VentMedic

In parts of Florida, the power company is alerted to a technology dependent person in their area. The person is usually warned if a power outage will be in their area. That area is also given a priority in service. Homecare patient and their family members are very well trained before they leave the hospital. My patients are probably even better trained since I know the abilities and limitations of many EMS providers. These patient have a wide variety of airway devices but the Paramedic may only seen the "trach" and may assume everything is a "trach" when there are about 300 other choices. Not all will have the standard 15 mm adapter.

There are probably alot of people on this forum who live in in areas where the only "gangs" they will ever encounter are those bored upper middle class brats hangin' at the mall. As if I don't have enough crap like this in my part of Florida, I was at a conference in SF last week and see this article. How did this poor guy and his kids know he was unintentionally not making the turn fast enough for the liking of a Mara Salvatrucha (MS-13) gang member? This guy wasn't even supposed to be out of jail. http://www.sfgate.com/cgi-bin/article.cgi?.../BA5C11SK2S.DTL Yes Michael, I know this isn't a flashing lights story but do you think the consequences would have been any different? The guy wasn't from the U.S. and may not know that flashing the headlights is a "neighborly" thing to do. At least this guy didn't just pick on drivers but also terrorized pregnant women to diversify his crime portfolio. I sure a few of you would have flashed your lights at him if they saw him speeding. How about "carjackers" who take a hostage, which can even be a little baby, and then speed away? What about Amber alerts? You gonna warn that person that the LEOs are just ahead? So no, spenac's "kidnapper" scenario is not that far fetched depending on where you live. You don't even have to dream up scenarios when there are newspapers with this stuff in them. I'm sure the family in the SF news article didn't even know their chance of pissing off an MS-13 gang member was just a turn away. Ex. This is just one weekend in Oakland. http://cbs5.com/local/dellums.oakland.violence.2.755752.html I'm sure those in LA probably hear about it so much also that it isn't even news anymore. I've had young gang members in the ICU shackled to the bed that have been accused of attacking people in cars just because they thought the person was looking at them wrong. They end up in the ICU because their enemies knew they may not get chance to make a hit on them if they go to jail and so they get to them before the LEOs. So no, not all of us who live in an area where violent crime is a reality are going to attract too much attention when driving if at all possible. And, if that person is a carjacker or someone who just killed some innocent people, I don't plan on helping their get-a-away by warning them that the cops have set up a check point to possibly stopping them. I've had some gang members as patients who have a claim to fame of stealing a 100 cars, most of them violently, to take on joy rides. Miami even made a big deal out of this issued safe driving tips a few years ago when we were losing too many tourists by death from violent crime who thought saw no danger or felt safe in their cars. And yes, Miami-Dade county still has some 2 lane roads that seem like you are in the middle of nowhere. I offer the advice that if you visit, resist the urge to flash your headlights even if you think it is a friendly gesture. So those of you who live in nice safe little sheltered worlds who don't believe any violent crime exists or that you are safe inside your car and nothing can happen to you, I advise you not to venture outside of that area.

That depends on where you are. So far Oregon is the only state that requires 60 hours of college credit and it doesn't have to be a degree in EMS. Texas has another "license" for those that have a 2 year degree. The minimun number of "hours" to be a Paramedic is 700 in many states, a few with 1000 and a couple with only 550. There are many "career schools" (medic mills) and now online schools that can get you through the Paramedic program in under 6 months. I believe there is one school that is still advertising its 3 month Paramedic program. To be an RN you must have at the minimum of an Associates (2 year) degree. Just their clinical hours will be over 1200 with much more patient contact time per clinical session than the Paramedic student. Nursing will give you many more opportunities than being a Paramedic and you can do all the skills of a Paramedic including EMS in some areas, Flight, Critical Care Transport and Specialty transport where you can seriously challenge your knowledge and skills. However, to get on one of these teams will take several years of experience in critical care medicine will many critical care procedures observed by the intensivist (ICU physician). It takes that long to master many disease processes, critical care and med-surg pharmacolgy and the many different ICU protocols as well as the numerous skills.

