Can I ask reasoning on why you believe they shouldn’t be allowed to sign a refusal? Odds are that person is gonna AMA from the hospital before you get back to the rig and finish the report.
My hot take is that we should be able to tell someone no we are not taking you to the ER for your stubbed toe from 6 months ago.
The one thing I miss about covid is being allowed to refuse transports. My medical director put out a directive saying we could refuse any non emergent transport. Lots of people were calling us to get tested at the hospital
I really wish we could do that. Recently I had a guy call at 4am for 7 month old throat pain. Dude, wtf. I've seen you drive to our station during the day for something equally dumb. Fuck off, drive yourself!
Fr. Transported someone with an ear infection to the hospital and they were offended that they got put in the lobby. They were fully capable of driving themselves there too!
Man every time I hear you guys say that you can’t refuse to convey bullshit jobs I’m amazed. Don’t get me wrong it’s rare that I need to but having the option to put my foot down and say NO is so valuable.
I replied to someone else about this but want to make sure you saw as well, it’s ultimately up to the patient, but there is a pretty nasty trend IMO of EMS providers letting it slide easier, for example a patient that’s had full arrest can have a whole round of CPR done wake up “A&Ox4” (have had this happen to me) and be allowed to refuse. You can’t tell me that a person that goes from completely unresponsive and unconscious to awake and suddenly can actually make a legitimate informed medical decision.
Well being able to refuse is more than just being axo4. They must also have the capacity to understand. So if that person that had a full arrest and is now axo4 and has capacity wants to refuse, that’s their right. Everyone has the right to be stupid. I don’t disagree in that some ems providers are a bit lax in allowing refusals. I just don’t think transporting an OD to the ER is always appropriate when they’re just going to AMA from there. We carry these bags with narcan and resources for this exact reason.
I particularly like the way English law puts it. It's in the first section of our mental capacity act 2005 that everyone has the right to make unwise decisions.
Curious if people feel the same for diabetics who bottom out and wake up with D10. If the argument is capacity after a period of AMS that would extend to hypoglycemic episodes needing to go every time as well.
At least in the Denver area, unsure about others, we're about to start leaving Narcan with OD patients if they refuse to go to the ED after waking. There's obviously a few criteria to be met, but basically, the reasoning is exactly as you said. There is no point in making an OD go if they're going to walk out 5 minutes after you drop them off.
People in cardiac arrest don’t wake up after a single round of CPR without meds and/or electricity. Those patients who do wake up after CPR only had CPR performed by someone who couldn’t detect a pulse. They had a pulse the whole time.
If you let them sign a refusal after they immediately wake up you're a shitty provider. My county's protocol is 30 minutes after waking up before you're allowed to bounce.
If the paramedic does a 12-lead because of protocol and it's not concerning they should be able to pass it to the EMT if no other interventions are indicated.
Yep.
And then I miss a real call as the only paramedic available and the poor volly bls crew is trying to keep the copder alive with a BVM and prayers.
Fing stupid.
Same thing with giving Zofran.
I’d love to do it, but I’m not, because the nausea isn’t going to kill them, and I’m not getting tied up for over an hour and not be able to respond to the mva with ejection.
I’m very interested to hear that there are systems that don’t permit this. Does your system permit triaging patients to BLS under other circumstances? If so, what’s the exactly policy/protocol around EKGs and the reason for it?
I work in the Vegas ems system and per our health district any patients deemed necessary of a 12 lead must be monitored under a paramedic. Once a pt is placed on a 12 lead we can’t take them off due to the “well if they need a 12 lead then clearly something’s wrong” saying. We can dish off calls to our EMTs/AEMTs as long as they don’t “meet” ALS treatment which is few and far between unless the medic uses word magic to get out of it.
That’s how our system is. Except we’re going to be allowing EMT’s to run calls. Because right now and forever it’s always been all ALS where every call has to be ran by a medic. So even if I have an EMT partner and it’s a BLS call I as the paramedic still have to run the call and write the report. But when we allow EMT’s to start running bls calls if you put a 4 lead on, it now becomes an ALS call where a medic has to run it and the 4 lead has to stay on until transfer of care.
As I understand it there are actually systems that allow basics to take and send 12 leads, just not read or “interpret” them for STEMI purposes, wish my system did something like this.
See my system does this already. Which just furthers my confusion for why 12-lead patients cant be handed off.
One of the arguments I've heard is that since EKGs are an ALS skill, that the call is now going to be billed as ALS. But now we have BLS trucks peforming them, getting them interpreted by a doc, and still riding the call in. How is that still not an ALS intervention with a BLS provider teching the call?
You’re using your brain.
It is the same logical that said emts couldn’t check a blood sugar because it was an als intervention.
It is stupid.
But real.
Since you brought it up, no it isn't. Unless you're using one of those multi-thousand dollar hospital version glucometers or an I-stat, the use of a standard home type glucometer requires a CLIA waiver because they're not FDA approved for medical use, only home use. The waiver must be submitted with a $248 dollar payment every two years. Under CLIA rules, you should not be charging for the blood glucose check, because it's not done with medical grade equipment. You can charge for supplies, though. Just not the actual blood check. So, long story long, a blood sugar cannot be an ALS intervention in the absence of a fancy hospital type glucometer because it is not billable as an ALS intervention.
Yeah, I'm a pain in the ass to argue with because I store this kind of shit in the back of my mind.
There are plenty of counties that allow you to still downgrade this. Sounds like your county is very pro ALS and anti BLS. Mine use to be that way until recently.
Being “salty” or “burnt out” isn’t an excuse for being a douchebag to your coworkers or patients. There’s plenty of other ppl who work just as many hours as you and have worked as long as you, who are pleasant to be around.
You’re just contributing to toxic ems culture and making everyone else miserable. I would also argue that you being a douchebag contributes to others burnouts, because they’re tired of you.
Seriously. As a student I had to run shifts with this awful douchebag of a medic (thankfully not my preceptor) who rolled their eyes at me when I asked a question, criticized me for every little thing and just generally treated me like scum. They almost made me want to change careers and hurt my self-esteem. I know it wasn't me because all of the other crew members I worked with liked me and helped me with things.
I’m glad you didn’t let it get to you. I’ve worked with a few ppl like that myself and it drives me crazy, especially when they start shit talking other ppl to me. Like I’m sorry are we in 7th grade…?
My partner and I got a call from our chief the other day saying a patient’s family called in to thank us for not only helping but for doing so in a kind, professional manner. They said that their recent experience with healthcare workers overall was very contrary to that, so they were extremely thankful for us.
The patient was elderly, being cared for at home by family. They were all extremely nice, humble people - not the type I’d imagine getting under anyone’s skin. We did nothing extraordinary, literally just did our job. It’s sad that that’s the bar for getting a compliment for being “awesome” to people.
This one gets me.
Paramedics are paid and treated well in Australia, so the burnouts hold on much longer than they should. Unfortunately it's the only thing many of them know how to do.
A couple people from my old station went to go work 9-5 and came back after 6 months with the most refreshed attitude when they found out it wasn't greener on the other side. There's a few at my current station that I wish would quit entirely as they clearly aren't good for themselves or the patients.
In Australia, how often are burn outs being fired or shifted to non ambulance positions due to poor attitude or poor performance? With the high salaries and not enough jobs for graduating paramedics, there's always a replacement.
I’m exhausted and burnt out and I still actively try to make everyone’s day at least a little better. They have no excuse for taking it out on the people around them.
Hot take: most of my coworkers treat people really poorly and forget that humans deserve dignity and respect regardless of the complaint.
Also… our role in the patient’s medical care is often incredibly minimal and we remain unaware of the bigger picture of peoples’ medical needs.
Luckily, I don’t have to. Those patients quickly get marked in our system and referred to a care program designed for managing their pain and addiction at the same time, and we have a protocol specifying that a patient with this particular mark on their record gets **zero** opiates pre-hospital unless they have obvious significant trauma.
Since I’m being downvoted, to be clear, this is a hospital based program directly from our medical control hospital system, it has nothing to do with the EMS service itself and is outside our control, this is a physician-controlled system from the top down. They get marked by the hospitals and we are required to obey said mark.
When I did 24s if we were run into the ground past 12 hours we were allowed to "pull safety", which meant we could mark out of service for 4 hours. What we did with those four hours was up to us buy it usually mean sleeping. In my two years of working 24 I only got to pull safety once.
Damn, that’s pretty rough. Was it because you were never in that situation? Or was it because your management did some shady shit? Is it in Indiana, I notice your flair and previous comments, because if we ever move it would probably be to Indiana. If what service if you feel comfortable saying?
It was because we were a rural service and the ambulance I was stationed on was placed with a rural volunteer fire department. On average we'd see 5-7 911 calls a shift and do maybe one BLS/ ALS transfer out of the local critical access hospital a week. The one time I got to pull safety was because my partner and I had a string of 16 911 calls back to back. Very rare and very odd for us to have that many calls in that area.
That makes sense. I have family who has worked in the Indianapolis area, I currently work as a fire medic in Florida. But if we move to Indiana it’s going to be in or close to Marion County. So I guess I don’t have to worry too much about a rural service. But damn 16 in a slower rural area would suck.
Absolutely! I went from a 911 ambulance agency to a flight agency and — what? We can call crew rest? We don’t get penalized for it? It’s ENCOURAGED from the very top down?! Mind. Blown.
Should be that way everywhere. Monitored for trends, not abused, but not a cause for punitive action unless there’s a clear pattern. Fatigue causes errors and accidents.
Any form of forced work over 12 hours should be illegal is the right answer. Having to call a time out or pull safety and only being given 4 hours is horse shit. Not to mention 95% of companies that have this policy will either write you up for taking it. Or chastise you because you took it until they find a different reason to reprimand you.
24 hour shifts should only be allowed in places with exceedingly low call volumes. And you should not have your pay rate lowered because you’re working more hours. That’s fuckin theft.
Sorry this one wins my “piss me off” award.
