Bieber

Old topic, but one we're still struggling to fix. Anybody have any experience with cot quilts? (https://www.boundtree.com/cot-quilts-group-9844-177.aspx) Easy to clean? Warm for the patient?

We must be lagging here in regards to this new mandatory BSN stuff because jobs for ADN's are still a plenty around here. Although I did hear that it would be harder to advance without a BSN now.

A mixed system with EMS-based BLS first response along with BLS (EMT/EMT) and ALS (paramedic/AEMT) ambulances as well as Community/Advanced Practice Paramedics and supervisors in fly cars dispatched as requested by providers on scene or according to call type:

Omega: first response only

Alpha/Bravo: first response + BLS ambulance

Charlie: first response + ALS ambulance

Delta/Echo: first response, ALS ambulance, C/APP

C/APP's do Community Paramedic work between emergency calls, ALS ambulances hand over care to BLS units if the patient doesn't require ALS capabilities. Also have some trucks dedicated to BLS/"light" ALS transfers (AEMT/EMT), as well as some critical care capabilities (CCP x2 + EMT) for critical care inter-facility transfers.

Have an ALS:BLS ratio of about 4:10, target highly educated, highly trained paramedics and put them through an intense "on boarding" academy. Six months probationary period under an experienced paramedic.

For vehicles, my picks would be:

Chevrolet Suburban for BLS first response and C/APP's
Type II Sprinter for BLS and ALS ambulances

Type III Sprinter for critical care ambulances

Scrub tops (durable with a radio mic clip sewed on the front), EMS pants. No patches, just agency logo over left breast and name/cert over right. Make the uniforms ANSI compliant (a safety vest you can't forget to put on).

Alpha/bravo/charlie responses, no lights and sirens.

Delta/echo, lights and sirens as deemed safe to do so by crew.

Lights and sirens transport by clinical supervisor order only.

Entry level payscale

EMT: $34,000

AEMT: $38,000

Paramedic: $45,000

C/APP/Supervisor: $50,000

Requirements
EMT: Valid certification. 3 month academy + 3 months probation/field training
AEMT: Valid certification. 3 month academy + 3 months probation/field training

Paramedic: Associate's degree minimum. 3 months academy + 6 months probation/field training.

C/APP/Critical-Care Paramedic: Bachelor's degree minimum and/or Associates + CP/CCP certification and/or Medic + RN. 3 months academy + 6 months probation/field training.

Supervisor: C/APP equivalent or relevant management/administrative education.

Capabilities

EMT: Same as state regs.
AEMT: Same as state regs.

Paramedic: Supraglottic airways only.

C/APP: ETI, (maybe) RSI, wound care (simple sutures), port/cath maintenance, limited dispensing, etc.

CCP: Vent management, IV drips, IABP monitoring/management, etc.

On-boarding academy be a mix of online and in person lectures as well as skills lab and would include:

Medical foundations (bio/A&P/patho review for both BLS and ALS)

Pharmacology review (not just EMS meds)

Protocol/guidelines

Operational guidelines and policies

Equipment familiarization

EMS defensive tactics (something like DT4EMS, not guns and tasers and all that stuff)

EMT's and AEMT's operate under protocols or paramedic direction. Paramedics and up operate under guidelines with options for alternative care pathways available to them. C/APP follow-ups for high-risk refusals or patients targeted as "at-risk" by call review or internal/external providers.

12-hour shifts rotating between busy and slow stations every month.

An X-box and a copy of the original Star Wars trilogy in every station.

I joined up!

Actually I think that you do need to start from Scratch unless you have taken A&P and the pre-req classes that we have all argued till we are blue in the face. Do you think that a medic in the field for 10 years should be able to bridge without those classes?

Here's the link to a paramedic to RN bridge program pre-reqs. Unless the student has what is listed, then they should have to get those completed prior to entering the bridge program. http://www.ccbcmd.edu/nursing/Prerequisite_-_PMtoRN.html

More info - http://catalog.ccbcmd.edu/preview_program.php?catoid=1&poid=237&hl=Paramedic+Transition+Course&returnto=search

Maybe we are thinking the same thing but articulating it differently.

I think our perspectives are going to differ on this mostly because we already have to take most of the same pre-reqs (including A&P) to get your medic here; I would agree for places without a degree requirement for medics that having those pre-reqs is appropriate and vital to bridging.

Absolutely correct Chris, the evidence is anectdotal at best. What would be a landmark study for EMS to RN bridge programs would be a cross sectional study of all that you mentioned. I've been told by numerous nurses (all were traditional RN trained) that many have worked with paramedics gone RN via bridge programs and their competency was somewhat questioned by many of those nurses.

I have even talked to nurses who did the bridge program from paramedic and several of them have said that if they had it to do all over again they would not have chosen the bridge route.

