AnthonyM83

I wish!

Here's another one to comment on: Course length (p61) (150 - 190 clock hours is too little to get a good grasp of materials and proper assessment/scenario training time) Field Experience (p61) (Field experience should be enough to prove EMT can function on their own doing at least basic assessments and interviews...or at least include some way to measure outcome of ride-alongs.) NeoNatal Care (p47) Newborn assessment is only included in paramedic, not EMT. So basically we don't even need to know APGAR anymore? That's what it's seeming like...Why get off easy? At least basic newborn assessment is necessary Chest Trauma (p39) No need to know aortic disruption/AAA stuff? This is crucial part of trauma assessment, MVA's and such. Etc Etc...it's pretty easy to scroll through the PDF and find stuff. Not much reading at all. Just be willing to write those emails.

Update: PDF at http://www.nemsed.org/draft_standards/pdf/...ds_document.pdf is the most up-to-date version. Use that. Good stuff starts p13 (but good stuff in intro, too). All comments for any section can go: To: db@nemsed.org; dc@nemsed.org; jf@nemsed.org; kn@nemsed.org; lk@nemsed.org Subject line: Comments on ______ (Include specific subsection from left column)

It's never taken me five seconds to get a signature. You hand them the clip board and pen (and wince as they contaminate both). They fumble to secure it on their lap properly, and find where they're supposed to sign (where you finger is). Most aren't in great shape, so they struggle to sign with jittery hands, trying to make it as perfect as possible. I tell them initials are fine just to make it easier, but they haven't signed anything in a decade and want the accomplishment of signing their entire name. If you're talking while they sign, they'll stop and look up, then have to re-find the signing box (with the X right next to it). Then you have to point to the Privacy Notice box and explain that and re-do the process. Then, depending on the patient, you have to wrap wrap the pen in your glove and/or set the clip board down in a safe place to decon it before continuing paperwork. Honestly, unless they're in good shape and they're there for a broken toe, I'd say more than half the time it's this whole little one minute ordeal. It's not that one's lazy about doing it, but there's this need to avoid the one minute of standing there hanging on each pen stroke waiting for the patient to finish, plus any decon issues after. And now we also have to get a nurse's signature no matter what. Then you have to get the medical record number. It all turns into one big process I hate to do. But we ALWAYS get either signature or mark why they couldn't...if not it gets kicked back to us. One warning, second time is a write-up.

Have you had the chance to have a conversation with him about it and let him know the accident really wasn't a big deal. I think I forgot about my first DOA MVA an hour after the call and that was only b/c we were sitting around the station with nothing else to talk about. You might also let him know some studies have shown increase in PTSD for those forced to take CISD.

Wow, they went kinda harsh on her. She got herself run over while acting as a backer, right...it's not like she drove into anyone. I've seen murder suspects get less flak on the news...

Oooh, I have an opinion on this one. Paying good teacher a lot of money will lead to better teaching. Paying all teachers more probably will not. The school district where I worked for a year paid pretty darn good for teachers, but those teachers were (mostly) stellar and deserved every buck. You had 5th grade teachers stay later to 7PM almost everyday planning activities and ways to fit lecture to each of their kids, etc etc. But with low pay, even good teachers can get burnt out and not do their best. Edit: I totally just saw the correlation to EMS workers...I wasn't thinking about that when I wrote it.

Does knowing the results of an EKG (based on hospital transmission) affect treatment? It affects which hospital they're going to . . . closest receiving or cath lab hospital...

Haha nice. The other day, a medic read the printout "Let's see...Abnormal EKG...Possible left anterior block...whatever the F that is...yup, no star star star acute MI, we're good, BLS".

When you guys say racemic epi, do you say that just because it's the formal name or do you guys also carry a separated non-racemic mixture? What's the difference between the racemic and separated enantiomer forms?

Great article JP. Good job to all involved.

Related article: http://www.officer.com/web/online/Top-News...-Deaths/1$41099 27% of officers killed last year were not wearing vests. Not that they would have survived for sure, but that's a whole 1/4 who MIGHT have survived and gone home to their families. Doesn't mean we need to rush out and get one, but if you're considering their effectiveness.....

Ya that's pretty funny Scara. As far as coverage during the strikes, it's only one district of LA and I think there will be a lot of IFT companies to cover during the strike (Heard there's about 50 in LA). It's going to be botched. It's a lot of land area, it'll be unfamiliar territory for them, and they will have either low or no 911 experience...so it might be a bit of a circus on-scene with significant ambulance delays. I believe they cover a couple extremely busy cities. LA has a whole lot of EMTs...but most of them work IFT...many because of the better pay (since few really want to do transfers) but many because they have trouble getting hired onto a 911 company. I know our company has no shortage of applicants...but definitely a shortage of QUALITY applicants. Like our managers said, "We could have every seat filled in a couple weeks...application pile is over a foot high...but we'd be shooting ourselves in the foot". AMR might have to lower their hiring standards if they fire everyone who strikes. Maybe the transfer EMTs will support them and not apply to replace them and then AMR will have to fix things? Not sure...don't really know too much about strikes and stuff.

