Dustdevil

I have never, ever in my career, heard an RN of ANY education or experience level mouthing off about how they could/should work EMS without some extra education and training in pre-hospital care. Never heard one trying to find a way to get around the additional requirements. All that I know of went at least to EMT-B school at a minimum, and many of them went to full paramedic schools rather than challenging the exam. You simply don't see this "I don't need all that book learnin'" mentality in nursing. On the other hand, almost every paramedic I have ever heard mouthing off about being able to work in the hospital was contending that they were adequately prepared to do so with no more educational preparation. Damn few of them ever actually make it to nursing school. Most try to find some "accelerated" or "bridge" programme, or more likely, an online programme. And the majority never even finish the prerequisites, much less nursing school. They just spend the rest of their careers talking about how much better they are than nurses. They're only fooling themselves. And, of course, the latter outnumber the former by about 1000 to 1.

I would disagree with that. They know exactly what you are capable of. And, more importantly, they know what you are not capable of. That is why you are not used any more than you are. You're not an untapped resource. It sounds to me like you are being used for exactly what you are good for: performing mundane skills-based tasks so that licensed professionals can be freed to focus on more important things.

Just FYI, there are only two Nationally Accredited paramedic schools in Illinois. Loyola University Medical Center - Maywood, IL Website: www.lumc.edu Emergency Medical Technician-Paramedic Program 2160 South First Avenue Building. 110LL, Room 0221 Maywood , IL - 60153 Degrees: Certificate Concentrations: Paramedic Program Director: Lauri Beechler RN BSN TNS Email: lbeechler@lumc.edu Phone: (708) 327-3547 Trinity College of Nursing & Health Sciences - Rock Island, IL Website: www.trinityqc.edu Emergency Medical Technician-Paramedic Program 2122-25 Avenue Rock Island , IL - 61201 Degrees: Certificate, Associate Concentrations: Paramedic Program Director: Karen Wilson MSN RN Only the Trinity programme offers a degree, which should be a major consideration for you when choosing. Unless neither of these two schools is even remotely close to you, I would probably limit my choices to them. Good luck!

I hate it when he does this. It makes me feel so damn inadequate. :? I just saw an interesting commercial on CNN. A Johnson & Johnson sponsored commercial promoting this website showed three different nurses portrayed in action. One of them was bagging an intubated patient in the back of a rolling ambulance. Another was kneeling beside a motorcycle accident victim on a highway. Only one of the three was in a hospital. I have to admit that I am far removed from nursing politics these days, so I don't know if there is some current initiative to push nursing into a bigger EMS role. Quite probably, the commercial was just sensationalising nursing to appeal to those people who would never consider the field because it is stereotyped as boring by most. Regardless, it is interesting. Be afraid!

I don't get it. If She can read your mind, and knows your thoughts, wishes, and intentions, then why is saying a prayer necessary? Without necessity, there is no point.

That is for sure. On my first attempt, I got failed on traction splinting for not using a partner to pull traction for me while applying a SAGER SPLINT. Yes, we all know -- including the examiner -- that you don't pull manual traction before applying a Sager Splint, but hey... it's on the checksheet, so you have to do it anyhow. Idiots. However, I have seen on multiple occasions that, even if you do go right down the NR line, you can still fail. The examiners are human with human fallability. They misunderstand things you say. They misinterpret things you say. They forget to tell you things they were supposed to tell you. They get distracted and overlook things you do. And some of them are just idiots. Even the best prepared candidates run a risk of failing the NR practical because the process simply is not objective enough. It should be trashed altogether.

And if God can hear silent prayers, can he not also read your mind? If so, is there really any point to prayer? If not, is she really God?

