Jwade

I cannot see how the statement in question applies to CPR pulse checks per se? It was based on electrical versus mechanical capture in the setting of TCP. I think he was simply saying you can have electrical capture without the presence of mechanical capture or a pulse.

Take care,

chbare.

CH,

That is why I asked for clarification,

I simply provided the article as a refresher just in case....

Respectfully,

JW

I have seem few try pacing in cardiac arrest, and it has never worked. I really wonder if anyone has seen it work?

I figure you can always try pacing, but chances are it is not going to circulate or get capture. Is the capture a femoral pulse or just capture on the monitor?

I have to agree with Mike. Even here in the city where I work we work the cardiac arrest for 20 minutes with a few other basic criteria but do not transport if no ROSC after calling medical control. There is more criteria to it than that but that is the basic of the protocol.

Speedy,

Can you clarify the above for me please? Not sure I understand? Femoral pulse checks are pretty worthless. See below...

Respectfully,

JW

(Circulation. 2005;112:IV-78 – IV-83.)

© 2005 American Heart Association, Inc.

2005 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care

8. Connick M, Berg RA. Femoral venous pulsations during open-chest cardiac massage. Ann Emerg Med. 1994; 24: 1176–1179.

Assessment During CPR

At present there are no reliable clinical criteria that clinicians can use to assess the efficacy of CPR. Although end-tidal CO2 serves as an indicator of cardiac output produced by chest compressions and may indicate return of spontaneous circulation (ROSC),1,2 there is little other technology available to provide real-time feedback on the effectiveness of CPR.

Assessment of Hemodynamics

Coronary Perfusion Pressure

Coronary perfusion pressure (CPP = aortic relaxation [diastolic] pressure minus right atrial relaxation phase blood pressure) during CPR correlates with both myocardial blood flow and ROSC (LOE 3).3,4 A CPP of 15 mm Hg is predictive of ROSC. Increased CPP correlates with improved 24-hour survival rates in animal studies (LOE 6)5 and is associated with improved myocardial blood flow and ROSC in animal studies of epinephrine, vasopressin, and angiotensin II (LOE 6).5–7

When intra-arterial monitoring is in place during the resuscitative effort (eg, in an intensive care setting), the clinician should try to maximize arterial diastolic pressures to achieve an optimal CPP. Assuming a right atrial diastolic pressure of 10 mm Hg means that the aortic diastolic pressure should ideally be at least 30 mm Hg to maintain a CPP of 20 mm Hg during CPR. Unfortunately such monitoring is rarely available outside the intensive care environment.

Pulses

Clinicians frequently try to palpate arterial pulses during chest compressions to assess the effectiveness of compressions. No studies have shown the validity or clinical utility of checking pulses during ongoing CPR. Because there are no valves in the inferior vena cava, retrograde blood flow into the venous system produce femoral vein pulsations.8 Thus palpation of a pulse in the femoral triangle may indicate venous rather than arterial blood flow. Carotid pulsations during CPR do not indicate the efficacy of coronary blood flow or myocardial or cerebral perfusion during CPR.

Assessment of Respiratory Gases

Arterial Blood Gases

Arterial blood gas monitoring during cardiac arrest is not a reliable indicator of the severity of tissue hypoxemia, hypercarbia (and therefore the adequacy of ventilation during CPR), or tissue acidosis. This conclusion is supported by 1 case series (LOE 5)9 and 10 case reports10–19 that showed that arterial blood gas values are an inaccurate indicator of the magnitude of tissue acidosis during cardiac arrest and CPR both in and out of hospital.

Oximetry

During cardiac arrest, pulse oximetry will not function because pulsatile blood flow is inadequate in peripheral tissue beds. But pulse oximetry is commonly used in emergency departments and critical care units for monitoring patients who are not in arrest because it provides a simple, continuous method of tracking oxyhemoglobin saturation. Normal pulse oximetry saturation, however, does not ensure adequate systemic oxygen delivery because it does not calculate the total oxygen content (O2 bound to hemoglobin + dissolved O2) and adequacy of blood flow (cardiac output).

Tissue oxygen tension is not commonly evaluated during CPR, but it may provide a mechanism to assess tissue perfusion because transconjunctival oxygen tension falls rapidly with cardiac arrest and returns to baseline when spontaneous circulation is restored.20,21

End-Tidal CO2 Monitoring

End-tidal CO2 monitoring is a safe and effective noninvasive indicator of cardiac output during CPR and may be an early indicator of ROSC in intubated patients. During cardiac arrest CO2 continues to be generated throughout the body. The major determinant of CO2 excretion is its rate of delivery from the peripheral production sites to the lungs. In the low-flow state during CPR, ventilation is relatively high compared with blood flow, so that the end-tidal CO2 concentration is low. If ventilation is reasonably constant, then changes in end-tidal CO2 concentration reflect changes in cardiac output.

Eight case series have shown that patients who were successfully resuscitated from cardiac arrest had significantly higher end-tidal CO2 levels than patients who could not be resuscitated (LOE 5).2,22–28 Capnometry can also be used as an early indicator of ROSC (LOE 529,30; LOE 631).

In case series totaling 744 intubated adults in cardiac arrest receiving CPR who had a maximum end-tidal CO2 of <10 mm Hg, the prognosis was poor even if CPR was optimized (LOE 5).1,2,24,25,32,33 But this prognostic indicator was unreliable immediately after starting CPR in 4 studies (LOE 5)1,2,32,33 that showed no difference in rates of ROSC and survival in those with an initial end-tidal CO2 of <10 mm Hg compared with higher end-tidal CO2. Five patients achieved ROSC (one survived to discharge) despite an initial end-tidal CO2 of <10 mm Hg.

In summary, end-tidal CO2 monitoring during cardiac arrest can be useful as a noninvasive indicator of cardiac output generated during CPR (Class IIa). Further research is needed to define the capability of end-tidal CO2 monitoring to guide more aggressive interventions or a decision to abandon resuscitative efforts.

