VentMedic

So along with the 50+ different recognized titles in the U.S for EMS providers, we also have just as many for "ambulance". No wonder not many people, including the providers themselves, know who or what EMS is.

Many states do not require that an "ambulance driver" must be an EMT. In some states only one of the two people on a BLS truck must be an EMT. I do know this to be true in Florida. We operated for many years with just one certified or licensed person on a truck. Some of the specialty teams have an "ambulance driver" since there is usually no role for the EMT. FFs can be assigned to drive for Rescue/Ambulance and not be required to have an EMT cert. We did operate with a FF driver and 2 Fire/Paramedics back when 3 person rescue/ambulance trucks were the norm. We also didn't have to run engines and ladders to every call with this arrangement. But now, almost every FF is a Paramedic in my area and we have certified Paramedics still working at Burger King waiting for the FD to call. Oh well...so much for that train of thought.

Some do require additional medical needs documentation. Dialysis the procedure is NOT the only thing that must be considered. What caused the dialysis may be of some importance also. Too many EMT(P)s, due to inadequate education or whatever, just view dialysis itself as a "disease". If the patient had a hx of many MIs, some type of transplant or hx of cardiac arrests, the physcians might feel the patient need a little extra observation when traveling to and from dialysis. Both to and from are critical times for some dialysis patients. Obviously some in the ambulance services view these patients as "BS" and unworthy of an EMT's time. Yet, very few even know that much about the patient's past history to make an honest judgement or to make an accusation of fraud against the patient and doctor. Again, ambulances are used for a very small percentage of the total dialysis patients a center sees each day.

That may be another agency entirely that does welfare checks. Abuse is willful neglect, physical and verbal battery or any unsafe condition that may cause harm to the person. If you have a training officer, they may be able to go over this with you or direct you to a CE class that will provide more information. This is an important issue and one you should fully understand for both adults and children.

Now to get back to the original questions. Things to look for: 1. Accreditation - CAAHEP, CoAEMSP 2. Cost 3. Contract...loss of money, promises, too good to be true (A college program may be pay by the semester and a hospital program or medic mill may want everything upfront and is a total loss if you drop out.) 4. Transferability of credits (Be careful of the words "may", "could" or "should" from the school's rep or contract when inquiring.) 5. Quality A&P prerequisites - college level You can work as an EMT-B while in school. That will be enough experience especially if you pay attention while continuing to learn things in Paramedic school.

When you make comments like this: or make remarks like this because a year old thread was asking you to reply: or If you take my response to your question about "dept of aging" as undermining you by referring you to your OWN state's protocols, then yes I guess I have been. We're all entitled to our opinions but you seem to be very touchy about having things explained to you or being criticized even though you could probably care less about who you may have offended by some of your remarks on this forum.

Correct there will be a place for EMT-Bs but the entry level education should be raised to where it at least requires a decent A&P class. They should NOT be the highest level of care on a 911 call. The fact that you use dialysis patients as an example is interesting. Did you know that Paramedics also transport dialysis patients but they are taken to a monitored bed and not to an outpatient center? Do you know how many emergent dialysis procedures are done in some hospitals each day and some from 911 calls? Do you know how many different types of dialysis can be done? You seem to lump them into one category. Do you know how many patients in your area have dialysis each day? Do you know how many patients don't come by ambulance to a dialysis center? Very few actually do take an ambulance. How much do you actually know about dialysis patients? Have you ever read the history of a dialysis patient to see why they are on dialysis? Looked at the lab values? That in itself is a scary read. Do you know the complications of dialysis? Have you treated a bleeder yet? There's a good chance you probably don't have enough education to properly take care of a dialysis patient when things don't go well. These patients are a ticking time bomb of health problems. The fact the you used them as an example for EMTs vs Paramedics probably means you have not taken the time to even properly assess these "routine" patients.

Elder and Child abuse reporting is a mandate in all states especially where healthcare providers are concerned. Pennsylvania clearly spells out the steps, procedures and paperwork necessary for the EMS provider. http://www.dsf.health.state.pa.us/health/l...tocols_2004.pdf These steps are similar in the other states with just the agency to file the report with and the forms being different. The laws for Elder and Child abuse reporting should have been covered, even if very briefly, in your EMT(P) class as well as listed in your company's protocol and policy manual. The hospital ED can be very helpful with this but don't expect them to do what is also YOUR responsibility if you witnessed something. Yes, when reporting I do give my name and make sure the correct documentation is done.

