Dustdevil

If the question is, "is this a good idea?" then I think the answer is very definitely 'yes.' There are a lot of potential positives to this idea. However, I'm not so sure that any of these in-house programmes actually meet their potential. From what I have heard of Acadian's academy, they sure don't. This is really the same question as "is private EMS a good idea?" Sure. The idea is great on almost every level. The problem is, it's rare that anybody actually does it right.

No kidding! I bet it was even less palatable in Canadia! It's like every episode was almost a parody of real EMS. Every run they showed, I found myself thinking, "Is this the bizarro world, or what?" Actually, I've only seen a few episodes of "Paramedics." It's nothing I ever went looking for. I just stumbled across it a few times. It's like a train wreck. You know you shouldn't watch, but you just can't help yourself. The one episode I specifically remember was with AMR in Orlando. They start off with this crew, and these two guys are on camera telling us how they were recently chosen as "Crew Of The Year." Then they proceeded to fumble every run they made.| I'd hate to meet their worst crew of the year! :shock:

LOL! I have to admit I spent a considerable amount of time myself trying to visualise exactly what took place there! I see several different possibilities: 1. The tube was upside down, the stylet was rightside up, and he was trying to put the adapter through the cords. 2. The tube was rightside up, the stylet was upside down, and he was trying to intubate with no way of removing the stylet afterwards. 3. Both the tube and the stylet were upside down, and he was trying to shove both through the cords. 4. He picked up the tube to prepare for intubation, and way before he was even ready to start sticking it anywhere, the EMT decided to show how much he knew about advanced skills by reminding the medic to turn the tube over before it was even necessary. 5. The EMT doesn't know enough about intubation to even know what he saw. Having watched enough episodes of "Paramedics," I realise that none of those are really out of the realm of possibility.

Wow, just shows you how clueless people are about the history of their own "profession." For the first fifteen years I was in EMS, you had to take a refresher and re-test every two (later changed to 4) years. This whole CEU thing has only been around since the late 1980s. I don’t like this new policy either, but for totally different reasons that the original posters. I don’t like it because it is just too easy. Not only should medics be re-testing to re-certify every few years, but the test should get progressively harder each time, forcing medics to actually advance their education, not just maintain eighty-percent of the entry-level knowledge from their initial course. Anybody who is sweating the prospect of meeting that bar is just a very sad practitioner, indeed. It’s too easy. Hell, I’m surprised all you people aren’t praising this new policy! After all, you already know it all, right? You don’t need no more edumacation, right? So, just take the ENTRY LEVEL test and show them! A hundred and ten dollars? You think that is more expensive than forty hours of continuing education? Think again! It’s a good deal! An especially good deal for the NR, because now THEY are making that $110 instead of the CE providers. This is where we should be setting a standard ahead of all other medical professions, not just playing 'monkey see-monkey do.' This is something that gives us credibility because people are forced to maintain a verifiable level of competence. There is no downside to this at all. It is more important to us than to the rest of the professions because -- unlike other medical professionals -- an overwhelming majority of our registrants do not practise professionally or on a full-time basis. Once EMS is actually a real, career medical profession, instead of just a patch for volunteer wankers, this won't be an issue anymore. But for now, it's a huge one.

And that is just another glaring example of the cluelessness of the undereducated. We keep hearing the absolute BS nonsense about, "You medics have forgotten where you came from!" or "You forget that you were an EMT once too!" That is really the most clueless, asinine thing said here on a regular basis. It is because we remain so keenly aware of where we came from, and what it was like as an EMT, that we are so qualified to discuss the differences! How is it that an EMT -- or any person with a high school education -- can be so stupid as to suggest that I don't understand where they are when I have been where they are, yet they have never been where I am? And honestly, Marty, don't you wish to God that you had all that education BEFORE becoming a paramedic, instead of after leaving the field? I know for sure that I do! Yet -- as if to prove that stupidity is not exclusive to EMTs -- how often is it that we hear medics and medic students telling us that all those "non-EMS" courses wouldn't make them a better medic, because that "piece of paper" is meaningless? And that is a point that too many EMTs and volunteers seem to miss around here. Those of us who "bash" most, are equal opportunity bashers. Idiots exist at all levels, and I for one am not afraid to call them out. The only reason that EMTs may seem to get bashed more here is simple: First, because there are more of them, and second, because more of them have attitude.

