tracymae

Tracy, I mean no disrespect here but let me ask you this.

Do you know the actions behind the drugs that as a medical Assistant you are able to give? Do you know the pathology behind why one drug does one thing while another acts a different way.

Do you know why you are giving a medication to a patient or are you just going by what the MAR says to give? If you are just going around giving medications to your patients without knowing what that medication is really going to do for the patient then do you have any Business giving medications to anyone?

I'm a diabetic, I give myself daily injections of a medication called Byetta. It is to help me with my diabetes by lowering the blood glucose level as well as regulate my pancreas. It was developed from Gila Monster Venom. I know that if I take it on an empty stomach I know that my blood sugar will fall. I also knwo that a side effect (good one to me at least) of this medication is weight loss.

Using diabetics or heart patients that give themselves injections as a reason for you as a basic to be administering medications is an improper analogy. Those patients who are giving themselves medications usually are better versed on the medication than you are as a medical assistant and those patients are better informed of why they have to give the meds to themselves.

I don't understand why a medical assistant can give medications anyway. With no pharmacology or a very basic pharmacology knowledge I have seen medical assistants giving many injections yet they usually cannot tell me why they are giving the meds. Physicians do their patients a disservice when they have a person with no training in medications giving me or anyone else a med. That's a recipe for disaster and I'm sure that medication errors and adverse reactions occur with surprising frequency yet are not reported because they happened in the confines of a private physicians office.

Your argument that you can train someone to do something has been put out there but do you train that same person what to do when the unthinkable happens? I'll bet your training doesn't encompass that aspect does it?

Honestly, the thought process that a basic can do everything a medic can do SCARES THE HELL OUT OF ME. With 400 hours of classroom work and 48 hours on the ambulance, sure EMT's can do what I can do after 2 years of school and clinicals.

I guess the next thing the do more with less education group will advocate is Open heart surgery by Nurse Practitioners.

This is what gets me, we as a society want to get more for less. More money for less effort, more this for less of that.

What ever happened to working for it. To prove yourself and then getting more and more responsibility. We have raised a generation of "I want it now" kids who are now in society as a whole as "contributing" members but they want to take the short cut.

I went to school for 2 years to get my paramedic and when I see these people advocating for more responsibility on a EMT's training level, I want to say NO NO NO NO. I worked for my medic and they should also have to work for theirs. Am I holding those whiny little snots back from their dream, nope, not at all, I'm merely making a stipulation that they put in the same level of commitement that I did, and giving advanced skills to someone with 3 months of education rubs me the wrong way.

Tracy, I look forward to a reply.

You completely took everything I said the wrong way. Maybe it was my rambling. I DO NOT BELIEVE I SHOULD BE ALLOWED TO PERFORM ALS AS A BASIC. I do believe that people can be trained. I have had pharmacology, it was pretty extensive. When I discussed being a Medical Assistant, compared to an EMT, it was in the context of being able to do things as one and not the other. It was not being compared to being a medic or wanting to get training and not work for it in medic school.

There have been several posts regarding how useless Basics are. If you do not have the basics skills then you have nothing. My point is that why do medics feel the need to degrade a basic when if you don't know the ABC's your Narcan and D50 do not mean squat.

I do know why I give injections and what the indications and contraindications are and what to do when something bad happens. I have instructed patients many times on the use of home injections. It was probably a Medical Assistant that trained you on the use of Byetta. I am completely aware of it and its uses. As a Medical Assistant, I am required to obtain CEU's and on going training. Although there are many Medical Assistants who were grandfathered it. I am not one of them. I went to school for 2 years as well for Medical Assisting and Medical Office Management (and a couple of other degrees that have nothing to do with this). However, I do not think that I am better than anyone else because I have a higher education or higher skill than anyone else. I used the example of the First Responder. I do not feel that I am better than them because I am one level higher than them. And I do not feel that they are useless or that I would not want them to respond to MY emergency. They are trained on ABC's and that is the most important thing with any call. It is nice to have I's and Medics, but with out the ABC's, there's a dead patient. That was my point.

