Ridryder 911

Actually this would be the 2'nd event of this caliber. The first occurred a couple of years ago in Las Vegas. Unfortunately, I was unable to attend but received several unusual phone calls... .. Apparently, there were some great times and friendships.... R/r 911

Good old days? I believe if we were to be truthful there are still more of those that work codes than those that have field termination, especially in the rural setting. R/r 911

I totally agree .. but that is the general standard of care. One has to also remember that EMS is business here, we even charge for pronouncement or declaration without transport. There are very few medical directors and services that want to "step out" and totally go for tying up units, and then placing the full responsibility and liability upon the EMS. (Have you seen the recent trend of pronouncing of live ones?).... I believe it will be several years before field termination is the quote.. general standard. Remember, ECC/AHA only recommends and does not endorse nor discourage such practice. Until there is total encouragement as a standard, then there will not be an active change. It usually occurs only at most progressive EMS or Medical Directors. R/r 911

In the U.S. very few services have field termination guidelines other than traumatic arrest or not to work fresh codes and then those that are allowed are specific to aystole prior to arrival . As well, many do not have the luxury of spending 20 minutes on the scene to work the code and then call/pronounce it and await for M.E. another few minutes, etc.. Although, recommended it is not the usual guideline as of yet in most areas. Maybe in the future more and more would adhere to such practices. R/r911

As they say, you learn off your mistakes.. I once had a call that a first day employee complained of testicular pain after a large amount of dirt (they were placing industrial sewer lines in) fell on top of him. Of course, the foreman pointed out it was his first day and he was walking around.. describing severe pain. Being the jaded Paramedics we were, my partner was already beginning his PCR report before I had latched the stretcher. I noticed blood in the heavy jeans. I suggested we examine further (the look of shock on my partners face). Upon further examination, what was revealed was a eviscerated testicle. Now, real shock was on our face... even more so than the patients.... I learned off that experience. If you do not see or look, you do not examine. You do not examine, you do not assess... you do not assess, you are performing negligent care. I get irritated from medics who describe... "their bleeding from down there"... not knowing if it is from the rectal or urethra. Many will describe that it does not matter... again, how are they going to document on an assessment? Amount, color, origin or are they going to describe on what the patient described? Because of such assessments, one has to assume that further half arse assessments will occur. Remeber, high possibility of missing injuries on trauma patients, even GSW or stab wounds can be very small and difficult to locate. I have always endorsed using all senses on patient assessment. As an educator, I always endorsed "hands on" practice with fellow students. Even blind folding the examiner, increases the awareness of palpation and tactile examinations. Many times our initial examination is in the dark. One can learn and recognize normal anatomical structures versus abnormal and the feel of wetness, warmth, etc with a gloved hand. Again, we want to be a health care professional, we must perform as such. R/r 911

Naw... just meant that they get to be the gopher, get their cofeee and enter the data for the Doc . R/r 911

hint to WANTYNU, I believe Vent is very familiar with degrees and college, university requirements. She holds a degree in EMS as well graduate degree in cardiopulmonary studies, so in comparison to knowledge of educational systems, I believe she holds quite a bit of knowledge. R/r 911

I thought it was interesting they "lumped" trauma funding into EMS funding. Ironically, our trauma system was displayed as one the "best operated and funded" when they were discussing this on a ABC News a couple of weeks ago. Why I said ironically, is because those that work within the system ( as I assisted in developing) know it might be financially operating well; but know how poor it is operating as a system (always on neuro divert and divert although there is no patients in the center). As well, we are one of the leading states loosing EMS agencies in the U.S., so trauma funding and EMS funding should be addressed separately. Like the other posts that describes the dangers of "waiting times increasing in the ER"; this is also just the beginning of problems and tip of the iceberg. R/ r 911

