Timmy

Do you guys use text paging or voice over?

wow I must be behind the times! I keep my pager and a torch next to my bed...

I agree, you need to collaborate some data and statistics on this matter and present it to the relevant people. Maybe you could look at some funding or grants? I know in Australia there are Road Accident Rescue grants for organisations who supply this service. We have a similar situation where I live in regards to a rural area, covering highways and the major hospitals being some distance away. Fortantly in Australia all emergency services are government funded and so on. Paramedics, Fire, Rescue, Police and tow truck often dual respond to MVAs so all services arrive on scene within a similar time frame. Being not fimilar with the level of care your EMTs provide, is there any ALS responding also? Being in a rural area with long transport times and the possibility of having a prolonged extraction time (especially if you having to call for rescue after you arrive) it may be a good idea to add this to your proposal (if it's not already in place?) Also remind these people, if they cut the essential services and something goes wrong, guess who has to face the music? If they do cut the services make sure your local community are aware of it. You need to also include a strategic 'real life' situation in your proposal. Say you have an MVA down the highway with the travelling time of 30 minutes before any service is on scene, EMS or police arrive on scene to find patients are trapped and call for rescue, that's potentially an hour before you can even start extraction and pushing the time frame for timed critical care patients to reach the hospital. What if the car is on fire? Again, EMS and police will arrive and have to call for the fire service delaying access to the vehicle and endangering life. How can they guarantee scene safety? After all, who has the equipment and resources to deal with chemical/fuel spills, LPG leaks, disconnecting the battery ect which are all very real possibility's responders will face upon arrival. Your already a volunteer service, cutting funding and possibly delaying road rescue and fire suppression services is not a proactive move, push to have all emergency services dual respond to MVAs.

Well this is quiet embarrassing! I've only just stumbled across the thread. Thanks everyone!

God, that makes me feel so old!

I teach first aid skills to high school students through a program called party safe. In a nut shell we have a presentation that is delivered by police, medical, youth workers and fellow youth who have something to say/experience in the related area. We focus on safe partying, the effects of drugs, what to do if something goes wrong etc. The police talk about legal issues, the youthys present on drugs and there effects, we have a lady who presents quiet an emotional speech about losing her son in quiet a horrific car accident due to drugs and then I present on what to do if it all goes wrong. There's plenty of practical interaction, powerpoints and movie's, a little theory, a lot of listening and the occasional tear. I'd really like to think what we present to these kids will hit home, unfortunately more ofern than not it doesn't. If one kid takes it in and manages to 'save a mate' than the message has gone through. I have no issue with kids wanting to learn advanced first aid under the appropriate supervision of a competent clinician. As for being responsible for providing clinical care, save that for university placement.

Excuse my non new south walinness but why are they wearing T Shirts on the fire ground?

I've read an article called “cervical collars in patients requiring spinal immobilisation”. The researchers come to the conclusion that cervical collars provide minimal benefit to patients suffering from spinal injury. As with everything I guess it depends on what literature you stubble across, some people preach cervical collars while others say it provides minimal benefit. I think spinal immobilisation is one of those things that just needs to be done to the best of our ability. I've been in an unfortunate situation at a Motocross race were no matter what we did or from what angle we approached the situation if we moved the dude we were going to cause further damage. What can you do? Leave the guy prone in the mud for the rest of his life or get him to hospital. Fortunately there was someone senior to me on the scene who made the call to move him, you need to provide adequate documentation and justification for your actions. I'm a fan of evidence based research and best practise so until some new wiz bang guideline is published and recommended by the appropriate authorities I'm sticking to what I've been taught which is collar on, strapped to the board and head blocks.

Never the less, I let my fear and personal feelings interfer with my professional conduct. Anywho I guess we live and learn by our mistakes, that's what being a student is all about. Despite having my confidence ripped from underneath me she hasn't completely deterred me from a career in healthcare, just made it temporarily harder to reach.

