Lee County (FL)

akflightmedic

Forum Deputy Chief
3,891
2,564
113
$0 per hour, $0 annually !!!

Sign me up!!!!
 

VentMonkey

Family Guy
5,729
5,043
113
Because I am completely ignorant to FL EMS, what makes Lee County EMS so sought after?

Is it considered a career department? I know they have their own HEMS setup, and are a 3rd service. That is about all I know. Is fire in their particular area BLS, ILS, ALS, of a mix of all three?
 

akflightmedic

Forum Deputy Chief
3,891
2,564
113
It is desired because it is one of last departments in FL which is NOT merged with fire and seems to have decent call volume, decent protocols/scope, and a career ladder.

Yes, Fire is in the area...fire is everywhere in FL and it is very rare you will see Fire that is NOT ALS in FL. FYI, there is no such thing as ILS in FL...it is BLS or ALS.
 

VentMonkey

Family Guy
5,729
5,043
113
FL EMS sounds very similar to CA EMS in general. It's very heavily fire-based EMS, and the opportunities for career single-roles sounds pretty limited.
 
Last edited:

akflightmedic

Forum Deputy Chief
3,891
2,564
113
The MAIN difference I see between the two is that the FL scope of practice is light years ahead of CA.
 

VentMonkey

Family Guy
5,729
5,043
113
The MAIN difference I see between the two is that the FL scope of practice is light years ahead of CA.
Yeah, but that's not really saying much, TBCH.

Personally I don't get the whole scope thing aside from select paramedic jobs (e.g., off shore, CCP/ HEMS, rural, and overseas). In The States, on the ground generally speaking I don't see the need for some huge, flashy formulary.

I think realistically if we could swap certain meds for others, and work off of state protocols I would be ok with that. As it is now, much of what we're even allowed in my county we don't necessarily see enough of to justify keeping.

I could work in a dozen systems, and sure each is different, but as far as what the "end goal" for field paramedics is, it typically stops after a certain step. Here, even when I do ground work I hardly call for, nor do I need orders or think "Man, I really wish I had 'X, Y, and Z' because I just know it would have made all of the difference".

Plus, how many of these systems, or states with elaborate protocols really enter them routinely, aside from perhaps some of the more rural areas?

I guess I feel like the entire state itself gets branded as archaic because of Los Angeles County, which in fact is false. I'm only speaking in terms of EMS, not all the other California mumbo jumbo.
 

akflightmedic

Forum Deputy Chief
3,891
2,564
113
I would say you are incorrect. When I worked in FL we had a very advanced scope compared to what I had done previously in SC, LA, and even OR. AK was the only place where I far exceeded all those. Now that I am in ME....holy crap, scope DOES make a huge difference!!!!

People die here due to limited scope and with the rural aspect of it all, this IS where the scope would be most helpful yet they do not.

As for all the formulary and procedures in FL, yes we used them quite frequently. RSI, NTG drips, and many other advanced medications were given or started pre-hospital, justifiably so. And this was in the city, not just rural areas.

Forewarning, my eyes are opened "bigly"....do NOT get acutely sick or injured in ME. They are where EMS was about 25-30 years ago!
 

VentMonkey

Family Guy
5,729
5,043
113
In all fairness my experience is limited to California only. I don't see (or haven't) people dying because ground paramedics can't RSI, don't have Ketamine, or some other item that may be considered advanced for this state.

These are all nice to have items, but as an example I can't see myself taking time to set up a NTG gtt on an AMI even if it's only a few extra steps, while the cath lab is only a stones throw away. IMO, clinical judgment dictates when to withhold therapies as well when to set my personal ego aside.

I will say, I think it may also depend heavily on the provider themselves as individuals, again ego. Would you not agree that in the wrong hands, some of these procedures---regardless of the county, city, state, whatever---could be detrimental?

Is it sad? Yes, but it's anywhere. Also, I have no hard facts, articles, or stats to prove who does or doesn't die because of what we do, or do not have in our scope(s).

Generally speaking, in the more rural areas here, the HEMS crew with the expanded scopes---but more importantly---(theoretically), and more experienced clinical judgment seems to suffice. When it's coupled with a competent field paramedic who knows exactly when to utilize such resources, at least on the front side, it seems to flow seamlessly.

My personal opinion is people that die from lack of such things more often die from poor patient care and provider judgment both in hospitals, and out of them. I get how you mean though, but here I'll respectfully disagree.
 
