Private EMS

Got our ass beat today. Back to back all day.

I start up blogger to bitch, complain and scream about my job in private EMS. However, when I got here and started writing this it occurs to me that I could be in a factory punching out car parts for more money. I could be screaming "Would you like frys with that?" and proabably be making more money... BUT.. what i couldnt do is: Write a blog, read a book, watch television, play video games, eat a sandwich, take a nap, sit in a lawn chair, web surf, or take a lengthly crap. All the while being paid to do it.

My job aint that bad. Sometimes you get the bull, but sometimes you get the horns.

Z

Realisticly Speaking

If you look at EMS realisticly it's pretty simple. The whole process of Emergency Medicine is simple: You see a problem and you correct it. I like to relate it back to the old BASIC programming days of the TRS-80 and the Commodore C=64.

IF THEN

IF the patient cant breath THEN we check the airway.

Almost every single problem in any given circumstance can be over come with simple logic, remember it is not the EMT's job to "cure" the patient. It's the EMT's job to get them to the doctor alive and as stable as we can. Long term care is left up to the doctors and nurses. It simply is not our problem. The reason I bring this up is because I'm tired of the following:

You arrive to a patients house, they cant breath. The have a history of COPD. A breathing treatment later and some high flow O2 and your on your way to the hospital. Yes I know all about the respitory drive of COPDers, I don't care. It's not my job to worry about the long term care of these patients. At the hospital you are met by a nurse that receives your report and then snatches the non-rebreather off your patient lightning fast. I don't have a problem with them doing this, but I do have a problem with them assuming they know my job and glaring at me as if I have done something wrong.

Sir/ma'am It is your job function to give this patient continuous care, and get them to a point that they can return back to their residence, it was my job to get them to you alive. If their respirtory drive would have magicaly dropped out in the 15 minutes I had the patient, I would have tubed them. I would be doing my job maintaining this patients life and once again you would have to provide for their continuing care.

I WILL NOT deny my patient the O2 they need to sustain their life, because of a "maybe". If I don't give this patient O2 they will die. If I give the patient O2 nd it knocks out their respirtory drive the I will tube them and breath for them, but they wont die.

All I ask is respect the part we EMTs play in the grand scheme of things and we will respect yours. Don't assume because a rule is steadfast for you it's the same for us. Most of the time it's not.

Documentation Evils

Paper work, paperwork, paperwork, if you didn't write it down, it didn't happen.

They have been preaching this to you since you were in school for your basic card.

I have noticed a few things in my years as an EMT and I think this is a good time to talk to you about a couple of my pet peeves. The "by the book report writer" and the "forecast report writer".

By the book report writer:

This is the guy that can have 40 thousand things go wrong on his scene and when you read his report it's as if he was teaching a class on the proper way to do things. They are marched out step by step in his report perfectly, just as you would see them in the EMS book. Everyone that was on the scene knows it didn't happen the way he wrote it, but none the less it looks pristine.

Come On! We are not stupid, everyone knows that the scene NEVER goes the way the book states, and to make your report look like it did only undermines EMTs everywhere. Tell the truth! A doc would always choose an accurate report of the actions at the scene over a "pretty" fabricated one. Sure you might have done everything you wrote in your report, but it sure as hell didn't happen the way you wrote it.

The Forecast Report:

This type of report writing is very common with non-emergency transport and I have heard of it being utilized a lot. This is the guy who will sit and write his entire report (usually minus the vitals) before he even sees the patient or will write it in the first 10 minutes of patient contact and then just sit in the truck for the rest of the trip. It could be a 1-2 hour trip and his paperwork will be done in the first 10 minutes.

Come On! You cant possibly tell me that there was absolutely no change in the patients status in 1-2 hours, further more you're "guessing" about the patients continued condition during your trip. What if the patient starts complaining of pain that they didn't have when you started transport? What if the patients becomes incontinet or vomits? What if the patient makes comments that you need to document. If your report is already done, I doubt very seriously that anything but a full arrest will get you to rip up your old report and start a new one!

Now that I have vented, lets hear what you have to say!

