Ridryder 911

Unfortunately, we still carry the needle type tubing but have needleless syringes and med's.... "makes sense huh" .. something to do with cost 20 cents more..... It took me some time to get used to needless systems being from old school, but the local hospital has some really good ones with a nice "lure lock" type device and many ports... So for now, I usually have saline locks (which has the lure lock needless port) and push most of med's through it... If I have to hang a bag, then I will have to use a needle. R/r 911

Ditto... to what Dust said. For us that have fought mangers, CFO's , CPA's, and every other managerial "justification" team... the best defense is a good offense. Sounds like you are getting well prepared, but I would practice and have as much prepared statistics for them as possible. Remember, you are going to have to paint a flawless picture of why and how you are going to justify raises and existence. I have been at corporate, city, managerial meetings where the EMS personnel came in "loaded for bear" and expected to win.... only to loos more than they would had if they just had kept quiet. Removing ALS personnel, and resorting to back BLS staff..Remember bean counters have no conscience except to save money!..... We do wish you the best of luck and let us know how it turns out! R/r 911

Here is link to the JEMS Survey ... http://www.jems.com/data/pdf/JEMSSalarySurvey05.pdf R/r 911

Bottom line everyone needs to be cautious on all medications given.... Phenergran is usually a benign drug which is probably one of the most administered medications and is commonly administered with analgesics to decrease the s/e of nausea. There are way much more dangerous medications that ALS personnel comes into contact with. I know in the U.S. that as year ago, my insurance was paying $42.00 a capsule for Zofran, and $1150.00 for ready-dissolve tabs (box of 10) ... when my wife was on chemo... R/r 911

As well if we had true industry monitors like JCAHO certifications that made industry reimbursement easier, and apply and required "true" education requirements then we will things processed through. As long as Medicare and organizations like American Ambulance Association (AAA) does not require it... and administrators do not have to pay for it.. why should it change ? R/r 911

Show me very many chronic diabetics with good peripheral veins...... I would love to have any line... Heck, I have used 24g... yes, it is slow but as long as it works and flows..... R/r 911

Depends on the patient... if it is an older patient that appears not to need anymore fluid (Hx CHF, CRF etc...) no, I don't. What I ave found, so many attempt to "push so fast".. I do push some allow a little fluid, allow to dilute so it will not "burn" the vein. R/r 911

Most do not care about the "past" if there is no legal action that had to be taken or a criminal record, or unless you have a substance abuse history Most will perform a drug test to detect certain types and some may have routine "spot" checks to verify this.... Good luck, R/r 911

