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Old 02-17-2008, 22:08   #1
Peak_Oil
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I quit today

This morning before my shift started, I pulled the shift super out into the parking lot and got a few things off my chest. We have a new dispatcher who apparently doesn't know county code and is sending BLS units to ALS calls. This happens so regularly that I'm either turning down every call or taking calls way out of my scope. Every run, run after run, all day long. I've had one call in the last month that was within my scope.

Look, I said, let's just cut down on the worst of the most retarded calls. If we get a call for a hip fracture, which is right here on the list of calls outside our scope, then have them call 911. Right? If we get a call for SOB, let's get an o2 sat and a respiration count. If it's elevated temp... what's the temp?

The shift super was kind of noncommittal on the whole thing. Yeah, he agreed, but said he'd still send us to assess. But what about the stroke calls? These people are in imminent danger of irreversible brain damage and time is of the essence. Why send us to a stroke call? We can't assess appropriately. Don't make these people wait for 90% of their Golden Hour for an EMT that can't assess.

Our first call of the day comes in.

F%$kin AMS, which is an ALS call in my area. I told dispatch, AMS is an ALS call, this is a BLS rig. Why are we going? He says to evaluate.

AMS can be a stroke. We can't check for diabetic hypoglycemia, we don't have glucometers. We can't check for hypoxia with a pulse oximeter, we don't have any. And as of this week, we can't run code, because we need some new certification to flip on the lights. WTF.

Why am I running 45 minutes to a call that can potentially need to be under the knife or on throbolytics within an hour to avoid PERMANENT BRAIN DAMAGE???

OK Fine, I'm enroute. Hope it's not a stroke and this pt doesn't need to be in the ER any time soon.

Get to the pickup, and lo and behold, the pt has one-sided weakness, one fixed/dilated pupil, and is trying to open his eye with his opposite hand. No speech, A&Ox1 or 0 depending on who you ask, and one foot cold one foot warm. It's a stroke. Dispatch, this is XX, it's a stroke. Nice call. Congratulations.

Please advise.

Silence.

More silence.

Dispatch, this is XX. This is a status post-stroke, the patient's family is here, they have a cat scan negative for cranial bleed from last night. Please advise.

Dispatch? hello?

We take the pt to the ER, and two supervisors are in a rig in the parking lot, apparently writing me up. I walked over and tapped on the window, hearing my regular supervisor on the phone with the GM, apparently setting me up for something. I tapped on the window and told him not to bother with all that bull****, I quit, gimme a ride back to the station.

Lots of whispering.

Whatever, I'm done with this **** job and the crap they pull. I'd rather sell insurance.
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Old 02-17-2008, 23:09   #2
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I feel for you man.


Currently getting my EMT-B and I hear the horror stories.

Sometimes you can only do so much.

Good luck with whatever you decide to do.
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Old 02-17-2008, 23:46   #3
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I feel for you... I got dispatched for a "low blood pressure". It ended up being 50/10 or so. This patient was CTD, and going south fast. Hospital was closer than ALS, so we threw her in the rig and ran her hot to the ER. Ditto for a patient who was in freaking V-tach when I showed up. On my BLS unit. I figured it was a matter of time before someone died or I got sued... I wrote the problem up, handed in my badge, and never looked back. Takes a while, but find a company you can live with. Nothing's worse than having a life on your conscious. Some days I wish I'd quit and switched employers earlier...
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Old 02-18-2008, 00:30   #4
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Originally Posted by 4095fanatic View Post
I feel for you... I got dispatched for a "low blood pressure". It ended up being 50/10 or so. This patient was CTD, and going south fast. Hospital was closer than ALS, so we threw her in the rig and ran her hot to the ER. Ditto for a patient who was in freaking V-tach when I showed up. On my BLS unit. I figured it was a matter of time before someone died or I got sued... I wrote the problem up, handed in my badge, and never looked back. Takes a while, but find a company you can live with. Nothing's worse than having a life on your conscious. Some days I wish I'd quit and switched employers earlier...
Transfer to the Eternal Care Unit.
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Old 02-18-2008, 07:15   #5
DaleGribble
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Sounds like you did the right thing by quitting.

I do have one question though. Maybe things are different where you are but I'm not sure I understand why you can't do a stroke assessment? Stroke assessment was part of my basic class.
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Old 02-18-2008, 09:54   #6
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Sounds like you did the right thing by quitting.

I do have one question though. Maybe things are different where you are but I'm not sure I understand why you can't do a stroke assessment? Stroke assessment was part of my basic class.
We can do a stroke assessment, but we can't check for diabetic hypoglycemia or hypoxia. There are times when a stroke can look like those other things. Or rather that those other things can look like a stroke.

Also, we state a 45 minute response time instead of a seven minute response time. I can get there and say Yep, looks like a stroke, we wasted 90% of this guy's golden hour, call the fire department.

It's not such a good idea. In Los Angeles County, there's a fire department within seven minutes of everywhere, so there's no need to have a BLS rig go assess and THEN call fire. I know it's different in other places, this is specific to LA county.

If there are any LA county fire guys on the board, please weigh in. Our area is unique in this aspect.

When I get out of school I plan on keeping my EMT-B license and working on an ambulance in Oregon specifically because of the much-expanded scope of practice. EMT's do a great job in most of the places in the US, and I would like to be of service in my new community both in the capacity of RN and EMT. They're very different jobs.
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Old 02-18-2008, 10:00   #7
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i feel your pain, no pun intended.....im in police work and have the misfurtune to work with some clueless dispatchers...

