Steve Whitehead

I'm sure that there are a few of those in there, but all the test authors I know are active duty paramedics who are involved in EMS education. I guess I'm just not seeing the problem with this. Why not make the writing style in your EMT or paramedic textbook clear and uncomplicated? The textbook I teach from includes an extensive glossary of words that I could not comprehend in 10th grade. Learning medicine is like learning a new language. It makes sense to not complicate the matter. I'd prefer the author lay out the information in the least complicated manner. (But no less.) And while we may wish it weren't so, there are currently many, many references for the use of both of these interventions. (In our textbooks and in national standard curriculum and in our protocols.) And, until that changes, both of these interventions will be represented (in quantity) on the test. It's only fair to test students on their understanding of where medicine is, not where it's going.

Big fan of fresh lemons. I've never tried lemon juice, but in the absence of lemons...why not? Bleach works really well but then your hands stink like bleach for the next two days.

Some great information here, and some common misconceptions about the NREMT CBT. Thanks for posting the video. I think it explains a bunch of stuff very well. I created a fairly popular NREMT basic study guide that's available on the internet. While I've never written questions for the NREMT, I worked with a bunch of people who have been on development commitees while I was developing my products. (I couldn't work for the NREMT and publish the stuff I publish online. It wouldn't be premitted.) I'd like to speak to a few ideas I found in the thread: Regarding the test questions seeming like they aren't applicable to your certification level. If you are answering questions correctly, they will get more and more dificult until the test finds the upper level of your ability. (And it will find it.) If your knowldge level is advanced, the questions that appear at the upper level of your ability may be far outside of your typical scope of knowledge. Keep answering questions correctly and you'll eventually see physician level questions. Regarding the test "finding your knowldge weaknessess" and then exploiting them. The degree of question difficulty will adapt and change, but the subject matter does not adapt or adjust based on which questions you got correct or incorrect. Regarding the registry spending more money on developing good questions, they currently spend around $1,100 dollars per question from development to pilot testing to test integration. You may not agree that the money is well spent, but I don't think investing more money in question development is at issue. I haven't heard that the test wording is targeted to tenth grade comprehension but it's possible. However, the knowledge assessment is targeted to an entry level EMT or Paramedic, not a tenth grader, so I'm not seeing how this correlates to anything that has to do with test quality. Each question that you find on the test is created by a single question author. It is then placed in front of a review panel made up of various certification and education levels from physician down through EMT basic. Most of the question reviewers are involved in EMS education except for the grammar and statistician specialists. The original question author is present, though they are not required to identify themselves as the author of the current question under review. Each question needs to be validated using multiple medical references. The process is extremely rigorous. Some folks may dismiss the test questions as ridiculous but I think you'd be hard pressed to design a better system for question development. Thanks for the discussion ya'll, Steve

This whole interaction is proof that anything, absolutely anything can be debated in an online forum.

I disagree. This is a generalization that looks past the fact that private EMS systems can be just as problematic as fire based EMS systems. My change would be that we would all come to work with an appreciation for how great of a job EMS really is. (and stop the whinning) Did it need to be something practical?

From all the comments I was expecting something much more significant from that video. Folks sure do get riled up about stuff easy. Sure I think you could make an argument that this display was unprofessional in a fairly public place. But unsafe? Not really. Damaging to the public equipment? Doubt it. Lucky they didn't flip it? Come on. Pull their certs? What? I was an EMS supervisor for five years and I encouraged crews to drift in the snow. I do think it's helpful to learn where the vehicle looses control and how to correct it. And yes, while you're doing it, it is fun and you do grin from ear to ear. If I came across this scene as the supervisor I think I'd say, hey guys, let's take this somewhere else. This would barely register on my care meter. I'm glad to see the city managers are taking a resonable approach to this.

What a great thread. I dig hearing everyones take on this. Nothing helped me recognize how great my job was quite like getting a non-EMS job. I don't think it's such a bad idea to go looking for something non-EMS related. You may find your happiness and never look back. If you do come back you'll have a great deal more clarity on why you do your job. I had "put a fork in me" moments like these. Until I spent 9 months in sales. After I returned, I understood exactly why I was born to be a paramedic. I understod what Crotchity was talking about when he said "take care of your patients and go home." If you want to know why you need this job, start not doing this job. It will give you great clarity on what's important. It will also give you a greater sense of control knowing you have a choice to show up to work or not. It's always been up to you. Good luck.

