pfitz1079

I generally try to steer people away from the EC-type programs. Some states are refusing to license folks from them. Really a nursing program without clinicals is pointless. I've heard all the justifications about prior experience and just don't buy it. There are some budding bridge programs out there that show some promise. I think if a paramedic wants to become a nurse (or a nurse a paramedic) that person should attend a full training program. There's more to it than just the credits or the diploma. Pete Fitzpatrick RN, CFRN, EMT-P

Short answer: yes Most defibrillators that do syncronized cardioversion are designed so that the device will drop out of "sync" mode after delivering a syncronized countershock. The idea being that if a patient converts to v-tach or v-fib an unsyncronized counter shock can be delivered immediately. I always use this scenario when teaching ACLS or paramedics - it is a common error best made in training. If you had delivered the unsyncronized shock at the wrong point in the cardiac cycle, you may have sent the patient into a more lethal rhythm. Whether or not the patient would have died as the result of your error would depend on the team's actions thereafter. Of course there's no accounting for luck, some patients respond better than others. I'm going to be a little harsh here, but it's for your own good. As a basic rule, one should never put into play a device, medication, or treatment modality with which one is not completely familiar. It's one thing to make this error - it's another to not understand its implications. If that was the case, you had no business pressing those paddles to that patient's chest. The object lesson here is get the training then do the job. If you are given a task for which you have not been trained the time to speak up is not when the paddles are in your hand. Best of luck in the future, Pete Fitzpatrick RN, CFRN, EMT-P Writing from the Ninth Circle

- There's no line for the bathroom during breaks from training classes. - You're kid asks for you, not his mother, when he's sick. - You always sign up to work Valentine's day, but never Super Bowl Sunday. - You always have to tell your wife you're going out with "friends from work" when what you really mean is "a dozen hot chicks who are ten years my junior". Pete Fitzpatrick RN, CFRN, EMT-P Writing from the Ninth Circle

Have you tried staples? Pete Fitzpatrick RN, CFRN, EMT-P Writing from the Ninth Circle

Fetal death could well precede maternal death, particularly if the maternal death was not sudden. Hence the reason almost all perimortem c-sections are not successful. Pete Fitzpatrick RN, CFRN, EMT-P Writing from the Ninth Circle

You're not really a Colts fan if you, - Have ever watched a home game indoors - Can't quote at least one line from the movie Diner - Pronounce "water" without a "d" sound - Refer to this year's AFC Championship as "The greatest game ever played". - Don't know Artie Donovan's number. - Think steamed crabs or raw oysters are gross. - Don't know where to find the "World's largest outdoor insane asylum" - Believe Superbowl III wasn't fixed - Can't sing The Baltimore Colts Marching Song. - Have ever used Mayflower for a move. There can be no compromise with evil. A pox on the house of Irsay. Go Bears! Pete Fitzpatrick RN, CFRN, EMT-P Writing from the Ninth Circle

I'm kinda fond of the paychecks. I also get to help people. And work with a lot of hot chicks. But, mostly, it's the paychecks. Pete Fitzpatrick RN, CFRN, EMT-P Writing from the Ninth Circle

I, for one, would need to know the patient's weight. How else would I know if I'd have enough paralytics left after intubating the patient to pry the home health nurse off the back door of the ambo? This patient was failing to improve with treatment and was heading for a tube. The nonrebreather was a good choice to preoxygenate prior to intubating, which I think the paramedic had the good sense to see coming. In my state, on a the patient's physician who is "physically on scene and willing to accompany the patient to the ED" can override the jursidictional medical command authority. As someone posted, the patient can refuse care, but that puts the paramedic in a tight spot. I mean, determining competence in a patient who's hypoxic and probably will need to be intubated. is a crapshoot. Pete Fitzpatrick RN, CFRN, EMT-P Writing from the Ninth Circle

I think I'll side with the Nobel-Prize-Winning economist, thanks. Did you use red for emphasis by coincidence? Pete Fitzpatrick RN, CFRN, EMT-P Writing from the Ninth Circle

"If you put the federal government in charge of the Sahara Desert, in 5 years there'd be a shortage of sand" Milton Friedman Pete Fitzpatrick RN, CFRN, EMT-P Writing from the Ninth Circle

