EMS49393

Well, you once again proved yourself cooler than us. You, Sir, are genius. Bravo.

I was going to steer clear of this debate because it was supposed to be about fire, and frankly I could care less about firefighters. However, since someone had to throw the slavery issue into this, I am compelled to chime in. After much soul searching, I finally am pursuing the degree I should have been working on whilst I was earning my worthless EMS degree. I am working on a masters in history, so with that being said, I am fairly qualified to give a lecture on the lies a person learns in their regular high school, and often college history classes. White European people were not the first to enslave any population. They were also not the first to begin to enslave people from Africa. Would you like to know who the first to enslave them happened to be? I thought you might. Once upon a time in a land far, far away... Slavery is a system of servitude. In the early part of the 16th century, the Portuguese, yes I said PORTUGUESE arrived in Africa to negotiate slave trades the muslims, yes the MUSLIMS had already been trading slaves for hundreds of years. The Akan had gold and needed labor, the Benin had labor (slaves) and needed weapons, the Portuguese had weapons but wanted gold. They went to the Benin to trade guns for slaves, and then to the Akan to trade slaves for gold. Eventually the Benin have only women and children left, which the Akan can't use. Enter the Congo. They want guns and culture and negotiate to collect more slaves in return for guns. The Congo also offer to accept Christianity. The only thing the Portuguese originally wanted out of this deal was to spread Christianity and gold. The slavery thing was already in full swing within the African nation long before any sort of "white man" arrived. I don't have to get into the issue of slavery in the Americas, unless people are interested, because I have proven my point. Slavery existed long before the American/African episode of slavery in the 17th through 19th centuries. It still exists in many countries today. There are many people that have been enslaved throughout the course of history, not just the Africans. Yet, it's the Africans we hear griping about how hard their lives are because of slavery and the white man. Well, they proved their point, they are not educated, because they are completely ignorant to the fact that it was their own people that had been trading them for centuries before any white people got involved. I am the third generation of my family, on both sides, to graduate high school. I am the second person of my father's family to have an associates and bachelors degrees. I will be the first to obtain a graduate degree. I am the fifth generation of my family on my Mother's side that is literate. My father's grandparents immigrated from Czechoslovakia and Russia with nothing, and settled in Pennsylvania during the depression. My family NEVER owned slaves. I grew up poor. By the time my father was able to actually cash in on his degree and experience I was in high school. Where in the hell is my 200 years of education? Since that is the reason you put forth about why blacks can't pass standardized tests, I should be about as dumb as a tree stump with my history. Oh, and I'm also a woman, my "people" had no rights until the 1920's. We were slaves to our men-folk. Cooking, cleaning, and putting out, all without a paycheck. At least your people's slavery ended in the 1860's. I don't buy that black people are stupid. I think they are ignorant. I think most white people are ignorant. If you can't distinguish between the two, get yourself a dictionary. Grow up and stop using your heritage as a crutch.

That is it! I've had it! I refuse to EVER toilet another one of my patients. I'll just let them crap all over the cot. I have an EMT, they can clean it up. As for the patients that are covered in crap or vomit, tough. I'm going to have my EMT wrap them in a sheet and throw them on the stretcher for transport. Next time, don't crap on yourself. Apparently I'm working too hard trying to do right by my patients and my team. I'm open to any more suggestions about what is NOT my job so I can go to work tomorrow and have the easiest day in my career. Sad to say, but you Sir, are pompous. I bet everyone is just chomping at the bit to work with you.

“Firefighters trained as EMT’s or paramedics deliver the same emergency medical services as single role paramedics assessing the patient’s condition… even transporting patients to the hospital and they do it all while bitching about being on the ambulance instead of the fire truck.” Heroes!! Fire-based EMS - BLAHHHHHH!!

In my book it's called teamwork and development of interpersonal skills, and you just proved how well developed you are. I think I've run across a few of your paramedic prodigies. They're the ones that trash ambulances on routine transfers and stand by smoking a cigarette while their EMT cleans it up. They're the ones that walk into a supervisors office and make the broad statement that all the new EMT's suck, yet they refuse to do anything to improve things. That's okay though, because those paramedics make me look like Mother Theresa, especially when my EMT opens the back door of the truck to see that I know how to hit a trash can. I'm sick of this "it's not my job" mentality and the lazy idiots that preach it. Clinicals do more than provide technical skills practice, they provide a chance for the student to begin to develop relationships and teamwork with other health-care professionals. From Merriam-Webster: Teamwork - (noun, c. 1828) work done by several associates with each doing a part but all subordinating personal prominence to the efficiency of the whole

