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Wow, haven't been on emtcity in a long time. I'll have to get used to navigating the site now that it's a little different. There's alot of new faces. For all the people who remember me-yes, I am still opinionated, but in a good way lol. I did a search, but didn't see where anyone has mentioned the Texas EMS Conference in Fort Worth at the end of November. Anyone else going?? Edit: I just noticed people can rate a person's reputation and a warn status is posted. LOL Oh boy.

an eye for an eye makes the whole world blind - Ghandi Mahatma Gandhi, as you know, walked barefoot most of the time, which produced an impressive set of calluses on his feet. He also ate very little, which made him rather frail and with his odd diet, he suffered from bad breath. This made him (oh, man, this is so bad, it's good) ... a super-calloused fragile mystic hexed by halitosis.

Here's the million dollar question. You're the medical director. Outside of exceptional circumstances (e.g. "advanced practice paramedics" like seen in Wake County) you're going to have one set of protocols for each level. Let's say that you have a 900 hour paramedic and an associates degree medic in your service. Who are you going to design protocols around since they both are going to work under the same set of protocols?

That was my point- I KNOW PA's and NP's need physician oversight, although they are still more autonomous and can provide more "independent" care than 99% of other allied helath professionals. I was responding to the issue of education and expanding the role of an EMS provider. We can have a PHD in EMS but unless someone ELSE(MD) is comfortable with AND is willing to allow us- to go beyond our current scope of practice, our future is limited. That's why I think that at least in the short term, we need to try to effect change within the boundaries we currently have. Being a cynic and a realist, I look at what organizations are in the forefront of legislation and initiatives. EMS issues are being dictated primarily by a group who's primary function is NOT EMS because they have the political clout, the numbers, the organization, and the money. The IAFF is the primary adversary here but for those who have been around for awhile, they are well aware of groups like the ENA and other nursing organizations that have a vested interest in this. Any time you propose something that is traditionally the domain of someone else- like home health- you are stepping on another group's toes and taking money and jobs from their members. They have and will continue to push back. We do not have the political capital to push back, and honestly, I wonder if we ever will. Think of all the resistance EMS saw just 20 years ago- often times we had open hostilities with ER RN's. Yes, this has changed, but as anyone who deals with old school RN's knows, there are still some hard feelings. They do NOT like the intrusion into their domain. Food for thought- Once EMS starts branching out into areas like public health initiatives- vaccinations, public inoculations, home health, hospice and palliative care, etc- can we still be called EMERGENCY medical services? Won't we morph into something very different? From a fiscal standpoint, would a local government love to see EMS providers participate in these things traditionally reserved for nurses? Of course, especially when at this point, an EMS provider is not paid the same as an RN.

I'll give ya a +1 for coming back. It's been a long time since you graced us with your presence. Sadly, I will be unable to attend the conference. I am renewing my ACLS,PEPP and ITLS that wknd.

Apparently somebody didn't realize that the "Suicide: Doing It Right" statement in "You Know You're In Medicine If..." wasn't supposed to be taken seriously.

I recently had a training bus that is federally funded come through our county and got to experience some new equipment that had recently been placed out on the market. The one I was most intrigued by was the S.A.L.T. (Supraglottic Airway Laryngopharyngeal Tube) Apparently, the U.S. Government uses them in the military with the combat medics. I've done some (not a whole lot but enough to be familiar with its uses and the like) research on the device and am quite impressed with it. I got to use one during the training simulator and intubated 4/4 times. They even changed out the airways in the dummy to the a Mal # 4 and I still had ease of use. Now, given the fact that this device has been used in the military and is slowly working its way in the urban EMS market. What are your thoughts? Do you think that this device will change what we use for airway control? Does anyone around you or even your service utilize this device? If so have you had any luck with the device, does it improve overall patient care? Some might seem hesitant and I'm also looking for your opinion. Obviously, the old fashined way most people will not want to let go of. But, I'm for anything that will improve my patient's outcome safely and quickly. This device promises to do both. The device itself is made of semi-maliable plastic with an elongated tube with a large base to "block" off the esophagus to prevent aspiration. It is a dual use BLS/ALS airway, in which using it BLS wise would be an advanced type of OPA. The device would also in turn eliminate the use of the laryngeal scope and properly intubate every time. Here is the web address: http://www.mdimicrotek.com/prod_salt.htm

