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A woman and a man are involved in a car accident on a snowy, cold Monday morning; it's a bad one. Both of their cars are totally demolished, but amazingly neither of them is hurt. God works in mysterious ways. After they crawl out of their cars, the man is yelling about women drivers. The woman says, 'So, you're a man. That's interesting. I'm a woman. Wow, just look at our cars! There's nothing left, but we're unhurt. This must be a sign from God that we should be friends and live in peace for the rest of our days.' Flattered, the man replies, 'Oh yes, I agree completely, this must be a sign from God! But you're still at fault...women shouldn't be allowed to drive.' The woman continues, 'And look at this, here's another miracle. My car is completely demolished but this bottle of wine didn't break. Surely God wants us to drink this wine and celebrate our good fortune. She hands the bottle to the man. The man nods his head in agreement, opens it and drinks half the bottle and then hands it back to the woman. The woman takes the bottle, puts the cap back on and hands it back to the man. The man asks, 'Aren't you having any?' The woman replies, 'No. I think I'll just wait for the police...' MORAL OF THE STORY: Women are clever, evil bitches. Don't mess with them.

Why did I expect this to come from you Annie????????

Young Paddy bought a donkey from a farmer for £100. The farmer agreed to deliver the donkey the next day. The next day he drove up and said, 'Sorry son, but I have some bad news. The donkey's died.' Paddy replied, 'Well then just give me my money back.' The farmer said, 'Can't do that. I've already spent it.' Paddy said, 'OK, then, just bring me the dead donkey.' The farmer asked, 'What are you going to do with him?' Paddy said, 'I'm going to raffle him off.' The farmer said, 'You can't raffle a dead donkey!' Paddy said, 'Sure I can. Watch me.. I just won't tell anybody he's dead.' A month later, the farmer met up with Paddy and asked, 'What happened with that dead donkey?' Paddy said, 'I raffled him off. I sold 500 tickets at two pounds a piece and made a profit of £898' The farmer said, 'Didn't anyone complain?' Paddy said, 'Just the guy who won. So I gave him his two pounds back.' Paddy now works for the Royal Bank of Scotland

Paddy is planning to marry, he is, and asks his family doctor how he could tell if his bride-to-be is still a virgin. His doctor says, "Aye, Paddy, all Irish use three things for what we call a Do-It-Yourself.... Virginity Test Kit.... a small can of red paint, a small can of blue paint and a shovel." Paddy asks, "Aye, and what do I do with these things, doctor?" The doctor replies, "Before ye climb into bed on your wedding night, you paint one of your balls red and the other ball blue. If she says, "That's the strangest pair of balls I ever did see...", you hit her with the shovel. May I just say to those who will not read this as humour, or try to read more into it than they should, I never have & never will condone violence towards women.

I think we really need to look at this in perspective. If a person has cardiovascular disease, we have no hesitation in leaving them at home to self administer meds & in essence care for themselves. Same with diabetics, epileptics & just about any other illness. The problem with mental illness is the stigma that is associated with it. This is primarily media driven because they are at pains to point out that a person was bipolar or schizophrenic. Why dont they tell us that the person suffers from IDDM? or cardiovascular disease? Mental illness covers a range of illnesses & the vast majority of people with mental illness can be & is sucessfully managed at home, as are most other illnesses. What we see in EMS is the wort cases of people who have a severe mental illness & represent a very small percentage of people who suffer a mental illness. This tends to give us a jaded opinion of mental health overall. In most commonwealth countries many people over the years (and this included such things as women with PMS) we held at the pleasure of Her Majesty until they could be cured. Would we consider this at all for any of the other illnesses I mentioned (although this was the case for many years for people with epilepsy, but attitudes changed with advancement in medical science & epilepsy became an 'acceptable' illness). People with mental illness, rgardless of personal opinions, still need to be treated with dignity & the wholesale institutionalisation of sufferers has not been a standard practice for many years. There are those who do need to be kept under scrutiny for their safety, as well as the safety of others, but personal liberties need to be maintained. Here, & I can only speak for my state, this is covered by legislation & to keep a person, they can only be held for more than a minimal period (time frames vary depending on availability of psych beds & full competency assessments) under the order of a court. This legislation stipulates what the persons entitlments are & appeals processes. However the main underlying tone is that the aim is to keep the person only for the period of time that is long enough to assess & if necesarry medicate & monitor with a goal of release back into the general popuus at the earlies possible time. This is becomeing increasingly important considering the World Health Organisation lists that by 2020 worldwide Mental Illness will be the second biggest killer in the world behind trauma.

