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According to Fl, he lets his EMT's all start IV's. Florida only has EMT-Basics and Medics, and I for all my searching I can not find any formal augmentation courses for an EMT-B to be allowed to start IV's. It is one brave medical director if he allows EMT-B's to be sticking people with IV catheters. Hey, Fl, I was thinking of retiring, may you could give me the name of your county you work in, I'll take a vacation, have some chest pains, and then have some mysterious irreversible nerve damage after on of your basics puts an IV in on me. Whaddya say? I have a feeling I know what the court would say when an untrained medical provider is performing skills like that and causes injury to a patient and you can prove causation. You know, its funny, FL medic whines about egos, but then goes and makes a statement "Sure, the rest of the country says 120 hours of training isn't enough to play with invasive procedures, and neither does any one of the governing bodies of EMS, but you know what, its okay because its under MY supervision." I have an idea, how about you stop trying to play Mr. Teacher Special Person and guiding your padwan learners through the process of an IV, do your job as a paramedic, start the IV, treat the patient, go to the hospital, and call it a day? You think you might benefit your patient a little more that way? You wanna talk about egos? Guys like you love letting people who aren't supposed to be doing certain things do them because they get a certain rush and power trip out of the whole deciding who gets to play and who doesn't. Maybe on the playground you got to rule over all when you had the shiny new ball and could decide who plays with it and who doesn't, but this is the adult world, and you are playing with patient's health and well being by your actions.

Yeah, the other day I let the janitor have a whack at IV's and intubation. Why not? You know, FL, not for nothing, as they say in my neck of the woods, but if you are letting your basics play with the sharps, you are not only guilty of a fairly serious crime, you are also endangering your patients and setting up your EMT's for major ramifications. Way to go, hero.

Barnes, I fully agree. However, if those of us who care to do so keep up our educational standards, it will in time have an affect on the profession as a whole. A profession can only survive for so long with the ones on the bottom having more education, intelligence, and experience than the ones calling the shots, or at least I like to think so. Welcome to the frontlines in the battle for EMS. Your target is the 34 year old assistant director who's last job was managing a Wal-Mart. Go! Go! Go!

No, I've never noticed, not ever. And Rid, one of the kindest, most down to earth people I have ever met was a neurosurgeon. That's why I can safely say when someone is being all high and mighty "I've met neurosurgeons who are more down to earth than you are." Anyway, Notsobrite, if its any consolation, the ego factor tends to be more of a hinderence in the volunteer sector. This is why, besides my old volunteer Fire Department which was a bunch of working class shlubs, I've never done a day of volunteer work in my life. Somehow once people reach the level where they can actually collect a paycheck for their abilities, they tend to come down off their high horse because they have less to prove. That at least has been my experience.

Bbbrammer, while I am much more sympathetic to your plight than to what most people usually present as the stresses of the job, as someone said before, you are to a certain extent letting your department take advantage of you at the expense of your loved ones. 96 hours a week is pretty excessive, if they can't find another ALS provider to employ, then they'll have less ALS coverage, its as simple as that. No one ever asked you to save the world. Its not your duty to destroy your life for the sake of the community. As for not telling your husband about your calls, again, I say screw HIPAA. If you need to vent about a call, do it, if your husband can learn to keep his mouth shut I doubt the feds have your house bugged to make sure you don't violate any laws. You have such dedication to your job because you'd feel awful if something happened and you weren't there. It's an unfair position to be in, and its one you need to get out of before it really destroys your life. This is my humble advice, take it for what you will. At least you have the strain on your relationship for apparently true altruistic feelings. As I said before, most people who complain about the stress of the job are really complaining about the stress that their own egos and selfishness cause on their lives.

I have always challenged the notion that police, fire, and EMS have high divorce rates because of the stresses of the job. I say they have high divorce rates because a lot of the people who work in the profession are a**holes. Sure, a lot of people in each profession's relationships have suffered because of some job related stress, but you know what, each job has its own stresses. I say that most of these problems are caused by the sense of entitlement that many people feel because of their jobs. In other words, if you are an EMT who is very "close" with his female partner, needs several nights out with the "boys" to "unwind", and then still expects his shoes shined and his dinner ready when he comes home, you'll be divorced shortly, and it has nothing to do with the job. And what's this crap with HIPPA? HIPPA is not a sacred oath that means you can't discuss specifics of your job with your spouse, so long as you keep the details of the person's identity private. Most people just don't want to hear about it, period. Doctors suffer the same way. Nurses do to. Funeral directors have incredibly stressful jobs. The reason for our high divorce rate is the high percentage of scum we have working. Okay, there, done, enough with the rookie excuses for why your girlfriend left you, we have standards to keep up around this berg.

You know, its funny, Catholic Heaven is much like every single one of my family get togethers in the last 20 years. Except for the dancing part, and Jesus doesn't show up much anymore.

