VentMedic

People, even licensed doctors and RNs, who respond to an emergency outside of their regular place of employment can be protected under some Good Sam laws. However, they must perform as any other would in a similiar situation with similiar training. If their training is not emergency medicine or they do not know CPR, they may be only able to act as any other citizen in the same situation. Likewise, if a physician, RN or whoever and whatever is on scene with other EMS workers, the EMS workers remain control of the scene and can ask the others not to interfere unless they are capable of accepting full responsibility for the patient. A Podiatrist probably would not be in any position to provide emergency care in any capacity higher than a Paramedic or even EMT. The EMS providers did not cause the violent act to kill the fetus.

Where did that quote come from and what is PW3NED?

They WILL find out eventually. You don't have to be the one to have them blurt it out in front of their parents or to deny it and risk more harm. And yes, documenting pregnancy for a patient with abdominal injuries IS IMPORTANT. You need to get the confidence of that young one for the immediate plan of care. If they are not pregnant, great. For your own purposes, whatever they might be, you don't need to ask if they have had sex at work or pee in the shower.

Do you not see the value of an accurate answer for assessment purposes? It doesn't MATTER whether they are declared an adult at that moment especially if they are 13 y/o. You may now have two lives to be concerned about instead of one or you don't want to do more harm to the 2nd if it can be avoided.

Possible abdominal injury of a teenage or preteen female: Any chance of pregancy? With mother present - No. Without mother present - Yes. In the ED, mother or any family member is brought in by ambulance from MVA, placed on stretchers next to each other and all needing X-rays. The same question will be asked and the same answers will given. Missed pregnancies? How many have delivered a baby from an overweight 13 y/o when called by the mother because her daughter was having severe stomach cramps? Asthma attacks? 8 y/o frequent flyer. You may be the best to spot something not right in the household just by the reactions of the family in your presence in their house. Even without something very wrong in the house, asthmatic children may react differently with each parent. They may deny some of their symptoms or frequency to please one parent or over state them to get more attention from the other.

One more article about the consolidaton stuff. For those that believe the public doesn't know anything about what a Paramedic is or don't have any interest in EMS, you should listen to the talk at the diners during breakfast while they are reading the newspaper. Take it as fortunate or unfortunate that all of the dirty laundry is hanging on the line. Few may come out of this with much respect. This is getting to the point of being shameful for all involved and does little to put EMS or FFs in a favorable light with the public. http://www.naplesnews.com/news/2008/dec/08...ittee-oversee-/ Collier leaders contemplate a new committee to oversee paramedic operations By I.M. STACKEL (Contact) 11:06 p.m., Monday, December 8, 2008

