Ridryder 911

After hanging atound & chatting with Dr. Bledsoe last week. We started reminiscing about old times in EMS and EMS forums, Dustdevil name came up.... thought I drop back by and see if any old timers were left? I'm no longer working primary in the field or even ER, but started as consultant for a large hospital. Telestroke with 18 hospitals attached. Ahh the corporate world.. but still educating medics & nurses! Hope all is well with everyone. .. R/r 911

I am all in favor of evidenced based medicine (EBM), the problem I have is in the true research of what is legit and what is not. There are several articles citing where bogus pay-offs to endorse EBM. Of course large fines have been set but ... the millions of dollars and opening of potential law suits because physicians follow set guidelines only to later find out they were falsified. I have worked professionally in research and development, I have seen and understand the importance of rigid standards and ethics... and I also have seen the opposite to be published and some set as standards without questions. Here is a link to an interesting article. http://gaia-health.com/gaia-blog/2011-12-09/evidence-based-medicine-is-a-fraud-heres-why/ R/r 911

AMEN!! So many needless blood cultures, etc... We have became a "follow the alogrithm/tree" practice...

Love the pod cast... I do think this is definitely an area that EMS (even in hospitals) fails to recognize.. R/r 911

Should I become an EMS student and eventually an EMT? As many discussed, what are your intentions? If you have to ask.. probably not. This is really tying to be a profession. My advice is to go to academic studies and obtain your general education. You will need them no matter what you decide to do. Also, will my age hinder me greatly? Yes!.. Most professional services require minimum of 21 years of age for insurance (unless self insured) .. I have seen many of requiring up to the age of 23. Again, this is a profession. What are the challenges of studying to be an EMT that I should be aware of? It is nothing like you see on television. Usually, there are several hours of boredom with few minutes of terror! Studying basic EMT is simple, it is set at at a 10-12'th grade reading level. Repetitive practice will allow you to master the basic skills. Again, as you master other academic courses such as anatomy, chemistry, English, Psychology, EMT course will be a breeze. If you're concerned about the emotional and mental strain of the job, but know it is a challenge you want to try and overcome, should you think twice? There is an emotional factor that we are now seeing more than ever. Not everyone is emotionally stable enough to handle the hum-drum of EMS and the abuse calls. If your looking for a high adrenaline job, chances are EMS is not what your looking for. I used to say age is not a factor, but I regret saying that. I believe the nature of our business is being able to understand the whole business of EMS. That we are there for patients (not vice/versa) and the 3' o-clock for grandma being lonely is just as important as that truama call... grieving parents or the new widow of the spouse of 65 years.... and yes, it's also a business. To provide care but also make money.... It's not that younger members can't but research has proven that many do not mature until early twentys. I ask you... What's the hurry? Really.... EMS will be there for you, if you do make a rational and educated answer. It's much better than entering only to never really enter it or leave it in 3-4 years, before one has obtained true experience Good luck, R/r 911

1. How often is your ambulance inspected by an outside regulatory agency (State, City, Province, Whomever) ? Yearly, per EMS Division but.. we also have spot inspections at anytime anywhere. Yes, even at 0030 at an ED. 2. Is the inspection a true inspection, where the inspector truly verifies that you are totally in compliance, or is it pencil-whipped ? I guess to put it more clearly: does your pucker-factor go up when you know you are about to be inspected, because the inspector is such a hard-ass ---- Or do you have no worries at all because you know the guy just wants to lay hands on a few items and get on to the next truck ? No, a better way to put it --- If the airplane you were about to board was inspected like your ambulance is, would you fly in it ? Used to be paper whipped, now differently. Heck, they even check the KY expiration dates... Pucker factor... not really, your unit should be ready. I will admit, it was a bit embrassing when we got a de-merit because the KY was out of date. Then again, you know what runs down hill?... Yep, all units were stripped and checked and double checked Fly in it?.. EMS Air is also inspected as well.. so yes, I would fly in it... It's a pain, but it's also part of being a professional within a profession. R/r 911

