zippyRN

probably based on the volume they sell while it seems some people are wedded to doses that i'd consider ' won't touch the sides' like 2 mg being the total dose rather than the initial bolus .. and others will use 10 mg and titrate .. which might leave 4mg out in the cold volume wise as the actual cost ofthe drug is probably small compared to the cost of the prefilled device like a carpuject ...

speaking of multiplexed control systems , this is the kind of thing most kit in the Uk is being fitted with http://www.carnationdesigns.co.uk/18way.html or the very similar Woodway optilink http://www.woodwayengineering.co.uk/top.html ( click on control ) now i'm not suggesting you should even consider the two above ( unless Whelen will support the opti-link as Woodway is the UK Whelen main agent/ type approved assembler) but multiplex doesn't mean pain in the ass - also could some of the touch screen systems not be installed/ programmed with custom 'frontpages' which replicate the functions of something like an optilink with big clear 'respond' 'scene' 'leave scene' 'arrive' 'clear' etc 'buttons' as cost is all ways an issue you might not go with touch screens but it doesn't mean that multiplexed isn't an option if you chosen builder can provide you with a simple® control panel or 2 for the cab and saloon and door-way repeater panels for lights / steps / ramps and panic alarm. I know I mentioned livery in my first post but people have been quite since - how much 'passive' warning via livery does your existing vehicle have and would you be open to looking at a livery with more passive warning capability. Even if it were just chevrons to the rear rather than the whole battenburg cake deal increasingly common in Europe ?

do you know what the actual price, as in cost to produce, of morphine is ? well under a dollar ( US, Loonie or Upside Down it doesn't matter) for a 10 mg ampoule ...

Has a certain person being praising the Army (TA) and Johnner Nurses of his acquaintance ... and their flexibility , willingness to do transfers and their all round rugged charms ! Has the same person been praising the relationship between the ED and the Ambulance staff at his previous place of work as well ? ECP ( Emergency Care Practitioner) works the biggest boundary in the UK has been the obsession with the A8 response time which lead to ECPs being used as overpaid responders ( to the point I know of people who voluntarily 'demoted' themselves back to an ambulance line as a band 5) or alternatively being BONGOs as the sector controllers were too busy playing catch up on the A8 target to think aobut deploying the ECP to ECP able calls

Emergency Care Assistant roles, especially the band 3 roles were a management bloody nose to the 'uppity' Techs who thought they should get band 5 pay same as a paramedic, in a few services they did get band 5 e.g. the London EMT4 role and the Yorkshire AS 'TWAT' role ... it was done to prove a point and for a cash saving Band 4 Assistant practitoners is another cash saving idea, they are what techs 'should' have banded at and what some services banded their techs at- their job evaluation score is kept down by removing the creep of extra decision making that got techs into band 5. Overall the UK is now closer to a Paramedic on every Emergency Ambulance than it ever was before because of 2 main factors 1. more direct recruitment to planned out 'Student Paramedic' pathways i.e. where there is a 'course' in place from the beginning rather than sending people on a tech course + driving and then saying you have to keep applying for para courses as they come up ... 2. ECAs and APs to backfill techs being abstracted to attend Paramedic training ( whether that's 'quick and dirty' IHCD courses or seconded out to HE based Diploma/ foundation degree), as this was one of the issuesi nthe past with releasing people for Paramedic courses.

an NG or OG tube on anyone intubated is great idea esp. if they've been ventilated with pharyngeal or no adjunct - this is one of the things which hacks me off slightly about those Anaesthetists or Resus Officers who oppose supra glottic airways on hospital crash trolleys - it's not instead of the anaesthetist dropping an ET when they are there it's stop the ward staff and/or the medical SHO from distending the patient's belly in the initial stages ... an NGtube on an a patient with bloated , belly from gas or gastric stasis who is distressed because of it is a good measure, randomly putting NG tubes down any surgical patient is ritualised care and doesn't take account of the damage you can do with an NG tube rarely indicated vs charcoal in recent ingestion and very very risky if performed on the unanaesthetised patient alternatively the issues of anaesthetising the patient and the risks and resource implications that brings ...

