Ridryder 911

I find that offensive and degrading to my faith. In my opinion, that would be in comparison of me making light and fun of those involved in the 911 tragedy. It would be juvenile and tacky, at the least. What amazes me, is if we were to make fun of another religion, faith, etc.. the politically correct would be outraged and people wold be banished! Yes, I have a sense of humor, but at the same time grow up! Admin.. shameful IMHO it is time to lock the posts. As usual a conversation between those of faith, have to justify their beliefs. Then those want to mock and persecute.. professionalism and maturity at its best.! R/r 911 R/r 911

I agree with your points. That would be ideal, but realistically how effective do you think that would really be? We are supposed to have refreshers, and CEU's but I see so many write offs, and coffee cup CEU's. The same with TQI and reviews, I see many EMS Physicians that are never involve with EMS, in fact can say most EMS physicians are usually more laxed in review and protocol development than any other part of medicine. Wish it was different, but as long there is no reimbursement, no law requiring such, then it will remain the same... I know of many Paramedics, that if it was not for ACLS, there would never be any review of any cardiac protocols, ECG review, etc... Shameful, yes and I wished it was an isolated case.. R/r 911

Now, you can understand the laxity attitude when someone announces that they have passed ACLS, or any of the AHA programs. As Dust describes it was never designed as a teaching course, only that you have successfully completed a course designed by AHA and that you understood the ECC recommendations. At least one can say in the early years, that successful participants had a knowledgeable understanding of emergency cardiac care. The test was much more difficult with questions on ABG interpretation, difficult arrhythmia interpretation as well as several lab skills of pass/ fail including central lines, intubation, and intense mega code for example. There usually was about a 40-50% pass rate, and the text was in a 3 ring binder due to the large quantity of material. I was one of the first non-physician ACLS instructor and I can assure, during that period of time passing it usually meant that participants had a basic understanding of emergency cardiac care. Now, the current course has improved the methodology of less stress, however has totally lost its credibility. I have seen nurses and medics complete the course, then after lunch not be able to recognize what a PVC was. That is why I believe as others, that we need to eliminate the AHA ACLS for re-registration for NREMT/P and replace it with another type emergency cardiac care program. R/r 911

Wow ! That is surprising since really no one should "ever fail" an AHA ACLS or even PALS course. There is usually remediation scheduled immediately afterwards, and most courses now have a "no fail" type policy, since there is really no certification in such, rather one attended an AHA ACLS event. As well, it appears they had crappy instructors in the ACLS. The main intent of the new AHA ACLS is not to see failure or place pressure. Was there a 'strict megacode"? If so, they are teaching using the past methodology. How hard is AHA ACLS? Show the video, perform a cardiac arrest station, airway is OP's, NP's, Combitube or LMA (intubation is no longer even taught or tested) some very basic ECG's (v-tach, blocks, aystole, fib) a written exam (that can be retested), that is about it. Even our X-ray tech scored a 96% on the written, and they never had any cardiac training. ... Sorry, something smells wrong. I might inquire was these ER nurses or ICU nurses, or were they general med surg, O.B. or surgery nurses. Remember, critical care and emergency specialization is NOT part of the general curriculum for nursing. It is a speciality, with that one takes special courses such to be competent in that area. Still, I have not seen anyone fail AHA ACLS in about two years. Remediation, usually clarrifies the problem (usually instructor fails to emphasize) and megacodes are very calm, checklist performance. Again, airway is just a teaching station, with repeat performance. Curious.. Is this from the same group that taught your Paramedic and emphasized treating PVC's and use of Lidocaine?... R/r 911

It surprises me when many describe their hourly wages, as being above minimum wage, then yet, when reviewing the yearly salary of most it is just above minimum wage. What I have seen and continue to see is many describing making $10-20 hr., however; many do not describe that they maybe working 24 hours shifts and only get paid partial pay.. (16 hr pay out of 24, with O.T. after a certain time), or receiving a large hourly figure with no benefits. In which, what does one really have? Having a large hourly salary does mean fiddle if one has to pay for health insurance, retirement, schooling, uniforms, etc.. So yes, my hourly salary is not that great, but yearly compares with my nursing range. As well, I only have to work 10 shifts a month, and have all the benefits, which I much rather have. The reason many Paramedics is not used is in ED's is because they are not educated to do so. There can be a wonderful working relationship; but there has to be a major change in the standard Paramedic curriculum. The standard paramedic definitely does not have the knowledge, or clinical exposure for broaden exposures. The same as placing a regular RN in the field setting. Two separate professions, with the same goal. R/r911

