medic511

OKAY, yes, I know these are definitely older and no longer top of the line. That said and acknowledged, we are a rural fire district that has never done vary many transports, leaving that to private ambulance companies. These days that is having to change due to a combination of COVID, economy, scarcity of EMTs, and VERY LONG turn around times at ER. So, we are now transporting about an hour each way over rural (bumpy) roads. Many of our patients are elderly. We have resolved to add automatic or semi-automatic vital sign monitoring to supplement our all-manual current practice. Because of price, availability, and reputation and a generous in-kind donation of several of them, we have decided to go with the Welch Allyn ProPaq Encore line. We have mostly 202EL and 206 EL units, with Option Numbers of mostly 223 and 225. These units, therefore, use Nellcor SpO2 sensors but from there I am confused. Some say MP-203 sensor and some say MP-507 sensors. I have also been told that Nellcor DS-100A sensors are what we need and I can find off-brand replacements for those. I particularly want to maintain the motion tolerance that made these model popular "back in the day." Can anyone help me with which goes with what for the SpO2 sensors? Also, a smaller matter is that I cannot find even a part number for the DC (12 volt) three-pin power cables. Thanks so much for any info, wisdom, suggestions or hand-holding anyone can provide. Take care everyone!

Yes, I think Just Plain Ruff's advice is a good starting place. This is a question neither you nor any of us can answer until you (and we) understand what he means. In preparing for that conversation (or evaluating it later), you would be well-advised in my opinion to review the closely related but very different concepts of compassion and empathy. they are different but related. Like so many things in life and especially in EMS, too much of even a very good thing, can become a bad thing. Using compassion as an example, it is a good thing to calm a worried, excited, and ill patient. It helps you get the info you need for a quality and accurate assessment. If the core complain is, for example, a twisted, dislocation, or fracture, and you are so compassionate that you stop your lifting or splinting every time the patient cries out in pain, you will actually cause the patient more intense and longer lasting pain than if you are less compassionate and plan your move fully with your partner, realize in advance that this will hurt and decide to complete the process in one move. Then there is the matter of time. Too much compassion may lead to longer on scene times, which is fine for minor complaints when multiple other response units are available. But, if the patient's condition is more serious, what they need is a quick (but still safe) ride to definitive care at the ER. When your patient has a relatively minor complaint but your system is out of resources and has calls holding, or is likely to have calls holding unless your unit gets back in service, then you have to also add the needs of those (perhaps not yet individually identified) patients into your overall decision. Finally, your employer also has an interest (that to me is a legitimate one to some degree) in seeing that you are not "unnecessarily" taking up either your time or the time of your patients when your patients are in fact your employer's customers (patients you are being compassionate with are also not spending money and, to be frank, compassion usually feels good, so it CAN be tempting to some providers to spend a bit too much time with talkative patients that are enjoying your supportive attention, which is another one of those too-much-of-a-good-thing situations.) Professionalism requires a good balance in all things, which is much easier to state in the abstract than to pull off in reality. Good on you for showing compassion! That alone gets you well on your way.

Medic511 here. I have been a member here for a long time but not very active as a poster. Your question lit a fire under me today because of a local issue here that I had, in almost 20 years as an EMT and Medic,yet actually to see stated in writing. The manager of ALS EMS in this county yesterday actually sent out a memo/email that says we should save for reuse N95 masks and gowns unless they are visibly contaminated by blood or poop. I understand that it seems that our country or its government has been remiss in stockpiling an adequate reserve of PPE. But this seems to me like an outrageous plan to address the situation. On the first evening of my first EMS course (it was then called First Responder), I was taught about the fundamentals of Universal Precautions, BSI, and PPE. For twenty years I have followed that practice and as I became more involved in Instructing, taught it to 1,000s of students at all levels. As a National Registry examiner, I failed those students who ventured into a scene that they had no verified as safe. Donning a mask previously used during assessment of a suspected or confirmed COVID-19 patient cannot in anyway be said to create a safe scene even it it does not have any visible blood or poop. Similarly, taking a disposable gown already used treating a potentially contagious patient from a paper bag and donning it just because there is no blood or poop on it visible to the naked eye is a safe practice only in the eyes of an untrained or callously indifferent bean counter. As you can probably tell from my language, I am appalled, frightened, and devastated by the panic that must be behind this directive. Universal Precautions have kept me healthy through hep-c, HIV/AIDS, Swine Flu, and ebola and I have never been reluctant to assess, treat, and transport those patients. But I do not see how I can justify the risks of seeing possible SARS-CoV-2 patients wearing used disposable masks and gowns. My fire chief? Oh, yeah, he says he is convinced that "this is just a bunch of bull poop being spread by the media, and not something to worry about." Somehow, that scares me far more than the directive.

