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So. I'm currently in the back stretch of my Paramedic program, that will certify me both as a NYS EMT-P and as a REMAC medic. I'm planning on working 911 in the NYC system, but, here's my question. I'm also considering taking a position per diem at one of the (numerous) transport agencies. Not because I think they're better or worse than working in the 911 system--I'm looking at it as a completely different school of thought in paramedicine (stabilize and run to the nearest 911/trauma/STEMI center vs manage this patient for 2-3 hours between facilities, work with IV pumps and vents, etc). Can anyone provide any relevant information on who's good to work for as a medic in transport? Who carries what drugs, who has more lenient/intelligent/medic-oriented protocols (REMAC vs NYS ALS protocols: who uses what?), who pays well, who actually respects their employees? I spent some time working for one of the above as an EMT, which, I have to say, made me want to shoot myself, but... For the purposes of the poll I removed Presbyterian/New York Hospital as a candidate, since from what I've heard you either have to know someone or blow someone to get in. If there's anyone who knows that *not* to be the case, please, let me know. Oh, and guys? I'm NOT looking to trash-talk transport EMS as a whole. The question is, is it worth my time to work transport instead of 911 overtime? How does it look on resumes in the future? I want to hear from anyone who's worked *as a medic* in txp here in NYC... the good, the bad, the ugly. Wage estimation for brand-spanking-new medics would also be *massively* appreciated. Thanks! ~Miz Black Crow

Food for thought. 4000 hours is the statutory minimum undergraduate medical education (medical school) for physician education in California. Somehow I doubt that paramedics complete as much in less than a year in many cases as a physician does in 4 years. Heck... 4000 hours is 46% of the hours in a single year. Are you seriously going to tell me that paramedics spend 23% (2 year program) or 46% of their time in class? Remember, this includes days off like weekends and holidays.

I'm sure we're all aware of Rawles and Kenmure's (1) old RCT from which the BETS have sprung on the matter of uncomplicated MIs. I'm sure in this situation I would already have put oxygen on him because we're told we are supposed too, and there's not really enough evidence I know of to defend my not supporting the paradigm. Presumably too, the service would already be p***ed off at me for not "slapping 8 through a hudson" on everyone anyway . I do, however, I feel like this is one of those situations in which, with a Sp02 ~ 100%, extra O2 is of no particular help. Certainly that is the position of the British Thoracic Society which recommends that their is no need for supplemental O2 in non-hypoxaemic pts (2). Although as a student I'm not sure of the wisdom of using that as a reason to not follow service guidelines. Unless there is some research that I'm not aware of, I'm not sure any of us can answer that question with any particular authority. It would be a terrific area to get some research done but I can only imagine the small forrest you would have to cut down to provide enough paper for the ethics approval forms. (1) Rawles JM, Kenmure ACF. Controlled trial of oxygen in uncomplicated myocardial infarction. BMJ1976;1:1121–3. (2) http://www.brit-thoracic.org.uk/Portals/0/Clinical%20Information/Emergency%20Oxygen/Emergency%20oxygen%20guideline/Appendix%201%20Summary%20of%20recommendations.pdf The full version of the BTS oxygen guidelines makes some interesting reading: http://www.brit-thoracic.org.uk/Portals/0/Clinical%20Information/Emergency%20Oxygen/Emergency%20oxygen%20guideline/THX-63-Suppl_6.pdf

I agree completely....In the OP original scenario, I would not blast anyone with O2 until 12 lead was done. If you have a blocked vessel causing injury or ischemia to the heart, then blasting O2 will not do much....(And please spare me the lecture on diffusing into the plasma again). The ENTIRE GOAL of treating, pre-hospital chest pain is to decrease MVo2 demand. It has been my experience most people who are truly having a cardiac event will get more anxious( read: claustrophobic) when sticking a NRB at 15l on them right off the bat....I will usually start with a NC at 4-6 and titrate along with other meds to relieve MVo2 demand. Respectfully, JW

