# KCM1 Video



## KingCountyMedic (Apr 19, 2013)

http://vimeo.com/60817271

Our new recruit video, we test every year.


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## mrg86 (Apr 22, 2013)

Great video, saw a few familiar faces. I take their physical today and providing I pass it, have an interview later in the week.


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## Luno (Apr 22, 2013)

Good Luck!


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## Christopher (Apr 22, 2013)

KingCountyMedic said:


> http://vimeo.com/60817271
> 
> Our new recruit video, we test every year.



Can you elaborate on why your unit's lack captain's/airway chairs?

Also, are the video feeds always active, and if so are they used during QA/QI?

(very impressive video)


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## terrible one (Apr 22, 2013)

Cool video thanks for sharing. Question what's with all the bullet proof vests?


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## NomadicMedic (Apr 22, 2013)

The production notes show the video was produced with GoPro cams and some standard HD cameras. Those aren't video feeds from in the trucks. 

I was impressed with how good it looked until Dr Copass said, "we want people who can shut up and take orders". And bragging about the ability to perform RSI and Central lines?


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## Ecgg (Apr 23, 2013)

DEmedic said:


> The production notes show the video was produced with GoPro cams and some standard HD cameras. Those aren't video feeds from in the trucks.
> 
> I was impressed with how good it looked until Dr Copass said, "we want people who can shut up and take orders". And bragging about the ability to perform RSI and Central lines?



Taking orders and RSI, one can build a strong argument and data to support. What I will agree with you is the central line placement in the field. This is how not to "survive sepsis" campaign and that frame at 4:41-4:47 probably goes against everything that Dr Peter Pronovost had in his checklist study  
http://www.nejm.org/doi/full/10.1056/NEJMoa061115


What is the education of your Medic One? Associate or Bachelors degree? 
The clip made it seem you come in as an EMT and in 10 month you are entry level Medic One. It even stated in the video you do not need a college education just to learn on a college level.


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## RocketMedic (Apr 23, 2013)

KCM1, Im sorry, but that does not look like anything other than Kool-Aid. Aside from ensuring that most of your patients who could benefit from ALS never see a paramedic, your own video showcases 1989's finest patient care, touts the ability to perform highly controversial techniques with little proven clinical value and emphasizes rote learning over education.

I do think the Harborview educational model is superior, but the KCM1 system looks like a horrible one to have anything other than a cardiac arrest in.


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## Sublime (Apr 23, 2013)

Ecgg said:


> Taking orders and RSI, one can build a strong argument and data to support.



What does this sentence mean? 



Ecgg said:


> What is the education of your Medic One? Associate or Bachelors degree?
> The clip made it seem you come in as an EMT and in 10 month you are entry level Medic One. It even stated in the video you do not need a college education just to learn on a college level.



I was wondering this also. Could you clarify the education requirements? At one point it says no college education is required.



Rocketmedic40 said:


> KCM1, Im sorry, but that does not look like anything other than Kool-Aid. Aside from ensuring that most of your patients who could benefit from ALS never see a paramedic, your own video showcases 1989's finest patient care, touts the ability to perform highly controversial techniques with little proven clinical value and emphasizes rote learning over education.
> 
> I do think the Harborview educational model is superior, but the KCM1 system looks like a horrible one to have anything other than a cardiac arrest in.



Not going to lie when I first watched it I thought the system looked awesome. I can see where you're coming from though. I think the educational model is what I liked most. 10 months working in the ER with the docs (after completing medic school) seems like a huge step in the right direction. I wish more places would do something like this.

I also liked the idea of a tiered response system... in theory at least. I know the way our calls get dispatched you never know if its really als or bls till you get there. Perhaps they screen better... idk.

Also now that I think about it, I find it odd that they emphasize their ability to perform advanced techniques... but from what i've heard they don't even use CPAP.


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## Handsome Robb (Apr 23, 2013)

I'll echo rocket about the Harborview Medic program.

For whoever asked, you are correct but often they hire medics with years of ALS experience and then put them back through their school. 

*To work at KCMO you have to attend their medic program. Even if you're already a medic with experience.*

I don't understand how they cover such a large area with only 8 medic units. I understand tiered systems but for an area that large with that population 8 units doesn't seem like enough and I've heard plenty of stories of patients that should be attended by an ALS attendant that end up getting turfed to BLS so the medic unit can stay in service. 

They're running the same amount of medic units that Sussex County EMS runs and they cover a much smaller area with less population. 

Sure there's not a lot of evidence that prehospital ALS changes outcomes as much as we'd like to think but the fact is that there are cases that it does affect outcomes for the better just like sometimes waiting for ALS rather than scooping and running causes a negative outcome.

Maybe I'm just used to having a medic, if not two, on every run. There's been plenty of times in my short career that the ILS FD and my ILS partner didn't pick up on something that I did and ended up having to intervene to keep the patient alive a few minutes down the road. Would the EMTs in the KCMO system picked up on this and requested an intercept? Maybe yes, maybe no... I'm not a paragod by any means, I've got lots of respect for Bs and Is but the education just isn't there and that's not their fault. Some programs go above and beyond but that's not the norm. Some basics and intermediates do a lot of self study and are extremely competent but again, that's not the majority. I think tiered systems can work very well with the proper education. For B/ILS providers, I just personally don't agree with the way KCMO does it.


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## VFlutter (Apr 23, 2013)

Sublime said:


> I was wondering this also. Could you clarify the education requirements? At one point it says no college education is required.



"King County Medics are trained and expected to treat patient's exactly as an Emergency Physician would"....No college education required 

I love the central line placement with non sterile gloves, no masks, and what looks like no prep what so ever. But then again an ambulance is not even close to a clean let alone sterile environment to begin with.

It looks like a great education but I am really not impressed with the system or the "progressive" procedures. 

So I am guessing no one gets pain management unless they are an exiting trauma?


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## Summit (Apr 23, 2013)

Who needs pain control? Didn't you see the video? The only things KCMO does is CPR except for the occasional GSW, cric, or central line.


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## Ecgg (Apr 23, 2013)

Sublime said:


> What does this sentence mean?



One can build a strong supportive argument for having strict medical orders that "medics follow direction" or having the capability to RSI. Where the benefits outweigh the risks. However not with field initiated central lines.


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## RocketMedic (Apr 23, 2013)

Summit said:


> Who needs pain control? Didn't you see the video? The only things KCMO does is CPR except for the occasional GSW, cric, or central line.



Pediatric respiratory distress? Meh, get an epi-pen.


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## chaz90 (Apr 23, 2013)

Robb said:


> I don't understand how they cover such a large area with only 8 medic units. I understand tiered systems but for an area that large with that population 8 units doesn't seem like enough and I've heard plenty of stories of patients that should be attended by an ALS attendant that end up getting turfed to BLS so the medic unit can stay in service.
> 
> They're running the same amount of medic units that Sussex County EMS runs and they cover a much smaller area with less population.



We actually run a larger area by square mileage than they do, albeit with a much lower population density. Sussex County is ~1000 square miles, and I think the video mentioned that the portion of King County that this division covers is 600 square miles. That being said, our population density is significantly less. We have a residential population of 200000 vs. 700000 in KCM1s district. I haven't been here for a summer yet, so I'll get back to you on how coverage of the greatly expanded summer population works with 8 medic units. 

One thing I have noticed is that we routinely use our ability to split our crew and respond to multiple calls at the same time. I don't think KCM1 can do this as they run a crew of two medics, but respond and transport in their own ambulance. By having two medics with two chase trucks and sets of gear available, we essentially double our surge capacity to respond to calls. Theoretically, our 8 medic units can balloon into 18 single medic ALS units by splitting each crew and adding each supervisor into the mix.


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## MrJones (Apr 23, 2013)

DEmedic said:


> ...I was impressed with how good it looked until Dr Copass said, "we want people who can shut up and take orders"....



Agreed. I'd rather work in a system that wants people who understand the science behind what they're doing and speak up when the "orders" don't make sense or aren't in the patient's best interests.

On a side note, I'm guessing that this thread isn't moving in the direction that KingCountyMedic expected..... :unsure:


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## Christopher (Apr 23, 2013)

MrJones said:


> Agreed. I'd rather work in a system that wants people who understand the science behind what they're doing and speak up when the "orders" don't make sense or aren't in the patient's best interests.
> 
> On a side note, I'm guessing that this thread isn't moving in the direction that KingCountyMedic expected..... :unsure:



A bit standoffish if anything. Many of the complaints would be better phrased as a question as most of us are shooting in the dark 

For example, instead of, _"I love the central line placement with non sterile gloves, no masks, and what looks like no prep what so ever. But then again an ambulance is not even close to a clean let alone sterile environment to begin with."_

We could try, "I noticed that the clip of the supposed central line placement showed IJ access without sterile precautions. What sort of setup do you follow when performing central lines? Is there any increase in CLABSI from EMS placed lines?"


