Mateo_1387

I too share this sentiment. I think Skip is a well intended person, but I do not always view things eye to eye with him. Dust, thanks for the thought out comment. I really thought this would bring in some good discussion. I am not sure where this letter was published because I came across it on myspace. I do think he brought up some good points about career development in EMS. The options of movement within an ems system and not being just a paramedic or a supervisor is great. With more opportunities I would think that it would improve EMS as a whole, by combating the whole Medic Mill system working to counteract the burnout rate. I think it will help because to do some of these positions that Skip talked about you would need better education. Also with these movements in the system the paramedics I would think would stay with the system longer, which would hopefully help agencies realize they need to start looking at how to keep employees interested in their job. With these experienced providers more skills will come about which will put us more along the lines of medicine and not public safety. With these advanced skills the noOb medics will have to have a better education and understanding of the body to be able to function.

Dude, where did you work? I have not seen the pay as bad as you say it is. Maybe if you were in one of the intermediate systems, or position. Paramedics in NC can provide for their family without food stamps. Jake brought up a good system. I would suggest to the OP to check out the site, view the protocols, and contact them. They are always willing to talk with potential employees. www.wakeems.com I will also say that if you look at the Raleigh area (Raleigh is in Wake Co.) that it is a great place to live, its growing, and really a great place to be a medical professional.

I am going to take a stab at this. SVT = Supraventricular Tachycardia. This means any tachycardia that originates above the ventricles. Some possibilities are junctional tachycardia, sinus tachycardia, atrial tachycardia, uncontrolled atrial fibrillation, atrial flutter, and multifocal atrial pacemaker. So SVT can mean a lot of different tachycardias. It is easy to call a rhythm SVT when one cannot see P waves and just lump it in the SVT group. To figure out with "SVT" you are looking at the following information might be helpful. Wandering atrial pacemaker will be at a rate less than 100, with variable p wave morphologies. Multifocal atrial pacemaker will be the same as wandering atrial pacemaker, but at a rate greater than 100. Atrial tachycardia caused by a re-entry pathology will generally be at a rate of greater than 180, with a narrow QRS complex, and no visible p waves.

Do you agree with Skip kirkwood? What do you think should be offered for paramedic to move horizontally or up the ladder?

