Ridryder 911

I have a lot of opinions but would like to see more. My ex-brother in law help assist in developing some of those systems in the 80's. As well when I see the name Jack Stout and PUM; the hair on my neck stand up. In regards to PUM; I don't believe they are a considered a dinosaur yet. There are still many that are still attempting to operate such as those in my home state... how successful is still debatable. Hence, the reason the Fire Services are circling alike a buzzard just awaiting their time. R/r 911

No, neither would I bless or allow them to work under my license. Period. Again, Medical Directors can and should pull a lot of weight. I honor those that are truly involved and do participate as they should. What many of the Medical Directors do not recognize is, that they can be the screening process. Who is to say whom becomes a functional Paramedic?.. You do! Will it be the EMS service or the one that has the license they will operating under? Many may say ... "the service is too large to control"; is it really? NO! All one has to do is look at the statistics in the QI program. If there is not one then as a physician demand one! Again, it is your license! Demand better education and more in-depth training and reviewing at the service. Guess what you also control the purse strings! You will get what you want or reduce their provider level.. you will get their attention! Be pro for better and quality care, but NEVER compromise patient care! This also means removing proven procedures that increases survivability! If you do not like the care then DEMAND a change! You are the one that really is in charge. Do some house cleaning. They may have the license/certificate/patch but that DOES NOT mean they will get to operate in that capacity.. only you can really determine that! Most EMS medical directors are poorly educated and trained as such. Majority have never attended a formal EMS Medical Directors Course. Again, whose fault is this? Fix the problem or be part of the problem, the choice is yours! R/r 911

Again, they are not addressing the problems. Why do away with a proven effective procedure because the system is broke? Would we do away with I.M. injections in clinics because many physicians refuse to hire qualified personal?..no. Paramedics can't intubate, then who's fault is it really? Instead of throwing the baby out with the bathwater, how about correcting the problem? Naw.. that would make sense. If the physicians are really and truly worried about the problem become involved! Require a true educational system, don't allow but so many to work under your license. You have the power but don't remove a procedure when performed by qualified personal and proven to prevent deaths because it is much easier to do so. So I turn this back to them.... don't like the outcome, then change the reason why, but don't change the correct treatment and procedures to do so! R/r 911

There should be an automatic dispense of Haldol when the video starts. It would reduce the nausea and sedate at the same time... R/r 911

Hence, part of the problem in EMS even of those in EMS education. Majority are not properly educated in EMS nor have a real understanding of the system or the educational standards that are in place, currently in the works or being considered. Do you realize the new curriculum has been in the works for the past 13 years? That it usually takes at the least 5-10 years to change any type of National changes? As well that NREMT has NO standards for EMS nor have they ever or ever will. It is a testing agency that supports and promotes EMS, and it uses the NHTSA EMS curriculum's to test by. Although it sparks interest on the forum, other than that it is just yapping. Placing polls even discussing is easy, but really how many here are really and truly interested in change? .. How do you do this? By being involved in Federal and National changes that will be introduced to the State level. How many are actively involved in NAEMSE? Realize that they are now the ones making the changes in the standards? How many are aware of the required "transitional courses" that will be required beginning next year? How many are involved in State EMS projects, State and Federal legislation, member of EMS Advocates, even the NAEMT? Again, sure discussing is interesting and may spark fire, but again how many here have the credentials (education level) to be taken seriously on recommendations? R/r 911

It also has to do with the location and geography. I know in my area, one calls an elderly man "Sir" that may be the cause of fighting words as the usual reply is "I worked for a living". I agree, the traditional sir names should be used, but that saying I also know many of elderly like the empathetic words of "sweetie, hon, sug.." etc.. especially elderly men from females. Again, if used correctly. I guess the lady would be really upset if one would call her the other slang.."old bitty".. R/r 911

