nremtp

I need PEPP Advanced or PALS and I wouldn't mind AMLS if it's the right price. Can you please put a list of links for those training courses or pm them to me please dust? Would be much appreciated. Doing my Para with EMT Inc

I need PHTLS, ACLS and preferably some other alphabet soup courses as soon as possible. I was going to train with emtinc but they have dropped virtually all of their courses and don't have any coming up. I need the courses at the same time within a week or so because I can't afford to fly from England to USA repeatedly! Ideally I would like to come over and do the courses in one trip. I have an EMT-P accelerated course coming up but want to get the alphabet soup ones out of the way first. Anyone know of any good training providers with courses coming up?

We have a cereal called "Rice Krispies" in the UK which make a "snap, crackle and pop" noise when you pour milk on them. Sub Cutaneous emphysema (called surgical emphysema over here) sounds a bit like that when you touch it. I have only seen it twice, once in an elderly lady in LVF and another time in an asthmatic. I found it both times during my primary survey of the respiratory system when I lay my hands on the chest and feel for equal expansion. I suspect that this is how the original poster found it as well, but I am just guessing based on my own experiences. I did see one episode of "Emergency Paramedics" (a documentary series) where a man had suffered a chest injury and was puffed up like the michelin man. It looked like severe anaphylaxis but was actually surgical emphysema. Crepitus doesn't just refer to bones as another poster has stated. Just my tuppence worth.

t depends on their competencies doesn't it ... the point that seems to be being missed repeatedly is ... that a registered practitioner of what ever profession's duty of care is notdischarged by the simple presence of another provider AND, IF the other provider is not registered, the registered practitioner may well beheld accountable until thepatient is delivered into the care of another registered practitioner That is the funniest quote I have ever read! In a roundabout way, zippy is trying to say that a speech therapist, arts therapist, chiropodist, dietician, clinical scientist, occupational therapist, prosthetist and radiographer are more qualified and appropriate to deal with a medical emergency on account of them being "registered". So beware all NHS Ambulance Technicians because you will have to give way at the scene of any emergency to any of the above healthcare staff because their first aid certificate is far more appropriate than your emergency medical training and experience. You are so full of shit zippy and that post proved it. You have no credibility whatsoever and on the basis of that one post alone you have proven what an idiot you really are. Do you honestly believe that any Court in any land will ever agree that a speech therapist or dietician is more qualified to deal with an emergency than a Technician/EMT? Do you really think that "registration" automatically means someone is more appropriately equipped to deal with a medical/trauma emergency? You are pathetic! You are the worst type of healthcare professional because you do not understand, respect or recognise either your own limitations or the limitations/scope of practice of other healthcare workers.

I think this thread should be allowed to run because it raises a very important point that affects us all. You have still failed to answer my question though zippy. Your entire argument stems from the fact that nurses are registered but Technicians aren't. Do you therefore think that simply because a Physiotherapist or Chiropodist is registered that they are also more competent and appropriately qualified to deal with an emergency over a Technician? A PGD is only valid in the workplace and only for a set group of circumstances, you cannot deviate from these. You cannot for example give morphine to lower blood pressure if the PGD is only for chest pain. A PGD is essentially a document signed by a doctor, pharmacist and senior nurse giving you permission to administer a drug in a set circumstance. This is called a protocol, something which you attack US Paramedics for having to follow. This is not autonomy! Autonomy is having freedom to administer a drug or perform a procedure when you and you alone deem it fit. NOT when a protocol says you can/must do something. You are not a nurse prescriber, you do not have any prescribing rights therefore you have no right to administer any medication outside of your workplace. If you take drugs from my ambulance or my bag and try to take over the care of my patient then you are committing a criminal offence. Those drugs are there for me and my crewmate, not some jumped up off duty nurse. You have no authority or legal power to use those drugs on anyone. Pre hospitally, you are about as qualified as a first aider and have the same rights if not less. If you honestly believe that you can take drugs from your workplace and use them pre-hospitally then I hope you do so because when you die you will go to hell where you will be eternally spanked by the baby jesus. Failure to recognise limitations is the biggest cause of error in the health service and inability to recognise human limitiation is the biggest cause of aviation related accidents. You zippy, need to recognise your limitations and scope of practice. You are not allowed to administer or prescribe any drugs autonomously, you cannot simply give a paramedic (or even technician) level drug without direct reference to a doctor. Technicians can give schedule 7 drugs as they are administering them in the course of their employment. You cannot just walk into a pharmacy and demand a drug for a patient, a paramedic on the other hand can! Your authority to practice is through your employer which is why when you are in St Johns, you are no more than any other St Johns ambulance attendant. A Technician's authority to practice is also through their employer via the medical director. A Paramedic however, is licensed to prescribe, administer and supply medication through statute. They have the freedom to practice and make their own decisions, although they are accountable to a higher body who judge those decisions (sometimes unfairly). This is the difference, freedom to practice, make own decisions rather than having to seek permission or approval. A written PGD or spoken direction from a doctor is NOT AUTONOMY! A legal staute empowering one to make decisions and administer drugs IS! Heck, even chiropodists can prescribe more drugs than you can!

