Dustdevil

I don't mind the honesty of 46Young's statement that it is "us or them" about the jobs. I can respect that. That's the world we live in. What I don't like (among the many things I dislike about this) is when dishonest arguments are made to push that agenda, and when the firemen pretend to hold some moral high ground of altruism over the privates. At least when it is a third service agency they are competing with, they lose the ability to float that stinker.

Especially since Morphine and Fentanyl are cheaper, more beneficial and less risky. Most prudent practitioners will still maintain that it should not be given at all without already having an IV and a 12 lead completed. The first time you actually cause someone to go into cardiogenic shock by carelessly administering NTG, you'll remember that mistake for the rest of your career... assuming you still have a career.

Well, I definitely do not believe it is easy or cheap. But I absolutely believe that it is not complicated, and it is simply the price of doing business. How many snow-plowers could they have contracted for the more than million dollars this death is going to cost the city?

Actually, in the video clip, he flat out says that he believes his department will provide "better service". The video is actually pretty funny. At the council meeting, all the Medic West guys showed up en masse in red t-shirts, which looked really stupid and un-professional. But the funny thing is, all the firemonkeys showed up in yellow t-shirts. I bet they were pissed that Medic West got the red shirts before they could.

FD wants to take over EMS to save their jobs. What a shock. And out of the other side of their mouths, they're always telling us it's all about the patients, and that the privates are only doing it for the money. Hypocritical bastards. http://www.ems1.com/...s-to-save-jobs/ Good vid at the above link, so check it out. Interesting, the fire chief says they're "not interested" in taking over all EMS, only the most serious patients. Sound familiar? In other words, they're not interested in actually having to work for a living. They just want to skim the money and glory off of the top. Yeah... that's in the public interest. Below space reserved for 46Young's rebuttal.

"Us"? Ahem.... !

ROFL!

I think one problem may be that too many of today's instructors never took the CBT, since it is a relatively new thing. It sounds like things really haven't changed much though, from the written exam days. Having already been a paramedic for thirty years, I took the NREMT-B written in 2005 and walked away honestly wondering if I had passed or not. The questions were that confusing. Although, I have to say that basic questions are a lot more confusing for an ALS practitioner than for someone straight out of EMT school. As for your friend, I have to honestly say that this simply may not be her bag. No matter how interested she seems, or how intelligent she is, some people simply don't have the aptitude for certain subjects. I'm a good medic, but I can't boil water, much less cook. Whether or not I can sing is a matter of heated public debate, but I digress. If she is bound and determined to do this for whatever reason, then I have but one piece of advice for her; She needs to LEARN THE MATERIAL, and not learn the test. Flash cards and review question books are shyte. They are marginally useful as adjuncts to gauge your knowledge. However, they are absolutely useless as test prep material, especially if you have already failed once or more. In fact, they are probably hurting her. She needs to read, read, read, and re-read the book until it is not just memorised, but UNDERSTOOD. She should be immediately reciting the answers to questions, not because she has them memorised, but because she UNDERSTANDS the answers. When a student doesn't actually understand the concepts concretely within their brain, either their instruction sucks (entirely possible, but this is her second school), or else she simply does not have the aptitude for this particular field. There comes a point where one must be honest with themselves about their limitations.

She went to Humber for PCP and Niagara for ACP. I haven't talked to her in awhile though.

Good point, Phil. I went to school Upstate, and I know that 95 percent of the pick-up trucks on the road there have mounts on the front for snow plows. It's not difficult to do. How hard can it be to get hold of one of these guys and get him to where you need him within 30 hours? Why not work this out ahead of time? You have at least 6 months out of the year to do so. If you're going to provide services in a region prone to this snow crap, it seems negligently short-sighted to do nothing to prepare for it.

God, how wonderfully refreshing it is to see an EMT pursuing a deeper, intelligent understanding of complex issues! Plus 10 on this thread.

On the original topic, if you run many cardiac emergencies, it doesn't take you long to realise that a pretty significant portion of acute cardiac patients are mildly, but noticeably hypoglycaemic. And if you're well educated in physiology, it's not any big surprise when you realise it. I agree with Crotch to a degree. You cannot just go blindly "treating" signs and symptoms without any intelligent regard for the total clinical picture. That is an extremely valid and important concept in medicine. However, in order to make that intelligent decision, you do first need all the facts, which means getting all those tests and exams done before jumping in feet first with potentially contraindicated interventions, i.e. D50. It does appear, from the story presented here, that the crew did make an uneducated mistake by jumping at the chance to pop the top on another drug vial without any clinical indication, and without sufficient knowledge of the potential consequences. Education FTW. If your agency doesn't make a major learning issue out of this incident, your agency sucks.

Although I have used diphenhydramine as an antiemetic in a pinch, I have never worked any EMS system that had this written in protocol. We've always either had Phenergan and/or Vistaril as an option. I would be surprised if the system you are referring to, who does not use Zofran, did not have Phenergan, especially if they use morphine.

