Eydawn

There's a boatload of difference between a firm, professional correction or intervention and flat out bullying and hostility. I'm not talking about getting yelled at when you're about to majorly screw up, I'm referring to unprofessional behavior, much of which happens BEHIND the care scenes... It is one thing to yell "Where do you think you're putting that line, STOP!" and "You f*cking moron, you have no idea what you're doing, give me that and get out!" You can't tell me that politics don't affect how students are precepted, and that it is not always beneficial. Also, many of the more "bully tactic" type instructors resort to that because they feel threatened in some way, or because they simply don't care to take the time to actually teach. All of us do things that we deserve to get chewed for. It does matter how the chewing is delivered, and for which reasons. There is absolutely a trial by fire that must occur for a provider to become worthwhile. This idea cannot become a convenient excuse for workplace hostility. There is a difference between "rougher" teaching methods and methods of "teaching" that are wholly unproductive and even counter-productive, allowing those with poor practice to remain in charge because they have made themselves unassailable. You can have all the 'nads in the world and learn as much as possible from every encounter, and still end up with the short end of the stick because your instructors are less-than-optimal. And yes, we have to run off the chaff somehow... but having seen some of the folks that STILL somehow make it through nursing and EMS, I'm all for implementing more modern and psychologically adept teaching methods in order to better the odds of keeping the good ones and tossing the losers. What we do now, as far as I can see, could definitely be improved upon. As far as me personally, I will *not* exceed my scope as long as that scope is clearly defined. Patient advocacy is first and foremost. Of course there will be rough situations- it doesn't mean that your instructor somehow needs to bully you in order to teach you critical thinking skills, which is what I'm kind of inferring from your post, Vent. Wendy CO EMT-B

Lone, I see a lot of my earlier attitudes mirrored in your posts. I used to think that it was foolish to view lower level providers as somehow detrimental to the system. The pure and simple fact of the matter is that it is not about the *PEOPLE* at the lower levels, it's about the basic education all of the levels receive (or lack thereof) and the culture surrounding education. You can only do so much with limited understanding, and unfortunately, since school is expensive, employers and unions fight to keep the lower standards. You, my friend, are the EXCEPTION, not the rule when it comes to the whole "intelligent provider" thing. You seek to expand your understanding and advocate for a teaching culture. Most people functioning as EMT-B or EMT-I simply are not aware of their educational shortcomings, and as such, fail to appreciate the greater understanding that comes with education that is appropriately approached. You're right- someone can have had all the "education" (aka: classes, degree, etc.) in the world and still be a freakin' AWFUL paramedic. No bones about it. However, the best EMT-B in the world will only EVER be able to practice with a shallow understanding of medicine unless they avail themselves of the educational opportunities that are out there. Nobody is saying that by virtue of only having had EMT-B or EMT-I education that someone is an intentionally shoddy provider... what we are trying to say is that our patients deserve the best possible medical practice we can give them, and that involves educating ourselves and promoting a climate in which knowledge is valued and put INTO PRACTICE in our every-day interactions with our patients. EMS providers who are preceptors and educators should without a doubt try to explain material and provide more education to those they are responsible for. However, there is only so much you can teach someone about medicine if they haven't had the building blocks, per-se. It's like teaching someone who hasn't learned the alphabet to read in multiple languages. And sure, you could teach every single student who crosses your path the alphabet- but maybe that isn't really your specialty and you aren't the best person to teach them that system. It's the same deal with human anatomy, physiology and psychology. Sure, any of us who have learned something in those fields can pass on what we've learned to others, but students should receive the best instruction they can from people who specialize in those subjects. Irritation with the system in general is what promotes the "eat the young" mentality. I got chewed pretty hard when I made my first attempt into the field... because I wanted to use knowledge and think about medicine (being younger in that regard, it takes me more time to synthesize and put it all together), and was trying to do so in a system that didn't value that approach. It's easier to brow-beat someone and get them to accept half-ass practice at their level than it is to bring every single person up to your level, especially if your system rewards that kind of mentality and n00bs learn that you can coast by WITHOUT learning more as long as you keep your head down and your mouth shut. Don't think it's just EMS though. There's entire journal articles written about "horizontal hostility" with regard to nurses and the in-fighting and bullying that happens in the field of nursing. EMS isn't the only field with its head in its arse (generally speaking)with regard to how students and newer practitioners are treated--not to say that all EMS companies and all avenues of nursing have this problem, but that it's wide-spread enough for there to be articles written on it... I hope this makes sense. Wendy CO EMT-B

