VentMedic

While I argee with Rid, I do not believe it should replace the EMT-P if CCEMT-P is not recognized in your state. Also since there is not listed standardizations or even the disclaimers that come with other NATIONALLY recognized certification such as FP-C, CCRN, CEN etc, it is misleading to put that on your signature after a 24 hour weekend "critical care" course which can easily be done in many parts of the country. That is a deception of who you are presenting yourself to be to the public. The RN credential always precedes any nationally recognized certification. Usually, in the hosptial, staff is allowed 1 education listed, license, and 1 specialty cert for the area they are working in to be on their tags. Sometimes 2 might be listed. The "certs" RNs list are nationally recognized with a standard exam. For each of their "certs" they may be required to maintain up to or more than 100 CEUs in addition to their other requirements such as ACLS and PALS.

When the college programs started in the late 1970s, that was the intended route. That is how I and a few others on this forum got a 2 year degree for Paramedic 30 years ago. Unfortunately, since it was a "skill" and "recipe" focused profession, it was cheaper and easier to do it the medic mill route. Some actually thought if the Paramedic did too much "thinking" on scene it could delay transport. You can't imagine all the excuses I've heard over the years from people avoiding "education".

Yes, and now we have the opportunity to weed the garden of those that were minimally trained "tech RTs" from the 1 year programs. The minimun entry is an Associates from an accredited college Respiratory or Cardiopulmonary program. I got my Associates in RT after my Associates in EMS. At least I had the college A&P to transfer but it was still two more years. It was trully an excellent choice which enhanced my opportunities in EMS later for CCT and Flight. I would not have gotten the opportunities just in EMS to work in ICU, NICU and PICU with the complex patients and technologies. http://www.broward.edu/respiratorycare/res...m/page8021.html After that, when the hospitals were pushing for Bachelors educated RTs, I went to UCF in Orlando. http://www.catalog.sdes.ucf.edu/UCFUGRDCatalog0809.pdf (page 130) Then, I needed a Masters to advance in the profession as well as to teach. So: http://www.education.miami.edu/Program/Pro...p?Program_ID=16 This Masters solved the teaching issue, enhanced my respiratory knowledge and opportunities in research and provided practical information on maintaining the body to avoid injuries. Now there are Masters degrees in Respiratory but teaching future generations is the focus now for growth. I will not teach in a Paramedic program unless they require college level A&P. Without it, too much time is wasted trying to explain simple concepts that should already have been learned before getting to the "ALS" stuff. Of course, many instructors teach only what is to be memorized in the book. Respiratory Therapy has two credentials for national certification by exam from the National Board for Respiratory Care (NBRC). They are Certificied Respiratory Therapist (CRT) and Registered Respiratory Thereapist (RRT). www.nbrc.org There are also specialty certifications through the NBRC that gives credibility and may be required in some states to work in those areas. Neonatal Pediatric Specalist Certified Pulmonary Function Technologist Registered Pulmonary Function Technologist RTs have a strong national organization that represents them in all levels of legislation. http://www.aarc.org/ Each state has its affiliate organization to the national. http://www.aarc.org/links/links_affiliates.asp BTW, I retire from EMS with my vested 20 in November. That gives me 30 total.

And, you can not legallly present yourself to be a paramedic until you have achieved certification and licensure. Bledsloe pointed out there are only a handful of states that have a Critical Care level by state statute. TN http://health.state.tn.us/ems/criticalcare.htm WV http://www.wvoems.org/Services/Certificati...20/Default.aspx One of Florida's "chain career schools" is now offering this program. It is interesting to see how they have presented their credentials behind their name. The name of a program does not replace the license credential you are working under. Florida still has two credentials by statute: EMT-B and Paramedic. http://www.fmti.edu/criticalcare.htm Also, as Bledsloe pointed out, there is not a national standard for these courses, and the education varies as does the testing. For a legal signature, it should only be the letters that pertain to education, licensure and a RECOGNIZED certification. http://www.ems1.com/columnists/bryan-bleds...e-Vanity-of-EMS Where did you get your certification? What status and authority did the school have to certify you? Was it presented to you in the same manner that ACLS offers the disclaimer for its authority in actual practice? How many hours? 24? 40? 80? 200? Clinical experience? RNs that work CCU don't call themselves CCRNs unless they pass the NATIONAL certification and then it goes behind their licensure credential of RN. Flight Paramedics may have FP-C, but again it goes behind the EMT-P. CFRN is a cert for RNs that can go behind the RN. Both CFRN and FP-C are nationally recognized with standards for certification. However, it is only a demonstration of knowledge. It is acceptable to put your job title on your tag. Ex. CCT Paramedic or EMT-P, Crtical Care Paramedic. But, it should not be presented in a way that is misleading about the license you are working under. You may also work inside the hospital without any reference to your Paramedic license if it is not recognized within the walls of the hospital (ex. ED Tech).

