Ridryder 911

This is an old trick PR and managers want to try... I did. The trick is you will be seen in 30 minutes or less... yes, but by whom ? Yes, it is true a medical person will see you ... that is a triage nurse. Now, if you read the fine print as described ' you are met by a nurse "... Now, we basically abandoned the triage nurse and do "bedside registration and triage". With portable computers and we are now paperless patients are brought straight back after a c/c is found out. This has decreased the wait time, but complaints remain the same because peoples expectations are those of a drive through. R/r 911

Whom ever told you did the wrong thing obviously is after their own ego in this business, and not the wishes of the patient and have no busines in this profession. You did the right thing, you used your gray matter and thought out the process both logically, legally, and morally. Too many medics these days are "cookie cutter" prepared that they only know to "follow protocols" and not able to think with their brain. The main intent and purpose of the patient was for the patient to die among loved ones. Probably why he lasted long enough to get home, and when he did, was able to "sense" and quit trying to live. Good going, using your noodle... you will go far ! However; I forewarn you many will criticize you for trying to "think"... just ignore them and know what you did was right. You placed the patient first. R/r 911

I wished teaching positions would offer that much. My professors at 2 large private universities and 1 state college made less than my fellow Paramedics.. and they have a PhD or DNSc. One of the problems of nursing shortage, there is not enough instructors. I was offered a full time nursing faculty position at a prestigious local private university for a whopping $25 $28 K a year, (oh, we would like for you to finish your PhD as well...) the state college was for $30 K for 9 month contract. .. no, thanks . I make more as an ambulance driver :wink: .. R/r 911

I too sucked at math, and probably one of the reasons I did not pursue medical school at a earlier life. I was fortunate to have a wonderful EMS professor that is now a anesthesiologist, that took me under his wing and tutored me in Algebra without me being aware of what he really was doing. It turned out I had a horrible fear of math (as we found out many do). Later when I became faculty, we designed two courses in cooperation with the science and mathematics division of the university. One was called .. Fear of Mathematics and the other was Math for Pharmacology. They have became a big hit within the local college, and after twenty five years still successful. I even taught it for one year, which is a testimony of itself. Now, after completing advance statistics, chem. etc... I know I could overcome it. There are many Mathematics for Pharmacology books and workbooks out there. Take your time, find a good math tutor (they do not have to be medical at all) and lower your fears as much as possible by taking courses like i described. Here is a link with some really good points and clarification for math/pharmacology written by a Paramedic instructor. http://gaems.net/download/drugcalc.pdf I wish you the best of luck ! R/r 911

Too good Ak !.. LMAO.. and hell yes, I thought it was hilariously funny !.. I guess, some never made a joke during a code or a TBC, DRT...etc... R/r 911

Not all schools/universities require a baccalaureate degree, rather a high enough MCAT and prerequisites. I have several physician friends that never had a B.S. degree, that entered with their A.S. degree in EMS. Even then medical school is only 4 yrs. post B.S. One is awarded the Doctorate in Medicine. To practice is all dependent upon the specialty one chooses. One chooses the specialty after they have became M.D or D.O. the time for specialty is all dependent upon the residency program.

Again, we do not know what was said or really occurred, but the firefighter that appeared to be kicking (balding/shaved head) has the typical small man testerone syndrome. Even attempting to fight another after the occurrence. Department needs to review and take disciplinary measures. I agree that many times we get tired of being abused, but the difference is we are above that. We are supposed to be professionals. They were not attacked... it was vice versa... R/r 911

The link above took me to a Dove commercial?... There is no reason to kick anyone when they have been subdued. It does sound like he was a dirtball, but we don't need to lower ourselves to his standards. R/r 911

Hey.. here is NEW concept, instead of trying to add onto the basic level. Let's be sure that they can actually perform ...hmmm maybe "basic life support" satisfactory, since BLS/ CPR has demonstrated better outcomes than airway and IV placements.. and GASP!!.. that is the skills that they are already trained (at least supposed) to do. WOW! You mean no substitute(s) or an excuse to have a placebo ALS, but actually place well needed money and educational time for reinforcing something that we already we know works... But then again, a physicians and their groups may not get published... aww! R/r 911

I see " ER DOC" is getting the "usual" ER patients, no one would believe what we see and hear. R/r 911

