There are many posts going up about guns in EMS and allowing concealed carry on ambulances.
Rogue
The ever wise Ambulance Driver
I am not going to take the time to research the numbers because I do not need to. We see story after story of EMS personnel killed in motor vehicle accidents while operating ambulances. We all know of personal friends that have had to switch careers because of work related back injuries. I have had friends severely injured in falls and other hazards that are common to allot of the scenes we go to everyday.
Why the hell are we so focused on the "what if this happens" and the need to "be able to defend ourselves" of something that is so rare and unpredictable there is no way to prevent it 100%. I now only know of one person shot at while working EMS in the 17 years I have been doing it. This on person was fodder in random violence and no firearm or amount of training could have prevented it. Thankfully he is OK and escaped with a few minor injuries. Would he have been able to respond if he had been carrying concealed? Sure but, out of the shot out window in the back of a truck going hot he would have been totally ineffective with a sidearm against another vehicle. All he would have done is put a lot of others at risk with flying lead.
We can decide to worry about the risks we can mitigate:
Back injuries are a needless thing and are caused by the carelessness of lifting mechanics. You know those classes some of you are daydreaming in. Daydreaming of how we can get concealed carry on the ambulance instead of learning something and applying it.
Vehicle accidents cannot be taken out of emergency driving but, proper training and risk mitigation can lower the numbers and injuries. Maybe a proper priority dispatch system and an attitude change of fast and reckless driving. This is by far the number one killer of EMS personnel, not a violent bystander or patient.
Instead of weapons we should be asking for Non-Violent Crisis Intervention training. We should be asking for Verbal Judo training. We should be asking for self defense training so when the time comes to run and someone wants to stop you from running you can persuade them to let you go. If I remember right there was an incident in Louisville KY a number of years ago that killed a Paramedic and her partner. When they entered a house they were shot and killed. There is no weapon that could have prevented this and they did not know what hit them. If arming medics was the answer why do we have Police Officers being ambushed and killed? They are trained and armed to deal with that.
In my medium sized city we have had 66 stabbings, 63 shootings, 321 robberies, and 14 homicides so far this year. 464 incidents of violent encounters in the city and 1 against EMS, less than a .2% chance in 1 out of 17 years I can remember that EMS was targeted. I know of 4 ambulance that have been severely damaged out of 15 trucks, 27% of the vehicles. I am more concerned about 27% than the .2%.
We need to get out priorities straightened out and fix what we can.
Thursday, September 27, 2012
Thursday, June 14, 2012
C'mon man, EMS style...
Clicky here for full story...
Low speed accident staged for insurance fraud. Ambulance arrived and flew two patients that had minor injuries. Patients became criminals and were arrested for felony insurance fraud.
I was not there but, the Trauma centers found minor injuries so I feel it is safe to assume someone needs some remedial training on assessments and when to fly. To review here is some data from a study done earlier this year:
Vital Sign changes - 2.8%
Injury only - 4.7%
MOI - 8%
Vitals Sign changes + Injury - 15.4%
Vital Sign changes + MOI - 14.6%
Injury + MOI - 10.6%
Vital Sign changes + Injury + MOI - 50%
Those are the numbers on how accurate each indicator is on predicting major trauma. If you feel the need to fly based on mechanism maybe you should contact the local National Guard Base and find out the availability of a Chinook or Blackhawk to fly the vehicle instead of your patient. It would free up both HEMS resources and the local wrecker companies for the real work they need to do...
Low speed accident staged for insurance fraud. Ambulance arrived and flew two patients that had minor injuries. Patients became criminals and were arrested for felony insurance fraud.
I was not there but, the Trauma centers found minor injuries so I feel it is safe to assume someone needs some remedial training on assessments and when to fly. To review here is some data from a study done earlier this year:
Vital Sign changes - 2.8%
Injury only - 4.7%
MOI - 8%
Vitals Sign changes + Injury - 15.4%
Vital Sign changes + MOI - 14.6%
Injury + MOI - 10.6%
Vital Sign changes + Injury + MOI - 50%
Those are the numbers on how accurate each indicator is on predicting major trauma. If you feel the need to fly based on mechanism maybe you should contact the local National Guard Base and find out the availability of a Chinook or Blackhawk to fly the vehicle instead of your patient. It would free up both HEMS resources and the local wrecker companies for the real work they need to do...
Wednesday, June 13, 2012
A Good Start
Six months ago last Sunday I completed my first six months as a Paramedic on the street. Five of those months have been solo and it has been the most fulfilling six months out of all the years prior in EMS. I have withheld treatments that in the end I kicked myself in the ass for withholding. I have been called to the carpet by the armchair quarterbacks and came out of it better at charting. I have learned how valuable and irreplaceable a strong EMT is when the shit hits the fan with multiple patients and no second truck. I have learned a whole new way to practice medicine and remember why I thought this was the best job when I started years ago. But, there is one lesson that I have learned that is the most important thing that cannot be taught in class.
Sometimes you have to go with your gut feeling. Monday I responded to a call of a weakness and dizziness. On patient contact I really was not given anything concrete to go with other than sinus tach, confusion, weakness, and hypertension. History was a little concerning with three weeks worth of spells of vertigo still undiagnosed. Gut feeling was CVA even though I had no clear symptoms with a FAST exam. I went with it and was off scene in five minutes delivering the patient to CT in another nine. Yes, patient contact to CT was 14 minutes. On arrival those clear signs were beginning to show with facial droop and more pronounced left sided weakness than right side. An awesome ER staff and Doc who trusts us and our field judgments started TPA within 70 minutes of onset of symptoms. The results were a patient who had no deficits being transferred to the ICU later that evening.
