DwayneEMTP

And a thought Dust... Requiring so many field internship hours, in such a full schedule, doesn't that put EMS back in the court of the kids living at home? Doesn't it again disqualify the people that are likely to be better for the profession? I'm not suggesting a bunch of hours is bad, it's obviously not, but perhaps like someone stated before, the sevices need to step up to the plate and create paid internships for all, or part of the hours. I haven't really thought it through... Dwayne

I guess I'm going to disagree with just about everyone here... When I take a class, I pay my money to get an education, not be a resource for other students that don't share my near freakish need to get good grades. I do absolutely agree that teaching is the best way to learn, but that implies that the person you're teaching is motivated to learn and excel. If not? I don't have the time to carry them. An example. At the beginning of every class that I've had at the college level I've started a study group. In the first month or so there are always 3-4 people that are interested in participating, it doesn't seem to matter how large or small the class is. We get together and study 2-3 times a week for about 5 hours or so at a time. I make up flash cards for each chapter, pass them out to the group, and we take turns asking/answering/discussing until we know them so well we want to vomit. It's a great way for me to learn as I remember a lot from creating the flash cards, but it also puts everyone in a position to explain the concepts that sunk in for them easily to the others that didn't pick them up so well...and everyone has some of those subjects. So everyone ends up both teacher and student. The problem comes when my study group has aced their first month or two of exams...then the boneheads, that had no desire to excel, want to join the group to attempt to save their grades before the end of the semester...but they are no longer welcome. It simply takes too much of the groups time to attempt to bring them up to speed, get them caught up. I offered to help, they didn't want to make the effort, I'm not going to carry them now. If I was placed with a student, that was expected to share my work, and therefore my grade, I would absolutely demand to be changed if they didn't share my goals. Again, I paid for my education, not to be a teaching resource for the class. I enjoy being a resource, but only for those that share my drive. Are you not so bright, but truly want to grow and learn? Welcome. Do you simply want a piggy back ride to your C, to maintain your financial aid? Come back when you've grown up. No disrespect intended for typos, I don't have time to reread this as I'm off to class...I hope it makes sense. Have a great day all! Dwayne

I was rushing...and not doing anything correctly. The thing that worried me most was that she seems focused on mechanical interventions. I'm much more focused on, or wish to be focused on, assessments and proper medical interventions. My line of thinking went something like this... First shift: I really don't know anything that isn't theoretical, other than 300 hrs of hospital clinicals, so I'm focused on doing what I'm told, prepared that much of it might not make sense at first. Ass chewing after ass chewing for not getting history, vitals, and IV. My assessment was approximately 50% complete on most patients, but I often had an IV. Second shift: In my pea brain I say "Ok, I've now started 10 IVs that I didn't think were necessary and haven't managed a single complete assessment, which I do think is necessary. This doesn't seem to be a well thought out plan. To medic "It seems like I'm trying to do too much at once, and not doing anything correctly" Medic "Well, it takes experience, and you don't have any do you?!" Then it occures to me, there are three of us here, but only one of us that will have to live with the results of this time...so... Shift three: I decide my preceptorship is not designed with logical, intelligent steps for progression and success, so I'm going to design my own...and she can be damned if I can't get, or choose not to get her wondrous IV. (only have two Life Flight transferes the whole shift) Fourth shift, first call: Bumped ahead of medic to patient, started my own history and assessment, started packaging her with the basic to move her to the ambulance, asked the medic to set up the monitor and spike a bag of NS. The lady was difficult to waken after possibly taking an additional vicodin for back pain. (Medic is way pissed, but I've decided that if she won't define the parameters of my preceptorship then I'll force her to define them, or kick me off of her truck, we need to stop wasting each others time. I've got shit to do, I'm unwilling wait for her to decide if she likes me or not) Get to the hospital, Sats are up, fluid is running, full assessment and history completed. I'm feeling pretty peachy...Of course, the ca ca hit the fan, starting with Medic "You have no business stepping in front of me! I will not allow you to make me look bad!!" Me "Did I make you look bad?" Medic "No." Me "Then what are you so mad about? Medic, "I don't like you getting all cocky, thinking that you can run things!" Me, "Then explain what it is you do want, up front, instead of sniping me for something different at the end of each call. And why (honest to God) do you have to explain everything at the top of your voice?" She said (quietly)"Well, you did ok...what did you like about that call...?" (wait! Didn't she kind of sound like a teacher for a sec...?) I thought we'd had a break through, but my instructor called today saying that it is probably best if I leave that truck and take one that "won't be so tough on me." 8) I think I'll stay where I am for now...Maybe this preceptor will actually give the next medic student an education... Have a great day all... Dwayne

