triemal04

Pt privacy issue definitely, but not a hipaa violation. Either way, the guy was fired within about a week of this coming to light back in March for various reasons, none of which were listed in the article.

CCR has been used with (supposedly far as I know no firm numbers or reports have been published by anyone) success in various agencies in Arizona and Wisconsin for around 2 years I believe. Most point to there being much more benefit during the hemodynamic stage of cardiac arrest (8-15 minutes in) versus the electrical phase (first 5 minutes). I haven't looked into it for awhile, but last I checked there still wasn't any real concrete evidence on how it worked, and how it should be integrated into ACLS treatments. That may have changed by now. The theory behind it is fairly sound; circulate blood that should still be oxygenated before attempted to shock the heart from an abnormal rhythm; kind of like the new CPR standards, they just took it a step farther and completely removed ventilations, at least initially. Stopping compressions causes the pressure built up by those same compressions to vanish, which essentially means that each time you restart you really are starting from scratch...another thing that's being pushed as a benefit. There's probably more current info about it out there, but these have some good information on what it is and why it works. What they don't have (yet) is how it should be integrated into the rest of the treatments we have. http://circ.ahajournals.org/cgi/content/full/111/16/2134 http://www.ncbi.nlm.nih.gov/sites/entrez?c...f1000m%2Cisrctn http://web.kshb.com/kshb/pdf/ACurrentOpini...REwy06MCC58.pdf

Nobody is talking about on every unit; least I'm not. But having supervisory personnel IN THE FIELD, and not sitting in an office is almost mandatory, unless you're working for a very small system or non-emergency transport service for all the reasons that have been listed and more. And yes, at some point they may end up dictating your patient care to some extent (this is why they should be required to be certified at the highest level of care provided); at an MCI who do you think should be running the show? Who decides who gets put into triage? Transport? Who get's to be the gopher? Communication? All of this will affect what you do for your patient(s). If you encounter a situation that you aren't sure of or aren't capable of handling, the supe should be available to assist (should be, again, this is why a stringent testing process should be mandatory) which again may have them telling you what to do. Like it or not, you will have someone above you in the services structure (unless you get to that level yourself) and like it or not, they will have the authority to tell you what to do. How much will vary, but it's always gonna be there.

letmesleep- You've got a good point with medicare refusing to pay the full cost, if any, for transports that aren't neccasary. And while this may not affect the healthcare system as a whole, it definitely impacts EMS services; there are some out there, but the number of services that allow their providers to refuse to take a pt are still on the low side. It's better in some areas, but the "you call we haul" mentality is still the most prevalent theory it seems. So services still take the jackass with a toothache and never get paid (since that douche won't be paying). I don't neccasarily have a problem with medicare refusing to pay for that type of call, but I do have a problem with the service getting stuck with the bill. And unfortunately, while the answer to this problem is easy, I don't see it happening anytime soon. This isn't to say that medicare is doing the right thing with how they reimburse services; they aren't. Far as I know, there is still a cap on how much they will pay, and it's generally less than what the service should get (not sure, so anymore info is appreciated). Having accountability is great, not paying for BS is fine, but shortchanging the services isn't. And making these decisions without input from the field is asking for trouble. Which is what's happening now; more and more places are losing money on their emergency transports. Not a good thing. To be honest, I don't know that we really have all that much of the blame for healthcare problems at our feet. You can say that ER's are being overburdened with BS complaints being brought in by EMS, but I'm guessing a fair amount (not all) of those people would still make it in on their own. You can say that EMS is getting money that isn't "deserved" from medicare, but that problem (if it ever was) has been taken care of and now it's the opposite. Personally, I think the biggest problem with healthcare, besides the lack of funding for it and the extremely high insurance rates, is unrealistic expectations on the part of the average person. Everybody wants their problem solved NOW, no matter how trivial or unsolvable it is. Everybody has seen to much TV where the nice doctor spends weeks figuring out the obscure problem and everyone lives happily ever after. Not the way it really happens. But people will still keep trying. Oh well. In the mean time just remember: EMS-when you absolutely, positively can't afford a taxi!

Actually, in my case it was the opposite; laying down I showed RAD and sitting up didn't. Got the nurse all worked up though. Go figure.

