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That will not apply until the end of this year. People who already have NREMT credentials will have to transition to NRP regardless. Each state will have it's own transition process if it intends to follow NREMT. You will need to follow up with your state EMS office for specific details.

Until proven otherwise, I'd call BS on a BSN programme requiring proper gen and o-chem along with physics. Most nursing and allied health programmes mandate what are known as survey courses. These may share a similar name but will not transfer as a proper pre-med course.

http://circ.ahajournals.org/content/99/1/168.full

Let us also talk about antiventom as well. First, there are fiscal considerations. CroFab, the common agent used in the southwest costs about $4,500-$5,000 for a two vial powder kit. Next, there are several, significant adverse reactions that must be considered. At the top of the list we need to be concerned about serum sickness, anaphylaxis, and ethyl mercury exposure. Additionally, it takes a significant amount of time to mix the CroFab. If you rush the reconstitution process, you make a bunck of foam. Finally, CroFab is not a magic bullet and should not be used in every case of snake bite. The potential risks and benefits must carefully be weighed. As stated earlier, death from snake bites in the United States (Pit Viper) is rare. Often, monitoring and supportive care is the name of the game. In over a decade of living in the southwest, I've seen many bites and have yet to see a single fatality. While it does occur, the psychological "hype" is probably one of the biggest issues that we run into with uninformed patients and friends/family members.

The pathophysiology is complex but can be distilled into a single concept. Venous clots are composed mostly of fibrin while platelets do not contribute much to the venous clot. This is why anti platelet aments such as aspirin and platelet glycoprotein inhibitors are not commonly used to treat DVTs. This also explains why agent such as warfarin, heparin and low molecular weight heparin are commonly used. A new study has demonstrated that aspirin does appear to prevent dvt formation in some patients, but the results have yet to be replicated in other studies to my knowledge. Edit: "Complex."

The doctor was right. Aspirin does not have much of a place in the treatment of DVT in many guidelines. Prevention is somewhat debatable however.

I was involved in a lightning related mass casualty incident while supporting a field artillery unit during a storm. I also decided not to seek treatment mainly because of the number of casualties that required ground evac out of a remote training area because flight resources were unavailable due to weather. That aside, I would have serious issues about forcing an alert, oriented and informed patient to go to the hospital. Edit: totally unrelated, but I hate when volts, amps and so on are used without proper context.

You will have to make some decisions. If you are seriously entertaining PA school, I'd focus on completing an undergrad degree and getting good grades while focusing on the science pre-requisites. You should also obtain good EMT experience and consider PA shadowing. You can also check out PA specific sites and SDN for additional information.

My experiences pretty much mirror what AK has already stated. I worked primarily with the locals and expat contractors. Most of the local people were humble, gracious and valued life. Yes, there were frequent kidnappings and occasional bombings, but if you are going to be working behind the wire, you will not have all that much to worry about. I also agree with overpacking. Go with what you need. I learned the hard way about bringing tonnes of crap. A decent company should outfit you with what you need when you arrive. However, some breathable cold weather clothing is never a bad idea if you'll be outdoors at all during the winter months. I'm not as up on Kandahar, but Kabul can be miserable during the winter. Most of your expat patients will be typical swollen wimp node complaints; however, some of the guys have complex problem that are not well managed or become difficult to manage. I had many cases of HTN, diabetes, a couple of MI's, several subarachnoid haemorrhages, and I even diagnosed a case of haemochromotosis and blew a diagnosis of malaria. Ended up treating a suspected MI that turned out to be variant angina. Also, had numerous skin conditions and cases of cellulitis and skin abscesses. Did a fair number of I&D's with empiric anti microbial treatment. I would know common PO meds for treating MRSA. I only saw trauma patients when I did medevac missions. However, I only saw about six real trauma cases with the majority of our medevacs being complex medical patients.

A Higgs Boson walks into a church and the preacher says "we don't allow your kind in here." The Higgs responds by saying, "but without me you will not have mass."

Actually, defining a composite object like a proton is very difficult. Even it's name is a fallacy. However, at the time of it's discovery, it was thought to be a fundamental object. If we had waited a bit, the electron very well could have and should have been named the proton as it was actually the first fundamental object discovered.

