Niftymedi911

Wow, I must of not really read it through enough last night until now........ I simply cannot help but think..... do the medics in the field now really want this? Accorrding to Wake's PP, they're taking the intubation, the advanced pharmacology, and the more advanced and infrequent skills and placing them under the APP. For one thing, if they're rarely used as it is (infrequen skills) how the heck will the APP be able to perform better then a road medic? And if you say well better training.... well why not provide the better training and QA/QI training necessary to maintain those skills to your entire department.... instead of re-inventing the wheel, removing certain items off the trucks, and placing them under a new job classification? (oh your kidding me, that would just make toooooooo much sense) It's funny how everything comes back to education aint it? I simply can't help but feel they're "progressive" medical director can't trust a road medic to accomplish their task, when placed under pressure to perform. It's more of a CYA thing then anything else. And if your going to degrade the skill set of a Paramedic because you don't trust them and placed them under an APP, why bother having "regular" medics? Mentorship, smentorship...... it's smoke and mirrors. Example: You respond unknown distress, upon scene secure you find a 48 y/o/m not awake with agonal respirations, posteuring, and an intact gag reflex. You notice multiple blunt force tramua areas to the head and neck and you obiviously need to be able to intubate the patient. <10 min on scene time and you really need to be able to perform the skills enroute. But in a case like this, your APP with RSI capabilities is 14 minutes out and your approx 12 min from the trauma center. How good is that APP program working for you now??? What benefits will this patient have, now that the APP is the only one who is able to DAI/RSI?? Didly squat, because you only had a BLS airway and during transport he aspirates because he starts vomiting...... yea, ummm no I'm not living in Wake County anytime soon. In my book any program that has loop holes where majority of the patient's that fall through the cracks end up having a negative outcome, are nothing but a ticking time bomb. APP's have their place like as outlined in MD's and Urgent care centers, but not in EMS. UM, I was not attacking your credentials so please don't take offense. A mere generalization was used to shine a light on the subject. There are numerous people who have extensive amounts of training and experience. But, on the flip side there are also an extremely large amount of people who have "Joe the plumbers" medic mill certificate that have no formal education. Which is where I was trying to address.

UM, when you stated that EMS or the paramedic cirriculum has the opportunity to progress or advance. If given the current situation with educational shortfalls, why focusing on advancing, when the most focus should be placed on standardizing the current system nation wide and fixing the broken wheel that EMS has become. Essentially, the roles you are describing UM are the Physcian's Assistant cirriculum. I don't agree with a more advanced Paramedic, simply because, lets face it, if we're having trouble promoting higher educational standards for all (In the EMS world), what makes you think that this new cert or educational standard won't end up falling suseptable to the rest of the EMS cirriculums down falls? However, I completely agree with a PA specializing in EMS, to perform the minor variety of calls (and major too) the currently help offset the downfall EMS has become. Simple sutures, simple scripts, simple tx's that can be performed in the field and won't require transport are the immediate benefits. Long term..... financially, for less medical malpractice suits, a higher EMS satisfactory rating with the public, and overall better public education on the risks and benefits of EMS. I also if this was implemented would like to see the new smaller sized (portable) lab machine be utilized with this feature. That way the patient wont even need to step inside a hospital to obtain simple and lipid blood draws. Thus providing a very wide spectrum of not only life or death treatments, but also providing those non-emergent services, where an ambulance would normally be tied to a non-emergent transport, thus decreasing unit availability, increase in response times, and increase in practioner skill degradation and complacency. I really think before we start to try and advance our cirriculum now, we need to fix it. There are too many problems associated with the lack of education in this field. Creating a new more "advanced" cirriculum would be like putting a band-aid on a close proximity shotgun wound. As Dust said, We don't need to re-invent the wheel

1 mg of Ativan should do the trick

True, but we're not the majority we're the minority. It doesn't take a rocket scientist to confirm that someone is currently licensed to practice medicine.

Ruff, that would make too much sense.... a thing that a majority of people here lack.

I was gonna post this..... but you beat me to it!!!!

I've got only one word to say.... "Sparky". I joined this profession to be challenged. I can't take sitting a a desk job doing paperwork. I'm all for good challenging calls and also having a "break" a good mixture of the two as not to get complacent. This day in age it's extremely rare to find.

