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You take your partner aside, and you tell them that if they keep this up, eventually a time will come when there is a critical call, you will not be available to respond, and someone will die. When that time comes, you plan on submitting all of your documentation of the behavior you have spoken to your partner about, including staying on scene for 55 minutes with a patient with no medical complaints, and submitting it to your supervisors, medical director, and state boards in the midst of the uproar there will be when someone was dying and an ambulance isn't there to respond. Everytime she does this, pull out your notepad and start making notes. She should get the hint, and even if not, you'll have CYA when the caca hits the fan. BTW it should be Whiskey Tango Foxtrot, not Whiskey Foxtrort Tango, and since you're a civilian it really should be William Tom Frank.

Kaisu, the more you describe your workplace the more and more I get the sense you have made the wrong choice of places to work. Not giving you a proper uniform or at least something to identify you as such is really unprofessional of them. Fanny packs are one thing. Uniforms are another. A big huge major red flag for me. I'm actually kind of curious what service you are working for, now. What is stocked on the ambulance is up to the medical director, not the paramedics. Have you spoken to your medical director at all? The SP02 isn't really required... its pretty much standard equipment, but it isn't a requirement. I'm not sure what monitors you are using, but as far as I know, simply speaking, an EKG has too modes, monitor and diagnostic. A 3 lead EKG is in monitor mode, while using the 12 lead uses a far more sensitive diagnostic mode, and therefore ST elevations cannot be properly assessed on a 3 lead machine. I don't know if you are required to have 12 lead capabilities but you should check. Not everybody carries fentanyl. I've only used morphine, and I had to get permission to use it to. Compared to the other things you are describing these seem minor. Kaisu, I'm not sure if you're really looking for advice or if you just want people to tell you it'll be okay. I think you know me well enough to know I'm not in the latter category. But I really want you to take this to heart. From what you are describing, you are employed with a very poorly run ambulance service that has little to no regard for safety or patient care. The problem is that as a paramedic, you will held responsible for safety and patient care issues on a call, held responsible both civilly and legally. My advice is that you need to resign from this place before they put you into a situation on a call that I wouldn't want anyone to be in. If you value your certification and you value the care you provide to your patients, you need to really need to work elsewhere. You are really juggling molotov cocktails here.

That's what the cat is for.

Kaisu, it sounds like you are pretty much going through everything every person with brains who enters into paramedicine goes through in their first couple of months. It sounds like you're not in with a bunch of winners, and unfortunately you're not in much of a position to do anything until you get off probation at least. Start to gradually slide into a different role. You are a student and a new hire but you are also a paramedic and expected to have the brunt of responsibility of patient placed on you very soon. Do not let people tear you down over petty mistakes, know your protocols and your laws by heart, and stick to them. And if at the end of the day, if after a couple of months, you come in on time, treat people in accordance with your local laws and protocols, and go home, and they still treat you badly, give them the finger and move on, because you will only be hurting yourself by continuing to work there.

Its financially irresponsible to buy a $50,000 car when you make $10.50 an hour. Its is not financially irresponsible to get $25,000 in loans to double your salary. There's a difference. The problem is that people want the money and glory without doing the work, and they get pissy when they are not handed what they want when they want it. There is also a myth prevalent in this country, and its reinforced by TV and movies, and its the myth that the important things in life are really simple, and that it takes a down to earth, simple solution to cut through all the pointy headed BS. Its a myth fostered by people who can't understand complex solutions yet refuse to accept their impotence. Its why in movies the day is saved by the blue collar working guy, or the child, or the innocent farm boy. In real life, that doesn't happen, but people like to believe it does. They like to believe in a crisis, be it a fire, or a medical emergency, there will be a bunch of educated people throwing there hands in the air and not having all that book stuff working for them until a good ole boy can stroll in, hitch up his belt, and tell everyone how its done. Its why I get stories like sirduke's and why people bought GWB's solution to the war on terrorism. Its it a myth, but people believe it. They honestly believe that knowing less is the solution. They stubbornly cling to the idea that "there are things ya can't learn in the classroom", and its because THEY can't learn things in a classroom. But accepting your limits is a hard thing to do, and so we nestle in to comfortable stories about how the guy with the least education saves the day because of his special breed of gumption. Which is why people refuse to be educated, and why I hear so many cockamamie stories about the paramedics who couldn't get the IV till the EMT with the belt buckle came along and showed them that there BLS skills came first, and it is all bullshit. Compounding this problem is what I call "The Oprah Effect", whereby people assume they're opinion is just as important as everyone else's because they've watched too much Oprah Winfrey and American Idol. Its why don't grasp the concept that other people who know more than they do are more qualified to make a decision than they are. They refuse to accept that they don't have a say. Which leads people like me to be in a very frustrating position, where I am held to highest standards of responsibility and duty on a call, because I am working against years of indoctrination by TV, movies, and society, I simply cannot get people who are supposed to be subordinate to me to follow orders and get the job done. If people wanted to be EMT's, I'd be really happy, but they don't, the never do, they all want to be a fucking hero instead and step in and save the day. Which is why nursing school is looking really appealing right now.

