I saw them probably two years ago. Definitely not a regional thing. There are just a lot of places that are not yet compliant. We'll be seeing more of these. Here's a quote of the applicable code: Stretcher Access: The 1997 Uniform Building Code (UBC) Section 3003.5 stipulates the following minimum requirements for stretcher access in case of medical emergencies. 3003.5 Stretcher Requirements. In all structures four or more stories in height, at least one elevator shall be provided with a minimum clear distance between walls or between walls and door excluding return panels, of not less than 80" by 54", and a minimum distance from wall to return panel of not less than 51" with a 42" side slide door, unless otherwise designed to accommodate an ambulance type stretcher 76" by 24" in the horizontal position. In buildings where one elevator does not serve all floors, two or more elevators may be used. The elevators shall be identified by the international symbol for emergency medical services (Star of Life). The symbol shall not be less than 3 inches and placed inside on both sides of the hoistway door frame. The symbol shall be placed no lower than 78" from the floor level or higher than 84" from floor level. Source: http://www.hkaconsulting.com/Pages/Elevato...ar%20Sizes.html

GO BIG OR GO HOME!!! :twisted: I think either Anthony was attempting some EMT City style, "Go big or go home" humour, or else he was confusing dilation checks with visual checks for crowning. While I agree that the male stereotype hurts us (many male nursing students report problems being allowed to fully participate in L&D rotations), I really don't see any need whatsoever for this in 99.9 percent of the systems out there. I worked one very rural, hospital based system where we had a grand total of three medics, and our drivers were RNs, that we would occasionally do a dilation check in order to decide whether or not to get a doctor out of bed ahead of us. It was something they wanted us to do and we got lots of regular practice at it in the hospital. So yes, I can envision a remote potential for this in EMS, but damn rare. Knowing what little I do about spenac's situation, this could possibly be something that would benefit them. And who really cares anyhow. They're just Mexicans, right?

Excellent points all the way! I just want to make sure we are on the same page on this one though. I too don't believe that rushing people from EMT to Paramedic is the answer. But I DO believe that rushing them from EMT to Paramedic school is an answer. Were you referring to the rush to begin advanced education, or the rush through advanced education, as done by the short, tech school courses?

That's true. There are plenty of OTC meds, as well as legitimate Rx meds that can innocently cause such side effects. I've been so wiped out on 25mg of Benadryl before that I could hardly walk, and that certainly wouldn't be "drug abuse." Because of that, I'll hold judgment on this guy. However, I do judge him guilty of being an uberwanker. Generic "EMERGENCY MEDICAL SERVICES" t-shirt and EMS pants on a non-emergency transfer ambulance driver? Puhleeze. There oughta be a law. And dude, do something with the sideburns. :roll:

It's a valid point you have. But four 12 hour shifts a week is only 576 hours over three months time. Most internships seem to last about that long, but with fewer hours. You could drag it out another month or two, but then you end up not riding the same shifts with the same crews, unless they are some lame 24 hour shift system, in which case you would go every third day. That's only 120 hours a month, which comes to right at 600 hours in five months, which I could live with. I'm open to ideas, and a lot depends on the shifts your service is working.

Whoever decided this was a "kickback" needs to get real. This is how healthcare works. In fact, this is how business in general works. Ever looked at your health insurance policy? If you go to the doctors that they have worked out these contracts with, you pay only pennies on the dollar for your care. If you go to a doctor that does not have a contract with the insurance company, you eat it, because they have a lower rate worked out with the contracted doctor. Such contracts benefit everybody involved. I don't see a thing wrong with it. And you would be extremely hard pressed to find a legal opinion stating there was anything improper about it. I am, of course, assuming that this "contract" was on the up-and-up, and not some kind of shady, back pocket kind of deal.