MSNBC Article: Fast Morphine Treatment May Prevent PTSD It seems that earlier administration of morphine, at least in this small study group, seemed to reduce the likelihood of injured soldiers developing PTSD. Though it needs more exploration, I think we should think about it in the EMS community... I know we always debate about when and how much pain relief to give, so with this new information to work with, would this potentially change your treatment practices? They say in the article that it isn't known if it is the pain relief itself, or the inherent properties of morphine that lead to the reduced PTSD rates. Just some food for thought... Wendy CO EMT-B

Banning a clothing practice related to a major religion is not a good move. However, making it clear that the interests of national security supercede the interests of religious privacy is a good idea. Women may wear the burqa all they want, as long as they realize that they WILL have to show their face for identification purposes. Non-compliance with that should not be tolerated. Anyone who is unable to understand that (or willfully chooses to disregard it) should not be allowed the same freedom of movement as the rest of the citizenry. Wendy CO EMT-B

LTC facilities are definitely a challenge, I can safely say, as I'm sitting here on graveyard shift at an assisted living. There are many that provide good care, if not excellent care... I would second what Dave said, though, as far as staffing inadequacies and weird mixes of levels. Now that I work in this setting, I totally see where some of the LTC stuff comes from as far as why we didn't call sooner, what we didn't do, etc. The honest to God truth is that LTC facilities attempt to care for problems until it becomes WAY out of their capacity (which is part of what they're supposed to do), OR, problems just honestly get missed/overlooked. It's not intentional neglect, as far as I can tell- it's mainly that the nursing staff is overworked and simply doesn't remember everything reported to them by the care providers/CNA's over the course of a shift. I had to report someone's SOB with exertion and increasing pedal edema about 5 times over the course of 1.5 weeks before he finally went to the doctor. Surprise- nurses got fired in between his doctor visit and results being faxed back, and it took another week before folks realized that he had been diagnosed with CHF. The BIGGEST challenge to providing good care is consistent communication. Where EMS only has to get the basic history info and acute history and treat the patient for ~ 1hr at most, LTC facilities provide care for weeks, months, or even years. Try getting every nuance observed over your shift communicated to the next shift, and have them communicate that in turn to the shift after that... it's like a giant game of "Telephone" and so you have to be vigilant in your documentation and reporting to make sure important stuff doesn't fall through the cracks. Then there's the issue of how good your nursing staff is... we had a few LPN-FAIL! types and now we mostly have very good LPNs with a few pool nurses to help fill out the schedule. I totally get why it's frustrating from both sides and why LTC facilities and EMS don't always play well together- they're coming from different worlds, and sometimes EMS sucks and sometimes the LTC facility sucks. Throw some egos and misunderstanding of what the medical purpose of your given role is in there, and you've got a grade A cluster! Just my rambling... Wendy CO EMT-B

Holy crap, Batman! What happened to this thread?! First of all, I see no issue with Lisa O's comment. It does indeed seem like an attempt to empathize, and nothing more. Secondly, Siffalis, you really seem to be screwing the pooch on this one. You're implying all sorts of things that aren't present, and your tone is just atrociously antagonistic. Arctikat is right: If you wanted the thread to go a certain way, you should have given it some guidance and set-up first! You even seem to take issue with people discussing the actual content of the article... not sure what's up with that. Short on sleep lately? Thirdly: You said it yourself. This is an open forum. Nobody needs your permission to post what they like in this thread, whether it's the direction you wanted it to go or not... How'zabout everyone takes a step back for a little bit? Let's cool things off a touch and figure out what the real issue is here once the red fog clears... Wendy CO EMT-B

