Dustdevil

Excellent choice of a case presentation. A couple of really good points in that story that it is important for us to remember. This stuff is everywhere. Hell, it's all over my property. And, just like in the above case, it grows very close to my mother's garden. Can any recent grads tell me if the Jimson mnemonic was taught in your EMT or medic school?

Congratulations! Your persistence and dedication have paid off and I am very happy for you. A great many wannabe's give up after their first rejection. They don't have the devotion, the drive, or sometimes even the intelligence to get through some upgrade classes. You have proven yourself worthy and I think you have a bright future if you keep that good attitude. I've never been to Toronto in my life, but a big city is a big city, and I have worked in a couple of really big ones. I didn't know a thing about the streets of Dallas until I went to work there. And this was many, many years before GPS was invented. It's not really a problem at all. They are not going to stick to total rookies together in the first place, so there is not going to be a "blind leading the blind" situation. If you don't know the streets, your partner will at least know the major roads and can take you the rest of the way by map or GPS. The only time I ever encountered problems was after getting to a scene, trying to find my way out of a neighbourhood and back to a main road to get to the hospital while my partner was too busy with the patient to give me directions. When that sort of situation comes up, you simply ask him BEFORE you get behind the wheel how to get out of there. Ask a cop or fireman if you have to. No shame. It's not like medical info where they expect you to know it from day one. You will learn the major roads very quickly, and nobody knows all the roads. Not even the old vets. This would truly be the very last thing you should spend a single moment worrying about. It's simply not a big deal. You are unfortunately correct about the PCP glut in Ontario. Toronto and most of the surrounding regions (including Peel, I believe) treat rookie PCP's like cattle. You're just a number. You turn in your application just like the other thousand people applying for the same job at the same time. You all take the same tests at the same time. Then those agencies get together and pick over the applications of those who score highest to decide who they want. Not everybody with a licence gets hired. Such is the situation in almost every metropolitan area in North America. There is a huge glut of entry level providers, so not everybody gets in. You're chances get exponentially better the farther away you get from TO. As far as I know, the only way to really make yourself more attractive in the hiring process is the same things that would make you attractive anywhere else. That means scoring highest in the testing process and having superiour communications skills in the interview process. Politics will sometimes play a part in the process. You're going to Humber, which is a positive thing for the area you want to work in. Making contacts and friends in low places is always a plus, so never pass up the opportunity to meet people in the business. You never know where that may lead you. And becoming a part of the EMT City community -- with its large (and beautiful!) Canadian contingent -- is also a step in the right direction. Other than that, really, all newbie PCP's are alike. It's hard to stand out. Welcome aboard, my friend. I wish you the best of luck!

There are no "national protocols." This is America. We don't have a central dictatorial government telling local practitioners how to render care. And are you sure that NJ has statewide protocols? Very few states do. It's almost always a matter of local control. But if any state does, I would expect it to be NJ.

The above rant was not about this scenario. Neither was the previous rant. You changed the subject. It is about your community's failure to provide its people with professionally operated medical services and about the inflation of your self-worth. For what it's worth, it sounds like you did all that could be done by any provider on that particular run. But not all patients are hopelessly terminal like her. Many of them could benefit from better educated, full-time EMS professionals who could respond faster and provide more clinical sophistication. That is what we are now talking about.

Your community isn't giving you anything. But, if you really want to "give back" to your community, take the lead in demanding that your community leaders start providing the full-time, professional, advanced EMS that the community really needs. Use your contact with the newspapers to push the issue. Instead of sitting at home and staring at your pager, sit in on every city council and/or county commissioners meeting that comes up and keep asking why they can pay the guys who answer the city phones, mow the courthouse lawn, empty the city hall trash cans, work on the police cars, pump the water, fill the potholes, dispatch the sheriff and man the jail, drive the school buses, prosecute crimes, and every other so-called vital function, yet can justify not providing EMS for their taxpaying citizens. And don't feed us this, "we can't afford it" bull, because we all know it's crap. By volunteering to provide half-arse service, you aren't giving back to your community. You are taking from your community. You are allowing them to say "we have EMS!" when they really don't. You are preventing your community from ever having professional coverage. You may get a cheap thrill out of the thank-you letters you receive, but the simple fact is that those people don't know any better. If they knew what EMS should be, and that their community leaders were negligent in not providing it, and that you are complicit in withholding it from them, they would sing a very different tune. You aren't part of the solution. You are part of the problem. But if you raise enough stink, you could be part of the solution. THAT, my friend, would be giving back to your community.