I have been in this situation myself recently! With 4 weeks to go in Nursing School I failed a placement because I lack basic care and communication skills. I get terribly nervous when on placement and my preceptor was known to be an old battleaxe and hard to please. Within the first 5 minutes of attending to the first patient she was on my case and snapped at me about eye contact, posture, my level of care/compassion, communication ect. Of course I immediately went pale, freaked out and didn't think clearly which didn't help my case. For the remainder of the shift I fumbled around, looked incompetent, my heart sunk every time I saw her walking towards me, I felt weak at the knees and she kept on snapping at me for minor things and making it awkward when attending to patients. When I finished the shift she threw my assessment folder on the table and tore shreds through me, told me I was incompetent and should never work in healthcare. Just goes to show no matter how close you are to finishing your course, never forget the basics! I have no problem with medications, clinical techniques, preforming patient assessment etc. I normally have no issue with communicating with people but her negative blanket, always looking over my shoulder and critising my every move just completely such down my confidence which interim resulted in me failing. I've worked in this hospital every other day for over a year, I always feel confident when attending to patients, communicate well and have never had any issues or complaints but when it came to the crunch I crumbled! Amazing how after 2 years of working hard it can all come falling down over an 8 hour assessment. From myself and other university trained nurses that come through my hospital I see what your talking about. Were not really taught how to communicate with patients and were not given any practical guidance in class before were let out on placement. There seems to be a lot of assuming in higher education, teachers assume everyone does their self directed learning, they assume everyone will memorise and learn all those hundreds of powerpoint slides they go through in lectures, just because you get good marks on exams they assume your competent etc. I think as a preceptor it's important to identify what the students weakness is and let them know ways to improve - there's no point going off your head telling them there incompetent without providing a rashional.

Bloody Ambos

I'm yet to sight any literature referring to volunteering in the emergency department on this thread but I can think of many positive outcomes one could achieve from emergency experience. The emergency department is a very dynamic, fast paced work environment, your constantly exposed to different presentations, there are very well educated people who will supervise you. If you spent a day in the ED, your willing to learn and display enthusiasm then I highly doubt you would walk away without learning something or gaining a new skill. My advice, if your ever offered a chance to volunteer or work in ED – take it up.

Just a quick update on life because I've been quiet sedate on the EMS forum scene for some time! I graduate as an RN in less than two months! It's quiet exciting, we have 3 exams left and 6 assignments. The two major exams (pharmacology and anatomy) which I struggled with have passed so it's smooth sailing from here on in! I can't wait to finish, I'm sick to death with all the politics, harassment and belittling my hospital has portrayed to the 2 students they employ. For anyone who doesn't know, I've been part of a trail program to attract nurses to rural areas. The local hospital employs us for 24 hours a week and we spend 16 hours in class (all paid for) with full week blocks of class at staggered intervals through out the 2 years. Both myself and the other student have had to make contact with the union 9 times which resulted in the hospital being investigated. We've been subjected to working overtime with no pay, our pay rates didn't match the award rates, we've been used as part of the clinical skills mix and multiple other problems, some of which have not yet been resolved. I almost resigned from the program because on my community health rotation I headed up a program (with the help of the community health nurse) aimed at rural youth in this area. Were in a major drought here and farming is a pretty rough lifestyle choice at the moment. Suicide and morbidity problems in the farming environment are high. There's government supported programs which aim at giving money to some farmers but there was nothing aimed at youth. I did some research, managed to secure some funding and we started a program which encumbered doing welfare checks on some at risk youth, suicide prevention and mental health awareness, making sure they were ok at school and had the right stationary ect, getting them involved with local sporting clubs all this aimed at increasing social needs by providing some funding and support to make it possible. The hospital decided to pull our funding and direct it to other resources (aka, there flash executive cars and stupid things like this!) this meant the termination of the program which resulted in a youth suicide! I was so angry and lost all faith in the healthcare system. Anyway, not to beat the drum and carry on to much but they could have tried to make our experience a little more pleasant. My contract with them ends in October and this is when I plan to leave that horrible place! I've applied for a job in a major hospital 45mins from my town as an acute care nurse. It's a rural trauma and major referral centre for this area which beats a crappy rural hospital with 30 acute beds, 4 ED beds and a sour, burnt out nursing contingent. The job is only nurse bank working across acute medical and emergency but I'm starting my Front Line Emergency Care Course at the end of this year so I'm hoping that will lead to permanent shifts in the ED. Finally they opened a paramedic course in a rural town here! (2 hours from my town) Its a bachelor of health science and master of paramedic practise which I had no hesitation in applying for as soon as applications opened! So, figures crossed I get in. I'm a little nervous and was apprehensive about apply for a masters program but why not, you never know until you try I guess. I'm also doing a Diploma of Management and Diploma of Training and Assessment via distance education, which is a little dry and not related to healthcare but will open a few opportunity down the track in management and teaching. Anyway, mini essay over. I hope to contribute a tad more to the forums! See ya'll around.

