paramedicmike

Wasn't trying to be. I'm familiar with spider bites. The story was a curious one as what was presented isn't common among those who report them.

Perhaps some additional reading from sources other than your medic book is in order. If you have a subscription or access to UpToDate you'll find a pretty good discussion regarding alleged spider bites. Also, some spiders get aggressive when threatened. They aren't blood suckers. They don't go looking for people to bite regardless of the time of year.

Spiders get a bad rap. Most spiders, with a few notable exceptions, in the US can't actually bite people. To diagnose a spider bite three things are generally needed: 1. A witnessed bite 2. Positive identification of the spider (usually entomologist or arachnologist) 3. Exclusion of other possible causes Usually, if there are multiple lesions present that can exclude a spider bite as bites are usually single lesions. Without knowing more specifically the circumstances surrounding out intrepid OP, of course, it's all speculation. Regardless, I agree with MikeyMedic that it's good you're on the mend.

Well, that somewhat explains the wide net they're throwing. Unfortunately, it doesn't shed any light on what actually happened. I agree that it's curious the cause of death wasn't released.

Throw a wide net and see what you catch?

Hello. With restrictions and based on local law and law enforcement practices. Not if they're competent to refuse you can't. Perhaps you should be asking the State of Florida what they require. You're welcome.

Welcome.

What kind of "internal use only"?

We don't set the path. That you don't like the path is not the point. The path is what it is. If this is what you want to do you will follow the path. What's more, that you don't like the comments that you solicited doesn't make any of them wrong. Nobody has belittled your service. Nor does your military service have anything to do with what you don't like in the civilian world. Good for you. Just like the Army trained you their way to do their job, civilian EMS trains you to do things their way in their job. It's no different. Want to do the job? You earn it. You may have little experience with this yet, but EMS has a pretty bad rap for people wanting things for nothing. It hurts the profession when people take shortcuts or try to beat the system. There are times when a workaround to solve a problem can be a good thing. When it comes to education, however, it creates bigger problems. What's interesting here is that you have no idea who you're talking to. You don't know our backgrounds, our experiences, our education, where we've been or what we've done. Yet you're presuming an awful lot. What's more interesting is that just about every combat vet I know or work with none of them make a big deal about it. Downplay it, even. It's the loud one's you need to look out for.

Yes. That is what you earned. The certification you earned is an EMT-B. That it has some extra technical skills thrown in is inconsequential. Maybe it'll help people down the road if they pursue advanced education. In the military you do one thing. It doesn't translate to the civilian world. Don't like it? I don't make the rules. I'm well aware of the job of a 68W in a combat setting. I'm well aware of the job of a 68W in a non-combat setting. In the Army you were a 68W - Health Care Specialist. That's not 68W Combat Medic. That 68W - Health Care Specialist. You do the job you are assigned to do whether that be with an infantry unit, MP unit or hospital unit. You're confusing training of technical skills with critical thinking. You are trained to react. You are trained to do certain things in a certain environment. If you take the time to think you and the soldiers you are trying to protect will die. Technical training to perform technical skills, rather like a monkey can be trained to do, is still training. There's a difference. That's why AIT is called training. Capable of understanding what you lack? Perhaps. But it's still lacking. Don't want to come up short? Go to paramedic school just like every other paramedic out there. Are there some who've taken the initiative to learn more, do more, educate themselves while in the military? Yes. Do these guys get out with civilian certifications that let them work in the civilian world? You bet. Does a 68W getting out of the military with an EMT-B certification meet those standards? No. Want to do more? Gotta earn the education first. Does that mean these guys, including you, would need to go to paramedic school to earn it? Yes. So the Army is dragging off retirees to combat? The title of your thread specifies combat medics. The military, by and large, does not send people off to combat who are unhealthy or unwell with chronic medical conditions that would put a single soldier's, or group of soldiers, life (lives) in danger. Do things develop on deployment? Sure. What do you do then? Send them to your PA/MD/DO staff. Will you help with the technical skills? Blood draws? Immunizations? Lab work? Sure. But that's all it is... technical skills. And before you blow another gasket you're taking things that were not meant personally awfully personally. That you are unable to separate comments you asked for from a personal attack is, unfortunately, pretty telling. You asked for opinions. You got one. 68Ws getting out of the military with an EMT-B card need to go to paramedic school if they want to operate as a paramedic in the civilian world. The advantage they have getting out of the military is already having an EMT-B (if it was kept current and expiration wasn't timed with the soldier's ETS date) and the GI Bill to help pay for it.