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## chaz90 (Apr 23, 2013)

MrJones said:


> On a side note, I'm guessing that this thread isn't moving in the direction that KingCountyMedic expected..... :unsure:



That's one of the idiosyncrasies of this forum. In much of the EMS community, Medic One is seen as the Mecca for US ALS care. On EMTLife however, we seem to have gone the complete opposite direction and sometimes seem to criticize them overly harshly. No system is perfect, and I think we react to the perception that they are by some providers. In truth, I think they do some things really well and fall short in others, just like all of us. I like their emphasis on education, can understand their desire to have some consistency in background, and think they do the best job of effective PR of any EMS system. At the same time, I agree (from an outside perspective) that they seem to put too much emphasis on a narrow subset of cardiac arrests and may have a system bias towards BLSing less than glamorous calls that should be ALS.


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## NomadicMedic (Apr 23, 2013)

Well, this video was shot as a recruitment video and it should stand on its own, don't you think? Shouldn't the video be a clear depiction of how the process is performed every day? Displaying a video for potential recruits that shows a paramedic performing a skill without the proper PPE or the proper sterile procedure is simply an egregious error. 

However, this video seems to rely on the sizzle… And has very little about the steak. If you want a job where you "do cool stuff and lots of skills" this may be the perfect job for you. 

Let's be honest, King County medic one has a fantastic promotional machine that continually churns out material. That's not to say that they're not a good system. But when you start believing your own press releases, there's a problem.


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## VFlutter (Apr 23, 2013)

Christopher said:


> A bit standoffish if anything. Many of the complaints would be better phrased as a question as most of us are shooting in the dark
> 
> For example, instead of, _"I love the central line placement with non sterile gloves, no masks, and what looks like no prep what so ever. But then again an ambulance is not even close to a clean let alone sterile environment to begin with."_
> 
> We could try, "I noticed that the clip of the supposed central line placement showed IJ access without sterile precautions. What sort of setup do you follow when performing central lines? Is there any increase in CLABSI from EMS placed lines?"



It was somewhat meant to be snarky. Central line placement is a controversial skill that KCM1 puts on such a high pedestal and in the video used as example of how advanced their paramedics are. I am judging the clip as I see it. I do not think my observations are a shot in the dark. 

I have asked the OP about central lines before and here is the response I got...



KingCountyMedic said:


> We place IJ, subclavian, and Fem central  lines. We use the Trauma Arrow Kit with sterile drape and sterile  procedure and suture them in place. We are required to fill out Central  line forms for every line placed in the field, same as we fill out  airway form for every tube placed. A central line is to be placed only  when we have a patient that has no other peri access available. We have  recently started using the EZ IO as well and that has cut down on  central line use a bit but we still do quite a few. We place them in  cardiac arrest patients, trauma patients, anyone that needs one gets  one. We are required to perform at least two a year for recert. Our  complication rate is very low, as is our infection rate. We are trained  in placing central lines with sterile technique by trauma surgeons at  Harborview Medical Center. All lines in King County are yanked if the  patient is admitted, especially central lines started in the field  unless there is no other line to be had. We are required to document  everything we do, every IV, central line and ET tube placed is reviewed  that week by our medical director. If you screw up you will hear about  it usually in less than 24 hours. I have placed many central lines in  awake patients, local lidocaine prep and sterile tech used of course. We  do a lot of stuff here that isn't done in a lot of places.



This is not what I saw in the video. I saw a open sterile central line kit and a medic placing an IJ central line wearing unsterile gloves, no mask, and no sterile drapes. 

Even in codes we still use sterile gloves and a heavy lathering of betadine before placing a central line.


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## RocketMedic (Apr 23, 2013)

Lets see...I saw plenty of ineffective manual compressions, gastric distension, questionable invasive venous access, old equipment lacking power cots and autopulses, a tiered system discussing how low-priority calls are turfed with no further discussion of them and an educational system that seems to be first-rate until you realize that it boils down to thirty-five years of tradition unimpeded by progress.

Why would I move there?


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## Ecgg (Apr 23, 2013)

Rocketmedic40 said:


> Lets see...I saw plenty of ineffective manual compressions, gastric distension, questionable invasive venous access, old equipment lacking power cots and autopulses, a tiered system discussing how low-priority calls are turfed with no further discussion of them and an educational system that seems to be first-rate until you realize that it boils down to thirty-five years of tradition unimpeded by progress.
> 
> Why would I move there?



To do all that while wearing a cool tactical bullet proof vest that has MEDIC 1 in big bold letters!


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## Summit (Apr 23, 2013)

Did their medical director see this crap before they showed the world?


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## KingCountyMedic (Apr 23, 2013)

Sterile technique is not always possible, true our environment is not the most ideal place in the first place. When we are placing these types of lines it is to save a patients life. We are highly trained in doing this and we track all that we do. Most of our lines are changed out if the patient is admitted, as are I'm sure most of any other programs. 

We have never had a captains seat or airway chair or whatever you call them. We have a full bench on both sides and a lot of room to work. We like this style of rig, we design our rigs to our custom spec from Braun Northwest. 

I wanted to share our video as I am proud of my work and proud of my program. I am also proud of the job the guys did that made the video. It is an exciting video with lots of "cool stuff" a video of Medics wandering around a nursing home asking for a patient chart would have been a bit boring.

I wish I could say the response on here surprised me but it really doesn't. This is by far the rudest EMS forum I have ever seen on the web, any kind of forum for that matter.


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## Christopher (Apr 23, 2013)

KingCountyMedic said:


> Sterile technique is not always possible, true our environment is not the most ideal place in the first place. When we are placing these types of lines it is to save a patients life. We are highly trained in doing this and we track all that we do. Most of our lines are changed out if the patient is admitted, as are I'm sure most of any other programs.



Is the rate of CLABSI tracked explicitly? 



KingCountyMedic said:


> We have never had a captains seat or airway chair or whatever you call them. We have a full bench on both sides and a lot of room to work. We like this style of rig, we design our rigs to our custom spec from Braun Northwest.



Any chance you could find out why your rigs don't have them? I've never seen one without one (besides old Cadillac ambulances) and I'm intrigued that they are left out.

Human performance issues are a big deal in my day job, and it seems like this is a useful omission in some respects.



KingCountyMedic said:


> I wanted to share our video as I am proud of my work and proud of my program. I am also proud of the job the guys did that made the video. It is an exciting video with lots of "cool stuff" a video of Medics wandering around a nursing home asking for a patient chart would have been a bit boring.
> 
> I wish I could say the response on here surprised me but it really doesn't. This is by far the rudest EMS forum I have ever seen on the web, any kind of forum for that matter.



The responses have certainly been off-putting.

I find KCM1 to be top tier mostly due to how rigorously performance is tracked. If you're not measuring your system, it is hard to know just how well it is performing. I can't say I necessarily agree with all of the system implementation details, but I can certainly say you work at one of the few services which actually seems to know, "how it is doing."

If you could address the cameras bit I'd be very interested to know if they were there simply for filming, or if they exist for QA/QI in the long run.


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## medicdan (Apr 23, 2013)

KingCountyMedic said:


> Sterile technique is not always possible, true our environment is not the most ideal place in the first place. When we are placing these types of lines it is to save a patients life. We are highly trained in doing this and we track all that we do. Most of our lines are changed out if the patient is admitted, as are I'm sure most of any other programs.
> 
> We have never had a captains seat or airway chair or whatever you call them. We have a full bench on both sides and a lot of room to work. We like this style of rig, we design our rigs to our custom spec from Braun Northwest.
> 
> ...



We thank you for sharing this video, but with all due respect, I think the "rude" comments shared were all productive, raising legitimate questions about how you operate, not primarily to question your actions, but wonder aloud why they haven't been implemented elsewhere (or are performed differently elsewhere), and whether they are actually associated with any improved outcomes (central lines, for example). We are all aware of the impressive public relations and statistics related to cardiac arrest survival, but wonder about the effectiveness of the service in other measures. 
I think some legitimate questions were asked, and while you may not be able to answer them, we'll keep searching for explinations.

Again, thanks for the video, and I hope you don't confuse productive questioning with rudeness.


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## chaz90 (Apr 23, 2013)

KingCountyMedic said:


> Sterile technique is not always possible, true our environment is not the most ideal place in the first place. When we are placing these types of lines it is to save a patients life. We are highly trained in doing this and we track all that we do. Most of our lines are changed out if the patient is admitted, as are I'm sure most of any other programs.
> 
> We have never had a captains seat or airway chair or whatever you call them. We have a full bench on both sides and a lot of room to work. We like this style of rig, we design our rigs to our custom spec from Braun Northwest.
> 
> ...



I think we really are trying to be measured in our response to the video and not completely tear apart your system. Like I said before, I think there are some things KCM1 does extremely well. As far as "cool stuff" goes though, shouldn't we be trying to recruit people based on EMS realities rather than myths? Our average day doesn't involve a surgical cric, cardiac arrest save, or incredible rescue with multiple patients involved and good outcomes all around. Let's make recruitment videos that find people that want to start this profession for the right reasons. We can do plenty of which we can be proud, even if we don't save lives everyday. I think this is the reason some on here have had these reactions to your video.

