AnthonyM83

I suppose I had a different experience with my classmates. My class of 15 was made up of people in their 30s with stable respectable jobs and full-time CC students who knew the career they wanted to get into (Nursing, FF..), as well as a couple HS students with med school plans. I was the odd one out, having just graduated college and working several part-time jobs/internships/trainings allowed me to slack a bit on those and immerse myself in the EMS/Medical world. I also know the relaxed attitude on professionalism allowed everyone to look forward to this class (for several people it was their weekly highlight). I believe that part was appropriate to our class. I wish the relaxed attitude on depth of structure & medical material on part of the instructors was NOT so, though. I believe it was enough to get into the field (our instructor would definitely know), but not enough to be immersed in it. NOW, after Dustdevil &Cookie's posts, though, I see there is a DEFINITE need for more stringent professionalism requirements in some areas. I agree Dustdevil that it would be doing those youths a disservice. I think the ideal would be for schools/instructors to self-callibrate for each class, but that might not be plausible.

I like the overall principles that argument is pushing. I think something that would help promote these things is making EMTB classes a bit more challenging, in some places. My class did not have any homework (except for write-ups of our clinical rotations) or extra assignments. No presentations or outside research. Very lax. Didn't go very in-depth on most medical topics. I don't know about dressing up for class, though...not even medical students do that (it's mainly casualwear & PJs). Most people in my class would be completely fascinated by class in whatever they were wearing...though it could be argued dressing up would increase importance even more? Something else inhibiting total immersion in the subject is the outside commitments people have. Out of my class, some were in high school (so they're schedule was packed with homework), others were in jobs with rough schedules (more than a 9-5, flying for business, studying for MCATS), many weren't immediatley going to practice EMT (prepping for anothe career). In fact, I think there were 3 or less (out of 15) who was planning to go right into working as an actual EMT (on an ambulance). Just throwing some thoughts out there...

Neb.EMT, I remember getting similar feedback when I did my clinicals. Apparently, they were used to students jumping in without being asked. My fear was doing something that didn't need to be done (when I did try to help, like getting a patient some water when he asked, I got in trouble). BUT if the ER Tech or Nurse had just told me, jump in and do whatever you think needs to be done, I'll be here watching to stop you if you shouldn't do it or doing it wrong, I would have been all over it. I also agree that assigning her as primary to a call would help her a lot. Even during trainings, I'll be much more aggressive when put as primary, because it's like I am now allowed to make my own decisions.

I know this is an aside, but I wonder how they're mortality/morbidity rates compare to the US for patients treated by an ambulance crew.

What exactly is tactical medical training and what is it used for? Is this for working as part of a law enforcement team and being on-standby during stand-offs? Or is it part teaching tactical positioning, self-defense, and so on for regular street medics? Or other?

You might also consider that possibility that you might not get along in a professional setting as well as you do in a personal or even classroom setting. The whole don't move in with your best from high school in college b/c you end up getting on each other's nerves principle. I've had a girlfriend I loved dearly out of work, but at work I couldn't stand her and would have chewed her out had she been someone else. Didn't like that situation at all. It's also cool to have different friends from work to have different things to share with each other after work (like the other guy said).

I just learned about a new service they're putting in place here for EDP calls: http://www.co.sanmateo.ca.us/smc/departmen...9831632,00.html There will be a special AMR vehicle for behavioral code 2 transports, taking care of the paper work. For emergency psychiatric holds, officers will still do that themselves, but now they have another option for Code 2 holds and (hopefully) won't have to wait forever on-scene for the one BLS ambulance sometimes available on the other side of the county.

Around here it tends to depend on the situation. If the patient is combative the PD will take them. If the patient is resistive, but not actively combative, they might just be strapped to the gurney and a police car with follow the ambulance. If patient is cooperative, they'll go with the ambulance and the officer will meet EMS at the hospital. I imagine a cop would feel uncomfortable being enclosed with a subject in an ambulance, instead of in their backseat....

