scott33

In leads I, II, and III you can pretty much rule out VT if you do not have extreme right axis deviation in all leads. That is, all QRSs pointing more downward, and below the isoelectric line rather than upward and above it. VT would be confirmed if lead V1 was upright (had you done a 12-lead). This does not appear to be the case in your lead I (the middle one) so yes, it could be ruled out, to the trained eye in a second or so. Of course the 12-lead would tell for definite. If you get a chance, go to Bob Page's multi-lead seminar, or buy his book. I thought I knew the basics of EKGs until he blew me out of the water.

St Vinnie's EMS is now run out of St. John's University in Queens. Just in case you had their old details

Well, I have tried, but I really can't answer the original question, as to be honest many EMT-basics are no more of use than the average police officer on scene. I don't mean that to offend, as one is only as capable as ones training or education, which in some places isn't much. I think the mindset has to change however. Not enough basics see his / her position as a stepping-stone to a higher-level EMS qualifications. Too many people just want to run about in ambulances, making as much of a spectacle as they can, then do very little in the way of a good assessment and treatment when they reach the patient. I know the level of training is pitiful, but it's a starting point, and should be all the more reason to want to go onto bigger and better things. It is too easy just to stay a basic and do your two-week, once every three years, refresher. Just to go off on a slight tangent, perhaps a small part of the problem is the historic (and can I say outdated) affiliation many systems have with the Fire Dept. Good for the FD as it's a clever way to quickly quadruple their call out figures. The problem arises with those who see their EMT-B as a mere adjunct course to being a FF. How many FF / EMTs can you think of, who see themselves as primarily an EMT, then a FF, in spite of what most of their calls will relate to? Then there are the volunteer systems which have many of its members "unable to put in the time for a Paramedic class due to work / financial commitments" (deliberate quotes as I have heard this many times). Again, if you are serious about EMS, this should not be an issue. How many of us work full-time and still manage to put ourselves through...nursing school for example? It baffles me why someone would not wish to go further with their EMS training / education if they were really taking it seriously, not just seeing it as a little hobby. It's like someone who wants to train to be an airline pilot, but just wants to taxi around the airport...not actually fly. All the glory, without the responsibility. Not that it ever happens in EMS :roll: A little extreme perhaps, but maybe there should be a cap on how long someone should be permitted to be a basic for, before being encouraged to move up a rung or two on the ladder. The powers that be should at least pitch this idea at an entry-level interview, or to a fresh out of school probie. It would be to everyone's advantage to have more advanced providers out there, if only, at the very least, to become more capable "basic" providers.

Does this include Placing NG tubes, Foley catheters, infusion of blood products, TPA administration, conscious sedation, and (in some places) radial artery sticks for ABGs???

That would be laaavly. Milk and four please! I think there are more issues out with that of the US having a Medical Control-based system, which can sometimes be quite lenient, depending on where in the country you ride. I find it extremely frustrating at times, knowing that in the US, we have an infinite amount of resources, many many thousands of people trained in at least the basics of EMS, a country which is very pro-college / university education, and in my part of the world at least, financial stability! There are many systems or states though, who simply lack the desire to turn a pastime into a profession. A paid volly system, for example, does not constitute a professional EMS system. The best comparison I can make between UK and US EMS, is that between the US and UK coastguard. Same idea, but in reverse. One has a higher (in this case the US) professional status than the other. At the risk of being labelled a hypocrite, I have always been for the idea of having EMS on a level peg with nursing, as far as professional status, salary, job prospects, higher education (RNs can go all the way to Doctor of Nursing here) etc goes. At the moment in the US, this is not the case. I also have no problem with the US looking at other systems abroad, and [ahem] adopting their ideas. We just have to look outside the box a bit. Good for the few US states who provide degree-level paramedics and national registry...a move in the right direction. Shame its not like that everywhere else in the country. All the potential in the World.

Zippy is right (did I just type that?) Paramedics are registered health care practitioners in the UK, unlike here. As far as UK goes, the ambulance service is the way ahead. Degree based entry level to practice (EMT will be phased out over time) a bearable salary at last, room for growth up through the ranks, or continuing education for ECP, or Critical care para (coming soon I believe) Fire Service? good if you have a desire to gain 30lbs by wanting to sleep all day. Not many calls compaired to the ambulance service...London ambulance alone, handle about 4 thousands calls A DAY UK EMS is evolving, and moving in the right direction, we could do worse than take a leaf or two out of their book.

