Ridryder 911

Both... A college is contracting me to develop a CCP course. I recommended having both text. The Bledsoe volume is geared for the field and does meet the basic criteria, but lacking in some of the ICU knowledge, where as ICU is laking of course in pre-hopsital setting and equipment and general operations of the CCP. Approximately $150 is not too bad for 2 good resources... R/r 911

There was a response from an Emergency Physician I wish I could get his video that was posted. Unfortunately, it has been removed. He discussed the "dumbing down in emergency care". This is a societal issue as well. Fail frying fires at McDonald's University then try being a Paramedic... chances are you will make it then return to McDonald's because the benefits are better. Yes, ACLS has been "dumbed down".. a couple of reasons. One it is no longer politically correct to say to anyone " YOU ARE TO DUMB TO DO THIS JOB & YOU DO NOT NEED TREATING PATIENTS !" As the physician described in his lecture, we used to respect ACLS, because it meant you met the basic criteria , that you knew what to do !. Now, since it is NO longer a certification (hence a education credit, NOT a CERTIFICATION !) one cannot even fail the test. Mega codes are no longer in place to challenge individuals of emergency cardiac care.. As he described in his lecture.. "these patients are sick.. the will die ! You are supposed to know. what to do. it is your job ! .. You don't know what to do ...then you fail!".. If you pass and are allowed to perform in the same manner, these patients will die and in a way you are grossly neglect. Some of the other reasons emergence medicine has change. Is the reason I went back to the field full time EMS and quit being an ER/ RN. In ER, you rarely truly see an emergency patients.. It is not like it was even 10-15 years ago, where most patients that went to the ER was at least somewhat an emergency. It is estimated that 80% of ER patients now could had been seen in a physicians clinic. This means you are busy with a "toe ache" for 3 months, while you are taking care of the AMI and GSW, also as well with the patient that came in ER to have a pregnancy test performed. Knowingly all the time if a patient complains....it is your arse.. and you better have all that paper work in order as well. So what happens... those that really care and perform well in crisis situation(s) gets all the S*itty patients, along with minor and those that are pretty clueless of emergency medicine gets all the minor B.S. .... hmmm see the fairness ? As one nurse told me.. " I could and would be better at emergency care, but why should I ? More work, more responsibility, more paper work, no more money.. no thanks !" After they said this they asked me. "Did you get to have a lunch break or go to the restroom?".. I did".. I can't argue with her there.... So now we are stuck with piss poor attitudes and the new "teaching" of everyone can do this.. and the "world is great attitude"...meanwhile more and more are entering with this new attititude. R/r 911

Always love a non U.S. person.. telling me how it is in the U.S. Second, I don't get affirmative action, free medical prescription (dental, eye exam and glasses, food allotments or a monthly check cause of my tribal affiliation (even though I have more N.A.I. than most Indians) and priorty in jobs when many say "minority or tribal preferred). So yeah...I am the lucky one that gets to pay for it ! :twisted: R/r 911

I don't see how anyone would consider EMT or even Paramedic classes are too high (U.S.). Try getting an education in another medical field and do some comparing. R/r 911

No offense taken at all JPINFV. So many of non university setting believes getting into Nursing is like EMS, you pay for it then Wham- O . By far I am not the biggest nursing advocate, (ask my professors) lol... but; was trying to elude to some clarification. Yes, all education is worthy and definitely organic would be nice.. but in the long schemes of things for application purposes, I would love to see the Paramedic have a basic understanding of general science. Ask almost an Paramedic about Krebs cycle and how sodium and K= pump theory and watch them shudder... The reason you do not see research by EMS for EMS is because for academia standards, true research must be carried out by no less than graduate level students supervised by Doctorate levels. Undergrads can perform or obtain the data, however; graduate (preferred) level is to compose for quantification. Institutional Review Boards (IRB) is very picky who performs, what type of studies, and the controls as well as medical ethics is overseen. Again research is very costly and time consuming, (not saying it should not be done) performing some test would take years to perform since a most of EMS would have to have quasi-experimental with quantitative and qualitative mixture. Very little true quantitative research could be performed in the field, which medicine particulars like. PRPG you are right, like medical school, even nursing school each applicant should be reviewed individually and worth some basic ground work to meet to get that interview. That almost all those profession as well monitor the job market, with fluctuating numbers of students. Check medical and nursing school entry level numbers they are never consistent.. again they do not flood the market. Makes sense and very professional. I believe we are in one BIG AGREEMENT, definitely more educational requirements rather than just applying like it is done now. Like I have over emphasized, it is way too easy to become a Paramedic. The curriculum is easy (I don't care which school) and the board test are a breeze in comparison to other medical specialties. If it was not very few would ever leave the profession, too much hard work, time, an money would had been invested. Be safe, R/r 911

