Niftymedi911

In FL, like what was said. Just because you've had a couple of drinks during the day deosn't render you to an involuntary consent relam. It states that if the pt cannot answer questions appropriately or is giving you the impression that he/she cannot make the sound medical decisions for themselves, you have the right to transport on involuntary consent. Now, if the pt's aaox3 and can follow simple comands and refusing transport even though he's had a couple to drink, I'm going to have them sign for himself. Dust, you don't want to know......

Dust I cannot thank you enough for posting in that short, brief paragraph what my 8000 word response would of been. You have to think beyond the words here. Dust got what I was trying to say. I don't mind bueing busy at all, if fact I love being busy it makes the day go by fasterand I get better calls . What I don't like is an administration that as Dust put it knowingly and willingly put you, your partner and your patient at risk. Think all the way back to EMT schol, whats the most important priority when it comes to running a truck or call? Your safety!!!!! Even though I'm in the ripe young age of 20, I'm not nucking stupid ok? Some young adults this day in age, actually have a brain on top of that neck. So next time you fly off the handle with a response like that. Stop and think for a moment...... Oh by the way, it takes on average 1 hour to 2 hours depending on how long we have to wait to offload our patient at the ER. Any hospital we have to go to theres always an offload wait with 4 trucks in line. I've waited 4 1/2 hrs to offload one day. The other 19 hours I'm in station, I read, surf the net, strip and clean the unit, study, sleep, watch TV, lift weights, clean the station, oh yea the most important EAT!!! .

"can hang" Funny you should mention that...... I honestly wouldn't apply, because if you state that 1 24hr truck runs anywhere from 10 to 20 calls a shift that obviously shows that the agnecies administration needs a real wake up call. Not to mention they don't give a damn about the safety of the crew or the patient for that matter. If you've ran 18 calls in a 24 hour period (I'm sorry but you're gonna have to send someone else if it was one of my family members) and each call last roughly 45 to 1 hour, you've been up the entire shift in between breaks in emergency traffic and time spent out of service at the ER's while you finish paperwork and offload. I know there are "nation wide shortages" of medics etc. Honestly, why would I want to get my arse kicked if I could work for a service get paid 3 times as much and work maybe 5 to 6 calls a shift? I've been in that situation before and it sucks arse. So I "can hang" It used to be like that here before the new admin rolled in. They've put up 5 or 6 new stations and have implemented a first responder system (ALS FD) that can run Alpha/Bravo (medical priority dispatching) responses without always having to tie up an ambulance (public assist, fall down and go boom, no transport required, minor MVA's, etc). By the way I might add that all 22 FD's are independant fire districts in the county. It's not a metro based system. We've dropped our call volume by almost 15 % believe it or not. We still handle over 80,000 calls a year for a county wide system and to be honest last duty day I ran 7 calls and transported 4. Last call at 2000. Slept the rest of the night until shift change. It's not very bad at all.

Well, You can't always tell from the outside looking in, you would have to be there in that particular moment to understand, but that's why EMS is never the same twice. Unless you get that 3 am stubbed toe everyone seems to get. Dust, sorry to jump and take offense to what you had said, but with me being new, I get the same thing from around here, I feel that most of the medics in the South either take advantage of me or mock me becuase of how young and "green" I am. I really am soo used to snapping back to show that I am not the tpye to push around or talk about behind my back. I don't tolerate it, I will let you know. It's all Gavvvvvy Dust I can also understand your side of the relm Dust. I could of very well did the transport. I knew it after I posted what I read. Sucks how you get so narrow minded sometimes. But hey, either way I was doing what was BEST for the pt I didn't kill her and that's what matters most right? Not how many letters you can fit after your name. Being as young and new to being the Medic in charge as I am I felt what I did was in her best interest. With more experience and balls I would of probably handled the call in a much different way. Either way I would still stand firm on my decision to fly her out, but I would never rule out transporting on my own.