Why? They don't need to be called by an officers rank per se, but the need for having some type of supervisor available each shift (and maybe more than one, and more than one level, depending on the size of the service) is neccasary. Unless you're part of a very small organization. VERY small. Richard B did a good job allready, but even beyond larger incidents there is a need. If a patient or Joe Blow off the street has a problem with something one of the paramedics did, who handles that? If the ER has an issue, who do they go to? What happens when 2 partners really can't get along and create a real bad situation between the 2 of them(yeah, in a dream world it won't happen, but welcome to reality)? Who handles that? Who evaluates the paramedics performance on a yearly basis? If a problem occurs in the middle of the shift, who is responsible for handling that? And on and on and on. And yes, there should be a process for being promoted, or whatever you want to call it (demoted for some that I know). Length of time in service...lack of problems...higher level of education....extra training...written test...oral tests...enough to ensure that the supervisor is of a good quality. Course that doesn't always happen...hence why it's sometimes a demotion.

I don't know why anybody would have a problem with this article; it touches on many of the things that most (sane, or at least reality appreciating) people in EMS know; that the certification standards nationally are a joke, and even that the educational levels are a joke. The difference between being licensed or certified...honestly, that can wait to be resolved, and really doesn't matter that much. The bigger issue is what Bledsoe talk's about with the CCEMTP certifications; almost anyone can get one, yet many states don't recognize it, and the process for getting it varies widely. Sort of like saying you're a paramedic from LA and saying that you're a paramedic from Seattle; your patch says the same thing, but what you know/can do is a lot different. Having extra education and training is great, I'm all for that, but unless there is a standard process to go through that is recognized beyond each little local area (because medicine, and EMS extend well beyond a services boundaries, despite what many think) adding a new patch to the uniform, or adding another spray of letters after your name is pointless, since nobody else will know what you are talking about, not care, or more likely, because the course you took was a half-assed one at best and the standards non-existent. (this doesn't mean don't take them if they are worthwhile; just that there isn't a need to shout it to the world, since the world won't give a damn) Make the standards for EMS nationwide, sort of like they are for most other healthcare professions (the established ones anyway). This would include the extra levels; if you want to be a flight medic, then you need to meet certain requirements that ALL 50 states recognize, same for critical care. Then the alphabet soup will start to matter in situations beyond a resume. The bottom line in this isn't people calling themselves a CCEMTP when their state doesn't recognize it, or saying they are a licensed provider vs a certified provider; it's the complete lack of standardization in EMS. It's every state having different certifications that mean different things, even if they have the same name. Fix that, and a lot of other problems will be a whole lot easier to take care of. Edit: chbare: the problem isn't the soup after some people's names, it's how they got those titles. While you may have gone to a great CCEMTP course, one that is recognized, well run, etc etc, others may not have. And since there isn't a national standard that I know of for what it takes for a paramedic to call themselves "critical care" then it starts to become meaningless when you get lumped into the same boat as Joe Blow the medic who does interfacilty transfers from the ICU which allows himself to toss a CCEMT-P patch on his shoulder. Make one standard that the whole country MUST follow...why is that so hard?

medicv83-Sorry, maybe that didn't come across clear enough. I'm not advocating using the Parkland for electrical burns, not at all. What I am advocating is to remember that To make that clearer; even if you can't "see" the damage that has been done to your pt, you know (or should) that they have a very high potential for internal injuries and cellular breakdown...so treat that as best you can. Hope that's clearer. And no, you don't know the path of the electricity...it may be much worse than you think...or much less. Again, you are going to have to decide based on your pt's presentation and voltage involved what you will do...which means that for any significant burn they will be getting fluid. And while giving to much fluid can be a problem, don't become so concerned about this that you do nothing; an otherwise relatively healthy individual can easily take in 1L+ without problems. (this is going to sound bad, but bear with me) Don't get so caught up with what the pt will need overall that you ignore what they need now; for this situation, an estimate about damage and fluid needs is all you will have to work with, especially if you are dealing with short transport times. Use your judgement and use the amount of fluids you think is appropriate; what get's done later will be adjusted around what you have done in the field. I have given fluid based on the Parkland formula before (for thermal burns)...and it is really strange the first time you do it to see how little is called for. Now for the rest...yes, based on some of your own comments I do think you have very limited experience. You indicated in the past that you only started Paramedic school this January and had never worked as either a Basic, or Intermediate. Now who knows, maybe you were previously an RN, or RT, or PA, LPN, CNA, whatever...but I'm thinking probably not. You demonstrate that again in this thread: you based your impression of an entire profession (nursing) off of the experiences you've had with nurses at ONE HOSPITAL. So yes, Nancy, you are doing a disservice to both our profession and theirs by making that assumption. Don't. Do. It. Again. I'm glad you agree that learning is an ongoing process, but that doesn't mean you should just be learned about medicine; learn about your own profession and about the ones you'll be dealing with. Learn how the system actually works. It's not bad or wrong or a problem to be new, but it becomes a problem when someone starts to think they know it all and can make judgements that they aren't qualified to make. And while you may not like the names...it worked didn't it? Got you to sit up and take notice about what I said? It's definitely not the best way to teach or get a point across, but it is one, and does work sometimes.

