Ridryder 911

I agree with CHBare. We need to totally revamp the thinking and level of our education before a drastic change occurs (not for the better) I personally feel we are on a slippery slope, with one agenda to produce quality and thoroughly educated medics and the other to crank personnel out as fast and cheap one can to fill the need. Unfortunately, EMT's educational system was poorly designed. It was formatted to train existing ambulance attendants, the curriculum took in account that ones taking an EMT course already had previous experience and understanding of transport systems. Tragically, the curriculum and educational systems have never corrected or changed this as of yet. We continue to hear the outcry from students, working EMS personnel, managers, physicians, and even now research is pointing the faults of the system. I personally believe within the next 5-7 years, we will see the pendulum either swing toward to requiring formal education or to the opposite to develop very minimal criteria for economic reasons. It is all dependent upon our actions at this time, what the future holds. If we (EMS) are smart we would explore and observe what other medical professions have done. Not all other medical professions were established as they are now. Compare what respiratory therapist, radiological technologists, and yes even nurses have changed to enhance their profession. I remember the dilemma that those professions had which were similar to ours. Let's not reinvent the wheel. They wanted to perform better patient care, increase salary and benefits to the members of their community, and have more of a say of the their future. Ironically we have had it demonstrated by several EMS forums that demonstrated many are well satisfied with the status quo and on some points much rather to "lower" some of the mandates. This is shocking to some of us but over all this does not surprise many of us. Apathy is our number one problem in EMS. Be it pro or con for more education, the lack of concern and involvement will kill the rights of EMT's to change their own profession. I do believe that if we do not take action and show some steering of it, other professions (F.D., EMS Admin., Physicians) will do it for us. Although it might appear to be subtle and in a non-direct manner; it will be done. As CHBare described a comprehensive curriculum needs to be established with associated formal requirements to accompany the program. There needs to a a clear removal of the Paramedic from a technician status to a practitioner or professional level. Until we change the education, we will not be able to accomplish this. Formally accredited educational institutions should be established as well as requiring EMS instructors to have a minimum of bachelor's or masters prepared. We require those that teach crayon coloring and learning ABC's to have such, but those that perform intubation or crich's, RSI to only have a GED.. there is no logic in this! Once we have a formal educational system of institutions, instructors, then a national examination can be developed as well as potential increasing level of academia. There should never be a formal national scope of practice or protocols. Practicing medicine is an art with a knowledge of science. Individuality of the local medical community should be considered. Each community needs are different and treatment regime should reflect that. Each state should develop a Board composed of members of the EMS Community to govern those in EMS. This board should be composed of EMT's and Medics with advice from other medical professionals. However only as advisement capabilities. This board should develop individual state scope of practice which could be uniquely developed for that area, these could be added upon and give restrictions and guidelines for violators. Since we do represent the medical control and we work and perform under the authority of the local medical director we should not have national standardized protocols as well. Having such could enhance or possibility limit some EMS providers. This could as well as tie the hands of the local medical director. We want physician involvement and do not want anything to detract from it. Tying the hands of the local EMS Director will only cause distraction and potentially no advancement or progression in therapy. So the question returns back to the same statement as been described many times in this forum... What type of EMS do you want? And what are you going to do about it ?

I feel there is nothing wrong for them to view or remark about them. If you are wearing their uniform or describe an association with their company, then you no longer are just representing yourself, rather you are representing them as well too. So don't post anything that would be distasteful, violate HIPPA, or could embarrass the company. R/r 911

1. No ? 2. Phisohex or Phisoderm ? No 3. H202-Definitely not ! 4. Maybe .. probably no, unless you have copious amount. Sorry, wound care is a difficult topic. Even though I was once certified in such, there is so many new changes and endless microbacterial cleansing agents out there that is much superior these days. So many feel initial debridement and cleansing is essential, but should be done thoroughly. Betadine has been the old school, but many feel it can provide a medium for bacteria development as well so many are now have allergies to it. It is still used and maybe better than nothing. Phiso-soap, have not seen often in ER's, maybe OR (Spock can answer that better) H202- chemical debridement of the skin and tissues.. looks neat when it bubbles, but that is all. Saline..good, but a good thorough irrigation with a pressure device such as a syringe, ear bulb syringe, or some may have pulsating pressure washers designed for irrigation. Again, some feel if not performed properly, one can actually force more bacteria into spaces, and scatter debris if not cleansed well. This is a WOCN (wound care nurses specialty) .. I would suggest to discuss this with regional skin care nurses and surgeons that will be receiving those type of patients what they might prefer or want (if anything). I would believe the surgeon discussing it with your local GP would be more effective and probably yield higher results. Good luck ! R/r 911

