VentMedic

Shooting a gun safely and being trained to use deadly force for the many different situations you face on the job are two very different things. Children can be taught to intubate also or any other skill. Does that mean they know when and how to perform the skill? Do you want to be known again as Public Safety Officers? Do you believe EMT(P)s should be required to be concerned more with training and retrainng for firearms then medical applications? Should they be again recognized as a Public Safety Officer rather than a medical professional? If so, then some need to stop whining about FFs doing EMS since the argument is also about doing two very different skills for very different professions. EMS already has an identity crisis.

And this has what to do with medical professionals? They have a place of business that someone might enter with the intent of doing harm in attempts to obtain property by force. They do not have the luxury of calling PD and sitting around the corner or having a dispatcher screening the customers and sending PD if it sounds like trouble. But, these store owners have made a choice to be in that business. I took those appitude tests also and spent two hours arguing with the recruiter and high school counselor that, even though I scored very high in math, I did not want to be an accountant, bookkeeper or computer programmer. I wanted to be a medical professional. The military may place you where their need is and it may not be by your choice. Many Vietnam vets will tell you they were medics because that is where the need was. Few has any interest in medicine and fewer remained a medic after the war. Those that did probably needed a job after discharge. Also, all the toy soldiers I saw growing up had a good in their hands or part of the accessories. There is no mystery that you will be using a gun when going into the military. The arguments on this forum have been to keep EMS as a medical profession and not public safety. I reserve my own opinions about the FD and EMS because that is where my roots are and I do believe many FDs can be effective in EMS. However, adding a gun to their belt takes us back to the issues we had in the 70s and 80s with the Public Safety Officer concept. For another reason why guns are not a great idea, look at what the flashy medic mill ads and L/S attrack now. Imagine if a gun was added to the list of skills. All those soldier and cop wannabes that coudn't be would be wanting a job where they could still carry a weapon. Those interested in being medical professionals might be stuck partnering with some serious problems. Thus, those interested in medicine would seek other opportunities. Even doctors and other medical professionals that volunteer in troubled countries refrain from wearing a weapon especially if there are people who are specifically trained for weapons around them. They want to maintain the image of healers and not present as those who have destroyed that country through guns and violence. Also, just as you questioned about store owners defending themselves from certain people entering their store, consider how long LEOs take to enter a facility safely by identifying themselves. This also tells the people inside to expect a gun on that person. Now imagine, at 0300, a bed head EMT(P) wearing a T-Shirt and faded cargo pants wearing a gun rushing into a building. Can one see the potential for danger here?

Did you even bother to read anything I suggested? You are writing your own story for this accident. The NTSB already wrote theirs. If you have any flight knowledge you would know where to look for the information without all of your own speculation. This crash did not happen yesterday and many changes have been evolving from it.

You can read a review of this fatal crash online through the links I posted. The weather is mentioned in the conversation and the pilot also mentions 810. I guess you don't fly now. When a pilot uses words like "ought" , "maybe" or "probably", my partner and I will ask for a recheck of the weather or whatever situation. I have my life at stake here also and we may not get another chance to say "could have", "would have" or "should have".

It also depends on how up to date the information is that the pilots are basing their decision on. Read the link I posted earlier http://www.ntsb.gov/Publictn/2006/SIR0601.pdf and this link has more info including other links to more information. http://www.ainonline.com/news/single-news-...ses/?no_cache=1 The one I do find disturbing is when dispatchers know the weather conditions and pilots are refusing to fly but eventually they talk someone into it. The voice recordings between the pilot and dispatch from the Maryland crash were also very disturbing. http://www.wjla.com/news/stories/1008/5658...l?ref=newsstory

If you know the patient has an altered mental status for a medical reason, even if they answer your 3 little questions, they can still be held for medical evaluation. If a patient puts their head through the windshield of a car in an MVC and is wondering around dazed but answering questions, are you going to just let them walk away. Hopefully not. If a patient is seriously hypoxic to where they are altered, they may still respond to questions, but are in no shape to make a decision for themselves. Pts with high alcohol or drug levels can also answer questions but should not be signing a legal document saying they are competent. There are also several electrolytes imbalances that present with slightly altered mental status to where the patient is not displaying enough good judgement to make a competent decision. These are also reasons why we hope for a rational adult availabe who is also able to assist in making some medical decisions for patients. Getting a signature on a piece of paper may not relieve you from liability. It may just prove you failed to do a full assessment or talked a patient having an MI into taking an antiacid for that chest discomfort. No an insurance company can not force you to do anything. You can just go into medical debt and pay for medical treatment yourself which will include the ambulance bill.