Zippy your whole argument stems from the lack of registration for Technicians (EMTs). Are you seriously suggesting that a Physiotherapist or Chiropodist is better placed to deal with a pre-hospital emergency than a Technician? They are after all registered with the same body who register Paramedics (the HPC). You cannot argue that simply because you are registered, you are more qualified and equipped than a Technician. You (that's YOU not anyone else) are not allowed to prescribe or administer any drug which has not been prescribed by a doctor for a specific patient. St Johns might not value Technicians very highly but I can assure you that the rest of the healthcare world does. Prior to registration, were Paramedics any less professional than they are now? Prior to registration, Paramedics still had the right to supply and administer drugs without reference to a doctor unlike nurses who can't even administer oxygen unless it is prescribed by a doctor. You cannot argue that some nurses have prescribing rights because we are not talking about "some" nurses we are talking about you. All registration did was affirm that Paramedics are accountable to a body rather than just their employer. All registration does is create an extra level of accountability; nothing more, nothing less. I seriously suspect that you are jealous of any healthcare professional who has more autonomy than you which is apparent from your blatant attacks on any non St Johns and non Nursing staff. You have attacked junior doctors before, Technicians and Paramedics and now you are attacking an entire country's healthcare system. Seriously, go back to school and be a Paramedic it's what you really want to do after all. I don't mean anything personal but I am sick and tired of reading posts from people (not just you) attacking my profession. A profession which I am extremely proud to represent and which is my life. I wouldn't do anything else and I get so mad when nurses act superior when in fact we have far more autonomy. You are the doctor's bit ch get over it.

Not this again! Please zippy why do you constantly attack Technicians? Who are significantly better trained in a specific area of medicine. Technicians (EMTs) serve a particular function and are trained specifically for that role. I have had a nurse removed from a scene recently and she was threatened with a new law which we have here in the UK. Promptly left the scene when the police constable told her what would happen if she didn't. St Johns is not the organisation you promote it to be on this website. The only reason you get away with some of the crap you post is because most of the people on this site don't have first hand experience of St Johns or know who they actually are. St Johns are generally the degenerates who were refused positions in the UK ambulance services. Their training is significantly less than an NHS EMT and they are simply there to stop the clocks (called ORCON or more recently Call Connect). As the NHS do not have to get a particular response to a casualty (any response will do regardless of suitability) they utilise St Johns as they are often free or very cheap. An ambulance stops all the government clocks regardless of whether the crew are properly trained or if the patient survives so the NHS see a cheap/free clock stopper and at least it keeps the degenerates from interfering with children (or does it? See BBC news link). You have to stop believing that simply because the NHS use St Johns when they are really desperate that this means they are somehow credible. The majority of NHS ambulance crews cringe when they see St Johns and if I am backed up by a St Johns ambulance then I beg my dispatcher to send me another resource. If there is none available then I do not let the St Johns crew perform any interventions and neither do my Paramedic colleagues. Over Christmas when we have to tolerate them on station, they are not allowed in the crew room and are not allowed to change the TV channel. They can pass through the crew room to the kitchen but aren't allowed to stop and must pay for their tea and coffee (we have to buy it ourselves.) They aren't allowed to sit on our chairs and not allowed to touch our stock room (although they can often be seen looking through the window and masturbating over the cannulas and ET tubes.) We hate them! We don't want them, they are dangerous and risk patient lives.

