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I know there are semantics and generalities in your statement, but you should always treat the patient before you treat the equipment. When I started out, we did not have glucometers, pulse oximeters, or 12 Lead, and it amazes me to see how many Paramedics trust the equipment over patient presentation, history, and signs and symptoms. The first thing I did for any new Paramedic on my truck was to take all of that equipment away, so that he had to assess the patient first.

Perhaps Professor Wade you missed this post and seeing as you lecture on this topic and are an expert on EMS world wide Ground and Air you would kindly provide your in sight / clarifications as these prior statements:

Looks like we may have a BBB. Need a 12 lead to know for sure though. In the following order please. 12 lead O2 @ 5lt Nasal cannula. Listen to air entry. When last seen a Dr? Excersize? Career? Smoker? Drinks last night... OK. Does he drink everyday? Street drugs? Family Hx?

Well, <55 & >35 on the age! I don't give out personal info on a public forum. OLD ENOUGH to know what the hell I am talking about! 2002 - 2010 That would equal 8 years +/- a month or two. > than the 5 years you quoted in your earlier post. Germany to be exact, Are you familiar with Medicine at the University of Heidelberg? My link Respectfully, JW

HVA bought their 12-leads in 2001 and went live officially around 2002. Just how old are you since you also worked for 11 years in Europe?

I didn't ask any questions that require an answer. What service were you with? When the data was being collected for prehospital 12-lead usage, Michigan was stil looking to establishing theirs and only a could of agencies were considering it in the late 90s. A few years later a few more did consider the 12-lead and did impliment the programs. Thus 12-leads in Michigan seem to have come about later in the last 10 years rather than earlier. Detroit FD was attempting to get their program started around 2005 as they were still working on the technology side with the hospitals. That acutally was an interesting conversation on another forum and at one of the EMS conference to see them evolve while still plagued with other controversies.

crotchity: http://www.cardiosource.com/cjrpicks/CJRPick.asp?cjrID=4555 Full document: http://circ.ahajournals.org/cgi/content/full/118/10/1066

I can't believe that we are having this discussion, a patient c/o of chest pain should receive an immediate assessment along with cardiac monitoring, oxygen, aspirin unless contraindicated, a 12 lead ECG, IV access, labs should be drawn if you are allowed to do so & a pre-hospital checklist/screening should be completed. You might also want to consider giving nitro & pain medication like morphine prn as tolerated!

I once drank 5 gallons of milk in an hour.

it is also impossible to hang by ones fingertips all night, no matter how strong you are.

Did it rain bleach? Radioactive Isotopes? No? Then no, your clearly fake story, isn't possible.

As unpopular as it may sound, I'd recommend witholding the O2 until your 12 lead is complete - clear and readable. There are examples of missed opportunities for recording ischemia, unique injury patterns (Wellens syndrome) and the like. Cardiologists love our early 12 leads, the earlier the better (before O2, ASA, Nitro).

Nope - O2 first. If it is ischemic chest pain, then as much O2 that we can get (both attached to hemoglobin and dissolved in the plasma) the better.

Well, short term clinical expertise, it wont. Long term career growth, it will. Business degrees will help you in many areas, not just upper management. It helps you with statistical analysis of resarch, simple interaction with buisness owners in the poublic arean, etc....So will education degrees, etc. But in the short term, for that first gig, see my posts above.

Will a business degree make you a better PARAMEDIC? NO, HOWEVER, and I am going on the assumption that you are probably young, and there is a saying, " You dont know, what you dont know". This applies here.... While you are asking what will enhance your NREMT-P, ONE never knows what the future will hold, therefore, I think it is imperative you finish your business degree while waiting for the medic course....Trust me, after you have been in this business 20 years, you will more than likely want to do something else, and going back to school in your mid thirties or forties is not exactly fun.....( Ask me how I know)..... Knock it out now! Also, when you go to apply to Flight Programs, having a 4yr degree will set you above MOST everyone else....A 4 year degree on a RESUME is NEVER a bad thing or a waste of time...The ONLY people who say this are people who do not have one! Respectfully, JW

A business degree will do you more good than nursing degree. When you're in the management roll you have to look at it a business (even if you're a non-profit organization). Someone with a business degree will run circles around someone with a nursing degree trying to manage a business (unless they just happen to be the next management guru). -Nate

My buddy at work went home after our last night on duty together and discovered his wife in bed with her toy boy latino lover ! This brave guy, this excellent life saving Paramedic, this former marine , this war hero, this red blooded country loving American had no idea his wife was sleeping around. I found out 24 hours later when I got a call that some nut job had commited two murders and was now threatening to blow his own friggin head off with a 45 . I recognised the address. Holy cow I discovered it was my buddy. To cut a long story short he was arrested, sedated and locked up in the funny farm. He will now finish his life in pokey ! God dammit that hurt. To see a guy of that caliber reduced to a trembling gibberinng wreak by a lousy two timing broad , was heart breaking. I just wanna say the next time you poke fun at some sap who has found his wife with another guy, just think that it could be you.