In the patient with ROSC, continuous or intermittent monitoring of end-tidal CO2 provides assurance that the endotracheal tube is maintained in the trachea. End-tidal CO2 can guide ventilation, especially when correlated with the PaCO2 from an arterial blood gas measurement.

Partner, and fellow new medic, was working an asystolic patient. Glucose WNL, 3 rounds of cardiac meds onboard, amp of bicarb. Minimal history of current condition. Went through the list of possible causes. MCP wouldn't let him DC resuscitation. he was just exhausted, and no available units to help, as none of the VFD's roll on medical patients, just MVC's etc. He was wondering if an attempt to pace would've been successful. I didn't think so, but it was an interesting discussion that just had me curious. I'm not afraid to say that I just didn't know, but I was willing to ask.

Well, you will see two schools of thought from people on this, some will say yes try it, others such as myself will say no...

In my 19 years experience in EMS, the PROBABILITY of pacing working is NOT statistically significant. Also, there is case law to support the medic D/C compressions based on sheer exhaustion......

Respectfully,

JW

A few of us were discussing this, and I wanted some opinions. I work in a very rural setting, minimum transport time is 60-80 minutes to an ER. Sometimes, you can't get an extra hand onboard during bad calls. So....if you're working an arrest alone, and you're just to tired to do more compressions, is pacing a feasability? Isn't it still going to circulate, providing you get capture?

Well, Short answer, NO and it depends....

First, to answer your question accurately, please " qualify" arrest?

If the patient is in V-Fib or Pulseless V-tach, the answer is NO.

If your patient is in symptomatic bradycardia, refractory to medication , then obviously pacing and or CPR are indicated. ( This is also making the assumption one has figured out WHY the patient is in arrest and is instituting specific TX modalities.

Respectfully,

JW

Honestly, with the media exposure and the "what could of happened" scenarios do you really think the crew will need "remedial training to lessen the chance of it happening again"????

I know if it was my mistake there is no chance it would ever happen again. I would be absolutely horrified that my "mistake" or moment of complacency could have killed someone and wouldn't forget it ever!

I try to learn from other people's mistakes and as a result of this one I will be even more diligent in my "walk arounds" now. Better to learn from someone else's mistakes, I say. Life is too short to make them all myself!!! I am usually diligent anyway as I have heard of pieces of equipment or mechanic's tools being left where they shouldn't have been.

You said the key word in this entire scenario..." WALK AROUND"

As a pilot, this is something I do EVERY single time before every leg of a flight...........As a Flight Paramedic, this is something I did as well, EVERY SINGLE TIME........Complacency Kills! Honestly, how hard would it have been to open the door and put it on the seat? Seriously.......MAJOR FAIL........

JW

We discussed this story on the forum about a year ago. I used to work in Kern County. Don't remember all the details, but basically a medic showed up and the cop told him, "He's just drunk. He's going with us." The medic made patient contact but apparently also thought he was just drunk. He didn't do a proper assessment. One story I heard was that the medic claimed he could not do a proper neuro assessment because the patient was handcuffed. I'm not sure if this is really what he claimed or if that was the case then why he didn't just get the cop to uncuff him. Again, this is just what I heard and I'm not in on all the facts of the case.

The medic took off, and sometime later a nurse from the hospital came by because she recognized the doctor. She realized he was having a stroke and had PD call for another ambulance.

The lawyers will still have to prove that the delay in medical care would have made any difference in this guy's outcome. That doesn't seem very likely if he had a bleed, which is what I heard he had. Regardless, it's really tragic that this highly skilled doctor has become disabled. If I remember correctly, he was specialized surgeon of some kind.

Just wanted to elaborate a little more on how " Negligence" is actually proven in a court of law. Just finished up a law class, so this is pretty fresh in my mind!

Negligence claims require the plaintiff to prove 5 elements:

1. Duty of care owed to the victim, and

2. Breach of that duty of care, and was the

3. Actual Cause of the damages or injuries, and was

4. Proximate Cause of the damages or injuries, and

5. Damages or Injuries resulted.

Duty of Care owed?

The basic premise of the law of negligence is that each person has a duty to conduct their affairs in a manner which avoids an unreasonable risk of harm to others. But one doesn’t owe a duty of care to just anyone. Courts look at fairness and public policy to determine whether a duty is owed, also whether there’s a special relationship e.g. doctor/patient, attorney/client, also whether there is a statute that creates a duty of care to that person, e.,g. traffic laws. Generally, a promise made to another person is not sufficient to create a duty of care.

Breach of Duty of Care?

The standard by which a person's actions will be measured is that of a hypothetical reasonably prudent person. The standard is thus objective, but is also flexible by assuming the reasonably prudent person has the knowledge of the defendant and is viewed in the circumstances of the defendant as of the time of the objectionable conduct. If the conduct falls below the minimum standard of care, then a tort will be found to have been committed. Thus, a specific intent to commit the tort is not required -- merely to have failed to exercise that degree of care that would have been exercised by a reasonably prudent person.

Actual Cause?

Courts use the “but for” test where one person is at fault. If more than one person is at fault, then courts generally use the “substantial factor” test.

Proximate Cause?

Even if the defendant owed a duty of care, and breached that duty, and actually caused the damage or injury, the defendant must also be the proximate cause. That means that the actual consequences were reasonably foreseeable.

Damages or Injuries?

Courts require more than emotional distress. They require some evidence of property damage or physical injury.

Here are some special negligence doctrines:

1. Negligence per se. A statute or ordinance establishes the duty of care. A violation of the statute or ordinance constitutes a breach of this duty of care.

2. Res ipsa loquitur. A presumption of negligence is established if the defendant had exclusive control of the instrumentality or situation that caused the plaintiff's injury and the injury would not have ordinarily occurred but for someone's negligence. The defendants may rebut this presumption.