I know my home city and the surrounding towns like the back of my hand. I can give you directions from any street in the town to any other street in the town or surrounding areas. Why do I know this? Because when I was a kid out cycling with my friends we didn't have satellite navigation and we didn't have map books. You had no choice but to learn the streets! Nowadays people just type it into a computer and they don't learn the streets because they don't have to. My employer moved me to another town after we merged with another station and my response times started dropping because I didn't know where I was going or the sat nav took too long to get me there. So now, I completely ignore the satellite navigation and take a minute to find the address in the map book. After a couple of weeks you know roughly where you are going and it doesn't take long to learn how to read a map! If you get used to using maps then you will find that even being moved to another town shouldn't affect your response times. It does help to have someone who knows the area though. I was recently working in my home town with a crewmate from further afield who didn't even know where the hospital was. While he was still programming the sat nav, I was already halfway to the patient. If you really want to learn a town, I would get a map book and start learning it. Drive around the town/city with the mapbook and learn the main streets/areas. This is what London taxi drivers have to do ("the knowledge") and it works very well.

What do you really hate about this job? To be perfectly honest, there is only one thing I hate about the job. Everything else annoys me (the drunk who vomits on my new boots, the regular caller who monitors his BP every hour which has risen 10mm/mg so he calls us) but there is one thing I cannot tolerate which is starting to get me down. We are not seen as healthcare professionals! We are considered lower or inferior to RNs and every other healthcare profession. We are not taken seriously by the doctors or nurses and are seen as stretcher monkeys by people who wouldn't be able to do our jobs even if they had the balls. What is the one thing you hate about this job? What is the one thing which makes you want to leave EMS?

We have liquid morphine which is called "oramorph". Surely if someone drank injectable morphine it would undergo extensive first pass metabolism which would render the morphine inert.

BM in the UK means blood sugar levels, the name comes from a particular brand of blood glucose machine. A normal value is above 7mmol/l but less than 4 is considered an indication for treatment.

My first call was to an elderly lady collapse query cause. Strong offensive smell in the room (apart from my partner) so we deduced a UTI and dehydration.

Did I hear correctly? Did they give his name to the reporter? Is that allowed then? I too will reserve judgement because I have also been wiped out with prescription medicine last winter I was on cold medication which made me feel very euphoric and drowsy. I got to the end of the road because I felt fine but turned parked up and walked back home when it got worse in my warm car. Innocent until proven guilty? Or has the American legal system changed?

In the UK we have to prove that we have maintained our knowledge and skills. Certification as such is not required, just proof that we have kept our advanced life support skills up to date which can be through attendance at a seminar or simply just logging how many times we have performed the skills for real. However, I was expecting more for my money with the ACLS course. The ALS course just deals with rhythm recognition and when to shock. I was informed that the ACLS course covers significantly more and deals more with cardiac care than pressing a shock button. The job offer requires current AHA ACLS certification so I guess I have no choice but to attend the course and get the card. Are candidates tested or is it an attendance course? The UK course has skill stations that have to be passed and a report is written on each station. Fail a station and you fail the course.

they sure aren't going to teach it to you Then what am I spending my money on? A plastic card that isn't recognised in my country? Seems like a waste of time and money to me!

I have a job offer in the middle east subject to me passing AHA ACLS. In the UK it isn't reocgnised and we use RCUK ALS instead but the job I went for needs AHS ACLS. How tough is the course compared to the UK one? Is there anywhere I can buy the course manual to do some prior reading?

All the care assistants in the nursing homes I get called out to wear the same uniforms that nurses do (royal blue tunic) so it's impossible to tell who is a nurse and who is a carer. We had a 999 call to a nursing home for a cardiac arrest, when we got there it took them 5 minutes to answer the door. We were banging on the door and the foreign staff were walking past and looking at us but not one of them let us in (the door was glass so they could see us.) When we eventually got to the room, they had locked the patient in to prevent the alzheimers patient wandering into the room. Then we found out that the patient had been down for half an hour because they had called the GP first who promptly told them to dial 999. We reported the incident but guess what? Nothing happened. The nursing home were potentially responsible for the death of this patient but got away with it. Every single one of the care staff was Asian/Indian and spoke very little English. The patient would have probably died anyway even if they received immediate CPR and an AED but at least they would have had a chance. I have seen some horrendous abuse in nursing homes (yes it is called abuse, let's not give it a nicer word, let's admit the truth) and it sickens me. I would never put my Mother into a nursing home having seen what I have seen. Prior to my EMS career, I was a care assistant and I would never treat a patient/service user the way I have seen people treated. A lot of the time, the stories the care staff give us don't tie in with the condition of the patient. If it was a child then the authorities would take him/her into care and prosecute the parents. But it seems the government don't care about the level of care given to the elderly and allow these abusers to continue treating them this way.