How did you help her? Anybody could have driven her to the hospital to die. It doesn't take half an EMT to do that. Not criticising you. Just pointing out how EMS providers -- especially basics -- have a real tendency to overstate their importance.

That raises a good point. In the areas where there is an actual critical need, there are indeed grants and scholarship opportunities available. Rural frontier areas, Indian reservations, the military. All will pay to train you in return for an agreement to work for them for a nominal amount of time. If you can't find grants, take that as a really clear clue. It means there is no critical need for EMT's in the area you are looking. And, of course, that is a really clear clue that even if you pay for your own school, you aren't likely to find a decent job very quickly. Continuing to pursue such a thing after learning that does not speak well of a persons intelligence! Funny how, with all the pointless crap they teach in high schools these days, they still don't bother to teach kids how to intelligently choose a career field, do job market research, or to apply for and land a job. DISCLAIMER: The above is not aimed at anyone in particular. Just a general observation.

Neesie, I'm afraid I have to take issue with your primary point. We SHOULD be concerned with what others are doing. There is no better way with which to evaluate our own practice. In fact, it is the very reason I came to this board. I don't want to be blindsided by progress a year after the rest of the profession already knew about it. I want to see progress and trends coming from a long way off. I want to know what everybody else is doing. It is way too easy in EMS to become isolated in your own little world, doing only what you've always done and what everybody else is doing in your system, and have not the slightest clue when the rest of the world has found a better way. We see this here on EMT City constantly. People chime in with how they do it at the Hooterville VFD, completely unaware that their practices were obsolete three years ago, yet fully believing that they are practising the state of the art. Being concerned with what others are doing is exactly what EMT City is all about. And I highly recommend it as a way to improve yourself.

Well then we should just drop the EMT requirement altogether and replace them with 8 hour standard first aiders. After all, education doesn't really matter. As long as somebody is "willing to help, that's enough.

I'd just like to get hold of the syllabus and curriculum. I could do some damage with that! :twisted:

The analogy is not wholly valid. There is much more to consider. First, the nurse does the first five to ten minutes of assessment for the doctor, shaving time off of his exam. Second, the doctor's knowledge and experience allows him to arrive at a diagnosis faster that a paramedic. Consequently, he will often forego much of the standard exam once she has an impression. And, of course, the medic is providing treatment at the same time she is performing her examination, further contributing to the disparity between her exam time and that of a physician. Conversely, medics can't unilaterally decide to forego any part of their exam very often. You start leaving exam details out of your PCR or writing "deferred" in place of half of the exam and see how long it takes for your QA to call you on the carpet.

It's part of the SOCOM Medical Operator course at Fort Bragg. It includes the NR paramedic curriculum as part of a much broader (close to PA) curriculum. They do their ambo time in Miami, I think. Haven't looked in awhile. SF medics and Air Force Pararescue medics all attend, although they are not the only ones. The classes stay full with non-special ops guys from all units, but especially flight medics. 91-B no longer exists, and has not in several years. And the current 91-W is being restructured again. Regardless, I would hardly call their scope "expanded" in the EMS sense. A lot of the curriculum is preventative medicine, military doctrine and tactics, and routine health assessment. It's a great course that gives an impressive foundation. But, it doesn't cover ET intubation or any cardiology, so it falls short of both the US and Canadian Intermediate level scopes of practise. It's designed for guys who will be dealing almost exclusively with young, healthy men whose biggest concern is trauma, not medical conditions.