I do understand the rural and less numbers ratio, and as you described there are many times one has to suction and re-attempt because they have a reversed garbage disposal situation coming at you as they attempt to intubate. I have yet seen a real effective suction unit in EMS that can remove most of the debris and mucus. Majority of the medics will attempt to visualize prior to suctioning because of this and then afterward have an afterthought of suctioning when and if needed. Whereas I do predominately see suctioning performed before an attempt is even made in a hospital setting. Although intubation is definitely a skill and one does need to be well educated in the process and have an in-depth knowledge of the respiratory process, I do wonder if we are not "over killing" a technique. If one was to step back and really take note, all one is really doing is visualizing the glottic opening. In reality one can wonder how hard is this procedure ? I personally have found placing a NG tube is much more difficult than intubating someone at times, and believe if we studied NG tube placement it would demonstrate a high failure the first attempts as well. I do wonder if we not worrying too much on a simplistic procedure such as intubation. If the patient is being well ventilated in-between and monitoring for vagal stimulation; is there much difference if it was the first attempt or second attempt ? Yes definitely our goal should be 1'st time success. The main point again, that it was performed within a number of reasonable attempts and pre & continuous oxygenation occurred during procedure. And then that the procedure was successfully verified and continouslly monitored per EtCo2 Possibly addressing the problem of skill retention would be better stated than just "failure of attempts". Again if this was the case; there is no specific mention or correction was recommended such as Q.I. and clinical rotations to maintain proficiency was made. Maybe reinforcing suctioning prior to attempts ( better suction units) more emphasis on proper head placement angle and the level of the head is off the floor to permit better and more direct view of the hypopharynx. One can begin to wonder though; if Wang (and et all) does not have a "hidden agenda" in their studies. This is not the first time he has performed studies on the same repeated subject (his first was found to be skewed) and one can wonder what biases the researcher is bringing to the table prior to the research. p.s. : mediccjh, we don't have as many mountains (yes, we have some!) But we do have the worlds largest documented hill!... R/r 911

This opens a whole new can of worms, but here it goes.. This is a system failure, not a procedure or "lack of proficiency". The principle is there is too many ALS personnel in this area to the ratio of request or need of that procedure. The same could be stated if any physician could perform surgery in lieu of referring to a surgeon. How many number of surgeries would each physicians would be proficient at ? Flooding the market with qualified personal and then expecting those persons to be "proficient" is unrealistic. What many always fail to see in the study was this poor ratio and demand. So the study is flawed in the attempt or actually gave a misguided perception that the "lack of intubations" was caused by the lack of knowledge or exposure. When an a first response arrives with 6- 8 persons qualified to perform intubations on each call how many times would those provider be required to keep that EMS proficient in any skill? What should be addressed is why there is so many of these "qualified" responders in one system, when obviously it is not warranted. Does each 1'st response need to have a Paramedic on each engine company? I will even debate that even a Basic EMT level would be more than what most first responders need and have. A qualified medical 1'st responder is sufficient enough in majority of the responses, with a few EMT's. Reducing the number of ALS personal will increase the ratio of exposure and as will increase the number of intubations and hopefully success at the same time. .. I either failed to read or forgot that Wang adressed that issue.. R/r 911

Many prefer not to use the "shotgun" approach and rather use more specific antibiotic therapy. Using a broadspread antibiotic has its good and bad points. Many do not feel prophylatic therapy is a needed idea until they know what bacteria they are really dealing with since so many patients are now becoming resistant to antibiotic therapy. Giving the wrong antibiotic can make some situations worse. Although Rocephin is a great antibiotic therapy, many use cefazolin as was mentioned like Ancef prior to skeletal and orthopedic injuries. Wound care is time involving and requires much more care that I believe that can and should be given in field settings. I agree preventative measures should be more addressed. R/r 911

Thanks.. AZCEP About the time you thought most of the "lower mentality of ambulance driver syndrome" may have been dissolved, along comeschicagoambo to just prove to us we have a long way to go. One of my reason to place my titles is to irritate many like calling oneself "Paragod".. It usually gets a rise and response from those that are not qualified or never will be able to obtain such titles. As well, it demonstrates that most never have read professional responses in forums and journals; which you should post your credentials to at least allow others to know you have experience and expertise in that area. I have to admit as disappointing and discouraging chicagoambo comments are, it does cause me to be more motivated to remove the ignorant idealogy and ambulance drivers in EMS. Apparently, many assume it is always the rural area that always lack the mind set to advance past the 1960's .. but at least he removed that myth. chicagoambo if you are against education at least try to post in defense of it rather than calling names or bragging about salaries. In comparision sanitation engineers make more $$ than most paramedics, as well as factory workers where screwing a bolt in is the most mind baffling thought of the day but that does not impress many of us. We realize in comparision health care workers are poorly paid. It would be interesting to hear logical thoughts against increasing one's knowledge and improving care for patient's. R/r 911

