Ridryder 911

Interesting things are occurring. Even with the so called "high saves" which if you look at the numbers there are really no significant changes. Tulsa F.D. ( under Dr. Sacra wing), and a few other F.D. are doing a trial study on allowing enhanced EMT/I's to administer certain medication(s) that are not usually allowed. It is no secret that Tulsa F.D. does not want to be in the EMS business or have Paramedics, however; part of their city agreement was that they would be able to perform ALS treatment (hence Intermediates) .. cheaper and fulfills their obligations. What surprises me is more and more studies or so-called theories of skill attribution rate etc.... and NONE EVER ADRESSES PHYSCIAN LEVELS ! C'mon with all the patients physicians see, how many intubations, central lines, etc. are they really proficient at ? Especially if they have either been placed on fast track side for a while or playing internal medicine or some other specialty. When was the last time you think that surgeon intubated someone? But, where is those studies at? Although, I am glad we are being paid attention to and definitely we need to improve, it does appear and seem we might be interfering with either physicians skills or treatment plan or reduction in costs. I am aware there are more and more pressure and studies to "secure" positions in hospitals. For example one state has just passed a bill allowing only a physician or CRNA can establish an EJ/ I.V. The same is true now here in mys state regarding consious sedation, it is now that no RN can give conscious sedation except for CRNA's and physicians in a hospital settings. (Can you imagine what speciality endorsed this ruling?) Now, physicians are complaining that they cannot administer meds, intubate, etc.. all at the same time, and reversal of the ruling is expected. Again, studies were performed to "justify" such actions. As the "old saying" goes studies are just as good, until the next one is published. We in EMS ned to pay close attention of not just what is published or performed, but how well the study is conducted and validity of it as well. Be safe, R/r 911

First I am by far not an EMSA hater... but bull sh*t is Bull Sh*t.. short and simple. The article main intent was to describe that with increase number of Paramedics the higher the skill attribution rate is. What they do not discuss is that every truck has at least one Paramedic, and prior to that usually a F/F medic at the scene. Although, Tulsa F.D. isstudying to change to increase their EMT/I to be able administer medications. The save rates that was reported number had to be changed. EMSA does not have BLS response units, so that is not what the article is presenting as well. Again, DUH!... more medics < ability to perform skills... no joke and that took a study? Hmmm.. so if we have fewer physicians .. the save rate would be even higher? Like I have discussed many times before, EMSA has some outstanding Paramedics and some of their services are okay. They provide fair to adequate response for local urban calls.. but don't call if there is a critical patient from one facility to another with any I.V. med.'s other than Dopamine or Lidocaine...they still have a way to go. Be safe, R/r 911

I have been so burned out on multiple times, Kentucky Fried has nothing on me. Seriously, most people don't truly understand what burn out is. Some even describe that there is really no such thing. But, others call it "stomp out"... Basically, it is really not performing your job that gets you down and it usually happens more often in lower call volume areas than busier ones. Being prepared for "the big one" at all times with in-between down time, can grate on ones nerves. Usually as others describe, it usually is caused as well by other underlying problems. There are different degrees of "burn- out". Unfortunately burn out is contagious as the flu and more powerful than someone on crank. Bad attitude (which can be a symptom) runs rabid among staff & is hard to control. I also suggest some personal counseling, this will help more areas than you are aware of. Along with this they will be able to help direct you in preparing and noticing the signs, maintaining prevention of it re-occurring. If one is not careful it will and can affect you physically and permanently. It can literally kill you with stress, and increase disease process as well as poor immune system. I wish you good luck, hang in there... please get professional counseling and you will see and feel the difference. R/r 911

Welcome to EMS or for that gos any medical board examination. They are all written, basically the same way.. confusing, frustrating, and I have yet met anyone really 100% sure of what they made after they have taken the test. If your state or locality is taking the NREMT, the school should had prepared you better by using scenario based questions and stem-key test answers, along with multiple group choice answers. I consult schools, and really encourage them to start using computer based questions ASAP, so students will be prepared for the use of computers as well. I routinely take the exam (don't ask) to see how the test is designed.. not the questions, but to see what topics and how the test is structured. We as instructors have to prepare students for the examination, without passing it they cannot get a license, without a license = no job, I don't care how damn good they were. The basic is really not hard... unfortunately most people make it a lot harder than what is is.. that is what fails most. Don't look too much into a question... remember they are only asking the minimum required. I wish you luck in your future testing... R/r 911