Obviously, you have never worked a CCU or ICU, I agree with ERDOC. We routinely see V-tach on a hourly, daily basis, that we never treat because this is normal for the patient. This could be caused by many factors either electrolyte imbalance to ischemia or just an irritable foci, who knows most of the patients never code or ever have any s/e from it. Again, treat the patient not the monitor. R/r 911

I fly when time is the element and is beneficial to the patient. Now, when doing this one has to consider time to fly and respond and of course transport. We automatically place our air service on stand-by when we have a potential major MVA, to reduce flight time. The advantage of flying patients is time element, about half of ground speed. This of course depends upon terrain, weather, wind speed etc.. I agree with Dr. Bledsoe, we fly way too many and needless transports. CAMTS used to have a protocol that many utilized. R/r 911

We get a couple of these calls a week... and just think our average wait time is only about 45 minutes in ER... We personally do not accept the call as they are refusing medical care if they are not going to be seen there. If the physician authorizes transfer then it is another issue. The supervisor will notify the charge nurse or triage nurse and inform them of such incident. This usually resolves the problem. If there is an agreement to go somewhere else after proper paperwork is done, then (dependent on situation) we might consider transport. We actually have patients request for us to pick them up out of ER and re-transport them back into ER so they would be seen faster... one was for a tooth ache.. As far as EMTALA describes that patients should be evaluated even if they are on their property site, the patient should fill out a refusal if not wanting to be evaluated. Again, this should be an administration policy within hospitals and EMS, and handled internally first and then notify EMS if cleared. R/r 911

I used to teach flight nurses and paramedics after being a chief flight nurse. Most flight services have one protocol for both license, but the reason they are there is for the past expertise. The paramedic for scene flights and traumas as well out of hospital care and the ability to manage the airway. The nurse should have plenty of ER and ICU/CCU experience. Even neonate would be an added plus. Inner facility transports is part of many air services. Flight services are very competitive and as well, as cut throat business. I will admit it is very difficult to be able get into the business. If I was advising new people, I would obtain my RN, then obtain at least 2-3 yrs. in a progressive ICU, and then about a year in a ER/trauma center. Meanwhile one could attend an accredited Paramedic program, I will forewarn you though emergency and critical care is not taught enough in nursing to make one competent for flight nursing. That is why being progressive is important as well going to an well developed paramedic program. Although, I love flying, it is way over dramatized and what most do not realize there is very little difference in care, in fact may not be as aggressive.. the mode of transportation is the only thing changed. Air safety is imperative at all times, and with ambient noise and very small, cramped quarters, one must be able to deal with claustrophobia and as well as many have limitations on body weight and height as well. I know many flight crews that actually make less than ground and in hospital pay. So pay may very in different areas. R/r 911

One of my favorite quotes from another EMS forum.. it sums it up! Whenever you say, "I can do everything that a blank (Intermediate, Paramedic, RN, MD, etc) can except for (or but)" basically you are saying you are something that you are not. It is a disclaimer in an attempt to garner credibility and respect. If you want to be the something you are trying to equal yourself to, then go to school. Otherwise, don't try to convince the rest of the world that you are something that you are not.For example, if you are an EMT with special skills or EMT/I that can utilize 90% of the skillset of a Paramedic with only 50% of the education, who would you rather have treat you or your family? You can train any lay person to start an I.V, intubate, decompress a chest or give any plethora of medications (training) versus teaching that person the who, what, where, when, why and how to come to the decision to do it (education). Period This is a cheap way of getting pseudo Paramedics. The management trick is this.. they can legally charge for ALS without paying the pay structure of having paramedics.. remember, you pay for what you get! R/r911

Will be celebrating 30 years this June EMS full time. I believe "burn out" is a phrase of mind. I have usually seem majority of burnout occur do to the work politics and very little to do with patient interaction. I have gone through multiple mini burnouts or I would call set backs because of the non-aggressiveness and repeated same mistakes of those in EMS. R/r 911

