toutdoors

Jw, if you want to become a paramedic, go for it. If you want to become a firefighter, go for it. If you feel that by becoming a medic it will enhance your chances of employment, great; but be aware, be very aware, that you will still be a medic, and that means you must perform to the best of your abilties when dealing with patients. Even if you would rather be on the engine or truck that day, put 100 percent into your patient care. I have seen firefighters who do not provide the care they are trained to initiate. This is a shame, a great shame. I am a career firefighter and love it, I also work part time for an ALS ambulance company and love it as well. The one thing you may see on here is the non stop controversy in regards to fire based EMS, expect it, learn to live with it. It will be there as long as there is EMS. I will also have to say that I have seen medics who have burned out, and become less enthused about work, and don't put 100 percent into patient care at times as well. I just finished my paramedic this week, and it was a lot of study. A lot of field and clinic time, and a whole bunch of fun. I have made some great friends, some of whom I am now working with because they have been hired by the ambulance company. What ever road you choose to travel, put your heart into it, and give the very best you have to offer. Learn as much as possible, and be willing to learn more. I never thought I would say this, but I am seriously considering more school. We will wait for deer season to pass us by first though. Good luck to you in your pursuit of a new career.

I agree somewhat with Dust in the regards to learning something and doing it well, I don't think he was trying to draw a line in the sand and say that when said pt crosses the line, he will begin care and treatment. EMS belongs on rescue scenes, and should take an active role in the rescue. However, the EMS providers need to have an understanding of what is occurring during the rescue. If it is a vehicle accident, the EMS provider should be familiar with what types of evolutions might occur, such as a door removal, roof removal, dash displacement,yada yada yada. This is not to say that the EMS provider needs to be proficient at using the tools, just understand what can be done to extricate the pt. In a rope rescue scenario, the EMS provider should be at a level trained to be able to be "put over the edge." In some areas this may involve extensive moutaineering climbing skills. In our area, it is grain elevators, or steep hillsides, which are pretty much earthen hills, not the rocky type. It is not that difficult to train the paramedics that are willing to participate from the private side how to rappel, and be on a belay. They basically are being lowered or lifted, while still transversing the hillside on their own two feet. This has worked quite well for us. In regards to the really technical stuff, our USR team has paramedics trained in structure collapse and has received specialized training in how to treat for crush injuries and the like. I think it pretty much boils down to what type of rescue a person is talking about, and that will determine how involved the EMS personnel on scene will become involved in pt contact while rescue is being performed. Some of what is considered technical rescue, is pretty basic, and not that dramatic. The most common scenario I can think of is an MVA. If a medic needs to be in the vehicle to intubate and BVM a pt as extrication is occurring, so be it. If I am working fire that day, I have no problem with it. With that being said, you can't expect fire or rescue personnel to be very good at removing a pt from some sort of entrapment if they do not possess some minimum level of EMS training, which should be EMT at the very least. Even if private sector medical providers don't like fire EMS, we all need to work alongside one another to provide for the best possible pt outcome. Don't forget the proper PPE for the scenario and ensuring everyone's safety, should go with out saying. However, if I don't say it, I am sure someone would point it out. Way to keep a fella on his toes.

Dust, while I am a firefighter, I don't always agree with some of your opinions. I gotta say though, your comment about failed and fd was funny. I am not 100% in agreement that it is entirely the department's fault that the guy faked his papers. I would see it more as a character flaw than anything else. Good riddance to the weak link that did not have the desire to take his paramedic, learn new skills and become educated. Better now than later. If he had not been busted now, he would have faked something else somewhere.

