I really want to work for AMR

[Juarez]

Do they tell you what days you have to work or are you able to choose as a full time?

 

[DesertMedic66]

Do they tell you what days you have to work or are you able to choose as a full time?

For part time you get to choose. For full time we do what's called shift bidding. You pick a partner and add up your points. Then you place a bid on up to 3 shifts that you want. If you have been with the company for a long time then it's really good because you can literally pick what shift you want. If your fairly new to the company then you pretty much get the shifts that are left over AKA the shifts no one really wants.

 

[thisismikedee]

If responding with lights and sirens only saves a few minutes and the first responder unit from the fire department has the paramedics (since the transport ambulance is only staffed with EMTs), then there's no need for the ambulance to respond with lights and sirens since it's not needed in the first 5-10 minutes of care anyways.


The size of the ambulance is irrelevant for cardiac arrests as cardiac arrests shouldn't be transported anyways absent of ROSC or specific special circumstances.

Umm, who are you? Lol

Okay...here we go

The point of code 3 response is to get to whatever is happening right? Alright, so for example (and this is very common down in the AV since Fire Station 33 is the busiest in LA County):

Code 3 for a cardiac that just so happens to be down the street from a posting ambulance. Where I'm from it's very common that we beat FD on scene by approx 3-5 minutes. An ambulance not being able to respond code 3 to something like that can mean the difference between life and death, especially when the earlier the defib the higher chances of life. All you paramagics should look at the statistical save rates for ALS then take that number and look at what is most crucial for preservation of life, and no, it's not cardiac drugs and intubation, it's early defib and hard fast compressions (all emt skills)

Paramedics are over rated, every credible source says there is no replacement for EMT skills and rapid transport. I've loaded and gone and have met squad en route numerous times, I don't need the fire dept to replace standard protocol. Many squadies down here have even loaded pediatric drownings in their squad and have booked it wo ambulance becuz we took too long (and we respond code)

I know ur not supposed to transport pulse less, but I've had patients code on me with a medic follow up and it's hard to get all the stuff set up with minimal space. Ask any FD medic and they will tell you the space in the Care Mods is second to none

 

[Juarez]

So let's say starting out as someone new is it possible to pick your days or is it just whatever day is left?
Also if your part time can you pick up more than 40 hours?

 

[DesertMedic66]

So let's say starting out as someone new is it possible to pick your days or is it just whatever day is left?
Also if your part time can you pick up more than 40 hours?

Not really. If your part time then yes you get to pick. If your full time you pretty much get what the other employees don't want.

Yes and no. It all depends on the division and the time of the year. I know part time guys who have picked up 60+ hours per week.

 

[thisismikedee]

So let's say starting out as someone new is it possible to pick your days or is it just whatever day is left?
Also if your part time can you pick up more than 40 hours?

If you are hired on as part time at AMR you get to choose what days you work and u can work as many hours as you please so long as the overtime is available and your able to do so. Usually they don't hire as part time first, in la county AMR will hire you full time and give you the option of going part time later

 

[DesertMedic66]

If you are hired on as part time at AMR you get to choose what days you work and u can work as many hours as you please so long as the overtime is available and your able to do so. Usually they don't hire as part time first, in la county AMR will hire you full time and give you the option of going part time later

that all depends on your division. My division will only hire part time. Your FTO time will be a full time position but after that you are placed on part time. You can put in a letter to go full time but we (my division) will not hire full time.

 

[thisismikedee]

that all depends on your division. My division will only hire part time. Your FTO time will be a full time position but after that you are placed on part time. You can put in a letter to go full time but we (my division) will not hire full time.

My apologies, I assumed we were talking about the Los Angeles county division. What division are you?

Representing North Los Angeles County ops! Lol Antelope Valley station 106

 

[JPINFV]

Umm, who are you? Lol

Okay...here we go

The point of code 3 response is to get to whatever is happening right? Alright, so for example (and this is very common down in the AV since Fire Station 33 is the busiest in LA County):

Code 3 for a cardiac that just so happens to be down the street from a posting ambulance. Where I'm from it's very common that we beat FD on scene by approx 3-5 minutes. An ambulance not being able to respond code 3 to something like that can mean the difference between life and death, especially when the earlier the defib the higher chances of life. All you paramagics should look at the statistical save rates for ALS then take that number and look at what is most crucial for preservation of life, and no, it's not cardiac drugs and intubation, it's early defib and hard fast compressions (all emt skills)

If you're just down the street from a call then you won't save any time anyways. Think about it. If it takes 2 minutes to respond without lights and sirens, it's going to be, at best what? 1:45 with lights and sirens? Do you think 15 seconds is going to matter? The fact is that lights and sirens response doesn't save that much time.