Almost all scene calls I've had to call for Medstar (our own flight program) they've been "hot" LZ's. There was only one time when they did shut it down......during an arrest which he was also having an MI and the closest hospital that could treat him was 8 minutes by air and approx 30-40 minutes by ground. He went into arrest twice after the chopper had landed. We finally got him back and loaded into the chopper. He stayed with a perfusing rhytym til they got to the hospital. We're not allowed to approach the helicopter unless instructed to do by flight personel. They have two medics sometimes three. We really don't go near the helicopter unless they need help in loading them into the chopper. We approach from the side, wait for the wave from flight personel, approach to the rear, load and walk straight out from the side away from the helicopter. We don't go to the right of the helicopter when lifting, flight personel do. We stay to the left as not to have to go around the stretcher near the rear blade for safety reasons. Helmets and ear protection are worn at all times.

I'm not quiet sure..... although it would make sense to cover all basis, I guess maybe to check for cardiac involvement with ischemia in the leads due to the hypovolemia in the leads?

That's certainly an FLB

Richard, here in Lee County, Fla. LeeWay (Lee County Transportation Authority) issues the "LeeWay Passes" which are equal to the "Sunpass" in the rest of the state. There are four tolled bridges in Lee county. Cape Coral Bridge, MidPoint Bridge, Boca Grande Brdg (privately owned by the Gasparilla Island Transit Authority) and the Sanibel Causeway. The CC brdg has tolls for westbound traffic heading into CC. The toll is $2.00. There is no toll coming from CC eastbound. The Midpoint brdg has tolls coming westbound from Fort Myers into CC. No tolls going eastbound. Toll: $2.00. The Sanibel Causeway is a network of three brdgs that span the mouth of the Caloosahattchee River when it enters into the Gulf of Mexico. That is also only tolled westbound heading towards Sanibel and is not tolled coming off the island. Toll is $6.00. The GITA, tolls $5.00 for coming onto the island but not off. All county vehicles, beit PD, Sheriff's Office, EMS, FD, have a Sun Pass installed in the windshield for tolls. County Employees do not pay out of pocket while in county vehices. However, when anyone is in their POV. Reguardless of circumstance, you must pay out of pocket. LeeWay bills the county agency responsible for the device and that comes out of their operating budget or account they have set up. It really sucks the most when you work Sanibel (Medic 5) for a month and have to go over the brdg every 3rd day and have to shell out the $6.00 each trip just to get to work.

That picture is funny (above)...... I don't care who you are...... (well, not for the EMT injured, but that picture is really worth a thousand words). Not to mention.... We pay better then SunStar and have recently hired a few people from there who jumped ship. Anyway, as many times before I've stated and twice on this forum post already, Lee County or Lake/Sumter or your best bet. Both pay great salary, benefits and are 9-1-1 ALS certified. Lake/Sumter is a collaboration effort between two coutnies and Lee County is a 3rd service County Based EMS service. I currently work for Lee County and I really do enjoy it. PM me if you would like more info.... or just search the forums for Lee County posts........

Good Luck with finding a decent place in Fla. Just keep in mind... If you don't want to be fire certified.... think north.... of Naples..... meaning Lee County EMS. Edison State College is a nationally recognized AS- EMS Tech. program. I just went through the program in '07-'08 and finished and I really recieved a decent education from there. And if you want to be FFII cert..... good luck with that too! It's almost season and majority of FD's and EMS agencies down here are gearing up for it. Your bound to find something good around here...... (I hope).

I've been watching Colier's progress...... the only thing bout here, is the FD's do not have enough balls or data to justify them having ALS transport. The only department that tried was laughed out of the county comissioner's meeting and completely denied by Lee BOCC. We're actually re-couping close to 70% of all the money that the comissioner's spend on us. Not to mention we pull in more and more grants for the county, which brings in the total grand amount of about 15% the county actually has to shell out for ouor operating budget. There is no reason for the county to get rid of us. We're making money for them. The market currently is obiviously in pain. If they we're to go Metro, they'd lose the money the county's gaining by keeping EMS and Fire seperate. The county does however, want all the FD's to become Lee County FD. Thus being able to take control over the individual tax dollars the departments have control over. Lee County EMS will be Lee County EMS well into the future. There are safeguards in place with County Ordinaces in place to keep it that way. Not to mention, we also do all of the transfers for Lee Memorial Health System which generates even more money. And our Aeromedical program pays for itself and some of the 9-1-1 operating budget. The FD's tout duplications of services, but what they don't realize is the plain fact, that whenever we go to compeitions and other FD's from the county compete with us they usually finish last. (Lehigh) We placed 5th out of 47 teams in July. They're skills and comptencies are unmatched to ours displayed by our service. If and when it all comes down to budgetary means, we win hands down. All the FD's here in the county can't afford to become transport and even then, they need permission from Lee BOCC and Lee County EMS to transport. And they will not get an ok ever from Lee County EMS. And if they think they can tout response times, we're 91% <8:59 for the year 2008. BRING IT!!!!