I am a National Registry Medic certified in Florida and will soon be moving to the general vicinity of Jacksonville, Florida, due to the relocation of my significant other. I understand that Jax city and Duval county are combined and EMS is fire-based. Other than that, I am sadly naive about what agencies provide what EMS in the area, what continuing education opportunities may be available, and such things, in neighboring counties like Nassau, Clay, St Johns, and Putnam. Any info would be appreciated. Thanks.

The surprising answer is, when the "medic" works for the National Park Service. Being a federal agency, the NPS does not feel that it is necessary to have their EMS personnel be licensed or certified in any state and they just rely on National Registry status. But things get really confusing because the National Park Service's official title for NREMT-I's is "Park Medic." (NPS RM-51 at Section 6.3.5) So, when dealing with the National Park Service, it's necessary to remember that their "medics" aren't paramedics at all. The Park Service does, however, call NREMT-P's "Paramedics." So. I guess the Feds would like us to stop calling ourselves "medics" and start calling ourselves "paras." In the meatime for a quick, painless upgrade from Intermediate to "medic," just join the National Park Service.

NIBP stands for Non-Invasive Blood Pressure. That is, as opposed to an intra-arterial transducer placed inside the artery by an MD such as used in the ICU, CCU, etc. Manual BPs are also NIBPs. So, ALL EMS BPs are NIBP but they can be machine or manual. (The button on the machine often says NIBP).

From my perspective, we are really looking at a combination of ideal/textbook on the one hand and practical/in-the-field on the other hand. "Best" is meaningless until defined: most accurate under all conditions is one thing and which is in the patient's best interest in the existing circumstances may be quite different. So, you have to know, IMHO, if the call is a trauma with major MOI on the one hand or a probably minor medical with a not-likely-life-threatening NOI on the other. I don't think that a properly taken BP over a loose (neither really tight nor really bulky) shirt or blouse will vary significantly from one taken at the same time, same situation but with the single layer of cloth removed. IF the clothing bunches up around the upper arm, you are much more likely to get a bigger variation than you would had you left the single layer of loose but not-bulky clothing in place. I personally STRONGLY prefer a manual initial (or soon thereafter) BP but I really think that it's more because I get a better "feel" for the patient's overall condition. I have found that properly taken machine readings are actually more CONSISTENT in difficult conditions (usually noise related such as on-scene radio chatter or en route road and siren noise) as compared with readings taken by different personnel manually. ANY unexpectedly high or low machine readings should, IMHO, be immediately confirmed by manual readings and I like to use the other arm because its quicker and kind of has a built-in check for whether is this a unilateral rather systemic issue. Regarding the ECG lead placements, my initial observation about varying with circumstances is still true but maybe less important. The clinically "best" locations in a still room, with a patient without muscle tremors, and in an environment without problematic radio or electromagnetic interference, is clearly the just proximal from ankles and inside of wrists. However, in a moving vehicle, in an electrically noisy room, or with a patient that has continuous tremors, these placements will frequently increase the artifact (that's the meaningless random noise), which makes manual interpretation harder and thus less accurate. Machine or computer interpretation can filter out much of the artifact and thus better placement MAY result in a more accurate interpretation even though it also brings increased artifiact. Regardless of location chosen, you will improve results by (1) making sure that the locations are bilaterally symmetrical (that is not right clavicle and left wrist) and (2) making sure that the location chosen is backed by solid masses (like bone) rather than bouncing muscles that produce electrical impulses that are unhelpful (i.e., noise). Just remember, time is blood and muscle and brain, so DON'T waste time when it's critical trying to get the "best" or most "accurate" pressure or waveform. Your patient may be "best" served by a quick and sufficiently accurate assessment to get enroute quickly to the most appropriate facility. A few or even several millimeters of mercury or a few degrees of axis deviation really don't matter in the pre-hospital setting. Especially with BP, the trend is FAR more significant than the actual numbers as long as you are in the right ballpark; thus, consistency is often more important than absolute accuracy.

