JPINFV

Lets face it, protocols have to start at some level, and above that level, the providers do what ever they want to (just checked by insurance and hospital privileges). Granted, 4 years of general, post-secondary education, followed by 4 years of applied education, followed by 3-4 years (assuming straight EM, not FP or a combined program) of on the job training is a lot more education then even the degreed medics have. Let's not compare this to the training basics get. Not every patient follows the protocols. Should there be mandatory contact for the rare procedures (child birth, any thing involving needles but not veins, etc)? Sure. Should there be a base hospital available for those weird presentations? Sure. That said, a paramedic should be able to treat patients as they present, which may not be completely in line with protocols. Unfortunately, the amount of education required to do this is not achieved by the vast majority of basic schools.

Pyramids are fun!

Which makes sense since Israel is in the middle East...

please tell me this wasn't a real call. Hmm, "lividity" of the face and hands sounds more like cyanosis (calling captain obvious?). So, umm, are you [ems crew] getting good chest rise when bagging? Is he intubated (can someone say esophageal intubation?)?

lividity of the face? How long has the patient been down? What is the current rhythm? What rhythms has the patient progressed through and what treatments have been preformed? ETA to the nearest paramedic receiving center?

http://www.thefirestore.com/store/category.cfm?cID=761 http://www.officerstore.com/store/manufact..._chest_harness/ http://www.mooremfg.com/radioharness.htm Google: Radio Chest Strap

:roll: I guess some of us just like to be able to provide our patients better care then oxygen and transport. Besides, I've never gotten any flak for being a basic in any of the scenarios. Knowing and understanding the limits of 120 hours of training can be a little painful.

Is there an actual difference between having a "license" and having a "certificate?" Or is it just sematics in most cases? I'm a certified EMT-B, but a licensed Ambulance Attendent (You must have an EMT cert to be an Ambulance Attendent). So, I guess I'm both certified and licensed, but I don't know any practical difference between the two...

43, second try. time for bed. try again in morning. brain no work after midnight (12:43am PDT)

They have in some places, apparently. I know ALS in my area can terminate resuscitation after talking to med control (arrests are a mandatory contact anyways). This scares me. Do you still practice fluid resuscitation for trauma patients? Do you still use MAST pants? How about leeches (yes, I know leeches are used for wound care post surgery, but it really isn't used that much)? There is a reason those aren't used anymore, and it is those studies that you are decrying. If EMS is going to be viewed seriously in the medical profession, then it needs to get its act together. We need to start using science to guide our treatments instead of giving into emotion. I agree with no plastic surgery. Viagra should be a no-no too (except pulmonary HTN) Different reasons why people don't want to transport. The stub toe isn't an emergency and can be taken POV or taxi to the hospital. The ambulance should be available for critical patients. The arrest shouldn't be transported (generally speaking). Yes, work it till you get a pulse or asystole. Recognize that asystole is dead, though. The ambulance should be available for live patients. Or maybe some people are dedicated and take a little bit of time to gain a better picture of emergency medicine. We let science be our guide. I don't want my loved one taken out of my home, abused, tubes shoved in every orifice, and left to die in some hospital where the staff would like nothing better then to get rid of my loved one so that they can actually treat someone who needs help. Furthermore, any system that transports every arrest forfeits the right to complain about holding the wall or being diverted away from a hospital. That extra bed that you're patient needs might just be holding that asystole arrest that was brought in earlier. Because a hospital can treat a dead body better then the coroner? I believe it is important to know what other places are doing. Maybe you can be the one that finds a new protocol and suggests it for implementation? The more you know, the better you can treat your patients. Just because I'm BLS doesn't mean that I can't limit myself to the questions and information learned in my 120+change basic class. While my treatment is limited, my understanding can be used as a guide of if I need medics, how much O2 should I give, etc. Just as an ALS provider can do the same.

