firemedic37

In Iowa you are required to take and pass the NREMT in order to ontain state certification at all EMS levels.

I passed both the written and practicals my first time at both the NREMT-B and NREMT-P levels, last day of EMT-B class we took the written and practical NREMT test. My Paramedic class ended on a Tuesday took the practical on Sunday and the written on Tuessday. I think the sooner you test the better off you are, the longer you wait the worse off you are.

It also depends on how well your instructor prepared you for your tests. Some people teach to earn extra income others do it because they enjoy teaching and helping others become good EMT's.

NREMT is a step in the right direction, yes there are flaws but it is much better than nothing. I hope that someday I can go to another State and work as a Paramedic without having to retake the NREMT examine even though I hold a NREMT-Paramedic card.

It seems that we all have agreed on a couple things here, pt is in A-Flutter/A-Fib, pt needs O2, IV, ECG, 12-lead and further evaluation by a physician. Would I have treated his symptoms? Who knows I was not there to see how the pt presented. Was his SOB mild or severe, does he have a new onset of CHF causing his SOB? There is much more to consider than what can be communicated easily through postings, like what did he look like? This depends on many factors, lighting, our eyes adjusting, etc.

Would I of given Adenocard? I cannot say 100%. I have given Adenocard for a HR of 130 - 140 because the pt was boarderline unstable. So for us to say that we do not give Adenocard for HR's of 130 - 140, I have because the pt was boarderline unstable. We have to assess the situation each time and do what is best for that pt. There are many pt's that can tolerate a HR of 130 - 140 for days if not months before it comes an issue, then we have the ones that cannot tolerate it for any period of time.

Where do you write it?

I write my report enroute back to base, let me explain. I work for a 911 service that has a 30 - 60 minute transport time and a transport service that has transport times up to 4 hours. When we get back the report is printed off and sent to them. I always ensure that the hospital does not have any questions for me before leaving. I do give them a hand off sheet with all the information that I got, on that sheet. I also include my cell phone number so that they can contact me with any questions that may come up after leaving.

I feel that this is the best way for me to get back in service sooner and provide excellent patient care. I have only been called a hand full of times for further information. I have not had any hospitals complain about me not writing my report there since all reports are sent to them in a timely manner. And yes the reports are legiable since my services use Electronic PCRs.

I work on a interfacility transport and a 911 service which have their own protocols. In our interfacility transports we usually continue what they have them on unless they are hypotensive. On the 911 side we do not do RSI but do Medicated Assisted Intubation which we use Etomidate 20 - 30 mg IVP, and Versed 2 mg IVP every 10 minutes (I don't use it since it is not a high enough dose for most patients) or Valium 5 mg IVP every 15 minutes. And if I need anything else for continued sedation I just call Medical Control and they usually give me any order that I need to keep the patient intubated and sedated. We do not carry Fentanyl on our 911 service yet, but I have a feeling that it is comming soon.

Times vary greatly depending upon what type of call and which hospital I transport to. Some hospitals push you out faster than you can give a good report while others invite you to see your Acute MI pt go into the Cath Lab. I am sure it is like this everywhere, an average time for BLS calls is 5 - 10 minutes and ALS 10 - 20 minutes and no I do not write the report in the ED.

Here is my personal veiw on the matter, each member that rides in an ambulance must me the minimum of EMT-Basic if they are providing any medical care. If the purpose is for an Explorer Program then CPR and First Aid should do.

I have heard and still hear to this day that "children" (Individuals under the age of 18 or still in High School) should not be allowed to take an EMT course or allowed to work / volunteer for a service. I believe that there is more too it than just an age, some people are more mature than others at an earlier age and are capable of handling the situations.

For me it just made sense for me to take my EMT-Basic course during my summer vacation between my JR and SR year in High School. My class had five high school students in it with me being the oldest at 18 and the youngest being 16 (she was 17 by the time it was time to test). We all completed the EMT-Basic course and we all passed it on the first attempt (both the written and practical). Four of us obtained National with the youngest just obtaining State due to her age.

Three of us joined our local EMS Service and attended to patients by ourselves, after being signed off on by our service.

What was the outcome? I became a Paramedic, three are in Medical School and the fifth is in Law School. I firmly believe that if the individual is mature enough and has completed the training that is required to become an EMT-Basic then they deserve to be on a service. I am sure that some people will disagree with me, but hey it is a free world.

I keep seeing on here the samething over and over again, why are the EMT-Basic's getting more skills to use? This comes down to your State and what they allow them to do. Simply put some States allow EMT-Basic's to insert a Combitube (My State Allows This), and they are allowing them to use the King airway. I am not aware with what other States are allowing their EMT-Basic's to do, I am just familiar with what my State and my services allows me and my crew to do. An Iowa First Responder can insert a Combitube, yes that is definitely something that most States would never even think about allowing, however they allow it.

