Dustdevil

You would do well to spend a LOT more time here before embarrassing yourself with such ridiculous accusations. Thank you. You just proved my point. I don't know what your level of training is, but it is obviously inadequate to provide you with enough understanding of the Combitube to be utilising it. I hope your school is teaching better than that. Educated hands are much more important than skilled hands. Back to school with you.

Did somebody say "boobs?" :shock:

According to what most EMT schools are teaching these days, as long as you repeat the words "Scene safety BSI" aloud as you exit your ambulance, then everything will be just fine. No worries.

Really? I thought it just meant she had short hair. :?

That is pretty much where I am coming from too, AZ. I fully agree with Rid and PRPG that rural is where you will really hone your skills and become a good medical provider. However, the number one most difficult and important skill you have is patient assessment. Regardless of how long you ultimately spend caring for your patient, the assessment is the same. It is not better learned in either the rural or urban environment. The only thing that contributes to the development of your assessment skills is volume. The more patients of the more variety you see, the more patients and conditions you will assess. Consequently, you will become a better clinician faster in most urban environments simply due to volume and variety. I am certainly not saying that urban experience is better experience. In fact, as Rid said, it is not. But again, volume and variety are the keys to developing your assessment skills. And until your assessment skills are developed, I don't care how many IV's you've started or how many tubes you've dropped, you are not yet a competent medic.

It is a one-time test. After that, unless you lapse, you just keep your continuing ed current to maintain certification. It is definitely on the site.

Most non-FD ambulances do not. While I have been in many situations where it might have been nice, I have never been in a situation where it was absolutely necessary. In fact, I've been in many situations where it would have been a hindrance. Most places I've worked, the firemonkeys took care of all the extrication anyhow.

Hammer is très sexy when she speaks en Français! :love4:

I don't know about your state test, but with NR, they are the same thing. The NR exam is structured situationally, which is exactly like real life. What you need to know to pass NR is exactly what you need to know to function as at least a minimally proficient EMT. Therefore, teaching the test is fine. That is the benefit of the NR. Many state exams have not yet figured that out. They are asking questions of rote memorisation. Anatomy questions. Disease facts. Names of devices and procedures. It's nonsense. And if schools teach to that sort of test, their graduates will be ill prepared to function. I think your concern is completely invalid. Schools will teach to whatever test is given, no matter whether it is NR or a state test. NR does not cause it. It is already happening. So it might as well be a nationally validated test that is geared towards actual practise, like the NR exam is.

The obvious solution is to not put them on the board in the first place. Scoop them at the scene. Unscoop them onto the ER table. Patient is comfortable. No equipment is left behind.

Well, that's a mixed blessing. It is a very positive step towards becoming a paramedic. But it is one major nail in the coffin of your medical school dream. I hope this means you intend to give your total attention to being an EMS professional. We need you, but you need a little focus. Congratulations on the job and the school prospect! Best of luck!

The question was not about putting the patient on a board. The question was about leaving the patient on a board. Unless there is more to the patient's condition than I am aware of, no, I can't think of any good reason to leave him on it.

LMAO! Isn't that near Scarborough?

Change of plans. Baghdad is out. Fallujah it is. :?

I had been in EMS for thirteen years before I went to a rural county service. Even with that experience, it was a rude awakening! I had to increase my game. I had to dive back into the books and gain a much better, more advanced understanding of what I was doing. Had I not already had significant hospital experience, I might have panicked. Without that experience, most medics have no idea what to do with a patient after the first fifteen to twenty minutes. You definitely do NOT want to be learning your operational basics in a rural setting. Learning at the expense of your patients (and partners) is not a good thing.

You could have done that with a radial pulse for free. And what exactly can you do with that information, even if you have it? Of what value is this information -- and the device itself -- to you or your patient? This is silliness. It's doing things simply because you can, which is the absolute worst practice in EMS. So why not fix it? Do you have any idea how bad it makes you look to ignore simple details, yet waste time on things outside your scope of practise? Your reputation is everything in this business.

