Bieber

Kiwi, our training department is somewhat useless when it comes to getting us OR time for tubes and stuff. I might be able to get an airway mannequin--failing that, I know the directors of the two local paramedic programs that I was thinking of hitting up. And yeah, I know, I'm torn up about it but logically I know when I've only been getting the opportunity for a tube once every other month there's not a real easy way to stay proficient in it. Still frustrating, though. Island, thanks for the kind words, man. If I was honest about it, all my recent airways have been kind of junky and not the most ideal. The most recent one I was sitting too far to the side (should have asked fire to move so I could sit directly in front of the head) and another one the patient started coming to (NOBODY should have attempted a tube after that; but you can imagine how that went). As far as necessity, none of them have been vital (all code blues), but it's still a bit of a pride thing (I know, stupid). Dwayne, I got about 29 tubes during clinicals, 5 during internship, and one since I've been on the field. So out of those 35 successes + the last four misses isn't a tremendous percentage, it's just that they've pretty much all been in succession and they've all been since I've gone full time. I guess the most frustrating thing is that our supervisor shows up on pretty much all of our code blues, and he's VERY tube aggressive, and because of that he's had probably about twenty tubes this year and is pretty damn good at getting them. It's a little frustrating having him always shows up because there is that pressure to get the tube before he swoops in and snatches it up. NY, I don't think I'm freezing up necessarily, but like I said there's definitely added pressure to get a good tube since I don't have a great track record since I've been working with my regular partner and supervisor and the latter is always going for them tubes. Thanks for the words, everyone. I'm gonna work on getting a mannequin or some OR time or something.

So out of about the last five intubation attempts I've had I have only successfully intubated one patient. My last tube attempt before tonight was at least 2+ months ago. Tonight I completely blew it. I can't successfully intubate. I need more attempts, more training, or more something because this problem isn't solving itself and I'm starting to get really depressed about it.

I'll echo Dwayne, Chris, and Mike's sentiments that online classes take a lot of self-discipline to stay focused on, and I think that in general doing online education requires more self-study and self-motivation than a traditional classroom, but I'll also add that I have had great luck with online classes as well (in fact, my BSHS in paramedicine is all online, seeing as I'm taking through an out of state university). It all depends on you and how well you do in online classes. Speaking of which, I should probably be working on homework right now instead of dicking around on here...

Driving, lifting, vitals, setting up IV's, ventilations, CPR, history taking, hemorrhage control, splinting, wound care, suction, applying ECG electrodes, carrying equipment, history taking, blood glucose level acquisition, supraglottic airway placement, etc, etc. That may not seem like much, but those are all things that free paramedics up to perform invasive procedures, conduct an assessment, etc. And I'm not saying that EMT education doesn't need a major overhaul, but I'm saying, we've got to be careful that we're not just adding to their skills, because in all honesty we don't want too many people in the system who will be competing for IV's, tubes, chest decompression, and all those other advanced skills that take practice and repetition to remain proficient in. I would say that in a system with only two levels of providers (basics and advanced), we want to increase EMT education more than anything, and maybe throw IV skills in there as well. That's just me, though. Addendum: I guess what I'm getting at is that I don't think we have a skills deficit in EMS, if anything I think we're moving towards skills oversaturation. What we have, more than anything, is an education deficit--and it's certainly not limited to EMT's.

Stay in class. Finish the fight!

I can't agree entirely with the concept of a single-provider system, however I agree with you on point number 1 and will say that I believe, for the sake of the public's ease and to help establish a professional identity, that all EMS providers from the EMT level up to Paramedic should be renamed simply paramedic for ease of use. For industry reasons, I would advocate for affixes that indicate their particular level of education (i.e. Basic Paramedic, Advanced Paramedic). As for your second point, I can't venture to guess what the public's perception would be if they knew more about ambulance staffing models, but I will say that our principle job is not to appease the public's perception of what adequate medical staffing is (because, in all honesty, the layman does not know what an adequate medical staffing model is), but rather to actually provide adequate medical staffing. There is little to no evidence that an all ALS system improves patient outcomes and in fact evidence that suggests that a paramedic/EMT staffing model provides just as adequate (and possibly better) outcomes than dual medic units. In my humble opinion, I think that we should adopt an EMS educational system similar to that of some of the commonwealth countries, with a Basic Paramedic (2 year Associates degree) and an Advanced Paramedic (4 year Bachelors degree). And maybe something like a Critical Care/Community Health/Advanced Practice Paramedic (Masters degree) as well.

