Ridryder 911

We too have stopped in the field for field draws, still do for most lab's in the E.R. however. I agree, most of the decision is usually because of time (15 minutes) and now most labs use bar codes or hospital I.D. #'s to place into computer before running lab. One lab, that is usually never used is the type & screen or x-match, lab personal usually demand to draw that personally. R/r 911

Man these ex-Paramedics ..piss me off! I have tried to contact E-bay, to ban such sales. Then we wonder why & how so many EMSimpersonations occur ! These patches are a Registered Trademark, and legally are supposed to be worn only by current registered members. Definitely, like to find the real identity so action can be taken. R/r 911

I doubt there are very any hospitals that would ever accept "lab draws" for blood type to be able to administer blood. Even though most hospitals I have worked in allowed "lab drawn" for almost anything but "type & specific" due to legal considerations. Which, I don't blame them. As well most "lab specimens" must be < than 15 minutes old, and have properly labeled to ensure correct sample. Be safe, R/r 911

Oklahoma, you have to be initially, Nationally Registered then you no longer have to be after the initial test or entry level. Oklahoma utilizes the NREMT test as the state license as well. Every EMS service I am aware of also requires you have to have maintain your NREMT certification as well. Since our state renewal is the same, the additional fee is the only difference in paper work. Like many other people, many prefer to have it as a back up for reciprocity.. Be safe, R/r 911

From what I have read of the studies, actually in comparison of the "heart attacks" may not have been linked with the study or medication, but possible underlying previous cardiac problems. Again, like MAST trouser studies, it is difficult to pin-point subjects... since outcome measures and variables are so wide. The patient that needs to have traumatic intervention or traumatic resuscitation, criteria off-sets the null standards. So would they had died any way ? Again, this is the problem with these types of studies. I believe this is also why the study is still continuing. Be safe, R/r 911

Although state protocols have some definite merit, I also see a potential restriction or may even the opposite of allowing ones to perform care not up to standards or control. I agree Mike, there should be some continuity in at least general scope of care (gulp) a national scope of practice .. It is a shame, that it became such a political battle and lost it's goal and mission. Now, whenever you hear such .. snickers or waves of nausea approaches some. This could had lead to easier reciprocity for most and have the state(s) develop their own scope of practice (similar to nursing). With this diversity in career, career ladder, and educational opportunities could had been developed. Another possibility of the EMS being a profession shot down by political and focus groups agendas. Many in EMS do not know how licensing boards operate or even having a authority board over them (not to be confused with EMS divisions). A professional board composing of actual members of EMS, could be placed knowing the needs of the community and local profession. This again if properly had been performed could had opened the door for many EMT opportunities. So what do we do now? Become very involved in local, State, & even National EMT associations. Over-all, I could probably predict that most EMT associations are being managed and ran by the same "old" group that has been doing for years. Their agenda and your may not be the same. Change it...Do you know your local and state EMS division personal by name? .. Do you know when the state EMS meetings and policy, rule committees meet?.. Are you still certified instead of licensed ?.. How is your state educational standards?.. Look at how many EMT's in comparison to EMS agencies, is there a flood of EMT's, but no jobs ..? Get involved, get your crew involved, it really does not take much time.. a few minutes a day on the phone, e-mail your legislature, etc.. Expect confrontation, change (good or bad) will always get attention... If you expect someone else to do it... it will never happen, tired of the same old B.S., then change it ! Be safe, R/r 911

Poly-Heme has received a lot of un-do criticism because of the studies. The studies is not any different than most other pharmacological outcomes however; because of the substance it is being over exaggerated. There needs to be more studies, and there is no other way except on human models. Again, many are confusing that this is a blood substitute, (which it is definitely not) only a temporary oxygen carrying fluid, until PRBC can be administered. Once. the flaws has been scientifically worked out, the uses in the prehospital arena is endless. Be safe, R/r 911

I will use a saline locke for the secondary or third I.V., or a after the fluid bolus. I usually have one infusing, one at a keep open rate with a blood set on it so PRBC's can be immediately placed. Be safe, R/r 911

Just don't get it.. part of the problem of EMS is having multiple levels. Why is there even such? Because, the persons entering the field really have no true desire to go into full force patient care. Make all the excuses you want.. I have probably have heard them before at least a couple of hundred of times. Yes, it is tough to go to school and work full time.. I know, I have 4 college degrees, and working on another one, and while working 24 hr shifts, also having a wife and child so YES it can be done.. All other professions is not any harder than EMS, it is those that enter realize that they have to either a) have to work more, to pay for school, and study harder obtain student loans, and pay them off with interest later. Having multiple levels has damaged the EMS system beyond repair, again the patient suffers. In comparison, if you were a patient in an E.R.; which one would you rather see or be treated by an R.N., or a certified medication aide ?.. Both can administer medicines... If you are going to have the responsibility and duties to administer medication(s), one should have a thorough understanding of pharmacology effects, both physiologically and cellular, as well as to be able respond clinically to all effects desired and untoward. That is the responsibility of being able administer medications. Far as not going through completion of program, EMS educators and leaders need to be awaken now! Look at how poor and degrading the system has become since allowing "excusable" multi-levels. Yes, in the beginning, (as they were initially designed) to have ALS UNTIL Paramedic programs were developed. They were NEVER intended or designed to EVER replace the capabilities of a Paramedic. BE safe, R/r 911