At the service I used to work for it was anywhere from 10-30 minutes. We transferred patient care with verbal report and immediately left a paper "short form" with demographic info, basic assessment, our vitals and any treatments we may have initiated. This short form also had our call reference number (CRN) on it. Carbon copies are great- one went right into the patient's chart at the ER, one went back with us. If we had to book it immediately (no units left but you) then we'd wait until we got back with the next patient and make sure both "short forms" got into the correct patient charts. We would then fill out our ePCR and submit it online, either en-route back to whichever station was vacant or sitting at the ER if it was our turn to be "central posting." Our paper shuffle included a basic "run sheet" with time records, nature of call and CRN, and this was stapled to the carbon copy short form and chucked into a collection box... not sure where it went from there, although I suspect it was to QA/QI. As far as restocking/cleaning, the ambulances were rarely cleaned thoroughly in my experience. We stocked heavily at the beginning of shift, often enabling us to run 4-5 calls between needing to re-stock important supplies (including drugs, as our go-bag contained duplicates of our drug kit on-board the ambulance). As far as having to go to the next call before you were ready... closest unit to the location dispatched was supposed to jump on the call, but units would cover for each other if someone was completely discombobulated. You could also call in to dispatch and make yourself unavailable temporarily in order to deep-clean, and that would cause the next closest unit to start drifting towards your location in order to better cover your calls. I will say that the "short form" with the bare bones important stuff was a great idea. It allowed the doc to know what drugs had been given and the basic gist of why you did what you did, and had the CRN on it so they could access the ePCR later if needed. Now, if only the medical practice out there had been good! Lol... Wendy CO EMT-B

I have not seen anything from you that I would construe as a violation of patient privacy, HIPAA or otherwise. That said, you need to have Admin send you the deleted threads and I would also second the advice to lawyer up and shut up. A lawyer can use IP address information to show who was posting and inciting you, and if that can be connected to whoever is after you in real-space, it significantly improves your case. Kaisu, you're a good lady, and I know you'll get through this... but now would definitely be the time to have head down, eyes and ears open. Wendy CO EMT-B

You Found Me- the Fray Everything- Buckcherry Numerous other Fray songs go in there for me... guess I have a soft spot for the hometown boys. Went to the same high school as the lead vocalist/pianist... weird to think about, really! Wendy CO EMT-B

Well, par for the course for me growing up was hiding in an upstairs hallway away from windows with my family and waiting for the ghetto rats to quit filling the sky with lead. Strange? Matter of perspective, really... I think the best place I've spent it is Skate the Lake at Evergreen Lake with my venturing crew, doing medical support. Love it! Gotta work for pay this year though... day job got to me first, so I won't be joining my buddies out there. Had some good trauma in the past few years... kept Evergreen FD running transports like mad one year... Wendy CO EMT-B

Ya really have to ask?!? Why do you THINK there are negatives?! Duh! Wendy CO EMT-B

Look, it's always easier to justify taking action in the best interest of someone than it is to defend yourself against allegations of neglect. That's my gut feeling on this. We don't know what happened. We don't know exactly what the EMTs' status was at the time this happened, and what their field qualifications are. I'll give you that. But you BETTER be ready to stop what you're doing and at least attempt to render aid if you're going to be wearing something that identifies you! If you want to really take your break and not have people recognize you, put on a jacket that covers up your patches. Don't wear your sweatshirt with patches on it while off-duty. The way I look at it: If you're in uniform or any clothing identifying you as a member of emergency services, be prepared to assess the situation just like you would if you're on duty. Call 911 and request PD to get there if you feel unsafe, and then do the best you can and explain that you don't have an ALS kit in your back pocket. I agree that this may have been a lose/lose, but it always looks worse to do nothing than it does to attempt SOMETHING. Draft bystanders to help you. Make people feel like something is being done until the cavalry arrives. We all agree that there is an image issue with regard to EMS... do something to help bolster our image. Purport yourself professionally, and if you are unable to start providing care, explain why but do whatever you can to help in other fashions as well. As for the comment about them not getting to eat... this is why the smart ones carry granola bars in their pockets or vehicles. Sure, you absolutely need to eat. Bring some emergency rations, for crying out loud! Wendy CO EMT-B

