chbare

I agree. I fail to see what is so wrong with putting a credentiall after your name, so long as you do not use it to produce a false image of your actual credentials? I know how much work went into passing exams such as CFRN, CCEMTP, and CEN. Why should I not display these titles after my name? Take care, chbare.

http://ehs.umbc.edu/CE/CCEMT-P/ Look at the link above. No where in the program description does it state critical care paramedic. In fact, many other types of providers can take this program. It is not exclusive to paramedics. In addition, it is considered a basic introduction to critical care transport. A few states may consider successful course completion a critical care credential. However, this is not the case in many parts of the country. http://www.mass.gov/?pageID=eohhs2subtopic...amp;sid=Eeohhs2 I do not see critical care paramedic among the recognized EMS providers in the state in question. Take care, chbare.

Honestly, I do not have a problem with people who display their credentials. I have CEN, CFRN, and CCEMTP after my name; however, these do not change my title which is simply nurse. I do think it is funny when people put CCEMT-P after their name. Since the course is Critical Care Emergency Medical Transport Program, not paramedic. I agree with how it was described above. Paramedics, physicians, registered nurses, and respiratory therapists are all able to take the program. It is not a dedicated critical care certification, it is simply an introductory course that covers the critical care transport environment. I think it is fine to display credentials; however, do not bend the truth or make up a title when in fact the credential gives you no such ability. Take care, chbare.

Well, yes and no. There is a difference between START triage in the field and what may occur at a hospital. Many hospital triage systems require a slightly different way of thinking. For example, you may use mental status to sort out some of the "less critical" patients at an MCI. However, depending on your triage system within the hospital, you may sort out people by resource utilization. You may find your self asking, how many resources is this patient going to require? Compare a deep laceration with controlled arterial bleeding to an abdominal pain patient. Who will need more resources? What specific findings suggest one patient may need more resources than the other? It is a different way of thinking than the field in many cases. I agree with Ridryder911 that triage is a very important area and in many facilities with a dedicated triage position, it is considered a crap assignment. I still do not see where Doczilla tried to offend other providers. I guess if you really want to spin it that way; however, he asks some good questions. Not saying I agree one way or the other; however, can other providers effectively perform triage in the ER? We also need to remember, things you do in your backyard may not be the same things somebody else does in their back yard. For example, it was stated earlier that somebody had not seen an LPN in 15 years. However, where I live and work LPN's are common place. In fact, one of my part time jobs had me as the only RN in the facility. I had a LPN and a CNA on the floor and a LPN in the ER with me. This was the entire facility staff excluding our ER physician. LPN's are common place where I live; however, they may not be common in other areas of the country. Take care, chbare.

I did not see his post as condescending. I think his definition of a tech differs from your definition. I see his point and see this occurring in my geographic location as well. One example is in the cath lab. I see hospitals taking people and putting them through an in house program where upon completion, they work as a cardiovascular tech. I think there is a difference between say a lab technologist and a lab technician. In my area, one has several years of education where the other has several hours. Take care, chbare.

However, the lines blur when we go into small facilities that do not have JCAHO credentials. I have seen a major policy shift with many hospitals however. In fact, some hospitals have all RN staff in "critical care" areas. I am not sure where the incident in question occurred. It would be nice to look at that states' BON SOP and facility guidelines. Take care, chbare.

Hmm, we are in somewhat of a grey area. If we look at EMTALA for example, it essentially states every patient must have a "medical screen" to determine if they in fact have an emergency medical condition. However, triage is not really considered a medical screen. Triage is more like the process of determining who receives the medical screen first. Now, when we talk about who can perform a medical screen. Again, it is a bit on the grey side. Usually, a physician will perform the medical screen; however, in some cases the physician my delegate to another "qualified provider." However, this can only lead to increased liability. Clear as mud? Take care, chbare.

You may be pushed ahead a few weeks when you start your AIT. When I went through AIT, nationally registered EMT's were pushed ahead of the Delta Modules. However, the MOS was 91B at the time. It has since changed a bit. Agree with Flight-LP that the additional education should help you better understand many of the concepts taught. Take care, chbare.

Most patients I have transported were interhospital burns. I calculate the fluid delivered PTA and compare it to the parkland calculation. Then, I look at the overall hemodynamic status and deliver fluids based on that assessment while taking other disorders into consideration. Remember, these formulas are simply maintenance fluid calculations. They will not take other causes of fluid volume depletion into consideration. Again, you must be flexible and use a certain amount of clinical judgment when implementing your plan of care. Something I as a nurse must am not able to do. Sorry, could not help it, just playing bro. As far as what I do when working a fresh burn. Again, be flexible and use the formula as a guideline. Typically, an otherwise healthy adult can tolerate a 20 ml/kg bolus of isotonic crystalloid up front. So, I have no problem hitting patients with a bolus of 1000-2000 ml up front, then taking it from there. Take care, chbare.

Thank you for the kind words everybody. I am not sure what services I will have available; however, I plan to remain an active member of this community provided I have net access. Akflightmedic, I look foreword to meeting you as well. Take care, chbare.

It looks like I will be heading out of country to Iraq in the next month. Thus far, it looks like a done deal. I will be in a position where I will provide medical support. In addition, I hope to see other parts of the world, network with other providers, and experience other cultures. Take care, chbare.