I agree ! I personally like Roc for longer transport times. I do wonder what he was thinking of Narcan and then attempting to keep one sedated for vent care. Problem I see is a potential disaster of paralytic without sedation and near impossible for sedative to as effective with atagonist aboard. For as Romazicon... nothing but danger! Especially if this patient is a chronic benzo user! R/r 911

Apparently not, we only have about a 64% pass rate on EMS exams from a book written at 6'th grade science level. Remember Basic EMT is just above 1'st aid. What are you talking about ? Have it or not.. this is not a John Wayne movie depicting courage.. yes, in some it occurs more natural than others. Some require more study and practice.. remember not even cardiologist are born, they are created! If the mechanic does not know the parts of the car, he cannot repair it. You don't send a mechanic into a garage without knowing the parts, how the engine runs, understanding of combustion, fuel mixture, timing, etc.. before handing them a wrench. It does not matter how "well" he can turn that wrench if he does not know why or what he is doing. Skill and knowledge; should not be considered separately. Because one has an education, does not mean they cannot perform skills as well ! Like EMS skills they are acquired and fine tuned with experience. Skills is the easiest part to learn, even research has proven it does not take high mentality to perform skill levels, they are acquired with practice and reputation. Unfortunately, O.J. Simpson I agree, experience and education is the key for sucessful knowledge. Anyone can improve on their level. This gray haired person watches newbies and still learns something new every day! Depends on your definition of "outperforming them" You mean understanding what is wrong with the patient such as diagnosing or one that start an IV faster or performs tasks better? Most trauma surgeons are crappy at establishing peripheral IV's than the medics or nurses, but which one do I prefer to examine and treat me ? Don't are patient's deserve the very best.. or should they only get what they can ? Usually, it those that truly do not have any formal education or even understands general medicine and adult education that will make ludicrous statements. Again, just compare us to any other medical profession... seriously there is a reason they require one to learn about things before attempting to treat patients. Okay... my rant not directed to any specific person I have worked in the health care arena for several years, and it still amazes me that we are the only personal not required to have a at least a college level entry way and as well to fight to remain to uneducated. Why would anyone want to brag about their right to remain ignorant ? Is this just me or does this go past even the poorest logical mind of wanting to remain stupid ? (Remember ignorance is the lack of knowledge, stupidity is the ability to have the knowledge and refusing it) Can one imagine any other health profession having a debate that they do not need better and formal education ? Wow! Folks. EMS is not rocket science but we are responsible for people lives. We should have at least a profession that the text books are written above grade school level. Pretty pathetic ...and why would anyone disagree to make EMS at least the minimal of a two year program & to require one to know at least basic anatomy and have the ability to read and write above high school level ?.. Again, why and how could anyone be against being more knowledgable in their profession, especially emergency medicine ? Why would anyone want to withhold the profession from advancing and be able to provide better care?

Maybe pictures will help, if you notice the right side is dark (air/blood) and how the heart & lung has been pushed over.. you will see that the trachea (outline in white) has deviated over as well... this is a severe tension hemo/pneumo.. * p.s. the patient only complained of sh.o.b... (go figure!)

It is a shame your not worth it, and just to show you what idiots there out there in city management! I guess the old saying money cannot buy everything! R/r 911

Whenever I see salaries like that I realize a couple of things... it must be a some extraordinary cost of living there, or no one wants to work there for a reason! R/r 911

Good goals.. but you will have plenty of time to narrow that down. Make good grades, keep out of trouble, and have fun. You are like a half a million others.. obtain your degree either in EMS or Nursing. Then after several years experience, you will be able to find out the rest of the qualifications and experience needed. You have plenty of time to figure that out... R/r911

I guess nothing could be more said than reading posts from this thread : http://www.emtcity.com/phpBB2/viewtopic.ph...94&start=60 This sums it up on the need of education.. thanks Chicagambo, you just proved our point ! R/r 911

Awww.. I doubt he is a paramedic. I know of some of Chicago's Paramedics as well as Dr. Shea that was instrumental in their EMS system. He was a pioneer in advanced protocols and advancing paramedic education. This individual attitude is one of those people that failed the entry tests or never 'quite" made it, or if they are a paramedic is one prefers the colored box system. If he is a real Paramedic, they are a prime example of an ambulance driver title . R/r 911

Okay.. hopefully you are in school. Medications should not be "direct" line for very many reasons. First, the medication is added as a supplemental and infused into a patent IV. Once the medication is finished the medication is removed thus allowing the IV (NSS, D5W, 0.45%NaCL, etc) to continue. Second, one would NEVER want to mainline in case of reaction(s) such as allergy, medication interactions (reaction between two medications), and one wants to have a patent IV line to administer treatments to resuscitate or correct those problems. If you have the medication main lined, then you would have to discontinue from the hub and re-establish another fluid. Those that main-line are just asking for troubles. R/r 911