I have been an AHA CPR Instructor for years but only recently am I teaching with new department and I now need to provide "disposable" supplies which includes a new one-way valve for each student along with a mask (ideally, the BVM type without the B&V!). What is the least expensive reliable source of supply? Thanks for suggestions.

Leener77 makes an EXCELLENT point here. The quality of care that the patient gets in the bad depends at least as much upon the skill of the driver as upon the skill of the attendant(s) in the back. The best damn medic in the world can't do the best job possible when they are having to hold on and are fighting to avoid being thrown about in the back. Leener77 makes an excellent and most valuable part of the "care team."

From a "liability potential" (as well as from a good-of-society) point of view, that is a REALLY bad policy. It shows an abuse of discretion. Failing to use any judgment is the worst case of bad judgment. Lights & siren ("running code") always increases the risk to ambulance personnel and the general public. Therefore, running code to ALL calls amounts to taking risks without reason. "Code" response should be used only when, based upon information actually available at the time, it seems reasonable that the added risks of running code are outweighed by the patient's circumstances. So, we should run code to cardiac calls and SOBs, but not to minor injuries and nausea calls. Sure, it's always possible that the nausea is really a stroke in progress, but until there is information that would lead a reasonable EMS staffer to believe that, it should be a "routine" response. That does not mean stopping for a soda at a convenience store, but it also does not mean running code. The sad part is that your protocol requiring a code response to ALL calls was probably written by someone who thought that it was guarding against the possibility of getting sued when your agency responded routine on what in fact turned out to be a critical call. But that myopic thinking is just creating fodder for the lawyers; protocols need to address all the competing risks and suggest, direct, and require sound judgment.

That's certainly true, but neither is providing ambulance transport. If the Feds want to be be involved in clearly local issues like EMS transport, then they should certainly be willing to provide other, clearly less-local functions within healthcare, like universal healthcare. Of course, I guess "emergency transport" is a lot "sexier" than boring old primary healthcare. That's EXACTLY my point. Transport IS immediately available by local ambulance. Always has been. Seems the NPS and the citizens they serve would be better served by the Park using its limited resources to perform their primary functions, like traffic control and enforcement, accident investigation, backcountry policing, search and rescue, and -- how quaint an idea -- interpretation and education about the Parks and their natural and historic features.

Thanks for all the input. This is NOT a case in which the Park necessarily provides better or quicker care. Response times are about the same, depending on where in the Park the calls are and where the Rangers are in the Park when paged. The town limit and the Park boundary are the same line, so it is NOT that our EMS comes from the hospital -- quite the opposite, it's more like a straight line with the hospital at one end, the Park at the other end, and us touching the Park but between the Park and the hospital. I guess it's a political issue but it is so contrary to what the Founding Fathers envisioned 230 years ago. (The federal government providing a uniquely local service and one that is already being adequately provided locally.) Golly, if only the Feds were so interested in universal healthcare.

Not if the military base ambulance is transporting military personnel but if the base ambulance began transporting non-military patients from auto accidents that occur on a State Road that just happens to pass through the base, then, yes, I would. Are you aware of any other National Parks that transport sick/injured visitors for pay?

