Floridastudent

I'm Dana, but anyway - not sure why the link didn't work - try this? http://bit.ly/b39EiC

This was in today's Sentinel. Hope they're all right! $%^&#! careless drivers. http://www.orlandosentinel.com/news/local/orange/os-orange-county-firefighter-injured-20100214,0,4728936.story

I definitely plan to continue my education. Last semester I took medical terminology, and I'll be taking biology, A&P I and II, etc., some time in the near future. I'm not against transport in the short run. It would actually be a great way to learn in a lower-pressure environment. However, my ultimate goal is responding to 911.

Thank you SO much! I'm going to cut and paste all of this! You've given me a lot to go on - this was like a thesis on what to look for in an employer! And since I'm not on the inside, I wouldn't have thought of any of those. I don't know yet where I will end up once I get my EMT and/or paramedic - I'm looking around FL, I'm still considering NYC - I have to consider quality of living as well as salary in the cities that I apply to.

That's true - I should have mentioned that I am definitely interested in working for agencies that do 911, not transport. Since I live in Orlando area, I am almost definitely going to have to move in order to get a job, because most of the 911 here seems to be fire department based. I'm fine with moving, even out of state if I have to. In an economy like this you have to be flexible.

I know this is a little premature, because I've only finished my first month of my one semester EMT program, but...what are some things I would look for when considering what EMS agencies to apply to? Salary enters into it to an extent, but beyond that - what are desirable characteristics of an EMS agency? Yes, I am going on to paramedic at some point. Not sure yet if it's going to be immediately after this semester is over or if I'm going to try to get an EMT job first and then go to paramedic school while working for an EMS agency. (Money is an issue. As in, I'd like to start earning some sooner rather than later.)

Oh, as to the question why I would use an oropharyngeal airway before suctioning - according to The Book - all hail the almighty book - The two principal purposes of an oropharyngeal airway are: To keep the tongue from blocking the upper airway and to make it easier to suction the oropharynx if necessary.

In the real world, that would be fine, but in the context of this class - our teacher continually tells us to just go by what the question says. Take whatever the question says as being the absolute truth. If the question says that you show up on a crime scene and the scene is safe - don't ask how you know the scene is safe. Don't ask who told you the scene is safe. The Question says so. In the real world, you'd question bystanders - but in the class - if the question says you don't know the events leading up to the cardiac arrest - you have to assume possible trauma. My partner could be elevating the patient's bed while I'm assembling suction, or he could be trying to manually clear the patient's airway. Hey, I am DELIGHTED to ask questions on here! There's not always the opportunity in class.

DwayneEMTP - Okay, I'll bite! "You are dispatched to the local nursing home for an older man who is "difficult to wake". You arrive at the nursing home about five minutes after the initial call and find the patient to be lying supine in bed with oxygen flowing at 2 l/min via nasal cannula. THe nurse states that the patient was fine last evening but they were unable to wake him this morning. They state he has a history of COPD and recent pneumonia. The patient has shallow gurgling respirations at a rate of about 8 breaths per minute. You also note cyanosis around the lips. WHile you are assembling your suction unit, your partner is placing the patient on a pulse oximeter. Book question - How would you manage this patient's airway and breathing? Would you change the position of this patient? My guess - insert oropharyngeal airway if he doesn't have a gag reflex (nasopharyngeal airway if he does), suction the patient for up to 15 seconds, then 100 percent high flow oxygen via bag valve mask, squeezing every 3 to 5 seconds. Ventilate for up to 2 minutes, then suction again if needed." DwayneEMTP - Can you rethink this and see if you can explain why this isn't the most logical order of events? (Note, you won't find this answer in your book.) Unfortunately, at this point while I'm struggling to keep my grades up - they're varying between 90 and 95 percent depending on how well I did on the most recent test or quiz - all I can do is memorize and recite back what I've been told. Once I pass the NREMTB I can start thinking for myself and paying attention to what actually works in the field. (Well, okay, once I start doing clinicals and ridealongs and talk to real EMTs I can do a little thinking for myself, but honestly - I'm cramming so much rote-memorized stuff into my head - I don't have much room for anything else. Okay - what would I do differently for the nursing home patient in the example above? From the info the book gave me - the patient is breathing but his breathing is clearly inadequate. He is gurgling. In the book it says, if the patient is gurgling - suction! Should I have tilted his head back first before I put in the airway, to see if the cause of the gurgling was his tongue?

