# EMS is public safety.



## emt seeking first job (May 17, 2011)

It crosses over with health care in the ER room.

The staff of the ER room is public safety and health care. The rest of the hospital is not.

An instructor in my police academy said he never wrote ER staff but he said nothing of health care providers who do not work in an ER.

It also crosses over with transportation.

Regardless, nobody's job defines them. I am sick of peeing matches over working in transport or 911, or being a security guard, or having peace or police officer status. Nobody cares.

And it does not matter.

Brinks Security or the FBI ?

Whose life was more noble, Joseph Trambino or Robert Hanssen ?












You can see the difference in their facial expressions.


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## usalsfyre (May 17, 2011)

Emergency MEDICAL Services. 

EMS is medicine. We don't arrest people who present a public threat. We don't stop fires from burning half a city down. We tend to individual patients needs on a call, not the "public at large" needs.

The arguments I've seen around EMS falling under the "public safety" banner center essentially around "us too!". 

The garbage man does a lot more for "public safety" than EMS does.


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## MrBrown (May 17, 2011)

No its not, and until you and all the other public safety hobbyists bugger off and go ride into the sunset there will be no advancement.

Ambulance is emergent healthcare intervention.

It's absolute manure like this that keeps you blokes getting paid $10 an hour for your 100 hour course.


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## emt seeking first job (May 17, 2011)

usalsfyre said:


> Emergency MEDICAL Services.
> 
> EMS is medicine. We don't arrest people who present a public threat. We don't stop fires from burning half a city down. We tend to individual patients needs on a call, not the "public at large" needs.
> 
> ...



Sanitation is public works.

Policing is not about arresting people, it is getting people to voluntarily comply with the law using the least amount of intervention possible.

EMS responds to mass casulaty events and triages all the patients, we dont just serve one. A doctor serves one patient (at a time) and can decline to take a new patient.

EMS has to take everyone equally without regard of ability to pay.

EMS keeps the public safe, they take care of the public at large, EMS deals with an emergency, with time sensitive incidents. There are no appointments.


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## emt seeking first job (May 17, 2011)

MrBrown said:


> No its not, and until you and all the other public safety hobbyists bugger off and go ride into the sunset there will be no advancement.
> 
> Ambulance is emergent healthcare intervention.
> 
> It's absolute manure like this that keeps you blokes getting paid $10 an hour for your 100 hour course.




A job is a job regardless of level of pay or even no pay.

A hobby is building models or creating art.

Professionalism and higher standards in conduct and training will get people paid more, but again, if it was about the money, why do people in my service forgo paid work to ride in an unpaid ambulance ?

In the US, at least, you cant be a $10 an hour EMT with a criminal conviction, however, you can have a health care position. That paramedic who got the conviction for the traffic incident now works.....in health care, in a hospital, but he can never be a paramedic again.

And the 100 hours of training + experience is enough to package, load and go to the....badda bing.....hospital for health care so the patient can get better.

People never get better in an ambulance, their diseases and not cured, their injuries are not fixed, however, they are stabilized and safely and rapidly transported to a place were they do get health care.


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## HasTy (May 17, 2011)

emt seeking first job said:


> And the 100 hours of training + experience is enough to package, load and go to the....badda bing.....hospital for health care so the patient can get better.




Ok kid I have tried to keep my mouth shut through all of your questions but this statement just makes me feel like I have to respond...you seriously think that your 100 hours of course work gives you suitable knowledge to hold someone life in your hands....

Now about this public safety bit...at our current level I would say that most basics are nothing more than cops with out the law enforcement training...they know about as much about medicine. 

Now if you take an Intermediate who knows a little more or a Paramedic (with a degree but that is a side thread) who has had at least 2 years of education then no they are not public safety at all. However I don't believe we have gained enough respect from the medical world to be called medical professionals either so...


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## MrBrown (May 17, 2011)

emt seeking first job said:


> A job is a job regardless of level of pay or even no pay.
> 
> A hobby is building models or creating art.



No, a hobby is being a one hundred hour wonder be they paid or volunteer.



emt seeking first job said:


> Professionalism and higher standards in conduct and training will get people paid more, but again, if it was about the money, why do people in my service forgo paid work to ride in an unpaid ambulance ?



Professionalism is not about money it is about standards to uphold the integrity of the body of specialised knowledge, skill and conduct required by the members of the profession.

If you are such a true professional, please, sit down and read the thousands of pages of medical textbooks that Brown has and gain an understanding of applicable microscience and context of praxis.

That is what is expected of nurses, physicians, physical therapists, and every other health professional.  

Why are people at your service? You mean the one with the Paramedics who think a bradycardic patient will die if they stand up or who give supraphysiological amounts of oxygen to normoxaemic patients? Because they are idiots, and public safety hobbyists.



emt seeking first job said:


> And the 100 hours of training + experience is enough to package, load and go to the....badda bing.....hospital for health care so the patient can get better.
> 
> People never get better in an ambulance, their diseases and not cured, their injuries are not fixed, however, they are stabilized and safely and rapidly transported to a place were they do get health care.



With due respect sir, you are a naive figurative myopic who has no understanding of what the concept of health care is.

Therefore, you are a public safety hobbyist.


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## emt seeking first job (May 17, 2011)

HasTy said:


> Ok kid I have tried to keep my mouth shut through all of your questions but this statement just makes me feel like I have to respond...you seriously think that your 100 hours of course work gives you suitable knowledge to hold someone life in your hands....
> 
> Now about this public safety bit...at our current level I would say that most basics are nothing more than cops with out the law enforcement training...they know about as much about medicine.
> 
> Now if you take an Intermediate who knows a little more or a Paramedic (with a degree but that is a side thread) who has had at least 2 years of education then no they are not public safety at all. However I don't believe we have gained enough respect from the medical world to be called medical professionals either so...



This is an online forum. There is no reason to remain quiet.

An EMT is not a cop. The 100 hour class is enough training to package someone and get to the hospital for treatment.

And by package I mean perform interventions to maintain the patient asclose as possible to the same condition in which they were found. 

Ideally we would all have paramedic training as the interventions are far broader but not everyone has the reasiurces to attain that level. In absence of a paramedic an EMT is better than leaving them in the street or friends and family driving the person in the back of their Camry.

EMS can be a gateway to a healthcare career. It can enhance someone's potential to go that route. However, EMS is not healthcare, paramedics should not be making health outreach visits or invovled in people's general health.

There is cross over in EMS/Police/Fire.

Fire Marshalls arrest people, Fire and Police do EMS calls. 

But making EMS healthcare is like saying the Police is a legal profession or the judiciary.

The police should never have the power to prosecute and met out punishment, they take people to the courts where that happens. 

Just like someone in EMS can go into healthcare, some cops go to law school. Having that prior experience likely enhances their chances for success.


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## emt seeking first job (May 17, 2011)

MrBrown said:


> No, a hobby is being a one hundred hour wonder be they paid or volunteer.
> 
> 
> 
> ...




Mr. Brown, why hold back ?

Why not go to medical school ?

Why limit yourself to riding in the ambulance ?

Once again, 100 hours is enough to package, load and go. 

This is the USA. There is no snobbery. There is a history of self reliance and as EMS is a new thing, as once was policing, back in the 1800s communities formed "possies" to get the bad guys.

Now they have professional departments. They dont go to law school. They take about 1,500 of formal training together with common sense and experience they get the job done.


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## usalsfyre (May 17, 2011)

emt seeking first job said:


> Sanitation is public works.


Doesn't mean they don't do a massive amount more for public health and safety in a modern city than police, fire and EMS combined.



emt seeking first job said:


> Policing is not about arresting people, it is getting people to voluntarily comply with the law using the least amount of intervention possible.


But it still in the best interest of the public for this to happen right?



emt seeking first job said:


> EMS responds to mass casulaty events and triages all the patients, we dont just serve one.


How routinely does this happen? At my service your looking at once or twice a year. Hospitals do FAR more triaging with bed assignments.



emt seeking first job said:


> A doctor serves one patient (at a time) and can decline to take a new patient.
> 
> EMS has to take everyone equally without regard of ability to pay.


Are you familiar with EMTALA and exactly how far it extends? 



emt seeking first job said:


> EMS keeps the public safe, they take care of the public at large, EMS deals with an emergency, with time sensitive incidents. There are no appointments.


EMS in it's current provides limited treatment and transport to the ED. The vast (as in 99% or greater) of our work is not time sensitive. We are solely reactionary, we don't "keep the public safe" we respond after an incident that causes injury or illness. To "keep the public safe" we have to move to a far more preventative/community health model (i.e. a MEDICAL model). 

Most serious EMS providers recognize this. The ones that don't are usually new, or couldn't get into another "public safety" field.


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## HotelCo (May 17, 2011)

emt seeking first job said:


> This is the USA. There is no snobbery.