Mood ring? I thought those went out in the 70's I gotta go and get me one ! Who in the city is selling them? Hook me up ! In all honesty, it was difficult to discern exactly what type of response you were attempting to provoke. You received documented answers from intelligent people along with links to research from established medical centers yet you only choose to comment on the "mood" of the responses. Perhaps if you chose to listen, read, and educate yourself on the links provided you could maintain an intelligent conversation instead of joining into a peeing match. Instead of adding to the discussion (which could have really led to some great insights - it wasn't a bad topic) you left me going

Me neither...as long as they ride in cargo.

That's a ridiculously huge person ... not sure if it was just Canada or the USA also, but within the last year it was made 'illegal' to charge a severely overweight person for two seats, should they exceed the posted size (or however that works). It was supposedly discriminatory and unfair. Sure it's sad and I'd hate to be that person, but do I need to be punished for someone's unhealthy habits? So tell me ... is it unfair that I lose partial circulation in a hip because the juggernaut beside me is too big for one seat? If you can fit in one seat, great. If not, one should be paying for two or find another method of transportation more suited for one's size. Fair amd comfortable for everyone.

-1 for needing a sense of humor transplant.

try using bbcode, not html also, hope it's not a meal flight...

Yes finally done. Passed NR CBT and Skills first attempt and did them back to back days. Just think how opinionated I was as an Intermediate, is this site big enough for me as a Paramedic? <img alt="devilish.gif" />

I am aghast with shock and indignation ! Am I alone in thinking that the very fact you even considered taping a purile American sit-com before going on a priority detail showed a gross lack of proffessional , moral and ethical responsibility ? I will not recant my original statement regarding your actions. What is more my colonial cousin ! In England Ambulance Services are run with military precision. Between jobs we do not lark about watching television. We are given a myriad of duties, ie cleaning vehicles,cleaning the Station,checking stocks etc,etc. In England we have no time for slacking ! I can only assume your indignation has been caused by the guilt that my wise words have provoked.

Volunteer for Hatzolah. They'll take anyone.

Allow me the privillage to reply to your wildly absurd rant. 1) Firstly the matter of independence, you didnt beat us. History shows that we graciously allowed you your freedom on account of your questionable loyalty and fighting ability against the French, and for your skill and panache for killing native Americans. 2) The war of 1812 is a minor triffling affair and is not even recorded as a proper war such as was fought against real opponants such as the noble brave Frenchies or Spanish. Twas little more than a piffling border dispute with a minor nation. 3) Some people crueler than I may question the USA very late entry into both world wars. I however do not wish to dwell on accusations of cowardice. Suffice to say, thanks very much for the money. You saved us all from starving and freezing to death. Good on you ! Could we have a bit more ? 4) I have never once insulted or poo pooed the ability of American Paramedics. Far from it. They are the envy of the uncivilised world. I have only questioned the moral and ethical traits of the individual concerned.