Yes, compressions and defibrillation is what saves cardiac arrests. However the vast majority of calls are not cardiac arrests, nor should all calls be treated as cardiac arrests until proven otherwise. Ok, you're on scene of a chest pain patient for 5 minutes. Are you planning on intiating transport sans paramedics? Can you give acetylsalicylic acid? Nope. You can give oxygen, but the benefits of oxygen are in question to the point that the standard of care is changing away from every patient receiving a non-rebreather mask (see AHA Emergency Cardiac Care 2010 guidelines). So, instead you're going to package the patient (which still needs a 12 lead EKG to be done to determine destination and cath lab activation), and then stand around waiting for fire to show up.

Oh, and sweet! I've been promoted to paramagician? Let me put on my robe and wizard hat!.

Paramedics are over rated, every credible source says there is no replacement for EMT skills and rapid transport. I've loaded and gone and have met squad en route numerous times, I don't need the fire dept to replace standard protocol. Many squadies down here have even loaded pediatric drownings in their squad and have booked it wo ambulance becuz we took too long (and we respond code)

OPALS definitely cited benefits from paramedic level care in medical patients. Additionally, US EMS levels do not exactly match up with Canadian levels. To most of Canada, our EMT level is their first responder level. I can also cite studies that shows that transport by POV results in better outcomes for trauma patients than transport by ambulance.

Also, you can't compare pediatric drownings to a standard EMS patient.

I know ur not supposed to transport pulse less, but I've had patients code on me with a medic follow up and it's hard to get all the stuff set up with minimal space. Ask any FD medic and they will tell you the space in the Care Mods is second to none

What's more common, though, patients coding in the ambulance, or patients coding someplace outside of the ambulance. If the patient isn't in an ambulance when they go into cardiac arrest, then there's no reason to move them to the ambulance.

 

[thisismikedee]

If you're just down the street from a call then you won't save any time anyways. Think about it. If it takes 2 minutes to respond without lights and sirens, it's going to be, at best what? 1:45 with lights and sirens? Do you think 15 seconds is going to matter? The fact is that lights and sirens response doesn't save that much time.

Yes, compressions and defibrillation is what saves cardiac arrests. However the vast majority of calls are not cardiac arrests, nor should all calls be treated as cardiac arrests until proven otherwise. Ok, you're on scene of a chest pain patient for 5 minutes. Are you planning on intiating transport sans paramedics? Can you give acetylsalicylic acid? Nope. You can give oxygen, but the benefits of oxygen are in question to the point that the standard of care is changing away from every patient receiving a non-rebreather mask (see AHA Emergency Cardiac Care 2010 guidelines). So, instead you're going to package the patient (which still needs a 12 lead EKG to be done to determine destination and cath lab activation), and then stand around waiting for fire to show up.

Oh, and sweet! I've been promoted to paramagician? Let me put on my robe and wizard hat!.



OPALS definitely cited benefits from paramedic level care in medical patients. Additionally, US EMS levels do not exactly match up with Canadian levels. To most of Canada, our EMT level is their first responder level. I can also cite studies that shows that transport by POV results in better outcomes for trauma patients than transport by ambulance.

Also, you can't compare pediatric drownings to a standard EMS patient.



What's more common, though, patients coding in the ambulance, or patients coding someplace outside of the ambulance. If the patient isn't in an ambulance when they go into cardiac arrest, then there's no reason to move them to the ambulance.

