Ridryder 911

Thanks I appreciate that..I decided to have a personal life & not live EMS. My full time position in education also involves ensuring our personnel maintains licensed & renew with NREMT (my state requires it). Also having close working relations with NREMT does not hurt either...lol R/r 911

Partly true. Actually the online process also requires one to be associated or have a specific assigned "training officer" that must authorize or acknowledge that the information is correct and true. As well, a licensed medical director is also required to confirm that your skills are correct by field examination or a Q I type evaluation. As noted all this information is found on their website.. www.nremt.org Good luck, R/r 911

Never left too, but glad to see that your still posting.... R/r 911

LP 10 is still new, I thought maybe we were discussing the LP 5. (yes I still have both and they still work great! I use them in trainng as the "good ole days) R/r 911

I have not read yet, that further investigation reveals that ......."The deputies told Midland County Sheriff Gary Painter that they had about three to five beers each"...... http://www.msnbc.msn.com/id/32503068/ So not only were the officers using no gray matter in deciding allowing a scantly clad female holding a weapon, they also were under the influence of alcohol while using law enforcement vehicles. So not were they stupid in one area, they had a case of dumbass in many other areas. Good riddance, such idiots should not be wearing a uniform and be responsible for guns with ammo. R/r 911

Actually, an autopsy report (including toxicology reports) are considered public records in most states. The truth is don't do the drugs or alcohol and you would have not to worry about reputation as if they could (since they are dead). R/r 911

While we are at, since one of the leading variances and dangers in patient care is the stretcher. Then maybe we should remove it as well. Since there is a large number of patients dropped, that fell and workman's comp it would be much easier just to have the patient walk to the unit. Yeah, instead of educating and reviewing the why's and how to repair we can simply just ignore ways to improve our methods. Sure resort to doing what is the most simplistic... aren't we glad the rest of medicine did not follow that path? R/r 911

Actually, never left practicing as a Paramedic, as I continued in the field 10 years full time after becoming a nurse. I actually did both full time for a period of time and recently (5 yrs ago) returned back to EMS full time and do part time nursing (although at times work as many hours as a nurse than some of those of full time ). In regards to our local EMS as a being all, I am the first to describe our system is screwed up. The reason I was in meetings at two different educational facilities Friday. We desperately need to change our system, and the reason I continue to attend legislative sessions and lobby to improve on what we have or I should say don't have. The only way real change occurs. No state has the best EMS; but at the same time we have great providers that actually do know about medicine as much as some other health care providers. Something we both always agree upon that the numbers of those should be improved upon. Fire EMS unfortunately is usually managed by those that do not understand medicine or where or what emphasis should be placed. I admit, as far as providing benefit packages and financial support and PR they usually have better options to offer (for now). Yet, there are more and more third party EMS, that now offers equal or even better benefits and their main and only focus is EMS. Something we in EMS should be supporting, as it would only benefit the profession. The studies I believe are skewed and very biased, as I previously described. Something that a few of us that know how to read not just what is in a journal article but read between the lines as well. Yes, there are poor results in certain areas. Why? Again, look at the systems reviewed and studied. For example let's review Seattle where there is not a Paramedic patch on every firefighter but one that can provide good, quality initial care followed by a seasoned Paramedic. Yes, I do have reservations on their studies and outcomes on cardiac arrest but in comparison of intubations their numbers do not lie. The service I referred to perform thousands of intubations as well at >98 % success. How? By studies of their own, continuous improvement by implementing the usage of flex guide, ensuring EtCo2 and good assessments are performed. It really is not that difficult of a procedure as it has been performed millions of times a day, without an overall non drastic result. I agree, good proper sound education is needed but this is not neurosurgery either. There are new devices that almost totally eleminate poor visualization and even prevent movement while intubating, why has that not been discussed or explored in these so called "scientific studies" as to prevent needless deaths and poor outcomes? Again folks, I am not paranoid but seasoned as I have seen previous hidden agendas with so called studies and opinions. Let's be very open to studies and methods to improve our care but at the same time, let's not do a knee jerk reflex because of a few bad systems that was studied. It would had made more sense to study why their system had poor intubation rates and how to correct it than to just state one's rates is poor and therefore all systems must be have the same and perform the same as well. If we did this for all hospitals and medical procedures, very few hospitals would perform many procedures and surgeries. We need to be methodical and enforce proper education on what we have available. For a service not to utilizeand use EtCo2 is negligible. For Paramedics or those not to be able to detect a wave form and be able to interpret the changes in numbers and not perform accurate assessment techniques is non tolerable. Again, we need to improve on what we have not just remove a well needed procedure. R/r 911

