Ridryder 911

Aike what was said, it is a credentialing process NOT an educational one. Sorry, its a testing not a teaching examination. At least now, they are allowed to obtain the skill list in which when I took mine was a sacred sheet and no one was allowe to even know the steps. If he had studied properly, and praticed well; chances are they would had passed. It's a shame we have to have a skill test, but thank goodness we do. Appearently they are not teaching in detail enough at the training and educational facilities. Instead of criticizing the test (which actually has a high pass rate in comparrision to medical boards) maybe look at the one taking it. I will also state as one that has multiple license and medical board certifications, no one is allowed to know what they missed as it would also ruin the credibility of the test. Rr 911

Most traumatic arrests (multi trauma) are not worked for a reason. They have very poor outcome as evidence based of survivalbility. I know of very few EMS that even have traumatic arrest protocols unless the cessation occured during after treatment had started, even then many have other measures to cease resuscitative efforts. If you are surprised by the lack of efficacy of medication therapy in trauma, then of course you should not be alarmed as the resuts and poor effects in non-trauma patients too. Most traumatic arrests are decleared dead upon arrival and no resuscitation is attempted for a reason, as most have learned it is a futile attempt.

Agree that is poor judgement and bad parents but that is still no excuse to kill, mame and have sex with a corpse.... R/r 911

Take him to the woods, tie him to a tree and forget about him. R/r 911

As one that just attended the test writers for the NREMT a few weeks ago, I can say that the NHTSA curriculum and as well as the medications found for the ECC in ACLS. All cardiac related questions are referred to those sources. R/r 911

Actually, we are paying for that too!... Way too much hand outs instead of hand ups... and we wonder why we have made them dependent upon the "system". R/r 911

There is several articles about CPAP; as it has been out in the EMS world for several years now as a well proven device. Yes, they are one of the best devices to treat pulmonary edema. Remember, it is not for all types of respiratory diseases. As well, one should be formally educated in respiratory diseases and the details of CPAP before utilizing them. In reference to oxygen usage, yes they use more than the normal nonrebreather but who cares? It works. True medical devices that increase outcomes and reduce morbidity and mortality should not be referred as a trinket. R/ 911

I would want to know why they want duplicate cards. Appears they have an office jock; that don't seem to understand to instruct also means you met the standards as you passed the course. Just pay the $5 & give up trying to understand some people. R/r 911

Well, alike t.v. channels don't come on by themselves. I am sure you had to actually enter EMT City. Don't like the posts.. guess what you can do? There are many FIre and EMS forums I don't visit because of the Fire drool and lack of understanding of medicine by vollies. Yet, I won't bitch because its focused upon those specific interest and is their site. R/r 911

No, I doubt they do. It's hard to state someone with only a few hundred hours of training and no formal education as in not having a degree to state they make a diagnosis is being asinine. Even stating they can make a clinical impression is stretching it. I even have a hard time accepting most Paramedics as being able to make a good clinical impression can be wishful thinking. There is no such thing as ALS or BLS except in EMS where they have had to differentiate because of training vs. education. Medical care is medical care, the assumption especially regarding in making a differential diagnosis is much farther advanced than just simplistic signs & symptoms. There is NO debating this. This is the way medicine is and yes we are division of medicine. We all can learn no matter what the level but let's be realistic. R/r 911

I am not against such courses as long as they are credible. But you & I both know that is not always the case. I agree refreshers usually have a lot to be desired and if this was a viable option that is great. Again the whole purpose of the refresher is to review areas and recognize those that one may have become rusty in. As long as it does it purpose. R/r 911

We treat patients NOT numbers. As the previous posts described. Not all mid 20 year old as well may have a lower blood pressure all dependent upon the make-up of their body. Realistically, and truthfully you will NOT know what their ideal blood pressure or even what a normal BP is unless you perform serial readings. Even then one has to be sure to take them about or near the same time of the day, activity, same arm and position. One of my pit pees is to hear v.s. WNL. Really, you know what their normal limits are? Nope. R/r 911

Just alike the scams of study questions on-line and test review crap that is out there one needs to be very careful. I know my state does not allow on-line refreshers. It has to have a certified authorized course number, and be pre-approved before it even occurs, as I know of many states also are reviewing many of those on-line courses. There are very credible on-line courses but be sure they have met the credential of being Distributive Education with a CECBEMS approval rating; otherwise it maybe rejected. Just because there is an abundance of online programs does not always mean each State will allow it within their own State. As one of the educators of a pilot program on-line Paramedic program within my State I will tell you not all programs are grandfathered in. Alike online programs of those within the Nursing profession. There are States that are increasing additional education or may totally refuse to accept those licensed from another State. (Just because you have a license does not automatically guarantee permission). I am on a committee that will start reviewing such programs for EMS to ensure quality education, not just having completed a program. Be aware of what your State will allow. R/r 911

