VentMedic

It is interesting that they used 3 years for their goal of 120 paramedics. That is when the NREMT deadline starts for accreditation.

EMS mag usually publishes the numbers yearly. This is the 2005 survey on the website. http://www.emsresponder.com/survey/ The 2007 survey is here: http://emsresponderlibrary.epubxpress.com/

Gut truck? How much more insulting can you get to EMS professionals? I pity those working the ambulances in your service on you shift. You lack of respect for EMS is just a little too obvious. Is this attitude wide spread in the Memphis FD and what is being done about it before more problems arise with more Paramedics being created? Or, is it just your issue with education and Paramedics? I must reply since you took this to a personal level. I served my time on ground EMS with part of it in a FD. As soon as I realized I wanted to be part of the medical profession as a professional Paramedic and not a "fire medic", I moved on. In my "golden years", as a Paramedic, I now do Flight and use my higher education to teach at a college to promote higher standards for the Paramedic as a medical professional. My other medical profession is working in a hospital and doing Specialty transports. You can't even begin to imagine some of my protocols for transport. There are still many EMTs and Paramedics out there much older than me who work for EMS agencies and love being a medical professional. I've seen the results of medic milling and have seen the degression of EMS from it. I see the FD's involvement in EMS and their torn priorities and see what an injustice is done to the public they serve. This is not just in my area but across the country if you again would just educate yourself about the profession you are attempting to discuss on a public forum. No, it is because you have stated little knowledge about EMS or what the topic is actually about.

???? You insult Paramedics yet this is a thread about Paramedics who you are supposed to be arguing for? Yes, as I said before, what you do in Memphis does concern the Paramedic profession. I can not believe a city the size of Memphis does not have access to medical journals or even JEMS to where you haven't heard about this. Get mfdffp back on line so there can be someone that did display a higher intelligence or knowledge of the system representing Memphis. There are probably some in Memphis that may be wishing you had chosen an anonymous screen name also. BTW, your knowledge of Hank's is probably even less than your knowledge of the NREMT. "They too passed the exam". Hank's was around while you were still in diapers. Hank's had a long history.

That explains your Paragod remark and lack of understanding for appropriate education at an advanced level. From your posts, you have already displayed that you are not the most knowledgable person on the subject of EMS and educational standards. Your credentials now speak loudly and explain your lack of credibility on this subject. Whatever arguments mfdffp made earlier in an attempt to bring some information to the discussion have now been voided with your remarks. At least mfdffp put forth the effort to explain the program. You should have left him to continue the discussion and not try to play the"Lieutenant of an engine company" card. It again just shows your lack of respect for Paramedics and belief that just a passing score on a test is the only qualification needed. Anything beyond that would be a "paragod" by your standards. It's only another cert, right?

Unfortunately yes. I had a grandparent code at the funeral of a child who had drowned. His funeral was 5 days later. I also had a gang related shooting at a funeral that resulted in two codes but both were called at scene which was very uncomfortable considering the location.

Thank you MemphisE34a. Your replies have just emphasized everything I have stated in my posts.

And I wonder why it has remained as such after 40 years? Could it be because we have allowed people who are not cut out to be or have no interest in being medical professionals easy access to programs that assist in passing a test for a patch? The Memphis FD is not the first to do this and now will probably not be the last. What is being done in Memphis is no different from the many other FDs that have milled their own Paramedics. Your FD could have diverted the funding to contract the local college to extend its services and accommondate your needs also. You could also have offered EMS as a service separate for Fire to attract Paramedics who want to be "medical professionals". Unfortunately what you are doing does affect the rest of us as a profession. You seem to not understand the importance of a standardized educational process to boost the Paramedic into being a recognized medical profession across the United States as some of our neighboring countries have.

That's essentially what I said. If you spend time getting an education and a CAREER as a medical professional, you usually seek to maintain your professionalism or advance within the medical profession. From the article: The birth of a medic mill....

When you start taking a "medical program" away from a standardized educational system such as a college, you are opening the education up to many variables, including instructor competencies, that may eventually be difficult to control. That is why almost all other healthcare programs took their programs to the colleges so that is would be easier to control the standards at both the state and national levels. 1 year at 16 hours/week is still not that big of a commitment by other healthcare professional standards. Ride time can usually be done while on duty if the program is FD sponsored. That is the biggest advantage to training your own. How many of these FFs would have had any interest in becoming a Paramedic if the education was not paid for and a financial incentive or promotion was not involved? Is it also understood that they may only have to work the ambulances for the usual (FD) average of 2 years before rotating to a nice engine in the suburbs? Most do enjoy working as Paramedic in the FDs and this statement sums it up: Medical professionals that do "heroic" things everyday rarely make the front page of newspapers. Just a little ranting from one of the leading medic mill and fire medic states. Been there, done that and have seen the progression or degression many, many times over the last 3 decades.

