fireflymedic

The NR passes the buck to the NAEMT - if you look on the web site they advertise the NAEMT and I believe you get a free year with them when you register (I know you used to - don't know if that's still the case). However, the NAEMT needs a swift kick in the rear to get jumpstarted to do anything as far advocating for EMS as currently they are doing nothing. They want to take dues, use them to promote the thing more, but they are doing very little to further EMS education or benefit us. Shame, because they could do some good.

There's less room for advancement because there is no demand for it. We increase the pay, benefits, etc of the EMS profession with the improved education standards there will be more options out there. People are more willing to stay if things are good rather than using it as a stepping stone to get out to a better job. As previously said, it's going to be painful, I don't minimize that, and you are stuck in the comment of well what do you do with the people that already have significant time in but no degree? Do you start bringing in degreed medics at a higher pay? Or do you raise their pay with the caveat of having their degree within a certain amount of time? Do you keep them at the same level of pay until they are degreed? Personally I go for the second option, but that's just me. As long as they are progressing towards it, I think that should be rewarded. If they stop though, they are reduced to their prior level of pay until classes resume or they find employment elsewhere. That would soften the blow and encourage them to further their education until we have a fully educated group in place to move forward with. Then you can start demanding the benefits PD and FD have. I think with the improved education, there will be an expansion of EMS possiblities within patient care and we will see better benefits. I'm not cruel and heartless to those already in and I think those who previously chose to go the easy way out should have the option of degree completion. I'm not saying get rid of them - just bring them up to the education level within a reasonable time frame (ie two years or so) to equate with the rest of the medics graduating. We can sit here and debate all day, but until we decide to agree on something we'll not ever get anywhere. Fire and PD learned a long time ago - unite and we get what we want. We're too busy bickering with each other to get what we need ! Oh and guys - you say well I never got that college level a/p class - why don't you go get it now? It's sure not going to hurt you and most schools will let you just sign up for a class or two without pursuing a degree. Why not give it a try and see how much it will help?

Herbie, I think you are a bit mislead about certain aspects. Despite the fact that the IAFF is resistant to change on the EMS perspective, many are starting to require at least some college education to get in there, and then usually a degree to advance through the rank. This is why you are seeing so many degree completion programs popping up on the internet and within the technical college system. The vast majority of police departments require at least two years of college and the more you have the better off you are. In this state, hiring for FD's and PD is done on a point system and things like college, veteran status, prior experience, etc help you gain more points in consideration during application. Also, almost any EMS service in the area requires a bachelors degree and 5 years EMS experience with prior supervisory experience to consider moving up into a directors roll. A degree in EMS will make a huge difference as it did when nurses went from a technical education to degrees. Yes it took them a bit, and agreed it was painful - it weeded out those unwilling to move up to a higher level of education. And I believe that's exactly what would happen with EMS. I don't argue too much with leaving the basic at a technical level of education as a degree shouldn't be required for those who only solely want to volunteer and rarely make calls, or for PD and FD who are cross trained. Let a two year degree be the entrance which would be like an I-85/AMET level but at the same proposed skill set. Then a four year degree be a full paramedic, and post graduate be your critical care medics. I'm not concerned with whether the degree came from a technical college, a degree completion program, or a university. I'm not arguing it would be a bigger output of funds but I believe it would move EMS from the public safety sector to more the healthcare provider area such as hospitals, etc. If we want more skills and responsiblity and to move from the taxi mentality we must increase education. Though as previously stated, a piece of paper will be a start, but it's up to the individual person to learn the content. Just as there are people who slip through the cracks with other professions, there still will be, but much of that will be reduced. For those currently working, degree completion options should be offered. I don't argue too much with leaving the basic at a technical level of education as a degree shouldn't be required for those who only solely want to volunteer and rarely make calls, or for PD and FD who are cross trained. However, basics complain of not being able to do very many skills beyond basic first aid (heads up guys, that's why it's called a BASIC). They're still useful for taxi rides to doctor's offices, dialysis runs, etc and there is still a market for them or solely as drivers. However, I do feel for any significant IFT's or 911 then you should be a paramedic to give your patient the best possible care. Nursing Assistants complain of being nothing more than a glorified butt wiper and they have comparable education essentially to the basic emt. They aren't entrusted with a large skill set because of that so why should we extend basic's skills for a similar education? I'm not knocking either one - the are important within the role they serve, but would you want a nursing assistant pushing medications without the education and knowledge? They aren't even allowed to distribute medications without additional training. This is the entry level though and a great majority of nursing schools require six months of working as a nursing assistant prior to application (which didn't use to be the case), so are we off to ask basics to do the same? I think basics have seriously over rated themselves in terms of knowledge and what their scope of practice should be. I know this post will be far from popular, but if we really want to see education progress these are the advances we are going to have to make, as painful as they may be. And to those of you that say well it doesnt make a difference to you - the changes would affect me as well in having to pursue additional education so I'm not exempt. But change and growth are painful and hard, but worth it in the end. EMS moved from nursing homes to the county/private/fire areas to advance, and now it's time to move again. We'll see better pay and a better respect and reputation.

