Ridryder 911

Part of our responsibility to our profession and to our patients is accountability. We should have to be able to justify any and all of our treatments. Just because it is a procedure we want to perform or like to do is not reason enough. Not only is it unethical, but billing for a procedure and knowingly that procedure when it is not warranted could be considered fraudulent. Can you imagine a physician performing an IV or FSBS on routine dental carrie? Just because they can? Again there is a difference between even treating as per standard and then treating appropriately. I know of many medics making the patient fit the protocol instead of treating the patient as an individual. If one is performing an accurate history and detailed assessment, many of those procedures can be eliminated and may not be needed. Remembering, the main reason for an IV in the prehospital setting is for only two reasons. They are : fluid replacement and route for medication administration. FSBS is validating glucose levels, not being used to solely identifying the reasons for symptoms or treatment. I know of a ED Physician that would order a FSBS on each patient, and within a month had accumulated over $10,000 billing on patients. All because at one time he had been "burned" ; fortunately he was challenged and make changes.. to say the least, it immediately changed. Again, we need to be aware of accountability..it is our responsibility to our patients and employers and our profession. R/r 911

You are correct, only in EMS setting there is so much "labeling" of BLS vs. ALS. It started in the late 60's when nurses were allowed to start performing procedures on their own per verbal order of IV, EKG, etc... many of these programs of an extension of coronary care unit. I know there were a few historical units, one of those was located in my region in OKC. In 1968, a "Mobile Coronary Care Unit" was staffed by two nurses and a firefighter driver to respond with the ambulance or squad on "heart attacks". Like other programs, even those that were training ambulance attendants to deliver procedures more than the usual "ambulance attendant or first aid" level, it was considered to be "advanced". Again, it was never really initially designed to allow fireman, ambulance attendants, funeral home to be "health care providers". Like everything else, we place a band aid on an arterial bleed and deal with it later. Unfortunately, we never get around of dealing with it. One needs to remember as well, that nurses were strictly to follow physician orders and nursing programs were not as detailed in direct patient care. It was a quite different then. I agree, that it is unfortunate that such labels were created to separate care as advanced and basic. Now, patients and the system has to suffer. If we had only one level... communities would be expected to deliver the full care. R/r 911 R/r 911

Geez.. another person attempting to "justify" the difference between short cuts and promote cook book medicine. Before you cut and paste the history of the " White Papers, you might want to read a little more than what is posted on a internet site. (You see, this college boy did a thesis on this... yep, one of the differences). One of the purposes or reason the white papers was performed during the LBJ administration, was more people were dying in U.S. from trauma than in the Vietnam war at the time. It was never intended for a ambulance attendant to be trained more than at a first aid level. Rather, its intention was to place physicians/surgeons to ride with ambulance crews, similar to other countries. Undertanding, that this was a unrealistic endeavor more training was developed. Remember at this time Vietnam was beginning and training medics was being considered to help out. If you actually read the " White Papers, you will find that the wording Emergency Medical Services (which some reported as a fluke) was number 46, after bridge railing, seat belts, etc.. Again, education is also knowing your professions history. As well, you described... " the National Registry is a set of standards that all participating states agree on must be met in order to license in their state" .. which is as well false. NREMT does NOT, and has NOT ever licensed anyone. I still cannot understand why anyone would want to have the Paramedic compared to a LVN or LPN level (having a non-college level, 10-12 month trade school program). Both does not require reading levels above the 10'th grade, both usually uses only one text book or series, does not go into detail, no prerequisites or adjunct studies. Even a beautician in your state requires more training than the Paramedic level. Both are considered trained NOT educated since there are no degree requirement or studies to supplement professional standards. Thus the non-degree Paramedic should be compared as the same or equal to a LVN/LPN and should be paid in comparrision as well. (Yes, this is how one differentiates professional standing versus non-professional). This is one of the reason Texas has attempted to differentiate Licensed versus certified. In comparison to your analogy of school chums, I have not seen any of these "types" since high school. Sorry, I out grew that type of "friends" when I was a kid. I went to college and university to pursue a career and profession, to be a leader and to perform and understand emergency care, to the highest standards which can only be taught at a higher education institution. Remember, one is judged upon their profession credentials for reimbursement, pay structure, and growth. Again, you much prefer to have our profession to be compared to "blue collar" technical trade persons. One of the few medical professions that does not require a degree (at least an associate). You realize that the only way to promote the profession is by education. We have seen it in all the other medical profession. R/r 911