Found this on the web.. You've Been In EMS Too Long If When SOB now means Shortness of Breath, and not necessarily how you feel about a person... When your spouse/girlfriend has his or her hands on you, and it's not passion it's for practicing patient assessment... When you're doing ambulance duty, and go home, your own dog won't let you into the family house, because he no longer recognizes you... When members of the opposite sex are on the same vehicles in various states of half-dress, and nobody seems to notice it, mention it, or be embarrassed... When "latex" no longer immediately brings to mind safe sex, but the gloves you wear... When family pets clear a path when they hear the tones go off so they won't get mowed over, then greet you when you get back home, forgiving you for doing just that... You find humor in other people's stupidity... You believe that 90% of people are a poor excuse for protoplasm... Discussing dismemberment over a gourmet meal seems perfectly normal to you... Your idea of fine dining is anywhere you can sit down to eat... You get an almost irresistible urge to stand and wolf your food even in the nicest restaurants... You plan your dinner break while lavaging an overdose patient... Your diet consists of food that has gone through more processing than most computers... You believe chocolate is a food group... You refer to vegetables and are not talking about a food group... You believe a good tape job will fix anything... You have the bladder capacity of five people... You can identify the positive teeth to tattoo ratio... Your idea of a good time is a full arrest at shift change... You believe in aerial spraying of Prozac... You firmly believe that if Dilantin, Haldol, Noranyl, and Narcan were put in the water instead of fluoride Dentists may be busier but EMS would grind to a halt... You disbelieve 90% of what you are told and 75% of what you see... You have your weekends off planned for a year in advance... You automatically assume the patient is a drug seeker when presented with a complaint of: (choose one ): migraine, lower back pain, chronic myalgia and , a list of numerous allergies to meds (except Demerol),the statement that the family doctor is from out of town... Your idea of comforting a child includes placing them in a papoose restraint... You encourage an obnoxious patient to sign out AMA so you don't have to deal with them any longer... You believe that "shallow gene pool" should be a recognized diagnosis... You have discovered a new condition that you call "hypo-Xanax-emia"... You believe that the government should require a permit to reproduce... You debate which is worse, spaghetti and meatballs with red wine or pizza with beer, while performing gastric lavage... You believe that "Ask-a-Nurse" is an evil plot thought up by Satan... You believe that having an ambulance at a "Health Fair" was his next idea... You believe that unspeakable evils will befall you if the phrase "Wow, it's really quiet" is uttered... You threaten to strangle anyone who even starts to say the "q" word when it is even remotely calm... You refer to Friday as Con-Home Dump Day... You are totally astounded when someone from a convalescent home is understandable... You take it as a compliment when someone calls you dirty name... You say to yourself "great veins" when looking at complete strangers ... You don't think a referral to Dr. Kevorkian is inappropriate... You have ever referred to someone's death as a "Celestial Transfer"... You have ever referred to someone's death as a transfer to the "Eternal Care Unit"... You have ever answered a "lost condom" call... You refer to someone in severe respiratory distress as a"smurf"... Your idea of a good time is dueling shock rooms... You have ever wanted to hold a seminar entitled "Suicide...Doing It Right"... You feel that most suicide attempts should be given a free subscription to "Guns and Ammo" magazine... You believe that "too stupid to live" should be a diagnosis... You have ever had a patient look you straight in the eye and say "I have no idea how that got stuck in there"... You have ever had to leave a patient's room before you begin to laugh uncontrollably... You have ever wanted to reply "yes" when someone calls the E.R. and asks "Is my (husband, wife, mother, brother, friend, etc.) there?"... You have ever issued a "dead head" alert... You have ever referred to the E.R. Doc , triage nurse, or partner as a "shit magnet"... Your favorite hallucinogen is exhaustion... You think that caffeine should be available in I.V. form... You have ever restrained someone and it was not a sexual experience... You have witnessed the charge nurse muttering down the hallway "Who's in charge of this mess anyway?"... You have ever used the phrase "health care reform" to instill fear into your coworkers' hearts... You believe the waiting room should be equipped with a Valium fountain... You play poker by betting ectopics on EKG strips... You believe a "Supreme Being consult" is your patients only hope... You want lab to order a "dumb shit profile"... When you notice your worse "pre-EMS bad hair day"isn't even close to your very best "EMS hair day" and neither you nor your partner seems to notice it... You have been exposed to so many X-rays that you consider radiation a form of birth control... You believe your patient is demonically possessed... You believe that waiting room time should be proportional to length of time from symptom onset ("You've had the pain for three weeks...well have a seat in the waiting room and we'll get to you in three days")... Your most common assessment question is "what changed tonight to make it an emergency after 6 (hours, days, weeks, months, years)?"... You know the phone number to the local Detox Center by heart... You have ever had a patient say, "But I'm not pregnant, I can't be pregnant. How can I be having a baby?"... You have ever had a patient control his seizures when offered some food... You carry your own set of keys to the "leathers"... Your idea of gambling is an blood alcohol level pool instead of a football pool... Your bladder expands to the same size as a Winnebago's water tank... Your feet are slightly flatter and tougher than Fred Flintstone's... Your immune system is so well developed that it has been known to attack squirrels in the backyard... You have a special shrine in your home to the inventor of Haldol... Your idea of an X-ray prep is a second dose of Haldol... Your idea of a CT prep includes Norcuron and a vent... You have recurring nightmares about being knocked to the floor and run over by a portable X-ray machine... Your shoes have been seized and quarantined by either the Centers for Disease Control in Atlanta, OSHA, the EPA, or the Nuclear Regulatory Commission... You're able to tell the difference between a medical order and the ground around a poultry farm... You've been chipping away at your Bachelors Degree for longer than most people take for a Doctorate... Your idea of thawing the holiday turkey consists of an IV and warmed saline... (and if the holiday turkey you usually see has arms instead of wings and is sauced instead basted) You have every referred to subcutaneous emphysema as "Rice Krispies"... You hear the phrase "I love you" more from the town drunks than you do from your Significan Other! You know the patient's medical history better than they do... When a motionless child is no longer a desired sight... When caffeine becomes a sedative... When starting your personal vehicle, you reach for the "Battery On" switch and the column-mount gear shifter... You wonder why you're being pulled over for speeding in the middle lane and passing people on your way home... And finally..... You might be an EMS professional if you find any of this funny!!!!

