HERBIE1

Yep- radio traffic is generally very terse, as it should be. A quick acknowledgment on the air should not be a problem or too much of a distraction.

THe problem I have with specialty courses is that many times they are not transferrable as college credit outside the program. I spent a year studying to be an Xray tech, and the Radiologic Phsyics class I took was pretty intense, but I received no credit for it when I transferred to a 4 year school. In other words, if you are going to spend the time studying, making it a legit college level course so you can apply it to any future plans you may have after- or in conjunction with- EMS-ie RN, PT, PA, or even MD. Of course you can tailor it to the EMS field if you so choose, but the fundamental principles are what's important.

Yep. Drives me crazy, but as the saying goes, the older you get, the smarter your parents become...

LOL I gave you an out, Richard- you chose not to take it. BTW- those moldy oldies are usually pretty good. I could quote The Three Stooges and Curly all day...

Good stuff. Geez, I wish my kids asked such pointed questions. They went through the "why" phase, as many kids do, which made for nearly endless conversations. At the end of these sessions I would usually really want to answer with ""Because I said so!", but always refrained... LOL

Knowledge is never a bad thing but I think basic chemistry should be a stand alone class and a prerequisite BEFORE you take your paramedic core curriculum. A good working knowledge of chemistry can better help you in understand things like shock, electrolytes, acid/base issues, pharmacology, and cardiology. I had quite a bit of chemistry in college, so when I went to paramedic school, I certainly had a leg up in understanding those areas when the time came.

Florida- first, the only way to be 100% safe from diseases is invest in a full body wrap of plastic... Just kidding. Good advice from all, and best of luck in your new career! I'd reiterate the back precautions. Make sure you do core work- strong abdominals are VITAL to keep your back healthy. Good body mechanics, good nutrition, as well as keeping fit are also important- we tend to forget those things after we've been in this business for awhile.

It's against the rules to be on a cellphone while in the apparatus, in our department. I would assume that also applies to texting, although it does not specifically say that. It only makes sense- a couple idiots were caught by bosses driving to an emergency response while talking on the phone and the rule was established. Even before the that, I had a partner(only for a day) who was constantly on his phone. When he made a call while driving lights and siren, I hit the ceiling. I first asked if it was a family emergency, and he said no. I told him to hang up the phone immediately or I would smash it into a million pieces. He looked at me like I was nuts. I said that HE was responsible for my safety while he was behind the wheel, and if I ever caught him doing that again- with or without a patient, I would write him up. I may be an "old timer" and cannot understand why the younger generation needs to be on their phone 24/7, but if someone cannot wait a few minutes to make or receive a call or send a text, it seems pathological to me. NOBODY is that important that they need an instant response to every call they make or receive.

I know some people swear by chiropractors, so like some here, I can't argue with success. If it works for someone, far be it from me to discount what works for them. Me, I don't think I'll be visiting one anytime soon- too chicken.

Thanks for the reply. I think that this is a turf war. Many people feel- and rightly so- that the fire service receives most of the attention and the funding when it comes to public safety. The problem is on both sides of the issue- fire service wants to make sure that they remain "in the loop", and despite the fact that we will ALWAYS need fire protection, thanks to advancements in construction, building codes, fire prevention, and education, fires are down. That means to maintain their level of funding they need to become more relevant, and absorbing EMS is the best way to do that. EMS feels that fire infringes on their turf and does not have the same level of commitment towards providing medical care- ie fire is only doing to because they have been forced into it. Yes, many of the opinions expressed about fire, EMS, and their relative capabilities are generalizations, but there is some truth to them. I've been in both worlds and in hospitals as well. Again, the problem is that a pressing issue for one area is NOT an issue at all somewhere else, thus to have a united front- on either side- is tough. The reality is that for some time, agencies are being asked to do more with less, and anyone who can wear multiple hats is an asset to their agency and their bottom line. In these economic times this couldn't be more accurate. Is this the best thing for the public- well, that still remains to be seen, I guess but what choice is there? I think we all must adapt to these changes in order to survive and that means compromise on all sides of the issue.

I'll jump on that. In who's realm are we talking about here? What is your call volume? Do you have ample opportunity to exercise your skills? I submit that many folks who have all the training in the world may be great providers, but are inexperienced. Big difference. Same with being a FF. You may have all the certifications in the world, but unless you get to use those skills, you can't be on top of your game until you utilize that training. Additionally, as a FF, if you don't get that experience, I submit that it could be a dangerous thing to have all the credentials and be asked to be in charge, but reading about something and actually doing it- especially in our business are 2 vastly different things. I've seen many guys who have gotten every possible fire certification, FF2, 3, officers, all the technical rescue classes, etc, but have seen limited fire duty. They become officers or chiefs and suddenly are in charge of situations they may never have experienced. To me, that is a recipe for disaster, and have seen first hand how dangerous that can be. In the EMS setting, the danger isn't necessarily to yourself, but to the patient. The more you are trained to do, the more possibility there is for harm. That's like asking a 1st year medical resident to lead a difficult operation or treat a medically complicated patient with no back up. Bad idea. I don't think you can peg this is a fire based vs single role EMS issue. Much depends on the experience and training of the provider, as well as how often that provider- FF or EMS person- can use their skills. Additionally, some fire based EMS systems are very pro EMS, while others look at EMS as a necessary evil or a red headed step child. Conversely, a cross trained FF may be vastly superior to a single role provider if that single role does not have the opportunity to use their skills.

