croaker260

Dwayne, I agree that the reportes style is abrasive and a bit sensationalist, but lets look past that to the system itself. In addition to Detroit as a city being on the verge of collapse…The FD ran EMS has had so many problems in the past 5 years (and likely well beyond that) that this story actually isnt that out of place. Broken down Ambulances, responses to priority calls (in an inner city) in excess of 20 minutes, SEVERE understaffing, 10 % pay cut across the board with impending layoffs, money missing from their budget, and a string of ineffective leaders mean that Detroit EMS may be (IMHO) one of the most engangered urban EMS in the nation. So , set against the backdrop of the system, this story is not that far out of bounds. In fact, it may be PAR for the course. Croaker Here is a good overview of the problem http://www.detroitnews.com/article/20120816/METRO01/208160383 Some other stories of interest: http://burnedoutmedic.com/2010/09/detroit-ems/ http://www.jems.com/article/news/detroit-ems-employees-speak-ou http://firegeezer.com/2011/12/21/detroit-ems-one-year-later/ http://usatoday30.usatoday.com/news/nation/story/2012-07-19/detroit-boy-death/56328496/1 http://www.myfoxdetroit.com/story/19467190/paramedic-and-vocal-critic-wisam-zeineh-quitting-detroit-ems

Sounds like more of a leadership issue than an ethics issue.

Interesting idea. And not without its merits, but an expensive and time consuming one. When I was my agencies reserve coordinator, I had to justify the expenditures for the extra pay for the FTO/Mentors for the return result. By using two FTO's you double the expenditure in the shift deferential but more than double the cost of the shift by tying up two experienced FTO's for a single trainee for a 12 or 24 hour period. (throughout most of the Phase II (training period) the trainee works on a two man crew with a an FTO. This is representative of our typical response configuration. You do a three man crew with senior FTO's that over even a two week period the costs mount up exponentially. Now in a volunteer organization, where salary is not a concern, this may be more feasible than in a larger paid organization. What we do do for our phase III is pair the new medic trainee with an EMT. Our FTO's will dress in presentable attire that while it clearly identifies the FTO as a member of our organization, sets him apart (think business casual) from a normal responder. We then observe the Trainee functioning with an EMT just like he would on any call once he is cleared, with instructions he cannot use the FTO as a resource except in the most dire situations. This gives a very good evaluation of how they can function. One other thing we have done is pair two trainees to one FTO. We only did this with our strongest FTO's , but even this can be problematic monitoring both simultaneously on a really bad scene. After all as an FTO you are held responsible for all their actions. We will still do this,due to logistic/schedual issues, but we try to avoid it. Most cases it was done during some of our larger academy or paramedic class graduations.... when the number of trainees outstripped the number of FTO's.

This is similar to my own agencies approach, though by the time they enter the final phase of their program they have had 3-6 different FTO's (they rotate every 6 weeks). There are a number of reasons for this, not the least of wich is after about 6 weeks you begin to develop a comfort level with eachother that is closer to a partner relationship instead of a FTO/mentor type relationship. On the opposit end of the spectrum this prevents personality conflict from having undue effect on the process. EVERY FTO will eventually run into a PO whome they just cant get by with. Sooner or later, it will happen. By having the additional FTO's, compensates for this. All of our FTO's get a shift diff. for every shift they have a trainee. Not much but equilivent to about 5% roughly. The FTO's pay here is not related to the probationary officers success however, though by the time the PO has gone through 3-6 different FTO's, and all 3-6 have been unable to effect change or success, then a very careful evaluation is undertaken complete with remedition and discussion. If this is unsuccessful, the PO is let go and all agree that every effort was typically made. I do not know if the OP's agency is big enough to facilitate this depth of a program, but the point remains that having different FTO's through out the process is a valuable one.

