VentMedic

Belgium

VanHools is well known for supplying buses for city transit systems such as in California in the Bay area. However, there are very mixed reviews on them.

San Francisco has 3 females in high ranking positions. All have had their share of controversies. Fire Chief Joanne Hayes-White Police Chief Heather Fong Mayor Gavin Newsom

Now, for another issue in this problem county: http://www.naplesnews.com/news/2008/aug/30...on-idea-electe/ Collier fire chiefs to take consolidation idea to elected leaders By I.M. STACKEL (Contact) 6:21 p.m., Saturday, August 30, 2008 The next step to fire district consolidation in Collier County is in the hands of elected officials. Collier fire chiefs agreed Thursday night to take a proposed consolidation study back to their fire commissioners, or, in the case of cities and the county, the councils or county commission. The Collier County Commission likely will hear the presentation on Sept. 9. The fire chiefs also agreed to put out a request for proposals on how to legally accomplish the job of consolidating 10 currently separate organizations in order to take ambulance service off the county’s hands, and eliminate duplicate service. Right now, county government-operated Emergency Medical Services has the ambulance concession in Collier. While some fire districts have paramedics, they don’t have the transport vehicles to take patients to hospitals. More than two years ago, county commissioners asked fire districts to start meeting to find out if they can consolidate into one large Collier department covering fire, rescue and emergency medical services. A consolidated department would have its own elected officials, and would be independent of the County Commission and county budget. Currently, in addition to EMS, commissioners have to approve budgets for Ochopee and Isles of Capri fire districts while others are under the direction of elected fire commissions or city councils. Golden Gate Fire Chief Bob Metzger presented an overview at the Fire Chiefs Steering Committee meeting on Thursday night, saying the plan requires further study. “Elected officials must determine whether they want their organizations to participate in this concept,” Metzger said, reading off the report. “Once determined, the legal research will need to be performed to map the process necessary for consolidating the participating organizations.” Also, chiefs, elected officials and a consultant need to identify the new governing structure, and how to even out property taxes that vary from district to district. The Collier County Fire Chiefs Association Operations Committee, chaired by Assistant Chief Orly Stolts of North Naples Fire-Rescue, asked for the study at its Oct. 25 meeting. The numerous chiefs and firefighters from most of the districts since have volunteered their time to construct a workable plan. The committee began by looking at the location of each fire station and EMS station within the county, identifying equipment assigned to each station, and by looking at overall and shift staffing. There are a total of nine fire department-only stations, 16 combined fire-EMS stations, and four EMS-only stations. The four EMS-only stations are close to fire stations, according to the report. Among the 10 agencies, there are 25 engines, seven aerial ladders, five water tenders, two crash fire-rescue trucks, and 25 ambulances available for service at any given time, meaning there’s more equipment than used per shift. The fire chiefs agreed that consistent fire-EMS training throughout the county would benefit all Collier residents, and, therefore, would have its own independent training and safety program. Although it wasn’t an aspect of the consolidation presentation or discussion, Big Corkscrew Fire Rescue Chief Rita Greenberg reported that talks are under way with Edison State College to include a county fire academy. Chiefs around the county have all acknowledged financial hardship as a result of declining property values, mandated tax rollbacks, and annual union negotiations. They will all, soon, be presenting their final budgets to the taxpayers. That includes the existing EMS service controlled by county government. East Naples Fire Rescue Commissioner Tom Cannon suggested that the steering committee send official messages to the Fire Chiefs Association, stating that the steering committee supports the consolidation study. “It would look good,” Cannon said. Those involved in developing the consolidation study believe a tax rate of $1 per $1,000 of property value throughout the county could support a countywide fire-EMS department. ANOTHER ARTICLE: http://www.naplesnews.com/news/2008/aug/23...ill-alive-coll/ Fire-ambulance consolidation talk still alive in Collier By I.M. STACKEL (Contact) 9:59 p.m., Saturday, August 23, 2008

But, you will now have private ambulances whose paramedics haven't intubated, started an IV or done a 911 response EVER. Their CCTs in the area consist of an RN and 2 EMT-Bs. If the acuity is high, the transport waits for a 2nd RN on call from that company. Thus, many hospitals have their own CCT RN on standby. SFFD is notorious for dropping off an MI which qualifies for the Cath Lab at one of the local little general hospitals. The ED does a 12 lead EKG (I don't believe SFFD does that yet), establishes an IV, and maybe an airway, and a Nurse is put on the SFFD or Private truck to go another few blocks to the cath lab. Either way it is a lose, lose situation in that city.

