JPINFV

Woa, wait a minute here. Your online medical director has to CLEAR them to use an AED? Those things are at just about every security station at my school. Hell, if there's one of those at the 4th floor sky bridge entrance security booth, I would hope that EMT Basics could be able to use it without directions over the radio.

^ Sounds more public health than public safety.

What does PET stand for? If it's what I'm thinking (Positron Emission Tomography), then it isn't really something that you can train for.

Wow, now that's a borderline Godwin's Law violation there.

So, what exactly happens if the patient is competent [note: A/Ox4 does not equate to competent for other people reading this], but med com refuses to let the person RMA? Are you forced to take the patient and is the patient still billed for a service that they refused?

Why is it that 2/3s of the posts that you've made have been about nursing homes? Sure, I've seen my fair share of stupid nursing home stunts, but variety [of topics] is the spice of life.

No, you just need to make a minimum of 3 non-spam posts. A lot of people are making pointless threads/posts to reach the 3 post requirement and those threads/posts are being deleted. As far a the topic of this thread. The company I used to work for utilized Wheeled Coach vans as well as a hand full of Wheeled Coach custom and Wheeled Coach city medic type 3 modular ambulances. When I started working there, they had a few Leader vans and a few Horton type 3 modulars. Those units have since been phased out of the company.

There's a difference between a request and a requirement. Why shouldn't a paramedic not be at least a BS with a strong understanding of the science underlying the disease? Besides, all that extra time would insure a stop to the penis measuring that goes on over a 12 month program vs 10 month [or worse, basics who think they're better because their course was 140 hours instead of 120].

Congratulations, you have a JOB. Heck, I've been called out to an assisted living facility because a resident fell down in the elevator and the staff couldn't pick him up. No transport required. All we had to, were requested to do, and expected to do was help get the poor man back on his feet.

At least you have access to the chat room now. Maybe if you participated a tad since JUNE you would have passed.

I've always kinda of wondered if society has stopped human evolution. We try to keep nature from killing off people with bad mutations or people unfit for survival and the most fit in society generally don't breed to their potential.

It doesn't have to be a quality post. Here's a tip. If you are having trouble getting posts to chat, try making a thread in the meet and great section and introducing yourself!

^ Just wondering, what county in CA do you work in?

Which is right after my first post....

^ Said firemen weren't really mentioned in the original post. But that's really neither here nor there now anyways.

You want to try sitting up a 500 lb patient alone? Be my guest. As far as the NC, it was a stop gap since you didn't have anything else at the moment.

I haven't really followed the thread. Judging from the last two pages, this thread is full of drama. If there's one thing that working at a movie theater when I was in high school has done to me, it's leaving me with a distinct dislike of popcorn. Hence, I'll refer back to the first post. flash light: Front breast pocket works great. sheers, knife / multi tool: individual holsters. The multi tool can go on the hip while the sheets goes in the small of your back. metal O2 wrench (plastic just sucks): put on key ring, attach to keys [at my old company, the unit O2 wrench was attached to the key to the ambulance] keys: front pants pocket or breast pocket glove case: Lose glove case, put gloves in front pocket. The "cell phone pocket" on Dickies (R thigh pocket) works well too. phone… Front breast pocket. Put on vibrate and you'll feel it (I always had problems for some reason when it was in my pants pocket, especially the "cell phone pocket." window punch: front pants pocket, front breast pocket, one of the bags you have to carry. Pick one and be happy. This is, of course, assuming that you HAVE to carry all those things. You honestly don't need most of the belt clip things, and to be honest, most of those have no comparison to the rest of the stuff you "have" to carry on every call.

Well, while your partner is out getting the gear, let's start with what we can do. Ask the brother if this has happened before and what his baseline mental status is. Also turn the NC up to 6 LPM and see what a head tilt chin lift does for his breathing.

^ I don't know what they pay meter maids in Boston, but I hope it's better than minimum wage. From what I've seen [thankfully I don't drive that much], they are damn good and efficient at their job. There's nothing like seeing a line of cars with tickets 5 minutes after no parking goes into effect.

Because, unfortunately, EMS is so easy a caveman can do it?

It's all about packaging and a strict no refunds policy. You put the few cute and hot ones on the packaging and websites [it doesn't have to be action shots or anything], and the rest could be the ones who's doing it because the on the Stryker is the only place they have a chance. Oh, another good edition could be Ferno's Bunnies.