How many even knew Collier County existed before their EMS and Fire fights started to make headlines? Collier county is not the boondocks and CCEMS has a helicopter for outlying parts of the county. This is becoming a "How many Paramedics does it take to...." joke. Almost every responding FF is a Paramedic as well as those for CCEMS. If you have 2 - 6 Paramedics on scene, how many more do you need? Is this due to giving up on getting the many FFs up to a higher standard for care or even baseline quality? I see more trouble coming if the most politically "correct" paramedics are not picked. http://www.emsresponder.com/article/articl...p;siteSection=1 Seasoned Paramedics Rove Florida County in New MedCom Program LIZ FREEMAN Naples Daily News (Florida) They listen to the scanner for the worst of the worst calls for emergency responders, heading to scenes of struggling heartbeats, bloodshed and trauma. They are roving paramedics and Collier County has 12 of them now, two per 12-hour shift, but they work solo driving SUVs. Shortly, a third and maybe a fourth will be added to the shifts. In late October, the county's Emergency Medical Services launched a new MedCom program, selecting some of the department's most seasoned paramedics to respond to calls that involve serious medical issues and injuries. Their intent is to provide an extra set of hands to support the dispatched paramedic team as necessary. Officials hope the new MedCom program will resolve a dilemma where EMS battalion commanders were intended to be a "watchful set of eyes on the street" but over the years became administrative and supervisory jobs, said Dr. Robert Tober, EMS medical director. About two months ago, he learned that emergency medical services in Wake County, N.C., was developing a MedCom program and he wanted to give it a try. "Lets take a group of our experienced paramedics and deploy them for 12-hour shifts and have them swoop down on some of the complex calls," Tober said. The MedCom paramedics are self dispatched, listening to the scanner and deciding on their own which serious calls to respond to, he said. They avoid overlapping by talking with each other to decide who is closer to a scene, he said. They are not limited to any geographic area and have no administrative, supervisory or training obligations. If a MedCom paramedic arrives at a scene first, he or she can initiate treatment and then defer once the dispatched responders arrive. In some cases, the MedCom paramedic will ride in the ambulance with the patient to the hospital, Tober said. The 12 MedCom paramedics were selected based on their experience and ability to not try to take over a scene from the dispatched crew, Tober said. So far, rank-and-file paramedics have been receptive to the MedCom support, he said. "They call them the black knights, they are so relieved to have such an experienced set of hands come on the scene," he said. Jackie Lockerby, a paramedic for 17 years, is part of the MedCom team and agreed first responders have been open to the program. "Whenever you get an extra set of hands on the scene, the better it is for the patient," she said. "You can't have enough experienced hands on the scene. Everybody has a role on the scene. It is teamwork." On the other hand, the MedCom program may wind up causing further friction between EMS and the independent and municipal fire districts and the long-standing consolidation debate. More than two years ago, the Collier County Commission asked the fire districts to explore consolidation whereby the fire districts would take over EMS. Tober says firefighters are not as medically skilled as his EMS paramedics, even though firefighters with advanced life-support training have to be state certified and operate in Collier under his protocols. "The fire districts see this as competition but MedComs further put my money where my mouth is," Tober said. The cost is budget neutral, he said, because EMS launched the MedCom program instead of adding two more regular transport units to the street. Adding more transport units would translate into fewer calls for paramedics and ultimately would mean their skills are not being put to use as often. "I am trying to thin down my paramedic ranks to serve lots of calls every day to maintain competence," he said. Golden Gate Fire Chief Robert Metzger said the intent of adding an extra set of hands on a scene is good but the MedCom program flies in the face of what the fire districts are doing with firefighters having advanced life-support certification. Metzger also questions the logic behind allowing the MedCom paramedics to decide which calls to respond to. "All of it sounds terribly undisciplined to a service that prides itself on discipline," he said, adding that he doesn't see the program as a good use of resources. Metzger believes Tober's launch of the MedCom program is connected to his stance on consolidation. "He is apparently trying to institute a new type of program or make up for a loss of (Advanced Life Support) first response by the fire districts because of constraints he has placed on the fire districts to operate (Advanced Life Support) first response," he said. He first learned about MedCom at the Nov. 19 meeting of the EMS Advisory Council, a few weeks after the program was launched. At the time, he did not express all of his concerns. East Naples Fire Chief Doug Dyer said he has no particular thoughts about MedCom and sees the program as roving paramedic in SUV's. "I don't particularly have a dog in that fight if that is how they choose to use their personnel," Dyer said. http://www.emsresponder.com/article/articl...p;siteSection=1

He just joined the forum. You have the option of not posting your myspace site if it is not current. He may not realize how some things can influence others' decisions. While the Goth look may just be a fashion statement there are some that view it very differently and choose a very different lifestyle to accompany the clothes.

Yeah, that could be one of those situations where what you post on the internet could influence what others think. Remember for the future, employers will pay background checkers to do an internet search.

I bet they are trying to crank out as many Paramedics as possible before the deadline. I believe it was Michigan that also ran all of the "oh poor us" articles a few months ago about the accreditation requirement.