I cannot begin to explain how rewarding and fulfilling it is to know you started a process that involved a whole bunch of people and it literally gave someone their life back. If there is one thing I can suggest to a new paramedic or if I was allowed to share one piece of advice to others it has to be what my trainer told me: "Sometimes you have to listen to what your gut says and run with it." The next would be sometimes we do not need to inflict our skills for a best case outcome. The only advanced skills I did on this patient were an EKG to rule out dysrhythmia along with an IV en route to the ER.
I am looking forward to the next six months and years to follow. I have a full-time job in the works for the end of this year or beginning of next year. I have been working full-time hours in a part-time position for the last six months and will be in heaven when I do not have to report to my current full-time job in the future.
Sometimes you have to go with your gut feeling. Monday I responded to a call of a weakness and dizziness. On patient contact I really was not given anything concrete to go with other than sinus tach, confusion, weakness, and hypertension. History was a little concerning with three weeks worth of spells of vertigo still undiagnosed. Gut feeling was CVA even though I had no clear symptoms with a FAST exam. I went with it and was off scene in five minutes delivering the patient to CT in another nine. Yes, patient contact to CT was 14 minutes. On arrival those clear signs were beginning to show with facial droop and more pronounced left sided weakness than right side. An awesome ER staff and Doc who trusts us and our field judgments started TPA within 70 minutes of onset of symptoms. The results were a patient who had no deficits being transferred to the ICU later that evening.
I cannot begin to explain how rewarding and fulfilling it is to know you started a process that involved a whole bunch of people and it literally gave someone their life back. If there is one thing I can suggest to a new paramedic or if I was allowed to share one piece of advice to others it has to be what my trainer told me: "Sometimes you have to listen to what your gut says and run with it." The next would be sometimes we do not need to inflict our skills for a best case outcome. The only advanced skills I did on this patient were an EKG to rule out dysrhythmia along with an IV en route to the ER.
I am looking forward to the next six months and years to follow. I have a full-time job in the works for the end of this year or beginning of next year. I have been working full-time hours in a part-time position for the last six months and will be in heaven when I do not have to report to my current full-time job in the future.
Tuesday, June 5, 2012
Ready....Set....Hut...
There is a Jems article comparing EMS skills to a football play...
I cannot begin to portray how demeaning and appalling that I find this article to be towards EMS as a whole. Maybe it was wrote and published with good intentions. Maybe I am taking it in the wrong context. I do not know but it is not how I want my profession portrayed for a number of reasons.
I can teach a monkey to perform a football play and run through a certain gap in the line. I can teach a monkey to intubate a patient because it is repetition and muscle memory. That is where the similarities stop. What I cannot teach to a monkey is the discretion that it takes to be a Paramedic. Fourth and long is not that big of a deal in football, punt the ball and try again later. Fourth and long is life and death in EMS and that is where the playbook is usually of no help.
I read through the article and it a very little to do with calling a play and everything to do with laziness. Not bringing in the cot with the rest of the equipment, when did the trend happen that the cot is left out in the truck? The most important piece of equipment that we cannot function without or transport the patient is the cot and we are primarily a transport service after all. I can do a lot of things for my patients but, transport in a timely manner means more for a critical patient than anything else I do. I thank God for my firefighters and the assistance they give me when they are there but, I definitely do not rely on them to get my cot in the door. They are first responders not hose or cot jockeys.
Most Paramedics would take the airway kit, drug box, and monitor without hesitation on a dispatch like this. The mindset would be doing as much as possible without wasting time but, they left the cot outside...
Did this trend start when Paramedics and EMTs decided that they held the power to determine if this person's 911 call was legit? Maybe quit complaining about the last patient and how many cars were in the driveway, yes it is annoying, and start treating every call as an emergency until proven otherwise. If they had taken nothing in more than the cot, they would have been able to get this patient to the ambulance in a timely manner. Personally I have scene times of 5-8 minutes on critical runs because I have a cot with me and can do the rest while going down the road. Stroke symptoms, load and go…STEMI on the monitor, load and go…Respiratory distress or failure, load and begin treatment. These are the fourth and long situations of EMS, and without the ability to transport an audible is not available.
This scenario was doomed from the start because of an EMS crew that came in the door unprepared for a critical patient. The debriefing should have had nothing to do with a pep talk about football and everything about an ass chewing for being unprepared without the ability to begin immediate transport, an ass chewing for the Paramedic that did not take charge immediately with scene management. Maybe a hose drill for the Paramedics is what is needed but, instead of a hose use the cot. A few trips up and down the stairs to the roof lugging a Stryker Power Cot will create a lasting impression to treat the cot a little more like American Express and never leave the truck without it.
I cannot begin to portray how demeaning and appalling that I find this article to be towards EMS as a whole. Maybe it was wrote and published with good intentions. Maybe I am taking it in the wrong context. I do not know but it is not how I want my profession portrayed for a number of reasons.
I can teach a monkey to perform a football play and run through a certain gap in the line. I can teach a monkey to intubate a patient because it is repetition and muscle memory. That is where the similarities stop. What I cannot teach to a monkey is the discretion that it takes to be a Paramedic. Fourth and long is not that big of a deal in football, punt the ball and try again later. Fourth and long is life and death in EMS and that is where the playbook is usually of no help.
I read through the article and it a very little to do with calling a play and everything to do with laziness. Not bringing in the cot with the rest of the equipment, when did the trend happen that the cot is left out in the truck? The most important piece of equipment that we cannot function without or transport the patient is the cot and we are primarily a transport service after all. I can do a lot of things for my patients but, transport in a timely manner means more for a critical patient than anything else I do. I thank God for my firefighters and the assistance they give me when they are there but, I definitely do not rely on them to get my cot in the door. They are first responders not hose or cot jockeys.
