paramedicmike

I think that was a shot directed at Kiwi.

Welcome.

Fair points of which I'm aware. But it's the Holidays. I'm trying to give the benefit of the doubt.

Welcome, Akulahawk. The good Doctor is correct. Admin really does a good job with site management from a content perspective. (This is not to say he doesn't do a good job with other aspects of site management... because he does.) I believe such limited moderative meddling, as opposed to other topic discussion forums, is an asset. Sure, discussions get interesting from time to time but so does life. It's not always unicorn tears and rainbows. So jump in. Have fun.

Well, to be fair to Mike, I think it depends on where you are. For example, one place (mixed suburban/major metro area) I worked hired a guy who had no previous 911 experience. He had only worked on IFT ambulances. Not even a critical care ambulance... Just routine, run of the mill transports. We were dropping off a patient once while he was still orienting and we ran into his former transport cronies who did the same thing Mike described previously for an otherwise run of the mill patient: <all with stars in their eyes> "You're working 911? How'd you land that? Will they hire me? Did you start that line? Did you have to bag the patient? What's it like running lights and sirens?... That must be *awesome*!" The new guy was eating it up. My partner and I were beside ourselves laughing. Yes, my n=1 doesn't do much to support or detract from Mike's argument. However, perhaps it's a system mindset where you get a lot of transport guys who see nothing but dialysis transfers and routine ambulance transfers. At that point anything out of the ordinary could elicit the type of response Mike reported. Most of us don't see it as anything unusual because we've either done it before or do it with enough routine that it's just another day at work. But to the new guy stuck in IFT hell who had dreams of glory working on an ambulance and saving lives it could be a big deal. Of course, I have limited knowledge of the transport logistics of the greater Seattle area so I don't know for sure if what I've experienced in a different area actually exists in Mike's area. So he legitimately might be trying to blow smoke up our collective asses.

That doesn't mean he's learned how important it is to get regular sleep. Falling asleep at the drop of a hat could be a symptom of chronic sleep deprivation.

I hope you learned how important sleep is and how dangerous it is being awake and trying to work, never mind drive, for that long.

Try this link.

Excellent question.

Have you ever started an IO on a conscious patient?

It sounds like you're looking forward to it. You're not going to know what to do with yourself.

Though this may be true, they still have to cater to the lowest common denominator.

Interesting concept. What's your take? There could be pros and cons to something like this idea.

Welcome.

This. I made it all of about 10 seconds before turning that off.

King County Medic One in Washington State. Not Kansas City, Missouri.

Here's a recent article published by Bryan Bledsoe regarding the use of LSBs in EMS. At the end of the article is a good list of sources for further research. Maryland EMS is a unique beast. The Maryland Way used to be, at one time, the way to do things. Unfortunately, many EMS providers in the state still live in that same mindset simply because "...that's the way we've always done it...". Be smart. Do your research. Respectfully challenge what you can when you have the evidence to back it up. Be smart about what you're doing. As was already mentioned, don't let yourself be a protocol monkey. That's a common mindset in Maryland. It's tough to be an independent thinker.

My old partner works out there now. No matter your current education or experience, if you want to be a KCMO paramedic you go to their paramedic school. It is an extremely competitive hiring process. What can you do now? Focus on your education. A well rounded education encompassing a solid science foundation along with a good liberal arts balance will help mold you into someone who both knows the medicine but also knows how to deal/work with people. Also, learn how to play and play well. It's all about balance.

More photos here.

It can also go IN. More food for thought.

Just to clarify are you a paramedic student? Or are you a paramedic? Have you taken ACLS yet? Answers to these will help frame answers from here on out. What was your impression of this guy? Was he sick? Or not sick? Stable? Not stable? You decided not to cardiovert him. Why? What was your thinking?

Ok. So tell us what you did and we'll tell you what we think.

Ah yes. The S-76. I loved working in that air frame. I've worked in Sprinters, too. It was a nice ride up front. They were a little cramped in the back.

I think you're making your point pretty well and I agree with what you've said. The comment you quoted was based on the thought that upwards of 60% of EMS transported patients, based on the study in the OP, wind up admitted (system dependent). While the time critical cases are, indeed, few and far between compared to the more run of the mill calls, the acuity is still there. Further breaking down those admits to an ED Obs versus floor admit versus ICU admit et cetera, from an academic point of view, would be interesting to analyze in light of EMS education and how to improve upon it based on what we're actually seeing. Perhaps it was me who wasn't expressing thoughts clearly. I'm still not sure that I am. It wouldn't be the first time it happened. Maybe I just need to go to sleep.

Depending on where you are patients are boarded in the ER simply because there are no beds available up on the units. This isn't the ER holding on to these patients. This is simply a lack of availability of beds in the unit. The ER wants these patients out as soon as possible. It serves no purpose to keep and board these admissions in the ER. It takes up a bed that can be used to assess and treat someone else. It also ties up nurses taking care of patients that need floor/ICU nursing care. The ER in which I work hates boarding patients where they were initially seen. It affects metrics that hospital administration uses to gauge effectiveness of the staff, satisfaction scores, billing and more. Don't think we don't hear about it (even though it's not our fault and there's little we can do about it). And it's a drain of ER resources. I can't speak to the politics of your wife's hospital. But there has to be more to it than the ER holding on to people. This comment had me thinking. Sure. Very few of our patients may not be time critical. However, given the number of admissions from EMS delivered patients that still indicates a pretty decent level of patient acuity. I think it would be interesting to note just how acute some of the patients are and break down the time critical cases versus not time critical cases. How do these differences play into the larger role of EMS, EMS education and our future direction as health care providers?