uglyEMT

Update.... Dad goes for cath this thursday at Mt. Sini in NYC. Cardiologist feels he has a good prognosis if done now and not later. Showing a 1* Bundle Block on ECG which the Doc has to monitor. I will keep you all updated..... PS thank you all for the advice and education on this situation with my family.

As the sign says in the back of my rig. You Dont Die Or Multiply Here I know corny but anyways.... Yes my OB experience is nill so far but I learned alot in the 2 hour class I was in [turn sarcasm off]. Probably just enough not to crap myself, doubt it though

NJ is doing the same Richard. 5 year renewals but I missed the cutoff by 3 days LOL. I still have a 3 year renewal. As for the CEUs, I am the same as you the "in-house" stuff is immedatly approved but all my on-line or independant classes (non in-house) seem to get rejected but at least the DoH accepts them so my creds are current. Its funny that it works but it does. Surprisingly I might add

Sorry to hear about the lack of employment. That sucks. But you are correct about our general area. It is a detriment sometimes. Again I am NOT advocating BLS doing ANYTHING ALS or ABOVE THEIR SOP. This general area does well with the BLS ALS thing but unfortunatly they do need more medics because the areas that these few medics cover is large and they are not always available. Hopefully one year the powers that be will wise up and change the status quo. Our town is now talking with our current hospital ALS unit to see if we can have a unit staged at one of our towns squads thus offering a quicker response time then 20 minutes. Basically the talk is for the ALS to still be hospital based BUT during either the day or night have their second unit staffed and waiting in either of our squad buildings. At the end of the shift they would leave and go back down to the hospital. Its up to our medical director right now and the hospital to see if it will happen. It is amazing to think that there are portions of the country that this is what is happening. Paramedics not having a job but BLS being a dime a dozen. It does create the whole "I will stay BLS just because" mentality. Thankfully though there are squads, mine is one, that stresses countinued education and maintaining skills. Im not just talking cookie cutter CEU classes but drills frequently involving other agencies and departments. Everything from water rescues (we work around a large lake) to MVAs to MCIs. Once a week we break out the training dolls and practice our PAs, CPR, lung sounds, ect. just to keep us proficient. I know this doesnt make up for true education and I will never knock someone for going to the next level (which here in NJ is P, we did away with I a few years ago). I respect the medics I work with and understand all they went through to get where they are. I do not notice them looking down on us (EMTs) so much in general but the do "teach" the folks that are being mediocre. The medics I work with encourage an EMT to be the best they can within their SOP and like to see and hear from one when they get onboard. If you give them good vitals, lung sounds, PAs ect they actually invite the dialog and use it. If you BS through it, its the eye roll let the LP12 and my ears tell me.. you go sit down over there routine. When they are on board I pick their brains as much as I can. Not to be able to do what they are doing but as to why they are doing it. I would NEVER try to do what they do but knowing alittle of the whys helps me understand the whats. If I have a difficulty breathing Pt with diminshed lung sounds and I let them know and they ask me what my assesment is I let them know honestly what I feel. If I am right they let me know and if I am wrong they let me know and explain why (not always in front of the Pt usually at the ED after the call). Thats good learning. When i watch them CPAP or other interventions and inquier as to why it actually does what it does vs what it does it helps me understand the body's response to the treatment and what to look for during continued assessment. It makes me a better provider that way. Again staying inside my SOP but advancing my knowledge of the human body and its functions and systems. We come from many diffrent syatems here at this site, nationally and internationally, what works in one area doesn't sometimes in another. As was stated by the previous poster sometimes its detrimental sometimes its advantagous. We all work within our given system and make work what we have. Again I AM NOT ADVOCATING ON ANY LEVEL THAT A BLS SHOULD DO ALS ANYTIME ANYWHERE, I do feel American educational requierments are lacking, we strive twords minimalism, we rather have it quick and easy then long and right. But one thing we ALL have in common is our Patients, as long as we do the best of our ability and to the level we can then we will be the best advocate that we can. AGAIN... BLS STAY INSIDE YOUR SOP AND DO NOT DO ALS WORK. If ALS asks you to lend a hand then by all means do what is asked of you BUT inside your SOP.

