Ridryder 911

True; but unless one can master the objectives and the way we measure the objectives in education by issuing of a degree. One could continue to pursue both and never achieve either. Having the education, knowing how to use what they have learned and applying it wisely will only demonstrate the proper attitude. A truly educated clinician realizes continous learning and education is essential. R/r911

Again, NREMT has never been against education; quite the contrary and even promote professional development so I do not understand your anguish against an organization that would be promoting your ideas? Look at it this way, each professional organization needs some continuity of assurance that it is meeting at least the minimal standards. I know of collegiate Paramedics that never attended a formal anatomy class because the Paramedic course was contracted out to a Career (Vo-Tech) Tech. They were awarded college credit for their courses that did not meet the usual collegiate level requirements. In reality. although an associate degree is great it is not the end all. Can you assure me that all program graduates have the same continuity or meet the minimal standards? Would it not make sense the NREMT be pro for us in EMS, since they have not raised their rates in decades? Remember, the more professional we become the more successful they can be as well. I am assured they would love to see our profession grow in both education and in professional development. After being with them two weeks ago, I can personally say they are more pro EMS in way of professional development and also wanting the Paramedic to be compensated for such, than most of the other organizations out there. Think about it. What other organization has changed or even to attempted to increase the education standards other than the NREMT? .... Degree is a worthy thing, but it alone does not make the difference. Having the degree and meeting those standards to ensure public safety is the key point. R/r 911

Want to back those words, or just speak from your anus? You use same repeated comment without any explanation leads one to believe you must have failed one of their tests. NREMT has and still endorses formal education. Without their persistence we would not be heading for accredited programs. You can thank the NREMT for this or is this one of their "scams" you adress? Validity of tests per academia and again wanting programs to meet such standards. Yeah, a whopping $10 a year scam.. poor baby. Apparently, you don't know the costs of most professional health care organizations and again I doubt you know or read the scientific research and the presentations they have performed within EMS. So your asinine statement makes no sense, obtain your degree and NREMT demonstrating you have met the minimal national standards. R/r 911

Actually, the NREMT has NO practical tests for the Basic Level. They accept state and school standards; they only offer those sheets for referrence purposes. R/r 911

About four years ago, I found a video from a physician that was describing the demise of AHA ACLS courses and more so other similar courses such as ATLS and all the other alphabet courses. The problem began that we assume that all could provide efficient and quality emergency and critical care. AHA attempted to train (not educate) providers in all hospital arena to be able to provide emergency care. More so they limited emergency cardiac care to strictly resuscitation measures. Then even more so dilute it down where true ALS is not performed or the best iniatially started to be followed up by specialty care teams. Amazingly, he was an a National Affliliate Faculty for AHA. Oh, if you want; one can purchase and pay to attend for those speciality care courses such Advanced Airway, Experienced ALS providers, I/O courses, etc.. so on and so on. Was ACLS the demise.. no not the sole reason but one of the many waves. We are allowing anyone with $$ in their pocket to attend a 8 week course. We even brag about taking short cuts and not being knowledgeable in the speciality of our profession... How ludicourous? We need to redefine EMS programs. Remove the basic level all together from the EMS programs. Offer them alike they are.. first aid courses. Alike nurse aide courses are in regards to nursing. Don't allow just everyone into EMS programs. Only those that profess and have demonstrated completion of pre-courses, well written references and continues evaluation of them during the program. Let us make it difficult to enter as well to exit the program. Bring back intergrity to delivering emergency care. Alphabet courses should not be needed if we really as a profession knew what and how to perform our jobs. Unfortunately, our education systems is not really an education rather a training system. We have not as a profession grasped what it takes to be a medical profession because many are not within the medical profession rather only wears that hat when needed to. I personally recommended that ACLS be removed from the re-registration of the NREMT. I was informed unfortunately, that is one of the few ways that they are aware that Paramedics have kept abreast of new standards and kept current. How unfortunate! R/r 911

Immaturity. No matter what the age. As well, full of ego and B.S. Just alike those that abuse children, strikes females, geriatric population it is a "power trip". Shame we cover and even endorse some as being .."Cool".. I have heard the laughs and I will personally tell my thoughts. Sorry, your a loser and I am not. No, I am not a hand holder or "goody two shoes" but; I want to be the type of provider that I would want for myself. R/r 911

