Dustdevil

[spoil:2da52cec93]http://www.fleshlight.com[/spoil:2da52cec93]

Ooooookay.... :? Now, where were we? Oh yeah; edumakation!

I hope he also told him to dump his worthless girlfriend immediately afterwards. 8)

:shock: Dude! I can't wait to see this!!

Wait... what exactly do they mean by "support?" And are there any young women who need "support?" This could be a volunteer gig I could really get into! Ames, usually when some drama queen posts an "I QUIT!" thread, my one and only thought -- after the laughter -- is 'good riddance.' But not only are you somebody I have always respected here, you also present an intelligent case for our consideration. I do understand your disappointment. But I would agree with the previous poster who said that these posts usually are not about people. They are about levels of training and contributions or detractions from the profession. Obviously, it is people who attain these levels, and it is people who make those contributions. But again, we -- or at least I -- try to focus only on deeds, not people. Even those people whose deeds I disagree with are still people with personal merits I do not question. Just because many of us believe that Basics and volunteers (and I would not consider your volunteer position to be in this category) are harmful to our profession, it does not mean that we believe those individuals are not welcome in EMS. Obviously, most of them have a lot to offer the profession. All I ask is that they step up to the plate and elevate their game to professional levels. To contribute to the profession as a whole. To be the very best they can possibly be, not just what is "good enough" for the volunteer fire council. Those who have what it takes to be a professional will answer the call and give 110 percent towards achieving that goal, and I will be the first to proudly welcome them aboard. Those who take personal offence to the suggestion that it takes more than 120 hours of eighth grade level night school to be considered a medical professional simply don't have what it takes, and nobody is going to miss them. Which ever of those two epiphanies they come to, I am happy to have helped them reach it, because it is a positive thing for them personally, and for the profession as a whole. Ames, I know you have what it takes to be a pro. I have absolutely no personal doubts about you whatsoever. Quite honestly, I am excited that you would even consider EMS as a profession, and I truly hope that you do it, excel at it, and love it for the next thirty years. Because I believe that, I believe it is my responsibility to tell you that, if you choose to leave this site, you will only be hurting yourself. This site is packed to capacity with members, and more are joining everyday. Probably nobody but me would ever even notice your departure. But you will be denying yourself the best possible source of intelligent discussion and information about the career you are seriously contemplating simply because there are some truths that you take too personally and would rather ignore than ponder. And let me tell you, the disrespect you feel you get here is absolutely nothing compared to the brutal disrespect you will receive from your employer and patients every single day of your EMS career. Toughen up, Bro. Show everybody else that your continued participation is actually worth caring about. :wink:

Well, my guess would be for the very same reason we don't ask new med school grads to work as a nurse for a couple of years before allowing them to practise medicine. Fruit which is not picked and consumed when it is ripe will wither and spoil. The longer you wait to put your knowledge to use, the less grasp of that knowledge you will retain. And the less of it you retain, the less you have to assimilate into your experience in order to build a practice of intelligent, professional quality. Any system worth a shyte is putting those new grads directly to work, utilising them to their fullest level, placing them alongside an experienced and proven preceptor, in order to quickly and efficiently develop these people into their fullest potential, to the benefit of the system and their patients. Systems that suck arse will waste years of education and potential by not utilising these people (Boston), or worse yet, stick them out there alone with nothing but an EMT for a partner. Yeah, it's a no-brainer, but brains seem to be a rare commodity in EMS once you get any farther north than Virginia. Any other simple questions we can clear up for you?

Absolutely. It is WAY easier to do when you are still fresh out of high school and in educational mode than when you are living on your own and solidly in bill-paying mode. If you don't take advantage of this timing, you will seriously kick yourself for decades to come down the line. And if you hit 21 years old with a paramedic degree already behind you, you will be in a position to take your pick of employers, not just take whatever you can get. Taking what you can get at 19 with nothing but an EMT card will result in a lot of job dissatisfaction and bad habits that will hurt you and probably result in an early departure from the field. Build a foundation first with serious education. During that time, you will have enough first hand exposure to other medics to know exactly what type of practice you want to choose, and you'll be ready to make that choice. And you'll be light years ahead of almost every other 21 year old in the field. Until then, don't even tax your mind thinking about it. Good luck!