3. Dram Shop Acts. State statutes that make taverns and bartenders liable for injuries caused to or by patrons who are served too much alcohol and cause injury to themselves or others.

4. Social host liability. Some states make social hosts liable for injuries caused by guests who are served alcohol at a social function and later cause injury because they are intoxicated.

5. Guest statutes. Provide that a driver of a vehicle is not liable for ordinary negligence to passengers he or she gratuitously transports. The driver is liable for gross negligence.

6. Good Samaritan laws. Relieve doctors and other medical professionals from liability for ordinary negligence when rendering medical aid in emergency situations.

7. Fireman's rule. Fire fighters, police officers, and other government employees who are injured in the performance of their duties cannot sue the person who negligently caused the dangerous situation that caused the injury.

8. "Danger invites rescue" doctrine. A person who is injured while going to someone's rescue may sue the person who caused the dangerous situation.

9. Common carriers and innkeepers. Owe a duty of utmost care, rather than the duty of ordinary care, to protect their passengers and patrons from injury.

10. Landowners. Landowners (and tenants) owe the following duties to persons who come upon their property:

a. Invitees. Duty of ordinary care

b. Licensees. Duty of ordinary care

c. Trespassers. Duty not to willfully and wantonly injure trespassers.

Respectfully,

JW

There is no good option for an online A&P class. If there is one, it sucks. And most programmes won't accept one that did not include a lab component anyhow, so you will have wasted your time and money.

I don't know who does an online pharm class, but I'm betting someone does. And I don't see any problem with taking it by distance. Just a fair warning, if you have never done distance learning before, don't try more than one class at a time. It turns out to not be for a LOT of people, and there are no refunds for figuring that out.

Good luck!

I would not go as far and say no good option.......

MIT ( Massachusetts Institue of Technology) provides many outstanding lectures and video courses online free of charge...I have literally watched 2 semesters worth of various MBA and Health courses.....

MIT LINK

Just click on the Health Sciences and Technology link, or go to the video courses, or whatever else you need.....

Many top rated schools have put their lectures and courses online for free. One just has to know where to look...

Respectfully,

JW

EDIT......In fact, I just went through HST 151 Principles of Pharmacology, ( found under the Health Sciences link) The lecture notes are all in PDF form and are VERY GOOD! Let me know what you think...

1) Anything in the 400 MHz realm and above is UHF, not VHF. FYI.

2) To give an idea of Aviation frequencies, take into account that JFK International Airport Tower is 119.10 AM. (I am a Registered Radio Monitor/Short Wave Listening Station, courtesy "call-sign" KNY2SC, so I think I know at least a small bit of radio stuff)

3) Most, but not all, aviation radio traffic is in AM (Amplitude Modulation) mode, not FM (Frequency Modulation) mode. Most of our (LEO, FD, EMS) radio communications are FM mode.

While 2 dudes (or dude-etts, as not to be sexist) might want to start up an Air Ambulance/S&R Service, as already pointed out, you have the cost of the aircraft itself, fuel, the concept, as told me by friends in the NYPD Aviation Bureau, and cost of 2 hours maintenance for each hour of flight, the cost of keeping on at least one trained pilot for every hour of the day, the cost of a mechanic for similar hours, and let's not forget insurance for the helicopter, the office space, and the hangar areas.

While I do not say it can't be done, I would go on record that the chances of the company surviving into a second year would be microscopic.

By the way, another agency you might want to check out for information is Just Helicopters, an organization of helicopter pilots, helicopter aviation agencies, and "Rotor Heads", which are fans of helicopters (pun unintended: "fans"). I have used them as a reference on several postings in the city in the past. They are at http://www.justhelicopters.com .

Used helicopters formerly operated by the military? From the late 1960s to about 1980, the NYPD operated 2 "Hueys". Per my friends there, when they were delivered to the NYPD, they still had bullet holes from North Vietnam and Chinese troops' AK-47s in them.

Richard,

Good info about the radio stuff......The cost structure you outlined above SHOULD be covered ad nauseum in a well written Business Plan...As a Pilot, Paramedic, and someone who holds an MBA, I certainly agree with you the chances of startup and making it past year 1 are slim at best without proper leadership and capital.....

Respectfully,

John Wade MBA, FP-C

This was just a quick post to see what people had for ideas. I never meant any harm by it. I will post a longer, in depth post later tonight when I have time. You see I was at work with him and he wanted me to post and see what kind of responses people could give him so he could research more. There is a lot to the story and yeah, I know I didn't post an in-depth post, but I was just asking for idea. The couple of people who posted something useful...I thank you. Look for my new post in a few hours.

Dart,

Here is the REAL, NO BULLSHIT deal answers to your questions...

FIRST AND FOREMOST......

1. You and Your Friend need to write a BUSINESS PLAN for your future Helicopter Service....

For Example

I am currently in the process of starting a fixed wing operation with a friend of mine, and the business plan we wrote was 35 pages, with 15 of those pages being nothing but FINANCIAL INDICATORS. This will be the HEART and SOUL of the operation and not something that can be thrown together quickly or done mediocre.

For example,

1. Personnel Plan

2. Profitability %

3. Activity Ratios

4. Leverage Ratios

5. Liquidity Ratios

6. EBITDA

7. Debt to Asset Ratios

8. Revenue Forecast - Broken down monthly

9. Revenue Forecast - yearly

10. Break Even Analysis for 1st year

11. Pro Forma P&L ( Profit and Loss) Statements, Must Pro Forma out 5 years

12. Gross Margin & Monthly Profit

13. Pro Forma Cash Flow - 5 years Projected

14. Pro Forma Balance Sheet - 5 years = Assets & Liabilities / Shareholders Equity

15. Sensitivity Analysis

The above was just my financial section alone, and it took us months just to write the plan, revise, revise, revise, etc......We are now in the process of dealing with Angel Investors for our initial startup funds.....

