Jwade

CC, If KZOO has switched completely to dual RN, then I stand corrected. I have an MD friend who flew with them not too long ago. I also called my contacts up in Saginaw after reading your post, you won't see dual RN any time in the near future up there either!. But, as you said, we are not debating this. Now, as far as your Biased BSN opinion, I think it is strictly that, Biased and more than likely the programs you speak of would likely fall into the statistical outlier category. As CHBARE stated, I cannot imagine what other hard science classes or clinical rotations in a BSN program that are not covered in any standard traditional ADN program. If that were the case, you would probably see more BSN's with minor's in a particular science related field. The overwhelming majority above ADN classes in a BSN program are VERY BASIC MGT related, leadership, community health, etc......Again, some programs might provide for further ICU rotations etc.... but this is definitely not the norm. Again, if your comparing apples to apples, Take the BSN, if your comparing oranges to apples, I would take the oranges! Respectfully, JW

First of all, There is NOT a lot of HEMS in michigan to begin with...So, lets clear that up first and foremost. Second, Survival Flight has been RN/RN or RN/Resident MD for many years. Third, The HEMS program in Western Michigan has been flying RN/MD also for many years. This is NOTHING new and has been that way when I lived and worked in Detroit. Fourth, The HEMS program that flies out of St.Joes in Ann Arbor continues to fly RN/EMT-P to this day. Fifth, a BSN really does not provide much more education in the way of patient care, a few VERY BASIC management classes, maybe a stats class or finance....I would still hire a 10 year ADN ICU nurse over a 3 year BSN ANY day of the week! Respectfully, JW

Hey, As much as this pains me to say, the RN is probably the easiest route for you to go. There are MANY programs out there where your previous BS will allow you to obtain a BSN in 1 year. Granted this year will be busy, but not impossible. However, my caveat for you is this, you stated you love the pre-hospital environment, well, so did I and always have. Hence, you do NOT see RN after my name. I wanted to be a paramedic and work the streets, and I did, in DETROIT no less.....( Does not get any worse than Detroit). I made enough money to live and that was fine by me, I also worked in the OR as a Surgical First Assistant in Detroit. Being around all the RN's day in and day out, did nothing but reinforce my decision to NOT go to nursing school. The streets are where I felt at home! So, go with what your heart tells you, I did, and I do NOT regret any of those decisions. Contrary to what some have suggested, there are plenty of agencies in the US where a paramedic can achieve a solid critical care education. You just have to be willing to travel out of a particular state if necessary. The RN field is great because it gives you a TON of options and a decent salary, but one thing i have learned in the last few years, is money is NOT everything! Just make sure, whatever you decide, let it come from the heart and you will be fine! I have many friends who went the RN route, and after only 1-3 years have left the field completely, because their heart just was not in it....You can relate i am sure! One last thing, if you go the Paramedic route, go to a school that is a 2 year degree program. My school was such, and required all the same classes as the Nursing Students. I.e. Micro, A&P, Organic / Inorganic Chem, Pathophysiology, Pharm I&II, Nutrition, etc........ Good Luck with your decision. Respectfully, JW

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First, without looking at the 12 lead myself, this anecdotal evidence is pretty useless IMO. Is the Atrial Flutter versus SVT what the 12 lead printed out as interpretation, or was this interpreted by the paramedic? There can be a huge difference in what the 12 lead says at the top, and what is actually going on. Aside, from having a tachy HR and mild tachy RR, he " sounds " pretty stable. Did anyone think to call his cardiologist or cardiac surgeon before transfer? Respectfully, JW

Two Songs for me!!! Joan Jett = Bad Reputation Curtis Stigers = This Life ( Theme Song from the SONS of ANARCHY) JW

Vent, I was not insinuating that a paramedic will spend hours with a patient, just merely pointing out that including " 15 min" in your entire statement seems a bit presumptuous. Just saying..... Yes, I remember those conversations very well, I am hoping to get enough time back in my schedule soon to start having those in depth discussions once again. I have just a couple classes left for my MHA, and then I am DONE with school! :-) I really do enjoy reading your posts, always very educational and well written. I just always like to play devil's advocate when needed ;-) Hope your well, and Happy Holidays! JW Hells, Agreed, and I never stated I would NOT give O2, I was simply trying to get people to think about the " WHY " you do things in practice.....I see so many people who can only do If A, Do B, and have NO clue about why! Respectfully, JW

VENT, Great Reply and Good Info, However, Speaking of " Blanket Statements" as you so elegantly stated, I do believe the above highlighted portion is indeed a blanket statement and a very big assumption on your part? JW

