Arizonaffcep

Na...my wife agrees with me... That's why she says things only happen at night...

In most of Arizona (except for the most rural parts who are not dispatched by a fire/ems dispatch) they use the EMD system to determine if a call is ALS/BLS. If it comes in as a GT/or "non-emergency" response (we all know how how those go...) to a SNF, then the SNF requests the desired response level. As far as 911, specifically in the Tucson area, TFD will respond with an ALS unit for those that require an ALS unit (the city transports all ALS call, and turfs the BLS to Southwest Ambo). The ALS unit can be an engine/ladder/ambulance. Or, if the call dispatches as an "alpha" call (lowest priority, one resource BLS responding normal traffic) then they can do that as well. The unit on scene determines if the call is ALS/BLS, and if there is any question, they are supposed to contact UMC (their base hospital) for a consult. All I know about that system is, when I was a basic on the BLS contract for the city 8 yrs ago, I got more ALS calls off that than I did in my first 6 months as lone medic in my fire district. The only thing they really have on their side for this is typically, they are no more than 5 to 10 min away from any given hospital. Most of the other fire departments respond with only ALS equipment, and if the ALS unit (usually the transport unit) decides that it can go BLS (with hospital consult), then the EMT-B who is the one typically driving the unit (as well as performing BLS skills on calls) will take the patient, while the medic will drive in. The nice part about this is, if the patient tanks or what not, it's still an ALS unit, they pull over and switch places. Others, (Rural/Metro, Southwest Ambo) have a policy (their transport units are EMT/Medic) that the medic will always attend.

My father-in-law has a phrase for these things...logicide.

Well, they say beauty is only a light switch away...

I completely agree...no one under the age of 21 should be able to, as PRIMARY care, be in charge of a person's well being. Now...I would encourage those in the ages for an explorer program to do that, if it's something they think they might be interested in doing as a career.

True...however the reason it's got an inversion is because of the cost of medics vs EMT-B's, and typically, (forgive me if this is a misstatement) it seems as though the more rural areas have volunteers, which it's much easier to find EMT-B vollies than medic vollies.

Best thing to do is to call and get in touch with the county health department that oversees EMS in your area. They will best be able to guide you through the process. The best frame of reference I have is several years ago I taught an EMT-B class, there was a student who got a DUI 10+ yrs ago, and the state health dept. (AZ is not county by county) was giving him a bunch of grief over it, even though he'd been on the "straight and narrow" since the DUI. Eventually, he did get it and works for a local FD. But, your county HD would know if they have a time frame from DUI to be able to get certified/licensed.

I agree completely with what's been said thus far...there is a time and place for cursing/using profanity, and during an MCI DRILL is not one of them. There should be no "panic" amongst the players, as it's all make-believe, and a good time to build skills and confidences. Who was the person that this medic said that too? I know you said she was a "victim," but was she a student in another program, or someone volunteering from this profession? Not that it really makes a difference, but just wondering. I don't really know how they could, as an EMS system downgrade him for a certain amount of time...(at least that concept is not used in AZ). If YOU as the practicioner want to downgrade your cert, no big deal, but otherwise, your medical direction can be suspended for XYZ time frame, which of course means you can't practice until that's dealt with. Or they can put some limitations on your certification...need to contact the hospital on every run vs. using standing orders, etc. That's about it system wise here. Either way, that medic really shouldn't be invited back next time...

I agree, there is really no place for "dumbing down" in this industry. In fact, this is one of the primary reasons that my wife and I have opened our own school. In Pima County (where I work and the school is located) had (until we opened) only one other paramedic program...the local CC. I work in the only level 1 trauma center in southern AZ, and as such, eventually ALL medic students come through for clinical time. I am also one of the hospitals "preferred" preceptors for medic/emt students, and I have watched with much dismay over the last 2 years that the quality and knowledge of the students is FULL of holes. And they have a "great" NR pass rate! This all started (forming the school) over a table top discussion where we were posed the question, "if you aren't happy about the situation, how are you going to make it better?" So...we've opened our own school and are taking some very progressive steps to make the course not only difficult (because the caption is correct, "Killem in the classroom" so they turn out good), but totally different from anything AZ has previously seen. While this will be our first year in operation, I am excited to see how it works. And the nice thing about owning the program...we can change it at will if need be, and not cater to some CC's version of bureaucratic red tape. In regards to your comment on NR pass rates, we are stuck between a rock and a hard place...so to speak. AZ's DHS (who oversees the certification) does look at the NR pass rate to help determine the success of a program. Although I think that the NR pass rate is bogus (if the program is not great, teach to the test and get a high pass rate, if the program is good, no need to teach to the test because the students will have a high pass rate because they know the material).

Technically, if it's not flammable, it can't explode (rapid oxidation wise, not pressure wise). It makes everything burn hotter and faster. Cool experiment I do with my EMT-B classes, take a lit cigarette and stick the butt end into O2 extension tubing, and run it at 2, then 4, then 6 lpm.