Yes, that's a tough one with COPD and giving oxygen. What they are having difficulty breathing and if you give them oxygen and they stop breathing? I assume you would provide artificial ventilation via BVM or mouth to mask until you get to the hospital.

Book vs. street - Tell me about it! I start ridealongs next month. From what I gather - in class we need to memorize and mindlessly parrot back the book when we take quizzes and tests. In the field we need to do what makes sense, as long as we follow our local protocols. I'm a CNA and what we learned in class doesn't have much to do with what they tell me to do when I go cover nursing home shifts. Good to know about raising the head of the bed! We haven't been taught anything about a diesel bolus yet. I'll go look that up.

I am in an EMT class, and we're on the respiratory section. I have a few questions and I'd love some clarification. 1.) If someone is breathing, but they are breathing inadequately - say, shallow breaths, labored breathing, etc. - am I correct in assuming that I would use assisted ventilation (bag valve mask) rather than a nonrebreathing mask? The nonrebreathing mask would generally be used if breathing is adequate but hypoxia is suspected? Also - once you start the assisted ventilations via BVM - do you continue with the BVM after breathing becomes adequate, or switch to a nonrebreathing mask? My guess is you would continue the assisted ventilations with the BVM until you arrive at the hospital and transfer care - is that right? 2.) Scenario in book - you are called to the scene of a cardiac arrest and find that bystanders have initiated CPR. Patient was not breathing for about 3 minutes before they started CPR. Patient has occasional gasping breaths. You decide to open the patient's airway. You have no history of events leading up to the point of cardiac arrest. What is the preferred method of opening the airway? Head tilt chin lift, jaw thrust, nasal airway, none of the above. I say jaw thrust because you don't know if there was any trauma - am I right? 2.) "Points to ponder" scenario in the EMTB book - You are dispatched to the local nursing home for an older man who is "difficult to wake". You arrive at the nursing home about five minutes after the initial call and find the patient to be lying supine in bed with oxygen flowing at 2 l/min via nasal cannula. THe nurse states that the patient was fine last evening but they were unable to wake him this morning. They state ha has a history of COPD and recent pneumonia. The patient has shallow gurgling respirations at a rate of about 8 breaths per minute. You also note cyanosis around the lips. WHile you are assembling your suction unit, your partner is placing the patient on a pulse oximeter. Book question - How would you manage this patient's airway and breathing? Would you change the position of this patient? My guess - insert oropharyngeal airway if he doesn't have a gag reflex (nasopharyngeal airway if he does), suction the patient for up to 15 seconds, then 100 percent high flow oxygen via bag valve mask, squeezing every 3 to 5 seconds. Ventilate for up to 2 minutes, then suction again if needed. Change the position of the patient - once they have been suctioned, before putting on the BVM, I would do the head tilt chin thrust maneuver (because no trauma is suspected). How did I do? I didn't kill my imaginary patient, did I?

I'm not an EMT yet, I'm just in my first month of class, but I would also emphasize what a previous poster said - you can not afford to use bad grammar or poor spelling or punctuation while applying for a job, ESPECIALLY given your age. They are already wondering if you are mature enough for this kind of life and death position - when you write like a first grader, unfortunately, that does not speak well for your maturity. Also - my teacher keeps emphasizing that it is extremely important to spell properly, because when you write out a patient report, if it is written poorly - 1) The patient may receive inadequate care because of it and 2.) If you end up in court, or even end up the subject of an internal investigation, and you have written a report that is riddled with errors - they will assume that you provided inadequate care because of your sloppy reporting skills. So when you are applying for these jobs and they see that kind of writing - what kind of documentation do your potential employers think that you will be providing with every run report? If I were you, I would: 1.) Improve your writing skills, including taking an English class at community college if you need to. Then, and only then, I would consider moving to an area where they either have volunteer ambulance companies that will allow you to ride with them at your age, or an area where they will hire you at your age. If you can only find an area that will allow volunteers - work somewhere else and keep your skills up by volunteering, and also make sure to keep your certification current. Yes, it means you have to wait a while, but sometimes you have to make sacrifices for the job that you want.

Speaking as a CNA who has worked a few shifts in nursing homes - I agree that the nurse described by the OP sounds awful. However, sometimes the nurses and CNAs are doing the best they can, and are overloaded with too many patients, constantly running back and forth trying to get everything done, and really ending up only able to provide the minimum of care because the facility is understaffed.

http://www.orlandosentinel.com/business/os-fl-unemployment-november-20091218,0,448561.story And another reason to leave Florida, at least for a few years...our economy is taking an unbelievable nosedive.