Having read and reread that post over and over, it still seems to me that you are agreeing with me, not disagreeing. :dontknow:

That's because he stuck a stupid teaser of a topic name on the thread, making it difficult to identify it in the thread list. Somebody didn't bother to read the directions. You're showing your ignorance and inexperience. Quite obviously you have never taken ACLS before, or you would know better. I've been taking ACLS for twenty-five years, and I can assure you that they do not "train" you to do any of that stuff. It's not a school. They review a bunch of stuff that you are supposed to already be adequately educated about PRIOR to attending, then they test your knowledge on the topics. That's it. Nothing more. Can just about any idiot pass it? Sure, nowadays. That's what a joke it has become. That's also why current ACLS isn't accepted by ANYBODY as a certification to practise. It is nothing more than a card saying that somebody on one day thought you were familiar enough with current protocols (not knowledge or skills) to know what order to give drugs and shocks in while treating the most common arrhythmias. That is why employers want you to have it; because it show's you are protocol current. It says nothing whatsoever about the quality or quantity of your education. Once you take the course, you'll hopefully realise this and divest yourself of your dilusions.

I would agree with that, with qualification. The NR is indeed a profit making commercial venture, just like a private ambulance service. But the NR is not about the certificate. The NR is about the test. Certification is not their product. Their tests are their products. They are in business to provide a validated, entry level examination process to states and other regulatory subdivisions that standardises with the rest of the nation. They do that reasonably well. Unfortunately, since a lot of states -- particularly in the Northeast -- march to a different drummer, and want to do things their own crappy bureaucratic way, a portion of the nation is left believing that NR is something it is not. If you are in a state that doesn't require NR, there are basically three reasons why you should take NR: 1. Your employer requires it. 2. You want to relocate to another state. 3. You want to challenge yourself and your knowledge to see if you are as good as you think you are, in comparison to the national standard. Otherwise, it is understandable why somebody wouldn't give it much thought. I'm all for the concept of the NR, and think they do a reasonably decent job of it. But I think they need to chlorinate their gene pool and update their operation to the 20th century. Even with the Computer Based Testing thing, their questions and foci are pretty stale, confusing, and in many cases pointless. It seems that all the same "usual suspects" are always involved in the question validation process, and it shows. Time for some fresh blood and a progressive outlook.

You need to clarify exactly what you are talking about by "nationally accredited." Do you mean National Accreditation as a paramedic school? Or are you referring to the REGIONAL accreditation that grants an college or university the authority to confer nationally recognised educational degrees? They are two separate and very different entities and processes. You can be a Nationally Accredited paramedic school without being a degree conferring college or university. And you can be a degree conferring paramedic school without being Nationally Accredited. I think you may be confusing or interchanging the terms. Suffice it to say that there are some non-degree programmes that provide an education that is vastly superiour to that provided by many degree granting colleges. If that were the case in your area, then I believe it is totally reasonable to choose the superior education over the sheepskin. Not the optimal way to go, but certainly the best choice given the circumstances. And you should note that most degree programmes will give you credit for a tech-school medic education when you go there to finish up a degree, so in most cases you have not attended for no credit. What's to lament? You want it? Go take the test. There is one given somewhere in this country almost every day of the week. Take a couple days off. make the drive, and take the test. How hard is that? Don't pass? Study like Ruff did, and go do it again. If you bomb it the second time, it's not the test. It's you. The NR is not some gold standard mark of higher achievement. Those with NR are no better than those without. It's simply an ENTRY LEVEL test of your ENTRY LEVEL knowledge. Anybody who cannot pass the NR written after a couple of years of practice should seriously consider retaking their initial course. I would agree with Ruff though, that the NR skills exam is more about playing their game than actually knowing what you are doing. As for your question, I can understand why somebody wouldn't go for NR if it wasn't required in their state. Hell, why would you pay for a licence in Alaska if you live in Kentucky? Same thing. Other than to pay money for the privilege of challenging yourself and your knowledge (not an unreasonable thing to do), what is to be gained? Better employers will require NR certification even if it isn't a requirement for their state simply because it does challenge their applicants to a standardised level of knowledge that they can objectively rely upon. But how many people actually move out of their state to take an EMS job? Damn few. It's not like EMS is one of those professions where you earn a degree and then market yourself to the world at large, then move off to earn six figures in another state. Most people join EMS because they want to work in their immediate community. So really, I can totally understand why those who are not required to have NR cert would not invest the time and money necessary to take a test just for the challenge of it.

