Nate

I have to agree with the above statement, how did this get to three pages? I would also like to throw this out for people to chew on. How many times do you notice EMS crews who fail to use a BVM properly? I see it a lot, people seem to forget how important that "seal" is when bagging a patient. If you bag someone with a good seal, you should have a good SaO2 and CO2 numbers on most patients. I understand that many EMT-B's wish to do more, and there is a way to do more. However; you have to go back to school, and I don't understand why so many people have a freaking problem with that. You might get lucky and win the lottery and get a new car with out earning the money, but that doesn't happen in EMS. You can't win some EMS lottery and gain the ability to intubate or start IV's.

Our primary hospital supplies us with the materials to draw blood, however they have asked us to only draw blood for the following: Cardiac Pain, Cardiac Arrest (if we have time), or Observed Cardiac Dysrythmia CVA, TIA, or Stroke Like Presentation AMS Suspected Drug Use or Overdose Other hospitals is a different story, I don't generally draw blood unless the doctor/nurse I'm giving report to requests it (I do offer) because I see no point in wasting materials and the risk (most people don't believe that there is a risk with blood draws, but there is). As far as gray tubes (thats the color of PD's alki tubes), we don't draw blood for PD. If they want blood then can ask the hospital to do it (which they usually do).

Is your mom cute?

As far as the issue with running calls that don't amount to much in the city, I'd like to offer a different look. That depends on the city, and the area that you work in. I work for two services in two different cities that are divided by a street and some rail road tracks. The call volumes on the two sides are very different, and the types of calls are as well. In one city we have no freeways, so our MVA's are usually minor, and involve objects such as telephone poles, the ditch, or a building. For the most part, we are able to get them out with very little effort and their injuries are usually minor. However, the stabbings, GSW's, and other forms of trauma are very high. Our medical calls are usually the real thing because the people of this area are mostly hispanic and a good portion of them are illegal. They prefer to avoid any city employee at all costs and will only call if they need us. Now I'm not saying that all I do is paramedic calls, but a good portion of them are. In the other city, which is larger, we have two major freeways (and several miles of them), then several city roads that have high speed limits, so that is were I get most of my entrapment calls. Also, since the population is more mixed, we see a wide range of EMS abuse, crack heads, and other calls that don't really amount to much. I'd say that about two thirds of a our calls here aren't anything major, and the rest are (which is more similar to most city break downs). Another thing to focus on is this observation. When I worked on a "nicer" side of town our MVA's didn't really see that many injuries because of the air bags, quality of build in the new cars, etc. Down here we have a lot of people still driving all steel cars with lap belts. I'm not saying that Volvos, BMW's, and other nicer cars mean you won't see injuries, you'll just see more with these older cars that lack the safty features of today's cars. I think you should go where YOU want to go and just focus on being the best medic that you can. You should do your best (I know it is hard) to avoid the BS that negative people seem to find, and focus on the ones who still love this line of work. The first thing I tell new hires with little to no time under their belts is this: "I've been where you are, and we will never know all of the answers. Do your best, admit when you don't know, and remember that you should enjoy this job."

I think that I can speak for most ALS personal when I say that we will still do our own assessment (including our monitor & 12 lead). So even if BLS has this toy, it is still of no real use to ALS because they will conduct their own assessment. Also, you don't treat what some toy tells you. You treat what is going on with your patient as a whole.

EMS abuse tends to happen more in low-income areas where EMS is the doctor or a better alternative to the long lines at a clinic. Free medicine does come with a cost to the person there for it, time. Time is a big factor, and most of them do not want to wait all day for treatment. So they call for an ambulance and get into the ER and usually quicker then it would take a clinic (most of our are running about a 3 day wait that starts over every day at 0800 when the clinic opens). While this is not the only source of EMS abuse, it does bother me that we have people who don't understand something as simple as patient refusals and why we have them. These are usually the same people who don't understand why they don't get any respect. EMS ignorance is on both sides of the issue. We should see more articles about interesting medical problems, not reports on how we suck at our job (as in industry), or when to get a refusal, or how the refusal is being abused, etc. Nate

Break a window out and toss them out with a blanket for a parachute. The stair chair idea or standing them up are the two ways I've used.

:roll: And we wonder why EMS isn't seen as a profession. Believe it or not, we don't need a doctor to hold our hands every step of the way. Wait, you might need a doctor to hold your hand every step of the way. Most (paramedics and EMT's) are actually capable of thinking through a patient assessment. If you run every little thing to the ER and don't allow for refusals to be offered to the patient (who doesn't want to go or doesn't need to go), then you run the risk of opening yourself up even greater costs due to lawsuits (not having enough ambulances) or belly up (not being able to pay for all of the ambulances).

