VentMedic

No, some flunked out of nursing and tried to enter RT school. They finally ended up as Paramedics with the FD in the 90s when the mills took over.

John, You just quoted me. How can you state I said the hospital CEO's and Administrators have no clue? Those of us who have been around awhile know that the MBA was as common in the 80s and early 90s as the BA was in the 70s. Some thought of the MBA as a program for the undecided and others realized the BA was not enough education to get a decent job and definitely not a career. A nurse can do okay with just an ADN but one who wants to make a good career in nursing with many options should be adequately prepared for the future. I also remember the nursing program recruiters standing outside of the RT classroom door on test days to snatch up whoever came out in tears. Since the RT prerequisites were actually higher than the nursing programs at the time, the RT students were an easy transfer. However, it was very rare that the RT program took someone who failed the RN program.

Even from a scene response there are major differences. Some FD and SO HEMS just fly the patient from the scene in a swoop and run manner. Others may have RNs, RRTs or well educated/trained Paramedics that can begin a stabilization process beyond that of the local ALS. Also, the better trained/educated ground crews may not have a need to call a helicopter if they have more protocols to stabilize a patient and not have to call a helicopter for airway or BP management where the time of HEMS response and distance to hospital by ground might be the same or longer.

http://www.nypost.com/p/news/local/brooklyn/emt_shun_gal_had_asthma_CQq7kJN4aPsA2baxKiP3LJ#ixzz0c1cHQ8S9 January 8, 2010 An ailing pregnant Brooklyn woman who was ignored by two EMTs on their coffee break likely died from an asthma attack, an autopsy revealed yesterday -- sparking outrage from her family. Although that tentative finding still leaves open the question of whether the EMTs could have saved 25-year-old coffee shop worker Eutisha Rennix -- and her unborn baby -- there was no doubt about the answer for Rennix's mom. "They should have helped her," said Cynthia Rennix after the autopsy at the Medical Examiner's Office in Brooklyn. "She would have been here today. "This should never happen to another family again, because my family is destroyed right now," said the heartbroken mom outside the ME's office, where she was accompanied by relatives, including her daughter's 3-year-old son. "It makes me very angry." Cynthia said the EMTs, Jason Green and Melisa Jackson, "could have given her the care that she needed to help her." The autopsy was attended by former city medical examiner Michael Baden, who observed the procedure for the family. The family's lawyer, Sanford Rubenstein, said: "Preliminarily, it appears the cause of death was simply an asthma." "Had the asthma attack been addressed by the EMTs, would she have died? That's the question that has to be answered," Rubenstein said. "If there is criminal culpability, the EMTs should be held accountable." City authorities have said that the emergency workers had a duty to check on Rennix. Baden said an autopsy that was performed yesterday on Rennix's daughter showed the baby died as a result of oxygen deprivation. She was delivered some time after Rennix died. Rennix collapsed Dec. 9 in a back room of the Au Bon Pain at MetroTech Center in Downtown Brooklyn, where she worked. The coffee shop is a favorite of firefighters and emergency medical technicians who work upstairs at the FDNY's offices. Shop workers said Green and Jackson blew off repeated pleas to check on Rennix themselves, saying, "We're on our break, so there's nothing we can do," as they waited for their orders of Asiago cheese bagels. Jackson eventually called one of her fellow emergency dispatchers upstairs to notify them that a woman was having "difficulty breathing," but she and her boyfriend Green left with their bagels before an ambulance arrived -- and without even looking at Rennix. Rennix died hours later in a hospital, as did her baby. Jackson and Green -- who have been suspended by the Fire Department without pay -- now are targets of a criminal investigation by the Brooklyn District Attorney's Office. The EMTs' lawyer, Douglas Rosenthal, yesterday said, "It's premature to comment at this point." http://www.nypost.com/p/news/local/brooklyn/emt_shun_gal_had_asthma_CQq7kJN4aPsA2baxKiP3LJ#ixzz0c8ATmfS9

