WolfmanHarris

Welcome to the City. I'm not from Chicago, so I'll only respond to the couple of points I have some input for. Don't bother. EMS isn't skills and adding these things without a good foundation of knowledge is a waste of time. How much understanding do you think you'll get of cardiac physiology or fluid balances in a short workshop on ECG and IV therapy. Without the grounding in A&P and patho you're learning skills, not prehospital medicine. Hold off on these merit badge courses and get a proper education. Neither course is of real benefit to you as a basic. ATLS can only be audited by non-physicians, not taken for certification. ACLS is for healthcare providers and the course is of arguably limited utility even then. Depends on the area but from my understanding most HEMS programs in the USA are RN centred with medics being in a secondary role. If medicine interests you, go to Paramedic school as quickly as possible, preferrably a college program (I think they're Associates degrees in the states). EMT-B and Paramedic courses don't really speak the same language and you can pick up some bad habits to unlearn. That being said, this is HOTLY contested. Please use the search function to find the corpse of this horse. I ride in an Ambulance, though sometimes I take the bus as parking downtown can be expensive. Other than that I come from an area that is all third service municipal EMS. I will withhold my thoughts on Fire based EMS and once again strongly suggest you search this topic too. You'll find it among the top three overdone, knock-out drag down fights on this site. I'd say our top three arguments are some variation on the following: 1) Education and experience? Basics good or bad? 2) Fire Based EMS, Good or Bad? 3) Volunteer vs Private vs Public vs Fire vs Hospital vs Circus based EMS? Once again, welcome to EMT City! Keep an open mind, be willing to challenge your assumptions and don't take things personally and you'll do just fine. Cheers, - Matt Edit: Shouldn't have taken that break half way through typing this. Things really picked up in the interim. Once again, I draw your attention to "don't take things personally." Some of the members here (myself included) can be REALLY unforgiving sometimes.

Check out their site. They cover an area of 17000 people that's mostly rural. They have the following apparatus: - 3 Pumpers - 1 Rescue Squad - 1 Ladder - 2 SUV's - 1 Crown Vic - 1 Brush truck AND the two gigantic Ambulances Take a close look at the compartments on those ambulances too, they're not carrying a tonne of equipment in there. I stand-by by big frigging waste of tax payer money comment. In comparison, the town of Cobourg in the county I've been riding in has 18 200 people. They have a paid department with volunteers (who are paid for weekly training and all calls) as back-up. (EMS provided by County Third Service; 1x24hr ALS and 1x12hr ALS Ambulance just for Cobourg) Their apparatus includes - 2 pumpers - 1 mini-pumper/light rescue - 1 Ladder - 2 SUV's City of Peterborough (where I live) 74 800 people has an entirely paid department at three main stations and a back-up airport station. (EMS provided by County with 5 24hr ALS Ambulances and 1 12hr ALS Ambulance within the city) Their FD apparatus includes - 4 pumpers - 1 ladder - 3 SUV's - 1 Brush truck - 1 Water rescue trailer - 1 Special Ops (HAZMAT, trench, confined space) trailer - 2 public education and inspection vehicles - 1 crash tender (reserve) at the airport Maybe our area's drastically underserved and I don't realize it, but I look at this VFD and I see a tonne of wasted money in all the wrong areas.

Why am I not surprised they're a volunteer BLS only service? Why the frack do you need a rig that big for BLS?! Maybe spend that money on some ALS coverage or even two reasonably sized ambulances? And look at that cab; what exactly do you need 4 basics on a crew for? This VFD has as many apparatus (not counting EMS) than the paid professional department in my city of 80 000 people. Waste of tax payer money, big time.

Do the counties have active, accessible medical directors? Meet with them briefly and get ahead of this, let them know you're simultaneously trying to remember two sets of protocols that while essentially the same, vary in the details. Ask for their patience and trust in your clinical judgement and let them know that until you have both down you'll be referring to your protocols on the call more often then you'd like in order to ensure you have them correct. If both are reasonable they shouldn't have a problem with this. I know my preceptor ran into this when he came to his current service (and different base hospital) after 8 years in another service and a short stint on CCT mixing things up. He carries his book in his leg pocket and refers to it regularly.