Actually this article was originally written in 2002 with USA Today. Dust, I believe you are right about the Stout's involvement. Jack's son was a mgr. at EMSA at the time. The studies was also done prior to this published.. and yes, even EMSA (Dr. Sacra) had to re-state some findings. Each EMSA unit is ALS and has a Paramedic, so I really do not know even how this study would involve them. This was in comparison of how ALS was being utilized. Unless is similar or identical to the same study, this is actually "old news"... The EMSA stats was also in regard that Fire Dept. ALS rigs made no difference in comparison of survival rate thus demonstrating BLS for FD was just as beneficial. This study was to emphasize that ALS is not needed on each call as well. I am sure, I have a copy of the original somewhere... it hung in the ER for months. Might check USA archives... too tired and heard the propaganda too many times. R/r 911

I am sure not getting upset or having an apathetic attitude maybe great, but most of you are the future generation... for me it wont be too bad.. there still be money. If you are under 38 there won't be... but hey... thanks for the piggy bank. Seriously, how long do you think this can continue ?... Will things change.... yes, they have to, there is no more m-o-n-e-y.. Will this afect you ?... damn straight.. right now, medicaid reimburses ER's approximately <25% .. some even have a capped rate of $25.00 so how much profit do you think EMS will make .... not upset yet?...hmm like to make more money than those on assistance? Or are you satisfied for being an EMT and making less than those guys that makes whoppers? .. or at least have insurance and medical for your family?.. Re-modification begins with the first step.. you bet, I attend and support legislative changes. Do you think EMS suddenly appeared as well.. apathy only harms a community. Be safe, R/r 911

That is what I figured.... this is not ground breaking psychological news... actually these theories hit its peak in the mid-80's as was found not to be clinically significant. Now they are trying to cash in on the private sectors for training and sales... it and CISD came out about the same time. Both now being considerd "bunk".... Science and research has shown that patent's retract to Maslow's Hierarchy and basically cannot handle such type of questioning or even making decisions. That is why they called you not so much on what you can do, as much as they do not know what to do. Over whelming circumstances overloads the sensory. Many psychologist is recommending a more softer, but direct approach, instead vagueness and open ended questioning. Since we have been through many disastrous events recently these type of studies are always an on-going process..... R/r 911

I wonder why they are re-running a story that was initially published in 2002 ? The study as well as the article was full of flaws. EMSA, number(s) was totally misconscrewed, and I had read others were too. News must be boring.... to have to "dig up" old articles. R/r 911

College... seriously, take some general education classes, if you have not yet. Basic science classes like anatomy then physiology and some English, writing, college algebra, as well. I much rather hire an educated person, than one than can join clubs... If you have an education, then I suggest going back for your medic. NAEMT is really considered a joke, NREMT is a good starting place for registration. Take some supplemental classes like PHTLS or BTLS, PEPP, etc... there are many out there. Good luck on you adventure, R/r 911

Here are a few things to think about that you probably have never thought about; -------------------------------------------------------------------------------- Can you cry under water? -------------------------------------------------------------------------------- How important does a person have to be before they are considered assassinated instead of just murdered? -------------------------------------------------------------------------------- Why do you have to "put your two cents in".. but it's only a "penny for your thoughts"? Where's that extra penny going to? -------------------------------------------------------------------------------- Why does a round pizza come in a square box? -------------------------------------------------------------------------------- What disease did cured ham actually have? -------------------------------------------------------------------------------- How is it that we put man on the moon before we figured out it would be a good idea to put wheels on luggage? -------------------------------------------------------------------------------- Why is it that people say they "slept like a baby" when babies wake up like every two hours? -------------------------------------------------------------------------------- If a deaf person has to go to court, is it still called a hearing? -------------------------------------------------------------------------------- Why are you IN a movie, but you're ON TV? -------------------------------------------------------------------------------- Why do people pay to go up tall buildings and then put money in binoculars to look at things on the ground? -------------------------------------------------------------------------------- Why do doctors leave the room while you change? They're going to see you naked anyway. -------------------------------------------------------------------------------- Why is "bra" singular and "panties" plural? -------------------------------------------------------------------------------- Why do toasters always have a setting that burns the toast to a horrible crisp, which no decent human being would eat? -------------------------------------------------------------------------------- If Jimmy cracks corn and no one cares, why is there a stupid song about him? -------------------------------------------------------------------------------- Can a hearse carrying a corpse drive in the carpool lane? -------------------------------------------------------------------------------- If the professor on Gilligan's Island can make a radio out of a coconut, why can't he fix a hole in a boat? -------------------------------------------------------------------------------- Why does Goofy stand erect while Pluto remains on all fours? They're both dogs! -------------------------------------------------------------------------------- If Wiley E. Coyote had enough money to buy all that ACME crap, why didn't he just buy dinner? -------------------------------------------------------------------------------- If corn oil is made from corn, and vegetable oil is made from vegetables, what is baby oil made from? -------------------------------------------------------------------------------- If electricity comes from electrons, does morality come from morons? -------------------------------------------------------------------------------- Do the Alphabet song and Twinkle, Twinkle Little Star have the same tune? -------------------------------------------------------------------------------- Why did you just try singing the two songs above? -------------------------------------------------------------------------------- Why do they call it an asteroid when it's outside the hemisphere, but call it a hemorrhoid when it's in your butt? -------------------------------------------------------------------------------- Did you ever notice that when you blow in a dog's face, he gets mad at you, but when you take him for a car ride; he sticks his head out the window? -------------------------------------------------------------------------------- R/r 911

