Re: Progressive services?

[Guest guest]

On Wednesday, March 24, 2010 23:26, " Louis N. Molino, Sr. " lnmolino@...>

said:

> I'll grant you that point about 20 year Medics but isn't a 5 year

> Medic who treats only ALS Patients likely to have more Patient Contact

> Houra (for want of a measure). Therfore those Patient Contacts are

> more meanigful ( for want of a better term) to that Medic and his

> professional development?

I don't think I have disagreed with anything here more in a very long time than

this.

Lou, I thought you said you didn't like " paragods " . The above quote sounds like

it came straight from the mouth of one. " I'm a paramedic! I am too important

to be bothered with anyone who doesn't require ALS! Give me an EMT so I can

dump them all on him! "

Those are exactly the kinds of " paragods " that most EMTs end up hating.

Rob

[Guest guest]

The perfect system... you mean the one without people?

I can't wait to see how they do it!

Alyssa Woods, EMT-B/PFF

(The above was written out of humor and not anger, aggression, or any

such negativity.)

> Ah but you assume the world is populated with a majority of

> Paramedic Providers and while it is in Texas there are other places

> outside the Great Republic where the Systems I describe do in fact

> exsit.

>

> I'll grant you that point about 20 year Medics but isn't a 5 year

> Medic who treats only ALS Patients likely to have more Patient Contact

> Houra (for want of a measure). Therfore those Patient Contacts are

> more meanigful ( for want of a better term) to that Medic and his

> professional development?

>

> We've discussed studies where having multiple Medics on a scene has a

> possible harmful outcome to the ALS Patient and we've talked about

> skills degredation in all or mostly Medic based systems hence those

> things suggest that less is more, do they not?

>

> I have nothing but respect for good Medics I know dozens from around

> the world. I envy them as I was one of those 7 year olds that long on

> a Saturday night wanted to be ny Gage. I never got there but it's

> been a wild ride ever since.

>

> The perfect system doesn't exsit maybe conversations such as this will

> make it possible.

>

> Louis N. Molino, Sr. CET

> FF/NREMT/FSI/EMSI

> Typed by my fingers on my iPhone.

> Please excuse any typos.

> (Cell)

> LNMolino@...

>

>

>

> > I'm going to take the rare step of agreeing with Rob on this one.

> >

> > Mark the date, folks.

> >

> > While Lou's suggestion of finding a place to practice to the fullest

> > extent of your training and finding a paramedic mentor to shepherd

> you

> > through your first few years of EMT practice are good in theory...

> >

> > ... in my experience, it rarely works that way in practice. There

> are

> > very few paramedics out there with twenty years of experience, and

> > many

> > more with one year of experience repeated twenty times.

> >

> > It's the first kind that every green EMT wants as a partner, but

> it's

> > the second type they usually get. And when they come to paramedic

> > class,

> > I am usually faced with a supposedly " experienced " basic whose sum

> > total

> > of field experience has only taught him to be rude, cynical, take

> > shortcuts, and memorize all the fast-food joints that give EMT

> > discounts.

> >

> > , the good news is, the medics you want to emulate are pretty

> > easy

> > to spot, and even the idiots can teach you how *not* to act. Where

> you

> > wind up working isn't so important as who you wind up working

> *with.*

> >

> >

> > >

> > > On Wednesday, March 24, 2010 19:40, krin135@...

> > > said:

> > >

> > > > Is there a reason a paramedic can't stand back and let his/her

> > basic

> > > > partner handle a basic run while providing tutelage to the

> basic?

> > >

> > > In reality, it's rarely " tutelage " . It's the " paragod " syndrome

> that

> > > Lou referred to, where the medic simply dumps those patients he

> > deems

> > > unworthy of his presence onto the lesser provider. Without an

> EMT to

> > > dump on, there are no " paragods " .

> > >

> > > But more importantly, if the EMT is doing any of those things

> the OP

> > > listed, besides splinting, then it's not a " basic run " , so it's a

> > moot

> > > point. And if that is the case, I as a medic don't want a

> helper. I

> > > want a full partner.

> > >

> > > , don't rush things. You've still got two years of college

> > ahead

> > > of you to become a paramedic. Take things deliberately as they

> come.

