emsbrian

Places I rode, even if a basic was in the back with a guy who has a stubbed toe, any care he gives is under the "supervision" of the medic. Sorta a bum deal. While I have never seen it play out where anyone gets blamed for anything but what they did, that is the "theory". Didn't mean you had bad advice there ERDoc, just worried some might misunderstand :-) I think for the most part we have to look at just that Anthony. The ride is the important aspect, Safe and smooth come first, this is patient care and comfort. When expedition is needed the smooth can be reduced for a little shorter time, but safe has to stay. ERDoc makes a good point that most calls do not require L/S, and we transport A LOT normal traffic. So to go L/S is a huge decrease in the time to get to the hospital, as we normally have about a 15-25 minuted drive anyways. We do tend to respond L/S more as dispatchers have to communicate with people who obviously feel someone is about to die and called 911, so their perspective on the needs of the patients may be more severe then the facts once we arrive. Anyways I'm out on this thread, Great advice guys :-) Sorry for the misunderstanding their Asysin, people seem to browse my posts a lot and not get the whole information. Most the time what I say is no basic advice, as I fear people want just a black and white answer and am trying to give them thoughts about it.

ERDOC: True, but a little dangerous to say just that. The higher cert is of course in charge, and blamed for everything. So while the driver may be making decisions as to L/S based on traffic and safety, he must try his best to follow the needs and requests of the care medic. Never should a driver decide to go code 1 when the medic needs a code three. On that note I agree with you on most everything, just wanted to clear that up a little, general statements scare me.

Whoa chill there buddy. Never said that. Said they were a good resource for me as a supervisor to judge my medics. Their are as many dangers to bad habits as their are from inexperience. Never would I want a medic to be scared to question what they saw as a problem, new or old. And that is what I said their. I knew I would piss someone off, but didn't think it would be about that. I never said that experienced medics are less valued then newbies. We have a big problem with times changing and medics not. But my experienced medics are the life of my business. Without them I would have nothing. Never in my life would I trust a newbie to go teach no matter what. But never would I trust an experience medic until I know they don't have bad habits. The whole point of my comment as I have said many times on here, is to increase the professionalism of EMS. We must value both experience and knowledge. When one has both they are at a peak of our job. But both have value and dangers by them selfs. I urge the EMS world to be more professional, do not make anyone scared to speak up, and supervisors/managers should treat their employees equal in both listening to them and correcting them.

I rode a few choppers as 3rd on... SUCKED now I fly a cessna for fun, Nothing like a stall practice to get that thrill out :-) Good point there my friend

I will say up front, my advice has limited experience as a flight medic. But around here you need four-five years with your medic/RN working before you can even have a chance. I recommend if you can afford it to finish both schools. The knowledge you gain in each is highly important. While after 5 years working EMS as a paramedic you will have honed skills, if you challenge it as an RN you may very well pass, but will pose some risk to patients who will have an emergency medicine inexperienced paramedic (although I do not know how long you have been a basic). On that note you can also become a paramedic and apply that credit to nursing school (it is a 2 year paramedic to RN transition through distance learning). But I recommend getting your RN before and challenging it as the best course if you wish to save money.

