Kiwiology

lol -I know it ain't me who is pregnant, and I am SURE I would recall if I was the daddy......

Paul have you been cheating on me again

Yo happy freakin' birthday like y'know you crazy old bastard

Herbie, those are exactly the issues I was talking about

Now nearly everyone has proven you are against the fire based EMS concept to begin with regardless of where training comes from.

I cannot speak for everybody here but personally; but lets say that Big City A wants to intergrate fire and EMS, here are some of the flags that go off in my head ....

- Does the fire department want EMS or will it become the neglected stepchild?

- Do they understand EMS and what is involved in providing it or is it a way of getting more money?

- Do they have the leadership and motivation to support these medical professionals?

- Are the firefighters going to be cross trained, dual role firefigher/paramedics?

- If they are, how much time do they get on the ambulance?

- What clinical leadership, mentoring, skill revalidation and continuing education resources will the FD have?

- Are the firefighters required to become paramedics? (see above post)

Paramedics are medical professionals; when the fire department wants to run EMS you come up against the issues of leadership and oversight. If the fire department doesn't understand them or even want them (I know some places where EMS has been thrust upon the fire department; I think the FDNY was one) then you can bet it won't have quality systems in place to motivate, guide and lead its paramedics. They will probably end up the neglected step child without the quality clinical support, mentoring and continuing education you need.

I don't think anybody here is any more against the fire department running EMS as they are say .... the freaking phone company running EMS. If I knew the phone company paramedics were ...

1) were dedicated to the practice of paramedicine because they wanted to be there and not just killing time

2) had excellent leadership behind them which was motivated to further patient care/provider education, and

3) had a solid clinical skill revalidation process that ensurd excellence in practice

... then I wouldn't have a problem with them rocking up in thier Dodge utility with the Telecom logo on it and treating my cardiac arrest and DSL upgrade at the same time.

If I knew the Fire Department was the same and that the Paramedics were not either ...

1) just firefighters who had to be there until they could out onto an engine or

2) Paramedics who were not supported by the department in terms of leadership, clinical revalidation and continuing education

... then I wouldn't have a problem with it either.

Here in good ole New Zealand we have fire/rescue (supression/extrication/heavy rescue) and we have EMS. The two are totally seperate except for a few rural communities where Fire provides a first responder capability to assist EMS because they better able to respond faster and the capital (Wellington) which is a plan to get the cardiac arrest survival rate up by utilising AED equipped engine companies.

I do not have a problem with fire based EMS; what I (and I think everybody here) has a problem with are the departments who require paramedic certification in order to become a firefighter.

You cannot tell me that you can create the same calibre of paramedic out of a firefighter who is only a Paramedic because he has to be one to pass his probation or keep his job nor can you tell me that you will create the same calibre of firefighter out of a paramedic who only got his FF ticket because he had to in order to be employed.

The danger in doing that (as I know a lot of US departments do) is that you run the risk of getting subpar paramedics who have only just done enough to pass because they didn't really want to do it in the first place and who have only minimum knowledge or interest in the practice of paramedicine (again, enough to tick the boxes until they get on an engine and don't have to play paramedic).

I recall one story a few weeks back where a very high percentage of firefighter/paramedic candidates failed a pharmacology exam (I think it was about 2 out of 14 that passed). By forcing firefighers to become paramedics you ultimately run the risk of providing substandard care by using substandard providers whos interest or knowledge in paramedicine is only the barest minimum required to keep thier job.

My father, cousin, brother, two greatgrandfathers and uncle are/were firefighters. They were experts at thier job because all they did was supression and rescue. I cannot see how you can create the same calibre of practitioner out of somebody who is forced to do two jobs - be a firefighter and a paramedic. It makes no sense.

Like playing doctor???

No no if she did that, an insurance card would be required before assessment would begin

Kevin; that question is like asking how long is a piece of string. There's a lot of good advice here and I'll try to add my two worthwhile cents too. I went through a lot of career ideas; lawyer, doctor, firefighter, web designer/computer tech, teacher, 007 style hired assassin, and a few more I can't think of. Not all those ideas were practical or ended up being what I really thought I wanted to do.