Florida homes, especially in rural regions, may not have a defined driveway once you enter from the street. My residence is in that category. Non-Floridians are usually very confused about parking the first time they visit. Unfortunately, since septic system laws change frequently in Florida, you may not know if the previous owner had an older system that was too costly to remove when installing a new one or hooking up to the city. It's Florida! We love a parade of as many EMS vehicles as possible including those big Fire trucks to see where our tax dollars have been spent. One could also argue if we didn't spend so much for 3 - 4 vehicles responding to each call, our septic systems would be better. That's already been done. http://www.vanosteen.com/mcdonalds-coffee-lawsuit.htm

If you are already not an EMT, I would take reaper's advice and see if you can get some ride time. It would be wise to know if your perception of EMS and actual reality have any similaities. Take a couple of prerequisite courses such as college level A&P, whether required by the Paramedic program or not, and network with other future health care professionals that may also be going through the same struggles you are. You may also be able to talk with the EMS students and the Paramedic instructors as well as observe the classes at the college. Community Colleges are usually more reasonably priced. Some may even have daycare for the children and the credit can be applied to another degree if you decide becoming or being a paramedic is not for you. Community Colleges can also better assist you in get the proper financial help you may need and not get you stuck with an expensive "just sign here" loan. By starting with a college class you may be able to find out, without it being too costly, if you can manage your time and have the discipline needed for more extensive study. It will also get you better prepared for the academics if you have not been in a classroom for awhile. If you chose to go to paramedic school, find one that is accredited (CoAEMSP and/or CAAHEP) preferably with a community college. "Career schools" that offer a Paramedic program may not have these acceditations. The Paramedic program can be the easiest to enter but can be the most expensive in the long run if you chose the wrong school and financial assistance. Other healthcare programs such as Nursing (RN), Respiratory Therapy (RRT), and Radiology (RT), require at least an Associates degree. Other fields such as Speech (SLT) and Occupational Therapy (OT) start at the Bachelors degree. Physical Therapy is at least a Masters with the Doctorate now becoming the standard. However, if you start with a couple of classes such as Anatomy & Physiology which can be applied to almost all healthcare degrees, you will be setting a good foundation. In many areas a two year degree in any program, including EMS, can still be obtained for $5000 to just under $10,000 at a community college. A "career school" Paramedic program may be quicker but will cost $12,000 to $15,000. They may push you into an "easy to get" loan that can be very costly later. With what an EMT and Paramedic may make for a wage in some areas, you could be paying for that loan for many years. If you are not an EMT yet, you can pick up an entry level job in a hospital relatively easily and they may offer many tuition assistance benefits to at least get you started. You can also check out the world of healthcare and see if it is something you will like for the long haul. Prehospital medicine is different but you still must want to do patient care to be successful. Choosing a career and getting an education are like investing. You have to think of your future and choose the best method for you to secure it.

The "save money" logic is the part I don't think some in EMS understand. In many areas, CA and FL which I know, still have very reasonable community college tuition. A 2 year degree in EMS can still be obtained for about $5000. Yet, most would rather spend $12 - $15,000 on a 700 hour or 6 month Medic Mill. The reimbursement will make the investment worthy in the long run for companies. RT started "preferring" the 2 year degree graduate almost 20 years before it became mandatory. Much of this was done through peer pressure and working in a close environment to other educated professionals to see where they were being left behind by accepting the 1 year wonders as a "standard". More RNs are getting their BSN degrees because they have looked around and saw what other professions are requiring as entry level. It is a b*&%$ to realize that while your profession had once ruled, it was now the least educated at the multidisciplinary meetings. Continuing your own education is excellent but remember; piece milling bits of education in technology may not achieve the results you want. Technology advances too quickly and before you know it, like the computer, you have yesterday's model and are already way behind without the funds to upgrade. Education in the sciences to enhance one's knowledge to prepare for the changes will take one into the future.