I seriously laughed at this. Are you serious?

The excuse that it'll take time to advance EMS is a load of :censored:. We have other countries that have advanced their systems, and we can use that as a model. We needn't figure it out as we go.


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## HasTy (May 17, 2011)

emt seeking first job said:


> Mr. Brown, why hold back ?
> 
> Why not go to medical school ?
> 
> ...



For Starters where Brown lives to become a paramedic is the US equivalent of being a pre-med student. It takes three years for Brown to become a qualified ICP. (Correct me if I am wrong Brown)

100 Hours is what a MFR should have as required training my friend...In one of your other threads you stated you would put oxygen on a patient. Do you know why you would put oxygen on that patient if indeed it were a neccesary intervention or are you just putting it on there for the sake of air is good so 02 must be better?

As far as cops having 1500 hours of formal training....not out here in CA they don't here they have a 2 year criminal justice degree...they are well rounded individuals with knowledge of many things not just laws. I feel like this makes them better cops because of the fact that they are able to interact with the public at an intellectual level.


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## Lone Star (May 17, 2011)

emt seeking first job said:


> This is an online forum. There is no reason to remain quiet.
> 
> An EMT is not a cop. The 100 hour class is enough training to package someone and get to the hospital for treatment.
> 
> ...



Police ARE part of the legal profession, they are the Law Enforcement division of the Legal branch of the government (remember the Executive, Legislative and Judicial branches of government?)

The police do not have, nor will they ever have the power to prosecute, that is for the lawyers; but the Law Enforcement Division IS a profession.

Since EMS is solely devoted to Emergency Medical Response (including emergency medical interventions), it IS and always will be a subset of the 'Health Care Profession'!  If you actually take a Paramedicine degree program from a reputable college, you'll find it listed under 'Allied Health Care'...

Just because the local Fire Marshall's office has direct arrest authority, you will not find them investigating any crimes other than arson.  Just because the local police department/sheriff's department or fire department has an EMS division, doesn't automatically include any private ambulance company as 'public safety'.


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## emt seeking first job (May 17, 2011)

*About standards :*

In addition to enhanced medical training, IMHO, EMS should have enhanced driver training.

There should be a formal classroom and  behind the wheel EVOC/CEVO program as a requisite for the EMT or Paramedic credential.

People who can not drive correctly and will not train to do it should not be in EMS. The most importent intevention EMS performs is getting the patient to the MD in the ER.

Also, basic human realtions, Verbal Judo, something like that, higher standards of conduct in the field. No arguing, bickering and more command presence.


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## MrBrown (May 17, 2011)

It takes a minimum of four years to become a Paramedic and six to become and Intensive Care Paramedic.


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## HotelCo (May 17, 2011)

emt seeking first job said:


> In addition to enhanced medical training, IMHO, EMS should have enhanced driver training.
> 
> There should be a formal classroom and  behind the wheel EVOC/CEVO program as a requisite for the EMT or Paramedic credential.
> 
> ...



EVOC/CEVO is hardly advanced. I could put a driver with two months experience in CEVO/EVOC and they'd pass with flying colors. It isn't all that hard, and doesn't teach much beyond common sense.


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## mycrofft (May 17, 2011)

*I think "public servant" is more appropriate than "safety"*

Having been in a sheriff dept as a RN and not being a safety employee (less pay, darn it), I can tell you therr's a line. In fact, correctional officers in our county don't get safety pay either. "Safety" here is defined by actuarial likelihood of risk to the worker's person (it sounds better than "Dangerous Job" on job postings, no?).

As regards trashmen, actually they and their civil enginer brethern save millions of lives daily, from disaster, disease, poisoning, and physical danger. So do power company linemen, sewer workers, architects. By comparison, lifeguards, USAF crash/fire rescuemen, and most other "rescue"-category jobs have a relatively low risk due to the infrequency of risk, training, and specific safety practices and devices. (Most dangerous job in the over-all USAF? Aircraft mechanic).

Firefighters, EMT's, nurses, cops, all share one characteristic: we are priviliged with the opportunity to have an unedited look into other people's lives, and to help them.

So sez me!B)


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## emt seeking first job (May 17, 2011)

HotelCo said:


> EVOC/CEVO is hardly advanced. I could put a driver with two months experience in CEVO/EVOC and they'd pass with flying colors. It isn't all that hard, and doesn't teach much beyond common sense.



See the rigs rolling in NYC ? Many of them dont have common sense.


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## HotelCo (May 17, 2011)

emt seeking first job said:


> See the rigs rolling in NYC ? Many of them dont have common sense.



I never said common sense was common in this field...


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## mycrofft (May 17, 2011)

*Snobbery is a social disease.*

Like athlete's foot, we all have it to some degree but don't talk about it in polite circles.


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## emt seeking first job (May 17, 2011)

*The whole thing about people being EMTs thinking they are cops.*

What I do not get is why people who have this great thirst for advanced medical training, why not become a doctor or a nurse ?

Back in the 80s, as a student, I was in the former USSR. Each ambulance had an actual doctor. In fact there wer veru few para-professionals in healthcare. Most people a doctor or a nurse.

Being a doctor required quite a bit of training but held not to much in way of compensation. Back then, compensation was more with where you got to live, shop, vacation and send your kids to school then monetary salary. 

A lot of front line doctors were not so well compensated, but they did it anyway.


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## mycrofft (May 17, 2011)

*EVOC?! Wonder how long the training is to fly a B-52?*






"I'd say he's flightworthy"


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## HotelCo (May 17, 2011)

emt seeking first job said:


> What I do not get is why people who have this great thirst for advanced medical training, why not become a doctor or a nurse ?



How do you know they aren't in the process of becoming a nurse/doc?


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## usalsfyre (May 17, 2011)

emt seeking first job said:


> What I do not get is why people who have this great thirst for advanced medical training, why not become a doctor or a nurse ?



Why hold yourself back to being just slightly above a taxi-driver?


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## emt seeking first job (May 17, 2011)

*Take nothing for granted, there is no "common sense" these days:*

For money I am an instructor at a driving school.

In Brooklyn, many people put learning to drive and do not have access to cars.

Half of what I have to do would seem like common sense. I take nothing for granted.

People either wear flip flops or too large boots, dont tie hair back, chew gum or have drink with them, will not turn their phone off and then reflexivly dig for it to check it when it goes off, look down at their feet, dont put the car in gear, dont turn the key on, getting into pissing matches with strangers over going first, and the list goes and on.....

In my EMT class, a large portion of people were on their devices texting, people left in the middle of training drills because they had to "take this call", if I was running an EMT class, I would have a phone off and put away rule.

I cant sya anything in my service out loud because I am a noob, but a guy around my age who has been there 20+ years gets rightly pissed off with people texting on calls, or while riding around.

And the effing eating, EMS could be more discrete, small snack, a bite hear and there, I see rigs on the side of the road with dudes digging into a huge trough of junk food. Literally I saw a dude with a huge KFC bucket in his lap chowing away like a lion.

I think the 100 hours of education, enhanced with 50 hours of both emergency and non emergency driver training , and a bit of decourum could go along ways to improve EMS and perceptions of it.


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## emt seeking first job (May 17, 2011)

usalsfyre said:


> Why hold yourself back to being just slightly above a taxi-driver?



There is never a sitaution when taxi drivers can disregard the traffic law, not that there is anything wrong with being that, they should have higher standards for that also.

I worked a few years in a high end car service that charged $90 for a sedan, not a stretch, we had to be clean, no cologne, no cell phone, no idle chatter, had to know english, had to be able to navigate ourselves, and drive conservativley.....this service charged $90/hr, round trip from the garage just for doing what a driver is supposed to.

The car service I use, $35 to the airport, you get a dirty old car, a guy who smells, either can not talk english or wont shut up, you have to coach him on directions, put up with his choice of radio and you get nautious from the jack rabbit acceleration and hard breaking.

The car service I worked for was around $185 for the airports. And it was not a stretch limo. Just a clean car with a driver that did what he was supposed to do.


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## MrBrown (May 17, 2011)

Lets see, Brown has the choice of some bloke with 100 hours of "training" and an oxygen tank who is probably a siren freak or a cab driver to take Brown to the hospital .... Brown is going to choose the cab driver


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## ArcticKat (May 17, 2011)

We've transitioned to the "Mobile Health Services" concept.  During our shift we routinely visit high risk individuals who require some sort of medical treatments that can be done in the home.  Dressing changes, welfare checks, living conditions evaluation, and post surgical evaluations are just some of our cases.

We also provide occasional clinic days to treat and/or refer clients to medical care.


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## medichopeful (May 17, 2011)

emt seeking first job said:


> And the 100 hours of training + experience is enough to package, load and go to the....badda bing.....hospital for health care so the patient can get better.



Yep, that's pretty much ALL it's good for, which is sad.  And that is NOT medical care.  That's providing a ride to the hospital, with very, VERY few interventions.



