EMS49393

That's frickin' crazy! Whack-jobs like that clown are generally 17 year old kids with access to a credit card attempting to be more important then they will ever be. I hope the fire department he is supposedly associated with is tearing him from grill to bumper over that atrocity.

I didn't personally bash anyone, re-read my post for clarification. I explained why things are how they are in Maryland. I've been in this career for over 10 years, and through that time I worked hard to change the way things were done. Instead of assuming I'm at fault for not making the place better for all those involved, why don't you move to Maryland and see if you can do any better then I did. I was one of the few that lobbied for instituting the National Registry exam for basics. I was shot down every time I brought it up. I led by example. I drove several hours through several states to take the National Registry exam eight years ago only to be told I couldn't have the NR part on my name tags because it's not recognized and it never will be. They stated too many people wouldn't be EMTs anymore if they had to pass that exam. So coddling them through a state test was the answer to a shortage in EMTs just as having CRT was an answer to the shortage in ALS. One person can only do so much. I have since moved from Maryland and I am quite active in my new system. My only hope is the bad press will draw attention to the many problems there and open some eyes up to the changes they need to make for the sake of their citizens, including my own parents.

Since you were not a responding provider to this call, how are you able to judge whether the crew should have been flown or not? It is not up to anyone to judge that unless they were the paramedic in charge of the incident. You do not know anything about the private services in Maryland. You have no idea the type of provider that generally ends up working for those places. I was turned loose to function after 2 hours of "training" at my first job there. I worked part-time for a few services there off and on for some extra money and I'd rather have a vet take care of me then most of the full-timers they had working for them. Ask anyone in EMS in Maryland, most private ambulances are a laughing stock, because they do ridiculous things like let 18 year old drivers speed in construction zones for no reason. If I did that in my current job I would be dismissed, before my shift even ended. A quick story... Several years ago Maryland went through a welfare reform program. They told all the single mothers of multiple children that they could either be trained as a CNA or an EMTB, and that they would place them in jobs when they were finished. You didn't go to school and get a job, you lost all of your benefits. Most became EMTBs and ended up at the private ambulances in the greater Baltimore area. They were consistently late, constantly out of uniform, sloppy, inadequate providers that could care less about a job. They used their kids as an excuse to NEVER work nights or stay late on any calls. They gave the all of the private services a bad name there. You don't have to pass National Registry to become an EMTB in Maryland, you only have to pass a state test administered by your instructor. Now, you tell me what kind of quality they can put out with standards like that. If you've never lived and/or worked there you have no right to scrutinize the system for downing it's providers. It dumbs them down enough on their own by not having unbiased and set standards for passing exams and becoming certified. Incidently, the specialized critical care programs are run by University and Hopkins. They hand pick their providers and train them extensively from the private company they contract them from. I went through over 3 months of training to be allowed to work on those teams including floor time in the TRU. There is no question how good the CCT EMT-Ps and nurses are. The problem is with the BLS end of the services.

Nate, A private ambulance is never 15 minutes from a nursing home in Maryland. The average ETA is generally better then 2 hours for a transport, which is why the facilities are directed to call local 911. One reason this Bulter ambulance is under scrutiny right now is because they have a policy to guarantee they will be at a facility to transport in under one hour. That's a hard ETA to keep considering they have contracts both in the greater Baltimore and the greater DC area. With traffic as it is there it's difficult to go that 40 to 60 mile distance in under one hour, safely. Whereas, a 911 ambulance is generally less then 15 minutes away from nearly any facility, and quite often, even closer. The system there was designed this way for a more reasons then I can illustrate in a forum board. It is not perfect, however no system is perfect anywhere.