Two words... LONG...ISLAND More funding thown at us than I could ever count. Obviously an atypical system. Anyway back to the original thread :wink:

Hmmm, perhaps my system and those like it, is soon to be in the minority. It does beg the questions though, what is the point in having a volunteer system at all, if patient billing is in place? Traditionally, "volunteer" meant unpaid and free of charge. So where is the justification for also having state or township funding to operate these systems (if applicable) as well as funding for the upkeep of the buildings and maintenance of the vehicles and equipment? Lastly, what consolation is it to the public to have to pay for their "Volly" EMS stystem twice (state taxation and point of use billing)? Or am I missing something?

100% free in my part of the world (Rural NY) . Different places have different systems. I have no problem with volly 911 systems billing insurance companies if their government funding is nominal. But insurance status should never be a consideration for treating / transporting those who genuinely need it. I do hope it never comes to that.

It's a good idea in principle, but it opens the door for "trial by media" cases such as this one. Guilty or not, this poor guy has this on his record. Not good for PR, not good for career prospects. As for using good clinical experience and judgement, the "fitness to practice" section of the HCP web site shows that human error / negligence / malpractice etc will always be a potential problem. PTS aside, I believe most 911 EMS systems in the US are run by volunteers, who get their funding from the state, donations, and their county. Nothing is billed in these systems (as with MRT, and RNLI etc) certainly not in my part of the world... It's free! Like I said, what you are suggesting is a good idea in principle ( I know it would make sense for some chav-town on a Friday night) and I for one would never dream of transporting anyone just for a ride, it's not happening! I know of numerous instances where one particular time waster in our district gets transported by PD, once we have done our H&P. You do know however, that it won't take long for Joe public to catch onto the fake "chest pain" mantra, which will put the ball firmly in your court as to your transport descision. I am not siding with the LOB jobs, some of them are the scum of the earth, I know that. But as long as your job entails providing a service for the public, there will always be members of the public who will abuse this. There is an other alternative to what could end up being "picky" on who NHS staff chose to transport. More servicable ambulances on the road, more paramedic crews, and less FRVs. It will always come down to the one thing the NHS does not have...money

Phil, educate me! Which particular service is it who pay their Paras a "basic" rate at the very top of band 6 ???. Let's not pull the wool over anyones eyes :wink: most Paramedics will be on Band 5 wages: £19, 166 - £24,803 for a 37.5 hour week. This will get you just as far in the UK, as being on the same figure in dollars in the US, irrespective of exchange rates.

Somehow I think you are underestimating the hoops you have to jump through for a UK citizen to work in the US. Establishing credit, medical insurance, and accommodation are huge obstacles in themselves, and will take weeks to even get off the ground. Your employer will not pay health insurance to people on temporary work visas, so expect to pay about $800 per month just for that alone. You will be high risk for any credit given to you (no credit history), so again you will be paying top dollar for anything on tick, from a TV to a car. You say you have to start from scratch, so where will you be working while you are doing your EMT / Medic courses? You cannot work as one until you have the qualification. You cannot stay in the country unless you are working (USCIS check up on this) How long do you reckon it take to go from zero – NREMT-P in Texas? You may want to look at this, if you haven’t done so already. Can't see anything in regards to fast-tracking. Canada or Australia would have been waaaaaaaaayyyy easier

Which can only mean that you are over here already. The form SS-5 (application for a social security card) requires that all foreign workers coming to the US produce their I-94 (arrival-departure record) for inspection, as part of the application process, and prior to receiving their SS #. This can only be stamped upon arrival in the US. Licensed professional??? Well that cuts down your choice of State to about four. It’s mostly all certification over here with the exception of (I think) TX, SD, CA, and WY.

Your (and my) BCG provides limited protection against certain strains of TB. We do NOT have immunity and it wears off in time. It wouldn't. You would receive your annual PPD, which will show up as abnormal (slightly raised and reddened after 48 hours) you will follow up with a CXR, which will be normal (unless you have active TB) Job done, sign here, get back to work. All of this has to be done before they will stamp your US visa in the UK anyway.

