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Phil, I know that wasn't directed at me, however I was referencing utilizing the EAP's (employee assistance plans) that permit someone to come to their employer and say I have a drug problem, I need to get it resolved so I can function appropriately without fear of being fired or facing disciplinary action. I am fairly certain this is nationwide in the US - I know it is statewide here. The employer is required to assist the person in finding treatment and not penalizing them. However, if they are busted in a drug test (without this reporting or after they state they are okay and cleared to return to duty) then there is no obligation on the part of the employer. I think this is a great thing for employees to utilize and assist them in getting and staying clean. Alot of this came in part from a rash of disciplinary actions that were referred to the state from employees coming on duty under the influence of drugs, attempting to use from sharps box, OR not wasting (and using for themselves). I can only help this does something to help the profession in this respect.

Guess you never had a dying patient look you in the eye and ask, "Am I going to die ?" And what's the difference between lying to your boss (I am too sick to work today) or lying in your documentation to cover your butt versus lying to a patient. If you lie you lie.

Creo que la prueba debe ser en Inglés. Si usted vive aquí tiene que leer y entender nuestra lengua patria. . . . . . . Translation: I think the test should be in english. If you live here you need to read and understand our homeland language. In our service areas we have a lot of Spanish, Portugese and Asians. So not only needing to know atleast basic spanish should we learn Portugese and Asian?

...but this conversation isn't about bilingual providers. It's about providers who lack even a working understanding of English. How many dispatchers in Florida do not speak English? I must have missed the national "Disney ticket seller certification exam." Also, I'm willing to bet dollars to donuts that the employees at Disney that work with guests speak English in addition to any other language they know. ...and, yes. I would love to see my racist, classist, homophobic comments where I even came close imply that I only consider some skin colors, socioeconomic classes, political affiliations, or sexual orientations as being worthy of being American. In fact, if this is the route you want to take, I see no sense in continuing this conversation until proof is shown that that is how I view America. I'm all for open discussion and don't expect everyone to agree with me, however I'm not going to be libeled in the process.

I just reviewed the entire thread and those replies can fall into one of two categories. Either it doesn't matter if an EMT doesn't speak English because it's just a just a tech certification or that it doesn't matter if an EMT doesn't speak English. While yes, I agree that if at all possible health care teams at any level (hospital, prehospital, out of hospital, etc) should be able to communicate to the patient in the patient's preferred language. However, there's still going to be communication issues if the information from the patient can't be translated to the dominate language of the team. Sure, the EMT that speaks English can give report, however if the history provided by the patient can't be translated into English (since this thread isn't about bilingual providers but having a provider who speaks a language other than English and not in addition to English), then that patient care report isn't going to have any additional information in it anyways. As I posted earlier, I seriously doubt my ability to go to, say, Italy or Mexico and get a job in EMS since I don't speak the local language. Sure, there may be pockets of people who speak primarily English, however that doesn't mean that the people I'm working with professionally will be able to speak English as well. I was confused by the use of the term "medical license." I don't expect each and every health care profession to be discussed, however a medical license isn't a generic term.

Lying, falsifying information or coercing a patient are all great big ethical no-no's in my book. The hardest thing for many EMS providers to accept is the patient's right to make stupid decisions. They have the right of refusal as long as they are alert, awake, and oriented... There is a sincere difference between honest education about potential consequences and using "scare tactics" to make them do what you want. You can educate until you are blue in the face; if the answer is no, then it is no. The exception to this would be a situation where you know that something is profoundly off with the patient, and you consult online medical control to get a legal "medical hold" in which you can supersede the patient's wishes. But then it is on the doctor's responsibility, and you have to paint a pretty good picture of whatever the funky situation is for a doctor to be willing to back that decision. Selective omission, as far as I see it, is much preferable to falsification, but only in certain circumstances. I think Vent covered that idea pretty thoroughly. I think the statement that has been called into question was honest and sincere in its intent, but poorly worded... I think what the educator probably meant was to emphasize encouraging care with whatever means you had available in order to increase the odds of good patient outcome. I don't think he was endorsing just flat out lying and scaring the crap out of people to get them in the ambulance all the time. I also think he was emphasizing that you shouldn't downplay something because you don't want to transport. In other words, I think I understand the purpose of the statement but disagree with how the message was delivered. Wendy CO EMT-B