> > > It is my experience that those EMTs with the least experience make

> > the

> > > best paramedic students. They don't come in with all the bad

> habits

> > > and mistaken notions picked up from Lou's " paragods " , and are

> > > therefore much more receptive of education. Be that guy.

> > >

> > > Good luck,

> > >

> > > Rob

> > >

> > >

> >

> > --

> > Grayson, CCEMT-P www.kellygrayson.com

> >

> >

[Guest guest]

The perfect system... you mean the one without people?

I can't wait to see how they do it!

Alyssa Woods, EMT-B/PFF

(The above was written out of humor and not anger, aggression, or any

such negativity.)

> Ah but you assume the world is populated with a majority of

> Paramedic Providers and while it is in Texas there are other places

> outside the Great Republic where the Systems I describe do in fact

> exsit.

>

> I'll grant you that point about 20 year Medics but isn't a 5 year

> Medic who treats only ALS Patients likely to have more Patient Contact

> Houra (for want of a measure). Therfore those Patient Contacts are

> more meanigful ( for want of a better term) to that Medic and his

> professional development?

>

> We've discussed studies where having multiple Medics on a scene has a

> possible harmful outcome to the ALS Patient and we've talked about

> skills degredation in all or mostly Medic based systems hence those

> things suggest that less is more, do they not?

>

> I have nothing but respect for good Medics I know dozens from around

> the world. I envy them as I was one of those 7 year olds that long on

> a Saturday night wanted to be ny Gage. I never got there but it's

> been a wild ride ever since.

>

> The perfect system doesn't exsit maybe conversations such as this will

> make it possible.

>

> Louis N. Molino, Sr. CET

> FF/NREMT/FSI/EMSI

> Typed by my fingers on my iPhone.

> Please excuse any typos.

> (Cell)

> LNMolino@...

>

>

>

> > I'm going to take the rare step of agreeing with Rob on this one.

> >

> > Mark the date, folks.

> >

> > While Lou's suggestion of finding a place to practice to the fullest

> > extent of your training and finding a paramedic mentor to shepherd

> you

> > through your first few years of EMT practice are good in theory...

> >

> > ... in my experience, it rarely works that way in practice. There

> are

> > very few paramedics out there with twenty years of experience, and

> > many

> > more with one year of experience repeated twenty times.

> >

> > It's the first kind that every green EMT wants as a partner, but

> it's

> > the second type they usually get. And when they come to paramedic

> > class,

> > I am usually faced with a supposedly " experienced " basic whose sum

> > total

> > of field experience has only taught him to be rude, cynical, take

> > shortcuts, and memorize all the fast-food joints that give EMT

> > discounts.

> >

> > , the good news is, the medics you want to emulate are pretty

> > easy

> > to spot, and even the idiots can teach you how *not* to act. Where

> you

> > wind up working isn't so important as who you wind up working

> *with.*

> >

> >

> > >

> > > On Wednesday, March 24, 2010 19:40, krin135@...

> > > said:

> > >

> > > > Is there a reason a paramedic can't stand back and let his/her

> > basic

> > > > partner handle a basic run while providing tutelage to the

> basic?

> > >

> > > In reality, it's rarely " tutelage " . It's the " paragod " syndrome

> that

> > > Lou referred to, where the medic simply dumps those patients he

> > deems

> > > unworthy of his presence onto the lesser provider. Without an

> EMT to

> > > dump on, there are no " paragods " .

> > >

> > > But more importantly, if the EMT is doing any of those things

> the OP

> > > listed, besides splinting, then it's not a " basic run " , so it's a

> > moot

> > > point. And if that is the case, I as a medic don't want a

> helper. I

> > > want a full partner.

> > >

> > > , don't rush things. You've still got two years of college

> > ahead

> > > of you to become a paramedic. Take things deliberately as they

> come.

> > > It is my experience that those EMTs with the least experience make

> > the

> > > best paramedic students. They don't come in with all the bad

> habits

> > > and mistaken notions picked up from Lou's " paragods " , and are

> > > therefore much more receptive of education. Be that guy.

> > >

> > > Good luck,

> > >

> > > Rob

> > >

> > >

> >

> > --

> > Grayson, CCEMT-P www.kellygrayson.com

> >

> >

[Guest guest]

Not at all what I meant.