From my experiences with DPH medics in San Francisco in the 90s and with DG medics here in Denver, I think I could offer some insights as to why larger city medics tend to put a greater premium on scene time. I’m not offering these as the right or wrong way to do medicine, these are just some of the philosophies expressed to me by some very talented medics while they were encouraging me to work on faster scene times and more efficient care. 1.) Scene safety. The shorter your exposure to the scene, the better. 2.) A sense that the back of the rig is your area of control where the scene is the patients area of control. 3.) A desire to get the rig back in service as soon as is appropriately possible. 4.) An idea that fast and efficient medicine should be practiced on all calls to improve the skill for when it is needed. I will say this. While I remain a stay and play medic at heart I took many of these lessons to heart and I think being trained in this way was helpful for me. Overall it improved my medicine. I have great respect for medics who come from big city, high call volume systems. The DG dudes I work with are some of the most knowledgeable and talented medics I’ve known. One idea that I would refute is the idea that fast = sloppy. That may be the case in some regions, and believe me, I’ve seen my share of medics who race to the hospital to compensate for poor skills, but I never saw that with the DG guys. The one remarkable thing I’ve noticed about most of the guys that came from that “knife and gun club” system is that they are just fast … like crazy fast. They are not sloppy. They just get a lot of stuff done really fast. And if you’re really sick, they’ll save your life. If you do die I guarantee you’ll die looking at a doctor. Final verdict for me … if we can bring definitive care to the patient there’s no excuse not to do it, but there’s nothing wrong with doing good medicine fast. One last point, Urban EMS providers don't "fear" longer scene times. They just don't prefer it. It's a matter of preference, not fear. The title of this thread slants the argument unfairly by implying that big city medics are afraid of something. Thanks all.

I think your suggested advocacy group has some flaws. Some have been stated well by previous posters some have not. You would do well to simply take the good advice already posted but I’ll add mine as well. 1.) Mother Teresa once said that she would never attend an anti-war rally. She then added that if you ever have a peace rally she’d be happy to come. As previously said, advocate for something not against something. Advocate for good patient care. But then you’re going to need to get over the fact that in some instances your group may end up advocating for fire EMS and against private EMS. Your own personal biases may prevent you from taking that leap. 2.) You’re trying to apply regional ideas to a national scale. In some regions and communities fire based EMS may be the best thing for the community. My department took over EMS when the private provider gave 90 days notice and up and left in 1995. Before being considered as a paramedic candidate for my department I endured an 8 hour medical assessment day that had a 70% fail rate. This process couldn’t compare to any private service I ever worked for and today I work with some of the most talented medics I’ve ever met (as well as a lot of good EMTs). Where would our community fall in your anti-fire agenda? If you advocate for the patient, then what would you suggest is best for the citizens of Parker CO? 3.) There is good medicine everywhere and there is bad medicine everywhere. I applaud your desire to see good medicine continue and bad medicine go away. In that effort we are fellow soldiers. I will fight with you till my dying breath my friend. I think the first step might be to recognize that the dividing line between good for the patient and bad for the patient does not run cleanly through fire vs. private EMS. Could you bring yourself to see a firefighter / paramedic standing next to you and fighting the same fight? Or does my allegiance to the honor of the fire service preclude you from fighting with me? If you put the patient first in your agenda we will go farther. Good luck to you.

... but no covered parking?

A few thoughts. 1.) I don't believe this guy for a second. I just don't. His story pegs the needle on my BS meter. Doc friends writing him scripts. Not trained on a pulse ox. Sorry. I don't buy any of it. I do agree that the kit was not stocked by a trained medic. 2.) I think this guy works somewhere with access to supplies and he never met a bandaid that he didn't like. He cleans the floors at a hospital or makes food for a USAR team or something. Or he just cut and paste the whole deal from another source and made up the back story. 3.) If he's this excited about caring for sick and injured people he should take an EMT course and learn all the good stuff he can do with his two hands and brain. Untrained dudes with this pack are useless. Trained dudes without this pack .... are ... better. But that's the thing with a lot of these dudes. They don't want to put the work in, they just want to squirel away shinny little trinkets and sew patches on their clothes.

