Dustdevil

Exactly what I was saying. Good job. :thumbright:

Yes, I am more than a little confused on that point too. Is that indeed your protocol, or did we misunderstand you? That is simply asinine. Significant and progressive hypoglycemia can present in a multitude of ways that would not affect the GCS. Why would we wait until their brain starts malfunctioning before identifying their problem?

Probably because he takes his vows and responsibility to his family seriously and holds them in a regard well above his so-called "dreams" to be a professional fisherman. Too bad the wife doesn't take her vows and responsibilities as seriously. Word. =D>

Yes, apparently there are people building ambulances who are unprofessional and do not pay attention to details. I bet they are horrible spellers with poor grammar too! It's a good thing they aren't EMT's! :wink:

Point 1: Minimally qualified professional firefighter = 12 weeks full time training. Minimally qualified professional paramedic = 2 years full time education. Percentage of calls for fire service = 10 percent Percentage of calls for emergency medical service = 90 percent Of course, those first numbers are for a PROFESSIONAL agency, not a volunteer agency, but the point remains the same. This is really and truly an absolute no brainer. Anybody who cannot look at the numbers and clearly understand where the priorities should logically lay is either blind or stupid. They are completely separate professions with absolutely no professional similarities beyond lights and sirens. The only logical argument that can even be remotely made for combination is that of budgetary concern, and even those are dubious. However, if your budgetary concerns are so absolutely overwhelming that you are willing to sacrifice quality to satisfy them, then I suppose you must do what you must do. But at least use your brain and work to assure that your professional priorities are coincidental with reality.

Anything that is not clearly, obviously, and absolutely diagnosed by my exam will get a blood glucose level (BGL) determination. Almost all medical patients will receive a BGL. A fair number of trauma patients will also get a BGL's. Broken leg from motorcycle crash = no BGL. Broken leg from a fall of undetermined cause = BGL. In the first situation you gave, while the symptoms point to some specific diagnostic possibilities, it does not clearly and positively point to any one specific condition. Consequently, they would receive a BGL. The second situation you gave is a given. Any altered mental status or weakness or diminished coordination abilities gets a BGL. A history of diabetes might prompt me to do a BGL on a patient with isolated illness or injury that I might not otherwise check. However, a lack of diabetic history would never discourage me from checking BGL on any patient with possibly associated symptoms or conditions.

I love this topic! Best topic ever! "You might be a wanker if..." runs a very close second.

Meh... that assumes that we actually save lives on a regular basis. Statistics say this may not even be true. Most of those who die would have done so even with our intervention. And most of those who live would have done so even without our intervention. So really, I have serious doubts as to whether there would be much "sacrifice" at all in the interim. But of course, I agree with everything you're saying. Just supporting your theory.

Thank you, Sir. I know it is easy to jump to the conclusion that I am merely trying to belittle EMT's, or to claim they should not be practising at this level, but that is not my intention at all. All I am trying to do is make EMT's understand that, regardless of their certification level, they ARE practising Advanced Life Support, and to give that practise the respect and consideration it deserves. There is a real danger in the attitude that the ALS skills they are given are "just basic stuff." It results in what we commonly see here, which is people giving drugs with next to NO understanding of the pharmacology and physiology involved. If we can make those basics respect the level of care they are giving, it will go a long way towards making their practise safer and more professional. If you want to truly be a professional, that is crucial.

Wow, excellent point, Phil! Something that has been seriously overlooked in previous discussion.

And it would NOT be the NAEMT and one of their grey haired old men in their goofy arse "class A" uniform that looks like it was stolen from Idi Amin. And it would not be Joe Fire Chief in his gold badge and bell hat either. But likewise, it would not be Mr. Slick with his MBA and pin-striped three-piece suit looking and smiling like a funeral director either. The key to success would be to establish our own unique new identity that isn't mistaken for any of the above, and proceed to promote that image publicly. But, therein lies the conundrum. The debate over whether or not we are medical professionals or public safety labourers is still raging out of control and cripples any efforts to rehab our image. Too many people in positions of responsibility in EMS are too interested in perpetuating the status quo. They want to keep doing things the way they've always done them while still hoping for different results. Or worse yet, they don't even realise that the system is broken to begin with. Consequently, we are a very long way from a clear consensus on what our image even is, much less how to effectively present it to the public. Just look at that ridiculous PR film that PA made last year. That's what you happen when you hire a PR firm to promote an image they don't even have the slightest understanding of. I rest my case. Another disgusting, fatalistic display of negativity, without any answers or positive suggestion, brought to you courtesy of The Dustdevil.

They need those local people and are quite happy to hire them when possible. I have yet to see an instance of AMR coming in and cleaning house of all the locals. Bad business all the way around. On the other hand, AMR quite commonly has higher standards than the existing provider. Consequently, not all of them can be hired. Nor should they be expected to hire every 300 pound basic EMT who can't pass an agility test or exam over medical knowledge. They'd be retarded to do so, and the local government would be retarded to stipulate it. If they wanted more of the same old sub-standard crap they are currently unhappy with, they wouldn't bring in AMR in the first place.