A few thoughts... I'm just passed my second week of Phase One (of four, 500 hrs/min.) preceptorship after going straight from basic to medic. The only real challenge I've found so far in relating to patients is the time aspect. It's difficult to get the information I want, apply the monitor, get a BGL, and start an IV (the requirements my preceptor has for me for me for about 85% of our patients.) with the 5-12 minute average transport time that we have..(This is my observation phase) But why would I be better off gaining this experience with less knowledge? Is the theory that I would do better simply because I would have less to think about? So my empty head is an advantage somehow when it applies to learning assessments, patient interaction, and treatment? Would I be less nervous if I had a year of experience as a basic? Probably. Should I be doing this at all if I need a year to get over the jitters and learn to speak to patients? Not really for me to say... For me, I agree with Dust and others...my school did very little to prepare me for preceptorship. We ran few scenarios in school, had no access to the service's protocols before hand, etc. As well, preceptorship started with the paramedic saying “I don't like the way you've chosen to become a paramedic, it shouldn't be legal, and I'll tell you up front that I won't pass someone like you through on their first attempt.” (Well...alrighty then...) Not exactly the welcome you'd expect from an educator...and so far I've gotten pretty much what she led me to expect. Common interaction: Me “I didn't really expect her breathing to deteriorate so quickly, what did you see that made it your priority?” Medic “That comes with experience, and you don't have any do you!?” (Was that somehow an answer to my question?) I perhaps have a somewhat unique view, being older, having held professional, responsible positions most of my adult life, as well as having been responsible for teaching people for the last 20 years or so... The system is broken. From the expectations set at the beginning of basic, to the 'figure out a way to pass everyone' medic program, to the immature, ill prepared preceptors that many are exposed to. It's a system run on egos and convenience. I'm not sure I have seen even a small percentage of this path that is designed to progress EMS as a career...it needs a good exorcism. An outstanding example of this? My preceptor was giving me a scenario that required me to run through my ACLS protocols...She thought the new standards were pretty stupid, and said “The protocols, OK, maybe are written by Dr.s and such, but they haven't seen a patient in 20 years! On the street we ignore them and do what works!” I came into EMS with high standards, believing I would enjoy spending my days with others that shared these standards, yet at nearly every junction there are educators, preceptors, employers, demanding that you drop those expectations in order to proceed... Am I cut out for professional EMS? I am, I just can't find any.....

Not only saves money, makes money!! I went and talked to them in California when I lived there, though Dust and others convinced me to get a degree instead... The gist is this... $8,000 (if I remember right) for the 7 month didactic. Prereq of A&P for healthcare professionals - 5 one hour classes over 5 weeks (Yes, I actually mean 5 hours total) It seems like they had the same hospital and ambulance clinicals...Not sure, but assuming it's the same as my current school, 300 hospital, 500 preceptorship (Min), then an additional $1300, as clinicals were charged at $1/hr hospital and $2/hr ambulance. They claim NR pass rates in the high 90s if I remember right. One other thing...they wouldn't guarantee you a local preceptor. If you wanted a guarantee, you had to spend your preceptorship in Vegas, and were required to live there for all 4 phases...Some medics told me, though I was unable to verify it, that some people waited a year or more to begin their preceptorship locally. (When I asked about it at the interview they said "Oh, that's silly, we get people in as soon as possible, no one has ever waited that long" So I said, "So you'll guarantee in writing that I can begin my preceptorship within 6 months, and continue until finished" They said "well, we can't do that." Some of their medics taught at the basic academy I went to...in fact that is part of what caused (notice I didn't say inspired) me to become a medic. I though "Christ, if these guys can do it, how hard can it be?" I'm quite a bit more humble now....