My post did get to be a lot of ramble. Mostly out of frustration. I see posts everyday about the respect EMS demands, yet EMS professionals do not respect each other. Much like the Medic/RN relationship. Each thinks they are better than the other. The RN feels that the Medic is full of crap because the RN had a more extensive A&P and Pharmacology course. I have been in the medical field since I was 14. I have seen the bickering and it makes me sick. I am here for the patient. Not to show off my credentials.

I was also a Transplant Coordinator, which was on the job training. They usually require RN's, LPN's, or Medics. I was fortunate to have a fabulous mentor that taught me everything I needed to know. I did not perform ANYTHING if I did not know what I was doing or what the consequences were and what to do if something else needed to be done. I assisted in many organ recoveries, inside the body cavity, all with an associate's degree, AND a lot of mentoring. I'm just saying it's possible. It may not be something that everyone can do. I also built a kidney preservation lab for the number one rated hospital in America, because there is no training or manual on kidney preservation. I learned what I know by trial and error and mentoring with physicians. There is no school for it. So, when I said that people can be trained, I was not speaking of all basics or that they should be. I was just saying that I was able to be trained.

So, once again, I was not advocating for Basics to provide ALS. I was rambling on about how it's all fine and dandy that you can start an IV and give Narcan, but that doesn't mean crap if the person doesn't have an airway. Being a higher level of care does not mean you are more important. ALL EMS PROVIDERS ARE IMPORTANT. That was my point. If EMS wants respect from the public and other public safety professionals, we should respect each other first.

Don't take what I am saying out of context. Unfortunately you do not know me, you do not know the type of person I am, or how I convey myself. I stated in my first post that I was not looking for a bunch of haters. It was a post to open peoples eyes to respecting each other in OUR field. I am not hating on Medics or nurses, your skills or knowledge, and I am not saying that you are unimportant. I am not looking to come kick your ass, but I will if I have too! That's a joke. I am also very sarcastic. You just do not know me to understand the way my words are flowing,

It is very difficult to convey in writing, much like a text. Why can't we all just get along!?!?!??! Maybe that's all I needed to say in the first place. Good day to you!

I don't know how things are done in the Pacific Northwest, but in GA, the EMT-I course (while combined with the EMT-B course) is 200+ hours IN ADDITION to the 120 or so hours of EMT-B. Since the EMT-B course must be successfully navigated first, by my figures; this equates to about 360+ hours to achieve EMT-Intermediate (and this is only the I/85 status). Here in GA, that's what it takes to reach the MINIMUM level to be able to treat patients in the field. An EMT-B in GA usually does nothing more than chauffer (if they can get hired at that level at all!).

This is a point that I've been trying to make for a while. Far too much of the emphasis on the curricula standards set forth by the D.O.T, NHSTA, NREMT and state and local governing boards for EMS place far too much emphasis on 'minimum hours required'. This whole concept only serves to turn out students that have no real understanding of the human body, the systems that comprise said human body and how they actually function. By limiting this knowledge, we also limit the understanding of the effects of our actions and how they affect the various body systems.

The whole post by tracymae is so rife with misconceptions and errors in critical thinking; I don't even know where to begin!

While I was an EMT-B, I never understood this comment. As I delve deeper into my education, I find this statement to be more and more accurate. The EMS educational curricula structure is sound, each level is a building block placed on the level before it.

The biggest problem I have with the whole curricula is that its focus is only on the 'minimal education needed'. This is especially evidenced by the 'patch mill' schools that are churning out the woefully under-educated EMT (at any level).

I admit to falling into the 'We don't need no higher education' group as I started out on my EMS career. While I realized that the EMT-B was the thinnest part of that very fine line between the patient and 'dead', I felt that I had all the education I needed to go out and 'save every patient' that I came in contact with.

I won't be the first 'former EMT-B' to ever agree with that statement, and I know I won't be the last! As one progress through their educational process, they can't help but come to the realization that "So THAT'S why we do that!".

