DwayneEMTP

You bet! But hell North, you're welcome here any time. Dwayne

[align=center:7e1198e7e1]Examination Scored [/align:7e1198e7e1] "Congratulations on passing the NREMT cognitive examination. Your passing result on the cognitive examination will remain valid for a one year period from the date of the examination, 4/25/2008(provided you meet all current requirements for National EMS Certification. Please allow 2 weeks for the NREMT to mail out results letters. " Pretty crazy. You go like hell for a couple of years, and then....Done. No classes, no clinicals, no homework. Crazy. I got stopped at 80 questions, so I was pretty confident that I either completely hosed it, or did OK. Thank goodness for OK! Graduation is Friday, and I'll get my AAS in EMS...and though it feels as if I've really done something this time, I know it's been a team effort. Thank you all for your time, advice, explanations, encouragement, and support! Yikes...I better go tell Babs...speaking of teamwork. Have a great day all! Dwayne

Yeah, but I'm to dumb to know better. We expect more from you! Dwayne

We're not saying you can't do it because your BLS, we're saying you can't do it because your goofy...and funny looking. Just sayin'.... Dwayne

I have two issues with online training... First, they are not for me personally, as spenac stated above. I benefit from the class environment, hearing other's questions, etc. Second, I have trouble giving much credit for online classes that don't test with a proctor. When I took Bio105 online, I got some of the folks together for study groups, the problem was that after the second study group or so, no one studied any more. They simply sat together at one computer, with their books in their laps and took each person's test as a group. Maybe basic would be ok I guess, I'm not sure. Or perhaps even one proctored final exam, but no proctored exams means that, once again, the weakest links excel. Dwayne

While I know this isn't a phychology thread, (actually it is, but most won't see it that way) you are mistaken here... Reinforcers are always more productive, when used properly, than punishments (negative reinforcement is an oxymoron that isn't used in behavioral psychology except when speaking with laymen. Just trivia, not sniping.).It makes no difference the group being studied, the age, nor even the species. The issue arises when we attempt to define a reinforcer that will encompass varied groups. As Dust said, his pain may be my pleasure, and vice versa. But as much as EMS likes to consider themselves individuals and beyond description, Professional EMS has much in common. Let's say Dust and ak and, I don't know one of the Docs, decided to start an ambulance company tomorrow. All we have is their posting history available to judge their intelligence, honesty, commitment to intelligent management and fairness, as well as their complete disdain for sloppiness and laziness. But we'll call it good as I've no reason to believe otherwise. So they are committed to up to date equipment, spotless ambulances, and way cool uniforms, and progressive protocols. But, they can only afford to run this top notch service by paying wages 10% below local averages. Each person will start at a base rate, but will have a share of the profits at years end tying each persons EOY wages to the success of the company. No financial promises for individual acts of good behavior, but a promise of possible compensation later for outstanding behavioral habits. How many of you are going to leave your jobs tomorrow and go to work for them? I'm going to take a guess that a bunch would. Because they've created an environment that reinforces the types of medics they would want working for them, and money isn't really even one of them. Professional look, aggressive medicine, access to management as well as access to the profit that their success produces. What do you suppose the retention rate would be? See what I mean? I don't need a reinforcer to fit every person. I simply need a set of reinforcers that has proven to reinforce the type of person that I wish to keep. Add a set of punishments to this, and it is destroyed. Firing is the only punishment here, and that is only for issues that couldn't be trained away. (Because in our company field failure that isn't morality or ethics based is considered management failure. Hired poorly, trained poorly, managed poorly.) Anyway...I know I've gone completely off the subject, but I start trying to write out these types of thoughts and then think..."hell....I should have stopped half an hour ago...but I can't really spend another three hours to finish"....and end up with this crap. So here it is for what it's worth... Dwayne

