Ridryder 911

Well you have been fairly warned. Good luck R/r 911

Go to any EMS forum and just type in New Jersey and see all the postings. Any state that still has "first-aid" squads in lieu of EMS and many numerous other blunders. I agree one state to avoid for a future in EMS or even to drive through......just in case something could happen. R/r911

That is part of the problem with EMS of today. When EMS was primarily based in hospital settings, EMS personnel could observe and realize that job duties required more than was normally thought of. As well, they were exposed to medical and medicine on a daily basis. Now the most they are exposed to medicine is the ambulance receiving area or on their limited clinical assignments in their 10 month program. Yet, they assume they know all about the medical field and even then it could be debatable that many EMS providers are truly medical providers. I do not know if I would recommend someone to be a nurse to just to get the education and experience. Really, there are too many nurses today that are there just for that. When in reality they could care less for the nursing profession or the care that a real nurse provides. Unlike many that enter the profession today, it is not just essential to provide great medical care but to give the psychological and "gulp" empathy as well. Yeah, the humanistic part. Hopefully, we won't flood the market with those that just to use nursing as a stepping stone; alike we have in EMS. Fortunately, professional nurses take their profession much more serious than those in EMS. At least they continue to realize the need of a formal education. Even now; I am seeing more & more states increasing the requirements and denials of distant learning programs, even with the shortage. Evaluating that even though one may have passed the test, they are not meeting the industry requirements..."administering adequate care". Again, something we could learn off them. I would suggest, if you want to teach EMS professionally obtain a good science degree and then a graduate in adult education. The understanding of general science and care would be fully understood but the need to understand philosophies and modes of educating the profession would be understood. Again, one of our pitfalls in EMS. The educators are not educators rather they are instructors that train. R/r 911

Yes, its sad that families do not enforce or mandate reading or even worse; increasing one's knowledge. If there is any emphasis placed, it is to memorize to pass or have the best score on a test. Knowledge of the material is irrelevant to many. Just get the score to succeed! As a professional educator it is becoming more and more difficult to teach from EMS textbooks that are written at a 6'th grade level. Even worse is the majority of the students are still having a hard time comprehending the material or the new generation attitudes of wanting it to be "spoon fed" to them. Whining and making excuses seems to be the new agenda instead of studying. I have had students that actually failed open book quizzes at home on their computer with no time limit(s). Is this what we are producing and expect to save lives? We have lost one important thing in today's society. Common sense. One should know reading is essential in life, spending more than you make causes you to go in debt, not being employed will not bring in money to pay bills. I do disagree with the author "that those of the Christian Rights are completely unmoored from reality". When in reality, we realize that a "pied piper" cannot change anything. Politicians (no matter which party) lies & only tell you what you want to hear, as well NO single politician can ever correct the problems. As those of the right side does promote private education and harder standards in lieu of bureaucratic government mindless programs. It has not worked yet over forty years and we still attempt to make it work. We still attempt to change the standards and qualifications instead of how to reach those standards. I believe it is going to get much worse than we want. Hopefully, some basic values and common sense can reemerge. Educational knowledge will be required and rewarded respectively, hard work will make you succeed, that money is NOT the whole purpose of life. Unfortunately, many have never been taught any different, we will see the results of this. R/r 911

Many professional services insurance requires the age to be at least 21 to 23 for employment; so kids are not usually placed in charge. R/r 911

They work as a ER Tech/Paramedic they can assist and administer med.'s , IV's etc. Again as I IM'd you, they also work on the ground transport unit and assist for Neonate transports. Again, as well one has to have the minimum of five years as a Critical Care Paramedic and I believe all the traditional alphabet certifications before applying. It is a competitive and difficult position to get as there are many qualified applicants (with flight experience). I do not believe there is any vacant positions at this time. Also I believe (not 100%) one has to be at least 21 years of age as well, as driving will be required. R/r 911

Morphine is also routinely administrered sub-q as a secondary route after administration IV or even IM. The good thing about the route is that the duration lasts longer. Therefore helps controls the pain and helps control breakthrough pain. R/r 911

I would like to add that most do not know much about obtaining lab specimens. Many are not aware as well the time allotted for the blood, as well as some has to be drawn first, lightly rotated, placed on ice, etc.. Believe it or not, there is a reason most hospitals do NOT want the baseline labs drawn by medics as pointed out. It was used at one time, but alike anything else experience has proven it not to be beneficial and risky. R/r 911

The first thing is medics have to be involved. Apathy is our real killer, the problems is because of our lack of actions. In review, if we were dependent on todays medics to start EMS again, we would be in bad shape. Thank God there were those before those of today. Lip service is cheap, action(s) are not. R/r 911

