WANTYNU

Don't forget bystanders... LOL There's a lot of reasons to use resources "just because you have them" some good, some bad, most political (IMHO) I'm sure Richard B could easily elaborate on the last two... -w

Try [web:96f3b22184]http://www.notfortourists.com/newyork.aspx[/web:96f3b22184] for a start, it a great insiders guide to NYC. May give you some ideas.

This gets my vote for one of the most ridiculous posts I have seen to date. But not to be left out of the fracas, I’ll add my cent and a half… In a pinch watch MacGyver then try the improbable. Someone said it’s like trying to run faster than a bullet, instead of wearing a vest, I agree. Another suggested putting a concealed knife down the crack of your ass (OK this wins for the dumbest) why bring a knife to a gun fight? Not to mention what it would do to your pants when you bent over… And other answers from getting in and staying in shape (a good idea anyway) to getting a good pair of running shoes not practical as you should be in toe protective work boots. Finally the last (so far) stated your body is the best protection, I guess that applies if your superman. The best responses have intoned scene safety and the ten second survey… Truly the BEST protection you carry is your Brain, try using it BEFORE you put yourself in a dangerous situation. Remember: FOOLS RUSH IN… -w

Vent, first don’t worry about me, I have had far worse beatings on this site, then a little ranting from an experienced point of view. Second I have done and continue to do CC transports, so I don’t consider myself all that isolated from what happens on the floors (as opposed to the ED, which admittedly many EMS providers never get past). You and I may have advanced training and degrees, but I looked back and this was a discussion of education for paramedics compared to other disciplines, and I still maintain a 2 year degree is, a 2 year degree, and even suggest that a medics 2 year may be superior to that of a basic intro LPN, because the latter’s education basis is palliative care. I make no argument that there are individuals that are better trained and have more authority than their counterparts with the same title, take the Nurse PRACTITIONER who can write limited scripts as an example, but again the foundation of their training evolved from a different route of medicine then say a PA (who has the same script writing privileges). The unfortunate part of this discussion is in the noted limitations of “Paramedicine” as a career (btw which is not an “official” designation in Emergency Medicine). I work in a busy urban environment, at a very progressive hospital; I admittedly do not possess the viewpoint of what the majority of this country’s EMS face and deal with, case in point a one Doctor ER… As always IMHO. Be Safe, WANTYNU

Uncomprehending when they have heard, they are like the deaf. The saying describes them: though present they are absent. Heraclitus Don't be so hard Dust, through open forum, enlightenment can be achieved. -w

Spenac first thank you for starting this thread, it is so important to put this issue on the table and open it up. I see it in a slightly different order with one more item: 1. Nobody can even agree to disagree 2. Education 3. Money 4. ACTIVE / INVOLVED GOVERNMENT Representation All items are important, but in my view, one leads to improve the next. Thanks again for starting a GREAT thread! Be Safe, WANTYNU

Yea, it was in the early 80’s, worked in a lab that experimented on primates mostly, (I WISH I only entered data...) I’m not proud of it, pretty much the reason I didn’t push on to med school. Did help create a special drill that saved a guys life, still not worth what went on in the labs. After all that, funny where I am now. Payment for sins of the past. -w

So you mean the year I spent as a neurosurgical assistant at the Bronx VA hospital NY , my studies in undergraduate medical science, with subsequent Bachelors Degree and advanced Degree in computer science were wasted? Bummer. -w Of course I did a sterling job of demonstrating my education with that sentence… -w

Hobbits, where are the Hobbits, you can't have ground trembling earthquakes and middle earth without hobbits.... -w

Don’t get hung up on the specifics, just because they name certain drugs, the questions don’t ask for effect or are the choices correct, they’re really only math questions. You stated you were looking for word questions, not pure math (6/2=3). Take another look, they not as hard as they seem, and you are testing for aptitude, after all, the purpose of a word problem is to see if the person taking the exam can pick out the relevant information. -w

Wow, OK, well then first you should know I read and like your posts, I always find them educated and well informed, however I’m not sure what you’re saying here, it seems except for a couple of statements, we basically agree, and where we don’t, you’re entitled to you opinion as I am mine. I think we’re in agreement here, as I’m not talking about what is not, but what is, as in you can compare one two year associates degree with another, in both quality and substance.

