VentMedic

It is a combination of Albuterol and Atrovent with the trade name Duoneb by Dey Pharmaceuticals. It was expensive when initially released and many in EMS as well as hospitals just continued to used 0.5 cc of 0.5% concentraton Albuterol which is available as individuals to mix with a unit dose of Atrovent. Some also just mixed the two unit doses. Now there is a generic Albuterol/Atrovent mix available so Duoneb is not around as frequently as our drug buyers shop for a bargain. Some hospitals also insisted on orders being written by RRTs and MDs as Albuterol/Atrovent combination neb just to avoid the brand name issue or for clarification and avoid confusion with other meds that may contain the same ingredients. So, the term Duoneb may not have been heard by all. In some areas it may not have been heard at all depending on the formulary of the hospital or EMS agency. When teaching respiratory meds for both the medical professional and the patient, we make sure they know what their meds are and not just a brand name such as Duoneb, Advair, Symbicort, etc. An example of this is when a Paramedic is asked if the patient got albuterol and atrovent enroute to the ED and the answer may come back as "No, they got Duoneb".

Let me clarify that: Gotta love California's license oversight or lack of if you have something to hide. This is for those who believe the press just picks on EMS especially in California. At least the nursing board jumped into action at the first break of scandal but their lack of action for the past 2 decades is inexcusable. The EMS board is also still trying to deal with its own ineffective licensing process with many more examples of EMT(P)s behaving badly that could fall out of the tree with a good shake. We also have many other states that have lax oversight to protect against criminals infiltrating or remaining in their system. Many of us licensed in the early years may never have had to submit finger prints. http://www.latimes.com/news/local/politics...0,2084628.story California nursing board will require fingerprints from all licensees Board votes to expand oversight after a Times investigation found dozens of nurses were allowed to keep and renew their licenses after being convicted of crimes. By Charles Ornstein and Tracy Weber October 24, 2008 The California Board of Registered Nursing unanimously approved emergency regulations Thursday requiring all of its licensees to submit fingerprints, allowing law enforcement agencies to flag the nursing board any time a nurse is arrested. The move comes after a Times story earlier this month revealed that dozens of convicted criminals had kept their licenses for years. The new rule will have the greatest effect on about 146,000 nurses who were licensed before 1990, when the board began requiring new applicants to provide fingerprints. Assuming that the rules are approved by the state's Office of Administrative Law, nurses who have not been fingerprinted will have to do so when they renew their licenses, beginning in March. At Thursday's meeting, the board's executive officer disclosed that her agency would add eight new positions to its enforcement program to act on new conviction information received from renewing nurses or from arrest notifications sent by the state Department of Justice or the FBI. A joint investigation by The Times and ProPublica, an investigative reporting newsroom, found more than 115 cases since 2002 in which the nursing board failed to act against nurses' licenses until they had racked up three or more convictions. In 24 cases, nurses had at least five convictions. The investigation also found cases in which the board had never acted against nurses convicted of sex offenses and Medicare fraud. At least one nurse is currently in prison; another was able to renew his license from there for years after being convicted of attempted murder. After the article ran, the nursing board also said that, effective immediately, it would ask all nurses renewing their licenses if they had been convicted of crimes since their last renewal. Carrie Lopez, director of the state Department of Consumer Affairs, which oversees the nursing board and more than 30 other professional licensing agencies, praised the board's vote Thursday. "While the board was an early proponent of fingerprinting new license applicants, there has been a population of licensees that have been allowed to operate under the board's radar," she said in a statement. "The people of California expect much more from our regulatory entities." Criminal past is no bar to nursing in California Times investigation finds the state nurse licensing board allowed sex offenders, drug users and convicts to retain and renew their permits.By Tracy Weber and Charles Ornstein, Special to The Times October 5, 2008 Dozens of registered nurses convicted of crimes, including sex offenses and attempted murder, have remained fully licensed to practice in California for years before the state nursing board acted against them, a Times investigation found. The newspaper, in a joint effort with the nonprofit investigative news organization ProPublica, found more than 115 recent cases in which the state didn't seek to pull or restrict licenses until nurses racked up three or more criminal convictions. Twenty-four nurses had at least five. In some cases, nurses with felony records continue to have spotless licenses -- even while serving time behind bars. Nurse Haydee Parungao sits in a federal prison in Danbury, Conn., serving a nearly five-year sentence after admitting in 2006 that she bilked Medicare out of more than $3 million. In her guilty plea, Parungao confessed to billing for hundreds of visits to Southern California patients that she never made, charging for visits while she was out of the country and while she was gambling at Southern California casinos. Yet according to the state of California, she is a nurse in good standing, free to work in any hospital or medical clinic. Reporters reviewed stacks of nursing board files and court pleadings, consulted online databases and newspaper clippings and conducted interviews with nurses and experts in several states. The investigation included an analysis of all accusations filed and disciplinary actions taken by the board since 2002 -- more than 2,000 in all. The offenses included misdemeanors and felonies ranging from petty theft and disorderly conduct to assault, embezzlement and bail jumping. Among the cases in which the board acted belatedly or not at all: * An Orange County man continued to renew his nursing license for years even after he was imprisoned for attempted murder. * A Redding nurse was convicted 14 separate times from 1996 -- a year after she was licensed -- through 2006 on charges including several instances of driving under the influence, driving with a suspended license and drug possession. * A San Pedro man amassed convictions for receiving stolen property, as well as possession of cocaine and burglary tools, before the board placed him on probation. He subsequently was arrested two more times, for possessing cocaine and a pipe to smoke it. In response, the board extended his probation. * A Calimesa nurse has a clean record despite a felony conviction for lewd and lascivious acts with a child. "I'm completely blown away," said Julianne D'Angelo Fellmeth, administrative director of the Center for Public Interest Law at the University of San Diego and an expert on professional licensing boards in California. "Nurses are rendering care to sick people, to vulnerable people. . . . This is a fundamental failure on the part of this board." Escaping scrutiny California has the largest number of registered nurses in the nation. Hospitals and clinics rely on the website of the California Board of Registered Nursing, in part, when checking out job applicants because all accusations and disciplinary actions are posted there for public review. MUCH MORE AT: http://www.latimes.com/news/local/politics...0,7577034.story

