WelshMedic

I just knew which way this was going when she said she didn't know what a pathological # is. It's a rather unfortunate combination: ignorance and arrogance. (I bet she's the type that bullies the new vollies as well.....) Let her burn in hell... WM

OK, that's my take on the Zippy situation dealt with.....so now I'll move on to my thoughts on the original subject matter. For starters, I have problems with the title. It should have read: "Difficulties with other healthcare providers" Nurses are just a part of the team and as already has been stated here: there are plenty of HCP's that need to take communications skills 101. It's across the board, so don't just tar nurses. We are just as individual as any other group. But why does this occur? Well, I once had a colleague in the ER that had a background in psych. nursing. He was a real people watcher...fascinating. Here's his theory on the subject (I could claim it as mine, but I'm far too honest ): Certain personality profiles are attracted to the acute specialities in healthcare, let's just say, "the adrenaline junkies". These people often have quite strong characters and are, generally, not easy to walk over. This has it's benefit's: you can be sure that these people have the self-confidence to deal with a stressful situation. However, it also has it's downfalls: the same people are strong willed and are more likely to become involved in a conflict. And therein lies the problem, if something does not please us then we are apt to start a war to solve it. Just my take on this, I'd be interested to hear other's views on this subject. WM

Zippy, Do you see the link between the following two statements? It's a shame that some people are not aware of the limitations in their capabilities. If I were the provider on scene and you dealt with me in the same way that you deal with your (virtual) colleagues on this forum then I, too, would have you immediately removed. Why do you insist on turning everything into a pissing contest? I'm sure it is a form of frustration. You are obviously a resonably intelligent person and so I'm left wondering why you, instead of becoming increasingly frustrated, don't choose for a career change and join EMS? I'm not sure whether you realise it, but you just confirm the image that some here have of our profession that is stated in the opening message on this topic. I am sure that your not at all like this in real life (well, I hope not anyway), so why do you insist in giving our profession a bad name when it comes to interprofessional relationships? It doesn't matter who you are in the chain, we are all important. If it weren't for the cleaners at your hospital you'd still be polishing the floors just like our colleagues did in the first half of the last century. Which speciality do you work in anyway? WM PS -This is meant as good advice, not a opening to attack me, by the way...

Not the case in the US. Each individual organization licences and covers it's practitioners. I would not be able, officially, to start an IV on american soil as I am not registered with the State Board and have no employer to cover my arse when the excrement hits the oscillating device. wm

Now this is the only way to go clothing wise This is the result of years of research into the subject - it's safe and hi-vis in all weather types. And no-one could accuse you of being a cop, could they? WM

I personally prefer to use the term "meat wagon" or " bloodtub" . Most of the time just " taxi" will suffice though........ :wink: WM

How are the medic students learning to intubate if they are not getting OR time? Come to think of it, what excuse does the hospital use for not letting them in? This is a very poor situation and really shows a lack of respect towards the colleagues in EMS. The only way to intially learn intubation is in a controlled environment with a fasted pt. Only when you've mastered that should you go onto progress to the stressful EMS intubations where the pt is covered in vomit and weighs 350lbs. (and smells too..............). I far as I'm aware, all of the countries where ALS is practised out of hospital require an OR rotation to learn the basics. And that is the only way it should be, because as charming as ResusciAnnie is, she really ain't the real thing. WM WM

Ruff, You don't need to practice intubation, you need to practice counting..... WM

Thanks Dust for weighing in on this topic. I had an idea we would be of similar minds on this subject. It's always difficult for an outsider to form an opinion that may aggrevate certain members here. As you know, I do have a fair experience of US EMS and so my opinion is not entirely based upon "ER" and "Grays Anatomy" (no, I don't watch. Honestly, your honor ). Another good point has been raised by Trial, what do you do about retention of skills? I know that here, in the less busy areas, the medics are required to jobswap with medics from urban areas; this keeps their patient contact numbers up. Every two years we go back into the OR to intubate, cannulate and polish up the old BVM skills. Is there anything similar with you guys? WM

Whilst I am aware that there are plenty of people doing a stirling job in volunteer organisations, that wasn't really my point. And whilst we are at it: let me retract my statement that volunteers are poorly trained and educated. This statement would imply that everywhere is the same. My point is this: EMS, at point of contact with the public in a 911 setting, should be professional ALS. Therefore there are SOME members of the EMS community that are under trained and under-educated to perform the tasks their community expects of them. Is there anyone who still wants to take offence at this statement? WM

Volunteer=unpaid EMT-B= educated and trained to a bare minimum standard. Simple really! WM

Who's banishing? I'm just expressing my opinion. And that is what the forum is for. Now, prove I'm wrong by using reasoned argument, otherwise this is gettting boring... WM

What's so ignorant about that statement? Feel free to take a shot, that's what the forum is for...but make sure you back up your argument instead of taking cheap shots like this. I was simply stating a truth, albeit a truth that a lot of people don't want to hear. When you have system where EMS is all ALS and the minimum entry requirement is a nursing degree + post-graduate critical care qualifications, then you can take a shot at me.... :twisted: WM

