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Dude, I do truly hope your joking? You want to do Pediatric Critical Care Transport having JUST finished Paramedic SCHOOL? Short Answer = ABSOLUTELY NOT! I will tell you what, if you can tell me the pathophysiology of Tetralogy of Fallot without having to use GOOGLE, then I might be willing to listen to your argument. I really hate to sound like an A$$ here, BUT, there is NO way on this earth, any brand new paramedic is ready to do ANY type of CC transport. That included myself back in the day.....In fact, I have tons of CC experience, education, and when I took PNCCT last year ( Pediatric Neonatal Critical Care Transport Course) ( 10 Days, 8 hours day) i only scored an 86 on the final exam........This stuff is NO joke, and will truly be beyond the mental capacity of 99% new paramedics. So, Unless you are the statistical outlier, the answer is NO..... I suggest, go work the streets for 3 years, start taking CC courses, PNCCT, read some ICU nursing books, do ride alongs with a CC crew. Send me a PM, I can point you in the right direction for books and classes to get you started. There is an old saying, You don't know, what you don't know, ( Until it is too late)! Respectfullly, JW

I think I may be an OZ at heart. Its all good. I shouldn't hijack this thread arguing with Phil (whom I do respect) while distracting from the topic at hand. Sorry folks, it was rather rude on my part. If anyone wants to finish the discussion, we can do it in PM.

You might get hired as a Paramedic right now but your title would be Driver and with no patient contact. Why pediatrics as a new Paramedic? The Paramedic curriculum barely prepares you for pediatric emergencies for the short term to get the child to the hospital. If you really want to work with pediatrics you would have better chance for a pedi critical care team by getting your RN. Even an RN for many teams needs his/her BSN and 5 years of experience with at least 3 of those in the critical care unit. The same goes for most RRTs. Here is a good article from the AAP which provides the guidelines for Pedi transport. Interfacility Transport of the Critically Ill Pediatric Patient* http://chestjournal.chestpubs.org/content/132/4/1361.full?ck=nck Here are just a few books you might want to study. The list is from the new Neonatal Pediatric Transport exam site which is a very watered down exam. Advanced Pediatric Emergency Care, Jenkins, James, Pearson Prentice Hall, NJ, 2007 AeroTransportation A Clinical Guide, Martin, T, Ashgate, 2006 Air & Surface Patient Transport Principles and Practice, Holleran, Renee, Mosby, St. Louis, 2003 Air and Ground Transport of Neonatal and Pediatric Patients, Woodward, et al., AAP, Illinois, 2007 Atlas of Procedures in Neonatology, MacDonald, LWW, 2007 Comprehensive Neonatal Care An Interdisciplinary Approach, Kenner et al., Saunders, Philadelphia, 2007 Core Curriculum for Neonatal Intensive Care Nursing, Verklan, Saunders, Philadelphia, 2009 Core Curriculum for Pediatric Critical Care Nursing, Slotga, AACN, Saunders, Philadlephia, 2006 Current Diagnosis & Treatment in Pediatrics, Hay, et al., McGraw Hill, NY, 2007 Egan's Fundamentals of Respiratory Care, Wilkins, et al., Mosby, St. Louis, 2009 Handbook of Neonatal Intensive Care, Merenstein, et al., Mosby, St. Louis, 2006 Infectious Diseases of the Fetus and Newborn, Remington & Klein, Elsevier Saunders, Philadelphia, 2006 Kendigs Disorders of the Respiratory Tract in Children, Chernick, Saunders Elsevier, Philadelphia, 2006 Manual of Neonatal Care, Cloherty, LWW, 2007 Maternal, Fetal & Neonatal Physiology, Blackburn, Susan, Saunders, Philadelphia, 2007. Mosbys Paramedic Textbook, Saunders, Micki, Mosby, St. Louis, 2007 Nelson Essentials of Pediatrics, Kliegman, et al., Elsevier, Phildelphia, 2006 Neonatal and Pediatric Pharmacology Therapeutic Principles in Practice, Yaffe, LWW, 2005 Neonatal Perinatal Medicine, Martin, Elsevier Saunders, Philadelphia, 2005 Neonatal Resusictation Textbook, AHA, AAP, 2006 Neurology of the Newborn, Volpe, Saunders Elsevier, Philadelphia, 2008 PALS, Aehlert, Barbara, Mosby, St. Louis, 2007 Pediatric Cardiology for Practitioner, Park, Myung, Mosby, St. Louis, 2008 Pediatric Dosage Handbook, Taketomo, Lexi-Comp, 2008 Pediatric Education for Prehospital Professionals, Dieckmann, Ronald, AAP, 2008 Pediatric Emergency Medicine, Baren, et al, Saunders, Philadelphia, 2008 Pediatric Trauma Pathophysiology, Diagnosis and Treatment, Wesson, David, Taylor and Francis, NY, 2006 Red Book, 2006 Report of the Committee on Infectious Diseases, AAP, Illinois, 2006 Robertsons Textbook of Neonatology, Rennie, Elsevier, 2005 Textbook of Pediatric Care, McInerny, AAP, Illinois, 2009 Textbook of Pediatric Emergency Procedures, King, et al. LWW, 2008 Journals Advances in Neonatal Care Air Medical Journal Clinics in Perinatology Newborn and Infant Nursing Reviews Paediatrics and Child Health Pediatric Clinics of North America Pediatrics Respiratory Clinics of North America Seminars in Perinatology The Journal of Perinatal & Neonatal Nursing

