HOW MANY CERTS DOES YOUR STATE RECOGNIZE

[ks_emt]

well here in kansas we have a few different cert levels.

First responder

EMT-Basic

EMT-Intermediate

EMT-Defibrillation

EMT-I/D Intermediate/Defibrillation

Emergency Mobile Itensive Care Technician

then we also have different training levels which are.

Training Officer 1

Training Officer 2

Instructor/Coordinator

[Dustdevil]

It is amazing that the state of Maryland still views itself as a "leader" in EMS based on "advances" made about 35 years ago. If I hear one more time that Dr. Cowley is the "father" of shock trauma I think my head will explode, just like in Dustdevil's infamous picture!

LOL! Good point!

Being a "father" is meaningless in any real sense. Not all "fathers" are good fathers.

And because Cowley was from Maryland does not make the State of Maryland the perpetual heir apparent to the throne of EMS innovation.

LA County is considered by many to be the "father" of paramedic systems. However, nobody in their right mind would ever consider today's LA County paramedic system to be in any sort of position of leadership in American EMS.

The Wright Brothers may have been the first to fly (yes, I know this is disputed, so spare me), but that does not mean that their relatives -- and the state of North Carolina as a whole -- will forever remain the state-of-the-art authorities on powered flight. My dad was a rocket scientist for NASA, and I don't recall him ever consulting the Wright Brothers' relatives or the Governor of North Carolina for advice. Similarly, if Maryland want's to hold claim to this "Father of Shock Trauma" laurel, they need to do something to earn it, not just usurp it from the thirty year-old disproven work of somebody else.

[CBEMT]

Backasswards Northeastern state which shall remain nameless.

EMT-A(mbulance)- No longer issued. The original basic level before the NREMT, phased out in 1995. Anyone who still has an A license keeps the designation but refreshes with a DOT standard EMT-B refresher course.

EMT-B(asic)- NREMT certification for licensure, DOT standard refresher to maintain. NREMT maintenance not required.

EMT-I(intermediate)- No longer issued. Phased out in the early 80's I think. Skill set, as I've been told, was IV access and Epi 1:10,000. Like the EMT-A, anyone with an I license maintains the designation but refreshes with the DOT standard EMT-B course. Very rare to find someone with an I license that didn't either drop down to EMT-A or step up to EMT-C. I only know one myself.

EMT-D(efibrillation)- optional skill level for As or Bs. Consists solely of VF/VT rhythm recognition and manual defibrillation of pulseless VF/VT, as opposed to auto or semi-auto AED deployment. Uncommon but they are out there.

EMT-C(ardiac)- created under pressure from cities and towns who wanted to be able to claim ALS services to their community but didn't want to pay for paramedic school or have to wait for the personnel to finish. Pretty much the standard level of care, results in very, very few BLS emergency responses due to how widespread they are. IV (no EJ), manual defib (no pacing), cardioversion, oral ETI, 30 meds including narcs. May initiate Dopamine and Lidocaine drips with MC, may transport if already established. BLS refresher plus 24 additional state-designed hours. May initiate Dopamine and Lidocaine drips with MC, may transport if already established.

EMT-P(aramedic)- NREMT-P for initial licensure, must maintain it as well. Standard Paramedic skills up to and including pacing, NG/OG, nasal ETI, central lines, needle/surgical cric, etc. Several meds and infusions on standing order that EMT-Cs must make MC contact for (Dope, Lido, Amiodarone, etc). May transport Heparin/NTG/etc drips without a nurse after an additional IV pump/anticoag training class after licensure (pretty much required by your employer if you work for a commercial service. Without a pump card you're basically no better than a Cardiac to management, depending where you work).

Screwed up for the moment, but I think there's a light at the end of the tunnel. I wouldn't be surprised if EMT-D is the next to go, and the remaining A's and I's are coming up to retirement age. I figure EMT-C has another 10-15 years of life left before the state grows a pair, cuts the cord, and grandfathers whoever's left. That'll be a hell of a battle though- you'll see the fire unions combine forces with their city and town governments to fight that one aaaaaall the way.

