hammerpcp

If they are on a "form one" (committed by a doctor under the mental health act, a.k.a. non-voluntary) and they are being transferred from, say the ER to a long term psychiatric facility they go by ambulance. Usually a PCP crew as per our P & P. A medically cleared voluntary psych pt would generally not be transferred to a long term facility, but if they were they could take a cab. I always do.

On chest percussion: let me simplify. Do you know enough about it to use it as a diagnostic tool? No. That's my point. On RPN vs. RN. I wanted to clarify for our not so informed readers that although "nurse" is in the title of RPN, the term "nurse" when used in general language is not referring to the skill set of an RPN but rather an RN. Clarity. I think you're last question has been answered.

Ya, really. That’s the dumbest acronym I've ever heard. It doesn’t even make sense or serve any particular purpose.

Okay..........I've let this go long enough. An RPN is hardly the same as an RN so stop taking on airs. And yes we did cover chest percussion in PCP class. Just enough to know what it is. :roll: I have never seen anyone attempt to do this in the field for several reasons the main one probably being ambient noise. Half the time it’s nearly impossible to auscultate the lungs effectively. Also it is a skill that takes a lot of practice to perfect. The difference between chest sounds on percussion can be very subtle and difficult to interpret. Obviously Lithium thinks he can do this accurately. I am a PCP and I often spend 15-20 minutes on scene, so I can see how it would be easy to spend that extra ten minutes if you are starting a line or giving drugs or doing a pelvic exam. But seriously, it is definitely a balancing act between doing the extra assessments/interventions and getting the pt to definitive care.

Remind me never to get sick in Kentucky. :shock:

Would my "growing a pair" really make you happy? Unfortunately in the real world just because something makes sense doesn't equate to it happening. In fact it often seems the opposite is true. Our union is currently concerned with getting us a contract (which we have not had in 6 years), getting us sick days, and constantly fighting management to protect the individual rights of their employees. Changing our shift schedule to something like you describe above (although theoretically it’s a great idea) would be such a giant leap, and straying form the norm to such an extent that it will never happen. Making such a drastic change involves great risk for those that instigate the change, and once again the "that's the way we've always done it" attitude wins out. It is the norm for health care workers (hospital staff) and emergency workers (police, fire and EMS) as well as the steel companies, basically any job that involves shift work, to employ these outdated and detrimental hours and rotations. The only field that has smartened up is the nuclear power plants. They have applied the knowledge and research, and plain common sense: if your people are tired, mistakes are more likely to occur. I guess the motive for this is the disaster mentality. The potential for mass casualties is much more frightening to us then the reality of individual injury and death. Although thousands of people die in hospital due to medical errors every year, that is nothing compared to the millions that would die in a radiation related accident. For some reason there has not been enough public pressure generated to produce any form of change. They think we are ambulance drivers for fugs sake.

LOL.....You're a dork Micheal.

Nate, I don't think anyone is claiming that night shifts and rotating schedules are ideal, or safe, or good for you or the pt or the individual, etc, etc. In fact I think it is common knowledge that the opposite is true. However, this is the reality we have to deal with in EMS and health care in general. Someone always hast to work nights. So I would like to know what you suggest as a solution. How do you plan to keep the rigs staffed and 911 calls responded to? You say your crews can speak up if they are too tired to answer a call. But I ask you who then answers the call? In many places we are it. If I don't take the call that just came in, no one else will be able to respond to it in a reasonable time frame. So there are two options. No paramedics, or tired paramedics. How do you suggest we remedy this issue? Lithium, You and I could never be partners. We'd both sleep right through the tones.

I hate to admit it, but I agree with Dust on this one. Lithium and VS-eh are demonstrating the prevailing attitude here in Ontario. I have yet to hear anyone logically justify it though. As you said Dust, there is no reason why with the right amount of training before hand (of course) a new graduate could not practice ALS skills. It is only this way because that is the "way we've always done things". This is not a progressive or productive way of thinking, yet it seems to be the popular mind-set in EMS today.

That is the funniest thing I've ever seen. Tomorrows headline: "A recent string of blunt trauma deaths of EMS workers has prompted the discontinuation of use of the new 'man-canon'"

Is this a new procedure I haven't heard of? It's never occurred to me to do this, and I have never seen it done, and it seems inappropriate. Pt's that will be gowned in hospital are usually more critical, and thus, I will not be spending time on putting a gown on at the expense of assessment/treatment/or developing a rapport. And less critical pt's that don't need to be gowned.........well, they don't. This being said, I can see how having a gown on the rig might come in handy to cover a pt up. I usually just use a sheet for this purpose though, and it does the job fine since the pt is not going to be walking around.