In a system that has 6 two man medic units on the street at any moment with

500,000 plus or minus population Medics turf BLS jobs to BLS and BLS

recall the ALS on BLS only jobs day in and day out as a part of resources

management.

Louis N. Molino, Sr., CET

FF/NREMT-B/FSI/EMSI

Freelance Consultant/Trainer/Author/Journalist/Fire Protection Consultant

LNMolino@...

(Cell Phone)

" A Texan with a Jersey Attitude "

" Great minds discuss ideas; Average minds discuss events; Small minds

discuss people " Eleanor Roosevelt - US diplomat & reformer (1884 - 1962)

In a message dated 3/25/2010 12:47:09 A.M. Central Daylight Time,

rob.davis@... writes:

On Wednesday, March 24, 2010 23:26, " Louis N. Molino, Sr. "

_lnmolino@..._ (mailto:lnmolino@...) > said:

> I'll grant you that point about 20 year Medics but isn't a 5 year

> Medic who treats only ALS Patients likely to have more Patient Contact

> Houra (for want of a measure). Therfore those Patient Contacts are

> more meanigful ( for want of a better term) to that Medic and his

> professional development?

I don't think I have disagreed with anything here more in a very long time

than this.

Lou, I thought you said you didn't like " paragods " . The above quote sounds

like it came straight from the mouth of one. " I'm a paramedic! I am too

important to be bothered with anyone who doesn't require ALS! Give me an EMT

so I can dump them all on him! "

Those are exactly the kinds of " paragods " that most EMTs end up hating.

Rob

[Guest guest]

Not at all what I meant.

In a system that has 6 two man medic units on the street at any moment with

500,000 plus or minus population Medics turf BLS jobs to BLS and BLS

recall the ALS on BLS only jobs day in and day out as a part of resources

management.

Louis N. Molino, Sr., CET

FF/NREMT-B/FSI/EMSI

Freelance Consultant/Trainer/Author/Journalist/Fire Protection Consultant

LNMolino@...

(Cell Phone)

" A Texan with a Jersey Attitude "

" Great minds discuss ideas; Average minds discuss events; Small minds

discuss people " Eleanor Roosevelt - US diplomat & reformer (1884 - 1962)

In a message dated 3/25/2010 12:47:09 A.M. Central Daylight Time,

rob.davis@... writes:

On Wednesday, March 24, 2010 23:26, " Louis N. Molino, Sr. "

_lnmolino@..._ (mailto:lnmolino@...) > said:

> I'll grant you that point about 20 year Medics but isn't a 5 year

> Medic who treats only ALS Patients likely to have more Patient Contact

> Houra (for want of a measure). Therfore those Patient Contacts are

> more meanigful ( for want of a better term) to that Medic and his

> professional development?

I don't think I have disagreed with anything here more in a very long time

than this.

Lou, I thought you said you didn't like " paragods " . The above quote sounds

like it came straight from the mouth of one. " I'm a paramedic! I am too

important to be bothered with anyone who doesn't require ALS! Give me an EMT

so I can dump them all on him! "

Those are exactly the kinds of " paragods " that most EMTs end up hating.

Rob

[Guest guest]

Likely the dumbest response from someone I think is way more educated and

inelegant than it alone would leave me to believe. .

Last I checked O2 and BVM's were both well into the realm of BLS and

frankly if anyone chases an ALS provider from anyone who is even SOB let alone

not breathing I would like to shoot them for gross stupidity. It's called a

load and go in most places I believe, or would you have me sit on scene for

the Medic Unit?

Rob, it's obvious you and I are on opposite sides of this argument.

I will let it die but I do feel sorry in ways for any BLS provider that you

deal with.

Louis N. Molino, Sr., CET

FF/NREMT-B/FSI/EMSI

Freelance Consultant/Trainer/Author/Journalist/Fire Protection Consultant

LNMolino@...

(Cell Phone)

" A Texan with a Jersey Attitude "

" Great minds discuss ideas; Average minds discuss events; Small minds

discuss people " Eleanor Roosevelt - US diplomat & reformer (1884 - 1962)

In a message dated 4/1/2010 6:52:40 P.M. Central Daylight Time,

rob.davis@... writes:

On Wednesday, March 31, 2010 17:10, " Louis N. Molino, Sr. "

_lnmolino@..._ (mailto:lnmolino@...) > said:

> If BLS arrives and recalls the Medic the BLS. Often it's a matter of 7

> minutes till the ALS arrives versus 5 to Lue hospital.

