Mateo_1387

Or how about the medic that said "we are en route to your facility with a patient who has a decapitated hand"

I assume the FF had EMT training or MR training or whatever the equivalent is for his area. It did say in the article that If he did have the training, then I would expect him to know his job too. So what would be extra special about him doing it?

Jake, we do the same thing if we are lucky. Over where I live if you are out in the country and have a critical patient you just go, getting the FD out there would be a miracle in some places. Hopefully as paramedics we can keep our patient stable during transport. I am curious, you are willing to apply pads and have the intubation kit ready, why not the autopulse? I have never had the pleasure of even seeing the autopulse, so entertain me as to why you did not apply it in those instances you applied pads and readied the intubation kit.

One agency I work for started working codes on scene and calling them on scene without medical control. Their save rates have increased, and customer satisfaction has been high. The medical director has received no complaints from working codes on scene. The paramedics are great (because there are a ton of resources on scene) to talk with the family and explain what is going on. They explain the gravity of the situation, and that everything that can be done is going to be done. After working the patient for the appropriate length of time and the paramedics decide to "call" the code, they explain to the family that everything possible was done and that the patient is dead. We are told that dealing with the patient, that we are to be blunt and not there to sugarcoat anything. We are told to tell the family that "soandso has died." We were also instructed that if possible we could have the family enter the room where resuscitation is occurring and let the family witness that we are doing everything possible. I have had family members come in and touch the patient while I am pumping on the patient's chest. The community has been really receptive and satisfied with our treatments.

LOL, I just went to youtube and looked both up. Yea, I could just see someone putting on the thumper, that would be too funny. "no ma'am, you won't feel a thing...." I am sure there is someone out there that has done it though, hahaha. I think the autopulse would probably fit better if you thought your patient was about to code. I have heard of people applying the pads for patients they thought would become unstable.

I think racism does affect patient care. I found myself when I started doing ambulance service treating people of color different than white people. I had grown up listening to racial comments and never was exposed to a lot of people of color. I also have seen these qualities in people I work with. It is so easy to judge people, and even though my coworkers tendencies may not be intentional about their actions, they were there none the less. I saw these qualities in myself and changed how I operate. I made sure that I was unbiased when dealing with people. It was not the kind of person I wanted to be. Most of the people we deal with are blacks, and the poor, and in my opinion, they are treated different from most other patients. I have seen many that were talked to unprofessionally, denied any pain control, and overall thought poorly of. The fact is that it is in the field. I do not see it all the time but it is there. I do not see how someone can be racist, use racial slurs in their personal life, and truly feel that there is a difference because of skin color and can say they provide unbiased care. It is ingrained in their thinking. It is something that I am sure they do subconsciously, if not consciously.

This is something for anyone to answer. Has anyone put the thumper or autopulse on a patient because they thought they were fixing to code?

What all is in the book? Is it dysrhythmia interpretation or is it 12, 15, or 18 lead interpretations, does it cover it all? How much anatomy does it go into? Do you think I would come out know more after Cardiology in A&P and a full semester of Cardiology? What is the degree of information in it?

That is not what I have been trying to say at all. I do believe that the paramedic or doctor is the highest medical authority in a situation (ex. Doctors over nurses, Medics over Basics). I also think it is a failing to think that one person is the almighty. My whole argument is more on the structure of the team and how things flow. Information should flow up to the leader and then back down the the team members. It is not to say that anyone is better than the other. The other part of what I am discussing is the pecking order, but this is only used in limited situations. What I did not focus on so much in my views was how much a leader should listen. In almost all my post I say that a leader should not discount the information given by the team members. I think that overall we are saying the same thing. I personally am not an authoritarian (at least I hope not), even though it may seem so in my posts. There are skills to being a leader, and not so much to being a follower. That is why my argument was the school needed to focus on teaching leadership and not teamwork. I just do no see EMS as mutual group work. Things will work more efficient with one leader who can guide an operation. By personal attack I did not mean that you were trying to insult, or belittle me or anything of the like. I just did not see it as relevant to the discussion. To me it seemed an attempt to make what I said worthless. It was just something I though that maybe needed addressing. But its all good ! I am not really that worried about it 8) Thanks for the compliment !

You need to go back and read everything to put it into context. I am not sure what you read. No, a nurse is not autonomous. If they are, correct me and explain how. Again, it looks like you just read my above post and nothing else. Go back and read all the post in this thread, and what I said, and it should make more sense to you. I really think it will. It is a personal attack. He is trying to discredit what I say by saying I need to grow up because of age. There was no need for that comment. He needed to just do what he did previously and explain why he is arguing that point. This is a learning forum and the improvement is gained through discussion. Why not come in and join the discussion. I did not obtain any sustenance out of your post. Show me where you think I am wrong. I have tried to explain a viewpoint. Please explain yours.