Okay, so... time for some plans to improve internships. Off the top of my head, these come immediately to mind: 1. Many, many more hours required. The internship process itself should last as long as most firemonkey medic schools. We're talking you being on an ambulance twelve hours a day, 4 to 5 days a week for three or four months. I don't want any of my students taking their first job as a medic and feeling like it's their first job, even if it is. And I don't want their employer to start thinking, "geeze... doesn't that school teach them anything?" Both are bad for my school, my students, and for EMS. 2. A specific, intelligent, progressive plan for educating you, not just haphazardly having you ride and jump in here and there as the "preceptor" chooses. For example, one shift of simply observing the teamwork of the primary crew so, unencumbered by the pressure of having to act, you can take it all in. Then two or three shifts being the secondary, performing all the skills except for assessment, learning to physically function in the field, but without having to make a lot of decisions. Then some shifts of being the primary assessor, doing nothing but the assessment while the crew does all the skills work for you. Then finally, put it altogether and be a full, solo medic, with the crew just there to help at your direction. None of this "sink or swim" nonsense, and none of this, "you just do what I tell you" crap either. 3. Balance of continuity and variety. You obviously should be exposed to a variety of styles and preceptors so you can assimilate the different things they have to offer. But you should spend at least a good week or more with each one so that you have time to progress with each one instead of having to adapt every shift to different personalities and expectations. 4. Preceptors that have themselves been through a programme that educates them on how to precept an intern. They should not just be "good medics" doing what they always do and you along for the ride. If they are not teacher material, they are not preceptor material. And if their education level is less than that of their students, no way. 5. A two-way evaluation process. I want to hear the student's impression of the precepting crew just as much as the crew's impression of the student. That way no conflict goes unnoticed, and we can put a context on any evaluations that are less than positive. If one of them is just a hardass to everybody, it is important for me to know that before I ream a student for that evaluation. 6. As a system administrator, I want to be just as involved in the process as the instructor is. I want to see and hear how each student is doing, and read their evaluations of my employees. If they are representing my agency in a particularly positive or negative way, I need to know this. And I also want to know who the future stars are so I can recruit intelligently. I want to compile a list of who's naughty and who's nice, so my recruiter knows who to pursue, and whose calls to ignore. We've bitched enough. Now, please help me make some positive recommendations for improvement.

Geeze... is she a really tiny girl, or is that just a HUGE farking patch? :? If it weren't for the huge point deductions for wearing a big, ugly service patch on the wrong shoulder, they might have placed in the top ten.

This will be different in every state. Call the state. After they give you an answer, call back and talk to a different person and ask again. I'd do that at least three times, and not settle on an answer unless all three are in agreement. What you describe would be perfectly legal in many states that aren't all anal about "state protocols" and such nonsense. Certainly not the best of situations, but if you and your MD and your base physicians have a good understanding and working relationship -- assuming the state doesn't prohibiit it -- it's not unheard of. I'd at least get my MDs signature on a standing order to allow it though.

It is important to quantify the term "recently." What do they call "recently?" For a lot of people, if they don't pinch one twice a day, they feel like they haven't had one "recently." Medically, we don't really give it a second thought until they've gone three days. And even then, we don't start thinking bowel obstruction until they are symptomatic and have failed to respond to laxative measures for a few days. It's something that is not diagnosed in the field, and the contraindication is for diagnosed obstructions, not the remote possibility of an obstruction. As always, the benefits must outweigh the potential side effects, so each patient will be different. But in the great majority of cases, I'd say you could safely give it to most patients, even if they've gone three days without a BM. It's a personal call based upon your patient's presentation and the options you have available. Are they really calling it Maxalon in that system? I thought Maxalon was strictly a PO form of metclopramide. I've never seen it as Maxalon.

Google is your friend. The first several links that come up when you search "start triage" all include a pulse check as an alternative to the cap refill. They are all reputable sites that you can refer your dimwitted training officer and coordinator to. It's been that way as long as I can remember, and I seriously doubt they have been around any longer than me. Good for you for standing up to the status quo. It's inexcusable that a training officer would be so out of touch. I'm betting there are a lot of other things your fearless leaders are seriously misinformed about, so take their guidance with a grain of salt.

