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I understand that some people find them valuable, and some find them a waste of time. I've received several PMs from EMS folks that have been involved in a CISD event and they've all agreed to answer some basic interview questions about the process. If you'd like to throw your 2 cents in, I'll be happy to forward the questions to you. Good or bad, I'm interested in all opinions. In addition to the anecdotal information I'll be gathering from you guys and gals, I'll be digging through research, including Bledsoe's article, and forming my own opinion to deliver in my paper. And as an aside, I think this is a really valuable portion of the curriculum of the Paramedic Education Program I'm enrolled in. Almost anyone can tube a rubber head, not everyone can write a cohesive college level position paper. I'm glad it's a requirement for us.

EMT-I(99) seems to me like Paramedic Lite . 80% of the skills, with only some the education. Same great taste, 50% less calories. How is that not a stop-gap measure? I'm not meaning it to be an insult. I've been an Intermediate myself (although an I-85...Texas doesn't recognize I-99). I'm not implying that someone would "settle" for I-99 because they couldn't make it through paramedic school. I do however have issue with states that use I-99's to compensate for lack of paramedics...or in Iowa's case, calling an Intermediate-99 a paramedic and an NREMT-Paramedic a "paramedic specialist". I've also found that in most 911 systems, the powers that be aren't quite sure what to do with EMT-I's. Their scopes vary, in some systems they may be the lead provider on an ILS truck or first response unit, in others their ILS skills are sharply restricted. Our intermediates (85) are allowed to perform fluid resuscitation, administer D50%, naloxone, establish intraosseous access, and place rescue airways (King LTS-D). They are not permitted to perform endo/nasotracheal intubation or start E.J.'s, for example. Your suggestion to make I-99 the minimum may hold some merit. That model is very similiar to Australia/New Zealand's. Their entry-level paramedics are capable of 3-lead interpretation, manual defibrilliation (and in some cases cardioversion/pacing), IV access, ACLS medications, naloxone, dextrose solutions, antiemetics, analgesia, rescue airway placement (usually LMA), etc. The advanced/intensive care paramedics are trained to interpret 12-lead ECG's, perform oro/nasotracheal intubation, perform cricothyrotomies and needle thoracostomies, administer fibrinolyitics, perform rapid sequence intubation, etc. I really don't think that oro/nasotracheal intubation should be authroized at the ILS level. You need to have other tools/procedures to fall back on. Surgical cricothyrotomy if efforts fail. Benzodiazepines to sedate the patient post-intubation if needed. Waveform capnography and the necessary skill in its interpretation. Needle thoracostomy if you inadvertently create a pneumothorax. Rapid sequence intubation if your medical director authorizes it. Just having a laryngoscope, some blades and a set of tubes isn't enough.

