VentMedic

My mistake. I thought the Canadian RRTs were educated professionals. So why is it you take to bashing other professionals the minute a mention of education comes to play. I just can not believe you would rely on a 2 day course to be all that for the Paramedic and that is meant to replace medical oversight and competency. The RNs, MDs and RRTs you may see in your class are there probably because they know they don't know much about ACLS and didn't want to embarrass themselves in their own house. You will probably not see the ICU RNs and RRTs since they are usually trained in their own classes by their medical directors. Remember that some hospitals also do their own research for the ECC and their GUIDELINES may be different. However, the first thing you do is jump on them for being "RNs" or "RRTs". I could also get on my soapbox, just as this thread is promoting, about the substitution of qualtiy education for a weekend cert. It seems that is what the Paramedic education is still all about. I also have been in EMS to have seen the changes and now see where some still have not dropped their dependency on a "cert" even though the AHA has reevaluated their teaching methods. It is long overdue for EMS to change with the times.

The ATS, CTS and ERS also set the GUIDELINES for Pulmonary medicine which comes down to RT eventually. However, you don't see Pulmonologists and RRTs bashing them because their schooling was too inadequate to get them through a weekend cert class.

RRTs in many places are still required to keep up ACLS, PALS and NRP but they also spend 2 - 4 years in college studying Critical Care Medical concepts. They damn well better know some of the principles of ACLS. Taking an ACLS class is a mere formality for some since their education and training come from other sources. As other professions increased their own educational levels, ACLS while it may still be required, should not be the only source of training. To say your whole Paramedic education comes down to a 2 day cert is a slap for those in EMS that do have an understanding of medicine and the purpose behind ACLS. Why should the AHA be totally responsible for teaching ACLS concepts? The AHA is right in the fact they realized how much material there was and now they have placed more responsibility on the individual and employers. Unfortunately, Paramedics still want to be spoon fed and take little initiative to do more than a 16 hour class. You also must remember that Paramedics are relying on their ACLS "certs" to work. It doesn't look to good for the FDs or any other service if they fail ACLS. If Paramedic schools can no longer prepare a student to fully understand the concepts of ACLS well enough where a review or update "cert" class will suffice, then EMS education is truly in a sorry shape. Let go of the past, increase your education level to understand ACLS concepts and not rely on a 16 hour class to teach you every thing you should have learned in Paramedic school. Even back in the day, the AHA ACLS cert was not intended to replace a very important part of Paramedic school. Unfortunately, too many came to rely on it. 500 + pages are more than most Paramedic text books. Many complain they can't get through everything in the Paramedic text either. Some still only memorized what they needed for the mega code. AnatomyChick And you are blaming the AHA for their lack of education and preparation? Blame the employers who still accept ACLS cards instead of providing their own competency training programs.

So you are relying on one little weekend course to insure "training" and "competency" for the Paramedics? And, if ACLS is not hard enough where you do not study, you don't study or stay current for the sake of doing good patient care? Even when it was a difficult class, our medical director arranged other training under his direction to assure competency. It is irresponsible to rely on just a "cert" class to prove ones competency or have it be the only time one reviews ACLS protocols. I don't blame the AHA. I blame the Paramedics who get such a "cert" mentality that they forgo true education. Once one is truly educated in what ACLS is all about, one should only need a periodic update or review. If one is not responsible enough to maintain the basic concepts through their own education, then they are doing the Paramedic patch a disservice.

Don't lump all professionals into that category of declining education. As I stated before, other healthcare professions have raised their education standards and don't place an emphasis on an ACLS cert when they get much more "ACLS" education through their own education programs either in school or at work. This basically concerns some in EMS who are worried they will eventually have one less "cert" to declare or their easy "recert" might again be replaced by something worthwhile.

Other healthcare professions have moved on to more educaton and put little weight on the "training" they get from a weekend cert class. ACLS should only be used for an update on what's new and that may not even be necessary. Many involved in resuscitation in professoinal organizations, be it EMS or the hospital, are either well read or informed of changes by their Medical Directors. These organizations may also conduct their own ACLS class and while they still keep within the guidelines set by the AHA, they also are made aware of any deficiencies with their employees. However, some still need the formality of going through such a class or they would be unlikely to get any updates if it depended on them reading something. Or, they just wait for the recipe change by their Medical Director.

While patiennt privacy is an issue we do have problems with watching so many patients at one time. Many hospitals now have live cams feeding into an off site area for MDs and RNs to monitor various patients in the ED, select Tele and med surg rooms, and every ICU room. They can also act as another set of eyes to prevent mistakes as well as identifying when a patient needs attention quickly. In the ED, we may also record codes or any patient and treatment that is of teaching value. As far as cameras in the ambulance, it would be great to keep headlines like "129 sex offenders working as EMTs and molesting patients in the ambulance" from getting a chance. It would also be witness for the EMT(P) who is wrongly accused of criminal activity. It could be a defense if the EMT(P) defended themselves from a patient who attempted to do bodily harm to them. However, some ambulance companies do have a difficult time with just the day to day oversight of personnel, medical and billing issues. They may have a difficult time keeping track of the cameras and the information they record as it refers to patient privacy.