If you read the article, there was no patient on board at the time of the accident. It is against the COBRA regulations in Maryland to run "code" or priority as we call it, to a facility for a patient in a private ambulance. That is why the state has 911 ambulances and MSP helicopters. If a nursing home calls for a patient transfer and they report the patient unstable in any way they are directed to call 911 for their closest emergency ambulance. The state doesn't want private ambulances running emergent calls, period. As for the BLS crew transporting that particular patient, I hope that is one of the run forms MIEMSS pulls and questions. MIEMSS started making private services do Commercial MAIS forms just so they could keep an eye on these private ambulance providers. If it had been an ALS crew, it would have been acceptable for them to continue patient care and transport, however a BLS crew should have contacted 911 themselves, and had a rendezvous with an 911 ALS ambulance if their patient was in that much trouble. That's the regulation. Carroll County has 14 fire companies and they are no more then 15 minutes apart. All but one company has a paramedic unit. Harney doesn't have any ambulances, but they are out in the middle of no where and I believe still house their fire engine in a barn. Several stations have 2 staffed paramedic ambulances, including Sykesville. Westminster staffs three paramedic ambulances. I'm sure county 911 has the emergency ambulance business covered in Carroll County. I lived in Maryland a long time. I worked private ambulance part-time there for more years then I want to admit to. I know the rules and regulations set forth by the state inside and out because I was one of the few providers unwilling to break regulations for my company to make an extra buck. It was never worth my certification to do so. Hated by management, loved by timid providers for taking a stand on numerous occasions. I was never fired by my company either, simply because I had copies of the regulations with me, and I wasn't afraid to call MIEMSS for clarification if need be. This cowboy wanna-be EMS garbage is why private ambulance has such a bad reputation in Maryland. Private ambulances do transfers, that is their job. If that critical care patient is in such bad shape they are either flown to the appropriate facility or taken by a specialized critical care transport team out of University or Hopkins. In all my years both BLS and ALS we NEVER had to run a patient into a facility priority.

Link from the fire department responding to the accident: Sykesville Fire Based on an article from the local newspaper, none of the crew were wearing seat belts. An employee from the same private ambulance company that was involved in this crash was recently ticketed for failure to wear a seat belt by the Maryland State Police. He blogged about that incident on his myspace page citing that someone could die in the amount of time it takes to put on and take off a seat belt. Keep in mind, private services in Maryland do NOT run any 911. Last time I checked, a nursing home transfer did not constitute life or death. Has anyone heard any other excuses for not buckling up?

Good joke, even if it is over 10 years old.

18% Dixie. Wow! You are a Duke of Yankeedom! I should be 0% Dixie, that test is wrong!! At any rate, I may live in the land of the hillbilly people, I'm still a Yank, and I always will be! Guinness and hoagies all around!

I've never been business-savvy, so pardon my stupidity. I work for a hospital and my average cost for health insurance is over $110 a month for a single person, no children. My co-pays range from $20-$100 dollars depending on seeing a PCP or an ER. Our prescriptions average $10-$50 dollars a month. Hospital employee, hospital insurance. If we go out of the network of our hospitals providers our rates go even higher. I received roughly a 3.4% increase in pay this last year. They're griping about a 17.5% raise over two years? That's 8.75% a year. They are changing health coverage and co-pays will increase. What are they increasing to? They must be pretty high if they are getting a $500 bonus to cover out of pocket expenses. It almost sounds like they won't have any co-pays at all if that's the case. I really don't understand why they're complaining. It seems like they're getting more then most providers will ever see. If they pull something stupid like a strike, the company can hire me. I'll be more then happy with that fat pay increase and a health coverage bonus. Perhaps I'm missing something.

This is so exciting! This is by far the most educational post I've read on here in a long time. 20 to everyone involved. Thanks, I learned something new, and I appreciate that so much.

moistened dog food

Brother, I don't even know you and you are my hero today! My sides hurt. :laughing3:

No offense, but I'd rather lay still and pray for adult ALS then be "treated" by children. If you can't drive a car, you can't drive an ambulance which means you can't get a patient to any definitive care. I doubt your basic first aid is going to cure a c-spine fracture. That type of patient generally has more underlying injuries and requires at least monitoring and fluids, if not more advanced interventions. They also require a fast ride to the trauma center, something that you can't provide if you're unable to drive an ambulance. What kind of "urgent treatment" are you providing that is so life-saving? Could you please share an example or two of this "treatment." The thing is, you make very little sense with your reasoning. Your writing itself is barely understandable with it's shoddy grammar and spelling errors. You expect me to trust you to handle a medical emergency when you can't drive me to the one place I need to be in such an emergency? On a side note, I counted 19 spelling errors, and more grammatical errors then I have fingers and toes. The least you could do is utilize spell check. The point you are attempting to prove is overshadowed by your childlike ramblings.

