chappy

First, being a southern born and raised redneck, I take offense at the stereotyping. Suppose I said that everyone who lived north of a certain arbitrary line on a map was a rude, thoughtless person who did not know how to drive, speak the language properly or enjoy a decent glass of iced tea? Yes, all of yoins up thar caint talk no good Anglish. EXPERIMENT PICTURE # 1: This is obviously a man and his kids out for a fun day of plinking. No, he's not hunting. No hunter in his right mind would go shirtless. They are proudly exercising their constitutional rights and enjoying it. They don't appear to be the militant type. In fact, it is impossible to tell what their social and economic status are. Although, judging by the weapons and the Jeep, they would seem to be middle class. I did notice that the girl was wearing what looks like culottes ... that comes from fundamental Christian or Mormon. However, the man is shirtless. That is not fundamental Christian or Mormon. EXPERIMENT PICTURE # 2 No context was given so assigning a label would be morally wrong. EXPERIMENT PICTURE # 2 Aside from assuming this guy was in a bad way of some kind... No context was given so assigning a label would be morally wrong.

Well, it is obvious that this particular person was, at least, wrong. For those who believe the Bible, Jesus was plain that no one, not even the angels in heaven know the day or the hour of the rapture. Jesus was also equally plain that we should not believe anyone who claims to know the time of the rapture. Here's a question for you all, though... If the CDC is warning that we should prepare for a zombie apocalypse, what are your contingency and emergency response plans for the Rapture? I'm not worried, I won't be here after the rapture.

I don't know that I could effectively argue with that point, nor do I want to. However, transport medicine is a valuable tool in the medical system. Supposedly, everyone wearing that NREMT-P patch has the same basic set of skills (or, at least they did at one point). But, we all know that any given skill will decay with lack of use. I think it is sad, almost comical, to see a low-volume unit pull on to a serious scene. Sure, the senior person on the truck has run the rescue squad for the last fifteen years. So, he is a seasoned medic, right? Nope. In all of his fifteen years, he's only seen one call like this one, and this one is it. Don't get me wrong, I am certainly not discounting the rural EMS units. They are extremely valuable. But, here is my point. Mike, you are exactly right in one point: there are many paramedics who have a patch and a card in their wallet which says they met some minimum core competency at some point in the past. That card and patch does not make a good paramedic. Perhaps a change in paradigm would offer some a chance to exercise their skills on a more frequent basis.

If we look at the role of a Paramedic strictly as Prehospital Emergency care, then the APP is stepping outside of the defined role. However, if the Paramedic is viewed as a skilled medical provider and a valuable resource in the chain of medical care, then there are plenty of roles for the Paramedic. Essentially, the Paramedic operates under the direction of medical control or indirectly with standing orders, right? With that in mind, what is wrong with a paradigm shift in the role of the Paramedic? Such a shift would allow the Paramedic, under the direction of medical control, to provide a vast and diverse service to the community. How many of us know (or, in my case, remember) regulars who, if there were some in-home followup, would not be regular users of EMS? So, are you saying that inter-hospital transports, convalescent transports, etc., are not EMS? Don't misunderstand what I am saying. I am not recommending that line EMS units be scheduled to do home-health calls. However, why couldn't a licensed Paramedic, operating outside of the EMS system - perhaps as an extension of the local health department or county hospital, be allowed to make these types of calls? There are those who claim there is a shortage of nursing professionals. If so, using Paramedics in this role would provide more skilled providers, right?

In Wake county, NC, they are running a pilot program for what they are calling an Advanced Practice Paramedic. Here is a link to the program. What do you think?

A recent news article mentioned an EMT who was discharged because he performed a procedure he was not licensed to perform. Click here for the article. In cases such as this, should personnel records be made public, so long as patient information is kept private?

Thanks. We have an ER Nurse, me (re certifying) and some folks with AHA First Aid. We have found that, since our medical team will be providing incidental medical services, as opposed to operating a clinic as a part of the ministry, we are covered for what we do to provide immediately necessary medical treatments. Additionally, no one is getting paid for participating in our response team. Therefore, Good-Sam laws cover us in our state. Got that in hand... Haven't thought of that... I did contact the EMS director ... shall we say, cranial-anal impaction. see above. Hey, everyone, thanks for the input!