In the majority of states, an RN is not allowed to delegate a responsibility such as triage. If someone has to bring up a Paramedic with 18 years of broad experience to compare with a 1 year RN, then I am not the only one that thinks highly of RNs. The other factors to consider, why would a Paramedic of 18 years want to work in an ED? Burnt out or injury? What was the Paramedic's initial education? How much effort was put into continuing education during those 18 years besides just the minimum to renew? Define broad experience. Does that mean the paramedic has seen a few calls of peds, a few of geriatrics, a few belly aches and a few MIs? A few good war stories? A lot of attitude for "BS calls"? I'd be all for an 18 year experienced, educated and enthuiastic Paramedic to do triage. But, what about all the new Paramedics who might want to do the same job because they decided they didn't like the street? The job description would probably just read "EMT-P cert, some experience preferred". The new RN may have done 6 months med-surg and 6 months ICU. Both of which involves more education, training and lots of patient contact for 12 hours per shift. The RN could see almost as many patients in that time as an 18 year Paramedic who sees 1 - 2 patients per shift, 2 shifts per week. The Paramedic is expected to do assessments after just 700 hours or about 6 months of technical training. What is so absurd about an RN with a 2 year college degree that includes 2 semesters of A&P, Pathophysiology and Microbiology with all these courses reinforced through 2 years of the nursing processes courses as well as the 1200 plus clinical hours. It is this arrogance that always manages to show itself at the regional EMS meetings when the topic of education is presented. So many think that their 6 months of education makes them the same as RNs and continuously try to compare themselfves to other professions. So, instead of establishing our own identity the Paramedics make the case for "don't need no more book learnin'". I defend Paramedics on a lot of things both inside and out of the hospital. However, I will not defend or stand for the belief that 6 months of training is sufficient to state that the Paramedic is prepared to take on more responsibilities than for PreHospital at this time. Any half-way decent attorney could take just the few questions I presented at the top of this post and make a case. EMS has not broaden its education and it has become too blind to see the rest of the healthcare professions expand their knowledge and scopes. Now Ruffems: I know you didn't mean that...at least not the Respiratory Therapist part. BTW, it hasn't been all roses for 30 years between RNs and RRTs either. However, when the RRTs got out of their "tech" status by achieving an Associates minimum for entry, Bachelors for some of the reimbursement Bills and minimum for some job descriptions with more Masters degrees in the professions, RNs took notes. They saw we were more than someone who just intubated, set up vents and put in A-lines when one was needed. We now had an education to compliment the technical skills.

Is that the only part you go out of that whole article? Nurses have a stronger educational foundation and don't believe that their "education" exists only in weekend certs. Numerous other professionals also use those same "certs" but it is merely a formality and not an end to all education. Your statement implied that your education levels were the same because the RNs also had to take ACLS and PALS. An EMT-B can also take those classes. Paramedics are well trained with a technical education for PREHOSPITAL situations. The exception being those that have put some effort forth and have gotten at least an Associates degree in EMS or the sciences. RNs are educated for the fundamentals of disease processes and have a stronger foundation to specialize than the career school 700 hour Paramedic. A Flight Paramedic has additional training and if hospital based, do spend a great deal of time in the ED to keep their advanced procedures current and provide assistance. Triage is still done by an RN. Flight Paramedics usually have at least 3 years of experience but even that can vary. Out of 100+ applications that we get for each Flight Paramedic posiition, only 5 - 10 might meet the bare minimum qualifications and that is being generous. Out of that pile, we may get 1 that is a decent candidate for the position. As Bledsoe pointed out, there are no national standards for the Paramedic and most of the letters they put behind their name. Even the credential EMT-P is variable. Lack of accreditation for the schools at this time leads some medic mills to teach by memorization and "for the exam only" method. The hours to be a Paramedic vary from 500 - 1500. Even the exams vary from state to state. Other professions have a more structured and accredited educational standard. Even 2 years of a mediocre nursing education beats a 3 month "for the exam only" medic mill. At least in nursing, they will get several weeks of orientation and additional education once they graduate to get them up to speed if they have potential. If not, they may be told to seek employment elsewhere. The Paramedic grad from a bad medic mill or online program rarely gets the same benefit and may continue to work on the job regardless of their abilities. All the while they can collect more letters and patches without much accountability through weekend courses. They may even put CCEMT-P behind their name through an inferior knock-off of the UMBC program. If you want to work "as a nurse", go back to college and get a nursing degree. Isn't that similar to what you tell the nurses that want to work in the field?

Nurses are very aware of med errors. If you are not aware of this also I suggest you do a little research on the topic. A nursing home or inhospital RN may care for 3 - 20 patients at one time. That can add up to over 300 medication contacts per shift. Let's do a little clarification on "cert classes and education". A weekend "cert" does not replace higher education. ACLS, PALS and NRP can be taken by just about anyone with recommendations only for previous education or license. It truly doesn't take much effort to pass any of these classes as they are meant to be an overview of guidelines used in resuscitation. This is the weakness in EMS that it relies on "certs" to replace solid education. RNs and other professionals know these "certs" are in addition to their degreed education and any additoin education and training they receive for their profession. See the Bledsoe article: Vanity in EMS. http://www.ems1.com/columnists/bryan-bleds...e-Vanity-of-EMS

