dougd

Medics in CEMS and CFD are required to pass the test every 3 years to continue functioning as a medic for the city, I believe. I don't know what they do if you don't pass it - I'd assume they make you ride basic until you complete some sort of additional CE or remedial training but who knows? I'm going to have to ask around.

Ok, I'll say it then... taking a d-stick is a so easy a caveman can do it. Which is why anyone can walk in to any Walgreen's on a street corner and buy a glucometer. Which is why OH considers it a basic skill. (http://www.ems.ohio.gov/policies/EMS_Guidelines_Procedures07.pdf) You're assuming every hypoglycemic patient you encounter is going to be unable to tolerate oral glucose - and while that may often be the case, it isn't always.

Oh, I'm not saying it isn't a basic skill in OH - it is. I'm just not aware of anyone around me that is doing it. If I moved an hour south, I'm sure I'd see it.

" Cleveland police are investigating possible cheating on an exam given to sharpen paramedics' life-saving skills. Safety Director Martin Flask said Tuesday that officials believe an employee smuggled a copy of the city-administered test last October from the Fire Training Academy... 'The exam is really an internal exam, above and beyond what's required by the state,' Flask stressed in a phone interview. He added in a news release that the incident, 'while unfortunate, does not compromise our ability to continue to provide the highest-quality service.' http://www.cleveland.com/news/plaindealer/....xml&coll=2

letmesleep - Sorry, I just couldn't pass up the chance to make an Emergency! reference when you were discussing "old-school." I really wasn't being sarcastic towards you or the question. Now, as for some serious answers: Should "old school" ways of doing things change with up-to-date treatments? It's good to know what the "old school" way was of doing it - either so that you know it is a bad idea to try it, or so that you know how to do something when that new gizmo your department has to perform a specific task stops working. But obviously we need to adapt as best we can. Are the newer medics and EMTs coming in to the field with more knowledge base? I'm a relatively new EMT, so I probably can't answer that intelligently. Can we and/or should we try to learn from each other? What do you want to learn from the other generation? I put these together... Yes. Anything the guys and girls who have been around the block can show me I'm willing to listen and learn. Experience is a harsh teacher, so any pointers I can pick up in advance is a good thing. What is your over all perception of the other generation? Been there. Done that. Honestly, most of the "old school" partner's I have had have been wonderful to work with and very helpful. Of course, the ones who aren't have pretty much gone out of their way to avoid the new guys. How do we make change to better understand each other? Too many new guys who think they already know everything about everything. A lot of it has to do with the fact the new guys are, for the most part, gung-ho 19-23 yo's and still think they're invincible. I was like that 10 years ago in everything I did, and I'm willing to bet the "old school" guys were too.

I've heard in southern OH and very rural areas this is true. It is taught as a basic skill up here, but I assure you, I don't know of a single medical director in the greater Cleveland area this is allowing basic's to intubate. I'm not sure I like the idea of pulling the rescue airways. Although, with everything I've read in the forums here, it sounds like most of you don't think the combi-tube was really buying the patient anything more than an oral airway and effective bagging would have. If the patient is unresponsive to the point they'll actually tolerate one, you really need an ALS provider and an ETT anyways. However in communities that don't have ALS or ILS, this would probably be viewed as a "bad thing." Without research one way or another, it's difficult to make any sort of informed decision. (I might see a library search in my future tonight.) Another step in the wrong direction, I believe, is moving BGL to the "Advanced EMT" level. If we can't agree that getting a d-stick is pretty basic stuff, we have a problem. On a squad running B/P, it frees the paramedic up to take care of other parts of the assessment and on a BLS squad it at least gives you an idea of what you're dealing with. Sure, if they're down far enough they're going to need a line, but if we can identify and treat our hypoglycemic patients before we have to move to an invasive intervention, I'm all for it. As long as the national registry's headquarters remains across the street from the Ohio EMS Board, I suspect we're going to see OH following whatever NREMT likes, regardless of what NHTSA publishes.

Unless you're planning on having Johnny and Roy call Rampart for orders to drop 2 of bicarb and start an IV of lactated Ringer's for your calls , I would say yes, the way we treat our patients should continue to evolve based on research. If we find a particular intervention isn't helping patients, or worse is harming them, we should be moving away from it.

Welcome to the fun-filled world of EMS... enjoy your stay. Seriously though, what were you so furious about? Granted, I find it odd that they thought the issue was serious enough to call for an ambulance yet didn't bother to leave a nurse with the patient. Other than that, the Dr. recognized the patient had an emergent need and the common sense to decide to send the patient to the ED where a doctor with more experience handling such patients (not to mention a full range of diagnostic tests/procedures at hand) than he did. Now then, if you're upset about having to wait for a receptionist to "saunter over to unlock the door..." well, get used to being upset. It's going to continue to happen. I haven't had any doctor's office pickups, but I've done plenty of nursing home ones. Only once have I been to a run where staff was standing outside waving frantically at us. More often than not, you'll be lucky to find someone who can tell you anything about the patient, or even who called for a squad for that matter. Oh, and the one time you see the staff standing outside waving you down, you'll look at your partner and both of you will say, "Oh Sh*t!"