I am hoping that someone may have some information (or at least research suggestions). I work for a small, rural EMS organization in a western state and our town is adjacent to a National Park. In years past, when a visitor was injured or became ill inside the National Park, we always did the transport to the nearest hospital (about 40 miles away). Transporting patients out of the National Park was about 50% of our annual call volume and revenue. Now, the National Park has purchased a new ambulance and is transporting injured and ill visitors in-house and, we are told, billing the patients for its services. The Park's "ranger medics" are all National Registry but they do not "bother" getting a state-issued "certification" because "as federal law enforcement personnel, they don't have to." I suspect that much is probably true. However, I am uncomfortable with the concept that the Federal government can spend taxpayer dollars to buy an ambulance and take over the transport of sick and injured Park visitors to a hospital 40 miles outside of the Park and then bill the patients, all in direct "competition" with local EMS. What do you folks think of this? Is this common with the National Park Service?

I agree with the others that your IV and EKG skills (while GREAT to have) are less important in terms of being well prepared for medic school. I think that some form of A&P would be a really big help, and would in effect get you off to a running start rather than bogged down early on. Personally, I would get a "programmed learning" medical terminology book and really learn those latin and greek roots and suffixes. A couple weeks of hard work on that will make learning the A&P that you will need in medic school MUCH easier. (Note I said "medic" school not "medical" school!) A "programmed learning" book is one that has two or three paragraphs of new info, then a series of fill-in-the-blank sentences that repeat, refine, and build upon the initial few paragraphs. You take small bits and you use the new words yourself, learning the spelling (and hopefully pronouncing them to yourself as you go along). An on-line unabridged dictionary (or a CD-based medical dictionary) will really help because you can have the computer speak the words for you and that way you will SOUND like you know as much as you really do and most of us learn vocabulary more easily when we can "hear" the word as well as spell it and read it. The "speaking" dictionary that I used was the unabridged version of Merriam Websters on-line (it costs a few dollars a year) and it really helped me. Once you have the basic word roots down, you will have so much less trouble understanding rhinorrhea and diarrhea and all those -ostomy, -oscopy, -otomy, et cetera. Really! Good luck you are going to be a great medic; I know because you are planning ahead.

EVOC (emergency vehicle operator course) is a US-DOT curriculum course and, as taught in Fla anyway, is more or less two days, one day (or evening) in the classroom, then another day on a driving course. I think the concept of a "course" was good but much of what is taught does not translate into safe or patient-helpful skills. You learn how to check fluid levels, tires, etc. Stuff that most adults know anyway. You also learn some of the physics behind vehicle dynamics, like coefficient of fraction between tires and wet versus dry concrete, etc. You learn how to back up, and follow a marshaller's directions, and stop within 12 inches of a cone without touching it. All good skills, but not the real meat in my opinion. The real "meat" is learning that when running code and there or two vehicles in front of you, it is likely that the farthest from you will pull over to the right and the one right in front of you will pull to the left to pass the first vehicle, just about the time you are trying to pass it. (A common cause of wrecks.) You will learn that the vehicle right in front of you that has not shown the slightest inclination to yield to you is probably operated by a nearly deaf, half blind dear old lady who is now frightened ^&*less by your lights and siren and so she slams on the brakes. In terms of patient care, you should learn that in almost every really life-threatening critical call, smoothness in back is preferable to speed. This is because if the patient is really critical, may interventions are likely needed and the caregivers can't do well when they are holding on with one hand and fighting gravity and centrifugal and other forces. Gentle acceleration, a smooth transition into braking, and gradually letting up on the brakes when braking is no longer needed are essential. Easing into and out of curves helps greatly too. As the driver, think of a raw egg (still in its shell) sitting on a book lying on the cot. Drive like you need to keep that egg sitting on the book. You know that many drivers are idiots, many are yapping on their cell phones, arguing with their spouses, and that some are substance impaired. You have to plan and expect them to do the least helpful, most stupid things. They guys and gals in the back are responsible only for one life, as the driver you are responsible for the lives of the patient, all the caregivers in the back, your own life, and the lives of each and every driver, passenger, bicyclist, and pedestrian you pass on the way to the ER. Like the other guy said, I learned all the real "meat" of driving an ambulance from my partners not in class.