Interesting views on this topic, and I will have to say that I will be hypocritical on this topic. On the one hand, there is a male paramedic that I work with on my part time job with a private ALS company. He has quite a few, although not a full sleeve, of tat's on his arms. He has to wear a long sleeved shirt. He is only allowed to wear one earring. He is a heck of a medic. Great with the elderly, you would think he was talking to his grandmother anytime he has an elderly lady in the rig. His skills are very good, and he is possibly one of the sharpest medics on drugs I know. My first impression of him was a little reserved, but he has proven to be a very competent and caring medic. On the OTHER hand. I was doing one of my last days of clinicals in the ER a few days ago. In comes a paid crew from a smaller hospital, one of the providers, (not sure if EMT or medic). This person had two full sleeves, his lip and nose pierced, and those big old hole piercings in both ears. Sorry, but I lost 100% respect for the guy right off the bat. I don't care if this guy taught the medic I work with that I just described, I had no respect for the guy. Personally, if this person were to show up to care for my mother, I would in all likelihood file a complaint with his employer. Valid or not, if he has the freedom to come to work in that manner, I have the freedom to explain to his employer how his appearance made me uncomfortable and made me question his skill level. Shallow minded? Quite possibly, but then again, just a personal viewpoint. It was stated earlier in this thread that this is a profession. It should be treated as such. Questions have been asked as to why EMS is not a get rich line of work. Here is one example, as weak as it may be. From what I understand, there is a dress code at pretty much every service out there. So if you work in a private company, they can be as picky as they want in regards to dress codes. I believe that if you show up to someone's personal crisis, they (and their family) will take your appearance to heart. If you look, talk, and act professional you will quite possibly win their hearts and minds. On the other hand if the first thing they see is a person full of tattoos, and holes the size of a quarter in your earlobes, you may very well have lost a lot of confidence in your patient. People must remember, that in this profession, our patients do not care about OUR life, they are concerned about theirs. They may not see the "art" in all the ink that is on a person. They may see something totally different. For this reason, I think that conservative is a good approach. Not to say an EMS provider can not have a tat, just understand that visible ink may impair your ability to be employed at some companies or make some patients uncomfortable. For the record, I like tasteful tat's. I think some of them are incredible works of art, although I don't have one.

Our protocols state that if we witness the arrest, then we apply the AED and push the analyze button to determine if shock is advised or not. If it is an unwitnessed arrest, even if CPR is being performed upon our arrival, then we, (FD) do two minutes of CPR, then let the AED analyze. Our AED's are also set up so that once you place pads, and turn the machine on, it begans a two minute countdown for you. This is nice, so that we all don't have to take off our shoes and socks to count to two minutes. The AED is programmed however, that after it starts up, it will state "If arrest was witnessed, push analyze." So for us, we want to get the AED on as soon as possible, allowing the two minute countdown to occur. We use Lifepak 500's, and our department just purchased two new models that have a screen that shows the rhythm as well. The older ones do not have the screen. I have not had a chance to use the new model yet, except for our quarterly d-fib refresher training, it seems like a nice unit. I thought that it was the "new standard" to go this route with AED treatment. By that I mean, the way I have described the protocols I work under. Not saying we are the only ones doing it the right way, just wondering, have I missed something here?

FormerEMSLT, Iowa has the EMT-B, EMT-I, which is basically going through the EMT-B all over again, but adding IV access, and acid base balance into the cirriculum. The clinical/field hours are 120 however, well now they are contact based. The "Iowa Paramedic" is what would be considered the EMT-I99. The "new paramedics" are paramedic specialists. Oh, and don't dare forget the first responder as well. I am currently what is considered an Iowa EMT-I. Then again the next two days hold my written final and practical final for paramedic (specialst) class. The biggest advantage I have personally seen with the Iowa EMT-I, is that after I was done with the class; I felt much better at pt assessment. Simply because I had (at that time) 120 hours of clinic/field time to do in addition to the class time. Did the acid base balance stuff seem clear as mud? Dang right it did. We also covered, very quickly, and very sparsley, the P QRS T complexes, and what each wave meant. They weren't trying to teach us EKG interpretation, just broadening our horizons a little. Does our system "work for us"? Yeah I guess you could say it does. I have seen a few times where it was nice to be able to gain IV access to a critically injured or ill patient as we awaited arrival of ALS, or at times, assist ALS with getting a line as they worried about advanced airways, such as in a code. I know, some will say that 120 hours of class and 120 of clinics does not completely or properly introduce a person to A&P, or pathophys, but, in some truly dire situations, a line was accessed early, and it facilitated the care that the paramedic specialist provided. Of course, you first have to worry about the basic stuff. As for being called a medic? Paramedics are medics, EMT's B's and I's particularly, are just that; EMT's. I never let someone call me a medic, because I wasn't. I still am not a medic, just a tired student praying to get through the next 48 hours in one piece. Personally, I think that when you say medic, people think of you as a person who is trained to give meds and hook up the monitor. They may not know what all the stuff is, but they see it and hear about it, so they expect it. What is a name but a name? Nothing really, but what is important is how others, the public in this case, percieve what is in that name. Just my few cents worth.