http://www.ems1.com/columnists/bryan-bleds...e-Vanity-of-EMS The Vanity of EMS by Bryan E. Bledsoe Here, in the Republic of Texas, there are five levels of EMS providers: Emergency Care Attendant (ECA), Emergency Medical Technician (EMT), Emergency Medical Technician-Intermediate (EMT-I), Emergency Medical Technician-Paramedic (EMT-P), and Licensed Paramedic (LP). The ECA is the same as a first responder in most states. The LP is something unique to Texas. Let me digress. In Texas, as in most states, EMS personnel are not truly licensed like physicians, nurses, plumbers, barbers and so on. There is no state statute that defines the profession and details licensing requirements. Instead, EMS personnel are “registered” with the Texas Department of State Health Services (TDSHS). Several years ago there was a push for licensure. Licensure, in Texas, would require that a new law be established by our legislature, which only meets biannually. EMS has never been on the legislature’s radar screen and the bill never went anywhere. In a gesture of good will, TDSHS established a provider level called “licensed paramedic.” To become an LP, you needed either a two- or four-year degree in any field. While the intentions were good, I considered this to be a step backwards. From a functional and legal standpoint, there is absolutely no difference between an LP and an EMT-P. Some systems will pay a little more for LPs as an incentive — some don’t. While the LP level does recognize those with a degree — and I don’t mean to downplay education — it does not really benefit the profession. LPs are not truly licensed and are not allowed to perform any additional skills or have any responsibilities above an EMT-P, despite their increased education. That is wrong. Instead of having a higher level that providers would actually want to strive to reach, an LP is simply an empty moniker that serves to bolster our vanity. But, as has been the history of EMS, the slogan, “Give them a patch and they will shut up,” seems to have worked again. If the state does not give you a patch, you can simply make your own. I have recently seen Texas EMS patches for “Tactical EMT” and “Tactical Paramedic” (whatever the hell that is). Recently, I saw one that read “Dive Medical Technician.” These patches are simply knock-offs of bona fide EMS patches and create an adverse effect on the industry’s image. The motivation to make these and wear these is beyond me. Another vanity favorite in EMS is the self-assigned title of CCEMT-P, which is the acronym for Critical Care EMT-Paramedic. Most people self-assign this title after completing a CCEMT-P course or a similar course. And while some states have started to recognize this level (i.e. Tennessee, Louisiana, West Virginia), most have not. This became a point of contention in a legal case not too long ago where I was an expert witness. The paramedics called themselves CCEMT-Ps, yet there was no evidence they passed any sort of certification examination. The plaintiff’s attorneys had a field day with that and the paramedics looked foolish. In many countries, critical care certification is available for EMS. Generally, you need four to six years of field experience and a year of critical care education — similar to nursing. Then you take an amazingly difficult certification exam. That is quite different than in the United States, where people take a 120-hour EMT class, go immediately to an 800-hour EMT-P class, then take the 80-hour CCEMT-P class – after which they feel really competent to take care of complicated ICU cases. We are only fooling ourselves here. I am very pro critical care paramedic; I wrote a textbook on the subject (heavily based upon the Canadian, nursing and flight nursing curricula). You cannot master 1,160 pages of complex material in two weeks or 80 hours! Imagine if we all used the initials from each class we took (e.g. Bryan Bledsoe, TCHGC, CTOP [Texas Concealed Hand Gun Course, Case Tractor Owners Program]). http://www.ems1.com/columnists/bryan-bleds...e-Vanity-of-EMS And finally, there is mental health care. Virtually anybody can call themselves a “mental health care provider” in the United States and this term can be found sprinkled throughout EMS. There is a significant discrepancy in education in mental health care. Psychiatrists are physicians (MD or DO) who complete a four-year residency after medical school and take certification examinations in psychiatry. Overall, they have 12 or more years of education beyond high school. Clinical psychologists are health care providers who hold a Doctor of Philosophy degree or Master’s degree in Clinical Psychology and have passed a certification examination in clinical psychology. They often have eight to 12 years of education beyond high school. A PhD in psychology does not automatically make one a psychologist. Social workers — usually with a bachelor’s or master’s degree — do a great deal of counseling. Then, there are marriage counselors, substance abuse counselors, music therapy counselors, and on and on. Then, there are pastoral counselors — priests, rabbis, ministers — who also provide counseling. Some have received counseling education in their seminary — some have not. While the standards for psychiatrists, psychologists, social workers and other professional counselors appear standardized, many of the other providers are not. This has given rise to various certifications in mental health care. You can become certified in such areas as Thought Field Therapy (TFT) or Eye Movement Desensitization and Reprocessing (EMDR). With TFT, you repeatedly thump the patient in the head which unblocks Qi (energy flow) and heals various problems. The founder of TFT even reported success at using this method to treat atrial fibrillation. Advanced practitioners can even treat people over the phone using only their voice — no tapping needed. EMDR is similar. If interested, you can obtain “board certification” in a mental health field. For instance, the American Academy of Experts in Traumatic Stress (AAETS), based in New York, offers “certification” in various mental health disciplines. You can become certified in: Board Certified Expert in Traumatic Stress Board Certification in Forensic Traumatology Board Certification in Emergency Crisis Response Board Certification in Motor Vehicle Trauma Board Certification in Disability Trauma Board Certification in Pain Management Board Certification in Illness Trauma Board Certification in Bereavement Trauma Board Certification in Domestic Violence Board Certification in Sexual Abuse Board Certification in Rape Trauma Board Certification in Stress Management Board Certification in School Crisis Response Board Certification in University Crisis Response Later, if you have the time and money, you can obtain a Certificate in Traumatic Stress Management or a Fellowship in the American Association of Experts in Traumatic Stress (FAAETS). I called the following organizations to determine whether AAETS was recognized as a certification body: American Medical Association American Osteopathic Association American Psychiatric Association American Psychological Association National Association of Social Workers Of these organizations, only one had ever heard of AAETS. None recognized their board certification scheme. The term “Board Certified Expert in Traumatic Stress (BCETS)” comes up a lot in EMS, especially related to CISM. Interestingly, you do not even need a college degree in psychology to become a “board-certified expert.” Amazing. This discussion came to light because I recently had to re-certify my emergency medicine board certification (required every 10 years). The examination was quite intense with both written and oral sections. I bought several books, took a review course, and then turned off the phone for more than a week to study. I flew to Philadelphia and completed the exam. It cost well over $4,000 overall, but it was worth it. To people who don’t know me, board certification by a nationally-recognized body assures the public that I have met certain national standards. The term NREMT or NREMT-P means the same. You can’t say the same thing for LP, CCEMT-P or BCETS. While these monikers may make us feel important, they actually dilute and degrade our profession.