I am not sure I believe that neither The City of Pittsburgh, nor any of it's neighbours, has any snow plows, and that one could not have gotten through in less than 30 hours. I see no way to excuse this failure.

Agreed. It has just taken a very long time for some of the manufacturers to catch on to that concept. You gotta figure that the tech-heads that design these things are about as clueless as all the software eggheads who design software, with unreadable help manuals, that it takes an IT engineer to figure out. Lifepak was the absolute worst of them all for a very long time, preferring to focus on the first responder market. Yet they still had the top-selling public access AEDs, simply because all the ignorant firemonkeys advised the public to buy the same brand they bought. It took Philips taking a big bite out of their market share for Physio to finally wake up. I was a little surprised to see several AEDs in Japan (where they are everywhere) that I had never even seen before, and had never heard of the manufacturers. But luckily, it seems that Philips does good business there too. I'd sure like to have heard the Japanese voice prompts just for fun!

Absolutely do NOT waste your time with a paramedic degree. Your employment options will be so severely limited as to be practically non-existent. The only non-driving medics I have ever seen were already employed before they lost their driving privileges and put on punitive non-driving status. It is not an exception that anyone is likely to make for a new-hire. ER work is a possibility, but the positions are often hard to come by. They are popular among students who cannot work 24 hour ambulance shifts, so they stay pretty full. If you can get an ER tech job as an EMT while attending nursing school, that would be the perfect plan though. Your idea of the excitement factor in EMS is seriously off. The only excitement that exists in EMS that doesn't exist in the ER is the driving factor. But there is a LOT more hardcore, lifesaving medicine going on in the ER than on any ambulance. If it is the intellectual challenge of medicine that excites you, then be a nurse. If it's the excitement of lights and sirens and badges that excite you, then be a volunteer fireman. It's not as exciting in real life as it looks on TV. And whatever excitement it does provide you very quickly fades, so don't go away feeling like you've lost out on anything. I was forced to give up EMS one time because of serious on-job injuries. Told I'd never be able to return, I went to nursing school. That broken neck was the best thing that ever happened to me, because it forced me to get off my arse and do what I should have done twenty-five years earlier, which was to get a real education, a real job, and start practising real medicine. You too should take your physical disability as a very positive thing, especially since you recognise it before wasting twenty-five years in a go-nowhere, low-paying grunt job like EMS.

Or else he simply didn't take enough of them. Either way, FAIL! Good luck, Bro! Hope it works out!

Screw sabbaticals. They don't work. Take drugs. They work.

Damn, where is HammerPCP when we need her? She graduated from both of those college programmes.

Retreating is not the same as giving up. The rescuers in Washington didn't just say "fuck it" and go home to forget about him.

Well, the list of those whose heads should roll over this debacle is long but distinguished. I'd put Dr. Jeff Clawson at the top of that list and work my way down.

Agreed. But FFS, we're nearly 40 years into this ALS thing now. WTF is anyone still thinking that an EKG is "special training" that only special paramedics get? Yes, I know it is true, but damn! Why?

They got off way too easy. But then again, most do. But lord help you if you miss a year of tax returns or tear a tag off of your mattress.

And I've seen it work wonderfully without fire too. So then, why should we rob Peter to pay Paul, when Peter can do the job all by himself? Fire based ALS first response "works" alright. It works to take resources away from the problem it is supposed to be fixing. It works to take money away from the problem it is supposed to be fixing. And it works to justify your existence, which is the biggest factor for you. If your theory is so sound, why don't we take resources from the fire department to fix the shortage of cops on the street? How about fire-based first response to violent crime? Of course, you may be there awhile by yourself, unarmed, because we had to put off hiring more police officers to pay you to do first response, but hey, "it works", right? There is only one intervention we have that is soundly proven to make a difference to our patients mortality and morbidity, and that is transportation. First responders don't provide transportation. And the more money we spend on them, the less we can spend on transportation, which is contrary to the interest of our patients, even though it is in the interest of the IAFF. Give your idiocy a rest. You're a smart guy, but you're a myopic broken record too. As for the incident at issue in this thread, I'll repeat what I said on another forum: While I certainly agree that the news media is often far from accurate in their reporting, it does appear that city officials confirm the news version of the story in this case. Access problems can definitely cause extreme delays. But I have a hard time understanding how they simply cancelled the response over it. I'm betting that if the victim had reported to have been shot, or the house was on fire, they would have found a way to get there, access problems be damned. I am not a big supporter of the FD "first responder" concept, after all these years. It often creates more problems than it solves, as well as perpetuating the problem it was established to address in the first place. However, if a fire truck could make it to that residence where an ambulance could not, then that step definitely should have been taken. This is just like if someone has fallen off a cliff, or is trapped in a confined space. We don't just cavalierly blow it off and say, "sorry, we can't get to it." We adapt, improvise, and use our heads to come up with solutions. I really just don't see any way of explaining this one away. It appears to be a serious failure on the part of the system on many levels.

And what a fine job of it they did!