Well done you... no mean feat as far as BS and red tape go. So where will you be working?

NYC, San fran, San Diego, LA, Many parts of the mid west, AK etc can all make similar figures, and of course they pay less tax :bootyshake: Also, your exchange rate rationale makes the common mistake of misinterpreting how far the pound can go, compared the dollar in their respective countries. You can get just as much out of $40,000 in the US as you can with £40,000 in the UK, if not more. Don't believe me? Try pricing the things we take for granted in our lives (using the dot-com and co-dot-uk as the two variables). Items such as all the electrical and perishable goods we use daily, and you will see the huge mark up for the UK market for the same item (housing is probably comparable though). EMS goodies??? Try galls.com versus SP services...no contest! Cars? I will use my own just as an example... Price in US ~ $21,800 OTR, price in UK ~ £18,000. Convert the monetary value into pounds and you will see I paid £7,550 ($12,700) less for the same vehicle. Then there is the cost of fuelling the damn thing...$8.00 or so for a GALLON in the UK, compared to $2.00 or so here, so my dollar is taking me 4 times further, literally, in this instance. The exchange rate thing is only relevant if you are taking money from one country, exchanging it, and spending it in the other...I live this; I know! No argument there. He wasn't being dramatic. The poster stated ..."the violence that is growing against EMS providers over there", and his point is 100% correct. Show me a link or citation from a frontline NHS employee, with evidence to the contrary and I will shut my mouth. The fact that stab / bulletproof vests are now part of the operational uniform in many trusts, is an indication of an obvious problem. Here are just a couple of the many, many daily instances we read about all to often...here, here, here, here, here, here. And just so the nurses don't feel outdone...here The problem seems to be that the typical underclass chav (similar to white trash) views anyone in uniform as fair game for assault and abuse, and they are basically getting away with it Scott-free. They resent anyone who chooses to conform with society, obide by the law, and work for a living. Those in any public uniform (such as NHS tech or paramedic) will epitomize this, and the severity of this social menace should not be down-played. The other factor is the "take it on the chin Son" attitude many people in the UK have, when it comes to physical assault. Hence, the lenient sentences for those few (who are actually prosecuted) receive are laughable. All is forgiven if ETOH is involved. That said, I would still encourage anyone who wishes to live and work in the UK, to do so, but not on a whim. It still remains a great place, (you may just have to watch who you sing the Star Spangled Banner in front of, when you are out on the piss) and as for EMS, it is certainly ahead of the US in many (not all) ways, with the NHS utilizing their staff as practitioners, rather than providers. I would though, strongly discourage looking anywhere else but here as far as actually starting the application process. Those who promise the World rarely deliver it, and if a web page doesn't have dot-gov-dot-uk, don't waste your time. And for God sakes, visit the place first ](*,) :violent1: PS somedic, stick your comment about Glasgow up your arse :wink:

A bit of a pet peeve of mine... Would suggest all of the above, plus: I also agree with the mimum 25-year-old age limit, with clean license etc. Sorry to be a party-pooper, but there are too many numpties driving emergency vehicles IMO, and it needs-a-fixin' seeeee! :protest:

You have very few options, unless you have dual nationality, or family who legally reside in the UK who are in a position to petition on your behalf. Even with the latter, it would probably take several years for you to have permanent resident status. Citizenship itself will take even longer, and will involve you satisfying a minimum of 5 years permanent residency, before you can even apply. There is no (legal) quick fix for US citizens wanting to move to the UK (as with UK citizens wanting to move to the US) If you don't have a sponsor, in the form of an employer or a family member, it probably isn't going to happen any time soon. Certain professions carry certain privailages, but they have many limitations. You may want to spend some time in the UK on a tourist visa to feel it out for yourself... There are a few websites which will help you out if you do a search, but avoid the ones which promise to assist you in "jumping the line"...they are scams. Here is as good a place to start as any: http://www.ind.homeoffice.gov.uk/

The alternative being to "bill" the entire country for healthcare, whether they need it or not, as with the UK national insurance system. As I have said, the US system isn't perfect, but neither is the UK's. Money (or lack thereof) is the big problem with the NHS. Companies such as BUPA and BMI would not have survived in the UK, had there not been a demand for private healthcare.