You are looking at "management" from the only perspective you have been taught with is probably very different than the health care leadership model BSN and BSRTs get. Our pertain to a health care setting and with direct patient care that covers leading and organizing many different services for the good of the patient. If the nurse wants to get more into health care administration and less with patient care they can go the MHA or MBA route. The management in these "lower" degrees is still geared toward patient care. BSNs are needed because the RN has traditionally been the higher educated clinician who was responsible for the whole patient. However, if you attend a multidisciplinary meeting, most allied health providers will have a Masters and are quickly gaining more respect from the MD and Hospital Administrators since legislators and insurers are impressed with their evidenced based research for patient care and have shown that professions with higher education can cut costs in the long run. This must be the "basic" management course that you are referring to. NUR 4828 CON-NURS 3(3,0) Nursing Leadership, Management and Role Transition: PR: Admission to the BSN program, successful completion of the first four semesters in the nursing curriculum, and concurrent enrollment in NUR 4945L Directed Practice; NUR 4637; NUR 4637L; NUR 4257. Professional development and role transition of baccalaureate graduates entering professional nursing practice focusing on principles of leadership and management applied to health care settings. Except for a couple of community and public health classes, the RN to BSN candidate can choose from several patient care based electives to enhance his/her clinical knowledge. However, I would not dismiss the importance of community and public health nursing. That is a huge issue right now and it has the potential to shape the way health care is delivered in the out of hospital setting. NPs and PAs as well as RTs are already very involved in the legislative processes for out of hospital settings that will directly influence their professions. If a nurse wants to get more education for management as it pertains to running a nursing unit, there is an MSN with a management track. If the nurse wants to run a health care company or participate in corporate nonclinical level management, then he/she would get the undergrad requirements to enter an MBA program or anothe graduate business degree. Again, management in the direct patient care setting and dealing with patient as well as "leadership" issues is a different specialty and you should already know this since there are MBAs with varying tracks for different specialties as well as MSA (accounting), MST (taxation) MSBM (sport business management), MS (human resources) or whatever your specialty. Nursing is a very expansive profession and the BSN is just one step that really is an entry level for patient care and one the gives the RN more credibility with focus to the broader picture of things to come in the clinical setting and the future. The ADN provides only the core courses with their prerequisites much like the RTs are now seeing how outdated their A.S. degree is for achieving their goals and providing a better educated clinician at beside. We're still learning what OT, PT, SLP, Athletic Trainers, Radiation Therapists and a few others have already mastered.

Also, with this program and almost any other medic mill, you have to sign a loan for the full amount and it is often well over $10K for about 6 months of training. A community college is cheap and if you find out your teachers are horrible or that you do not want to be a Paramedic afterall, you are only out of the cost of that semester. If you drop during the first week, you can get a full refund. If you drop at midterm after you find out you are failing, it will not affect your overall GPA.

Wow! What's with the attitude toward educated RNs? They are improving their profession through applying themselves to get a degree and not settle for a cert or the bare minimum. Did you also miss what I stated in my post? RNs know their limitations and do demand more education/training whereas some Paramedics believe they can do it all with a few hours of training. Thus, we get some very dangerous CCT and Flight teams. Did you also think I was talking about a nursing home RN or one that works solely in Endoscopy? Did you not see this in my post? Why does nursing have to make do with their lowest denominator just because it is acceptable in EMS? No other profession is lowing their standards for entry because a few whine. Now I see where you are coming from. Having an MBA, you don't like the fact that RNs can take a few management courses. Do you own all Flight companies in the U.S. to where you can speak for all of them? Probably not. Why are you defending those that practice the "warm body" interview style? They only give those which are professional a black eye? The Paramedic can be acheived by a "certificate" and then they can apply for a state license. Other health care professions need a degree before they apply for state license. That is the difference and not what your state calls the card that gives you the privilege of practicing in that state.

But working someplace for 10 years may not necessarily equate to someone "experienced". Some people may just exist in a job for 10 years and decide to get a flight job because they need a change and especially if all they need is an ADN. If the requirements were any higher they probably wouldn't put forth the effort. However, if someone has done their homework to find out that a BSN is preferred and then works their butt off in the best ICUs trying to learn all they can to get a job they have set their goals for, I would find that to be the best candidate. You are also stereotyping the RN. One thing about RNs is that many are capable of adapting to most situations since they may be required to float t/o the hospital or between hospitals. Some are also tossed on an ambulance at a moment's notice if the pateint is beyond the scope of a Paramedic. Right or wrong they make the best of it and most with then demand additional trasining The training for a Paramedic is not really that extensive either in material or time but yet some are expected to function on their own after just a day or two of orientation. This may be coming with no previous medical experience except for the required EMT-Basic experience which doesn't prepare one very well for medical issues or doing lead on a quality ALS truck.

