VentMedic

California tuition per credit is some of the cheapest I have seen in 30 years. Isn't it still $20 - $25/per credit? Community colleges in Florida are $55 - $75/credit.

This is on Excelisor website: https://www.excelsior.edu/Excelsior_College...ursing_Students The California Board of Registered Nursing (BRN) met December 5, 2003 to consider the recommendation of its Education/Licensing Committee to restrict the eligibility of Excelsior College graduates for licensure as RNs in that state. The BRN voted to accept the Committee’s recommendation which will affect all students enrolling in Excelsior College’s School of Nursing on or after December 6, 2003. In light of the decision of the California BRN and until or unless the decision is reversed, the College (1) will not encourage persons seeking to practice as RNs in California to enroll in our ADN program and (2) will not recommend that they take Nursing Concepts 1 & 2, either as practice tests or for credit. And then from the CA board later: http://www.rn.ca.gov/whatsnew.shtml#excelsior2 Decision Regarding Excelsior College The California Board of Registered Nursing adopted the following motion at its board meeting on February 6, 2004: "The following action supersedes and replaces the December 5, 2003, Board action related to Excelsior College:" "Excelsior College graduates, like other out-of-state graduates, must meet the requirements set forth in California Business and Professions Code Section 2736, including supervised clinical practice concurrent with theory, in order to be eligible for examination and licensure as a California registered nurse. This eligibility requirement applies to students who enrolled at Excelsior on or after December 6, 2003." And then in 2006 California BRN wins again: http://www.rn.ca.gov/pdfs/forms/excelsiornewsrelease.pdf I like this part: On a related note, in August 2005 the National Council of State Boards of Nursing adopted a position paper that recommends “nursing education programs shall include clinical experiences with actual patients” and “should be supervised by qualified faculty.” There is license by endorsement for RNs from other states but they must still do the application. http://www.rn.ca.gov/applicants/lic-end.shtml I know as an RRT (RCP) it cost me almost $800 to get my California license and that was almost 10 years ago.

My apologies. I was replying to ccmedoc. You are right about California not honoring the Excelisor program.

Why wouldn't he be able to get a CA license? It is a full RN program complete with clinicals. Instead of calling it ADN for the two years, they honor his Bachelors and call it an MSN. Entry Master of Science in Nursing - Students complete the full pre-licensure curriculum in an accelerated, 16 month program. Entry MSN students experience all clinical components described above, enabling them to sit for the NCLEX licensing exam. After completing pre-licensure content, students continue in their declared clinical track (see below).

I have a friend in this program in California. It is expensive but he already has a hospital willing to reimburse him for most of his tuition. http://www.samuelmerritt.edu/nursing/elms_nursing I can not remember which of the many Florida nursing programs also have the entry level MSN. I just know we have a lot of NPs in the area. Some of the NPs are flying to California to work a few days for a serious wage and then returning to their FL home for the rest of the month. Edit: for clarification of which program being referred to.

If you obtain an entry level RN degree by mail order, you will have no practical nursing experience. The first time your nurse preceptor has to show you the correct way to take a rectal temp it will be your arse that's feeling the pain. For Florida, I believe an Excelsior grad must work in another state for at least two years before applying for a Florida Nursing license. The ICUs at the hospital I work at will not even interview an Excelsior grad. You might be able to pick up an ED job in some desparate hospital. Nursing homes are desparate but they prefer an RN that has proven themselves to handle a full+ med-surg assignment. EMT-P does not prepare you for that. For a decent RN job, you may be competing with the BSN graduates which are coming out in big numbers in some areas. I have 8 different schools in just my area graduating new RNs. There is also another higher degree that the hospitals are paying big money to recruit...the entry level MSN. If you have a Bachelors degree in another profession, regardless of what it is, you may get your entry level MSN in 14 - 20 months depending on your sciences. Since most nurse educator positions either in the hospital or college systems require a Masters, these grads are being recruited in a big way. In summary, despite what you have heard about a nursing shortage, the competition is there for the better RNs jobs. Very few Paramedics-turned-RN last more than a week on med-surg if not adequately prepared.

