Ridryder 911

Okay a couple of things..... Learn how to or pay someone to do a professional resume. Invest in well grade paper as well. I highly suggest the book " What Color is Your Parachute" You can usually find this in a local library, it has very helpful. professional hints and how to write a resume. Second, I am surprised they sent back your application with "you left this out" etc.. as a administrator or hiring committee, I automatically trash applications that are not filled out properly. If you have a blank, then place not applicable or see resume attachment etc.. never leave a section blank unless described to do so. Third, contact EMS recruiters... some national EMS services have a budget for "travel expenses" . Do some research before applying, and investigate as much before applying. Be prepared to ask questions and to be asked questions as well. Some services are now doing on-line interview or telephone interviews for long distance applicants. Work if possible in any EMS until you can get the position you want or any related medical field. EMS providers understand, you have to have money.. just describe that to them... Good luck, R/R 911

The reason you describe does not make sense.. so you can relay for ALS. If it is chest pain (cardiac in nature) ALS should be dispatched. If you can read ECG, then you should be ALS already. Take the money and invest in education. This toy will be off the market by the time the ink on the warranty is dry... just like the Amway rescue choking suction device. R/R 911

Just because you have paid professionals, will not mean you will develop more EMS calls .. You know I heard the same type of analogy when we were trying to get Level I Trauma Centers... if you have one, there will be more trauma ... what ? Just because you have an EMS to respond and provide care does not "create calls".. if your call volume goes go up, it is because the public recognizes the difference, and maybe actually trust the professinal service. No, total volunteerism will never die.. thank goodness. But, they way it is now will. With the rash of wild land fires locally, requiring many volunteers to respond to 10 -12 fires a day lately, the drop of volunteer firefighters has increased remarkably... the reason, working 2 jobs is difficult, especially if you are only getting paid for one. With the increase of EMS calls to be doubling or even tripling, the demand will be great for the local companies. As well as financial drain on most. It is not anyone fault or blame, just simple supply & demand. Running 12-20 calls per shift , every shift will cause a paradigm shift. Again, it is not I believe they perform lower care, just the need to redefine their role. Be safe, R/R 911

I see you posted this correctly.. "Funny Stuff"............... :wink: R/R 911

I see you posted this correctly.. "Funny Stuff"............... :wink: R/R 911

Even if you can recognize serious patterns.. what the heck are you going to do about it ? Why waste the time to hook them up to that device, then now attach to your monitor... This device needs to be with all of those other devices "with good intention" but, fail to hit the common sense level. R/R 911

Again, there are so many that do not recognize their own responsibilities. While there have been so many post of BLS before ALS, so many does not recognize the full extent of providing good and full basic level care. Recognizing side effects of common drugs is a responsibility of the basic EMT. Such as patent's that has a hx. of fall and they have a history of medication of Coumadin, Digoxin, Lisonopril. Certain clue signs and recognition should alert the basic of potential injuries and the patient history by the medication alone. Part of the responsiblity of administering any treatment to someone is to know the outcome ... good or bad. (intended or adverse effect). This being applying an Ace wrap to using the AED to assisting in use of NTG or even ASA. All have potential adverse side effects, and harm. Knowing these and how to manage them is part of responsibilities of having the qualification of being to administer and use them on patients. Be safe, R/R 911

Hmmm why buy one ? R/R 911

For those that want to really know how Viagra works.. it is a lot more complicated than was discussed. Here is a free site on the patho-pharmokenitics written for nurse. http://www.rnceus.com/course_frame.asp?exa...irectory=viagra R/R 911

Actually, I see a lot of physicians ask about insurance.. simple enough.. Am I going to place you on Levaquin ($5.00 a capsule) or Amoxicillin ($1.30 capsule) as well as some other procedures etc. I ask about insurance .. not unusual if you don't dwell on it. It is pertinent information, depending upon the type some require notification prior to certain procedure if non-life threatening. Be safe, R/R 911

As above posts describe, she might have some cariomegally, causing the the elevation as well with a hx. of CHF. Also wondering about axis deviation. She might have had some associated ischemia. I am glad that you are recognizing the need and concern of not giving "carte blanche" treatment, and as other suggestions as posted. You will encounter many other scenarios that don't follow the outline or has many other factors. R/R 911

Sorry, not always true. Need to contact local and state areas for local laws. Here (local city, county) the prisoner is responsible for his/her costs of medical treatment and prescriptions. After several counties have had extensive medical costs for prisoners with their extensive "old habits" and worn & torn body, they have decleared legally that the city, county are no longer respnsible if it is a pre-existing cause. If it occured while in correction they will pay... like insurance companies. Be safe, R/R 911

Wonder about a camouflage sweatsuit? ... and those that attended church and read the story might recognize the original story from scripture.... is not from NY times or the subway... rather the good Samaritan. R/R 911

I was in ER when the EMS actually transported a very prominent citizen with a gerbil ..etc. Unfortunately, as things goes the word got out.. The person(s) involved were whom both were routinely in the local media daily, and one owned a large store... One day some guy though it would be funny and release a box of gerbils in the store... the former patient did not see the humor. The parties involved sued the hospital for "breech of confidentiality" (before HIPPA) and the case was settled out for undisclosed amount. Although, it might be a myth in some parts.. I know it was true in one case.. I was there and know how surprised radiology was...this was about 17 -20 years ago. R/R 911