Must be a Kalifornia thing. In Texas, it is mostly black females in their late 60s or usually 70s, in the front pew of a Baptist church, and the preacher standing over her, screaming into a PA microphone for God to cast the demons out of her, and the rest of the congregatation repeating, "HOLY JESUS! HOLY JESUS! HOLY JESUS!" over and over the whole time. And, of course, you can never get a no-ride out of the deal because of their age. :? Firemonkeys must be different in Kalifornia too, because in Texas they no-ride everybody. Even the actual AMIs. :roll:

Nope. And obviously, over a thirty five year span, this has not always been my policy. Like most of my SOPs, it is a policy that has been shaped by years of experience, and forever changing. But what it is based on is the police's own current policies. Current national standard taught in law enforcement is that, to subdue a violent psych, an officer must be available for each limb. That's what the physical restraint tactics instructor from the local academy is going to show up in court and testify is the current state of the art for them. Why should it be different for them when the guy is in my ambulance? I want them to take at least as much concern for my safety as they would take for their own. If not, screw them. That's what they have a cage for. Exactly. That's why, at the first sign of trouble, I'm pulling over and letting them out. Letting them out of a STOPPED ambulance. If they drag me out with them, it won't be because I was standing in their way, and it won't be a moving ambulance, as seems to appear in the news regularly.

I'm thinking that CMK must have been talking about our EMT's, not you. :wink: And I would agree. In fact, I would like all EMTs to know that it is indeed time for a career change.

I wasn't forgetting that. It was the very point I was attempting to make.

Seems to me that you are looking at all of this completely backwards. The way I see it, dual medic trucks allow for STRONGER providers because a poor medic has somebody to LEARN from all the time, someone else to help them with their skills if needed, and someone to encourage them through their assessments until they improve. So what is your alternative? For weak providers to have an EMT partner that can provide none of those things for them? For them to stay weak, poor providers? To just hope that the system eventually weeds them out, rather than helping them grow? I just don't see how that is an option, much less a good one. No, you're correct there. It is usually (certainly not always) a positive thing for an EMT to have first hand exposure to the big picture, so they can see how little they really know, and how far they have to go before they are a medical professional. But it is definitely not necessary. In fact, if the EMT level disappeared, as it should, it would no longer even be a factor. If there were no more EMT's, we would no longer be encumbered by the responsibility of babysitting them, and they could come right out of school already understanding the big picture. That makes no sense whatsoever. Beat their chests to whom? Their paramedic partner? How does that work when your partner is your equal? How do you beat your chest and impress somebody who is no less qualified than yourself? The answer is, you don't. Take away the imbalance of power, and you take away the conflict. That's the whole point of this topic. Oh, it will work for everybody. It just won't make everybody happy. And the reason we are getting nowhere is because too many people are worried about making everybody happy.

This alludes to a point that most of these vollies don't want to admit. That is, they are not doing it for the community. They are doing it for themselves. They are not doing it because they want their neighbours to have quality EMS available. They are doing it because they want to be the one providing EMS, even if somebody else could do it better. This whole thing about "giving back" to the community is such a load. I've watched many volunteer fire and EMS services shut down and go paid. Not once have I ever seen any of those volunteers take their volunteer spirit down the road to the public library to put away books, to the parks department to mow grass, to the city hall to answer phones, to the sanitation department to pick up trash, to the school district to drive buses, or to the city garage to wash cars and change oil. Wait... what happened to that volunteer spirit? What happened to all that concern for giving back to the community? If you were so concerned about your neighbours having EMS, then why did you fight the city plan to go paid at every council meeting for three months? And if it is all about YOUR community, why are you now driving ten miles to the next fire district to volunteer? The first time I see a volunteer EMT volunteer to go be a janitor at the courthouse for free, so the janitor's salary can be used to hire a full-time professional Paramedic, I'll bow down and praise his volunteer spirit and true devotion to "giving back" to his community to assure they have essential services. That would be a man worthy of my deepest respect and admiration. That would be a man who could honestly say, "I am giving back to my community because I want them to have quality EMS care" without being a lying narcissist. But, other than that one elusive altruist, each and every one of them is either incredibly naive, incredibly stupid, or incredibly selfish. That's why I would never hire a single one of them.

