UMSTUDENT

Whoa, whoa, whoa. World Wars? How about European wars that we got involved in? Sure, we got there kind-of late in WWI, but I doubt anyone would discount the Dough Boys as being influential in ending that war. AND...had your countries listened to Wilson and his 14 points you might not have had Hitler corrupting the collective minds of the German people. SECOND...Hitler? Appeasement anybody? Massive American invasion force while simultaneously fighting a war in the Pacific? Come on dude...if anyone here is preaching cultural imperialism it is you. Edit: I'd like to also qualify this statement by including that in both wars, especially the first,other Allied nations had a considerable role in the victory. I feel many Americans often forget this fact.

I disagree that everyone needs to be "educated" to perform a job. The military has "trained" people who perform their job rather well in my opinion. A lot of procedural things we do, at least in some respects, can be taught through good, hardened training in academy fashion. An education allows you to formally think through, and understand, the consequences of your actions. Something that I believe is absolutely essential to a competent paramedic. Something Dust said on here the other night that intrigued me was his statement about insurance companies. Every insurance company, having half-a-brain, should realize the amount of money that could be saved by utilizing a properly equipped advanced practice, formally educated, paramedic. An insurance company should assess fees to customers, and their employer, if a person lives in an area that does not provide full 24/7 ALS coverage. A subsequent fee should be assessed if the majority of those paramedics possess less that an Associate's degree. Theory: Less coverage= Less access to early advanced care=increased cost of hospitalization later. Theory: Advanced practice= lower cost, less diagnostic test, and decreased hospitalization with a reasonable level of clinical confidence. Theory: Paramedics w/o degree=less educated= less knowledgeable= increased chance of malpractice=new medical problems + lawsuit! This puts pressure on big business, which in turn puts pressure on cities and municipalities to provide properly educated, 24/7 ALS coverage. Biggest benefit? State workers generally have great insurance packages with the cost being deferred to the tax payer. If the state had to start paying out of pocket, because they’re geographically not up to par in EMS, I guarantee overnight education requirements and state funding would shoot through the roof. It’s a great deal for insurance companies. Initially there are increased profits from the fees, and years later after reform, you get decreased healthcare cost with lower customer premiums. PLUS, as an insurance company, you can defer angry customers to local municipalities by fooling them that their out-of-pocket cost will decrease with better service. In all reality, the state will defer the cost to the taxpayer…

I think imaging technology will be relatively small within the decade. I wouldn't be surprised if it reaches hand-held size within fifteen years. I remember reading in a magazine recently that mentioned a UK company who is developing a handheld devise that can identify common infectious agents from small blood samples. It uses holographic technology to compare the image of the microbe with those stored in a database. It was specifically being marketed for use in EMS... Imagine being able to hold a small device the size of a radio that tells you blood gases, CBC, Chem-7, and whether or not your patient definitively has pneumonia. We write a script for an antibiotic and go on our way with a relatively high level of confidence that our diagnosis is correct. Think about a device that could compare patient blood chemistry with a list of possible syndromes and determine a list of differentials. I recently heard about a company developing a vest that can deliver an 80-lead ECG. The technology is being developed; EMS just needs to push for higher education so these devices can be properly used. All of the technology in the world doesn’t replace a properly educated provider.

Let me clarify. I said that our standard of living is unparalleled almost anywhere else in the world. "Almost" is a justified statement. The U.K, Australia, Germany, etc qualify as modern western nations. There are what? 20-30 nations in the world with comparable standards of living? We are among a lucky billion+ people who enjoy such a great lifestyle. It is important to understand, that we (collectively) are the extreme minority. We can't forget the billions of people who struggle to eat everyday. Second, I find many other nations extremely interesting, wonderful places. I've traveled and seen the differences and they're surprisingly comparable. Third, I wasn't saying other cultures owe us anything. I think the amount of relative bitching is probably justified from your perspective. American culture is flawed, but also an amazing thing. It doesn't do any culture any good to bash the other. I didn't intend to "throw" anything in anyone's face. Nationalism is still alive, in all of us. That's all. I think it's also important to remember that the U.S. is an infant in the timeline of world affairs. European nations have thousands of years of war and social experimentation that lend to their cultural identity. We have 200+ years of history and a hodgepodge of cultures to reference...