Hence the reason I went back into the field full time. Basically I have seen the rhetorical reasons: 1. Don't have insurance 2. Don't have an assigned Primary care Physician (PCP) or Doc 3. Wants immediate treatment and do not want to schedule preventive care at a clinic. 4. Wants Rx (usually narcotic prescription) to be refilled 5. Don't want to wait 6. Don't want to wait 7.Wants Rx (usually narcotic prescription) to be refilled 8. PCP does not want to see them in the clinic and punts to the ER The type of patient that was seen in the 80's and early 90's are not the ones we now see in the ER today. Unfortunately, we still attempt to operate emergency departments in the same manner today as we did then. Majority of ER patients do not require monitors, SpO2 monitoring, or even changing into a gown. (Does the PCP clinic perform this on each patient?) Many perform bedside triage per portable computers and reduces downtime. Most ER's are finally addressing that ER patients are really "clinic type" patients and have a fast track system. Some having physician extenders performing triage (PA & NP's) with treatment prescribed right in the triage room. No need for special test for otitis, strep screen can be done at bedside, etc.. Again, this is just the tip of the iceberg. That is the scary part .. the worse is yet to come. This again will affect EMS and yes our profession will have to adapt to the ever changing methodologies of health care. As I predict EMS will be more used as a screening tool on whom will get to be seen and those that can and will be treated at home. R/r 911

Welsh has some very good points. I like to add many are told to be preceptors, not asked. Yes, after pulling many hours straight many of us that even like to precept can get tired of a "third wheel". I have to admit clinicals are tough. It is hard to "fit in", ask enough questions and not too much, talk .. not talk, etc. Be sure to ask to participate on non-EMS activities as well, such as cleaning the unit, emptying trash, etc. Be sure to understand and know your objectives. Meet and discuss with your preceptor on how you would like to accomplish them, ask for any advice and their wisdom. Everyone like to be honored for their experience and knowledge. Attempt to discuss and review calls afterwards. If they appear to not really want students, then be blunt with them. It appears that you rather not have me or precept for students, do I need to contact my school? Sometimes, this will awake them, and as well if true, maybe a clinical with another person should be made or re-scheduled at another date. Good luck! R/r 911

I was in the understanding most PA programs were now graduate level or to be required by most states to have such. The one I attended was for a B.S. but changed to a M.S. level, as well. It used to be solely for RN to PA but now a B.S. is all that is required, (of course with other requirements). The North Dakota program was developed for rural areas, and one can attend at the University for a short period (usually 6 week interval) and then return back to their home town for clinical period inter acting back and forth, usually over a 13 month period. They then set for the PA-C graduating with a M.S. Usually, there are grants for such programs. Here is a link :http://www.und.edu/dept/registrar/catalogs/Year0305/graddept/depts/pa.htm For as NP's having to have a post graduate/Doctorate level, it is still a hot topic but probably will be required as it appears now. The advantage is to allow and recognize educational level and professional status. This also opens up the ability to increase and compete in billing status similar to what Psychologist/Counselors, Physical Therapist; many Pharmacist, both now requiring a Doctorate Level as well for full reimbursement from payers. Our state now requires new P.T.'s graduate to have to have post graduates, and the P.A. program is within the medical school as a post graduate study. Ironically, it is told that the P.A. program is more difficult to enter than medical school. Good luck, R/r 911

I always chuckle when reading these posts. It always appear those that inform what Paramedics can do or how inferior one or another are those that do not possess both license? Another, chuckle.. those that do not have a license as a health care professional rather certified, usually does not understand the difference. No, it is NOT semantics, again if you had one, you would understand.. I suggest looking at the formal definition for clarity. I don't care how many Paramedics or Nurses one knows, or if your granny is both, unless, one has completed the curriculum and educational process of both, one cannot make a fair analyses. I know a lot of surgeons and dentists, but I do not try compare them with each other. Dust and I will be the first to inform the faults of both profession, as some others that hold the education and license of both. We have been in EMS and Nursing long enough with academic backgrounds of the educational and instructional methods and knowing the didactic and clinical requirements of each profession. Paramedic have a limited educational scope. Period. It maybe more in-depth in certain areas, as it should be, but limited, but that is part of the problem. It does not have to be, unfortunately few educational facilities enforces and requires anything more than that. Where as nursing has a more broad spectrum and diverse educational back ground. The specialization usually occurs after graduation, but they have the general education allows for expenditure. Again, remarkably emergency and critical care is not the only speciality in medicine. Now, with that said general nurses are definitely not ... highly trained or educated in emergency or critical care .. through their general nursing studies. In fact cannot even be tested in the license exam (NCLEX) over emergency treatment other than BLS. Again, it is they become specialized to become proficient in that area. Back to the topic, let's get away from first aid and emphasize medical care. No ALS, BLS just providing medical care. Whatever license level that is (hint Paramedic) should be the primary goal. Teaching first responder care, can be just that ... (hence EMT's as EMFR) and they can do that without being part of EMS itself. R/r 911