This is an unfortunate incident. Yes, there was definitely an incident, now ... did this cause ALL those stated problems? I doubt it. Yes, they will sue the EMS.. and yes, they will probably settle out and or win. I did not hear if the patient was immediately taken to examined to the ED, etc...? YES, the family appears to be already counting the money. Yeah, mamma appears to be post stroke state and WHO knows how long, she has not been NORMAL?.. It was an occurrence, something unfortunately (or similar event) we or hear that happens daily within EMS or anytime a patient so happens to be on an object that has wheels. So let the lawyers start the bidding war, let the QI review if all the straps were on appropriately, the stretcher did not malfunction and so on... . I will comment for the most part, the medics appeared to keep their composure and start appropriate CYA treatment. Best of luck for the transport company, and the medics and re-training.. R/r 911

Sniff ..... Sniff...... Smellls like a PR and marketing strategy. Alike UT when they studied and then introduced the EZ I/O with Vidacare. I am always careful, when I hear .."we are joining.. teaming up.." in lieu of true benefits. Alike others have discussed, what time element will really be reduced? I know the traffic is horrible in that area but would the monies be spent in educating the public? I really do doubt that with even over 1800 stroke like patients; how many of these notified EMS prior? Alike they said, "We have to be bigger, the first" and so happen we build mobile clinics... hmmmm.... Hopefully, we can see a true evidence based report that will either justify or kill this idea. R/r 911

Thanks for the welcome back, nice to see all of you here again, I do hope all those that are newer in EMS will read the White Papers. You cannot go forward, without knowing the past. If you read the details, the emphasis was never to develop Paramedics rather place surgeons or physician to go with the rescue/ ambulances. Well, we know how far that went.... Ironically, it was the list of many things to do for the Johnson (LBJ) administration (I believe number 14 or 16) on highway safety. Ironically, this is the first we seen the term Emergency Medical Service (EMS) and why we were associated with Department of Transportation (DOT) now called NHTSA. Part of our demise or blessing? ... R/r 911

Unfortunately, EMS will be considered an occupation because of our own demise. Professionals, usually require the minimum of a college degree or not being able to proceed any higher within their occupation (i.e physicians, attorneys, engineers, etc) You may not like the nursing profession, but over the past 40+ years they have rallied to see that most stand alone (i.e hospital based) programs have almost eleminated. You will find almost everyone is associated with some form of academic educational site. Now, with NREMT bashing. True it is a testing agency... BUT .. without their push and drive of many of their ideas and encouragement, there would be no accrediating EMS education sites, local yoal Paramedic exams would be the norm. If you think paying more than a $150.00 for a professional test is high, obvioulsy one has not taken many professional level test, don't believe me .. just Google any CEN, CCRN, or even RN NCLEX exam. The chances are, your local territory i.e State/City etc. has attached fees causing the costs. Alike NCLEX for nursing, NREMT is more than a test generator. they also conduct many formal and national surveys to see where EMS os heading; the highs and lows as well. This is scientic data not just someone sending out radomn questionares. If one really wants this to become a true profession, then yes; we should look at the agency the performs the most used test that validates those that work in this field. Testing (developing, formatting, etc) for a professional level; has many componets that the majority of EMS providers are not qualified (most do not have a PhD in academics, statistics, testing, etc) that ensures professional standards. I do not work for the NREMT; and yes, I agree there are definitely some problems within the organization (as they will tell you too) but: I have been on many test writing committees and sessions and have seen and met the professional staff. I have discussed and heard some of their ideas on what they would wish to see EMS go forward. They could only profit more if those in EMS could become more professional. So to the original post; yes we are a given profession/occupation. We need to become more professional within this. We have a long way to go before it will really become one. Beginning at minimal entry points for Paramedics (degree level) , educators have a minimal graduate degree (alike healthcare provider programs); administrators are educated within the health care business. Our standard of care is based upon clinical evidence and standard of proof; not tradition or just protocols. We start enforcing professional standards and professional ethics within each chapter, courses, clinical sites that educate. It can all be started first by looking at self first and be sure that we are leading the example. R/r 911

