Ridryder 911

Hmmmm...open book, memorize signs and symptoms, then drive real fast. ... I guess, all chest pains are AMI until proven otherwise ? I guess some have never heard of pleuritic type pain, or chest wall pain.. even in traumatic injuries. There is a difference between treating accordingly and treating them appropriately. R/r 911

Actually, not all states are created equal. In Oklahoma, we have a regulation of individual protocols, that allow a BLS service to employ and use the Paramedic at their current license. There are many that are operating that way. This allows services in rural area that may not have enough Paramedics for full time 24 hr coverage to still provide ALS care. There are specific guidelines, and must be under protocols of the medical director. Personally, I think it is a stupid allowable guideline. Many have enough to go Paramedic level, but never will since this will "fix" them into having to employ and have Paramedics on each responding unit. R/r 911

Oops !:oops: .. When I did look up, I did not recognize the name...that it was Reglan.... my bad. Actually, I have used that several thousand times for nausea.. but, personally I do not see it as effective as other anti-emetics such as Compazazine, Phenergan.. but better than Zofran, if they have already started vomiting. Doc, I have seen the "angered mentation" that I have read and heard about.. I thought, that it would be an isolated incidence, but have had two occurrences after adminstering Reglan .. Have you seen very many of those incidences? R/r 911

Actually, I had to look this one up. I have never heard of the medication or seen it used in ER or prehospital setting, and I see why. It is apparently a popular antiemetic medication associated with those receiving chemo treatments, but has a high incidence of decreasing motility and causing bowel obstructions. I am sure the medics want to be sure that motility is good before potentially causing bowel obstructions, and bowel infarction. The point of not giving it to patients with diarrhea, I believe is not "pushing it through" faster, rather actually some of the clinical signs of bowel obstruction is leaking diarrhea around the obstruction. Therefore; potentially having a misdiagnosed B.O. The medication is excreted through the kidneys. Personally, I am sure they rather use an antiemetic that has less side effects and more commonly used. R/r 911

Wow!.. This threads title is an old song... Like CHBare, I have seen this in all professions.. in fact maybe a little more brutal. I agree it sucks... but that is they way it is. R/r 911

You know I read and hear about how "stupid" and "out dated" many nurses there are. Now, with that in mind, remember many states do NOT require any CEU's, refresher education for re-licensure for them. I know in my "home state" the only requirement is that all I have to do is click my mouse and make sure my Mastercard will process through, and my State taxes are paid up. Sure, it is very easy.. so easy, there are card carrying members everywhere that can acclaim they are RN's. Even though, they have not reviewed or read any literature in 40 years. EMS has always required CEU's because of the ever changing profession and treatment. In fact, many have taken notice and implementing changes on their professional recert/license similar to our profession. Can one imagine, if we did not? Yep, it would like those "horrible, stupid nurses" that many complain of. We have enough ignorant and poor medics out there, let's not make it any worse... R/r 911

Actually, if one would take time out and read the Registry News Letter, and even their web site the NREMT has been pushing for license levels. YES there is a difference between certification and license, it is NOT just semantics. Myself and others fought hard to overcome being licensed over certified. Definitely considered more professional among healthcare providers and again read the definition of each... accountability. Also NREMT does NOT have protocols or standards ! They are a TESTING AGENCY ONLY ! For more clarification, NOT all EMS agencies are managed through state health departments, most are or should be.. but some are an independent branch or placed under different division. I definitely do agree a formal "standard test" should be developed. I do NOT agree on a standardized of practice, especially if it would allow a basic to do more than "basic skills". I believe advanced levels should be based on the local medical community needs with more scrutiny. Just like other health practitioners based upon state requirements. So areas can be better served upon geography, the type of medical communities involved, and special needs that may need to be addressed. r/r 911

Boo hoo, Boo hoo ! What a bunch of whiners! One can take the usual PHTLS, PALS, etc and meet requirements easily a whopping 24 hrs for Paramedic level. You mean your service does not provide CEU's ( at least one to two hours a month) ? Then you probably have a problem in other areas. Pleas really review other certifications and licenses. P.A.-C. (physician assistants) have to have CEU's as well as challenge the board exam every six years.. and we complain. Can one imagine working for a dermatologist for 6 years, and now be tested over pediatric and cardiac questions? The same as any of my speciality board credentials... CCRN, CEN, either meet their CEU's or challenge the test again, in which I do. It makes me review and study.. it is called credibility. So before we attempt the conspiracy theory.. let's really look around. This is a great alternative to re-register to an agency that promotes professionalism and some form of unity in EMS. R/r 911

