Fox800

I'm assisting with the formation of an EMS explorer post at my agency and I've been tasked with formulating the training/education requirements that we will require Explorers to complete before letting them do rideouts. I would appreciate it what you guys think Explorers should be trained/educated in before letting them ride out with crews. Here's what I have so far (as a draft, be gentle):

Departmental/Post Orientation

• Introduction to EMS as a field

o Description of an EMS system

o Description of certification levels (EMT, EMT-I, EMT-P, communications operator, first responders, medical director)

• Requirements of EMS training programs/schools

• Introduction to our department

o Vital statistics, mission, state of affairs

o Organizational structure

o Different positions within EMS

• Paramedic, Communications Medic, Supervisors, Special Operations, Administration

o Field EMS response

o Special events

o Community interaction

• Take 10 CPR

• Child Safety Seats

• Tour of ambulance, supervisor vehicles, etc.

• Tour of communications center

• STARFlight (our air medical/rescue helicopter)

• Expectations of Explorer Post Members

Safety/Legal

• HIPAA training

• Bloodborne pathogen training

• PPE isolation

o Gloves, eye protection, gowns, hand washing

• Scene safety training

o Traffic accident safety

• Vehicle rescue awareness

o Rescue operations awareness (water, trench, land)

o Tactical assist awareness

o Scenes of violence (psychiatric patients, domestic violence, gangs, crime scenes, large fights, shootings/stabbings, staging)

o Extreme temperatures

o Large crowds

• Downtown responses

• HAZMAT awareness

Operations

• Explorer roles and responsibilities

• Prohibited activities/safety concerns

• Radio operations/frequencies

• Maintenance and use of equipment

Clinical

• Certification: AHA CPR for BLS Healthcare Providers

• Certification: First Aid

• Spinal Immobilization Awareness

o Also, orientation to scoop stretcher and stair chair

• Blood pressure measurement, taking pulse, auscultating lung sounds

• General patient assessment (BLS level), overview/orientation of BLS medications

Keep in mind that in Texas, you cannot be certified as an EMS provider until age 18 so we'll be aiming for CPR/BLS for Healthcare Providers and a first aid course as the only "certifications" for now.

To make a living wage you'll need to work as a paramedic for a municipal 911 agency or a well-paying private. I don't know how well the privates pay or who they are.

Reputable places to work: Montgomery County Hospital District (MCHD) EMS, Cypress Creek EMS, Northwest EMS (kinda slow/small system but if you can get past that they pay pretty good)

Places that could be questionable: Harris County ESD-1 (it's what you make of it, really...I've heard stories of just shady, shady things going on at this agency, but they pay well and you WILL get experience with lots of critical patients), Cy-Fair VFD (cronyism has been a problem in the past, protocols are lackluster and I hear that you don't get first responders on many calls)

Places I know nothing about but might be good: Atascocita VFD, Crosby, Clear Lake Emergency Medical Corps (CLEMC)

Places to Avoid: Any of the 200+ private EMS companies unless you do your homework and find one that might be tolerable

I disagree. EMT-I's in some states, such as Maryland, have just about the same protocol as an EMT-P. I understand the I-85 protocol is vastly different than the I-99 but to say that the EMT-I level is essentially a "filler" is somewhat of an insult.

While I agree that EMT-I may be considered a stop-gap and that ALS should be a 2-year degree, it isn't fair to just say they are a filler and a way to bill for monitoring a lock. EMT-I/99's in most places can do a hellova lot more than monitor a lock.

I think EMT-I/85 should be removed, and I/99 be the new basic level and the scope of practice to include IV's, 3-lead ECG, advanced airway, and code drugs (plus a few more but that's more to debate). EMT-B should be done with, they are valuable members so don't get me on "bashing basics", but they should be I/99's. EMT-P scope should remain the same but be required to be a 2 year or 4 year degree and have the ability to do more diagnosing in the field...

Just my $0.02 worth...

EMT-I(99) seems to me like Paramedic Lite . 80% of the skills, with only some the education. Same great taste, 50% less calories. How is that not a stop-gap measure?

I'm not meaning it to be an insult. I've been an Intermediate myself (although an I-85...Texas doesn't recognize I-99). I'm not implying that someone would "settle" for I-99 because they couldn't make it through paramedic school. I do however have issue with states that use I-99's to compensate for lack of paramedics...or in Iowa's case, calling an Intermediate-99 a paramedic and an NREMT-Paramedic a "paramedic specialist".