Jackson Community College is the college mentioned in the above article. No wonder the FDs want their own classes. This program requires real college A&P, Algebra and pharmacology. I will say their tuition is a little high for a CC at $86.50/credit hour for a county resident. http://www.jccmi.edu/studentservices/catal...t/emms.cert.htm Emergency Medical Services Related Requirements - (17 credit) Take the following: ENG 131 Writing Experience MTH 120 Beginning Algebra or higher NUR 121 Pharmacology MOA 120 Medical Terminology BIO 155 Human Anatomy & Physiology or BIO 253 Human Anatomy and Physiology I and BIO 254 Human Anatomy and Physiology II FYS 110 Life Maps

http://www.lenconnect.com/news/x776474883/...raining-courses By Dan Cherry Daily Telegram Sun Dec 07, 2008 Fire departments team up to offer reduced-cost training courses WOODSTOCK TWP., Mich. - The cost of training rescue personnel can be an expensive process, and Addison Fire Chief Tim Shaw said he wanted to do something to make advanced training for emergency medical technicians affordable and convenient. Shaw said the cost of emergency services education may have deterred county men and women from completing the courses required to be licensed emergency medical technician (EMT) specialists. Education through schools such as Jackson Community College, Shaw said, typically will cost between $8,000 and $9,000 for someone to receive a paramedic license. After exploring training options for 18 months, Shaw said he took the initiative and started a training course in conjunction with the Somerset and Cambridge township fire departments. The class started Aug. 25 with 33 participants from fire departments in Addison, Blissfield, Clinton, Madison, Somerset and Jackson County’s Leoni Township. The class Shaw started is being taught for $3,500, he said. Passing the course offers the student a chance to take the national exam to become a fully licensed paramedic. “We all benefit from the level of medical services the EMTs and paramedics have to offer,” Shaw said. The way the trainee typically pays for the course varies from department to department. Some pay for it themselves, then are reimbursed if they remain with the sponsoring department for an agreed-upon length of time. Others work at departments that have no budget for the classes, so they must foot the entire bill themselves. “We have had quite a few capable people who have not been able to afford these courses,” Addison Fire Department Deputy Chief David Aungst said. “We’re working with budget crunches like everyone else. Anything we can do at a reduced rate and still provide the same service to help taxpayers is a great thing.” Classes are held in the training room at Addison Fire Department Station Three on Round Lake Highway. The weekly four-hour training course is taught by independent Jackson County paramedic instruction coordinator Michael Booher, who has been assisted by Stacy Robinson and Ryan Rank from the Madison Fire Department, and Chad Rodgers and Mark Cleveland from the Addison Fire Department. As the course nears completion, only two have been unable to complete the class, Shaw said. A prerequisite to take the course is to be an EMT, with training offered to upgrade to either an EMT specialist or one step higher, to the title of paramedic. Each student must also hold clinical hours in an emergency room setting or in an advanced life support ambulance. There are four basic levels of medical services, officials said. A medical first responder, trained in advanced first aid, can then become a basic EMT, who is knowledgeable about basic life support. After training to become an emergency medical services worker, one can then take courses to become a fully licensed paramedic, trained in advanced medical practices. David Miller, a captain and EMT with the Somerset Township Fire Department, is participating in the class to receive the highest available level of pre-hospital emergency medical service licensing, and is happy with the class and the savings. “It’s excellent,” he said. “It’s almost half of what it would cost me going through college.” Scott Damon, Cambridge Township’s fire chief, said his personnel are pleased with the opportunity. “I think it’s an excellent program,” he said. “It saves us a lot of money. We don’t do this to make money. We’re paying the local instructors and educating EMS personnel, and that is working well.” Somerset Township Fire Chief Scott Friess said the pilot course may open the door for future educational opportunities for area emergency specialists and paramedics. “This course has worked out well,” he said. “We may look at other classes later —maybe an EMT class once a year, then perhaps a paramedic class every two to three years. “This is a great opportunity for the surrounding areas to get this quality class at such a reduced rate,” Friess added. Jen Britt, a Madison firefighter and EMT specialist, said having a class close to her Adrian residence has proven beneficial for both time and economic reasons. “I was excited to have Addison offer this class so close to home,” Britt said. She added the class being taught is comparable to what is offered an hour’s drive away at Lansing and Ann Arbor colleges. “It’s saving me tons of money.” By the end of the course, Britt said, she will have a state paramedic license and expanded education in advanced practices. “It’s a good career opportunity,” she said.