Typical .. human response, instead of understanding that ..man or woman is responsible for their own demise. It is much easier to blame a deity. Who causes most diseases and murders, sicknesses and illnesses and horrible events? Karma or whatever you want to call it, there is always the event what goes around comes back around. It may take time for it to occur, but sometime or another it will. This may be specific to any person, or to the human race in general. (i.e global warming, war, etc) No one (even in Biblical terms) promised anyone a rose garden. Without bad times, and events, no one would appreciate the good and be thankful. I didn't understand life as well, when I was younger too. Yes, there are still times I question, and suppose to. We were never made to "know all the answers" nor, will we ever. Usually, with more life experiences, one begins to understand this. R/r 911

I agree Azcep, Dwayne I am not sure what protocols they are using. Since '84 the initial dosage of Lido has been 1-1.5 mg/kg and the underlying causes of the etiology first. In the past ten years the recognition of the toxic effects of Lidocaine has been addressed. Personally, I cannot remember, when I administered Lido for PVC's. The first medication, that should be addressed is oxygen, since it is usually hypoxia and ischemia that is the cause of most irritability. Most agree the rules of when to treat is more aggressive than in reality, unless it is considered to be cause and in the presence of an AMI. Remember, treat the patient NOT the monitor. For as mixture of med.'s , it is recommended to stay with one drug (the old saying, bring the one home, you brought to the dance) . The NREMT representative should be familiar with Amiodarone and since AHA recommends either one, and since the NREMT utilizes AHA guidelines, it would be a mute point. I am sure your instructors maybe well intended and since we are only seeing one viewpoint, it is difficult for even the best to teach in-depth in a short period of time. I would highly suggest reviewing AHA ACLS for more clarification, and view the video (even though corny at times). I also recommend obtaining the checklist from the NREMT web site. Good luck and hang in there! R/r 911

I don't believe it has been addressed yet, since I have not read all of the posts (because they are getting boring.. AHA ACLS.. yes, it is a joke!) What does not come in, will not go out. Since in the U.S. the primary payer is Medicare and since the reimbursement rate is low and co-insurance (if there is any) and collection rate is about 30% there is no money! Period! Now, with that saying, should Medicare really be paying $800 for a taxi cab ride? Now, I have your attention, justify our pay. Realistically what percentages of patients requires any medical care, rather than just transportation? I get amused at those asking for moderate salaries and then describe how .."they would not perform, if the pay was not this or that"... I feel the same way on the pay of athletes, and truck drivers, they are definitely not getting for what they pay for. Someone attended a twice a week class from 2 weeks to 10 months, the most 2 years and you want as much as a person that has a graduate or even doctoral degree in education or special studies? Wow! C'mon tell me how tough it is, is it as tough as the road crew in the 100+degree heat, the oilfield worker, or as mental strain as the G.I. loading up weapons? Now, that you are completely upset... justify, why we need such salaries! This is the first step to ever change such. Why EMS administrators is not outraged and why HCFA (or whatever its new name is) has not made changes? Simple, it is hard to do. Again, we do not require formal education, most states only require certification not license, there are no modification on supply and demand (we flood the market), there is no professional standards, or demonstrating that communities even requiring an EMS service . I understand why some work for low wages. I do. I can make over double an hour by walking across the street and working as a RN. The reason why, I don't is that I enjoy what I do. I choose to be a Paramedic, not that I have to be one. I am still fighting for this job to be a profession, and attempting to still see changes made. Yes, monetary is essential and nice, and yes the pay should definitely go up, for the old saying..'you get for what you pay for".. is part of the problems we have seen in our profession. We have to "justify' and show the reason(s) we need recognition and larger payment to EMS. Until then.. nothing will change and all we are doing is whining...

I agree, not knowing the baseline of INR, as well as creatinine, etc. on some medications can be risky, as well as the costs involved. Remember, most EMS will only receive one payment structure for ACLS II payment, etc.. If one is looking for a lower risks of clot inhibitor, after ASA, I would suggest Loveknox route, some EMS are administering SQ and IV route. One needs to really investigate in depth before making such changes, especially the receiving hospitals with cath labs. Many prefer not to cath with certain pre-meds... R/r 911

I would bet there were pressure on allowing him to get up and display that he was okay. Just like sporting events and other dramatics, there is more than just logic going on. He probably refused anything, as well as his team .... R/r 911

I know of a RN/Paramedic that is the fleet maintenance (mechanic) for a large EMS. It appears, he makes more money and less hours... were taking over...hee..hee..lol R/r 911