No, it is not working. Unfortunately I see the Paramedic heading down the same path so many "techs" before them have. The LVN (and CRTT) were probably some of the most "skilled" health care workers of the hospitals. LVNs could do every "skill" an RN could do plus do basic radiology and US at one time. The same with the CRTTs (Respiratory Techs) of the early years. Many were "educated" on the job and had a multitude of "skills". Some even picked up a college class or two besides the "tech training" just like the LVN. Now these 1 year "techs" have started to vanish. The CRTT is no more and had to become a 2 year college graduate, but the same skills and many more came with that education. The LVN is out of the ED and ICUs as well as off many med-surg floors. The RN has discovered what opportunities the 2 year degree could bring as a foundation for many specialties including CCT and Flight along with hundreds of other employment opportunities. Their "skills" are now almost limitless in some states including doing whatever "skill" the Paramedic has. RTs have also managed to achieve an open-ended scope of practice in may states that can give them whatever "skills" their medical director wants. However, for credibility and reimbursement is such areas as US, one may have to be Registered in that field. But skills such as intubation and various line placement are fair game if they already fall within your scope of practice and are recognized by the various agencies for reimbursement by your education and credentials. Do I believe the Paramedic will vanish? No. Do I believe they with ever get the recognition, like the LVN, worthy of their skills? No. Medicine has become competitive. When RTs, RNs, PTs and SLTs have their representatives go before some legislative body for reimbursement money, these professionals are competing with each other on services that overlap. Usually the one with the most education wins as they can show both "skills" and formal education that is universally accepted. RTs have had to petition for a new category for a bill concerning reimbursement in home care by making a Bachelors the minimum for that area. You wouldn't believe have many had already planned for that day including myself although its not homecare that I am particularly interested in. It doesn't hurt to understand how education and legislation had been the motive for change with other professions. You also don't know when stricter standards will come out of some profession's legislation as Radiology, RT and Nursing have already set higher standards for who can do some of their procedures. Even phlebotomists are now establishing a national standard which now since CLIA and JCAHO approve of this higher standards, it affects Paramedics who work in the ED or who draw blood specimens on the ambulance. US also closed the loop hole for certification by other professionals that now must meet stricter requirements. RT closed its loop hole for RNs touching some ventilators in Florida. Yet, the Paramedic exam can still be challenged by RNs and other healthcare professionals because we have not defined our standards well enough to prevent it. Since JCAHO does the leg work for Medicare, it would be interesting to see an accrediting entity similar to them involve in ambulance standards of care. Yes, there are extremely accountable and highly trained EMS companies out there that are more than qualified to take on any new skill and challenge. But, as a whole, the industry will still be only as strong as the weakest link. Again, it is found within the education systems and that also includes the minimally qualified instructors.

But Rid, I still hear and see crap when it comes to the use of the pulse oximetry in the field and the hospital as well as reading it on the forums. And yes, when people waste time trying to "get a sat" on someone who hasn't had good circulation below the shoulders in 10 years...well whatever. The AED was first introduced around 1983 (Stevie Nicks "Stand Back") and it has taken 2 decades for it to become accepted. The 12 - lead came shortly there after and has been very successful in many parts of the country but is not even a thought in others. And then there are those that rely on the machine interpretation. Again, a skill without the education for some. ETCO2 is not that widely available yet nor is RSI. The education for its proper use is even less. Many Paramedic programs still do not have it in their curriculum but hopefully that is changing. And then, we have the IO. How many services have mastered it? EJs? All relatively simple concepts of access and yet not that widely used. But, we have EMT-Bs doing ETI. At least get a college level A&P class as the prerequisite for all Paramedic programs before adding more "certs" and technology which the richer FDs will acquire and do half-arsed because they can. I am not one that is against change but with the different "certs" and "skills" EMS providers acquire the same argument against education will exist. Why go to college when you can do all this in just a few months for an exciting career? (Medic Mill commercial) Thus, EMS providers will still remain at a tech level in the eyes of legislators and other professionals. Raise the bar on standards and not the budgets.

I was taking FAST to be Focused Assessment with Sonography for Trauma. The FAST exam I was referring to covers alot of area with the 4 different regions: perihepatic, perisplenic, pelvis and pericardium. You have made my point for "build the educational foundation and the skills will follow". You are a physician with many years of education and a variety of skills. You had probably already been required to look at various diagnostic images prior to doing US. And, you had the expertise of other physicians to mentor you. I know what our residents go through when they are first learning any procedure, including US, from their attendings. I understand if those days you would rather not remember. Unfortunately, for some Paramedics that have met only the minimum requirement of 700 hours to get their patch and only have the A&P provided by the Paramedic text, the "whys" might not come as easily. Yes, they may go through the motions but understanding all the potential possibilities might not come as easily. I'm sure you've seen some of the scenarios played out on the forums and have seen the wide variations on working diagnosis. Not everyone will have the same mastery of anatomy and pathophysiology. Those that don't know what they don't know will be the weakest links but will profess to knowing the most with a little bit of "education". Now for those that have put more effort into their education with at least picking up some college level A&P and pathophysiology may appreciate the true value and understand the limitations much better. The only other issue would be getting the experience on as many different body types as possible with various diseases or traumatic injuries. Like getting intubation time, that may be an issue in some regions.

