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Sorry, it should be 'dope' instead of 'dupe' on my end. My apologies, I guess I must have missed the previous. To all, again, my apologies. Thanks Rav.

Then what have I been helping Intensive Care Paramedics do? You mean to tell me that I've been lied to? OMG WTF! /sarcasm I don't see the harm, anybody who thinks this is a bad idea needs to get thier head out thier arse and spend over twenty years being raised by smack addicts like I was.

while some live by the saying of "Keep your friends close and your enemies closer" i am not that person. To be labeled a "trouble maker" is ignorant when you don't know what really goes on. While my thoughts and ways of doing things definetly come out of left field sometimes, there is sanity to them and cause. Since meeting Kaisu, i've become a better person. She has taught me things and is what I consider to be my best friend. Management knows they couldn't get me to throw her under the bus. We would end up going down together. However, thank you for your concern and looking at another aspect. No hurt feelings.

You guys can come work with me anyday: Wanted : Healthcare providers to act as decoys for local EMS personnel. Must be rather large to assist in adequate cover to both partners. Pay and benefits suck, but you'll get the satisfaction of knowing that if you are the chosen target, that at least the locals can aim well and you will be well medicated in your passage as hospitals are a luxury not a neccessity in outlying areas. All types of medics welcome, but ones with a shallow gene pool preferred to assist in reduction of holler rats. Gun toting permitted and encouraged. E-mail at don'tshootmegrandpa@saveme.com for application, interview and target practice.

Sounds fishy to me. Must have been an educated fish: after all, they travel in schools. I said that for the Halibut. I said that on Porpose. Don't mind me, as I'm just fishing for a compliment. Just compare a radio and a fish: You can tune a radio and tuna fish. Am I flounder-ing?

Let's clarify a few things about what the Ryan White Act actually does. For the large part, the IAFF should have spent their money lobbying at the state level for improved state regulations about testing and seeing their own departments had effective DICOs. In 1990, largely at the insistence of the IAFF, this section was added. Its purpose was to get money to set up some education for employees and a Designated Infection Control Officer in EMS/FDs. Since this was not the primary purpose of the Act, EMS/FDs did establish a DICO but it was usually just a title and not necessarily a working job description. Policies should have been written but often they relied on those from a hospital for exposure on a case by case basis. However, Public Health laws are enforced and if the DICO of any agency taps into them with their policies, the blood and airborne pathogens that are worrisome are covered. In the states that have OSHA, they can also be used for policy making guidelines. Hospital infection control officers will also contact an agency but they can not force the DICO of EMS/FD to do whatever. Public Health notification for certain diseases are there to also assist and enforce certain regulations for that state. The other thing the Ryan White Act does not do is mandate testing without consent for an exposure to a blood borne pathogen. If the state does not allow it, then you again have to rely on your department's policy for prophylactic treatment or to obtain a court order if the exposure is serious enough. OSHA does spell this out and in the states that don't have OSHA, they either a specific state statute or a section in their Public Health laws that addresses this. The DICO should be familiar with his/her policy to get the employee whatever care is necessary. The employee should also make sure they understand their policies. If neither the DICO or the employee take some responsibility, it doesn't matter how many people notify them. Since the Ryan White Act is almost a $3 Billion/year expenditure for People With AIDS/HIV over the next four years and it has been each year for 20 years, EMS/FDs departments would be foolish to rely on those few paragraphs buried inside this Bill. The intent of this Bill was to provide health care and housing to people living with HIV/AIDS. It is a good piece of legislation that is needed and actually $3 Billion in not nearly enough. But, any health care reform could again repeal this Act. It is also sad when most in EMS/FDs only know a couple paragraphs of this Act and believe the Ryan White Act is solely about them. Few even know who Ryan White is. If EMS/FDs fail to establish an effective DICO and have the necessary policies in place to protect their employees there is no assurance that anything from the Ryan White Act will even be followed by that department regardless of the hospitals' part per the Public Health regulations. Most of these regulations are stricter and can be enforced more easily. However, there is no guarantee that the hospitals will test for some diseases if it does not pertain to the immediate illness/injury. Even TB has gone undetected for several ED visits because the symptoms were not all present. So, if you are waiting for an engraved letter from the hospital, you may be waiting a long time if there is no reason to notify you because testing was not done. That doesn't mean you do nothing for a needle stick or when you feel you may have been exposed to something. Again, that is what your DICO is for. He/she should have a relationship with the various hospitals and a policy to see you are covered quickly for whatever exposure. There is also nothing more frustrating than when the ED doctor already knows what he/she is going to diagnose a patient with and asks the EMT(P)s who their DICO is so they can be contacted and prophylactic treatment can be given but all the doctor gets is a blank stare. Sometimes that blank stare is even from the EMS supervisor when approached about a situation. Side note, Florida does have a section in its statutes for testing without consent. California leaves it to the discretion of a doctor and the written informed consent is no longer required. I believe NY still requires consent before blood can be tested for HIV. The same for the Veteran's Administration system which is Federal. The hesitation of some states to have testing without consent is for the protection of the employee and everyone else who enters the health care system. Many states do mandate that if you have HIV or Hep C and are working in health care that you disclose this. However, mandatory testing for health care employees has not yet been legislated and enforced.