Alright! Kiddo was found safe and sound. I can't begin to tell you how relieved we all are... some of us were very afraid that we were going to be recovering a dead kid. Never fun for anyone. Here's some of the inside info, and I would like to state that this is my opinion and does not necessarily reflect any official statement by the sheriff's office my SAR team operates under, and also does not represent any official statement by SAR. This is purely from my perspective as a SAR member for your entertainment and edification. All indicators initially were that the kid HAD actually gotten into the balloon. You believe the witness until there's reason to believe otherwise, even if your best witness is a 9 y/o kid... once the balloon came down (props to the folks waiting for the balloon, that was handled GREAT) and the kid wasn't in it was when the focus of the incident changed. And yes, that balloon was large enough to lift 40lbs, which is what the little guy weighs. I also was evaluating balloon motion and thought that the erratic listing indicated a load. Right after the balloon came down, local SAR on the launching end was put on standby for a search. There was also simultaneously an eyewitness report in Weld County that something had fallen from the balloon over by Platteville, and so immediate search by Weld County folks was initiated there in case the object was the kid. This was a HUGE multiagency incident. We even had OEM coming in at one point in Weld County, according to the radio traffic I was listening to. Which meant that things took a little longer... we had local FD, local PD, local Sheriff, SAR, national guard, media... it was a big operation!! Once the gears got turning, they decided they needed SAR, and we were paged out. We ended up staging in a local neighborhood park surrounded by media sharks and it was determined that we'd send up a SAR member with each media helicopter we had available to be trained eyes in the sky. Note to any non helo media reading this: if I *TELL* you to get out of the backfield when we're landing a helicopter, you BETTER listen! Same with bystanders. I swear to you I was pulling people out of bushes less than 5 feet from our landing zone, as other members of the team were bringing the choppers in. Drove me crazy... We really wanted to get a dog team out right away to search the house. We were declined. For the sake of politics, I'm not saying who declined. But it was really frustrating, especially for our dog folks who have made multiple "kid missing" finds at the home with use of a dog. So they were getting ready to deploy us as though the kid had run away/crash landed nearby, and we had just broken into teams when our lead hopped out of the command truck with a big grin. Safe and sound!!! I'm telling you, this kid couldn't have hidden better if he had tried... and in hindsight, we're probably going to be a lot more insistent about bringing in dogs way earlier in the future. As to whether the kid let the balloon go and then hid, or tried to get in and got back out, or whether his brothers did it and tried to cover tracks by saying he was in it, we'll never know... I would also like to emphatically state that this was NOT a publicity stunt. You didn't see the parents, obviously, or you wouldn't be saying that it was a stunt... it was just a genuine "whoopsie" that really could have happened to any backyard balloon enthusiast. It's only riveting because the balloon was home-made and looked like a UFO. I'm sure the family will be keeping the kids away from any potentially mobile science projects in the future. This was kid stupidity and a bit of parent stupidity, but it was not a ploy for attention. PM me if you want more info... Wendy CO EMT-B

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.

Is it? Listen, I'm no advocate for legalizing marijuana, cocaine or anything else, but seriously... What is honestly the ratio of calls that directly/indirectly involving alcohol abuse (either acute or chronic) compared to all other "illegal drugs". I assure you the alcohol has a far more adverse effect (from a 911 standpoint) than any other "illegal drug". It also has nothing to do with availability of said substance, as many "illegal" drugs are readily available. It's simply an antiquated cultural/governmental issue. Imagine if marijuana was legalized and taxed like tobaccoalcohol? There is no reason why it shouldn't be. I would love to see the stats from a place like Amsterdam, where certain North American "illegal drugs" are legal, and see what the ratio of EMS calls/hospital admittances are. So a person can get hammered every night and/or every day off and that's cool if you were to do a call with them involved, but with cocaine or marijuana it's suddenly a huge issue? Fucking bullshit. I hate posts like this, there is no issue. The issue enters when substance abuse starts interfering with a person's job.

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.

Hi all! Just wondering if any of you knew how long this virus can live on a surface (such as counter tops, phones, etc.). I am working with a friend who wants me to get something out to his staff, yet insists it is 48 hrs. I know this can't be true, or hope it is not true. I am searching now for sources and info, and just getting over this myself (the swine flu), my mind is not quite getting that second oar to the water. Any help would be greatly appreciated. Thanks! Chaser

Nothing personal mate but I find the whole idea you guys get caught up in so many "advanced _____ life support" or alphabet soup clases run over a weekend nothing more than a farce to be laughed at. We had an American trained guy come down here; he proudly spouted out he had ACLS, AMLS, ADLS, PALS, PEPP, ATLS, PHTLS etc etc and how he could practice all those down here too if he got our version of them. Boy did he get the shock of his life when we told him not only 1) do we not have any of those (except ACLS) but 2) we don't require them and 3) they are of no value because a weekend course is not adequate education. Our system does subscribe to the international consortium's on various topics (like ACLS and PHTLS) but we do not do the weekend certification classes instead we build the underlying principles and established best practice into our education programs and whatever updates our Clinical Management Group feel we should incorporate get updated in our Clinical Guidelines or in the case of the Universities who offer the Paramedic degree they would incorporate whatever changes into their education cirricula. Again it drives me spare the way your system works; I have never spoken to a doctor about how to treat a patient, never have, never will and we hope it stays that way as we have no desire to change it.