I'm going to side track us a little. Everyone has brought up some valid points and there are plans of action in place now to at least prevent some errors, unavailability of doctor or doctor not responding to the urgency and many other potentially harmful situations. I am most familiar with those in place in the hospitals but I have heard about the LTC facilities now developing some of these plans. itku2er might be able to provide that information. The programs are through the Institute for Healthcare Improvement. http://www.ihi.org/ihi This used to be the 100,000 Lives Campaign and it is now the 5 Million Lives. http://www.ihi.org/IHI/Programs/Campaign/ The website is full of information about issues that affect the patient's well being. In many hospitals, including mine, Rapid Respone Teams (in addition to Code Teams) have been developed to respond to patients before they code. We have a huge SNF and Sub-Acute attached to the hospital so the Rapid Response Team can go there as well as Dialysis and all of the med-surg floors. The team consists of a Respiratory Therapist and ICU RN. We essentially act as an EMS team carrying bags of equipment to set up a mini ICU where it is needed. The team acts under the extensive protocols of the ICU which is under the direction of the Intensivist who needs not respond unless requested by the team. We do whatever is necessary to stabilze, order labs and intubate if needed. We will remain with the patient until we can move them to a higher level of care. This may create another issue that may have caused this patient to fail or the system had failed the patient. There is no room in the ICUs and the least critical patient will have to be triaged out. Patients may not get an ICU room when they are needed and somehow get placed on med-surg. If they do make it to ICU they may get pushed out too early to make room for another patient from either the ED or the floors. Thus, the med-surg RNs who have a higher patient to RN ratio will now have high acuity patients. It becomes a vicious cycle. We put the priority to get a critical patient from the med-surg floors but that may mean bumping a pt in the ED. Hopefully the ED has RNs capable of handling even a ventilator ICU patient for awhile longer. But, the ED staff is stretched and a back up happens. Yes, it is frustrating when something that seems rather simple comes into the ED but there are other frustrating events happening all at the same time. RNs also kick themselves if they skip over a patient that they know should have gotten more treatment. Every RN knows the danger of a decubitus ulcer yet will also groan when someone presents with one or is at risk in the ED. That, too, is not the glamorous side of ED nursing but most still know what must be done and done correctly. And no, when a patient codes in many hospitals, there is not always an abundance of help around. I would dare say there are more ALS providers on most prehospital medical scenes in Florida or California than available RNs and RRTs in a hospital. I say available because not everyone can abandon their ICU patients and run down 2 floors for a code. Often it may be just an ICU RN, RRT, CNA (hopefully) and the patient's nurse. The charge RN will be making phone calls and the others will have their own patients. The exception might be a teaching hospital but then the ICU RN and RRT will be carrying the load many times depending on the level of resident. We are not oblivious to the problems and those of us who work in NHs, SNFs and hospitals are trying our best to provide quality care. But, sometimes it seems like the cards are stacked against us. Yet, dedicated staff still return to their work place to take abuse from all (patients, MDs, EMTs etc) while trying to smile for that little elderly person who had to give up everything including their independence. So when you think you have it rough taking care of one patient, think about what goes on behind the walls of a hospital or SNF when it is only a handful of licensed providers for many patients with many different needs. Back to the program.