Guess what? You do. A&Ox3 may not be the best indication of competency. Many people in psych facility can answer those 3 questions. This is why we have medical and legal guidelines for people that will do themselves harm by refusing medical care. Even if you answer these questions correctly, a 72 hours hold can be placed on you for "observation" which will confine you to someone's care. This will be in your best interest per some laws. States have a variety of statutes that will confine you for drugs and alcohol against your will "for medical treatment". There will always be do gooders that will want to force feed you even if you have your DNR papers in order. This can also include your family if they are pressured by the opinions of others. You will also have medical insurance problems that will dictate which doctor you see, which hospital and what tests you can have. They will also tell you which disease you can or cannot have if you want coverage.

I have a concealed weapons permit and I own guns. I also qualified for firearms as a Correctional Officer many, many years ago. However, I have not carried a gun at work even under the worst conditions during the 1980s in my area. It would also have been too tempting be make gator food out of several partners from the medic mills.

Please read the Flight Dispatch Procedures at this link: http://www.ntsb.gov/Publictn/2006/SIR0601.pdf It a little more involved than a Paramedic saying its okay for the pilot to fly. That pilot has a lot of responsibility resting on him/her and must rely on accurate updates for the different flight and landing conditions. His decision should not be based on medical necessity or the insistence of 2 Paramedics that it is imperative that they fly to attempt to change his/her mind. Nor should egos come in to play as what may have happened in the Maryland crash when the pilot made the statement "if they can do it so can we". If our pilot says we don't fly, we don't question his/her judgement. If we don't feel it is safe to fly the pilot respects us and monitors the incoming data to see if conditions change. Ground transport will be arranged. If I am with a Specialty team at the sending hospital when conditions change, the pilot stays with the helicopter and will fly back when the weather clears. The team stays with the baby/pediatric until ground transport can be arranged to transport the team back to the hospital if the weather does not clear within a reasonable time. If it is an adult, we turn the responsibilty over to a ground CCT to see the patient reaches their destination if possible. We will then stay at base if we haven't gone in flight or wait with the helicopter until the weather clears to return. For HEMS, the patient should be with a Paramedic on a ground crew at scene and they will have to make their way to some hospital without us if it is not safe to fly. In others words, we know our alternatives and utilize them. Specialty teams, such as NICU, will also not go in flight until viable life is confirmed. We also do not make it a habit of telling our pilot how critical the patient is so it will not influence his/her decision to take an unnecessary risk.

Regardless of the level of medical competency, you are now asking EMT(P)s to certify on a weapon which is the same argument used on this forum during the "Public Safety officer" or aka Jack(Jill) of all trades and master of nothing threads. It is also the same argument used against the FDs by some on these forums when it concerns two very different fields and the mindset that goes with them. Are you going to spend more time training for law enforcement and maintaining your firearm cert or are you going to be a medical professional. Inadequate training for either medical or firearms does no one any benefit. Carrying a gun may also give some a false sense of security and they may put themselves into situations that they might otherwise steer clear of until PD backup arrives. Remember training/educating someone for the use of deadly force is a little more involved than training a grandmother for her concealed weapons permit. I can not see a city or county assuming responsibilty for several hundred EMT(P)s using a firearm when their LEOs are constantly being questioned about their use of deadly force. Once this becomes part of your responsibilty with certain expectations, the public may view you differently and not cut you any slack for your actions. Instead of viewing you as an EMT(P), the public may have the same expectations of responsibilty they expect from an LEO even if it is a justified shooting. In almost all of these situations, justified or not, the city/county end up paying millions for each incident. The one issue brought up at each investigation is how much initial and ongoing training is done by the officers. What would be the appropriate level before an EMT(P) could carry? What additional training besides just how to shoot should be involved? How many hours at the shooting range each month or quarter should be required? How often to recertify? Just like those in EMS should, most LEOs take their profession seriously and do continue to train/educate on the skills necessary for their line of work. Carrying a firearm is a big responsibilty regardless of what uniform you wear.