Dwayne and Bieber have posted a lot of relevant and spot on stuff here there are a number of things you need to address 1. what is the purpose of your placement, are there specific competencies to be signed off ? 2. do you have a named mentor / preceptor for the placement ? is this a requirement for the programme ? are you routinely working with your named mentor? 3. what 'extra' do you want to learn from your placement Don't over think the medic- nurse issue in the 'getting in the way' issue, having a student of any profession can be a real pain in the behind for the mentor ... especially if you are relatively limited in what you can be set off to do with reduced supervision - when you've got 'senior' students or supernumerary preceptees the student can be an effective 'force multiplier' but if you aren't in a position to do that you can 'slow things down' and if the pressure is on workload wise it;s unsuprising you feel 'in the way' another thought with respect to the OPs personal situation - is it common for people where you are to go straight from EMT class to paramedic class without Any ride time ? if this is rare then you might find that it's harder work for your mentors as they aren't used to this ... All my new crewmates in my EMS role are all experienced Events first aiders and/or community first responders so have got a certain level of skills in various areas of practice and it's more about shifting up a gear thinking like crew and adding in the extra decision making and psychomotor skills rather than looking at the whole package from rookie status ...

firstly congratulations on your appointment potentially with the relatively wide open spec you've got you could innovate depending on the willingness of the organisation and the flexibility of the suppliers livery ( i.e. passive high visibility), moving and handling , crashworthiness ...

not a lot to add to the above three posters except, i find IFT and Doctor's urgents (admissions) to be a wonderful training ground for breaking new crews in, far better than events or doing low priority emergency calls where the patient walks on and walks off

as others have said consider it a Hazmat scene , and that the patients need decontamination before transport .... which means a proper decontamination set up - which means either activating your equivalent to HART or that Fire respond if they do decon at scene. the recieving hospital needs to be informed in case they want to decon again before the patient comes into the department, you and the vehicle may also need decon - decon at hospital is a valid option for the crew.

they and the employing ageny are vicariously liable anyway, what you actually need is increased accountability of the providers in the field to a professional regulator i.e. 'proper' Health Professional Status the whole ALS/BLS split thing is peculiarly USAn way of thinking especially as you point out that EMT-Bs have so little preparation for practice odd then that elsewhere in the World , paramedics ARE Health Professionals and earn the same or more than the 'Bedside' Registered Nurse ( for Same example the UK where both jobs start at AfC band 5 , for same or more the Dutch -Scandinavian model where the 'Paramedic' is an Nurse practitioner something which has been in existence in Europe as a 'voluntary' but effective compulsory CEN Standard for 10 or more years ( though not with airbags in the salloon as far as i am aware) , along with better manual handling practice as well yep agree with that - again effective health and Safety / employment law should make that a complete no-brainer symptom of driver training ( or lack thereof ?) and the way in which some localities have their driving licence structured , if you make ambulances vocational licences either specifically or by weight / mass and then require proper driver training , not just a 16 hour classroom course ... effective skills audit through field based assessment by properly prepared Team educators and lectuer practitioners ? why ? especially given that polo shirts are an increasing staple in Emergency services uniforms around the globe ... now if you said 'stop looking like plastic policemen ' with shiny badges and arms full of boy scout badges .... 2 main issues one easily solvable one much harder without a backlash 1. resolve or minimise cultural bias in recruiting and retaining , 2. changing viewpoints among populations both inside and outside the profession, as has bee nseen with certain south asian ethnicities and Nursing i nthe UK - if the members and leaders of the ethnic group consider the role to be 'below' members of the group as it is dirty or demeaning - then they can't expect to see the profession matching proportions in the wider community ... part of the problem is the fragmentation and too smallness of the services - this is apparent in many US fire services and EMS services where the service is stand alone around a relatively small centre of population rather than serving populations of millions and areas approaching State sized ...

occasionally floated in the UK but never seems to happen, sometimes Hospital Resuscitation ( training and audit) Officers are Paramedics and they will come to crash call in the hospital or trauma calls in the ED and work as part of the team if needed other ROs are Nurses or ODPs and do exactly the same. some ECP schemes rotated ECPs of whatever background through Comms, on the road and ED / minor injuries units

as the sums from in hospital arrests show ... I think i'm doing well with a 66% ROSC and 33% 6 month survival on my last couple of years of in hospital Cardiac arrests ( make it 75% and 50% if you include the guy who never quite made it to peri-arrest thanks to my my colleague and a switched on locum Doc... and us spotting his hyperkalaaemia and low Mg... ROsc from pre-hospital arrests generally relies on the first 3 links of the chain of survival being in place and being there in seconds to minutes ... which is why the figures in hospital can seem good as drop to shock in all the places i've worked has been routinely 30-90 seconds

the easiest way to make a Small Fortune from Ambulance Operations is to begin with a Big Fortune ...

