EMS49393

First of all, Annie, your avatar looks like my beloved dog Mo. She's a princess. Anyway, on to my post. There is no "formal" protocol for determination of death at MEMS. At least, not that I had ever seen in my two years with them. They have a protocol manual, but it's pretty hit or miss if you'll find what you're looking for. One of the best death determination protocols I have ever seen is in Maryland, and can be found on the miemss.org website. That being said, they just had a similar incident in Maryland where a paramedic determined a patient to be deceased when that was not the case. Protocols are nice, education is nice, training is nice, but you can only lead the horse to water, so to speak. All the protocol and education in the world isn't going to help a provider that is just lazy, or stupid, but I see lazy with greater frequency. I saw a LOT of lazy at MEMS. That call just happened to be right around several shift changes. There is a change at 5:30am, one at 6am, and another at 7am for twelve hour trucks. I hate to say this, but I've seen the end of shift bring out the absolute worst in a medic. As far as the coroners and training, they are correct. Most coroners in southern states only have to be a resident of the county to which they are elected. A lot of southern states still elect constables and sheriffs. Nope, I'm not lying. They aren't required to have any training either, just a residency requirement. I'm surprised they don't have elected, untrained medics, but I have not been to every southern county. I can't say much about living in the south other then stereotypes aren't created out of thin air. Have you ever seen Deliverance? Just sayin'...

English eye candy, you're damn right I'll watch it for that! I have so few pleasures in life.

It was 120% better then Trauma. Of course it stars an ultra-hot English actor, so I might be a little biased. I'll keep watching, if for nothing else, because I adore Jeremy Northam after seeing him as Sir Thomas More in The Tudors.

One of our local hospitals supply cards that neatly fold up and fit in a wallet. They give us a stash when we need them so we can hand them out to our patients. If I have a patient with multiple issues, medications, and allergies, and they do not have a card, I will give them (or a family member) a card and explain it's importance. In addition, I offer to assist them in filling them out once they are discharged. I give them the number to the station and tell them to call and leave a message for me. I will go and visit them, take my PCR with me, and conduct a nice, thorough interview. I'll ask to see any discharge paperwork as well, to make sure their form is as complete as possible. Many are grateful for the help, and I think many are grateful for the company. I'm lucky that I work in a pretty small area now with a call volume around 4000 a year. I've gotten to know my regulars, and I've had a lot of patients that I've grown fond of. We have several multi-residential buildings for elderly and disabled people and I try to make rounds to them every so often to check on my most frequent fliers. Our community knows us, and they support us very well with donations. I really believe it's these small acts that help the community understand who we are, what we do, and that we want to be there to take care of them when they need us.

When I worked for MEMS in Little Rock, I got a different truck nearly every shift. I checked it from top to bottom at the beginning of the shift only stopping if I was put in service for an emergency. I usually got to work 30 or so minutes early just for this reason. At least once a week I found expired drugs on the truck. They are supposed to be "majored" every month on the day of the month that corresponds with the truck number, however that rarely, if ever, happened. The most outdated drug I found during my time there was an EPI 1:1,000 that was four years out of date. Of the six required to be on the unit, four were four years out of date. I have no idea how that slipped by state inspection, nor do I want to know. I work for a much smaller service now and we are all very diligent with the stock. We have two drugs that have to be rotated out monthly because they are only good for 30 days outside refrigeration. They are marked on the dry erase board for both ALS units and every one of us checks them at the start of our shift to ensure the dates are correct. Drug date checks and inventories are generally done once a month, at the first of the month and the drugs that are expired are replaced. We also note any drugs that are going out in the next two months inventories so we can insure we have adequate stock to replace them. You know what works really well to keep from having expired drugs on your ambulance? Responsible employees that take their job seriously and do it correctly. This also works well in regards to having adequate stock and equipment that is checked to make certain it is in good working order. Responsibility. Have the eliminated that word from the vocabulary of the grammar schools?

I already posted this two days ago. AR Woman Dies

Now I'm really glad I don't work here anymore. The company runs a 6 month medic mill that graduates 8 paramedics a year. I use the title paramedic loosely. In the two years I was there they had 4 of these medic mill paramedics make mistakes that were so big they were busted down to EMT or terminated. What's that, roughly 25% of the graduates make fatal errors a year. Seems like pretty bad odds to me. This year we have two more prize winners: She's dead, I think. Maybe not. I dunno. This is becoming a nation-wide EMS epidemic. What in the hell is going on with providers these days?

