Going Beyond The Minimum: Paramedic or Ambulance Driver?

[DesertMedic66]

Nothing at all about any companies, fire departments or anything, but I am the source of the bonfire on PoF and TMIACITW. The "Paramedics or Ambulance Drivers" thing.

I think it's within policy, and I ran it past a few AMR folks to make sure, but my old man is still hyperconcerned.

I stopped following TMIACITW a while ago. I'm still on PoF just to make myself feel smart by reading the comments haha

 

[PotatoMedic]

I saw nothing in there that I feel would be termination worthy. Maybe you have ruffled a few feathers... but other than that, not much.

 

[DesertMedic66]

I saw nothing in there that I feel would be termination worthy. Maybe you have ruffled a few feathers... but other than that, not much.

Same thing, after I got done reading the worlds longest Facebook post

 

[Anonymous]

but I am the source of the bonfire on PoF

you posted that on Plenty of Fish? :unsure:

 

[shfd739]

I think you'd be fine here. You might wanna lay low for a bit though

 

[RocketMedic]

Lets hope it doesnt come to that. EMSA itself is a great place where I really enjoy my work, my partners and our patients. I can help people here. Id hate for a few angry people to ruin it.

 

[TechYourself]

Went to PoF.


Pretty sure I now have cancer.:glare:



I'll admit that the "Paramedic vs Ambulance Driver" manefesto had me a little pissed off.

That was until I got to the last few paragraphs.
It's funny what reading the entire post will do...


As for the IV cath size debate, I'm pretty sure that this is the reason EMTs shouldn't start IVs.

With attitudes like that it's a wonder that some Med Directors let anyone in EMS start lines.:glare:

 

[PotatoMedic]

It is interesting the completely different response that it got on Nocturnal Medics...

 

[VFlutter]

I think it's within policy, and I ran it past a few AMR folks to make sure,.

Would it be against policy to openly admit, and even brag, about using large bore IVs to punish annoying or intoxicated patients? Or just poor taste?

Just curious.

 

[Carlos Danger]

Would it be against policy to openly admit, and even brag, about using large bore IVs to punish annoying or intoxicated patients? Or just poor taste?

Just curious.

I think that depends partly on whether you have a "nurse habit".

Seriously, no one should ever again wonder why paramedicine is stuck where it is. If you really need a reminder, just look at PoF.

In one 5-minute glance this morning, I saw the ignorant reaction to Rocketmedic's diatribe, a thread espousing the physical assault of patients and insulting those who question the practice with accusations of being a "nurse", the normal, self-congratulatory "paramedics: doing the same thing as doctors at 60 mph" - type sentiments, and another discussion about why it would be so much better if we all followed statewide or even national protocols.

 

[TechYourself]

I think that depends partly on whether you have a "nurse habit".

I know exactly what thread that is on PoF.



You have given yourself away

 

[Wes]

And now y'all know why some of my posts have been so negative about the state of EMS. I need to remove most of those EMS Facebook groups from my news feed on Facebook.

 

[RocketMedic]

Would it be against policy to openly admit, and even brag, about using large bore IVs to punish annoying or intoxicated patients? Or just poor taste?

Just curious.

That's street credit and commendations for you from your coworkers!

 

[Bullets]

Do we, as paramedics, tend to avoid pain management, complex ventilators, new-type alternate airways and the like for reasons of educational or knowledge deficiency, a desire for simplicity above fractional improvements in effectiveness, familiarity with existing options or simply tradition?

Agencies avoid new things for all these reasons. With the rise of actual science in our treatments, i feel there is reluctance to implement new things without a proven benefit on a large scale. SMR is something that 100% of providers deal with, and changing the national view will be important and makes sense to most people once shown the evidence. Things like IN Narcan for BLS may not be as readily adopted because not everyone deals with those patients on a consistent basis (like my agency) so it would sit in the truck and expire again and again, costing the agency money.

How amicable is your agency to change?

Somewhat. We are a new (2 years old in December) PD-based system, but our director is a lifelong volunteer. He is an excellent guy, but myself and our clinical coordinator have had to drag him kicking and screaming into the 21st century. Regionally, my county is still 85-90% volunteer, so as a whole, not much change is going on there. Some individuals are good, but most haven't picked up an EMS document since the class.

Our tactic for changing things is basically bludgeoning the department heads with scientific evidence. Thankfully our medical directors attitude is "If you guys can prove it and support it, ill support you"

How about you in your own practice?