Hey Ruff, I get your point about the figurative speech thing, I might say something off the wall but I usually mean something else a habit of mine I really need to stop. I also respect you Ruff!! But from talking with you before I kinda saw where you came from, but never the less I shouldn't of generalized ya. My mistake! I just get so damn sick and tired of everyone ripping my posts apart as if I'm nothing but an idot. I might be new, but I am not an idot. Bout the pt choice thing, I give them their choices based upon their signs and symptoms. If they want to go XYZ but XYZ has no cardiac, I'll name the 3 hospitals that can handle cardiac and if they don't want to go to either of these, I have to inform the pt, call that hospital, and if they refuse to take her then, she's got no luck to go there. That usually summs it up to the point of I give the 3 choices again and then she chooses. I cannot take her to a facility AGAINST her wishes, it's called Kidnapping in the USA. If it's a priority 1 they really have no choice. Priority 1's usually go right to the closest facility. But here in Lee County each of the 6 hospitals specialize in only one thing, they don't all take in everything. So if it's a AMI pt they go to nearest cardiac hospital, CVA goes to the stroke hospital, Trauma goes to the Trauma center and minor crap goes to the hospitals with small 9 and 10 bed ER's. The LZ topic, Medstar has usually a 10 min response time anywhere in our county. From the time I call for them to the time they get on scene is roughly 12 minutes. FD usually lands them on scene but if there' no place to land they find one within a certain distance. I get what you say I could be driving already by the time they land. But to be honest, by the time I do my definitve Tx on scene and get the pt loaded and ready to fly, MedStar's already at the LZ waiting for me. The key is to have the assessment skills to know when you'll need MedStar within the first few minutes of arriving on scene. As any medic knows. From the time I arrive at the LZ to the time they're usually lifting off is under 4-5 minutes.

After obtaing the vitals and hx thats been posted I would: IV L 18 or 16 G any location obtainable I would like to try a jugular in this instance if a/c's are not obtainable Blood Draw O2 NRB enough to keep bag inflated* per local protcol // readying my intubation kit along with drawing up some Succ's, Etomidate and hanging a Diprivan drip in case of "Airway Alert" whats called on the radio to let dispatch now someone's getting tubed and to send an extra unit for help if necessary. By our Airway protocol dubbed CAM (Crash Airway Management) * I would also use caution though with the Diprivan as well with the local hypotension, more the likely I would just double up on the Versed and Etomidate to keep her sedated if all else fails. 12 - lead ATT I would venture to agree with most and call it WCT with definately a LBBB and maybe a hint of WPW * Call for MedStar ( aeromedical helicopter), I work in the south sector of Lee County, which is roughly 40 min by ground to any facility that can handle this pt * by local protocol Versed at 2-3 mg IV, if IV unobtainable, *administer .2 mg/kg (for a total of 8 mg)(.2*40=8) intranasal via MAD* by local protocol Defib pads on, 100 J ready, set, clear, *bam* If converted, Amiodarone 150 mg in 100 cc of D5W over 10 min Repeat Cardioversion if unsuccessful at 360 J Pray to God it converted If pt is not converted by this time and mental status is still is still declining, definately getting tubed for airway protection Haul ass to LZ, wait for Medstar 10-97 (arrival), transfer pt, call the hospital, and clean up for the next one.

When rescue randy's landing the chopper in the roadway. EMS, FD and PD are just now pulling on scene. The best comes to my mind.......... "Medic 20, respond possible airway obstruction" Comments: Female Y (Awake, Alert) / Y (Breathing)// unable to remove vibrator from throat." "Medic 6, respond to General Illness" : Female Y / Y // Vomiting Fecal matter "Medic 15, respond possible Signal 7 (DOA), Comments: Caller states, "strong odor coming from apartment x 2 weeks and dog is usually present has stopped barking", //// *Rescue is not responding*

2nd level 91!!!