I don't know where "Crochtity" worked at but I started in the late 70's in a small poor rural town. We had MRL monitors (LP was not invented for prehospital yet) no strips but we carried about 30 medications and performed intracardiac sticks as well. We as well performed intubations and yes we had to mix medications which was a bummer but at least Paramedics knew how to perform medication admixtures. As well, I performed RSI when I worked in a small oil town about 8,000 people and had protocols to do central lines and yes even in the late 80's Fibrolytics (TpA). No 12 leads, but we did perform multi leads and yes even a pacemaker that attached to the LP5 with a 9 volt battery in it. So yes, there was such a thing. In retrospective my protocols were much more advanced than now. We had albumin, and even had Troopers transport O- to us to start on patient with a long extrication or for scene to interfacility transfers. Prehospital Dilantin & Phenobarb.. so in patient care I was able to provide more care. Now, I have to admit as well that the majority of Paramedics I worked with between 1982 and 1992 Paramedics had a degree as well. I will admit the units were primarily van and at one service suburbans and unfortunately were not well taken care of. Yeah, I have sawed more than one LSB to cover a hole in the floor and the wind going through the trailer was so strong it would literally blow out the gas heater. One night alone all trucks were shut down do to poor maintenance. So yes, it definitely had it bad points. What I did notice though was the personal at the time usually did the job because they really wanted to. The pay sucked (more so than it does now). Now, I will admit that the units is nicer, the pay is better, and the living conditions are tremendously are much better than they used to be. Also working hours is much better as well such as most do not work in ER and field at 48 hours at a time. So there is a pay off. As much as there were good times, I would not want to go back to the past. I miss the personalities and the dedication of those in the past. Rarely, I see such of this anymore. It is much more about the "me" than the patient. I am glad though that some of that attitude is there (usually from us old medics) enough to want EMS to change into a profession. Making it a better profession than when we started. R/r 911

Unfortunately, you are correct many (even educators) are promoting Fire Service. Why? Well, they fill the classrooms with paying bodies. Then again, what in the hell is EMS Administrators doing? Then the viscous old "not enough education" pops it ugly head up again. This time in EMS Administration level. Shameful, that even Fire Service may even have us beat on this one too. How many EMS Administrators actually have formal training other than being a medic prior to promotion in Health Care Administration? What does American Ambulance Association (AAA) promote other than either large corporate philosophy? How shameful, that there is not a real type of accountability in EMS. As much as a Nurse Manager, I loathe JCAHO but at least it has made some advances in hospital regulations. Yes, we have one in EMS but it is a joke as well as most State EMS Councils and Divisions. EMS will never go far for a couple of reasons only. Medics will take the easy way out and never give the support needed. They even blew their own wad when adjusting Medicare rates in comparison to air EMS. How embarrassing. Medicare would had adjusted rates accordingly but the administrators groups could not justify net raise in rates and distribution. Why? Number of potential qualified applicants versus pay structure and costs off-sets. Where as aeromedical could state: "We have to have this $$ much for this qualified applicant".. and Medicare said ... Okay, name the minimal price. So ground EMS is suffering for our boss's mistakes. Meanwhile don't provide more intense care cause it will costs more to offer, don't become more educated- you will want a raise, let's promote Paramedic mills and flood the market.. You know the supply and demand issue..

I guess it always goes back to the education or lack of. Until we have really met the needs of the basic education we should not expect anything but ambulance driver pay and really should not do anything more than that. If I was Medicare or Insurance payer, I would look into detail why I am paying several hundred dollars to a few thousand for a glorified taxi ride. Seriously, just placing oxygen and a set of vital signs on someone, justifies such a bill? I know we have soap boxed this to death, but until we quit trying to live inside the box we will never increase revenue, and never pay what salaries should be. Then the vicious circle is we have to have the required education to accompany it. In regards to checking internal ear, yes I do educate Paramedics the use of the otoscope and opthamaloscope as well. Yes, they are taught to check for bulging, detached ear drums, redness, etc.. The same as in the use of opthamaloscope use to evaluate retinal artery, etc... Is it always appropriate to perform and need to perform? No. Is there a time and place? Yes. Again it is dependent upon how well you what your Paramedics to be educated.