With your limited experience in the air-medical industry and limited formal business education, I would say you have your work cut out for you indeed, not impossible, but, you're going to need the right help from the right people....

Once, you get this done and perfected, you then need to decide if you are going with a specific Vendor, and whose Part 135 certificate you will be using. This is also something that must be planned for, as the FAA just doesnt give these out like candy....They are VERY EXPENSIVE and time consuming to get one....and without one, you do not fly anywhere.....

Now, after those things are done, you must think about aircraft type, Single vs Twin, VFR vs IFR, Single Pilot vs Dual Pilot, Medical Crew Configuration, training, continuing education, maintenance, Night Vision Goggles..., etc.....

Where are you going to base the helicopter, Hospital, airport, or some other option?

Medical Director....You must have a medical director for the program.

These are just some of the very basic things you must have done to even remotely have a chance to get this thing off the ground......again, Not impossible, but highly improbable with what I have read so far.....

Let us know more.

John Wade, MBA, CCEMT-P, FP-C

Seems like EMS is not the only people who can't agree on entry level standards......Thoughts?

Nursing Tug of War

Is this in the United States?

How many hours of actual education for the care of the ICU patient did you get in your Paramedic program and how many hours of hands on care in the ICU did your clinicals provide. There is a considerable difference between a patient that is stabilized for transport from the field and one that is in an ICU. There's a different focus, different protocols, many different meds that are rarely mentioned in most Paramedic classes and technology that one would not use in the field.

Even RNs who work in the ED don't consider themselves to be ICU capable unless they have had the training/education due to the dynamic nature of the ICU patient. The same goes for many ED physicians. I don't believe there are too many Paramedic programs that produce ICU capable Paramedics. Yes they may be able to handle some ICU patients for a very short time but that would be only if the medications are familar to them as is the technology. However, it would be wise to have additional training and education beyond the normal Paramedic program.

The focus of the Paramedic is emergent care in the prehospital setting which includes stabilization. The patient is not yet "ICU" and all the things that make the patient "ICU" may not always be initiated until they reach the ICU. Not every ED is capable of performing at the level of an ICU. Have you never heard "gotta get them upstairs to ICU as soon as possible"?

Exactly,

I heard this EXACT same quote from 2 different ER nurses today while I was teaching ACLS........ The paramedics who would be capable of working in an ICU would be considered statistical outliers. ( Yes, there are some) However, definitely not the mean of the population...

Respectfully,

JW

Posted earlier in this thread:

Were the chemistry classes required for your Paramedic or were they in preparation for a Physiology degree?

Course Requirements for AAS Degree

Paramedic Courses Required

All courses with the PAR prefix must be passed with a "B-" or better in order for a student to progress through the paramedic program sequence.

PAR 1000 EMT Basic (2)

PAR 1001 EMT Basic Lab (4)

PAR 2000 Intro to Paramedic Practice (4)

PAR 2010 Medical Emergencies (6)

PAR 2020 Traumatic Emergencies (3)

PAR 2030 Special Considerations in Paramedic Practice (3)

PAR 2040 Paramedic Clinical I (4)

PAR 2100 Advanced Paramedic Practice (4)

PAR 2110 Paramedic Clinical II (3)

PAR 2120 Paramedic Internship (9)

Students participating in the distance education “Skills Camps” will also complete the following:

PAR 1011 EMT Intermediate Intro Lab (2)

PAR 1021 EMT Intermediate Lab (2)

PAR 1031 Advanced Cardiac Life Support (ACLS) (1)

Biomedical core courses required (or acceptable equivalent)

HTHS 1101 Medical Terminology (2)

Must be taken in sequence

HTHS LS1110 Health Sciences (Biomedical Core) (4)

HTHS 1111 Health Sciences (lab) (4)

Acceptable Equivalent to completing the anatomy and physiology requirement

ZOOL 2100 Human Anatomy (4)

ZOOL 2200 Human Physiology (4)

or HTHS 1115 Biomedical Principles for Certificate of Completion for Paramedics (4)

Support Courses Required (15 credit hours)

COMM HU2110 Interpersonal & Small Group Communication (3)

HLTH 3400 Substance Abuse Prevention (3)

HTHS 2230 Pathophysiology (3)

PSY SS1010 Psychology (3)

SOC SS/DV1020 Social Problems (3)

This is how the program stands now, as compared to when I started 20 years ago. Most of the same requirements still in place. The differences from my day are I don't see any specific Pharm I,II classes, and the Chemistry, Micro have been combined into the year long Bio-Medical core classes, which give you A&P, Micro, Organic/Inorganic Chem over the course of a year, minus summer semester. Obviously, on top of the above are all the general requirements as well, English, Psych, College Algebra, etc.......

The chemistry was required for the AAS when I started, again, the chem is still in the program if the student takes the BioMed Core classes. This was NOT in michigan.

Respectfully,

@jwade

I, too, love working as a paramedic; and I still do. I do not, however, have any illusions as to the extent of the differences between the educational requisites of either profession; EMS or Nursing.

I find those courses to be a bit excessive, and I would love to see the program, if the anomaly still exists.. You must agree that is no where close to the norm. That is on par with average entry requisites for a BSN program, an AAS most likely does not require all the science, particularly chemistry.

I am not arguing this, simply stating it is borderline inconceivable.

EDIT: Vent, it is because MI is becoming a cesspool..Not much is going well in this fine state..

I guess it depends on how you "qualify" normal? This was my world when i started, so for me, that was my normal. Now, what has happened over the last 20 years is up for debate obviously. In looking at UMSTUDENT list of schools, seems there are still some doing it correctly.....