What I find absolutely amazing about this conversation is the fact that although what we have here vs. what you have there is like day and night, we are still faced with making things better in the system. I was trained in a very advanced part of the country for EMS in a state 2000 miles away from where I am now. We do things here that would absolutely floor my compatriots up north. If people have only worked in their own system, they don't know that there are better ways to do things. Some of the "better" ways up there are unworkable here because we don't have the equipment or the mindset to make use of the equipment. I would love to start a dialogue with you specifically addressing how to bring progressive change when 1 - we are "just" paramedics and 2 - we need to get support of the hospitals and other health care providers.

Hey guys, I also want to emphasize SA is talking about care in an environment so far removed from what we know in the United States, that making a comparison is nearly impossible. If you have never experienced the horrors of some of these places, you really cannot adequately appreciate the profound differences. Therefore, I am not sure I would go so far as to call the doctor in question incompetent as much as simply not having access to resources? Then again, the patient was placed on CPAP, so the hospital in question had access to this resource. I tend to agree with Vent that the prognosis for this kiddo is quite poor. I understand what you mean SA, I was forced to leave patients to die a miserable death during my time over seas because of lack of resources, qualified providers, and cultural beliefs that punish even the most innocent kids. Take care, chbare.

I am not talking about a children's hospital but rather a pediatric nursing home that takes ventilator kids until they are 21 y/o. If they do manage to save this child in terms of the body, the baby will probably require special care for the rest of his life. Unfortunately even in the US those facilities are few and often very crowded.

Apologies for the delay in my reply, Monday's at the office is at best a day to have rather stayed in bed. Also apologies for not giving more information on this case, I was slightly more than a little pissed at the initial medical treatment and facility. Starting at the beginning (and I wish I could show you this medical facility and it's staff). The only information we had at the time of dispatch was that the child (male) was born 2 months prem and is now 2 months old. The parents were unhappy with the current treatment being given at the Government facility and wished to have the child transported to the private facility 5min down the road. On arrival I found the following: 1) Baby weighing 1.2kg (slightly less than 3lbs)on CPAP, 2) Severe dehydration (evident by the loss of tugor on the abdo and calves) 3) Cyanosis (particularly evident in cranial area and the chest) 4) On palpation the child was cold (to the extent of my sats probe did not detecting anything, warming the baby with the warmer blanket helped) 5) The baby was not crying nor showing any normal / expected response from being examined 6) Auscultation revealed a rub of right and no audible air entry in left (PDA question: No murmur audible) 7) Resp: Rapid (-> 60/min) with deep suprasternal retractions 8) Pulse rate: 67 (as mentioned in initial post) 9) SATS: 56% on CPAP (as above) 10) IV insitu ® arm. 11) BP 50 systolic 12) Lymph nodes small and palpable No labs nor any xrays were available (according to the treating doctor and nurse) The treating doctor informed me that the child was admitted with pneumonia and has received no medication / antibiotics to treat the infection. The only treatment that was confirmed would be the CPAP and IV (as mentioned). This is when I decided to intubate with a 2.5 tube and ready for CPR. I confirmed (as required) tube placement via auscultation (still no audible air entry left) and started bagging. With the stats going up and the HR increasing it was evident that no compressions would be needed. Thus we transported to the receiving facility while informing them that we are inbound and need an ICU bed. As mentioned earlier, chest x-rays were taken at the receiving facility revealing the pneumothorax of the left lung. I have not had the time yet to follow up with the paediatrician but will update you as soon as I have had the chance. In reply to CH - True, we have three levels of qualification in SA. 1) BAA (EMT- which is a one month course or 3 months part time 2) AEA (EMT-I) Three months full time (only attainable if you have 1000 pt care hours documented, passed the entry exam and obviously the course) 3) CCA (EMT-A) 12 month full time (only attainable if you have documented 1000pt care ILS hours, passed the entry exam and the course itself) The CAA / Paramedic course has changed in recent years allowing a school leaver to do a National Diploma via the Univ. No road experience required, yet after 4 years you walk out a Paramedic. You can then go and do B-Tech, M-Tech and D-Tech in Emergency care. The first two levels have a "under supervision" license whereas the rest have a "unsupervised" practitioners license. No doctor needed, nor any medical consult needed before administering meds / drugs as per protocol. In reply to Kaisu - I am in Namibia, how does a situation like this develop? Probably the same way a doctor flies a pt to my city indicating she had a CVA that's visible on the ECG! I do a check and low and behold, she's had an anterior infarc (I will scan the 3lead print out when I remember). In reply to Vent - I hope we use the same abbreviations here as you do over there. PDA question, see above for answer Probe was post ductal as you will no doubt have noted from my post above. PMI - Apical Pulse? If so, there was a shift to the right Sadly we do not have the "paediatric specialist" we can call to jump on our vehicles, nor am I allowed to ask for a x-ray to confirm tube placement. It's a resource that's bolted to the floor of the Govt hospital (some do not even have x-ray facilities). I so wish I had the facilities and resources you have across the waters. We still have to tube, confirm tube placement via auscultation, stabilize, load and go. This makes for interesting conversation though and helps keep me on my toes and dreaming. Keep it coming

