Ridryder 911

Good points Asysin2leads.. but, would it not be better to be educated more in depth at all levels of EMS since really... come to think of it .....all of our patients are mental health patients?... Even the trauma patient whom just lost their loved one or the AMI patient that is going for the CABG?....

Sorry, can't help you personally. However; several years ago JEMS ( I believe) did a feature article on amputee. You might do a literature search or e-mail them and see. This might get you some further information. Good luck! R/r 911

Glad you are taking an educated approach on going to school. I highly suggest that you speak to a financial counselor at the college prior to getting any other financial loans. They can inform you that you might qualify for grants, loans, etc... Talk to EMS counselors or instructors. They might inform you on some helpful classes or pre-reading before classes. If you really are sincere about Paramedic, then I would get a student loan. The costs should not be that expensive in lieu of any other junior college courses. Good luck! R/r 911

I have talked to many NP's and P.A.'s on their idea of this question and as of yet, they all felt only a physician should be medical control. Likewise, (approx 15 or so) felt that they probably were qualified to do so for education level, but agreed there is not much to medical control anymore. Most medical control is pretty much standard protocols and standard of care. Again, none of them showed in any interest in ever being such, if it was even offered to them. They too felt it would be much more a headache, than its rewards... R/r 911

To be able to diagnose in the field, we need to "stand back" and look at proper medical evaluation and accreditation occurs. Definitely, will be those with M.D.'s , D.O.'s, PhD's, J.D.'s will make the determination of what, how, and wording of any and if diagnoses will be made. Whew... I can't imagine the bureaucracy this will be... Legal "wording" not to conflict with medical diagnoses or even nursing diagnoses. As well, as the education level that will be required and tested for certification and license to make diagnoses. This as well would have to associated with carriers and providers of insurance/medicare representation. I do think it would be something to pursue and will be pursued someday... when, who knows? We have a lot of other impending issues that needs to be addressed, like EMT and Paramedics being able to read and write, and have a basic understanding of how the body works. R/r 911

One of the reason the psychiatric calls is demanding and difficult as well is multi reason. One the EMS provider is not properly trained and educated properly in psychiatric emergencies, one chapter or few pages in not near enough to even touch the tip of the iceberg of mental health disorders. Did you perform mental health scenario and how many clinicals did you attend during EMS training? The second part.. we cannot see or pinpoint mental health problems. There is no "physical" illness to correct or see an immediate result in change from treatment. Mental illness is really is a chronic illness in regards that most of the patients will have to be treated forever. R/r 911

Basically the way I have seen it performed is they pay them a pretty good salary per hour for the 16 hrs then nothing or pay them a lower wage for the full 24.. it all comes out the same salary. R/r 911

Spock, in my area the P.A.'s are more catered since the P.A. program here is under the medical school and is their .."baby".. the NP is considered a "step-child". The P.A.'s here are almost guaranteed at least up to $ 100K starting, if one applied themselves. I just finished a study on NP salary, profession, etc.. and the average salary was about $78,000-$94,000 and this considering ER and acute speciality areas. I do agree, it is definitely regional. NP have not caught on as much here in this region, but I am seeing a large trend to them because of liability, insurance and autonomy reasons. Many CNS, & NP have recently replaced a lot of the P.A.'s because of the speciality instead of "broad medical model" education, as well linking to a specific physician for license. CNS, has not caught on or recognized for their speciality, one of my choices not pursuing that level. Yes, we have a long to way go, but I believe within a few years, things will be changing drastically. As you know when they can save money and still re-coup the costs their hearts and loyalty will follow. More and more states are allowing NP's to be medicaid reimbursed. Now, it will be interesting when the debate hits the fan.. when NP's will be required to have a doctorate level... and physicians calling them Dr.'s... it is already getting steamed...LOL R/r 911

