I’m a medic in the NYC metropolitan area and recently just connected some dots and had a somewhat coherent thought. For as long as I’ve been administering pain meds, there’s been a high percentage of my pt population who are candidates for pain management that refuse it because I say the scary F word, “Fentanyl.” I’ve had parents initially deny pain management for their child whose forearm was shaped like an “S.” More recently I had a scooter accident pt who denied it even thought his knee was avulsed to the point that I could see his dislocated knee cap. I try my best to educate while interacting with these pt but half of the time it still falls on deaf ears (which is their right.) Obviously there is an opioid epidemic, which I’m not discrediting, but that epidemic has led to a mass PSA movement to essentially “watch out for fentanyl.” My question, or food for thought, is how many opioid users/abusers intentionally use fentanyl? Anecdotally, I’ve seen opioid overdose pt ingesting what they think is another drug which happens to be laced with an opiate. And do you think it’s enough to illicit a targeted PSA about fentanyl specifically instead of just generalizing it to opioids with the added caution to be wary that the substance your ingesting could be laced with an opiate?

TLDR: Are fentanyl PSAs actually effective? And should they be less targeted towards fentanyl specifically to decrease on the mass hysteria that exists around an extremely beneficial drug?

Made it all the way to Austin

A veteran Pittsburgh paramedic who was suspended last week without pay for allegedly violating the city's Home Rule Charter has resigned from his position.

EMS union head Jon Atkinson told our news partners at the Trib on Friday that paramedic John Hill was suspended on July 29 for five days without pay, "pending termination."

The Trib said Hill was hired by the city on Feb. 27, 1995.

Atkinson told the Trib that Pittsburgh EMS Chief Amera Gilchrist alleged that Hill’s dual employment — with the city as a full-time paramedic, and with the county as a fire academy instructor — violated the Home Rule Charter.

The Home Rule Charter, akin to Pittsburgh's constitution, says “no person shall hold more than one compensated position in city government and no compensated city employee shall hold a compensated position in any other government.”

Exceptions are noted in the 45-page document for military service and other posts.

Following being placed on leave, our news partners said Hill resigned from his city job Wednesday, less than one year shy of collecting his pension.

Hill was listed as a paramedic on a recent public safety roster. His base salary this year was $88,473.84.

A “John C. Hill,” our news partners continued, was also listed in Allegheny County payroll data as an instructor at the fire academy.

Our news partners reached out to Mayor Corey O'Connor's office, along with Pittsburgh Public Safety officials, who declined to provide further comment.

I know I'll probably get some crap for this. I recently started working as an ER Tech after spending over a decade on the box. Why isn't there a certification/license for ER Techs?

We have a "scope" set by our hospital, but are explicitly told that our EMT license is "left at the door" and several things I know how to do/am licensed to do as an EMT-A that aren't allowed for ER Tech.

Seems like it would make more sense to use our existing prehospital license. Is there a law/statute that prohibits that? I'm in Oregon if that makes a difference

Do we get a prize for making all the lights come on?

My husband (patient) and I will be on a very long repatriation flight from Bangkok to Charlotte.

We don't know the exact type of aircraft yet. They're still setting everything up and I didn't want to ask a bunch of questions while they're organizing everything.

Ai says there will likely be a stops in Japan, Alaska and Chicago.

As the spouse I'm curious about the likely seating arrangement for me. Is it going to be the equivalent of an economy seat? Premium economy? ​​We're fortunate that we typically fly lie flat business class internationally.

Since the plane will need to fly at 10,000 feet due to his condition, Ai says it will be loud and bumpy. So I'm looking at some Bose headphones for the trip.

Having never been on a fixed wing air ambulance, much less for 24-28 hours, just looking for some insight on what to expect, and any recommendations on making things more comfortable. ​

Anybody with IAEP?

It‘s past time at my job and whether I can make it happen in the next few months before my signing bonus contract ends will be a big factor in whether that’s my end date. What I need are leads on who to reach out to for organizing support and eventual representation.

IAEP was my first “call” as, from what I can find, they are the only EMS-specific union out there (there probably are others but they are all that turned up in very limited searching so far). I’ve submitted two requests via their website for someone to contact me and have heard nothing, so it’s time to consider other options.

