Dustdevil

Invalid analogy. Separate fields. Separate professions. Apples to oranges. Stagnating within your own field is not the same thing as progressing in your own field and not moving to another. A more valid analogy would be to ask if every medic who doesn't progress to a college education and advanced certifications is an idiot. And my answer to that would be yes. It is also invalid to hold yourself as a common example, because clearly you are not common. Just like one bad EMT doesn't make them all bad, one exceptional EMT doesn't make them all good either.

Callthemedic's point was about the only thing I could fathom even being remotely relevant as I was pondering the physiology in my head. Oxygen is a vasoconstrictor, even without hyperventilation. However, that is hardly relevant in this context at all. There is no interactive relationship that I am aware of between oxygen and anticoagulants. And vasoconstriction is exactly what we use to treat and prevent epistaxis, so that's not a problem. Maybe the medic was simply using her cookbook brain to classify the nose wound as a "head injury?" :? If so, she was certainly ignoring the patient's key issues to focus on a red herring, totally disregarding the patient's obvious perfusion and oxygenation deficit. Looking for zebras in a horse stable. But even then, wtf does that have to do with the anticoagulants? Sounds to me like she's an idiot who just put 2 plus 2 together and came up with 7. :roll: I agree with Asys. Go to the ER doc and push the issue. Have her arse written up, and hopefully decertified, both for her ignorance and her unprofessional behaviour. I can almost guarantee you that she is badmouthing you and hurting your chances to ever get moved up to EMS. Politics are a bitch. And, of course, if she happens to be the supervisor's girlfriend or management's golden child, then you're just screwed no matter what you do.

Plus 5 to both of the last two posts. :thumbright: You're absolutely right, nsmedic393. I am not taking anybody's knowledge and skills for granted just because they have a card in their wallet. That's sheer idiocy. Not only are there a tonne of horrible providers out there at all levels, but there are also some out there who never even finished school that have faked credentials! If you ASSume that every stuffed shirt they stick on an ambo with you knows what he or she is doing, you're a fool, and you deserve the trouble you are going to get for it. While EVERY partner I get receives the benefit of the doubt and a friendly welcome, they are still going to have to prove to me that they know wtf they are doing before I put my arse on the line for them. That's just common sense.

As long as he repeals the gun registration and legalises polygamy, I'll vote for him!

Then why is it you are concerned about having a third-party "witness" only with suicidal females instead of all patients?

There ya go! Supply and demand in its purest form. And I have no sympathy for all those guys in that big city. They should have done their homework before they wasted their money on EMT school.

That's interesting, but not totally surprising. I suppose all those Asian physicians who come to Canada and can't get licensed would like a chance to do something with their training instead of driving cabs and running motels. :?

Start with the CAPS LOCK button. But, other than that, nice rant. :wink:

Sweet! Glad to hear that somebody took the image thing half way seriously! That's a good sign! :thumbright:

Yet still dressed exactly like police or fire, I bet. Chances are that nine out of ten people watching didn't have any idea who you were.

LMAO!! O ye of little faith!

Maybe it means you want a puppy? :wink:

And you didn't seek out the answers yourself? No offence intended, but your supervisor isn't the person you should be relying on for your continuing education. YOU are the person responsible for YOUR education. It isn't going to come to you. Like a job, you have to go looking for it. And if you are actually interested in being a medical professional, you are expected to go looking for it. The new guidelines have been posted here a few times in the last year, as well as every other EMS resource I keep up with. Agencies and employers have known about it for a year now, so it filtered down to full-time professionals long ago. And those who take a pro-active approach to their education are already up to date on this issue. I am not even employed in EMS and I managed to get word if it nearly a year ago, so it is disappointing that anybody active in the field would still be totally in the dark. Regardless, I think the reasonable and prudent medic with a question about CPR guidlines would go to the source for answers. It just stands to reason if AHA is making a major change in standards, they probably have it announced on their site, right? So, the path to enlightenment might go something like this: 1. Go to www.google.com and type in "american heart association." Click "search." 2. Click on very first link that comes up, which happens to be www.americanheart.org/ 3. Look at menu and find "CPR & ECC" to be the fifth link down. Running your mouse over it you see a sub-link that says "2005 Guidelines" and click on it. 4. The resulting page gives you the options of reading the full text of guidelines, or just a summary of significant changes, or even watching an online video explanation. 5. The very first changes discussed in the summary, including rationale, are the compression rate and ratio changes and is less than five minutes of reading. Viola'! Now, in five short minutes, you are better informed, and probably smarter, than your supervisor and everybody else in your agency. And you really won't find a better, clearer, more to-the-point summary of the changes and their rationale than at the AHA site. Did your supervisor seriously just come around and tell everybody to change their compression:ventilation ratio and leave without any explanation, literature, or schedule of retraining? Did you ask him for an explanation? If so, did he really not know? I think if any of the above situations apply, your employer sucks and I would leave immediately.

