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"BLS has better patient outcomes than ALS" "You may think your a cool paramedic with all those fancy skills but remember OPALS..." I hear this and variations of this on multiple EMS forums a the time. The same people that say these things all the time like to also push the idea that BLS is solely in the domain of the EMT, and ALS is solely the domain of the paramedic. Somehow in their mind, the fact that limited scene time in severe trauma is better than stay and play equates that EMTs are the gold standard for patient care in the prehospital setting. These people also like to point out that ambu bag ventilation with a "BLS" airway may be better than intubation in some patients. True. However these same people seem to interpret that as EMTs are better for these patients than paramedics. Who is better at BVM ventilation: An EMT who bagged a mannequin a few times in class and MAYBE once during the ER observation, or, the paramedic who was an EMT and than spent time with an anesthesiologist in the OR learning the right way to hold a mask before they even touched the laryngoscope? It was in the OR that I learned that a BVM is not a BLS tool, but a medical device that required expert training to use properly. Can you get expert training in a EMT tech school that has no access to experts in airway management? It blows my mind that certain things are considered basic and advanced when they are not. They are just medical care.

I would like to know how many users feel Private EMS Providers Uniforms are Substandard. Not taking the Bloodborne Pathogens Issue into the Picture, it Appears EMS Provider Uniforms In General are Cheap, Do Not Provide the Proper Thermal Protection (cold weather), etc, etc. When is the DOT going to come of age and follow the NFPA, and Create Mandates for EMS Personnel and Their Safety.

I agree with Arctickat. I am also an EMS provider, and I appreciate honesty regarding careers. We know most EMTs don't stay EMTs, primarily due to the pay. It is an open door to begin a medical career. I work with my staff who are in school, and encourage them to continue their tracks. Be truthful to your current and prospective employers. Those who won't hire you because you are in school aren't worth working for, IMHO.

As an employer I would appreciate an up front applicant rather than for me to find out the hard way. All that will do is alienate you and your employer and likely have you back in the employment line real quick. If I have a student who wants to work for me I make the extra effort to ensure they have time off for school and still give them as many hours as I can. I consider it a two way street. If I give them as much opportunity as possible to complete their education, then I may end up with a paramedic working for me, at least for a while.

I was up front from the beginning at the ambulance company and hospital I work at. They were willing to work with me to find a schedule that fit (friday night + weekend nights). Although I'd say skip medic and go straight to RN

There is more to the removal of furosemide than purely the risks involved in misdagnosing pneumonia. Patients with acute cardiogenic pulmonary edema (ACPE) have traditionally been treated for having too much fluid - after all, there is fluid in the lungs, so they must have too much fluid everywhere. Hence the use of diuretics in the acute setting. However we know that this is not actually the case. ACPE occurs not because there is too much fluid, but because there is fluid in the wrong place. It is at it's heart a problem with pressure - innappropriate systemic vascular resistance leads to a redistribution in fluid and the subsequent vicious circle of decreased oxygenation, increased sympathetic response aggravating SVR, decreased contractility aggravating back-flow, leading to further decreased oxygenation. Eventually the right heart gets in on the action too, with a RV afterload mismatch caused by hypoxic shunt from increased pulmonary cascular resistance. Bad news. Most ACPE patients are not in fact fluid overloaded, but euvolemic and in many cases they are actually dry, so diuresis is not going to provide anything beneficial. Whilst some may argue that there is a degree of vasodilation that occurs due to furosemide administration (and this is true) the degree of dilation and the time it takes to happen is extremely variable and not clinically relevant when superior agents such as nitrates are available to achieve the same ends. THere may be some call for furosemide in certain cohorts of patients, such as those with a history of fluid overload, however it should be used with caution if at all. Now, on top of all of that, there may actually be a place for the use of furosemide in the setting of a patient with pulmonary edema, just not in the acute or pre-hospital setting. It seems that patients who recieve positive pressure ventilation for more than about 24s have a subsequent inappropriate production of anti-diuretic hormone and their fluid balance and CVP and so forht needs to be monitored carefully (which of course will be done in the ICU, not the ambulance) There are a number of good papers and text books out there that discuss this issue that are not too hard to find if you look for them. Paramagic

I just got back from Haiti the other day after eight days in country. I was working for the Federal Government. Any one considering taking a job down there should be very careful about what you are getting into. That's the wild wild west all over again. It isn't pretty. Live long and prosper. Spock

I'd much rather have a LEO than a local yokel volunteer hosemonkey drive my bus (and around here at the private country service I PRN with, it's required to not let fire drive the bus, which I'm fully agreed with)