Agreed... I don't really know why the powers the be decided to go with IAFF. But for us it's working. And besides.... according to IAFF by-laws....... a union brother cannot take the place of another union brother's job..... So by that, they can't have FD take us over...... or more law suits will ensue.

ASA 81 mg Tablets Albuterol Atropine Adenosine 6 / 12 Ativan (Lorazepam) Bendaryl (Diphenhydramine) Cardizem (Ditilazem) Amiodarone (Cordarone) D50 / D25 Diprivan (Propofol) Dopamine (Pre-mix) DuoNeb (Albuterol/Ipatroprium Bromide) Epi 1;10,000 / 1;1,000 Etomidate (Amidate) Fentanyl Glucagon Heparin Integrilin Lasix Levophed Lidocaine Mag Sulfate Morphine Sulfate Narcan NTG Drip (Tridil) NTG Spray Phenergan Parlidoxamine (2-PAM) Sodium Bi-Carb Sol-u-Medrol Succinylcholine Thiamine Valium Versed Vassopressin

What I was trying to say was thre was 30 employee's that sued the county in federal court for the wages that were owed. These same employees and case led to the formation of our union in 1997 after the back pay was awarded to the employees. The union was formed to prevent anything like the sort from happening again. So, that's where I stand. And yes, Lee County is a busy system, but to be honest there is only 4 or 5 trucks that actually run enough calls to consider breaking it up into 12 hr shifts. Majority of the trucks run from 4-8 calls in a 24 hr period. The busiest run 10-20 calls a 24 hr period. I'm perfectly happy with 24 hr shifts.

Reaper, I, like LetMeSleep also work for a 3rd Service County based EMS service that does 9-1-1/IFT's/ and Critical Care and no FD. The state of Florida is a right to work state.... meaning u could be fired without due cause. Our IAFF union was founded in 1997 based on the fact that Admin was not paying OT to the road crews. Well, the newly formed union fought it and thus became our IAFF union. Since then, we've gone from 12 hr system status to a 24/48 work schedule with stations, better equipment, better pay and benefits, not to mention representing you when admin swings the ax..... The policies and procedures that the Union has insituted since it's inception in 1997 here are priceless. They allow us to be the better organization it is today. Administration has also come a long way, both our local and admin collabrately work together on issues that are important. They handle things in a manner that should be a model for all. We're close to 85% union and out 370 employees that's an accomplishment. Yes, our union dues are pricey, but the price offsets the value that we get out of it. Everyone has their own opinion and are entitled to it. So Reaper, if u choose no union then ur entitled to that choice. I just know for me I chose my union. Have a nice day!

LOL...... Technically..... Snow Birds......... And one of them is an extremely good friend of mine..... he's from Quebec.

We've got a couple Canadians working for us. eh?

My dream job is where I'm currently working.... 4 yrs of service as of November. I would also like to work for Austin -Travis County and Wake County. Lee County Public Safety Division of Emergency Medical Services EMT-B / Paramedic / CCEMT-P Highest paid 3rd service EMS system in the State of Florida. EMT's start @ 44k/yr and Medics start @ 53k/yr 37 Truck ALS 9-1-1 Division // ALS / BLS IFT divison // Critical Care Division (2 Helo's and a Critical Care Truck) Advanced, Pro-active, Agressive Guidelines 99% off-line directives (only need to call for orders if you would like to administer more of a drug that u've axed out on based on protocol) provide a true freedom to practice medicine. Tridil Drips, CAM (Crash Airway Management), EMT-B IV's and administering Beta agonist updrafts, a wide range of drugs including Ativan and Fentanyl, and coming soon an advanced induced hypothermia not only for ROSC pt's but also Traumatic head injuries. The area's most agressive training department with monthly in-services with specialists, paid training and CEU's, and a full-time Clinical Educator to further the education and knowledge base of the paramedics and EMT's. In the works is a combined Regional EMS training facility for all of Lee Counties First Responders. Stryker Power Pro's, Zoll M Series with 12 lead, NIBP, SPO2, ETCO2, IVAC pumps, CareVents, ResQPod's, Image Trend e-PCR program Proactive Public Education and Envolvement www.lee-ems.com/ems/default.htm

GYD= Graveyard Dead

I say its Rid

Thanks a bunch guys!!!!! It's been kinda of a weird day. After I passed my test and I went to work. Have had nothing but two non-emergent neuro patients so far. Dammit, I want something better......

I'm now offically a FL state certified Paramedic..... Passed with a 91% and finished in 55 minutes!!!!!! Woohoo!!!