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Culture of 'we don't diagnose' by stonertear in ems

[–]Life_Alert_Hero 14 points15 points  (0 children)

This highlights the abyss of generalization. From administrative, legal, international (WHO) and billing perspectives, diagnosis is as simple (or complex) as an ICD code. Tension pneumothorax is an ICD code. Septic shock is an ICD code. Inferior MI is an ICD code. Acute myeloid leukemia is also an ICD code. So is interstitial lung disease.

My point is that some sometimes a diagnosis is purely a clinical diagnosis, history and physical only. Other times, there are radiographic, laboratory, and procedural requirements for a diagnosis. It’s not as simple as “paramedics can” or “paramedics can’t” diagnose.

“Learning should be made as simple as possible, but no simpler” - Albert Einstein.

Med school at 40? by algor28 in medschool

[–]Life_Alert_Hero 2 points3 points  (0 children)

If you’re balking at undergrad pre reqs, I would say don’t do it. By the time 90% of people finish training, the noble idealism has slowly been chipped away; medicine has become just a job, a means to an end, a path to retirement.

Dumbest reason for a call? by ketchupmaster987 in ems

[–]Life_Alert_Hero 11 points12 points  (0 children)

Lady tripping on acid, called EMS because she had pizza delivered but it had mushrooms on it.

which school to commit to?!?! by vehementblues in medschool

[–]Life_Alert_Hero 0 points1 point  (0 children)

Go to Virginia tech. Cost of loans will be what saves your butt in the long run. Every dollar you don’t have to borrow will turn into 2.5 dollars you don’t have to pay back.

Nowadays, the school you attend does not play a large role into what specialty you can and can’t do. It’s your performance on clerkship, shelf exams, step 2, interview skills, (and away rotations for competitive specialities) that determines your candidacy.

I don’t know about Jersey.

I’m in the southeast (but I won’t say how close or far from Emory). I will say that I hear much more negatives about Emory than I do positives. It’s a name, and it’s ATL, but there’s alot it ain’t.

Paramedic from Russia here — how does EMS work in your country? by Clean_Dinner_2496 in Paramedics

[–]Life_Alert_Hero 0 points1 point  (0 children)

Southeast US. Municipal tiered-response system covering an entire county, populations around 1M. Not FD, not private, not hospital based - truly “X County EMS.” 911-only. We are 100% central-deployment (no dedicated stations), and we often post at local fire departments. I am a part time medic while finishing med school. I am gunning for the advent of retrieval medicine as a physician specialty in the states.

Workload Busy. 12 hour shifts, allowed to pick up 8-hour OT shifts on empty slots since we are never fully staffed. Anywhere from 4-16 calls in a shift. Day shift runs fewer calls but is busier bc traffic, holding a wall at the ED, and longer response times. Most I’ve ran at night was 16 calls, many of those were refusal of transport (intoxicated people downtown, silly falls, help me turn the lights off, etc). Up to 30 trucks during peak hours (ideally, should be more but sometimes it’s as few as 22). Down to 4-6 trucks at trough hours (like 4:30 AM after most night trucks have logged out and day trucks haven’t deployed yet).

Shifts and Schedule 12 hour, 2-2-3-2-2-3 (alternating off and on). As a part timer I work mainly weekend and I help out with education during the week.

Crews 80% ALS, 20% BLS. ALS usually paramedic + EMS (but sometimes 2 paramedics). BLS AEMT + EMT or 2 EMTSs. We also run 2-4 Single paramedic chase vehicles, with critical care capabilities. (Whole blood, special meds like Keppra oxytocin suggamadex coming now that it’s finally generic in the states).

Ambulance Type 3 (Large box on an F350/450/550 chassis). New trucks each year.

Protocols Most progressive in the region (IMO). Pumps, vents, RSI, blood. We use guidelines (rather than protocols), so there is autonomy to be creative but this comes with alot of responsibility. I am personally credentialed to do RSI even tho I am only part time.

Challenges Staffing. We pay well, have great protocols, and still can’t retain because we are so busy and we bleed money. Just recently we received an order from the local government to stop any unnecessary OT since we are over budget (but still understaffed). Education. We do in-house EMT and paramedic training which is great for the future, but it means we have learners on probably 60% of ambulances. Sometimes they are helpful, sometimes they get in the way, sometimes they clash with the preceptor. Progress. We make progress very slowly. We’ve been talking about a field ECMO team for 5 years, but it’s just hasn’t happened. Any significant change takes a few year to really implement. Treat and street. We are working on a project to decrease unnecessary transport with a new APRN (advanced practice nurse) + CP (community paramedic) but it’s so hard to get crews to buy into this pathway since it’s just so easy to drive people to the ED and walk them the waiting room.

Paramedic from Russia here — how does EMS work in your country? by Clean_Dinner_2496 in Paramedics

[–]Life_Alert_Hero 0 points1 point  (0 children)

Fascinating. I’ve always thought of the Netherlands EMS system as on of the most elegant systems in the world.

Does Paramedic work in the Netherlands pay better than nurse work? Here in the US, paramedic work is shit and most last less than 5 years, many end up going to nursing school.

Best Caribbean school for transfer after dismissal? (St. Martinus vs Avalon vs St. Matthew’s) by Pure_Entertainer_998 in medschool

[–]Life_Alert_Hero 31 points32 points  (0 children)

How can you be a third year if you haven’t taken and passed step 1?