No, I just believe EMS needs to get its credibility through education and the correct legislative processes. I don't believe in a bunch or random certs without a solid educational foundation. If you think more "tools" and "patches" push the profession forward, that is your opinion. As other professions have proven over and over, get the education and the skills will follow. Reimbursement policy makers have also recognized this fact. I don't know how else I can explain the advantages of a solid education for any profession before trying to sell themselves and others on more "skills". Will EMS be able to recoup their expenses for purchase AND maintenance of this equipment? How many will have to be purchased for each service? Training costs? What will have to be sacrificed for the purchase? Will only some get it and some not? Like the ETCO2 monitor, we have the haves and the have nots. Unfortunately even that "tool" gets used so infrequently by some that have it that competency in its use lacks. I am familiar with US from my involvement with specialty transport and flight where this could be a more reachable reality. And yes, we explored many of the potential benefits especially on our long distance trips to the islands. Even there, we have to prioritize our equipment and budget into what will do the most immediate good for the patient for transport. Respectfully However, I do enjoy a good debate with you spenac. I believe we both have mentioned good points. Your situation due to distance to the hospital presents with a more challenging patient care environment.

I guess I lead you into assuming their acronym was "RUT". I do love to introduce EMS professionals to other professions especially those that are younger than EMS and have some standards in their industry. Since US is made of several different specialities, it takes a bit of training and education to become good at more than one body area. Although the Paramedic will only be looking for that big bleed or air space, not every patient is going to be the typical 75 kg nicely structured non-complex patient that is an easy US. Missing something and having a false sense of security thus changing your transport destination away from the trauma center can also have its consequences. Physicians do US at bedside in the ED, ICU and OR everyday but even as MDs they had to spend some time with another professional to perfect their technique and interpretations. The American Registry for Diagnostic Medical Sonography (1975) http://www.ardms.org/downloads/Prerequisite_Chart.pdf http://www.ardms.org/default.asp?ContentID=1&menubar=1 http://www.ardms.org/default.asp?ContentID=30&menubar=3 Credentials RDMS – Registered Diagnostic Medical Sonographer RDCS - Registered Diagnostic Cardiac Sonographer RVT - Registered Vascular Technologist RPVI - Registered Physician Vascular Interpretation Examinations Abdomen Adult Echocardiography Breast Cardiovascular Principles & Instrumentation Physics Fetal Echocardiography Neurosonology Obstetrics and Gynecology Pediatric Echocardiography Ultrasound Physics & Instrumentation Vascular Physical Principles & Instrumentation Vascular Technology Physicians' Vascular Interpretation Sonography Principles & Instrumentation

Based on your initial assessment from scene and patient, would you have enough to go to the trauma center? If your FAST was negative, where would you start your US? Would you even consider doing US? In other words, the US probably would not change your destination. The US may not even be brought out in all cases just like the long board and C-collar is being disputed for all MVCs.

Enough with the insulting name calling for the Paramedic in your reference to yourself. Poiniting out educational differences is very different from calling someone a moron. I see you only read what you wanted to in my post. Let me recap: Why do you think college level A&P, math and a few other science classes are required in the 2 year degree for other professionals? It introduces the students to medical and scientific terminology that might just be useful in their chosen or future professions. The 700 hour Paramedic program may not adequately prepare the student in the sciences including A&P. I hope you don't consider a college level A&P book too advanced for the Paramedic. College level classes expect the student to do a large amount of outside studying and research. This unfortunately the logic that so many have ignored by expanding the scope of practice with more "certs" to those with the minimum amount of education such as the 110 hour EMT-B into areas where there is little educational and knowledge base for them to draw upon. You're going to scan what and you are going to catch what? How good do you think you would have to be to pick up a small but potentially harmful bleeder in every area of the body. If you don't see something, are you going to say "all is well, I already did the US". That can be a false sense of security. That is why the hospital utilizes a quick CT scan. Most hospitals are capable of doing a CT Scan quickly.