Anybody watch the CERN brief? I actually had a few tears in my eyes when they panned over to an elderly Peter Higgs as he wiped tears from his eyes. Regardless of the ultimate findings, it's been a glorious week for science and humanity even if we will not fully appreciate the implications for some years.

Whatever fits well and is within your employer's specifications. I'm at a point where I can wear a good pair of trail runners and get away with it. When I flew on a regular basis I wore a pair of jungle boots that were about 10 years old and dated back to my days in the military. They were free, fit well, we're breathable and were easy to shine since I'd put do much work into them over the years. I'd focus on school for now however.

Can you link the article, I'd like to see this new concept as it puts forth a very different hypothesis than our current model. Regarding the sPO2, I pretty much have to parrot everybody else. It's a good question and the answer is complex, but it's basically because of electrons. Electrons in a certain arrangement will only absorb a certain, discrete amount of energy. With an electron, you either have the right amount of energy or you don't. There's no half arseing here. Certain electrons are in a very specific configuration when it comes to oxyhaemoglobin and will absorb light at very specific wavelengths. Remember, wavelength of light tells us the energy. The red and infrared light used in pulse oximeters has a relatively long wavelength and thus is at lower energies. Certain molecular complexes absorb light at other wavelengths and we can make use of this in other modalities such as co-oximetry.

From my experience with anaphylaxis, I would probably not initially go to an epinephrine infusion. It takes time to mix it and delivering reliable doses in the field when so many EMS units do not have pumps is a potential problem. I would administer IM epinephrine first along with IV fluid boluses and steroids/H2 antagonists first, then move onto an epinephrine infusion if needed.

From respiratory failure, seizures, CPR and being flown to a major hospital where you were on a ventilator to taking EMS calls in a week? Perhaps I am misreading something here, but I am having a difficult time digesting this story.

Sorry mate, my days of flying are pretty much over. Unfortunately, I've developed somewhat of a fear of flying. I do find your assessment of undergrad degrees prior to medical school interesting.

Going back to literature that focuses on EMS providers, I have found a small study that is somewhat significant. I remembered listening to a Dr. Jeff Guy podcast (http://itunes.apple.com/us/podcast/ems-pharmacology-for-prehospital/id290936644) where he mentions a paper from North Carolina that looked at paramedics and their ability to perform medication calculations. I was able to find an abstract and you can pay to access the full paper: http://www.sciencedirect.com/science/article/pii/S1090312700700554 While limited, it does indicate that college level education is associated with an improved ability to perform dosage calculations.

What a physician and a consenting, well informed patient decide to do regarding end of life care should be their business. IMHO of course.

PA school is probably not the best example. Virtually all PA programmes in the States are graduate level. This means you need to have an undergrad degree with a pre-med like load of classes before considering putting in an application. Additionally, many will require a decent GRE score. This is significantly different from an AAS/AS for entry into practice. Also, the PA fills a very different role. Edit: "."

Okay, let's see literature that looks at outcomes with degree paramedics versus Bob's firehouse medic mill medics.

I did not appreciate much beyond how they plan to gather evidence and areas where there will probably be improvement. However, I must admit some of the terminology is not as intuitive to me probably because of a slight language barrier.

Just wanted to add: I'm not trying to be a smart arse and I'm all about for looking at other countries and their educational models but what I am really pushing for is the evidence used to create these educational models.

Yes; however, the term GP does not apply in the United States in a "traditional" context as it went away in the 1970's as family practice required a residency and board certification. Semantics perhaps; however, this entire thread is in the context of United States educational standards. Feel free to educate us again on the New Zealand educational standards for EMS and other medical providers; however, my underlying question of evidence remains the primary concern. Is there literature that compares several outcomes across the health/illness and age spectrum between providers of different countries? Is this even a possible comparison? I am not sure, but I would honestly like to see how outcomes change when comparing medics in the United States to their foreign counterparts. Another study with weak evidence that suggests certification and undergrad education improves outcomes: http://ebn.bmj.com/content/early/2011/12/20/ebnurs.2011.100228.short Again, I am not sure how well this translates to paramedics.

He is actually a family practice physician.