I must agree with you on many points. It is important to remember that the globalization of US markets is what drives the world. Not many modern nations could afford their comfortable existance without the United States, something which their governments understand all too well. I'm not saying our government isn't extremely corrupt, because it is. Disgustingly so. Our capitalist society breeds the type of corruption that thrives in almost every member of congress and certainly in many members of our society. At the same time though, much good comes out of a society that is so free to choose both corruption and great good. Our reward-based system conveniently drives much of current human innovation and provides for a standard of living among most Americans that is unparalleled almost anywhere in the world. The simple, although shallow, reward of owning more stuff is enough to drive us towards discovery, innovation, and great progress. Everyday a thousand kids are born in American with the wish to do great good. To lead armies, to end poverty, to cure AIDS. Sometime around 15ish they learn that these goals are lofty, and take the resources of an entire group of people to accomplish. Capitalism allows those resources to be brought together. Somewhere between the multi-million dollar mansions and private yacht clubs is a group of people who harness those resources to develop new drugs, technology, or new non-profits. What would social welfare nations do if they didn't have such a large economy to drive pharmaceutical development? While I understand that nations such as Germany, France, the UK, etc develop many great technologies, I also understand that having such a behemoth in the game helps. Our government and its citizens functionally support much of the world. Be it through our consumers or extensions of our government. While we may not be the most generous group of people in the world, I find it hard to call us evil. Misguided sometimes...perhaps.

I don't see why. I never said we weren't also forced to fully understand what we were doing. It pretty much comprised an entire semester. More specifically, it was an entire class by itself. When I mean memorize, I mean when I got to my integument exam I had to resight word for word what I was doing, while also doing it on a mock patient. I mean we had to understand what we were looking for with an ophthalmoscope. It wasn't just "inside are pretty colors and they mean something." At that point in my career I should have obviously understood the structures and functions; however, the pathophysiology of abnormal findings was a large part of class.

I used the Mosby Guide in class. Good book, but I must say, I learned most of the material hands on from several specialist. We were simply forced to remember, word for word, comprehensive assessments for every body system.

How am I incorrect on all points stated? How familar with PUM and SSM guidelines are you? Dust, you can make statements but please back them up with something more than just personal experience. Maybe some excerpts from that article you wrote or a copy of the initial plan made to Fort Worth. You have a sour mouth over a system you didn't like. What was the end result of PUM being instituted in Fort Worth? Is MedStar still around?

Again, Jack Stout. A man who has done considerably well in EMS, and despite significant controversy, still is highly regarded in many circles. What is the most amazing thing about Mr. Stout is that instead of constantly complaining about the sub-par standards that exist in EMS, he attempted to fix the problem. If you want to advocate a socialist economy where everyone works for the greater good of humanity with no financial incentive then you might want to start looking for the starship Enterprise. I mean come on, how ingenious is it to utilize math and historical data to predict call volumes? Even if it doesn't necessarily always work, it at least sounds good! The real world works on this type of ingenuity. SSM isn't flawed, EMS is flawed. Human beings have been using mathematical equations and computer programs to predict everything from earth quakes to hurricanes with amazing accuracy for years. SSM works in a profession that deals almost entirely with the dynamics of biological death and human stupidity. Both are hard to predict and neither are kind to small mistakes. I mean come on; Wal Mart knows to ship more strawberry Pop-Tarts during large storms because of the exact same theory! The difference? Our society has deemed it necessary to demand nothing less than perfection in regards to healthcare with no clear societal obligation to fund such a standard. One guy came along and tried to make due with what existed and in the process some holes were punched into the theory. Most well managed EMS systems utilize some form of SSM today, by themselves molding Stout's ideas into their unique demographics. "When in doubt, go Stout!"