The color of the tank can be misleading. It is better to check the label, the DISS and Pin Index. There are many different composite tanks on the market and even in home care you may have patients on different gases by portable tanks with Nitric Oxide. Mixed gases may have a green should but may contain the majority in another gas such as an HeliOx mix of 70/30 where only 30% is O2. Never assume anything. The international color code has a different color coding: O2 - white, N2O - blue, Air - white & black. It is not uncommon to see these tanks also mixed in with the others in some parts of the U.S. Industrial O2 may be black and Scuba tanks come in a variety of colors even for the mixed gases. Pure O2 may have a white shoulder. Check the label. I like venturi masks since they are a true high flow but at a low FiO2. NRBMs are actually not "high flow". They are limited at whatever flow you set them for. Testing and researching Oxygen? Guess why I became a Respiratory Therapist? The other reason was to be able to do so much more for a patient's breathing problems than I could ever do as a Paramedic. We have been doing research through special grants for many years. Just one of the journals that carry such research is: http://www.rcjournal.com/ Almost any medical journal will give you their methodolgy for research. If you want more information, there may be an email listed. In the reference section of even JEMS, you can check out the links to the serious medical journals. EMTs and Paramedics don't believe that other health care professionals have "protocols". However, when we enact our protocols in the hospital there will be many different pathways and guidelines to choose from. We are not bound by "recipes". Even within the same hospital we may utilize several different variations of an ARDS, Acute Lung Injury, Lung Protective Ventilation, TBI or Sepsis protocol. The protocols will be written for both the RN and the RRT. Research may be pulled from careful documentation at a later date or the patient's data will be entered into a collective database for multiple studies.

Let's find out what a review of the literature shows. This research was to see if Paramedics can adequately triage in the field to determine if transport is warranted. http://www.naemsp.org/pdf/triageevidence.pdf Accuracy of Prehospital Triage and Non Triage: What Does The Evidence Show? David C. Cone, MD Chief, Division of EMS Section of Emergency Medicine Yale School of Medicine

You truly live in an area where nurses are limited by something and probably not their state protocols. Nurses can and do all the skills a paramedic can and much more in the majority of states. This has been the case for at least 3 decades for nurses on Flight and specialty teams. Nurses that work in progressive EDs and ICUs definitely are nothing like you described. It is too bad you have such a limited view of these very valuable professionals. Being able to do a few skills is just a few of the things that go into patient care. It is the belief that these skills are the absolute end all solution to all problems and for that reason many paramedics have seen no need to get past that for more education. You can argue that a nurse can not do an EJ. But, do you really want to get into a peeing match with the things a nurse can do? I can guarantee you will lose that match very quickly. Even the LVN could list some impressive skills back in the day they were used. Okay, the Paramedic may be able to triage under the supervision of an RN. That exception was made in Kentucky since triage is not a responsibilty that an RN is suppose to delegate under any circumstances. Unless your state also has that clause in the statutes, there will eventually be penalities to pay as in this case. Also, the paramedic would not be able to do equal share if an ICU patient is held over, so other accomondations would have to be made since the Paramedic is still not capable of doing everything in the ED in the majority of states. Most states still say their license/certification is good PREHOSPITAL and PREHOSPITAL only. Work on the eduation and standardization issues so you can present some valid arguments instead of trying to boast your "skills".

Many home care ventilator patients do not need supplemental O2 and will just run of the compressed air from the vent's compressor. (ex. Christopher Reeve) Infants with cyanotic heart disease may also be ventilated by 21%. Often both compressed air and O2 are blended for infant transport ventilators for more stability of FiO2 delivery as opposed to some venturi methods on some adult transport ventilators. Anyone working with any type of medical gas should also be able to identify the tank by the Diameter Index Safety System (DISS) and Pin Index for added safety regardless of the color of the tank. The exception again will be for those that work with Neo/Pedi transport teams that will run other gases through they ventilators other than O2 and Air. This could include Helium, Nitrogen, CO2 and Nitric Oxide. They will use a custom high pressure hose that has the specific gas connector at one end and either an O2 or Air connector at the other end to couple with the ventilator. This can present some hazards if you are not well versed in the different gases used by the teams. I hope the welding supply company was supplying you with medical grade O2 and not industrial grade. QA can be a pain when when using some cascade systems. Medical grade O2 is pure oxygen. Oxygen Bars are able to slide under the law by providing oxygen which is slightly higher than an FiO2 of 0.21 from an industrial grade concentrator. Home care patients use medical grade concentrators which may provide close but not quite the same O2 concentration for liter flow as from an O2 tank. In other words, a patient that is on 5 L/min NC on a home concentrator may only be the equivalent of 2.5 - 4 L from a tank depending on the make, model and service record of the concentrator.