I don't believe the pharmacology is the biggest issue here. Remember these FFs still have their notes cards from the medic mill. I seriously doubt the test was given as "What is the dose of Epi for....?" It was probably word problems or scenarios. Now you have: Reading comprehension? Math? AND medical assessment? So, where is the actual deficiency? 40 hours will not be enough to correct this mess. I can't believe the test wasn't given out to the entire department but that would have disable EMS in Naple to where Collier County EMS would have had to step up to the plate. Dustdevil, remember the thread you started about the Marco Island FF faking his credentials? Marco Island is next door. This is not an exception to the standard for the area.

For kids that is the general rule. For adults some text books use the terminology of "1 cm past the tip". And, others say until resistance is met. I just don't like Oregon's phrasing of "advance as far as possible". Especially, with the FD lack of understanding of some basic ALS principles, (See Naples FD thread), there could be a lot read into that. For intubation, with kids and babies, I put my finger at the desired level and am careful not to go deeper. For adults, I grap about 1- 2 cm more than what I think will be the correct placement.

This is what happens when you memorize and don't LEARN pharmacology. The medical director was probably testing for an understanding of the medications. The month of studying probably consisted of pulling out the note cards and more memorizing. Of course it would have been better if the 700 hour medic mill education with clinicals on an ALS engine wasn't the norm for some FFs to get their cert.

Live saving drugs pulled from fire truck in Naples http://www.nbc-2.com/articles/readarticle....d=21540&z=3 LEE COUNTY: In an emergency, you trust paramedics will have the equipment and skills needed to save lives, but when members of the Naples Fire Department respond to their next call, many crucial tools won't be on their truck. We asked the fire chief and a paramedic whether your safety is at risk. Many firefighters double as paramedics with skills and equipment to save your life. "You need care, you need it right away," said Adam Nadelman. Twelve of fourteen paramedics with the Naples Fire Department failed a test on drugs and their side effects. Because of that, a fire truck at the main station was stripped of medicines, IVs, breathing treatments, heart monitors and other advanced live saving equipment. "You as a private citizen want every confidence they know when to use the drugs and when not," said Dr. Robert Tober, Collier County's EMS Medical Director. Tober says Naples paramedics had a month to prepare for the test. He decided to pull the drug boxes until paramedics learn how to use them. "They have to follow my guidelines because it's my license they're operating under," said Tober. "I don't think it was fair," said paramedic Adam Nadelman. Nadelman didn't take the test but says removing potentially life saving equipment from a truck is putting lives in jeopardy. "It could be 10 minutes before you get advanced care," said Nadelman. Nadelman says the failure of the paramedics was just a fluke. Naples Fire Chief Jim McEvoy says they are all state certified paramedics. We asked if he was concerned. "No I'm not concerned. This is what we do in our business. We do a test to determine what skill levels are," said McEvoy. "I am concerned," said Councilman Gary Price. Price is disappointed Naples paramedics failed their test. He says safety should be the city's number one priority. "Let's do what we need to, to get it right, and get them trained," said Price. Naples paramedics will get 40 hours of training next month, retake the test, and if they pass the fire truck will be re-stocked with advanced life saving equipment like IVs and drugs. Councilman Gary Price plans to bring up the issue at the regular council meeting on Wednesday. Dr. Tober says all paramedics in the county will also be tested. http://www.nbc-2.com/articles/readarticle....d=21540&z=3