We do nebulize steroids but find that the MDIs are much easier. Mag Sulfate has gotten another look fo rnebulizing and a few hospitals are still trialing it. I personally have not heard of this in EMS in my neck of the woods. IV is common in the hospital but not for ALL asthmatics. The cost of the correct nebulizer and the inability to mix with a bronchodilator makes Mag Sulfate very impractical for EMS and very short transports. As well, not all asthmatics meet criteria nor should all athmatics have Mag Sulfate as a blanket protocol. Lasix nebulized is another that has found to have specific purposes. Morphine and Fentanyl are popular. We have nebulized Morphine for over 30 years and fentanyl has now become the popular med of choice for some patients with specific comfort needs. We nebulize over 100 different meds for anything from bronchospasm to pulmonary HTN and everything inbetween including many antibiotics as well as Pentamidine for the transplant patients. We have another 10 or so that we are trying to develop and fund studies for. The other thing to consider is that many asthmatics are severe enough to warrant a Helium mix to facilitate the medication delivery. This will include while on the ventilator as well as off. We also have several different types of nebulizers for all the many different meds. For instance, there are few meds that I would use in the standard EMS acorn nebulizer besides albuterol. The waste is too great. Besides all of the med nebs we can use Helium, CO2, N2 and NO. All for specific purposes and disease processes. Before considering any med that has not been well researched you much also consider where you are giving the medication. The back of the truck is not the ideal situation for exposure to the provider. We take many procautions, even with albuterol, to avoid close exposure if at all possible. We do have enough RTs to document long term side effects from some of the meds we have been exposed to over the past serveral years.

We, RT guys, call that placing a neb "inline" and it can be with almost any apparatus. You are not "changing" the purpose of the nebulizer nor are you altering the equipment. You are merelyl placing an adapter with the nebulizer to make it fit "inline" with your equipmment. This is also done with MDIs. We can bag a treatment in by mask or ETT. It can also be placed inline with ventilators and with some CPAP/BiPAP machine. However, one must understand forward flow and exhalation allowance or flow follows path of least resistance to ensure the lungs do not become more hyperinflated. Too many crank the BVM with the nebulizer and bag like the wind while the neb is not allowed to vent of excess flow or pressure. You will then cause the patient to decompensate cardiovascularly. There are several commercial devices available for both the neb and the MDI. They have been on the market for about 25 years that I know of. Caution with the MDI ports on the BVMs. The new HFA inhalers may not fit as well some inhalers may not fit the HFA inhaler port. Likewise for some of the commercially availabe MDI adapters for vents and other inline applications. Since regulations and meds in Canada and the U.S. are not the same, different info for device application with different meds in each country will be different. When rigging O2 equipment, on must understand how and why they work. An SVN has baffles designed to deliver medication at a specific particle size. That is why if it is used as a "humidifier" and with the wrong liquid, it can cause bronchospasm. Many medicines that we deliver with it MUST also be delivered with a bronchodilator. If we want cool mist to an irritated throat or croup, we would use a nebulizer designed to give larger particles. If we want meds (vaponephrine) delivered to the throat we may use a different nebulizer from the one we would use the same med for bronchiolitis. If you don't understand these basic principles of delivery, you can do more harm by bronchospasm or be a total waste of time and a good med by the wrong device. Unfortunately, Paramedic training teaches very little about the fundamentals of O2 therapy. Even the ridiculous debates about whether to us 2 L or 4Ls by NC demonstrates a lack of knowledge as to how and what O2 concentration is delivered. Too many also think that a NRBM can give "high" FiO2 and "high" flow. It can give neither if the patient's demand/minute volume is high.