I am, however, starting to notice a trend of people getting their C licenses, practicing for a couple of years, and then going medic, usually while working for a commercial service. Typical career paths here are Basic--->Cardiac--->Fire Department, Basic-->Cardiac-->RN/PA, or Basic/Cardiac-->Paramedic-->leave the state/work out of state.

[Rescue0ne]

I would think that a "shock trauma" guru would keep up to date on the latest trauma trends. Like Rid stated, Dr. Bledsoe's article should open eyes to that Golden Hour myth as well as taking the latest PHTLS class with the 6th edition, which also discusses that there is no golden hour rule any longer, only the "platinum ten".

Maaaaaaannnnnnn...

I'm no Shock Trauma Guru, nor did I make that pit-stop of EMT-ST. I'm merely stating what I remember about UMaryland's ST Center, and Dr. Cowley in particular. I never met the man, just read alot about him at the time (and this was years ago). I'm very familiar with Dr. Bledsoe's Myths of EMS, and he's right on target (imo). I think my first EMS textbook was authored/co-authored by him. Remember, it's been years.

In keeping with the thread topic, EMT-ST is being phased out now in VA...only to be replaced with "EMT-Enhanced". It's basically the same thing, imo. It doesn't really even make sense to have it, because even the least funded volunteer agencies in VA can find a way to send their providers to EMT-I class.

[emtd29]

New York (upstate at least)

CFR- Certified First Responder - Cannot transport - the only time we have one is when a 17 yo gets permission to join the squad and plans to upgrade to EMT when they turn 18. Some of the surrounding villages have First Responder Units.

EMT - Basic - our squad doesn't have any, see below

EMT - D - Basic Defib - Tioga County requires an AHA CPR/AED Cert. at Healthcare Provider level

EMT - I - our squad has only one of these, grandfathered in (Hell, he is a Grandfather!)

EMT - CC - Critical Care - Almost all of the skills of a P with less phys and pharm training

EMT - P

NY doesn't use the NR, but the tests are derived from it. If you choose to take the NR test they recognize the NY skills test and give you credit for it.

EMT-D is no longer recognized by NY since defib (AED) is taught as part of the basic curriculum Anyone that still has a EMT-D card ( if there's still any out there )will recert as an EMT-Basic

Also NASSAU and SUFFOLK counties do not recognize EMT - Intermediate ( as well as NYC someone correct me if I'm wrong ) Individuals with such certs are ONLY allowed to function as EMT - BASIC

[UMSTUDENT]

Whoa your Highness ! Maybe, your not aware that the "Golden Hour" is a myth!..just like responses should be in < than 8 minutes! Another traditional hand me down medical myth from one generation to another that has no scientific basis! The "hour" has been researched do death and can not be proven

I highly suggest you read Dr. Bledsoe's article in this months JEMS ..."The first peak of deaths occurs within minutes of the event. Approximately 50% of trauma deaths are in this group The second peak occurs in the first few hours after injury. The third peak accounts for 20% of trauma deaths. It occurs within a few days after injury, with death often resulting sepsis and end organ failure"... As well EMS does very little in treatment and decrease in outcomes.

Narrative quote mine: Bledsoe,B.: "Have We Set the Bar Too High?";JEMS 116

Please, if one wants to refer to being a "Shock" specialist, then one needs to really understand shock physiology and the expectations and treatment as well outcomes. Look beyond the "paramedic manual" and read some true studies of trauma. I suggest:

Lerner, ED. Moscati,R: "The Golden Hour Scientific Fact or Medical Urban Legend? " Academic Emergency Medicine 8(7):758-760,201

Trunkey,DD: "Trauma", Scientific American 249:28-35, 1983

We need to come to reality folks, so much of what we do and think is CRAP! It has never been challenged scientifically and we are finding out a lot is a bunch of B.S. ! Many of what we presume is just ideas (good intentions or for research grant money) that was pushed through and immediately was accepted, because we in EMS are undereducated to challenge such. What a shame to our system. profession and more so to our patients!