Wow – I read this thread, which appears to have become a stone-throwing contest, with much dismay. Siff posted a news thread as information, not as an opinion – I didn’t know an opinion was required to post an informational item… When people post, sarcasm, and true meaning are sometimes lost in the words. A post in this thread by someone fairly new to this site was misinterpreted by me. I am well known, even to myself, to be very pessimistic, and when I read that post, I did not interpret it as a “we should all thank our EMS workers” post. A post following that had sarcasm in it that was, I think, missed by many. I am positive I did not interpret things in exactly the same manner as others did; I suspect others did not either; however, throwing stones is not the answer. Misinterpretation happens…. Both have tried to explain the intent of their posts, and both have taken their share of abuse in this thread. Rather than throwing stones at who was more rude, who said what, who didn’t say what, who didn’t post right, who has how much experience or not, who sent who a nasty pm (isn’t that the point of pm, so that things stay between the 2 individuals, and out of the threads???)… how about we look at the original intent of this thread – the sadness of the situation, and the things people will or will not do in an extreme situation like that. How about we all say a small prayer to the diety of our choice for the family of the deceased, and to those who have been affected by it. How about intead of questioning the intent of posters on this thread to insult others, or try to put others in their place, we focus on the original news article, and reflect on how we may have handled it, and be glad that we haven’t been put in that situation.

Well said. Not sure who Jaime is, but ok. The context of this post I assume is directed towards the original poster, which was me. Thanks for the input, I'll form my posts more to your liking next time. I am after all giving your opinions ... I originally made the post to share the information I had read; a simple story of a horribly sad incident. I was rather speechless (rarely happens), and the story almost brought tears to my eyes. Does that explain my "lack of effort" as you put it? A brother of ours had the strength in his DYING moments to say thank you to 4 of his own. Unfortunately some people didn't read the story in its entirety, and the posting just went off in a completely different direction. You I'm sure have started/been a part of similar threads that meander. Please take your own advice and keep things civil when in a main forum. If you want to blab at me in private message go right ahead, I really don't care. I don't want to read through useless bickering in a forum, and I'm sure others don't either. As for posting somewhere here, I will do so where I please as this is an open site and don't need an invitation to do so. Neither do you. I'm going to consider this matter

I don't think you needed to explain yourself. You can relate it if you were grateful then fantastic - I'm sure it was appreciated by them ! Every medic and EMT likes to feel appreciated. We rarely see a thank you and when you get one it makes you step just a little brighter. I'm glad your injuries weren't fatal - why is it we only care what people think when they're dead. Brings back a good thought that someone told me once - everybody loves you when you're dead - so true. At any rate, it seems the guy in this instance was very troubled courtesy of brain condition or not. I won't pass judgement though as I don't know the surrounding facts. It's a sad situation for all parties involved. Have to say though, during my time in Canada, I was very impressed by the attitude of the Ottawa officers (they were so kind directing a poor VERY lost american in the proper directions lol) as well as the RCMP who were invaluable at a few events we were participating in. Don't let an entire dept be judged by a single individual. I just hope now, he receives the help he needed.

This was a little more than tonsilectomy ... What kind of cop WOULDN'T have a vest on? Unfortunately they don't make them for tracheas ... This was an extreme situation that doesn't happen every day. DUH, I think we all know these medics SHOULDN'T have done what they did. Great thing to point out there rock ... I only hope I have the same courage to do what they all did, should I ever be faced with that situation because I know I couldn't live with myself if I ran away. Yup.

Syphilis, have you ever tried shutting off that switch without the keys in the ignition? It simply shuts the vehicle off. Same as the Demers model with the switch on the console. As far as door locks go, many ambulances are also equipped with a hidden exterior switch which unlocks power door locks, in case the crew unwittingly locks themselves out. At least in this theft the driver left the keys in the unlocked ambulance. LOL

Many 14 year olds have cars where you come from?

Way back last month you were notified? Then you definitely were a replacement for someone. I was offered my spot back in 2008 and already spent 10 days orienting at the Sliding Centre. I'm sorry I can't be much help to you, but VANOC is supposed to be arranging accommodations for you. If you like, PM me we your venue details, and if I'm able to offer you some insight and e-mail addresses to VANOC members responsible to assist I'll pass it along.

