paramedicmike

Yes. Fentanyl is addictive with potential for misuse. Morphine is also addictive with potential for abuse. As are the benzos we carry for seizures/sedation. Ketamine? Well, that's so blatantly addictive/misused that it has it's own street name. When used appropriately it is exceptionally effective. With what do you suggest it be replaced?

I've been saying it for years but people are only now, slowly, beginning to realize it. Facebook is the devil.

I'm not convinced this is actually "hypothetical".

How'd it go, Mike?

Analgesia does not inhibit or prohibit adequate or accurate evaluation of a patient or a patient's pain. It's discouraging to see from this discussion that there are providers out there, specifically the two docs 1EMT-P encountered, who are unaware of this by both literature and direct practice.

The cost of the JCCC program you linked is under $6K for Johnson County residents and a little over $7k for other Kansas residents for the entire program (tuition information here). That's a little cheaper than current tuition for the program from which I graduated. (When I went there it was cheaper than current rates dictate.) That's not an up front cost. That's over the entire two year course of study. It may require some budgeting (like not buying that light bar for your car and maybe a couple pair of Dickies instead of that one pair of 5.11 pants) but it can be done. In many places trade schools are through the local community college. Cost won't be that much different. This can be done. As mentioned up-thread Oregon already requires paramedics to have a degree and have done so for years. As EMS education improves and, with it, the standing of EMS as it's own legitimate component of emergency medicine wages will improve. The industry needs to stop making excuses for why we can't. We need to start advocating for why we *can*.

Not bad, Mike. I like the composition requirement. I like the sociology requirement. I really, *really* like that there's an ethics component. For an associates level program it's a good start. Ultimately, I'd like to see something like that become the entry level requirements for a BLS provider. I'd like to see a bachelor's degree become entry level education for a paramedic. The course of study outlined in your local program is similar to the one for the degree awarding program I completed. (I had a computer skills class that I had to complete.) For a bachelor's program one should, yes *should*, have to take additional classes like psychology, history, even literature and philosophy in order to complete the program. There is a benefit to a well rounded education. In EMS we deal with every part of the population of the area in which we work. Having a broad educational base as a foundation for the technical knowledge and skill training will only serve to help us in dealing with the very people we serve. Speaking more broadly there seems to be an increasing sense that education is somehow a bad thing. It is not. Education, in all it's forms, is a GOOD thing. There is nothing wrong with leaning something new. There is nothing wrong with increasing our knowledge base. Having a broad educational foundation will only help not only in dealing with other people but with improving the overall functionality of society.

This is an excellent question. I'd argue that we don't need to reinvent the wheel. I'd also argue that this will not be an overnight fix. It will take time and will require patience. As loathe as I am to make this comparison look at nursing. Nursing used to be a diploma or certification only educational program. Now it's at least an associates program. It some places nursing jobs are only available to BSN applicants. It didn't happen overnight for them. It won't happen overnight for us. For EMS I think NREMT has sort of started this process. Paramedic programs need to be accredited (as of 2013) by the Commission on Accreditation of Allied Health Programs. This is a good first step. It's been this way for six years now. The next step might be to require accreditation at a degree awarding institution by a certain date. Then require new those earning new certifications after a certain date hold at least an associates degree. It'll be a multi-step process undertaken over years to make the change. There will probably be some grandfathering in of older providers and/or a grace period during which providers will need to complete a bridge course of sorts (similar to the RN to BSN programs that are out there). There will be push back from old school EMS-ers (No degree is going to help me start that IV any better!) and fire departments (What do you mean our medic mill that pushes out paramedics from a condensed program only so they can ride an engine isn't good enough?). Like old school nurses and old school nursing diploma programs, they will lose. As to why there is a shortage in some areas you have to look at a larger picture. Is there a shortage of just EMS-ers? Or is there a shortage of everything else? RNs? Docs? PAs/NPs? Access to basic services? Why is that? In a lot of cases because it's rural and there's little incentive to undertake the effort. Stop relying on the volunteer aspect which, ultimately, cheapens us all and accurately value the services provided by educated EMS providers. Do this and I think you'll see a change in the shortage. (Maybe not fix entirely, but certainly lessen the shortage.) Under no circumstances am I arguing this will be easy. It won't be. There will be a lot of push back from a lot of entrenched special interests. Until we fix education, however, nothing will change. Fix education, align ourselves as legitimately educated, degreed, licensened *MEDICAL* providers and not some haphazard add on to another public safety agency, and every problem currently facing EMS will go away.