Ya know, you never fail to surprise me, just when I think you couldn’t be more wrong, I see you couldn’t be more right. I think you and I are getting hung up on this “Practitioner” wording, as you noted, I also look at the ambulance (may I say Pre hospital setting) as our domain, we need to own it, it is ours and ours alone. When I say Practitioner I am only trying to raise the descriptive language to that of other fields, as I feel strongly we are a specialty in and of itself. If my statements were viewed to imply that we start providing non emergency care, let me clarify that home palliative treatment should be left to the visiting nurse services. As for the folks that want to work in the ED, let them take tech or nursing classes, or go to medical school… for me the less time I’m in the ED the better! (did you know there are SICK people in there?)! Thank you for your post. Be Safe, WANTYNU

We should know our place… ??!? I usually like your posts, but you missed the side of the barn with this one. So by your language since I sometimes transport people on a vent, I should have a RT with me, drips, a Doc, or RN, plus there is no need for EMS on tactical teams, USAR or SAR teams, DAT teams, Airports, Transit, or any where there isn’t a transport. Where is our place? Just on a Bus, then bring back the MVO. Of all people, you’re a self stated professed history buff, you tell me in the past when the statement “Know you place” is a good thing? The folks that should “put down the crack pipe” are not the ones talking about establishing a new “level” of practice (requiring a degreed education), it’s the ones who are essentially saying sit-down, shut-up and like what you’re served. I thought of a lot of ways to respond to this post, and have rewritten it a number of times, to take as much of the rancor out of it as possible, as I said I respect your opinion, but feel very strongly you missed the mark on this one. On a side note, you have been the author of some the most insightful, thoughtful and intelligent (if not prolific) posts on this sight. But as of late you have taken on a decidedly acidic and negative tone. You once said you respected my opinion, so please don’t take offence, but nearly 8000 post in 30 months? That works out to nearly 10 a day, every day with no breaks, ever. I’ve been to Texas a number of times; it’s a beautiful state, put things in perspective get outside and get some sun. Be Safe, WANTYNU

One question? So WHAT! Who cares, it's not like we're smuggling illegal aliens across the Texas border.... Incognitogirl, you don’t have to apologize. -w

Give these a try: 1. Ordered: Trilafon 24 mg po bid. Available: Trilafon concentrate labeled 16 mg/5 ml. How many ml will you administer? 2. Ordered: SoluMedrol 100 mg IM q8h Available: Vial 1 ml in size labeled 125 mg SoluMedrol/3 ml How many ml will you administer? What size syringe is best to administer this dose? 3. Ordered: Ampicillin 400 mg IM q6h Available: Vial with powder. Label reads: For IM injection, add 3.5 ml diluent (read accompaning circular). Resulting solution contains 250 mg Ampicillin per ml. Use solution within one hour. How many ml will you administer? 4. The physician orders Lasix 20 mg IV stat for a child weighing 34 lbs. The pediatric handbook states that 1 mg/kg is a safe initial dose. Should you give this dose? 5. A child with a BSA of 0.32 M2 has an order for 25 mg of a drug with an average adult dose of 60 mg. Calculate the child's dosage. Is the physician's order correct? 6. Ordered: Infuse 2 L of Lactated Ringers solution in 24 hours. The administration set has 12 gtts/ml. How many gtts/min will you administer the IV? 7. Ordered: D5W 50 ml with 20 mEq KCl to infuse at 8 mEq KCL/hr per IV pump. How many ml of solution will you administer per hour? 8. Ordered: Gentamycin 100 mg/100ml IVPB q8h. The IV handbook states that it should be given over 90 min. What rate will you set on your IV pump? 9. Ordered: Nafcillin 900 mg IVPB q6h for a 27 kg child. Available: Dry powder in 1 g vials. Admin.. set: 60 gtts/ml. The vial states to reconstitute with 3.4 ml diluent to produce 1g/4 ml with concentration of 250 mg/ml. The medication book recommends giving a concentration of 100 mg/ml, duration of infusion 10-20 minutes. How many milliliters of the reconstituted medication will you draw up for each dose? 10. How much fluid will you need to add to the medication drawn up in question 9 to achieve the recommended concentration? 11. What rate (gtts/min) will you infuse the medication in question 9? Good luck! Be Safe, WANTYNU

