Bieber

My partner's relief does the same thing, Island, except he rents out his houses. Sounds like an interesting thing to get into, and a little money on the side never hurts.

Ak, I'm interested in hearing more about that "profit share plan". It sounds like you do quite a lot to keep morale up within your service. How do you find the funding for it? Or is that a non-issue for you? Unfortunately, right now the budget crunch has made it difficult for my service to dole out any sort of rewards or pay incentives for performance or morale. I know they're talking about implementing an awards pin type of program, though its slow to come. For someone who's placated by more liberal protocols and an increased opportunity for advancement, the service is a dream right now; but most of our staff are more interested in pay raises which won't be coming anytime soon.

Asys, what do you mean by no fire service intrusion? As in, fire doesn't respond to medical calls at all or do you just mean that they're respectful of the boundaries between EMS and fire and don't try to cross them?

I agree with Arctickat, ultimately the safety of your safety and that of your partner lies with you. You've got to make sound, reasonable decisions based on what you know about the scene and keep in mind that every decision you make regarding scene safety could mean the difference between you two going home and you two going to the morgue. At the end of the day, no one is going to keep you safe but yourselves and while I understand not wanting to risk a patient's life or well being, YOUR life and YOUR well being needs to come first every time. If you're uncomfortable or uncertain about the safety of a scene, just ask yourself, "Whose lives are more important? Mine and my partner's or our patient's? And if me or my partner go down, can we take care of that patient?" Twenty minutes lost may or may not mean the difference to the patient's life, but it could also mean the difference to you and your partner's lives as well. Stay safe out there.

Dwayne, you caught me. I admit I didn't do any in depth research on the subject. I recall SI briefly from having read about it before, but it's been a while and I should have done a little bit more research before coming to any solid conclusions. I'll do some more reading on it tonight. My bad for dropping the ball on it. Here's some links I quickly found regarding SI: http://www.ahcmedia.com/emreports/pearls/pearls27.htm http://www.ferne.org/Lectures/2008_research_lecture/pubpdf/DCLHb_saem01_shock_index_newformat.pdf http://journals.lww.com/euro-emergencymed/Abstract/2011/04000/The_utility_of_shock_index_in_differentiating.8.aspx http://www.ncbi.nlm.nih.gov/pubmed/8922013 http://www.annemergmed.com/article/S0196-0644(94)70279-9/abstract It looks like, from what I'm reading, that while a low SI is too insensitive to rule out anything, an elevated SI can be associated with serious illness.

Thanks for the kind words, Kickass! It's good to know there's other providers out there that share the same views as me when it comes to EMS and patient care; now if only I can stay off my lazy ass and stick around here this time, that should boost my morale. Mikey, I feel you, man. I live in Kansas, so everyone's all about those big, gas-guzzling trucks around here, but to be honest, never having paid more than thirty bucks to fill the tank of my Prius makes catching shit for it all worthwhile.

I agree with Mobey, I prefer MAP.

Lots of changes at work lately. New protocols coming out this summer (very liberal, very progressive). Got on the clinical education committee, working with a couple other committees to develop a formal FTO program. Got into a heated debate with my fellow committee members about the benefit (or lack thereof) of dual paramedic trucks versus mixed crews. Got frustrated with them. Beat my head against the wall when one of the guys went on about how they're not "much of a stats guy"; beat my head harder when he went on about his anecdotes on the matter serving as evidence. Another committee member helped remind me to be tactful; let me know some folks think I'm just an arrogant prick. I am. Oh well. Getting frustrated with my partner, he likes to rush and doesn't always give very great care. Next month I'm hoping I'll be allowed to be an "acting lieutenant" on the truck, and be allowed to work with non-lieutenants as the lead paramedic when my regular partner's gone. Got admitted/accepted into a bachelors program in paramedicine; working on getting enrolled in classes. Bought a Prius; caught shit for it; 45 mpg makes me okay with it. Been playing Mass Effect a lot lately. That, plus computer issues, kept me off of here. Got a new computer last night. New computer busted today. Exchanged it for a different computer; working good now. Things with the girlfriend going good; resolved a lot of our issues. She's signed up to take an EMT class this summer. Need more money, but things are about to get ugly at work; a lot of people will be resigning over these new changes. Room for advancement within the organization is looking brighter every day. On vacation for the next six days. That's all!

First car was a white '92 Honda Accord coupe. Second car was a silver 2002 Saturn L200 sedan. Current car is a charcoal grey 2006 Toyota Prius. 45-50 mpg? My wallet is happy. =) And I happen to think it looks pretty snazzy.

Our administration and the current initiatives being driven by our administration (evidence-based medicine, studying usefulness of lights and sirens response/transport, more liberal protocols, high quality CPR going away from transporting code blues, community paramedicine/advanced practice paramedicine, a formal FTO program) are all VERY good stuff. The problem, believe it or not, is that we have a huge number of employees who are extremely resistant to all of these changes, essentially it seems because they're changes.

