NREMT-Basic

Having started the optional pre-course classes and seminars for paramedic school, I can now officially, after two years of basically holding the "Paramedics save lives and Basics save Paramedics" view of the world, I now stand here with my hat in my hand. I can now officially state that I am in the place of knowing what I do not know and lord oh, lord is there a lot of it and honestly it started with the extreme number of ways that a good, patent vein could be screwed up by an incompetent with a needle when time is of the essence and there is a shortage of all around skill and training in the box rolling down the road. After graduating from oranges to a number of very expensive IV access simu-aides, I have gained extraordinary new respect for those paramedics amongst us who can hit that bugger first time every time and am happy (though not yet experienced enough to be proud) that my first "live stick" (conducted on my instructor which increased my pucker factor to +100) was a success with a beautiful flash and a lovely, babbling brook-like flow. Once I remembered to take off the tourniquet. LOL. I couldnt figure out why the proctor was just staring at me. I got my flash and thought I was all good. Ooops! So to all those medics, nurses, and ER docs out there, some of whose experienced hands may be guiding me over the next 18 months, I say "I realize that, though I was a good Basic, what I was giving was stabilizing first aide and what I am now being taught to give is life saving medical care. I now know what I dont know and have also gone to the nebulous place of I dont know what I dont know. So be gentle with me. Each new procedure or algorhythm learned is a maiden voyage, as it were" The EMS stick of awakening has come down hard upon my shoulders and I am humbled when my instructor, who just retired after 30 years it the field as a medic, both military and civilian, can look at a 12-lead and say quite confidently and correctly "Well...there's your problem." I now also see why so many of my Basic friends (and I include myself at times in this) get excited over the lights and sirens cause a lot of us still hear William Shatner narrating even our most basic of BLS calls. I have also learned the difference between what to me used to seem an emergency an what I now know are the types of emergencies that should strike fear in the hearts of all who behold them and awe for those ALS responders who can not only bring order to that kind of chaos, but actually bring order which is compatible with life. It used to be enough to know "the breath goes in and out and the blood goes round and round." Now I see why so many of my paramedic friends have said "Yes, but can you see why its important to know WHY the breath is not going in and out when it fails to do so and WHERE the blood has ceased to go round and round when the body decides to go FUBAR." I will always be proud of the work that I have done and will continue to do as a Basic and will never be a Basic -basher. But after the last few weeks, I can truly say the real work has begun and I look forward to the day when I can bring order compatible with life to the chaos. After my first couple of ride alongs in medic school, I am also smart enough to know when to look to my medic proctor and say "I got nothin'" and know that I need assistance and to go home and study harder. I hope all the ALS providers out there will be willing to answer my plethora of questions over the next year and a half.

But...to add yet another wrench to the works, the National Standard curriculum of the DOT/NHTSA still uses EMT-Basic, EMT-Intermediate and EMT-Paramedic and EMT-Paramedic is what we use hear in IL an according to my friends and the IDPH, a lot of agencies are soon going to have to change their patches and emblems to reflect that they are all EMTs and then also reflect what "level" of EMT the responder is. Except of course for the MFR, who is, of course, at least in IL, not an EMT at all according to the law.

Not to mention that I know a certain EMT from the Pacific Northwest who used to frequent this forum and perhaps still does under yet another alias, that never got past Basic and even that licensure was dubious at best who always called himself a "medic" and when he got called on it said "the public doesnt know the difference anyway and thats what they call us all."

This dry-drowning business is something that I had not heard of until recently. In EMT school, I was taught about drowning and near drowning...that is to say death from drowning and death from near drowning with death from drowning being immediate and death from near drowning being a death from complications secondary to the inhalation of water and occurring 24 to 48 hours after the actual event. When I spoke about this with a medical examiner friend, she stated that they will list manner and cause of death variously for water related deaths. It can be listed as "Manner: Accidental---Cause:Drowning" or "Manner: Accidental---Cause: Injuries or Illness Secondary to Near Drowning Incident" or as specific as "Manner: Accidental---Cause:Complications Secondary to Aspiration Pneumonia." Oddly for some reason, my medic school syllabus has us studying environmental MOIs early on in the course so I will be interested to hear what the lifeguards from the Chicago area beaches that will be teaching us about drowning and water related MOIs will have to say in terms of how these are defined and differentiated. I had also heard that aspiration of "clear" water and aspiration of salt water caused different MOIs if anyone can speak to this. What I have been told is that the clear water fills up the lungs, broncioles, etc and air simply cannot enter the lungs and salt water essentially corodes these structures causing them to fail and is generally the cause of what was defined above (read as I was taught....) as near drowning. As I live in IL, I'm not likely to deal with salt water aspiration any time soon, but I wonder if chlorine in pool water can have similar reactions with the structures of the lungs causing similar complications. I also see that there has been some discussion in this thread about "swallowing" water and "inhaling" it. While I have heard the terms used interchangeabley ( as in when we used to vacation in the Land of 10,000 Lakes, we would hear that someone had "swallowed a lung-full of water). But to me the term "swallowing" anatomically speaking has to do with the act of taking something into the stomach and inhaling is taking something into the lungs. Obviously, if there is an epiglottal "malfunction" something can go where it isnt supposed to go. I also learned during a recent AHA CPR refresher that there seems to be a lot of confusion surrounding the term "choking" not in terms of how the AHA or other medical bodies define it (gonna run and look it up in Taber's) but in terms of people's (both lay and emergency responder) understanding of the exact mechanics of choking. Personally I was surprised at how many folks looked surprised in that recent class when the instructor said "if your patient is coughing or gasping, they are NOT choking." Everyone sort of looked like stunned dear on that one but it made perfect sense to me. I guess the best way to determine if it is actually happening is still to ask your patient "are you choking" cause Im thinking that pretty universally, if youre choking, you know it. I look forward to the emergency docs among us pontificating on this since, as a new medic student, I have had to become much more involved with all matters cardio-pulmonary than I ever did as a Basic.