In the past, you would NOT have had to re-cert (meet the CEU requirements) because of your 11/07 initial date. Definitely, check with the state. When I was in Fla, they were very good on the phone but the web site, which they do not do in-house but which is done by state ITS people, was often wrong and/or months out of date. As always, make a record of the name of the person you speak to and the date and time of the call (just in case!) Good luck. Personally, I would prefer to see you get at least a few more months on-the-street experience before starting medic school. EMS is a mix of academic knowledge and hands-on skills and it takes a while for the two very different skill sets to get working together.

Great to hear things are going well. It really takes someone who is really, and justifiably, self-confident to make a good preceptor. The ones that belittle you do so because they do not feel comfortable enough with their own skills. They may only know one way to do something and jump to the conclusion that your way is "wrong" rather than just different from theirs.

When I was working as a medic in the Florida Keys, Medics trucks were seen in the Miami-Dade area. If I recall correctly, they did primarily intrafacility and ambu-care type transports rather than 911 response. Most of the people at AMR seemed to feel that Medics was a step down from AMR, but I don't know if that was just meaningless rivalry or more fact-based. So, all in all, I really can't help much. Sorry. Good luck.

Thanks for asking. I think so - yes and yes. I THINK I still have it, although I have moved since then. I'll look. Yes, I emailed the publishers a couple of times (there was an address in the book and there was also an address on the on-line "extras" site for the book. Never got any repy at all. I will commence the hunt.

Both of the Bledsoe titles are about the same. One (the series) is marketed to academic-oriented courses while the other (single, 2000+ page monster) is marketed to vocational single course classes. Compared with the Mosby books, the Bledsoe books are AWFUL in my opinion. The fault lies not with Bledsoe, but with his editor(s). The individual Chapters were written by one or more subject matter specialists, few of whom worked on more than one chapter. Not a bad idea, but without effective editing the result is that what one Chapter says is "the best," the "most important," or the "first sign" of whatever, several other chapters may view differently. Often, one is not right and the other wrong per se, just different opinions or perspectives. The real evil, however, come about when a non-subject matter expert tried to write OBJECTIVE multiple choice questions based on individual chapters. These are published for instructors, who them choose them at random or without realizing that what is the correct answer in one chapter is the wrong answer to either the same, or essentially the same, question in another chapter. The result: lots of discussion and argument by perceptive and vocal students and massive confusion and frustration on the part of everyone. Someone once described the Bledsoe paramedic book in an Amazon.com review as "2,000 pages in desperate search of an editor." Sad but true. During one class, I complied literally hundred of errors and contradictions. Some, including the formula to determine minutes of air in an O2 cylinder that is missing the tank-size factor and a pediatric dosing error, could be life-threatening. The cardiology section was called "impossibly confused and confusing" by the CCU charge nurse who taught classes for us. Mosby's books are more direct, explain things in simpler more concrete terms, and have a common point of view from start to finish. Hands down, Mosby is the way to go if you have a choice. If not, at least know that it's the Bledsoe books that are muddled, not necessarily you! Good luck.