Common physical finding in TBI, and herniations with pressure on the optic nerve, and ICP. Usually, it is both pupils not unilateral. However; about anything can go. As well other neuro findings, we definitely need to increase neuro assessment and understanding for the EMT education. R/r 911

Check with the Federal Wage & Labor Board again, if you provide rescue etc. they have to pay additional. As well as much shortage as there is on medics, they would be advisable to pay the full 24 hr. it would be cheaper in the long run. I guarantee, my trip time would be no sleep. Yes, it is legal and that sucks.. I highly suggest they do a community comparison to see what others do if they want to keep their medics. Otherwise, as soon as they become medics, they will leave for higher grounds... Good luck... p.s. I like your avatar :wink: R/r 911

Yes, we diagnose. Period. You assess the patient, determine no pulse, start CPR (tx.) then what else would you call it ? Maybe field clinical impressions?.. Whenever, and if ever EMS matures and becomes educated, then & only then we can legitimately start discussing our own field diagnose categories and classifications. They will have to be different name as medical diagnoses, (since we cannot legally use those) but could be similar to the NANDA Dx. such as impaired oxygenation etc... the same thing, except semantics for legal purposes. Hopefully, EMS will mature in educational and professional standards to gain this. Reimbursement rates will be better collected, and the professional will have its' own standards to follow. R/r 911

Only ones restricted by HIPPA are those that perform electronic billing. Now, everyone is bound by confidelity rules and laws is another thing. R/r 911

Aww yes, an LP 4 . they were a lot lighter than the 9's.. I believe you might find some material in some books.. such as "Emergency Cardiac Care" as well as "Principles and Practices for the EMT- Paramedic", "Advanced Life Support Procedures for the Paramedic" I will try to find some of my older books.. these are from the mid to late 70'2 early 80's copyright. They have steps on how to use the MRL, etc.. as well as some pics... R/r 911

May I sugest a writing class as well?.. To go on the side of all that medical "crap" you are learning ! C'mon folks, what type of EMT's do you expect to be if a first aid class is difficult for you ? I hear McDonald's is hiring. Geez.. and we wonder why the profession doesn't make but minimum wage? R/r 911

There are probably more details that we do not see. As well as many jokes, being a mason and blues singer struck by lightning.... Everyone should had been taught there are "special" circumstances of prolonged period of time to do resuscitation.. "cold water drowning, hypothermia, electrocution.. etc.. I am very skeptical on electrocutions unless they are really fried... and then I will be careful and assess in detail before proclaiming death. R/r 911

I highly suggest you that you really evaluate your career decisions. Remember, that the Basic EMT is based at a junior high school level and if you are having a problem with some of those simplistic tasks, medical courses are probably not for you. Patient assessment is the only way one can find out injuries and determine what is wrong with the patient. "Learning" all that "crap" as you describe is essential, and missing one part could cause a patient to die. Basic EMT is not rocket science.... and if one is having a hard time at this, please consider that it much harder as one progresses up the ladder and has a lot more "crap" than the basic level. This is exactly the reason and need for prescreening on EMT applicants.... R/r 911

Very soon we will be faced with the dilemma of those that will get to go by EMS instead of those that do not. With the increase in baby boomer and no ER rooms, as well as Medicare and private insurances not wanting to pay several hundred dollars a day for a taxi cab ride.. we should in medicine, have to justify transport as much as not transporting. Like not all patients require spine boards on falls, not all medical patients need EMS for transports. Is this patient in need of continuous monitoring, and medications? Does this patient on-going medical assessment.. and continuous monitoring of v.s, repeat neuro.. etc. Does this patient require a stretcher for transport or can the patient sit in a wheelchair? Does the EMT feel it would be in the best interest for the patient to be evaluated because of the scenario, situation of social and psychological reasons? Yes, EMS needs to be careful not to prejudice and make irrational decisions, that is why it is so essential more education is needed for EMS, as well as always error on the patent's behalf. However; there are many that are not in need of emergency care. R/r 911