Those would be the ones that had good teachers. At our teaching hospital the senior RNs and RRTs do the teaching when it comes to bedside manners and fundamental skills like intubation, IVs and A-lines.

You are so right Dwayne. Even in the ICU, we realize that the pulse ox may not work every time with perfusion deficits, pressors and the hypothermia protocol. I do hate to not get my data especially when we're working on a research project and at times wonder why we spent $thousands$ out of our budget to upgrade to the latest and greatest.

EMS49393, I don't really care how thick or thin your skin it or if you consider my posts a flame. I just want people to understand the equipment they use when it is applied to patients. Too many skip the formality of reading the manual or a clinical rep inservice because the equipment looks self explanatory. Masimo takes pulse oximetry technology to a whole new level and has a steeper learning curve than other brands. Even those of us who utilize pulse oximetry extensively for many applications need extra training to fully understand and appreciate Masimo's pulse oximeter sophistication in analyzing data. Masimo is just one of serveral pulse oximeter brands on the market, each with their own unique quirks that one must be aware of for proper use.

I sometimes mess with 1st year residents by putting a pulse ox probe on my favorite patient, Ted E. Bear, in the PICU. With the probe positioned to pick up the light in the room, I can catch the young doctors in focusing on the monitor and not the patient.

Absolutely! That is why there are different probes for different applications. There are differences in wavelengths, transmittance and reflective properties as I mentioned earlier. A false high reading can lead to believing oxygenation is better than it actually is especially if one is relying on the machine and not the patient. Wasting time to adapt equipment for other than its intended purpose is also not recommended.

Because a probe "fits" does not mean it is the correct technology, as in transmittance or reflective, for that particular site. A lack of understanding how the technology works has burned more than one professional in court. For some manufacturers, the neonatal probe, which is designed to be placed on the infant's foot may be used on an adult finger. Almost all manufacturers discourage the use of finger probes on the ear lobe or forehead. Nellcor and Masimo went to great lengths to explain the discreptancies between the different probes when used in ways they were not intended. The ear probe was not invented just for the company to make another sale. So do your patients a favor and read your manual and/or consult that specific equipment's clinical representative to learn the probe's intended application. Just because you have seen "everyone" do something, does not always mean they received the correct training but rather went with the "it fits" mentality.

With the CORRECT probe, you can get a pulse ox reading from the fingers, ears, forehead or nose. However, DO NOT adapt a probe designed for the finger to the ear, nose or forehead. It may give you a reading but not with accuracy.

These situations are not easy but how much are you willing to play God? I have seen patients badly broken from accidents that pull through with few if any deficits. Anybody here who has ICU experience, especially pedi, can tell you about some amazing recoveries. Of course, there is also the sadness. Myself, I cringe every time I intubate a 90+ y/o during a code. Yet, I know I have a job to do and it is not my decision to decide who lives or dies.

At the scene one would not know level of injury, the extent of injury or permanance of paralysis. A spinal fx in itself does not alway mean permanent damage. A contusion to the cord can bring apnea which can even resolve in a few days, weeks or months or not. While a quad's life span may be long, they can accomplish much during that time. Of course, it can also tear a family apart as well as bring them closer together. I have worked with many quadriplegic patients as an RRT and it is very rewarding when I can decannulate some pts to where they will be free of the trach. Every patient is different and each will face their own unique circumstances their own way. Every family is also different. Some may want a chance to say good-bye while there is still some life in their child's body and some may prefer that the child was killed out right without any chance for prolonged suffering. Of course, a family may not know what their preference is unless they have experienced such an event. Also, if an EMT(P) did not do something at scene, they could also be charged with negligence if the injuries are determined to have not been life threatening by a Medical Examiner.