Although, I agree with the "baby boomer" will me more demand than the ability to provide care, the rest you spew is just that. Actually, I have seen a sudden change in the Paramedic to RN. Alike I have done obtaining multiple nursing degrees, went back to the field full time. This is not just those that just became an RN but even myself after being an RN for 19 years realize I can make just as much a year as a Paramedic than as a RN. Sorry, even at $28.00 hr, I still make more per year.. yes, less an hour but the one thing is, I do not have to stand on my feet for a solid 12 hours, I know my schedule for the entire next year, in general I only have to take care of one serious patient (not two vents and one B.S. or baby sit 4 or 5). I know of at least three very seasoned RN's and Paramedics returning back to the field. One can find that happiness is sometimes better than a pay raise. Your analogy of only one medic is pure B.S., there will be those that really want to be a medic. Sure financial security is very important and who does not want to make more? I can assure you though, one will not find it in nursing either. Bottom line, you want to get paid as a professional then one has to to go through the hoops alike all the other professionals and a 1 year Vo-Tech program won't cut that. You are getting the same pay as equivalent for the same length and training ... an LPN. Until you have proven such, we will never be recognized or be paid to be such. Hopefully, there will be those that entered this profession for the right reason and will remain it for that. R/r 911

Those in EMS is the cause for the fall of it. Very rarely you see any in legislation to cause change, nor any truly educated Paramedics to set an example by. So we get what we ask for.... R/r 911

You know, after reading this and the CPR posts; should we ask ..."are we getting to big for our britches?"... Seriously, who in their right mind would ever believe it would be okay to remove a human body part and then flaunt it to others? Should we not be concern of the mentality that this displays? It was NOT just poor judgement, or "what was she thinking?" ... Rather, I am concerned that this person has some mental disabilities, obviously she cannot make competent and rationale decisions. Then the employer to continue to allow her to function is a slap to the victims and safety of the public's face! Unfortunately, we know why she is still allowed to work. Have we stressed so much of the importance of our so called profession and hero syndrome, that we failed to emphasize it is illegal and unethical to snatch body parts to take home to Fido? ... Duh!... Did we loose sight of what it is really about? That the emergencies and responses are really not about us (providers) but the patients! The more and more I read posts and articles the more I see our profession heading to the toilet. I can see where the public would want ambulance drivers back. It is a shame, but maybe we will have to add an additional chapter on Medical Ethics... "It is wrong to steal from patients ( including their body parts)"..... Time to start cleaning up our profession! R/r 911

No, what is scary is considering that the highest education for the majority of Paramedics is just two years long and they believe they know what is best for patient care. Along with those that are a lower level of being a few week long courses. Who in their right mind, would even think that a person that attended a trade school for their education should have so much power? The same building that next door teaches cake decorating and diesel mechanics, one can hold power of determining who should be resuscitated or not. Anyone else see something wrong with this? The same folks that cannot distinguish quantitative or qualitative research or even form a paragraph with a sentence structure, should have so much power? The most clinical performance was less than a year in a ambulance with few days of split rotation in limited various parts of a hospital. ( Now folks, there some expertise !) Are we impressing ourselves yet? Let's look at the hard cold facts: Majority of the Paramedics are trained NOT educated Very few Paramedics understand physiology and most have very little knowledge of anatomy Majority of Paramedics are very, very limited in medical clinical knowledge and procedures and skills. Very few understand the scientific process of research or even how to interpret data and even how to read scientific journals to make a true rationale decision. (to prove this , just look at the posts presented here) Skills and procedures are isolated to only simple performance and usually then multiple tasks can be presented in a "tree" algorithm, not to confuse caregivers. So before we attempt to discuss whether treatment(s) or procedure(s) should be performed, we have a lot of cleaning up and becoming qualified to even make a rationale statement or idea.

As a professional educator I realize that our main job is to motivate students. That no one can really teach anything to anyone that is not receptive to learn. Reinforcement tools to motivate students can come from a variety of ways but is exercise the best given this is not a P.E. class? I much rather build up their minds, than their bodies. Yes, one should be healthy to perform in the field but what does push ups and sit ups have to with EMS? Sorry, I much rather have you spend your time researching through journals and texts to locate the answer than being a Drill Sargent. Now, what did you really learn during those push ups? To be better prepared? That's it? ... Let's leave the boot camp mentality to the so called heroes and let's focus on more professional educational methods. R/r 911