You can not provide humidification through a standard NRB. The port is too small and the bleed out through the pop off will actually decrease your ability to maintain adequate flow. The patient will be forced to attempt to breathe around the mask somehow since a NRB mask is NOT a high flow device. Dramatically altering a medical device as you have suggested for the NRBM is not adviced and further decreases the effectiveness of the mask. Also, if you notice in hospitals, we do not use nebulized saline for long term humidification in any device. If a patient needs humidification and high FiO2, they need intubated. The high FiO2 may be for the high CO levels if there is smoke inhalation. Humidification in short term does very little and definitely is not effective if not done properly with the proper devices. Other than that, the additional time setting up the correct equipment may delay transport or other care. If you keep a set up open and ready in your truck at all times for humidification, you may just introduce serious contaminants into the airway. I suggest you find an Intro to RT book and read the basics of relative and absolute humidity, what a high flow vs high FiO2 device is and why certain nebulized liquids work better than others. Some of the things suggested can do more harm than good. Make sure you thoroughly understand the working principlesof O2 and humidity before screwing around too much.

I have seen co-workers in my age group still in denial as we're taking them to the cath lab and wanting any glimpse of hope that it is all just a big mistake. It wouldn't take much to convince someone who is already experiencing "denial" that it could just be reflux. Just the same, it may not take much for the patient to sound "like it might be nothing (and hoping)" for FFs and Ambulance personel to jump on it as a chance to get a refusal. Hopefully when looking at someone with these symptoms, other things or risk factors should be considered besides what he just ate. And considering what he just ate, what meds was he taking for BP or cholesterol? Has he even been seen by a physician in the past few years? Body type? Other things to consider especially when considering all of the recent controversey with Washington D.C., how much training did they get for ECGs? Machine interpretation? Even in the hospital we may check a previous ECG to see if there are any sutle changes since not all MIs are textbook and some MIs may not have ECG changes at all. This too will be interesting to follow. I doubt if it will in any way jeopardize their jobs and there will be a liability cap on the pay out to the family. So, it really doesn't matter if they were right or wrong.

No, the OP has not given an outline or guidelines if there are other agencies involved. Again, your definition of a "frequent flyer" may be entirely different from a medical point of view. Paramedics on fire engines may have a totally different view of what they perceive to be "BS" and may view a "welfare check" as something totally different than one who is all about EMS and medicine with no other obligations or agendas. Spenac, Read my posts. I am NOT talking about the drunk on the corner who, yes, those of us in the medical profession realize he/she has many needs and most of which EMS is not capable of providing. I see other patients with medical needs who fall through the cracks EVERY day and many rely on EMS to get them to the ED for just daily maintenance. Do I think of them as bullshit calls? NO! They have legitimate needs that fail to somehow get into the correct system. You are talking about PR calls which are warm and fuzzy but there is a greater need. Unfortunately, Paramedics at this time may not be ready to step up to the plate to much more than that. However, Paramedics in other countries have been doing this for quite some time.

Thank you. You have just made my point from an earlier post.

If the public or anyone picks from the continously scrolling recent posts, they may not see the "funny" category. The internet is an amazing thing. EMS providers always complain the public doesn't know much about EMTs and Paramedics. Guess what happens when this site appears through the search engine as the public does investigate? That is not too farfetched since everywhere I turn in two states there are posters about EMS and Fire left over from the election. Of course, it could now appear in a search by those that are looking for something about sex in a fire station or ambulance to add to their fantasies. Not too long ago a quote from one forum about chemical restraint and other methods of "knocking" a patient unconscious was used by a reporter in an article about the routine use of Versed in the field and then getting a consent. It did not paint a pretty picture and give the reporter fuel to investigate further by whatever means. EMS providers often wonder how reporters get their ideas for stories, particularly those that are scandalous, and don't realize they often give them plenty of ideas just by reading the posts. While the credibility of what is said on these forums may be questionable, it would be relatively easy to interview these in EMS. You will always find someone who wants to chat about both the good and the bad.

