JPINFV

Dust, I believe your sarcasm detector is broken (or mine is, because it's peaked).

I'll remember that when I get around to it. [spoil:a0ea43e56e][/spoil:a0ea43e56e]

Would "ignorant" be better? (Look ma, I can do one liners too! Ain't personal attacks fun!)

Yes. Since underage drinking (which, for the record, is a federal mandate for highway funding, and is thus, just a hair away from being unconstitutional) is illegal, adults engaging in underage drinking have very little incentive to drink responsibly. The punishment for 0.01 BAC and 0.5 BAC is going to be the same. By lowering the drinking age, hopefully adult underage drinking comes out from the shadows and can be properly monitored. Of course, I'm a little biased since I've had alcohol since I was a kid (wine with dinner on special occasions), and thus, while engaging in underage drinking, have learned that you can drink alcohol without getting plastered or drunk.

You know, when ever I tell people that I'm an EMT-B and it only took 110 hours, they get this kinda of horrified look on their face ("You can do all that with only 110 hours?") until I explain the difference between basic and paramedic. I bet that the public would be shocked if they understood just how undereducated the EMT-B level is. Oh, and just because someone disagrees with you doesn't mean that they're mean. That means they have an opinion on a topic, and in the case of many people here, are more than willing and able to defend those opinions (something that is sorely missing in my generation). If anyone is too immature to accept that people are going to have different opinions, then they are too immature for an internet forum (you know, a forum. Like a place to go and discuss things) and EMS in general. Same if anyone is so immature that they can't disassociate themselves from their job/level/etc to objectively analyze a situation.

Take a step back and actually look at the requirements and expectations for EMT-B. How would you feel if someone with 110 hours of training got to decide if you saw a doctor at an emergency room?

Dust, I believe the term is now VPIF, not MILF.

Yes, it really is a county by county certification process and a certification in one county is good throughout the state. The problem that the Bee found was that, while almost all counties require a background check, a couple didn't. This meant that there were people who were driving 3-4+ hours to go to a non-background check county to get a cert. I know that at least Orange County got around this by requiring a second license to work on an ambulance besides the EMT-B certification. I'm going to assume that the required background check is "Livescan," (Livescan uses an electronic fingerprint machine and is available at almost all police stations as well as at private locations) so I'm going to assume that there's going to be very little impact from this new law since most counties already require a background check and the infrastructure is already in place for people to obtain a background check.

Is she like the Governor of Alaska or something?

Option D. Orange County, CA does not have a written EMT-B protocol. As per EMT-B class, and common sense, I use NRB at a high enough rate to keep the bag filled (hence common sense, but yes, at least 10 LPM), and 2-6 LPM for nasal cannula. I decide between a NC and NRB based off of my patient's presentation and have zero problem upping the oxygen dose as needed. To be honest, I don't believe in the "one size fits all, everyone gets a non-rebreather because oxygen is harmless" nonsense. No, not every patient needs oxygen. No, not everyone that needs supplemental oxygen needs a non-rebreather. No, oxygen is not harmless, even if it's pretty darn close (and no, I'm not referencing hypoxic driver either).

No, no, no. It's 15 liters per minute by nasal cannula and 2 liters per minute by non-rebreather. /sarcasm

The way I read it was that her family is sick and tired of her older sister and her using them as assessment practice adjuncts.