medicv83- I called you sally to get you to take notice and hopefully pay attention to what was written, both by you and everyone else. If it had that effect then don't expect an apology. Now isn't the time to be making judgements on an entire profession based on your own very limited personal experiences, now is when you should be open to learning EVERYTHING POSSIBLE about the medical field in it's entirety and not making snap judgements. Far as electrical burns go...Parkland is a good way to start, but in judging BSA you need to take into account at MINIMUM the amount of tissue between the entrance and exit, and that very well may not be enough. This would be one of those times to treat your pt, how they are presenting and what you know is going on physiologically with them and ignore the formula. Edit: Didn't mean you hijacked the thread Ruff.

Nice. Take what could have been an interesting topic and throw it way the hell of track. Before it get's that far, I'm curious why you say that most services that carry LR don't carry enough to provide fluid rescucitation. Taking burns in particular, unless an extremely small amount is carried (think less than 250ml) a couple of liters should be good. While the Parkland formula is 4 x %BSA burned x wt in kg, that is the total amount to be given in 24 hours. Half of that should be given in the first 8 hours. So, take the worst case scenario: 100% burns to a 100kg pt. 4x100x100=40000. 40000/2=20000cc over 8 hours, 20000/8=2500cc/hr for the first 8 hours. 2.5 liters per hour...that's not a whole lot, unless you are dealing with a very long transport (which may be the case). Now, that doesn't mean that the pt might not require a whole lot more fluids to begin with, but, when using the Parkland formula, the amount of fluid that's given actually ends up being really small. And as far as fluid rescucitation goes...just remember that dumping more than 2-3 liters of fluids into someone who's bled out won't fix or help the problem. As a side note, an easier way to remember the Parkland formula is (%BSA burned x wt in kg)/4=ml/hr for the first 8 hours. Much simpler. Either way, if the pt needs fluids, don't withhold them just because a formula says they don't need it. With that out of the way...hush up on nurses sally. If you haven't figured it out by now, a nurse and a paramedic are not interchangeable, and while both are in the medical field, that's about as far as it goes. All your comments are doing is showing your own ignorance of BOTH professions. Just stop now while you're still ahead.

So nobody is figuring it's Michael yet?

Good point. With the exception of the pharmacology class, that was what I took to get my Associates. To explain the classes better: Intro to EMS-history of same, expectations, current trends, possible future trends, duties, roles, and the like. EMS Rescue-basic rescue class, had some hands on, but mostly was to get everyone familiar with what would be going on during an extrication, technical rescue, collapse and so forth, not to train them to participate. A lot focused on scene safety, which was great. Comm' and Transport-not much about transporting, just how to write professional, accurate charts. The rest should be pretty self-explanatory. That what you wanted?

Chem 112 or O-Chem Biology 114 (both are pretty basic courses) A&P 1,2,3 Inro to EMS Comm' and Transport for EMS Crisis Intervention EMS Rescue Algebra Speech 111 Medical Terminology WR 121 (English Comp) Concept of Computing (this is how to use a computer, create spreadsheets, etc) Health 275 (health fundamentals and healthy living) Paramedic 1,2,3 P-Clinicals 1,2,3 P-Internship 1,2 4 Human Relation/social science electives Pharmacology (EMT-B is a prerequisite...another 180 hours of class time) Edit: Pffft...following directions isn't fun. Total credit hours=114 Total clinical hours=don't honestly remember...a guess would be somewhere in the 350-500 range. Total internship hours=variable. State minimum is 200 (embarrassing I know) average for most classes, depending on the school, is probably about 600. Total cost=I prefer not to think about that. Let's just say it wasn't all that cheap.