Well, he was a cut up

I have been hired as the "Cleaner". Recently two schools have contracted me as consultant and educator to help reduce the "slackers" and improve their focus upon quality products. As well, to ensure those that do finish and pass the course to actually pass the NREMT or license examination. Yes, everyone knows those that cannot "pass" the exam but are good field this or that. That maybe fine but let's face it; if you don't pass the boards, it really does not matter how good you are in a class room. Without that card, your nothing. Also, this is a profession. To be a professional; you must think as one, act as one, perform as one and then be one. It first start with aptitude and attitude. Take the courses and studies serious. As an educator, it is NOT my job to read to you what is contained within your book. I am there to motivate and direct, clarify and guide your journey to learning. If you can't read then that itself is an educational and personal problem, not mine. I will direct you to the appropriate persons and areas to increase your reading; then come back when you are ready. I give assignments for a reason, for you to learn. No one can teach you anything if you do not want to. I have found the majority of EMT students do not take the course or their studies serious. So; I don't take them serious when they fail. Remember, educators/teachers don't fail them; they fail themselves. When asked how many actually placed any true effort within the course? How many actually have set study time? How many read the assigned chapters; specifically the objectives way before class night and have outlined the chapter and already answered the objectives? Have questions related to the studies to ask the teacher/professor? How many sign up for the extra lab or ask for extra time to practice? I also see that majority of EMS students fail to learn what "group study" is. Without it usually means failure. I can assure one, without such late night "study groups" my studies and interest and competitiveness would be less. Sparks of being in-depth and drive as well as coverage of all not "just" enough. So yes, it is expected to have a high drop or fail rate. My last course I taught last fall 6 out of 24 made it. R/r911

Ironically, I was at the State Capital most of the day yesterday, one of the HB is a law that will change assault on EMS and Fire workers a felony. This appearantly got the Representatives attention as the attacks have became more frequent on both professions lately. Even though it was the boys in blue, this event added fuel to our bill. R/r 911

It would appear we may need to have a refresher on pharmacology and maybe seizures. Look at what medications terminate seizures, and those that relaxes the muscles. Much different actions. Now, why would one want to chase a vein when you can spray IN Versed and terminate the seizure, after you had performed a FSBS to rule out the etiology? Stop the process, if it appears it a continous and status. The initial comment was on status seizure activity, why continue to prolong? Repeated studies have demonstrated IN route works as fast and in some fster than IV route on Versed. As well, my seizure patients may get a NP. Yeah, its called an airway. No it's not invasive and I have yet not seen one yet that did not have large amount of nasal & oral secretions. When they become post-ictal, simply remove, no problem. Chances are they will never know they had it. Cmon, this is not a chicken or the egg debate. R/r 911

As one that is very familiar with OKC and Tulsa, one of the first things is ensure that EMSA treats their employees well and remove the "EMSA way" attitude. Unfortunately, many believe that it is the only way and have never worked or explored elsewhere. Actually I have never seen them not hire anyone that was closely qualified; true they may wash out in the academy but they were hired. Attempting to teach in-depth care is frequently difficult at times. Mainly because it is a strictly protocol cookie cutter system. I don't know if having one medical director over everyone is also a good idea. Too many hats for one person (OKC FD, Sheriff, EMSA East & West, Tulsa FD, etc). We will have to await and see how the new one turns out. As usual, every five years or so the Fire Department makes it ugly head stick out to want EMS. This time they planned a little better, but from my personal resources do not plan until about another three to five years when they are more staffed. Of course no one wants to discuss the costs that it would be to promote the change. With the city budgets being crunched and the new water surcharge many may not want a change feeling they are paying enough! Some of the responding companies are okay, but unfortunately the experienced ones allow the Paramedic expire since the pay incentive is no longer attractive after ten years, why keep it; when you are already making a great salary? Unfortunately your union is not the best representation as well and never has been. In regards to SB 357 it is not an active bill. It will never change metro areas EMS services. I do not who informed you of such there are four current bills in legislation. http://www.ok-emscoalition.org/legislation As Monday is legislation day, please inform all peers if possible to be at the State Capitol 0830 Blue Room. There is only four but important legislation bills in place. I don't disagree with some of your recommendations. Yes, more units is needed but alike anywhere else in the metro area everyone else is responding 10-12 calls per unit. The advantage is you get to go home after 12 hours. Twenty four trucks are and should be a thing of the past unless you are in the very rural area. Pull 24 and respond to 12 calls but have a turn around over an hour, it's the same. Your extremely tired and worn out. Even in those areas you discussed are too busy for a 24 hour truck. What many administrators fail to understand is the shortage. Many assume that it will soon pass and I can assure it will not. Right now, Paramedics have an opportunity to change the systems but most will be involved. I wish you the best of luck. R/r 911

Got to play with one the other day and was not impressed. For the predicted costs of the device I am not convinced its worth the price. Weight is just a few pounds in difference, not notable when lifting it. Yeah, it has a pretty multi color screen monitor and can reverse black & white for those sunny days. The only true advantage I see was the Sp02 probe can also monitor Co but I really don't have that many Co poisons to jusitfy the cost adjustment. The other adjustment was the monitor defib cord was more firmly attached & BP quick connect was better designed, items that should had be modified with the later LP 12's. The ALS package that will accept art line & other hemodynamic wave forms, and blue tooth capability is nice but very few services will require such. Now here is a down side, the batteries are a totally different size. Hence no more LP 12 batteries, etc. being able to fit or be used. New batteries, new charger for your unit. Now, comes the "bite em in the butt"; since they are awaiting FDA approval. Seeing how the market is going to go instead of producing products that will not sell immediately. I was told predict the LP15 to be about >$25 -30k a piece.