If separating service members maintain their EMT-B then that's the level at which they should be certified. If they let it expire, however, then it's expired, and they leave with nothing. Yes. The focus is on trauma for obvious reasons. Unfortunately, you just provided a list of technical skills. Anybody can be trained to do them. There's not much behind a list of technical skills if there's no critical thinking component behind it. And this is exactly where your problem lies. You have no idea what you don't know. You think you received training. You did not necessarily receive an education. There is a difference. The focus on trauma skills does not automatically transfer to civilian thinking EMS. There's a difference between the two environments and the training reflects that difference. In the military you're dealing with, and the training reflects, an otherwise young, healthy, free from chronic conditions population in a combat trauma setting. You're not dealing with ongoing medical conditions in an aging population with a lengthy list of comorbid medical factors. Of course, this is assuming that an Army 68W was assigned as a medic to a combat unit. The MOS can wind up being assigned to any variety of healthcare or even non-direct healthcare work environments. I believe the same applies for the Navy and Air Force as well. So, a straight transition from military medical technician is not a wise choice in this case. Transitioning is easily done, though. Veterans hiring preference can help vets get jobs. GI Bill funding can help with educational and career prep once separated from the military. Should a vet decide to pursue civilian EMS education, PA education, nursing education, medical education, there are tools in place to help that vet succeed.

I don't know if you've mentioned your location before. If you have I've just plain missed it. You've recently asked a lot of good questions. However, the fact that you're in New Jersey is part of the problem you're facing. In fact, I'd go so far as to say it is a HUGE part of your problem. New Jersey does something right. I like that they require ALS to be hospital based. After all, this is medicine. The First Aid Council full of jolly volly good ole boys running the BLS side of things, however, is an example of what not to do. Things are starting to make more sense now.

To be fair there is a difference in being a leader versus being a manager. Perhaps you could agree upon which of the two terms you best think fits and move forward from there.

Come again? How does this work? So are you arguing that providers in another service should be held to the standards set by your service? On what grounds are you basing this argument? Focus on those things to which you can reasonably apply yourself. Other services have their own management structure, their own medical command structure and their own standards to which you are not held because you don't work there. If you don't trust providers in another service there's very little you can do organizationally to change that short of getting involved in that organization. Yes. I think this is absolutely true because nothing you have posted since your OP has followed a logical train of thought. It may make sense in your own head. However, you're not coming across very clearly here. This isn't a matter of what we all feel. Are you seriously going to base your decisions on what we all feel? Stand up for your own positions. Be able to defend them and your actions if asked. Do the right thing for the right reason at the right time. Who cares what other people do? As I noted earlier, this has nothing to do with the question you asked in the OP. You need to make the best decisions for you. Do you want to stay where you are? Then stay there. Do the best job you can. Succeed. Do you want to change your focus to a 911 environment? Then change your focus and move to 911. I get the feeling you're trying to bait an argument here. Based on what I'm reading from your comments the only person who can answer your questions is you. Do what *you* need to do.

I think you missed it: she had prostate cancer? Are you sure?

With that kind of diagnosis I can imagine she would be in pretty significant pain.

So what's really your question? What would be a better course of action for you and your career? Or is it something else? Why are you concerned about who may be better at something than someone else? Why aren't you worried about you being good at what you do no matter what type of patient you have in front of you? I don't understand your concern about who is better when looking at a 911 versus interfacility and how it plays in to your decision to move into management or move into a 911 environment.

