WolfmanHarris

Might be the EMS equivalent to the media news' "if it bleeds it leads." This specific situation brings up charged emotions and related to strongly held beliefs and people are more likely to jump in.

I couldn't disagree on this one more. It's a mistake to ever accept something, especially this awful, as unchangeable. Because the eventual step is giving up. Creeps and sex offenders are very different. I've worked with people who I considered kinda creepy, who were creeps or gave others the creeps. That in itself is not a problem. Sex assault, especially of a vulnerable sector is. I don't think I get your point here. How would it be different if we make it impossibly easy for people to enter EMS and keep standards so low? (I'm speaking in general; mainly about the US. Not that our s*** doesn't stink in Canada, but American stats are the issues currently being discussed.) Besides, by it's very nature while EMS providers can act professionally, in many areas it is not by most definitions a profession. How working with the ill or injured would change the pathology of a sexual predator? If anything, ill, injured vulnerable people implicitly putting their trust in the predator who is in a position of authority would be more of an attraction for the predator. These things will not turn them off.

One point made in the article that I found interesting was: I know we always harp on the education thing (with good reason), but I wonder how many of those involved were Basics? I don't mean to denigrate the basics on this forums, most of whom by being here and seeking any form of further education, have got to be head and shoulders above their peers as they've been described on here. But say you're a predatory individual, attracted to power, looking for vulnerable victims and someone tells you that with a couple of weekends, you too can work on an Ambulance and be a hero to everyone. Predators are going to actively look for was to hunt, but we don't need to make EMS a ridiculously easy to enter haven for them.

Welp, it wasn't the Fire Department this time. Just goes to show that when you take anyone who doesn't want to be in EMS and make that a part of their job whether they like it or not, they're going to take the easiest, laziest approach to it possible. And as an FYI, their website.

And what is that claim based on Crotchity? Where? What countries? And more importantly, what's the mortality/morbidity rate of these C-section?

Crotchity it is one thing to treat your employees well and create a familial feel among them, but when you lose sight of the fact that they are people with a job to do you're likely to make the wrong choice for the right reasons. It is good and right to care about the welfare and situation of your employees and to a certain extent to consider it. I don't believe it should be one fail and out and from the sounds of it, in DCFD, it isn't. But I also don't think your judgement should become clouded by personal factors. Maybe it's the social safety net in Canada that makes me a little colder to the situation and makes me feel less personnally responsible for the actions of another provider, but while I would empathize with any of the examples you mentioned, I would still not change the requirements for them based on it. Perhaps a hardship or medical leave of absence would be best for them until they are ready to do their job, do it competently and prove it with more than "I've been doing this for 20 years." I have the utmost respect for most of the senior providers I've learned from, but that's not based on a number of years nearly as much as on what they've taught me, how good they are at their jobs and their commitment to continued education. I have met "medics" with 20yrs on who were grandfathered in when they went from Driver/Attendents and then grandfathered in when they became EMA's and then were grandfathered in with some minor CME when they became Primary Care Paramedics and couldn't find their ass with both hands and comic book instructions when it came to medicine. By being grandfathered they were never exposed to a culture of education and have never felt a need to pursue it. Good enough to get by, is their standard and that should not be acceptable.

In that case if were an ALS provider (and thus actually had a scalpel on my Ambulance) than yes. Right now, nowhere in my gear do I have anything that could do it. It would be a multitool or trauma shears. Yikes. Just hopped off the fence.

It's interesting because policy here allows for a medic to run first responder only if that's all that's available. (Say their partner leaves early sick, a new partner hasn't come in yet and they're the closest available vehicle for a call.) A transport unit will still be sent and dispatch will be aware from the beginning that they're operating first responder only, but they will be sent in the interim. Whether that be alone in the Ambulance or in one of the service's SUV's. In fact looking now we even have a code on the ACR for "Paramedic accompanied pt. in vehicle other than Ambulance." and a box under crew type for "First Responder." I'd think there'd be way more liability for not sending a crew at all when one was available, but unable to transport. I think either way someone was going to sue on this one, because there's a dead person and it has to be someone's fault. Everyone's got to find meaning in everything and fault is a form of meaning I guess.

