FDCaptainMedic

All too true! I don't know about your area but here abouts we have to deal with the "professional" instructors that either have deep pockets, or their agencies paid for all their Instructor programs, and they eat you alive (personally, or through their agency) with fees to be an Instructor as well or will not offer the Instructor courses local so that you must travel further away to obtain the course. Then comes the dilemma of added expense and time. Once you acheive that you must then teach X number of classes each two or so years to remain active and in a rural area that is hard to do, especially if you have several discipline Instructor certs to maintain. But, it does saves all the regional money for them. However, the down side to that is that they often develop that frequently seen medical condition called PIA ("Professional Instructor Attitude"). Sadly, this also incurs additional fees which are necessary to take care of the need for redesigning the top portions of the door frames to allow them access to the classrooms. Sometimes this creates a secondary side-effect symptom of PIA of being stuck with a "professional" instructor(s) in an area that is/are more "book smart and field stupid." There is an old saying I have heard in the fire service and EMS for many years....those that can't do...teach... Now the disclaimer...that is not always the case as there are some very fine Instructors and Trainers I have learned from in 30 + years...but there is that secondary side-effect...

I suppose if I was in it for the money that would make sense....however, I try to do it to help make our rural system better. I like my way better... If the little agencies will get together for the class, and buy the books (and card fees if applicable) I'll teach the classes for free. And the program makes their money off the books and fees. I have done that for years and I know there are probably many others out there that think the same way. Most small rural agencies can't afford hundreds of dollars for books for these courses AND hundreds more for Instructor(s) as well. Maybe that's one of the reasons the rural areas are so often behind the curve on being able to obtain the training programs that the bigger communities and cities take for granted. HMMMM....decision time...let's see....pay hundreds for books AND instructors for that course the want to take...or....buy some new PPE, equipment or medical supplies for the volunteers....HMMMM....such a tough choice....

Years ago I stumbled onto the biggest scam money maker in EMS...become an Instructor!!! (i.e. AHA, NAEMT, etc, etc, etc) There needs to be a more standardized system for Instructors, such as a clearinghouse system, that does not require you to pay exorbitant fees to have to be classified by EACH independent body...even for their multiple disciplines. NAEMT and AHA are the worst of all of them. If you want to teach PHTLS...pay for a Provider AND an Instructor course...AMLS...pay for a Provider AND ANOTHER Instructor course...EPC...pay for a Provider AND ANOTHER Instructor course. Ditto for AHA NAEMS has at least figured this out as they will recognize other courses, such as FI1, to meet their reqs and let you go ahead and test. Every time you want to get an Instructor rating from some other "specialty" course you must pay much, even hundreds, of dollars to attend the same xerox copy "how to teach adult learners" courses. The only difference between the "Instructor" courses is the logos on the PowerPoint and the paperwork...which is also so similar it's ridiculously humerous. If you live in a very remote area like I do it can cost a fortune for travel, rooms and meals. And the rural areas is where the Instructors and courses are really needed. If you have taken the Provider courses (more money), and have the level of certification necessary, already instruct other disciplines you would think that a better system could be designed. AAOP is the only one that has made it reasonable to gain more instructors and in turn get their PEPP courses out. Be recommended, take a free online course/test, and start teaching. It's not like we're trying to reinvent the wheel here people! And it's also not like you need to have a M Ed to understand how boilerplate Powerpoint courses work!!! Even Paramedics can figure that out..(though we may need a Basic to show us how the projector works!!!) . Until they realize that the very folks trying to get their programs out are the ones getting gouged the worst this is not likely to change. So....who has some ideas how to break this squeaky wheel with spokes missing?

With the availability to utilize so many different airways now I believe we will see the end of intubation in the field very soon...and its death knell has already sounded in many areas. Many will scream to the bottom of the fall about it...but the reality is... the quality of airway maintenance with the King or LMA really precludes the necessity of intubation in the field. I have been "tubin'" for years but there are times, especially now that I have RSI (and in some areas RSA - the "A" being for airway, which ever is used) is becoming so prevalent that unless a medic works in a very busy system where they tube all the time, the skill is easily lost. And we all know how diligent every medic is about keeping up their skills My personal policy in the field (and my company's, as I own a small side EMS company that does Special Event EMS) is if the tube isn't hit first time go to a King or LMA and be done with it. This is especially true in cardiac arrest situations. Here, we have been using CCR for many years, and the most valuable lessons are saving time and concentrating on the basics. Much valuable time is wasted in a code if medics are more concerned about "gettin' the tube" than keeping up good compressions and appropriate electric/drug therapy. I only use the King LTS-D's as they work very well, they're easy to insert without the necessity of multiple syringes to fill lumens, take up far less space in a tube roll, and they can also be suctioned through. And, if you get the chance, get your medical director to let you do a field study, only if you have capnography, and set it up so that you can evaluate the oxygenation of both airways (King and intubation). Then compare the ABG's when they arrive at the ED. You will be quite surprised at the results and may also make you rethink the "necessity" of keeping intubation in your system. Sometimes we have to evaluate when some of our skills are more ego than practical. I'm sure that that will upset some of my fellow "old timers!"