Have fun at the conference! Now, in regards to multiple level of nurses, as per say you have to understand LPN's, CNA, etc work directly under the supervision of the RN.. period. In the hospital setting the LPN/LVN's are not approved enough to even perform the initial assessment, or even triage (even Paramedics are not approved to do so in a ER) . Again, they have to be under the direct supervision or monitoring of the RN, never the only nurse seen. Actually, there has been a wave of changes called "total nursing care" ever heard of it ? This is where there the only nurses are RN, check local hospitals and you might be surprised the only label of a nurse is the RN. Other assistants are called patient care representatives (PCR) or tech.'s. JCAHO does not endorse LPN in any critical care areas. Many hospitals have now removed their status and label, replacing it with a technician or PCR with advanced level label. Many PCR or tech.'s maybe actually RN students, since some states allow them to obtain their LPN license after their first year of nursing education. I know of many hospitals that have totally removed and discharged all LPN's and only allowed RN's to be the only nurse. Again, PCR ( nurse tech) and PCR II (sometimes LPN's) are allowed to perform certain procedures, but are not called nurses, and only perform these tasks assigned by the RN. I lecture at both LPN and RN schools. Majority of the LPN's in my area no longer practice in a hospital setting rather nursing homes and offices and clinics. So back to the thread and to answer... yes the only acceptable entry level for acute and intensive care such ICU, CCU, ER is now the RN. You see, we have policed our area, and did not allow the normal excuses as in EMS to get in our way, even in the rural areas... and now it is time we do the same in EMS. R/r 911

There we go again! You know I would had at least thought at a Paramedic level, one would understand there is not really a BLS or ALS treatment! There is treatment as a continuum, with no separation. Medical schools and even nursing schools do not teach .. BLS then afterwards ALS. Even in medical textbooks; BLS is regarded as making sure patient has adequate ABC's ... including intubation, IV's etc.. Only in EMS do we have to separate such due to the fragmentation of levels. We all are quite aware that dual Paramedics would provide the best care for our patient. Period! Unfortunately, this is where the difference between our profession and other health care providers separate. Other medical professions have not diluted their programs and instituted alternate levels to provide lower care! Hmm.... can we see some of our problems? Are we really that patient orientated to jeopardize care to anyone but at the Paramedic level? Can we truthfully say we always have the best interest of the patient in mind? Apparently not! Look at other health professions, that have progressed upwards... and then sadly look at ours. How embarrassing! Where others have met challenges and rallied to increase their profession ... we much rather dilute our profession, our patient care and ourselves... all for ego's ! Again, compare any other medical profession. Look at what they have done within their practice. They have stood firm on education levels, (actually increasing) where we have coward down and used any excuse from geography, payment, to shortages instead of correcting the problem. Oh, we much rather take any other route than to stick it through and fight for patient care. Which leads me to the question, if you are for anything but the best for your patient, "how good of a Paramedic are you?" Sure, you might be adequate in skills, knowledge, but as in the profession as a whole why would you allow anyone less to perform treatment? What is a shame most medics really do NOT care about patient care! Seriously, EMS is over 40 years old and there are still places that cannot even deliver the type of care Johnny & Roy provided thirty two years ago! How shameful! We have allowed a continuation of piss poor care and lack of concern to our citizens and patients! Again, if you are not part of the solution, then you are part of the problem.. like it or not! R/r 911

Outstanding points, that could be used for multiple job descriptions. If one was to have this on presented before clinicals and emphasized during professional development, maybe students (and yes Basic EMT's) would understand things better. p.s. tskstorm I would like to copy this and post in other EMS forums, where many students and Paramedic visit.... R/r 911

AMEN! .. whoops!.. :oops: R/r 911

You are correct I was against AED when they first came out and the reason is still valid. It is not that it would definitely decrease needless deaths or be performed before I arrived, far from it. It was much that communities assumed that they would provide the same or equal care as having a Paramedic on board. I watched in the mid 80's as hundreds of communities rallied together to purchase AED's and to send EMT's to EMT/D classes. From every bean and bar-b-que dinner in attempt to "save lives", Ironically, for about the same costs as the monitor then, would had paid for a person to attend Paramedic school. Now, we have AED's and no one to follow the course of ACLS. Yep, we again attempted to place a band-aid on an arterial bleed, quick-fix and half assed. I realize your in a situation of teaching the state curriculum so be it. I am too, like any other licensed instructors, since many like to compare us to nursing the same as their instructors were at 30 years ago... the difference is they demanded better and they changed their profession. Where as the main point of my original post was we allow status quo. How many field medics are represented on your state board? Now, compare that with other medical professions. As an educated Paramedic, you know and realize what is right and wrong. You also know short cuts in medicine will only lead to tragic events. Somewhere, someone will have to pay. You also know that an immediate fix never cures a long term problem, and rural EMS is a long term problem. I am sure we will never convince many, because they refuse to see the "whole picture" again, seeing with blinders and refusing to ever develop or see alternatives to do the right thing, the first time. Again, compare us with any other medical profession and we are disgraceful. There are many reasons, but the main one is we are our worst enemies by being apathetic, and non-committal in promoting changes.