NAEMSP has been out for several years. They do have some outstanding programs that promote EMS Medical Directors residency programs, and as well Medical Director programs for rural health care areas, and many programs for EMS itself. Unfortunately, many believe that ACEP is the main emergency organization for EMS. Which ACEP does recognize us, but rather we are one of their promotions and side track committee, where NAEMSP main focus is upon EMS itself. It has not gained the power and respect alike other physician level organizations. Hopefully, with time and exposure they will. R/r 911

In my state all EMS is licensed. The Basic, Intermediate, and the Paramedic are each licensed through the State Department of Health and the license is governed by State Law just like the RN, the electrician, plumber, physician., etc.. I do not agree of removing the EMT; but rather the Basic level should be placed as a medical first responder only. Not included in the Paramedic curriculum at all. That it is what their curriculum is aimed for, nor what their primary job is for. This means they are NOT for continued care, or for transporting injured or ill patients. Again, rather for stabilizing until professional help arrives. One will never remove EMT in some areas. Sorry, that is the fact of life. Just like some areas will never have a local hospital, or have a orthopedic surgeon, or neurosurgeon some may never have ALS capabilities. Unless the government wants to fund the EMS and possibly rotate medics through to keep proficient in skills then we will never see such. Yes, the areas that the need them the most will not have them and since EMS is a business and as professional medics we would like to have comparable pay, whom or what would pay for areas of of a call volume of < 100 calls a year or a population < 10,000 in 900 square miles? What does anger me is those areas and communities that can provide such services but rather keep the service as BLS or utilize volunteers strictly based upon tradition and self inflated ego's. No exploration of upgrading ALS or placing professional Paramedic services, rather keeping status quo with no regard of patient care. So what could be done?.... Again, change the EMT level as a first responder emphasis only. Not associated with Paramedic education at all. Only in rare and very remote areas (it would have to be proven/documented) that they be allowed to progress or transport and perform additional skills due to transport time to ALS provider. This would be an exception instead of the norm. Require the Paramedic to be at the least an associate degree level. With the same general education as other science degrees. No exception or "technical" degrees. Each State would license through a board of EMS within their own state, like the nursing and other health care professionals. National license would never occur, but the NREMT could be improved and used as a standard organization to test and used as a reference center allowing easy transferring of license from state to state. Will this ever occur ? Probably not as fast as I want it to. I do believe when the NREMT starts their requirement of accreditation facilities we will see a major shift and change. Other educational facilities that are not even NREMT will have to follow or be left behind per professional standards or peer pressure. With the requirement and emphasis of having it placed into a true educational facility we will see many of the technical or trade schools loose their ability to teach anything but basic and intermediate level.. thus producing those that are not in demand and with time increase the flooding of the market, and finally dying out themselves. R/r 911

NREMT requires 24 hours of CEU for Paramedic level, 36 for Intermediate and 48 hr for basic level, however; the refresher hours are increased as the higher level.. i.e 24 for Basic and 48 for Paramedic. Do not confuse the refresher with CEU a totally different topic, and verification. I was informed by the NREMT that you are able to take the NREMT test once if you are choosing that route to re-certify. I would presume that most would not re-test unless they did not have the other requirements. As well, the test is the same for initial and re-certification, there is no special "re-certification" test. Far as pass rates, I have seen multiple variables with the new CBT. Similar to NCLEX, one does not really know or what will be emphasized anymore. I have seen idiots pass it, on which most of the questions were scenario based and the next week those with Master Degrees in Science take it and fail having physiological questions over ACE inhibitors and v/Q perfusion levels... so I would not gamble with the new inconsistency. As the State EMS official described to me yesterday, we do not really know the outcome yet. The reports of the low & high areas, have not been published yet and definitely as educators we need to know the weaknesses and strengths of our graduates. Again, something I would not gamble with for my license.. similar to my RN. I thought was a joke of a test, but would not do it again. I agree FP-C would be great, but unrealistic. I know of many RT's, Paramedics and CCRN's that failed that test and actually is not realistic for those that do not perform SCT's or CCT's. Really not sure understanding IABP alarms and pressure limits is relevant if one is never going to be exposed or see one in a career. I know I was surprised when I passed mine, I thought it was more difficult than majority of medical cert tests (including CCRN) R/r 911

It was an old memory aid back in the days of Lidocaine versus Bretylium. Choose one or another, in other words don't push Lido then hang Cordarone... If you push one thing and it works, then hang it respectively... R/r 911

