EMS49393

I live and work in Maryland, in a county that is fairly heavily populated but does have some rural areas (not Colorado rural, mind you). My county is largely volunteer and is supplemented by some paid BLS and ALS providers, and I can assure you that it's not supplemented nearly enough. I was stationed on an ALS chase vehicle with a BLS partner. The partner is not a mandatory spot and they are often pulled from me to staff another opening. We have another ALS chase vehicle in the northern part of the county that is staffed with two ALS providers during the day and one ALS provider at night. Both of us are dual dispatched with three different fire stations for every EMS call (BLS and ALS) except the lift assists. We are not terribly busy, but response and transport times can run the northern unit into a three hour call very easily. My furthest response time is currently about 30 minutes for areas I cover when the northern car is out of service on a call. My furthest response time in my area is about 22 minutes long. Unfortunately, we have beaten in the volunteers a few times even with these long responses. Many of the stations now have at least a paid BLS provider/driver during the daytime. Sadly, it's difficult for the stations in these areas to retain volunteers when you only run 400 calls a year and have the chance of being stuck on a call for two or three hours. We can't blame the volunteers, but we can't seem to get them the help they have been asking for either because funding is a constant issue, even with unbelievably high taxes in this state. What's even more sad to me, is that response times don't seem to really bother anyone but the paid providers in the county. It doesn't seem to bother politicians, or even the public, unless it is the person waiting for the help to arrive. It's a largely fire driven county and they're pretty reluctant to shift money from fire to EMS regardless of how high the call volume for EMS is compared to fire. We are working hard to change that but like everything it takes time or a major catastrophe. That being said, I couldn't imagine trying to recruit and retain volunteers in a place as rural as some of Colorado. The amount of time it takes to run a call has to run into several hours. I don't know where your closest hospitals are to some of your areas, but if your response times are greater than 30 minutes, your time to hospitals is probably equal to or better that time. Add in the possibility of having to bypass a hospital because it doesn't have the services your patient needs, you tack on more time. Then you transfer the care, drive all the way back, and are faced with a report that could take an hour or better to complete. That's a serious amount of dedication for a person doing it for free. I still volunteer myself, but a three hour call is pretty rare for me. My first due has a hospital right in town that handles 85% of our calls, and most of my calls last about 90 minutes from dispatch to the time I drop my finished report. Hopefully the residents and travelers understand the risks of being in such a remote area. I think this article does a pretty good job outlining those risks along with making the services in the areas out to be very professional, both paid and volunteer. They're doing the best they can with the remoteness of the landscape, and the resources at hand, but it looks like they still look for ways to improve the responses as well as the level of care received on the scene. That's what I took away from this article anyway.

I've never had a policy in place for this anywhere I've worked. It's always been provider discretion. I will let parents of minor children, spouses of hospice patients, and foreign language translators in the back with me, in the captains chair, because it has both a shoulder and a lap restraint. That's only if they are under control and giving me a calm vibe. Aside from that, I'm not a big fan of family riding along in the front. I have actually had seemingly calm family members become panicked because they're only hearing part of what is going on in the back, and they're intermittently turning around to catch glimpses of treatment or care and working themselves up no matter how reassuring the driver is trying to be with them. I've had a few instances where they have actually grabbed me while I'm driving, or grabbed my EMT driver while they're driving. They can be a VERY big distraction and my main objective is to have my driver concentrate on getting us safely to the hospital. I do not welcome any distractions for them, be it riders, radios, and especially cell phones! I play it case by case, and I'm much more inclined to allow older spouses to ride, but in general, if I can get them to just safely go behind or ahead of us in their own car, I strongly advise it. When I worked urban EMS I often had several people that would say they just "had to go with the patient to the hospital." I'm not toting around five of your closest friends with me, especially when I know I'm putting you in triage anyway. That goes for patient X's boyfriends-girlfriends-aunts-friend that just happens to be on scene and want to go along. It's not a taxi or a party, it's an ambulance.

I'm not reading this entire post right now but I'll still chime in. We have awesome quarters were I work. I do work a pretty busy station, but we are sort-of a combo department (it's a long story) and the volunteers do come out and ride the other ambulances pretty regularly. We work 12 hour shifts, 2 days, 2 nights, off for four. Several of us often swap in to 24 because of the cost of gas and our commute times. Personally, I love 24's, no matter how busy, because my drive is over 50 miles one way and takes me 75 minutes. My last job had great quarters as well. We weren't nearly as busy. We worked 12 hour shifts. My drive was less then 4 miles round trip. Until they come up with affordable flying cars or lower the price of gas, I'm going to keep loving the 24.

