Ridryder 911

Remember, critical thinking can be used for any strategy. This is not always for patient care, as it is highly recommended for administration skills. In fact, many are using and utilizing testing for those that possess such skills for management and leadership capabilities. Yes, one can "hone" and improve their skills, many never are able to comprehend and obtain it though. That is why there is a difference between "management and leadership". I do believe this is one of the areas, EMS definitely needs to improve in. By doing so, so much of repetitious training could be removed, as well having protocol manuals several hundred pages in length. Some have to be led either by others or by a policy and can perform or act within stringent protocols, and step by step procedures. While others can comprehend and understand the "nature" or "intent"of the rule(s). This is a hot topic, and we have just seen the tip of the ice burg of this discussion and theory. R/r 911

I fail to see the question :?: R/r 911

How ironic, I was going to do a post on this subject. (Actually, trying to compose an article for JEMS, on this matter). First one must understand what critical think is, and what it is not. That is where it become a problem. Some believe that many are more "born" with this and develop it better, with experience. Some educators and theorists believe it can be taught and a developed trait. This is a scientific term and yes has been proven effective. In the field use, yes, it may be called "multitasking", or "thinking outside the box" for many possibilities and multiple disciplinary means. More than looking outside the protocols, thinking ahead such as counting the steps before entering the house, examining the patient for medical problems while on a traumatic call, managing 5 EMS units on separate calls at the same time.. etc.. Things are not "black and white" , and usually in EMS are gray... in color. As we know, nothing is simplistic in EMS. The nursing profession has been investigating and attempting to teach and test students during the nursing program to explore this. they realize the importance of having these skills. I feel we in EMS should as well should explore this and start recognizing the importance of this knowledge and trait. I do believe that this type of skill needs to be addressed and be tested in the classroom and as well in clinical arenas. Starting at the Basic level on... This is not to so much to discourage anyone but to point out the need of this knowledge and as well, might to be used to explore that this profession requires such. I feel many become dissatisfied, job, and their performance in the job market and their performance. Because of inability or lack of having critical thinking skills, never are able to fulfill the job requirements. Some people are "black and white" and never are able to cope with the demands of this profession. I believe in this so much, I wish there were practical scenarios on the NREMT exam, using critical thinking skills. As well, should be part of the clinical objectives for field, ICU, ER , etc.. clinical sites. R/r 911

Couple of things, definitely not to discredit you UMstudent, you have only have the theory at this time, not the pratical aspect and application of medicine and health care administration yet. Trust me, when you do become a physician I doubt you will want to work for a lower middle income position instead of the normal salary the physician makes in comparision. Please repost, when you are through residency and then tell me how physician's should not be making so much .. I'll be glad to hear, your views on how we can reduce health care costs. True, Basic EMT really is not much more than 1'st aid, and the procedures that are allowed are usually harmless (there is a reason for this) but, again we are talking about critical thinking process, as well as maturity to be able to receive and interpret cognitively. The exposure of tragic events cannot be screened for ride alongs, for basic to called upon, etc..They are called Emergency Medical Technicians for a reason, unfortunately we in the profession have allowed the dilution to occur, which is a shame for the patients and EMS system in general. By allowing a further degredation of the profession is not going to help it. Second, since we cannot promise no exclusion from harmful exposure to exposures to potential psychological, physical harm, with such events can cause possible long term events, we must and should limit minors exposure to such. Yes, those are called impressionable years for a reason. Why ride to see the job if one cannot truly see the job in action? Now, do you see people shadowing other medical careers... not really. I have seen students (already enrolled in an approved program) to follow lab, x-ray, etc. Sorry, there is a reason physicians do not have "wanna-be" doc's to follow them around, most patients do not want to be exposed during a pelvic or rectal. The patient does have the right, on whom, what, and on treatment. Shame on the physician for not respecting the profession any more than that. As well, anyone that allows juveniles to perform treatment, must be apathetic to the well being of the patient and provider both. I bet his/her malpractice insurance and attorney dreads the day as well. Again, there is a reason for the age requirement. Cognitive and critical thinking skills have scientifically been demonstrated not to develop until the past of age of 21. Sorry, just scientific proof. Ever wonder why Police officers, have to meet an age requirement? Sure I bet most youth could pass the gun range, the written test, but it is again the cognitive and critical thinking skills, that mean life or death, as well as the psychological maturity. Similar what is required in EMS. Doe one have to shadow, FBI agents, surgeons, nuclear physicist, space engineering to go or obtain interest in a profession.... no ! To summarize, this is a profession, not a game or week-end retreat. Unfortunately,the Basic EMT is the current entry level for this profession. Most professional services requires one to be at least 21 before application, so they have plenty of time to figure out what the job entitles from high school and even college. Far as watching t.v, I was referring to documentaries and real life exposure such as Paramedics, Trauma in the ER, etc.. not dramatic parodies and sit-coms. R/r 911