Thanks for the response. Sometimes scenarios are hard to decipher. As I stated in my original posting, I would go with the croup/epiglot. route barring a an object in the airway. I guess the best thing would be to attempt back blows and thrusts to see if anything popped out and/or improved the condition. This is what I meant when I said "barring". If this were not to work, then it would be a "pucker" situation. So barring out the foreign object in the airway, I would treat this as croup. My tx. for this would be listed off my SMO's, nebulized EPI, if no improvement, then attempt intubation X 1. We don't have RSI in my SMO's. We used versed and etomidate. Etomidate is for adults only, so we are to used versed for sedation and intubation. You can't really rag on me for it, since I am not the medical director. Sorry. During intubation I'd be on the look out for a foreign object and swelling of the epiglottis. If I could not get the tube, I would cric. I'm not sure why you are disappointed with my treatment plan, or why exactly you take personal offense to my posting. People are strange around here. I see there is a little negative by my posting name, a -1 reputation. I find that quite amusing. Thank you! I still stand by my response to the SPO2. Based on the appearance of this child I would not waste time with it. And I guess when I say waste time, I mean go digging for it, it is deep in our bag. So that situation is unique to us I guess. My priority would be on getting a line and some sort of airway intervention done immediately. Especially with the child who I quote the OP of thread has more cyanosis "than able to shake a stick at". This kid looks like shit and needs agressive, fast treatment. By looking at this kid I know SPO2 is less then ideal. The cyanosis tells me that. I think SPO2 is a great tool, however in this situation I would not worry about it. One thing I do love about SPO2 is trending. So I guess we could use it to see if the neb has helped the kid. However, I think a visual/auditory assessment with be a more reliable/quicker indicator of improvement. By no means did I mean to rile you up. This is a scenario on a forum which I glance at every so often, and I wished to respond. I know the die hards here like to treat this like a firehouse and bust balls etc. I want no part in that. cheers sir. hope you had a merrrrry xmas! Here is a good write up that summarizes my position on Pulse Ox magic! http://tooldtowork.blogspot.com/2008/06/one-where-he-rants-about-pulse-oximetry.html whoa what kind of conclusions are you jumping to? Why are you taking this to a silly level? Let's be real here. I don't NEED the pulse ox in this situation AT ALL. Does cyanosis, stridor and DIB not ENOUGH EVIDENCE to determine whether this kid is in respiratory distress?? Do you need a baseline pulse ox to justify intubating the cyanotic kid with stridor to the doctors in your ER? If you do, it really sucks to work where you are. Pulse ox is NOT going to change my treatment of this patient. Will it change yours? Hell if I never did a serious peds call ever again I'd be very very OK with that. But we know that isn't going to happen. So your thread is well appreciated by me. Thanks.

We don't "need" That's your argument?? Why not use all the tools at hand when assessing resp status? I know damn well any ER doc will ask the $100 question when you present your intubated kid to him. "What was his SpO2 on room air?" Don't you gather a "Baseline" to compare to after treatment? Hmmm.... I guess we don't need a cuff to assess BP either.... Cap refil will suffice. We don't need a thermometer to assess Temp either, skin to skin contact will do. Heck... Why even use EtCO2 after he is intubated, you have a stethoscope! IMO, using all the tools available is part of a complete assessment. Maybe it takes you longer to snap on an SpO2 than it does me though.