I know you asked for basics and intermediates, but Maryland has universal state protocols, and it is an EMT-I/paramedic level drug. Pennsylvania also has fairly standard state protocols. They only recognize basic and paramedic. It is a paramedic level intervention in PA. It's paramedic only at MEMS in Little Rock, AR; St. John's EMS in Springfield, MO; and CoxHealth EMS in Springfield, MO. No EMT-I level in AR or MO.

How do you know all this information about him? Has he told you that he has stopped taking his medication? Has he made other statements that indicate he is depressed and lost his will to live? I ask for this reason, if he told you, chances are he is looking for help and this is his way of asking. People that are committed to ending their life typically will not tell anyone before they take the final step. It's the ones that make the subtle remarks that you can truly help. I would definitely figure out who is the most appropriate person to tell and let them know the situation. Sometimes medication stops working. A person can be on, say, Effexor for 15 years or 3 years and wake up one day completely depressed and suicidal. It means their maintenance anti-depressant has likely stopped working and needs changed. This guys medication could have stopped being effective which is snowballing him into a depression where he is exhibiting potentially dangerous behavior. Bottom line, he wouldn't share with you if he didn't need you to figure out how to help him.

I have to do it as a requirement for my PCR. Honestly, I could care less about GCS. IMHO, we have too many little systems for determining a patients mental status when it's much easier to say "they're alert, oriented, with normal mentation" or "they're responsive to voice, garbled speech, no movement on the left side." Those are much better descriptions of what is going on then "en route with a 60 year old male, rule out CVA, GCS of 9 (maybe 10 or 11, who knows, his verbal doesn't fit any of the numbers)." The trauma bay here asks for a GCS breakdown, but it's the only place I've ever transported to that does. Most ER's want to know if they're acting normal, and if not, what is abnormal.

I'm not a big fan of feminists either. I think they do more harm then good for women's rights. There is a tactful way to approach and issue and attempt to get your point across. I liken feminists to the Malcolm X's and Louis Farrakhan of the civil rights movement. You're going to win more people over by appealing to the greater good of all people, not just "your people." And before you start all that "you're a racist" crap with me crotch, I happen to be a huge fan of Dr. King, which probably explains why I'm not a fan of Malcolm X. Two different people, two vastly different approaches. Criminal men find women and easy target. Stop thinking like a strong woman and think like a psychopathic man, who would you target? Bubba or Barbie?

I'm not reading this entire thread, but I am tossing in my opinion, for what it's worth, which isn't much. I'm female, and I generally HATE working with other women. Women make me crazy with their incessant chatter about their boyfriends and baby daddies and whatnot. I do not like the gossip, I do not like the catty crap, and if I don't feel like talking, I shouldn't have to talk. I've had several female partners through the years and of them, I could only stand one. Ironically, she was a lesbian and more masculine then most men I know. I hardly have any female friends. I'm just not designed "girly." I have always gotten along better with men then women so I prefer to work with them. From a psychological standpoint, I feel double female crews are dangerous. Not because they can't lift, because a lot of them can, and not because they can't do the job, because most of them do, but because a female is a bigger target then a male. Imagine you're some seedy dude up to no good wandering the streets at night looking for a victim. You see an ambulance parked on a street corner, which is not unusual in a third service or public utility model, and you know you have your target in sight. Once you walk around to the side you see a man and a woman, or a man and a man, will you walk away and look for something easier? Very likely. Same ambulance, this time with two women. All you can see is "easy target" because there is a natural assumption that women are the weaker sex and can be over-taken with little effort. It's not sexist, it's about safety. A douche of a creepy man looking for a target is much more likely to choose an all female target then a combination or all male target. Be a woman and hear you roar. No one is more pro women's rights then I am, but I'm also pro staying alive, and if that means I have to take into consideration that some scumsucker is likely to target me at work because I have a female partner versus a male partner, then I'll take safety over my rights.

I was taught how and to use them in paramedic school. They are within the guidelines for ALS providers in both Maryland and Pennsylvania, so I do make every effort to drop one when I intubate a patient. I'm pretty sure I'm the only medic I know that does place them.