In Dallas and Fort Worth, the official policies were much like NY, I guess. On the books, and according to state case law precedent, it says we had to run both or neither. In practise, everybody uses discretion. Some use way too much discretion. Some don't use enough. But they all use discretion. And nobody gets disciplined unless they get in a wreck, then management gets all indignant and pretends they didn't know what not everybody kept their siren on during the entire response. :roll: Really, the issue is not judicious use of lights and sirens. The issue is how you are driving. It is my belief that "code 3" driving usually doesn't mean driving any different than anybody else. If you are speeding, cruising through stop signs, making wide turns or running down the wrong lane, then you need to have everything going. But if you are cruising down a straight away with the flow of traffic and not forced to disregard any traffic laws, then yeah... I can do without all that noise. Especially since it has been well established time and time again that it makes no statistical difference in response times. Also, it took me many years to grow up and figure it out, but earplugs are wonderful little items! They hang around my neck all shift long, and I wear them on all hot runs. Any employer who does not provide you with hearing protection is either stupid or simply doesn't care about their disposable EMT's since they never stick around long enough to get hearing damage anyhow.

Olympus cameras are crap anyhow. I already wouldn't buy one, so I don't guess I could boycott them.

That's actually a very good point, DC. Communications is a two way street, and it only works if both parties are capable of listening and comprehending at least as well as they speak. It is crucial to the success of a partnership. And that is exactly why the better paramedic programs require a course in college Speech and Communications. I am very patient and communicative with my partner. In fact, as you might imagine, most of them want me to STFU. But the situations I was speaking about were not simple questions or discussions about treatment options. They were flat out insubordination. They were undereducated EMT's who got mouthy and either interrupted my plan for a loud debate, refused to follow orders, or even physically interfered with my treatment because they thought their month of night school taught them everything they needed to know about emergency medicine. Explaining things to them doesn't work, no matter how hard you try. Their school and their instructor and their education is the "best in the state," so if I'm doing something that they didn't learn in school, then I must be the one who is incompetent. :roll: I am a medic with a lot of patience and understanding for my partners and students. It is my goal to ensure their success, not to weed them out. I bend over backwards to help them in any way possible. But quite frankly, some people are beyond help. If you just aren't getting a grasp on medical concepts, I'll do all I can to help you. But if you have a bad attitude, I don't give a rats arse how well you did on NR or how much experience you got as a junior member of the volly squad in Hooterville when you were in high school, you're useless to me and to my patients, and I will not waste my time or sanity trying to help you change that.

Good job! The only part that I have a dissenting viewpoint on is this statement: In my experience -- which certainly can vary greatly nationwide -- the Paragod usually refuses to work the patient unless he deems them serious enough to be worth his time. He wants to drive all the time. Especially if he can play with the lights and sirens, as they are an extension of his manhood. That means the EMT or junior medic is made to attend on all non-critical patients and is allowed to drive only when the Paragod finds a patient so critical (or hott) that he thinks they are worthy of his attention. In fact, what I have seen most of them do is drive to the scene, jump out and do the full history and assessment on the patient, then shove their EMT into the back with the patient while they drive to the hospital. Meanwhile, the EMT is stuck caring for and documenting a patient they never even evaluated. That is my experience with a Paragod. Most of them prefer to work with EMT's instead of other medics because other medics are a threat to their superiority and can't be bossed around or bullshitted as easily. It is extremely uncommon for a Paragod to prefer working with other paramedics, although a lot of them still mouth off about how they hate EMT's.