For Dwayne and everyone else- You asked about news on whether this vaccine has been fully vetted. I did a quick search and here is an article from the NIH. Note this paragraph from the article: The ongoing NIAID-sponsored trial began in mid-August at five sites nationwide. The trial is assessing the safety and immune responses to one and two doses of either 15 micrograms or 30 micrograms of vaccine. Data from the trial is being compared for three age groups: children 6 months to 35 months old; 3 to 9 years old; and 10 to 17 years old. OK, I'm no expert, but this study began approximately 1 and a half months ago, and they already want to push the release date up from November to October. Is this an adequate amount of time to sort out all the potential problems with the vaccine? This is the link to the article: http://www.nih.gov/news/health/sep2009/niaid-21.htm This vaccine may be the best thing since sliced bread, but I simply feel that rushing it's release AND making it mandatory is a slippery slope, and a potentially dangerous idea.

Not a problem. When I first started posting here, I had a hard time remembering that this community runs the gamut of prehospital care. Volunteers, paid on call, privates, ER techs, 3rd service, hospital staffed, fire based, BLS, intermediates, paramedics- we have it all. Throw in the folks from all over the world and they have titles that I''ve never even heard of. Then, toss in the variations of system protocols and things get really interesting. Some areas are incredibly progressive, some are operating as if it's still 1977, some have all the latest toys and gadgets, while others operate on a shoestring budget. That's why so many problems are difficult to get a handle on. What is a huge issue for my area is nonexistent elsewhere, so there is no one size fits all solution to most problems. Add to this the political drama that exists in many places- the pissing contests between fire and EMS, and it can make for a major head ache. LMAO Thanks a lot- I just spit my coffee all over my keyboard...

I understand the concept of being "out of alignment", but when you have a documented physical problem like a bulging or ruptured disc, THAT is the problem, not being out of alignment. The adjustment may help short term, but it doesn't get to the root of the problem- it's like a bandaid for an arterial bleed. Maybe I'm wrong, but chiropractors to me are like therapists and shrinks. Yes, they may help folks sort out issues, but when was the last time you heard someone go to a therapist and be told they don't need therapy? It's like a problem that is never "cured"- you always need to come back for 20 more adjustments, 20 more sessions, etc. I am curious though about acupuncture- has anyone tried it? To me, it's more about a general well being than addressing a specific illness, but I don't know. I wouldn't discount the herbal remedies though- most of our most powerful meds come from nature, and the Chinese and others have been doing it for centuries. It would not surprise me that they also know about uncommon herbs, plants, and extracts that can even surpass many of our current therapies. Problem is, unless there's a big profit in it, Big Pharm isn't interested.

Tough situation. Nothing worked for me, but the biggest help I have found is from doing core work to strengthen my abs. Steroids, PT, and meds did not work. I still have the occasional flare ups for no particular reason where I am crippled up with pain, but in between those, the pain is manageable. The only option I have left is fusion, but unless I am wheelchair bound, that is not happening. I guess the problem I see is age. Abs and core work excercises are tough when you get older- they're tough enough in your 40's. Good luck, and keep looking. BTW- Never tried chiropractors. I know a husband and wife team that turned me off of them. They are friends of mind and I swear that profession is like a cult. They have tried to tell me that adjustments can do everything from curing the common cold to solving world hunger(exaggerating a bit for effect). If it works for someone, I know they have a huge following, that's great, but honestly that whole thing creeps me out.

I look at that old sage advice in medicine- First, do no harm. In the case of these vaccinations(especially when made mandatory), I do not see that they can even come close to ensuring that. No, there are no guarantees in medicine, but if you already know there may be a significant risk- or at least the risk of being ineffective- then I am not on board with anything that mandates this treatment. Yes, we are in the health care, but we make sacrifices every day for what we do- risks of exposures, risks of injuries(from the job and from patients), lack of sleep, and even our mental and physical health. Thus, I see no moral imperative that we need to also be guinea pigs for a vaccine that has NOT been fully vetted.

Sounds like a bad day. I've worked with a few people who I know are frauds- out to scam the system, and nothing irks me more. Most of the time these duckers end up hurting their partners because they are lazy/incompetent/and too busy looking for a free ride. I recommend a frosty and festive beverage of your choice to get ready for the next work day.

YOu brought up a good point. This issue also depends on the type of apparatus you have- ie is there a CPR seat. We don't, so it does get pretty crowded back there during a code.

