I am feeling really bad....

[p3medic]

Thats too bad, you should be evaluated by the same person (in my opinion) for a set period of time, one shift doesn't cut it. It sounds like a tough place to work, you can tough it out, or perhaps look elsewhere. I have no idea where you are or what other opportunities you have but I wish you luck. My only advice is to try to take a little something from each of your FTO's, even if that something is how NOT to do something.

[Mateo_1387]

Kaisu,

First, thanks for posting this. The responses have been helpful for me, as I will soon be in a position where I may face some of the hardships you are now facing.

Second, I get the idea from your posts that you are dealing with people who do not understand things outside of their own realm (such as how to do paperwork) or are intimidated (such as running directly to their supervisor). I would be willing to bet that you are the top dog at that agency. You know you have an education, you know you have clinical experience, and you know that you have the experience of emtcity. You are certainly a well rounded individual, with life experience that I am jealous of (I am entering a Medic position at a young age). You just lack working full time for an agency. Getting up to snuff with the agency will be easy. Getting familiar with a "mother may I" (having to ask for morphine) system and less than competent personnel is going to be easy. You already had them beat when you walked through the door. Kaisu, you have value, DO NOT let them beat you down. Show them that you are a Paramedic, and you can hold your own. It may mean just hold out until you get your own truck and are working with one partner. When you get to that point, be in charge ! I do not think it will take you long at all to be well respected among your peers as a competent medical provider. You are going to excel fast, its in the cards.

Third, If things do no work out for you, then come to NC. We have some good EMS systems, and we would be all the better to have a paramedic like you !

Good luck Kaisu

[reaper]

Kaisu,

If there are other job opportunities in your area, I would explore them. This system sounds like it is outdated and does not really care about catching up.

It is up to you, but if something happens, they will leave you out to dry. The service and the people will cover their own butts, before covering yours!

[defib_wizard]

I asked for the protocols. Was told that there is only one per station - cannot take it home - cannot carry it on the rig - and SOPs do not match the protocols which are poorly written (old flowchart style).

Call your base hospital prehospital coordinator for them. If you don't have their number you can get it on the dhs web site.

Paramedics make remarks like - amiodarone is crap - we are taking it off the rigs.

It is an optional drug in Az we don't carry it here because it won't work if it ever gets hotter than 77 degrees.

We have no 12 lead capability - people call ST elevation on only one lead - which is crap.. as far as I know it has to be 2 continuous leads

You are right but 12 lead is not a requirement here, yet!

[portables often are missing or dont work./quote]

You are required to have one per dhs.

Sorry but the drug box contents is a state thing. They make the rules and for right now all we have is morphine as far as pain control.(Its been that way for a long time ) Up until the past few years we always had to patch for orders for it.

Again people are resistant to change. The good news is if the hospital will give them to you take them and use them. Who cares what they are called, we don't carry heparin so we use saline. why not hang a bag on everyone if they need fluid ( and most of us in the desert do ) you can give it. If they don't then run it at tko. Plus if your patient crumps then you can give them a bolus immediately instead of needing to set up and attach an iv line to it. In my opinion saline locks are better suited for in hospital anyways so the pt can get up and go to xray or the bathroom without a pole if they are ambulatory. This isn't in-hospital it is pre-hospital so hang a bag and go with the flow. ( pun intended )

Please don't think I am being mean. That is not my intention but here goethe the butt chewing.

You have trained to be a paramedic now it is time to be one! Leave your emotions off your sleeves or the dickheads will see you as a target. See if you can make copies of the protocols if not go get a paper pad and write them out. Keep it simple here is an example;

Chest Pain- O2, IV, ECG, go to dysrhythmia if cause, ASA, NTG Patch for MS.

Laminate them and study them and carry them with you. Make sure your ride is ready, if they turn off the O2 without draining it so what if you leave it on the O2 is still in the line. They probably leak so the line will purge them selves. For right now my advice is this try to learn from your FTO's, even if it's what not to do. Find your niche, Pick your battles wisely, let the base hospital learn through your actions and documentation that you know your stuff. Then try to change things, otherwise they will just think your a know it all from somewhere else and try to force you out. Learn the system, earn their respect, then you can fight the system and try to drag it into the future. We have made some good changes in the past few years in Az. You can help us progress into to future.

[Asysin2leads]

I am getting so much valuable information and insight from you folks I can't believe. You all are my secret weapon :wink:

OK - so I have some more questions - I have no uniform - they told me I don't get one until after I am off probation. I bought some navy pants and white polos and show up on scene with nothing IDing meas a paramedic or EMT or anything.

Kaisu, the more you describe your workplace the more and more I get the sense you have made the wrong choice of places to work. Not giving you a proper uniform or at least something to identify you as such is really unprofessional of them.