Fun and funny can be interpeted very differently. Nigger and Jew jokes can be quite funny but also offensive. I don't want people in the community believing that almost half of the EMS providers are having sex while on duty. I would like people to look at us as medical professionals and not wondering if what they just read on this forum is true. Now all we need is another thread about "we don't get no respect".

I would love to lighten up but unfortunately I see another side to a very discouraging reality. There are too many people that fall through the cracks of our health care system that have little choice but to become frequent flyers. Even that rarely gets them the necessary or appropriate care they need. Instead, EMS considers them a nuisance and the EDs/hospitals are out of ideas where to put them if they don't qualify for this or that service. At any given time in almost any hospital, out of 1000 patients there will be over 300 that are inadequately insured but don't qualify for any assistance. Most when discharged can not get the meds they are prescribed to even be compliant if they wanted to. This is not because of a lack of trying. Many involved in the several systems try their best to get things right for Americans caught the healthcare entanglement. Again, as to the OP, it just depends what type of people will be included to be checked on and what policies will be in place to guide how much will need to be done. There should still be a plan in place for those that do require more assistance rather than just dumping them in the ED only to continue an endless cycle and not providing a solution to better meet the needs of the people. Welfare checks following a storm or extreme weather are of course a courtesy that should be done.

Do you really not understand the security and validity of an anonymous forum? Any of the many thousand lurkers who have a sign on name could have voted. Also, many of us who did post may not have voted. Those 18 votes or whatever may not be any of us that have posted or it could be only one or two. What are you out to prove?

This is an anonymous international forum. There is no way to tell who voted what from where and what their credential actually is. How many are just messing around because they can? How dare you make such a broad statement!

What about good enough for the patient? Until you know the expectations of what is being asked of Paramedics by whoever is suggesting this program and the needs of the frequent flyers which could be serious medical needs patients, it would be difficult to say what is actually good enough. I think you may have a stereotyped view of "frequent flyers" as be BS. The "frequent flyers are not always just lonely old person who wants to serve milk and cookies to the young firemen. Many of ours have lung problems or very brittle diabetics both of which are also compounded by recurring infections in various areas of their body. Helping them management their care at home would be more appropriate than a BP check and a not to say "Been there". These programs are excellent but EMS must be aware of what services are available in the community to refer to if the patient's care is beyond a BP check. As well, the Paramedic may need to understand what they are able to do and acquire more training to recognize more than just emergent situations which you pointed out by your statement "I'm a Paramedic" earlier when I talked about preventitive medicine. As a patient advocate I believe the people in the community should have access to the appropriate programs and levels of care and not just a band-aid that might be convenient for the moment. If the program is well thought out with adequate preparation and all available resources can be utililized to facilitate the success of the care for the people then great. Community health has always been one of the areas where a paramedic could expand their abilities. However, the "I'm a Paramedic and I only do emergencies" has stagnated the growth potential for more education and advancement into that area.

I don't see much difference between AK and the many other states that add another CERT purely based on "how to do A SKILL" and not expanding the education. There are only 50 hours and 10 patient contacts for the inbetween levels. Where is that productive? "I can do this skill but I haven't gotten to the next level to know why yet?" I don't mean to sound critical but AK's certification levels appear to be as wacky as those in many other states. http://www.chems.alaska.gov/EMS/Levels.htm ETT Emergency Trauma Technician ------ 40 hours EMT-I Emergency Medical Technician-I is equivalent to the National Standard EMT-Basic ---- 120 hours Defibrillator Technician--- EMT-I with an additional 16 hours of training EMT-II Emergency Medical Technician II --- 50 hours ---- IVs and a few meds EMT-III Emergency Medical Technician III ---- 50 hours --- use of morphine, lidocaine, atropine, and epinephrine MICP Mobile Intensive Care Paramedics - 500 didactic; 232 clinical; 480 field internship (just over 1200 hours - CA is 1090 hours which is about average for the Paramedic programs in the lower 48). All total with ALL levels including "ETT" it barely comes close to a mere 1500 hours of training. Granted that is more than some states but....