...gets a prowler call, doesnt keep the caller on the phone to advise that the police are there searching the outside of the house....now i have to worry about a home owner taking a shot at me thinking im the prowler....

fight call, doesnt get discription of assailant(s) or if they are still on scene or if there are any weapons involved....

i had to have a heart to heart with my command staff who were appathetic to the whole thing until i said "they take the call, i take the risk, and somebody better start listening before a lawyer does".

negligent retention is very "sue-able"
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Old 02-18-2008, 12:26   #8
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Wow, just quiting ? Sounds like you should have never started. Sell insurance.? Now there is a career..For some reason you probably wont like that either. Life is not perfect, but make the best of it. It's all in the attitude. Sorry no sympathy here. Good luck !!
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Old 02-21-2008, 19:50   #9
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Wow, just quiting ? Sounds like you should have never started. Sell insurance.? Now there is a career..For some reason you probably wont like that either. Life is not perfect, but make the best of it. It's all in the attitude. Sorry no sympathy here. Good luck !!
Sorry, but there's no excuse for a department that operates the way he says his operates. It's a huge liability if they're doing the things they're doing, and definitely not in the patient's best interest. I don't blame him one bit for quitting.
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Old 02-22-2008, 12:23   #10
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Sorry, but there's no excuse for a department that operates the way he says his operates. It's a huge liability if they're doing the things they're doing, and definitely not in the patient's best interest. I don't blame him one bit for quitting.
I've talked about this with a couple of paramedics and a few nurses and they all turned gray when they heard the story. A doctor told me that I need to have a mindset where I protect my licenses. I need to stay in the game if I'm going to help anybody at all, so sometimes you have to play defense.

Also, think about it from the patient's perspective. You have an hour til you need to be under the knife or have thrombolytics administered. Would you want somebody who can't help you make you wait 45 minutes of that hour, or would you want the paramedics to be there in 7 minutes?

The problem is the new dispatcher is being trained by a guy who is much more interested in climbing the ladder at this company than he is in following county protocol or even common sense. We've complained about this numerous times and it just keeps getting worse. The formula in his head is more calls = my promotion.

The company wasn't like this six months ago. It's a real shame the place deteriorated so far so fast. I used to recruit people to work here and now I'm quitting because I can't be put in these kinds of situations in good conscience.

LA County is much different than your average EMS service. The fire department has to maintain a certain response time, but there aren't that many fires around here. We get the annual wildfires and the like but it's not like a house in Los Angeles catches fire every day. So the fire department has to keep busy somehow, we can't have these guys just sitting there. They do the medical calls and the trauma calls. EMTs do interfacility transfers the vast majority of the time. Con home to dialysis, ER discharge to con home, pickup at an apartment going to a doctor's office, con home to chemo treatment, that kind of thing. Even the EMTs that work 911 calls GENERALLY show up behind the paramedics who do all the work, and they then take the bundled-up patient to the ER and report off. EMTs have a very reduced scope of practice here, and it's because there's so many paramedics 7 minutes away from everything. We're lousy with paramedics. We have so many paramedics in LA county that LA City Fire has almost a standard protocol of not allowing paramedics in their first year of service to touch a patient. There's that much spare capacity in the system on a day to day basis. Any LA City Fire guys want to weigh in on that? That's what I hear, maybe you can confirm/deny.

And trust me, we're busy with the IFT's all day. Many times we don't get a meal break at all during a 12-hour shift. There's no need to further overstretch our work to include calls that are way outside our scope.

I know it's not like that in most other places but that's how it is here.

It's stupid, stupid, stupid to take out of scope calls when you know in advance that they're out of scope. And when time is of the essence.
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Old 02-22-2008, 21:25   #11
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Do your paramedics carry thrombolytics? If not then there really isn't much more they can do than a basic.

From what you wrote it seems the the company is wrong, but you could also use a more advanced assessment class. You can assess a lot without the need of electronic equipment.
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Old 02-22-2008, 22:33   #12
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Your boss was, is and always will be a moron. Good job quitting
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Old 02-22-2008, 23:55   #13
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Do your paramedics carry thrombolytics? If not then there really isn't much more they can do than a basic.
That's not the point. The point he was making was, EMTs are not allowed to transport ALS calls where he works, so when they send his unit to an ALS call that they cannot transport, it's a waste of valuable time because they have to wait for a paramedic unit to get dispatched and arrive. Even if the paramedic units did carry thrombolytics, there isn't a service out there that's gonna implement their use in CVAs because the pt has to have a CT first to determine if it's a hemorrhagic or an ischemic CVA. Obviously not something that can be done in the field.
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Old 02-23-2008, 00:15   #14
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Since you can't assess whether it's a clot or a rupture in the field do you operate on the knowledge that most CVAs (over 80%) are ischemic?
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Old 02-23-2008, 03:25   #15
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Since you can't assess whether it's a clot or a rupture in the field do you operate on the knowledge that most CVAs (over 80%) are ischemic?
Again, it's not like any EMS service out there is going to carry any form of thrombolytic for use in a CVA, so it really doesn't matter whether to us whether or not it's probably ischemic. Our main priority in the field is protecting the patient's airway. Everything else is secondary. We perform a stroke score on the patient to determine if they meet all the other criteria for thrombolytic use, and notify the neuro team if they do, but that's all we'll ever be able to do. As for telling the difference, there are often signs or clues that let you know you're dealing with a bleed, but they're not consistent. If you have a patient that all of a sudden became limp on one side and aphasic, and has a B/P that's sky high, and within minutes they're unresponsive, that's a pretty good clue you're dealing with a major bleed. Unfortunately, it's not always clear cut like that. But again, it's not like your treatment is any different to begin with.
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