Its a very simple answer actually. Here in NJ all ALS is hospital based. No squads, privates, or paid services are allowed to have a medic. If you want to be a medic you must work for the hospital. Not every hospital has an ALS unit and the ones that do have them, keep the number of medics ont he payroll very low to keep overhead down. Alot of carrer EMTs in the state do so because they work a regular full time job and cant afford to quit their job or carrer and persue the paramedic level of education and qualification with the uncertanty of finding a job when the become certified. I inquired about a medic level cert while I was doing my clinicals at a hospital with ALS. I told them I would be able to work nights, this way I could keep my carrer and continue my education, but was told unless I become a full time employee of the hospital I could not work for them. I said OK fine I can work a full time shift at night, they said no full time means I soley work for them that way they can schedule me whenever necessary. This is the biggest problem in our state right now. Alot of folks want to become Medics but with such restrictions around folks stay as EMTs so they can keep their regular jobs. I feel this is a problem but until the State Board Of Health begins allowing nonhospital based ALS this will continue. As for these folks not pushing themselves, yes some do the minimum, but most strive to continue their education and stay as current as possible with the latest in the field of emergent care. Just a quick not on our squads long timers, the 25yr person worked in the ER as an RN until retierment now serves our squad almost full time everyday. The 10yr folks are all ER techs with one in school right now becoming a PA. Some of the 2 to 5yr folks are younger guys and girls currently in college becoming RNs or PAs or higher. Using the experience on our squad to help further their understanding and education while in school. We also have a 7yr member that works for Medivac service as a flight medic and he is the one that complains the most about not being able to do his level of cert while on a BLS call with us. State regs dont allow him too. But with these folks and their experience in the fields of both ER and prehospital care I would not agree with them being mediocre. Not trying to be crass or anything with anyone and again I will state unequiviclly that NO EMT-B should be doing ANYTHING ALS or beyond their SOP.

Two things I can think of. 1. Remeber its her day 2. Remeber its her day Thats the most important. After that, make sure the food is good and the liquor is free. Music hopefully is good. If you have the food, booze and music covered the rest is easy. Mistakes ARE going to happen, things will get screwed up but in the end it goes by so fast you wont have time to remeber it. Most of all enjoy your beautiful day and dont sweat the small stuff. Congrats

Please read my posts I NEVER said an EMT should be doing anything ALS. I have stated repedatly that EMTs need more education then 120hrs. I have always said EMTs should have more training but NEVER,NEVER go beyond their SOP. Also I never complained about Medics what-so-ever. In fact I respect them (check my posts) and hold them in high regard. My quoted post was in response to another poster saying EMTs dont have the knowlege to make a decision to call ALS. Thats all. As Aeromedic stated some EMTs have many many years experience under the belts and can make informed decisions. On my squad alone we have 4 memebers that recently celebrated 25 years with the squad, several members at 10 years, and a few with 2 to 5 years. Now I am not saying the 2 to 5 year guys should be making judgment calls but surely the 10 and 25 year members sure can. As for more medics... concidering NJ is a hospital based ALS state talk with the hiring hospitals, some dont want ALS units and the ones that do keep the amount to a minimum so unfortunatly its not the medics that are in short supply its the jobs.

Not saying we are a shinning example by a long shot. As I hear it we are the laughing stock of EMS. As for why not just send them... 2 ALS units for a 75 mile area. Why have an ALS onboard my difficulty breathing thats being managed effectively with 15L NRB and 20 min from the ED and take them off a possibly necessary call? Not saying we dont utilize ALS for alot but we just got done with our 6 month reviews and out of 95 ALS dispatched calls ALS stood on board 3 times, all others they released Pt to our care ( the three times they stood... Cardiac Arrest, Anaphylactic, Cocaine OD). That was the 95 times we didnt cancel them. Im not trying to make this about ALS or BLS or anything like that. I was just pointing out in my experience thus far in the EMS field a BLS can make an informed decision through both education and experience as to wether or not ALS is required. Are there times we may miss something? Probably but 9 out of 10 times we get it right. Most times ALS jumps onboard hooks up a 12 lead looks at the strip, checks the BP against our findings thus far, then says "really nothing for us here released to you guys." The delay in ongoing higher care just for them to say that after meeting them enroute to the ED plus the added stress to the Pt of more folks on the rig is not necessarly a good thing. Our SOP where I am is ALS gets dispatched along with BLS, they radio us to see our findings, ask if we feel they are needed, and together we make an informed decision as to yes or no. ALS is letting us decide based on our findings. Again this is my local area and as stated previously by me I feel the biggest disadvantage is not a comprehensive standard of care across the country. What we have is what we follow and our SOP may be diffrent then yours but it doesnt mean what we do is wrong, it just means we work withing our SOPs and thats where , I feel, we get these kind of threads and arguments industry wide from.