IFSTA has the cirriculum for the FF I and FFII. I honestly thought the FFII test was easier than the FFI test. Not sure if it was the years of experience between the tests or what. Hope (but seriously) doubt I can say that about my medic test vs my EMT test pretty soon. FFI is basically the entry level to firefighting. Teaches the basics. FFII goes in to a little more depth in regards to fire alarm systems, fire extinguishers (for some strange reason) and has more hazmat questions. Many times you will need to have FFII prior to taking other certification programs, such as instructor, apparatus operator, fire officer and such.

I believe in the PPE phenomenon. If ya gotta Poop, Pee, or Eat; you get an alarm. Of course, if you are going on that fishing trip early in the morning, you stay up all night running too.

Thanks for the offer doc, I got that part covered. I think it is the lack of walleye fishing this spring and summer that is affecting me. Not to mention I am anxiously awaiting the fall walley trip, not to mention that deer (bow) season is only 8 weeks away now. I think that is most of my problem. Later.

Wildfire, why in the world would you want to have firefighters be first responders instead of EMTs? I don't understand it. Now I know there will be a lot of backlash from the non fire service folks here, but that is ok. The truth of the matter is that fire departments provide some level of EMS to alot of communities. Why then would you want just a first responder to go on these calls? If your department answers EMS alarms, then you OWE it to your patients to be as prepared as possible to deal with their sickness or injury. I truly feel the best way to begin this treatment of the sick or injuried person is to have (at the minimum) your EMT. I was a first responder "back in the day" when I was volunteer. Then again, we only answered fire or MVA's and that was just for extrication. The EMT's were seperate from us, and they did pt care. First responder, in my opinion, is not much in regards to knowledge or training. Not to mention no clinical time, at least I did not have any. At least in the EMT you do some, but not nearly enough, clinical and or field rotation to achieve some pt contacts. I also think EMT should require at least 100 hours of clinical/field time to generate more patient contacts and build some sort of knowledge base to assess a pt. We provide a BLS non transport service to our community, and are tiered with an ALS transport service. It works pretty good here. Good relations on the personal side between fire and medics, alot of us work the transport side on our days off. I think that anyone who will actively take part in patient care needs to be at the EMT level at a minimum. Like I said, you owe it to the people you will serve. They deserve the best care possible, ideally this would be paramedic. As much as the non fire service folks are gonna drill me on this next comment, I will still make it. If you want to be a firefighter, you need to WANT to be an EMT as well. (At the very least an EMT) It is the trend that is upon the fire service. I am sorry if I offend you, but you are not going to spend as much time answering fire alarms as you will answering EMS alarms. With that being the case, you should want to be an EMT, because if you have no desire to be an EMT, you will be of no value to your patients. Then those of us in fire based EMS who truly do care about learning more, and becoming better at our patient skills and assessments, will suffer the truly harsh, brash, and sometimes volatile remarks that the non fire oriented providers are very willing and capable of delivering. It just isn't fair. I am not hacking on all of you out there who are non fire based EMS neither. I can understand that there are times you folks get a little upset with the firefighters who don't seem to care about being on the EMS alarm. I think that is too bad. Wildfire, from my limited experience on this site, I feel compelled to offer you humble and free advice; be catious in regards to asking if people here feel that less education/training is a good thing. Some folks will pull out the old testament on ya and begin stoning you to death. I don't think that less training/education is ever a good thing, on the contrary, I would say that more education needs to be conducted. This should be at a minimum, monthly training, sometimes every shift if need be.