> People never get better in an ambulance, their diseases and not cured, their injuries are not fixed, however, they are stabilized and safely and rapidly transported to a place were they do get health care.



If people continue to have this attitude like you do, then the above statement will continue to be true, which is horrifying.  True, they are stabilized and in many cases that's all that can be done without surgery, but there are many, MANY times when stabilization and THEN CARE can actually be done in the ambulance.


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## medichopeful (May 17, 2011)

MrBrown said:


> It takes a minimum of four years to become a Paramedic and six to become and Intensive Care Paramedic.



Wow that sucks!  150 hours here is MORE than enough to provide good care! 
h34r:h34r:

/end sarcasm


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## medichopeful (May 17, 2011)

HotelCo said:


> How do you know they aren't in the process of becoming a nurse/doc?



Because it says it in our signatures!


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## MrBrown (May 17, 2011)

It is obvious the author has no understanding as to what health care actually is


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## abckidsmom (May 17, 2011)

emt seeking first job said:


> A job is a job regardless of level of pay or even no pay.
> 
> A hobby is building models or creating art.
> 
> Professionalism and higher standards in conduct and training will get people paid more, but again, if it was about the money, why do people in my service forgo paid work to ride in an unpaid ambulance ?



Because they are working at their hobby.  I love EMS, and have been in this field for a long time.  For the last 8 years, I've been, for all intents and purposes, a hobbyist.  I am a stay at home mom who WAS a full-time medic...the call volume of full-time EMS and the ability to make it the primary focus of your work life make you a professional.  It's totally possible for a volunteer to act like a professional, but it's really, really rare for a volunteer to actually be on par with a real professional.



> In the US, at least, you cant be a $10 an hour EMT with a criminal conviction, however, you can have a health care position. That paramedic who got the conviction for the traffic incident now works.....in health care, in a hospital, but he can never be a paramedic again.



I don't want a $10/hr criminal in my house at my most difficult time.  It's hard enough knowing the people who ARE coming in the house.  At least at the hospital, there's ALWAYS supervision.



> And the 100 hours of training + experience is enough to package, load and go to the....badda bing.....hospital for health care so the patient can get better.
> 
> People never get better in an ambulance, their diseases and not cured, their injuries are not fixed, however, they are stabilized and safely and rapidly transported to a place were they do get health care.



People get better in an ambulance all the freaking time.  It's rarely dramatic like on TV, but there are plenty of times when the resources available in the ambulance are all the patient needs at that time.  

If a person is having an asthma attack and their inhaler isn't working, but I come in and give them a couple of nebs on the way to the hospital, the hospital is going to look them over and fast track them home.  What they had was not an emergency, but a failure of their primary care to adequately meet their needs.  They didn't actually need tertiary care.


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## 18G (May 17, 2011)

emt seeking first job said:


> In the US, at least, you cant be a $10 an hour EMT with a criminal conviction, however, you can have a health care position. That paramedic who got the conviction for the traffic incident now works.....in health care, in a hospital, but he can never be a paramedic again.



This is false. You can be an EMS provider with a criminal conviction depending on what the conviction is and how much time has passed since the conviction. 

Some states do have "barrier crimes" which is a list of offenses that are meant to automatically bar someone from taking a position in healthcare (yes, EMS is healthcare) but are not always absolute.

Nobody is perfect and what someone did 15yrs ago should not automatically preclude them from a profession.



abckidsmom said:


> I don't want a $10/hr criminal in my house at my most difficult time. It's hard enough knowing the people who ARE coming in the house. At least at the hospital, there's ALWAYS supervision.



A single, isolated charge does not always make someone a "criminal". Sometimes it's just a case of bad judgement and circumstantial factors that do not parallel a person's character.


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## abckidsmom (May 17, 2011)

18G said:


> A single, isolated charge does not always make someone a "criminal". Sometimes it's just a case of bad judgement and circumstantial factors that do not parallel a person's character.



I was just being inflammatory.  There has to be a line somewhere, and if you can't mind your impulses such that you get busted doing whatever, I'm willing to let it roll.

Dana, who just housed a family member for a year who'd had a felony conviction.  I still love him and know that he's a great person, but he's ineligible for a lot of opportunties because he did something really STUPID.


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## 18G (May 17, 2011)

^^^^ gotcha


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## JPINFV (May 17, 2011)

emt seeking first job said:


> Sanitation is public works.


Sanitation saves more lives than EMS could ever hope to, as well as do more to impact public health than EMS could ever hope to. Using a pure definition of public safety, sanitation ensures the public's safety much more than EMS does.


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## usalsfyre (May 17, 2011)

JPINFV said:


> Sanitation saves more lives than EMS could ever hope to, as well as do more to impact public health than EMS could ever hope to. Using a pure definition of public safety, sanitation ensures the public's safety much more than EMS does.



My point exactly. You could further make the argument EMS isn't really essential to public safety (about to play devil's advocate here). Without police services modern cities descend into lawlessness, without sanitation you have wide spread disease and filth and without fire protection half the city burns down. Any of these results in the collapse of the city. Without EMS you have? Certainly not wide spread death and destruction. People would still find there way to hospitals, as they were able to before the 1960s. More deaths might occur, but not enough to cause complete collapse of civilization. 

So what are we if not essential? Well, right now nothing. We have a REALLY hard time selling our value on anything other than emotion. We have to potential however, to be cost savers by reducing hospital admissions, not to mention add to patients lives by delivering care in the home before it's needed. This requires more education and a change on focus, away from the "public safety" persona and the "us vs them" mentality that often goes along with it. It requires a realization that driving is a just something you do to get to a call as the majority of calls are not in the least time sensitive (should home health have CEVO?), and that our medical KNOWLEDGE is far more important than a few monkey skills. 

Which is lost on the OP, not because he's dumb, rather I think the opposite of him because he's willing to ask questions. However he's new, and enamored with the system in which he works, which is certainly not an unusual condition.


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## the_negro_puppy (May 17, 2011)

Please stop making threads


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## JPINFV (May 17, 2011)

emt seeking first job said:


> People never get better in an ambulance, their diseases and not cured, their injuries are not fixed, however, they are stabilized and safely and rapidly transported to a place were they do get health care.




Never get better? So the patient with depressed respiration due to opioids is not better following an appropriate does of naloxone? The patient in hypoglycemia who gets a dextrose injection is not better afterwards? The patient with a reactive airway disorder who gets Albuterol which eases their ability to breath is not better?

The hospital cures very few diseases or injuries. Many diseases are never cured, only managed. Plenty of other diseases and injuries only heal with time, often outside of the hospital, and often with medicine only assisting instead of doing the heavy work. I think you have a profound misunderstanding of what medicine is and where it occurs, and this is coloring your views on how EMS fits into the bigger picture.


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## Too Old To Work (May 17, 2011)

JPINFV said:


> Sanitation saves more lives than EMS could ever hope to, as well as do more to impact public health than EMS could ever hope to. Using a pure definition of public safety, sanitation ensures the public's safety much more than EMS does.



Sanitation is public health, not public safety.


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## JPINFV (May 17, 2011)

Too Old To Work said:


> Sanitation is public health, not public safety.




Yes, but my point is that public health does more to ensure the safety of the public than EMS does. 

By the way, are you of TOTWTYTR fame? 
-the EMT-Medical Student...


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## Anjel (May 17, 2011)

TO THE OP

Do you not realize that every time you post you get a million people telling you that you are wrong. When every single person says you are wrong, and basically you don't know much. You haven't been in the field long. Why don't you sit back and listen to others instead of making threads to start arguments.

You ask questions already knowing the answer you want to hear. And there is no other answers that could possibly be right.


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## Smash (May 17, 2011)

What is going on here?

Why do I have to be a Doctor?  Or do I have to be a cop?  I can't keep up!

100 Hours?  That's barely enough time to learn to make a good cup of coffee! It takes 7 years to become a paramedic...

I might just have to sit in the corner rocking until someone explains what is happening


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## Too Old To Work (May 17, 2011)

JPINFV said:


> Yes, but my point is that public health does more to ensure the safety of the public than EMS does.
> 
> By the way, are you of TOTWTYTR fame?
> -the EMT-Medical Student...



No, public health does more to ensure the health of the public than EMS does. And that's questionable since much of public health is merely nannyism. Public health systems came into existence during the 18th century to curb contagious diseases such as Cholera, TB, Smallpox, and so on. Since most of those diseases have been eradicated (in the US), public health has morphed into a nagging nanny telling people to wear seat belts, not to smoke, not to drink sugary drinks, eat healthy, wear helmets, and vote for Democrats. 

Except for Democrats, none of those are real threats to the public health. 

Sanitation is part of public health, but not public safety. At least it shouldn't be. 

