JPINFV

And how much would ya'll expect out of a medic student halfway through class? :roll: Rotations are about exposure to different medical fields, not training. The specility training/education takes place after medical school in residency.

Yep, got it. Just never heard those specific terms before.

Is it really too much to ask for?

The situation Lith gave was, "You give 2mg and nothing happens." Hammer is thinking, "Well, if 2mg isn't enough, then lets try 4." In this case, more isn't better. Quick key term check. "Antagonist" is the same thing as a "competitive inhibitor," correct?

Once again, true be told, there is very little difference between a paramedic and a basic in the eyes of the admissions committie. It might actually go against you, more then anything else. Might I suggest this thread (as well as forum)? http://forums.studentdoctor.net/showthread.php?t=238346 The site is geared mostly for med students (pre-med through residency). DocZ is over there, actually.

Nope, but I think we can interest him in a grammar class. From one premed to another, focus on grades and your courses. My understanding is that most adcoms have no idea who and EMT (B, I, or P) is, what we do, and are unimpressed by the rigor of the education. Hospital volunteer experience is much better suited. You want quality, not quantity with your clinical experiences. If you can't articulate how being an EMT would make you a better doctor (and, no, 120 hours of "medical education" will not compare to the 4 years you're applying to take), then no one will care. Similarly, if get cut at the primary or secondary application phase (i.e. the grades, MCAT, LOR and money stage), then you will never get the chance to explain it during the interview. Will being an EMT "help?" Sure, just don't expect it to make up for poor grades, bad letters, or a low MCAT score. Pre-med EMTS are a dime a dozen.

First and foremost, how long is the Australian basic provider's class. Over in the US, its generally around 120 hours. This includes all the patient assessment, legal information, treatments, etc. There is very little amount of time actually spend on physiology. NTG is basically broken down to "give if they have CP, BP around somewhere above 100 (even the books can't make up their mind), and call medical direction. Of course the ever important "how" of NTG is never discussed. Not everyplace has online medical control for basics, either. So, lets look at what would probably happen. Basic sees patient passed out in house. Basic sees drugs near by. Basic does half assed assessment party because they don't know any better and partly because they just want to do the fun stuff (i.e. push drugs). Basic calls med control, either over simplifies or embellishes the situation and gets order. Basic pushes way too much narcan (because he can, no other reason why). Patient wakes up, beats the crud out of the basic. The driver comes around to see what's happening and gets beaten up too. Patient then crashes after the Narcan wears off. Result, one dead patient, two basics in the local trauma center, basics reverted to being organic vital sign machines that can put patients on oxygen. EMS is about patient care and transport. An EMS system is more progressive by removing procedures that are dangerous, misused, and have little benefit to the patients then by giving their EMTs (P, B, J, what ever letter you may be) what ever toys they demand.

Elininate the basic level. There is no reason to have a level that is equivalent to boy scout first aid training with the added bonus of blood pressures and oxygen. That said, as a matter of protocol, if the intermediate is using an ALS treatment, it must be done either while waiting for a paramedic to respond, or enroute to the nearest facility if the facility is closer then the paramedic. They do not get to sit around and try to stabilize the patient.

Education and training are two different things. A 5 hour course that goes over the skills, indications and contraindications an education does not make. Furthermore, if this "education" includes giving fluid to hypovolemic patients secondary to trauma, then it's wrong. A good BP means nothing if in the process you cause the patient's hemocrit to plummet.

Going back to the topic. The problem is partly that this profession attracts jack asses. The medic gets to be "in charge," "stick things in people," "save people," and "force other people to pull over while you pass." Lets also throw in a basic who's training does not begin to compare to the medic's training. Training will not cure jack ass-itis, but education will weed them out (which leads to the other big problem. Paramedic class washouts who think they're shit don't stink, even though they are still a basic). A medic who proclaims, "If I'm on board, you're going code 3" is a paragod. [Really, a simple yes would do]. A medic who has you transfer a patient to a competition company because they have a mod and you have a van is a boarder-line paragod [because their approved ambulance is better then my approved ambulance?] If I go to set up the monitor and you would rather have me take a blood pressure, "Why don't you do your job and take a blood pressure" is not the correct way to ask me. My job includes assisting the medic. I didn't call you because I wanted to play with a monitor. I called you because the idiot RN (grant it, confirmed by the RN at the almost empty ER) told me that the ER 2 blocks away was on divert. [A simple, "could you get me another BP" would have done nicely, though]. The tone is more important then the content.