Vent, I think you are naive about the IAFF, and also are applying standards from a hospital setting here. Inappropriate. You also misconstrue and misinterpret what I said. First, simply getting a degree will NOT change the problems in EMS. You need to understand the underlying reasons why EMS is struggling for respectability and recognition. The vast majority of IAFF members have nothing more than a high school education or a GED. They may have multiple classes in HazMat, technical rescue, but their baseline education is the same. Some places require various levels of college education to advance within their ranks, but in most areas, an entry level FF does not NEED a college education. Why? Because what they do does not REQUIRE advanced training or education. The vast majority of what they learn is technical instruction in a fire academy, and the rest is on the job training. So, why are they able to dictate and determine the future of EMS in many areas? It's about established culture. They, along with LEO's are the dominant force in public safety. Why? History, numbers, and tradition- NOT the level of their education. More education will certainly benefit the provider, but not necessarily EMS in general. A college degree or advanced education is not like a magic wand that will cure what ails EMS. It's far more complicated than that and education is only one piece of the puzzle. We are at a crossroads in EMS, and I think we need to be very careful how we proceed here. If you are suggesting(as is the current trend) that we transform EMS into something new- ie advanced care providers with multiple certifications and competencies- that's fine, but it's also a fundamental shift in prehospital care. Like I said, I think you are neglecting the impact this would have in smaller areas who would be unable to pay the salaries someone who has these competencies and education would demand.

Hey! Welcome to the madness. You'll find us an opinionated bunch, and numerous amongst us are always right (even when we are not!), but all are willing to share. You'll find some ongoing battles between members, the majority of which are in fun, like spinac and itku2er. Just use the search feature to find if someone else has had similar questions to what you might ask, figure out a spell check program that works for you, and if you feel someone else had a bad answer, give your version as to why that individual was wrong. On that last, give something that stands to some form of logic, as I am only one of many who will jump all over someone for saying, in effect, "You're wrong because you're too stupid to breath without prompting" (used as an extreme example, although on the joke forum, there's one based on that as a "blond" joke). One more thing: Please, no shouting, here represented by going all caps. Again, welcome!

Perhaps you have to pour gasoline on it to extinguish the fire? LOL.

Has it been raining? I just stepped into a poodle. We're all just barking up a tree, here. That video is all bark and no bite. It is also the first indication that George Carlin was wrong when he asked what a dog does on it's day off, as it can't just lay around, that's it's job.

So are you saying that those working in the hospital don't need none of that there book learnin' stuff? Your paragraph here makes absolutely no sense. RNs, RRTs, PAs and NPs already saw their need for advanced education to work outside of an ED or ICU. This could also bring us to the Paramedics that attempt to do CCT half-arsed with a pathetic 80 hour overview of a few basic concepts that pertain to ICU. No Paramedic should be allowed such responsibility without more education. At least that is one thing CA did do right by having predominantly RNs on CCTs and Flight. That state at least knows its Paramedics are not educated to accept that responsibility. RRTs, Radiology Techologists, RNs and a whole list of health care providers in rural areas have managed to get their 2, 4 and 6 year degrees while living in rural areas. Why is it that EMS seems to attract those that are so incapable of seeking education and use everything they can as an excuse. Believe it or not, education might just bring a change to some of that volunteer stuff. Florida has very rural areas also that were once covered by volunteer. Now it is an all paid ALS state for 911. If you ever get a college degree, it is something to be proud of. Those who have yet to obtain that accomplishment usually make statements like yours. Nobody is asking EMTs to get a Ph.D. Although, if a few did they wouldn't have to use the nurse educators for their academic leaders. An Associates degree is not going to make you an independent practitioner. Why should doctors extend advanced privileges to those with so little education? You are also not going to force a doctor to grant privileges to Paramedics who are not capable of advanced protocols. The type of system, oversight and area will also play a role. Not all Paramedic ALS systems should be doing RSI regardless of the national standard. But, those who are capable can be given great responsibility. Flight Paramedics and some CCTs do have expanded protocols but also have closer oversight and are often extensively trained. Others may just be given 2 hours of orientation in the back room of an ambulance service and that is all. The basic education of a two year degree should be there so the PRIVILEGE of advanced protocols can be granted to the Paramedics by their medical directors. Just because you can does not always mean you or everybody should. Another example: look at what the RNs and RRTs can do on transport for patients of all ages that most Paramedics have never heard of. They also aren't just responsible for that patient in a truck, plane or helicopter for 10 minutes but may be with that patient for 12 hours. They were able to build upon their basic 2 or 4 year degree to be clinicians that can function anywhere. Again, does the IAFF come to you personally and forbid you to go to college? You are using them as an excuse. Once more saw the importance of an education and quality did improve, the 3 month wonders might be scrutinized closer. You need to get past your attitude againt the FDs. And no it is not the IAFF that is keeping your wages low. For the amount of education it takes some to become a Paramedic, you should be happy with what you are paid as those making minimum wage at other jobs involving more hours of training. You might complain about how bad your working conditions or how much responsibility you have but if you even looked at some of the others jobs out there, you might have a different opinion. If you want to try the argument about responsibility for the patient that is invalid also as you don't see it as enough of a responsibility to see that yourself and those around you should have a decent baseline education to see what type of quality care that can be provided. I don't know what it is going to take for EMS to see it is about health care and medicine. It is NOT "so different" as some would like to believe. The only thing that makes it different is all the labels EMS uses for avoid the word "medicine". Thus, all we get is excuses for some to not take responsibility for their own destiny. Waiting for someone (or IAFF) to make you get an education is not the correct attitude or path.