I took what you said as every time. My attitude of teamwork is to be receptive to your team members and listen to what they say. Usually having to be an authoritarian is rare. Most providers know what they are doing, and can give appropriate care. The team members are usually educated, understand what is going on, and things run smoothly. When a conflict arises between cert levels, I say the leader has final say. I do not buy either of these comments. What if the doctor decides NOT to do something that is in the best interest of the patient. Does that mean that you will take the initiative to do it yourself. The answer is no, you are not an autonomous provider, the MD is. Again, most providers are intelligent, and when they make mistakes and are corrected by others, they can shift their treatment plans. It is great to have a checking system of other educated providers who can assist with treatment and question(in a professional manner) your treatment. For example a fatigued doctor orders amiodarone for sedation (I know farfetched, but applicable) may be appreciative of you asking if he would rather have versed. Sometimes, our educations do not prepare us to know as much as an MD about treating people. That is the reason we follow orders even when we do not understand why. We cannot know everything. Usually this is not the case. When it comes down to the patient dying without time for debate, and you are ordered to do a treatment, and you question the doctor and he says "do it, I need that to be done now with X or Y" then it should be done. I agree with this 99%. The other 1% is that we do not know everything, so sometimes we just have to be sheep and follow what we are told. Maybe this was poor wording on my part. What I guess I should have said was "As a team member they are assigned a specific task, they should be busy doing something else, they will possibly miss points that I see ultimately." I have never said do not listen to what others have to say. There is chance to miss points that others may see. When working in a team though it is expected that the team members are followers. They understand that when there are too many leaders that things become disorganized and then things will be missed. When things are going on fast the leader is calling the shots. He should not have to explain every little thing to every other person twice. Sure the team members need to try and keep up with things, but as a team member you should expect not to follow everything going on. Elaborate. I have engaged in discussion and have provided a basis for my view. The personal attacks are not necessary.

Thanks for the other link. That definitely answers some questions. I wonder where he gets the figures to justify a $2 million lawsuit.

Poor argument. This is not a cause and effect. Sure, it is possible to miss things, but it will not happen every time as you say. With a competent provider this should not be a common problem. If it becomes a problem then I did say I am the one who is taking in all the information, I see the big picture, I see what is going on with the whole scene. As a team member they are assigned a specific task, they should be busy doing something else, they will miss points that I see ultimately. That is why it is acceptable to have a suggestion, but when I call the shots I see the big picture and take everything into consideration. That is what you do as a leader. I have always thought that a rig should have a single medic because it makes for strong providers. In the case of riding with a lower level partner they should have enough sense to know that they lack the education of a degreed paramedic. As for a partner that disagrees with your patient care and is hell bent that they are right, then somebody is missing something major with the patient. How do you expect and answer for this? We will never know who is right in this context. Obviously one person knows what is probably going on, I guess all we can do is hope they are large and in charge. Exactly. When it comes down to it the nurse may disagree with the doctor but she WILL follow his orders or get out. This is where it is not a team sport. In a team you must conform what you do to what other players are doing. As a doctor or paramedic in charge they are not a part of the team, they are the leader. That is the difference. I agree, but this also works both ways.

Why did he get out of his seat? What are they going to do, push me out the door of the plane? That is crazy, I would sue Jet Blue too ! Another point I would like to know is why did they choose that guy to give up his seat and not someone else? And why did they not offer him to sit on the jump seat. Where was the customer service? It would be nice to have a follow up on this one.

I think you were being sarcastic about parking behind the wreck, considering you went on to say to park in front of the wreck for egress and such. You ask which one I prefer to get sumshed, my car or myself? I say neither, we place the fire truck as a barrier They usually block the wreck and the next lane over to get drivers away from the scene.

