Working at McCormick/Banking overtime

CbrMonster said:
Far above my pay grade but the patient was not in dka anymore. But was put back in to dka with the orange juice he drank. But I learn something new everyday. I assume fluids saline + d5 would be better.

I will agree that ems attracts a ton of stupid without doubt.

There def is a paragod complex in the air even with emt’s in 911 vs ift companies
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DKA does not work like that. It’s actually diagnosed off of ketone levels. The glucose level does correlate, but the ranges themselves are not diagnostic criteria.

WRT Hall, if you’re serious about your craft, you’ve got to get out of LACo. Hall, Liberty Ridgecrest, American, etc...or move further.

FWIW, 90 percent of EMS is the same everywhere. There are things CA does better than TX, and a motivated, intelligent professional can find a way to be successful anywhere. But while y’all are trying to impress Orange County Fire into letting you check a glucose, we’re doing field blood transfusions.
 
RocketMedic said:
DKA does not work like that. It’s actually diagnosed off of ketone levels. The glucose level does correlate, but the ranges themselves are not diagnostic criteria.
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Yup. BGL is just a 1st step, then it’s all about correcting fluids balance, electrolytes balance, acid-base balance, doing follow up labs, checking for infection etc. Lot of work.
 
Lot of information here, thanks guys.

I will take a closer look at Hall, it would be a drive definitely so I don't know how the commute would work.

But after hearing the politics of EMS(Specifically SoCal), I am admittedly more apprehensive of where to apply. My main goal is to go to medic school and move out of state to some FD. Maybe Wisconsin or Pennsylvania(or Texas hah). Politics aside, I just want to get my exp in the field and be done with it, so if that means working with some 'holier than thou' medics or some really ****ty company policies, than so be it I suppose.

But thank you for all the responses, I'm sure I will post an update if and when I make a finalized decision on a company.
 
Virgil said:
Lot of information here, thanks guys.

I will take a closer look at Hall, it would be a drive definitely so I don't know how the commute would work.

But after hearing the politics of EMS(Specifically SoCal), I am admittedly more apprehensive of where to apply. My main goal is to go to medic school and move out of state to some FD. Maybe Wisconsin or Pennsylvania(or Texas hah). Politics aside, I just want to get my exp in the field and be done with it, so if that means working with some 'holier than thou' medics or some really ****ty company policies, than so be it I suppose.

But thank you for all the responses, I'm sure I will post an update if and when I make a finalized decision on a company.
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If by “exp” you mean you just want to get your hours to be eligible for medic school then it doesn’t matter what company you work for. If you want the best work experience then the others have already touched on that.
 
Virgil said:
I just want to get my exp in the field and be done with it, so if that means working with some 'holier than thou' medics or some really ****ty company policies, than so be it I suppose
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Both Care and McCormick will give you "good" 911 field experience that the SoCal medic schools will look for. Both have "good" "high class" areas (Malibu anyone?), both have their ghettos full of GSWs and whatnot.

Never worked with OCFA, but I've heard they're not substantially different from working with LACoFD.... I can tell you the Compton Fire and Redondo Beach Fire guys are pretty cool, easy to work with, whereas LACo is hot or miss, plenty para-gods, "shut up, do what I say" types, as well as squaddies who are chill, expect you to work up to your scope, etc.

Of course, now that I'm in a system where EMS is EMS, and Fire, we're just first responders, no medics at all, after seeing the difference in systems...as much as I enjoyed my time at McCormick and still chit chat with my former coworkers there... I would wholeheartedly support you going up to Kern Co lol
 
CbrMonster said:
i've worked in hospitals and watched mastered degree'd nurses do the dumbest thing imaginable like give a patient (stepped down from icu to a med surg floor dx of dka) orange juice to raise their blood pressure.you know instead of just giving them a 250 bolus of ns and see how that went. a degree doesn't mean everything.
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Qulevrius said:
You know, as someone who worked in a hospital, you should know that giving a DKA pt a NS bolus is counter indicated, because it can drop their BGL too fast. There are dumb people everywhere, but EMS seems to attract them en masse. Not to mention the holier than thou attitudes and the completely uncalled for air of superiority.
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CbrMonster said:
Sorry not sure how to private message on here: but just for my education sake and I like picking peoples brains for information and to self Improve.

