Ridryder 911

The problem is EMS is exempted from the normal wage & labor rulings. EMS has their own special areas, One have to contact them for interpretation, they will even discuss how difficult it is to decipher. R/r 911

This is a common event if not more in some rural places. Most assume since it is rural they will get rest, not considering some calls and transfers are in hours, not minutes. Yes, it could be a dangerous event. I just came off a 36 hour tour with about a total of 6 hrs of sleep. It happens way too often and since there is no regulatory sanction and enforce hours there is not much that will be done. I even know of a flight service that had a flight nurse that worked 9/24 hr shifts with very little down time and since they were not CAMTS certified, not much could be done. When she rebuked about it, they questioned her dedication.... to say the least she informed them what they could do. Personally, I like 24hr shifts because the available days off, but like many other services the run volume has increased with down time is a luxury. IAFC has performed several sleep studies showing the effects.http://www.iafc.org/displaycommon.cfm?an=1&subarticlenbr=559 Ironically, truck drivers that transport cargo only can work so many hours, yet we that transport precious cargo and perform tasks that can be dangerous or life saving have no regulations. Make sense? R/r 911

?? I suggest maybe going to EMS responder then magazines (EMS) then article? R/r 911

Wow! I thought this would get more responses, discussing the end of volunteers and changes within EMS system. Especially in a National EMS magazine, and authored by Thom Dick. R/r 911

What is a shame is EMSA is still placing the priory of the money going into the trucks instead of paying medics. So you have pretty new trucks .... with a shortage so bad due to the pay sucking the "bonus packages" is not working. After discussing with the medics that work there, no difference in rides and faster? Really? Better discuss the ineffectiveness compliance's of the required time. Again, it does not matter if they have a "bigger engine" if there is not a crew to man it. Better to have a smaller engine without all the "fancy gadgets" and have a full roster of people to man the trucks/ R/r 911

Finally! It appears now many are finally recognizing the problems and woes of EMS. I will not go into details or give opinons about it until others can read and voice. article in current issue on page 74 http://emsmagazine.epubxpress.com/wps/port...VBRlM2QjAwSjA!/

Our biggest opposition is ourselves. We may blame the stagnancy on multiple reasons but the biggest opposition is truly from ourselves. A bitter pill that we must swallow. The only way to begin to change is to change within our own first. Consider that there were a few of us that started out here and on multiple EMS forums that shared different ideas of thinking outside the norm. Dust is able to get attention easily by his arguments with knowledge, poignancy, sharpness and wit. Others and myself have been promoting here and on other forums the same or near ideas of not just increasing training but having the right and focusing upon the proper education. Again, most of us with that attitude catch much opposition not from outside sources but from our own because it is different. Something that frightens most EMT's new and those with experience. Change is never easy, especially in EMS. EMS has always preferred to take the road of less opposition and follow the path of half arse ways and temporary fixes. It is hard to be considered professional by medical peers when we have and still continue to use the analogy of .."placing a band-aid on an arterial bleed"..methodology. Unfortunately, most EMT's much rather use this method because it is easy, quick, and does not take effort. I agree we are a new profession in comparison to others, but that is not valid excuse not to proceed, grow and improve ourselves. We should embrace academia and those methods that have successfully changed and improved other allied health professions. Yet again it has to come from within. It is okay to have different ideas and approaches; but we must gather as one and agree that a change must occur and what we are currently doing is NOT working. This is the first hurdle. So where do we start after this? Focusing is hard to do. I personally believe that educators have to firmly believe in education methods than the current normal standards of training. The mind set has to be taught from the beginning. Continuation of the norm will only promote the same ideas and changes will never occur. This first hurdle is going to be the hardest. When reviewing those that instruct EMS education, very few have a formal education and more important that they have an education in adult education or related studies. The mythical thinking that one is a good medic, they are automatically a good teacher/instructor has to change. We must realize that there is a line of separation of education profession. methods and the application of clinical practice. Again, something new and frightening to many. Before we even attempt to start screening calls and attempting to treat and release we have to increase our level of knowledge and diagnostic skills. We are far, far from this level. Please still consider that most EMT's and Paramedics are still trained with no proper background sciences and definitely no differential diagnostic education methods. Let us be sure NOT to place the cart before the horse. Again, a definite goal; but let us achieve this goal by going about it the right way through proper education. A long process but let us do it the right way! This has to be performed at a national level, not as individual systems or states. We are far from advancing our profession at this time. We have to clean up and modify our foundation on up. Changing and redefining the roles and levels of providers and thus changing the educational requirements. Starting at the beginning of requiring a screening process and then implementing those requirements for entering EMS programs. As mentioned change within our methodologies of what & how we teach and expectations delivered by our students. Although I agree discussion is a great tool and promotion, talk is cheap!. Change will never really occur unless one takes true action. How many on this site are involved in real change other than talk? How many take an active role at local, state and national levels? Even better; are members and actively participate in professional organizations that can promote and cause change? .. Another fault of most of those in EMS we are all bark and no bite. I myself have became actively involved in legislation changes, and getting into the nasty business of the bureaucracy again. Finding out that there are changes occurring from all levels but they are not from those in the field and most not from EMS. Many will be blindsided of changes until it is too late. Then again, until those that actively work in EMS actually become involved, nothing will change to promote our profession. We will whine, gripe and then take it because it is the "easiest route" again the norm of an EMT. Until we grow a backbone and actually take a stand for our own profession and develop true standards there will be no positive changes. It is not going to be easy, then again anything that is really worthwhile or successful has ever been easy.. a new concept for most in EMS R/r 911