This has been going on in Japan for several years. This has actually become quite the trend overseas. I wrote up a bit more on the topic at my website. http://theemtspot.com/2009/02/27/hydrogen-...he-us/#more-320 Thanks for the heads up.

Homeless convict or not, that's a bad day.

Lets hope this was creative journalism.

OK, this info comes from nobody in particular. The medic has several similar previous complaints from partners and patients. The patient was a post-ictal siezure. Patient was not notably injured when they left the scene. The patient was fully restrained when they left the scene. The medic reports that the patient slipped the restraints enroute to the ER and he requested help from his partner and PD. DG restraints are tough to slip. Partner states that the medic delivered an inappropriate beat down on the patient. DPD reports the patient was back in restraints when he arrived and he did not render help. Medic reports that DPD gave the patient the beat down. That's all anyone's giving up. Steve Thanks you itku2er. I'll fix it. Thanks for looking out for me.

The link below my name was my website. If that's a rule break I will stop doing it.

It means that when I'm on the medic there is a medic on the engine responding with me. When I'm on the engine there is a medic on the medic unit. My driver is usually an EMT. Sometimes he's a paramedic. It means exactly what I said. I'm not sure what you're getting at here Dust?

Nope. School bus drivers help kids. Nothing about them carrying a first aid kit redefines them in the eyes of the public. I'm not assuming that at all. I do believe that violence is in many cases predictable. So do may others. Like this guy. http://www.amazon.com/Gift-Fear-Gavin-Beck...7039&sr=8-1 And I was saying that I think your gut and your observations can bail you out of a lot of bad situations. Yes, saying that would be absurd. ;-) I'm glad I didn't say that. Steve www.theemtspot.com

Enough time has passed, I can probably get more on the lowdown from inside. Stay tuned. Steve www.theemtspot.com

I couldn’t agree with vent more. It redefines us. You can’t pick up one end of that stick without picking up the other. It’s just not our purview. The little voice in my head that says, “I wish I had a gun on me right now.” Is the same voice that tells me to back off. I think most paramedics are more than qualified to carry a side arm and the rest could be trained, but it’s not the point. It’s not a question of whether we could, it’s a question of whether we should. And the answer is no. Steve www.theemtspot.com

Sure Dust. I hear you. And I agree. It should be taught and it should be remembered and the skill should be retained. But often it's not. If it's valid to know, it's valid to teach. even if the learning rate is less than optimal. I think you could also make the argument that the EMTs who wern't motivated to learn or retain the skill the first time are unlikely to be motivated to read EMS Magazine each month either. I'm sure there's some truth to that. I tend to have one other paramedic on scene with me, yet I rarely ask them to strip my line. That job often falls to the EMTs. Most of them do it well. Some don't. When one of my coworkers jacks my line, I fix it and we move on. If that rules my organization out for potential employment, so be it. Steve www.theemtspot.com

A few thoughts. I've watched hundreds of my EMT students graduate and go on to take the NREMT exam. Our class has a first time pass rate above 90%. When a student fails their first run at the test, I am rarely surprised. I can predict which ones are going to struggle. Say what you will, but NREMT does a fairly good job at identifying the student with knowledge deficits. I have never run a bear attack, but I suspect a bear would inflict trauma. Our patients will test us every day. The final exam doesn't come from the NR it comes from the patient. We are obligated to test and test rigorously before the student is given the "patient exam" alone in the back of a rig with someone's grandfather. Steve www.theemtspot.com

I love Thom. He’s a great friend. I think we may want to brush this basic skill aside as too simple to warrant review but, for many of us, experience says different. Perhaps the question should be, “How many times have you asked a trained EMT to strip out a line and then had them hand you a line with an empty drip chamber and a bunch of bubbles?” I think Thom might suspect that this information is more useful that anyone might want to say. Steve