Oooh, good point! Not all nursing instructors have such a bias, but it is indeed pretty common. I had one nursing prof who didn't like medics, didn't like men, and didn't like white people. Let me tell you, that was a tough semester! :shock: Because of that, you will definitely not want to do a lot of mouthing off about your medic experience in school. Resist the temptation to tell war stories in class. Try to stay back and blend in with the rest of the students. It seems to vary. Army is all BSN in the active duty. However, National Guard (and I believe reserves too) will take ASN's on a case by case basis. Last I heard, Air Force would also take ADN's on a case by case basis, depending upon need, but it is not common. And you can forget making O-3 before you earn a BSN. But back in WWII, hospital programme nurses were the norm. There were no ADN's, and BSN's were much less common.

Again, we're not talking about 91-B's (which no longer exist). Those are standard line medics, which indeed are usually only certified to the EMT-B level. The question is about Paramedics. The military has it's own Paramedic school and the graduates are NR certified EMT-P's.

Ah! I am clearer now. Hmmm... okay so you have A&P and whatever prerequisites are required for nursing, but they are too old to transfer? Is that the problem? It seems that if they were too old to transfer for the regular program, they would be too old to transfer for the transition program too, no? That is the way it works here. :dontknow: Simply having a course on your transcript and actually having the knowledge at your ready disposal are two different things. That's for sure. I have a degree in Biology and I can't remember ten percent of it because it was simply too long ago and I don't use it. I intend to re-take both semesters of A&P and Microbiology over again simply because I recognise that I need the refresher. It would benefit you to do so too if you want to be all you can be. But anyhow, about the transition thing, you can become a nurse either way. And eventually, with practise, you will become just as good a nurse either way. I just don't want you thinking that anything you have done as a Paramedic will make a difference in that process. It really won't. You won't be repeating or relearning anything in nursing school that you have already had. Nursing is a whole 'nother deal. You will miss out on at least a semester of experience and educational reinforcement with a transition that will take you time to make up in practise. But you're obviously a smart person with the capacity to learn and excel, and the desire to always continue learning too. Either way will work for you. All other factors being equal, I would definitely spring for that extra semester and get a full education. It's not like you are in a hurry to leave EMS right now. You have no need to retire from the field immediately. The best way to go would be traditional, getting all the education you can. But if for some reason the bureaucracy will take you significantly longer to do it traditionally, and you have an immediate need to move out of EMS, then take the shortcut and then immerse yourself into practise and becoming the best you can be. You'll do fine. Just a little slower to adjust to clinical practise. But you will immediately be a much better medic! Either way, good luck!

He wasn't talking about EMT-B's. He was talking about Paramedics. Military Paramedics are Nationally Registered EMT-P's.

I think my head is going to explode. More mindless acronyms that contribute nothing to the student's understanding. :? I'd be a lot more impressed if they were asking you questions about the signs of such injuries instead of pointless terminology that they made up just for grins. Sorry to break this to you, but your school sucks. Good luck!

You are misinformed. Both EMT's and Paramedics in the Army are Nationally Registered and can carry their certs into civilian life. There are several on this board. And what "other down side?"

Agree with the above. You're only going to save a semester with a transition programme. If your only goal is to get a diploma, then that's no big deal. But if your goal is to get an education, then you are screwing yourself out of a very valuable semester. There really was very little in nursing school that I already knew from field EMS. Only my hospital experience (military, ER tech, and respiratory therapy) helped me in nursing school. It seems that you are not fully informed as to what a transition or accelerated program entails. You still have to take A&P and all the other same prerequisites. There is no getting around that. The NLN won't allow you to test without it. And the A&P you got in paramedic school was a joke. Basically, they just cram the nursing content in at a faster pace because of the assumption (erroneous in my opinion) that most medics already have enough of an advanced medical understanding to grasp the curriculum faster. You will very definitely suffer for that lack of an extra semester. When you graduate, you will take longer to become a competently functioning nurse than you would have with a traditional education. You said you are looking to continue your education. If that is the case, then why would you seek a shortcut? If it is about education, then obviously more education is the answer. If you don't have significant hospital experience, I don't recommend transition programmes. And even if you do have such experience, you are still shorting yourself the benefit of more education and experience. And I disagree that nursing is a "logical progression." It's not progress. It is change. Completely different professions. Nothing wrong with changing. Damn few people can stick out the streets for 30 years to retire, so it's a good move. But it's still just a change, not a progression. Consequently, it is wise to make it a fresh start with a complete education, not a "progression" of paramedic education.