Vent, Just to play devils advocate with you for a minute, I am confused as to your statement above, Why is is so IRONIC that Cosgrojo chose to get a BS in a non-ems related field....? I have been in EMS since 1992, moved up through the ranks from EMT-Basic, EMT-I, EMT-P, FP-C blah blah blah, I am 36 now, and just finishing a Double Masters Degree in NON-EMS related fields. MBA / MHA . I have always loved saving lives just as much as the next person, but honestly, we have to truly look at the statistics I think to understand we are rarely saving lives anymore, and have become for the most part expensive taxi rides, and primary care providers. I always teach and preach having to understand the " WHY" your doing something as opposed to knowing you have to do something, just yesterday in my ACLS class, I had to sit down and explain Cerebral Perfusion Pressure and why a CPP of 42 is bad in an adult. I am PRO education for paramedics, and I agree with 99% of what you say, I just don't see why it is so IRONIC for people such as Cosgrojo and Myself to pursue advanced degrees regardless if they are EMS related or not...... One last thing, CAREER versus JOB debate, these lines are becoming more and more blurred today, society has changed dramatically over the past 50 years and people are no longer willing to be subject to society dictating they MUST pick a career and work it for 30 years, retire, and move to Florida....:-) I read a recent study that showed, todays teenagers will likely have 3 different substantial " Careers" during their adult working life.....I personally regress against the thought that someone must stay in a chosen career field just because they like to do something.....I have multiple passions in life, HEMS, Aviation, Fishing, Cars, and I would be happy to be working in any of them..... Respectfully, JW Just in case anyone was wondering about Fallacies.......... Logical Fallacies An Encyclopedia of Errors of Reasoning The ability to identify logical fallacies in the arguments of others, and to avoid them in one’s own arguments, is both valuable and increasingly rare. Fallacious reasoning keeps us from knowing the truth, and the inability to think critically makes us vulnerable to manipulation by those skilled in the art of rhetoric. What is a Logical Fallacy? A logical fallacy is, roughly speaking, an error of reasoning. When someone adopts a position, or tries to persuade someone else to adopt a position, based on a bad piece of reasoning, they commit a fallacy. I say “roughly speaking” because this definition has a few problems, the most important of which are outlined below. Some logical fallacies are more common than others, and so have been named and defined. When people speak of logical fallacies they often mean to refer to this collection of well-known errors of reasoning, rather than to fallacies in the broader, more technical sense given above. Formal and Informal Fallacies There are several different ways in which fallacies may be categorised. It’s possible, for instance, to distinguish between formal fallacies and informal fallacies. Formal Fallacies (Deductive Fallacies) Philosophers distinguish between two types of argument: deductive and inductive. For each type of argument, there is a different understanding of what counts as a fallacy. Deductive arguments are supposed to be water-tight. For a deductive argument to be a good one (to be “valid”) it must be absolutely impossible for both its premises to be true and its conclusion to be false. With a good deductive argument, that simply cannot happen; the truth of the premises entails the truth of the conclusion. The classic example of a deductively valid argument is: (1) All men are mortal. (2) Socrates is a man. Therefore: (3) Socrates is mortal. It is simply not possible that both (1) and (2) are true and (3) is false, so this argument is deductively valid. Any deductive argument that fails to meet this (very high) standard commits a logical