In regards to your last two sentences, I would have to disagree with you (assuming that I am getting the meaning out of it you were intending). I agree with Dwayne that a leader must hold himself as an individual and not part of the team. There is nothing in stake of the team if things do not go right. The only people at stake is the leader and the patient. A paramedic leader must be able to come into a situation with people he has no interaction with and be able to guide them to provide the best patient care. The leader does not need a rapport to make the best decisions. As an educated professional you will know what you patient needs, you will not be worried about how well your rapport is with your team. This is especially true in big urban areas. You work with different people all the time. It is necessary that you as a medic can lead these people to accomplish goals, even though you have no rapport with them. I would go farther to say that rapport with a team makes for weak leaders. Just something about knowing someone too well makes them look at you more as an equal than as a leader that they must follow. If you do not have a rapport with them then they have nothing to hold against you. When you come to a situation with them they do not have any stake in it with you, they should follow your commands, and go on with life after the situation is over. I do not see what the difference between a boss and a leader is. To me a boss must be a good leader. In my experience the leader is the boss, what he says goes. When I am in charge of a patient and I have a team working for me, I expect what I say to be done, even if you disagree. As a leader I should also be receptive to input from my team, but in the end I am "numero uno" when it comes to the care the patient receives.. As Dust said I do not think the school should focus on making a team out of the students but rather have them focus on being a leader. Working in a team is not difficult when dealing with medicine. As a team member you are expected to follow what the leader says. When he says do a skill, you do it. Plain and simple. The harder part is going to be the leadership position. This person has to weigh in everything that goes on and make the best decisions. That is where I think the focus should be. On a side note, if they traded hockey players with Hooters girls, then we'd be rockin' !! That is my idea of a good experience

I agree. We use EMS charts an I find it easy to use. Apparently if you have administrative rights you can change the program around to fit your agency too. I have not had many problems with it, and it is by far my favorite.

I think that is a great point by the OP. In an EMS Management class I took a few semesters ago we discussed dealing with the press. From everything I read in the class it is best to have the press invited to events of the EMS department. When new treatment are initiated, programs are started, issues that are important, or anything you can offer the press. When you invite them into your area and get a good repoire they will hopefully give your department a positive image. We were taught to treat the press well and get them on your good side so they do not give your agency a negative image.

For the violent ones some IN versed would calm them down so they are not a danger to themselves or others and prevent injuries to them. After the arrive at a facility they can then diagnose the patient and treat them appropriately.

Dwayne, that is a great point. That is why I think the needle cric is not worth much. I guess you would have to push on their chest to put some pressure on the chest allowing the air to slooowwwlllyyy escape through the lumen of the catheter. Not worth much in my opinion.

Did anyone watch the video to the link that Jake sent? The news reporter said the 9 month class was the equivalent of an associates degree. And just think, all this time I could have saved 15 months of my life from school, sheesh ](*,)

Help during a code is great. My point is that with equipment like an auto pulse, quick IO access, meds that you pop off tops and screw, and a ventilator, a fire crew is not necessary. If I have this equipment, then I do not want the fire department there. They would not be able to add anything to the call at that point. After the auto pulse would be applied the FD would not have any more tasks. So why not have a paramedic start CPR and the other get the auto pulse on? All other tasks as this point are paramedic skills (monitor, drugs, intubation) This would save the FD from having to come. It leaves them open to take a fire call. Above is only one example. I do not want to take away from what the big picture was. The big picture is that for 99% of the calls I go on, I do not need FD assistance. Granted it is nice to have a little extra man power, but it is a waste to send a whole engine just to have some extra hands to move the patient or carry equipment. All the calls I go on the fire department is of no use as a medical provider.

I think it is great that the county is realizing that they are sending too many units on calls. One area I work in sends the FD to quite a few calls. Every time the FD shows up they do not contribute anything to the call that my partner and I cannot do. For the occasional patient, the FD is helpful because of the shear size of the patient, but for the majority of our calls I have no use for the fire department showing up. The only times I have ever been truly grateful to have FD backup has been when we have a heavy patient and when we need a driver. I would rather not see them on cardiac arrest cases. With the autopulse or some equipment like it, that eliminates the FD. I know everyone says they need to respond for initial CPR and defibrillation, but I do not remember in any book of life, or our constitution where when we die we are guaranteed CPR and defibrillation in less than 5 minutes. But this is a topic probably for another thread. In my honest opinion, the system is set up so that FD will respond first for the all so mighty "cardiac arrest." Those calls account for a very small percentage of what we do. I think it is more important to base our system on the people we help most. Where we need to focus is on the points where we help the patients who have decreased hospital times because of our treatments, where we save the health care field money because our initial treatment fixes a problem early. Oh, and I am sick and tired of the FD leaving their gloves on the floor in the back of my truck. We get yelled at if we leave a dirty dish in the sink, but no, you're gold because you help US, so you can leave your filth on our floors, sorrry, it just does not stand. Just a little rant. Matt

I searched Akflightmedic under google images and got a pic of Dust. There were also other avatars that people use on this site.

Aw, com'on, We had to give Durham something. We have everything else !