Ridryder 911

Okay, some of you have read my discussion on new curriculum and some changes that will be occurring. Here is a link to the committee and some of the development of EMS educational committee. http://www.nemses.org/documents.html R/r 911

That should explain it.. it says on the label I.M. ONLY !... they should know better. R/r 911

Actually, in the U.S. most do not have a true "scope of practice. There is a difference between protocols and "scope of practice". Remember, the "scope of practice: was shot down. R/r 911

One has to use good "common sense". Does this mean I will not apply oxygen if I am assisting an EMS off duty or even establish an IV in the same predicament ? There is a difference in performing unnecessary risks and being a fool. The difference is again wise judgement. I personally do not like Rescue Randy that are presumptuous off duty, at the same time I really do not like those that are "bound by the book" of protocols and procedures. Sometimes in this business one has to have "gonads" (sorry, not to be sexist) and break the rules in the best behalf of the patient. Otherwise, nothing ever gets changed ... I was the first Paramedic in my state that diverted from local facility to another appropriate facility which was quite a bit of distance. Yes, many wanted me to be "burned at the stake"; and if it was not for some "gutsy" physicians that proved my decision was right, I would be non-licensed. Ironically, afterwards the state changed its policies and now it is a common protocol (which, I got to write :wink: ) .. There is no "right or wrong" answer. It goes there is a time and place.... knowing when is the hard part. It comes with experience, maintaining competency, and again wise critical thinking skills that only comes with practice. R/r 911

Deleted on purpose.. R/r 911

Vistaril is also used for anxiety a lot as well. p.s. it can only be given I.M.; never give IV! R/r 911

Actually you summarized it up well. Insurance companies dictate the treatment, whom the treatment will be performed, how much education should be required, etc.. all back to $$$ I don't care how poor your community is, how hard it is to get volunteers, or if your a damn good basic EMT... Insurance corporation will institute on whom, how much, and what they will pay.. and yes EMS will follow; just like the physicians followed. I remember when EMS allowed anyone to drive an ambulance without age restriction and it was the insurance companies that mandated age and yes even EVOC training. When they refused to insure.. guess what.. yep, administrators was very willing to comply. Now, rumors are insurance companies are tired of high $$ taxi rides.. they want more for the bucks. Want more report on .. why the EMS was needed, more detailed examination, and more treatment (EMS is cheaper). So yes, we will have them to thank for our changes..unfortunately, it will not be us (EMS) that will making the decision. R/r 911

Short and simple .. We have a failed system. Does every call and everyone need ALS personnel .. ? No. Does every trauma patient need to have a surgeon in house .. no; but does our patients deserve such? Yes! We have always attempted to place a band-aid on an arterial bleed and have done nothing but bled out the system, with the patient making the sacrifice. Can any EMT actually state that their patient should not have at least ALS capability on every call? No.. If they can, they are in it for themselves and self ego's and not for the patient sake. Should we require a medic/medic combination.. you bet! Our patient deserves at least the highest level to perform care, and at this time it is the Paramedic. Do basic's have a role YES! But; not in the ALS transport system. Their role should be only as a first responder approach. I have worked almost every imaginable configuration, and yes medic/medic is the best. Yet again our patient deserve the best. Now, everyone has compared nursing ...okay let's do that. Only RN's are permitted to work in critical areas (ICU/ER) as the primary nurses.(assessment, triage, responsibility) . I hear the same yadda ... yadda; when they phased out LPN's in the ER and ICU setting across the nation. You know what? Somehow they were able to do it. It is amazing, communities & the medical institutions manage to meet such requirements everyday. The same requirements in EMS should be true, the highest level of care each & every time when a patient summons help, not doing so is just an excuse.. period. Yes, we have to bring educational standards up. At this time the Paramedic should be compared as the same level as an LPN. Unfortunately, in comparison using the current national curriculum, length in hours, clinical hours, etc. it is usually the same or maybe even lower than the LPN level. The Basic EMT is now about the same length of an approved nurses aide course. Unless, one has attended a collegiate level one cannot compare themselves equivalently to an RN. Sorry, I don't care how many "classes" or what your "protocols" are; in a professional and educational comparison it does not equal out. Compare.. Basic's , Intermediates, and all "comparison" levels should be outraged that their patients are not receiving the "highest" level of care each time a response is made. Rather than thinking of themselves, maybe we should be thinking "what is the best for your patients". Dual Paramedics would assure such, decrease stress levels, more detailed exam and history, higher percentage of successful ALS skills will be performed. Utilize EMT's at the appropriate level.. first response, stabilization until ALS transport can arrive, assist while enroute. There will still be plenty to do. R/r 911

Want to know what a "real intubation" looks like?.. Here is a view what the land marks, cords should look like, albeit it is a lot closer than a usual intubation. Similar devices such as this is being tested in the field...

