PRPGfirerescuetech

Second step: Apply to paramedic school

Mobey

You do not need to apply to paramedic school to be taken seriously as a BLS clinical provider. Simply stated, your responsibility in the grand scope of becoming better involves actively taking steps to improve your skills and abilities at the current level.

To suggest that one must actively want to take their education to the next tier to be "taken seriously" is a silly thought.

Other than that, your post was on pointe.

PRPG

PRPG: "60 year(s) old male, acute onset CHF. Monitor, IV, Nitro, (further story inserted here)

Nurse: "You gave nitro? Did he have chest pain? Why would you give nitro for someone in pulmonary edema?"

Seen something similar to this before, but it's still always a gem & so much nicer than I would care to phrase it sometimes...

Open Letter From A Paramedic

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Date: 2007-06-05, 7:31PM PDT

Dear citizens of (and visitors to) Multnomah County,

By and large, you're a good bunch. I enjoy providing you with the help you need when you call 911. You make my workdays (and nights) interesting. However, from time to time, I notice a few small issues -- perhaps we can call them gaps in your knowledge? -- that make my job a little bit more frustrating. Herein I offer a few simple pieces of advice to help make everyone's emergency experience more satisfying.

1. When I ask you questions, please strive to tell me the full and complete truth. There's no badge or gun on me. I'm not going to get you in trouble for being high on drugs, but I really would like to know what exactly you did. You're not fooling anyone. Likewise, I don't care who you were having sex with, where, with what exciting accessories, and what your respective spouses will think, but if it's contributed to your condition you should probably bring it up.

2. I regret to inform you life is not like TV. We do not run from the ambulance to the patient, we do not drive everyone to the hospital with lights and sirens, and most dead people stay dead despite our best efforts. On the other hand, we are not just a fancy taxi ride. I can start an IV (in your arm or leg or neck), put a breathing tube down your throat, do an EKG to see if you're having a heart attack, shock your heart if it's in a bad rhythm, and give about thirty different drugs for different medical conditions. I can do more in the short term than most nurses. I had to go to school for years. Respect me and I'll respect you.

3. In a related vein, if you could keep the drama to a bare minimum when your parent/sibling/spouse/friend/neighbor/coworker is hurt or sick, it will help everyone immensely. I understand that the situation is upsetting, and I respect your feelings, but the best thing you can do for the patient, me, and even yourself is try to remain as calm as possible. Shouting at me to do something or hurry up will not help. Yelling in general is not, in fact, helpful. Trying to keep out of our way, answering the questions we ask in a succinct and informative manner, and keeping your dramatic tendencies restrained are the absolute best thing you can do.

4. However, if it is your young child who is badly hurt or critically ill, you are allowed all the drama you want.

5. If I am trying to help you and this makes you upset for some reason, please do not try and hit me. I may not be as big and beefy as some of my coworkers. I make up for it in dirty tricks. If you do decide you'd like to tussle, I'd like to point out that you get ONE swing and it is never free. I have giant zip-ties, sedatives, and a radio that can call a whole lot of cops, who aren't nearly as nice as me.

6. If you are driving and happen to see my big vehicle with all the blinkies and woo-woos, please get the hell out of the way. Specifically, pull ALL THE WAY to the right of the street and STOP YOUR CAR. You don't know where I'm going and when I'll need to turn. Unless you're driving a Hummer I've probably got more weight than you, and if you do something stupid that I can't avoid and we stack it up, things won't come out well for you. Also I'll lose my job.

7. Finally, exercise a modicum of common sense about when to call 911.

Examples of when 911 is IS appropriate: Traffic accidents with injuries. Chest pain. Trouble breathing. Lack of breathing. Serious bleeding. Unconsciousness. Seizures. Strokes.

Examples of when 911 may NOT be appropriate: Blisters. Small cuts. Dissatisfaction with your fast food order. Needing a prescription refill. Colds. Minor problem (sore leg, stomachache) which has been going on for three days.

Bearing all that in mind, it's a pleasure to serve you, and hopefully I won't be showing up at your doorstep, street corner, or car door anytime soon.

Love,

One of Your Many Hardworking (If Underpaid) County Paramedics

But again, the only people on the crew of an EMS ambulance should be highly educated medical professionals. EMTs simply do not even come close to meeting that definition. But, if it makes you feel any better, neither do most paramedics in the U.S. Yet. And that is what we are trying to change. That change will never happen if you can still be one of us with a 3 week first aid course.