Hey Cali and Zebra, thanks. Getting nervous here. Not because I haven't studied, just hoping I remembered what I studied. Yesterday at practicals was the the first day all over again, don't know why, summer fun bug hitting maybe, or my wedding this weekend, one of the two. Well with my luck, I will nail every pathophys and cardiac question along with the bizarre medical scenario, and forget what the ABC's are. Hey seriously though folks, thanks for the input.

The ambulance service I work with part-time has put a powered stretcher into service. It is charged as it sits in the bracket. It is awesome for the "big ole boys/gals" We keep that rig at HQ, and have begun to flag the common addresses with the large pts. If we get called to one of these, our training officer, field supervisor, or business supervisor will start heading our way with the power cot rig. If it is a non life threatening event and we can wait the extra 5 or 10 minutes to transport, we do; if not, everybody gets ahold and we lift. We did demo two units on the streets running 911, and I will say the weight was a little to get used to. Thankfully we have 3-4 firefighters on scene as well to help lift if needed. All around I think they are nice, they have their place do doubt about that. We also tried the powered stair chair, it had tracks on it. I did not personally use it, but it got rave reviews from the medics who did use it. Only problem we had was it was a little big for our side compartments, just barely fit in with the O2 bottle.

Oh, one more thing Zebra, CONGRATULATIONS!!!

Zebra, How did you like taking the test on line? All my other classes were the paper and wait forever method of testing. I am not crazy about these things in the first place. I am getting ready to take it in about 6 weeks, just finishing up our medic class here. I have heard a few people say they like the new computer testing. Not that I am looking for answers to questions or quoted questions either, but was there any part of the test that was hit on more than you anticipated? Just curios to see how it is out there in the testing world.

I never mentioned pulse ox, but now that you mention it, several BLS services utilize it. At least around here, I should say. Does it change any of their interventions? Not a whole lot, other than go from a nasal cannula to a non rebreather maybe, this they are capable of. What I meant to say is that although a basic will not administer D50, they will have a measurement of the blood glucose level. Much like a basic isn't going to administer 0.5mg of atropine to a patient with a heart rate of 48 , but they still take a pulse; of course we don't have to poke a finger to do it. Now before everyone gets jumping on the bandwagon, let's remember we don't just shoot some atropine at ya cause you are bradycardic. Let's hook up the monitor to ya, and ensure we are talking a sinus bradycardia. Maybe not the best comparison, but I think you understand what I am saying. Maybe the basic can not perform an intervention that is needed in certain patients, yet they do know what is happening, maybe. I am not saying that interventions are "So easy a cave man can do it". Rather my intent was that it is merely another way to provide more documentation in regards to assessment. When I am working fire, and we get a blood glucose on a pt, and it is 32, pt has Hx of diabetes along with an altered LOC, and ALS is still en route, I will call them and tell them what we have for V/S. I would like to think that this is streamling pt care in this instance. The medics know that they need the drug box, as they don't always take it in with them on every call. Not bashing them, just stating how it happens is all. JP, I understand what you are asking in regards to where does the line get drawn? For one thing, maybe the hours need to increase for the basic?

Here is my thought. If I happen to be the unlucky person to discover that we are short on "supplies" and the wife does not respond to my yells, I will call the house on my cell. Otherwise, that is my quiet time.

