NRPinNEPA

A nurse might take the attitude that a paramedic doesn't have a god-given right to pre-hospital care, but one could flip it around and say that a nurse doesn't have a god-given right to hospital care. One could also say that paramedics may not have a god-given right to pre-hospital care, but neither do nurses, especially since there are interventions that paramedics can perform but nurses can't (unless they're a PHRN). It's convenient that nurses have been given a way to function in a paramedic role, but there is no such bridge for paramedics without becoming nurses. As far as a reasoned argument goes, what's yours? What is the rationale for a PHRN in the United States other than putting paramedics out of work?

I'm specifically referring to EMS in the United States. In the United States, PHRN serves as nothing more than a way for nurses to obtain paramedic skills, come into the field with authorization to use more drugs than a paramedic, and take paramedic jobs. Instead, I say give that qualification and education to a paramedic and make them a real critical care paramedic with an actual expanded scope of practice. I'm a firm believer that paramedics belong pre-hospital and nurses belong in the hospital... two different worlds, two different mindsets.

I wrote a big thing but firefox crapped out on me. Here's the reader's digest version... 1. Make EMT a one-year CS or move it to a first responder role and replace it with AEMT or EMT-I as a one year CS 2. Make paramedic a minimum of an AAS 3. Do away with PHRNs and instead create a REAL critical care paramedic level (a bachelor's) 4. Make bachelor's the minimum for paramedic/supervisor. 5. Get EMS away from fire departments 6. Drop "EMT" from EMT-Paramedic 7. Do away with volunteers 8. More anatomy, more physiology, more pathophysiology, and more clinical time 9. Rigorous QA/QI 10. Adhere to the national standard

Per the National Standard Curriculum, an intubation attempt should take no more than 30 seconds. That is from when ventilation ceases to when ventilation begins again. Anything more is, by the book, unacceptable.

LOUD NOISES!!!!

With a stroke, you're going to have hypertension, so why would you want to add more volume to the container? I would just throw in a lock or (if my service didn't have locks) a 250cc bag of NSS KVO.

I can't see the posted image, but does it look something like this? H+ + HCO3 <-> H2CO3 <-> H2O + CO2 If so you're getting into the bicarbonate buffer system and acid-base balance.

In Pennsylvania, paramedics are not blessed with paralytics. Typically any pre-hospital sedation uses the combination of fentanyl and versed or (in more progressive regions) etomidate. The unfortunate thing about etomidate for us is that you must have two ALS providers on board to administer it, which becomes problematic in the more rural areas of the state, so many rural services don't even carry etomidate.

Reasons to palpate the abdomen... Apendicitis Ruptured ovarian cyst Gastroenteritis Gastrointestinal bleed Abdominal aortic aneurysm Crohn's disease Intestinal Obstruction Diverticulitis Intestinal perforation Ulcerative colitis Need I go on? As for students performing actions while on clinical time, my paramedic program is designed to gradually transition the student from observer to being primarily responsible for the patient, like JPINFV suggested. In fact, our clinical time during our final semester is called "Advanced Pre-hospital Practitioner" and we actually get college credits for it. I am in the second semester, and the only ALS interventions I am allowed to performed at this point are IV therapy and phlebotomy, but my preceptors already have me interpreting 12-leads. They also basically let me run the call and do anything I am not allowed to do... medication administration, intubation, needle thoracostomy, etc. I fully support this type of training because it allows the student to make the decisions themselves while they still have a paramedic there to catch them if they fall. However, when I started, I was allowed to do nothing more than EMT skills and assessments. Again, I fully advocate this approach because it allows the students to build good strong assessment skills before worrying about interventions.

Good. Step in the right direction... somebody has to do dialysis transfers and inter-hospital critical care transports.

Paid BLS is the way to go for you then. That way you'll be in the back with the medics and can watch them/pick their brains.

You know you're a firefighter if... You can't realize that EMS is a completely separate field from fire supression and post fire-only items on an EMS website and actually think you'll get a positive response.