Hold your breath for seven minutes, then get back to me on this theory.

Rob

[Guest guest]

On Thursday, April 1, 2010 19:08, lnmolino@... said:

> It's called a load and go in most places I believe, or would you have me

> sit on scene for the Medic Unit?

No. I would have you send an appropriate response to the patient in the first

place, so you don't have to go to plan B.

That's the point.

Rob

[Guest guest]

On Thursday, April 1, 2010 19:08, lnmolino@... said:

> It's called a load and go in most places I believe, or would you have me

> sit on scene for the Medic Unit?

No. I would have you send an appropriate response to the patient in the first

place, so you don't have to go to plan B.

That's the point.

Rob

[Guest guest]

On Thursday, April 1, 2010 19:08, lnmolino@... said:

> It's called a load and go in most places I believe, or would you have me

> sit on scene for the Medic Unit?

No. I would have you send an appropriate response to the patient in the first

place, so you don't have to go to plan B.

That's the point.

Rob

[Guest guest]

Ok only systems where you work are any good all others are second

class. You win

Louis N. Molino, Sr. CET

FF/NREMT/FSI/EMSI

Typed by my fingers on my iPhone.

Please excuse any typos.

(Cell)

LNMolino@...

On Apr 1, 2010, at 19:40, " rob.davis@... "

rob.davis@...

> wrote:

> On Thursday, April 1, 2010 19:08, lnmolino@... said:

>

> > It's called a load and go in most places I believe, or would you

> have me

> > sit on scene for the Medic Unit?

>

> No. I would have you send an appropriate response to the patient in

> the first place, so you don't have to go to plan B.

>

> That's the point.

>

> Rob

>

>

[Guest guest]

Ok only systems where you work are any good all others are second

class. You win

Louis N. Molino, Sr. CET

FF/NREMT/FSI/EMSI

Typed by my fingers on my iPhone.

Please excuse any typos.

(Cell)

LNMolino@...

On Apr 1, 2010, at 19:40, " rob.davis@... "

rob.davis@...

> wrote:

> On Thursday, April 1, 2010 19:08, lnmolino@... said:

>

> > It's called a load and go in most places I believe, or would you

> have me

> > sit on scene for the Medic Unit?

>

> No. I would have you send an appropriate response to the patient in

> the first place, so you don't have to go to plan B.

>

> That's the point.

>

> Rob

>

>

[Guest guest]

Nice try at diversion, but I am retired and have been for years. If you are

unable to articulate your point intelligently, at least have the integrity to

admit it and not waste our time with silly diversionary tactics.

Rob

On Thursday, April 1, 2010 20:41, " Louis N. Molino, Sr. " lnmolino@...>

said:

> Ok only systems where you work are any good all others are second

> class. You win

>

> Louis N. Molino, Sr. CET

> FF/NREMT/FSI/EMSI

> Typed by my fingers on my iPhone.

> Please excuse any typos.

> (Cell)

> LNMolino@...

[Guest guest]

Nice try at diversion, but I am retired and have been for years. If you are

unable to articulate your point intelligently, at least have the integrity to

admit it and not waste our time with silly diversionary tactics.

Rob

On Thursday, April 1, 2010 20:41, " Louis N. Molino, Sr. " lnmolino@...>

said:

> Ok only systems where you work are any good all others are second

> class. You win

>

> Louis N. Molino, Sr. CET

> FF/NREMT/FSI/EMSI

> Typed by my fingers on my iPhone.

> Please excuse any typos.

> (Cell)

> LNMolino@...

[Guest guest]

Nice try at diversion, but I am retired and have been for years. If you are

unable to articulate your point intelligently, at least have the integrity to

admit it and not waste our time with silly diversionary tactics.

Rob

On Thursday, April 1, 2010 20:41, " Louis N. Molino, Sr. " lnmolino@...>

said:

> Ok only systems where you work are any good all others are second

> class. You win

>

> Louis N. Molino, Sr. CET

> FF/NREMT/FSI/EMSI

> Typed by my fingers on my iPhone.