spenac, I'm trying to get a gentler attitude. I must admit the expression on the faces of some EMTs and Paramedic students is priceless as they recognize me when I show up to teach a class. It is usually after they have tried to give me some sh*& attitude in the ED. Of course all of us hospital people look alike and are all nurses.

Spenac, I am so not used to your gentler and kinder way of putting things. The scenarios I was referring to should have had access to a lab since some of them have the patient in the ED. Usually the critical diagnostics can be done at beside and within the first 5 minutes of arrival. Once you cross that threshold out of the "prehospital" phase and want to continue the scenario within the walls of the hospital, anything should become fair game. If not, that is ignoring a large part of medicine. Just wanted to show that the generalizations in SNFs and nurses can easily be applied to EMTs and Paramedics. My criticisms are for some to get the idea that there is so much more to medicine and even with advanced degrees some of us learn something new each day or at least strive to. Unfortunately, if RRTs, MDs and RNs make the mistakes you used in you examples, we can be subject to penalties even with the promise of no blame medical error disclosure. It is lucky you did catch the errors. SNF RNs have a big responsibility and they know their limitations. They don't try to "guess" with patients that are multi-system broken. For some of these patients, you plug up one thing and something else springs a leak. Age is no longer a factor since I have many 30 - 40 somethings that have more extensive histories than the 90+ y/os. It would be nice if there were more mobile hospitalists and labs to accommodate routine calls but this is the U.S. Right now we do have a few doctors that makes house calls for the well insured. Yes, there could be better education on some things for SNF nurses but by the time they take their RN CEUs, mandatory recerts, state safety mandatory classes, med refreshers, and etc, they have may easily have over 200 hours invested in education. Except the CEUs and CPR, the others are usually yearly. I stick up for these nurses because there is not way I would want to do their job. They are treated like rugs even by EMT-Bs who think they know so much more than MDs. SNF nurses do have parameters to function with but again they are trying to view ALL the systems in a LTC patient. That is not easy. In a teaching hospital it will take no less then 15 minutes and sometimes up to 1 hour to review all the data on a complex patient. The complex patients will probably end up in a SNF to finish their recovery or existence. If the patient doesn't warrant transport, let it go MD to MD. If there is truly a legit complaint against a facility "dumping", let the Medical Staff (MDs) use their channels for investigation. I can tell you they, too, will be cautious with accusations and it is more than protecting one of their own.

Okay I'll be nice but let me give you another example: EMT-Bs or even EMT-Ps respond to a SNF where labs have already be done by an outside agency. Pt is slightly altered with a Temp of 38 C. Significant labs included a Serum Lactate of 6 mmol/dL. When patient arived to ED, we had already had copies of the labs with a report from the RN. What we got from the ambulance crew is "Can you believe we got called for a fever of 38?!" They were unfamiliar with labs and the RN did not have the time to explain each value but the EMTs did admit to hearing something about it when asked. So often what is cast as BS can in reality be significant if you look for and listen to. In this case, they just didn't know lab values and that is understandable but shouldn't be taken as BS. If you ever noticed in the majority of scenarios on the EMS forums, no lab values are mentioned even if they are in the middle of a modern ED. Yet, some believe they can "name that diagnosis" and that is the definitive answer. Lab values are not part of EMS programs but are still valuable tools even if the EMT or Paramedic doesn't study them. Many times the RNs realize what may be askew in a patient by the meds or other sutle symptoms that the Paramedic may not have studied. Thus, they may be working on lab values or the need for further evaluation by diagnostic testing. In other words, it takes a lot of balancing to keep a patient in long term maintenance. That part is not studied in EMS. Med-Surg nursing is a whole medical science in itself and many good ED or ICU RNs still reflect on those hard days in their career. The nurses that choose to work in long term care facilities take med-surg and geriatric medicine to the Nth degree. Just being responsible for passing out 200 - 400 meds a shift accurately is an amazing feat.

