Dustdevil

The problem is, God is the one who gave me my problems in the first place, and she has a strict no return policy. Therefore, I deal. The only option is suicide, and I enjoy living too much.

Yes, but we're not talking about healthcare providers. We're just talking about ambulance drivers.

I would have. In fact, that was my immediate impression from your first paragraph. Great case presentation, GC! It is a reality check for all those people out there who think that training is more important than education, and that only skills separate basics from medics.

Anaphylaxis, yes. IM because if they are already in anaphylaxis, the sub Q circulation is already compromised to the point that absorption will be seriuosly delayed, if not almost prevented. Consequently, IM or IV is the way to go. I have seen anaphylaxis patients given a couple subQ epi's with no improvement. Then when they got IM or IV epi, their circulation came back to normal, dumping a milligram or more of epi rapidly into their now normotensive system. Not good. Especially in an older patient. For that reason, SQ is strongly discouraged in anaphylaxis.

Yeah, I wasn't disagreeing with you at all. Just with the theory of making people go find "experience" that they should have gotten IN school, not after it.

Such questions will always be a question of local policy. That is nothing that any of us here can answer. Qualified? Probably. Allowed? It's up to that hospital and possibly up to your state certification agency. Here, I know lots of medics who have applied for phlebotomist jobs only to be told they must have graduated from a phlebotomy school. Other hospitals are hiring them to suture. So ya never really know. :roll:

She would be accommodated, just like the nurse who refuses to participate in abortions, or as I was for refusing to participate in circumcisions. I suppose the difference is that EMT's and medics are a dime a dozen. Nurses and pharmacists are not.

It's a good premise, but a bad approach. Medics and EMT's should be getting sufficient experience BEFORE they graduate, not waiting until they are a primary provider to get their $hit together. 150 hours to be an EMT? Ha! They should be getting twice that amount of time just in field practice, not even counting classroom. It is not the job of employers -- especially transfer services -- to educate EMT's and paramedics. It is their job to employ them. The education system needs to get their act together and start producing adequately prepared graduates. Until then, it is laughably hypocritical for them to not want to admit somebody for a lack of experience.

Agreed. As both a medic (public and private) and an ER nurse, I can assure you that the uniform makes a difference in many cases. That's sorta like saying it doesn't matter what a girl looks like as long as she has a great personality.

There is a very good programmed text that teaches med term, much like the Dubin book teaches EKG's. If nothing else, it would behoove any EMT or medic who has never had a formal class to buy that book and complete it on their own. But I know... far be it for the average EMT to accept that he doesn't already know everything he needs to know.

Could be the fire department uniform. :wink:

Would you change the levels of education and training for these?

I was lucky to learn that in EMT school. The instructor was constantly throwing PVC's (as well as a long list of other medical problems), and she had each of us check her pulse while watching the monitor so we could see and feel how it actually affected the pulse. It was a great experience. Too bad all EMT instructors don't have heart problems!

I did not mean to imply that conscious intubation was a rarity in the other thread. I was saying that it is extremely unlikely to be peformed by a basic. To clarify your point, are you saying you use topical anaesthetic spray for intubations in your system?

I got interviewed for a career day video some high school student was making some years back. She asked this question and I made up a total bull$hit story about how I got all reflective and contemplated my career and the meaning of life. Truth is, it was just another run. Left and drove back to the station to watch television and eat lunch. Never gave it a second thought. I've never given any of them a second thought.

