Dustdevil

Agreed. I have always been a big proponent of the anal probe. I haven't had any experience with the temporal temps, other than it being used on me during physicals, so I wasn't aware of the problems with them. But I don't think I would have trusted them from the beginning... well, maybe a little more than ear temps, lol. But yeah, I just didn't want anybody blowing off a 100.2 axillary temp because they read here that only 100.4 and above was a fever.

I just wanted to clarify for our audience that this is a RECTAL temperature standard. There are different thresholds for oral and axillary temps, and probably for forehead and ear temps too, depending on what you have them set for.

According to many systems and MDs, yes. If you make contact with a PATIENT -- that is, a person with any signs or complaints of illness or injury -- you will either transport or obtain a formal refusal. That is the way it has been in most systems I have worked in the last twenty years.

Ah, thanks for the clarification. Are you absolutely positive that your system requires you to get "refusal" from persons who are not patients? No injury or illness = no patient in most systems. Of course, Khanek raises a good point, in that once you decide they are worthy of a medical evaluation, you have turned them into a patient whether they are injured or not. The moral of the story is, if they say they are okay, take their word for it and drive away! Of course, the Trooper throws a monkey wrench into this scenario by calling you out in the first place. It may cause somebody in your organisation to question how you could clear with "non injuries" when a Trooper called you out reporting injuries. As in society in general, cop's word always trump's medics word, despite his total lack of medical training. So anyhow, in this situation, I agree with Anthony that no refusal is necessary.

Minus 5 for unapproved abbreviation. I have no idea what this means.

All you are missing is semantics, really. PEEP and CPAP are the same action. The difference is that it is called PEEP when it is applied to a patient who is being mechanically ventilated, and CPAP when it is being applied to a patient who is spontaneously self-ventilating. So really, the difference is more in the patient than in the device. Consequently, the terms are tossed about interchangeably in a lot of cases, and there is no real problem with this except to old-school purists. Technically, if the device you are talking about is a ventilator, you are using PEEP. If it is not a ventilator, and you are using it just to provide positive pressure without ventilation, then it is CPAP.

Interesting that Knox talks about a "federal D.E.A. two-lock rule" in their literature. Unless things have changed, there is no such rule. It's just a loosely agreed upon standard that exists in the field, not an actual rule of law that exists on the D.E.A. books. I wonder if Knox knows this and is intentionally misleading people in their literature, or if they are just ignorant.

:?

I think that is pretty much as it should be. I'm afraid I don't really see a lot of outlets for those with graduate education in EMS, even in the future. That's pretty much how it is in every other health science too. Heck, that's pretty much how it is in any field, period. And look at nursing. A MSN gets you a management job, a teaching job, or a clinical specialty (CRNA, NP, CNS), but it does pretty well price you out of the wards. In over thirty years, we still haven't even gotten EMS education up to the Associates Degree level. I am all for plotting our course for the future. But even if that standard were implemented today, it would be at least thirty more years before we started seeing significant numbers of Bachelors degreed paramedics, much less Masters and beyond. I'd like to see them in education primarily, because that is the most critical need. Things like the so-called "Advanced Practice Paramedic" could exist at the MS level, and practise in a similar realm as the PA or NP, but obviously with a different focus. But, again, education and management would be our priorities, so that those running the field and those preparing the next generation have the insight necessary to do it, and not just MBAs and MPAs. Now, working out here where I am, with a lot of paramedics who think their little 1000 hour first aid course prepares them to practise medicine, I have come to the very definite realisation that a significantly focused educational track is necessary before letting people loose delivering primary care like that. Paramedic school is a lot like karate school. A little knowledge is dangerous. And what you get in one or two years of either one is really just enough to get your arse kicked.

So... wankers lose trust of community. Community wakes up and replaces wankers with full-time professionals. Hmmm... and you're saying this would be a bad thing?

Hell, they wouldn't even have to take a leadership role to get the ball rolling and start improving EMS. I've always dreamed of seeing somebody like ACEP step up and put forth some serious propositions, and back them up with ultimatums. Take a position, for crying out loud. Step up and say, "we will no longer allow uneducated and inadequately trained lay persons to practise under our licensure. Period." I would never let one of them work off of my licence, that is for sure. EMS has had thirty years to get its act together and has failed miserably. Drastic times call for drastic measures. If you aren't part of the solution, you're part of the problem.