Nah dude, you respect phil ? OMG we have to SO have to talk... I respect you totally and your a leader but thing is but please and WTF ? is liters per 100 kms, vs MPGs now thats something I just can't just wrap my brain around and PM no way figging way, if Vent medic can accept my apologies then the OZ will accept yours, no worries mate, water under the bridge .. and despite the perversion and the humping roos and wallabies/ camels and the like, we luv phil why the hell the women worship him as a sexual god .. I have no idea ... and quite positive pharmacologically induced ..... cheers We are a cohesive force in this EMT city and have this venue and thank's to you ADMIN and AK and Terror the ability to exchange ideas and really improve the biggest problem ... solidarity in EMS, watch for my next thread .... (thats called fore shadowing) I met with rock_shoes today and my total pleasure, united we stand divided we FAIL in Dust Devil speak. plus 1 for you Matteo.

If you are lamenting the lack of pride and blaming it on the young and/or the absence of mentors, the culture, etc. then I have news for you. You are part of the problem. A single person can make a difference on the shift and on the station and then on the company. I am living proof. I am still a newbie medic at my company. I have not hit the magic 2 year service that qualifies me to be an FTO, a mentor in any official sense or eligible to precept anyone. (as it should be). I have no interest in advancement for the company and thus it is in no one's interests to kiss my butt or to do anything I ask of them, but I know I have made a profound difference on my shift. Once regarded the red-headed step child of the company, we are now considered the premier shift and it is acknowledged by all shift supervisors that we don't have a single "bad apple" among us. How is it done? First and foremost by example. I will not tolerate half-assed anything when it relates to the job. My rig is spit and shine and ready to run at the beginning of each shift. I come in 20 minutes early to make sure and I don't give a crap who turned over a bad rig to me - If it ain't right, I fix it. I am extremely tolerant of people's idiosyncrasies, personal likes and dislikes, sexual orientation, bad language, poor sense of humor, ever hungry ego, etc. etc. anything at all AS LONG AS IT DOESN'T IMPACT patient care. I sure don't want to sound like a know it all saint, but I am in this business for the right reasons. I also have the added bonus of financial independence, so I can pretty well take stands on anything of importance to me without fear of retaliation. I will not tolerate slipshod performance, lack of pride or professionalism or anything less the the very best from myself and anyone in my control (my EMT partner). It is done with sensitivity and tact, but 0 tolerance. It spreads. Amazing but true. If you truly care about your co-workers and your job, and take the initiative to go the extra mile, you can influence all around you and create positive change. Do not sit around and wait for someone to fix this. Take on the role yourself in whatever part of the EMS world you find yourself.

Hi everyone, I have a quick question for everyone - is it possible, common, or even advisable to be hired as a hospital-based critical care medic soon after finishing medic school (say in the time it takes to achieve one's CC certification)? Does the answer change if the job is at a pediatric hospital? Thanks for the input.

About your car, is it possible to keep it registered in FL? Much cheaper. Everyone else in NY does it. Go down any street, particularly in poorer areas, look down the block, and you'll see PA, NY, PA, PA, NC, NY, PA, FL, GA. I'm sure that Bed Stuy isn't exactly a prime destination for tourists. Long Island in general has cheaper insurance rates, and reasonable rates in the New Hyde Park area. Something else to consider.