I won't lie here, I stopped at the post about "starting a line enroute" to the ER post. It was enough for me. 1. Assess the patient, completely. If the only reason I am called is to transport really is for forgotten labs and I find nothing acutely wrong with the patient, I will handle it from there. Until then, I owe the patient an assessment, because, as we all know, we always get a COMPLETE report from the sending facility. 2. Should I see no acute reason this patient needs to be taken from their nice warm bed, put into an ambulance, dragged to the ER, probed and proded by more people, enduring a return trip, and most likely, arriving back to the nursing home after breakfast, I will handle a few different ways. First I would ask to see the order from the physician stating to send the patient out for a non-emergent procedure. If that isn't there, it will make things a lot easier if I have to go all the way to the end of my decision tree. If it is there, then it's ordered, and I will comply with the order, no matter how pointless and unethical I feel it is. He may know something the nurses are keeping from me. If said patient is their own person legally, and is able to make decisions, I will explain this whole deal out to them and let them decide if they want all of the above done to them. If they have a legal power of attorney because they are no longer competent, I will wake that person up to explain the situation and ask them what they would like done. I'm sure they'll be thrilled that I woke them up because XYZ facility "forgot" to collect their loved-ones routine labs today. If none of those apply, I'll call the receiving ER and talk to the doc. I'm so fortunate to have a great rapport with most of the doc's here. I'm more than sure they will tell me the facility will wait for the morning to torment the patient. After that, our doc will handle it, believe me, they will handle it, both with the facility and the sending physician. 3. DOCUMENT! It is unethical to move a patient from a long term or rehab facility in the middle of their night's sleep because you forgot a doctors order that day. Ambulance rides are very hard on most of these patients. Transfer from bed to gurney is often very hard on these patients. If it's not warranted, it shouldn't be done. This doesn't really have much to do with the original post, but since someone brought up a completely unnecessary IV, I just had to jump up on my soapbox. It gets right up in my arse how people want to start IV's on every damn patient, often without even assessing them. If I pull Gramma Moses out of a nursing home for a complaint of a fever, she is 900 years old, has one good vein (maybe), and is hemodynamically stable or compensating well enough for transport, I will usually forgo the IV. The bigger picture tells me this patients more than likely getting a septic work-up. We're talking two sets of blood cultures, CBC, CMP, and anything else that may interest the duty doc. I'm leaving the nurses that one vein. If I don't need an IV for fluids, medications, or potential of them, I'm not starting one. I have fought this protocol here, and won. It's not necessary, and often, it takes away the only port in the storm left. Antibiotics are time sensitive, and need to be administered as quickly as possible upon diagnosis. Prolonging that treatment to establish a PICC or central line is irresponsible on the part of the paramedic. DISCLAIMER: Please note I used the word "facility" instead of nursing home. Long term sub-acute hospitals, rehab hospitals, psychiatric hospitals, etc., do their fair share of transferring patients for no real reason. Besides, my new years resolution was to stop picking on nursing homes and fire departments.

My, my, those lazy CNA's have punked me into making more beds than I can count. Just who do they think they are? It shouldn't matter that they have 8-16 patients that needs labs, ECG's, urines, blankets, and all that other crap that goes along with being sick. And those nurses, they have some nerve thinking I'm put on the earth to make their beds. What a completely RIDICULOUS statement. It takes less than three minutes to wipe down a gurney and toss a sheet on it. There are a lot of times I have to do it myself when I bring a patient into the ER. Most of the staff in our ER's are not lazy, they are overworked. The extra minute you spend doing menial tasks might just win you the "get in on the cool procedure" award. Not helping with simple tasks when needed gives off one type of vibe... "I'm too good for that job." I guarantee the lack of playing nice in the sandbox and sharing toys will not help you win friends and influence people. If you act like a pompous jerk, you'll get treated like a jerk when you start bringing them patients. I did a ton of crap that I didn't need to do for my rotations. I also made a lot of friends and quickly became the student the nurses and doctors would seek out for interesting cases or procedures I needed. I'd hear horror stories about how crappy staff would be to some of my classmates, only to find out that they went into clinicals with a set list of things they would do and they refused to do anything more than those things. Even now I get students that have all of their IV sticks for class and flat out refuse to start an IV. Consequently, I refuse to give them stellar scores on their rotation sheets. You have to understand, this job is all politics. You need to use this time wisely, not just for building on your skills, but for building on your relationships. Although these people are not your partner, they are people you have to interact with on a daily basis once you're in the field. I'd suggest getting off on the right foot now when your in the infancy of your career. How you deal with the many different types of people is more important than if you can start an IV in the dark, upside down, underwater, in a treasure chest, on 30 hemophiliacs involved in a bus wreck. Be nice, be helpful, and you'll see how far you get to go in your rotations. You'll end up like I did during my rotations, being the one paged overhead to assist or perform procedures.