Couple of clarifications.. I'm on the site review for CAAHEP/CoAEMSP. EMT programs do NOT have to be "accredited" program" rather only the Paramedic programs. This is OLD news. What makes the CoAEMSP special, well it is composed of EMS educators and endorsed and have participants by several EMS organizations such as National EMS Educators Association. Again, this has been in the making for the past 15+ years and NO surprise, following the national blue print. NR has NO curriculum as well, it follows the NHTSA and AHA standards for testing. The new curriculum is no longer objective based any longer, so technically educators can emphasize areas and not follow a cookie cut program... If you do have specific questions, as others described feel free to contact NREMT R/r911

It's easy to read a blurb from a news report and armchair quarterback... Sounds like a cluster call, glad I was not on it! Hmm... a seriously ill child, i.e asthmatic (even the most seasoned medics nightmare) and then to have a vehicle contact while transporting... Are there potential errors and things that could have been changed to have a better outcome... yes. Before we start reviewing assessment and treatment modalities, let's remember this was ten (10) years ago.. and yes, EtCo2 was not a routine assessment (Paramedic should remember Co2 entrapment ) and albeit one would prefer to delay intubation if possible, (again 10 years ago) securing an airway was a priority. Delaying transport.. sure we all can say, what we would do differently. Did they make the right decision.. apparently not. Yet again, I was not there nor know the internal policies and politics, which will not be described or published also... Main point, is to learn and not repeat the same mistake (if any) .. R/r 911

A black eye to the profession? Yes.. and every profession has losers in it. The good news is that out of the hundreds of thousands of provides, with the lack of continuous background history and monitoring.. we have very few incidences and occurrences! We should not have to have a "blackbox" in the back of the rig to monitor for incidences. Unfortunately as our profession grows, we will see a rise of undesirables and their actions in the news. R/r 911

ABLS has not been popular in years due to most of the education and training follows American Burn Association guidelines for prehospital care, ( as a former burn nurse and ABLS instructor) and truthfully there is little care and treatment prehospital care providers can provide in the initial steps. R/r 911

Hi gang! Yes, like the rest it was a shock and very sad to hear the loss of a fellow EMS Lifer... We all can agree that Dust (Rob) was unique.. and even if you did not agree with what his comments or ideas, you had to admire and respect that he .. " made you think"!. We personally chatted several times, and yes agreed on the majority of things as being very seasoned veterans of the EMS system, that so many do not attempt to see the whole picture and to get out of the comfort zone .. "or out of the box". I still have a RedRider sign that he purchased and sent me.. thinking of my nickname.. the other side many did not see. Rob would love to atagonize posters to make them develop reasoning skills, and then without them even knowing it.. explain and allow them to look at life lessons to make them justify and to makewise and informed personal decisions; based upon their own accordance; not just some protocol(s) or the " we have always donet it" idea... What a great life lesson teacher.! ... Dust, your shift is finally over brother; you did us well.....your imprint will carry on.... R/r 911

Actually, it was NOT the NREMT but many of us educators and a whole new idea of curriculum and methodology of educating (not training EMS) as this is the new standard and wording of NHTSA. The wording is not really the whole point as there will be a required transition course for each level. The Intermediate level will be abolished (replaced by Advanced EMT) and one will notice the wording of EMT totally removed from the Paramedic level ( Yea!!) as this puts stigma on professional level as a technician and not practitioner level. No more objective based teaching but rather traditional methods of teaching. Allowing instructors to teach more in-depth but requiring lesson plans and follow up as professional educators should. This is also in allowance with the requirements of acreditation of Paramedic Education facililty (those taking NREMT exam). These changes have been introduced and hashed about for the past 5-10 years, so many of us; this is not really new changes....lol R/r 911