Last edited:

akflightmedic

Forum Deputy Chief
3,891
2,564
113
In the wrong hands darn near anything we do or do not do could be deadly, fallacious argument. We both argue for better initial foundation...also as you say, you do not have the advantage of working in different systems or different states from which to formulate different opinions, no?

I am unsure what a "stone's throw" means in your mind cause in any city in FL, scene to hospital time could be 10-45 minutes depending on traffic. We also have the scene time which on medical can be up to 20 minutes or so on average...so do you think none of the interventions or procedures should be done simply because the way the crow flies says otherwise?

You also have to keep in mind paramedic saturation. A drip is set up while you are doing something else. You are in the land of Fire Rescue, therefore you have 2-6 paramedics on nearly every critical or serious call. A LOT can be done in very short time. I do miss Florida in the sense that we did the very best for a lot of patients in a very short time frame. One can argue skill dilution as we have in the past, however when it comes to getting stuff done for the patient, the time to do so is inconsequential. By the time you load the patient in the truck, you would have things all set up ready to connect. Would you still wait even when it is clinically indicated?

Ketamine is ESSENTIAL especially for some of the drugs on the street....again this is FL, land of cannibalism. :) Most counties have standing orders for high doses of ketamine to knock them out. I think it comes issued with a blow dart gun for faster administration. :)
 

VentMonkey

Family Guy
5,729
5,043
113
I always figured Maine would have halfway decent protocols. Then again, the only thing EMS related I know about in Maine is LifeFlight.

Also, any continued rebuttal from me at this point would merely be my ego talking. I'll gladly admit I don't know what I (in fact) don't.
 

EpiEMS

Forum Deputy Chief
3,815
1,143
113
I always figured Maine would have halfway decent protocols. Then again, the only thing EMS related I know about in Maine is LifeFlight.

Also, any continued rebuttal from me at this point would merely be my ego talking. I'll gladly admit I don't know what I (in fact) don't.

Maine BLS protocols don't seem too too bad to me, and they have OK ILS protocols (I don't love all the ILS cardiac protocols...). I'm not so so sure about the true ALS side of things. Here are their protocols: http://www.maine.gov/ems/documents/2015Protocols_maine_ems.pdf

NH > ME though, for protocols


Sent from my iPhone using Tapatalk
 
Last edited:

akflightmedic

Forum Deputy Chief
3,891
2,564
113
LOL...Maine EMS protocols...

At the Paramedic level they carry 13 drugs and you must get OLMC even to treat chest pain. Hmmm, really, I need to get OLMC to give fetanyl for chest pain??!! It gets worse from there.

Oh, a status asthmaticus...2 nebs then OLMC to do more....seriously? OLMC to give epi or mag as well.

Blind insertion airway devices...you know the things so easy that a first responder can do them....ONLY medics can insert any device. EMT and AEMTs...nope, no airway devices for you!

And if someone is circling the drain and say I could not turn them around with drugs, CPAP or whatever...I can do nasal intubation (hello 1990)....but absolutely no RSI is happening.
 

EpiEMS

Forum Deputy Chief
3,815
1,143
113
@akflightmedic, I think they have improved perhaps as of the last iteration
369d7396982eaa2ea17e93ac101ea752.jpg



Sent from my iPhone using Tapatalk
 

akflightmedic

Forum Deputy Chief
3,891
2,564
113
Maine gets a HUGE +10 however for insisting on NO TRANSPORTING of cardiac arrests unless you get ROSC. Kudos for this...rest of it is archaic and "mother may I", but thats ok, it gives me something to work on. :)
 

akflightmedic

Forum Deputy Chief
3,891
2,564
113
Guess you missed the part where I am here now, licensed and practicing in Maine. :)

You are looking at the flow chart....you need to look at the actual instructions. Medics do the BIADs only...


(I bought a house here this past August and split my time between FL and ME now, when not overseas tending business...and like any Medic, I simply cannot stay out of EMS) I have political plans which are better pursued up here in Maine.
 

VentMonkey

Family Guy
5,729
5,043
113
Guess you missed the part where I am here now, licensed and practicing in Maine. :)

You are looking at the flow chart....you need to look at the actual instructions. Medics do the BIADs only...


(I bought a house here this past August and split my time between FL and ME now, when not overseas tending business...and like any Medic, I simply cannot stay out of EMS) I have political plans which are better pursued up here in Maine.
Perhaps the rabble rousing folk on this forum oughta move up yonder once you have it all worked out...
 

EpiEMS

Forum Deputy Chief
3,815
1,143
113
Top