It's nice that we are recognizing a potential problem. Potential is the key. Shame that services and personal are not being taught to use the EtCo2 or worse ausculatating for verification for ETI. Although the studies are nice, don't lump the thousands performed daily that are sucessful into the same group. They hand pick areas that may or may not have adequately trained or educated Paramedics. As well, I see no mention of attempting to resolve the situation of helping or aiding Paramedics in becoming more successful in intubations such as maintaining QI or even providing airway classes by these so called professors of anesthesiology. No, its much easier to cease or cancel a self assumed procedure. I still believe ego's are involved. They failed to mention or recognize that there is less and less clinical availability by guess who? Oh, there is room for CRNA students and anesthesia students as they charge the universities to allow residents and students to allow clinical sites. One group wanted $100 per intubation attempt per patient by EMS students, of course the Paramedic training site could not afford such, they soon filled those spots with an out-of state CRNA program that did. I know of two instutions that the students have to travel > 90 miles for clinicals; because of a such scenario. Yeah, economics has nothing to do with this.... (cough, cough) Sorry, but I know of two large services and my smaller one that has over 98% success rate and even then secondary airway placements are successful. I would love to compare that with even first attempt intubations per anesthesiologist or even ED physicians without the use of RSI in an ideal environment. I knew Vent that you would jump on the band wagon. it must be a wonderful world everywhere you work. CRNA's work in a variety of cities and communities, yes mainly smaller ones that cannot afford an additional $250-500K for routine surgeries. In regards to the EJ comment it was not my service or even within my state. Actually it was a hot topic at the ENA convention few years ago as it was within a state motion in a South Eastern state; not to even to allow any physicians or any other staff members to be able to perform the procedure. Yes, it was strictly money as it was primary mention that they had lost revenue as per not performing special procedures as they had previously. Fortunately, it was killed. Don't be fooled that economics does not have a major role of who and what is performed. Vent, we realize you don't like EMS and usually rarely have any positive statements in regards to those that provide care. So be it. You are a master of respiratory and airway control and well know the risks of intubation as you stated but as well realize in the real world BVM would be as catastrophic. Studies have shown even the simple technique of CPR is difficult to perform in moving and prehospital arena and we would want to perform BVM? I would like to see a study of those that work in anesthesia current rates on first try intubations as since the increase usage of LMA, Fastrach and other alternative airways. As well, most of the flight teams here have went with glide scope and we are considering similar screen laryngoscopes that one can actually visually see and record as one intubates. Oh my... a kink that could prevent unsuccessful intubations and still allow prehospital providers to intubate and yes still provide the same airway as the physicians would charge to provide. Again, another B.S. cause. Similar to the early 80's acclaiming that IV's should be discontinued in the prehospital environment; because of delay of care and so called documented that Paramedics were taking >20 minutes attempting IV's. Killing patients, even the establishment of IV in ED's were being questioned. Later to be found bogus... and from supposedly from those of high academia ratings. Wang has yet had any positive findings in his studies of airway in EMS. Seriously, none? There are plenty of EMS services that perform quality improvement studies, yet he never compares or studies those.. Why not? Decades of studies and still none? C'mon surely one would want a fair and honest study or at the least acknowledge them? I am all in favor of scientific studies when performed accurately and fairly. Yes, we definitely need to improve and look at ways to change to prevent and decrease errors. Just to cease a procedure because some services are not able to control and modify their programs is an injustice to those that can. Again, what the studies has demonstrated is : Compared rates to services that do not have an abundance of Paramedics (their skill rates are above those that do). Paramedics that are well educated and have a quality control and the skills are monitored in comparison to cook book medics and services that have a poor monitoring system, have better success rates in care and skills. But wait that would make sense... implementing common sense. R/r 911

One other piece of factor is the $$$. Many physicians (especially specialty) are feeling the crunch of not performing extra procedures. I know of one state that attempted to remove EJ from the scope of anyone except anesthesiologist and anesthetist. Why? The procedure would generate extra income, short & simple. I realize it may sound petty but I have seen worse in studies and all in the name of money. Anyone elsde remember the B.S. studies that acclaimed that EMS was taking 15-20 minutes to establish an IV?... Yeah, all from notable researchers. Amazingly, it was debunked and there were no apologies...