Meningitis Rash, as such a child with s/s of otitis media and developing diffuse rash and other mild symtoms R/r 911

As a professional EMS educator, I see many variables. What I have determined is that there are those that have the advantage of having access and resources; but it does not make up the one that has the drive to become the best! It is the internal drive that one must possess to really make the difference. This person, recognizes their potential limitations of learning environment but compensates by taking the initiative of studying hard, obtaining information .. (non traditional method). I use the analogy of those in medical school. Harvard vs.. (almost any state university) Does one that graduates from such an institution automatically make them better?... No, they study the same material, usually have the same clinical exposure.. So what's the difference? .. Usually, it's the drive and make up of the person. Harvard (and of course others) have a higher demand, expect more, higher competition.. So those that graduate from a distinct program usually have that drive, have that motivation to excel and be the best! The same is true in many Paramedic programs.. I still say, we are WAY too easy on most medic students! The harder you demand, then those that REALLY want to excel will be left! Good luck! R/r 911

As a test writer for the NREMT, let me attempt to explain some things. First, NREMT is simply a testing agency... not a certifying agency or licensing agency per state, although many choose to utilize the NREMT as the test to offer. Unfortunately, EMS is so fragmented and so out of touch with professional and educational standards it is ridiculous! The sole basis for any certifying and professional tests is to assure that they meet the minimal and safe practices as a beginner practitioner. This is NOT based upon a 5 year experienced Paramedic, or one with a high academic science degree. Unfortunately, NREMT can only test what is based upon the current NHTSA curriculum , AHA ACLS/BLS standards, PHTLS and that's it ! Nothing else... no State protocols (as each state and areas vary) no specific manufacture book (i.e. Mosby, AOOS, etcas the ONLY reference material is as I mentioned (NHTSA, AHA, PHTLS) for test questions. So one should look at the source if that is where the material is coming from.. i.e. Don't blame the testing agency, if the curriculum is faulty! So, the new curriculum is out and guess what? Major anger and head bleeds from those that want to resist and fail to understand professional standards. NREMT has been at the forefront encouraging increasing educational standards and better evaluation tools from true academic and scientific research (as true professional testing agencies have to do) and they have met resistance along the way from professional, state EMS groups due to their demands of requiring educational institutions to be accredited to have students test. (Really, why would should a healthcare education be held accountable?.. satire) So the problem is much more than what is on the surface. As well, majority of the personal in EMS do not understand professional standards, testing procedures (blind studies, question writing and values) that are required by academic and professional standards (why most states opt to NREMT due to costs). Simply, don't blame the messenger ... change the system R/r 911

Yes... I'm baaack.. Like Dust described.. "educated" person. With this saying, truthfully I do see it being a standard on simple or first degree lacerations. We teach Nurses all the time on how to place steri-strips, even derma bond at some local ER's. Again, not all lacerations should ever be thought of; but those simple lacerations that have clean edges and good proximal closing.. why not? If the wound can be cleansed well and DPT is up to date.. Should the patient recieve a transport to the ED if that is the only complaint? Again, good active medical control and great medical education is the main key. R/r 911

I believe many will see an immediate change in the future. The new curriculum has not been tested yet, and as a test writer for the NREMT; I know that more emphasis on complex and higher academic questions is being developed. We will have to see educational paradigm shift, that is if institutions want their students to pass. Alike all other health professions, the pass rate (or lack of it) will cause educational centers to have to change their teaching methods and criteria and even those teaching such courses. For example; statistics and public health courses are part of the new criteria. The number of Paramedic(s) or even EMS Educators that truly understand those topics are minimal but are very relevant to have a good understanding of medicine. We need to check our ego's at the door and widen our horizons and learn off other health care professionals and not take "hundreds of years" to change our profession. EMS is at a crisis point. Unfortunately, what we are currently doing obviously is NOT working. Only an idiot would expect a change in results if you continue the same pattern. We will either have to broaden our horizon or be replaced by others that will do it for us. The whole "healthcare system" is undergoing radical changes. The current system will be changed. Either we can be a part of it and prosper or be reduced, replaced or eliminated. Don't believe me? Look at other medical professional exploring prehospital care as an avenue to expand and secure their profession(s). More physicians are making more house calls than before in decades including physician extenders (PA's, NP's) or even prehospital RN's. Don't bury your head in the sand and not be aware of the surrondings and NEVER assume anything... In other words be part of the change or suffer the consequences. R/r 911

