AZCEP

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Most of the EMS magazines will have several different sources for this. NAEMT offers some to it's members as well. You can also ask any of your local insurance carriers about it. If they don't offer it, they can direct you to someone who does.

If you want to be treated like a professional, you have to carry yourself like one. That includes spelling and grammar.

Dust..Whats really the problem here? Do you feel because people Volunteer their time for their community that you will never make alot of money as a Paramedic? I would never spend a year in school to become a Paramedic for 2 reasons..I think its crazy to spend $8,000 to become a Paramedic and get paid chump change when you finally do get a job, that you cant even survive on when you have a family..The other reason is this is not something i want to do for a living...I have a Bachlors Degree in Business Administration and i make a damn good salary..Soo if i just want to help out my community without making money for doing it then thats my problem not yours or anybody else's..

So then, why did you decide to upgrade from an EMT-B?

If you think you make "chump change" as a full paramedic, what exactly do you make as the occasional EMT-CC? For that matter, why did you decide to venture into EMS in the first place? Like many have said before, as long as the policy makers know that there are people that are willing to provide a service for nothing, no one will be reimbursed to the level that they should be.

That goes for the volunteers as well. If you look at the big picture this will be painfully obvious.

Just to illustrate, if I can get a service provided to the same levels at $5 per incident, why should I agree to pay someone $10 for the same thing. Then the administrator from a neighboring district takes a look at how I'm running my service, and he makes the same decision. In time, there are more getting a lower degree of service, for cheaper, all because a few have decided they did not want/need the money to be spent for it.

The kicker is the areas that need the higher levels of care are the ones that hold onto the idea of using non-paid volunteers the most. Areas that have hospitals and definitive care that probably could get by without paramedic service, due to the shorter transport times, can more easily afford this level of service.

The areas that don't have these resources, need the level of care that only a paramedic can provide. Perhaps not because we provide more in the way of treatment, but because we spend a lot more time learning about how disease processes work.

As long as there are people that are willing to do these things for free, the entire industry will suffer.

That's right, have your ego stroked while the "profession" you have chosen to participate in takes it in the shorts.

I refuse to accept that we are doing this for "our communities". That is the single most damaging statement that providers will make in regards to the job that they do. You find me one provider that can honestly answer that way, and I will show you a student participating in an oral board screening.

That nonsense feels good for the first couple of days after you get your card in the mail, but after that, it quickly becomes a matter of what you get to do for you.

I can see it coming, so stop before you dive into it. Unless you are "volunteering" to fill the potholes in your community's streets, or haul the trash, those that make the decisions are taking advantage of you. If it so happens that there are no EMS providers one weekend, and the mayor's wife dies because of it, they will quickly realize the service is needed enough to pay for it.

First suggestion, get comfortable actually using the little bit of information you got from you EMT class.

That does not mean work for a transfer service. It may mean you have to drive out to the sticks, or volunteer your time, but you have to have a feel for what managing a situation is all about.

Get the thought of a mid-level upgrade out of your head. The EMT-Intermediate, in all of it's versions, is a complete waste of time. It was thought up only to provide minimal ALS care to areas that did not want to foot the bill for full paramedics. It is a half-assed attempt to tell the community that the government cares about it's citizens. It needs to be abandoned entirely.

Dive headlong into some actual college courses that will directly affect your ability to think through a problem when you encounter it. Art appreciation, and Underwater Macrame will not fill the bill for this. Math/Science/Anthropology/Sociology/Psychology come in real handy at many different levels in the EMS world. The medics that haven't taken them are using them without even thinking about it, so by the time you have gotten your feet good and wet, and have some of them behind you, you will be that much further ahead.

I was thinking maybe Tb.

I take it this gentleman was an east asian indian, right? In my neck of the "woods", an indian would be a native american, and they rarely give any indication that they are feeling pain.

Short of breath for 3 days would tend to make you think, not so sick. Unfortunately, this guy was indeed VERY sick.

This guy must have forgotten to read the book on how to present.

What are the extreme temperatures that you speak of?

If the units in question spend their time in a climate controlled bay, you really don't have much to worry about. The biggest concern is a loss of effectiveness from excess heat. It is pretty rare for the temperatures in a unit to exceed 80 degrees for a period long enough to degrade the meds.

Even here in west AZ, with common summer time temps >100 degrees F, the drug cabinet in the first out units never hits 90. We watched it closely last year, just to see if we needed to make a change. Turns out the amount that each drug degrades following exposure to excess heat is different. Epi is roughly 3-5% after 4 hours, Lasix is slightly less, and Succinylcholine is slightly more. We solved this issue by exchanging the more sensitive meds more often.

Treat it like one of your scenes.

Stay calm, answer honestly, if you don't know or remember--say so.

Most agencies will keep paperwork for 5-7 years depending on location, so it becomes a matter of tracking it down.

Everyone will hit the proverbial wall at some point. Some sooner, some later.

Look for "Case based" study guides. I know that Brady has one for ALS, so I would guess that they have one for BLS also.