I googled this as well but actually found something LOL no offense richard. A fire card is obtained after successful completion of a safety/fire class. The instructor is usually a retired firefighter certified by the county or city to teach the class. The class is about 6-8hrs and completed in one day. Most if not all hospital employers offer the training and certification to their nurses and employees. As of December 2009, fire cards in Los Angeles are valid for 4 years. Anyone wishing to update their fire card can go through their employer's educational resources. Student nurses are also required to obtain and keep their fire cards current to work in the hospital. Your school's nursing department should have information about how and where to obtain the fire safety training. I dialed 311 from my phone and spoke to the fire department's dispatch office and was transferred about four times before I was given numbers to available instructors in the Los Angeles area. I contacted one of them who told me that they were teaching a class at a local hospital. Not all hospitals allow individuals that are not employed by them to take the class, but I got lucky with my local hospital. This is worth giving a try if you're trying to find a class that's convenient your schedule and/or shopping around for the best price. Unfortunately, all hospitals reserve the right to charge those not employed by them any amount to take the class. The instructors have no say as to what the hospital charges individuals. Hope this helps.

That would be great LOL

Welcome to the City.

It seems like we are all saying the same things here LOL We all understand that BLS is woefully under educated and ALS can do what basics do but also be able to immediatelly begin advanced therapies when necessary without the need to wait. Basically the bottom line we are all striving for is proper and complete medical care for every patient in a timely manner. I read in a post, " Basics are for the most part, [are] unable to determine if an intercept is necessary due to their lack of education." This I do not feel is true. We all have our algorithims and general knowledge of proper patient vitals and anatomy. If you follow what you were taught and know from experience a BLS should be able to know when ALS is necessary. I cant speak for all systems but the system I am in dispatches ALS to almost every call and it is up to BLS to cancel after our initial assessment. Have we called for ALS without them being dispatched already? Yes we have. Has there been times when ALS is not available when needed? Yes there has. Is this system good? Not in my opinion, but that is the way it is in NJ with ALS being hospital based only. Like I said in my previous post I do NOT feel BLS should be given more responsiblities, no way, but what i do feel needs to be done is a National Standard for all systems that will make them work to take care of the patients in a timely and proper manner. One thing I have been noticing also in the threads, be it this one or any BLS/ALS thread is this. So many folks work on just ALS rigs in systems that are droping BLS from them then tell folks that every system should be that way. I am only speaking from personal experience in my local area, not internationally (although I have spoken with a number of you) or even nationally. Some areas can't have fully staffed ALS rigs for everything. Be it from the State's mandates or what-have-yous. I know the argument is that if you can afford the cops or the fire dept you can afford ALS only rigs or that the tax payers will understand the need. Yes I wish it was that easy but living in the highest taxed state in the US I can attest to the fact people are fed up with paying ANY higher taxes. Hell right now they are even cutting teachers and closing hospitals and schools to try and allivate some tax burderns!!! I know this is totally wrong and the dumbest thing around but it is what it is. We all need to realize that our local systems are what they are and no system is better then the next guys because each one is tailored to their specific area. Some are fire based so are independent. Some are all volunteer some are paid. Some have ALS rigs some dont. But what we all have in common is that we as EMS have the patient to worry about and not titles or initials or anything else. We need folks, be it BLS or ALS, to be as well trained and COMPITANT as possible to give the proper interventions at the proper time in the proper sequence to provide the best possible outcome to our patients. Its been stated before but I will restate it here... when someone calls their emergency number they dont care who comes through the door or to their aid. They just expect that whoever it is can help them, to the best of their abilities, to resolve their issue. Its about our patients not our egos. Again I stress I DO NOT believe that basics should do anything more then their SOP. Basics need more education to begin with and WE ALL have a role in prehospitial emergency care and our most important thing is our patients.

NJ has started using RSI also. Was wierd seeing it for the first time, wasnt expecting the siezure like shaking.

How about a real good ponzi scheme? LOL j/k couldn't resist

Ruff although I dont know of any in NJ being you've help me out I took a look for you. Acreage For Sale 369 pages from all over the US. Minimum acerage is 100 maximujm is 500 as you specified. Happy Hunting

LOL Ruff beat me to it. Our bariatric equipment is the crew, the responding LEOs, and a call into dispatch for a lift assist which brings out the fire dept. Now we have the Pt on a stretcher or stokes, 3 EMTs 2 cops and however many fire guys (usually 4 or 5 show up in full gear minus the SCBA) usually crammed into a 1 bedroom appartment on the 3rd floor! So 9 or 10 plus the patient trying to make it work. Gotta Love It I wish we had some of that stuff the OP mentioned. Would make life alot easier. so would the Pt living on the ground floor Thankfully most of my crew does wear back braces or cares them in the rig so if we are the responding, we can put them on. I just wear mine under the uniform all day.

