EMS49393

I would really like to know why all these new EMT's don't want to do transfers. Are you too good to do transfers? I've been in EMS for nearly 15 years, and I've worked part-time for transport services for 10 years of it. The current emergency service I work for is hospital based, so I'm still doing transfers. You want a good looking resume? Take the ambulance job you can get, make the most of it, and put a good amount of time into the job. If you can stick out running on a BLS transport car for a year, you can stick out any job.

("tskstorm This makes no sense to me ? What you said to me sounds like @ dont take your mva pt to an ER if the dialysis ctr is closer cuz he has [u) n stage renal failure. Every now and again, I feel the urge to purchase English textbooks and hand them out. :roll: I hope you don't write "pt being transported to dialysis for n stage renal failure" on your run tickets.

Now that's just silly. Is any hospital room or any nursing home room automatically a crime scene in NJ? What a horrible waste of resources. No wonder the homicide rate is what it is. :roll:

Her fibromyalgia made her do it. :roll: Long gone are the days when we were held accountable for our actions. It's nice to live in a world where we can just blame some garbage can diagnosis syndrome as permission to act like a total jacka**. Long live the blame game.

How does your service survive at all if 90% of runs billed are never collected? It seems a little high to me, but I'll give you the benefit of the doubt as I've never lived in a "boarder city." I've been in EMS for a long time, run a lot of calls, and worked in five or so different cities. I've always treated every patient the same way, regardless of who they were, if they could pay, or if they were just using the service. People abuse 911, that's a fact. I feel a great deal of loathing in your posts. You don't sound as though you like your service, area, patients, or job. If you're butting your head against a wall attempting to effect a change, I can understand your frustration. If you're just one of those EMT's that wants to sit in the chair all day, watch cable, eat ice cream and bully patients out of going to the hospital because they're just another non-paying illegal, then perhaps, it's time you seek another line of work. Do you have legitimate stats to back your claims of non-payment? Do you have all of this need documented on paper? Have you tried to appeal to your tax paying base? Have you pleaded your case with anyone, even the state, with any sort of passion? Have you tried, or are you just sitting here, spewing off incredible numbers and complaining about your patient base instead of using your energy for the good of the people you are supposed to be serving? You've managed to skirt around a few questions already asked of you. I'm interested to see how you skirt around the difficult ones I've posted.

Spenac, no offense, but I hope you're not a paramedic. The bottom line, they call, we haul, that's all. We do not have the power or privilege to determine a person is full of S%*^. Of all the 911 calls we receive, probably 80% of them do NOT need an ambulance. However, that 80% creates enough run numbers to allow us to continue to provide three ambulances in our county, with the recent consideration of adding another unit. Giving us three ambulances makes at least one of us available for the 20% of the patients that really need an ambulance. Now, I realize you said you only have one ambulance. Imagine if you hauled every patient that had, what you consider, a "benign" complaint. You might generate enough revenue to have two staffed ambulances in your area, or at least be able to prove a need for more then one ambulance. In this business it is not our right to tell a person they will "be okay" without being willing to stand up in court and suffer the consequences of our actions after that patient mysteriously dies. It's also poor form to bully a patient into thinking they are wasting your time and don't deserve the pleasure of riding in your ambulance for what you feel is a BS complaint. You need to understand, our definition of an emergency is far different then the lay publics definition. I think I'll stay out of Texas.

The correct answer is D. Auscultated wheezes. You will hear wheezes in a patient with bronchoconstriction, inflammation, etc. Often this is a finding in an asthmatic or COPD patient. You might see tracheal deviation in a patient with a tension pneumothorax, although it is generally a late finding. When air is trapped in the thorax and the lung is unable to expand, you could see a shift of the trachea to the opposite side of the "collapsed lung." The pressure in the chest cavity is causing the shift to the unaffected side. As a BLS provider all you can do is provide 100% O2 and treat them with diesel. A person with a tension pneumo needs a decompression, which is performed paramedics, and then, most likely a chest tube. Hope that helps you! Good luck.

I used to work under a DO at a medical clinic. I had a chat with him one day about the differences between DO and MD. For clarification, an MD is a Medical Doctor, and a DO is a Doctor of Osteopathic Medicine. Apparently, the education is the same, with both requiring a four year degree and medical school. However, a DO has additional education in the musculoskeletal system, and is able to perform surgeries, along with several other procedures. They understand how injuries can affect other parts of the body. A DO is not a lesser doctor, in fact, I'd consider them more of a "complete patient" physician. The DO I worked for was one of the best doctors I've ever had the privilege meeting. When I did my internship at the ER, I had both MD and DO mentors, and I feel I got more education on treating the whole patient from the DO. No offense, but I find it hard to believe that many DO's run expensive tests without good reason. Most I've met prefer to perform physicals with their own hands, and utilize the machines fairly sparingly. Perhaps you should do a little research before you insinuate that the DO is a "lesser doctor."