Mine has clearly changed somewhat from when I was going to school there. However, for the most part, this program is still clearly a few standard deviations above the mean! :-)

Respectfully,

JW

I have read this last part of the thread, and I really don’t know what can come from this discussion. The education of a nurse and a paramedic are different. Maybe in the community college the pre-requisites are the same or similar, but the core classes are different. As far as I know, ADN nurses do not need chemistry courses, but require a biology/microbiology course. I think this is not required for AAS paramedic yet is it, it wasn’t for mine. I think these go a long way to understanding the base of disease and treatments, certainly from an outcome standpoint. Most nursing pharmacology courses are much more in depth than the paramedic curriculum, if you attended the same course as nursing, count yourself lucky and in the majority.

Paramedic training, education if you are lucky, focused on emergent, short term care and taught in a very medical model. Find the problem, focus on the problem, and fix the problem. Nursing is a more holistic assessment and treatment process, and brings into this process a lot of psychosocial and less tangible factors than medicine. I think you can assume, and you would be correct, that the nursing model incorporates many aspects of the medical model; plus the additional factors of home situations, recent lifestyle changes, ability to care for oneself, support systems, etc. None of which would be taught in any paramedic program I have been associated with, although they are all proven to affect the healing process significantly. The additional education in psychiatric nursing is far beyond anything you will see in paramedic school; community health is non-existent in any programs I have seen; geriatric medicine is a specialty barely touched upon in paramedic education, but what percentage are the elderly in your patient logs? Pediatric education is severely lacking in the paramedic education, but is a primary course in nursing; how many pediatric clinical rotations were in paramedic school? There is a depth and breadth of education issue, I believe, at the heart of the question at hand. Nursing education is much deeper in detail and wider in breadth than that of a paramedic. Simply a difference in curriculums and focus; the intent was never to have a paramedic perform long-term care, as far as I know.

As far as skills; monkeys can learn skills and perform repetitive tasks, but thinking through the technology and how it is going to affect the patient is certainly dynamic and an exercise in critical thinking. During all the “clinical” in the ICU, CCU, Stepdowns, med/surg, etc; how much time did you spend actually caring for a patient, talking to the patient and their family, assessing the treatment plans, adjusting the plans accordingly, conversing with the physicians and students and interns…..

I still believe that there is a big difference between the “education” a paramedic attains and that of a nurse. Most paramedic programs are based on training that, like it or not, is based on cookbook type medicine. The average paramedic school graduate doesn’t not have the education that an average nurse has, and I can also pretty much guarantee you than a well educated paramedic would not have anywhere near the education or training that a well educated and trained ICU, CCU, or other intensive care based nurse would have, unless they were also the latter. This, of course, would start the micturation competition you were not looking for.

As both a very educated paramedic and a fairly educated nurse, I can assure you there are differences between nursing and paramedic. Both have their place in the health machine, and are two totally different animals.

Although I don’t think nurses should insult a profession they possibly know little about, if the nurse worked in the ED for any length of time, the insult was likely warranted. You say you are educated to a much higher level than most paramedics (medically I assume); she sees most paramedics. Most medics are the same way towards nurses and they are both way off base.

I still think that comparing a paramedic education to a nursing education is ludicrous, and I also know this discussion will be going on long after this thread is closed, regrettably…

If you don't want to be a nurse, don't. There are already too many disgruntled practitioners out there that are only in it for a paycheck. This can make for very poor patient care and you will be very miserable....I guarantee it.

CCMEDOC,

My paramedic program REQUIRED A&P I,II, Microbiology, Organic Chemistry, Inorganic Chemistry, Pathophysiology, Pharmacology I,II, All these classes were taken in a 300 seat auditorium at a very big University, where all the students of Nursing, EMS, RT, PRE-MED, all sat together for these classes.....Only when we went for our " core" classes did we break up into our respective fields.........

So, after reading this last 2 pages of the thread, both sides present strong and valid points. Unfortunately, politics and ego continue to dominate the efforts needed to make meaningful change. I love EMS and being a paramedic with all my heart, I have NEVER wanted to be a Nurse, but, I went to Graduate School to pursue an education that will hopefully allow me at some point to cut through all the BS on both sides and make some change.....

Respectfully,

JW

Just wanted to give you all a heads up the the ResQshop critical care resource has been released for the iPhone/iPod touch. In addition to the plethora of critical care resources such as ventilator setup, medical management, infusion calculators, Parkland calculator, balloon pump quick guide, ABG and electrolyte manipulator, RSI, and quick equipment resource guide, the addition of a lab reference/resource section is a much appreciated addition.

With the Fast Facts, Informed, and now ResQshop, the medical resource abilities of the iPhone are currently unmatched IMHO.

Take care,

chbare.

Agree with CHBARE i do!!!! ( My best YODA impersona) Go to the APP store and search for iRESQ. I downloaded it tonight, and it is amazing...by far the best out there....

Also, the author is a friend of mine, and if you have any issues or problems, he will take care of them ASAP for you.....

JW

I applaud nursing for having high educational standards for the educators. I personally feel that EMS is lagging because it has not set the bar higher for its instructors to become educators. Once education becomes more visible to the students, an example is set rather than "look at the cool things Bubba has done and he only had 4 months of trainin'". For RT, I am really impressed at the support for education but then after having all the other health professions looking down their noses at the RTs in the 80s when the tech mills tried to ruin the profession, it is nice to see this profession emerge stronger than the weakest link. Unfortunately, EMS is still catering to the weakest links.

RT combines the best of two worlds; technology and health care. For those who love gadgets and taking the human body to extremes with technology, it is a fascinating career. However, Physical Therapy ranks up there in gadgets and a fascinating profession with many different opportunities as well as being one of the better paid with sign-on bonuses that make even the RNs drool.

Vent,

My cousin is a PT in Michigan and her program was a Masters in Science. I am pretty sure just about all PT programs are all Graduate level now? We could take a lesson from these guys and the Pharm people i think!

JW

John,

You just quoted me. How can you state I said the hospital CEO's and Administrators have no clue?