The problem, though, is that intership/residency (3-4 years for emergency medicine, depending on the program) is more akin to clinicals/field training and not working as a lower level. Someone who works as an EMT-B for 3 years is going to have the exact same scope, supervision, and responsibility on day one after training as he is going to have at the end of year 3. A provider going through clinicals (of any serious duration), residency, or field training are going to see an increase in their scope (in essence what they're preceptor will allow them to do, even if it ramps up quickly to full scope) and responsibility decrease while the oversight provided decrease as training progresses. As far as 3-4 years vs months (thrown to the wolves), your also looking at completely different expectations. A paramedic isn't going to decide to admit vs transfer care vs discharge in most places or cases (I'd say 90% of providers are required to choose option 2). Similarly, the range of skills performed is vastly different between medics and physicians. No one is expecting most paramedics to read x-rays or decide which laboratory tests (ignoring d-sticks) are needed or which specific drug would fit best for this patient (most medics don't really have all that much of a choice between medications). Besides, shouldn't learning to collect, distill, and interpret a patient assessment something that should be done during clinical time as a paramedic student? Physicians are expected to be able to do assessments before they graduate medical school. It's not something that's learned during their residency, but instead taught over the first two years (as a note, interviewing is taught to first year medical students at my grad school). As far as IFT v 911, I will agree that IFT work can provide a wealth of information for medical patients (especially when dealing with chronic conditions). After all, a self motivated provider working the worst IFT job would get more out of the IFT job than the laziest provider working the best 911 job. It's definitely all about what you (generic "you") put into it. That said, it can be challenging to take a job seriously if the employee culture (as cultivated by management) is completely against any sort of thought past making the SNF happy.

Is it wrong that I find the concept of Hitler on Ice mildly amusing?

Of course the basic counter to that is that EMS is the only career that I can think of where the main level (paramedic) requires providers to work at a lower level first. Doctors don't have to be PAs first. RNs don't have to be CNAs or LVNs first and EMS has a lot more in common with health care fields than with the fire service.

Added a little for you.

Fixed...

I worked for 2 years in Southern California, but I haven't transfered my cert to Mass. yet because I was busy with grad school, but it sounds like most privates are the same the world around (good and the bad). So, short of as a way to 'justify' higher wages, who exactly is an officer going to lead on a crew of 2?

As I already said, mangers, QA, crew chiefs, etc. You don't need a 'captain' or other such nonsense on every unit. The last thing I want to deal with is some [insert random rank basic] talking out their rear and thinking that it matters that they are [insert rank]. Unless QA or supervision is your (generic "you") job or you're a higher medical level, care should be cooperative and not about ordering people about. I don't care what rank some basic is. If he/she/it is talking out their rear end, I have zero problem disregarding what is being said.

If I remember reading the guidelines correctly when they first came out, patients in v-fib on an unwitnessed arrest are normally found in fine v-fib. Fine v-fib is more likely to convert into asystole whereas 2 minutes of CPR can 'covert' fine v-fib into coarse v-fib. Coarse v-fib is more likely to result in ROSC following defibrillation.

Another place to look at is the Regional Occupational Programs (ROP). My basic course was $120 including books. I'm not sure, though, if the Inland Empire has ROP programs or not.

Every operation needs management, oversight, and leadership. That doesn't mean that providers need brass on their shoulder tips nor that every unit needs an officer on board. You standard EMS call does not require a large enough number of people to require a formal rank system. If two providers of the same level on an ambulance can't work it out between themselves who's in charge of a call, then both probably need to be removed from the field for failing to communicate. Now that's not to say that you don't need someone in charge of the organization a a whole, people to train (although, in my experience, FTOs tend to not be the sharpest knife in the drawer), people to do QA. They're called managers, crew chiefs, FTOs, and a whole sort of other things that does not require a paramilitary mindset. The last thing I need any scene is someone who thinks that they're all that and a bag of potateo chips and doesn't have to listen to anyone else because they're a [insert random paramilitary rank] yet the same level as me.

Sure, it's misleading, but it's not unheard of at the state level. Where's the outrage that Iowa calls their EMT-I/99s "EMT-Paramedics?" What about military medics using the term "medic" if they aren't a paramedic as well? What I can't get behind, though, is complaining that federal employees aren't necessarily complying with local laws. There is a separation of government levels for a reason.

I give this rant 3/10. It would have been higher, but Iowa calls their EMT-Intermediates "EMT-Paramedics" as well. (yes, it's Wikipedia. Yes, it's sourced).

Out side of training officers, I really don't see the need to have officers in EMS.