zippyRN

'field' experience should start before preceptorship UK (in fact all EU ) RNs have 2300 practice hours before they complete their pre-reg programme , our University Paramedic programmes follow a similar pattern i'd agree with that statement Higher Education qualifications are the thingswhich will make profession stand on it;s own and not be subordinate to Medince , the main problem of ccourse being that many in the US consider all health professions to be subordinate to medicne becasue ofthe disproportionate power vesting in the admitting specialist by the crazy messed way the USA fails to provide healthcare to much of it;s population

chicagoambo you are a muppet of the first order ... odd how everyone else on the left side of the pond bemoans the money that Nurses make over and above Ambulance staff, even those who have sold their arses to the dripstands ... odd how in all the other health jobs education = money and status odd how most of the rest of civilised world has either Helath Professional in their own right Paramedics (UK, Eire, Canada, Australia... even the Germans ) or Paramedics as Advanced practice Nurses (netherlands, Scandinavian countires)

Uk (non clinical ) Bachelors degrees are 3 years long so it breaks down into 'certificate' , 'diploma' and 'honours' levels a DipHE is 2/3rds of the content of a Bachelors - and in the case of Nursing DipHE it's actually 3 years long - 4600 hour programme 50/50 split between practice and theory the 'advanced' bit comes from doing 60 of the 12O honours/ level 3 credits in that programme (leaving a 20 credit module and 40 credit dissertation to do ) thanks for the googling dwayne

personally - 'advanced' DipHE Nursing Studies ( adult Nursing) ( the advanced bit is becasue you do some levle 3 stuff in the programme as well as the DipHE) BMedSci (hons) Nursing Studies I would certainly advocate DipHE / foundation degree level preparation for any Health Professional role - which is whatthe Uk is currently going towards with Paramedic programmes ... and along with it making sure that Paramedics are treated as proper health professionals with their onw scope, own powers to hold and adminster their meds and undertake the core set of invasive procedures

Ondansetron is off patent in the Uk now ... which bodes well for prices ... alf is even shorter lived though agree with your assessment of diclofenac as well - it's very good except IM when it;s evil - becasue it's 3ml of thick oily gloop

as has been said - check out local to you guidelines on event cover i could score it using the UK scoring system but it may be different to the systems in use where you are but as an off the cuff estimate for 40,000 people with cars, alchol ?camping and barbecuing i'd be looking at several ambulances on site , a couple of fixed treatment centres, possibly a mobile medical team (Emergencny med Higher specialist trainee or consultant doc, Senior A+E /Critical care Nurse , Paramedic or QAT as 'driver' ) and making sure there was decent fire cover on site ( i.e. real FFs and a proper appliance with rescue tools etc)

look at the UK system while not quite as extreme as that the Quallified Ambulance technician working for an NHS Ambulance service will have undertaken the following the training minimum six , usually 7 or 8 - 10 week clinical training, 3 week advanced and emergency driving course , other local training , a period of time working with a training supervisor and a year's probationary period with review by training officers and writeen assessments across the year. middle tier staff and staff working forthe volunteer agencies - who don't generally go to unselected Emergency Calls without additional training and supervisions again 5-6 weeks (equivalent) training - driving courses ( same 3 week course if doing emergency driving) and ongoing review by training officers even none emergency patient transport staff do 3 weeks training and a week's driving course ... UK paramedic preparation for practice is moving to Foundation Degree/ DipHE ( 2/3rds of a bachelors) level withi increasing numbers of bachelors programmes

the questions is do people pay 'significantly more' the UK health and social security 'tax' is called 'National Insurance' almost as a historical quirk now, but if you consider that money as an insurance premium then it is pretty good ... how much are people in the USA paying for health insurance with the following benefits - 'Free' Primary care consultations - 'Free' Specialist consultations - 'Free' Investigations - 'Free' Emergency Department treatment - 'Free' Emergency Ambulance treatment and transport, - 'Free' none emergency Ambulance transport if you meet the mobility / disability / vulnerability criteria - 'Free' emergency inpatient treatment - 'Free' elective inpatient treatment - subsidised dental care - free optical care for under for under 16 (19 if still in secondary education) and over 60s as well as free opthalomology services provided by medical opthalmologists ( as above) for all ... low 'co -pay' prescriptions (6.65 gbp / item regardless of prescribed number - 28 days / script is standard for chronic meds) for 16 -60 year olds and free prescriptions for under 16 (19 if still in secondary education) and over 60s plus the various time frames for investigation and treatment 14 and 62 day rules for cancer invesitgation and treatment and the 18 week rule coming in at present for treatment http://www.18weeks.nhs.uk/public/default.aspx replacing waiting time time tagets for referaal to consultation and consultation to treatment plus the various provisions within other social secuirtty benefits for meeting the costs of healthcare ( i.e. free prescriptions for people on low wages / recieving tax credits ) plus the contributory Social Security benefits Graduated Retirement Benefit; Incapacity Benefit; Job-seekers allowance (contributions based); Maternity Allowance; Retirement Pension (category A & ; Widowed mother's allowance; Widow's pension. Widow's payment. NIC rates http://www.hmrc.gov.uk/rates/nic.htm NI FAQ http://www.hmrc.gov.uk/faqs/nicqc1.htm wikipedia article http://en.wikipedia.org/wiki/National_insurance graph showing income taxand NI in relation to earnings http://en.wikipedia.org/wiki/Image:UK_Tax_%28percent%29.svg

