zippyRN

is it required for the data set ... in narratives it's one of the things that has become ritualised , and given the lack of education of the average EMS provider it's unsuprising that ritual and drills predominate, ( even without fire monkey involvement- and we all know how the trumpton loves their drillz)

but that is also a case of do the training = play with the kit it's only like the paeds retrieval services who employ their own clinicians

an AREMT 'qualification' is not going to get you a job in a NHS ambulance service or be recognised by St John Ambulance or the British Red Cross, it's not going to get you HPC paramedic registration ... and whether it is acceptable for private work as an EMT will be down to the CQC when they assess the provider organistion.

the problem is in some places, the statutory service simply see themselves as 'above' other providers doesn't matter - see above not all services dispatch on the basis of declared levels of skill of the crew , if response time is the primary metric and there is not penalty for not sending an ALS unit - they'll send anything - hence the phenomena in some places of 8 hour courses for 'community first responders' because the response target can be met by a monkey with an aed strapped to it i doubt there is , what there is in many services in the Uk at least ( and i suspect elsewhere) a protocol that says if you aren't trained to manage it you can't transport a patient with it - hence the reason hospital staff are needed on transfers etc ... see above i'd agree with that Bernhard

are you recognised as a Paramedic under the relevant legislation ? does AREMT 'registration' actually provide a licence to practice ... alternatively does your Nursing registration allow you to independently administer the medication you administered ? whether that's via a Independent prescriber status or by virtue of patient group directives authorised by the State Service or by your employer and acknoweldged by the state service. if you were to pm me your name , dob and location or registration PIN would I be able to verify your registration(s) ? if you want to play silly buggers over organisations - go boil your head mate, it killed ambulance999.co.uk and I don't want to see EMTcity dragged down the same route there has been questions previously raised over the legitmacy of AREMT , especially when they started suggesting to people outside Aus that 'their' qualifications could be used to gain certifcation / registration with other Countries Professional regulators you want to play Nursing pissing contests, EMT city is not the place to do it there are plenty of US RN+Paramedics / PHRNs / Flight Nurses and a generous sprinkling of other RNs from various countires who work in pre-hospital care including iirc at least one 'Dutch Paramedic' aka a Nurse Practitioner in pre-hospital care due to the way their system works , myself i'm an RN I don't claim to be Paramedic or imply that i can do Paramedic only procedures...

not yet, but each organisation offering it has to be HPC approved rather than the fact it's IHCD being good enough, this is where some of the issues with courses delivered outside the UK comes from, aside from the issues that HPCSA have with students not on a SA course practicing in in SA.

there's big questions about whether the Paramedic courses Ronin run are HPC eligible as discussed above ..

i'd agree with that flab is 'springy' Oedema even if not barn door pitting oedema will take a little while to settle ...

the question that has to be asked is why are people going to the ED from Doctor's Offices or Urgent Care ?minor Injuries rather than direct to the relevant speciality bed base or via an Acute Assessment unit ... ? - obviously the need for resus room care negates this argument again as symptom of the none joined up (not a )system ?

biggest problem is that certainly UK PTS with a month's first aid, AED, oxygen administration, communication skills, and patient handling training and a driving course are actually better/ more comprehensively trained ( although they may have fewer shiny toys) than the minimal requirements of EMT-B ...

There have been numerous previous discussions regarding Entonox use on EMT city, sadly where it's been in a general analgesia topic, the topic disappears off in to 'narcotic panic' ... Entonox if used appropriately is extremely effective , so effective I have seen a quite a few dislocations spontaneously reduce under Entonox alone , it's also extremely effective when applying splintage etc ... it's extremely widespread in use in the UK have a look at the BOC site http://entonox.co.uk/en/index.shtml

point missed here, the fact is his university aren't required to contribute to his medical bills - any more than any other employee ( via the employers NI contribution and the usual pay roll functions related to income tax and employees NI), I do however believe that his Personal Assistant (carer) is employed by the university , equally Frank Williams ( he's a C6 tetraplegic follwing an RTC) PA is employed by Williams F1 - but many people directly employ their PAs - and i know people with carer PAs who run small to medium businesses who employ their PA through that payroll... Certain ill-informed 'Conservatives' suggested that the NHS would have killed off Hawking becauae of the so called 'Death Panels' the fact is Prof Hawking like the vast majority of UK residents doesn't have to pay out of his/her own pocket twice for health care... that's the point Prof Hawking just like any other legal UK resident isn't waiting weeks to access primary care and doesn't get held for days in the ED if admitted as an emergency , because quite simply it doesn't happen - legal UK residents have 24/7/365 access to NHS funded primary care and if they are admitted to hospital as amatter of clinical urgency they will not be held for days in the ED waiting for a bed as a 12 hour bed wait is a Serious incident which triggers a review lead by region and reported to the highest levels .. becasue quite simply the USA is deluding itself over the quality and equity of access to health care.