So many different names lol… We call it post operative recovery in Australia. I love working post op, its quiet a busy and challenging environment. We complete a full set of vitals signs every 15 minutes for the first hour and half hourly for the next four. (I’m surprised they didn’t stick the student with this job lol) The patient has to expel the tube, airway management and suction, attending to wound care, pain management, managing infusions, IVs and medications, drains and vac drains, fluid balance documentation, post op documentation (a lot of), monitor for signs of hypoverlimia, post op general and breathing exercises. limb observations, implementing care plans and treatment pathways, organizing the return to ward, managing nausea and anxiety, liaising with the doctors family and allied health guys n gals nutrition and fluid intake. The list of things to do is endless, if something goes a little pear shaped with one the patients it throws you right out with everything else you had to do. I like to research new procedures or medications before I go to do them, as already mentioned a lot of people get caught up with just doing it because its always been done that way. I find things flow a lot smoother if you know what you are doing and why you are doing it. I find an 8 hours shift fly’s by even if you have 4 patients under your care. I know all this really doesn’t appeal to paramedic students but placement is what you make it.

Nothing like a bit of UPS

You need to look at the national website in the members area and download the national personal first aid kit order PDF. It dictates what you can put in your bag. Personally your division should give you a bag or you just use the bags out of the trucks (like my guys do). Even though you’re a AFR you can’t have your drugs/bgl/asthma etc gear in a personal kit.

Really depends on your geographic local, weather and terrain. I live in a rural farming community next to a river, its heavily irrigated via water channels. You get your normal urban (in town) fire incidents like direct alarms, minor structure fires, smoke issuing from buildings ect. We get get a few barn fires, house fires that are quiet some distance away and everything is almost over upon arrival, grass and scrub fires, brushfires, river rescue, body recovery during summer when the campers flock in and water skiing goes wrong, remote MVAs, assisting paramedics with extracting patients who fall off there dirt bikes or crash there cars deep in the bush, drunken emergency calls to camp fires, drunks lighting fires on total fire band days, grain silo rescue, farm machinery rescue, farm machinery on fire, farmers lighting a fire near the barn and a field of dry grass and having the whole place go up, car fires along the remote highway, ATV accidents, HAZMAT – mainly farm type chemicals and orchard chemicals, kids lighting massive bon fires down the bush having a big party and things like this... I guess if your on a mountain you'll be doing search and rescue, remote patient extracting, snow rescue etc... It takes a long time for backup to arrive so sometimes you have to be creative and strategic in the way you attack a fire. We also have a real problem with water, were in a drought here and sometimes it might be a 20 minute drive to the next lake or access to river before your re filling the tanker so make sure you always have extra trucks on the road, you can always call them off.

We certainly don’t have anything like this in Australia. Sometimes the high ranking officers wear funny patch things on there collar (like the Nazis) but there embroider in. Apart from medals (on official occasions) I really see no need to wear pins, hell even my name badge is velco … Besides, the more official you look the more questions people will ask… But good luck anyway.