^ But think of the income that could be generated by PPV and DVD sales of "EMTs Gone Wild" or "Code 3 Club: Medics on the Prowl"

How is lowering the age the same as telling people to go and drink and drive? That's like saying that increasing the speed limit is akin to telling people that it's OK to drive recklessly [sidenote: "speeding" and driving recklessly is not the same thing].

Emergency Medicine in México Carlos Garcia-Rosas MD*, Corresponding Author Contact Information and Kenneth V. Iserson MD, MBA† †Department of Emergency Medicine, University of Arizona College of Medicine, Tucson, Arizona *Mexican Board of Emergency Medicine, México Received 29 April 2005; revised 8 March 2006; accepted 25 May 2006. Available online 12 October 2006. Introduction México, a republic of 1,972,550 sq km (712,130 sq miles), borders Guatemala and Belize to the south and the United States to the north. With 101,842,000 people (2002 estimate), it has the third largest population in the Americas, after the United States and Brazil. Although México is not thought of as a large nation, its population is 35% that of the United States, more than three times that of Canada, 58% that of all South American countries, 2.76 times all Caribbean countries, and 2.9 times that of all Central America [(1), pp 70–76, 81]. With a birthrate of more than 22 live births/1000 persons/year, a death rate of 5.1/1000 persons/year, an emigration rate of 2.7/1000 persons/year, and a life expectancy at birth of 73 years, México’s population is growing at the rate of 1.6% annually. The country is skewed toward youth: 32.2% of the population is 0–14 years old; 62.9% is 15–64 years old; 4.9% is 65–85 years old; and only 0.4% is over 85 years old (1). Medical services Several sources provide funding for Mexican citizens’ health care: the Social Security Medical Services (60%), the Federal Secretary of Health (about 20%), and private physicians and hospitals (about 10%). Approximately 10% of Mexican citizens have no source of funding for their medical care other than the hospitals for indigents. Family physicians and general practitioners provide primary care through family medicine clinics, rural clinics and general hospitals. They typically have walk-in times for semi-urgent or new problems, although they see most patients by appointment (2). There are several types of hospitals: Social Security hospitals, such as those run by the Mexican Institute of Social Services (IMSS) and the State Workers’ Institute for Security and Social Services (ISSSTE), municipal public hospitals, military hospitals, state-run general hospitals, and private hospitals. In all cases, the range of services depends primarily on the institution’s size. Specialized hospitals provide ambulatory surgery, specialized intensive care, geriatric care, and rehabilitation. The social security services (IMSS and ISSSTE) provide medical care using a tiered system. Their family medicine clinics offer primary care, preventive medicine programs, and minor emergency treatment. The next level is hospitals with basic specialties. Patients in need of special procedures or subspecialty care are sent to the third level, specialty medical centers. However, because Article 4 of the Mexican Constitution guarantees a person’s right to health care, patients who feel that they have an emergency can seek treatment at any hospital. If they have no insurance and they or their family cannot afford the care, they are transferred to a state-run general hospital (3). Emergency medical system Different groups provide pre-hospital care within México, with the most prevalent being the Red Cross (Cruz Roja), which is found throughout México, and the Escuadron de Rescate y Urgencias Medicas (ERUM), which is part of México City’s police department. The training these providers receive varies widely, from a 300- to 600-h Tecnicos en Urgencias Medicas (TUM) course to virtually no training, especially among the wide range of volunteers who supplement the pre-hospital care system. Occasionally, physicians staff ambulances. Physician-based emergency care is primarily provided by public hospitals, patients with less serious complaints being seen by general practitioners in small clinics or private hospitals (2). For several years, México City had an emergency telephone service using “080” in a few areas. This access number has now been replaced with several different numbers to call the police or public ambulances; the Red Cross ambulance service has its own number. The country has yet to institute a national system such as exists in the United States and Canada, so the receipt of calls for an emergency ambulance service is often delayed, slowing patients’ arrival at the Emergency Department (ED). Most large EDs see adults and children in separate areas or, in the larger cities, at different facilities. Whereas some de facto trauma centers exist in large cities, most large hospitals set aside two or more rooms for trauma patients (2). The number of emergency physicians has increased dramatically from the initial 15 residency graduates from México City’s General Hospital of Balbuena in 1989. However, many EDs throughout México continue to be staffed not only by