Staten Island is too isolated. The city is either too expensive or too rough, depending on the area. No middle ground there. I've lived in Bushwick Brooklyn. I don't recommend it. Greenpoint is relatively safe, Bay Ridge is OK. So is Park Slope, but it's expensive. I wouldn't recommend any other neighborhoods. I've also lived in Ridgewood and Middle Village Queens. Both areas have buses and the M train. Ridgewood was getting a little ghetto, but the Eastern Europeans have bought up a lot of property there, and maintain it well. Glendale is OK. Bayside, Whitestone, Flushing, Fresh Meadows and Glen Oaks are good to live, but are expensive and lack much mass transit (except for Flushing). Best bang for your buck while being in a safe area would be Middle Village, Glendale, or Ridgewood from Fresh Pond Rd down to about Onderdonk or Seneca Ave. Stay away from Myrtle Avenue unless you're above Seneca. Metropolitan Ave from Forest Ave up through union Tpke is safe. Stay out of LIC, Astoria, Corona, Jackson Hts, Woodside, Sunnyside, East Elmhurst, and most of the Eastern/Southern part of Queens to include the Rockaways, and anything down Woodhaven. I've either lived, worked EMS or both in all of the areas I've mentioned so far. When you work nights, you see what really goes on. stay away from any areas along the J or A lines. I don't know much about the Bronx. Many parts of the Bronx are rough. Middle Village has no alternate side of the street parking, so you could easily keep your car there. Crime is relatively low there. My in-laws live there.

To make any appreciable amount of money, you'll need to work in NYC. BLS pays around 10/hr for privates, maybe 15-22 for 911 participating hospitals. ER techs can make 15-20/hr as well. Working conditions are poor in the privates, but are decent at the hospitals. It's easy to get hired by a private, but difficult to get hired by a hosp. (except North Shore LIJ CEMS) without any prior 911 experience, or an "in". CNA's make anywhere from 10-15/hr, check openings at the hospitals. 1 BR in a decent area runs 1000-1200/month. 2BR maybe 1500-1900. Car insurance is oppresively high. Also, I would focus my energy on an ER tech or CNA position at the hospital. If you want to break into 911, apply to a hospital system that has an EMS agency, such as NSLIJ or NY Presbyterian, so you can focus on getting hired from the inside. Working conditions in the hospital will trump that of the street, and is way more school friendly. If you want to go RN (challenge the medic afterwards) there are many schools available, and plenty of employment available post graduation, unlike elsewhere in the country. The city did have a program that gave aid for those wishing to pursue LPN school. you can look into that, also. Medics make around 20-22 in the privates, and 22-32 in the hospitals. It's typically been easy to get hired with FDNY EMS. The working conditions are horrible, though. http://nyc.gov/html/...ts_042607.shtml When you park your car, lock your steering wheel with the club lock facing the dash. This makes it way more difficult for the perp to pick the lock.

Everybody should make their own decision about the vaccine. I don't believe that any vaccine should be mandatory UNLESS failure to vaccinate puts the rest of the population at risk. I remember, as a grade schooler, going to my elementary school and getting the flu vaccine in the 1960s (it was mandatory). I am taking the shot as soon as I get to Las Vegas early next week. As a group of emergency physicians (at UNSOM), we decided not to take the nasal vaccine because it is a weakened (attenuated) form of the H1N1 virus and we were afraid that we would shed some of the virus which might adversely affect some of our patents who may be immunocompromised. But, we are taking the injection. I am making sure my two kids (in their 20s) and my son's pregnant wife (also in her 20s) get the injection vaccine. I intubated two people last shift at UMC who had H1N1. I had one patient, a male in his 20s, who was in the hospital for 7 weeks, spent 5 weeks on the vent, had bilateral chest tubes, a DVT, and ARDS. He was low sick. This H1N1 is scary and if you are in your early adult years or pregnant, you should be concerned. The Obama administration has done a horrible job of providing information about the H1N1. While in Texas last Friday (I am in San Jose now), the TDSHS web site showed that two pharmacies near my Texas house was supposed to have the vaccine. I went by both to try and get the vaccine for me and my family. Neither pharmacy had the vaccine and neither knew when they would get it. It is available in Clark County, Nevada. Go figure. I was in Mexico when this H1N1 emerged several months ago. The way it affected children in the Mexico City area was scary. Although the predominant strain in the US appears to be less virulent than the one on Mexico City, it is still a bad deal. Vaccines save lives. If you give people enough of a substance, be it vaccine, drug or placebo, a few will have an adverse effect. This does not mean that the vaccine is dangerous. The links between childhood vaccines and autism are pseudoscience. Far more kids will die from not being vaccinated than will suffer ill effects from the vaccine itself. Look at the evidence and make your own decision. I, for one, will get my vaccine next Monday.