The problem is that some of these are respected physicians, and anything that is quoted from them get immediate attention. The other problem is you are right panic does set in... Too many times I have seen medial directors yank protocols over 1 study or administrators etc.. change, instead of validity or even a remedy of the problem could occur. Yes, I believe the studies is very tainted... Just because there are problems with services, the whole system should not be penalized. Again, let us look in ER. On the case of number of intubation daily, I feel that Paramedics do it 3: 1 per day in comparrision to the one the ER physician does... now compare it to the internist.. when was the last time they intubated ?.. Not because I can intubate, but what is right for the patient. Most of the physicians are aware that they too do not intubate on a regular basis... in fact, the few would be ER physicians and anesthesia groups. Hopefully. we can gather ourselves as a wake up call. NAEMSP & American Ambulance Association ( EMS Administrators) needs to emphasize the need of CQI, and skills retainment. NAEMSE needs the states to mandate clinical surgical rotations for intubation with a a required number of cases. Instructors need to realize that Paramedics ARE NOT coming out prepared!! The time of shrugging their shoulders and being apathetic is over. Cranking out students that cannot perform at their level of credentials is YOUR responsibility. Administration needs to be sure to put in place a QA/QI program not only for maintaining credible care, but for risk management as well. Supervisor & FTO, are you monitoring your medics, are they rusty or competent and how are you dealing with their skills.. not just ETI, but ALL skills ? Paramedics need to pull their head out of crevices and wake up that this is really a potential threat and not blow it off! This is a wake up call for our profession... the thoughts of substandard airways, because incompetent care was provided should never be considered. There are already some states that only allow anesthesiologist to establish EJ in hospitals, because of studies shown high infiltration rates.. don't let treatment modalities decrease because of apathy. Sorry, but I feel better when I know my patient has a patent airway. Yesterday, we had a 3 year old with a TBI and was unresponsive, it was better for that patient she was intubated when she had projectile vomiting. Aspiration did not occur, ventilation's was maintained as well as sedation to decrease ICP. Again, for the best for the patient. What is next ECG in comparison of cardiologist ? Let us not revert backwards.. but be progressive and move forwards. Make other medics aware of the situation... R/R 911

Good points ACE, Unfortunately, since we do not have Doctoral programs in EMS, we are at the mercy of having outside sources providing our research. We need to find out the agenda to "why" the study was performed. Was it a "national notice" or a local one in particular. Yes, MD/DO is our masters in providing "direction" however; again in what comparison in ratio was the "success" based at ? I really would like a comparative study to see if we are "below par" or maybe even "above the norm". Agreeable, <100% is not acceptable (theoretically).. What I am angered about, we continue to allow ETI to be brought in in the wrong place. If it is during transit or movement.... this is simple to correct. Stop !.. run a EtCo2 with verification and clinically assess the patient. The reason for the strip... it written, absolute. Others can not change the words afterwords.. AFTER verification them move patient onto stretcher. We have just started this policy due to staff not attaching pacemaker to patient during transit... etc.. So we have now made policy that the before transit.. an ECG strip with Sp02, EtC02.. etc.. will be performed, then and only then the Paramedic WILL disconnect wiring. pacer, etc.. Usually a verbal acknowledgment of confirmation of ETI .. the patient then will be reassessed after movement for proper placement etc.. There will be NO debate that the patient was intubated upon arrival... word We need to monitor and inform other paramedics of the seriousness of this study... most are "blowing it off" .. but, I have seen things change that had no reason or enough data to cause radical changes. Our patients deserve "gold standards" of care... not secondary devices, because of sloppy care, education, or laziness. Be safe, R/R 911

We need to evaluate the studies in detail. Some of us that can actually interpret studies (have some basic statistics and study interpretation classes) should see what the study entailed. Again, as the other post have mentioned, we need to correct the problem after we identify it, Second why are we the only ones being looked at and whom are we being compared to ? We do not allow a "knee jerk" reflex to occur like the horribly flawed MAST/PASG initial study did. Pandemonium set in and no one actually read and understood the poor validity of it. Yes, let us identify, correct and re-study.. before major changes occur. R/R 911

Couple of things come in mind after thinking about this. Before we throw the baby out with the bathwater.. let us find out why in the hell this has increased.. especially now we have absolute means of documenting successful intubations. If you are not in.. then don't say so.. there is not embarrassment of not having them intubated and performing BLS, blind intubation device etc.. again, assessing upon arrival to ER should be mandatory and EtCo2 wave form documentation is guarantee you were in, non-disputable. Second, not trying to share the blame... but, we all know we probably intubate more than ER docs... now about a study on them as well ?.. I would like to see the comparison..before anesthesia was notified. Again it is easy to play arm chair quarterback when you are not judging yourselves. Yes, let us find out why.. and correct it, not change the standard after 40 years because there has been a decrease recently. R/R 911