Most Paramedics would take the airway kit, drug box, and monitor without hesitation on a dispatch like this. The mindset would be doing as much as possible without wasting time but, they left the cot outside...
Did this trend start when Paramedics and EMTs decided that they held the power to determine if this person's 911 call was legit? Maybe quit complaining about the last patient and how many cars were in the driveway, yes it is annoying, and start treating every call as an emergency until proven otherwise. If they had taken nothing in more than the cot, they would have been able to get this patient to the ambulance in a timely manner. Personally I have scene times of 5-8 minutes on critical runs because I have a cot with me and can do the rest while going down the road. Stroke symptoms, load and go…STEMI on the monitor, load and go…Respiratory distress or failure, load and begin treatment. These are the fourth and long situations of EMS, and without the ability to transport an audible is not available.
This scenario was doomed from the start because of an EMS crew that came in the door unprepared for a critical patient. The debriefing should have had nothing to do with a pep talk about football and everything about an ass chewing for being unprepared without the ability to begin immediate transport, an ass chewing for the Paramedic that did not take charge immediately with scene management. Maybe a hose drill for the Paramedics is what is needed but, instead of a hose use the cot. A few trips up and down the stairs to the roof lugging a Stryker Power Cot will create a lasting impression to treat the cot a little more like American Express and never leave the truck without it.
Saturday, May 26, 2012
Memorial Day
John 15:13 "Greater love hath no man than this, than a man lay down his life for his friends."
Time to drop your rucks and relax awhile, we got the next few patrols so you may rest in peace Brothers. From the cold of the Potomac River to the mountains of Afghanistan, and everywhere in between, you will never be forgotten and we will never allow you sacrifice to be downplayed or dismissed.
Take a moment to pay respect to those that have fallen to allow all of us to have a day off of work. Without those of our Armed Forces that gave the ultimate sacrifice none of this would happen. That is the true reason for the day.
Time to drop your rucks and relax awhile, we got the next few patrols so you may rest in peace Brothers. From the cold of the Potomac River to the mountains of Afghanistan, and everywhere in between, you will never be forgotten and we will never allow you sacrifice to be downplayed or dismissed.
Take a moment to pay respect to those that have fallen to allow all of us to have a day off of work. Without those of our Armed Forces that gave the ultimate sacrifice none of this would happen. That is the true reason for the day.
Wednesday, May 23, 2012
What the hell...
Video Here
Watch the video first.
Each of them, for their own reasons, concluded that the wars they fought in were wrong, and so they marched together today, about four dozen veterans of the wars in Iraq and Afghanistan, each prepared to return their Global War on Terror medals in symbolic protest. Soldiers like Sgt. Jacob George, who did three tours in Afghanistan.
"I do not feel like the intentions of the overall mission matched my intentions as an individual and most of the people who served," said George. "I am willing to give them back even though it is a very emotional thing for me."
"I was in Iraq in '03 and what I saw there crushed me," said Ash Wilson. "I don't want us to suffer this again, and I don't want our children to suffer this again. So I'm giving these [medals] back."
One by one, 45 veterans spoke of their own anger or pain, and each turned and threw their medals toward McCormick Place. They had asked that the NATO representative formally accept them. That did not happen.
"I'm one of 40,000 people that left the United States Armed Forces because this is a lie," said one veteran.
"I will not continue to trade my humanity for false heroism," said another.
Vincent Emanuele is from a multi-generational military family. Returning his medals, he says, is about sending a message to the world, but is also cathartic.
"For many veterans to deal internally with what it is we have experienced overseas and then to come back and to make amends for ourselves," said Emanuele.
"This medal right here is because I'm sorry - I'm sorry to all of you," said Aaron Hughes. Hughes, who served in Iraq, helped organize what became a moment on an international stage - a moment meant, he says to show disdain toward policymakers and not the men and women still fighting.
"I love all my brothers and sisters that are in Afghanistan still, and I hope they get to come home soon," said Hughes.
And I bet everyone of the 45 or so were the only ones drafted in the last 40 years. You signed up for a reason and when you were called upon to do your job, not duty since you have no idea of the meaning of the word, you fucking cried and said you never signed up for this. You were the type of Soldier, Marine, Airman, Sailor, etc that fucked up a unit and you never were able to make it in the military so you got out. You got out and then fucking cried about it and how horrible it was. But, you are the first ones standing in a line to get "what they owe you" all while speaking out against everyone of us that were there and did what was asked of us. I see your type everyday I am around liberals...
Do me a favor, pin the medal to the only copy of your DD214 and toss that over the fence with a note saying you give up all VA benifits and I may think of you as a person again. Until then you are lower than what I left in the port-a-johns at FOB Warhorse and other locations except, that material was at least good for fertilizer...
As I used to tell my privates, feel free to go and suck start a shotgun since it may listen to your crying...
Another piece of free advise to those that may want to join the military in the future. You may some day be called upon to do your job in combat. Do some soul searching before you take an oath and ask yourself one simple question; Can I go to another country and kill someone that my government says is a threat and an enemy. If you cannot answer that, without any doubt, as a yes then become a politician and try to make a difference, stay out of the military. The military is not a free ride through college or a good looking uniform that will get you laid. It is the greatest fucking machine on earth with two purposes. The first is peace by presence of force, we will fuck you up if you mess with us. The second is to be the most efficient combat machine in the world when the time comes. That time is not for anyone in uniform to decide, you also do not get to quit and go home when that time may come. When you cry about it be prepared for one of us out there to possibly shove that medal up your ass...
Watch the video first.
