chute

How about if the worker had a legit script for let's say, Marinol? Hey read a PDR on alot of SSRI's and other anti-pysch drugs. All legal no body says crap yet many EMS. Cops, Firefighters use these (hey they are legal by gosh). Obviously ya dont want someone impaired on the job right ? A urine test tells you a person has a drug in their system. It does not tell you when or how long that drug has been in their system although we know some drugs dont stay in your system that long compared to others. I respect doczilla's medical opinion as an MD but if all MD's agreed about all treatments and Rx, then medicine would be a science instead of an art eh? I think most services would have their Medical Director give a GO/NO GO for an EMS worker on a DEA scheduled 4 Rx before they were cleared to work. I would if you were working under my license! Be safe and remember just cause a PDR says an Rx is indicated for this or that, an MD can pretty much write a script for what he/she wants. Look how many people you transport taking cardiac/resp/GI/Endocrine Rx combo's clearly contraindicated per PDR so why and how does that happen? Yes I expect rounds to start coming in now but thanks just my opinions folks! Be excellent to each other!

Very interesting topic and responses as well. My experience in LV, ATL, LA, and other states is that there were many times when it was better to book to the ED instead of intubating at the scene. In my opinion, it's all about making a good fast assessment with regards to where you are at, what do you have, and where you are going + time to get there. Also, it is my opinion that it will depend on the type of service and EMS system you work in. The two tier systems used in many states out west waste alot of patient time in my opinion - too many cooks in the kitchen! One thing I do believe, until EMS gets the education and training standards implemented to enable true licensure leading to a scope of practice and a national standard for us all, then I think EMS is doomed to remain like it has been for the past ten years. A low pay, no respect, stepping stone medical job! Dr. Bledsoe's article and many posts on here by veteren members are spot on regarding this post, Thanks.

Hey there Katiebug from Shelby County! Well that was interesting but of course vaporizers have been around a bit along with other alternative goodies. The worship of money in it's many forms will prevent any of these alternative things from gaining too much steam to start an overthrow in my opinion. Besides, if we would legalize some things, then we could use vaporizers properly and not have all the tragedy associated with legal stuff like alcohol, SSRI's, tobacco etc... Also, maybe this new Pres. will get some of this alternative energy stuff in motion. Cant' see any overthrow of the govt. anytime soon though! You take care and thanks for the informative post! Rgrds, Chute

Hey amigo, Try IHR canada, Helen Ziegler, CCM out of Dublin with offices in Sydney & UK too. They post some jobs in that neck of the woods. UAE is mostly RN as stated earlier. Other opportunities check with Frontier Medical out of UK or Remote Medical out of Seattle. Good luck! Rgrds, Chute

Chattanooga EMS has a great system with Fire response on most calls. It is not a two-tier system like most out west and HCEMS has scene command. The fire dept. and HCEMS work well together however sounds like Fire is just upgrading to enhance the system. Exactly what level 4 EMT care entails will obviously be spelled out as the process moves forward and further information will come from Nashville and locally I'm sure. HCEMS site and Chattanooga Fire site might have some info on this. Interesting. Rgrds, Chute

Down & Dirty Dopamine Drip with 1600ug bag: Patient weight in Kg divided by 27 Multiply result by how much you want to give ; 5mcg, 10mcg etc Answer = gtts/min Better to have a pump or dial-a flow though! Rgrds, Chute

Don't sweat it sounds like you are ready! I took the cbt in mid Jan. I was suprised the questions were short compared to the long scenerio based studying I did. My test stopped about 67 or 72 questions. I felt pretty good and dont feel like there were hardly any bizarre questions. I passed and now have a new star date haw haw. Anyway, clear your head the day before. Your ready so relax and do it! It's a heck of a lot easier than doing the ole 48 refresher and such especially if you work remote. Not bad for 110$. Doing it the old way was more time comsuming and left me skint after the proverbial EMS cashectomy thats performed every time we take a course! Sooooooooooo, your ready amigo. Do it! Kind Regards, Chute

I agree the bottom line if you want to travel in EMS is get your NR! Plus all US government jobs require it and you'll need it for international gigs as well. Reciprocity means different things in different states whether they call it certification or a license you'll still be working under an MD license as there is no standard scope of practice for EMS providers (hence no true licensure!) Anyway, the main hoops you'll jump thru will be the surgical procedure performed on your wallet (cashectomy) and all the forms, tests etc you'll have to do to get your knighthood for a particular kingdom. Some states are easier than others. Good luck and enjoy. I've enjoyed working in different systems and learning more. Take care.

There is no reason to cheat on an EMS exam at any level. If you pass, you will simply be required to take further exams despite having passed exams for certification/licensure. Example: Why do services test an applicant who already has certification/licensure as an EMS provider? To get the best of the best of the best? To certify that the EMS provider really really does have valid credentials? It is mad the way our "profession" has evolved over the last 40 years compared to other medical professionals! If we truly are EMS professionals at what point are we considered certified/licensed?

Fentanyl has a better side effect profile than Morphine in my opinion. Use of both in the prehospital arena is a Medical Directors decision based on cost issues and preference. It's nice to have multiple tools in the box though depending on where your at. Same issue with Phenergan vs Zofran. Depends on MD preference and cost (and kingdom rules ha ha). Certainly a dynamic issue! Thanks

I would reccomend investing your time and money into another medical discipline where your pay and benefits are commensurate with your responsibilities and duties like Nursing, X-ray, PT. Resp. Therapy etc. Once you complete your training and get certified/licensed, you will not have to take test after test when job seeking nor jump thru hoops that cost you lots of time and money. EMS can be rewarding for sure but pick a field where you get paid decently for doing something you desire! Good hunting.

Does your city use two tier EMS systems and what do you think about it? I have worked systems that have Fire respond for manpower, car crashes and to assist EMS and I have worked with two-tier systems where an ambulance responds with Fire (city or county depending on where the call is) and Fire has ultimate scene command. My experience is two tier systems are more challenging (too many cooks in the kitchen many times) and lots of unnecessary scene time and conflict. Two examples are Las Vegas NV and Albuquerque NM.

Until and unless all states can agree on standards, EMS in the US will never have a national scope of practice for EMS providers. Some states call it certification and some call it licensure however no matter where you work in the USA as an EMS provider, you still work under the auspices of a physician. Plus, no matter where you go to work as an EMS provider, you still have to take more tests and jump thru many hoops to work even if you have current certs etc. and it just is not commensurate with the responsibilities and pay/benefits. (unless you go fire or flight). Tough all around eh! I had NREMT and two current state certs plus all my cards, (ACLS,PALS,PHTLS,AMLS, CPR etc), and I moved to FL. They said great, we will allow you to take our state test ($85). Then when I could apply for a service, I had to take more tests etc etc. Its been the same in a few other states as well. Tough to travel as an EMS provider. Anyhow, ya gotta do it if you want to work thats just the way it is with EMS in this here good ole USA! Best to all EMS providers thanks!

Regards All! My SITREP is not a problem inhouse at all however just now I'm working a two-tier system which can really be too many cooks in the kitchen so with regards to dual Medic partners it's a good deal & no worries. Here in LV it's an interesting 2 tier system that works but you can get some wanks who'll muck your scene time up with nonsense! Mostly though it's a decent time. Thanks for the time! Chute