Thanks. Most of the kids I'm talking about are indigent and do not have cell phones. While their parents may have a phone somewhere, it is likely that their phone number may change every month and we may not have the correct telephone number for them on file. It is also likely that the parent may be as much as 45 minutes away, if they are home when we get there. Also, there is little doubt that we would call EMS in the event of any injury or illness which is even slightly more than minor. The question is in how to respond to the very minor injuries. The county I worked for had a policy of transporting any person under the age of eighteen, unless a guardian could be located to refuse transport. This was a complete waste! Are you suggesting we defer every injury (skinned knee) or illness to EMS? That would seem like a waste of resources. My quandary is in finding that balance between a need for EMS and a waste of resources, then defining that line in a policy which would protect the church. The other issue is in defining minor. My perception of a "minor injury" would be different than the perception of one of my team members who has had no experience. Thanks!

Our church has a security focus and is getting a focus on providing for emergent medical needs. As the only one with any real experience in the area, I have been drafted to lead the medical team. So, at the moment, we are working on developing policies for this medical team. I am writing because I have a policy question. We have a regular congregation of about 450 people. During revivals and other special services, attendance may reach 550-600. In addition to that, we run buses and bring in an additional 250-300 children. These children are predominately from impoverished / low income areas. We plan to incorporate ‘consent to treat’ into the standard permission form these children’s guardian sign already. My question is: when we cannot locate a guardian, when should we call EMS? Of course, with that many kids running around, we have the usual bumps and bruises which really do not require EMS, but without parental input, should we make that call? Over the last year, we have had two incidents which I feel required a little more care than was provided. One was a 5 year old who ran into the corner of a table. He had a small (about .5cm) head laceration with a small hematoma. He was scooped up and taken home to mommie. The other was a sixteen year old female who was brought to me complaining of chest pain and shortness of breath. She had a good, strong and regular pulse, no obvious respiratory distress, no sign of apnea, etc. Against my better judgment, we drove her home also. What if the head lac represented and underlying head injury? What if the chest pain was more serious? We would have been sued! I have spoken to our local EMS director seeking guidelines, but the only answer I could get from him was, if you have any doubt, call 911. Well, I obviously don’t want to abuse EMS. However, it is often difficult to locate a guardian for these bus kids. So, if we cannot locate a guardian, and there is a seemingly minor complaint, what would you do? What guidelines would you suggest for activating EMS as opposed to treating and releasing a minor child. I would like to put a policy in place which does not require any thought, at all, on behalf of our responders. As I said, I don’t want to abuse EMS, but I am also looking for a way to defer liability from our church. My thinking is: if EMS shows up and recommends no transport, it becomes their decision (and liability), not ours. However, that leaves us with the prospect of our church being labeled as an abuser and potentially displacing a truck which could respond to a serious call. Our church is in the middle of nowhere, on the county (and state) line. Assuming everything is in place, the nearest BLS crew is 10 minutes away, the nearest ALS crew is 15-20 minutes out. Also, how does your service handle minors when you cannot locate a guardian?

So, when you show up at someone's house and they say, "I had a run of PVC's a few minutes ago, see..." as they show you their strip, what will you do? Seriously, what are your thoughts of these little hand-held EKG's getting around? Should the average lay-person have one? Click here... and here...

Congratulations!

Around here, and EMT-P starts at about half that.

To funny ... Maybe we need a new thread called: Fresh Underwear Moments...

Hmmm, I see thousands of dollars swirling down the toilet.

No, I don't think so. If a part of the job is wearing a uniform, then the applicant should be able to be uniform. If part of the job description is presenting a professional appearance, then the applicants should expect their appearance to be evaluated at the interview.

It will also depend on what level of RN you're wanting to get. If you're primarily interested in working in the street, focus on becoming the best EMTB or I you can. From there, get the EMT-P and some more experience. Then you may want to start looking at a paramedic - RN bridge program. I don't know about other areas, but around here, govco is only interested in providing the bare minimum necessary crew required. That amounts to a Paramedic who makes about $24k and one other warm body - maybe a basic, maybe more, maybe less. I heard of one call in North Carolina where EMS drafted a bystander (not one of the three dozen firefighters at the car-accident, not one of the PD, but a bystander) to drive the ambulance. "Hey you, slack-jaw, come drive for us." Don't believe me? Click here for the story... There is certainly more money in nursing and EMS is a good start. But, I'd say take the time to get the experience. If you're interested in being the best healthcare provider you can be, you'll learn more in the street than you will ever learn in a classroom.