Almost impossible since they generally want you to be a SWAT member first, which involves becoming a LEO on a department with a team. For most of us, tac-med courses are an expensive waste of time and there are lots of better ways to spend your EMS educations dollars, though few are as fun. I took a tac-med course knowing I would probably NEVEr use it in the field, but I learned stuff I can use and it was a good time. Plus now I am also proficient with a Mossberg 870, MP-5, MP-4, and Beretta 9mm as well as various chemical, contact and "distraction" less lethals.

That's because if you actually did research other than a 3 minute wiki quote, you would know that the bail bond system as well as bail enforcement agents have long been stricken from the books in IL. We dont use them here which is why there are no requirements since neither can operate within the state. A bail agent, while he may cross state lines to apprehend a skip, may not enter a state for the purposes of a fugitive recovery which does not have an operating bail bond system or allow the use of bail recovery agents or "bounty hunters" to recover those who skip bail.

Here in IL, if a person is refusing care but will not sign the refusal, the signatures of the medical responder and a LEO are considered sufficient along with an explanation of same in the run report.

Except for the fact that bail agents have (in most states where they are legally allowed to operate)the right to "break and enter" a residence in which they have a reasonable belief that their skip is residing. In laymen's terms, they can kick down a door and turn the place upside down to find their skip. You or I do that and we will find ourselves on the receiving end of multiple felony counts including home invasion. Also, bail agents are not bound by the same laws as law enforcement officers so comparing the two is apples and oranges. In many states, LEOs must take a defendant to ED if they have been sprayed with a chemical agent or tazed. Most bail agents are not required to do this.

Actually, they do affect a lawful arrest (assuming they follow the rules) since they are apprehending people on surety warrants which either automatically issue when the person fails to appear in court or are issued by a judge in the form of a bail revocation/bench warrant. And no. They are not bound by HIPAA since they are not health care professionals.

I am a huge Bates fan. I wear them all the time even when not working. I wear their 6", side zip with velcro to cover the zipper so it doesnt wear out the legs of my pants or get caught up on stuff. I've had the pair that I am wearing now for two years, they are amazingly water proof (working in the recently Mississippi flooding proved that) and have good BBP protection. Also, in two years of wearing them on almost every surface imaginable, the sole is just starting to show wear.

Peg- thanks for the kind words and best wishes right back at ya. We will have to stay in touch for periodic sanity checks. Like you, I also like the long programs. I think the boot camp styles should not be accredited in anyway as I have worked with some of the medics they produce and most of them can barely start a hydration line. Unlike some other aspects of life, faster does not mean better.

I was interested in this method of taking pressures and checked it with my ER doc friend. He is of the opinion that taking pressures on both arms simultaneously will throw off your readings and make them inaccurate. He also states that in his experience and due to anatomical variations (IE location of heart, etc) that left and right side BP readings will generally differ by about 10 points in the systolic. Also, in school, I have taken BPs over shirts, on bare arms and on the wrist and gotten the same readings and if there is one thing that I absolutely know that I took away from EMT school its how to get accurate BP's.

One of our local private agencies actually carries one of those things that usually say "CAUTION WET FLOOR" on them except it has the SOL on it and says "EMS CREW INSIDE---DO NOT MOVE" and its weighted heavily enough to hold open most doors. I also know of a particular crew that experienced exactly the scenario you are describing (minus the EDP) and they ended up having a state trooper force entry back into the building by breaking out the windows next to the door with his baton. One of the many reasons I prefer external walkway to internal egress hallway buildings.

Well...now I've gone and done it! I have finally taken COMPLETE leave of my senses and will start the 18 month paramedic school process the 2nd week of September. No... I don't know what moved me to such insanity either. Maybe I just decided that since I like to make snarky comments anyway, I may as well go ahead and become a paragod so that occassionally someone will agree with me. Wish me luck, send me your crib sheets and light a candle for my soul, if thats the way you roll. PS- I haven't been around for a very long time because my quality made Dell Inspiron 1100 overheated to the point where the hard drive/case actually split open and died and I have to go to the public library and wait in line for my two hours a day of computer time. It's now being used as a bookend.

Nice, comprehensive list. I'd read some things about Illinois also having the EMT-Coal Mine certification and even seen some sources that say we do have it, but the Illinois Dept of Public Health seems not to have heard of it. Of course, no matter what one asks the IDPH EMS Division, they refer you to the EMS Region you live in and here in IL my Region is run by one person whose qualification for the job of Regional EMS co-ordinator seems to be the ability to kiss the right butt. And we all know that state jobs are virtually impossible to lose...as an example, visit your local DMV