That's an Ontario college too. Not sure which one.

I quickly hopped onto the Illinois Department of Public Health website and a quick search there didn't dig up anything too helpful. You're best bet would be to contact them (if you haven't already) and get the requirements. Once you post them here it may be easier for us to provide relevant suggestions, because as it stands now you haven't given us a lot to go on.

Agreed.

I'd imagine you'd need a strong state EMS authority to set standards and to increase the minimum. It wasn't that long ago that BLS education in Ontario went from one to two years in the length. The main impetus for this was the inclusion in 1996 of SAED and symptom relief (ASA, NTG, Glucagon, glucose, epi and ventolin) to the BLS scope. After a few years of it being essentially in-service training it was moved from the services to the colleges and at that time the province changed the length of the program to not only reflect these skills (which realistically isn't a full year's worth as written) but an increased depth of knowledge of A&P, patho and the like. The timing of this was around the same time that the province downloaded operation and funding for EMS to the upper tier municipalities so it can be hard to draw a clear correlation between it and the other many changes in EMS in Ontario, however, after this Ontario saw a drastic increase in wages. We now make an income comparable to RN's in many specialties.

So would it be best to rethink the education so that the experience gained at a BLS level is actually relevant for the eventual ALS provider? Ensure that BLS education is longer, covers A&P, pharm, patho.

Ya it's so crazy to have the person whose medical license these idiots operate under to set standards and expect them to be met. Demanding honesty and competence, I mean who does this. Doesn't he know that these FF's only want ALS for the job security? Did he not receive the wink-winks and nudge-nudges at the appropriate time? I mean come on, who forgot to let the Doc in on the joke?!

What is this based on? Anecdotal evidence is quite possibly EMS' biggest enemy. Since we've all seen something work, or make a difference we are awful for refusing to accept evidence contrary to this. That being said, I've been keeping an eye out for a study on response times with L&S is rural areas. Where I'm consolidating at the moment is very rural with single lane roads. People in this area are very good at moving to the right. I've done some back of the envelope calculations on some of our responses and have found that when we proceed L&S (allowing us to travel 100km/h in an otherwise 80km/hr zone) with everyone moving to the right I've noted ~20-25 savings in response times, which equals about five minutes for our average rural response versus responding non L&S. Is this time clinically significant? I highly doubt it. About the only consistent benefit I've come up with is that without L&S our ability to meet the window for the regional stroke centre or STEMI bypass might not be met as often. That and we keep beating the VFD to all these calls they're tiered on, which should make it easier to claw back the tiered response agreement so that we don't have them "first responding" to all these calls. But remember this is one station in a county, in an entire region of the province. My one unit's experience can't dictate best practice for a profession.

For rant, please see affirmative action thread. Will add more later. For now I will resist to avoid more cursing. Friggin idiotic.

Maybe it's because the ACLU is too busy giving themselves a self-congratulatory circle jerk over how they've been able to lord over and reshape small communities to their agenda (which is incredibly selective of the civil liberties they support) who are unable to defend themselves against their large legal budgets, while still trying to find relevance in the face of increasingly petty fights?! Or perhaps the medical school is right, and this 100% correct description is horribly offensive. I mean every minority group has been able to change their self-identifying language at will for years, why shouldn't they also exclude others from the same privilege? Shit. Now I feel guilty.

Couple of gift certificates for massage for those first few sore back days. A coffee card for Starbucks with a big balance. A good neck pillow for naps on long standbys. A couple good pairs of socks. A pair of big shears.

Collar brass must be a US thing. Only place I ever see it is on dress uniforms. PD, FD and EMS all do epaulets on duty uniforms. If you considering options for a service, rather than just a safer alternative for yourself, might want to consider them as a cheaper, no pin alternative.

Ya I heard Hastings-Quinte was issuing extrication gear. Good on 'em. Hopefully it's something other services will copy them. I know it feels weird to be in a car with a helmet and shirt sleeve looking around and noticing all the FD guys in turnouts or extrication coveralls. Kinda gives you pause. The tyvek and dress uniform are nice touches too.

I've definitely used my blackberry to look up drugs not included in my pocket guide. Usually after the call though rather than during. (Haven't had a call where I needed to, yet.)