In Pennsylvania L&S is at the crew's discretion when responding to a scene, but during transport it is up to the ALS provider. No ALS provider on board? Not en route to rendezvous with an ALS provider? NO L&S!!

I looked at the pics of the face-to-face method and it seems like it would just be awkward. Personally, I think I would just go for the digital intubation in that situation. As for holding the laryngoscope in the left hand, we've been told in class that even if you are left-handed you are to hold the blade in your left hand. I would think left-handed people would have an advantage in this regard since the major issue some of my classmates seem to be having is use of proper technique in displacing the patient's anatomy due to lack of strength in their non-dominant hand. I could be wrong though...

A nice glittery gold patch on my shoulder and the post-nominals that come with it. A girlfriend would probably be pretty sweet too.

On the bright side, this show did give me a great idea for a costume for the Halloween party at medic school... I'm going to wear a jumpsuit with the sleeves rolled up to my elbows and a pair of aviators and walk around arbitrarily injecting people with versed!

Don't try to make a philosophical debate where there isn't one. We don't determine if a patient is obese or not. Since we are medical professionals, we use the term "bariatric". Determining whether the patient is bariatric or not is simple. You only need to ask one thing... "Do they fit on a regular litter without delicious spillover on the sides?" If not, they just bought themselves a bariatric litter and a bigger bill. End of discussion. Why charge them more? Simple... you have to buy a special litter JUST for their fat ass. To say nothing of paying the medical bills of employees who ripped their spines apart lifting said fat asses.

Absolutely, 100%, emphatically, never-been-so-sure-of-anything-in-my-life, definitely NOT.

Apparently somebody didn't realize that the "Suicide: Doing It Right" statement in "You Know You're In Medicine If..." wasn't supposed to be taken seriously.

I'd seriously love to see that guy interact with his friends. "No! No! Call me 'Mr. Cool Ice'!" "Ok. Whatever, David."

Here's what I propose for the new levels... Paramedic - Certified (PM-C) Paramedic - Advanced Practice (PM-A) Critical Care Paramedic (CC-P) Eliminate "technician" from the job title, make PM-C equivalent to EMT-Basic in terms of skills, maybe give them a few extra tools, and make it a one year certification program. PM-A would be equivalent to the current EMT-Paramedic and would be a two year associate in applied science. CC-P would be a four-year bachelor's. This is my perfect world. As long as we have "technician" in our name, we will continue to be treated like technicians and continue to earn a technician salary. Look what happened when RTs became Respiratory Therapy and upped their educational standards. Besides, everybody calls us paramedics already anyway.

And here, 46Young, is the root of my gripe with Fire-Based EMS. My chosen profession is NOT a fire specialty. It is a unique and distinct area of HEALTHCARE. Then again, you and I have been round and round on this issue more times than I care to count, so you should know this already.

12 leads became the big new thing in my area three or four years ago. Even though the treatment doesn't change (O2, IV, monitor, nitro, aspirin), the 12-lead still gives a much better view of the heart than the traditional 3-lead and can save the roto-rooter man, er... interventional cardiologist some time. In reference to sending EKGs to physicians before arrival, Geisinger (our local heart hospital) has a program where paramedics can take a picture of the EKG with their phone and send a picture message to the physician. I've never used this or seen it used, so I don't know exactly what happens after it's sent, but it's a nifty idea.

That never made sense to me. "Kapowie!! Hold on, let me go get my ambulance and make you better now." Yes, you can be a firefighter and still be a good paramedic. The problem is not having both certifications, although I agree that it's damn near impossible to remain proficient in both disciplines as they're so different. The problem is the fire department-run three month medic mills that teach their medics to interpret whether the machine says the patient is having an MI or not, rather than interpret the 12-lead on their own and focus on skills and training rather than education. Plus, Fire-Based EMS just leaves a bad taste in my mouth. I just want to stand outside FDNY firehouses with a bullhorn shouting "Let my people go!"