Dustdevil

Exactly. Those factors you mentioned are not negatives in American EMS. They are positives! Why would management want to retain staff long term? The longer somebody works for you, the more likely it is you will have to give them a raise. God forbid that somebody might actually stay long enough to earn retirement benefits. Now THERE is a cost for you! So, it is much preferable to pay low wages and treat them like $hit so they don't stay very long. And, as long as we keep the educational standards down to 120 hours of 6th grade level first aid training, there will never be a shortage of replacement suckers. The two largest private providers in the U.S. have both been around for nearly 30 years, yet I have never heard of anybody working for either of them long enough to retire. There it is.

I think Mike pretty well covered this. Taxi drivers and 7-11 clerks have a more dangerous job than EMTs, unless you're doing something seriously wrong. Again, Mike covered this well. So long as you don't drive like a maniac or drop somebody, you don't have anybody's life in your hands anymore than a 16 year old lifeguard at the YMCA. Don't get too full of yourself. Dang! How many times did you take the course? You must have failed once or twice for it to take a year. So go ahead and brag to us. Just how many contact hours was your EMT course? I've known a few quality EMT courses to take upwards of 250 hours, but those are the very rare exception. And even that calculates to two hours a month to come to one year in length. Obviously, you did something, VERY, VERY wrong for the last year. You need some serious career guidance, not just back-slapping congratulations from the EMT cheerleaders. If you decide to stick with this attitude of yours, rather than listen to the advice from elders that you supposedly came here looking for, then I predict complete failure and disappointment for you in short order. If you're smart, you'll realise that the comments you didn't like were the most positive comments you received.

This is the kind of thing that Cosgrojo was talking about when he talked about "pigeon holing" yourself. Step back and take in the big picture. It seems like you are getting tunnel-visioned on "the" one fire department you are bent on working for, when it sounds like that department sucks. It's cheap and lazy and let's wankers do the job for free so they don't have to hire more professionals. That isn't the only fire department on earth. As Mike mentioned, most professional departments (Floridia notwithstanding, for some bizarre reason) don't give a rat's arse about the "fire standards" you volunteered part-time to get. They will send you to THEIR acadamy, no matter what your background is. And they aren't much more likely to hire you with "fire standards" than they are the next guy who just spent four years working in a grocery store. And they're probably LESS likely to hire you than the guy who just spent four years in college. Spread your wings. Nothing wrong with being a fireman. It's a good gig. But take it seriously as a career, not just your next job. Do a thorough job market research. Talk to all the other fire departments in your area and see what their hiring standards are. See what their pay is. See what other benefits they offer. Find out if they are a professional, career minded organisation that you can lock into for a long-term future, or if they are just another "job" site, like the department you seem to be so focused upon. There are enough unhappy people in fire and EMS as it is. Don't be another one. Start off on the right foot.

Do I get to be King of Cape Cod?

That is certainly an oft cited consideration. And at the start-up, it is certainly a valid one. Fifty stations comes to $25 million dollars at least, plus construction time, etc... Then there is maintenence, etc... No stations equals a much faster and cheaper start-up. But, of course, those numbers don't tell the whole story. Now you are running your ambulances almost 24 hours a day without ever turning them off. You're rolling them more miles too. Your vehicle maintenance and replacement costs are skyrocketing, compared to a stationed ambulance system. If nobody has yet (I suspect they have), I would sure like to see a study that gives us ten-year projections on the cost of starting up and running a station-based system versus a SSM system. I'm betting that the $25 million you "saved" by not building stations is a drop in the bucket over what you spent on high mileage vehicle maintenance. The FD is probably working 24 hour shifts, and you probably are not. If not, you don't need no stinking stations. If you wanted a job where you could sit on your arse and sleep all day, you should have become a fireman. Folks, this is just another area where we need to think for ourselves and quit worrying about what the firemonkeys are doing. We are not them, and they are not us. Other than red lights and sirens, there is absolutely no similarity between us and them. And as long as wankers continue to get all hung up on trying to be like them, we will continue to be nothing but second-class labourers with no identity and no respect. It's time to establish what is best for the optimum provision of emergency MEDICAL services and do that.