EMS is a system designed to provide medical care in out of hospital settings and then provide transport to hospitals. We can debate if it's public safety, public health, an industry, or a hobby. Take your pick, depending on where you are, it's one or some combination of them all. 

EMS is not designed, nor was it ever intended to focus on prevention, primary care, wellness, or any of the other things that people think it should be. When we try to expand into those areas, we run into other professions or industries that ARE intended to focus on those areas. If we don't think that those professions or industries are doing their jobs, then we should push them to do their jobs, not try to add to our duties to make up for their shortcomings.


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## ShotMedic (May 17, 2011)

Too Old To Work said:


> No, public health does more to ensure the health of the public than EMS does. And that's questionable since much of public health is merely nannyism. Public health systems came into existence during the 18th century to curb contagious diseases such as Cholera, TB, Smallpox, and so on. Since most of those diseases have been eradicated (in the US), public health has morphed into a nagging nanny telling people to wear seat belts, not to smoke, not to drink sugary drinks, eat healthy, wear helmets, and vote for Democrats.
> 
> Except for Democrats, none of those are real threats to the public health.
> 
> ...


 Hit the Nail right on the head! solid work, must really be an old salty dog


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## JPINFV (May 17, 2011)

Too Old To Work said:


> No, public health does more to ensure the health of the public than EMS does. And that's questionable since much of public health is merely nannyism. Public health systems came into existence during the 18th century to curb contagious diseases such as Cholera, TB, Smallpox, and so on. Since most of those diseases have been eradicated (in the US), public health has morphed into a nagging nanny telling people to wear seat belts, not to smoke, not to drink sugary drinks, eat healthy, wear helmets, and vote for Democrats.
> 
> Except for Democrats, none of those are real threats to the public health.
> 
> Sanitation is part of public health, but not public safety. At least it shouldn't be.


What public health is now and what it's successes in the past is a valid point, but isn't completely germane either. There's a valid interest in ensuring clear air, clean drinking water, and removal of solid and liquid waste, in order to decrease infectious and chronic diseases. Yes, that has largely been achieved and it's a valid question to ask where the goal should be now that we've largely achieved the original goal (i.e. not simply pouring the chamber pot out of the closest window). Similarly, as long as a large portion of certain health bills aren't being paid by the consumer, there's a valid argument for laws mandating helmets and seat belts. Personally, I don't care if someone decides to wear a seat belt or not. I care when my tax dollars goes to support medical care that would largely be prevented by the use of a seat belt (this is, of course, the slipper slope with single payer/nationalized health care, but that's for a different thread or PMs). 

So, while yes the current agendas of public health agencies are past the original intent, I won't take those successes away from them. 





> EMS is a system designed to provide medical care in out of hospital settings and then provide transport to hospitals. We can debate if it's public safety, public health, an industry, or a hobby. Take your pick, depending on where you are, it's one or some combination of them all.
> 
> EMS is not designed, nor was it ever intended to focus on prevention, primary care, wellness, or any of the other things that people think it should be. When we try to expand into those areas, we run into other professions or industries that ARE intended to focus on those areas. If we don't think that those professions or industries are doing their jobs, then we should push them to do their jobs, not try to add to our duties to make up for their shortcomings.



It's a good point. The problem, though, is that EMS is really failing to prove that our cost is worth the benefits. This is especially true when the areas that most need paramedic level service is the areas least likely to get it, and the areas least likely to need paramedics (due to short transport times) are the areas most likely to need it. As long as the goal for EMS is to transport, then that's the context that it's going to be viewed in and reimbursed for. Sure, EMS could save health care a ton of money by helping to ensure that people access the proper health provider (and certain limited treat and release options which could go past what is often currently available), but that requires options besides leave the patient at home or go to the ER, which requires education on primary care, wellness, etc. 

Just because EMS is not designed for those things doesn't mean it can't evolve to include those things. Evolution is important, especially since the vast majority of EMS calls aren't really warranted, and the vast majority of calls that are end up being just a horizontal taxi ride. If millions of dollars are being spent on EMS with essentially no return on investment, does that make EMS simply a "make work" program?


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## Too Old To Work (May 17, 2011)

JPINFV said:


> What public health is now and what it's successes in the past is a valid point, but isn't completely germane either. There's a valid interest in ensuring clear air, clean drinking water, and removal of solid and liquid waste, in order to decrease infectious and chronic diseases. Yes, that has largely been achieved and it's a valid question to ask where the goal should be now that we've largely achieved the original goal (i.e. not simply pouring the chamber pot out of the closest window). Similarly, as long as a large portion of certain health bills aren't being paid by the consumer, there's a valid argument for laws mandating helmets and seat belts. Personally, I don't care if someone decides to wear a seat belt or not. I care when my tax dollars goes to support medical care that would largely be prevented by the use of a seat belt (this is, of course, the slipper slope with single payer/nationalized health care, but that's for a different thread or PMs).



The answer then is to change the paradigm, but we won't do that. Why should the public have to pay for other people's poor choices? First it's helmets and seat belts (which I wear and think everyone should), then it's smoking or not smoking, then it's what you eat, what you drink. The "The public is paying" meme can be stretched endlessly and there are those who are trying to do just that. 



> So, while yes the current agendas of public health agencies are past the original intent, I won't take those successes away from them.



I'm not, but when an organization is designed to eradicate a type of threat and that threat is organized, then what? Create new "threats" for them to eradicate? Or disband the organization since it's achieved it's mission? 



> It's a good point. The problem, though, is that EMS is really failing to prove that our cost is worth the benefits. This is especially true when the areas that most need paramedic level service is the areas least likely to get it, and the areas least likely to need paramedics (due to short transport times) are the areas most likely to need it. As long as the goal for EMS is to transport, then that's the context that it's going to be viewed in and reimbursed for. Sure, EMS could save health care a ton of money by helping to ensure that people access the proper health provider (and certain limited treat and release options which could go past what is often currently available), but that requires options besides leave the patient at home or go to the ER, which requires education on primary care, wellness, etc.



It requires a top to bottom restructuring of medicine, not just EMS. That in it's turn requires a top to bottom restructuring of our society. I don't see EMS driving either of those. 



> Just because EMS is not designed for those things doesn't mean it can't evolve to include those things. Evolution is important, especially since the vast majority of EMS calls aren't really warranted, and the vast majority of calls that are end up being just a horizontal taxi ride. If millions of dollars are being spent on EMS with essentially no return on investment, does that make EMS simply a "make work" program?



This is our own fault. EMS as an entity has spent almost 40 years jumping up and down and telling people "Call us if you think it's an emergency or even if you're not sure." So they call us all the time. Some of them certainly know that they do not have an emergency, but since that demographic likely abuses all forms of entitlements, we are not going to fix it. The rest of it is people who are finally doing exactly what we've been telling them to do and now we complain that they call us for bull poop. 

Let's get us to the point where every EMT can take an accurate blood pressure and recognize a cardiac arrest before we worry about expanding our scope of practice.


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## JPINFV (May 17, 2011)

Too Old To Work said:


> Let's get us to the point where every EMT can take an accurate blood pressure and recognize a cardiac arrest before we worry about expanding our scope of practice.




Well, yes, education standards (or lack there of) is the elephant in the room. As long as the education requirements for EMS are relative jokes, very little can be done to evolve EMS from, well, anything. It's hard, if not impossible, to change a system where some providers can barely follow cookbook protocols while other providers crave, and warrant, flexibility to essentially do anything when provided with an appropriately limited tool bag.


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## Too Old To Work (May 17, 2011)

JPINFV said:


> Well, yes, education standards (or lack there of) is the elephant in the room. As long as the education requirements for EMS are relative jokes, very little can be done to evolve EMS from, well, anything. It's hard, if not impossible, to change a system where some providers can barely follow cookbook protocols while other providers crave, and warrant, flexibility to essentially do anything when provided with an appropriately limited tool bag.



The 1994 EMT-B curriculum, followed by the dumbing down of the rest of EMS education is the proximate cause of many of the problems EMS is facing. Sadly, that curriculum was decontented to satisfy those who were worried that it would scare away it's members.


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## JPINFV (May 17, 2011)

In regards to the 1994 EMT-B National Standard Curriculum, 
"The following priorities from the 1990 consensus workshop
recommendations played a directing role in the revision of this EMT-Basic Curriculum:
...
Revise basic course to be no more than 110 hours in length."

...was probably some of the most horrifying sequence of words I've ever read.


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## Too Old To Work (May 17, 2011)

JPINFV said:


> In regards to the 1994 EMT-B National Standard Curriculum,
> "The following priorities from the 1990 consensus workshop
> recommendations played a directing role in the revision of this EMT-Basic Curriculum:
> ...
> ...



