Just Plain Ruff

this is paramount in the discussion of education. They understand and were capable of asking the right questions but worried about getting them out of sequence. We are teaching students to pass the national registry which I believe truly represents cookbook medicine at its finest. Every student I've talked to has said that all they want to do is know what questions to ask for the national registry. They dont' really care what the difference between rales and rhonchii are, or what to do for a specific injury other than what registry says. Is it possbily time to abolish the national registry and start to teach students to think with their heads rather than recite what the registry wants to hear?? I never have been a supporter of the National registry, it always seemed to be a bit of a money maker instead of a national standards setter(bad grammar I know)

EMS was mentioned quite a bit in this article. I guess what I took away from it was that if you get caught up in razor wire, don't struggle like a insect in a spider web and wait for the heroes, the medics.

If the lecture is not fresh or new in some way then I say only like 1 time before it becomes more of a chore than a educational experience.

Yeah a digital recorder is in my opinion a bad idea. did you check with your department as to their rules on recording things? If you think of it this way, if you record a call then that should become part of the medical record. There are rules as to when that stuff can be erased. It's my understanding that a medical record remains open for the lifetime of a patient and some amount of years past their death. If the patient comes back and says that you recorded them and there is a legal issue surrounding your care, the patient's lawyer can ask for that tape. If you said you erased that tape then suspicion falls on you to prove that you didn't erase the tape because of what the plaintiff alleges and you fall under suspicion. I would suggest not taping things in the future or buying a lot of extra tapes. Talk to your company about this or you may find yourself on the wrong end of a subpoena.

I'm up against a problem at work here. We have a computer based system that documents medication orders and we are seeing something hinky. A dosage of .01 mg or smaller may give us incorrect warnings. I'm trying but failing to think of any meds that would be given in that small of a dosage in an emergency room setting. Can any one help me with what meds might be given in less than a .01 mg in dosage? I don't think there are any but this is a possible patient safety issue.

the hardest part of EMT classes for me was like SSG said, not falling asleep in class. I already had a bachelors degree, I graduated with a 3.6 gpa from UMKC and the class was taught at what I felt was a 3rd grade level. We had a lot of students who couldn't tell their right hand from their left or to be blunt didn't know blank from shinola. The class was so easy a cave man could do it but in deference to my instructor, he was pretty darn good at relating real life situations to the material. I couldn't wait to get out and be the ultimate emt complete with all the whacker tools until a seasoned medic told me to snap out of it and told me that to be a good emt was to ask questions, don't hesitate to learn new things and for gods sake get rid of all the stuff on my belt, you'll never need it he said. and you know what, he was right.

I think that before you should go out in the field you should start an IV On yourself. ha ha

I find nothing wrong with personal web sites as long as they don't violate the rules of your company What I do have a problem with is when those websites cross the line into company bashing, revealing of company information, revealing of patient care situations etc. I go by this rule of thumb - if you would not like it if someone posted the same thing about you that you post about them on a web site then you should keep your mouth shut. Look at the following situations: John Edwards campaign workers - anti-christian remarks got two of them in trouble - it more than likely ended their careers. Another example: CHP is being sued for 20 million for pictures that somehow got posted to one of those rotten.com or whatever sites. A young woman in a fatality accident is seen - it's my understanding that these were really graphic. The family saw them and they got mad - rightfully so. Other examples are those people who are looking for jobs and a prospective employer finds their blogs and read that they bashed their previous companies. Needless to say, they didn't get the job. The internet is not anonymous by any means folks, what we do on the net can and will come back to bite you in the ARSE if you aren't careful. If someone wants to find information out about you they can, it's not that hard. The only advice is, if you post something that you would not want made public then don't post. I also believe that if you post something bad about your company in a blog or a private web site and you are found out then you should suffer the consequences. It's even worse when you are on a companies computer and you do it.

That's a good thing.. One other thing, make sure you know that job description backwards and forwards. Know what you can and cannot do. Do not go over that because if you do something that is not allowed by the job description then you are liable and the hospital is not. I've worked in the ER before as a medic and we had a very strict stringent guideline of what we could and could not do, those guidelines were we worked in the capacity of a nurse but could not hang blood. We could do everything else but hang blood. Good luck and keep your eyes out on extra classes and free education - hospitals are full of em. Even if they don't apply to your certification go to them because they can only help you in your future as a medic or from here on out. Good luck - if you need anything feel free to PM me. I've been there before my friend.

it sounds like your hospital doesn't have a clue about what you can or cannot do then I would stay away from that place until they can get you a good valid job description and what you can and cannot do. You are putting yourself in extreme liability that if you do something that your hospital does not make allowances for you to do then both you and the hospital are in extreme danger. I would never work somewhere that did not have what I could do delineated out. You do something that the hospital doesn't have you allowed to then you are SCREWED!!!!!!!!!!!!!!!!! Be real careful on this one. With that information you put out on your last post, I'd turn that job down in a heartbeat. No job is worth your licensure and livliehood. That hospital if you were to do something that they didn't have a clue on whether you could or couldn't do, will drop you like a hot potato when the legal eagles start to circle. In my opinion - too much liability on your end my friend. Work there at your own peril.

my first call as an emt -=-= pediatric non-breather - he died first call as a medic - standby at a fire

dwayne some meds out there require the oil to keep the solution mixed. I'm not sure of the actual drugs that require oil based but I don't believe any of them have a place in pre-hospital EMS. Most of the drugs based on a google search are vitamins and fat solutions. I remember giving one med in the ER that was such a thick emulsion that we had to use the z-track method of administration due to the medication coming out the injection site. Yes they do hurt more goin in and they stay in the tissue longer. ERDOC, Asys or Rid you have anything to add?