That’s just to hide the infected phlegm.... :tard: -w

New York, New York. So nice you have to say it twice. -w

Because debate and discussion, with the recognition that the other party has a point is something adults do. Money is always a factor, but (in a perfect world) it should not be when concerning patient’s treatment. In a case of Paramedics, the adage “Two is better than one” is true. The reasoning is simple, because Paramedic DIAGNOSE a patient’s condition, and then TREAT it, this is invasive, and if done wrong can have detrimental outcomes. When in a hospital environment you often see two or more doctors confer on a diagnosis, before they start a treatment regime. Why deny this same benefit to the patient in the field? Be Safe, WANTYNU

I think my last post needs some clarification; I did NOT mean a name (title) is important as in “Call me Paramedic SIR!” (However ask a Doctor if their title is important…). I meant that our identification is as a SERVICE that provides prehospital emergency medical care and not just a taxi with lights is what is important. Paid vs Volunteer is a separate subject, but is important to the folks that make a living as providers, (as I’ve stated in previous posts). Personally I think we should all be called Medic’s, as that would be easier for the public to understand. As for what level of service we as individuals can provide, that is up to us to identify and understand. -w

Nursing in most states is a 2 year program; and there are many 2 year Associate degree paramedic programs with more following. My program was 1800 hrs, (the equivalent time of two years in college) with that said I also have a four year degree, and truth be told, the Medic was harder, as it was more intensive then when I carried 21 credits in advanced science (Bio, chem., etc), as that was over in 5 months, and I had time to drink beer, while my medic program was 10 months, of 4 days a week of class (not to mention clinical rotations) and I worked as an EMT full time. But I stray: I agree this field is in the same disorganized position nursing was 30 years ago, I disagree “we should know our place” and we will never be positioned to demand the same salary as other patient care services. Hippocratic medicine has long put doctors at the top, this is changing, nursing has come a long way, but is still taught under a completely different system then Doctors, palliative care verses definitive treatment. Unless by obtaining an advance degree (more hours but still working under a doctor’s license) a nurse cannot even give an aspirin in the hospital without a Dr’s OK, there are no “standing protocols” for nurses. A PA’s training is more like what a Dr goes through, yet it is still 2 years in length. I have long thought this (nursing / medic) was a bad comparison in the first place. Better is the respiratory therapist, (many examples on this thread, no need to repeat them). I’ll give you there is a point with the basic EMS curriculum, but I don’t think you find a EMT-B comparing themselves to doctors on this thread (which would be missing the point as well), as most of the posts have been suggesting raising the education standards anyway. 30 years in EMS is an admirable sacrifice, however with all due respect your view is skewed. About 20 years ago, hospitals (because they were failing on a business level), began to hire business people to run them, these folks had a different view point, and the statement “because we’ve always done it that way”, no longer held water. Hospitals have since changed and so have the metrics we measure them by. I put forth the same is needed in the prehospital field, and change is brewing, but as of yet, it is not organized. As it is today, Paramedicine has changed from the Johnny and Roy days of calling for a blood pressure, and popping the green vile for the blue patient, to the requirement and practice of real clinical diagnostic skills. The ability to make a judgment on one’s own and effect a treatment for an unassisted diagnosis is required and expected. Every day we come one step closer to becoming true practitioners, the amount of education required for the advanced Paramedic specialties is enormous, that our pay has not caught up with the responsibility is just a factor of recognition, and a growing symptom for the need for change in how we're viewed as a branch of medicine. In medical school, they teach prospective doctors what nurses do, they don’t even mention paramedics. It’s far and away time we were given mention. Be Safe, WANTYNU PS. Still a GREAT first post! Please stay with us. -w