P1, P2, P3? = Dispatch and transport priority codes. Priority 1 is immediate life threatening emergency. Priority 2 is potentially life threatening emergency. Priority 3 is a non-life threatening emergency. Uaually, P1 or P2 means with lights and sirens, and P3 means without lights and sirens, but with due haste. ETOH? = alcoholic beverages SNF? = Skilled Nursing Facility (nursing home) Dx? Diagnosis? CXR? = Chest X-ray LPM? = Litres per minute of oxygen flow (also possibly confused with LMP = Last menstrual period) DNR? Do Not Resusitate MVA? = Motor Vehicle Accident. Not necessarily multiple. HGT? = possibly HCT which is Hematocrit, a measure of the red blood cell percentage in the circulation. GCS? = Glasgow Coma Score. A number between 3 and 15 that represents a rough assessment of a patient's mental status. PVCS? PVC's are Premature Ventricular Contractions, but I don't think it was meant that way... ICP? = Intracranial pressure. Like blood pressure, the pressure in the head goes up in response to certain injuries or illness. Not measured in the field, but it manifests itself through several observable signs the paramedic can see. I would only be guessing on DNI, DNH, AMS, and COA. However, COA may actually be GOA, which means "gone on arrival," or the patient was not found at the scene. Narcan is an antidote for opiate narcotics like morphine and heroin. Simplistically, it goes into the bloodstream and knocks the opiate off of the nerve cells they have bound to, stopping the effect of the drug they have taken. Lavage is to wash out a body cavity, like the stomach. A tube is placed into the stomach through the nose or mouth, and a lot of water is flushed in and then vacuumed back out to remove all contents and toxins. Usually done for overdoses of pills. EDIT: Damn you, Robert!!

Of course, job experience is not the "life experience" that was being referred to in the earlier post. And job experience is a whole 'nother issue for a different thread. But I would like to point out that the lack of entry level medic jobs is a consequence of allowing EMT-B's to work 911 ambulances. Nine out of ten employers are going to opt for the cheap labour over the qualified medic.

Remember, VS, even though the City of Toronto may, most employers - here or there - do not require that in-depth of a physical exam for employees. But also remember before you get too long winded about our inadequacies, almost every employer here does test for drug abuse, unlike there. I'll take a hearing impaired partner over a strung out partner anyday.

What are you going to school for? That could make all the difference in my advice.

That is pretty much what my personal policy has always been. And, except for one employer (a fire department, of course), it has always been policy that EVERY patient encountered gets transported if he or she wants transportation. Even if you are the last ambulance available in the county. Now of course, I do agree with Rid that this is far from ideal. In fact, it makes about as much sense as immobilizing everybody who is an any MVA. But unfortunately, there is no nifty little algorithm backed by NAEMSP that purports to reliably and safely sort those in true need from those who do not need us at all. And with the sad state of EMS education in this country, I personally have no faith that every medic in my organization (if I had an organization) possesses the medical knowledge and critical judgment necessary to make that determination with one-hundred percent accuracy. So, despite the fact that we all know there must be a better way, we have yet to find it. Therefore, you call, we haul.

Back pain and neck pain. Chest pain and abdominal pain. Pain all over. Headaches. Weakness. Fevers. Difficulty breathing. Altered mental status. Unconsciousness. Nausea and vomiting. Fractured hip. Fractured ankle. Head lacerations. Hand lacerations. That's the most common complaints. As you can see, EMT school doesn't hardly prepare you for any of that.

The conventional wisdom, and my natural inclination is to set a lower age limit. But when considered realistically, I just can't do that. Any number you set would be extremely arbitrary and probably without significant scientific or factual support. If there are any scientifically valid controlled studies that set clear age limits on maturity, I would certainly like to see them, as I am completely open to suggestion. But I think that all of our speculation is anecdotal at best. So, how do we do it? Why 21? Where do you get that number from? What credible evidence do you have that excluding 18-20 year olds from the profession will improve the delivery of care? Let's see the evidence! For every immature 20 year old you point out, I'll show you an immature 30 year old currently practicing in the field. Then what? The only tangible justification I can think of for a minimum age above 18 is insurance regulations. If your agency's insurance carrier says there is a half a million dollar difference between insuring drivers under 25 and over 25, then there ya go! The choice is obvious! But that doesn't have anything to do with patient care. That's just driving experience and maturity. I think it goes back to education. Education is the cure for ninety-nine percent of all the ills of EMS, and I think that includes this one. If candidates spend two years in college becoming an entry level paramedic, it will go a very long way towards solving the maturity issue. If nothing else, it will ensure that most medics are at least 20 years old when they start practice.

Yes. The legal age of consent plus two years. Age of consent because I want the option to take advantage of my partner should the feeling hit us. And plus two years because that is the minimum amount of time they should have spent in school to become a medic.

Very optional. Since we were in the front seat and they were way in back, they usually couldn't hear us over the roar of the 454 and the wind coming in the windows anyhow.

I thank God there is no ACLU in Canada. and...