P_Instructor

Watch out. Pushing D50 and the patient waking up is one thing, but when they refuse and you have them sign a refusal without contacting medical control, you are basically practicing medicine without a license. Check the legalities with your medical director. I agree the patient should be treated and transported. If there is some sort of dilema that you have to treat in the dwelling (because of size, extrication problems, etc.) do so, and then if the patient refuses, talk to medical control or have the patient talk to medical control to put that on their shoulders, not yours. AMEN BROTHER! I know this is off subject for this particular forum, but why not try Midazolam (Versed) IM for the seizures before the IO? It absorbs faster than Valium and does work well in our system.

It does depend on the system that you work for as well as the area you service. I believe that it also depends on the type of person you are. I've worked both the 24 and 12 (day and night) shifts. The only draw back is screwing your biorhythms up when you keep changing the shift pattern. It does create a provider to patient problem when you are up and working for the whole 24 hour shift (it can be done, but who wants to keep the coffee companies in business). My advice is if your employer is willing to let you try out each shift, do so, and choose the one that best fits.

I agree. Knowledge is great, but you need the competency/skill mastery along with the knowledge base to be a good Medic. They go hand in hand. I think that institutions that provide the National Registry Skill Evaluation need to step up their game. I hammer my students (and also get headaches from banging my head against the wall) every day on skill mastery. They get to the skill stations and breeze right thru them, then come back to me and say they were too easy (wow, get that from a student!). If they are not competent in the clinical setting, keep on them until they can do it in their sleep, then scenario them to the brink of extinction using knowledge and skills to be a good Paramedic.

Thanks. It was meant for a snicker or two, but I am apparantly like you.....an old time Medic (20+ years) who had the old curriculum and was taught these skills. I just wanted to see how 'wide-eyed' the newer Medics would respond.

How intense is the subject matter? Are you thinking like a First Responder course or EMT-Basic course? First out of the gate, look at the First Responder with additions that would meet the needs of the country and area you will be teaching.

I apologize...it was meant to be in fun only. Subclavians are cenral lines, and have worked with them in the aeromedical field only upon very discipline Medical Direction only. Have also done a couple of femorals. I do agree with you completely. The EZIO is probably my best choice, even though the EJ is not difficult if done correctly (which would be dependant on availability or position for access). Again, sorry for the confusion.

Perfect Medic vs. Nurse story....Working flight (rotorwing) shift with new flight nurse. All he wanted to do was be able to intubate someone. Tired of all the practice and wanted 'real' patient. Got request for scene flight with local service and information received was for 'cardiac arrest'. The nurse's eyes got big and very happily offered his services to intubate the patient in which I replied, "Hell, I don't care as long as it gets done". As the nurse was getting the airway equipment ready, I began thinking (as a paramedic would), how can I screw with him? We landed at the scene and exited the aircraft. Walking up to the ambulance that housed the patient, I realized this was my chance. I asked the nurse if they had the monitor in which their was this perflexed look of confusion on his face, realizing that he forgot to grab it. He immediately retraced his steps to the aircraft to get the needed equipment. As this was being done, I entered the ambulance via the side door and took airway control. As I was intubating the patient, the nurse opened the back door and viewed me now confirming proper placement with this astonished look on his face. Little did he realize (but which I knew) the service already had a monitor/defibrillator placed on the patient. My only words to him was............ROOKIE! He had never forgotten this incident and still shakes his head everytime there is the possibility of intubation. And you can bet I will never let him forget.

Perfect response! I think it just may be your area. I currently instruct a Paramedic class that can be offered either diploma (just the Paramedic class) or also the AAS (Paramedic class with specific college course requirements). The kicker is that the current class has 4 fire fighters (1 basic and 3 intermediates), all looking to improve their own knowledge and skill base. The aspect of starting Paramedic Engine Companies is a National trend, but could have problems (i.e. the Naples, Florida debacle) unless everything (and I mean everything) is completely spelled out in what needs to be done and what is expected. My opinion is that many Fire Departments are looking into EMS because we handle more call volume (even though we are reimbursed less). This sounds like job security. It will also be determinate upon if Fire Departments are transporting patients or just providing first response (non-transport). I believe the majority that the fire unions are pro education and responsible for many increases in EMS education is FALSE. Personal note - Love the area around there, vacationed at Royal Gorge and made it into Canon City numerous times.

I bet if the dog was a Dalmation, it would have been given a burial with a Honor Guard!

Has anyone thought about a subclavian? Lets break out the 14G (2.1mm) 5 1/4 (13.3cm) Angios and head for the hills!

Well it always takes a "BOOB" to want to photograph a 'Boob'.

Medical Directors NEED to take an active role in pre-hospital medicine and care. The paramedic is working under THEIR license. It is to the point now that even when taking a Paramedic class, the National Registry will soon not test anyone unless they come from an accredited institution. To become an accredited training facility, it is imperative that there is ACTIVE MEDICAL DIRECTOR involvement. This is what the country needs. Competent Paramedics that are looked over by medical leadership in the emergency field. Trust me, I know. We've recently become accredited and this was one main point in the process-------ACTIVE MEDICAL DIRECTORSHIP in training and operation of services rendered to the public, our clients that pay our wage.

Who in their right mind would want to become the Medical Director for this Department? No pun intended, but I thing the FD 'burned' the only bridge they had. I would not grant anything unless all the evidence was presented, and there was a complete CQI process in place and place the service on 'probation' for a minimal of 2 years until everything has compliance. The new Medical Director better know what he is getting into, or the union may just pay under the table for one to get their wishes......easy street without having to do anything, and non-competence in the public's expected standard of pre-hospital care. They want to be firefighters, let them. Get them out of the Paramedic field. Deny any application for Paramedic status and leave it to the true professionals that provide the competent care.

OK, So we have the Medical Director doing his job, the Fire Department in an uproar because they don't like the way he supposed to do his job, the FD union throwing their weight around, the council cowering underneath their desks, Firefighters not keeping up on their skills, the public potentially suffering the consequences, cats fighting dogs, mass hysteria............... Question......What in the State EMS Bureau/Department doing about this? Are they involved in any investigation? Should they be? Oh yeah, State of Florida. This could come down to a recount. Fire the FF/Medics, retain the Medical Director, kick the Councils Butts, and what is the true public opinion?

From Wikipedia, the free encyclopedia Within emergency medical services a medical director is a physician who provides guidance, leadership, oversight and quality assurance for the practice of local paramedics and EMTs within a predefined area. The medical director is generally responsible for the creation of protocols for treatment by paramedics. The medical director may also assist the EMS agency in extending its scope of practice. While this definition is a fair description of the role in North America, significant variations can occur in other countries and in other health care systems. Note: In the interest of clarity, medical directors exist in a variety of other settings in addition to EMS. It is largely a generic term used to describe a physician who has responsibility for the medical control and direction of various types of organizations. Enough said. These gentlemen are working under the medical directors license and need to follow his rules. Rarely do you see a Medical Director that is this involved within the EMS community. I applaude this Medical Director for he is making sure that the Medics that work under his guidance meet the criteria to provide the upmost care.