WolfmanHarris

And now it's clear this is just an awful joke. Work on the material.

I can't speak for First Responder in the USA but the course I teach for the Canadian Red Cross was based off of the American Red Cross course. It's 40 hours long and does include all of those skills highlighted except the monitoring fluids one. I still think I'm missing something though. There's no way someone can jump from a 40hr Advanced First Aid course to a level that includes IV starts and drugs with just 8 hours. I've been actively fighting this crap among the campus first aid teams that have found unscrupulous Doctors to sign the standing order for them. And they're adding at least double digit hours to their training. [Rant] It drives me nuts when skills are used to define competency. I lost my s**t on the director of a campus team last week when he had to gaul to suggest in a proposal that his team was comparable to PCP's because they carry epi, salbutamol, NTG and ASA. It got messy when I asked him to explain the difference between alpha and beta receptors or to explain to me with more than the words "chest pain" why he'd give someone nitro. Maybe EMS is beyond saving in the USA. Here's what we do, let the vollies and FD's have EMS is its current form. They can have a million different titles and call themselves all Paramedics. Then take all the competent people and have them form a new profession entirely and start responding to EMS calls in SUV's or something. Then after awhile start arguing we should just take over the transport side as we end up riding to hospital anyways as EMS can't handle the complex calls... I don't even know if I'm joking on this one. How do you guys not run screaming into the night? [/Rant]

I'm going to assume that the information is wrong or incomplete, but the only training mentioned is 8 hrs by Hamilton County EMS. I hope that's on top of the couple of weeks they spent going to that level.

I'd go a step farther and call it f'ing negligent. To call this sort of care Emergency Medical Services is a joke! It's got as much in common with medicine as the standard first aid class I teach. Actually less as we use AED's in every single one of them. With the advent of PAD programs all over the place why aren't you EMT's without defib up in arms over this and screaming for increased standards?! It's ridiculous that this passes for EMS anywhere in the world let alone the United States.

I think the point you're missing and the one I'm having trouble refuting is that we all learn about scene safety and yet despite our best efforts still occasionally end up in incredibly bad situations and (though thankfully rare) get severely injured or killed. There is no 100% fool-proof way to forsee violence, especially once drugs and/or severe mental illness are factored in. These cross socio-economic and racial lines and tend not to be as obvious as: Dispatch: "Respond Code 4 for a GSW." Paramedic: "10-4, have Police arrived and secured the scene?" In the rare and unpredictable acts of violence on a Paramedic (or EMT for the American and Albertan folks), where the provider's life is at clear, imminent risk, the use of firearm is justified. Whether it's legal or allowed under company policy depends, but ethically I can't come up with anything that would override the right of that provider to use whatever means necessary to defend themselves. Hence, despite my personal dislike for firearms mixing with Paramedicine, the arguments against just aren't compelling for the situations where the gun would be used and how it would be carried.

How can they write that damned thing without a trace of irony?!

I did a quick hope over to the Tennessee EMS board website and looked up reciprocity. I'm not sure I followed all the details but it looks like EMT-IV = EMT-I. Couldn't find any clear information on levels in the state on their site though, so I had to read between the lines. Makes sense I suppose; all the skills of a Paramedic with none of the pesky knowledge, education or increased CME.

I find myself in an awkward position here. I do not like the idea of having Paramedics armed, but I do not find any of the arguments against it compelling and I don't have any great ones myself. Finally I realized that the reason I can't find fault with the arguments against carrying a weapon is that they all start from the presumption that your life is at risk and you have no other option. How can we fault anyone for using any means at their disposal to preserve their own life? I don't see anyone arguing that a provider should look for reasons to pull their or not use any and all of the other means at their disposal to prevent its use, but if there is no other option and the firearm is available I would use it. I still don't like the idea of being armed on-duty, and even if the gun laws in Canada allowed it, I would likely not carry a gun while working, but as it stands now I can't fault the reasoning of those that would.

I think what we need here is a midway solution to the problem of letting new providers loose on the roads running L&S. Obviously closed track training must be the first step, but it can only go so far. There seems to be no disagreement on this point. The main point of contention seems to be whether these closed course trainings should be followed by practice runs on the road and whether the educational opportunity is worth the risk. Especially given the lack of evidence to back up the clinical benefit of L&S. Would a good compromise be placing a third crew member on these units for the first few weeks whose main role would be to a preceptor for the new driver. It seems from what's been said there is no shortage of L&S responses for them to be supervised on.

Though I'd suggest pursuing a thorough physical assessment before ruling it out entirely, including a brief neuro exam. Rule out on more than chief complaint and rule in on more than airbag deployment. Consider using a spinal clearance protocol if you're not sure of your clinical judgement such as the Maine Protocol for SMR as a way of confirming or dissuading your impression.