As much as I hate getting these calls, plain and simple what can ya do? Your dammed if you do and dammed if you don't. My simple saying is this, I'm sure everyone's heard it, "You call, we haul". Now, I'm in complete content in calling sherriff's office to have them handle and explain the procedure to the pt that insurance anit gonna cover it, you will end up in triage, (almost all priority 3 pt's who are not backboarded and are taken to the ER, are sent to triage before they even see a bed) and you'll get sick of waiting and sign out AMA. But the sheriff's dept. they'll just "accidently" find something wrong with her (cough cough, opps mam I didn't see there while I was opening my door") and then calls us back. So plain and simple, "You call, we haul". To be honest it helps us out at the end of the year based on our call vloume. And with our 67% (I think national average is roughly 47%??) revenue recovery rate for a 3rd service government operated county EMS agency which operates on a 48 million dollar / fiscal year budget, it helps me keep my job and the taxpayers happy. BTW our trucks have the "magic button" they stay locked not matter what. Approx. 38% (28,500) of 75,000+ calls here can absouletly find other means of transportation. Just another day here in God's Waiting room. If I had my way, we wouldn't even get on scene fire would cancel us, they tend to be a good voice ( the only thing they're good for) every now and then. I'm not always bright and shiny though, so if you call me at 2 in the AM for BS aka "My ankle hurts, it felt like pins and needles, numb (I'm rolling my eyes by this point) and now it's hurting a little bit, I think I might of hurt it when I kicked my flip-flop off, can you take me to the ER so I can get seen quicker?". No deformity no edema, please do not expect a smiling face. Our agency is supposed to be trying a new taxi voucher program for these people. Don't know when it's coming but word is it will be soon. Ok hack away!!!

I will not use 10 codes for future referance. I can make all the excuses up in the world to make it sound right, but you know its useless. With that said I was having a very bad shift, it caught me off guard and I took it offensively. My apologies.

Thank You Ruff For those of you who are lazy and cannot read between the lines: 10-6=busy

funny you should ask this question Ruff, Sat night I ran a mvc call. Rescue parked their truck diagonally across the road while on scene in a residential neigborhood. Lady was stoned and doing 70 mph and went head first into a 5 ft deep ditch. If it wasn't for the ditch it would of been the house. Anyway, rescue was still 10-6 on scene and we had a priority pt in the back, the only way to get around the rescue truck was to go off road around them to get back to the road. Well we have those extended cab freightliner MAV's and the rear end is a pain in the ass. Made it around the rescue truck but when the rear end swung back around when I turned and head for the road, I clipped and took out a black mailbox. Notified dispatch and my shift commander at thie time and a supervisor met me at the hospital to do a report. Being told that I have to replace the mailbox.

Would it be too far fetched to go into HazMat situations?I would my assessments accordingly like as previouisly stated only adding the following : Airway Management Definately a repeat blood sugar Law Enforcement invovlement ( if not for suicide reasons, but an attempt to scare the kids into talking). ETCO2 Cardiac Monitor

Dust, oh dear friend. you crack me up. BTW that shit is wack, yo, lemme shout out to my peeps in EMTCity land!!! Yo. LOL I do talk like a normal person, when I'm not messin around. Later haters!

EMD doesn't make very much of a difference, except in one instance. Cardiac Arrest. If EMD is not refused, some type of cpr is being done, ill biet it might not be the absouletely best way, but at least something like that is getting done. Remember the 5rings in the chain of sruvival. Early CPR is the best case scenario. We get alot of people down here who are CPR certified and if the call just happens to be there, EMD is utilized. ( Only a few calls however have turned out for the better utilizing this system).

Here's the article reffering to the 24 hr stations what they are equipped with in our contract between LCEMS and our Local 1826 IAFF union: Atricle 34.3 Twenty-four (24) hour stations shall be supplied with the following minimum equipment and services: Two (2) twin beds Air conditioning and heat Microwave oven Video VHS/DVD player Full-size refrigerator In stations where a stove is not permitted, but an outside gas grill is permitted, said gas grill and a propane tank will be provided. Employees will be responsible for providing the propane. Radio Plectron Assortment of dishes, to include plate, drinking glass, coffee cup, knife, fork and spoon. Color television with cable service or satellite. Telephone (local service) Internet ready computer Sink /Counter combination for kitchen area Water service Bathroom with bathing facilities Assorted cooking pans and utensils One (1) night standllamp per bed Electric service Desk area for paperwork with lamp Shift loclters - three (3) to nine (9) as space permits Chairs for desk and tables, recliners for the day area (one per person on duty) One (1) Union bulletin board (to be supplied by the Union) Properly secured location for storage of Weapons of Mass Destruction (WMD/Extrication) bags As far as part-time employees, you have to be credentialed by the LCEMS FTO program, Medic or EMT that currently works for another ALS service in Lee County under the Lee County Wide Medical Protocol. Meaning working for a fire department (ALS) and then work part-time for us. You cannot work more then 48 hrs in a 2 week period. But must work at least 1 24 shift a month. You do not recieve benefits part-time. In other words you have to be a full time employee to get hired, but if you get throught the FTO program and are credentialed (released), then if you have a fire cert and get hired on with one of the 22 fire departments that are ALS, you can switch your status to part time and still work with us. Otherwise we don't hire part-time employee's outright from the outside.