[marq=down:b89b252688]Amen-ah[/font:b89b252688][/marq:b89b252688]

Egamukayshun gows aye lonnnnnnnnj waiz.

One thing I picked up on this lovely thread was........

USE SPELL CHECK :roll:

What do you think is missing from the current paramedic scope? Most states don't even define paramedic scope, other than to say it is whatever the MD orders. Considering that, I'd say our scope is pretty unlimited, except in places like Kalifornia and Maryland. And, as UMSTUDENT correctly implies, restrictions are currently a good thing in those places.

Im working under the previously defined national scope of practice as the basis for my prior statement. That being stated...

The future of EMS is a larger pie of primary care, moreso as the ED's of this nation become overcrowded. We need to step up education and scope of practice, to meet the demands of our potential future.

Ahhh... now you're making sense! Total agreement. It's just that, once you do that, they would no longer be EMT-Bs. So really, you're talking about eliminating the EMT-B level altogether and making paramedic the new entry level, no matter what you call them.

The ALS scope and education does need expanding, as they are both woefully undereducated to perform the job duties of an advanced provider.

Both ALS and BLS education and scope are far too low, and need to be brought higher to match our other peers in medicine. This is NOT just a BLS issue when it comes to poor education and scope of practice.

Consign to the prior post[/font:f5c6ef5abb]

I long considered that theory, but it just doesn't bear out.

Some n00b medics do indeed get too focused on the next drug they think they are supposed to push and forget about the basics. No doubt about it. But his medic partner is no less capable of being the one to remind him than an EMT is. As always, the EMT is not as prepared or capable of doing the job as a medic is. Consequently, the theory is just silly.

And, of course, with all this talk around here about how EMTs are "useful" if they can set up a line, hand me the right drug, and get my laryngoscope for me -- not to mention all the EMTs who think that they too should be doing ALS interventions -- who does that leave doing BLS? Nobody. They are just as likely -- if not moreso -- to forget the basics as a medic is. That's why I'd just as soon they stick with what they were meant to do, not what they want to do because BLS bores them.

You do, however, make an excellent case for further limiting the skillset and scope of practice for EMTs.

I dont buy it. Both EMT's and Medics are equally at fault for forgetting basic skillsets, which concentrating on "getting that line", or some other silly crap like that.

LEts educate all levels of providers to the point that we can close this website down, due to no need to discuss crappy EMT's and medics who this they are gods but are just as undereducated.

XoXo

PRPG

Respirators...as in the N95s? Because that's really as much protection as we have. We don't have those masks that are fitted to your face or that have an actual filter on them. And anything can get through the sides of those N95 ones...they don't really fit your face.

You have to be fit tested for N95 respirators to ensure you can get a tight fitting seal.

PRPG

I don't have any experience with EMT supervisors in an EMS situation. However, I have been with an agency that had both EMT and Paramedic FTOs. And part of the FTOs job was to QA all of the charts that were turned in. But only Paramedic FTOs reviewed Paramedic charts. I really can't imagine it any other way. :?

As long as the EMT supervisor isnt the highest operational officer, then im ok with it....

Are they relevant? DO they serve a purpose in the system? Most definitely they do. Why, the short and sweet answer is framed in a statement: go to school and spend 18 months and approx. $20,000 then go to a true rural setting and try to find a job that pays well enough (or at all) to pay off your college loans. Until a paragod can drug or assess an answer to that they need to shut up and realize that short of in the population centers (where it seems to be the only place that this is an issue) the rest of the country does just fine with bls transporting agencies backed up by als units. Now for the nuts and bolts (thats country talk for the proof) The main premise for the emt basic is to arrive on scene and provide basic life support. And for those who think they are educated that means Air goes in and out blood goes round and round. People, at this level of care it is not rocket science. So how does the basic achieve this simplest of goals? They do it by assessment of the PT. There are those of you that are going to get all riled up by this statement, but please read on before you reply (ya right, I to have read the post and replies in here). Is this the same assessment that the paramedics do? should it be? Obvious answer no, but is it? The purpose of the bls assessment is two fold, first determine if air is going in and out and if blood is going around and around, second to determine if this PT needs or, and more importantly, is going to need a higher level of care than the basic can provide. Oh my!! there is the value of the emt basic. Now back to is it the same assessment is the answer obviously no? Well yes and no. Answer this question and you will see what I mean: can a paramedic be a paramedic without being a basic? So how unimportant can the role of a basic be. Are the levels of als bls care different? apple and oranges. Some of the post I have read in this thread seem to be discussing bls as partners new people in the industry I hate to be the person who brings the bad news but it is only like that in the cities and suburbs. most of you don't seem to remember that basics are also stand alone care givers in the same chain as the paramedics. So if your reasoning about basics not being relevant or then every argument you use to justify that position can realistically be said by a doctor or PA about the position of paramedic. As I said it only serves to divide a profession. Now to tell you where my point of view comes from. I write this at 2:45 in the morning sitting in the front of my medic unit thinking back to my years as a lead EMT basic on a bls transporting ambulance in a location that the closest hospital was 45 min away code 3 and could be as much as 4 hrs away code 3 then as an intermediate for another Ils transporting agency and now in this dam paramedic unit in the big city. To conclude the basics role in the system is not the role of the paramedic so to try to compare them to justify why one should be considered irrelevant is ignorant.