That's a good number since you don't actually need a blender to obtain an FiO2 near to that.

Now, let's talk about how the Paramedic fits into this. A Paramedic's training is focused for PREHOSPITAL. Since many of the Paramedic programs differ in how the minimum standards are taught and that many schools are not accredited, it is hard to maintain a standard of education for comparison at even the simplest level. Paramedics have the choice of a career college, state or community college and online programs with outsourced clinicals. The instructor oversight varies greatly even within the same type of educational system. The medical oversight for the initial and continuing education varies even more once the Paramedic enters the work situation. Some medical directors fail to adequately monitor the core skills of their staff to where even those have to be questioned. One could only guess how much effort is placed on their knowledge as well. Not all Paramedics will have the same work experience. In Florida, you may be at a disadvantage for getting work in a 911 system if you are not a FF. It is not unually for many Paramedics to work an ALS (not CCT) transfer truck and not start an IV or intubate for years. They may also not put the same effort into their assessments as one might in a different job description. Those that may want a change may find themselves placed in a situation to which they are not fully prepared for. Some may not even know how unprepared they are. The few that do realize the need to seek more education than their prehospital training prepared them for may excel at new opportunities. Unfortunately it will be difficult to assume all will be on the same page. EMS is still adding more certifications even as I am typing this with new layers between EMT-B and EMT-I. Kentucky just added AEMT which is something like an EMT-I. The professions mentioned in the previous posts must have their education from accredited schools, pass a NATIONAL certification for state licensure and only have 1 - 3 levels per profession even though their educational levels extend through Masters and Doctorate. Other professions are also more critical when their peers that fail to maintain certain professional and educational standards. Nursing is no exception. Of course, not every hospital will have the same professional standards within their walls and may become very lax in maintaining their own inhouse mentoring and educating. Some barely meet the minimum required by JCAHO. If you go to JCAHO's website, you may even see the lower scores and recommendations for these hospitals.

This is more about the education rather than the word itself. He thinks that those professions are just spinoffs of nursing. Physical Therapy and Rehab medicine got its routes long before RNs were getting their acts together. As technology evolve the RN with a diploma or 2 year degree could not keep up with all the changes and still do their nursing profession. RNs used to work the ambulances also and pick up sick people. RNs, however, are now feeling the fact that they are in the category of the 2 year degree being the minimum degree for licensure while the other professions have moved or are moving on to Bachelors. Those "techs" that were mentioned have NATiONAL standards. In his statement for Radiology professionals implied that they don't need an education to do what they do. Have you actually asked what the titles are for those lab technicians which yes, the Technologist can go to Masters and Doctorate just like most of the other healthcare professions. But, the question is what is the minimum for them to be LICENSED? Certified or unlicensed staff have a totally different set of responsibilties. I doubt if you would confuse a CERTIFIED Nursing Assistant with a LICENSED nurse. BTW, have you looked at the educational level of the "cath techs"? The requirement that is being established in this area is a 2 year (Associates degree) which is usually Respiratory, Cardioppulmonary or Cardiovascular science and with a licensure to accompany one of those degrees. I worked as a "Cath Lab Tech" but functioned under my RRT license. Again, these are National standards and not just whoever wants to make some rules in that county. This is stemming again from various legislative and reimbursement issues as to getting what you pay for. It may just take some areas longer to comply than others. Some of these cath techs may have been grandfathered in for some licensure with special provisions or they are back in school completing the needed education. The surgical tech is about the only one that can still be OJT and that, too, will be changing if their duties are more than with just equipment. In RT, we don't require our equipment techs to be licensed. They are usually students who move on with licensure. But again, there's a vast difference in responsibilty between a licensed, certified and OJT "tech" these days and it is the education that establishes the standards for the differences.

