Ridryder 911

Actually, I have found that it is really not that much of a "stigma" as one would think. I know of several medics that have "attempted" or as some have said "done something stupid". So, yes at first it is the gossip behind the back, but after a while I have found it is no more interesting or considered as bad as the one cheating or screwing around with each other.... what a profession! :oops: Most are very forgiving very fast... R/r 911

We have had to deal with this type of situations. I will require that they have a release just alike any other medical condition describing and stating from a licensed physician that they are able to return to work and that stressful environment. I have not yet seen one return without some length of time and then very few. Personally, I believe we should be more careful and have screening processes alike LEO and other agencies on mental health alike physical health. Our job and working environment is not alike many jobs. We also tend to attract those that have a unstable psychological background. I have had to deal with too many people that have to medicate themselves to "deal" with things. Not against mental illness, but alike a diabetic working in a candy store the stressors and working environment is not the best for those with problems. R/r 911

I do not endorse RN's on transfers unless they are cross trained or specialty trained. Most do not understand that their license/insurance usually stops outside the door, unless the EMS is owned by the transferring hospital-no matter how many physicians orders it. Our pumps are small enough to carry in the house. They are three chambers, and as well have a function to read out the exact amount administered while enroute. So actually I can give you an exact amount administered during my trip. They also have a "cheat" program for dosages that are programmed in it. True one has to change tubing, but I can discard the bag if I like and use a syringe if I want to. This is nice that I do not have to "hang" anything and can tape the syringe to the pump itself. No need to "hang a bag" if the infusion is < 60ml/hr. Again, if need be and a bottle has to be used, it can. What I have found is most medics are not familiar with their equipment. I can change tubing in usually less than a minute and do not have very many troubles. I do see many that do get air in the chamber, have difficulty clearing lines, etc.. again; most from not using and being very familiar with the device. R/r 911

I find it ironic when describing what they can and can not do to get hired. C'mon, let's get real! Attempt to bring a law suit against an EMS agency for not hiring you and I can assure you every EMS will know your name within a few days..... and then see how well your career will be. I have seen people "black balled" before anything could occure, and it follow them for years or until they give up trying to fight. EMS alike most health care professions is a very tight group. I have seen more people NOT hired for unprofessional behavior (off duty) and poor display (tongue studs, tattoos, etc) professional demeanor. Really, attempt to "pin" them down for the reason they were not hired versus the "real" reason. Poor interviewing skills is hard to disprove. Best advice is to be a great employee and a damn good medic, if you plan on being in this profession very long. I can assure there are many things that follows medics reputation. R/r 911

AHA ACLS no longer has any credibility. Rather, they have placed their attention into making separate classes for ACLS and placing their intent in pacifying participants in lieu of assuring that candidates truly understood ACLS procedures and emergency cardiac care. Should people fail such type of courses alike the older version or style of ACLS? YES! Believe it or not, not all participants are smart enough, or prepared to pass such courses. Not all people can perform emergency cardiac care, which is okay by eliminating them. Emergency cardiac care is very serious business and should be performed by those that are actually informed, educated and tactfully skilled in providing such care. I do wish NREMT would eliminate AHA ACLS requirement for Paramedic level. It is a waste of time and has no value to it any more. It is a shame that no other organization has attempted to challenge AHA and develop a true program similar to the older ACLS programs, where one had successfully passed, one could be assured that they were aware of emergency cardiac care. Definitely not the way it is by today standards. R/r 911

I am sure you are joking, right? I feel like bringing Stuart Smalley in and having the SNL character give his daily affirmation.... "and gosh darn, I am special and people like me, for I am special ! " speech. Our pet EMS chimp can start IV's as well. He even shows off with one foot tied his back ( prefers to start them with his feet, you know the old thumb thing". He gets irritated when we keep telling it is not always about the skills that count... In reality we are not any more special than the RT that suctioned the lung cookie out the patient or the nurse tech that had to physically dig out a fecal impaction on the quadriplegic. We have a job to do and we should be educated enough to perform that job very well. We should have acquired the common sense enough by life experiences and possibly EMS experience to perform critical thinking and decision making (multi tasks) and along with this be very proficient in the skills required. Giving patient care ... not BLS or ALS .. patient care that is needed. That's it... period. We don't need medals or pats of accomplishments, we have a job to do. It is an important job (at times, sometimes its not) and we should be above competent in performing it. Knowing when and how to apply and interpret the best care needed at that time, is what is all about. R/r 911