Sound advice. After years of crashes, viruses, trojan horses, and worms, I finally took the plunge. I will never go back to PC. This is especially true with the Windows Vista program. Worthless and flawed, it should be a crime to push this onto people. IMHO, of course. :wink: Take care, chbare.

Yes. Typically, I will place a Foley and note the immediate return. Then, I get rid of it and start monitoring hourly urine output from there. In addition, do not get so wrapped up with obtaining the perfect number that you render yourself unable to see the forest through the trees. For example, I am not going to get all crazy and adjust the fluid rate if I notice my patients output is 110 ml/hr provided they are stable otherwise. I really think this whole concept requires clinical judgment and common sense. Take care, chbare.

First, let us better define a few concepts: 1) The Consensus Formula is not the same as the Parkland Formula. Two common burn formulas are the Parkland and Modified Brooke. The Consensus formula is a combination of both formulas. 2) I suspect you would have a very difficult time using any of the burn formulas to calculate for adequate fluid delivery in the electrical burn injury patient. 3) Many experts have all kinds of thoughts on proper fluid type and delivery for burn patients. Generally, I find most people are at least ok with using an isotonic crystalloid. 4) Urinary output is going to be a critical indicator of adequate resuscitation when considering the electrical burn patient. 5) Rhabdo is a concern. Rhabdo can lead to ATN and ATN can lead to ARF. 6) We must consider all other injuries and conditions in addition to the electrical burn injury. With that, I understand that you were told to use a conventional burn formula to calculate how much fluid is required to resuscitate these patients? We already have a good indicator of adequate resuscitation; urinary output. We can use the recommendation of 75-100 ml/hr. These patients will need a Foley, and we will need to closely monitor I&O. In the initial phases of resuscitation, the EMS considerations will include; safety, removal from the scene, supportive care and stabilization of the ABC's. Then, we can make fluid resuscitation decisions. We need to understand that this is a dynamic process. Initially, we will may not have a urine output, so we will have to use our judgment regarding how much fluid to give. In most cases, an adult who is otherwise healthy can tolerate a fair amount of fluid. Personally, I would not be afraid to initially be aggressive with fluid delivery provided the patient can tolerate the fluid. The bottom line: You will have to use your own judgment and remain flexible. Even the burn formulas with a conventional burn patient should not be looked at as commandments set in stone. The patients overall condition and urine output should guide your therapy. Take care, chbare.

My initial basic course was 130 hours long. It was integrated into my Army AIT. The EMT phase of training was just over two weeks long. At the time, four booklets covered the material. They were called modules. Delta 1-4, or what we called the Delta modules covered the material. You could teach somebody to pass NREMT in about 1/3 of the time if that is your goal. Take care, chbare.

Both bicarb and calcium chloride were used frequently in cardiac arrest management. Take care, chbare.

I am not sure what you are asking. In my prior posts I thought I stated I really did not think doing a FAST exam would change the way I treat a patient. I thought it was implied that assessment of the scene, MOI, patient hemodynamics, LOC, and overall condition would be what I would use to guide my approach to patient care. Take care, chbare.

I tend to agree with AZCEP on this one. I am simply not sure this would have an impact on patient care and outcome. Perhaps it will prove to be a great tool with triage decisions. Does this patient need a trauma center or can this other hospital care for the patient, may be such a situation. However, I have seen people with critical injuries have a negative FAST. So, instead of asking why not, I think we need to ask why. Take care, chbare.

A neat idea; however, will this change the way practice? What real benefits exist with this technology in the field. My employee is looking at fielding one of these devices in one of our aircraft. The data obtained will help our clinical bubbas decide if it is worth taking the plunge. I know Austin has a progressive Medevac service using US. In addition to diagnostics, US is used to guide some procedures in the field such as IV placement. Currently, I am not sure many services will have real use for such a device. Sure, it would be cool to do a FAST and ID an injury; however, will this really change the way we treat patients? Take care, chbare.

Strange how so many people are assuming she's trying to milk the system. Perhaps she is; however, the information I see so far does not support this theory. Why did she not go after the hospital? That really is a good place to hit up for money? Why did her family come out and say they were happy with the hospital and went so far as to say they place no blame on the hospital? In fact, the doc is the only one named in the lawsuit. Take care, chbare.

Hey, it's all good. It comes down to what you think is a priority. Personally, I see no problem with getting the 12 lead first. I simply disagree with calling poopoo on somebody who would do the 12 lead first. Why not wait for the 12 lead? Is the ASA that much of a life saving intervention? Take care, chbare.

Hmm, I did not read that JakeEMT would not give ASA based on the 12 lead findings, I understand him as saying "I want to do a 12 lead first." Perhaps he considers assessment a priority? We do not start cramming interventions down our patients throats without a proper assessment. Is a 12 lead not part of a proper assessment? Take care, chbare.

Thank you everybody. I really enjoyed this contest. I really like looking at other peoples ideas. It is neat that we all seem to have specific areas of focus, and this is apperant in the various curricula posted. For example, I focused on explaining specific aspects of the molecular biology course while somebody went out of the way to focus on a class for crime scene operations. Take care, chbare.

The POM class would focus on many aspects of stats. Mean, median, mode, and standard deviations would be included among other functional aspects of stats. Take care, chbare.