It stands for Critical Care Emergency Medical Transport Program, not Critical Care Paramedic. CCEMTP is trademarked by UMBC. It is available to RNs and RRTs also. CCEMT-P may be a license level granted by a state or a title (job description) given out by the agency you work for after as little as 2 hours of training in the back room of the station. STABLE: Sugar, Temperature, Airway, Blood pressure, Lab work, and Emotional support.

But, in all fairness, how much does 8 - 16 hours of clinicals with maybe very little patient contact with different patients prepare for appropriateness?

In the EMS setting? See previous posts. Every patient is different and it will vary from disease process to process. There is no recipe that says a patient will stop breathing at 1 hour after you give O2. It will also vary as to the active disease process which may be the cause of a patient to fatique which many mistaken for "knocking out the hypoxic drive". If a patient has a bad PNA, other infection or whatever, they will be HYPOXIC and no matter how hard you try with some patients, with even the best technology, they stay hypoxic until they die or get better. Pts with "COPD exacerbations" often have an underlying cause. The other thing to remember is not all COPDers are CO2 retainers and not all CO2 retainers are COPDers. I get more concerned about those that have a chronic hypoventilcation syndrome or hypoventilation caused by a neuromuscular or CNS disease than I do about the 3 pack a day or 100 pack year cigarette smoker. If you want a fansinating read try Ondine's curse which is congenital central hypoventilation syndrome or CCHS.

Unfortunately there are others that would fit this same act of fraud. http://news.bostonherald.com/news/regional...position=recent State claims Hamilton cops falsified EMT training By Associated Press Thursday, December 11, 2008 HAMILTON — A state investigation has found that members of the Hamilton Police Department, including the chief, routinely falsified EMT training records by claiming to have taken classes that were never held. The state Office of Emergency Medical Services suspended the EMT licenses of one former and eight current officers, including Chief Walter Cullen, saying the department’s actions "endangered public health and safety." The agency also has pulled the town’s ambulance license for at least one year. Police had provided the town’s ambulance service for at least 40 years. Since September, Lyons Ambulance Service, a private company, has provided emergency response service for the community. "Training requirements are in place for a reason: to insure the highest quality of care for the residents of the commonwealth," said Paul Dreyer, DPH’s Director of the Bureau of Health Care Safety and Quality. EMTs and paramedics in Massachusetts are required to undergo a minimum of 28 hours of continuing education, and complete an annual refresher course to maintain state certification. The officers received extra pay every year for taking the courses. State officials said they found a pattern of alleged deception in Hamilton that goes back 10 years. Cullen did not return calls from The Salem Evening News, which first reported the suspension, and did not immediately respond to phone and e-mail messages from The Associated Press. The agency also alleged that the fraud was known to town officials. Board of Selectman Chairman Dick Low said the town was looking into the situation, including possible disciplinary action. Low said Cullen, who is scheduled to retire in February, was still in charge of the department.

Coal Workers' Pneumoconiosis is a fribrotic and inflammatory process which tend to make it more of a restrictive disease unless there is a smoking or asthma hx that can present as obstructive. Glad you mentioned Combivent. It was on my list of things to do today for checking to see if it got its stay of execution for at least another year or until 2010.

Here is the link to Jeff's page. http://home.pacbell.net/whitnack/ Whether you agree with all of the literature he sites or not, it does offer an indepth explanation to the various receptors. The powerpoint at the bottom of the page is decent also.

An O2 concentrator, depending on make, model and maintenance, may not deliver anywhere near what a flow meter from an O2 tank delivers. People get hung up on memorizing numbers for O2 delivered for "2 L/min NC" as it to be 28%. That number all depends on the minute volume of the patient. The number 28% is derived from a normal Joe Public breathing at a text book normal rate with a normal tidal volume in no respiratory distress. That is why I find the arguments of "2 or 4 L/min?" so ridiculous in that it shows little understanding of respiratory basics 101 and the equipment. If a person says they can't breathe...give O2. If they are blue, give O2. If the SpO2 is low and you have every reason to believe it is in the ball park give O2. If they are symptomatic with any signs of increased work of breathing, give O2. If they are talking to you, they are still ventilating. The BVM is your friend because if you "knock out their drive" with an extra liter of O2 in the few minutes you are with them, they were going down anyway. You must take into consideration V/Q mismatching and shunting along with all of the disease processes that are causing a low SpO2 and difficulty breathing. The dx of COPD always skew some from doing an adequate assessment to treat the real problem(s). A dx of COPD does not mean they are even a CO2 retainer. Less than 5% are. I see that everyday. I may draw 20 ABGs on 20 different "COPD" pts on any given day and see only one that fits the criteria of being a CO2 retainer. They hypoxic drive has been debated for almost 30 years. Do a literature search or check out the name Jeff Whitnack who has done the search for you on his website. The only patient for which O2 is used with extreme caution or not used at all (16% may even be used instead) is on an infant with a ductal dependent cardiac anomaly or CHD.

