Dustdevil

And that is the problem. They're trying to learn and memorise some basic arrhythmias when what they should be doing is learning EKGs from the foundation up. UNDERSTANDING EKGs is MUCH easier (and smarter) than trying to learn to recognise some squiggly lines by memorising random rules and features. Again, the Dubin book is the ONLY answer. Every other thing you try will just complicate things for you, and leave you still needing to learn a lot more later when you move to 12 leads.

The SEARCH FUNCTION is your friend. This gets asked here at least once a week. Trust me, you're not alone, lol. There is ONLY one answer: go get Dale Dubin's "Rapid Interpretation of EKGs" book today. Spend the next several days working through it (it is a programmed learning book, not a dry textbook) from cover to cover. Then go back to class and blow everybody else away. Guaranteed. Any school that doesn't have you do that before the EKG segment even begins sucks! Good luck!

Why not both? It's important to put the material into perspective, especially for a student who has yet to experience anything else. Seriously, wouldn't you want to have all available information about this process before you started? If somebody had been up front and candid with some of these people ahead of time, they might have been better prepared. And they might not be here today telling us they failed. I fail to see how your kinder, gentler, less candid, blowing smoke up the arse is of any benefit to those who wish to succeed. Again, what are you doing to help prospective new EMTs? If you're not part of the solution, you're part of the problem. Wendy, comparing undergraduate biology to a silly EMT-B course is asinine. They aren't on anywhere near the same level, yet they are both aimed at the same level of student. But in both cases, if you bomb it, either you didn't put the effort into it that you should have (the majority), or else it just isn't your thing. Or else, yes, you might be an idiot too. But the major point I originally made was that most people fail EMT-B for the same reason most people fail college classes: because they didn't give it sufficient effort. And if you aren't interested enough in EMS to give it 110 percent, then you don't need to be here.

You kind of have to decide what you are going to use this notepad for. Are you going to write everything except your narrative on there, as Fiznat has done? Just VS and key points that stand out to you? Are you going to use it as a poor man's field guide to remind you of quetions to ask the patient? Most people, I would venture, who write anything down on note pads/gloves/tape, only write down those few things you need handy for phoning in your report to the E.R. All those PQRST, DCAPBTLS, ABCDE, etc... things you should be committing to memory, because that's where they are most important, not on paper. I see too many n00bs get all caught up in asking questions, writing down the answers, but never actually processing that information in their brains. They ask all the right questions, but they're just going through the motions. That is the key to functioning competently as a paramedic. If you are actually listening to and analysing the answers your patient gives you, you won't have any trouble remembering it for the PCR. And speaking of PCRs, this is one thing that sucks about electronic run reports. Paperless my arse! You are STILL writing everything down! The only difference is now you have to write it down AND type it instead of just writing it down once and being done with it. We hardly had to use note pads at all back in the paper PCR days. All the demographic info, VS, meds and allergies, etc... was being jotted down directly onto the PCR as the patient provided it. Everything else, you just remember. The only things we had to write down on a pad or our glove or knee was repeat VS and event times. Anyhow, there really is no real set-in-stone format for these things. You are right on to make up your own in a way that suits your needs. And your needs will change rapidly as you gain experience. You'd be amazed at how little most really experienced medics write down on a scene. I could just about get all the way to the hospital without even needing a pen on most patients.

Uhhh... you might want to improve your reading comprehension skills too. How, by encouraging prospective EMTs to buckle down and give a serious 110 percent to their studies, are we discouraging them? The only thing we are discouraging is failure, and they should thank us for it. What have you done for any up and coming basics lately? Minus 30 for saying anything about anybody's mother, tosser. :roll:

Seriously. You could fight a structure fire with the flow rates we see through IOs out here. Where are you plugging these things, the phalanges?

That's a flaw in your system, and it should be dealt with by your system management. Perhaps it is your dispatchers who you should take your "tough love" to. If your system is dispatching you to these patients, then it is your job to take care of the patient. Period. Whether or not they should be dispatching you to these runs is certainly a fair point of discussion. But as long as they are, it's not your place to lecture those patients about how your system sucks. A lot of administrators would boot you out the door in a heartbeat for that kind of thing, so I'd be very careful about who you brag to about this.

That would be the considerate thing to do, since that's what he asked for. Isn't that what I did in the four paragraphs prior to your first post?

Okay, so like I stumbled across this discussion at another forum that contains this quote: I'm curious what you guys think about "futurechief1's" theory that once an instructor leaves the field, he is no longer qualified to impart relevant wisdom to the students. Any validity to this? If so, what do we do about it? Is this even what a classroom instructor (at the paramedic level) should be doing, or is this something that is more the realm of clinical/internship coordinators and preceptors?

