nremtp

We have a no lifting policy over here in the UK and all of our vehicles now have stretchers which do not have to be lifted at all. We have a combination of powered stretchers from Stryker and those with a foot pump from Ferno. If you don't want to go to the expense of fitting a tail lift ($15,000) to your ambulances, you can go for the cheaper option which is an electric wedge ramp ($5000) or even cheaper still a portaramp ($600) which folds up manually and is hydraulically assisted so it can be operated with one hand. Even taxis over here have them now for wheelchair access so it amazes me that the EMS market doesn't have them!!! We still have one or two older ambulances with Ferno 35A or Pioneers but everyone refuses to work on them and if the ambulance service tried to make us the Unions would just get involved and argue manual handling regulations, health and safety at work act etc etc

We have the option to thrombolyse CVAs although it is done in hospital in most areas. A 12 lead is essential for stroke treatment pathways, so you are possibly being asked for one in order to aid later treatment. You may also wish to rule out co-existing pathologies. Just because they have had a CVA does not mean they don't also have other problems as well.

I use a fantastic invention called a 'book' titled the BNF which includes every licensed medicine in the UK. It is free if you know a friendly pharmacist or you can buy them for £40. Can't see the need for these electronic gadgets and the like, if it has a battery then it can fail! I also find the PDA style applications cumbersome and time consuming when with the book I can just turn to the right page in seconds.

Having worked as a civilian paramedic attached to the military (Royal Marine Commandos) I have been taught MARCH which in my opinion is a far more useful method than ABC of approaching a casualty. ABC means nothing if your casualty is bleeding out and what is the point in compressing the chest if all you are doing is pumping blood out of the wound? As civilian EMS is shaped, guided and in fact based on military medicine it is highly likely that this will become mainstream EMS practice. We wouldn't have EMS if it wasn't for the military battlefield medical care of Napolean and more recently we are seeing battlefield EMS hit the civilian streets.

If it helps, I don't know anyone who has ever failed an EMT-B and you should have seen some of the degenerates on my class (Texas) who couldn't even string a sentence together yet they passed EMT-B without any dramas. When some of them practiced their skills you could almost a banjo in the background! Don't worry, and don't cram!

As I read this I'm glad I work in the UK. We don't have protocols and we don't work under a physician's licence. We have the freedom and education to selectively immobilize. The only way to 'clear' a c spine is radiologicaly as has already been said. We do however apply canadian rules to decide whether to immobilize. The official stance is, immobilize everyone where the mechanism of injury suggests an insult to the c spine and then remove the immobilization if CCR indicates no injury. When I worked in Western Australia, we did not carry back boards or KEDs on the ambulances. This was due to research which came out of South Africa which indicated that only 3% of people presenting with neck pain in an MVA would have a c spine injury. The most common cause of neck pain is a rear end shunt and the evidence shows that this mechanism of injury does not cause a c spine insult. In WA, we had to walk all patients with nothing but a soft collar on. I disagreed with this but the medical director (in a quasi american system) decided that was what was to be done and to date I can only remember one case in the whole State where a patient actually had a fractured cervical vertebrae. In the UK, we have the freedom to decide whether to immobilize and do not work under a doctor's licence; we have our own licence and are accountable for our own actions. I certainly don't immobilize everyone but I am cautious of the mechanism of injury and factors which would rule out the selective immobilization. If for example there is a distracting injury, I always immobilize and if the patient is unable to pass a neuro or comply with my questioning then I always immobilize. If docs choose to use their x ray eyes then let them get on with it! A recent case I treated involved a jockey who had come off a horse at high speed and had landed directly on his head with the horse then landing on top of him. We (two Paramedics and a Technician) proceeded to immobilize the horse until a doctor (an orthopedic surgeon) ordered us not to immobilize the patient and decided (without any examination) that the patient was fine, we objected but this was met with profanity and we discharged our duty of care to him. 20 minutes later, the patient reported tingling in fingers and a lot of pain in neck. Pt was take immediately to hospital where it was discovered there were 2 fractured vertebrae. If the rules are applied properly and the clinician is competent in the assessment then there is no need for the patient to be immobilized.

EMT-B can be done in two weeks, nothing wrong with that. EMT-P can be done in 3 months straight after EMT-B but that's another can of worms altogether! I don't know much about the US military but I am sure a colleague told me the US Army funded his Paramedic training for him. He just had to sign up for another 3 years or something like that.

The guy clearly has some kind of psychoses and is illegally in possession of various narcotics. I don't know the specifics of US law but in Australia a Poisons permit was required to possess morphine/fentanyl etc and in the UK we require a controlled drugs licence. I am sure that doctors are required to register for a narcotics licence in order to legally possess it so there must be some legislation that controls EMS workers. This guy admits in his opening statement that he has no medical training and is not even trained to use a pulse oximeter yet he carries all of this equipment, some of which isn't even on 911/999 ambulances. He has also neglected essential equipment in favour of some advanced equipment. There are individuals like this in the UK who are unfortunately running private ambulance services in the absence of any legislation preventing them from doing so. An example is www.mhmedicalservices.co.uk and another is www.markthemedic.com who scott33 will be able to verify have no training, no qualifications and yet they seem to think they are EMTs. They don't just have kit bags that would make this zombie bloke jealous, they have ambulances and more importantly access to sick patients!!!