I have a partner who relies so heavily on SPO2 and it drives me crazy. He's a piss poor medic. Do you really have to waste time throwing the SPO2 on when the kid is in obvious severe resp. distress? He's cyanotic w/stridor. Barring a foreign object in the airway, I'm going down the epiglot./croup route. (we have no evidence of a allergic rx) Lets have my partner start some racemic epi while I ready the intubation and cric equipment. If the epi does nothing, I will intubate (utilizing versed per my systems SMO), while intubating I'll be looking for a foreign body and/or swelling of the epiglottis. If I see any evidence of this and cannot get the tube, I will be cric'ing. Not slamming you BTW with the comment about the pulse ox. I just feel a good visual assessment is more reliable. We don't need a pusle ox. to tell us whats going on, and in this scenario out on the street with 2 people, I think it is a waste of time to be worried about that. I would probably bust out our SPO2 when we intubate since it has digital capn. on it as well. merry xmas guys

Lets go back to basics - what could it be? I would suggest we do something pretty quick befofre this kid arrests; we've probably been on scene for 10 minutes, total time since this kid started having hypoxia is maybe 20 minutes

I agree with the additional history and assessment considerations. For example, sudden onset stridor is going to have different pathology considerations. I would most likely not go with salbutamol for an upper airway obstruction problem such as this kiddo. I would want to consider something like racemic epinephrine and ensure we are nebulising this medication properly, because unlike salbutamol, we want inertial impaction and deposition of the aerosol in the upper airway. I would agree, that at least a loading dose of a steriod will be indicated in this patient. While not an EMS consideration, this patient may benefit from Heliox therapy. If we are still looking at croup, I would not consider antimicrobial therapy unless we have other indications of a bacterial infection. We must remember, croup is typically a viral infection. Take care, chbare.

I'm sorry... I thought this entire thread was about giving the EMT-B exam in a language other than English. Oh, wait. It is. Gasp. Who's talking about pestering people who has a functional grasp of English to the point that they can communicate and pass the EMT-B exam? I'm not as all of my posts were about a binary "able to use English" and "not able to use English" differentiation. This differentiation is completely separate than 'speaks languages other than English' and 'doesn't speak language other than English.' Hmm. Yes... because the ability to speak any specific language has to do with skin color or sexual orientation. So, which skin color does the 'dark skin peoples' speak? What language does 'the gays' speak again? Remember, you where the one who brought sexual orientation and skin color into this. You might not know this, but there really are other languages that are spoken in countries that are predominantly white and my opinion that people should be able to have a functional use of the English language when working in a direct patient role in the USA applies to those people as well. If I was as racist as you want to make me out to be for disagreeing with you, then I should be making an exception for Russians and French who don't speak English. Unfortunately for your character assassination attempt, I'm not. I guess I'm racist against white people then. As far as speaking or not speaking a specific language does not make someone an idiot. Incompetent for a specific job? Yes, and I hold myself to that standard. Since I don't speak Spanish, I am incompetent (as in failing to have competence. As in not able to preform the job properly. I'm incompetent in a lot of things. Flying an airplane is one of them. Strangely, I'm also ignorant when it comes to flying an airplane as a pilot) when it comes to providing direct patient care as a job (to contrast this with medical missions) in countries that don't speak English because I can't properly communicate with other health care providers, unless I want to hire an interpreter to follow me around. It would be imprudent, for example, for me to move to Russia and open up a private practice unless I learn to speak Russian.

There is San Francisco city which seems to be a good program. And one closer to me that is a community college in Pittsburg, but that one is 5 months VS the other two programs that are 8 weeks. And I was told by two people that its not the "best choice". There is actually another that is only 4 weeks in Berkeley, but something about that doesnt feel right. I narrowed it down to NCTI and the San Francisco program, but, have not put any money down on either as of yet. I really am looking for a school that has great hands on time during and after its program. I dont want to just textbook learn everything, take the NR, pass (hopefully) and then be a wreck in real life. I live about 40 minutes plus from both schools and about 15 minutes from the community college one. I know that when it comes to the Paramedic program I want to go to San Francisco, it seems to have the best, but, more costly.

