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It kind of hurts me to say this but ... Your system is a piss poor joke that gets laughed at around the coffee table down at the station here. We have had some American ALS medics come over and go straight back down to BLS level until they learn to operate without talking to a doctor. Add to that the fact state is different, you have the Fire Department rallying to keep education as low as possible, and you still seem to be stuck in the days where things like GTN. glucagon and salbutamol are still "advanced' procedures (National Scope of Practice)and they have gutted a good chunk of the cardiac module out of I99 so they are no longer allowed to manually defibrillate or acquire an ECG. Oh did I mention the EMS Agenda for the Future (p 24/25) still advocates those skills for EMT/A-EMT which can be performed with "limited training"... WTF ... now do you see why we kind of look at the US and shake our heads? Over the past 10-15 years we have liberated much of what was the traditional very strong boundaries between basic, intermediate and advanced care. Our BLS level now includes nitro, IM glucagon, salbutamol, zofran, aspirin and supraglottic laryngeal masks while we have upgraded our ILS level to include cardioversion, adrenaline, anti-emetics, IV analgesia and naloxoe. When we moved from our old more-theoretical BLS qualification to the new "practice" based one with less theory I bitched something fierce because they were removing a good deal of the micro level A&P around cells and tissues. They have now moved to a system-level method of teaching yes, 5 out of the 11 body systems (cardiovascular, resp, nervous, digestive and endocrine) ... don't ask an Ambulance Technician here what renin and angiotensin are and how blood pressure is effected by a guy on ACEIs coz he sure as fuck won't know! That makes me kind of angry. The argument here was "it is too complex for the rural volunteers". #*$*@($*!!! From 2011 all services are looking to remove BLS and move to the ILS Paramedic level (for all paid staff -- they do about 80% of our national workload) and preserve our BLS level for the volunteer staff as a reasonable alternative. There is one of our services here which by that time will be a totally ALS service where all staff will hold Bachelors Degree or Post Grad qualifications.

In regards to the highlighted portion of the text......In the most basic terms....NO, Advanced education is the key, and I will probably offend a lot of people on this board in a second when i say, YOU REALLY DONT KNOW, WHAT YOU DONT KNOW!!!!! There is NOTHING worse with someone who has a little bit of knowledge on a subject to start imparting opinions to the masses as if fact...... Unfortunately, I can easily give an example is the world of HEMS.....You take type A medical people, put them on a helicopter or airplane for 1 year, and all of a sudden they are experts on METAR's, Cloud Ceilings, Prognostic charts, Approach plates, and last but not least, think they can fly the aircraft if ever needed in an emergency.....I see it all the time.....This is why you have the inherent in fighting between pilots and medical crew.....It makes for a bunch of second guessing....However, you never see a pilot lean over and say, " Did you really need to Intubate that patient?" I can speak on both sides because i have the education as BOTH a pilot and flight paramedic! So, the bottom line IMO, Make the EMT-I the new EMT-B, and force all Paramedic programs to a minimum of a 2 year degree, and then give us the option of pursuing the Critical Care Paramedic or Certified Flight Paramedic.....Both latter certs are way beyond the general paramedic and require much more extensive knowledge....I cannot imagine not having taken Pathophysiology, Organic / Inorganic Chem, Pharm I & II, etc.....and be where I am at today....Again, a little bit of knowledge is the scariest thing alive! I apologize in advance if I offend anyone..Not my intention.... Respectfully, JW

Not impressed.

I disagree. My EMT-I course equated to over 1000 hours in both the classroom and clinical experience. In Maryland, I's only have to consult for at most 3 drugs that P's don't, and they only have one or two skills that they need to consult for or can not do. So that was a pretty big generalization you made there. My EMT-B was 240 hours versus the 1000+ hours of EMT-I, so personally I would really rather the EMT-I on scene than the EMT-B.

