saboats

The theory about this is simple; we inhale approx 21% (20.89) O2, when we exhale we expel a mix gas containing approx 16% O2. Now remember that this is in a normal living, breathing, digesting, full metabolism churning ALIVE person. So it would make sense to think that in a non-breathing, not digesting, no alive person that the 02 uptake at the cellular level may decrease, so say the "dead" exhale 17-18% 02. This means that we use approx. 5% of the 02 inhaled Alive, the theory is if we are only using 5% per breath cycle, then there is plenty of 02 still in the bloodstream if you are not breathing for sometime. I'm not saying that I either agree / disagree with this theory or method of CPR since I have not read any studies on it (they are out there, I just haven't ventured there yet). However, since there are plenty of studies proving that we over ventilate patients, and not allow for full chest recoil decrease return of blood to the heart (negative pressure) I'm curious to what studys of 100 /2 ect may show...

Is it right: I think still open to interpretation. Is it legal: I don't see anything illegal about it as long as you can back it up with some sort of formal training or evaluation eg. testing. I can not think of anything illegal; unless you jurisdiction specifically does not allow it.

Just to throw this out there, as it appears timely... This months JEMS has an article in it about EMS Chiefs, and (in the writer words) why they are valuable in many areas vs titles of Director, Operations Manager, President, ect. Interesting read..... JPINFV: If you location is correct, you work somewhere in the Boston Area, and unless that's for Boston EMS, means you work for on the many private forprofit services in the area...Doesn't matter which one, and I'm not disparaging anyone there, used to be there myself, but in those companies it seems that people are promoted via the buddy system, through attrition, or simple time in service - not through education, mentoring programs, testing ect... So if that's your experience I can totally see where you are coming from. But in the municipal industry, rank structure is important - expecially when divvying up tax payer money at budget time and competing with Fire and PD for the ever shrinking public safety funds....

minimum ANSI2 for Vests, and ANSI3 for outerwear if not wearing a vest....

I see what you were getting at, and I agree it's not the same in a scenario as you state it. And it's soon to be a dead issue anyway with the Final Draft 1.0 of the National Standards being out today. In NH EMT-I(85) is a minimum 80 hour program, - (that's how low you can go!) A lot depends on your states rules and laws regarding initial training programs. Many follow the standards, e.g. if the NHTSA DOT Standards state a minimum of 120hours to complete, then the state requires 120 minimum. I don't think I want to open up the issue that an person in <200hours of training can become an EMT-I here, start IV's, initiate advanced airways, give medications ect ect, but the Wal-Mart training for new hires is 3 weeks to work a register (120 hours); but I digress....

Not that I really want to disagree.... But..... The I/99 curriculum IS word for word the old paramedic curriculum. The fact that many institutions had 700 hours (many back then including clinical hours) for a course that was listed at 400-500 and using that as the basis for saying that they weren't the same is non sequitur . When the 1998 (Current) Paramedic Curriculum was published and placed into practice, the DOT standard EMT-I was the EMT-I (85). After the change to the medic program, a decision was made to use the old paramedic curriculum, and in 1999 was released as the revised Intermediate Curriculum. After many states bucked this change the old I(85) was kept and states used whichever program they choice. However - due to this change in 1999, many states wrote there own Intermediate Curriculums and don't follow either the I85 or the I99. If you still have the DOT National Standards from back then lying around somewhere, and the current I99 standard, take a look. They are practically identical.

I agree you need some kind of structure in any agency, this can vary depending on size, organization, or affiliation. I don't know if paramilitary style structure is the best way or not. Lead me to the question; is EMS public health, public safety, a hybrid of both? This is why I am in this conundrum: #1: Public Safety; means PUBLIC or municipal. Good Pay, Benefits, Retirement on par with you FD/ PD types. #2: Public Health: Safety and Wellness. Promoting the public good, welfare checks, vaccination clinics, BP clinics, ect. #3: Hybrid: All of the Above. Good Pay and Advancement, Retirement as well as all those things in #2... Now, all " Public Safety" is in some sort of paramilitary system. It works, Police Officers in most places patrol alone, yet there is still a Sgt. or Lt around and a Chief in the station. (to ask about the 2 people on-scene, no need for rank comments). We, as EMS are always looking for better pay, better training, more respect, etc. FD/PD types have got this down. EMS is fragmented with Public, Private, Hospital Based systems, low pay and an overall lack of respect in general. Maybe public safety is the way to go. Municipal agency on-par with our cohorts in Fire and Police. Same pay structure, same benefits. Just a thought..... Any opinions?? DISCLAIMER: I currently hold rank in a Municipal EMS Agency, so my opinions my be influenced. But I worked in the private and hospital based world for many years, so I see both sides....

The Interstates are fine, the town roads are pretty well maintained. I ride my bike through the mountains during "leaf peeper season" every fall without much trouble!

LOL: except in New Hampshire, Still have no Seat Belt Law, only state in the Union, and therefore no Federal Highway Funds coming under that law already!!! Live Free [s:e20f6d2732]or[/s:e20f6d2732] And Die!