So it's all done with smoke and mirrors and that EMS responsibilities are assumed only to increase budgets and to procure more suppression apparatus? You've worked for my dept and/or neighboring jurisdictions? Of course you haven't. But just keep making broad generalizations. Racial prejudice is also based on generalizations and assumptions against a certain population, and we know that those reputations are untruthful in large part. As far as my "idealistic" solution, I don't see any real change happening otherwise, only by like minded individuals, degreed, which is necessary to earn positions of influence (admin, gov't agencies). As it stands, EMS, at least in the states, is fragmented and transient. As such, no significant organization and change will be possible until some educated trend setters go to work where it actually counts, in admin and gov't. Won't happen without four year degrees and higher. As it stands, it's all to easy for a well organized profession, fire suppression, to take over the EMS profession largely unopposed. My reference to education wasn't at the field ops level, but rather at the admin level, which is what the four year degree does. It's also puzzling why any progressions past an EMS AAS is admin related, rather than increased medical knowledge, since we're told that a paramedic's education is inadequate for IFT, critical care txps and flight by some on these forums. Anyway, back in my single role hospital based EMS days, I've worked with many a competent medic, none of them degreed. I don't hold a degree myself, but I'm currently in the process of completing my EMS AAS. A P-card gives me 37 credits. Add some math, english, and social sciences from back in the day and I only need less than 20 credits to finish. Anyone else can do the same. So, if my vision is too grandiose, how do you see EMS advancing regarding education and politics? I've only heard vague answers such as "increase education", "create a national standard", "make an EMS AAS the minimum standard for job entry", and such. Fine ideas. But how do you see that actually happening? What's your realistic plan? Oh yeah, my FD trains incumbents, ones who volunteer for an ALS upgrade and pass certain standards, to a degreed paramedic program for their ALS training. We also hold a 16 week ALS field internship, on ambulances not engines, with lectures by PA's and RN's as well. That's way more than most third service EMS agencies are doing, when you think about it. And that's just to start.

I understand where you're coming from, but have you never had someone freeze on you so cold to the point where prompting wasn't working at all, and you had to take over the call (not fight over it) because nothing would get done and patient care might be compromised? (Over and over again I might add ...) Squint was right, the topic did get way off topic

It wasn't the title ... it was the fact that you actually came across as being a dickhead in your subsequent replies.

What is a RCMP officer? Was that someone he was working with? How sad, just sad. Last February I had a tonsilectomy that put me in the ER about a week later with massive hemorrhaging. The blood was puring out my nose, and my mouth, but I still did the best I could to thank the medics who rushed me to the ER...

I didn't think you were, but there are those on here who just feel the need to compensate for their own inadequacies and demean their peers to elevate their own status in their eyes. It is really too bad.

Sorry Jaime, I was having a discussion with Lisa regarding the antics of some on here. Your input is welcome though, so long as you keep it civil. If you had wanted the thread to form some sort of position, you might want to consider posting more than a simple link to a news story rather than respond with attitude to a response which empathises with the officer. To me, Lisa's comment was in complete association to the news story you posted as she expressed her understanding, if even in a small way, of how that officer felt. So, why did you post the article without a comment to give direction to the thread? To bring attention to the fact someone appreciated the efforts of the paramedics? To bring attention to the fact that these medics acted selflessly? To bring attention to the fact that it was a dangerous act and they risked themselves? There are any number of ways this thread could have gone after you started it. If you don't want people making particular comments in a thread you started, then put some effort in rather than a simple cut and paste and make an actual comment.

Speaking of misinformation and confusion. You feel free to continue to PERSONAL ATTACK REMOVED -ADMIN, and continue to use the term "us", though doesn't it say student under your name? What part of "us" don't you understand? You agree that 'we' crawl into cars and do all sorts of other bullshit heroic stuff...when did you do those things exactly? Before you send hateful, ignorant, vulgar emails to our new members perhaps you need to take a reality check babe. Lisa, I recommend you forward those emails to Admin....He won't be pleased with the language, nor the threatening tone. As well, any more shit she sends secondary to this post, forward them as well... PERSONAL ATTACK REMOVED -ADMIN At least have the ovaries to do it in public with those of us that have been here a few weeks... Dwayne

I'm really getting sick and tired of all this 'fire bashing'! If Firefighters were such 'terrible drivers', there would be more fire apparatus wrecks. If EMS were such 'great drivers', we wouldn't be hearing about all of the ambulance wrecks... Driving a fire truck (which is more top heavy than ambulances), also deals with shifting weight (can't put 'load locks' on a tank of water). This forum is rife with so many misconceptions (usually perpetrated by those that have never performed firefighting duties). Those of you that know me, know that I fought fire for 15 years AND worked full time EMS for 12 years. You also know that within the scope of practice for the level I was at, I was pretty damn 'smart', and damn good at both professions! In my opinion, the energy spent whining, crying and bitching about what 'fire does', that energy would be better spent elevating EMS to the status of a 'respected profession'! Furthermore, if EMS wants to shed the 'bastard stepchild' image, maybe it's members need to stop acting like one! Fire and EMS have always been inextricably intertwined, and with the 'tough times' because of the poor economy, that bond will be further strengthened. Deal with it!

