Ridryder 911

To truly understand alpha & beta responses, one needs to understand and know some basic pathophysiology of CNS. Actually most of our medications affect either alpha 1 or 2, and Beta 1 or 2.. or a combination. I found this site that is pretty simplistic, but at least gives you an insight of the CNS and ANS , then the divisions. After you understand the nervous system you will apply the responses appropriately.. i.e. alpha constricts and beta dilates.. theory. http://www.anaesthesiauk.com/article.aspx?articleid=100506 So get a good grasp of CNS and ANS , then apply the medication actions to that ... R/r 911

It was cancelled many years ago... now they have a drama show to watch, which is more exciting than the real thing. p.s. you probably critiqued their actions wrong, since most of the shots was filmed in the late 80's early 90's ... That was when they filmed us anyway. R/r 911

One needs to remember that not all diagnoses has to be used in the same terms as "medical diagnosis". For example in nursing, they have their own diagnoses and not use the same terminology as the medical diagnoses such as "impaired oxygenation', potential for injury, etc.. We in EMS would have to develop approved ones for EMS as well. I am sure we would never be able to utilize the same terminology as physicians do. Legality, of having the same would be tremendous. R/r 911

Yes, I even had successful BLS resuscitation, however; less than 1-4% nationally is not really enough to call it a success! Until, there is something new that is all we can do.. but, if was another medical procedure we would had called it a failure and not be used. R/r 911

Not really a skill is it? How hard is it to teach and perform ? Fifth graders have been tested to be able to perform it without complications. Obviously it is not that hard anymore, we teach people how to do from DVD's This is not brain surgery folks! Hmm you can't get worse than dead.... there is not a past tense version. So more harm, impossible. Without CPR prior to EMS, the patient has no chance of survival if it is a BLS unit and < 10%% for a ALS unit... basically without citizen CPR prior to EMS, your dead. Without CPR, then we don't have to worry...their dead. You can live over those complications but you can't live over a stopped heart. I wished EMT's could perform al their skills at least once ecery two years... but, that is a different story. The same as EMT's; how many babies, does a medic delivery every two years ...Should we make EMT's deliver to be proficient?.. Again this is just CPR. If they really portrayed EMS the way it is in real life, no one would call us or ever enter the profession... 90% boredom and 10% sheer terror. R/r 911

Did the physician talk to the staff or D.O.N./Administrator ? It appears this staff needs formal education and training. Albeit, it is usually the opposite in manner that they usually do NOT perform CPR.... R/r 911

Some people appearantly need a better life... R/r 911

Yes, much rather for them not to spend $4.00 on a device (in which I am sure you have to buy a box full). You won't be able to bill for them, and if you pry or using a "fulcrum" method to intubate then you are improperly performing the procedure. I have seen a midget anesthesiologist intubate many times and if they don't need to pry, no one does! Well first of all why would one need to have a light for a blind intubation technique in using a combitube? Second, how is a blinding light going to increase my visualization in oropharynx versus the hypopharynx when in actually a dark background is better... (see link to video) Has this device been approved by the FDA, or field tested, where is the scientific data that backs up their claims? Glad I am not their medical director or better they should be glad I am not their medical director. In my nearly thirty years, I have only seen 2 teeth broken off a partial plate. Either they need to RSI, or learn proper positioning, there is NO reason that should had occurred, especially that often. I would definitely investigated why?.. and yes, we are busy enough we enough to intubate daily, as well and have patients with poor L & M scores. I would hate to be their EMS insurance provider. Now, let me ask you .. do you know of the Amway rescue choking removal device, the suction/laryngoscope blade, CPR glove ?.... Want to know why? Because they were all designed with good intention and yes even with some great success, but this does not make them marketable and long lasting.. EMS services are aware of this, that is why administrators would rather for those to intubate make bite blocks with tape, for 15 cents and perform the procedures with ease. Want to see how new devices are tested and should be marketed.. here is a neat new laryngscope. We have used only a couple of times, there is no "prying on teeth, you will see actual intubation process, and even has a "heating element" to eliminate the "fogging" of the lens, and yes it is disposable or can be "cold sterilized". We have used them on trauma, spinal injuries (no movement of neck needed, and small grades of posterior pharynxy.. the problem is the cost at $100.00 each.. thus, you will not see them until they get cheaper... http://vam.anest.ufl.edu/airwaydevice/airtraq/index.html ahttp://vam.anest.ufl.edu/airwaydevice/videolibrary/airtraq3p15.html#simnd video They still need to be studied for effectiveness and worthiness... Sorry, not to "pop" the bubble, but just because it appears neat.. does not make it worthy...buy it if you want to, just don't expect your service to. R/r 911