In a true "disaster" situation the last person I'm worrying about is the person I can't save. I'm worried about the patients I can save. This wasn't a disaster. It was an inconvenience, and nothing more. The patient complained of abdominal pain and must have been legitimately sick considering he died the next day. You can't assess someone over the phone and say "well sir, you only have some belly pain, take a tums, and walk to the ambulance if you want a ride." It's unethical, period. Do your DAMN JOB! If you don't want to do your job, then quit and let one of the countless providers that do what to do their job take your spot. If it was safe enough for the patient to trek to them, it was safe enough for them to trek out to the patient. Period.

I was not working during the snowmageddon of 2010 because I was on sick leave. However my husband was at work during both the first and second storm. The service increased staffing, and he told me at the end of his shift that he had waded through waist-deep snow several times to get to patients. He's 6'1", so waist-deep is pretty far up there. He also told me that he and his partner along with help from another paramedic on a chase car and the fire department successfully removed a patient via stokes basket and ropes from a residence. The had to move him nearly a block in around 3 feet of snow. The patient was also on CPAP that was initiated in the home before they were packaged and moved. He said the operation took nearly a hour to accomplish and was more difficult then he could have ever dreamed. The point is, he, along with several other people DID THEIR JOB. They did it in adverse conditions, and had to wait for enough help to clear up from other calls to have enough people to safely do the job. He initiated treatment in the residence, after upgrading the call from a BLS dispatch to an ALS call, called for more help, and took care of the patient while he waited for help to move him. For the record, we are in South-central PA, and we had just as much, if not more snow then Pittsburgh. We also have the PA priority dispatch crapola here as well. Dispatch decides if a call is an ALS or BLS response, and more often then not, they are wrong. So really, they couldn't get to the patient? I don't buy it. They didn't try hard enough, period. Even if they had to wait for help to move the patient, they could have gone to the patient and began to assess and treat. While I agree they are not the only ones at fault, I do believe they did not act in an ethical manner.

I have given notification several times when I work an arrest and obtain medical control for termination. I put myself on the same level of the patient, i.e., if the patient were seated, I would kneel near them before I began to talk. I calmly describe that when we arrived their family member did not have a heartbeat and was not breathing. I then explain that what we did, such as medication, breathing tube, CPR, defibrillation, etc. I do not go into gory details, but I make sure that the person I'm talking to understand how hard we worked to save their family member. I then tell them that I spoke with a physician at XX ER and he agreed that everything that could be done had been done and that we should cease efforts. I offer to answer any questions that I can, or obtain any outside support that they may need such as additional family or clergy. Of course, the above only works for me if the family is not hysterical to the point that I feel we are in danger. As of yet, that has not happened to me. Most family is so busy grieving that they want comfort more than they want to fight. It's a delicate situation, and something they do not teach you how to do. I really feel that a large part of my job involves social work, not just fancy medications and toys. I'm there for a patient, and I'm there for family when I have taken care of the patient. I am a big fan of requiring sociology and psychology for paramedics for this reason.

This happened to me last night, except I was the paramedic, not the fire fighter, and the nurse was only a CNA. Oh, and I didn't curse, but I wanted to. I'm glad the facility called me, because after I arrived there was one person in the room that could figure out what was actually going on. Just because a patient is often "pleasantly confused" doesn't mean they are lying to you when they tell you they are in pain. Especially when the painful extremity is twice the size it should be and inflamed to the point that it might spontaneously ignite. "She's altered, she keeps screaming Help Me!." She's not altered, in fact if she's screaming "help me" she's probably less confused then you might think. I'd be screaming that as well if I had to live here.

How old were your kids when you started your EMS career? I was already full-swing into my career when I got pregnant. So was his donor. Long story short, my parents did the lions share of work helping with my son. They still do. Did it get easier as they got older? No, it's harder. One of the major reasons I'm trying to change careers is because I'm tired of missing holidays, weekends, and nights with him. I've missed 10 years of my one and only child's life. Because of my age, I will probably never have another child. How supportive is your significant other? Are they in EMS? My son's donor jumped ship six months into my pregnancy. Apparently, nurses that are not pregnant are much more attractive then EMT's that are pregnant. His loss, my family's gain. My new husband is a paramedic. He is very supportive. He is my son's Dad. Do your children hold any resentment towards your long hours / missed holidays or do they understand / think it's cool? He doesn't resent it, but he doesn't think it's cool. I make it a point to celebrate the holidays full scale, even if it's a day or two off from the real holiday. He doesn't seem to mind getting two sets of presents on Christmas. He's an awesome kid with a fantastic and huge supportive family. I spend as much time with my son as I can. I'm at a point in my career that I only have to work one job, and I work an average of 84 hours biweekly. I rarely work overtime, and I refuse to get another job. We steer clear of expensive hobbies and habits and live a very comfortable life including a big vacation every year. My kid is pretty open with me. There have been occasions when he'd let me know how mad he was that I picked up an overtime shift. I just decided it wasn't worth it anymore.

