JPINFV

True, but if a commercial pilot starts to hate his job you don't see him doing steep dives and climbs for no reason but to mess with the passengers.

So I ended up working today and we were fairly busier than normal, but a few incidents with two separate coworkers (including a high level manager) got me thinking. What is it about EMS and medical transport that makes so many people spiteful towards their patients? One of my coworkers used to work as a medic and he was telling me almost with glee about how he used to push the full two milligrams of Narcan all the time, including waiting till right before reaching the hospital if he didn't like the nurses or the hospital. After all, what fun it is to completely destroy a patient's high and get them swinging. Especially when you only have to see them for less than 5 minutes. The manager spent the entire time going back to station complaining about how the patient screws himself up forcing him to go to the hospital and forcing us to run his discharge. My question, based off of today, past experiences, and posts in some of the threads on internet EMS boards, why is so many EMS providers just down right spiteful towards their patients? What is it that attracts such people to this field (for the record, lack of education standards is more of an enabler than a cause)?

I know Boston EMS responds and transports everything hot (I witnessed an emergency transport that went around the block. Literally 3 right turns to reach the ER entrance. For bonus points, if there is a paramedic and basic unit on scene, both go to the hospital with lights and sirens). I have absolutely no clue as to why they do this, but it is really... really... really stupid. Especially with some of the driving that I've witnessed in the past year and a half.

Flamers?

Well, I can reach the abstracts without signing up for anything, but unfortunately my school doesn't have an institutional subscription like it has with most of the other journals.

The Myth Busters always seem to be able to get their cars to blow up.

"EMS Education" "My Assessment" by tech school fire medics.

I think the big problem lies in determining when being overweight lowers the ability to do the job. I weigh in at around 225 lbs, which makes me technically obese at 5'10. I've had two partners so far tell me that I in no way look 225, but the dialysis scales don't lie. Am I over weight and can I spare to lose some fat around the waist? Sure, but I'm not sitting there waddling to the ambulance or always lifting the feet of the gurney because I'm overweight. I think insuring that providers can pass lift tests (including a yearly repeat test) is much more important than setting an aribtrary weight or BMI limit. One of the well known flaws of BMI is that it doesn't take into account body composition.

Only if you're inside the ambulance when the call comes in and you know how to get there without looking at a map. There are plenty of reasons why the alert time and enroute time can have a one or two minute delay. There's a major issue with this though. Are your treatment and vital sign times also provided by the dispatch center or by someone's watch on scene? I'm of the opinion that all times on a run sheet (treatment times, V/S times, movement times (enroute/on scene/patient contact...) etc) should come from the same device if possible. It's easier to explain why all of the movement times are, say, consistently three minutes behind the dispatch time than why it took you so long or so little to go up 5 floors in an elevator and make patient contact.

Nothing to lash out against here. That would just be opening up scars. Bad, I know. I just can't help it.

Bloody hell. I must say, good chap, that is an interesting condition. A tip of the hat for finding that one.

As with everything, there's a Scrubs clip that addresses this.

As someone who worked for one of the major interfacility companies in OC (red vans, not blue stripes), I have to disagree that the current system works. Right now, unless a SNF calls 911, the response is going to be EMT-Bs regardless of the chief complaint unless a ventilator is involved (then it gets kicked to an RT led CCT team). Congestion? BLS call. Unstable V/S (I did once get a call where the CC was a B/P of 70/40. The facility knew this, the patient was full code, and they called for a non-emergent transport to the ER)? BLS call. Electrolytes out of wack? Abd pain? ALOC? BLS, BLS, and BLS simply because that is the only option available without accessing the 911 system. These are calls that basics should not be running alone on a consistent basis in a county of 3 million people. Unfortunately this setup does not address the massive gap in service between basics and RN led CCT calls.

Wait, you mean I don't have to touch the patient with my scope to do a proper assessment? Awesome! /sarcasm.

Then the question is, does "rendered" apply to care AND conduct or just care? Can you render conduct like you render care?

Probably not. Both CHOC and University Children's Hospital (UCI) has established transport teams with backup contracts. It would probably still be ran by RNs. One of my major problems is that if a patient crashes, they need help now, not in the 5 minutes it'll take to either reach a hospital or the fire department to reach them.

I r a winnar!

So Orange County, CA has decided to start allowing paramedics to operate on private company, interfacility ambulance units. Prior to this point, the only paramedic provider allowed in the county was the fire departments running 911 calls. Private companies used EMT-Bs (EMT-I [one]), RNs, and RTs to meet the needs of interfacility transports, including transports going to the emergency room. Now for people who aren't familiar with the screwed up California system, direct EMS system management is left to the "Local EMS Authority" which is either the county or a group of counties. There are three levels, EMT-I (one, EMT-, EMT-II (two), and EMT-P. There is a list of expanded skills for EMT-B which must be approved by the state. Similarly, counties can only use EMT-IIs [known as "limited advanced life support"] if they absolutely can not provide paramedics and only after approval by the state. Here is the current proposal: http://ochealthinfo.com/docs/medical/ems/i...ort%20units.pdf I can't, for the life of me, see how this is useful. The drug list is essentially limited to glucose, nitro, saline, albuterol, ASA, narcan, and EpiPen. No ACLS drugs. No pacing. Only combitubes. SAED monitor (not sure if they'll allow manual defib). Probably the best part is if the patient crashes, the medic has to request a 911 medic. Why even use a medic for this? Why even apply for a medic spot with these restrictions? Call for comments memo: http://ochealthinfo.com/docs/medical/ems/45dayreview.pdf

Length matters. A 200 hour program more time to properly instruct students than a 110 hour course. A 110 hour course is a 110 hour course regardless of if it's 12 hours a day for 10 days or spread out over 3 months.

Wait, you don't want to be lumped into the same group of people that takes a 110 hour course in 18 days, but you're defending the use of a learning device that essentially reminds you of basic trauma injuries? This isn't SAMPLE or OPQRST, or AEIOUTIPS (I have concerns about the last one, but not nearly as huge as the concern I have for providers who use DCAP BTLS) or half a dozen other ones that are/can be useful. Seriously, who is going to sit down and say, "Damn, this patient's leg is sitting at a 90 degree angle, is that important? Should I, ya know, wright it down on my PCR?"

Refuse three times, then accept while being eternally grateful and humble over the experience. I don't do this job for tips nor do I expect tips. That said, I understand that there's a point in time where refusing tips and signs of gratitude are more insulting.

The general consensus is that stopping between EMT-B and EMT-P is a waste of time. The general consensus also is that class time and ride time for EMT-B is way too low, so don't feel bad (good job on recognizing it though. Ask for as much as you can get). What will help you with paramedic school is obtaining a good, college level foundation in anatomy, physiology, microbiology, chemistry, and a handful of other courses.

Strange, I thought the same damn thing when I first heard of it.

Deformations Contusions Abrasions Penetrations Burns, Bleeding Tenderness Laceration Swelling I think I'm missing a few since a couple have multiple meanings. It also seems that every school teaches it slightly different, but the above is the general idea.