chbare

MAST is not tested at any level (AEMT/PM) of the registry psychomotor exam process. I left out EMT because a formal registry test site no longer occurs when testing the EMT but rather a state certified examination of skills

The AEMT exam is not adaptive however.

How about we move beyond n=1 anecdote? What does the evidence suggest? http://www.ncbi.nlm.nih.gov/pubmed/19586701

No hard, fast rules. I too believe that this life, this existence is our only shot. Therefore you have to weigh your life ambitions with the reality of your situation and make a decision. This will be a dynamic process and differ between people. We cannot absolutely tell you yay or nay. Good luck in any event.

Unfortunately, the name of the game is often "cooperate to graduate" when it comes to nursing school. I have a degree in nursing and have never considered teaching nursing, focusing on respiratory therapy and EMS instead. Clearly, if you are concerned about abuse, your programme and college have policies and said policies should be available to look up through the student handbooks (online line or in print). This route will be a judgement call and just understand that you have to choose your battles. I am hesitant to comment on knowing more than somebody. I may catch or notice certain issues, but I also expect a physician to call me out when I'm having a moment where I'm not at the top of my game. Things like allergies and harmful medication interactions, routes or doses are quite easy to slip through the cracks. I rather see it as doing my job as part of a greater team. This is especially true with residents who are essentially students learning the ropes.

Assuming the environment is safe and we did not place pads over any patches on the patient's skin, we have an unstable patient with a tachycardia and barring "smoking gun" information from her chart, synchronised cardioversion is indicated.

It is a different concept I mentioned. It is a type of spin that very small objects such as electrons have, but it is not a literal spin like the angular momentum a spinning basketball has, rather it is something that cannot be directly visualised but is present nonetheless.

Intubated patients walking around bagging themselves? I am not saying it could not happen, but I'd ask for evidence of such a thing occurring. The major ethical issue I am aware of than come out of Denver relates to what went down with the Polyheme study some years back.

It is not uncommon to come across concepts that are so far beyond our experience in medicine, they simply cannot be explained in any intuitive way. Often, they are explained with mathematics, but an intuitive model is often lacking. One concept I have come across is the concept of spin. I have had an exceptionally difficult time explaining this concept without all the talk of Pauli matrices and so on. Going away from that, I would like to hear about concepts that you guys have found difficult to explain as students or instructors, (EMT, Paramedic, RN, RT, MD, DO, PA and so on) or non-intuitive to describe. Even better, I would love to hear about the different models and pictures you use to attempt to intuitively describe some of these concepts.

Dave, did you see my link on gastrointestinal decontamination techniques?

However, there have been studies where near death like and out of body experiences have been induced through various neurological/sensory methods. The evidence certainly suggests that the near death experience is a natural set of phenomena that can to varying degrees be reproduced in the lab. Also, if religion or God creates morality and purpose, how do we explain all of the atheists and agnostics who undeniably lead good, moral lives that have meaning and purpose? Additionally, if you believe in one religion, you have chosen to disbelieve in other religions and/or Gods. Which God is the the real God? Will the real God please stand up? A question to ask regardless of your answer is the following: Does this universe actually need a God, is there any evidence that a God is required? I appreciate the ongoing dialogue and since people are putting their arses out there to discuss such a divisive topic, I thought I should share something that I have never shared in public as far as I can remember. When I was a child, I developed a serious pneumonia and collapsed at home in the bathroom. I was very sick, had very high fever and was hypoxic. I do not remember the entire ordeal and hospitalization all that well, but I clearly remember passing out through my head and found myself floating above my body on the floor of the bathroom. It was a vivid experience for sure; however, is it wrong for me to apply logic to that situation, to look at the evidence and conclude the experience was well rooted in the natural world and simply an experience or an interpretation of an experience, in other words, just brain chemistry?

Actually Einstein was not religious in any traditional sense. Einstein's "God" was not the traditional faith based view of an intelligent, omniscient, omnipotent being, but rather more like the God of Spinoza, like the God of beauty, harmony and so on. In other words, it is somewhat debatable what exactly Einstein thought, but most would certainly agree that he did not believe in any sort of personal God. Newton was religious, but he clearly used the God of the gaps argument and I can only wonder what he would say today now that the gaps he used to justify his beliefs in his writings are now answered? Actually, I have to be very careful how I talk with students. Discussion about religion, faith and such are very divisive subjects in the United States and teachers have been disciplined and even fired due to religious themed activities and discussions. Therefore, talking to somebody about religion in the context I have presented, requires one to be very careful in how they approach the topic.

Anybody know what the evidence has to say about gastrointestinal decontamination techniques such as lavage, single dose charcoal, whole bowel irrigation and so on? What about official position statements? http://www.clintox.org/positionstatements.cfm

Ghost, this thread is several months old and AK is no longer active here. However, you can look TMH up and see if they have any open positions or contracts.