Usually the monitor will not synch when the "R" wave is not upright or not high enough, turn up the gain or height, or change lead positions. Cardioversion does not detect the rhythm or "p" waves, rather the upright tall R waves. I have seen rats > 250 able to be synchronized. Some cardiologist much rather "defib" one and clear all refractory period than to attempt to cardiovert and have a chance of ventricular fibrillation to occur. AHA does describe if a patient is too symptomatic and one thinks it will take to long to cardiovert, defibrillation is acceptable, in severe cases. R/r 911

There are a ton of subjects already posted on this, but I can tell you it all depends upon your EMT and basic education level. I see that you are from OKC, may I ask which institution you received your EMT from ? OSU, OKCC, EOCC, Metro ? If you already have a good general science background Paramedic may not be difficult as well, it all depends upon where you want to pursue you paramedic education at. Just remember, the more difficult the better results in the long run .... many choose the easy way out in OK and it shows.. If you have not decided yet, PM me and I will give you information on some local programs... R/r 911

....."Despite the squad's name, it is a private rescue company that is contracted for emergency calls in the town. We are really separate entities," said Bourne. The squad is all volunteers, and Bourne said it has been that way for 30 years. The members are trained and certified by the state. Because of their value of service to the town, the town votes on a regular basis to support them with an annual donation," said Bourne. For the past five years, the donation has been $4,400. This year, the squad purchased the rescue boat that was carrying Yates across the river. Mark Attori, an attorney representing the squad, said in a statement, "The people on the Cornish Squad are devastated. Their hearts go out to Mrs. Yates' family and friends. They are doing everything they can to cooperate with the investigation and find out how this terrible tragedy occurred." "They provided years and years of service to Cornish and Plainfield," said Selectman John Hammond. "I hope that is not forgotten. It was a tragic accident, and I hope it doesn't overshadow what they've done in the area." Bourne said that regardless of the accident, she doesn't doubt the rescue squad's ability and would not hesitate to call it in an emergency...... How many people will have to die before city administrators and councils awake allowing yahoo's to perform resuce and medical care ? Just because someone is caring and empathetic does not mean they will perform adequately ! Again, they are concerned it does not give them a "black eye" of what they had been doing for the past several years !.. Give me a break! Fortunately, those they provided care for was lucky! More disturbing ..."The question addressed by Hathaway and answered in his report was straightforward: Did Robert Drye, as the operator of the Cornish Rescue Squad airboat, negligently cause the death of Virginia Yates? In short, the answer is no... WHAT ? Let's see .. over weighted, inexperienced, non-trained, inadequate equipment.. Wow ! Can we say the good ole boy system.. Now, the city will claim they are not responsible and the service probablyhas no malpractice insurance. Would it not been cheaper and less horrible to do it right the first time ? For God's sake, when are we going to get rid of the whackers and self proclaimed do-gooders ? R/r 911

Because one works in a high volume does not make them any better, actually I have seen quite the opposite. Yes, you make more calls but have less time to perform aggressive care. I much rather have one that can handle a patient for a period of time and actually know what they are doing. I must have missed that curriculum portion in trade schools that taught how to perform that special triage a special way. Ironically, in my area we had one of the largest MCI events next to 9/11 and performed excellent triage and MCI response. Enough, that is considered the "gold standard" to be taught now, so there goes your theory. Education level has nothing to do with working the so called "ghetto". Street sense can be taught on any level of education. One does not need to be uneducated to stay alive in such areas, everyone has "bad areas" in their local area and develop street survival skills. Again, education level has nothing to do with each other.. it comes with experience, common sense, and the will to learn it. Just because someone has the intergity to learn some basic sciences and learn English and other associated courses does not remove one from the ability to perform in heavy or dangerous areas, quite the opposite. The difference one might see is that when one does obtain an education they may prefer and have the choice of not having to work in such environment. R/r 911

Ours is systolic below 90 or appears to be hemodynamic compromised. It is based upon the medics "judgement". I personally prefer not to administer a diuretic on top of NTG, M.S. CPAP etc.. if the pressure is already going down. Adding fluids is not going to help them, and unless I can initiate med.'s for pre and after load (Dopamine & Dobutamine), you are going to get screwed. R/r 911

me too..! R/r 911

What else is for them to do ? R/r 911

and law enforcement officers fight crime.. so? That's their job..

I am curious what the dosage is for your Loveknox and route and indications and dosage of Inapsine, since the recent scare of Inapsine. R/r 911