Problem being, the I99 level of education is rather minimal when you look at all the drugs and skills at their disposal. They can do allot; however, does this actually mean the education they receive prepares them for this scope of practice? This goes back to my chemistry thread. If you do not have a real understanding of the fundamental sciences and how things work, should you be performing interventions that actually effect these fundamental concepts? Rather significantly in some cases. The point is moot as somebody pay grades above me thinks the I99 is roughly equal to a paramedic and should transition into the medic role with some classroom bridge training. I actually covered these national SOP changes several months ago in a thread with links to official sites and publications. Pretty scary stuff actually. Take care, chbare.

I disagree. EMT-I's in some states, such as Maryland, have just about the same protocol as an EMT-P. I understand the I-85 protocol is vastly different than the I-99 but to say that the EMT-I level is essentially a "filler" is somewhat of an insult. While I agree that EMT-I may be considered a stop-gap and that ALS should be a 2-year degree, it isn't fair to just say they are a filler and a way to bill for monitoring a lock. EMT-I/99's in most places can do a hellova lot more than monitor a lock. I think EMT-I/85 should be removed, and I/99 be the new basic level and the scope of practice to include IV's, 3-lead ECG, advanced airway, and code drugs (plus a few more but that's more to debate). EMT-B should be done with, they are valuable members so don't get me on "bashing basics", but they should be I/99's. EMT-P scope should remain the same but be required to be a 2 year or 4 year degree and have the ability to do more diagnosing in the field... Just my $0.02 worth...

Education requirements didn't go far enough. The biggest mistake made was not divesting non-emergency medical transport from emergency medical services. These two fields are separate with different patient populations and different needs. Neither is more important or better than the other just as RNs, RTs, and other allied health can't be compared in terms of importance or better. Once you remove non-emergent medical transports from EMS you remove one of the big reasons for keeping the EMT-B level around.

Honestly...EMT-I/AEMT needs to go away. It's a stop-gap measure for communities and agencies that can't/won't pay for their EMT's to go to paramedic school. It's a filler...a way to tell people that they have "ALS" or to bill for an ALS transport to monitor a saline lock. I can say this having been a former EMT-Intermediate (85).

Ok, just got back from heated discussion/meeting concerning the new national standards and EMS level criteria. Now, what is your true opinion concerning the new levels. For, Ok, whatever, what?, or just WTF. Give me your honest opinion, even if you are one of the potential transitional providers (85I, 99I). I would greatly appreciate your response with possible debate. Thanks.

OMFG, they're going to ruin the one credible character in the entire show by turning her into a whacker! RIP Marisa

Why do you put so little faith into education? Do you think all the professions I mentioned were wrong and they just got their nice salaries out of the blue for no good reason? Their education made them marketable. Once more EMS professionals start taking their own careers seriously, the IAFF will not be able to keep their strong stance. The more you use the IAFF as an excuse for not continuing your own education or discouraging others, the longer they will have a say in YOUR career. If you have not gotten higher education, it is difficult to sell this concept you. If you have never attended a committee meeting at the state or national level, it would be difficult for you to understand how professions are evaluated. For RT at a national level, we can say all RTs entering the profession must have an Associates with a large percentage now having a Bachelors. This is the push we have made for a Bill that puts the RTs with a Bachelors or Masters as an Independent Practitioner realm for reimbursement for certain services. That bill in now its final stages of reimbursement. For EMS at the national level, "we have 50 plus different certs and for the Paramedic level the training starts at 500 hours and one state does require a degree". Now which one sounds better? Yes it is about marketing but only if you allow lobbyists like the IAFF to rule YOUR own destiny. The more in EMS that realize the IAFF does not control what education they get, the sooner the educated can gain some ground. Once RTs took control of their own destiny, all that was left was signing the paperwork at the state and national levels for the Associates degree. The RTs themselves did all the preparation prior by getting their education as they saw a benefit to it for the profession and to their patients. Now, most see how lacking we are with just a mere 2 year degree in the world of medicine.