Now that is insulting to the Paramedic. Should a Paramedic not be able to understand a little more advanced medical procedure with real medical terminology? I think it is time this profession comes to grip with where the inconsistencies in education lies and fix this so it can converse with the "edumacated folk". It seems like whenever education is mentioned it is so much easier to bash those with education than to extend the effort to get educated themselves. A new gadget is not going to instantly bring credibility to the profession. It can bring more scrutiny if not utilized properly. Getting another "cert" in something else is not going to bring this profession in to the 21st century until some standards are established across the board. A FD with outdated protocols is venturing into this? That's a credible place to utilize US. Let me explain about education. We're talking about explaining technical terms to people who are supposed to have some educational background in the medical sciences to understand some basic concepts for the technology. This is not about medical professionals being able to talk to the patient in simplistic terms. When I explain the straw concept of breathing to a patient, I do it in very simple terms. If I use that same straw concept for RN or RRT students, they had better be calculating the resistance and compliance factors for that straw from the technical data. There is an expectation of knowledge for the appropriate audience from their educational background in some basic sciences. Other professionals (RNs, RRTs, CVTs etc) have ventured into US to aide in their occupations. It is not a far stretch when you have a few semesters of the sciences in your background to take a Survey of Anatomical Structures for US and understand it. If the course has to be dumbed down because not every Paramedic has the same educational background but rather just the 700 hour minimum to get their patch, that is a problem. Those that have taken more than just the bare minimum will probably not have much problem understanding medical terminology and will feel at ease conversing with other professionals about the procedure. Just as it stands, not every Paramedic is starting on the same level of education. EMS has so many controversies now with just stabilizing an airway where even the ETCO2 monitor or the pulse ox is not adequately understood. Intubation competencies are not even being maintained in some services. We can also talk about RSI which many departments are not allowed to go there even in the trauma patient. 12 lead ECG interpretations come from the machines and not the Paramedic in some areas because "that extra education is too difficult to obtain". This profession wants to "be like another profession" or get the same cert/patch that the other state next to it has but it has not concentrated on establishing its own identity yet with what it is doing with the "skills" and education it has now. I am aware of the future that may bring about the Paramedic Practioner someday but just adding a mish mash of "skills" is not going to bring the credibility the profession needs to obtain that goal. I think this money could be better spent educating, training and supplying the equipment that will make an immediate difference or improve patient/crew safety. If the patient does go "negative FAST", what can you do about it in the truck other than what you are hopefully already doing? Are you going to rely on trying to get a "good picture" or will you start accessing and getting some treatment that is within your abilities started? Hopefully your assessment at scene of mechanism and vitals will give you enough information to notify the ED or Trauma center of what potential injuries you may have. You should also have some protocols in place for when to call for a helicopter or trauma alert.

I pulled up another interesting article on this from Odessa FD. http://www.odessa-tx.gov/public/firedepart...calGov2008w.pdf The "golden hour" was stressed again. Sidney Sinus node anyone? No science required. This got a chuckle out of our Registered Ultrasound Technologists.

Money? (Expensive piece of equipment for IVs) Durability? Time on scene? Transport time? Training? Competency? More training? Frequency of use? (Doctors may use them in the ED regularly to keep their skills.) Retraining? QA/QC? Intervention capabilities? Is the service able to do chest tubes and not just needle decompression? What meds do you carry? Blood products? What OB interventions? Yes, OB specialty teams may or may not use them. Usually they know their limitations in transport but also have more knowledge and skills in their "tool bag". They may also have more time at the sending hospital in a controlled environment to obtain a quality US scan. Flight medicine is different but that also depends on total transport time and the abilities of the crew.

Tell the ED and do the appropriate paperwork without delay. If your report says morphine and a drug screen is done on the patient for whatever reason, suspicion may be placed on you for other things far worst than a medication error. Benzos will appear on the results instead of opiates. There is also no guarantee that your partner won't blab it out somewhere after the fact or when questioned to protect his/her own license.

Don't apologize, EDUCATE! You, of all people, with your family history of diabetes, should be most aware of other things that can go wrong with the diabetic patient since this disease can affect any and all systems. Looking at one piece of the puzzle is great but other things should also be assessed. Even things like caring for the site after puncture to make sure it stays clean can be a big deal for the very brittle diabetics. Endocrinology is usually not a strong point in an EMT or Paramedic's education. Even the questions to ask are vague and not direct enough to get a good idea of what is happening in the patient's life. Use what you've learned from personal experience and combine that with your education to stress the importance of good technique, assessment and education.