Each of them, for their own reasons, concluded that the wars they fought in were wrong, and so they marched together today, about four dozen veterans of the wars in Iraq and Afghanistan, each prepared to return their Global War on Terror medals in symbolic protest. Soldiers like Sgt. Jacob George, who did three tours in Afghanistan.
"I do not feel like the intentions of the overall mission matched my intentions as an individual and most of the people who served," said George. "I am willing to give them back even though it is a very emotional thing for me."
"I was in Iraq in '03 and what I saw there crushed me," said Ash Wilson. "I don't want us to suffer this again, and I don't want our children to suffer this again. So I'm giving these [medals] back."
One by one, 45 veterans spoke of their own anger or pain, and each turned and threw their medals toward McCormick Place. They had asked that the NATO representative formally accept them. That did not happen.
"I'm one of 40,000 people that left the United States Armed Forces because this is a lie," said one veteran.
"I will not continue to trade my humanity for false heroism," said another.
Vincent Emanuele is from a multi-generational military family. Returning his medals, he says, is about sending a message to the world, but is also cathartic.
"For many veterans to deal internally with what it is we have experienced overseas and then to come back and to make amends for ourselves," said Emanuele.
"This medal right here is because I'm sorry - I'm sorry to all of you," said Aaron Hughes. Hughes, who served in Iraq, helped organize what became a moment on an international stage - a moment meant, he says to show disdain toward policymakers and not the men and women still fighting.
"I love all my brothers and sisters that are in Afghanistan still, and I hope they get to come home soon," said Hughes.
And I bet everyone of the 45 or so were the only ones drafted in the last 40 years. You signed up for a reason and when you were called upon to do your job, not duty since you have no idea of the meaning of the word, you fucking cried and said you never signed up for this. You were the type of Soldier, Marine, Airman, Sailor, etc that fucked up a unit and you never were able to make it in the military so you got out. You got out and then fucking cried about it and how horrible it was. But, you are the first ones standing in a line to get "what they owe you" all while speaking out against everyone of us that were there and did what was asked of us. I see your type everyday I am around liberals...
Do me a favor, pin the medal to the only copy of your DD214 and toss that over the fence with a note saying you give up all VA benifits and I may think of you as a person again. Until then you are lower than what I left in the port-a-johns at FOB Warhorse and other locations except, that material was at least good for fertilizer...
As I used to tell my privates, feel free to go and suck start a shotgun since it may listen to your crying...
Another piece of free advise to those that may want to join the military in the future. You may some day be called upon to do your job in combat. Do some soul searching before you take an oath and ask yourself one simple question; Can I go to another country and kill someone that my government says is a threat and an enemy. If you cannot answer that, without any doubt, as a yes then become a politician and try to make a difference, stay out of the military. The military is not a free ride through college or a good looking uniform that will get you laid. It is the greatest fucking machine on earth with two purposes. The first is peace by presence of force, we will fuck you up if you mess with us. The second is to be the most efficient combat machine in the world when the time comes. That time is not for anyone in uniform to decide, you also do not get to quit and go home when that time may come. When you cry about it be prepared for one of us out there to possibly shove that medal up your ass...
Pull your weight...
As a part timer I get the privilege of working with many different full time people from EMTs, EMT-As, and Medics. I call it a privilege since I get to learn from all, it really helps to round you out as a Medic when you see all the different ways to do everything. There is a downside though.
Enter into the scene the 20 year, 50 something, career EMT that has no plans to go further or do more. The one that hates any type of change and thinks that as a 20 year employee they are the one in charge of the truck and responsible for everything. That one person that feels the young kid can do all the work, all the charts, all the driving unless they are doing patient care. The, I'm down four charts at 4am 21 hours into a shift that has not involved any sleep for me, I'm not taking that BLS patient because they said their pain was a 7/10 after being woke up.
This is after you checked out the truck, while they slept. This is after you did all the station chores, while they slept. This is after you restocked after all runs that you did the patient care and chart on, while they played on the internet or slept. This is after you gave the truck its evening bath, while they watched TV and went to bed. This is Had a partner the other day that gave me yet another first since switching from an EMT to a after a whole day of listening to complaining of how the manager is ruining the service. At least I got three hours of quiet to catch up on charts before the last run they refused to take. Fast forward 6 days and you get to repeat it all over again...Suggest that they pull their weight a little and you get, "I was pulling my weight before you were born sonny."
I wonder how you seasoned medics handle someone like this. I do not like to make waves with people who have been there longer than me, I believe in a little courtesy for seniority, I am a union man in my real life after all. But, enough is enough, and believe me, WWIII happened for the sonny comment; I pulled my weight in the sands of Iraq while this asshole sucked off of his co-workers tit. Do not get me wrong no one owes me shit, I will not be disrespected like that by anyone…
Enter into the scene the 20 year, 50 something, career EMT that has no plans to go further or do more. The one that hates any type of change and thinks that as a 20 year employee they are the one in charge of the truck and responsible for everything. That one person that feels the young kid can do all the work, all the charts, all the driving unless they are doing patient care. The, I'm down four charts at 4am 21 hours into a shift that has not involved any sleep for me, I'm not taking that BLS patient because they said their pain was a 7/10 after being woke up.
This is after you checked out the truck, while they slept. This is after you did all the station chores, while they slept. This is after you restocked after all runs that you did the patient care and chart on, while they played on the internet or slept. This is after you gave the truck its evening bath, while they watched TV and went to bed. This is Had a partner the other day that gave me yet another first since switching from an EMT to a after a whole day of listening to complaining of how the manager is ruining the service. At least I got three hours of quiet to catch up on charts before the last run they refused to take. Fast forward 6 days and you get to repeat it all over again...Suggest that they pull their weight a little and you get, "I was pulling my weight before you were born sonny."
