Just Plain Ruff

Of course it would, but you would be hard pressed to find anything else about me in EMS that qualfies me as such. But of course, thes pictures are from your personal collection that sits in the trunk of your car in addition to your harrier jet and inflatable ambulance(for cases when you just can't get the ambulance anywhere else).

I corrected your statement doc.

Mike, I did the same, I looked and didn't find anything on Google that showed the abbreviation of SMR to be spinal motion restrictions. I also still am trying to find what COA means I have no problems with abbreviations but if I do not know what they are I will look them up and then I will make notice that I don't knwo what they are. Rock, I know you want this to progress but there are some pretty smart people on this thread (I include myself) that didn't know what SMR or COA or COG meant and your links to Stedman's really didn't help the issue, it provided 1 out of 3 of the abbreviations in question. But I do have a link now to go look up abbreviations that I am unsure of and I do than you for that.

I had this same issue on a patient but the blood wasn't coming from his lungs but from his Esophageal varisces that had ruptured.. He bled out and died. We were able to intubate him but it was a Gold medal shot in the dark that was successful. We also had a physician on the ambulance doing a sort of "see what we do" kind of thing and he recommended that we intubate the esophagus as well to provide a conduit for the blood to go. When he went to put the tube in he was able to see (he said he was) the varisces that had ruptured and he tried to tamponade the bleeder by inflating the cuff of the tube. That failed. The patient succumbed to his illness and that as we say "is that".

I think Chris might be pissed off at us.

I've got a plectron in my closet here in my home. I took it from a previous service that was getting rid of it, The antenna's broke though. Bummed out on that one.

My experience is strictly anecdotal. Remember my 440 hour course was 20 years or so ago. But my main criticism of the 190 hour course is why the hell didn't I go throgh that one instead of spending 32 hours a week in a class that now is being taught for 190 hours and they are teaching these students to do more stuff than my basic emt class taught me. Granted, our class had many other extras that I'll bet the EMT classes today do not have. for example Rapelling/rope rescue Water rescue (in a pool, in a moderately flowing river and in a lake) 2 classes on extrication (one on cars and the other on large farm machinery and other large vehicles) 8 hours on scene safety(our class was taught by a medic/cop hours and hours of vehicle operations and oodles of test prep for the state test (we had a 96% state of missouri practical test pass rate) Self defense course and several large scale exercises with the entire class of 40 students participating (one was a school shooting and the other was a building collapse). And we put on a high school drunk driving demonstration with MADD> All that for 600 bucks.

good link to the spinal motion But that stedmans link does not have the abbreviation for COA though unless the person is looking for Coenzyme A. But COG fits the bill for center of gravity.

To move the conversation forward, drops in volunteer numbers aside, Can you tell us why you are concerned, if it's due to your wanting to get your EMT and it's a far drive for you to get a class Here's an alternative http://www.percomonline.com/ If you go there you can get zero to hero in less time than Frozone took to find his suit when Syndrome invaded the city in the Incredibles. But if you are a serious education seeker, then a 1.5 hour drive might just be what you have to do.

Yeah that's what is really scary, the 190 hour course is teaching basics to do more and give more stuff than my 440 hour class taught.

you are correct, and thanks for the SMR definition. You will notice that didn't even make it in my list of abbreviations. i'm done. Now on the the regularly scheduled thread. Is he conscious? If so then let's get a history and 1. Vitals 2. blood glucose 3. EKG If he was assisted to the ground by friends then we can rule out boarding and collaring him but.... If he was not assisted and he's conscious, we should apply our noggins to the case at hand and if we are so blessed to be able to rule out the need for SMR's then let's do so but if we have to go by protocols then we gotta do what the "great big book of protocols" tells us and I'll bet that is to board and collar the guy. If he's unconscious - let's start down that path when and only when the great OP comes back to tell us the answers to our questions.

But no-one has said what SMR means. Unless I missed it.

Why is it 190 hours, my EMT Class was 440 hours plus 48 hours of ride time and 48 hours of clinical time. 190 hours is simple - you can probably teach a monkey the rote skills needed to do cpr and backboard a patient in 190 hours. So people need to stop complaining about how hard 190 hours are. I'm not saying that Finney is complaining about having to go to class for that many hours but honestly if you look at it, if you are in class for 4 hours anight and your class is held on monday, wednesday and 8 hours on Saturday, that's 16 hours a week and you only will only be in class for 12 weeks. Yeah, god dangit, 12 weeks to become an emt. Seems a little short when you look at the time it takes other entry level careers. Look at pipefitters or electricians they have a lot more time to put in to get certified I believe. And like Island said, you mess up a pipe or drain, unhappy homeowner, you mess up in EMS unhappy family and very happy lawyer. 190 hours is not enough time to have someone's life in your hand if you ask me.

well doc if he fell out of the unidentified 777 then he is triple screwed. But seriously, we need more info before we start down any road of SMR, I mean SMR is normally reserved for the Stepwise multiple regression of the Superficially Medically Refined in a Super Macho Resistence. I mean SMR AMR PMR EMR IMR vmr and that's my story and I'm smr'ng to it. ok, it's late and I'm tired.