I am appalled at the responses. Seriously folks if don't know the value of twelve lead use in the field then I have serious doubts of understanding cardiology. C'mon its not rocket science teaching and understanding twelve leads, as well if you do not see the whole picture of an ECG then why even hook them up on a simple monitoring lead? Really, what good or what does that really tell you? If your medics do not understand the physiology and do not know the differential treatment from an inferior wall and being able to see a post inferior then you have problems. Your medical director should be one of the first to endorse a better diagnostic tool. Times are changing. Alike trauma center alerts and appropriate transports there will be designated and appropriate centers to handle coronary problems. At this time we our investigating a "heart alert" in which will be similar to trauma alerts to inform the EMS unit which hospital will receive the coronary patient. Alike trauma registry, there is going to be a heart registry as well. Not all hospitals have interventional therapy in the cath lab and thrombolytics have fallen out of favor if they can be in a cath lab in a reasonable time. Although I agree relying upon technology is foolish, not using it appropriately is reversing and stagnating the system. I now see hospitals paying attention to prehospitals twelve lead due to the new JCAHO twelve lead rule, and with the technology of blue tooth and faster transmission makes it easier and more clear. I believe we will be dong more tests and yes, will have to increase the responsibility (of course increase the education) of the Paramedic. I-stat will help make the determination of potential versus non-AMI. Again, the role we will be playing will be much different than it is now, with the increase of no available beds in hospitals and ED's EMS will be more a screening process. R/r 911

Most nursing programs only teach the very basic of cardiology. It is considered a speciality and cannot even be tested on the NLN Board. It is presumed that one will attend speciality classes and orientation courses in the field they choose after they gain employment. The BSN has no more or less in emergency education than a ADN, rather the emphasis is usually management and public health care. CEN is test similar to the Paramedic examination, actually better written and wished we would utilize it. It is for nurses that have ED experience and have attended courses to make them aware of Emergency Nursing and the knowledge and skills required. It does NOT allow them to perform or do anything differently than before, rather it is a recognition that the nurse has taken an initiative to increase their profession and to promote speciality knowledge. I recognize your concern, just remember though I have seen as many medics be as stupid and attempt to convince others that they have the required knowledge (since EMS is a specialty) and they do not. This comes down to watered down ACLS and cardiology courses, that I now also see the same results in the prehospital arena too. Maybe a possible dual in service after discussing the problem with the Clinical Mgr. this would hopefully gain education for both and promote a better working environment. R/r911

Requirement would be at the least a B.S. degree and another medical license before entering Paramedic school. This would eliminate a lot of our problems. At the least most would have to be able to read and this would eliminate a lot of the wanna be firefighters and having another medical license would mean at the least you have a partial understanding of health care.

You have just represented yourself as not knowing very much about medicine. There is NO such thing as basic or advanced as there are only treatment modalities. The only reason such terminology was even invented was because it was necessary for EMS to have division. Do a little research on the history of EMS. Unfortunately you and alike many others assume that EMS is only mainly compromised of the prehospital arena. In fact it is only a small portion. To answer your question; EMS would be best placed as a third party type system. Alike those of the Fire, Police then EMS. I now ask you, how do you feel of some successful EMS agencies now offering to manage Fire Service at a lower and more economical rate(s)? Possibly even privatization? I do believe as cities come under the crunch, this will be a very favorable option. Not alike EMS (which can be a profitable) Fire Services can definitely be managed better and better streamlined. Again, city officials not having to deal with union(s), benefits, retirement, etc. Equipment could be owned by the city alike many of those that contract EMS out, the personal could be contracted alike EMS personal. R/r 911

Again you confuse the issue that an EMT course is a medical course. It is not much more than a First Aid course. I leave by saying history repeats itself and again Memphis prominent history and poor reputation is represented by statements alike yours. R/r 911

Naww... Just remember either they are a 13 year old pimple faced kid with no friends or an 40 year old that still lives with their mother. Poor pitiful life that they must troll onto forums and attempt to stir up debates for some conversation. Either they were banned from the beastuality porn site or have to use a computer in the public library. R/r 911