For many cops it is better than depending on their feet to get them somewhere faster since foot patrols are coming back to many cities with troubled neighborhoods. There are several ALS Segways in service throughout the country. Florida unbelievably did not start this trendy mode of transportation to compliment the engines or golf carts. In California the Segway is now replacing the polo pony.

But, Lee County EMS and Collier County EMS (not Fire) have demonstrated for many years what a professional county EMS system can do. Broward County EMS also used to have that same reputation but now it is all merged up with whatever to leave whoever in charge of the EMS part.

This is at least the 2nd time this has happened in the Collier County FDs this year. The other incident was the Marco Island FF/"Paramedic" that didn't get his license but continued to work with a fake license that no one bothered to check initially. These are not large fire departments. If they can not keep track of a little thing like a medical certification/license, how to they track CEUs and other training for both fire and EMS?

State investigates unlicensed EMT http://www.nbc-2.com/articles/readarticle....d=22293&z=3 Originally posted on: Thursday, October 16, 2008 by Kara Kenney Last updated on: 10/16/2008 6:26:46 PM NAPLES: The State of Florida is investigating if a Collier County fire department broke the law and put public safety at risk. Records show an unlicensed EMT responded to dozens of medical calls - some of them serious - in North Naples. The North Naples Fire Department calls it a "clerical mistake" that put Jon Steffen, a two-year veteran, on an ambulance for six months before anybody caught the mistake. Steffen responded to 46 medical calls, administering oxygen, taking vital signs and doing blood glucose readings. "It was an unfortunate mistake," said deputy chief Jorge Aguilera. "Was he working without a license? Technically (yes)." Aguilera says Steffen simply forgot send in his application and no one caught it - but patient safety was not put at risk. "This was not an untrained person. This person went through his training, passed his national credentials, didn't send in his application," Aguilera said. Most of the firefighters with the NNFD are also EMTs and paramedics, meaning they can ride on ambulances and provide medical care. But because those firefighters are operating under Collier County's medical license, the county is concerned they may face fines over the error. County spokesman John Torre says they are taking the incident seriously, but points out they are the ones who reported the mistake to the state. "I'm not in the position to point fingers. What happened was unfortunate," Torre said. The NNFD say it is tightening up its procedures to make sure no other firefighters work as EMTs without a license. They've already created a database highlighting exactly what each employee is signed off to do. "It was an unfortunate oversight. I can tell you nobody was ever in jeopardy," Aguilera said. The state investigation is expected to wrap next week. A state spokesperson says chances are it will be the firefighter who would face fines or a formal reprimand, rather than the county.

The seceretions that hang on to that cuff are pretty nasty in appearance and order also when we finally pull the tube several days later. Unfortunately some of them get knocked off as the tube comes through the cords. That example can also mimic the pressure in the cuff as the trachea and ETT size varies. Not everyone needs 10 cc of air in the cuff. A very small tube for a large patient can also need more. Different tube cuffs also have different requirements so some recipes aren't always the best or apply to all tubes. (More reasons I dislike the Combitube) We also have to be extremely cautious putting or pulling a deflated cuffed tube (if one is ever used) through the cords of a child. The extra width and roughness of the cuff can severely damage the cords. Again, only very skilled practitioners should be doing this. A typical inhospital (or extended transport) VAP bundle includes: * two-hour oral care * subglottic or at least pharyngeal suctioning of pooled secretions * head of bed elevation 30 degrees to 45 degrees on all intubated patients * reverse Trendelenburg position for patients with femoral lines or on intra-aortic balloon pumps to achieve increased head of bed effects without compromising femoral site integrity as well as spinal or TBI protocols * deep venous thrombosis prophylaxis *prophylaxis for peptic ulcer disease. We also use OG tubes instead of NG on intubated patients and try to avoid nasal intubation totally. Nasal tubes from the field also get changed quickly.