error, and so, technically, is fallacious. This includes many arguments that we would usually accept as good arguments, arguments that make their conclusions highly probable, but not certain. Arguments of this kind, arguments that aren’t deductively valid, are said to commit a “formal fallacy”. Informal Fallacies Inductive arguments needn’t be as rigorous as deductive arguments in order to be good arguments. Good inductive arguments lend support to their conclusions, but even if their premises are true then that doesn’t establish with 100% certainty that their conclusions are true. Even a good inductive argument with true premises might have a false conclusion; that the argument is a good one and that its premises are true only establishes that its conclusion is probably true. All inductive arguments, even good ones, are therefore deductively invalid, and so “fallacious” in the strictest sense. The premises of an inductive argument do not, and are not intended to, entail the truth of the argument’s conclusion, and so even the best inductive argument falls short of deductive validity. Because all inductive arguments are technically invalid, different terminology is needed to distinguish good and bad inductive arguments than is used to distinguish good and bad deductive arguments (else every inductive argument would be given the bad label: “invalid”). The terms most often used to distinguish good and bad inductive arguments are “strong” and “weak”. An example of a strong inductive argument would be: (1) Every day to date the law of gravity has held. Therefore: (2) The law of gravity will hold tomorrow. Arguments that fail to meet the standards required of inductive arguments commit fallacies in addition to formal fallacies. It is these “informal fallacies” that are most often described by guides to good thinking, and that are the primary concern of most critical thinking courses and of this site. Logical and Factual Errors Arguments consist of premises, inferences, and conclusions. Arguments containing bad inferences, i.e. inferences where the premises don’t give adequate support for the conclusion drawn, can certainly be called fallacious. What is less clear is whether arguments containing false premises but which are otherwise fine should be called fallacious. If a fallacy is an error of reasoning, then strictly speaking such arguments are not fallacious; their reasoning, their logic, is sound. However, many of the traditional fallacies are of just this kind. It’s therefore best to define fallacy in a way that includes them; this site will therefore use the word fallacy in a broad sense, including both formal and informal fallacies, and both logical and factual errors. Taxonomy of Fallacies Once it has been decided what is to count as a logical fallacy, the question remains as to how the various fallacies are to be categorised. The most common classification of fallacies groups fallacies of relevance, of ambiguity, and of presumption. Arguments that commit fallacies of relevance rely on premises that aren’t relevant to the truth of the conclusion. The various irrelevant appeals are all fallacies of relevance, as are ad hominems. Arguments that commit fallacies of ambiguity, such as equivocation or the straw man fallacy, manipulate language in misleading ways. Arguments that commit fallacies of presumption contain false premises, and so fail to establish their conclusion. For example, arguments based on a false dilemma or circular arguments both commit fallacies of presumption. These categories have to be treated quite loosely. Some fallacies are difficult to place in any category; others belong in two or three. The ‘No True Scotsman’ fallacy, for example, could be classified either as a fallacy of ambiguity (an attempt to switch definitions of “Scotsman”) or as a fallacy of presumption (it begs the question, reinterpreting the evidence to fit its conclusion rather than forming its conclusion on the basis of the evidence).

