Ridryder 911

Treat the cause then the effect (if even needed). R/r 911

I know their director is in D.C. at the AAA (American ambulance association) meeting (she is with my boss) but I probably will see her next week. I will try to get more info as well. R/r 911

Their protocols are in their web site. Never heard anything bad about them. I have taught a few classes for them. They appear to have fewer turnover than most, pay is average for a Paramedic service in Oklahoma. They do not make any differential in level of Paramedic, and I understand they have as much O.T. you want. I suggest you check into local pay. Most Paramedics make about early $30k to $40k a year. Remember, the costs of living is much cheaper also. As well most work 24 hour shifts or few 12 hour tours. Although, there is a Paramedic shortage, I have never heard of them being short handed, as well as Tulsa is not that far from them also. You can contact their associate director and discuss any questions, they are a nice group of folks.

Muskogee County is a more aggressive EMS in Oklahoma. It actually covers more than Muskogee county, as it covers other parts of surrounding counties, and as well it has a V.A. contract. Most of the Paramedics are Critical Care rated especially for inner hospital transports. A busier system, than one expects as it covers a large area. Here is their web site.. http://www.mcems.us/

I have some apprehensions since the Basic is still being used as the foundation for Paramedic education. Although, I personally do not like the system we use, that is irreverent but we need to be sure that the core is strong. Most online courses I have taken are much more in-depth than classroom. Although most assume it would be easier, I have the opposite of being more time consuming with more reading and writing so the instructor can properly evaluate. I do wonder what the drop out ratio is (will be), the percentage of pass rate of NREMT, employment percentile, etc.. The college program I teach will be utilizing an online for some theory courses. I believe the "mills" will soon be a thing of the past (Paramedic level at least) for NREMT states when the accreditation requirements occur. R/r 911

Online EMT=oxymoron? Not saying the concept is not nice and can't work but let's be careful saying it has "worked in every profession including EMS" when in reality online courses have been out less than ten years. We need to see more results to really see how "successful" it is. I believe there are portions and some classes that can be taught online, but there are definitely areas that formal instruction should be given. R/r 911

Actually, all levels of license for EMT's are considered: EMT-________For example EMT/Intermediate, EMT/Paramedic; so Paramedics are considered EMT's. You are right some of us have thought of that as well. The Dept of Health will be responsible party for managing funds. I hope to raise the benefits per tripling in a few years when the funds increase, so it is more worthwhile if needed .

Myself, Rodney, Leaugeay and several others have been working hard on these bills and some other legislature. We were able to develop and start an EMS Coalition, something that is not easy to do. To be able to get EMS, Fire, Air Services all to agree upon certain things is a miracle. As well as dealing with the old "politics" of things going on. Actually Scaramedic there are few "mom & pop" services anymore. That is part of the problem, AMR and some of the private industries have invested here as well as some other chain services that cannot make it and then leave. As well, alike EMSA and many others that depend upon supplemental support such as cities and government funding. Oklahoma started many years ago one of the first supplemental tax ad valorem strictly dedicated to EMS. 522 is a tax citizens can vote in for EMS funding. This bill uncapped the amount of funding, so more money can be funneled into to supplement EMS companies. Yes, we have drastic problems, at least the Governor and some legislature have recognized this and is a hot topic within the state. I also would like to announce that we now have a life insurance through our EMS license. It will not be enough to plant in you in the ground if something would happen to you. Albeit it is not the best bill but at least a start and the legislative did demonstrate interest in EMS workers and something we can add upon. ...This afternoon, Governor Henry signed HB2693, by Rep. Paul D. Roan, D-Tishomingo and Sen. Susan Paddack, D-Ada. The bill directs the Department of Health in the event of the death of an emergency medical technician while in the line of duty to pay his/her designated beneficiary $5,000. The bill creates the Emergency Medical Technician Death Benefit Revolving Fund. It establishes a $10 fee for new and renewal applications for emergency medical technicians and directs revenue to the revolving fund. "...There are some more EMS bills that have been tabled for the season, but we will be fighting for them at a later date, I also would like to introduce a few others.... R/r 911