I live and work in a tri-state area. The ALS ambulance service I work part time on provides paramedic assist to the neighboring communities in the bordering two states. All three of these states have different levels of providers. It is confusing. I believe this topic ties directly into another post that was active just a week or two ago in regards to a more professional EMS system. I don't think it does us, as an EMS population, much good if there are so many different levels of certification in the country. I understand that all one has to do is travel about 30 to 60 minutes in any direction from where they sit, and see some differences in EMS no matter how slight they may be. Now, let's travel to the middle of our neighboring states and see how they operate, could be dramatically different. This is one of the biggest issues that should be addressed. In my humble opinion. I am sure Dust and Spen will agree that the best way to solve this solution is to just have everyone that wants to be in EMS become medics. I honestly doubt if I will ever see this happen in my lifetime. I don't think that taking blood glucose measurement away from basics is a real smart idea, it is a great assessment tool to utilize. I agree with Dawn, when the comment is made "if grandma can be taught how to stick her finger, don't ya think an EMT B can be taught as well?" Of course, this isn't to say a basic may be able to correct the hypoglycemia if the pt will not tolerate oral glucose, but it at least gives you one more tool to use to evaluate your pt. I am all for streamlining the levels of providers out there. I was never crazy about the first responder, and I was a first responder for a couple of years. I think the basic, an advanced EMT, and paramedic, then throw in the critical care paramedic for good measure. Can't really see where you need to get a whole lot more diverse than these four levels. Does this mean that folks are gonna have to go get some more training/education? I imagine that may be the case. Then again, a little extra knowledge never hurt anyone. I am not really all that up on how much influence the national registry has on the individual states, but maybe it is time that the reigns get tightened a little bit. I let my national registry EMT go, and kept my state, simply because I never intended to move from my job. After I get my medic, I will keep the national on that though. If for no other reason, I can have that cool looking nationally registered patch. In all seriousness, I think it is high time that the EMS world stood up for themselves and said that as an orginization, this is how we feel things need to be. A good working relationship with medical directors who are interested in being advocates for EMS to the state and national levels, would also do wonders for all of us. In short, I think it will be interesting to see how things pan out here in the near and somewhat distant future. Just my meandering thoughts.

I have seen the same thing, and on occassion, been "guilty" of said bad practice. The one thing that I will say about it is this; when myself or another responder would come across the accident scene on our way to the station, we would stop to see if there was anything we could do to help such as hold a manual c-spine or try to slow or stop that life threatening bleeding. Now of course this was when I was a volunteer. The one thing that happened 99.99% of the time was that if someone was not dressed as they should be, they would back up and get out of the area of immediate danger/unsafe situation while those who responded with the rigs could do the job in the prescribed manner. A practice that should be encouraged or engaged in more times than not? Of course not, but a scenario that does play out in the realistic world we live in. Would I needlessly place myself in grave danger with out proper PPE? No. The idea simply being that if I can help one injured person prevent a crippling spinal cord injury or slow some terrible bleeding while the rest of the folks show up, then I will procede with extreme caution, and let the properly attired individuals tend to the patient when they arrive. I do agree with everyone when we say that once the responders show up, all personnel that are not properly geared up need to step back.