I can understand the frustration that you all are experiecing if your State does not allow an EMT-Basic to insert an Combitube but now is allowing them to insert Kings. However I feel that the best thing for all of our patients is the ability for all levels of EMS the ability to establish and maintain a patent airway. I feel that the King airways allow us all to obtain a patent airway that is proven to work and simple to use. Now the question is what type of training are they receiving prior to placing them into service.

My FD runs a fully staffed BLS Non-Transporting Heavy Rescue Truck. It includes all the equipment that a BLS ambulance has, with the exception of a cot. We have all the backboards including a pediatric one, scoop strecher, vacuum splints, KED boards, LifePak 12 (with 12-Lead ECG, NIPB, SpO2 and AED defult mode with ALS manual mode with pacer), jump bag, trauma kit, pediatric kit and all the other equipment that the state requires a BLS rig to have.

We have one engine that we run as a BLS rig and it is much simpler. Jump bag that has airway kit, OB kit, suction, c-collars, meds and other misc equipment. We even have a LifePak 12 that only has SpO2, four lead ECG (no 12-lead), defaults to AED but can be changed over when ALS arrives to be maual defib and pacer. We have no backboards or splints on this rig. We have this since it is second out to MVC's and first out for fire's and haz-mat.

The reason we have the Rescue Truck is because we respond on 100% of 911 calls that our ambulance has. Hope this helps.

Okay sorry for not following this closer and putting up the link when I first put this topic on here. I since have lost the link for this study and have not been able to find my hard copy of it. I think it may be on the University of Iowa Hospitals and Clinic website, where at on there I don't have a clue. I was given this information in Paramedic school, it was used as a tool to educate us on being aware of our time and the other options that we had other than the ET when securing an airway for our patients.

Clearification on who can insert this airway. This is who it is in Iowa, even if you don't agree with it. EMS First Responder (NREMT-FR), EMT-Basic (NREMT-, EMT-Inermediate (NREMT-I/85), EMT-Paramedic (NREMT-I/99), Paramedic Specialist (NREMT-P/98) and RN/PA exception. And yes even the ER doctors don't understand the different levels that we have.

I understand that EMS levels differs state to state and that's why I put the NREMT level that is required for certification in the State of Iowa. And yes Iowa is a Registry State.

Training is required to be completed by someone who has been trained and aprroved by the services Medical Director. For my service we help a mandatory course and went through our local Community College and completed the Airway Refresher in the 24 hour DOT Refresher to include the King airway and a mandatory lab to follow the lecture. This way we all got hours for recertification and the colege also has a record of who took the course.

Hope this helps, even though it is late.

My BLS Non-transporting Fire Department currently has (5) NREMT-B, (3)NREMT-I/98 and (3) NREMT-P/98. My ALS transporting ambulance has (6)EMT-Basics, (4) NREMT-I/85,(3)NREMT-I/99 and(5)NREMT-P/98. Both are rural volunteer services.

My current protocols call for Valium IVP for seizures in adults and Versed IN for seizures in children. Resently at work we have been having to use Ativan due to a shortage of Valium, our hospital cannot get Valium the last time I checked which was about two weeks ago. Is anyone else experiencing a problem getting Valium?

Three for three, two in the ED and one in the ICU. 100% first attempt sucess rate. I work at a hospital based service with very little 911 so I get the ones that they missed in the feild or the ones that crash in the ICU.

Neb.EMT:

Anyway... If there were mistakes made by your agencies crews - perhaps you can turn this into a positive and address the mistakes in a positive way, though training to prevent the same mistakes in the future?

I could not agree more, if you think there perhaps was a mistake made and make it into a teaching moment. Perhaps your service can sponsor a PHTLS course that can improve the outome of future calls.

Perhaps they (your fellow co-workers) too were good friend of the victim and they just froze and could not think what to do.

I understand that you made a choice and that you cannot change, nor can you change the outcome of the accident.

Please seek help that can offer you closure and assurance that you did not do anything wrong by not choosing to respond to this call.

My Paramedic class is 15 weeks long in the classroom and then approx. 620 hours clinicial/field time. The cost is as follows:

Non-refundable Application Fee $25

Tuition ($500 non-refundable deposit) $5,000

(Tuition subject to change)

Textbooks $600

Hobet $50

Anatomy & Physiology Test $50

Malpractice Insurance (approximate) $150

Hepatitis B Vaccinations $150

Certification Examination Fees $140

Parking (approximate) if needed $100

Student Physical $50

Uniform shirts-three (approximate) $75

University of Iowa Student Fees $790

Includes:

Base Student Fee

Computer Fee

Student Activities Fee

Student Services Fee

Student Union Fee

Building Fee

Career Services Fee

Total anticipated expenses $7,180

Plus the cost of a apartment.