Easy. ACLS, call the doctor, pronounce, call it a day, although, really, once the doctor says its okay to pronounce, its pretty much on his head so long as you can prove you followed your protocols prior to contact. What happens and what is documented is always the same thing. Always.

Easy. ACLS, call the doctor, pronounce, call it a day.

99 y/o woman, called for unconscious in bed, approximately 20 minutes prior to our arrival. Asystole on the monitor, unfortunately DNR could not be found, so we worked her. After standard round of epi and atropine, no response, asystolic the entire time, for about another 20 minutes. While on the phone with telemetry for a pronouncement, notice something that looks very much like NSR on the monitor, with a strong pulse, patient weakly raises her hand. Its a good thing I didn't have a hammer and a wooden stake at that point. She later died again for good at the hospital after the DNR had been located, and I felt like a very very bad man.

Okay, now that EMTwannabe has had his little bitch fest, back to intelligent discussion. Ah, how sweet it is. All right NREMT, you asked how EMT's doing ALS skills takes money away from paramedics, and then said that it saves the community money. I'll answer the last part first. Having two paramedics on an ambulance only costs the company or city more than running, not the patients. You see, when a patient recieves a bill, it looks something like this: ALS Assessment (me saying hiya): $500 Oxygen: $100 Transport: $200 Cardiac Monitoring: $400 Etc. To the best of my knowledge you can't bill for having two seperate paramedics. You can basically bill for ALS treatment and assessment, but it doesn't matter if you use 1, 2, or 3 paramedics, you can only bill once. Some Fire Departments have all of their firefighters as medics. I'm sure you don't get billed five times if one of their engines shows up. Now, if it is a municipal based service, yes the increased salary of a paramedic does cost the community a bit more, but seriously, in a reasonable sized city, how much of the budget would really be eaten up by shelling out an extra $10,000 a year for a medic over an EMT? Secondly, I'm not saying your department in particular, but if you can afford the $70,000 Freightliner ambulance with the airshocks and thrust vector engines that people are so fond of, you can afford to pay the extra to have another medic on your staff. Now as to how this decreases the salaries of paramedics. As Dust said, its economic theory of supply and demand. My good friend Frank Slaughtery played by Barry Pepper in "The 25th Hour" explains it thusly in relating unemployment figures to inflation. "Look... More jobs means fewer people looking for work. Means it's harder to find good people to fill those jobs. Means you gotta raise wages to get them. Means inflation goes up. You got it?" However, I don't think raising the wages of paramedics would have a dramatic effect on inflation anytime soon. I hope this answers your questions.

I say we need to do more to attract the right people to paramedic school. We need to do more to recruit from the serious college students. Anyone ever seen that movie "Higher Learning"? Lawerence Fishburn has a great line, "College is here to teach you how to learn." Being a serious student is not easy. It takes hard work, patience, and determination. That's why I like associate's degree programs, if you do a year of prereqs, you weed out a lot of the boneheads, especially if you put in grade restrictions (I.e. you must have above a 2.5 GPA to go on to the core courses). If you can do well in A&P, and you can do well in English Composition I and II, and you can do well in Biology and Chemistry, you'll have a good student coming into your paramedic class. Now, whether they can hack it in the field is another story, of course, but you will have at least the basis for something to work with.

That's why I added the pro-commie comments at the end Dust, I realized I sounded a bit Marxist in these theories. I'm not really all socialist and workers unite and stuff. I worked for a store where the owner was fiercly conservative and I saw how unnecessary intrusion into private business can really be a detriment to free enterprise, I've worked for a non-unionized ambulance company that treated its workers like crap and saw the ugly side of making a profit in EMS, and now I work a civil service job as part of a union, which isn't too bad, so I've seen the benefits and drawbacks of many different types of labor relations. Of course organized labor isn't always a good thing, just look at what the UAW did to Detroit. Simply put, however, EMT's doing IV's and advanced procedures not only is bad medicine, but from a strictly economic stand point, it takes money out of the pockets of paramedics and gives it to the owners or shareholders of whatever company you work for, or in cases like mine, takes it out of the pockets of paramedics and gives it back to the city, and quite frankly, I'd rather some shareholder get my money than methadone clinics, but I digress. Take our proposed "Mensa Medic" program, where instead of 2 paramedics you have 1 paramedic and 1 EMT. Do you really think we have a crisis of ALS numbers to the point of this drastic action being taken? Or do you think some ugly, short, mean spirited bean counter with coke bottle thick glasses said "Hey, Medicare only requires one paramedic to make patient contact to bill for an ALS transport! MUHUWAHAHAHA!!" Do you think when this was being considered, someone said "Well, if we do this, we'll CERTAINLY have to pay the paramedics more because we'll be increasing their workload?" I doubt it. I really think EMS must be about one of the only professions where if someone said "Hey, who wants to work more and get paid less?", a couple of hands would go up in the room. Being a hero and wanting to do as much as possible to help others is fine. Being a tool of the man in his quest to persecute and oppress my brothers is not.

