How to buff calls in NYC?

[Chewy20]

lol, so many misconceptions in these posts here.

You do not just get hired by a 911 service in this city. It just doesn't happen. 911 experience with the vollies is usually a big factor in decisions, whether getting in to fdny or with the 911 hospital agencies. And a lot of paid workers show up to help up newbies like OP so that they don't go too far off the track.
And while I agree that you do learn a lot doing ift, you're still lose something from not being in an actual pressure situation ever.

So what "pressure situation" would you encounter on a BLS IFT truck?

 

[squirrel15]

So what "pressure situation" would you encounter on a BLS IFT truck?

A code brown after a taco bell lunch while transporting long distance

 

[sirengirl]

And while I agree that you do learn a lot doing ift, you're still lose something from not being in an actual pressure situation ever.

I agree with this. What he is trying to say is IFT world and 911 world are very different. I learn/ed a lot at my 8 months/continuing PT gig at IFT, but when I started at 911 it was like being sent back to school. IFT causes you to lose your sense of urgency, your snap-decision making skills, your pressure to get things done. IFT is so routine that a lot of the time I see providers who have to ask me to verify their manual BPs and lung sounds. I started 3 IVs in 8 months of full time IFT work, and now as a part timer there are medics there who have been there so long and are so far removed from the emergency game that they will literally ask me to perform the ivs and all the"advanced" interventions because they're rusty and are honestly afraid to do it themselves. So yes, I agree that there is something to be learned from IFT, but there is also something to be lost, which is why I always encourage either working in an ER (hand on critical patients and some of your skills get used there), or volunteering- but doing so the right way.

 

[akflightmedic]

I would like to pick apart your post and offer a different perspective and what I say is with respect to you, not to slam you in any way. If none of this applies to your particular situation, it may very well apply to others. (like the disclaimer?)

I agree with this. What he is trying to say is IFT world and 911 world are very different. I learn/ed a lot at my 8 months/continuing PT gig at IFT, but when I started at 911 it was like being sent back to school.

I disagree. Both gigs are about assessing, treating if required and transporting. I know IFT has less treatment required and is more of a taxi service, I get that. But as you know, you can do and learn a lot at a higher level than you do in Emergency. You can build essential life skills or make weak skills stronger during the course of IFT and not even realize it. I have spoken about this before and it is a shame so many overlook it in our field. I am talking about developing a sense of empathy (not everyone has this ya know), social skills, knowing how to build rapport, manage difficult patients (even personality wise), how to document properly and more thoroughly, on and on. These skills have extreme value which may not provide obvious returns until years later.

I equate this to when we lose weight. Sure we see some of it sometimes but if we do it slowly, the proper way...we do not really see our selves reshaping that drastically, right? But then when you bump into someone you have not seen in a couple months or longer, they are ecstatic, cause to them, the change is obvious and drastic.

Well this is the same in all those important skills I wrote above. You think you are not developing and refining them, but one day down the road, you will have that surreal moment, that epiphany when you self check and say "wow, I am pretty good at this". Your colleagues will have noticed, but the newbies...they will be coming to you for your wisdom, advice and respect your experience based on how you conduct yourself day to day. And you will think again...When did I grow up? How did this happen?

IFT causes you to lose your sense of urgency, your snap-decision making skills, your pressure to get things done.

Sorry, I call BS on this one. I am never "pressured" to get things done. Pressure is not part of the equation. Education is what builds confidence. And when an assessment shows something needs to be done, we do it. In a calm, methodical method. Being pressured will lead to mistakes. It is not we do not care, we know time is SOMETIMES a factor, but the reality is the majority of interventions we perform or "snap decisions" are really not all that urgent. They can and could wait. You only get this if you have the knowledge.

I spoke before about skills. Skills can be taught to anyone. The actual performance of the skill is muscle memory. That comes with repeated attempts and eventually we get to the point where we can do it without thinking much about it. However, knowing WHY the skill is actually needed, unfortunately that skips many providers. They do it simply because they can or "it doesn't hurt anyways" or there is a very basic mental checklist which dictates they should.

Again, knowledge will build confidence. In my little bubble of the world and my perspective of experience (which is quite varied actually), I have yet to see anyone simply falter with a sense or urgency due to being out of the game. I have had medics return after YEARS ad climb right back on that bike.

IFT is so routine that a lot of the time I see providers who have to ask me to verify their manual BPs and lung sounds.