Asked your opinion? The last post on this thread was October 2007. Your comments came across like a 10 year old saying "oooh gross" instead of someone presenting a coherent statement of opinion. Communication skills and tolerance for others are two very important characteristics one should have to work with people in healthcare. When you repeatedly write with a first grade understanding of the English language, you will eventually write like that on your patient care reports. If you continuously act intolerant to others, either patients or co-workers, it will be difficult for anyone to take you seriously as a professional. We all have our preferences and dislikes but the way one expresses them is what sets them apart from or included as just another basher against those different from oneself.

Your tolerance for others seems to be about as good as your spelling and grammar. If you want to make a point that will be taken seriously, write it correctly. Otherwise, you appear as just another uneducated buffoon making a statement. If I threw up every time someone I did not want to "hit on me", I would be emaciated and taken for having an eating disorder. You should take a lesson from some women who have had to put up with this from men who thought they were "God's gift" to us and we should be honored to put up with them for a 12 hour shift. BTW, I am probably as cute as spenac, and maybe even much more, for my age. I do enjoy a good compliment regardless of who it is from. That is just part of having good social graces and knowing how to accept or stop different situations with a good attitude.

Is this you own equipment or their equipment. If it is their equipment, that may not be a "cert" but a competency requirement for state and Federal agencies. That can also go for the bloodborne pathogens and infectious disease certs which are part of an OSHA standard and will be reviewed during accreditation inspections. Our hospital will not longer "loan" equipment to any ambulance (BLS, ALS or CCT) unless a member of the hospital staff going with it. At no time will they be touching the equipment. This definitely includes IV pumps.

My comment from that forum: Why do EMT-Bs put so much time and effort into getting so many "certs" for individual "skills"? It is this type of piece mill stuff that has gotten EMS to the point of 50+ different levels. It seems that some just want to say they can do the skills of a Paramedic but without the extra responsility the comes with knowing why.

I do have a lot of experience when it comes to airways. I hope you would first take the time to correct your tube placement before running to the computer to inform me. At sometime during one's career almost everyone may put a tube into the esophagus. It is when they don't realize it that it becomes a problem. I personally could care less how good you are intubating so you can save the arrogant remarks. I just disagree with your blatant criticism of students and/or professionals learning new things when you yourself have expressed limited knowledge for establishing a secure airway by any means other than DL.

Since that is a dash cam running in the vehicle following, I wonder if it is LEO, FD or another ambulance. If one knows the distance between the utility poles, one could estimate the speed of the vehicles.

My plan? I am pro education and that should also start with establishing a much higher minimun standard for those teaching in EMS. The minimumly educated should not be teaching as role models if higher education is to become the norm. Demands? This is not a union picket line but the birth of a profession that is long past due at the age of 40. And no, nothing will be accomplished to reset the reimbursement schedule unless EMS becomes a profession with established titles and education minimums across the board. Change can come slow and some professions were able to establish their mark in under 20 years. But, they took lessons from others in healthcare and were careful to lay a foundation. EMS has isolated itself into believing it is very different and thus some do not identify with being a part of healthcare. The "nobody understands us" statement is more of an excuse for the lack of progression and a reason to stay the course as it is because anything else might look scary. Some just don't want things to change or going back to school for some is a scary thought that brings out insecurities. Each heathcare profession from nursing to all of the allied health professions have gone through this. They did however have the advantage of working with others who had achieved respect and recognition by Federal/State insurers through education and professional organization. EMS has got to give their lobbyists something to work with other than 50+ different certs and education all over the map for "hours". Presenting this mess to educated legislators, who know what their titles are and how much education they had to get to be where they are now, is a difficult task for even the best supporters of EMS. One member from the House was even quoted as saying "Come back when you know who you are". Unfortunately, that message still did not spark a movement forward but rather just the same old "they just don't understand us" complaining came out of it. Pocketing the revenue? Other places that employ healthcare professionals can turn a profit. It the FDs can also gain then so be it. It is going to be difficult to get FireMedics to leave their career job but if the educational standard is raised, there might be an attitude change toward the profession as a whole. With increased education, there might also be a "demand" for more accountibility. While it may sound insulting it does have a ring of truth to it. Some in EMS did not attend a "school" but rather were OJTed in the backrooms of ambulance and fire stations. Many of those from the 1980s were trained this way. AMR at least established a "traditional Medic mill" (NCTI) and took their training program out into the open. Some FDs are putting the training back into the station and taking it out of the colleges as seen with recent headlines and a rather heated discussion on this forum. Surgical and Ortho techs in some hospitals are still trained by OJT programs and they must reply in all honesty, NO, when asked the same question. Their programs may also be up to a year in length with more classroom hours than the Paramedic. However, there are those that are also trained at a votech school or college (like some in EMS) who may have a different point of view about their education and their own thoughts about the OJTs. My ending message: Stop making excuses. Enough with the "we're so different" isolation statements. Join the world of medicine. Learn from the trials and triumphs of other healthcare professions. The comparisons should be constructive and not the juvenile "we can intubate" or "we start IVs too so we should be paid just as much". Educaton should go with the skills. If that truly was the case now we would be hearing less remarks like those just mentioned. Attend those boring meetings in your county, state and at the national level...not just the fun stuff. If you don't speak out, listen to where others are coming from in their views of EMS. Even if the steps you take may seem small, they are steps nonetheless. Florida has recently passed a bill to obtain specimens without consent for exposure incidents which should be of interest to EMS providers. This was in anticipation of the Ryan White Act not getting extended. States should not have to depend on such a lengthy and costly bill to establish one very important aspect of care. Yet few have actually read the Ryan White Act. This was something I lobbied for since I am becoming tired of fighting Medic Mills in a state where many of the Paramedics are obtaining or holding the cert for the wrong reasons and don't want to see the "hours of training extended. The agrument I hear most is that 700 hours is way too much and 550 or 600 would be more reasonable. Afterall, many FDs only give FFs a year to get their Paramedic. How can one take these arguments to legislators when lobbying for increased reimbursement? However, if the education was raised across the board to 2 years, those in the profession now would be grandfathered and those that want to be FireMedics by the time they are 21 y/o had better hit the books in a college program. That shouldn't be too much to ask for. It might even change the way some view FFs as also having brains to go with the body.