After my 16'th refresh, I find them boring and too long. Thank goodness we are abolishing ours and going to CME (ACLS, PALS, PEPP, AMLS). R/r 911

If you over or under treat, then you inappropriately treated the patient. The example of giving Epi for bee sting that was not truly anaphylactic reaction rather a reaction, then the patient was treated inappropriately, not over treated. etc.. R/r 911

One will see more and more IFT and actually they pay & 911 calls don't. We have pumps on each truck, no problem. No one gets micro or mini drips anymore. Few bumps and you have missed up the right dosage. No rate minders either, those are approximate drips, and the manufacture even states they are not meant for medications. Going to give IV drips, get a pump. There are plenty of good ones out there. R/r911

Notice a pattern here (other than the funny boxes)? The ones with higher education are saying and describing the same thing and many of the ones with lower ratings are saying the same thing? Really folks, the reason many of you disagree is because you cannot understand patient care! There is really NO such thing as BLS care and ALS care. Rather it is appropriate care! The stupid labels of the so called BLS and ALS when in reality it is one thing = medical care. Only in EMS we have to dumb it down into categories, BLS or ALS ! Allowing different levels of categories thus allows one not to feel inadequate in not being able to do or provide something or doing it the most correct way to begin with. Categories only encourage mediocre care to exist. R/r 911

Wow! It would take more than an hour to go to most of my response area! Our law is simple. One can go as fast they want to. Have a incident, no matter what; it is the EVO fault. R/r 911

I have awaited from posting on this. As a former line officer as well as having formal education in Fire Service, I have seen both sides. Fire Service did not take EMS as a public service. Most have not been in EMS or Fire Service long enough to remember the 80's and even the early 90's, when most did not want participate. It was not until they seen that their statistics was moving towards "downsizing" that EMS was considered something to look into and potentially something to perform. Fire Service has done their job, maybe too good with fire prevention and building engineering, suppression techniques. Unfortunately, for every one step there is always two more to go forward. It is unreasonable to consider one to wear so many hats and be proficient. Not that some cannot perform multiple tasks, but how many can one acclaim that they can be truly proficient in? Haz-Mat, Suppression, Over-Haul, Prevention, and on and on? Not even a surgeon diversifies. I have not yet seen addressed is the "white papers " of the Fire Chiefs Association, pronouncing that they want to be in charge not just EMS nationally, but all Emergency Services! A little grandeur, would you not say? Majority of Fire Services do want EMS to justify budgets for FTE, grants, and yes even re-coup some losses. One of the few services that a public service can actually NOT loose money on. Again, many of the Fire Services just now are realizing. The problem I have as well with Fire Service EMS; is that many have attempted to justify their existence and remove public or third service EMS to save Fire Fighter jobs. There are even documented well established EMS that was forced out to sustain non-EMS firefighter positions. Some communities going from Paramedic ALS to BLS level, all in the name to save the Fire Department. With all the new buzz words of "justification" going around, maybe fire service needs to learn them. Justify having so many FTE's, so much equipment (seriously a WMD equipped truck for a community of 5000?). Number of responses, length of responding and education required for such levels. Sorry, most Fire Departments still hire from the neck down. Even compare entry level tests, one can see many still use the "middle" and not the high end. As well, it does not matter if one has a PhD or Master degree, majority of the Fire Commander (FGC) is still based upon Fire Ground Command Structure, based upon experience, training levels not education based. One may have a FGC with only in-house training and being the "good ole boy" for several years, being promoted with tenure. Not all but very many still perform as such. I am working with Fire Services to increase our state EMS response. Some has some very good responses and good points, however; I disagree with the "do it our way, or no way" responses. The advantage they have learned is to use the "Hero Syndrome" to their advantage in public sympathetic response, and the law makers are quite aware of this. If you were to ask a Firefighter thier legislatures name, chances are they know them or their Union Rep. has them on speed dial. Ask the same to a EMT and it is doubtful they know what you are talking about. Something, we MUST change within our system. Something, we need to learn off of Firefighters and teachers alike. Can we work together, yes in some ways. If we look at the end goal... the patient. The problem is the ego's (both sides) tends to get in the way. R/r 911