Actually one cannot enter nursing that easy.. even with a degree or even a master degree. Also, it is usually a 2 year class as well. The Doctorate level can be in education, but most are focusing in Doctorate in Nursing Science itself. (DNSc) This is usually referred to research, or some programs have now expanded it to nurse practitioner, clinical specialist and some nurse anesthesist programs. I can tell some of you are pre-med... the typical semester long off medico-legal is a waste of time.. If a law suit or litigation is to occur, you do like every other physician have malpractice insurance and an attorney on retainer. More emphasis on proper documentation, education, and TQI with effective communication skills stops patients from litigation's. Remember Rule Number 1 .. patients don't usually sue Dr.'s they like.... that is why litigation's occur more and more . physicians sometime loose site of being human.... Organic chem, trig is nice education, but again a waste of time in application of the role of the Paramedic. Again, cadaver anatomy, more in-depth respiratory, cardiac, and kinesiolgy would be more appropriate as well as medical terminology. Expand the pulmonolgy/cardiology to one year in length. Ask a physician how often they use most of the B.S . classes like History of Medicine or even embryology.. the will tell they wished they had more applicable classes. I would suggest a basic statistics course and basic research, so interpretation of B.S. research can be interpreted and identified in Journals, so things are not taken at face value. Right now, there is no application for EMS/ B.S. Research requires at least graduate level to successful conduct research findings. Until we have developed the need and the mechanism to utilize graduate levels, we have to have our EMS personnel with associated graduate degrees or Doctorates. Again, most will monitored by physician level anyway. I would again be happy to see a required associate degree level for entry level. Get rid of the 6'th grade EMT books and the junior high Paramedic "book"... even the author hates, himself. Yes, it is nice to dream... but I would prefer to make it more workable program so the medics could get a job ... R/r 911

Okay, I have received my CCP text. I have not read the entire text as of yet. Nice hard cover, over 1000 pages, takes for granted you have basics down, which is nice. Goes into some detail on some pathophysiology & mechanisms. Good color graphics to express some difficult topics (i.e Kreb's Cycle & Sodium/K+ pump) etc.. RSI very simple, but detail enough to get the "gest" of it. Section on lab data, central lines, detailed cellular shock patho, and routine ICU meds, as well as basic hemodynamic stuff.. Would make an excellent book to teach and accompany an CCP course. Definitely, a book every Paramedic needs to keep as a reference. Shame that this could not be encompassed into the regular Paramedic programs. Hopefully, more institutions will develop CCP course (no, not the Maryland EMS 2 week program). A course using this ans some other accompany text for a 8 to 16 week course, would be excellent and definitely improve the care we give and our image as well Ironically, it addresses that the ONLY CCP test is the Flight Paramedic for critical care.. (I knew that, but so many differ). It's worth the $ 60- $70 ... yeah, it falls short on many topics, but have not yet seen a perfect EMS book. Good job Dr. Bledsoe and et. all Be safe, R/r 911

These posts amaze me !.. At the time of writing this it is 10 think they should and 11 agree they should not. 1 Undecided. Now, if you agree to administer it at least be able to give a rationale why ?.. Just, like other posts, many have an opinion but, cannot back it up.. Does this not at least may you wonder ? Hmm.. maybe this is ONE of the problems of EMS ? R/r 911

I wear boots.. one to give my ankles more support. Never wore shin gaurds.. might be wise to some though... of course I never got kicked that much ...LOL :wink: R/r 911

-------------------------------------------------------------------------------- OKay.. I might not have M.D. behind my name... but I am not a moron either ! Sounds a like a used car dealer trying to sell something, better put him on a infomercial! First.. Let's put your money where your mouth is Doc.. so. after implementation .. let's say in 2 years, we study results of CPR in studies across the nation with your current ideas of CPR properly, let us then review the results... If we do not have a 300 % improvement in neuro, let's recant your findings and apologize to emergency medicine and all those future grant monies and be banned from doping further research!.. Loose your professorship as well. Then next time physicians make claims they would be more careful.. Second, C'mon it is does not take a rocket scientist to know if a patient does not have respiratory drive, placing an oxygen mask (NRBM) will NOT or NEVER ventilate a patient. Sorry air floating around the orpharnyx will not cause inflation of the lungs... DUH! I did not have to go to 10 years of residency to figure that out ! Stopping CPR for intubation .. okay, lets build up the ATP then intubate.. I can buy that.. Now does that mean we won't stop CPR for your physicians to dig around and tube as well... and to stop CPR to place central lines and art lines, that you Doc's love so well... oh, yeah I forgot, this does not imply to you guys... A woman doing CPR and talks on the phone and the guy opens his eyes... first thing I think is he probably does not need CPR ! Hmm maybe a little more investigation Sounds to good to be true... yep, I buy that as well. Wow is the now the same group that used to sell us the old Bicarb theory and Bretylium .. oh yeah, no it's high dose epi that we had so many saves !... Like I said, when all the Lazereth's meet we can thank him personally. R/r 911