There has been some interesting discussion on this topic from a regulatory standpoint. The interpretation I've seen most is that, once the patient is on the grounds of the hospital, the hospital is responsible for the patient (EMTALA). The root of these concerns seems to stem from urban ED's forcing EMS crews to wait with patients to the point of excess (wait times routinely greater than an hour - crazy but true). Also, the EMS crew is not tied to reporting to an RN. A physician meets the EMS standard of transferring care to a higher level. It's the ED's responsibility at that point to continue the care. I think you'll see a dicotomy of opinions on this. EMS crews on onside, ED staff on the other. Hopefully, we can fix the greater problems (staffing, the need for better primary care, etc) and this little one will take care of itself. Merry Christmas, Pete Fitzpatrick RN, CFRN, EMT-P

SA, Why did you expend so much energy demanding numbers only to ignore them? This study has some unsettling conclusions, but it has survived peer review and has been published. Sorry, unless you're a Republican running for president, you can't ignore science. I can't argue with your tactics. If one can't win an argument ("show me numbers"), one should change the argument ("those are bad numbers"). For the OP: Try flightweb.com, or individual program websites for jobs. Pete Fitzpatrick RN, CFRN, EMT-P Writing from the Ninth Circle

"The risk helicopter EMS poses to flight crews, including pilots, paramedics, flight nurses, and physicians, is palpable. During the same 22-year study period, there were 144 crew deaths. Still, the 22-year average annual odds of a helicopter EMS crewmember experiencing a fatal crash were 1 in 1,158.5 Incidentally, The Book of Risks7 has published a number of activities that generate a 1 in 1,000 risk of death. By their numbers, 33 hours of helicopter EMS flight time compares with 25 hours of rock climbing, 50 hours of skydiving, and 55 hours of riding a motorcycle.5 The dedicated crewmembers of the air medical industry do expose themselves to an appreciable level of risk in their profession, greater than that of any other profession tracked by the National Safety Council. And many have lost their lives in the line of duty. We owe them a debt of gratitude on behalf of the patients for whom helicopter EMS makes a difference." Souls on Board: Helicopter Emergency Medical Services and Safety, Annals of Emergency Medicine, Volume 47, Issue 4, April 2006, Pages 357-360 Alexander P. Isakov "Based on estimates of the numbers of crewmembers and crew deaths during 1995 to 2001,2 the death rate of helicopter EMS crewmembers was 75 per 100,000 person-years, 16 times the occupational injury death rate of 4.6 for all US workers during this period (emphasis mine). Wright reported an average rate during 2000 to 2004 of 1.8 fatal helicopter EMS crashes per 100,000 flight hours. At this rate, a helicopter EMS pilot or crewmember flying 20 hours per week during a 20-year career would have a 37% chance of being in a fatal crash" EMS Helicopter Crashes: What Influences Fatal Outcome? Susan P. Baker MPHa, Jurek G. Grabowski MPHb, Robert S. Dodd ScDa, Dennis F. Shanahan MD, MPHa, Margaret W. Lamb JDa and Guohua H. Li MD, DrPHa Center for Injury Research and Policy, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD. Annals of Emergency Medicine Volume 47, Issue 4 , April 2006, Pages 351-356 I don't think the work's dangerous, but clearly there are risks involved which are not typical of the nursing profession. I don't think anyone should be discouraged from entering into flight nursing because of the dangers, but I understand those who chose not to because of the risks. One should enter into this job with both eyes wide open, and a fair hearing should be given to all sides before making a decision. Good luck with the job search. Merry Christmas, Pete Fitzpatrick RN, CFRN, EMT-P Writing from the Ninth Circle

Didn't see it. About half the helicopters that have appeared on that show in its history have crashed or had some other misadventure. The other half have been staffed by physicians who hop on and save the day. Whatever. I get enough reality at work. If the public buys network TV as reality, then that's their problem. Pete Fitzpatrick RN, CFRN, EMT-P Writing from the Ninth Circle

There are many ways to evaluate a nursing program. That having been said, it doesn't bode well that Coppin State has failed to meet the Maryland BON's NCLEX first-time passing standards three of the last six years. If waht you need are pre-req classes, I think your best bet would be to take them at an area community college. The cost will be less, and, in many cases, the education better. Pete Fitzpatrick RN, CFRN, EMT-P Writing from the Ninth Circle

Try http://www.flightweb.com, it has pretty good classifieds and a lively forum. Sometimes it helps to scan the websites of individual companies. Good Luck, Pete Fitzpatrick RN, CFRN, EMT-P Writing from the Ninth Circle

