JPINFV

Define "exciting." Pushing medications, starting IVs, doing assessments, assisting with more invasive procedures (medicine is a team sport), etc? Sure. RNs in the ER intubating? Not so much. You mentioned that you are considering medical school? If so, shoot for that as your primary goal if you're sure that you want to.

...but without the labs we can't write out those cool little shorthand diagrams to record lab values. >---<

Agree... no one really cares. In fact, if you live on a state border, some companies will run dual state licensed ambulances and require their providers to have two licenses.

Missing: Why it isn't surprising: Low barrier to entry with a flooded market. Additionally, poor medicare reimbursement to ambulance companies.

Here's the thing with that. Why shouldn't a company with both 911 contracts and IFT contracts be able to use IFT as 911 surge capacity and 911 units as IFT surge capacity provided a minimum available 911 coverage is maintained. I will grant, however, that for a lot of companies will find reasons to need to "surge" their 911 units to help the IFT side. However, as long as non-emergent patient transport is linked to EMS, I view the relationship having the potential to be synergistic rather than antagonistic. I guess I should have gone into EMS management instead of medicine.

http://legeros.com/ralwake/photos/weblog/pivot/entry.php?id=3034#body The initial call was for respiratory distress. Upon arrival, the original response team found the patient complaining of nausea, vomiting, and diarrhea. Upon additional questioning, it was learning that about 150 students in town for a conference were complaining of similar symptoms which resulted in a mass casualty event being called. Additional EMS resources responded, including a medical director and local public health resources and about 30 patients were treated with only 5 being required to be transported to local hospitals.

Rhythm checks? Naw... these are DOAs where a simple two finger pulse check was the deciding factor. Edit: I went through the past 100 links in the news section. The following links were found on pages 1, 3, 6, 7, and 9 respectively. 10 links per page. http://www.emtcity.com/index.php/topic/17505-another-victim-survives-doa-declaration/ http://www.emtcity.com/index.php/topic/17269-yes-yet-another-death-determination-fail/ http://www.emtcity.com/index.php/topic/16304-another-death-determination-fail-by-fd/ http://www.emtcity.com/index.php/topic/15900-another-death-determination-fail/ http://www.emtcity.com/index.php/topic/15325-arizona-victim-thought-dead-not/

The problem is opposite of what you think. The problem is when paramedics declare patients dead when they have a heart rate causing the coroner to call 911 because the corpse is moving. I'm not defending the practice of transporting patients in cardiac arrest, but it seems like the same story, different location comes out every 2-3 months. Where are you going to find these EM board certified physicians to begin with? There are still hospitals without board certified EM physicians and there isn't nearly enough EM certified physicians available to provide prehospital care in the quantity needed. Heck, there isn't even enough EMS fellowship or medical director trained EM physicians to provide a properly trained physician to every service that needs one. Now if we could get Medicare to start paying for a significantly more graduate medical education spots and throw a bunch of those into emergency med, it might be a possibility.

Yes, there are plenty of areas where transporting non-ROSC arrests are common place, even if protocol allows requesting a field termination.

The problem is that that requires paramedic determination of non-transport, a concept that US paramedics have consistently shown themselves to be incapable of. It's kinda of like calling cardiac arrests on scene. It needs to happen. It should happen. However a few tards can't seem to get with the program and ruin it for the rest of us.

The volume only gets bigger the higher up the food chain you go. However hopefully some of the why's are sticking when memorizing information. After all, just because you can use tools like Epocrates in the field doesn't mean you can use it on a licensing exam.

I'm not going to insinuate anything here. I'll flat out say that there's very little foundation material in EMT-B training to do anything but crude inferences and rudimentary DDxs unless serious extracurricular education is sought. You can't think critically about pathologies that you don't know exist.

Regardless of the sad state of US EMS training, you don't need a physician to do everything. Physical therapy doesn't require a physician specialized in PM&R. Nurses are entrusted to follow the orders of a patients physician, including PRN orders, as well as their department's standing orders, hence a physician doesn't have to be present in a ward 24 hours a day, 7 days a week. While I agree that prehosptial medical care shouldn't be provided by technicians in the strictest sense of the word "technician," there are plenty of EMS systems around the world, including the US, where paramedics are no longer just technicians or are in the process of moving away from being technicians just following a cook book.

NOOOO... this is pulling me back to pharm and I'm really hating antibiotics right now. Amoxicillin falls under the category of aminopenicillins, which I don't have listed any complications beyond those general for all penicillins. Complications for penicillin: Hypersensitivity, including upto anaphalaxis. PCN is a hapten, so by itself, its not big enough to trigger an immune response or immune memory. However, when it's bound to other proteins it can trigger a response and cause the immune system to both the PCN-protein complex as well as to PCN itself (however at a much lower rate than the complex). Super infection (c-diff) Seizures A hypersensitivity like reaction in patients with syphilis (Jarisch-Herxheimer Reaction). Diarrhea

/runs out of the room and hides....