I think a big relief to the frequent flier callers would be the ability to transport to alternative destinations as opposed to the ER everytime for minor things. Obviously, major complaints should go to the ER and be evaluated, but minor things could be handled outside of the ER. Let them be transported to the health clinic or urgent treatment facility, be evaluated more thoroughly by a MD/DO, PA, or NP. Then if they feel it significant, have them transported out. I think there are many things that could be handled in office. It's not quite the freedom once given in certain areas for complete refusal of transport, but instead gives a moderate area that functions as a "fast track" ER (which sadly most of the hospitals around here have done away with due to expansion and limited space). I think it would relieve the strain on the ER's and also have a quicker turn around time for EMS than a patient in the ER. Also, the urgent facilities tend to have more time to address certain concerns as does the health clinic and can give more guidance towards resources than the time crunched ER's. They can provide info to free clinics, senior citizen assistance, food pantry's etc. Also, you could still charge for transport, but the patient wouldn't have the stress of a huge ER bill. THere was a county that tried to charge for refusals here, and another tried to charge for non citizens of the county involved in accidents/wrecks but both of those were repealed due to response of people. They didn't last long, perhaps other states have done better, but it hasn't worked well here.

That's a dog gone shame those poor pooches were subjected to such torture. What in the world convinces a human to even conceive of something like this? Dress up a bunch of kids to look like poodles and put them in an exercise video? Man, she needs some serious psych help - though just out of curiousity - can you find one with sheep for squint?

JW - I will not speak as to what I don't know. However, the one incident that stands out in my mind was the desire to accept a flight when the particular county requesting had just had a tornado spotted in their county. Do I think it was inappropriate to accept that? Very much so. It was sheer ignorance to begin with and yes, on an instance like that I am all for putting my foot down. You are trusting the pilots with your life, and yes, if there is a valid concern as to accepting the flight, then I would express my concerns. Though I agree the ultimate decision lies with them and they are the ones that will be scrutinized even harder should something go wrong. I am far from a weather expert and as previously stated, I respect your input as you can speak from both sides of the fence. However, this discussion is not on flight medicine, so I'll apologize for hijacking a thread here. If you care to continue the discussion JW - feel free to PM me about it. Now back to your regularly scheduled discussion.

He may be grounded until he's 100, but at least this had a happy ending. It very easily could not have been as positive. The parents are probably going to be keeping a closer eye on those kids.

I think it would be rather interesting to get someone from Oregon's perspective on this topic as they are the only mandantory degree state. I would also be curious to hear how their pay rate stacks up to the rest of the U.S.

To the first comment - I'll state let pilots do their jobs, medics do their and while I can definitely appreciate your input from both sides of the fence I have no qualms about telling a pilot I'm not going anywhere if they are pushing weather minimums or I feel my safety jeopardized. I'm sure the vast majority feel the same way. Safety issues addressed, it's their aircraft, and their job to fly it, just as it is my patient, and my job to treat it. I am definitely in agreement though in that the more advanced certifications the better educated you are the more it helps. I have absolutely no argument with that at all. I know it helped me. Second point - when released from class the first thing I was told - "you know just enough now to kill somebody"...didn't think it at the time, but later realized how very, very true it was.

I'm sorry, I was thinking for some reason you were more advanced...don't know why, just did. And yeah, I'll be the first to say it sucks to have to pay for CEU's. Fortunately I get mine paid for.

Sorry Dust - I was referencing the gentleman that squint talked about. Though I think it would still be hard, it wouldn't be as hard in the situation you describe as the one squint described.

I'm not sure of your level but I do know the farther up the ems ladder you go, the more difficult it is to find CEU's. I find myself almost always going out of state for CEU's because most of the things around here are the same topic just repeated multiple times. For example, I skipped the state conference this year for that very reason - I had heard all of the topics at another conference. I am in agreement rural services do have the most difficult time trying to find them simply because there just isn't much to choose from locally. As I said, to get much anything of any quality, I've had to go out of state. Sorry to sound rough, but I'm afraid if you are going to be particular about what you get education in and not the typical refresher that everybody usually does then it's going to require a bit of time and investment on your part away from work. Check with flight services see what they offer in the way of education (I know many offer a vast amount of classes), call your state board, check the net (medic ed is a great site with alot of different topics approved for all different levels), sometimes the hospitals offer things and will grant EMS credit. I also know alot of the foundations (ie diabetes, als, whatever) already do the paperwork to get CEU's for nurses and don't mind putting forth a little effort and getting it for EMS as well. Check with them - you can learn an amazing amount about stuff that won't put you to sleep. I don't argue that there are some good resources here and I've been sent in good directions as well researching things. I know the suggestion was brought up to admin about at some point putting CEU's on here, but I don't know if that's possible. Best of luck to you and always stay safe.