I disagree that that was drastically off topic. If we are to discuss pre-reqs, discussing the time line that would be needed to complete them is valid, as well as comparing to other health care professions. Should grades and experience be everything? No, but close. How else can you objectively compare students? There are ways to increase your GPA, though. Take a few community college classes, either working towards a degree or because the class seems fun. The grades should count into your GPA when applying as well as make you more marketable then other students. The other thing that we can do is develop a standard admissions test since grades can highly depend on the difficulty of the course/school or grade inflation. The fact is that EMS should require students to be able to understand science. Not everyone can (not saying you can/can't handle biology. I don't enough about you to even begin to touch that). Nothing against those who can't, the person just needs to know their strengths and weaknesses. Personally, I can't stand philosophy (but it did provide the best hour of sleep I think I've ever gotten for 3 days a week). Therefore, I would refuse to major in it. While grades and experience might be the best indication of an applicants ability to do well, there isn't very many other options.

Yes, the EMT-B books/courses are too shallow. Sure, O2 is the drug of choice for the basic, but if your working BLS (be it out in the boondocks or IFT), you will also have to make the decision to call for ALS or transport L/S. These are big decisions to make that will not only affect the patient, but also the entire EMS system. What would happen if every CHF patient that presented with rales got an ALS unit? How far from the normal ranges of V/S should the point where you call medics be at? Is 30 reps/min bad? Sure, its elevated, but you need to look at the whole picture. As long as rales is just "crackling meaning they have some fluid in their lungs" is the extend lung sounds are covered, then it's not enough education to properly evaluate a patient. Shrimpcan? My class was taught CHOD (yes, it was a FF/paramedic). Cardiogenic, hypovolemic, obstructive, distributive.

Medical schools don't require you to have a biology degree to get in, though (common myth, even among pre-meds). Its actually better if you're not (53% of math majors get in, 52% of humanities majors get in, only 45% of bio majors get in ) because you stand out. The requirements for a bio degree, though, are much more then required to get in. My school has 5 quarter classes (4 units each) of lower division and then 3 major upperdivsion courses, 3 upper division labs, and 4 upper division labs (plus G chem, O chem, physics, math). Besides this, you also need to take breadth. The point I was trying to make was that the pre-reqs stated would take 3 years and then you would have trouble finishing with a BS in 4 years.

Sorry about that. I wasn't trying to imply that the entry level MSN program was easy to get into (heck, most do have greater pre-reqs then med school too. Microbio with lab seems to be a unifying theme), but it was an available choice for a person with a BS already. I also wasn't trying to imply that DNSc (I didn't know the acronym at the time) equaled a MD or DO. Yet its available for advancement if a nurse chooses to utilize it (grant it, my understanding is that the DNSc is controversial too). The O-Chem point is funny because it actually came up with when I was getting my DOT physical. I believe that O-Chem is like physics. A doctor doesn't use most of what is taught (the doctor doesn't need to know, physically speaking, how the electronics in a monitor or defibrillator works. He just needs to know how/when/physio how/etc it works). Its the critical thinking skills used in mechanisms and problem solving that is more important. Now the big question (I love questions that challenge the status quo). Why aren't more paramedics involved in research? You want more toys and protocols? See a need in your patient population for something? See a procedure/protocol that might work better (example, opti-con no L/S vs L/S transport maybe)? Develop a research thesis and start a study on it. I agree, as it is now paramedicine doesn't require very much formal education. More is good, but you will eventually get diminishing returns. That said, nothing will change until someone decides to advance themselves.

Ok, the bold is whats offered at my school. It is on the quarter system and there are three quarters to a year (summer session makes it 4, but its not included in tuition). While more education is never bad, there can be too much as a prereq (think about rolling some of these into your program instead of being a -prereq). That's 36 courses, not including labs (2 quarters of labs for physics, G-chem, and O-Chem...). At 4 courses a quarter, that's 3 years of school, unless you are willing to count high school courses for the science courses (I wouldn't). These requirements, by comparison, are over twice as much as required by the standard medical school (year of bio, year of G-chem, year of O-Chem, year of math. requirements vary). This, of course, isn't counting the other breadth requirements the school might require (foreign language, international issues, intercultural studies, humanities, etc). You would be hard pressed to finish in 4 years because of the unaddressed upper-division course. Should para-medicine go towards a graduate level and/or multilevel education level style of certification/education (think nursing on this one. They have certificate, ASN, BS-nursing, MSN, advanced practice, and starting to develop doctorate levels of education)? In the long run, yes. That said, it would be hard to attract a college level graduate with $10-40k+ in debt as it is. Also the multi-level approach allows better access to those already out of college. If I want to go into nursing after I graduate, I don't have to start at the lowest level. I can always take a MSN-entry program. First year gets the nursing license. The next year or two is the masters level of education. Another option is to pressure your local university to start a medic program. Its time to expand BS-Para-medicine past only a hand full of schools. Some of these classes need to be put into the medic education. Have the first two years focus on the holistic education (the entry sciences [physics, g-chem, intro bio, etc], the medico legal, the communication, and the rest of the breadth). The next two years are the paramedic education. recap. Its not that I'm against education, but lets make it some where reasonable.