Apparently, spelling and sentence structure must not be one of the required subjects. ..

No, nor I suggest it as well. Fluorescein strips are okay if you have a black light to detect foreign bodies and and a slit lamp to detect more details. This is out of the scope of training or education level of EMS personal. As well, I would not suggest to remove debris unless it can be done by simplistic techniques (inverted eye lid..etc) to prevent cornea abrasions. Flushing with saline and irrigation lenses such as Morgans lenses. I do wish more services was able to carry anesthetizing med.'s for eyes and maybe eye "lube' to prevent cornea from drying out. R/r 911

For all you fans of TLC Paramedic..

Actually that is not true. Paraquat was a chemical that was sprayed on marijunia to decrease the sales. Oxygen did cause a burning sensation, and many felt it was dangerous.. but no proof. Here is some information: [web:3dea2dbe78]http://www.bt.cdc.gov/agent/paraquat/basics/facts.asp[/web:3dea2dbe78]

I agree Bates is the bible of physical examination, like Tabers is the choice for dictionary. Some things, no matter how old is still good. R/r 911

Hmmm... me remembers a certain dispatch problem in priority dispatch (Dust you remember the Dallas incident). Actually, this is not a new concept. Many trial physician or physician extenders (NP/PA) has been placed in Pseudo EMS units under HMO contracts for non-emergency. This was not to decrease the ER visits, rather it has been proven to reduce the number of tests, procedures and definitely admissions. Many argue that this would be costly but in reality, it would save millions daily for insurance providers. Think about the mild pneumonia, that could be prescribed antibiotics without all the tests, without the potential admission, back pains, general malaise, etc... again no costs for EMS, no ER charges, and no admission charges.. thousands saved. Enough saved that one to trip has paid that persons salary alone... EMS had the chance, but rather increase our educational values and system we much rather water and dilute it down to see how fast we train and process through a program to pass a test to get a patch. R/r 911

Does it count if you were the boss? :oops: R/r 911

You might want to review history a little, I was doing just as much maybe more and had twice as many drugs to give and administered in the 70's. Hmm you ever given epi intracardiac established a central lines, gave epi and bicarb every 5 minutes in a code, as well as Calcium chloride, establish an Isuprel drip or Mannitol drip for a head bleed and or apresoline...? and these medics now a days give the routine 5 drugs and spazz about it. ACLS was as well a 500 page text book with skill stations including true "mega" code testing that consisted of at least 30 minute duration.. not like the paint by number courses today. I just wished medics were tested in ACLS as well as they used to. Shame we are not as stringent.. R/r 911

Sorry, Dwayne just a sore nerve.. I spent over a year to "please management" and lost several good ER nurses because they did not get a "5" perfect score on their public over-all rating, yet these are the ones I would want taking care of me when I was sick. What I see part of the problem is for every company that does these ratings or patient surveys are consulting firms on how to increase patient satisfaction. Of course they will always find there is a problem! That is how they make their real money.... I caught one of our non-biased surveyors calling a mother of one our nurses. Which should had been immediately excluded, then stated.."most people don't rank very high".. there were several other problems with the surveys, this included at least two other companies. As well, many of our "frequent flyers" are quite aware of the hospital attempt to raise patient satisfaction levels and will even tell you.. "if you don't do this or that.. I will give you guys a bad rating".. so basically real problems. This has even affected some physicians. I know many groups are paying specific attention to their satisfaction ratings as well.. ans again many of the "shoppers" have attempted the "I give you a bad rating".. What people do not understand due to increase number of patients, it is acceptable to have a 3-4 hr wait.. they predict in 2 years the waiting time will 4-6 on average. R/r 911