Personally, I much rather give Vasopressin first then followed by Epi. It buys me time, to package the patient or get a better history etc... My question is why not give Vasopressin, its so easy to use? R/r 911

Awww.. you know your really an old timer. EMS years are like dog years. R/r 911

Dwayne, Personally, I do not understand the antagonist attitude. Your entering the profession, then I would expect that you would want changes to occur before you retire. Exactly how much information does one need to recognize the troubles in EMS? Even consumers, participants can see EMS is in crisis. Ever consider why this site as others have only a few members posting in comparison to the hundreds of thousands of professional medics that work out there? My experience is simple. As medic and also as a Paramedic student I was active and remained active in the development of changing EMS in our state and even working at a national level on legislation, in the late 70's and early eighties. I learned the process as a Paramedic student and EMT involved in the profession. I knew early on that anyone can recognize problems, but someone has to actually do something for change. How do you think such educational blue prints appeared, Federal funding for EMT training. ambulance specifications came about? I later went onto full time research into Trauma Research as a consultant/researcher. This involved bureaucracy and understanding legislative changes, knowing there is always a lot of talk out there but no backbone to it. I now teach part time at a Paramedic program at a local college. They have an active EMT student organization. Part of the professional development portion of the course requires having an understanding of needs and changes of the system, not just patient care. Again, similar to other health care professions that actually take the time to teach that it is just as important as patient care. In fact in just two weeks; two classes will spend all day at the State Capital meeting their legislature and discussing EMS needs. This started a few years ago, and became popular & now most of the other schools have now picked up the same agenda. Similar to nursing programs that do the same, and visit their Board of Nursing to understand their profession. Like to decrease the medic shortage, increase educational requirements, have better funding so medics can in return receive better pay? The majority of the topics that is posted on this forum, then one should be involved. Just discussing here is NOT going to change anything. Will it inform some? Possibly. I doubt that anyone that has worked more than a few weeks as a professional medic could can make the same interpretations without reading it from other medics. Again, the typical discussion anyone can overhear at any EMS gathering. Not busting chops for sparking ideas, but there is a difference from fantasy and reality. Want to know what agencies that I am involved in that make changes? Simple. Check out ANA, AACN, ENA web sites. Look at the legislation that is occurring. Look at the salary ranges, the educational requirements and changes that occurs daily. Compare that the changes mandated for their profession has been limited time, and that they continue to change daily. One can see that they too have problems, such as the shortage, but compare the educational opportunities allowed to students in comparison to those of in EMS. Again, why? The members of the profession are pro-active and does more than "talk about it". I even suggest to view forums and organizations of physical therapist, respiratory therapy, etc.. Compare their growth and structure in the past ten years to those in EMS. One does not have to be an "expert" to realize the changes needed. Shortage in EMS providers, not having appropriate funding for EMS, poor educational systems in EMS. Again, all the same repeated subjects that are in these forums daily. Unfortunately, these problems are not in a limited or specific area. In fact, you ask how to become "experienced"? By being active and involved. Alike any organization that needs changes within a problem. I know each state has funding problems, educational problems, and legislation that needs to be supported. Are most of these posters even aware of what is occurring within their own state or national movements? As much as I respect Dust and usually agree with 100% of his opinions, there is not squat he can do or anyone else can do to change EMS without getting involved and getting legislation to occur. As much ranting that can occur, that is all it will be, it will continue to be the same. Ironically, in another posts and others we continue discuss the fire service. The difference is to ask the firefighters the names of their legislatures and they can tell you, if not they can direct you to a fire rep that has them on speed dial. Information is only so much, then what one does with that information is what makes the difference. The reason I continue post is simple. I alike many others read and interact with others, as well as learn of changes occurring in EMS. As an educator discuss topics, and yes to socialize. Just because I do post on multiple EMS forums, does not exempt me from actually doing something to change the system, in fact quite the opposite. The reason I left nursing full time and return to EMS is to change the system. Alike what Dust described nothing really has changed in the past thirty years. Is that not long enough? So, I work 10/24 hour shifts and most of my "free time" is being involved on committees and developing programs as the coalition such as the one I posted, so EMS will change. It has to or it will be replaced. I can or will invite respected members of associations to participate on this forum if they would like too. One can only speculate that they are already quite aware of the needs without reading multiple posts, but again probably need help in changing those problems, as I have addressed. My intent of my post was this; with a site at least 10,000 strong, advocating changes and possibly supporting such agencies would help promote their/our causes. Signatures, letter writing and endorsing legislation may actually cause a change. R/r 911