Those of us who have been around awhile know that the MBA was as common in the 80s and early 90s as the BA was in the 70s. Some thought of the MBA as a program for the undecided and others realized the BA was not enough education to get a decent job and definitely not a career. A nurse can do okay with just an ADN but one who wants to make a good career in nursing with many options should be adequately prepared for the future.

I also remember the nursing program recruiters standing outside of the RT classroom door on test days to snatch up whoever came out in tears. Since the RT prerequisites were actually higher than the nursing programs at the time, the RT students were an easy transfer. However, it was very rare that the RT program took someone who failed the RN program.

Vent,

My apologies, I must have misread your statement earlier. I stand corrected on the Hospital Admin and education issue! :-)

From what I have read about MBA programs from the early 80's compared to programs currently, the focus seems to have changed dramatically, and just like nursing, has expanded to encompass areas as you have pointed out in the previous responses.

Dust,

I have also heard some friends of mine express the same thing about RT school being much more difficult than nursing school. One of my close friends who was a 2 year degree medic first, said nursing school was just beyond boring and mundane. He really enjoyed RT school after 2 years as an RN, and was happy he made the change.

CHbare,

Here in Arizona, there are very long wait lists for nursing school due to the lack of qualified Nursing instructors.

Respectfully,

JW

Far be it for me to speak for JakeEMTP, but I believe I understand where he is coming from (and yes, I have worked flight). I believe it is just the opposite of what [i think] you are suggesting. Most ground medics who have never been on a flight feel the opposite of JakeEMTP. It's a bizarre kind of "man crush" kind of thing that they have with the airplane and the flight suit, with no real understanding of what the job itself is all about. It's a big reason why HEMS is so overused. Whackers get a woody when they hear the rotor blades, as if they enjoy some glory by proxy simply for having called them. Take away the sexy factor, and there is little left that is particularly appealing. Not that there is anything wrong with working flight. But the hero-worship factor from the ground pounders is silly and unwarranted.

Dust,

Very well stated! HEMS is overrated, and people take themselves way too seriously. You would think with some of the EGO's involved, they were curing cancer or something!

JW

You are looking at "management" from the only perspective you have been taught with is probably very different than the health care leadership model BSN and BSRTs get. Our pertain to a health care setting and with direct patient care that covers leading and organizing many different services for the good of the patient. If the nurse wants to get more into health care administration and less with patient care they can go the MHA or MBA route. The management in these "lower" degrees is still geared toward patient care. BSNs are needed because the RN has traditionally been the higher educated clinician who was responsible for the whole patient. However, if you attend a multidisciplinary meeting, most allied health providers will have a Masters and are quickly gaining more respect from the MD and Hospital Administrators since legislators and insurers are impressed with their evidenced based research for patient care and have shown that professions with higher education can cut costs in the long run.

This must be the "basic" management course that you are referring to.

NUR 4828 CON-NURS 3(3,0)

Nursing Leadership, Management and Role Transition:

PR: Admission to the BSN program, successful completion

of the first four semesters in the nursing curriculum, and

concurrent enrollment in NUR 4945L Directed Practice;

NUR 4637; NUR 4637L; NUR 4257. Professional development

and role transition of baccalaureate graduates entering

professional nursing practice focusing on principles of

leadership and management applied to health care settings.

Except for a couple of community and public health classes, the RN to BSN candidate can choose from several patient care based electives to enhance his/her clinical knowledge. However, I would not dismiss the importance of community and public health nursing. That is a huge issue right now and it has the potential to shape the way health care is delivered in the out of hospital setting. NPs and PAs as well as RTs are already very involved in the legislative processes for out of hospital settings that will directly influence their professions.

If a nurse wants to get more education for management as it pertains to running a nursing unit, there is an MSN with a management track. If the nurse wants to run a health care company or participate in corporate nonclinical level management, then he/she would get the undergrad requirements to enter an MBA program or anothe graduate business degree. Again, management in the direct patient care setting and dealing with patient as well as "leadership" issues is a different specialty and you should already know this since there are MBAs with varying tracks for different specialties as well as MSA (accounting), MST (taxation) MSBM (sport business management), MS (human resources) or whatever your specialty.

Nursing is a very expansive profession and the BSN is just one step that really is an entry level for patient care and one the gives the RN more credibility with focus to the broader picture of things to come in the clinical setting and the future. The ADN provides only the core courses with their prerequisites much like the RTs are now seeing how outdated their A.S. degree is for achieving their goals and providing a better educated clinician at beside. We're still learning what OT, PT, SLP, Athletic Trainers, Radiation Therapists and a few others have already mastered.

Vent,

In the MHA classes we look at a variety of different models that are being taught to various other allied health providers, including BSN, NP, PA, CRNA ( including the new DNP, DNAP), MD, DO, PT, PharmD. We have done many statistical analyses to see which models have proven effective based on a variety of variables. However, this would clearly be beyond the scope of this conversation. Do you honestly think that Hospital CEO's and Administrators have NO clue as to what other professions require for education?

I agree Nursing is a very expansive profession, I do believe I stated that in a previous post somewhere. I think we are just looking at it from two different spectrums clinical versus business.

Respectfully,

JW

WOW! I wasn't quite expecting the response. Guess it's a subject that stirred up some opinions, haha. Anyway, thank you all for your thoughts and suggestions, I really appreciate it. I know that if I were to go nursing, it would defenitely make the most sense to go for the BSN, especially with my science and technical background, I could do it in a year to year and a half (full-time). The big obstacle there is entry requirements - they're competitive programs and my GPA won't make the cut (I've looked into Michigan State and LSSU). I wasted too much time fighting my ADHD (and losing) rather than dealing with it the first time around.