JW, You have a Paramedic cert with an MBA. What was your 4 year degree in? The classes that make up the RN - BSN transition prepares the nurse for a broader spetrum of nursing for the future such as community health and research. Too few get a very limited view of medicine as a whole to know how systems work and what their role can be for the future. Also the additional research and writing can only improve skills that are necessary for day to day life. If you haven't noticed by some of the posts on the forums, that readin' and writin' stuff can come in handy. The better you are at it the better your presentation may be as a professional in your reports and other forms of communication. As a manager or owner of a Flight company I can see where the ADN RN would be to your liking. If they haven't started a higher degree after 10 years they probably won't so you will not have to worry about working around a college schedule or be concerned they might ask for education perks. They also know their options as an ADN are very limited especially if other flight teams want a BSN. Even some ICUs now prefer a BSN degree especially since they do have a large selection of qualified nurses despite a "shortage". Thus, the ADN RN will not be as likely to argue about salary and safety concerns if flight is something they really want to do. A BSN RN with 3 years of critical care experience knows they have several options and can be upwardly mobile in their careers.

Maryland State Police flies only one Paramedic and may pick up a volunteer EMT from a ground crew to assist. The ground member killed in the Trooper 2 crash was a volunteer EMT. Several FD HEMS also fly one Paramedic and sometimes it might just be a ground Paramedic with not extra training. We have one in FL that is owned by the Sheriff's Office and would fly a S.O. pilot to the scene to pick up the patient and a Paramedic. They then flew "real fast" to Miami. They are now staffed by full time RNs. There are also a few other S.O. EMS helicopters that still just pick up any Paramedic including the one that couldn't get the tube or IV in on the ground. I also know that some of those who failed our application process miserably for a variety of reasons can walk into some of the less reputable services and be a superstar.

You should fit right in with the other middle aged overweight men and women in these classes. It is not a sight for the weak.

Several states allow the RN to challenge the EMT-P with a few requirements like a PDQ EMT cert and/or a Paramedic refresher course. There are also bridge programs for RNs which are about 100 - 200 hours in length. It would be rather insulting to have a CCRN sit through a Sidney Sinus or Abe AV node lecture or endure some of the A&P that is watered down in a Paramedic program. Some states also have a level for RNs in prehospital positions such as MICN or PHRN. The RN generally makes more (in some places, a lot more) than the Paramedic. If a Paramedic gets his/her RN and decides to apply for the RN flight seat, the RN experience requirements will have to be met regardless of how many years they have functioned as a Flight Paramedic. It is the critical care expertise that sets the RN apart from the Paramedic. If an RN for some reason loses his/her RN license but still has a Paramedic cert, they may have no problem filling that role. As well, if a Paramedic calls in sick, we just use another RN for an RN/RN team. Also, even if they hold a Paramedic "cert", an RN (or RRT) will work under their RN (or RRT) license. As a Paramedic even on Flight, I am still more restricted, and we do have a fairly liberal scope of practice, than my RN partner. If I was working flight under my RRT license, which I do on a Specialty transport team, I leave the Paramedic card at home. Also, I unfortunately can not do any of my RRT scope when working as a Paramedic. Some RNs run into that problem especially if they also work as a Paramedic with some EMS/FD. I know a couple of FD Paramedics who got their RN in California and fortunately they were Paramedics first so it wasn't much of a shock to know what they couldn't do as Paramedics vs an RN in an ICU or on CCT. However, for those RNs who want to run off and join the FD later are greatly surprised and very frustrated by the limited protocols.