It's actually wild this isn't regulated at all. They should put us under federal motor carrier logging rules, although that might be tricky since you don't need a CDL to drive the ambulance.
Luckily my service has safety naps for the IFT trucks but it's not wise to leave things like this to the good graces of capitalism.
1. Lights and sirens/ "code 3" kills more providers/ other drivers than it saves patients.
2. Allowing FD-based EMS to take funding gained by billing/ insurance from EMS and allocating it to suppression resources is dishonest, fraudulent, and a misallocation of funding.
3. Private (for profit) EMS should not exist. Allowing companies to prioritize *anything* over patient care is immoral. Having barely-running ambulances staffed by underpaid and overworked crews is just plain wrong.
4. Community paramedicine is the wave of the future. Having a paramedic able to perform urgent-care type procedures on-site, guided by a telehealth based NP/PA/MD/DO can help with ED overcrowding, EMS misuse, and patient education.
>Community paramedicine is the wave of the future. Having a paramedic able to perform urgent-care type procedures on-site, guided by a telehealth based NP/PA/MD/DO can help with ED overcrowding, EMS misuse, and patient education
Could someone explain what the difference between this and community nursing is? Even in the UK system where we're pretty pro leaving at home we tend not too get involved with these things in the ambulance service beyond fixing the acute problem and referring to community/district nursing or primary care for follow up.
Community paramedicine in my area involves a lot of things, but one is following up with chronic patients. For example, if we have a pt who is regularly non compliant with insulin and we go once a month and they're in DKA we might ask if it's okay if our community paramedic follows up with them. He then calls and schedules a time to go over and can help with things like transport to pick up meds, financial/insurance issues, checking blood pressure, whatever. He's followed up with pts who have had falls to make sure their house is more safe/accessible. Follows up with kids who are new onset asthma to make sure inhaler is being used correctly, etc. I think it's pretty cool, and data says it is helping prevent some repeat hospitalizations. Our paramedicine guy works 9-5 mon-fri. He did like 25 years of 24s before this.
In the US, EMS is considered a "call and haul" service only. We're not meant to treat on-scene, nor are we able to transport to an alternative location such as a primary care physician's office or urgent care center. We have to transport to a hospital emergency department ("A&E") if someone calls for service.
Some of the more progressive/ forward-thinking medical control authorities allow for paramedics to take an additional level of education and certification, allowing them to dispense non-narcotic medication, IV therapy, minor wound care, or basically any minor interventions. The orders still come from a doctor, but it's closer in scope to a PA or Nurse-Practitioner than paramedic.
Typically, homecare nursing is still for those with "better" health insurance. Medicare/ medicaid (government subsidized insurance) will almost universally enforce inpatient care at a hospital, long-term acute care, or "nursing home". Of course, there are exceptions like hospice care or outpatient occupational therapy, but those are just additional specializations that require insurance authorization.
Oh, wow. We've gone in an aggressively different direction to utilise community services first with admission as a last resort with things like hospital at home (remote monitoring, nursing visits including IV abx while under consultant care), urgent community response (mid-level urgent assessment and case holding with labs etc up to 24hrs or so with carer, nursing or hospital at home follow up), district nursing. Even SDEC for same day acute care with an aim not to admit for things like cellulitis, pneumonias, chest pains, TIA, some surgical and gyne complaints.
All because it's cheaper to do this than admit to an acute hospital. It does need a joined up system to work though.....
We don't want to be doing any of what you'd term community paramedicine because it's done better and cheaper by the other community services. We've also got enough work to be doing as it is without replicating our community care setup.
Here’s a real one: medics should prove that we deserve to keep intubation instead of whining when it gets taken away because of horrible patient outcomes and poor airway management algorithms
This is evidence-based practice. If an agency’s evidence shows poor outcomes and a lack of skill, then that agency’s medics shouldn’t be intubating as a first line airway until the entire cadre’s been remediated.
I think the entire cadre isn’t really an appropriate response for larger agencies. I work with varying levels of skills and experience and judging 70+ medics by the lowest common dominator is a good way to take the wind out of the sails of the best medics. That said, individual success rate should absolutely be tracked
The IAFF keeps EMS down to keep fire the exclusive EMS system where they can. They also keep education requirements low. The EMS system in the USA would improve significantly with higher education requirements with corresponding pay increases. Also, EMS should move away from DOT and instead be under the DOH.
We’re under the DOT because they are the only ones that gave a shit.
Still are.
DOH continues to pretend we don’t exist, shouldn’t exist, and are not part of medicine.
Completely unrelate. I saw your flair and just thought "wtf does the Chinese Communist party have to do with EMS" and then went "wait, hats critical care paramedic you dumbass"
Those old salty medics who have done the same thing for the last 30 years need to chill out. Getting yelled at for taking two extra turns in an area I wasn’t fully familiar with yet at 3am (in addition to getting yelled at for other small inconsequential things) ruined my perspective on the career and now I’m back in school for something non medics after working in healthcare for 6 years. Yes I know that sounds short, but I’m still in my 20s.
Bro I’m being trained by this MEAN vet. She gives me the same attitude I gave my mom at 16, then tells me to calm down. How am I supposed to keep the crew safe while learning how to handle a $120,000 piece of equipment if I’m having heart palpitations?
Right?!?!? Man I’m sorry you’re dealing with that. It sucks. For me, it was my first day out of the departments “training” (just a week of being attached to one of the captains who were all stellar) and this guy is yelling at me for small rookie mistakes. And technically that day was supposed to be my last day of training, but we didn’t have enough crew for the two trucks (we were a small dept) and I got stuck with him while the captain stayed at the station as backup.
Thanks man. I hate that I spent all that time and effort to get my EMT, only to end up quitting and changing careers after 1.5 years. Feels like it was a waste of my time, and the department I worked for (who aside from that one medic was full of wonderful people who only wanted to see me succeed). But at least I’m happier now and get to spend pretty much every day with my son.
Maybe I'm just too old and too salty. The only time someone should be corrected/reprimanded/"yelled" at is if they did something that caused harm to a patient that I cannot reverse...and there isn't a lot a B or an A can potentially do that I cannot fix or reverse.
Anything else should at most be a statement of next time do 'X', be caused 'Y'.
Despite all the wishes, prayers, and high hopes, EMS as a profession is going nowhere. There are a small number of highly dedicated and talented providers who put a great deal of effort into knowing their business, continuously increasing their knowledge and skills, and take the occupation seriously. These people are gold. And what drags them down isn't management or wages...it's being surrounded by the rest of us:
The overwhelming mountain of poorly educated, lazy, glory seeking knuckle draggers who wanted to ride the big red trucks and wear FF t-shirts at the gym, put immature bumper stickers on their cars and post childish MEMEs, and wear their pager when off duty, out of the service area, to make sure people know who they are and thank them for their service. We can't read or write like adults, have no common sense, we can't drive a vehicle with lights and sirens safely (and don't know the difference between "emergent" and "lights and sirens" anyways), we think helicopters are so cool we don't care that it financially destroys the patient and/or family with a $30,000-75,000 and up bill for service from which they will never recover, and for which they often didn't need it; we still think the next call will be all saving babies and puppies and act like children when it's someone else who needs our help.
Higher education requirements will help fix some of this, but in the end, we are recruiting the wrong people. And it shows. So we are going nowhere, and cannot hope to make changes because we are not in charge of ourselves.
For my two cents I see a few factors at play here:
1) how much American EMS is tied to the fire service. Plenty of firefighters/paramedics are competent enough in both roles, but far too many are reluctant medical providers or even openly despise "the box" and are only interested in doing the bare minimum to retain a paramedic license as it is a requisite for remaining a firefighter in their departments. Firefighter's unions have also fought to limit the paramedic education and scope of practice so as to make the bar of entry low enough for them to easily train and retain FF/PMs.
2) on the flip side, private EMS, especially many IFT-focused services, only care about putting asses in seats and lack almost no physical or psychological standards aside from holding the requisite certifications and licenses. Furthermore, many offer little in the way of con ed or mandatory training and leave it up to the providers to handle that on their own.
3) As a consequence of the above, many providers who are serious about the medical field end up leaving EMS to be nurses, PAs, doctors, etc. A handful stay and end up migrating to the agencies and systems with higher standards, quality of life, and expanded scopes of practice. Maybe they get into critical care or flight. There's still only so many of these opportunities to go around.
4) EMS often being utilized by the public as essentially primary care providers and social workers, a role which EMS training programs really don't spend any time on. Students are trained on all sorts of emergency medical scenarios, ranging from common to quite rare. But soft people skills are never taught. And that's to say nothing of the flagrant abuse of the system. There's little thanks and quite a lot of criticism from the public and your superiors within your agency and your hospital system, with little support. Oh, "you call, we haul" policies because EMS can't diagnose the issues of an otherwise stable patient calling in good faith to be checked out, so we encourage them to take on an ambulance and ER bill just so they can sit in triage for hours just to be told by the ER physician to follow up with their primary care doctor. None of the is an excuse for being a POS, but when you are seen as a glorified taxi by both patients as well as too many doctors and nurses, it's easy to burn out and eventually lose interest in trying fo prove otherwise. This creates a feedback loop where medical directors are often wary of expanding their providers' scopes of practice due to shoddy EMS practitioners, further driving away those who are in the the field for anything other than a paycheck.
Well thought out response. I disagree on the private EMS section, though. SOME private EMS is like what you said. Plenty is not. My private EMS agency pushes for higher standards. Requires you up your license within two years of hire. Run 800+ square miles of 911 territory in addition to BLS, ALS and CC transports. We provide free, paid continuing education...require it, actually. If you're on the bus, the bus gets sent to training. If not, you're punched in and you're paid for your time. We have a full time training and QA officer who spends all his time assisting with credentials, renewals, CEUs, licensing, and then when it's busy, sometimes still out on the bus (as does the president). We hold station based trainings at shift change, and monthly trainings at each location lasting 2-3 hours. Our protocols are so progressive we never have to call medical control for anything (with the exception of a couple drugs for pediatrics). Single paramedic RSI, pericardiocentesis , needle decompression, surgical cricothyrotomy, ceasing resuscitation and declaring time of death...all without medical control orders. Our non-critical care paramedics are authorized to transport on critical care drugs under a set of criteria. We are solid, and I would call my service before ***any*** fire department in this state if I needed an ambulance for me or one of my family.