Actually no, they do not have the right. HIPPA which only involves those that perform electronic billing, is separate from the privacy rights. The chart and the information on the chart is owned and managed through the institution owning that chart or record. Yes, most institutions allows one to see a copy or obtain a record after it has been processed (Notations, chart review, QA, Billing, etc. ) but not until authorized from the medical records or medical information division, unless they have other institution policies. Since many of the charting is now electronic as well, they will have to allow notations and printing as well. I know many hospitals have began charging for copies as well. Patients must sign a waiver for information, where to send the chart, and how many copies being made, purpose, etc. Just because someone is a patient does not mean they have access to their chart, especially immediately. I know all the hospitals I have worked at has specific directions on that the patient cannot view their chart, even if they are staff or a physician. Most institutions even have regulated viewing on whom can see the chart within the hospital (i.e. someone from O.B. viewing a ER chart) it must be r/t care, or direct care of the patient. We had a nurse discharged for reading her own chart (electronically) without signing the waiver, another on probation reading about their son chart. Again, because of lack of waiver prior and authorization. R/r 911

Actually, the NTG probably did not cause hypertension, rather the NTG had worn off and the patient's underlying pressure was hypertensive. The NTG probably caused the pressure to decrease. R/r 911

I allow patient's to see my documentation after they sign the release then obtain it from the business office M-Fr 0900 to 1700 the following day, just like hospitals. It should be QA and reviewed first. It is about the patient; however, technically it is not the patients and are considered the property of the institution. They may purchase or obtain copies. The reason being is yes, I document some personal facts of that patient, that the patient may want or find argumentative at that time, which is not time to perform. I may document the dishevelled appearance or poor living conditions as well as ill kept, grossly obese, over dramatization and inappropriate behavior, drug seeking tendency behavior, poor coping skills, rude obnoxious behavior, etc. Along, with my medical impression of the condition and physical findings, such as AAA, CVA, cerebral neoplasm, etc... R/r 911 Ruff, actually your classification was an abortions (spontaneous not elective) but still classified as such.

I agree some of this criteria is for academia gloating. It is irrelevant on some of the specifics, when the main point is to treat the suspected AMI and ischemia. There is a time and place for details, usually emergency medicine is not one of those places, rather to see the forest not identify the types of leaves. Most authors agree that BBB precludes and alters most ST identification of ECG's. Rather the identification of a new LBB and suspected AMI should be the goal. Treatment will be broad based upon clinical findings. R/r 911

The reason EMT's get paid minimum wage is really simple. First very few jobs one can immediately enter after just attending a 16 week course (some is only 2 weeks) and the costs is nominal in comparison to other professional education. Second, since it is so easy to become an EMT, we have flooded the market so much, we have people that will work for free! Just to be able to "ride" in an ambulance and keep up their license/certification. There is no respect or demand for a profession, that allows such. I know of Flight Paramedics that make <$10.00/hr and have to have all the usual alphabet titles and at least 5 years experience from an progressive service. The reason... they have a stack of applications, so why should they have to pay for it, when they don't have to? Again, we our a product of our own demise! In my state, we crank out at least >500 Basic EMT's every 16 weeks for a state that only has <200 licensed EMS services. Many of these are ALS and would not consider most with < 3 yrs experience and then prefer medics. A viscous cycle. We will not ever increase the salary, until we : Make it difficult to enter and to exit the EMT program Truly make it an education program and thus probably removing the EMT level altogether Use the supply and demand method.. Compare our profession with other healthcare professions. R.T.'s, Sonographers, Nurses, etc... all increased their education level, limited those that could enter, and have a check & balances method on how many can be allowed into the program. Again, supply and demand... R/r 911

Unfortunately, most administrators will not adjust the remaining wages for those already above the minimum wage level. Therefore, pay levels will be actually lower than before in comparison. Again, most still don't understand when one raises the minimum level everything else will increase to offset the costs. R/r 911

A couple of calls weird. One was a major MVA-head on many, many years ago when we played M.E. as well. We had 2 DOA (husband and spouse) that was killed instantly on a head on, they had a 12 y.o. daughter that was in between them and actually took the impact saving her life. While enroute we noticed the husband arm had came loose and I went back to re-strap it. When suddenly the wife's arm fell out as well and her hand fell into her husbands. My boss was watching in the rear view mirror and helped clear the way as I ran back into the front. It spooked both of us... Apparently the couple (mid 30's), he had just found out he was cancer free after his last treatment.. The other was in my BSN, I has a fellow student that died about 2 weeks prior to graduation. What was odd she died on a Monday, and the following Wednesday, everyone in class received an e-mail from her (computer) about having special friends... etc. She lived alone, and did not use computer often, and very non-savvy on using internet, etc. Definitely, was weird. R/r 911

There will be an answer for changes, it's called litigation. When the fire chief, (you can bank upon the attorneys are already salivating) awakens (if) there will be one hell of a law suit. Even though, he was in command, there will attempts that he was not closely monitored and etc... etc.. After the first million or two, they will change their policy. The same is true, allowing alcohol consumption upon city property.. an accident occurs, or a DWI kills someone... whammo And rightfully should get their arse sued! How can any city claim it is all right to consume alcohol beverages and participate in any city activity? As well, the city should not be endorsing alcohol consumption, if they have any sense... geez! R/r 911

