Mateo_1387

My service is mixed on this issue from shift to shift from station to station. Two of our city stations are at FD's, and they sometimes sleep depending on which crew is working at the FD and which crew is working EMS. The rules technically say we are not allowed to sleep, but it is not enforced. The supervisors realize that (especially in the City) things get busy all the time, and a nap may be necessary. They expect chores and building duties to be done before napping. If the supervisor does walk in on you napping, just play it off, and they are usually good. Same rule for the tv, if they walk in, just turn it off, and they let it slip, providing daily chores/duties are complete. For busy companies that require their employees to work long shifts (ex. 12 hours or more) I think sleeping should be fine. It really is not fair to have persons work long hours in "fight or flight" without allowing for sleep. It is not fair to the employee, or the patient to have a tired paramedic working on them. I normally do not take naps, cuz I be at the slowest station :twisted:

Does anyone here think that without proper medical care, that the household provider's health will impact the economic status within a family? I would think that far more people rely on good medical care than they do good fire service.

I thought of this problem too. I am sure it is bound to happen. But, again, the way it is being talked, it seems that a paramedic will be there to help guide and or perform if necessary, the advanced procedure. I would not be surprised if they just end up putting it in the hands of the APP's, but who knows?

The way I am understand the Wake Co. APP program (from my limited knowledge gained from friends within the organization) is the APP is to in essence bring experience to the critical patients and non critical patients who do not require transport. Wake Co. is finding that patient outcomes are better when handled by experienced paramedics. Wake Co. like many other places are short of paramedics, they are having to resort to placing medics with intermediates/basics. I do not think they are diluting the paramedic population. These paramedics arrive on the most critical calls and provide an extra hand, as well as experience. The medic on the ambulance is still involved with the patient care. The idea of making the paramedic a poor man's PA is not the idea of Wake Co, at least this is not what I am seeing. For emergency calls that are what we call "BS" because they do not have a life and death emergency are transported, and given simple treatment at the ER. This program is still treating emergency patients, or providing the reference to the proper medical professional. The program design is to take unnecessary stress off the EMS system and ER when care by each is not necessary. Care may be necessary, but an ER evaluation may not. The APP will also be involved in complex cases that need a Paramedic with experience to make the necessary judgement call, such as if a patient requires transport or not. The idea of placing the critical interventions into the hands of the APP is to not necessarily take them away from the regular road crew, but to have the APP more proficient in the skills. For example, we all know that in order to be proficient at intubations it has to be practiced/performed frequently. The APP should see and perform more intubations because they are sent to the most critical calls. On these calls, the patient gets an experienced medic, and so does the regular road medic. The APP can help guide the road medic to performing critical interventions to make the road medic a better medic. The idea is not to take away skills, but to provide better care for the patients by experienced paramedics.

I heard that they were pushing to use the King primarily, but as of the last updat I have, they are still intubating. It is my understanding that the choice is up to the medic if they want to intubate or use the King. Personally, I think they will place intubation in the hands of the APP's when they get them going. [align=center:6cb5623dea]:wink: [/align:6cb5623dea] You know too much ! You'll have to get used to Grits too !

I was disappointed :twisted: (To be sure I am not the only person who expected something else !)

Why? There are plenty of valid arguments against psychological egoism, what is yours? Do you think the reason people volunteer EMS is solely to help others? Or do you think there is a large degree based on self interest? I vote for self interest, as it is mostly self interest that guides someone to makes EMS a career, as well as self interest that guides someone to become a volunteer EMT. At least my reasons are mostly based off self interest, and not benevolence. I find it hard to believe that someone volunteers in EMS to help others, there are easier ways to help others than to do EMS.

Versed would be nice too... The video was well made. For anyone who does not know any better about volunteer EMS, they would think it is the way to go. I was truly surprised that there were two doctors who ride as EMT Basics, as well as Occupational Therapist, Astrophysicist, RN's, and Computer Programmers. What makes it surprising is they all have college degrees! Yet they want to give their services away for free. It is the only way I guess they can get that special feeling without giving up their paychecks. I guess it is all about the money in the end.... I mean, please do not get me wrong, I enjoy helping people. But that is not why I work EMS. What I like about EMS is that it is challenging to do it right. To do it right, I have to be competent, to be the best, I need a degree, it is independent work for the most part, I am not stuck behind a desk, I work outside of a building and get to meet people from all walks of life. Being able to manage a scene and patient care as well as directing your partner(s) with ALL the proper tools is what makes it a challenge. That is what I like about EMS. Then there is the small fact that what I do may benefit someone else. But if all I wanted to do was to help someone, I could find easier ways to accomplish it. I really believe that most actions are explained by the ethical theory of psychological egoism. In a nutshell, it says our actions are based on selfishness. I think that anyone in EMS does so because it satisfies something within us, somehow, it supports our selfish ways. The question as to what makes it right or wrong is what number of people are affected by these selfish reasons. For example, the FD's who run EMS are normally doing so to improve their own agenda, the Volleys are there mostly to focus on their own glory and self satisfaction, and the paid personnel are there for the love of the work and profession. That being said, as we have discussed multiple times, the best one is the one where the least number of people are affected, a utilitarianism approach, which I think most people agree is paid, professional, EMS only agencies.