The patient was in icu and in dka there it was resolved and brought to a medsurg/tele floor for continued care at a lower level. What happened was the nurse was a new grad msn. And have he patient multiple orange juices like 5-6 of them which sent him back into dka. And consequently back into the icu they went.

Out of curiousity are you a nurse or what experiences do you have. Not doubting your skills knowledge, just for the asking for the sake of knowing what I can and can’t ask.

Thanks in advance
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Blood sugar levels have very little to do with DKA. While a very high sugar suggests DKA or HHS/HHNK (among other disease processes), it is more representative of their poorly managed disease state.

The ketoacidosis of DKA is associated a higher need for energy than than can be supplied by glucose in the cells. In most cases we see this in patients who are medication noncompliant or are new diagnosis, but you can have IDDM patients who are on their regular insulin dose but have increased metabolic demand (often from being sick) who aren't getting enough sugar in the cell and also resort to breaking down fat as an additional energy mechanism. Also keep in mind that the presence of ketone bodies on UA can be caused by many pathologies and not exclusively from DKA nor should UA ketones guide DKA management.

DKA can be diagnosed via a plethora testing, and different providers will have various opinions on what is the best combination. In addition to the presence of DM you can test for PH, bicarb, and gasses on an ABG/VBG electrolytes and calculated anion gap on a chem panel, β-Hydroxybutyric acid, and a myriad of other tests.

Since the body is flushing out glucose through their urine patients are often profoundly dehydrated so we often give 20cc/kg up to 2 liters of NS or LR from the beginning. There used to be a large concern that dropping sugars to fast would cause cerebral edema, especially in children, but a recent update in the literature suggests that this may not be as true as we thought [N Engl J Med. 2018;378(24):2275]. Patients are then continued on maintenance fluids, typically at 1.5 times maintenance up to 250 ml/hr; in adults it's not uncommon to see Ns as the maintnece fluid, however in pediatrics and some adult centers they will use the two bag method of D5 and D10 with K (depending on how fast their glucose is dropping).

A core tenant of DKA management is the administration of insulin at a controlled rate such that the goal BGL drop is between 50-100 mg/dl/hr. Some systems do this by changing insulin rates, although often it is better to change the maintenance fluids instead. Insulin is continued even if the glucose is normal (with an appropriate dextrose containing maintenance fluid) if they still need to close their gap, correct acidosis, or resolve their ketotic state.

We cannot starve our DKA patients into a normal state, in fact starvation leads to ketoacidosis as well which we often see present in alcoholics. In the above example the orange juices would not have caused or worsened DKA, the patient probably needs nutrition anyway but a lack of appropriate insulin could have caused a worsened or new DKA state. In all likelyhood that patient was on a fairly aggressive insulin drip and when transferred to the floor the accepting hospitalist put in a insulin plan that simply didn't provide enough glucose to the cell, either out of insulin resistance (especially prevalent in mixed type diabetes) or increased metabolic demand.

If you have any questions I'm more than happy to answer them. In a former life I was a fire medic on a department that ran our own ambulance, I'm now an ED Charge RN for a tertiary/quaternary referral adult and pediatric hospital and still do some prehospital and transport stuff among other random tidbits.
 
Jim37F said:
Both Care and McCormick will give you "good" 911 field experience that the SoCal medic schools will look for. Both have "good" "high class" areas (Malibu anyone?), both have their ghettos full of GSWs and whatnot.

Never worked with OCFA, but I've heard they're not substantially different from working with LACoFD.... I can tell you the Compton Fire and Redondo Beach Fire guys are pretty cool, easy to work with, whereas LACo is hot or miss, plenty para-gods, "shut up, do what I say" types, as well as squaddies who are chill, expect you to work up to your scope, etc.