Routine = Boring? I am unsure why the verification would be needed on those things, especially for routine work, however they could simply be putting you to work..? Kind of shut up and get out of my hair. LOL Why are so many of them defaulting to you for verification? Are they that poor of a medic or is this another EMT asking? Maybe they do not know what they are hearing and are doubting themselves...again that knowledge breeds confidence. They lack both and maybe you display more of it, so they get confirmation that what thy heard is nothing to worry about. Sadly in these situations, there is a lost teaching moment.

I started 3 IVs in 8 months of full time IFT work, and now as a part timer there are medics there who have been there so long and are so far removed from the emergency game that they will literally ask me to perform the ivs and all the"advanced" interventions because they're rusty and are honestly afraid to do it themselves.

Laziness of the provider cloaked in they are allowing it for your own good. I am guilty of this. There were times when I was in a funk and just "cruising along". And if I got an eager partner who seemed competent and capable....I would let them run as far as the leash would take them, until I had to choke it up a little. I had no issue saying, "hey that looks like a difficult stick, you want to try first?"

It kept my partner busy, it was training for them as I felt I did not need it, and what is the harm, right? It never really was a case of being so far removed and being unable to do an IV, it was a case of being lazy. Lazy in the sense that those things do not bring the same "high" or challenge that they once did. We do our jobs, but the glory moments are sparse. Yes, there is an ego in all that we do, it is normal.

You sound excited and eager...I would do the same for you. Run Forest, run...

So yes, I agree that there is something to be learned from IFT, but there is also something to be lost, which is why I always encourage either working in an ER (hand on critical patients and some of your skills get used there), or volunteering- but doing so the right way.

I agree. There is lots to learn in both. But I disagree on there being something to lose. That is only the case if you allow it...a self fulfilling prophecy if you will. This is why attitudes in IFT are so challenging. It is filled with a lot of EMTs and Medics who do not want to be there. It is a job but it is not The Job. But if you bring that negativity to the job, even if it is a little tiny seed in back of the brain...and you allow it to slowly grow, it will consume you, you will hate your job and be very unhappy. Then comes worse or low productivity, then comes moving on...

 

[graycord]

So what "pressure situation" would you encounter on a BLS IFT truck?

In my experience, it has mostly been when things inside of a dialysis or nursing facility start to turn bad and you are literally in the right place at the right time.

I agree with this. What he is trying to say is IFT world and 911 world are very different. I learn/ed a lot at my 8 months/continuing PT gig at IFT, but when I started at 911 it was like being sent back to school. IFT causes you to lose your sense of urgency, your snap-decision making skills, your pressure to get things done. IFT is so routine that a lot of the time I see providers who have to ask me to verify their manual BPs and lung sounds. I started 3 IVs in 8 months of full time IFT work, and now as a part timer there are medics there who have been there so long and are so far removed from the emergency game that they will literally ask me to perform the ivs and all the"advanced" interventions because they're rusty and are honestly afraid to do it themselves. So yes, I agree that there is something to be learned from IFT, but there is also something to be lost, which is why I always encourage either working in an ER (hand on critical patients and some of your skills get used there), or volunteering- but doing so the right way.

---

Sorry, I call BS on this one. I am never "pressured" to get things done. Pressure is not part of the equation. Education is what builds confidence. And when an assessment shows something needs to be done, we do it. In a calm, methodical method.

I disagree. To me, education builds knowledge. And repetition builds confidence. In this crowded city where potential flag downs are literally everywhere, I've heard of more than a few instances where a bls ift crew stumbles upon a scene and freak out in a situation because their daily routine is just so different.

 

[NightHealer865]

Running emergency traffic to call you weren't dispatched on? What happens when you hit someone running emergency traffic and kill someone? I'm the prosecution would eat you alive. People tend to use emergency traffic was to liberally.

 

[triemal04]

In my experience, it has mostly been when things inside of a dialysis or nursing facility start to turn bad and you are literally in the right place at the right time.

So there is a lot of pressure involved in picking up the radio and saying "we need a paramedic at this location"? Or calling 911 and doing the same? Or, if you are the thinking type, just beating feet for the nearest appropriate ER if that is faster than waiting for a paramedic? Sorry, not seeing a lot of pressure here.

Let's be honest. At the EMT level there is very, very little that you are going to be doing for someone when things "start to turn bad." So what is there to get worked up over? You do your job, which is to either a) call for the appropriate resources, or b) get the patient to those appropriate resources.

 

[adamNYC]

In IFT/Txp I can say I was privileged to encounter quite a few flag downs including MVAs, ped struck, and a Cardiac arrest. In our private ambulance we do respond to emergencies with L&S at docs offices, assisted living, SNFs, and assist Hatzolah w/ their txp for their housejobs (mostly for the sick) I've heard of privates that mostly do dialysis and rarely run L&S i.e. Midwood, Priority1, etc. and am glad I don't work for a strictly non-emergency company.