Actually, the service I worked for did use nurses in the ambulances for backup Wait a second, I think we've worked together before. you came to my service from the big city where you thought you were the best medic out there cause you worked in the inner city. We ran a call with 4 critical patients of those 4 two became trauma codes in front of our eyes. You know the call, the one where the 4 kids drove off the bridge and tipped over into 6 feet of water, and two of them were nearly drowned. You started to scream on the radio, get me all this additional help and when I told you that it was you and me and the next nearest unit was 25 minutes away you freaked, you focused on one patient and left me with the 3 others. I thought you quit after that call. So that wasn't you. I could have sworn it was you based on your crap don't stink attitude. So you are saying that because you work in Chicago that you are better than all of us? you need to stop and think I will ask this of you. since you have seen our titles. Why don't you give us an idea of your experience. Is chicago the first ems job you've ever held? how long have you been a medic? have you ever transported anyone with a longer than 1 hour transport time? You tout your way is the best so show us why you think it's the best?

Rid is that similar to synchronized swimming? Synchronized ratting???

One reason I've always heard is that piggybacking makes it easier to stop the infusion. Plus it also allows a more precise flow of the medication. imagine having a patient with an IV of dopamine running. they code on you. Thats your only iv you have. You do not have another IV bag hung and ready but not infusing in the iv. So they code, you are now not able to just turn off the infusion, you have to unplug the iv tubing from the iv catheter and then start the new iv. You waste precious time doing this when you could have just turned off the piggyback and opened the iv bag. I know there are others but I'm out the door in a few minutes to catch a plane. I hope it doesn't get away. ha ha

well skills should be no problem for most Learning - not much different than EMT School - you study, you learn, you memorize and you get taught according to how to pass the NREMT exam But the real skill of applying all you learn to the real world. A newly minted EMT will have no or very very minimal field experience to apply what he/she is learning. If the only experience you have to differentiate between medical conditions comes from a book then I truly believe you will be hard pressed to do a good job as a medic. It's sort of like this "you gotta crawl before you walk" It is not like Geico where it's so simple even a cave man can do it. You might be someone who can go right into paramedic class, pass the tests, pass the skill stations, pass the nremt and go out and get the needed experience but I truly do not believe that 95% of the people out there can. Especially if you do not have the other education that we have been drilling into everyones head in another thread here. don't rush your career, go out, get a job as an emt and work towards getting your medic but going directly from emt to medic class even when your license ink isn't completely dry is a foolhardy move. The Ruff Educational approach My alternative would be that EMT get abolished in the general sense. My program would be like this. the states no longer recognize EMT licensure from Jan 1 2008 for any new people. What we have in it's place is a paramedic program that incorporates all that you learn in EMT School but on a broader Medic level course load at the Associate degree level or if wanted the student could pursue a bachelors with additional requirements in each class to make them Bachelors level. Your end result would be a 3 or 4 year paramedic program which is really what we have been talking about. 4 months to get the EMT basic class done, then the program delves more into the medic level. The student could work in an EMS system at the level of EMT but they would be restricted to non-emergency basic transfers. Now the student has a job and continues on in their schooling with medic level courses and at the end of the 3 years they are full fledged medics. If the student drops out of the class then they lose the ability to work in an emergency service except for being a BLS transfer truck driver. They do not lose the credits that they have accrued and can re-enter the medic program at any time but proof of competency would be required. After more than a year out of the class, they would be required to re-enter the medic program and start from scratch. The school would integrate EMS courses with the required courses for an AA Degree or of the school wanted to they could grant BS (bachelors) degrees if the student completed an additional year in EMS management or Bachelor level classes. I know that this won't work because there would be too many whiners out there who would say, it's toooo hard, I can't take the time to do all this, I've got to get a job. until some type of re-vamping of the education of the medic/emt is done then we are just going to be head butting a wall on our quest for professional recognition and respect.

ok before we start down the path of rural versus urban my post was in no way to be construed that rural was better than urban. Before anyone on this thread goes down that road My intentions were not to start that debate but simply that if chicagomedic thinks that his ghetto homies(co-workers) can run a scene better than an educated person I challenge him to go to a rural area where the resources of the chicago pd, fd, od, ed, xd and all the resources of his area are not to be found. Have him run a couple of mass casualty incidents and critical patients where a hospital is not on every street corner(gross overgeneralization but you get the picture) and run these types of calls in a rural area. I'd like to see how he handles it.