Better yet, leave your whole uniform at the door. Come home in a bra and panties and see how fast your significant other forgets that you abandoned him to go play hero.

LOL! Actually, both sentences were pretty funny!

You are incorrect. I am required to maintain CEUs to maintain my nursing licence. Pretty sure that is universal. Same with PAs and physicians. Reading around this board, it is painfully obvious that, even with that whole 24 hours of CEUs that is required for EMTs, many of them are still practising in the 1970s. In fact, many of them are still being taught in the 1970s.

You call that "logic?" Law is a government function. Medicine is not. Minus 5 for an invalid analogy.

Exactly. Professional caregivers are educated, not trained. When all most of them can tell me of oxygen therapy is that everybody either gets 6 or 15 litres per minute, can you really expect me to be impressed with their "medical" sophistication? That is not education. That is just training. And pretty poor training, at that. And it's only been a year and a half since I last sat through an entire EMT course, so I am not ignorant to what they are like these days. You yourself just told us how few hours were involved in yours.

First aid. Any layman with a couple of hours training can do it. And that's what an EMT is.

Minus 5 for unapproved abbreviation. Can you tell us what MONOC stands for? It isn't even defined in the article. Anyhow, it's amusing that this dude defends his organisations reputation by saying they are well received at public relations events. Yeah, that's a concrete measurement of quality!

I have mixed feelings. I have a very good friend who is one of the sharpest medics I ever worked with (graduated with Dr. Bledsoe back in the 70s), and who is also diabetic. I remember him frequently getting a bit lethargic on the job and it being a problem. His eyesight started going really bad, but he kept on working and compensating with the help of a good partner. They finally pushed him out of the field after a little over 15 years when he was discovered unconscious in the back of the ambo with his patient, upon arrival at the ER. And, of course, when you leave EMS, you take no pension or retirement with you because there isn't much chance you have actually worked for the same employer for very long. Now, with the pump, you are a little better off in that you don't have to remember your shots as often. However, you still have to carefully manage your diet and other factors just to stay conscious everyday. That is a significant risk in this business, where lunch breaks are not a right, but an anomaly. I am no endocrinologist, but I think the Occupational Health Physician has a significant point. Maybe we're not too far away from things being different, but for now yeah... it's a risk that not every employer is willing to take, and it's their dollar and reputation on the line. Of course, a big part of the problem is that there are about twenty-billion EMT-Bs in the country, so you are not particularly a hot commodity that is in demand. Otherwise, they might be a little more accommodating. All that said, if you are just a glutton for punishment, and stupid enough to actually fight for a shitty, abusive, poverty-wage, blue collar labour job as an ambulance driver that you'll lose or quit within five years at the very most, then I have one piece of advice. Don't get all hung up on this one employer. Again, they have absolutely zero reason or motivation to hire you. They don't need you. And there's fifty other applications on their desk right now from guys who can pass the physical, so don't fool yourself into thinking they are going to make some sort of exception for you. Move on. There are other employers to call on. And if you don't know who and where they are, then minus 10 for not doing your research before shelling out the $$ for your 120 hour first aid course. You will get a job. No doubt about it. But seriously consider if this is what is best for you, your family, and your patients/partner before you go wasting a lot of time and effort for nothing. Good luck!

Two best quotes in the thread: (Translation: Some people are just idiots.) (Translation: Write the bastards up!)

Intentionally disregarding EMT City Site Rules is always offensive. :wink:

A few years ago I would have hunted you down for encouraging frostbacks to immigrate to Floridia. But it's a lost cause now. Florida is crap. Jersey has overtaken English and Spanish as the most commonly spoken language there now. It's disgusting. I'll never move back.

I'm with you there on the hunch thing. But I think the concern here is that very fine line between a hunch and an excuse. While some of us are giving ASA to the atypical patient on a hunch, others are giving it to anybody they can find an excuse to give it to. Nausea? Well a lot of MIs have nausea, so let's give ASA since we have nothing else to give! It's the EMT-B mentality here that, thankfully, you don't have to deal with to much up there in Canadia.

I dunno about that. I've noticed that those with the least experience seem to use the most pointless abbreviations and codes. Considering the guys here with the most experience are the ones that use the least abbreviations and codes, it must be pretty easy to avoid that habit.