Ridryder 911

And...I'm going to go for one more...cuz that's how I roll.... 8

One more for good measure. What is the "colbert report"?

You know what, I totally agree you !. Now we agree upon this, we should also agree that this is not just isolated to medical treatment and care. Incompetent of knowing ones profession and what the current standards and treatments are, incompetent of knowledge of how to read, interpret studies and stay abreast of what the current medical treatment in ones specialty is as well. The same being one can be incompetent of ones profession by not participating at local, state and even national levels to change education requirements and EMS scope of practice. Increasing public awareness to reduce abuse of the system. Incompetent of being a patient advocate by promoting a decrease waste of governmental spending and patient costs on needless treatments and transports. I am glad both of us agree on one thing, that there is a lot of incompetence out there . :wink: R/r 911

Certainly seems it... Ok...this is getting kinda....trippy.

hmmmm well try it this way maybe ...lol Race YAY worked that time that 14 and counting

Just remember you can't fix it, if you don't know what is broken. No education is wasted, you might be surprised on what influence and mentoring you might be providing. I worked with a Basic EVO, that had a graduate degree in Bio-Chem. and he no desire to ever go further in EMS. He however had the desire to be the best EMT and EVO he could be. I truly say, I never had to ask for equipment, prepare any equipment, and get a mapbook out. He performed very highly at his level, and had a lot better knowledge of pathophysiology than most Paramedics. I always tried to encourage him to pursue Paramedic, because of his patient care and professional demeanor. Although, I had a higher medical license than him, he taught me calmness in a stressful environment when the feces hit the fan, being prepared, and gentleness to patients, and the main thing professionalism. So, attempt not to too discourage, no matter what level you are at, you might be teaching someone. R/r 911

welcome to health care.. I hear this with physicians spouses as well.. at least you do see him. Seriously, maybe he can arrange some time off for the both of you to spend some quality time. Although I am sure the might be nagging him and he is the new guy.. he will have to say a couple of letters to change things.... No...- I can't work. It is hard to do, but if he is not careful he will be burned out physically and emotionally. It sounds like he was a medic before you met him, so being supportive mate is very nice I hope he appreciates that. Many would not be so supportive. As well, remember that as a new guy, he is probably trying to get build up some time and experience, as well as some cash. I suggest writing a letter with your thoughts and describing how much you miss him.. ( worded nicely). since he is tired, attempting to discuss this with him might be misinterpreted as nagging. This way he can read it possibly on some down time. If this does not work, then I would discuss this one on one. I realize by being a medic and had been married to one as well, it can be very difficult at times.. Good luck, R/r 911

We are open 24/7 and no bashing EMT's is not are main point. Difference between ignorance and stupidity, is ignorance is not knowing and that is simple to change, stupidity is refusing to learn and expand ones knowledge. Something that is not tolerated on most EMS forums (that is what there for) . We attempt to promote thinking outside the box and exploring ideas other than incestial ones. I do suggest reading new text, journals and research studies, things have changed within the past 15 years. it might be nice to know what the rest of the EMS world is doing other than your own.. R/r 911

Even though, I have lived in rural areas most of my life... now it has became urban. Yes those people are aware that they probably will not receive care like those in urban and metro and yes, it would be hard to make the decision for risking lives of those in far away land.. although we risk our lives for less ones (cranksters, gang-bangers, etc.) Please however; If I just so happen to be passing through to another town.. I hope me and my family can get the best.. R/r 911

Actually tinman, most of the educated and professional medics I know pay no attention to EMS forums. That is why there is the usual same posters. Most profesionals regard these sites as "wanna-bees" and volunteers. Mainly those that really do not represent the true EMS. How many truly professional medics post here? < 50 .. <25 out of 5000+ members, and these are from hundreds of thousands of professional medics. Says something about the regards of what professional medics really consider in regards about EMS forums. As far as playing Dr., never professed to be one nor do I have the desire to be one either. However; this does not excuse us from having the knowledge of emergency medical care and providing competent medical care, that education not training can provide. The intent was always to stabilize patient for transport, the definition of stabilization has broaden and will continue to even more. As well, as the "you call.. we haul attitudes" will soon be long gone. The day of the overrated taxi cab is over, insurance/ medicare is tired of feeding them. They expect something in return and the patient should receive it as well. Anyone can load a patient onto a stretcher and transport. Treating and preventing injuries /sudden illnesses is however is a different story. R/r 911

Wow all those boxes were hurting my head!! R/r 911

Wow I thought Dixie (Alcomedicism).. was back!!!