Education. No doubt it does no harm in expanding one's horizons and gaining a more in depth knowledge of a subject. Here is where I have a problem when people say education is the answer to everything. I saw officers in the Marine Corps that made deciscions so stupid you had to ask yourself if they were serious, or just messing with you to see if you were dumb enough to do as they said. I have seen college graduates come into the fire service, pretty sure of themselves, thinking they have all the answers, and they have no knowledge or skills retention. I am an engine company officer, so I can say this with having seen this trend with my own eyes. It is sad. Some of the problem is the attitude of society in general as well. The younger generation seems to believe that they are owed something. Where did they ever come up with that idea? If you want to put college classes into the mix for medic, that is ok, but then I think we should keep them classes pertinent to the subject material at hand. A&P I agree with, as well as some biology, how about medical terminology. I am enrolled in the paramedic program at our local college, and so far, the medication administration has been pretty straight forward as far as I can tell. Seriously, the vast majority of them are somewhat along the lines of : X amount of drug in X amount of solution, per Kg of body weight (sometimes), over a certain period of time. This isn't rocket science. It is basic math. It is Jr high general math, dealing with fractions, and ratios; simple addition, multiplication, and division for pete sakes! Oh sure, when we deal with a dopamine drip we are talking micrograms but then again, the majority of the time we deal with a situation like that, we titrate in the field, and the pump is used in the hospital. English Comp as a college course? I don't know. I mean seriously, we are talking about writing a few simple paragraphs detailing what you saw, what you did, what the outcome was, and a few other pertinents. Sounds simple yes, but we all know a good report is a little more than that. Honestly though, this is simple composition. Another high school skill that was taught to me 20 years ago. Where has it gone? Are we that in depth with "No child left behind" that we pass any kid that walks through the doors of a school? How about we spend a little more time on this subject in the class? Make people write reports on the skill scenarios they had in class; everyone one of them, this way, they can make the mistakes in class, and not lose a court case someday. I am not sure that college is needed to be an EMT. Now I am talking a basic here, not an advanced EMT. Let's think about this for a second. Basic EMT's are trained to identify and intiate treatment in life threatening illnesses or injuries. The word basic describes their very training and skill level. ( No offense to the B's out there) They are not trained in AMLS, ACLS, or PALS, they are taught how to treat for bleeding, identify a patient that is in danger of going into shock, and how to package with out causing further harm. These people are generally volunteers. (I know, we have talked about that too, but let's leave paid vs vollie in the other forum) They not only need to be educated to be able to perform to their skill level, but be educated enough to say we need ALS, or we need to get moving quickly if ALS is not an option. Can this be done with out college? I think so. Remember, these responders are the first line of defense in circumventing death.(I know, talked this one over too.) I do feel that the national registry needs to play a big role in this. Maybe the DOT needs to get involved and mandate that all states start to be on the same page, so that an EMT basic in FL is the same as SD, CA, MN, MO, NY, IA, or TX. Same would go for an advanced EMT, and Paramedics. This way we as an EMS community would be able to talk more clearly to one another for one thing. In this way it would be easier for us to talk to one another and identify problems, and hopefully solve a few of them. In a perfect world, we would all have as much education as possible on the subject of EMS, have 4 year degrees, and be the utmost professional paramedics, there would be no EMT's or vollies. (No offense guys, just trying to make some of the others feel good) Then again, in a perfect world, we would be out of business; be careful what you wish for. I humbly believe that we can not be faulted for doing the very best we can with what we have and strive for improvement. I don't think that the problem will be solved overnight, nor in a matter of a few years. I also think that when we do set new goals, we have to be realistic as to what we are trying to accomplish, and who will be impacted by these new goals. Yes, of course the patient will be impacted, but so will the provider. Let's be careful on how we dish out the requirements, and make sure we don't get our egos in the way when we began talking about how good we are because of how many letters are behind our names. No offense to anyone with a bunch of letters and abbreviations. I am just a fire based ems provider anyway.

Ah, yes, the age old adage that it only takes one bad apple to spoil the bushel. This holds so true for our field of work, as well as elsewhere. The biggest problem? We deal with human lives. We have had a shady character in the department I work in, and in the ambulance service I work for. Oh yeah, same guy too. First he was convinced he should retire early from the department, yet the ambulance service continued to employ him. I have no idea why, it was no secret what he been in trouble for. Of course he burned a few fellow employees, as well as associates from work, such as pilots for the helicopter, a widow of a former employee who was killed in the line of duty, and gave a few false reports. How is it that these people manage to stay employeed for as long as they do? Thankfully, there are a very very few number of these people around our line of work. The unfortunate part is when something does happen, such as the medic who stole the credit cards, we all get a black eye from their actions. I do believe that for the vast majority of people in EMS, there is a genuine concern for the people we serve, and the thought of doing something so ludicrous never crosses our minds.

