A neat call last night, I want your advice

[HotelCo]

Sounds like you did a great job. Excellent assesment skills. It's a good thing that you went and re-checked the pupils. Not enough people do that. That definetly saved some brain matter.

 

[mycrofft]

Show off...Advice indeed!


Ask about facial pain if there is a recurrent or recent droop (Bell's Palsy), and be cautious with all that fluid if you think cardiac insufficiency. Well-played down the middle of the course, and good on you for not giving ASA as a knee jerk, since it might worsen a bleed.

 

[Ms.Medic]

Ask about facial pain if there is a recurrent or recent droop (Bell's Palsy), and be cautious with all that fluid if you think cardiac insufficiency. Well-played down the middle of the course, and good on you for not giving ASA as a knee jerk, since it might worsen a bleed.

Oooh, nice. I didnt even think about the asa situation (not giving it for the chest pain). Yeah, I guess Im glad that wasnt givin huh.

 

[Melbourne MICA]

Mixed crewing

Yes, I was riding being observed by a senior paramedic for our service. So basically a senior paramedic watches and doesnt get involved to see if Im ready to be cut loose to ride by myself.

The hospital is a level 1 in downtown Houston

Thanks. I take it a level 1 facility is top notch and can well manage a stroke pt.

But do you have mixed crewing? ie one EMT-B and one EMT-P and is that standard for your county/region/state? The reason I ask is because crewing is the latest target of many services looking to cut corners and at the same time sell reduced services (in overall quality) but expanded (because they can claim they have "more").

Here in Melbourne our elite staff were so badly managed that they left in droves over recent years to the point where our management (and government) are now going to sell a (mostly -about 65% of the total) ALS single responder system as the equivalent or better of the system we had.

By splitting the crews they now have twice as many staff for the same number of rostered shifts. A very neat trick and one many services are now pawning onto an unsuspecting public.

I see there have been many threads on this and other forums about the subject.

(Sorry for the political distraction) and once again well done and enjoy.

PS Wait till you do a pediatric arrest as the top gun and watch that old sphincter tighten up!!!!

MM

 

[Melbourne MICA]

"Well-played down the middle of the course".

Nice turn of phrase mycroft and very appropriate as a descriptor for a management approach - I'll remember it.

MM

 

[emtfarva]

She said I did awesome, but that I should delegate to my basic a little more. I was trying to do everything myself, and that I was doing things a little disorganized due to that. But overall, a good job.

If you had a great basic, you wouldn't have to delegate, it would have been done. When you are on a truck with a regular partner you will learn what to expect from your basic. Right now you are riding third, when you are by yourself you will be better off. Plus you can mold your basic to the way you want him/her. My partner and I review each call after. It works, because I learned over a few calls what she wanted done while in the back of the truck, also we review while driving to the call. I don't know if this will help. I always drive, so my partner has time to read our protocols before we get there too.

 

[Ms.Medic]

If you had a great basic, you wouldn't have to delegate, it would have been done. When you are on a truck with a regular partner you will learn what to expect from your basic. Right now you are riding third, when you are by yourself you will be better off. Plus you can mold your basic to the way you want him/her. My partner and I review each call after. It works, because I learned over a few calls what she wanted done while in the back of the truck, also we review while driving to the call. I don't know if this will help. I always drive, so my partner has time to read our protocols before we get there too.

Its not that we had a "bad basic", she is one of our very best, whos been in the service for 14 years. I just tried doing it all myself, I guess "delegate" was in some ways the wrong term to use.
For myself, its very hard trying to transition from basic to paramedic, when Ive been doing the basic for so long. I think what she meant was let them do their job/skills, and that way I can focus on mine as "paramedic role". I know we're supposed to focus on "basic first" even as a paramedic, but in some ways thats what I have her there for. If Im trying to do ALL of the basic stuff, theres nothing getting my partner involved to build that trust with each other, as well as getting them involved on calls.
I need to learn to work extremely well with my basic partner, and not leave them out in the wind, while I try to do every single thing, from holding c-spine down to bgl.
Thank you guys for all of the input, as I go over it, its reminding me of a few things.

 

[8jimi8]

could you give me an example of things that your preceptor was thinking you should have delegated? Other than c-spine and BG? I'm just curious what you were doing that excluded your partner?

i understand the scope of the basic, but are you talking about things like vitals, while you performed your assessment?