That can be very true depending on how they contracted your company. If the physician is a resident who just "wanted to ride along" without any transport experience assuming you were actually going to do the primary care, then you may have a problem. Unless you and your medical director have lots of neonatal experience in a NICU, I would suggest calling his/her superior or attending to get the doctor pointed in the correct direction of care or divert for care at a closer facility while waiting for a qualified team. This is the reason roles and responsibilities should be established at the originating hospital when ANY PERSON accompanies the patient, regardless of title, that is not a member of your staff. The American Academy of Pediatrics (AAP) also has guidelines established for the requirements of the personnel transporting children. Sometimes the egos of Paramedics cause them to find themselves in situations that are not adequately educated or trained for. This can happen easily when they start a "BS chat" session with the resident who also may not be ready for such responsibility either. Together, they can make for a very bad situation. Specialized physicians, especially neonatal, of any level should have some transport orientation before assuming any long distance transport unless they are with an experienced Specialty transport team. Specialty teams rarely take physicians along except for the purpose of training them. Transplant and ECMO are usually the exceptions to the rules. The team performs under the orders and protocols of their medical director. If the physician in training does not abide by the rules established, they may get a time out and could find themselves taking a taxi back to the NICU to "chat" the attending physician.

If I am working in the ED, I love to hear the Thumper coming in if I don't want to start up a ventilator for the ICU. I have not seen many success stories come out of its use over the past 20+ years. I have seen it thump a lot of different parts of the body besides the sternum. The Autopulse is just hitting our area so I can not say much about it from personal experience.

There are too many questions that should have been answered before the transport began and even before arriving at the originating hospital. This transport was doomed because those initiating the transport from all ends did not recognize the level of care needed for transporting a neonate long distance. That also includes the doctor that accompanied the baby. The peds hospital should have had some protocols and guidelines in place for every type of transport. Did the ambulance service ask the stability of the baby and what was expected of the ambulance crew? Our NICU transport team essentially only wants a truck and warm bodies to carry some equipment regardless of your title. We are straight forward about that before contracting the ambulance service for a transport. How much Neonatal experience did the paramedic have? Did he/she assume he/she could handle a baby long distance or be of adequate assistance to the doctor? I am reading into this that the Paramedic was not at all experienced in neonatal transports. If he/she were experienced in neonatal transport, at least a few of my questions listed here would have be asked prior to departure from the originating hospital. The doctor may have had a false sense of security by thinking a "Paramedic" can do it all. The Paramedic may have been thinking the same with having a doctor accompanying the baby. Once realizing they did not have an adequate team or environment to work the baby, the doctor should have diverted to a hospital that had some level of NICU or decent ED. The level of trauma center is not as important as the level of NICU within a hospital for neonates. However, there should still be nurses and doctors experienced in neonates that can assist during an emergency at an ED that provides higher level of care. What was the surgery? Was this a stable back transport? Why then a doctor? Did the peds hospital have a transport team? Was the neonatal doctor an attending or resident? Who authorized the transfer at the originating hospital, receiving hospital and ambulance service? Was the baby already intubated prior to transport or did that occur enroute? I would take it the baby may have be intubated enroute since nobody should bag a baby long distances in this day of technology unless in the case of equipment failure. Who supplied the isolette? Who supplied the meds? Who ran the code? A good neonatal team will NOT run Code 3. Some of our transports are 100s to 1000s of miles in distance and several different modes of transportation may be utilized. NICU teams are trained to be a self sufficient unit. However, we will park preferably at a hospital of whatever level if we have to and work a baby if we still have a long distance to travel. This takes the pressure off the driver who may make an error while driving if knowing the baby is coding and we are a long way from home. We will not relinquish care of that baby unless authorized by our medical director to do so if there is a qualified NICU team at that hospital. Usually we just want to plug into some electricity, O2 and an overhead warmer if available to open the cover of the isolette for easier access. Once the baby is stable, we will continue our transport. Glad the baby lived and hopefully will not be in the trach and peg group. Moral of the story; ask questions before departing. If you are transporting with only one hospital staff member (MD, RN, RRT), make sure you are clear on responsibilites. We see incidents happen way too often with interfacility transports where a hospital staff member is placed to accompany the patient and no one knows what anybody is capable of. Never assume you can do something you have only read about, done maybe once or that it looks easy enough. Be honest with those who will be your team members for the next few minutes or few hours.