Lazy nurses? Do you know how many patients each of these nurses have? One less or one more isn't going to make that much of a difference. The nurses are also caught in a legal and medical liability issue that damned if they do and damned if they don't. Often they are following predesigned directives by doctors, their superiors, AND your superiors . Since this is also a billing issue check first with your company to see if there are any agreements on the books that you may not be aware of. Before accusing people of being part of a scam, you seriously must have your documentation very accurate and able to prove your allegations. Yes, Nurses are jumpy and believe in covering all bases because RNs are not afforded the same immunity from liability as EMTs and Paramedics are. Unfortunately some NG tubes require X-Ray confirmation. If would be nice if your area offered the service of portable X-Rays or a routine transport truck. But again, check the agreements with your system. Many of the things you listed can also have a very serious underlying medical cause which can progress quickly and could lead to death in an elderly patient. Maybe you should check out a course on Geriatric Medicine to broaden your knowledge. I lost count at the number of seriously ill NH patients that EMTs/Paramedics have literally dumped on our stretchers while mumbling "BS call". As an EMT-B you should be looking through the history for other reasons that might warrant why such "simple" things could be a big issue for different patients. How do you think the geriatric patient feels to be caught in the middle of the American Healthcare system mess? Or being dependent on others? Do you think they like being a bother? And of course by you arguing with the nurse about taking them to the hospital, the patient probably feels real special. Assess your patients instead of trying to find fault with other professionals or a broken medical system. Your attitude toward NHs and SNFs may keep you from adequately assessing the patient because you are too busy assessing for fault with others.

He first needs to get a Paramedic certification. Not having a Paramedic cert to even give up would not fly in the many FDs that do EMS especially if you wanted the rank of lieutenant.

You can read through your posts here to a refresher. Many of your comments have been highlighted. Again, when you put something in writing it can come back to haunt you. This is not the only forum this is being discussed and some are linking to this site. Your name is very well known now but not in the ways you may want it to be.

Your priorities are different. Holding a cert on paper for 18 years and actually having an interest in it as a profession are not the same. People who don't care about something usually do not have any worries. But, as you have stated many times, you are FIRE and have little to do with EMS except for the Paramedics who you call Paragods at your station. So, why are you trying to discuss anything about EMS on an EMS forum? To you EMS is just another job or just a bunch of Paramedics that you have to oversee. It means little to you as a career. Fire Fighting is your career as you have stated over and over. We get your stance on FIRE and EMS. Nobody has declared being a expert. If you had been keeping up with the EMS profession even if it meant reading JEMS or EMS mag occasionally you would know a little more. But by your posts you don't have any idea about the EMS profession on national issues yet you bash someone who does take their career in EMS seriously enough to stay informed.

As the article mentioned and the point I have been attempting to make is that this will be the first program offered outside of the college system. TN has been prided in the education circles for having programs accredited by CAAHEP and college based. As seen in other states, once an exception allows for deviation from a previously established standard, there is no turning back. Hopefully Memphis Fire will be able to meet the requirements for accreditation if the NREMT is their Paramedic exam. However, they may also only need their program for 3 years as their plans were stated for that time frame. That will bring them to the NREMT deadline. As previously stated this is not just a "FIRE" issue but will soon be an issue that will come up again as another program will also want to establish a PDQ medic mart in the neighborhood. We have also gone through 3 very long decades of FDs and ambulance services training their own to where we finally saw a decline in that practice but still had the "career schools" to deal with. I would hate to see another back slide further from the goal of obtaining a college based education standard for some credibility in the eyes of the legislators and medical professionals.