Our focus should be more on the service aspects of our job that can make a difference in one person's life. Let's say Grandma fell and broke her hip. She would probably survive being rolled on a background and transported emergently with high flow oxygen, but paramedic promotional videos could focus on how much better that transport and cara can be by initially managing her pain with IN Fentanyl prior to movement, quality stabilization of the affected limb, and comfortable transport with repeated dosing of pain management as needed.

Most comments have brought up legitimate concerns with aspects of your system. You can be proud of your place of employment but still able to recognize flaws and ways you can improve.


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## Summit (Apr 23, 2013)

Don't confuse critical analysis instead of compulsary bowing towards "Mecca" as rudeness.


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## NomadicMedic (Apr 23, 2013)

I don't think it's particularly rude, I think some of the content of this video is questionable, and you may be a little close to it. Nobody wants to hear that their baby is ugly. I also think that the mystique of King County medic one supersedes the reality. There's no such thing as a perfect service, where I work is far from perfect… We have a lot of issues and I'm sure if King County medics came and rode with my system, they would say "what the hell is this mess!"

However, bragging about the fact that you can push paralytics and perform central lines is really not what I would hang my hat on. I know that all of the other counties surrounding King County can do the same thing. Snohomish County? RSI. Jefferson County? RSI. Pierce County? RSI. Grays Harbor County? RSI. Thurston County? RSI.
And most of those services, if not all, have removed central lines in favor of the IO. 

But King County medic one paramedics go through all that schooling! Great point, I think that most paramedics should have the exposure to the patients that King County paramedics get while in the program. I don't think anybody would ever question the amount of education that King County paramedics are exposed to. However, making all new hires go to the paramedic program seems ludicrous. A six-week refresher/review? Maybe. 

But bragging about the fact you get to "talk to the doc on the radio and present your case?" Come on man. Unless we're calling for orders for RSI or something off the page… Our docs don't want to be bothered.

Amazing cardiac arrest survival rates? Utstein for Sussex County is 52%. Utstien with bystander CPR is 54%. I think that's pretty comparable to most of the "progressive" EMS agencies. So maybe Seattle isn't the best place to have a heart attack anymore?

If you really want to recruit great medics, talk to me about the pay. Talk about the retirement. Talk about the equipment. Talk about the Continuing education. Talk about the research opportunities. 

If it's just a flash piece to get Sparky new paramedics to apply at Public Safety testing, then you did a great job. If you really want to recruit paramedics from other systems, tell us about the salary versus cost-of-living, the availability of affordable real estate, the green community that makes up King County… There's a lot of great things about the Pacific Northwest. The fact that you guys do RSI and central lines isn't the biggest one.  Talk about the things that would make me want to move (back) to King County.


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## VFlutter (Apr 23, 2013)

Christopher said:


> Is the rate of CLABSI tracked explicitly?



I would assume not since they are all pulled in the ER. 

After seeing that video I would be very interested to see line cultures after they removed them.

I totally understand you can not be 100% sterile in emergent situations but it does not take that much time to throw on a mask and a pair of sterile gloves.


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## RocketMedic (Apr 23, 2013)

I should hope that they are only being done in extremis...precautionary central lines sound like the start of a nightmare.

Wheres your power cots? What about your c-spine? Exactly what do you have to call in for, as opposed to standing orders? Can you medicate falls, or do you never see them?


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## 46Young (Apr 23, 2013)

This is a recruitment video. Its purpose is to highlight the most desirable attributes of the organization to a prospective employee. What do medics typically complain about? They complain about pay, working conditions, scope of practice, not seeing enough sick patients wither due to being in an all-ALS system, or a rural area, lack of training, and turnover. 

In the video, a medic stated that he's paid well. It was stated that their medics typically stay 20+ years (I don't remember the exact number). A medic said that he used to run five cardiac arrests a year, and that he had at least that many in his first month at KCMO (this is a reversal of me leaving NYC for Charleston and later NOVA BTW), it was stated that the work environment was desirable, some features of their scope of practice, such as RSI and central lines, were selected to imply that they do everything else up to those relatively rare interventions. 

The recruitment video was basically a hiring commercial. Certain aspects are highlighted, and others are purposefully omitted. It was effective to that end, IMO. What's the problem?


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## 46Young (Apr 23, 2013)

chaz90 said:


> That's one of the idiosyncrasies of this forum. In much of the EMS community, Medic One is seen as the Mecca for US ALS care. On EMTLife however, we seem to have gone the complete opposite direction and sometimes seem to criticize them overly harshly. No system is perfect, and I think we react to the perception that they are by some providers. In truth, I think they do some things really well and fall short in others, just like all of us. I like their emphasis on education, can understand their desire to have some consistency in background, and think they do the best job of effective PR of any EMS system. At the same time, I agree (from an outside perspective) that they seem to put too much emphasis on a narrow subset of cardiac arrests and may have a system bias towards BLSing less than glamorous calls that should be ALS.



Envy is probably to blame. When talking about desirable EMS employers, very few places are mentioned. KCMO is consistently one of them. If the worst they can get dinged for is gloves and cardiac arrest save criteria, then they're doing better than pretty much everyone else. Just sayin'

The EMS workplace can be a cut throat, back stabbing place. I'm seeing some of the same behavior patterns when people try to nit pick and deride (as said previously, there's a more proper way to question the video's content) a system that's probably #1 single role EMS employer in the country to work for, if not at least in the top 5.


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## Aidey (Apr 23, 2013)

I don't think it is envy. If you look at the people who are critical of the system they tend to be people with first hand knowledge of it, or who know people with first hand knowledge. 

I don't think very many people are disagreeing that it is good to be employed by KCM1. But that doesn't mean the system doesn't have major issues. People can work for an agency with a good schedule, good wage, and good benefits that still delivers questionable medical care. I think they do some things right, but I would never ever work there.


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## 46Young (Apr 23, 2013)

Aidey said:


> I don't think it is envy. If you look at the people who are critical of the system they tend to be people with first hand knowledge of it, or who know people with first hand knowledge.
> 
> I don't think very many people are disagreeing that it is good to be employed by KCM1. But that doesn't mean the system doesn't have major issues. People can work for an agency with a good schedule, good wage, and good benefits that still delivers questionable medical care. I think they do some things right, but I would never ever work there.



I can agree with you. I just think that it's a strong response to a top-of-the-line department's recruitment video, which is basically an advertisement. Advertising is basically smoke and mirrors. The video is not an accurate depiction of the department's operations, just a sales pitch with certain aspects cherry picked to dazzle the intended audience. 

If I were looking for a desirable place to work, this video would make a fairly strong impression on me. The Medical Director talked about the medics taking criticism well, not getting offended, etc. I took it as their medics don't have egos, and are interested in QI. The lengthy educational period isn't a turn off, since I'm on the payroll. I'll shadow doctors all day and pick their brains. The main sells for me are the lack of turnover (implying favorable working conditions), the pay, and the frequent high acuity patients. Bragging about interventions such as RSI and Central lines is a little tacky IMO. Progressive guidelines that facilitate independent thinking (which was addressed in the video) are a solid selling point, not what skills and interventions are available.

I wouldn't want to be busy for 25+ years, though. 15 years then a promotion to supervisor, or placement in a slower station (retirement house).


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## Aidey (Apr 23, 2013)

46Young said:


> I took it as their medics don't have egos, and are interested in QI.



Not having an ego with your very involved medical director is smart, but if you want to judge the presence of an ego, don't talk to their superiors, talk to other medics and people they view as inferiors. We're talking about a group that is notorious for blowing off the input and concerns of the EMTs from the private agencies.


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## 46Young (Apr 23, 2013)

Aidey said:


> Not having an ego with your very involved medical director is smart, but if you want to judge the presence of an ego, don't talk to their superiors, talk to other medics and people they view as inferiors. We're talking about a group that is notorious for blowing off the input and concerns of the EMTs from the private agencies.



A quick way to alienate me is to exhibit an elitist attitude. What input and concerns are the KCM1 medics blowing off?


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## Sublime (Apr 23, 2013)

KingCountyMedic said:


> I wanted to share our video as I am proud of my work and proud of my program. I am also proud of the job the guys did that made the video. It is an exciting video with lots of "cool stuff" a video of Medics wandering around a nursing home asking for a patient chart would have been a bit boring.
> 
> I wish I could say the response on here surprised me but it really doesn't. This is by far the rudest EMS forum I have ever seen on the web, any kind of forum for that matter.



The reason your system is getting so much criticism is because of its reputation. King County is world renowned for its cardiac arrest survival rate. This and the fact that you guys are supposed to be one of the most "progressive" systems opens you up for being criticized when posting a video like this. 

If you worked for some unheard of system in the middle of nowhere then nobody would be so quick to make judgements or be so curious. It is only natural to question the ones who claim to be the best. 

I do believe some legitimate questions were asked, and you really only addressed central line placement. Not that you owe anyone here answers, but when you post something like this I'm sure you expected people to ask questions.

I for one wonder why you guys use central line placement at all, especially in a cardiac arrest. An IO is so much simpler, faster, and involves less risks. Also the hospital pulls it anyway so why even bother!? What are the benefits over an IO? 

And can you confirm for me that you guys use CPAP or not? I've heard you don't but that could be a rumor.


