Dustdevil

And to further clarify on that point, when I speak of basics, I am speaking of a level of training and care, not a class of people. EMT-B is a level of training. It is not a statement on the intelligence, dedication, professionalism, or worth of specific human beings. One of the problems in EMS (and "public safety" in general) is that too many people get so immersed in the "lifestyle" that they are unable to separate their personal life and worth from the patch on their shoulder. It is unfortunate, but if somebody takes personal offence because I think the training they were given in their course was inadequate (through no fault of their own), then all I have to say is, 'get over it.' Hmmm... I suppose you are speaking specifically of Ontario, where the entry level is a two-year diploma, unlike the other provinces. I dunno. Here, we have a bunch of people who are overtrained and undereducated. There, we have people who are properly trained and educated at all levels, but underutilised. As well educated as they are, the PCPs in Ontario are, unfortunately, not deployed to their full potential. It's definitely a better option, without a doubt, but it still provides an inadequate level of care to too many patients. I really can see no justification for tiers of care in EMS (ambulance EMS) other than bugeting concerns. Certainly no medical justification.

We're not far apart on this. Education is the key. But once entry level education is raised to the appropriate point, it will no longer be appropriate to call them "basics." This pretty well dooms the title of EMT-B. So our choice is to either change the semantics as we change the education, or to keep EMT-Bs as a non-professional, first responder level of first aid.

Yep. Never heard of it before. "Around here" is the key part of your statement, Speedy. And around here, nobody ever says "SOA." And it's not about being smarter than you, although I suspect that is probably the case. It is about me having thirty more years of context than you when I draw my conclusions. Yes, I started out as less than a Paramedic. So what? That was the dark ages, when yo mami was still in diapers. This is the 21st century now. I'm afraid you were born about twenty-five years too late for that to still be appropriate. It should no longer be happening. Period.

That's it. However, perhaps I was too vague. By "team," I am referring to two entities: the ambulance crew, as well as the greater picture of healthcare professionals involved in the patient's ultimate recovery (RNs, DOs, MDs, RRTs, LPTs, MTs, etc...). Neither of those two groups should include EMT-Bs. First Responders are a whole different story, and EMT-Bs are welcomed and encouraged there, but they are just First Responders, not medical professionals. And medical care does not begin until arrival of medics. Therefore, while they are a valuable part of the overall equation, they are not part of my "team."

I'm afraid I don't have $3k to spare. I have a Europaean honeymoon to pay for soon. But I will give you 10 points for figuring out, in two years as a basic, what many people never figure out in ten years as a medic. :thumbright:

Fire is a cruel mistress, but it sounds like they really whipped her this time! I'm just curious if the firemen wear leather helmets there. 8)

Haha! I can't believe you missed the "disciplined and controlled" part!

LOL! I feel your pain, Bro. A lot of those can be covered by this simple caveat: Just because I asked you nicely to do something does not mean it was merely a suggestion. It was an order. Do it. Now. Without discussion. Don't make me institute the "Yes Sir" policy. And, of course, the same thing applies to those things I asked you nicely to not do.

:shock: Not sure exactly what you are trying to say here, but it sounds sorta gay to me. Oooohh... there is 5 points that you really can't afford to lose, but sorry. Unapproved abbreviation. Shit Out of Arse? :? Or were you trying to say SOL?

I'm not sure either of those were stellar analogies for what Fiznat is talking about. Obviously, this is another case-by-case proposition that cannot and should not be addressed in cookbook fashion, which I believe is the valid point that Fiznat is getting at. Again, this is where education comes in to play to give you the scientific foundation to evaluate each patient individually and come to a reasoned determination of the need for ASA, which, of course, is more for it's anticoagulant value than for analgesia (which is what makes your morphine analogy not such a good one, and why I never have been a fan of the whole "symptom relief" term).

You must be mistaking me for somebody else. I have never recommended that EMT-Bs be part of the team. But yeah, I agree with Zilla regarding the misleading and sensationalistic tone (previously referred to as hyperbole) of this article, which tries to make across-the-board generalisations based upon old, re-discovered facts. I would agree that this is certainly something to be followed up upon in greater detail. But it's way too early to start tossing out the baby with the bath water.