Nobody bashed your FD. You bashed your own FFs and Paramedics all by yourself. Take it up with your administration and news media if you have a problem with your department's stance with paramedics and EMS. You still don't have a clue as to what this thread was about? Did we really have to know you tried gay sex in a fire station?

Homecare companies would not likely give a hand powered suction device or at least none that I know of would except as a possible backup for power outages. After a rather lengthy discussion about "the basics of suctioning" on another forum, I would like to know what "skills" EMT and Paramedic schools teaching. Are they forgetting the fundamentals and skipping right into the really good stuff like IVs and intubations even for EMT? I could bore all of you to tears with tales of CPAP placed on a mouthful of scrambled eggs or oatmeal and trach patients whose trach was pulled because of secretions which could have been easily removed by suctioning or just removing the inner cannula. Of course now the rescuers have to figure out how to re-establish the airway and end up false tracking or ripping the trachea. When asked why wasn't suction attempted first, "It was an emergency" is the usual reply. And then I have to put up with the same Einsteins transporting a trach patient from our facility. They don't move until I know they are capable of suctioning correctly.

Do you even bother to read the posts? Is that all you got from 92 posts? You have offered nothing credible in comments that concern any of the many issues discussed here. When you don't understand the issues you just resort to personal insults. At least I threw examples of your comments back at you with an explanation of why they were incorrect or inflammatory. Your only rebuttals were more personal insults and inflammatory statements with continued use of terms insulting even the FF. I was trying to get you explore what is being said from an economic and legislative viewpoint since it was useless to try it from the medical stance with you. At least your co-workers were able to carry on a good discussion. Your inferiority complex as an EMT doesn't do that level of the EMS professional justice either. That is evidenced by your never-ending statements against the Paramedic. You can continue to show your arse here or log on to the many FF forums that will allow you to bash Paramedics and EMS.

I think you believe I am talking out of both sides of my mouth because you don't have an argument or understand what I and others are talking about when we discuss medicine and economic issues. Your posts already speak loud and clear about your opinions. Not all of our opinions have anything to do with our departments or our titles nor do most of us have to hide behind a title thinking it will intimidate. Considering the initial article, some of the things you have posted would be considered an embarrassment to your fire department or any FD so I wouldn't be bragging about disclosing your identity. Remember this is a public forum viewed by others in EMS, FDs, the media and taxpaying citizens. Words written have a way of haunting an individual. No one has said anything about eliminating fire departments. ENOUGH with your inflammatory misleading statements of generalizations. However it is a reality, if you want to talk economics, that several in EMS have found themselves unemployed from a CAREER that they loved because of FIRE/EMS mergers. Often these EMT (P)s are not merged into the FDs but rather the FFs are forced to become Paramedics. If the EMS employees are merged they are also forced to become FFs. Any professional from either side will tell you the problems that this brings. We also have some forum members that can give you first hand information on that subject. We could also talk taxation issues where a school might not get needed educational materials because of the unnecessary greed displayed by another public service. Stay informed and understand where your dollars are coming from. Don't just put up the bashing and inflammatory statements. The posts that you viewed as demeaning to FFs also contained a wealth of information that can easily be researched. Even the questions I posted about taxation and funding can usually be easily found on your governmental website or if you have ever voted in a local election I would hope you have read the ballot's issues. And, if anyone is a homeowner, I hope they know where their tax dollars are going. Again, you are the one that continues to use the word Firemonkey. None of the forum members (except mfdffp) have used that term in their recent posts. The majority have NOT used it at all. Your friends have all come to your defense but I would say you are not making them very true to their words.

So are the comments about the useless paramedic that just wants to play doctor and the disregard for recognition as a medical professional or higher medical education. I think if you bother to read the comments by Kramer that have been highlighted you will see how offensive they are even for "Fire Medics". Kramer's continued use of the terms even after no else replying to him used them as well as some of his own, such as "retarded" in reference to FFs, was not called for since no one on this forum made any direct reference to FFs as such. My remarks were directed totally at him and his unjustified attack on a profession to which was the basis for the article and should have had his support as a Lt. representing his company. He should not have been tearing down the professionals his department was attempting to train and add. Again it was the education concept that was being argued and not if Memphis FD was crap or great. If you look through the forums here we often used a news article to get the conversation started.