We have to look at some myths in EMS. Such as every fire truck and every person has to be a Paramedic. Those with having a higher save rate actually has fewer Paramedics than those that a having multiple Paramedics. Would you want a surgeon to describe that he has performed a surgery once every 6 months or one that is able to perform it every week? Again, over saturation of a good thing = skills deterioration. Second, why is such a simplistic procedure became so hard? With the invention of EtCo2 and good assessment there should NEVER be any patients delivered to the hospital with esophageal intubations. Seriously, poor and gross incompetence behavior. This does not mean we should eliminate the procedure however. How many central lines or intubations do I see missed by physicians all because they too have became relaxed or poor skills? Yet, no discussion is ever made to remove their ability to perform such procedures. Such studies are slanted. Never is discussed the reason or a working solution of resolving the problem other than a knee jerk response. I do wonder how many of those anesthesia areas allows or would allow Paramedics to intubate to maintain their skill level? Yeah, I thought so. R/r 911

What the post does not say is that EMS personal witnessed the event (if you watch the video) R/r 911

I am still trying to understand where anyone assumes he will be making money? The most he can obtain is $75, 0000. That includes attorney fees and everything getting wealthy? I don't think so. Do I think that he probably did some wrong in the action(s)? Yes, but I also feel that he was attacked. If another person had acted as the trooper did they would be serving time, not just 5 days suspension. Yes, very unfair, but this is not OHP's only problem at this time. I do feel we will see some major overhaul within their programs in the future. This has unfortunately tarnished their well deserved reputation of one of the most professional organizations I knew of. Does Maurice past work experience has anything to do with this case? No. Sorry, it was not him who placed or interfered with the care or exited his vehicle cursing and demonstrating anger and emotional problems. It does not matter, he performs his job well there and has been employed for a while at that service. How many of those have been in EMS (non fire) for more than 25 years can always say that they agreed with management or others? Personally, I have only seen him once or twice on the news. Always professionally, the reason the trooper has been quiet because he has too. It is really old news by now, but will admit it has locally opened the eyes of many. R/r 911

I agree our system might have started the ball rolling but definitely dropped it. What appears we have and you don't have is the stark opposition in progress. For example one of the cities such as Tulsa is coming under scrutiny and the push of moving EMS into the FD, even though there had been re-registration procedures that had been found out to fraudulent. Even its sister city in OKC the push alike so many is to guarantee FTE for the Fire Service. Then the ugly head of many of the volunteer systems arises and protests against increased education and push for lobbying against formal education. Unfortunately, it is not always the rural as you have described but those cities that could afford and provide 24/7 Paramedic ALS level care but due to "tradition" and being cheap and ignorant refuses to. Who would have thought after 40+ years, that we would still have "first aid" units and worse boast about it? Yes, we could learn a lot from other systems. Truthfully, we already know what we should do... rather what we cannot do is what makes it frustrating. Those two main groups have very powerful lobbying and active participants, sadly more so than those that acclaim that they want good care for patients in the U.S. R/r 911

I see two options but it is determined who really gets involved into promoting EMS. If the insurance and healthcare administrators were wise, they would mandate and force EMS to become a true recognized health care profession (academic and degree entry level). With our diversity, and background we will make great "screeners" as the move towards the "health care for everyone" becomes not just a popular but demanded stand. With this and the current number of baby boomers, the industry cannot meet the demands that will be placed upon the number and level of providers we have now. We may debate day by day tasks on EMS forums, but it is a rarity we discuss the truth of what the demands of health care will be like within 5, 10, 15 years. Just the aging population alone is factual enough to demonstrate that the number of hospital beds versus the ratio of patients will not be met. Hence, EMS will have no choice but to be a filter of whom and when and if one will get to go to an ER. Of course, we could not expect those graduates of the current curriculum and scope are adequately educated enough in performing what we now call a medical screening evaluation (MSE) which is (should be) performed at every ED. The advancement of detailed assessment would have to be greatly increased and of course correspondence education and advanced skill levels. At the same time, it will not be necessary for all of those in EMS to be able to perform this clearance but as soon as the patient is stabilized I do predict such advanced level practitioners will have the authorization to perform this task and thus reducing needless hospital visits. Many may laugh, or describe that physicians will not want to be responsible or the pay structure will not be enough to sustain such levels. I do believe though, the savings will be enormous and those that have the fortitude to go to higher education level can and will be compensated appropriately. Insurance corporations have been attempting for years to prompt us into advancing our profession but we still resist progression. Unfortunately, as I always describe if we don't do it; they will develop or find someone else that will. It's our choice. R/r 911