You do realize you just jinxed yourself.... :shock: R/rr 911

Amen Dust!... What is next requiring physicians to attend Universities?..oops.. wait that happened, oh.. what about nurses, lab techs.. oops that happened as well...well at least I can be an ambulance driver. The public is demanding we have better education as more baby boomers become older adults they were raised upon Johnny & Roy and they expect at least that level, as well as their children. Now physicians is studying why we continue to screw up procedures and the outcomes are going down. Even the insurance companies and medicare are tired of paying high dollar amounts just for a taxi ride.. the only resistance to change is ourselves. Now this is a shame and sucks. Our own so called profession, rather boost upon ego on how things are so good (are they?). Are we the only ones that are not seeing it ? Apparently so. John Q. Public is tired of hearing and seeing excuses. You want to play health care, you better damn well better be prepared. This means in all realms. The public is now expecting excellent prehospital care, this includes AMI recognition, ACLS, pain management, and competent medics. We want to be recognized and honored for such, but at the same time we do not want me our obligations. These being whatever is for the good of the patient, not just for ourselves. I know there will be a possibility of composing a tri-district in my area in the distant future. Am I happy about this? No, but this would be in the best interest of the patient(s). All persons wold receive Paramedic level of care as well as establishing a funding to maintain that level for all citizens. Again, the good of the many outweigh the needs of one. I predict within 5 years, there will be a rapid amount of changes. Public will demand it so much, major changes will have to occur. The unfortunate thing will be someone else will mandate it and not ask our opinion, thoughts or really care what we think.. but alas we are going to allow it to occur. The writing is is on the wall, instead of fighting change we need to be sure that we (EMS) will control it and make the appropriate changes for ourselves and not have to depend on someone else to do it for us. R/r 911

Are you aware your Brady book is written at a 10th to 11'th grade reading level as well? Want to know why? It is assumed by studies that most Paramedic students cannot read above the Senior level. Makes one proud of a profession huh? Still want to debate the need for education? Just because you have experience at various services does not make one an expert (might want to look up definition of such). Obvious it is clear you do not have a higher level of education, otherwise we would not be debating a proven thing. I will no longer will debate the values of education with you. It is apparent you do not understand educational concepts, theories and what truly mastery level of standards and skill performance really are. As well, have you not recognized we are the only health care provider that does not require a formal education. Does one not see why our profession is in the crapper? Want better pay, recognition by health care peers, one needs to do the minimum level as everyone did. You allude to incompetence in the field. Are the current methods of training or educating working? Obviously not, again even you allude to that several times. You can not fix something unless you admit it is broken, and you are right it is broken! They way we train EMS personnel is horrible. That itself is the problem we train, not educate, which would mean one would have to think and rationalize, not just follow protocols mindlessly. Again, there is complete difference between the two. Remember providing health care is not black and white, it is not an exact science, it has an art as well. Making rationale decisions based upon education, and good clinical background experience is essential. Far as making a statements of incompetence, one better have proof other than field experience. Acting like an idiot and being incompetent is totally two different things. Even saying such or implying such on one, can have grounds for slander.. you might want to look that one up as well. R/r 911

Thanks Dust.. exactly. That is why there is an asterik on each protocol : Upon discretion of the Paramedic. This allow the Paramedic variables to treat the patient accordingly. R/r 911