Again, it's always better to assume the worst than under treat. Although my examples do not happen often, they do happen, and you never know, 15 seconds could mean the difference between life and death. I've personally seen a difference of up to 3 mintues in responding code and responding code 2. There are also many sources that are citable that show that there is a fine balance between prehospital care and hospital care. I'm sick of seeing the FD take a million years to do their 12 lead...only to find out that our possible ALOC stroke patient is NSR with no ectopics, this ruling out process takes too long and is almost always repeated at the receiving hospital anyways. Again, the need of paramedics? We don't need your epi, atro, ami. Don't care for your bicarb, or your dopamine drips. Benadryll? Yeah I agree w that. About the only thing I see use for is d50 IV, only cuz it saves me a hosptial trip. Your airways are overrated. Paramedics are constantly losing skills to legal battles and questioning of pre hosptial necessity. Again, bringing them closer to EMTs. All we are is people movers, getting to the hosptial is still of up most importance. If my squads not there and I see that rapid trans is more important I'm gonna go and I don't care, my patient is more important than a medic practicing his skills. Medics are just EMTs with needles. I'm a nursing student, and I'm glad I'm gonna just skip medic, unnecessary in 95 percent of common cases.

 

[jgmedic]

Again, it's always better to assume the worst than under treat. Although my examples do not happen often, they do happen, and you never know, 15 seconds could mean the difference between life and death. I've personally seen a difference of up to 3 mintues in responding code and responding code 2. There are also many sources that are citable that show that there is a fine balance between prehospital care and hospital care. I'm sick of seeing the FD take a million years to do their 12 lead...only to find out that our possible ALOC stroke patient is NSR with no ectopics, this ruling out process takes too long and is almost always repeated at the receiving hospital anyways. Again, the need of paramedics? We don't need your epi, atro, ami. Don't care for your bicarb, or your dopamine drips. Benadryll? Yeah I agree w that. About the only thing I see use for is d50 IV, only cuz it saves me a hosptial trip. Your airways are overrated. Paramedics are constantly losing skills to legal battles and questioning of pre hosptial necessity. Again, bringing them closer to EMTs. All we are is people movers, getting to the hosptial is still of up most importance. If my squads not there and I see that rapid trans is more important I'm gonna go and I don't care, my patient is more important than a medic practicing his skills. Medics are just EMTs with needles. I'm a nursing student, and I'm glad I'm gonna just skip medic, unnecessary in 95 percent of common cases.

Wow. 1. No, 2. You work in LACo, where paramedics are barely more than intermediates, anyways, why don't you step outside of your bubble and see the way EMS can be run in systems where mommy doesn't have to tell you what to do on every call.

 

[cstiltzcook2]

hey why don't you go p rick off on some nursing board mikedee. this is a family you are pissing on, and it doesn't look like you are trying to contribute anything positive.

 

[JPINFV]

Again, it's always better to assume the worst than under treat. Although my examples do not happen often, they do happen, and you never know, 15 seconds could mean the difference between life and death. I've personally seen a difference of up to 3 mintues in responding code and responding code 2.

15 seconds won't mean the difference between life and death. If it did, then EMS responders (including the fire department) should be forced to sit in their vehicles, engine on, ready to respond at all times. After all, how much does turnout add to the response time? Similarly, 3 minutes is highly unlikely to change the outcome either under the same reasoning.

There are also many sources that are citable that show that there is a fine balance between prehospital care and hospital care. I'm sick of seeing the FD take a million years to do their 12 lead...only to find out that our possible ALOC stroke patient is NSR with no ectopics, this ruling out process takes too long and is almost always repeated at the receiving hospital anyways.

You know what takes longer than the fire department doing a 12 lead to check for STEMI? Having a non-PCI hospital find the STEMI and then arrange for a transfer for the patient to a hospital with PCI. Also, just because something is repeated at the hospital doesn't mean its a waste of time to do it prehospitally. The hospital repeats a history and physical, therefore should EMS just skip taking a history and physical?

Again, the need of paramedics? We don't need your epi, atro, ami. Don't care for your bicarb, or your dopamine drips. Benadryll? Yeah I agree w that. About the only thing I see use for is d50 IV, only cuz it saves me a hosptial trip. Your airways are overrated. Paramedics are constantly losing skills to legal battles and questioning of pre hosptial necessity.

No epi? What are you planning on doing to reverse the immediate side effects of anaphlaxis?

No atropine? What are you planning on doing for an organophosphate poisoning?

Amioderone? What are you going to do with a patient in a tachyarythmia?

What about albuterol? What about pharmacological pain management? What about pharmacological (chemical) restraints?

The ironic thing about your list is D10 has been shown to be better at managing hypoglycemia than D50. Oh, but wait. You only care if you have to transport, not about patient care. I gotcha now.