ah the myth of mass international Health Tourism into the USA for procedures ... and how often is the Queue jumping or cosmetic ? please take your McCarhty award and then sit down and shut the fornication up about 'socialised medicine' as though it is is some great communist plot , because after all the 'Death Panels' in the 'socialist' NHS killed Prof. Stephen Hawking ... http://blogs.telegraph.co.uk/news/jamesdelingpole/100006517/stephen-hawking-not-killed-by-the-nhs/ http://www.telegraph.co.uk/news/worldnews/northamerica/usa/6017878/Stephen-Hawking-I-would-not-be-alive-without-the-NHS.html http://hopisen.wordpress.com/2009/08/11/stephen-hawking-not-killed-by-nhs-yet/ http://www.spectator.co.uk/alexmassie/5255761/stephen-hawking-has-not-yet-been-murdered-by-the-nhs.thtml the USA has possibly the worst healthcare for a country which considers itself 'civilised' , odd how most of Western Europe , Canada, Aus and NZ comes out better in nearly every objective measure of performance other than ' how quickly can you get something done by paying cash', ' let's take so much blood for testing the patient will need a transfusion ' and ' let's irradiate people for the fun of it '...

the problem is none of this is about REFUSALS it's in fact aobut APPROPRIATE CARE OUTCOMES. one of the reasons Health insurance is expensive inthe USA (aside from the admin bloat) is the way in which it encourages the status quo and unnecessary consumption of resources to meet some fantasy 'standard of care' promoted by lawyers and fee for service providers ...

resourcing patterns would change, look at 'front loaded' systems, there iss a different skill mix and fleet mix , primarily because in the FLM - the practitioner in the response vehicle is not automatically backed up apart from certain types of job, s/he is empowered on the basis of clinical findings to prioritise any further resources not only by skill level but also by time -frame , there is also no presumption of transport as the default outcome of ALL calls. A similar picture is being played out with the Fire Service in the UK where the traditional one response ( of 2 multi crewed rescue pumps in urban areas and one going and one standing to in the sticks)to everything ) is being challenged by the fact that a significant number of the fires reported during the early evening or all day in the school holidays are nuisance fires, often on waste ground and not involving premises, vehicles or technical rescue / extrication - meaning that the valuable resource of the multi crewed rescue pump is tied up using an extinguisher or at most a hundred litres of water from the HP reel on a bin fire or a unattended bonfire ... is there any evidence to suggest that avoidable patient deaths are a regular occurence in systems which don't transport everything ?

hate to break it to you, we can re-direct from triage to other services ( usually out of hours primary care) and discharge from triage if there is no requirement to see another practitioner ( no need for legislation to prevent WALLET-ABC) ... oh yeah, that's because I work in an evil socialised system where everyone has access to primary care, Registered Nurses and (Health Professional) Paramedics are trusted to use their knowledge, skills and experience as Practitioners and Doctors don't get paid per item of service.

So you advocate being a taxi driver over using professional, education, knowledge and skills to direct your practice and determine what (if any )interventions you need to perform and what advice and information you give your patients? let's swap the LP12 for a AED and a taximeter ...

hate to break it to you but the role of the Professional Emergency Care Provider is to direct people to the most appropriate means of meeting their care needs , whether it's telling them to go to Wally-World for 20 p box of paracetamol or calling in helimed to fly them to a tertiary centre - via every outcome in between, the key variable is knowing what outcome when and documenting the decision process and differential findings that led you to that outcome. while Ambulance services are glorified taxi services , ambulance crew will be paid as taxi drivers. buit it isn't in vast trtacts of the civilised world nothing to do with lawyers and everything to do with poor clinical management and poor preparation for clinical practice, the legal aspects are as a result of that and of the'mother may i' system rather than Paramedics being Health Professionals in their own right ...

and someone with bad constipation / bordering on impaction often has a hyper-resonant abdo due to gas trapped in the bowels ...

was the amputee on anything other than opiates for pain ? as his stump pain may well be neuropathic in nature ?

http://www.hpc-uk.org/landing/?id=7 is the link to the HPC page for applications for registration.

richard's post sums it all up, great to have you back

most EMS personnel who haven't worked as Nurses or HCA /CNAs would get their backside handed to them on a plate to work as a floor nurse and that's before even considering the technical skills they don't have... Unions seem to be another thing where the USA has taken a perfectly good system and messed it up, no doubt helped by the fact that the US retains closed shop practices with regard to unions,

except of course when the KE transferred from the hitting vehicle flips you over ...

is there a US equivalent of NCAP ? http://www.euroncap.com/Content-Web-Article/a09ae60e-8ee4-4e3e-b784-d7e07a1c1168/euro-ncaps-best-performing-cars-of-2010.aspx something like a BMW 5 series or Volvo V70 or XC 90 may in fact be safer than a truck ...