WelshMedic

I've refrained from reacting to this topic before now, just being contented to read and digest the different standpoints. It does, however, seem that most of the salient points have been made by the different camps and now we are just repeating ourselves. It's inevitable that a consensus is impossible when this is such a morally-charged issue. We are a sum of our beliefs and moral values and they are usually so ingrained that it's difficult to change a person's view. Reaching a consensus here is not the issue. It's about listening to one another and having the courtesy to read what someone else has written, however much you disagree. Once that starts to diminish then we can all pack up and go home. And this is a very real possibility, I know of several fora that disappeared after they just turned into a series of slanging matches and the place to play out personal vendettas. WM

I met a few of the members during last year's EMS today, a really lovely bunch of guys! It sucks that they would be treated like this. One more reason why Fire should be separated from EMS, the sheer arrogance of the water fairies is bloody astounding! :evil: :evil: Oh, and I bought the right t-shirt, from the band itself.... WM

This is an interesting question as it raises a number of issues: 1) Should we extend our scene time to assess the pt fully or just accept the fact that we are primarily there to transport people to a higher echelon of care? 2) Is it safe to perform invasive skills in a moving vehicle? 3) Who are we starting that IV for, the patient or the hospital? To answer 1), I can remember as a new medic that I would try to be as thorough as possible with every patient and get my documentation just right on scene too....was that the right thing to do? No, in retrospect. I probably didn't jeopardize any one's health as I never stuck around long with a critical trauma; but I came to realise that even though we have a neat bag of tricks available to us, it isn't always appropriate to use them. I find leaving time to talk and reassure my patients can have a far more therapeutic effect than any IV. To 2), just think about this for a second: sticking a pt in a moving vehicle is leaving yourself open to a needlestick injury and decreasing your chances of getting a hit. I don't care how good you are, bouncing down the road at 60mph causes enough vibration to significantly lessen your chances. I have seen this too, during a ride-along. The pt was a woman with COPD and although sick, certainly not critical. The medic decided to transport emergently and then missed three IV attempts before giving up. Would it have been such a crime to spend a few minutes on scene to secure that IV? Doing so would have meant being able to give corticosteroids and therefore making a start on the definitive treatment for the pt. To 3), there are nursing staff that will bitch on you even if you bring them all in with a needle , but the decision should be made on an individual basis. What do I want to acheive with my IV? Is the patient dehydrated or hypovolaemic? Go for it! Do I need to give medications? What are you waiting for? But what about the rest? There is a significant infection risk with an IV started prehospitally versus one started intramurally. So much so that some services are limiting IV starts to the pt groups that I just mentioned. Australian Study London's Experience I suspect this is a more european perspective to the issue at hand. I would be keen to hear what you think. WM

Well, that about covers this topic. Next...... (and Dust, don't dock points for over-use of the emoticons, don't ruin my good mood today ). WM

You don't happen to have an infectious disease as well, do you? Sorry...couldn't resist To give you a more coherent response: I have personal experience of someone that is on acenocoumarol (also an anti-coagulant) and works in EMS. He is always very cautious in what he dos, but to be honest, he is the example of good practice to all of us. So no, I don't really see a problem. You would not be putting a pt at risk, and you could certainly minimize the risk to yourself by good practice (always making sure you have sharps container next to you when doing an IV, for example). WM