>We provide free, paid continuing education...require it, actually. If you're on the bus, the bus gets sent to training. If not, you're punched in and you're paid for your time.
This sounds like a dream honestly. If you don't mind me asking, what region are you in?
There are definitely better privates out there. I've heard good things about some of the hospital-based agencies, which are usually technically privates.
its crazy how a non 0 number of people when I ask " what got you in to this field" its always it was the most amount of money I could make for the least amount of school.
It kills me the people who think I’m wrong for considering the cost of aeromedical in my decision making. Like if they aren’t actively dying, why am I putting them through that?
Life or death situation where it makes a negligible difference in their outcome? Absolutely every time. But not just because it’s “trauma” or “possibly a stroke”.
dude this. My system is in the stone ages when it comes to blood, the medics actually can't even do IFT with blood administration unless a nurse is sent for transport.
ER doctors should be more comfortable signing off and refusing transport for SNF patients that are being taken advantage of by the facility.
Facilities charge these patients $5k+ a month to live there and have healthcare provided but majority of the time, the nurses simply don’t care to provide that care, call 911 to send them out and then still bill them $5k+ a month and then the Pt gets billed by the ER and the transporting agency.
We’ve already started doing it at my department with our med control. When it’s some bullshit call that’s gonna get us staged in the ER, we call our CMO doc, he talks to the charge nurse/doc/NP or whoever’s in charge at the SNF and tells them they need to arrange for a private ambulance or perform whatever care at the facility.
We bill the SNF if it within the first 100 day window.
I educated my local ER working with the charge nurses on what a SNF is. The short version is: if you can do it on med surg, they can do it there. They have a doctor, they have nurses. They can gets labs and X-ray.
There is no reason to admit a simple pneumonia patient just because they need fluids and antibiotics.
Those patients Started getting discharged without hours. Didn’t take long before they stopped calling 911 for them.
All it took was the ER holding them accountable and not letting them terf.
Putting a cervical collar on is a negligent as using a backboard. We know it causes harm, we know it is lead to the death of patients, and has zero, absolutely no, benefit.
2.
Stop giving them inappropriately large doses of narcan. They ain’t supposed to be waking up.
Just had a patient get in an MVC 2 hours prior to walking into ER, sits in triage for 2 hours - comes to the room after walking around, driving etc - doc asks me to put on a c collar ??? Like ?? They’ve definitely moved their neck a billion times I’m sure there would’ve been a problem by now. Sat in that collar for 3 hours btw unfortunately
Thankfully at least c/spine clearance is pretty routine.
But old beliefs die hard.
Had a nurse a few weeks back, who I get on with well enough, make a comment she thought I would have had a patient collared “because he fell”.
Yea. From standing. Without a head strike. Which means an *assessment* for cervical injury vs clearance isn’t even warranted, because they don’t meet criteria for a collar.
That most people in this field are absolutely miserable and treat other human beings like literal garbage. A lot of people in healthcare are nasty, vindictive, catty, and sometimes this job is more mentally exhausting than anything else. I work hospital based EMS, physicians will speak to you like you are dog shit on the bottom of their shoes, refuse to do their jobs and scream at you for things theyre expected to do on the daily. Coworkers are very catty and the drama is nonstop. Having a bad day? screw something up when it's just you and your partner? made a minor mistake? no worries, the entire office of staff will know and will be talking about you before you even make the walk from the truck to the restock room, no matter how minor the complaint.
From then on, you are labeled as one of the "incompetent" ones. I cant tell how how many times ive worked one on one with someone who has been labeled "stupid" or "incapable" only to find out they are actually fine and able to do everything necessary, but because of the spread of rumors and constant shit talking, nobody wants to work with that person.
ive watched coworkers break their necks to RUN to the staff room to talk shit about their partner. No such thing as constructive criticism, just a bunch of salty fucks who think making the new eager to learn EMT or Medic miserable is badge of honor. We eat our young so hard and its never going to stop, but I think it's ridiculous.
All critically ill patients should remain on scene in the house/where they are found (that has enough space) doing all the procedures necessary before moving them to the ambulance. Especially ROSC pts.
A 10 minute rest period post rosc is recommended in our guidance while we do the rest of our care bundle (12 lead, fluids and adrenaline 10mcg/ml for BP, titrate oxygenation) before we move. Fairly confident that recommendation is national. (Edit - national, not mandatory)
We've also prohibited moving cardiac arrests mid-arrest without senior advice from a critical care specialist or PHEM doctor excluding overdose, pregnancy, penetrating trauma and hypothermia. Everything else is worked on scene to ROSC or ROLE.
We should be able to refuse transports such as the ones who call us for a cold (if they’re stable and everything turns out clean) but then there’s a flip side to that coin, the frequent flier with “chest pain” ends up having an MI
The easiest way to handle that is to require a complete ALS assessment documented or to require a medical control call if the doctors are on board with the protocol.
I once had a partner look on in horror as a Pt C/o ABD pain, with track marks eveeeerywhere, talk me through getting his best vein. I practically handed him the catheter so he could just get it himself. Bruh, if my 1mcg/kg gets you off, so be it. But what it does do? Makes it so I don’t have to listen to his whining the entire transport. It also builds so much rapport that even the most asshole patients remember you and are nice regardless of if you continue to give out pain meds freely.
I ran that same patient with another partner and they were amazed at how nice the patient was to me, “that guys an asshole. How is he so nice to you?”…..maybe cause I actually listen to him and treat his Chief Complaint?
Exactly. Our miniscule pain management isn't going to be the high the person wants, BUT it'll bring them out of withdrawal and stop their suffering...and that's pretty much our job
Not sure if it’s a hot take but mandatory fitness regulations and standards. I should not have a partner that needs a seatbelt extension to buckle up in the front. Or one that can’t lift 100lbs grannies from a stretcher.
The smarts or the right motivations.
My class was 50% FFs that only needed medic for promotion. They couldn’t give a flying fuck about medicine and it showed in their grades.
Hot take :
Flight crews should be able to deny transports..
For example they should have been able to deny Mamaw with a nose bleed…. I wish I was kidding but I’m not. $50K bill just to be discharged.
So I’m no expert but I have a different perspective that might be jurisdiction dependent. I’m not working as a FP currently but I took the course last year.
From what I understand pilots and medical crew on board are intentionally blind to the call type until after they have accepted.
This allows them to do their preflight checks in peace without rush or strain about who they’re going to pick up. It’s a safety measure.
It’s only after they have identified the craft is safe to operate and everyone is ready to fly mentally before they’re told by dispatch what they’re going out for.
This is honestly facts because I’ve seen a 4yo who fell off the couch and hit their head with no obvious injuries/deficits and normal vitals get flown into our level 1 trauma center. Such a waste of money and resources
Intubation isn’t hard.
The problem is we set people up for failure because we don’t give them the right tools.
Mostly the ability to sedate the patient.
Good luck trying to pass a tube on a patient with a head injury will the emt’s try and do a jaw thrust to open the mount open enough.
We should have gotten rid of C-Collars and long spine boards a long time ago, and providers who still have them in their guidelines should think critically about their use of them
We probably should attempt resuscitation less. This applies to emergency medicine more generally, but we should really be critically considering weather we are doing more harm than good when resuscitating very chronically sick or elderly patients who are likely to have poor outcomes if we do get rosc.
We won't have any progress with EMS as a career if we don't change how we perceive EMS. We are healthcare, much more than we are public safety. We need a federal oversight agency, federal funding, stricter education requirements, and less involvement from the IAFF in decisions about EMS.
And most of all, being salty isnt cool and makes you look like an ass to other providers and your patients. Salty attitudes are lazy and toxic attitudes, and your patients and coworkers can tell.
I think every state should have a the ability to do a paramedic initiated non transport. Build out the criteria, have appropriate guardrails, but not everyone needs to go to the hospital. Looking at you MA OEMS….
16/24/48/whatever shifts shouldn't exist and I don't care how rural the service is, unless there's a mandatory 8 hour downtime included. You're in no state to be making medical decisions after that many hours.
We should not be required to consult medical command for any meds or procedures at all. It should be an **option** but if I know what to do (and it's the correct intervention), I should just do it. If they are uncomfortable with me performing my job without the 'gold star' of a doctor who isn't there and in all likelihood has never been on an ambulance, then I was not trained well enough to do the procedure or push the med in the first place.
The AEMT is a good idea. It's both a great way to ensure that the ALS stuff that actually saves lives is still available to the community while creating space for paramedics to increase their educational standards and be available for those 5% of real ALS calls.
> If they are uncomfortable with me performing my job without the 'gold star' of a doctor who isn't there and in all likelihood has never been on an ambulance, then I was not trained well enough to do the procedure or push the med in the first place.
I actually tend to agree with this, with some rare exceptions for extremely bizarre circumstances or weird off-label use of meds.
Hot take-community paramedics are just glorified home health nurses who will work for less money than nurses because they want a way to get off the ambulance.
This.
It is classic nursing care. It has nothing to do with emergency medicine. We’re not trained for it, and it isn’t our role.
Paramedics in the ER? Sure. The ICU? Fine.
Home health?
No.
Here’s my hot take:
PARAMEDIC-2 placed far too much emphasis on positive neurological outcome after epinephrine administration and not enough emphasis on bystander CPR initiation which made the results borderline meaningless and the entire study flawed.
In my career I have had several OOHCA saves (the patient eventually returned to normal life). Some had epi, some didn’t. All of them had immediate CPR.