I have long maintained that Peds should be a calling. If you have a talent for it then by all means go for it. That instructor was clearly over stepping. It was a private conversation, so there's not much to be done here. I would ask her to meet with you and the department head and see if she's stupid enough to repeat that line of crap in public. No instructor should attempt to disuade a student from a practice area based on gender. It's that sort of attitude that has kept men out of nursing and given life to the stereotypes those of us in the profession face. There is no practice area that should be off limits based on gender. Good Luck, Pete Fitzpatrick RN, CFRN, EMT-P Writing from the Ninth Circle

I think the general trend here shows that nurses who frequently work in close contact with EMS providers (ED, CCT, flight, PHRN) seem to have little problem with them. Those that have infrequent contact, like the original poster who was floated to the ED and had some problems in ACLS, tend to have more. My experience is that this is pretty typical. The EMS world with its distinct culture, language and mores, is vastly different than that of nursing. Some of that stuff is actually functional (it takes a pinch of arrogance to walk into some of the situations with which they are confronted) and some of it is clearly dysfunctional (think time and place). When the two worlds rub up against one another, either in the ED, a LTC facility, or wherever, there is likely to be a bit of uncomfortable friction. Best to all, Pete Fitzpatrick RN, CFRN, EMT-P Writing from the Ninth Circle

Look, bombing ACLS is no big deal. I'm sure they let you retest. Having never been faced with the scenario, I can't really say.

Obviously. You started this whine-in. What's your real motivation? It seems to me we have two basic types of responses here. On one hand we have the basic nurse self-lovefest. You guys know what I mean: "Yay, nurses are best . . . . We're sooooo profesional - compared to those apes. . . . (insert argument equating skills required in varied practice areas) . . . We're better because they make less money and don't know where to shop. On the other, we have folks who seem to get along with paramedics pretty well. The common theme among the second group seems to be a greater willingness to accept EMS providers as equals. Frankly, I'd rather bend an arm with the second group, but I'm not too picky about who I'll drink with. Pete Fitzpatrick RN, CFRN, EMT-P Writing from the Ninth Circle

Take this scenario: A milk truck hits a minivan at a rural intersection. The force of the impact traps the teenage driver between the steering wheel and her seat, which in turn is jammed against a bent post. The patent's airway is compromised, she probably has a closed head injury and a likely tension pneumothorax. Extrication by a short-staffed, volunteer crew will take at least 30 mins. Somebody has to climb in that van, secure the airway, decompress the chest, and start treating the head injury. Understand this: The person who will attempt this, and be successful, will likely not be a shrinking violet. I was a paramedic for a long time before becoming a nurse. Good paramedics are not always going to the most amiable folks. They tend to be very action-oriented and have little patience for those who aren't. The above scenario is no exageration. It really was encountered by a buddy of mine. He got in that van and went to work. Not something just anyone could have done. Sure, he's a little rough around the edges, but I wouldn't want him any other way. In his own way he advocates harder for his patient's than most nurses. That having been said, there's a lot of paramedics out there who aren't cut of that sort of cloth. They're probably the ones who give nurses the hardest time. They see the really good medics behaving with a "devil-may-care" attitude and sort of adopt the swagger and the attitude. Usually they're a little younger and a lot louder. Pete Fitzpatrick RN, CFRN, EMT-P Writing from the Ninth Circle

Where are you working at JHH?

The Baltimore area is more expensive than, say the South, but is much more affordable than New York or Boston. Nurses here do pretty well salarywise. The housing market is a bit rough, but most of our new nurses seem to have no trouble finding nice apartments. I can't really speak to the singles scene, but my old unit hired a lot of new grads and took special requests for "wedding vacation" so it must be ok. I work at Johns Hopkins and feel that it's a great place to be a nurse. One can work in just about any specialty and find oneself on the cutting edge. We are an acredited Magnet Hospital, there are great prospects for advancement, and salary and benefits are top notch. Being here I don't think about it much, but the Johns Hopkins name carries a lot of weight on a resume. On the down side, it is a very large center and that can be a bit much for some folks. We're also located in a fairly depressed urban area. Good luck with your plans.

The AHA PALS program has an excellent module on coping with the death of a child. It offers good stuff for both the provider's well being, and for things like parental notification.

Good advice, here's one more. Get a St. Jude medal, but remember, just because a cause is hopeless, doesn't mean it's lost.