Ironically in my area, it is common that the mix of physician ratio is 50/50 DO/MD. A far cry from about 20 years ago, when many was considered similar to chiropractors. As well, many of the residencies or professors of the M.D. programs in my area are now D.O's especially in emergency medicine. In comparison, in my state it is more difficult to get into the D.O. program than the M.D., they are more popular at this time. Featuring holistic medicine. Personally, (nothing against M.D.'s) but I much rather work in critical situations with an D.O. and as well from now own my personal physician will be a D.O. Yes, there is not much difference in education, but rather the approach and personal traits of having a less MDeity attitude. R/r 911

Ignorance vs. Stupidity. Ignorance is acknowledging one's weakness and then learning to improve one self; where as being stupid is refusing to increase one's knowledge and remaining at that level. Okay another self acclaimed expert. Thank you for your insight and educated opinion that you obtained from that whopping 150 hour course. I am sure that they taught you the educational basis of competency, skill deterioration,, retainment while you were in that one or two night a week class. Of course, all of this was located in that 10'th grade reading level medical book that you obtained this expertise from. Sorry, you are poorly informed about nursing, and medical profession and also EMS as well. Please attempt to understand, when one is involved obtaining their nursing license, they attend years... this as in at the least four times the length as well as in multiple courses. Also, after employment mandated education is required. This usually in the form of weekly to monthly in-services, classes, college courses, clinical performance. Much more than the usual 48 or so CEU courses, that Basics are required to have. As well, nurses and physicians maybe specialized such as in Board Certification above their license. This again, ensures they have increased their education level and as well increased the number of CEU's to be required on top of their regular license. Of course, I doubt when you performed or check your references, you noticed that there are states that also require CEU's for maintaining license as well. Now, back to the original post. Again, thank you for posting. Your opinion, again re-emphasizes our points exactly. Those that they assume they even understand what EMS actually involves. Since you like comparisons, this would be similar to a volunteer nurse aide attempting to understand the nursing profession. Part of it, yes; but really to what degree would you validate their input and understanding? Really, would one take such seriously? To start calling names and slang, demonstrates the lack of education and understanding of the EMS System and profession. As this thread has demonstrated over and over by those that lack the education and understanding of the EMS Profession. Please refrain if possible, it only deteriorates the image of those that offer excellence as a volunteer. It is obvious, that you have not kept abreast of this profession. If you would like I will refer to several studies that demonstrate that the EMT course is lacking for minimal care, that the education required to renew EMT certifications is nominal in comparison. Have you examined the Physician Assistant's? One has to have CEU's and re-test the examination, would you consider that easier? My recommendation is to study and read about the subject, then obtain an informed opinion. Spouting emotional thoughts only displays your feelings. So call me a Paragod, pompous, or whatever you might. Remember, by doing so only reiterates my point. R/r 911

Okay, maybe I am missing something. EJ is nothing more than an peripheral site. D/C it just alike another IV site, place firm pressure and dressing on it. So if they have hematoma> Place some cold pack on it, just alike any other IV. again, its just an IV. R/r 911

Unfortunately, organ sharing has dropped and the push and interest has dropped as well. Very few to no retrievals are made and I am only about 1/2 hr away form major institutions. Yes, I can assure you the network is notified ASAP but the network appears to be apathetic and really has the attitude "we will get there, when we can".. In the field in my area, if death occurs, it is an M.E. case until otherwise. With the information needed for the sharing network, I would doubt they would harvest, except the usual extended time organs, bones and tissues. So to answer, no protocols, and really doubt to see any aggressive measures for such, in fact quite the opposite. Good idea though... R/r 911

Do we really want to do this? ... I agree all the background science will only benefit us, but remember if we require more than some medical schools, we will never get Paramedic students. Not that I am in favor of dumbing anything down, but seriously who wants to get their pre-med and work for peanuts? I would settle for the basic science courses, to start out at. Maybe if one wants to focus or pursue a special tract, higher level of math, science, etc. should be mandated. R/r 911

What to give the Paramedic that has everything! * yeah, I have to admit, I would like to have one... R/r 911

Yeah, damn those EZ I/O's.. :twisted:

Why not? It is a peripheral IV. I could see if the patient was combative but otherwise I have no problem sticking one in the neck. I have stuck in worse places. R/r 911

That was not "tunnel vision" that was bull headed ignorance! Majority of services as well most medics with experience realize if you cannot obtain IV access by the second time, then you will not be able to. If you are able to administer Glucagon, then that would be the next step, or even oral glucose bucossal and monitor the airway closely. Yes, be careful of aspiration but a Paramedic should be able to suction and place the patient in lateral recumbent position and again closely monitor their airway. I much rather prefer starting an EJ over distal IV sites such as in the feet. Diabetics are known to have phlebitis and other complications r/t IV's in the feet, especially when using hypertonic solutions is risky if infiltration occurs. EJ is just another peripheral site, although one has to be careful if infiltration does occur, yes swelling may occur thus the reason one should only attempt once only on one side.