I thought this was worth sharing. Careers in EMS: What Could That Ladder Look Like? Most people who choose EMS love what they do and would love to have full careers in it. Yet they are painfully aware of several things. First, most EMS organizations are small and built around flat organizational structures, so opportunities for advancement are limited. Second, the same characteristics that make them great medics make them prone to boredom and driven to seek variety in their work. Third, as EMS is organized today, it is difficult for providers to achieve financial security. Fourth, we have failed to build the infrastructure nationally or at the state and local levels to train EMS providers for career development. Let's look at each of those issues in a bit more detail. Organizational Structures and Career Ladders Many EMS organizations are small. How many career options can a small organization provide? It's no wonder these organizations lose employees to larger outfits that offer them more options. And even larger EMS organizations tend to have limited hierarchies. Establishing a career ladder can be daunting. Many medics want paths that provide increased pay and status for simple longevity. Some employers have acquiesced. Where this occurs, it reduces opportunities and incentive to advance. Another barrier is EMS' lack of a standardized system of rank and position. We often use functional titles that have different meanings from place to place and make interagency comparisons difficult. In my agency, a field training officer is an experienced paramedic with some special training who is assigned to teach and evaluate a new paramedic during their first few months of employment. Two counties away, a person with the same title is a shift-level officer responsible for the training of all personnel assigned to that shift. Confusing? You bet! What happens when your HR staff tries to compare salaries? Career Breadth and Lack of Lateral Opportunities "Horizontal," non-promotional career opportunities are almost totally lacking in EMS. The law enforcement patrol officer, without promotion, can be trained as a K-9 officer, school resource officer, tactical officer, bomb technician or more. A firefighter can become a prevention officer (inspector) or investigator. Why has EMS failed to develop similar opportunities? The roots lie in the historical accident whereby insurers pay for ambulance transportation, rather than medical care. A common tactic used by private-sector ambulance operators to woo elected officials has been the "little or no subsidy" offer. To win local contracts, they promise to operate with zero or minimal tax funding, and cost-shift to cover their expenses. In doing so, though, they often provide only what's mandated--often only "ambulance" response and transportation. Many EMS systems are now strangling because of the entrenched belief that they should live within the transportation-based revenue stream. We now know EMS and ambulance service are not the same thing. EMS consists of both ambulance operations and special operations--e.g., mass-gathering medicine, technical rescue/USAR medicine, and a variety of other services. It is in the special operations arena that advancement opportunities lie. After cutting his teeth on an ambulance, an experienced medic could be assigned to patrol on an EMS bike team, or work with a service's specialty teams (tactical, WMD, etc.). And were they freed of the burden of living within transportation-revenue streams, EMS systems could provide a variety of additional services--think injury prevention or medication- compliance programs, school resource paramedics, etc. Personal Survival and Economics As opportunities for cost-shifting evaporated, so did the ability of ambulance services to pay a living wage. Many large private organizations came to accept that they could get 3--5 years out of a medic before the medic moved on, so they built their business models to accommodate the revolving door. Public and non-profit agencies got dragged along through "market comparability." And let's not forget about the volunteers. Volunteers are noble, but they have contributed to the economic difficulties of their career colleagues. When you look at the cost of providing EMS, it only takes a few zeros in the compensation column to drag the market average down. Why should anyone pay more when right down the road there are communities getting it for free? Career Development Infrastructure In EMS, we have failed to develop comprehensive pre-service educational programs, leaving the development of our new members to institutions committed only to following a nebulous national standard curriculum. It's amazing that we're still debating whether we should teach hazmat awareness or emergency vehicle operations in our EMT and paramedic schools. Is there an accredited police academy in the country that doesn't teach EVOC, defensive tactics or shooting? Look at the advertisements for senior EMS positions in our trade journals. A college degree, some experience as a supervisor and a paramedic license, and you're eligible, whether or not you've ever managed an MCI or built a budget. What are the competencies truly required of a chief EMS officer? Where is the road map? What does an intelligent, energetic and ambitious young medic do to set his or her course for the future? Conclusion Those of us in EMS leadership may have failed our followers. We have not effectively advocated for career options within EMS, and we have failed to provide the structure and infrastructure for our providers to see and effectively navigate career paths. What can we do now to improve this situation? 1. The EMS community must understand the difference between "ambulance service" and "EMS" and work to ensure every community enjoys a full spectrum of emergency medical services. 2. We need to decouple EMS funding from transportation. Elected officials must understand that EMS is an essential element of communities' quality of life, and that using tax dollars to fund it is not inherently wrong. 3. We need to develop career breadth for medics whose aspirations may not involve supervision. 4. We must build a commonly recognized rank structure and adopt it across the industry. 5. We need to develop an accepted set of educational and technical competencies for EMS officers at all levels, then develop the educational and credentialing infrastructure to support them. Any EMS provider with career aspirations should be able to see a road map that leads to their desired destination. Skip Kirkwood, MS, JD, EMT-P, is Chief of EMS for the Wake County (NC) Department of Public Safety.

I have a question, why did the paramedic crew not open the door and get in? It makes no since to bang on the door unless it was locked. If the door was locked then that would rise to another question, why was the door locked?

AWESOME BRO !!!!! I feel like the last 10% to find out, maybe because I am on page three on the day it was posted, haha. I have to admit, I doubted you, I figured after your breakdown in Orlando you did not have it in you ! jk.

Nope, not intentional at all !

Nope, not intentional at all !

It is great that your department gets along. What people are saying though is that both jobs are two separate fields. You even said so in your post. A lot of times thought EMS and fire do not get along. Again, it is great that your department does, but on the other hand what is good for your community is not good for everyone else. I personally like the idea of having one paramedic per ALS unit for the most part. When you have one paramedic it forces them to be competent. As a single medic you should be confident and have the proper education to care for the patient. A paramedic should be able to make the proper decisions without having another paramedic (a crutch). I also do not agree with having paramedics out the yin-yang on every emergency vehicle within an area. When there are so many paramedic in the system they reduce the chances of every paramedic to do skills such as intubations, see a variety of sick patients, and the such. There are so many medics that it dilutes the calls/skills a single medic can see and do. This makes for a system with weak medics. Explain this please? I do not see how patient care would be greatly hindered if you were not a medic. You make an interesting statement here. There are so many people here who could offer great information that share no brotherhood with the FD. I am an example. Where I work EMS and the FD do not get along. There is no brotherhood like there is on the FD. Yet these people would be able to offer you any help pertaining to EMS.