Evidence based medicine beats emotion based medicine any day of the week and twice on Sundays. A "save" isn't a "save" unless they are discharged with decent brain activity. Just because you got a pulse back doesn't make it a save. There is no need to waste resouces (EMS, hospital, etc) so you can play hero abusing a dead body. I volunteered a bit (about 6 months [i was in the program for 2 years, but on different units] and one during my EMT clinicals at a different hospital) in a local ER. I saw a relitivly fair number of dead (asystole) bodies come in being abused by paramedics. Every body that came in in asystole left in asystole.

OK, it seems that there has always been talk about different things that could be improved (pay, education, staffing, etc), but never a full layout. So... If you were the leader/medical director of an EMS agency (your choice of type (fire ran, police ran, 3rd government agency, private, volly), how would you run things. What trade-offs would you make between on-line medical control/standing orders? Levels required to staff an ambulance? Education levels? Types of calls? Sources of money? All are fair game to try to cover, but remember, money and degreed medics don't grow on trees. If a specific plan sparks debate, please form a new thread. Questions for clarification on specific items are welcome.

(in no particular order) 1. Lobby 2. Organize (as much as I have a distaste for unions in general) 3. Get an education and get into leadership (note, just as education and training are different, leadership and management are different. A manager may not be able to dictate hiring standards. A leader should) 4. Be prepared to take one for the team (would you rather, A. Make 30k/yr running only 911 or make twice that amount running 911/interfacility combined. You've got to work to play, and, like it or not, interfacility is where the money is. Maybe 3rd government agencies should embrace it and reinvest the money into higher pay, more education, etc) 5. Become involved with PR (the FD and PD didn't become highly recognized overnight. EMS won't either. This goes with 1. We do need a catch phrase, though. If the PD is America's finest, and the FD is America's bravest, are those involved in EMS then America's Smartest?). Make your community know WHAT you do and ensure that they believe that you are worth every penny, plus some, that their tax dollars go to. 6. Fight Fires (hey, if the FFs can become crappy medics, can medics become crappy FFs for the extra money that being a FD would bring the system? We could send an ambulance to all fire calls just for shits and giggles.) /sarcasm. 7. Form partnerships with other local resources. (Maybe instead of having a paramedic teach A/P, have it taught at the local university There should already be a biochem, human physiology, human anatomy, neruobio, chem, physics classes at the university. Better yet, have the university run the program and have it become a degree-granting program)

On the flip side, you're technically supposed to do that for any procedure you preform so you can obtain informed consent too.

Simple. Any action taken without consent is considered battery. IF the person is of sound mind and of age (state law dependent), they can refuse any treatment, assessment, or other action, including transport. If you feel that it is in the best interest of the patient, have no reason to believe that the patient can not make rational decisions, and the patient is refusing, then you document and move on.

I, actually, currently have a different path in mind. Why are their still classes? Because the FD wants to train people at a lower level and the IFTs can charge more then just sticking a gurney and an O2 tank in the back of a van and transporting that dialysis or discharge that way. Good you you. The average basic is still under-educated. You have to talk about the average person, not the exceptions. I'm not going to apologize for trying to improve this profession at all levels. The only way to improve it is by increasing the amount of education to be considered competent to start. You have to know the faults before you fix them. Um, what you do on scene is actually up to the person with the highest level of medical education. Hopefully, that will be at least a paramedic. Your only choice is to limit yourself by not embracing higher education for yourself or higher standards for your level.

What I'm saying is that giving a drug without understanding either why the patient needs it or what it does is stupid. EMT class teaches the how and when, but not the more important why. Oh, and I'm a basic, so it's not some sort of "paragod" mentality with me. While I would love a larger scope of practice, the idea of basics who lack even a basic understanding of physiology also getting that same scope scare me to no end. Things like understanding why you need oxygen is, actually, so basic that it's taught to high school students. Personally, I want the people transporting me to have more then a high school understanding of biology. Unfortunately, too many providers lack even that. Because of this, the basic scope is so dumbed down that our indications for a nasal cannula is that the patient can't stand a non-rebreather (and the NRBs are dumbed down, as it is, so that we don't kill the patients if we don't connect it to oxygen). The fact is that the EMT- B level of training is not enough to understand WHY we're doing what we're doing. This makes us dangerous, unloved, and, ultimately, unneeded in a 911 system. One last point. I have no advanced training. I do have more education, though, then the average basic. There is a difference.