This has got to be one of the best 'in your face' comments I've heard in a long time! While I don't agree with some of the things in the post that comment came from, I have to say I LIKE that last line!

triemal04.......you should read my post again. I am NOT advocating that Basics provide ALS. The major post was to support respect between the different levels of care. You are the reason EMS does not receive the respect it is demanding. My point is that it is great that you can push meds, but without the ABC's you have a dead patient, so why do you feel the need to rag on Basic level EMT's. I was not advocating that I deserve to do things outside of my scope of practice. I was comparing levels of care with in the health professions. Such as, a Medical Assistant and EKG's. I find it ironic that an EMT-Basic is not taught any interpretation and is not taught the use of a 3 lead or 12 lead.

I am rambling again, because there is so much frustration. You think you are better than a nurse too, just like they think they are better than you.

Be nice to each other in the field and the public and other public safety professionals will be nice to you! I bet you hate to be called an ambulance driver!

I've traveled the country on organ donation. Perhaps you gained some CEU's from me for an elective. You have no idea what my critical thinking skills are. Ok, I have wasted too much of my time on you already. Check out my reply to the first hater I had. He was much more cordial. You totally missed the mark, you may need a critical thinking refresher course. Read the whole, not just want you want to see bro.

For NREMT, you can break up the refresher by obtaining CME hours covering the specific areas as specified. These CME hours are in addition to the 48 hours of CME required outside of the refresher. Alternatively, you can recert by examination which takes the place of the entire 72 hour requirement.

GOTCHA! Thanks! :-)

I too would like to know if FEMA classes can be used. Also, the NREMT website has a section to keep track of all of your CEU's. Does anyone know if it is REQUIRED to take a Basic Refresher for your CEU's? Can you break the sections up, or does it have to be a refresher?

If anyone is from Ohio on here, is the Refresher required for State re certification?

THANKS!

OK I saw in another forum a discussion of Basics doing "ALS" procedures. One post though seemed to indicate by sarcasm that it was a bad idea. Here is that qoute of Medic417

"Once when the hospital was in serious crisis I was asked to assist in surgery. Since I knew how to spread a chest I did to save time for the surgeon. Thinking about it I think we should start doing it in the ambulance to save time for the surgeon. I mean all we're gonna do is seperate the ribs,not actually touch the heart or anything like that. I mean its so simple a monkey can be trained to do it so why shouldn't we add this skill?"

So what are your opinions?

I do not want to start an argument with this discussion, so please do not hate me. I just want to clarify that without the BASICS, Paramedics can not do their jobs. It doesn't matter that you are a Paramedic if you if the basics skills are not performed. EMS is definitely a cluster f***. Each state with it's own protocols, FD, PD, and EMS can not get along, EMS can not receive respect, EMS providers are ambulance drivers, etc. When then, would we degrade each other?

Yes, I am ONLY a Basic to you, but the knowledge and skills I have acquired are the most important at ANY level. Remember the ABC's? I volunteer with EMT-I's and they seem to forget the ABC's because the are I's and can start IV's. Umm.......dontcha wanna check their pulse first and maybe do some chest compressions before you start that IV there EMT-I?

Ok, I bantered a little. My point is that we are all important, on all levels, because without the ABC's covered, you just might end up with a dead patient and your knowledge of D50, Narcan, and Morphine won't mean crap. I read a of these posts and I see a lot of degrading of Basics.

I do not think you necessarily need the philosophy behind the techniques of some things. People are trainable. One thing that cracks me up is that I am also a Medical Assistant. I was trained on EKG interpretation. I do not know if it is at the same level of a Paramedic, but I am aware of some interpretation. As a Basic, I'm not even suppose to touch the monitor. I can also give injections, as a Medical Assistant, not as a Basic (except the epi pen).

Diabetics give themselves injections, patients give them selves Lovenox injections, B-12 injections, do you think they had any kind of training? No, the nurse said, "Poke here."

I was a Pathology Assistant, I performed autopsies and dissected surgical specimens. I did not always know what I was looking for, but I knew the technique. I was an on the job trained Perfusionist with the local Organ Procurement Organization. I was part of the surgical recovery team from organ donors to recipients.

People can be trained. Now, I was interested and wanted to know why I was doing things the way I was doing them, so I asked questions, had a great mentor, and have gained a tremendous amount of knowledge.