Yes. To do that they had to take the medicine out of EMT training. "Do without thinking" as an acquaintance of mine once said. As a result we have poorly educated EMTs, who don't understand any of the theoretical underpinnings of EMS, don't know how to speak to or like medical professionals, and as a result are treated like idiots. It also makes it hard to teach someone to become a paramedic since much of the basic education was never taught at the EMT level. But don't worry, no doubt the ALS level will be similarly dumbed down. :sad:


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## usalsfyre (May 17, 2011)

I'd say it already has been dumbed down. When a paramedic, supposedly the highest level of pre-hospital provider, can't tell me what the alpha and beta branches of the adrenergic nervous system are responsible for, it's time to get scared (I had to have that conversation with an intern not too long ago).


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## crazycajun (May 17, 2011)

usalsfyre said:


> I'd say it already has been dumbed down. When a paramedic, supposedly the highest level of pre-hospital provider, can't tell me what the alpha and beta branches of the adrenergic nervous system are responsible for, it's time to get scared (I had to have that conversation with an intern not too long ago).



It may be dumbed down in texas but here you can actually get a degree. It requires 98% of the same classes as an ADN-RN.


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## usalsfyre (May 17, 2011)

crazycajun said:


> It may be dumbed down in texas but here you can actually get a degree. It requires 98% of the same classes as an ADN-RN.



We have degrees here to, up to a B.S. specifically in paramedicine. I'll bet I can look in the Carolinas and find at least a few mills as well. It's a systemic, nationwide problem having to do with low standards. Pointing to one or two states only marginalizes the problem.


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## JPINFV (May 17, 2011)

crazycajun said:


> It may be dumbed down in texas but here you can actually get a degree. It requires 98% of the same classes as an ADN-RN.




So all courses in your state are essentially 98% RN, or just the ones that grant a degree, or just some of the ones that grants a degree?


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## DrParasite (May 17, 2011)

usalsfyre said:


> My point exactly. You could further make the argument EMS isn't really essential to public safety (about to play devil's advocate here). Without police services modern cities descend into lawlessness, without sanitation you have wide spread disease and filth and without fire protection half the city burns down. Any of these results in the collapse of the city. Without EMS you have? Certainly not wide spread death and destruction. People would still find there way to hospitals, as they were able to before the 1960s. More deaths might occur, but not enough to cause complete collapse of civilization.


without fire protection half the city burns down?  says who?  fires will always go out.  even if it's just a citizen with a garden hose, the fires will eventually go out.  what happened before there were fire departments?

Take away sanitation, and you have people who pay private companies to take away their garbage.

without EMS, what happens?  people die.  people don't get to the hospital in a timely fashion.  people bleed to death.  ghetto taxis pick up shooting and stabbing victims and drop them at the ER steps instead of being transported in a vehicle designed for that purpose.  Can you take a taxi?  sure.  but an ambulance should be quicker, make for a better ride, and in theory should be more comfortable.  plus the taxi isn't going to carry the 350 lb person down 4 flights of stairs when the person starts to have chest pains and difficulty breathing.



usalsfyre said:


> So what are we if not essential? Well, right now nothing. We have a REALLY hard time selling our value on anything other than emotion. We have to potential however, to be cost savers by reducing hospital admissions, not to mention add to patients lives by delivering care in the home before it's needed. This requires more education and a change on focus, away from the "public safety" persona and the "us vs them" mentality that often goes along with it. It requires a realization that driving is a just something you do to get to a call as the majority of calls are not in the least time sensitive (should home health have CEVO?), and that our medical KNOWLEDGE is far more important than a few monkey skills.


how can you say we are not essential?  the only reason you can is because everyone says they can do our job as a subset of their job.  FD can do EMS. PD can do EMS.  volunteers can do EMS.  hospitals can do EMS.  and of course, those for profit companies can do EMS, usually at a lower level of quality than everyone else.  

it's kinda hard to say we are professionals, and necessary, when everyone else says they can do our job too as a side job to their full time job.


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## Too Old To Work (May 17, 2011)

DrParasite said:


> without fire protection half the city burns down?  says who?  fires will always go out.  even if it's just a citizen with a garden hose, the fires will eventually go out.  what happened before there were fire departments?



Whole cities burned to the ground. Several times over in the case of London. Duh. 



> Take away sanitation, and you have people who pay private companies to take away their garbage.



Or they don't. In which case you have pockets of pestilence. 



> without EMS, what happens?  people die.  people don't get to the hospital in a timely fashion.  people bleed to death.  ghetto taxis pick up shooting and stabbing victims and drop them at the ER steps instead of being transported in a vehicle designed for that purpose.  Can you take a taxi?  sure.  but an ambulance should be quicker, make for a better ride, and in theory should be more comfortable.  plus the taxi isn't going to carry the 350 lb person down 4 flights of stairs when the person starts to have chest pains and difficulty breathing.



Or people drive themselves to the hospital. Or get friends to do it. Or take taxis. Did you ever see those studies on trauma patients that self transported? Generally they do better than those transported by EMS and MUCH better than those transported by ALS. 



> it's kinda hard to say we are professionals, and necessary, when everyone else says they can do our job too as a side job to their full time job.




Which is our own fault. We've allowed EMS to become a skill set, not a trade or even a profession. We've made the education too easy (1994 curriculum) and done nothing to set standards of performance or competence. Every thing about EMS is controlled by some outside entity and most people in EMS don't care. Mostly that's because mostly people in EMS are doing it until something better comes along.


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## crazycajun (May 17, 2011)

JPINFV said:


> So all courses in your state are essentially 98% RN, or just the ones that grant a degree, or just some of the ones that grants a degree?



There are still a few certificate courses than run 12 to 14 months but DHEC who oversees EMS is wanting all paramedics to have a degree with the new system coming in place. Of course anyone with 5 or more years would be grandfathered in I presume but that is just my guess. I had no intentions on going back to school but one of the directors for DHEC insisted so at the age of 42 I am back in college. I posted my course curriculum somewhere on here. I will find it and send you the link.


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## usalsfyre (May 17, 2011)

DrParasite said:


> without fire protection half the city burns down?  says who?  fires will always go out.  even if it's just a citizen with a garden hose, the fires will eventually go out.  what happened before there were fire departments?


The Great London Fire, The Great Chicago Fire, The Great San Francisco Fire....



DrParasite said:


> Take away sanitation, and you have people who pay private companies to take away their garbage.


Take away sanitation period and you have conditions that become untenable for residents. This wasn't a public vs private question.



DrParasite said:


> without EMS, what happens?  people die.


Of your last 50 patients, how many would have died without EMS care? Maybe one of mine.



DrParasite said:


> people don't get to the hospital in a
> timely fashion.


To wait on the wall for an hour? An extra 20 minutes so rarely makes a difference, the extra deaths wouldn't even be a blip on the national radar.



DrParasite said:


> people bleed to death.  ghetto taxis pick up shooting and stabbing victims and drop them at the ER steps instead of being transported in a vehicle designed for that purpose.


According to the study done in Philly not to long ago the ghetto "throw'em in the car" method KEEPS people from bleeding to death.



DrParasite said:


> Can you take a taxi?  sure.  but an ambulance should be quicker,


Again with the time thing.



DrParasite said:


> make for a better ride, and in theory should be more comfortable.  plus the taxi isn't going to carry the 350 lb person down 4 flights of stairs when the person starts to have chest pains and difficulty breathing.


Agreed, but I can pay two guys minimum wage to run a stretcher taxi with no medical care provided.



DrParasite said:


> how can you say we are not essential?


Because there's not a damn bit of data that says we are. 



DrParasite said:


> the only reason you can is because everyone says they can do our job as a subset of their job.  FD can do EMS. PD can do EMS.  volunteers can do EMS.  hospitals can do EMS.  and of course, those for profit companies can do EMS, usually at a lower level of quality than everyone else.


Look at say AMR in Arlington, Texas vs Detroit or DC Fire or Cleveland EMS. That's WAY to broad of a generalization to make.



DrParasite said:


> it's kinda hard to say we are professionals, and necessary, when everyone else says they can do our job too as a side job to their full time job.


Agreed, but perhaps the reason it can be done as a side job is EMS, in it's current, US form, isn't essential?


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## DrParasite (May 17, 2011)

Too Old To Work said:


> Whole cities burned to the ground. Several times over in the case of London. Duh.


really?  I've seen London, it's not an empty husk.  cities burn, and sooner or later, the fire will go out.

there is a very old firefighter saying: all fires go out eventually.


Too Old To Work said:


> Or they don't. In which case you have pockets of pestilence.





Too Old To Work said:


> Or people drive themselves to the hospital. Or get friends to do it. Or take taxis.


or they don't.  any they die at home, or get worse and die at home.  in which case, you have pockets of dead bodies just waiting for the funeral home to pick up the body.


Too Old To Work said:


> Did you ever see those studies on trauma patients that self transported? Generally they do better than those transported by EMS and MUCH better than those transported by ALS.