Hi Redneck, This is an interesting post as it covers a topic that affects students on a regular basis. The are no simple answers, but I'll try and give you an outline as to why this is the case. Am I qualified to speak? Well, I think so - I have more than 10 years of experience in mentoring new colleagues. I have always enjoyed doing so, but that doesn't apply to everyone. Here goes: 1) Your preceptor may have personal issues that make it hard for him/her to come to work, much less have a student asking questions all day. 2) Some people like the routine of their partner and frown upon a third person that interferes with the group dynamics. An "outsider" if you like. 3) Your preceptor may have had bad experiences in the past which makes him/her sceptical of students. You can only try your best in these situations 4) How is your attitude to your preceptor? (Not suggesting anything here, just food for thought). 5) Your preceptor isn't keen on having someone scrutinize his work (which makes them unsuitable for preceptorship, but it happens). 6) There can be tendency to think: "Why should I invest time and energy in this kid?. He'll be gone in a few weeks/months". Again, inexcuseable; but it happens. 7) And finally, this is after you've ruled out all other causes: THEY ARE JUST PLAIN LAZY. The only thing you can do in these situations is to sit down with your preceptor at the beginning of the shift and map out what the expectations are of both parties. You need to talk about these issues in order to resolve them. I guess this is also a learning process, you need to acquire a healthy form of assertivity - something which you will also need in your practice when you qualify and are the senior provider on scene. Hope this helps and good luck, WM

Hi Dust, Just try: www.sovam.nl or www.azn.nl. I'm not sure the protocols are online yet. There are plans to do so, but we are all issued a little green book called the "Bible" at the moment. (Some would sat that I need the real bible the way I practice, but that's another story.... ). Failing that, there's a snazzy film in english on the second site... WM

That, for me, is the statement of the week. Brilliant! And sad too..... It says a lot about American EMS, doesn't it really? And you're right too, call volume should not be the deciding factor when it comes to staffing issues. This creates a paradox whereby the larger cities have ALS for the 3-4 minute ride to definitive care whilst the less densely populated areas with far longer transport times (and, by definition, more chance of complications) have to rely on the goodwill of their community. There are so many good EMS professionals out there that deserve recognition. Not just in a literal sense but also in terms of renumeration. Is it any wonder why well trained, motivated individuals can barely make a decent living when others are giving it out for free? That's just plain wrong.... WM

To paraphrase the great Dust: That's +10 points for having the self-introspection to review earlier posts and subsequently having the humility to admit your mistake. :thumbleft: WM

Now that's an interesting question in itself. Would anyone like to hazard a guess as to which way the scale tips on a national level? I can't seem to find conclusive proof anywhere. For what it's worth, I don't agree with volunteerism in EMS either. You will never gain the the credibility and professional status that is required by having unpaid, poorly trained and educated people doing this to satisfy their own ego's. They may well have the misguided notion that they are doing it for their communities, but if their community prioritized differently (ie- paid ALS) then everyone would be better off. Answer to all the problems - EMS should be at least degree level, no volunteerism and a national set of protocols that were robust enough to make Medical Command unnecessary (it really would drive me mad to have to ask the doctor every time I wanted to do something other than the absolute basics). Oh, I forgot - a workable no transport policy would be quite nice too... WM

Oh boy, you sure got the bug real bad....... (Ps - Scott is right about Zippy, he real does talk bollox. He describes a world that I never encountered in the 10 years I spent nursing in the UK)

Practice on a mannikin first...they don't generally tend to scream in pain so much when you miss the vein and push the stick subcutaneously WM. ( A real tip: keep calm and make sure you know the procedure and the required materials through and through before you even start..) And congratulations on the test

Surely it is society's duty to protect it's vulnerable. This is a form of neglect that has been given a veneer of respectability because it is the teaching of a particular religion. If a child was denied food or drink then I'm sure everyone would be up in arms about it. I don't see this as being any different. As far as a child being treated differently after transfusion is concerned, that just shows how misguided some religious fanatics can be. I would rather see a child fostered in a loving home than let it die because of some misguided interepretation of the bible. WM

Amen to that, bro! Dust has hit it on the head again. Religion is all about indoctrination of a lot of gullible souls that are unable or unwilling to see what life is really all about. And don't bother praying for my soul, you'd do better to pray for yourself that one day you'll wake and see the true light. WM

Hi Spenac, Thank you for the link. It makes interesting watching and auto-transfusion has, undoubtedly, improved medical care in these cases. However, auto-transfusion is only suitable for certain types of surgery. There is also a plethora of hematological conditions that can only be alleviated by transfusion. My point, by the way, was the misinformation that I have encoutered. I stated that plasma expanders were being propagated as a qualitative equal partner to whole blood. That is just not true. I wish it were, we'd be saving a whole lot more people; but plasma expanders just do not have oxygen transport properties that whole blood does. I'm off to work now, (nights, errrgh..) maybe we can spar again later? WM

This is, indeed, a very emotive subject. It also happens to be one that tends to polarize opinions, so it's good to see reasoned debate (so far....). My belief rests in science, and therefore I have little affinity with religion. That applies across the board, coincidentally, and not just on this topic. I have no problem whatsoever with an adult refusing treatment, on whatever grounds, just as long as they are sound of mind. However, one of the issues not discussed so far, is that of "informed consent". A child, being a minor, is never able to give informed consent. If a parent denies treatment to a child that susequently dies, the same parent is denying his/her child the right to grow up and decide for themselves whether or not they believe. My own personal opinion is that in cases such as these, the child should be made a temporary ward of court and be given the necessary treatment. I think we owe that to a child, at the very least. On a slightly different note, I can't help but wonder how well-informed the Jehova's community is on this subject. I can remember a recent conversation with a Jehova's Witness whereby he swore that a plasma expander exactly the same properties has as whole blood. There was no amount of patient explanation able to get him to see my point of view. WM

This is probably a little superfluous, but the picture in question is a German MCI bus. Not for everyday use..... European norm (CEN) states that only one patient per ambulance should be transported. This means we have no need for those monster trucks. We also suffice with just the one backboard and KED and whatever else. If you need more of these then you also need more trained personnel to use them= additional EMS units on scene. As for Dust's suggestions (some way back in this thread): the 6ft blond medic is on her way, but she's got halitosis and a personality disorder. Believe me, you're welcome to her..... WM