I'll second the special needs kids. Not fun or easy to deal with.

Why did you not run check V4R? Because you "didn't want to screw with it"? Explain please. Inferior and right-sided go together fairly regularly which hopefully you guessed based on his presentation. As well, why the morphine before checking to see if there was any right-sided involvement? Why? Whywhywhy?

Short sweet and to the point. I like it. =D>

What's the average starting pay for a PCP in Canada? What are the benefits they get, if any, including a retirement package? What was it say 10 years ago? I'm guessing that it's significantly higher than it is for an EMT-B (the lowest level of EMS provider in the US)...actually, I'm pretty sure of it. And I'd be willing to go out on a limb and say that it's that high because the amount of education for even the lowest tier provider is pretty high. So, as the long as the pay is good (better in fact than here) I don't think you'd have any shortage of people going to school and applying for jobs; the numbers might actually increase, not for those who want to volunteer or do this as a hobby, but for those who actually want to do this as their profession. If the entry level has a fairly high level of education and each progressive level is higher, I'm guessing that many people who don't stay in EMS due to the limits on care would stay, and some that never got into it for that reason (because they felt they could provide better care as an RN or PA etc) might get into it. As well, if you are able to live off of the salary at the lowest level, then, while there may not be as much of a reason financially to move up, it will be easier. Rimdup...I really doubt that the average paramedic course in the US is anywhere near 16 months long, let alone 18. I'd try something more like 12...or 10...or 9. Sad, but I'm pretty damn sure true.

I prefer to have them drink the D50, if they are alert enough to handle swallowing a liquid. I've had more people say that the paste (we carry the cherry flavor...imagine your standard childhood cherry candy on steroids) tastes worse, and it seems harder to swallow, as sticky and gooey as it can be. And (this is based only on my own observations) it seems like D50 tends to have a faster effect than the paste when taken orally. Personally, if they are awake enough to be given oral sugar I prefer to use what they have on hand whenever possible; OJ, PB&J, etc etc, although this isn't always possible.

Oh baby...I love internet balls. It's great. It's better when the person sporting them really has a good, fundamental knowledge of what they're talking about, beyond crunching numbers for one service, but I suppose that's a start. It's nice that you've got a...masters?, it's nice that you were an Air Force medic, and it's nice that you work in the office of an ambulance service, but all that still doesn't make you an authority. Doesn't make me one either, but then, I know that I don't know it all. Somehow I don't think you know that. Actually, most of the ambulances in King County are FD run; that's part of why King County Medic One can be somewhat hard to understand. Seattle runs it's ambulance along with several other Fire Departments. Each hires the personnel, is responsible for getting them to their initial training at Harborview and then ensuring their continued education, as well as medical oversight, QA/QI, supervision, pay, benefits, yadda yadda yadda. So no, while medic one is not run by the fire department per se (didn't say it was), the majority of it, (outside the actual King County Medic One ambulance service) is administered by the individual fire departments that operate it. As I said, each service, in this case fire departments, runs itself as they see fit. That's not the best description, but, looking at it from the outside (way outside in your case) it's a different way to run things. Actually, yes, I'm sorry (again) to rain on your parade, but most fire departments do meet at least 3 (usually more) of the requirements you listed. And yes, I'm talking well beyond just my state; see, I don't base everything I think on what gets broadcast in the TV news. On a side note, do you really think that's all it takes to make a good EMS system? Oh my... As long as the system is the size of the departments I already listed, I'd love to hear about it; seriously, I would (the ones you listed are to small, sorry). As I said, while not exscusing anything those places have done, when a service gets that big it will get harder and harder to ensure good hiring practices, good continuing education for all employees, a good QA/QI program, if publicly funded, good pay/benefits, etc etc. The smaller you are, the easier it is. The bigger you get, the harder it is. That'll hold true for almost every public service agency, and many businesses. So, if there is a place that size out there that's problem free, I'd like to know. Unfortunately, or fortunately I suppose, I don't live near Seattle, so I have no clue about the levy. See? I don't just go off what I see in the news or what I personally experience. I'm well aware of the faults of many fire-based EMS services, just like I'm well aware of the faults of many private-based, third-service based, and even your own precious Denver Health. That was the point of the first sentence in the last post; you need to be damn sure you know what you are talking about when it comes to this topic; hell, any topic in EMS really. Don't just read a quick headline or go on the belief that you've seen it all and all is the same; you haven't, and it isn't. I'm still waiting for the slap Mr. Pyle. Edit: Far as the parity in pay goes...when it comes to fire based EMS, excluding the minority (vast minority) of departments that have civillian medics, you do know that most paramedics working for a fire department, especially one that transports get paid more, right? Just checking.

