Lone Star

I remember a similar situation a couple years ago. While I can't remember the specifics of it, the display in question then was visible from an expressway. The local sheriff's department ordered him to take it down due to the fact that it could be seen from the expressway and presented a distraction to the drivers. I think the whole display is in poor form, poor taste and should have never been put up in the first place. While he may be protected under the first amendment, it DOES have it's limitations. Since this display is visible from the highway, he too may be causing a condition that is unsafe for the drivers, and therefore can be prevented from putting it back up; even after he talks to his lawyer....

At least your husband came to you with a specific complaint, and came to you before there was disasterous actions were taken. Being 'on the inside', it's all too common to 'miss things' because of how close you are. As was stated a couple of times, you leave the 'medical mindset' at the door in order to decompress after a long day. This doesn't make you a 'bad wife', it makes you HUMAN.

It's my understanding that you can inform the other crews of the tendency to spit on/at practitioners, but you cannot pass on the 'condition'(hep pos)unless it's directly related to the transfer of care. As far as conversations unrelated to the 'condition' or care; I wouldn't be discussing that with anyone other than the patient. As I stated earlier, practitioner/patient privelige applies. Not only that, but "John Q. Public said...." equates to nothing more than 'gossip' in my book, and I try to steer clear of that as much as I possibly can. What I discuss with my patient (uless it's something I'm REQUIRED to pass on, stays between the patient and I. While conversations not related to patient care may not be governed by HIPAA, I'm pretty sure that you'd still have to be careful not to cross that line of slander/libel.

As an EMT yourself, how do you justify talking the patient into transport by POV over an ambulance? What criteria does a patient have to meet before you'll 'allow' them to go to the E.R. by ambulance? Since EMT's aren't able to diagnose in the field, how are you able to make this determination with any certainty? In today’s litigious society, you’re not only opening yourself and your partner up for legal action, you’re also placing your department/company in a very precarious position. If the patient has called for an ambulance, you are in NO position to try to ‘talk them out of transport’ by the ambulance they’ve called! If you respond to a scene and an ambulance has been dispatched, you’re in NO position to try to ‘talk the patient out of transport’! Yes, we all get the ‘bullshit calls’ where we’d rather not transport, but we do it anyway simply because it’s in the patients best interest. What I’m getting from the original post is that there’s some ‘bad blood’ between your department and the local EMS company. How close am I? If this is how you approach patient care; might I suggest that you either go back to school and relearn the ‘basics’ or just simply turn in your EMT license? Rather than fretting about ‘cheating the local EMS agency out of runs’, you should be praying to whatever deity you believe in that you and your department don’t end up in the courtroom facing a huge civil suit!

Divulging patient information directly related to their care is protected by HIPAA, we all know this. Unless the 'non-medical information' revealed is not something that we're morally, ethically or legally required to divulge, then one could conclude that it's still 'protected by privelidge'. Not only that, but could divulging this information be considered libelous? We are held to the same standards as anyone in the medical community asw far as 'patient/practitioner privelidge.

Ga. firefighter makes video of fatal car crash THE ASSOCIATED PRESS Published: 8:49 a.m. Monday, Oct. 18, 2010 GRIFFIN, GA. — A Georgia county is looking into whether any rules were violated after a firefighter took graphic cell phone video of a fatal crash that was shared with other firefighters, patrons at a bar and was later received by the father of the woman who died. Jeff Kempson tells Atlanta station WAGA-TV he doesn't understand why a firefighter would have taken the video of his daughter, 23-year-old Dayna Kempson-Schacht. She died July 17 when her car crashed into trees. The Spalding County Sheriff's office says a firefighter took the video on his personal cell phone and shared it with other firefighters. An unknown firefighter later took the video to a bar and texted it to other patrons. From there, the video spread. Information from: WAGA-TV, http://www.wagatv.com/index.shtml1 1. "Ga. firefighter makes video of fatal car crash." Statesman.com. Austin American Statesman, 18 OCT 2010. Web. 19 Oct 2010. <http://www.statesman.com/news/nation/ga-firefighter-makes-video-of-fatal-car-crash-977921.html>.

I've never had occasion to use them. There are other methods we can utilize if we suspect that the patient is faking unconciousness, like scraping the bottom of the feet, brushing the eyelashes and the 'hand drop' tests. I've heard stories from other crews about how they picked up a drunk during their shift and popped 3 or 4 of them into the NRB, and then laughed about how fast the patient 'came to'... Yeah, we've got to do things that will cause discomfort and even pain, but to intentionally do it is abuse. I've heard crew members talking about how they intentionally used the largest bore cath they had on a drunk, unlicensed pharmacist or the 'urban outdoorsman' just because they could. I find these practices appalling, and I'm utterly disgusted by those that feel the need to employ such tactics for their amusement!