Now, my whole point to this is why hate on the Basics? With out the basic skills, you have a dead person, so why do you feel that you are so much better? I didn't become an EMT because I wanted to be a hero or degrade Emergency Medical Responders because I have more education than them. We are all here for the same thing and that is to help people. If we want respect from our peers and the public, we should also respect each other:-)

P.S. Don't be hating on me because I can intubate as a Basic in Ohio! :-)

Don't be hating on me now! I'm a newbie:-)

Hey everyone,

I know I have been MIA for quite awhile, As some of you may remember, my wife Janice was diagnosed with lung cancer in July 2009. Well after being given the all clear on April 30th, she began having neurologic problems and back & neck pain in early May, then on May 12th she had surgery to remove a ruptured disc in her neck that was pressing on her spinal cord. While that did help the neck pain some, it did not relieve the neurologic problems (Tremors in both arms and hands, Dizziness, and severe headaches and syncope when standing up, and weakness in her legs) so about a week after surgery they did a lumbar puncture and discovered that the cancer was back in the CSF and in her brain.

This past Saturday, June 12th, Janice lost her battle and passed away.

I am attaching a copy of the obituary with memorial info. for anyone who may be interested.

Thank you all for the well wishes and prayers back when we began this journey,

I will try not to be such a stranger in the city from now on.

Thank you

Sorry to hear of your loss. My heartfelt sympathies go out to you and your family. Thoughts and prayers to you.

Since I really haven't had any time to vent to anyone else about this whole situation, I figured putting it down on paper, so to speak, would make life a little easier. I'm not unlike most of you, averaging 4 days a week but a total hours alotment of about 72 per week. Why, well the plan was to help the now EX get back on her feet and through school! So I thought....

I was at work on Sunday, my birthday to boot, when I found out she had logged onto my back account (not sure how she got the info) transferred money out and when withdrew said money zero'ing my accounts. As if that wasn't enough she didn't just stop there. She took my entire IKEA bedroom set, sleep number bed, my hi def TV, my new IMAC, and my god damn dog!

Now I'm the type of guy that puts everything he has, his heart and soul, into a relationship and I work through problems when I know they exist. As a Paramedic it's my job to look after the well being, both physically and mentally, of those I contact on a daily basis. What I don't understand is both what I did and why this shit happens to me? We were together for 4 years.

My previous relationship was 7.5 years and she cheated on my 3 times, her excuse was that I wasn't home enough. Now granted I was working 96 hours a week because we were on a single income with a new baby and putting myself through paramedic school at the time.

I just don't get the female species, I'm a good fuc*ing guy. I don't get why this always happens to me!

This really sucks and I am sorry this has happened to you! You should press charges against her! The shoe does fit on the other foot though. I was in a similar situation and was ripped off by my ex boyfriend. Hope things look up for you!

I was just checking this website out it is a branch off of People of walmart. Most of them if not all are drunk an passed out in vomit or some other "fluid". Frankly it is gross and I saw some pages not the whole site. It was not something that is entertaining. I like funny things as much as the next person but this was just gross. It got me to thinking I am not good with vomit, most others I can handle BM grosses me out too but you just get thru it.

What grosses you out and how do you "make it thru a call"?

I do not get grossed out easily, but when I see/hear someone hack up a big huge hocker, I could puke. I can't stand to see people spit on the ground. When it comes to patient care, I do not even think about it. I performed autopsies over 10 years ago and sometimes I still get a whiff of "dead."

Sounds like it was a seizure. There are many types now days. I started having seizures last July. Both of my brothers had seizures when they were young. My older bro had Petite Mals and my younger bro had Grand Mals. The last memory I had was petting my cat in bed. The next thing, I am in the back of an ambulance. Apparently I went out of the house into the neighbors yard and was witnessed by some constructions guys. They called 911. Before hitting the ground, I was apparently on the phone talking to a friend. She said I was talking "out of my head."

I hate to say bad things about EMS because I am part of it, but the crew that came to my aid told my friend that I must be on drugs. I do have a sluggish memory of hearing people talk to me but I could not see them or speak. On the way to the hospital, I could finally start to talk.