You are making $14 dollars an hour because the Paramedic has not achieved professional recognition in legislative issues that concern the insurances. With over 50 different certs in EMS and all of them at a technician status there is no way for the legislators to even figure out what exactly a Paramedic is or does. This is not about advertisement. This is about achieving professional status that is recognized by the insurances. Do you realize that for the "tech" health care programs, there are only the Medical Assistants, Nursing Assistants and Paramedics left. The EKG techs have moved on to the 2 year CVT and the Massage Therapists are now petitioning for the 2 year degree in many states. For goodness sakes it is only a 2 year degree that some are discussing for the Paramedic. But, it seems that it will be a long time with the reluctance that exists. Do you realize even nursing and RT are embarrassed by having a mere 2 year degree for entry into their profession? Thus, both professions are pushing for as many of their students to get the Bachelors. RT long ago saw the 2 year was going to be the minimum and started pushing people in that direction long before the change took place. RT, SLP, OT, RN, PA, PT, NP and MDs are not crazy for getting degrees and lavishing in their professional status for reimbursment. How many of them still make $14/hour since their profession achieved that? And, while times are rough, do you know the number of people that are still willing to make the sacrifice to get a decent education? You could also look at any other profession. Bookkeeping cert from a tech school or Accountant with a degree? How about teachers? Most require at least a 4 year degree to teach 1st grade and usually a Masters. But yet for the Paramedic we are content with 700 clock hours of training from a tech school. Cosmotologists, Massage Therapists, pet groomers and manicurists require 2x more clock hours than that for their tech schools. The fact that some even want to argue that is "best" for the patient gives the wrong message about EMS to those that hold the purse strings of reimbursement.

Welcome... and sorry about spenac... we never should have elected him as director of the greetings committee. It is a failure of us all.

What's another gas in the toolbox of RT... I have heard rumblings about this from UCSF but it is still a long way off from a definitive trial in humans. But, we still have O2, CO2, Nitrogen, Nitric Oxide, HeliOx and a few others to use in the mean time and that doesn't include the ones from the OR that occasionally find their way to the ICU. Some of these gases haven't been around that long either like Nitric Oxide and was controversial. Some hospitals are still afraid to try it. Others don't leave home without it on transport. I also will remind those in EMS not to take it for granted that the tank the home care patient is running is oxygen. You might be surporised.

Thank you. As an instructor of a tech college, it is my job to provide guidance to the student so they can fully comprehend what being a paramedic is, all facets......It IS what the student makes of it. If they know their 'worth', and are willing to learn, they will do fine. If an instructor cannot do their job, the student will suffer and the public will suffer, maybe......the key as you stated is judge them on their merits, but be careful moving on to figuring out who is to blame, as this will most likely be the student themselves. Thanks for the 'vent'.

My FRD has always considered I's and P's the same for all intents and purposes. The problem is with the difference in knowledge base between the two. There are many areas in the US where an EMT I-85 or I-99 many be the only game in town. Some say that if EMT-P becomes the entry level position, mandated by federal law, then these local Govt's will somehow find the money to compensate degreed medics. I'm not so sure. It's like trying to squeeze blood out of a rock.