Apparently you are not aware that the ED & EMS is considered one of the most dangerous spots to work. We are there to help them not be abused by them ! What gives them any more right to harm, abuse, and violate us ? .. If one is incapacitated that is another thing, but to make a conscious decision NO ! Name any other place in business that would tolerate assaults to employees and staff. Far as "running them away" how many empty ER's have you seen lately, as well are these the ones that management really care to have in their ER ? If one can not behave appropiately then stay at home... Sorry, after one of my nurses received 3 fxr. ribs and a displaced sternum, because she applied the BP cuff to a drunk, or a medic received a fxr. jaw because she refused to be "felt" up .. I have no sympathy. Either behave in an appropriate manner that is reasonable or get the hell out of my ER or ambulance! No where does any curriculum, work description describe one has to be tolerable or be abused by patients verbally or physically. If you cannot behave, I will have an officer to assist you out the door! Management, is always afraid. They did not like I encourage action until they had a nurse suggested they had inadequate security, and threatened to sue them as well. That changed their mind set immediately.. and from then on developed a policy to make an I/R and police to be notified dependent on the case. Even some of ER Doc's have pressed charges and testified in court, enough now that the Judges know they mean business. We in the health care have an obligation of taking care of patients, but take care and protect our selves as well. Again, before anyone makes excuses I am not discussing medical or trauma patients that represent behavior disorders such as diabetics, senility, trauma, etc.. That itself is a related side effect and proper restraining (either chemical or physical) should be advised. R/r 911

A couple of things.. http://www.dt4ems.net/ is an excellant Paramedic and LEO/martial art instructor that has developed "self defense" courses to safely protect you and the patient. Take a look at his site, he might be able to answer your question more in detail, he is a very nice guy. The second is dependent of the cause (i.e. CVA, head bleed, diabetic, patient not aware of what they are doing). If the purposefully hurt me I file formal assault and battery charges, if there is damage I will SUE them as well. When I was ER manager, I encouraged staff to do this.. and suddenly the word of mouth went across town the nurses will not take sh*t.. be careful! After a night in jail and a hefty fine.. they get the message. Many administrators do not want to " hurt their image".. my answer is fine.. cough up some cash and cover all my expenses. If you were injured be sure to get evaluated and potentially file workman's injury.. this will get the administrators attention as well to get courses like I described as well as encourage legal action. Good luck, R/R 911

Ditto .. We have the premix of each and mix them together. I personally rather use Xopenex, as well I have found albuterol first then combo.. works somewhat better. But, I have to call to deviate from the protocol... R/r 911

It is not the "pupil" that changes places rather the way the pupil is pointed to. I agree the statement was confusing and its description would be anatomically impossible. R/r 911

I believe dzmohr has illustrated well. Medicine is an art not just a exact science. That is why health care providers "practice" medicine, not just perform duties. Each situation is unique and has to be handled appropriately. Part of the problem is those that try to "box" them into a category or protocol. Sure, we all have performed, treated, and transported under distress and might would handle the situation differently next time. The uniqueness in this studies is to address Basic Level making the determination. I am sure we will hear and see more as medical directors and emergency physicians are agreeing aystole patients are and non-viable patients should not be worked. As well as ACLS measures do not change from pre-hospital to in hospital settings, with no increase in survivability. Likely it will not be in curriculum changes but will probably introduced in AHA, State and local EMS up-dates. R/r 911

I believe oxygen carrying type fluids will be used but probably not within the next 5 -10 years. I heard aboutPolyheme or its counterpart about 12 years ago and it is still being investigated. The last I heard they are pulling some of those products from studies to increasing AMI's, I believe of last week. AS well as ethical questions of patients not being asked or informed that they will be given susbsitute. (kinda hard to do on an arrest, but one has to) So we still have a long way to go. Oxygent may be under trial studies but who knows when and if this will ever be released as well the costs and containment may never make to the field level. Heck, most EMS still don't even carry Cordorone (antiarrhythmic) and Zofran (antiemetic) due to costs. So I would not hold my breath on it. It would be nice .. but that does not always make it available. R/r 911

This is why I wished they would bring back the term electrical mechanical dissociation (EMD). It makes more sense the PEA. Technically this is what is occurring albeit for split seconds.... People can understand the physiology better.. good posts guys. R/r 911

My suggestion is to contact the NREMT personally and discuss this with them . Because one is licensed within an area does not automatically means one is eligible for NREMT. You might have actually exceeded their requirements. Again, one needs to correspond with them for official interpretation. R/r 911

+10 to AZCEP! Now this is what the forums all about !... R/r 911