Almost all the state technical colleges and state communities colleges that have a nursing and/or allied health program have cheap CEUs. For online: Florida Medical Education Services http://www.fmes.net/ They are reasonable and report directly to CEBROKER which you will become familar with when you get a professional license. http://www.cebroker.com

Timmy, according to one of the "comments", the poster thought the T-shirt was supposed to be worn UNDER her turnout gear. But whatever, I see it as a non-issue. If you want to join the fire brigade, that is the uniform. Wear a sports bra maybe.

I would like to thank all of you for the lively responses concerning this topic. It will be interesting to see the outcome of the changes, although maybe not for a few years. Thanks again!

A well placed Monty Python quote always gets my vote! And the way to my heart is through my stomach, so chef's always get a warm welcome too! Welcome, fellow Floridian. Sounds like you're on track for a good plan. I would be remiss if I did not stress that nursing school BEFORE paramedic school is a ten-time better plan in almost every respect, but especially for your educational development. Ask any of us who did it back-asswards, and we'll tell you. But if being a fireman is your ultimate goal, then meh... you gotta do what you gotta do, I guess. Good to have you here. I hope we can help you out, and I'm looking forward to following your progress.

Welcome my East European buddie. Now you are free of commie oppression you can enjoy friendly and benevolent contact with the free West, particularly the great land of freedom ---- The USA. Good luck and may the red chains of communism never again wrap themselves around Poland.

I've got a few people bugging me to go, and I am certainly considering it. Should be a good time. Even better if some EMT Citizens make it! Always good to see you, Tigger!

Hey Im canadian and Im hot (well does menopause count)

Regarding the first paragraph, a CCEMT-P with a bachelor's, such as EMTinEPA suggested earlier could have the sufficient knowledge base to do the home care thing. That's dependent on the course material, naturally. The CCEMT-P with a bachelor's ought to be able to perform well inn CC txp's, and perhaps NICU's and PICU's with specialty training. Ditto for flight. As far as needing college to have any credibility as a pro education spokesperson, how about cutting me some slack. I already have A&P and pharm. After medic school I worked OT frequently as well as per diem jobs for two years, to get out of debt, and then to fund investments to provide my family with some measure of financial security. I then moved to Charleston for 6 months. Then it was a 9 month internship/recruit ordeal with Fairfax. The Fairfax career is proving way more lucrative than having an ASN or BSN. I now have the option of pursuing those goals, already being financially secure. Now I'm completing my rookie year. I spent those 9 months prior making only 53k without incentives, so I've spent my time post academy working OT and a side job, as before. We plan to buy a house soon. It's all about priorities, what's most important at the present. Did I not start the thread "RT vs RN" to ask for educational advice? Those wheels are in motion for the spring semester. It just so happens, as I've come to find out during a conversation with a colleague at the ED today, that NOVA CC's paramedic program is an accredited assosciates. Why is this important? It's important because the Fairfax County FRD sends selected employees that submit a letter of interest to the FRD to NOVA to earn their paramedic cert. Fairfax sends their employees to college for a paramedic assosciates. No fast track medic mill here. The dept also seeks to upgrade all their I's to P's when economically feasable. Fairfax no longer hires I's to function as ALS providers, to my knowledge. Score one for the fire service. I knew that I came to the right place. I did a quick google search and found this: http://education-por...n_virginia.html Look to the Annandale campus, not Tidewater, which is down near the Va Beach/Norfolk area.

The major difference between EMS and other allied health professionals is EMS believes it is so different and forgets it is part of medicine. For the RNs and RTs, there were a few hold outs but the majority of RNs and RTs already had their degrees long before the 2 year degree became mandatory or even before they had licensure in their State. FL and CA just got RT licensure in 1986. The RRT just established their 2 year degree mandate and many now have 4 year degrees. Exercise Physiologists have a Master's degree and have license in only one or two states. But, eventually that will change. Athletic Trainers with a 4 year degree do have licensure but have been around a little longer. Do you see how education plays a role in the career you have chosen? Why put the Paramedic at the far end of nowhere with just a tech cert when it deals with patients' lives? Many RNs also now have 4 year degrees. The majority did not have to be told they needed more education. They sought it themselves. That is part of being a good clinician and professional. The one advantage of working in a hospital is you get to mingle with other degreed clinicians. You also get to see the differences of those with a tech menatlity and those who realize they need more education since medicine is ever changing. EMS has alienated itself to where it does not relate to the world of medicine. The "oh we are so different" crap has seriously played a role in warping attitudes against education. Since you, who tries to say you are pro education but have not made any attempt to get a degree, you do not represent those who are pushing for higher standards. In fact, you are part of those holding it back. You spout off one way but state "make me" or offer every excuse not to get an education until you are forced. It is a mere 2 year degree. No one is saying you must even get a Bachelor's degree. What is so difficult about taking a couple of A&P classes and a few additional classes? Why don't you set an example instead just using "EMS" as an excuse not to get a degree? Maybe if you actually got the degree and saw what you are missing, you might be a better pro education spokesperson or at least have a little credibility when you do try to talk about it. 46young should do the same. Since you and herbie are hung up on saying the RNs did not want to get educated, let me given you an example of how you are not correct. In Dade (Miami) and Broward(Ft. Lauderdale) counties, there are 2 community colleges (2 year) that offer the nursing program. Miami-Dade Community College Broward Community College There are at least five major 4 year colleges that offer the program and all have a waiting list. University of Miami FIU FAU Barry University St. Thomas University Nurses are already preparing themselves for the future. If nursing students thought a BSN was a waste of time, they would just wait for an opening in the community college. The other programs are very expensive but most are willing to do what it takes to get a good education and secure a future. But then, that is also what every parent wants for their child also.

