Dustdevil

I spent this New Years Eve with a cop buddy of mine and his family. About two minutes after midnight, the first run of the year was dispatched to EMS, and lo and behold, it was a shooting. We were cheering and toasting to what appeared to be an omen for the year!

Where do you write it?

Fixed that for ya. Lisa, you can go many places in the US and become a "paramedic" in three months with nothing more than a GED and an EMT card (and a buttload of money). So no, you do not 'have to' have all those courses to buy a patch. But you said you wanted to be a "damn good" paramedic. To do that, it takes a LOT more education than most shake 'n bake schools will give you or require of you. As a paramedic, you will have much more independent responsibility for human lives than a nurse, who requires a very minimum of two years of education, and usually at least three just for that "two year" degree. Don't you think we need at least that much? Physical Therapists, Medical Technologists, Occupational therapists, Radiology Techs, Speech Therapists, and Social Workers require a minimum of four to six years of education just to begin at the entry level of their professions, and THEY DON'T EVEN PERFORM INVASIVE PROCEDURES ON PEOPLE! To be a paramedic with less than an associates degree level education -- including the same prerequisites as required for an RN -- is criminally negligent. You can go directly to paramedic school and be a paramedic with no experience in two years. Or you can screw around and be an ambulance driver, picking up bad habits and half-baked notions from bad, half-baked partners, and be a crappy EMT with two years of experience in two years. I don't think I have to tell you which one is more likely to get a job, and which one is going to be making more money. And I don't think there is any question about which one you'd want responding to your emergency.

You heard wrong. You certainly didn't hear that here. Does that mean you are already working hard on your college prerequisite courses, like A&P, Chemistry, Microbiology, Psychology, Sociology, Algebra, English Compositon, Speech Communications, etc... ? If not, then you are not yet serious.

Fair enough.

This is really two separate questions: 1. How long until your unit is available for the next run. 2. How long until you actually clear the hospital. It should rarely take any more than fifteen minutes to make your unit available for the next run. It is the driver's job to IMMEDIATELY take the cot back to the ambulance, clean it and the ambulance, replace linen, restock supplies, and notify dispatch that we are available, but still out at the ER pending paperwork. The driver shouldn't be dicking around in the ER, flirting with nurses, gawking at patients, eating and drinking snacks, smoking fags, or just generally being useless until AFTER the unit is ready for the next run. In my experience, the problem is usually that the driver fiddle-farts around forever before returning to the truck to ready it. As for actually returning to the street, it takes as long as it takes. If there is opportunity to do so without neglecting my patient, I will do some basic charting enroute. Mostly, I only get demographic info during the trip, as well as charting vitals and other immediate concerns. The narrative will all be done at the hospital when I can concentrate solely upon it, with all information finally available. That usually takes no more than thirty minutes max, and unless a priority run comes in, will always be completed before leaving the hospital. Of course, if you're using the lame-arse charting system (whether electronic or hardcopy) that is a simple system of box-checking and drop down answers, then this should all be happening in about half the time of a narrative. In that case, the medic should be ready at about the same time as the driver, unless there are unusual complications.

I don't want to jack the direction of the thread, but I certainly agree with this. And I am not against giving basic students advanced concepts and procedures to practise. But the key term in your statement is, "if the EMT is ready". This is, for the most part, an anomaly in US EMS education. Consequently, it's not something I advocate tossing out there casually. But when I get a basic or basic student with a solid medical background (nurse, RT, corpsman, or other allied health professional), or a solid foundation of educational prerequisites (A&P, etc...), who has a good attitude, an intelligent demeanour, and a solid grasp of the basics, I am all for giving them as much education and experience as we can manage in the field. But again, this is just rarely the case here.

FAIL! Welcome to 1985, Lee County.

Awesome info, Seb! Thanks for chiming in. I'm glad to see you are staying with us here. I was worried you would be gone after the TRAUMA talk died down. Chris, very cool find! Baby Timothy should be 44 this year! And nice catch on the hi-vis markings too. Just shows to go you that there are damn few 'new' ideas in EMS. Just a lot of ideas that have been very slow to be embraced.