So let's stop CPR and resuscitative measures in the hospital as well. Why not? Why not stop all the medical care as described as ALS. Remember, that hospitals have a lower save rate than those in the prehospital arena in those in cardiac arrest.. What? You don't think that would happen? I agree if CPR was another procedure, and the results was as reported we would abandon it immediately. But since there is NOT another measure or procedure that has any better results, that is the method we perform. Until then, either promote field termination on specific cases or do what is currently proven to have at least some success. The other option definitely is tilted and we know the results of it. (actually, I had this same discussion/post two years ago).... The good thing. Paramedics are not respected enough to really carry or have a weight of what we really think matters. No medical procedures, nor anecdotal statements or even research is going to change the methods of resuscitation that comes from a Paramedic. The reasons are obvious. R/r 911

It was not a study more than a QI improvement drastically noted after the introduction and usage. I will try to obtain that though. As well, there are tons of literature on the use of such devices, especially in the O.R. R/r 911

One of the many reasons RSI has a black eye in EMS. Poor undereducated medics not fully knowing or understanding a medical procedure. I guess whenever an EMS and a few Paramedics get their arse sued for emotional distress, then maybe we will learn the difference. Doubtful, they will probably ban it ... unfortunate for us that understand and the patient that need it. So many assume Versed has total amnesic qualities which is false. Not all patients that receive Versed forget, as well many co-relate paralyzed and sedation as the same thing, when it is NOT! R/r 911

One of the larger EMS in my area has been using the "elastic bougie" or common one in EMS is the flex guide and has increased their intubation rate from 93% to 99%. I personally have used them on two very anterior anatomical intubations and recommend them for difficult intubations. I highly recommend them! They are disposable, easy to learn to use, and economical. Better to have and be able to grab than not to. R/r 911

Personally love "popping" sebaceous cyst. Especially when reaching the core. I have seen much larger. One of the physicians used a Yankauer to suction the contents then had to place nu-gauze (packing) and penrose to allow for the I & D. Of course we always wore gloves and aseptic techniques. R/r 911

Congrats ... Just to think I was only a Paramedic for a mere 6 years then.... and happy birthday! R/r 911

Pyxis is not without problems. One can override as it just a computer that counts. The other thing pyxis are extremely expensive (yes thousands of dollars) for a few med.s? I much rather be held for accountability and take the money. R/r 911

The only place I did not have to account paralytics was for a flight service where I had a case of Sux. I thought it was dangerous, so as Chief Flight Nurse, I instituted a count policy on such type of med.'s (we had other type of RSI, paralytics). Even though not legally mandated, it was a safety factor to help prevent any missing or wrong doing. R/r 911

No. Nor is there any. NREMT has over 3,000 test bank questions to pull from. Many books may instruct you on the type of questions used or similar type of testing methods. If you go through your text and complete all the objectives, it will be as helpful. R/r911

Sorry you feel that is the "fullest assessment" or patients do not need a secure airway. Thus the reason some EMSA medics have to be re-trained. The reasons some employers "cringe" when they see EMSA as a past employer. Part of the problem is so many are installed into that the "EMSA" way is the only way. Many never realizing what emergency medicine is all about. I don't care if the patient was in the drive way of St. Francis they deserve an airway. Anything less is negligible. Again, they do have a lot of great medics, so that is why I try to avoid generalization. Unfortunately, many only think inside the box and the current protocols and methodology does not promote anything but to follow protocols and not think . I do wonder how one receives a call, performs any real assessment, follow a protocol of an IV, ECG, and then e-PCR that one has to complete before going back into service in less than 30 minutes? If one is running nearly two calls an hour. I know most in the Central area is allowed 20 minutes before going back into service to ensure medusa is complete and unit cleaned and the central area makes more responses. Even with this allotment there always remains a shortage, and they have placed sign on bonuses as well as now attempting to pay for EMT's to go to Paramedic school. Albeit, it is still controversial of the programs they maybe considering and the pay off or penalty is extreme if they choose to do so. Again, let me emphasize there is a lot of good but there is many areas to improve alike anywhere else. Part of the problem though is most assume "it is the best!" because they have never worked anywhere else or have came from a service that was worse. Many cities that are using EMSA are now beginning and planning to start their own EMS services. Tired of the costs, response time, and care provided. I do believe this will cause a problem as well. EMSA has continued to ask both cities (Tulsa & OKC) for millions of dollars to maintain costs. Hence the reason the thoughts and discussion of placing EMS into the FD. Personally, I would hate to see such a decision be made to place into the FD, in either cities. I would like to see better management techniques and better, broader education for the medics. Even if responding over one call per hour, it has scientifically demonstrated that mental stress and focused attention drastically drops and unsafe measures increases. Is this the best for the patient or staff? No. Personally, I recommend EMSA for those that want a lot of experience in a short period of time. I do always recommend one not to spend more than one to two years, for many reasons that I won't go into. Longevity is not one of their better aspects. R/r 911