Sounds like someone is pushing the old "mind imagery" theory and maybe now following up with a book ?.. Same old psycho babble.. it has been out for several years and was popular for a while in mid 80's, until most medics found it was a waste of time. However, it did some good .. most patients started laughing when used... R/r 911

Welcome to medicine. You are correct by your observations, just the facts.. not racism. That is why I quit working in ER full time, got tired of pampering those who did not need to be there and not having room for those needed it. It is called responsibility for one self. Wow ! A new concept, although some of our Northern friends don't believe that each person should be held accountable for individual action, and allow the government take care of you. Look at it this way, why should anyone leave the 'system"? The average medicaid recipient has benefits approximately $28K a year (medical, dental, pharmacy, and food benefits). This is far more than most working class salary. Approximately >85% of the patients I see in ER, have no private insurance, but are assigned state medicaid with a primary physician (PCP), and approximately out of those 75% do not see that physician because "they would have to wait"... of course these are the same people that complain of waiting >1 hr in a ER. They know they have to be seen, no matter how trivial the matter. It is the same ones who "do not have money for Tylenol" but have 3 packs of cigarettes in the purse. So what do we do ? We develop MORE programs, new housing (which a new apartment complex was destroyed in < 30 days), give programs to educate at technical schools and then PAY them to go as well... of course, some purposely fail, to re-enter the system again. So what have we accomplished?... A group of socialized dependent retards. It is our fault for making them this way... becoming dependent on a government, or any subsidy is not healthy.. emotionally, physically, or socially. Now, not all take advantage of the system, there are some honorable ones that do need a hand-up, but these are very few and rare. It has been proven through out the years, welfare and medicaid systems fail. Unfortunately the ones that need it such as the truly emotional & physically disabled, as well as those that do need the hand-up not hand out, will no longer be assisted rightfully the system will be broke. Laziness, greed, has taken advantage of the system and broke it. Sorry, life is a bear...no one promised you a rose garden and everything in life is free. You have to work hard, bust your ass once in a while to get ahead... Quit whining!... especially for those that are physically capable of working. It should not be my responsibility or any company for paying your way, or nor am I going to feel sorry for you as well. Get a job.. flip some burgers, get a Pella grant go to school.. do something except have someone else take care of you! R/r 911

I agree however; it should start before being employed. Some of the problem lies that employers are usually "seasoned medics" which does not give an additional thought of professionalism. Hopefully, some of them have attained upper education and has as well been exposed to professional demeanor. If we instituted it in the beginning, we would have at least a foundation to begin with. R/ r911

They just don't get it Dust.... R/r 911

Why is it because it involves EMS, people assume the government or "grants" should be available?... What separates us from any other medical community or profession ? R/r 911

Excellent posts... many do not like reading or discussing it... it is called professionalism. One thing that is very lacking in EMS. Shame we cannot mandate it in classes, yet again so many instructors do not understand it as well. Professionalism is like providing good care and fine wine. It is developed initially with proper education and grows each day with experience. Sometimes, the wine becomes vinegar and is discarded, like many of the medics, unfortunately once in a while there are some vintage medics that still have that "gall" flavor. Behavior on and off duty, dedication to their profession (not lusting over L & S or Star of Life's), as well as educating oneself to be better each time should be a standard for each medic. This is not installed or emphasized enough in schools. R/r 911

Good comments Spock, we do appreciate your professional in-put. I too agree with ETC[sub:c15e211778]0[/sub:c15e211778]2. There is no debate, either you have it or don't intubate... this would stop all the madness of "misplaced" tubes. I would personally like to see and use a "King LT" tube . I had a very difficult intubation the other day, that the only back up airway this service had was an old "EOA" (shutter) and it was still unsuccessful... even the anesthesiologist had a very difficult time intubating her. You are right there are some, that traditional methods are not practical. As you discussed chbare, condensation and even chest wall movements are NOT reliable assessments. It is time educational and training institutions to STOP teaching this. It has been well documented that it is not reliable, as well as even lung sounds can even be mis-leading. Hopefully more and better alternative airway devices will be designed for those airways from hell... R/r 911