The reason we use testing though is it's standardized and provides an objective way to compare people of the same (on-paper) qualification. It shouldn't be the only way we evaluate them as their are test competent medics who should not be on the road, but I believe it's a good starting point to separate the wheat from the chaff. Let someone show that they know their stuff, than worry about how much the patient's like them. Not the other way around. I kept an incompetent first responder on my campus team way longer than I should because they were sweet and nice, and minded their p's an q's and patients and teammates liked then. I also believed I could rehab them and make them a half-decent first aider despite evidence to the contrary. It took me eight months, being called in by our oversight board to account for it and an incredibly messy separation of this individual from the team. If I'd based knowledge and technical competency in front of the people skills I would have seen it right away. And this is a damned campus first aid team. When evaluating we need to establish base levels of competency before muddying the water with the person. If I worry any time I evaluate a student in my standard first aid, or lifeguarding classes about how they need this for work; or how bummed they'll be when they flunk, I'm doing them and myself a disservice. An instructor/trainer shouldn't write off a student based on a single test, but they also shouldn't push someone through until they get that bare pass just because they like them and would like them to succeed.

Don't forget to ask me about the bear attacks. So we jump to the defense of incompetence out of fear that we might not be up to snuff ourselves? Sound ass backwards to me. How about, if you're worried you couldn't pass the test you needed to certify/license in the first place, you stop wringing your hands about who's head is on the block next and remedy the situation. Two explanations can be taken from this. Either A) the test is evaluating a knowledge base that is not important to practice and therefore much will likely be forgotten in the intervening years. or the test is evaluating a knowledge base that should be important to practice but rote learning and habit have replaced knowledge to allow the provider to continue to do the job without knowing the background. If A) the education and testing is not relevant to the job. If the providers have allowed themselves to atrophy and should remedy that instead of the tired "well we don't need to know that stuff on the streets." I have had questions on tests I could not for the life of me remember (including today). But my answer wasn't to call B**s**t on the test. It was to realize I had stuff that needed to be reviewed more.

But it's a multiple choice test right? So even if you think there must be something unique about treating a bear attack pt. (or any other such scenario that might be out of your frame of reference) you can look and see that there is no crazy bear option. It's not like the test would have all these almost right priorities questions that deal only with the trauma and one that says "Shoot the f***er and turn it into a rug." That makes someone go "Well that is the only answer directly related to the bear." I know Basic is a joke, but if each question has to be spoon fed to someone with direct text quote presentation, then they may be too stupid to have any responsibility of the lives of others. Fire or EMS. I mean come on. Could you imagine providers that narrow minded; "Hmm... they're pale, diaphoretic and SOB but they don't quite have crushing retrosternal chest pain. Must be indigestion, they'll be fine." Oh wait. Nevermind. - Matt

I know. That's why I didn't say outside of scope. I said outside of protocol. The point being that they're different.

Some people though are very comfortable putting everything out there online. Between facebook, myspace and the like some people are willing to leave their life story out for anyone. I don't understand it, but that might be the case here.

One of my saddest was not particularly critical but for a couple of reasons/similarities left me with a "there but for the grace of God go I."

What's this ER like? I know every hospital around here has an emergency department, but the one tiny rural hospital is often referred to by medics as "The Campbellford First Aid Station" as their one Doc is usually going to put the medics to work on anything big before they transfer to one of the bigger hospitals. I doubt they've done too many intubations in the ER in the last year, possibly less than the ALS crew that works out that way. Not all ER's are created equal.