I hope so. I am trying to tell myself that I have maturity (kinda..lol) and age on my side, while not being too old. Then I kinda worry that someone in their 20's will breeze past me since I am well into my thirties..*sigh I am just gonna grin and bear it, try hard, and do my best. I really really like your plan o action with the city college. Sine I plan on going through to Paramedic at SFC anyway, its only a big duhhh to start there. I just am not a huge fan of the city streets, thats just the sissy in me. I guess there is only one way to get over that. Okay then, I feel better, its a more solid option. The spring 2010 classes are closed already. I need to get a jump on the summer or fall classes ASAP before I lose a spot there. Thanks so much

Thank you! LOL If you have a strong accent I wont mind giving you anything you want, medically speaking I tried to call CCSF yesterday, but I am going to assume that they are out for the holiday. The spring 2010 classes are all CLOSED!! Yikes. But in a way, I am glad, I wanted to wait till summer. However, I am afraid if I dont pay for my classes NOW, I will get shut out of the fall classes..lol So now, I am on a slight OMG mode and trying to get my name out, and possibly some early info so I can make sure I dont miss out. Its months away, I know. But, I am a planner. I like to plan, plan again, plan for it to not happen, and plan again... lol

Hi everyone. I am new to EMS, and will be starting school June 2010. It took a few weeks to decide which school to find out here in CA (Bay area) but, I think I settled on NCTI. I am 34, and finally forcing the path (wayy too many excuses before) to do what I have wanted to do for about 10 years now. I am married, have two tweens, and am ready to make this happen. I hope to be certified, and working by late next year. Right now, on papaer, my goal is to work as a Basic for about a year and a half, maybe 2, and then go to school for Paramedic. I am not in any rush as I want to do this correctly and with lots of thought and planning. I signed on here to maybe meet a few people from my area, to definitly learn from as many angles as possible about the good, bad, ugly, and rewarding of EMS. I have also heard that people who are not in EMS, esp. family do not understand a lot of what your going through. So, even as early as school, I thought it would be great to have some friends who have been there and "get it". Thanks Lisa

tHE CHALLENGE IN ANY SEDATION PROCEDURE IS MAINTAINING A AIRWAY AND EXCELLENT PERFUSION. BACK WHEN I WAS A MEDIC FROM 1977-1996 (PROMOTION) WE ALWAYS SEDATED BAD PULMONARY EDEMA PATIENTS . DUE TO THE HYPOXIC INDEX, REMEMBER IT ONLY TAKES 5% DE SATURATED BLOOD TO CAUSE ISCHEMEA AND CYANOSIS. YOU CAN HANDLE A PATIENT WITH LESS AGITITAION BUT THE RAMIFICATIONS ARE THESE.NO1. MANY ELDERLY PATIENTS ARE NOT WEENED OFF THE RESPIRATORS SOON ENOUGH AND USALLY DIE FROM SOME PNUEMOCOCCI VIOLATION. NO 2, WHEN INTUBATING A PATIENT THAT IS HYPOXIC FROM HEROIN OVERDOSE I HAVE SEEN SOME OF THESE PATIENTS LIERALLY PULL OUT A VOCAL CORD FROM NOT RELIEVING THE 10CC IN THE CUFF. BESIDES WE HAD ONLY MORPHINE WHICH CREATES VENOUS POOLING WHICH HELPS WITH REDUCING PRELOAD AND REDUCES THE HIGH PULMONARY PRESSURES; THE CONVERSE SIDE IS THE RESPIRATORY COMPONENT WHICH CAUSES HYPOVENTILATION WHICH NEEDS TO MAINATINED WITH A PULSE OXIMODOR. MIDAZOLAM IS A BY PRODUCT OF DIAZAPAM A BENZODIAZEPINE WHICH ACTS ON THE BRAIN FOR ANIETY AND MANY PEOPLE SEEM TO HAVE A ALLERGENIC RESPONSE TO IT. OF COURSE THERE IS NO REASON WHATSOEVER TO SEDATE A TRAUMA PATIENT AND MASK THE % OF BLOOD LOSS. WHAT MAKES A GOOD PARAMEDIC IS THE ABILITY TO BE INTIMATLY FAMILIAR WITH THE MEDS AND THEIR EFFECTIVENESS AND A MASTER DIAGNOSTICIAN.