Looks like another way for firefighters to "justify" their existence. Great!.. with diesel at $4.00 a gallon and let's put that COPS in a smokey smelling apparatus.. hmmmm. As well, they could not enter most ER drives I know of with small turning radius. Like others describe hard to "justify" over half million dollar to million dollar ambulance. Be safe, R/r 911

Again, most people are not aware what minimal competency means and represents. Basically, just enough knowledge not to kill anyone. So yes, NREMT, and every other state (no matter which one) is going to be the same.....why ? Because they all use the same national curriculum, and until that changes, we will continue to have uneducated, poorly skilled personnel. So while the states foolishly spends their money on designing and organizing new test, to be in a pissing contest with NREMT, nothing new is accomplished. Okay, maybe a higher pass rate because their students could not read a 6'th grade level EMT test. If you are going to criticize NREMT, then you should be criticizing the system. They are only a testing agency.. that is is it. Nothing more....They don't develop the criteria to test, only test in what has been presented to them. This would be like comparing the Bar examination for attorneys, describing since the exam is crappy, it the examination's fault of knowledge of attorney's.. no, you would place it on the education and curriculum agencies. As well, as the old saying "you pay, for what you get" could be true. Most EMT's are very ignorant on the costs of most medical license, board examinations. In comparison <$100 to those of nursing of usually ranging from $200 to 500 per examination.. and you don't even get a patch !...lol For those that criticize, have you ever attempted to change things? Are you actively involved in legislation and curriculum review and even have a knowledge who develops the curriculum?... I have learned over the years that is very easy to criticize, but harder to change things. Be safe, R/r 911

I am fortunate, when we developed the laws for our state EMS rules and regs., that is one thing we insisted upon was licensing. So here in Oklahoma, each EMT is licensed, not certified. Just like any other professional group. This is hard subject to convince most EMT's, that their is truly a difference. I too pro for a national CLEX examination, and it this time NREMT appears to be the closest thing. Then each state should have a "Board of EMS" that is composed of EMT's and managed by people of EMS. Similar to what nursing has in each state, with its Board of Nurses and scope of practice. This would allow reciprocity so much easier, even allowing travel medics, exchange medics etc... We limit ourselves so much with ego, not educational standards. If each institution was actually providing a true base level, we would have no problems. Be safe, R/r 911

So does an ER that routinely see cardiac not need to carry hypertension medications, or vasopressors, or even pitocin for O.B.'s since deliveries rarely occur ?.. Yes, there is a happy medium, but to just use or have the ability of what you really use is asinine. I have not given Epi sub-q only about 10 times in 30 years, should I not carry it ?... How, about Dopamine, which I only use about once a month.. should I discard it as well.... that is all fine and dandy, until you are on that call with anaphylaxis or cardiogenic shock. Please, don't even think of diesel medicine. I am health care professional. Yes, each service needs to be reasonable on what is used and important, but at the same time be wise. Be safe, R/r 911

The main reason for any testing is to have a continuity of testing the minimal but safe practice examination. Opinions like those above is a good example why EMS is fragmented and non cohesive. Of course most EMT's do not understand that any test or any agency that test you will have the same results, that they are only testing you on the minimal knowledge base to practice at that entry level point. NREMT points that out very clearly. No you should not receive additional monies because you passed a minimal entry level test. Yes, every state should require the NREMT because then we would know and acknowledge that at the least they had met these requirements. My test is better than your test can go on forever, yet again showing the immaturity of not just the people who make up the system but the general uneducated and narrow mind of State EMS Directors and their counterparts. We as a system will NEVER exceed as a profession with individual tests (city, county, state, doo-dah) again showing our piss poor egos, like a banny rooster, all show and no material or true strength behind it. Yes, NREMT has flaws, I have yet seen any test (city, state) that did not. But credibility, and allowable reciprocity is one the advantages of the NREMT. R/r 911

I personally have not used the EZ I/O. I have used the FAST for sternals though. I know that OKC EMSA and the OKC Fire Squads have the Easy I/O and from the reports I have heard really like them. As well, they have been studying them in sports medicine at Oklahoma University (OU) for the past couple of years using them on conscious patients. The results were impressive that they rated the pain almost = to peripheral I.V.'s Some of the conclusions were that to place 1-2mg of Lidocaine in the 1000ml of fluid because of the "pressure" pain from using a rapid infuser and the amount of pressure needed as it goes into to the cavity and pressure of the perioustem. Be safe, r/r 9111