The class is at the University of Iowa - EMSLRC there website is:

http://www.uihealthcare.com/depts/emslrc/paramedics.html

I hope this may help someone.

Coralville, Iowa all Police Officers are minimum EMT-Basic and respond to all medical calls in the city of Coralville. They do not transport just act as first responce.

Hum, rural EMS? My service is a Paramedic Level service and run approx. 320 calls per year. Our paramedics use their skills when needed and it is more often then you may think when the nearest hospital is 30 - 45 min away. We still have cardiac arrests in the rural settings and traumas that requires intubation and advance skills, so yes we can keep our skills up. We have one full-time Administrator/Paramedic that works 5 am - 5 pm Monday thru Friday otherwise its volunteers and yes we operate at the Paramedic Level 24/7. We have thought about going to a full-time service with EMT/Paramedic staffing, but for now the staffing we have now works very well.

Consider C-Spine. With a GCS of 6 consider intubation, Trauma Center 10 away and gag reflex intact, I would do a nasal airway and bag the guy. Establish IV of LR, 12-Lead, monitor vitals, administer Nalozone and Thianamie, if no response then consider D50.

What medications was she on? Could it be a poisoning (overdose) of some type? Respiratory alkalosis due to Aspirin Build up, since she has hx of MIs?

The study actually does not say which level of paramedic was doing this study, did it. I will look into it and get back with you guys.

In 2006 Iowa Department of Public Health reported 1,324 intubations done in the feild. Of those 14% were done by Iowa Paramedics (NREMT-I/99), 14% were done by RN Exception, and 72% were done by Iowa Paramedic Specialist (NREMT-P/98). Of these intubations 65% were done in a rural area probably by a flight paramedic and the other 35% was in a urban area. Just some food for thought.

Also these times are only from the SUCCESSFUL intubations.

Here are the Paramedic Stats:

Combi-tube - 37/45 (82.2%)

ETT - 31/45 (68.9)

KingLT - 45/45 (100%)

Here are the EMT-Basic Stats:

Combi-tube - 21/24 (87.5%)

KingLT - 24/24 (100%)

70.0 seconds does seem like a long time to intubate, however in Iowa state wide paramedic get anywhere from 0.4 (rural) to 5.3 (urban) intubations per year. Paramedics are rarely allowed in the OR or ETI to maintain their skills. And when the paramedics need to intubate a person they are dealing with less than preferred conditions. I understand some Paramedics may intubate a patient a lot faster than others and this is due to the fact that they intubate a lot more people per year. Most services in Iowa do not even run 3,000 calls a year because we are a rural state.

I do not know where ccmedoc intubates his patients in 15 seconds.

A recent study completed by the University of Iowa Hospitals and Clinics found that the AVERGAE time for a Paramedic to intubate a patient in the pre-hospital setting was 70.0 seconds with a success rate of 68.9% on first attempt. Compared to the average time for the King LTS-D was 22.7 seconds with a success rate of 100%. I do agree that the ET Tube is the Gold Standard for ALS, however, it is not available to BLS.

As you can see that the King LTS-D airway is very effective in the pre-hospital setting to manage people without a patent airway.

This study was done with 69 working EMS Providers (45 Paramedics and 24 EMT-Basics). It was conducted in the back of an ambulance using the standard airway mannequin. Providers had no previous training on the King LTS-D airway. ETT and Combi-Tube evalulated first. Allowed 30 seconds to read the King LTS-D instruction card before attempting. Time elements measured time to placement and first ventilation.

Sorry for the misunderstanding, I met this for all EMS Systems both Rural and Urban. All BLS Systems should have this as the "Gold Standard".

I just posted it under the Rural EMS section.

My service recently just added these to our protocols (Sizes 3-5). The University of Iowa did a research project on the effectiveness of the King LTS-D Airways and showed a 100% success rate on first attempt. So the State of Iowa now allows all levels from First Responder and up to use these. I personally found the King LTS-D to be an excellent alternative to ET intubation and combi-tubes. Iowa also currently allows all levels from FR and up to use the combi-tube which is not as successful. I personally believe that the King LTS-D will be the new Gold Standard for BLS airways.

If you are looking to use these or are currently using these I recommend the King LTS-D because 1) Suction Channel, 2) Distal Cuff was redesigned to have a better seal.