I think the biggest thing I'm taking from this whole thread is that those of you who have followed the medic route and enjoyed it don't regret the decision, even if you're making less etc. Having spent so much time fighting what I want vs. what I "should" do, it's nice to hear "real adults" talking that way. I think ultimately, I know that I'm dragging my feet on the nursing business because it's not really what I want - I just don't want to deal with my dad seeing that as the end result. If the genius child who drives him nuts isn't going to be an engineer or a doctor, she should at least be a nurse and make a living... But that's another issue altogether.

It's great to see all the info and emphasis on education in general though, as I am a firm believer in always continuing to learn new things and challenging myself. You all put a professional, intelligent, educated light on the EMS field - kudos!

Haha, maybe for some. For me, it just makes sense coming from 6 years working in air assault and MEDEVAC.

P.S. As far as leaving the state for either education or work - I intend on getting out of Michgian ASAP!! That won't likely be for another 18mo or so (so I can finish up the medic course), but I won't be job hunting around here long term.

Maverick,

Have you checked into Wayne States CD2 BSN program? This is a 1 yearish ( 16 months) BSN program for students with a previous Bachelors and all prereqs completed. I have had at least 5 friends of mine go through this program when I lived in Detroit, and all were successful and anecdotally stated it was not really all that difficult. Granted, most had previous medical experience as well.

Wayne State University / CD2 BSN Program

Again, Follow your heart!

Good Luck,

JW

I think you are missing the point, the patient was 1 month Status Post CABG & he developed Atrial Fibrillation & Atrial Flutter in the hospital after his surgery, he was treated with an Amiodarone Drip & 2 Grams of Magnesium IV & converted back to SR & discharged to home, three weeks later his symptoms returned. He developed palpitaions along with some shortness of breath! The patient was not in a ST, he was in Atrial Flutter!

Trust me, I am not missing the point....

I understand he was not in ST, that is pretty easy to figure out, however, I still would NOT have pushed adenocard.

Based on the anecdotal info you have provided, this patient would have been provided O2, serial 12 leads in route, depending on timeframe, possibly pain control, and I would have insisted his Cardiac Surgeon been called from his PCP's office. I still would not classify him as " Unstable" so, I would have waited to see some labs before I started him on any drips. Just because someone is in A Flutter, does not make one immediately deemed unstable....

Respectfully,

JW

I am sorry, but I have to respctively disagree with you on the ancedotal evidence. A patients history & physical can tell you a lot more than a 12 lead! As I am sure you are aware Atrial Fibrillation & Atrial Flutter are fairly common among Status Post CABG patients. This patient had a history of Atrial Fibrillation & Atrial Flutter following his CABG surgery. The ED & PCP were the ones who did the interperetation of Atrial Flutter vs SVT on the 12 lead. So a patient who is 1 month S/P CABG with Atrial Flutter, palpitations & shortness of breath is stable??

No offense taken. Excellent reply.

I will qualify " anecdotal " as your initial post stated " YOU WERE TALKING TO A PARAMEDIC". This in and of itself makes the entire scenario anecdotal. It would be completely different if this was your patient, you looked at the 12 lead etc......

Second, Having spent 8 years as a Surgical First Assistant, I can tell you, S/P CABG patients can have these symptoms for months. They can be caused by a variety of reasons, including spasms of the graft, I have seen this firsthand looking into many open chests during my time in the Heart rooms.

I am not saying one way or the other, stable or unstable due to the inherent nature of the information provided. This patient could very well be unstable, however, with the info provided in this manner, I would be hesitant to call this patient unstable and have that prompt me to push adenocard.

AND, No offense, But I certainly would not allow any PCP to determine my 12 lead, I would insist on having the cardiologist on call or the cardiac surgeon who had his or her hands in the patients chest to determine this info....To each their own though!

Most Respectfully,

JW

There have been reports and studies showing a direct correlation to reduced mortality and morbidity with higher educated nurses (ADN vs BSN.

Something from the ACCN:

I am curious where you get the information about the basic education classes included in the BSN programs, if you have not gone through one yourself. Your "BSN MGT 101" reference seems to be a sticking point for you. If you believe the only difference between associates and bachelors degree is this, you are sorely mistaken..

There have been many reports issued that also state that a major determinate in good patient outcomes is education of the caregiver, not experience.

We could debate this all day, and the evidence to the benefit of BSN can be presented as well, I seriously doubt you will be swayed so the point is moot...

Source: http://www.aacn.nche.edu/Media/FactSheets/ImpactEdNp.htm

CCMEDOC,

Good info, Thank you. I would have to read each study independently to verify the validity of the study and see what variables were excluded to reach their conclusions. It is often not what was included in the study which makes it valid, often times these are manipulated by leaving certain demographics out, as you probably already know being an MSN.

Again, I think you are taking my point out of context. In fact, even though I am NOT a BSN, in my MHA classes we have studied these programs quite extensively for reasons such as you provided in your post. So, I have a very in depth understanding of what these BSN Management classes are teaching, and they are a very basic level. I will qualify basic by saying they only teach a broad overview of concepts such as accounting, finance, stats, healthcare law, etc......Very few offer entire semesters of these classes as I stated would be a beneficial track if made available to the BSN students for those interested in future leadership opportunities. As it stands now, most are poor leaders being held back by a lack of formal education in this area. Of course there will always be outliers, but most in my experience tend to operate at two standard deviations below the mean. :-)

Just to clarify, I am certainly not against a BSN by any means, one must compare apples to apples in order to be swayed, for which, I am always open. Just not through a bunch of anecdotal evidence.

Respectfully,

JW

Lawyer up and shut up. I would not post anything more or say anything else at this point. Good luck.

Take care,

chbare.

Kaisu,

Take the above advice quickly. One of my previous employers tried to do the same thing to me with some comments I posted on Flightweb. Unfortunately, Upper Management was completely inept and did not do their homework before opening their mouths to me. So, I called my lawyer, I had her print off the thread in question, and then proceed to call the Program Director and explain the finer points of our constitution to him and a few other business law statutes. Needless to say, My base supervisor called with an apology very quickly, and the Program Director refused to even make eye contact the next time I saw him. ( You really have to love the uneducated!)