I already figured out that medical journals were not part of your reading material but what about just watching the news or picking up a newspaper? I've even seen articles about the economic impact of Emergency Services and healthcare in the Firehouse mags. Yes, it affects FDs that provide these services in a big way which is why one wonders why they would even get involved if it wasn't for the tax base funding structure and unit justification issues. Do you even understand why this is so debated in the political arenas? What about the upcoming Presidential election? Didn't you notice healthcare issues being debated? Have you not noticed news articles about our ERs across the country? Hospitals? When you become part of EMS you become part of a SYSTEM. You can no longer just identify yourself as a FF doing some skills. You are now part of a working system with other facilities and professionals. Each time you down play the role of EMS, you provide argument that maybe the FD's participation in EMS is not doing justice to the SYSTEM that is trying to provide a broader approach to the healthcare crisis.

Once against EMS is behind in investigating what other professions have already discovered when it comes to providing these services. The minimal standards for the specialties of anywhere from a 2 year to a 6 year degree is rarely enough in our complex medical systems. Even Respiratory Therapy is now going with 4 year degree for homecare and that has legislation to reimburse at that level. And, that is just for one specialty in homecare. Social Workers and Case Managers all have recognized this and you would be lucky to find any for this specialty with less than a masters degree, many with the RN as a base. The Paramedic is still at what level of education? 500 - 1100 hours? I believe it was Lee County EMS that attempted the public health model a few years ago and that did not get a good reception from the Paramedics. Remember, many people did get into this profession for the L/S and trauma stuff, not clinic work. It is also very difficult to compare our medical system with any other country. In case no one noticed, our medical system is just BROKEN. Our patients are coming to us sicker and sicker with the costs rising to maintain them. If we give them more excuses to not visit a doctor or hospital to where more potential or existing problems can be identified, we are just adding to the declining health issues. Even a 2 year Paramedic degree does not prepare one for that level of diagnostics. PAs and NPs have eased the burden of some clinics' physicians but they are allowed by their scope of practice to order advanced diagnostics and prescribe medicine outside of the emergency situation. The base education for the Paramedic (and the U.K. model also uses a nurse) in other countries is also already established at a much higher level so it makes any additional higher levels more realistic. U.S. Paramedics also are specialized in treating very acute situations and have little knowledge or experience with other things that go into understanding long term diseases, those other "vitals" or even many of the "med-surg" type meds that are usually thought of as BS to a prehospital provider. So some knowledge and even the way of approaching an assessment would have to be relearned. Other countries may already have integrated of this into their Paramedic education. As far as advanced skills, we already have this in many systems that utilize EMS helicopters. Often they will come to the aide of a ground crew if needed to perform RSI or other interventions but with transport by them being the ultimate. Since many of these helicopters are also involved in interfacility transport, they can do advanced stabilization. However, many of these helicopters also have an RN with several years of Critical Care experience and usually no less than a BSN. But, the concept is still there. I just can not see the situation as described in Wake County being practical time wise or valid use of resources. I will note that there are exceptions to some HEMS. If they are fire based, it is often with Paramedics that have the same skills as the ground Paramedics. There are also a few services that have a pilot fly out with the helicopter and pick up a medic from the ground crew to go with the helicopter. So that again brings us to the FD issue and with their prevalence in controling EMS in many regions. Higher education with advanced skills will not always be a popular idea. As recently stated on one thread, CPAP and the 12-lead EKG are viewed as "progressive" in one FD.

That is true of almost any medical service in the U.S. What are your tax base ratios? How is the distribution proportioned? Is there a statewide accounting base for funding sources or is it local? Does TN have an amendment updated from its taxation statutes for allocation of funds with proposed changes? How often are the funding issues voted on by the public either locally or state? If you review some other threads on this forum and others you will see how each of these questions affect EMS and FDs.

You bash a service that you know nothing about but saw one of their ambulances when you were not even 15 y/o? Was it because it wasn't a big pretty fire truck? You can not always judge a book by its cover. You were probably just meant to be a FF (nothing wrong with that) and not a medical professional. Seriously? You don't understand the difference between EMT and Paramedic? You are in charge of Paramedics? Why are you even replying to this thread if you don't believe your department needs Paramedics? At least we may agree that an engine needs only FFs with an EMT-B or EMT-IV cert. This thread was not started with the intent to BASH Memphis FD but rather to discuss an educational concept that eventually affects a profession as a whole. You have done quite well all by yourself at bashing your own FFs, Paramedics and department.