I was an EMT-B for 12 years. Due to circumstances beyond my control, I ended up in a position where my license expired and was faced with the arduous task of starting over. I began this task at the age of 43 years old. I'm currently working on my Associates Degree in Paramedicine. I've often been older than my instructors and preceptors, and definately won the title of 'oldest guy in the class'. If you're physically able to do the duties that EMS entails, there is no reason why you shouldn't give it a shot. I've also found that your patients will usually be more relaxed with you than with your younger partners. The general public automatically will assume that because you're older, you've been at this a lot longer than your younger partner. They will trust you more and be more relaxed with you. NOTE: I am NOT implying in any fashion that the younger providers aren't knowledgeable and excellent providers! If you are going to work before deciding to move on to Paramedic, might I suggest that you don't let yourself fall into the same trap that plagues a lot of us......we have every intention of getting a better education and moving 'up the ranks', but because we work so many hours, or whatever other reason, we find that we just don't make it back to school. Another 'drawback' of putting a lot of time in the field before moving up to Paramedic is that we increase the length of time to develop bad habits based on minimal education. Furthermore, if you are serious about EMS and decide to pursue a career in EMS, I'd recommend getting your Associates Degree, simply because of the requirements for your degree. I have to take two additional Anatomy and Physiology courses as well as what they teach in 'the book'. Please, please, please, stay away from the 'patch mill schools'! Most are only geared to teaching you what you need to pass the test. 'Assembly line education' isn't always condusive to retention and understanding! You owe it to yourself and to your patients to get as much education as possible! I think by now, you already know that we're going to be dealing with people who are sick, broken and bloody. If you know you've already got an aversion to this, then EMS might not be your 'cup of tea'. I've had too many new partners who were clueless as to what we face in the field, and they promptly left the field because they couldn't deal with what we face on a regular basis.

I'm currently working on my Associates Degree in Paramedicine. I haven't found a college (locally) that offers a Bachelor's Degree in Paramedicine yet. I've been told that the BS degree in Allied Health (Paramedicine/EMS) is geared more towards the administrative side of things. I've never been one to languish in an office for very long. I have however thought about a 'back up plan' when I can no longer do the duties required in EMS. At the rate things are going in my life, I'll be lucky to finish my Associates Degree before I'm 90!

Now I can finally finish watching that movie on "On Demand"!

I'm sure that A.J. Foyt, Mario Andretti, and all of the Unsers would wholeheartedly concur with your assessment!

I'm going to have to echo Mike's sentiment about not losing your focus on finishing school. I was an EMT-B for 12 years. I had a litany of reasons why I couldn't go back to school to 'move up the food chain'. From I couldn't afford it, to I couldn't afford to take the time off work to go to school, to I didn't have the time to go to school. While they were valid reasons at the time, I never moved up the food chain. There are still things that cause me great anxiety about moving up to Paramedic, but most of them are borne out of my lack of knowledge and education. Now at 45, I'm about half way through my degree (the longest part is the medic course itself), with emphasis on the sciences (Intro to Psychology, Intro to Sociology, and will probably look into another Psychology course as well). I know how much hard work it is, and I firmly believe that by not continuing my education as I am now; I've cheated not only myself, but the patients I've treated over the years.

http://www.youtube.com/watch?v=xBMEZvZSWFQ

The climbing/plateau/climbing is a great analogy. The only thing I could hope to add is that when you're on the plateau, don't think you journey is over, there are many plateaus before you reach the mountain top! Develop good study habits, and don't put your homework off until the last minute. That only leads to rushing to beat deadlines, and decreases comprehension and retention. We all go through that "I just don't get it!" phase just before that "AHA! moment", it's perfectly normal; especially when you're learning something new. Don't give up! Best of luck! LS

Each time I had to start an IV for a patient, I kept expecting them to scream bloody murder and dot me on the top of the head! Starting your first IV's on 'real, live people' is scary as hell in the begining. I don't have a ton of 'starts' yet, and each one is nerve wracking! I'm still trying to learn proper technique, and Spenac is right, it's far better to palpate the vein as oppose to just visualizing it. It also saves on doing alot of 'fishing' to harpoon it.... IV's are one of the things I feel I still need lots of practice on, and when I get back into a medic class (March, if all goes well), I'll be setting as many as I possibly can! I had to learn 'odd ways' because I had one hand in a cast when I started setting them in clinical rotations, and I don't feel that I have a good 'technique' yet. I've only got about a dozen starts, and only about half were 'successful'....