A lot of people have problems with the BLS stations (for medic class). I can only think the reason is the emphasis is on the ALS stuff and the BLS stations are neglected.

For the service I work PT for, they have a "you call, we haul" mentality. That being said, if a patient wants some treatment but no transport, they get charged for treatment without transport (cost depends on treatment rendered) In the case of a diabetic that got D50, for instance, we must ensure that either they can take care of themselves or someone is there to watch them. If no one is there, then we must actually witness them eating a meal, then we can depart. I've made many a sandwich for many a patient because of it. Which is fine...I prefer not to be called back for what would be called a "rekindle" in the FF world .

I don't. But I do try to present the material in as many different "learning styles" (kinethetic, lecture, visual, etc.) to give them the best chance of learning the material. No one can fix stupid, but giving the students the best possible chance of making it, then that is part of my responsibility. If they can't make it, the can't make it. If I am wrong in my interpretation of your post, forgive me but it does seem that you indicated that if they don't get it one way, then forget it. That's not what being an educator is about. I know many great pracitioners who learn best by kinethetic, others that are great and learn by lecture. Does it make one better vs the other? No. Just makes them different.

In Arizona (for the most part) everyone is cross trained, there are VERY FEW departments that are "3rd service." With this in mind, I don't know of a single department that requires their FF's to become medics. I think it's a bad idea to force anyone to "be a medic." Should it be encouraged, yes, to the right people (must be somewhat selective), but not forced. This breeds incompetence, and people who are now medics, who really shouldn't be. That's not to say FF's don't make good medics. I know MANY FF/CEP's that are phenomenal! I also know a lot that aren't. Some, who would be more effective if they put the B/P cuff and POx on the monitor, rather than the patient. BUT, there is a similar ratio between FF/CEP's (good vs not good) and private sector (good vs. not good). There was one private medic in Southern Arizona who took a heparin drip on a pump, programed the incorrect dosage/drip rate (based on lack of knowledge/stupidity vs pump error-this medic admitted as much) and infused a 250cc bag of heparin in 10 minutes! They were going for a cardiac cath, which then had to be postponed and the heprinization reversed.

Just for clarification, how can ANY medical procedure that takes 5 min be "very profitable?"

I can see some issues with this... 1. (Personality dependant of the chaplain) They may try to step in and end up interfering with Pt care. 2. If they get involved with Pt care, asked to by crews or not, where is their liability? 3. If this is for the crews, then where does CISM/CISD come into play? Not necessarily a bad idea, as long as these things are addressed. The biggest question is, is this necessary? With CISM/CISD in place and available when needed, do we need another "vent?"

I just took the CBT a few months ago for recert...heavy on the pathophys and scenarios. From the feed back I'm getting from others who have taken it, is the computer really varies the questions quite a bit.

I'm sure at some level...they smell the same...

Actually, the Catholic religion wasn't formalized until latter than that...Jesus and his disciples practiced Judaism, and were Jewish. They were actually considered a sect of Judaism for a long time.

The young boys I refer to had NOT been circumcised. I think the irritation and resultant inflammation have to do with being in a diaper too long and improper/infrequent cleaning. Almost akin to diaper rash. As far as my opinion on the matter, it doesn't matter either way (although I shudder at the thought of sharp objects down there...). However, families need to be prepared if they are NOT going to get their boys circumcised, then they need to know how to clean under the foreskin appropriately.

In line with the posts on keeping calm, one of the things to remember is, it's NOT YOUR emergency. You were only asked to help provide a stablizing force to an out of control situation. Good luck! Remember with the wedding...what's the phrase, never point a loaded gun at anything you don't want ....oh oh my kid's screaming! Good luck!

IV, O2, monitor, D-stick etc. Not much else I know of for prehospital. What about VSD?

Maybe someone knows the IFSTA definition/determination/difference. AZ is an IFSTA state...

I am getting ready to hold an NREMT-P refresher (with CPR and ACLS) in the next few weeks, and was wondering on some topic ideas. My plan: to cover the required NR topics as quickly as possible. Then, with the remaining time, address some new/not often covered topics in ALS refreshers. So...with that being said, does anyone have any suggestions? The audience in the areas are mostly FF/CEP's with some private CEP's (certified emergency paramedics), with most doing 911 and a smaller percentage doing interfacility. Also, anyone have any creative things to do? I've come up with several, which I am working on and once I am done, will post them under the resources area. Any help would be great! Thanks!

In reference to the venturi/Bernoulli effect, I've known how they work for much longer than I've been in fire/ems. Learned all about them dealing with protien skimmers and what not for salt water fish tanks... That's interesting about the 40lpm...we aren't allowed to touch them once their set by RT or an RN at the hospital/SNF, whatever. As such, it's not gotten into much detail in classes here.