Well, no aches and pains today(other than the usual back pain, LOL) so it's all good.

Whoa pardner.....Since I originated this post concerning the different levels and new standards, I was very interested in other opinions. Concerning this statement you made above, just what 'issue' do you have? I am from Iowa, was an 85-I, then took the paramedic course a long time ago and saw the progression of the 99I. Do not pen the phrase 'for lack of paramedics'. There were many other factors why Iowa provided this level, and the term 'Iowa Paramedic' for the 99I was because of the specific topics taught within this curriculum aligned with Iowa's scope of practice. Did I completely agree with this.....no.....but there are numerous other items to consider. This has created a nightmare for some of these individuals currently at the 99I or 85I level on whether to move up or down to the forecasted EMT, AEMT, or Paramedic level. It's a dilema that this post was originally started to see how others within the nation felt about the changes.

Well, I'm thinking my initial cynical hunch was accurate. The kid's statement, the parents reaction to it- busted, IMHO. I heard an interview with a sheriff who said that house AND garage was thoroughly searched. He said they were not aware of storage space in the attack and that there was debris/stuff in the garage, and a pole, but no ladder or stairs that led them to believe there was any attic storage area in that garage. The sheriff suggested that maybe the kid climbed up on the debris and/or the pole and hoisted himself up(or was helped) to the rafters. The sheriff also said that while they were at the house, it seemed that the parents had absolutely no control or discipline over these kids- they seemed to be running around like maniacs and were oblivious to what was going on. Here's the thing folks- If anyone has or had a kid that age, they know a child's perception of time is warped. Tell a kid to stay in his room, take a time out, no TV- whatever, and a 10 minute punishment seems like 12 hours to them. This kid was hiding for several hours. I am not buying it. I feel bad for the kid- he was probably doing what his parents told him to do- it's not his fault. Then I hear the kid has the flu- which, in conjunction with the media attention, would explain why he threw up while doing the national TV thing. So, let's pretend this was an accident/mistake/misunderstanding (BS) but, WTF are the parents doing dragging that sick kid in front of the media- CNN, GMA, and countless other interviews? They could make a statement, tell their side of the story, issue a press release, etc as they should in a case like this, but to drag that kid out and do multiple interviews- they are media whores. You need a license to fish, to have a dog, but any idiot can be a parent. And so folks, we have the next nominees for parents of the year...

AK search is your friend my friend. Already a discussion on the automatic news we get here.

"We did this for show." -Falcon Survey says, daddy.

If memory serves me correctly, Johnny and Roy responded to a situation like that. It turned out the gas company repair guys were attempting to flush it's 600 PSI natural gas lines with an 80 PSI water main feed.

