LoneRider

EVAC, a non-Fire Department EMS provider, recently became part of Volusia County Emergency services, they operate near the Daytona Beach, Ormond Beach, DeLand areas.

I recently ran across this article for EVAC, a 3rd Party EMS for Volusia County, Florida. In the article the EVAC employees chose to unionize under the International Association of EMTs and Paramedics.

EVAC News Article - Daytona Beach News Journal.

I am curious what the opinions of EMS practicioners on this website is about the matter.

I am doing what in the US Army we call backwards planning to figure out my education and training to hopefully become a paramedic (My initial information request is here). I have planned to go to EMT-B and following that EMT-P before my FF1 and FF2 to practice in the state of Florida while serving in the reserve component of the US Army (National Guard). Given the fact that my home state is largely either 3rd party EMS or Fire Department based the logical thing to do was to attain my FF1 and FF2 for hiring purposes.

Summaries aside my question is what sort of continuation training or recertification is typically required of an EMT-P after one is hired by either a fire department or third party service? I understand I'm asking something in the neighborhood of the 300m target versus focusing on the 25m target (becoming an EMT-P), but I figured that I'd ask.

Sad to hear it. Dustdevil provided me plenty of wisdom when I first began to ask for information on EMS back in 2008.

Rest in Peace.

One of my friends is in PA school now while finishing out his reserve duty. He's managing pretty well. I would argue, too, that PA school is just a tiny bit harder (yes, that's sarcasm) than EMS training.

So it can be done.

Good luck.

I appreciate the input.

If all you are doing is Reserve time and training you should be fine, it is when you try to balance full time work + reserve + medic school

In all likelihood it'll be reserve time and training only, provided I don't wind up deployed at any point in that timeframe.

In about three years I intend totransfer into the Army National Guard while undergoing the education and training required for an EMT-B, EMT-P and also my FF1 and FF2 training (for better employment prospects) in Central Florida (Daytona Beach/Orlando areas) or Northern Florida (Jacksonville area) and God willing practicing in those areas.

Out of curiosity has anyone ever balanced their medical education with reserve duty?

The New Guidelines are: Direct Pressure and then Tourniquet. My 'guess' is that in 10 more years, we'll go back to: Direct Pressure, Elevation, Pressure Point and THEN Tourniquet. This has been an on again off again thing for many years.

By the way... The latest feedback on the use of Tourniquets in the Civilian World is based on the success with them out in the Sandbox.

AC

AC

That's more or less what I'd imagined but I figured I'd ask actual practicioners vice making wrong assumptions.

Even though I'm presently stationed all the way across the country from my home state I still check my local news on my lunch break and stumbled across this (admittedly dated) article regarding Volusia County, Florida's third party EMS EVAC Ambulance. It states that the contract is being renewed for another two years.

One thing in the article that jumped out at me was the following:

In October, the county approved a projected $1.5 million subsidy to fill the gap between Medicare and Medicaid reimbursements and what EVAC says is the cost of services provided to patients who are dependent on those programs. The subsidy was part of EVAC’s $17.4 million budget.

At Thursday’s meeting, County Manager James Dinneen outlined options for emergency medical transport:

• It can be bid out to a private company.

• It can remain the “hybrid” it is today.

• The cities can provide some services.

• The county can provide all services.

Currently, EVAC has an exclusive contract with the county; fire departments aren’t allowed to transport victims. Over the years, Deltona and Daytona Beach have asked for permission to provide emergency transport, but more recently have backed off that request, Dinneen said. Daytona Beach has postponed a decision for another six months.

I'm just curious as to what opinions of EMS professionals are with regard to these options.

As a military veteran I've had nearly three years worth of CLS initial training and recertifications under my belt. During those training sessions I was taught that tourniquets are not last resorts for controlling bleeding from extremities and the MARCH system of patient assessment (Massive Bleeding, Airway, Respiration, Circulation, Head Injury/Hypothermia). I am also aware that military trauma treatment methods don't always mesh with civilian trauma treatment methods as what military medics/Corpsmen deal with differs vastly than what civilian paramedics deal with on a day to day basis.

