Dustdevil

Just for clarification, are you wanting to start an EMS service, or just an ambulance service? The differences in funding possibilities are vastly different.

Such is the nature of statistics. Bad choices or piss poor planning. I've managed not to knock anybody up in the last 48 years. Those who are less responsible are not my problem. Nope. I only want to meet my primary responsibility: to provide reliable service to the citizens I serve. Absenteeism by females is a concern when planning for that provision. Therefore, I will take it into consideration.

If anybody has ever wondered why the nursing profession is so screwed up with it's perpetual shortages, there is your answer right there. Any profession predominated by women is going to have such problems. They simply (and correctly) have priorities that take precedent over their careers. As the percentage of women in EMS increases, we will undoubtedly encounter those same problems profession wide. *takes mental note to hire as few females as possible when running EMS agency*

I've used cocaine in the ER for nasal haemostasis, and seen it used for nasal intubation. Of course, it is an ingredient in TAC (c for cocaine) too. Those are the only medicinal uses I have seen for it.

The big problem is that we have been jerked off for so long by the AHA that we really don't know what to believe anymore. Bretylium, anybody? :?

The only place this will have any potential usefulness is in those areas that would be the very last to afford it. It's pointless in an urban system. And rural systems are still whining how they can't even afford to hire paramedics, so they're not going to show up in those areas. Instead of all this focus on expanding the paramedics scope of practice, how about somebody seriously focusing on educating paramedics to the level they SHOULD be for the skills they already have?

There is another "when pigs fly" proposition. The people who make such decisions for many services are completely clueless about communications. And like most every other public safety agency, they live in their own little world, completely oblivious of the need for interoperability. If a medic or two says it would be nice to have a direct frequency or two for scene usage, they get looked at like they have three eyes, or have just accused the manager of incompetence. Forget getting any kind of positive response to that. Once I moved from a rural, county based service that had all sorts of commo options (full interoperability with all agencies, plus direct channels) to an urban system who honestly had no clue that EMS could operate anywhere other than the 10 MED channels. I carried two VHF-Hi walkie talkies in my duty bag. They had all the PD, hospital, helicopter and inter-agency frequencies in them, plus several direct channels for comms between my partner and I. Frequently I would have FD or a supervisor come to me on a scene to borrow one. But I still got called a wanker. :roll:

Not the question that was asked at the beginning of this topic. It very specifically said there were no circumstances which required rapid transport or departure from the house. That is why I worded it this way, so I wouldn't hear a bunch of "what ifs" and "whatever the patient requires" equivocation. Again, the question is -- very specifically -- all things being equal, and you have no need to immediately depart the scene, do you work your medical ALS patient where they lie, or do you routinely drag every carcass back to your "domain" out of pointless habit?

Ah, okay. So it's not about the patient. It's all about you. Nice.

It's not about validity. It's about usefulness. That would be why I specifically used the terms "pointless" and "useful." And it is why I specifically did not use the terms "flaws" or "validity." I think this points out why you fail to realize the pointlessness of this and many other studies. You obviously are not reading closely. You think people are saying things they have not said. But since you are looking for personal confrontation here, let me ask you; do you have express written permission to reprint and distribute these copyrighted works? Can you provide us with proof of that permission. Certainly you realize that such things are regulated by federal law, right? Not to mention this little gem from the EMT City Terms Of Service:

Doesn't matter. That time would have been wasted by the physician trying the exact same thing anyhow, so in reality, you have lost no time whatsoever. But if you wait five to ten minutes to attempt that intervention because you want to get on the road first, then you HAVE indeed wasted time getting them treatment. Again, this is regarding those conditions in which we are providing the same therapy that will be given at the ER. I am not referring to any situation where surgical intervention is the immediately required definitive care. Again, you ARE delaying their care if you have the means to provide it, but are not giving it to them in the house.

That's a very good point, with significant historical precedent. But I don't see it as a problem, really. What will be pushed is that the states will have to meet that changed minimum standard, which is *mostly* a good thing. But again, I don't see this affecting anybody as far as limiting their potential for advanced practice standards on a local level. Rid also makes an excellent point in that the problem is that there seems to be some push for increased ALS skills by basic providers without a significant increase in educational standards. Increasing the capability of entry level providers is a wonderful thing, and I am all for it. But if it is done on a piece mail basis, without appropriate educational increases, then I wholeheartedly oppose it. And the more progressive states will do so also, regardless of what this committee of politicians disguised as fire chiefs says.