Of course, now that I'm in a system where EMS is EMS, and Fire, we're just first responders, no medics at all, after seeing the difference in systems...as much as I enjoyed my time at McCormick and still chit chat with my former coworkers there... I would wholeheartedly support you going up to Kern Co lol
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Much obliged haha, are there any company-specific things I should know about McCormick? I heard PTO is nonexistent, and that you can get "marked" on your record for little things and such. Any truth to those?
 
^ with that being said:

We usually hang 2-3 bags for DKA pts (LR + piggybacked dextrose, KCl, K acetate) plus insulin drip & BG reassessment until their sugar drops down to >200, then they’re cleared for ICU. Additional stuff applies.
 
PTO is there, and available at McCormick. I used it a handful of times, basically whenever I had a test, or PAT or interview here at Honolulu Fire, I used a PTO day when I needed to fly out. Which worked out rather nicely for me lol

Obviously you need to request it in advance and get approved first, but just work with the scheduler, dont try to request it the week before or try to take a month off at once or anything crazy lol

Now there are days that they do discourage calling off. Especially days they expect a lot of people to try and call off (some holidays and even festivals like Burning Man and Stagecoach) they'll have increased points for calling off (get too many points in too short of time, incur discipline, up to termination).

Now calling off once on a high point day isnt gonna get you fired, but the points are set high to just below discipline thresholds, so if you have a habit of calling off, or tardy or whatev, trying to call off Christmas day, isnt gonna be good... but if you work your assigned shifts, and go thru one of the approved processes to get a day off in advance, you can make stuff work (you can do shift trades if you can find someone willing to work the day you want, in trade of you working one of their shifts, you can work a deal with the scheduler to work one or two open shifts in trade (that ones less guaranteed), request vacation or PTO well in advance, etc

What they're trying to prevent is people calling off "sick" the morning of, because they couldn't find anyone to cover while they go to Coachella (along with half the company doing the same).

It sounds harsher than it is. One of my friends who still works there just did like a week long trip to Japan, I was able to use PTO to go to Honolulu a few times for the FD hiring process here, so time off is quite doable (and pretty much all the 24 hr shifts mirror the fire schedule for their area, mostly LaCo Fires Kelly schedule, some of Torrances 48-96...either way you only work like 10-12 days a month... as long as you work within the system for shift trades/swaps/coverage/PTO/non paid vacation days/etc, it's pretty simple really...heck it was easier at McCormick to get a shift off than my current FD! Lol
 
That doesn't sound too bad. Hall Ambulance emailed me back today to take their behavioral assessment test, pretty good sign I think!

I'm gonna wait for McCormick's response, but I'm hopeful. Congrats on landing Honolulu btw, sounds like a sweet gig.
 
Virgil said:
That doesn't sound too bad. Hall Ambulance emailed me back today to take their behavioral assessment test, pretty good sign I think!
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Hall has a multi-phase hiring process. Phase 1 is the standard behavioral assessment (if anyone has trouble passing it, then they’re misanthropic sociopaths that have no business working for any company). Phase 2 is an interview with HR (and, consequently, where most fail). If you pass Phase 2, you’ll be scheduled for Phase 3 which is an interview with the VP and, if passed, get a conditional job offer. Phase 4 is your physical, and only then you’re a new hire scheduled for orientation.
 
I don’t have any direct info on their hiring process anymore, specifically for EMT.

I can say that there’s been some shifts in management. I don’t know who does the interviews these days. Chances are I’ve worked with, or directly under them as a (supervisor) subordinate.

Again, I don’t know what steps are past the psych test but if you make it to the next round just be honest and forthcoming. It really is a good place to start, and grow; particularly for basics.

It truly does beat the hell outta any LACo company. Even the “911/ fire call” ones.
 
Thanks guys, I like that it's a small family run company.