I like the way you put that Mike. I do want to explain that EMT instructors taught me about informed consent, but police officers taught me the legal stuff. Officer safety is my number one priority. This includes seeing things that could be used as weapons against you if a patient went sideways on you (including your own tools), watching surroundings, non verbal communication from people around you, stances/positioning, exposing self while leaning over or listening to lung sounds so close to a patient, traffic dangers, environmental and non-human dangers) and many more that I'm sure I'll learn when I get out on the road somewhere or hopefully from others on this site.

Kevkei, No offense taken. I understand sometimes one must be blunt in order to get the message across, without meaning disrespect. Especially true in public safety. I want to re-re-re-emphasize that safety is my first priority as well. I don't want anyone to put their safety at jeopardy by not searching someone when they feel it's the best course of action, regardless of legal technicalities. I just want to pass on information I've learned from other trainings. Maybe if you have a patient that looks like he might want to cause you trouble, you'll be sure to do the search in in front of your partner or do extra documentation on why you searched or whatever else to CYA, IF you feel like taking those steps. Or just use the info however you'd like. You decide. Your statement that we'd be guilty of battery on a daily basis is right, but usually don't have to worry about it, right? No harm is done and people usually don't care or are grateful for your contact. IF that contact leads to say, patient being arrested for possession of a firearm or controlled substance, there's the potential for him to try to drag you into his mess to TRY and save himself. Not likely, but in public safety, you tend to deal with the unlikelies a lot more than the general public, right? While I've worked in hostile environments in another public safety capacity, I haven't worked in EMS yet, so I don't mean to tell you it's impolite; rather I just mean to tell you to keep aware. Respectfully, Anthony

Dustdevil, we've been talking about searching without consent, like doing a pat down and removing weapons. If there's consent, then there's no problem. I would also give them that choice: Give consent or wait for police transport. The law doesn't need to be a federal law, because every state has some sort of battery or unlawful touching law. Like I've said before, I don't know the specifics of everyone's laws, so you need to check with local police, DA, etc etc etc. I'm not some expert. I just wanted to share what I thought was an important point to be aware of, but everyone's jumping on me for it. I thought of not even mentioning it, b/c I'm a newbie here and not a great way to start off, but decided it was important enough to at least point it out. Look, I'll provide my law if someone can provide me a law saying you can search and can remove something that might be used as a weapon. Remember, I already said I don't think any police officer would actually arrest for this, but I don't have to tell you how many ridiculously stupid suits have been won on a technicality, so just be aware. (I'd post it right now, but right away I'm going to get debates on what the law really means. I can see it now, a 10 page thread. But the reply will be that it's been explained to me by police officers and instructors several times what the law constitutes. It comes down to touching without permission. We even covered this slightly in EMT class discussing how some EMTs won't hold c-spine before introducing themselves as an EMT and asking permission to treat because it's technically batter...though in that case you can justify it b/c if they do accept treatment they might be injured if they move before accepting treatment.) Sorry for being so awfully wordy.

Kev, The way consent (with normal LOC adult) was explained to me in EMT class was as informed consent. We have to explain each step of treatment, not only because we're being nice, but as a technicality, so that at each step they know what the treatment is and what it's for, so they can continue giving consent (even though they're not actually saying "yes" to each treatment). Now, obviously, there's going to be times when that's not possible, things are moving too quickly, and we just do without. But as explained to me by the instructor (whose position at his Fire Dept. is to investigate complaints/mistakes) consent to treatment is not just a blanket consent without restrictions. The rudimentary patting down for purposes of searching would still not be a treatment and someone could turn it around on you, after the fact. (I'd probably try to disguise it as a full secondary survey.) If it's a psych or EtOH patient, then like I said, I'd think you'd have a pretty good justification if it went to court. If searching if part of your protocols, then it can even fall under a treatment that you had to give and would be covered by implied consent (in my opinion). I like your idea of searching their belongings after they've been removed from them, though...thus not touching them. And again, I think we both agree on the same bottom line. Doing what you have to in order to come home safe. My goal with these posts is just to pass on info and defend EMT100 b/c his statements were technically right on legalities.