Well, I have stayed out of this until now. One could really describe firefighters job as "one that only places the wet stuff on the red stuff".... if one was ignorant on the understanding of Fire Science. Seriously, as one that even has a formal degree in Fire Science & Safety Engineering and a former line officer, realizes and knows that the majority of Firefighters are primarily hired from the neck down and emphasis not placed what is in between the ears. Hence, why many have even boast that the candidates comes from; not the "highest scores" to be the best candidates. Unfortunately, it is the educated Firefighters that is usually placed at the higher level of command and not in the line firefighting. Those that place persons for a profession or job placement recognizes those that enter that profession is usually better suited to be "trained" than to have to have a formal education. If you do not know or recognize the differences then there again that is part of the problem. The industry of Firefighting itself is a vocation rather than profession. There is very little requirement of complexity of objectives in the general role of a firefighter. It is again a vocational trade that is usually considered to be a "blue collar" profession and again the basic general role of a line firefighter is not complex. The system is supposed to be set up for those with experience and some training and maybe even those with a true education will be placed in command or supervisory roles. Similar to paramilitary that those in command should actually have the required knowledge and experience and monitor and direct those in the line that does not. Hence the problem. EMS is not firefighting nor public safety. Unfortunately, somewhere there was confusion placed that because a few cities dumped the ambulance or EMS in the fire department that they are medical too. No where in the abbreviation of EMS is there the wording or similarity of extinguishment, rescue, etc. Emergency Medical Services; again even the wording medical and again where many firefighters and their employers fail to recognize it is medicine not safety, suppression or even rescue. No similarities ever should had been made nor should ever be made. Here we go again. A self proclaimed expert. One that is not even a Paramedic attempting to inform us on how and all about the profession. Unfortunately again, one that is speaking for our profession that is really NOT in the profession. Sir you are NOT in the health care field. So really you are speaking out of turn and in ignorance. Due to your education or lack of are NOT capable to give a informed opinion about anything in EMS. Again, not to be rude or callous but truthful. Pure fact. We would not take the opinion of a Law Enforcement Officer spouting off limericks and half true opinions because they have responded to structure fires as part of their duties or they took a basic firefighting course at one time to be credible within your profession. Why should I or anyone take a Firefighter seriously as well? We that have been in this profession as well as those that have been in Fire Services more than twenty years know the real reason for the sudden interest in EMS. Alike other professions that has done a good job in their duties, as Fire Service has in fire prevention and code enforcement, the real reason for sudden interest is job security. Suppression numbers has been in the decline for decades, equipment and salaries has escalated and city funding has been increasingly tight. It is not surprising to attempt to justify existence other than for the sole reason of ISO ratings. Truthfully many cities realize that if it was not for such, many Fire Departments (even large ones) would and could be primarily a paid/volunteer type system. Would it be in the best interest of the public? No, neither is having EMS within Fire Services. Again, neither having any similarities. The reason you do not understand what "my job" is; is not really your fault. Unfortunately having such an opinion just actually demonstrates and represents the majority of those that where either poorly or ill prepared for the EMS profession. Not receiving the proper education one could easily gather such an opinion again assuming they really do know about EMS. Just because one thinks they know, does not make one an expert. I use the analogy of ...."place the wet stuff on the red stuff".... as an example of ignorance of knowing about a profession, the same could be true about those that acclaim to know about the EMS profession. I have been in EMS long enough to know and recognize Memphis reputation. It has always been known to be one of the most problem areas in public safety. Recruiting techniques have and are currently in place because of just such. I do doubt that they will be able to maintain the required accreditation level. It is not because it can't be done, rather the mind set of most Fire Services is aimed at training not educating, which the accreditation emphasize. R/r 911

Good, we need more that have a feel for both sides and bring medical to EMS. I am going to p.m. you later, I found out that a fellow graduate of my Paramedic class is in adm at St. Johns EMS. I had not heard from him in about 24 yrs... R/r 911

Here is the reason they did not interview you. They probably had NO job vacancy for a basic. You were top in your Basic EMT course... so? I don't even let students know if they are or are not.. no reason too. EMT is just one class. Saying such would be similar to saying "I was top in Psychology 101 course!". You should had been informed that Basic EMT's are a dime a dozen. If they had an EMT opening, it probably went to an EMT already in Paramedic school. Remember, it is a competitive position and those that demonstrated that they are serious or already have experience than are advancing will be chosen over new graduates. R/r 911

Why? I do it sometimes with 48 on and 24 off even in a busier EMS. Also know of services with 48-72 on. Remember, not all services run extreme number of calls. R/r 911

I find it amusing when all those "Paramedics" run and enter into nursing school and graduate only to find they take a cut in pay. Even at $25 -28/hr in comparison to the yearly salary. Even more so, instead of baby siting the patient for 30 minutes now has them for 10 hours. There is usually no break time and one can barely sit down. If one is able to provide the "best care" they can; it is an oddity and rarity and not the norm. Hence I am seeing many of the former Paramedics to RN's now wanting to return back into the EMS arena. Alike myself, realizing you did not recognize a good thing when you had it. I currently have three RN's in a refresher course to allow them to re-take the NREMT for their Paramedic license again. I do believe we will see an influx of those that had left the field as the pay, shortage and demand increases for seasoned Paramedics. I know employers will welcome those back in lieu of the new generation of graduates with the new "generation Y" attitude. All I will say is that is nice to see Paramedics again that will want to work, give excellent care & enjoy their job while doing so. R/r 911

Kelly shift is usually a 24 hour on and 48 hour off with a rotation of rotation of the cycle of seven times, one got 6 days off. We use a modified Kelly of 24 on and 24 off, then 4 days off. In comparison for salary based upon costs of living, for example renting a nice apartment in my area ranges from $400-700 a month w/utilities included, a very nice home w/land can be purchased for little over $100k and I am paying just $2.00 -2.10 a gallon for (real) gas. Which in comparison of some areas is much cheaper but again the salaries are adjusted. R/r 911

Yes. but compare your costs of living in proportion? R/r 911