Whats your "criteria" for starting iv access on a pt?

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mrhunt

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I'll take that as a no. Sounds like the ambulance company I used to work for in Kern county and a very specific hospital.
 

CanadianBagel

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I'll take that as a no. Sounds like the ambulance company I used to work for in Kern county and a very specific hospital.
I’m from St. Louis. We seem to have a different dynamic out here than other places do. Nurses and medics not getting along is a daily problem.

We also don’t have nurses or physicians ride along with us, ever. Our critical care division acts like supervisors and meets us at CCT calls in fly cars. It’s also weird at nurses make more than medics other places. Out here being a medic is typically a six figured job.
 

mgr22

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You have no idea how ****ty the hospital staff is in my area. I’ve seen a MD try to intubate a two year old with an an adult sized blade. First pediatric arrest I worked and they literally stopped chest compressions for a solid minute to check tube placement with an X ray. Couldn’t even find the right sized ET tube in the crash cart. Same hospital also refused to give any sedation to a pediatric GSW to the face until one of our critical care guys demanded that someone get propofol for the kid. It’s pretty bad when the medics have to tell the ED staff, who are supposed to be higher levels of care; how to do their jobs.

I have a bias, and I understand maybe it’s not always justified; I’ll admit that. I learned how to do IV’s from nurses exclusively, and there are a few that I like.. but in general I’m just not a fan of hospital staff. I don’t really trust them after seeing them hurt so many people.
Your profile says you're an EMT. Are you?
 

medichopeful

Flight nurse, ground paramedic
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I’m from St. Louis. We seem to have a different dynamic out here than other places do. Nurses and medics not getting along is a daily problem.
I’m sure that attitudes like your really help that dynamic. Referring to nurses as “doctor helpers” and basically saying that they are incompetent doesn’t really do a lot to help improve relations between specialties.

You also said in one of your earlier posts that you don’t have faith in the hospitals because of what you have seen. Man, do I have some news for you about what I’ve seen EMS do as well.

I would drop the “holier than thou” attitude you have.

Edited for spelling
 
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CanadianBagel

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I’m sure that attitudes like your’s really help that dynamic. Referring to nurses as “doctor helpers” and basically saying that they are incompetent doesn’t really do a lot to help improve relations between specialties.

You also said in one of your earlier posts that you don’t have faith in the hospitals because of what you have seen. Man, do I have some news for you about what I’ve seen EMS do as well.

I would drop the “holier than thou” attitude you have.
Sorry if it offends you, but it’s just the way I feel.
 

medichopeful

Flight nurse, ground paramedic
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Sorry if it offends you, but it’s just the way I feel.
I’m not offended, but I’ve been on both sides (EMS and nursing). There is a divide between the two at times, and attitudes like yours do nothing to improve that.

How long have you been a medic for?

Edited for spelling
 

CanadianBagel

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I’m not offended, but I’ve been on both sides (EMS and nursing). There is a divide between the two at times, and attitudes like yours do nothing to improve that.

How long have you been a medic for?

Edited for spelling
I’m not going to be apart of a pissing match. It doesn’t matter how long I’ve been a medic, your opinion is not superior to mine because of how long you’ve been in the field vs my time in the field. Cheers
 

DesertMedic66

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I’m not going to be apart of a pissing match. It doesn’t matter how long I’ve been a medic, your opinion is not superior to mine because of how long you’ve been in the field vs my time in the field. Cheers
Actually it kinda does. Newer medics tend to show more of the “in right and your wrong” or “I’m better than you” attitude especially when it comes to nursing staff. The more you interact with nursing staff the more you realize their education is much different from ours. They also have a much better understanding about the next steps in patient care than paramedics have. Typically we drop patients off at a facility and magical things happen inside the cath lab or neurological department and the patient gets better without a real understanding of what actually happens.

I work with a nurse on every single shift and they are a great and extremely valuable resource. IMO the nurse/medic configuration makes for a very strong team.
 

CanadianBagel

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Actually it kinda does. Newer medics tend to show more of the “in right and your wrong” or “I’m better than you” attitude especially when it comes to nursing staff. The more you interact with nursing staff the more you realize their education is much different from ours. They also have a much better understanding about the next steps in patient care than paramedics have. Typically we drop patients off at a facility and magical things happen inside the cath lab or neurological department and the patient gets better without a real understanding of what actually happens.