I've also found that in most 911 systems, the powers that be aren't quite sure what to do with EMT-I's. Their scopes vary, in some systems they may be the lead provider on an ILS truck or first response unit, in others their ILS skills are sharply restricted. Our intermediates (85) are allowed to perform fluid resuscitation, administer D50%, naloxone, establish intraosseous access, and place rescue airways (King LTS-D). They are not permitted to perform endo/nasotracheal intubation or start E.J.'s, for example.

Your suggestion to make I-99 the minimum may hold some merit. That model is very similiar to Australia/New Zealand's. Their entry-level paramedics are capable of 3-lead interpretation, manual defibrilliation (and in some cases cardioversion/pacing), IV access, ACLS medications, naloxone, dextrose solutions, antiemetics, analgesia, rescue airway placement (usually LMA), etc.

The advanced/intensive care paramedics are trained to interpret 12-lead ECG's, perform oro/nasotracheal intubation, perform cricothyrotomies and needle thoracostomies, administer fibrinolyitics, perform rapid sequence intubation, etc.

I really don't think that oro/nasotracheal intubation should be authroized at the ILS level. You need to have other tools/procedures to fall back on. Surgical cricothyrotomy if efforts fail. Benzodiazepines to sedate the patient post-intubation if needed. Waveform capnography and the necessary skill in its interpretation. Needle thoracostomy if you inadvertently create a pneumothorax. Rapid sequence intubation if your medical director authorizes it. Just having a laryngoscope, some blades and a set of tubes isn't enough.

The "academy" is 9 weeks long...it encompasses a ton of topics that aren't taught in paramedic school, or that the education staff really wants to hammer home. It's Monday through Friday 0700-1700.

Topics include (but aren't limited to) airway management, cardiology, paramedic safety/defensive tactics, EVOC, helicopter utilization, MCIs, NIMS/ICS, Hazmat, swiftwater awareness, physical conditioning, Advanced Medical Life Support, crime scene awareness, scenario training, etc.

This is followed by 2-5 months with a field training officer on the truck. They evaluate every aspect of your call, from dispatch to clearing the hospital, and your overall shift performance. How soon you clear depends the particular person. Some clear in 6 weeks, some go almost six months. After this, you are cleared to duty as an independent ALS provider. You are expected to be able to act as a lone paramedic in charge of a scene, although all of our ambulances are staffed with two paramedics.

Sounds like a great place to get some experience, if you don't mine working in the cesspool that is D.C. Plenty of places to work that pay better and have lower costs of living.

Honestly...EMT-I/AEMT needs to go away. It's a stop-gap measure for communities and agencies that can't/won't pay for their EMT's to go to paramedic school. It's a filler...a way to tell people that they have "ALS" or to bill for an ALS transport to monitor a saline lock.

I can say this having been a former EMT-Intermediate (85).

I submitted my paperwork to ASNSW yesterday. We'll see what happens. Fingers are crossed.

Thanks. I hope my US EMS education won't be an issue compared to the Australia/NZ/UK model. I know you guys like your BSc degrees. Hopefully it won't be a problem.

Anyone have the exact details for paramedic vs. ICP as far as scope of practice goes?

Well guys, I'm getting my paperwork together for the Ambulance Service of New South Wales. They seem to be the most accommodating towards international applicants. I'm really interested in Queensland but I don't meet the three-year requirement for a sponsored permanent residency visa. With ASNWS I can apply for a sponsored temporary visa which is good for four years and then reapply for permanent residency (and citizenship at the five year mark). I'm just waiting for my certified driving record to come in and then I'll be mailing off my paperwork! I plan on visiting Australia at the end of the year/beginning of next year on holiday and to interview. While I love New Zealand, I think that the opportunities for career advancement are better in the land of Oz, not to mention the salaries are quite a bit higher. With my qualifications here I anticipate being offered an ICP position if my application process is successful (just looking at their scopes of practice). Wish me luck.

I'm writing up a summary of my education/work experience/scope of practice. Do you guys know of places that are *actively* recruiting international applicants and have had good experiences recruiting those types?

I'm considering applying for employment in NZ or Australia and would like any advice or feedback you guys can offer. I've been a full-time paramedic in Texas for about one year and nine months.

On the Oz side, I'm specifically interested in the Queensland Ambulance Service, due to their active recruiting of international applicants and the overall positive feedback I've received regarding the service and life in Queensland in a whole. I am interested in other services as well if you have any to recommend to international applicants.

As far as New Zealand goes, if you guys have any experience or anecdotes about international applicants with St. John's or WFA, I would appreciate it.

I'm young (early twenties), single, and I have no kids. I'd like to experience life in another part of the world and I think that both countries would be incredible places to live and work.

Thanks

Are there any forums that are specific to EMS in Australia and/or New Zealand? I'd like to read up as much as I can. I'm considering applying for employment in the near future (after I visit) and would like to find out as much as possible.