Yes, One of our helicopters crashed and killed a friend of mine. We went through the entire CISD stuff. Let me know what I can answer for you. JW

I fully agree let people do their jobs, the inherent problem is, how many non-pilots can tell the difference between an 800ft & 500 ft ceiling? 3 or 5 mile visibility? Temp / dew point spread? How many of you can look at Nexrad weather and decipher the radar picture in depth? How many people know how to tune in the ILS or Localizer, or read an approach plate properly? I am all about keeping my a$$ on the ground if weather is closing in, or could deteriorate in route, but too many times people jump the gun and start quoting something they know minimal about, and this includes flying, medicine, sports whatever..... This is what really irritates me to no end..... VentMedic, Nice to see you are still ruffling feathers on Flightweb! LOL......Same old crap over there i see! Hope you are well... Respectfully, JW

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.

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!

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.

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.

First no billing if upon arrival patient says I did not call and do not wish your services. If the Paramedic denies transport because it is not deemed necessary for an ambulance patient is still billed because they called. EMT's should not be denying transport but a properly educated Paramedic has the ability to in limited cases to deny transport. Why should we not be paid? A doctor could tell the patient nothing is wrong and they would still charge. No not saying we are as educated as doctors just illustrating payment for similar treatment, which was no treatment. And no need to argue the deny protocol as we both know each others stance on that. There is no business that can survive w/o income. By billing you are having those that use the service pay to help limit the amount the rest of the tax payers pay. In my experience this stopped only a few callers. We had some that would call at 5am to take their BP because they did not want to bother family. They had no complaints just decided to get a morning BP. Those type stopped calling when they started having to pay. The frequent caller with angina still called weekly when they misplaced their nitro. They requested treatment and no transport and are billed. At least we recoup something.

I can see this being a problem if it is not the "patient" who made the call. What if a well meaning family member, friend, neighbor, passerby or LEO at an MVC/bike/skateboard or whatever accident who just wants to cover him/herself makes the call? What if the patient says they were told by the EMT(P)s they shouldn't go? Technically, that is not their refusal especially if it is done because the EMT(P)s don't have the protocols amd/or the confidence to just state no transport or just don't want to transport. This is were some of those signed refusal forms could be tested if the signature was not properly obtained.

"Attention Medic XX respond 17th St and Skyline Blvd for a reported MVC, time out 0130" Already on the road your responce time is under two minuets and you arrive to find a small crowd of bystanders on the sidewalk, an SUV approx 3/4th of the way down a city sized block and a female patient lying supine next to a sidewalk on the street. The patient per bystanders was struck by the SUV while riding her bicycle at a moderate rate of speed and bystanders report the suv "is messed up." The patient is a female in her twenties and appears to be approx 25-30ft from the inital impact and is also approx 10ft from both of her shoes. The patient has a standard bicycle helmet on and bicycle has been moved away from the patient. You and your partner are both Paramedics, working in an urban setting where a Level I/University level trauma center is 5min away. On arrival your partner approaches the patient as you gather the equipment. The patient is rolled with assitance of bystanders onto a LSB, C-Spine, CIDS, etc packaging is preforming rapidly on scene. The patient is found have no purposeful movements, a small laceration next to her left eye, and dilated pupials, the paient's respirations are shallow, and radial pulse is weak. You request the Engine Company from your station (approx 5 blocks away) to respond for manpower as you move to the ambulance. The patient's clothing is removed and abrasions are noted on the left arm and leg, the patient continuse to have no response to painful stimuli. 02 via NRB is placed, and vitals are as follows, BP 70/40, HR 38, Resp 10-12, EKG-Sinus Braycardia, Sp02 100% on 02. Bilateral 16g IV are established, and BVM ventilations w/OPA replace the NRB. On arrival of the Engine Company (approx 2min later) you instruct your officer "I just need a driver, lights and sirens, fast, go now." En route a approx 200cc NSS is admin for hypotension, 1mg Atropine is admin for Bradycadia, the heart rate increases to 90, the hospital is notified and you arrive within 3min. -------------------------- On arrival at the Trauma Center the patient is intubated after several attempts, assessed and found after scans to have serious brain injury. --------------------------- I'm looking for what you would have done/or do differently in this situation. Also any specific studies in regards to Braycardia and the use of Atopine in these patient's.