We cannot advance until we focus on and correct our fundamental problems first. In my four years of teaching I've yet to see anatomy and physiology, English and college level mathematics required for paramedic education in my area. Through hard work and support, I am at the cusp of seeing this occur. Again, we are struggling to even establish ourselves as a profession and we are talking about going up against some of the most powerful lobby groups in nation? Nursing could destroy us. Sorry bro, as I stated earlier, following the failure of the Red River Project in the 90's, fundamental education issues in EMS has changed very little compared to other countries with robust education in place and relatively independent practitioners. CCEMTP is a 100 hour curriculum. I'm not sure you can make a competent critical care provider in 100 hours. Also remember the PA was derived from military medics (mainly corpsman who served in Vietnam) and is a direct descendent from prehospital medicine.

I cannot fault the passion and desire to advance the profession. However, the greatest battles that are being fought revolve around minimal educational standards, pay and the formal establishment of the paramedic as an allied health professional. I cannot support taking steps to put forth a practitioner with a few hundred hours of training while neglecting the fundamental problems with EMS. This way of thinking is hurting nursing and I've seen two nursing programmes loose their NLNAC accreditation in the past year where I live due to several unresolved issues that are largely being neglected in part because of the focus on less fundamental issues. As an educator and provider who holds multiple degrees and licenses, my biggest goal is with trying to work on fundamental EMS issues. A paramedic practitioner is not on my list of issues that need to be resolved.

Let us not forget that residencies and fellowships are beginning to become more commonplace for PA's. Emergency medicine residencies and fellowships are starting to be available for PA's. As stated, the PA educational model revolves around primary care already, now we can add on formal specialization. I do not realistically see mid level paramedics happening any time soon in the United States. As stated, we still have shake and bake programmes that offer little in the way of basic sciences. In addition, the EMS lobby is nowhere near as strong or organised as other groups. We also need medical directors on board as I do not see the role that physicians play changing in the United States anytime soon. Unfortunately, what I fear is just another 100 hour shake and bake add on that lacks any real educational experience or value when compared to other allied health providers let along mid level providers.

All advanced practice nursing (NP) curricula mandate a core of three classes consisting of parhophysiology, pharmacology and assessment. All of which can be completed in a single semester. FNP's have a pretty broad scope of the lifespan. Interesting thing is that a typical residency will be longer than an entire nurse practitioner programme. Heck, I've seen post residency fellowships that rival the length of an entire NP programme.

If nurses want to be doctors, why not a full on premedical curriculum complete with a year of general chemistry, a year of organic chemistry, genetics and a year of physics? Then add in science based courses that focus on biochemistry and so on. Aside from that, the clinical requirements are laughable with some NP's doing direct entry programmes and graduating with less than 1,000 hours of experience. Frankly, I am ashamed of what is going on in nursing. There is a huge push for indi practice and much work going into DNP programmes, yet we are struggling to bring well educated, entry level nurses to the bedside. It's almost as if nursing has lost it's way when it comes to being the backbone of health care.

This level of autonomy is not new. Let us be clear, these are often nurses with little basic sciences beyond what is taught in undergraduate nursing and an additional pharmacology class beyond their undergraduate experiences rolling with less than 1,000 hours of clinical experience. Yet they are in some areas working completely independently of a physician without even a collaboration or chart review requirement. They are in essence, working as a physician.

What advanced surgical procedures would you want to be able to do? What exactly could you do while waiting for transport? Also, why do you not want to take the PA or NP route? What is your aversion to using a concept like the PA that is already well established and capable of providing care in the way people explain on this site? Why the need to reinvent the wheel when we already have established "practitioners" in the form of midlevel providers? Additionally, I have not changed from my position two years ago.

Dwayne: The safest thing to say is that there will always be a non zero probability of HIV transmission regardless of the "viral load." However, I can apply a few concepts and make somewhat of a working model. According to the Swiss model, the probability of infection during heterosexual sex if the viral load is less than 40 copies/ml of blood is quite low, but non zero nonetheless. When appreciating a "typical" course of HIV infection, you have about 2-3 weeks before the viral load reaches 10(2) or 100 copies/ml. Since 10(2) is on the order of magnitude of 40, we can safely say that in an "average or typical" course rates of infection from heterosexual contact will probably be very low.

Allow me to nudge the dialogue in another direction? Is an environment where we have hide their beliefs a good thing? A staple of many sects of Christianity revolves around the fact that if you do not believe, you are going to hell. In other words, you are doomed in the worst way imaginable from the Christian perspective. This is also true of other religions as well. Therefore, if you are a Christian who believes this to be true, what kind of person are you if you don't go out and proselytize? If I believed, honestly believed that you were on the train tracks with a train coming to ruin your existence, what kind of person would I be if I didn't at least try to get you to move off the tracks, even if you failed to acknowledge that the train was coming? Are religious people who keep it to themselves really any better (from a moral perspective) than the people who are actively proselytizing?

Also, I'm not sure why you want a "legitimate definition" as this conversation is broadly about dealing with people who experience conflicts with their belief systems, religious or otherwise. Therefore, the context of this thread is broad enough that specific definitions are not really needed.

We can go of off Merriam-Webster as the primary definition is as good as any: Religion: The service or worship of God or the supernatural.