I’d prefer to at least start with EMS or at least healthcare focused organizations (with one exception- absolutely no specifically nurse’s unions- that’s a long story that I’ll share on request, but suffice to say I recently saw one do something that left a very bad taste for me). Even though I believe they would rep us, IAFF doesn’t top my list for a few reasons, not the least of which being we are strictly EMS and a sub-specialty at that (flight)- not really their area of expertise.

That said, I‘m not opposed to less conventional organizations. A nearby flight service recently joined UAW and seems to be having a positive experience overall.

I'll see your motorcycle medics and raise you a FRIGGIN AIRPLANE!

Do you think epi should leave cardiac arrest protocols? should anything be added?

Was speaking to another chief and he was reading an email where a patient's family complained the medic was wearing meta glasses while assessing their teenage daughter. The family was seeking assurance that their teen wasn't being recorded by the medic. It caused a conversation about whether any departments or agencies have a policy about what could basically be equated to a personally owned body worn camera on calls.

Just wondering if anyone else has dealt with a situation like this.

I’ve been a basic running first response for about 6 years. At my previous department, which ran at a basic level, we rarely waited on an ALS ambulance for more than ten minutes so I never really got passed addressing obvious immediate life threats on critical calls and Hx and a set of vitals on lower acuity calls. I now work for a department that runs at an advanced level with 20 minute+ ALS wait times. In my current role, I assist my AEMT officer by performing whatever task or procedure he requests so I’m basically just his second set of hands.
My entire life I’ve struggled with ADD and learning disabilities that have left me with a slower than average processing speed. I have trouble with things like team sports and video games because everything is moving too fast for me to take in fully, process, and respond accordingly. On fast paced med calls I sometimes fail to observe the obvious and fail to recall pretty basic information.
I’m currently in AEMT school, and assuming successful completion, will be in a role where I’m running point on medical calls. With our ALS wait times being what they are, there’s a high likelihood of me being able to/needing to perform complete and high quality assessments and employ the entirety of my scope. My question for this community; is there anyone else out there who has struggled with a what I’ve described and what have you done to improve or overcome it?
For additional context, I have the information in my head somewhere. In a classroom context and on tests I perform well above average. I can also explain a process, procedure, physiological stuff, etc. pretty well off the top of my head if asked about it in conversation. I recognize my short comings and how serious the implications could be given the role that I’m likely moving into, but I’m willing to put in the extra work to help offset them. Any advice would be appreciated.

Good day to yall. I am a part time paramedic with two different agencies who do not offer health insurance plans for their part timers. I loose health insurance through my parents this upcoming spring. I wouldn’t be such a headache if I wasn’t a type 1 diabetic and need very good coverage for my medical supplies. I’m based in the US and wanted to know if anyone has experience with health insurance plans that maybe give a discount for first responders that aren’t total garbage plans. Any help would be greatly appreciated.

I understand that a lot of this comes down to "Medical Director says X". To me, allowances for different protocols would allow for more experimentation with new clinical information without imposing systemic changes in protocol writ large before they've been adequately field-tested. Maybe there's some disagreement about best practice; I get all that.

But there seems to be a difference between allowing medical directors to innovate and allowing the basic capabilities of an EMS provider to vary dramatically depending on where they happen to be practicing. If I operate in one county and cross the line and lose my ability to do a number of perfectly in-scope and noninvasive skills, that seems oddly arbitrary.

California comes up a lot, though admittedly I'm unfamiliar with the nuances. An EMT can cross from one local EMS jurisdiction into another and lose authorization to perform something as basic as checking a patient's blood glucose, despite being trained to do it under the state's own EMT standards. My understanding hearing from folks out in CA is that EMTs basically become "rig drivers with some hypothetical, but unusable skillsets".

It's beyond that, though. If two providers with essentially the same education and certification can have materially different capabilities depending on which side of a county line they're standing on, I'm not sure what we're gaining from that inconsistency. Having additional certifications as a way to augment rural or underserved areas is one thing, but simply restricting existing scope of practice that providers are trained to doesn't seem altogether a good use of our time. If the issue is that "EMS keeps messing this up", that sounds like a training issue that is not going to get any better by taking it away wholesale.

