VentMedic

This doesn't just apply to the EMT and BLS. We have ALS transfer trucks and even some that call theselves CCTs using "CCEMT-P" labels that call for the FD Rescue to provide 911 care if they find the patient at the LTC facility in more need than just hooking up a cardiac monitor or monitoring a medicated IV. They should be able to at least get some emergent things started but some believe "if it ia a true emergency" then the FF/medics must handle it.

That's just part of it. He's bound to generate some monetary gains with the talk shows he has lined up for this.

Did you follow the links I posted earlier or the comment I made? CoAEMSP is under the auspices of the CAAHEP and is concerned with the EMS specialty. I think the FF certs were covered in the previous thread as were the medic mills. http://www.emtcity.com/index.php?showtopic=14350&hl=

The problem is many partners that will mentor the newcomers continue to make the same mistakes over and over because they don't realize they are mistakes. To break this cycle, there needs to be education and clinicals done under the watchful eyes of educators. We must first educate the educators and stop the bubba see, bubba do mentality. We must develop a generation of those that have enough of a foundation in the basics of medicine and the sciences to think. Florida provides ALS to every community in the state. While this has helped the medic mills to flourish, Florida also has many excellent two year degree programs for Paramedics. Unfortunately, EMS has acquired a quick fix and shortcut mentality that keeps the tech certificates the mainstay of the industry.

If I remember correctly, he forgot 22 times to get those statements.

One could also pick up a copy of Nancy Caroline's Paramedic textbook and read the adventures of Sidney Sinus and Abe AV Nodes. Although that might be more like 5th or 6th grade level as opposed to that of a 5 y/o. Or, you could just memorize the pretty pictures of the squiggly lines. BTW, Dubin's hobby was "photography".

I thought you had a degree in English? Did it include 2 semesters of Anatomy and Physiology with lab, Microbiology, Pathophysiology, Pharmacology etc? If you just want a certificate there are plenty of tech schools, both private and public, that will get you in and out quicker. Are you still considering the Orlando area in Florida? http://www.emtcity.com/index.php?showtopic=14350&hl=

Start here to look for an accredited Paramedic program. http://www.coaemsp.org/ http://www.coaemsp.org/accreditatedprograms.htm This is a division of CAAHEP linked by paramedicmike. Hopefully the same school will also have an EMT-B program. Stick with state community colleges or 4 year programs so that some of your previous credits will apply. For a well rounded medical education, you should have some sciences: college level Anatomy & Physiology with lab - at least two semesters, Microbiology, Chemistry, Pathophysiology. A good program should take you about 2 years and you'll have a degree. There are also a few program that are 4 year programs where the majority of your undergrad degree will transfer and the rest will still be about two years. As far as experience as an EMT-B which is essentially a first-aid provider. You don't need any more time at that level than what it takes to finish your Paramedic classes. Or, you can do the zero to hero route by finding a 2 - 3 week crash course (120 hours) for EMT-B and then follow up with a 3 month medic mill. At this time there are only one or two states that require a college degree. Oregon is definitely one of them. Texas has an optional degree "license". Kansas is another but I am not at all familiar with that state.

HIPAA - Health Insurance Portability and Accountability Act - review what it actually means instead of just using it as an excuse for everything. The Paramedic left the back of the truck leaving his patient open for anyone and anything. He could have just stuck his head out and gave a quick explanation of having a patient.

So you are viewing this as a definitive exam to "rule out" and that the patient is a band-aid case even though something made you use the US? We did not use it to downgrade care since we already had a good idea where we were taking the patient. We did not "rule out" but rather "ruled in" what we already suspected based on physical signs and MOI. If needed, we did have a couple of advanced procedures that could be used at scene or in flight. No it is not difficult to learn the knobs of an US just like all the other gadgets used in EMS. However, it does take some practice with different body types. My question to the OP is how the US was presented as to its purpose and what was being emphasized.