Again, it's what you get into it and how you apply yourself to the courses that is what makes or breaks the person and their education/competency.

The cross section of nurses I've talked to have been from across the country during my work in implementing electronic medical record systems.

Like you said, anecdote is anecdote. Still, it's interesting for me to hear opinions on medic to RN programs and experiences from people in other parts of the country because everyone I've ever spoken to here who has gotten their RN has basically the complete opposite opinion of it in terms of difficulty, educational value, etc regardless of whether it was the bridge format or traditional route.

probably already been answered but it goes back to the zero to hero mentality we have in EMS. Why do it the hard way when you can actually do it the easy way and these programs make it easy for medics to go to RN school even though like someone already said, they have not heard many good things about medic to rn bridge.

But that's just my humble opinion.

What's wrong with the bridge program? I mean, we don't really think that a medic needs to start from scratch with an RN program, do we?

this.

and the union bashing on this site if incredible. I guess people like min. wage. Fire based, single role paramedicine is the way to go. You have the resources (union) and the respect to get it done. Or any public servant position---be it county etc.

Yeah, what Mike said: the IAFF is terrible for EMS as is the fire service in general. Fire has no more place in the business than a dual-role plumber/RN.

Oh, and I don't have anything specific against unions, just the IAFF.

Let's define this a little better. What are we talking about when we say a bridge program? Are we talking about something that provides credit for classes taken for EMS education and knocking those off of the required coursework for the new pursuit? Something that is shortened based on previous experiences? Or an online program similar to what Excelsior College does?

It's a dichotomy for sure. Support for the overall advancement of a profession (big picture) or improving your personal situation. At the end of the day I would never fault somebody for choosing to improve their personal situation particularly if family, children and major life changes are involved. It's easy to preach big picture stuff when you are in a good place. I do it all the time as an educator and it certainly makes me a hypocrite. Also, nursing isn't the holy grail of job opportunities and higher educational standards that many people believe.

I agree with you 100%.

Artickat, you're right about that.

And it will continue to do so unless the group as a whole steps up and takes ownership of your profession...otherwise you'll continue to have TV commercials of nurses working in an ambulance like that one Johnson & Johnson put out.

Chris, we're in a good place now because a few dedicated individuals sacrificed the blood, sweat, and tears for years to get us to the position we're in now rather than take the easy path out.

If the overgrown path were traveled more, it would be easier to take.

Artickat, you're right and we as an industry need to try to advance ourselves. I will say that I do think that the bridge program is appropriate here, in my location, in my personal opinion. I don't see any problem with it as far as competency goes.

It baffles my mind. We had the same issues in Canada, until some very smart people managed to figure out that we can't have people do things for us and expect good outcomes, and started the ball rolling. Rather than jump to another profession, why not start improving the value of yours to the point that it's got good wages, less stress, improved hours, and an education sufficient to meet the needs of the public?

I would like to see that happen as well. At the same time, my perspective isn't the same as others and when you can easily bridge over to RN and make more money with fewer of the problems you experience working EMS, it's a tempting offer that has lured away from us a significant number of competent paramedics.

Can someone please explain why EMS-ers are so interested in "bridge" programs?

Low wages, high stress level, and uncertain or erratic schedules make traditional schooling difficult to commit to as well as to pay for.

I'm planning on doing the medic to RN bridge through one of the colleges here that does it in an online format. A lot of the medics around here have gone through it, though their opinions of the RN program have been mostly negative. A lot of them work PRN at the hospitals now, and actually the ER's seem to prefer Medic/RN's.

Addendum: Just for clarification, the complaints with the RN program have been more with the RN education in general, not the bridge specifically. Medic/RN's around here don't have a lot of positive things to say about RN school regardless of the format (traditional or bridge).

I seriously doubt that deafness was the culprit as much as being postictal. Had he been able to hear you, I doubt the situation would have changed. In the future, get enough resources on scene so that you can PROPERLY restrain the patient. Sitting on the patient does work, but it puts you at serious risk for injury from the patient or a vehicle accident. You can not do proper patient care if you sit on the patient for the ride. Even in the most rural areas, law enforcement is usually available to assist.

This. Unless you have another reason to think that the patient is normally violent, he was most likely post-ictal. Restrain him and let him come around and then attempt communication.

I would have a conversation with your boss first. Rookie Paramedic and Rookie EMTB ????? That is not only stupid, it is dangerous.

Dangerous? That may be a little too much. Depending on the system it could work just fine.

Patience, I think one way of finding the balance between achieving your goal without stepping on any toes is to simply let your partner know what you need done, and then allow them to figure out the best way (for them) to meet that goal. When I'm working with someone new, I just try to ask a lot of questions about their own current experience, what they've done, what they haven't done, how it worked for them and share my own experiences using my own approach to similar problems. Without some more specific examples of where your frustration is, I can't get you much more specific advise.