But, they are NOT to prevent aspiration. They are meant for a specific application with a ventilator. There are also size 3.0 tubes with a cuff for these purposes but only used in extreme cases. Cuffed pedi tubes should not be placed in the hands of practitioners who don't understand cuff/tracheal pressure relationships and don't have the ability to monitor the pressure. The practitioners that use a cuffed pedi or neo tube to make up for their inadequacies of choosing the correct tube size also should be banished from any airway management duties until they are re-educated. That blurp about cuffed tubes in pedi that the AHA put into their guidelines should not be a substitute for not understanding what happens when one doesn't know the consequences of good airway management.

14 months sounds great unless it is stretched out by having class on only one day as to not interfere with FF duties too much. That is why a degree educational system is much easier to compare length than "hours of training". When presenting you education to legislators and the general public, they can then associate what time you may have put into your education easier. It is like when an EMT-B says their program took almost a year. It is hard to tell if it was because the program was college based and may have required pre or co-requisites or if class was only held 2 hours per week for 52 weeks. College courses usually have much higher educational requirements for their educators or at least for the people in charge of overseeing the education. No nursing or RT program would even consider having instructors with only a certificate or an Associates degree.

I rarely use the word stable unless it is a patient on life support meds and technology. The word is over used and not always understood. Stable on one patient may not mean the same for another patient in terms of acuity. Too often we will hear the word "stable" from Paramedics bringing in a patient with GSWs to the chest or TBI. That patient is not stable regardless of the BP because there is a short term compensatory period and there are still too many unknowns that have yet to be assessed. Thus they either don't have an understanding of mechanism of injury, disease processes or just watch numbers on machines. We use the word "stable" in the ICU when we think we have found all the problems and covered all the bases. Even then we use the word with caution. I also relate this to the Paramedic or nurse that will argue with a patient that he/she is not in pain because their HR and BP are not sky high and fail to notice the meds the patient is on to prevent that.

We will not risk the chance of putting an alternative airway on mechanical ventilation. The chances over extending the gut to where serious damage from over extension, impaired ventialtion and aspiration can occur even with an OG or NG in place. Even if the Combitube is in the tracheal, we will change out as soon as possible to prevent cord and soft tissue damage. Some of our smaller EDs have access to a bronchoscope from the OR, ICU or RT dept and somebody in house knows how to use it if the ED doc is a moonlighter or "rent-a-doc". If more Paramedics learned how to consistently assess a difficult airway some scoring system such as LEMON or Mallampati score, there would be less trauma done with repeated attempts and reporting their findings while in the field can get the ED moving on the right equipment or personnel for the job. The scoring should be done before any RSI attempt is made in the field if you recognize some feature that is going to give the intubation process difficulty. Assessment for degree of intubation difficulty is like any other skill. Some paramedics don't even get the education on airway difficulty assessment and it is usually taught as "just go for and keep poking until you get it". The use of OG and NG tubes should also be utilized by some paramedics if extended BVM or when there is a chance of vomiting from air or other stomach contents. Too often we'll get a patient who has been butchered in the field to where we have to use packing to control the bleeding just to get the scope thru the cords. Many times some of these patients end up trached because of the damage and their cords many never function properly again. The G-tube may also be a realty in their from impaired swallowing. This may have a profound effect of some of the younger patients' lives like college students who get intubated for airway protection after a frat party with large amounts of alcohol. One misconception to clarify: ETTs and trachs that have cuffs DO NOT seal to prevent aspiration. Cuffs seal to assist in ventilation and should not be over inflated with the notion that less vomit and blood will enter the lungs if you put more air into the cuff. The cuff itself can do a lot of damage if mismanaged. The cuff is located below the cords and anything that gets past the cords is ASPIRATED. The ETT cuff just slows the inevitable and makes it easier to get the secretions out of the lungs. Many EDs and definitely the ICUs are using the subglottic suction ETTs which are part of VAP protocols and is also why you may see a doctor or RRT changing out your field tubes shortly after arrival. Note: Pedi and neonatal tubes do not have cuffs.