If placing a hand on someone's shoulder as a comfort measure is considered to be touching the pt more than needed; than yes I am guilty. However, I have never touched a pt in a manner in which is inappropriate. I personally feel that there are the times when holding a little old lady's hand as you transport her home for hospice care is possibly the BEST pt care you can provide. Oh sure, a little O2 to help with her saturation, but hey, she is going to die anyway so what does the O2 matter? Sometimes it is simply the touch of another human being that lets us know we are not alone, and that someone cares. Of course, there are the times I have been on autopilot also, and just did what had to be done at the time. Bet most of us have been there too.

I agree with most everyone who says this is a play on banning guns. Knives and guns don't kill people; people with knives and guns kill people. It is no different than locking your car or home. All a lock does is keep honest people honest. Sane and rationale people are not the one's performing these ridiculous, psychotic acts that just illustrate to us how brutal and savage we can be to one another. Hold individuals accountable for their own actions. The defense of "The gun/knife made me kill them your honor." is NO defense at all. Next we will want to ban fast food for all the heart attacks is causes.

As a current EMT, who is in the paramedic class, I am not 100 percent sure on what I would recommend, or what should or should not be allowed. I do know this much though. When working as a basic, my paramedic partners have normally been very very supportive of answering questions, and helping me become better at my skills. Then when you start to ask the right question at the right time, they are normally more than happy to provide you with some incredibly in depth answers. My suggestion would be to talk to the people you work with, preferably the medics, and ask them what they think. I would have to say this, and Dust will probably hit me on this, but that is ok; an EMT can be an asset to their partner, if the medics will work with them and teach them a few things. I agree Dust, we need more ALS, but lets remember some EMTs are only temps, they are our future medics. I do not see any thing wrong with teaching an EMT an advanced skill. We all know they can't use it, but I can tell you this; it really made me feel good to know that the medics respected me enough to teach me something. Sometimes they show you a skill, such as intubation, because you ask the question "Why are some intubations harder than others?" This can be a very good question, if asked in the proper manner. (ie. not to insinuate a medic is incompetent) This is when a lot of the times, a medic or two will get the dummies out, and the training bag, and show you how to intubate, then you get to see first hand, to a degree, just what is going on. I do believe this though. If a system is going to run with basics and medics, everyone needs to train together, and the basics should be included in the aspects of ALS, so at the very least, they have somewhat of an idea as to what is likely to be happening. This could be considered an awareness step for the basic, and should never, in any way imply that a basic can intubate, or perform a needle decompression. But hey, if you let them play with the dummy someday during some down time, what has it hurt? If the medic taught the skill correctly, they had to think about it, and that means, it simply reinforced the training in the medic as well. This also will allow the basic to gain a small amount of insight into what they can expect in the medic class. Some of the best classes on anatomy/physiology have been in the rig coming back from a transfer with a medic who liked to teach his basic partner a few things. So far as PHTLS for BLS and ALS, I would have to say that it was one of the BEST classes I have ever taken. I loved it. A lot of info that reinforced alot of what you already knew. I have been through ACLS, it was good, but did not seem to have the intensity that PHTLS had. AMLS was also a good class. Can't speak on PALS, have to do that one yet.