There are several good CPAP's out there. We field tested several. We found that Emergent PortO2Vent was the best for us. It is easy to use, and one cannot find a better mask. We also found that it uses less oxygen than others, in which in our coverage area is essential. After close reviews, we have increased our use of CPAP on almost any major respiratory difficulties. This includes of course CHF , but pneumonia, asthma, bronchitis, etc. We have drastically reduced our need to RSI, intubate and ventilator procedures. As well, our ICU admissions are down drastically too. In my state CPAP has just been approved for Basic EMT's to use in CHF setting. R/r 911

Does your service perform QI or discuss this with administration and possibly your Medical Director? Just, because they have received a pay check for years does not mean they have been providing good care.... one can be stupid for a long time ! Sorry, I have been around for a long time. Nothing irritates me more than an old timer not wanting to do their job... they know better. Good luck! R/r 911

I have the high end Garmin, and it even has a mode for emergency vehicle. It has worked pretty good and definitely helps in rural areas, displaying hidden roads and curves ahead before approaching. R/r 911

Actually there is quite a bit of difference between training and education. Sorry, if one goes for four years and only memorized anything that is crappy education. Whom is to say how much limitation a medical director will allow? Can you imagine if Physician Assistants had this attitude? Remember, there are still PA programs that are an associate degree level and even non-degree and they prescribe and perform minor surgery! I have been in 30+ years, I have seen from calling in for IV's to central lines and ultrasound in the field; things that many "Paramedics" swore would never occur in the field. Quit thinking inside the box! Why do we have to only provide emergency care? You are right, there is no incentive for pay structure changes, why should there be? Until we focus on what really pays and quit trying to be Johnny & Roy, and expand ourselves as a health care and not strictly a transport & taxi we will never be reimbursed. Actually, Medicare should demand more from EMS! A nice little ticket for simple first aid care and transport for a hefty costs. There is a lot EMS can do, first change the mind-set of Emergency Medical Services and get out of the "pre-hospital" thinking. Instead mobile health care. Not all patients need to be transported, many can be treated and released or monitored. Our role will drastically change within the next ten years. It has too. There is not enough ER's and hospital beds to ever meet the demands, as well as the lack of staff to care for those that could be admitted if there were beds. We have not even seen the tip of the iceberg. Instead of transporting, our role will be to triage to see who gets to be seen in the ER. As well, many more ill type patients will be discharged to and be treated at home. So yes, more in-depth; and more in-home treatments will be given. This will be the payment structure to off set the emergency calls that does not pay. Remember, those that usually get shot & stabbed usually does not have Blue Cross & Blue Shield. Medicare is tired of paying for expensive taxi bills. Technology and advancements has superseded our progression of care. Many patients never need to be transported and can be evaluated by their PCP the next day. Insurance companies are quite aware of this and have placed NP's and PA's in some. Saving them billions of dollars a day. We have the choice, either we take the reins or allow another group do it for us. It is our choice for now, like it or not; but it will occur... it has to. R/r 911

It's a job.. short and simple. Some will have good days and some will never bitch and gripe and some will always complain. I have seen in nursing, radiology, respiratory therapy and yes even physicians of all levels. Not that it is right, it's part of life in any business. Chalk it up for experience and don't be like them. R/r 911

I have never been able to use any other color than black ink in any hospital, EMS in my career. I was informed from medical records that blue ink does not copy as well as black ink. R/r 911

Sorry, there are already a specific post area for that. http://www.emtcity.com/phpBB2/emsjobs.php?...447232004692029 As well, I am from OK and if your age (19) is correct, I know of very few places that employees anyone < 21 to 23 unless you are a Paramedic. Even then mot still require age of 21 for insurance purposes for driving. We have openings but again the age requirement is 21. I.M. if interested. R/r 911