I wonder how you seasoned medics handle someone like this. I do not like to make waves with people who have been there longer than me, I believe in a little courtesy for seniority, I am a union man in my real life after all. But, enough is enough, and believe me, WWIII happened for the sonny comment; I pulled my weight in the sands of Iraq while this asshole sucked off of his co-workers tit. Do not get me wrong no one owes me shit, I will not be disrespected like that by anyone…
Tuesday, April 24, 2012
Response to AD on pay...
On the topic of pay, we are at 0% in the industry. I am a Union man so I always feel there is not enough pay. The problem is how do you judge what is right and fair with pay?
I work full-time in an industry that has nothing to do with EMS. I can lay a sewer pipe to grade and repair or install water lines all day long. My experience includes everything from being the laborer to the equipment operator and now spend my working hours inspecting or investigating problems. It is a skilled labor job and I can go make $60k-$70K almost anywhere I want to go. In my area an experienced Paramedic can expect wages in the area of $35K-$60K depending on whether you work for the small county service or larger Fire Based service. Big difference is: I would be paid, at my current salary as a Medic, about $45K a year to work half the days I work now. I think that puts me in the middle. I want more, everyone does and should but, how do you justify that.
A lot of the people I know in EMS and at my full time job say we are paid way to little for "saving lives". Lose the hero complex be honest with yourself and everyone else, when was the last time you actually saved a life? 99% of what we do in EMS is for patient comfort. I may not be a popular person for saying that but, we see very few patients with true life threatening illnesses or injuries and the ones we do benefit far more from rapid transport and BLS care than anything in our ALS toolbox. In my opinion the argument for more pay of "we save lives" works about as well as trying to eat a soup sandwich.
For every experienced Medic that is employed the local Paramedic Factory, read Community College, is turning out 10 green, never stepped foot in an ambulance except for clinicals, Paramedics. These people want a job so bad that they will work for half of what an experienced Medic will work for. The seat of the truck or lazy boy never cools off between employees and that is what is actually driving down the pay right now. We are not the only industry experiencing that problem, Nursing has the same issue locally.
The larger issue with pay is the attitude it causes. Maybe we should ask our patients what we should be paid. Were they treated with respect and did we make them feel better or did their Paramedic or EMT treat them poorly because of they felt it was a waste of time to do this transfer or run. The 25% Mr. Grayson refers to can be like a drink of sour milk. Their attitude leaves a bad taste in the mouth of our patients and managers which reflects on the other 75%. As one of the guys I respect and look up to, Elite Series Bass Fisherman Kevin VanDam, says "It's all about the attitude." You have to change the culture if you want more pay and the culture cannot change until the attitude of entitlement changes. Paramedics and EMTs exist for the patients they have not the paycheck they want.
I work full-time in an industry that has nothing to do with EMS. I can lay a sewer pipe to grade and repair or install water lines all day long. My experience includes everything from being the laborer to the equipment operator and now spend my working hours inspecting or investigating problems. It is a skilled labor job and I can go make $60k-$70K almost anywhere I want to go. In my area an experienced Paramedic can expect wages in the area of $35K-$60K depending on whether you work for the small county service or larger Fire Based service. Big difference is: I would be paid, at my current salary as a Medic, about $45K a year to work half the days I work now. I think that puts me in the middle. I want more, everyone does and should but, how do you justify that.
A lot of the people I know in EMS and at my full time job say we are paid way to little for "saving lives". Lose the hero complex be honest with yourself and everyone else, when was the last time you actually saved a life? 99% of what we do in EMS is for patient comfort. I may not be a popular person for saying that but, we see very few patients with true life threatening illnesses or injuries and the ones we do benefit far more from rapid transport and BLS care than anything in our ALS toolbox. In my opinion the argument for more pay of "we save lives" works about as well as trying to eat a soup sandwich.
For every experienced Medic that is employed the local Paramedic Factory, read Community College, is turning out 10 green, never stepped foot in an ambulance except for clinicals, Paramedics. These people want a job so bad that they will work for half of what an experienced Medic will work for. The seat of the truck or lazy boy never cools off between employees and that is what is actually driving down the pay right now. We are not the only industry experiencing that problem, Nursing has the same issue locally.
The larger issue with pay is the attitude it causes. Maybe we should ask our patients what we should be paid. Were they treated with respect and did we make them feel better or did their Paramedic or EMT treat them poorly because of they felt it was a waste of time to do this transfer or run. The 25% Mr. Grayson refers to can be like a drink of sour milk. Their attitude leaves a bad taste in the mouth of our patients and managers which reflects on the other 75%. As one of the guys I respect and look up to, Elite Series Bass Fisherman Kevin VanDam, says "It's all about the attitude." You have to change the culture if you want more pay and the culture cannot change until the attitude of entitlement changes. Paramedics and EMTs exist for the patients they have not the paycheck they want.
Saturday, April 21, 2012
Favorite day of the year...
For those of you that live up north here you can understand. Tomorrow officially starts my marathon run of Bass Fishing Tournaments. I have fished a couple this year, earlier than I ever have but, tomorrow morning at 0430 I leave for the first club tourny and I have a tournament planned for every weekend until the last week of October. So, to my wife, I'll see you again in October for a couple of weeks between fishing and deer season. To my employer, now you know why I saved those sick days...
I love this time of the year and as the King of Bass Fishing, Kevin VanDam, says "It's all about the attitude."
I love this time of the year and as the King of Bass Fishing, Kevin VanDam, says "It's all about the attitude."
Healing begins...