I don't know what "new" way of test you are discussing unless you are talking about the computer method that has been performing for three years now. As well, as long as one completes a formal refresher that is authorized by their State and meets the qualifications of such as the NHTSA curriculum. I would be very leery of any "guaranteed' thing. If one actually studied properly the NHTSA and AHA/ECC reference in regards to all cardiac/CVA/ ASCHD questions one should be prepared enough. There is no..."trick" in questions or specific proportion in the questions. As one that just returned from NREMT a few weeks ago at a test writer meeting, I know and understand their idealogies. Good luck, R/r 911

So very true. As well, part of the problem is majority of EMS administrators are not properly educated in business nor the effects of the American way of payment .... Medicare. Dependent upon the State you are located but Medicare has a special section for those that have to transport drips that require special education up and beyond the general NHTSA Paramedic curriculum (i.e. Lidocaine and Dopamine are the only two discussed) then a Speciality Care Transport charge can be added. Of course one should have the proper education and evidence to back this but the fee usually is increased and can actually off-set the equipment within a short period of time. Even known to be profitable. R/r 911

Actually, it is. Read the drug insert. If it describes it should or has to be per pump (i.e. Levophed, NTG) then you as a practitioner should had known and then you willingly administered the improper way. I know, as I have testified against an EMS that transported a medication that should had been per pump only. Their defense was, they did not have one. The court & jury, stated that if that was the case they should had declined the transport or made other arangements. Do you take a NICU without a transport incubator or if the patient is on PEEP/Vent ... BVM them? Ignorance does not make State standards correct. Weight/volume and toxicity does not equal in good patient care. Bolusing medications that were intentionally prescribed as a IV drip can land you & your medical director for review. I don't care how long, etc. Tell me when you see the immediate effects of Dopamine in the field and I will tell you probably have overdosed them. As EMS matures and is assumed to be responsible health care providers, part of the risks is we will be scrutinized by litigation cases that will point our faults. Part of the problem of Paramedicine is we fail to teach and educate pharmokenetics properly. The only reason ..."desired effects" was ever taught was because most assume that Paramedics were too stupid to understand other dynamic parameters. Let's not reenforce their theory. R/r 911

I am sure there are already thoughts of using specific Elephants parts....

I hope your not considering transporting Levophed or even NTG not on a pump. Even their manufacture informs that it has to be performed as such. Titrate to effect = I can't perform pharmacological equations. Sorry, that is like saying give Epi until it works or any other medication until you see your desired effect which may over or under dosing the patient. Many medications alike Dopamine are dose dependent that varies its actions dependent upon the dosage. Does no one carry micro or mini drips anymore? I have been an expert witness against Paramedics transporting even considered simple drips such as K+ or Heparin. Sorry, one cannot give a precise measurement then they do not need to be transporting and allow someone else that can. Remember as well, if you are not familiar with the equipment (i.e. hospitals pump) and there is failure or problems, you better be able to trouble shoot the device. R/r 911

We are digging through the rubble. Alike our other natural disasters of tornadoes it hit and missed homes. The initial total is greater than 100 homes, and these were family type structures; some maybe occupied by medics/families. It is now believed that it might be arson related... God help his soul if they are caught. R/r911

One as well need to recognize mean arterial pressure (MAP) to assess the depth of shock in addition to pulse pressure. R/r 911

There are very few events that are time sensitive. In reality lights and sirens have not be proven to save time if so very little (that is if the they proceeded safely). Return in emergency status is very limited as well, again for time sensitive injuries and illnesses. Hence the reason you are supposed to have a medical professional in the back providing medical care, one should not have to respond back in emergency status. Running in emergency status increases risks and jeopardizes all. R/r 911

"Medicare paid for this"

Wow! I need your rep! It costs me $6200 for 6 drivers with four needles. Of course the newer model (short handle) was $15 more. R/r 911

Just purchased some EZ I/O's today. They run about a grand a piece with a few needles. The cost is about $100 bucks a pop and $120 for the larger one. As well, you can insert manual if there is battery failure. Most rep.'s will give you an additional drill free as the money is made off the needles. I did not even consider BIG or FAST as I have heard horror stories and I have used FAST and was not impressed. R/r 911

Do you know the sources? Have you really investigated where or who they are? As one that just returned from the NREMT test writer meeting, I can assure the sources are very limited. That being they are only two things. The NHTSA Curriculum and cardiac material is from the AHA. All questions are reviewed and pilot tested and then restudied and re-critiqued. It is a very scientific process and one that has to be analyzed often for credibility. You can take Brady, Mosby, etc and study from them but the questions are verified to be in the official curriculum. The costs is nominal in comparison to other professional tests. NREMT did not set the fee, Pearson/Vue costs is what caused the increase. Don't like it.. well I guess we could go back to scan tron grading and awaiting 6 weeks for results. The pass/fail ratio is one of the highest for a medical examination, so in the real world it probably in comparison too easy of a test. Something most of us educators would like to see changed. Unfortunately, most use the NREMT as a screener to eliminate those that should had never passed any EMT course. Go take another health professional test, then compare costs of the organization. Usually several hundred dollars are required every two to three years. Part of the problem it is too easy and too cheap to become a medic. R/r 911