Several services I worked for had dash cams. A couple aircraft for my flight service had cockpit cameras and voice recorders. I think a camera in the back will face some serious HIPAA challenges.

<--- Has an EMS degree. EMS-ers have long complained that they are viewed as the "red-headed step children" or whatever industry they're trying to pawn themselves off to on that given day. Unfortunately, many are unwilling to do what it takes to change their circumstances. Want to be taken seriously? Create entry standards that are more challenging than becoming a barber. Want to be taken seriously? Require basic education standards that go beyond a high school diploma. Want to be taken seriously? Create entry standards that show that those pursuing this as a career give a damn about what they're doing. Fix EMS education and it will have a positive impact on every single other problem facing EMS in the US. Every. Single. One.

No standing orders for pain control on interfacility transport? I'm going to channel Dust a bit here: Your agency sucks. What kind of advocacy did you attempt for your patient? How many times did you call to ask? If you weren't pestering them for orders every five minutes why weren't you? What was the reasoning of the doc in question to deny your request and to provide such short term pain management before the onset of transport? What does it matter if the doc in question is not a fan of ketamine? So many questions.

What are your treatment guidelines with regards to pain?

Don't underestimate influenza. Not that Tyler did. Just generally speaking. RIP, Tyler. Condolences to your family and friends.

Heh. BMs. Sounds like a good a good abbreviation for what sounds like a rather sh*tty company. BMs. Sh*tty. HA! I'll see myself out.

Welcome. Good luck.

Unless, what I meant by actually posting a link to the study, was that you read it. The study looks at outcomes. Take a few minutes to review the abstract. Not entirely sure where you're coming up with the things on which you're commenting.

We've talked about this at length here before. Saw this and thought it was was worth a mention. Link.

Have your upvote, Spock. Well said.

In areas where I've worked these types of care plans have been individualized for the person in question. There was no template used as a basis for patient interactions. And honestly? Most of these care plans were "ensure patient and crew safety, transport to the ED". For some of these folks social work at the receiving hospital has had to get involved as the ER was seeing these folks as often, if not more often, than we were. If that's not a resource you've looked at yet they may be of help. Sorry this is not of more help. These are tough cases that usually don't follow a global script or fit into a neat template.

Dust wasn't the only one who didn't, or doesn't, suffer fools lightly. If you're interested in intelligent, well reasoned and fact based discussion this is the place to be. It has been the place to be for years. If you're looking for some ego-fluffing prepare to be disappointed.

No, Ruff. "Assenite" is not a real word. The irony demonstrated by our new contributor's posts is not unnoticed or, sadly, unexpected.

How is it ignorance? Did you read and comprehend the discussion taking place starting with the initial question posed? Or did you jump to conclusions and instantly feign offense because you didn't take the time to think through what was being said in the context presented? Your posts so far point to the latter which, sadly, only proves the point Dust was trying to make with his initial comments in the thread. You are missing the point being made entirely. Whether innocently or on purpose for some other nefarious reason remains to be seen. Please go back and read, from the beginning, the thread starting with the question posed in the OP.

Did you read his very next contribution to the discussion? Did any of you guys go back and read beyond Dust's initial comments in the thread?

This is the post in question quoted in its entirety for context. For our new friend who referred to DustDevil as a moron some perspective is in order. Dust was one of our most senior members. He was one of our most experienced members, too, having been an EMT, paramedic both in a civilian and military capacity as well as an RN. He was no nonsense, pulled no punches and called things like he saw them. As such this was likely to ruffle some feathers... usually of those who didn't like being put back in their place in such a blunt manner. That you were so willing to jump in, take one post out of context and then refer to someone about whom you knew absolutely nothing as a moron says more about you than you'd perhaps like to admit. Sadly, Dust is dead. He died a few years ago from complications of ALS. That doesn't change the veracity of his statements within this thread or elsewhere in these forums. Fortunately for us, his comments are still available for people to read. It may be worth your while to get to know someone, virtually if necessary in a situation like this, before jumping to conclusions about anything. Welcome to the City.

Here's an interesting story about a patient with a chest tattoo reading "Do Not Resuscitate". We've joked about this in these forums before. We've questioned how legitimately we should consider a tattoo like this. It seems we now have a case study to look at.