They are still used, although not as much. Yes, they can be inserted nasally (although I would not suggest or want it myself). I have seen it done, (amazing how much a nasal nare can stretch)... R/r 911

Awww. I remember in my youth, my first V.A. ICU clinical (which I believe everyone should have to attend an VA clinical) the rows and rows of football helmets. Truthfully, I had no idea what the hell why would an ICU need so many helmets... only until later on that night, I had my first date with Big Bertha I understood there was more than one reason for masks on football helmets. I found this why reviewing Varicies and found some of the numbers interesting...... "The management of oesophageal bleeding disorders remains a challenging problem in the emergency department. Oesophageal varices are dilated veins; they are most commonly a result of portal hypertension and are often associated with a poor outcome.1 Haemorrhage from oesophageal varices is a life-threatening emergency with a mortality rate of 30–50%. Approximately 90% of patients with cirrhosis will develop varices, of which bleeding occurs in 25–35%. Balloon tamponade is one of the methods for temporary control of acute variceal haemorrhage and works by directly compressing the varices at the bleeding site. Placement of a Sengstaken–Blakemore tube into the gastric fundus controls variceal bleeding via a tamponading effect. However, incorrect placement of the tube with inflation of the balloon in the oesophagus may cause oesophageal perforation or extrinsic compression of the trachea".... Placement confirmation of Sengstaken–Blakemore tube by ultrasound A C-M Lin, Y-H Hsu, T-L Wang, C-F Chong3 ;Emergency Medicine Journal 2006;23:487; doi:10.1136/emj.2005.031922 Now you why I will not place those NG tubes down the alkies.

Wow! Did I boo-boo :oops: .. I totally screwed up the spelling of the Sengstaken Blakemore tube.. Sorry! It has been several years since I've used one. For those that wonder what a "big bertha" looks like here is a pic as well how the Senstaken Blakemore is positioned.

Lupus is broad and generic term. There are several types of Lupus, as it is an autoimmune disease and can affect multiple areas throughout the body. Within the past few years increasing research and treatment modalities have reduced the morbidity rate, for the type that affected nervous, kidney and heart but still is a serious disease. Although it is a well researched disease, there is still a lot that is unknown.. like the etiology. Basically, you name it, they've got it. A bad disease that is treated but never cured. The type you described which is very common is called Systemic Lupus Erythematosus, and can affect or spread into various areas of the body. Here is a very brief synopsis of the major areas: Dermatological- Like you described is usually seen up to 30% have it, and over half get it at some time. The typical rash you described "butterfly rash" (malar rash). Again usually a thick, red, patchy type. Sometimes it will increase from sunshine and those that have Lupus should avoid direct sunlight. Hematological- Anemia (low Hgb) and low iron deficiency. Many may have low platelet and low WBC. Which in turns can increase or prolong the PTT (clotting factor) caused by antiphospholipid antibodies. This of course can present as bleeding disorders. Muscular and joint: Common areas of pain and discomfort. Most will have some form of joint pain (usually wrists). Cardiac- common all the "carditis". Pericarditis, myocarditis, endocarditis can occur. Of course effecting the valves, and also have occurrence atherosclerosis. Lungs- pleural effusion (fluid level in the lung), P.E., pulmonary hypertension Kidneys- poor renal clearance and may have asymptomatic (painless) hematuria. Later renal failure. I won't go into the greater detail. It is a very complex disease. After reviewing it, I agree I have seen it more in women and it is not age discriminatory. I have worked with several medics that had it. I realize that it is not that easy to place a correct diagnosis as well and many of the symptoms have similar appearance to carcinoma. The general treatment is supportive for the problem at hand. Many maybe under steroid use and are actually presenting complications related to that. Again, since it is so diverse caution has to be used to label one area. R/r 911