R/r 911

It is amazing that the state of Maryland still views itself as a "leader" in EMS based on "advances" made about 35 years ago. If I hear one more time that Dr. Cowley is the "father" of shock trauma I think my head will explode, just like in Dustdevil's infamous picture!

I've spent the majority of my life in Maryland, and love it like anyone loves "home". My Dad was a Medic in Baltimore City through the 60's and 70's, when all these advances were occuring. Actually, I think the highest certification then was Cardiac Rescue Technician. Take note that Maryland still utilizes this cert.

Maryland has some of the richest counties in the nation, several large metropolitan areas, surrounds our nations Capitol - yet remains mostly volunteer, using archaic certifications, and touting its world-famous University of Maryland Shock-Trauma Center and its 35 year old history. The "kingdom" hasn't changed much there in a long, long time. Rather than leadership, it seems to me that Maryland is a glaring example of what is wrong in EMS today, holding the profession back from true advancement.

I know - way off topic, but I had to get this rant out of my system. But all the best threads evolve, right?

I have problems taking too much advice from someone who has had their share of problems! I know you understand what I'm talking about...

Regardless, if you know anything about Dr. Cowley you would know that the Golden Hour principal was purely political. Cowely himself didn’t purport that there was any specific scientific time where shock began to become irreversible, but it sure as heck was a good number to throw out to the governor and the people of Maryland. Who cares if it is an hour, an hour and twenty minutes, or three hours? The fact is simple: Quick, efficient transport of trauma patients with good prehospital care en route saves lives! To his credit, he developed the first, and still to this day, only state agency solely dedicated to EMS. Modern treatment of trauma patients is based on Cowley's revolutionary ideas and much of this nation's current methodology on trauma management still comes out of U of MD. Just because Texas and the Midwest have Baylor doesn't make it any better or worst. I would suggest reading the book Shocktrauma if you’d like to know the real story.

While it is true that Maryland EMS is fairly archaic in protocol, I would not say it is a state overrun with volunteers. As one of the richest states in the US, it has some of the most well developed, most highly funded paid municipal and county systems in the entire country. Prince George's, Montgomery, Howard, and Baltimore Counties all have fully paid fire/EMS systems. Do they have volunteer stations? Yes, but they're really only there to allow the local community to interact with the fire departments. They DO NOT rely on them! These counties constitute over 80% of the state's population...easy. Many other, more rural counties have paid components that are more heavily supplemented with volunteer staff.

Also, Maryland has the only comprehensive medevac system in the nation. 8 helicopters from 8 geographically located bases provide over 9,000 transports a year via the air to the state's 9 trauma centers. That is fairly good for such a small state.

[Dustdevil]

Also, Maryland has the only comprehensive medevac system in the nation. 8 helicopters from 8 geographically located bases provide over 9,000 transports a year via the air to the state's 9 trauma centers. That is fairly good for such a small state.

I suppose that might sound impressive to somebody who has been living in a cave for the last four years, and was unaware that the necessity, utility, and safety of helicopter EMS has been as thoroughly trashed as the so-called "Golden Hour."

It's about as meaninful as saying, "Sure, we pay the highest taxes in the country, but we sure have some pretty parks!"

[UMSTUDENT]

I suppose that might sound impressive to somebody who has been living in a cave for the last four years, and was unaware that the necessity, utility, and safety of helicopter EMS has been as thoroughly trashed as the so-called "Golden Hour."

It's about as meaninful as saying, "Sure, we pay the highest taxes in the country, but we sure have some pretty parks!"