Transmission technology now used by some in EMS in the U.S. http://content.onlinejacc.org/cgi/content/full/50/6/509 The ECG is tranmitted and prehospital treatment can be continued without fear of the hospital missing ST segment changes or waiting until you get to the hospital. It is amazing that for an area with the size and wealth of LA that the 12-lead ECG is just now getting started. But again, there are many areas in the U.S. that can not do 12 lead ECG and many areas that are only BLS. Michigan just announced their first 12-lead ECG about 5 years ago. Here's an article from September 2009 about Chicago. Believe it or not Chicago FD EMS does have a decent reputation. http://www.chicagobreakingnews.com/2009/09/chicago-behind-the-times-in-heart-attack-response.html Here's another area in California: San Luis Obispo County http://www.sloemsa.org/ http://www.sloemsa.org/policy/pdf/619.pdf

When I was coming out of college, the career services people told me, "The resume gets you the interview. The interview gets you the job." I'd recommend a resume template you can find on most any word processing program and probably a million other places online. Then focus on your interview skills. I know a medic who went for a job, and he could've run circles around the other candidates clinically. But he died in the interview, left a horrible impression on the committee.

It's for the select few of use that are on the naughty list. We are a elite group with a very stringent selection committee.

It sure is a shame that some people are like this. I don't know what this guys story is. Maybe he had legitimate glandular problems. Maybe he is a fast food junkie. Regardless, he is human and maybe a really nice guy. Everyone should be treated equally. If is fair for the person next to them? Probably not. Is it fair for him? No, it's not fair for him either. Sorry, live isn't fair. Maybe next time I fly I will complain about all the people around me. He is too black, she is too Asian, the kid is too Jewish. It's the same thing people! No matter what his size is, it's the same thing! seriously? a negative for giving advice to the OP on posting the image in question after he made the statement of it not posting? you people have issues

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.

You guys are kidding right ? You would withold treatment that could help for a diagnostic test that is worthless in the field ? Let's try this thinking in other situations: You have an arterial bleeder; do you put pressure on the wound or do you wait until you have a blood pressure palpated ? You have a COPD patient with serious respiratory distress (tripod, cyanosis, accessory muscle use), do you put on the O2 and start an IV immediately, or wait until your pulse ox confirms distress ?

Just what kind of problem would that be? I hear lots about these "Glandular problems" and how they make you retain weight (fat, not fluid that is). of all the A&P I have taken, I have yet to understand what gland and specifically what hormone would make you retain this amount of sheer FAT on a healthy diet with regular exersize, while taking the proper prescription hormone replacement therapy??

Kaisu, Hey girl, NO, this was NOT intended as a rebuttal to anything you implied. I simply stated this because, from my experience, this is what I see being done time and time again. This was not a personal reference in the least..:-) Where in Havasu are you working? I am coming out that direction after the first of the year to do some teaching. Respectfully, JW

FIRED! Oh, that's right... they're just vollies.

Vent, Yes, I have made blanket statements, I have the experience and education to make those statements, and while I certainly agree with your above statements about ALS et al.....I think you might be a tad biased based on your experience in Florida and California. Each of us see things through different filters, and therefore express opinions based on those filters instead of looking at the bigger picture. I have spent way too much time in marital counseling to learn all that stuff, so I try to put forth majority opinions based on what I know to be factual. One cannot argue the fact that I spent 11 years in Europe and have done countless flights to Europe and Middle East, Japan, Australia, Israel, to have a big picture perspective at what is going on in world medicine. I will be in New Hampshire visiting my best friend this weekend, I will get a copy of his protocols and post them for you when I get back. I will also dig out my protocols from Detroit, and send a few other emails out requesting hard copies. Again, I answered the OP based on his limited info scenario, in which I would not arbitrarily stick a NRB @ 15l on that person. I have done this many times throughout my career, and not once has any ER, Cardiac Surgeon, or Medical Director ever questioned me on the process. I realize that every patient is different, but, I have been fortunate to work in some progressive EMS( minus ARIZONA), HEMS companies and forward thinking hospitals, which has influenced my decision making process. To each their own however.... Respectfully, Jw

I agree with two or three of your droll (?) details. A) A womans heart certainly beats faster when I am around. A Woman blinks more. Again this is true. The little temptresses do tend to flutter their alluring eyes at me teasingly in a luring coquettish manner. The little minx do try to lead me on. C) Modesty and common decency forbids me from making a comment on the size of my manhood. However, I have never had any complaints in the trouser department if you know what I mean, eh ? Sadly not all men can claim to have such a profound effect on the biology and workings of the female body as I.