Without readin too much, what is the priority whe a person suffers a cardiac arrest? Is it airway? No, Is it breathin them up? No. Is it defibrillation? No. Is it gaining IV access & dru administration? No. Simply it is effective CPR. Do I need to be a medic to perform CPR? I don't think so. Relity tells us survival rates are minimal, regardless of Basic. Intermediate, Medic, or doctor.

Glad someone picked it up. I was curious to see who would.

Does than include proper grammer & proper english?

The term prehospital is a relevant one. We work in a prehospital area. Some patients need hospital (still referred to as inpatient) some can be treated on an on going basis at home (outpatient). We are too hung up on making ourselves sound more important than we really are. Paramedics (a generic term) now calling themselves Emergency Medical Technicians, Police are now Law Enforcement Officers etc. Lets cut the BS. We provide in essence a care level that is pre hospital. To break the word down, dictionary.com states that & . we are providing care before the patient goes to hospital. If they refuse, or, as described in some cases choose not to go is irrellevant, we are providing care before the hospital does.

chbare, that is why i suggested a total review of EMS service delivery. The primary function of a medic is Cardiac. This is why we call them Intensive Care Paramedics. If you have a basis that allows a platform of quality pain managment (morphine as a minimum), the ability to control seizures etc, then you can offer these officers different options. Instead of having 1 option - Intensive Care - why not look at Competency Assessment for referral to community based, in home care, or extended care, take basic medicine to the people who most need it & can least afford it? A complete review can allow for this to happen, all the time remembering we are not doctors, we treat symptomatically. That is, if a person has chest pain, we treat them with ASA, nitro, O2 & morphine with transport to hospital for difinitive care. We do not look at lifestyle, blood work, diet, smoking, ETOH consuption etc, all contributing factors. Nothing to do with EMS. What we are seeing is a manifestation of (in most cases) years of self abuse, obesity etc. Alternativley, if we see someone with Hypoglycaemia, is it our position to be looking at lifstyle etc or treat the presenting problem & at the very least reccomend a visit to their local Dr? A total review can put these processes in place & deliver better services to the public. Relicance on Intensive Care, & thinking that they are the be all & end all is misguided to say the least. Reality is the main time we here use ICP's is in a Cardiac Arrest situation. Lets look at it objectivley. How many survive? Regardless of a piece of garden hose (yep we secured the airway) & some embalming drugs (I am sure we got some fine VF there, or was it artefact) the results are very similar. The latest guidelines tell us that CPR & defib are the priority, even before airway. Most definitley well before drug therapy. The most common problem we encounter is pain. By upskilling & allowing the use of pain managment (quality) at an intermediate level is paramount. Understanding pain is also paramount. I say again, we really need to consider is having medics the be all & end all, or should we completely review current practices & upskill them at the basic level, then the intermediate level, to provide better care for our patients?

This is indeed an interesting & rare disease, also known as Stiff Person Syndrome. I have treated a patient with this, post diagnosis. The patient was on high doses of Codeine, valium as well as anti depressants. When we were called to this patient, it was usually at their darkest time with pain in the extreme. All we could do was pain manage them until we got to hospital so they could implement further stratergies developed by this patients neurologist. I pity any person diagnosed with this illness. It is truly a case of knowing that someone is really worse off than you are.

Isnt that more reason to have a complete review of EMS (no I do not want to debate fire here as well) systems, skills & increase their skills?

