Ace844

Ummmm...that's not even an indication, why did you put the Mast on a Hip FX? What rationale did you use to explain it, and more importantly, what did your Med con.@ QA/QI say??? out here, Ace844

Hi All, For those who are interested, here are a few recent journal articles which provide info on my previous post. The sensitivity of cardiac markers stratified by symptom duration Prevalence of acute myocardial infarction and other serious diagnoses in patients presenting to an urban emergency department with chest pain Potential diversion rates associated with prehospital acute myocardial infarction triage strategies Non-Myocardial Infarction Chest Pain Psychiatric Issues in a General Cardiology Practice Hope this helps, Ace844

I have been told that this accreditation is "pending" for this program. It is taught/run with insight/help very closely with the Brown school of medicine/residency programs. I will chaeck into this further to see what came of it. as for the rest of your post. I agree. Ace844

"Asysin2leads," My post was infact true, and it did happen ( This incident occured about 4 yrs ago. Funny the medics seemed to get smarter for awhile, now it seems lately that more and more we're back to what I will now call "the box color mentality") , this was essentially the report given to the ER staff. This medic no longer works, nor has a cert to practice, it was revoked by the state in which it occured. To limit the possibility of "slander" I will post no further details. I used this story to illustrate the fact that there is a decently large sample of medics who are grossly under/un educated and are clueless about medicine, yet think they are in fact "knowledgeable", a significant number of these also seem to suffer "the paragod complex" we are discussing here. As someone who went to an extremely progressive medic school, and has spend several thousands of hours in the hospital up to this point, I think this takes abit of a chunk out of your statement of; In my program we were taught way beyond what most programs teach in your aforementioned post. As a matter of fact, I know a few schools around these parts who do "teach" using the method I mentioned as well as memorizing the protocols so they can "pass a test" Most medic classes here, teach verylittle about the subjects you mentioned. I know what the colors mean and I never use that terminology in my practice, although I do know a significant # of medics that do. So I guess I am abit more than an under educated BLS provider who has no clue about paramedic education... I also take serious offense to you questioning my integrity, and honesty when you neither know me, or anything about me. Also, I never made a personal attack against you! I think up to this point as an individual on this board...since it's inception, my posts speak for themselves. Feel free to apologize anytime! You also can "see" what my paramedic class/program is like here. MHRI Program of Paramedicine As you will see we greatly exceed the national standards and are taught to the highest levels, perhaps even beyond those to which you may have been taught yourself!! out here, Ace844

My post was infact true, and it did happen ( This incident occured about 4 yrs ago. Funny the medics seemed to get smarter for awhile, now it seems lately that more and more we're back to what I will now call "the box color mentality") , this was essentially the report given to the ER staff. This medic no longer works, nor has a cert to practice, it was revoked by the state in which it occured. To limit the possibility of "slander" I will post no further details. I used this story to illustrate the fact that there is a decently large sample of medics who are grossly under/un educated and are clueless about medicine, yet think they are in fact "knowledgeable", a significant number of these also seem to suffer "the paragod complex" we are discussing here. As someone who went to an extremely progressive medic school, and has spend several thousands of hours in the hospital up to this point, I think this takes abit of a chunk out of your statement of; In my program we were taught way beyond what most programs teach in your aforementioned post. As a matter of fact, I know a few schools around these parts who do "teach" using the method I mentioned as well as memorizing the protocols so they can "pass a test" Most medic classes here, teach verylittle about the subjects you mentioned. I know what the colors mean and I never use that terminology in my practice, although I do know a significant # of medics that do. So I guess I am abit more than an under educated BLS provider who has no clue about paramedic education... I also take serious offense to you questioning my integrity, and honesty when you neither know me, or anything about me. Also, I never made a personal attack against you! I think up to this point as an individual on this board...since it's inception, my posts speak for themselves. Feel free to apologize anytime! You also can "see" what my paramedic class/program is like here. MHRI Program of Paramedicine As you will see we greatly exceed the national standards and are taught to the highest levels, perhaps even beyond those to which you may have been taught yourself!! out here, Ace844