I agree, if Paramedics were all created equally. Right now, I have seen such a diverse in education in training, it no longer matters what title or patch they wear. There are many Basic EMT's that have hospital experience and even maybe have a B.S. degree that supersedes the Paramedic they are assigned to. Yes, it is shameful. Now, if you were to asked me ten years ago, I would had stated that dual medics was the only way to go, now I have second thoughts. In returning to the field full time about 3 1/2 yrs ago, I have seen a different product of medics. I have always worked with dual medic systems or be with those in school to be become one. I was taught to discuss patient care among each other (especially in those situations of the poop hitting the fan), realizing both of us were equal and if one was closer to the head, body, extremities, etc.. then to perform without prompting or permission from the other medic to treat at the Paramedic level. There was a lead medic on the call, however; I never heard .. "this is my call.. etc.. as I was taught it was a team approach. Now, I hear this is my call.. just do as I tell you. You can be the lead on the next call, then you tell me what to do. WTF? Why do I need to tell any peer what to do or be told what to do? If I or the other Paramedic does not know what to do, perform, then personally they need to be gone. I have even had near physical confrontations dealing with newer Paramedics, whom suddenly think once they get the patch... the call is an "I" response, more than a "we" approach. I wish it was an isolated case or be able to blame it on one school, institution, or area, region, but this is not the case. I even have one explain to me, that if I had missed something upon examination, they would not inform me about it and allow the patient to suffer, "since it was not their call if they were not the lead". Apparently about the late 90's on.. it has been stressed that there should be only one in charge and others obey... Wow! what a different methodology I always come back it would be much cheaper and easier to just have a basic or intermediate with me. If I am going to only be limited to perform only the direction of the "lead medic" and do the tasks and the only advantage is to switch or alternate calls, then place me with a basic. At the least I can teach and not have to argue with someone whom is supposed to be my peer and equal. It is apparent most of the medics have now never worked in medicine. The most they have experienced is the few clinical hours or to drop off a patient in the ER. As well, have never experienced grand rounds, to consult and give suggestions, supplement each other.. again team approach. Definitely, never to be critiqued and reviewed. I had thought maybe this was an isolated personal issue, but after talking to some "seasoned" medics, found it was a general occurrence. I even talk to administration to be told that "it is a "new generation" and "new work ethics". Fortunately, I have had some of these "newer generations" describe that they felt less stress after agreeing to do it "my way" ... wow, working as a team is easier! Part of the ignorance is they do not realize that in litigation that it will be an "us" in the courtroom, not just a single person. I can no longer see advantages of dual medics, if this is the general consensus of how it is going to be performed. R/r 911

To summarize the multi problems in the U.S. EMS in one word.. it would have to be .. OURSELVES! There are multiple problems as addressed and I agree, but realistically we are the source of our own demise. What is the difference between any other successful profession and ours? Compare ourselves with nursing, it took them years to finally decide enough was enough and change their profession drastically. We can and should learn off other medical professions as well. Respiratory therapists, physical therapists all changed and not only demanded more from their profession, demanded more from themselves. All successful professions became actively involved in the legislative process. They defined themselves as professionals and would not allow anyone to lower their standards and in fact would increase them more and more. Quite the opposite from EMS. Some reason we implore the fast and quick and half-ass methods than to ever do things the right way. Even though we attempted not to mention education, we cannot discuss progression without it. Again, comparing other successful medical professions, we have to acknowledge one of the first requirements was to increase the education requirements. As well, with that as an ace in the hole; they were able to lobby and campaign for higher reimbursement rates. I am surprised EMS is not in worse shape than it is in. I am also surprised that Medicare pays as much as they do for a 20 minute taxi ride. In comparison with other medical professions we are lucky to get what we get. It is not atypical to send a person that has a first aid type course and then be able to transport a patient to the hospital, and collect $200 to $300; that is not too bad. Especially since most of the treatment is rarely more than palliative, and few patients get more than the basics, and very little treatment really provides changes in outcome. As well our profession is very limited, we continue to only "lock" ourselves and limit our education and skills to "emergency" scenarios and situations, especially since we know that those specific areas do NOT pay, and to be realistic emergency calls are rare and few. Those that are really in medicine know whom causes the real changes. One would wish it was physician and health practitioners; it would make sense. However; ask a physician if they can admit anyone that really needs it or whom they personally believe needs treatment... and you will find they are restrained. The controller of medicine and EMS is the payers of services rendered. Medicare and insurance payers. They set the standards by what the reimbursements or payments is made (how much, when and how). Again, we need to turn and look at other medical professions and see how they increased their reimbursement rates. By doing so increased their professional benefits (pay, respect, and longevity). Again, one thing in common was they increased their education requirements so they could justify themselves to the payers. So until EMT's really become involved to become shakers and movers, not whiners and moaners, nothing will improve and yes things could become worse. We will see how important this so called profession is to all. If you do not work upon and support changes, then you are part of the problem... short and simple. R/r 911