Cardiac Arrest : Mine is simple. Follow current AHA/ECC current published guidelines. * If patient has been found in cardiopulmonary arrest, with a documented time > 15 minutes and confirmation of aystole in multiple leads; resuscitation measures may be withheld at this time. Special consideration and conditions of cold water drowning, electrocution does not apply to these situations. One can contact medical control for field termination if patient is in aystole (confirmed in multiple leads) and has not responded after second round of ACLS pharmacological agents. ** As with all protocols, Based upn the discretion of the Paramedic. Notify Medical Control as deemed necessary. Changes... no, cardiac arrest is one of the simplest calls to work. The only change we are considering is increasing the Vasopressin dosages. Our local Heart Hospital has been doing clinical research on response to Vasopressin on a higher dose. R/r 911

Appearantly not. If you did read the studies, you would find out this was not the case. Appearantly poor confirmation of assessing the tube plaement was the main key factors as well as displacement during movement. These studies were performed in high volume areas, so intubations occured often and routine. The purpose of reading studies is see the weaknesses and possibility of changing to correct the problems. You are endorsing protocols so much, this is a good example. I read the four studies of poor intubation ratios studies and the protocol committee along with our medical director, administrator decided to avoid having such incidence changed the protocols to have EtCo2 wave form on all intubated patients and as well show run a strip of such just prior to movement of patient onto ER stretcher. With this information, we will always have 100% intubation ratio.. other wise the patient will either have alternative airway, crich or basic BVM. But no patient will present with an ETT in wrong placement. How does one think protocols would ever change, or physcian becomes aware of new methods, better treatment regime, without reading studies and research ? Do you not have inter action with your medical control and re-evaluation of outcomes, and treatments? Just because the protocols are written does not mean they have to stay the same again they should be used as guidelines not direct "what to do" in every case. They need to be evalualted at least twice a year and have revisions made as necessary. R/r 911

Apparently, you are not aware the difference of "training" and education. Training is the basis of being taught, specific objectives of a specific area only (no outside theory studies or discussion) and the direct application of such & if skills are associated with those objectives. Where as education is one is tested on the objectives of that specific areas, including theory, application of use, and may require prerequisite or co requisite courses to enhance the knowledge needed. If skills area are required, then one must properly demonstrate competency in those areas. Therefore one finishing up through an education system should have the minimum knowledge base. Again, this is what all board exams test upon. Minimum knowledge to be able to provide safe, accurate patient care. Then to build expertise later, after clinical experience. Although, there is incompetence at all levels, including physician this is not based upon their education level, rather it should be based upon the individual and how they applied their knowledge. It is apparent at one time they had a level of competence, and knowledge otherwise they would had never graduated, and pass board examination. Of course this where part of the basis of negligence can be made. Yes, clinical experience should hone these skills and one should be able to apply their knowledge as well. With time one should as well become proficient in his/her profession. Now the concern I have is for lower level EMT's to describe what is incompetent? Really, by what standards are they using to evaluate and judge such? I hope it is not the basic or intermediate level text (6'th grade reading level), or training they have received. Or is it the anecdotal way of doing things? Like I describe earlier, yes incompetence occurs at all levels.. but be sure that one does not "make a blanket statement", which displays lack of knowledge to themselves. R/r 911

Personally, I experience such patient experiencing such symptamology, I would not refer to SVT/PEA. Further examination needs to be addressed. There is something missing upon assessment, or interpretation of the rhythm. Again, as many has described, SVT in a PEA syndrome is unheard of... enough I would re-consider my interpretation, and look for other clinical findings. Such as differential leads, and more detailed assessment and history. I have only experienced a few bizarre non-perfusion rhythms of tachycardia. Usually those were of patients on dialysis which can produce an ultimate array of arrhythmias and situations, they are so electrolyte imbalanced, anything goes. Again, the key would be to treat the patient and start resuscitation measures... since there is no pulse. As Punisher describes epi.. and follow the regime of cardiac arrest/PEA guidelines, with ruling out causes and trying to determine the etiology. R/r 911