As for your learning style, you will know better how to direct your energy than anyone else. Take the information, and manipulate it until you are able to make it yours. If that means writing everything down, do it. If it means reading it into a tape recorder, then listenig to the tape for hours on end, so be it.

I would suggest you get a group of your classmates, with similar goals together, and make scenarios of your own for the practice you will need. Most EMT programs run into this same problem. There just isn't enough time to get you all the practice you want/need.

It is the system's fault, but it will become your problem in fairly short order.

Good luck to you.

Yet another example of not being taught things that will actually help you.

The natural kyphosis that you describe makes standard issue spinal precautions near impossible. It sounds like you improvised the solution as well as could be expected. Sometimes you can pad behind the patient so that the padding accomodates the curvature, but this will make it hard to restrict movement.

Capnography isn't the only true confirmation, gents.

Revisualization, esophageal detection devices, colorimetric EtCO2, auscultation of lung sounds are all viable methods of confirming tube placement. In the breathing patient, the use of a BAAM whistle will confirm placement better than any other method.

Capnography/capnometry is still a secondary confirmation of ET placement. Yes it is a very good one, but it is still just a secondary method. Even with the moving of a patient, you can use the other methods. You just have to make sure that they are done following every move. Better yet, place the patient in spinal precautions and eliminate some of the risk.

For the fiber-optic tube, there must be more than a dozen different types of fiber-optic systems already available. The major hang up with all of them is cost, followed closely by durability. You really don't want a prehospital provider taking a $15,000 piece of equipment into a scene and destroying it, now do you.

The traumatic aortic rupture is dead. Very simple, no muss, very little fuss.

An actively dissecting thoracic, or abdominal aneurysm is a different matter altogether. More often than not, they won't be able to hold still due to the pain. Relaxing or maintaining abdominal muscle tension as you describe, would be difficult at best.

Very possible I missed where you were going with this, but that is my take for now.

How are hospital gowns like insurance?

You only think you are covered.

Seems to me that we are over-specializing our "emergency" care.

Trauma to a trauma center

Cardiac to a cardiac center

Stroke to a stroke center

COPD to a respiratory center?

Diabetics to an endocrinology center?

Sickle cell patients to a hematology center?

I can accept the fact that the facilities that specialize, or deal with a specific problem are going to be better at it, but to what end? Pretty soon we will end up needing multiple "centers" for the complaints that we see every day.

I can see it now:

The stubbed toe center, or how about the "lonely elderly patient" center. The list goes on and on.

Wow, that went cynical fast, didn't it?

I can just imagine the scene in that house.

Parent: Oh my! Little Johnnie has stopped breathing!

Concerned friend: Don't worry, I know CPR.

P: What will we do? What will we do?

CF: You go call 9-1-1, and I will revive him

P: Hello 9-1-1? I need an bambulance to XXXX ABC street(with much noise in the background)

Operator: What is your emergency ma'am?

P: My little boy isn't breathing! Oh lordy, lordy, lord!

O: Ma'am, can you tell me what that noise is?

P: My friend is doing CPR

CF: Now Johnnie, this would be so much easier if you would just hold still!

Johnnie: (screaming) Mom! This guy was trying to kiss me! Get away from me!

Oh the laughs we could have.

I think it will be tough to find anyone who will give a significant dose of a narcotic to someone with this degree of "pain" medicine already on board.

If the patient was communicating with you, and tolerating the pain, my tendency would be to hold off as well. If the pain was unbearable, then I may consider using a little. This might be a good time to get medical control involved though. Explain the situation, and let them decide.

The question was not the causes it was the mechanisms [the person knows the causes], and its called the 5 H's and 5T's, not 4.

Regards.

You can also use 6H's and 6T's but the causes are all closely related. Some even use PATCHHHH MD for the causes, and if it is the mnemonic you need to help you remember, then go for it.

Hairs effectively split.

Unfortunately, there is a lot more to the answer than just, "Is it safe to give XX medication to an asthmatic?"

Like Rid said already, you have to understand your pharmacology to have an idea about how safe one drug or another is.

To parphrase Paracelsus, "Everything is a poison, there is nothing that is not. Only the dose, separates a poison from a cure."

Anytime you receive an education from a college or university, it will be more expensive than one from an independent contractor like AMR.

Look at the overall education that you will receive. From the looks of the PPCC program, you will finish with a degree, right? If they are requiring all of those courses without a degree at the end, then I would consider it a waste. The degree may not be important to you now, but if you don't get it, you will come to realize you have made a mistake.

Ask the director to send you a catalog, and as much information as possible on their program.

Besides, CO is a nice place to live.

I have to go with "The Sputum Song"

Snot is always better than poop!

Great stuff.

From Yahoo news:

Ethicists Blast Study Testing Fake Blood By LINDSEY TANNER, AP Medical Writer

Thu Mar 2, 11:59 AM ET

CHICAGO - Imagine being in a car crash, lying unconscious and bleeding in an ambulance. With no blood on board, paramedics give you an experimental substitute, but even at the hospital, you get fake blood for several hours before doctors try the real thing.

ADVERTISEMENT

Medical ethicists say a study that is doing just that on hundreds of trauma patients without their consent should be halted.

