paramedicmike

Dude. I am sincerely glad to hear you're still out there, kicking and doing well. I do hope this means we'll start seeing more of you around here again.

Hey man! I wondered what happened to you. Glad to see you're still out there and doing good in the world. When did you finish residency? How've you been?

Vent seemed to have some issues that came through in her posts. AK called her out on a bunch of stuff when it started. She's come back a few times under various pseudonyms usually to demonstrate some pretty angry behavior only to get called out again.

He left a message at one point saying that he was stepping away from the site. Tried to find it but don't have a lot of time to dig for it at the moment. Looks like he last stopped in sometime last year.

Codeine products OTC? Interesting. How does that work? How's it regulated? Sounds like it's going away from your statement. Abuse issues with this kind of availability?

All of our folks used to be prescription opioid abusers. We've been clamping down on prescription narcotics for a while now. While we still get some folks who are angling for narcs from the ER it doesn't happen nearly as often as it used to. When oxys and percocets became more expensive due to decreased supply they started going to heroin. Or going back to heroin.

Meth isn't a big thing in my area. I'm in heroin central. Heroin, heroin and more heroin. It's cheap, plentiful and potent. At one of the ERs where I'm working we get pretty regular drive up for the unresponsive respiratory arrest from heroin OD. The few meth patients we have seen can get pretty scary pretty quickly. They'll flip like a switch and become wicked violent. Ketamine has worked well as, similar to your experience, midaz wasn't doing much.

Bushy, Am also glad to see you came out on top. Sounds like an interesting ride. Hope to see you around here more often. 'Zilla, Texas is supposed to be a good practice environment for docs. Congrats on the new gig!

Bushy! It's been way too long, mate. How've you been?

Paramedics don't have the educational foundations to do the things mentioned. Having worked in more than one arena within health care (paramedic and PA) I don't know that EMS providers are necessarily the best people for the interventions that are mentioned. This isn't to say that paramedics can't do those things and more. As Ruff mentioned education is ridiculously poor. This lack of education is a significant barrier. Many of the PAs I work with currently are former EMS providers. Several of them are current EMS providers outside of the ER setting where we work. PAs, and to some extent NPs with an EMS background, would be best suited to work in that community health role doing the things needed to help reduce ER overcrowding and all of the complications that arise from that. Unfortunately, there are barriers to this as well. Who is going to pay for that PA to be out on the street? I guarantee I'm more expensive as a PA than I am as a paramedic. Will call volume change when people realize the "ER will come to them"? How long until that becomes overburdened? There are logistical issues involved, too, never mind the legal issues that need to be considered. The EM group for whom I work has talked about doing a community medicine response with the local 911 providers (both BLS and ALS). There has been talk about putting PAs into a street provider role to start providing care outside of the ER. I'm fortunate to work for a group that employs the state ALS and BLS medical directors as well as the county medical directors who could help make this happen. I've volunteered my services as have several of my colleagues with EMS backgrounds. If anything comes of it I'll keep everyone posted.

Crazy, isn't it? The more you learn the more you realize how little you know. Why stop there, thought? Paramedic school?

Welcome. Picking a topic can be the hardest part of writing a research paper. Good luck deciding on one.

I don't know that I've cooked but I've made sandwiches for people. I've bought food for people. It happens.

We cannot help you. Are you there as security or are you there as EMS? Is this a written protocol that you initiate care or is it just understood that it's something you do? Is it a requirement of your security position that you be an EMT and provide BLS level interventions? You say you won't be operating under any direction. Does this mean you're not there as part of an official BLS response and have no medical director to whom you would answer? There are too many questions here without any answers. From what you've written so far it doesn't sound like you're there as an EMS provider. You admit you have no direction implying no medical direction. It could reasonably be argued that under your current situation, as you have explained it here, you have no obligation to do anything short of immediate life threatening interventions that would be expected of any bystander (e.g. CPR). That being said nobody here knows anything more about your situation. Nobody knows where you are. Nobody knows the legal requirements of where you are. Nobody here can answer your question. You have a legal question. Go ask the legal minds under retainer by the university for whom you work. You cannot reasonably take anything offered by any possible response here to be applicable to your situation short of "go talk to your employer/attorney". Do not rely on anonymous internet responses to an anonymous internet question about how you should apply yourself to any situation with potential legal ramifications. That's a sure fire way for you to get into trouble. How do you respond in your situation? Will you be abandoning a "patient"? Good questions. Go ask your employer and/or employers attorney. Get the best answer for yourself right from the legal folks to whom you will answer should something go wrong.

Welcome back, Dwayne. Glad you're here.

Re: back braces Here's a Cochrane Review of the literature. Probably worth a read. Congrats on passing the test.

Welcome. You're right. No sense worrying about it now. What's done is done. Wait and see what your score turns out to be. Let us know.

Wow. I just realized I wrote my second sentence incredibly poorly. It should say, "It doesn't sound like those who wrote the petition have reviewed the data." Damned double negatives. Anyway, I like Matt's idea of petitioning for higher educational standards. To the topic in the petition I'll agree there are some circumstances, however rare, where intubation is warranted and the need to be proficient improves success. However, until we start considering ourselves to be medical professionals and have the educational and training background to support it we'll continue to be treated like the lights and sirens jockeys we are widely seen to be.

What does the data say? It doesn't sound like those who wrote the petition haven't reviewed the data.

There is nothing wrong with you. There is nothing wrong with seeking help. Sometimes we all need a little extra help with learning new tricks to deal with life. You're on the right track with finding a counselor. There are mental health professionals who work primarily with health care providers. The trick is finding one. If you still have an in with any of your previous medical directors ask them for a name(s). Ask your PCP. You don't have to be asking for you. "Hey, Doc. An old partner of mine is having some trouble dealing with life at the moment. Got any recommendations for a mental health professional who deals with health care providers?" Sometimes finding the right counselor takes a couple of tries. Just don't give up on it. Keep hanging in there.

Condolences to your family, Mike.

Mike, my point wasn't along the lines of fire truck driver vs ambulance driver vs police car driver. It wasn't even disparaging as far as being a driver at all. It was more along the line of the perceived air of superiority demonstrated by the comment implying that driving a fire truck gets OP there first, before the ambulance, therefore somehow that's better.

If NR told you a 24 hour refresher plus written and skills testing was all you needed to renew then go with what NR told you. Despite your concern that EMT class is double what your EMR required that's still less time than many places require for a license to cut hair. A bad haircut never killed anyone. Ambulance crashes have killed people. Poor care, improper care and negligent care have certainly contributed to the death of people. You sound hesitant about additional training because of the time commitment. Why? Why do you feel it necessary to note that you're a fire truck driver getting to scenes before an ambulance? Why is your service so short sighted and financially irresponsible to roll a $500K piece of equipment when that money could be spent on up to five ambulances thereby saving the suppression pieces for actual suppression work?

Welcome. If you're an EMR you're an EMR. Just say you're an EMR. You don't have to specify your Registry designation unless you feel compelled to or it comes up in conversation. You can't say you're an EMT or otherwise because you're not. Just because the patch says "NREMT" means nothing more than you are an EMR as certified by NREMT.

Read this article today. It's an interesting read. He insinuates some cause and effect that he doesn't back with any solid evidence. But the overall message is a good one.