The fluid bolus was given as the BP was below the "permissve hypotension" line which I believe per PA protocal is 90 systolic. My logic behind the Atropine was that even with the aiway addressed with OPA/BVM there was no increase and I saw the potential for it degenerating into an arrest situation en route. So how would you have explained in your report to the hospital that the patient was initally in Sinus Bradycardia and en route dereased until finally you decided to treat PEA/VFib/Vtach? We had a very similar call a few weeks prior where a pedistrian was struck by a car at a high rate of speed, wasn't hypotensive but was bradycardic without adequate ventilations. This patient recieved ETI en route due to agonal respirations, blood in the airway, etc.

I assume crotchity that you are the picture of health, what 6 feet tall, 190 lbs of lean muscle mass? You have never abused a substance in your entire life. Never woken up with a hangover, or regretted something you did in the clear light of the morning. Where in Canada do you work dude? Outline your work history. You seem like a troll, pure and simple. Your post count reflects that. If your partner "reaks" of alcohol or are "obviously" altered by some type of substance, then ya. I would do like any other sane person would do. Talk to them, say listen, maybe you should go home, and go from there. If they refused and I had solid evidence, then ya I might escalate it. I'm no angel, and people do have problems. It's not your place to pass judgment unless you have substantial evidence.

Pay thier own health care costs as opposed to those who drink or smoke? There is no difference. It's the same as those who eat like shit, don't excercise, etc... Feel safe for a heroin abuser, as opposed to an alcohol abuser? A script drug abuser? Again, looking at the big picture, there is no difference. Any form of substance abuse has the ability to interfere with day to day life. Do you report people who say they are tired because they had a rough night the night before? Do you question on what substance's they may have ingested, take a tally, and then tell them to go home? Report them to a supervisor? If they drank X beers is it ok, but smoked one joint its not? I'm sure you are an angel with all things crotchity... Unless you have SOLID reason to believe that a person is at work and directly under a mind altering/decision making/clear thinking substance, then you have to give them the benefit of the doubt.

AK, did you purposely post this on... Sunday! Sunday! Sunday! LOL, at "the show must go on". Chistine Moe at the end crying about how they didn't stop or anything. Ummmm HELLO CHRISTINE!? The show must go on! This is monster trucking after all, not some cricket match or something. Go back to Russia...

I've given midazolam IN to two patients both pediatric, both with underlying seizure disorders, and both with significant cognitive/neuro diagnoses and compounding medical issues (G-tube, etc...). Both patients were also long duration (15+ mins), refractory seizures (SL ativan was given in both cases). I have done presentations/research on the effectiveness of IN versed/narcan and it is well warranted. First patient my partner tried a line, could not get, and I said forget it and just gave IN versed. Second patient, parents said the Children's Hospital here could never get a line (one of the best in the world), and they always went PR. Didn't bother with IV, went IN. In both cases seizure activity ceased in about a minute. Personally I would always go IN versed first line for ped. seizures from now on. In both ped cases I didn't bother trying for a line even after the seizure stopped. Adults I would generally try for IV diazepam first, but I won't dick around with an IV with I/partner can't see/get one. I honestly can't remember the last actively seizing adult I've had pre-hospital. Always get a history guys before you start treatment, even if it is basic (yes multitask). Generally speaking, seizure's are self limiting, and besides that there is no reason not to get some type of story (IV's/procedures aren't done instantaneously like they can be in scenario's). Seizure disorder? Duration? Number of events? Full Body? Witnessed/events that lead to discovery? Meds? Compliance? Generally these will be 95% of your patients (when a history is decently available). If not ask about ETOH/drugs/head injury/cancer or ongoing medical investigations. This takes like 1-2 mins. ABC is pretty self explanatory. Nasal? Meh... Unless they are grossly obtunded for a prolonged period post-ictal or cannot maintain airway (self/positioning). c-spine? Did they fall down a flight of stairs? No? Just make sure they don't bash their head while actively seizing. Active seizure management is generally uncomplicated prehospital. EDIT - You should get a blood glucometry prior to managing seizures with benzo's. There is really no reason not to get one. If they are hypoglycemic, I would manage accordingly prior to benzo's.