We use CPAP at least daily on several types of patients. We no longer just use on CHF but on majority of pulmonary congestion. It has reduced our admissions about in half, as well ICU admission three fourth's and elective intubations to nearly neal. It is true it uses a lot of oxygen. Some CPAPs are beter than others. We use Emergent Portovent and appears to be conservative and easy to use. Here is the link for some articles in regards to CPAP, that you might find helpful. http://www.merginet.com/index.cfm?pg=airway&fn=CPAPuser http://www.emsresponder.com/features/artic...=11&id=6076 R/r 911

It all depends. The duration of transport, the amount of weight an degree of potential crushing injuries. Is there adequate circulatory and neuro involvement? Compartment syndrome involves swelling within the fascia and I know of no EMS performing emergency fasciotomy. Some however; initiate treatment for rhabdomyolysis. This is tricky because rhabdo is usually made of the CPK (>10k) and many EMS treat fluids and with NaHCo3 IV drip. The general treatment is to treat for potential fractures, pain management and possibility of cooling application to reduce swelling (dependent upon circulatory compromise). Personally, I cannot answer with a text book answer. There is too many variables. Depends again, if I am considering a true crushing trauma injury, or compartment syndrome from the swelling or potential rhabdo. R/r 911

Couple of things, being licensed as both. Control the scene, don't let the scene control you. Three people in the back of the unit not including my partner is two too many. Sorry family or not. If she raised the stink of being a nurse and a sibling, then I would inform her that she should obviously know better and as well that she/he is NOT licensed away from their facility. But thanks... anyway :wink: In regards to the trouble maker nurse, I would forewarn her that it is a two way street. That you would prefer not to be in pissing match. That there are far more medics that can witness and testify on her delivery of care and attitude to patients as well. Just point out, that EMS witnesses her care far more than she witness theirs and give a big -o-smile.. . In fact, I highly suggest to talk to the Charge Nurse about this and have her witness the statement, I doubt she will go forward. There are arses in every profession. Chances are she probably was an EMT first.. it appears many of those with an attitude usually was an EMT before hand. R/r 911

What department heads and others in hospitals did not really want was EMT's that had lack of education. Then now you have someone that portrayed to be the "Jack of All Trades and Master of Nothing"..Which in reality means = Cheap Labor = you get for you pay for. I am sure most were also aware JCAHO would tear them a new one for placing an inferior person that could half arse everything. All because in the name a saving a few bucks only later to have to replace with qualified personnel. Just consider this, we have discussed how EMT's are not even properly educated enough to perform field intervention then why would anyone even consider them educated enough to perform interhospital care? My suggestion is to make up your mind, where and what one wants to do. Then go for that education to do it, instead of again performing having the typical EMS mentality and take short cuts and doing things half-arse. R/r 911

Usually these patients have other associated complications as well. I have to admit within the recent years the morbidity I believe has declined quite a bit, but still is not very good ( I don't have the complete data). I come from the days of taking care of these folks with the "big Bertha Blakemore" esophageal tube. From what I recall many if they survived the initial bleed also presented with DIC shortly thereafter. Definitely a "messy" and dangerous presentation. R/r 911

Actually, I posted the discussion about placing input and possible changes over two years ago. As well with updates, etc.. The reason those that actually write and participate in making changes in curriculum do not post is simple. Read the majority of the postings. Most of those involved with policy changes are not going to participate or even care to be involved with some of the type of demonstration of the ideas and educational levels. I actually know a few that was on the committee, as well as some on the new committee members for the Paramedic revision. From a few I know of, have actually visited EMS forums and either find them humorous or typical posting from those that do not understand educational standards and the requirements that is needed for a system. Seriously, you have a doctorate in education and you want to review posts about how difficult the Basic EMT was or how many skills they should know? Let's be reasonable and serious.... I have attempted to even get State EMS Directors involved. Difficult to take these forums seriously... R/r 911

I had thought that too, but after reading about tissue damage, and cold exposure I decided to post... R/r 911

???? Why would you want to save the emesis? I can assure you they will believe anyone that has a patient with a varices. Estimation of amount can be made. Esophageal varices, used to have a poor outcome and was treated with Sangstain Blakemore Esophageal tubes attached to a football helmet for traction of the tube. (V.A. hospitals used have plenty of helmets) introduction of gastroscopy and the use of laser cauterization has remarkably improved the outcome. Personally, I have used devices such as combitubes and even EOA that can occulude the espohagus, to help occlude the bleeding so intubation can occur. Common problems of those with history of alcoholism and portal hypertension. R/r 911