In defense of my brothers and sisters out here on the Left Coast, the only other choice was BustaMEChA. He would have turned the state over to Mexico faster then basics are "educated." Grant it, I love living behind the Orange Curtain and what little protection it provides on this insane part of the country.

Just wondering, what were his lung sounds like? Any change in V/S in route? Granted, you already told us the outcome, but is there any thing that points to it?

:cheers: :wav:

Sorry about that, I wasn't trying to imply that the entire heart was connected by gap junctions or that the gap junctions functioned as a pacemaker. My point was that, unlike muscle cells where each motor unit is connected to a nerve and is activated by neuro transmitters, the heart uses gap junctions to coordinate muscle contractions. Hence you don't need to worry about creating more transmitters, transporting the transmitter to the end plate, or pumping out the Ca++ used to release them. Also the cardiac muscles primarily use Ca++ to extend the AP. The primary rise is still produced through Na+. I would argue that ATP and ADP are similar, but different molecules by virtue of a phosphate, but that's getting a little too nit-picky. Similarly, most of the ATP is produced in the electron transport chain. Krebs does produce ATP, but the FADH2 and NADH is much more useful. Discussing A&P is always good. You aren't always going to remember everything and its a good way to review. Ohh, source=Silverthorn's Human Physiology Third Edition.

Probably that and the need for ATP for muscle contraction (ATP replacing ADP following a contraction is what releases the myosin head from the actin filaments. No ATP, muscle stays contracted and this is why you have rigor mortis). [physio analness coming] You don't need ATP at the receptor for the heart. Remember, the heart uses gap junctions (literal gaps in the cell membrane where two cells are directly connected to each other) to transmit the action potential throughout the heart. You will need ATP at all of the Na/K pumps to reset after the action potential opens up the ion gates that maintains the action potential, though. Medical reason: Coarse VF is more likely to convert into a perfusing rhythm then fine VF. More ATP means stronger contractions means (hopefully) coarse VF equals better chance at getting a good rhythum back. Finally, need to know about the 2005 guidelines? Check out the AHA webcasts for EMS (they also have a section for the community and for the hospital) http://americanheart.org/presenter.jhtml?i...ier=3037720#ems

Time spent is relative. I highly doubt that anyone is saying, "Dude, this sucks. Lets go out and picket the stores and send a billion and one emails to every retailer, distributor, and every member of their board." I doubt that someone is going to spend hours complaining because of a commercial. Taking 5 minutes, though, to send a quick, "You are mischaracterizing the members of a health care profession..." yada yada yada to their PR rep shouldn't nearly as much trouble as everyone is making it out to be. By the way, does anyone have a link to the ad online?

Do you think that nursing would allow nurses to be seen as thieves unchallenged? Do you think that doctors would allow doctors to be seen as thieves unchallenged? Do you think that police officers or fire fighters would allow their professions to be seen as thieves unchallenged? Why should EMS be allowed to be seen as thieves unchallenged? We want respect in the medical field, but we do not have the education. We want respect in the eyes of the public, yet we let our profession be portrayed negatively without backlash. We want respect, but we aren't willing to actually do anything about it.

Spelling, grammar, and caps lock is important for understanding the written word. Since this is an internet message board, the vast majority of communication uses the written word. Would it not be in the best interests of the original poster and any one who replies to insure that their view as interpeted as clearly as possible? Is it honestly that hard to attempt to use proper words instead of chatspeak, use the spacebar, the shift key and the enter key?

Unless we're told that the patient reacts to males (hypersexuality, for example), then they get what they get. If at any time the staff member thinks that a male attendent is bad (since I'm not on the insurance to drive), then I would have dispatch send another unit. Act professional and 999/1000 times there shouldn't be a problem. Just hope that someone else keeps getting that 1.

I completely disagree with this statement. If no one had any opinions then there would be no replies in any thread. I believe part of the problem does lie on both sides. Sometimes the posters can use a better tone when posting. That said, just because someone disagrees with you doesn't mean that it is personal. Society nowadays is so touchy feely that people believe that if you disagree with them that it is a personal insult. 9 times out of 10 there is nothing personal about it. The truth is that there are a lot of broken things in EMS. Unfortunately if you are part of the broken area, knowingly or not (and most of the time not) then you view any critque of that area (for example, the formal education of basics, or the lack thereof) as a bash.