Which itself was a "people in glass houses" response to a previous post, in which a UK member had a slated the US EMS system as a whole. Nor here. Emergency care (911 / ED) cannot be denied to anyone, due to their inability to pay. I would like to see a credible reference of anything which states otherwise, as many UK bods seem to be under the misapprehension that we check the patient's wallet before the ABCs. Whether or not the NHS system is free is another argument however...you do still pay NI contributions out of your wages I assume? :wink: My comments (if I am who you are referring to) concerned the figures found as a result of impossible ORCON targets, in a grossly underfunded NHS. The figures are what they are, but I never once said it was the fault of the frontline staff. Having spent over 30 years living in the UK, and having family employed by the NHS ambulance service, I think I have more than just a forum-based insight of how things are done, and the problems faced on a daily basis. I have nothing but respect for the frontline NHS staff, and you will never see me claim that the US system is comparatively superior to the UK in every respect. On the contrary in some instances; such as licensure, professional recognition, and degree-based education (at paramedic level) to name but three.

Nothing against the man myself, just needs to wind his neck in sometimes, when it comes to criticism based on belief, versus experience

It’s true we are not forced to make any call is any particular time scale. We drive as quickly as we feel we need to, though obviously dilly-dallying will not go down too well. As far as goals go, I have heard "under 9" for our more life threatening calls, but it's not enforced and I have not seen it in writing. PD are often on scene with the AED for arrests in no time, and work in a similar role to the UK FR Different calls will necessitate different responses, and although we run hot to almost all our calls, common sense should prevail (not always the case sadly) I have never liked the idea of ORCON, and would be surprised if any UK road staff did. It just screams of "accident waiting to happen". Perhaps the money used to design, implement, staff, and monitor such a system, would have been better spent on having a couple more satellite ambulance stations in the more remote areas, which are failing their ORCON targets. That's what the the poor figures would tell me, not "Oh you have to drive faster" ...Probably implemented by some pen-pusher who has never stepped foot in an ambulance As far as driving and response goes, we have the guidelines, you have the protocols...sux doesn't it?

Though less so than referring to an entire nation of EMS providers as chimpanzees who lack any diagnostic skills etc. You are entitled to an opinion, as am I, but your response was the most broadest of generalizations, which was only posted for provocation purposes. Be nice man :roll:

Zippy, I am not letting that one go mate :x Zippy's knowledge of American EMS is limited to this forum, and perhaps a couple of TV dramas. .......................Further rant removed by original poster (anything for a quiet life :roll: ).......................... Don't believe me? Try typing the likes of "ambulance fail to meet targets", or a variation of the same, into Google and see what comes back...nothing but UK stuff. Anyway, taking the positive from his derogatory post (thought you were above that Zip) and giving him credit where it's due...he is correct (somedic) in that your options are very limited. The grandfathering rights have now closed and I don't know if you have any other option but direct entry as an ambulance technician, which will in time be phased out for entry level. UK paramedics will very shortly only be able to practice having completed an approved uni course in the UK. In spite of your experience, it is a different beast in the UK, similar to how nursing is, with the regulatory body, professional licensure (not certification) protected title etc. None of this takes into account having to have a UK commercial driving license for two years, on top of the biggest problem you would face...immigration. You can't usually take a job from a UK citizen, and you would need to have a job before being permitted a work visa. Good luck though, Scotland's a wee bit different than SC and I would suggest you fly over and scope it out if you haven't already done so. Don't worry about Zippies, they are curious creatures you may encounter in the UK (real name comes from the Latin Gobbus Shiteus) fiercely territorial apparently... just give as good as you get :wink:

Another reprobate from the UK forum here. Lived most of my life in sunny Scotland, manage to get back twice a year for a beer and a scrap. Have lived in NY for six years. Occupation / EMS as per profile. Have a few old friends in the UK in both nursing and the NHS ambulance service, and we regularly swap tales...different systems from the US but with a common goal. Both have their good points and bad points. Zippy, my guess is you are in Notts (or is that too obvious?)