Like a lot of old hands here, I can't remember my first death either. I guess it would have been about 10 yrs ago, but I have no recollection of the details. There are always incidents that, for one reason or another, stick in your mind. Mine was the MVC on a sunny june morning. We were dispatched to the incident with very limited information. Approaching the scene I wondered why there were so many police officers present. And why they all seemed very stressed...... Once on scene I found out why. It was an unmarked police vehicle with 3 officers and a suspect. Two occupants had remained in the car but were obviously non-viable. The other two were ejected and lay in the grass with agonal resps. Where do you start? (you have to remember that I was the only EMS provider on scene at that point). Well I made my decision to start on the pt that I felt was most viable, thereby depriving victim nr 2 of a chance. The whole thing went down the drain from there.... I couldn't get the tube, we didn't have IO in those days and the IV wouldn't go in...... all the while I have at least 10 police around me all willing me to save their mate. The look in the eyes was enough.....at one point one of the female officers that I knew personally started to cry and I thought I was going to lose it too.... He didn't make it. That won't come as a surprise, I think. I had difficulty in dealing with this situation for a while, moreso because my actions fell short of my own high expectations. It resulted in me having an extended period of leave to reflect on the situation. It took a while, but now I realise that the outcome had been as good as decided when the car rammed the tree at 100mph (no joke, this came out of the investigation...they had been transporting a very dangerous suspect and wanted to get him to the station fast). As long as you know you've done your best for someone, there is no place for guilt or bargaining (what if...?), even though these are normal reactions. I find, too, that it helps to write things down. You can choose to keep it "up close and personal" in the form of a journal. However, were you to publish it here, it could be of benefit to others. It also helps to talk, I find that this gives perspective. Whatever you do, don't carry it with you as a burden. Before you know it, that psychological bagage will get too heavy to carry..... WM

Never a truer word spoken..... a few months ago I presented 2 pt's to the same professor of traumasurgery in 2 days. The first time I was a bit distracted (a late night, but heck, I never said I was perfect, did I?). He ripped me apart, he told me to fcuk off out of his ER if this was the best I could do... The following day I made sure it was said right....and got compliments. If you think we are hard out there on the street, just put yourself in the shoes of a 1st year surgery intern..... you don't know you are born!!!! WM

Dust makes a good point here, EMS is not a new profession. It should be constantly evolving, developing itself and gaining the respect of it's peers in the healthcare community. An utopia? Well, it shouldn't be, but whilst there is so much infighting and backstabbing going on then I'm afraid you have a long way to go.... For what's worth, I do believe there's a role for volunteerism in EMS, but not in it's present form. I would suggest that the anglo-saxon model of Community First Responders would be more appropriate. Have volunteers respond in their community in cases of life-threatening situations. Back this up with a paid ALS transport capacity that will start to provide definitive care. Recognize the volunteers for what they should be: motivated individuals that want to serve their community and not have them fill in the gaps in professional health care due to a lack of political will to change the situation. Every form of certification that allows an EMT-B (I, A, CC, whatever) to perform ALS on the cheap is not addressing the real issue, the need for ALS in every community; regardless of the financial situation. Surely everyone agrees that they would want the best when it was their turn? If EMS is to get the respect it so desperately craves, then this is the only way forward. Make EMS paid, all ALS and degree level entry. The rest will follow automatically..... WM

Whilst US healthcare is a model to behold for the civilized world....hmmm....

I'm just glad my name gets a mention in this fantastic thread (even though it is in a negative light, Dwayne ). The City is, to me, a great resource for learning about EMS in the US. Also, it gives us clues to the latest developments in our profession. I wish I could spend more time here, but the constraints of working full-time and having a young family limit that. There are a lot of very knowledgeable people around here. There is, generally a very high standard. It sometimes makes me wonder why it is that US EMS is such a mess (according to some on here.....I reserve judgement). Maybe we should start EMTCity Ambulance Co? (oh no, that was another thread, wasn't it...) WM

EMS, Whilst I wholehheartedly agree that women can make damn fine medics I'm not sure it's wise to make a blanket statement that women are inherently more empathetic. That's certainly not always my experience; I have female coworkers that, whilst being very competent, show little empathy. The reverse is also true of some male colleagues. I do however thank you for sharing your story with us, I found it quite moving to read. Taking this discussion on a slightly different tack; I was once told by a wisened old colleague that pediatric trauma/arrests were worse when you had children yourself. I found it a rather arrogant and misplaced statement at the time. Now I have 2 small children; and my god, how right that old sage was. It is different - it affects me much more now than before Daniel and Hannah came along. To EMTb, I had a spate of bad runs a while ago (there was a lot of pedi's involved) and took some time out to give it all a place. Luckily I had a boss that was very understanding of the situation and I was able to talk about it. That's the key to this - talk to someone about it. Medication is not the route that I would personally go down, it only made me feel worse (dizziness) but if all else fails, then it is an option. Good luck, WM

I'm left wondering why on earth we are still trying to convince Zippy that he's full of shit. I think we all know that, at the end of the day, he will beat us into submission with his totally misplaced and misinterprated quotes. Zippy, I beg of you, please stop before I am forced to slit my wrists and die a horrible death whilst listening to Nick Drake. Frankly, at this point, that has more appeal to me than listening to you continuing to put our proud profession into disrespute with the folks here that do just an important job, whether it be registered or not. WM. You win, OK; I hope you are happy.