Sorry, this is a profession. Hence medical care.. your physician don't allow "shadow's" to follow him while you get a pelvic, rectal exam, or any other treatment. The same should be for EMS as well. Want to know what we do.. read the job description or hey even a read a book about it, or watch t.v, ask some experienced medics, and yes even a guidance counselor. It is just like any other medical field... why do we think we have to have someone watch to see if they are interested? Sorry, don't see too many x-ray tech or lab tech with people following to see "if they want to go to school, or if they want to do this?" ... Yes, shame on the Medical Director. He should be aware of patients rights and privacy as well. Once those doors shut on the ambulance, it has the same legal privacy as the hospital does. And NO !... I don't allow, just anyone to observe any procedure, or treatment to patients in the ER and especially in the field. No, I don't need kids observing me.. Apparently, he/she does not take your EMS serious enough as a profession, to respect that. Yet, again if I had kids running calls, I probably would not either. Again, I ask does your parents realize if you (<18 y.o.) are sued, they will be financially responsible? Sorry, minors are that.. and yes patients have the right to refuse care, especially from a minor caring for them. Most professional services will not hire anyone <21 years of age, so they have plenty of time to study or learn of the profession by the time they reach adulthood. This is an adult job with that involves critical thinking skills, that science has proven majority of those ages <18 to 21 basically do not or cannot have. Nothing personal, just facts. Again like Police or truck driving or any other industry that has age requirements, if one is really serious about this as an career, they will wait and get information about the industry as I mentioned. One does not have "shadow or ride along" to make a career decision.

Wow ! A new concept ..........it's called thinking! R/r 911

Well the strips you are showing does not reflect "capturing" by a ventricular pacer. Even if their are "blips" the QRS is too wide as well as there is no pace spike at the beginning, then look at the rate. No pace maker is usually set so low, as well as amplitude. Unless, you are calling those little "fib" waves as QRS. It appears to be it can be an idioventricular rhythm, or possible a LBBB. This is what I seen, that might had made the possible "delta" wave and can be misinterpreted as WPW. Mike Taigman has an excellent section in his book as well as Bob Page discusses the misinterpretation of WPW in his as well. If you can get additional strips (especially XII lead that would be great!) R/r 911

Nope their dead!... R/r911

I am not thoroughly convinced that it was WPW, usually one will have a ( -) delta "B" wave in the V [sub:9ad21d514a]1[/sub:9ad21d514a] V[sub:9ad21d514a]2[/sub:9ad21d514a] leads. Usually you will see type "A with a + in precordial leads. One needs be very cautious in the treatment of such if you really think it is, as you can see bradycardia can result. Most WPW is associated with A-Fib with rates > 250/min. Now, it looks like the pacer needs to assessed why it is not firing and capturing as well. R/r911

It is not so much the run of V-tach concerns me as the PVC's that are occurring close to the T-wave. Now, I am wondering why the ICD did not convert him unless his pacemaker/ICD failed to capture and the pacemaker failed itself. Without the base ventricular rate, I cannot detect if the PVC's were fusion beats to increase the ventricular rate or not? If he was brady then I would had proceeded to that accordingly, not "knocking" out ventricular firing. R/r 911

Both. seriously. The service that is predominately slow, take advantage of down time and study. Watch on calls how performance is given .. both good and bad. Making mental notes on how you can apply what you have just read and how you would handle the situation... both positive or negative, making mental notes. Ask questions about care after the call, letting them know that you are not so much questioning their abilities but questioning on the general assessment and care. It appears they want to teach you as well, by asking you questions as well, that is good. Give yourself some time, becoming a good medic does not happen over night, and not all experiences are good ones. This is what builds up life learning experiences. Observe, be active on what your level can perform, talk to the medics, listen and watch their performance on H & P. Note how they "focus" on specific areas, and eliminate other non-pertinent areas. You will do fine, if you study hard, pay attention, and practice... Good luck, R/r 911

Okay there itself is the problem(s) .. first, ever figure out why the rest of the U.S. other than New Jersey and a couple other states still have first-aid squads instead of EMS? And NO their not the same. Believe it or not there is a reason why NREMT does not allow kids to take the test, it is not the didactic training and skill stations. It is the maturity and ability of life experiences and the ability of thought processing .. yes, scientific speaking does not occur until about the ages of 18 to 25. Now, the community does not allow you to respond to emergencies that involves alcohol... That is smart since that means over half of the MVA's and GSW's, domestics, altercations, fights, falls, overdoses, involve ETOH intoxication. Makes the call volume small huh? Take vitals signs.. good, after the first set, I have a machine that can do that.. Not worry about other crew members.. there again, is the immaturity. I worry about members that are double to triple your age on calls. You see it is my responsibility.. that is part of the job. Do the paper work? I certainly hope that you do not mean the patients report or medical report. Attorneys, would have a field day on a minor .. not just giving care, but documenting it as well. If you did a procedure wrong, does your parents know that they may loose financially as well? Now, I have your feathers ruffled, let me inform you I too started in the field at the age of 16. Even completed my first Paramedic training by the age of 17... and that was 28 years ago. So, yes I can speak from experience. EMS is a medical profession. The role of EMS can and does affect many at any age that can produce long lasting effects. Be it traumatic events or psychological tragedies. How a person can deal with such events is largely based upon coping mechanisms developed during their life time. It even effects some at the age of 40 forever. read a few of the posts.... Just knowing how a piece of equipment, the memorization of classroom lecture is really only about 10% of this job. The other 90 % is difficult to describe and has to do with dealing with people (even the drunk ones), taking care of peoples needs (albeit may not be medical), and yes, even worrying about your partner. It is nice to see youth interested in EMS, but placing the responsibility and liability on one is dangerous for both the patient and Junior Medic. I highly encourage you, if you have the desire to continue into EMS is ... to enjoy life and have fun.. EMS will be there when you reach the appropriate age.. you will have not missed anything. As well, within 2-4 years, you will see a major difference in yourself on how you think and react. If the community really cared for its citizens they would contract or install a professional EMS, that can provide more than First Aid or at least use them for that ... provide the first aid followed by EMS for medical care and transport. Especially not using youth for free labor. R/r911