Isnt this a reaso to look at an across the board skill set change? Lets face reality, times have changed & what changes have been made in the past 30 years to an EMT-B or an EMT-I? To demand a medic is not always the most appropriate thing, we have many stations that do not have 'medics' on them, with the nearest, i some cases over 1 hour flying time away, but with upgraded skills that have been developed over 30 years, we can adequatley treat these patients & get them to appropriate care. In my humble opinion, that is, right across the country, going to be more beneficial that stamping your foot demanding medics in 1 area. As a suggestion, if you have some down time, go back over your cases for the past 12 months & work out how many really (not just might have) needed the services of a medic. I think you will be genuinly surprised at how little they are needed.

I cannot speak for Canadian or New Zealand systems. Within Australia we have 6 seperate services, 1 in each state, with 5 of them government run, 1 privatley run, under contract to the state government. I can only speak for my service. A government run service. We have 2 forms of entry. Graduate & general. Graduate entry requires the completion of the university degreee & the person is fast tracked to a set level. General entry is for everybody else & takes additional time to achieve the same level. Both commence with an 8 week induction program. This covers Anatomy, physiology, pharmacology & skills needed to operate on road. During this time all officers have 1 week where they are observers on road. From there, these officers are laced at a station as a Trainee Paramedic (all officers here are referred to as Paramedics). They spend 10-12 months undertaking practiacl experience, as well as distance education in preparation for their next stage. They work under supervision of a senior officer. Once this stage is completed they return for 3 weeks of education. This encompases more in depth anatomy, physiology & pharmacology, as well as assessments on skills, learning new skills etc. At this point these officers are posted to a station. This will most likley be rural. This is for a period of up to 24 months. During this time they have continuing contact with Clinical Training Officers, Paramedic Educators. They then return for another 3 weeks of didactic education. More in depth anatomy, physiology & pharmacology (added to each time) & more skills added & assessments. Provided they pass all exams, they will graduate to Paramedic at this time. Graduate students skip the second level of study & qualify as a Paramedic after serving as a trainee for up to 12 months, as recognition of Prior Learning. After this our service calls for anyone interested in becoming an Intensive Care Paramedic. This is a competitive process requiring a written application & interview selection process. If sucessful, the person then undertakes 6 wseeks of didactic training, 4 weeks of theathre time to develop intubation skills & 6 months supervised on road time. Following this they then continue to work, unsupervised but are not considered fully trained until they have completed their first recertification 1 year later. Those who have attained a Bachelor of Clinical Practice (Paramedic) as still subject to standard employment applications & are not gaurenteed a career. Many who choose tyhis degree also undertake nursing & prefer that as a career option.

Ruff, well said, & from the heart. In some ways I doo agree with you. In many others I cant. Competency is relative & where there are dual roles there will always be a stronger focus on one over the other. It is the nature of the beast determined by who is in charge at the time. The problem is, when Fire envelopes EMS, the managment structure is Fire based so will maintain a Fire based focus firstly, EMS secondly. When we arrive at a persons house who is having a possible cardiac event, there are 2 of us, in uniform who quietly go about our business. We try to avoid creating a scene & have the patient removed quietly to hospital. This can be & does have the opposite effect when a fire truck pulls into a quiet suburban street. Why, because now with the noise, everyone know whats going on. I have seen it directly increase a persons heart rate & increase the chest pain they were suffering, & we only needed an assist load down some stairs. If there is an insistance that they be combined, run them completely seperate, no dual roles. Keep the BRT in the shed. Allow those who only want to be involved in EMS to do so, without forcing fire on them. Dont hinge wages on holding an EMS qualification to those who chose to fight (the lack of) fires. This allows them to concentrate on what their passion is. By pinning the 2 together, in many ways the lies & propaganda that is out there is being perpetuated. It is only there for fire to justify their existance & FF's are only taking on EMS to bolster their pay packets. Surely this is not in the best interest of the patients out there.