You sir, are extracting the urine....now that's "proper" english for you! WM

Well here's one UK trained RN that definitely doesn't agree....but then you all knew that anyway...... WM

And on we go... Will someone shut down this bloody thread for the sake of my mental health...... WM

I think you'll find that this thread is sustained by the fact that we are all drawn to reply to the uttter shyte that our colleague Zippy spouts. In the past I have vowed never to get drawn into it, but I have a weakness for a good fight. Don't think for once that this is the first time that he comes looking for an argument. Search the following sites for his posts: here and Especially here Trouble is, it's getting boring now; he seems to have started repeating himself a lot. That and the fact that everyone in on the same page except Zippy. I personally have strong doubts about him prescribing drugs and performing ALS interventions. The way he acts here, I wouldn't let him wipe my arse, much less cannulate me. WM

I just hope I never slip through that hole, WM

Scott m8, Don't waste your breath, the mighty Zippy is always right..... WM

I think I may have to put your hypothesis to our learned colleagues at the BWTS. I'm curious to hear what they think of it. But I think you already know the answer to that, don't you? WM

Zippy, All of the above is applicable to the work situation. Do you think I have something to fear if I have a "colleague" that is obstructing me at a RTA removed? Please remember that I stated that if you showed the same lack of respect at a scene that you do here, that THEN I would remove you. If however, you were co-operative and were competent, I would let you help; something which I have done in the past. But remember, I am the scene's senior medic and have the responsibility as such. If there are any ALS interventions to be carried out, then I'll be doing them. If you cross that line (Dutch law only recognizes pre-hospital RN's as ALS providers extramurally) then I will not ony remove you but also have you for assaulting a pt. I have been in a situation at a cardiac arrest on a golf-course whereby a woman came running up stating that she was an anesthetist. She then proceeded to rip everything out of my bags and started barking orders. She too was removed. I never once heard any more about it... WM

Yes, me! Dust, I think you are being a little hard on the captain. Zippy brought this on himself with his "better than the rest attitude". He even accused me, a fellow nurse, of professional misconduct. I'm still waiting for him to answer me as to why he thinks he can write such rubbish. And for those of you not familiar with him. He volunteers for the St John Ambulance, an organisation that provides event cover, mostly. They are looked down upon by professional EMS in the UK (that too has a history - they provided cover when EMS went on strike in the early 80's for better pay and conditions). I suspect this is where his attitude stems from. But who knows, since I've asked him to explain himself repeatedly in the past and have yet to get a decent answer, what motivates him? WM

I meant that the person concerned deserves all they get. I don't believe in Hell, so I can't really let anyone burn there, can I? WM

FireDoc, I take on you point, but I was purely referring to the title. The title is, after all, the first thing anyone will notice. And that is what I objected to. What happened as a result of the title? People proceeded to regale horror stories about nurses. I'm not knocking the authenticity of these stories, I just find it a little unbalanced. There are good and bad in all professions....we can't be categorized as good or bad in terms of a whole profession. WM WM

It was a figure of speech..... No offence intended.

That surely cannot be directed at me........ the point was that, by virtue of an RN ticket, a nurse is not necessarily placed above an EMT of whatever level. I was NMC registered between 1991 and 2000, I see nothing in my comment that leaves me open to discipline. You really need to clarify that one to me. Yes, I couldn't agree more; that's why I replied to your post..... Pot, Kettle, black, ringing any bells here? Did I not say that it wasn't personal and that I wasn't looking to continue the pissing match? But it's OK Zippy, spend all you time and effort trying to out -quote me. I hope it makes you feel happy m8. WM