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Hey Ian,

I'm a Paramedic in Northern Maine. I work for the largest service north of Bangor. I know where you are coming from.

I want to respond to a few of your comments though. I hear countless EMS providers in the area complain about the lack of recognition of EMTs and Paramedics during the 911 incident. It is definitely a heart felt and legitimate complaint. I feel the same way. The only thing I can offer you to make you feel a little bit better is that as an ex-New Yorker myself, I can tell you many EMS providers perform a dual role as Firefighter/EMT on behalf of the fire department. Many of the few hundred fire fighters who lost their lives were EMTs. Now keep in mind that as they fell, they were acting as firefighters which in the public eye warrants the consolation on behalf of the fire service.
Is it right to look at it this way? Not really, because there were private services involved with the losses; but putting it this way tends to make me feel a bit better.

The problem is that EMS is a very underrated profession. The general public still views us as "Ambulance Drivers". Most do not know about the Associates degree I had to get to "drive the ambulance". Or the recent requirements placed upon us such as Advanced Cardiac Life Support or the Paramedic Interfacility Transfer Module which now makes us responsible for 30+ additional meds (on top of the 60 we already had to know). They do not know that we perfom tasks equivelant to what the doctor performs in the ER. They do not know that we even perform tasks that Registered Nurses can not perform (such as intubation, chest decompression, surgical trach's, etc...).
All they know is that they call the ambulance and we "Drive" them or a loved one to the hospital. The sad thing is that it is going to take years to overcome this problem and get EMS to be viewed as something more than just "Driving the Ambulance".

As far as the show goes, I actually tried watching a few episodes, but found that it fell far short of what actually happens in EMS. Take for example the episode when Wyatt pushes the "Crush Meds" despite direct orders from medical control not to. You know as well as I do, if that actually happened; you would be handing in your license in the not too distant future. The way I see it with this sort of portrayal of EMS on behalf of producers is that in order for the EMS concept in a TV show to sell, they have to add quite a bit of drama and exagerate many situations. The reason for this should not be a mystery to you. An actual day of EMS does not make for a prime time show without the exageration. Grandma can't have a bowel movement, some deadbeat who doesn't have a car and calls the ambulance because letting medicaid pick up the bill rather than paying for a cab is much cheaper for a simple ailment like a sore throat, or the repetitive shortness of breath calls for people who still have a cigarette jammed in their mouth when you arrive, or the.... Well you get my point. Only about 10% - 15% are calls worthy of being placed in the concept of a TV show. Repetive protocols and procedures to go along with these common calls do not make a hit show either. So I can accept the exageration, but some of the show content was downright wrong. Couple that with less than average acting (Elizabeth Reaser, Curtis Caravaggio to name a couple) I can see why the show didn't last long. As a Paramedic, I was hoping for so much more for it.

I hope my views help out a bit, and sorry for being so long winded.


...There is no spoon! (The Matrix)

Capman,
At the service in St. Louis that I work at, we do have standing orders for all of those drugs that you mentioned, except fentanyl because we don't carry it anymore. We only need on line med control for special circumstances ie: patient with pain that is on a pain management regimin. I do have to call for some repeats, and additional or abnormal doses. I can give morphine without asking, but only up to 4mg, so if the patient needs more, I have to ask. I am even expected to manage abd pain. You are correct about different states and standing orders. Most services in my area have standing orders for every first line intervention. DOPamine is considered a first line drug in suspected cardiogenic shock, so in that case it is covered under my standing orders starting at 5mcg, and titrate to effect. Versed for premedication for cardioversion, and also for post endotracheal intubation is covered. Ativan I can give for seizures up to 2mg, and also 2mg IM for chemical restraint - covered. Benadryl is a first line intervention for allergic reaction and anaphalaxis, I would hope that would be a standard standing order along with SQ epi. Phenergan is covered for N/V and anytime I give morphine or demerol. In this area, our hospitals are all very busy, and so are we. Most physicians would rather we just call and tell a RN what we were called for, what we found, and our progress treating the patient, then ETA. They don't want to take the time to talk to us if they don't have to. We also call for unconventional methods that are still kind of standard pratice, like Mag for a crashing asthmatic. Most docs would rather we just tube them though. I would never push drugs against med control either, and anyone that does would be investigated, as long as it was in the best interest of the patient, the punishment would be a slap on the wrist. Also, it is common practice to do what we have to do, then ask. Sometimes it is easier to beg for forgiveness. There are, however, services around here that have to ask for almost everything, those services all share the same medical control hospital, and that hospital doesn't beleive in EMS, they would rather we "just get them here." I didn't mean to cut down your education, I am sorry if I somehow offended you. Reguardless of national registry, we all have to take CEU classes. We all end up with the same knowlege, from CEUs, medical control, standing orders that are ever changing, but most of all from our experiences. I am glad to hear that you have been in the field for so long, burn out rates are climbing. So many people have no idea what they are getting into. The peole that do what thay want, and push what they want are know as cowboy medics. I have a different way of doing things. Around here, all I have to do to get orders is paint an accurate picture with my report, works 99% of the time.