MONA's a new one for me and too common for a google search and not in my text. Little help? Now on protocol. Correct me if I'm wrong. But my perception of protocol is that it lays out the minimum standard for autonomous care. The idea being that the protocol says what you can do without any contact with medical control or with minimal contact. Therefore if you're calling for Physician direction through the whole thing, that's naturally outside of protocol. Example, my Ischemic CP protocol does not allow for the 12-lead to be used as a diagnostic to rule in NTG and ASA. But, I find myself with an atypical presentation with no classic S&S of MI until the 12 lead give me a nice big ST elevation in V2, V3 and V4 with reciprocals in II, III and aVF. I have a 30 min transport time to hospital and waiting for the hospital to give it is going to cost muscle. I can either not give NTG and ASA as it doesn't fit protocol or I can patch the Base Hospital Physician and ask for an order for NTG and ASA. I may get it and then give the meds and at no time will I have violated accepted practice. Guys and gals I can understand the reluctance to perform the procedures from a technical standpoint, but I don't know if using the protocol is the way to go on this.

Beat me to it Dust. There's nothing I hate more than hearing "is this going to be on the test?" when teaching or in class. When teaching First Responder my answer is always yes. Now every service I apply to will have both a written and practical test as part of the hiring process so even if our whole program was geared to the provincial test, there's tonnes of other tests oh ya, and that whole real life thing.

Hey Dust, I've got question for you. I know you've had exposure to our system up here and I was wondering whether you'd also argue for getting rid of BLS here in Ontario? (Other provinces too but I'm not familiar with their education) Two years for BLS with a further year for ALS (usually after road experience) where A&P, patho, pharmacology and the like are front loaded in BLS. And not saying a 4yr degree wouldn't be better or that it couldn't be done better. Just curious about your take on things outside of the US.

Oh I agree entirely. I appreciate the article and found it interesting and frustrating to read. I just didn't want to dive back into it again.

Oh hey great, you missed the point entirely or chose to ignore it to take a dig. That's a really good way to not have a productive discussion.

Just because someone doesn't agree with you, doesn't mean they don't understand the issue. Come on Crotchity, dial back up the intelligence in here. Little jabs like that are what starts the rapid decline of these threads into a troll fest.

Umm... for my response please see every other thread on education and why FD will kill proper education in EMS. Take my disdain in those threads and multiply by two for my current thoughts on DCFD. If this gets going I may come back later for my kick of the horse.

CPR is not a controlled medical act in Ontario. Thus no certification needed. Can't speak to the rest of the world. Seriously man stop trying to convince with these analogies, slippery slope arguments and the like. I think everyone here understands all the factors and considerations but still disagrees. These aren't going to get anyone closer to one side or another. And if I cared about what it said about me in the paper, I'd have become a Firefighter. (oh. That's nasty.)

That's great and the way it should be done, failing a proper education. But I think we've well established on various threads on this forum that this proper attitude and commitment is the small minority of EMT-B training in EMS in the US.

Okay. Couple of things. Part of this disagreement might come from the various system we work in and the relationships that are had between the providers and medical direction. For example, if you have a very good relationship with your medical director on top of experience and a good education (like Dust) you're going to feel more comfortable in this environment as you come from a system where operating outside your usual scope is comfortable. (like Dust) If you come from a system where this makes you think that your ass would be grass and that the province/state would hand you out to dry then you're not going to feel comfortable with this at all. This may be a case where education aside, our systems and experience are going to have more influence on our opinions and hypothetical action than what is said here as that's what we're filtering through. Might also explain why I can't seem to pick a side on this; as I don't have that context yet to filter through. Crotchity, drawing that parallel between Lifeguarding and this is quite possibly the most asinine straw man argument that's graced this thread so far. They don't compare one bit beyond a surface similarity. Also, the idea that you as someone with no rescue training would jump into any rescue situation you saw rather than wait puts you into that category of people who kinda scare me as potential partners. People who makes these unqualified assertions and then follow through with them end up in one of two categories; in the paper as a hero or dead. There's a time to break rules (including scene safety), but to admit off the bat that you're unwilling to choose inaction over action regardless of the risk/cost. So of course you'd perform the C-section. You'd likely consider the bic pen and pocket knife in a pinch, running into the fully involved building with no turnouts, or be heard responding "Dammit, there's no time!" This attitude is rarely about the patient and more often about the rescuer.