I remember the day vividly. Heat, dust, that smell in the air, the taste of the fucking place. I was in the middle of the Sunni Triangle and had just finished another mass casualty incident, not the drill type. A suicide bomber had blown up a DFAC near Mosul and it was the breaking point for me. That was the day my ability to have compassion died. That was the day empathy left me. That was the day that I told God to go fuck himself. That day I became a robot...No emotion on the outside, empty being on the inside. If I lost one more patient I was going to die myself. I turned from compassion and empathy to hate and rage in order to survive. I had reached the point of emotionally losing it so I forgot how to care and started treating slabs of meat, not Brothers and Sisters that shared the uniform with me.
I shared this with a counselor at the VA a few weeks after my blow up at work. It was the day my emotional self began to heal. I had forgotten how to feel emotions and be a human being. By looking at and talking about the breaking point I had experienced it allowed me to begin to tear down the wall I had put up inside. I cried. I sobbed. I cried some more. I am sure the Counselor contemplated committing me that day. I took the cap off of the bottle and began letting out years of emotions in a healthy and controlled environment.
I eventually had to go through two years of therapy to get where I am today. I am still not the same person I was before but, I have a good understanding of what it takes to stay sane and emotionally stable to be an effective clinician. I still have the bad days, days that will be forever engrained in memory. I still have dreams and nightmares, they are like that horrible 50 Cent song set on repeat on the CD player, and there is no escape from them.
We all have had that one scene or one call that stung deep and threatened to unravel us. That is OK and normal. It is what we do with that experience that will determine who we are as clinicians and how effective we are at treating our patients. Everyone is different and there is no one fix to emotional scares. There is however a fix for each of us that will allow us to cope. Take it from a badass Soldier, talk to someone, see a professional, or whatever is needed. We are all human and it is not a sign of weakness to say you need help.
I shared this with a counselor at the VA a few weeks after my blow up at work. It was the day my emotional self began to heal. I had forgotten how to feel emotions and be a human being. By looking at and talking about the breaking point I had experienced it allowed me to begin to tear down the wall I had put up inside. I cried. I sobbed. I cried some more. I am sure the Counselor contemplated committing me that day. I took the cap off of the bottle and began letting out years of emotions in a healthy and controlled environment.
I eventually had to go through two years of therapy to get where I am today. I am still not the same person I was before but, I have a good understanding of what it takes to stay sane and emotionally stable to be an effective clinician. I still have the bad days, days that will be forever engrained in memory. I still have dreams and nightmares, they are like that horrible 50 Cent song set on repeat on the CD player, and there is no escape from them.
We all have had that one scene or one call that stung deep and threatened to unravel us. That is OK and normal. It is what we do with that experience that will determine who we are as clinicians and how effective we are at treating our patients. Everyone is different and there is no one fix to emotional scares. There is however a fix for each of us that will allow us to cope. Take it from a badass Soldier, talk to someone, see a professional, or whatever is needed. We are all human and it is not a sign of weakness to say you need help.
Saturday, April 7, 2012
Emotion Part 1 - My Story
I have often wondered what emotions other Medics feel. I also often wonder what emotions other Emergency Professionals feel are appropriate to have on scene and after. How does everyone deal with it, and not the textbook answers...First my story.
One hindrance of being a Military Medic in a combat zone is the inability to process and deal with emotions. God knows I bottled up over a years worth of seeing brothers and sisters in uniform fucked up on a daily basis. Seeing the innocents of war, children, torn to pieces both physically and emotionally. The emotions must be bottled up because you have to be the rock, that one person that can work in added pressure of trying to save a life on top of trying to staying alive. Any weakness you show can have a huge blow to the confidence your patient has in you. It can also make you combat ineffective since it can be a distraction.
Sure I had a couple of moments; watching a First Seargent and a Seargent Major shed tears over the loss of a soldier in front of the medical personnel. The two NCOs in a unit that are supposed to be the emotionless baddasses that do nothing but kick ass and get the mission done. Watching a mother read a letter that her son sent home the day he died, read on Mothers Day, one week after he was your patient and despite everything you did he died. Those two incidents offered me a few minutes out of over a year to lose control of that emotionless facade and break down in private. Maybe five minutes each time. In retrospect I managed to stuff a career of emotions into 14 months and allowed myself to shed some tears for maybe 10 minutes. Also, in retrospect it was not a good plan.
Fast forward 2 years, back home and back to the job I left, barely holding it together. I had gotten divorced because my ex-wife did not know me anymore, I was close to the unemployment line, and pissed off at anyone that did not serve their country. Seamed like all I wanted to do was beat someone, I could not sleep, I could not allow myself to have emotions, or release what was bottled up. I was scared that if I allowed any of the emotions to come out they would all come out, anger and rage included. I was scared of myself and the monster I had bottled up inside.
It all came to a head on a job site when the cap was loosened on the bottle and a little pressure was vented. I made some decisions out of rage and the resulting actions could have seriously injured someone. A coworker was trying to push me over that edge and almost succeeded, I ended up having a choice of getting professional help or collecting unemployment. I was fortunate that my employer was very Veteran friendly, they pushed me to do what I was too proud to do on my own: Talk to someone...
Part 2 -The Process of healing begins.
One hindrance of being a Military Medic in a combat zone is the inability to process and deal with emotions. God knows I bottled up over a years worth of seeing brothers and sisters in uniform fucked up on a daily basis. Seeing the innocents of war, children, torn to pieces both physically and emotionally. The emotions must be bottled up because you have to be the rock, that one person that can work in added pressure of trying to save a life on top of trying to staying alive. Any weakness you show can have a huge blow to the confidence your patient has in you. It can also make you combat ineffective since it can be a distraction.