Im here arent i?

On a larger level, do you see yourself as a transporter or as a clinician? What about your peers? Your agency?

I try to be a clinician, especially as i gain more education the closer i get to the NCLEX and i understand this stuff more. My peers are improving, because we email and leave relevant articles and studies around the station. Some are more receptive to this than others, but everyone improves because those that do a lot of research improve them by osmosis.

Unfortunately, our clients view us as transporters

Why the difference?

Im going to say it, intelligence, and by extension, education. Those that poses the education, even if it isnt in EMS or medicine, are more open to the science and rational of improving and changing. I posses a BA in History, my clinical coordinator got his first BA in Psychology (MS in Homeland Security), our director has a BS and MS in Accounting. The guys i work with who are most resistant have Associates degrees or less. This is the same across all levels of providers. I know some really stupid Paramedics.

EMT should at least be an Associates of Science, Paramedics should be at least a Bachelors of Science.

 

[Bullets]

You're thinking of nitronox. Different animal. Nitrox is a mixed gas, usually with a higher oxygen percentage than air, in the breathing gas. Is anyone using (or knows of a facility) Heliox?

The hyperbaric chamber uses it for dive emergencies when they know the divers used Nitrox or Heliox. Pretty much the only time iver ever seen Heliox was on a SCUBA Divers back

Found it...

I immediately regret this decision. Holy crap. Are there no sane minds...

Ok my God, thats painful


And i want to add to the whole "Ambulance Driver" thing. People always take offense, but your damn right im an ambulance driver. Im a professional driver and i good at it. How many people can drive a 42ft 102in bus down a 106in chute into a hotel casino convention center? Even within my department i have guys who cant or wont drive the heavies or trailers. I drive for a living, and it may be an ambulance, a evacuation bus, a heavy rescue, or MCI trailers. I can put them anywhere and everywhere. Take pride in being a professional driver.

 

[Akulahawk]

Heliox is some very interesting stuff. I'm not referring to tri-mix like you'd find on a really deep diver's back or in their surface supplied air for long-term saturation dives. It's a mixed gas, but basically you're mixing helium and oxygen. There's no nitrogen there. While it's good for helping to remove nitrogen from the body, heliox also has a low resistance to flow. In other words, you can get it to flow in lungs that won't ventilate well using air or nitrox mix. It's possible to use a standard ventilator with heliox, but they may be only calibrated for air, and thus you'd need to correct for that.

I don't know if heliox is used much, but it certainly can be useful.

 

[Bullets]

Heliox is some very interesting stuff. I'm not referring to tri-mix like you'd find on a really deep diver's back or in their surface supplied air for long-term saturation dives. It's a mixed gas, but basically you're mixing helium and oxygen. There's no nitrogen there. While it's good for helping to remove nitrogen from the body, heliox also has a low resistance to flow. In other words, you can get it to flow in lungs that won't ventilate well using air or nitrox mix. It's possible to use a standard ventilator with heliox, but they may be only calibrated for air, and thus you'd need to correct for that.

I don't know if heliox is used much, but it certainly can be useful.

Most times ive seen Heliox and Trimix are the deepest dives, as stage bottles. They are sunk to the anchor and divers switch them out when the reach the bottoms

One local dive outfit has begun experimenting with Argox as a deco bottle, they hang it at around 4m and is only used for emergency ascents in an OOA situation. Its a small red pony bottle, but its very new. Something we just covered in their dive emergency class at the hospital

 

[VFlutter]

I don't know if heliox is used much, but it certainly can be useful.

I have seen Heliox used a few times in the ER for status asthmaticus as a last ditch effort prior to intubation and once for a kid with Croup. I heard they sometimes use it when attempting to wean mechanical ventilation however I have never seen it personally.

 

[Clipper1]

I have seen Heliox used a few times in the ER for status asthmaticus as a last ditch effort prior to intubation and once for a kid with Croup. I heard they sometimes use it when attempting to wean mechanical ventilation however I have never seen it personally.

It should NOT be a last ditch effort. When you wait too long you have to then hope the ventilator is compatible with heliox. Weaning? No..it is an attempt at life saving. Asthma is no joke and some ER are just not equipped which can also explain the high mortality rate especially for children.

 

[Hockey]

lol there is talk around my work about that post. People totally missed the point of it