trained emergency physicians, but also by generalists, family physicians, general surgeons, pediatricians, and others. The number of trained emergency physicians has expanded more rapidly since 1991, when the Mexican Institute of Social Services (IMSS) initiated a network of Emergency Medicine residencies, accepting 150 residents per year throughout México into 3-year programs (4 and 5). Emergency care Mexican emergency medical care came of age in 1986 with the initiation of its first Emergency Medicine residency. Nearly all the nation’s EM residency programs started in 1991, so little more than a decade has passed since the first large wave of emergency physicians entered practice. During this time, the political situation spawned by a change of leadership and ruling parties in the Mexican government, coupled with the effects of currency devaluation, have greatly decreased the resources available to develop the specialty’s infrastructure. Over that period, the government has given spending priority for the country’s relatively limited health care resources to primary care and preventive medicine programs while providing insufficient funds to equip teaching EDs and residency programs (4 and 5). Although México’s emergency physicians have worked to develop their emergency medical care system, the lack of national planning and a sense among governmental officials that developing such a system is not a high priority have limited their successes (6 and 7). Nevertheless, México has developed some elements of an effective Emergency Medical System (EMS) (communication, pre-hospital transportation and training, hospitals equipped for emergencies, and emergency physicians) that can act as the basis for future improvements. Much of the technical improvements are due to private sector funding, because they have more resources available than the local and national governments seem willing to allocate. Emergency Medicine education programs México’s Emergency Medicine residency programs are relatively new. The first Emergency Medicine residency program began at the General Hospital of Balbuena (a part of the Medical Services of Federal District, México City) in 1986, and the second was started in 1991 by the Medical Institute of Social Services (IMSS). Institutions such as IMSS, the federal Sistemas Estatales de Salud (SESa), etc., offer Emergency Medicine training through their own programs with slightly differing requirements in each. As in other countries, many of the programs have their residents rotate through more than one of their hospitals to gain various types of experiences (4 and 5). The Superior School of Medicine (IPN) recognizes the residency programs run by the IMSS, the SESa, the medical services of México City’s Federal District, and some others, such as the program in Monterrey. Other universities or state medical schools recognize the rest (4, 5 and 8). Graduates of all programs qualify to take the Emergency Medicine Board Examination (6). As of 2004, there were 14 Emergency Medicine residency programs in México, 11 of which are run by IMSS, one by the México City Health Department, one by the Federal Secretary of Health, and one, started this year, by ISSSTE (Table 1). In the near future, the ISSSTE plans to open residency programs at the General Hospital First of October and at the General Hospital “Dario Fernandez” (4). To generate the patient volume necessary for training and to be located in large hospitals, all Emergency medicine residency programs are located in urban areas. Table 1. Emergency Medicine Program Sites and Sponsors4,5,10 El Instituto Mexicano del Seguro Social (IMSS) — in México City Hospital General de Zona 1-A “Los Venados” Hospital General de Zona No. 8, “San Angel” Hospital General del Centro Medico Nacional “La Raza” Hospital General Regional No. 25, “Zaragoza” Hospital General Regional “Gabriel Mancera” IMSS in other regions Hospital de Especialidades, Centro Medico Nacional, Ciudad Obregon, Sonora Hospital de Especialidades, Centro Medico Nacional, Puebla, Puebla Hospital de Especialidades, Centro Medico Nacional, Veracruz, Veracruz Hospital de Especialidades, Centro Medico Nacional, Torreon, Coahuila Hospital General Regional No. 46, Guadalajara, Jalisco Hospital General No. 33 Monterrey, Nuevo Leon La Secretaria de Salud Federal Hospital Dr. Gea Gonzalez (begun 2001) Servicios Medicos del Distrito Federal Hospital General de Balbuena Instituto de Servicios de Seguridad Social para Trabajadores del Estado (ISSSTE) Although the numbers fluctuate, on average, between 120 and 150 physicians enter Emergency Medicine residencies annually. Based on the available funding for all Mexican residency programs, this number relates to the approximately 3,500 physicians accepted annually into all Mexican residencies—about 12% of those who apply. Emergency Medicine training All Emergency Medicine residents must have a valid medical degree, obtained by completing 4 years of medical school, 1 year of “internado de pregrado,” and 1 year of social service. During the social service year, students must pass their professional examination to become a physician and obtain a “titulo,” a degree of “Medico Cirujano” (Physician and Surgeon). Once