I have been using the Phillips Heartstart MRx for over a year between two services. They're making it seem like it's all that and a bag of chips, and while it's a great monitor, it's no substitute for a well-educated practitioner. I am particularly bothered by the statement that "it detects thing I wouldn't." I can tell you one major reason it detects things I do not is because it's incorrect. You simply can not rely on your monitor to interpret your 12-lead, period. It may produce a correct analysis 99% of the time, but it's that 1% that will bite you if you can't interpret the reading yourself. It is unable to interpret the 15 or 18-lead ECG correctly for obvious reasons. Don't get me wrong, I love my Phillips a whole lot more that I ever liked the lifepak, but in my experience it's produced an incorrect analysis on numerous occasions. In particular, it has trouble interpreting sinus bradycardia or sinus tachycardia. It often interprets them as normal sinus rhythm despite the high or low heart rate. I've also had a lot of problems with it telling me the patient is in asystole, even when I see a beautiful sinus rhythm and I'm talking to the asystolic patient in question. Bottom line, don't expect your monitor, no matter how fancy or expensive, to do your work.

I maintain that it is premature to be name-calling. This story has changed so many times since it was first published that it seems impossible to determine what those two people did or didn't do at the bagel shop. I understand the American way is guilty until proven innocent. However, since this began, the following "facts" have been written about the incident by the local media: - In one of the first articles, it read as though there were two sets of employees, one that ignored this woman and one that "tried to keep her still while the other called for an ambulance." - In a later article it read that there was only this set of providers and they were the ones that attempted to keep the patient still while the other called for an ambulance. - Conflicting stories on whether or not they actually left the scene before arrival of an actual ambulance. - Initially she had a seizure, but according to this, another employee called upstairs to report she was having difficulty breathing. There are a host of other inconsistencies I've found while reading all the articles, I'm just too sleepy to trace them. Bottom line, I think it's unfair to crucify a person based on what the media states. I think the fair thing to do is to wait and see until the investigation is completed and it's facts released before we start calling this crew a bunch of "heartless bastards." You know, because the media always has the correct facts. You also have to consider how distraught this family is after their loss and what they're willing to say to the media. I understand they weren't even on scene so how would they have any idea aside from hearsay what happened? Perception is everything. FDNY did the right thing by suspending them without pay pending the investigation. I think the fair thing to do is to allow the investigation to run it's course and if it is found that they did not act appropriately towards this woman, let the Crucifixion via public forum begin. I would think that any one of us would want to be treated fairly if we had be accused of something this vicious, because right now, it is an ACCUSATION. For the record, I'm not on anyone's side. I'm just working on being more diplomatic.

Brand new basics in this area make between $8 and $9 dollars a hour. The cost of living is so high that many of them work two and three jobs to make ends meet or the live at home with their parents. In 2000, I had been a basic for nearly 10 years and was still making $6.50/hr in the Baltimore area working private ambulance because I am not a fire fighter. I worked two other jobs and I could barely pay my rent. Just as Fireflymedic stated: we have all paid our dues. You either man up and do it or find another job.

I was first certified as a basic in a state that didn't recognize NREMT at that level. After being at that level for seven years I decided I wanted to move and try to finally get into a paramedic program. I ended up moving to Kentucky and I had to take the NR exam to become state certified. I'd been out of class for nearly eight years and passed that exam with flying colors on the first shot. The test is easy, too easy, period. If a person can't pass that exam, it's more than likely their fault. I've known people that can't pass it and they spend more time bitching and complaining about the exam then studying for it. No wonder a person can't pass with that attitude. As for the high fees, I paid nearly $500 total to test for paramedic. I had to drive six hours, pay for a hotel, pay my testing fees, and eat on that trip. It cost me dearly, and I passed that the first time around. Do you really think it should be free? It costs money to hold exams, to print paper, or now, to book space at a testing center. Nothing is free. Seventy-dollars seems a small price to pay for your "dream job in EMS." Sounds like a lot of cop out to me. I have no sympathy. If you want something, you work hard for it, period.