Strange video, they have a pediatric mask as well as intubated and and an adult mask on the supposed patient as well. I have seen patients talk in cardiac arrest, yes it can happen... albeit not very long. R/r 911

I was reading my monthly JEMSand came onto the article; "Re-Directing EMS Education" ..( http://www.jems.com/news_and_articles/arti..._EDUCATION.html ). This is something I have been monitoring, as an active member of National EMS Educators (NAEMSE) in which proposals and drafts have been made to replace the current antiquated DOT curriculum, in which is being used. I will not go into great detail over the changes, for one really needs to examine it themselves and make an objective opinion ( www.nemses.org - "right click on related docs" to view ). What concerns me is much more than the proposed changes. For you see, we have seen attempts to be made in the past in regards to the National Scope of Practice revisions. Unfortunately, instead of moving forward and being pro patient care, there are many that rather protect their own special interest. I see that it is much more important to satisfy their feelings, secure their jobs, than to ever provide thorough patient care and improve our profession. Sorry, I know I may offend many, but personally do not care. Apparently there are those that do not care how they offend me and others by their lobbying and special interest in restricting the growth of the EMS as a profession. You see, this is my career, my livelihood. I chose to obtain multiple degrees to have the knowledge, as well as chose to remain in this profession. It is not a hobby, side line job, part of another job that requires me to be an EMT. So yes, your "special interest" affects me and thousands of others As usual any thoughts of increasing the knowledge requirements of EMT to the Paramedic level education is already being under scrutiny and fire. For example in the article Chief Gary Ludwig; who chairs the International Association of Fire Chiefs (IAFC) EMS Section describes .." We have concerns how this will affect volunteer and combination fire departments:.. So Here We Go Again! Let's protect the volunteers and the firefighters! To he*l with the patient and the profession! As long as we protect ourselves is what really matters! They say history repeats itself. It must be true. Review why the curriculum was diluted in the 90's and why the National Scope was canned. Sure, not all volunteers and firefighters have such opinions, unfortunately they are being represented by those that describe they speak for the masses. I would definitely let my voice be known, if it is not your opinion. I highly encourage those that really care about EMS as a profession and want to see a more defined curriculum and increased level of education to speak out. If you don't other will speak for you! R/r 911

The main objective on a triple A is to allow permissive hypotension. In fact most practitioners prefer to allow and encourage hypotension > 70 & < 90 systolic in AAA. It is not unusual to establish Nipride IV med.'s & even NTG drips to permit deceased pressure on the anyeursm. It is our standard practice to administer M.S. to permit such hypotension, again to monitor closely but much rather have controlled hypotension than a pressure >100 systolic. Vasopressors should be used very cautiously, and only to produce & maintain circulation level pressures for cerebral, coronary and renal perfusion. Again, increasing pressure may only execebrate the aneurysm. Toradol IV is great for renal calculi, I have found it to be one of those med.'s to either work or not. R/r 911

I used to "roll my eyes" on comments like this and chuckle... but; after seeing the "New Advanced Airway" course, I am going to have to agree with you. Apparently in the wisdom of AHA, they removed intubation skills in ACLS and now (oh! How surprising!) developed another course on intubation and advanced airway devices (combitubes, etc) for an additional fee of course.... I guess, why have it in a course, when you can develop another course.. and so one. Who knows what the next one will be? .. Maybe IV therapy, administering medications, defib, very basic ECG interpretation?... Think of all the possibilities! R/r 911