Hours or credits.... really? Neither matters. Arbitrary units of measure do not define the quality of the education. There are tech schools that are just as good if not better than college and university schools. As someone who went to a traditional college (with a good reputation) and graduated with a BS in BAD, I can tell you I was quite under-impressed with my educational experience. I have taken classes at "Tech" schools since and currently teach for a "trade" school, and feel that the education provided is on par or better than that of traditional colleges. The people who are teaching at these trade schools teach with more passion then their tenured counterparts... and it makes a difference. It is the curriculum that matters... it is the quality of the educator that matters... and it is the quality of the student matters. Now I understand that these factors are not really able to be broken into easily deduced numerical values, and thus makes it difficult to quantify, but they should not be ignored because it is easier to. My feeling is that any educational endeavor that its' quality is judged by the "credits" or "hours" it takes to complete it, is probably not worth taking it. I don't care if your basic class took 120 hours or 400 hours... if you know what you are supposed to know and you have been taught even the slightest bit of professionalism, then you are OK to ride with me. While I am all for increased education and increased standards, I do not buy in to some of the elitism that we some times espouse in conversation here at the city( of which I have participated). I read a lot about bashing "medic-mills" and "tech schools," and while I understand why we don't like them, sometimes I get the feeling that we are downgrading the providers just for having taken that program. I do not believe that the program or the school makes the provider. Any educational experience is what you make of it. Sure it can be easier if the program is top notch, and your instructor is top notch, but they don't have to be for a student to take the bull by the horns and overcome the inadequacies of their program. If I were to start tomorrow to read every paramedicine book that there is, completely engross myself in learning everything about being a paramedic, would my knowledge mean less because I didn't have an "instructor" tell me to read it? Of course not... knowledge gained is knowledge gained. Obviously, I would be violating many laws, and possibly some civil rights, if I were to take the practical portion of it into my own hands... but I think reasonable people will see my point... which is... judge a provider on his own merits first, then move on to figuring out who is to blame for their quality. This was not directed at anyone by the way... just a rant I've been feeling coming on for a while, and it kinda fit into this discussion. This is more of a self-check than it is a referendum on anyone else. Thank you, and have a nice day!

Yeah, I know. Problem is, there is no way in the world to prove or disprove that. Coincidence? Secondary to the vaccination? Sore muscles due to "old" age? All in my head? At this point, I'm leaning towards the last 2 options- I just talked to my partner and he's fine. In fact, he said he's getting ready to open a beer. Hmm... LOL

If the U.S. BLS was the equivalent of BLS in other countries, this would not be such as issue. Those in the U.S. who try to argue for BLS have attempted to use the OPALS studies which used the BLS qualifications for that area of Canada. Their education and training is longer than the ALS Paramedic in the U.S. Increasing our BLS eduation and eliminating "inbetween" levels must happen to see any advancement in the U.S. system. The patchwork, make do stuff has go to be eliminated. The EMT-B is wrong for MEDICAL transports. The medically complex patients need someone who is educated/trained for medical situations with knowledge of disease processes and not a first aider. The EMT-B's clinic time would also be better spent with a hospital nursing assistant logging in a couple hundred sets of vitals on many different types of patients as well as learning to move medically complex patients with brittle bones and many tubes or lines. The skill of communication between provider and patient might also be acquired. Sitting around a coffee pot waiting for a cool trauma call that may never happen or hanging out in the corner of the ED serves very little purpose for educating/training one to adequately and appropriately care for a sick elderly patient. The fact that many will transport several dialysis patients in their trucks but can not tell you why the patient is on dialysis except for "renal failure" or know why some of these patients do need an ambulance speaks volumes of the inadequacies in the EMT training for the job of medical transports.

Incorrect in your analysis. You are viewing the college semester credit hour as the equivalent of "tech school" where the expectation is counted as literal clock hours. The number of credit hours assigned to a course quantitatively reflects the outcomes expected, the mode of instruction, the amount of time spent in class, and the amount of outside preparatory work expected for the class. These consistencies have made it possible for accrediting groups to compare programs at multiple institutions. Additionally, federal and state reporting requirements can be analyzed, achieved, and communicated. For lecture, each classroom hour is expected to have 2 hours of prep work. For lab, each credit hour can be up to 200 minutes per week or almost 4 hours. For clinic, each credit hour can be up to 300 minutes or about 5 hours per week. Thus, a 3 hour class is about 16 hours of clinic per week. When you look at tech school clock hours, they are usually literal. Also, when someone says their program was 2 years long but only 700 hours, there but is a 1 night per week 2 hour class, there is no comparison to a college credit system with the work of an Associates degree. Thus, when legislators attempt to evaluate worth, the clock hour system is not feasible. The other advantage of a college system is the different in educator education. The instructor must meet minimum educational requiremments. Thses same standards are lacking in the tech schools.

