Dustdevil

That sounds like a good study topic right there.

Here's your answer: You don't know until you get there. And trying to assess your patient before you even get to his side is tantamount to malpractice. That's why most doctors will tell you, "I don't practice phone medicine." We shouldn't either.

Yeah, what possible good could come from instituting patient care earlier?

Hehe, what a coincidence. That's exactly my position on entering potentially violent scenes too!

Especially if the caller requests that we do not!

Hmmm... that's a different take. In my experience coming up from the funeral home ambulance days of the early 1970's, damn few of those guys I worked with made the transition to EMS. Once FR or EMT was officially required, the educational process washed most of them out. They didn't have book smarts. They didn't have any smarts at all! Certainly not enough to become a paramedic. A few of them did make it though. One of them was a young rookie named Bryan Bledsoe. You know him as Dr. B.E. Bledsoe, the guy who wrote your paramedic textbook.

Unfortunately, I've had way more than my fair share of serious injuries in my lifetime. Consequently, I have had the opportunity to experience just about all of the known analgesics at one time or another. Trust me, I'm not bragging. :? But interestingly enough, the most absolutely whacked out of mind I have ever been was on the non-narcotic synthetics. Stadol and Ultram are highly hallucinogenic! I really don't remember if they actually killed the pain or not. All I remember is that I simply didn't care if I was hurting anymore.

None of that is nearly as much fun as Demerol.

I'm not so sure how common it is, but it is certainly normal. Different people react to different stimulus. Apparently you respond well to reality based stimulus, and not so well to theoretical stimulus. Nothing wrong with that. It will serve you well in the field. Just to compare this to another common situation, there are many people (myself included) who do poorly with theoretical mathematics. The professor has not been born who can teach me college algebra with any level of understanding. Yet in the real world, many of those people excel at mathematical problem solving. For instance, although I do horrible in mathematics classes, I am the nurse that all the other nurses come to to work out their drug calculations for them. And all those other nurses made A's in college algebra. So long as you are doing well in the field, and as long as your preceptors are recognizing that, I would not worry too much about it. However, it is certainly something that you will want to work on in order to further your career. A public speaking or communications class may prove helpful to you. It doesn't seem to be so much of a knowledge problem as it is the ability to quickly compose and express yourself in formal situations where you are on the spot. Someday you will be the preceptor, and the ability to one-on-one with your students and recognize when they have similar problems will be invaluable to you. Good luck.

That's the crux of the problem, right there. Here, an EMT is anywhere from 14 days to three months of part-time night school to learn nothing but advanced first aid. And then they want to put on patches and badges, a stethoscope around their neck, puff out their chest and proclaim themselves to suddenly be a healthcare professional. I ain't buying it. The medical and nursing profession ain't buying it. And the public ain't buying it either.

I'm going to warn my little sister to never go into EMS.

Be careful to not overlook any signs that you may be burning out. Seriously. If you have never had migraines like that before, then this could be a sign of burnout. I remember when I burned out the first time (14 years into the field) I had migraines so bad that I had to have my partner drive the entire shift while I sat or laid in back with the lights out because the light made me throw up. Couldn't concentrate. Skills were suffering. A couple weeks off is all it took and I was fine. Never another headache. I'm just sayin... be careful.

Dude, that ER sucks! I would never go back there. I sprained my ankle on the job once. Got taken to the hospital in my own ambulance, and wheeled into the ER by my own partner on my own cot. I thought for sure it was fractured, but it was just a major sprain. That didn't stop them from giving me Demerol/Vistaril and a script for Vicodin. And I am sure your finger hurt at least as much as my ankle did. That's just wrong.

But that was the school, was it not? It is my understanding that the state does not currently run a routine check on every applicant unless they reply affirmatively to the criminal history question on their application. It is interesting that every school I know of now runs criminal checks on their students, but the state itself does not.