I'm curious as to what EMS doctrine (at levels ranging from the first responder, EMT-B and EMT-Paramedic), so to speak, is regarding tourniquets? The last thing I recall was that tourniquets were viewed as last resort measures when it came to first aid. Admittedly the reference I got that from was a lecture given to me as a student at the National Outdoor Leadership School in Lander, WY in 2005 and shipboard damage control training from 2006-2008 timeframe when I served in the US Navy before I transitioned to the US Army in 2009.

*Hyperlinked thread leads to a discussion I'd started over a year ago regarding the MARCH versus ABC (Airway, Breathing, Circulation) means of assessing patients.

I realize I've been absent a while from the forums and figured I'd say hi again. I've completed my schooling as an Engineer Officer and completed the Basic Airborne Course in April of 2010 before going on to Fort Irwin, California.

I've been doing still more research about the EMS field when time permits, recently having accquired the book Paramedic by Peter Canning (realizing the material is dated to the late 80s but there have to still be some core lessons to keep in mind).

As to when I intend to move to resrve duty wtih the Army National Guard (state TBD) I'm moving my time for that transfer to the right a couple years. I've researched some California and Florida programs and am weighing the benefits and costs of residing in either state. If I elect to return to Florida I likely will look to practice either in Jacksonville, Daytona Beach, or Orlando. So far it is looking more like I'm returning to Florida, but that's likely to be in a state of flux as well.

I'm considering going into EMS in the San Diego area (as a full fledged Paramedic) while being part of the California National Guard. My Army contract has two and a half years left to run and I'm getting stationed at Fort Irwin so I can check facilities out myself.

I've heard Miramar Community College has a good EMT-B and Paramedic program. Does anyone have any recommendations?

I work for a private company, we hold backup 911 contract for Heartland Fire. And as far as pay for R/m they make minimum wage for EMTB.

Thanks for that info exodus.

Does anyone know about any of the other San Diego area agencies? Who does primary 911 response for San Diego's emergency medicine?

San Diego is an interesting city. 911 is handled ALS for every call. All City of San Diego fire is being handled by Rural/Metro. They are a third party company that are based out of fire departments, and run with FD. It's like a third party FD system. And then there are smaller cities like Santee, Lakeside, Oceanside, etc. where it is totally FD based, this grouping of FD based response in SD is called Heartland Fire. And yes kiwi, most of the rigs here are Red But Santee fire is white!

Exodus: Thanks. Which department do you work for?

Thanks for the insights thus far. And as for City of San Diego are the ALS guys part of Rural/Metro or SDFD. I'm additionally curious as to what Rural/Metro's pay and benefits are like?

Just wanted to say hi again and catch everyone up on what I've gotten up to in the past few months. In October I transferred into the US Army after eight years of Navy service. I branched into the Engineer Corps and am up at Fort Leonardwood learning the trade of the military engineer before I move onto Fort Irwin, California for two and a half years. During that time I'm going to network and then transfer my commission into the California National Guard and hopefully serve in San Diego with an EMS service there.

In about two and a half years I'm contemplating going into the California National Guard after my active duty stint with the US Army expires. To those who know me I moved my commission from the US Navy after eight years of service to the US Army as an Engineer. I'm curious about EMS in San Diego. According to the website for San Diego Fire and Rescue EMS is handled by a third party working in conjunction with the fire department. Can anyone shed some light on this mystery?

I don't even know what half of this stuff is!!! You'll be fine, I have a feeling I might see you on a P90X commercial at 3am while I'm eating some cheesecake.

Well I don't condition for looks cosgrojo, I condition for functional strength to carry out the tasks required of a paramedic and a soldier.

If Im not mistaken youll be heading out to L'wood if your ganna be an engineer?

That's affirmative. I'll be headed that way for training. On the upside I might garner some useful data for FF1 and FF2 whilst learning how to demolish obstacles and buildings.