The STOMP II is becoming the standard for the US Army altogether now. They are being officially acquired and issued in some units already. I think those of us who bought our own should get a nice $300 dollar reimbursement cheque! By the way, the London Bridge med bags are comparable to the STOMP II, and are preferred by some. Just depends on your style. The London Bridge bags seem a little more accessible. And they're American Made, as opposed to Vietnamese. But they are definitely a little more expensive. Check them out at: http://www.londonbridgetrading.com/backpacks.html The London Bridge Tactical Field Care Medical Backpack and The London Bridge NSW Training/Coverage Medical backpack are the same inside I believe. I think the difference is the TFCMB has the two outer compartments added, whereas the NSW has only interior compartments like the STOMP II. While being a good EMT Citizen and clicking on the sponsor links, I discovered this company:

There is no problem with the concept. The problem is simply in getting everybody on the same page. I hear a lot of provincial whining about Ontario's high time requirements being a stumbling block to reciprocity. And I hear whining about Alberta's advanced OCP's being a stumbling block to reciprocity. It seems obvious to me that combining the best of those two is the answer to standardisation. However, the conventional wisdom -- at least in the United States -- is that the answer is to dumb standards down to the lowest common denominator, not to raise them to a gold standard. It should not be those who hold out for lower standards who set them. It should be those who strive for a higher standard that set them. If you can get that little matter straight, then the concept of a nationally certifying body is not only valid, but ideal.

Still trying to figure out how the comment that an assessment and initiation of treatment can take up to thirty minutes somehow turned into the ASSumption that Lithium ALWAYS spends at least half an hour on his patient assessment. Everytime a topic turns into a marathon back and forth like this, it can be traced back to somebody's silly assumption. Let's try actually taking the time to read these posts carefully before launching into stupid tirades that are irrelevant to the topic. As with every other question in EMS, the answer to why an ACP does a more thorough assessment than a PCP lies in going back to school.

It might be a tumour.

What you are describing is two different problems, inconsistent education and inconsistent medical direction. Of course, as always in EMS, both are really the same problem. Education. Neither are the problem of the NREMT. And neither would be the problem of any other testing and certifying agency. That's why we can't understand your contention that NR is a joke. You have yet to tell us why local problems make the NR a joke.

Yeah, that is a solution, and it would work fine anywhere. PCP's are fighting for jobs up there. Not exactly a shortage. And since they are currently not even whining to their unions about having the worst of all possible shift schedules, they're certainly not going to start complaining en masse if you went to a more intelligent and humane schedule. Half your people will work nights. Half will work days. It's that simple. You can leave it like that forever, letting people pick and choose based upon seniority, keeping a good amount of employees extremely happy that they are on exactly the shift they want. You can rotate it every three, four, or six months so everybody has to eventually work whatever shift they don't like, keeping the junior people happy that they aren't forever stuck on a shift they don't want it. I have never heard of this Canadian shift lunacy before I met Ontario people. It is insane. I am extremely disappointed that in a heavily unionised system that you people just bend over and take this while spending all your time whining about much less important matters. There is absolutely NO benefit whatsoever to that kind of schedule. It's complicated for you. It's complicated for the agency. It doesn't save them money. It doesn't make you money. It doesn't improve service quality or response times. They do this for one reason, and one reason only: to burn you out so they don't have to pay your retirement twenty years from now. And if your union leaders haven't figured this out and said something about it, WTF good are they? I am an exceptionally anti-union guy, but I would have pushed for a strike over those shifts years ago. You guys in Ontario need to grow a pair, quit taking it up the arse, and speak up. They're screwing you without lubrication and you know it.