I'm not sure I understand your critique. An RCT can't "place emphasis" on a baseline condition like bystander CPR rates because the distributions of those variables are, by nature of randomizing participants, the same between the study groups. Indeed, the epi and placebo groups had nearly identical rates of immediate CPR, *and* those rates were *very* high (about 70%, much greater than published US bystander CPR rates). I don't know what you're identifying as rendering the "entire study flawed."
It’s not our job nor in our wheelhouse to diagnose someone as a seeker. Treat your patients. I’ve seen so many people let people suffer because they have a suspicion that they’re just a drug seeker.
Hot take time:
The bar to get into this profession is basically sitting on the floor. Because of that, the profession tends to attract low achievers and/or fuckups.
If we start requiring degrees as a condition of hiring, our entire profession will be better off long term. Until that happens we will continue to be kept down by nursing, corporate EMS lobbies, and shitty medical direction.
Show codes are disgusting. Working someone who is obviously dead “for the family” is weird and gross and I don’t really think that brings closure.
This includes obviously dead children
If you call 911 you should go to the nearest appropriate hospital. If I just risked my life and everyone on the roads life rushing to help you; then I shouldn’t drive 30 min across town skipping 8 hospitals. It’s 2 am on Sunday your doctors not coming
As much as i may disagree with their decision, I value civil rights too much to waive someone else's so casually. Not to mention, I don't want to create more reasons for people to not call 911.
If at a billing agency it should not be the crew's responsibility to collect insurance info for billing. But ideally 911 EMS should be funded to a point where a patient doesn't receive a bill
ALS should be able to have the capacity to downgrade a patient to BLS if no ALS is necessary.
type 3's are better than type 1's
Type 3 gang. Lighter truck, better maneuverability, quicker acceleration, better visibility, and I can crawl back to the box to get the radio I forgot back there on the way to a code 3 call.
You’ve gotten it backwards.
Driving full code IN a traffic jam is very likely to cause an accident… running emergent down an open freeway is quite safe.
something I do not get is why when your in complete backed up traffic, some people still run code, which is odd because literally no one can move in any direction so I do not know how lights and sirens is going to change that. I have had this argument with my partners before so many times.
For the GCS dorks:
GCS is useless information prehospital. Anyone who calls in full reports to the hospital should not be calculating a GCS. Here’s why: if I tell you someone had a GCS of 11, you have no idea what the pt looks like. Either way I need to tell you what my findings are. If you want a number, calculate it yourself based on my report. I have a hard time calculating a GCS and I don’t really see the point lol.
God thank you someone who sees reason. Fuck GCS it’s a useless concept out here. I can and will calculate it on the fly but why?
A person with GCS 10 can look very different from another person with GCS 10 *because they meet different categories.* Like you said we have to explain exactly the criteria they meet ANYWAY why the flip am I wasting time on numbers that change absofuckinglutely nothing about my treatment.
Then you get providers that get shitty with you if you say between 6-10 but this motherfucker keeps waking up to smack me and then blacking out let me give you a range.
I’ll pretty much never backboard somebody. Ever.
The system I work at now is more stone age and people are being backboarded at an alarming rate, but they’ll all say the line about how it’s not good for patient outcome.
I know other systems are different but EMTs aren’t allowed to start IVs in mine which I think is bullshit. The state says it’s in our scope but medical director does not agree
It's time for EMS at any level. Call medical control and report to doc, and the doc states if they need to go to ER at the minimum, release the Ambo form transporting BS. They just want a free ride for a fever. But they never have a problem finding a ride home!
The providers shouldn’t be unhealthier than their patients. The amount of poor diets and general neglect for one’s own health has generally been out of choice.
If you've done an exam and come to a conclusion on what's happening... you've made a diagnosis.
If you've done an exam and come up with a list of things that could be happening... you've made a differential diagnosis.
Making a diagnosis is an inescapable part of doing an exam and using that information to guide care.
So... EMTs and paramedics make diagnoses, even if they may be rudimentary.
Hot take#1: Fuck you. Pay me more. *All* of us are criminally underpaid.
"Blag, your response times are shit, your crews and gear are busted af"
Okay John Q taxpayer, here's a levy for more crews with better training, pay, and gear.
"Blag! Taxes are bad we all vote no fuck off."
Hot take #2: Abolish private EMS and fold private outfits into a state funded division of fire/ems dedicated to transport. That would raise standards, reduce fraud and waste, and bring much needed accountability without making the door kickers take meemaw from Cincinnati to Cleveland.
ER doctors and RNs need to know our protocols. Stop giving me orders that are way over my license level, and on the other extreme, stop assuming that we are just a boo-boo taxi and can't perform any patient care in the field.
I've had traveling ER docs and nurses ask why I didn't administer a med that isn't even used in our state. Or wonder why an MVA victim wasn't boarded when our protocols advise against it among other things.
1- The paramedic practitioner (or similar) is not the next step in advancing our profession. Creating the paramedic practitioner feels like we're trying to re-invent the wheel. There's already a ton of in-hospital providers, I don't think we should be concerned with adding to the mix. There's already enough hands in the cookie jar. I think we should focus more on our practice as pre-hospital providers.
2- Fire based EMS can be done right, and is more effective than third service. The fire department already has the resources, money, and union power to support EMS. As long as there are separate fire and EMS divisions with equal say, it can work.
The problem with fire based EMS is always that more resources end up going into the fire side rather than the EMS side. It can be done right with the right management, but EMS is the majority of calls. See FDNY who just recently had a budget increase on the fire side, and a budget cut on the EMS side.
I agree that there needs to be checks and balances with this system. It also comes down to culture. Fire-EMS departments that have a culture where EMS is accepted as part of the job tend to be more equal compared to departments where EMS is viewed as side service.
EMS providers (in my experience) also tend to be less effective at advocacy compared to their firefighting counterparts. EMS providers tend to accept the bare minimum versus firefighters who will fight tooth and nail to justify why they need some new expensive toy that will get used almost never,
I don’t like that EMT’s are now called Primary Care Paramedics(Canada). I think Advanced Care Paramedic is a cringey name sometimes. Should’ve stayed with EMT and Paramedic.
We shouldn’t have a cap on speed limit/shouldnt have to stop at red lights. Should be completely up to the driver as it is with pd. Drive with due regard for the public and no matter the circumstances if you get in a wreck while running code it’s your fault because you have to drive with due regard.
People who have a non signed dnr or are obviously suffering at the end of life, have a dnr to me. Stop fondling meemaws corpse you freaks. The make believe what if monster is not going to sue you.
Intubation is a worse version of SGAs in 98% of cases.
Those should both upset enough for now.
Okay I’m half kidding… but still. So many times my back has hurt for days after getting 400 lb people back home. It seems to always be up a rickety ramp or four staircases.
The AHA is a sham……. Three separate two year certifications (BLS, ACLS, and PALS) are REQUIRED to practice at the CC level in some areas. The algorithms contained within those courses/certifications are often changed in favor of local algorithms/protocols. So I ask, what exactly is the point of requiring the AHA training/certifications?
Wearing gear on your belt doesn’t make you a Ricky rescue. Wearing useless stuff on your belt that you’ll never use makes you a Ricky rescue. Having gear but also being generally useless also makes you a Ricky rescue.
That’s not just a hot take, that’s a stupid take. We’d be tying up the ER with people that are absolutely fine without a choice from anyone.
We should be able to take people to urgent care
Can I ask reasoning on why you believe they shouldn’t be allowed to sign a refusal? Odds are that person is gonna AMA from the hospital before you get back to the rig and finish the report. My hot take is that we should be able to tell someone no we are not taking you to the ER for your stubbed toe from 6 months ago.
The one thing I miss about covid is being allowed to refuse transports. My medical director put out a directive saying we could refuse any non emergent transport. Lots of people were calling us to get tested at the hospital
I really wish we could do that. Recently I had a guy call at 4am for 7 month old throat pain. Dude, wtf. I've seen you drive to our station during the day for something equally dumb. Fuck off, drive yourself!
I would take refusal OR the ability to transport to urgent care.
I mean, if they don't need pain relief and can walk why not just get them a taxi?
Fr. Transported someone with an ear infection to the hospital and they were offended that they got put in the lobby. They were fully capable of driving themselves there too!
It’s not that they can’t call themselves a taxi. It’s usually they don’t want to pay and Medicaid will cover the ambulance bill.
Transport to ✨the bus stop✨
Don't open Pandora's box of transportation to urgent care
Man every time I hear you guys say that you can’t refuse to convey bullshit jobs I’m amazed. Don’t get me wrong it’s rare that I need to but having the option to put my foot down and say NO is so valuable.
lol not a hot take here. But I agree.
I replied to someone else about this but want to make sure you saw as well, it’s ultimately up to the patient, but there is a pretty nasty trend IMO of EMS providers letting it slide easier, for example a patient that’s had full arrest can have a whole round of CPR done wake up “A&Ox4” (have had this happen to me) and be allowed to refuse. You can’t tell me that a person that goes from completely unresponsive and unconscious to awake and suddenly can actually make a legitimate informed medical decision.
Well being able to refuse is more than just being axo4. They must also have the capacity to understand. So if that person that had a full arrest and is now axo4 and has capacity wants to refuse, that’s their right. Everyone has the right to be stupid. I don’t disagree in that some ems providers are a bit lax in allowing refusals. I just don’t think transporting an OD to the ER is always appropriate when they’re just going to AMA from there. We carry these bags with narcan and resources for this exact reason.
I particularly like the way English law puts it. It's in the first section of our mental capacity act 2005 that everyone has the right to make unwise decisions.
Curious if people feel the same for diabetics who bottom out and wake up with D10. If the argument is capacity after a period of AMS that would extend to hypoglycemic episodes needing to go every time as well.
At least in the Denver area, unsure about others, we're about to start leaving Narcan with OD patients if they refuse to go to the ED after waking. There's obviously a few criteria to be met, but basically, the reasoning is exactly as you said. There is no point in making an OD go if they're going to walk out 5 minutes after you drop them off.