Semantics. "semester hour" = "semester credit" Most colleges operate on a 16 week semester and therefor, 1 credit = 16 contact hours. That is excepting labs where you usually get half credit for time spent... or less... No debate there. And certainly, poor instructor quality is a major issue in EMS. But is time a worthless measure? ABSOLUTELY NOT Take two equal professors and give one 48 hours to teach his students Algebra and one 16 hours to teach his students Algebra, guess whose students are going to be better (assuming the students are equal). Now take two equal EMS educators and give one 200 hours and another 400 hours. I bet they can take that extra 200 and put a lot good information to help their students understand WHY they are doing what they are doing in the protocols which will make them better care givers. As well, they'll have more time for their students to do proctored practice. So all students being equal, which class is going to create the more competent provider? I'd place money on the longer one. As it is EMS classes are too short to cover, for example, in depth pathophysiology. Wouldn't TIME to teach that be a GOOD THING? Or more advanced A&P? Or pharmokinetics? Great question. Actually, I said: I preferred 300 hours, but I'd rather have the 300 hours spent creating a provider with a smaller scope, but who understands their medicine better vs a provider with a larger scope who understands it less. Of course the ultimate goal is to get the provider with the larger scope who understands it better. But that takes even more TIME, effort, intelligence, and ultimately money.

WTH is a semester hour? Every college I know of in the US uses semester credits... so a typical class is 3 credits meaning you meet for 3 hours a week... But I agree with Dusty... hours don't mean jack shyt if the instruction is piss poor. I know some colleges who I wouldn't trust the quality of their degrees at all but they're still universities and colleges.

Something to draw comparisons too: New Zealand Basic life support (Ambulance Technician): Education required: 120 hours self directed learning + 120 hours classroom + 180 hours clinical Scope of Practice: OPA, NPA, LMA, AED, GTN SL, ASA PO, glucose PO, glucagon IM, salbutamol neb, zofram PO, entonox Intermediate life support (Paramedic): Education required: Bachelor of Health Science (Paramedic) - 2,400hrs didactic & simulation and 1,200hrs clinical Scope of Practice: IV cannulation, IV fluid, 10% glucose IV, manual defibrillation, syncronised cardioversion, 3 lead ECG acquire and interpret, 12 lead ECG acquire, adrenaline IM/IV/neb, morphine IM/IV, zofran IM/IV, naloxone IM/IV/IN Advanced life support (Intensive Care Paramedic): Education required: Post Graduate Certificate in Intensive Care Paramedicine (12 months) Scope of Practice: Endotracheal intubation, cricothyrotomy, pacing, 12 lead ECG interpreatation, intraosseous, atropine IV, amiodarone IV, ketamine IM/IV/PO, midazolam IM/IN/IV, frusomide IV and for selected ICPs: heparin, streptase, suxamethonium and vecuronium IV

Well I am sorry that you do not agree with my opinion and feel that I am not educated on the standards in EMS. But the original poster asked for our honest opinions and I gave mine, again, sorry you don't agree with me but you don't have to and that is what is lovely about an open debate forum.

Ruff: Respectfully should not the question be: Do the outcomes of Helo transport effect to door discharge or in any way improve care ? cheers