I asked for a fanny pack (which is issued to all paramedics) got a bunch of double talk. I carry my ears around my neck and my pens in my pockets - 1 credit card, my motel key and a bit of cash. No place assigned to put my stuff. My probie book is out on the desk for all to see. My car keys too - unless I stuff those in my pocket too.

Fanny packs are one thing. Uniforms are another.

I asked for the protocols. Was told that there is only one per station - cannot take it home - cannot carry it on the rig - and SOPs do not match the protocols which are poorly written (old flowchart style).

A big huge major red flag for me. I'm actually kind of curious what service you are working for, now.

Paramedics make remarks like - amiodarone is crap - we are taking it off the rigs. The main O2 is turned on and off each call - and the regulators and lines are NEVER purged - uses too much O2.

What is stocked on the ambulance is up to the medical director, not the paramedics. Have you spoken to your medical director at all?

We have no SPO2 on the Lifepak and the portables often are missing or dont work.

We have no 12 lead capability - people call ST elevation on only one lead - which is crap.. as far as I know it has to be 2 continuous leads.

The SP02 isn't really required... its pretty much standard equipment, but it isn't a requirement. I'm not sure what monitors you are using, but as far as I know, simply speaking, an EKG has too modes, monitor and diagnostic. A 3 lead EKG is in monitor mode, while using the 12 lead uses a far more sensitive diagnostic mode, and therefore ST elevations cannot be properly assessed on a 3 lead machine. I don't know if you are required to have 12 lead capabilities but you should check.

We have one option for pain control - morphine - and even in MI we have to get permission to give it.

The catheters are awful - they are a pain in the ass to use. Everybody gets a bag hung unless we pick up saline locks from the hospital - which everyone looks at me like I am speaking martian because here they are still hep locks...

Not everybody carries fentanyl. I've only used morphine, and I had to get permission to use it to. Compared to the other things you are describing these seem minor.

OK OK.. I guess I am coming across as a whining crybaby - but I have not said a word about any of this to anyone - I figure as a newbie on probation I have way too much on my plate to ask these kind of questions.

It doesnt make me feel good tho. It undermines my confidence in the system and in myself. I dont want to learn the wrong way to do things. Now I've gone and gotten myself all upset again.

big breaths - deep, cleansing, big breaths...

goes away muttering - maybe something mindless on tv....

Kaisu, I'm not sure if you're really looking for advice or if you just want people to tell you it'll be okay. I think you know me well enough to know I'm not in the latter category. But I really want you to take this to heart. From what you are describing, you are employed with a very poorly run ambulance service that has little to no regard for safety or patient care. The problem is that as a paramedic, you will held responsible for safety and patient care issues on a call, held responsible both civilly and legally. My advice is that you need to resign from this place before they put you into a situation on a call that I wouldn't want anyone to be in. If you value your certification and you value the care you provide to your patients, you need to really need to work elsewhere. You are really juggling molotov cocktails here.

[Kaisu]

There is a nutshell is part of my dilemma. Defib is an Arizona paramedic. This is business as usual in this state. Coming from NY as Asys or in my case NE Wisconsin (where you can't beat a bush without flushing out medics) I am appalled. It is a huge shock. I know how things are run in my state. This is not how things are run in my state. It makes the adjustment even more difficult. I am NOT looking for people to tell me it will be OK. The insight I have gained from your comments is invaluable to me. I have been very careful to not appear as an out of state know it all. That also has been a difficult balance to strike because now I am being treated (by some) as a target cause I take s**t. I am going in in about an hour for my first shift after 2 days off. At least my stomach has stopped churning and I can actually walk in there and give it another whirl. BTW - I have been told that I need to get my driving in. I have been in this city for 2 weeks today. They will have to get someone else to drive.

PS.. I don't know if I mentioned, but my family and friends are 2000 miles away. I am living in a motel room until I get into a house on the 6th of October. You people here are my lifeline because there certainly is no-one at the station that I know well enough to trust.

PPS - When I mentioned to my supervisor about the 12 lead thing he sneered and said we don't have that luxury. You can always run a modified 12 lead. So then I asked about the monitor vs. diagnostic mode and he ignored me and walked away. During the chastisement I got for something else, he asked me if I was comfortable with the operation of the LifePak. I said NO - He gave me this long speech about how he would be happy to break out a set of pads and let me play with it. I guess I have to add this to my list of things to do - after my rig checks, after writing out the protocols (or obtaining a set) etc etc etc etc. That's the overwhelmed part I was referring to earlier.