Well, we see how well it works for the fire monkeys ... The problem is the mind can only absorb so much in a certain amount of time. If you have had previous medical training or science background... then maybe yes, if not think of learning the basics of a whole new profession in a few weeks. The Basic Curriculum already sucks as it is going over 16 weeks, I can't imagine it be better in an abbreviated short time period. R/r 911

It might be better if she would wear a tube containing her written DNR, as well as instructions to freinds and family not to notify EMS in the event of an arrest. R/r 911

Search and Google can better answer you. Basically the difference in EMS and EMT is like stating .."Health Care and physician". EMT's usually work in the division of health care called Emergency Medical Services (EMS) There are over 100+ levels of EMT, however; there is usually 3 main levels in order of hierarchy. Basic Intermediate/Advanced Paramedic R/r 911

I agree experience is great, but then we will have to split hairs on what type, level, etc.. What if they only ran one call a month or worked at a very non-progressive service..? One can see the dilemma. I believe NAEMSP has the medical control course. They as well have very good information out there. R/r 911

Thank-God we are still funding old stuff. I wonder what those researchers would do without attempting to prove something that has been discussed and researched and re-researched, eventually someone has to believe in it. This has been disproven and then only to reappear at the least of 8 -10 times in the past 25 years. Maybe I can get some research grant money to prove MAST trousers still should be used... R/r 911

I totally disagree... just because some yahoo.. rode in the back of EMS unit while he attended medical school does not make them any better. There is NO correlation of medical control and being a former medic. In fact, I have seen some sharp paramedics become medical control and become sh*tty at it. Restricitng medications and procedures, that they as medics would had fought for. The reason, now the risks is on their license. There is a medical control/EMS medical physician course that all those that have interest should be required to attend (even those that had been medics). As well, as EMS Physician residency programs. There is much more than just authorizing protocols and procedures. Unfortunately, most EMS Medical Control is not aware of that or care more than that. Until, we have support from the top, we will never improve our profession. R/r 911

One has to remember, that even using LP 5, 10's, etc.. is not a bad thing. Chances are, if they were really good medics they used multi lead and actually probably could teach better XII lead than those whom can push one button. As well, again it does not take much review current trends. Do you think that because one operates in the back of a unit, that makes them automatically "up to date"? Just because one has not drawn up Amiadirone and injected, does not mean one cannot understand it nor teach it. Do you actually think Cardiologist actually administer the medications, or perform cardioversion, defibrillations or a trauma surgeon actually bandages the wound? So that would make them poor instructors? Medicine is medicine... period. Riding on a unit, in the ER, or teaching. Keeping up is part of the professional requirement. Just because one is active in clinical practice does automatically make one "proficient". R/r 911

Good thing medicine does not believe one has to be in the trenches! Observe most medical professors and note when the last time they were responsible for direct patient care? Even some states require nursing instructors mandate clinical performance, but there is no exact time requirements. I agree, it would be nice, but not essential to maintain some clinical performance. Yes, they should be up to date on current studies, research and approved treatment modalities. However; if the person has twenty plus years appropriate experience, then one can learn new methodologies in treatment in a few hours. EMS is not rocket science... I much rather that they would increase their knowledge in adult education, to be able to really know how to teach, not just instruct.

Part of being in health care is to teach. True, many have heard the lectures and preaching before, and there are appropriate times and inappropriate times. Sometimes, if you actually listen to a patient, one can find out, why the abuse of the system and themselves occur. Many are surprised at my frankness and honesty to patients. I am not mean, just up-front. If they are dirty or filthy, I tell them to take a bath ( bacteria does live in warm, moist environments, etc.) Heck, one can even have the possibility of making a change with the interaction of social workers, home health, hospice, or even contacting family members. If you don't have the compassion to listen when needed to, or to touch or hold the hand of a patient when needed as well, do us a favor and get the hell out of the profession! Compassion, is as much a part of the job, than giving any med.'s. In fact, one will or should use compassion much more than any other part of the job. R/r 911