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## Aidey (Apr 23, 2013)

46Young said:


> A quick way to alienate me is to exhibit an  elitist attitude. What input and concerns are the KCM1 medics blowing  off?



In an effort to not derail this thread too much, I suggest you read through some of the past threads on KCM1, because I know a lot of examples have been given. The short of it is, they have a history of turfing patients to BLS crews even after the BLS crew says they aren't comfortable with the patient. This includes patients that have been treated, and then had lines yanked so they could be sent in BLS.


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## RocketMedic (Apr 23, 2013)

Aidey said:


> In an effort to not derail this thread too much, I suggest you read through some of the past threads on KCM1, because I know a lot of examples have been given. The short of it is, they have a history of turfing patients to BLS crews even after the BLS crew says they aren't comfortable with the patient. This includes patients that have been treated, and then had lines yanked so they could be sent in BLS.



Theres been some excellent threads about it. Also, on the video itself, I didnt see anything really earth-shaking and quite a bit thats antiquated (Ferno manual cot).


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## Fish (Apr 24, 2013)

KingCountyMedic said:


> http://vimeo.com/60817271
> 
> Our new recruit video, we test every year.



Well put together Recruitment video, thank you for sharing.....


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## Ecgg (Apr 24, 2013)

46Young said:


> Envy is probably to blame. When talking about desirable EMS employers, very few places are mentioned. KCMO is consistently one of them. If the worst they can get dinged for is gloves and cardiac arrest save criteria, then they're doing better than pretty much everyone else. Just sayin'
> 
> The EMS workplace can be a cut throat, back stabbing place. I'm seeing some of the same behavior patterns when people try to nit pick and deride (as said previously, there's a more proper way to question the video's content) a system that's probably #1 single role EMS employer in the country to work for, if not at least in the top 5.



It's certainly envy no doubt. 

Directly from: http://www.publicsafetytesting.com/agency/view/list/ 
King County Medic One PARAMEDIC Requirements: 
High School Grad/ GED	 	 	 
EMT Certification	EMT or Paramedic certification	 	 
Paramedic Certification	EMT or Paramedic certification 	 
Prior EMT Experience Required	Minimum of 3 year’s experience as EMT or Paramedic working in a urban / rural prehospital care delivery system. Twelve consecutive months of that experience must be with one agency
Salary Information
$15.19 per hour, + Overtime.  (Approximately $50,000 anually during training)
$28.51 (2448 hrs per year)  upon certification (2010 CBA Rates)	

All I see is the same old GED, EMT or P card, and years on the job as the primary criteria for hire.  Following that you go through their 10 month boot camp with “no extracurricular activities” and “70 hour a week” where you follow instruction “keep your mouth shut” and do the grunt work (we all went through medic school rotations and sadly you will not be one of the “residents” in the ER) while getting an EMT Basic salary and hey they want “people to make a career commitment” because we want people who lack formal education to do things our way period.  Here is a video of us looking cool and all tactical with our bullet proof vests because that is paramount for progressive patient care while putting central lines without any care for sepsis just because we are allowed, they will get taken out anyway upon admission. Remember we will treat the patient exactly as an Emergency Physician will, with my GED and 10 month boot camp training. 


I believe all the questions asked were legitimate questions. I would still like to see a proper response instead of “this forum is rude” and “sterile technique is not always possible” shall not be a deterrent from our progressive practices of field central line placement.

*What is the formal college education level of your paramedics?

Why delay transport for placement of a central line while using questionable sterility methods? What was the goal on establishing said placement?  

With only 8 medic units in service does everyone who needs ALS care receive it? Or on a busy day you get what you get?*


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## 46Young (Apr 24, 2013)

Ecgg said:


> It's certainly envy no doubt.
> 
> Directly from: http://www.publicsafetytesting.com/agency/view/list/
> King County Medic One PARAMEDIC Requirements:
> ...



So, KCM1 is basically like any other third service tiered system, except that they pay well, have a lengthy internship process, and play up their skills and abilities.


I'm beginning to see what everyone else sees. Those are excellent questions you've asked, and I hope to see a proper response.

I guess I can ad KCM1 to the list of single role EMS providers that value experience over education. Seriously, this is supposed to be a premier agency, and they only require a GED, certs, and some experience? $50k/yr @ 70 hours/week (as stated on the video) for ten months of training? Whenever someone blames the fire service for retarding efforts to increase educational requirements, I counter that every other delivery model is also to blame. Surely a department as desirable as KCM1 could require a degree to have their application considered, and still have no shortage of applicants, no? Instead, I could start work as an EMT, do a six month medic mill, do two more years as a medic, and be qualified to apply with KCM1. When the top EMS employers take people with just a GED and a cert, it's no wonder why we're not getting anywhere with the education issue. 

KCM1 has a tiered system that allows medics to see only sick patients (relatively rare outside of NY/NJ). That's good. They pay well. I hope that they have a pension. They have a decent scope of practice. Other than that, I don't see how they're superior to anyone else.


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## 46Young (Apr 24, 2013)

I have some questions:

What positions are available besides field EMS transport? How many of these opprtunities are available? Are there ample opprtunites to get off the road as you get older?

What is the average call volume per ALS unit? I think that the video said 14,000 calls divided over 65 medics. 2448 hours a year is a 47 hour workweek. That would be four calls a week for each medic, on either 4 12's a week, or two 24's a week. Does that sound right? Edit: (Actually, based on the hiring info, 14,000 calls over eight units is just under 5 calls a day per unit)

Could we see a coply of KCM1 guidelines? Let us judge how progressive these guidelines are compared to other systems, and if the options are necessary.

My county has 1.08 million residents spread over 395 sq miles (2749/Sq mile). We have 41 transport units, which are all ALS (15 are dual medic). What are the population stats and ambulance deployment (both BLS and ALS) for KCM1's coverage area?


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## NomadicMedic (Apr 24, 2013)

There are some things about KCM1 that are great. The education is way beyond any other paramedic program. Because its held at Harborview, medic interns have a great opportunity to practice the skills that we all know are lacking in other programs. Namely intubation. Medics come out of that program with far more than the standard 10 live tubes. 

There are also research opportunities, if you're into that sort of thing. 

In reality, it's a just a system that's above average in some areas, below in others, has passionate employees and a really good PR department. 


Many of us could take lessons on how our system is presented to others.


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## KingCountyMedic (Apr 24, 2013)

We do 24 hour shifts. 1 on, 1 off, 1 on, followed by 5 days off. We have "debit days" which are used to cover vacation. We have 4 platoons, each shift has a MSO (Bat Chief) along with our Chief and 4 other day time MSO's that oversee training/hiring/operations etc. Each shift has an acting MSO that fills in for the shift MSO and then we have FTO's. So there are some promotional opportunities. We do have very good benefits and retirement. We are in the IAFF Union under our own local but we are not firefighters. We do carry bunker gear for car accidents and other operations were full protective gear is needed. We are all custom fitted and issued our own ballistic vests and we are required to wear them on all assault w/weapons calls. Our pension plan is LEOFF 2. Our pay is quite good and overtime is usually always available to those that want it. As far as education requirements yes you can get hired with a high school diploma/GED and an EMT card. Many of our people have multiple degrees, we have a ton of RN's that work here as well. Everything we do is overseen by some of the nations best Doctors, as far as our scope of practice and what we do in the field, everything is overseen by Physicians who are actively involved in running our program. Every patient we see is documented and the case is reviewed by our Docs. Our program was designed by a group of Doctors that wanted to save life. They wanted to see if they could train a firefighter to go out and operate as an extension of the ER Physician. We have a history that we are proud of and we love to go to work. If you are interested we test almost every year. Here's the rest: 


http://www.kingcounty.gov/healthservices/health/ems/MedicOne.aspx


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## RocketMedic (Apr 24, 2013)

KingCountyMedic said:


> We do 24 hour shifts. 1 on, 1 off, 1 on, followed by 5 days off. We have "debit days" which are used to cover vacation. We have 4 platoons, each shift has a MSO (Bat Chief) along with our Chief and 4 other day time MSO's that oversee training/hiring/operations etc. Each shift has an acting MSO that fills in for the shift MSO and then we have FTO's. So there are some promotional opportunities. We do have very good benefits and retirement. We are in the IAFF Union under our own local but we are not firefighters. We do carry bunker gear for car accidents and other operations were full protective gear is needed. We are all custom fitted and issued our own ballistic vests and we are required to wear them on all assault w/weapons calls. Our pension plan is LEOFF 2. Our pay is quite good and overtime is usually always available to those that want it. As far as education requirements yes you can get hired with a high school diploma/GED and an EMT card. Many of our people have multiple degrees, we have a ton of RN's that work here as well. Everything we do is overseen by some of the nations best Doctors, as far as our scope of practice and what we do in the field, everything is overseen by Physicians who are actively involved in running our program. Every patient we see is documented and the case is reviewed by our Docs. Our program was designed by a group of Doctors that wanted to save life. They wanted to see if they could train a firefighter to go out and operate as an extension of the ER Physician. We have a history that we are proud of and we love to go to work. If you are interested we test almost every year. Here's the rest:
> 
> 
> http://www.kingcounty.gov/healthservices/health/ems/MedicOne.aspx



Everyone charts all of their patients, its how we get paid. Claiming that as a hiring incentive is like saying "sky is blue here too".