It's a renewed attack on research that began in 2004 after Northfield Laboratories got federal approval for its study of the blood substitute Polyheme.

Debate was reignited by a Wall Street Journal story last week that suggested the company tried to hide some crucial details about another blood substitute study back in 2000. The Journal reported that 10 heart surgery patients in that Polyheme experiment had heart attacks, while other patients given real blood did not.

The Evanston, Ill.-based company halted that study and hasn't published the full results, but Northfield Chairman Dr. Steven Gould says there were no attempts at secrecy.

Gould said Tuesday that Polyheme didn't cause the heart attacks or disproportionately more deaths. He said the study was stopped, not for safety concerns, but because enrollment was declining and the company wanted to focus on trauma research.

The current study should never have begun, said Nancy M.P. King, a University of North Carolina ethicist who co-authored articles for an ethics journal. She and colleagues wrote that real blood shouldn't be withheld from people who need it without their consent.

"There is a serious ethical flaw in this complicated and novel study," says the article to appear next week on the Web site of the American Journal of Bioethics.

Finding a viable blood substitute would revolutionize emergency medicine and could potentially save millions of lives. The idea is to create a product that works like human blood but could be carried in ambulances and given quickly to people of any blood type.

Baxter International Inc. halted research on its contender in 1998 when more than 20 patients given the substitute died.

Northfield now seeks to lead the race and says Polyheme fits the bill. It is made by extracting oxygen-carrying hemoglobin from human red blood cells. Unlike saline fluid, the standard pre-hospital trauma treatment, Polyheme has some of blood's tissue-nourishing properties, Northfield says.

The company's previous study — from 1998 to 2000 — involved hospitalized patients with defective heart arteries who consented to get Polyheme. Northfield's stock sank nearly 28 percent after the Wall Street Journal reported there were 10 heart attacks among Polyheme patients. Company stock rebounded later that day and closed up about 2 percent Wednesday, but that's still nearly 13 percent lower than before the report.

In the current study, which began in 2004, trauma victims get Polyheme or saline fluid on the way to the hospital. Once there, Polyheme treatment continues for up to 12 hours, while those on saline get blood transfusions.

More than 600 patients at 31 trauma centers in 18 states are enrolled in the study, and preliminary results are expected later this year.

The ethicists say the problem with the study is when the patients arrive at the hospital. Testing Polyheme against blood should be done separately in patients who can give consent or who have family members who can consent, wrote King and University of Hawaii ethicist Ken Kipnis and Philadelphia anesthesiologist Dr. Robert Nelson.

Kipnis said if the hospital phase can't be eliminated, the whole study should be suspended.

Some hospitalized patients inevitably will die because of their injuries, but they will have died "while being denied an available treatment (blood transfusions)," the authors wrote.

A separate journal essay by Duke University ethicist Karla FC Holloway says the study, in mostly urban hospitals, disproportionately exposes minorities to questionable science.

The trauma study was approved under a federal "informed consent" exemption that applies to emergency research. It requires community briefings in which residents can opt out — in this case by getting plastic hospital-style bracelets in case they are injured and unconscious.

But King says community briefings have not made it clear that patients will get experimental treatment and not blood transfusions for several hours even while in the hospital. Many briefings also did not mention the previous Polyheme study, and withholding that information was unethical, the ethicists said.

King noted that in January, Northfield sued to keep a weekly San Diego newspaper from publishing information about the trauma study, arguing that publication would unfairly reveal trade secrets.

"So much about this trial is secret because the FDA doesn't release information to the public about products that are being developed by commercial sponsors," King said.

Gould dismissed concerns about ethics and secrecy and said periodic reviews by an independent monitor have deemed the trauma study fit to proceed.

A Northfield spokeswoman said a survey of 12 study sites found that more than 2,000 people had requested "opt out" bracelets, mostly for religious reasons. Also, 11 of the 600-plus patients dropped out during the study's hospital phase, she said.

___

On the Net:

Northfield Labs: http://www.northfieldlabs.com

My understanding is the ethicists want to ensure that the patients are informed, before they are given an experimental treatment. I may be oversimplifying the issue, but isn't that why new emergency treatment is so slow in being developed?

Your thoughts.

So long as you get the information that you need to make a good decision when it comes to management of a problem, the alphabet soup you use to get there is really immaterial.

Most clinical guidelines would tell you to re-evaluate interventions for effectiveness and discontinue those that are shown to be ineffective.

How could you, in good conscience, continue to allow anyone to languish on life support for this long? After nearly a month, with no signs of improvement, it is time for the difficult decision to be made. Could be the parents are missing that God has already made his decision? The soul of this child is already gone. Keeping his body alive, while waiting for his mind/soul to return could be considered cruel.

You might consider contacting the program director or management directly.

Accreditation is a good sign, but it means nothing if the program is using that piece of paper to wallpaper the men's room.

What area are you in? If you want to know first time pass numbers, you might want to consider what degree of importance to place in that one criteria. After all, if someone graduates last in the class, and takes 3 attempts to pass NR, they are still a paramedic, right?

More along the lines of poor ventilation.