scott33

Your medical director and / or whoever would normally sign your CME paperwork. You are still required to be signed off as competent in some of the practical skills after taking the written. The recert by exam form is below. https://www.nremt.org/nremt/downloads/54329%20paramedic%20form.pdf

Antro, C., Merico, F.,Urbino, R and Gai, V. (2005). Non-invasive ventilation as a first-line treatment for acute respiratory failure: “real life” experience in the emergency department. Emergency Medical Journal 2005, 22:772-777 Bendjelid, K., Suter, P.M., Jacques, D. and Romand, J.A. (2005), Does continuous positive airway pressure by face mask improve patients with acute cardiogenic pulmonary edema due to left ventricular diastolic dysfunction? Chest 2005, 127: 1053-1058 Crane, S.D. Elliot, M.W. Gilligan, P. Richards, K. Gray, A.J. (2004), Randomised controlled comparison of continuous positive airways pressure, bilevel non-invasive ventilation, and standard treatment in emergency department patients with acute cardiogenic pulmonary oedema. Emergency Medical Journal 2004, 21:155-161 Dieperink, W., Weelink, E.E.M., Van der Horst, I.C.C., De Vos, R., Jaarsma, T., Aarts, L.P.H.J., Zijlstra, F and Nijsten, M.W.N. (2009). Treatment of preumed acute cardiogenic pulmonary oedema in an ambulance system by nurses using Boussignac continuous positive airway pressure. Emergency Medical Journal 2009, 26:141-144 Dieperink, W., Jaarsma, T., Van der Horst, I.CC., Nieuwland, W., Vermeulen, K.M., Rosman, H., Aarts, L. PHJ., Zijlstra, F. and Nijsten, M. WN (2007). Boussignac continuous positive airway pressure for the management of acute cardiogenic pulmonary edema: prospective study with a retrospective control group. BMC Cardiovascular Disorders 2007, 7:40 Gray, A.J., Goodacre, S., Newby, D.E., Masson, M.A., Sampson, F., Dixson, S., Crane, S., Elliott, M. and Nicholl, J. (2009). A multicentre randomized controlled trial of the use of continuous positive airway pressure and non-invasive positive pressure ventilation in the early treatment of patients presenting to the emergency department with severe acute cardiogenic pulmonary oedema: the 3CPO trial. Health Technology Assessment 2009, 13: 33 Hubble, M.W., Richards, M.E., Jarvis, R., Millikan, T. and Young, D. (2006) Effectiveness of prehospital continuous positive airway pressure in the management of acute pulmonary edema Prehospital Emergency Care 2006, 10: 4, 430-439 Kallio, T., Kuisma, M., Alaspaa, A. and Rosenberg, P.H. (2003) The use of prehospital continuous positive airway pressure treatment in presumed acute severe pulmonary edema. Prehospital Emergency Care 2003, 7:209-213 Kelly, C.A., Newby, D.E., McDonagh, T.A., Mackay, T.W., Barr, J., Boon, N.A., Dargie, H.J. and Douglas, N.J. (2002) Randomised control trial of continuous positive airway pressure and standard oxygen therapy in acute pulmonary oedema. European Heart Journal 2002, 23: 1379-1386 Kosowsky, J.M., Stephanides, S.L., Branson, R.D. and Sayre, M.R. (2001) Prehospital use of continuous positive airway pressure (CPAP) for presumed pulmonary edema. Prehospital Emergency Care 2001;5:190-196 Masip, J., Roque, M., Sanchez, B., Fernandez, R., Subirana, M. and Exposito, J.A (2005) Noninvasive ventilation in acute cardiogenic pulmonary edema: Systematic review and mata-analysis. The Journal of The American Medical Association 2005; 294: 3124-3130 Park, M., Sangean, M.C., Volpe, M.D., Feltrim, M.I.Z., Nozawa, E., Leite, P.F., Passos Amato, M.B. and Lorenzi-Filho, G. (2004). Randomised, prospective trial of oxygen, continuous positive airway pressure, and bi-level positive airway pressure by face mask in acute cardiogenic pulmonary edema. Critical Care Medicine 2004, 32(12), 2407-2415 Plaisance, P., Pirracchio, R., Berton, C., Vicaut, E. and Payen, D. (2007). A randomized study of out-of-hospital continuous positive airway pressure for acute cardiogenic pulmonary oedema: physiological and clinical effects. European Heart Journal 2007, 28: 2895-2901 Taylor, D.McD., Bernard, S.A., Masci, K., MacBean, C.E. and Kennedy, M.P. (2008) Prehospital noninvasive ventilation: a viable treatment option in the urban setting Prehospital Emergency Care 2008, 12:42-45 Thompson, J., Petrie, D.A., Ackroyd-Stolarz, S. and Bardua, D.J. (2008). Out-of-hospital continuous positive airway pressure ventilation versus usual care in acute respiratory failure: A randomized control trial. Annals of Emergency Medicine 2008, 52(3): 232-241 Winck, J.C., Azevedo, L.F., Costa-Pereira, A., Antonelli, M. and Wyatt, J.C. (2006), Efficacy and safety of non-invasive ventilation in the treatment of acute cardiogenic pulmonary edema – a systematic review and mata-analysis. Critical Care 2006, 10(2),