You will be fine ... hell, I break out in a sweat eating a sandwich ...

cheers

Thanks for all the advice guys.

The reason I decided to go into EMS is because of my SAR swimmer training in the Navy. Although I didn't complete it due to a gooned up safety check (I learned from that experience: do everything right and throughly even if it takes longer), the program gave me four words I took to heart: "So Others May Live."

In the Army I'll add that to four other words: "We Clear the Way..." -Motto on a US Army Corps of Engineer poster.

My creedo for active Army Service: "We Clear the Way...So Others May Live."

Well Christopher.Collins we use High Speed in the Navy too. Usually referring to SEALs, EOD, Diver types.

Thanks for the good advice from all comers.

Christopher Collins, you weren't a Medic with the CT National Guard at all, were you?

You're probably doing more than 99% of providers. I would pay particular attention to your core, and abs, back, shoulders. The problems generally result from repetitive motions over a long time- knees, back, shoulders.

Really, I imagined a profession where you'd be lugging, dragging, carrying a dead weight (i.e. a fully unconscious survivor) would entail a good deal of physical fitness, especially if in a firefighting getup.

Having worked as a civilian paramedic attached to the military (Royal Marine Commandos) I have been taught MARCH which in my opinion is a far more useful method than ABC of approaching a casualty. ABC means nothing if your casualty is bleeding out and what is the point in compressing the chest if all you are doing is pumping blood out of the wound?

As civilian EMS is shaped, guided and in fact based on military medicine it is highly likely that this will become mainstream EMS practice. We wouldn't have EMS if it wasn't for the military battlefield medical care of Napolean and more recently we are seeing battlefield EMS hit the civilian streets.

That's good to hear. When I transfer to the reserves in three years I intend to work in EMS for my local fire department (Orlando, FL). Good to hear that some of my military trauma management training will still be useful.

I absolutely agree, it will deffinately be a problem if we start treating bleeding before airway.

It depends on how traumatic a bleed we're speaking of. And I agree with the MARCH system's tourniquet methods.

These recommendations grew from combat trauma, which is mostly penetrating trauma, rather than civilian trauma which tends to be blunt trauma. Life threatening hemorrhage from an extremity is fairly rare in the civilian setting, so this is probably why it's not catching on that fast. Still, there are important lessons in it, and I think that for civilian trauma, it should still be used.

And don't car accidents/industrial accidents also have incidents of large amounts of bleeding too? Just curious. And car accidents are a fairly high incidence occurance. I would imagine they entail a lot of blunt force trauma, but can't life threatening hemorrhage also be entailed too?

RBC is precious in major trauma, and ideally major hemorrhage is controlled while A and B are assessed. That's assuming you have the manpower, otherwise it's still ABC outright in the primary survey.Realistically, as a paramedic or lead EMT in charge of the scene, aren't you going to order another responder to address a major hemorrhage as you assess airway/breathing? At least by direct pressure with a gloved hand while dressings/tourniquets are opened up. PHTLS stresses that every

In the case of a bleeding or amputated limb, a tourniquet can address that issue rather swiftly and decisively and then one can tackle the airway issue, again from what I've been trained on the CLS front.

I accidentally double posted this thread a while back, and requested it be deleted and both copies were in fact deleted. So I'll repost my question again.

Sometime last week my unit held Combat Lifesaver Training (roughly akin to civilian first responder training) and learned how the US Army prioritizes trauma management.

Having gone through the US Navy Search and Rescue Swimmer and Repair Locker Leader courses where first-aid and trauma management were extensively covered, and having taken a basic first aid course at NOLS (National Outdoor Leadership School) in Lander Wyoming four years ago I'd always been taught ABCs (Airway, Breathing, Circulation) for patient assessment.