 

[evantheEMT]

This is why I love my company I work on the transfer truck but we do both routine calls and emergencies. Just never know what the night or day will be like.

 

[LACoGurneyjockey]

Youre very limited if you think emts can do very little.

1). How long have you been doing this?
2). What are you going to do if something goes bad? O2, shock position, rapid transport? Maybe some bleeding control? CPR? Am I missing anything?

 

[evantheEMT]

1). How long have you been doing this?
2). What are you going to do if something goes bad? O2, shock position, rapid transport? Maybe some bleeding control? CPR? Am I missing anything?

"If something goes bad" like what? Difficulty breathing, dizziness? What a way to leave it wide open.

 

[LACoGurneyjockey]

"If something goes bad" like what? Difficulty breathing, dizziness? What a way to leave it wide open.

Difficulty breathing, chest pain, syncope, ALOC, tension pneumo, airway compromise, what more do you want? What are you really going to do for them? This is the point where you sit, read my response, and realize that O2, vitals, shock position, and rapid transport tends to be the end of it.

 

[Tigger]

"If something goes bad" like what? Difficulty breathing, dizziness? What a way to leave it wide open.

Does it matter? What as an EMT will you do (and me for matter) besides take the patient to the hospital? Not only do EMTs have limited education, they also have nothing to treat their findings with and potentially fix the problem. So again, what will you do?

 

[LACoGurneyjockey]

Does it matter? What as an EMT will you do (and me for matter) besides take the patient to the hospital? Not only do EMTs have limited education, they also have nothing to treat their findings with and potentially fix the problem. So again, what will you do?

"Get mad and complain about the scenario, hold off on the ALS backup because that's a waste of resources, make sure to seek out congrats at the hospital for BLSing a respiratory failure."

 

[Bullets]

"Get mad and complain about the scenario, hold off on the ALS backup because that's a waste of resources, make sure to seek out congrats at the hospital for BLSing a respiratory failure."

you forgot "Post about it on Social Media"

 

[DesertMedic66]

"Get mad and complain about the scenario, hold off on the ALS backup because that's a waste of resources, make sure to seek out congrats at the hospital for BLSing a respiratory failure."

That is something that I hate. We have had some BLS providers in my area try to brag about drips the have transported that are not in the BLS scope or even the ALS scope. That quickly ended once management found out what they were doing.

 

[RedAirplane]

Unless the vollies can staff 24/7 or two tours, why bother with the headache of trying to keep track of when they have staff and when they dont?

Since this thread appears to have been resuscitated...

I don't think it's that hard at all. A log in / log out procedure is what they used when my volunteer team and the fire department were jointly covering a large event.

Team XYZ logging in,
Team XYZ temporarily out of service,
Team XYZ logging out.

Then the main dispatch can post you where they need you.

When you log out, they go to the deployment plan for one less ambulance.

 

[DrParasite]

1). How long have you been doing this?
2). What are you going to do if something goes bad? O2, shock position, rapid transport? Maybe some bleeding control? CPR? Am I missing anything?

1) 15 years. 2) if you think a paramedic can deal with every situation that "goes bad" than you are obviously new to EMS. 3) Paramedics are great at treating many cardiac and respiratory problem but there is a huge list of things that paramedics can't do anything to fix.

 

[NomadicMedic]

1) 15 years. 2) if you think a paramedic can deal with every situation that "goes bad" than you are obviously new to EMS. 3) Paramedics are great at treating many cardiac and respiratory problem but there is a huge list of things that paramedics can't do anything to fix.

I never understood this argument. Paramedics are specifically trained to deal with the most statistically common life-threatening issues. By virtue of additional training, paramedics are better equipped and better trained to handle these emergencies.

Playing the "what if" game is simply burying your head in the sand. Yes, paramedics are great at treating cardiac and respiratory issues. They're also much better equipped to treat anaphylaxis, start treatment for sepsis, deal with hypoglycemia, hypertensive crisis, or manage an overdose, aren't they?

Tell me about the things that go wrong during a typical transport and what paramedics can't manage as or more affectively then a BLS crew?

 

[triemal04]

Tell me about the things that go wrong during a typical transport and what paramedics can't manage as or more affectively then a BLS crew?

Cue the standard response of "well this one time I saw a paramedic forget to..." or "paramedics never do..." or the oldy but goody, "OMG BLS before ALS paramedics can't BLS OMG OMG EMT's save paramedics OMG!!!!!!!!!!!"

You all know it's coming...