LOL. Have you noticed that you are the one using the term "fire monkey". Not very many others including myself have ever used it in their posts. You are now offending FFs as well as Paramedics. Let me repeat my statement from earlier to you: Or maybe they didn't want to be a FF. Memphis is not the only city that has Fire-Based EMS. Why I have even heard about a couple in my area! :shock: When you mentioned Hank's Ambulance earlier, I realized how out of touch you were with what is happening with the American Ambulance and EMS systems. I could go into the economics and reimbursement part of that but why bother with you and the professional EMS providers usually have a grasp on this. Priceless. Even if I wanted to do a little name calling directed at you or even your FFs, it would be difficult coming up with something you have not already called them or yourself. It is not your department that is being discussed so much as it is the EMS profession and the changes it is undergoing with each deviation from the goal of an educational standard.

MemphisE34a, My post was merely stating that the FD is one of the very few work situations where an EMT would be giving orders to a Paramedic. Another exception might be the military. Do you ever read what you have written? All of your posts have been sooo predictable. Right now I am just toying with you because I can and you keep giving me more material that is of little relevance to EMS. But, it is useful for a deeper look into the mind of Lt. MemphisE34a. BTW: Has anyone ever seen the term "fire monkey" in any of my posts either on this thread or elsewhere? Same or separate? Yup, I bet you make your Paramedics feel good about their work. quote from article: So what's all the stuff about not being able to find Paramedics? Just tell them to grab some paper with a patch attached from a medic mill and come back. Right now trading posts with you is only for amusement since you are so easy to mess with and you don't even realize it. I apologize to other forum members for derailing this thread slightly.

Since the FDs are not structured according to medical credentials, you will have FFs with or without an EMT cert to supervise the Paramedics. In a non-FD setting that would definitely create problems and that type of situation would be avoided. Lt. Robert Kramer aka MemphisE34a has already shown his attitude toward Paramedics and it is stated he will be in charge of some. Not to just pick on him, this could be anybody in the FD who may have the rank but not the "patch" that can enjoy their position of supervision a little too much by knowing where their stance would be in a non-FD setting. Thus, even if the Paramedics are also considered FFs and hold the same Fire cert, they may not fit in or allowed to fit in. I think we've all read enough opinions on EMT vs Paramedic threads to get the jest of how things could be even without the FD issues.

Here's the link: http://www.coaemsp.org/aboutaccreditation.htm http://www.coaemsp.org/ Link to a discussion on this forum: http://www.emtcity.com/phpBB2/viewtopic.php?p=140851 I know that 9 of your TN Paramedic programs offered at the colleges are accredited. There are a couple of members here that are intimately familiar with the NREMT exam and the stance the NREMT has taken. Ridryder911 is an excellent source of knowledge on the subject. The state of Florida still uses its own Paramedic exam and will probably continue to do so as not to upset our medic mills. Yes, Florida is the capitol of the medic mill kingdom and has one of the largest concentrations of Fire-ALS systems in the country. We also provide ALS services of some type to just about 100% of the state. However, I hope you take note of the mistakes we have made and are still making. Welcome to the forum!

Barry's attitude was declared in his first paragraph with You really don't get it? I guess that could be the base for the whole discussion. You are a FF arguing about something you have not a clue about as evidenced by your posts. You have demonstrated no understanding about the Paramedic as being part of the medical community and no understanding of the NREMT. Even the way your friend had to defend you by saying: Again, you repeat your lack of respect for Paramedics or any EMS professional. So, are you against having these extra Paramedics in your service? Or, will you be more likely to show how superior you are to them because you are a Fire Lt. to make up for the lack of a Paramedic patch on your uniform? Nothing you have posted has shown any support or a welcoming mat for them. Considering your attitude, I truly do hope they are only applying because of the recruitment gimic as just a chance join the FD or it seems life for them will be pretty miserable if they say they want to be a paramedic because they enjoy the medical aspect of the job.