Found the studies: http://www.ncbi.nlm.nih.gov/pubmed/16766969 CONCLUSIONS: The majority of trauma patients transported from the scene by helicopter have nonlife-threatening injuries. Efforts to more accurately identify those patients who would benefit most from helicopter transport from the accident scene to the trauma center are needed to reduce helicopter overutilization. http://www.ncbi.nlm.nih.gov/pubmed/15674165 CONCLUSION: Ground ambulance transport provided the shortest 911-hospital arrival interval at distances less than 10 miles from the hospital. At distances greater than 10 miles, simultaneously dispatched air transport was faster. Nonsimultaneous dispatched helicopter transport was faster than ground if greater than 45 miles from the hospital. http://journals.lww.com/jtrauma/Abstract/2004/01000/Effective_Use_of_the_Air_Ambulance_for_Pediatric.15.aspx Conclusion : Retrospective analysis was not able to demonstrate any benefit to direct transport from the scene to a trauma center. Hospital stabilization before transfer by air ambulance may improve survival and shorten ICU stays for patients with major trauma. http://journals.lww.com/jtrauma/Abstract/1998/07000/A_Critical_Analysis_of_On_Scene_Helicopter.29.aspx Results: Patients transported by helicopter were significantly (p < 0.01) younger, were more seriously injured, and had lower blood pressure. They were also more likely to be male and to have systolic blood pressure < 90 mm Hg. Logistic regression analysis revealed that when adjusting for other risk factors, transportation by helicopter did not affect the estimated odds of survival. Conclusion: A reappraisal of the cost-effectiveness of helicopter triage and transport criteria, when access to ground ALS squads is available, may be warranted. http://www.ncbi.nlm.nih.gov/pubmed/12169944 CONCLUSION: The majority of pediatric trauma patients transported by helicopter in our study sustained minor injuries. A revised policy to better identify pediatric patients who might benefit from helicopter transport appears to be warranted.

One licence level for all EMS personnel. Period. Just like physicians and nurses. No basics. No intermediates. Just degreed paramedics. Anything less is a strictly BLS first responder, not licensed, regulated, or employed by EMS authorities.

In response to the OP question.... ABSOLUTELY HEMS is way over utilized! Having just finishing up an MBA, I can tell you, I have extensively studied the statistics of everything HEMS.....( 3 Graduate Stats classes will force this). I have to disagree with the above poster, HEMS can easily be a money-maker dependent upon aircraft type, location, time and distance, etc..... For example, Take an A-Star B3 , Single Engine, staffed with 4 pilots, 5 nurses, 5 Paramedics for the base. Average number of flights to cover fixed costs for the month is 16-20 with average reimbursement in the 10 - 15k range. Lets take my previous rotor base, Airevac 9, We would average 60 flights month. 60 * 15k = 900,000 dollars gross subtract your 20 flights to cover fixed costs, ( Salaries, DOC,etc...) leaves you with avg of 40 flights @ 10-15k. this will leave you with a net income of 400,000 - 600,000 dollars a month.....NOW, you throw up 10 more bases on every street corner like there is in Arizona, and do the simple math......You tell me if it loses money or not..... ( NOT) Why do you think the amount of helicopters has quintupled in the last 7 years? This would not happen if there were not money to be made..... Again, each company will be different based on aircraft, reimbursement rates etc...... Arizona is by FAR the worst offender of flying patients who have no business being flown.....Many of the ground crews do not want to make the drive into Phoenix, especially during rush hour, so they just say fly them out, regardless of appropriate........This is one of the main reasons I left Rotor wing and went to Graduate School..... having moved to AZ from Michigan, where there is such strict criteria for using a helicopter was a huge shock to me.....In all my time working the ground in Southeastern Michigan, I called for a helicopter twice......Once for a 95% burn patient who was 45 min from ANY hospital, and the other was a very prolonged ICE rescue from Lake huron. We were expected to take care of our patients, and not punt them off to the quickest taxi ride available......It is just absolutely asanine out here in AZ.....There are over 25 helicopters in the METRO phoenix area.......Do you really think there are that many patients who need Air Transport? The studies prove >75% of the patients who are flown DO NOT need HEMS......75% you tell me what is wrong with this picture!!!!!! From this proliferation has come a detriment to the HEMS provider, the talent pool has been watered down to nothing more than a BP and a pair of boots, and a license.......Back in the day, one would have to have a minimum of 10 years experience, instructor status in everything known to man, someone would have to die in the flight program or retire for a spot to open up......and then you would pray you had an inside friend to make a recommendation for you..... Respectfully, JW

