Advice on new job i just started

[04_edge]

So I started my my first job in EMS today, its for an IFT company doing mainly dialysis transports. The people are great, and the pay is ok i guess, i should be making 13/hour after training, and ill be working on a 24 hour truck after I finish training. My problem is, after talking to some of the people, this seems like WAY too easy of a place to work. One of the medics I talked to today said they have only given one drug in the 7 months that theyve been there, and that was albuterol. We also put a pt on the monitor and I was told that was more then they usually do.

I guess my question is, is some experience better then no experience? Or should I just work here in the meantime until I find something better?

I am by no means wanting to push drugs constantly and do all kinds of invasive stuff all the time, but it seems as if there isnt going to be a challenge at all here..

 

[m0nster986]

You work for an IFT company, what else were you hoping for?...

It's not all bad, I heard you may get an opportunity to master your patient assessments, diagnosis, and care. Just don't hope for any trauma, drug administration, or something that makes your rear pucker.

 

[Death_By_Sexy]

I did a lot of IFTs my first year as a Basic, and I agree it can be a huge help with patient communication, assessment, etc.

That being said, it's called "Emergency" Medical Technician for a reason. I know I wouldn't be happy with myself only doing transfers.

My advice is to keep your job for while, get what you can out of it, learn as much as possible. Then, in a year with some experience, take what you've learned and move on. There's 911 jobs out there, trust me.

 

[04_edge]

Basically what I was wondering is if i will actually get any valuable experience in a place like this, and yall answered that, thanks.

 

[JPINFV]

That being said, it's called "Emergency" Medical Technician for a reason.

 

[18G]

Having many years as a 911 provider and now doing IFT, don't dismiss the IFT experience!

Speaking for myself, doing IFT is VERY valuable and allows for a lot of growth as a Paramedic. It exposes you to things that most 911 Medics will never get exposed to.

It's nice to have a patient diagnosis, receive a detailed report from the nurse or physician, ask them questions one on one, and correlate your exam to the diagnosis already known. It truly does help build your assessment skills, increase your knowledge, and make you a better provider.

Where I work, IFT Medics are allowed to do more than 911 Medics. We transport blood products and other drip medications that are not permitted as 911.

For example...
I had an IFT the other day from a small ED going to a larger Medical Center. Patient presented to the ED in DKA with a BGL of 817mg/dl, profound dehydration, and elevated potassium of 5.5. Patient also had the commonly experienced DKA symptoms of N&V and weakness.

You would expect to see a DKA patient with a lowered potassium due to loss through diuresis and insulin therapy. This patient was very volume depleted and was having some renal failure as a result which caused the potassium to be increased instead.

While straight forward it is a case encountered in IFT that helps illustrate the disease processes and complications rather than the protocol driven approach in a lot of places. It makes you think and put your education to use. In the field we would never have known the potassium was 5.5.

I would recommend working as a 911 provider part-time somewhere though just so you can keep up on your IV skills, intubation, and working in that environment too.

 

[usalsfyre]

The most challenging patients I have taken care of in my career have been IFTs. Take a vented post-arrest patient on three pressors who's so preload dependent slowing the fluid down tanks their pressure on an hour long road trip and then tell me IFT is too easy...

That said, the dialysis derby is something that usually only requires a strong back. Don't expect a lot of intelectual challenges. Get what you need out of it, and move on.

 

[usalsfyre]

For example...
I had an IFT the other day from a small ED going to a larger Medical Center. Patient presented to the ED in DKA with a BGL of 817mg/dl, profound dehydration, and elevated potassium of 5.5. Patient also had the commonly experienced DKA symptoms of N&V and weakness.

You would expect to see a DKA patient with a lowered potassium due to loss through diuresis and insulin therapy. This patient was very volume depleted and was having some renal failure as a result which caused the potassium to be increased instead.

Just a quick, off topic word here. You should fully expect hyperkalemia with any type of acidosis. However it's what's known as a relative hyperkalemia, and although it can cause the same issues as any other hyperkalemia, it can also cause serious HYPOkalemia issues as the acidosis is corrected. As pH goes down, extracellular K+ goes up (for every 0.1 change in pH, K+ moves the opposite direction 0.08) in the bodies attempt to balance out H+. Keep in mind your body is still going to be dumping the excess extracellular potassium, but once the acidosis is corrected the K+ is going back into the cell...without being replenished.

Depending on how acidotic he was, I would wager to say 5.5 stood a fair chance of being hypokalemic. Insulin therapy eats up K+ anyway (as you noted), and once you start correcting the acidosis it's going to drive the K+ even further down. 5.5 is the high side of normal anyway, not leaving a lot of room for correction. I would be EXTREMELY alert for signs of ventricular irritability from hypokalemia if his DKA was being actively treated enroute.

Sorry to stray off-topic.

 

[04_edge]

The most challenging patients I have taken care of in my career have been IFTs. Take a vented post-arrest patient on three pressors who's so preload dependent slowing the fluid down tanks their pressure on an hour long road trip and then tell me IFT is too easy...

That said, the dialysis derby is something that usually only requires a strong back. Don't expect a lot of intelectual challenges. Get what you need out of it, and move on.

Unfortunately thats what this company basically is. They are currently trying to get some contracts with hospitals, but as of now 95% of what they are doing is dialysis transports. I am one of only 3 Medics that work there, and I believe i will be the only Full-time one. The company seems to be growing, and i think has potential, but i believe it will be quite a while before they become something more then a dialysis taxi...

 

[18G]

Depending on how acidotic he was.

pH was 7.2 and patient was being actively treated enroute. Pt. was on third liter of NSS running wide and was bolused with IV and SQ insulin just prior to departing (insulin infusion is one were not allowed to take.) BGL was 560mg/dL during transfer.

Pt. did have a diagnosis of acute renal failure. And agreed, acidosis does cause K+ shift and hyperkalemia. With DKA you can see both... with this patients ARF dx the 5.5 k+ was attributed to that as well. Thanks for expanding on that.

 

[Death_By_Sexy]

New here, but not to EMS.

I obviously am aware of the truth that most patients don't require critical and immediate care, and many will live or die with no outside help from any EMT or Medic.

That said, you can't deny that people get into this profession to care for people with acute injuries and illnesses, not to take the elderly to hemodialysis.

 

[JPINFV]

That said, you can't deny that people get into this profession to care for people with acute injuries and illnesses, not to take the elderly to hemodialysis.

If you're in Orange County or Los Angeles, there's very little difference between being a stretcher fetcher for dialysis clinics and stretcher fetchers for the fire department.

 

[Death_By_Sexy]

If you're in Orange County or Los Angeles, there's very little difference between being a stretcher fetcher for dialysis clinics and stretcher fetchers for the fire department.

I don't know if you're trying to be derisive towards me, but yes, I agree completely. I worked in a rural, first-in EMS setting before coming to SoCal, and down here might as well be a completely different profession. The main reason why as soon as I'm done with school I'm out of here.

 

[JPINFV]

I believe you're mistaking derisive with tongue in cheek.