Majority of our psych patients are transported by LEO as they should be. Unless one is going to sedate or administer psychotropic medications, why should an EMS unit be tied up for just transporting from one facility to another. As well, in my state only "Peace Officers" can legally formally place one under an "Emergency Order of Detention"; (Pysch evaluation/ 48 hrs). None of the EMS, I am aware of have specialty transport units, rather than local police units. There are some LEO specially trained in the metro areas, that have "Psych Techs" that are LEO/EMT and have attended speciality training. They patrol the local hang outs know for those with pysch problems in a "special bus" and transport them to the Crisis Intervention or Psychiatric Hospital. R/r 911

Short and simple, if they are handcuffed then they must be under arrest or and an officer will be in the back with me. Hand cuffs are NOT an approved restraining device, as this has been demonstrated by litigation's in the past. As well, restraints are to be safe and to prevent harm and damage to the patient, and the device should be able to be removed immediately by the health care provider. Again, if shackles, hand cuffs are used for protective reasons, then they should be under custody of the LEO... period. Yes, I have transported patients in hand cuffs.. Police officer would be in the back with me or they can transport the patient themselves... easy choice. R/r 911

Actually, your area is MY area! If I drive through there, or a family members so happen to be located there, and becomes sick or injured then guess what .... that is my area too! I expect my family, myself and others to be treated by professionals that actually have a knowledge to know what they are doing! If I was going to the local physician, should I expect them to be stupid or only have attended portions of a program because he or she lives in a rural environment? Again..lame excuses! Guess what, the physician had to go to school for the whole entire program.. why can't you? Actually it does; the basic, advanced and Paramedic. It is shame there is that many levels. Amazing, I am sure there is a nursing home, health clinic, even maybe a public mobile center that visits your community.... and guess what, they had to have an education before going there. Only in EMS do we excuse persons not to have formal education and training. Wow, we actually excuse ourselves to be ignorant! Well, if you have that many diabetics, anaphylactic reactions (which I do doubt, since it is a rare occurrence) then a community could justify higher educated medics. If you respond on one or two a week, then you could justify the offset on charge to employ them. True you are correct, it should not had to come down to such. Unfortunately communities like yours has made it that way! Everyone deserves a chance to be treated appropriately by educated personal with clinical knowledge and skills. Again, since you are attempting to be a health provider, then one has to do like all other health providers and go to school, perform clinicals to obtain exposure and experience, then maintain levels of competency. NO MATTER WHERE YOU LIVE... Yes, I personally live in a rural area. With an attitude like that .... nope. How much has your town investigated in rural health grants, or discussed with other governmental medical facilities such as Indian Health Services or many other agencies... what I thought. I have managed communities with less than 800 people with a Paramedic on each truck, and no it was not a wealthy community. So YES it can be done.. then again, if the community chooses not to have them .. so be it. They should not have the choice of choosing in between or half assing it or making excuses. Fortunately, professional EMS is finally getting tired of the whiners and excuse makers. Hopefully, they will lobby too and make sure that professional standards are endorsed and patients actually receive care that have at least met some standards. R/r 911

Exactly, the old " sole provider" rule. I can see various options with it. Until such, EMS companies were literally fighting for calls (yes, fist fights) and cutting each others throats and no one was winning, especially the patients. Unfortunately, like Dust described these public trusts, counties, etc.. have now contracted out their services to the lowest bid. Then excusing themselves from any responsibility whenever feces hits the fan. R/r 911

What Dust has said is true. From those of us that have been there and done that. Unless, you like working >100 hrs a week at minimum wage type salaries, with little to no benefits. Sure, one can find some better pay, but in comparison you won't be making much more than the kid at Wendy's drive thru. You need to ask yourself why a health career? Then if you really feel it is the thing to do, considering nursing it takes about 2 yrs prerequisites and another to get in. Being an EMT does NOT ensure you any better qualifications to promote in nursing as well, actually could be quite the opposite. Many see flashy ads of those 'medic to RN" per on-line courses. Very few ever make it through them, then many states are now no longer honoring their education, so they cannot obtain a license... There are many EMT programs out there that will flash produce an EMT in a few weeks. Unfortunately, there are several thousands of unemployed EMT's... even those that will work for free. So, one can see the dilemma... Like Dust described, attempt to find a real job with benefits until you are able to be stable and investigate what you would like to do. Good luck in the future! R/r 911