This could get intersting. SFFD loses dominance over 911 ambulances http://www.sfgate.com/cgi-bin/article.cgi?...4.DTL&tsp=1 Jim Doyle, Chronicle Staff Writer Saturday, September 13, 2008 State officials have revoked the San Francisco Fire Department's lock on emergency ambulance services, a move that is expected to force city officials to put those services to competitive bid, according to documents obtained by The Chronicle. The decision, which cited the lack of competition among San Francisco's 911 medical care providers, comes as the California Emergency Medical Services Authority is pressing counties across the state to improve the quality of patient care. State regulators zeroed in on San Francisco's ambulance system when recently inspecting the city's emergency medical services plan. Many California counties, including Alameda, Contra Costa, Santa Clara, San Mateo and Solano counties, have put pre-hospital emergency services out to bid in recent years, and many counties have contracted with private ambulance firms to deliver 911 medical services under strict performance standards. In a series of reports, The Chronicle has raised questions about the quality of 911 medical care in San Francisco after finding that first responders arrive late in about 27 percent of the most urgent medical cases - falling short of the city's goal for help to arrive within 6 1/2 minutes after receipt of a 911 call involving a potentially life-threatening emergency. Virtual monopoly For the past decade, the San Francisco Fire Department has enjoyed a virtual monopoly in providing emergency ambulance services. But the decision by state regulators could compel the fire chief to demonstrate that her agency is the best qualified to deliver quality 911 medical care. "If the state requires us to go out to rebid, we will go out to rebid," said Dr. Mitch Katz, director of the San Francisco Public Health Department. But he stressed that the state's ruling turns on "a very narrow legal question that's based on an esoteric statute. ... The (state's) letter itself is a little puzzling, so I'm having the city attorney review it." In a July 31 letter to Dr. John Brown, the city's emergency medical services director, California Emergency Medical Services Authority Director Steve Tharratt rescinded San Francisco's long-standing antitrust immunity in running its 911 ambulance operations and advised city officials to begin a competitive process. He made his ruling after the city submitted 127 pages of documents. Bonnie Sinz, the state's EMS systems division chief, said the Fire Department as well as any private ambulance companies interested in providing 911 emergency services in San Francisco would be expected to participate in the public bidding process. The Fire Department has been the primary provider of 911 medical services in San Francisco since taking over the ambulance fleet from the Public Health Department in 1997. Firefighters and paramedics are dispatched by the city's 911 Call Center. Private ambulance firms handle fewer than 2.4 percent of the city's 911 ambulance services, down from about 20 percent in the late 1990s, state officials said. "The ambulance service in the city has a long, rich tradition," said Fire Chief Joanne Hayes-White. "In my opinion, it's something that works very effectively." Emergency medical consultant Mike Williams, who helped develop California's emergency medical standards, said private ambulance companies have succeeded in delivering a highly flexible emergency response in some cities, putting more ambulances on the street during peak hours. Accountability "Where you would see improved quality is in a higher confidence level that an ambulance would arrive in a certain number of minutes - based on a written performance standard that they have agreed to," Williams said. "With a franchise, you can hold an ambulance provider accountable to a much more precise standard." But there is no silver bullet, he said. San Jose, San Diego and Seattle rely on partnerships between fire agencies and private ambulance firms to deliver 911 medical services. Boston, Denver, and Austin, Texas, provide these services through a "third service" public agency that is not a fire department. "A community deserves to have high-level ambulance service, because that's what they're paying for," he said, "and if they're not getting it, that's when they should be asking a lot of questions." For decades, state officials had granted San Francisco an exemption from federal antitrust laws in operating its emergency ambulance system. But after close inspection, they determined that the city was no longer qualified for that exemption because of significant changes in its system since 1981, when the state enacted laws for emergency medical services. In recent years, 911 medical care in Oakland, San Jose, Monterey, Riverside, Los Angeles, Santa Barbara, San Luis Obispo and San Diego has been put to bid. Such competition among providers, experts say, helps ensure that taxpayers receive quality care at a reasonable cost by holding public officials and ambulance providers accountable. If a public agency or private ambulance firm delivers substandard care, that agency or firm is less likely to receive a contract when the services are rebid. Many contracts also include financial penalties for slow 911 ambulance responses. Suburban communities have relied increasingly on private ambulance firms to deliver emergency pre-hospital services. But it can be difficult, experts say, for private providers to turn a profit in an urban area where so many patients are uninsured - unless their ambulances simply provide backup service for a fire department or public health agency. Private ambulance firms may also place a premium on profits and, in some circumstances, may be less accountable to the public. David Nevins, president of the California Ambulance Association, said: "Going out to bid can be a costly endeavor. There may be some alternatives to just jumping in. ... First, you would want an impartial evaluation system by an industry expert to identify the strengths and weaknesses of a system and make a recommendation to the governing body." Competitive process Federal antitrust laws, which apply to local government as well as businesses, discourage the creation of monopolies and restrict price-fixing by service providers. State law allows local agencies to choose emergency ambulance providers "if a competitive process is utilized to select the provider or providers of the services." An exception to this rule, known as a grandfather clause, allows an antitrust exemption to a jurisdiction "that continues the use of existing providers operating within a local EMS area in the manner and scope in which the services have been provided without interruption since Jan. 1, 1981." Tharratt wrote on July 31 that "it is our determination that (San Francisco) is not eligible for grandfathering" because of what he called "multiple changes" to its emergency ambulance service in the past 27 years. Brown, who heads the San Francisco Emergency Medical Services Agency, had told state officials in a June 3 memo that he "cannot determine in good faith that there have not been one or more material changes in scope and manner" of the city's 911 ambulance services since 1981. He cited several changes, including the number and continuity of ambulance providers and the declining number of 911 calls handled by private firms. San Francisco officials had not sent an emergency medical services plan to the state since 1999, although state law requires the submission of a revised plan each year. When city officials submitted one in March, state regulators focused on San Francisco's lack of competition for 911 medical care. http://www.sfgate.com/cgi-bin/article.cgi?...4.DTL&tsp=1

