Dustdevil

Good point, and I should have made that clear. No machine becomes my primary for anything except transportation and defibrillation. Otherwise, manual is the standard by which I live. But for serial measurements during transport and care, these machines are valuable (not INvaluable) tools that I would rather have around than a pulse ox or an ear thermometer.

Never heard of PB or EA either, for that matter. I thought you were just dyslexic or something. :? Anyhow, I have only used one electronic BP thinger in the field, and that was at a flight service over a decade ago. It was quite accurate and perfectly reliable. And I never experienced any significant problems with the electronic machines in hospital practice. I hear a lot of people slamming them, but nobody saying they have actually had first-hand problems with them. Funny how something as tried and true as these machines get slammed, while dubious devices like pulse oximeters, and worthless crap like the ear thermometers get praised by the same people. And yeah, there are plenty of times when either the ambient noise or chaos preclude easy BP auscultation in the field. Even more times when you simply have other things to do with your only two hands. They were great devices when I last used them. And I can only imagine that they have gotten smaller and better in the last decade. Unless you are going to give me a full-time partner who does not have to drive also to do it for me, I would like to have the device available.

How is success defined?

It is over fifty percent greater than minimum wage. And in this country, we don't have to give sixty-five percent back to the government in taxes.

English please?

Hmmm... there seems to be some confusion up there then. As recently as two weeks ago I was told on the phone by TDH that only EMS associates degrees qualified for LP. All others must have at least a bachelors. And the TDH website still says that. Not that confusion is uncommon at TDH. :roll:

Thanks for that insight, Zip! This is the first I have heard of UK training titles. Can you give a little info about the educational requirements for each?

You would if you had it. Incorrect. Unless your degree is in EMS, you must have a Bachelors (four year) degree or higher.

I'm completely with ya, Kev. I have always suspected that the case against analgesia for the acute abdomen has been overstated and unsupported by the evidence. But, as always, we have to live with the sacred cow until somebody gets the guts to slay it. That's a good article, and I hope that the author and others are actively pursuing definitive evidence to start some positive change in medical practice. The worst feeling as a paramedic is being unable to alleviate somebody's pain. It's worse than watching them die.

I'd like to see if there has been any studies done on this, as opposed to us simply running off of old myths, like the so-called "Golden Hour." It appears the aim is to allow the physician as quality of an examination experience as possible in order to eliminate the need to do laparotomies on people to r/o surgical abdomens when they might have been able to rule it out through exam if the patient had not been gorked in the field. That is an admirable goal. But again, I would have to see studies showing that field administered analgesia actually impacts the surgical decision process in reality before I would be 100% for or against field analgesia in acute abdominal pain.

I suppose that same doctor gets upset if his patients are shot before they arrive at the ED. After all, if he doesn't see the injury occur, how can he adequately assess that hole in the patient's chest? :roll: Ask him how the presence or absence of chest pain upon arrival changes his plan of action. Be prepared for a long, awkward silence. Or a bunch of irrelevant babble. How old is that idiot? Are you sure he's not an intern?

No Massachusetts paramedic schools are accredited by the AMA, CoAEMSP, or CAAHEP. Not Rhode Island either. Closest one is in New Hampshire. Call them up and ask them why they are not. I'd be interested in hearing what excuses they offer. Sorry to hear about your situation. That is entirely unacceptable and disreputable. It is evidence of the poor state of EMT education today, not just in Mass. As for your question, since I don't live up there, I can't really offer you any useful insight. All I can say is that most places I have worked have openly welcomed students. If your school is not arranging this time, I would suspect it is because they have a poor or non-existent working relationship with area EMS providers. And again, it is unacceptably shady that they would offer an EMT course without such a relationship. Call the EMS providers in your area and see if you can arrange something on your own. You won't know until you try. But make sure it is an EMS provider, and not the local transfer jockeys. Good luck!

:shock: I am beginning to understand why there are no accredited medic schools in Massachusetts.

Not anymore. Check ebay!

You forgot "LP" or Licensed Paramedic. It is one step above EMT-P in Texas.

