Ridryder 911

I am quite aware of the design and intent of CCEMT/P and what it has unfortunately been turned into a marketing gimmick. Unfortunately, Maryland still attempts to market it as more than an "continuing educational" program and as well has copyrighted the CCEMT/P abbreviation, so now the official title is CCP. Now, I am wondering what UMBC will do, when the new Paramedic curriculum is released with CCP material already included in it. Now, at approximately $2000 per person, that is significant amount even at professional standards, for nothing more than an "introductory in-service". Now, they have developed a pediatric speciality transport, again without credentials or any authorizing body, and again representing that it is more than another CEU. Selling patches, trademarking abbreviations, and then not to "really" authorize anything is my dispute. To me that is just as questionable of integrity, more than those that dispute and publicly announce such at national conferences. Please remember, that some of those of that dispute such programs are well respected authors and consultants of state and national curriculum developments. Yes, I am sure Maryland has an outstanding program... but, like any other educational theories and delivery systems, should be reasonably questioned and monitored. Even as students of prestigious institutions, I am sure you would agree all university programs and research programs should be thoroughly monitored. R/r 911

In regards to the CCEMT/P (formerly called critical care paramedic) now referred to as critical care transport programs.. yes it is popular.. for right now. The reason is simple since it is one of the few that has been publicized in the past 10 years. I attended one several years ago, and unfortunately from anecdotal observations I have seen very little control in their courses. Rather as long as the money is paid, a course will be presented. True, it is one of the only recognized CCEMTP courses; but ironically the FLP is the only nationally recognized test to certify a Paramedic in Critical Care, which they fail to administer and describe in their courses. I agree with Dust, CISD is now accepted to be a crock of feces... the implication and development was never based upon scientific and clinical studies. Investigations of many systems using this for federal funding and other profitable sources is still being looked at. Yes, we need some type of psychological interaction with our members, but the current CISD is not the answer and in-fact may be more detrimental. Again, Maryland has an over-all good reputation, but like so many others are basing much of that on past accomplishes, rather than new development of new programs. I am eager to see and read any new accomplishes they might produce. R/r 911

So True !! Negligence is continuing or repeating to make those same mistakes again... R/r 911

Okay... I agree too of not hearing "death screams" with femur fractures; in fact I suggest if one wants to really hear "death screams" go visit a ortho ward of patients with osteomyletitis and post amputations.... then come and tell me about what screams are like. I agree with ER Doc and use local guidelines. Each case should be evaluated on individual basis. I respect the military and the personal... but, it is not civilian nor are the standards the same. They are trained for specific tasks and do well at those tasks, but are trained not to question or divert from standards and protocols. The difference is as well is difference in patient make up, diverse medical care needed and as well as potential litigation which mandates most of our care. Now, for experience it is nice and yes, needed. But, it does not matter what experience one has if they are performing it wrong or unaware they are and continue. I am sure everyone will agree that EMS needs education, not training. Yes, collegiate level should be the entry level. One might remember even those with little or no experience are still called Dr. (physician) and can dictate what you can do or not able to do... no matter, what the experience one has. So yes, education is far more valuable than experience, and one can always get experience after obtaining their education level. Experience, where and how is all relative. Twelve years in comparison could be substantial or little, dependent again on how it was obtained. R/r 911

WHOA!!!! Before you start slamming people, know a little about medicine as well! I am a PHTLS Instructor Coordinator since its conception about 1983. So I am quite aware of the "PHTLS" recommendations. Now, please if you will read as well these are "recommended standards"..and just like another trauma course, the BTLS is sponsored by one physician group and association, PHTLS is sponsored by another... semantics and some different standards. Remember, there is committees that work upon these for years, and then as well to take the least resistance, then summit for publication, which takes years.. Remember it is just a course.. that's it... just like AHA ACLS is a suggested standard from an organization, does not mean that it is the only and proper way of treatment of cardiovascular emergences. If you were to ask many cardiologist of their opinon of that program, one would find it to be very controversial. There is more than one way to treat patients.... appropiately..that is the difference, from education and training. Remember the intent for traction is to reduce muscular spasms and reduction of risk for possible laceration of the femoral artery. Now, compare that with the ratio of lacerated arteries and with osteomyelitis. I believe you would be surprised, the numbers. so yes, in PHTLS, I teach this as well as informing it still a controversial area and to follow their local protocols... R/r 911

You know what they call Doc's that do that ?......................................Defendant. Seriously, I know a medic that "popped" a few caps and placed them into a BVM and blew into the patient. Since then he lost his license, prosecuted for attempted manslaughter, etc... you get the hint, sine the patient was treated for ammonia inhalation, and NO medical literature, that was found cited that as treatment... R/r 911

I agree that Maryland has an been instrumental in EMS programs, They have had a fine reputation of quality Paramedic programs... but remember all Paramedic programs are designed on the same basis, and what they want to include and demand makes the difference. But, if I was from Maryland's program, I would not be bragging on the CCEMTP program or even the CISD. This is for another thread, but many of such programs have been questioned and shown not to be accountable. When applying look for your intent and what the outcome you expect. R/r 911