Wow! With all this logic of "no brainer", "Grandma can do it", "a child can do it", "just a finger poke", "just clip on the pulse ox", along with the "nothing to it" stuff in the EMT-B intubation thread, it is a wonder there is any need promote EMS providers as medical professionals. It's like expecting the magic box (glucometer) or pulse ox to provide the answers. Uh oh, what if the numbers are "normal" and the patient is still unresponsive and/or short of breath? Do you know how many other diseases and meds cause abnormal glucose values? Again, only the "skill" is stressed. That is enough for the FD, insurance companies and law makers to hear and keep the profession at a "tech" status for reimbursement, wage issues and professional status. Arguing for the "skill" before the education is going about it the wrong way. If the education is only a short lecture on a couple of pointers about the glucometer, how much is missed in the assessment that may go unrecognized because of the infatuation with this "skill"? I've already seen enough of that with the almighty pulse ox and inadequate education. Both the pulse ox and the glucometer are good tools but are not a replacement for solid education to provide a good assessment. Learning just on piece of a very large medical picture takes things out of context and can lead one down the wrong path of assessment or stop the assessment because one thinks they "fixed" everything. If the educational foundation is built, the skills will follow.

This profession is almost 40 years old and we are still concentrating on expanding the "skills" of the lowest level of certification (or adding more low levels of certification) instead of pushing for the highest level to be recognized as a medical professional. It is about time we concentrate on something that will endure the test of time and not just a "skill" to keep up with the next state. Other professions already discovered this about 2 - 3 decades ago. Many of these professions are much younger than EMS. Unfortunately, those that focus just on skills don't realize that many other professionals would leave them in the dust if you just added up the "skills". Now add the education they have to back up the skills and you get a "medical professional" and not a patch collector. It seems there are some that want to do a few things but not to where they will have to assume that much responsibility. They want to be "like a Paramedic" but not put the effort into it. It's fine as long as they are just "helping" and don't have to do any real intervention. I find expanding the scope for the EMT-B just another excuse for someone not to do the extra 700 "hours" to get their Paramedic. Piece milling does little for patient care if you are not able to put the assessment puzzle into some logical order. Edit: Yes, there is still a need for BLS but there is a greater need to get EMS recognized as a medical profession with some real education.

Let's clarify a few things concerning the patient and THEIR glucometer. Once a patient is diagnosed with diabetes they don't just go to Walgreens and buy a glucometer. This person will go through several hours of education/training by other medical professionals about their disease, diet, insulin, lifestyle and how to regulate everything accordingly by the use their glucometer. I can assure you, in most cases, the "hours" will add up to many more than an EMT-B will get as an explanation for it. That is because the patient is also doing their own interventions by giving insulin which an EMT-B can not. Don't insult the intelligence of all diabetic patients because for many, this is their life and not just another "skill". Maybe if it was looked at with a different attitude by some as to how it can improve patient care and not "because they can in that state", expanding the EMT-B education would come alittle easier.

Jaded? Have you ever been inside even a small to moderate sized Trauma ICU of 20 beds to see patients whose lives were cut short or changed forever? Just one Trauma ICU might do anywhere from 2 - 20 terminations of life support per month. That doesn't include those that may die in the ED. Many patients are there as the result of speeding, reckless driving or the result of some violent crime. They can be the one initiating the life changing act or the one who gets in their way. Those that don't die may become some of those nursing home "routine BS" calls that so many complain about on the forums. Warning someone in advance of a speed trap could cause the person who may have an voided DL and or tags to detour through a residental area. Unfortunately, there have been way too many hit and runs in these neighborhoods by speeding vehicles some of which may be avoiding the possiblity of meeting the Police on the highways.

Either way, I don't flash my lights. Granted, some people here may live in rural areas where they know everyone they are flashing their lights at. Of course the other side of me doesn't care who you flash your lights or not or why since we could use more organ donors to keep up with the demand.

I don't flash my lights at anyone while in my POV. It is more than an urban myth when it comes to tales of gang selection of victims and road rage. I have had an ICU full of people with those tales to tell. It doesn't take much to set the wrong person off into a rage or a dare. We recently had a mother and her 12 y/o son shot for flashing lights at the car in front of her. The car pulled over and shot both as they passed. Then, they sped away. If the person is warned, they will speed up again as soon as they think it's clear. The LEO will not have gotten a chance to lecture them on the dangers of speeding or at least get their financial contribution to the city or county.

Yes, some professional forums such as for Respiratory Therapy and EMS educators are in the Members Only section of their State and/or national organization. I think someone in the general public could put "versed", "police" and "violent patient" in any search engine and come to their own conclusion from what pops up. Unfortunately, some of the search responses are much worst than the one quoted.