VentMedic

It is difficult to move forward if you do not know where your profession has been, how the infrastructure of healthcare works and how it pertains to EMS, routes to take for change, key roles of local, state and federal government, and what national organizations are out there. In addition to the degree program I proposed a few posts back, I would like to include another mandatory 3 hour class. It would include: 1. the history of EMS 2. an overview of healthcare professions 3. how medical legislation works 4. how to stay informed about medical legislation that affects EMS rather than the glaring general headline makers 5. how funding and benefits are lobbied for and by whom, why and for who 6. local, state and federal taxation structure and funding for municipal, county and private 7. how medicare and private insurances provide reimbursement 8. how national medical organizations fit into the various professions 9. what role unions actually play in professional healthcare 10. the dilemmas, of both the insured and uninsured, to accessing the U.S. healthcare systems

Actually EMS is not the newest medical profession. There have been many technological advancements in the last 3 decades that have created positions for professionals who initially started as techs/OJTs that are now degreed and licensed. These professionals also practice advanced skills to coincide with their education. EMS has been around for over a century in some form or another but utilized physicians, nurses and morticians in the early years. Early modern EMS got the idea that it could teach unskilled and minimally educated people, who were able to respond faster, a few life saving skills in the 1960s. It is just unfortunate that this mentality has stayed with EMS for the last 4 decades.

I've seen many attempts over the past 3 decades of this at both the state and national levels. There are several organizations that do collect dues but none have established enough clout to get the game into play. Reasons: 1. There are more non-degreed EMS workers than degreed (EMS degrees). They may not be willing to join an organization that is pushing education in fear of job security or egos. 2. EMS workers mistakenly believe a union, to which they are already paying dues, is their "professional" organization. Other professionals, which I mentioned in a previous post, are not as isolated as EMS workers. Although, I believe some of this isolation for EMS workers is by choice and not necessarily the nature of the job since there is still interaction with other professions even on BLS transports. It is, however, easy to compare within the hospital walls what you need to run with the big dogs. The difference between having a tech status vs professional is very noticeable in patient rounds with members of other professions. Each state, which already has an EMS board and lobbyists, must initiate the change. If EMS workers start to petition their state's EMS board and ask why they have not been proactive for education like Oregon or Texas, they may have to provide and answer. If one looks at the legislature passed within the states for funding, it is in favor of the big organizations, either private or public. These are easy to slip through because very few EMS workers take an active interest in the government section of their state's website. They then act surprised when they hear some organization got money for a new supervisors's cars or whatever. Starting at the state level can be individual at first. Writing letters to the board and questioning various pieces of legislature is a start. The more people you can get, the recognition and the possibility of a response either public or private. Start a paper trail. It has been a long battle in the state of Florida which is a leader in the world of Medic Mills. However, I am now noticing a couple of "career schools" offering an Associates degree in EMS which is accredited by "private post secondary" organizations. This could just be because their educational credits transfer to few if any state colleges or they want another $10 -$20k from their students by promoting the way of the future. Florida does offer fully accredited 2 year EMS degrees at just about every community college. Currently, it seems that no matter how much we try to keep the students in college after they finish just the certificate, they become influenced by the working world with little foresight for their future. Accreditation (CoAEMSP/CAAHEP} for EMS programs is set with a deadline of 2012 for the NREMT test. The state of California has already required schools to be accredited since 2003. If the paramedic training at a tech school is accredited, it may be easier to receive some college credit to continue on to a degree. With this in motion, I believe each state should ask their EMS education directors if it is feasible for their state to change to a degree requirement for licensure within 5 - 10 years. If that is deemed obtainable, the state should set the deadline in the statutes. People that only obtain certificate training as Paramedic or those who don't advance to a degree by the deadline would be grandfathered in with a designation on their license that they are of lesser education. They would still be recognized as Paramedics but if someone was to look up their status on line they would see they are not degreed. This could now be also used as a factor for promotion since the standards are higher. After the deadline, degree only to apply for licensure. Those that would oppose an increase in educational standards such as the FF union may be found to be unpopular by the media and the aging baby boomers who are well educated.