We trialed it about 4 years ago on the helicopter but found it did not make much difference since our destination was usually a trauma center from scene. As well, due to good response times and the nature of certain internal bleeding situations, there could be a chance some things would not be immediately recognizable. Thus, at the trauma center the patient may get a FAST scan as well as the possibility of a CT Scan before the surgeon takes the patient to the OR. We already got the doctors' attention by our assessments and relay of specific information that could get a surgeon put on notice. After weighing the costs, storage, maintenance, extra training and relatively no difference in what we would do that we probably would have done with or without the US, we decided to spend the money on safety items and update some older equipment. We also had so many other pieces of technology that we MUST know very well just to keep contracts for IFT with some hospitals. Questions for you: What have your supervisors said you would be looking for? What will this change in your care? Do you transport to a trauma center? Will it change your destination for a trauma if you don't "think" you see anything abnormal? I am not opposed to any new technology or skills. But, they must prove themselves to be of use in the prehospital environment and make a difference. We still have well over half of the EMS systems in this country that do not use ETCO2 monitors, 12-lead ECGs or CPAP.

LOL! I take it they haven't found a way to get reimbursed for it yet to pay off their purchase cost, training, retraining or maintenance fees. Usually a good assessment can determine which facility is best for the patient. I seriously doubt if most of these Paramedics pull our the US unless the BP is dropping which should clue in even the clueless that a higher level of care might be needed. There are also many things that won't be picked up by the EMS version of US assessment that could give a false sense of security that all is just fine when their physical assessment might be telling them something different. Again, it depends on whether you are ruling in or ruling out as it pertains to the accuracy and confidence factor of the findings. We could use the pulse ox and the ETCO2 as EMS "toys" that are under or over used as well as inappropriately and very much misunderstood rather than for the value both of these devices are intended. Some need to master basic (not as in EMT- assessment knowledge and skills before jumping in. Finding 3 organs on a normal 75 kg young male should not be very difficult and probably not very practical. Now if they were to do 100+ exams on a variety of patients just for practice, that might be more credible. Even 50 exams would be somewhat reasonable.

Are you questioning HR intensity or Target HR for exercise or stress tests? (220 - age) x the percentage of intensity = Target HR Example: for cardiopulmonary stress tests we may calculate patients to 60% for the low limit of intensity. We may also stop the test at 50% or lower if symptomatic. Healthy study participants will usually acheive 85% with no problem. This is a good formula for anyone in EMS or Fire to maintain their fitness level and to monitor while exercising. It is when your HR reaches these percentage rates or max and stays without excercise that SVT may be an issue.

Okay, so you will be 17 in a few days. Most of the info was already given to you in the other thread. Florida now uses the NREMT for its EMT exam. Florida no longergives its own state exam and hasn't been for a few years. A state exam still exists for the Paramedic in Florida. From the other thread: I would like to know which of our great medic mills this young person is taking his EMT-B. They should have explained the age requirements. However, if it is one of our medic mills, they are all to happy to take money from anyone regardless of the state's requirements and have probably got him ready to be enrolled in the medic program for a discounted rate of $15k. When it is a kid they are taking money from, I get a little more disgusted with them.

Where did you take your EMT-B class?

The article About a dozen D.C. paramedics were ordered into retraining and others have been required to take course work, but D.C. Fire Chief Dennis L. Rubin told a city council committee that a series of poor performances in medical-knowledge tests did not require punishment or a major shake-up in the department. {Only a dozen?} D.C. Council member Phil Mendelson, however, called the results "completely disturbing." The Washington Times reported in April that dozens of the District's paramedics either failed to meet a minimum national standard on written exams that tested their medical knowledge or had mishandled basic lifesaving procedures during videotaped assessments. During a hearing Monday at City Hall, Mr. Mendelson, chairman of the D.C. Council's Committee on Public Safety and the Judiciary, took note of The Times' report and questioned Chief Rubin closely about the District's emergency medical services and the test results. "Why shouldn't people be alarmed?" Mr. Mendelson asked. Chief Rubin stressed that the exams were evaluations that were meant to guide the department's training program and to improve medical protocols. He added that the department's medical director, Dr. James J. Augustine, recognized that the tests showed a "generalized deficiency" in two areas, including one related to paramedics' reading of the electrical activity of the heart. But he said the workers were not in need of discipline. {They didn't maintain minimum requirements to do their jobs. Discipline in other healthcare professions would mean a loss of privileges or dismissal. I take the electrical activity to mean from a rhythm strip and not a 12-lead.} "We feel like we have turned the corner, but we'll continue to provide education to bring them up to national standards, and we'll do it in a way that's not punitive," Chief Rubin said. Instead, he said, the paramedics were required to take a two-day, 16-hour course related to the heart activity issue, while 12 to 15 workers who still performed poorly were forced to undergo remedial training. "I don't see a need to provide any kind of discipline," Chief Rubin said. "But we've made some significant improvements, and with a little bit of time I think you're going to see a lot more." After the hearing, Mr. Mendelson called the test results "completely disturbing" in an interview with The Times, but he likened the exercise to rounds in a hospital where there can be "a discussion of shortcomings to improve skills." "You've got to be able to have a discussion of shortcomings to improve skills," said Mr. Mendelson, an at-large Democrat. "So it can't be a punitive process." The written tests - equivalent to the National Registry of Emergency Medical Technicians test for paramedics - were performed last year at the Maryland Fire and Rescue Institute (MFRI) and taken by about 175 of the city's 250 advanced life-support providers. The same 175 paramedics were videotaped during a practical skills assessment in which they were required to deal with a cardiac arrest on a high-tech mannequin. The Times obtained about 90 of the videotaped assessments and 95 of the written test scores. On the written tests, only three paramedics scored 70 percent or above; a passing grade for an entry-level paramedic on the national registry exam is 75. More than 75 of the 10-minute videos were submitted by The Times to multiple local and nationally recognized paramedic instructors and quality-assurance specialists, who said they observed egregious health care violations. Chief Rubin said 75 employees still must be tested. MFRI then will provide officials with a comprehensive analysis of the results.

