VentMedic

The same things were said about intracardiac epi, subclavian central lines, pericardiocentesis, chest tubes and retrograde intubation which were skills commonly used by most Paramedics many years ago. You could also include the MAST into that list and there are some EMT(P)s that still do not want to part with it because it is one less "skill" to list dispite the evidence based literature that does not suppport it.

That is not a good comparison since an RN can do much more than most Paramedics in similar circumstances and this can include intubaton. This is the reason they are essential on Flight, Specialty and CCT. The difference is they know when they need to acquire more education and are more accustomed to profiency monitoring. If an RN has intubation responsibilty on Pedi or Neo teams, they know the importance of maintaining not only the skill but also having the proper educational foundation for airway management and maintenance. There is little or no chance this "skill" will be removed from their protocols for these reasons. Paramedics often believe the "skill" itself is the beginning and end to all. Was this instructor instructing or educating? If he was educating, the failure rate should not have been that high unless this was a class that had nothing but wannabes for the wrong reasons. The object is not to see how many students you can fail. Thus, we can get into an instructor vs educator debate. EMS needs more educators who are trained to teach. Did this class have any prerequisites? If the Paramedic programs were to make a few prerequisites mandatory, that would eliminate more from even applying to a Paramedic program unless they were interested medicine. Look at the examples in Florida where ETI for adults is now in question. How can you respect an education system that allows medic mills to push through students who may only use mannequins for their intubation checkoffs with no live intubations? How many students are even getting a chance at doing a pedi intubation? If you also look at the reasons people are going through the medic mills, you will find it is not about the medicine. We recently had the FD hiring events for a couple of major south Florida FDs. It was astounding at the number of applicants who were Paramedics but had never worked in EMS or even on an ambulance and will not work in EMS until they get a FD job. You will also find this in other states like California.

Either way the ventilator will be pressure controlled to adjust for the flutuation in VT. They will not allow the volume to expand to 3x normal. It is frowned upon to take a whole ventilator into a chamber due to machinical parts. The ventilator may be attached from the outside through a special port or pneumatically powered at the simplest level. Again, just review a few gas laws and a few simple pulmonary equations, which a Paramedic should have at least at introduction to, and this will be easy to see why these things are important when considering dive injuries, flight, HBO, altitude, tank pressures and just plain oxygen carrying capacity. The oxygen clock will start but the patient will not be in the chamber for 24 hours. Since HBO greatly reduces the half life of the CO molecule attached to the Hb, the O2 can be weaned quicker once out of the chamber from that 100%.

A cuffed tube does not prevent aspiration either since the cuff is below the cords. What is missing here is the basic concept of airway management. Too many want to do ETI but forget a few basic principles about maintaining an airway. This should be reinforced in EMT-B but again the education is lacking there also. In Paramedic school the "skill" of ETI is jumped into without a good basis. The ones who usually complain the loudest about losing ETI are viewing it as just a "skill" that they can claim. It they had an actual understanding of the airway management concept and how ETI fits into the concept, they would also understand the rationale behind the need for proficiency and continued competency. They may have had neither to begin with in this "skill" but just had it in their scope of practice or protocols. You might ask those pondering the loss of pedi ETI how many times they reviewed their procedure manual and at least made an attempt to stay familar with the many sizes and shapes of children. Playing with an intubation head in PALS once every two years to impress the new nurses doesn't count.

Review the basic gas laws and respiratory equations to find out where barometric pressure fits in. The standard treatment for CO poisoning is oxygen, to reverse hypoxia, compete with CO for haemoglobin binding, and promote carboxyhaemoglobin dissociation. Effects are increased at high pressure, shortening carboxyhaemoglobin half-life from 4–6 h to <30 min. Henry's Law Most oxygen carried in the blood is bound to hemoglobin, which is 97% saturated at standard pressure. Some oxygen, however, is carried in solution, and this portion is increased under hyperbaric conditions due to Henry's law. Tissues at rest extract 5-6 mL of oxygen per deciliter of blood, assuming normal perfusion. Administering 100% oxygen at normobaric pressure increases the amount of oxygen dissolved in the blood to 1.5 mL/dL; at 3 atmospheres, the dissolved-oxygen content is approximately 6 mL/dL, which is more than enough to meet resting cellular requirements without any contribution from hemoglobin. Because the oxygen is in solution, it can reach areas where red blood cells may not be able to pass and can also provide tissue oxygenation in the setting of impaired hemoglobin concentration or function. Review Boyle's Law.

The ambitious type...