Wow! All that in depth explanation and no discussion that the properly way to place anything cold is place padding between skin and coolant. Even nurses aides are taught to place padding in between as well as to monitor skin temp to prevent damage. Now to add the advantages is that is does reduce swelling, coolant does decrease pain, and yes even bleeding (thus reduces bruising) . R/r 911

"....I'm good enough, I'm smart enough, and doggone it, people like me" Sound familar? Okay your special. Feel better? Seriously, this would be similar in comparison of a nurse aide attempting to keep telling a RN on how important their role is and how much training they have. Sorry, this is not a personal issue, it is the facts. You have less hourly education than the person that cuts my toenails. Don't like that then go back to school! Like any other profession, get a job, get a loan, go to school. Seriously folks, its not that hard. Just like everyone else and every other profession has to do the same thing. Are you inferior in position? YES! Sorry, that is the truth. Is this personal NO, again the hierarchy of the profession. Again, don't like it, then quit whining and go to school and correct it. As long as Paramedic is the top or gold standard that is the way it will be. You knew this when you entered the profession, so quit attempting to justify yourself and the lower level. Your role is simply to provide the elementary care and to assist those that can provide more in-depth care. Just like a nurse aide that is trained in the simplistic basics of nursing, the BASIC EMT is trained in the simplistic didatic and skills. Sorry, that is the way it is, even if you had a 500 hours course. You are still the entry level and that level is currently only able to provide non-in depth care and just enough stabilizing as a first responder. Dust and myself have brought up these issues because without such stimulation and most would presume that this is the just the way things are. Unfortunately, most that enter this job are ignorant about their chosen profession. Again, most do not attempt to foresee or look into the future for developments or change within the system. I am on several state committees attempting to change things. EMS as a system has NOT changed much in the past 30 years. Again, one that HAS been through this, I can also attest to it. Yeah, there are some new toys to aid and assist in patient care... so what? We would had had those because of patient care within emergency medicine. It was not EMS that invented them or even performed studies that changed patient care solely. Has the system changed? Not really, many people in the U.S. can still only recieve BLS care when they need medical treatment. EMT's are still only expected to read and study from elementary level books. EMS systems still have no professionalism benefits such as entry requirements, pay structures, and benefits in comparrision to other medical professionals. Don't blame Dust, he is simply the messenger to awaken others of the problems. Without awakening many entering the profession, most would assume status quo. Again, you don't care for what he describes, change it. R/r 911

If you are pursuing going onto Paramedic then I would not waste my time. If you plan on working in outside the metro area, then I would consider there is demand for Intermediates outside OKC area with differential in pay. Inside the metro area, most EVO drivers are basics or Intermediates but usually get paid the same. This would be a personal choice. I also would look at all programs that teach Paramedic school in OKC as well. Especially those that are accredited by CoAEMSP, CAAHEP (there is only one-OKCC) and that offer degree programs. It may not pay off initially, but in the long run it will. Clinical instructors, sites, and ability to move forward unless you are just considering going into the fire service only. Good luck, R/r 911

Keep you conviction and good luck in your studies. Their loss and someone else's gain, when you get more education and experience, after your law suit, come back and be the manager... R/r 911

Whom told you this? I was at the OSDH Thursday as well as been involved in the development of the new EMS Coalition and have not heard of such. What has happened is many or majority of the schools are no longer teaching the Intermediate level as an individual course, they are having it included into the EMT to Paramedic curriculum. Some allow testing while in the Paramedic course where others do not promote it at all. If you want to attend an Intermediate level course alone, there are still a few places teaching them, notify Kay or Eddie @ OSDH and they can inform you of the scheduled courses. R/r 911

Usually most learn to use common sense. The very minor fender bender, falls, etc. non major traumatic patients with specific isolated injuries may not have to be exposed. The difference is knowing and being able to determine those that have potential injuries and those that do not. Because someone twisted their ankle does not give us the right to totally strip the patient. I had assume that this would never occur, but unfortunately I have seen in the past such occurrences, again for no reason other than they were told to "strip all trauma patients" . At the oppossite end, those that should have exposed and examined patients and did not because of hestitation. Unfortunately medicine and EMS is not black & white, it is gray. One has to make decisions based upon education and experience. This is what gets many into trouble. R/r 911