Dustdevil

Were the scenarios all where the individual respondent was the one in error? Or were the scenarios where somebody else made the error? Or a mix of the two? Makes a HUGE difference. I think the bigger problem that is illustrated here everyday is that a great many providers are too stupid or uneducated to even know when they have made an error. :?

It's the standard simply because most administrators -- like most paramedics -- don't have the imagination or originality to do anything different than what they've always done. Until a few years ago, Lifepak was about the only option, but things have changed drastically now. Lifepak still leads the market simply because of name recognition and lazy administrators. It certainly isn't because they have the best products. The Lifepak (both the monitor-defibrillator and the AED) is at the bottom of the list of good products. This has already been cussed and discussed at length in an earlier topic or two, the most complete one being this:

No. But it's getting close. It's still the best we've got. :?

I'm going with psych emergency.

I disagree. Practice is not where you gain your knowledge. Practice is where you increase your understanding. The scientific knowledge base cannot -- and should not -- be taught in the field. It's book knowledge. It comes from a text and must be learned in a controlled and programmed fashion. The haphazard process of picking up pearls of wisdom in the field does not give you your medical foundation. It only gives you understanding about how to utilise that knowledge base. I do, however, think that our disagreement is really not much more than semantics. What you are talking about is about the same as what I have long been advocating -- a mandated, and significantly lengthy internship process after the classroom process is over. Unfortunately, it won't happen. The fire chiefs won't let it happen. And too many students would not support schools that increased their course length from 110 hours to upwards of 300 hours when they can get the same patch in a month at another school. Not to mention the problem of finding a service to host your interns that has both the quantity and quality of runs and preceptors to make the experience effective. It just does not exist across much of the country. There simply is no way to increase a student's clinical and practical competency without increasing their experience. And, unless you start eliminating even more classroom time and required knowledge from the curriculum, there simply is no way to increase their experience without significantly lengthening the course.