I would have to agree with Bushy. The system itself is at fault when the majority of those inhabiting the system are idiots. You can't blame the idiots themselves for taking an opening in the system when they see it. After all, the system asks no more of them than they have or can give, so why shouldn't they? The establishment of reasonably professional minimum entry level standards would quickly bring the number of such idiots in the field down to a statistical anomaly instead of the norm. I am all for personal responsibilty. Yes, individuals should be striving to be the best they can be, regardless of minimum standards. But the fact is that the EMS system itself is the problem in the US.

$5k just for a one-day merit badge course that can be had for around $50 bucks? The fact that an EMT-I can pass the thing is testament to just how pointless and useless ACLS has become. And, of course, you having the card gives the company (and you) absoluely nothing extra to bring to the table. I'd be more inclined to pay my employees extra for a BS in underwater basketweaving than a silly ACLS card. I seriously question the intelligence of those running your system. :? Be scared. That's two separate questions, but I look forward to the discussion.

Couldn't we just tattoo numbers on their forearms? It worked well in the past.

I am fairly liberal in allowing patients access to their records. I freely allow my patients to view or have copies of their records at any time, once they are completed, reviewed, and signed. The only formality is that they sign a standard release of records first. Of course, this is for a clinical practice, and not ambulance EMS. However, were I administrating an ambulance EMS service, my policy would be much the same, subject to review by my legal advisors.

Minus 5 for a teaser subject line. It is unfortunately necessary in much of American EMS simply because medics are inadequately educated to accurately assess their patients' conditions, resulting in misclassifications that delay definitive care. Yes, in a perfect world, MOI would be nothing more than a statistic. But with medics in this country sucking as badly as they currently do, it is understandable that some hospitals take such measures to ensure readiness for those patients that are under-triaged by EMS. These sound like pretty much the same question to me. I have no experience with this "alert" charge to patients. Never heard of it. Sounds semi-shady to me, but then it might be a pretty "reasonable and customary" (the standard by which insurance companies judge) thing in practice. I'd say that if insurance companies are paying it without a lot of squawking, then it is probably a widely accepted practice. And when you think about it, it is really no more unreasonable for insurance to pay for this than it is for them to pay for a helo flight that was based only on MOI. Consequently, I would be tentatively in favour of the practice, pending further evidence and discussion. As for the "alert" vs. HEMS thing, I definitely see a benefit to it. The benefit of a Level I over a lower level is in the immediate availability of surgical specialties. If they can have those people standing by at the level III in the same or lesser time than it takes to fly to a Level I, then I'd say that benefit is, for the most part, negated. And when you consider the negatives involved in aeromedical transport, I'd say they are probably onto an innovative solution with this concept.

Maybe if the United States ever does that successfully, they can show the rest of the world it is possible. Unfortunately, for now the US is the laughing stock of the EMS world with their pitifully inadequately educated "Paramedics" who are, for the most part, hobbyists and firemonkeys. For the life of me, I can't imagine why anybody who has seen the US EMS system first hand would even consider utilising "paramedics" instead of nurses for EMS. Yes, there are countries who have done so very successfully, but they did so by starting from scratch and eliminating the fatal pitfalls of US systems. And even countries like Canada, who have done quite well, still have some serious problems in their "paramedic" based EMS systems. I don't know where this whole "six years" thing came from. Two to four years of nursing school, followed by 9 to 12 months of specialisation doesn't add up to six years in my math. But there is no doubt that the US would be much better served by a system staffed with those with a professional nursing education before moving into a specialisation in paramedicine than by the hodge-podge of tech school losers and firemonkeys we currently have. Anybody who disputes that is either ignorant, stupid, or simply selfishly protecting their turf with no regard for the good of the community or the profession.