I have, and think they are awesome.  but they aren't self transported, they are transported by a ghetto taxi, ie, someone driving them and dropping them off, not them hoping in the car and going by themself.  and it doesn't address medical calls, just trauma ones.


Too Old To Work said:


> Which is our own fault. We've allowed EMS to become a skill set, not a trade or even a profession. We've made the education too easy (1994 curriculum) and done nothing to set standards of performance or competence. Every thing about EMS is controlled by some outside entity and most people in EMS don't care.


no arguments there.


Too Old To Work said:


> Mostly that's because mostly people in EMS are doing it until something better comes along.


no arguments on this either


----------



## JPINFV (May 17, 2011)

DrParasite said:


> without EMS, what happens?  people die.  people don't get to the hospital in a timely fashion.  people bleed to death.  ghetto taxis pick up shooting and stabbing victims and drop them at the ER steps instead of being transported in a vehicle designed for that purpose.  Can you take a taxi?  sure.  but an ambulance should be quicker, make for a better ride, and in theory should be more comfortable.  plus the taxi isn't going to carry the 350 lb person down 4 flights of stairs when the person starts to have chest pains and difficulty breathing.



You, of course, have evidence that EMT or paramedic level ambulance is better than Home Boy Ambulance service (tm)?

http://www.ncbi.nlm.nih.gov/pubmed/8611068



> how can you say we are not essential?  the only reason you can is because everyone says they can do our job as a subset of their job.  FD can do EMS. PD can do EMS.  volunteers can do EMS.  hospitals can do EMS.  and of course, those for profit companies can do EMS, usually at a lower level of quality than everyone else.


...because the streets were littered with people dying every day prior to organized civilian EMS? 



> it's kinda hard to say we are professionals, and necessary, when everyone else says they can do our job too as a side job to their full time job.


I'll help you out. As EMS currently stands, it is not a profession. The truth may be hard to bear, but it shouldn't be hard to say.


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## MrBrown (May 17, 2011)

Smash said:


> 100 Hours?  That's barely enough time to learn to make a good cup of coffee! It takes 7 years to become a paramedic...



Yes, but you come from a nation of Convict out casts who would want to follow anything you do? 

/taking the piss



JPINFV said:


> In regards to the 1994 EMT-B National Standard Curriculum,
> "The following priorities from the 1990 consensus workshop
> recommendations played a directing role in the revision of this EMT-Basic Curriculum:
> ...
> ...



That IS the most horrifying sequence of words Brown has ever read!


----------



## DrParasite (May 17, 2011)

usalsfyre said:


> The Great London Fire, The Great Chicago Fire, The Great San Francisco Fire....


 all fires go out eventually


usalsfyre said:


> Take away sanitation period and you have conditions that become untenable for residents. This wasn't a public vs private question.


your right.  and if you take away the gas company no one has heat in the winter, or the electric company no one has power.  doesn't make the PSEG guys public safety though, despite that without them, you have conditions that become untenable for residents



usalsfyre said:


> Of your last 50 patients, how many would have died without EMS care? Maybe one of mine.


hmmmm, worked sunday in the suburbs, finished the night with 7 jobs, one with a 60 yom in SVT who had his AICD go off, and around midnight had a lady having a CVA.  would either have died without EMS care?  ehhhh, well, the one was in SVT could have gone in a cab (but i don't think the cabbie can push amiodirone or cardiovert), the the CVA lady could have gone in a cab, but having the doc ready with a brain attack team standing by probably helped her our a little.  


usalsfyre said:


> To wait on the wall for an hour? An extra 20 minutes so rarely makes a difference, the extra deaths wouldn't even be a blip on the national radar.


sure, tell me that when your family member is the one that isn't on the national radar.


usalsfyre said:


> According to the study done in Philly not to long ago the ghetto "throw'em in the car" method KEEPS people from bleeding to death.


 while I agree with that study, that's due to philly GSW victims waiting upwards of an hour for an ambulance to become available and respond to calls.  And philly isn't an EMS department that I would use to compare anything, because it's pretty much a disaster that is grossly understaffed and mismanaged.


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## Too Old To Work (May 17, 2011)

DrParasite said:


> really?  I've seen London, it's not an empty husk.  cities burn, and sooner or later, the fire will go out.



Silly position since a lot of people died in those fires. After all you're all about saving lives, aren't you?



> or they don't.  any they die at home, or get worse and die at home.  in which case, you have pockets of dead bodies just waiting for the funeral home to pick up the body.
> I have, and think they are awesome.  but they aren't self transported, they are transported by a ghetto taxi, ie, someone driving them and dropping them off, not them hoping in the car and going by themself.  and it doesn't address medical calls, just trauma ones.



Remember, time is muscle, time is brain. So, the faster we transport the better. Or should I say the faster anyone transports the better. I've seen both medical and trauma patients drive themselves to the hospital. Not that I recommend it.


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## usalsfyre (May 17, 2011)

DrParasite said:


> hmmmm, worked sunday in the suburbs, finished the night with 7 jobs, one with a 60 yom in SVT who had his AICD go off, and around midnight had a lady having a CVA.  would either have died without EMS care?  ehhhh, well, the one was in SVT could have gone in a cab (but i don't think the cabbie can push amiodirone or cardiovert), the the CVA lady could have gone in a cab, but having the doc ready with a brain attack team standing by probably helped her our a little.


Strokes, STEMIs and serious traumas present to the ED via POV all the time. It may involve a slight delay, but they still get the care they need. And if "seconds count", why aren't trauma surgeons, cardiologist and neurologist running code three to the hospital from home?



DrParasite said:


> sure, tell me that when your family member is the one that isn't on the national radar.


I'm not saying I would want it to be my family member. I'm saying emotion-based "what if it was you" arguments fail miserably in the face of facts and reason.


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## DrParasite (May 17, 2011)

usalsfyre said:


> Strokes, STEMIs and serious traumas present to the ED via POV all the time. It may involve a slight delay, but they still get the care they need. And if "seconds count", why aren't trauma surgeons, cardiologist and neurologist running code three to the hospital from home?


ummm, because they are already in the hospital, occasionally running from the on call rooms when they get a page for a seconds count response?

and good sumaritans stop burglaries, help women in distress, and in texas, shoot dangerous people who are threatening life and property.  just because it happens, doesn't mean we should get rid of those who are trained and equipped to handle the emergency.


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## usafmedic45 (May 18, 2011)

> Policing is not about arresting people, it is getting people to voluntarily comply with the law using the least amount of intervention possible.



So is being a moderator on the forum.  Unfortunately, in both settings, some people just don't learn and forcible restraint or other heavy handed measures need to be applied.  It's a good lesson and more people should learn it.


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## usalsfyre (May 18, 2011)

DrParasite said:


> ummm, because they are already in the hospital, occasionally running from the on call rooms when they get a page for a seconds count response?


You need to brush up on community-based medicine. The vast majority of attending physicians in this country take call from home. The only place you find in-house docs in the above categories is academic centers (and the majority of stroke, STEMI and trauma centers are not academic).



DrParasite said:


> and good sumaritans stop burglaries, help women in distress, and in texas, shoot dangerous people who are threatening life and property.  just because it happens, doesn't mean we should get rid of those who are trained and equipped to handle the emergency.


I don't think we should either. But you have to have good, well constructed arguments when the budget ax comes around. Nothing you've presented here is a well constructed argument.


----------



## Melclin (May 18, 2011)

I should have just hit myself in the head with a moderately sized hammer instead of reading this thread.

All this "package, load and go....*fist bump* we got em to the doc alive" bullsh*t makes me wanna vomit. 

I'm ganna go and get drunk and forget that this level of stupidity exists.


----------



## Too Old To Work (May 18, 2011)

Melclin said:


> I should have just hit myself in the head with a moderately sized hammer instead of reading this thread.
> 
> All this "package, load and go....*fist bump* we got em to the doc alive" bullsh*t makes me wanna vomit.
> 
> I'm ganna go and get drunk and forget that this level of stupidity exists.



So, you don't get your patients to the hospital alive? Is that what you're getting at?


----------



## MrBrown (May 18, 2011)

Brown thinks what Oz is trying to say is that unfortunately the "load and go red lights and sirens golden hour saving lives in the street trauma cardiac arrest look at how our great medical knowledge and capability from our 100 hour course" mentality only seems to exist in the US?

*Brown throws up a little


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## JPINFV (May 18, 2011)

usalsfyre said:


> Strokes, STEMIs and serious traumas present to the ED via POV all the time. It may involve a slight delay, but they still get the care they need. And if "seconds count", why aren't trauma surgeons, cardiologist and neurologist running code three to the hospital from home?



More importantly, if seconds count why do we allow station based deployment? After all, what sort of response could be quicker than a crew strategically positioned in random parking lots, waiting in the cab for the call? If seconds count, then any sort of station is detrimental to patients.