It would be pretty funny for the state that is home to the National Registry were to withdraw from it. But, as funny as it would be, it would also be a nightmare on many levels for your state to do it as you are outlining. Most other states would quickly cross Ohio off their list of approved states for reciprocity. Then we would start getting daily post from newbies in Cincinnati crying and whining about how unfair it is that their certification is no good across the highway in Kentucky. Then would come the outcry from those Ohio registrants who challenge the NR and fail miserably talking -- just like you -- about how that "book learnin'" isn't important and the only thing that matters is their "skills." Eventually, the State would be so inundated with complaints from schools and registrants that they would have to either go through the enormous hassle and expense of establishing their own exam process (more of a hassle and expense than you think!), or go back to NR, which they wouldn't do strictly out of stubbornness. Not only will other states shun Ohio graduates once word circulates of the lack of impartial review and standards, but regions across the state will begin to shun graduates from other regions that they believe are inadequate. Once the community college in Cleveland gets a reputation for cranking out functionally illiterate morons who can't even spell EMT, those people will find themselves unable to get a job outside of the big city. And, of course, even more of the better, more progressive employers will begin to require NR for employment simply to establish a standard because they know none exists there. And, since the educational standards will be dropping in Ohio, even fewer people will pass NR, meaning even fewer grads will be able to get jobs, resulting in even more whining. If Ohio's educational (using the term loosely) process is so horribly inadequate that a significant percentage of people are incapable of passing NR, then things will obviously only go downhill from there. Yes, people will get passed for showing up. It already happens in many locations. That's why "refresher" classes are packed full of people going back for their fourth shot at the NR written. The occurrence of such practise will increase exponentially. Fire departments already put a lot of pressure on many institutions to railroad their hosemonkeys in and out of schools as quickly as possible with little concern for anything other than the quantity of people they can show are certified on paper. The fastest, easiest school is always the most popular school in any given region. This move would lower that bar significantly, and more schools will dumb down even more in order to be competitive, as well as passing even more idiots to avoid upsetting fire chiefs who send all their people there. This whole thing seems to be the result of an attitude of entitlement that I see in EMS, but not any other profession I have been involved in. Every idiot that pays his money seems to think that he is the smartest guy in the class. And worse yet, they all seem to think that his instructor (the only instructor he's ever even met) is the best instructor in the world at the best school in the state. So when one of them fails out of class, all we hear is a bunch of self-serving crap about how smart they are, how the test is bogus, how great their "skills" are, and how all that "book learnin'" ain't important anyways, and therefore are entitled to graduate and get that patch for showing up. Similarly, the ones who pass the class but fail the State or NR exam whine about how good they did in class and how awesome their "skills" are, and how if their wonderful school and instructor passed them, then it must just be the test that is bad because they could not possibly have been inadequately educated. If I had a dime for every EMT or Paramedic student over the last thirty years who honestly accepted his failure as a sign of inadequacy, learned a lesson about how to do better next time, and humbly walked away to fight another day without blaming everybody but themselves, I would still be working on my first dollar. This focus on "hands-on care" skills, and seeming lack of concern for a solid foundation of knowledge, is troubling. Why is it that so many people simply can't understand that "skills" are completely without value if the provider lacks the intellectual capacity to make the sound clinical judgements necessary to determine what "skills" are needed for their patient? How can anybody be so stupid as to suggest in one breath that all that "book learnin'" isn't important, yet in the next breath whine about all the extra "skills" and drugs they ought to have at their disposal, like we see here everyday? Would you want your doctor to be the guy who was the best cutter in his class, but never mastered the process of figuring out what was wrong with the patient? Would you want your hairdresser to be the most artistic person in the class, but the one who failed to understand the important concepts of microbiology and hygienic practise that keep you from getting her last customer's bugs? Would you want your bug exterminator to be a pro at spraying deadly chemicals in the house your children live in, but have an inadequate understanding of toxicology? Good "hands-on" skills don't come from education. They come from practise. They aren't knowledge. They are skills. Consequently, ANYBODY -- even the average fireman or monkey -- can become quite good at bandaging, splinting, bagging, and taking vital signs. Big deal. It's simple repetition. The more you do it, the better you get at it. It doesn't require any intelligence. They are nothing to be particularly proud of. And, since everybody who does them long enough will eventually get better at them, they are the very last thing that anybody needs to concentrate their focus upon. Especially considering that over ninety-percent of all our patients don't need bandaging, splinting, backboarding, bagging, OPA's, or any of that other simple first aid crap. There is only one "skill" that is required by one-hundred percent of our patients. That skill is patient assessment. And, contrary to popular belief, patient assessment is more than reading down the checklist you were supposed to memorise in EMT school. In fact, patient assessment is not a "skill" at all. Patient assessment is an cognitive process that requires a specific aptitude and intellect. And, unfortunately, not every person who can pay their thousand-dollars and learn to perform CPR has the aptitude and intellect to become proficient at patient assessment. Consequently, all of those repetitive "skills" they learned are all but useless to any employer. If you cannot accurately diagnose the problem (yes, I said DIAGNOSE! Don't give me no $hit about it!), or at least narrow it down to the most relevant possibilities, then you have no business calling yourself an EMT or Paramedic. And that is exactly what the National Registry -- despite it's faults -- effectively measures in those candidates who take it. Do I have faith in ANY individual school to assure that its students leave their school with both monkey skills AND the medical foundation necessary for good clinical judgement and patient assessment without independent oversight and validation? Hell no! If you know of, or have ever even heard of one school with a bad reputation, or one EMT graduate who had poor "skills," then be honest. There is no way you can intelligently argue that allowing each school to establish its own criteria is a good idea. I am certainly no defender of the quality of the NR or their exam. They have problems on several levels. But the remedy to those problems is to either participate in the process to have them improve, or for your state to simply write a better test. Poor standards are not cured by more poor standards. No good can come from this idea. And Ohio will become the laughing stock of the already pitiful U.S. EMS community.