Bieber, Welcome to the City! Just out of curiosity, I went back and looked at your other posts. I'm impressed! Not only were you willing to jump in and join the discussions; but when you found out that you had made a 'mistake', you stepped up and owned it. If this is how you are in the field, I can see good things for you. Not much in EMS is 'black and white'; (hell, this applies to the whole field of medicine!). You're already showing signs of someone who isn't content to rest on your laurels, and is willing to keep activly learning as you go. I, for one; am looking forward to your discussions/debates. Now that you've gotten your feet wet, jump on in; the water's fine and the pirahnas have been fed.......for now....

I'm just like any other guy on the face of the planet. I like checking out the female form whenever possible. But there are times it's appropriate, and there are times that it's not (not even gonna address the ones that I'd wish I didn't have to see ). To expose a female patient just because she says "It hurts 'down there." isn't enough justification without exploring other avenues first; one of them being a detailed history that's as complete as possible. To expose a patient 'just because we can' ranks right up there with the same thinking process of "This is the way we've ALWAYS done it!". I WILL expose a female patient (with privacy concerns addressed as much as possible) IF there is enough evidence to support the action. Having been both the practitioner and the patient, I can see both sides of the situation here. There is a place and time for everything we do, regarless of the level of licensure we hold. Taking baseline vitals on scene, only helps the doctor decide if the patient is improving with what treatments we've adminstered or if the situation is still 'out of control'. It gives that doctor an idea of the condition of the patient when we 'found them'. I may not be able to do a great deal to mitigate the situation the patient is in, but that doesn't mean that taking baseline vitals and detailed assessments are a waste of time. As far as not posting as much as I used to, I'm taking 15 credit hours per quarter (which translates into around 30 credit hours per semester). I've been quite busy with schoolwork, and I've got some pretty 'heavy classes' to deal with.

Congratulations, Wendy! With all of the members that have started school, or are just getting their degrees, people like AK, Dust, Dwayne and a bunch of others are probably sitting back and gloating because their posts about 'more education' have been heard and acted on! I have a feeling that the medical community has just become richer by you 'moving up the food chain'!

Ruffles, Unfortunately, I've hear too many stories like yours when the name AMR comes up in conversations. I've seen with my own eyes how they do 'buisness' and I've watched them get run out of damn near every county in the state of Michigan that they had a base. AMR's only goal is to be the BIGGEST EMS provider in the U.S., but they seem to forget that in order to do that, they need to be able to keep people, and they have to have something called 'business ethics' as well. Big isn't always better, and if you're going to shit on the people that are allowing you to bring in the money, you won't have them for very long! AMR is a 'stepping stone company', unfortunately, I've also seen where having AMR in your resume is a 'black eye' with other companies.

I've never been able to understand the need that some people have to go out and spend $50.00 on up to well over a couple hundred dollars for a stethescope that's going to get thrown around, beat up and quite possibly stolen just to be able to brag that they have a Littmann. Like Rid said, it's not what you put in your ears that counts. There's way too many spending high dollars on a stethescope that is only relegated to taking blood pressures and maybe lung sounds. I'm not saying that these stethescopes don't have their purpose and use, but really...in the field? I can understand a medic requiring a more sensitive stethoscope, because they're educated and trained to interpret more than a Basic and Intermediate is. BLS is far underutilizing a stethescope like a Littmann. I've also seen Paramedics do some amazing things with a simple sprague style as well.

The best advice I can offer, is to check with the Financial Aid department of the college you plan to attend. They can help you locate funding to go to school. I would do a little 'homework' before that though, and make sure the college you want to attend even has a Paramedic program. Best of luck! LS

Forgive my 'student ignorance' but I've got a question or two here... You mention Narcan IV/IM/SC/ET. I'm pretty sure that means Intravenous/Intramuscular/Subcutaneous/Endotracheal. Am I right so far? Next question: If you have to intubate the patient due to airway compromise, doesn't it sesem counter productive to be adding liquid meds to a system that already has problems? Since drugs like Narcan, MS, and others don't naturally occur in regular atmosphere, wouldn't it be logical to conclude that the lungs would recognize these drugs as 'foreign substances' and try to encapsulate it in mucus in an attempt to get it out of the lungs? This could then add to the pulmonary edema, increasing airway compromise.

Now that a sample of your skills has come to light, Mr. Brown; I'm fairly certain you can kiss that orange HEMS jumpsuit good-bye!