Here is a link to the Education Standards Gap Analysis Documents, which is the study for developing bridge courses according to the new levels. Developing educational standards to those standards that is currently used at this time, in other words education vs. training. http://www.nasemso.org/EMSEducationImpleme...t.asp#GAT071709

I agree Dust. I chuckle on how they are glorifying him about being impartial but yet gave his personal view on Vietnam? It appeared to be an agenda and it worked. R/r 911

................"And that's the way it is, July 17, 2009".......................RIP Cronkite. R/r 911

Actually, that is in the testing phase as we speak. Some states are having such levels. The NREMT is exploring that possibility as much further education will be required. As far as a NP some states allow the NP to practice within their own license without being under a physician license. Also you do understand that the general salary of a NP and or P.A. is between $75 -150/hr? That is a lot of Paramedic salaries. You might meet one that will be willing to help but to be responsible for that care at that level, I doubt it would be free. Realstically, not much more they could do. We have ACNP on some of our helicopters and perform the same roles & procedures as the Paramedic but the salary of couse is much different.

So let's see if I got this right. Your now going to pay an NP or a P.A. $150,000 base rate and how much a year to make EMS calls? Your assuming that they would want to give away their talent and time. Since the average PA or NP starting salary for most rural ER's and clinics are about that much .. without additional workload. Could be a nice way to run off your help. Good idea but I believe impractical. You work all day, then to be expected to be on EMS call? Think about it, how much down time, what about the litigation issues for malpractice and again on top of the responsibility. As well, P.A. are not independently licensed as they too work under the license of a physician. I've had P.A. 's and NP's run calls with me. Fun but they would be the first to inform you that they are out of their environment. Not that they can't help but a lot of stress trying to adjust.

I never heard of such and as well, doubt it will for at least another five to ten years. The reason being it is not contained within the new curriculum and before it makes it into traditional studies it will have to be reviewed and placed into standard courses such as ITLS/ PHTLS and so forth. It might be placed into standard curriculum for military medicine, but doubtful for civilian at this time. The old saying and labelling of primary and secondary survey (replace initial and detailed) is just now returning after being gone for nearly a decade. There was much debate of even returning the traditional wording of what is already usually taught. R/r 911

That is why I am so glad that required statistics will be a part of the new Paramedic scope of education. Maybe, we can also enforce to read more than just is being told. Even the Fifty Cities report, is full of holes and propaganda hype of some of the statistics given. I recognize that Seattle has done some neat studies and developments (marketing and public relations is one of them). R/r 911

Alike CHBare advise, coronary and vascular disease = potential other problems. Your looking at the tunnel and not looking at the whole problem and assessing the whole patient. There is a high incidence and risks of those with CVA's having several multiple problems. Do you not also perform a FSBS as well? You should. There are many related illness and injuries with associated problems. I have seen many CVA's with associated AMI's and other related disturbances. Twelve lead is just simply another assessment tool, should be used on any potential vascular problems. If it takes one more than 1-2 minutes to perform a 12 lead, then you have technical problem such as they don't how to do their job. Twelve leads never delays care, if one knows how to do them . R/r 911

At least it is nice to know your not God. Sorry, as one of faith, I didn't read anywhere that child molesters, those that murder and even those that judge others cannot go to heaven. That is if they truly repent and ask for forgiveness between their maker and themselves. It does not erase the past, and to those of us with faith, God is the only one to determine the eternal fate. If he was guilty, then just action will be taken and carried out appropriately. Since your a non-believer what would that matter to you? Actually, you have more faith to believe that there is not a life after than if there is. That itself is a whole lot of faith, to think that this is all there really is. I may not understood or even approved his action(s), lifestyle but the more I have heard from those they actually knew him, and it appeared he was more screwed up emotionally and was more asexual than anything. This is not uncommon especially of those that had been sexually and physically abused while in their youth. The whole family has more skeletons than many grave yards, and it definitely is shown in each of the children. There are a few that really do know the real truth and I doubt they are posting in EMS forums. What I do know is that he was simply a great entertainer, musician, dancer and humanitarian. That he definitely had issues, but how much and what degree?......Who knows and really who cares? He's dead. Let him RIP and appreciate the music that can be associated with the memories it produced over the decades. R/r 911

The good thing is not all states are alike Florida. Many have tightened down instead of easing up. They may be able to get a license in Florida, but that does not ensure them to get one anywhere else. If they are provisional I hope that Florida's board nips this B.S. in the bud... R/r 911