It has to do with volume and the pressures... thus is why when you do piggyback drips, it is essential to adjust it if you want the primary to run after the initial infusion or start another infusion. Second, why would anyone have such a configuration? Establish another IV line, and run it appropriately. R/r911

I posted a response.. R/r 911

I have taken ACLS since its first conception and Lidocaine has never been indicated in PEA (EMD) or Aystole situations. Calcium Chloride was at one time was indicated for electrical mechanical dissociation (EMD/PEA) and Isuprel, Na HC03, for Aystole, other than that medications have basically remained the same. R/r 911

Unfortunately, I do believe this is not a joke as well, just ignorance gone wild. I would respond not with venom, but with education. Remind him that there was a reason from change of funeral home to EMS research showed ..."that troops in war time activity, had a better expected survival rate than those that was in civilian life, related to trauma"... (White Paper research). As well, noting the same delivery of medical care provided at home, such as treatment for heart and trauma, reduces mortality. Since he is as well is apparently older or elderly, one would assume that he would be more concern of chance of survival and treatment rather than nominal costs. Then yet again, how much price is a life really worth..... especially if it is your own or loved one?... Maybe a cheaper way would be to wait a little longer and have the funeral home, only have the need to respond only once?......Brain injuries (TBI) that occur within a few minutes of trauma that is hypoxic, can costs an average of over $300,000 year annually. This is much more costly than getting an "GED" and awaiting the great white hope of having a "industry" to save a community.... You might even ask if he even aware of the benefits or lack of now a days associated with "blue collar" employers?... R/r 911

It would be inappropriate to place physician level providers for several reason in addition to what has been presented already. First, try to even get a physician to want to ride a EMS unit.. they do like controlled environments.. (observe a physician in a hostile environment and they leave immediately) they are NOT adequately educated for such.. (yes, theory wise) but for proper clinical skill and application ... no. Ask a physician the last time they initiated a peripheral IV, or how to apply an KED, traction splint or even turn change an oxygen bottle... they are clueless, as they should be. This is not their expertise or working environment.. . this is why, we have subspecialties, so the patient will receive care from the most expertise in that situation. The same would be true as a physician attempting to provide nursing care, or a neuro attempting to perform a cardiac cath.. R/r 911

From the novel .....'House of God"......opening page ......."Life is like a penis when it's soft it's easy when it's hard you get screwed"....

What I have found is it is usually the attitude of the Paramedic of what they get to do and how much they get allowed to do... and with certain attitudes as posted, one can see why. So you want to what.. ? Be above anyone else..or be excluded? Guess what I have 3 college degrees, and I still do those functions if needed.. it's part of the job! I have worked as a Paramedic in the ER setting and as well with Paramedics as being the charge nurse.. some good .. some bad .. just like the RN's. Most that was treated like crap, was because they thought their crap did not stink.. that they though they were above and beyond any menial tasks and expected only to do the "glory" procedures.. guess what this is true medicine. Yes, it can be a bear.. and yes, it is actually hard work.. standing on your feet, getting frowned upon because physicians lagging behind, and answering to some stupid physicians orders, and taking care of more than one patientand one medication at a time.. However many Paramedics come in with a "holier than thou" attitude and only having a <1 yr "training" and a certification and patch and thinking this should impress most staff members?.. I don't care how many people you have "tubed" or how many "14g's" you have started.. (probably have you beat, anyway).. If you have that attitude, get over yourself and attitude, you are only impressing yourself. ER can be a great learning tool and it is a shame we do not require EMS to be in hospital base and to work occasionally so most medics can really be exposed to medicine.(Especially since that is what EMS is really about). Better understanding of all professions and their roles would be better understood.. treatment and stabilization would be better understood as well from more than what was taught in the one text book that most Paramedics are taught from... R/r 911

When I first entered the field rotating tourniquets were standard treatment and yes they were effective in some cases, but don't be mislead that they are "true tourniquets" such as more constriction. Do a literature research and you should find more information on this topic. I had seen recently of possibly re-introducing the method on a different level.... R/r 911

A cell phone... and no unless, I really feel like stopping I will, other wise I will dial 911... R/r 911

Okay, since approximately >80% of all illnesses are psychosomatic, then we are in trouble in EMS! First realize, EMS is piss poorly educated in pysch and behavioral medicine illnesses. Second, just making excuses about not knowing what and how to handle medical calls is B.S. ... yet again, the piss poor attitude of ......"if I can't see it, I can't treat it"... attitude. NO!!.. I would never recommend a mentally unstable to "drive themselves" to ER in a 4 ton weapon, missile.. If there is a reason that they ......."could not handle it "...then we need to assess and treat appropriately. Yes, this might mean a time you don't have to start an IV or place a monitor on them (god forbid !!) ... Yes, it is a shame that EMS has not recognized a large portion of the medical health problems in the U.S. we still only address this in one chapter.... where other health care professionals adress this in more detail. R/r 911

