AnthonyM83

Saying that an EMT level of training doesn't allow one to be able to properly decide if ALS is needed isn't a result of large ego. It's a medic's job and an EMT's job to promote the best patient care regardless if it hurts or damages their ego. Detach from who is saying it and how it's being said...and the logi will still stand

I'd like to add a PS to my last post. While we are harsh on certain topics here even though we mean well, I think we should be aware that it can still exclude a lot of newcomers who are perusing this site along with 'other' EMS sites. If we want the site to grow (and ultimately allow the spread of ideas such as furthering EMS profession, etc) we have to have new people rolling in...preferably at a larger rate than people dropping off.

I tried doing a search, but searches are so hard on this site since it won't find specific phrases like "set medic"...you always get dozens of returns of posts from the last few days and countless others. ANYWAY, Are medics or EMTs who do movie set work on here? I'm interested in being a set EMT through a company that hires and provides medics/EMTs and perhaps other standby work (college sports games, award shows, fairs, etc). Also, some of these companies want you to provide your own equipment. What do you guys think of that? Whackerish at all? Is it normal for the industry? Also, I've seen some ads asking for EMTs for random events and even for night clubs. These don't seem to be through a company. Is this kosher? Or do you need to have a company medical director with protocols or are your county protocols good enough? Just looking for more info/insight in this area.

I imagine it's difficult for a person whose either not yet in the field or new to the field to contribute to the forum in other ways, so they end up just asking questions they have.

ZZ, who is the main medical provider in SD? Is it the ambulance and then fire engine comes to help or is it an ALS fire engine and they then transfer care to the private ambulance? ParaLoco (and others asking about S. Cali EMS), In Los Angeles County, FD is the main EMS provider everywhere. There's a few cities that have their own city FD with FD ambulances, such as Los Angeles City itself, Manhattan Beach, Santa Monica. Most other city's contact the LA County FD for fire and thus medical services (they come as a package). LA county dispatch receives the call and it's concurrently sent to both FD and private ambulance service dispatch computers, who's dispatchers then dispatch their crews. In our area ambulance and FD arrive within 1 -2 minutes of each other on the vast majority of calls (FD has advantage of receiving call straight to their station computer and on the radio, so they get it immediately. Ambulance gets it in dispatch, dispatch needs to read what area it's in, speed dial the appropriate crew quarters, answer in two rings usually, then they get ready and go to rig). Anyway, each call gets a dual paramedic squad (two FF/Medics in pickup truck-like thing), a fire station (usually just an engine, but sometimes an engine AND ladder truck) usually 4-5 FFs, and an ambulance (I believe five companies partake in the county 911 contract, but only one does 1EMT/1Medic...other 4 are BLS except for their IFT medic rigs that also respond to 911 calls). If engine is there first, they can cancel the medic squad (I don't THINK they need to have a medic on the engine crew to do this...I've seen crews without any patches do it, but sometimes they don't wear their medic patches) or ambulance. Squad can cancel engine or ambulance. Usually everyone arrives around the same time, though. Ambulance can ONLY be canceled by FD, not by patient, themselves, PD, unable to locate, etc. Either squad medic or engine medic does assessment, call base for almost everything (due to protocols), then decide to "ship it BLS" or "go for a ride" with the patient in the ambulance. All kinds of things get shipped BLS, either by medics lying on their run sheet, bad patient assessments/interviews, or technicalities on their protocols. When one crew was once told to do ALS follow-up to hospital 11 month old who fell off his high chair and was "disoriented" (for age) for a couple minutes after (not crying until a couple minutes later), they were aghast. They asked under which criteria and base told them "Judgement". After they hung up, they kept repeating "judgement!? Since when is that criteria?" . . . that left ME aghast. (Only reason they called based in first place instead of just shipping it BLS is that mother wanted to self transport..any patient under 1yro needs base contact for that). . . . so if you're wondering one of the reasons why LA protocols are so limited, the above is an example why. Anyway, the FD then hands us a carbon copy of their run sheet for us and one for the receiving hospital. We then do a continuation PCR which is usually just VS boxes and "Patient condition/changes during transfer" and a bunch of lines. If it's someone who should have gone ALS, I use that include all the stuff FD left out like "Positive LOC, Blood in Vomit, SOB, clonic-tonic seizure, pain rating, OPQRST, pertinent medical hx, and other details". It's also good practice for writing PCRs. FD PCRs are usually limited to 1 to 3 sentences and 1-3 pertinent negatives and VS. The patient is considered the FD's patient the whole time, though, as soon as it's time to go, they basically just say "OK, load 'em up guys" and they walk out. Of course, there are some very good fire crews, captains, and medic squadies who are exceptions.

The only reason for bashing vollies isn't the whacker syndrome. It has to do with advancement of EMS as a professional field. Maybe someone will reply with more detail or you can do a search of Dust's and others' posts. As far as bashing basics, the comments I've seen are more criticizing the position, not the people who hold the positions. I guess as certain ideas gain momentum and are shared by more people on the forum, they start coming up in a lot of th threads...again and again...I think mainly in efforts to educate, but there might be a superiority / teaching everyone the right way thing going on at times? Not sure...but I have noticed the trend, whether it's for a valid reason or not.