This is on the theme of some of the other threads. I have heard similar words when Florida started accrediting schools outside of the colleges. Since this is not a degree program, it is difficult to tell exactly how many hours of training they are getting. At least Tennessee requires its instructors to have an Associates Degree. I hope the FD has given some thought about continuing education and maintaining competency with as solid QA/QI program in place. I don't see too many sacrifices for the FFs as stated in the article since they will be paid for their time and the education is paid for by the taxpayers. I just see those in the profession slipping further from becoming recognized as medical professionals with the minimumal EDUCATION standards as others in healthcare. But, is it really a medical profession to some? Do some Paramedics and Fire Medics want to be called a healthcare professional without the distinction of being with a FD or ambulance service? Is it just the word Paramedic or Fire Medic that attracts some? We've had those issues when hiring Paramedics for ER Tech positions and they get upset when the title is not Paramedic even when they are not working under their Paramedic license. http://www.emsresponder.com/article/articl...p;siteSection=1 Memphis FD Launches In-House Paramedic Education Program Lisa Kelly Eason The Commercial Appeal (Memphis, TN) The Memphis Fire Department's efforts to put more paramedics on the streets have gotten a boost with the recent launch of its in-house paramedic education program. There are 36 firefighters in the charter class of the intensive, 14-month program, designed to give firefighters advanced lifesaving knowledge. "It's a commitment to the citizens of Memphis to deliver the highest possible care to save (a) life," said Deputy Fire Chief Gary Ludwig. Faced with a shortage of paramedics in recent years, the department sought both short- and long-term solutions to the problem, said Fire Department Lt. Lynn Thompson. A bonus policy for paramedics helped address the immediate need - the number of paramedics in the department has increased from about 180 to more than 300 in the last three years. But the paramedic education program will allow the department to "train our own so that we never see a shortfall again," Thompson said. Prior to establishing the paramedic program, which launched Sept. 29, the department was allowed to train its employees only to the level of basic emergency medical technician. Success with that course encouraged emergency medical services instructors to pursue their own paramedic program, said Lt. Kevin Burns. "We get to train them the way we want them to be trained," Burns said. EMS personnel spent 18 months preparing for the course, including training instructors, developing skill stations and lesson plans, and acquiring clinical affiliations with local hospitals. The Tennessee Department of Health Division of Emergency Medical Services board unanimously approved the course last month, making it the first accredited paramedic training program in Tennessee not affiliated with a college or university. In addition to classroom work and training with state-of-the-art equipment at the Chester Anderson Training Center, students will conduct emergency clinical work in hospitals and ambulances to gain experience in advanced medical techniques. The program - with a first-year budget of $275,000 - will initially focus on firefighters hired after January 2007, when the department implemented a policy requiring state licensure as a paramedic within three years of being hired. Following a one-year, state-mandated probationary period, the department plans to expand from 36 to 72 candidates per session and hopes to train 120 paramedics over the next three years. Jakuma Johnson and Chris Robinson both joined the department in October 2007 and were eager to sign up for the paramedic program, despite the sacrifices required of them and their young families. "It's an opportunity to help people and get back into science," Johnson said. "I've always dreamed of being a hero." Johnson and Robinson expressed admiration for their instructors and noted the department's commitment to advanced medical training. "This organization," Robinson said, "is very dedicated to getting more paramedics on the street."

Marco Island is in Collier County, Florida. The FDs dictate the training and education of their Fire Medics and get irrate when the medical director questions them. I don't know if this department had gone under Dr. Tober's direction at this time.

Last time I checked Paramedics still work under a doctor's license. The doctors may not have any say when the FD chief says all FFs will be a Paramedic (easily done through a contracted medic mill) and all engines will be ALS. The doctors also have no control over the initial paramedic education which can be a 3 month medic mill with coffee clinicals on an ALS engine. For those, it would take extensive training to get them up to par with a medic who actually got a decent education. Then, the chances of these individuals, who may have looked for an easy Paramedic program over one that might have involved a couple of prerequisites like A&P or Pharmacology, having much desire to advance or maintain skills/knowledge are very slim. That is unless it is handed to them in neat little note cards. There are also some Paramedics that have gone to CCT and have virtually no chance of getting an intubation or IV since the hospitals may have the patient nicely packaged for transport. In some areas, the Paramedic, due to limitations in scope (state or county), can only look but not touch the IV pumps with the meds already calculated and started for the transport. It is now mid October. That is only about 1 a month. Other professionals who intubate regularly may be pulled from the frontline until they got caught up with a preceptor.

You and DustDevil will have to make the AARC conference next year in San Antonio. I'll be retired by then from EMS and will be doing RT full time. This year's conference is in California. http://www.aarc.org/education/meetings/con.../attendees.html

This is Florida we are talking about. There is almost always at least 1 engine and maybe a ladder as well as the ambulance on every call. There are at least 2 fire medics and usually it is 3 - 4 Paramedics on each fire truck plus the 2 Paramedics in the transport ambulance. The 14 Paramedics that flunked the test were from one small FD station and all FFs. There is also a transport EMS vehicle in that area.