I was considering replying with only quotes from my previous posts, because it's pretty much all there, but once again (with elaboration): I'm in California. Searching without consent would be a violation of California Penal Code 242 (battery). You are touching them without consent. They might be giving informed consent to treatment, but not to touch them by searching their pockets or patting them down for weapons or removing weapons. You wouldn't be violating an unlawful search law; you'd be violating a battery law. What I admitted was that there might be CASE LAW which I'm not aware of where someone rendering aid may have already been brought to court for conducting a search and the court deemed that the search was okay in those circumstances. I'm not a lawyer and haven't researched this topic at all, so we're just going off what normal state law says. If someone thinks EMS is an exception, they have the burden of proof of showing there's a law, caselaw, court precedent, or other that makes provisions for them. I know what I'm basing my comments off of, but I don't know what everyone else is basing theirs off of. Furthermore, I hope everyone takes their safety into consideration first and remember the saying: Better to be judged by 12 than carried by 6. I just want people to be informed about POSSIBLE consequences when searching the fine suit-happy members of our society.

Well, you directed your post to " those of you that are nieve enough to think it is illegal to "search' someones pockets " and I had just made the statement that it was illegal, so I thought you were replying to my post. My apologies then. I hear you that lawsuits are common, nowadays, but in this case, the patient can actually say you were violating the law, and he'd be correct. So, for those times that you will find yourself in when you need to search someone for safety reasons, be aware that you're breaking the law (but with good reason) and that someone could bring actions against you. No one is saying not to be safe and my goal here isn't an argument. Simply reminding people that this common practice is technically illegal, so they might want to consider other options IF possible. Oftentimes it's won't be, so just do it with caution. I really just wanted to share the legal aspect of this discussion. PS These is based on laws in my state, as best I know them, not taking into account any case law that might exist that I'm not aware of.

Reread my last post. The threat isn't DA or police, it's the patient deciding to sue. Sometimes there's going to be cases where you might have to search patient anyway, for the safety of everyone, but you should be aware of the low possibility of future legal reprecussions. Hey, you might end up winning and creating case law in our favor, but just be aware of the law. One of the things I can think of that will save you is if it's an implied consent treatment (Suicidal, Under the Influence, Altered LOC). They can't refuse treatment and you would have searched in order to treat them, thus implied consent might cover searching them. Protocols such will come into play during the case, but unless there's caselaw on that, you can't count on that as a defense.

EMT100, I was waiting for someone to bring up this issue as I read through the thread. You posted pretty much exactly what I was going to say, including the two options. Guys, we can't just start searching someone without permission. If I was standing on a street corner and a guy started going through my pockets, he'd be going to jail for assault or battery (after the trip to the ER). I realize that you guys are talking about searching a patient for a call you've been dispatched to, but I don't think there's a specific law saying EMS personnel can search patients. The burden of proof isn't on EMT100. You guys each have to consult with local law, case law, local LE, wording of your EDP/involuntary psych hold laws, your medical director, protocols, or state DA, because while you certainly won't be arrested (b/c the cops understand why you're searching), the patients can bring action against you, later, because they has a law backing them up (242 P.C. in Calif.). Most patients wouldn't want to do this, but if they ended up going to jail b/c of something you found, they might choose to pull you into their mess to try and save themselves.

Do you mean when you're travelling lights & sirens or for all transports? LIZARD, I'm sure the gloves do work, but I think it'd be a pain to put them on and off each time, as well as to carry them with you. I don't think they fold nicely into a pouch.

I believe you do have to include cost of prosecution in this case, because those extra costs are so high and common (pretty much guaranteed to happen). Using your metaphor, I believe it's smart to add in cost of gas and insurance when weighing pros and cons of getting a car and when budgeting. And while, it might not be cost effective to prosecute anyone at all for most crimes, we continue to do it because monetary cost isn't everything. It's one factor in many things. Another factor would be keeping a sense of order in our country. In similar fashion, cost of executions is only one factor in whether we should have a death penalty. The reason it's brought up so often, is because it's so much higher in death sentences (even compared to life sentences).