Not exactly epic. We all know that for every FF/medic job lost, there are ten or more created. Don't hold your breath. Actually, we like to play chess and watch movies in the evening. I thnk that every house here has seen The Hangover. I can't stop saying reTARD whenever it fits the situation (you know, the scene when they're driving in the desert and fat Jesus says that Rain Man can count cards and he was a reTARD).

I have worn turnouts to the point that avoid putting them on at all cost. I have been on the largest fires in the history of California. You guys are not getting it and that might be why we have a problem. <br><br>Are u willing to wear the gear you have been issued for a week, running 24 calls a day, day and night in a disaster zone. It seems a couple of you have an aversion to the Fire Service. The Fire Service runs the show in 80 percent of america when it comes to 911 EMS, and I see an aggressive take over of Private EMS by the Fire Service in the next few years due to budgets needing to be justified. Unified Fire in Salt lake has just about ran every company out. They do Medic Engine Transports. <br><br>The point is that Dickies style pants, Red Cap, Lyons, whatever.... are not appropriate clothing for long term EMS Operations. Look at England, and other countries. Look at the red cross in Spain and France. This was an issue during the world trade center 9/11. It was an issue during Katrina. Why not have a Standard Ensemble Outer Wear that could be adapted or modified for use by the user for cold wx or warm wx. Somewhat like Ski Patrol wears. Mandated by the DOT. Same Color and spec in every state. If a person saw you in San Diego or Miami it would be the same uniform. <br><br> I am not Ricky Rescue......it is your emergency not mine. I am not going to expose myself to the cold or heat or the rain, get my boots wet, get my shirt wet. Some of you have higher levels of medical training. OK.........why is it that you don't touch a sink with your scrubs when you wash your hands? Why is it that you don't allow soiled linen to touch your Scrubs? Why is it that you Don't allow Scrubs to be removed from the hospital, and why do they wash scrubs in a SEPARATED washing machine. The first code of the day, your uniform is contaminated, and you take back to the Quarters, it cross contaminates the Rig etc, etc. Then you put it in your washing machine at home where you wash you kids cloths. SICK......my sons mom never let me wash my uniform it the washing machine she said take it to the laundrymat. <br>Her mom was a trauma nurse, she knew about MRSA, and all the microbes and pathogens that remain. I challenge you to do some research on the subject. Now I feel the subject might be that EMS providers are not receiving the correct training, they don't understand what they are&nbsp;&nbsp;being exposed to. The first SNF you go into and kneel on the bed of a PT to lift them on the Gurney you have contaminated the crap out of your pants. <br>Then you go eat lunch in those pants, gross.<br><br> <div><br></div><div>The globe stuff is right on point.....hats off to the FDNY EMS division. Ever run into Captain Morris from Rescue 1.?&nbsp;</div>

BLS before ALS you have to be an emt for a year atleast before you can start to be a medic.good emt skills is what makes a good medic.i dont give a damn if you are ALS is you cant to the basics then you are no good to me.think about how many ALS calls really go down on any given day,where i work(in manahttan) alot of calls get upgraded by the callers because they want an ambulance to get there faster but when you get there its bullshit. yes ALS is hard,i was in medic school til i got hurt at work and had to drop out but so is emt work.medics need us and we need the medics.alot of places double as bls/als and are usually run by fire and thats the true issue imo. if you are a fire fighter then thats great but the system should be kept seperate.ems should be run by someone who has medical traning and not by a fire fighter. getting back to which is better,neither is better,its what you know and how you do it.i can start a line,do the leads and push drugs better than some of these medics out here but i have seen als do better immoblization and basic bleeding control better than some of the techs who have been on the job for 20 years. if you are an medic then you need to keep up your emt skills because all als protocols say BLS interventions first and just because we are on scene there to help you otu doesnt mean have us do all of that because you dont want to.learn the new tricks from your emts as for the techs learn the simple things from the medics like how to spike a bag or how to put the leads on the pt. ems isnt going to go anywhere if we keep bashing eachother,als saves bls but its bls skills that saves als