Where do you work John? Four nights in a row is a lot. I hope you have at least three days off to recover form that in between your next shift. Shift work sucks. Period. There is nothing positive about it. Unfortunately these damn people keep getting sick outside of regular business hours. So what are you going to do? 24/7 EMS coverage is not negotiable and shift work is the standard way of achieving this staffing requirement. It seems that it will be a long time coming before this changes, so as it is now we just have to live with it as best we can. Chances are the medical schools will smarten up before EMS even thinks about it, and med schools are showing no sign of changing no matter how much supporting evidence comes to light. I do as you described above as well. I stay up as late as I can on the few nights preceding the switch over. thbarnes, great advice, but you wouldn't want me showing up at your house around the 4 am hump, to look after your father without my coffee. :coffee: I try to get my paper work cleared up as fast as possible (if you are anything like me I highly recommend proof reading your ACR before handing it in, it's amazing what seems to make sense in the middle of the night :wink: ) and then sleep whenever I can. The sleep I do get during night shift (if any) doesn't seem to count towards how much I need the following day, but it does help get through the night, and the next call. Although I think I have had several minor MI's from the tones going off while I was asleep. Either that or I just sleep through them. I recommend having gum on you at all times. I nearly got killed by a fire fighter on scene who had obviously gotten some sleep that night, from the smell of his breath :puke: . Even if you are okay, you may need to start handing it out if you have a code or otherwise long scene time in close quarters. Anything useful? Take care. :sleepy1:

OOOOOOOOH! Racemedic likes to be spanked! :shock: I'm all about the leather, Race. :thumbup:

Play that funky music white boy! LOL.......I can't believe I just sat through that whole thing. I noticed one glaring omission though. What happened to "vogue"?

I am glad you posted this. I think everyone who has worked this job for any length of time has ghosts. But they do fade with time. The most important thing is to take care of you. Literally. Take care of your body and it will take care of you. Eating right and exercising are so important I can't stress this enough. Yes CISM has been pretty much debunked as of late. But what has been found with recent research, is that those who have a stress management strategy in place (can be as simple as eating right, exercising and talking to friends or family when you need to) deal much better in both the short and long run with stressful situations such as those, that you describe. We don't need any more burn outs in this field. Someone mentioned above, that it is these calls that make you a better person and medic. I couldn’t agree more with this. No matter how jaded or callous people in this profession appear at times, they inevitably have an insight into life and the human condition that the average person is lacking. It can be a high price to pay for this insight. Is it worth it to you? I have wondered lately why people seem to be so much more affected by calls involving children. I used to think that kid calls would not get to me because I don't have any myself. In the meantime though, I have found otherwise. One of my worst calls ever also involved a young child who died senselessly. But please continue to vent. It is not only good for you to let it out, but it is good for me to hear that others have similar feelings and experiences.

Are you telling me that isn't a realistic goal? But, seriously, there are some great suggestions here. Visual and tactile stimulation is the best and most effective teaching tool, and the most interesting for all age groups. Showing the equipment while giving brief descriptions as to function and indications for use (dumb it down. They have the intelligence of an ape with verbal skills remember) and ask for volunteers. The KED is a great piece of equipment to show, and the Sager (applying traction may not be a good idea though). You can splint an arm, attach the ECG and print a strip, if you have a partner demonstrate how the stretcher comes in and out of the vehicle, show them the stair chair, have a volunteer sit on it and wheel them around. You can take five minutes at the end, to just let them look around the back of the truck (supervised of course). Maybe play with the siren. Also if you decide to try and add a bit of basic education, like how and when to call 911, keep it really simple (it actually is pretty simple, if some of the pt's we get can master it). But repeat, repeat, repeat, throughout the demonstration. Perhaps give out colouring books or Band-Aids (do you have printed ones?) as rewards for answering questions correctly or participating in demonstrations. If you do this though, make sure everyone goes home with something. It will be great. The worst thing you could do is just stand there and talk at them for twenty minutes. They will quickly lose interest and so will you. I find the best way to teach something is to be enthusiastic about it yourself. Enthusiasm is contagious. You will know it's going well if you end up with a shorty mayhem on your hands (but that is the teachers problem :wink: ) but they will remember this demonstration. Even if they never call 911 in their lives, they might correct their parents the next time they refer to us as ambulance drivers. Public education will never hurt our profession.

A Newfie visited a brothel in Toronto and decided to approach a prostitute. He asked her, "How much do you charge for the hour? "$100,"she replied. "Do you do Newfie style?" Not knowing exactly what this was she refused. He tried to sweeten the deal and said, "I'll pay you $300 to do it Newfie style". Again she declined. Being the persistent type, he laid down the final offer, "I'll give you $500 to go Newfie style with me! What do you say?" Finally she agrees thinking, "Well I've been in the game for over 10 years now. I've been there and done that, and had every kind of request from weirdo's from all over the world. How bad could Newfie style be?" After several intense hours of every possible way and position, she turned to him and said, "That was fantastic, but I was expecting something perverted and disgusting. Where does the 'Newfie style' come in?" The Newfie opened a beer and replied, "I'll pay you next week when I gets me EI."

Man, I must be losing my touch. Because in the middle of the night that seemed to be a perfectly innocent comment. :oops:

You guys don't honestly think we won't be hearing from him even in Iraq do you? Even an ocean and lots of sand can't keep Dust from EMT CITY to bash the newbies and dummies. :wink:

What job are you referring to?

Front yes, back no.

He could easily be catheterized. As far as I know there is no rectal catheterization though. Hmmm............Necessity is the mother of invention?

I concure.

Is he supposed to be on tricyclic antidepressants? This is a great scenario BTW.

Botox injections?