Locally, someone who is on pain management for a chronic condition has a contract with their pain management provider (who is generally not their PCP). Should a chronic pain patient present to the ER I can treat the acute pain. I cannot give them a prescription for narcotics. So when a pain management patient with a chronic pain condition presents to the ER with a story, no matter how true, that they don't have any more of their pain meds I can treat them acutely and that's all I can do. They don't get a script from me. If they want more they need to see their pain management provider. What's more, a copy of their discharge paperwork is automatically forwarded to their pain management provider. (All of this being said I have more resources in the ER for tracking down prescription history, medical history, past visits and more than what is available on the ambulance. Figuring out if someone is seeking can be somewhat easier in this setting.) When I'm working on an ambulance I am a lot more liberal with pain medication than some of my coworkers. Some pain complaints are easy. Others are more nebulous. I'll investigate the more nebulous complaints a little more thoroughly in those cases. But I won't refuse someone pain medication simply because their vitals are normal (there's enough literature out there to be pretty clear on this point). This is where assessment skills come into play. A complicating factor on the ambulance is that in many places it's either narcotic pain medication or nothing. Not that a non-narcotic pain medication, with the exception of nitrous, is going to kick in fast enough for most transports. It's a tough position in which to find yourself. From a pre-hospital perspective I'm more concerned with a needlessly painful transport than with supplying an addict/seeker.

This sounds like you're either trying to justify one is better than the other or looking for information to help bolster your argument with your coworkers that one is better than the other. Care to clarify?

Welcome.

Welcome. 1. Sometimes. 2. Why are you purposefully inflicting pain on someone? Especially on someone who is, as you describe, conscious? 3. I do the best I can all the time. This usually means ignoring the gossip. 4. Ignore the others. Take a vacation. You're burning yourself out. 5. Because your diet needs a lot of work. 6. Yes. 7. Grow up. Tell your partner to grow up, also.

Welcome. You'll find a good group here willing to help out. However, you need to put in a good faith effort to get answers yourself before people here will help you. When asking questions you will do much better to begin by telling us what you found in your research prior to getting to your question. That way we know you're at least trying. This has come up several times. People here are willing to help. They're not willing to do your work for you.

Because we're not cops.

Medication errors affect everyone differently. The effects of medications can vary widely. Establish a double check system. One place I worked encouraged two people checking meds when possible. Were one person to give a medication it would be verbalized and visually identified by both providers (assuming dual medic coverage). If the other provider drew up the medication both the syringe and the medication vial were handed to the person administering the medication to verify. Working as a single medic I just got in the habit of saying everything out loud like I was explaining things to the patient. For example, as I was drawing up medication I would say, "Ok, I'm going to give you medication X. You're going to get Y amount of it which works out to be <volume>. This will help with <complaint>." Sometimes they care. Sometimes they don't. It can be a good habit to get in to. At least, it works for me, anyway. Reported medication errors are usually handled as part of the QA/QI process. Sometimes, depending on the situation it can be as simple as a "...pay more attention...". Other times, if an education or knowledge deficiency is determined (e.g. new medication or not one commonly used), more educational follow up can be mandated. How common are med errors in EMS? I don't know. Do you have any resources on the subject?

There is a time and place for everything. Figuring out that time and place will come with experience. As Mikeymedic said if your partner(s) is/are obviously killing a patient then the time and place to say something is right then and there. Otherwise, if you're not running the call watch, learn, observe. Suggestions as questions, (e.g. "Hey, do you want me to splint this obviously deformed and fractured arm?") can be a good, non-confrontational way to get involved. Understand that you might be told "No". Being the new guy is a tough position in which to find yourself. Part of gaining experience in this field, however, comes with learning how to be a good partner. This position is different from taking the lead on a call. You don't have to, and most likely won't, lead every call. Learn from each call. Be patient. Continue being involved. As you build experience you'll do more, get more involved, earn the trust of the others there.