What the f*ck are you talking about? Read the thread friend, all I ask.

Side note: The good qualities of the EMT basic that you describe can be provided by EMT's on a First responder unit, not on an ambulance.

Good points AK.

CAL OSHA is likely a regurgitation of OSHA statutes, if I had to guess. After re-reading the statute, my mistake was that the facial hair is a "reccomendation..." not a "statute".

Regards-

PRPG

PRPG, excellent points, as usual. .

Takes a bow.

Anybody who actually listens to me knows that I -- as does PRPG -- advocate the total renovation and elevation of educational standards at all levels, not just Basics. So I don't want to hear this selfish whining about Basics being singled out.

Agreed.

At that point, they would no longer be "basic," would they? Everything that is "basic" is already within their scope of practice. And a comprehensive, Ontario style entry level education certainly puts them out of the realm of "basic" regardless of scope of practice, doesn't it?.

As compared to a higher level of education, you could consider it the basic level, certainly. However, in the grand scheme of things, these would be titles really, and nothing more in the ideal world of EMS. Elevation and retitling of these lower level of providers, similar to the canadian system would be appropriate, but to suggest the complete removal of a lower certification would be no good in my thought. Our system works as it stands now, with the correctly educated professionals with the correct scope.

When I say that I have no use for a Basic, I am speaking of Basics as they currently exist in the U.S. And any meaningful change has to be comprehensive. You can't just give them more skills and say they aren't basics anymore. And you can't just change the labels either. Putting lipstick on a pig doesn't change that she is still a pig.

Correct. Then I stand by you in your opinion.

Something amusing of note however...I have been the attendant on 73 percent of my calls this year, since 1/1/07. Thats 426 of 601 patients being deemed BLS. Seems someones got a use for me.

PRPG

in my opinion...

YOUR ALL WRONG![/font:5249314c47]

Now, heres the thing. When it comes to EMT's vs. Paramedics, the sad truth is that no one on here has enough education to be an adequate EMS provider. Period.

That being said...

EMT-Basic level providers have an ABSOLUTE use in the field. They might be a useful level, when their level of education, professionalism, and scope are expanded as they need to be. When the "special" folks among our ranks are weeded out, and have moved on to jobs at BK asking about "fries with that" and all that jazz, then, and only then, will their usefulness being as it needs to be.

EMT-Paramedic level practioner education is a complete joke as well, but their level would be useful when we can raise the level of education, professionalism, and scope are expanded as they need to be. When the "special" folks among our ranks are weeded out, and have moved on to jobs at BK asking about "fries with that" and all that jazz, then, and only then, will their usefulness being as it needs to be.

Now...

The discussion on the usefullness of a tiered system, or a limited MICU/Mensa medic system is a completely different discussion, meant for a different thread.

Sorry for the reality check kids, but above is the harsh reality of the topic. The only reason we argue about who is better than who is because were all inadequate, due to our level of education, and the standards established by our forefathers. You want my respect? Get a real education, not 18 months of trade school making you an overpaid skills monkey.

Discuss.

No, OSHA cannot be violated because a union negotiated.

Yes, you do need all facial hair removed for use of respirators. Ill post the pertinent parts of the OSHA statute.

The only negotiable part is if OSHA is a recognized entity with your state, allowing them to come down and apply fines for violations. If so, the to allow facial hair will be a immediate poor financial decision by the company, if OSHA were to find out.

If your state does not quantify as an OSHA state, then the only liability is when one of the staff gets hurt, and it can be traced back to your company being in non compliance with the OSHA "standard of care.

Then, your company is still liable for not complying with the standard. Kind of a damned if you do, damned if you don't if you will....

Sorry...had to do it.

*hides*

XoXo

PRPG, the EMT-B

Flags-tacky.