In the late 1980s, the idea was tested by the NYC EMS, but borne of necessity: Due to a managerial problem, over half the EMS fleet was mechanically "down" for repair. Until that issue was corrected, and the Chief of EMS fired, we had EMTs in Command cars (Supervisor's vehicles), with radio designations like "T" for "Triage" cars, that would respond to calls to at least start patient care, until an ambulance could arrive to effect transport. If the Command car was manned by Paramedics, the designation was "U" for "Union", and same concept involved. Then EMS Station 41 had a lot of their transports done with 41-Union assisted by 94-Larry, also known as Peninsula Volunteer Ambulance Corps. Part of the problem was, the "specs" for the ambulances were incredibly complicated, to the point that at least one manufacturer or vendor went out of buisiness trying to supply NYC EMS with the ambulances. Another problem was, Central Repair Service was running Monday through Friday, daylight tour only. To get the fleet back up, EMS farmed out the busted down ambulances to the NYPD and Department of Sanitation CRS facilities, just down the street, and a few more to "Red Square", the FDNY CRS a few miles away. A few also got sent to private venders for servicing. FDNY CRS was called "Red Square" because they could, on any day, have more (pumper) engine and (hook and ladder) truck vehicles in and around the building for repair, preventive maintenance, or new vehicle final preparation, than some countries have fire service vehicles within their borders, and, of course, the vehicles are "fire engine red", hence the name. The department purchased a bunch of ambulances that didn't have to be matched to a "spec book" that reportedly was a yard thick, hired a civilian to run the EMS, fired the chief, and got away from Triage or Union cars as the new ambulances got assigned to stations, and then to crews, and started Monday through Friday around the clock mechanic schedules, and daylight on Saturdays. There are also Roadside Repair crewman and vehicles assigned full time for any vehicle breakdowns After the FDNY/EMS merger, the FDNY tried going back to using something like the televised LACoFD "Squad 51", manned by one Paramedic, and one Paramedic Lieutenant, who would bring the start of "definitive care" to a patient, and also do field supervisor duties. The teams were called "PRUs", for Paramedic Response Units, and kind of looked like the iconic Dodge truck from the "EMERGENCY!" series. It didn't work, as the Lieutenants also had to do duties in the stations, so they had to decide if they were more useful in the field or the stations. They eventually took the concept, and the PRUs, off the road, reassigned the Paramedics to Paramedic ambulances, with a partner of course, and turned the former PRU vehicles over to the Roadside Repair crews from FDNY EMS CRS. And, again, I mention we keep turning down the use of the concept of "Mensa Medics" (single field Paramedics) in favor of a "Pair-A-Medics". So, fenwayfrankee, take this as one system's attempt to use non transporting ALS, and list it as a concept failure.

Why would they be doing it on their own accord? They should be doing it under your direction, since you're a part of their education. How is that different from your education as a working EMT? You've seen decompensation from the palpation or decompensation that naturally occurs? If the latter, then the palpation can help give you a sense of urgency and perhaps help you with transport priority decisions. Negative Vents, A&P is a not a prerequisite for medical school and many students have not taken it. The A&P they do get in school (depending on the school) may only be in specific systems by the time they start doing exams during 1st year preceptorships. Additionally, supervision is not always "direct" for all patient contacts. And their physical exam skills lab time may be limited to less than 10 hours (maybe 2 of abdomen). I've been present for all physical skills labs a local prestigious medical school. In the end they get great training, but with their first exams they have practice time similar to some EMT. Now, that doesn't invalidate the arguments made about needing better education before attempting skills.

You think that someone with maybe only a month done of EMT class (my class put us through our ride alongs at about 1/4-1/2 the way through the semester), should be preforming an assessment of an emergency patient on their own accord? I don't. By observing, I mean soaking in information like a sponge and helping out where asked. An EMT student should be expected to be able to take a blood pressure or put a patient on oxygen, but both only after being asked by the paramedic on scene. They should not be palpating an abdomen without asking, when this may not even be indicated. In some patients, the pain may be so severe that they will barley tolerate the initial exam of their abdomen by the paramedic, and do not need to be prodded again by the EMT student who does not even have knowledge of anatomy and physiology. ( You can argue all you want that some people may have taken an A&P class prior to EMT class, but it simply is not required so we will always be looked at by the lowest standards).