they obtain their “titulo,” individuals can take the Examen Nacional Para Residencias Medicas (ENPRM), which qualifies them to enter a residency program. This test, similar to the United States Medical Licensing Examination (USMLE) in the United States, is designed and approved by the Secretary of Health, the National University of México, and a committee composed of representatives from México’s private and public health institutions (the Inter-Institutional Committee of the Health Sector). Fewer than 15% of students pass this test. Some of those who fail find work in other health-related fields, whereas others leave medicine completely (4, 5, 6, 7 and 8). In addition to passing the ENPRM, individuals must possess the academic prerequisites and personal qualities required to enter an Emergency Medicine residency. They include: a Being registered to practice medicine in México in the National Register of Professions kept by the Public Education Secretary (SEP). To be registered, a graduate who studied medicine in México and is a Mexican citizen must also do a year of internship and a year of social service. Other physicians, such as those who studied outside México or are not Mexican citizens, must obtain a special work permit. b Demonstrating a willingness to devote full time to the Emergency Medicine residency training program. c Being physically and mentally healthy, and possessing a capacity to work under pressure. Both a psychological test and an English-language test are administered. d Having a clear understanding of the mental and physical demands of a career in Emergency Medicine (7, 8 and 9). Emergency Medicine residencies are not combined with any other specialty training. The residencies follow curriculums approved by the associated medical school, which monitors their compliance. The overall goals are for trainees to obtain the outlook, knowledge, and skills necessary to carry out the diagnostic and therapeutic procedures required in clinical practice, to acquire the administrative skills to manage an ED and the emergency medical system, and to be able to access and appropriately apply published research to Emergency Medicine practice. In essence, at the end of their training, Emergency Medicine residents should have the clinical skills necessary to deliver good care to patients with an acute illness in any ED in México (4, 5 and 8). Emergency Medicine specialization in México requires a minimum of 3 years of training. During their training, Emergency Medicine residents take examinations every 2 or 3 months and at the end of each training year. If they pass all the examinations and also demonstrate that they practice excellent Emergency Medicine in their clinical evaluations, they receive the “Medico Especialista en Medicina de Urgencias” (Emergency Medicine Specialist) diploma from their training institution and the affiliated medical school (4 and 5). Candidates take their Board examination in Emergency Medicine once they have successfully completed residency training. To become a recognized specialist in Emergency Medicine, the graduate must then take the Emergency Medicine specialty board examination administered by the Mexican Board of Emergency Medicine. Founded in 1992, the Board has administered this specialty examination, equivalent to specialty board examination in other countries, to about 2000 physicians, with pass rates varying between 70% and 85% (6 and 9). Approximately 95% of these physicians continue to practice Emergency Medicine. Between 30% and 35% of all physicians working in Mexican EDs have taken the Board examination. They average 30 years of age. In accordance with Mexican law, physicians generally retire at age 60 or after 28 years in practice in the IMSS system; emergency physicians are expected to follow this model. If they wish, they can still work in the private sector. As of yet, however, Emergency Medicine is still too new in Mexico to have such retirees among residency graduates. After an additional 2 years of study through IPN and some other schools, Emergency Medicine graduates (as well as internists, pediatricians, etc.) can obtain a masters degree in Toxicology and qualify to take the subspecialty examination, leading to the Diploma of Toxicology (10). Emergency Medicine graduates can also do subspecialty training in resuscitation (reanimatology), although only the Superior School of Medicine (IPN) recognizes this subspecialty (10). Alternative Emergency Medicine Training: Diplomado For physicians who practice or want to practice Emergency Medicine, but who have not completed an Emergency Medicine residency program, an alternate educational route exists. Through the Comité Mexicano para el Cuidado del Corazon y Trauma and the Escuela Superior de Medicine del Politecnico Nacional (a México City medical school), physicians can enter a “Diplomado in emergency medicine and trauma” program. The program consists of 200 h of didactics in 20 modules and 10 workshops. A 1-day animal (dog) laboratory allows trainees to practice venous access, placement of thoracostomy tubes, and to perform cricothyrotomy, tracheostomy, peritoneal lavage, thoracotomy, and other procedures. The course, 10 h a week, lasts 5 months. In 