Back in the early 1980s there was a case in rural Alabama where a logging truck hit a car containing a woman who was on the way to the hospital to deliver her baby. Full term and obvious death to the mother made that decision relatively easy and it helped put a few laws on the books in some states that can be brought up. However, obvious death should be reasonably obvious. In the situation of the OP, this is a gray area. Did you do all you could for the mother? All Hs and Ts considered? Or, as evidenced by the many emotional posts, would your reasoning be skewed by the need to save a baby that may or may not be viable and forgo covering your bases with the mother? If you can without any doubt argue before any board that you did everything possible for the mother and can demonstrate further resuscitative efforts were futile, the next call would be yours and your medical control. But, in your haste to save the baby or lack of training to perform a field C-section, you damaged the baby which resulted in its death, you may have other issues to answer for. The charges for either could mean more than loss of license. Luckily, there may be some "done in good faith" protection under some state statutes that will protect you although not entirely. Know your state statutes, pose this question to your EMS board and your medical director. Don't be shy. Too many fail to even read all of their P&Ps and are even more clueless about all the information in their statutes. Members from an anonymous forum will not be protecting your license or writing your protocols.

Exactly. In Florida we deal with alligator and shark attacks which can present with similar trauma to a bear. California has wild mountain lions attacking in the suburbs and caged lions attacking in the zoos (recent attack in SF). Pit Bulls or other dogs? Whatever the animal, scene safety and working the trauma are the issues. All of this should not have been a surprise since the Paramedics had to retest their skills earlier this year. It almost sounds like Collier County (Naples) where 30 days was not enough for them to prepare. It also sounds like the FD trained their own to pass their local exam and not much more beyond that.

Exactly. I just didn't take you for one that supported bashing a medical director who wanted to determine what protocols his paramedics worked under and not be told what he should allow them to do by a fire chief. In the case of Collier County, I am anti-firemedic. However, fire-medic was my title for much of my own career until I realized how much I enjoyed the medical profession. After hearing the fire-medics complaining and seeing their protest demonstrations in Naples, I can see the point being made by that statement you quoted. They have just enough knowledge to believe they are entitled to perform certain procedures but not enough to know they don't have enough education or experience to do it correctly or safely.

According to the internet dictionary, that is not a favorable term. So I take it you are not a Dr. Tober fan since that statement appears to be lashing back at the FF/medic who is bashing Tober. May I ask why? Tober just wants Paramedics to be medical professionals. I had been under the impression you supported that also.

You don't have to do the Paramedic after EMT-B. For the martial arts, a couple of college A&P classes might even be worthwhile. Who knows? It might take you down a path of Sports Medicine, Athletic Training or Exercise Physiology, all of which go into emergencies at a much more indepth level. Since others have downplayed EMT as a first-aide course, take it for that. You can also get almost the same training through the American Red Cross with all of their first-aid classes. However, the timing of the classes may extend it greatly. I might even suggest a couple of ARC classes after you take the EMT. Some are very well taught from a practical sense. The problem with some EMT schools is that they are teaching only to pass an exam and little else.

Our NICU team will not go in flight until there are signs of a viable life confirmed.

Helicopters do not like to accept a patient already in cardiac arrest. By the time the helicopter gets dispatched, arrives, loads etc, time is lost. The facility should be the one that is capable of doing a surgical procedure immediately on arrival. Some ED docs have this capability and some rely on surgeons. If their OR team is a "call back" type that could be up to an hour. If the ED has a surgeon on call that can be at the hospital on your arrival, that is the best choice, providing the ED doc makes the call. Many EDs are capable of stabilizing a neonate until an NICU team arrives. A children's hospital that doesn't do L&D may not have a surgeon willing to do a crash C-section nor would their ED want to work a materal code. A hospital with mixed services would be ideal if they have a surgeon available in 20 minutes for your arrival. In the meantime, do great CPR and DRIVE safely. The mother is dead and the chances for the baby may be very, very slim for survival. There is no need to put yourself and others in more danger. Even when this situation happens in the controlled environment of a hospital, it is not a pretty site and the chances of survival are not always good.