Yes, there are cutbacks for EMS and even some FDs. But, some have been due to poor management and allocation of funds. Pork projects got money which should have been directed at the areas that provide direct patient care service. Some departments that are feeling the cutbacks are also those that have become accustomed to "more" when they could have easily done with less and saved for a rainy day. Also, the greed of some have affected the services that have managed to survive on little but are watching their funds being diverted to support the excesses of a few. So, let's not blame this all on the public. They see this happening in so many ways the don't even know what or who to support. Right now, many families are concerned about their children getting a decent education and many are spending their life's savings or every dime they make to see their kids just get a decent grade school education. Between Florida and California, over 25,000 teachers have lost their jobs with school closures and consolidations. Young adults who do make the grade to get into colleges are now finding there are very limited space at the colleges and are being turned away. It used to be if you graduated from a state community college with decent grades you got into a state university. Not any more. It is also hard to support everyone's needs when your house is being foreclosed on. Many are just worried about the day to day necessities. If you look at the total of recent layoffs and the amount of people that are unemployed, it is pretty astounding. Health insurance is no longer there for some who need it because of job loses and the inability to quality for the various assistance programs. You know the type that fit this picture, the hard working middle class person who suddenly is without a job. Just getting necessary prescriptions filled is a challenge and some will just have to go without and hope for the best. Look at California's unemployment rate. It is averaging over 10% which is more than double of what it has been for CA or any state. http://www.calmis.ca.gov/file/lfmonth/countyur-400c.pdf Here's a comparison with CA and the U.S. http://www.calmis.ca.gov/file/lfmonth/calpr.pdf So don't lay all the blame on the public with the same tired "they don't understand us" line. Many know all too well what will happen if they have a catastrophic illness or accident right now. They know it is hard times for many. If you have a job, quick bitching and be thankful. Be supportive of those who are not as fortunate. Don't try to place the whole blame for the economy or whatever cutbacks are happening on their already burdened shoulders. There's enough blame to pass around but there are many who were in control of the funds that some fail to give due credit for the rough times. I think we can include some of the unions in this also.

Apologies. Those of us who were around at the beginning of HIV as it became known in the U.S. and who helped gather data for many studies throughout the years, rarely joke about it.

I've heard plastic surgeons can do creative things either way.

Usually you agree to have your medical history followed and you will fall either into the circumcised or uncircumcised group depending on what your parents' preference had been. If you are near a teaching hospital or medical university, you may be able to sign up for whatever they happen to be studying. Sometimes you may even be paid for being part of a study. Others may get the benefits of a new medicine or treatment that is considered to still be in the trialing phase.

Unfortunately, where a lot of the studies have been done, it may be hard to find a Walgreens.

Remembering some of his other posits, I couldn't tell if he was an EMT (U.S. standards) looking to take a swing at Paramedics.

If the patient has already called you... For the patient, it is their emergency. It may be the first time they felt that chest pain that you write off as just indigestion. Okay, a little extreme unless you are from Washington DC. But, if you approach the education wrong, all you will do is make the ones who may really have an emergency think twice about that chest pain because you said to "be sure you have an emergency". It will be the middle class businessman that doesn't want a scolding for abusing the system for his chest pain. It will be the little elderly person who hears your words and will take them to heart by not wanting to be a bother and will not call until it is too late. The ones that abuse the system probably aren't going to listen to you. It is not just medical calls that are flooding the system. Remember, 911 is also used for PDs and FDs. People use 911 to complain about their neighbor's dog, get directions on the freeway, see if there is a traffic jam, complain about a news story (see the Dallas Police thread), get a cat out of a tree, find Fluffy, find Rover, the kid should have been home from school 5 minutes ago and the kitchen faucet is dripping can the FFs do something about it. You don't have to take it to that extreme with the name calling. However, there are several studies that do show Paramedics are weak in determining the severity of illness and complications especially with medical calls. Right now we have too many 3 month wonders roaming the streets which still makes many systems only as strong as their weakest link.

So with you the patient can not win. She didn't call EMS. Someone else called EMS. She wasn't feeling symptomatic at the time. EMS was canceled. What makes her stupid? YOU would have probably have thought she was stupid if she had wanted transport without obvious symptoms. When someone suffers a fall, I look at how the fall happened. If a ski instructor or martial arts instructor, who see hundreds of falls, tell me the patient took a hard hit, I may give some weight to that. I would also look at the patient's age, overall body structure, fitness level and medications. How she fell would also provide some clues. Did her feet just fly out from under her not allowing time to break her fall? Other injuries to arms, hands or knees that indicated she may have broken her fall before her head hit? Surface? I seriously doubt if this is going to have everyone running to the ED. Our radiology department was talking about this but still have not seen an increase in people demanding CT Scans. And, that is with our sometimes overly cautious doctors. We also will admit some patients on a 23 hour hospital stay for observation it there is something that makes the doctors feel uncomfortable. But, so far, admissions have not increased from people who are scared they have a subdural hematoma.