Everyone has doctors as medical directors, although most are not as involved as yours seem to be. Every paramedic out there work s to some extent as an extension of the ER.

What is your actual scope of practice?


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## KingCountyMedic (Apr 24, 2013)

Rocketmedic40 said:


> Everyone charts all of their patients, its how we get paid. Claiming that as a hiring incentive is like saying "sky is blue here too".
> 
> Everyone has doctors as medical directors, although most are not as involved as yours seem to be. Every paramedic out there work s to some extent as an extension of the ER.
> 
> What is your actual scope of practice?



http://www.kingcounty.gov/healthservices/health/ems/MedicOne.aspx


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## RocketMedic (Apr 24, 2013)

KingCountyMedic said:


> http://www.kingcounty.gov/healthservices/health/ems/MedicOne.aspx




I see that you are allowed to perform several nonstandard surgical procedures, but no CPAP or BiPap? What about cath lab activations? C spine clearance? What is KCM1s policy on pain mangement and relief of nausea?

What sort of calls are you dispatched on? What is your working relationship with local FD and private ambulances? 

How many of these surgical skills are performed in your system? What are your ETI rates? 

How are errors managed? Clinical errors?


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## PotatoMedic (Apr 24, 2013)

Rocketmedic40 said:


> Claiming that as a hiring incentive is like saying "sky is blue here too".



Just so you know it is not.  Constantly gray.  If we see blue we know something has gone wrong!


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## KingCountyMedic (Apr 24, 2013)

Rocketmedic40 said:


> I see that you are allowed to perform several nonstandard surgical procedures, but no CPAP or BiPap? What about cath lab activations? C spine clearance? What is KCM1s policy on pain mangement and relief of nausea?
> 
> No CPAP or BIPAP yet, ongoing discussion amongst provider groups and physicians. KCM1 is a part of a much larger county wide EMS system, everyone has to agree to using it but probably coming soon. Pain and nausea are treated if it is a ALS patient requiring our involvement. We carry MS, Versed, Ativan and Zofran and Promethazine for nausea. We activate cath lab from the field on confirmed STEMI, we have the ability to transmit 12 leads with our LP15, often times we bypass the ED and go straight to the cath lab. As far as clearing c-spine not something we really do or see, I don't go to all MVC's just the bad ones.
> 
> ...



Probably the same way most places handle them. Peer review, MSO review, Physician review. You will get a meeting with the MSO and the Medical Director and it can go a number of ways including documentation, counseling, medical probation, being sent back to Paramedic Training, having the Doctor ride with you or suspension/termination/prosecution if it's bad enough.


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## RocketMedic (Apr 24, 2013)

FireWA1 said:


> Just so you know it is not.  Constantly gray.  If we see blue we know something has gone wrong!



Touche...it is seattle i reckon.


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## RocketMedic (Apr 24, 2013)

fair enough...why no power cots?


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## BandageBrigade (Apr 24, 2013)

Rocketmedic40 said:


> Lets see...I saw plenty of ineffective manual compressions, gastric distension, questionable invasive venous access, old equipment lacking power cots and autopulses, a tiered system discussing how low-priority calls are turfed with no further discussion of them and an educational system that seems to be first-rate until you realize that it boils down to thirty-five years of tradition unimpeded by progress.
> 
> Why would I move there?



AHA recommends against device such as the autopulse.. why would they want it? I also hate power cots. Heavy and slow. Give me a manual stryker any day.


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## KingCountyMedic (Apr 24, 2013)

Rocketmedic40 said:


> fair enough...why no power cots?




That could fall under the "40 years of tradition unimpeded by progress" category. We have looked at many models and the majority have not wanted them due to weight and other factors. Our new rigs that we will be getting by the end of the year will have power cots with power loading. We are going to the new International Terrastar rig which is a huge rig so we'll have more room for more stuff like power loading cots and transport vents if we go that route. We don't go in for a lot of new gadgets just because they advertise in JEMS and have lots of reps throwing note pads and coffee cups at us. At the top of our medical food chain are some very smart, very old school Physicians and for us to use something or change the way we operate it has to really show a benefit. Not everyone is in agreement both in and outside of our community but that's the way it goes sometimes.

I hate Ferno cots, been a Stryker fan forever and would love power cots and they are coming


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## RocketMedic (Apr 24, 2013)

BandageBrigade said:


> AHA recommends against device such as the autopulse.. why would they want it? I also hate power cots. Heavy and slow. Give me a manual stryker any day.



So you prefer manual compressions?

Any oposition to cot weight goes away when I can move 500 pound Manatees with my thumb.


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## RocketMedic (Apr 24, 2013)

KingCountyMedic said:


> That could fall under the "40 years of tradition unimpeded by progress" category. We have looked at many models and the majority have not wanted them due to weight and other factors. Our new rigs that we will be getting by the end of the year will have power cots with power loading. We are going to the new International Terrastar rig which is a huge rig so we'll have more room for more stuff like power loading cots and transport vents if we go that route. We don't go in for a lot of new gadgets just because they advertise in JEMS and have lots of reps throwing note pads and coffee cups at us. At the top of our medical food chain are some very smart, very old school Physicians and for us to use something or change the way we operate it has to really show a benefit. Not everyone is in agreement both in and outside of our community but that's the way it goes sometimes.
> 
> I hate Ferno cots, been a Stryker fan forever and would love power cots and they are coming



Welcome to 2007. Power cots rock.


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## KingCountyMedic (Apr 24, 2013)

Rocketmedic40 said:


> So you prefer manual compressions?
> 
> Any oposition to cot weight goes away when I can move 500 pound Manatees with my thumb.



Manual compressions all day, we switch out every cycle and shoot for >90% compression fractions and we get the numbers back on how we did.

For our large patients we use special Bariatric Ambulances from our private partners. They have a lot of them equipped with cranes and all kinds of stuff.


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## Christopher (Apr 24, 2013)

Rocketmedic40 said:


> Welcome to 2007. Power cots rock.



I dislike the power cots...far heavier when taking it into/out of homes and heavier when loading a patient.

Nicer when raising is about all it has on the normal ones.

Also the Autopulse has not been shown to be superior than CCC, and our fire depts do a pretty good job. The LUCAS apparently might be, but I think the honest answer is once you have good compression fractions a mechanical CPR device only wins in the rare case you'd like to transport a working arrest. I saw a paper from Dana Yost which showed it took quite a long time to get setup a lot.

If I were to beat up KCM1 for being outdated, it would be for not having CPAP; if that rumor is still true.


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## 46Young (Apr 24, 2013)

Christopher said:


> I dislike the power cots...far heavier when taking it into/out of homes and heavier when loading a patient.
> 
> Nicer when raising is about all it has on the normal ones.
> 
> ...



The power cot does not need to go in the house; we have the Reeves and a stair chair. The power cot can also be loaded into the ambulance with one person on each handle, which negates the weight disadvantage by cutting the weight in half. 

Of course, if the FD responds on each call, you're not lifting the patient either, so then it doesn't make a difference


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## RocketMedic (Apr 24, 2013)

+1...if I have to lift it in, we are not taking it inside. I will never work routinely without a power cot again.

Does Medic 1 interact well with other ALS services?


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## NomadicMedic (Apr 24, 2013)

Rocketmedic40 said:


> +1...if I have to lift it in, we are not taking it inside. I will never work routinely without a power cot again.
> 
> Does Medic 1 interact well with other ALS services?



There are no other ALS services in the county. Some of the private ambulance companies have nurses that run ALS IFT. But in King County, medic one is it.


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## Ecgg (Apr 24, 2013)

KingCountyMedic said:


> We do 24 hour shifts. 1 on, 1 off, 1 on, followed by 5 days off. We have "debit days" which are used to cover vacation. We have 4 platoons, each shift has a MSO (Bat Chief) along with our Chief and 4 other day time MSO's that oversee training/hiring/operations etc. Each shift has an acting MSO that fills in for the shift MSO and then we have FTO's. So there are some promotional opportunities. We do have very good benefits and retirement. We are in the IAFF Union under our own local but we are not firefighters. We do carry bunker gear for car accidents and other operations were full protective gear is needed. We are all custom fitted and issued our own ballistic vests and we are required to wear them on all assault w/weapons calls. Our pension plan is LEOFF 2. Our pay is quite good and overtime is usually always available to those that want it. As far as education requirements yes you can get hired with a high school diploma/GED and an EMT card. Many of our people have multiple degrees, we have a ton of RN's that work here as well. Everything we do is overseen by some of the nations best Doctors, as far as our scope of practice and what we do in the field, everything is overseen by Physicians who are actively involved in running our program. Every patient we see is documented and the case is reviewed by our Docs. Our program was designed by a group of Doctors that wanted to save life. They wanted to see if they could train a firefighter to go out and operate as an extension of the ER Physician. We have a history that we are proud of and we love to go to work. If you are interested we test almost every year. Here's the rest:
> 
> 
> http://www.kingcounty.gov/healthservices/health/ems/MedicOne.aspx



I appreciate a serious response to the questions posed. I think people have misconceptions or have own ideas what the program should be instead of what it actually is. What it actually is “train a firefighter to go out and operate” and this is not a knock by any means, just call things for what they are. You take a group of guys who have done this job for at least 3 years or more as primary benchmark and retrain them over 10 month to run sequence of events more proficiently (i.e. the code) with consistent rudimentary  drilling.  Well what you know? The basics do work and they the results speak for themselves. If you are the sole ALS provider you can control such variables.