Agonal respirations are characterized by, usually, slow..shallow respirations with periods of apnea (sometimes long) and occasional gasps. One of the hallmarks of this type of breathing is it's irregular rate, rhythm and depth. Most commonly associated with near death, though sometimes the term is incorrectly used to define other types of breathing that have more accurate descriptions. When observed it is certainly a sign that aggressive interventions are needed. The only times I've seen this it was presented by family members of mine in their last moments, to hours(!), of life. The apneic periods were sometimes so long that the family had time to say their last goodbyes, only to be shocked when there was a huge gasp, followed by respirations that once again followed the description above. Next: Respiratory acidosis

When I read this it occurred to me that perhaps this is the reason for the disconnect between medics and basics on this issue.. With each class that I take the picture gets bigger and bigger. There are times when I'm unable even to keep the edges in view! As a basic (speaking only for myself), trouble breathing = Obstruction. Foreign body, positional, or some undefined medical problem. As a medic student, trouble breathing = Obstruction be it foreign body, chemical, structural, many options of blood/gas exchange barriers, volume, electrolyte, or cardiac issues, and on and on... My point here isn't arrogance, it's simply that we continue to blame basics for the things they don't know, and therefore can't be realistically expected to understand. It's like when my wife wants to explain problems to me that she has no intention of fixing. I don't get that...it makes no sense...anyone should be able to see that she is obviously wrong in this approach...yet gazillions of smart, successful, emotionally sound women view this the same way. And they are right. I simply don't have the necessary equipment to understand it. I guess I'm wonder if, after trying to make this point to basics a hundred times in the same way, if perhaps changing the way we view the problem might change the way we address the problem, and help lead to a solution. There are some very, very smart basics on this board. I simply can't believe that the concept that lower education will seldom have the ability to save higher education (Though I absolutely believe that higher experience can often save less experience) is getting by them, or causing any real confusion... There's got to be something else going on.... Have a great day all! Dwayne

Phil, meant with no sarcasm... How do you define better in terms of the EMS field? Why does this question make the people that use this statement so angry? Why are they never willing to simply tell their stories and be done with it? If a basic saves a medic, simply because s/he's not a medic, would a first responder or boy scout save them equally well, as they meet the same requirement of being a "non medic?" Is it your feeling that "medics save lives, basics save medics" is a valid statement? Dwayne

Hell Mike, that word's brutal...it's gonna take a few minutes....

Hey LS, Speaking for myself, no apology, in any form is necessary! Your passion for correctness is vital, I was only questioning the productivity of the tone of the message. You know as well as anyone that attempting to foster good spelling, grammar, and above all, logic, is, and should be a constant goal of those that mentor others here...I just wanted to make sure you felt that the message you seemed (to me) to be sending, was the message you intended to deliver. I often go off in the ditch, I hope you'll yank me up short when/if you believe that I'm negatively effecting the efforts of those that we are here to share knowledge with. And I was completely sincere when thanking you for the corrections. Just filling in posts does no one any good here...they need to be accurate...it was a kindness that you took the time to point out what many of us missed. Have a great day LS! Dwayne