It's a tie between complacency and cheap talk. A majority of the people are complacent with how things are and view change as evil. Those that aren't complacent should get off their duffs and back up the talk. "We need more education!" Go enroll in some classes at the local college. "People are lazy!" Who is, and why aren't you working to flush them out? "EMS is young." Bullcrap, it's had centuries to evolve. That's right, centuries. They had makeshift stretchers used to carry wounded off the battlefields 250 years ago. They were our first medics folks. Again in the Civil War they found ways to remove soldiers from the battlefield to makeshift hospitals. During the Korean war, they had actual military medics complete with a complement of drugs and dressings. EMS is not a new idea, but it's taking a hell of a long time to evolve. Stop talking and start doing. Make sure those around you SEE you doing. A heated discussion on a website doesn't count. Talk is cheap, people need action. The lazy masses will eventually either get fired or give up. What a way to have a nice, healthy cleansing of useless meat. You want to progress EMS? Get off your hind-end and lead by example, everyday.

Agreed, I was also finished high school at 16. Although my brother wasn't finished until he was 21. Apparently education means more to some than to others. As for a disruption, it's a school bus, not his fifth go-around in basic arithmetic. I bet there is a lot more to this story than we're being told. This kid had to have been let back at least once which means he is either: (a) has behavioral issues or ( is an idiot. Perhaps this flatulence episode is a cover up for a bigger crime. God Bless America, and our crappy public school system. At least we'll never have a shortage of McDonald's employees.

I'm too brazen to be bashful. I hate to say it, but being female in this profession is a real advantage when it comes to stripping down for assessment. Patients don't think twice when I tell them I have to listen to their lung or heart sounds. I never have any problems doing ECG's. I never have any problems stripping my trauma patients. There are a few men in my company that have run into problems in the course of doing their job. Most of that stems from not being properly taught how to perform assessments on female patients with utmost modesty. I feel that if you bothered to call 911, you better not mind getting a little naked for me, and a lot naked for the ER. I'm not making any excuses for male providers, I'm just saying it's a sue happy society and that could put some fear into the occasional male. You touched my booby, and I'm calling my lawyer!

I've noticed it becoming harder to make a quick turn around this month in our ER's despite our "no diversion" policy. I see this as becoming much worse before it gets better as people continue to need medical care and are having increasing difficulty paying for the services. The ER isn't free, but they can't demand payment before exam. As more people are laid off, we will find ourselves running more calls and having a harder time turning patients with the over-crowding of the ER. One of our area ER's is seeing 30-50 more patients a DAY than they were in January. Most of these patients are candidates for the PCP but simply can't afford the bill or copay because they are either uninsured or under-insured. I can't be the only paramedic that is thinking about this. How can we work with the ER to facilitate a faster turn around? Can we start pushing for more ability to treat and release? Should there be more low-income clinics available? Socialized healthcare? I'm curious if any of you are seeing the same volume increase. How do you think you would handle that type of increase every few months? Are your companies preparing themselves to function in a different capacity should your system become over-whelmed with people that simply can't afford a regular doctor anymore?

Speak for yourself. I am damn good at interpreting the 12-lead, and I find it to be a very important assessment tool (thanks, Bob). It can only be an appropriate assessment tool if you know what you are looking at. Imagine if a paramedic "didn't read much into" the strip and called it V-Tach. Why run a 12-lead, after all, we don't read much it them. Meanwhile your patient is unstable due to this rhythm, you don't have amiodarone and you go ahead with some lidocaine. Congrats on your kill. What is the point of having this technology to our advantage if we aren't able to use it to its fullest? Being a paramedic isn't an excuse to not push ourselves to learn as much about medicine as we can. In fact, it is the paramedic that does not advance their knowledge that keeps our profession behind.

On first look, I called it a fast wandering atrial pacemaker which essentially is MAT, so I agree with the above. Thanks for sharing it, I don't get to see that very often.