It definitely wasn't that way everywhere. When I became a Paramedic (1979), if you were in the degree program, you just kept continuing with your education with no break between EMT-B and Paramedic. Of course, you also had to have college level A&P classes and was doing clinicals during this time. Those of us who did work on an ambulance could take advantage of whatever advanced assessment or A&P we learned as well as having access to instructors to discuss what we were applying in the field. Too many work an an EMT-B today and have no one to discuss much of anything with or to oversee what they are doing as being correct. Often they continue assess at an EMT-B without actually knowing what they are assessing or know only a very limited number of differentials. This is not progressive education. And, if it takes someone 3 years to master the few skills in EMT-B, then maybe EMS is not the correct employment path. I do agree that it was definitely more selective as to who worked as a Paramedic especially with the FDs. You actually had to know your stuff and not everyone worked Rescue or the FD ambulances. Thus, this was the reason many of us in the late 70s and early 80s obtained degrees instead of a certificate in EMS to be more competitiive when applying to a FD. So ideally, if one was to work as an EMT-B while continuing their college education towards a degree in EMS as a Paramedic, one would have more than enough experience with the advantage of gaining education from the college classes to enhance that experience.

While are your transport times? How much extra time in total will be spent at scene using the US device? Do you not already have trauma criteria or other facility determination in place to determine appropriate destination? How well trained are you in all patient ages, sizes and body position? How many live patients, of various sizes and ages, will you have to demonstrate your skills on before being allowed to utilize the US in the field? What additional treatment protocols, skills and meds are implemented? What will change in your overall treatment of the patient? Are you still going to go with the other vital signs, symptoms and MOI to provide treatment regardless of what the US may or may not show? Are you "ruling in" or "ruling out"? If you have lengthy transport times and the appropriate advanced protocols to treat your findings differently than how you do now, it might be appropriate. If you are only looking at three organs with a limited focus, you may not be looking for other possibilities that could also be life threatening or require treatment at a specialized center. A false sense of security could be given if the findings appear normal just from age, size and body position but the patient condition still warrants treatment. Or, you may not have had that chapter for abnormal findings. Portable US can be of very high quality but unfortunately it often becomes an expensive vein finder rather than being used for its intended purpose. US is used by some Specialty and Flight teams but if it doesn't change what you do, it becomes just another piece of equipment that requires careful storing and maintenance. It may also take a few minutes away from something else that also needs to be done and if you only have one Paramedic with an EMT partner on scene, this could be crucial. If it is used too infrequently, more time may be lost and a greater margin of error by lack of familiarity may influence findings. Will extra training sessions in a hospital be setup to periodically review? (Like the ones so many do to keep their ETI skills perfected.)

Do you think I do not know the different between a tele monitoring system and an eICU? Also, it seems your hospital has grown some since your first post. I was referring to eICUs which are monitored 24/7 and not just during certain hours. Patients don't stop having emergencies just because you have put in your 8 hours. We are able to provide eICU coverage to all 4 of our hospitals with all the same ICUs you mentioned. Maybe it is time you upgrade your system to keep up with the rest of us to give your patients 24/7 coverage. If you have studied anything about hospital management, you would know the various factors associated with the configuration of the units including monitoring and staffing. That is Planning 101 and each factor must be considered in any remodel with all aspects to ensure patient safety.