I am a STRONG advocate for this Vaccination, H1N1 stop it in its tracks because if it mutates and it will we could be in a real world of hurt. Problem is we don't have it available in Kanukistan yet sheesh ... my name has been placed on a list for Emergency call out in event of pandemic as an RRT ... so best have a room in cells for me as I will not set foot in a hospital until I receive it, ps have also been in my own ICU as a patient for a viral pneumonia ... not doing that again thanks. I have also volunteered to assist in administration as I have a friend that is a Health Advisor for a First Nations reserve right close to my house. Word has it that compliance with HCW is not good ... so could we be part of the problem ... I say yes. cheers

Ruff - that was a rather gracious response that Seb Wong provided to you. All along I've maintained the same thought - I feel sorry for him as he is the one that has to deal with the public's image, not only of EMS, but of his particular department. That puts him in a tough spot, especially since they are a municipal department as he states, they don't have the luxury of saying no. Their funding depends upon keeping the mayor happy. As much as some of us may not like fire based depts, ems I think it's time to seriously sit down and give this guy credit for at least trying. I know his job can't possibly be easy. Best of luck to him on cleaning up the mess this show may create and my sympathies certainly.

OMG television!

I would be curious to see any evidence against a C-collar and if there is any evidence against manual stabilization... I agree there are arguments to both sides, and I can see where in some situations the collar would cause more harm either emotionally or physically, but what about the consequences of those people who are paying more attention to the hot chicks than keeping in-line stabilization? Without a collar to at least help hold them in a neutral alignment, couldn't the distracted people holding manual cause more harm if there is in fact a spinal cord injury?

That is where I have an issue. How many people are competent at holding manual stabilization?? I have seen it too often in the field done improperly to have any confidence in manual stabilization alone. With regards to the situation you provided though, why not apply the collar yourself once you get on scene to assure it's done properly? I would have a hard time moving a patient, with any degree of suspicion for a spinal injury, without a c-collar in place. I personally like to apply them because I am confident in my ability and if I am the primary provider, then I am ultimately responsible for how the collar is placed. There are situations where you have to adapt and overcome, but priority should always be placed on maintaining control of the spine and not causing further damage.

I'm scared about the "sticky test" wtf... If you do things backwards you are putting your patient at risk. EMS Standards state to place the collar THEN move onto a backboard.... Follow protocol and SOP's... and wth is a sticky test?!?

I'm taking notes from "Trauma" on how to do this job.

Those kids seemed to hold off pretty well. But we don't know how long they actually had to wait. When I was a kid, my mom told me about similar tests the did when I was in pre-school. Along with general assessment stuff and determining if the kids could function in kindergarten. She told me how I was asked to name colors or something. I told them I did not know the colors. Then I got go to go home. On the way home, mom asked me why I said I didn't know them, because I did. I told her, because I was hungry and wanted to leave. I knew that if I said I didn't know, they would stop asking me questions.

I'm not insulting anyone. I am strongly opposed to the idea of making a 300 hour I99 course the bottom level of EMS and I do think that the I99 concept is a stop-short in terms of educational thoroughness (the aforementioned 1000 hour rarity is a violation (in a good way) of the I99 concept!). That is a criticism of the system, not the people in it. Now stow your 'tude, dude. So Canada and New Zealand are the "perfect world." OK... I wouldn't mind living in either place... but don't we like to think of ourselves as slightly more perfect? Why can't we do what they are doing? They are more rural than we are!

No. I did not make a big generalization. I am talking about classroom hours ONLY. Please educate yourself: Most EMT-B classes are 100-120 hours in the classroom. EMT I/99 is usually 200-400 hours in the classroom. EMT-P is 700-1200 classroom hours (the DOT requirement is actually only 500 not counting the A&P prerequirements (usually about 200 hours)). If you had over 1000 hours in your EMT-I, it would be a statistical outlier, a true rarity. Even if that 1000 hours included field time, it would be a rarity. I find it hard to believe because 1000 classroom hours is equivalent to two years of college classes.

It's an improvement, but not much of one. I think Canada and New Zealand are the models we should be following. However, If they are going to do it the way they are going to do it, I think they should have given AEMTs needle thoracostomy. Agreed!