So why are you lecturing the kid in, what, his second or third week of basic class? That is exaclty why no rational person would draw that conclusion from what was written above. I like that you're nit picking...I just don't like that you're preaching. He's one of the few people participating, he took a shot, in his own words, not a cut and paste, and made a small error. What sent you off on the rant instead of simply correcting his error? Why so preachy today? That doesn't normally seem to be your style... This would have been a great post had you left it here... Bull pucky! This is exactly the place to make these kinds of mistakes. The ones that worry me don't have the gnads to participate....they can make all their mistakes for the first time when someone can get hurt. Take a chill pill LS. Pretty cool you took the time to post the corrections, a thread like this depends on that, I'm just not exactly clear why they came with a beating.... Dwayne

Pretty inspiring RM...Keep us infomed as to how things are going huh? Congrats! Dwayne

That would be great...I picked the dorkiest possible name...but I didn't know we could change it? Maybe you know the secret bat handshake....cause after two years I have never gotten a response from Admin on anything... Can you make it happen Terr?

Get your ass in here! So far Terr and Mikey are carrying the show!! I'd hoped to show that many here are hungry for education...but so far I'm getting egg on my face. But...I have faith...

Cervical verebrae – The 7 bones of the neck. Beginning with the atlas, directly below the foramen magnum, at C1 and ending at C7, directly above the T1 (Thoracic)vertebrae. Often the site of spinal injury due to the small muscle mass surrounding it and the weight of the head. Next: Cranial nerves

Thanks for that...are you a basic? How do you feel about the nitro/IV question? How do you feel about those protocols? Welcome to the City!! Thanks for posting! Dwayne

Sorry Doc, I guess we were typing at the same time or I might have reigned myself in a bit... I agree with you 100% on every point. My frustration at the search wasn't really aimed at you alone so much as Spenac's comment after...the combo of the two just got under my skin. There seems to be a tendency lately, by some, to take easy shots at anyone that's not likely to fight back...I guess I might at times go overboard fighting for them. Apologies to all for grumping. Dwayne

And this post is more productive than the original how? Man, I'm just tired of people sniping other's posts for being a waste of O2, with a post that was a BIGGER waste of everyone's time than the original. What's up with that? And for the record, I guess you better add my name to the remediation list...I can't seem to search for anything here and get less than 100-200 responses. I guess it's too complicated for me as well. By the way, I have Bio 105,201,202, biochem, psych 101-201, entro to chemistry, sociology, two semester of English, and 40 units of medic school....Are you suggesting that I need "intro to EMT City's search function" before I get my ticket?

At the time the nitro is delivered, it is certainly preferable to have a good IV started. No question about it. Why? Because a patent IV gives advanced options if things get squirrely. No different than playing with fire. If you have the option to have a hose nearby in case things go sideways, wouldn't it be reckless to ignore it? And if you find there is no hose to be had...would you still choose to play with fire? You've asked a good question, this is exactly the way you should be thinking. 'Why' and 'what if' being constantly in the front of your mind is what will separate you from the great unwashed masses. Thanks for posting! Dwayne

I'm guessing you're not asking for yourself Vent...But do you mean why PPV as opposed to the normal physiological process?

We used PPV or assisted ventilations in basic. We may have asked for a BVM, but it was always an item, not an intervention, as opposed to PPV or assisted vents where you were expected to justify your rate, force and mixture. Not that I don't agree with your logic Dust, just adding this tidbit of info in case it makes sense when others post... Have a great day!

Commonly four, but if I remember correctly often 5 or 6...I'll have to look it up...

The large heavy bone at the base of the spine, which is made up of fused sacral vertebrae. The sacrum is located in the vertebral column, between the lumbar vertebrae and the coccyx. It is roughly triangular in shape and makes up the back wall of the pelvis. The female sacrum is wider and less curved than the male. The name comes from the Latin "os sacrum" (holy bone). Why it was sacred is matter of conjecture. Source: http://www.medterms.com/script/main/art.asp?articlekey=7936 (I'm not wild about cut and paste, I only did it as an example of siting a source) vertebral foramen

Fair enough! So the next word is: Patella

Not bad...but what is the patella's direct relationship to the talus? (there may be one, by the way, I'll have to look it up :wink: )