Wow. Just.... wow. It seems that there are at least three different questions here: Should abdominal palpation be done on this patient? Should it be done by an EMT or EMT student? Should it be taught to EMTs at all? Was the situation handled correctly by the OP? 1. Yes. Abd palpation is indeed indicated in the general examination of abd pain. However, it should be done at the proper time, by the proper person, utilising proper technique. And, of course, it should be deferred if the clinician determines a potential for exacerbation of the situation by the manoeuvre, or if it causes too much discomfort for the patient. Remember, it's going to happen again, probably at least twice, in the ER, whether yo9u do it or not, so there is little to be risked by deferring it in the field. 2. I'm a little mixed on this. There are instances where I would say this may be indicated. However, none of those instances would involve an acute abdomen, as in this case. And even then, it should be done only under the close supervision and guidance of an advanced clinician who has confidence in the EMT or student. 3. As already well stated by VentMedic, with the current state of EMT training in the U.S., I have to say 'no', abd palpation probably should not be taught in the basic EMT curriculum. Hell, for that matter, there are a lot of paramedic schools that shouldn't be teaching it either, because their students are neither the anatomical or physiological foundation necessary to properly implement and interpret the results. Most of them are wholly incapable of even identifying where organs and structures are located within the abdomen (and yes, my students get verbally quizzed on that within the first hour of showing up to my ambulance for a ride). And I am not for just doing shyte that looks cool, just to look busy, when it offers no benefit to the patient. 4. Should the OP have stopped the student from palpation as he did? Yes. No doubt about that. However, the reason he had to do so is because he FAILED to establish the ground rules and a clear line of communications with his student at the beginning of the shift (this, of course, is an assumption. He may have, and the student may have just been an idiot.). Before you ever make it to your first patient with a student, EXACTLY how things will work should be discussed, understood, and agreed upon by all parties involved. As an educator, I encourage my students to be assertive and pro-active, using initiative to be a part of the team. This should be tempered by the student's knowledge of his/her own limitations, of course. If a preceptor wants to play 'mother may I', then such problems are obviously going to arise quickly. For this reason, I also counsel my students to establish the communications and ground rules mentioned above, whether the preceptor brings it up or not. In this case, it appears that both student and preceptor FAILED in this, and both need to learn a valuable lesson from it. Ideally, the student would have known the limitations placed upon him by the preceptor ahead of time, preventing him from overstepping his role. This would have prevented the embarrassing incident in front of the patient. And it would have given the student a good question to write down and remember to ask the preceptor and instructors about after the run. I do believe I would like to have seen the verbal intervention handled a little more diplomatically, if for no other reason than to avoid worrying the patient. Instead of the old, "DON'T YOU EVER..." line, perhaps a gentle, "Uhhh... I think we're going to just defer the palpation to the ER, okay?" Yeah, I know that when you see something wrong about to happen, it is sometimes difficult to remain calm and diplomatic. However, that is what is expected out of a preceptor. You are, after all, a professional educator. Try to sound like it.

The Dutch are not "regular" gents.

I like it!

FAIL, Tom Woolverton! Welcome to 1985!