EMS Personnel Are Most Apt to Report Errors in Emergency Care By Bryan E. Bledsoe, DO, FACEP May 2006, MERGINET—If you practice in the field of emergency medicine or emergency medical services long enough, you will make a mistake. It has happened to all of us and it will happen to you. In an interesting study, researchers compared emergency medicine physicians, emergency nurses and prehospital EMTs in their identification, disclosure and reporting of medical errors. Providers were given 10 case vignettes that represented two types of errors (medication and cognitive) and three severity levels. Each provider was asked to answer the following questions about each case: 1. Is this an error? 2. Would you tell the patient? 3. Would you report this to a hospital committee? One hundred three providers completed the study (40 physicians, 26 nurses and 35 EMTs). Physicians were more likely to classify an event as an error (78 percent) than nurses (71 percent) or EMTs (68 percent). Nurses were less likely to disclose an error to a patient (59 percent compared to physicians (71 percent). EMTs were the most likely to report an error (78 percent) compared to physicians (54 percent) or nurses (68 percent). Overall, EMTs are honest and likely to report errors. There are various reasons why nurses and physicians are less likely to report. But, this affirms that prehospital providers are genuinely honest and will report most errors. This should be a reassuring study for EMS system administrators and medical directors. Reference Hobgood C. Weiner B. Tamayo-Sarver JH. “Medical Error Identification, Disclosure, and Reporting: Do Emergency Medicine Provider Groups Differ?” Academic Emergency Medicine 2006; 13:443-451. ^^^^^^^^^^^ ^^^^^^^^^^^^^^^^^^^^^^^^^ ^^^^^^^^^^^^^ ^^^^^^^^^^^^ ^^^^^^ Is this really the point or are more of attack dogs upon each other and back stabbers ?... As seen on some post, some medics cannot wait to be able to report someone, before even discussing it with them, or are we just that honest and truly look out for the "good"..? R/r 911

Thought this was interesting.. nurses have had enough too.. http://nursingadvocacy.org/media/media.html R/r 911

Good post Dust... R/r 911

You can check out Bledsoe's protocol web page as well. We have such protocol, listed under anaphylaxis (3 levels) minor, oderate, severe. The minor which usually is truly a reaction, we give the usual Benadryl (25-50mg) I.V., then Solu-Medrol 125mg I.V. as well, if there is potential respiratory we can administer a nebulizer treatment. Epi etc. is held for severe reactions.... Be safe, R/r 911

Actually, Ohio was one of the later states to use the National Registry. I always found that ironic. The problem is you hear or even may see states that remove themselves only to find out nothing really changes, except they go more in debt. The State will now have to spend millions to develop and quantify a test, keep their standards, administer it and then it makes it harder for EMS personnel to enter the state and leave. Although the NREMT definitely has its problems, from what I have seen most states try it for a few years only to return, again for because costs. Shame the State cannot funnel that monies into education and make sure that all programs are up to par, and increase educational programs. This would appear to be productive, than trying to change the minimal standard test, no matter what State it is, is what they can only test for. Be safe, R/r 911

We have one on each unit. I also used on the helicopter as well. Really like them, easy to use, however; they have no fancy options (sigh) etc. You can use PEEP though. We transport a lot of ICU transfers, fro about 30-45 minutes and the do very well. We have Parapack and Burdick portable vent.. the Para is much more easier to use and there e is nothing much to getting it set up. Good luck, R/r 911

[quote="ncmedic309 I think some services have way too many drugs than necessary. You look at some services that have upwards of 40-50 medications in their bag and they might give 15 of them on a routine basis. What's the point in having a large selection of drugs that your never going to use? What's the eduction like for those people, how many of them know the inside and out of each of those medications that never get used compared to the ones used routinely? Too many drugs in the bag can be a bad thing...

I believe the minimal to teach should be AAS, truthfully at the minimum a B.S., but that would be hard to enforce. Many do not know to teach in a nursing school, they have to have at the least a Masters Degree. Most University settings require or recommend a Doctorate level. I truly believe one of the reasons our medics are so un-educated is because many of our instructors are as well. We should have EMS teachers/professors not instructors. Formal education on adult education and techniques should be mandated more than the "EMT Instructor Course".. Development of curricula and studies as well as lesson plans and testing, should be part of the instructors job and performance. Be safe, R/r 911

Let's look at it this way... remember in your basic class, on that 1'st day.. when everyone was telling "what they wanted to be or why they took the course".... how many said they wanted to be a physician. As an instructor, I have always had at least 2-3 per class. In my 25+ years teaching, a couple hundred students a year, I have had about 5 that made it. These were medics, that worked the field for several (>10) years before entering medical school. R/r 911

Remember, that very few states recognize the EMT/I 99. So be cautious... R/r 911