Me condescending? You just insulted most of the "techs" in a hospital. You must not be aware of how much these professions have progressed or you think of them as insignificants that got the RNs' leftovers and have not taken the time to know what their education level is. I guess it is easy to see how much you think of the "techs" in the hospital in your hierachy of patient care. I have not seen an IV tech around for about 20 years so I can not comment on that. RNs do most of the IVs as well as the PICCS. EKG techs may also be Cardiopulmonary, Respiratory Therapist or CV Technologists, all of which require at least a two year degee. Just because you see someone doing a simple skill does not mean they are uneducated. Departments have had to cut out the majority of their unlicensed staff many years ago and the licensed staff must now do those "tech" skills. Hence, RNs are again doing their own EKGs and IVs. Lab Tech start with a 2 year degree but a Bachelors is now their preferred minimum. In some hospitals, it is a CNA who has extra training, MLT (2 or 4 year degree) or a phlebotomist which is low level with 150 hour cert. Radiology: minimum of a 2 year degree with Bachelors preferred for specialty Respiratory: minimum of a 2 year degree with Bachelors preferred Occupational Therapist: Bachelors minimum with Masters preferred Speech Therapist: Bachelors minimum with Masters preferred Physical Therapists: Masters minimum and Doctorate preferred Do you even have any idea of what each of these professions do or are capable of doing and what role they play in patient care? You just finished your residency so you may not be old enough to know how much technology has evolved of the past few years and the growing need for specialists. Yes, I, too was an OJT "tech" almost 30 years ago but it didn't take long to see that education was necessary. So, why should the ED again settle for a "tech"? Until the paramedic can at least get the same education level as the rest of the licensed staff, they are techs. A two year degree should not be that much to ask for. Most ED jobs don't even require they have prior experience to be an ED tech. I was not referring to "CME" classes for RNs but the college programs to prepare RNs for different specialties that last 1 - 2 semesters. There are also the hospital sponsored programs that run for several week and months to get the RNs ready for their chosen specialty. Some new Paramedics are lucky to get 3 shifts with their training officer or "senior" partner that might have just a few more months than they have of experience. The whole EMS world is not as rosey as you believe it to be. That is why some of us old dogs are still in the race hoping for some improvement through legislation. I would say that an RN who works triage has a higher educational level in medicine with a broad spectrum of medical problems as well as EXPERIENCE inside the hospital working with medical patients. Would you want a 3 month medic mill wonder triaging your child? While there are excellent Paramedics out there who have excelled there are many that haven't. Have you not noticed the comments on education on this forum? Remember doc, you are going to be working inside a hospital. Don't disrespect the lowly "techs" (what a crappy attitude you have toward Radiology professionals) and all those nurses you believe to be so incompetent. These nurses also have to manage critically ill patients for several hours until an ICU bed is ready. I am truly disappointed that you feel this way about the people you work with inside the hospital. The Paramedics will get their due respect when they eliminate their weakest links in their educational system that keeps the playing field uneven for them. I've held out for 30 years waiting for it and have only seen it more erroded by more "skill" certs instead of education. As long as there is not an incentive for the Paramedics to get a higher education level and they are led to believe their 700 hours is just as good or better inside the hospital than the many "techs" and RNs who have much more education and training inside the hospital, there will still be a need for 3 month medic mills to now meet the demands of the EDs. Quess you wasted a lot of time and money on medical school.

TBIs and ICP have and are continuously being studied by many hospitals across the country. We do have protocols for specific O2 titration in these patients in the hospital but we also have the advantage of SjvO2 monitoring. Not every patient will behave the same and may require different pharmacological and/or ventilatory/oxygenation intervention. Of course, it is well known for the effects of high FiO2 and the infant with cyanotic heart disease. Nitrogen washout and absorption atelectasis on an FiO2 of 1.0 over extended periods of time is also well documented. Thus, some doctors want the ventilators on 95% when running a sepsis protocol instead of 100%. Occassionally you will hear of someone speak of the oxygen clock in the ICU. Other areas that have also be studied is O2 resuscitation of the neonate. http://www.fsrc.org/NRPUpdate1-16-07.pdf However, it gets complicated when some patients have mixed problems that have conflicting protocols for oxygen. ARDS protocols have the goal of sparing the lungs from volutrauma and getting the patient off the oxygen clock quickly. If that is also a sepsis protocol, it recommends that the patient be kept on 100% or 95% until the lactate level starts declining and/or 4 mmol/L or lower. For the Stroke patient that has not presented with any other issues, we use a very minimal amount of O2 or none after any other problems that may require oxygen, such as pulmonary problems from aspiration, have been ruled out or do not give an indication of compromise.

If you want to do the job of another profession, you should have at least the minimum educational level of that profession....not less than 1/2. RNs started changing to the two year degree in the 1970s. That was the same time colleges started with their degree programs for Paramedics. For awhile it was thought that the Paramedic would emerge as the stronger and very respected profession with a lot of promise for an outstanding career choice. At least that is what the college career counselor said when I signed up for the program in 1978. The thing to remember about the nursing profession is that they know a two year degree is just the beginning of their education and training. They may work on a med-surg floor for several months or several years while mastering the skills for that area. They may also take the prep work such as training courses for other specialties which can be 1 - 2 semesters in length for each specialty. This also includes the specialties for Critical Care, Flight and Prehospital. ACLS, PALS and NRP may be part of the extra certs needed besides the professional certifications. After they get accepted to a Critical Care Unit, another several months of training and education will be in store for them. If they choose a specialty such as CVICU, NICU or PICU, many, many months of training may be needed before they are truly "solo". If they want to do transport for any specialty team, they may need 3 years with 5 preferred to even apply. If accepted, it may take up to a year to get all the additional education and training, including numerous intubations, to be ready for transport. After that, their competencies are closely watched with many hours of more mandatory training and education. Guess what group makes up many of the applicants for online nursing programs such as Excelsior? Unfortunately no matter how much your ego leads you to believe you know, there should be no shortcuts for the hands-on skills and the hours of numerous patient contacts that a nursing student will have during clinicals. That could be the reason the nursing graduate from Excelsior is not accepted in all states. Often it is the thought of doing these clinicals that make some seek out programs such as Excelsior. They may also believe it is the easier and less time consuming than going through a regular program. However, most lack the discipline to finish. The diploma programs that are still around may or may not give the student the status of RN. Most are not associated with colleges to earn a degree. Until that degree is earned, some states may only recognize the training as a PCT or LVN.