Nice job, kiwi. See, I didn't even know for sure. I'm sad to say that's actually a little surprising to me.

EMS49393, what you're describing is a big part of what caused me to take a break from EMS. I went though the exact same thing you have. Except, I'm not sure how it is in Baltimore, but imagine those same cell phone blabbing, card waving, ebonics speaking individuals are not just your EMT back up but also your supervisors too. You'd be where I was. It is frustrating beyond belief, and not only that, it is just too much of liability to be held accountable for the actions of the GED and 120 hours of training set. I just couldn't do it anymore. Oh, and my hats off to you for working the streets of Bodymore, Murderland... I mean Baltimore. :-D

Hey man, you said it, not me. You can joke around about me thinking you're uneducated because you're live in my old Uncle Sherman's favorite shooting ground, but the truth is that I think you're uneducated because you are one of those people who can't even grasp how much they don't know. Usually insulting my mother would get you a one way ticket to flamedom, but the nice thing about having a couple of years under your belt is that you can just say "You know something, you can flap your gums all you want, but at the end of the day, only one of us can really say with authority they know what it takes to be a good paramedic." And that ain't you, pardner.

. First of all, I don't think anything. I know you can't speak intelligently about being a paramedic because not only are you not a paramedic, you are also a very immature, uneducated individual. You know, if your first statement about the not understanding why you can't speak intelligently about being a paramedic when you're not, in fact, a paramedic, was pretty dumb, you just showed the depths of your idiocy by saying something like that when you don't even know me. But for record, I know in your thar parts when someone says something like that I'm supposed to slap you with a white glove and demand satisfaction and all that, but because I actually have an adult life and things to do, that's just not going to happen. But if I told my mother what you just said SHE would come down their and kick your ass. Yeah, there's a shocker. :shock: Not really, if they were any good they would have recognized what a danger you are and made sure you were back managing the Dairy Queen by sundown. No. What is beyond my scope of understanding is how you've made it this far without being left tied to a tree some place by a grumpy paramedic crew. If I was still arguing with you, I'd point out that I didn't say you're failing your classes, I said that in my EXPERIENCE as a paramedic student and paramedic preceptor, people like you tend not to do very well. I've failed enough of them to know. And speaking of not knowing a thing about you, aren't you the one who made claims about my lack of a mother??? Well, how about you do name her, name your service, and name your school so I can give them my professional recommendation about what to do with you? Or are you just another rebel chickenshit who hides behind the Internet? Yeah, yeah, yeah... run away little man. You are out of your league here.

Honestly, I don't know how the decisions are made at the state level as to who they certify. All I can say is I know they can't be all THAT picky, lol. But as others have said, it really depends on the type of felony.