Actually you could name just about any of the allied health professions and few people either lay or EMS personnel knows much about them. And actually, some that think they know the nursing profession really don't know except for isolated areas of experience. Physical Therapists: Doctorate level of education OT, SLT: Bachelors and Masters RT: Associates and Bachelors 1. Each has strong national organization with state affiliates 2. National and state organizations have strong lobbists for state and national legislature. 3. Each has nationally recognized exams for entry, advanced and specialty levels provided by the same nationally recognized organization. 4. Licensure by each state with retroprocity. 5. Each only allows x amount of time for the slackers to get with the rest of the flock for each educational increase. 6. Each strictly monitors CEUs. 7. Solid educational foundation makes the addition of skills and growth opportunities within an easier reach. 8. One's worth to each profession is not necessarily measured by the number of "skills". 9. Entry level education for these professions is equal or greater than RNs so there is a more level playing field. 10. Each profession spends more time contemplating on how to improve themselves for better patient care by education, monitoring and lobbying for patients' benefits than worrying about what an EMT or Paramedic might call them. Their patients know who they are when they need them. And yes, even some members of this forum will refer to a Respiratory Therapist as a Respiratory or even Inhalation Tech. I may correct them or I may not. If you are my respiratory patient I will give you my correct title. If I am working on you as a Paramedic that is the title I will use. I may or may not bogle your brain with terms like CCEMT-P or whatever. I also understand that not everyone got the memo on what the new terminology is for the day. Both RT and EMS have changed and/or added credentials over the past few years. RT now only has two primary credentials with a few specialty. All require a minimum of Associates for entry level. In EMS, we have confused the system, the public and ourselves with the many certifications, inconsistent credentialing and lack of education standards. As I have stated before, when an ambulance arrives a program should be given to the public giving the titles and duties of each member of the crew. With all of the different certifications, do you honestly think the program would be an easy read? I am still trying to figure out the recent thread with and with the Kansas EMT-B/RN/IV/First Responder/volunteer FF thing.

One more interesting KW news item: 8) 11 January 2008 New Medical Helicopter At Hospital http://www.kwtn-blue.com/2008/01/new-medical-hel.html LifeNet, a division of Air- Methods, the largest provider of medical helicopters in the world has contracted with Lower Keys Medical Center to make Key West a permanent base of medical flight operations. Air Methods oversees, partners and maintains more than 200 helicopters, surpassing the number of helicopters in the United States Coast Guard fleet. On the hospitals helipad right now is the Eurocopter 135. These highly sophisticated medical helicopters become airborne intensive care units for transporting critically ill patients to medical facilities on the mainland. The EC 135 can carry up to 2 patients and up to 4 medical crewmembers at a time and can fly a total distance of 300 miles without refueling. The medical crews of these advanced high-flying air ambulances are the “best of the best.” “We are very pleased to be able to offer our services and expedite transport for the Lower Keys community,” said Alana Scalia, Base Operations Supervisor for Key West. LifeNet/Air Methods are the only provider that requires all of its programs to be independently accredited by the Commission on Accreditation of Medical Transport Services (CAMTS). Before being based in Key West, the copter used to take up to an hour to arrive from Miami. Now the crew can be on the helipad in minutes and ready to go on the approximately 50 minute flight to mainland medical facilities.

Lower Keys and Fishermen's Hospital (Marathon) are owned by HMA - Health Management Associates. Mariners Hospital - Upper Keys is owned by Baptist. AMR does almost all interfacility transports off the islands that does not go by Flight. Except for HBO and transporting a "well baby" from Fishermen's to Key West's Level 1 nursery, there should be little reason to transport between hospital facilities within the Keys. However, in recent years, there have been a shortage of specialty physicians. This then leads to the problem of transporting broken bones to whatever hospital has ortho or whatever specialty. Getting to the mainland for health care can be very expensive for the pt. The hospital in Key West is the largest and provides a fair amount of community hospital services. Fishermen's and Mariners are very small and offer a limited number of services. It truly is not the ideal place to live if you have serious health problems or expect a complicated pregnancy. Throughout the Keys you will have serious trauma calls with head on collisions, boating propellar accidents, moped accidents (KW) and burns from boat/RV explosions. Nursing homes are now almost extinct in the Keys since Marathon Manor closed. Marathon's FD is now in a new building also since their old one was destroyed in Wilma. There are Paramedics and EMTs that live 2 - 4 hours away due to the cost of living in the Keys. It is relatively easy to get experience in the Keys as a Paramedic or a Sheriff's deputy while waiting for a chance to get on with a mainland department.