Hmmm.... Let's see double taxed? One is already being taxed for supposedly to be able to provide those services? I understand the shortfall but maybe .... better management or "GULP!" contract out to private services that can provide the same or better services?.. R/r 911

I understand your frustration; as one in EMS Management I understand the difficulties. I do know though in payment structure, HEMS is definitely paid in more proportion than of ground EMS. The reason being is the "specialized crew". Review the payment structure discussion with CMS and the justifications given. Yes, EMS is not considered as a true health profession and thus reimbursement rates are poor. Unfortunately; as you and I know there are many reasons for this. True, they will audit and yes it is getting harder to obtain proper credit. Then again; have we as a profession (in whole) really presented anything different? It's hard to describe that you need increase due to shortage in the ability to staff when there is a surplus of EMT to Paramedics and in reality within 5 to 10 months completely have a whole new staff! The medical skill level complexity is only rated very low. Insurance companies are seeking alternative ways to prevent premiums. If our education level and service would meet the demands of the health community; then we could make a change. Not all patients need to be transported to an ED. Insurance corporations (including Medicare) pay trillions on incidences that could be treated and not have to be transported. With the technology, increased acceptance of physician extenders, it is a shame EMS is not progressing and making a move to secure its future. R/r 911

I would like to see EMS to begin to become a profession. This would include removing those that don't know the difference between skills and knowledge (i.e. plumbers vs. clinical practitioners- blue collar vs. professional services). Usually only those with limited clinical experience or those that have worked in limited areas could have obtained such a narrow opinion. Funny, it is usually those that work in FD type service would ever consider or would want to be associated as a blue collar. (No, not all FD are created the same). Hence, the reason I obtained an education. (You know the old saying, a Doc can dig a ditch but a ditch digger can't practice medicine?) Remove the old stigma of "Emergency" from our profession. We should be Mobile or Out of Hospital Medical Services, and not limit our scope. Citizens and insurance payers are tired of paying high dollar $ taxi rides with a 500 hour trained ambulance attendant proclaiming that they are a medical professional. Remove the ability of every person with a pulse, having the ability to enter the Paramedic program and decrease the amount exiting by half then we will see a demand. Only those with a true professional education (not training), and proper clinical exposure be released. Place a one year residency with an accredited EMS, so those released will have proper in-sight of what medical care should be like... (Hmmm... just like other medical professions... oh, yeah that's what we are supposed to be!). Yes, CMS and other Insurance providers would gladly pay EMS millions of dollars a day in reimbursement rates if..... we were properly educated and do more than just provide first aid and a taxi ride. We can justify salaries to triple, if we could save ED admits and transports, but to do that providers would have much further education and clinical exposure than what is currently taught now. Want to be treated, respected, paid and thought as a professional?.... then become one. I will agree with the statement of making physicians more responsible but; I would also add increasing the liability of the Paramedic to be solely responsible if they did not perform proper treatment and remove the physician liability all together, alike some countries already have in place. There is no excuse for ignorance in knowledge of medicine other than those that do not want apply themselves maybe just simply lazy and truthfully there is no place in healthcare for them... get another job or go back to your primary job!

I have found that it is not so much what you put in your ears as much as what is between them that really counts! ... Yes, quality stethoscope does matter if one is trying to distinguish clicks, murmors, tones... etc.. which most EMS medics never perform or even understand. Purchase one that meets your expectations... R/r 911