RRV = 30 k gbp vehicle+ kit Ambulance = 50 -120 k gbp vehicle and kit ( depending on ALS/ BLS and coachbult or van body) Full sized fire appliance = 250k gbp upwards single man staff your RRV and you save further ... reduces the use of appliances and the 'cost per call' because the none Paramedic trumptons are standign around at the call tasked but not actually doing anything ...

simple answer ifthe traffic on a multi lane road with shoulders/ breakdown lane is really slow / stopped and your road traffic legislation allows you to use the shoulders/ breakdown lane as an EV then do so , but be careful and 60 mph is way too fast for that

happy now? :twisted: and this can't be achieved without creating another Health Profession? contrary to the picture painted by some on tUS -centric boards the NHS is very much into optimising the use of it;sbeds, firstly to keep an eye on costs - and secondly to reduce the average stay to sensible minima ( i.e. having people in the lowest safe acuity of bed ) the question has to be asked - why create another professional role instead of addressing the preparation for practice of others ? it quite often seems the US way is to create a new role rather than address the preparation for practice of other roles and each role likes to carve out it's niche of exclusivity and require others to be registered in that professional group as well if they dare to cross the line i nthe sand. UK health professional development is much more about common standards for skills regardless of who undertakes them and there is little exclusivity or ring fencing of roles

identifiable need for what? another person to bill for? i really don't see how diluting the care given can ever benefit someone - the best number of people to be responsible and accountable for the care of any individual is the minimum that can safely and effectively be achieved. I'm not quite sure what you mean here , especially given that the UK has Occupational Therapists, Radiographers and various flavours of clinical scientist recognised as Health Professionals odd then that Uk critical care and emergency care Nurses and our medical colleagues manage to drive our own ventilators quite effectively working as part of a team that doesn't include 'respiratory therapists' the competencies are more important than the collection of certificates and badges - the UK has a open scope of practice for all health Professional groups where expansion and extension of role in the most part is not reliant on gaining a further registerable qualification, and standardso f practice are profession and settign independent other than their other multiple health needs or is holistic care for the RRT just like holistic orthopaedics in that in might just include the other parts of the system... not in the past 20-25 years

yes - hence the comments about their use ... no , we manage quite well without a further dilution of patient care to yet another 'single function professional' , also don't forget the UK is very much anti ringfencing roles at present , and most descriptions i have seen of the RT role are tasks undertaken by nursing staff and/or physios in the uk context i'm not even sure these products are on the UK market, i'm almost certain they are not in NHS supply chain and i haven't heard of anyone clamouring for them to be added.

'flow and concentration are mutually exclusive depending on delivery devices ignore nasal cannulae for a moment as they are only really suitable for chronic disease management or patients who refuse a mask. you can have high flow low concetration O2 - venturi masks - even if 'overdriven' w still deliver the advertised Fio2 withina few percent... the volume of gas passing through a venturi mask often considerably exceeds 15 lpm the partial or none rebreathing mask does deliver a high FiO2 and is often over used vs a .50 or .60 venturi if you have them the prehospital management of COPD patients seems to be universally poor.

it's a gut feeling it's also situationally dependent I've had a 'simple fall' flown out before ... however the simple fall was off the top of an ice cream truck at the Moto GP just as the actual GP race was finishing ... so the guy was immobilised becasue of MoI ( fallen 10 ft backwards off the top of a van) and ?LoC ... normally load him up and take him the 10 ofr so miles down decent roads to one of the 2 nearer trauam recieving hospitals , however add 60,000 people trying to leave the circuit ... no brainer to get him flown no traffic jams in the skies equally there's a few events i've covered where when you finally get to the event you start looking for LZs and where the wires are just because of the fun you've had getting to the site ( e.g. med cover for a Quad manufacuturer launching his next year's range to the farming and motorcycling press - in a big field at the back of the 18 hole golf course at the back of a nice country house hotel in the sticks of rural West Yorkshire ( up towards Nyorkshire for the Uk folks) - a couple of miles fro mthe road to the site on loose surfaced autmunal tracks including some pretty steep hills and humps ( had to put the none patient carrying response vehicle into low range to get up a couple of them) fortunately no one fell off and a good day was had by all ...

perhaps a little more about those favourite fire fighter pastimes of polishing their helmets and poles ... what does that make them yes... you guessed

that is a departure from an internationally accepted standard of care, which is odd given it's also a potentially chargeable item as well ... i would suggest there are other routes to achieve larger peripheral access if you can get small peripheral access ( e.g. the filling of veins against a 'tourniquet' by placing a small line distally and the tourniquet proximally ... plus of course EJ lines etc...