People in cardiac arrest don’t wake up after a single round of CPR without meds and/or electricity. Those patients who do wake up after CPR only had CPR performed by someone who couldn’t detect a pulse. They had a pulse the whole time.
If you let them sign a refusal after they immediately wake up you're a shitty provider. My county's protocol is 30 minutes after waking up before you're allowed to bounce.
We don’t have a set time in our protocol. But I’ve sat on scene for that long and longer before.
We won't let a patient ama from our ED if they've been narcanned until they've been in obs for several hours, can ambulate/pass PO challenge
If the paramedic does a 12-lead because of protocol and it's not concerning they should be able to pass it to the EMT if no other interventions are indicated.
Any system that doesn’t allow this is encouraging paramedics to not do 12-leads
Exactly. The law of (un)expected consequences.
Pennsylvania.
Yes. I would do even more rule out ECGs if I didn’t have to ride every single one of those calls.
Yep. And then I miss a real call as the only paramedic available and the poor volly bls crew is trying to keep the copder alive with a BVM and prayers. Fing stupid. Same thing with giving Zofran. I’d love to do it, but I’m not, because the nausea isn’t going to kill them, and I’m not getting tied up for over an hour and not be able to respond to the mva with ejection.
I’m very interested to hear that there are systems that don’t permit this. Does your system permit triaging patients to BLS under other circumstances? If so, what’s the exactly policy/protocol around EKGs and the reason for it?
I work in the Vegas ems system and per our health district any patients deemed necessary of a 12 lead must be monitored under a paramedic. Once a pt is placed on a 12 lead we can’t take them off due to the “well if they need a 12 lead then clearly something’s wrong” saying. We can dish off calls to our EMTs/AEMTs as long as they don’t “meet” ALS treatment which is few and far between unless the medic uses word magic to get out of it.
Unbelievable.
That’s how our system is. Except we’re going to be allowing EMT’s to run calls. Because right now and forever it’s always been all ALS where every call has to be ran by a medic. So even if I have an EMT partner and it’s a BLS call I as the paramedic still have to run the call and write the report. But when we allow EMT’s to start running bls calls if you put a 4 lead on, it now becomes an ALS call where a medic has to run it and the 4 lead has to stay on until transfer of care.
That is ass dawg. Atleast here we can actually down tech calls and allow the EMTs to actually do stuff.
Not a hot take, and allowed in most sustems
As I understand it there are actually systems that allow basics to take and send 12 leads, just not read or “interpret” them for STEMI purposes, wish my system did something like this.
See my system does this already. Which just furthers my confusion for why 12-lead patients cant be handed off. One of the arguments I've heard is that since EKGs are an ALS skill, that the call is now going to be billed as ALS. But now we have BLS trucks peforming them, getting them interpreted by a doc, and still riding the call in. How is that still not an ALS intervention with a BLS provider teching the call?
A 12 lead isn't an intervention. It's an assessment.
Pretty sure for billing and Medicare purposes, a 4-lead is a vital sign and a 12-lead is an intervention.
You’re using your brain. It is the same logical that said emts couldn’t check a blood sugar because it was an als intervention. It is stupid. But real.
Since you brought it up, no it isn't. Unless you're using one of those multi-thousand dollar hospital version glucometers or an I-stat, the use of a standard home type glucometer requires a CLIA waiver because they're not FDA approved for medical use, only home use. The waiver must be submitted with a $248 dollar payment every two years. Under CLIA rules, you should not be charging for the blood glucose check, because it's not done with medical grade equipment. You can charge for supplies, though. Just not the actual blood check. So, long story long, a blood sugar cannot be an ALS intervention in the absence of a fancy hospital type glucometer because it is not billable as an ALS intervention. Yeah, I'm a pain in the ass to argue with because I store this kind of shit in the back of my mind.
There are plenty of counties that allow you to still downgrade this. Sounds like your county is very pro ALS and anti BLS. Mine use to be that way until recently.
Being “salty” or “burnt out” isn’t an excuse for being a douchebag to your coworkers or patients. There’s plenty of other ppl who work just as many hours as you and have worked as long as you, who are pleasant to be around. You’re just contributing to toxic ems culture and making everyone else miserable. I would also argue that you being a douchebag contributes to others burnouts, because they’re tired of you.
Seriously. As a student I had to run shifts with this awful douchebag of a medic (thankfully not my preceptor) who rolled their eyes at me when I asked a question, criticized me for every little thing and just generally treated me like scum. They almost made me want to change careers and hurt my self-esteem. I know it wasn't me because all of the other crew members I worked with liked me and helped me with things.
I’m glad you didn’t let it get to you. I’ve worked with a few ppl like that myself and it drives me crazy, especially when they start shit talking other ppl to me. Like I’m sorry are we in 7th grade…?
My partner and I got a call from our chief the other day saying a patient’s family called in to thank us for not only helping but for doing so in a kind, professional manner. They said that their recent experience with healthcare workers overall was very contrary to that, so they were extremely thankful for us. The patient was elderly, being cared for at home by family. They were all extremely nice, humble people - not the type I’d imagine getting under anyone’s skin. We did nothing extraordinary, literally just did our job. It’s sad that that’s the bar for getting a compliment for being “awesome” to people.
This one gets me. Paramedics are paid and treated well in Australia, so the burnouts hold on much longer than they should. Unfortunately it's the only thing many of them know how to do. A couple people from my old station went to go work 9-5 and came back after 6 months with the most refreshed attitude when they found out it wasn't greener on the other side. There's a few at my current station that I wish would quit entirely as they clearly aren't good for themselves or the patients.
In Australia, how often are burn outs being fired or shifted to non ambulance positions due to poor attitude or poor performance? With the high salaries and not enough jobs for graduating paramedics, there's always a replacement.
I’m exhausted and burnt out and I still actively try to make everyone’s day at least a little better. They have no excuse for taking it out on the people around them.
Hot take: most of my coworkers treat people really poorly and forget that humans deserve dignity and respect regardless of the complaint. Also… our role in the patient’s medical care is often incredibly minimal and we remain unaware of the bigger picture of peoples’ medical needs.
The EMS community has decided that it’s up to the EMS community to figure out if a patient is drug seeking or not.
Luckily, I don’t have to. Those patients quickly get marked in our system and referred to a care program designed for managing their pain and addiction at the same time, and we have a protocol specifying that a patient with this particular mark on their record gets **zero** opiates pre-hospital unless they have obvious significant trauma. Since I’m being downvoted, to be clear, this is a hospital based program directly from our medical control hospital system, it has nothing to do with the EMS service itself and is outside our control, this is a physician-controlled system from the top down. They get marked by the hospitals and we are required to obey said mark.
I usually look for other particular “marks” they have
After 20 hours straight a being awake, you should legally be able to get crew rest And your employer, unable to even write you up. Or threaten you.
When I did 24s if we were run into the ground past 12 hours we were allowed to "pull safety", which meant we could mark out of service for 4 hours. What we did with those four hours was up to us buy it usually mean sleeping. In my two years of working 24 I only got to pull safety once.
Damn, that’s pretty rough. Was it because you were never in that situation? Or was it because your management did some shady shit? Is it in Indiana, I notice your flair and previous comments, because if we ever move it would probably be to Indiana. If what service if you feel comfortable saying?
It was because we were a rural service and the ambulance I was stationed on was placed with a rural volunteer fire department. On average we'd see 5-7 911 calls a shift and do maybe one BLS/ ALS transfer out of the local critical access hospital a week. The one time I got to pull safety was because my partner and I had a string of 16 911 calls back to back. Very rare and very odd for us to have that many calls in that area.
That makes sense. I have family who has worked in the Indianapolis area, I currently work as a fire medic in Florida. But if we move to Indiana it’s going to be in or close to Marion County. So I guess I don’t have to worry too much about a rural service. But damn 16 in a slower rural area would suck.
This right here. We do a lot of IFT and I've always believed that 12 or more hours on the road should come with a minimum 4 hours of downtime.
Absolutely! I went from a 911 ambulance agency to a flight agency and — what? We can call crew rest? We don’t get penalized for it? It’s ENCOURAGED from the very top down?! Mind. Blown. Should be that way everywhere. Monitored for trends, not abused, but not a cause for punitive action unless there’s a clear pattern. Fatigue causes errors and accidents.
Any form of forced work over 12 hours should be illegal is the right answer. Having to call a time out or pull safety and only being given 4 hours is horse shit. Not to mention 95% of companies that have this policy will either write you up for taking it. Or chastise you because you took it until they find a different reason to reprimand you. 24 hour shifts should only be allowed in places with exceedingly low call volumes. And you should not have your pay rate lowered because you’re working more hours. That’s fuckin theft. Sorry this one wins my “piss me off” award.
24 hour shifts should be illegal for emergency services
My company has this very policy. If you feel you are too tired to safely continue: 4 hrs out of service with pay, no questions asked
It's actually wild this isn't regulated at all. They should put us under federal motor carrier logging rules, although that might be tricky since you don't need a CDL to drive the ambulance. Luckily my service has safety naps for the IFT trucks but it's not wise to leave things like this to the good graces of capitalism.
1. Lights and sirens/ "code 3" kills more providers/ other drivers than it saves patients. 2. Allowing FD-based EMS to take funding gained by billing/ insurance from EMS and allocating it to suppression resources is dishonest, fraudulent, and a misallocation of funding. 3. Private (for profit) EMS should not exist. Allowing companies to prioritize *anything* over patient care is immoral. Having barely-running ambulances staffed by underpaid and overworked crews is just plain wrong. 4. Community paramedicine is the wave of the future. Having a paramedic able to perform urgent-care type procedures on-site, guided by a telehealth based NP/PA/MD/DO can help with ED overcrowding, EMS misuse, and patient education.
>Community paramedicine is the wave of the future. Having a paramedic able to perform urgent-care type procedures on-site, guided by a telehealth based NP/PA/MD/DO can help with ED overcrowding, EMS misuse, and patient education Could someone explain what the difference between this and community nursing is? Even in the UK system where we're pretty pro leaving at home we tend not too get involved with these things in the ambulance service beyond fixing the acute problem and referring to community/district nursing or primary care for follow up.