You should be treating several factors as Dust describes.. the old silent AMI, we have seen so many times in patients that so happened to be examined because of another c/c such as a fall or non related trauma. I look at treating AMI like a jig saw puzzle.. sometimes there are many pieces .. sometimes, you get luck and the puzzle is easy to figure out.. R/r 911

All applicants will be on point system. The more points, the higher the chance one will have to be able to attend. Each system would be weighed on importance of the section. Experience? How much and what type? Preferred EMS with one to two year level experience. Not required but preferred, with recommendation letters from EMS crew members, Supv. & Administrator, and EMS physician. Not just he/she's a good person, but specific regarding critical thinking instances, etc.. Hospital. dependent on area of work, responsibility, Fire/ Rescue less point(s) than EMS, but has some merit. Job status? Are those currently in EMS given preference to those working non-emergency or in another field? Dependent on job requirements, to be reviewed on individual basis. Prerequisites? How much and what type? All general education requirements must have been completed or majority before entering advance portion. Mandatory science course(s) of Anatomy and Physiology or A & P /II with individual labs each.. Human anatomy cadaver lab, extra point. Basic Microbiology or Chemistry. Advance mathematics classes above college Algebra as well advanced chemistry is irrelevant to the EMS profession. More emphasis on communications, psychology, and basic sciences. **Must pass the following to even be considered : Nelson Denny Reading Placement Test with at least a Sophomore College level reading level, Basic Mathematics (College Level Algebra), Critical Thinking Test, Modern Language Assessment Test with at least Sophomore Level Placement. (** Must have completed this even for Basic level EMT course) Education? Their high school GPA? Their college transcript? Is more always better? Does the MA in Fine Arts get preference over the third year Biology major? Must have at least general education as described. GPA must be at least 3.50 with courses less < than 3.0 not counted as cumulative GPA. College Transcript will evaluated on one on one basis. Science course would be given higher score level, however a completion of under or graduate degree will be given higher points. Aptitude testing or intelligence? What kind? As noted above reading, science, critical thinking skills exam as well as mathematics. Medical knowledge testing? Who makes the test and what sort of test is it? Two medical tests. (1) EMS (2) General medical knowledge. There are plenty of test on the market with reliability for testing. Again each segment would be based upon point system. Skills testing? What kind? Basic skills on patient assessment (with differential scenario of medical vs. trauma), standard testing of splinting KED , oxygen & resuscitation skills (including use of basic airway & oxygen administration) Personality or psychological testing? Specifics ? No. But a personal interview with an EMS academic counselor suggesting history or problems in this area is highly non-suggestive in the work force. Physical condition or agility testing? What type, and who sets the standards? How? No, but strong emphasis would be placed on the ability to lift weight at least 150 pounds to waist level. Scenario base lab skills will be required for class and must be able to perform without concerns to pass the required lab sessions of Paramedic class. I do not believe in agility testing of medics, we are not military, firefighters or police officers. We are medical personal. Our main performance of job requirements does not require running, sprinting. Majority of response calls is ability to lift and carry. Morbidity obesity is discouraged, and prudent living should be enouraged. Drug testing? Urine screening, that is. No, cannot legally perform. But as outlined history of drug, or any substance abuse could lead the student not to be tested for licensure Criminal history check? What disqualifies and what does not disqualify? At this time all schools that have patient interaction require a FBI and usually State Investigation, some even require financial investigation as well. Students with a criminal history will be explored as for reasons stated. No reason for a potential student not being eligible to take the Boards. Personal interviews? What do you want to ask them? What answers do you want to hear? What answers do you NOT want to hear? What do you want them to ask you? If you were not allowed to enter, what would you do ? Why they want to enter advanced level program ? What is their expectation of being a Paramedic ? What does professionalism mean to them ? What is their goals? What would be their favorite type of call ? Social interaction question(s) No wrong or right answer.. Critical thinking skills .. generalized on life...may not be related to EMS at all The best things in life ... the worst things Answers I don't want to hear : I want to help other people I want to be " any of the following: I am taking this because I want to be: " a firefighter, to Volunteer, medical school, nursing school, get onto a helicopter, use as a stepping stone.. can't wait to : start I.V's, intubate, shock someone, give medications.... ! Letters of recommendation? From whom would it make a difference? As noted above. Reference letters will have an outline, not a blanket "they are a good person. Specific reason(s) why they think they should be allowed to go forward in their career. What type of care they currently perform, specific areas of strengths and weakness. Letters should reflect that the person actually know and is aware of the applicant and that their reputation of recommending such person is being trusted. A verbal reference may take place from the instructor talking one on one with one of the reference person(s). Time on the waiting list? Does an applicant who was qualified this time, but was not admitted for lack of space, get preference next semester? Just because there is no room for the applicant, the applicant should not be penalized. The next opening the applicant should have first choice, if however; they decline, such applicant would have to re-submit with all re-application testing. Any and all other criteria you might consider when doing admissions, I would like to hear about and thoroughly discussed. There should be a formal process. Not just "pay" for the class. Interview and thorough discussion of the advanced level program should be made with instructor or coordinator of the program. Questions about the program, and a "no-bar" explanation of the demands of the program and expectations of the student responsibilities. Students should had prepare questions to be asked. Students will be prepared that a 15% "wash-out" might occur. The students will recognize that study time, library and research will be required as intense clinical skills and demand. Staright honest discussion of EMS will mede such as pay structures, working envitroment, and expectancy of career, etc. As well, the student should recognize they will receive formal education, professor or instructors with a high level of knowledge and expertise in that field, and have the expectation that they will pass the license and board without extensive external programs. Job placement will be encouraged by the institution as much as possible. Be safe, R/r 911