Ugh, I have a simple question myself for you GAMedic. Are you illiterate or lazy? I would guess it's not the first since you're giving headaches with nearly every post you write. I went through six or seven of the links posted for YOUR reference and finally found one that had some numbers associated with it. That took me all of about 10 minutes, and that's on the slowest computer still in existence. According to one link given by our friend and respected colleague, Ace, a study in Toronto put the no-transport rate at between 2.0% and 9.0% in the time frame they were conducting their study. I know very little about Canadian EMS, so I have no idea what service they were looking at, however logic would dictate they were studying their very own community EMS there in Toronto. I don't know about anyone else, but 9.0% is way different then 50% or even 36%. Toronto a rather large urban area as well. I would hazard a guess that the numbers there would be close to our own urban numbers. I work for a moderate sized urban area in the Midwest, and based on the calls I run, and hear being run when I'm on shift, I would guess our no-transport rate would be less then 15%, and that's in the city. Our rural areas transport nearly every patient that calls 911. So there you go, I've managed to do the work for you and get you a set of numbers to correlate with a service area. I have to agree with everyone else here, be prepared to back up the large numbers you put out there. I'm sure if you had written proof that Washington D.C., Baltimore, MD, Detroit, MI, and many other rural cities have exceeding high no-transport numbers, it wouldn't be a surprise to any of us. It's not service slamming, it's bringing attention to a problem. Exceedingly high no-transport call volume means there is a problem somewhere in the system, either with the patients themselves calling, then refusing to accept help, with providers that do not want to transport, or even with poor public education on when to call 911. Bottom line, don't let your mouth write a check your brain can't cash. Please pardon the poor flow of this post, as I'm writing it rather hastily at work, waiting for my next no-transport call to come in!

Once again, I'm going to totally disagree with GAMedic. You don't learn confidence, you develop it. I hate have to be brutally honest and tell you the best way to develop confidence in talking and taking care of patients is to work a private ambulance transfer gig on a BLS unit. There is very little stress in running transfers. Perhaps less then 1 in 100 ever go totally south. Most transfers are DNR, which take the pressure off of having to work a possible code in transit. You'll get a chance to talk to your patients. Use it as an opportunity to do a full assessment, regardless of how many EMTs laugh at the notion of a full assessment on a transfer. If you're taking over care of any patient, you own them and yourself a full assessment. You'll begin to be able to correlate medications and diseases. You'll be forced to function independently. It sounds boring, and I know so many EMTs that feel they are above running the renal roundup, but I assure you the experience is invaluable. It also enables you to develop this very important skill while being PAID to do it. I would never go to work and ask to ride third for FREE. If you do it for free, they have no reason to pay you. FYI, I ran on a BLS transfer truck for about a year when I started my career over a decade ago. That year was essential to my ability to feel comfortable interacting with a patient. If you're just not interested in EMS and your passion is music, then you should consider leaving this profession. The educational demands are often too great for moonlighters.

GAmedic, obviously you really don't know what it's like to eat ramen noodles three meals a day because your employer pays you less then welfare wages. All of that fluff and flutter sounds so great, but in reality I don't see my supervisors enough to care. I want the green. I want merit raises, decent benefits, and my recert CEU's paid for. Heck, if you want me to have ITLS, PALS, ACLS, etc., then you should offer and/or pay for the courses. Don't shower me with praise, praise doesn't pay my bills. SHOW ME THE MONEY!!

With huge teeth!

Did I miss a meeting? Are basics dispensing ASA now? Did they change the dose to 235 mg and not send me an email at work about it? Ugh, that place. ](*,) As for a assessments, the above is a fantastic "by the book" assessment one would use to pass, oh say, the national registry. In the real world, if you can't communicate with your patient and build a rapport, you can't treat them appropriately. I don't agree you should practice on friends and family members. I do agree that you should consider doing some more time in the ER or in the field. Friends and family offer comfort, and are quite forgiving. Strangers that rely on you to handle their emergencies are not so forgiving. Take a deep breath and relax. It's not a sin to do more clinical time then required by class. The fact that you do means you care a great deal about being the best provider you can possibly be. You are able to address and overcome in the areas you have trouble with. Good Luck.