I would really struggle with that one - knowing they are conscious and talking to you and as soon as you stop they will be dead. How do you explain that to them? "I'm sorry but we're going to stop because we can't continue this forever, and you will die." I believe that would be even more difficult for the family as they know if you continued that the person would be alive and push you to keep going. I know we speak many time of the cruelty of doing CPR to certain populations (the very old, end stages of terminal disease, etc) but would you react differently if they were able to communicate with you? I can deal with open eyes during CPR as I know there is no one there, but to experience someone literally "coming back to life" and then dying again would be troubling. Very few calls in my career have haunted me, but that is one that I will be the first to say would. Interesting topic we got started.

Okay I think I'm going to give a weigh in - I was waiting until the peeing match was over. First off as many have said, your education is only what you make of it and continue to make of it. Frankly in EMS we are too lazy about moving forward and learning after we are done with class. When you sit down and think about it - how many people do you know that are making that last mad rush to get their CEU's in before their certs are due? We talk of continuing education which should always be happening, not wondering if at the end of the year if we have enough. Someone dedicated to their education should be in more than excess of the required hours (they're not that many anyway). I'm a big advocate for degreed medics. However, there are some non degree programs which are almost as thorough as a college program only minus the "fluff" classes thrown in there. Granted they are few and far between, but they are out there. And yes, I don't see the purpose of a women's literature class for a degree in paramedicine. I am a bachelor degree medic and I think how much better the focused associates degree would have been to pursue - less time and the same quality of classes for the degree. All of the same exact classes would be required within the paramedic program. Just a lower amount of general education courses. So are those medics any less quality than me? Are they any better quality? I don't know - it's only what they made of the program. There is also a certification option within the college that eliminates all the general education classes minus the paramedic program pre reqs (anatomy/physiology 2 semesters, basic english, college algebra, cardiology, pharmacology, and medical ethics). So as far as prep and program content - all of it's the same, just the number of general education courses varies. There are some great instructors there and some fantastic medics and some really sorry medics. Entirely dependent on the work the student puts in. Ultimately we are not arguing for a piece of paper - we are arguing for improvement of education. Be that with or without a degree in place, if that improves, we have taken a drastic step forwards. Finally as far as the AEMT/Intermediate level. I have mixed feelings on this. I do see it as a way to cheapen ALS, but I also see it as a way for extremely poor counties to cheaply upgrade their services when they cannot afford not only the cost of hiring medics (which everyone discusses) but the cost of supplying drugs, additional materials, etc. Many counties in this area run multiple BLS trucks and one medic per shift. They stay very busy and often are left struggling caring for a critical patient with no options other than basics. However, I do see a potential problem of further cheapening EMS, especially for the larger services that can afford dual medic trucks currently. I can see them no longer putting dual medics on a truck, but rather two AEMT/intermediates. Playing devil's advocate a bit though - how many calls require true ALS interventions? Many times we just place them on a monitor, put in an IV and that's all. For counties struggling with the option of downgrading service to BLS, or even potentially even closing their doors and becoming volunteer or passing the buck to surrounding counties (which yes, it's happened here) due to poor economic conditions, then this may be a viable option. There are several services in this area which have a low run volume, and are struggling to make it day to day. Pay has been cut as low as it can go, and the days of medics working for 8.00 an hour aren't gone in hopes of keeping the doors open. It's different when you're in a very rural area and when you are in the city with larger resources. Long term, I don't see it affecting the ability of medics to get a job as if we increase the education it will open even more doors for them to go into. Ultimately, yes some services are going to see this as an opportunity to increase profit while minimizing cost hiring lower qualified ALS through the AEMT/Intermediates. I would be interested though to see if the billing structure changes as well for reimbursement. Something to consider.

My apologies - the book is called Emergency by Mark Brown M.D. It is a collection of stories from physicians and nurses in the ER from across the country, so I would say it was pretty easy for someone to take the work and call it their own. The actual story was written by Jerome Hoffman M.D. To be fair to whoever posted this comment as you say, it's possible they were the medic caring for the patient as they state the paramedics brought him in like that in the middle of life and death, not choosing which side he wanted to be on. Persistent V-Fib was his rhythm never changing and a two hour code when they finally called it quits and let the man die. As far as how common that phenomenon is - the doctor stated in the story he had been a physician 20 years in a busy urban ER and had never seen it before. I've never heard of it, but that doesn't mean it's not happened elsewhere. This is the only case I've ever heard of. I guess theoretically if you were perfusing the brain well enough via CPR you could improve level of consciousness. I am only guessing at this point though. Would definitely be an eerie position to be in. As far as how common is it for someone to take a story and turn it to their own - dust stated best - extremely frequently. I've seen it more than a few times on this board and others.

