chbare

Actually, many states do not technically use the DOT I-85 NSC; however, when their curriculum meets or exceeds the 85 level, the NREMT may allow graduates to test out at that level. However, many states do not use the NREMT-I/85. Unfortunately, all you can find is the I99 curriculum. NREMT will still test the 85 (very limited amount of time with the new SOP changes). Your best bet is to pull the I-85 material from the 99 curriculum if you are looking for a guideline to the standard. The I85 standard consists of the introductory material, medical terminology, airway management (The State can specify if ETT is taught), shock management and IV therapy, and patient assessment. Anything else is supplemental to the original I85 curriculum. In fact, the NREMT-I/85 psychomotor stations only include; airway, patient assessment and management trauma, IV therapy, and a random basic skill. ETT is not a requirement of the airway station. Take care, chbare.

Unfortunately, we are not getting off easy. We are simply doing a half arsed job. Anybody who is unsure of the sequela of a half arsed job need only look at the houses down here in the southwest where people are paid a few dollars a day to build the said houses. I agree with the stance on other countries. This stance was only solidified after working with South African B-Techs who all had four year degrees and Australian ACP's with three years of education under their belts. Take care, chbare.

Actually, no solid evidence points to any medication being particularly effective. Unless, you have a case of early or near arrest with a known and correctable cause such as hyperkalemia. Take care, chbare.

Unfortunately, I live in the real world where even the new EMT's under the latest and greatest national SOP will have a massive addition of 40 hours to their training requirements. While I agree with you guys in theory, this simply will not be the case for many paramedic programs. Therefore, the only route I can recommend for EMT's, is to take a year and obtain the said background, unless they can get into a good AS/AAS program. I would love to see AAS degrees as the standard; however, I fear it simply will not happen. Take care, chbare.

I have actually revised my original stance on this topic. You should obtain a year of experience. This will give you enough time to have two semesters of A&P, two semesters English, a semester of math, and a semester of psychology under your belt before entering paramedic school. Take care, chbare.

I am not sure how any of this relates to the situation at hand. First, the patient is in no position to make decisions about his health. He clearly does not fully understand his situation. (With the current evidence available.) As stated earlier, his condition has a very good chance of responding to treatment. (Provided things have not progressed as states earlier.) Anecdotal arguments have limited value when we look at these situations. If we look at the evidence, five year survival rates are actually quite good with proper treatment started early. Thus, it is more likely that the treatment could prolong his life. Not treating the disease is typically a death sentence. In addition, the judge did say that if further testing indicated a poor prognosis and the physicians would allow treatment to be with held, then so be it. At this point, he must be re-evaluated to see if additional treatment would be helpful. Seems a prudent thing to do IMHO? Take care, chbare.

Get your information from the horses mouth. You can download the DOT NSC in PDF format. If the medication is mentioned in the NSC, it would be fair game to potentially answer a question about that medication on the NREMT IBT. This link would be a good place to start your search: http://www.nhtsa.gov/people/injury/ems/EMT...%5B1%5D/1-7.pdf Take care, chbare.

Since we are off topic, are we really that different from dogs? I dare say much of what we do in life is simply fulfilling "biological programming." Guys, ever notice what happens when you see a hottie sweating it out on the treadmill in front of you at the gym? Perhaps, we are evolved enough to refrain from humping her leg like a dog (some of us) ; however, I dare say our "biological programming" and "operant behavior" still kicks in. Sure, we have fancy ways to describe our reasoning and understanding of our behavior; however, are we really all that different from the other animals of this world? Food for thought? Take care, chbare.

I respectfully disagree with you as well. I stated "one of the reasons" is the over emphasis on RSI. I agree that poor education and experience is part of the equation; however, this is not a new medic problem as many people across the board are having problems in systems that use RSI. I do not want to go into a RSI debate, and simply used RSI as an example. I still stand by my point that I have seen providers push for RSI on every head injury because they only see the worse case scenario. I agree, the root cause is perhaps poor education. Take care, chbare.

I do not disagree; however, my concern is that we have people who are trained to take this concept to a zealous extreme and tend to assume the worst with every patient. This is where I disagree, and unfortunately, I have been around many of these proviers who simply have to perform an intervention based on half arsed evidence. I suspect this is some of what is fueling the RSI problems we see. People are performing RSI on every head injury or every altered mental status patient without actually considering the big picture. I agree, be prepared for the worst case scenario; however, do allow your self to fall into the every patient is going to crash on the way to the hospital concept I often see taught to EMS providers. Take care, chbare.