AED if over one year old. If under, manual defibrillation only. The AED's are made by Phillips. Our monitors are Lifepak 12's. Starts at 2J/kg for defibrillation.

Do you guys take riders/civilian observers? I'm planning to visit NZ next year.

The academy is 0630-1700 Mon-Fri. You go to class for six weeks, then to the field for four weeks with your FTO, then back to the academy for your remaining three weeks, totalling thirteen. After graduating from the academy, you ride out with your FTO as you pass through the phases (I through V) and credential as an independent provider.

Shift bidding is based on seniority, AKA how low your employee number is. When you clear, you will get a list of the available shifts and can pick based on what's left, since it will probably be in the middle of a bid cycle. Regular bids occur every 6 months and you pick what's left when it's your turn to choose.

I dont' post very often but I had to share my good fortune. School and trying not to be a knucklehead has paid off. Now I guess I can really start learning.

Congratulations. I was hired there last June, I was released into the wild on my own in October. Let me know if you have any questions.

I'd fire their easily replaceable arses and hire people for half their salary in order to both help with the budget and make a profound statement about whining.

We have nice protective equipment (helmets, extrication turnouts, ballistic vests), and my cohorts whine and complain because "it's too hot", "it's too heavy", "it's too expensive"...give me a break. Then they violate policy by not wearing their protective gear when they're supposed to and THEY get pissed off about the discipline that follows. "We've never had a medic get shot since the service started!" Great argument. I tell them to be thankful that the powers that be decided to provide you with gear that most agencies couldn't care less about...they just want to meet the OSHA/USDOT minimums so they don't get in trouble. I feel like I'm talking to a wall.

Pepper spray would be nice, it can be easily concealed in a utility pouch. A Taser with an attached video/audio camera would be ideal. That would help cover the agency's ass if it was ever used.

Some of my coworkers are whining about our ballistic vests, saying we should sell them because of the budget crunch. Then I send this link out and they get pissed at me for "giving management reasons to keep them" :roll:

I carry the Informed ALS guide at work, I think it's great. Very useful for looking up a patient's meds to find out some of their history...because we all know that a lot of our patients don't know their medical histories or understand their medications.

It's an all-around great reference to have, especially at 03:00 when you're foggy and trying to figure out abdominal pain, some medical Spanish, drip rates, overdoses, etc.

So Big Shears are a piece of gear that are actually worth the cost and perform as advertised?

Yes. I won't ever go back to regular shears. I've been on scenes with a coworker fumbling to cut through clothing...hand em the big shears, and it goes through it like a hot knife through butter. People may raise some eyebrows or poke fun at you until they're asking to borrow them and are inevitably impressed...then they ask where to order them from.

There are some things a professional paramedic shouldn't skimp on. Boots...a quality stethoscope...and I'll add these shears to that list.

This is the vest that I am issued at work. The vest itself is made by Point Blank. As you can see, it consists of a navy blue external carrier that goes on over your uniform. It has removable level II plates by Second Chance (not the best but better than nothing...I'd like level III if possible). We also have a blunt trauma pad that goes above the front plate.

Have you moved on from EMS to greener pastures? I want to hear your story. I'm still new to the game but I'm already looking into new things. I don't have a family to tie me down so I can really go anywhere and do anything. In particular I'm looking at becoming a military officer or pursuing a federal law enforcement position (FBI, Customs, State Department).

I'm supposed to start my prerequisites for medical school this week (I have a B.B.A. and none of the sciences I need). Somehow the future for physicians isn't looking as shiny...with baby boomers retiring, lawsuits, malpractice insurance, reimbursements down, etc.

I just got mine in the mail...pretty kickass. I know some of you had complained that the Big Shears holster only allows you to wear them horizontally, in the small of your back. I found that this: http://www.bianchi-intl.com/product/Prod.php?TxtModelID=8011

fits Big Shears just great, and allows for vertical carry. Get the largest model, made for the Streamlight Stinger LED (the one made for a regular Streamlight Stinger won't fit...the LED model is a little bigger).

$10.85 + S/H here: http://www.copquest.com/14-6500.htm

Just thought I'd pass it on.

we are all better off reviewing past mistakes of ourselves and others than running around in a vest thinking it's going to save us. Every medic I've worked with or around who wears a vest has, either through attitude or plain bravado, consistently been far more likely to find him/herself in a dangerous situation than the next medic. Coincidence? Not likely. More often than not it becomes a false sense of security.

Also fail. By your logic, do you think we get a false sense of security by wearing gloves, reflective traffic vests, or extrication jumpsuits/bunker gear? If anything, donning my vest reminds me to be even more careful.