You could explorer Long QT syndrome for a cardiology one. Not a particularly exciting one...but you'll learn a lo about the heart and how conduction occurs. For an actual pathogen topic....you could explore AIDS...tetanus...heck common colds / upper respiratory diseases and associated immune responses...I've been at work for over a day with little sleep, so I'm kind of drawing a blank on others.

I definitely agree that tact is a necessary tool. I've had a few EMT student ride-alongs this summer and I've never been annoyed by their comments, yet. I guess they've just been able to phrase things well and without even having to do it indirectly or with a preface. Tone of voice and intonation of the sentence (if there's a difference) as well as rapport with your preceptor makes a difference. Our last ride along reminded us of something (I forget what it was), but she said, "don't you want to ___". Even though it didn't have to be done that way, it actually impressed me, because it showed me she had been listening and remembering in class and was able to apply it to the situation. Most of the ones who say things more bluntly tend to be premed students and as long as it's said in appropriate tone, I really don't mind. But if it was said in the way it was said in your post, I think I would have been pretty annoyed, though I wouldn't have chewed you out, but definitely discussed the whole situation with you afterwards. But anyway, good advice was given in this thread. I hope you do additional ride-alongs for your class (if they don't put a limit on them).

Dust, you're certainly right in that IFTs make money. They're guaranteed payment from what I've been told. For the past year at our company, we've been having to do IFTs mixed in with 911 calls as a supplemental income to the company. After they picked up the 911 contract in the area, their net gain plummeted...yet previously when they were just a transfer company (with a good reputation), they were (according to old employees) making bank. How are EMS companies to survive when providing services to areas where no one has insurance? There are two cities we cover that I like working OT in where I have yet (in maybe 10 shifts) to have a patient with medical coverage, other than occasional infants with state coverage. Our company was lucky enough to also get some of the more glamorous LA areas (though they're low call volume, yet require a number of ambulances because the area is so spread out with lots of curvy canyon roads. But without that, I think we'd be going under. And this is a company where they come down on you hard on paperwork (so insurances pay out).

For interfacility transfers, we check the non-emergency box on the PCR and have the nurse (though I think it should technically be the doctor) fill out and sign a form saying why the patient requires transport by ambulance instead of private vehicle or one of those medical transportation vans (which I guess insurance won't pay for).

Diabetes would be a good one because it's one you'll encounter in EMS often. You can keep it just cellular or take it down to the genetic HLA genetic level. Cancer (a specific kind) could also be informative. Multiple myeloma? Ovarian? Colon? Breast? These the ones I've most seen in the field. How about a neurological disease? You'll see those in the field. Alzheimer's...Lou Gehrig's...Depression. What areas are you interested in?

Aside from monetary reasons, why would one prefer having ALS only units? And do you think BLS level crews are trained well enough to detect underlying problems to chief complaints that seem BLS on the surface.

We're getting the Mike's confused. The questions were addressed to the poster "romee". BikeMike80 is the one trying to get into the field.

I can't tell which direction you're leaning toward with that post? So, I'll just say those are the type of calls that EMS responds to and they sometimes are indicative of underlying problems requiring ALS that might not be readily apparent.

Well, if Dust's idea doesn't work, I'd tell her we have a protocol to follow and her children won't get an ambulance until she gets loaded up, so if she wants her children to get going, she better let us help her or she's delaying treatment of her kids. If she still refuses and she's definitely A/O to make the decision, have her sign AMA to be treated last and go ahead with the kids. They'd probably just go BLS in LA County anyway...

I'll have to disagree with that part of the post in that the trend has been reversed. At least in Los Angeles County, being a paramedic makes you much more eligible as a fire department applicant. Not quite the Golden Ticket, but provided you don't have anything weird in your background and you're a decent candidate, it's pretty close to it. And it's only increasing now....I've heard both LA City and LA County have a plan to put all their FFs through paramedic school (they have a real short and cheap one they send them to).

I find it usually goes okay if you put the disclaimer in front of your question that you've been trying to learn more about blank (working full arrests, studying EKGs, trying to read up on respiratory emergencies, learning my drugs, etc) and was wondering blank (why you gave that med for that patient, what made you call that rhythm __ versus ___, etc). That way you can still refer to the call you just witnessed, but you can put a teaching/learning context around you question.

Tator, financial reasons aside, is it still a waste of money?

I'll defer to the old thread by DustDevil asking anyone to justify having EMTs on 911 ambulances (or similar). Only one people could come up with was financial reasons.

Why couldn't workers, where applicable, respond with their policy? I just hate to see so many threads go south by turning into an opinion debate on an issue we've gone over so many times and always arrive at similar outcomes with.

Hmmm....don't think this was an opinion poll...rather a policy poll....

Your answer to what is no? Timmy's original question?

You guys have non-manual BPs in the field!? Grrr....

Such long transports are very rare and they page them out in advance and pay them out as a 24 hour shift, which is actually our normal shifts, so not much different. I would guess that I'd get more sleep on such a transport than on a regular day of work. I would just try to get my sleep the night before and trade off sleeping and driving on the way back. Such a long transfer would really suck, though.

I've considered that issue actually and if ever needed to haul ass in my personal car for whatever reason, I would not use hazards, because not all cars can see that you're using hazards. Cars to your left and right will believe you're making a left or right turn, which would increase your chances of a crash. Though if this is your personal car being used for 911 calls, then you wouldn't be hauling ass each time...