Yeah I was tired and grumpy last night, and I didn't really realize how non-specific and overly nasty my last comment seemed. It was directed at tnuiqs. The mood ring reference is from one of his posts. Well I'm certainly glad to hear how you feel about your foreskin, but what has that got to do with sucrose's efficacy for analgesia in minor procedural pain. Again we were talking primarily about heel pricks and venupuncture. If the point you are trying to make is that sucrose is being extended to procedures for which it is not appropriate, then say it. Stop with the sarcastic examples and condescending rhetoric. I showed you a reference to the fact that it is accepted that it should be combined with other analgesia/sedation where appropriate, and the article we are discussing mentions it too. Morphine infusions, acetaminophen etc. Why do you continue to argue on the premise that we are suggesting a little sucrose is enough sedation for intubation? I don't necessarily disagree. What astounds me is that after having said, "The point of my question was simply to establish whether or not anyone else had heard of it being accepted practice, and any discussion that grew from there was a bonus. I simply thought it was an interesting idea, and wanted to know more about it, regardless of its applications in paramedic practice", That you still feel it necessary to repeat that point. As an aside, I won't have either kind of access on paeds when graduate, and maybe the glucose issue is worth some further investigation - more likely is that we will just get IO. But I certainly, won't be instituting a new treatment modality because I read some links in forum thread. Now this is what I'm getting at when I talk about condescending rhetoric. Obviously we already have glucose paste in the kits (I think it's actually sucrose) and if we didn't, I certainly don't have the authority to go adding drugs to the bag. You know this. So what is the point of that question if not to sarcastically infer that I'm stupid enough to change my practice and add junk to my whacker bag, based on an afternoon spent on an internet forum? FIRFLYMEDIC: It was numerous comments with that attitude, and a confusing inability to structure sentences, and indeed, entire posts, which lead to my ill-considered grumpy reply. Few things rile me like condescension and poor grammar. Where does the study talk about sucrose being the only sedative/analgesic used for vent pt? The study looked at a number of practices that were not necessarily associated. One was sucrose analgesia for minor procedures, another was pain management and sedation in vent pts. Not once under the heading you posted is the word sucrose used, nor its use recommended. Even if the two sets intersect somewhere, it does not mean they were using sucrose to sedate intubated pts. Even in the section on circumcision, it is clear the sucrose is co-prescirbed with acetaminophen. Am I missing something? Is it the NPO pts? If all your experience affords you the ability to read between the lines, then you will need to explain that. It is not simply enough to post a sub-heading of an unrelated topic in the same paper and then condescendingly tell others to 'read the paper', if we don't understand your point. http://pediatrics.aa...cetype=HWCIT://

"unlike nursing which is standardised" ----- is that statement a joke. I have worked in both hospital based trauma services and prehospital ems since 1994. A blanket statement suggesting that U.S. or foreign trained nurses can hold a candle to an EMT is moronic. Unlike nurses many EMT basics in the united states are responsible for care of the patient door to door. Oftentimes the EMT basic is the only level that is able to care for even critically injured patients until more highly CERTIFIED professionals arrive. Based on my now 15 years experience with RN's; only about 25% could perform at the EMT level. Only about half of those 25% could perform at or above the skills of a decent EMT-Paramedic. Most nurses in the United States exit with a R.N. license after two(2) years of rudimentary nursing training. Of course most paramedics are trained for the same two(2) years OR more in ADVANCED LIFE SUPPORT. As far as other countries laughing at the EMT-B certification, I wouldn't know. I do know that few if any states accept foreign training in EMS. I also KNOW that the national registry does not recognise foreign trained Medics. On this disparity, there should be a national accreditation body. Still, to suggest that a medic in Britain is somehow more experienced or has thousands of more hours of training...well that just sounds like a pretty long stretch...And frankly the facts do not show this to be true. Typical US medics have well over 4000 hours of didactic and clinical training by the end of EMT-B through NR-EMT-P. Of course there is always the exception to the above facts. Besides who wants to go to Israel and get shot at when I can just stay here in lovely downtown detroit.

Congratulations my dear fellow. All my life I have lived in the hope that one day somebody would break the 4 gallon barrier and create a new world record ! Mankind has produced yet another super human. Darwin, Gallileo, Newton, Einstien and Hawkins have been eclipsed by you, you big old genius you.

Can a mans hair turn white over night due to fear ? Can a man be so consumed with terror that his locks fade to grey before the morning arrives ? It is a debatable subject and one I can finally claim to have witnessed. Like everyone I have heard far fetched tales on this emotive and questionable topic and I have always discounted it as mere piffle. Last week a man was lost on the remote moors near where I reside. All of the emergency services searched for him to no avail. I by chance discovered him the following morning, hanging from a thin branch above a steep craggy abyss. The poor petrified creature had been hanging all night by his finger tips, in fear of his very life. Although a young man his hair had turned white through fright during the night.