You can apply to the Heath Professions Council as an international applicant, to have your qualifications verified. http://www.hpc-uk.org/apply/international/

If the OP wants to work as a paramedic in the UK, he will need to be registered by the HPC, whether PAS or NHS. He will also need the appropriated visa to reside and work in the UK.

You have arguably one of the best EMS systems in the country on your doorstep - Wake County EMS. I would suggest learning as much about them as possible.

Never a good thing to have a negative reputation score which is in excess of your post count.

These question marks were not in the original email I hope. No mention of hemodynamic parameters when giving NTG. You may find that after your first few doses of NTG, if the pain hasn't resolved, it probably isn't going to. Is your suggestion to keep dumping nitrates, or look at another treatment option? When you say it is a "medical consensus", you should provide a citation which backs it up. Wrong. Concrete wrong! Lasix has proven itself to be a terrible medication for use in prehospital care and REMAC are quite right to bin it. Studies have shown (see link) that the average paramedic cannot differentiate between wet sounding lungs of CHF, and that of pneumonia. That's the sad truth and if you give it for the latter, all you will create is a drier mucous plug which will be harder to treat. Additionally, many patients in CHF are not fluid overloaded. They just have a fluid distribution problem due to a decrease in LV function. Many a "CHF" patient has to get fluid boluses in the ER, due to field misdiagnosis by the paramedic. CPAP is the way ahead for the prehospital treatment of CHF - if you were current with EBM you would know this. http://www.ncbi.nlm.nih.gov/pubmed/16531376 And once again, after 3 treatments with no relief, shouldn't you be looking at some other interventions (mag, epi, CPAP)? No mention of the dangers involving continued benzo administration may cause. Forget RSI. It involves more than just sedating the patient. You are taking away their ability to breathe by paralyzing them. This is not a procedure without its many dangers, and not one to be taken lightly. RSI will be reserved for certain progressive systems, transport, flight and other countries. Everyone else will may just be left with intubating the dead, or even seeing a push towards the use of supraglottic devices in the years ahead. I am sorry, but your email makes for painful reading. It seems that you just want to repeat standing orders ad-nauseum and limit contact time with MC. Reading your posts there may be a language barrier that has prompted all this, but nothing is going to change. NYC MAC protocols are becoming more simplified with each rollout. As I said before, there is a reason for that, and it begins with the level of provider in the system.

Here are two links in order of greater importance first... http://www.ukba.homeoffice.gov.uk/workingintheuk/ http://www.hpc-uk.org/apply/international/ Good luck.