Sure I had a couple of moments; watching a First Seargent and a Seargent Major shed tears over the loss of a soldier in front of the medical personnel. The two NCOs in a unit that are supposed to be the emotionless baddasses that do nothing but kick ass and get the mission done. Watching a mother read a letter that her son sent home the day he died, read on Mothers Day, one week after he was your patient and despite everything you did he died. Those two incidents offered me a few minutes out of over a year to lose control of that emotionless facade and break down in private. Maybe five minutes each time. In retrospect I managed to stuff a career of emotions into 14 months and allowed myself to shed some tears for maybe 10 minutes. Also, in retrospect it was not a good plan.
Fast forward 2 years, back home and back to the job I left, barely holding it together. I had gotten divorced because my ex-wife did not know me anymore, I was close to the unemployment line, and pissed off at anyone that did not serve their country. Seamed like all I wanted to do was beat someone, I could not sleep, I could not allow myself to have emotions, or release what was bottled up. I was scared that if I allowed any of the emotions to come out they would all come out, anger and rage included. I was scared of myself and the monster I had bottled up inside.
It all came to a head on a job site when the cap was loosened on the bottle and a little pressure was vented. I made some decisions out of rage and the resulting actions could have seriously injured someone. A coworker was trying to push me over that edge and almost succeeded, I ended up having a choice of getting professional help or collecting unemployment. I was fortunate that my employer was very Veteran friendly, they pushed me to do what I was too proud to do on my own: Talk to someone...
Part 2 -The Process of healing begins.
Tuesday, April 3, 2012
My night so far...
Patient tells me they did not do any drugs...
Found K2 packaging all over the house, the house he completely destroyed. That was prior to going outside in a pair of boxers and tearing shit up. But, no drugs...Oh yeah, they tore up the ER after the Versed I gave them wore off...but, they did no drugs...
Next patient calls because they cannot sleep...
30+ ambulance runs on them in 2 months on top of an unknown number of other trips to the ER not by ambulance...
Some days I wonder why we do it...Maybe I'll get a legitimate patient I can feel some compassion for before the morning, just maybe...
Found K2 packaging all over the house, the house he completely destroyed. That was prior to going outside in a pair of boxers and tearing shit up. But, no drugs...Oh yeah, they tore up the ER after the Versed I gave them wore off...but, they did no drugs...
Next patient calls because they cannot sleep...
30+ ambulance runs on them in 2 months on top of an unknown number of other trips to the ER not by ambulance...
Some days I wonder why we do it...Maybe I'll get a legitimate patient I can feel some compassion for before the morning, just maybe...
Monday, February 27, 2012
When will we change?
If we, EMS as a whole, were right less than 15% of the time there would be a outcry among Medical Directors and Managers for remedial training and a plethora of terminations happening. The study results Rogue Medic has posted are not new. Looking at the following numbers makes me wonder why are we not changing our ways. To summarize, the accuracy of the indicators of major trauma are (percentages based on the number of patients entered into the trauma systems in each catagory vs. the confirmed number of major traumas):
Vital Sign changes - 2.8%
Injury only - 4.7%
MOI - 8%
Vitals Sign changes + Injury - 15.4%
Vital Sign changes + MOI - 14.6%
Injury + MOI - 10.6%
Vital Sign changes + Injury + MOI - 50%
There will always be the patients entered into trauma systems based on altered mental status on scene that were over triaged because of a concussion along with the ones that we are given no choice because of abdominal pain or percieved chest trauma.
I was pleased during my recent PHTLS update to find out they have taken assessment and added it to MOI for the criteria of admission into a trauma system. I have seen some of the worst trauma that can be experienced while deployed for Operation Iraqi Freedom and seen how much the body can really take. What we classify as major trauma here was normal, everyday injuries for us there. It has given me a whole new perspective of "major" trauma.
This does not even begin to address the overuse of HEMS, that is a whole other post...
Vital Sign changes - 2.8%
Injury only - 4.7%
MOI - 8%
Vitals Sign changes + Injury - 15.4%
Vital Sign changes + MOI - 14.6%
Injury + MOI - 10.6%
Vital Sign changes + Injury + MOI - 50%
There will always be the patients entered into trauma systems based on altered mental status on scene that were over triaged because of a concussion along with the ones that we are given no choice because of abdominal pain or percieved chest trauma.
I was pleased during my recent PHTLS update to find out they have taken assessment and added it to MOI for the criteria of admission into a trauma system. I have seen some of the worst trauma that can be experienced while deployed for Operation Iraqi Freedom and seen how much the body can really take. What we classify as major trauma here was normal, everyday injuries for us there. It has given me a whole new perspective of "major" trauma.
This does not even begin to address the overuse of HEMS, that is a whole other post...
Thursday, February 23, 2012
WOW
Captian Chair Confessions stirred it up. I agree 100% and if you have a problem with that I offer this to you:
Available at Power Point Ranger and an Army Supply Point near you...
Available at Power Point Ranger and an Army Supply Point near you...
Bring it on
I am released to work solo, bring on the nausea every time the tones go off. Years of experience at the BLS level help but, still nervous as hell...
Tuesday, February 14, 2012
Been There, Done That
I was having a conversation with one of my fellow students
from the Paramedic class today and the conversation turned to experience. I was lucky enough to have the BLS skills
mastered and have years of experience at assessments prior to going to
Paramedic School. He had zero experience
and landed a job at the BLS level prior to class being completed. He is still waiting to finish testing for his
Paramedic and was struggling to train into a job at the BLS level in a large
urban system. He related feelings of not
being comfortable on runs and being frustrated. I tried to encourage him in the fact that all of us have been there and the only difference between him and I was experience prior to taking the Paramedic class.