I have never done drugs in my life!!! I actually had a christian tshirt on and thought it was funny that they automatically chalked me up to be a druggie. I do have a long and complicated medical history. I ended up having a couple more seizures with in the next couple of months. The first one, I don't remember anything. The second, I remember feeling "funny" and had a metal taste in my mouth. The third, I was hanging drapes and heard a deafening sound in my head. I thought we were being bombed. I had enough time to sit down and call my Dad to tell him I was going to have a seizure. The fourth, I was in an MRI, I had tremors in my lower extremities and was alert. The fifth, I also only had tremors in my lower extremities and was alert.

I know this is a long story, but I wanted to give as much history as I could. The Neurologist thinks that it may be caused by a severe vitamin B-12 difficiency and stress. I was so difficient that I have suffered permanent nerve damage in my hands and feet.

So, I just wonder if this lady may have a vitamin problem or something is snowballing from her thyroid problem. There is more research out there regarding thyroid disorders that snowball into more. I also have hashimoto's which has snowballed into a half a dozen other auto immune disorders.

I think you did a great job with her. We are not doctors and can only do what we can with the training we have. There are a number of websites that can explain what other types of seizures look like. You can start with the epilepsy foundation and follow some of the other links they may provide.

Thanks for sharing your story! :-) I think you did great!

quote name='jwraider' date='24 May 2010 - 09:56 PM' timestamp='1274756163' post='242542']

OK I'm go to make the title obsolete and say yes it was as this patients LOC changes dramatically about 15 mins after arriving at the ED. She was sitting up and conversing normally with no memory of the event.

Initial dispatch @ 1am: 39 yo female unresponsive by the river at 601.... yadda yadda (The potential causes were going crazy in my mind!)

In reality PT is in a nice RV/mobile home thing in a vacation park in bed with her husband standing there. (Pucker factor went way down!)

The PT is "shaking"... looks like shivering. No major movements of the body just tremors all over. Her eyes are also moving rapidly and randomly in small movements.

Seizure?

Well for some reason I do a sternal rub and ask "Mam can you hear me?" and her eyes stop jerking around and stare right at me until I move away.

I ask the husband about her medical history and he says (no joke): "She ate 15 packets of taco bell hot sauce for dinner". I reiterate the MEDICAL part of the question and get: "Thyroid problems and they think some medication of hers caused fluid to build up in her brain last year". He denies any history of seizures, stroke. but does say she has been feeling "sick" for a few days. He denies substance abuse and everything else I came up with.

Vitals: (And yes I got these during the possible "seizure")

GCS 9 (eyes wide open[4], no verbal noise at all[1], withdraws from pain [4])

HR 100 Sinus Tach no ectopy

BP 166/88

RR 12

Sp02 100% on 02 (BLS on scene already had her on a NRB)

BGL 96 (PT withdraws from pain during the stick, during the "seizure")

Pupils reactive, same size, right size

Skin PWD

So I don't know what the heck is going on because on one side I have no history of seizures, she can look at me, no incontinence, no oral trauma, not hot/warm/cold, no magic wand... So maybe this is a stroke, poison/OD, or some metabolic thing to do with her thyroid and the cerebral edema.

On the otherside she really looks like she is having a seizure and eventually wakes right up in the ED.

So thankfully despite my lack of recognition I'm able to move the call quickly and get her into the ambulance and moving. This is where I notice her body is still "tremoring" but now her eyes have stopped going crazy and she is even moving her head alittle to respond to me. Eventually the tremoring/shivering stops (she didn't feel cold but I turned the heat on so maybe that had an effect).

Still she counts as a GCS of maybe 11 if you say her head movement counts as normal motor/sensory.

So like I said at the ED I go back into her room and she has no memory of the event or me and is conversing totally normal without any complaints. The MD initially thought some kind of ingestion or a bleed. But the common perception after she woke up was a seizure.

What do you guys think? Did I really blow it and let a seizure go on (or repeat seizures) for close to 10 minutes? That's the amount of time it took before her eyes were no longer rapidly moving. I'm very frustrated by this call feel free to offer criticism I want to be better next time.