"DustDevil", I recently sat thru an EM lecture taught by the director of the RI Hosp. ER. This lecture was on "Risk stratification of chest pain patients, treatment modialities and litigous risk." Essentially what it boiled down to in regards to this discussion is this. 1.) A 12 lead ECG is 98% specific and 50% sensitive. In short, just because you have a "normal" 12 lead doesn't mean your patient isn't having a myocardial event.....As a matter of fact, you could get the same senseitivity of info by a simple coin toss.... (Remeber: the 12 lead is just a snap shot of a few millisecond in time)B.) This is why one needs at least 3 sets of - enzymes and a period of observation, "to rule out" if you will. c.) Tort law has now made it a pateint's "right" to be pain free. It is your duty to try to alleviate it. D.) The "pain" felt in MI can and will usually absolve when the underlying etiology has been appropriately treated, i.e.: MIO2 has been restored with blood flow, etc... The reason most often MSO4 is given isn't so much for the minimal vaso-dilitory effects as anxiety control, and "perception of pain decrese". Lastly, your decision to treat or not to treat a CP patient's "pain" should have nothing to do with whether you have chnages on the 12 lead. As a matter of fact there is an overwhelming amount of evidence which shows that pain can completely devoid of an ischemic event... Hope this helps, Ace844

ummm...in that big country south of Canada aka: America.....

Admittedly I see this as well, and also run into a number of providers on all levels who fit the provided description. Another example I will provide is this. In a local 911 system at approx 2000 the ALS crew gets dispatched solo to an address "for the Diabetic reaction." The patients wife says to the crew, he's "just not acting right. They quickly do a FSBS which comes back WNL, and they do no further assessment. They end up giving getting a pt. refusal, they provided no care, etc.. All's good then, right???!!! Yeah, all is ok, right up to the part where it's 2am and the patient had went into cardiac arrest!!! So we get dispatched with FD, ALS, to the same address as earlier. We arrive to find a 32yo Male who's only PMHX was IDDM, and HTN with the meds to match. The wife was unable to wake him so she got concerned. Fire beat us by 2 min. and was found providing CPR on the patient's bed....What good that does the patient is anyone's guess..... So we apply the monitor, and HF pads, the patient gets intubated, a line, etc... The is found to be in PEA....We extricate to the truck. Sounds godd so far right? Yeah well the medic who is teching, has about 6 months out of school on the street. You can't even talk to this guy, it's a wonder his head can make it through the door of the truck. Long story short, we get to the ER and this medic as part of his report says to the doc/nurses, "yeah we gave him 4 purple boxes, a yellow, and a green! He stayed in a pulseless type rhythmn, and never came back. Unknown down time, and he's a diabetic, we were at his house ealier but he was fine and we got a refusal!!!" You've got to be kidding me!!! This is what you consider a banner of shining paramedic education right!!! YYYEEEEAAAHHHHH.........rrrrrrrrriiiiiigggghhhhtttt. Then after the call, while cleaning the bus we all got regaled with stories of "how it was a good thing that ALS was there because they made a big difference in this patient's outcome, and ohhh...he wasn't down long, because you could just tell, etc.... kevkei wrote, These are all integral parts of the same disease!!! Those medics couldn't be bothered with doing even the barest of essential job functions due to the factors you mentioned, and the "paragod disease". They were too good to take the time to actually assess and help these patient's, because they were missing their movie, not drinking their coffee, fill in the blank! My short point which follows a long story is this. If you encouter a provider who you may feel is "arrogant, or a paragod" see if they can back up their words and claims with actions, experience, wisdom, compassion, professionalisim, etc...when it's called for (see my previous posts). Give them the opportunity to prove they are lacking in everything necessary, and that they are in fact an incompetent, idiot before you pass judgement on the mere basis of "an attitude". Then surely you have a basis to slur someone as a "paragod".....A$$&*())...or whatever you choose to refer to them. They come form all levels of education, werw either always this way, or mabe to be, they have differing statures, the difference is in their ability to perform, or not. I rest my case, Ace844

[quote="kevkei And Dust, to answer your question, I agree with your statement in that a spade is a spade regardless of the number on the card be it a deuce or an ace

U talkin to me!?!??!?!?!??