I'm going to keep it short and sweet (didn't know I could do that did you?) You pretty much lay it out yourself, you know the rules follow them. I trust my drivers with my life. I can count the number of times I have driven (with a patient in the back) on little more then one hand. I don't know about this 8 minute thing, we get questioned for an unreasonable run time, but unless you have a small area to cover (never the case around here) 8 minutes is pretty much a perfect response time, and you can't expect that every time. Stay safe, there is a lot of FF/medics out there who only do it for the pay, they don't care about the patient. They are adrenaline junkies. I know I'm going to get bitched at by any who are on EMT City, BUT IF YOU'RE READING THIS YOUR ONE WHO CARES. It is true your world would possibly be valued less, but as a supervisor the fact that my newbies could be anal was an advantage. You can learn bad habits of your "experienced" medics that way. As far as the siren, rules vary a lot obviously. My particular experience says its a judgement call of the drivers (unless I say "we need to be there!!!"). No need in a residential unless you expect traffic or pedestrians. If your hauling ass through residential then I would probably have them on just for worry about kids and the such. (even though they may end up staring instead of moving) But for the most part it is to dangerous on residential roads to speed much anyways. In general we don't speed more then 10 over for safety reasons if speeding. Interstate/highways/major thoroughfares always get siren, but if you could flow better without it as an in-charge I would not mind one bit, as long as you judged it safe. If you truly need to speed (example: working a code) you need to have a PD escort. I know these are rear, but the places I have worked I have tried to work with the PD to be able to arrange them. They respond to all codes when we call them back to dispatcher as on scene with arrest. (along with everybody and their mothers around here) And when we leave they shut down intersections in front of us, so we can go full speed code 3 safe. Remember, if we hit someone, we just screwed up royally. The patient is screwed AND the person you hit, never a good scenario. Well I'll shut up now, since this wasn't short. Just remember to stand up for yourself if you feel its better for the patients. (or just rant on here, so we can join in.

I once sat at a conference for a 2 hour lecture by a nice MD who made many great arguments why we done even need a stethoscope. Changed my views greatly on EMS... Still like my stethoscope though. It was more of a jab at the over treatment and over thought that happens we paramedics forget that one major step: Transport decision.

A good point is made above by Ozmedic. My advice in the thread IS STRICTLY NREMT PRACTICAL EXAM ADVICE. Please do not apply it to real life by any means. Your knowledge should be so great as to pass no problem. A majority of my advice centers around test taking for the exam. While a practical exam should be infinitely more comprehensive there is only so much that can be test in 10 minutes. Sadly NREMT examiners are only meant to ask questions to clarify. We can not ask leading questions or questions not related. For example we can not actually ask what % oxygen is in air. But if you bag the patient we can ask you what tidal volume you will use, but not why. Get the idea? Why is a written test thing in there opinion. Expect to answer more questions on the verbal as their is a little more to do there, but its not horrible. When you learn to take the test anybody can pass is, which is why we always wait until the last month of classes to begin to teach test taking technique that way students learn. This is the reason that FTO's and company entrance exams can be very tough. The reason we teach the test at all is time constraints, stupid things like HAVING to put high flow O2, and HAVING to say BSI fail to many people. Personally I feel to forget BSI is important but why not fail for forgetting to check scene safety? I digress. Feel free to call me, or e-mail me. The company line will get me most the time, as I prefer to keep track of business. Oz, I hate to say it, the NREMT practical offers very little in the way of EMS screening. Especially at an EMT basic level, which has been made even easier. Most skills can be passed in less than five minutes if you know the checkoff and critical criteria. I could say I could teach someone with NO EMS knowledge to pass them in a week :-( Because we know what questions will be asked. (Excluding paramedic only skills) But this is a topic for another post. Skills teaching, and skills training are sadly two very different things.

I was replying to the main topic of the thread, not just to you O2 curiosity. As far O2 for the NREMT tests just about every patient is in "shock" of one kind or another so get high flow O2, cover to retain heat and position of comfort (or whatever depending) So yes for test purposes you have to say hi flow O2 which is clearer to the instructor if you say 15lpm by NRB, other wise we have to ask you to make sure you don't think Hi-flow is a NC at 20lpm or something like that LOL. In general 12LPM is acceptable but 15LPM is the best answer. Any less than 12 on a a NRB is dangerously low, so we wont take that. If you want you can pump up higher then 15, but no reason. I'm sure all that is pretty obvious. And of course NC is not hi-flow for us. Hope that answers your questions direct about Oxygen and the National Registry Practicals. :-)

