Eydawn

If you are the one providing the majority of the care, you should be the one documenting including narrative. Nobody should be crossing out your narrative and substituting your own because that's the way they LIKE To do it. Also, no good FTO fails to address a problem directly with a trainee (unless the trainee is totally unapproachable) before going to the super. Sounds like you found some of the more difficult coworkers in this company. I agree with Dwayne... perform your care as a paramedic and keep your chin up. Especially if they're making your gender an issue. You're getting turned loose in 2 weeks? Then stick it through until the 2 weeks is over, and develop your own style from there. Wendy CO EMT-B

That's the sort of well thought out response I was looking for in this discussion. Well said, Dust. I'm going to be interested to see if anyone has rebuttals to it... (P.S. 15 hours without response from me is due to school and all that... ya know... that edjumication thing.) Wendy CO EMT-B

Take notes on how each FTO wants you to do it with them, then try to act accordingly. Refer to the notebook if necessary- tell them it's your notes on what they prefer because they are offering different approaches to medicine and you'd rather work in a cohesive team than irk anyone, and you don't want to cause offense to any of the FTO's. Make sure the second you get on shift you go over your inventory in the rig. Tell the FTO's it's because you're wanting to memorize where everything is so it's second nature to you. Take healthy snacks with you, and in your space between calls, take at least 5 minutes for yourself (even if it's locking yourself in the bathroom) to take several slow deep breaths and recognize that you're only human. Also, explain to your FTO's that you wanted to gain the medical knowledge to help you develop the right kind of experience and habits- that you felt like you needed the background base to be the best medic you can. Don't apologize for going straight through; do ask them to help you and give you tips to handle the pressures that come with real life EMS. Also, freely admit that you're still learning since you don't have that many hours under your belt in the field, and that you appreciate advice but that unwarranted criticism is unhelpful to everyone. You can learn to handle this. It will just take a bit of time. What is it that feels so overwhelming to you, other than the switching FTO's (I know that kind of thing drives ME nuts) and the pressure of jumping right in the deep end? Are you afraid that your inexperience will lead to stupid mistakes? That you won't be respected ever, because you're green now? This will pass. Make sure you take water with you and stay hydrated... control what you can control, basically. Also, when you get paired with an EMT, be upfront about your level of experience and that you're still establishing how you, as a medic, run things and that you're open to suggestions, but that you will have final say over how calls are run with you. I think you can do that without offending someone if you phrase it right. Stick with it lady! You're an amazing person and a very smart paramedic. The chops part will come... just keep with it. Wendy CO EMT-B

There's more of what I was hoping to see. Way to go, folks. Okey dokey... so we've established now that being under the DOT has contributed to our fragmentation and ridiculously low educational standards. Solution: Extricate ourselves from the DOT Solution: Require a 4 year minimum education to practice as a prehospital medical provider Here's my questions that follow... how many of you actually would actively participate in a campaign to establish us in a department other than the DOT? What are some suggestions or ideas as to how to go about this? How many of us are willing to petition the NREMT to change their educational standards, thereby forcing change at the state level? Even if it means forcing you to go back to school yourself, as an associate's degree Paramedic? And the original questions still apply... what is the real source of this problem and how can it be solved? More ideas on that original topic are still fair game. Wendy CO EMT-B

Why are they complacent with where they are? How do you propose they "get busy or get out"? Are we talking legislation, company policy, etc. requiring a 4 year degree before you can work on an ambulance? Wendy CO EMT-B

All right. You've named the peeve. NAME THE CAUSE. Why do they resent you pursuing a higher level of education? NAME A SOLUTION. How can you convince them that education is the way to go? Why is education important, and how could that be communicated to these people? Thanks. Wendy CO EMT-B

Alright, since the other one got locked, how about we really continue the dialogue? Not just what ticks you off about the other level, but where you think the real source of the general problem is. Not just "I hate the ______ at *MY* department because of X" rants... but "I think this is where/why this problem is caused." I want to hear from both levels, and if you offer a problem, you must offer its cause *AND* a tentative solution from how you see it. I also would like to have honest responses from Basics... if you were given the scholarship and social support, would you go for Paramedic, or are you holding back for another reason? In the spirit of an actual discourse, any responses that are simply put as "Basics suck" or "Paragods are tools" or suchlike have invite from ADMIN to immediately delete them. I put out a lengthy post on this topic in the now locked thread. If anyone wants to resurrect it or link it, feel free. I want to know what everyone else thinks. I know we can think critically about this problem without infusing our whole emotional local crapfests into the thread and causing lockdown tighter than organic cashew butter. Alright... ready? Go. Wendy CO EMT-B