Has it even been accepted by the committee? After all, this is the fourth version that has been titled the "final" draft. And if it is truly only a draft, who would rush to adopt it? And why? This thing started out with a wonderfully noble purpose of elevating the profession and assuring that high minimum standards are met across the board. Unfortunately, it has become nothing but a political football, being tossed about haphazardly -- mostly reverse and laterally -- on a field occupied by more than the usual two teams. And as always happens in these bush league kids games, the biggest a-hole on the playground (IAFF/IAFC) wants to just take his football and go home without even playing the game. Of the educators and administrators I have talked with, I have found none who are the least bit interested in rushing to adopt any of this. In fact, most threw their hands up months ago.

Another absolutely pointless study that tells us nothing of any use or consequence. I dunno what you are paying to subscribe to all these articles, but I think you're getting ripped off. Looks like the number of them that actually offer a useful conclusion that we did not already know is extremely low. I recommend somebody do a study on that and submit it! A lot of these so-called "researchers" are just going through the motions without achieving a single solitary thing. Reminds me of a karate student bringing balsa wood boards to class to break instead of white pine. Sure, he goes through all the same motions as the other students, and even breaks the board, but in reality he hasn't achieved anything. What a joke.

I think there is a deeper question here. Is it not important to distinguish those patients with instabilities that we can correct from those with instabilities we cannot correct? Our ultimate goal is the improvement of the patient's condition and outcome. Sometimes the only way to achieve that is by rapid transportation to surgery or other definitive resources. But many other times, it is achieved by us in the field through medical intervention. I don't care how "unstable" my patient is, if the cause is something I can correct, then the place to do that is here and now, not later. Our decision to stay or run should be driven by science, not by adrenaline.

I'm not going to go find the stats to prove the obvious. But most states have a statistical breakdown of the registered personnel in their state which clearly shows that the majority of registered EMTs do not actively work in the field. And then, as you note, only a fraction of those actively working actually work in 911 EMS. Texas' stats were recently discussed at length on the Texas EMS discussion group, so I am acutely familiar with them. And similar statistics have long been discussed nationwide. With all the EMT's we keep cranking out, all the employers are still wondering where the heck they all are, because they are not working.

Fact: MOST EMTs do not work in EMS. Therefore, it is a fact that most EMTs are not providing patient care. What is to dispute?

That hasn't been a problem for me. There are at least two of us, each with two hands. There is no reason for me to ASSume I won't need the airway/oxygen, med kit, Lifepack or suction unit for any kind of medical run. It all goes in, each and every time, without exception. Only trip back to the ambulance is for the cot. And the fire monkeys usually get that privilege. The only time in the last ten years of my career I made the patient's side without the equipment I needed for care (excluding immobilization) was the time my partner accidentally left the Lifepak at the ER when restocking after the last run. Yeah... that was not a fun lesson! When you ask for a second ambulance to be dispatched to assist you on a simple "chest pain" run, and you already have FD on scene with you for assistance, the dispatcher tends to ask you over the air why you need a second unit. And I found out that they will not accept "equipment" as your answer. Pretty damn embarrassing to admit to every other medic and scanner listener within six counties that you don't have your damn monitor with you. :shock:

But the majority of transports made by the majority of EMTs are simple transportation without medical care.

Safe for whom? The medic, or her unfortunate partner?

Sure are a lot of people out there doing lame, pointless studies. I think they just like seeing their names in print. They want "credits" to pad their resumes. This study tells us nothing we didn't know 30 years ago. What next, a study to tell us the sky is blue? :roll:

Why? You carried all that crap in. Why not use it?

Chet's right about that. Doesn't happen as much in the fire service, simply because there are not many females and there are always other people in the station with you, lol. I can assure you from experience that it happens a LOT in the police service. Those guys are shagging each others wives. Closest I have come is dating other nurses working in the same ER as me. Not quite the same thing though.

Not often enough to make me watch.

Yeah, that's my category. Choices 2 and 3 both applied equally, so I didn't bother to flip a coin and vote.