Only good reason I've heard for an arbitrary age requirement is that legally an individual may not be able to complete legal documents, meaning they couldn't sign a PCR without a parent. All the other reasons assumed that age=maturity. Which in the case of 17, versus, 18, versus 19 year olds isn't the case consistently. 18 versus 25 maybe.

No disagreement here from me Herb. I do think it's important to ensure that students know how to work the cot before you add any weight to it. I've done a lift with someone in class who started fumbling with the trigger (cot's fault, not theirs the thing ended up going for maintenance) but they lost their focus and rather than put it down almost tipped the thing over. This was a 4th semester student, imagine someone on the first day, with no grasp on their own physical abilities, no experience with how the stretcher works? That's really my issue, don't give them the weight until they know the equipment. It's not just their backs on the line it's their partners too. I had classmates I refused to lift with given their history of dropping the stairchair and failing every lift they'd done to that point.

Just went for uniform pick-up this week with my new service. Holy crap, they gave us a lot of stuff. - Navy Short sleeve uniform shirts x3 - Navy Uniform pants x3 - Wool Sweater (with the epaulets and elbow patches) - Clip on tie (not for day to day, just office stuff I guess) - Rain coat - Winter coat - Splash pants - ANSI Vest (marked Paramedic) - Service t-shirt (not uniform it seems, just SWAG) - Gear bag (really nice one too) - Bullard helmet - Duty belt (2 piece) - Heavy leather gloves - Voucher for boots (1/yr for PT and 2/yr for FT) - 3 sets of epaulets I think that's it. Service also provided N95 fit testing on that day to make sure we'd have correctly fitting masks available. Not really issued gear, but I was glad to see it was high on the list when we started.

How many do you carry on your Ambulance? It might be time to reevaluate that. We have a full box on the shelves, with the gloves, extra glasses, gowns and disposable coveralls, as well as a few stocked by the suction and in the front for easy access. I've also made it my personal rule to keep a pair of gloves, my safety glasses and an N-95 in my left cargo pocket at all time (luckily I sleep on my right side or front). That way if for whatever reason I need PPE and can't get right to the shelves or the bags I'm set.

You're at an MCI in your area and the mayor shows up. Are you: A ) Relieved to have their leadership on site. B ) Pissed off. That idiot's gonna screw things up for those who know what they're doing. Just a thought.

Reread the initial post here and have one big gaping question: why the frig were students starting with near full weight first time out? In my program, first week, the stretcher, stair chair, even backboard were kept empty until we were practiced with coordinating our lifts, working the trigger mechanism, walking with another person. We then slowly added weight until at the end of first semester we had to lift with 150lb dummy, then 175 at midterm, 190 at 2nd semester end and finally 210lbs for third semester onward. A LOT of people can't lift anywhere close to the final weight safely at the beginning of the program. I think it's really unsafe to start students lifting that high a weight before they been trained on the equipment and have practiced. Sure many will be fine, but those that won't be are a huge potential liability for the school and instructor.

Never forget that in order to seek and win high office in a western democracy one needs money. So while anyone can theoretically come from the poor everyman to become President/Prime Minister, by the time they reach that point they're usually quite rich and running with a crowd of other rich people. Those are their peers and despite any ideological differences in terms of welfare, the economy, foreign policy, they will continue to have more in common with the person across the aisle/floor than they do you or I. If you have the money for $500 shoes, they're likely what you wear all the time and probably don't even notice.

Could someone please enlighten me on a question I have with the American political system? I don't get why you demonize your opponents so readily? This goes both left and right (relatively speaking given that both the DNC and GOP are right of centre). Dem's were super quick to demonize G.W. Bush as the worst leader this side of Hitler and now Republicans are ready to declare Obama as the worst leader this side of Stalin. Anyone got any insight into what causes this? Seems awfully divisive to me. I don't like our current Prime Minister ideologically and disagree wholeheartedly on many policy decisions, but not all. I'd rather see someone else in office, but I don't think Harper is bringing about end times, nor do I think Layton or the Greens would bring about a utopia. They're friggin politicians in a populist system, the best we can hope for are shades of beige that we kinda prefer over others.