Many state regulations, however well-intentioned, seem to me to work a real hardship in situations like Island is facing. Here in Utah, the state requires that to be a paramedic level response organization, requires having two medics on duty 24 x 7 x 365. Trouble here in Utah is that any organization, however large, only needs two but every ALS provider, however small, also needs two medics. Thus, you can run 4 or 5 street trucks with only EMT-I crews so long as you have two medics in a chase (supervisor, or rescue) vehicle on duty in your area. It gets worse when you read the rest of the rule, which requires that BOTH medics respond to any ALS call. So, what happens is that two medics respond in an SUV (we call them rescues here), then one hops out and gets in the ambulance and the other drives the rescue back to the station. The result is that only one medic does anything. But, and here lies the real absurdity in this state, if you have only one ambulance you STILL have to have two medics on duty (or on call) and they BOTH have to respond to the scene. Once at the scene, only one has to ride with the patient! The state just does not seem to get it that having a Paramedic Driver is not really of much benefit to the patient. And yet these regulators consider themselves rational, intelligent people(?). I think that in EMS we are less tolerant of this sort of absurdity than in many other fields because it has such an immediate and obvious impact on the care received by our patient and while this rule may make sense in a metropolitan area, it simply denies many patients ALS care in the most rural areas, whichare the areas that have the longest transport times, which are the very people who, IMHO, need ALS care the most.

I was a medic in Lower Keys for some time. Key West Rescue is an AMR operation. They have 24 hour shifts, with many of the part time shifts filled in 12-hour blocks. I think they are still 8 am to 8am. They are licensed as ALS and serve only the city of Key West, which includes the island of Key West and the northern half of Stock Island (which is the part of the island with the Sheriff's Jail which serves the whole county, and ALF elder care facility, a nursing home with a dubious history IMHO, a couple of deluxe condos and a golf course, as well as the Lower Keys Medical Center hospital owned by HCA). Usual staffing is two street trucks and one or two on-call inter-facility ground transport trucks. A typical shift will have three medics and one EMT as well as a Supervisor, who is always a medic and responds in a non-transport truck to critical calls or calls when both street trucks are already on calls. Medical Director is Dr Joe Nelson, who is the best. The Manager and Supervisors were always fair, fun, reasonable people while I was there. Protocols are liberal and include RSI. Transport times are very short. First Response is provided by Key West City FD. Almost always (by now, probably always) there is an FD medic as well as several EMTs. Probably about half of the FD medics are also PT or FT medics for KWRescue, so pretty much everyone knows each other. I felt that the AMR operation was excellent, far above average, but I'm probably biased! Down sides include no better than average pay and a LARGE unfunded homeless population and resulting relatively high number of transports to ER with patients who really need only a few hours in the drunk tank, but the jail (the only one in the entire, 125 mile long county!) refuses to take intoxicated prisoners, so the ER staff gets to baby sit them until sobriety returns and discharge to street is possible. Another down side is the limited availability of housing within Key West itself, and extremely high cost of housing anywhere in the Keys. Be very sure to carefully check this out before considering the Keys. Pluses are part-town USA, excellent (if damp) weather, really laid back people, reefs (water quality is failing faster than the mortgage market however). Rescue also just recently moved into a great new facility, long past due as we had a slowly rotting single-wide trailer when I was there. One crew and supervisor sleep at there and the other crew sleeps at Fire Station 3. Rescue and Monroe County FD provide mutual aid and cover each other from Big Coppitt Key (mile marker 10) to Stock Island. Marathon (at mile marker 50) has its own FD based ALS EMS program and handles most intra-facility ground transports from Fisherman's Hospital. This program broke off from the County about two years ago and seems progressive. Usually a medic and EMT are partners. Islamorado is also incorporated and provides EMS through it's FD. Key Largo EMS is legally affiliated with the FD special service district but operates under its own management and has a very distant relationship with the FD. It has a somewhat unusual structure the full details of which I am not certain. Basically, ambulances respond with PT, paid medics and meet volunteer EMTs enroute or on-scene. The rest of the county is served by Monroe County FD and the sole surviving truly volunteer FD, Sugarloaf. (www.sugarloafVFD.org) County EMS has one medic and one EMT per truck. The medic always treats the patient and the EMT always drives. Career fire service is relatively new in Monroe County although career EMS began in the mid 1980s. There have been growth and volunteer versus career issues but things seems to be working out more recently. I think that BC Boswell leads the EMS operation and he is extremely well-trained and I liked him. I found Key West Rescue an enjoyable and good natured place to work. Anywhere in the Keys has a fairly large amount of trivial drama, but many places do. If you have more questions, please feel free to ask or PM me. [web]http://sugarloafvfd.org[/web]