With that in mind, let me ask you this: why do you want to be an EMT/Paramedic? Is its omething you want to do long term or just an "interest" or "stepping stone" to becoming say, an MD or RN? It would be a shame to commit yousrelf to the expense and effort of becoming certified and not gain the full use of your certificate because you lost interest halfway through.

Secondly; do you have any background in the medical or healthcare field or know anything about emergency medical services? I ask because one must have a realistic expectation of what to expect out there on the street as an EMT or Paramedic. Your class will certianly help with that and the required clinical and road time will be a great learning experience. There is a lot of difference between what's out there in the street and in the classroom. I also say that because I once got myself into a situation where I thought I knew what I was in for and it seemed all good, come day one it was totally different and I found myself struggling to keep my head above the water so to speak. I'd hate for you to build up an unrealistic picture of what to expect and then have it turn out to be nothing like it!

Thirdly; as with any academic undetaking (and unfortunately I speak from the experiences of having made these mistakes) you need to be 100% focused on your goal and stay ontop of the work. If you have no background in medicine or healthcare then I can probably assume that 99% of what is being taught will be completly new to you and therefore will take a bit more time to wrap your head around. It's really important to be self motivated as you won't be spoon fed information by your instructors and you will be required to be competent in all of it to pass. It's also really important to have good study habits because if you fall behind it's hard enough, but falling behind when the information is new and unfammiliar is even worse. I've washed out of one or two courses that way by simply not being goal orentaited (i.e. on passing) and having ineffective study habits.

If it's an area you maybe need help on then I encourage you to go seek it out - go to the library or look around the web for guidance. I cannot stress how important it is because I've learnt the hard way. I've gotten behind and it can really make a mountain out of a molehill whih adds to stress and makes learning harder!

I would also recommend you build in some time for expanded learning, search out additional information on what is being taight. This will really help you to gain a better understanding and more competent knowledge of the subject matter. It's also a great confidence booster, the more confident you are the better you will do, which will ultimately (I believe) make you a better EMS provider.

Sure does hope this helps! 8) .

That's auctually a very good point Scotty. In Guidelines 2005, the American Heart Association made it a point of recommending changes to the next generation of AEDs because the current analysis to shock times of some AEDs could be as long as 30 or 40 seconds while those using a manual monitor/defibrillator were much, much lower.

I'd definately look at an AED which also includes a manual mode over-ride, such as the Zoll AED Pro or Phillips Heartstart FR2+ which would allow a trained rescuer to use it (argubly) more efficently than in automatic mode.

I believe in the strength of a good rapport but firmly believe in also being polite, professional and respectful.

When addressing anybody I either use sir/ma'am or Mr/Mrs/Ms as appropriate.

I've called teenagers "dude", a little girl "honey" and Grandma's "dear" before but I only use those terms sparingly and if I really feel it is appropriate and beneficial to building or maintaing patient rapport.

I agree with the decision to send ALS. Stabbing is different from being cut by accident with the kitchen knife; the chest contains lots of vital organs (yes ... I think I learnt'd that somewhere); even though you say the wound may not have been very deep you have the potential to do major damage. We don't have portable x ray and CT in the ambulance so there's really no definate way of knowing where that knife has gone or what it's done.

Character and Background: Proof of good character and satisfactory background will be an absolute prerequisite to appointment. Persons convicted of a felony or who have received a dishonorable discharge from the Armed Forces are not eligible for appointment to this position.

The "Paragods" (nobody here in particular) need to get thier heads out thier ass. Simple.

Ever since I was five years old being a Paramedic is all I ever really wanted to do. I blame Rescue 911 and its co-hosts of Shatner and the Lifepak 10 The streets may be where I start but I don't see anything wrong with becoming an ER or EMS RN or maybe even an MD (emergency med or anaesthesology).