So what happens while you are waiting for your certification to come through? You can't work at all?

That is definitely the best way to go - the problem for me at least is, when I graduate, I am going to need to get a job and in this competitive field and horrible job market, I pretty much need to go wherever I can get a job, even if it's another state. Also - we live in Florida and my daughter wants to go to college in NYC, so we were thinking of moving there her last year of high school, so she could get reciprocity. Advantage of going to school in Florida - the cost of living is very low which is important when you are in a program that is so intense that you can't work.

Well, it's something to think about if it's going to take me months to be able to start working when I move somewhere. I need to be able to support myself. The reason for wanting to move to NYC is that my daughter wants to go to college there and it will be cheaper if we had residency in New York. Also, the pay scale in Florida is terrible. However, as has been discussed in other threads on this forum, the higher pay scale in NY may well be eaten up by higher rent and higher taxes and higher everything else. And I do love the weather here. Ultimately when I graduate, where I move will depend on where I can get a job. I should be done with everything in a year and a half and then I can see where people are hiring. Well, it's something to think about if it's going to take me months to be able to start working when I move somewhere. I need to be able to support myself. The reason for wanting to move to NYC is that my daughter wants to go to college there and it will be cheaper if we had residency in New York. Also, the pay scale in Florida is terrible. However, as has been discussed in other threads on this forum, the higher pay scale in NY may well be eaten up by higher rent and higher taxes and higher everything else. And I do love the weather here. Ultimately when I graduate, where I move will depend on where I can get a job. I should be done with everything in a year and a half and then I can see where people are hiring. Well, it's something to think about if it's going to take me months to be able to start working when I move somewhere. I need to be able to support myself. The reason for wanting to move to NYC is that my daughter wants to go to college there and it will be cheaper if we had residency in New York. Also, the pay scale in Florida is terrible. However, as has been discussed in other threads on this forum, the higher pay scale in NY may well be eaten up by higher rent and higher taxes and higher everything else. And I do love the weather here. Ultimately when I graduate, where I move will depend on where I can get a job. I should be done with everything in a year and a half and then I can see where people are hiring. That is helpful! I guess I'd want to apply first and get hired - if that's possible - before relocating to another state. I do have a CNA license, I could work as a CNA while waiting - oh wait, I'd have to get that certification transfered too.

I've been looking into the paramedic to RN option as well as the LPN to RN option. One thing to make sure of - if you're trying to get your RN with one of those online programs, like Phoenix, check with your state board of nursing to make sure that they will accept that educational institution. Many of these programs are accredited in some states and not others - and you can pay a ton of money to take an online LPN to RN program, or paramedic to RN program, and then find out your state won't let you sit for the NCLEX because they haven't accredited the online program.

You could be right. I haven't lived in NYC in a very long time. What if I lived in New York State rather than NYC?

Very interesting point. I'd MUCH rather be busy than be answering call after call to senior citizens who thought they had difficulty breathing but are fine by the time we get there. My big concern though - okay, two concerns. 1.) Rent in New York is expensive. I have two teenagers, so I can't go live in a studio apartment somewhere, and I MUST be in a good school district. 2.) I'd need to be in New York for a full year so I could be a resident of New York before I could take the courses at community college and get the New York State resident college price, wouldn't I?

So it would be easier to transfer to another state as an EMT then it would as a paramedic (depending on which state?) I'm most likely looking at New York or New Jersey if I were to move.

Thank you!

I am about to take an EMT course, and then probably paramedic course next year. At this college we get national certification as well as Florida (assuming we pass the test!) How hard would it be for me to work in another state once I'm certified? Does this vary by state?

Why, I never thought of it that way - you are absolutely right! I need to keep researching to get an accurate picture of rents in NYC. I live in one of the fancy high end neighborhoods next to Orlando. School system is excellent. I rent a small 1334 foot house with a yard (on a very busy street, granted), 3 bedroom, 2 bathroom, nothing updated at all - but it's only $1000 a month. I'm literally one block away from million dollar homes, which helps keep the local school system decent and the crime in this area is very low. Then again, CNA's make about $9-$12 an hour, and I think new nurses - and I mean RNs - start out at about $20 an hour and earning much more than $30 an hour would be challenging in this area, from what I am told. My mother is a very experienced CNA earning $10 an hour. So does getting ALS significantly increase your chances of getting a job? Obviously it pays better, but is the employment picture better?