So true.. I guess I have been unfortunate or fortunate depending on how you look at it to be on some of those shows. I was on the shows "Trauma Center" and "Paramedics" (TLC) which was not too bad, but many years ago there was a t.v. show called Rescue 911 which was hosted by William Shatner, that did a re-enactment of one my calls. This show was "gobbled up" by the public, but it was such a farce to professionals. During the filming they instructed my partner and I to "run" from the unit to the patient. We described we never "ran " to anything (okay maybe to some female gender & beer...lol ) but we never ran on calls and refused to. The directors were uhh.. more than a little pissed at us. They edited in two backs of people running from an ambulance into the segment..lol What is funny, their detail was so poor.. with different uniforms, and even the ambulance went from a type II to a van ?.. wow. R/r 911

Total B.S. I hope that they can "fake" their illness right into a nice medication allergy reaction. ER's is already over whelmed as it is. Here is a nice reminder to all "....Emergency Department's are not HOTEL ROOMS"... and should not be considered as one!. I got so fed up with the "fluff and puff " attitude is why I left the ER full time. One does not have time to treat the legitimate ..sick .. patients, because I am running my arse off having to answer the ringing of nurse call lights of demands change my t.v. channel, I want something to eat, adjust my pillow...' Meanwhile, the next bed I have a GSW that requires a chest tube, the next bed to that is a AMI, and the one beside that is dental caries pain for 6 years.. Now yes, each patient received a nice little report card.. a less than excellent score was called upon and followed up. After many of us voiced anger with management, they defined our roles as more of our role is giving "attentive care, than medical care".. WTF? So, I can fluff your pillow, while the next room is not breathing? Many nurses are leaving ER in droves due to more and more because management is more worried about their "image" instead of true patient care. Programs like that described is one the prime example. I don't care if it is only two "fake" visits a year, that is two too many. During those fake visits, means a real patient may potentially have to wait or may not be seen is it that fair to the real patients? Sure ER should ever mindful of the type of care, delivery of care, and yes they are in a customer business.. as well I am sure the demeanor of the staff will not be the same as to a patient that really needs to be there. We should not be encouraging non-emergency illnesses and injuries to seek treatment in the ER. Now, with your whole one day whopping experience, they got to experience a slow day.. wow! Like ER Doc described, your experience was probably "unusual". I am sure if you were to re-visit them the other 360 or 364 days of the year and at different shifts it would be totally different. This is typical, like management; people judging things they do not really have a clue about... It is the the same as people judging EMS personnel should be busy all shift long non-stop. That you really don't need ALS personnel on all calls, since < 10 % require ALS. One should be ever mindful of how to improve things but do it with some forethought and reasoning. The funny thing is after most management receive the report card it and the suggestions on how to "fix it" They will only find out they should increase staff members, have less patient to staff ratio, deter "non-emergency patients' .. and then management will describe they have no "financial means for that"; of course the costs of these "satisfaction" programs would had helped pay for the off set. R/r 911

Ditto.. could be something simple and maybe more complex. Without seeing, examining, I would not even attempt to guess what it might be. I know the payment sucks, but it is better to get it treated and be safe. R/r 911

Urban myth.. just check JEMS general pay scale, no matter where you work at most are still middle to lower income level according to cost of living. For a $150-200,000 a year I know Board Certified ER Doc's that would be applying. R/r 911

Leave it on, if they want clarification or more details they will ask you for more specifics. R/r 911

If the Paramedic is busy, and if it is a pre-dose syringe, all has been cleared with the 5 R's.. so what ? I am watching them... so they stuck the needle in the the tubing & plunged the syringe.. it is a mechanical maneuver, just like an IV or med pump.. nothing more! I don't care who is pushing the barrel as long as it is the right med, dose, route, and appropriate way... it again is a mechanical thing. R/r 911

Again, it is not ...what you put in your ears, but what is between them, that makes the difference"... Unless, you can verify, clicks, murmurs, gallops, bruits, crescendo, floppy valves, etc. Anyone paying more than the usual $50 or more is foolish. Auscultating adventitious breath sounds such as rales (crackles), wheezes, etc.. can be heard with a cheap one.. R/r 911