So, now I have no idea if I'm supposed to respond or not.... :wink: Dwayne

Man, I'm glad we got that worked out. A suggestion though. Ak responded in defense of your post based on your positive posting history, perhaps next time taking that into consideration will help avoid this type of response. At his point I'm honestly wondering if you left your computer logged on and someone else posted under your name? This just doesn't sound like you, but if it is....step away from the caffeine, man, and no one needs to get hurt! :wink: Which is why ak stepped in to attempt to keep the thread on track. I think you just limited your pool of people to learn from and teach to to....One? This was a terribly foolish statement. I'd expect if from one of the wah baby n00bs...but not from you. National average says that your dept does the same as most of the others...runs medical calls and begs for a fire. Unless you happen to live in a neighborhood that is perpetually burning down, it's not so different from the others. Not your fault, it's the way things are. But yeah...we do pretty much have a clue. Nice to see that you did your part to bring everyone together today. What is up with you today by the way? You seem way off in the ditch. Ok then...having said that, I guess I don't understand the question. So you do have b/b rigs now and think they should go away? Is the city looking at creating p/b rigs separate from the fire dept? Who runs EMS now? Maybe I should know this, but after rereading your op I don't really get it...(This is me staying on track, just so you know. Sometimes it's not so obvious...) Dwayne

If checkersfire is explaining his incentive program correctly, that you start at the higher rate and then lose it for 'below standard' performance, then his attitude is exactly what this company should be expecting from their program. From a behavioral psychology point of view there is a HUGE difference between giving the incentive before it's earned, and then taking it away for substandard performance, and starting at a lower base and adding for superior performance. It's the difference between punishment and reinforcement. Let's start from the point of view that the reward/punishment system isn't perfect, as he describes it. With reinforcers you are rewarded for "being better." So the incentives don't only increase your ability to supply for your biologic needs (more money helps buy food, pay bills, lessens stress) but they also, for most, define the companie's opinion of you as an employee and a person. More bonuses equals "you are superior, thus we like you better, (and for many), therefore you are better." So the reinforcers don't only make you want to continue to chase the carrot, they help you shape your work related behaviors so that it becomes easier and easier to actually catch the carrot on a regular basis (shape new habits, instead of individual examples of random behaviors). As well, it becomes fun to play the game, because I never really lose, I simply win at different levels. Punishment on the other hand, the removal of the reinforcer, is negative. It tends to decrease your ability to supply for your biological needs, but much more important it sends the message that, "You have failed. You are unworthy." So instead of being a punishment for specific behaviors (which it can do, in the short term), for many, it becomes a reinforcer for negative attitudes and behaviors. People will work strongly to support their idea of their self image, so in an effort to not be a 'failure', they will find ways to describe to themselves why they are better than the company and each punishment, or lack of reinforcement, reinforces this image that "I'm great, but the company sucks." Sometimes punishment is absolutely necessary. For instance, if you mishandle a patient in a non dangerous manner, you can stay home for a couple of weeks without pay. Do it again and you can stay home for the rest of your weeks as well. I don't have time to engineer this problem away. This will work, and will decrease the number of people that exhibit this type of behavior, but it is a short term solution. It is much more powerful to reward those that exhibit the behavior I'm seeking, thus adding confidence that the behavior will become habit and be continued even when not monitored, than to punish those rare instances of 'bad' behavior on the few occasions that I can catch them. More important is the fact that the 'bad' behaviors are easily hidden, therefore removing my ability to deal with them in a consistent, predictable manner. Should any of these punishments/incentives be necessary when dealing with adult professionals? I don't know. What I do know that they are very powerful tools in the management toolbox and, as with any other tool, using them indiscriminately, without reading and understanding the instructions is just as irresponsible for management as many of the behaviors they despise in their employees. Dwayne

The twelve lead would be great. Try and post it in a size large enough that it can be read clearly, would you? Lasen, great fourth post! I think there is some to be added, and I don't have time now (Yeah, I should be sleeping, NR in 8 hours) but it was very professional...and if you haven't noticed yet, you will soon, that we value professionalism very much here. Thanks to both of you for your posts! Dwayne