Might want to "perform"search there are many on this nad other forums. The best advice is to study an learn conversions and basic Algebra as much as possible. There is many good text books on Math for Pharmacology as well. This is one of the better sites that has some good information on pharmacology and math for Paramedics. http://gaems.net/download/drugcalc.pdf Good luck ! R/r 911

I too use 5 - 10 ml/kg of the ideal weight of the patient, not the true weight of the patient. Yes, many use 10 ml/kg but lately, many have found out that that is too much. As well I too use just enough to make the chest rise and adequately filling lungs with ventilation per auscultation as well. Many make the assumption, to base it upon sat.'s which should not be confused with Fi0[sub:cec05f215b]2[/sub:cec05f215b].. R/r 911

Okay, I though it was these guys.. the Original Atom Ant not be confused with Adam Ant...LOL ! p.s. .. good to see Doc back on!...

True, technically we cannot diagnose, yet again when one determines there is no pulse, and start CPR , have we not actually made a diagnosis? So yes, we make clinical impressions, not technically a diagnoses. With that we don't assume anything, we attempt to obtain an pertinent H & P, and make such clinical impression and yes, treat and transport accordingly. It really, does not have to be a "doc" to make the right decision. I would not trust any level of an EMT that did not know and could not at least interpret the differential between the usual flatus pain and an appy pain, versus a AAA. As well, this definitely does not excuse anyone or give permission to endanger the patient and others while running lights and sirens. R/r 911

You need to ask "initially accredited" for what and to whom? This could be anything from private business school to state vocational or even the true Commission on Accreditation of Health Care or Co AEMSP programs. One meed to investigate and ask what is completed. It takes about 3 years and lot's of paperwork to become truly accredited. There are very good programs that are not or not yet accredited, but accreditation does reflect that they have placed interest, time and money into a program, not just classes. Good luck on your endeavor. R/r 911

Actually, since the "ant clamped down" on the tonsil, rinsing with soda might had been easier, but doubtfully it would had removed the ant in fact might had irritated the insect more. I too, presumed that the visualization of the oropharynx with the laryngoscope was more for visualization and use of magils was to remove the attached insect. I agree, I did not interpret the post as larygnoscopy of the pharynx area. I personally thought it as an odd call, and personally might have done the same, since I usually do not carry tongue blades and very few times even a penlight with me.( Yes, I routinely use a laryngoscope to check pupils. it works and easy to get to). R/r 911

$14 K.. Wow.! Someone is taking you to the cleaners, a brand new one we are considering purchasing is only $9K... with all the whistles... Yes, they are worth it, if the extra 30 pounds is going to kill you something is wrong.. take of the packs, and all the gizmos on your waist. Repetitive lifting is what ruins medics back, not necessarily the amount on one call.... review workmens comp cases and see how a much a back injury costs the service.. Sure their not the "end all", but in a few years, one will wonder whatever happened to "manual cots"; I heard the same gripe when everyone went from the traditional two man lift to the folding cots... If you have not used them, you really do not have an actual opinion then... R/r 911

Dubin's is most trusted and has been around for years, most medical schools use Dubin's as well. There are several other cardiology books to accompaniment Dubin's.... R/r 911

Invite him to enter this forum. Now, with this said.. "he's an idiot".! First, if he does not know what it is or know what to do, then he needs to seek a career counselor for a different profession. There are only a few conditions I will run back "hot".. an AMI, that only chance is a CABG and this is dependent on how anxious the patient is, CVA in occurrence for thrombolytics, and AAA that appears to be tearing.. maybe a few other cases. Like you described, you saved maybe a whopping 30 seconds and for what ? I would invite him to consider this, if the patient was killed in the EMS unit while responding back to the hospital and yes, he apparently was stable as you described, what would his legal coverage be? Good luck, hopefully you can get a partner that knows "what to do" R/r 911

Too good ..like Al we share the same D.O.B..... R/r911

This has been discussed earlier as well. I agree, formal grammar may not be required, but at least some form of sentence structure and spelling (p.s. there is a spell check & it is free!) R/r 911

Good luck to you!.. R/r 911

here is one...