Amhet1

The NREMT provides a "standard" for each level of prehospital care. This at least provides for some reciprocity between states so that we can move from one state to another and they know that they meet a minimum set of standards. There is a group putting together educational standards. THese standards need to be higher than the current standards. Personally, I dont have a problem with Basics having a 1 college semester program because the basic is going to be frequently a volunteer is a small communiy department. The key is a transferable college level program, not a free-standing vocational "cna" school. If you move from a volunteer service to a full-time, professional EMS, an additional, college-level program should be required. This should include A&P, some english, biology, some public health, etc. Intermediates need to have basic plus at least 1 year of college, preferably an associates degree program. P school, should then be a Bachelors level program. I know, "everything I needed to be a paramedic I learned in P school" attitude. By the time you enter P school, you should have all the required basics. But the difference is being able to be a better medic. From the point that a paramedic is a bachelors level program, there can be a split in the career tract. To continue your education within the medical field, WE can develop an "advanced level Paramedic" which could be equivelent to an ER BSN, or Primary Care Paramedic where they can function semi-autonomously in rural areas (somewhat similar to the canadian model, if Im not mistaken). (The Air Force IDMT is similar to what I describe as the PCP as they care for patients without direct phycian oversight. Is there any reason that a doctorate level Paramedic isnt reasonable at some opoint in the future? The other option would be an administrative tract, where education focuses on the administrative side. This program would involve leaders hip and management could be developed. Bachelors, Masters and Doctorates. THere are already Masters and PhD programs in the Public Health/Publich Administration arena. These can be adjusted to meet the needs of the EMS Administrator. If this sounds familiar, it is. You see career ladders such as this within the FD and PD. The difference is that we have the ability to build the system WE want to build. WE can set the standards for basics, intermediates, Paramedics, Advanced practicioners, our leadership needs and requirements. This is the same thing nurses do. The lower levels are CNAs and LPNs needing a certificate or 1-2 years of school. They have diploma RNs from (hospital) nursing schools, ASNs, BSNs, Advanced care nurses, Nurse Practitioners, CRNAs, MSNs, and now Doctorate degrees in Nursing. I dont know the educational fire requirements, but a basic fireman needs a certificate an it grows from there to Chief-level education. There is a career ladder and lateral moves into specialties. So tell me why WE as EMS cant do the same thing?? We have flight medics, SWAT medics, We can develop NBC medics, knowledge in the public health aspect and have formal training to build our new managers, build advanced practice Paramedics. Obviously this is not an exhaustive list, but we need to look at things like medical care in Alaska, Indian health service, and still be able to provide basic medical care in rural BFE america. These are all things described in the Agenda for the Future. And it is up to us to find a way to blaze our own path! lastly, I apologize for the typos...... dont mix drugs and alcohol.

As I said, I was just pullin it out of my [s:3a8c0ef24d]ass[/s:3a8c0ef24d]..... I do remember something about tasting the urine for sugar content, obviously it was DM, not DI. From Wiki: "Signs and symptoms: Excessive urination and extreme thirst (especially for cold water and sometimes ice or ice water) are typical for DI. Symptoms of diabetes insipidus are quite similar to those of untreated diabetes mellitus, with the distinction that the urine is not sweet as it does not contain glucose and there is no hyperglycemia (elevated blood glucose). Blurred vision is a rarity. Signs of dehydration may also appear in some individuals since the body cannot conserve much (if any) of the water it takes in. The extreme urination continues throughout the day and the night. In children, DI can interfere with appetite, eating, weight gain, and growth as well. They may present with fever, vomiting, or diarrhea. Adults with untreated DI may remain healthy for decades as long as enough water is drunk to offset the urinary losses. However, there is a continuous risk of dehydration." So if ya dont know if youre dealing with DM or DI, taste the urine. So there is the use of the sense of taste...... BTW, what was the topic again?

Thanks CB! I think that was the study I had read previously. "An important issue this study raises is “Is it ethical to do any further studies?” of this type and even more importantly, given the now well described morbidity and mortality associated with EMS transport, and the dramatic improvement in safety with the use of this system “Is it ethical NOT to have these devices in all EMS vehicles?”, given the safety benefit and cost savings demonstrated in this study." In the body of the study, based in Little Rock EMS, they describe 1 minor collision in 1.9 million miles. That in and of itself is a strong basis for the Fed to start requiring them if we (the EMS community) dont buy into the need for them. As CB mentions, the black box can be used as a teaching tool or a disciplinary tool..... Unfortunately, AMR finds their people to be a disposable commodity.