Well, at least he has a good dog. I absolutely love Pit Bulls, but that is all he has going for him in my book. :wink:

Maybe they should be required to go through a paramedic course. So they can learn what they do not have any clues about. Sometime I just cannot believe the gall of some people.

Wow, I think the garmin would be cheaper than getting married. I always heard marriage was expensive

You have to read the joke with his accent in mind ! It makes it even better. Welcome to the City

The DNR to me is never really clear. To me it means treat them until their heart stops beating. There is so much grey area though. You know the patient is ready to die, they have the DNR in place, the patient is terminal with all kinds of bad things that make their life horrible to live, would you feel comfortable intubating them? I do not think there is a right or wrong answer. My point is that the DNR is just not very applicable in my opinion. I like the new MOST form that is out. It stands for Medical Orders for Scope of Treatment. The MOST form has four parts to be answered. The parts are: CPR, Medical treatments (including intubation, electrical therapy, and comfort measures), antibiotic usage, and fluid/nutrition administration. I think the MOST form is more appropriate than the DNR because it gives providers a clearer picture of what the patient's wishes are. Jake, are you familiar with these forms?

In my experience it has been the other way around. Quite often the paramedic is put in a situation of teaching. Students have questions that they expect the paramedic to be able to help them with. Also while doing patient care and afterwards the paramedic must be able to teach them why certain things were done, what presentation the patient gave, and yada yada. As for new employees they often times must be taught the ways of their new system. Not only should they tell them this is how its done, they must also explain to them why its done. They are in this case (and in my opinion) teaching. To me its more than monkey see monkey do. I do not follow you on this one. Where should it be taught? I agree that it should not be tied to your academic success. If someone does not want to contribute, then do not worry about them. Later folks ! Matt

I agree that you should not be a crutch for another student to pull them through. At the same time, I think that working in groups (or with a partner) is a fine idea in Medic school. Especially if you are paired as one weak one strong student. Let me explain why. One day in EMS, your job will be to teach someone. Be it a student that comes and rides for a few days, a new employee, an observer, or whoever, the point is that you will be in charge of guiding them during that time. By being exposed to it in class you can already start to get a feel for it in the field. In just about any college class these days, you are expected to work in groups. The reason for that is that they are giving you a feel for what employment is like. You will be required to work with other people, and you should start to get exposed to it while receiving your education. Its these experiences that help prepare you for the "teaching"/ working parts of the EMS field (or any field for that matter). That is also why I feel a methodology course should be required for medics, along with all the other hardcore classes that everyone feels should be required for a Medic degree. A question for the OP, what kind of work are you and your partner required to do? Dwayne, while I absolutely do not think you should have to "carry" anyone, I do think that you should have dynamics in your group. Not everyone is as "freakish" as you are about getting the grade. That does not mean they lack the aptitude to contribute in a positive way to the group. Later folks ! Matt

Each ambulance consists of a two person crew. Mostly they are dual medic. The only single medics are the District Chiefs (which are supervisors, they also carry the hypothermia supplies for ROSC). It is not uncommon to have two ambulances (=4 people), one district chief (=1 person), and an engine (=3-4 people). So on a cardiac arrest there is between 6-9 people on scene. The code commander is a paramedic on the first paramedic unit to arrive. I am sorry about the confusion. I forgot to put in the above paragraph that we work all codes on scene. There is no transportation until ROSC. Well, the first problem is IMHO, is that they transported a code. The success rates are much lower when a patient is transported. The patient should have never went to the ED unless there was ROSC. I am not trying to make my system out to be the best in the world, because it is not at all. We do have some good things going for us, and what I previously mentioned was one of them. I agree things were getting done. I just got the impression from the OP that things did not run smoothly and that he probably did not feel that the code was done properly, and that the patient probably had less of a chance of survival. IMHO I think the patient probably lost his/her chances when the patient was transported. As EMS stands now (for the most part) I agree with this statement. I hope this changes in the near future where ER staff can trust EMS to have done what is the highest level of care paramedics can provide. Of course this will come with education and everything else the old, dead, and beaten (multiple times) horse stands for. I still think that everyone should be prepared to change gears, ER staff or paramedics alike. ER staff may have to change gears from what someone tells them in a radio call report. Paramedics need to not rely on dispatch for all information and be prepared to change gears when the patient presents different from the dispatch.