Unlock your CAPS button please! No, you don't have to be a F.F. to work in Florida. But, Florida is a large fire based EMS state so it might help to chill the fire god and just a medic attitude. There are a few county EMS services in that area such as Lee County that have decent pay and benefits. Florida likes ALS everything from ambulances to engines to golf carts. Many of the services have 2 Paramedics per truck. There are few if any BLS only 911 response in this state. ALS something will run also. Florida has its own state EMT-P test which is not the NREMT-P. 36 y/o? That would depend on your physical shape and conditioning. Here's a rough list of the EMS providers in FL and whether they are Fire, private or gov. http://www.floridaemstars.com/pilot_group.htm

Here's an interesting skills check off from Oregon: http://www.oregon.gov/DHS/ph/ems/certific/...rence_guide.pdf page 26 I can advance a bronchoscope in pretty far but that is through direct visualization and care. I would not even think of doing that blindly with a suction catheter. One must be aware of what they are poking in the lungs. So, take your pick of any or all of the possible correct answers. Unfortunately for some questions, the correct answer for the test may not always be the practical answer for a real situation. That's where your own judgement and commonsense takes over.

We don't have to wait for the autopsy. A quick bronoscopy will tell volumes about the "traumatic intubation". Being a teaching hospital we love to photograph and/or save to CD all those great examples of what over zealous intubators can do to the respiratory tract. It also helps when vocal cord paralysis is noted after extubation and the patient wants a settlement. The damage a suction catheter can do in unskilled hands is pretty amazing too.

ETTs are different lengths based on the size. Thus, whatever physical landmarks you use on the patient will still vary according to the size of the tube. Look at the ETT in reference to the stylet before you intubate and then use the stylet as your guide. Dust, you may be thinking of the distance for NT sx. Or, to the way we used to confirm tube placement was to palpate the cuff at the sternal notch. I don't think anything like the Chula formula will be on a Paramedic exam.

If you read 4 different text books you'll get 4 different answers. I can also guarantee the answers will differ from an RN or RRT exam also. The two most common are: Until you feel resistance and 1 cm past the end of the ETT Even with the resistance felt, you should pull back before applying suction. You don't want to suck up lung tissue or tear it to where blood will be your primary secretions. I never advocate "until you feel resistance" with a pedi or infant. For those you measure to the mm. Leaving skid marks on their carina is something you want to avoid.

All personal opinions aside, it will still depend on what the State of California has to say about the issue especially with the new rules that are being pushed forth. After determining that, if the OP still has a year, 2, 3, 4 or 5 to go before California considers the length of time lapsed after conviction acceptable, he will then have to find a school that may or may not accept him before that time. Many employers will go by the state's acceptance of the conviction as a guide to hiring. Other character factors will also need to be considered. Some employers may have gotten burned by hiring someone with a previous conviction and will not be as accepting for insurance and/or liability concerns. Others may be forgiving for a 2nd chance. So, the OP must find out from the State what the acceptable time post conviction is to even be able to start an EMT class. Everybody's opinion and every State will be different. In California, every county is different but that is now changing a little. At this time one misdemeanor DUI conviction will not prevent him from becoming an EMT provided the time post conviction is acceptable by the state of California. He should be prepared for more scrutiny about his character traits overall. Right now the responsibility rests on the OP and not the opinions of an anonymous forum.

Get it repaired ASAP especially if you are continuing to lift or plan to lift in the future. This is not something you want to mess around with for too long. If the heaviest thing you lift was a pencil, the advice might be different. If you don't want a pencil to be the heaviest thing you can lift, take the medical advice about the repair. If you feel more pain it could mean the hernia has become incarcerated or strangulated. That could mean it can no longer be reduced or pushed back into place. This could lead to a blockage in the intestine. If it is severe enough it may cut off the blood supply to the intestine which leads to necrosis. I don't think I need to go into details about what happens then. Your abdominal muscles are what keep your back in good position regardless of how well you lift with your legs. Any weakness there will eventually have a cascade effect. If you experience a sharp and sudden pain while lifting, it could also throw off your partner's balance and cause injury to him.