You don't half talk a lot of crap zippyRN! The St Johns ETA course is 6 evenings long. You cannot include all the first aid level courses when calculating the hours spent training otherwise you have to include any first aid certificate and First Responder training into the EMT-B calculation. You have this ridiculous ability to exclude all information which disagrees with your opinion and include irrelevant information that supports your opinion. You also think that you are involved in EMS. This is rubbish, you are a nurse who volunteers for a pretend ambulance service. You have never been employed within an NHS ambulance service and have never experience proper EMS. St Johns don't even let Nurses administer drugs! St Johns policy allows qualified Technicians to administer Technician drugs but not nurses. So you are at the bottom of the health professional ladder in terms of EMS. 120 hours and potential no help for hours You clearly know nothing about American EMS. I am a registered EMT-B and am working towards my EMT-P. This statement is complete crap as usual. EMT-Bs in most systems are backed up by Paramedics and most services operate at least one Paramedic on every vehicle with EMT-Bs on fire trucks. Pull your head out of your arse, you're not even involved in EMS.

Of course the Queen's english or She wouldn't be the Queen of England :wink: zippyRN you really have to stop attacking American Paramedics and EMT's. Your own precious St Johns crews have less training yet you think they are "equivalent" to the NHS Ambulance Technicians. 120 hours can't be inadequate for an EMT-B and considerably less training at a lower level for a St Johns person be considered equivalent. You can't have it both ways Mr (or Mrs) zippyRN.

No, the purpose of a business isn't to provide a service but to provide a good service. If you provide a poor service no matter how cheap, you business won't last long. It is in the interests of a business owner to improve the reputation of his business and provide a good service. Customers are more likely to use a business which provides a better service than a cheaper business which provides a poor service.

"Private ambulance companies put profit first, patients second, and employees last" This is a blatant lie! Not all companies are like this. You also state the municipal services are cheaper to run. There is extensive evidence in Europe that proves, private enterprise is cheaper for EMS and also better for the patients.

My sanity lol The only way I can get a visa is if I get an investor visa which means investing a minimum of $150,000 in an american business (either a start up or existing business). I can't get a visa if I just want a job as a Paramedic as immigration don't consider Paramedics "professional" or "in demand". Nurses on the other hand....... So my only option is to purchase or start an ambulance service. Buying a service that already has contracts and a cash flow will make life a lot easier. I am particularly looking at California but the Cali Medic board is annoying. Not only do you need to register as a Paramedic with the State but also with each individual region you intend to work in. This is bereaucratic bullsh*t gone mad! Why register three times and obtain three licences? (NR, Cal, region) I have asked one of the sellers about 35 comprehensive and in depth questions about his/her business but have yet to hear anything back. I don't even know the name of the company! I have also emailed the AAA (ambulance not autos) but have not heard anything from them. Do you guys have some kind of public holiday going on? In the UK it is easy, you buy some ambulances and approach the discharge manager/bed manager at the local trust with your proposals. Private hospitals, you approach the matron. But who do you approach in US hospitals? I wouldn't know where to start. That's why I'm considering purchasing a company with existing contracts. Also, the outgoing owner provides training, there are already competent staff in place and money is already coming into the business. A start up might require 6 months capital before money starts coming in. If Cali Med (I think that's the name for Medicare in California) are as bad as I've heard, they will take months to settle invoices and staff don't work for free!!! EMS work is simply a case of applying for the contracts when the board put them out to tender, compete with everyone else for the work. I plan on starting off with IHT work to get some staff and money coming in and then once the business has a track record, we can apply for the 911 work. Is there anywhere I can go for specific advice on starting an ambulance company? The AAA haven't been very helpful so far.

I am considering purchasing an existing business with established contracts etc. This will reduce the risk and I am more likely to get an investor visa. I think finance companies are more willing to lend to existing businesses as well as they have a proven track record.

Can anyone recommend any revision/review materials for the NREMT-P exam? There are literally hundreds of books out there which claim to help you prepare for the exam and there is even a crappy flash card series which isn't worth the paper it's printed on. What I'm asking is, can anyone personally recommend materials which helped them prepare for their exam? Thanks

I am a strict atheist and this job makes me even more so. I was an atheist before I came into EMS and now I'm a card carrying atheist! The more I do this job, the more I realise that there is no God and if there is He is a vindictive bastard.