I think that highlights a big conceptual idea. I've always felt that the front line employee is the most important at any company. They are the ones that are dealing with the customers and their actions can go a long way towards creating customer service disasters that reach front line (or beyond) management or diffusing disasters that would have reached that far otherwise. Any complaint that reaches management at any level is a failure. As such, I've always viewed management as being something who's goals should be to support their front line employees when ever possible. Congratulate crews on a job well done. Thank them when they go beyond what they have to (like coming in early or on a day off, or staying late). Accommodate requests when possible. Morale, as you mentioned, is a big thing. After all, think about how much every new employee costs before they're cleared for work on their own? Between field training and orientation at my old company, an EMT-B who couldn't drive cost around $600 (18 hours of orientation, 42 hours (3 12 hour shifts, but 1.5 time after 8 hours) of field training and an EMT-B who could drive cost around $1000 (additional 42 hours of supervised driver training). Turnover is not chump change, even when not considering the difference between an experienced employee and a non-experienced employee. If you view your job as a job to support your employees, you should be able to find plenty of cheep ways to provide incentive. Meeting starts at the 53 second mark... http://www.youtube.com/watch?v=GOJzpeCMJzs Yes... that is everyone's friendly physician on the left.

I'd hope that most paramedics are also in it for the long haul, at least assuming that the long haul was more viable than it currently is. Making the long haul more viable should be priority number 1 for any national organization representing professional EMS providers. That's $30/yr for students. Two quick points. First off, if you give potential members a trial period, they are going to be more likely to join. One year of cheap or free membership is worth everything if you can convert them to free membership. I probably wouldn't be joining AAEM as a student if it wasn't for the free membership. Second, at the very least, free introductory membership gives organization a chance to expand their numbers, even if they have a low conversion rate. A student member is still a member.

First off, it is possible to have an affect on reimbursement (both at the company level and at the provider level since these are separate when compared to my example) without being a union. I don't think that anyone would argue that the American Academy of Emergency Medicine (AAEM. Essentially the NAEMT for EM physicians) is exactly toothless when it comes to issues regarding emergency medicine, yet physicians aren't unionized. I do agree that membership is the biggest problem with NAEMT, however I also think that is largely their own doing. I'll use AAEM and emergency medicine as an example. Essentially every medical school has an Emergency Medicine Interest Group (EMIG). EMIGs set up shadowing, clinics (suturing clinic, intubation clinic, etc), have representatives from local EM residency programs to talk, and other events. While two huge differences between medical school and EMS courses (EMT-B, P, between) is that undergraduate medical education is a general education while EMS education is specialized education and the length of the courses, I don't see why EMS programs can't set up some sort of outside interest group to promote EMS and further learning. Granted, a lot of the EMIG events are setup by the students and not the adviser or professors. Similarly, this makes a great place for AAEM to market their services. I know (now) that student membership for NAEMT is something like $30, however first year of student membership for AAEM is free. That makes a big difference in how easy it is to get members. Thus, I think NAEMT's big problem isn't what they do as much as their market awareness. People won't join something they don't know about and will think twice if that something costs money.

Of course it can work without increasing taxes... all the government has to do is print more money!

To be fair, it is similar to what pilots do. One common commercial pilot license (common license) with additional ratings below it (specializations on that one common license). We can even call a private pilots license a first responder certification and a recreational pilot license a first aid certification.

...and if she works at multiple hospitals then she might have to have multiple sets of different color scrubs. Not all scrub color codes are the same from hospital to hospital.

...because everyone is running 24 calls a day, day and night, in a disaster zone. Yep... that's it. The EMS based fire suppression only exists to appease the IAFF and provide jobs. There's a reason why California is one of the laughing stocks of American EMS. Heck, AMR in Riverside County is held to a higher standard clinically than the fire medics in Orange and Los Angeles Counties. Go figure that one out. They aren't reading the machine interpretation on their 12 leads like the fire medics in the neighboring counties are. Yes... because a mini-Katrina or mini-9/11 occurs every day. Yep... that's it. First off, are you seriously going to say that Alaska has similar climate issues to Hawaii? California to Maine? Texas to Washington? The big bulky company issue jacket I wore in MA (where, you know, it snows) is completely inappropriate to wear in Orange County, CA (where, you know, I can count the number of days with significant precipitation in a year on 2 hands). Second off, who's going to decide this? Do you understand what the 10th amendment says? Unlike HIPAA, I highly doubt that Medicare is going to want to play uniform cop. So if it's raining you refuse to respond? I hope no one gets sick in adverse weather where you live. After all, God forbid a single rain drop falls on your boot. <div><br></div><div>The globe stuff is right on point.....hats off to the FDNY EMS division. Ever run into Captain Morris from Rescue 1.?&nbsp;</div>

See... I don't have that problem. My current jacket trumps turnout gear.

Why in the world would an EMS authority be forced to follow what a fire agency wants? Every company I've worked for provided company jackets for use which was more than adequate for the climate encountered in their service area. Obviously, the type of jacket provided in Southern California was drastically different from the type of jackets provided by my company in Massachusetts. At no point in my short EMS career have I ever felt that my uniform was substandard. No, I have also never worked for any cutting edge company either. Of course I also lack a fetish for turnout gear... go figure.