I work with a nurse on every single shift and they are a great and extremely valuable resource. IMO the nurse/medic configuration makes for a very strong team.
That’s your job. Mine is adamant about having our district operationally autonomous. No doctors or nurses on our trucks, because we don’t need them. Our staff is trained to handle any case thrown at them. Critical Care here does not have protocols, they have guidelines. Their care is based on their research and experience, much like that of a physician.

You just told me to stop generalizing nurses as ****ty, but then you just generalized new medics as stuck up and self righteous.
 

medichopeful

Flight nurse, ground paramedic
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Actually it kinda does. Newer medics tend to show more of the “in right and your wrong” or “I’m better than you” attitude especially when it comes to nursing staff. The more you interact with nursing staff the more you realize their education is much different from ours. They also have a much better understanding about the next steps in patient care than paramedics have. Typically we drop patients off at a facility and magical things happen inside the cath lab or neurological department and the patient gets better without a real understanding of what actually happens.

I work with a nurse on every single shift and they are a great and extremely valuable resource. IMO the nurse/medic configuration makes for a very strong team.
Dunning-Kruger in action.
 

mgr22

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That’s your job. Mine is adamant about having our district operationally autonomous. No doctors or nurses on our trucks, because we don’t need them. Our staff is trained to handle any case thrown at them. Critical Care here does not have protocols, they have guidelines. Their care is based on their research and experience, much like that of a physician.

You just told me to stop generalizing nurses as ****ty, but then you just generalized new medics as stuck up and self righteous.
You said you're from St. Louis, but are you working in the U.S.? I'm asking because of your statement about "no doctors or nurses on our trucks." That's the norm in this country, although nurses often accompany critical care transports. As to your staff having research and experience "much like that of a physician," are you talking about a largely paramedic staff? There's a pretty big difference in formal education between doctors and medics here.
 

CanadianBagel

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You said you're from St. Louis, but are you working in the U.S.? I'm asking because of your statement about "no doctors or nurses on our trucks." That's the norm in this country, although nurses often accompany critical care transports. As to your staff having research and experience "much like that of a physician," are you talking about a largely paramedic staff? There's a pretty big difference in formal education between doctors and medics here.
I’m an American. Never lived anywhere else. Critical Care Paramedics aren’t trained to the level of physicians, but they are trained to be autonomous like physicians. I don’t believe our critical care medics ever contact medical control for anything. I’ve never contacted medical control, I literally just call critical care. It’s easier than way because those guys are always at our base and always available to meet us. They are single resource, and they are the highest level of medical authority in our county. They can override any fire or EMS Officer in terms of medical treatment.
I respect the HELL out of my medical directors, but they expect us to talk to critical care before calling them.
 

Akulahawk

EMT-P/ED RN
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I’m an American. Never lived anywhere else. Critical Care Paramedics aren’t trained to the level of physicians, but they are trained to be autonomous like physicians. I don’t believe our critical care medics ever contact medical control for anything. I’ve never contacted medical control, I literally just call critical care. It’s easier than way because those guys are always at our base and always available to meet us. They are single resource, and they are the highest level of medical authority in our county. They can override any fire or EMS Officer in terms of medical treatment.
I respect the HELL out of my medical directors, but they expect us to talk to critical care before calling them.
News flash. You and the Critical Care Paramedics derive ALL of your ability to do things from your Medical Directors. Your EMS System Medical Directors are the highest medical authority for EMS in your County. There's a HUGE education gap between even the CCP and a Physician. While you are given some autonomy, you are not autonomous. Although you have "guidelines" for your practice, if you significantly deviate from those guidelines, you still have to pay the piper or have a well-reasoned argument as to why you deviated from them.

Newer Paramedics really don't know what they don't know. Same with newer Nurses and newer Physicians. I've been a Paramedic and an RN for quite a while. I'm not anywhere near a "new" RN or Paramedic. Most of us here have see a LOT more than you likely have as an advanced field provider. Nurses in particular have a knowledge of what happens after you drop off a patient. I'm absolutely comfortable with being able to take care of a patient from the time I pick them up in the field all the way through transferring care to an inpatient floor or ICU. That's HOURS, not minutes. Now can you do that with 4 or 6 patients?

The point is simple. While you have seen things that aren't great, you also likely don't know what else has been going on within the ED. It very well could have been that the intubation equipment for peds was not available so the Doctor used the next best available thing. It could be that while sedation for an intubated patient would have been nice for the patient, perhaps the sending ED was concerned about bottoming out the patient's BP. Propofol is a decent drug but it's not without it's side effects.
 