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## Smash (May 18, 2011)

MrBrown said:


> Yes, but you come from a nation of Convict out casts who would want to follow anything you do?
> 
> /taking the piss
> 
> That IS the most horrifying sequence of words Brown has ever read!



Ahhh... but I don't come from such a place...  Be careful that the toes you step on today are not connected to the arse you'll have to kiss tomorrow h34r:  :lol:

I have to agree, I can't ever imagine 100 hours being considered "too much" of anything!

I'm still confused what this whole thread is about though.


----------



## the_negro_puppy (May 18, 2011)




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## Melclin (May 18, 2011)

*We do things other than take pulses.*



Too Old To Work said:


> So, you don't get your patients to the hospital alive? Is that what you're getting at?



I know your joking, but I feel like expanding on my point a little...



MrBrown said:


> Brown thinks what Oz is trying to say is that unfortunately the "load and go red lights and sirens golden hour saving lives in the street trauma cardiac arrest look at how our great medical knowledge and capability from our 100 hour course" mentality only seems to exist in the US?



This, and I hate that for so many people in EMS, the pt having a pulse on arrival at ED is the only outcome measure they think or care about. 

How about putting thought into things like health promotion, falls prevention, building coping capacity to prevent inappropriate ambulance attendances, pain relief, reduced time of hospital/ED stay, disease specific outcomes measures.... honestly the list doesn't end.


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## MrBrown (May 18, 2011)

The attitude of some people makes Brown so horrendously unquantifiably disgusted it makes Brown want to vomit to the point it would be unhealthy as Brown would become dehydrated and depleted of essential electrolytes Brown would become mortally obtunded and die.

Brown can no longer willingly participate because it makes Browns head explode.

*Brown takes Oz, Negro and Smash to the pub .... come lads, let us forget this thread ever existed


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## Sasha (May 18, 2011)

> People never get better in an ambulance, their diseases and not cured, their injuries are not fixed, however, they are stabilized and safely and rapidly transported to a place were they do get health care.



I'm starting to think you've never stepped foot on an ambulance before.


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## Too Old To Work (May 18, 2011)

medichopeful said:


> If people continue to have this attitude like you do, then the above statement will continue to be true, which is horrifying.  True, they are stabilized and in many cases that's all that can be done without surgery, but there are many, MANY times when stabilization and THEN CARE can actually be done in the ambulance.





Sasha said:


> I'm starting to think you've never stepped foot on an ambulance before.



The act of "stabilization" means that at a minimum the patient does not deteriorate and may in fact get better. That does not mean that we do nothing, but it does mean that we very rarely cure someone. I can treat CHF very effectively, I can treat hypoglycemia very effectively, I can treat an Asthma flare very effectively. In no case can I fix the underlying cause of any of those conditions. In fact, for the most part, neither can medicine. We can treat, we can stabilize, we can relieve pain and suffering in many cases. 

So, depending on how you define it, people do or don't "get better" in the ambulance. By that same definition, people "get worse" in the ambulance as well. 

Back to the case of diabetics. It's pretty routine now in my system to treat a hypoglycemic Type I Diabetic and then have them refuse transport to the hospital. As long as they meet our systems criteria for refusing transport, they are free to do so. We haven't cured them, although we have treated and alleviated the acute crisis which prompted our call. Is the patient better? Inarguably. Is the patient "cured"? Not at all.


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## Sasha (May 18, 2011)

Of course you get better on an ambulance. Going from AMS due to hypoglycemia to a normal blood sugar is getting better. Going from respiratory distress to breathing easy is getting better. Going from a 10/10 pain to a more manageable 5/10 is getting better. From bleeding to not bleeding is getting better.

There is no cure for asthma or diabetes, or CAD, or afib or many diseases that you get called for. You can manage the symptoms to make them better, a lot of the time that is achieved on an ambulance.


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## Too Old To Work (May 18, 2011)

Sasha said:


> Of course you get better on an ambulance. Going from AMS due to hypoglycemia to a normal blood sugar is getting better. Going from respiratory distress to breathing easy is getting better. Going from a 10/10 pain to a more manageable 5/10 is getting better. From bleeding to not bleeding is getting better.
> 
> There is no cure for asthma or diabetes, or CAD, or afib or many diseases that you get called for. You can manage the symptoms to make them better, a lot of the time that is achieved on an ambulance.



This is merely parsing words. What you are calling "getting better" is in fact stabilization. A cardiac arrest patient with ROSC is better than one without. Still, what we do is stabilization since we can't fix them to the point where they don't need transport. Any patient that still needs to go to the hospital after we treat is being stabilized.


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## Sasha (May 18, 2011)

Many go to the hospital just as a formality. The diabetic/asthmatic/allergic reaction you treated? Probably wont recieve much more in the way of care and will be home within hours.


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## the_negro_puppy (May 18, 2011)

MrBrown said:


> The attitude of some people makes Brown so horrendously unquantifiably disgusted it makes Brown want to vomit to the point it would be unhealthy as Brown would become dehydrated and depleted of essential electrolytes Brown would become mortally obtunded and die.
> 
> Brown can no longer willingly participate because it makes Browns head explode.
> 
> **Brown takes Oz, Negro and Smash to the pub .... come lads, let us forget this thread ever existed*



Your shout


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## thegreypilgrim (May 18, 2011)

God in heaven.

I'm pretty sure that I am now dumber as a result of reading this thread.

I'm heading to the pub with Brown and company.


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## DarkStarr (May 18, 2011)

I made it to page 3, and I don't understand the point of this thread (as is the case with most of the OP's threads).


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## CAOX3 (May 18, 2011)

Ok I thought the breast implant thread was ugly, then I flipped through this one.

Its official there is no hope for EMS, or civilization for that matter.


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## Smash (May 18, 2011)

DarkStarr said:


> I made it to page 3, and I don't understand the point of this thread (as is the case with most of the OP's threads).



I've been through the entire thread several times and I still have no idea what is going on.  

I'm beginning to wonder if the OP has adult onset anencephaly.  Or perhaps Feal Encephalopathy.  


Monteiths Black for me Mr Brown!


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## LucidResq (May 18, 2011)

Please don't take this thread the same path of the other and keep your criticism constructive.


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## Melclin (May 18, 2011)

*Lucid*

If someone tells you the moon is made of green cheese, you naturally reply with an explanation, perhaps even respectfully worded, of why it isn't, despite having a bit of a private giggle. If you then find yourself being told, in the considered prose of an 8 year old, that you are wrong for a host of laughably poor reasons, being constructive in you criticism seems a bit pointless. 

Not to point any fingers, but in a general sense, its a waste of time to argue with idiots because they're too stupid to know when they're wrong, no matter how much you huff and puff.  



Smash said:


> Monteiths Black for me Mr Brown!



Do drink it all. I'll even shout you a few. Just to make sure I never accidentally get served with any 

A pint of Boags Premium, cheers Brown.


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## LucidResq (May 18, 2011)

Although I understand your position, name-calling and literally accusing those who do not agree with your opinion of lacking a brain does not get us anywhere. Whether they are right, wrong or indifferent, calling someone an idiot or belittling them does nothing to advance the field or our community. Just keep this in mind. It's not necessary, really.


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## fortsmithman (May 20, 2011)

I believe a few years ago the Government of Canada declared that EMS workers are public safety.  Air traffic controllers were also declared to be public safety.  I believe that EMS is half medicine and half public safety.  That's just my two cents worth.


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## emt seeking first job (May 23, 2011)

Too Old To Work said:


> This is merely parsing words. What you are calling "getting better" is in fact stabilization. A cardiac arrest patient with ROSC is better than one without. Still, what we do is stabilization since we can't fix them to the point where they don't need transport. Any patient that still needs to go to the hospital after we treat is being stabilized.




yes yes yes

IMHO, nobody gets better in the ambulance.

We stabilize them. 

We transport them safely. Without endangering other motorists. Better than a hysterical relative.

What we do as EMS is important. But do not confuse it with what happens at the hospital.


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## emt seeking first job (May 23, 2011)

fortsmithman said:


> I believe a few years ago the Government of Canada declared that EMS workers are public safety.  Air traffic controllers were also declared to be public safety.  I believe that EMS is half medicine and half public safety.  That's just my two cents worth.



I will agree it does overlap. The interface is in the ER room.

My point is, there is nothing wrong with public safety. No shame in being an "ambulance driver", as far as standards, we have to impose greater standards on that driving. No texting talking on phone, chowing on a trough of take out crap food while driving, and being defense and diplomatic about it on the road.

Avoiding crashing the ambulance.


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## Sasha (May 23, 2011)

Sometimes eating while driving is the only time a crew member gets to eat. So id rather have a poor image than an emt passed out from hypoglycemia.


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## EMS49393 (May 23, 2011)

Ten pages of arguments over something posted by a person that has proven themselves to be a forum troll in previous threads.