The community college may be the cheapest to get EMT-B. If you are in CA, it is $20/credit hour for maybe a max of 8 semester credit hours. At a private "mill" it is $1000 - $2000 for a mere 110 clock hours. The other advantage of a community college that also offers the Paramedc, you will have your foot in the door. Those EMT-B college credits may also be applied to a degree. Note: there is a difference between clock hour of training and semester (or quarter) credit hours of education. While you are taking the EMT-B class or waiting to start the Paramedic program, you will be able to take other college classes. You can check with the college to see if CPR is required at entry or if they provide the card. If it is required they may have a list of providers and may even offer it in their healthcare continuing education section at a reasonable price. Also, you can pop into the college's library to read some EMS journals and textbooks to get an idea of what EMS is all about. Surf up your state's EMS website for an idea of the steps to certification. The website may also have a list of schools. If you decide EMS is not for you, the college has many other interesting programs to consider. I promote the college because it at least gets someone exposed to the world of higher education. An EMT or medic mill will have others who are just looking for a quick easy fix to life and few have any thoughts about a career. Many are there due to a "Do all this in a few weeks!" commercial and get suckered into a huge loan that many cannot afford. The disadvantage to a college education in EMS, you may end up smarter than most of your co-workers who will constantly down play the importance of knowing how to add and subtract or how an A&P class can't teach you street smarts. Many don't have enough in the intelligence department to know street smarts comes with experience which is made a whole lot easier with education.

There is an irony to this. In the Access to Emergency Care report, Washington DC was top ranking. Prehospital is not included in this grade. http://www.emreportcard.org/overview.aspx?id=388

I thought they had taken care of some of the retraining issues last year when they tested the Paramedics about the time they gave them back the narcotics. I take it that this very difficult exam is the "NREMT" and is used now instead of their own state exam. When I went to the DC gov website to confirm this, I noticed that those in DC also spell HIPAA as HIPPA. I have now lost all confidence in what happens in DC. http://hrla.doh.dc.gov/hrla/site/default.asp DocHarris, I agree this is a dead horse but unfortunately this is our nation's capitol and crap like this makes headlines in some of the most circulated newspapers in the country. The legislators who make some serious decisions about EMS may notice. The rest of the country must set a better example.

Controversial Exam for D.C. EMT's http://www.wjla.com/news/stories/1208/576376.html posted 3:15 pm Tue December 09, 2008 WASHINGTON - A plan to raise standards in the D.C. fire department is stirring up a controversy. Some firefighters are losing their jobs because they can't pass a tough new exam for emergency medical technicians. The new exam is part of an agreement with the family of murdered New York Times reporter David Rosenbaum. Now the department is agreeing to give recruits more chances to pass the test just to keep their jobs. Graduation day was a proud moment for JaQuante' Staton. Born and raised in D.C., he always dreamed of becoming a firefighter. After six months of training, he made it. "You have to understand, my whole family was there at graduation. They were proud of me, they were cheering for me. To have it stripped away just a couple of months later, it's not fair," said Staton. Staton's dream was shattered when he was among the 28 percent of firefighters who failed to pass a new national registry exam for EMTs, put in place after graduation. Staton had already passed state standards. "I'm not disgruntled. I'm sad actually. I'm sad that they would spend the money on me to graduate, shake hands with the mayor and the chief of the fire department and then fire me," said Staton. "It was definitely a wakeup call because by no means have I ever considered myself a failure. I still don't. It was just one of those things. It was an unfortunate event and I did the best I could," said Evan Pace who was also terminated. Both Pace and Staton say they studied extensively on their own, but that the department offered no instruction. "There were questions about bears and what would we do if someone got attacked by one," said Pace. You have like 30 guys sitting in one class with no instructor, said Ronnie Williams. Even some veteran firefighters are having trouble. Williams fought fires for six years, but has now been on the bench for 11 months. He failed the test multiple times, he says because of his dyslexia. Williams is still on the city payroll. "I haven't done nothing on a fire truck. And that's what I wanted to do to serve my city," said Williams. When asked what he did for work everyday, Williams responded "Just go down there, sit in the classroom, get on the computer, do some test-taking online and try to find some ways to pass this national registry," he said. "It is not true that the recruits have sat in a classroom without an instructor. There are independent study times," said Dr. James Augustine, acting medical director with D.C. Fire & EMS. The department says there is training as well as mentoring programs for those who need extra help, both of which are disputed by six firefighters that were interviewed. "You have to take a look at yourself in the mirror and say did I do everything that I could do to pass this test? Did I study on my own? Did I ask for help?," said Kenneth Crosswhite, deputy fire chief. After our interview the department said it now plans to bring Staton and Pace back for three more attempts at passing the exam. And this time, officials say they'll make sure the new recruits have every opportunity to prepare.