If I could make that much and work less that would be heaven, but to be honest I'm used to the 24 on 48 off work schedule. Our union is tyring to get us the Kelly day included, but management right now doesn't want to hear it. (Of Course). Life at LCEMS has its ups and downs as with every other agency, management doesn't always have their head screwd on straight, but at this point in time, I started young enough with the FRS I can enter the DROP program at 39 and retire by the time I'm 44. Now thats what I call retirement. I understand what your saying about the whole smoke screen, I know admin, likes to do this alot. Our union does fight for us though. Which I am very thankful for. Oh yeah, BTW we have 33 stations in the county, all have high speed internet, cable TV, a fully stocked kitchen, seperate bedrooms, a majority of them are with the fire departments at this time.

I'm not a management person..... I'm "just an EMT" who is trying to help someone out. Do I really think LCEMS is the greatest place on Earth to work? No. But is it worth the troubles that we all sometimes have? Yes. Hey Former, Stop being a hater (jealous) just because you dont have what we've got. My base salary is $27,808.99 /yr. Period. But you have to factor in my built in OT bc its hrs worked in my regualr schedule (833.6 total hrs). I'm EXACTLY at $44,539.34/yr. To be a EMT-B and make that much money with 2 yrs experience in EMS, I'm making dam good money. I would guess one of the biggest items we have that most agencies don't like is OT. We have an abundance of OT which anyone is eligbile for. I do 48 hr on / 24 hrs off. The maximum amount our agency lets us work in a 72 hr period. My 2006 total salary as stated on my 2006 tax return for a 20 yr old EMT-B with 2 yrs ems experience..... $54,620.00. The way the pay rotation goes: Every 2 weeks we are paid, The during the process of a month are given 2 big checks (ones with the built in 40hrs of OT) and a smaller check which has 16 hrs of OT built in. So to recap is 120hrs / 120 hrs / 96hrs the it repeats. Math: The following is appiled to starting EMT salary, if you choose to find out Medic salary use the same formula just plug in the higher hrly rate. Total hrs worked per yr in 24 hr rotation: 2,912 OT included. Total hrs of OT worked 833.6----> OT figuring: Of the 26 paychecks we recieve /yr 17.4 of those have 120 hrs of OT on them the rest 8.6 have 16 hrs of OT. So, 17.4 * 40= 696 // 8.6 * 16 = 137.6 ///// 696+137.6= 833.6 2912(total hrs worked)-833.6(total hrs of OT)= 2078.4 hrs worked at base (13.38/hr) 833.6* $20.07/hr (rate of OT)= $16,730.35 total amount of OT earned in 1 yr working regular shifts 2078.4 hrs * 13.38/hr = $27808.99 $27,808.99 (base) + $16730.35 (OT earned working regular shifts) = $44,539.34 total annual salary for EMT-B starting with LCEMS. So, I hope this helps ya!!!! Fred Jackson AS, EMT-B C Shfit / South Sector LCEMS

I'm not quite sure of the name of the guy who invented the technology, but someone from Texas created the technology which gets implanted into the car's stock radio and when it detects certain noise levels its shuts the music off and alerts the driver of an oncoming emergency vehicle. It looked very promising but havent heard anything since. I would love it. . And the whole age thing is bogus. I'm 21 and can drive better then most 30 yr olds in my service. Most pepople prefer me over someone else because of that.