I know AMR in Houston can take a while. I've had friends who were hired a week after, and I've had friends who were hired a month after. They will let you know one way or another, and usually tell you the reason why you weren't hired. Remember, they have to send that information off to a regional office who processes it for all of the offices in that region.

We don't have it at either service that I work for; however we have our own driving class geared more around the way our citizens drive (if you've ever been to Houston, then you know what I'm talking about). :wink:

Make the shifts like most hospitals (in our area at least) where you work either day or night, not one shift this week and another the next week. For buys urban systems, it works better then 24 or rotating every other week shifts. At my station the BLS crew is on the ambulance and I'm on a squad, which usually means I don't run nearly as hard as they do. So should one of them feel to tired, I can climb on the truck and leave them at the station. We have only had a few instances where a crew member was to tired, but we are lucky to have that option. We also have multipule trucks in each district to share the call volume, so at night we are pretty calm (yes I know anything can change). I'll admit, it is nice that as the call volume increases we are able to add trucks, most services don't have that advantage. To set one plan for all of EMS isn't possible, each service has to be looked at one by one. I know of friends at other services that tell me if they even dared speak up about being "to tired" even just once they would probably lose their shift or be "let go." Like others, I tend to spend my free time sleeping between calls. Which leads to my late night internet posting on EMT City. :wink:

Depends on what they have on, it can be a real PITA sometimes.

Like Dustdevil said, these shifts aren't any good and that you should seriously consider getting your union or talking to your management team about adjusting that kind of work schedule. Many of the chemical plants here in Texas have learned the hard way that working days one week, nights the next, and days after that leads to a number of problems including death. You can take my comments however you want, I firm stand where I am because of what happened to my friend. I think it is stupid that someone would subject themselves to this kind of schedule knowing what could happen. Not everyone can adjust and work with this schedule, and I'd hate to see anyone find out it doesn't after they kill someone. Twenty-four hour shifts aren't even that great in my eyes, but they work if your service isn't rolling non-stop 24/7. I know of to many people who have had accidents while working nights or 24's, and that is the reason why I watch my crews and tell them to speak up if they are to tired to run a call. I'd rather them admit they couldn't do it, then kill someone and live with that horror the rest of their lives.

Crap, I can't spell today.

I could really careless what you think, it is hard to see a close friend in a wheel chair because an EMT slammed into his car after falling asleep at the wheel and running a red light. Sorry, but I take this stuff very serious. Forcing your self to stay awake when your tired IS NOT an acceptable solution in my eyes.

This is why we have blankets and sheets.

Make sure you have insurance, because if you wreck the ambulance and hit me or my loved ones, or kill one of us because your to tired; I'll own your ass. I know it sounds mean, but I'd rather you not work the shift then do something you or your body can't handle.

Relax and enjoy it, clear your plate so that you can spend a lot of time reading your books, paying attention in class, and taking advantage of the clinical time.

Yeah, it never seems like you have enough room or AC in the ambulance during a code.

I once stood in line at triage while a paramedic from another service informed the doctor that he gave Thiamine because the patient was drunk. EMS is funny.

Did you have fun?

1. Just because you see me outside, doesn't mean that I want you to stop me when I'm trying to eat to ask me to show your kid the ambulance. 2. It is not okay to call just because your lonely. 3. I'm sorry, we aren't (insert other ambulance service) here, we can only take you there, there, or over there. 4. Please be understanding that your dog humping my leg is not viewed as a "nice" thing. 5. I'm sorry your in handcuffs, and no you can't use my cell phone to call your mom. 6. I have no money, stop expecting me to give you money because you ask for it at the stop light. 7. Please don't walk up to me and show me some odd thing growing on your penis, you have a doctor for a reason. 8. Our phone number has changed, it is 1800-555-5555; that 911 thing is no longer in use.

No more drugs in the bag doesn't equal better patient care directly, the drugs don't just walk up and inject themselves. If the person giving them doesn't know when to use it, how much to give, etc...then there is no point to them. Better patient care can arise from having the proper drugs to either comfort them, start working on fixing the problem, etc... I know there have been a few times when I wish we had something more for pain then Nubain for the patients comfort. It does not matter if I carry a few drugs that are rarely used, the one time I need them is worth it.

We actually record the the episodes of Paramedics and point out what the crews did wrong, the last one I saw was Detroit...they had some "interesting" c-spine methods. :?

I don't watch TV to learn, I watch TV to fill a bit of time in which I feel like being a vegetable.