Amazing little scam... a lot of people in my town have bought those, unfortunately no hospitals I am aware of allows any outside device to be put in their computer systems. Most hospitals have a "no outside" sources into their systems to prevent viruses, and unwanted programs. R/r 911

Another device for a "whacker" to carry.. I am sure that might even start another EMT level for this... Hey it has a light!.. I am not worried the price will destroy its' future.... as well hopefully knowing how to properly introduce laryngoscopy one should not have to have it ... or more simpler make bite blocks out of tape for pennies... R/r 911

Professor took us out for Chinese and Saki, he gave us a short lecture on how our real education was just beginning. We know enough, just to kill someone, and that we took an obligation to continuing learning something new everyday. Ironically, every one discussed how we were not going to stay in EMS very long... out of 12 of us that graduated 11 are still in EMS in some form or another, after 25+ years ago. From this class all worked in the field at least 12 years, and range from ER physicians, PA, flight nurse/paramedics etc... so you never can tell what a class can produce. Congrats and good luck!

You see you answered it yourself. Not, all Basics are created equally. Personally, within the past ten years + one or two, since the revision of the Basic curriculum, the mindset, the poor knowledge that the majority receives cannot be assumed as being responsible, and having adequate knowledge from most or all Basic EMT's. Yes, it is a shame.. but Medic's have became a "mother hen" figure protecting their patient, themselves. I have heard many say .." I much rather do it myself, then have to depend on someone else to do it, or screw it up".... although not a good attitude I agree, but rather the product of being burned multiple times, it is much easier to live with having a "Paragod attitude" than being in the hot seat. So it will be dependent on the medic the good experiences, trust, and hopefully they will not as well have a grandeur attitude... Good luck, R/r 911

Okay, I have seen some insults on Basic levels, even maybe from myself but never specific more of the need of repair of standards of education and training. The competency level, how and what is trained is horrible. As well, most of the post I have seen was mainly directed of not so much not allowing Basics to perform at their job or function level more of being competent in those functions and role. No, they should never have to ask to perform within their role & function as long as it does not interfere with current treatment. This is there job and function .. then do it. Now, part of the problem is EMT's and EMS personnel do not have a real "scope of practice".. ( remember this was shot down....uhumm cough by volunteers and basics). Each system is unique.. yes there are some that treat basic EMT's as drivers and actually that is what they prefer to be.. I have seen many that is all they ever wanted to do & have no desire in patient treatment at all. The same as in ER that I have sen physicians that would not allow an RN to establish an IV until after they have examined the patient. So there is usually no real written rules.. it is all dependent upon the Captain of the Ship. Even if there is protocols, orders , etc.. Yes, it sucks.. but that is life ..roll with punches and either form committees, complaints, to either change it or accept it.

Vanderbilt University has an outstanding NP program, and the South actually utilizes NP's more than any area in the U.S. Albeit, many EMS providers may never see or experience this because there is more medicine than in emergency departments. Most of the medical care provided in the Appalachian areas are provided in clinics and public health departments are by NP's. The same is true in regard to pediatric clinics are usually staffed by Pediatric NP's.As well many NICU's are staffed by in house NP's. In regards as not correcting the title after 30 patients continue to call you Dr.; after repeating "no I am not a physician" one get's tired and basically ignores it after a while. The same as patient calling an EMT a Paramedic.. I have seen very few stop and say ..."no, I am a basic emergency medical technician"....especially after doing so repeated times...even by the same patient. Dust, you are right the chart is very misleading. As one that has entered both the P.A. and NP programs, I can at least speak from personal experience. P.A. programs only require one to have a B.S or B.A. and have met those requirements, their degree maybe in basket weaving and still be able to enter. Minimal to no healthcare experience is require in some, so the two years education is their sole exposure to medicine. As well the P.A. is diverse and can work from dermatology to urology to ER, the NP is restricted to their speciality and only focuses on that speciality (because of the general education, BSN and required experience as a RN). This could be compared slightly similar to a residency after general medical..only focusing in that area. This does not allow NP's to go from one area to another.. Again back to the original topic.. I have yet had a P.A. or NP that even feel that they are qualified, the liability is to high, and really have no interest to be responsible for the current educational level of EMS personnel. R/r 911

Yeah her favorite color was corduroy...sorry, had to ! Now back to the topic... R/r 911