I think ERDoc has hit a vital point here... the division of levels of care like this is killing us. And our patients. It's time to stop seeing this as an us vs them issue... and look at it as paramedicine as a whole. See my previous post on how we convince our workforce peers that this is not only necessary, but will benefit everyone... Wendy CO EMT-B

My prayers and thoughts go out to the victims and those who knew them... This is starting to make me sick. I'm starting to be afraid to look at the news, for fear I'm going to hear about another chopper crash. --Wendy

First of all, let me say that I have been an EMT-B for over three years now and was a First Responder for a couple years before that. Initially, when I was first introduced to the forums, I resented the attitude of many higher level providers towards EMT Basics. I didn't really grasp how small the educational scope for EMT really is until I spent some time evaluating it and undergoing a formal college education with which to compare the EMT class. Now, I understand the frustration with the inadequate education that is given to us as EMT-B's and I fully understand why higher level providers are allowed more skills, greater judgement, and more responsibility. It is not because any individual person, as a paramedic, is better than any other individual person who happens to be an EMT-B or EMT-I. I blame a lot of this dissent on EMS culture. Most of us became attracted to the field for the chance to be a hero. As someone much wiser than myself indicated, it is a normal and very human attraction to want to be the "person who comes to the assistance of the person in need." Unfortunately, the mentality of "being the hero" can give one an inflated sense of self importance, especially since many of us in the medical field identify at the personal level so closely with our professional endeavors. Think about how EMT class starts out. You are informed that you will be exposed to things that many people cannot begin to imagine... that you will not only be witness to but actively part of the most important moments of people's lives. That you are there to *MAKE A DIFFERENCE* and help those in need. This attitude is reinforced when you get into the field- everyone talks shop, rehashes "good calls" and so on... and you are an active part of that, with community thanks and supervisor praise to reinforce the job you are performing. Think about it... now, you're an individual who has performed medical interventions and assisted with high priority calls, you take pride in who you are and what you do... and now someone comes along to tell you that your education sucks and that you, as an EMT Basic are essentially worth little more than a Thumper robot that can spike IV bags and use a BVM. This is not just assaulting someone's education or intelligence... for many people it is an affront to their very IDENTITY. If you grow into an EMS culture like the one I describe above, how can you be blamed when you react violently or angrily to someone's attack on how you understand EMS? Here's the problem. The good old boy, heroes at the front line, saving lives EMS culture does not program EMT-Basics to understand why a paramedic is really a higher level of care. As a matter of fact, it reinforces that each individual, regardless of training level, is important to the department. Unfortunately, Basics are also cheaper- lower education levels means lower pay and less overhead for an agency. Another part of the problem is in how those who have advanced to paramedic choose to interact with lower level providers. What many paramedics and RN's fail to realize is that having a college education forces you to think differently and gives you tools that many individuals who are EMT Basics do not realize truly exist. It's like trying to explain calculus to a 4th grader; you can be the best mathematician in the world, but if you can't bridge the gap to realize that the 4th grader doesn't think the way you do in order to try to get concepts across, you're just going to sound like a pompous ass who likes to sound off their own knowledge and you're probably going to make the kid cry. You can't approach ignorance and try to bludgeon it into submission. I'm not saying that EMT-Bs are ignorant PEOPLE... however, due to the social treatment and conditioning that they experience they have a level of educational ignorance that must first be bridged in order to provide the proper motivation for pursuing higher education. Why, if someone is managing to make a living wage and enjoying what they do, should they fork over the money for a higher level of education, just because some uppity paramedic says so? There is also the fact that many EMT-B's have found something that they feel a level of competence in, when the US school system has convinced them that they're really just stupid people who will never make above the C/D level grades wise, so they might as well not even try for higher education. You'd be surprised how many EMTs I've met who think that little of their intellectual ability. They're *scared* to try for the paramedic level, because they don't think they're smart enough. But! They understand the very basics of medicine, and they enjoy it. I have to admit, that as a person with a certain modicum of intelligence, I have made the mistake of trying to explain something that seems pretty simple to me (usually biology stuff to my non-science oriented friends) and been greeted with blank stares, laughter, or criticism because what I have been saying is so far over their head that they have absolutely no idea what I'm talking about. They might have a few of the same vocabulary items that I do... but conceptually, things are very different. Unfortunately, that is how many paramedics, satisfied with their level of understanding and knowledge, come across to recalcitrant Basics who really don't *KNOW* how inadequate their education is. You have to teach someone how to appreciate the subtler rewards that come with further knowledge, and teach them how their situation around them affects their self perception and knowledge, before you can hope to convince them that their level of education is inadequate. You have to be able to reach through all of the social conditioning that goes along with the EMS system we work in and teach someone that they are capable of pursuing higher knowledge even though they themselves think they are the stupidest M*f**** on the face of the planet-- even if they are too ashamed to outright admit it. That's the real disjunct. And then you have the fact that certain individuals, regardless of educational level, revel in the anonymity that the forum provides and let out their frustration and anger through vitriol-- regardless of who that filth hits or hurts. You don't have to be explicit to damage someone through a personal attack on the internet. I think if this gets any longer, no one will read it. But that's my take on the situation. I am in a unique position; I am currently undergoing formal college education and have long term medical education goals... and I am an EMT-B. Do I think the paramedics go overboard with the arrogance? Sure. But so do the Basics. And I will say this in closing... if you feel that you have to be arrogant or cocky in order to perform excellent medicine, you're compensating for some weakness you feel. Some of the best medical providers I've seen, at all levels, were very gentle personalities who led by respect and action, rather than "I'm the best" attitude. Wendy CO EMT-B

