DwayneEMTP

Yeah, man, I read this elswhere, and it makes me want to spit. Some hosemonkeys turned off their radios so they could sleep, the dispatcher didn't wake them up, they all lied about it, and got a few weeks and a letter in their files? Disghusting.

If you have no medical director, then you really don't have any scope of practice beyong basic first aid. The same scope that your kids or neighbors has. If that sounds like I'm trying to bust your balls, I'm really not, but only trying to be clear. I've worked in many different environments, and the one thing that I've found to be a constant is that very often you're put into a position where your education will outmatch your scope of practice or resources. Trust me on this...you need to, right now, decide how important caring for those that you're responsible for means to you. As an ALS provider you will, sooner or later, be called upon to treat a patient that you have the education to treat, but not the allowable scope. What will you do then? I know a medic that, so I've heard, put a few tiny stitches into the flap of a scalp of someone that had fallen in the shower. It was theoretically outside of his scope, but the closest available qualified facility to do so would have been 14hrs distant, min. This medic believed that waiting for that time would have allowed the flap to be damaged leaving this patient with several medical and aestietic issues in the future so decided to act outside of his implied (no clear definition) scope of practice. I've been told that the flap healed nicely with the hair growing normally and very little scarring. You need to decide where you want to fall. You must decide, before the time comes, to protect your job, do your best medicine, or something in between. My advice is that you understand your comapany's, country's, and local legal and medical protocols and follow them, as I've heard that the above medic has had his ass handed to him a few times for his/her outlook on "doing the right thing." Good luck. I'd love to hear what you discover.

It's also, and in my opinion, mostly, about attitude. You need to adjust your attitude on how you feel about making errors, especially in front of others. In my experience students often try and appear more inept than they actually are, either consciously or subconsciously trying to lower the expectations of those around them so that less will be expected of them with the intent of "Doing better once I'm more comfortable." Every experience is an opportunity to get better, and stronger, but too often a students goal is simply to "get through." And this is a bad, but also, really scary place to be. And forget about speed. You will "perform as you practice" so practice as perfectly as you can. You can't do that fast. Should you make this a career you'll likely be able to count the number of patients 20 years from now that were positively effected because you got an IV in 30 seconds instead of 90 on one hand most likely. When you practice your skills, slow down. Place your hands an feet in the places that you want them to be with purpose and decide why you wanted them there. Slowly. Always focus on slowing down and doing everything correctly the very first time, you will naturally become quicker with time. In EMS you will gain speed by eliminating wasted steps, not by moving faster. Trust me on this. Focus on what YOU think is wrong or right in every scenario or patient contact. Understand that you are going to really suck in the beginning, and sucking is exactly where you're supposed to be in the beginning...there is no shame there. The shame should come when you discover that you've decided that you're to important to make mistakes. That mistakes are for others. That you're not committeed enough to put your best effort forward every time so that it can be judged and improved. I don't think that I've ever come away from a scenario or call and didn't think, "Dang it...I wish I would have done this sooner, or done that instead." I'm never uncomfortable now working in front of people because I'm confident that I've done my best to prepare, that I'll focused just on my tasks instead of wasting brain power wondering what others are thinking. I remember that I'm just a simple country paramedic..that I'm going to make mistakes, that is a certainty, but they won't be stupid mistakes made by trying to hurry, or appear super human, and that I will learn all that I can each time so hopefully make fewer next time. If you find yourself at any time thinking, "I don't know what to do, God, I'm such an idiot." Then understand that you're wasting your time, the time of those trying to help to educate you, and giving very poor patient care, because those thoughts are taking up the majority of your mental and emotional energy that should have been applied to succeeding instead. When you don't know what to do...slow down and ask more questions. When you're scared, confused and can't figure out the simplest thing...slow down more, get more information. When everyone around you is freaking out and telling you to hurry, slow down again, gather more information still, until you know the right thing to do. Action is never, ever a substitute for calm thought, though you will find that most around you feel that it is. Slow down, breath, think. You'll do awesome.

Man, I want to know what his favorite lotto numbers are....

Gotcha Brother...posted with both emails...and no, it's none of your business why I have two....Ok, the second is for porn. I'll continue to vote until it closes and try and encourage others as well.

Thanks 1 C, edited.

Man, I didn't know that the stations had letter designations...which one is 'B?' And, as chbare said....that's really the best answer.

Hey! Good to have you back....it's been friggn' years, hasn't it?