Your not serving your country, your serving your residents in a medical based profession. In lieu of wearing scrubs, either a company and cert patch on opposing shoulders, or a company patch on both shoulders is appropriate.

If you must wear a badge, dont wear patches on your chest. Enough insignia's makes you look like the back window of a red-necks pickup truck.

However,...if you must wear a flag...

The only true way to wear it is as Paramedic Mike noted. Blue field always towards your front side, stripes to your back.

If you are going to wear the flag only truely earned by professionally serving the country it represents, then do it the same way the military people do.

Just my opinion,

PRPG

We're not far apart on this. Education is the key. But once entry level education is raised to the appropriate point, it will no longer be appropriate to call them "basics." This pretty well dooms the title of EMT-B. So our choice is to either change the semantics as we change the education, or to keep EMT-Bs as a non-professional, first responder.

Semantics, yes.

However we dont part far as long as your on board with a two tier ALS provider system, similar to the canucks...

That's it. However, perhaps I was too vague.

By "team," I am referring to two entities: the ambulance crew, as well as the greater picture of healthcare professionals involved in the patient's ultimate recovery (RNs, DOs, MDs, RRTs, LPTs, MTs, etc...). Neither of those two groups should include EMT-Bs. First Responders are a whole different story, and EMT-Bs are welcomed and encouraged there, but they are just First Responders, not medical professionals. And medical care does not begin until arrival of medics. Therefore, while they are a valuable part of the overall equation, they are not part of my "team."

Our opinions seperate here.

EMT-B's should be a welcome part of the team, as well as medics. This however is after both medics and EMT-B's education level is raised to the pointe that both provider levels can be truely referred to as medical professionals.

Until then...

WERE ALL JUST TRAINED MONKEYS!

Last time I checked a TRAINED MONKEY COULD NOT do the job of an EMT-B. If it wasn't for EMT-B's you would be screwed around here. I think that I have enough brain cells to decide wether I need medics. I also know I don't need a medic to tell me it's a BLS run. When you run out here in the middle of no where land you let me know how it works. And yes protocols are in place for that reason. But there are many times that we as educated EMT's know that we do or don't need medics. I am a newbie here and very insulted by your attitude toward EMT-B's. It would be like me bad mouthing First responders. Out here they are a great asset to us and do there jobs well. But then I guess cause were not medics they could pay monkeys alot less.

Be insulted. Thats a good thing, and means you show promise. Your recognition of this means your smart enough to have formed your own opinion, regardless of how wrong it is.

We are all trained monkeys, just some of us realize it in the hope of a real education system and a brighter future.

In the mean time, I wish you luck in your employment.

Side note, I've worked both extremely rural, as well as extremely urban systems. Regardless of length or distance, I was a well trained monkey. Your only variant is how long you have to utilize that training.

Regards,

Mr. PRPGfirerescuetech, well trained monkey EMT-B

Wow.

This, like many posts here, has turned into a measuring contest.

Heres the deal.

None of us have enough education to be doing what were doing.

This is why the medical field laughs at us, doctors dont trust us with 4x4's, let alone much more, and our education system has fallen wayside to a curriculum similar to a "how to" first aid manual.

Basics call medics too much, because thats what they are trained to do. They call the ALS providers with a whole bunch of "monkey see monkey do" training on ALS interventions they shouldnt be allowed within 10 feet of.

So, what have we learned?

Basics shouldnt be allowed within ten feet of primary care without an incredible amount of additional education.

Medics shouldnt be allowed within ten feet of many of their ALS skills without an incredible amount of additional education.

So trash the basics, feel free. However, in the grand scheme of things, were all just overcompensating for being trained technician monkeys.

Discuss.

One attempt.

Minimal education with overall theory being straighten the leg until periphery gets veinous blood return, then strop and splint in place.

The is a EMT and/or medic "skill".

Im not saying its right, but we can do it.

I have seen them usually identify themselves as EMS and ambulance service. This being, usually as they will provide EMS and then provide ambulance transport for non-emergencies. Many of these services will also provide non-emergency services as well, again to increase profit.

For as "transport" anything, I do wonder on the percentage of payment and then how much paperwork in coding is changed to be able to justify for payment?

R/r 911

TONS.

The fraud in EMS is mind-boggling.

Lots of stories to support this.

Just go to a documentation class and listen. Somewhere, they will remind you to always document a non-ambulating patient who rode on the stretcher.

As if medicare cant decipher "tooth pain" shouldnt be non-ambulatory.