Shannon, Is there a difference, YES, but just worry about doing your normal routine.......Start bagging the patient as you would any other normal patient who needed an airway. This will be more than sufficient. JW

My gut tells me this poster is trolling for an argument, however, 1. I agree that one cannot reasonably expect to " Get them all" BUT, 82% is pretty poor. 2. If you have never used a backup rescue airway, how did you manage those 5 airways you could not secure? 3. My personal limitation for Intubation on the aircraft are 2 attempts at DL, followed by 1 attempt by my partner, and then we switch to King, Combitube, LMA, Crich, etc...... 4. Any reasonable competent ER will not arbitrarily pull a rescue airway if it is providing oxygenation and ventilation until they have sufficient resources available. In my world, this means having an MDA or CRNA at the bedside ready to manage the airway. ER docs like to think they are the airway guru's but, when the SH$T hits the fan, who do they call? Anesthesia! 5. Having success with difficult intubations is all well and good, but the most important issue in my mind is being able to do a complete airway exam and recognize when things have the potential to get FUBAR. It is important to recognize when EGO is dictating the outcome and you as a competent provider must have the ability to say, just because I can, should I be doing this? Respectfully, JW

Just curious as to why you would even attempt to intubate someone with lividity? What does night and race have to do with your success rate? again, not trying to flame, just curious on your logic. Thanks JW

BREATHE!!!!!! Memorize your sheets, as this is what will hurt you during the practical if you miss too many points. Combitube should be the last of your worries....Just remember, BLUE FIRST, and TAKE THE SYRINGE OFF THE CUFF AFTER YOUR FILL IT UP! This is where most people fail the section. Did I mention BREATHE? Good luck, you will do just fine. JW

82%? 22/27 And people wonder why there is so much talk about removing ETI from the paramedic scope of practice. I would hope you are more concerned with the 5 you missed! To answer your question: We should accept nothing less than >95% success rate. My last service required 5 live field per quarter, or off to the OR we went. Respectfully, JW

1. Yes and No 2. I don't understand the statement. 3. You are misunderstanding what Vent and I are speaking about. 8 years is the time HVA has been using 12 leads as opposed to her " About 5 year quote for Michigan" 4. All of the above minus the C-130, with the addition of a Hawker, G-4, G-5! 5. Drop me a PM, we could have some friends in common for sure. 6. Bitburg, Weisbaden, Landstuhl, Ramstein, Took an american out of a Tel-Aviv Hospital a few years back when all of the suicide bombers were blowing crap up on the streets...Made for an interesting ambo ride under military escort, and even more interesting security search at Ben-Gurion Airport. Those guys don't F around! 7. To your scenario questions, DO we have Retevase available to use? Respectfully, JW

Well, <55 & >35 on the age! I don't give out personal info on a public forum. OLD ENOUGH to know what the hell I am talking about! 2002 - 2010 That would equal 8 years +/- a month or two. > than the 5 years you quoted in your earlier post. Germany to be exact, Are you familiar with Medicine at the University of Heidelberg? My link Respectfully, JW

VENT, Medstar was one of the agencies I worked with that was using 12 leads, Lifepack 12, we did them all the time. One of my friends worked for HVA as a paramedic during his entire Medical School and Orthopaedic Surgery residency, and he was using them as well. So, I can say with absolute certainty we were using 12 leads in Michigan before your recent 5 year mark. Hell, I have been in Arizona for 5 years now! JW

Vent & Tniuqs I don't have a lot of time to answer your previous questions at the moment but i will get to them promise.....Just a quick question about the above highlighted area. What does that mean " announced"? I was doing 12 leads in Michigan back in 1999 when I was working, so not sure what exactly you are talking about. Thanks JW

Kaisu, Hey girl, NO, this was NOT intended as a rebuttal to anything you implied. I simply stated this because, from my experience, this is what I see being done time and time again. This was not a personal reference in the least..:-) Where in Havasu are you working? I am coming out that direction after the first of the year to do some teaching. Respectfully, JW