In this situation, the patient absolutely needs to be seen by a doctor as soon as possible. Albuterol only alleviates the symptoms for a short period of time. It is not treatment for the cause which needs to be followed up before it exacerbates further. Because a patient feels a little better immediately after the treatment (with 6 L of O2 added), it gives both the patient and health care provider a false sense of security. Meanwhile the inflammation could be continuing its progression until you could end up with a severe condition quickly.

I will fly an organ donor. It the patient has strong vitals but head injuries that will probably be fatal eventually, he/she goes into the helicopter. The young girl left for dead along the roadside by the San Antonio Paramedics would have been a good example. This is also done as interfacility transport by both flight and ground if the patient can be moved to a nearby tranplant center where both procurement and the recipients' surgery can be done. If not, the procurement surgeons are flown to the patient for retrievable. Unfortunately, a procurement team from the University of Michigan is also amongst the fatalities for air crashes. I will not fly a dead body or a code (trauma or otherwise) being worked. That patient is dead and the organs will be of little use. Whatever will be procured from them can be done later at the hospital if taken by ground or at the morgue.

While this may be true for some, it is not true of most. And, even if it is or not, imagine the problems we have finding qualified flight Paramedics. Finding one that has both education and a decent appearance can be a stretch. Out of 200 applicants, 10 might meet the minimum qualifications for education and be fit enough to get into a helicopter. As for the nurse who is a little on the thick side, she should have known the fitness and weight requirements before she applied. This is not necessarily a beauty contest and these requirements are in place for safety reasons.

If the patient pulls a gun, are you going to "outdraw" them like in the old western movies? If you pull a gun, you must have the ability use it and maybe kill someone. That could be a tall order for some. Talk is cheap and without extensive training, one really doesn't know if they can make an appropriate decision to kill someone. Some talk a big talk but how you will react if you actually had access to a gun could be very different than what you think. Any hesitation once you've initiated your own attack can put yourself and others in danger. Just having the gun out may not deter all and some patients with suicidal or psych issues may want you to do what they can not do for themselves. If they know you have a gun, they will force your actions. If it is a knife and you are so close that you can not back away, do you think you can safely fire a gun and not risk it getting knocked by the assailant with the bullet killing someone else? A taser, yes maybe. But, only if it is meant to be used in self defense if you are in immediate danger of bodily harm or losing your life and not for a heroic "take down". Once the public perceives you now as gun carriers, you may not get the same support if attacked as you have in the past. It will be just you and your lawyer fighting your battle. Even if the shooting is ruled as justified, you could still have a civil suit to further drain you and your family. There is even talk to prevent LEOs in some areas from carrying weapons because they can not maintain adequate training or the nature of their location may put the public at risk.

When you carry a gun, you can say "EMT or Parmedic" as many times you want when entering a scene but that gun will say something else. You will not be viewed as a healthcare professional entering the room but as an armed person who is probably law enforcement there to arrest or harrass and not perform medical treatment. That could put you in more danger and you do not have the PD academy training behind you and extensive field mentoring from an experienced LEO to prepare you for a situation of deadly force or prevent it from escalating to that level. I can also see some EMT(P)s being charged for the use of their weapon inappropriately or escalating a situation out of control. If anyone has been following the aftermath in Oakland, CA of the Police Officer shooting and killing a "poor victim", you can see that even by just doing what you perceive to be your job can land you a murder charge. Deadly mistakes can also happen. With today's cellphones and videocams, everyone will view the scene differently and it won't be always in your favor even if you think it was justified. By the time the courts are through with you and your family, everyone's life will be in shambles financially and emotionally. Even if the shooting is found to be justified, your life and those close to you will not be the same even if you can say you are still alive.