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## KingCountyMedic (Apr 24, 2013)

Ecgg said:


> I appreciate a serious response to the questions posed. I think people have misconceptions or have own ideas what the program should be instead of what it actually is. What it actually is “train a firefighter to go out and operate” and this is not a knock by any means, just call things for what they are. You take a group of guys who have done this job for at least 3 years or more as primary benchmark and retrain them over 10 month to run sequence of events more proficiently (i.e. the code) with consistent rudimentary  drilling.  Well what you know? The basics do work and they the results speak for themselves. If you are the sole ALS provider you can control such variables.



The training never stops really. After completing Paramedic Training you are on probation for 1 year, You are assigned to a shift and assigned to an FTO that will evaluate you on every call. You are not allowed to work with anyone but FTO's for your first six months. Once a month the Shift MSO will come and ride as your partner and evaluate you. Our Medical Director will also ride with you quite a bit while you are on probation. After six months is up you are released into the wild to work with all the folks on your shift. We rotate trucks most every month so you will experience working in very urban areas with tons of trauma and violence and then move out to rural areas and work with mostly volunteer fire departments and spend a lot of time with patients as transport times go much longer out in the sticks. We have a recert test every 2 years. You are required 50 hours of CE per year, 12 intubations per year, 36 IV's per year, 2 central lines per year. These requirements never go down like in other systems that I have worked in. We have multiple opportunities for CE every month and the majority of it involves hands on training with our Doctors present. The first Tuesday of every month we have "Tuesday Series" at Harborview Medical Center and it is 3 hours of Physician lectures. You attend in person and you will get 3 hours CE as well as 3 hours of overtime. You are also able to watch it online for the CE but you only get the OT pay if you attend in person and you are required to attend at least 3 per year in person.


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## Ecgg (Apr 24, 2013)

KingCountyMedic said:


> The training never stops really. After completing Paramedic Training you are on probation for 1 year, You are assigned to a shift and assigned to an FTO that will evaluate you on every call. You are not allowed to work with anyone but FTO's for your first six months. Once a month the Shift MSO will come and ride as your partner and evaluate you. Our Medical Director will also ride with you quite a bit while you are on probation. After six months is up you are released into the wild to work with all the folks on your shift. We rotate trucks most every month so you will experience working in very urban areas with tons of trauma and violence and then move out to rural areas and work with mostly volunteer fire departments and spend a lot of time with patients as transport times go much longer out in the sticks. We have a recert test every 2 years. You are required 50 hours of CE per year, 12 intubations per year, 36 IV's per year, 2 central lines per year. These requirements never go down like in other systems that I have worked in. We have multiple opportunities for CE every month and the majority of it involves hands on training with our Doctors present. The first Tuesday of every month we have "Tuesday Series" at Harborview Medical Center and it is 3 hours of Physician lectures. You attend in person and you will get 3 hours CE as well as 3 hours of overtime. You are also able to watch it online for the CE but you only get the OT pay if you attend in person and you are required to attend at least 3 per year in person.



That is excellent and definitely attributes to the success. However training, drilling and CE ≠ formal college education! It is my opinion and a strong belief that you *need strong emphasis on both *to be a progressive system and they not interchangeable as some believe. However, Paramedicine is stuck in that archaic model where years on the job and annual performed numbers “X iv sticks per year, X tubes per year, X central lines per year” is king and formal education is trivial.  
 You may certainly make an argument that what we strive to accomplish is coordinated action that is drilled constantly and you do not need a college education and we have results to prove it. I have no argument with you there. However to put on a façade of being progressive yet listing the same archaic employment criteria.  One thing to consider is that someone who has gone through formal schooling (not just CE and on the job training) has a much better understanding at the limitations and consequences of both actions and inactions. Much better at factoring in patient priorities.
Enroll into real college microbiology with lab class and read the leading causes of ICU mortalities. Browse the surviving sepsis site during the class, perhaps read the checklist manifesto book and  after come back and tell me about field initiated central line access and how it’s not always possible to have sterile technique in the field yet we need to hit our numbers spiel.


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## PotatoMedic (Apr 25, 2013)

My understanding is that the KCM1 program was working on making the program a BA degree in Paramedicine if you took a few classes post completion of the program.  I don't know the status of that but I heard it in the rumor mill a year or two ago.


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## 46Young (Apr 25, 2013)

A few people have questioned the need for certain advanced procedures in the field, including central lines. We were told that the first due can be urban, or it can be rural. If the transport times are long, and a medevac is not available, ten certain advanced procedures may be warranted.

I have a deployment question. My department has nearly 1.1 million residents, over 395 square miles. KCM1 serves 750,000 over 500 square miles. We formerly had 14 medic units (all double medic), with one day time medic unit, and 27 BLS units. We also have 37 ALS engines. We now have 15 double medic units, and 26 medic/EMT units. The engine deployment remains the same. 

When we had the 14 medic units, I felt that we had adequate coverage over the 395 miles for ALS calls. How does KCM1 manage with 500 miles to cover? If one of the rural units gets a call, how does that area (with a presumably large geographical first due) maintain ALS coverage? Do you have ALS engines or medic chase vehicles?

The reason I'm asking is that these two systems are somewhat close in size and population, with yours being somewhat more sparsely populated. I desperately want to have a tiered system, not the expensive all-ALS nonsense we're currently stuck with. Going on our old deployment model with 14 medic units for 1.1m, your 8 medics for 750k is roughly proportional, where we have one medic per 78k residents, and you have one medic per 93k people. You also cover an area that's more than 125% larger than ours. I'm looking to show how you make it work with less medics and a larger coverage area than we had.


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## chaz90 (Apr 25, 2013)

FireWA1 said:


> My understanding is that the KCM1 program was working on making the program a BA degree in Paramedicine if you took a few classes post completion of the program.  I don't know the status of that but I heard it in the rumor mill a year or two ago.



You'd have to take more than a few extra classes to turn a 10 month program into a Bachelor degree. Also, I think the point being made was the desire to emphasize more in depth learning with full courses in subjects like anatomy, physiology, pharmacology, biology, microbiology, and chemistry. This doesn't mean just tacking a degree on to the same vocational education.


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## KingCountyMedic (Apr 25, 2013)

46Young said:


> A few people have questioned the need for certain advanced procedures in the field, including central lines. We were told that the first due can be urban, or it can be rural. If the transport times are long, and a medevac is not available, ten certain advanced procedures may be warranted.
> 
> I have a deployment question. My department has nearly 1.1 million residents, over 395 square miles. KCM1 serves 750,000 over 500 square miles. We formerly had 14 medic units (all double medic), with one day time medic unit, and 27 BLS units. We also have 37 ALS engines. We now have 15 double medic units, and 26 medic/EMT units. The engine deployment remains the same.
> 
> ...



Our rural areas are typically not high call volume areas, and the way we have our units deployed our transport times to a hospital with cath lab, CT scanner, Level 2-3 are probably 20-30 minutes at the longest end of of the rope. For the big time trauma and super sick needing surgical care we have Airlift Northwest Helicopters and we typically fly the the stuff we get in the most rural areas. We have the option of splitting crews when we need to, one Medic may jump onto an aid car, engine, or private ambulance and go to the next call. We also have our MSO's in SUV's that can cover when the system is busy. During the day we have up to 6 MSO's that are all certified Medics with full kits and they all will run calls if needed. The other thing we will do is if the Medic is coming from a ways out our aid cars or ambulances will load and go meet us. Another option is if the BLS crew feels they can get the patient to the hospital much faster than we can get to them we will discuss it on the radio, they will give us a detailed short report on the patient and we will make the decision. (this happens very rarely) we also have mutual aid agreements with providers both in King County and counties on our borders. And last in many of the more rural areas we have quite a few of our Medics that live in these areas and have volunteered with local departments and have been authorized to have gear with them in the past. I don't know about your system but I imagine you guys probably send Medics to a lot of calls that we don't typically send a Medic response. Not knocking yours or anyone else. I came from a county that had Paramedics on every street corner, every engine company.


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## KingCountyMedic (Apr 25, 2013)

FireWA1 said:


> My understanding is that the KCM1 program was working on making the program a BA degree in Paramedicine if you took a few classes post completion of the program.  I don't know the status of that but I heard it in the rumor mill a year or two ago.



I think that is still being worked on as an option if the student wants to pursue it. Don't think it's up and running yet. It was more than a few classes I believe, it was quite involved.