No, I don't work at EMSA but I have trained and worked with many of their medics and serve with many on board positions. I have yet not seen anyone they would not initially hire. Yes, it is a large service as they have a EMSA East (Tulsa) and Central or West (OKC). As far as large services go, I would say they are in the middle. They do have some very good outstanding Paramedics that work there and alike every EMS have some that are not very sharp too. They have a new Medical Director, so we will see how the protocols develop but I can say they did perform several new procedures and toys. Unfortunately, they are strictly protocol driven service with a protocol book that could be used as weight training device. As well as plan on going through a formal academy for a few weeks before hitting an orientation round. In regards to the pay, it is not bad nor good for the area. One has to remember, the costs of living in this area is much lower so the pay equals out to that. The normal salary ranges between $35,000 to 38,000 for Paramedics. It may vary with overtime and etc time. As well, they are operated as a Public Trust as one of Jack Stouts brain image. Most do post and sit in a truck for the 12 hours. The employees themselves however; are not employees of EMSA rather a fim in Texas. They do have e-PCR (Medusa), Vents, CPAP, LP 12 , moderate protocols (NO RSI, NO critical care transports on normal trucks) and and over all work well with the medical community. I foresee major problems with EMSA in the future. There always have been rumors of the Fire Department take over, and I usually dismissed them. As in the past the talk had always been there as well as prohibiting costs to prevent it. Now, I have witnessed that the majority of the new recruits were Paramedics (as they were given priority) and EMSA as well as many other services lost experienced and seasoned Paramedics to them this fall. I have insight with some of the administration of both and realize it is a very good possibility of it occurring within the next 2-5 years. I heard that this was the goal of the FD as they gear up and prepare for it. Most Engine and Squads, now have a Paramedic(s) on it and the protocols and even the Medical Director are the same. So switching would not be that difficult, as I see the FD being the emergency responding and EMSA as the transporting unit and routine calls (nursing homes, etc). Something to investigate and think of... R/r 911

Two of our guys got on with the OKC FD recruitment round and took a major cut in pay. It will be nearly five years before they make up the difference in Paramedic pay. Yes, rice benefits and longevity pan but other than that don' t see the benefits. I guess if you want to be public servant. R/r911

Everyone attempts to blame the NREMT for the failure of teaching EMT's. Remember the sheet is ONLY a reference that one has to be sure that all the critical areas are performed properly. If we had educators instead of instructors, then possibly the "sheet" could be done away with, but until then we have to comply to make sure that the drones are able to follow a step by step process. I don't think NREMT is all happy about the sheets as well, from what I understood. Unfortunately, would you trust many of those finishing the programs without it? Look around and observe. Yes, I agree its a horrible method and I hope we can abolish skills stations someday* but until then we know at least know that at one day, during a specific time period, they were able to recite and perform those required skills. * In the future, if one completes and graduates from an CoEMSP accredited Paramedic program; one will not have to perform all skills station(s) at the NREMT Paramedic exam. Watch for more up-dates from the NREMT.

Yes, I agree but you have had over 40 years of EMS availability. How long and more important how many have to die until you decide to change things? Seriously, do you NOT see a problem? How does one state (the only state) out of 50 and out of countless number of countries (even third world countries) have a better system than NJ? Not to speak ill .. but.. hmm; one has to wonder what century you are awaiting on? R/r 911