It pains me to say this because I'm pretty anti-volunteer EMS, but have you tried joining a local volunteer fire department? Even if they don't run any ambulances, the will often put you through EMT-B so you can first respond on medicals. You can be up front with them about wanting to run medical calls only and most of them will worship you because fire jockeys do not like running EMS calls. In my neck of the backwoods we have some departments that are first response agencies for medical calls simply because our paid ambulances are spread so far out over the area. They do pay for people to attend first responder and basic classes, and there are plenty of "EMS only" folks on these departments running first response.

:thumbup: I like ya! Anyone that agrees with me is alright. LOL

Sinus arrhythmia. Crash course: P-wave is present, it's sinus in origin. It's upright and uniform, so it's coming from the SA node. ORS complex is normal, the ventricles are depolarizing properly. T-wave is upright, uniform, the ventricles are re-polarizing. It's irregular, so it's an arrhythmia. In the one labeled EKG 4, there are two unifocal PVC's present. Your SA node probably didn't fire fast enough, and the ventricles decided to depolarize without the SA node, that's a PVC. They're unifocal, meaning they look alike, so they're coming from the same point in the ventricles. Anything could have caused your symptoms, including your blood pressure. However your blood pressure could have been caused by your arrhythmia. IMHO you should take the information you have and talk to your physician. See if he'll set you up with a cardiologist for further testing. It's possible to have cardiac problems in your 20's. An AMI is not the only cardiac problem there is. There are also conduction pathway problems, and re-entry pathway problems. Both of those can present in children as well as adults. Without a 12-lead it's often impossible to detect a some conduction re-entry pathway issues, such as WPW. BTW, that was pretty cool reading them sideways!

First, I'm a female, as my little icon indicates. Secondly, I would not ride with you. I prefer my partners understand their educational limitations and scope of practice, as I understand my own. Oh, and spellcheck rocks when it's utilized!

Correct me if I'm wrong, but don't the PCPs in Canada have a year or two of didactic time? They have A&P requirements? They have educations? The little I've learned about the Canadian system I've learned through here, and if I've been reading correctly, the above is in indeed true of our northern neighbors. So, let me reiterate, the EMT-B in the US has 120 hours of training, roughly. They have NO A&P requirements. The class I teach for has to do 10 hours of clinicals in the ER, and run 5 calls before they can pass the class. Can PCP's administer Glucagon and understand what it's mechanism of action is, the indications, contraindications, etc? I bet a dollar they can. Judging from the training, I'd trust them to be able to make a decision like that. Can EMT-B's do the same? Absolutely not. If you can't tell me how a medication works in a way that I know you understand it, then get your hands out of my drug box. The one big fact that the EMTs fighting for this privilege have left out regarding glucagon... It's a one shot deal. There has to be adequate glycogen stores in the liver for this drug to work, and once you use those stores, the person then has no other way to increase their blood sugar without receiving actual glucose. On a side note, PRPG, you can hop on my ambulance anytime. I'd take your young, yet knowing self as a partner a million times over Whit. Age doesn't always mean you know more. And Whit, if you want to push drugs so bad, do what a lot of us did... go to paramedic school and get an education. Educational shortcuts are the devil.

I hope you pass the test this time, however I did want to take an opportunity to warn you about Missouri EMS. I see your occupation is a pharmacy tech. I suggest you stay a pharmacy tech. You have a snowballs chance in hell of finding a job as an EMT in this state, a slightly greater chance if you should decide to be a paramedic. Even if you get one of the very few PRN spots somewhere, you'll certainly notice a pay cut from your current employment. If you really, really like EMS and can't seem to get it out of your system, and you pass the test and become registered, and you want a job in EMS, I suggest you relocate. The grass is much greener in other states systems.

Don't be hating on the people doing 911 because you're doing transfers. Obviously you enjoy paying taxes that go to take care of the people we're talking about. I suggest you re-read THbarnes post. It brought up very valid points about how we financially take care of these people and they can't go the extra length to even get their prescriptions filled. Our tax money could go to more useful ventures, just as he said. I'd personally like to see a cure for cancer, but the more money we waste on people that don't care to do anything but drink their 40's and smoke their chronic, the less we have for taking care of that mother of four dying of breast cancer. Just for you information before you bust my butt, I did transfers, including the "renal roundup" for years before getting my hospital based job. My current service does it all. Personally I'd rather run transfers, taking grandma back to the nursing home, then 911 here, and that's because the 911 calls are 90% BS and I know granny really needs the ride.