ER Technicians can take vitals in the triage area also before the triage RN sees the patient. In most EDs you are not working under your EMT-B cert which can be extremely limiting. Under the hospital title, you may be able to do 12 lead ECGs, IVs, phlebotomy and basic ortho skills. Some places may require you to have a Phlebotomy cert which is about 140 hours of training in some states and take a national exam. I have seen many EMT-Bs limit themselves by not accepting some hospital jobs because they were going only by the scope of practice of their EMT-B which may not even be recognized within the walls of a hospital. In several states, EMS wanted to be very different from other medical professions and wrote their statutes as "prehospital only" thus limiting the opportunities of their own providers. If you are interested in working in a hospital, find out what an "ER Technician" does and not an EMT-B. Then find out if they will train you or if you need to get the phlebotomy cert on your own. Doing 12-lead ECGs correctly can be taught in under 15 minutes by a good teacher. All the EMT-B does is help you get your foot in the door as proof you may know a few skills. Some hospitals prefer CNAs, PCTs or Medical Assistants for ER Technicians since they are familiar with the hospital culture and are more varied in the skills required for long term care which is also essential in an ED. They are also team players with the experience of dealing with many different health care professionals. So, if you apply to an ED: be a team player, have an open mind and be ready to learn whatever they want to teach you.

Interesting article and one that has been researched many times since the late 1980s. There are also 40 references cited at the end of this article. Something about it makes sense.

Any reason for this not to be included? Does your service do RSI? Are you able to do paralytics for maintenance?

If the patient shivers, you defeat the purpose of the hypothermia by having the body work to raise the body's temperature.

I would not be in favor of using an LMA with a hypothermia protocol since paralytics are usually part of it. You should have a secure airway (ETT) established and verified before any paralytics are used in the field.

Since NPs and PAs are already working on that project and already have the education to step into this role, why not work on something more realistic like a 2 year degree for the Paramedic? A Master's or Doctorate degree might be a little unrealistic at this time as is getting a DEA number for another profession. !970s? Try 1967. The Freedom House Ambulance service had some of the first Paramedics. It was hospital based and if EMS had followed its intended path, the word Medical in EMS might actually mean something. Several states, including Florida, already had two year degrees for EMS established in the 1970s. I graduated in 1979 with an EMS degree and I believe Rid and Dust graduated from a degree program just before that. At that time we were told that was the future and a degree was a must have. That also included many of the FD Paramedics at that time.

The people that change they minds will probably not be the ones that would stay at the job very long anyway. What they need to do is sell the area to Paramedics who want a home for their families. Promoting a secure outlook for jobs, housing and education for their children may attract those that who plant roots and be solid employees. Those that can't wait the time it takes to process as application probably have few responsibilities and may be accustomed to job hopping to look for that greener grass. Those who want to seriously relocate will spend that application time researching the area. Some may just take that opportunity to try out a place if they just lost their job someplace else or while they are waiting for their license application to process in another state. The companies may end up spending more on turnover than expansion. For those that have carefully planned and who would be a good long term employees may lose out when there actually is a number of jobs and those have been filled by people who are spontaneous with no long term plans. States like this with what other professions call "walk in licenses" are very popular for traveling health care professionals. Often some areas will put up a big bonus to get a slot filled even temporarily. If you are in between your "paradise" assignments, you can pick up one of these jobs with a nice bonus quickly. If it is a real sh** job, you will have comfort in knowing you will only be there for 6 - 13 weeks and have no ties to the place after that. It is expensive and the hospitals pay a small fortune for each of these employees.

Excellent! It is good to know our 3 month medic mill wonders who have been convicted of a crime will have a job at least for 90 days. They just have to leave my state (Florida) before the licensing agency finds out about their crime. But, for states that have lax or nil state reporting (California) for crimes with convictions they will have no worries as their license will still be valid. Only that finger print thing might be a problem...but not for 90 days which is how long some results take to come back.

Pilots have human and electronic monitors watching them. EMS often has lax oversight and the "what happens in the truck stays in the truck mentality". Maturity is what is lacking in incidents with the examples given. This profession does not always attract those that are in it for the patient but rather to satisfy their own fascination with L&S, pretty trucks, nice uniforms and a feeling of being in control of someone's life if just for a few minutes. If the person has no interest in medicine or patient care, it can just become playtime for their own amusement or personal agenda at the patient's expense. If education and clinicals were longer, this type of future provider could be weeded out. It is more difficult to wash out those that shouldn't touch patients during a three month program with sleepovers on an ALS engine for clinicals.

LOL... I guess we can at least say those being spiteful know their drugs well enough to understand the reaction each brings but not well enough to know the potential consequences for the patient or from other medical professionals.

Complaining and name calling directed at patients and other professsionals is one thing. Doing something intentionally like slamming narcan because you can just to have a little fun at the patient's expense is something else. I also have known of a couple of Paramedics who enjoy pushing a paralytic without sedation just to "teach" the patient a lesson. There have been incidents of that during field intubations and on CCT. They didn't even try to justify not giving sedation due to BP or urgency.