Aww.. Hillary's great plan! :wink: I remember in the 90's discussing with surgeons and other practicing physicians the dilemma of the national healthcare plan. Many were discussing on how they were going to have to change. From what I recall the main objective was to be sure everyone had a card so no one would know if what and type of coverage until services were rendered. This was to eliminate "wallet biopsies" and be sure to ensure everyone gets treated. Unfortunately, there was no direct plan on how to pay or reimburse such programs except to increase taxes and cut health payments directly. This is where the physicians preferred to kill this action. They were quite aware that their life style and income was to drastically change. Such proposals could be interesting. Either this could kill EMS or be a shot in the arm. Either such plans would increase the recommendation of increasing volunteerism or perhaps kill volunteer units unless they meet and compete against public utility models or such similar programs. Since the best care should be provided for all. Personally, I do not think this will ever occur in the near future. The two largest lobbying groups will make sure of it. Insurance companies and AMA. Probably one of the few times that they will actually agree upon something. R/r 911

Like Dust, I too have been both for several decades before it was popular. I agree that ICU/CCU is great but as well ER's can be life learning as well. A good ICU that has the capability of teaching is wonderful, but be cautious many have so many "assistants" and health providers, I have seen nurses totally ignorant on ventilators and balloon pumps, as well even basic arrhythmias due to EKG techs monitoring for them. So be careful and selective. I agree as well, get your BSN, it will open many doors much more than any EMS degree, as well, if one wants to really pursue EMS, one can still do so. Again, good luck in your endevaour. R/r 911

Actually, in Oklahoma, they are allowed to assist in giving NTG. If the patient has NTG it is presumed that they have angina, hence this maybe what the cause is. Again, many people do not have IV's in place and perform administration quite well by themselves. Now, the problem arises as it has been mentioned multiple times is those that are NOT having angina, rather are having a TRUE AMI and even one that is located in an area that NTG could be harmful. I am not in favor of any basic administering any medication. This being from ASA to NTG to nebulizers, rather I much rather the education focus on vital signs, history taking and assisting medics on a cardiac call, as first responders. Permitting Basics to establish an IV would be of no value for those that was administered NTG, since they again would not be able to determine or distinguish the underlying cause or etiology. R/r 911

This is something I had thought I would like to investigate further as well. Like Dust, I have met some that was associated with a local EMS that contracted out. I was informed that if you were "union" that preference was to be given. Which, is why I did not pursue any further. I thought it would be lucrative to have some medics contracted out while filming for first response and first-aid type services and then notify local EMS if needed. I am sure there are tons of OSHA and other regulatories that have to be met, but would be interesting. R/r 911

I have worked for a Police EMS once. Norman, OK (home of OU) EMS was a division of the Police Department. They performed it over 25 years until it was moved into the hospital setting (which the city still owns). Personally, they were a very pro EMS and like the P.D. required a degree to work there. One had to go through the Police Academy as well although they did not wear weapons on-duty, you had the same privileges as an officer. What concerned me was the uniform was exactly like the officers, except the isignia was S.O.L. instead of a state symbol.. (some difference!) I have to admit, all the officers were trained as first responders (really trained not passed through) and they actually had some officers at the ALS level that could first respond before an EMS unit could arrive. As well, they provided all the rescue and extrication, the only rescue not provided by the Police was of course fire entry. The F.D. at the time was only called out for wash-downs.. to say the least, some attitudes was developed. I have to say, there was never a time that I did not have help and as well knew I was safe too. The only down side I had seen was the testerone rampage, that could be common in any EMS. I believe due to economics and some political changes it was shifted to the hospital. They had a choice to remain as officers or go to the hospital, most went to work for the hospital and some chose to remain as officers. Even now, it is a hospital type EMS it still is somewhat paramilitary and well disciplined. They are known to be one of the best EMS providers around. R/r 911

Shame, that while they were "supposedly" teaching this procedure, they did not teach you on how to spell it as well. R/r 911

I would argue with you, but it is obvious you do not understand cardiac care and therefore it would be fruitless. Yes, time is muscle and so is increasing damage to myocardial muscle if one administers NTG to a damage right side infarct and it has to compensate. I don't know how long it takes you to perform a XII lead but the additional 30 seconds to 2 minutes definitely makes the difference in my treatment, expectation, and assessment of my cardiac patient. There is a difference between angina and true AMI, and the old saying "those that view in leads 3; can't see"... If time is such an issue... why even take the time to place them on the monitor, why not just scoop and run...? Then again, you described .." interpreting* isn't that important".. I bet you still return with lights and sirens as well... R/R 911 (*corrected spelling error)