CanadianBagel

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News flash. You and the Critical Care Paramedics derive ALL of your ability to do things from your Medical Directors. Your EMS System Medical Directors are the highest medical authority for EMS in your County. There's a HUGE education gap between even the CCP and a Physician. While you are given some autonomy, you are not autonomous. Although you have "guidelines" for your practice, if you significantly deviate from those guidelines, you still have to pay the piper or have a well-reasoned argument as to why you deviated from them.

Newer Paramedics really don't know what they don't know. Same with newer Nurses and newer Physicians. I've been a Paramedic and an RN for quite a while. I'm not anywhere near a "new" RN or Paramedic. Most of us here have see a LOT more than you likely have as an advanced field provider. Nurses in particular have a knowledge of what happens after you drop off a patient. I'm absolutely comfortable with being able to take care of a patient from the time I pick them up in the field all the way through transferring care to an inpatient floor or ICU. That's HOURS, not minutes. Now can you do that with 4 or 6 patients?

The point is simple. While you have seen things that aren't great, you also likely don't know what else has been going on within the ED. It very well could have been that the intubation equipment for peds was not available so the Doctor used the next best available thing. It could be that while sedation for an intubated patient would have been nice for the patient, perhaps the sending ED was concerned about bottoming out the patient's BP. Propofol is a decent drug but it's not without it's side effects.
Propofol is short acting, and isn’t hard to manage as long as you have vasoactive drugs and airway control available. I’ve never felt uncomfortable managing a propofol drip, and I’m not critical care.
 

CanadianBagel

Forum Crew Member
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News flash. You and the Critical Care Paramedics derive ALL of your ability to do things from your Medical Directors. Your EMS System Medical Directors are the highest medical authority for EMS in your County. There's a HUGE education gap between even the CCP and a Physician. While you are given some autonomy, you are not autonomous. Although you have "guidelines" for your practice, if you significantly deviate from those guidelines, you still have to pay the piper or have a well-reasoned argument as to why you deviated from them.

Newer Paramedics really don't know what they don't know. Same with newer Nurses and newer Physicians. I've been a Paramedic and an RN for quite a while. I'm not anywhere near a "new" RN or Paramedic. Most of us here have see a LOT more than you likely have as an advanced field provider. Nurses in particular have a knowledge of what happens after you drop off a patient. I'm absolutely comfortable with being able to take care of a patient from the time I pick them up in the field all the way through transferring care to an inpatient floor or ICU. That's HOURS, not minutes. Now can you do that with 4 or 6 patients?

The point is simple. While you have seen things that aren't great, you also likely don't know what else has been going on within the ED. It very well could have been that the intubation equipment for peds was not available so the Doctor used the next best available thing. It could be that while sedation for an intubated patient would have been nice for the patient, perhaps the sending ED was concerned about bottoming out the patient's BP. Propofol is a decent drug but it's not without it's side effects.
At my agency, as long as you do the right thing, the district backs you. A guy at my work did a finger thoracotomy on a pt before they had a protocol for it, and since it worked they backed him and wrote a protocol for it. I work for a hardcore progressive agency.
 

medichopeful

Flight nurse, ground paramedic
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Propofol is short acting, and isn’t hard to manage as long as you have vasoactive drugs and airway control available. I’ve never felt uncomfortable managing a propofol drip, and I’m not critical care.
Why are you managing propofol drips if you are not critical care?

Your attitude is, quite honestly, scary. You present yourself as someone who knows way more than they actually do, and that is going to end up hurting a patient.
 

CanadianBagel

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Why are you managing propofol drips if you are not critical care?

Your attitude is, quite honestly, scary. You present yourself as someone who knows way more than they actually do, and that is going to end up hurting a patient.
We’re allowed to manage propofol here without critical care. You do you, I’ll do me. Cheers
 

mgr22

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I’m an American. Never lived anywhere else. Critical Care Paramedics aren’t trained to the level of physicians, but they are trained to be autonomous like physicians. I don’t believe our critical care medics ever contact medical control for anything. I’ve never contacted medical control, I literally just call critical care. It’s easier than way because those guys are always at our base and always available to meet us. They are single resource, and they are the highest level of medical authority in our county. They can override any fire or EMS Officer in terms of medical treatment.
I respect the HELL out of my medical directors, but they expect us to talk to critical care before calling them.
The part about paramedics being "autonomous like physicians" -- it's simply not true. It may seem that way to you, or you may have been told that by another medic. You may even work in a system or for an agency that is reckless enough to preach that philosophy, but I urge you to read the healthcare laws of your state and perhaps consult with an attorney before you start hanging propofol drips or inserting chest tubes.
 

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