NO - standards of practice and so on - if a patient recieving a central line in the Anaesthetic room gets full prep, then they do so in the ED and in the field ... also if radiological confirmation of placement is required in hospital how do yyou justify placement and use without confirmation of placement in the field when there are other valid options which have reduced risks of sepeis and pneumothorax... NO - Central lines do not provide faster / greater flow rates than well placed peripheral lines ( central lines don't feature in the alphabet soup fo courses for that very reason ) the placement of aproper central line is often the last action taken in the preparation of thecritical carepatient, long after the ABCs, placing a peripheral arterial line for IBP , urinary catherterisation and further imaging ... it is very rarefor any kindof emergent or urgent critical care transfer to go with a central line ine in situ but all with have peripheral arterial access for IBP as well as standard monitoring and ETCO2... i may have this wrong but it sounds lie some people are calling EJ IVs a central line

central lines - slow, require prep and sterile filed can't actually infuse a great deal move via a centrla line than you could with a nice big 14 or 16 in the ACF or EJ Adult IO is a bit of evidence desert as has been suggested but given the tools now on the market for IO placement in adults i suspect it will be a lot quicker than a central ine unless 'central line' in USAn EMS terms isn't a central line in UK Emergency Medicine / critical care medicine terms

250 ml stat of 10 % has the same amount of glucose as 50 ml of 50% - into a good 16 or 18 g cannula how long does it take to give 250ml of a not that viscous fluid? not that long I know some places in the Uk are using 20% as well as or instead of 10 or 50 %

first line treatment for a diabetic with an intact gag reflex is oral glucose ... unless of course you are in a position to bill for 'ALS' services where every patient must recive the obligatory IV line... then of course is the issue of 1. IV cannula / insertion technique related complications (infection, thromobphlebitis , nerve damage, risk of vascular structure damage) 2. the side effects of 50% dextrose ( e.g. risks of extravasation and local reactions to this highly hypertonic solution 3. the fact that you've messed up a big vein for days to weeks even if there are no problems hierarchy of interventions - oral sugars, then carbs and consider discharge at scene - Glucagon IM , then oral sugars then carbs , consider transport - IV glucose and transport

and lost their place in the queue being re list on the time of their return attendance

utter grot " we could get here quicker than it would take to do it on scene " is always an excuse for not doing somethign in thefield - as long as you genuinely mean it ...

depends how many vehicles you have on days vs nights, also the second vehicle doesn't have to be an Ambulance , does it?

off duty kit ? personally i carry the same kit in my car as i use when doing EMS stuff becasue it's 'my' kit - most if not all the consumables are supplied by one or other employing agency but the bag itself and the durable items are mine ... not i nthe car - gloves and cheap face shield in the zip bit of my wallet - another couple of pairs of gloves a pocket mask and some ambulance dressings in the daysack that mrs zippy is prone to referring to as a 'man's handbag ' ( there's also pens, filofax, scrap paper, tourniquet , cheat cards for the ER systems, can of pop etc in there ) stopping when off duty? a judgement call - if someone is obviously in distress and there's little or no help, i'll stop and see if i can assist - if there's obviously more casualties than resources again i'll stop if it;s safe to do so and speak to the OiC on scene and offer assistance ( occasionally this does result in 2 + hours on scene and a nice letter to my boss - like when mrs zippy and i stopped at an RTC on a rural road in derbyshire where there were 3 casualties 2 ambulances and a 'unknown' ETA on the 3rd ambulance - a diecision which the oiC appreciated when they decidied the van driver had to by moved to a Helo LZ ASAP - no way of getting the helo to scene , being at the bottom of a wooded valley where hte road and the river ran along the bottom - meaning rapid chopping up of van by the fire serivce and out and loded and away ... leaving one ambulance on scene with 2 people trapped (relative entrapment) in the other vehicle ... gave the OiC the opprtunity to be able to stand back and do OiC things rather than be hands on with the 2nd casualty. the 'rules' for stopping off duty 1. don't stop unless it's safe enough to do so ... 2. if the locals are on scene - ask if they would like the help and be prepared to be told no ... if the locals aren't on scene make sure they are on the way - or if you are in a fully equipped ambulance - talk to the powers that be for the locals ... 3. be guided by the locals OiC and be prepared to hand over the scene on the arrival of the locals 4. restrict your own off duty equipment to that you will be supported in using by yout employer and/or your professional duty of care / practice guidelines ( if you are a Health Professional in your own right) 5. respect usual professional boundaries - which means if you aren't dressed / equipped to stay withdraw gracefully ( e.g. thinking aobut stopping at RTCs here and whether you have suitable PPE once the firebods get started ... respect the locals authority when it comes to performing advanced interventions - there is no point in tryign to acquire a set of government bracelets... be judged by 12 rather than carried by 6