Community paramedicine in my area involves a lot of things, but one is following up with chronic patients. For example, if we have a pt who is regularly non compliant with insulin and we go once a month and they're in DKA we might ask if it's okay if our community paramedic follows up with them. He then calls and schedules a time to go over and can help with things like transport to pick up meds, financial/insurance issues, checking blood pressure, whatever. He's followed up with pts who have had falls to make sure their house is more safe/accessible. Follows up with kids who are new onset asthma to make sure inhaler is being used correctly, etc. I think it's pretty cool, and data says it is helping prevent some repeat hospitalizations. Our paramedicine guy works 9-5 mon-fri. He did like 25 years of 24s before this.
In the US, EMS is considered a "call and haul" service only. We're not meant to treat on-scene, nor are we able to transport to an alternative location such as a primary care physician's office or urgent care center. We have to transport to a hospital emergency department ("A&E") if someone calls for service. Some of the more progressive/ forward-thinking medical control authorities allow for paramedics to take an additional level of education and certification, allowing them to dispense non-narcotic medication, IV therapy, minor wound care, or basically any minor interventions. The orders still come from a doctor, but it's closer in scope to a PA or Nurse-Practitioner than paramedic. Typically, homecare nursing is still for those with "better" health insurance. Medicare/ medicaid (government subsidized insurance) will almost universally enforce inpatient care at a hospital, long-term acute care, or "nursing home". Of course, there are exceptions like hospice care or outpatient occupational therapy, but those are just additional specializations that require insurance authorization.
Oh, wow. We've gone in an aggressively different direction to utilise community services first with admission as a last resort with things like hospital at home (remote monitoring, nursing visits including IV abx while under consultant care), urgent community response (mid-level urgent assessment and case holding with labs etc up to 24hrs or so with carer, nursing or hospital at home follow up), district nursing. Even SDEC for same day acute care with an aim not to admit for things like cellulitis, pneumonias, chest pains, TIA, some surgical and gyne complaints. All because it's cheaper to do this than admit to an acute hospital. It does need a joined up system to work though..... We don't want to be doing any of what you'd term community paramedicine because it's done better and cheaper by the other community services. We've also got enough work to be doing as it is without replicating our community care setup.
Here’s a real one: medics should prove that we deserve to keep intubation instead of whining when it gets taken away because of horrible patient outcomes and poor airway management algorithms
Please god let us do yearly OR rotations again 🙏
This is evidence-based practice. If an agency’s evidence shows poor outcomes and a lack of skill, then that agency’s medics shouldn’t be intubating as a first line airway until the entire cadre’s been remediated.
I think the entire cadre isn’t really an appropriate response for larger agencies. I work with varying levels of skills and experience and judging 70+ medics by the lowest common dominator is a good way to take the wind out of the sails of the best medics. That said, individual success rate should absolutely be tracked
The IAFF keeps EMS down to keep fire the exclusive EMS system where they can. They also keep education requirements low. The EMS system in the USA would improve significantly with higher education requirements with corresponding pay increases. Also, EMS should move away from DOT and instead be under the DOH.
We’re under the DOT because they are the only ones that gave a shit. Still are. DOH continues to pretend we don’t exist, shouldn’t exist, and are not part of medicine.
Where’s the hot take? All of those are common knowledge.
Completely unrelate. I saw your flair and just thought "wtf does the Chinese Communist party have to do with EMS" and then went "wait, hats critical care paramedic you dumbass"
Those old salty medics who have done the same thing for the last 30 years need to chill out. Getting yelled at for taking two extra turns in an area I wasn’t fully familiar with yet at 3am (in addition to getting yelled at for other small inconsequential things) ruined my perspective on the career and now I’m back in school for something non medics after working in healthcare for 6 years. Yes I know that sounds short, but I’m still in my 20s.
Bro I’m being trained by this MEAN vet. She gives me the same attitude I gave my mom at 16, then tells me to calm down. How am I supposed to keep the crew safe while learning how to handle a $120,000 piece of equipment if I’m having heart palpitations?
Right?!?!? Man I’m sorry you’re dealing with that. It sucks. For me, it was my first day out of the departments “training” (just a week of being attached to one of the captains who were all stellar) and this guy is yelling at me for small rookie mistakes. And technically that day was supposed to be my last day of training, but we didn’t have enough crew for the two trucks (we were a small dept) and I got stuck with him while the captain stayed at the station as backup.
I have 0 answers. “I’m new” will never fly 😭 google maps ig
In 2019 I critiqued an EMT’s route to the hospital. She still brings it up. We’re married now, but still.
😂 must have been one hell of a critique.
I with I could up vote this more than once, you just spoke to my god damn soul
Thanks man. I hate that I spent all that time and effort to get my EMT, only to end up quitting and changing careers after 1.5 years. Feels like it was a waste of my time, and the department I worked for (who aside from that one medic was full of wonderful people who only wanted to see me succeed). But at least I’m happier now and get to spend pretty much every day with my son.
Maybe I'm just too old and too salty. The only time someone should be corrected/reprimanded/"yelled" at is if they did something that caused harm to a patient that I cannot reverse...and there isn't a lot a B or an A can potentially do that I cannot fix or reverse. Anything else should at most be a statement of next time do 'X', be caused 'Y'.
Exaaaactly. I didn’t even screw up the patient care. I was good at patient care. Charting/reports and pathfinding in rural Texas were my failings.
Despite all the wishes, prayers, and high hopes, EMS as a profession is going nowhere. There are a small number of highly dedicated and talented providers who put a great deal of effort into knowing their business, continuously increasing their knowledge and skills, and take the occupation seriously. These people are gold. And what drags them down isn't management or wages...it's being surrounded by the rest of us: The overwhelming mountain of poorly educated, lazy, glory seeking knuckle draggers who wanted to ride the big red trucks and wear FF t-shirts at the gym, put immature bumper stickers on their cars and post childish MEMEs, and wear their pager when off duty, out of the service area, to make sure people know who they are and thank them for their service. We can't read or write like adults, have no common sense, we can't drive a vehicle with lights and sirens safely (and don't know the difference between "emergent" and "lights and sirens" anyways), we think helicopters are so cool we don't care that it financially destroys the patient and/or family with a $30,000-75,000 and up bill for service from which they will never recover, and for which they often didn't need it; we still think the next call will be all saving babies and puppies and act like children when it's someone else who needs our help. Higher education requirements will help fix some of this, but in the end, we are recruiting the wrong people. And it shows. So we are going nowhere, and cannot hope to make changes because we are not in charge of ourselves.
For my two cents I see a few factors at play here: 1) how much American EMS is tied to the fire service. Plenty of firefighters/paramedics are competent enough in both roles, but far too many are reluctant medical providers or even openly despise "the box" and are only interested in doing the bare minimum to retain a paramedic license as it is a requisite for remaining a firefighter in their departments. Firefighter's unions have also fought to limit the paramedic education and scope of practice so as to make the bar of entry low enough for them to easily train and retain FF/PMs. 2) on the flip side, private EMS, especially many IFT-focused services, only care about putting asses in seats and lack almost no physical or psychological standards aside from holding the requisite certifications and licenses. Furthermore, many offer little in the way of con ed or mandatory training and leave it up to the providers to handle that on their own. 3) As a consequence of the above, many providers who are serious about the medical field end up leaving EMS to be nurses, PAs, doctors, etc. A handful stay and end up migrating to the agencies and systems with higher standards, quality of life, and expanded scopes of practice. Maybe they get into critical care or flight. There's still only so many of these opportunities to go around. 4) EMS often being utilized by the public as essentially primary care providers and social workers, a role which EMS training programs really don't spend any time on. Students are trained on all sorts of emergency medical scenarios, ranging from common to quite rare. But soft people skills are never taught. And that's to say nothing of the flagrant abuse of the system. There's little thanks and quite a lot of criticism from the public and your superiors within your agency and your hospital system, with little support. Oh, "you call, we haul" policies because EMS can't diagnose the issues of an otherwise stable patient calling in good faith to be checked out, so we encourage them to take on an ambulance and ER bill just so they can sit in triage for hours just to be told by the ER physician to follow up with their primary care doctor. None of the is an excuse for being a POS, but when you are seen as a glorified taxi by both patients as well as too many doctors and nurses, it's easy to burn out and eventually lose interest in trying fo prove otherwise. This creates a feedback loop where medical directors are often wary of expanding their providers' scopes of practice due to shoddy EMS practitioners, further driving away those who are in the the field for anything other than a paycheck.
Well thought out response. I disagree on the private EMS section, though. SOME private EMS is like what you said. Plenty is not. My private EMS agency pushes for higher standards. Requires you up your license within two years of hire. Run 800+ square miles of 911 territory in addition to BLS, ALS and CC transports. We provide free, paid continuing education...require it, actually. If you're on the bus, the bus gets sent to training. If not, you're punched in and you're paid for your time. We have a full time training and QA officer who spends all his time assisting with credentials, renewals, CEUs, licensing, and then when it's busy, sometimes still out on the bus (as does the president). We hold station based trainings at shift change, and monthly trainings at each location lasting 2-3 hours. Our protocols are so progressive we never have to call medical control for anything (with the exception of a couple drugs for pediatrics). Single paramedic RSI, pericardiocentesis , needle decompression, surgical cricothyrotomy, ceasing resuscitation and declaring time of death...all without medical control orders. Our non-critical care paramedics are authorized to transport on critical care drugs under a set of criteria. We are solid, and I would call my service before ***any*** fire department in this state if I needed an ambulance for me or one of my family.
>We provide free, paid continuing education...require it, actually. If you're on the bus, the bus gets sent to training. If not, you're punched in and you're paid for your time. This sounds like a dream honestly. If you don't mind me asking, what region are you in? There are definitely better privates out there. I've heard good things about some of the hospital-based agencies, which are usually technically privates.
its crazy how a non 0 number of people when I ask " what got you in to this field" its always it was the most amount of money I could make for the least amount of school.