Wonderful, but I believe he already has the 'what to write on' part covered. He's asking us what do you write on those pages?

Whatever you do, don't invest much in it, because you won't use it for very long at all. It's kind of like those drug cards that you can't live without. After 6 weeks or less in the field, you'll realise you don't need them and just start writing on tape on your leg like the rest of us. One of the cooler ideas I ever saw was a guy who had a rubber stamp the size of a pocket notepad made up with little prompters engraved on it. Then he just got those spiral pocket notepads from the dime store and stamped each page. Voila! You have an entire book of cheat sheets printed to your exact specifications! Whatever you put on there is up to you. I guess if you are a total scatterbrain, you could put all the little acronyms like AEIOUTIPS, DCAPBTLS, ABCDE, PQRST, etc... on there. Maybe just a simple CC, Hx, Exam, VS or SOAP layout. Seems a lot of people want lables for each individual vital sign, but that seems kind of silly to me. I mean really... does anybody have trouble remembering to take those? And does anybody have trouble telling the BP from the pulse or respiratory rate if they're not labelled? And a problem with pre-printed VS charts is that most patients only get one set of vital signs. If you leave room for multiple sets, you waste a lot of space. If you only have room for one set, then your complicated patients' notes get all jumbled and unreadable. There is no one-size fits all These pads can be good for noting treatments/drugs administered and the times they were given, like on a code board in the ER. But again, most pros either just write it on their taped leg, or on the time-stamped EKG strip. Those are less likely lost than a scrap of paper.

I dunno... by the time those kits get to the scene, those people have already bled to death. But, of course, if somebody has been holding manual pressure up to that point, then yes, it's nice to finally have some TKs to slap on before transport. LOL! That's classic!

Geeze, dude! Please stand up and go to the head of the class! You just made it a lot harder to give you any advice. :? I'll begin by saying that I wish everybody entering EMS had what you have to offer in education, maturity, goals, and attitude. You are the kind of person that can help us change the future for the better of the profession. Although, again, Kalifornia is a very, very long way from ever seeing the future, EMS wise. I would love to see you take the professional EMS route. Get into a good, long, solid, comprehensive EMT-B programme and milk it for every bit of foundational training you can. Then move straight on to a paramedic programme, with quality being the primary focus. With a biological BS behind you, your foundation is set, so calendar length of the programme -- or even degree status -- are really not important factors. It is damn rare that I would endorse an accelerated (not shorter, just faster) programme for a n00b, but it is something I would recommend that you consider. The good thing is, many of them don't have the same EMT-B experience requirements that the community college programmes do, so you can move up faster. I won't rehash the whole argument about needing years of EMT-B experience before going to medic school, because that silly theory has been pretty thoroughly trashed here so many times before. If you can work that, I'd do it. After that, then it is job time. Of course, you can get some EMT-B work with AMR or somebody while you attend paramedic school, and that would be beneficial for you on several levels. Not only will you get a lot of valuable exposure to reinforce concepts you are learning, but you will also get a look at the non-fire end of things in Kalifornia. It'll give you a chance to see if it holds any career potential for you or not. Believe it or not, some people do make it work well for them. And somebody with your qualities certainly has the potential to move into supervision and education without undue delay. I have friends in private EMS who actually do quite well, so the potential is there. Just not for the guys who don't have what it takes to move up from the bottom of the scrotum pole. Quite honestly though -- as much as I would love to -- I don't see you staying there in Kalifornia private EMS, or even in EMS education, unless it is as a side-job to the FD. I think your future -- with the satisfaction, rewards, and security you want and deserve -- lies either in the fire service end of EMS, or moving forward into a PA programme to practise some real medicine. Unless you have some serious medical problems or other skeletons in your closet, you'll be on with an FD in short order. Again, your chances will be much better -- and your medical education and competence also better -- if you get that schooling out of the way first, so definitely get on that right away if you can afford it. But even without it, you're the kind of guy they are looking for. If medicine is your bag, then I would certainly do serious research into the types of EMS programmes each department runs and choose some priorities accordingly. I'd steer clear of places like L.A. County and other departments that run the "squad" concept, because it seriously cuts down on your patient contact and hurts your overall medical competence in the long run. You end up being the king of gunshot wounds and CPR, but not knowing the difference between appendicitis and kidney stones because you never see any medical patients. Those guys are one-trick-ponies with very limited competencies. You're cut out for greater things. Unless you get in a nice, posh little suburban department, burn-out becomes a factor quickly in SoCal. You won't be on EMS duty for more than two years before you want to move to the ladder truck, where you can do less, and have more fun doing the few jobs you do get. I hate to see that, but it is the rule in fire based EMS, not the exception. With your educational background, and a few years working as a paramedic, there is no doubt in my mind that you would be a shoe-in for a PA programme somewhere soon. From what you tell me, that may well be more suitable to your interests and goals. It's a career, and a darn well paying one, but with a professional focus on medicine. Yes, firefighting is a career, but certainly not a profession. It's just a life-long job you can retire from. I'd hate to see a guy like you wasting away on the union roster just for a retirement cheque, when you have so much to offer our profession. Whatever you do, I hope it meets your expectations, and I hope it contributes to our future. Good luck, Bro. Let us know!