Then again if the right balance came along I'd work on the street for my career. Who knows where I'll end up

That's funny

Can't we all just get along?

That's too much to ask I think; see this is why we are not allowed knives at work!

I am basically in the same boat here.

National registry is a step above state certification (which is required before you can take the NREMT exams). You would have to get certified by a state EMS licensing agency before you can take the National Registry exam.

Reciprocity is set up for the 50 US states (e.g. Nebraska to say, Delaware) rather than nations (e.g. Canada to the US) so you would have the approach a state licensing agency.

Texas will let you become certified if you approach a Texas licensed educational provider and get a transfer of credit to there so you can "graduate" from that program and take the Texas exam; which would allow you to take the NREMT exam.

Take a look at California, they also seem to be a little bit more liberal than some of the other states I have checked out.

Let me know what you find.

Couple weeks ago I heard something like this from a cop I know....

"1-1-1 Emergency: fire, ambulance or police?"

"Police"

(brief disturbing pause for connection here ... )

"Police emergency, where is your emergency?"

"Yeah hi there are some guys running round outside my house trying to get in!"

"Do you know what they look like?"

"Um, yeah, they are a bunch of guys in black clothing with guns!"

"Sir are you at XYZ address"

"How did you know?"

"That's the police sir, you need to let them in"

Looks like the AMR ambulance I saw parked at 42nd St and Times Square .... begs just one question, was Kool Aide man driving?, ooooh yeah

Allbuterol

Amiodarone

ASA

Atropine

Dextrose 10%

Glucagon

Lasix

Metaclopramide

Midazolam

Morphine

Ketamine

Naloxone

Nitro

N2O

.... pretty crappy really

Hey I called 911 instead of 311 once, whoops

First choice would be Seattle/King County medic one - I know they had (and may still have) the highest cardiac arrest survival rate in the nation, must be doing something right.

Second choice would be Las Vegas - America's playground should bring some interesting calls.

Third choice would be Los Angeles County - I mean, who can say no to riding in the footsteps of Johnny and Roy?

LA clear - KMG941

I was shooting the bull with the FDNY on 4th of July and they pretty much said best route was to become a Paramedic. They also said Rudy shut down illegal fireworks sales, they've gotten much less business on the 4th meaning they can stretch out a bit until the next bum comes up and hassles them for medical attention

NYC Methodist offer a two day a week program, St Vincents and BMCC run full time programs.

Our EMS thrombolysis indications are:

- 75 years of age or younger and,

- A cardiac clinical history and discomfort for less than 12 hours and,

- No history of recent trauma, injuries due to falls, or extended CPR less than 2 weeks ago and,

- No CVA or head injury history within the last 6 months and,

- No major surgery within the last 2 months and,

- No GI bleed within the last 2 months and,

- No peptic ulcer disease within last 3 months and,

- Not be taking Warfarin and,

- No uncontrolled hypertension greater than systolic of 200mmHg

Assuming this guy check's out and because he has anterior ST elevation (5mm in V1, V2 and V3) I'm gonna get on my trusty radio and check in with the doc's at medical control about warming up the heparin and reteplase.

Is he still throwing PVCs?

I personally think it's just about finding the right person and the right balance. My uncle is a 27 year veteran of the fire department and has been married all that time. Friend of mine's wife hated him being a firefighter and they got divorced in about 6 or 9 months. My dad was also a firefighter (engineer); he and my mother have a terrible relationship which has nothing to do with his involvement in the fire service, so it goes to show it can be everything or nothing.

If you find the right person I don't think anything is impossible, even if you're both working opposite shifts and never see other. The future Mrs Kiwi also plans to become a paramedic; so I hope for sleep's sake and mine we can make it work with our partners

A brave man once requested me to answer questions that are key: is it to be or not to be? And I reply, oh why ask me?

A wise man once said to find a job you love and you will never work a day in your life.

.....without Lidocaine, Bretylium, Procainamide ... I must truly be old school.

Sure got that right, damn I haven't heard any of those drugs used in ACLS for years