What level of education is this student attempting to achieve? Doesn't the students statement that they will go to rehab at a later date illuminate the fact that this is an adiction "only" and not a medical need? I'm afraid that I have no opinion on whether or not you have the right to request a drug screen in an educational environment, though my guess would be that you certainly would based on suspicion, assuming that you can justify your suspicion. I would not allow them to continue for several reasons, and non of which is me trying to be a hardass. There needs to be some baseline standard for education and entry into EMS, wouldn't you agree? Though the student, and perhaps you, believe that no one else is aware of this issue, I can promise you that that is not the case. Knowingly allowing this student to continue lowers the expected standards of your program to an unacceptably low point, in my opinion. You not only show the respect that you hold for your program, but define it for those that follow as well. Also, this seems like a really big liability to me. If you believe that this person has such a significant need for narcotics then they certainly don't belong in the physical world of EMS. Also, and this would be pretty big for me, when they become injured, or further their injury, they will always have the ability to say, "But, I told F9m and she allowed me to continue so I assumed that it would be safe for me..." Doc's note or not, it seems that it puts you and your institution at a significantly increased unnecessary liability, doesn't it? And I'd be curious to know if the doctor's permission was verified. My guess would be that it wasn't, and even more so that it was never given. Though we're not supposed to say such things in our politically correct world, they've admitted that this is an unhealthy issue and yet have chosen to continue it until 'some other day.' This shows an unhealthy, and immature personality and neither of those should be encouraged to enter the EMS family. And lastly, and I promise that no offense is intended, but more than likely the last thing that this person needs is another enabler in their lives. It's time for them to make some hard choices, and helping them to postpone those choices is feeding their pathology...again, in my opinion. Good to have you back!!! Dwayne

Hey Mike, good to have you Brother.... As's been mentioned....jump in man.

I've no issues with his holding c-spine, but with him deciding to do so after those in charge of the scene decided that it wasn't necessary, stating that he was the highest level of care on scene. He seems to believe that obtaining an EMT cert. made him an entity, when in fact he's simply a bystander unless associated with a responsible organization.

But see, that's kind of my point. If he's unassociated with an organization, and therefore a medical director, he has no scope of practice above any untrained person that chooses to stop and try to help..

Yeah, I'm mixed on this to tell the truth... Tonight we got our redneck on and went to a monster truck rally. During the opening ceremony they asked for military, police and firemen to rise and they played "God bless the USA" in their honor. It didn't bother me nearly as much that I wasn't included, in fact I don't think at all, but it kind of pisses me off that firemen were asked to stand with military and police. And of course many that stood were 300lbs with volly fire Tshirts on.... I'm not sure what it all means really...

Yeah DFIB, I had the same thought. He controlled it, shot the dog in the eye, and there was no collateral damage, so in no way am I implying that he was wrong, only that I had that thought. I also wondered, and maybe it happened before the vid started, why they didn't choose to taze him much earlier instead? But again, I believe that he shot to defend himself, his shot went where he intended, no other bad things happened, so these are curiosities for me, not judgements. But it is curious about the guy on the ground. It's almost as if they'd checked him and found him to be deceased?

Remember that precepting is about creating a strong spirit, and you can't do that with fear. Make him/her get ALL of his/her own second/third IVs on every non time critical patient, right from the beginning. It will help them to plan their first stick better as well as teach that despite it sucking ass that you have to poke your patient a second or third time that they still need to keep moving forward, especially when things suck ass. Don't give too much information all at once. If they're uncomfortable with IV sticks, don't have them answer questions about the appropriate drug dosage, or drip rates while they're doing it. Let them get comfortable with one thing, then add pressure to that, then add content without pressure to it, then pressure to the skill plus the new content. Always try and teach/proof newer skills under conditions that allow for the highest predictability for success, then push. Make sure that s/he understands that you can't do EMS without making mistakes and that honest mistakes have amazing power and value, but any dishonesty, on anything, is a 'no warnings' trip off of your truck. And, I believe the most important, is that you can't teach without laughter. Other than that, make him/her just like you and all should be well.

Yeah, man, sounds like a nasty call. Getting professional help for yourself or your coworkers is certainly the right thing to do. But don't confuse CISD with professional help. No only can you see if you look at the way that they provide 'counselors' that it's nonsense, but the scientific data is clear that it shouldn't be considered useful for nearly any situation. Before contacting anything CISD related, be sure to look at the facts. Good luck man...

I'm confused as to what authority he believes gives him the right to do anything without being affiliated with a medical director? He claims to be the highest level of authority on scene, but where is that authority coming from besides his 'education.' Without being affiliated with medical control he's really just impersonating an EMT when on scene, isn't he? No different really than any other impersonator? I mean, being certified as an EMT is an actual title when sitting at home, becomes an abstract when considering acting, but a non title without medical control when acting it would seem to me?