I have seen costs as little as $ 3,000 to $6,000 here in the Midwest.. now, the real fight will be with the pilot unions... and getting someone to fly by remote control.... R/r 911

I would do in-line alignment. it is not so much horizonal movement as flexon/extension of anterior/posterior movement. R/r 911

Been in a similar incident. Discussed with a DEA (Medical Division) Agent of "what to do"?.. Was informed to make a note/log about it and witness a waste by 2 licensed personal as usual. Now, if you were short medication that is a different story. I was told this is not that unusual of a circumstance in companies such as pharmacies, etc.. and they personally have much bigger issues to deal with than a 10-20 mg of Morphine.. He described that local institutions and boards are much harsher than they would be...and internal police is much more effective ..... R/r 911

Usually the only that says that are Zolls sales reps..

Very good posts so far. Wow, after all these years and things never really change. Okay, things not to do ..... Be over competent that you know everything ..... remember you just finished a nighttime class. Be under competent... yes, you are allowed to do vitals, place oxygen etc.. there are things you were taught .. as many described perform at your level. I agree with Dust.. no tobacco use, and no cellphones ... especially when driving. Don't chit chat with the Police, Fire.. etc.. when we have a patient to take care of..yes, tell then thanks or hi.. then do your job. Don't live like a Pig at the base... clean up after yourself and have good hygiene... Keep some personal things to yourself.. I really don't care to hear about your sex life, or hear you fighting with you mate.. Don't ASSume anything... you know the old saying. and many other things as was described in earlier posts.. Want to do is as important.... Be friendly to me .. learn to joke, carry on true conversation with proper sentence structure would be nice.. Do your job.. be sure the truck is stocked and ready to go...it BOTH our problem if is not! Learn the area... yes, I will help navigate you.. but, at least know the area. The same if I am driving, learn how to read a map book. Yes, you will tech a lot of the B.S. calls... that is the way you get to learn on patients... Be professional in ER and in the public arena... sorry, this job was not made to be a "love connection" get your dates off duty. Know that you need to study.. and learn. R/r 911

What i have found is most EMT's are either flirtatious (which many of the nurses either prefer or totally dislike) or try to appear that they are so important because they "ran a code"... not knowing that was the second code and he/she has another one that may be circling down the drain as the speak, and a toe laceration that ringing that nurse alarm.... and the medics are complaining because they took care of one patient.... I agree with Dust on most of his perceptions except most of my ER nurses are former paramedics with several year experience if EMS. They do understand EMS. The night time crew as well is totally different at most places. In my area, most Fire Dept. medics are thought as hose jockeys, and most nurses in this area still do not know what F.D. and medicine have to do with each other.. (come to think of it, so do I) Many nurses only socialize with the LEO, because they believe it might help them not to get a citation later...only later to reply what a ego they had... LOL There is a time to open the mouth and be personal and a time to keep quiet. Most, appreciate little small talk... "busy night, or How is it going"... be courteous, maybe assisting family in the hall, offer them a cup of coffe when ou are getting one your self, or getting equipment and paperwork out of their way.. is helpful. Don't let things upset you... it takes time to develop relationships in work... those that are usually too quiet never get noticed or remembered, and those that are too loud are known too well. Many times we are too busy to socialize.... Hang in there... it takes time R/r 911

1. The current EMS System and the way it is established: It is fragmented, disjointed and a lost in it's own world that has no home. Step child of many systems that mainly have no real interest in patients or the system itself, rather just to use for EMS as an ace in the hole. 2. EMT's or EMS personal... again we are our own worse enemy. We are fragmented, too loose of standards, no continuity, no real standards and definitely no cohesion. No true professional development or expectations that requires development having an increased in knowledge, growth, education, pay and true professional peer pressure. 3. Education.. what can be further said? All EMS training and education needs to be done away with! Scrap it and restructure it totally! Start with standardized requirements like other professional health care providers requiring a minimal entry phase of a degree. No substitution or in between levels allowed. We are own demise.. 4. Administration and Management of EMS at national, state and local levels: Check the qualification of those at the helm.. One would be surprised whom, what. is guiding our profession. 5. Proper reimbursement to EMS to be able to attract those that have qualifications and want to make this a true profession. This would allow salary to increase, career ladder to be develop. Make a decision that either EMS is medical or not... period, since our job is medical, then it should be such. We should be under medical control not police, fire, county, etc.. separated as it's own identity. R/r 911

Understandable frustration however, after a while you will see that not everyone is as interested in learning medical procedures. One could ask if your house is child proof in all poisons, hazards, or do you check tire wear and pressure routinely on your vehicle ? All within normal safety questions... Just remember although as frustrating as it is.. CPR is not very effective even if performed properly. Don't beat yourself up... R/r 911