That Doctor wouldn't be a certain Dr Crippin would it? Old subject I know but it raises an interesting point, GPs are refusing to work because patients have the flu.

Autonomy vs Protocols, Education vs Training this is what happens when you man the equipment instead of equipping the man!

We don't need it, all our PCRs meet the UK minimum data set so we only need to tick boxes and it's all done.

It is hard to post objectively without attacking what seems to be a very stupid person who seems to completely misunderstand an EMS system he has very little experience in. Our MPDS categorises calls in one of three categories, A (life threatening) B (serious) and C (neither serious or life threatening. Only A and B calls get a lights and sirens response, purely and simply because we cannot rely on information from the caller as being reliable enough to determine the seriousness of the patient's condition. Numerous studies have shown that the information provided by the caller is unreliable which is why MPDS exists. It isn't a perfect system but neither was CBD (the predecessor of MPDS). We do not "run fake calls" on lights and sirens as you claim. We undertake a prescribed course of training in emergency driving and are supervised by a driving instructor under controlled conditions. Just like intubation, cannulation and other skills; we practice them under supervision before doing them for real on a sick patient. It is now a legal requirement to undertake emergency driver training before being permitted to exceed the speed limit on lights and sirens. In a nutshell, our system is much safer than your sheltered little world where people don't need training. We also have (as zippyRN says) "Urgent" calls which are not run on lights and sirens. This is where a physician has assessed a patient either in person or over the telephone and decided they need to be admitted to hospital but has decided that it isn't life threatening (sometimes wrongly) so we respond under normal road conditions. We only use lights and sirens where MPDS has identified a potentially life threatening condition. Once we reach the patient, we rarely use lights and sirens to transport them to hospital unless they are time critical (chest pain for example or multi system trauma). In the case of chest pain or obstetrics we don't tend to use sirens as it causes anxiety in the patient but we still respond under lights. Your whole argument seems to hinge on the fact that you find sirens annoying, well boo hoo; they are there to protect the crew in the vehicle and warn other drivers that we need to make progress. If I am responding to a call which MPDS has categorised as life threatening then you can bet your last dollar that I will respond with lights and sirens as we are required to get there within 8 minutes and my Paramedic licence is at risk if I don't. I will however drive safely and in accordance with the law and because of this we have an excellent safety record in the UK.

Therein lies one of the differences between our EMS systems. Yours runs dangerously long shifts which endanger the lives and safety of the crews and patients (see various US case law regarding patient safety and long shifts) whereas ours protects the rights of the worker whilst limiting the duration of shifts and providing rest periods in order to improve patient safety. 0.5mg can look a heck of a lot like 5mg when you are tired and haven't slept for 24 hours! We are entitled to a rest period and we require one in order to function safely and effectively. Doctors have realised this and now their working hours are strictly controlled due to some high profile patient deaths. Are you really safe behind the wheel of an ambulance towards the end of a 24 hour shift? Are you really a safe clinician towards the end of a 24 hour shift? I find it shocking and disgraceful that this shift pattern even exists especially when you describe 38 shouts a shift with no down time. One of the main causes of patient death is human error, now you sit there and tell me (despite medical and scientific evidence to the contrary) that you are a safe clinician after 24 hours without sleep or rest.

I am a Paramedic in the UK and you really need to live or work here within the EMS system to understand the meal break issue. Imagine working for 12 hours solid with no opportunity to rest or take a break, with no food, drink or being able to use the toilet. We are entitled by law to a protected rest period, this falls under the Working Time Directive and Driving Hours legislation. If we are on a break then we only have a legal duty to respond in line with our employment contracts. Where I currently work we are required to respond in our break period but if we do then we get paid £20 for the inconvenience. In my new employment which I am currently transferring to, we have a protected break where they aren't allowed to disturb us. To the poster who mentioned granny coding, that isn't my problem! If I am on my break then I am not available and dispatch can utilise another resource to respond. It is not my job to fly around the city in a red cape saving all the citizens. This is a job, it is a job I enjoy but it is no more and no less. I am a professional paramedic paid to do a job and the hobbyist EMS in the USA struggle to understand that concept. We have the same problem with the Johnners over here who are undermine this as a professional career. I respond when I am paid to respond because this is the career I have chosen, I don't do it for free as I am a professional and deserve a level of pay commensurate with my qualifications and experience. This isn't a hobby and I am a human being who needs to rest in order to function safely. I wouldn't expect an EMS system which has 48 hour shifts to understand my point of view though...... We in the UK take worker's rights very seriously and we are required to function safely and effectively as part of the EMS team. I cannot function safely if I am so tired and so hungry that I cannot concentrate. What use am I to the patient if my BSL is so low through not eating for 12 hours that I feel faint and sick? What use am I to the patient (or any other road user) if I am so tired that I cannot concentrate on the road as I haven't had a break in 12 hours? Think about the bigger picture, it is not any individual paramedic's job to take on the care of every patient in the city; that is why we have dispatch and other resources. From what I have read, I really am not suprised that USA paramedics burn out so quickly!

Thanks for the replies, I am looking for a State who will reciprocate my UK and Australian training so that I don't have to sit an expensive and time consuming NREMT process. Those who insist on NREMT have simply said no so I'm hoping the others will reciprocate and allow me to challenge the State exam. NY is a firm no, they said they will recognise out of state but not out of country training.