Hello, HB.....that is different. From my experience at a few different hospitals an infusion is always hung asap for a tubed patients with a sedation goal. Two common ones I have seen are; Richmond Agitation And Sedation Scale (RASS) http://www.icudelirium.org/delirium/training-pages/RASS.pdf Ramsay Scale (RS) http://www.aic.cuhk.edu.hk/web8/sedation%20scale.htm They are useful because you have a goal. An ARDS patient needs a RASS of -4. Want to wean..... a RAAS -1 on PSV overnight then a vacation in the AM . From my experience it prevents people in the ICU from snowing a patient too deep (to have a easy shift). Or worse, keeping a patient too light. For transport (depending on your vent) I think a RAAS of -3 or -4 would be ideal in most cases. We had a Dragger Oxylog 1000 that was ok. Then we got a LTV 1000 that was more dynamic. Cheers.... David

Mom and Dad have different attorneys? One denies, the other confesses? These idiots are going to get hosed. I'd laugh, but I feel sorry for the kids.

Yea no kidding about the money, but if your 42,000 ft asl and one may have to divert to another country, state or province well it sure comes in handy and worth every penny, especially when flying out of a foreign country LDT, especially all the dang antibiotics. I still have my hand made cards from back in the day and it IS the best way to learn as it puts the regular used drugs and doses into long term memory. cheers blue skys and calm air ....

If extra people are required and /or if special equipment is required I say charge extra, because it cost the service more. Only fair to cover the expenses incurred. I will also say that there are some people that are fat because of issues they have no control over. The majority it is just a lack of motivation and possibly education. Though I see a lot of well educated fat people.

Fat people get FAT by eating way more calories than they burn off. Ever been at a restaurant and watched a FAT person eat. They don't order a small salad and a water. They order a big deluxe triple cheeseburger and a large fry along with a desert , Oh and don't forget the 32 oz sized DIET coke! Like the quart of DIET coke will keep them from putting on weight! [ Hope you note the sarcasm ] To blame a "medical issue " as the reason they are FAT is just a crock. They eat too much, period. Yes once they get fat, they more than likely develop health problems. I treated a 5' tall 10 year old recently that outweighed me by thirty pounds. I'm 6'2" & 205 lbs, same weight as 35 years ago when I got married & 10 lbs more than when i graduated from High school.

Ha. I do not disagree that the US ought to use a common system. I disagree with the pompous position you take by bringing your standard to this board and refusing to accommodate your post to our standards. Had I went to an Auzzie forum and spread the same bull, you would have eaten me alive. Rarely have I seen you post your Auzzie slang on this board, and I assume it is out of respect because that is not the 'standard' by which this board communicates. I guess it is more of a respect thing. Thanks for sharing your views though, bro. Matty (edited twice, once to figure out the multiple quote system, the second to make the reply post, the third to explain the edits.)

Do many feel differently that I do when giving/taking points? That it's not based (as it is for me) on the quality of the post, or whether or not an opinion is expressed to the best of the posters ability, but that it's based on the popularity of the opinion?? I'm finding that many of the posts I see that have been given negative numbers simply have ideas that may not be popular, but that the posts themselves fulfill the standard set down by the Admin as well as the standards of many of us here. If this is KooK's experience, then why should s/he not say so that we can be exposed to this point of view and discuss it? And, if the above has been this poster's experience, then I believe that the opinion certainly belongs in a thread based on professionalism, right? This post has good spelling, punctuation, decent grammar, actually used the accurate word 'derided' instead of resorting to 'treated shitty' or some such language, and expressed an opinion on behavior that is too often exhibited in EMS. Can someone that gave a negative rating please take a moment and explain why you chose to do so? I'm not saying it was an incorrect thing to do, only that I don't understand it. Thanks in advance. Dwayne Note: If I could vote for myself I immediately give this post a -1 for lousy sentence structure, but then give it right back for breaking the world record for the most commas used in a single post. But it's late, and I'm lazy, and I'm willing to take my beating rather than reword everything.