Do you think that if you had introduced yourself in the beginning with your title instead of wasting everyone's time, while watching your partner get set up for embarrassment things, might have gone differently? The patients and people across the room did not know it was mistaken identity. They just know some guy, your partner, must have screwed up royally to get blasted by a doctor while you looked on. I doubt seriously if you got anybody's respect that day. Your opinion of nurses as ass wipers and doctors as paper pushers is not going to get you much respect in the future either. If somebody does not know your correct title out of the 40 something to choose from, try to educate and not agitate or inferiorate. Get over your insecurity with what you are called be it right or wrong. You may have to remain professional while being called a lot worst than ambulance driver someday. I see this is only your 5th post. Welcome to the forum. I work both in and out of the hospital. Playing well with all professions gets you more respect than pissing matches.

Give out? Whatever you want them to know whether it is about who was on scene or what will actually happen when they vote for a trauma tax amendment? Skilled PIOs can educate the public very effectively with good press releases with different news items. The PIO and the media can be be very useful together. How hard is that for you to understand? Now, did you read the OP's post that started this thread to see what lead to my statement? You are just being argumentative about the same points over and over. And, you are contradicting your own arguments against me.

My quote from an earlier post: Posted: Thu May 08, 2008 6:55 pm I don't think you actually read any of my posts. I have no issue with the media since as I pointed out they have been instrumental for achieving many milestones in our EMS systems. My posts aren't about some TV show but about "real life stuff" like taxes and political battles to achieve the systems that are in place and still evolving. You seem to be confusing fiction with the actual news. Real life issues that affect households and people living on fixed incomes do attract the attention of many citizens and they do watch the news shows. And, yes, healthcare issues including EMS are discussed by educated and/or informed people. Maybe you should try listening to the people in the district you serve instead of trying to show off your resume with the "it's all about me" attitude. Educating people in little ways like community CPR or fire safety give the people a more personal view of what you do and who you are more than a chest thumping article. It also gives them a sense that you might actually care about their welfare and not "what do they want now". You want to talk about how great it would be if this system was in place or if we had that or whatever. My point is, if you don't know the answers yourself, don't invite the public in too soon. You could end up looking very silly. Adults do know the "kid in a candy store" routine.

Excellent! Let me help you out with a couple of links. Alveolar Gas Equation (PAO2) - Interactive site for the formula http://vam.anest.ufl.edu/simulations/alveo...n_complete.html Actually that whole website has some interesting stuff including how a BVM works. http://vam.anest.ufl.edu/simulations/simulationportfolio.php Arterial Blood Gases http://www.cprworks.com/ABG%20interpretation.html ABGs simplified Interpretation of the Arterial Blood Gas http://www.orlandoregional.org/pdf%20folde...Blood%20Gas.pdf Good PPT presentation on Hypoxia, V/Q mismatch and Shunting http://www.anest.ufl.edu/ccm/Hypoxia_files...#slide0011.html V/Q Mismatch http://www.emedicine.com/ped/byname/respiratory-failure.htm Respiratory Physiology: Pulmonary Circulation, V/Q mismatch, PAO2 http://medschool.slu.edu/gpbs/syllabus/200...physiology2.pdf PaO2, SaO2 and Oxygen content http://www.lakesidepress.com/pulmonary/ABG/PO2.htm Oxyhemoglobin Dissociation Curve http://www.ventworld.com/resources/oxydisso/dissoc.html

Journalists can be represented by the Media Workers' union and the term can be used as a collective title for some. http://www.mediaworkers.org/