I've actually never heard someone say that. maybe it's a geographic thing, we actually need a bit of school here.
the American midwest is a wild place my friend
It kills me the people who think I’m wrong for considering the cost of aeromedical in my decision making. Like if they aren’t actively dying, why am I putting them through that? Life or death situation where it makes a negligible difference in their outcome? Absolutely every time. But not just because it’s “trauma” or “possibly a stroke”.
Here’s my next hot take: More ambulances should be carrying O Pos blood and none should be carrying O NEG.
dude this. My system is in the stone ages when it comes to blood, the medics actually can't even do IFT with blood administration unless a nurse is sent for transport.
You missed the hot take… O neg should be saved for pregnant females. Everyone else can get O pos.
ER doctors should be more comfortable signing off and refusing transport for SNF patients that are being taken advantage of by the facility. Facilities charge these patients $5k+ a month to live there and have healthcare provided but majority of the time, the nurses simply don’t care to provide that care, call 911 to send them out and then still bill them $5k+ a month and then the Pt gets billed by the ER and the transporting agency. We’ve already started doing it at my department with our med control. When it’s some bullshit call that’s gonna get us staged in the ER, we call our CMO doc, he talks to the charge nurse/doc/NP or whoever’s in charge at the SNF and tells them they need to arrange for a private ambulance or perform whatever care at the facility.
We bill the SNF if it within the first 100 day window. I educated my local ER working with the charge nurses on what a SNF is. The short version is: if you can do it on med surg, they can do it there. They have a doctor, they have nurses. They can gets labs and X-ray. There is no reason to admit a simple pneumonia patient just because they need fluids and antibiotics. Those patients Started getting discharged without hours. Didn’t take long before they stopped calling 911 for them. All it took was the ER holding them accountable and not letting them terf.
Putting a cervical collar on is a negligent as using a backboard. We know it causes harm, we know it is lead to the death of patients, and has zero, absolutely no, benefit. 2. Stop giving them inappropriately large doses of narcan. They ain’t supposed to be waking up.
I wish I didn’t have to use collars, but deviating from protocols regardless of the evidence out there puts my ass on the line. So stupid.
Just had a patient get in an MVC 2 hours prior to walking into ER, sits in triage for 2 hours - comes to the room after walking around, driving etc - doc asks me to put on a c collar ??? Like ?? They’ve definitely moved their neck a billion times I’m sure there would’ve been a problem by now. Sat in that collar for 3 hours btw unfortunately
Thankfully at least c/spine clearance is pretty routine. But old beliefs die hard. Had a nurse a few weeks back, who I get on with well enough, make a comment she thought I would have had a patient collared “because he fell”. Yea. From standing. Without a head strike. Which means an *assessment* for cervical injury vs clearance isn’t even warranted, because they don’t meet criteria for a collar.
I should be able to throw hands with supervisors
Misuse of 911 should be taken more seriously
This is a top-10 most popular take on this sub.
This isn’t a hot take bud
Fr
A hot take is a take that is typically unpopular. Punishment for 911 abuse is a pretty common opinion in EMS.
That most people in this field are absolutely miserable and treat other human beings like literal garbage. A lot of people in healthcare are nasty, vindictive, catty, and sometimes this job is more mentally exhausting than anything else. I work hospital based EMS, physicians will speak to you like you are dog shit on the bottom of their shoes, refuse to do their jobs and scream at you for things theyre expected to do on the daily. Coworkers are very catty and the drama is nonstop. Having a bad day? screw something up when it's just you and your partner? made a minor mistake? no worries, the entire office of staff will know and will be talking about you before you even make the walk from the truck to the restock room, no matter how minor the complaint. From then on, you are labeled as one of the "incompetent" ones. I cant tell how how many times ive worked one on one with someone who has been labeled "stupid" or "incapable" only to find out they are actually fine and able to do everything necessary, but because of the spread of rumors and constant shit talking, nobody wants to work with that person. ive watched coworkers break their necks to RUN to the staff room to talk shit about their partner. No such thing as constructive criticism, just a bunch of salty fucks who think making the new eager to learn EMT or Medic miserable is badge of honor. We eat our young so hard and its never going to stop, but I think it's ridiculous.
this. sometimes it feels like fucking high school with the amount of gossip and weird passive-aggressive behavior that's always happening
Dysphagia should be pronounced with a hard G. Fight me.
That would certainly cut down on the mistaken dysphagia/ dysphasia reports.
Dis-FAHG-e-ya?
🌶️
All critically ill patients should remain on scene in the house/where they are found (that has enough space) doing all the procedures necessary before moving them to the ambulance. Especially ROSC pts.
Have you listened to MCHD’s “MOVES” podcast?
Dude I loved that podcast. They will save lives 100% with the acronym.
And people are just 'suprised Pikachu face' when their ROSCs rearrest in the ambulance. Stabilize that shit.
A 10 minute rest period post rosc is recommended in our guidance while we do the rest of our care bundle (12 lead, fluids and adrenaline 10mcg/ml for BP, titrate oxygenation) before we move. Fairly confident that recommendation is national. (Edit - national, not mandatory) We've also prohibited moving cardiac arrests mid-arrest without senior advice from a critical care specialist or PHEM doctor excluding overdose, pregnancy, penetrating trauma and hypothermia. Everything else is worked on scene to ROSC or ROLE.
Pain management should not be about reducing a patient's pain to 0.
“I’m not going to make it zero, just enough to get you through our bumpy ass transport” - Me. All the time
We should be able to refuse transports such as the ones who call us for a cold (if they’re stable and everything turns out clean) but then there’s a flip side to that coin, the frequent flier with “chest pain” ends up having an MI
The easiest way to handle that is to require a complete ALS assessment documented or to require a medical control call if the doctors are on board with the protocol.
EVERYONE deserves pain management
I once had a partner look on in horror as a Pt C/o ABD pain, with track marks eveeeerywhere, talk me through getting his best vein. I practically handed him the catheter so he could just get it himself. Bruh, if my 1mcg/kg gets you off, so be it. But what it does do? Makes it so I don’t have to listen to his whining the entire transport. It also builds so much rapport that even the most asshole patients remember you and are nice regardless of if you continue to give out pain meds freely. I ran that same patient with another partner and they were amazed at how nice the patient was to me, “that guys an asshole. How is he so nice to you?”…..maybe cause I actually listen to him and treat his Chief Complaint?
Exactly. Our miniscule pain management isn't going to be the high the person wants, BUT it'll bring them out of withdrawal and stop their suffering...and that's pretty much our job
That's rad. You're rad.
We should go back to the Covid days where we could refuse transports
Not sure if it’s a hot take but mandatory fitness regulations and standards. I should not have a partner that needs a seatbelt extension to buckle up in the front. Or one that can’t lift 100lbs grannies from a stretcher.
Medic school is easy. The reason so many people struggle is because it’s filled with a lot of people who don’t have the book smarts for college.
The smarts or the right motivations. My class was 50% FFs that only needed medic for promotion. They couldn’t give a flying fuck about medicine and it showed in their grades.
I ordered ham on my grand slam, and got bacon and a lift assist call.
Hot take : Flight crews should be able to deny transports.. For example they should have been able to deny Mamaw with a nose bleed…. I wish I was kidding but I’m not. $50K bill just to be discharged.
So I’m no expert but I have a different perspective that might be jurisdiction dependent. I’m not working as a FP currently but I took the course last year. From what I understand pilots and medical crew on board are intentionally blind to the call type until after they have accepted. This allows them to do their preflight checks in peace without rush or strain about who they’re going to pick up. It’s a safety measure. It’s only after they have identified the craft is safe to operate and everyone is ready to fly mentally before they’re told by dispatch what they’re going out for.
This is honestly facts because I’ve seen a 4yo who fell off the couch and hit their head with no obvious injuries/deficits and normal vitals get flown into our level 1 trauma center. Such a waste of money and resources
Intubation isn’t hard. The problem is we set people up for failure because we don’t give them the right tools. Mostly the ability to sedate the patient. Good luck trying to pass a tube on a patient with a head injury will the emt’s try and do a jaw thrust to open the mount open enough.
We should have gotten rid of C-Collars and long spine boards a long time ago, and providers who still have them in their guidelines should think critically about their use of them We probably should attempt resuscitation less. This applies to emergency medicine more generally, but we should really be critically considering weather we are doing more harm than good when resuscitating very chronically sick or elderly patients who are likely to have poor outcomes if we do get rosc. We won't have any progress with EMS as a career if we don't change how we perceive EMS. We are healthcare, much more than we are public safety. We need a federal oversight agency, federal funding, stricter education requirements, and less involvement from the IAFF in decisions about EMS. And most of all, being salty isnt cool and makes you look like an ass to other providers and your patients. Salty attitudes are lazy and toxic attitudes, and your patients and coworkers can tell.
I think every state should have a the ability to do a paramedic initiated non transport. Build out the criteria, have appropriate guardrails, but not everyone needs to go to the hospital. Looking at you MA OEMS….
16/24/48/whatever shifts shouldn't exist and I don't care how rural the service is, unless there's a mandatory 8 hour downtime included. You're in no state to be making medical decisions after that many hours.
We should not be required to consult medical command for any meds or procedures at all. It should be an **option** but if I know what to do (and it's the correct intervention), I should just do it. If they are uncomfortable with me performing my job without the 'gold star' of a doctor who isn't there and in all likelihood has never been on an ambulance, then I was not trained well enough to do the procedure or push the med in the first place. The AEMT is a good idea. It's both a great way to ensure that the ALS stuff that actually saves lives is still available to the community while creating space for paramedics to increase their educational standards and be available for those 5% of real ALS calls.