I would agree Dust had it not been trashed by someone who has rallied behind a country full of EMS providers desperately trying to understand "scientific-based medicine." 80% or more of EMS providers wouldn't know how to even begin analytically looking over one of his articles, let alone how to properly verify the sources.

Mr. Bledsoe has NEVER himself done any legitimate research on the utility or usefulness of air medical helicopters. A simple literature review in one or two peer reviewed journals is simply that...a literature review! He draws broad conclusions based on some loosely related articles and facts. Do I agree with him on certain points? Yes. I believe that in most areas helicopters are used at an alarming rate, unnecessarily. Does this happen in Maryland? Sometimes. I think you'll find that in most states this is a problem because of the, and I quote, "hidden dragon which is competition." In Maryland, we have a state supported system. SYSCOM and the individual pilots make flight decisions, not managers looking at the bottom dollar. Oh, and Shock Trauma has an alarming save rate...over 96% of the trauma patients who arrive walk out the doors. That's what happens when you have a state sponsored, tax payer supported, primary adult trauma center solely devoted to treating and researching the disease of injury.

Don't get me wrong, I agree with the guy on a lot of stuff, but I don't think he's absolutely correct on every issue.

I didn't say the Golden Hour was a sound scientific principal. I don't necessarily agree with using air medical services at every drop of the hat either. I think Bledsoe's conclusions are valid to some extent, but to make broad sweeping generalities about an entire industry that is DRASTICALLY different from one part of the country to the next is fairly short sighted too.

[Dustdevil]

In Maryland, we have a state supported system. SYSCOM and the individual pilots make flight decisions, not managers looking at the bottom dollar. Oh, and Shock Trauma has an alarming save rate...over 96% of the trauma patients who arrive walk out the doors. That's what happens when you have a state sponsored, tax payer supported, primary adult trauma center solely devoted to treating and researching the disease of injury.

Okay, so where is YOUR scientific evidence that any of those 96 percent actually survived because of the helicopter ride?

Hell, I've never had a patient die on me in a basic transfer ambulance. Maybe we should let basic transfer ambulances run all EMS.

[UMSTUDENT]

Okay, so where is YOUR scientific evidence that any of those 96 percent actually survived because of the helicopter ride?

Hell, I've never had a patient die on me in a basic transfer ambulance. Maybe we should let basic transfer ambulances run all EMS.

There is no scientific evidence to my knowledge which would point to the helicopter being the reason these people survive. I would be more inclined to believe that it has everything to do with how the system works as a whole; a fluid machine developed over years to deliver rapid and effective trauma care.

If you know anything about the topography, population density, and economics of the DC/MD/VA area then you'd at least understand that the helicopters probably do have a great deal to do with the survival rate. Traffic here is horrendous. I've worked in areas around Baltimore and DC where even though you may be 5-7 miles from the nearest trauma center, the transport with lights and sirens may take 30 minutes or more during peak rush hour(s). The western parts of the state have level 3 trauma centers that certainly are not equipped, IMHO, to handle complex trauma issues. Transport to Shock Trauma from there would be over 1 hour by ground on a good day.

In every way it appears that the people who fly walk out alive. To the people of Maryland, and to many people around the world, Baltimore may very well be the medical capital of the world. You don't look at every hospital to have the same capabilities as the next. Here, people take into account the skill and atmosphere of the medical community that will be treating them.

For instance, we fly these patients too:

Hand injuries go to the National Hand Center at Union Memorial Hospital.

Pediatric Trauma Patients go to Johns Hopkins Pediatric Trauma Center or Children's Hospital in DC

CO poisoning, Nitrogen Narcosis, etc go to Shock Trauma for their multiplace hyperbarics chamber.

Burns go to Johns Hopkins Bayview Hospital.

Eye Injuries go to the Johns Hopkins Wilmer Eye Institute

We don't mess around here sending patients to unqualified doctors. People want specialist and honestly, if it means the difference between a favorable and unfavorable outcome, then the money is worth it.