We are talking about triage within an ED. We are not talking pre-hospital. If you want to go there, there are also enough examples in that area that has demonstrated a need for an improvement in education also. Scope of practice? How about training and education? We could get into a long list of things that a nurse is much more familiar with for day to day health and chronic care than a Paramedic. Where to start? G-tubes? Insulin? Nutrition? Dialysis? Ostomies? Chronic illness? BMs? I&Os? Indwelling cath care? Decubitius ulcers? LVADs? Trach stoma? Post operative wound healing care and complications? I haven't even scratched the surface of med-surg problems seen in an ED on any given day. How about all the things that usually have little interest to the Paramedic working in the field. I know you've read some of those threads. The Paramedic is trained for prehospital medicine and not on the broader sprectrum of med-surg problems. Pick up any Paramedic text and then pick up the many textbooks, including the Lippincott, to do a little comparison. How much information are you going to find about Lupus, renal failure, quadri or paraplegic issues and identifying wound care situations are you going to find in the Paramedic text? Nurses will have a base education and work experience with these patients. Granted not all will be an immediate emergency but some may need to be attended to rather quickly just the same. A nurse and a Paramedic are very different in education. A nurse who is working triage in an ED has not only received a 2 year degree in basic nursing but has also done additional education, training and working in various areas of the hospital and ED to get that triage seat. A Paramedic education may take as little as 500 hours in some states to obtain without any college education and very limited exposure inside the hosptial. Heck, even some of our PCTs have over 700 hours of education/training. Many get this cert while they are continuing to nursing school. I actually find it insulting to the LVN who for many years worked in all areas of the hospital and had at least one year of education to be replaced by a Paramedic with no inhospital patient care experience and limited knowledge of "med-surg" procedures which make up more than 90% of emergency room patients. And yes, LVNs were trained for emergency situations. If the Paramedic wants to be like a nurse and work in the same capacity as a nurse, education is the key. For an ED to step down its standards in one area while the rest of the healthcare world within the hospital is advancing does not make sense. Maybe if the paramedic certification/licensure had grown up to at least have the same minimal education requirements as other healthcare professionals, this would not even be a topic for a thread. Doczilla News article It does bring about more questions that should be addressed if this fact is known. Kids don't usually doc hop for no reason especially if they have a pediatrician who most parents would rather trust. The one thing about meningitis in a child, it won't be long before you know you missed the diagnosis. Fortunately, some hospitals do take the health of children seriously and don't just blow off any and all sniffles that comes along nor is a lumbar puncture necessary either. However, a child deserves the benefit of the doubt regardless of your opinion of the parent(s) or how much BS you perceive it to be to take up your time. No need to have a crystal ball if you and your hospital practice good medicine. Mistakes will still be made but less serious ones if certain guidelines and quality care are maintained to the highest standards possible. My statements come from work experience and not reading media hype.

Our Fast Track is for minor boo-boos that can be taken care of quickly and released. Children and the elderly rarely get sent there for medical problems because they can be many times more complex as well as needing observation after some treatments. They are taken in quickly though because both age groups can decompensate quickly. A physician also sees them. We also don't draw labs on kids in the triage area since it can be a traumatic scene for the child and anyone near the area. medicv83 Our ER Techs (EMTs and Paramedics) can do vitals in triage but the RN does the questioning and determining how fast and where the patient goes.

There could be cause for concern if they had something serious that might compromise their immune system somewhere in the future. This could be a disease process, traumatic injury or some very stressful event. Other than that, TB should stay dormant. Many of the RRTs and RNs that have been in the profession for more than 20 years converted long ago. With stricter precautions and better filtration systems in the hospital, this does not happen that often today in the U.S. I've been exposed to patients with Active TB while working as a Paramedic and RRT for 30 years. It wasn't TB that messed up any of my relationships. Although, in the 1980s I described my job as, "I test patients for TB in an AIDS clinic" to scare away undesirable suitors. The public has since become more educated and unfortunately that line no longer works. Seriously though, even the people living in the same household with someone diagnosed with active TB rarely test positive for TB. The factors influencing this could be the health and age of the other family members and if the patient has common social skills when it comes to coughing on others. The ventilation of the living quarters also can play a big role which is why homeless shelters, jails and prisons have a higher rate of TB.

I haven't seen an LVN in the acute hospital setting for about 15 years. At one time they were in the SNF attached to the hospital but that has also changed since the RNs were responsble to do the initial assessment on all patients. It was easier to hire RNs and do a different assessment and patient management approach that put the RNs more intouch with each patient rather than 1 RN trying to supervise 4 LVNs and 60+ patients as many nursing homes still do. Sometimes the Paramedic, as evidenced by some comments in the different threads, looks more for "BS" rather than disease processes that don't initially appear as true emergencies. Some may be likely to dismiss something that is truly life threatening like a high temp in an elderly nursing home patient as a 0300 BS "fever" call. Few will know that this can be life threatening to that patient. We had a similar case in Miami a few years ago where the paramedics wrote a 17 y/o off as having the flu and told him to get his mother to take care of him instead of them transporting him to the hospital. He died from meningococcemia. The overview of diseases that a paramedic gets does not qualify them for triage in the hospital setting where the wait to see a doctor could be several hours. The fact that the paramedic did not pick up this fact or see the serious of a little girl with the same symtoms continuing for 2 days without improvement is negligence in itself and should have admitted that maybe pedicatrics is not his specialty. Any child that young that has "flu like" symptoms for an extended time needs to be at lease considered for dehydration which in itself can be an emergency. Some of the "traditional ER nursing" questions which would be necessary to fully assess this child's condition are not in a Paramedic's training. If these facilities are not JCAHO, do they accept medicare or insurance? JCAHO is the accrediting agency that goes out to make sure that each facility is qualified so medicare and the insurance companies don't have to. A hospital really doesn't want a "Medicare" inspection. JCAHO is even considered much gentler and kinder.

