JPINFV

It was rhetorical. I was basically getting at the fact that if fire service administrators think that they can turn fire fighters into medics, then why shouldn't medics be turned into fire fighters? After all, if one is true, shouldn't the other side be true as well? Especially since at least one poster seems to think that medic-fire fighters [as compared to fire-medics whose primary job is fire suppression] is not possible.

but but but socialized medicine will save everyone.

Well, if fire fighters can learn to be paramedics, why can't paramedics learn to be fire fighters?

United States: Canada's Mexico?

looking for this Courage?

well, technically speaking, yes, you can learn without asking questions. Asking helps, though. Asking while being aware of the tone that you are using while asking that question [especially online where there isn't any non-verbal cues to help out] is golden though.

from doing manual labor. I'll be here all week.

Well, this will be fun. Issue one, YOUR TITLE. Have you ever had a bad impression because of a bad first impression? I know I've given my fair share of bad first impressions to people. Your title is YOUR first impression [and with 4 posts, you have no reputation to fall back on, good or bad]. Quite frankly, the title you picked could, at best, be considered a troll. Since your first impression with this thread is that of a troll, you are, right or wrong, going to be treated as one. Hence the results [garbage in, garbage out]. Cardiac problems can cause respiratory signs and symptoms. Either your call volume and gomer [yes, I'm reading HOG right now, give me a few weeks to finish reading it for the references to stop] population is low, or your 15 years of experience means nothing. I find it hard to believe that a Basic with 15 years of experience has never seen a CHF patient. Well, if you have a question about treatment, approach the medics you are comfortable and ask them about the call and the treatments. Don't provide names and ask in a non-judgemental fashion ["I had a call a few weeks/months [lie on the time frame. Yes, flat out lie here to make it harder to track down which call it was] and the patient presented with A, B, C, and the medic treated with X, Y, Z. I was wondering if it was appropriate? Could you explain why?]. If you're 100% sure that it is a bad judgment call, then I would say ask, and ask immediately. If you feel that you might be missing a piece of the puzzle, ask after the call. Again, be non-judgmental. [sarcasm]Can I get a job babysitting medics? Babysitting looks like it pays more than working as a Basic. [/sarcasm]

No, but I know how/where to speed without getting a ticket [6 years, no ticket. Not counting my time in Boston [still no tickets, but much less driving]]. The last thing I want is some cop to be thinking about how I should know better because I am an EMT.

Yes, this is a 1.5 year bump.... Book:The House of God: The Classic Novel of Life and Death in an American Hospital Author: Samuel Shem Publisher: Dell Cost: $10-15 ISBN-10: 0385337388 Discussion: It's a satire on hospital residencies, but several of the terms and "Laws of the House of God" have made their way into EMS usage [LOL in NAD, Gomer, the first thing to do at a cardiac arrest is to take your own pulse]. Similarly, the picture of interns starting off fresh out of class with little to no experience providing patient care seemed eerily similar to starting off fresh out of Basic class. While definitely not for novice providers [the cynicism could be a turn off], it should be a must read at some point for all providers. I give it 7/10 stars of life.

I love that... "But but but cardiac arrest patients have a similar timeline as fires" Err, why then is saves still abysmal? Oh, and does anyone have a link to the study that showed that fire based services had a higher "save" rate?

Eddleston, M., Juszczak, et al. "Multiple-dose activated charcoal in acute self-poisoning: a randomised controlled trial." The Lancet. 2008: 371: 579-587 http://www.thelancet.com/journals/lancet/a...602706/abstract

I was going to make a smart ass comment about them reverting back to a fire fighter, but I guess helping to evacuate people helps more people in the time till backup arrives than if they sat down and helped one or two people instead.

No problem. A person does not have to be huge, or neccessarily out of shape, to reach a BMI of 30 (medical definition of obese). There, no I don't think that obesity is necessarily a disqualifer of appearing professional.

Quick clarification, are you talking about morbidly obese (public perception of the term obese) or people who have a bit of extra weight that pushes them into the medical definition of obese?