These are the units we use:

Here's mine!!!! It's Florida!!!!! Pro's: Sunny year round, fishing is awsome, shopping can't be beat, the pay is the second highest in the state of Florida. The con's: Housing is expensive, cost of living here is high, traffic is somewhat to be desired. The angecy is very progressive medically, we have one of the nation's most aggressive RSI protocols and have recently placed Lopressor on our units. We utilize Zoll monitors which include NIBP, ECG, 12-lead, Pacing, Semi and Automated De-fib, ETCO2. We utilize Stryker Pro strecthers and have added the Stryker Power Pro (hydralic lift ones) to our arsenal, soon to be released to all the units. We utilize American LaFrance Medic Assault Vehicles (MAV) on Freightliner chassis. We utilize Wheelen LED and strobe lighting packages on our units. We utilize Motorola's 800 Mhz Astro Digital Trunked system for communications which enables us to provided 100% inter agnecy interoperability. We utilize Motorola's computer aided dispatch system (CAD), Premier Mobile Data Computer system (MDC) to operate the 911 system. We currently utilize the ProQA medical priority dispatching process. We currently utilize GPS tracking for closest unit response. We are in the process of installing the Marvlus and Siren dispatch systems which control and anticipate call volume and unit statuses. We currently operate 33 ALS units 24/7. We are in the process of creating a tiered (ALS/BLS) response system. We handle all emergent and non-emergent interfacility transfers as well as all 911 and non-911 calls within Lee County. There are 22 fire districts in Lee County. All offer first-response. 17 of the 22 offer ALS first response, 5 offer BLS. 2 ( Lehigh Acres FD and Fort Myers Beach FD) of the 22 are ALS/Transport. No private ambulance service has a C.O.N to work in Lee County. We have 2 work shifts currently 12 or 24 hr and are paid based on a 56 hr work week. Meaning any hours worked over 40 is OT. Boiled down thats 32 hrs of OT per paycheck just by working your regualr shifts. We also belong to the Local IAFF 1826 district 2 LCEMS union. BTW our website is http://www.lee-ems.com/ems/default.htm. You can view it and explore at the bottom. Salary: 24 hr Shifts: EMT-B starting : 13.38/hr (roughly $45,000/yr) EMT-P starting : 14.76/hr (roughyl $52,000/yr) EMT-B Maximum: 19.67/hr (roughly $62,000/yr) EMT-P Maximum: 21.73/hr (roughly $73,000/yr) 12 hr Shifts EMT-B starting: 17.84/hr (roughly $44,800/yr) EMT-P starting: 19.71/hr (roughly $51,800/yr) EMT-B Maximum: 26.23/hr (roughly $61,800/yr) EMT-P Maximum: 28.97/hr (roughly $71,800/yr) Benefits: 100% paid medical, dental, vision insurance Paid pension into the Florida Retirement System ( 25 years of service and out with a 5 year DROP option) $250,000 paid life insurance policy Short Term and Long Term disability Tution Reinbursement Paid Vacation and Sick time [web:e187888069]http://www.lee-ems.com/ems/default.htm[/web:e187888069]

I'm in the same boat, our agency is nothing but ALS, but now that we have the AMPD-Pro Q/A service I'm trying to get Admin to take a look at the QRV response model. 1 QRV for every 2 units we have in the field. So total of 15 QRV's throughout the county that can handle the lower priority calls which in turn leaves the ALS transport units available for Echo, Delta, and Charlie responses. The QRV's (ALS) would be utilized for all calls, but if its an Aplha or Bravo response, send the QRV and they can decide if transport is warrented. We're nearing 80,000 calls per yr with 32 units now. It's time our dinosaur response dies.

Word Spock!!!!! We typically start right where your talking, and i've also seen someone under medicated with propofol and wake up with th tube. Not a pretty thing, if you've got a tube down your throat and 4 lead, spo2, capnograhy, NIBP hanging off of you. Anyway, We have all offline medical guidelines, we do not have to call MD unless we've given the maximum does of Morphine and still wanna give more or we want to pronounce someone dead. So a lot of this training we call "monthly in-service" where we meet our medical director, and he brings in trauma docs locally and upstate and they come down and talk to us on a particular subject. Last month it was based on our new protocols for carring Lopressor on the truck and certain changes in the protocol book. Next month if I'm not mistaken is an airway in-service. We're reguarlly trained and in serviced on new ways of handling things. We also in our agnecy must past a what's called 2 yr skills based credentialing. We have to demostrate all ALS if your a medic and BLS if your an EMT in front of our training department and if we meet standards we're credentialed for the next 2 yrs. If we dont we're either remediated until its done right or the send us back on an FTO truck for 2 months. If they still can't pass that then its game over. Anyway, the tones dropped and my relief is here so Peace be with you my brothas in EMS! Fred