AZCEP

Considering the majority of patients don't require any procedures to be done, and, aside from visual exam, you can palpate through most clothing, why in God's name would we completely disrobe every patient? Critical trauma--clothes are history Critical medical(especially cardiac/respiratory)--clothes are gone Most others, I will leave at least one layer of clothing in place. If just for the patient's comfort. There are very few strangers that I will feel good about stripping in front of, so why would I expect my patients to be okay with it?

Nope, pharmacology is given it's due time of about a month. Then you will discuss the specific meds for a specific problem. Pathophysiology is a pipe dream in most programs. Once you discuss acid/base and electrolytes, consider yourself done.

L.A. Rescue has some good stuff that come in a number of sizes so you can get a better feel for what all you plan on carrying. I like the Statpak. Holds plenty of gear and they have optional clip on modules for specific things like airways/meds etc. Go to Statpak.com for a look.

Geez Doc, this is the philosophy of most paramedic programs as well. With the number of programs that only want to get people out the door and on the streets with a certification, this problem is only going to get worse.

NTG will work for this individual, as the chest pain that occurs following cocaine use is related more to vasospasm than to vascular occlusion by a thrombus. ASA is also still indicated for the possibility of a clot forming in the stenotic vessels. Valium is a good call for the sympathomimetic toxidrome. Beta blockers would be a bad idea in most situations like this one, simply by leaving the alpha effects unopposed.

O2/IV/12 lead No legal drugs. How about illegal? NTG/ASA

I had a feeling that was where you were headed Dust. I just wanted to be sure. I would tend to think that to start on the street the B/C level would be acceptable. This would show that somewhere along the line, the individual was instructed about how the given medication acts, and was able to understand a good portion of it. Going further would be nice, but as an entry point, it might be excessive.

An interesting topic that is probably long overdue. Way to go Rid! The state of AZ requires three levels of program administration for all EMS programs. At the top is the program medical director, who must show competency or be board certified in emergency medicine. Next is the program director. This individual must be a paramedic or higher for all ALS courses, and most programs prefer RN or better. The paramedics must have more than 2 years of field experience, though most will have more than 5. The RN's don't have to have any actual clinical experience to direct a program. Finally is the lead instructor, which must follow all of the same guidlines as listed above. The only real difference between the levels, is the amount of paperwork that each is responsible for. The program that I manage has an RN program director with 30+ years of clinical experience and 20+ years of EMS educational experience. Extremely valuable when dealing with the upper levels of state administration. Our medical director is an Air Force Reserve Lt. Col, and has spent 15+ years as an ER physician, both military and civilian. I'm the low man on the experience totem with 12 years of EMS experience and a little over 5 years of ALS teaching experience so far. I've done most of the work with the full support of the upper administration, and make sure that I use/abuse their knowledge base before making decisions on the direction that I will take. We run a lenient program that forces our students to actually learn how to think through a problem. We require a minimum of 80% to pass the course, and we also give plenty of assignments that the students have to think about, rather than just look things up in the textbook. We are currently dragging the present class through pharmacology kicking and screaming the entire way. I refuse to allow anyone to complete this program if I think for a moment that they will be dangerous. When they begin clinical rotations, my wife and in-laws staff the ICU so I get frequent reports on how they are performing. Anyone not holding up is dismissed rather quickly.

Wow, looks like a lot of the same discussion that happens on every EMS specific site. Someday we are going to have to come to the realization that some should not be allowed to manage airways. And those that shouldn't be doing the most basic of patient care, probably shouldn't be allowed to graduate from a training program.

If they forget things after they graduate, why would you feel safe knowing that they were at the lowest level when they left class? I think I misunderstood your position, Dust. It is my feeling that the "C" level needs to be the requirement. If we allow anything less, knowing that the problem listed above will happen, how could we feel comfortable allowing these people to practice. If demanding students to have a thorough understanding of what they are doing to people is anal, then so be it. It won't be the first time that description has been sent my way.

I will respectfully disagree with you Rid. When starting out, the major hurdle that I've seen is a lack of ability to assess the situation when you walk into a scene. The call volume of urban systems helps to eliminate this shortcoming. 10-15 calls a day forces you to develop a style more quickly than 3-5 calls will. I do agree, however, that the longer transport/scene times that happen in the rural systems is very beneficial to figuring out how second and third line treatments work. With short transport times, you just don't get to see what your treatment actually does. Possibly the best situation would be a somewhat suburban setting. More calls than rural, longer transport times than urban, and just enough variety to get exposure to more situations. Then again, everyone has a different learning curve.