Many of those medics from the 1970s , myself included, have at least a two year degree in EMS. At that time EMS was in competition with nursing to see who could get the degree programs established toward becoming a recognized profession. The money was actually on EMS for a while. Then, many of the FDs and ambulance companies decided to train their own in the back room. Now you can brag!

While that is more than many Paramedic programs, it still is very little to brag about. Many of the "certs" mentioned in the article do more than that in clinicals and the degreed healthcare professions start at no less than 1000 hours.

This is a minimum of 1000 hours of training required for states like New York. Flordia also requires almost that much. They are licensed, not jsut certified in almost half of the states. An Associates degree, which is now offered in several Community Colleges is now preferred for employment in the hospitals and MD or DC offices. They are making themselves more marketable in various healthcare settings and reimbursement through education, nationally recognized exam, and licensing. Hospitals are recognizing this and have added them to the staff for a benefit to the patents and staff with decent reimbursement gains. Massage Therapists are becoming a very well organized group that is gaining professional recognition. EMT(P)s could take a lesson from them in this area.

With quick check to the local votech site, guess which "certification" requires the least amount of hours for training and has an accelerated class alternative?

How many have treated aspiration like CHF....with CPAP? That will buy a tube at the hospital and may later be fatal. A couple times a week I can count on suctioning scrambled eggs from the airways of an elderly NH patient who had an acute onset of "CHF" while eating breakfast. There is a big difference between CPAP and BiPAP (Respiratonics trade name). There is a big difference between prehospital machines. When looking at the studies, one shouldn't just read the oversimplified version in JEMS but should see what CPAP device was used for the study in the original article. The trick to CPAP is to know what your device can and can not do. Putting a plastic "toy" with low flow and high resistance on the face of someone who is about to fatique or in the face of an MI may bring failure quickly. You also need to know what you want to affect or will affect. Preload? Afterload? Oxygenation? Ventilation? CPAP has been around for about 60 years and maybe longer depending on other applications and machines it has been used with. It has also been used in homecare for at least 15 years for a variety of different medical reasons including decreasing risks of CHF. At this time you are not going to find many Bilevel (or BiPAP) machines in prehospital. Some people also use the term "COPD" as ONE disease. It is a category of many several diseases and can be mixed with many other lung disorders. Often, it is something other than the COPD itself that is causing the exacerbation such as PNA, right heart failure or pulmonary hypertension. Not all diagnoses will be blatant. Sepsis does not always have a big presentation but can turn deadly quickly. Some just follow protocols for a limited amount of "working dxs". Those that have knowledge of various pathologies can choose a treatment plan without having to pigeon hole a patient into ONE working diagnosis. Most patients are complex medically and may meet the requirements for the entire recipe book. If you ever listen to physician/professional rounds at a hospital, they may list 10 working diagnoses or identifiable problems that are being treated at the same time...and that is just for that day. Something else might break and add another problem that must be solved within the next few minutes.

BTW, if you want to see what Miami looks like when the City of Miami FD announces it is accepting applications, check out the national news channels today. Or: http://www.wsvn.com/news/articles/local/MI111600/ Here's an article from surfer news for Miami Dade FR which will also be hiring soon.: http://www.surfguru.com/surf-news/Miami-Da...cue-Hiring.aspx Only nonsmokers need to apply...Paramedic cert preferable at the time of application.