Just look at my posted age. I am almost as old as spenac!

That is because it is looked at as a tech service and not on the same level as a professional serice. I don't know if you meant the 4 year degree to be humorous, but look at the professions that do make a four degree their minimun. Look at Physical Therapy with their Masters and Doctorate degrees. I only wish either of my professions could command the opportunites, wages and sign-on bonuses that PTs have. It also doesn't happen overnight. The other allied health and nursing professions have encouraged their members to get higher education long before it became standard even if that meant still working for a lower pay with a college degree. It eventually paid off. When the bar was raised, it wasn't a stretch to make the change. The other part is deciding what should be the lowest level provider and where to place them in the hierarchy. RNs do not include CNAs and LVNs into their professional organizations and unions. While there is still an important place for these healthcare workers just like the EMT, how and where do you separate to advance the higher level? Now let's examine the orgins of EMS and other professions. Nursing has always been a "career path" for women in both private and military back when women did not have many options. The 1970s when nursing moved toward higher education and professional status, women as a whole were also making a move to advance their status. Most of the allied health professions were a spin off from nursing as medicine was advancing and the need for specialization came about. Nurses had been doing RT, Radiology, lab, EKG etc for decades. Nurses have also been involved in transport long before EMS. I do pity those that assisted in the earlier NICU transports and the 400 pound isolettes. EMS was put in the FDs for convenience since FFs were already there to prove that a few advanced skills could be taught and utilized outside of the hospital by those with very little or no healthcare education. It was not a separate career path but an addition to an existing one. One could also look at the Freedom House ambulance. There again it was thought that a few skills could be taught for the betterment of the community. There was a need and that need was filled. Freedom House Ambulance should have been the role model for EMS and not the FDs since it was totally focused on medicine and not an add on to an existing job for convenience. Unfortunately it never got the recognition it deserved and the model it set was basically ignored in EMS history. Here's a little info: http://www.freedomhousedoc.com/

No worries. This is an anonymous forum so you can brag to your heart's content. Whatever knowlege you possess will become evident in your other posts.