Wow, that's what contributes to crappy EMT education right there. You say their education is not enough to even practice skills on patients under direct supervision. So, what makes it okay for you and your coworkers to perform those skills on your own?

Citation needed. Heck, in the first year of medical school I've already had an entire lecture on reactive oxygen species, so sorry if I seem a little skeptical that oxygen is the end all, be all, cure all treatment that should be given out like candy.

Before I begin, I have to say something on behalf of all EMTs, who were referred to as "poor BLS buggers...who can't do much else...". EMTs are the cornerstone of EMS, and having served as one myself for half of my 18 year career, am proud to have done so. I've learned more as an EMT than anyone would/could imagine. Being a good EMT has allowed me to become a good EMT-P. And as for "not being able to do much else", well, in my opinion, what else is there to do? EMTs can handle any trauma case presented them, can handle OB/GYN and field deliveries, can treat anaphylactic shock with SUB-Q epi and, yes, oxygen. SCA can be handled with good CPR, airway management/O2 therapy, and an AED. This being said, I think that EMTs can do quite abit. I'm sorry, but I get a bit touchy when I hear that EMTs "can't do much". As a matter of fact, I've read an incredible article written by a state EMS medical director about being "just an EMT", and I must say how impressed I was with his insight...and he's a physician. He went on to say in his article that, in an all "BLS" system, EMTs would be just fine, and I have to say that I agree. OK, now I'll get off my soap box... Oxygen has been proven to be beneficial in virtually all traumatic/medical matters, and its efficacy remains firm. My personal experience has revealed that the use of oxygen has been beneficial, and has resulted in an improved outcome for a wide variety of scenarios. I'm not going to cite specific instances; however, I will mention that the aforementioned results apply to everything from acute abdomen to orthopedic injury. We have to take into account basic physiology with regards to oxygen use and traumatic/medical maladies. During any insult to the body there is an invariable increase in oxygen usage. This in and of itself warrants the use of supplemental O2. In addition, there have been studies showing an overall decrease in pain and anxiety with O2 usage. This is, in part, due to the widely-known effects of oxygen, as well as the probable "psychological" effect that it has on many patients. In addition to this, it's a well-known fact that oxygen enhances vascular function, and improves overall blood flow. I've studied oxygenation, and its effect on the cardiopulmonary and vascular systems. The use of O2 on patients who may not be defined as "critical" is absolutely appropriate, and in many cases will be of great benefit. I hope that my input has helped shed some light on the subject.

Well equipment is just that equipment doesn't make or break a service you buy what you can afford, as for education, well because ems has no standard that is up for grabs, I work for a very large FD in southern California and I do have a paramedic license and use it to my adavantage and make a good penny, as far as medical direction my department has it's own MD, as well as the county of Los Angeles has it's own MD, so lots of oversite, so it when people say LA is all messed up, if that were the case with all our medical direction /commitees and so forth things have not been so drastic in my opinion or those who have the pay grade to make changes if infact change is warranted. HFD is just in my opion probably in the same metropolitan catagory as that and lacks some other form of a higher pay grade to make changes if they are warranted.

I know you have read my posts about how and why other professions have advanced their education and I am really puzzled that you claim to be pro EMS as a FF but can not seem to see them as medical professionals. If you do not want to advance with EMS then you really should consider if you only got the Paramedic patch for a few extra dollars from the FD for your pension and not for the patient care aspect of the job. Your posts lately have only been about what the job can do for your bank account and not what you can do for the patient. Even when you were talking about getting a degree as an RN or RRT in other threads, you mentioned very little about the job or the patient care aspect. Neither you or Diazepam618 are a credit to Fire Based EMS when you fail to realize there is a patient involved.

I don't get it what is the rest of the country doing that is so amazing are they eliminating medical directors and making up their own protocols?, are they taking x-rays in the field, are they drawing labs and have the values ready when they hit the er door? are they casting broken limbs with in the field or perscribing meds?, what is it that is so better? Yeah come on patient care is noble and all, but people really do this for the money, you got to pay bills thats all Iam saying, but the other thing that gets me is when all this change is going to come about, I just don't see it happing like a two year degree min. for $12.00 an hour who is going to do that when you can get an RN two year degree and make so much more. and why should we in fire base ems not make the money we do?m we do two jobs, cheaper for the city thats why we wliminated single role paramedics, that model works where I live, maybe not in other places.

Why do we insist on sticking our head in the sand!!! We Have addict better teach them how to be safe&not spread diseases by sharing needles?

What you don't have any bills, or do you still live at home with mom and dad, look buddy I have a car payment , wife/kid and girlfriend on the side and guess what it all cost money.