 

[Ms.Medic]

could you give me an example of things that your preceptor was thinking you should have delegated? Other than c-spine and BG? I'm just curious what you were doing that excluded your partner?

i understand the scope of the basic, but are you talking about things like vitals, while you performed your assessment?

yes, exactly, along with trying to gather info, get the meds from family, talk on the radio, etc.
And no, we did not hold cspine on this patient, I was just giving an example.

 

[8jimi8]

ahh thanks! that makes sense. No worries! You will get your routine down and streamline everything. You have already gotten great assessments down, that is your cornerstone!

 

[tydek07]

Now that is a cool call, to be able to see it happening right in front of you! I have had a lot of CVA pts, but can count on one hand how many of those got to the ER in time for treatment. Most of the time its too late, so its always nice to have the couple you come across in time... but seeing it happening in front of you, now that is just awesome!

Good Job!,
tydek

 

[maxwell]

This is why we do what we do.
In the future (or you may have done this, just not written it)
-Did you take your drugs today? (Should you have)?
-Ask the family if he's been weird/how long he's been weirder than normal?
-12 Lead ecg: were there neuro T's?
-Start the lytic checklist? (even though you wouldnt need it)
Nice work!

 

[bonedog]

Thanks. I take it a level 1 facility is top notch and can well manage a stroke pt.

But do you have mixed crewing? ie one EMT-B and one EMT-P and is that standard for your county/region/state? The reason I ask is because crewing is the latest target of many services looking to cut corners and at the same time sell reduced services (in overall quality) but expanded (because they can claim they have "more").

Here in Melbourne our elite staff were so badly managed that they left in droves over recent years to the point where our management (and government) are now going to sell a (mostly -about 65% of the total) ALS single responder system as the equivalent or better of the system we had.

By splitting the crews they now have twice as many staff for the same number of rostered shifts. A very neat trick and one many services are now pawning onto an unsuspecting public.

I see there have been many threads on this and other forums about the subject.

(Sorry for the political distraction) and once again well done and enjoy.

PS Wait till you do a pediatric arrest as the top gun and watch that old sphincter tighten up!!!!

MM

Hate to see this bean counter application to our form of medicine.
WE were a targeted paired system, however with MPDS, target's are hard to see. ( used to be they used basic's trained to dispatch and multitask, now they follow the cards and use the stunned closed ended questions that wouldn't be tolerated on car, consequently dispatched as rarely meets diagnosed as)
Pairing in my neck of the woods is fairly consistent, however, part of my province has gone to a nurse/medic trial.

Sorry for the hijack Ms.M. Sounds like you did a good call. Learning to delegate is an intregal part of the job, which will make life easier, once perfected. (knowing the partner is paramount so you know when and what to delegate)

 

[nmasi]

How far is your transport time to a stroke facility?

I'm in the same position as you, we fly anything critical to Hermann or Taub.

I'm down in League City.

 

[Flight-LP]

How far is your transport time to a stroke facility?

I'm in the same position as you, we fly anything critical to Hermann or Taub.

I'm down in League City.

You are aware that Ben Taub does not have a helipad?!? Patients flying into BT have to land at Hobby and are then ground transported by HFD to the ED. Not the most effective method by any means.

Also, that would be the LAST hospital I ever took a CVA to. Hermann, Methodist, or St. Lukes are all preferred stroke receiving facilities.

Do you routinely fly CVA pts.?

 

[nmasi]

Ya, that was supposed to say Methodist...I was on the phone with someone talking about BT. My mistake.

Flying a CVA is something that happens some of the times but not all, depends on what the circumstances are. The transport time by ground to one of those facilities from our area is atrocious with construction and traffic so we fly a bit more than services that are closer and or have more efficient access to the medical center.

 

[Melclin]

Thanks. I take it a level 1 facility is top notch and can well manage a stroke pt.

But do you have mixed crewing? ie one EMT-B and one EMT-P and is that standard for your county/region/state? The reason I ask is because crewing is the latest target of many services looking to cut corners and at the same time sell reduced services (in overall quality) but expanded (because they can claim they have "more").

Here in Melbourne our elite staff were so badly managed that they left in droves over recent years to the point where our management (and government) are now going to sell a (mostly -about 65% of the total) ALS single responder system as the equivalent or better of the system we had.

By splitting the crews they now have twice as many staff for the same number of rostered shifts. A very neat trick and one many services are now pawning onto an unsuspecting public.

I see there have been many threads on this and other forums about the subject.

(Sorry for the political distraction) and once again well done and enjoy.

PS Wait till you do a pediatric arrest as the top gun and watch that old sphincter tighten up!!!!