Because we can't keep our mouths shut. :oops:

Let's get back to basics here. You said "Being an experienced EMT will make you a better paramedic." I said, "You know, isn't it really the height arrogance to say something like that before you know exactly what it takes to be a good paramedic? Shouldn't you have several years of practice and instruction under your belt before you can speak intelligently about that?" The reason I go into "attack" mode is because I have heard this exact same goddamn story about "The book learning paramedic who 'froze' up and was saved by the EMT who had some years under his belt and blahdidly blahdidly blah." I've heard it several times on this site, in fact. In fact, this story just happens to come up every single time by every single person who had gone the "yeah, its all about the experience" route. So when I read these tales of heroism, I tend to do one of these :roll: and know that if someone is arguing from far fetched anecdotal evidence, they tend to be full of crap. So let me ask you again, for the record, If you do not fully understand what qualities are necessary for to be a good paramedic, why do you think you are qualified to talk intelligently about what it takes to be a good paramedic? Where does that idea come from? Do you think that if you go into paramedic class with preconceived notions of what it "really" takes to do this job, you might not do that well in class? And how in my class, the EMT's who were always talking about their war stories and how well they knew this stuff and how many times they had saved a paramedic were the first ones to fail out? Hmmmmm? And while we're at it, how does your preceptor feel about you talking at length on the internet about you "took over" when she couldn't handle it? Because I would see it as being incredibly disrespectful, immature, and insubordinate, which, being such a knowledgeable guy, you should know makes for a really BAD paramedic. Maybe all those years as an EMT-I weren't so good for you after all.

You see? This is exactly the arrogance I'm talking about. Sirduke, maybe you should correct me if I'm wrong here, but if you're making a statement like that, shouldn't you have like, 15-20 years of experience at a paramedic level, and have precepted many different types of students, and can say, with authority "Oh, you definitely need BLS experience to be a good paramedic..." I mean, the fact that you haven't passed paramedic class yet, doesn't that mean you really don't know WHAT it takes to be a good paramedic? Or are you just that special? Are you just so on the ball and sharp that despite what colleges and universities say, you know the real deal? You don't see me on here talking about what it takes to be a good cardiothoracic surgeon do you? You know why? Because I don't know anything about cardiothoracic surgery! I don't! I wouldn't know where to start on a coronary artery bypass graft. To be blunt, if you were my student, I wouldn't let you near any of the drugs with an attitude like that, because you would be just the type of person, who, if I blinked, would be administering something he shouldn't because he "knew" better. Maybe you should stick with NS and backboards. You can't really screw those up.

Maybe an EMT can answer me this. Paramedics are always raked over the coals for their supposed "arrogance", but someone tell me, how arrogant is it to say "I know what's really going on, I don't need that book stuff." To me, that is the absolute height of arrogance, to put one's own opinion or desires over everyone else, no matter what the facts may say. I run into it all the time, and yes, more at a BLS level than at an ALS level. Being an ALS provider has an incredibly humbling effect on people. I've never had a paramedic accuse me of nearly killing someone because the NRB bag wasn't completely inflated. Its happened plenty of times with BLS, and to me, that is arrogance.

If it means anything, I know plenty of people with BS's who earn 40-50k a year or sometimes less. Just ask a biology teacher. Simplicity is a good thing. It always has been. I'm not arguing against simplicity. But what you fail to realize is that education does equal simplicity. An educated person looks for the most simple solution to a problem. Its the basis for most engineering.

People like reading stories like this. People read stories like this. Newspapers sell advertising space by running stories like this. The man is a professional, a professional writer and he is doing his job of writing a story that the papers can print and people will read. Its kind of like why there is a slight bias towards stories involving disappearing rich white people in the news media. Not because its particularly important or necessarily true, but because people read it and it sells advertisements. If you start just trying to write stories about the God honest truth about a field and notions that people have warm and fuzzy feelings about, you end up getting air space at about 12:30 a.m. on college radio or NPR. Truth doesn't sell. Flaming oxygen does, and as long as flaming oxygen sells, oxygen will burn readily. In that vein, how true does anybody think this story is?

Hey, the attitude got Tom Von Essen promoted to commissioner and a lucrative partnership with Rudy Giuliani.

Give them a break. If they're not on fire they kinda get lost as what to do. In my book, not checking vital signs at all... unless say the brain is in the back seat... but not checking them after seeing movement especially, isn't just a breach of duty, it really borders on a criminal act. But hell, we need to get accountability into medicine itself before it trickles down to EMS.