That would depend on the overall medical conditions and assessment of the patient before assuming PNA is "BLS". In the ED, if a patient has bilateral PNA, which is generally determined by CXR and other differential tests, they are placed on a sepsis protocol which gets them a higher level of care bed. Crackles in only one area does rule out PNA in other lobes. 99% on a NRBM tells very little if the A-a gradient is significant. I hope you understand the difference in PAO2 (partial pressure of oxygen in the alveolar gas) for a person on O2 as opposed to room air and what V/Q mismatching is. PaO2 is oxygen pressure in the arterial blood. Of course, even that does not tell us much about the content of oxygen in the blood until SaO2 and Hb are known. The Alveolar-Arterial gradient (PAO2-PaO2 gradient) for the average young healthy adult at sea level, will be 5 - 10 mm Hg. If they are on a nonrebreather it should be over 400 mmHg. Since you don't always have access to an ABG machine in the field, you have to rely on other signs to assess the respiratory status. A pulse oximeter number should not be used to determine the severity of distress since a good number can be misinterpreted to being "all is well" or mislead the rest of your assessment.

triemal04, Are the people in your area really that unaware that they have no idea what a paramedic is even remotely about? So what if they don't always get the terminology correct? Do they get a choice of calling BLS or ALS when they call 911 in your area? Is your dispatch capable on sending only BLS for 911 calls if ALS is not warranted? Does the public have a problem with not getting ALS if that is what they thought the might get? If that is so, then maybe they do know the difference. Since some of the questions you are asking involves an indepth look into your area's tax base, it is difficult for me to adequately speak if changing services would be appropriate for your community. Nor would I know how to adequately explain how that would affect different households if asked by the public. Your questions are a little more complex than "I like this one or that one". You have to look at how funds are proportioned at the local level and what percentage is from the tax base. If you increased taxes to support a change would you lose businesses and residents thus again decreasing your overall tax base? What would be the economic impact on your community as a whole including its govening infrastruture. If you want a good case study on the economical impact of public services, you can surf up Vallejo, CA which just filed bankruptcy. Niftymedic911 could probably explain how his county set up an extensive EMS system and the support received from the public. Their structure for taxes and fees is very well laid out. You can probably get a good overview through links on the Lee County (Flordia) EMS website. Maybe since Florida has a large population of retirees who really love to meet, discuss and compare anything medical that they stay more informed. We also have huge EMS systems, many associated with the FDs and some county, that are pretty much in their face about something on the next city budget meeting. Again, these retirees love going to those meetings also. The Floridians that have been around at least 30 years will know Florida was largely volunteer or small private ambulances. These people are aware of how they evolved into huge FD and County systems by paying attention to the various tax proposals on the ballot and their property tax information. Local newspapers and TV have always kept this in media. Of course, that could also be partially the blame for our over kill of services as bigger, better and more was promoted until it was too much. People who are in lower tax base areas are probably very aware of who or what provides their EMS. Small towns especially know what they have or not. For some it is a big deal to raise money for a new AED. Some town news papers do write articles of support to help them out in any way they can. They may also point out the haves and the have nots of various communities. Those in the have not category in the United States know our healthcare system is not equal. My focus is still changing educational requirements. Florida has over 50% of its paramedic schools as unaccredited medic mills. Now is the opportunity for our state to make changes in that area and that is what I am supporting at the moment. Being an RRT also helps since that profession has already been down that road of achieving educational standardization and legislative recognition. Also being at an age where MIs and CVAs are a reality, especially for professionals in stressful jobs, my other educational endeavor is to make health care workers and others more aware of their own health needs. Of course, that is where the degree in which I received my Masters helps. So no, I am not doing nothing. I've also been around long enough to be impressed at the changes in EMS through the years and how they have been supported by the public. I, however, am not impressed with the attitudes that exist in EMS that keeps educational standards low even as the equipment and technology advances. There is still more emphasis on what the public should do for EMS in terms of money and recognition and not what EMS should be doing to keep improving the standard of care for the public. People who still do the bare minimum in education to pass a test to be called an EMT or Paramedic are doing the public a disservice. I would say we won't agree on this because it appears that there is a vast difference in public awareness between your region and mine.