NoOnes, it sounds to me like you are stuck between a rock and a hard place. I say this because from the sound of it you are caught between what state protocols say and what your boss says. The thing that sounds a little scary is that if your boss is telling you not to perform a skill that your state protocols are listing in your skill level; who is gonna be the party responsible if you end up in litigation some day because you followed your employer's instructions, but diverted from state protocols? Especially if those orders in the company are not written down? Our medical director signs off on the protocols that the state has set out. Pretty good deal for us I think. Keeps things simple, you know the state protocols, you know your protocols by default. Can't get into to many gray areas there. As far as how much weight bears on respecting patient wishes? Well, for us it is pretty simple, all trauma goes to the Level II trauma center here in town, even if we bypass the other hospital. Cardiac arrest that is transported goes to closest hospital. If you are conscious, alert, orientated, you get your pick. I should clarify that on the trauma destination, it obviously correlates to whether or not a patient warrants a trauma center. The minor traumas, such as broken arm, cuts, stuff like that still gets their choice; most of the time. We have always been told by our medical director, field supervisor, and boss, that if we truly feel that the patient needs the services of the trauma center, we take the patient there, and explain to the patient why we are going. As far as the officer is concerned, well sometimes you just have to beg for forgiveness. Did you make a mistake? I am not sure from the sounds of it. Like Medic Troll said, if it was a serious patient, of course you would have been getting and going, no waiting on anyone. Hindsight is always 20/20. I am guessing this was more than likely one of those calls that were like so many other where nothing really weird ever happens, and you did what you normally do. Then all of a sudden the officer realizes who the driver was, and now is upset, maybe at you, or at himself, or just the situation. The thing is, you were not there when he found out, so you are by default the guilty party. You will learn this as a parent someday also, when you ask the child in the house who did it. (They will tell you it was the one who is not in the room at the time.) Learn from it, don't lose any sleep over it. If that is the worst mistake you ever make in emergency services work, you will have a very blessed career.

Yeah AK, my high school English teacher kept harping on me about that too, sorry. I agree with alot of people in here, Dust, and Jake are obviously incredibly intent on ensuring, or pretty much demanding that a paramedic be available on every ambulance. Dust, and Jake, I believe that most people here will agree with you that more ALS is needed, as I have stated, I won't argue that point one bit. The big question is simply this: How do we, as an EMS organization, get more ALS services to people? Where do we start the lobby efforts, and or the educational advertisements? Do we start with our medical directors, and ask them to start putting the word out to more medical directors that they should scrap their BLS and go to ALS? I agree it would be a starting point. It may even help get more ALS services out there. Will it solve the problem? I doubt it. but then again, the trend could catch on with smaller services going to ALS, then who knows, it hits the right person in the right position to have dramatic impact on EMS, and all of a sudden, it becomes a standard of care. Hey, that would be nice, and I say this will all sincerity. Dust, I see by your name you are from southern Cali. Nice place, was stationed there for most of my enlistment. I am familiar in a very vague way, as to how the Orange County area is as far as communities. So maybe when you and I talk about a community of 300 people, you may be thinking of 300 people who have the money to afford to live away from all the crazies. I think of that community as being 300 people, from maybe 75 or so households, who rely greatly on the local farming economy to support their business in town, which may be as simple as a small mechanic shop, a gas station with a few groceries, a bank, and post office. Now we cannot forget the feedmill, or farmer's elevator that will handle all the grain. These are your everyday hardworking bluecollar people who live in their community because that is where they work. These people understand that they have chosen to live in an area that may not even have a medical doctor living within 5 or 10 miles from their community. Do you honestly believe you are going to convince these people that they need to kick their EMT's out and pay an increase in property and or sales tax to have an ALS service available to them? I would believe that would be the way most of these services would be made available. These people have been bandaging themselves up and driving to the hospital or doctor office themselves for most of their lives. (Sometimes they should have stayed put and called 911 that is for sure, but hey, this is who they are). As I have stated, these people know the advantages and disadvantages to living in their little corner of the world. They accept these realities. So the question now becomes this: Who is it that will be the one to tell these communities that they MUST have ALS? I am curious Dust and Jake, if it were up to you, and you could have the say in the matter; How would either of you go about getting ALS everywhere? Not trying to call you out to the parking lot here, just curious as to how you think it should be done. I look forward to your reply. I am learning alot from you guys as to how others in the EMS world feel, think, and function. This is pretty good.