What fiznat said. Alex. Whereas your intentions may be commendable, your approach is really not. You seem to be clutching at straws here, and have yet to provide any evidence as to why you are asking for these changes. "What ifs" and "because other systems do it" do not count. You need to get your head into the books and come up with something that you could submit for professional peer review. If you want the powers that be to take note of your proposal, there is no point beating it to death here - why not look to get something published in a professional journal? The point is valid, that you should also be able to formulate your argument without reference to other systems. Just know that the northeast is not at the cutting edge of EMS. NYC protocols are, and always will be, geared towards the most incompetent medic in the system, and we both know there are a lot of them around. The oral and written MAC exams allow no room for lateral clinical judgment or reasoning. It is a test in memorization. Pure and simple. http://nycremac.com/2010/07/the-answers-to-the-test/ Good luck anyway, but I do think you are putting the cart before the horse.

http://www.bbc.co.uk/news/world-us-canada-11255366

Have to agree with you. I found the NR a piece of cake compared to the NY state and NYC REMAC (the latter being a test in your knowledge of protocols, more than actual knowledge of subject matter). Maybe I was just more relaxed taking the NR test, as it wasn't going to change anything if I failed it.

Well, there is another plus I suppose, you all take your teeth very seriously

I have dual UK / US citizenship, so can see things from more than one perspective. The sense of patriotism most natural-born US citizens have is very commendable. There is also an underlying optimism among the population, which I have always found impressive. Definitely not a nation of whiners or quiters, when things get bad, they will take on 2 or 3 jobs to make ends meet. The 75-hour week is commonplace in the US. The US work ethic is admirable, though that may be due to things like a lesser minimal wage and poorer benefits when compared to other westernized countries. Individually, the people are genuinely friendly and don't bite.

The RAF have personnel who are HPC registered Paramedics, and I know of one ex RAMC CMT who was grandfathered in by the HPC. All he had to do off his own back, was the driving component, prior to gaining employment. He is now an ECP working for one of the trusts.

Welcome to the forum. Did you find the EMT-B class easy compared to your CMT courses?

The replies here are probably going to echo those on another forum you posted on, in that nobody should be giving out medical advice on these types of forums. Your doctor is the best person to be discussing this with. The attached files show very little anyway (as do all 3-lead tracings), but what can be said, is that it shows a normal rhythm, a normal rate, with occasional artifact and wandering baseline, due to movement / breathing. Sorry, but you are definitely looking in all the wrong places for advice.

How does an advanced paramedic differ from a regular paramedic in the UK?

Yup, putting another unmarked vehicle into the mix could have easily have made it number 8. Taken from another forum, but relevant to this thread... http://www.wpxi.com/news/23763208/detail.html

I hate to generalize, but having had many conversations, and read many threads on many forums, along the line of "would you stop" - there does seem to be a common theme wherein the lower end providers are the ones who would be first to stop at the more risky calls (MVC at night on a highway with no vehicle markings). Like many things in EMS, a lot of it has to do with location, and who could be faulted for pulling over in the more remote areas to render aid if it is safe to do so, even if it is just to make a phone call. However, as already been pointed out, even the most experienced provider is limited in what they can do at the roadside, and if mechanism is significant, anything other than sitting holding c-spine is usually going to be the wrong course of treatment. There is a perfectly valid reason why most doctors do not have MD plates.

There is a clear line of demarcation in the training and education continuum amongst EMS providers, which pops up every so often. It usually involves the "would you stop?" discussions.

Here are another two toss pots who won't be getting anything other than a "please don't do that again"-type sentence. http://news.bbc.co.uk/2/hi/uk_news/england/kent/8701890.stm Every Day

Well done the Judge for having the balls to finally put someone behind bars for what is a daily occurrence in the UK. However... Shame on those who immediately appealed against the sentence and got it reduced to a non-custodial "suspended" sentence. JAIL FAIL

And had you given the Aspirin, the INR would still be 6.5 They have no direct relationship.

Then you will already be aware that the visa is the most important thing you need, and without one, nothing else matters. if you are not currently in possession of an EU passport, the visa application is going to take time, effort, and money. You may or may not fit the relevant criteria. Job offers mean nothing if you are not allowed to work in the country legally. I suggest you start here. http://www.mfa.gr/www.mfa.gr/AuthoritiesAbroad/North+America/USA/EmbassyWashington/en-US/ Good Luck.

Where is your source? As per the NYPD website, it will take over 6 years to make that salary http://www.nypdrecruit.com/NYPD_BenefitsOverview.aspx To put it in context, my starting salary on the first day working as an RN, in the same part of the world, was in excess of what an NYPD officer makes after 5 years of service. BTW, if you think NYPD make big bucks, try looking east of NYC.