I'm not entirely sure that you are making fair comparisons here. Ours is already a highly misunderstood profession. A "serious" show about EMS with the mistakes, drama, and inaccuracies of Trauma only further this misunderstanding with the general public.

In urban areas, yes I think there is a definite overusage of HEMS - unless you are in excess of 30 min from the scene which is really rare I do not see the neccessity of using them. As previously stated by the time call comes in, lift off, landing, report, take off, transport, landing and transport into ER you could have usually already had your patient in and evaluated. However, for rural areas that are an excessive distance from a trauma or definitive care facility (yes I'm lumping some medical things in here ie STEMI, suspected CVA, etc) I would rather see a service call for HEMS than sit and wait, the patient wait around then finally get transferred out (usually by air med due to distance and also the oh crap factor of the physician in the ER). Average time for a significantly injured patient from injury to evaluation at a trauma center is around 4-5 hours if diverted to another facility. There's alot of patients that can't wait that long. So yes, I don't mind someone calling based on mechanism of injury due to that. Easier to treat it earlier than later with better chance of recovery. I think it is entirely dependent on distance, local department's capabilities (and their availability - if they have one medic in the county it changes the position about than if they have one on every truck), mechanism of injury/nature of illness, what the patient's complaints are, and the potential for injury, and current status. If anything makes it high risk, then I wouldn't object to a helicopter being called for transport. If the indications aren't there or within 30 min of evaluation then go on by ground.

The literature I've read definitely shows overusage. (Goes to find those articles)

Due to the proximity of the hospital, 25 minutes from the further part of the district in which I am stationed, my partner and I have made use of the helicopter transport once in two years. In that case we had multiple patient's and the extrication of one was going to be in excess of 30 minutes. When we arrived on scene and had completed scene size-up and triage, the decision to call for additional resources including aero transport was made. I should add that the helo service is stationed at the hospital we transport to. There are 3 available, but honestly by the time they lift off, fly to our location, land, are given a report, load the pt then fly back to the hospital, we could be there by ground. Only in extreme cases will we fly anyone from a scene. When it comes to treating my patient's appropriately and transporting them effectively, the cost of the transport never enters my mind. We do what is best for the patient.

I cant believe this uppity group of wackers is willing to piss on this show. The latest attempt to bring our profession to the publc and there willing to step all over it then try and support it.

You should leave this forum. We are professionals.

That is really really silly. I99 can do almost everything a medic can do but they have to call in... because they only go to school for 25% of the time of a medic!!!!!!! I99 was a regression in terms of educational thoroughness. That is why it is gone now. Most calls don't need those skills. I'd rather see an EMT-B class that was 300 hours long instead of making the basic level of EMS a 300 hour EMT-I99. Better yet, let's make I99 skills the basic entry, but make it a 2 year associates degree. Then paramedic can be another year or two for a BS degree and have expanded scope. (Like CAN and NZ)

Like nearly everything else discussed here, looking for a universal answer is impossible in this business. We can't even agree on definitions of semester hours. To require anyone in EMS to be a paramedic is simply not practical. Think about the different systems all around the world. Some services operate with a doc on board, some or 2 medics, some are BLS, some are a combination of all of the above. Some areas simply do not have the resources to have an all ALS system. Isn't it better to at least have providers with SOME medical training vs having nothing at all? As we all know, despite national standards here, all EMS programs are NOT created equal. Some are medic or EMTB mills who's goal is to crank out as many folks as they can. Requiring a degree program is not the answer either. The quality of the instruction is not based on how many classroom hours you put in(although obviously more would probably be better), but the reputation, ability, and character of the instructors and program coordinators. Even medical schools vary- think about how a doctor who graduates from a Caribbean medical school is viewed by his peers. They could be a brilliant clinician, but will always have a stigma attached to their education. We could demand that a person must spend an unworldly amount of time in classroom and in training for EMS, and even require a college degree, but unless there is a payoff at the end- ie the person can make a decent wage once they are done, we won't be able to provide enough bodies to fill those spots.