He is lucky in the fact that he did get a BLS job, having an opportunity to learn and begin to master the BLS side
of pre-hospital care, prior to taking his Paramedic written test will make him that much better when he transitions to the Paramedic level. If there is one
thing I could stress to anyone who would like to pursue a career in the EMS
field it would be to become an EMT and find your place first. I have many reasons I say that:
1)
If you do not feel comfortable assessing and
treating a patient at a BLS level there is no way you will feel comfortable learning
it at an ALS level.
2)
How can you be sure that BLS treatment will be appropriate
when you have not had the time in the box doing it? This prevents over treating your patients
possibly creating problems with long term care.
3)
There are a number of skills you need to master
at the BLS level. Spinal immobilization,
knowing how to effectively and efficiently immobilize patients is a core skill
and the class room training and skills practices are just the tip of the iceberg. Airway control, knowing when it is appropriate
to control the airway using BLS means vs. ALS is a skill that you cannot be
taught in a classroom. Mastering those
BLS skills on real live patients will build your confidence and give you some
assurance when it comes time to intubate your first live patient. Starting IVs, an IV on a training arm and a
few live sticks for an Advanced EMT class vs. starting an IV on a patient that
has a BP of 60 is a huge difference. I firmly believe that I have gotten IVs based solely on having the confidence to stick them.
4)
BTDT, been there done that. Being able to walk in and see a patient
having a problem that you have seen in the past is something that a year and a
half of class cannot teach. No two
patients are the same but, there are similarities. Distinguishing between
COPD, Pneumonia, and CHF can sometimes be so subtle that, experience and making
the mistake in the past is all you have to draw from to decide. Taking the BLS patient into the hospital for
COPD that you find out later was CHF from the ED doc will leave you with a
lasting impression and you did no harm at the BLS level.
These are just a few of the reasons and it is time that the National Registry and
individual States start to require experience as a prerequisite to Paramedic
School. A few hundred hours of clinical time in an ambulance is not enough and the level of training would be
better with more time spent on the ALS in school producing better
medics. Medics coming out would have a
higher confidence level and better understanding of the disease processes that they
will encounter. My friend would have
been better prepared for school and would not be so overwhelmed now. He will do fine because his attitude and
desire to learn is there and he is now using the BLS skills every time he gets
into an ambulance. Even he admitted that
he would have done better in class at this point than he did.
Sunday, February 5, 2012
Politicians...
Not only am I a Paramedic I work a full time occupation outside of EMS that is Union. I am very proud to be Union and am disappointed in the partisan politics in the state if Indiana that has forced the Right To Work legislation onto the people and workers here. Not that I really want to discuss politics with anyone I am just saying that the partisanship politics in this state and country needs to stop. We need representatives that represent the people not the lobbyists and those with more campaign money than the rest. That is the change I can be behind.
Thursday, February 2, 2012
Gone and done it.
After more than a decade in EMS I have obtained my National Registry Paramedic certification, and as of today I have held it and my state certification for one month. I am a lucky one around here having a job waiting for me to transition into from being an Advanced EMT and I am completing my third week of orientation, and it has been as experience.
It has been weird from the standpoint that I do not feel like a medic yet. I still have another medic sitting in the back of the truck, critiquing everything I do and giving me a safety net if I get in trouble. That gives me a sense of confidence and even possibly a false sense of security. The only aspect that has changed is I get to make the decisions and treat how I feel is appropriate. I still stop myself from asking if I should do something or if the medic wants something from time to time like I am still doing clinicals but, that is where the reality sets in. I do not know if it is a privilege or a burden to have this responsibility, probably a combination of both. One thing still remains true, I love this job.
I have had a RSI and a full arrest within the first two weeks. That was a huge confidence boost to know I could control the airway and manage difficult patients outside of clinicals. I have gotten to use CPAP and manage multiple respiratory distress patients. I have treated the standard chest pain patients and even had a transfer to the cath lab, starting and managing multiple drips. The years of experience and the year and a half in school are really coming together. One big lesson I have learned through this is, the year and a half in school and the certification has not made me a Paramedic. It only earned me the right to learn how to be a Paramedic, the real learning comes after the certification. It has been fun and challenging and that is why I love this line of work. It has been awesome to have a preceptor that was in EMS exactly one year after I was born over thirty years ago, someone that encourages and corrects but, lets me be myself with how I treat patients. I am looking forward to the next few weeks and in earning the right to my first shift as the only medic on the truck.
.
It has been weird from the standpoint that I do not feel like a medic yet. I still have another medic sitting in the back of the truck, critiquing everything I do and giving me a safety net if I get in trouble. That gives me a sense of confidence and even possibly a false sense of security. The only aspect that has changed is I get to make the decisions and treat how I feel is appropriate. I still stop myself from asking if I should do something or if the medic wants something from time to time like I am still doing clinicals but, that is where the reality sets in. I do not know if it is a privilege or a burden to have this responsibility, probably a combination of both. One thing still remains true, I love this job.
I have had a RSI and a full arrest within the first two weeks. That was a huge confidence boost to know I could control the airway and manage difficult patients outside of clinicals. I have gotten to use CPAP and manage multiple respiratory distress patients. I have treated the standard chest pain patients and even had a transfer to the cath lab, starting and managing multiple drips. The years of experience and the year and a half in school are really coming together. One big lesson I have learned through this is, the year and a half in school and the certification has not made me a Paramedic. It only earned me the right to learn how to be a Paramedic, the real learning comes after the certification. It has been fun and challenging and that is why I love this line of work. It has been awesome to have a preceptor that was in EMS exactly one year after I was born over thirty years ago, someone that encourages and corrects but, lets me be myself with how I treat patients. I am looking forward to the next few weeks and in earning the right to my first shift as the only medic on the truck.
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