Cool. Sounds weird to me, because I thought all of the UK had some pretty good educational standards out there. If they're putting the equivalent of an American EMT on the streets, that's a bit disappointing to hear. I'd still like to know how you take it to the next level once you are working in Ireland. Aren't the same schools likely to try and shaft you when you try to further your education? I'd be worried that they'd hold it against you that you came to the US for sub-standard training just to circumvent their system. Anyhow, I hope you will stick around and get back to us here as things progress. Maybe bookmark this topic and update it as it happens for you. I am sure that there are people here that are interested in seeing if this really works. I know I am. And let us know if you head to Kalifornia. I and others can try and catch up with you for a beer.

All valid points. But it is really unflattering that you do not seem to understand that this has zero to do with the topic at hand. That's what makes you look silly.

I don't quite follow. Obviously, EMT in the states is quicker than anywhere else simply because it sucks. If you want to suck as an EMT, then please feel free to come spend some more of your money in the U.S. We'll be happy to have you. But what has your hearing got to do with it? It seems like you are saying that they either aren't allowing you to attend school in Ireland, or else they are not allowing you to be licensed there. What exactly are you saying? Either way, BEorP makes a good point when he recommends that you check OFFICIALLY with the licensing and regulatory bodies in your homeland to make SURE that a three week first aid course in Kalifornia is going to get you licensed as an "EMT" in Ireland. You'd have to be positively mad to do go off half arsed and do this because you know a guy, who once knew a guy who had a cousin whose cousin's brother-in-law once claimed that he quickly and easily pulled this off. I'm no expert on Irish EMS, but I have a few extra bucks to put on the line saying it's BS. If all this is simply because you want the fast-track to glory without having to go through all the serious education that UK medics go through, then don't expect a lot of support here. We don't need any more poorly educated medics in the world, even if they are only killing people in Ireland. And trust me, there is nothing easy about an accelerated course. But at least if you've had it all before, you'll be a leg up. That said, there is an EMT school on every street corner in Kalifornia. Especially in the south. The accelerated, one month schools aren't terribly hard to find, but damn, they're expensive! Some of them are so expensive that you could almost afford to live in Kalifornia for a semester long college EMT course (which is much cheaper) and still not spend any more money. Here's a website where you can find a list of links to some EMT courses in Kalifornia: http://www.emsa.ca.gov/Links/ed&trng.asp Here's a few of the accelerated courses in the Southern Kalifornia area: http://www.cpc.mednet.ucla.edu/SRRS/Programs/ProgramDetailUser.aspx (L.A.) http://www.schoolofemt.com/web/classes/EMT1.htm (Long Beach) https://ncti-national.securegw.com/cgi-bin/...nfo.cgi?info=38 Riverside (South of L.A.) That should give you an idea of what is out there. I would still do a full Google search of EMT schools in Kalifornia before I sent any money anywhere though. Once you do this, then what? You, of course, realise that EMT is nothing but a quickie advanced first aid course that adds up to little more than "ambulance driver" in the EMS world, right? If you're having problems getting basic training in Ireland, are you going to have any better luck with Paramedic level training there? Are you going to be stuck at the bottom of the scrotum pole forever? Or are you going to be stuck spending thousands of dollars and several months on an accelerated paramedic course in the States in a couple of years? How many years would you have to work as an EMT to even break even on this deal? Does your family own an airline or something? I admire you for seeking options, Bro. That's what life is all about. But do some serious research to make SURE this is going to work for you to begin with, and that you will have the ability to take it to the next level in the future. Otherwise, I'd hate to see you blow all this time and money for nothing. Good luck!