MM

Melb, when you say ALS single responder, are you talking about the MICA singles or is there some new hair-brained scheme I haven't heard about, to have ALS singles as well?

Also, out of interest (I live in Melb), which MICA van are you on? If you don't mind sharing in a public forum.

 

[Melbourne MICA]

Melb, when you say ALS single responder, are you talking about the MICA singles or is there some new hair-brained scheme I haven't heard about, to have ALS singles as well?

Also, out of interest (I live in Melb), which MICA van are you on? If you don't mind sharing in a public forum.

I'm on Z2 at the Alfred

As regards you're query, the problem is in the non - transferable job descriptions.

"Paramedic" in Australia now refers to any ambo as you know. In the US a "Paramedic" is an EMT-P - one of their highest levels roughly equivalent to our MICA types.

"ALS" in Australia is the skill set our "Paramedics" now have - (remember not all our Paras (normal ambos) are signed off as "ALS" - its a skillset.

In the US their highest skill-sets are roughly described as "ALS". It is also the skill level applied to certain types of clinical situations - but may not reflect the skill-set of those attending the patient. (At this point, corrections by some of my US EMT-Life friends are welcome if I have my definitions wrong)

Confused? I am and I wrote it - thanks to the ambos in Australia who pushed for our name changes!!!).

Therefore I am referring to "ALS" single responders in the context of US EMS services in the same way as our MICA single responders.

Hope that clears it up.

PS There are many regional and state/private sector service variations but from what I gather there is roughly three general classifications of skill-set in the US.

EMT-B (Basic)
EMT-I (Intermediate)
EMT-P (Paramedic)

Once again I'm sure our local people here will tidy up my suppositions.

Cheers

PPS Do you like the forum? The boys and girls can get fired up at times but they're all pretty good types from my experience.

MM

 

[Melbourne MICA]

Hate to see this bean counter application to our form of medicine.
WE were a targeted paired system, however with MPDS, target's are hard to see. ( used to be they used basic's trained to dispatch and multitask, now they follow the cards and use the stunned closed ended questions that wouldn't be tolerated on car, consequently dispatched as rarely meets diagnosed as)
Pairing in my neck of the woods is fairly consistent, however, part of my province has gone to a nurse/medic trial.

Sorry for the hijack Ms.M. Sounds like you did a good call. Learning to delegate is an intregal part of the job, which will make life easier, once perfected. (knowing the partner is paramount so you know when and what to delegate)

I agree totally. Our system has always been two tiered with a kind of intermediate level skillset as the "normal" ambos and our ALS MICA types as the second tier - supposedly to attend to time critical pts only. Not now.
Johnny on the spot, AMPDS, closest car, response times etc. You guys have suffered just as much from what I read and here.

Cheers bonedog

MM

 

[Melclin]

I'm on Z2 at the Alfred

As regards you're query, the problem is in the non - transferable job descriptions.

"Paramedic" in Australia now refers to any ambo as you know. In the US a "Paramedic" is an EMT-P - one of their highest levels roughly equivalent to our MICA types.

"ALS" in Australia is the skill set our "Paramedics" now have - (remember not all our Paras (normal ambos) are signed off as "ALS" - its a skillset.

In the US their highest skill-sets are roughly described as "ALS". It is also the skill level applied to certain types of clinical situations - but may not reflect the skill-set of those attending the patient. (At this point, corrections by some of my US EMT-Life friends are welcome if I have my definitions wrong)

Confused? I am and I wrote it - thanks to the ambos in Australia who pushed for our name changes!!!).

Therefore I am referring to "ALS" single responders in the context of US EMS services in the same way as our MICA single responders.

Hope that clears it up.

PS There are many regional and state/private sector service variations but from what I gather there is roughly three general classifications of skill-set in the US.

EMT-B (Basic)
EMT-I (Intermediate)
EMT-P (Paramedic)

Once again I'm sure our local people here will tidy up my suppositions.

Cheers

PPS Do you like the forum? The boys and girls can get fired up at times but they're all pretty good types from my experience.

MM

Ah, small world. I was there last Thursday at the JEPHC symposium.

Yeah I understand. I can't say I agree with much about the American emergency health system. Not to insult anyone's ability, but I'm glad there's a MICA van 5 mins from my house and not a fire fighter with an AED. That sounds really harsh, I'm not having a go at fireies, but you know what I mean.

Yeah I really like this forum. Esp the case study type posts, and posts with interesting ECGs. And everyone is very helpful and knowledgeable.