The only thing I keep in my first aid kit is a cell phone. That way whenever I see an urban outdoorsman napping on the side of the road I can tell myself "I'd better call it in, just in case". I try to only do this when I'm already late for an appointment however, that way I can justify not stopping to investigate myself.

Seems like an expensive alternative to changing out compressors frequently, keeping interruptions to <10 sec, metronomes, eliminating non-critical (defibrillation) tasks on cardiac arrests...

Just my $0.02.

Speaking of cpr, what is anyone's thoughts on the "new" process being taught by the AHA? If I understand it correctly it is soo easy to do by the average citizen. I am just not familiar with it yet. Hoping to take lessons within a couple of weeks. There is no certification involved for the average person, but it may at least keep things flowing for the patient til EMTs can get there.

We've been using compressions-only CPR (at least for the initial 6 minutes) here for a couple of months with tremendous results so far. We've also stopped pausing compressions for anything other than rhythm/pulse check and defibrillation and eliminated the requisite for advanced airway placement even later in the code.

It's good stuff, I'm glad the AHA's pushing it on the lay folk, but I'll be even happier when they push it on professionals as well.

We use the auto pulse with good results when the battery works. Had some issues initially but once we instituted the correct battery maintenance we are having better luck. When you have limited personnel and long (greater than 20 minutes)transport they are very helpful. We have had a couple true saves (patient left the hospital) but size of the patient can be an issue. Re your discussion regarding hands-only CPR.. great for lay folks but for providers we should still try to get air in AFTER good compressions are started.. From my research it is emphasized that we need to get those 0's moving as quickly as possible.

Did you mean "get those O's", as in oxygen, in as quickly as possible? I haven't read any research that indicates anything other than passive insufflation is needed in the setting of cardiac arrest. What have you read?

I haven't been in the situation so I can't say. I would hope that I would do the RIGHT thing (right for myself, right for my family, and right for my patients), but I haven't been there yet so I can't say. Like everybody else, I'm just as susceptible to making the emotional, WRONG decision myself...

I was going to look into having a culture done of some of our equipment and ambulances (including the wool blankets), and we do also stock some of the disposable sheets (I agree, complete crap). Unfortunately there doesn't seem to be much in the way of insulated disposable blankets for a reasonable price. I'm going to ask again about the exact situation with the hospitals, and ask about contracting a linen service ourselves.

Island, can you tell me more about your time in NH doing your own laundry service? Do you recall how much it was to hire a linen service?

Scuba, on the bright side that would make our hypothermia protocol easier to enact. =)

Thanks everyone.

Every place I've ever worked has swapped out bath blankets at the hospital.

Is the hospital making noise about cutting off access?

Pretty much, yeah.

Hey everyone,

I'm looking for ideas on blankets. Currently we supply a couple of wool blankets that are reused (washed sporadically) as well as a number of bath blankets that we trade out with the hospitals supposedly on a one-for-one basis (the reality is we're probably losing blankets). Well it sounds like the bath blankets are going away, and I'm trying to find alternatives.

I've only really found one disposable insulated blanket (http://www.buyemp.com/product/insulated-disposable-blanket) online, and at $100 for 18 of them, that's gonna add up quickly (conservatively... VERY conservatively), if we as a service only use 18/day that's $37,595 a year...

So I'm looking for some ideas. How does your service stock blankets? Do you use reusable ones that you trade out with the hospitals? Disposable ones? If disposable, which ones? Does anyone use a linen service to wash your own blankets separately from the hospitals? Anybody do the washing in house?

Thanks.

Pads are on and monitor is synched! Before we shock, is there any reason you can think of why we would want to delay or defer cardioversion of this patient at this time? (Not a trick question.)

Lead 2 shows a regular complex rhythm with a QRS of 150 ms, no discernible P waves, and a rate of about 210.

Finally, you're able to obtain a blood pressure of 84/58. Patient is being ventilated via BVM without difficulty, SpO2 is about 85%.

Nearest hospital is about 10 minutes away, full services.

You've got it, another ambulance is en route.

Patient is full code.

Staff says they think she was okay yesterday, but they're not sure.

Basic history of COPD and CHF.

Pulse is dubious. VERY dubious. Nobody's been able to definitively find one yet.

Patient gags when the OPA is inserted, however she tolerates the NPA. No resistance to bagging.

Patient has been sat up! Still not responding. Medical records are in the room, what information would you like to have?

Airway - Patent, no vomitus or obstruction.

Breathing - Shallow respirations, very labored and rapid at about 35 resps/min, lung sounds are diminished with barely audible rales in all fields. Perioral and peripheral cyanosis present.

Circulation - Skin is cool, pale, diaphoretic. No trauma or bleeding. Pulse is difficult to locate due to size of the patient.

Initial GCS 3 (1/1/1).