There is little worse than watching someone come out of a class ready to save the world, and have to sit on their hands because they don't get to run many calls. Go to the city. Learn what the sick look/sound/feel like, then move to the country. I've found that the types of calls are identical in the two areas. The only difference is volume. The sick people in the country tend to wait a bit longer before calling for help. The city units run more calls, and make up for it with more of the BS as well.

The grass is always greener, etc, etc... Real easy for an agency to tell you what they will do when they don't have to back it up. Pretty rare for a company to tell a new hire that they won't help them with scheduling for school, family, and the like. Perhaps you could try one while working part time for the other to get a better feel for the situation before you jump ship.

This toxidrome is caused by all of the anti-cholinergic agents. Benadryl will cause this, as well as most of the other anti-histamines. Want to calm little Timmy down before a flight? Give him some Dramamine. Then wonder why the little angel :twisted: won't settle down. He reacted with an anti-cholinergic response instead of the anti-histamine. OOPS! Maybe we should have tried this stuff out before we got to the airport.

My views are spun from my experiences in the US, so ignore accordingly. I have never really cared, one way or the other about what other providers decide to call themselves. If someone identifies themself as an EMT, then that is what I expect them to know. If someone decides to tell me that they are a paramedic, then that is what I expect from them. There have been more times that someone decides to fluff themselves up by calling themselves a paramedic, and then proving they don't know anything, than I would like to count. You want to be called a paramedic, fine. You want to be called an EMT, fabulous. You decide that you want your title to contain "Sea-going, wicker technician" well then by golly chase down the title. I will agree with the gentleman from the north that mentioned most of the public view us as "drivers" only. If your colleagues can identify your level of education, then why worry about the public's perception. Mostly, they will decide what you do or don't know based entirely on how your uniform looks when you show up on their doorstep.

That would be all well and good if not for the fact that the numbers of cardiac arrest patients that are responded to aren't all that high. We have all been guilty of complaining, at one time or another, that we don't have enough of the "real" calls. How often are the responders in these areas actually responding to an arrest. It would also relate to the demographic that the paramedics are responding to. At a time in America that department administrators are complaining about shortages of providers, are we to believe that fewer will do a better job? If they do, how long until the workforce eliminates itself through attrition?

45. Please don't interrupt me while I'm ignoring you. 46. If assholes could fly, this place would be an airport. 47. He's a regular legend in his own mind.

Two things First, search is your friend. Second, what type of environment do you work in? The opinions you will get from us will depend on where we are working, so if we knew what your situation is, we might be able to give better advice.

Scene times need to be considered relative to the transport times. Our average transport time is 40+ minutes. If we are on scene for 15-20, then transport for 40, have we really assisted anyone? Most of the time, probably not. Medical or trauma, chief complaint-meds if available-allergies-do they want to go to the hospital-then we are moving. Initial treatment aside, everything is done in the ambulance enroute.

The Combitube works pretty well if it is placed early, not so well if you wait until a couple of oral intubation attempts are made. Once the oropharynx is torn up, the cuffs just don't seal too well. If you are able to get them to seal, now you have to deal with the blood draining directly into the trachea. Use it early, or not at all.

It looks like if you are a certified EMT any where else you qualify to take the Florida test. If you are an EMT-Intermediate you will be taking the EMT test. If you are a paramedic you will be taking the paramedic test. Yes, Florida will allow EMT-Intermediates to test into the state, but they will not be doing so at the intermediate level.

The biggest misconception that I've found is the idea that NREMT is accepted everywhere. This is an unrealistic expectation with the current environment. Every state has a number of regulatory bodies that decide they do or don't want to allow NREMT to be accepted in their location. Some places allow NREMT with added focus on how their standards are different. Some allow NREMT, but require a practical or written test on top of it. Some will go so far as to allow NREMT, then when you go there, they will give you a state pharmacology exam. Is it optimal, probably not, but it is significantly better than not having it. If the local administrative bodies could come to an agreement on what the standard should be, maybe we could do away with it.

There are hearts to sick to live, and hearts to healthy to die. Best thing about a cardiac arrest is the opportunity to practice things you don't get to do every day. And the clincher, everything that you will do is a step better than where the patient is when you find them.

Ditto Spock. Versed is garbage when dealing with CNS events like seizures. It just doesn't last long enough. On the plus side, you can atomize it to be given nasally. I prefer Valium for most things. It gives a good balance of onset/duration between the other two, and we've been using it forever. For assisting with intubation, Versed is good stuff, as long as the patient doesn't have a trismus response. Ativan is good for prolonged sedation as well.

Do you have your textbooks yet? That would be a good place to start. The information on the internet can quickly bury you in minutae. Read your textbook, and use the web to clarify things you don't understand. You'd be amazed what you can find with little to no effort. Once you get the physiology and pathophysiology down, then it will be time to worry about something else.