PENS ... carry one for yourself (that you never EVER allow anyone else to touch and that you never EVER touch with a gloved hand) and one for everyone else on your person. Keep an extra BOX of disposable pens in the truck. NEVER NEVER NEVER chew on your disposable pen. Strangely enough, the guy who taught me the concept of a having a disposable pen would chew on whatever pen he happened to have in his hand. Eeeeeeeeeeeeeeeeeeewwwwwwwwwwwwah I like the Littman scopes ... Amazon for about $40.

What was the funniest thing that ever happened to you on a call? Not necessarily with the patients, but just weird stuff - funny accidents, equipment failures, etc. For me, the one that stands out is this... I was riding with the burnt-out Senior-Paramedic who was stressing over his divorce. He was bitter and I suspect he was supplementing his energy with street-corner pharmaceuticals. Anyway, we caught a car accident with entrapment. Our relationship with fire was, at best, bad. So, we did most of our own extrication's. This would be no exception. In addition to all the medical supplies, we carried a various hand tools, hurst power unit, o-cutter, spreader, ram, airbags and a 20lb dry chem extinguisher. In the late 80's the power modules for the strobes took up the better part of one compartment on the truck. So, packing everything in the truck was an interesting puzzle. We did the extrication, packaged our patient and loaded her up. Got almost all the gear back in the truck (it was late at night) and was about to pull off when the police officer asked, "What do I do with this?" He still had the extinguisher. We couldn't figure out how to get it into the compartment it was supposed to go into, so, we set it at the foot of the stretcher. Do you see where this is going? When we got to the ER, I had to move the extinguisher to get the stretcher out. Did I mention the PD pulled and lost the pin to the extinguisher? The patient was on 100% O2, so it didn't bother her, but my partner cussed for about a week. I don't think I ever got all the yellow power out of that truck. Looking back, it's funny but it wasn't funny then.

I honestly think it is crazy to think that one's status is more relevant than their ability to do their job. I certainly do not intend this next statement to sound offensive or sexist in any way. So, please take it in the intended spirit, K? At 5'9" and 270lbs (before you whine, I'm down from >340, with a goal of 220), if I am unconscious in my burning home, I really don't want the affirmative action whatever who doesn't weigh as much as his/her/its gear coming in to get me. IMHO, qualifications for a firefighter should include being able to move a victim out of a building. If the firefighter is able to drag me out, I don't really care what their gender is. Likewise, if I slip into a diabetic coma, I hope whoever shows up can find a vein - how they voted in the last election is irrelevant. However, there is also a uniform to wear. If you are wearing that uniform, you should be uniform. One reason for the uniform is identity another is professionalism. One local volunteer rescue squad is not allowed on the property of a local factory. Why? Some of them have showed up in torn T-Shirts, pajamas, etc. The assumption is that if you cannot take a moment to look professional, how can you act professional. Personally, I believe the volunteer rescue squad should be cut a little slack, but I also think they can look a little better. How hard would it be to roll out of bed into turnout pants? So, if you're in uniform and you have chandeliers hanging from your ears, you're not looking very professional. Tat's are a little different. But seriously, if I'm interviewing and your piercings set off the metal detectors as you drive by the airport on the way to our meeting, don't be surprised if you don't get the job. Now that I have successfully offended everyone (hopefully not), the point is: qualifications and ability should determine job placement and advancement. Nothing more.

In a lot of ways, I am pretty fanatical about what I believe. I am the type to give the kid at the drive-through a tract, and you don't have to spend a lot of time around me to know what I believe. However, there is some importance to knowing your audience. Who knows if I will see that kid again. However, if I get to build a relationship with people, I hope attributes of who I am will have an effect on those people. Plus (along the theme of knowing your audience), the message I would deliver from behind a pulpit is far different than the conversations I hope to have as a Chaplain.