> Please excuse any typos.

> (Cell)

> LNMolino@...

[Guest guest]

Stirring the pot a bit this evening, are we, Rob?

Moseley

On Thu, Apr 1, 2010 at 8:55 PM, rob.davis@... <

rob.davis@...> wrote:

>

>

> Nice try at diversion, but I am retired and have been for years. If you are

> unable to articulate your point intelligently, at least have the integrity

> to admit it and not waste our time with silly diversionary tactics.

>

> Rob

>

>

> On Thursday, April 1, 2010 20:41, " Louis N. Molino, Sr. "

lnmolino@...>

> said:

>

> > Ok only systems where you work are any good all others are second

> > class. You win

> >

> > Louis N. Molino, Sr. CET

> > FF/NREMT/FSI/EMSI

> > Typed by my fingers on my iPhone.

> > Please excuse any typos.

> > (Cell)

> > LNMolino@...

>

>

>

[Guest guest]

Stirring the pot a bit this evening, are we, Rob?

Moseley

On Thu, Apr 1, 2010 at 8:55 PM, rob.davis@... <

rob.davis@...> wrote:

>

>

> Nice try at diversion, but I am retired and have been for years. If you are

> unable to articulate your point intelligently, at least have the integrity

> to admit it and not waste our time with silly diversionary tactics.

>

> Rob

>

>

> On Thursday, April 1, 2010 20:41, " Louis N. Molino, Sr. "

lnmolino@...>

> said:

>

> > Ok only systems where you work are any good all others are second

> > class. You win

> >

> > Louis N. Molino, Sr. CET

> > FF/NREMT/FSI/EMSI

> > Typed by my fingers on my iPhone.

> > Please excuse any typos.

> > (Cell)

> > LNMolino@...

>

>

>

[Guest guest]

Paramedics may save lives, but Basics save paramedics.

Can you tell that Mr. Grayson and I have worked together in the past?

ck

In a message dated 4/2/2010 10:45:20 Central Daylight Time,

Grayson902@... writes:

And EMTs can't ventilate and manage an airway?

Don't look now, Rob, but your anti-EMT bias is showing.

On 4/1/2010 6:52 PM, _rob.davis@..._

(mailto:rob.davis@...) wrote:

>

> On Wednesday, March 31, 2010 17:10, " Louis N. Molino, Sr. "

> _lnmolino@..._ (mailto:lnmolino@...)

> said:

>

> > If BLS arrives and recalls the Medic the BLS. Often it's a matter of 7

> > minutes till the ALS arrives versus 5 to Lue hospital.

>

> Hold your breath for seven minutes, then get back to me on this theory.

>

> Rob

>

>

--

Grayson, CCEMT-P www.kellygrayson.Kel

[Non-text portions of this message have been removed]

[Guest guest]

And EMTs can't ventilate and manage an airway?

Don't look now, Rob, but your anti-EMT bias is showing.

>

> On Wednesday, March 31, 2010 17:10, " Louis N. Molino, Sr. "

> lnmolino@... > said:

>

> > If BLS arrives and recalls the Medic the BLS. Often it's a matter of 7

> > minutes till the ALS arrives versus 5 to Lue hospital.

>

> Hold your breath for seven minutes, then get back to me on this theory.

>

> Rob

>

>

--

Grayson, CCEMT-P www.kellygrayson.com

[Guest guest]

And EMTs can't ventilate and manage an airway?

Don't look now, Rob, but your anti-EMT bias is showing.

>

> On Wednesday, March 31, 2010 17:10, " Louis N. Molino, Sr. "

> lnmolino@... > said:

>

> > If BLS arrives and recalls the Medic the BLS. Often it's a matter of 7

> > minutes till the ALS arrives versus 5 to Lue hospital.

>

> Hold your breath for seven minutes, then get back to me on this theory.

>

> Rob

>

>

--

Grayson, CCEMT-P www.kellygrayson.com

[Guest guest]

And EMTs can't ventilate and manage an airway?

Don't look now, Rob, but your anti-EMT bias is showing.

>

> On Wednesday, March 31, 2010 17:10, " Louis N. Molino, Sr. "

> lnmolino@... > said:

>

> > If BLS arrives and recalls the Medic the BLS. Often it's a matter of 7

> > minutes till the ALS arrives versus 5 to Lue hospital.