:shock: Damn, Goose! Where you been? Plus 10 for another serious, Holy-Mother-of-Jesus-quality post! Can we count on you coming back in another three months with more words of wisdom, or can you stick around for awhile this time?

As I believe I said the previous time you ran this up the flagpole, I like it. I like everything about it. I think it is a reasonable, yet safe compromise between those who want a Bachelors Degree entry level and those who think things are just fine the way they are. I like the idea of doing what so many states have already done, and make our current EMT level of training the standard for all First Responders. In that context, it remains useful. As a member of an emergency ambulance crew, it is useless. I like allowing a limited entry into field practise before completion of a full paramedic degree curriculum. And I agree that their skillset (not to be confused with their education) would be similar to that of the current EMT-I. I would put this one stipulation on it: It would not be a stand-alone course. It would be a level only attained by completing more than half of a formal paramedic degree programme, including all prerequisite support courses, and passing a comprehensive examination at that point. Continued student status would be a requirement for continued eligibility. Dropping out of paramedic school would result in loss of practice privileges. It is not a licence or certification. It is just like a Junior or Senior nursing student being allowed to work as a "Nurse Tech" while finishing their final semesters. This MUST NOT become a stopping level for lazy people who think they are "good enough."

This would be ENTIRELY dependant upon exactly where you live and what options are available. Many places, you have no choice. Only one agency (or type of agency) runs the EMS in most areas. Whether it is private, hospital, or fire based, if you want to work EMS, that is who you work for. Or you move. If you want to tell us exactly where you are, maybe somebody here is familiar enough with your area to give you some insight. But there are no generalisations that we can give you that would be particularly helpful to you, other than that agencies that are focused solely on medical care (as in NOT a fire department) will generally produce a better service. One other generalisation... there is very little market for 19 year old EMTs in EMS. Most employers cannot employ them due to vehicular insurance regulations. Consequently, the choice will probably be made for you. The only job you're likely to get most places is on a non-emergency transfer ambulance that has nothing to do with EMS.

I'm confused by this scenario from the get-go. How is it an "EMT team" if it is staffed by a Medic and an Intermediate? Was there also an EMT involved in this team? And by "squad," what exactly do you mean? Your answer to the previous question did nothing to clear this up. Was the obstruction/occlusion cleared up by the head tilt-chin lift manoeuvre? You mention a low tidal volume. Does this mean that the patient was breathing spontaneously? If so, did he really even need a BVM? Most unconscious people breathe shallowly. It's not a problem. If it was really uber shallow and uber slow respirations, then he might benefit from assisted ventilations, but not everybody needs a blow every five seconds like in CPR. As for the 30 second thing, time has a tendency to slow down and drag when you are a n00b in emergency situations. What seems like ten minutes may be only one minute. And somehow I seriously doubt you were sitting there watching your second hand tick away for thirty seconds. At least, I hope not. And I don't know why you didn't take the initiative to do it yourself without having to be asked. Was there any question in your mind that the patient needed BVM ventilations? Would have you made that same call, or was this idea straight out of the head of your Medic without crossing your mind? If it crossed your mind, you probably should have been busting a move before he did. I'm getting the impression that this patient didn't really need it at all, and the medic knew it, therefore not really putting a big effort into it. I'm betting you were one of those unfortunate victims of a lame EMT instructor who filled your head with idiotic BS stories about how "EMTs save paramedics," and how you are an invaluable member of the EMS team because you are such an expert at all the BLS skills that your paramedic will forget all about. That's what it sounds like. If so, forget those stories. Whoever told them was full of it. There is a good chance that this medic knew exactly what he was doing, and how frequently he was ventilating. And no, an EMT student is not expected to know the difference. That’s why you do NOT start trying to correct a paramedic on a scene when you are there as a student. In fact, 99.9 percent of the time, you shouldn’t be doing it as a working EMT either. If you think something is wrong, fix it yourself, don’t verbally correct somebody on a scene. The EMT-I can suck a big one. You're not there to be his bitch. You're there to get practise at the medical skills you are learning. And if he wanted your help, he should have asked for it. He'd piss and moan if his medic jumped him for not doing something he never asked him to do.