Plus 10 for the quote of the day. :thumbright: You have to admit, you kind of stepped in that one, Riblet. This topic was about self-destructive patients. Going off on a tangent about invalids and the elderly in the same discussion wasn't really a good way to show anybody that you are cut out for the job. Ladyemt just gave you what this topic is all about: Tough love. You'd be wise to heed it.

Do one thing and do it well. To train a team up to minimum competency, and then to maintain that competency, is a major investment of time and money. If you are in an area that actually needs these services regularly, chances are that public safety is already handling this function. If so, stay off of their turf. It just creates friction we don't need. Most stand-alone EMS agencies won't undertake the liability that comes along with such an operation. I don't blame them. Especially when there are other agencies that are specifically tasked by law and tradition to do it. All that time and money I originally mentioned is time and money taken away from continuing medical education. There is no excuse for that. Again, do one thing and do it well. Or go be a firemonkey.

With a clearer picture now (although I would not claim to have an absolute understanding), I would suggest that your subject title is a little misleading. Training won't fix this problem. The problems are too complex. Again, supervision and management are at the very root of the problem, yet I doubt any of them are going to any additional "training" or education. They think they already know it all. But that seems like it may be the problem with a lot of these hastily hired medics too. No amount of training or experience will ever compensate for a lack of quality, foundational education. Sounds to me like you are getting guys who are ill prepared for practice, and sealing their fate by tossing them into a system that is ill prepared to nurture them into competency. What will a bunch of one-hour con-ed classes, merit badge classes, and M&Ms do for people who don't even have the basics to build upon? Even the best "training" programme will do little to fix that. Now, I could have a mistaken idea of what is going on here. It could be that, in the haste to throw together a crew, you've ended up with a lot of people from different backgrounds who just need some focused direction in order to all get onto the same page and function smoothly. Could also be some well educated people who simply have not yet had the experience to put it all together yet into a competent practice. If that is the case, then yes, training is a must. But this would take a lot more careful planning and administration than was given to the hiring process you described! They're going to have to carefully select some training preceptors with proven medical and communicative abilities who they can assign to the task of bringing the n00bs up to speed. And those guys will have to be working under a proven and structured programme of education and evaluation, not just riding with them til they *think* they *seem* okay. Of course, this will cost the agency a good bit of money. Three men on a truck is expensive. And, like you said, they're probably not even going to consider that, so you're back where you started. Again, I feel your pain. We've all seen this happen, I think. And it sucks when it is your hometown, where you hoped to make a future. But things run in cycles. Hopefully, the problems are being noticed by the powers that be, and not swept under the rug. If it gets bad enough, the MD says, "Forget it. I'm not putting my name on this anymore." Or, if enough bad press results, the city council steps in. I mean, I hate to see you take a personal hit on this deal when the company loses their piece of the pie, but it may come to that. But, if you're as professional as you come across, then I have faith that you'll land on your feet and looking good through it all. And dude, I hate to rag on you, because really, your composition is actually quite good and a refreshing read here. And you're the one who brought it up in the first place. But come on... the SPELLCHECK button is RIGHT THERE IN FRONT OF YOUR FACE! You can't miss it, unless you're just lazy. Attention to detail and a give-a-shit attitude are the two things that make a difference between a paramedic and a professional paramedic. Show us which one you are.