You should write in saying that with the suggestion that more in-depth knowledge be required on topics so that they have to be in-depth the whole way through...or something similar. 8 People has sent in comments...I guess that's okay....but I'm sure we have more than 8 "big gun" posters on this site . . . I expect at least the regulars to send in some input. Like AZCEP said, especially the lower levels (EMR, EMT, AEMT) need help. Let them know we want competent people walking in that door. I'm okay with having a lot of people either not recert or decide not to become EMTs as a result of it.

So, I taught a BLS Refresher course today and it reminded me of what Dust was saying about people getting nervous. We were just cleaning up, when a doctor came in late, asking if we could recert, even if it was quick he'd appreciate it. He seemed nice and good humored, so we said okay, but one of the instructors decided to have fun with it. He had mentioned he was a cardiologist, so the instructor's just: "So you're a cardiologist, so you basically know this, see that chart, that's the algorithm, memorize it, okay got it, let's go, start!" (Doc started hurriedly jitteredly reading to himself, repeating it...smart guy really) So, we rushed him into AED...basically just handed it to him. He was so nervous/rushed/panicked at this point when it said "ATTACH CONNECTOR" (with the blinking light right at the front) all he could do was fumble with it, turning it upside down looking for the plug-in, asking where it was, trying to blindly stick it into the underside...took all I had not to laugh. Anyway, afterwards we slowed down and reviewed with him and give him a decent class...but see how panicked people can get in a class....imagine in a real event with bystanders looking at you!

Ah, blast! Guess I won another one by forfeiture this time

What makes you say that?

What I gathered from our AHA liaison is that yes it's legally protecting the Healthcare Provider, because if they only did compressions it would technically be going against their training. It would be doing "faulty" CPR and some whacked family could try to sue saying that reason they didn't make it might be improper CPR. I think it's just covering their bases and putting their cards in order. It's saying they acknowledge that scenario and that it's okay to just do compressions. Also, a lot of HCP (think of ones who just do it as a job, but don't really care that much or do advanced thinking about doing only compressions) might realistically (very realistically) not step up to help b/c they don't want to lock lips with a dirty stranger.

I love Dubin's book. I actually think it might be worthwhile to read that at the start of cardiology to form a framework and context for what you're learning, then read it again when you get to EKGs or the end of the course

Okay, I went back to find out more about this. Here's the actual change. AHA has NOT caught up with (OR just disagrees and thinks more non meta-(retractive) studies are needed about) straight compressions leading to better survival. All it's saying is that now Healthcare Providers are allowed to do civilian CPR (compressions only, no ventilations) when off-duty. This would encourage more off-duty providers to become involved and to prevent legal action against them for failing to do "correct" CPR as they were taught in their BLS for Healthcare Providers class. At least that's what our AHA liaison told us. Anyone else gotten word from them? I gotta research their official stance myself, I think.

Well original poster was describing it as "anatomy & physiology, Eindhoven's triangle, the "drop of blood" through all the structures of the heart, coronary vasculature, cardiac diseases, or even basic rhythm interpretation" to the depth of "basic cardiology" (at a medic level, I presume). What VentMedic describes seems a bit different...?

I'm just saying it's over exaggerating that it would take two semesters. Even if it were one course on cardiology that met three times a week, that's moving awful slow. Or maybe we're saying the same thing. Don't know.

That so doesn't count as a "semester". A semester would be full-time school (4 classes). Or in medic schools around here, it's 8-5 Mon-Fri, like a job.

Thanks guys. Here's another email I sent to the general comments link (in addition to other section specific emails) and the director's reply: Me: Greetings, I have been looking through the NEMSES 3rd Draft and rather than leave various comments for each section, I wanted to send a more general note. I am certain you all wish to see an increase in competency and professionalism in the EMS field. That is the goal of many EMS personnel today, but due to a disconnect between various EMS systems and lack of access to groups in charge, it has been hard to move forward. I hope you see the development of new national educational standards as a chance to better this profession. This cannot come about without increases in educational requirements. Here is an opportunity! Creating more educated EMS workers, will lead to increased respect as allied healthcare professionals from the rest of the medical community, it will self-select those who are interested in the field for the right reasons, and may even lead to increased positive public perception and even compensation, possibly someday higher scopes of practice (which can only come from raising our own standards as the nursing and RT profession has done). As an EMS professional AND as a citizen, I urge you to make revisions with the bigger picture in mind of what this will mean for EMS in America which is currently not even close to the degree of competency and effectivenes Their reply: Thank you again! I share your thoughts. Another reply I got concerning the cardiac area: thank you for your comments. We will evaluate these in light of stakeholder's input and other comments. Deb Guess it comes back to money again...

I might get burned by this. . . but does it really take a couple semesters of education to understand the stuff Scott listed IN DEEP DEPTH? (Every single structure, pathway, conduction, triangle, vasculature, basic rhythms) (BTW, not saying we don't need semesters worth, I just mean does it take an entire year of school to understand just BASIC cardiology...if it did medical school would be a lot longer)