Newbies have no business in a rural system. Urban is where to get your best experiential base. You won't necessarily make more serious runs than a rural service, but you will make more runs total than at a rural service. Quantity is extremely important in developing and perfecting your style of practise. Also important is working with a variety of people and working for a very structured organisation with a good education department and close supervision. Usually, you will find none of those things in a rural service. Once you have established a routine and are comfortable in practise, then you are set to move to a rural service where you are more autonomous, have significantly greater patient contact time, and perform a lot more pre-hospital care. It is just not an ideal situation to be thrust into a rural situation as a rookie. In the city, you have lots of backup, first responders, and resources. In the country, it is frequently you and your partner, and that is it. If you don't already know what you're doing, you are not an asset. You're a hindrance. And the slower pace, as well as the lack of educational resources, will significantly delay your professional development. From what I can tell, Boston EMS is full of bad attitudes, so I think you can probably expect that attitude as a rookie. Of course, not everybody is the same. And you are certainly likely to find bad attitudes in a rural service too. It is not uncommon to find bad attitudes in the country because many of the people who end up there are either burnouts who fled the big city, or losers who are bitter because they never could get hired in the big city. And a lot of jerks in EMS simply enjoy shitting on those with less experience than themselves, regardless of where they work. So I wouldn't assume that it is really any better in either situation. Bottom line: if you can work city EMS first, do it. It is best for your overall development.

Good for you! Never allow yourself to settle for learning the minimum that school will allow you to get by with. It's not enough. Always strive to not just know something. Strive to actually understand it. Maintain that passion and you will excel in any field.

They do! But Dubin gave that car away to a lucky reader a few years ago. In 2001, Jeffrey Seiden, a third-year medical student at Yale University, was studying his electrocardiography textbook when he happened upon the following message tucked away in the book's copyright notice: Congratulations for your perseverance. You may win the car on page 46 by writing down your name and address and submitting it to the publisher. Dr. Dale Dubin had inserted the note into his 50th printing of his "Rapid Interpretation of EKGs," putting his classic Thunderbird up for grabs. Of the 60,000 who last year bought the book containing the offer, only five spotted the hidden message and contacted the publisher with news of their find. The five names were placed in a hat, and Jeffrey Seiden's was chosen at random. The 1965 Thunderbird convertible was delivered to him on 4 December 2001 by Dubin's daughter, who drove it to Seiden's school. Unfortunately, the last copy I bought was printed in 1991. I would love to have had that car!

What does that mean? You successfully visualised squiggly lines? Can you qualify or quantify that claim for us?

While I fully agree with the concept of paramedic initiated refusal (PIR), I have only worked in one system in my whole career where I trusted every single medic in the organisation to be capable of the medical judgement necessary to safely do so. And guess what... there were only three of us. Yet we still had a strict policy of no PIR, even though each transport left only one ambulance available in the entire county. It's a great theory. It's something to work towards in the distant future. But I challenge you to staff a large service with that many paramedics who have adequate education, experience, and intelligence to assure it is not misused or abused. With current educational standards in this country, it simply cannot be done.

I want to clarify that Dubin's book is not just "basic" interpretation. And it is not just a textbook. It is a full programmed course in EKG interpretation from the basics all the way through very advanced diagnostics. I really can't think of anything you need to know about EKG interpretation -- aside from experience -- that you would not get from completing the exercises in this book. I sat down and completed the whole book in just a few days. I was not even a paramedic at the time, and I was able to walk into the EKG room at the hospital, pick up a 12 lead, interpret it, and almost always found my interpretation to be identical to that of the cardiologist. And it does not just teach interpretation as a "skill" like IV's or intubation. You learn electromechanical physiology, so you understand the implications of the EKG's you are interpreting. If you complete the book, which most who pick it up never do, you will be leaps ahead of over ninety percent of all medics in the US. And if you complete the book before medic school, you can literally sleep through the pathetically confusing and inadequate EKG module included in most paramedic courses. Hell, you can almost teach it!

Actually, that was the very first whack I have taken at you in this entire thread. Up to now, you've been whining about nothing. I just figured if I was going to take the heat for it, I might as well get the satisfaction of bashing you.

That accusation would hold a lot more weight if you had not accused me of attacking and trying to discredit you. Others may have questioned that you know what you are talking about, but the only thing I have done here is ask you very simple and direct questions about the scenario in a vain attempt to get clarification. You have answered none of our questions. You keep changing your story. You won't even admit that you quite obviously do not know the difference between pronation and supination. And now you are crying "victim" in a silly ploy to make us feel sorry for you. I think the only person you are fooling is yourself. Honestly, I can't even figure out why you posted this scenario. You have no intention of telling us what happened. You have no intention of answering our questions. And you obviously are not interested in our critique. So what exactly was the point? And this thread is the perfect example of why I feel that way! Way too many of you take your 120 hour patch out to the world and pump yourself up as "lifesavers" when quite obviously you don't have a clue what you are doing. And won't admit it. Do you really still think -- after all this -- that you are "giving back" anything to your community? You're putting your community in danger, if anything. I hope you can live with that.

That's funny right there! I don't care who you are!