Doc you are right. I didn't realize that the location of the call was on the border between vt and nh. thanks

OH MY GOD Chicagambo - STEP AWAY FROM THE KOOL-AID you are drinking in Chicago Chicagambo I challenge you to work in a rural system and see if your ASSumptions hold water. You make broad assumptions that your way is best. You'd rather work with someone who has less education background than one with more education? Golly geepers pa, I only want someone who has minimal education to work with. But if he has more experience then thats even better. I've worked with many many many providers of all different types. Experience is important but education is key. Take for example one medic I worked with in the past. she got her license in one of the earlier paramedic classes held in the state. She is a excellent paramedic skill wise but when it comes to books and keeping up with her requirements she did the minimum. She has a hard time comprehending why she is supposed to give one drug over another. She gives the med because it's in the protocols. Not educated but a good medic. Another medic I've worked with is a awesome medic, he is book smart too. Who would I prefer to work with, well the second medic because he's learned to think outside the box and has furthered his education beyond the 9 month paramedic class. As for this new age paramedic you are criticizing, you are incorrect. experience is nothing without education to back it up. Triaging is done the same all over right? I thought there was a standard or did I miss that while going through my masters degree program???? The more education you have the more ability you are to critically think instead of doing cook book medicine. You cannot fulfill your commitment to patients if you do not have the education to back up your experience. Granted there are excellent medics/emt's out there that have the minimal training and they do their jobs admirably don't get me wrong. Drop down off your high horse and come back to earth. We now know you are the best medic in the world because you work in Chicago in the Ghetto. Get out to a rural service, take care of a critical patient for 50 minutes to an hour and see if more education would have served you better. by the way, when I and a new medic. I had a bachelors degree. We had a call where a school bus crashed. We had 24 children on the bus with minor to serious injury. The bus driver was critical. We had a total of 3 ambulances in our county. We also had minimal support from outlying counties. We triaged and transported all patients with the help of 3 helicopters, our 3 ambulances and 4 ambulances from the neighboring counties. Our last patient was transported from the scene 54 minutes after our arrival on scene. No one died, no one got worse and it worked out well. I guess that me having all that education should have caused the cluster you alluded to with triage but it didn't. hmmm your argument isn't so valid now.

My question is this. This is a river right? Ok we have that figured out. Why did the rescue crews not come in their ambulance near the dock? I'm sure that this area was not a island. It would have said that in the paper right? So if there was another way to get to the patient why was the ambulance not driven to that location instead of the rescue boat? I'll bet every one of the rescuers had flotation devices on, but they failed to do so with this lady. But then another question comes up she was secured to the board, then to the gurney and the gurney was secured to the boat. If the boat went down would any amount of flotation devices have saved this woman, witnesses said the boat went down like a rock. Either way, she's dead. I don't think she would have been saved even if she had a vest on.

ok let me try again you give your ambulance report to the nurse via either the radio or phone you get to the hospital and see a screen that has what bed your patient will go in to. that is the kind of system I'm wanting to know. shoot me a PM with the hospital name. I'd like to see if my the software company I work on has that hospital as a client and then I can call that hospital to discuss their set up. hope that was more clear.

What notes and additional articles??? What kind of preparatory work have you done for this paper?

I think that the cops are over the top on this show because they are on TV and that taking down these guys looks good on TV and it also helps their department look tough on these people I especially like the few guys who got down right away yet the officer had to knee them in the back as a means to subdue an already submissive subject. I do agree with you Scaramedic but I think that these guys just have the "Hey MOM, I'm on TV" mentality

Wendy, not to be critical but what in in the heck does your post have to do with pedophiles???? I don't see it, please enlighten me. Second, it is very true that children and young adults are more likely to be victimized by someone they know rather than someone that takes them off the streets. If a relative or someone the child knows is doing the molestation usually you will survive the molestation but If you are taken off the street you have a tremendously higher chance of being killed after the abuse is over. Yes there is the instances of realtives doing this and then killing the child but the chances are higher of being killed by a stranger abduction than someone you know. I read somewhere that in a stranger abduction if you do not find the child within 12-14 hours then that child has a 80-90 percent chance of being found dead, not alive. I read this somewhere or heard it on some news special. not sure how correct the 80-90% number is but most stranger abductions you hear about these days end with the child being found dead. Castration has been proven to not work. you take away the hormones and chemicals in the person's body it does not take away the desire in the mind. Now you have someone who cannot perform the deed(good good thing) but he knows that he wants to molest but he can't perform so he's got huge anger issues now so he will do what he can do and then kill the kid. We don't need angry, no balls perp's out there. I thnk we need to take an abandoned mine. put em in there and seal it up. But we can't do that, it would violate their civil liberties. I have no valid answers in what to do because there will always be someone to take their place. all my answers involve very negative and violent methods. I just have to say, if someone molests my son, they had better pray to God that the police get to them first, cause if I find em first, it's all over.

Scaramedic, I can see why the police are so pumped up, on next week's episode they catch a COP who enters the house with a gun. After they take him into custody they find a cache of weapons, automatic rifles, shotguns andpistols with a round chambered. Who knows why the cop brought all those weapons but after all the past shows, these people know that when they enter the scene they might be on the show. so why shouldn't the officers take these people down. The pedophile cop with the aresenal should be reason enough.