Welfare checks, maybe but... There is also nothing in the Paramedic curriculum that would prepare a Paramedic to do what RNs do in home care. When was the last time you staged a wound and applied treatment? What do you know about insulin and diabetes teaching? Nutrition? Tube feedings? Various vacuscular access devices for the long term? Chemo? Stoma care? Various ostomies? Evaluated BP medication effectiveness? Administered all the typical medications many, many times to be familiar with them? Did family education for all of the above procedures? To be effective, one should have enough knowledge and experience where all issues involving long term patient care should come easily for the practitioner. For the CCEMT-P, some ambulance services hand out those letters after a two hour inservice. They may even call them that so the truck can be a CCT but due to protocol restrictions they may not have any more skills or knowledge than a regular 911 ALS truck. Some Paramedics, such as in FL, can have an expanded scope to do IABP and ventilators. However, again, the training/education will vary from 2 hours to 2 weeks. And yes, some doctors have refused to let some Paramedics take the patient unless a nurse went with them when they appeared clueless or overwhelmed by a critical patient. We have also had some very back adverse outcomes from Paramedics transporting patients that were way out of their expertise. Unfortunately the Paramedics didn't understand enough to ask questions or what even what questions to ask. The UMBC CCEMTP is a very basic overview of a few critical care concepts. In two weeks it is very difficult to teach one to be a competent critical care clinician. Several RNs and RRTs have taken the program only to be disappointed in the material but most already had critical care experience and found it to be very basic knowledge. For the Paramedic, it is a decent program but should NOT be taken as an end all or even a good beginning for all there is to know about critical care medicine. Too many have come away from the UMBC class thinking they know everything there is to know and that leads to very bad things for the patient they are assigned the responsibility of. There are only about 5 states that do recognize the CC-P/CICP/CCEMT-P credential in their list of levels. I believe Ohio has a decent setup for their CICP but less than 100 hours of training is required. That pales in comparison to the training other practitioners get for critical care even without the experience. If you look at the degree of the RT, it is essentially an introduction to critcal care medicine and even at that it barely scratches the surface for all one can experience working an ICU. The Canadian Flight/Critical Care Parmedic program is very impressive. Their training is adequate enough to where nurses do not need to accompany them. But, it is built off of an already impressive education foundation. U.S. Flight Paramedics can also have an expanded scope and often do get a decent amount of education and additional skills from their employer. However, the ideal candidate should have at the very least college level A&P. Pathophysiololgy and Pharmacology would also be a big plus. As it is now, an RN is usually paired with the Paramedic if they do CC IFT. It is even difficult for CCT and Flight RNs to keep up with all the advances in Critical Care medicine unless they are hospital based or continue to work in an ICU on their off days. Paramedics do not have that opportunity nor to they have the base education required to fully grasp all the critical care concepts if they graduated from a Paramedic program that just did the minimum "hours of training". Just learning a few "tech skills" to be a knobologist for the IV pumps and the ventilators are not sufficient to manage an intensive care patient. Unfortunately, those that have gotten a CCEMT-P patch from their employers with little training rely on speed to get from point A to point B if taking a nurse is not an option or they bluff enough to make people think they are well qualified. There are of course exceptions. Rid has explained his program for CCT and it appears to be quality.