A key question in curriculum design is the clinical placement structure and the duration of of the course , placement and didactic phases From the UK perspective a Pre-Registration Nursing Course must have 4600 program hours split 50/50 between didactic and clinical and a minimum academic content of a level 5 award (Diploma of Higher Education = 2/3s of a Bachelors degree) although there are plenty of 'advanced diploma', Degree even Masters pre-reg programmes as well as graduate entry Postgrad Diploma. The College of Paramedics recommends a minimum placement experience of 1500 hours for paramedic pre-reg programs and the HPC currently accepts 'equivalent to' Level 4 academically - which is the 'traditional' IHCD course , most of the University based courses are level 5 ( either Diploma of HE or Foundation Degree) are level 6 Bachelors degrees. None Medical Health professional courses in the UK nearly always include aspects of 'early patient contact' as do a lot, but not all, Medical Degrees, which some of the proposals outlined above seem to ignore ... i'd be interested in the rationales people have against early clinical exposure or whether this exposure would be there in the courses in the modules suggested just not as specific units of study until later in the course.

and to truely mess things up I'd been doing Command roles at events before I was crew qualified - and doing 'command support' roles since I was a teen.

that's a 'cash equivalent' transaction at the end of the day ... the issue with pay before ride is as has been pointed out 1. A crew deciding something is minor and it actually being serious , regardless of whether the person travels or not 2. creates a fear of activating the service for calls that are serious incase people are charged 3. public disquiet over what is an isn't considered 'life threatening' i.e. indigestion in an over 35 year old - could be an MI .... and should be getting a 'free' ride' where a broken arm might not be getting a ride especially in an area where BLS has no analgesia options

I'm with Kiwi and Dartmouth Dave on this ... in that we've got someone with 2 lots of depressants on board ( the Booze and Morphine) and a I doubt the Gabapentin is helping either, who is likely to be acidotic because of what's happened and what he's got on board ( the Aspirin) . the Glucose stuff definitely bears consideration as well. HBEMT - DTs ? from an opiate - especially in acute overdose I'm not sure where you are coming from if you mean DT as in delirum tremens or other withdrawl symptoms ... or do you mean DTs as in something else

because the CoC does have the cojones to run Op. Minimise ? despite the opsec and persec risks to uncontrolled use of phones with out of theatre IMEIs .... the Logical Fallacy is that sexual orientation has the slightest bit of relevance to effectiveness in doing a job. It is those who support baseless discrimination that need to address their issues rather than the standard for the USA ad hominem of calling anyone who isn't somewhere to the right of Attila the Hun a Communist . At the end of the day the people with the problem about this are those who cannot or will not see beyond arbitrary descriptions and place a lesser value on human life because of these arbitrary descriptions... Plenty of Militaries have abandoned these arbitrary restrictions recognising that banning gays or DADT is; 1. pointless because sexual orientation has no impact on the ability to do a job there's not even the 'provable' physiological factors that can be used to justify sexist or racist policies... 2. a PERSEC risk which increases the risks because of covert behaviour or the threat of blackmail.

AOL (me too!) Zippy RN

so you support the imposition of arbitrary requirements based on the bigoted ideas of others ? straight or gay vanilla or kinky makes no difference to combat effectiveness ... and how many dedicated and competent soldiers/ sailors/airmen were disciplinary discharged for nothing more than a pathetic excuse? the only people who are 'distracted' by this issue is people who are gay or bi but won't admit it themselves, it's complete none issue for for people who are secure in their orientation or secure that questioning your orientation is Ok ...

'public facing ' anything where you deal with the public e.g. working in a shop , running a stall at a fair or fete , reception duties at school ... stuff where you have to deal with strangers ...

Excellent extra information there Kyle - this makes it easier to give you more advice. You need to make sure who you are crewed up with is aware of what you need and what you want to get out of your placement and what you need to be signed off on, don't run before you can walk though , what (if any ) experience in patient care and /or public facing roles do you already have ? Underdawg's post is good and there's a thread looking at it from the other side at the minute as well, ok it's called precepting new 'medics' but a lot of the principles apply regardless of the level the new person / student on placement is at. http://www.emtcity.com/index.php/topic/19280-precepting-new-medics/page__p__251090

you really haven't got a clue have you ... as for mixed showers ... well there's a few tales that could be told ... the land of the free as long as 'free' is bigoted and sexually repressed it appears ...

lots and lots of good ideas in this thread there is not a lot I can add extra, I'd echo what Dwayne and paramaximus have said about respect and treating your preceptee as an equal and peer - because after all once they are signed off that is exactly what they will be. there are 2 reasons to intervene in another practitioner's care 1. they are going to harm the patient. 2. they are going to harm themselves or another member of the team. personally i'm a fan of 'hot debriefs' and getting the preceptee to relate the rationales for treatment decisions while it;sstill nice and fresh , but without turning it into the Spanish inquistion