It is possible. In fact, there are schools that send you to another state for your internship because there are no suitably volumed systems in their area. No big deal. You aren't there to learn protocols anyhow. If you don't know those already, you shouldn't be in the field yet. You're there to learn how to function as a medic, evaluating and diagnosing medical conditions, and responding appropriately to specific medical needs, not painting by the numbers. You can do that, no matter what protocol differences exist. It's all up to your school, and maybe even up to your state, but NR doesn't have a problem with it.

Important? Absolutely! It has to be done, and if you're the one that's stuck someplace you don't want to be, then it is absolutely important. But it does NOT go along with EMS. It is not an EMERGENCY, and it is not MEDICAL, so how exactly does this have anything to do with Emergency Medical Service? I definitely agree it's important though. In fact, it is so important that those who need it should have multiple choices, so that they can choose who they want to perform it instead of just being stuck with whoever they are assigned. They should be able to call one of twenty providers out of the Yellow Pages and get somebody who wants their business enough to get there WHEN they want them there, not just whenever the 911 system can free up an extra car to make the run. EMS should not be providing private, non-emergency, non-medical transportation any more than the PD should be providing private, non-law enforcement security guard services. In fact, federal law should prohibit it.

Excellence! :thumbright: But remember, there is no end to this tunnel. The end is wherever you stop. Don't stop! Good luck!

There needs to be a written policy within the agency that establishes all of this ahead of time. This is not one of those situations you just leave up to happenstance. Look at tstkstorm's situation. He felt coerced to do things that were against his better judgement. Many, many people in EMS simply will not tell PD when the step off, and this is a real problem for us. Especially when it puts us in danger. You can sit around and second guess people all day, but the truth is that they should not have been stuck in that position in the first place. It is the agency at fault, not the individual who is working with no established guidelines. Guideline #1: EMS stands for Emergency Medical Service. If this person is not suffering a medical emergency that requires horizontal transportation or EMERGENCY MEDICAL intervention, then they don't go by ambulance. Just because somebody is psycho does not make them worthy of EMS transportation. If they require no medical care from me, they can ride upright in the police car just fine. This is not the 1950s. We are not the men in the white coats anymore. Guideline #2: If they are under arrest, then they are in police custody. If they are not in police custody, then they are not under arrest. Plain and simple. I will make absolutely no effort whatsoever to restrain this person from leaving. If they turn to me and say, "I want out," then by God, I'm pulling over and letting them out. If the cops have a different idea in mind, then their fat arses need to be there to effect it, not driving behind me or meeting me at the hospital. I can't turn my patients over to cops. Cops can't turn their prisoners over to me. Cut and dried. Guideline #3: I am not a professional wrestler, and my ambulance is not a UFC cage. As already stated, if they want out, I'm getting out of their way and allowing them out. I will engage in NO physical contact with this person that is not part of MEDICAL care. I will not restrain them. I will not subdue them. If there is any physical contact between us, it will be in the course of self-defence, or possibly (but not definitely) in defence of the cop. Nothing else. Guideline #4: Patient with proven violent potential or history gets four (4) cops accompanying him, or he walks. He will not be transported in my ambulance with less than four cops. Ridiculous, you say? Maybe. But I've never had a psych patient whip my arse or escape from my moving ambulance in thirty-five years. And I'm still alive after thirty-five years to talk about it. Will you be able to say the same?