You are guys are correct in some instructors are not fond of Paramedics, although I can understand why. I was one of the "first" guinea pigs about 17 yrs ago in the one of the first "bridge" programs. Although, the nursing school college did not have the paramedic program, many of the hospitals at that time wanted to have experienced medics as RN's, so they "funded" additional spots to try medics to RN's. There were a few select ones, and out of the 12 that was selected 3 of us made it through the first semester. The problem was the mouth(s) on the medics. Bragging rights of "how they saved lives" and "they didn't have to have orders, to do everything as well as I started ____14 g IV's..etc..". I found out real soon, the old saying when in Rome, comes true. In fact the more you keep your mouth shut and appear ignorant the better! You are a male entering "their sisterhood and profession" .... Like I said, some truly believe it is a calling....not just a profession, and you are coming to their profession, they are not coming to yours, and they really don't care how much training you have. Remember, unlike EMS they have to have a masters degree just to teach. Over-all, I was lucky all but one was really nice to medics. Most did feel intimidated when discussing cardiac etc. and since we were the new ones, many observed our behavior and discussed the differences in detail about how "we(EMS)" perceive things so much different than the traditional student. I guess it helped, the program is still going and successful. I know of some medics have learned not to even ever tell some programs they are EMT's... Again, good luck .... get those additional classes and apply early. R/r 911

I guess the NY'ers have retract saying they work out of a "bus" now... R/r 911

The old patch (blue and white) was just took out before I finished my EMT course, but I got to wear it for a short time.. (gag.. ambulance attendant!) .. I will try to find my old Oklahoma MICP patch.. there were only a few of us. Now want to see something interesting ?... see something odd? a blue and gold basic EMT patch ?... hmmm....a unique way of being blue and gold ?...lol R/r 911

In my area all Psych patients are cuffed and transported by Police. Unless they require continuous ALS monitoring, EMS is never involved in hospital to hospital transports. I wish you luck, shame abuse of EMS is occurring. R/r 911

Okay.. no problem there are many that don't understand and think that NREMT is an education organization... R/r 911

I personally, went through a transition program, however; I had worked mainly in hospital setting as a Paramedic for 12 years prior to entering. I only suggest such programs if you have experience in hospitals or diverse medical background. You are only going to save a semester taking a transition route. I agree, with going the full route, as well as I highly recommend the BSN or BSc route. You will really appreciate it later instead of returning like I did years later financially and time wise. The door it opens is wider and more prosperous in EMS and Nursing. There is nothing wrong with ADN, however, like Paramedic it does have its dead end. Word of wise, be sure nursing is really what you really want to do... please note * it is different from what one expects and definitely different from EMT or any EMT training. Some call it a "calling".. I really can't argue, if it is for the money, I suggest a different route, there are definitely better financial careers. Look around, if possible follow some nurses, to be sure this is what you want to pursue. Let me know if there is anything I can assist, and good luck in your career. R/r 911

Ak... you might want to get that checked out!... LOL Thanks Medik8 , you are correct. As an EMT you should know, that the various and vagueness of symptoms and the potential seriousness of a complaint cannot be accurately dx. over and in the forum. Even suggestions of "potential" can be misleading. I informed you like I would even my family member.. get a physical and work up. There are too many variables to even narrow down your symptomology. From anxiety attack, to caffeine to PAT or even thyroid disorders.. etc.. again, without examining you, performing diagnostic studies, and ruling out .. we would be like shooting in the dark. Again, not really addressing or answering or really helping you. Similarly, if you were to ask a physician what it could be after giving the symptoms, they would reply ... " We will have to see, after evaluating you ".. In the past, there has been numerous posters, wanting medical advice.. the most sound is to seek medical help by a competent physician. Any other than that we are only guessing and could be leading or guiding to a potential and even fatal consequences. I wish you luck and let us know how it turns out. Ak.. hope your ovaries get better! R/r 91

Actually there is : it is called the called the national curriculum, It is the states that has adapted different levels and each service and community that has incorporated placed either lower or more advance procedures. This is the way it has been since the development of EMS over >40 years. Again, it is obvious you did not read the previous posts, or understand EMS & the NREMT. NREMT DOES NOT " have" classes or ever has had or plans to have . It is ONLY , let me repeat again ONLY a testing agency. They do not set any curriculum, ONLY test over the national standard curriculum as designed by NHTSA, and the national standards in emergency cardiac care as set by ECC and AHA. Again there is a national uniformity standard, albeit I believe is poor, don't blame the messenger (NREMT) they only test what is the national standards. Want to change things ? Then become involved in agencies that make recommendations for curriculum development to the NHTSA, organizations like NAEMT, National EMS Educators Society, even you local state EMS Director's . This is the only way to ever change the curriculum and change what the NREMT tests over. Be safe, R/r 911