We just replaced 15 of our Lifepak 12's for the new Phillips MRx. We demoed a couple different monitors before settling on the Phillips. I have to say that lifepak 15 better come with a million dollars or no paramedic in my service will be remotely interested. I started my career with a lifepak 5 and had honestly never used anything other than physio-control. I went into our new monitor lecture with a lot of reservations. I've had my Phillips for two weeks and I will never willingly go back to physio-control again. We actually have some of the crusty old medics coming in from the rurals to work in the city just to use these brand new monitors. That aside, it is a cute little video on their new monitor. I'll be interested in seeing it when it's a little farther down the American food chain. Propaganda is nifty, but I need physical proof. Is anyone else using any of the new generation of monitors? I'd love to hear how they are comparing for people. Perhaps a spin-off thread.

That's just asinine.

I've been through what you're going through. It's tough. One day I had to stop being pissed off and realize that I just can't change it all. I go to work knowing that I'm going to be the best paramedic possible. I don't worry about who's whining or lazy. I worry about me. I worry about how others perceive me. I make sure that I do one thing my entire shift... I lead by example. Be who you are and be the best. It may not effect any of your co-workers, but it will effect yourself and your patients. After all, it is all about you and those you care for. Hang in there, the green beer is 12 days away. Cheers, K.

It doesn't make a tinkers f**k where any of us have ever worked, you're system will always be better. Congrats on that oh God of the paramedics. I'm glad you have 50 drugs and several hours between you and a doctor that had just a little more schooling than you obviously had. This type of juvenile "my toy is better than your toy" crap is one of the main reasons I'm spending even more money and pursing another degree. Boys will always be boys. I'm proud of where I came from (a steel mill in Baltimore), proud of where I've been (the middle of BFE Missouri with St. Johns), and where I am now (The Rock with MEMS). I went from 60 drugs to hardly any drugs. It's not my fault, and I do the absolute best I can with what I have available. I'm not fast. I don't throw patients in my truck and drive like hell because I'm scared, and I have NEVER asked for anything over the radio. I'm required to do a lot more calling with MEMS than I was with St. Johns, but I have never asked a doctor for an order. I've told them what I have and what I want. I have never been told no, and I'm quite friendly with a lot of the doctors in my system. I respect my medical director because he knows that he can't control a fleet of 200 paramedics from various backgrounds and in knowing that, he has pulled back the reigns on the service. So I have to call, big damn deal. The doctors know me well enough to listen and say yes. It doesn't make me stupid or cookbook. It makes me a person that respects and follows the rules that govern my service and ultimately, my paycheck. The whole reason behind my post was to point out that the vial of morphine this person is carrying around is a large amount. I've already had one of our esteemed doctors agree with me and add that it also can lead to medication errors. As in life, also on the boards. There are very few paramedics that I will talk to about patient care, and there are several dozen (nearly all of them) ER physicians that I will discuss medicine with. Thanks for reinforcing that for me.

Paramedic: “Hello Sir. What seems to be the problem today?” Patient: “I fell, and I’m pretty sure I broke my arm. It hurts so badly. It’s the worst pain I’ve ever had.” Paramedic (following standard physical exam): “Yes sir, that arm certainly looks like it hurts you. Are you allergic to anything? “No.” “Do you take any routine medication or have any medical problems?” “No. I’m very healthy, if it wasn’t for losing my footing on that truck bed, I’d still be up there shoveling gravel onto the roadway. I work out three times a week. What am I going to do if my arm is in a cast?” “Well, I’m sure there are alternative ways of exercising if that is the case. Let’s worry about your pain.” “Good idea, I’m telling you, this arm is killing me.” “Sir, you’re in luck. I’m going to start an IV while my partner is hooking you up to the monitor and putting this on your finger (shows pulse ox probe). You’re in good hands. I’m not going to give you just 5 mg of Morphine, or even 10 mg. We have a three hour ride to the ER. You’re going to get 300 mg of Morphine. Call me the candy man. While you’re calling people, call me a lawyer. I’m going to need one for the narcotic overdose I’m going to give you.” Meanwhile, the EMT is diligently setting up intubation equipment and pulling the boxes of Narcan off the shelves. Although his is angered by the notion that he will have to spend at least one of his days off in court, he is safe in the knowledge that this will be the last time he ever has to work with this cowboy paramedic.

At least you're not using the Schwartz.