I work in two different pre-hospital systems, one with true RSI and one without. My full-time job happens to be the system in which I do not have use of a paralytic for intubation and it's already caused me problems on two of my intubations in the past month. In one case we were unable to successfully intubate secondary to severe laryngospasms. Had we had access to a paralytic, intubation would have been very easy, and I'm sure much less traumatic for our patient. In my second case, I had a patient with exacerbation of COPD that went down easily enough with Etomidate, however he was in excess of 200 kgs, and already on prescribed benzos. He required a great deal of versed for tube tolerance. With a post-intubation EtCO2 of 95, I wasn't about to let him pull out his ETT. I had a good blood pressure thoughout my transport, however I dislike the pucker factor I get when giving that much versed. Had I had access to vecuronium for post-intubation with my versed and fentanyl, I may have decreased my fear of creating a very large, very hypotensive patient. I like having the option of RSI, however I do not wear it as a badge of honor and run around intubating patients because I can. After speaking to a few physicians, I've come to understand that this is also a fear they have of creating a protocol for RSI. I've heard more then one say they don't want paramedics intubating the difficult drunk patient simply because they have the drugs to do it. It's a difficult decision to make in a very rapid time frame. Will you intubate a patient, and how will you do it? Is it really the best decision for airway control, or is there another less invasive way that will work as well? Do you really need the paralytic? I am all about aggressive airway management. The question is how aggressive is aggressive enough to provide the best outcome for the patient we're treating?

Sadly, this is how a good majority of the public perceives EMS no matter the quality of care we deliver. I did not find this amusing, and in fact, found it embarrassing. That is wasted space the internet shall never recover.

It's been my understanding within the past few years, since all of this "National Scope of Practice" talk fell upon us, that EMT would be removed from paramedic. You would be an EMT or a Paramedic. I've said it before, and I'll say it again (at the risk of hurting all the EMT's out there) EMT-Basics are technicians, they perform skills. They may or may not know why they are performing the skill or even the outcome of a skill, but they are there to perform the skill. Paramedics are clinicians. They treat a patient based on assessment and and an advanced educational foundation (we hope). Now, before the basics get their star of life panties in a bind, I was a basic for quite some time. I knew what my job was and how to do it efficiently. I knew on 90% of our patients that I was going to put oxygen on (I could even get the liter flow and device correct most of the time), run a 12-lead, spike an IV bag, get a set of V/S manually, and put the BP monitor on. I knew when the patient would require EtCO2 monitoring. I could most of the time, pull out the appropriate drugs for the paramedic to draw up. I couldn't read a 12-lead, and outside of being able to associate a drug with a symptom, I couldn't tell you why the paramedic might want a drug. As a paramedic, I understand the end result of the treatments I perform. I can read the 12-lead and I know exactly why I would or would not use a drug on a patient. The skills I preformed as a basic were invaluable to good patient care and the flow of a call. An EMT doesn't "save" me, they make my job easier by doing the skills they were taught to do. You have to know your role, and that goes for both EMT and paramedic. If EMT's save paramedics, then paramedics save doctors! That's just silly.

Both services I work for carry the EZ-IO. I'm personally not concerned with the cost, however I can see where cost is an issue for equipment, especially in rural areas. The bone drill is used on adults and children, and our protocols are written that we have two unsucessful IV attempts and the patient absolute has to have IV access for drugs or fluid, then we are able to start the IO. Jamshidi needles have been in use for years for pediatric IO's generally in a code situation. In answer to the question on sedation, without IV access how would you sedate this baby before the IO was done? You could use nasal Versed and wait for it to work, or use the drill and have an unhappy baby with IV access for potentially life-saving medications. It is my understanding that the bone drill doesn't hurt any more then an IV. I wouldn't personally bank on that, however IV or IO, a still active baby will be ticked off. At the risk of p***ing off every basic here, I do not believe that IO is a skill that basics should be allowed to perform. It requires very precise knowledge of anatomy, and has very little room for error, especially on a neonate or child. It has more contraindications then IV access. It's also a last ditch effort skill. I expected some one to ask that question, even though I know it's just going to open up another big, nasty can of worms.