First, welcome to the EMS world. I think you have made a great choice. The single thing that I have most appreciated in EMS is the willingness of virtually everyone in the profession to "mentor" and assist newcomers with the ongoing improvement of their skills. That does not mean that everyone is always your best friend or that no one will ever say something that is mean or hurts your feelings but, at the worst just a little below the surface, I think you will find almost everyone willing and eager to help you as you help yourself -- especially if you ask. Being willing to do all the grunt stuff, especially when you are really new, helps a lot too -- kind of makes up for the extra time that it takes to explain things and show a better way or whatever. Speaking "better way," if you try really hard to remind yourself that "better way" is a very subjective thing and that the person showing you their better way is probably just trying to help. Keep an open mind and give it a try. I learned a great deal just that way and now find that some of what I was shown really was better after all! Your strong academics will make it easier for you to progress and, ultimately, become one of the best paramedics. I too have always had both a real interest in learning how things work and learning new facts, theories, numbers etc. But, I have never been a natural athlete and have always had to work a bit harder on training my hands to do what I wanted. And, although I like people, I was not the most socially comfortable person on the block. The physical eye-hand coordination skills and the "people" skills are just as important to your overall skill as an EMS provider as the academics. Particularly if you are working for an EMS provider rather than a fire department, strength alone is not what I mean by physical eye-hand skills. Sure, patients tend to be heavy, and being in reasonably good shape helps in numerous ways, but what I am talking about is just being comfortable handling the stretcher (even single-handed in the dark wearing gloves!) or threading all those darn straps on the KED, or getting the nasal canula on the patient correctly, the first time, from the head, from the foot, from either side etc. Learning to get detailed, personal information from strangers under the worst conditions is a really challenging task, even for the best, but it's critical to sizing up the patient's actual condition (we try not to say "diagnosing" but that's kind of the idea). For me, the key here was/is self-confidence. With solid academics and knowledge plus having mastered (not perfected!) the physical skills allows you to let your mind run the checklists and think of the important questions as you assess the patient. Your self-confidence also makes the patient feel better, trust you more, relax (at least a bit), and convey much more information to you. Throughout your career, try to keep in mind the essential and critical difference between self-confidence and cockiness. The former is great, a definite and maybe essential skill; the second is counter-productive, dangerous, and very annoying. Medics have a well deserved reputation for being cocky ("paragods"). You will be working with some of them, so try to see through that and find the benefits of their confidence and filter out the annoying crap. I think the single best thing you can do while in school and afterwards is to have as much patient contact as you possibly can get. In class, work with your classmates and take their BPs, find and time their pulse, palpate their jugular vein, hold c-spine on them, all as many times each class as you can. I know, you, like everyone else in that class, are going to feel "weird" about touching someone else. It's awkward with a person of the opposite gender and it can be even weirder with a person of the same gender. BUT IT IS CRITICAL. You cannot spot an abnormal pulse, irregular heart sound, adventitous breath sound, or JVD if you don't know what normal ones sound like, feel like, look like, etc. Pedal pulses (on the top of the foot) are really hard to find on a healthy person; determining if a trauma victim is without a pedal pulse is impossible unless you have thoroughly learned to consistently find the darned little critters on healthy people. Take advantage of every clinical opportunity to listen, touch, and talk with as many people as you can. Ask your instructor about additional opportunities and about volunteering opportunities. It is really comfortable to stand and watch (and you MAY learn something) but you will learn a heck of a lot more by doing whatever the preceptor/host will let you. As someone else said, what you "get" to do as a Basic will vary depending on how your system operates (a good thing to ask during job interviews!) but also how well you get along with and how much you are trusted and respected by your partner. If you express your interest to your partner, and have shown her/him that you keep your cool and do what you are asked, it may well be possible on some of the more interesting (usually more critical) calls to have another agency, often the FD, provide a driver so you can ride in the back and assist. When you are driving, be the best damn driver out there. Plan in advance with your partner whether speed or smoothness is the more important. Many partners work out a code of sorts in advance to avoid saying things in front of family or patient that would be best not heard. Like, "I think we should just run her on in" meaning I want this patient at the ER ASAP but don't kill us on the way, while "let's make it nice and smooth" means lights and sirens but that a reasonably comfortable ride in back to allow ongoing treatment (or reduce patient discomfort) is more important than saving a few minutes. The latter is what usually works best, even with life-threatening cases because no one treats well while having to hold on for dear life. Remember, ALL rigs ride far worse in back than up front. The key skill is no sudden changes of speed or direction. Avoid hard or repetitive braking and seesawing on turns. Think of an egg setting on a formica table in back. You job is to get to the ER without the egg rolling off the table. You know that someone WILL do something really stupid in front of you; it'syour job to try to avoid having to make sudden adjustments to your course of travel. Of course, safety is always first. Sudden braking is far better than sudden crashes. If you have not driven, parked, and backed up a very similar vehicle, ask to do so when waiting around for calls. The middle of the night, on a dark and stormy night with a very pregnant mother of four in the back, is NOT the time to practice your backing skills. If you have a choice, get a job with a 911 service rather than doing intrafacility transfers. You will drive more miles with the "slings" but your patient assessment and care skills will not have as much chance to develop. If you have to do transfers, try to be in the back, talk to the patient even if they don't make much sense, take vitals again and again (the patients will love the care and your skills will get great training). Read the patient's medical records, noting what their diagnosis is, what their signs and symptoms were reported to be and what was normal versus abnormal. Read the meds and see what the side effects were. As a basic, these are probably not your immediate concern, but this time will be well rewarded when you go on to paramedic or RN classes. Finally, your questions are by no means childish. Rather, I think they show that you have really thought about your career choice and have spotted many of the issues and potential issues. Others will tell you different things than I have I am sure. Listen to them all. The one exception is, and I really mean this, don't let anyone tell you you are "only a basic" or that all real care is provided by medics or some such nonesense. I have worked with poor medics and great EMTs; I would MUCH rather have a good EMT than a poor (or unmotivated) medic as my partner or my caregiver. Always remember, most care is BLS not ALS; the ABCs are always THE most critical and they are BLS skills. Take care and speak up if you have more questions.