I have reread my original post & I didnt say if I had a degree or not. Your assumption is incorrect. No degree here is 2 years. If you want to do an appropriate degree, on its own, it is 3 years. We also have the option og general entry, which, once again is 3 years to qualify to a stage that is somewhere between an EMT-I & EMT-P. Even those with a degree will go to this stage & then go through a competitive process to be accepted into a Paramedic training program, regardless of having a degree, for a further period of training. We are also required to undertake personal & professional development over a 3 year period with skills certification in that time as well. I have made many references to the need for the US agencies to increase their skills modelling, without claiming ours to be perfect. The body of knowledge we are taught from day 1 prepares us for autonomy (ie, no medical control to discuss options with), as well as giving us the skills & drugs to properly treat our patients. I suggest you read some of my medical posts to see if I am a Medical First Responder. 6 Figures is common for rural officers here, with metro around 90K US.

I have looked at the link & found it to be nothing more than propoganda for the fire depts. If I may I would like to address some things I found on the first page of the propaganda web site. Why can stand alone EMS systems not have the ability to To think that this is only available through a combined service is niaive to say the very least. I find this statment interesting. Interesting that they mention . The patient, the whole reason for being is mentioned last. To me this shows the priority is not on patient care as a primary function, but a secondary role. There are a lot of broad statements that are unsubstantiated. & finally, Where is the evidence. The PASG used to be an EMS standard, but we no longer use them because the evidence does not support it. Look at the discussions on the Golden Hour, the changes in fluid replacment therapy in trauma. All have changed, treatments for cardiac arrest. Changed. Were these changed cause someone said so? No. They were changed because the evidence that the change provided positive outcomes said so. If you want to be taken seriously, do provide this propogana as evidence that what you say is right. I could write a web site with broad statments like this one, with no evidence, to argue against what they say. EMS works on Evidence Based Practice. If an inquiry finds that EMS services are inadequate in an area, then it needs to be remidies, if it is a private company, then there operations need to be reviews. That does not mean that the fire department should jump up & down to demand it so they have more to do. The goal should be increased patient care. Improving patient outcomes. I have asked you for evidence on this before & never received it. Now you want to pass this self serving propoganda up as evidence??????? Lets get serious.

Dwayne, Unions here in aussie are strong, industrial bodies. We also have professional associations that we can be involed in. The main thing to remember is that our Industrial Relations systems are different. The state I am in has all employees under an Award that covers all employees, and is in force for a 3 year priod. In essence, our Union represents us on industrial matters, associations for other matters. That isnt what I said. I said without a degree. OT is optional unless extention of shift.

Has he got dirty knees?

Dude, we make 6 figures without the degree, without dual role, without a promotion to Lt & without ALS. but this isnt a pissing competition. enough said.

Hmmmmm, How much do I earn? Well, even on a poor exchange rate, more than 46young. Shifts are 8 on, with 7 nights on call, 6 off. Plenty of OT if you want it. House prices, up to $US270 for a 4 bed+ house. No dual roles. EMS Only.

You are a broken record. Nothing more, nothing less. I can gaurentee you that if we wanted to, we could run a media campaign that woiuld make ALL people understand the relationship between Fire & EMS & make them vote for whoever seperates them. Get your head out of your ass.

Crotchity, have you been reading my posts again? I like the idea!!!!

I agree Richard, but then we could also consider Oklahoma City. Another once in a lifetime. The point was there are one off events that happen that will overwhelm any cities resourses. No disresect was intented to anyone. However, the people of Kempsey said the same thing. They get on fine because SES/VRA/Police Rescue/Mines Rescue do not want to take medical work away from us. What is interesting is that fire are not interested in vertical rescue, but want to selectivley choose what they do. Road rescue is the main one. The biggest problem is that if EMS are doing their job properly, they are on scene & gone relativley quickly. The patient need to be in hospital, not on scene or in the back of an ambulance. Fire are required to stay on scene for a lot longer, so, by the time the TV cameras arrive, who is left there? People want to see something on their TV so they film a Fire Truck. It gives people a false sense of who does what, but makes Fire look like the Hero's. IAFF has 1 job & 1 job alone. They do it well, however, there needs to be fact put into any argument. As we have seen with threads here on The Golden Hour, the facts show us different to what was accepted as fact many years ago. Facts do not support their arguments.

So what happened when you took them Dwayne????????