Diabetes Insipidis =) Originally described by Ceasar Augustus' physician to test for sugar in the urine..... Or to differenciate heat stroke between sweat and just water poured on the patient... How about that for pulling some BS outa my butt?

Another reason for black boxes and drive-cams...... CYA! Because we all know its the ambulances fault until proven wrong......

Im more like the old timers here...... gloves in a pocket, and a pen in the shirt, and thats it unless I have to carry a portable radio. That said, I have seen others with cargo pant pockets so full they cant get a seatbelt on and personal cell, company cell, pager, portable radio, scissors, knife and glove pouch on their belts..... Just makes ya wonder how they can carry that, another 30 lbs jump kit, monitor and drag a gurney a few hundred feet without being exhausted by the time you get to the call..... With time, you'll find that all you really need is your 5 senses to know if you have a problem.

I recall the "Fifth Protocol" book when it came out, but never had the chance to read it. I have the feeling that it has fallen to the wayside. I did find a website with the "Missing Protocol" program. My guess is along the same line as the Fifth Protocol, in a classroom type format. http://www.themissingprotocol.com/site/textbook.htm EMSBooks.com has a number books on documentation that may be of interest also.

Ok, We can idle, freeze, or roast.... your choice. The other option is buy carbon credits from Algore and the UN.

Another bar joke..... Two guys are sittin at the bar having drinks. As the night went on, the conversation turned to sex. They get to braggin on about the size of their units. This goes on a few hours til closing time. By this time they are pretty well wasted so they decide to walk home. As they cross over a bridge, one turns to the other as says he needs to take a leak. The other concurs and start going about their business. The first guy turns to the other and says "Damn, that waters cold". The other responds, "Yea, its deep too!" ----------------------------------------------------------------------------------------------------------------- Are gay jokes inappropriate here? A gay freind gave me these gems..... How do you get 4 gays on a bar stool? Turn it over Whats the most common pick up line in a gay bar? Can I push that stool in for ya. How many lesbians does it take to change a lightbulb? None, they arent afraid of the dark. ---------------------------------------------------------------------------------------------------------------- A horse walks into a bar. The bartender walks up and asks "Why the long face"? ---------------------------------------------------------------------------------------------------------------- Three southern belles are sittin on the porch of their plantation house. One turns to the others and says "I learned a few things while I was back east". The others say "Do tell!" (all in best southern drawl) "Well, back east they have men that date other men". Oh, do tell more, the others say. "I think they are called homosexuals". "I heard of women that love women there too". Tell us more, they say. "I think they are called lesbians", she says. "And there are men there that will use their face and tongue "down there"." Fanning themselves more quickly now, our southern belles want to hear more about that! "Yes girls, I dont know what they're called, I just called him DARLIN!! -------------------------------------------------------------------------------------------------------------- Two pengiuns are taking a bath in a toilet and one turns to the other and asks "Can you pass me the soap? The other penguin turns to him and says "What do you think I am, a typewriter?" (Sorry, son gave me that one.... I dont understand either)

You have to love the global warming cultists. Man is causing the earth to warm... in the last 100 years, the AVERAGE global temperture has risen 0.5 degrees celcius. Though I havent seen it, almost every "fact" in Algores movie has been disproven, or was outright fraudulent. Even better is the well known fact that scientists use computer models to come up with the results they want.... leaving out any calculation that interferes with the answer they're looking for. Common sense says that even the climate is too complex to model, and there is not enough historical data to project the future. 30 years ago, Time Magazine was SURE that we were entering another ice age. 5 years ago it was "common knowledge" that we were suffering from global warming. Since both have been proven wrong, they decided that "Climate Change" is the politically correct term. Funny thing is that the climate is ALWAYS changing (but dont tell Algore).