It's not that obvious to many. If it were, I wouldn't have brought it up. And the problem wasn't that you weren't specific enough. The problem was that you were too specific. "Oxygen sufficient to maintain adequate O[sub:60b8887f32]2[/sub:60b8887f32] sats" is very non-specific, but would have been the perfect answer.

Despite the hyperbole in this article, this really isn't anything new or earthshaking. We were discussing this in RT school 25 years ago, and I worked with some physicians who were already mixing carbon dioxide. The only thing really new here is that somebody finally got around to documenting the effects with an MRI. With that, I don't think the rest of the scientific and medical community will be too far behind in exploring this deeper and becoming more judicious in their use of oxygen. And the protocol monkeys are going to be SOL when they can no longer just put 6 or 15 litres on everything without thinking about it.

Spoken like a man who knows a thing or two about Slim!

You have protocols that you do not understand? :shock: Have you made any attempt to understand them? How long have you been working there? Does your MD know you don't understand your protocols?

Is that allowed here? :shock: I love this article! It gives us an excuse to take one more drug away from EMT-Bs!

Unfortunately, there is a problem in that approach. Time and resources. How long do you sit with this guy on the scene, watching him eat lunch and rechecking his BGL? At what point do you decide it's okay to no-ride him and leave? At what point do you realise that you aren't going to get it over 35 and then either push IV D50 or take him to the hospital? Yes, it varies case by case, but in ANY case, you are taking your unit out of service for too long for a non-emergent patient. I don't want to sit in his smelly arse house for half an hour. And I don't have a food service certificate from the health department. I ain't feeding this guy anything but D50 or a pen to refuse with. It's time to take control of the situation and make a decision. No ride him or get on the road already.

Come on, guys! This is obviously PID. O2 at 6 or 15lpm, b/l 14ga saline wide open, cardiovert at 100 or 360, and haul ass to the LZ so the critical care medics in the helo can do an immediate ORIF enroute to the Mayo Clinic.

Plus 5. This is more of the "public safety" mentality nonsense that permeates and soils EMS. People think because they have a uniform and red lights that they are now somehow responsible for law enforcement and criminal investigations. Wanna be a super sleuth? Quit EMS and go to the police academy. But right now, it ain't your job. Seriously, what do you care if you get played by a seeker? You gonna lose sleep over it? You're going to lose a lot more than sleep if you peg the wrong patient as a seeker. Your MD is going to rightfully label you an idiot, and you're sacked.

I'm betting that 8151 was joking around and mocking the protocol monkeys. At least, that's what I hope he was doing. If so, it was pretty funny!

LMAO! That's funny right there! I don't care who you are! So was this patient by chance a nursing student? I used to do that all the time when I was in nursing school. 8)

I agree with Ruff. Plus 5 for not getting all bent out of shape over what did indeed look to be a personal shot at you. It was not. I wasn't addressing you specifically at all. But yeah, I can very definitely see why you or others might have taken it that way, and I apologise. Your reply was mature and respectable. Now, that said, after reading all of your rationale, I'm afraid I still don't see it. I am with Ruff, in that the numbers just don't add up to a helo trip for this girl. She's at school, not in the middle of the Everglades. And despite all their super duper, top secret critical care training, your ALS unit should be every bit as prepared and capable of handling her as the flight crew who are, despite all the extra letters I am sure they use behind their names, still just paramedics. I doubt their defibrillator has any better success rate than yours does. And she's not an immediate candidate for any pump regulated drips, so again, you should be handling this. Without freaking out. I do have to agree though, if you and your partner are freaking out and feel incapable of handling this patient, then yes... she probably is safer going by some other means. But it also means you guys aren't ready for the streets. While you are piddling around with all sorts of protocol monkeying around (as outlined in your posted treatment plan), p3medic and I already got her back to a normal rhythm. Now she is stable and half way to the hospital -- without hauling arse -- while you are still waiting for your magic helicopter. I'm driving. P3 is in back, admiring her breasts until the Versed wears off. It's a tough job, but somebody's gotta do it!

Cool! That's an awesome attitude, and a reasonable assessment. Heck, if I were any younger, I would seriously consider starting over there too. Sure, a lot would be a review, but you'd still come out a superior provider. Good luck!