I think a big relief to the frequent flier callers would be the ability to transport to alternative destinations as opposed to the ER everytime for minor things. Obviously, major complaints should go to the ER and be evaluated, but minor things could be handled outside of the ER. Let them be transported to the health clinic or urgent treatment facility, be evaluated more thoroughly by a MD/DO, PA, or NP. Then if they feel it significant, have them transported out. I think there are many things that could be handled in office. It's not quite the freedom once given in certain areas for complete refusal of transport, but instead gives a moderate area that functions as a "fast track" ER (which sadly most of the hospitals around here have done away with due to expansion and limited space). I think it would relieve the strain on the ER's and also have a quicker turn around time for EMS than a patient in the ER. Also, the urgent facilities tend to have more time to address certain concerns as does the health clinic and can give more guidance towards resources than the time crunched ER's. They can provide info to free clinics, senior citizen assistance, food pantry's etc. Also, you could still charge for transport, but the patient wouldn't have the stress of a huge ER bill. THere was a county that tried to charge for refusals here, and another tried to charge for non citizens of the county involved in accidents/wrecks but both of those were repealed due to response of people. They didn't last long, perhaps other states have done better, but it hasn't worked well here.

Will be happy to answer any questions that you have. My two cents worth: Its not a bad thing if it is voluntary, and it is closed to everyone except those who were involved in the call (should offer invitation to dispatchers, they are often forgotten). I have found that sometimes you have people show up that want to be spectators, who had no involvment with the event. But I think it should just be used to "vent", if someone is really troubled by an event they should see a true mental health professional. I have found it to be more useful in rural areas where you may have volunteers who are part-time providers, and due to the low call volume, they are not used to dealing with these calls, and/or the patient may have been a friend/relative.

The research shows that CISD on the whole is not recommended because while it may benefit a few, for most it does nothing or actually causes harm! Look for bbledsoe's article on the subject.

JW - I will not speak as to what I don't know. However, the one incident that stands out in my mind was the desire to accept a flight when the particular county requesting had just had a tornado spotted in their county. Do I think it was inappropriate to accept that? Very much so. It was sheer ignorance to begin with and yes, on an instance like that I am all for putting my foot down. You are trusting the pilots with your life, and yes, if there is a valid concern as to accepting the flight, then I would express my concerns. Though I agree the ultimate decision lies with them and they are the ones that will be scrutinized even harder should something go wrong. I am far from a weather expert and as previously stated, I respect your input as you can speak from both sides of the fence. However, this discussion is not on flight medicine, so I'll apologize for hijacking a thread here. If you care to continue the discussion JW - feel free to PM me about it. Now back to your regularly scheduled discussion.

Engine with articulating boom, usually 50-60ish feet

What is a squirt??

It only lets you give one negative in any 24 hour period, so it shouldn't be easily abused.

Ruff, I think the attitude reflecting those was different. Similar to the movie Pauly Shore did that I remember quite well "In the army now". I found it hysterical as did many friends of mine that are in the military. The difference was that everyone KNEW it was supposed to be a comedy and expected spoofs, much like with many of the movies you have described. I understand creative liberties were taken and I can only imagine what the navy seals had to say about "g.i. jane". However, they are a smaller group and their rejection was probably much quieter and amongst themselves. But it certainly didn't portray them in a good light. If I were one, I would have been ashamed. However, as I am not one, and know very little about them or their training (other than it is extremely difficult) it was a decent movie (partially because I think the actors did a heck of a job in the movie playing their roles) regardless of what accuracies/inaccuracies were done. I do recall a similar fuss for a bit about the movie Super Troopers (evidently state troopers don't have much humor about themselves). However, once they realized it was supposed to be a stupid parody of their profession they calmed and almost all of them I know (my husband included) think it's too funny despite it's incredible stupidity. If they had taken the approach to EMS that they did with Scrubs that it was supposed to be humorous and have inaccuracies in there, I think many of us would be sitting back watching and laughing like crazy. Instead they took a serious approach and wanted to make people feel like it was reality. That's a concern. Here's one question I have - Rabbit is supposedly the higher level of care (or is he a regular medic that just happens to be on a helicopter - haven't figured that out yet), yet he passes off a pericardiocentesis to a street medic. I understand VERY few places have this within a protocol granted under direct online medical direction. Think they went looking too much for the zebras and forgot the horses that are standing there looking at them. Good questions posed there though Ruff -

wow that's kinda freaky... water on fire??

