BEorP

It's nice to see some good comments. Has anyone actually worked in EMS under a manager with an MBA? I'm doubtful that the salary would be high enough compared to what they could make in the business world to attract them to EMS. It seems like it would in some ways parallel why the education standards in the US don't seem to be rising: there is no reason to pay people more unless they have more education, but there is little reason to get more education if you won't get paid for it. The same may go for EMS managers, if they wouldn't get paid what they are worth with their business degree (MBA or otherwise) then that would explain why the vast majority of EMS managers are just road medics who worked their way up.

Well no, not so clearly... that is why you have been shown studies that back up my point but have said nothing except that you are a superior provider so your judgement is best. That doesn't fly.

Dust beat me to the punch on the main line I had an issue with. The other thing that I am a bit skeptical about is this: I am aware that Seattle has a high success rate in treating cardiac arrests, but these numbers sound way too high. Does this only include VT/VF arrests?

I hope your patients know how lucky they are to have a paramedic who has never been wrong treating them. I don't mean to be disrespectful, but (this is not just directed at you) I always get concerned when I hear any level of provider speaking of themselves as if they do not make mistakes.

I showed you a study that said that it was a waste of resources to call solely based on your gut feeling in a pt who appears stable. Find me a paper that says otherwise to back up your point then. To me, the best example of our lack of evidence based medicine in EMS that "made sense" is the old defib guidelines. It just makes sense to try to shock someone as soon as you arrive on scene, doesn't it? If they are in a shockable rhythm you want to get them out of it as soon as possible and who knows how long it will last. And if you shock them once they might not come out of the rhythm so you should immediately analyze again and shock again if you can and then do it once more. It made sense. It was wrong. This EMS mentality of "we do it because that's how we've always done it" or "we do it because it makes sense" needs to end if we want the profession to move forward.

I was looking through an issue of Canadian Emergency News the other day (yes, I'm sorry I bothered) and they had an article about a hospital move that they did in Peel Region. What I noticed is that the person who wrote the article is the Manager of Planning and Performance and she had an MBA. Now to my questions: - Is there really a place for MBAs in EMS management? (both Canada and US) It seems that the majority of EMS managers now are just medics who have moved up the ranks but have no formal management training. Would the MBA's education help them to be a good manager for the EMS service? - Could the pay for an EMS manager even come close to the salary of an MBA who goes into the business world? - Does anyone have any experience working for managers with MBAs enough to comment on whether formal business training helps?

But money is not unlimited. If the hospital spends money on unnecessary trauma alerts and then can't afford enough RNs to staff the ED, how does that help anyone?

Well played, Dust.

I'm sure there are varying schools of thought on this, but just pulling up to the scene you would probably see the two patients who are obviously not doing well plus the driver who may have injuries. Based on the initial impression of the scene I would want another ambulance coming fast. If one or both of the guys on the ground ends up being dead then the priority of the responding ambulance can be adjusted (or cancelled if they are not needed).

Sounds like the physician has done their homework then... "Initial trauma team evaluation of hemodynamically stable blunt trauma victims whose only reason for trauma center transport is mechanism of injury is needlessly labor intensive and is not cost effective." (from http://www.jtrauma.com/pt/re/jtrauma/abstr...195629!8091!-1) And yes I know that cost should not be the only factor to consider but if there are high costs then that means resources being used (or wasted) also that could be better allocated to other patients.

The comment didn't offend me personally (I work on the road currently) but I just think that all too often uneducated field providers disregard what more educated people say because "they don't know what it is like on the road." I know that this is often true, but it is not always the case. I am curious now though about your education since you seem very confident in your ability to always do what is best for the patient. If so don't mind me asking, when is the last time you read an EMS research paper and what is your level of education?

That is exactly it. If the hospital is wrong, show us.

Since I think that your "desk jockey" comment was a bit too much I'm going to ask you an important question about the bolded statement. Do you have a study that shows that it does improve patient outcomes? Just curious.

Although I agree that no one should be treated disrespectfully, don't go into preceptorship so uptight that some innocent joking around suddenly becomes a big deal. Paramedics (at least around here) joke around with each other a lot. Whether you're a student or a new employee or even someone who has been on for a while you need to expect a little bit of this. It definitely can cross the line at times though and then I agree that it should be stopped.

Does 0.5% chance of survival count as "the slightest chance" to you?

I did mine with Metro. I haven't even heard of the other place that you mention so I can't really comment on them. Metro seems to be entirely focused on getting you to pass the test (rather than actually teaching any skills for driving larger vehicles... this may be a good thing or a bad thing). The F class test is not hard and you will almost surely pass when you do it through one of the driving schools. Which college will you be attending?

That is a valid point about the ACS part of the study not being completed yet. Wasn't it also OPALS who showed no benefit of ALS care for cardiac arrest outcomes or was that someone else?

Good to know. The one problem with this is that although the EMS provider may not be able to alert their treatment based on the 12-lead, if it decreases the time to definitive care then it could decrease morbidity and mortality.

Although I would never disagree that a more trained and better educated provider is better, do you have any studies that back this statement up? I'm just curious because the OPALS studies here in Ontario have not been showing as huge a benefit (in fact no benefit in some cases) of having ACP care as I would have expected. There is an observational study being run at various services in Ontario that will be beginning in the future that is evaluating the use of 12 leads by EMS. I can't recall whether it is strictly PCP or if it is ACP use also, but it will be interesting to see what that shows in terms of morbidity and mortality.

This is not meant as a question to the OP, but rather just a general question to anyone who may be in this situation. How can you consider yourself a medical professional when you're paid the same as a fast food employee? I'm not in it for the money either, but if I am not paid what I feel I am worth I would choose a different career.

Where I recently got hired here in Ontario we need to do three 12 hour third rider shifts and then have a 720 hour probation.

So if she were in VF/VT, you would not have shocked her? That seems like it would be a difficult decision to backup.

:roll:

I don't know about the 12 lead interpretation, but I sometimes even wonder about the shock/no shock decisions of the defibs.

Interview season has begun in Ontario for many services so I thought it might be good to have some sample interview questions posted (not just for Ontarians, but anyone applying to EMS). There were two other threads relating to interviewing that I found, but neither focused on questions you should be ready for (see the other threads for what not to do and how to talk about your weakness). I will start if off with a few but please add more. Why do you want to be a paramedic? Why do you want to work for our service? What do you have to offer our service? What is your best quality? What is your worst quality? Your partner comes to work drunk, what do you do? What are some of the challenges facing the health system in _______?