Exactly, Cosgro. Still not a single bit of evidence or information indicating they will do, or even have the potential to do, anything more than their predecessor. This looks more like a case of "throw the bums out" than any intelligent campaign of improvement. In fact, everything laid out above looks like the same old things every union does for the sake of appearances, or simply to perpetuate their own existence. Typical politics. The whole discussion of professionalism is a joke and a red herring. I know of no instance anywhere in US history where a union has transformed any job into a profession. How much you make and how good your benefits are have zero bearing on your status as a "professional." The guys who sit in a glass booth and sell subway tokens have a great union, and they probably make more than twice what you do too. So does that make them "professionals"? Give me a break. YOU decide whether or not YOU are a professional or not. Nobody else. And WE as a group of individuals will determine the future of this job, and whether or not it ever becomes a "profession" by our own actions and by encouraging lawmakers and educators to improve our standards. That is nothing that any union can or even would consider doing. Never have. Never will. Their sole purpose is to have an adversarial relationship with "the man," which only perpetuates our non-professional status. If you want to whine and moan and stomp your feet about the raw deal you're getting from AMR because YOU made a poor career choice and now can't afford to drive a new pickup truck like all the firemen or take your family to Disneyland every year, more power to you. I have no problem with that. It's every man for himself. But at least be honest about it. Any claim that you're trying to transform our profession is utter bollocks.

If you want to know what this job is really like, the first step is to NOT watch television. There is not now, nor has there ever been a television show that honestly or accurately illustrates the EMS profession in this country. Not even the so-called "reality" shows like "Paramedics". They're all crap. To this date, the truest illustration of the reality of EMS in this country remains "Mother, Juggs & Speed." Buy it. If the job you see in that movie is not what you are expecting, then take heed. That IS how it still is today, thirty years later. Yep, it's getting a little better, slowly but surely, in some places. But we still have a very long way to go. And unless you want to be part of that improvement process, stay out. And, as always, anybody who disagrees with me is wrong, so don't listen to them. :wink:

THis situation clearly illustrates the validity of two of my favourite pet theories: 1. Electronic PCR's are crap. All this filling in of blanks with drop down lists of canned diagnoses and interventions is watering down our documentation to a point where some medics aren't even allowed to document thoroughly. And those that have the option of narrative documentation are very quickly beginning to skip it simply because the ePCR tells them once they've filled in all the blanks, they are done. 2. I would rather have cops doubling as medics than firemen. Firemen are unsophisticated manual labourers who are trained to get their hands dirty on a menial task and go back to their recliner chair. Cops are educated to be very details oriented, understand and work with PEOPLE, and to over-document the hell out of everything, leaving no detail unmentioned. I learned NOTHING in the fire academy that contributed to my professionalism as an EMS provider. Almost EVERYTHING I learned in the police academy contributed positively to my EMS career. Oh, and people in Illinois have really weird names too. Is everybody there Russian, or what? :?

You must live in a smaller town or city. Sadly, it is the norm in any large FD system I have ever had any exposure to in any state.

wow... are you sure it wasn't a chiropractor? :?

LMAO! Korsakoff sounds are frequently heard in nursing homes. They are not easily confused with Korotkoff's sounds, but I suppose a rookie could make that mistake. Especially if you're a rookie using one of them $150 dollar Littmann Cardiology III stethoscopes.

I would have sure hoped so. Anybody who assumes an EMT patch -- especially on a new graduate -- actually means anything is a retard. Good for them. I wouldn't work for any organization that was so naive as to believe I knew what I was doing without testing me first. Good luck, man. Should be fun!

Amazing how you could take some much time and thought to put that all into type, and yet not give a single example of how this new union would be any better. Simply proving the old one sucked doesn't quite fit the bill.

Here's some dispatcher idiocy that drives me crazy: "Stage prior to arrival." (Don't tell me how to run my call from your air conditioned office in the basement of city hall!) "Your scene is secure." (Yeah, like you have the slightest clue what is going on at my scene from your air conditioned office in the basement of city hall!) "Medic 28 disregard. Medic 31 is closer." (No dumbass, their district is closer, but their unit is actually five miles farther away than mine!) "The computer system is down." (So what, you idiot! Did you forget how to use a map?)

I'm curious if it is a fair comparison. What is the cost of living in Oregon as compared to Southern California? All things considered, you may be much closer to them than you think.

Along those same lines, it is possible that the patient's initial presentation may have been so obvious to the medic that he already had priorities established for that particular patient and they did not coincide with a normal routine assessment, which is understandable in some cases. Perhaps the medic felt the condition of the patient was so obviously demanding of more direct intervention that the standard introduction and vital signs route was simply inappropriate and should have been more focused on the obvious problem. As an extreme example, it was as if you were attempting to SAMPLE a patient in cardiac arrest. Of course, the problem with that is, you simply cannot expect an EMT to be thinking and assessing patients on the same level as a paramedic. Chastising them for not having a paramedic level education and understanding of medicine is just stupid, so I am definitely not defending this medic's actions. I am just trying to explain why it might have occurred. The whole scenario confuses me anyhow. Was the medic on a different apparatus than you, or was he a member of your crew? Why is he coming in 30 seconds behind you? And was it really 30 seconds, or is it possible that it only seemed like 30 seconds to you and you had actually been there 3 to 5 full minutes ahead of the medic and lost track of time? Just really too many unanswered questions to fully appreciate the true scenario here. But yeah, if things are exactly as you say, then you were probably doing just fine. And regardless of whether you were right or not, the medic apparently needs a serious attitude adjustment.

Hehehehe... you said long and hard.

Absolutely. Unfortunately, it is a dangerous practice in the world of poorly educated paramedics who don't think they need all this "book learnin'" They translate the above comment into meaning everybody with an itch should get Epi, Benadryl, and SoluMedrol like it is some sort of allergy cocktail. They don't take the time or mental effort needed to determine who is having the "big episode" and who is just breaking out in a rash. Consequently, many people end up getting Benadryl inappropriately. Another reason why you have to make independent clinical decisions about your patient and not just treat symptoms by cookbook protocols.