I'm afraid I have to say you are splitting peach-fuzzy hairs here, Steve. No evidence vs. poor evidence? No or poor evidence of what? Now you have to further break it down to define what concept we are actually debating. Are we debating whether or not there is scientifically determined statistical evidence to suggest that there is a "Golden Hour," which, I believe, would be Dr. Bledsoe's point? Or are we debating whether or not there is any scientifically determined statistical evidence to suggest that there is some kind of optimum window for the delivery of trauma care, which seems to be your point? Two different points. Two different answers.

Nope. You get there and she's vomiting blood and in septic shock, then yes... she goes to the front of the line. If she's not, she gets what this poor woman got, which was a visit by the cops. Again, this isn't at all as complicated as some of y'all want to make it. You DO NOT KNOW what a run is until you get on scene. Period. Make the scene, just like every other caller is entitled to, then go from there. But this BS about call takers making ASSumptions on the telephone is absolutely unacceptable, and has already cost many an agency many millions of dollars. It's time we stop trying to be the farking phone police and start providing the service we are expected to provide. Otherwise, we get this kind of publicity and take another big step back from any small progress we have managed to make with the public. It's pointless and dangerous.

Uh oh... here we go again! :?

I thought this was going to be more Paris Hilton news. :?

And this is something one need consider before taking a job in the first place. Are you taking a job as a practitioner, or as a cookbook monkey? Do your "protocols" tell you, step by step, exactly what to do and how to do it, in response to specific criteria? If so, then I absolutely agree that this is what you better be doing. It's your agency that sucks, not necessarily you as a provider. But anybody with any confidence, pride, and professionalism would never work under such circumstances to begin with. You can bet that this is something I research before I even send a resume. When I left FD work, I left painting by the numbers behind forever, and I don't intend to go back. Yes, it is certainly easier and safer to perform techincal tasks according to a checklist. You don't have to worry about mistakes or having to ever explain your actions. You can just sit back and blame it all on "following orders" like the Nazis did. And hey, if that's what anybody want's to do, you're welcome to it, as there are plenty of places who want you to do just that. But don't kid yourself -- or think you're fooling anybody else -- by calling that a professional medical career. It is not. If you are going to be a practising medical professional, you're going to have to step out on your own and learn to think for yourself to provide the best possible care for your patients. You're going to have to take personal responsibility for the decisions you make and the care you provide, and not leave it up to "the protocols" to think for you. Yep... that is scary and stressful, and one hell of a lot of responsibility. But if you are doing anything less, then you are not a medical professional. DISCLAIMER: The word "you" is not addressed at Anthony or anyone else in particular, and is used in the generic sense.

Hmmm... this is a new concept to me. I have worked a couple of extremely rural systems where there were multiple units at one station. But I have never worked an urban (or even suburban) system -- fire based or stand-alone -- that had more than one unit in a station. That doesn't even make much sense, strategically speaking, except maybe in the centre of a very busy, urban system. :?

How about putting her on your cot and "transporting" her straight past the retarded triage nurse and into a trauma room, where somebody with some medical competence might immediately recognise the critical nature of her symptoms? Doesn't seem that complicated to me. The problem is, if you never make the scene to assess the patient, you have no idea what she needs. At the very least, she needs an assessment. And when somebody calls from a hospital waiting room, do you really know if they have received that assessment yet? No. So go.

Are you into desert camouflage? If so, have I got a deal for you!