This is going to get uglier. The comments at the end of the article are quite amusing also. BTW, these are very impressive salaries for Florida: Paramedic/Firefighter I : $52,220 - $76,794 annual Paramedic Firefighter II (credentialed) : $55,875 - $82,169 annual Paramedic/Firefighter Company Officer : $72,615 - $106,787 annual http://www.naplesnews.com/news/2008/oct/02...-director-outs/ Firefighters protest Collier medical director outside EMS conference By RYAN MILLS (Contact) 9:05 p.m., Thursday, October 2, 2008 NAPLES — Carrying signs reading “Help Wanted, New Medical Director,” more than 60 Collier County firefighters marched in front of the Naples Beach Hotel on Thursday afternoon protesting recent decisions and public positions taken by the county’s medical director, Dr. Robert Tober. The hotel was the site of a two-day conference of the Florida Association of EMS Medical Directors. Tober spoke to the group at 9 a.m. Thursday, laying out his position on a number of local issues such as the role of firefighters providing advanced life support, or ALS, services. He also asked for the association’s support. When asked about the protest, Tober said he believes the firefighters are “behaving like children,” and said they have turned responsible medical oversight of Emergency Medical Services into a “three-ring circus.” The firefighters said they just want to be able to provide the advance life support services necessary to keep the public safe. “By utilizing all the people in the system, we can provide better service to the people of Collier County,” North Naples Fire Capt. James Cunningham said. “This is about the people. It’s about the visitors and residents of Collier County.” Tober says the firefighter-paramedics at the four fire districts currently providing advance life support services — North Naples, the City of Naples, East Naples, and Marco Island — do not provide the advanced medical services often enough to maintain their skills. Firefighters primary assignments, Tober said, are to fight fires and to be extrication and rescue specialists. They also have a role performing basic life support and preliminary life support if they arrive on scene before an EMS ambulance. It is basic life support that saves most lives, he said. “I really need outstanding basic life support delivered to everybody within five minutes,” Tober said during his presentation. But Tober said firefighters don’t need the same training and clinical privileges of EMS medics. More medics does not always mean better service, Tober said. If there are too many paramedics, the experience level of each paramedic declines, he said. From June 2007 to July 2008, the 102 firefighter-paramedics in Collier County engaged in 162 encounters when they provided advanced life support treatment without EMS personnel on scene, Tober told the conference. EMS paramedics had about 43,000 advanced life support interventions during the same period, Tober said. “You tell me who you want working on you and pulling out and using sophisticated medications,” he said. For the firefighters, just one incident is enough reason to justify providing the services. “It is only appropriate that when fire is able to be on scene of an emergency ... that we have the ability, training and the equipment to provide that person with life-saving techniques,” Cunningham said. Tober recently pulled eight of 25 medications from Collier County fire trucks that he said were rarely used and more sophisticated in efficacy and side effects. Those medications should be administered by more experienced EMS paramedics, he said. “Very, very few drugs were used in any of these departments,” Tober said at the conference. “Fifteen doses of drugs were administered over thousands and thousands of medical calls by the fire departments.” Part of the reason of Thursday’s protest was to have the medications reinstated on trucks, Cunningham said. Some of the firefighters wore handcuffs while marching in front of the hotel. “We are handcuffed to be able to provide medical care to the residents of the county,” Cunningham said. “We want Dr. Tober to put the medication back on the trucks so we can provide the essential medical care to the residents.” Cunningham compared the situation with advance life support to a high-rise fire. Though firefighters rarely encounter high-rise fires, they continuously train for the situation in case they are called to such a fire. Firefighters aren’t receiving the training they need, he said. “He wants to take things off our trucks saying we’re not trained in them. It’s his job as medical director to provide that training,” Cunningham said. “As a medical director, he needs to make everyone a specialist.” Tober said that continuous training is worthless without continuous experience. Lives have been saved because firefighters had access to advanced life support medications, Cunningham said. However, Tober said the firefighters have what they need to continue to save lives. “I’ve armed them with enough bullets in their guns to take care of any emergency in the first 15 to 30 minutes,” Tober said. “That’s never been enough for them. They want the same identical privileges as Collier County EMS medics.” At the end of the conference, the Florida Association of Medical Directors unanimously backed Tober’s right, as Collier medical director, to make medical decisions for the community. “The medical directors recognize the right of local officers and the local EMS system to determine their own challenges and solutions,” Florida EMS Medical Director Dr. Joe Nelson said. “But the Medical Directors Association also supports the right and responsibility of an EMS medical director to make decisions regarding patient care in the system.”