Ooooh, good point! What actually goes on inside the ambulance is a complete mystery to most citizens. You're right, all they see on the news is the stretcher being loaded in and the ambo taking off. And, of course since the dozen hosemonkeys standing around in bright yellow reflective gear dominate the picture, they also assume, not surprisingly, that it is the fire department who is running the show.

Good recommendation. Another good alternative would be a basket stretcher. Less likely to drop anybody that way. If they need a backboard, they need a medic. And, of course, if they don't think they need a medic, then they don't really care about themselves anyhow, so screw 'em.

Agreed, but let's not forget that a very large number of EMT students are hardly adults in the sense of maturity. :? Unless the pool of students grows up, we will have to continue to teach them like kids instead of adults. But yeah, at least a BS for teaching -- including specific university coursework in education -- should be required. Wwithout four full-time years of university, you simply haven't experienced enough true education to know what it is, much less practise it. Being a good medic isn't enough.

Hmmm... I wonder if that qualifies them to do tongue piercings? It definitely pays better than an EMT!

Isn't that what I said? But yeah, spending a day learning about a drug isn't education. It is training. It is a piece-mail approach to the profession of medicine. It does not adequately prepare you for the provision of advanced life support. It's retarded, as is your medical director.

If you really have to ask that question, you are hopelessly clueless and incapable of understanding. Which is, in itself, an answer to your question.

Think about it. Where in this country do you think this sort of thing happens commonly enough that they would employ full-time professionals to sit around waiting for it? Answer: nowhere. Consequently, you'll have to find a job doing something else and hope that somewhere down the line they might assign you double duty to be on-call for rescues and such. Probably the only places that really do it seriously are some law enforcement agencies on the west coast, like California. Even getting hired is extremely competetive. Once you do, you're going to have to spend a few years just writing speeding tickets to even be considered for a special assignment. And frankly, not many agencies even have such a unit. The U.S. Park Police have rescue trained techs in their helos, I believe. They, of course, are in very limited locations though, with Washington, DC being the only aviation unit I am aware of. Sounds to me like you need to join the Coast Guard. Bout the only full time job for what you are talking about is there, and they are the best.

Having both worked as an office practice nurse AND dealt with a lot of elderly people in my career, I think I might have an answer here. The elderly woman misunderstood what the "nurse" told her on the phone. That is the most probable of all possible scenarios. But yeah, there are a lot of worthless "nurses" in a lot of doctors offices. Many of them are EMTs. 8)

I agree with you, PR, that progressive change is better than simply whining about the status quo. But, back here on Earth, we also know the reality. That reality is that the powers that be will not allow progress. EMT education cannot be increased because the fire chiefs will block it solidly everytime. It doesn't matter that EMS physicians and educational professionals nationwide are pushing it every chance they get. The politics of the fire service and the "it's all about me" volunteers will not allow it. So, obviously a frontal assault is suicidal. The firemonkeys will shoot us down everytime. That means if we are ever to be successful at elevating the profession, fire service involvement has to be either emasculated or eliminated. That is just as likely, for the same reasons. Consequently, if Bledsoe and the other heavy hitters of our industry can't get it done, then grumbling about it is just about the only option the frustrated professional is left with, besides moving to Canada. So really, I see no point in begrudging anybody their rant on the topic. It's all we have.

Don't forget, 90# females typically get points for hottness. They don't have to do well on the test. You do. :wink: Also, some departments don't have a formal "pass or fail" system on their exams. They simply use the scores to rate you on the list of applicants. While poor performance or scores definitely puts you way down on the list, it does not actually disqualify you. It just means that you hope others score as poorly or worse. That's how the munchkins and whales get in. Obviously, they are taking other factors into consideration in the hiring process and just using physical agility as a measure of potential.