It seems like there is a lot of animosity regarding the financial aspects of developing programs like this. If you develop something that is successful and there is an overwhelming demand for it, then money is sure to follow. Simple economics. I promise you, however, from my own personal experience that no one at UMBC is getting rich. It's a state school with an overwhelming mission and decent reputation. As far as an "authorizing body," well you have no one to blame but your own profession. A well-respected research university is about as close as it gets to professional integrity in EMS, especially when there exist no real governing body of educational development in this country. As far as the PNCCT course is concerned, I am fairly certain that it has been co-developed with Johns Hopkins Children's Hospital. It wasn't a singular effort. I won't even mention the integrity of some of the people who walk around these EMS conferences.

I agree with you on some points. Yes I do understand the scientific method (I would hope) and yes I do understand the controversy surrounding CISM, especially in the realm of efficacy. You cannot, however, have your cake and eat it to. If you argue that CISM has never been studied for effectiveness then you must also advocate proper scientific research models. Having a group of psychologist, who claim to understand the CISM methods, performing a controlled study is different that subjecting those same test individuals to a study where properly "trained" and certified debriefing counselors are used. If the psychiatric community is so disenfranchised with the practice then why have they not stepped up to the plate with a properly conducted research methodology? I don't care if everything else is up to par, leaving that one aspect out is tantamount to nothing more than a biased study! I agree that methods must change with continuing research, but I also question the ferocity for which certain individuals in the EMS community attack these theories. I also question why, if this theory is so horrible, it is still practiced and accepted by so many other well-educated professionals. Trust me; the theory is still widely used despite the opinions of certain organizations and individuals. In regards to the CCEMTP course, I think you misunderstand the goal of the course. While it is true that the course does overview many critical care procedures, I don't believe it has ever claimed to certify proficiency in these skills. The CCEMTP course is only an orientation to the realm of critical care transport. While being an ICU nurse is very admirable, it does not mean that the individual is qualified to be hauling a patient back and forth in an ambulance or helicopter. There are many dynamics to the care of an individual while in the field. The attacks on these practices have been almost entirely childish. They make great PowerPoints at conferences, but have little or no effect on the real world practice. The truth is that despite these claims, nothing is ever done to fix the so-called problem. The individuals touting the ineffectiveness of CISM and other practices have done nothing but prey on the hate most public safety personnel have always had towards these "touchy feely" debriefings. They make great topics at large conferences. Great topics=great money.

Dust, Just because yourself and Dr.Bledsoe are friends doesn't mean that you should tout everything that comes out of his mouth. Unfortunately, many of the "studies" (to put it loosely) that supposedly discredit CISM were biased in their assessment. It is especially important to note that the PTSD industry, in the name of capitalism, has heavily marketed and utilized debriefing practices that do not necessarily follow the Mitchell model. I'm not here to necessarily defend CISM, but I will acknowledge that the theory has been instrumental in bringing recognition to the realm of PTSD in public safety personnel. Part of progress is in improving upon theories and adapting them for future use. CCEMTP is the generally accepted industry standard for critical care transport. The popularity of the program speaks for itself. There are things about everyone that are questionable. People with tact just choose not to publicize them. I ask you to consider that when you make statements regarding "research" from certain individuals.

All I can say is that I ask people to take scubamedic's comments with a grain of salt. I'll leave it at that...

With a systolic blood pressure of 102 what else made you think this was a problem related to CHF? Was this patient presenting with any sign of infection? What was the onset of congestion? Does your system have CPAP available for first line treatment?

I'm interested in hearing about the particular EMS system you work for, and why or why not you think it is progressive. If you're willing to elaborate, please include your starting pay, a website (if your organization provides one), and information on the hiring process. I have a specific interest in progressive, highly competitive EMS organizations. A complex hiring or testing process is not of concern. Also, please include the type of delivery system. Does your system use a fly-car system that upgrades BLS units? Is it a PUM? Third party? Fire based? Please elaborate on the delivery system. Also, if at all possible, does your system currently utilize CPAP, RSI, aggressive IO administration, pain management protocols, or any other indicator of your system's scope of practice. I'd really appreciate it.