Wouldn't we all! And that is really the only key advantage to an FD administrated system. If anybody knows how to run a bureaucracy, it's the fire service. Just about every big FD looks wonderful on paper, with assistant chiefs paid to sit around and write policies and procedures, and publish statistics and mission statements, and all the other fluffy paperwork that impresses the academics. But you're right. If we could combine the best of both worlds, it would be great for the profession. However, I maintain that, aside from geography and taxes, there is nothing inherently superior about HFD that does not or could not be applied to any other service. And, as Rid says, the numbers would have to be vetted to determine a true cause and effect relationship before I could climb on board with HFD being excellent on any level. And even then, I don't think it would be impressive to international visitors that HFD's ambulances happen to all be within 10 minutes of a trauma centre. That's hardly clinical sophistication.

Yep. It's because the fire chiefs won't let us make it any longer.

I can't say that this is something I have specifically looked into before, but I would venture a guess that one of the key reasons that stethoscopes have two earpieces is because it doubles the chances that you will be able to hear. If we all had two good ears, we'd only need one earpiece on a stethoscope. If one ear works just fine, then you should not need anything special. Of course, you will only know this by practising with a teaching scope so you'll know if your readings are falling in line with the norm of your instructors and others. If so, then I certainly wouldn't waste any money on an amplified scope. Again, you only need one ear to take a BP. When I had an ear infection, I only used one earpiece and it worked just fine. The only thing amplified scopes are really good for is heart and lung sounds, and a normal scope will do a fine job on most of them too. For use in taking blood pressures, which is the vast majority of what an EMT uses her scope for, I think there is an issue of using electronic scopes because they may give you significantly different readings from an unamplified scope. If you can avoid using an electronic scope, I would.

Litigation-wise, you are correct. But operationally, I believe you are off the mark. Look at your own example in the broken monitor cables thread. You, like many, were looking for one person to punish and place all blame on. And, unfortunately, that is a pervasive mentality in EMS where "supervisors" are usually nothing more than the medic who has stayed around the longest, and have no formal education in supervisory or management practise. Management philosophy commonly focuses on making a public example out of some poor sap in order to intimidate the others, but specifically NOT placing blame on all who hold responsibility because replacing one suspended medic is easier than replacing five of them. Consequently, true remedial discipline is disregarded for managerial expediency. So yeah, Asys is spot on, as usual.

We're definitely on the same page. I agree with you on all points. My core point is that the best system to showcase American EMS would be a system (and community) that emphasises both quality and quantity in their education without regards for how fast they can get their firemen out of school and on the streets, as well as being staffed by people who actually chose EMS as a profession, and not just those who "ride the box" to pay their dues as a rookie fireman. The most extensive protocols, drug list and skill set on earth isn't going to impress our international EMS friends if those in the field have a condensed 800 hour "education," can't talk intelligently about pharmacology or physiology, and don't even want to be on the ambulance in the first place.

Of course, there are other issues to sleep time besides pay. The biggest question is, do you even get any sleep time? A lot of agencies for some bizarre reason have policies prohibiting sleep during the day hours. WTF? You have to catch sleep in this business when you can, because there will be many nights when you simply can't do it at night. Emergencies aren't scheduled. The employer may look at the run log and think, "they only made two runs last night, so they should have been able to get plenty of sleep!" but that doesn't tell the whole story. Usually those two runs were perfectly spaced out to allow you a grand total of maybe 3 or 4 hours sleep that night. Then the a-holes who relieve you the next morning come into the station at 0600 making as much noise as humanly possible with total disregard for your need to sleep. 24 hour shifts for EMS providers should simply be illegal in any high-volume (per unit) system. They contribute greatly to the burnout rate in this business, as well as promoting an atmosphere that is unsafe to both the patients and the crews. 24's are a retarded leftover from the FD roots that should have gone the way of MAST pants a long time ago.