I'd have to say yes and no to that. Yes, youth definitely has an impact, but remember that pride and professionalism have to be taught as well. As a chalk leader in the Army, I had 9 medics under me, 6 of whom were under 20 and green as grass. Basic military bearing and pride in the uniform was drilled into them in Basic and AIT, but it was up to me and my team leaders to show them what it really meant to be medics in a line company, to be professional and cool-headed under pressure, and to know that every man in the unit was counting on them to be the best when the heat was on. It was my job to give them a reason to be proud to be a "Red Rider", both by demanding excellence in training and encouraging outside socializing. They became a team, a family, and showed pride because of it. Constant training, often with a competitice twist, promoted confidence and professionalism, which translated outwardly in how they handled and carried themselves. There is no reason why the same type of approach shouldn't be used in civilian EMS. The whole mentor thing is right on - some one has to take that position of team leader, squad leader etc - call in the NCOs!

Hey NickD, I understand the importance of presenting yourself as a valuable potential asset to the company during the interview. However, prior to hire, matters such as salary, work schedule, benefits, leave policy, paid time off, selection procedures for promotions, deferred comp with match, etc. etc. need to be discussed. Several weeks or months into the job isn't the time to be learning these things, as they ought to be in writing prior to hire. So, if not at the interview, when and where should one address these concerns? All too often certain things are promised to the new employee (verbally, not in writing), and not delivered. "We've had a recent change in policy". "We never said that." "Where did you hear that we were giving (XYZ) benefits?"

I think this is a symptom of the disease "greed". Throughout the 80's until now, this younger generation has watched corporations down-size, merge,be taken over hostily, and rape their employees just so the stockholders can make money, and the CEO can make 40 times what the average worker makes. I think they saw their dads get screwed over several times, and they said they heck with being loyal to a company, or taking pride in a company. The second thing is that to have pride, you have to have something to be proud of. Most management in EMS today is lacking the ability to produce companies that you can take pride in. You would hope that people would do the things you suggested out of "self-pride" but I believe that died somewhere around 1990.

That's where I disagree. I tried really hard to watch the second episode not as a medic, but as a normal viewer. I couldn't get into any of the characters. The time spent on flushing out the main characters was too little, but they've made them too flawed to pull a Law and Order or Emergency! where they are just professionals whose home lives we rarely see. Right now they're more caricatures then anything else; too much front loading left them with little to explore. As a viewer we can't even care about the patients as the calls are so short and fast we never see much of them either. Maybe they should have copied Flashpoint and Saved which did those little flashbacks. EMS issues aside I don't find anything here pulling me back in; they are severely lacking in a hook.

I had mentioned the Jessica/Rabbit connection? I couldn't resist this link!

For those missing emergency - amazing NBC put a link to it on the page to watch videos http://www.nbc.com/classic-tv/emergency/video/categories/season-1/32399/

I would say that pride in the people we serve is a very large part of professional pride. I admit, I have not been a good example in this area in the past, and I still find myself sometimes slipping into the mindset, but I think it's imperative that people in EMS work undergo a major attitude shift. How many times have you heard EMTs and Paramedics groan when dispatched to an address in a predominantly immigrant area of town? What about jokes about the "trailer trash" we often find ourselves serving? Griping about going into nursing homes, even though the vast majority of our patients are elderly? Treating people who don't speak English or geriatrics as if they are children, or too stupid to know what's going on? I did quite a bit of thinking about this last night, and I came to the conclusion that lots of our EMS slang is actually very disrespectful to our patients - "frequent flyer" for example. Sure, you could argue that it is supposed to reference people who call all the time for very minor difficulties, but I've never seen it used for someone like that. In my experience, the term has been used for addicts, the poor (who have no way to get to a hospital, and no way to pay for non-emergency care), people with mental disabilities, elderly individuals with chronic conditions, in short: the forgotten of our society. Personally, I'm going to work to purge that term from my vocabulary. Here's a short list off the top of my head of things I have heart EMS and Fire Service workers either state in person or write about in various Internet media: -Joking about sexually assaulting minors in the back of the ambulance. -Joking about taking Spanish-speaking patients across the border and leaving them in Mexico. -Saying that a homeless "frequent flier" should just die already. -Saying that an incontinent elderly gay man must have been "quite a bitch" in his younger days. We all have our moments of ugliness, when a cruel thought comes into our heads (yes, it's a natural human reaction to frustration and weariness, but that doesn't mean it's right), but EMS seems to be an echo-chamber for those thoughts and words. If the industry truly had pride in who it serves, such attitudes and language would be unheard of, and regarded as utter nonsense. In addition, an attitude shift to one of service and pride would undoubtedly bring a trend of EMS/Fire clamoring for more education. After all, with pride invested in our patients, we would want to be able to give them the best care possible, not just "good enough" care.