The question might also be if you are serious about doing Flight, is the Paramedic worth it? However, many Flight RNs are expected to have a BSN which shouldn't be much of an issue since you already have a degree. Their experience should consist of no less than 3 years with 5 preferable of critical care experience and some in the ED. To be really valuable, you should also have a year in PICU and a year in NICU. Now of course, for Paramedic, you can get a quick cert and a couple years on a decent ALS 911 service and probably land some job on Flight even with about 200 other candidates applying. But, to land a competitive job on a decent flight team that just isn't looking for warm bodies, you should have the degree with the same prerequisite sciences as nursing. While you may be able to get all the additional weekend certs that look nice on a resume, the interview will determine whether you actually know what you are doing and not just collecting the alphabet soup. You will have to obtain a strong knowledge of critical care medicine which unfortunately the Paramedic is rather limited at obtaining experience. And, the interview will probably be done by a flight RN with extensive critical care experience. If you just want to do HEMS with a FD and not do critical care IFT flight, then just the Paramedic and FF cert may be all you need. It just depends on how hard you want to challenge yourself in medicine and critical patient care of the very sick patient.

Non-union healthcare workers, especially RNs, can make 1.5x that amount in the Bay area.

Some will be very disappointed when they discover SF has no medical helicopters and many of the flight teams consist of RNs. It is cheap education at the community colleges in California. At only around $25/semester credit, it would be silly to give the private tech schools $15,000 for 6 months of training.

This is some interesting reading. There might be a few lessons learned from the mistakes of others. The National Fire Fighter Near-Miss Reporting System is a voluntary, confidential, non-punitive and secure reporting system with the goal of improving fire fighter safety. http://www.firefighternearmiss.com/ For the search, I first put in EMS and got this: http://www.firefighternearmiss.com:7800/search?q=EMS&filter=0&client=iafc_frontend&proxystylesheet=iafc_frontend&site=iafc&output=xml_no_dtd Paramedic: http://www.firefighternearmiss.com:7800/search?q=Paramedic&entqr=0&filter=0&output=xml_no_dtd&filter=0&sort=date%3AD%3AL%3Ad1&filter=0&client=iafc_frontend&filter=0&ud=1&filter=0&search.x=60&filter=0&oe=UTF-8&filter=0&ie=UTF-8&proxystylesheet=iafc_frontend&filter=0&search.y=6&filter=0&site=iafc Ambulance: http://www.firefighternearmiss.com:7800/search?q=ambulance&entqr=0&filter=0&output=xml_no_dtd&filter=0&sort=date%3AD%3AL%3Ad1&filter=0&client=iafc_frontend&filter=0&ud=1&filter=0&search.x=60&filter=0&oe=UTF-8&filter=0&ie=UTF-8&proxystylesheet=iafc_frontend&filter=0&search.y=6&filter=0&site=iafc EMT: http://www.firefighternearmiss.com:7800/search?q=EMT&entqr=0&filter=0&output=xml_no_dtd&filter=0&sort=date%3AD%3AL%3Ad1&filter=0&client=iafc_frontend&filter=0&ud=1&filter=0&search.x=60&filter=0&oe=UTF-8&filter=0&ie=UTF-8&proxystylesheet=iafc_frontend&filter=0&search.y=6&filter=0&site=iafc

That was definitely a bad situation. However, I think the rape and beating in Richmond has that one beat. They know who many of the witnesses are and some have been interviewed on various news or talk shows. They have no comprehension of how bad the crime was even though they watched it for 2 hours with the girl beaten unconscious while being raped.

But the comments made by myself and a couple other about reporting an accident are not necessarily just about EMS. You are still a resident of that state regardless of whether you are in EMS or not and the term "reasonable" can still be applied. If you had read my statement for posting this thread, you would see I have ABSOLUTELY no argument about who should stop and when or why. The reason I posted it is even if you think you should, you probably shouldn't if it puts you, other people on the road and your family in danger. I started this thread for a reason and that was to show people to think before they just react or because they think they are obligated to put their lives in danger. Again, if you had read my posts, I clearly stated it can pertain to both accidents and crime and I am talking about just regular citizens and not EMS or PD. If you want to follow a case that will challenge the laws, surf up the rape of a young girl in Richmond, California that just happened a couple months ago. Not only was there a crime being committed in front of many witnesses, she also was in need of medical attention from the severe beating she took. Even if you are off duty, you can still call 911 on your cell phone as a citizen if that is reasonably possible. You do not have to ignore an accident or someone being raped or whatever just because you are off duty. That case is in almost every human psycology book. It is also now being compared with the Richmond case. http://www.cnn.com/2009/CRIME/10/27/california.gang.rape.investigation/ http://www.cbsnews.com/blogs/2009/11/05/crimesider/entry5535036.shtml

These laws do not pertain to "EMS". They pertain to every citizen in some states. If you are the immediate witness to a violent crime or accident, you have some "reasonable" obligation to at least call for help or make sure someone has. It is not meant for you as a layperson, citizen or off duty EMS provider to put your life in danger which is why the word "reasonable" is used in the statutes.