Hence, the double edge sided sword... we will not receive an increase in reimbursement until we have an educational level that can demand it. Medicare and other insurance company does not feel that they should pay for a "taxi" ride. Okay, you have an individual that started an IV and placed them onto a stretcher.. and they want $400 ?.. We have to justify why, and as well demonstrate our knowledge by better assessment and medical knowledge, better documentation skills and basically lobby for better reimbursement. Then again, I am sure Medicare may feel .."why should they have to pay for it, when they can get it for free at many places?".... Whenever, we are accepted by others professionals then we might be paid as such... R/r 911

Look at the national standards of response time, there are more that have > 15-30 minute response times than one would ever suspect. It's not that too uncommon. It would be impossible to staff and place units in areas that serve in counties with several hundred square miles. We too have a normal response time in some areas up to 30 - 40 minutes. That is the risks one decides to take when they choose to live in the rural areas. One cannot provide an EMS unit for a area that has an occasional call.... R/r 911

I have never heard of such, nor never seen in any policies and orders.. which I have seen many. I have seen to be sure to have a well patent line.. (which if one wants to check patency, I guess one could aspirate?), then flush afterwards .. to be sure the fluid is pushed through. I don't really think it matters as long as one makes sure it is patent line. R/r 911

Wow! No comments from women yet?... Too funny... R/r911

The K[sup:017a10982c]+[/sup:017a10982c] shift that one worries about in burns and the use of Sux, doe not occur until several hours after the burn. So initially, one can use Sux if performed immediately after the burn as well as the dosage that will be used for initial RSI, should not be that large amount. However; I would recommend another paralytic for keeping sedation/paralytic long term. If one is going to perform RSI on a previous burn patient (i.e ICU/hospital transfer) then I would look at the time and lab values. I would go to another alternate paralytic as well. R/r 911

Many years ago we had an employee wear his squad jacket off duty and purchased liquor. He was observed by a hospital employee that notified the EMS manager. to make it short, he was excused for unprofessional conduct and behavior, (as noted in HHR) that might cause embarrassment to the company. This person AK is illuding to, appears to be more than immature. Everyone makes mistakes, but it takes an idiot to ignore advice and purposely repeat them. Unfortunately, they will get caught. Their medical career will be over forever, as well as leaving a blackeye to whom they represent. Shame youth and ignorance will tarnish ones life forever, so many do not understand in this business forgiveness and a forgetful memory is hard to come by. Word of advice to all students and those new in EMS. You may hear of all the crazy behavior, (which sometimes is true) but those in business realize one stupid mistake is all it takes to ruin and end your career forever... so, think at long range and consider is it worth it ?