With the exposure of Dust, I had to take a picture and post for all to see ! (I used Jake's computer to upload the picture, I did not want to be tracked with that stuff.......BTW, he wants the name of your outside designer, should I tell him to call the local Squad?)

Dust invited me to his home.......but I could not risk being seen there..... [spoil:ee887e88af]How many Stars of Life can you count? :shock: (Click on photo for a bigger and better view) :wink: [/spoil:ee887e88af]

letmesleep, what is the problem with suicide being a selfish act? Many actions during our day are selfish in nature. Not wanting someone to commit suicide because others rely on them is selfish, IMO. I really do not think suicide is the right answer to mental problems because there is so much that can be treated to fix or curb the problem. For persons who suffer non treatable physical ailments, suicide is acceptable. It all depends on "why" someone wants to commit suicide.

I puked a little when I wanted this video. It was like watching 2girls1cup, I had to stop and restart it three times to finish it. :sad8:

:laughing3: I was disappointed when then started cutting down the side of the bread, instead of how they used to cut a V into the top of the bread. Now everything falls out the side.

I am not sure what you are specifically looking for but I would look for ST segment changes, J waves, PR interval changes, hypertrophy, and ectopic beats. Those are what come to mind. With CPR and defibrillation the kid regained a pulse. I would expect his pulse to be slower and to not just start galloping at full speed. Within a few minutes his pulse rate should start to come back up. This would be one of those good times to sit on your thumbs and wait. Atropine forcing the heart to contract faster may be a bit too much at this point. I would hold off on it. Great idea though to have antiarrhythmics ready. Without ectopy, I would be a bit hesitant to start a lidocaine drip. Providing this kids heart does not stop, his body will return to homeostasis (hence he has even regained conscience) and do what is best for itself. I would hold off on medication until we figure out what exactly is going on. How about a set of vital signs? Glucose? Toxicology report? Does the kid have any complaints since regaining conscience? Does he remember what happened?

I think it is still down the pike, as you say. I know for the Level II instructors you have to have at a minimum associates degree, so maybe that means the ball is rolling. I have not heard that associates degree will be a requirement by any certain date. Too bad though, I wish it would hurry up and get here !

Odorono, I can give you a bit of information. Medic911 out of Charlotte Wake County EMS out of Raleigh NC Here is the run down I can give you about: Medic911 has to offer: - a large call volume (LARGE). - All the overtime you will ever need or want. - 12 hour shifts. - City life. - Close proximity to the mountains (real close). - Aggressive protocols. - Medic/basic trucks, after you are finished riding with another medic. You can contact Charvetta Ford-McGriff at jobs@medic911.com to find out about employment. She would be very happy to talk with you, at your convenience. I had the opportunity to talk with her and she made it clear that she welcomes any contact from possible future employees, almost any time of the day. Very nice person to talk with. As far as protocols, I have not viewed a copy of them, but I would imagine they are similar to others in the area. I am sure they have 12 lead EKG, they do induced hypothermia for ROSC, STEMI alerts, Trauma Alerts, and all that jazz. I also believe they do EMS research. I can put it you this way, if I was to move out that way, I would probably apply to work there. Some other things they have to offer are in house CEU's, Cadaver Lab, and simulation labs. They speak like their education program is top notch, but I cannot speak from experience. Wake County EMS has to offer: - Large call volume . - All the overtime you will ever want or need. - 12 and 24 hour shifts. - City life. - About 2.5-3 hrs from the mountains. -Aggressive protocols. - Medic/Medic and Medic/Basic trucks. Raleigh, just may be your place. There are A LOT of good people working for Wake County EMS. They are working hard to get people and keep people. Their management may be a bit top heavy, but they seem to constantly be working to improve their EMS system. They really push for everyone in Wake County to get along and play nice, and they do! The system has great medic protocols. For the most part, they want them used as guidelines. The medics seem to be very appreciated by receiving hospitals, and for the majority of people (most people) are intelligent. There is so much to be learned at Wake County EMS. They started Induced Hypothermia in the field, Stemi Alerts, 12 Lead EKG's, call codes on scene, Trauma/Stemi/Stroke alerts, and CPAP. They will soon be starting an Advanced Practice Paramedic. These medic will be responsible for advanced EMS practice, such as at home treatment, refusal of transport, alternate transportation modes, RSI, Induced Hypothermia, treatment for complicated cases to be left at home. These will be QRV medics who will run on the major calls and the minor calls as well as wellness checks. The medical director is top notch. He is very dedicated to the EMS system and the performance of the system. He has a lot of respect. He is a full time EMS medical director. ' The shift work is changing. They have started moving trucks to 12 hour shifts, and people are starting to realize that 12 hour shifts are nice. They way things are going though, they are going to have to start supplementing their staff with basics or intermediates. They are trying to get people, and good people, with their growing system. Their CEU's are in house, and they have a good program going on. They are not just for EMS education but they push for you to know the continuum of care. They do research and continually update employees on the progress they make in the field. If you have anymore questions about these systems just ask !