Are there statistics that measure if RSI is improving survival rates of patients who qualify for it in the field vs those that do no receive RSI?

Oops, my bad, I totally missed it :oops:

Check this link out http://emscapnography.blogspot.com/2006/08...hould-know.html On this link find the LP12 about half way down, and three strips below that is a strip showing the gas exchange with CPR alone.

I Kind of have to assume without actually being there to see it. I see what you mean by it being there but maybe not functional. My idea of 30 seconds may be a bit off, but it does not take long at all to figure these things out. This is no excuse to me. In my system there are multiple agencies that respond to codes, you have a chance of getting two trucks from six different EMS agencies, 1 of five supervisors, and 1 Fire truck from 22 different fire departments. So there is a large degree of not knowing who you will respond with. Yet in every cardiac arrest there is an established code commander, and the cardiac arrest always run smoothly. In the cases reviewed where mistakes were made, there was not code commander present. We boast high resuscitation rates. Everyone knows there place on a call. Same should be the case for hospital staff. I have a different view on this. Say you get a good review from the medic. If they are 10 minutes out things quite possibly will change. The last drug given, tube placement, anything. When that patient comes through the door, you are going to check that the tube is in the right spot, weather they told you before hand or not. If you expected it to be in place when they came in and it was not placed properly, then you should be prepared to fix it. In my opinion the radio report should consist of "we are en route to your facility, full code, eta 10 min." That way you know to have a team ready to do anything you need to have done. If things are done before they enter your facility, kudos to them, otherwise be prepared. I think it is bad to have tunnel vision before the patient arrives and be thinking one direction, when the patient arrives just to be slammed and have to change up. At least if you a left in the dark, you will not be surprised, and can give appropriate care in an organized manner.

In my honest opinion it does take a couple of semesters to understand enough cardiology to be paramedics. In my school, We had a semester of cardiology during our first summer. We learned quite a bit, but as I did research, I found that there was still a lot more to learn. In my school the Cardiology course gave us a strong foundation upon which to learn. In the second year of paramedic school, we have reviewed our knowledge base from the summer, plus we continue to add to it during the spring and fall semesters, as well as our last summer semester. The basic concepts are not really that difficult, learning the anatomy and physiology. But you add on learning the rhythms, what each wave means, what different measurements mean and you have a different story. Then you add on to that how the patient presents and what physical finding you will find with certain rhythms and you have another level to comprehend. Then add on to that treatments, what drugs do in the body, and how they affect the heart, taking into consideration you patient, and it takes a few semesters to get the full grasp of it. But still that is the tip of the iceberg in my opinion. We still need patient encounters to still understand it better. And there will always be that Cadiologist that still understands it 100 fold what even the experienced paramedic knows. You can learn the basics, what you might get from the medic mill, but it is not worth anything to me. I think you get more knowledge from an Anatomy and Physiology class about the heart than the medic mill. I guess as a recap that what I listed above is my idea of basic cardiology. The field of cardiology is huge, and medics just do not have the full understanding. Medic mill = tip of a needle of what you need to know Paramedic degree with continuous study = Basic cardiology Cardiologist = Full Shebang. Understanding what I described in full is a must. It just cannot be done properly in three weeks at the medic mill. It takes a lot longer.

That is a classic McCoy is my favorite Star Trek character of all times. My personal favorite are: "He's dead Jim" and "That green-blooded ......."(in reference to Spock)

I was meaning dromotropic, not dopaminergic. Great point. There defiantly is a difference between unstable and need to treat. When I said unstable I mean the patient in shock that is about to code again. The Dopamine in the case would be to maintain profusion to the brain long enough to get the patient to a Cath lab to correct the blockage.