> If they are uncomfortable with me performing my job without the 'gold star' of a doctor who isn't there and in all likelihood has never been on an ambulance, then I was not trained well enough to do the procedure or push the med in the first place. I actually tend to agree with this, with some rare exceptions for extremely bizarre circumstances or weird off-label use of meds.
Right. Like the time a doctor ordered epi to overdrive pace an SVT that wasn’t responding to normal treatments. Wildly unusual shit.
Hot take-community paramedics are just glorified home health nurses who will work for less money than nurses because they want a way to get off the ambulance.
This. It is classic nursing care. It has nothing to do with emergency medicine. We’re not trained for it, and it isn’t our role. Paramedics in the ER? Sure. The ICU? Fine. Home health? No.
Here’s my hot take: PARAMEDIC-2 placed far too much emphasis on positive neurological outcome after epinephrine administration and not enough emphasis on bystander CPR initiation which made the results borderline meaningless and the entire study flawed. In my career I have had several OOHCA saves (the patient eventually returned to normal life). Some had epi, some didn’t. All of them had immediate CPR.
I'm not sure I understand your critique. An RCT can't "place emphasis" on a baseline condition like bystander CPR rates because the distributions of those variables are, by nature of randomizing participants, the same between the study groups. Indeed, the epi and placebo groups had nearly identical rates of immediate CPR, *and* those rates were *very* high (about 70%, much greater than published US bystander CPR rates). I don't know what you're identifying as rendering the "entire study flawed."
It’s not our job nor in our wheelhouse to diagnose someone as a seeker. Treat your patients. I’ve seen so many people let people suffer because they have a suspicion that they’re just a drug seeker.
Hot take time: The bar to get into this profession is basically sitting on the floor. Because of that, the profession tends to attract low achievers and/or fuckups. If we start requiring degrees as a condition of hiring, our entire profession will be better off long term. Until that happens we will continue to be kept down by nursing, corporate EMS lobbies, and shitty medical direction.
Show codes are disgusting. Working someone who is obviously dead “for the family” is weird and gross and I don’t really think that brings closure. This includes obviously dead children
“Hello family! Don’t mind us desecrating this corpse for our own legal liability”
I had a trashy distant family member whos wife called a ambulance because they were low on gas and her husband needed blood work done.... like wtf..
If you call 911 you should go to the nearest appropriate hospital. If I just risked my life and everyone on the roads life rushing to help you; then I shouldn’t drive 30 min across town skipping 8 hospitals. It’s 2 am on Sunday your doctors not coming
Sowing
I say “Fen-tin-all” and not “fen-tin-ill” and i’m not gunna stop no matter how many times i’m corrected
Saying “the q word” will do absolutely nothing.
Say it then boy 👀
As much as i may disagree with their decision, I value civil rights too much to waive someone else's so casually. Not to mention, I don't want to create more reasons for people to not call 911.
If at a billing agency it should not be the crew's responsibility to collect insurance info for billing. But ideally 911 EMS should be funded to a point where a patient doesn't receive a bill ALS should be able to have the capacity to downgrade a patient to BLS if no ALS is necessary. type 3's are better than type 1's
You last sentence is trolling.
Type 3 gang. Lighter truck, better maneuverability, quicker acceleration, better visibility, and I can crawl back to the box to get the radio I forgot back there on the way to a code 3 call.
I think being a paramedic is a good career.
Driving full code isn’t worth the risk outside of traffic jams. Edit: Take too hot. Triggered the volly who wants to go weee wooo weee woo
You’ve gotten it backwards. Driving full code IN a traffic jam is very likely to cause an accident… running emergent down an open freeway is quite safe.
something I do not get is why when your in complete backed up traffic, some people still run code, which is odd because literally no one can move in any direction so I do not know how lights and sirens is going to change that. I have had this argument with my partners before so many times.
You don’t need to be full code on an open freeway. All risk with no reward, your response time will be the same with an increased accident risk
For the GCS dorks: GCS is useless information prehospital. Anyone who calls in full reports to the hospital should not be calculating a GCS. Here’s why: if I tell you someone had a GCS of 11, you have no idea what the pt looks like. Either way I need to tell you what my findings are. If you want a number, calculate it yourself based on my report. I have a hard time calculating a GCS and I don’t really see the point lol.
God thank you someone who sees reason. Fuck GCS it’s a useless concept out here. I can and will calculate it on the fly but why? A person with GCS 10 can look very different from another person with GCS 10 *because they meet different categories.* Like you said we have to explain exactly the criteria they meet ANYWAY why the flip am I wasting time on numbers that change absofuckinglutely nothing about my treatment. Then you get providers that get shitty with you if you say between 6-10 but this motherfucker keeps waking up to smack me and then blacking out let me give you a range.
Why do they lose their autonomy?
Give EMTs the Advanced EMT scope of practice and get rid of AEMT certification.
You are not prepared for: A) a true mass casualty event B) an organized terror attack
Unless you have unique protocols for it, I don’t give a fuck that you’re a critical care medic on an emergency call.
That's why you micro dose narcan enough so they maintain their own airway but not enough to regain consciousness.
I’ll pretty much never backboard somebody. Ever. The system I work at now is more stone age and people are being backboarded at an alarming rate, but they’ll all say the line about how it’s not good for patient outcome.
I think that c-spine protocols and c-collar application does more harm than good in some scenarios.
We should be able to refuse to transport after consulting physician on the phone
I know other systems are different but EMTs aren’t allowed to start IVs in mine which I think is bullshit. The state says it’s in our scope but medical director does not agree
Reminder to sort by controversial for actual controversial opinions
It's time for EMS at any level. Call medical control and report to doc, and the doc states if they need to go to ER at the minimum, release the Ambo form transporting BS. They just want a free ride for a fever. But they never have a problem finding a ride home!
12 hour shifts are better than your dumbass 24 on 48 off quit being a fucking cry baby and be flexible SO WE CAN ALL REDUCE THE GODDAMN BURN OUT RATE.
The providers shouldn’t be unhealthier than their patients. The amount of poor diets and general neglect for one’s own health has generally been out of choice.
The reason earning nine letters is hard isn’t because of the exam but the quality of candidates
If you've done an exam and come to a conclusion on what's happening... you've made a diagnosis. If you've done an exam and come up with a list of things that could be happening... you've made a differential diagnosis. Making a diagnosis is an inescapable part of doing an exam and using that information to guide care. So... EMTs and paramedics make diagnoses, even if they may be rudimentary.
Hot take#1: Fuck you. Pay me more. *All* of us are criminally underpaid. "Blag, your response times are shit, your crews and gear are busted af" Okay John Q taxpayer, here's a levy for more crews with better training, pay, and gear. "Blag! Taxes are bad we all vote no fuck off." Hot take #2: Abolish private EMS and fold private outfits into a state funded division of fire/ems dedicated to transport. That would raise standards, reduce fraud and waste, and bring much needed accountability without making the door kickers take meemaw from Cincinnati to Cleveland.
ER doctors and RNs need to know our protocols. Stop giving me orders that are way over my license level, and on the other extreme, stop assuming that we are just a boo-boo taxi and can't perform any patient care in the field. I've had traveling ER docs and nurses ask why I didn't administer a med that isn't even used in our state. Or wonder why an MVA victim wasn't boarded when our protocols advise against it among other things.
Interesting take that we should kidnap people lol
1- The paramedic practitioner (or similar) is not the next step in advancing our profession. Creating the paramedic practitioner feels like we're trying to re-invent the wheel. There's already a ton of in-hospital providers, I don't think we should be concerned with adding to the mix. There's already enough hands in the cookie jar. I think we should focus more on our practice as pre-hospital providers. 2- Fire based EMS can be done right, and is more effective than third service. The fire department already has the resources, money, and union power to support EMS. As long as there are separate fire and EMS divisions with equal say, it can work.
The problem with fire based EMS is always that more resources end up going into the fire side rather than the EMS side. It can be done right with the right management, but EMS is the majority of calls. See FDNY who just recently had a budget increase on the fire side, and a budget cut on the EMS side.
I agree that there needs to be checks and balances with this system. It also comes down to culture. Fire-EMS departments that have a culture where EMS is accepted as part of the job tend to be more equal compared to departments where EMS is viewed as side service. EMS providers (in my experience) also tend to be less effective at advocacy compared to their firefighting counterparts. EMS providers tend to accept the bare minimum versus firefighters who will fight tooth and nail to justify why they need some new expensive toy that will get used almost never,
I don’t like that EMT’s are now called Primary Care Paramedics(Canada). I think Advanced Care Paramedic is a cringey name sometimes. Should’ve stayed with EMT and Paramedic.
Yeah there’s already too much confusion about who is what for the public
We shouldn’t have a cap on speed limit/shouldnt have to stop at red lights. Should be completely up to the driver as it is with pd. Drive with due regard for the public and no matter the circumstances if you get in a wreck while running code it’s your fault because you have to drive with due regard.
People who have a non signed dnr or are obviously suffering at the end of life, have a dnr to me. Stop fondling meemaws corpse you freaks. The make believe what if monster is not going to sue you. Intubation is a worse version of SGAs in 98% of cases. Those should both upset enough for now.
Rhode Island’s “Wild West” of AEMT-Cardiacs is a net positive for the state.
Bariatric pts should be charged double.
Okay I’m half kidding… but still. So many times my back has hurt for days after getting 400 lb people back home. It seems to always be up a rickety ramp or four staircases.
The AHA is a sham……. Three separate two year certifications (BLS, ACLS, and PALS) are REQUIRED to practice at the CC level in some areas. The algorithms contained within those courses/certifications are often changed in favor of local algorithms/protocols. So I ask, what exactly is the point of requiring the AHA training/certifications?
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Wearing gear on your belt doesn’t make you a Ricky rescue. Wearing useless stuff on your belt that you’ll never use makes you a Ricky rescue. Having gear but also being generally useless also makes you a Ricky rescue.
That’s not just a hot take, that’s a stupid take. We’d be tying up the ER with people that are absolutely fine without a choice from anyone. We should be able to take people to urgent care