First, I am not, nor have I ever been a "him." So you've got one wrong. Secondly, we run 12 ALS trucks and 4 BLS trucks at peak hours. We carry 20 mg Morphine on each ALS truck. That's 240 mg of morphine. We ran roughly 70,000 calls in the city last year. I'd call that a pretty rocking urban system. 300 mg of morphine is a lot of morphine. In fact, it's 30 doses of morphine. If you stock that much morphine, good on you, but we don't need that type of stock where I work. You claim you work in a very rural system with multi-hour long transports. You can't run that many calls if it takes that long to complete them. How you need 300 mg per truck is beyond me. You know though, I didn't call you out on any of that stuff and claim that you're full of crap regarding how much morphine you stock. Honestly, I don't give a rats behind how much you stock. My point was the same as several others here, that person is carrying a damn lot of morphine, period. I'm not interested in peeing in the wind with you. You don't know everything, despite what you think.

I have a bandaid in my glove box. Seriously though, the issue isn't bandaids, gauze, or even tylenol. The biggest issue I see with this bag is the 300 mg of Morphine. That's enough narcotic to kill several horses. You could park every ambulance in my company on the lot and we wouldn't have 300 mg of Morphine between us all. Keep in mind I work urban EMS, so there are a lot of trucks to park.

As a vampire (not necessarily undead, but pretty close) I am immune to zombies.

One of the hospitals in our metro area has stopped the use of promethazine except in patients with a central line. Apparently the drug has a black box warning (nothing new) and has caught the attention of the lawyers. Our EMS medical director happens to be on staff at this hospital, and as a result of this has removed promethazine from our units and replaced it with the ondansetron. This generic alternative anti-emetic is not as expensive as one might believe. If cost were any sort of an issue, my EMS organization would scrap the anti-emetic altogether because we have short transports and limited resources. Two years ago this generic zofran was issued and cost me around $4 for a 4 mg vial. Its not as cheap as lidocaine, but it's not as expensive as amiodarone. We still want to be able to provide this comfort measure for our patients. As a pretty regular GI patient myself, I am a big fan of anti-emetics and have had every one of them at one point and time. I have a pretty vested interest in helping patients not vomit. Phenergan works, no doubt about it. When I give it, I dilute it in AT LEAST 30 ml of saline and I give it slow with fluids running. Unfortunately, few providers take that sort of care with this drug. I've had Phenergan diluted and I've had menopausal nurses push that stuff full strength in less than 5 seconds on me. Aside from from the feeling that my arm was going to fall off, I now have absolutely NO venous access and require a PICC or central line every time I need a transfusion. I could blame Phenergan as a lot of people now do, but I won't because it's not the drugs fault, it is the fault of the person administering the drug. However, the lawyers don't buy that and in their endeavor to bring about yet another class action lawsuit against a drug manufacturer they have set out fliers asking that if anyone has had ANY adverse reaction to this medication they may be entitled to damages. Now that I think of it, the fault is two-fold. Poor administration of the drug from equally crappy providers and lawyers.

We can't say no to any patient that wants transport. We can call them a candidate for triage and that will sit their non-urgent butt in the waiting room. We have a problem with over-crowding in our ER's and went to a no diversion policy last March. Hospitals are allowed to divert services in a "temp" fashion. The hospital I work for has neuro capability, but rarely has neuro services. They can go on neuro-temp diversion on days they have no neuro docs. Our off-loading times have diminished since the policy was put into to place. The real change in off-loading times is really due to being able to put patients in the waiting room. That's a relatively new concept here, and most citizens still think an ambulance is a guaranteed bed in back. There are probably a dozen of us that are comfortable enough to suggest a patient is a candidate for triage. Putting stable patients with toe and butt complaints in the waiting room frees up beds for patients that are deemed urgent, emergent, or critical. There are also half a dozen or so of us that will not transport a code that we've worked on scene for a period of time with no result. We have the option to terminate in the field with consult, and I utilize it. That saves countless hours of a bed being tied up while waiting on transport to the morgue, clean-up, decon, etc. We don't actually have a committee on hospital turn times, but you gave me one hell of an idea to present to my supervisors, both in the hospital, and in my EMS job.

Sweet! I wish it applied to me. My state doesn't have a trauma system. Thanks to the government voting down a $0.56 additional tax on cigarettes to fund this trauma system, it may never materialize. You really have to love this southern thought process. :roll: In all seriousness, it outlines a lot of what I already consider when transporting a patient. It's nice to see it in handy-dandy pocket card form.