I was just providing info from the NY EMS website. It's up to the OP to dig deeper. But there are reimbursement for training funds and that's what I was getting at. But I also do not share the concern about falling volunteer ranks as we have discussed here on many occasions, that might just be a good thing re: volly versus paid. And honestly, I drove 2 hours each way to my paramedic course, I have driven 4 hours to take an ACLS or to even teach an ACLS class and I travelled from KC MO to middle of Tennessee to take a ITLS course so I do not share the concern as well for the hour and a half drive for education.

Finney, your concern is not just in New York but all over but I'm surprised that someone would need to travel 1.5 hours for education when there are thousands of agencies in New York state that are eligible for training fund reimbursements. http://www.health.ny.gov/professionals/ems/pdf/agencies_eligible.pdf Also, for the EMT's that are already licensed, there are online options but they only allow up to a certain amount of online education. New York accepts CE Solutions' continuing education according to the following guidelines: 3 Year Recertification Program: A maximum of 12 hours for "core content" and 24 hours for additional CME hours may be credited for self-study activities through documented continuing education via publications, video and/or Internet training. 5 Year Recertification Program: Continuing education programs should include many different learning activities. Topics must be relevant to EMS and/or prehospital care. You must be able to document attendance and participation. A maximum of 25 hours total may be credited for self-study activities through documented continuing education via publications, video and/or Internet training. There are also 21 pages of EMS education providing services/agencies that are licensed by the state of New York to provide BLS (at the least) education http://www.health.ny.gov/professionals/ems/pdf/csponsors.pdf What concerns me in your post is that the volunteers in your area are having to travel so far when with the hundreds maybe even thousands (42 pages of 42 providers each page = 1600+ providers) that surely one of those agencies in my first link is the volunteer agency you are close to. They are eligible for training reimbursement and while I don't know anything about what the payment rate is, I'm sure that there could be money for at least a few CEU classes or one EMT class a year. My home state of Missouri allows for all my paramedic hours for recertification to be taken online except for ACLS and CPR. That being said, I can relicense with a 100$ initial outlay I can relicense for my Missouri medic without even having to leave the comfort of my house. New York just seems to be behind the times in distance learning and allowiing it to happen. I would Print out the links that I showed you here and take them to your volunteer department and have them look at them. Who knows, you might just start a education frenzy when they realize there's some free money involved.

ok for the abbreviation challenged, what is SMR? Here is the problem with using abbreviations that I have. I did a google search because well dammit I'm not familiar with the SMR acronym and these are just one list of SMR Abbreviations I came up with. I dont' really think that Strategy Mangement and Research is the answer nor Severe Mental Retardation is the answer. So let's stop using abbreviations please. Standardized Mortality Ratio severe mental retardation sexual maturity rating Skeletal muscle relaxant Standard mortality rate standard mortality ratio submucous resection scanning microradiography scatter maximum ratio schistosomal myeloradiculopathy Scottish Morbidity Record senior medical resident Sensorimotor rhythm sexual maturity ratings sleeping metabolic rate small multidrug resistance somnolent metabolic rate standard metabolic rate standard metabolic rates Standard Morbidity Ratio standard mortality rates standardised mortality rate Standardised Mortality Ratio standardised mortality ratios standardized morbidity rates standardized morbidity ratio standardized morbidity ratios standardized mortality rates stepwise multiple regression streptomycin resistance streptomycin-resistant stroke with minimum residuum sulfamerazine

There really isn't any excuse for this. Any time a patient feels so unsafe or uncomfortable that they choose the DC Metro (THE DC METRO for goodness sakes) over an Ambulance for transport to the hospital or just to leave the area, then something is definately wrong with that particular call. Have you ridden the DC metro lately???? I have and it's not a ride I would want to take on any regularity.

When the wind blows the right way, Even Baltimore gets a whiff of your Gas laws.

http://www.jems.com/video/news/dc-woman-leaves-ambulance-while-crew-arg My god, if this is true, then DC ems has fallen to a new low. I'm more and more considering hiring my own ambulance to follow me around when I take my family to DC. This is just ridiculous.

And from what I hear from your partners up yonder parts, you have absolutely NO Problem with the GAS laws, at least not after you've hit the chili a little bit too hard the day before.

Trevor, as long as you can back up what you say and do it coherently, not like that toronto mayor, you should be fine.

And again, the best way to avoid the situation is to not get into it in the first place. I'll be honest, I have had some very close calls, and actually I have dropped a patient one time due to having the cot up in the full position, ran over a tree branch in a driveway. In full witness of the patient's family. A horrible horrible experience, but this was before cell phone video cameras. Patient was injured yes, but minorly so. That began a journey of my realizing that having the cot up all the way was STUPID and irresponsible when having it up 1/2 way would have worked just as well. I no longer (when I work that is, and I don't work anymore) will have the cot up fullly. Lots of paperwork, a free ambulance ride, a free ER visit and a couple of visits with Risk management and the hospital attorneys talking with me and my partner makes you change your practice. Just don't put the cot all the way up and you decrease a drop by a factor of 10 in my opinion. At least I didn't drop the patien on a tuesday.

Yep, that's why I want to watch it.

With this glowing recommendation, I'm going to start watching.