Wow !! I didn't know that Dustdevil was Santa ?.... R/r911

I can tell many have never worked at CAD systems, and if one was to stop and render care, then they could be held negligible for time delay to the initial call.... many systems only allow those in that assigned area to respond to calls. R/r 911

I carry a set of latex gloves.. but, it is not for stopping at incidences.... :oops: R/r 911

At least he is to the 'point"..! R/r 911

Now that was funny!... You know, I can tell those that do it for a living and those that don't. It does not mean we (that do it for a living) don't take our job seriously, rather ride with me for a tour of 24 on/ 24 off for 3 tours and get about anywhere from 2 hours to 30 hours of sleep dependent on the number of calls. The "new" wears off fast and turn off those %!#** sirens at 3 am... after a few nights and days of sleep deprivation, one sees it is just a job.. and no I don't stop at MVC's off duty! .. I stopped that non-sense about 15 years ago.. (hey, it only took me 14 years, to see what a putz I was by doing so). So yes, I have a RN & Paramedic logo on my car.. not for stopping rather for avoiding those unwanted stops on the highway and turnpikes..lol. R/r 911

Doc points out good points similar to Dr. Bledsoe.. and even as a blue blood Flight Nurse/Paramedic I agree most of the time is for the "system" not the patients sake. The scenarios does describe a long distance, as well as a severe or critical patient. Over triaging as Doczilla describes occurs in a lot of referral to Level I's by ground and even by local ER's. As one who used to set up and develop Level I's, over triaging is a common occurrence. When I read most trauma scenarios I usually read .. transport rapidly, to a Level I Trauma Center"... when most of the patients could had been stabilized at a Level II. With that in mind, one has to weigh the dangers of attempting to stabilize and then make arrangements to a Level I trauma center. Delay in stabilization for transport versus direct transport by ground or air... Good, rapid and thorough assessment as well as local Regional Trauma Plans of diversion and Trauma Policy is a must or least develop of them. R/r 911

Okay, I understand what you are saying, but... really what is the difference of staying 15 to 30 minutes and treating and what we will do in ER ? I can assure you for the first thirty minutes, it is the same if not more aggressive treatment.. since they are the only patient getting treated. Ten minute scene times.. heck, that is just barely the ability of "load & go" if you don't have to carry anyone.. I can see trauma scene time <15 minutes possible, since there is really no advantages of staying and most of that (what little treatment there is for trauma) can be done enroute. I understand each system requirements (ability of units, call volume, and limited scope of practice for Paramedics) but, of one can actually do the intent of EMS ...stabilize for transport"... why not? Yes, be sure that IV is patent, yes, tx with CPAP, NTG, and Lasix.. so when they do arrive, the initial treatment has been performed... now, even studies are proving decrease intubations/vents, decrease ICU admits and decrease hospital stays...so yes there is no difference from 3 blocks and 30 miles.. If I can treat I will, at least I will know they received the appropriate treatment in a timely manner. R/r 911

Okay, I see now interfacility flights... I was discussing scene flights. The reason being scene flights should be dictated by EMS personnel. There are places that I am aware of that needs and utilizes physician advice, way too much. Autonomy is part of the job. Far as protocols, yes I am quite aware of them to be used as "guidelines" and should be used as such, not "Gospel" for each situation. Anytime you have or need a protocol for everything, to rely upon one is opening a can of worms "no to think, on their own" and deviation of protocols, and increased chances of litigation. Again, I misunderstood you indication for flights... sorry. R/r 911

This is of another EMS forum debating the same problem, I wish I could say it was my words..but infortunately can't....... "Here is a tidbit for y'all to keep in mind. Whenever you say, "I can do everything that a blank_____ (Intermediate, Paramedic, RN, MD, etc) can except for (or but)" basically you are saying you are something that you are not. It is a disclaimer in an attempt to garner credibility and respect. If you want to be the something you are trying to equal yourself to, then go to school. Otherwise, don't try to convince the rest of the world that you are something that you are not. For example, if you are an EMT-I or EMT-CC or whatever, that can utilize 90% of the skillset of a Paramedic with only 50% of the education, who would you rather have treat you or your family? You can train any lay person to start an I.V, intubate, decompress a chest or give any plethora of medications (training) versus teaching that person the who, what, where, when, why and how to come to the decision to do it (education). These are examples of why EMS is at the crossroads that it is"...... R/r 911

You are joking, aren't you ?... You need to ask a Doc for directions on how a patient should be transported, then you just described all the political problems associated with that ? Hell, even our 1'st responders are trained what injuries need flight service and inform us so we can initiate before arrival. Not to be crude, but do you guy's still call in for orders as well?.... R/r 911