Scott33,,,,,,, Having worked and lived in Nassau County for 14 years, I will tell you IMHO Massau County Police, I one of the most backwards ways of doing EMS in the Country. He is why: A single, non-police officer Paramedic or EMT-CC, rides around ALONE, in an Ambulance. (Which bascially means you have to drive all the time, even when you do not feel like driving today, and conversly you need to always be to one t provide patient care, and you do not even have a medic partner t bunce ideas off of.) When a call comes in, s/he drives to the scen, and then provides patient care, AT LEAST 2 other POLICE Officers,, whom the cunty pays an average of 90-100K per year then drives to the scene. 3 people, including 2 LEO's are now tied up providing EMS. If the patient is critical, the 2 officers, who, while they get trained as EMT's, may or may not have any real skill, or interest in doing EMS now need to drive the amb. to the hospital, and the other assist with patient care. The officers who are driving are now tied up, waiting for the ambulance to pass off the patient and clean up n the ED. Or, worse, they send a second Ambulance, tying up a another medic, and knocking a transport unit off service. This does not even get into the dual response sytem of FD and PD both sending units, to calls, and tieng up multiple resources, etc. The Nassau Protocols, had Pain meds authorized for 10 years or more, but they have yet to put them on the street. If Nassau Wanted to do it correctly, they would put 2 medics, or a EMT and Medic on each unit, and eliminate the cops driving. There are however systems in Minnesota, Michigan, and Utah that using cops, as both LE and Medics. This might make PERFECT sense for areas that are very remote and do not have alot of LE or Medical calls going on, but then the better keep up their medcal skills with a lot of CME, or training so the do not get STALE. below are some examples: http://www.cottage-grove.org/ems.htm http://www.ingham.org/pe/Job%20Descriptions/SHERIFF'S%20DEPT/Field%20Services%20Division/PoliceOfficer.pdf http://www.daviscountyutah.gov/oopm/job_posting/job_posting_public.cfm?job_posting_id=5 Cop shoots then saves suspect: I think this is also Michigan, as Flint is mentioned . http://blog.mlive.com/flintjournal/newsnow/2007/11/paramedic_shoots_then_saves_ro.html Tha is not to say however that the Nassau County Paramedics are some very good providers, and they are dedicated to their jobs. It's just that as a SYSTEM, they are not a really good model. IMHO.

This isn't about being careful with what you say, it's a valuable lesson in identifying pathological issues in someone who's supposed to be a patient advocate. I'm glad this guy's license has been revoked, at the very least. I'm surprised that it got this far, with allegations of roughness throughout his past... if that is the case, someone screwed up somewhere along the line and this guy should have been identified and yanked a long time ago. Scary stuff to be sure. Wendy CO EMT-B