Only 40 cameras? What is the average acuity levels of your ICU(s)? Is your ICU more med-surg? More 1:1 patient:RN ratio? 2:1? 3:1? Centralized or Pods? You are listed as central USA. You definitely can not speak for all eICUs in this country and especially not at the hospitals I work at. Our hospitals are open 24/7 and so are the eICUs. We don't get lax on patient observation just because the sun sets or it is after 5 pm. You may just have a general monitoring system and not one that provides much in the way of patient observation.

What exactly does EMS want or expect? We complain when systems and states allow minimally trained and questionably competent EMT(P)s to remain without fear of being held responsible for their actions. We complain about Medical Directors who do lax oversight. We complain about field supervisors who look the other way. We complain that those who screw up are not retrained and educated. We complain that about the media who reports an issue although for CA I think that was a good thing although very little will be done about it. But, when a medical director and the state finally step in to investigate, retrain and reprimand 2 EMT-Ps and hold them accountable for their actions and charting, we complain about that also. So, what is it that EMS wants? To be left alone and not have to explain our actions or charting? Or, to become like the other professions and be held accountable as well as being able to explain or chart well enough for our actions to hold up in court? Do those in EMS want to be considered as professionals and held to a higher standard or at least be able to explain their actions? If anything, others should be reviewing their own P&Ps and charting proficiency to see if there is anything that could come back to bite them in the arse in a similiar incident. Making excuses and thinking all is perfect just doesn't advance the profession. Speculation that they "probably meant" to do this is just that, speculation. It also gives those who continue to mess up hope that their futures are secure because others have the same view for work ethics as they do. There is no need to explain anything in your charting because your peers are behind you and that just makes you fit in with the herd. Some on the forums have also said EMS is just getting picked on. Except for the people in immediate areas, only those in EMS see most of these headlines pulled from an EMS newswire. If you go to a nursing or RT site, you will see the headlines for those professions. However, for these professions, the state is often quick to yank the license before much media damage can be done. This is just one incident that happened to make headlines. Luckily, many medical directors try to correct the problems before they make headlines. There will also be those that will constantly complain that these companies are "not fun" to work because they have a atrong QA/QI program in place that "monitors everything". These are also the same employees who complain if their medical director doesn't feel they are up doing advanced procedures like RSI or even ETI. However, those that welcome medical oversight and quality assurance programs usually get the benefits of protocols structured more like guidelines and trust from their medical director to do advanced procedures when warranted. Now, for these two Paramedics, they should have known the call might be scrutinized because of the actions of their supervisor and the LEO present. They should have charted their butts off as well as made a separate report for their medical director and maybe even some face time with him. However, if they have been accustomed to just getting a gentle slap on the wrist, they probably thought this dead baby incident would be no big deal either.

Since we haven't seen the dash cam video, we don't know how far away he was from his patient or if his attitude totally distracted him from the patient in the back. The part in the cell phone video shows the later part of the whole incident and not the one in question. Too much is not known including the words exchanged and earlier actions of all when the initial stop was made.

Which is why we now the "eICU" in many hospitals. Physicians and nurses sit in a control room monitoring by video all of the patients when the nurses are not in the rooms. They make their own record of CR monitor numbers, meds, and ventilator settings.

The policies pertaining to exposure reporting will not be in your patient protocol book but rather in your employee or volunteer handbook that outlines what is expected of you or the company. There are also administrative policies that may outline the procedures especially if you know you have been exposed like for a needle stick or body fluids in your eyes. The hospitals you transport will also have an extensive reporting P&P in their infection control manual. Hospitals also have infection control officers who know the regulations and do see they are followed through. Since the majority of infectious patients that you will be exposed to will be taken to the hospital, their infection control person would be your best bet to see how they determine when, who and how if the situation occurs.

New Jersey has an extensive communicable disease statute, http://www.state.nj.us/health/cd/documents/njac857.pdf http://www.state.nj.us/health/cd/techinfo.htm New Jersey OSHA http://www.state.nj.us/health/ohs/medical.shtml Now, you need to check your own P&P manual. You can also ask about infection control policies at the hospitals in your area. Some of this information should have been mentioned in EMT class.