You work for Medicare? :shock:

Oooh! Excellent point! One I don't recall ever being discussed here too. How guilty are we of fostering this attitude in EMTs by coddling them and blowing smoke up their arses to make them feel good about themselves? This sounds like a really bad hold-over from the current state of public education. "There are no losers. Everybody's a winner! No grades. No scores. I'm ok. You're ok." What a load of shyte. This is all starting to make a lot more sense now, thanks to Risky's visionary observation! No wonder so many people come here and are totally shocked that anybody would not pat them on the back and congratulate their awesomeness for completing three weeks of night school. They've been raised to believe that everything they do is worthy of a party and a raise in their allowance. And we're enabling them by being nice to them. No more Mr. Nice Guy! :twisted:

That's what "MedStar" in Fort Worth, Texas has done. They started off with Hartson-Mercy running the public utility. Hartson-Mercy sold out to Laidlaw. Laidlaw sold out to AMR. The Authority kicked out AMR and replaced them with Rural-Metro. Rual-Metro defaulted. Who else is left to administrate a system of that size? Answer: nobody. So now the Ambulance Authority runs itself as a government entity without a public utility contractor at all. I haven't had anything to do with them in twenty years, so I'm not really plugged in to the particulars. I'd love to hear how things have changed with no contractor involved. Especially the finances and medical sophistication. I agree that it has great potential. I like the idea of private enterprise in EMS. It's the American way, and it simply works great in many places. It would work even better if Medicare would quit being Jews. But honestly, I just don't see a single private contractor getting the job done well in a system that big.

I don't want it to be about you. I'm sure you're a fine human being. But your grasp of the serious gravity of the practice of medicine is far less than intellgent. This is exactly why I tell n00bs that they must choose their school so very carefully. You never know who is teaching those things. How is reducing the education needed to provide advanced medical care an "improvement?" We have already reduced the 9 years of education necessary to practise medicine down to a technical training course of less than 1000 hours, and you still think that is unreasonable? That's insane. How about answering some of the questions I raised so we can better understand why your idea is such a good one?

What psychiatric education do you have that enables you to reliably determine if there are any questions as to your safety or not? Seriously, how do you know until it happens? There are always questions as to your safety. Complacency kills.

Because nobody but you has any idea what all that means.

Simple. Because if they were educated, trained, and have the clinical experience, they aren't EMTs anymore. They're paramedics. And conversely, if they are not paramedics, they do not have the education, training, and clinical experience. It's not really a complicated concept. Which part are you having trouble with?

What the well dressed nurse is wearing on convoy these days... And, I notice my image host lost my Chuck Norris pic. Can't be having that!

This is extremely common in adults who begin a martial arts workout without being in good shape. I'm not ashamed to say it has happened to me more than once, even when I was a much younger adult. Cool, pale, diaphoretic, tachycardic, weak, nauseated, bowels screaming for release. It is an extremely intense workout to begin with. But the clincher is that you are very nervous and apprehensive too, because of the unfamiliarity with the activity. It is as much psychogenic as it is physiologic. Although, it sometimes happens even to experienced martial artists who have just been away for an extended period too. You reacted the right way. Don't let it discourage you. Yeah, it's damn embarrassing, but you just have to buck up and push on. Try it again next class. When the feeling hits you, bow out and take a rest again. In short order, your body will adapt. But remember, in order for your body to adapt to anything, it must be repeatedly exposed, so don't quit or take extended absences. Good hydration and nutrition, as well as adequate rest, are indeed very important. Your body has to have the tools to work with in order to function optimally. But you are right, having it fresh in your stomach is a bad idea. It's even a worse idea than having an empty stomach, lol. If you take this up as a serious pursuit, then you will establish a routine that works for you. You'll know what days your workouts are on. You'll know what time you have to eat on those days, and what your intake limits are. That will contribute greatly to your body's ability to adapt. The body likes regularity and routine. That is what homeostasis is all about. Good luck, Bro! Stick with it!