Good, this is how it should be. I can't count how many times the EMT's have tried to give me their number and take the call when the patient could benefit more if I transport. It's not always about life and death crap. Very few calls are life and death. They say it's a chest cold, and it could be pneumonia working on sepsis. They say it's just a little nausea/vomiting, and I say we should make them more comfortable with some zofran (because the act of retching hurts like hell). They'll tell me it's just a hip fracture, meanwhile Mrs. Doe is in some terrible pain and might like a little morphine. I don't really like being waived off of calls. I'd rather do an assessment and make the determination then. There are things I can do for comfort that BLS providers can not. I do not have to be running a chest pain, shortness of breath, or cardiac arrest to be a benefit.

I have to throw my suggestion behind PL Customs as well. I've been in just about every possible kind of ambulance during my long career and for the money, the value, and most of all the service, PL was the best. It's pretty strange for me to say that because I was a pretty die hard fan of the Horton until one of my former companies took delivery of one of PL's ambulances. They converted me. Sounds like you're off to a great start. This is a long process, it's some serious brand of hard work, and it will wear you out. Good luck!

I was bit by a German Sheppard when I was a little kid. I'm terrified of German Sheppards. I know a dog is mean because it was trained to be mean or its a stray and is trying to survive, but I still have trouble with that breed. If its a service dog I will make every accommodation to take them with us, regardless of the breed. So if I can put away my extreme and unnatural fear of the big dog, anyone else should be able to, especially in the case of a well-trained service related animal. My husband has actually transported patients with service dogs several times. He adds that most of them will sit in a travel harness and are better behaved then most bystanders or family members on calls. Before the harness was standard gear for pet travel, he had a service dog just lay on the floor between the cab and box for the trip. He said it laid quietly and just watched its owner and never interfered even during the IV start. Dogs are pretty smart. I'll take a service dog over a human any day.

I do NOT trust anyone at work. Ever. I haven't trusted anyone for years and I'm not about to start now. This is one way I protect myself. The second way is to do my job. Work is work. I'm competent, and I'm in charge, which is an advantage. I never bring my personal life to work. I do not do any social networking with anyone I work with. It might sound cold, but you don't crap where you eat. The person is already being watched. They have a big bulls-eye on them as it is. Do your job the best you can and document the job you have done. You're actually lucky that the management already knows about this problem child.

I wouldn't worry as much about the protocols for LMEMS as the morale. Those guys are terrifically unhappy. They're still bent over the merger, and several of the JCEMS guys have since moved on. Last I heard they had ridiculous overtime, super high call volume, and more burnt out medics than several large services combined. Not to mention, they didn't seem real jazzed up about the director that came in a few years ago under a cloud of 9/11 pomp and very little circumstance. You could look at Oldham County, Georgetown-Scott, or Shelby County EMS. They're all around better services. Once upon a time there was a great website for Kentucky EMS... www.hultgren.org, but I don't think it's getting as much traffic as it did a few years ago. Personally, I think a job is what YOU make it. LMEMS gets a lot of bad internal press, but so has every other EMS service I've ever worked for. To be honest, I've been pretty happy in all my services regardless of how the other medics felt. There was even complaining and whining in the ranks of one of the service I worked for that had incredible clean, nearly new ambulances, moderate call volume, RSI, 60-odd drugs in the toy box, surgical crics, and a host of other fun toys along with a butt-load of continuing education every month. The place had real low turn around, but you would have never known that to listen to them complain. You have two choices when you go to work: you can be happy, enjoy your job and your day or you can be miserable, hate your job and alienate everyone you come in contact with.

A degree will always make you more marketable. If I have a choice between hiring a person with a degree or with the bare minimum, the degree will generally win out. Including the education, which you appear to need, it proves that you have the motivation to go above and beyond what is minimally required. Organizations generally like that, a lot. Not to bash you, but your posts are not very readable, and it's very hard to understand what you are trying to say. College English will help you in the arena. If a potential employer can not understand you, you will be bypassed. Lone, Dear, Maryland treats their EMT-I's as ALS providers. Although a full paramedic will get some preference in hiring, the fire departments only want an ALS provider, and the "I" will suffice. However, they can't move up the career ladder unless they become a full paramedic, or move to the fire side. You won't find many here that advocate becoming an ALS provider just because it's the only way to get a job as a fire fighter, it holds our profession back.