I never have used Solu-Medrol nebulized but I have used Decadron as per nebulizer. An old ICU trick to help reduce laryngeotracheal swelling, especially for new trachs. I remember using in a patient that had an idiopathic reaction to Bumex. He was already trached but the reaction caused severe swelling I nebulized the Decadron (along with the usual tx regime) and appeared to work. In regards to Diabetics I do make note of it. They may have to receive additional Insulin or be placed on supplement therapy. As well, I am sure to observe for previous oral therapy such as Prednisone and I may withold administration of additonal steroids. Again, a case by case matter.

Might as well give Kayexalate then. Personally, I would not give the Insulin/D50 combo until I had a good base line labs. At least the Albuterol and Kayexalate has lesser side effects. and is easier to contol. R/r 911

DTR = deep tendon reflexes. These should be checked q 5 -15 minutes when anyone is receiving Mg+

Just alike its cousins Decadron and other steroids. Reduction of inflammation, swelling, etc. We use it routinely for those with COPD (bronhitis, asthma) and of course allergic reactions. Our standard dosage is 125 mg SIVP.

Wow! A well informed medic. Hmm let's see first this is NOT the NREMT idea and this name change idea has been disussed for over three years in occurrence to the new NHTSA curriculum. (Didn't know about that one either?) Be informed and keep up, and better yet be accurate. R/r 911

We are not a profession due to what? Would one consider Fire Service a profession? Do a comparison. Most do not require any formal trainig prior to admission to Fire Services, as well do not require a license nor any formal education, just basically a hiring process being from neck down. This used to be a joke until more and more this is seen as such an acclaim that their personnel cannot pass the NREMT or should not be accountable to National Standards in other words "dumb it down" for us. I realize not all Fire Services are alike that, but one has to admit one can only wear so many hats and still be proficient. The problem is most fail to realize we are medical not safety, nor public service or supressionist. There is no objectives nor specifics in safety within our scope of training or education and even our name sake states it. Just because one's system default is to place EMS within a division that has nothing to do with medical is irrevalant. If they placed EMS within the city sanitation division, because that division is within the public health area should they thought as EMS experts to? R/r 911

Apparently you did not explorer any other community but the land of EMSA. Unfortunately, many feel that all EMS is the same. Yet, many did not ever look outside the local community or city. My system is definitely not alike EMSA nor is many others that provide care in Oklahoma (wanted to clarrify this) Although EMSA does have some excellent critical thinking medics, they do try emphasize cook book and protocol driven medics. Maybe you should place an ear to Tulsa's dilemma now and see what the opinion is of the fire service. Again, please don't make blanket statements. Not all Paramedics are created equal in fact very few are above the "trade" profession and I am NOT a public servant, rather I am a medical professional. Opinions of we are safety is just one of our problems in EMS. R/r 911

Interesting topic. Ironically I am in a EMS Instructor refresher, and it is interesting to see the difference in opinions from those that educate at a academia level and those that instruct at a career tech level. Yes, I used different discreption of methods of teaching because it is very evident of the methods or required method to present the material. ..."There is nothing education cannot do. Nothing is above its reach. It can turn bad morals to good; it can destroy bad principles and recreate good ones; it can lift men to angelship"... Mark Twain We will have to focus upon removing our stigma and as well requirements from being a "trade" and being a profession. We will never see respect, financial improvements, longetivity until this occurs. Part of this is removing our image as public safety workers to being educated medical personnel. Requiring not only core subjects to be taught but general education as well before one can enter any EMS level program. EMT should only be considered either a first responder program or a intro level only. Time limits upon completion of Paramedic programs should be instituted from start to finish, alike other professional programs. “A poor surgeon hurts one person at a time. A poor teacher hurts 130.” Ernest Boyer * thanks Dr. Bledsoe for emphasizing these quotes Scrutiny of whom can enter and even those with other degrees and professional license should be performed. We need to close the "open door" policy. I still say its too easy to become an EMT and definitely too easy to become a Paramedic. If we become more controlling we can not only control the outcome of whom will enter the profession but will control the degree of pathway our profession will go. We have to become firm at this time as there is great opposition against EMT"s having an education. The reason is mainly due to fear, ignorance and financial. Fear that one may not be able to pass or meet requirements, fear of change, ignorance of what education is really about and financial reason that one will have to be paid appropriately. R/r 911

Most States require you to contact them as well. I suggest not only talking to NREMT but to your States EMS Education Director. I am assured that they are very well acquainted and can contacts to assist you. R/r 911

Actually, that is the state's fault NOT the NREMT. Remember, NREMT does not really have a practical testing at the basic level, only recommendations of the stations. They recommend or allow the states to utilize their skills list. For advanced level, they gave a specific date when this was to be implemented. I still say .. probably the state's fault if they prematurely used it or did not disperse it. R/r 911

Yup. just received the NEW check list on hemorrhaging and bleeding control.

Must be another one that have failed the test. Contact your State EMS office. Most educators are given a percentile of pass rates. The NREMT has no problems releasing national stats, and possibly state as well. R/r911

This is pretty ballsy since they cannot even keep up their own education for EMS and contract it out to another Fire Dept. Central Jackson Fire District handles most of their Paramedic education.. (thank goodness, from what I understand). R/r 911