Congratulations! =D> Your state actually issues a "licence" to EMT-Bs? Not at all, if you know your stuff. But if all you took away from 120 hours was a few "skills," then yeah... you're in trouble. Did you seriously not consider asking this question before you invested in the class? :shock: I'd be scared about taking any job that I knew nothing about, much less one that is dangerous, stressful, unstable, and barely pays minimum wage. Good luck with that! And don't listen to ITKU2ER. There is no such thing as a "career" as an EMT-B. It's just a job, at best, and only a hobby for most. If you want a career, get into paramedic or nursing school immediately. :wink:

Can you explain a little more about what you are talking about. I can't quite figure it out. Even with a fixed station, it's still just you and your partner, so you're not interacting with any other crews there. You interact with other crews more in a mobile system because you probably all meet at the same point to change shifts. In the systems where you are allowed to freely roam within your district (as opposed to this assigned street-corner nonsense), you can meet up with other crews at your borders. And in a pure SSM system, you are constantly interacting with other crews as you switch shifts, districts, and cover each other's territories. Not to mention that you are sent to more areas of the city than in a fixed system, so you interact with more crews and hospital staffs than you would if you were in the same neighbourhood station every shift. Don't get me wrong. I am not an SSM proponent by any stretch. I'd like to see Jack Stout strung up and slowly tortured. But I have to disagree that SSM isolates you from other crews. In my experience, I was a lot more aquainted with other crews in a big city SSM system than in a big city fixed station system.

Excellent! Congrats on that! :thumbright: We've got enough NS dudes and dudettes here that you should get some great advice. Best of luck on that, Bro. I'm looking forward to hearing you talk us through the process as it develops. This is something that quite a few people will be interested in!

Straight up, dude.... admit it. You just made that word up, didn't you! Hey, when something works for me, I stick with it! And I don't know what you're talking about with this "old" stuff. I'm still in my second adolescence! :wink:

Ooooh! Good catch! I hate it when I pun accidentally. :oops:

Meh... he seems to have had his mind made up before ever posting this topic. Not sure why he wanted opinions. :?

Perhaps you missed this post...

Minus 5 for spelling. It's Bryan, with a Y. Obviously you went to a Mosby book school. :wink:

Yeah, you never know which side the cop is going to approach your car on anymore, so you have to cover all your bases. Besides, that's a lot easier than just driving safely and avoiding getting pulled over in the first place.

I believe you have a good point. But don't forget the cops. They are likely to eat it bigger than the other entities mentioned here. I would not disagree with the good doctor's assessment that this unfortunate lady was probably terminal before the 911 call was ever made, and that timely transport would have made no difference in the ultimate outcome. However, that fact notwithstanding, this case still illustrates a serious flaw in our current thinking that must be addressed before it again causes us such embarrassment, or worse yet, somebody's death. Yes, the current conventional wisdom seems to say that calls for service from within a hospital are to be ignored. But I am inclined to say the conventional wisdom is just straight-up wrong. There really is no valid justification for this policy. We have no way of assessing this patient's needs or situation without making contact with them. Call takers on the other end of a telephone across town simply cannot make an automatic ASSumption that this caller does not require service. This type of call screening has resulted in countless HUGE lawsuits in the past against public safety agencies. And the same principle and precedents will be applied to this case. Attorneys for the plaintiff will easily make the case that the ASSumptions being made by the call-takers were without legal basis, and will also raise equal protection and civil rights issues that will turn the whole case into a very sensitive issue that the government simply cannot fight. And they are right. A citizen is entitled to the very same consideration and service from their tax-supported agencies, no matter where they happen to be laying at the time. It is not the hospital that saves your life. It is the care that is given there that is the destination. This patient was not yet at that destination, and therefore was as entitled as any other citizen to be transported appropriately. This so-called "policy" has to change. And, thanks to this case, it will.

I believe it. Why wouldn't I? :?

Heck, if it'll make a few New York and New Jerseyites go back home, I'll recommend they cut taxes and services in Texas too! About the only places in Texas that taxes are high are where high concentrations of Yankees have moved in anyhow.