The abdo pain example reminded me of something I heard recently while listening to the podcast of the Merck Manual of Patient Symptoms on Abdominal pain. (not the most scholarly source, nor particularly easy to reference I know) In it, their speaker a Dr. Robert Porter (whose credentials on the Merck site are listed as "Clinical Assistant Professor, Department of Emergency Medicine, Jefferson Medical College") states that (paraphrased): While it was once thought that pain medication would mask abdominal signs, and some clinicians may still feel this way, that it seems clear that moderate doses of IV analgesic (50-100mcg fentanyl or 4-6mg Morphine) do not hide paretineal signs. In fact the decreased anxiety and discomfort in the patient may make examination easier. I listened to this section of the podcast again just to be sure since I can't post the exact source. Anyone have anything more credible to back this up or even protocols that allow for pain meds in cases of abdominal pain?

Maybe you missed my point, I already did. I've never been one to ascribe to the "what's the problem if you have nothing to hide" attitude that's been used to justify so many encroachments on privacy over the years. I know privacy is not a right in terms of the Canadian charter or the US Bill of Rights but that doesn't mean it isn't something valued and important. If you're not willing to stand by your principles and face the sometimes negative consequences of that than you're (the proverbial you, not you in particular) lacking in moral fortitude. Now which would concern me more as an employer, a candidate who believes in having a private life or one willing to cave on their principles when they are no longer convenient?

My student, volunteer, 24/7 (during academic year), non-transporting, First Responder trained only, team that I was on during University even had a required uniform. Cargo pants with reflective twill and red t-shirt with team logo on the back and in small on the front. Being a volunteer is no excuse for being slovenly.

Remember that the worry is how you would comport yourself publicly and how it would affect the service. Were an employer to ask that I would refuse, same as I would if they asked to see my journal or family photo albums. If it's publicly posted, it's a potential employer's concern, otherwise it's not. Once again the kicker is that the employer can chose not to employ at that point (depending on your respective employment laws), but that then begs the question: do you want to work for a company that considers every part of your private life their business?

Maybe I should join them and have them pay for my wedding. I don't need the whole 70k just a fraction of that. They can all come.

Please use the search function to find one of the many threads on this. I would suggest the one on Pheonix FD's in house EMT-P program. The upshot though is Paramedicine is a health care profession that is becoming more and more specialized and complex. It is not something that can be done effectively as part of a larger job description. Especially when the motives are related more to maintaining call volume rather than patient care. The issue is not with the individual providers, but the Fire Service system they operate under thay views EMS as the golden goose for maintaining jobs and budgets.

The unfortunate double edged part of being treated as a professional and being one, is that you start having to face more and more scutiny and higher expectation. For example, I don't care one bit about what the person serving me my coffee at Tim Horton's does outside of work. I do care whether the Police Officer pulling me over drinks/gambles to excess, or if my Physician posts nude pictures of themselves online; even if it has not effect on their job performance. This is admittedly not based on reason. I am however being honest with how I would feel about these things and there in lies the issue. An employer wants its Paramedics to be trusted and thought of as professionals by their patients. They know that patients, just like the rest of us, especially when we are detached from a situation, aren't always able to set aside our knee-jerk reactions. In fact the less invested we are the less likely we are to take the time and effort to engage with it reasonably. When we hear that another Paramedic has gotten into trouble, we dive in and try to look at the how and why and examine the issue and how to address it. When a massage therapist (or insert any other profession/trade) gets into trouble we tend to read the article, process it and move on with that initial reaction being our only one. Police Officers can and do get into trouble for what they do outside of work. Teachers can and do get into trouble for what they do outside of work. Lawyers. Doctors. Pharmacists. Professions have ethical codes and standards that usually go beyond the job. So if we want to be professionals and treated differently than taxi drivers, we need to accept that and realize that the more we clamor for the respect of the public, the more we must accept being under their microscope.

Okay let's get on the topic of merit badge course vs. education. ITLS is one that gets me. We get ITLS as part of our education. Well kinda. We study trauma months throughout the program and in order for us to have a card in case an employer requests it, the local ITLS examiner who teaches in Pre-service comes over and watches us during mid-terms. Why don't we take the separate course? Because there's little we're going to gain from two days on a topic we've spent months on. I see the use for these courses as CME and review for things that may not be done regularly (like NRP) or that may be changing regularly (like ACLS/CPR) but I have a huge issue with the way some people treat their completion of these courses as a mastery of any topic. Then again, I may have spoken too soon. If your entire EMS training takes 120 hours, than a few 16 hour courses is actually a significant increase in the amount of time spent learning. So... should your extra CME courses that you take in a year take longer than your Basic course?

Depends... were the meaty "hero" calls or a 2am abdo pain x3 days. The problem with volunteerism in health care is that most of what we do is not something most people want to do in their spare time, as a result if there's an option to go or not, why would they?