:banghead: I respect that you feel you are in one of the most progressive EMS systems in the country and that you feel you save medic butt on a regular basis, however being as young as you are, I doubt you have the experience most of us have with other service areas and states. It's easy to think you're the best when you have never seen another way.

This is an ophthamology kit. For your future reference, ENT stands for "ears, nose, and throat."

I don't believe he said he has control over the basic whether or not the crew is on a call. He stated he is responsible for any actions that occur. I'm sure he doesn't care whether you eat at McDonald's or Chinese Dragon for lunch. Our concern is patient care, and that is where we ultimately have the responsibility.

I'm not in the habit of PM'ing people because I want to be confrontational. With that being said, I'll publicly answer a PM sent to me a few minutes ago. I won't divulge who the message was from, because I'm sure the more experienced of our group can figure it out. I've been employed in EMS for nearly 12 years. Before that, I was a volunteer. You stated you have been an EMT less then a year, I can assure you I've been an ALS provider quite a bit longer than you have been a basic. I don't make excuses for my actions. I don't blame other people for my inadequacies. If I don't know the answer to a question, I seek out knowledge. I put myself through college, EMT-I and paramedic school. I worked in a large city for many years taking patients in and out of some of the nastiest homes imaginable, and I rarely came home from work looking as though I rolled around in garbage. I didn't use the excuse that because my job might get messy, I don't need to worry about my uniform or my ambulance being clean. I didn't use the excuse that because college courses were not required for my paramedic license that I wasn't going to bother with them. I don't confront people in PM because I don't agree with their views or I feel like I'll be a bigger person if I attempt to insult them. Now, you began this post and poll. If you can't handle the opinion of others, I suggest you refrain from beginning any posts.

=D> KSEMT122, I couldn't have said it better. It is becoming rather pointless to reply to a post when you know the original poster will become confrontational if you disagree with their position. As a paramedic, I wouldn't let my basic partner push any medications. As a basic, I never pushed any ALS medications. Now, couldn't the paramedic push the drugs and let the basic control the bleeding? Seems to me the medic should have had the basic control bleeding, after all that is a basic skill, and then attend to the ALS portion of the call. By the same token, the basic should have used their words, and told the medic they would be more then happy to control bleeding, but they are uncomfortable with giving medications, since it is not in their scope of practice. NREMT-Basic states, "And if you are a patient who has a broken midshaft femur with a compromised artery, do you think you give two flips who gives you that MS where it was within protocol or not." More excuses. :roll:

Always excuses. You know who has to ask me for permission to do anything? A partner that I know constantly makes excuses for all their short-comings. How am I to trust a person like that? I see a lot of excuses here. Two hundred and forty-five reasons why a person can't go to paramedic school. Twenty-five reasons why my uniform is dirty, and the fact that the public shouldn't care. After all, if it weren't for the public, my uniform would be clean. More excuses then I can count on why it is perfectly acceptable to post as though you have only two neurons working correctly inside your cranium. Turn the energy for making excuses into something productive and see how far you soar.

Pardon the hijack... This is a website, and is set up to be public domain. Any person can type EMT or paramedic in a search and be directed to this very site. How we post reflects on our profession. I can not see how a layperson would have any faith in an EMS crew after reading some of these unintelligible posts. Thankfully, we have many more literate people on here than not. I hope that is what the public remembers. Would you go on a call in a uniform that looked like you just rolled out of a sheet sandwich and smelling of cigarettes and funk? This is a profession in the publics eye, think about how you are perceived.

Easy 4-step Method to Drug Calculations by S. D. Foust. ISBN 0131134604. If your paramedic program didn't provide this textbook, it sucks. Do yourself a big favor and get this book, go through it, and quell the fears so many paramedic students have about drug calculations. If you can add and subtract, you can do drug calculations. This isn't calculus, it's arithmetic. Good luck.

Actually, Somedic, that was me that told NREMT-Basic to "pay his dues."