Actually, I do understand the need of carrying some equipment, Albeit, usually in rural versus metro areas. I usually found that I was: 1 By myself (partner was usually busy as well) 2. EMS unit parked at least half a mile a way.. and we have go through sticker bushes. 3. Call description was nothing like we had prepared for. 4. The bystanders did well to understand English albeit they were born and raised in the U.S. and had no other culture diversity. I did see an EMT at one time that had an construction belt and had placed his Orange AAOS EMT book within it. I personally rather carry a field guide.... Again, it does come down to practicality. I myself and many others carry a small bag, that we stash our field guides, stethoscope, flashlight, i-pod , etc.. in. R/r 911

First welcome to the site, I was not trying to belittle, rather to educate you. Since I thought you were a newbie into EMS I attempted to advise you not to carry excess equipment that most have learned over the years that is never needed. It is called using your personal resources wisely. Saving footsteps and backs, helps promote longevity. As well, you are quite aware of the usual standing of new personal always wanting to have everything on them. A couple of other things to answer to your reply and question: Yes, I know, what the correct legal definition of "Standard of Care" is according to the legal and litigation definition, rather than a SOP's definition; may I might suggest many should really look that up. As well, although I did not receive my CPR card in '77 rather in 76; but I did receive my Paramedic in the spring of '77 to only figure out by the summer of '77 not to carry so much stuff on my own person. I had bought one of those "Boston" Paramedic pouches, with the buck knife, window punch, tourniquet and 2 hemostats, to only figure out they were only good for developing a hernia. This is something one usually figures out within time, what equipment they really needed and what can be left behind. I as well have worked in large metropolitan areas to the frontier areas. Where a fence puller is the biggest piece of extrication equipment and there is no FD to perform extrication and you are to far out for even a helicopter to fly out to you. So yes, I to have been around and personally realize that larger services and especially metro areas usually have more than ample amount of responding parties, to assist and that will either go get the needed equipment or have it on them already, so I personally do not need to carry excess and cause drainage on me. I have yet seen very few scenes where fire or a LEO did not have a flashlight if needed, and a F/F did not have some form of a tool on them. So why should I have to lug around something else? The tools should be in the toolbox, and the oxygen key (which should be checked on every shift change) should be chained to the regulator. One might keep an extra one in the pack, so in case you do need one and it's not there, you will have it. Yet in my 30+ years as a Paramedic, I yet to have seen the need of a utility belt. Again, this includes working in a areas that might have farm machinery extrication, bailing wire, wire fence, and again metro areas, to climbing up flights of stairs, to skid row. Again, I guess it is up to personal preference, if one wants to carry baggage or not. Yes, it would be nice to have lighter equipment, that we all can agree upon. However; I have to admit, things have became a lot lighter than the 60 pound Datascope and Lifepak 3; Dynamed and Plano 747 boxes, along with all the other stuff we used to have to carry. I have seen the vests, and if that is what is needed, so be it. They should be able to hold enough equipment and supplies to last several calls. My main point was to address; why make it harder on one self? Personally, I am not impressed with any one EMS service or if a person works for a certain service, rather those individuals that serve their patients well. Most of those type choose services to work for wisely, or improves and stir changes upon the services to allow them to think and use common sense. R/r 911

You mean I would have to give up my belt?

Simple, tie the o[sub:2d47aa63d4]2[/sub:2d47aa63d4] wrench to the regulator, never seen the need in multi-tool in over the 30 yrs as a medic, leave the knife at home, never carried a "glove case" as well..a pair in the pocket or better yet, when you leave the unit put a pair on. Never carried a flashlight as well either, you should have a good one in the unit, charged and ready to go. Don't need a window punch or ever used one, except to demonstrate on how to use one. That is why God invented hose draggers... they can be responsible for breaking the glass. Well so far, all we have left is the cell phone and keys.. key ring, cell phone in the pocket or case... There you go ...10 pounds lighter and wow! Now you can perform your job easier without that backbrace...leave the "special" tools to Batman. R/r 911

Although, one would think common sense should tell you we are essential, as the old saying goes... "common sense is not that common". R/r 911

I do not promote NAEMT as well. They have been known and continue to be known as a piss poor representation of EMS. Unfortunately, it is the newbies that help support their funding, and prevents a true professional organization representing our profession. I have yet seen any advantage NAEMT has produced over the past 30 years. In fact I have seen the disadvantages and regression they have promoted. As long as the current board of directors, officers, still elect each other and promote each other it will continue to do so. No matter if they change their operations, etc.. it is the same operations. NAEMT has such a horrible and pathetic reputation among most professionals it would be better to scrap everything and re-start all over. This is a far cry from other medical professional organizations, that I am a member of. Yes, I endorse such organizations, but unfortunately EMS does not have one I could say I would belong to. R/r 911