As usual, I have a question along the lines of this thread..... Do any of your services use drivecams or black boxes? What has your experience been with them? The black boxes, such as Road Safety, is a double-edged sword. From a department standpoint, it assists drivers to improve their driving, which in turn, decreases insurance costs and vehicle maintenance. From a drivers standpoint, the concern is the "big brother" watching over the shoulder. The box can be set up to record everything from what lights are on to excessively hard braking. They can also provide annoying noise when certain parameters are being encroached on or exceeded. The other problem is what admin does with the information once its DLed and analyzed. If it is used appropriately, it can be a teaching and motivational tool. The problem is that the anal manager will use it in a disciplinary tool. In the case being discussed, would a black box have been a help or hinderance? The article says they used GPS to calculate the speed of the vehicle. The accuracy can be off by more than 50 feet or more depending on the group of satellites being received. And I have to agree.... What the hell is the county manager doing impersonating a LEO???

And dont forget the Pacific NW fruitcakes more worried about some owl than using renewable natural resources.....

Oh damn, I started reading that and was trying to figure out how in the world she told you that she had "passed"..... then read the rest of the comment. CONGRATS!! The newest member of the overworked and underpaid =)

Um...... OK then.

OK son, do you really want to have a pissing match in a forum, or would prefer to actually add something to the discussion? #1. The discussion in about SFFD. My point (in case you missed it previously) is the comparison of SF FD to the King County program is not comparable. #2. King County Medic One program is NOT a 3rd service or Fire model. It is overseen by the Health Department with strong medical oversight which is more closely associated with a PUM. #3. Though some of the Fire Departments are directly involved in the Medic One program, it is NOT an FD-run program. It is run by KC Public Health. As to your other points.... "Hell, most fire departments meet 3 or more (mostly more) of your standards and then some. (do you really think that's all it takes to make a good EMS service...wow...that's pathetic)" No son, MOST Fire Department EMS programs do NOT meet those simple standards. You may be lucky to have so many sterling departments in your area, but when you get the opportunity to see the real world, you will find that there are problems. When you grow up you may come to realize that providing EMS is far different than providing fire protection. And as far as I know and have read, King county meets goal number 4. They have a complete, dedicated SYSTEM providing EMS. Ill give you number 1, since I dont know the minuscia of your interpersonal relationships. I have seen reports of inadequate numbers of ambulances on occasion, but doesnt look to be a systemic problem. Number 5 is questionable but since KCEMS is not a fire-run system, Im sure Mr Kearne is adequately compensated and has equivelent authority. here's a quick question for you: can you show me a third-service EMS agency (or any agency that is primarily 911 responses) that is of equal size to those agencies that does not have problems? Wow, what a tough challenge.... a third service EMS agency that isnt screwed up. I guess the first thing we need to know is what measurement we are going to use? Population? Coverage area? Staffing? Population density? You're the one wanting "equal size". How about a few PUMs that work? Sunstar, EMSA (Kansas City/Tulsa), NEMSA Hospital-based? Wishard, (Denver Health 15 years ago before the FD influence) Private? Pridemark "And, in case you haven't noticed, most city budgets are not doing so good these days, so if you rely on public funding...ouch." You're right. When people become dependent on government, the money has to come from taxes. (Or in Medic Ones case, solicit donations). Thats why when you calculate subsidy, you have to also take into account reimbursement, payor mix, and community standards. "that the bigger you get the harder it is to run a problem-free workplace." And the problems are; (No, this in not an exhaustive list) 1. Failure to adequately fund EMS 2. Failure to maintain adequate oversight 3. Failure to provide adequate numbers of ambulances 4. Failure to ensure adequate staffing, adequate training, adequate supervision 5. Failure to maintain parity in pay between EMS and Fire I do have one sincere question for you since you're living up there. A $0.30 levy was proposed last year for the Medic One program. Is that with property tax, sales tax, fuel, or something else? I dont understand how that is calculated. Locally, we pay like .3 mills that go to EMS, which works out to about $35/yr for our property. Now, on a more personal note..... You may be "god" in your real life, but when you're on this website, you may want to use a bit more humility. Attempting to call someone "Gomer Pyle" is a tad immature, especially when you've only seen him in reruns. It may also suite you well to remember that as smart as you think you are, when you're here, there are FAR more knowledgable people that WILL slap you down far worse than I may have.