I've been an FTO for many years and have actually received formal training as such. I would love to pass it on. email me at croaker260@gmail.com and I will send you some of our forms, I would love to chat with you as well because I was our "Reserve Coordinator" (We have a reserve officer program too) for many years and had to incorporate a poorly defined volunteer program into our rather robust and detailed FTEP for our career department. I would love to share my lessons learned and brain storm, but I dont want to get typers cramp doing it. So email me and I'll drop you a line. I am also attempting to do an EMS FTO blog (link below in my signature line) but as I am new to blogging it is an learn as you go experience. Steve

Well, I fall at the other end of the spectrum. From an early point in my adult career I have always been fascinated with the specifications of the equipment. This was reinforced by my time in the military. "Know thy equipment" had always been one of my commandments. I can still recall that the 1911 is a "recoil operated, magizine fed, semi automatic pistol, caliber 45". I cant tell you how many times knowing some little obscure fact about the gear has helped me to improvise a solution in a pinch. Same with pharmacology, etc. Probably why I am picked to do these damn research projects so often. Anyway, thats my 0.02

Hey all, I've been tasked with yet another equipment review. Anyone use these? Because the hub has an internal diaphram to prevent back flow, I have some specific questions. 1- Can you draw blood through these? 2- Can you get a sample off these for BG? Any other comments pro or con?

Do you have a link to the CAP lab?

I respectfully dissagree. it makes no difference if it is the politicians telling the FD, or the IAFF "leadership" or just a bunch of hot heads inthe FD themselves. FD/EMS It only works when BOTH sides (EMS and FIRE) want it to in a merger and BOTH sides are equal parties. That rarely happens. Otherwise, EMS personel always get the short end of the stick.

I am a bit concerned at first blush with a class that started with only two students to begin with. ZCan you explain more about the program, and the resources it has to put into teaching, either online or in person...

I have no sympathy for FDNY, whom many of their own members bashed the "volunteer" ( A term used to describe the hospital based and private EMS personnel) EMS personnel who died in the same event. Many have refused to acknowledge their own FDNY paramedics were even worthy of mention in the 343, and have opposed their inclusion in FDNY memorials. Most of those comments are no longer searchable, but I remember them clearly. FDNY has for many years exemplified all that is wrong with the FD ran EMS model, and the IAFF. FDNY is no friend to EMS in general, or even their own EMS members. Technically...Neither and both. It is one of the last Large Public Utility Model (PUM) EMS systems, similar to KC MAST (wich was just taken over by KCFD despite approx 20 years good performance). In short, it is a private company that bids on the contract, but is directly run by an appointed board or other governance model. The pro's are that it has far more oversight and control for the tax payers, the cons are it tends to be more expensive than a straight private contract, but less so that a full 3rd service or FD based model. Obviously this is a simplification, but you get the idea. Often the equipment is owned purchased by the PUM itself, with the private service only providing personnel and day to day operation (again under deep oversight). Its the IAFF, when have they ever "Just wanted to provide assistance?". Having beenin this debate before, often they want an "in", and soon they want it all. Its a common tactic. Just look at Collier County FL as an example, or Kansas City. Reminds me of this saying: "Just because your paranoid, doesn't mean they arnt out to get you..." In other words...just because she is angry or desperate, doesn't mean she is wrong.... She isnt saying anything new we havent heard in different locals before, or thought ourselves.