I still disagree Dwayne talk and even posting is cheap. One does not have to have sheepskins to change things. You can participate on a local, state and even Federal level. There are multitudes of tasks and research that can be performed. Being informed about EMS and its profession should had been covered in your education but alas alike many others as we have discussed numerous times the education level is poor. Again, unless we actually do something nothing will really occur again just talk. The discussions on the forum are alike discussions at conferences located in a bar; all have good points but nothing occurs from them but good comradely. Something different than other medical professions, they actually take action, thus they get results. Sure they cuss and discuss but they actually do much more than that, they demand results. Hence they have professional benefits, salaries according to responsibilities and peer recognition something we do not have. I have been very active on this site for over three years, and what I am seeing is the same repeated discussions of the same thing over and over.. but in reality no changes. Just a few that are actively responsible for changes... even some of the popular posters are just dreamers and talkers, but that is not what causes real change. How many EMS students, EMT's, Paramedics, etc.. actually participate in EMS progression? Sure to come on here and discuss "how things should be" and "progression of education in EMS" is easy, but in the real world changing them is not that easy. With the membership we have, we could influence such organizations, ask for participation, and maybe actually cause a change. Propose some of the ideas that have been discussed and promote those ideas within their organization and help get these changes to occur. I still say; if your not part of the solution then your part of the problem. Why talk about it, if you plan to do nothing to correct and change it? R/r 911

NAEMT has had a major overhaul. Basically, reforming ... it is using its power to endorse and cause effect in such movements associated with NAEMSE, Advocated for EMS ( http://www.advocatesforems.org/whats_new.aspx), American Ambulance Association (AAA). all of these have national input of EMS bills and legislation. Another new one and appears to be very active is EMS on the Hill. They continuously monitor and watch for new bills that affect EMS. Again, we all can talk and chirp, but unless you are proactive as in involvement and participation, then it means NOTHING. Anyone can whine and bitch... R/r 911