Read about it. I really think that the future of EMS lies more with "mobile health services" similar to this; a la same vein as the numerous up and coming community paramedic initiatives.

Never having heard of it before today, I'm a bit skeptical about its usefulness.

I make the treatment decisions for my patients. Patients, and the parents of patients, do not get to request or implement treatments that I myself have not decided to give; they can refuse any treatment, but cannot request one unless I believe it is necessary. And family members ride up front, unless it's a low acuity pediatric patient. As far as the article goes, I haven't read the entire thing nor was I there, so I can't pass judgment without having all the facts.

Good discussion from everyone so far. Dwayne, you brought up some interesting points about the possible non-time-related benefits of lights and sirens transport, and while I won't discount them and I agree with you that we don't want to get tunnel vision on either end of this issue, we've still got to consider safer alternatives if one of the roles of lights and sirens is just getting folks at the hospital to get moving when they need to be. HellsBells, thanks for sharing that study.

So, at work we have an Employee Action Committee, which is made up of representatives of every shift who meet every month to discuss issues within the service and advocate for them on behalf of the street level employees to administrative staff. There is a new opening on my shift and I am tossing my hat in for it. The head of the committee asked me to write a letter to the EAC detailing my interest in joining the committee and what I feel I can bring to the group. So, I've written the letter, and now I'm looking for some folks interested in reading it over and telling me how it looks, preferably those with similar experience either serving on such a committee or group or other related experience. If anyone's willing to help this cool cat out, please send me a PM and I'll send you the letter for your critiquing. Thanks, guys!

You can always transfer to an urban setting later on down the line, and you'll have more bargaining power with more education. I'd say to stick it out rural and go for your education first, man.

Not another drug, but another treatment we give out "just because" would be spinal immobilization.

http://www.sullydog.com/sullysites/qm/brainischemia101syllabus/index.htm Great site, the information in it should be mandatory in every paramedic program...

I'm really sorry to hear about your brother and your departure from EMS, but I'm glad that you were able to recognize what's best for you and act on it to get yourself well again. I hope things get better for you and your mother.

Likewise, Kiwi. That was deep, real deep.

Speaking of drugs for agitated patients, I almost used some last night. Thankfully, dimming the lights and just creating a calm and quiet environment was able to do the trick.

Chbare, not at all! But on occasion you do happen upon patients who are symptomatic with signs of end organ damage, though I'd have to be pretty sure they weren't having a CVA before I treated it. My only concern with nitro for hypertension is the risk of rebound hypertension after administration. Do any of you guys with experience using nitro for such have any comments on this? (Dwayne, it sounds like this hasn't been a problem for you at the doses typically given by EMS?) My service carries labetolol, though we're about to get rid of it. I'd like to have metoprolol, but it doesn't look like that's going to happen.

Heh... man, I feel your pain. If you weren't here at the time, or if you didn't see it, I had a similar experience a little more than a year ago. Feel free to look over my own experience, though it was a little different from yours.. http://www.emtcity.com/topic/19392-was-i-wrong/ As for your particular situation, and for any future situations, I can't tell you what to do, only that taking patients from the ER to their home can be one of the most difficult situations and one of the biggest grey areas in this job. You have to temper the patient's rights with their condition and medical needs, and even if you're expected and paid to just shut up and take them where the doc says, you have to remember the humanistic side of this profession, and remember that we're patient advocates first and foremost. If your patient had a CT to rule out CVA, though, I think she was probably appropriate to discharge despite her wacky vitals. Good luck to you man, take this experience and remember it in the future, and don't lose that passion to do what's right for your patients, even if it means rustling a few feathers. Addendum: Also, for what it's worth, you handled your incident a lot better than I did mine. So kudos!

Because I didn't expect you to take such a black and white kind of stance on the issue, to be honest. And now I'm confused because you said you don't like to walk patients, but this post makes it sound like you're more of an advocate of it when appropriate or as a diagnostic tool even in some cases. Croaker, I liked everything you said up until you mentioned when you were supervising you didn't let crews avoid walking patients if they were tired. Were you ever concerned that their physical fatigue might increase the risk of them dropping a patient while moving them on a cot? And also, did you mean to say that even if the patient was appropriate to walk if their reasoning was that they were tired, you made them use the cot just because their reasoning for walking them wasn't founded in that clinical assessment? I've never heard of medicare/medicaid refusing to pay us because someone walked a patient, but I'm a long ways down the totem pole... I know I've never been reprimanded for walking anyone, and I always document if I did. J306, to be honest, I've walked that exact same patient (except she was so drunk she had voided her bowel and bladder on herself), with me and a fireman on either side of her. And yes, I knew beforehand that I would be starting an IV to load her up with fluid and an anti-emetic. If their condition won't be worsened by walking, with or without assistance, and they feel like they're able to walk with or without assistance, I walk them.

Dwayne, great story and you're right, that girl and the medic were the epitome of professionalism and objectivity. Still, I bet that that was the last time the poor lady ever showed up to class commando style! -Bieber