As if her 10 month tech school was a much better approach. Fired. Riiight... as if she has had SO many full-arrest saves in her career that she can quantitatively tell us what always "works." What she was really trying to say was, "It's a lot easier to just keep on doing what I've always done than to lose any television time learning new protocols." Fired. I just wish I ran that service so I could fire her and hire you. A little bit of that, and you will see standards and expectations change real quick.

I dunno, man. The only place I can speak authoritatively about is Texas. In Texas -- and in most of the U.S., for that matter -- the problems are almost all in the big cities where it's run by firemonkeys. Yes, there are scattered smalll, small towns that still get by with sub-par EMS, but not many, comparatively. I've worked rural county services for a great deal of my career. Some counties where the biggest town is only a few thousand in population. None of them ran vollies. They have almost all been running full-time, paid, paramedic level EMS since the mid 1970s. Dr. Bledsoe (when he was just a medic) was instrumental in instituting this all over North Texas. Volunteer ambulance corps are almost non-existent in Texas. BLS EMS is also almost non-existent in Texas. Except for a few areas of the desert out west, and in the deserted border area, full-time, paid, paramedic level EMS has been the standard for over twenty years. And here's the kicker; Texas has no state taxes. How is it that we can pull this off without state taxes, yet NJ cannot with HUGE state taxes?

I agree with that. And there were certainly some valuable lessons in there. My point is, if you are going to teach them only one lesson, that lesson should be that they will always be students, not that they are done learning. I think he missed the boat on that point.

I love what is being said here. These are great, simple ways to explain to students what it takes to transition from school to street. How to make this transition is something that isn't usually covered in paramedic school. They just kind of expect you to do it, which doesn't always work. I have to say, though, that I am a bit uncomfortable with this being applied to paramedic students, for whom it was not originally intended. I think there are a great many students who will interpret this to mean that, once they are thinking like a medic, that they are no longer students. That is dangerous thinking. The best medics are those who never stop being students. Too many medics I see today slip into a deep stagnation once they finish schooll. The points made above are great, but I think they would work better if presented in a different context that is a little more relevant to paramedic students. Unfortunately, they just think a lot differently than medical students.

Ooops! I missed the whole bilateral thing. :oops: But it wasn't mentioned in the original post. :x I'm going with PID. 8)

True! I should have said, Billy Jack was the Walker, Texas Ranger of the seventies. Tom Laughlin was no Chuck Norris!

Had to be later than that. I was in high school, so more like '72 or so. Billy Jack was the Chuck Norris of the 70's.

Yeah, you can still occasionally find centres that run an old skool ACLS class, with lots of instruction and educational content. They are the exception to the rule these days, though. I dunno your situation, nr, but if you are already extremely well versed in cardiology and pharmacology, and are comfortable running a cardiac code in your sleep, then just study the protocols and take the first class you can find. If any of that is not second nature to you, then make a lot of phone calls and try to find a class that is in depth, and not just a wham-bam card vendorl. Large teaching hospitals are usually your best bet for these. Good luck!

There's a lot of that going around! But yeah... seasonal allergies wipe me out a couple of days every fall, usually. Sometimes spring too. I have to take a day or two off because I simply can't function. Patients don't want you touching them when your eyes are all swollen, your nose is running, and you're sneezing every few seconds. And if you take something for it, you end up zombified, which is even worse. That's just how it is in Texas. You didn't mention anything about seasonal allergies, so you might not do too bad. You shouldn't be spending just a whole lot of time in any given house anyhow. Even if it causes a flare up, it should be self limiting since you are removing yourself from the irritant atmosphere. A hit of non-sedating antihistamine like fexofenadine should be sufficient to overcome the mild symptoms you describe. I can tell you that your allergies would get much relief here in Iraq. Come on over!

Basically. Have you not read the first page of this thread? It explains it all pretty thoroughly.