Oh my *GOD* I feel your pain. At the job I just left (CNA-type care for adults with developmental disabilities... definitely a lot of medical) I had my supervisors give me the same gripe about my incident reports which we used to document client injuries and illnesses etc.... Apparently I use too much medical terminology, too many big words, and parents and case managers don't understand what I'm talking about. Hello? I thought I was *supposed* to be smarter than my clients... Also, I'm too blunt and apparently, via an anonymous complaint that refuses to give itself a face and hides behind performance evals, rude to supervisors. That, among other reasons, is why I left. Apparently it never occurred to their lawyers that allowing me to use my EMT-B in lieu of a First Aid card meant that I needed to document to my level of training in case something ever came up in front of the state... because you *know* some pissy guardian's lawyer is going to zero in on that one little thing... But I digress. Suffice it to say, I know where you're coming from with that critique... As far as your documentation goes, it seems perfectly fine to me. I personally don't dig abbreviations except the really really obvious ones, like IDDM, HTN, COPD and O2... because Tx might mean transfer or treatment, etc. I generally try to use plain English as much as possible and paint a picture, which you seem to have done very well. If I can't paint the picture so that I can see it myself after being away from it for several months, it isn't documented well enough. I also hate check-box PCRs... even though they are technically adequate, I prefer the flexibility of the narrative. I think you're doing exactly what you should be doing, supervisor or no. Wendy CO EMT-B

Someone didn't do all their research before coming up with their new ad campaign. The concept is great... egg white flatbread sandwiches, a nice new "healthy" approach and all that... however... pay attention to the catch phrase. "Dunkin Donuts... DD SMART" Now... I don't know about the rest of y'all, but when I think DD SMART, I think developmentally delayed... DD, developmental delay... So basically (no offense to anyone) Dunkin Donuts just called their new sammiches retarded... Wendy CO EMT-B

Go you! I think it's awesome that you have the courage to face something you didn't realize was a problem until it was kind of shoved at you by near-strangers. With that kind of attitude, it won't be long before you're back in the exercise groove- this time with the nutrition to give you real performance power. Wendy CO EMT-B

I don't know how it relates to EMS either, to be really honest. I think it's looking for "can you lift something heavy on your own" which is definitely a plus... but I would have MUCH RATHER done a dummy with a partner up the stairs or on the cot... I've done that before, and I'm very much more used to carrying stretchers or baskets than boxes. Different muscle groups, if you ask me. Thanks for the welcome, guys... I'm looking forward to the challenge. It's taken me way too long to break into this part of prehospital medical care. Wendy CO EMT-B