If you have noticed many of us " Old Timers" have stayed silent. As much as I like EMT City, part of the problem is that many threads are started not really wanting to discuss or informing, rather than its just ranting and whining . Something, I have to say EMS personnel is really good at doing. All talk and no production. The original poster was very aware that the wording and phrasing would be noticed; hence the reason it was posted that way. It would be obvious that they demonstrated poor communication techniques. Especially if they have "worked with them for several years" and still have known how to talk to them. If poor care or wrongful treatment is being provided then proper action should had been taken, backed up with proper documentation and using the proper channels. If one did not take action then the accuser is just as guilty by not informing or allowing poor care to continue. If you want to know more about the care I or any Paramedic provides, then ask appropriately. If you do not know how to, then I suggest one to learn basic communication skills. One can ask without assumptions if the care was wrong. Any care or performance we provide; we should be able to justify them. Again, the mannerism on how it is asked is the difference. Have a problem with an individual; then talk to them. Next step is to follow the chain of command. Period.. case closed. Now to the other rants: Chances are if you are a basic you were either hired to be a first responder or it is associated with your primary job. For example incognito, you are a communication specialist and the EMT is considered to be experience and background education not the main emphasis. With changes within EMS and the advancement the role of the EMT is to be a first responder, to assist the Paramedic and to provide care when and if necessary. I now do find it ironic on how many "self appointed EMS experts" we have on this forum. Especially, since many of the posters have very little or no professional experience and many have not even yet completed a formal Paramedic or EMS educational programs. What is now considered to be the general foundation of any EMS structure. Yet, we have many these self pronounced experts present that their only education level consists of a 150 hour course, and few hours of observation clinicals. Should this even allow them to develop an official opinion? I would compare this to a nurse aide discussing the Nursing Profession. Their input is essential, but they usually lack the understanding of the "whole picture"; with their limited knowledge base. Of those new State and National EMS changes, should we not ask and wonder why there is no postings from those that are actually and seriously working on changes? Should we also wonder why they do not ask for opinions and suggestions from many of our posters? Again, like AK described; read the posts, the intent, and the emotions associated with many. Again, I like EMT City; but let's be realistic. It does have to be compared to a "hens party" a lot of clucking but nothing more than that. Unfortunately, the majority of those in EMS are not formally educated in EMS. Thus the problems of EMS. They lack the understanding or experience of systems development, development and comparison of professional standards, educational curriculum review, legislative practices and so on. Yet, many assume since that they have attended a whole whopping 150 clock hour course, they should be recognized as an expert in EMS. Unfortunately many push that persona and that they are really experts upon blinded municipalities and they unfortunately listen to them. Hence one reason EMS never progresses. I make a challenge. I would like to see from posters that are actively acting upon in EMS infrastructure changes, legislative bills (both State and Federal) and that are actually making the changes, not just talking or clucking . Since I have made the challenge. I am very active in NAEMSE , a member of NAEMT and local EMS Associations involved in policy development. As well here is a link to the State bills and action I am working on. http://ok-emscoalition.org/legislation any others?... Talk is cheap.. time to put up or shut up! R/r 911

This is an old item. This is NOT a Scope of Practice also. This has been a product of the National EMS Educators developing curriculum and definitions by educational standards of not only cognitive knowledge base but skill performance as well. Intermediate and Advanced EMT are synonymous. Technically, intermediate means "half way" and that many programs either produce EMT Intermediates that are less than half way or more than, the wording or classification was changed. Technically, NHTSA has always used the advanced title. Keeping it simplistic of EMT, Advanced EMT and Paramedic. R/r 911

I agree antiemetics should be given as soon as possible, why not? Personally, I much prefer phenergan IV for most nausea cases. Even though, it has had "bad" reports; I believe it is because of poor administration. I always dilute it before administering it as well as the amount given. In regard of Zofran, it is a good medication if they are not currently nauseated. It has very little antiemetic action if the patient is currently vomiting. Again, great if one suspects that they will become nauseated. I have heard the costs has been reduced since a generic version has been introduced. I know the costs of Zofran ready tabs are $1200 per 15. Compazine, is another one of my favorites but fell into poor favor when the manufacture site decreased the availability due to storm damages (which they so happened to also make Zofran...a coincidence?) R/r 911

One of most favorite books. I used to require all my EMT students to read "House of God. It is responsible for t.v. shows such as St. Elsewhere, E.R., and of course Scrubs. They made a movie based upon the novel, but AMA had bought the rights and refused to produce but decades later finally was released on VHS. Not as good as the book though... R/r 911

Actually, crepitus of the bone ends are actually a "grating" of the bone fragments grating against each other. Not a popping or crackle.. like in sq with air in the tissue. R/r 911

It is. That is what you get when you base findings found in Wikipedia. R/r 911

Free service to all? Maybe not the best way... I was sent this link, and found it interesting. It will piss off our neighbors up North.. http://www.freemarketcure.com/brainsurgery.php

I have to admit I would still be ignorant, as we still have tech.'s They have never went to school other than OJT and never attended a therapist program. we have one therapist that is charge of the department. They actually wear the name tag as respiratory technician, unfortunately this is not at one of the hospitals. R/r 911