1) You are absolutely right, and that is why formal education should be required for all levels. At least with this way we would be at the same minimal reading/math/ comprehension level. Along with this the 1 junior high reading level textbook could be totally eliminated, and detailed in-depth studies of systems, specialties could be explored. 2) There is not enough paper to write a protocol for every event, as well as having a medic memorize them. That is why protocols should be written as "suggested guidelines" so that they can be adapted to, not followed as a cookbook. There is an art of writing good protocols, again, leaving the discretion up to the medic. That is why medical director participation is so crucial. If one cannot be trusted with patient care, without specific treatments, procedures, written down, they not need to be there. There are plenty that can provide good care that could replace them. Allowing incompetency, stupidity, should never occur. Patients deserve more than that. Each service should have an active education department, that regularly tests protocols, CEU's and grade level and participation should be part of that employee evaluation for merit raises and ability to keep ones employment. An active TQI department to monitor skill and knowledge level. Unsatisfied skill levels or misdiagnosis comparisons should be closely monitored. If there is apparent poor skills, then either perform skill reviews by class, clinical performance settings, should be offered to that employee, if this does not correct the problem then discharge of the employee. 3) I have to admit it, I am not in it for the community. Nor, do I know of very few professional Paramedics that are. They are in it for a profession, that provides health care for the community, and by being competent, well abreast of the medical standards, keeping continuation of medical knowledge and skills, I am providing a much needed service for that medical community. One does not have to be community orientated, to provide good professional care to each of their patient(s). R/r 911

Actually, the article is half right.. what do you expect form a fire web site... lol Ambulance services such as ones in Florida, Washington State, Wishard in Indianapolis, instituted training programs for ambulance services. Remember, most ambulance services were funeral home, hospital, and some fire departments. The National Registry was formed to keep a "Registrar" hence the name national registry for trained medics in case of war time events. hmmm.. didn't see that in the article. Remember this was in 1968-69... and Vietnam was still going on strong. Johnny & Roy was not even a thought yet.. until mid 1972-73. The infamous late James Page ( hence a play on the name Johny Gage) was a technical consultant, and provided insight. The rest is history on promoting EMS advancement. Pioneer physicians that this article did not include or I did not see one was Nancy Caroline. I believe she was Chicago EMS medical director. She was one of the authors of the DOT curriculum and the produced it in bound copies called Emergency Care in the Streets.for easier distribution and $$. Yes, there many states that had variable training of Paramedic. Later when the D.O.T. did come up with the 15 modules for the EMT Paramedic curriculum there was at least a national standard. One needs to remember that courses like ACLS, PHTLS etc.. has not been invented yet, into mid 70's. The NREMT did not have Paramedic level until late 79 to 80's. Until then most states had their own testing and certification. Most allowed one to be a Paramedic if you had completed the program and pass ACLS ( it was a lot different then.. most Paramedics these days would never pass the physiology questions) There was no formal intrastate recognition. R/r 911

I am not against working aystole patients.. do it all the time, however; aystole patients that have been documented in II leads and traumatic arrests that has not received any resuscitation efforts for a duration period as well as working them then making the decision to cease resuscitation efforts after failure to respond to therapy.. want to talk about protocols.. those are mine. This again is not new, and has been standard of care at most progressive EMS services for over 15 -20 years. Please read thoroughly and carefully... there is a major difference, from arriving on a sudden cardiac arrest, then those who are obviously dead. Something fishy with whole scenario, and if I was a physician I would inquire on looking at documented strips... 2 +_ 2 does not = 4 here. Either the patient was down longer, or the patient might had a large dissecting aorta or P.E. as discussed. Levity ?.. usually takes a while, and pooling is gravity dependent. (post mortem hemostasis) .. If the patient has not been properly resuscitated, with no adequate airway, conformed in aystole for > 20 minutes without any ALS intervention.. yes, I would probably call it. Then have a M.E. inquiry.... R/r 911

Place on the monitor and try to get a better hx., was there any perfusion with compressions? R/r 911

Don't know where you can go for 6 months or should I state should go ?.. But, I do agree the need formal education .. yes at the least a minimum of an associate degree. Personally would like to the minimum to be a Baccalaureate, but at least I know with an associate degree, they can read. The text would at least be upgraded from junior high to college level, in which I am sure would eliminate many. There would no longer be 1 book, rather several books on each system or specific areas... (yes, there are books on O.B. that are thousand pages long). Basic EMT course is not much more than the ARC Advanced First-Aid course... please do a comparison. It is an entry level position, what you do after that is your business if you want to stay at that level. R/r 911