Ruff, I think the attitude reflecting those was different. Similar to the movie Pauly Shore did that I remember quite well "In the army now". I found it hysterical as did many friends of mine that are in the military. The difference was that everyone KNEW it was supposed to be a comedy and expected spoofs, much like with many of the movies you have described. I understand creative liberties were taken and I can only imagine what the navy seals had to say about "g.i. jane". However, they are a smaller group and their rejection was probably much quieter and amongst themselves. But it certainly didn't portray them in a good light. If I were one, I would have been ashamed. However, as I am not one, and know very little about them or their training (other than it is extremely difficult) it was a decent movie (partially because I think the actors did a heck of a job in the movie playing their roles) regardless of what accuracies/inaccuracies were done. I do recall a similar fuss for a bit about the movie Super Troopers (evidently state troopers don't have much humor about themselves). However, once they realized it was supposed to be a stupid parody of their profession they calmed and almost all of them I know (my husband included) think it's too funny despite it's incredible stupidity. If they had taken the approach to EMS that they did with Scrubs that it was supposed to be humorous and have inaccuracies in there, I think many of us would be sitting back watching and laughing like crazy. Instead they took a serious approach and wanted to make people feel like it was reality. That's a concern. Here's one question I have - Rabbit is supposedly the higher level of care (or is he a regular medic that just happens to be on a helicopter - haven't figured that out yet), yet he passes off a pericardiocentesis to a street medic. I understand VERY few places have this within a protocol granted under direct online medical direction. Think they went looking too much for the zebras and forgot the horses that are standing there looking at them. Good questions posed there though Ruff -

Ruff - that was a rather gracious response that Seb Wong provided to you. All along I've maintained the same thought - I feel sorry for him as he is the one that has to deal with the public's image, not only of EMS, but of his particular department. That puts him in a tough spot, especially since they are a municipal department as he states, they don't have the luxury of saying no. Their funding depends upon keeping the mayor happy. As much as some of us may not like fire based depts, ems I think it's time to seriously sit down and give this guy credit for at least trying. I know his job can't possibly be easy. Best of luck to him on cleaning up the mess this show may create and my sympathies certainly.

In urban areas, yes I think there is a definite overusage of HEMS - unless you are in excess of 30 min from the scene which is really rare I do not see the neccessity of using them. As previously stated by the time call comes in, lift off, landing, report, take off, transport, landing and transport into ER you could have usually already had your patient in and evaluated. However, for rural areas that are an excessive distance from a trauma or definitive care facility (yes I'm lumping some medical things in here ie STEMI, suspected CVA, etc) I would rather see a service call for HEMS than sit and wait, the patient wait around then finally get transferred out (usually by air med due to distance and also the oh crap factor of the physician in the ER). Average time for a significantly injured patient from injury to evaluation at a trauma center is around 4-5 hours if diverted to another facility. There's alot of patients that can't wait that long. So yes, I don't mind someone calling based on mechanism of injury due to that. Easier to treat it earlier than later with better chance of recovery. I think it is entirely dependent on distance, local department's capabilities (and their availability - if they have one medic in the county it changes the position about than if they have one on every truck), mechanism of injury/nature of illness, what the patient's complaints are, and the potential for injury, and current status. If anything makes it high risk, then I wouldn't object to a helicopter being called for transport. If the indications aren't there or within 30 min of evaluation then go on by ground.

Nice steal there squint

It looks like Trauma's DNR is in process and it is hanging on barely on life support. Evidently it's not going to make it past the end of this season if it even survives that long - hmmm how you gonna end in NBC? Blow up San Fransisco? Should we all sign the petition to prolong it's misery or put it down humanely? http://tvseriesfinale.com/petitions-and-polls/

makes me think of the story in the book "EMERGENCY" by jerome hoffman of the guy that they claimed came back to "life" everytime they started CPR and "died" everytime they stopped. Evidently he would open his eyes and blink everytime they started CPR back up, then revert to the partial closed of death. He stated everybody in the ER thought he was looking at them...was there awareness there? Who knows, but freaky indeed. BTW - if you haven't read the book it's a decent read. True incidents that are funny, sad, etc but best because all are true.

Was it something like this mike ?

Rabbit got shot? Oh my did he treat himself? Fly himself out - did he grab the blonde barbie medic to save him? Give himself versed? They're gonna kill him off yet and that's how they'll end this miserable show. I can see it now - Rabbit gets killed, barbie medic, and punchy pilot can't deal with and everybody up and quits. Yep - we could only hope. *note* I have not watched episode 3 so this is a predetermination of death