My A&P classes used cats both semesters, however, some universities do allow students to have exposure to human cadavers. A previous roommate, who eventually transferred to the University of Vermont, had an incredibly hard time transferring his Anatomy because UVM required that students have exposure to human cadavers. Some schools just have easier access to fresh bodies... When I started the clinical portion of my education I was informed that we would have several cadaver labs. I understand that this is unique to Maryland, unfortunately. I believe all of the paramedic programs here have access to at least one session where they can practice several different procedures, etc. Check with your individual state or program about the possibility of arranging some time with a human cadaver.

You're an idiot. First, I wasn't arguing with "Rid." Second, if you would take the time to read any of my post in detail, instead of making half-assed assumptions, you'd know I'm neither a "burned-out pre-med student" nor a rejected med-school applicant. You obviously have no reading comprehension skills or you'd know that this thread was turning out to be a rather academic discussion. Edit: Let me add that I did very much appreciate xcentrk's contribution to the thread, especially since he has valuable insight as a physician extender. One of the things I enjoy about EMT City is that despite many of our differences, we do accomplish much through out debates.

Sounds like class. Specifically the studies on the fluid resuscitation myth have been integrated into our study of shock. Seemingly new, they're teaching us to carefully consider the pros and cons of both the application of a fluid bolus and the PASG. In the case of fluid resuscitation, we're being told to consider them vs. natural "compensatory stabilization" to be specific. More directly, we're being told to consider the effects of wash-out and blood dilution in the development of clots during natural shock compensation, especially in the presence of DIC in stage III decompensatory shock. While I'm not familiar with the specifics of the study, I would imagine that the major dilemma for EMS providers is in weighing the benefits of increased intravascular volume and those of natural clotting factors.

I've heard significant information to counter the studies that supposedly "disproved" the use of PASG; mostly regarding the studies that were conducted in Houston. Some people say that the studies were "out to get" the PASG. I know a lot of paramedics who still use them and swear by them from experience. Granted, many of these people work in rural environments.

I mentioned it in my first post. The Enhanced Practioner Paramedics have a pretty unique scope of practice. I thought I heard, and I stand to be corrected, that they may be experimenting with basic prescriptions soon.

I appreciate your education, I really do. I also appreciate the education physicians receive. I just think those hours could be better spent on more pressing matters than skills that could be easily be done by a physician extender like yourself. A paramedic, perhaps with equivalent education, who could encompass all aspects of the "prehospital" environment. I'm not advocating that your average paramedic be out there stomping around... Thanks for the reply.

Your entire argument is circumstantial. First, many paramedics see a fairly substantial number of patients in a one-week period. It is totally dependent on the call volume of the individual's jurisdictions. Doing rounds at a hospital doesn't constitute total patient care. If you're seeing 70 patients a day there is going to be huge break-down in your level of care. Assuming you worked 24 hours straight with no break, you had the ability to teleport, didn't chart orders, and did not eat you'd only be spending an average of 20.4 minutes with each patient. Secondly, for you to assume that all paramedics completed a 10 month program is a little ignorant. Some PAs complete 25-30 month certificate programs, although it is my understanding that this is changing. Lastly, for you to assume that you have more education than every paramedic is a huge fallacy. I'll just leave it to that. At least paramedics are better at exaggerating.

So true. One of my current professors said the following in our "Introduction to Paramedicine" class. The major focus of the class is on professional development. He always says, "Paramedics are masters of disaster, starting with our own profession."

I'm not saying they don't have their purpose. A well trained, properly educated physician extender is capable of making these decisions. PAs and NPs (while more of an independant practitioner) are perfect examples. I just think it is something that had our profession been smart about, we could have jumped on a golden opprotunity. Your sentiment is one of the biggest problems I constantly find in EMS. We've become so restrained to the idea of being "under" physicians that we don't have the ambition to seek professional autonimity. Again, the skills these physicians are performing in the home are things we commonly do: nebulizer treatments, blood pressures, ECG monitoring, etc. A properly educated paramedic, with an advanced scope of practice and diagnostic skills, could do this same job.