Yup, I guess when you condense it all, it adds up to a whole bunch of teeth jarring in the back of a moving bus meeting potholes. Somethings got better, some remaind the same and some got worse, but the big apple no matter how you slice it, will continue to dish it out, long after you and I have left it's streets. I guess even if everyone left, the city would have stories to tell. -w

Because coni, some folks here rely on their jobs to feed their family, and (hopefully) pay their mortgage, and in most cases for far less than their counterparts in PD and FD do. What is in a name? Will Shakespeare wrote: in Romeo and Juliet "What's in a name? That which we call a rose by any other name would smell as sweet". - (Act II, Scene II)… Ambulance driver does not begin to touch the description of what we do, and what we need to accomplish in order to have the privilege to do so. Names are very important, especially when the public has neither understanding nor perception of who we are and what we do. I won’t delve into American history on what a “Name” can do, one just needs to look at recent movements focused at doing away with certain “Names”, for evidence that more than just a few people think a “Name” produces a stereotype, which in turn can be very damaging to the people it is associated with. There is a very old saying, ‘Perception is EVERYTHING…” Be Safe, WANTYNU P.S.: The answer: obviously none…. Just push the stuff with the purple cap when your patient is blue… Grananimals for ambulance drivers… -w

Rich, so do I which is why I made the statement…. However, I should have clarified when I stated “fight over” as not over possession, more like a game of “hot potato”, that IMHO seems to be why the DOA’s end up at the Dyckman dock (NY side, regardless of the side of the bridge they jump from…) as the NJ folks don’t take possession very often…. -w

This is the point in my previous post when I stated “How much is it worth to you”. When you ask why is this not happing? Look in the mirror; we are responsible for our fate, as it obvious no one else knows or cares. I could say put pressure on management, but once in the driver’s seat, your priorities change, including keeping costs down, an inexpensive replaceable work force is key to that mission. Although we may think our skills and knowledge came hard earned, the public does not know and therefore cannot understand. If you have a patch on your arm, stethoscope around your neck, and drive an ambulance, you are just the same as the next crew, regardless if it says volunteer or paid, EMT or Paramedic, it’s one day or 10 years old. So again I ask, how much is it worth to you? My EMT class had items one and two… The rest you’ll find in just about any economics 101 course at a local college, ahh talking about that degree thing again, this costs money and time which until there is a publicly perceived need for EMS practitioners to have a college degree, will not be required or funded. IMHO As Always, Be safe. WANTYNU P.S.: Dust, for most things EMS I usually am in agreement with you, however I don’t understand your point here. I feel professional EMS is part of the public safety “response group” that any municipality should have available for its citizens, in the same light as PD or fire. In your view why are we not part of public safety? -w

No pun intended? Man you are a black cloud! I'm glad I'm just "hanging in the happy heights", things are way too busy in your neck of the woods! (had a guy do a nose dive over the clifts by 153 and Bradhurst Ave today) not my job, but I figure you might have heard about it. Semi related to that we get jumper ups all the time at the George Washington Bridge, sometimes they turn into Jumper downs... if they don't land on the rocks, it's interesting to watch NY and NJ harbor fight over them. last one that did hit the rocks (about 150 feet and held together), the tour before mine had and one of the BLS cut this guys down jacket off... I couldn't understand where the stray feathers came from and why I was sneezing the whole next tour, until the earlier crew called to let us know. -w