Come on folks.  At some point we have to learn the lesson.  

IMHO this thread, like others started by the OP should be locked as it has gone absolutely no where.


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## emt seeking first job (May 24, 2011)

Sasha said:


> Sometimes eating while driving is the only time a crew member gets to eat. So id rather have a poor image than an emt passed out from hypoglycemia.



Have a light snack at downtime.

There is always downtime.

And nobody needs eat eat the huge container of rice and beans.

You cant use "I was eating" as a defense for crashing the vehicle.

Public safety work involves long stretches with unpredicatable breaks. There should be better screeening. Someone prone to hypoglycemia is not suited for this work. And EMT or Paramedic should be able to function long periods of time.

If someone cant, then they can get a job in a doctor's office with scheduled breaks.


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## emt seeking first job (May 24, 2011)

Sasha said:


> Sometimes eating while driving is the only time a crew member gets to eat. So id rather have a poor image than an emt passed out from hypoglycemia.



Someone unable to work during long periods of time should not have this profession.

There is always downtime for snacking.

Someone prone to hypoglycemia should not work in an ambulance, fire truck or police car.

People can not eat while you drive. It distracts the operator from controlling the vehicle.


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## emt seeking first job (May 24, 2011)

LucidResq said:


> Although I understand your position, name-calling and literally accusing those who do not agree with your opinion of lacking a brain does not get us anywhere. Whether they are right, wrong or indifferent, calling someone an idiot or belittling them does nothing to advance the field or our community. Just keep this in mind. It's not necessary, really.





NOBODY GETS BETTER IN AN AMBULANCE:

Someone is bleeding, the EMT stops the bleeding, they fdont get worse, but they dont get better.

They go to a hospital where a doctor heals the wound.

EMS is not law enforcement and people should be weeded out for thinking they are, at the same time, those people without the ability to go to medical school or nursing school should not play doctor or nurse in an ambulance.

You assess and stabilize the person, and get them to the hospital.

Standras should be maintained. Physical fitness. To many people in EMS "oh, I cant lift", be thick skinned, be able to drive, be able to work long periods without a break.

Why do so many ambulances crash ?

Really be strict about the driving.

EMS people should put their phones away, put the troughs of food away, and just do your job. Nobody that can not go 8 hours without eating should have this job. 

During emergencies there are times when someone can not eat or sleep for hours. If someone can not do that, they should not have this job.

The real issue is they just do not have the commitment for medical or nursing school or graduate , so they rote memorize a few $5 words and discuss things on the cellular level  and act as if they above everyone else. They use their $5 words to distract everyone from the fact they can't drive, can't lift, and cant go 10 minutes without checking their phones or wolfing down quarts of lo mein.


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## JPINFV (May 24, 2011)

emt seeking first job said:


> EMS people should put their phones away, put the troughs of food away, and just do your job. Nobody that can not go 8 hours without eating should have this job.
> 
> During emergencies there are times when someone can not eat or sleep for hours. If someone can not do that, they should not have this job.



I'm taking it you've never actually worked for an ambulance service that even flirted with the term "busy."


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## CAOX3 (May 24, 2011)

JPINFV said:


> I'm taking it you've never actually worked for an ambulance service that even flirted with the term "busy."



Agreed.


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## usalsfyre (May 24, 2011)

emt seeking first job said:


> Why do so many ambulances crash ?


Because we let immature asses pilot them like a sports car through traffic while disregarding laws even though it's been proven the time saved is minimal and clinically insignificant?



emt seeking first job said:


> EMS people should put their phones away, put the troughs of food away, and just do your job. Nobody that can not go 8 hours without eating should have this job.


Since 8 hours shifts are exceedingly common in EMS  



emt seeking first job said:


> The real issue is they just do not have the commitment for medical or nursing school or graduate , so they rote memorize a few $5 words and discuss things on the cellular level  and act as if they above everyone else. They use their $5 words to distract everyone from the fact they can't drive, can't lift, and cant go 10 minutes without checking their phones or wolfing down quarts of lo mein.


This is a shining example of why EMS loses most of it's intelligent, medically minded providers. You can only beat your head against this wall so many times before saying "screw it".

I suggest if you want a real future in EMS you revise you views. If this is what you profess to me, there's no way in hell I'd hire you.


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## the_negro_puppy (May 24, 2011)

usalsfyre said:


> Because we let immature asses pilot them like a sports car through traffic while disregarding laws even though it's been proven the time saved is minimal and clinically insignificant?
> 
> 
> Since 8 hours shifts are exceedingly common in EMS
> ...




I swear emt_seeking_first_job is either retarded, a troll or both.

Judging by his name, he has never worked in a paid, professional EMS job, and here he is spamming the boards like his personal blogs and telling experienced providers that their views.attitudes/ etc are wrong.


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## emt seeking first job (May 24, 2011)

JPINFV said:


> I'm taking it you've never actually worked for an ambulance service that even flirted with the term "busy."



In the NYC blizzard, the 911 system was overwhelmed and mutual aid was activated.

We had a backlog of 911 calls and direct calls to our service.

On the weekends we get a backlog.

During special events we man posts for several hours without eating.


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## emt seeking first job (May 24, 2011)

*Another thing.*

Anyone who bites their nails or chews gum in public does not belong in healthcare, public safety or any position requring working alongside others or the general public.


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## Too Old To Work (May 24, 2011)

JPINFV said:


> I'm taking it you've never actually worked for an ambulance service that even flirted with the term "busy."



Given his screen name, I was going to ask if he's found that elusive first job as of yet. Would that be a rules violation?


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## CAOX3 (May 24, 2011)

emt seeking first job said:


> yes yes yes
> 
> IMHO, nobody gets better in the ambulance.
> 
> ...



In my honest opinion you should probably  wait until the ink dries on your ticket before you paint a whole profession with such a broad stroke.

As far as no one getting better in an ambulance, when your knowledge of EMS surpasses what could fill the bottom of a shot glass, then you can make your assumptions, until then your opinions don't hold much weight and comments like this only prove the point.


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## Sasha (May 24, 2011)

emt seeking first job said:


> Someone unable to work during long periods of time should not have this profession.
> 
> There is always downtime for snacking.
> 
> ...




Really? There are days i get on my truck fifteen minutes early and then run from.facility to facility for the next thirteen and a half hours. Sometimes there IS no downtime and we are stuck running into the hospital cafeteria for two minutes on our way back to the truck. Not eating for twelve hours or better is not healthy and is enough to give anyone hypoglycemia.

Your podunk service has downtime. Thats great. Not everyone does and i have no problem eating while driving.


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## JPINFV (May 24, 2011)

emt seeking first job said:


> Anyone who bites their nails or chews gum in public does not belong in healthcare, public safety or any position requring working alongside others or the general public.


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## JPINFV (May 24, 2011)

emt seeking first job said:


> In the NYC blizzard, the 911 system was overwhelmed and mutual aid was activated.
> 
> We had a backlog of 911 calls and direct calls to our service.



Disaster situations! = day to day operations?



> On the weekends we get a backlog.


I'm not sure if you know this or not, but there are ways to manufacture a few minutes to get food at the hospital. 



> During special events we man posts for several hours without eating.


Several hours! = 8 or 12 hours?


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## the_negro_puppy (May 24, 2011)




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## Death_By_Sexy (May 24, 2011)

I didn't really understand the animosity the topic creator was getting....


....And then I read the last few pages. Good God almighty.


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## Voodoo1 (May 24, 2011)

MrBrown said:


> The attitude of some people makes Brown so horrendously unquantifiably disgusted it makes Brown want to vomit to the point it would be unhealthy as Brown would become dehydrated and depleted of essential electrolytes Brown would become mortally obtunded and die.
> 
> Brown can no longer willingly participate because it makes Browns head explode.
> 
> *Brown takes Oz, Negro and Smash to the pub .... come lads, let us forget this thread ever existed



Can I come too?


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## 94H (May 25, 2011)

emt seeking first job said:


> NOBODY GETS BETTER IN AN AMBULANCE:



Ever see a paramedic give a hypoglycemic pt D-50 and then have the pt sign a refusal for transport?


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## usafmedic45 (May 26, 2011)

Let me just finish this thread off:
Hitler.

*puts round through thread's brainstem*


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## abckidsmom (May 26, 2011)

usafmedic45 said:


> Let me just finish this thread off:
> Hitler.
> 
> *puts round through thread's brainstem*




What, now you're trying to say that HITLER was all about Public Safety?


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## usafmedic45 (May 26, 2011)

abckidsmom said:


> What, now you're trying to say that HITLER was all about Public Safety?


He was.....two words for you: Enabling Act, or rather, one very long German word: _Ermächtigungsgesetz_. If one wants to be really retentive, the full name was _Gesetz zur Behebung der Not von Volk und Reich_ ("The law to alieve the emergency/crisis of the people and Reich").


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