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About paramedicmike

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  • Occupation Pragmatist, Resident Cynic

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  • Gender Male

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paramedicmike's Activity

  1. paramedicmike added an answer to a question question   

    Here's the thing.  Appearance matters.  Image matters.  It's important.  It always has been.  It always will be.  This is true for all cultures, subcultures and underground movements.
    Dress for success.  Dress and present yourself for the the job you want... not the job you have.  It is better, in a business or interview setting, to be over dressed than under dressed.  Image and appearance is what people notice first.  Want to be taken seriously?  Then present yourself in such a way so as to give others a reason to take you seriously.
    Employers are free to put whatever kind of restrictions they want on their employees.  No tobacco policies, no drug policies, no visible tattoo policies and more are all well within the rights of employers to enact.  These policies are not a violation of anyone's individual rights.  Employers are free to present an image that makes their customers take them seriously.  If that means no tats, no facial hair, no <fill in the blank> then it isn't a matter of the employer being unreasonable.  Rather, it's more a matter of how badly the potential or current employee wants to work there.
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  2. paramedicmike added a post in a topic Capnography   

    Gotta agree with this.  While we are moving towards more quantifiable measures of the care we provide, and being asked to provide documentation to verify that care, there are still simple physical exam findings that can and will demonstrate that interventions we're performing are working.
    Treat the patient not the number.  If you have a number to additionally verify your interventions then use it.  It will benefit, and may protect, you in the long run.  But don't rely on nothing else except for the number.  None of these things are independent of the other.  It is all a part of the patient care package.
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  3. paramedicmike added an answer to a question question   

    Why say something when it's not the idea you're really trying to convey?
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  4. paramedicmike added a post in a topic Capnography   

    Oh, I don't know.  I think not ventilating and letting the patient die is far, far worse than ventilating without end tidal.  At least then you can wind up with a live patient and a potentially correctable blood gas.
    Ideally, yes.  We would do everything perfectly in every instance.  Ideally, yes.  We would have ETCO2 hooked up every single time we have to manage a patient's airway.  Don't think for a second that I'm arguing not using it whenever possible.  However, we work with what we have.  We all know, especially in EMS, that this is a very uncontrolled environment.  Inconsistent minute volumes and a live patient is far better than a zero minute volume and a dead patient. 
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  5. paramedicmike added a post in a topic ...   

    -.. .. -..     -.-- --- ..-     .... . .- .-.     .- -... --- ..- -     - .... .     .- -. - . -. -. .- .     .-- . -.. -.. .. -. --. ··--··         - .... .     -.-. . .-. . -- --- -. -.--     .-- .- ... -. ·----· -     -- ..- -.-. .... ·-·-·-         - .... .     .-. . -.-. . .--. - .. --- -. ··--··         - .... .     .-. . -.-. . .--. - .. --- -.     .-- .- ...     ..-. .- -. - .- ... - .. -.-. -·-·--
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  6. paramedicmike added an answer to a question question   

    A well prepared EMT student should have college level anatomy and physiology, math and writing/composition classes under his/her belt.  Bonus points for history, psychology and sociology classes will be earned once you start dealing with patients. 
    Hairstyle, grooming standards and personal hygiene requirements can vary from employer to employer.  If you want to work for a specific organization that has grooming and physical appearance standards as a condition of employment be prepared to cut your hair. 
    edit: double period fixed
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  7. paramedicmike added a post in a topic For those who advocate Community EMS   

    Interestingly enough I was one of two paramedics in my PA school class.  We had a few EMTs, one RT.  The traditional applicant used to be a military medic/corpsman.  That evolved into EMS providers.  Today, however, it's lots of younger folks with limited life experience.
    I would love to see US EMS education mirror some of the educational programs in other countries.  PAs with a solid EMS background would be ideally suited for community EMS programs as well as more critical care based programs (e.g. ground or air critical care transport).  Unfortunately, that's not something we'll be getting anytime soon.
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  8. paramedicmike added a post in a topic For those who advocate Community EMS   

    If appropriately staffed with a PA/NP level provider it'll be no different than people going to the ER for the same things they'd otherwise call 911.  If staffed simply with a paramedic or EMT crew then there could be problems.
    In the ER there are more resources for referral available than what EMS providers have on the street.  Put an appropriately educated provider into these types of community programs with the resources that s/he would have available in the ER, I agree that PA/NP would be ideal for this, and not only could you decrease inappropriate access of the 911 system but also, potentially, of the ER as well.  This would likely be geographically dependent.  It would certainly be interesting to study.
    Funding/billing would be difficult.  I'm way more expensive as a PA than I am as a paramedic.  To my knowledge (here in the States, anyway) CMS don't have a means to bill for these types of visits.  In other countries there may be different financial structures in place.
    EMS provider education is a huge factor.  Paramedic educational programs are not geared towards, nor do they provide an adequate base for, this type of medicine.
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  9. paramedicmike added an answer to a question MCI Command Structure   

    That seems like an excellent question to pose to your command structure. 
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  10. paramedicmike added a post in a topic For those who advocate Community EMS   

    Then log out and log back in.  Please don't try to post under another user name.  It'll get confusing.  Let Admin know and he can continue to troubleshoot.
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  11. paramedicmike added a post in a topic For those who advocate Community EMS   

    PM sent.
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  12. paramedicmike added a post in a topic For those who advocate Community EMS   

    Lots of abbreviations.  No idea what any of them mean.
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  13. paramedicmike added a post in a topic This is it - no more - never again - I'm done after this   

    Ah yes.  The Kingdom of Montgomery.  Better than PG County anyway.
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  14. paramedicmike added a post in a topic EMT online   

    I have heard/read of EMT programs offering a combination of online learning and hands on practice.  I know very little about the quality of the programs, however.  Most of the programs I've seen require at least a solid week for required hands on time.  That may prove a challenge if your job is as difficult with your schedule as you make it sounds.
    The big question to ask is if a program like the one you're looking for will allow for state or national certification.  It would be unfortunate to dump all that time and money into a program that won't leave you with anything tangible at the end.
    Online learning, though, isn't as easy or straight forward as one might think.  I've taken several online classes and they were much more time consuming than traditional classes.  Just something to keep in mind.
    In the end it comes down to how badly you want it.  Research locally.  Talk to your employer.  See what you can work out. 
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  15. paramedicmike added a topic in Patient Care   

    2015 ACLS updates
    Some interesting changes coming from AHA with their 2015 ACLS updates.  For example, Vasopressin is out.  Epinephrine is the first round drug of choice.  Ultrasound is an option for ETT placement (likely more hospital based but interesting for any prehospital systems using u/s).  In non-shockable rhythms give epi early.  Lots of oxygen during CPR; if/when ROSC returns titrate as necessary. 
    A hospital based intervention which I thought was interesting was ECMO in place of CPR if available.
    From an academic point of view it's interesting to trend the changes over time.  It's interesting to watch the research.  It'll be interesting to see what comes next.
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