That's about the size of it. Almost all of California is still stuck in the 1970s, EMS wise. Some rare exceptions have actually progressed into the early 1980s. Either way, it sucks to anybody who knows better. There are two paths available to you in SoCal. There is the firemonkey path you laid out, and there is the non-fire EMS path that Anthony explained. It will vary everywhere you go. There are no real professionally related positives to fire based EMS. However, especially in SoCal, there are definitely some personal positives to it. The primary positive is that the job is more secure and better paid. After that, it's all downhill. Non-fire EMS in SoCal doesn't really have much more potential than fire-based EMS because of the way systems are set up in California. But at least those working private EMS are mostly there because they actually want to be paramedics, and it is their primary interest. That is a real positive thing for a system, over a system full of people who really care nothing about the medical profession, and were just looking for a civil service job they could retire from, regardless of what it was. Although the plan you laid out in your original post is relatively accurate from a flow-chart perspective, I wouldn't want you to get the idea that all one must do is follow those steps and be guaranteed to ever reach the goal. It doesn't work that way. It is extremely competetive, with thousands of people applying for the same job you are after. Most of them are the civil-service slugs I mentioned above who could care less about being a paramedic. Paramedic certification does give you a bit of an edge with most of those departments. Paramedic EDUCATION (like a 2 or 4 year degree) gives you a much bigger edge. As does being in excellent physical condition, being well spoken and literate in interviews, and having intelligence and common sense when you take civil service exams. If you lack any of those, then you will flounder at the bottom of the eligibility lists with the rest of the losers. Most of those losers never get hired, even after years of applying with every department from Anaheim to Tijuana. If you are determined to stay in California, definitely don't put all your eggs in one basket. I would recommend that you take an honest assessment of two things. First, what are your personal characteristics? Are you smart? How well did you do in high school? Why, or why not? Do you have an exceptional scientific aptitude? Do topics like biochemistry, physiology, and microbiology worry you? Are you in excellent physical condition? Why, or why not? Those are the characteristics that -- IF you ever get hired -- lead to success as a Paramedic and/or firefighter. Second, what do you really want to be, a Paramedic or a firemonkey? Which one, and why? Or do you just want to do anything for a thrill, because they both look fun? What is more important to you, practising medicine, being a hero, or just having a steady, secure job that you can be assured of retiring from someday? Are you looking for the sure-deal career position, or is medicine your primary focus, regardless of the career rewards? What I am trying to say is, even though California has this weird thing about turning firemonkeys into Paramedics, they are two very, very different careers. And the future of EMS is moving away from the fire service, although So Cal is the very last place the future will ever come to, lol. If what you really want is to be a fireman, but being a medic kinda looks fun too, then concentrate on getting into the fire service. As long as you have all of the above qualities and don't mind moving, you'll get hired somewhere eventually. And whoever hires you may even send you to paramedic school without you having to shell out the big bucks to do it yourself. Then you'll be a medic for a few years and realise that you have to work a lot harder than the rest of the firemen making the same money as you, and you'll get off of the rescue wagon and move to a nice ladder truck where you can do nothing all day. After thirty years, you'll retire to a cabin on Lake Arrowhead. On the other hand, if medicine is your primary interest, and the fire service is just a means to that end, then what Anthony talked about (or better yet, what paramedicmike said -- leave California) is more applicable to you. Put 110% effort into becoming the very best educated Paramedic you can be. Find a professional opportunity to practise paramedicine in an atmosphere where it is your ONLY function. Someplace where you were hired to be a paramedic, not where they just make you be a paramedic as a side duty to earn your salary. Someplace where your promotion comes based upon being a Paramedic, not your knowledge of hydraulics and friction loss. If you stay in SoCal, then you will be seriously underpaid, your professional practice will be seriously limited (whether you are fire or not), and your education will be seriously underutilised. And, worst of all, you will always be a second-class citizen to the firemonkeys who think they are better than you because their paycheque comes from the city. But you'll be pursuing your primary interest, which is something that way too many people in this world cannot say. You'll have a steady job, even if not well paying. And you will be in a position to contribute to the growth of our profession, which we all hope will become a TRUE medical profession, no longer attached to the fire service, before you are ever ready to retire. After letting us know what you really want, we can advise you better on how to do that. But yeah... the best plan is still to get out of California. :wink:

We have no rules or protocols. We just rely on education, experience, common sense, and a knowledge of the current literature and practices. We just do it. If direct pressure does not immediately take care of it, or if you are too busy shooting back to apply direct pressure, we go straight to a tourniquet. Pressure points can work well. And we will sometimes use them in the ER/OR for temporary control. But your hand/fingers get tired pretty quickly, so it's used pretty sparingly as a transitional measure. Everything you heard in PHTLS is current, sound practice. However, in civilian practice, I've never even used a tourniquet, and it's pretty damn rare that you would. Serious arterial bleeding I have encountered in civilian EMS was either easily controlled by direct pressure or pressure points, or else it was in the groin or neck, where a tourniquet would not be practical anyhow. Or else they were already dead. Unless it is a disaster or mass casualty situation, you will almost always have an extra pair of hands to hold that pressure in the civilian world. Consequently, the actual need to ever go to a tourniquet is pretty slim.

This message... You were denied access because: Access denied by access control list. :roll: Besides, I already found me a wife. I don't need the chatroom anymore.

I think it needs to be said; why did you call medics instead of just transporting her ASAP? Yeah, I think that's what my dad did for my dog when he got old. My dad says he took him to a good family out in the "country," where they would love him and had lots of other dogs that he could play with.

LOL! That's news to me too! The EMT City chatroom has radically improved my love life, but I can't say I've learned anything about EMS there.

Correction. There is no absolute contraindication to hi-con O[sub:b38e3f8bb1]2[/sub:b38e3f8bb1] in the field. Thanks for the quote of your protocols, but what we are trying to intelligently discuss here is scientific rationale. Can you tell us what yours is?