Ditto... Dwayne

Sure. But what harm comes from revisiting it again, and again? And if you didn't get this in class (Hard to imagine) is the world a better place if you never get it at all? I don't really see an issue with article. It seems pretty clear, to the point, and reminds chuckleheads (like me) that someday you may have to defend every word in your PCRs, and perhaps even more so the words that never made it in. One of the things that impressed my about doing clinicals in CO Springs is that the medics were always comparing notes. I was taught by each preceptor that I should believe that I'll never write a perfect PCR, though my goal should always be to write a perfect PCR. So in the EMS lounge it was a daily occurrence for medics to ask each other questions about a better way to phrase something, how to spell something, etc. And these guys..well, when I read their PCRs it made mine, which I was pretty proud of at one point, sound like fourth grade nonsense. My point is simply that writing a PCR, at least a really good PCR, can, and seems to, require an evolution. A sharp bell curve in the beginning that resolves into a miles long plateau that never again reaches baseline. Though I can see your frustration at the well noted lack of education, I don't see where a regular review is a bad thing... Dwayne

Fire Basic, "But if we'd stopped, those stupid medics would have just wasted a bunch of time on scene! They they would have dicked around and this boy probably would have.....Oh hell...just sec...let me think for a minute." Note: My disparaging comments directed at these basics only, and on the assumption that they understood ALS was attempting to enter the ambulance and that there had been no dialog between them previous to their attempt to do so. Dwayne

By what definition of the word? Dwayne

I think eight hours is too lenient. They should have to continue until at least one of them gets the spelling and punctuation right... You know, I guess you just have to poke fun, because the thought that anyone can continue to get paid, after possibly causing (unclear) or helping to cause the death of a child, while being temporarily demoted to a job they'd rather have anyway, because of a turf war, is too tragic to digest all at once. (I would like to submit this to the academy as the longest sentence ever. Thank you.) Dwayne

Which idea, and why? Dwayne

I agree. Merit based plans are usually great for the company if realistic expectations are outlined clearly and enforced/reinforced fairly with all included having an equal opportunity to be rewarded. Sucks to be half-assed in such a system though. AMR in the Springs records nearly everything, including your driving performance through computers and then the crews are awarded play money based on their performance that allows them to buy stuff. The majority of the crews I rode with had DVD players, or satalite radios, or digital cameras, etc. paid or with their above average behavior. To the not so stellar crews it was simply "bullshit." If designed and managed well it can be a great thing for the company. If not it can suck the spirit out of the whole joint. Dwayne

One of the down sides of our touchy feely age is that ANY reaction is considered harmful. I've not been long in EMS, but I've seen some terrible things in life, and as most here will tell you, some reaction is normal. One of the problems of services that want to push their people to seek help, is that often those people don't need help! But, after enough resouces are thrown at them they can often be convinced that coping well on your own is a symptom that you are not coping well...see what I mean? They have proven that people that are emotionally equiped to deal with stressful situations can be GIVEN issues at the hands of those untrained in psychology. If you feel that you're ok, then probably you are. I had management talk to me several times after a shift where I had 3 patients die out of six. I was fine, but the basic that was riding with me wasn't. For him seeking help might be a good idea, for me, not so much. See? You have a responsibility to yourself, your family and your coworkers to seek help if you feel, or show s/s of needing it. It's not a macho issue. But if you're ok...you're ok. Tell your boss thanks, but no thanks, but you'll let him know if the situation changes. Good for him for asking, but more often than not the offer has to do with making him feel good for helping, instead of actually focusing on your needs. It sounds to me like you handled it, and continue to handle it fine. He was dead, you couldn't have saved him, you'll see a bunch more just like him. Good for you for not turning it into a major drama. Keep us informed, would you? You sound like a stand up gal, but I'd be curious to hear how your boss deals with this. Your being ok may cause him to need counseling. :wink: Dwayne Edit: No changes made that should effect the flow of conversation.

And isn't four days past quite a bit longer than usual for CISD?