The most common meds: Isoniazid (IHN, Nydrazid) Rifampin (Rifadin, Rimactane) Pyrazinamide Ethambutol (Myambutol) Other meds for the TB that does not respond to the above: Rifapentine (Priftin) Streptomycin (STM) Ethionamide (Trecator-SC) Cycloserine (Seromycin) Capreomycin (Capastat Sulfate) Levofloxacin (Levaquin, Quixin) Moxifloxacin (Avelox, Vigamox) These same meds may be used to treat extrapulmonary Tuberculosis as well. This could involve the pleura, lymph nodes, genitourinary tract, skeleton, meninges, peritoneum, or pericardium. If someone lists Tuberculosis as one of their diseases, you should ask if it is in the lungs or elsewhere. People who have active TB will take the meds for many months and there are some that require treatment up to two years. That does not mean they are infectious to others during this time if they are compliant with their drug regime. When first diagnosed with TB, the patient will be in isolation until he/she shows response to the drug therapy which can vary from a few days to a few weeks. If it is multi-drug resistant TB, they may need to be monitored closely for several months, usually by sputum tests for AFB, to see if there is a relapse. You will find people, including healthcare workers that test postive (convert) but are not considered to be Active with TB. This is Latent TB. You may have to take one of the antibiotics for 4 to 9 months the first time you test positive. Absolutely we take every precaution when a suspected TB patient arrives in the ED, clinic or anywhere in the hospital. Americans are usually not vaccinated against TB which in itself is not a guarantee since there are many different multi drug resistant strains coming from many different populations. The US is a multi-national commuter country which leads us to many possible exposures. The reason we do not have the problem other countries have with their vast TB population is through strict precautions and the continuing education of HCWs. Other countries do not practice these same preventitive measures and that is why TB is "common" in those areas. People in other countries may have taken the BCG vaccine, so yes, they will test positive and will have some immunity. However, they can still get TB and that is why they also must be tested after significant exposure and regularly if they are healthcare workers. These patients are isolated for the protection of all including HCWs and the sick people in the hospital environment who have weakened immune systems as well as the protection of any children that might be around. For some, TB is still deadly. TB is still very much active (but not "common") in some parts of the U.S. Florida still has a TB hosptial, A.G. Holley, located in Palm Beach county. http://www.doh.state.fl.us/AGHolley/index.html Everything you want to know about TB: http://www.cdc.gov/tb/ http://www.cdc.gov/tb/pubs/mmwr/Maj_guide/default.htm Casual exposure to a patient with Active TB for a short time may not present a high risk. Most HCWs or just about anyone have been around Active TB and did not know it. Those that convert to Latent TB may not know when they where exposed. For RRTs, RNs and EMT(P)s it could have been during that neb treatment for a cough. Your risk factors are determined by your age, health status and type/length of exposure. EMS providers may have the most unprotected exposure to TB and other infectious diseases but get the least amount of education about them when compared to any other health care profession. Other professions have a good initial education in their curriculum. They may also be required to attend yearly updates or take a couple CEUs on infectious diseases with each license renewal. Even the education on HIV/AIDS has gotten lax and we are again seeing more people in their early 20s being diagnosed.

Florida has had more than its share of idiots making the news. http://www.keysnews.com/333066563140311.bsp.htm Report: Fireman made fake 911 call BY ADAM LINHARDT Citizen Staff A Monroe County firefighter was placed on paid leave Friday while officials investigate whether he made a false 911 call to cover the fact he was arriving to work late. Fire Rescue Chief James Callahan on Tuesday said county officials will review whether Gabe Pacheco should be disciplined internally or charged criminally after he allegedly made a 911 call around 8 a.m. July 14. The caller said a person at the Key Haven boat ramp had a broken leg and needed medical assistance, according to a Monroe County Sheriff's Office report. Responding firefighters from Station 8 on Stock Island, including Lt. Andy McBroom, found no one needing emergency medical help at the ramp, reports say. According to the report, McBroom told deputies that Pacheco has a history of being late for shift changes. McBroom decided to check with the Sheriff's Office dispatch to determine what number was used to make the call, reports say. McBroom told deputies the number came back as Pacheco's cell phone number, reports say. A deputy found the same number on the station commander's call-out sheet, reports say. When a deputy asked Pacheco if he knew anything about the call, Pacheco allegedly admitted to making the false 911 call to cover the fact he was late for shift change, reports say. Pacheco declined to comment when reached by phone Tuesday. "Right now, Pacheco is on paid administrative leave and we sent the Sheriff's Office report to Human Resources," Callahan said. "We're moving forward with a disciplinary hearing and we'll see where it goes from there. This is very serious charge. Calling a false alarm, as far as I'm concerned, there is no excuse for that." Pacheco has not been charged with a crime, said Sheriff Rick Roth. "We're waiting for the chief to tell us if he wants to go criminally or handle it administratively — discipline him internally if that's what they decide needs to be done," Roth said. "Things are at the county level because we don't want to violate any of his rights and that's very important," Callahan said. "To my knowledge, this is the only instance." Pacheco will be on leave until the Human Resources Department has made a determination, Callahan said. "He made a very bad judgment call and he's been very remorseful and admitted he screwed up," Callahan said. "It's a tough situation giving advice to a young man, because of the severity of the offense. We can't have firefighters making false calls, endangering other firefighters' lives and [those of] potential citizens who may have needed help at the time."

I just wanted you to know that I knew I was "off topic".