Five. Yes, they were all discharged from the hospital walking and talking. Let me ask you, friendo, before we all lose a few more brain cells from this, are you actually looking at an AHA study or, is this just the stuff you kick around the squad room after a few too many Jagermeister shots? Because the AHA studies I have... in my book... that I read... for my job... shows a rapidly decreasing curve from around about 1% or so on the basis of minutes since cardiac arrest. Can we please stop this? Its making my head hurt. Go. Read. Educate. Return. I hereby enact rule #37 of EMS, which is "You can't argue with sheer ignorance. You can't talk to someone who doesn't even know how much they don't know. It only wastes your time and gets nothing accomplished." Arguement done.

I'm not so sure on "physical incentive" training, but it is nice that your school wants to turn out medics that don't have "Supersize Me" type asses and are encouraged to pay attention. Good ideas, though.

The dirty secret behind CPR is two fold. The first is that the new and accepted doctrine of CPR is not that CPR saves lives, but good CPR saves lives, and it does. Very good, regular compressions coupled with adequate ventilations can make a world of difference in a pulseless, apneic patient. That being said, there are very few people running around with AHA BCLS cards, and that includes cops, firefighters, EMTS, and yes you medic-haters out there, paramedics, who cannot do CPR effectively. In the rush to get everyone CPR certified the fact that most people can't do good quality CPR if THEIR life depended on it, makes you wonder if the AHA and certain CPR instructors don't have a little scam going selling pieces of paper for $50-$125.00 a pop. Secondly you asked about the pulseless, asystolic patient and why we even bother. On some points I agree with you. I am the biggest advocated in the world of pronouncing in the field rather than risk crew and public safety doing CPR in the back of a moving ambulance. I think the power to pronounce an asystolic patient in the field is reason enough to make every ambulance a medic ambulance, but I digress. The reason, however, that we do CPR even on the 86 year old pulseless and apneic patient is because not everything in medicine or in public safety is always based on evidence. We work in an emotional field. Sometimes what we do has nothing to do with patient outcome but in helping the family start the grieving process by letting them know that at least someone tried to help their family member, that someone cared (even if you don't, really), and that their loved one didn't just drop dead with no one to help, even if that's the truth. In another more cynical vein, you can simply say that medicine, particularly EMS, is about following orders. Our orders are to begin CPR and ACLS procedures on any pulseless or apneic patient who does not have obvious signs of death. This is what our system says to do. If we don't do it, we get sued, our doctor gets sued, our supervisors get sued, and then we don't get to respond when someone really needs our help. Orders don't need to have reason or logic behind them. In fact, they rarely do. But so long as you have sworn to discharge your orders, the ethical thing to do is do discharge them even if they make no sense, in fact, you could say especially if they don't make sense. So, in conclusion, there maybe no good medical reason to start CPR on an 86 year old pulseless, apneic patient, but there are reasons we do it.

Eh, all they have to do is well up some tears and cry brotherhood and flames and they can commit murder and get away with it. Arson too.

The story is here. The synopsis is that a nurse decided that someone wasn't dying fast enough and gave them a dose of a paralytic to help them along. Now, aside from the questions this raises, I think that it brings about a far more practical question. Generally speaking, in most EMS systems and hospitals, there are stringent efforts to control and maintain the administration and use of narcotics, such as morphine and benzodiazapines. However, other drugs, such as paralytics and even some sedative hypnotics, such as etomidate, are not held to the same standards of accountability. Do you think that there should be greater accountability and tracking for drugs such as paralytics? I'm a big fan of it, I have had to fall back on a paper trail many times when the feces hits the fan, but I know many people do not like having to fill out a form or play with the Pyxis everytime they want to give a drug. What is your opinion?

Timmy, I know I'm missing something here, and I'd love to engage in your discussion about euthanasia, but first you need to clarify what "I nursed someone to death" means. Not for nothing, but my attorney tells me if I'm charged as an accessory one more time I'm in real trouble. :-D

Meh, an old partner of mine once threatened to stab a fire lieutenant in the face with the intubation blade if he didn't back off. It happens.