double post

Spenac, I am writing this with respect but in disagreement with your words. You can not speak for every JW in this country. There are fanatics in every religion. Do not criticize those of us who do work in the NICUs and PICUs across the country who want a child to live no matter the religion. You are speaking from only what you know or have be told with in your area and your belief. Yet, you use the term WE as if you are the WORD for all JWs. I can not speak for all Catholics not do I want to. I would probably offend a few Catholics if I used the term "WE" when expressing my views or interpretation of the religion. And NO, not all members of JW share the same opinions about their religion. There are numerous websites that differ in views and even in the interpretation of the scripture within the JW religion. But, again, this is no different from other religions. And, NO, not all the blood replacers or partial transfusions are acceptable for infants and children. If they were we would have no need to beg for blood donors. I also have deep opinions about people that are will to die for their religion. I find it selfish that if an adult, that they would abandon those they have a reponsibilty to if they have a family. And yes, I have been witness to babies in the NICU left behind by their JW parents. Whether blaming it on their religion as they wanted us to believe or if they just didn't want the baby and religion was a good excuse after the blood transfusion, who knows. Babies are abandoned everyday for less reasons than religion. Again, you can not speak for every JW parents across the country. And, would you believe that there are physicians who are JWs that have no problem with writing orders for blood transfusions if warranted for people of any religion? It is their duty to do the most for their patients and put their personal beliefs aside. And, there are RNs who are JWs that must give the blood regardless of religion. There are even Catholic RNs that must care for Gay people. The medical profession only wants to do what it can to preserve life. It's purpose is not to offend or be seen as the enemy. So, do not criticize those of us who view life as something very precious and do our best to care for adults and children regardless of faith. And do not criticize those of us who live in other parts of the country than you and see different versions of the same religion. I have not use the word stupidity or uneducated in my posts. I have merely stated that I am in disagreement due to what I have worked with personally and professionally. EDIT: I am familar with bloodless surgery and again it may not be appropriate or adequate for babies and children. If a baby needs ECMO or an exchange transfusion, they would probably be SOL.

http://www.ems1.com/products/dispatchequip...rticles/333065/ Volunteer Tenn. EMT sues after arrest for responding to call Lawsuit moves to give immunity to unpaid emergency workers By Jamie Satterfield Knoxville News Sentinel Copyright 2008 Knoxville News Sentinel Co. SEVIER COUNTY, Tenn. — A decorated Sevier County firefighter who wound up in handcuffs as he sped to answer a call for help is asking a federal judge to order the Tennessee Highway Patrol to afford volunteer firefighters the same rights as paid emergency workers. Attorney Ronald C. Newcomb has filed on behalf of Sevier County Volunteer Fire Department Lt. Michael Huskey a lawsuit in U.S. District Court against the Department of Safety, THP Trooper Jackie Bailey and Sgt. Kim Ogle over an incident in January 2007. It is a legal action that could both test and shape the law on when and which emergency workers are allowed to disregard traffic laws in emergency situations. The lawsuit asks a federal judge to issue an injunction against the agency that would require its employees, including state troopers, "to enter into a mutual aid and cooperation agreement, the core of which is to require (troopers) to honor, respect, enforce and avoid interference with the constitutional and statutory rights, privileges and immunities of all Tennessee firefighters, fire departments and emergency communication districts," regardless of whether those workers earn taxpayer money. THP has declared Bailey and Ogle blameless in the incident with Huskey, according to a letter from the agency's Office of Professional Responsibility. A Department of Safety spokesperson could not be reached for further comment Wednesday. Huskey, named the 2005 Sevier County Volunteer Firefighter of the Year, hails from a long line of firemen. But in January 2007, he wound up jailed after Bailey intentionally crashed the fireman's car in a bid to stop Huskey, who was speeding to answer an emergency call, records show. According to the lawsuit, Huskey was traveling in his private vehicle with his wife and three young children on Newport Highway in Sevier County on Jan. 5 when he heard a call over his scanner for an ambulance and paramedics to treat a possible stroke victim at a apartment on the nearby South Flat Creek Road. Huskey intended to let his brethren handle the call since he had his family with him but became alarmed when he learned over the scanner that the ambulance responding to the call only had two medics on board but needed three - two to care for the patient in the back and a third to drive to the hospital. "Assessing the severity of the situation and realizing he was only a couple of miles away from the scene, Huskey radioed central dispatch advising he would be responding in his personal vehicle. … Huskey immediately turned on his hazard lights," the lawsuit stated. http://www.ems1.com/products/dispatchequip...rticles/333065/ http://www.ems1.com/products/dispatchequip...rticles/333065/