>

> Hold your breath for seven minutes, then get back to me on this theory.

>

> Rob

>

>

--

Grayson, CCEMT-P www.kellygrayson.com

[Guest guest]

it may be, but in the last 30 years, I have seen more Paramedics who have

either forgotten the basic techniques or forgotten how to apply them than I

like to think about.

Kind of like doctors and nurses in mass casualty situations who get tied up

dealing with one patient when they need to be supervising the care of

many...

ck

In a message dated 4/3/2010 03:41:04 Central Daylight Time,

rob.davis@... writes:

On Friday, April 2, 2010 10:56, _krin135@..._ (mailto:krin135@...)

said:

> Paramedics may save lives, but Basics save paramedics.

Yeah, and cops save lives, but meter maids save cops.

Puhleeze... that platitude is so wore out.

Rob

[Guest guest]

it may be, but in the last 30 years, I have seen more Paramedics who have

either forgotten the basic techniques or forgotten how to apply them than I

like to think about.

Kind of like doctors and nurses in mass casualty situations who get tied up

dealing with one patient when they need to be supervising the care of

many...

ck

In a message dated 4/3/2010 03:41:04 Central Daylight Time,

rob.davis@... writes:

On Friday, April 2, 2010 10:56, _krin135@..._ (mailto:krin135@...)

said:

> Paramedics may save lives, but Basics save paramedics.

Yeah, and cops save lives, but meter maids save cops.

Puhleeze... that platitude is so wore out.

Rob

[Guest guest]

it may be, but in the last 30 years, I have seen more Paramedics who have

either forgotten the basic techniques or forgotten how to apply them than I

like to think about.

Kind of like doctors and nurses in mass casualty situations who get tied up

dealing with one patient when they need to be supervising the care of

many...

ck

In a message dated 4/3/2010 03:41:04 Central Daylight Time,

rob.davis@... writes:

On Friday, April 2, 2010 10:56, _krin135@..._ (mailto:krin135@...)

said:

> Paramedics may save lives, but Basics save paramedics.

Yeah, and cops save lives, but meter maids save cops.

Puhleeze... that platitude is so wore out.

Rob

[Guest guest]

ah...then you are misunderstanding the meaning of the platitude by taking

it at apparent face value.

One of the things repeatedly emphasized in ACLS and ATLS (as much as I

despise the merit badge approach to medical education) is that if the patient

is NOT getting better, go back to basics and reevaluate your patients from

the ABCs.

These are the basics that save paramedics (and doctors and nurses)-

remembering and applying basic principles to every patient who is not responding

as expected.

Things like appropriate air movement as the gold standard of ventilation;

that leaks need to be plugged before fluids are poured in, so " don't pop

the clots; " hyperglycemia is bad but hypoglycemia is worse; paralysis does

not mean pain/panic relief; a very gravid patient should not be laying flat

on her back; and that the best antibiotic is often the hand washing and hand

sanitizing done before touching the patient (including sanitizing your

stethescope).

ck

In a message dated 4/3/2010 04:18:54 Central Daylight Time,

rob.davis@... writes:

If your EMTs are saving your paramedics, your paramedics suck, and your

system needs some serious work.

[Guest guest]

ah...then you are misunderstanding the meaning of the platitude by taking

it at apparent face value.

One of the things repeatedly emphasized in ACLS and ATLS (as much as I

despise the merit badge approach to medical education) is that if the patient

is NOT getting better, go back to basics and reevaluate your patients from

the ABCs.

These are the basics that save paramedics (and doctors and nurses)-

remembering and applying basic principles to every patient who is not responding

as expected.

Things like appropriate air movement as the gold standard of ventilation;

that leaks need to be plugged before fluids are poured in, so " don't pop

the clots; " hyperglycemia is bad but hypoglycemia is worse; paralysis does

not mean pain/panic relief; a very gravid patient should not be laying flat

on her back; and that the best antibiotic is often the hand washing and hand

sanitizing done before touching the patient (including sanitizing your

stethescope).

ck

In a message dated 4/3/2010 04:18:54 Central Daylight Time,

rob.davis@... writes:

If your EMTs are saving your paramedics, your paramedics suck, and your

system needs some serious work.