What percentages of their calls are IFT compared to 911?

Do they usually run with County fire?
 
Virgil said:
Thanks guys, I like that it's a small family run company.

What percentages of their calls are IFT compared to 911?

Do they usually run with County fire?
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IFT to 911 ratio for BLS? I don’t know offhand.

Again, the county just restructured the way we prioritize calls. A lot of calls us paramedics would respond to L/S have now been deemed BLS calls until proven otherwise. If ALS is needed they can request an intercept.

I don’t work a whole lot of metro anymore, but will occasionally catch the bleed over from our dispatch on our radios. Either way, EMT’s are really trusted—and expected—to run calls to the best of their judgement and abilities.

Again, if paramedic is a goal of yours, whether it’s short or long-term, you really can’t go wrong here.

And just to pay homage to my pal @LACoGurneyjockey, Liberty Ambulance in Ridgecrest is certainly worth a gander as well.

We run with county and city fire. Both of whom are predominantly BLS. Why does that matter?
 
VentMonkey said:
IFT to 911 ratio for BLS? I don’t know offhand.

Again, the county just restructured the way we prioritize calls. A lot of calls us paramedics would respond to L/S have now been deemed BLS calls until proven otherwise. If ALS is needed they can request an intercept.

I don’t work a whole lot of metro anymore, but will occasionally catch the bleed over from our dispatch on our radios. Either way, EMT’s are really trusted—and expected—to run calls to the best of their judgement and abilities.

Again, if paramedic is a goal of yours, whether it’s short or long-term, you really can’t go wrong here.

And just to pay homage to my pal @LACoGurneyjockey, Liberty Ambulance in Ridgecrest is certainly worth a gander as well.

We run with county and city fire. Both of whom are predominantly BLS. Why does that matter?
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Oh very good, this is all just curiosity on my part. When I decide to go for something, I try to learn as much as I can about it.

I was looking at Liberty out here in LA County and OC, but I will also check it out in Ridgecrest.

My next puzzle is if I get the position, how is that going to work logistically. Maybe spend 3 days up there and then 4 down here.
 
Virgil said:
Oh very good, this is all just curiosity on my part. When I decide to go for something, I try to learn as much as I can about it.

I was looking at Liberty out here in LA County and OC, but I will also check it out in Ridgecrest.

My next puzzle is if I get the position, how is that going to work logistically. Maybe spend 3 days up there and then 4 down here.
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Liberty Ridgecrest and Liberty in LACo/OC are not the same company, although they have the same name. Last I’ve heard, LR predominantly hires medics and getting on board as a Basic is tough (as in, requires plenty of experience and a few votes of confidence from existing employees).

Don’t buy into the 911 vs IFT BS. As a Basic with no experience, you want to do the private side for a few months if only to get comfortable with the job; I have, sadly, seen what 911 “exclusivity” does to fresh 20-something y.o. Basics, and it’s disconcerting.

The info on the hiring process I have, dates some 3 years back; if @VentMonkey says the company had been restructured, then I’d listen to him.
 
Hall gave me the no-go unfortunately.

But good news, McCormick got back to me with a testing date! It's going to be a written, dummy drag, and a scenario based assessment. I'm pretty excited for it, and am going to be studying pretty hard over the next couple weeks to be at the top of my game.
 
@Jim37F I thought I'd summon you once more for McCormick info if you please haha.

I've read all the thread on the FTO processes, etc. but for the initial testing, is this supposed to be NREMT style, or just demonstrate proficiency in the skills? How does that first " block" of testing go usually?(Written, Body drag, scenario)
 
Off the top of my head (and it's been 2-3 years since I went thru it myself), the scenario was basically an NREMT medical assessment skill sheet. They might throw in a trauma, or medical w/ trauma to throw you, but basically follow the assessment skill sheet in order, just like in EMT class and you'll be fine.

Drag test was easy, a weighted dummy, all of 50ft (and then the dummy becomes your patient for the skills scenario)
 
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