Once the accepting nurse has taken report and made contact with that patient. Since he/she did not make physical contact, I would feel if something happened it would be a shared responsibility. I agree as a health care provider, you allowed a "potential suicidal" patient to isolate themselves. Likely, they will describe that they had not intervened with the patient yet. Both sides would be responsible. You as a provide know better... R/R 911

If you are going to get workmens comp be sure to get a settlement for re-education. You might get enough to help asist or pay for college. Since you enjoy teaching, you might be able to go for a B.S in adult education. Good luck, R/R 911

I also question why a community would have 2 level II centers and can adequately pay for them in lieu of 1 Level I Trauma Center.. Sounds like the typical politics of medicine and hospital bureaucracy. Wonder what the private insurance rate would be like on a viper with L/S ?.. I know, when I investigated most private insurance companies prefer not to cover p.o.v.. Again, we are not exploring options best for the patient.. Early recognition and appropriate trauma alert Rapid & appropriate trauma assessment with no delay & expedite transport (not haul arse or diesel medicine) for tx in pre-hospital phase. Early recognition of surgical candidate and radiological services upon arrival to ER or Trauma Bay. Surgical team available with appropriate surgeon and all pre-surgical work up performed. Yes, we can not treat trauma.. having a Board Certified Thoracic Surgeon riding in the back of an EMS unit would not change outcomes, be realistic they are not-educated for prehospital care and are totally out of their surroundings. Look at them in an ER their lost & I have seen them in the field.they usually are clueless... . Folks, these are people too.. I worked in Level I and you have to do certain thing(s) prior to surgery..Surgeons are physicians with a specific role, not gods. .. Their main emphasis is to stop the internal bleeding and repair and remove organs that are injured. But, before they go in .. again there are certain things that have to be done & performed. Trauma is leading killer between the ages of 4 & 35 the 4'th leading cause of death over all. Trauma kills.. short and simple, if traumatic arrest occurs the chances of successful resuscitation is very poor. Study TRISS scores, and see outcomes are poor. Again, simple mathematics in response times... to reduce the time in half, you have to double your speed, no matter where or how far. To increase the time by additional seconds you have to increase speed and to increase that number you have to increase distance. Again, mathematics.. not, including stopping time, etc.. Be safe, R/R 911

Actually the EMT/ Paramedic has thought to drop the EMT porton nationally. This has been brought up for several years and still id debated. There is some discussion to change this, hopefully with the new NHTSA board. The EMT is accurate since it is actually at a technician level. Provider is to encompassing with a broad band of interpertation. R/R 911

I have a great nephew with CP & who is also autistic, that I routinely take care of and I do understand your predicament. He too, can not stand any bracelet, necklace etc... and with the CP communication is more dramatic and hard to understand. Yes, the description chances are he would be chemically sedated. Although, that is not always bad. We use bemzo's such as Valium, and Ativan. In the ER as well, we will use some form of "restraint" of chemical (sedation) rather than to physically restrain them. I like Fentyl lollipops, that are taken orally and sedate kids.. don't see them used much although. Again, Ativan and Versed which has a great amnesic effect and some still us ketamine. Since is better to sedate and treat the patient rather to try to hold them down and cause more fear. Like any other medications it does have side effects & risks, but if used properly chances are small. It is very difficult for the physician to suture a moving patient. Usually, experienced staff can sometimes determine patients with autism, CP, etc.. from head injuries, although there are times it is difficult. Might I suggest a shoe lace packet.. many joggers wear such that is attached to their shoe laces to hold small items. Placing a medical "star-of-life" decal on the outside might attract attention, and he might not mind it if it in place on the shoe. Place a brief med. hx typed and placed in the container. Good luck, R/R 911

Wow.. a lot of wisdom form one whom does not work in the system yet. Let me show some facts : "During 1991--2000, the most recent year for which data were available, 300 fatal crashes occurred involving occupied ambulances, resulting in the deaths of 82 ambulance occupants and 275 occupants of other vehicles and pedestrians" EMS personnel in the United States have an estimated fatality rate of 12.7 per 100,000 workers, more than twice the national average . This report documents 27 ambulance crash-related fatalities among EMS workers over a 10-year period site reference : http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5208a3.htm And it is on the rise.. Do you not think these EVO had not been through any EVOC class.. as a EVOC instructor, I can assure I am quite aware of the dangers as well. Now, show me the statistics that demonstrate that an additional 3 minutes would had truthfully made the difference in outcome versus response times. Again, we should look at shaving off times by decreasing dispatching time, proper dispatch, medical dispatching, and best route for peak times etc.. instead and in lieu of "running hot".. I am sure there is 3 minutes we could improve upon. The same on trauma alert to the Trauma Center.. this would give approx 10 15 minutes that would allow ample time for the physician to respond. Again... think outside the box.. Like I have asked before, how many would be in EMS if you could not use L & S ?... R/R 911

akroeze, I doubt that the physician would want to leave their practice or ER to treat, since this might even cause more trouble at the local ER. ALS response (helo) is not too uncommon. I suggest having a dispatch agreements with the local helo, and placing them on stand-by if needed. Pre-planning as much as possible is the key... Sometimes you can only do what your resources allow.. life sucks.. R/R 911