Army CLS has that in the curriculum only to tell us that such a prioritization is better suited to areas where hospitals are immediately accessible, i.e. most of the industrialized/post-industrialized world. The Army teaches us MARCH (Massive Bleeding, Airway, Respiration, Circulation, Head Injury/Hypothermia) as our priorities. They even told us that the MARCH system is making its way into the civilian EMT/Paramedic field, is this the case?

I can see where MARCH might be more useful than ABCs, i.e. industrial accidents, vehicular accidents, crime related injuries, etc...But what are the pros and cons of the MARCH versus the ABC in civilian emergency medicine?

I am an EMT-B in Mississippi and currently in paramedic school. I would suggest going to basic school and working on the truck while your in paramedic school. Plenty of experience to be found during that 2-3 years of paramedic school. I also suggest enrolling in a program that is accredited and offers at least an associates degree.

Thanks for the tip, I'll take that under advisement.

I'm presently going into the EMS community in a few years (after I complete my last eight months in the Navy and complete my Army active duty requirements (3 years) and transfer to the Florida National Guard).

I've always been the athletic type, my interests including martial arts (boxing, jiu-jitsu (recently) and now MMA), surfing and swimming. I always have been in mind to keep fit in order to do my job as a serviceman, and I'm also looking forward. I'm trying to make sure I am well conditioned because it is my duty to my future patients. I'll be damned if a future patient dies because I could not get to him or her fast enough or carry him or her to safety.

My present conditioning routine is thus:

Note: I also swim between 800 to 3000 meters a day when I'm back in the States.

Mon - Circuit training with 20 minutes cardiovascular training (deployed I use the bike or elliptical. In the rear areas I go swimming)

Tues - Run sprints

Wednesday - See Monday

Thursday - Distance running

Friday - Same as Monday

Saturday -

I do a lot of Crossfit-esque circuits. For instance today's circuit was:

6 x Ring pullups

30 x Flutter Kicks while holding a 100 lbs. barbell over my chest

25/5 x Regular/Diamond pushups (do 25 regular then transition to 5 diamond pushups)

20 seconds front plank

20 seconds two plate pinch (2x10 lbs. weights)

10 x kneeling bar rolls.

Then I biked for 20 minutes on the stationary bike at a high resistance.

I'm trying to balance my physical condition for my upcoming Army service while at the same time being ready to be a paramedic/firefighter (I'm going to try to work for a fire service in Central Florida, (Orlando Area)). Is there other areas I should focus on to make sure I'm ready for both?

Note: The link at the beginning refers to my other post on EMT training where I stated I know what I'm getting into by attempting the EMS route.

Ok, sorry for the misunderstanding. I've been under attack enough here lately that I've become paranoid.

I can't see why you've been under attack. Albeit from my admittedly limited perspective, you've given me plenty of useful information.

I still intend to work as a firefighter/paramedic somewhere in Central Florida. The agencies I've considered are Orlando Fire Department, Seminole County FD, Volusia Fire and Rescue, and Orange County FD.

As far as training goes it's either Valencia CC or Seminole CC.

There was certainly no gouge intended there. Not sure what you are talking about.

I am not sure if the Navy as a whole is considered a "centre" or not (as they are with the NR), or if it is a local issue. Sorry I can't help any better than that. When I was teaching with the military, it was a local issue that was inconsistent from base to base.

Gouge = advice or information given by more experienced servicemembers to junior or less experienced counterparts.

It's alright, I can ask my local units if their programs are certified by American Red Cross. I would think that such things would be standardized though.

A certified instructor affiliated with an authorised training centre. That means, not just anyone with an instructor card can do it. They have to be working under (in the case of the Red Cross) a specific Chapter's authority, issuing cards from that Chapter. It used to be that any AHA instructor could "freelance" to teach anywhere, anytime, with no oversight. Now they are structured much like the Red Cross, and require instructors to be affiliated with a specifically authorised centre.

Thanks for the gouge. Do you know if military training centers (I believe most Army medical units carry Red Cross Certifications but I've got a training officer over there I'm good friends with I can ask) are considered authorized training centers. How long are refreshers to maintain CPR courses usually? One day, two?