Didn't know that... but here's a question, how many paramedics out there have been practicing since 1999 or earlier? The reason for the question; if you were registered prior to 2000 as a paramedic, who have the same training, same curriculum, same level of initial education as all the EMT-I/99's out there. The EMT-I/99 is the "old" Paramedic Curriculum. There was nothing changed in that NSC when it was "demoted" the the I level. Now I'm not saying that you/we haven't increased our knowledge and training in the years since the curriculum change, but all those EMT-I/99's coming out of training now are being taught the same things you/we all were taught back in the day..... Interesting huh???

I 100% agree. I wasn't even broaching the subject of a need to increase education. I was actually having that debate with a former employee while I was writing my last post! It is not about skills, when I mentioned thing like permissive hypothermia in post arrest it was all about education. RSI isn't a "skill" IMHO ; it's a tool, that NEEDS to have A LOT of initial and ONGOING education/ QA/QI. 100% agree, education 1st, "skills" second... But isn't even an 80hour intro class (eg CCEMTP) more "education" and therefore a good thing?? PS; to the last post who stated you can bill CC / SCT if a CCEMTP was onboard, not really, unless you enjoy a CMS aduit. There needs to be interventions performed / continued that are above the scope of practice for a "street" paramedic. Simply having you there to give say a Lido IVI doesn't cut it....

Yes.. you are right about the ALS2 vs SCT Billing at most companies, and the lack of training most in charge of these services actually receive on this. As far as FP-C, VS CCEMTP: Both have CME requirnments after initial testing to remained "certified" by them. If you don't complete the required critical care con-ed for either, then you need to take the test again to retain the certification. As far as which test is harder, that's a matter of opinion. Some people found the FP-C test easier then the CCEMTP test and vice versa. I personally didn't find the CCEMTP test all that difficult, but I studied my arse off for it. FP-C, flight phyisiology kicked my arse - the critical care stuff is pretty much the same. I personally have no vested interest in either exam, and I won't advicate for 1 vs the other. The CICP also I've heard is a butt buster (out of the Cleavland Clinic) but I haven't had the pleasure. As far as "being challanged for state credientals if you use NREMTP" ; i had never been asked, excepted when OEMS was at the base doing inspections, and that state required you to carry your card at all times while on-duty. That state didn't even recognize the NREMT at any level and most of us wore our "gold patch" every day, in the state capital.... Again, I think that we as EMS practicioners have bigger fish to fry then this, and maybe we should be discussion permissive hypothermia in post arrest, or hypertonic saline in head injury, RSI, or thrombolytics for STEMI ect ect ect.....

If you look at the current CMS Fee Schedule Rules Specialty care transport (SCT) means; interfacility transportation of a critically injured or ill beneficiary by a ground ambulance vehicle, including medically necessary supplies and services, at a level of service beyond the scope of the EMT–Paramedic. SCT is necessary when a beneficiary’s condition requires ongoing care that must be furnished by one or more health professionals in an appropriate specialty area, for example, nursing, emergency medicine, respiratory care, cardiovascular care, or a paramedic with additional training. The SCT rate is intended for Transport, not 911 care. Those who have stated that the CCEMTP/ CICP does nothing to increase how you treat patients, in actuality this is true if you are providing 911 services only. The field of CCT is an arm of EMS, but knowing about ECMO or balloon pumps or VADS probably will not change your treatment of a 911 patient. These again, or specialty care transports, and a standard 911 ambulance is not staffed or equipped to make these runs. Now, as far as people using NREMTP vs CCEMTP after there names; really what's the big deal. The NREMT is not a LICENSING BOARD, or ACCREDITING AGENCY nor does it grant you permission to do anything anywhere. It is a TESTING AGENCY that certifies a CANDIDATE has met MINIMUM COMPETENCY in their field. It is up to individual states to Certify / License providers to render care. True many states have direct licensure with the NREMT; (eg. all you need is the gold patch and the state gives you a license to practice), some have their own test, whatever. But if you look at the basics of the argument here about using CCEMTP, then that argument would hold about NREMTP. I hold an NREMTP card, and 3 different State EMT-P Licenses / Certifications. If I would hold to this argument, then I should use NH EMT-P, or MA-EMT-P, or simply EMT-P, and withhold the NREMTP because it means nothing! Obviously I don't agree with this interpretation; and truly don't we have bigger fish to fry?!? But I digress, the real point of this post was SCT Rates; they are for transport, you should not bundle ALS2 with SCT as they are different rates, you can still use mileage, your GAF or RAF if applicable.

Who restricts you? Your employer? Ethical Concerns? State Boards? IS Dr. Bledsoe wrong when he has D.O., NREMT-P after his name if he is appearing as a physician? I'm playing kind of devils advocate here I know, but I know plently of Flight RN's who badges say: RN/EMT or RN/EMTP, (FP-C/ RRT also). So is this a standard in your area, or are you stating that this is a national standard? Again, devils advocate here, but if I'm typing it, many are wondering......IMHO