First of all, plus 5 for sitting down and attempting to map this out in an objective and logical fashion instead of running off half cocked. :thumbright: Kristo hit on the bottom line. I'm not sure why you envision yourself in the ER in five years. There's nothing wrong with that, but if that is the case, then I would say to take which ever job is most conducive to nursing school. That appears to be company B in this case, but it would depend upon scheduling, which you mention only for company A. It's certainly easier to go to full-time college while making $35k than $28k though. And transfer jockey schedules are generally more flexible than EMS schedules. Cost of living, and the cost of a community college ADN degree aren't that bad in rural Georgia, I wouldn't think, so Company A is probably a workable deal too, so long as you aren't currently married with children and living in the red. If you have that financial flexibility of being single and living at home, then there's nothing wrong with taking the EMS job to sow some wild oats and get all that silliness out of your system. I certainly wouldn't call it the intelligent choice, but I do understand the lure and the need to experience the streets that so many feel. But yeah... if you're out on your own and/or trying to support a family, then stop the insanity and go for the money and the fast track to nursing school. Anything less is simply immature and irresponsible. Only a complete idiot would even consider moving on to medic school from here if the ER is their goal. It's an absolutely pointless and dead end choice that will only leave you wishing you had gone to nursing school instead. Your post makes you seem smarter than that. Whatever you choose, best of luck!

Excellent point indeed!

Lots of potential factors here. A twenty point difference between different arms on the same patient is not terribly uncommon. A twenty point difference between an auscultated BP and a machine BP is not uncommon at all either. That in itself could account for a great part of the differences without any physical abnormality. And you are on the right track with the NTG connection. We don't know how much she took or exactly when, so it's hard to tell. But profound drops are not an uncommon reaction to NTG, and neither are hypertensive rebounds to those drops.

Me too. Sounds like they are applying different rules to alcohol than they would to any other confiscated property. I've known a couple (and heard of many more) officers who decided that the weapons they confiscated were theirs for the taking and ended up in jail and fired. Seems the same as alcohol to me. Just like the beer, the weapons were legal to own and no longer belonged to the original owner, so why not just take them for yourself, right? This just reeks of impropriety. Was this an "unwritten policy," or was it officially sanctioned? I'd be willing to bet that those involved wouldn't admit it to the mayor. I'd fire their arses and let the Union blow a bunch of money trying to get them rehired, just to be fired again. Policy where I work: No alcohol tolerated on premises for any reason whatsoever. Regular random breath alcohol testing of all employees, and zero tolerance for any amount of alcohol detected. Immediate termination and permanently ineligible for rehire. Exactly as it should be. While I understand what some volly squads are doing with their banquet hall scams, and recognise that it presents a special situation, I don't condone it. If they spent the time on training that they spend on these little side businesses, they'd be a lot better off. What's that you say? They have to do it to afford to operate? Sounds to me like it's time for them to go home until the community steps up to the plate.

The former. They're putting all this thought into providing transportation only, while still not giving a single thought to providing care. This is worse than the nonsense in SoCal. I don't oppose the NJ standard of only hospitals providing ALS care. I think it can be a very good thing, actually. Unfortunately, what it seems to create in most parts of NJ is a utter and complete disconnect between care and transportation, resulting in the chaos they have there now. Instead of trying to improve only one facet of EMS at a time, their efforts would be better spent improving the system as one entity.

I'm a little surprised this has never come up before if you are routinely forbidding people from reading the document they are signing. I'd be interested in reading exactly what it is that they are signing on the back. Can you quote it here for us? I would think that statement would make a very big difference on how comfortable people are signing it.

Best first post ever. =D>

Word. I don't sign anything I don't read carefully, and neither should he or you. Your system is flawed if it is asking people to sign something that they do not have full understanding of. We see the results of this everyday here at EMT City. People sign up and agree to the Terms Of Service, and then immediately start posting in a manner contrary to the rules they agreed to because they didn't bother to read what they were signing up for. Such lazy and uninformed people piss me off, and are an embarrassment to the profession. Kudos to your uncle for not being one of them. I'm curious what you or anybody else would have done to stop him from reading the PCR if he had chosen to. What are you going to do? Assault him? Rip it out of his hands? Get real.