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## KingCountyMedic (Apr 25, 2013)

Here's a link to the Resuscitation Academy. This is put on by our Doctors and Medics. It's more info about what we do over here.

http://resuscitationacademy.org/


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## 46Young (Apr 25, 2013)

KingCountyMedic said:


> Our rural areas are typically not high call volume areas, and the way we have our units deployed our transport times to a hospital with cath lab, CT scanner, Level 2-3 are probably 20-30 minutes at the longest end of of the rope. For the big time trauma and super sick needing surgical care we have Airlift Northwest Helicopters and we typically fly the the stuff we get in the most rural areas. We have the option of splitting crews when we need to, one Medic may jump onto an aid car, engine, or private ambulance and go to the next call. We also have our MSO's in SUV's that can cover when the system is busy. During the day we have up to 6 MSO's that are all certified Medics with full kits and they all will run calls if needed. The other thing we will do is if the Medic is coming from a ways out our aid cars or ambulances will load and go meet us. Another option is if the BLS crew feels they can get the patient to the hospital much faster than we can get to them we will discuss it on the radio, they will give us a detailed short report on the patient and we will make the decision. (this happens very rarely) we also have mutual aid agreements with providers both in King County and counties on our borders. And last in many of the more rural areas we have quite a few of our Medics that live in these areas and have volunteered with local departments and have been authorized to have gear with them in the past. I don't know about your system but I imagine you guys probably send Medics to a lot of calls that we don't typically send a Medic response. Not knocking yours or anyone else. I came from a county that had Paramedics on every street corner, every engine company.



You're right, we have medics on every call, sometimes 3-4 medics. Most of our call types are ALS (cookbook EMD and CYA up-triage), and every ALS call gets an ALS engine. I don't see how anyone can learn, or get better as a paramedic when most of our calls are non-acute, minor issues, or monitor/IV jobs ate best. I'm lucky if I run one cardiac arrest a month, or do anything past a 12-lead and an IV on 90% of our patients. I used to work in the NYC 911 system. The protocols were very restrictive, probably due to there being numerous hospitals and privates working with the FDNY, but at least it was tiered, and we only responded to ALS calls. No board and collar jobs, injuries, sick jobs, EDP's, drunks, postictal Sz, etc. I learned 90% of what I know from the three years as an EMT, and two as a medic before I left the city. These last five years have been spent basically learning how to slow down to the speed of the other people working on our typical slow paced 6-7 person bum rush into each patient's house. The idea is if we have 2-3 medics on the scene, one of us should know what we're doing.


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## KingCountyMedic (Apr 25, 2013)

46Young said:


> You're right, we have medics on every call, sometimes 3-4 medics. Most of our call types are ALS (cookbook EMD and CYA up-triage), and every ALS call gets an ALS engine. I don't see how anyone can learn, or get better as a paramedic when most of our calls are non-acute, minor issues, or monitor/IV jobs ate best. I'm lucky if I run one cardiac arrest a month, or do anything past a 12-lead and an IV on 90% of our patients. I used to work in the NYC 911 system. The protocols were very restrictive, probably due to there being numerous hospitals and privates working with the FDNY, but at least it was tiered, and we only responded to ALS calls. No board and collar jobs, injuries, sick jobs, EDP's, drunks, postictal Sz, etc. I learned 90% of what I know from the three years as an EMT, and two as a medic before I left the city. These last five years have been spent basically learning how to slow down to the speed of the other people working on our typical slow paced 6-7 person bum rush into each patient's house. The idea is if we have 2-3 medics on the scene, one of us should know what we're doing.



Over here in our state we have the same problem in most areas but mine. Most agencies outside of King County bill for transport, including most fire departments. The patient with an IV, blood draw, cardiac monitor, and O2 is worth an extra $500-$700 or more compared to just transporting them BLS. So most places pack on Medics and encourage ALS transport. Where I used to work the phrase was "O2, IV, Monitor every patient you can justify using it on, it protects the patient and your job."


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## KingCountyMedic (Apr 25, 2013)

Here's another one of our sites. We use this for our Airway and Central Line report tracking and we also get all of our CPR cases sent us to follow up on. Our call is recorded from start to finish and then one of our Doctors will critique it and give us feedback. We log in for our portion as it is all HIPPA/Legal but there is quite a bit of content on here for the public to view:

http://www.emsonline.net/


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## RocketMedic (Apr 25, 2013)

Home sick...cut out my last day because Im not spending 12 hours in a rig feeling like this.

24 y/o M, nausea, fever, headache, sore throat. If I were enough of a pansy to call, Id get a PO Zofran, maybe an IV and capno if I got a Kool-Aid drinker. In King County, what would I be triaged as?


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## KingCountyMedic (Apr 25, 2013)

Rocketmedic40 said:


> Home sick...cut out my last day because Im not spending 12 hours in a rig feeling like this.
> 
> 24 y/o M, nausea, fever, headache, sore throat. If I were enough of a pansy to call, Id get a PO Zofran, maybe an IV and capno if I got a Kool-Aid drinker. In King County, what would I be triaged as?



Dispatch would ask you a series of questions to determine if you met any dispatch criteria and if you didn't meet any criteria for urgent dispatch of a BLS unit 911 would probably transfer you to the nurse line. Nurse would talk to you more and figure out if any of our BLS units need to come see you or discuss other options of care. If you seem to be a shut in or have other special needs, or you call 911 a lot one of our fire department CARES units would come out and contact you and see what can be done to assist you. They have access to all sorts of options, get you hooked up with a case worker, medical clinic, etc. With your complaints of headache, nausea, and fever I imagine you would get an engine or aid unit dispatched. The BLS unit would come and further triage you.


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## 46Young (Apr 25, 2013)

Rocketmedic40 said:


> Home sick...cut out my last day because Im not spending 12 hours in a rig feeling like this.
> 
> 24 y/o M, nausea, fever, headache, sore throat. If I were enough of a pansy to call, Id get a PO Zofran, maybe an IV and capno if I got a Kool-Aid drinker. In King County, what would I be triaged as?



I've worked at opposite ends of the spectrum. In NYC, that pt would be BLS, and whoever's riding aid would probably just walk him to the bus, tell the driver to start driving, and maybe get a quick set of vitals en-route (or just use "vital vision"). Where I work now, they want everything done, because hey, that nausea could be atypical ACS or something. Like KingCountyMedic said about neighboring jurisdictions, making a BLS pt into ALS by justifying an IV and an ECG can bring in more revenue. 

With a patient like this, I'll play dumb and ask if they had already been to urgent care or their doctor, and what did they say?


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## NomadicMedic (Apr 25, 2013)

That would also be triaged as a BLS call here, unless you tripped the "ALS indicator" by answering no to "is the patient breathing totally normally" or "is the patient totally alert" questions. Then it's a Charlie or Delta ALS upgrade. (Usually cancelled by BLS when they arrive on scene and assess the patient.)


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## RocketMedic (Apr 25, 2013)

DEmedic said:


> That would also be triaged as a BLS call here, unless you tripped the "ALS indicator" by answering no to "is the patient breathing totally normally" or "is the patient totally alert" questions. Then it's a Charlie or Delta ALS upgrade. (Usually cancelled by BLS when they arrive on scene and assess the patient.)



Fair enough lol.


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## 46Young (Apr 25, 2013)

DEmedic said:


> That would also be triaged as a BLS call here, unless you tripped the "ALS indicator" by answering no to "is the patient breathing totally normally" or "is the patient totally alert" questions. Then it's a Charlie or Delta ALS upgrade. (Usually cancelled by BLS when they arrive on scene and assess the patient.)



I have a problem with places that use dispatchers with no medical experience, and train them to use EMD exclusively. Someone that drops a bowling ball on their foot. The dispatcher asks them if they're short of breath. They may be in a lot of pain, so they answer yes, and then it becomes ALS. Meanwhile, we get a lot of elderly falls, with a concurrent c/o dizziness or weakness, and it's BLS.

I miss the FDNY EMT and medics working as dispatchers for the NYC 911 system. The call types were pretty accurate much of the time.


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## chaz90 (Apr 26, 2013)

46Young said:


> I have a problem with places that use dispatchers with no medical experience, and train them to use EMD exclusively. Someone that drops a bowling ball on their foot. The dispatcher asks them if they're short of breath. They may be in a lot of pain, so they answer yes, and then it becomes ALS. Meanwhile, we get a lot of elderly falls, with a concurrent c/o dizziness or weakness, and it's BLS.
> 
> I miss the FDNY EMT and medics working as dispatchers for the NYC 911 system. The call types were pretty accurate much of the time.



That's the PMD system though. I don't agree with all of it either, but it doesn't leave room for dispatcher interpretation to downgrade calls. Thus, you have "not alert" calls with 102 year old demented patients dispatched as Deltas from nursing homes and a 50 year male who faints dispatched as an Alpha sick person. On the other hand, I've heard Omega calls dispatched with ALS because it's dispatch discretion to add them on. 

There has to be some form of priority dispatching to allow tiered response, but I do wish it could be implemented more effectively. Honestly, I don't think the average caller understands the definition of "alert" or "normal breathing" as it's presented by the call takers. Heck, we had a call the other day dispatched as a fever that was actually an unresponsive male with agonal respirations. There's no accounting for what people report on the phone.