How about a thread on basic HTML for quotes? My advice still stands for the OP. Check with the state and then the schools. Once you know you're clear there, check a couple of employers. Most of the big companies will post some of their requirements on line. Be straight forward and don't hide your conviction from any licensing agency or employer. That would be worst than the conviction itself. You may face tougher scrutiny in CA now as it is going through its tougher legislation changes but everything should be spelled out in the new requirements that are posted on the EMSA website. I do not approve of drinking and driving. If you are arrested a 2nd time, then whatever punishment comes your way will be very much deserved even if that includes losing your certification/license.

When someone makes statements like the above, it is usually inexperience talking. I also remember this person inquiring if a service hired new paramedics a few threads ago.

Unfortunately, California has already given us enough examples of those with criminal convictions that were allowed into a system that failed to do any criminal backgrounds checks. And, if you are convicted of a felony in one county that may even revoke your license, you just go shopping for another county that didn't do checks. Good example which made for interesting reading while I was in Calfornia,: http://firefightingnews.com/article-US.cfm?articleID=31586 Spouse beating and DUI both demonstrate a lack of control and good judgement. I don't get how you compare a vehicle collision if there is no fault declared or noted impairment by substance abuse with a conviction for spouse battering and DUI. But, that way of thinking is exactly how others will seek loop holes in the system. Beating your wife and wrecking a truck if doing everything by the book would have to be considered with the same weight in a court of law, right? As far as medication errors, the intent can be the deciding factor there. If you had the intent to do harm with the medication such as the case with the "Angel of Death" in Glendale, CA, then yes decert and prison is the answer as it was for that guy. If it is an error, no. If you drink and drive after knowing the risks, then I would say even if you did not have the intent to harm someone, you knew very well of the potential. If you hit your wife, the same can apply. Edit for the following post: How many of your slip in judgements have landed you in jail?

I didn't make the "I'm glad I don't live in your area" remark. However, I do know the inconveniences of working with people who have convictions. It doesn't matter whether it is drugs or alcohol, if they hold a license they may be treated the same. Nurses and RRTs will have restriction on narcotics. In other words, rarely will they be allowed privileges without direct supervision and transport will be out of the question. This also goes for a Paramedic in our flight program. In some states, the Paramedic may also be required to work at the EMT level. This may stay on their record from 5 - 10 years depending on the state. Some may have a probation period as part of their licensing requirement which may include random drug and alcohol screening for up to 5 years. Again, this will vary from state to state and in California's case in the past, county to county. RT schools and some nursing schools may not allow entry for 5 - 10 years after a misdemeanor DUI. Unfortunately, not all EMS state agencies even run background checks. California is just now trying to impliment some statewide checking and reporting system in their very much county divided system. I don't hold judgement against those convicted but there also should be a consistent oversight. Just being convicted once might also mean they were only caught once. Of course I'm not saying that for you or everyone but this is an annonymous forum. Sometimes people look here for validation of their actions. Many times they will find the support they are looking for but that may not mean the State and potential employers will hold the same views. It is very easy to check with the state of California and then the county to find out the pros and cons. If the state is not going to grant a licensure for 5 or more years, then why worry about the employment issue until you can get a license. If the school abides by whatever rules the state has on the books, then you may have a problem. California is in the process of changing its rules so before making any assumptions, just check with the state office and go from there.

Yes, but Ruff, in other professions if you are granted licensure (after you are even granted permission to take the classes) your license may be flagged with special notations. This will allow the employer to consider whether special monitoring may need to be in place as a condition of your employment. I don't believe that many of us in the profession have a conviction on our records.

You state your age as 33 now and this happened only 4 years ago. You can not blame ignorance of youth for getting the DUI. Besides insurance rates, an employer will have to look at your ability to make descisions. At 29, a full adult at least by age, getting the DUI meant you made a decision that could have had deadly consequences. However, in California, you shouldn't have too much problem since your conviction is petty compared to others that are turning up in their system.

If you take all the courses that the American Red Cross offers you could end up with more hours of training than an EMT-B. Since they are offered by individual class levels at various and not a straight through commitment, they may work better in your schedule. Some hunting and gun clubs also teach first aid with the outdoor type in mind.

Professional Welders would probably be some of the few that wouldn't be fooled by O2 Bars. Even some medical people don't understand the different grades of O2, concentrations, entrainment and the delivery systems all that well.