I love that, Wendy! Polarizing temporal weather patterns influencing increased greenhouse offgassing by oceanic fluids will lead to global weather pattern changes concurrently influenced by magnetic axis deviations which will, in turn, cause regional flooding in temperate climates and increased water levels causing dynamic shifts in ice flow patterns thus effecting penguin breeding grounds in the northern hemisphere and destroying the feeding areas of the great southern (hemisphere) 4-eyed newt. This will continue until caribou breed with llama's and start eating their own young until the total destruction of the species and Algore has to create a new internet to feed his carbon footprint with has increased the past year to $40,000 a month. But its OK because he has created an entire corporation to trade in carbon offsets. Because he is the high priest of the global warming cult, he know he has to set the example for the great unwashed. He pays his company $10,000 a month to pay for the carbon footprint of his private jet and as CEO and President, he pays himself $50,000 a month...... Not a bad scam, huh? I find it histerical that so many people have bought into the "[s:ed725f47cd]global warming[/s:ed725f47cd]" "[s:ed725f47cd]climate change[/s:ed725f47cd]" whatever the current fad term is..... The only ones gaining anything with this entire hoax is Algore himself, and academia. As long as scientists tow the line trying to prove global warming, the research gravy train will continue. There is no money out there for anyone proving global warming is a myth. Anyone against GW is branded as being in the pocket of big oil.... As far as SSM and GW...... blah. Ruff is right in that fuel prices will play more into influencing SSM than being "green".

OK, My bad. In the rant I deleted, I attempted to define "successful" in the context of a Fire-run EMS program. American Heritage Dictionary - Cite This Source - Share This suc·cess·ful Audio Help (sək-sěs'fəl) Pronunciation Key adj. Having a favorable outcome: a successful heart transplant. Having obtained something desired or intended: was successful in stopping the leak of oil. Having achieved wealth or eminence: a successful architect. In the context of this discussion I dont think a heart transplant as a gold standard of success. In FD-run EMS, success would be simple goals such as; 1. "lack of animosity" between the fire side and the EMS side 2. Adequate number of ambulances to provide full coverage and maintaining it 3. Equivalent pay for EMS and Fire with appropriate increase in base pay for cross-trained 4. A formal EMS System for the area providing unified medical direction, communications, etc 5. Supervision of EMS from the Assistant Chief or Deputy Chief level (whichever is higher) that answers directly to the Chief of the department and not another subordinate. I beleive that if any fire-run EMS could meet at least 3 of the above, you may be able to define them as "successful". I just pulled those goals out of my .... so Im sure there are other appropriate standards and these may have the bar too high.

"Posted: Thu Jun 19, 2008 12:32 am Post subject: -------------------------------------------------------------------------------- Amhet1 wrote: FL, CO, MI, and the military all require at least 2 EMT-Bs Are you sure about that in Florida? Florida: (7)(a) Each permitted basic life support ambulance not specifically exempted from this part, when transporting a person who is sick, injured, wounded, incapacitated, or helpless, must be occupied by at least two persons: one patient attendant who is a certified emergency medical technician, certified paramedic, or licensed physician; and one ambulance driver who meets the requirements of s. 401.281. This paragraph does not apply to interfacility transfers governed by s. 401.252(1). " 401.281 Drivers.-- (1) Each licensee is responsible for assuring that its vehicles are driven only by trained, experienced, and otherwise qualified personnel. The licensee must, at a minimum, document that each of its drivers: (a) Is at least 18 years of age; ( Certifies under oath that he or she is not addicted to alcohol or any controlled substance; © Certifies under oath that he or she is free from any physical or mental defect or disease that might impair his or her ability to drive an ambulance; (d) Has not, within the past 3 years, been convicted of reckless driving or driving under the influence of alcohol or controlled substances and has not had a driver's license suspended under the point system provided for in chapter 322; (e) Possesses a valid driver's license issued under chapter 322, is trained in the safe operation of emergency vehicles, and has completed an emergency vehicle operator's course or the reasonable equivalent as approved by the department; however, this paragraph applies only to a driver of a land vehicle; (f) Possesses a valid American Red Cross or National Safety Council standard first aid course card or its equivalent; and (g) Possesses a valid American Red Cross or American Heart Association cardiopulmonary resuscitation card. (2) The department shall periodically inspect licensees for verification of compliance with this section. Services that are unable to verify compliance are subject to disciplinary action as provided in this part. I stand corrected. I thought this was the 21st century and we got past "ambulance drivers".