Very limited. :? Now it takes you to a registration page to view the article. Can you summarize for us?

Oh, how we only WISH that were true! One word: Bretylium

I'm thinking it is a relatively new term. I never heard of it until two weeks ago at review.

"Anginal equivalents" is basically a set of signs or symptoms which lead you to suspect AMI even in the absence of chest pain. They include all the normal s/sx we look for, including dizziness, SOB, n/v, and diaphoresis. Also included are atypical pain presentations, such as pain in the jaw or neck, shoulder(s) or arm(s), back or abdomen. Obviously, the more s/sx present, the more confident you can be in your assessment. Significant 12 lead changes solidify your diagnosis. There is a current trend towards treating anginal equivalents as aggressively as a textbook AMI in the field

As for whether or not it is "worth it," that is going to depend a lot upon you, your education, and your job. If you are less than a paramedic, I'm going to say your time and money would be a lot better spent on something more appropriate for your education and skill level. You'll see and possibly do a lot of informative and educational things, but if you have yet to even learn the basics of F&E's, acid-base balance and advanced airway anatomy in paramedic school, then 90 percent of this is going to be over your head. Sort of like taking calculus without first taking algebra, geometry, and trig. You will never use the advanced skills you learn in that class, so although you may find the knowledge enlightening, you won't maintain any of it.. So no.... I wouldn't say it would be "worth it" for you. At the price, it's hardly worth it for the majority of paramedics unless the "been there, done that" bragging factor is worth a few hundred dollars to you. On the other hand, if you practice in a rural, hospital based system, or are planning on heading to Iraq or Central America soon, it may be something worthwhile for you. But even then, skipping ahead to emergency surgery without first learning the basics is not really an ideal way to go.

It is going to depend upon exactly what sort of position in EMS you take. If you're going to be a first responder, then it won't be as much of an issue as being on an ambulance. But being on an ambulance definitely takes its toll on the back over time. You can minimize the impact through proper usage of body mechanics, posture, and lifting technique, as well as always getting help when available, rather than worrying about your pride and trying to do everything by yourself, or with just your partner. But even then, you are likely going to lift, twist, or bend just the wrong way sooner or later, and then you get to be a patient on your own ambulance. Remember, even with roll-in cots, you still have to lift the patient onto that cot first. And you will still have to carry the patient AND the cot over rough terrain, curbs, up and down stairs, etc... And when you are lifting patients to and from hospital/nursing home beds onto your cot, you cannot maintain proper posture. You're going to be leaning. That is where a lot of the injuries occur. And it is why nursing is so hard on the back. Bottom line is, if you are on an ambulance, there is no way to completely avoid high stress on the spine. I would recommend that you talk to your orthopod about it. He's in a better position to judge the vulnerability of your back than any of us are. Be honest with him about the types of weights you would be lifting. If he says go for it, you definitely want to start and maintain a regular regimen of exercise designed to strengthen and condition your back and stabilizer muscles to minimize the risk of injury. Good luck!

I see the most potential for this technology being in rural areas where transport times are extended and the ability to get definitive therapy started half an hour earlier can make a big difference. Unfortunately, as with a lot of technology in EMS, those who need it most can afford it least.

Well, then we are on the same page now.

Correct. But that wasn't my point. My point is that you cannot honestly dismiss the majority of the nursing profession as non-existent simply because one or two urban hospitals in SD don't hire them. That would be analogous to dismissing the majority of paramedics because they aren't firemen. Correct again, but what's your point? Does a 4 year degree make you professional? What about a masters degree? Does that make you professional? You're playing a numbers game that doesn't seem to have a point. What on earth are you talking about? I didn't attack you, your education, your intelligence, or your professionalism. I had no idea what your educational level even was until now. But since you mention it, I would have expected you to be able to spell "genius" correctly. What's with all the victim mentality on this board? :roll:

You can't be serious. :? Kansas doesn't recognize paramedics without a 2 year degree. Should we not mention them either? Just like tech-school medics, 2 year RN's are the vast majority in their field. And I can't imagine that in rural SD, there can be any institutions no longer recognizing them.