The nursing diploma schools started to dissolve in the 1970s. Ironically, EMS had already established many 2 year degree programs at that time and was thought to have every opportunity to get stronger before the nursing profession did. I got my EMS degree in the 1970s as did some of the other 30+ year veterans of EMS on this forum. The degree was the way the profession was headed so we were told. By the mid 1980s, several ambulance companies and FDs were milling their own in the back rooms of the stations. It should have been done differently but people were wanting to make money quickly off this new profession. There was also an endless line of applicants for these schools due to the promise of an "exciting career" quickly. EMS actually took a lot of students away from nursing and other professions creating empty seats in some classrooms. Nursing shortage? Nurses have managed to handle their numbers well. They also have kept to their education standards in creating future professionals and have used that minimum of a 2 year degree to screen out those that truly have no place in healthcare. Some still slip through but most do not. EMS is still practicing a warm body mentality for recruitment. There is also a play on numbers for FTEs amongst all professions. Budgets like to be set around what the ideal is and not reality. A hospital may be fully staffed but still prefer that cushion of having a few extra positions not filled on the books. These numbers may be tallied in "shortage" numbers and used for whatever advantage. Ever notice how a FD presents its budget requests to the public? There are graduates continuously graduating from the many nursing programs at all levels. Healthcare is constantly changing. One area might be hard pressed to recruit RNs but it might be for many reasons other than a shortage of nurses. The geographical location might be undesirable. The hospital could be financially unstable on the verge of closure or a mess to work for. We have had many hospitals close and layoffs have also affected RNs. In Florida, we hire seasonal workers and provide no benefits except a slightly higher wage. In the Spring, we have no further use for them so they must move on. Lately, some of our regular staff RNs have been cut as well when the hospital census decreases. However, we also get numerous applications from RNs for our ICUs and can be very selective. As I mentioned before, Excelsior grads need not apply. There are many highly educated/trained RNs that are familiar with the basic skills of nursing that have had their work ethics and skills observed or developed during traditional clinicals. The nurses have a national identity as a NURSE. It doesn't matter if they work county, public, private, jail, clinic, OR, dialysis or whatever. They are NURSES with a common educational foundation that they have expanded their careers on through additional education. EMS has 50+ different titles or certs recognized with each of the 50 states doing its own thing. That doesn't include all the "specialty titles" for certs given out by individual organizations, We have yet to figure out what to even call EMS providers and agree on what should be the minimum education. The education itself varies for the Paramedic with as little as 500 hours being required in some states to a 2 year degree in one state. The states that are starting to promote a degree for EMS aren't even requiring it to be in the health sciences. Other healthcare professions have used their common education and identity to petition for reimbursement at state and Federal levels. Thus, the tech titles and OJT mentality of training have gone by the wayside so that a list of standards can be used as bargaining power. And no, that does not mean you just list "skills" but what worth you bring with those skills. Example: the skill of intubation is reimbursed differently for different professionals doing the intubations. If reimbursement drops, that skill may be turned over to another group of professionals. Another example: Nebulized respiratory meds should be the responsibility of RRTs. However, if reimbursement makes it no longer feasible for RRTs to do them even as a "therapy" per Medicare/Insurance guidelines, they are turned over to nursing and lumped in with their collective nursing services. RRTs then moved on to develop more ICU services or take over HBO, Cardiopulmonary Rehab or the cath labs. Healthcare is a business. You have to prove you have something to bargain with and be willing to bargain. If the traditional services aren't working, a different approach may need to be presented. CCT and Specialty are examples. But, even "regular" EMS could put a new twist into its sales pitch if it was unified with education and just a few titles for the providers.

These residents probably don't spend their entire 3 years in the ED. They may have been introduced to DL exclusively during another rotation. They now have the opportunity to use a device that they had not used during their other rotations. That is part of the purpose of rotating residents so that they will have different opportunities and different mentors. If at the end of their residency, they are only comfortable do something ONE way, then the teaching hospital and the residents have failed in their education. Even for ventilators, Volume Assist Control has been the "standard" for regular ventilation for the past 15 years. Before that it was SIMV and before that IMV. However, in a good teaching hospital, they may have the opportunity to be exposed to HFOV, HFJV, NPPV, PSV, PCV, ASV, PAV, NAVA, APRV, PRVC, other variations of Bilevel ventilation depending on make and model of ventilator and and Independent Lung Ventilation. They may be introduced to various forms of ARDS and Ventilator Lung Injury prevention protocols. Proning, Nitric Oxide, Flolan, HeliOx, Nitrogen, CO2 and Partial liquid ventilation therapies may also be part of their education. They will also be taught at least two methods of A-line insertion. They will know what is appropriate and when. If they can only say VAC 500/12/+5 at the end of their many unit rotations, somebody has failed. Even if they end up in the boonies working at some local little general that is no excuse not to know the advances in medicine and to either make them happen at their facility or get that patient transferred to one that can. VAC can not be depended on to save a life even if it is a "standard" no more than DL will work every time and another alternative should be available along with a good comfort level for that equipment. Thus, residents are exposed to whatever at some length during each rotation. However, at the hospitals I work at, the doctors will not have much and opportunity to perform a nasal intubation except to be made aware of it in a lab or if it is a Paramedic intubation from the field. Even in the OR for reconstructive surgeries a trach will be the alternative before nasal intubation if a tube is going to be in place for more than 48 hours. That is not to be said NTI still isn't done in some hospitals but we are going to give the residents enough education for sedation alternatives and intubation techniques so that they do not have to rely on it except in very rare cases. Field providers, of course, may not have that luxury. BTW, my apologies for the intubation arrogance remark. That was intended to be directed at CTXMEDIC who got us to this point with his harsh critiquing of residents learning new modalities by laughing at them or casting insults. Besides just rude, it also gives these young doctors an impression of Paramedics that may not count favorably if they decide to specialize in EM.