Whether a particular state calls its recognition of EMS field providers "certification" or "licensing," is merely a matter of semantics in my opinion. We must recall that, in all states, all medical interventions by any level field EMS provider (EMT, basic, advanced, CCT, medic, et al) require a physician medical director. As EMS providers, we do not in any state enter into a direct contract of employment or service with our patients. Our authority to act derives from our medical director. Thus, to me, "certification" is really the more appropriate term because the state board "certifies" that we meet the training and currency requirements, then a company or government agency employs us to provide our services to the public under the authority of its license and under the direction and control of its medical director. Frankly, other than the obvious job-preservation issues, it has never made any sense to me for any jurisdiction anywhere to require that an ambulance be DRIVEN by a paramedic. In my mind, the public would be much better served by requiring basic EMS training (like an EMT- plus advanced defensive driving training for the driver. Sure, it's NICE to have two medics on scene, and in a severe enough case, it can be essential to the best possible patient care, but we will never ALWAYS be able to provide the best POSSIBLE care. Heck, it would be better to have three medics on all rigs, so that two could treat while one just monitors and records. But, in the real world, this is no more of a possibility than having an MD on every rig. Lastly, just for the record, in my years on the streets, I have come to the firm conclusion that, just like a truly proficient secretary can make even a clueless executive look pretty darn good, a really good EMT ("basic") can vastly improve the overall performance of the medic/EMT team. In truth, I'd rather have a really good EMT as a partner any day as opposed to a poorly trained and unmotivated medic.