Be open to the idea that you may end up doing that anyhow. Those bridges just aren't that common, and with your own experience with the low grad rate from your I class, you can see one of the reasons why. Better to get into a full course and immediately be on your way to completion with a full education, than to spend months looking for a quickie bridge course and get nowhere. And trust me, you aren't so awesome educated and experienced that you couldn't use a review of all that stuff you already took. You'll be glad if you do. Good luck, and don't be a stranger!

Whew... that's a relief! I was picturing a city full of fat, hypertensive, hyperlipidaemic, diabetic, chain-smoking, sixty year old firemonkeys with COPD and angina creating a burden on the EMS system. And an amusing picture it is!

Welcome to the Dallas Fire Department! Minus the IV and EKG, of course. :roll: One extremely important thing for you to recognise here. This has nothing to do with "old school ways." I was in EMS ten years before the guys you are talking about, and I can assure you that "O2, IV and EKG" were not the state of the art 25 years ago. In 1982, we were still sitting on trauma scenes and shooting the wad with mast pants and bilateral 14 gauges and working chemical codes on traumatic full arrests. They only thing you're doing now that we weren't doing in 1982 is pacing and RSI. Other than that, don't think that EMS has done any major progression in the last 25 years, because you would be very wrong. These guys aren't old skool. They're just lazy, burned out arseholes who should have been moved out to pasture years ago. I've seen it happen to people in two years, so 25 doesn't surprise me at all.

Firedoc, you and Mr. Anderson have totally missed the point of this discussion. This isn't a matter of a crew whining about having to take a run they don't want to make. This is a broader operational discussion of system-wide significance. Just because you don't have the motivation or education necessary to supervise or manage a system does not prohibit the rest of us from discussing the broader issues in EMS, such as resource management. Sit back with your head in the sand of blissful ignorance if you like, but the intellectuals here will continue to talk EMS as a whole and our future, and not just the last cool run we made. Reading comprehension goes a long way here, folks. Brent didn't ask if those people needed an ambulance. He asked if they really needed EMS. I know this may come as a shock to all you transfer monkeys out there, but you are not EMS. I don't care what EMT stands for, how shiny your badge is, or how red the lights on your ambulance are, you are not EMS. You are there to transport people who require assistance or a supine ride, but not EMS. The question is, should EMS systems also be running non-emergency, invalid transports that do not require medical attention? Should they be separate industries? Should states even be requiring that such transfer ambulances be staffed with EMS certified personnel and equipment? Shouldn't customers have a choice? If I have absolutely no acute medical condition that requires any medical attention or assessment, but just need somebody to carry my decrepit old arse home, shouldn't I have a whole yellow pages full of options, instead of just the couple of "ambulance" companies approved of by the local FD, or worse yet, the "Public Utility Model" EMS system that runs my area with an exclusive hold on the transfer business, and charges three times as much as Joe's Transfer Service would charge me? Pull you heads out and look past your little ambulance and look at the big picture here. This is a question that may very well determine the future of EMS in this country. Will EMS continue to identify itself with non-medical transfer services just for a few extra Medicare bucks, resulting in us forever being called horizontal taxi services? Or should we maybe decide to take our name literally and declare that EMS is exactly what it says: EMERGENCY MEDICAL SERVICE? Words mean something. To be strutting around with our patches under everybody's nose and declaring ourselves to be an essential, lifesaving emergency service, yet spending more than half of our time doing nothing more than giving people non-emergency, non-medical transportation is living a lie. It's time to get serious about our primary purpose and specialise in what we claim to do best. No, Mr. Anderson, you are wrong. This isn't about "helping people." That's the biggest lie in EMS. There are a million ways to help people in this world that we have to choose from. Unfortunately, most of them don't involve badges and sirens. If our field didn't involve badges and sirens, three quarters of the current EMTs would quit tomorrow. Do you think they would go searching for some new way to "help people?" Hell no. They'd take the first union job they could find that didn't require a lot of book learnin’. They darn sure wouldn't go to work running a transfer car for a career, with no hope of ever driving with lights and siren or calling themselves "public safety." I guess that doesn't "help people" enough. The other twenty-five percent that would stay here are those who are here because emergency medicine is just the coolest, most interesting and intellectually satisfying thing we can imagine to apply our talents to. Those are the people that ought to comprise one hundred percent of the EMS ranks in order to call ourselves a true profession. EMS runs non-emergency, non-medical transports for the exact same reason that they hire EMTs. Money. No other reason. And the retarded laws that regulate non-emergency ambulances currently allow us a bit of a monopoly. It doesn't have to stay that way. It shouldn't stay that way. It isn't that way in Canada or Mexico, and their people seem to get to the nursing home just fine. If we continue to do things the way we've always done them, we will continue to get the results we have always gotten. That means we will forever remain nothing more than "ambulance drivers," with all the [lack of] respect that comes with that. Good luck making a profession out of that.