Again, bringing them closer to EMTs. All we are is people movers, getting to the hosptial is still of up most importance. If my squads not there and I see that rapid trans is more important I'm gonna go and I don't care, my patient is more important than a medic practicing his skills. Medics are just EMTs with needles. I'm a nursing student, and I'm glad I'm gonna just skip medic, unnecessary in 95 percent of common cases.

I feel sorry that you look down so much on paramedics. Hopefully nursing school will show you that in plenty of medical cases prompt diagnosis and initial care can change outcomes. Not always mortality, but morbidity as well as providing earlier relief.

PS. If you become a MICN, feel free to just pass all of your patients to me when I'm on duty as the base hospital physician.

 

[thisismikedee]

This made me laugh. I work in LACo for AMR too, and let's not kid ourselves. "Being badass and saving a life" is not the same as being an EMT. Driving to the scene, not doing/needing to do any assessment, putting the person on the gurney, and driving to the hospital with the medic is our SOP. Maybe I'm jaded from working in a first in county prior to this, but LACo is a transport county, being County fire's little helper elf isn't being a badass, or hero.

But on topic, I agree, for LACo, you're best bet are any of the 911 providers. I have people in my medic class from McCormick, Schaefer, and Care, none complain about their companies. I don't know their hiring status.

this is true, we do run 98 percent bull:censored::censored::censored::censored:, but when you get a cardiac save pin or a commendation, or a letter from family thanking you for what you did, it makes it all worth it. Compared to all other non 911 companies, we are bad ***, think about it...
jaded is correct

 

[JPINFV]

this is true, we do run 98 percent bull:censored::censored::censored::censored:, but when you get a cardiac save pin or a commendation, or a letter from family thanking you for what you did, it makes it all worth it. Compared to all other non 911 companies, we are bad ***, think about it...
jaded is correct

Wait, so the fact that you got a pin is more important than the fact that you saved a life (assuming your definition of cardiac arrest save is survival to neurologically intact discharge and not simply ROSC)?

 

[thisismikedee]

15 seconds won't mean the difference between life and death. If it did, then EMS responders (including the fire department) should be forced to sit in their vehicles, engine on, ready to respond at all times. After all, how much does turnout add to the response time? Similarly, 3 minutes is highly unlikely to change the outcome either under the same reasoning.



You know what takes longer than the fire department doing a 12 lead to check for STEMI? Having a non-PCI hospital find the STEMI and then arrange for a transfer for the patient to a hospital with PCI. Also, just because something is repeated at the hospital doesn't mean its a waste of time to do it prehospitally. The hospital repeats a history and physical, therefore should EMS just skip taking a history and physical?

all the hospitals i deal with on a daily basis are stemi recieving facilities.



No epi? What are you planning on doing to reverse the immediate side effects of anaphlaxis?

asist vents and move fast, most people with known anaphalatic reactions have epi pens, which tada, are emt skills

No atropine? What are you planning on doing for an organophosphate poisoning?

rapid transport

Amioderone? What are you going to do with a patient in a tachyarythmia?

rapid transport

What about albuterol? What about pharmacological pain management? What about pharmacological (chemical) restraints?

oxygen asisted vents, rapid transport, who needs pharmacological restraints when i can just throw a spit mask over them and strap em down


The ironic thing about your list is D10 has been shown to be better at managing hypoglycemia than D50. Oh, but wait. You only care if you have to transport, not about patient care. I gotcha now.

d50 only thing allowed besides glucagon in my county, and i care about if my patient really wanted to go to the hospital or not (they've probably had diabetes for years and easily manage it on their own, they usually just forgot to eat after taking their insulin this will potentially save them a FAT unwanted hospital bill and ambulance bill, which in turn is actually caring about my patient... by not caring about transport) anyways, 98 percent of the time the d50 brings em back and they tell us they made a mistake and would like to just eat some food and go on with their lives. im not going to impose a uneeded transport on my patient which could cause unneeded finical burdens to people that need all the money they can get to pay rising health care costs.