racist to complain? well you are entitled to your opinion. I was just asking about taking the test not dealing with pt's. i think everyone has had a pt that doesn't speak english ( in the usa). how would you communicate with your partner if you spoke different languages? let's say your partner was driving and since he or she can't read english doesn't know that at a stop sign you should stop and drives through and hits a car? or you ask your partner to get something for you or help you out but has no clue what you are talking about what do you do ( time is ticking)

The dispatchers aren't on the ambulance. What are you talking about? I have given you examples of how a system can work when there are non English speaking people in an area. Do you not understand how a bilingual dispatcher is of importance when dispatching trucks for either the community or the providers? You continue to argue that there is absolutely no place in any situation for a person who does not speak English in the U.S. in an entry level medical job that requires no entrance into a college. Even though this has been done you refuse to see how anyone that does not speak English can serve any purpose at all to patient care. The guy is not a doctor. He is NOT applying for a MEDICAL LICENSE. Oh the hell with it. JP you have your own close minded little world and refuse to see how entry level non English people can be of any value here in the U.S. to assist in patient care. So yes, my previous statement still stands or maybe you are tolerant only if they speak English.

Have you missed all the education threads we have had about the EMT? It is also not included for the accreditation by CoAEMSP. It is a 110 hour cert class that can be taught just about anywhere that can lay claim to a classroom. And how about the standards for the instructors? It can also be taught by bilingual instructors to give those in the class enough exposure to English language for the EMT student to master the few concepts and skills in it. Again, nonEnglish speaking people are not stupid and usually can pick up English medical terminology. But of course if some close their mind and refuse to help them learn what all they may not know, then there might be a problem. Luckily, that doesn't exist in all parts of this country. You seem to miss what I have stated over and over again. It they know enough English to pass a test that many who speak English fail and they are hired by companies that know their clientele, why are you complaining about qualified people getting an entry level job? The EMT cert again is not that difficult and not every EMT runs 911 calls. I over and over explained that proficient English would be needed for a FD. So again, if the person can pass a written test in English (THAT MEANS THE OP'S ORIGINAL QUESTION HAS BEEN SATIFIED) and passes the skills stations in English, why do you say they are not entitled to work? You do not know all the employment situations, dispatch situations, crew configurations and hospital situations in all parts of the country. Yes it would probably be so much easier if we did not allow anyone, including tourists, into this country that don't speak English but how are you going to stop that? How are you going to deny someone who does meet the minimal standards for a cert from seeking gainful employment? Do you think that an EMT who speaks Chinese or Spanish can not find employment in a hospital that caters to these communities? Or at a dialysis center for transport? Open you eyes, there are many opportunities for those who seek them. The EMT is an entry level cert. The communities these facilities and hospitals serve are over 100,000 people speaking a different language in an area. This is not just one or two patients to cater to. These EMTs probably won't be coming anywhere near you. I already stated that in another post that someone speaking Spanish probably will not be seeking employment in Indiana or Kansas. If you have never worked out of your own all English speaking area, you may not know what those who speak enough English to pass an EMT test in English are capable of regardless of where they come from. Open your mind a little.

Do you live in Afghanistan? Is it your community? I am not saying all this just to be a shithead. I live and work in a predominantly Spanish speaking community. Besides, the nonEnglish speaking EMT who can still pass a test in English can do all those BS routine calls that so many American EMTs don't want to do or believe they are too well trained and educated for.