PPS - I didn't know that about amiodarone and the temperature. See - now stuff like that is super to know. When I asked people why they didnt like it, they told me "it doesn't work". One said "it's onset of action is too long". The second was something I researched, the first didn't help me at all. So thanks for that too... (as long as its true - I will have to check it out.) :wink:

[dougd]

I'm not a paramedic, but I can't help but comment on some of this from a manager's point of view - granted, the phone company isn't EMS, but basic management and training concepts still apply.

OK - so I have some more questions - I have no uniform - they told me I don't get one until after I am off probation. I bought some navy pants and white polos and show up on scene with nothing IDing me as a paramedic or EMT or anything.

I'm sorry, but that's just crap. Unprofessional crap. At the very least do they have required dress standards for new employees (e.g. wear navy pants with a white polo shirt)? How about just a tank top and some ripped up jeans tomorrow? Is that the professional image they're striving for? Why can't they provide you an ID to hang on the shirt? Something, ANYTHING, to identify you as an employee of the company. I can't get in to the building where I work during the day, nor out of the hallway in to my office without my ID card - and we're not doing anything as important as dealing with human life. Same thing with my job at the ambulance company - I can't get inside the building without my photo ID which also unlocks the door. Do hospitals actually let you just walk in at night without any ID? Sounds like I could have a field day social engineering my way around down there.

I asked for the protocols. Was told that there is only one per station - cannot take it home - cannot carry it on the rig - and SOPs do not match the protocols which are poorly written (old flowchart style).

Again, crap. Big time, red-flag, screaming "WE SUCK" crap. A supervisor's job is to give you the tools you need to be successful. Unfortunately, you have a shift stupidvisor instead. Similar to the customs agent who seems to take a certain degree of pleasure out of harassing the stuffing out of someone who misunderstands one of their directions - if you take people with minimum education and no spine and put them in a position of limited authority, they'll go out of their way to get over on the few people new enough to let them get away with it so they can feed the need of their otherwise fragile and bruised ego. Time for them to suck it up and admit that the cost of a couple of bound printouts is a cost of doing business. If your boss can't provide you a written copy of the medical protocols, how exactly do they expect you to treat patients? How can they demonstrate what standard they are holding you to? I have to wonder how the doctor who is signing off on those protocols feels about that.

As for writing the PCR's. I can understand your FTO reviewing your run report. What I don't understand is the idea of making you write it on a separate sheet of paper, reviewing it, then giving you permission to write out the PCR. That's Mickey Mouse bullshit and you know it. A better solution would be for the FTO to do the first few PCRs and have you review them and ask questions you might have. Then, you write one and he reads it, challenging you if he has questions, and offering some suggestions or coaching on what you could do differently. You can always amend it, and if it really is that horrible, you can write a new one. That's the constructive way to do it and you'd probably both learn something out of the process. It's certainly useless for him to scratch out your entire narrative and then put in one bullshit line and basically say, "That's all we need, silly yankee girl." Frankly, at that point you tell your FTO to go f*uck himself and if that is a problem, you find a new employer. These people either do NOT want you to succeed or have no idea how to help you succeed.

[Just Plain Ruff]

copy your protocols if you can't take them home.

I'd be curious as to how many times that book has been looked at in the past 5 years. Probably 1 time per year by new employees.

If they refuse to let you copy them then that is a HUGE HUGE HUGE red flag that reeks of "I'm scared, put me back in the box" to semi-quote Achmed.

To re-iterate things - if there is another service you can work for, try getting on there. You may be forever harmed (mentally and careeer) by this service.

[DwayneEMTP]

Kaisu, what is your motivation for staying here? I know you're not a quitter, that you have issues with allowing them to chase you off, but this place, from your description, sounds ridiculous.

I know you killed in school, you've been successful in most everything you've tried in the past, I know you have other options....So what keeps you jumping through hoops to earn the right to work in a system you won't be proud of?

I know you're smart, beautiful, strong and have other options...Tell them to go pound sand and work for a place that has some self respect.

Dwayne

[Asysin2leads]

Kaisu, like I said, I'm not sure of the requirements of your area but you need to find out. You need to look at your protocols. My protocols say something along the lines of, specifically, "12 lead EKG's must be performed on all stable chest pain or cardiac patients," and from I know it is pretty much the standard of care. It is possible your area has not gotten in line with the national standard, but if it is a requirement, and you're not doing it, that is a major problem. I can't specifically quote the Medicare and Insurance billing requirements from the top of my head, but if your company is billing people for 12 leads and you're not doing 12 leads, this is really an area you don't want to get into and you do NOT want to be signing call sheets that say you did a 12 lead when you did not. The state, the insurance companies, and your medical director will not care what you were told to do by your employer. The onus will be on you. Watch your ass.