I honestly don't know the EMS arrangement but I think it is like the one in Oakland,CA with AMR. AMR also does the ALS "cath runs" to Miami for the hospitals via ground. That's a 2.5 hr trip each way. Sometimes they bring another AMR truck from Miami and sometimes they'll run an extra truck from KW. Give AMR or KW FD a call. I'm sure they wouldn't mind hearing from someone off the island. It's got that neighborly small town feel with island Bubba politics. AMR-Key West 1414 1st St Key West, FL 33040 Phone: (305) 296-2401

I respect religion but I can tell you from my experiences of working in NICU and PICU that it is truly not a good experience to watch an infant or child struggle for life while the lawyers and judges have to race the clock to get a court order. Sometimes they are too late and the child does die and many times needlessly. Sometimes we do get the court order or finally the family's consent after they see their child's life drain away. Often it is too late and the child may end up with a trach and peg with a life in a pedi nursing home. It is as bad as watching someone drown and not being able to give them a life line. These are not isolated incidents but happen frequently in NICUs and PICUs across the country as some babies are born with imperfect hearts and children do get injured. Cardiac babies with cyanotic heart defects must keep a higher HCT if they are to survive till surgery. Not all the alternatives for not using blood are appropriate for small children. While yes, I respect religion, at least give the babies a chance to grow up to decide their own religion. And as I mentioned before, it is not always about religion. Adults have a way of pushing their own agendas, such as in divorce cases, and forgetting the child. Some people are also too afraid to make decisions because they are overwhelmed by the world of medicine that can come at them fast and hard.

We do try to respect the different religions and cultures. Where we can we'll use the cell-saver or try to get their Hb up with meds. However, mishaps in utero or at birth may leave little time to prevent the baby from suffering permanent damage. As much as we would like to respect the wishes, it is hard to let a baby die when blood was the thing they needed to save their life. That leaves a lasting memory of frustration for the health care providers.

Not everybody that needs blood dies. We give transfusions everyday in hospitals for a variety of reasons from medical to trauma. Adults may be able to handle a lower Hb/HCT than children. Children can come through alot but are still fragile. This happens occasionally in the NICU and PICU so the hospital has all the right numbers for obtaining a court order quickly if needed. It can be interpreted differently if the family initiated medical care by calling 911 or taking the child to the hospital themselves. They may still have some faith in modern medicine. If a neighbor initiated the call there may be reasons to interpret other forms of abuse. Many times the parents are willing to do whatever necessary for their child...until the senior members of their church walks in. The hospital will act in reasonable faith on behalf of the child. As EMS providers, if the family initiated the call, you just do what you can to get the patient to the hospital. If the family wants to abandon the baby, no problem. We've had babies adopted by nurses or other staff who loved children but were unable to have any of their own. Although, I really find it difficult to see a baby abandoned by an entire family due to religious beliefs. It doesn't have to involve religion to be a difficult time with parents who have no medical training and are frightened. Discontinuing life support on a child is another difficult issue that may be presented to an ethics committee when the parents are reluctant to decide.

124 miles of narrow county property 3 hospitals (Miami is nearest trauma and NICU higher then Level 1-which is in Key West) Monroe County EMS and FD A few volunteer FD Key West FD AMR for the city of Key West http://www.emsvillage.com/career_center/item.cfm?id=177 One scene/interfacilty Sheriff's medical(?) helicopter - Trauma Star (that forgot to get the interfacility contracts with the hospitals) One private medical helicopter Rescue Medical helicopter from Miami for the northern part of the county (in dispute with Monroe sheriff's) Average salary $35k - $45k Cost of living makes SF look reasonable. www.keysso.net http://monroecofl.virtualtownhall.net/Page...nnel/employment http://www.keysnews.com/ www.keynoter.com

The UVC is an excellent choice for a newborn. You can gain practice by hooking up with the local L&D department for the cords to get a better idea of what you will see. We will do a quick UVC cannulation in the L&D room if needed and replace it later once the baby is stable.

But, you don't want to leave too many marks on them. I have used a couple of tongue depressors on the center under side of the upper and lower lips where the "web" is felt. This is how I occasionally get an intern's finger or ETT freed from someone's mouth which is quick and less messy than unhinging the jaw. It hurts like heck but usually doesn't leave a visible mark.

I didn't think Ammonia inhalants were around anymore either. Even health care providers themselves including RNs, RRTs, and EMT(P)s can become bronchospastic around ammonia. I also see several people in the ED each month just from ammonia based cleaning products. Our hospital environmental services dept has to be real careful about the products they buy due to the large number of respiratory patients. You may or may not get the desired effect from the patient, but someone near you could be seriously compromised including bystanders. In the ED, I prefer pulling a ventilator up along side the bed and discussing intubation, paralytics, trach, "life support" etc. Usually when the wrist restaints go on for "tube and line" precautions and we start to get the head in intubating position there are some signs of consciousness. In the ambulance, I just monitor their vitals and airway for documentation and enjoy the quiet also.