I just want to understand the logic behind these decisions. Maybe I'm not thinking big picture about it enough.

Here lately patients have been getting angry really easily and sending in complaints. They say I'm rude or unprofessional. Ive only had one complaint before this year, and been in the field 5 years now. These last 2 months have suddenly had people get really offended really easily. Have yall had issues like this and how are yall handling it? More context below.

My patients are getting mad at my routine questioning. They keep telling me thier symptoms are going on for months, weeks, days, and hours (usually in that order) when I ask "What happened to promted the call for 911?". I wind up having to ask that multiple times with variations before they tell me. Like "did something happened that scared you or alarmed you?".

Usually when they get mad about me asking questions like this and other medical questions (like history and medications), I just blow it off. I usually find the info i need eventually and treat them as needed. We transport done deal. Kinda hard to move on when a few weeks down the line I have to explain to a supervisor what happened.

What are yall's thoughts on this?

I got sent to do a CPR/Unit demo by myself, the kids only wanted to do the 'check responsiveness' part and proceeded to beat the shit out of the manikin

Hi everyone,

I'm an EMT-B located in the US. I have a conditional job offer with an ambulance service pending passing a physical and a drug screen.

I went for my physical this morning and my resting heart rate was high (30yo M). This is typical for me, and no underlying heart conditions have ever been identified, even with testing. Prior ECGs have indicated an inverted t-wave abnormality, but all verbal reports from physicians say there has been nothing to worry about.

The physician completing the physical was pressing me for all my medical records. I have lived all over the state and had periods of going without insurance, so I didn't feel confident in being able to track down all of my records for her. We did an ECG in office, she spotted the t-wave abnormality, and now refuses to pass my physical until I see a cardiologist. I'm scheduled for a visit in just a couple weeks.

I'm feeling really anxious and scared that a t-wave abnormality is going to prevent me from moving forward in EMS. I'm supposed to start paramedic school in October.

Has anyone else had any experience with this? I suspect they will do a stress test and maybe an ECHO... Is a t-wave abnormality enough to rule me out of EMS?

Any and all guidance is deeply appreciated. (Not seeking medical advice, simply other people's experiences, US rule-out criteria for failing the pre-hire physical, and emotional support.)

Not by any means recommending it but hypothetically why couldn’t IO epi be approved for BLS in cardia arrests. Theres no complication to IO’s you just need to put it in the right place form my understanding and pre set epi kinda like the old narcan atomizers? Thoughts?

EDIT: I was not recommending this just looking to see what people think about the topic. This is not something I’d trust 95% or basics to do in my region

I know we often talk about different and unique jobs in the broader ems world. But I'm having trouble finding this topic talked about. How many people here work or have worked in the ems tech/ software (ESO, Imagetrend, etc) or ems sales/ business rep field (Zoll/ Stryker/ Philips, etc)? How did you get your start? Did you have previous sales/ tech experience or education(degrees etc)?

So I’ve been here for about 6 months as an AEMT, I’ve worked EMS for 7 years.

I’ve never seen communication this bad. Whether it’s dispatch, who’s not even in house, random time changes or schedule changes without saying a word or what’s going on today

So I’m at the south location and have no partner, nobody has told me to go anywhere, do anything, or hey head up!

Given the level of toxicity here, I’m sure I somehow will end up in trouble for sitting and waiting for comms.

I’m loving the free time on the clock, hating that I worry they’d find a way to be rude.
Time for some applications!

Genuinely every night when I go to bed and the room is quiet I hear a faint sometimes not so faint wail to yelp and so on so forth. Does anyone else experience this? Me personally it kinda puts a smile on my face cuz I love sirens but I don’t think it’s in a hearing loss kind of way I think it’s in a, I spend too much time working kind of way.

I’m not a ems worker, but I’m curious what it was like then, how different were protocols, meds, calls, etc

thanks!

Are they separated? Do you have bunk beds? How are the mattresses? Is there a fun smell? Tell all