Don't worry about HIPPA, 99% of the people who talk about HIPPA violations have not even read the entire document. Their opinions are almost always anecdotal...

JW

EDIT---( P.S.) I don't like lawyers either, but they are worth their weight in gold when you really need one, so, my advice would be to NOT shut that door automatically! Keep your options open.

Vent,

Agreed, on the state license issue! You are correct, good point! As with Nursing some time ago, many diploma RN's did not have a degree and still able to get a license. EMS just needs to get with the program and force out all of the medic mills, volunteers, etc.....I personally think they should all be 2-4 year degree programs such like the one I provided a few posts ago. There would be ZERO arguments anymore as to which profession has the more basic knowledge base! Did Oregon finally institute this requirement?

Now, again you make huge assumptions, which, any decent critical thinking course would frown upon as you well know! I am NOT defending the warm body interview style at all...The issue is and has been, you have mostly RN's with zero to very basic business / mgt background running these programs and making poor hiring decisions. This is a fact, not fiction. Trying to compare an MBA to a BSN MGT 101 course is ludicrous. Contrary to your statement, I personally would push for some upper division MGT courses as a track available to the BSN students. Giving someone a broad overview of basic accounting, finance, business law, HR, maybe stats, does very little to prepare someone to be a manager, much less a leader of a program / business / etc......I would make the educational track for mgt where an entire course in the aforementioned classes would have to be taken. This would be a gigantic step in the right direction.

Respectfully,

JW

But working someplace for 10 years may not necessarily equate to someone "experienced". Some people may just exist in a job for 10 years and decide to get a flight job because they need a change and especially if all they need is an ADN. If the requirements were any higher they probably wouldn't put forth the effort. However, if someone has done their homework to find out that a BSN is preferred and then works their butt off in the best ICUs trying to learn all they can to get a job they have set their goals for, I would find that to be the best candidate.

You are also stereotyping the RN. One thing about RNs is that many are capable of adapting to most situations since they may be required to float t/o the hospital or between hospitals. Some are also tossed on an ambulance at a moment's notice if the pateint is beyond the scope of a Paramedic. Right or wrong they make the best of it and most with then demand additional trasining The training for a Paramedic is not really that extensive either in material or time but yet some are expected to function on their own after just a day or two of orientation. This may be coming with no previous medical experience except for the required EMT-Basic experience which doesn't prepare one very well for medical issues or doing lead on a quality ALS truck.

Vent,

You are killing me here...LOL....

Agreed some people just exist for 10 years.....HOWEVER, this is where someone such as myself who understands the business side of things and has extensive knowledge in business management would be able to " WEED OUT" those " Just Exist" people during the application review process and at the furthest during the interview process. So, they would never make it on to my team to begin with!

This is where a lot of Nurse Managers fail because they do not have the advanced business education from which to base sound hiring and business practices! Their very basic MGT classes in the BSN program are not sufficient by any means.

Again, I am all for education, and to get back on the OP questions, follow your heart, it does NOT matter how much education you have if you hate your job! I have friends who went to law school, passed the bar, and now went to med school, and one took up being a fly-fishing guide! Follow your heart!

Respectfully,

JW

JW,

You have a Paramedic cert with an MBA. What was your 4 year degree in?

The classes that make up the RN - BSN transition prepares the nurse for a broader spetrum of nursing for the future such as community health and research. Too few get a very limited view of medicine as a whole to know how systems work and what their role can be for the future. Also the additional research and writing can only improve skills that are necessary for day to day life.

If you haven't noticed by some of the posts on the forums, that readin' and writin' stuff can come in handy. The better you are at it the better your presentation may be as a professional in your reports and other forms of communication.

As a manager or owner of a Flight company I can see where the ADN RN would be to your liking. If they haven't started a higher degree after 10 years they probably won't so you will not have to worry about working around a college schedule or be concerned they might ask for education perks. They also know their options as an ADN are very limited especially if other flight teams want a BSN. Even some ICUs now prefer a BSN degree especially since they do have a large selection of qualified nurses despite a "shortage". Thus, the ADN RN will not be as likely to argue about salary and safety concerns if flight is something they really want to do. A BSN RN with 3 years of critical care experience knows they have several options and can be upwardly mobile in their careers.

VENT,

Let me start by correcting you. I have both, license and certification!

As I think you well know, Paramedics are LICENSED in the state of Michigan and others.

Second, It drives me absolutely crazy when people start throwing the licensure versus certification argument around with their limited knowledge. Having taken a few semesters of graduate level business law, criminal law, and healthcare law, the Case Law and courts have shown no distinction between licensure and certification. Without either one, an individual such as you or me does not partake in the taking care of others. This whole stupid debate was started by RN's trying to protect their EGO's and Turf.....

Seriously, they make people who cut your hair have a license!

Third, My undergrads are in Physiology and Business Management, My Masters Degrees are an MBA and soon to be completed MHA. Not sure where you are going with that.

Fourth, I do believe i said the BSN classes include community health and so forth. I agree with everything else you said about the BSN, although I have my doubts about how many BSN's could show me how to do a statistical research analysis.

My point was that a BSN nurse does not provide an education any more suited for taking care of patients straight out of school than a traditional ADN program. Again, I realize there are statistical outliers, however, we never base any decisions on an outlier!

I disagree completely with your last paragraph. My liking over a 10 year ICU ADN nurse versus a 3 year BSN nurse is obvious, based strictly on experience. If I am hiring for a clinical position, then 9 out of 10 I am taking the experience versus 3 years...( Assuming all other things are equal)...It has nothing to do from the business side of the equation.

Most Respectfully,

JW

(edited for a spelling error)