I would not gamble in taking the test. I talked to our State EMS Training Officer today and discussed the options. Apparently you have only one shot.. with the increased fail rate, why gamble? Wow for a Paramedic is only 24 hrs CEU, I usually have that at least every two months.. and I usually teach the refresher, or the other option is to have all the usual alphabet courses (AMLS, PEPP, ACLS, PHTLS) in lieu of a refresher.. so it is not that hard to re-certify. Personally, my state requirements are identical as the NREMT, so why not re-certify (as well, my service requires NREMT). R/r 911

I guess the reason of the frustration is simple, many are no longer taught the old simplistic addage us old farts were taught ... ........." Treat your patient, NOT the monitors!......

I agree with Dust, unfortunately your management did not have the mentality or gonads to stand up and stop it. I do wonder if upper city management is aware they are "double dipping" while on duty? It would appear they are getting paid double for their primary job. I am sure the public would not appreciate them receiving double pay. A little anonymous phone call to a city reporter might get the ball rolling.. Good luck.. R/r 911

Because, they do not realize it is not the "heavy lifts" that usually injures the EMT. It is the repetition of up and down. No one has even mentioned safety to the patient. There is NO multiple levels of the stretcher not catching or in-between levels, simply whatever level you choose. Sorry, old Ferno's and multiple level folding cots will be a thing in the past in about five years. Workmen's comp insurance will see to that. From an old medic, that prefer not to ever have something "fused" .. I much rather have the additional few pounds to roll around. In part of the cot not working because of dead batteries... I agree they were idiots as well. I have worked the cot many times without even a battery in it! As well, I never use the "power" to unload, rather allow the wheels to drop down naturally and it saves the battery time. Sorry, I've seen a lot and worked on a lot in the past 31 years, and I will attest next to CPAP it is one of the best tools... shame we did not have them decades ago.. there would be less medics with scars.... R/r 911

[marq=up:c0e4a0b03e]Congratulations! [/marq:c0e4a0b03e]

Hence the reason I changed gears mid-stream. After completing a major portion of ACNP, I have changed my focus and even Universities (Texas..gulp! ) to FNP. After investigating more and more, my opportunity for employment and ability to be diverse was very limited as an Acute Care NP, whereas the FNP has more options.. I agree some NP programs lack using the medical model of education, but also if medical schools used more a holistic approach, both professions could be better. R/r 911

this seems to be a question to ask your printers. Not all services use the same or near the same PCR as well as some use multiple copies, style, lay-out, size of paper, etc... Just curious on why, you are uncomfortable on why you do not want to use copies of an original? R/r 911

Actually, going to gym is not really going to help you lift that 500 or 600 pound patient. Also, who lugs stretchers and equipment to the gill on a cot anymore? That is what stair chairs, and entry to evaluate or MFR are there for. Repeated lifting is what injures more EMS personal backs. Anything to reduce potential injuries, or even reduce lifting/straining is good for the system. It is simple, if your service don't like them, okay... but, if I was your director I would let them pay for their own back injury claims. Apparently, it has reduced most EMS "back injury" claims up to 90%... and since that is the number one workman's injury and career ending injury, I would consider it is usually worth the extra 40 pounds. R/r 911

I am currently enrolled in a NP program. I was in a PA program previously, but due to personal and financial reasons (not being able to work >12 hrs a week) I chose the route of NP. Nothing wrong with either program, except in some states a NP does not have to be "attached" to a physician to practice, where as the downside is a NP usually specializes (neonate, acute, geriatric, etc..) whereas a PA-C is more broad based. I had been accepted to medical school (two of them MD & DO) on my 40'th birthday, but after discussing with several friends that were physicians, I took their advice and did not enter. Partly due to the amount of student loans, the time I was able to due residency, etc.. I only met one physician that described they would actually do it all over again. I have been a Paramedic for > 30 yrs, an RN for 18 and have a total of four collegiate degrees, and still drive an ambulance .... Personally, I only looked at MPH when I worked in Trauma Research and was closely linked to the State Department of Health. After reviewing the curriculum, did not have the interest in pursuing it. There are plenty of MPH out there. My suggestion is if you are considering PA route to work in a clinic/urgent care area or ER, and be exposed to general medical care. For the NP route, many programs require 3-5 years as an active RN. Good luck, R/r 911