Unfortunately, the list of differentials for low grade fever, sore throat, and generalized myalgia in the pediatric patient is quite long. You would be hard pressed to narrow the problem down to streptococcal pharyngitis versus meningitis simply based on the said signs and symptoms. If I had to care for somebody with these signs and symptoms, I would obtain an in depth history and perform a physical exam and assessment along with a complete set of vital signs before narrowing down the differential. I am actually not a fan of assuming the worst case scenario on each patient. Always be ready for the worst case scenario; however, looking at every patient with viral syndrome like signs and symptoms as a worst case scenario can actually lead to the dreaded tunnel vision and making hasty decisions that are not based on solid evidence. I prefer taking a more pragmatic approach to patient care. This also includes sick people. Case in point: Some years back I transported a patient with a pericardial effusion out of a small hospital to a larger sub-specialty facility. My partner began focusing on the "tamponade" problem almost at the point of patient contact. From the history, this was an ongoing problem that slowly developed over a period of several weeks. I disremember the specific history, however. The patient was alert, awake, and in pain. His blood pressure was around 100 systolic upon initial contact. In flight my partner became anxious continuously focusing on the diagnosis of pericardial effusion. The intubation kit was out, my partner had drawn up RSI medications, and pulled out the BVM. My partner continued to say, "this patient is going to crash." I administered pain medication and a little oxygen. Along with monitoring, I did nothing else for the patient. At one point, the patients pressure was in the 90 systolic range, following a few doses of fentanyl. My partner look at the monitor, then looked at me while grabbing the RSI medications and stated loudly, "aren't you going to do something about that!" I stated "nope." I told my partner everything was" ok," and the transport was completed without incident. While being prepared for the worst is good, focusing on the worst case scenario without considering the big picture is myopic and can lead to poor decisions and the consequences of those decisions. Take care, chbare.

Not much doubt that the medics did things wrong; however, equating the walking with the patient's death is a stretch and quite dramatic IMHO. Massive anterior wall MI's tend to have high rates of morbidity and mortality. While the situation may have been handled incorrectly, the drama and blame game stuff is a bit over the top to be balanced reporting.. Take care, chbare.

Give us the Reader's Digest version? Present a case study with critical learning objectives along with the highlights of the strip. Saves you the work and tickles our fancy at the same time. Take care, chbare.

Got it. Take care, chbare.

Would this apply to non DPN nurse practitioners? I understand PA's have their own certification process and do not take the USMLE. More specifically, where would you place the line on requiring a provider to pass the USMLE. What type of line would need to be crossed? For example, NP's who have physician supervision or collaborative relationships? Is this within the line and outside the line when a provider seeks total independent practice? Or, does another line exist. This is the link to the data ERDoc stated earlier: http://www.abcc.dnpcert.org/exam_performance.shtml Take care, chbare.

I think my question goes beyond simply saying,"ok you are sick." What I am talking about is more like; "you are sick, I have interpreted the results of labs and diagnostics, I have interpreted your physical assessment and history, and this is your diagnosis. In addition, I will treat your problem using A,B & C." Not the A,B, & C on our guidelines or protocols, but the A, B, & C that we definitively decide. In addition, I disagree with the computer making the diagnosis. At some point, somebody is going to make the decision to stay, leave, or transfer. For example, a chest pain with normal XII lead, labs, and PA chest. It is now decision time... Unfortunately, the treatment and diagnosis may go far beyond a chest x-ray and labs. What's say that dyspnea patient is in Atrial Fibrillation. Now we ask, what is the cause, how do we treat (rate reduction versus conversion), where do we go from here? So many factors and considerations that we often take for granted. However, at the end of the day, the buck stops at somebody. My question revolves around the buck stopping at non-physician providers. My question is based on autonomy. What I mean by this is the unilateral ability to make a definitive decision about the type of condition, treatment, and follow up. At what point does giving somebody this type of autonomy cross the line. Or, does a readily identifiable line exist? Currently, I think it is blurry and perhaps needs to be better defined. Of course, this could create additional problems. Clearly, mid level providers can effectively provide care. However, my question is how much of what physicians have traditionally provided can effectively and safely be provided by non-physician providers? Take care, chbare.