Oh, so if a MEDIC botches it, it must obviously be some that basics should be able to attempt also. After all, it's all luck. Oh, by the way, I'm not a medic and I don't exactly remember my basic class covering the basics of hemodynamics past "blood goes round and round pushed by the heart." Keep trolling though.

Ok, seriously now, do you have a point past ad hominem attacks? You do realize that criticizing the EMT-Basic level is not the same as criticizing the providers who make up that level? Ok, how about the fact that there is, in general, no reason to start a non-medication IV. How about the fact that the EMT-B level lacks any sort of educational background to understand the affect that extra fluids have on the body. Just wondering, did the name "Starling" ever come up in your basic education or the IV cert?

Well, solution one is to not take a job with the company. No offense, but it does seem a little disingenuous to be hired, and then immediately complain about the dress code. Second, is this a 911 company, interfacility, or mixed? Third, are you talking about requiring dickies or talking about the thin cotton slacks like what you should wear to an interview?

[devils advocate] Greatest good for the most amount of people would, ironically, be that hospital discharge. By discharging a patient, you open up a room in a hospital that could/would be filled by an emergency room patient. This opens up a bed in the emergency room that would be filled from a patient in the waiting room or a patient from an EMS unit. Stopping at an accident scene where there may or may not be a patient that you can do anything for [see personal anecdote below] prior to the arrival of the 911 units can end up with a ripple delay through the rest of the EMS system. [/devils advocate] [personal anecdote: After being dispatched for a call at my old company [non-911 call], my unit ended up rolling up on a car that had hit a middle concrete barrier [like a Jersey barrier] and ended up on it's side. 3 patients [15 year old student driver, mom, and a year old baby in a car seat] and none of them seriously injured. It sucked sitting there for 5 minutes for the fire department to arrive to extricate them because there really wasn't any way to get into the car. The fire department ended up holding us on scene until extrication was complete in case everyone wanted to be transported, though]

How is your ideal system set up?

ALS first response with paramedic supervisors in chase cars [in part to provide ALS intercepts if needed] with BLS units to be used for interfacility transports [funding in addition to tax funding]. The BLS units could be used to supplement the 911 units [supervisor+BLS unit=temporary ALS unit] on an as needed basis as well as in disaster/mass casualty situations. In addition, CCT units would be dedicated units with crew makeup dependent on volume and type of service calls [utilizing EMT-P, EMT-Bs, RNs, and RTs as needed]. Medical direction would be primarily by standing orders with the option for online medical control to be used as needed. 911 and non-emergent/non-EMT-P critical care would be separate. I would like to see the ability to have the EMT-Bs who are continuing their education [either in college or a paramedic program] have the ability to ride third man with a 911 crew on a voluntary/non-paid basis. For training, I'd like to see a partnership with a local hospital as well as a local university or college [preferably one with a medical school]. A paramedic program would offer a steady supply of paramedics that could be tapped as needed as well as give EMT-City EMS a chance to directly affect the educational makeup of the nation's paramedics. In addition, paramedic preceptors and educators would be a promotion position [merit based] that could help reduce turnover. Furthermore, by partnering with a hospital and an institute of higher learning, the instructors in the program need not be paramedics, though, but instead experts in the field being taught. As well, the regular "pre-req" programs could be rolled into the paramedic program by utilizing the courses already offered by the partnered college. This would help ensure "quality control" of the educational process. This would be a degree granting program. Continuing medical education would be provided in various topics by the partnership with the partner hospital. This would help to include "flavor of the month" health scare topics [recent example: MRSA]. As well, it would help to maintain skill proficiency as needed [the full time paramedics wouldn't just be another faceless student passing through]. Finally, the partnership between both the college and the hospital would provider a fertile research ground to advance the science behind EMS. Again, this would provide another opportunity to attract solid providers [especially ones with a science degree] and increase retention.

Maybe that's why the police are always at the Krispy Kream? The police are just hiding their dispatch system.

What you say !!

That still fails to respond to my point about negative vs positive rights. So, if healthcare is a "right" who decides what health care providers get paid? Who decides what amount of health care is enough? What about people who use more health care than 'their fair share?' Should people who have money be allowed to spend it on health care and get a higher level of service? If not, why? It's their money after all.