Instance #1: Hmmmmm....me and my partner in a 911 system respond to a NH for diff breathing we find a 78yo F In acute CHF, c/o SSCP/SOB, is +4 diaphoretic with a JVP of 15, and b/p 80/60, hr130, rr40's+, and all the accompanying S/s's @sx's . The paramedic truck pulls in just after we had loaded the pt in the truck shows up and hops in the back of my bus does a 2 sec assessment, and says..hmm this patient needs to get to the hospital, this is a seems like a BLS call..Triage to BLS..and leaves....You really mean to tell me that wasn't an ALS patient....?!?!?!?!? We get to the ER and give report to "the Team" and the attending asks me, "ace, why no ALS for this call???" I respond, oh we got an interecpt but they triaged down to BLS, and felt this wasn't an ALS patient....!!!!!" The doc, replies, "Really?!?!?!? WTF....which unit was this again?!??!!" Yeah certainly I was outta line in that call. Let's try another example.... Example #2: MVA car vs tree @ approx 100MPH, driver was ejected and was my patient, passenger was a fatality, the car was basically sheared in half. The patient had bilat. lower extremity paralysis and retrograde amnesia/head injury...The paramedic gets in the truck and does a cursory assessment, and says...you guys are all set right..He's not gonna get any better, so we're gonna stay with the fatal until the Detectives come.....Yeah that patient wasn't ALS either right.....?!!?!?!!? Yeah that was definately a case where I was the "BLS version of a paragod" We get the patient to the trauma center, see above for the MD responses/queries... . Now, I'll refer you to my other posts which I guess you may not have read..... To answer your query on, In my instance, and in some others how about a whole lot of education and street experience to back it up....Or are you one of those medics who think all basics are automatically stupid, even without you having given them the chance to prove different??? Oh and FYI, IMHLO, BLS doesn't save ALS, or even the other way around, we work together to treat patient's and help them!! Or at least that's how it's suppossed to work. Yet you obviously don't feel that way because of the statements you have already made here... This job isn't about a juvenille ego contest but about helping people at the time of their greatest need..Or at least where I come from it is. If you disagree then perhaps you should consider getting out!!!! So in closing, as you can see there are indeed many times where the basic is infact smarter or even has to "explain" to the medic how to do his job because as in the 2 examples provided, the patient suffers, and they are a patient's advocate..Or just as likely one may even be to ignorant to recognize their own ignorance...!!!!! Sadly sometimes this happens all too often...as is clearly evidenced by the amount of other threads here that even some medics themselves talk about their opinions/experiences with subpar paramedics...so which are you???? out here, Ace844

Also, some of the variants of HELLP/Preeclampsia present this way initially. Also, wa sht epateitn screened for protinurea, etc.....??? out here, ace844

I'd also like to add the following observation to my previous post. The things that allow some people to accel and to be exceptional at this career/profession/calling/whatever are not necessarily traits that make us easy people to get along, understand, and deal with ..... further food for thought... out here, Ace844

Hi All, I agree with you alittle "Nate" and will elaborate on this abit. I have been thinking about this for abit and I have come tothe following conclusion. The following is JMHLO/ .001.... I guess today may not be a med compliant day for me so I'm going to rant abit...please excuse me while I do so... ahahahaahah This whole "Paragod complex" has been partly developed, and abused out of some of the necessities of our profession. Perhaps some of these observations are limited to my own narrow experience, and if so please disregard them at your discression. When a first started doing this I worked with providers who were very knowledgeable, experienced, took pride in what they do and as a whole it was a work environment that fostered peer pressure to learn, accel at your skills and knowledge, be professional, and grow. If you didn't have a desire to learn, be good at what you do, participate as part of the team and were unable to do your fair share, then you weren't welcome. As a result there were more than a few providers who may have fit into your definition of a "paragod". Although I believe there were a few glaring differneces. Even though they had a "cocky attitude" they were able to back up their statements with actions, verifiable knowledge, confidence, compassion,as well as a drive to continuously improve themselves and those around them. So I think that in this debate it is important to differentiate between a "confident provider" whom may exhibit some of the traits of a "paragod", yet is in fact vastly different, and a "Paragod". The difference between the 2 you ask, is that the negative version of the "Paragod" complex mentioned in the majority of the posts here will be unable to do any of the things I have previously mentioned and will use a condescending demeanor, to mask their lack of confidence, to perform their function in EMS; both in themselves, and their abilities. The bigger problems begin to ensue when these incompetent "paragods" believe they are infact "competent," despite mountains of evidence to the contrary. Then they become a danger to all around them, and more importantly a detriment to patient care!!!! This is an important distinction, and I think we have both poulations here on this board... out here, Ace844

Yes, but lets not discount the occasion which sometimes one comes upon whereby the Basic has to take the time to explain to the Paramedic the phys, pathophys, and why they should be ALSing a sick patient and the paramedic does the "huh....what...hey, how do you know that...""?!?!?!?!? It's always a sad day when the basic is smarter than the medic..!!!! Some days, it happens alot more than it should.... ace844

Am I the only that these statements make shake, shiver, sadly bow my head and turn it from side to side...?!?!?! I mean is this really what we're coming to in EMS education...???? uuuuhhhhhhhhhhh...siiiiiggggghhhhhhh.....Neva mind, that's wicked screwed up, I withdraw my ? and statement... ACe844