You know, this is easily correctable by the phone manufacturers. VoIP phones put this in place a long time ago (after considerable pain and troubleshooting to figure out "echo" problems). Another neat thing VoIP phones figured out: You can save bandwidth by only encoding signal and not noise, so codecs and algorithms were designed that could differentiate speech from background noise. When there was no speech, the mic was basically "muted," for lack of a better term. The end result was: "Hello? Hello, are you still there?" all throughout the call. So much for that idea...

Bah! I missed an A in my statistical concepts class by 2%. I'm still a bit sore about it. Oh well, I should have done better on that final project. One of those math classes should touch upon some basic statistical concepts... but from a critical thinking standpoint, it's probably worth making everyone take a complete course in it. You certainly develop a healthy sense of skepticism when you hear politicians and their talking heads start throwing around statistics on the nightly news. If being a more well-rounded person doesn't do it for you, from an EMS perspective it will give you the fundamentals needed to know how perform your own sample studies in your system - very useful if you want to examine a potential protocol change and how it impacts patient outcomes.

Don't worry, the lottery is just a tax on the people who failed statistics class. Something I'm sure everyone would have learned had they been forced to go through one of the programs outlined above. (Wow, such a convoluted attempt to steer this somewhat on topic...)

You dirty old men... I'm appalled.... absolutely appalled. Seriously though, hopefully the 16 year olds are getting smarter about what they post on-line. If not, perhaps they should all be forced to sit and watch a marathon of "To Catch a Predator."

It's not just EMS getting a black eye recently: http://www.toledoblade.com/apps/pbcs.dll/a...EWS03/810056107 "Two Ohio Highway Patrol troopers in Sandusky have been fired after one was photographed by the other while dressed in a Ku Klux Klan-like costume..."

Or it could just be that minimum wage buys minimum employees - which simply means we'll continue to see such utter stupidity displayed throughout the EMS ranks until something changes.

I can count the number of days above 85 degrees in Cleveland in a given year using the fingers of both hands. That said, I certainly understand where you are coming from - as can the t-shirt I was wearing under my uniform Friday night that stood up and walked itself to the washing machine when I got home.

Of course it is.... in fact, it's even suitable to be quoted in a newspaper article, as we've already learned in another thread.

My work here is done. I hope you're not taking me seriously on this... :shock:

We had one (at least), paid, full-time, very well funded suburban FD recently switch to wearing navy blue shorts while on-duty during the summer months. :shock: Besides the fact that it looks horribly unprofessional when they bring a patient in wearing their department t-shirt and a pair of shorts, who really wants to see a bunch of middle-aged guy's pasty white legs? Maybe if they had a department full of females.... say 25, old enough to be respectable but young enough not to know better... :twisted: :twisted:

So a lawyer, throughout all of the internet found a post by someone who may-or-may-not be a paramedic (this is, after all, the internet) that made a sarcastic remark. :roll: Honestly, I'm not sure which part is funnier - the line itself, or that some supposed journalist actually quoted a source saying something along the lines of, "I found a post on an internet chat room..." Yeah, and this one time at band camp...

I probably should have thought of that... nevemind me. :-)

Interesting question from another thread that got me to thinking... "Wouldn't a PARAMEDIC use a ET tube rather than a combi-tube?" In Ohio, while intubation is listed under the basic's scope of practice, I don't know of a medical director around here that allows a basic to intubate - so my experience is limited to those few times on the dummy. So i defer to the experts, and maybe I'll learn a thing or three in the process: Given the research statistics* that would seem to show many pre-hospital providers are misplacing ETT's, do you ever consider using a dual-lumen in place of an ETT when the need arises? Are there times or scenarios where you would try a dual-lumen first before reaching for the laryngoscope? Is your service using waveform capnography or those little disposable in-line CO2 detectors (yeah, real technical name, I know...)? Also, how much ego is involved in our patient care choices? Are we (as a profession) being obstinate and insisting on tubing patients where a dual-lumen device would be sufficient because we don't want to get laughed at by the other EMT(P)'s when we walk in the ER? * http://www.pulmonaryreviews.com/may01/pr_m..._misplaced.html http://www3.interscience.wiley.com/cgi-bin...823709/PDFSTART

Likewise, the only times I've had to restrain someone I've left them on until they were turned over to the receiving facility staff. Once I have to put them on, they are staying on. That said, I've had to restrain very few patients and I've usually found that being very straightforward with the psych patients I have encountered has worked out pretty well - even with the ones dispatch told me were combative. Of course, I probably just jinxed myself for the rest of the year... :shock:

According to a partner of mine, you've never lived until you've watched the 600lbs guy strung out on PCP start fighting in his restraints and shifting his body weight enough to stand up with the ER gurney still strapped to his back because you didn't get his legs restrained in time. :shock:

Firedoc, my consolences on your friend.

Since my service only carries leathers, that pretty much dictates my restraint options. Most psych's I deal with are coming out of an ER and going to a dedicated behavioral center or the psych wing of another hospital, so if the hospital has them in soft restraints already I'll continue to use those as long as they are effective. If my partner and I can't get the leathers on, we call for backup - either another squad or law enforcement... or both.