I feel sorry that you look down so much on paramedics. Hopefully nursing school will show you that in plenty of medical cases prompt diagnosis and initial care can change outcomes. Not always mortality, but morbidity as well as providing earlier relief.

prompt diagnosis after prompt transport to the hospital where the diagnosis can be treated instead of wasting time diagnosing then re-diagnosing...saves time, saves patients money, saves hospital systems money, saves tax dollars, saves lives, makes health care more efficient, which makes health care better .

PS. If you become a MICN, feel free to just pass all of your patients to me when I'm on duty as the base hospital physician.

no need to bother a doctor, i'll just give my orders like i'm supposed to

 

[thisismikedee]

Wait, so the fact that you got a pin is more important than the fact that you saved a life (assuming your definition of cardiac arrest save is survival to neurologically intact discharge and not simply ROSC)?

negative, the fact that what we do should not be undermined by potentially burnt out employees.

yes neurologically intact discharge is a requirement for commendation in our operation.

 

[thisismikedee]

Wow. 1. No, 2. You work in LACo, where paramedics are barely more than intermediates, anyways, why don't you step outside of your bubble and see the way EMS can be run in systems where mommy doesn't have to tell you what to do on every call.

yes, paramedics cant do anything here, which may lead to my biased opinion, but again, working in a system like this i can see that the people that might need medics in other more advanced counties, are probably gone anyways...i've seen medics here mess things up quite horribly, and I have rarely seen them make interventions that me and my partner can do with a set of feet, a gurney, and basic emt skills...in a different manner that is

 

[JPINFV]

all the hospitals i deal with on a daily basis are stemi recieving facilities.

Which is not characteristic of all of the hospitals in LA County. Additionally, early notification allows for preparation to began sooner.

asist vents and move fast, most people with known anaphalatic reactions have epi pens, which tada, are emt skills

Epi-pens won't help out when you need a second dose. Ventilation is going to be difficult as angioedema sets in.

[organophosphates] [arrhythmia]
rapid transport

Why rapid transport when you can begin treatment in the field? Preventing cardiac arrests is much more important than reversing cardiac arrest.

oxygen asisted vents, rapid transport, who needs pharmacological restraints when i can just throw a spit mask over them and strap em down

Why assist ventilation when you can reverse the underlying problem? Sure, assist until the albuterol sets in, but assist + albuterol is better than assist alone.

For pharmacological restraints, pharmacological restraints are better for the patient than a set of leathers and a surgical mask. Why not provider a superior level of care to patients with acute psychiatric issues?

d50 only thing allowed besides glucagon in my county, and i care about if my patient really wanted to go to the hospital or not (they've probably had diabetes for years and easily manage it on their own, they usually just forgot to eat after taking their insulin this will potentially save them a FAT unwanted hospital bill and ambulance bill, which in turn is actually caring about my patient... by not caring about transport) anyways, 98 percent of the time the d50 brings em back and they tell us they made a mistake and would like to just eat some food and go on with their lives. im not going to impose a uneeded transport on my patient which could cause unneeded finical burdens to people that need all the money they can get to pay rising health care costs.

The issue with D50 vs D10 isn't about which works better at reversing hypoglycemia, as both will do that. It's about which will cause a smaller overshoot in BGL and which one will cause less problems with maintaining a proper BGL in the immediate future.

...and yes, I agree that known diabetics who make a mistake shouldn't be forced into a transport.

prompt diagnosis after prompt transport to the hospital where the diagnosis can be treated instead of wasting time diagnosing then re-diagnosing...saves time, saves patients money, saves hospital systems money, saves tax dollars, saves lives, makes health care more efficient, which makes health care better .

So, basically there's no point in providing any sort of physical exam or most treatments prehospitally? Just put them on the gurney and run lights and sirens to the nearest hospital?

no need to bother a doctor, i'll just give my orders like i'm supposed to

Why do I get the feeling, though, that you're the type of person who would deny most requests for treatment orders?

 

[jgmedic]

yes, paramedics cant do anything here, which may lead to my biased opinion, but again, working in a system like this i can see that the people that might need medics in other more advanced counties, are probably gone anyways...i've seen medics here mess things up quite horribly, and I have rarely seen them make interventions that me and my partner can do with a set of feet, a gurney, and basic emt skills...in a different manner that is

Tell that to the AMI in bigeminy that needed Lido(which we wouldn't have seen without a 12L), or the CHF'er in acute pulmonary edema who because we CPAP'ed them, now isn't on a vent.