Z

EMT's the other NOMADS

Have you ever noticed how EMT's seem to switch job locations frequently? Sure, you have a few lifers that stay in one place, but as a general rule, EMT's of all levels are very nomadic.

They move from place to place and town to town. They have stories that start off like : "When I was a medic in (random town) we did..."

Or

"Back in (Some place else) we..."

I have made many good friends in this business and I've had many good friends leave to persue other oppertunities. Some of the people that they left behind feel deserted or "cheated" on, but I never have. I always figured they did what was best for them and still considered them a friend. Nothing has changed in my eyes except I don't see them often anymore.

As health care providers we have a responsibility to our patients and above that we have greater responsibility to ourselves and our peers. If we let each other down there is no way we can be the professional we need to be for our patients.

My friends are my friends, no matter who they work for. I understand you have your life, all I ask is that you understand I have mine. We are each doing what we need to do, or what we feel is best for us and our families.

Z

HUGE FIRE

Yesterday we had a huge fire at a manufacturing plant. Our SOG (Special Operations Group) was called in to provide decon of patients and rescue personnel. Our EMS division was called to transport many patients to the area hospitals.

It was our big chance to shine! We have been training and practicing, and practicing and training for 3 years and finally a full scale activation of our SOG.

I'm not going to get into too many details of the disaster, but there is a couple things I wanted to express. First off, we worked exactly as we had trained. Training pays off BIG TIME in the long run. Even members that had never been to any HazMat scene before and only had book work to rely on operated to their specification perfectly. There was no arguing among the team members or with other other departments and there was no ego trips. We were there for the support of the local community under the authorization on the county EMA, and it went beautifully.

It was long though. The activation lasted about 10 hours and during that time we decontaminated many people and even 1 dog. I got to see the EPA in action and those guys are pretty impressive too.

One more note. Our company president was there, and when he first arrived I figured he would go on over to the administration area and chat it up with the other people way out of my pay grade, but then he asked "Where do you need me?" To tell you the truth it blew my doors. He suited up and worked a decon pool for over 5 hours with other crew members. Say what you want about big wigs, but some of them put their money where their mouth is. This guy earned MAJOR respect points with the team. They were talking about it for hours after he had to leave and head back to the office. To tell the truth, I was talking about it too. We all knew he was trained to the operations level, but it was damn impressive to see him voluntarily suit up and join the other guys in the trenches.

For our first major call out I could not have been happier.

Oh Orderly

I've mentioned before that I work for a private EMS system. We do 911 calls just the same as the city guys, however we also do a lot of medical transports.

For those of you unfamiliar with medical transport it generally involves taking someone who requires medical supervision to the hospital for x-rays or to a doctors appointment, then returning them to their place of residence; whether it be home or a nursing facility.

Today I felt less like an EMT doing a medical transport and more like a hospital orderly. We arrived with our patient who was due for a bone scan, we were told there would be a 10-15 minute wait and could we sit with our patient in the hall. The nurse told us that after our wait we would only be there 15 minutes "tops" she said. Well, we were pretty sure our dispatcher wouldn't want to send us away only to have to call us back in 3o minutes so we waited. And we waited some more.

During this waiting time either myself or my partner were summoned 2-3 times to come into the x-ray room and help move a patient. For the greater good of company PR we happily obliged.

Finally was our patients turn and just like she said "15 minutes tops" BUT, when he was done magically he needed some standard x-rays as well and could we wait in the hall. Now we are getting concerned. It's approaching a hour we have been here and we are sure our dispatcher is getting a bit on the concerned side. Not for our safety, but someone probably has to go somewhere else and we are tied up here.

We receive a page to check in. My partner relays the information to the dispatcher and we sit to wait with our patient again. During this waiting time we were asked to relocated our patient more than 6 times and summoned 2-3 more times to help with other patients. Over an hour passes and FINALLY we get in. The films are taken and we are on our way 2.75 hours after we got there for a 15 minute "tops" appointment.

I guess I'm a little frustrated with the entire health care spectrum. If they really need more help to process patients quicker, maybe they should hire more people. I'm an EMT, not an orderly.

Z