Step test? Not really.. I mean.. they had me dancing all over this aerobics step thing but that was without a weight... --Wendy

I'd be ok with it... but I wouldn't like the whole "do pushups with me because I fubared" thing. The runs after and before class though, and emphasis on physical improvement? Sure. It's a forced way of making you do what you should be anyway.. and moving around gives you more energy and better focus. I need a slave-driver to get me to exercise regularly. I'm just not motivated with it. If it were part of class (as it used to be part of the sports I did when I was younger) then I have motivation. Wendy CO EMT-B

I passed it. But here's what I have to say to that nasty box full of weights... curse you box, curse you! 60 pounds to a 39 inch shelf. 67 pounds to the 39 inch shelf, then to the "shoulder height" shelf (which was almost above my head). 75 pounds to the 39 inch shelf. 90 pounds to the 39 inch shelf. 115 pounds to the 39 inch shelf. 125 pounds to the shelf, then waddle back and forth in the office for 3 trips. Since when do patients come in box form? And if anyone posts a picture of spongebob, I will be forced to kill you... Man, that was a bastard of a test. I hated it. But I passed it so it looks like I'm golden, as long as I pass the IV class, to start working real prehospital EMS. :) --Wendy

Again... what is ultimately *right* and what you are ultimately *allowed* to do are two different things. As long as you're comfortable knowing that you can and eventually will lose your license for continually acting outside of scope, then it's your life and I won't argue with you. There *is* a reason we have protocols. You may not like them, but within your system, it's what you've got to work with. There's a reason doctors are allowed to play around with the rules- they have many years of education and experience with which to base their knowledge. Even as a paramedic with a BACHELOR'S degree, you wouldn't have nearly as solid a foundation to base rogue treatments on. Are you right? Sure. Is this something we should encourage every medic to do? No. Then you have anarchy and every single person exceeding scope saying "but it was my ethical duty to my patient!" Sure, it might be ethically justified... but it's still outside your scope. I think you're usually fine as long as it was in the best interest of the patient. But your judgement of best interest and a doc's judgement of the same may vary in retrospect... and that doc is gonna be responsible for your discipline and licensure... Again... this is something everyone has to do for themselves. We will all face situations someday where we either exceed protocol because it's justified, or we don't, and are legally covered. Wendy CO EMT-B

Reminder email time! Wendy CO EMT-B

The cop pressed charges because a drunk farted on him?! ROFL! No... not a biochemical attack. A biological psychological form of warfare perhaps... but man... Don't phart on the phuzz! Wendy CO EMT-B

http://ems-safety.com/emsfieldguides.htm various pocket guides... Now wait a minute... if you're moving there, and you have a job lined up, why didn't you just ask your future employer to send you a PDF copy of their protocols? Seems like NY doesn't have unified ALS from the quick googling I've done... may be county specific. I think that's why the DOH for NY didn't have anything under paramedic/ALS. Also you could PM asysin2leads and ask him to send you a copy if he's got one... or Richard EMT-B... Wendy CO EMT-B

http://www.ems1.com/guidelines/ There's some New York county specific protocols in this repository... Wendy CO EMT-B

http://www.health.state.ny.us/nysdoh/ems/main.htm Here's the main page. I found a page with a lot of links regarding BLS protocols... I'll let you know if I find anything else. Wendy CO EMT-B

Use the little world with a chain link icon... it tends to work better. Wendy CO EMT-B

Millwright, might I offer a suggestion? Don't look at this as something you have to TACKLE and FIX in your dear wife... go with her to the appointments and offer support, but don't push and make this your battle. It really isn't. If you place even more pressure on the issue than her mind already may be doing, it isn't going to help... it might even hurt. You have to let her decide that she wants to change it. Support her as much as you can... but let her know that you're not going to hate her or not support her if she doesn't change right away. There's a fabulous article that I remember reading, about a husband and wife who discovered that the wife had an eating disorder... if I can find it, I'll send it your way. It was very good on showing how to support effectively. Wendy CO EMT-B