Yes, bouncing around from job to job without seriously choosing a career, as well as attending a school for something you have no serious interest in, looks really good on an application. Not. Whoever told you that lie was wrong on so many levels. Go volunteer at a hospital. That looks good on an application. Being a temporary ambulance tourist looks like nothing more than what it is -- an ego trip disguised as a humanitarian deed. And if your essay, SAT's, GPA, and MCAT scores aren't in the top percentiles, trust me, they're never even going to see that you were an ambulance driver for a couple of summers anyhow.

We have a winner. :thumbleft: Several potential strains of stupidity come immediately to mind: They simply don't have the intelligence to comprehend the inappropriateness of the process. They don't have the imagination to think of a more appropriate process. They're too lazy to develop a more appropriate process. They're setting you up for forced integration in the future. The union has a contract clause that requires all operational employees to meet the same standards. Regardless, yeah... run. Life is too short to work for idiots.

LOL! Good for you for exploring all your options! That's a very good sign. Hell, when I retire again, I might just go open me up a school in AZ that doesn't require EMT experience and make a killing!

It's not obvious at all. In fact, after 33 years, it still completely escapes me, as it does many other EMS veterans. Any medic school that is cranking out people without the experience to solidify their judgment and practice sucks. It has nothing to do with how long you were an ambulance driver before attending medic school. It's about the quality of your educational experience. And I doubt that Arizona requires it. It is more like only the school you are looking at who requires it.

So why are you going to school for something there are no job opportunities for? I'd like to be an Indian Chief too, but I sure wouldn't wasted any time or money going to school for it. There aren't any openings. Not to mention that nobody hires somebody for a job they aren't yet qualified for. :? Consider yourself lucky. Welfare pays better than being an ambulance driver.

The question is really too simplistic. I don't so much advocate the elimination of any level as I do radically increasing the educational requirements for each level. Ideally, it would be a combination of those two proposals that would elevate the profession. For example: Elevate First Responder training to the level of the EMT-B. Elevate EMT-B education to (at the very least) a year long program with the EMT-I scope of practise. Eliminate the EMT-I level, as it is now redundant. Elevate EMT-P education to (at the very least) a two year program (including EMT- with the current scope of practise. And, of course, get rid of the silly EMT title altogether since we will now be educated professionals instead of trained technicians.

Excellent point! I blew a trauma scenario once because during the reading of the script, it was mentioned that there was a staircase near where I found my shooting patient. I forgot that part. There was no staircase in the room this scenario was given in. Had there been, then I obviously would have taken into consideration that the patient may have fallen down them and done a full immobilisation. The advice from this point is that you have to keep your ears as open as your eyes and listen VERY CAREFULLY to what the evaluator is telling you. You can't get tunnel visioned on the chief complaint and ignore all the little details that sound like irrelevant distracters. Attention to detail. It's what being a good medic is all about.

That seems to be a very common theme in PUM's. A greater than normal culture of supremacy, where their people are convinced that their system is the best and can do no wrong. Kinda like FDNY.

Wear it where? Are you talking about gearing up in BDU's for your daily EMS responses? :? I don't think there's any law against it. There isn't here. Although far be it from NYS to make some really, really stupid laws. But you will definitely get ostracised by every other provider in the area as a wannabe wanker if you do that. We've had a couple guys around here do that and everybody laughs behind their backs. Trauma medicine is sort of a misnomer when referring to Tactical EMS. Best I can tell, none of these courses really teach you anything about medical care that you didn't (or shouldn't have) already know. It's not about EMS. It's all about TACTICS and how to function within a tactical team. Your medical knowledge is already assumed. So that patch doesn't make you a trauma god. It just tells everybody you wasted a week and a couple thousand dollars learning how to crawl in the mud with a gun. Doesn't exactly inspire confidence in your medical abilities. I believe most medical professionals would have a lot more respect for you having a degree and some advanced medical certifications than a subdued patch from a week of playing army. And so will the real cops and military medics you meet.