Vent, Yes, I have made blanket statements, I have the experience and education to make those statements, and while I certainly agree with your above statements about ALS et al.....I think you might be a tad biased based on your experience in Florida and California. Each of us see things through different filters, and therefore express opinions based on those filters instead of looking at the bigger picture. I have spent way too much time in marital counseling to learn all that stuff, so I try to put forth majority opinions based on what I know to be factual. One cannot argue the fact that I spent 11 years in Europe and have done countless flights to Europe and Middle East, Japan, Australia, Israel, to have a big picture perspective at what is going on in world medicine. I will be in New Hampshire visiting my best friend this weekend, I will get a copy of his protocols and post them for you when I get back. I will also dig out my protocols from Detroit, and send a few other emails out requesting hard copies. Again, I answered the OP based on his limited info scenario, in which I would not arbitrarily stick a NRB @ 15l on that person. I have done this many times throughout my career, and not once has any ER, Cardiac Surgeon, or Medical Director ever questioned me on the process. I realize that every patient is different, but, I have been fortunate to work in some progressive EMS( minus ARIZONA), HEMS companies and forward thinking hospitals, which has influenced my decision making process. To each their own however.... Respectfully, Jw

VENT, I am going to disagree with you, I am JUST as familiar with ground EMS as I am with FLIGHT, I actually did work the ground in DETROIT no less.......Does NOT get any worse than detroit, trust me.... I have many friends who work ground all over the country, and the majority have protocols for retevase, and actually do use it.......I never said ALL cath labs would activate, I said, the ones with which I have experience both in Michigan, Arizona, Utah, Colorado, Oregon, Ohio, New Hampshire,etc....... will >90% of the time activate based on field 12 lead. I have personally delivered MANY patients both ground and air straight to the cath lab and bypassed the ER..... You keep using California and Florida as your primary ammunition in all of your comments, You could NOT pick any two worse states for crappy EMS services and education standards. Please remember, I also spent 11 years in Europe, so I am EXTREMELY familiar with what goes on all over the world... Respectfully, JW

If I may be so bold! Actually, Many places are now carrying retevase on the trucks, so YES we do use them and have been for many years!!!! I don't know what part of BFE you practice in, but almost ALL of the cath labs that are worth a damn will mobilize the team based on field interpretation of the 12 or 15 lead EKG, including both ground and air! Sorry to burst your bubble, but sounds like your neck of the woods is a little behind the times.... Respectfully, JW

I agree completely....In the OP original scenario, I would not blast anyone with O2 until 12 lead was done. If you have a blocked vessel causing injury or ischemia to the heart, then blasting O2 will not do much....(And please spare me the lecture on diffusing into the plasma again). The ENTIRE GOAL of treating, pre-hospital chest pain is to decrease MVo2 demand. It has been my experience most people who are truly having a cardiac event will get more anxious( read: claustrophobic) when sticking a NRB at 15l on them right off the bat....I will usually start with a NC at 4-6 and titrate along with other meds to relieve MVo2 demand. Respectfully, JW

Will a business degree make you a better PARAMEDIC? NO, HOWEVER, and I am going on the assumption that you are probably young, and there is a saying, " You dont know, what you dont know". This applies here.... While you are asking what will enhance your NREMT-P, ONE never knows what the future will hold, therefore, I think it is imperative you finish your business degree while waiting for the medic course....Trust me, after you have been in this business 20 years, you will more than likely want to do something else, and going back to school in your mid thirties or forties is not exactly fun.....( Ask me how I know)..... Knock it out now! Also, when you go to apply to Flight Programs, having a 4yr degree will set you above MOST everyone else....A 4 year degree on a RESUME is NEVER a bad thing or a waste of time...The ONLY people who say this are people who do not have one! Respectfully, JW

Derek, Excellent question, and I have no doubt you will get a lot of differing opinions. My ITAO is it depends on how long you plan on doing actual patient care? I have been in EMS since I was 19 and healthcare since 17 (CNA), so now at 36, I am DONE taking care of patients. Hence, I went to Graduate school for a double masters: MBA/MHA. Since you are looking to the 4 year route, I would recommend a BS in Business for sure...Nothing against the RN, BSN route, but if you are really not up for being a Nurse, ( As I was NOT), A business degree is where you need to go..... IF you are planning on Med School, PA, etc.....then I would recommend a BS in some science related field. The business degree will give you a boatload of options should you get hurt, or tire of taking care of patients. If you go the business route, I would also say go and get your MBA, as this will pretty much help you write your own ticket as you indicated you wanted to achieve. Good Luck, Respectfully, JW

JP, Thanks for pointing out the MD hours are almost Identical, I meant to say that in my post... Thanks for the link to the videos.....LMFAO! Also, VERY IRONIC, as I just finished another marketing class for my MHA, and my team used those exact BUD LIGHT commercials for our team project......Those have got to be the best commercials out there ever.. Respectfully, JW