I have mixed feelings on this topic. To give you a sense of where I'm coming from, I started as a first responder at the age of 16 with a local venturing crew. We did a lot of standby support at Boy Scout events as well as other public events, and we were also given the opportunity to shadow in a local ER and ride along with one of our advisor EMTs on a 911 ambulance. I thought it was cool as hell. I was very interested in medicine, and this experience helped draw my interest further. Here's the pros, as I see it: You get in early, and you learn early on whether or not this field is for you. You are younger and stronger, and have better reflexes, which is always a plus. Exposure is always a good thing. You can develop some very good habits, as you are malleable and impressionable. You can also develop bad ones if you don't have good mentorship, just as it is in any other field. Here's the cons: 16 is way too young to be on an ambulance. I'm lucky that I had a good mentor to guide me, but in all reality I was a liability. I didn't see it then, but I surely see it now. I don't regret having done the program, but I wouldn't have let me do it if I were my parents. There's a reason the program has been discontinued. I'm not the reason, but some of my age-mates were. You really don't know how much you don't know at the age of 16, or even 18. It's very easy to buy into the hero-mentality at that age- all of us wanted to do something amazing, and damn, riding in the ambulance can't get much more heroic! When you're that young, it's very exciting... which can be distracting. Getting into EMS that young and not pursuing a degree traps many at the Basic level for years to come... you're making decent money (better than you would at most entry level jobs in my area), you're doing something interesting, why would you invest in a degree? There are exceptions to this rule, as I can name some younger paramedics who are excellent at what they do. But most of my compatriots from that crew dicked around at the Basic level for a whole lot longer than they should have. I also know that emotional and intellectual maturity vary by age, but there is a reason we have the age of majority. I know that I was much more adept at handling myself and difficult situations at age 18 than I was at age 16, and I know that I am eons beyond that point now at the age of 23. I also recognize that there's a whole lot more for me to learn, and that there is a lot that I simply just don't understand. Also, think about the fact that many companies refuse to insure a driver until they are 21... it's not just because 21's a pretty number, it's partly because statistics show that younger drivers have more accidents. You need time to gain driving intelligence and experience, just as you need time with many other skills. I would not be comfortable allowing me at age 17 to drive an ambulance... and I have always been a very cautious driver. With all due respect to FormerEMSLT297, I would have to argue that the military is a whole different world. Most people are forced to grow up fairly quickly when they enter the military, and it is a very positive experience for many of them. I would say that an 18 year old who has been conditioned properly by the military is better suited to take care of blast injuries and the trauma of war than an 18 year old civilian who's just barely out of Mom's house. There's a system of accountability and personal development in the military. But, I would also argue that the military molds people too quickly in some ways, and doesn't give them enough of the emotional and cognitive tools to deal with the horrors that they see. There's a reason that PTSD and other mental illnesses are so prevalent in returning veterans. I really wish that our armed forces would step up to the plate and provide better mental health care. I see it in my cousins, I see it in a coworker of mine... and if there weren't such a stigma against receiving mental health services, our returning soldiers would be better off. As it is, many of them suffer needlessly and find it difficult to near impossible to re-integrate fully into civilian life. But that's a whole different can of worms! Bottom line: I would say that it doesn't matter if someone is in high school or just graduating, but they must be at least 18 prior to entering EMS. I also don't think kids should be on the ambulance. It's too risky on a variety of levels. I also think that this wouldn't really be a problem if EMS education were more similar to traditional professional or academic education, as that provides you a minimum of 3 years to develop and reach an age where you can be insured as a company driver... ;-) Wendy CO EMT-B

They pay really isn't bad at all. In fact, IIRC, we are one of the highest paid in the area, if not state. Some of our quarters are pretty nice, others, well, they leave a lot to be desired. However, checking out a SUV or Rescue body truck in the rain/snow/cold/wind really blows. I've thought about that area. But the prospect of cold, somehow, just dont rub me the right way.

The Texas Tower Incident August 1, 1966. Charles Whitman took position on a clock tower at UT Austin and commenced shooting at passersby after killing his wife and mother. An armored car was used to access the wounded. http://en.wikipedia.org/wiki/Texas_tower_shooting The LAPD SWAT team commandeered an armored car during the North Hollywood shootout (2/28/97) to retrieve the wounded as well. http://en.wikipedia.org/wiki/North_Hollywood_shootout The History Channel show Shootout! does a very nice job of detailing the NHS with 3D reconstructions and interviews. 'zilla

I guess I'll be divorced and gay.

I just want to take the opportunity to say something I think all of us in the USA take for granted. " I love this goddam country of ours, where freedom and opportunity are our natural born rights. Hallelujah, Im so glad im an American.

I want to RSI, cric, chest tube, pace, cardiovert, have 70+ drugs, ummmm c-section, amputate, operate, and diagnosis and send people home with 200 hours of education. No 300 hours. But then I can bilat amputate...and transplant ape hearts (look it beats)... Go home.

I'm sorry, I was thinking for some reason you were more advanced...don't know why, just did. And yeah, I'll be the first to say it sucks to have to pay for CEU's. Fortunately I get mine paid for.

I think it would be rather interesting to get someone from Oregon's perspective on this topic as they are the only mandantory degree state. I would also be curious to hear how their pay rate stacks up to the rest of the U.S.