Just like any other potential necrotic medication a good IV should be in place, as well I always dilute it before administering. I have seen bicarb and D50w cause problems as well. I believe Valium as well is supposed to be administer above the hand due to potential damage, (not sure if it necrotic or circulatory) R/r 911

The problem was not so much the education rather the system on how they were allowed to bill and establish their own practice(s). They made large amounts of money for home health consults, and then would send a tech./aide in for treatments. I had hired therapist for consults when I managed home care companies and they were making equal to most physicians at the time. Again, I would love to see a minimum of associate level for Paramedic, I'll worry about over education, when we have an abundance of master degree prepared medics... and we leave high school level books or should I say text book behind.... R/r 911

KSEMT122 I understand your frustration, but in reality wil this really cause a shortage? I am sure the nursing division heard the same complaints of diploma nurses vesus ADN, and even preferred BSN. In less than a year or two, no one will even notice it. Really, come to think of it is only about an additional semester, if one was really required to have an anatomy and physiology class. ... R/r 911

We understand that Whit, I would hope EMS would have at attempt to "inform"and "educate" patients of what warrants the need of transportation of EMS and what does not as well. Yes, a lot of the cardiac arrest maybe transported and hopefully more and more EMS will have DNR after failed attempts of resuscitation efforts. Personally and even scientifically there is no difference in performing a "code" in the field, than in an ER room. Actually. resuscitation efforts in hospitals have a lower success rate. So time is irrelevant. R/r 911

The Fire Chiefs Association must have had a recent meeting and presented .."Delusions of Grandeur" .. and how to become.."Kings of everything" seminar. This is the typical b.s. that is going on at more and more cities.... gives us control over everything.. uh, because we are firefighters. Even it is not broke. will costs more, and oh yeah.. treat EMS personnel as second class employees, without the Fire Service benefits and pay. If they cancelled my flight, and the child died with a 50 minute ground transport time, I would give the family a little phone call and offer my services as an expert witness. They may be not found guilty of the death, but I am sure there is a money hungry attorney to awaken these so called experts. Let them explain why rapid transport was needed and their rationale. As well, this might awaken the city of potential litigation's they may not want to re-occur an deal with. R/r 911

It is not that we have a shortage of Paramedics, in fact quite the opposite. But, rather no one wants to hire the Paramedic applicants.. we keep cranking them out.. and no one wants them due to poor knowledge and poor work ethics. So all the older pre-existing gets the jobs and they rather hire part time instead of full time. R/r 911

I personally like administration of Phenergran, in fact I have not found anything much more effective antiemetic except good old Compazine. The problem is newbie Doc's have been burned by poorly trained staff in and how they administer it and to whom they administer to. Zofram is only effective when administered prior to onset of nausea it was never designed as antiemetic, rather for chemotherapy treatments side effects when taken prior to onset of nausea, and it is very expensive ! Phenergran when diluted down, and administered s-l-o-w, can be effective and one has to be extremely cautious on giving to anyone over 65 years old. In fact, I will only give 6.5mg for people over that age, I have fought off delirium side effects too many times in ICU, until it wore off. Other antiemetics should be explored such as Reglan (which it too has hostile s/e) an Benadryl. R/r 911

I imagine the original poster meant to obtain XII leads, and as well blind intubation by use of LMA's etc.. as others describe. I agree, it would be non-beneficial to "train" to do advanced procedures without the full benefit. R/r 911

I know some that swear by the AHS but, I have yet seen much material, rather they are still using AHA criteria etc.. As well, I am not sure AHS is credentialed for JACHO for hospitals etc.. R/r 911

You are working under your medical control or EMS physician director license. However; just like any other health care worker, you may receive verbal and or written orders form a higher level provider.. i.e. P.A., NP, etc.. on a specific patient or procedure, if that person is licensed in that state. Just because it is not an M.D, does not mean they are not authorized to give and make decisions for that patient and there care (within limitations). For example, an order to maintain a Diprivan drip or keep patient supine post angiogram.. etc. Is one going to disregard an order, because they do not have MD/DO after their name? Especially, when that state has granted them permission to practice within that scope of care. If all dispute, one could notify their medical director for clarification. R/r 911