I just reviewed my Facebook profile with a super critical, pay nothing but lip-service to not discriminating looking for things the judge that wouldn't be on my resume or come up in an interview. Here's what I've determined people could learn about me. 1) I like science fiction and military history. I consider these things nerdy but don't care. 2) I'm a "fundamentalist agnostic" 3) I visit friends cottages from time to time. We drink beer, play cards, swim and repair docks 4) I go to Paramedic school and have pictures of lab. 5) I went to conferences. At these I danced. Not well. 6) My grandmother enjoyed looking at my pictures and looks forward to seeing me soon. 7) I support the troops. 8) While working at a summer camp I dressed up as the mad hatter once and was also involved in an intricate water balloon fight involving a trebuchet. 9) I once sang "You've lost that loving feeling" with a group of guys at a conference for someone's birthday. You can't hear it, but the picture makes it obvious that we probably sucked. 10) I played inner tube water polo. The most problematic for an unscrupulous employer is likely "fundamentalist agnostic" and "I Support the Troops." If they don't want to hire me based on that despite my resume and interview I'd rather not work for them as it's likely I wouldn't last long with that boss. I then Googled myself (that sounds kinda dirty) and found links to posts on here and EMS Village. I hope that I've comported myself well over the years and represented myself as a concerned future professional. Interesting exercise looking for oneself online and seeing what shakes loose.

I don't see a problem with a party for staff at a paid service. But it should be a small portion of the budget. $70,000 for 100 EMT's works out to $700 per person for the year in social spending. That's more than I'm spending per person for my wedding. For $700 I can have a BBQ in the backyard (well my friend's I'm in an apartment) for fifty people for sure. Looking back at my old volunteer team records again I found the cost break down of our end of year banquet. Fifty-five people in attendence, catered, no cost to attendents: $1495.00.

I'd like to save this for whenever a Volunteer EMS attempts to claim that they're in it for their community, etc etc. I don't mind volunteers, I do mind sanctimony. Admit that you're in it because you enjoy playing EMS and hanging out with your other Ambulance club members and that's okay. But when professional EMS starts to move in, don't argue that you can do it better and are more committed. Not unless your budget can back that up. Bill Maher had a great bit a few years back where he said: (paraphrased) "How about, your are what you do. Don't tell me at 2am at a night club that you're a very spiritual person. Put some clothes on and go to church." [/rant] Just pulled up an old budget from the Campus first response team I was on. We had an operating budget of ~30k (student levy of $5.25 per student). Of that $12500 was spent on training. $8500 was for uniforms and equipment. $6000 spent on team incentives (subsidizing conference costs, paying for meals when on shift, random candy/coffee drops to the on-duty team by the exec), banquet (Christmas and end of year thank-you) and a retreat for the weekend for the whole team.

We've managed to ditch most of the "EMS worker" moniker up here too btw. The benefit of having all levels of care called Paramedic. And I'm with Jake on this one, nothing wrong with belly-dancing. I have a facebook account, but there's nothing on there I wouldn't want an employer of family member to see. Largely they're photos from events I've been at that I wanted to share with everyone else that was there. Even still I'm considering shutting mine down for the rest of job application season and I don't even do anything "interesting."

Lord knows I wouldn't. That's why I went to college for two years for $30.00+. And that's BLS. I'm lucky that providers before me didn't fight education standards and allowed the increase of education from months, to one year to two years and brought us where we are now.

And that's where the lack of perspective comes in. Look beyond the trade schools and 120 hr wonders in the US and you'll see systems that work. Hell look within your own country and shake the wheat from the chaff and you'll find some excellent Paramedic education programs that turn out competent, professional providers. They're just choked by a sea of mediocre shit training. Examples of proper education for EMS. Ontario, Canada Primary Care Paramedic (PCP) - BLS 2 yrs of education Advanced Care Paramedic (ACP) - ALS 1 further year of education Critical Care Paramedic (CCP) - ALS 2 further years of education (Air or Land CCTU only) Alberta, Canada PCP - 1 yr education ACP - 2 yrs education Other provinces similar variations on the above, but I'm less familiar with their standards. Refer to the Paramedic Association of Canada's National Occupational Competency Profile for more info. Australia Bachelor of Paramedic Science - 3 year university degree Great Britain Couldn't find non-wiki info; Degreed education So yes if you continue to accept unacceptable levels of education EMS will never be more than a stepping stone. But if you look outside your own backyard (or look closely at where EMS works within your own country) you'll find that EMS is a very different profession than you realized with a great deal of potential. It just needs to stop being held back by those within it. I won't argue this point much further as a quick search of the forums will find the many equine carcasses of battles long past. I encourage you to read at least one of them and see what you can learn.