The endorsements of Intermediate level is a management ploy. They can still charge and recieve Medicare ALS charges and not have to provide the same level of care.... Why would you want the extra expense of paying Paramedics ?.. cheap labor ...high revenue... it's all economics folks! R/r 911

It will be interesting to see in about 2 years, how much revision(s) will have to re-occur. Like many others, this is my 30't year of CPR education and how many times I have seen the "oh, this is it!".. Technically CPR hardly works a very poor procedure..with very poor resuscitation results on any method that has tried and used. Alas, there is no other procedure that we can implement at this time...and thus we have no choice. R/r 911

Now if can just get producers from having Paramedics run back with L/S with a dead body.... never knew were they were going to ?... R/r 911

Neither nor would I suggest any service to carry it as well. There are better analgesics to use without the major side effects. R/r 911

No, they should not be administering Narcan as described by the previous post short and simple! Any State that allows it .. is a FOOL! Now, not to hijack the thread.. but here we go again.........skills versus knowledge...!!!!!! I guess, if you don't have the knowledge, you do not see the importance of it ! I guess, I can do that cardiac by-pass.. I have seen them done a hundred times... it does not appear to look that hard.. DUH! There is a reason skills should be associated with education and license base ! Unfortunately, EMS has not figured that out YET ! That is why EMS is still considered a joke among health professionals. R/r 911

I agree with others has posted..and actually since the patient was on blood thinner an increased oxygenation should had been considered. I however suggest not trying to get the medic into trouble. Although, she appears to be dumber than a brick... you are the "newbie". Sometimes, you have to pick you battles "wisely". Talk to the physician, and once he concurs with you, then I suggest to talk to the medic one on one. Ask her, the rationale and let her explain.. once she has, inform her that since you were new and learning, that you had discuss with the physician and describe then.. chances are, she will not want to make battles. After you have you were in the right, learn from this.. As you said, you are climbing the ladder.. be careful not to "tip it over".. The medic made a mistake.. you caught it... you know better, she knows better.. Chances are she have might learned something as well... Be safe, R/r 911

When evaluating resuscitation outcomes, one needs to really look at the statistics of the studies. I find them very questionable, and somewhat skewed. Not addressing one specific EMS, but in general. Like to see more comparative analysis to occur. R/r 911

You mean Fire Fighters...? Not Stillwater ..but in Okla. miles not too far..LOL R/r 911

It would be nice if the world was all perfect.. but here is the deal.. you get whom you get. To try to get a specific gender is a nice wish... that is it. If I am your nurse, Paramedic.. that's it. If you appear to be uncomfortable if I have to cath or assist in pelvics... then, I will TRY I will get someone else if available.. chances are.. I'm it. Yes, it is a double standard.. and yes, you have to be careful.. i.e if possible witnesses, time. But folks, if their going to claim something, it does not matter whom, where it occurs. I come across a professional, to point of no-nonsense affect .. most know when I do a procedure, it is my job and yes, I am empathetic but not overly warm. In our EMS units, we have type III, so the driver and back compartment is in plain site.. Like Dust described... you get the luck of the draw.. staffing EMS and ER with gender based is unreasonable, and not it does not matter their c/c .. just be careful, use appropriate wording, perform what is necessary. Document .. document ...document.. Be safe, R/r911

Cause we live in a private sector of the world... Some services have uniform allowences some don't ..and boots is not considered PPE at most. R/r 911

[quote="craigfor gawds sake grow up

Aww..that explains it. Cops/ firefighters all the same . Usually even Firefighters have more couth..

Now it would be interesting to see how many actually keep their cert/license current in comparing those of < 2rs. As well as the % of increase in pay with retention, in comparison of those not in front-line EMS. Alas, I would check.. but, I am taking a break doing my research thesis as it is.... R/r 911