That video is very misleading as it also spands with clips over 25 years. A few of the FDs I recognized have long since merged or consolidated with other services to become county services or whatever. The Miami FDs learned some big and expensive lessons from Andrew about getting their equipment out of harm's way which included the rescue helicopters they didn't fly out. The private ambulance services were stretched to the max evacuating NHs and hospitals all the way from throughout the Florida Keys to much of Dade county's coastal and low liying regions. That is a big order in one of the retirement capitols of the world. Andrew did not follow the projected path that most thought he would. Getting the correct patient with the correct paperwork to the correct destination is a tall order with just a few hours to accomplish it. Once that was done, they got their personnel and equipment/trucks out of the area because they knew what the aftermath would bring and they could not risk damage to either. Whatever damage done to the FD equipment had to be covered by neighboring cities and military helicopters. Unfortunately some of the military medical rescue helicopters were bigger than what the roof of Jackson Memorial Hosptial could handle but again the military brought their equipment/personnel in to move the damaged cars from parking lots for a LZ. The initial military response was from those already in the area as the Pres. Bush during that time was still not aware a hurricane had occured in Miami. Each area also has an operations plan for who is to stay behind during the actual storm. That will usually includes essential county and municipal employees with a plan in place for before, during and after personnel. Nobody was on the streets except stupid reporters once the front wall was approaching the coast. The FDs were able to hit the streets with enough manpower 1 hour after the storm. The private companies with their undamaged ambulances quickly mobilized to get those out of NHs and hospitals that were thought to be able to pull through a storm but ended up heavily damaged. The hospitals that were okay had to have some of their patients moved to make room for more injured and sick from the storm. Patients were moved to whatever location that could make room for them. This not only included Florida, but GA and AL as well. Hurricane Andrew was a group effort and the logistics for the number of patients moved during that time by the private ambulance services is staggering. Since Andrew, FDs throughout the state have revised their plans of operation to minimize their own damage and ensure personnel safety. While it may be cool to have a funeral with honors for your bravery, it kinda sucks to be dead because you didn't know enough to get out of the danger zone.

How do you know the patient doesn't die? Do you follow ALL the patients that get dialysis every day at a busy center? Our center opens at 0500 and closes at 0030. It can seat 30 patients at a time and that is considered only a moderate sized center. We also have 5 RNs that stay busy doing bedside dialysis in the hospital. That is besides the CVVH we do in the ICUs. There are days when we work more codes have more Rapid Response Team calls or work more codes in the Dialysis center than we do in the ED or SNF. Some patients start out from their residence and get diverted to the nearest ED before reaching the dialysis center. This is done either by the BLS ambulance or transport van with a driver. The patient may be stabilized and if that hospital does not have dialysis, a Paramedic or CCT truck may take the patient on to a dialysis center, ussually hospital based, that is capable of monitoring. I have taken many dialysis patients to a monitored center on CPAP/BiPAP via the LTV 1000. Patients usually get dialysis 3x/week. Occasionally if there is a holiday or even over their 2 day stretch, some patients have a difficult time making it through. If a patient is bed bound at home or in a LTC facility, a care provider may call 911 when it doesn't look like the patient will last until their dialysis transport and the BLS truck will have one less routine transport. If the person is fairly independent, they may try to make it to dialysis because they don't want to be a bother by calling 911. Too bad your messages about not calling 911 makes it to the people who don't want to be a bother but need 911 the most. What is more unfortunate is when the BLS EMTs pull up to a dialysis center with a dead patient that they thought was just "sleeping". This happens more times with the BLS ambulance and 2 EMTs than it does with the van drivers who bring several patients to the ED before they crash. The van drivers seem to recognize something isn't right even though they are driving while the BLS truck has an EMT who is looking (supposedly) right at the patient. What is also interesting is the recorded BP which is almost always 120/80 with a HR of 80. However, when asked what arm they took the BP from, they stumble because they can't remember which arm has the fistula or shunt. Yes, I know, every healthcare professional can screw up. But, how hard is it to watch JUST ONE PATIENT? I rant a lot about dialysis patients but that patient is probably where the most mistakes are made by EMS providers because they don't understand the causes and complications of dialysis as well as the "BS" stigma around the call makes some just too lax and careless in their assessment of the patient if they even bother to do one.

What state are you in? Several states, like Florida, only require one EMT on a BLS truck and the other can be a driver only. However, with the over abundance of EMTs and Paramedics that can not get hired by the FD, 2 EMTs are the norm on the ambulances.

When you have 3 more Paramedics on that same engine, another 2 FF/Paramedics on Rescue and maybe yet another 1 or 2 on a Private ambulance that does the actual transport, how much hands on is any one Paramedic getting per call? One Fire department in my area has over 600 FFs. Over 500 are Paramedics. Even though it is a busy smaller city, how many tubes, IVs or even ALS patient assessments do you think each Paramedic will get per month or year? How many of the FF/Paramedics that became a Paramedic because it is mandatory will be overly anxious to do lead?