To Riblett-----yes To Terri-------just remember who you serve ! To Defibwizard-Thanks! To Michael----What did you do to Dwayne?

Well folks, its finally here. Everything is coming together. I have graduated with an associates in Emergency Medical Science. I have my state certification, and I start a full time EMS job next week. So, as things are changing, I just wanted to say that EMTCity has been a great help to show me the light ! Thanks everyone for putting up with me. I am supposed to do medical boards on Monday, and then I will do the "training" third rider days. Things should sail smoothly, as I have been with the agency part time for coming up on two years. I hope to be released soon, as people for this agency don't quite understand "education" except for a few. But, since things are changing, I am happy for the moment! Thanks to those who have helped me along the way. Matt

Kaisu, First, thanks for posting this. The responses have been helpful for me, as I will soon be in a position where I may face some of the hardships you are now facing. Second, I get the idea from your posts that you are dealing with people who do not understand things outside of their own realm (such as how to do paperwork) or are intimidated (such as running directly to their supervisor). I would be willing to bet that you are the top dog at that agency. You know you have an education, you know you have clinical experience, and you know that you have the experience of emtcity. You are certainly a well rounded individual, with life experience that I am jealous of (I am entering a Medic position at a young age). You just lack working full time for an agency. Getting up to snuff with the agency will be easy. Getting familiar with a "mother may I" (having to ask for morphine) system and less than competent personnel is going to be easy. You already had them beat when you walked through the door. Kaisu, you have value, DO NOT let them beat you down. Show them that you are a Paramedic, and you can hold your own. It may mean just hold out until you get your own truck and are working with one partner. When you get to that point, be in charge ! I do not think it will take you long at all to be well respected among your peers as a competent medical provider. You are going to excel fast, its in the cards. Third, If things do no work out for you, then come to NC. We have some good EMS systems, and we would be all the better to have a paramedic like you ! Good luck Kaisu

Sooo....I guess, indirectly, what we do in EMS is backed up by this scientific observation. Were making progress by using science !! JK folks And Dust, thanks for clearing up the term related to all this monkey business !

That is mighty nice of them, at the agency I used to work for, they have had ambulances issued red light camera citations, which were to be paid by the employee driving.

Agreed, I do not think law suits are the best way to practice medicine. Education should be the best way, as you say, to know the negative consequences of an action. If you do not understand something and perform that something on a someone, that would be a bad thing. Thus, law suits keep medics from performing bad medicine, not because they do not know better, but because of fear. Now, letmesleep, stop dreaming, that only happens in the perfect world ! Sure, it is a fall out of poor patient care, but, the fear of law suits may prevent poor patient care. A simple example would be doing a procedure that you may know, but do not perform because. Also, you are not comfortable with the procedure because you are not "sure" if it is indicated. The procedure has a very great chance to worsen the outcome of the patient, but, not treating may not be detrimental, yet... So, ideally, an educated person would know why not to do something, or better yet, know the indications to do something. In the absence of education, law suits may prevent poor patient care.

I was not aware of the number that are settled outside of the courtroom. It is just not something that I hear of all that often. That being said, education is what is left to protect the patient. If you do what is right for the patient, with your level of education, then education acts as the protector. Aww hell........my bad :oops: The way I see, lawsuits protect patients by placing fear in the provider if they "screw up.". :shock: He does live !

LOL Simple answer....education and law suites. So many uneducated medics are out there, so many. The public is not protected from them. I do not see too many EMS law suites, so I guess all that is left is education. You have to know what you are doing, why you are doing it, and when to do it.