Hey, I appreciate the honesty. I can take an honest, sincere answer a lot better than I can tolerate outright abuse. To alleviate some of the concerns, I understand that everyone does not hold to the same values and faith I do. I certainly hope the opportunity would present itself where I could offer someone an evangelistic answer to their question. However, I don't expect my outreach to primarily be evangelistic. In any case, the answer would be a response to a question. I have no intentions of arriving somewhere (call, squad bay, whatever) and start preaching. I am actually working toward getting the certifications back, including the EMT-P. I will also have the Bible College complete as well as official CISM training. Yes, my answers to stress, CISM, etc. will be more Bible based than not. However, I completely understand that people have different coping mechanisms. I don't have to agree with someone getting plastered after a bad shift any more than any of you have to agree that my prayer, reflection and study are effective coping methods. My goal is to be a help to those who lean the same way I do. I suppose what I am saying is that the chaplain should be an option which is available. The beauty of the U.S. is that it does still have a few freedoms, including freedom to worship as we see fit, or not at all. If I am allowed to wear a uniform, I suspect it will come with restrictions which generally fit what I have already described. As I said, I intend to be fully re-certified. So, I wouldn't be dead weight. Again, I appreciate the honest input so far. What about the rest of you.

So, I am thinking about becoming a Chaplain and I have a few questions... Does your service have one? What would you expect from a Chaplain? What would you ant from a Chaplain? Thanks for your sincere answers!

Well, back when I was in the street, we worked 24 on 48 off. Technically, we had sleeping quarters, but it was not uncommon for the down-town units to work 25-30 or more calls in one shift. So, yea, there were beds, but who could actually use them? No No and no. I have actually been questioned about paperwork on calls that I simply could not remember.

Thanks. Great questions. Why? Well, to answer that question requires a little bit of a history lesson. I originally got in after I joined a rural VFD in 1988. They encouraged me to get my EMT-B. Once I got that, I got a job in the city and progressed. So, fast forward a few years. In 1991, I realized that, as a young man in my early twenties, I was not emotionally equipped to deal with some of the things I encountered. So, that realization combined with some circumstances resulted in my leaving EMS. A short time after I left EMS, I found Jesus - I was saved. A few years later, I realized God was calling me into the ministry. So, I've been doing different things since then, including some things a preacher shouldn't. I've been happily married for fourteen years and have two wonderful kids. In August of 2009, I restarted the quest for the degree from Bible college. Basically, Bible college is four years of studying the Bible, learning techniques of preaching, church management, counseling, Greek (ugh), Biblical history, etc. I am compacting the four-year degree into three years with no Greek (yea!). So, here I am. Over the last few months, I have come to two conclusions: first, the only vocation I have every really been good at in my adult life is EMS. Second, I believe the Lord is leading me to start a Chaplaincy for the county in which I currently reside. In time, I may expand to two neighboring rural counties. So, why a Chaplaincy? The obvious is to provide counseling to the medics. Yes, they can go talk to their own Pastors. However, how many of you have a Pastor or someone outside of EMS who really understands what you do? I mean, seriously understands what you do - not the TV fiction of saving the day at the last second, but real life? Second: I believe I was good at what I did, and I believe I could be good at it again. I remember happening upon an accident and waiting until EMS arrived. One victim had an obvious humerus fracture and, being alert, was screaming in the obvious pain. When EMS arrived, one of the crew-members yelled at the patient to shut-up. At that moment, I wanted to break the medic's arm to see how he would tolerate the pain. However, I realized he had the same attitude I once had. The same cold, dispassionate, morbid, you interrupted my lunch attitude I once had. I hope that I will be in a position to help people understand that the day EMS shows up at your door is likely the worst day of your life (unless you're a regular or a drunk). Second, of course, CISM Third, there will be circumstances when a Chaplain may be able to provide comfort and understanding to families. Ultimately, why? Because it is what I believe may be a calling by God upon my life. Richard, When was I in EMS? 1988-1991. Where? South Carolina. Why Chappy? Seems like a short, friendly nickname for the Chaplain. Maybe it'll stick, maybe not. I don't suppose I am a friend of ten-codes. I definitely see the advantage of plain-speech as well.

Mike, you said it, but really, what does it matter? Where I worked, and every EMS, fire and police department I worked with in SC used 10-8 as back in service. Big deal, calm down and lets move on. It was intended to be a light-hearted way of saying, "I'm coming back." It certainly was not supposed to incite some drama-filled debate.