And, as I stated before, use these forums to practice your writing skills. Take some of the criticism from some of the older members (spenac being the oldest) as a little push for you to strive for excellence. I have seen your posts on two different forums and I like your enthusiasm. I think you will do very well in EMS.

Many states have adopted a "duty to act" law for its citizens and it can pertain to anything including a crime being committed. The state at least wants you to call 911 and are very careful with including the word "reasonable" in the statute. I believe this all came about with a national headline when a woman was murdered while many people witnessed or heard it. No one acted to even call for help.

I've got to be blunt. Work on your spelling especially before you start messing with any medications. You need to write and spell well for any patient care report. It is also sad that your instructor is a bad speller as that does not set a good example. Are you taking your program at a college or a technical school? Good luck to you and do work on your writing. You are allowed to use the spell check. You can also use Microsoft WORD on a computer to improve your spelling by watching the corrections. These forums are also an excellent way to improve your spelling and writing even if they may not always be good for much else at times.

This doesn't have anything to do with all the "eewwww!" threads you see on some of the EMS forums where EMT(P)s are afraid to touch patients. Rather is has to do with understanding why you touch rather than just because you can. The fire chief article you posted could also have be defended that he as a medical person could have examined the woman's breasts for injuries and by your stance, clearly justified his actions. If all initial training and education was equal as well as competent and involved medical directors, then yes, things might be different. However when you have more services that are more like Collier County or Washington DC rather than Seattle and more mills mass producing warm bodies wearing EMT(P)s patches just for the sake of filling slots or having every FF be an EMT or Paramedic, then what is allowed by scope and what should be done are two very different issues. But, these same statements can be applied to just about any "skill". To many learn too little about intubation or giving medications and soon those become a problem. The whole group or even state may then be penalized for the actions of those who were not properly trained and educated. Collier county can again be used as an example as can some counties in California. Look at the recent epinephrine issue in Massachusetts.

It definitely makes a big difference when the students already have some prerequisite classes such as A&P. That of course is the reason why all the other health care professions have an extensive list for the students to complete before they are allowed to enter a program. Both the EMT and the Paramedic programs are way too short with the "hours of training" clock ticking away. When a lot of time is spent explaining basic A&P it takes time away from other concepts that should be covered very thoroughly. If one reads Nancy Caroline's Paramedic text, it is embarrassing that stories like Sidney Sinus and Abe AV node must be used because it is assumed no college level A&P was required. I have also tried to teach CPAP and a few basic ventilator concepts to Paramedics who give me a deer in headlights look when I mention preload, afterload, cardiac output, pulmonary or systemic vascular resistance,lymphatic system, gas exchange or intrathoracic pressure. Thus, some instructors do get frustrated and just say "CPAP pushes out lung water" or maybe some instructors themselves do not have the education to teach the topic appropriately since there are not many standards for EMS educators. It is also frustrating to think these same Paramedics are giving medications that can affect all of the hemodynamics and whose only defense will be "it in my protocols". So start early with advancing your education. Having college level A&P will definitely help you for an EMT-B class and should be, but isn't, mandatory for a Paramedic program.

As a public safety officier he may have had some obligation but does that mean his family has also? Putting bystanders and your own family at risk must be considered. You generally want to remove bystanders from a scene and not drive them to it. One has to remember when you are in your own car, even if it tricked out with a bunch of lights, it is not going to be as visible as a fire truck. Even a fire truck can be a major obstruction if not carefully parked to where it will not endanger others including the rescuers. Also, if you were on duty at a scene like this, one thing you would probably do is prevent people in private vehicles from parking as he did. Stopping is one thing but don't forget everything you have been taught and trained to do safely.