Like that will ever happen. I'm all for sealing this cave. Too dangerous, too much risk to rescuers and explorers. Some places, people just should not go. We've got a crevice up here in our area that people get wedged in, only a matter of time before someone dies and they quit using it... What wasn't said in that article is pretty interesting... google for the other articles on this and you'll see that the rescuers used a single-line system instead of a main/belay dual line system. Their rock anchor pulled out, the guy went back in, and that was all she wrote. There's a reason that MRA standards call for dual-line rescue rigging. This guy might still be alive if they had (not Monday morning QB'ing, just saying there's a standard that might have assisted here). SAR teams that think the belay is a pain in the ass or takes too much time, please take note... Wendy CO EMT-B

Glad to hear you made it out OK. How are your partner and the patient? I understand reticence to go into details as this may possibly go into litigation depending on circumstances, but I'm curious to know exactly how it happened and how it could have been prevented... that's where we learn the most. Good luck to you, and I bet you wear a seatbelt more often in the back... Wendy CO EMT-B

Any PR is good PR if you're some asshat of a celebrity. This is NOT the case where medical professionals are concerned, at least from my point of view... I mean come on, you can't possibly think that it's good to see a headline about an ambulance service crashing a rig or abusing patients... I gotta say, this episode was more tolerable than others I've seen. Maybe it was the 101.7 fever talking, however... Wendy CO EMT-B

Caffeine overdose/high is very possible, I have seen it before... tachy, icky, vomiting... usually happens with people who down energy drinks when they're not supposed to, or with high doses of diet pills. Wendy CO EMT-B

Here's to my cousins, damaged and suffering from PTSD from Iraq and Korea Here's to my coworker, struggling with demons, fresh back from his deployment to Iraq Here's to my several friends currently serving in the armed forces Here's to those I don't know, but hold a special place in my heart for There are not words to describe my gratitude and love. Go out and hug a veteran tomorrow. The life you enjoy is due to their work, and paid for by their tears, broken lives and emotional struggles. Wendy CO EMT-B

Well, looks like I can't go, even though I want to. Final exam for my wildland firefighting class was announced today, and it's the 10th. I can't go the 9th, as that's both my mother's birthday and my MIL's birthday. Have fun, folks!!! Maybe next year... Eydawn CO EMT-B

Let me iterate: This position of mine (that apparently warranted a minus point) is wholly based on the arguments we've had over the years here on the City. It is not a knee-jerk reaction, it is sheer frustration based on facts. Whoever had the gonads to negative-mark me without offering reply and explaining why it was given a negative, shame on you. Own your criticisms! Wendy CO EMT-B

Of COURSE they back fire based EMS, it means less firing for fire departments! It's not about providing good services, it's about maintaining the bottom line, and for the IAFF and IAFC, that's firefighter job security. I love the first comment on the article: Shame on JEMS for posting this propaganda. It'll probably get deleted, but props to whoever had the balls to post that up!! Wendy CO EMT-B

Pt. had lay down: Wrong tense. Pt. had decided to lay down: Right tense, but implies choice... Pt. had laid down: Right tense. Right word, wrong tense, and I would have written that sentence differently anyway, but that's because I'm an English major. "Upon returning to the room staff discovered the patient lying on the couch and "twitching" per their description. Per EMS visual inspection, pt. was lying in left lateral recumbent and displaying intermittent muscular contraction consistent with XYZ seizure activity..." (just inferring seizure for the purposes of writing the sentence.) Always use active language when you can. Paint the picture. You don't know if the patient in fact voluntarily laid down on the couch, or if they just ended up there, especially if there's "twitching" going on... Wendy Grammar Nazi CO EMT-B

I don't know if I can afford it. Airfare would be the biggie, as time off from work in November and December is severely restricted so a carpool is pretty much out of the question for me. So far it's looking like $250 for airfare alone to fly out on the 9th and come back either the 10th or 11th. I'll see what I can do... I really really want to come out for it. Wendy CO EMT-B

Bump! I'd hate to see this die. Anyone have any fresh ideas? --Wendy

Welcome, younglings! ;-) I started in Venture Crew 911 in Denver, CO with the Boy Scouts of America at the age of 16. I'm still an adult adviser there, even though I rarely make it down for meetings as I currently live further north in the state. Best thing you can do: Learn everything you possibly can, and never forget just how much you don't know. Stay safe out there!! Wendy CO EMT-B