I say we need to do more to attract the right people to paramedic school. We need to do more to recruit from the serious college students. Anyone ever seen that movie "Higher Learning"? Lawerence Fishburn has a great line, "College is here to teach you how to learn." Being a serious student is not easy. It takes hard work, patience, and determination. That's why I like associate's degree programs, if you do a year of prereqs, you weed out a lot of the boneheads, especially if you put in grade restrictions (I.e. you must have above a 2.5 GPA to go on to the core courses). If you can do well in A&P, and you can do well in English Composition I and II, and you can do well in Biology and Chemistry, you'll have a good student coming into your paramedic class. Now, whether they can hack it in the field is another story, of course, but you will have at least the basis for something to work with.

Okay, mistake number 1: Trying to restrain a patient with a dangling stethescope. Mistake 2: Trying to do it by yourself. Mistake 3: Well, its not really a mistake, but the woman in that photo just plain pisses me off for some reason. This is why I don't read EMS magazines, that and the fact that they insult my intelligence. Also, I have five bucks on Mr. Goatee there over pretty blonde with nice hair.

ERDoc, I realize most nurses do not make the same amount nurses around my area do. However, I do have it on good authority that per diem nurses are making around $40 an hour straight time. 40 x 40 = 1600 x 52 = 83,200. Anyway, if your paramedics are making more than your AAS nurses in your area, then God bless. The bottom line is that I believe paramedics, as a whole, make far less than similarly trained positions, and part of its due to the depression caused by people willing to work for free. That's my line and I'm sticking to it.

You MIGHT be able to get that type of data from OSHA, I'm not sure what kind of record keeping they do but they might track #of injuries vs. cause vs. profession. If you look at the EMS memorial website and do a quick check of cause of death, you'll find that the numbers caused by direct violence against an EMS provider is extremely low. If you go by their data, your chances of untimely demise would look something like this: Dying in helicopter crash: HIGH Dying in MVA: HIGH Dying from BBP related: Not so high Dying from getting shot, stabbed, mugged, mutilated, decimated, defenestrated or annihilated: Very, very low

In response to Nifty's post, I'm gonna delve into a little economic theory, the knowledge of which seems to be severely lacking in EMS as a whole. Okay, so we here in the rank of paramedic are, and while it may be debatable, pretty much skilled labor. We have a skill which is economically viable. Therefore, as skilled laborers, we like to get a reasonable amount for the use of our skills. Our interests lie in getting the highest pay for our skill, increased demand of our skill means increased wages. Management, on the other hand, who recieves money from billing, but then pays out a portion of that to salaries, wants to pay the least amount out while getting the most amount of labor, which generates the revenue. Many, many, many a labor dispute has been over increased duties without an increase in salaries. Go ahead, go ask a carpenter on a construction site if he wouldn't mind emptying the garbage bins at the end of the day. He's liable to hit you with his hammer. However, compensate him to empty the garbage bins, and you'll have much more luck. EMS I believe is fairly unique in that we have a workforce which kicks down the door to take on as much responsibility and tasks as possible with out being compensated for such. I'm an EMT. Give me the IV's, Give me the LMA, give me Hazmat training and counter terrorism training and have me patrol the streets on my off time, hell, you don't even have to pay me! I'll do it for free!!! I Trust me when I say this attitude has a real effect on the wages of EMS providers. If you went to my college website, you'd see that the AAS program for paramedic is 60 credits and the AAS program for nursing is 65 credits. Not too much difference in terms of educational requirements. Now, I will plead ignorance to the extent of an AAS nursing program or the demands of the job of nursing versus being a paramedic. That's not what I'm debating. What I saying is that given the educational requirements, the fact that at top salary, with overtime, I'll be making around $65,000 (gross), vs. something like $80,000 or higher for a nurse of similar education and experience, is absurd. There are a lot of factors as to the salary differential, but fact that you rarely see nurses volunteering to show up at your house and treat you for free has a lot to do with it. There are areas in this country that are economically depressed enough that cannot afford professional emergency services. I say in these areas EMT-I's or advanced EMT's are better than nothing, but other than that, the only people that advanced EMT's benefit are the people who actually get paid the money from the insurance companies. Don't be a tool of the bourgeois elite. Unite with your fellow workers. Dosvedanya, comrades.

Steph, please review the site rules as it applies to rules of grammar, punctuation, and the use of spell check. We like to keep it professional around here.

You know, I have this image of Dust standing over his mangled I-pod, and then coming screaming out of his base with an M-16 in each hand and cleaning house. "What happened to him?" "They shot his I-pod" "Ohhhhhh...."

That would explain the spitballs.

Heck, outside of my mom (don't ask), if I find a woman who can tell that the "CHECK OIL" light means something, I'm happy.

That would explain the spitballs.