If you don't put O's on the patient you fail NREMT practical. Get your skills sheets off the NREMT web page, while it is a skills test, it is still a test. It can be passed hitting every point in only about 4 minutes (sadly). I recommend you learn the failing criteria on every skill so you don't pass and make some little mistake and fail (Like oxygen) Treating things like difficulty breathing in trauma is normally simple, like suction. Don't go for the needle decompression, you may forget to suction and fail. I cant give way scenarios but I've performed many NREMT practical tests as an instructor and can tell you they are not all inclusive. There are key points, that are fairly simple, just make sure you learn the skills seat. Don't waist time, get your skill done hit all the key points. All the advice is good above, remember you have time, a lot of people write out their list of what they are going to do to begin with. Just be thorough a lot of people miss points in things like genitalia or abdomen vs. pelvis. Also remember medical is medical and trauma is trauma. Your trauma patient will not have a heart attack (if he does your examiner needs to have a talking to) Also remember that vital signs will either get better or worse depending on how your doing. But don't expect them to change too much, or necessarily more then once from the patients baseline. Lets see other things the National Registry doesn't require are things like a verbal report. I've seen many fail by going over their amount of time just to try to do a run report which gains and looses NO points. If you need more advice just e-mail me through www.medicaltrainingspecialists.com , we teach skills training but I also do alot for free. --Brian

Texas is always a great bet and for paramedics work here is easy to find, and supposedly pay is good ($15 an hour or so average in my experience, up to 25 if your teaching). Our state web-page is http://www.tdh.state.tx.us/hcqs/ems/default.htm The page about reciprocity is http://www.tdh.state.tx.us/hcqs/ems/stdrecip.htm mostly for out of state, but give you some idea. USUALLY this will gain you a year of Texas cert. Within that year you must sit for the NREMT exam, [s:21373d536f]if[/s:21373d536f] when you pass the test you will gain ONLY Texas certification. If you talk with the NREMT they may let you gain their cert, but that is not guaranteed by any means. Hope this helps you. As a note TDSHS looses 15% of there paper work, so call a lot and used registered mail when dealing with them.

justify my never vote. I have gone hardcore, I'm getting my MD so that I can make a careerer out of bettering EMS

Hmm we always call the patient near drowning until they are pronounced. (Probably just positive thinking lol) not a rescue diver instructor Just EMS and all related there lol Lifeguarding like CPR has changed a lot in the pas 4 years. It is indeed true that the abdominal thrusts were recommended to expel water a few years back, but that has gone the way of the pre-cardial thump. When in doubt follow your AHA guidelines water is a foreign body. They are unconscious therefor CPR. Its hard but we have to keep up to date in this job. On that note, lifeguards are still covered by good samaratian laws and anything is always better then nothing. Just remember that if you just left the person they would die, any half logical attempt improves there chances.

Ok just a little confused about the question but Ill give it a shot here: Scenario one: Our patient is near drowning but conscious (remember near drowning, to drown means that death occurred.) No abdominal thrusts are needed because he/she will cough up any water swallowed. Just watch out for the throw-up. Scenario two: Bob passed out while drowning. Unconscious patients get CPR thats what AHA says. Obstructed Unconscious is CPR so does it matter? Remember we now use chest thrust (compressions) to expel foreign objects in unconscious patients while performing just as we would doing CPR. While as a rescue diver (misnomer for my area) we don't see many living drowns we do teach CPR/obstructed by the AHA guidelines and Red Cross Life Saver and from my knowledge of those I hope this answers your question.

Sweet, I'm an idiot... Yep now I can't even get what I mean right lol. Oh well. Moving on the the other part, that previous statement was awesome, both polite and informative. I've learned a lot here which will help greatly in my classes, as at times perhaps the NREMT's definition, the practical definition and the legal definition are different. While even on the paramedic exam (and lets be careful here, the NREMT is not kind on test discussion) ethical/legal is barely touched because it varies greatly, their definition is perhaps made so that a paramedic could understand it. (While I in no way advocate "dumbing down" things, it is common amongst many schools here, mainly because a majority of our paramedics care nothing about it and just want to fight fire.) If faced with a question involving assault vs. Battery in EMS on a test the answer is A=verbal B=physical. I would prefer to think think that the test reflected the correct answer, but this is apparently a misconception common in EMS. Perhaps another thread should be created with your very clear and precise (got it in the first post you did) definition of it, maybe we can fix this misunderstanding as I have heard it from many lectures and conferences.