Looks like San Antonio firemonkeys have figured out the easy way to get out of ambulance duty for the remainder of their career. http://www.firerescue1.com/fire-ems/articles/733194-Care-of-San-Antonio-accident-victim-probed/ Care of San Antonio accident victim probed By Eva Ruth Moravec The San Antonio Express-News SAN ANTONIO — San Antonio Fire Department officials are reviewing whether emergency personnel responding to a traffic accident last week presumed a pedestrian was dead before they discovered she had a faint pulse. "The incident is being reviewed right now to make sure the proper procedures were followed," department spokeswoman Melissa Sparks said about Friday's accident. "It's too early in the investigation to determine exactly what happened." It wasn't immediately clear if paramedics checked vital signs upon arrival, as prescribed in the Fire Department's standard operating procedures. Last year, paramedics were disciplined after an investigation of a 2007 accident showed that a crash victim was mistakenly presumed dead and died the next day. On Friday, Alicia Trinidad, 56, was struck by a Ford pickup driven by Ruben Rojas, 37, just after 5 p.m. as she walked across Gillette Boulevard toting freshly made tamales she planned to sell. A San Antonio Police Department report states Rojas failed to yield right of way to Trinidad, who used a crosswalk at Moursund and Gillette boulevards. Rojas has not been charged. Trinidad had just left her oldest daughter's home in the 300 block of Gillette, where she lived with her daughter and son-in-law and their four children. She frequently walked to the intersection to catch a bus, said daughter Cindy Trinidad, 35, who came upon the crash on her way to pick up her husband from work. "About five minutes after she left, I drove down the street and saw the commotion," she said. "I saw the blue bag that she was carrying on the ground, and immediately, I knew it was her." She said that when she got to the scene, someone approached and told her it was too late. Her mother was lying on the pavement in the intersection with severe head trauma. "I began hysterically crying, and they covered her with a yellow tarp," Cindy Trinidad said. "Then, a few minutes later, someone told me they found a pulse and they uncovered her." A spokesman for the San Antonio Professional Firefighters Association said the union is aware of the incident and is conducting its own investigation. According to the police report, Alicia Trinidad was flown to University Hospital at 5:15 p.m. Less than an hour later, a doctor pronounced her dead. "Are there questions in this situation? Yes, there may be some. We'll never know what might have happened," Cindy Trinidad said. In December 2007, a paramedic concluded that Erica Nicole Smith, 23, was dead at the scene of a head-on collision. She was left in the crashed car and covered with a yellow tarp for more than an hour before a medical examiner at the scene noticed she was breathing. Smith was hospitalized and died the next day. City Attorney Michael Bernard later said that checking for vital signs, which the paramedic failed to do in Smith's case, is part of the Fire Department's protocol. While officials investigate what happened Friday, the Trinidads are wondering how they will cope with their first Christmas without their mother and grandmother. "That night, we made tamales to sell, but our tradition is to make tamales for the family on Christmas Day," Cindy Trinidad said. "She (Alicia Trinidad) would always head that up, and she left without giving me the recipe."

To quote the great early EMS visionary, Mother Tucker, "If you're gonna learn, then you may as well learn from the best." Therefore, I share with you this opportunity: That's all I know. Questions? See the e-mail addresses above.

Well said, Dwayne. Although many believe it should be, stupidity is not a crime. Consequently (in the boob instance), he committed no crime, and the State's hands are understandably tied in the matter. If we start decertifying every medic who does something silly, yet violates no laws or regulations, we're going to have a more serious shortage than we currently do. This guy may well be a total moron, who is guilty of much more than what we know. But looking only at the incident in question, I believe the State was correct to leave him be. People eventually show their true colours. And it looks like this one finally did with the alleged radar detector stunt. At least he didn't steal the victim's leg.

Ooookay.... not defending this loser or anything, but did you read the stories? Me thinks you overlooked a major detail.

Good observation. I was suggesting cutting off ALL this visa crap, regardless of whether or not they are on a watch list. The inn is full. No vacancy. The borders are closed. Screw everyone else.

Strangest place I ever spent it was Ramadi, Iraq. But the strange thing is that there was a lot less gunfire there than the countless New Years Eves I spent in South Dallas.

Meh... that's just Acadian's in-house shake n' bake school. Certainly better than some, but nowhere near the standards I would aspire to. Their job is not to educate the future generation. It's just to keep a ready pool of unemployed rookie medics who are ready and willing to work for peanuts, because the last batch already got tired of it and left. You'll get great reviews from n00bs, but then again, all n00bs think their school was teh aw3some. Most who have been around for awhile though seem to feel the education was inadequate, with a heavy emphasis on monkey skills and meaningless nonsense.

I particularly like the face on that watch. Very sexy.

Well, I was ready to fly up there and put that idiot out of his misery, but he saved himself with that last little bit of info in the video. If he sticks with replacing the FD with a private service, he's got my support.

That's one of the worst written stories I've ever seen in a newspaper. They FAIL to label the pictures, so we have no idea who is who. They leave you wondering if Gregson still is, or only was an RCMP officer. The whole article posed more questions than it answered. C-

Oh trust me, it's been addressed plenty by the Republicans. The Democrats, however, will have nothing to do with fixing it. I'll sum it up in two words: Bloodsucking Lawyers

I see Osama couldn't be arsed to put on a tie for his press conference on the matter. I guarantee you he doesn't have the gnards to fire Napolitano either.