How do you feel about it? Were you shook up? Did you second guess yourself while on scene? Any concerns that you'll do so on the next one? Are you showing negative, unreasonable mental/physical effects since it's happened? If it's important to him, is there some reason he won't send you to a professional instead of the CISD? (And unless there is something way different about your organization, don't let him pretend that this meeting is run by a professional.) There are many threads here addressing CISD, and most will tell you it's been PROVEN to be a myth, many times causing much more harm than good. Take a look at those threads via the search function, but keep your eye on this one as well as there are many wrinkly old farts here that have very educated opinions on the matter. There is a ton of data on CISD, most of it showing negative results for those that didn't want to attend. I don't believe there is the same data regarding those that felt that this was a good choice for them personally. Good luck to you. Dwayne

I see your point here Matty, but disagree. The situation you're mentioning is mentoring. It's a different ballgame than sharing tasks in school. First off, as a mentor, I've reached at least a minimum standard in my profession, there isn't the opportunity for the student or new hire to retard my development. They can learn from me, and I can certainly learn from them, but they aren't in a position at this point to hinder my education of the important core elements of the profession. Also, a student riding with me assumes that I have at least minimal authority to control their behavior. That is lacking in the classroom. There were a couple of times that I was paired with someone much stronger than myself academically. They simply left me behind and completed their assignments without me...as they should have. One of the girls was attempting to get into nursing. She and I paired up to study during Bio 201 and were always about 0.5% apart on our test scores...and well ahead of the next closest person in the class. During Bio 202 I was working 60+ hours a week and falling behind in my studies, she was carrying Bi0 202, Micro, and Chemistry, I think, 4.0 throughout as always. Even with her heavier class load, I couldn't keep up...so she left me behind. Was I a slacker? Kind of, academically, even though I had the highest score in class behind her. Could she have spent more time and helped me improve my grade? Sure. To my gain, but very much to her detriment. She was at least as driven as I was/am...she has a family and a career to plan, and rightly kept her priorities there instead of allowing them to shift to me. Others thought she was kind of shitty for doing it...yet she and I remain great friends to this day as she made the only decision that seemed responsible to me. I would have been disappointed had she taken her eye off the ball to "save" me. She has a responsibility to herself, her family and her chosen career to excel. If helping me reinforces that goal, outstanding! If not, she is irresponsible to choose to do so. I agree that this is an important skill, but should be taught separately, not tied to my academic success. If you pass up the opportunity to educate a motivated classmate then you’ve missed a golden opportunity to thoroughly explore your subject matter. Being forced to dedicated your motivated mental energy to an unmotivated slug only teaches you to be resentful and discouraged. Outstanding point! But I think we’re mostly discussing those that have no desire to add that dynamic. But I love the way you’ve thought around the corners of this subject. Thanks for sharing it. Dwayne Edited to clean up the formatting.

Man, though perhaps not the most productive step you might take, I like that idea a lot! Dwayne

That depends on whether or not the rent's due..But generally I'd say yes... :wink: Dwayne

What BS is that? For about the gazillianth time I'll ask you to state a point, and support it so we have some idea where you're coming from. Why do you bother to post if you refuse to back it up with any intelligent thought? Are you truly that enamored with your post count? So, somehow in your world 2 months is longer than 6 months? Man, we keep waiting and waiting but you somehow still seem to just shoot off the first thing that comes to mind! I have a feeling that you've got some real knowledge to share...I just hope we get to see it someday. Dwayne

My question is this...Ruling out the atypical female STEMI...Is this going to make a huge difference in our treatment? Again, other than the atypical female STEMI, or even non-STEMI for that matter, by 15 minutes I would hope that I've run through my entire "chest pain" protocol, if the s/s are present, before this test gives me the results I need to make any major decisions... Here, (CO Springs) significant chest pain with s/s of cardiac involvement go to the cath lab regardless of the ultimate outcome...Perhaps there are more places where this will make a larger difference? My experience is tiny, so I'm asking that my comments are kept within that scope and not seen otherwise. I'm not saying that this is not a valuable test, only wondering how it will make a difference in our treatment or transport location decisions with the exceptions mentioned above. Perhaps those are enough...but it's not been my experience. Dwayne Edit is for bonehead redundancy...no significant contextual changes made.