Appreciate the replies. Here is my take on this whole movement: I actually spent a fair amount of time working in a highly autonomous role when pulling remote clinic coverage. Ignorantly, I thought I was up to the task. However, it really hit me that I was making definitive decisions about the health and welfare of my patients. I remember having a rash/skin lesion day. It is actually humbling when you see six different people who have six different problems with similar but different characteristics. I spent allot of time in an internal medicine and dermatology book. Unfortunately, much of this simply included looking at pictures and making a guess regarding the problem. Obviously, I did close follow up on many patients. So, here I am getting stumped by skin lesions in healthy people who will most likely recover without incident. However, if I screw up? I actually was one of the only providers who would call one of our doctors every night and review every chart with that doctor. I would write their assessment into the records and any recommendations. In addition, I would revise the care plan of the patients based on the physician recommendations. In addition, I was not hesitant to have patients follow up with a physician at the main clinic. However, the security and logistical situation often did not support driving patients around Kabul at all hours of the day. I feel I am a pretty smart guy. Perhaps not the sharpest tool in the shed; however, I do not look at my self as an idiot. However, I know what I do not know. My concern is that unless there is some highly intense education regarding "medicine" when I go on for my masters or to PA school, I do not see how I could possibly be in a position to consistently make these decisions without a physician backing me up. Again, I am not here to cause any hurt feelings. This is just the observation of somebody who is not a midlevel provider. I admit my ignorance up front. I did look at the SDN forums and some of the nursing specific forums. The problem I have, is many people are shooting from the hip and naturally lining up to protect their profession and personal interests. By coming to this forum, I am hoping for more productive discussion in a "neutral" environment. Not that this is totally possible.

Touche. Take care, chbare.

Good evening, I suspect this will be a controversial topic, and people may develop hurt feelings or revert to an us versus them mentality. However, this is not my intent. With all of the talk about improved education, where exactly does the role of physician begin and end? As many are aware, the new doctor nurse practitioner is causing a stir among both the medical and nursing community. A thread on a nursing site I frequent disappeared before I felt we could have any type of intelligent conversation on the topic of midlevel providers and how this relates to practicing medicine and the bigger health care picture. In EMS we often argue about diagnosis and the line that exists between a health care provider and a physician. It seems this line is becoming quite blurry and much confusion and drawing of lines in the sand appears to be occurring. I would like to see if any type of intelligent productive conversation can occur on this topic as many people have discussed the future possibility of EMS providers who provide midlevel type care. Obviously, I find this topic quite interesting because of my nursing background. However, I will make my stance quite clear: I do not think there is any way to get around or replace the intense amount of education and experience physicians receive. In addition, the exact role of midlevel providers is something that confuses me, specifically NP's who technically provide "advanced nursing," is even more confusing in light of this DNP concept. Hopefully, people will see I have no agenda other than productive and thoughtful conversation. In light of my nursing background, I remain absolutely supportive of the bottom line. That being, the delivery of effective patient care. Therefore, I am not poised to take anything personally and hope to gain an appreciation for other people's views. Especially the midlevel clinicians and physicians who frequent this site. While not directly related to EMS specifically, perhaps we all could learn from this conversation. I hope for the best and understand that this could turn ugly. If the later occurs, I will apologize in advance. Take care, chbare.

I think you are correct in some ways Welsh; however, there exists a plethora of evidence pointing to the global lack of substandard providers in this specific system. Not to mention the victims of this care. I am not going to stamp on anybody personally; however, as evidenced by my prior post, when a paramedic cannot call a laryngoscope blade by its proper name in a simulated environment, major problems truly exist. Take care, chbare.

"I'm gonna try a mac because I just can't get it with this curve." Enough said. Take care, chbare.

Got it. Does Alberta ACP ~ to the US paramedic? I understand, some levels of PCP in Canada receive several hundred hours of education, yet operate at an intermediate-ish SOP. Not that I disagree with this model of education. Take care, chbare.

I would suspect some type of testing would be in order. From kilometers per hour, to kilo-pascals of oil pressure, to SI units of lab reports, there are differences between the United States and Canada. I suspect there is reciprocity after testing and perhaps additional course work or orientation? Take care, chbare.

If I read the prior threads correctly, I think people were saying the presence of a posterior wall MI leads to increased morbidity and mortality. Actually, I think there is increased overall morbidity and mortality with RVI simply because more of the heart is involved. Take care, chbare.

Another example of one I flew a couple of years ago: Take care, chbare.