Are you going to pay them out of your pocket? Good luck getting any political subdivision to fund your dream service. Doctors Bledsoe and Salomone have been fighting the fight you are talking about for over a decade each, yet the great majority of people in the field have no idea who they are. Both are physicians and former paramedics and outspoken proponents of advanced education in EMS. But all the initials after their names don't make politicians any more willing to spend money on things they have always gotten free or cheaply. As long as there are wankers and firemen whose only goal in EMS is to practice the most skills with the least education, the general public will continue to believe that EMS is just fine the way it is, and will accuse you and I and every MD out there of simply trying to get rich at their expense when we try to raise the bar.

Okay, sounds good. Was just trying to understand the theory behind your belief. I agree. It is my understanding that this is only a first step. Actually, it is now a "second step" since they have already tightened up once from the original requirements. It just makes sense to do this sort of thing in increments. Especially since there are only so many accredited EMS programs across the state to serve so many people. But eventually, as more programs become available to more people, I see Texas working towards the so-called Kansas standard and making the AAS an entry level requirement. They're just giving people plenty of time to get used to the idea.

Okay, then you are saying that it is worthless, but you'd do it anyhow?

I'm trying to understand here. I thought your whole point was that the LP licensure was worthless. If you believe that, why would you spend any time at all pursuing it?

Exactly. Ah, but there is. ALS is busy treating the patient all the way to the hospital, trying to do half a dozen more things at once than a basic would be doing. ALS also has a need for serial BPs to track the efficacy of therapy. BLS does not have that same need. And it has already been established that we are talking about serial BPs, not routine starting baselines. What is unacceptable is to utilize it for no other reason than you're too lazy or too mesmerized by technology to do it manually. What is acceptable is to use it to maintain a constant eye on the patient's condition after baselines have been obtained and therapy has been instituted. Has nothing to do with levels of provider, except that basics are not nearly as likely to be engaging in therapy to change blood pressure. Some have. Others have not. But that is certainly something you risk when you put dubious technology in the hands of people who have no need for it.

Okay, so you're saying that if you weren't interested in going to med school, you wouldn't be interested in a degree at all because it is meaningless to a paramedic?

Oh man, I remember those days, haha! IC Epi was all the rage around the same time we thought that 500 w/s was a good idea too.

That wasn't my point. I'm not accusing you of skimping on education. My point is if all those non-EMS classes don't make you a better paramedic, then why do all those non-medical classes make you a better doctor? And if they don't, why don't you have the guts to stand in front of the med school admissions board and tell them so? Just seems like you are subscribing to a double standard here. It's like you feel med school is worth "playing the game" for, but EMS is not. And I find that attitude mildly disturbing.

Pericardiocentesis was briefly covered in paramedic school (1979), but not as something we were actually expected or allowed to do. My class was nothing but urban firemen. No way would they actually teach them something potentially useful. Over the next fifteen years, it was something that was always quickly glossed over during refresher courses. Never actually covered in depth. Just by name. There was no mention of pericardiocentesis in the first paramedic textbook printed (Caroline, 1979). And it remained the same in the last paramedic textbook I ever bought (Bledsoe, 1994). No mention of treatment at all under "cardiac tamponade." The term pericardiocentesis isn't even in the book. Can anybody tell me what current textbooks say about it? In the mid 80's, the rural hospital based service I worked with had it as a standing order protocol and every medic was in-serviced on the procedure to the medical director's satisfaction, but I don't recall any of us ever using it. During a paramedic review a couple weeks ago, the instructor again glossed over it, mentioning it by name, but specifically saying, "of course, we don't do that in the field." What is your procedural protocol for pericardiocentesis in Canadia?

So then why bother with a pre-med degree if pre-professional education is so irrelevant?

The problem is, you have no way of knowing when they are and are not working "well." That is a flaw in the device. In BP measurement, you have a manual baseline for comparison, so you know when readings are off. But with the theromo, you have no manual baseline. If you took a manual temp, you wouldn't be using the thermoscan in the first place. That in itself is enough reason to not use them. But back to the device, they are only accurate when they are properly positioned. And there is no way to know if you are properly positioned. Therefore, any assumption that the reading is accurate is just that, an assumption.