Oh, really? You really think that 120 hours of basic first aid training that is just past what boy scouts get is really considered a proper education? Do you even understand most of the common diseases seen, even by a basic (CHF, a-fib, etc)? How much do you understand about psych disorders that are commonly seen (Schizoaffective versus Biopolar versus Schizophrenia). How much about the cardiovascular system did you really learn during those 120 hours? Of course, my personal favorite since oxygen IS the primary BLS drug. Do you even know why we need oxygen? Because even paramedics and [gasp] doctors sometimes bounces ideas off of one another while treating patients? Because maybe one medic might not be able to start an IV, but the other one can? Because it's probably nice being able to have someone else who can do more then get a BP and put the patient on oxygen when on scene? There are fire departments still? Can you really call an agency where the majority of their calls are for medical aid a 'fire department?' The problem with fire fighter/paramedics is that they, on average, either became a fire fighter to be a paramedic or became a paramedic to be a fire fighter. They neither care, nor devoted to one of those roles, and generally suck. The only reason why fire fighting is more respected then EMS is because of age. Personally, I would rather have good fire fighters that fight fires and good paramedics that treat patients then a mediocre fire fighter/paramedic.

Thats funny, I don't care who ya are. If you don't laught at that then you need to get out. /Larry the cable guy

http://www.moller.com/skycar/ New ALS fly car?

Three things caught my attention. First, you have the makings of an ugly battle over patient control here. Lets say a prehospital RN, PA, and paramedic all show up to render aid. No judgement is made over which is considered higher and all have been tested and shown that they can provide prehospital care (so it isn't some random SNF RN showing up here...). Who's in charge? Second. Are second year EM residents really advanced enough to allow total control (PH Physicans do not need to follow protocol) of patient care (granted, by the end of PGY1 they are licensed MDs...)? ERDoc or Doczilla? Two problems with this one. First, they just have had to completed a residency? No board cert? Second, does anyone here really feel comfortable with a family or IM doctor providing emergency medical care just because they passed an ACLS, PALS, ATLS, and a skills test?

Of coruse House MD is based off the little known TV series, Walker, Texas Ranger Doctor. Chuck Norris doesn't do pericardial thump with his fist. He does it with a round house kick to the chest. This makes his ROSC surprisingly high/ Chuck Norris can shock asystole patients back to life.

Of course I've never figured out why medics even transport full arrests. The doctor at the hospital isn't going to be pushing any different drugs anyways. The patient that was last seen an hour ago and is warm and in asystole on arrival is dead. No amount of lights, sirens, or letters behind your name is going to change that. L/S transport of dead bodies puts the public at risk.

Ohh, but those F'ed up discharges are always full of trauma. "Umm, can I get a DNR for your unstable hospice patient" "Here you go" (signed Name, RN) "Umm, thats no good, it needs to be signed by a doctor" "But the patient is on hospice" "Thats nice, but I would still need to turn around if the patient crashes" "But the patient is on hospice" :Begins beating head on the desk: "Will this do?" (hands over a face sheet saying "DNR) "Umm, no" ... 5 minutes later finally finds a DNR order in the chart. The hospital-wide DNR form can't be found /Not the only time that this has happened at this hospital. //Happy we lost half the contract to another local company.

How about get an education instead. Take an A/P and a neuro course at your local CC. You might learn something about all those wonderful things that the paramedics. side note: we learnt about benzos and GABAa today in my neuro class. Finally starting to learn something useful in class... So, pop a Valium and feel a little less stressed... Or take a class and learn how Valium works.