Wow, the only state I can think of still in the '70s is NJ..... I think the rest of them require a minimum of 2 basics. I dont think even an MFR even qualifies in most states. I know Michigan did away with the "Ambulance Attendant" certificate back in the 80s. FL, CO, MI, and the military all require at least 2 EMT-Bs Most (if not all) will have their code or enacting legislation online. You can do a lexis searh for your state. Oh, I see youre in Louisianna.... so much for finding any sort of legislation there. I think they just took Acadians business model and said thats the law. I looked at possibly moving to LA when I retired and liked what I saw at Acadian. I decided to stay in the FL panhandle instead. After the debacle following Katrina, Im glad I stayed here. (Withholding political comments).

"So, is the answer having paid BLS? To a point yes. But then you're back in a circle to who gets paid. If the BLS transports and the medic is in the back providing care. The BLS gets paid and the ALS gets nothing. How can a medic provider survive like that? " Medicare and private insurance reimburse for a "Paramedic Intercept". What is required is a written agreement between the BLS and PI for reimbursement. Only one of the departments can bill for the service. The two services would have to agree how much each service would get. As far as the rest of NJ..... The system must be torn apart from the top down and completely rebuilt. The legislature has to make the necessary changes before any worthwhile effects will be seen on the streets. Develop county EMS SYSTEMS! Design it in a way that works for that county but as an integral system with the state. Monopolies of ALS has to be disbanded. Any competent service should be able to provide ALS with appropriate oversight. Stop the TAXPAYER GRAVYTRAIN! Why does a small volunteer service need 3-4 ambulances when they clearly cant staff them or have a need for them. Disband those services that cannot or HAVE NOT met response requirements. Someone compared NJ to other broke systems like Houston, NYC, Phili, etc. It is fair to make the comparison because a broke system is a broke system. CA is broke because because of the top-heaviness. The state has the peices in place, but with any big government is going to be innefficient. The money CA has spent on administration of EMS at the state level could have paid for a paramedic on every ambulance and fire truck. Does anyone else see a common thread thru problem areas? NJ = Democrat. CA = Democrat. NYC = Democrat. Sorry, overtaxing, taking away personal freedoms and waste just [s:5c48bb2d43]pis [/s:5c48bb2d43]irritate the hell outa me. Im sure I could come up with more, but I think the other best option is give the entire state back to the atlantic ocean.

I did forget one bitch I REALLY wanted to make...... In one of the articles, they compare SFFD to King County EMS Authority. The implication for the article is that King County EMS is run by an FD which it is NOT. It is a public utility model functioning as a part of a complete EMS System What too many people forget is the second S..... The ambulance and staff are only a part of a larger system. A system of Hospitals and ERs, dispatchers, controllers, administration, LEOs, FD, social services, public health and other parts. The biggest problem is that the PUM is the most expensive way to operate an EMSS. The fact is that you get what you pay for. King and Pinellas counties have the best survival rates for VFib. Most big cities take the cheapest option..... FD run EMS. Again, you get what you pay for.

Are there ANY successful FD run EMS systems? [a long bitch deleted to remain on topic]

And the morals of the story are: 1) RLS is only makes the passengers of the unit feel safe.... nobody else cares. 2) If you use an Opticom (signal changing) system, trust it only as far as you can throw it. 3) When you dont have enough units, bad things WILL happen. 4) Just one more reason for using drive-cams, black boxes and other safety systems... when used appropriately. They provide a level of security for the department, assists drivers to improve their driving skills, and the insurance companies love em. The problem is when the black boxes are used inappropriately as a disciplinary tool instead of a teaching tool.

^5 Asys!! Fireman =/= GOD. Paramedic =/= GOD. If you know more than the next guy, teach them, dont preach to them.

As usual, I have a point that is kind of off topic, but can be meaningful in this context. Manual PCRs are can be a pain on a busy service. But as said here, the purpose of a PCR is to document assessment, care and treatment, but as important, if not more, is legally defensable. A PCR may be the only way for you to remember a run from 3-4, even 7 years ago. What I have a problem with is some of the new software packages. I am familiar with the local services' ePCR program. The medics love it here because it has an auto-narrative. In using it, I found that the narrative itself almost never exceeds more than 3 lines. Prior to uploading to the server, there is a chance to edit the narrative, but I have never seen that done. Now I agree that it can be a time saver in a busy service, but it is not much of an excuse when youre the one sitting in the witness box. Spenac is right in that you have to do an assessment on every patient and it is important to document your findings, but it is also important to inform the patient of what you need to do and why. If it is an option, have a parent or female ride along if there is any risk of this coming back to bite ya later.