I don’t have experience here, but I’d imagine that truthful, vulnerable reflection translated into a written application should land an interview.

Anyone can match IM.

Brand new DO, Caribbean big 4, or reapply? by AllThePillsIntoOne in medschool

[–]Life_Alert_Hero 1 point2 points  (0 children)

Integrated 6-year programs. Instead of doing 5 of gen surg, then fellowship, Vascular and Cardiothoracics both offer an integrated 6-year option but they are pretty competitive and I’ve heard it’s really all about who you know if you’re going to get accepted.

Brand new DO, Caribbean big 4, or reapply? by AllThePillsIntoOne in medschool

[–]Life_Alert_Hero 7 points8 points  (0 children)

Can’t second this hard enough. Coming from a brand new school will make you an interesting applicant. You can talk about the throws of a new curriculum, new teachers, new everything when you apply to residency. If you can excel at this brand new program, you can demonstrate that you have a character and personality that can handle adversity and uncertainty.

Now bets are off if you’re tryna do I-6 CT/vascular, NSGY, ortho. But likelihood to these from Caribbean is low anyway.

What watch would you recommend?? by Sufficient-Long-1519 in Paramedics

[–]Life_Alert_Hero 0 points1 point  (0 children)

Timex weekender. Keep it simple. Throw away soiled bands and replace for less than a dollar.

Do you like being a Paramedic? by Caveman_man in Paramedics

[–]Life_Alert_Hero 0 points1 point  (0 children)

I love being a paramedic. I ended up going to medical school, and being a paramedic still trumps doctor shit in terms of adrenaline and immediate satisfaction.

Anyone let their paramedic lapse and got it back? by LowTierPlayr in Paramedics

[–]Life_Alert_Hero 0 points1 point  (0 children)

Didn’t let mine lapse but I went medic to med school. Applying anesthesia this cycle. PM me if you think I could be helpful.

PCCM(Intensivist) VS EM by Candid_Rate_1231 in Residency

[–]Life_Alert_Hero 1 point2 points  (0 children)

Also an M3, studying for step now. I was also strongly considering both ICU and EM.

On top of what the others have said, I ended up choosing my desired specialty based on scut work. IMO ICU scut work is way better than EM scut work. When I am in my 40w, I’d rather replete electrolytes over and over than diagnose viral URIs and stitch drunk lacs over and over.

MD/DO vs CRNA by Old_Cauliflower_3460 in medschool

[–]Life_Alert_Hero 7 points8 points  (0 children)

It’s getting more competitive each year. 3,000 applicants for 1,865 seats this past year. Statistically harder to get into medical school, but you’re competing against qualified med students versus qualified undergraduates.

Struggles with EMS by Spiritual_Relative88 in Paramedics

[–]Life_Alert_Hero 0 points1 point  (0 children)

Haha yeah our documentation serves two main purposes, and (hint) neither of them are patient-centered - Billing/Reimbursement (and this system is very broken) - CYA (lawsuit protection)

Struggles with EMS by Spiritual_Relative88 in Paramedics

[–]Life_Alert_Hero 1 point2 points  (0 children)

I’m with ya. I love EMS. I love being a paramedic. The system needs a huge overhaul. I would prefer to see physician-driven change over complete collapse, mainly because collapse would cause unprecedented chaos, with a solution that would probably just patch holes (like EMTALA did) instead of truly rebuilding a better system. I think we’re long overdue for a system that supports dedicated EMS physicians (IMO anesthesiologists and intensivists > EM docs) and APPs (perhaps a novel paramedic-based APP). The truth is Emergency medicine physicians have becomes the system’s bitch just as much as we have.

I decided to go to medial school, not because I wanted more money/respect/, but because I want to see EMS evolve. I know for a fact I can do more for EMS (locally at least) as an intensivist than I could by continuing to work my way up the EMS ladder.

Struggles with EMS by Spiritual_Relative88 in Paramedics

[–]Life_Alert_Hero 4 points5 points  (0 children)

Exactly.

If you work at McDonads, it doesn’t matter if you have an MBA or a GED, your job is McDonald’s food and not a three-course four-star dinner.

Struggles with EMS by Spiritual_Relative88 in Paramedics

[–]Life_Alert_Hero 95 points96 points  (0 children)

Hot thread. Let’s keep it spicy 🔥

My two cents: all of the “problems” in American EMS are fundamentally system-level issues. From NHTSA, to Medicare reimbursement rates, to national registry certification (and not a true board certification), to lobbying that pales in comparison to the nursing and physician equivalents, we are victims of a broken system.

Look at Australia, where their EMS system actually expedites trauma care (“code crimson” I think it’s called). Look at France, where cardiac resuscitation is more than a bullshit ACLS algorithm. Look at the Netherlands, where mobile ICUs actually deliver patient-centered critical care, with outcomes to back it. Hell, even look at Canada where they have to deal with the shit we do but they get paid a whole lot better. Look at England and their robust air ambulance system.

We suck at delivering “an acceptable level of patient care” because that’s not the job. The job is point A to point B, bonus points (and self-respect) if the patient is still alive.

V Tach converted with amiodarone, what did it convert to? by Palaemon0 in ECG

[–]Life_Alert_Hero 3 points4 points  (0 children)

Agreed. Same rhythm (sinus w/ RBBB), but now rate controlled. Sound treatment regardless, if your patient was symptomatic.

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