Okay, over 6 months later... a reaction? R/r 911

Although being in EMS for over thirty years, until I became active in the forums, I did not hear the term "bus" so much. I only heard such terms when attending conventions, etc in the Eastern Coast area. Saying the slang " bus" in my area would be considered a derogatory term. I had a EMT interview two days ago and mentioned upon how "anxiously he was going to ride on the "bus". Not recognizing the term as used so frequently, administration was not pleased using such a description. In fact comment made after interview that maybe a "bus" was what they needed to work upon. I discussed the term was common in some areas, although it did not leave a good impression . It was not the final factor on determining employment, but I thought was interesting on perception of what one calls a vehicle. In my area, most ambulances are called units. I use this term because of local history as well. Many years ago this was to break the stigma of ambulances. Since most ambulances at the time were associated with funeral homes. As well, early Paramedic care was purposely associated with MICU to educate the public that medical care was being provided similar to hospital care as in the Intensive Care Unit. The transporting vehicle was just one part of the tools used and the vehicle was de-emphasized. Personally, I would like to remove the word "ambulance" altogether on some units. There are some days I perform a lot more than just transporting, against those in comparison to those that just do that. It is a term used to loosely and grouping individuals for non-emergency transports to those of specialty care teams. If those in the health care cannot differentiate, then one could only assume that the public has the same misunderstanding, hence our image and recognition as health care providers is lowered. R/r 911

The point exactly! As Vent has demonstrated that each patient should be thoroughly assessed and treated accordingly. Vent has demonstrated the eloquent point of being a practitioner and having the knowledge and skills to treat each disease state and how the patient might respond to the therapy. That patients and the disease state might be categorized but; should always be treated per individual case by case. Again, the need to learn ..."outside the box"... R/r 911

Although it would be great to have some "field" type questions, I doubt nor would I really recommend it. I did send my C.V. in and was notified to choose a date if possible to attend. We will see, from here. R/r 911

Wow! Don't carry airways? I use NP's about twice a month, one of my favorite on CVA's/postictal, etc. We carry a majority of the sizes... R/r 911

Here ya go! Anyone been in EMS more than a couple of weeks knows that NTG spray in the first spray usually mists and does not come out readily. But, I am sure your "mentor" already discussed that as well as the high rate of conjunctivitis that is associated with NTG spray because of the above problem. As a REAL Critical Care Paramedic and Critical/Emergency RN, I can assure you I probably have given more NTG in more multiple forms in one month, than most medics has performed in a year. As well, as one that routinely does administer NTG bucosal mucosa, I do not usually give it sublingual & definitely not on the tongue. Yes I use the the bucosal mucosa method ( pull the cheek outward and spray into the cheek gum area (y-e-s it is called bucosal but still considered a mucosal membrane) just like in your rectum. Like the above post, usually either I adminster it per IV or paste method. Bet you never read a blog or maybe an insert that you are supposed to have the patient rinse their mouth after NTG per bucosal/sublingual mucosal either? But, you already knew that too.... :wink: As far as going back to school, I was not the one that thought administering NTG was a spectacular event! R/r 911

Administration 101 for NTG. Remember, it is the mucosa membrane that allows the entry of the medication. The tongue (especially the ant. aspect) is a muscle and is not covered with the membrane. Hence, as Dust described probably bounces off the tongue and to be absorbed into the membrane. Now back to your Googling or if one wants real information attempt to read the basics of medication administration, oh you failed to discuss the other route that is not discussed "rectal". Don't recommend it but could be done, if one is persistent. R/r 911

NEMSES new educational standards are available to download & review. I would like to discuss the variables. http://www.nemses.org/pdf/Communique10.pdf R/r 911