Ok kids, its called PM… Seriously, there’s no need to hijack someone’s thread over 2 pages. Anyhow in regards to the original posters queries. I too started at a young age, at 16 I took a greater clinical role in event EMS, joined the fire department, worked in sports medicine and went to high school. I look back and reflect on the calls I attended at such a young age and I admit the maturity level and level of knowledge was not there. I did standby at motocross and football every weekend with a whacker partner and a lady who wasn’t that great to work with, I hadn't developed enough skill to be dealing with the level of injury sustained by the riders, you don’t think about scene safety, mechanism of injury, no idea how to mange grief or anger and ultimatly take control of a situation etc – pretty much everything had to be bleedingly obvious before you relies what's actually going on. Lack of supervision was another issue and I doubt having a 16 year old looking after you would look professional. I did all the EMS, fire and sports med courses and we did weekly fire and EMS training. I was so eager to learn more and go on more calls that I didn’t do very well at high school sure I passed but I only did the bare minimum needed to pass. I'm now in nursing school, I work at the hospital 3 days a week and spend 2 days in class. I'm classed as a 'employed student' but we have such a shortage of nurses here I regularly find myself with a patient load. When I really sit back and look at it I don’t regret starting at such a young age per say but I do wish I had an appropriate level of supervision and discipline. I defiantly feel that I was ‘one up’ when I started nursing because you already have the basics down pat, you know how to communicate with people, how to read the situation and I was able to build on those skills even more then build new skills and advance. Speaking from experience I don't condemn younger people working but they need supervision and mentoring, you also need to be careful you don't get burnt out.

Not to spoil the party or anything but, does anyone else find there name misleading? One would assume with a name like ‘Doctors’ Ambulance Service and Doctors printed across there vehicles that indeed a doctor would be responding to a call?

Maybe pot wasn't all they were smoking...

The problem I see with having him removed from duty is my organization is very finically bias, in my state we have about 5000 volunteers and the service knocks back business nearly every week due to not having enough volunteers to meet demand, I’d say on an average week we’d cover 160 events state wide and they also have the contract for most of Australia’s biggest events. Now, I say this with caution and with no refection on my service but purely based from my own observation. They really couldn’t give a continental about who there sending out to treat patients as long as the crew requirement is meet and there being paid for it. They couldn’t care less this guy is a complete moron and totally incompetent because if they lose an event over his unprofessionalism it doesn’t matter because they’ll just accept another event they previously rejected. 95% of those 5000 volunteers are great people to work with, there dedicated, willing to learn, professional and competent. Were lucky enough to have some extremely well know and knowledgeable health care professionals (doctors, nurse, paramedics) who are kind enough to volunteer there time to come out to events to mentor and educate the other volunteers as well as provide well structured training and education on other occasions. Its quiet frustrating that they still let this 5% of idiots and incompetent morons volunteer because they give the organization a bad name which is a kick in the guts for the others who put in the time, effort and dedication to be competent providers.

The scanner is a real issue, I had the appsault pleasure of working with him the weekend just past. We had to park the ambulance a fair distance from were the actual event was taking place and it required a lengthy walk down a steep embankment and a short distance down a sandy track along side the river bank and onto the beach. His fitness level was not at all adequate enough to cope in such an environment which put stress on other members having to pick up his slack. We set up in our area and he proceeded to fire up the scanner, all day he had the scanner blaring in full public view and past comment to members of the public on emergency calls occurring in the area. When I approached him later that day and raised the issue of professionalism and requested that he put the scanner in his bag he laughed in my face and began to tell me all the reasons why he should have the scanner on. He sincerely thought his personal safety would be in jeopardy if he did not have the scanner as we were in dense bushland and if a raging bushfire occurred he would need any information that came to light. He basicly used a catastrophic event justify the need to have the scanner on. The thing that scared me was there was no doubt in his mind that what he was doing was the right thing yet it was very unprofessional, an invasion of privacy and incredibly annoying to the public. I have no doubt there is some form of mental health issue boiling away. Once I dropped him home and I got home he sent me an SMS saying there was a house fire about 40mins from my house, he sends me regular SMS messages on fire calls around the area and if he knows my station is responding he will leave a voice mail requesting more information from me. He has more interest in the local fire service than he ever will with EMS, he really needs to go.

I haven't come across a study like this but I'm sure someone has conducted similar research. At a guess I'm sure there is strong evidence pointing towards better outcomes as one would hope with greater education follows a greater scope of practice.

Thanks for your responses everyone! Some great reading it is, indeed. In conjunction with the ‘powers at be’ were going to work on a fitness and clinical competency, his dismissal would be no great loss to the service and I thank you once again for your assistance.