I was a basic for quite a while before I went to paramedic school. I was a good basic that paramedics like to work with because I knew my place. I was the task master. I did vitals, put patients on the monitor, ran the 12-lead (which I promptly handed over to my medic), put on the oxygen, set up the IV, and asked if there was anything else that was needed to get the patient ready for transport. I talked to the patients and families, very minimally, enough to tell them what I was doing before I touched them. I also took the role of tracking down all the medication bottles or lists for the paramedic. When the call was over, I cleaned the truck, including the bench seat, action area, and floor. I made a mean cot, you could bounce a quarter off it. I wasn't being paid to "think," I was being paid to do. I was a partner, and most of the time I was treated very well by the paramedics because I knew what I needed to do to make their life easier during the call. I see a lot of basics rolling out of basic school with their 120 to 200 hours of training thinking they know it all and should be afforded luxuries I was never afforded. Don't get me wrong, I could "assess" a patient as a basic, however understanding the assessment was a whole other story. I relied on the SAMPLE, OPQRST, and the other monkey terms to assess the patient. As a paramedic. I rarely follow those acronyms. Honestly, my first thought when I see a patient is LOC, ABC's. When I establish those, the rest of my assessment is just a conversation between my patient and myself. What I need my basic to do is the same thing I did when I was a basic. Perform tasks. Make my job easier, not harder. I shouldn't have to tell a basic that I want oxygen, a 12-lead, an IV set up. I really shouldn't have to tell them the patient compartment is filthy. I establish how I treat patients early on in the shift. I clean up pretty well after myself on calls. I also don't need a basic that is going to complain because I won't let them have any calls. I like to do the patient care, period. If you want to do the patient care, go to paramedic school. As for giving medications such as patient prescribed NTG, or ASA. A basic better never give any drug other then oxygen when I am with them and the patient. Firstly, I don't use the patients medications. I carry drugs that I use. Secondly, you're not assessing the patient, therefore you are not treating the patient. That is my job. There have been times when I deviated from protocol and not given a drug based on the assessment of my patient. I am not a protocol monkey. I use them as guidelines. I am able to explain every action or inaction I take with regards to caring for my patient. I've gone so far as to consult with a doctor for drugs I have protocol to give without consult just because I like to have the second, more highly educated opinion on whether it's truly the correct course of treatment. I know your big gripe on here is "treat me with respect." Well, I can tell you now that if you act they way you act, whining about how you are "trained" to do this and that and the mean old paramedic won't let you, you'll never earn any respect. If you perform as a basic, and act very much they way I explained that I acted, you'll be invaluable as a basic partner. You have to remember the major difference between paramedics and basics. Paramedics have undergone an education (hopefully), and basics have undergone training. Ultimately, I'm licensed at the higher level, and I'm responsible for everything that happens on that truck. Before you get a bug up your drawers about how you're treated, remember that if you mess up, I'm the one in trouble for letting you do it. You don't want to be a task master anymore? Become a paramedic. Until then, pay your dues like the rest of us have.

Funny you're in Missouri. I'm in southwestern Missouri and I can't buy a job as a paramedic. I'm lucky to get 20 hours a week. My area is far from short. Pretty soon I'll be asking people if they want fries with their burger just to pay my electric bill.

AK, my service has used Zofran for the past year since removing promethazine. There isn't one good thing I can say about it. As many times as I've either used it, or seen it used, it has never proven to be a good anti-nausea. It's so bad my service is now giving us compazine back. That's fine, except everything I've read on compazine says that the dystonic reactions to compazine are better then twice as often to occur then in slow administration of promethazine. Promethazine also potentiates the effect of narcotics, making it very easy to get that patient with the deformed femur, or massive MI comfortable quickly. I say bring back Promethazine!

You do not lose your not for profit status if you bill. You lose your status if you make more money then you spend. Government funding only carries a service so long. You can't possibly upgrade old and outdated equipment, or provide paid staffing if you have no monetary resources in your budget. At one point and time I was a volunteer in a local fire department that ran two ALS ambulances. I try to forget that time in my life, but I do remember when we started to bill for services. We would bill insurance companies, and if the patient had no insurance, we would bill them directly. To the patients we sent one bill for the amount with a notice attached to it explaining that if they did not have the ability to pay the bill, we would still appreciate any donation to our company. If the bill was not paid by the patient, we did not put them in collections, we wrote off the loss. At the time this was happening we were in transition to staff our ambulances 24 hours with paid crews. We generated a lot of revenue off of billing, and it contributed to being able to afford newer ambulances, better equipment, and paid staffing. We never lost our non-profit status because those reasons stated above. There are a few computer programs out there that are designed for EMS billing. I would also consider running an ad in your local papers for someone with medical billing experience to join your organization and assist in the billing aspect. There are still a few people out there willing to donate their time for a good cause. Do the patients that despise paying an ambulance bill despise paying the ER bill as well? Very rare is the occasion when you get something for nothing. You should look into how much money it actually costs to treat a truly sick person, or for that matter, a person that isn't very sick at all but is still using resources. Keep up the mentality of not billing, and you'll keep your service in the stone ages of EMS, because you won't be able to afford to keep up with changing trends for improved patient care.