2004, other medical school sponsors began teaching the same course in México City (11). This course is only open to physicians in general practice, family medicine, and other medical and surgical specialties. Those in Emergency Medicine residencies go through the normal Board examination process. Although this course does not allow these physicians to be recognized as Emergency Medicine specialists in México or to sit for the Mexican Board of Emergency Medicine examination, it provides concentrated continuing medical education credits focused on Emergency Medicine, which is generally the field in which they work. Through 2004, about 200 generalist and non-Emergency Medicine specialist physicians have completed the Diplomado course in Emergency Medicine. Teaching faculty Currently, many faculty members in Emergency Medicine residencies are not residency trained in Emergency Medicine. Most are internists, intensivists, pediatricians, surgeons or other specialists. Ideally, at least the residency director should be residency trained and Board certified in Emergency Medicine; this is currently not the case for all programs (8). In addition to excellent clinical and teaching skills, the teaching faculty at Emergency Medicine residencies must have good communication skills, good relations with their colleagues and students, and be emotionally stable, with the capability of providing support to the residents. As in other specialty residencies, Emergency Medicine faculty are tasked with ensuring that all the residents receive complete training and the best possible opportunity to develop their skills in their chosen specialty (4, 5 and 8). Emergency Medicine organizations Aside from the Mexican Board of Emergency Medicine, several national Emergency Medicine organizations exist in México. The first, formed in 1989, was the Sociedad Mexicana de Medicina de Emergencia (SMME), which now has about 700 members. About a decade later, graduates of the IMSS residencies began the Sociedad Mexicana de Medicos Urgenciologos (SMMU), which now has about 400 members, and the Comité Mexicano para el Cuidado del Corazon y Trauma which has about 300, members all are headquartered in Mexico City. In addition, México is a part of the International Federation of Emergency Medicine (IFEM) and “cosponsor in Europe” for the Federation’s second meeting in Emergency Medicine (7 and 9). Organizations also exist for those involved in pre-hospital care. They include national groups, such as Cruz Roja Mexicana, S.0.S., and Cruz Ambar; the México City-based Escuadron de Rescate y Urgencias Medicas; and various other local police and civil defense/rescue squads (2 and 8). Emergency Medicine’s impact In México today, Emergency Medicine residency graduates have become chiefs of their departments throughout the country, hospital administrators and directors in a position to exert greater influence, and taken positions in the government, such as the coordinator of hospital groups. On the education side, residency graduates are now coordinating medical school Emergency Medicine curricula and directors of medical education in major teaching hospitals. The future In the coming decade, the hope is that Mexican Emergency Medicine will continue to improve and to meet the following goals: 1 Guarantee quality care in any ED in México to patients with an acute illness or injury. 2 Create a standarized residency training program in Emergency Medicine throughout México with the cooperation of academic hospitals and the faculties of medicine in coordination with the Mexican Board of Emergency Medicine and Mexican Academy of Emergency Medicine. 3 Assure that all Emergency Medicine residency training programs provide their graduates with the skills and knowledge necessary to give care in any Mexican ED at any level. 4 Upgrade pre-hospital care, including the implementation of a national telephone access number, improved and standardized training for ambulance personnel, and close cooperation with hospital EDs. References 1 Pan American Health Organization, Health in the Americas, Pan American Health Organization, Washington, DC (2002). 2 Plan Nacional de Salud. Secretaria de Salud. 2000. 3 Constitución de los estados unidos mexicanos, articulo 4. 4 Programa de Curso de Especialización en Urgencias Medico-Quirurgicas. Instituto Mexicano del Seguro Social 1991–94. 5 Programa del Curso de Especialidad en Urgencias Medico-Quirurgicas, Servicios Medicos del Departamento del Distrito Federal, Mexico City, Mexico, 1986–89. 6 Estatutos del Consejo Mexicano de Medicina de Urgencia a,c. Enero 1991. 7 Estatutos de la Sociedad Mexicana de Medicina de Emergencia a,c. Enero 1989. 8 C.A. Garcia, La enseñanza de la medicina de urgencia en México, Panam J Trauma 2 (1990), pp. 39–43. 9 Archivos del Consejo Mexicano de Medicina de Urgencias, Mexico City, Mexico, a,c. 2002. 10 Programas de Postgrado, Escuela Superior de Medicina, Instituto Politécnico Nacional, Mexico City, Mexico. 11 Estatutos del Comité Mexicano para el cuidado del corazon y trauma, a,c. 1997. 1. This is one of the sources I used for the Mexican part of my report. 2. I would have posted a link to it, but I needed to get in via VPN to get the whole article.