Most of you know I am a 22 year medic. Its been a long time since I have been a combat medic (1995 was when I ETS'ed) but when I was, I ran across an amazing bit of equipment from a British SAS medic TTY'ed over at my post. I was instantly hooked. I am talking about my Big Shears ( www.bigshears.com and no I dont get any $$ or kick back). Yes, they arnt as cheap as the 2 dollar trauma shears you see all over the place. But they arnt supposed to be. (Common now, most of you guys pay 200 dollars for a pair of sunglasses, but you wont pay 60 dollars for something that actually works?) Anyway, I digress... Now Ive been a civilian medic ever since. As soon as I could find these on line...I bought a pair. They are one of my favorite pieces of equipment and I use them every shift pretty much. . I've had my current set for going on 8 years, and they FAR surpass any other shear or other gizmo out there. I cut football gear, snow gear, motorcycle leathers, and heavy canvas rigging with ease. There is only one down side....the holsters suck, These scissors are just too big for horrizontal back carry ... also these things are a bit heavy for pocket carry. If you have a "rig" when you go the range, or if you are in the sand box, the holster they come with junt work well there anyway.... So... I wanted to share a bit of kit I had made, and I also wanted to give a shout out to the makers of said kit. I just wanted to give a big shout out to Raven concealment (http://www.ravenconcealment.com ) for putting together an affordable Kydex Holster for my Big Shears that is lighter, more versatile, and actually slimmer. If you decide to buy a shear holster from Raven Concealment, you may need to reference my order, it was Order ID: 42202 I dont get one penny of kick back. I just think these things rock! I know there are other users of big shears out there...I hope this helps you too. -Croaker P.S. Pics attached. Also, I have adjusted the wear of my holster actually a little farther back than in the picture, for comfort and balance with the huge radios we carry at work. I will add that the only thing I had to do to this set was add a bit of lock tite to the paddle screws.

Regarding Living Conditions: (In my state:) We are required under statute to report if we think it is related to neglect/exploitation (i.e. elder abuse) . We have an ethical obligation and immunity under statute to report other horrid conditions, even if they are not related to neglect/exploitation by another. HIPAA does not restrict this due to that HIPAA does not prevent such reporting.

Actually, I believe it was formed from a metabolite/degredated form of simple sugars, and is therefore unrelated to ASA , wich is dereived from salicylates, a completely different chemical structure. Now that i said that, I just double checked and there is a brief mention of People who are "allergic to Motrin should not take Aspirin", but since it is Drugs.com there is no specific reasoning, other than they both cause GI upset. It does say that morin makes ASA less effctive, so I seriously doubt they are structerally similar. So I guess I stand corrected, though I think that if someone digs, it probably wont be beause of cross-sensiivity. Eitherway, I stand by my comment on AA in the first 24 hurs vs. the first 24 minutes.

Shut up, sit down, learn all you can, and then learn more. If your mouth is running, you arent learning. If you fail out, you cant learn. Remember that as a student, while you have a brain, you dont have the tenur nor the experiance to have an opinion yet. Its not fair, but it is true. Good luck.

Motrin and ASA are not even in the same pharmacological family, they are simply in the same general theraputic class. Morphine and codiene are far closer related than Motrin and ASA, and we give MS to patients who are allergic to codiene all the time. To elaborate further, Morphine and Codiene are Opioids (pharmacologic family) and Analgesics (theraputic class) or more generally CNS depressants ( A broader theraputic class desription, I guess). I am not aware of any heightened cross sensitivity accross the various NSAIDS. Of the ones that are most likely to cause problems , I am pretty sure Mortin has a higher than normal association with some unsual anaphylactoid reactions....but that is another discussion. In short: I would feel pretty safe giving it. Keep in mind I would ask such questions as: 1- What happened when you took motrin? Any rashes, etc. Why were you taking it? Are you absolutely sure it wasnt another drug, such as ASA? 2- Have you ever taken Aspirin before? Any problems with that? To continue the discussion on ASA, if you have any doubt, dont sweat it and simly dont give it. The research on ASA is based on the patient recieving it with in the first 24 hours, not the first 24 minutes. So if you defer until arrival at the hospital, then no biggie as long as you document the reason.

That is pretty darn close to what we are doing, and I am pretty unsatisfied with..well... ,myself. Perhaps I am being too hard, but I am looking to squeeze about 250 hours in to cover the material at a more reasonable pace. . You bring up a good point, I am curious if requiring Med Math and/or anatomy physiology prior to class would free up some of our didactic time. Hmmm

Disregard, just confirmed my original assumtion was correct. https://www.nremt.org/nremt/about/reg_aemt_history.asp That is the way we are referring it to here around here, just as the EMT I/85 and the EMT-I/99. In Idaho we have had a level with the same/similar title for a long time ( it was the EMT-I/85)

Wich cardiac arrest management station? The AED one (wich we are preparing them for) or the mega code one...current AEMT-2011 does not have any EKG recognition material in it.