I'd suggest that you only count personnel on transport capable units; first responders are fine, but the goal still is to get them care in the field AND get them to a hospital, as appropriate. An even better way would be to ask how many people is EACH transporting unit caring for? After all, it doesn't matter if there are 2 paramedics or 1 on the unit; when it's on a call, it's on that call and unavailable for more until they clear. For only transporting personnel, about 7400. For all personnel on shift, about 3200. For just transport capable units, 13000-17000 (reserve which is not normally run, but capable of being used without any delay)

Gomer pyle, you must, must must get your facts straight on this issue; if you haven't noticed many people have very strong feelings about it, and while some are very well informed about the topic, many aren't, and will buy into anybodies rhetoric. Example: Seattle Fire Department does run one of the ambulance services in King County, as well, the majority of ALS care is provided by Fire Departments with King County Medic 1 (which if I remember correctly is a third service, not PUM) providing the rest. (AMR also does BLS transports in Seattle) Medic One is an interesting concept, and for my money, one that works very well, albeit one that can be confusing if you don't take the time to actually look into it. But, the thing to remember is that each individual service runs the service as they see fit; so yes, Seattle's success means that a Fire Dept is successful with EMS. Sorry to rain on your parade. And you may want to look into Springfield Fire Dept, Eugene FD, Columbia River Fire/Rescue, Seattle FD, Bellevue FD, Canby FD, Lebanon FD, etc etc etc. Hell, most fire departments meet 3 or more (mostly more) of your standards and then some. (do you really think that's all it takes to make a good EMS service...wow...that's pathetic) Get over it. Do some fire departments screw EMS up royally? Sure. Do some do a good job? Sure. Once again...get over it. Now, I'm sure you'll pull out the old standard of LA/LA County and FDNY, but here's a quick question for you: can you show me a third-service EMS agency (or any agency that is primarily 911 responses) that is of equal size to those agencies that does not have problems? This isn't to exscuse the crap that goes on in those places, but you have to keep in mind (unless you just want to rant and blame the boogeyman) that the bigger you get the harder it is to run a problem-free workplace. And, in case you haven't noticed, most city budgets are not doing so good these days, so if you rely on public funding...ouch.

How many ALS 911 services are there in New Jersey? I get it that there are a huge number of volunteer BLS services (more than there needs to be I see), but how many are ALS? Crap, the entire state is only 8700 square miles...you don't need 50 different services covering the whole place. Hell, you don't even need 10, even with a high population density. Hey, if corruption and crime are so bad, maybe everybody who wants a change should invest in a well priced...ahem...personnel removal specialist who can...remove...the members of the first aid council (can anyone explain why that even exists) and anyone else not pulling their weight. On a serious note, there has to be a way to sell it to state legislators that consolidating the system and removing redundant services would save them money, as well as lead to a happy populace. Well...somewhat happy...they do still live in Jersy I suppose.

ERDoc- Why the chest tubes?

Anybody want to place bet's on this guy actually being a volunteer somewhere? :toothy7: <ducks and covers>

Could have been. But, if that's the case, it just helps illustrate my point in another thread that, even if fire were to stop running EMS, don't expect a lot of station closures and drop in their budget that can be in turn passed onto EMS. Let me explain: If they had been (guessing, don't know how far away the station was, but we'll say it was <5min away from the house) in quarters then they'd have been there in an appropriate amount of time. If that station had been closed because they stopped running EMS and lost a large amount of their budget (which many people assume would happen), and the second due became the first due for that house (don't know if that was the case, let's just pretend it was) then you'd have had this situation all over again. Nobody wins. Stop Fire responding to most (the vast, vast majority) of EMS calls and get more EMS units staffed. But don't expect there to be a sudden surge in the amount of money available for EMS to staff those units. There should be some, sure, but to fully fund both services at appropriate levels will mean more money has to come into the city coffers. And I think everyone here knows how unlikely that is right now.