I disagree. Anybody who thinks that 120 hours of first aid is all they need to "help people" isn't in it to help people. They're in it for themselves, as most all volunteers are. Anybody who is truly in it to help people will do whatever it takes in order to be prepared to give people the best help available, not just the minimum they can get by with by law. Simply put, if you have not committed yourself to a full paramedic education, then you aren't serious enough about helping people for me, and I don't want you on my ambulance. And a shitty system it is.

I don't think it was missed. It just wasn't found to be relevant.

Yes. RM is pretty widely understood to be Rural Metro nationwide, just as AMR is understood to be American Medical Response. Since Romee had already mentioned Rural Metro at least three times -- and since I was specifically talking to him -- I didn't think the abbreviation was a big deal. When we talk about ALS, we generally mean paramedic level care. That is, the administration of fluids, drugs, cardiac rhythm interpretation and care, invasive airway procedures, etc... BLS refers to EMT level care. Although, these are only generalised definitions. The lines are blurry these days with a lot of EMTs operating way over their heads. It is important to note that ALS and BLS refer to the level of care being provided. They do NOT refer to the level of the provider providing them. ALS being provided by an EMT is still ALS. Pharmacological therapy does not become BLS just because it is an EMT providing it. This is relevant because in areas such as L.A., they put a very bold line between the two, with the firemonkeys exerting total domain over ALS in a sort-of "Me Tarzan, you Jane" kind of power play, relegating all other EMS providers -- even paramedics with more than twice the education of the firemonkeys -- to the role of ambulance driver. The firemonkeys ride in on their red stallions and save the day with their heroism and extensive 4 month medical education, then shove the patient off into the private ambulance to take care of the mundane tasks of patient care and transportation. Of all possible EMS system combinations, this one makes the least possible sense on any level, which is why it really hasn't spread much outside of California. What I was asking Romee is if that is how SD operates, or if RM actually runs the EMS system entirely, without having to split the pie with the firemonkeys and take the dregs.

Thanks, but again, how have things changed since 1994? Or have they? What are the current educational standards for the different levels, and how easy is it to find a place to get them?

Wait... is firemen abusing 911 really a significant problem in your area? :shock:

I'm sure this is a no brainer, but I'd like to know how South African EMS has changed since 1994. I'm guessing it was a pretty good system before then, considering the advanced educational standards that still exist.

Damn fine point, if I understood you correctly. We can never, ourselves, stop being students. We can never close our minds to new voices and new ideas. Ideally and hopefully, our students are coming from an environment where they are freshly absorbing the latest in theoretical and scientific knowledge. They should be receiving cutting edge information and ideas. Not to mention, they are freshly carrying many of the things we somehow forgot about along the way. It is important to both of us to engage them in intelligent discussion, not just lecture them about how we do things. I am never afraid to learn something from anybody, even those many years my professional junior.