I agree about the potential for transmission. Look at the AIDS epidemic and how it spread. The vectors were amazing and it clearly illustrated HOW such a problem can quickly escalate world wide. I still question the possibility for millions of people to die here from H1N1- especially when we are able to provide treatment for even severely ill patients. Critical care has come a long way since 1918. Does it have the potential to overwhelm the system- sure, but not everyone who becomes infected become so ill they end up on a ventilator in an ICU, will they? I think that the knowledge we have is a factor in helping mitigate problems and keeping them from getting out of control. I think we have the benefit over 1918 providers because of awareness, early recognition of signs and symptoms, clusters of cases, etc, and we can mobilize to slow and stop the spread of the problem. Will we still have places in this world where thousands may die- yep. These are also the places where sanitation is poor, lack of medical care, and other resources where similar numbers of people can die from things like starvation, cholera, chicken pox, and the common cold. I don't think I have blinders on, but I simply think we underestimate our capabilities. I'm most concerned about some thing like a small pox release or other such event(probably intentional) that will take us by surprise.

That comment was in regards to the inference that it's a waste of time to continue to do CPR if we have no ROSC. I was trying to say that in the absence of a termination protocol, although the odds are essentially nil, any efforts would be better than doing nothing. Before we had in field termination capabilities, it was frustrating to work a patient, even knowing our efforts were probably in vain, and as soon as we hit the ER the, MD would review our treatment, confirm asystole or even a PEA, confirm ET placement, and call the code without every doing a thing for the patient. We used to get the occasional- "This person is dead, why are they here?' from a new or moonlighting doc unfamiliar with local protocols. I would have to explain that we do cannot terminate a resuscitation without a doctor present. Now ER's know the person is at least still viable, they do not meet termination criteria, or we would not be transporting. Certainly field termination is a better use of resources- both of EMS and ER's but not everyone has this luxury- especially BLS providers.

Sorry folks, but I disagree here. Is optimal CPR being performed while in motion- of course not. Is it a reason NOT to do CPR enroute- no way, especially if you have a short transport time. WHat if the person does not meet your system's criteria for termination? Different scenarios. With multiple people to help, we do CPR with someone doing proper 2 handed CPR while someone holds the belt of the person standing. On my own, I will stand, hold the overhead bar with one hand and do compressions with the other. Effective? Apparently good enough, since I've had ROSC's and even saves using this technique. Again, we do the best we can with the circumstances we encounter. Guidelines- whether they are AHA, PHTLS, or CPR are just that- guidelines. Doing something is better than nothing.

When what is being offered as a benefit for public safety may infringe on MY personal safety, then the public loses. This is not a completely innocuous idea and has real risks, which I don't think have been fully explored, not to mention the questions of it's actual efficacy. There is a huge rush to get this vaccine to the people and I am afraid they are cutting corners. We are talking about millions of dollars here and the manufacturers have a gold mine on their hands, but it would not be the first time a medication was found to have some real problems later. I'm thinking about Vioxx- a wonder drug for many, including myself, until oops-they later learned it caused an increased risk for cardiac problems. Aren't we just a bit more knowledgeable now on prevention, transmission, and treatment of diseases these days? Do you really think we could have an epidemic of that magnitude here?

Unless this is another government mandate, the employer can chose to abide by or completely ignore any or all of these recommendations. Unless there are penalties for not complying with these CDC ideas, there is no teeth to this. The people most in fear for their jobs will not not push the issue- ie call the employer out on these CDC recommendations. They simply will not risk losing their jobs. That's how employers take advantage of low skilled and low paid workers in so many cases- they know they can get away with skirting laws and recommendations such as this. The employee needs the job far more than the employer needs them. Again, in a health care setting, it's a bit different. I am simply not convinced of the efficacy of this vaccine.

Now you are talking about a whole different situation- reporting to work with a communicable disease- from a common cold to the flu. It's great to say- don't go to work when you are sick, but that's easier said than done for most people. Many people do not have the luxury of being able to take off work any time they are ill. Missing work means losing money for people who may not have sick leave, so they show up to work and are a potential hazard to others. Some are afraid that if they do not work, they may lose their jobs- a real concern in this economy. Obviously someone in our business can cause serious harm to anyone in an already weakened state or a compromised immune system.

Testing is a whole different issue. I have no problem with a screening, but mandatory INOCULATIONS is a different animal. I think we overestimate our ability to handle many things- especially viruses. We have spent BILLIONS on AIDS research and still cannot come up with a vaccine for HIV. A virus is a an insidious beast that by design constantly mutates. A virus is designed to take over a host cell's processes and replicate, which makes a one size fits all "cure" sketchy at best since we are all different. Many times, the yearly vaccines we develop turn out to be far less effective than planned because by the time we develop the vaccine, the virus has already mutated to either a more or less virulent form. I think it is foolish to think we can rush into an H1N1 vaccine without those same issues- especially since this vaccine is not fully vetted.