Well thankfully Dad is home now They got in late last night do to delays but he looks good. Was clowning around, joking with me, and honestly if I didnt already know what happened I wouldnt have been able to tell. He will be seeing his cardio on Monday (earliest he's available) so I will know more then. For right now though, he is home, looks good, and is in good spirits. I want to thank you all for everything and I will keep you all informed.

It really does Lone Star. I felt I was a disservice to the public at first and sometimes feel I still am. I know experience has alot to do with it as well but as far as education alot I feel is just glossed over. 1 day for peds a day for burns we spent more time learning to fill out a PCR and how to ask a patient to treat them then we actually learned vital stuff like BP and lung sounds. The education needs to come up and if it does I feel alot of the "I can save the world" types will fall bny the way side. The class I took had a very high attrition level, 68%, and I noticed the ones failing or droping out were the ones that thought they would just get by under the radar and when you talked to them about calls they were on or what-have-you unless it was a major trauma the call wasnt worth their time. I actually had someone tell me it was a crappy slow night because all they got was a stupid guy in respitory failure yet it was a "cool" or "great" night if there was an MVA even if everyone RMAed needless to say that guy didnt last long. After speaking with many of you on this site from out of the country I do feel we are under educated by a long shot. We need PROPER education especially on the basic level. Honestly I feel it should be a college course, 120hrs clinical and ride time, and finally get rid of the basic title and have it as EMT, Paramedic. Combine the B and I catagories and as stated previously make the cert a college course. I would leave the 120hr course for the high schoolers that want to see if they want to be EMTs. Not a certification by say a permit of sorts. Let them go through it, PASS, and issue a permit of sorts to allow them on squads or ride along (no patient interaction other then verbal) and get a true feel for what we all do. Then if they want it by all means get into the real course work and become a certified EMT. Doing all that I think will weed out alot of the problems. But so far with todays current teaching, HELL NO, do not add more ways to kill a patient to the list. I did add on another thread though that (well in NJ anyways) checking glucose levels shouldn't be a paramedic level thing. I feel as a basic we should be able to put a drop of blood on a strip and press on. That brings up another problem I see today. Nothing is the same.. what is allowed in county A is disallowed in county B (or state for that matter) It should be nationally uniform. I was part of a bistate terrorism training excercise about a month ago and OMG what a cluster. Some EMTs were doing things that they normally do in their SOP while others were not allowed to do in theirs and it took a while for the Coordinators of each triage area to finally just find the right combinations of folks to get the job done. Not saying it didnt work or wasnt a good exercise but took a little while, but then again this was good because the folks running the thing took alot of notes as to update their "playbook" so to speak.Would just be a whole lot easier if it was uniform. Just look at FF all their training is universal so they can go to another country and still fight a fire effectively alongside another. Picture a basic going to another country we would be laughed at, either that or patted on the head and told good boy go sit over there and let me do it. Again these are my personal feelings and observations as a basic and nothing more. I kow it seems like I am being a *&^% but thats the way I see it, we have peoples lives in our hands with 120hrs under our belts.

Its all good Buddy I was just joking with you had one of my HAHA moments but as usual type does not come across as well as in person.

He has always included me with my Father so that shouldn't be a problem. Its funny actually, he knows I am an EMT so he rattles off all the medical jargon and I understand most of it, then explains to my Mother and Father in lay terms Hes a great cardiologist, one of the best in the country and has been part of our family for close to 20 years and been my cardiologist for 9 years. We have that nice report going. Just glad to be getting Dad home right now. Cant wait to see him come out the airport doors Thanks everyone for your support and comments it means alot to me and my family

Thanks guys. Well by tonight my Father will be home up here in NJ. They fly out at 5:30 so at least he will be close and his normal cardiologist will be assuming treatment. He is also my cardio so he will actually talk to me. Just keeping the fingers crossed that the flight is uneventful and Dad comes home, tired, but well and we get ontop of this. I will keep everyone posted...

So I would be a sub Nuff Nuff. what would that be a Duff Nuff Seriously though.... My school instructor I think said it the best. " After this 120hr class you will be expected to save people's life, a hair dresser's class is 400hrs, I guess their hair is more important!!" I think a truer statment has never been said. 120hrs of class time and we are thrown out into the world as EMTs. Definatly feel we should have ALOT more education and training. Some folks want more responsiblities with their "education" level In no way shape or form should it happen.

NICE Thanks for the laugh