I hate to break the news to you but a high pass rate doesn't mean it's a good school or program. It means they can successfully teach the minimum required to pass the test. Given that the tests are incredibly easy, it's not a hard thing to do. Graduating competent providers is a better testament to a school. I'd also consider accreditation, entry requirements, class size, and education requirements when choosing a program. Anyone can establish a fly-by-night EMT school. You have to be really careful that you become a success instead of a victim. I hope that your spelling and writing skills improve. It's very sad to see how poorly the youth of today communicate, not only with the written word but verbally as well. I correct my son's grammar a dozen times a day and I'm left to wonder what he's really learning in school. Being able to communicate is important when you're trying to get your position across to other people. You might want to take it seriously instead of feeling that it's acceptable because you have an instructor that is also poor at spelling. It's not a badge of honor, it's actually rather sad when you consider that spell check has eliminated most of the work. Try firefox browser and it's built in spell check. It won't help you with grammar and punctuation, but it's a start. Good luck.

You believe it's more important to sit there and write a chart than to interact and reassess your patient? The patient is why we are there. The charting is a necessary evil, and it can be completed after you take care of the patient. I've worked in a large urban system where I ran more than 14 calls in a 12 hour shift, and I didn't hardly chart a thing outside of basic information and pertinent findings while I was with the patient. I bet your patients feel all warm and fuzzy that you'd rather sit and do a report than interact with them.

It takes me an average of 30 minutes to clear the hospital, and that's without writing a PCR. We have some trouble getting rooms, unless the patient is critical, even more trouble getting a nurse to transfer care, and we have to register the patient before we leave. If it's shift change, it's even longer. Sometimes I'm super lucky and get to make a stretcher after I treat the patient, wait to transfer care, and get them registered. We have a few social butterflies at our company and making beds is just not high on their priority list. I generally have any other mess I've made cleaned up well before we reach the ER. As for the PCR, we use an internet program, so we don't actually even begin the report until we return to the station. The state gives us 24 hours to complete a report. Once completed, the report is faxed to the hospital. I don't really agree with this, but sometimes you have to pick your battles. Our PCR for an ALS provider can take anywhere from 45 minutes to several hours to complete. It's not my favorite program. I'm not sure how the BLS guys do for time, but I'd venture to guess they get finished a lot faster than we do.

With my huge library of music, this changes sometimes daily. However for the past few months it's been the same. Paul Weller - Hung Up. Now that I've said that, it'll be different tomorrow.

It was posted by medic_texas the day before. Can the topics be merged so the comments aren't lost?

I'm in south central PA, and if I made 63k a year I'd be rich. The cost of living here isn't terrible, and I'm doing REALLY well at a little over 35K a year. Now, if I relocated an hour south to Maryland, I'd be lucky to be able to eat if I made 63K a year, let alone afford a house and my car. It's all relative. The northeast is pretty big, did you have a particular area in mind?

We carry it and it's been used by one of our paramedics recently. He used it following a splash exposure to his face from a call. His feedback is that it burns a little to the eyes. Whether or not it truly kills the bad bugs, I can't be certain. He has so far tested negative in his exposure follow-up testing. He states that he does like the product and will continue to carry one close to him when he's working.

It sounds like he did a great thing and I foresee a screwing in his future for his good deed. It's a real shame if it happens. FDNY should be thanking him for facilitating some much-needed good press (even if the media doesn't know the difference between a sprain and a fracture) by acting like a compassionate professional.

Honestly, we really do not know what their attitude was exactly. All we know is perception. Did it really happen the way it was portrayed in the newspaper? Of course it did, the paper is always accurate. Understand, I'm not saying this behavior was appropriate, if this was what took place. I'm saying that our profession is greatly misunderstood and often the public perception of us is skewed considerably. "Those frickin medic's didn't do crap for that lady and she died." When the reality might be that they were, in fact, off-duty and without equipment, or dispatchers and again without equipment. Did the original "EMS" personnel tell them to call 911 and walk out of the shop? Maybe, but we don't know. We only know what we have read in the newspaper. I think it's unfair to judge anyone's actions without all the facts. What we can learn from this incident and from everyone that has posted is that perception is everything. What a person says, how they say it, their body language, can all be perceived in a way the person had not intended. That may or may not be the case here. I wonder how many people are going to be considering how the public sees them the next time they're on a call, a break, trying to get a meal, or use the bathroom.