I know. I got it from your post. But you FAILED at embedding the video, so I fixed it for ya.

I was involved with a CISD after I was on an MVC that killed a classmate of mine, and her sister. I would have much preferred an informal, grab a chair and pull it up in the engine bay, and just talk with the old salts and the counsilers, the CISD did work. I think the CISD is helpful, as long as it is not forced.

That first sentence is a gross misinterpretation of what Herbie actually wrote. At no time did Herbie state that hospital staff don't need no edumacation. Where are you coming up with this stuff? I agree that the higher the standards, the higher quality of individuals will be attracted to the Industry... provided that compensation and benefits are comparable to other industries with similar standards. Before you misinterpret that statement, let me say that I am not looking for any handouts, and I am not making excuses, just stating that people don't go to school for 4 years expecting to make 14-16 dollars an hour. It may happen, but it is not a decision many people will make on purpose. To attract the people you want we will have to offer appropriate compensation for the level of education you want to require. Your last statement quoted is both equally pompous and assumptive. Why must you assume everyone with an education would have similar ideas, and make similar statements? People don't always fit into the narrow rubric you have provided. paramedicmike- In order for this educational change to take place we first must organize as a profession, agree upon what the education will entail, and make sure that our organization is strong enough and influential enough to force the changes we suggest. That is not easy, if it was... it would have happened already. If it is your position that you think that if we all individually get Bachelor degrees in pre-hospital medicine (which, by the way do not exist everywhere) then the industry will magically bend to our will over time... well... let's just say that I disagree. Without a National presence that exerts influence and mandates change inside and outside of the Industry, I do not see the widespread educational changes that we all so desire.

Tuesday Morning, we sat infront of McDonald's contimplating breakfast but before we can enter the store we are dispatched on our last call.... Attention "Squirt 43, Ladder 9, Medic 7" respond to the West Bound Local Expressway for an Accident. Note, any responce to an expressway in the city has the Engine Company for hazzard, etc control and the Ladder as the Safety or Light Duty Extrication and the obvious BLS or ALS unit. My partner and I respond and arrive first finding a Police Wagon with heavy front end damage that appeared to have struck an empty full sized school bus. Standing outside the wagon are the two officers that look dazed but not seriously injured. My next question to the officers is "do you have anyone in the wagon?" As I heard there answer I walked over to the wagon and looking through the secure doors and see ten prisoners all who have various "complaints." Now the game has changed...My inital report to dispatch was "police wagon vs.bus I'll give further". I get back on the radio..."be advised I have a occupied police wagon invloved with two officers and ten prisoners dispatch me five more squads and my supervisor." Five additional squads are dispatched with eta's ranging from 5-10min, a fire batallion chief, and the (AM only) EMS Ops Chief responds. Approx three min later my Engine arrives and I give a face to face report with my lieutient, and follow with stanging orders for the incomming ambulances. Anytime the ems supervisor is dispatched the dispatcher determins the trauma centers capacities and relays that. Approx 5-6min into the incident...Two more squads arrived, we assembled a pile of ten lsb's by the wagon and I have advised the first white hat police officer I see that we'll need at least six escorts when the prisoners are removed and transported. Approx 1-2min later my EMS Lieutient arrived who I again gave a face to face with, a run down of the incomming squads, and that point was ordered to transport my two patient's. The ten prisoners are removed from the wagon once adequate police support has arrived, they are ransported with the remaining squads and split between two hospital with other police wagons as escorts. All patient's are stable with only MOI the real concern. So your thoughts???