I have nothing against DL and it can get the job done for most intubations. However a doctor or any provider should be open to alternative devices especially if their hospital has specialty units such as Burn or Head/neck surgery. If they are not open to learning different techniques and devices to better serve a unique group of patients, they may be doing their hospital a disservice. It can also save a doctor from calling in an anesthesiologist at 0200. Those that want to keep only one device in their tool box may be short sighted and one day may regret not broadening their skills, knowledge and available devices. This can also apply to CCT and EMS crews that do IFT for hospitals with known specialities. The same statements can be said if the hospital in their area routinely does heart and lung transplants, microsurgery, ventricular assist devices and CHD surgeries. Too many just accept or settle for the "standard" way of doing alot of things.

Physicians are usually responsible enough to adapt to the situations they are placed in by seeking guidance, education and training from their peers. If not, there may be a physician QA committee that will tell them if they are deficient and/or not grant them certain skills privileges until they prove proficiency. Their skills privileges will probably be listed clearly on the computer or procedure book in most hospitals. Remember too that in the hospital, a little more is being done then just sticking a tube through the cords. We may record our intubations with the videoscope for teaching and/or diagnostic purposes. Some of the recordings may also show the damage done either by trauma from the initial incident or that which is caused by bad intubation technique. The GlideScope is just one tool that offers a different approach. For some patients, such as those with burns, we will use the fiberoptic scope (also available as a convenient portable by Olympus) as an intubation tool either in the ED or burn unit. It may be assisted or not with DL. With some fiberoptic scopes we can achieve several tasks at one time while prepping for the tub and/or surgery as well as positioning specialty tubes since time may be a factor. Have a Pulmonologist or ENT doctor show you his/her cabinet of devices used to view and access the airways. If your sole purpose is to put the tube throught the cords, DL may suffice. However, it is good to also be knowledgeable about what alternatives are available and what advances are made available in medicine. You might also run into one of those 300 different airways that are not commonly seen by those in EMS on either an IFT or home care patient. Some "assume" a patient has just a standard ETT or trach and may not look closely at the device until something happens. I guess it is no secret that I love my other career choice. It has been a great compliment to what I also do in EMS. At one time, I, too, was very cocky about my great DL intubation record. I got a serious attitude adjustment when I saw how much there was to learn about just establishing AND maintaining an airway. Still learning....

Did you know that there are over 300 different airways that these doctors may have to come in contact with even in a short career? The devices you mentioned are just a couple from a long list of "tools" that they will see for managing an airway. Just the number of different ETTs is staggering if one was to try and list all of them. Visualizing the cords may be just one part of the battle. You may be able to see very anterior cords but have difficulty positioning the tube directly due to other structures. Hopefully you will see difficult airway management in a controlled setting so that you can learn some of these things before you get laughed at or your patient becomes part of the trach and peg club due to cord and throat trauma from repeated intubation attempts to save your "never miss" record.

It is also the sign of being a progressive provider or healthcare system that gets equipment to make any "skill" a little easier and maybe safer for the patient. If others in EMS want to hold on to just one way of doing things, no wonder some EMS providers still do not have access to the 12-Lead EKG or ETCO2. It will also be these doctors that will have a higher level of expectations for knowledge and technology. Thus, they may bring whatever system they decide to work in up to the 21st century. Considering the cost of the GlideScope, it is an ooohh and an aaaahhh for a hospital to purchase one. What do you have against technology? These doctors may go on to services that require an extensive knowledge of many intubation devices. Not everyone is happy to be skilled at only one way of intubating. It does sound like you have do very limited airway experience or knowledge about alternative devices to assist in difficult intubations. Thank goodness the doctors at your hospital are willing to try new things and seek devices to make difficult airways more manageable if the Paramedics or at least you aren't.

If you work where you are not going to utilize a skill, why take time from other "skills" that your specialty may require more? I would much rather have a cardiac surgeon continue to perfect his/her surgical skills since there will be many others around that can do the intubation in the OR. Intubation or any skill is something that should be done by people that can remain proficient in it. A physician's other skills and knowledge may be put to better use if one of the many other healthcare professionals can do the intubation leaving the physician to oversee or start another advanced procedure or operation. As for my statement earlier, intubation is a skill that Paramedics should be expected to be proficient in and yet that is not always the case for every paramedic in every service.