p3medic

Missed Kaisu's last post before I posted to you Dwayne. If what you say is true, and I certainly don't doubt it, start looking elsewhere for employment, it sounds like a lousy place to work. Good luck.

Dwayne, she posted that she has done 15 calls since leaving school, the company is busy, averaging 30 calls per shift split between 3 trucks. By my math she has worked 1.5 shifts, with two different preceptors. Having her chart reviewed by her preceptor for approval prior to submiting it doesn't seem like hazing. I don't see any evidence of her being singled out for not having prior EMS experience, although she seems to sense this, and could quite possibly be right. I don't know the OP, you do, so I can't speak to her "life experience" giving her any particular leg up on her experienced paramedic preceptors. I agree, she should be precepted by one FTO for a set period of time, and then sent to another if needed. We do 3 week rotations, with a 9 week field internship, sometimes longer. Yes, there is variablity on small things, but overall, the expectations are the same. It sounds like this probably isn't the case were she is employed, and that sucks. I didn't mean to suggest that since she was a brand new medic she was somehow less qualified to do the job, but I certainly believe that a medic fresh out of school is no were near at the level of a medic several years out, assuming, and that is a big assumption that the experienced medic has continued his/her education. Education, coupled with experience is a tough thing for a new medic to match, I think you would agree. I don't know the OP, I certainly wish her well, perhaps she is being treated unfairly, or perhaps she is a bit overwhelmed, I don't know. Is her experience with this companies precepting process unique to her, or is it of low quality across the board, I don't know that either.

Vent got this one earlier. Lets stop the propofol, hydrate and sedate with a benzo/opiate. Propofol is the likely culprit.

What makes you think her FTO's opinions are "uneducated"? Just curious. She's a brand new medic with no experience beyond her medic program. The company she is employed at has taken the time to place her with more experience, and perhaps more educated providers to ease her into the job. While they may not be going about it in the best way, I think we may want to give them the benefit of the doubt. As for having her chart evaluated prior to submital, I don't see an issue with it. I look over every chart when I precept new medics, and if it doesn't comply with department standards, they write it again. Its not hazing.

I guess the propofol could be a problem, especially at higher doses. The OP mentioned he required a large amount of sedation. In any event, some volume expansion is in order, would be nice to have a CVP as a guide, but given the elevated CK, creatinine and myoglobinuria and urine output of 10ml/hr, we need to get those kidneys working again. Also concerned about hyperkalemia, the 12ld didn't suggest it, and we don't have labs to guide therapy on that either.

Any chance we could get that 12ld and a basic metabolic panel? I like the idea of adding fentanyl.

I'm not convinced this is sepsis. Right now I'm concerned about his apparent V/Q mismatch. How about coags?

Lactic acidosis, markedly elevated A-a gradient, elevated CK, and significantly decreased urinary output. This guy is in shock, the question is why. H&H? 12ld? sounds like a fun trip.

I had a situation that might qualify. 40 yo male, single stab wound to the L chest, just below the nipple, holding himself up off the sidewalk with one outstretched arm, cyanotic and non verbal with JVD to the jaw, loses consciousness. We started to ventilate pt, clear bs with ventilation w/good compliance, sinus tach 130's w/o palpable pulses. Drop a needle into his L chest, no change, I am sure this guy has a tamponade, however pericardialcentesis is not within the paramedics scope of practice in my state. I have been educated on the procedure and have performed it in ATLS and in live animal labs and it crosses my mind that it MIGHT help, certainly not going to hurt at this point. Anyway, I don't perform the procedure, he gets a thoracotomy on arrival to the hospital and his pericardium is opened and evacuated, taken to the OR were he expires. Did I do the right thing? I don't know. Would he have survived if I had done it? Don't know. I do know that I sleep ok at night knowing I did everything I could within bounds of my authorized level of care.

We fielded the Glidescope for a trial, loved the view, but passing the tube was a bit different, there is no displacement of the airway anatomy w/the glidescope, so it was a bit different. As for using a bougie on every attempt, I don't. It is quicker to just use a tube and stylet, the bougie takes a few seconds longer, at least when I do it. I grab a bougie for an anticipated difficult tube, i.e. short neck, c-spine, etc...

If you look around the country at cities with non fire based, non private EMS you will see a labor organization representing them. This is what keeps the IAFF/FD at bay. I am all for a united national voice for EMS, that doesn't take their marching orders from the fire service. My union leadership has a voice in several national EMS organizations, and lobby at the city and state level. We have friends in Washington and are actively pursuing a national EMS memorial in DC that won't be a plywood board in a shopping mall in rural Virginia. From a somewhat selfish point of view, my union has negotiated with the city for better pay and benefits, on par with fire and police. This allows me to own a home, and live reasonably well without having to work 3 jobs and live on public assistance.

Intubated a guy yesterday with one, 50yo male, c-spine immobilized w/grade 3 view on laryngoscopy, placed a bougie and introduced a #8.0ett on first attempt.....big fan!

Our medical director is retiring at the end of the year, send him up!

I wasn't as clear in my post as I should have been. I am greatful for having a union (not the IAFF) that is politically active and lobbies for my interest as well as EMS in general, locally anyhow. The local IAFF has made several overt statements to the effect of merging or outright takeing over EMS, and has been successful in many areas around me. The IAFF thus far has helped you guys out with benefits, however for most non-fire based EMS systems the IAFF is a bad choice. Your dues go to an organization who has stated numerous times that they believe EMS should be run by the fire service. If it wasn't for the work of our union, we would no longer exist, of that I am certain.

When Big Red comes looking to take over your EMS system you will wish you had a strong, politically active Union to fend them off. How many EMS systems across the country have fallen to the fire service? Not having a union makes it way more likely that the IAFF with its political clout will roll right over you. Just the way I see it.

I'm glad it has worked out for you guys, I just don't trust the IAFF. Their mission in life is to promote the fire service, and if there was a big enough push to "merge" you into a fire service, I highly doubt they would be there for you. My benefits package is very good, pretty similar to yours in fact.

I'd ask around about that one, its happened before....Collier county, next step Lee....be careful.

Any non-fire based EMS agency that affiliates itself with the IAFF needs their heads examined.

"Known"

It comes from our operating budget from the city (taxpayer) and income from billing. Our billing rates have gone up recently, however we rarely collect on anything other than what insurance/free-care pays.

Our union has provided us better pay, better equimpent, better personal protection equipment, better retirement, a reduced residency requirement, lobbied city and state government for changes that would benefit EMS, and provided members with financial support when members have had serious illness/injury off the job. They have also spent more time than I would like defending crappy employee's who should be fired. I think, for us anyhow, the pro's outweigh the con's.

:roll: That sucks, you shouldn't have to be a medic to get a job as a firefighter. They will probably make you ride the box for a couple of years too.....Kind of like pergatory.

Hey Doc, that didn't take long.

Let them privatize the fire service too while they are at it.

Maybe laying off some Cleveland firefighters, who apparently are not needed to fight fires would give the city more money to hire Cleveland EMS Paramedics, to provide much needed EMS response. Typical IAFF Bull shyte.....Just my opinion of course.