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## EMDispatch (Apr 26, 2013)

chaz90 said:


> That's the PMD system though. I don't agree with all of it either, but it doesn't leave room for dispatcher interpretation to downgrade calls. Thus, you have "not alert" calls with 102 year old demented patients dispatched as Deltas from nursing homes and a 50 year male who faints dispatched as an Alpha sick person. On the other hand, I've heard Omega calls dispatched with ALS because it's dispatch discretion to add them on.
> 
> There has to be some form of priority dispatching to allow tiered response, but I do wish it could be implemented more effectively. Honestly, I don't think the average caller understands the definition of "alert" or "normal breathing" as it's presented by the call takers. Heck, we had a call the other day dispatched as a fever that was actually an unresponsive male with agonal respirations. There's no accounting for what people report on the phone.



EMD is a system that only works great in ideal conditions. Unfortunately no caller, not even a skilled medical provider will provide an ideal set of circumstances. We just have to role with the punches, and stick to our limited guidelines. We're flying blind every time we take the call, so everything we have is setup to assume the worse case scenario until proven otherwise.


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## NomadicMedic (Apr 26, 2013)

Okay, we got a little far off topic here. Let's try to get back to the King County recruitment video.


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## Common Sense (Apr 26, 2013)

terrible one said:


> Cool video thanks for sharing. Question what's with all the bullet proof vests?



The paramedics are required to wear their vests on all shooting and stabbings.  They just happened to be filming during 2 shootings.



Rocketmedic40 said:


> KCM1, Im sorry, but that does not look like anything other than Kool-Aid. Aside from ensuring that most of your patients who could benefit from ALS never see a paramedic, your own video showcases 1989's finest patient care, touts the ability to perform highly controversial techniques with little proven clinical value and emphasizes rote learning over education.
> 
> I do think the Harborview educational model is superior, but the KCM1 system looks like a horrible one to have anything other than a cardiac arrest in.



I missed where in the video it shows that "most of your patients who could benefit from ALS never see a paramedic".  Could you please point it out.  I would like to review it.  I looked at the video a couple of times and still could not find it.

I also think that making a blanket statment that "the KCM1 system looks like a horrible one to have anything other than a cardiac arrest in" is a bit strong.  Even if you disagree with everything in this video reguarding patient care, it only show a couple of contacts.  I am not sure how this video justifies your statement. Unless you spent time in the system then I would submit my humble appology.



MrJones said:


> Agreed. I'd rather work in a system that wants people who understand the science behind what they're doing and speak up when the "orders" don't make sense or aren't in the patient's best interests.
> 
> On a side note, I'm guessing that this thread isn't moving in the direction that KingCountyMedic expected..... :unsure:



In the King County system you are driven by science.  There is no set of protocals to follow.  Every patient is different and therefore the ability to think on your own is paramount.  They do "question orders" that do not make sense or are not in the patient's best interest.  The statement that Dr Copass made is in reguards to training.  When you begin training, you are there to learn.  Just because you spent "x" number of years as an EMT, you really don't know how to treat sick people.  You may have been treating patients a certain way as an EMT, but during paramedic training, you are learning a whole different way.



DEmedic said:


> Let's be honest, King County medic one has a fantastic promotional machine that continually churns out material. That's not to say that they're not a good system. But when you start believing your own press releases, there's a problem.



The last time I look at the King County Medic One Org. chart, I did not see a "promotions machine" person listed.  There is a lot of published studies that come out of that county, and I think that many people view that as a "promotional machine".  I look at it as a way to improve care for the sick and injured.  This video and maybe two others are the only ones that I have seen that have any hint of a "promotional machine".  Just my opinion.



Rocketmedic40 said:


> Lets see...I saw plenty of ineffective manual compressions, gastric distension, questionable invasive venous access, old equipment lacking power cots and autopulses, a tiered system discussing how low-priority calls are turfed with no further discussion of them and an educational system that seems to be first-rate until you realize that it boils down to thirty-five years of tradition unimpeded by progress.
> 
> Why would I move there?



I would like to know how you can tell the difference between effective and ineffective CPR by watching a video that shows only a few compressions.  I am sure that you did not have the capability to feel for a femoral pulse, or have a chance to look at end tidal CO2 (which is now the standard for quality CPR via the AHA) while watching this video.  But you can still make this statement.  WOW.  What do you mean by "turfed".  I can understand a system that utilizes BLS crews for non-emergent transports.  I don't think that is turfing a patient, I think that it is a good use of additional resources.  Again, my opion.  I would also like to add  "it is thirty-five years of tradition unimpeded by unscientific fads".


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## NomadicMedic (Apr 26, 2013)

As you'll notice, I've combined your posts into one for the sake of clarity. In the future, a single post, multi quoting the relevant items to which you're responding, would be appreciated.

Also, do you have any experience with the Medic One system? Are you perhaps an EMT in King County?


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## Common Sense (Apr 26, 2013)

DEmedic said:


> As you'll notice, I've combined your posts into one for the sake of clarity. In the future, a single post, multi quoting the relevant items to which you're responding, would be appreciated.
> 
> Also, do you have any experience with the Medic One system? Are you perhaps an EMT in King County?



My appologies for all of the single posts, I am new to the forum and not quite up on multiple posts/replies.  Thanks for the note.


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## VFlutter (Apr 26, 2013)

Common Sense said:


> In the King County system you are driven by science.  There is no set of protocals to follow.  Every patient is different and therefore the ability to think on your own is paramount.




So King County has no protocols?  That sounds like practicing medicine without a medical license. 

If King County is "driven by science" then why do they place central lines in the field without sterile precautions when IO access is faster, just as effective, and has substantially less risks. Or RSI but not use NIPPV. Etc, etc 

Like others have said King County seems to do a lot of stuff well but their Medics are not omnipotent like some try to make them out to be.



Common Sense said:


> I would like to know how you can tell the difference between effective  and ineffective CPR by watching a video that shows only a few  compressions.  I am sure that you did not have the capability to feel  for a femoral pulse, or have a chance to look at end tidal CO2 (which is  now the standard for quality CPR via the AHA) while watching this  video.  But you can still make this statement.  WOW.



Seriously? If I walk into a code I can immediately tell if the compressions a person is doing are effective or not without ever feeling a pulse or looking at ETCO2. I am also usually lucky enough to have an arterial waveform to confirm my suspicions.  

Here is a decent video showing the difference in compressions on a morbidly obese patient. 
https://www.youtube.com/watch?v=r8AcE__B3c0


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## NomadicMedic (Apr 26, 2013)

This look like a protocol to me. It even says it at the top of the page!


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## RocketMedic (Apr 26, 2013)

Common Sense said:


> The paramedics are required to wear their vests on all shooting and stabbings.  They just happened to be filming during 2 shootings.
> 
> *Fair enough, does KCM1 have any other crew safeties?*
> 
> ...



Turfed = placing patients who only need pain meds or palliation of nausea, or who are noncritical, to BLS. Once again, we have reports that KCM1 sometimes pulls lines and sends in BLS patients post-ALS. Many on this board think that that practice is retarded. 

Your video is long on hype and short on substance. What are your pay scales, internal options, etc like? Where are cpap, power cots and automatic compression devices?


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## KingCountyMedic (Apr 27, 2013)

It seems many of you will never be satisfied with anything, you love to argue and trash talk for the sake of doing it. I am baffled at the off topic BS and general behavior of many people on here when it comes to anything having to do with Seattle/King County. We have never claimed to be perfect. We do a few things much better than anyone else in the world and we have proven that beyond a doubt. We as Paramedics are a small piece of the pie when it comes to what we do in our system. Without the support of the medical community, the public, our citizens and our BLS providers, both public and private we would have nothing as special as our current system as it stands. You don't like the fact we do central lines in the field? I don't give a :censored::censored::censored::censored:! I have hundreds of Physicians all over King County that support what we do in the field 100% If your program had a bunch of involved, dedicated physicians tell you tomorrow, "we want you guys to triple your time in training and we want you trained in placing central lines in the field, we want you running less calls and we want you seeing the truly sick patients and we will give you the ability to really make a difference and save lives" are you going to say no??? I don't see any other threads on this forum that go sideways like this. The "mods" shut down stuff every day but I see many of these "mods" like to jump in on King County bashing so that would explain why they let it go on. How professional! I have tried to give information when I can, I have tried to be civil. I realize that even this post will draw nothing but more attacks from the internet medics and I'll sleep just fine tonight. You have the general means to apply for our program if you care to do so. Like I have said before, ANYONE is welcome to come ride with us anytime. I didn't create this system in King County, I just applied, tested, and worked my *** off to get a job here. Best thing I ever did. PEACE!


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## Aidey (Apr 27, 2013)

All those threads that go sideways are the ones "the mods" close. As I  have now closed this one. This is a recruitment video, and people are going to be curious and ask questions about the system. The conversation here was quite constructive,  with a lot of good questions and discussion by our members. If you chose to see that as  "bashing" so be it. If you have an issue with a specific person or  post, please report it.


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