I also believe that the Paramedic with a 2 year degree should be the entry level for Emergency MEDICAL Services. Then, extra education and certs for specialties such as CCT, flight and community health can then be obtained to build from that "basic" education. However, there are still people who need some type of EMT training or advanced first-aide for their professions. Examples are Firefighters, industrial safety officers, loggers, commercial fishing boats, mine workers etc who are the first to reach a patient and get them to safety and to the paramedics. Many of these professions do require some of their workers to take the EMT-B class even though it is not their profession. Would then each profession develop their own (miners do expand in their job related expertise) programs or enlist the services of agencies such as the ARC to assist in developing industry specific programs? The ARC has done an excellent job with several school teachers, camp counselors and disaster shelter workers in some parts of the country. I believe it is Texas that has both a certification and a license for the Paramedic with the difference being a degree education.

Dwayne, Don't take me for one that does not like technology. I LOVE my technology! That is truly the best part of being a Respiratory Therapist. However, I learned grass roots, look, listen and feel assessment skills way back when with Dust and Rid. I could just sit in a dim ICU room all day and watch the lights on the machines. I love the graphics and every piece of pt info at my finger tips. I've got machines to double check machines. I can also be in a remote location and check on my machines. Eventually, I will be able sit by the coffee machine and control every breath the patient takes. We do a lot of research so anything that will give us a number or a pretty print out is great. The patients have a probe in every orifice to send data to the computers. We have computer programs to tell us if we still have a viable patient. But, we still assess the patient the old fashioned way also. I've also been through enough hurricanes to know which of my equipment will get the priority plugs for several days. So, I am not anti-technology. But, I look at technology like a really fine car in the hands of someone who appreciates the car for its excellence in engineering as opposed to someone who has the car to make him/herself look impressive.

Florida 401.41 Penalties.-- 76 ( Practices or holds himself or herself 77 out as an emergency medical technician, 78 paramedic, or ambulance driver without 79 being so certified; http://www.doh.state.fl.us/demo/ems/Ruless.../CHAPTER401.pdf

He resigned. This little news story even made CNN tonight. http://www.local6.com/news/14996780/detail.html Fire Chief Resigns Amid Nude Photo Flap UMATILLA, Fla. -- A suspended Central Florida fire chief who e-mailed photos from a crash scene that included at least one image of a female victim's exposed breasts resigned on Monday.

It all depends on how you are going to use the photos. There must be reasonable effort to get consent from people whose photos will be used in books or sold for your profit. News events for newspapers are very different. Reporting the news is their intent. If that same photo is used in a book or print for sale, that changes things. Follow the links I posted earlier. It will explain the rules and regs of photography including the "Brittany" stuff. The link also includes the new California regs on publicity photography. This is not a HIPAA issue and yes photographs are taken in the hospital regularly for documentation and education. And, if you search through the Pulitzer Prize photos, you will see that most of the people who are in clear view are identified by name. http://www.pulitzer.org/cgi-bin/catquery.c...utton5=Retrieve

ABC World News Tonight, Charlie Gibson There are 48 different certifications in the U.S. Charles Gibson also covers international news which includes ambulances in other countries. Cut the guy some slack. Many of our titles don't even transfer across state lines. With, FR, EMT-A, B, C, D, I, P, 1, II, III, IV, EMT-Intubation, EMT-Intravenous (IV) etc, we should hand out a menu or program on each ambulance call to list what services will be provided by whom. We can also make a notation to include, "the part of the ambulance driver will be played by Paramedic whoever". And after reading the thread about the little volley service in Kansas....???

If photos are sold for profit and the faces are recognizable, then a model release form may be needed from the person or next of kin. If a photo is used in a textbook which is considered commercial then a model release form is needed. The photos at conferences are usually more for "entertainment" than educational purposes since it is usually just a contest for best photo based on "oohhh and aahhh" or Wow! without any educational narration. Since they are not intended to be sold or used for profit, a model release is usually not needed. The photos used by lecturers usually have the faces blurred. When our physicians use photos from the patients in our teaching hospital, they will blur the faces but will also inform the family complete with a consent form that they want to use photos and information from the patient for teaching purposes or if they want to publish specific data. http://www.asmp.org/commerce/legal/release...outReleases.php