Didn't know that LP 10 was considered old, but LP 5 maybe more in-line. This was the industries revolutionised change. Drastically reduced weight from 60 pound monitor to about 10 pounds.. R/r 911

Good posts and well taken. I do believe actually it is the parents right not to immunize, as long as they do not present those children in a public setting. It is not as much as the illness (which can be dangerous and lethal) as much as it is they are the carriers and transmitters of illnesses. They are not educated and closely monitored of hygiene, covering mouth and proper hand washing. Hence the prohibition of children in many hospital settings. Albeit, many adults as well do not take precautions, this is being of stupidity not ignorance. The problem is as well it is a "free society" to not have your children vaccinated, it is as well a free society not to have to be exposed and receive exposure of viral and bacterial illnesses. The immuno suppressed chemo patient, pregnant females, and elderly has as much right not to be exposed common acquired community diseases such as the flu, chicken pox, RSV, measles, and mumps. These illnesses have been proven to cause illnesses, blindness, disfigurement, and yes even death. Scientifically proven vaccinations are proven to be safer than the disease. Yes, vaccinations are not "perfect", or 100% effective, just like any other part of medicine there are risks. However; rolling the dice for others should not be allowed.. and if harm comes to children, when there is medical treatment is available is inexcusable, since the children cannot rationally determine for themselves. Most medical personnel would be upset if parents would refuse blood or surgical intervention for a child with trauma. I have the same feeling, when I see a child that has infected his/her siblings with contagious disease and who knows how many others? I do wish EMT's could spend some more time in pediatric clinics and ER's and I do believe many attitudes would change. Most EMS personnel are very ignorant on such disease processes. Again, education is the key... for all! If organic medications work so be it (which many med.'s are), but until they are proven as effective, we need to rely upon what we have. Sorry, for the rant.. but this area is close to me as spending many nights on rotation at PICU, and at long term facilities for children with severe disabilities due to "concern parents" that did not take precautions for their children... R/r 911

Too great!!!.. Needed that laugh... I bet it will be a while, before that telemarketer harass anyone......... R/r 911

Did you check with their State Dept of Health?.. I am sure they can tell you since they have to issue a CAN number prior to classes.... R/r 911

Well if the patient was ill enough to have to be intubated, I doubt it was the RSI that killed him. Sure Etomidate and Sux can definitely expedite things.. but, if he had esophageal tears... and Boerhaave's syndrome or esophageal varices, then he obvious has more of a hx. than one is aware of..... I say it was consequential... R/r 911

No, but I played with one at a convention.. The idea is great and appeared for a "normal" 170 pound patient it was nice and soft etc.. The problems was most patients are too large to "fit" in their compartments. Second placing and definitely removing them from a LSB or even to roll them over to check the back in the ED.. something to think about.. I would like to hear from clinical field trials... R/r 911

Okay, I thought I would place some general information about the flu.. incubation time, info about vaccinations, etc.. Since we will be dealing with it daily soon, you might want to be abreast of knowing about it... [web:ab69b6df8f]http://www.cdc.gov/flu/keyfacts.htm[/web:ab69b6df8f]

This is why when I hear people discussing that their child was born < 22 weeks and do not have disabilities, I question the gestation birth. Many physicians have been known to be wrong on the date.. as well there is quite a bit of difference from 22 weeks and even 24, 25 weeks of development. Surfactant and lungs as well as eyes, many < 22 weeks are even born without formal eyelid development, external ear pinna. It again comes down with education. (Hmmm funny how we use that word a lot) and informing the parents of the truth... honorable and yes, truthfully if it is your child, every parent would want to do the best.. but, that is the key word "best" .. what is best for the child, parent and society? Yes, it affects more than one can expect. The overwhelming costs, emotional demands, and other family members...thisi is why it is used to be a highly debated ethical dillema.. most medical practitioners agree the best is to let nature take its' course.... R/r 911