I'm a para-wish I could be....ahhhh..yeah, well then there's...ahhh....no wait, gonna be??? how bout in progress...yeah, yeah...ahhh..ummmm....rrrrrriiiggghhhhtttttt...... LOL Ace

"Angelkiss," I'm glad that the passenger wasn't with you when they found his "extras" in the bag. Also, glad to hear this skell, didn't decide to "show it to you" at an earlier time. Yes, we live and learn in this job and I hope that all of the situations posted in this thread will cause others to think abit more in general and specifically about these issues....Trust me as someone who's been taken "hostage" by an armed, angry, delusional, dangerous ETOH/Psych patient before, this is not an experience that you want to have....!!!!!!! As far as being fired...Well, I wasn't, well I guess I should say I didn't stay fired for long!! Much to this companies chagrin, they thought I might make it easy for them to cover this up. Needless to say that didn't work. The other issue that is part of the setiment of " You know what? I would not care if I got fired for searching a pt.....psych or not and the passenger traveling with the pt." The problem lies in that at least here, the privates talk amongst themselves at the "state level" Ambulance assn meetings and only tell part of the story to one another. So as soon as word gets out, that you A.) stuck up for yourself B.) This action resulted in a facility complaint, and or got the facility in trouble. You become the equivelent of Persona Non-Grata, in the area and in private EMS here in general. Right, wrong, or indifferent, this is the reality sometimes... out here, Ace844

I'll post more here about this call and it'saftermath soon. But, first I'd also like to hear some more from the general population here and see what else you guys add to this as well... Thanks, Ace844

"Ruff," I agree whole heartedly, I continue to practice in this manner, and will always look out for #1...I just hope others maybe able to learn something from these posts and this situation.... Also, my concern wasn't necessarily about the complaint, frankly in hindsight I wish I had pushed the issue at the sending facility, this could have turned out alot worse (read larger crap storm than the one which ensured post what this patient did) for me and my partner.... When I saw what this kid had in his pocket upset doesn't begin to describe what i was thinking/feeling..... out here, Ace844

Guess it worked that time....who knew?!?!?!?!!?

Here they are again in a diff format. I have no idea why they weren't working....I've also noticed that I have issues with the emoticons as well...Perhaps the admin can check this out... Here are the addresses, you'll just need to cut and paste.... 1.) http://www.emtcity.com/phpBB2/viewtopic.php?t=1183 2.) http://www.emtcity.com/phpBB2/viewtopic.ph...&highlight= 3.) www.emtcity.com/phpBB2/viewtopic.php?t=810&highlight=

"Ruff," Unfortunately, the realities of EMS and the companies who provide it in this state are such that if you make waves, for any reason, right, wrong, or otherwise, you get fired.... Do not pass go, do not collect $200.....Proceed directly to being Black listed, and unemployed... You asked, "Do I really want to do you really want to be working for a service who puts the safety of their employee behind that of the inconvenience of a search of a patient." The short answer is NO!! But again, lucky for me I'm abit smarter than I let on and I can take care of my self with most issues, + being good at what i do helps alot as well.... It's just that when this kid decided to make the decision that he did, it set into motion a chain of events; which when he did it, it left everyone, scrambling not to be the only one left standing when the music stopped. Also, please let me know when I can expect you to start paying both my salary and other expenses, ahahahahaha, lol!! I'm glad that afterI had a previous close call/bad experience with a call similar to this one that I initiated a policy to search all patient's who were of this type. Frankly, I was told that had I stuck to my guns at the hospital EMH in the first place it would have brought this out sooner, but I was later told it would have resulted in a facility complaint which would have gotten me fired anyway...food for thought kiddies!! It is a sad day when you have to consider if your safety is possibly worth getting fired over. So all of this got me to wondering how pervasive is this issue in our profession. Also, I had hopes that others may learn from this situation and maybe be more aware when encountering these types of patients/calls..... Hope this helps, Ace844

"ptemt," This was also discussed in the following other forums here, it might be worth checking them out...... EMT city and emt city and here: Emt city hope this helps.... Ace844

I've also experienced this in both municipal and privately covered 911 systems. I've even had PD outright refuse to search ETOH and EDP (psych) patient's saying it's not nessary....sad but true....Yet, I've also found that by asking them if they were going to be the ones stuck alone with the patient in a 8x6 confined space whether this would cause them to search the patient first...occasionally this causes their clue phone to ring...and they search the pateint..other times, not so much.... Ace