Yeah, all except for this stinker: There is not a single thing right in that paragraph. While I accept that it might make some sense from an Australian perspective, from an American perspective, everything in that paragraph is just dead wrong. There is not a single government agency in this country that is a model of efficiency and professonalism. The federal government has farked up every piece of healthcare that they have touched, including EMS. The government is the medical insurer (Medicare, Medicaid, Medical, etc...) that fails to pay upwards of eighty percent of the ambulance bills it receives. It's not time for them to take over. It's time for them to get the hell out. As for "for profit" private providers, they are the best of the best in American healthcare. In fact, they are the best of the best of Europaean healthcare too. Nobody in this country looks forward to being a patient in a government run healthcare facility. Anybody who can afford to do so chooses a private hospital. That's where the best care is available. Most any aspiring physician would rather get accepted to Harvard, Yale, Johns Hopkins, Duke, Stanford, Case Western, Vanderbilt, Loma Linda, Cornell, Washington, or Boston University (all private medical colleges) than the State University of Southern North Dakota - Bumfuck Campus (a government run college). My mother's health insurance (and other benefits) from her private industry job beat the hell out of the health insurance and benefits my step-dad gets from 30 years at his government job. The most clinically sophisticated EMS systems I have seen in the United States were mostly either private or hospital based. Things may be a lot different in your society, but there is nothing positive to come from government control of EMS in the U.S. Simply put, our government sucks at running anything but their mouths. They damn sure aren't the people who ought to be setting statewide protocols that would lower us all to the level of the lowest common denominator, resulting in every system turning into another Detroit or D.C. FD EMS, with nobody having any ability or motivation to excel. If firemonkey EMS is your golden standard, then you'll love the EMS set up by the government. ^ Quite possibly the most ignorant statement ever made at EMT City.

I think it is relevant to point out that there is indeed a special dynamic at work in the relationship betwen a medic and a new grad, and that it doesn't necessarily equate with that of two experienced medics working together. That's a good point to note in the context of this discussion. Because obviously, new medics should not be working with a basic. Yet, the relationship between a new medic and his senior partner is not typical of the dual medic relationship in general.

Good point. The reason gyms are usually a waste of money is simply because people don't stick with it. If you can't get into it as a habit, then yeah... you're going to waste your money. Beware of the long contract hard-sell. "If you sign up for a full year, you'll save 25 percent!" Yeah, that's a good deal if you keep going there after the first month. That can be a powerful incentive to keep working out, for sure, so it's worth considering. But before you sign up for any gym, take an honest appraisal of your commitment and discipline, or you're going to toss a good chunk of money down the drain. And, as spenac indicated, if there is a physical activity that can hold your interest and commitment long term, that is a good way to go. An intelligent gym plan will always be ideal for overall development and conditioning. But it's better to take what benefits you can get from swimming or kickboxing on a regular basis than the big fat zero you get from never going to the gym you paid a years membership to. Yeah, this is an individual thing. I find a workout partner works very well for me. Having somebody to chat with keeps me distracted from clock watching, and the time passes a lot faster, making it easier to stay longer. Of course, your partner has to be at least as devoted as you are, or s/he's going to drag you down and be wanting you to leave before you're finished. Then the interpersonal relationship suffers, which is not good for your workout or for your friendship. On the other hand, if you go regularly, you will likely find friends at the gym with similar interests and schedules that you can share your workout time with. I've had good luck with this. Having friends waiting for you at the gym becomes a good motivator for you to get up and go. Some people are more solitary creatures though. If you find that you can just stuff the iPod buds in your ears and float off into a zone that allows you to achieve the needed focus and intensity to maximise your workout, then that's cool too. Whatever motivates you is good. Try different things and stick with whatever feels most comfortable to you. Chaser is right. Technique is extremely important. It's all part of working smart instead of working hard. That's why I suggest a trainer, at least in the beginning. Just imitating what everybody else is doing is not a smart way to go. Even if the person you are imitating looks to be in good shape, you can still pick up some very counterproductive habits from them. Physical education is a science. Use that science in your favour and you will see much better results than you will through random experimentation. And let's face it, if you don't see results quickly, you will likely give up early. Don't sabotage yourself from the beginning by going off half-cocked, without a plan.