Hmmm, that is different than what we were told by the state EMS coordinator. Can you cite a source?

So, our first AEMT class is coming to a close. One thing is for sure, we needed more time. I am curious what the other sceduals and hours my fellow instructors have seen out there for the new AEMT course, to see if there is anything we havent thought of. This last class we did every WED/FRI for 8 hour days. We came in just over 200 hours over the summer. Steve

Keep in mind that the new AEMT level is just that, NEW. The NREMT will not even be testing AEMT-2011 until Jan of 2013. Considering that, most agencies are still figuring out what they are going to do with this new level. It may take a few years to get it into gear. Steve

uhmmm... we do.

After some time dealing with issues like this as a former supervisor and current instructor. ..... The first question is : What does your POLICY state? Both your department policy and your school policy. I can pretty much guarantee you that if you don't have one now, you should write one. The second question is; What have "we" done before? How has your department handled this situation before. Why? How did it turn out? If your department does not currently have a policy or prior precident, I would strongly suggest an informal conversation with the heads of the other allied health departments (i.e. Nursing) to see what they do in this situation. I promise you it has come up before. See what the prior precedent is. The third question is: What does our Human Rescources / Dean of admissions say? This is what they get paid to do, solve problems like this. Use them. The fourth question is: What is the right thing to do? When in doubt the best policy is honesty and transparency, avoid the temptation of simply "losing their application" or "not returning their phone call". And though we would all like to "give someone the chance", we need to make this decision on objective criteria. And that decision needs to be the same as if we had never spoken to the person and are simply looking at the case on paper, instead of looking across our desk at the student in person. My advice (after doing all of the above)....... Simply sit down with the student and tell him/her that until the issues are resolved, you cannot allow them into clinicals. Explain that clinicals are an essential portion of passing the class (or at least the NREMT). Offer to let them audit the course now for credit only (without clinicals) or to let them take it at a later date when the issues are resolved. Let the student decide weather to withdraw or not, your not denying admission. Finally, DONT DISCUSS THIS WITH ANY OTHER STUDENTS. Only your fellow instructors and your chain of command on a need to know basis. If they audit your course, treat them like any other student. Keep their secret like a professorial unless required ethically or by law to do otherwise. I couldnt disagree more. I would absolutely worry. At the local college where I teach , we have an ongoing problem with a local hospital because of another allied health programs student showed up high. Now we have a 100% drug testing policy prior to clinical. Take it form my personal experience.... The last thing you want to have to deal with is the lost of a clinical site(s) because a student showed up high, or at least "glazed", much less actually succumbing to temptation and stealing meds. I am not saying people with addiction issues cant be in EMS, but I am saying that people who have a self admitted problem and haven't completes rehab or other program shouldn't be until they resolve their issues. And I am sure that any addiction/recovery specialist would probably advise against entering such a high stress /high risk for relapse course of study/career until they are well into recovery...at least a year, if not 5. Addendum, I just saw this is for the First Responder License. Do you require clinical time for this? We dont locally. If not, then it may not be as much of an issue as you may think, unless they come back for EMT or another course where clinical are required. All in all I still stand by my earlier post.

I would have some concern about managing emergence phenomena post ketamine in a post surgical patient "on the floor". Specifically, these can be restraint nightmares (pun intended) and add the recent surgery on top of it? hmmmmmmm. theren there is the conscious sedation issue. In any other (in hospital) setting, ketamine, propofol, etc would have the airway cart standing by, and either the ER doc at bedside or even anesthesia a short call away I am finding it hard to believe there arnt SOME opioids out there..even methadone is an option, though not a great one. And while PCA's are nice for more predictable drugs....Ketamine is not what I would classify as predictable. Perhaos another method..less problomatic. Perhaps transdermal fentanyl with PO opioids for breakthrough pain? Granted I have no personal experience with this particular situation, but extrapolating from other settings, it seems like an accident waiting to happen.