Jim, thanks again for the response! I love hearing about the way other people do things and seeing what works for them.

Yeah, I've played ME3 till the end. It was disappointing, but it didn't ruin the game for me. It's still awesome and fun--up until those last five minutes.

Amazing. My first full time partner and I have been together for about nine or ten months so far. He's awesome. He recognizes that the operations side of the job is my weakness and has worked hard to teach me what he knows and build me up to being able to work independently as the lead paramedic on the truck (which I finally did for the first time last night, working with a part-timer). He's got about eleven years of experience and though you can tell he's starting to get a little crispy around the edges, he doesn't let that interfere with his patient care or with his teaching me.

I play the XBox 360. Assassin's Creed, GTA, Red Dead Redemption, The Elder Scrolls, Mass Effect, COD, Battlefield. I've been mad addicted to the Mass Effect trilogy lately.

Wolfman and Wendy, thanks for sharing! It's fascinating to see the differences in work structure across such great distances and healthcare environments. I'm always curious about other EMS and medical systems because really my service is the only one I've ever experienced and it seems like in some ways we do things very particularly when compared to other systems (from what I've heard from you guys and other healthcare workers).

Hey man, welcome to the forums. Unfortunately, I don't think we'll be able to give you an exact answer to your question here--the best thing you can do is to contact your local regulatory EMS office and speak to somebody there about it. They'll have an answer for you.

Kiwi and Rock basically nailed it. With seven months of training, I wouldn't expect to truly learn a great deal about how to be an autonomous, clinically-minded practitioner of medicine. I would expect you to race through anatomy and physiology, cover the bare surface of pathophysiology, pharmacology, etc, and focus on skills and immediate, protocol-based responses to symptoms independent of a deeper look into the underlying pathophysiology of the disease process causing the illness. Aspirin and nitro (x3) for chest pain (let the machine interpret the 12-lead ECG); albuterol for difficulty breathing; CPR, intubation and copious amounts of meds for cardiac arrest (remember, the tube and the drugs > chest compressions); something about pain meds but they better be "really hurting"; Benedryl and epi for anaphylaxis; scoop and run on trauma. High flow oxygen, IV and transport for everything else. That's about it! P.S. Not trying to be a dick, man, but you're going to get out of paramedic school what you put into it--and you just can't hope to gain a lot of education in seven months time. My real advice would be to say fuck off to the seven month program and go find yourself a good, Associates degree conferring college-based program that takes its time to truly educate you on the things you'll need to know. Don't do yourself a disservice by skimping on your education--that's not the kind of guy you are, right? Something tells me if you care enough about EMS to spend your free time on EMS forums, you care more about this job than the average hosemonkey. So care enough about yourself and your education to not take any shortcuts.

Chris, I agree with you on everything that you said, and it's unfortunate that we in EMS have begun to define ourselves by our skills (or maybe we always did?). While I wouldn't necessarily be opposed to paramedics being able to delegate certain skills to other providers under direct supervision, there should a safety net in direct supervision and delegation in that the decision making remains firmly with the paramedic, and unfortunately that isn't the nature of this tendency for skills creep--rather, intermediates are being given greater autonomy, greater skills, and greater independence without the necessary education to support that additional freedom. It ultimately comes down to this: when paramedics barely have the education to perform the skills they are allowed to (and in many parts of the country, they don't even have that), the notion of intermediates being given similar freedoms is frightening and has disconcerting ramifications for patient care--and downright terrifying consequences for the future of EMS education and professionalism. Sorry to go off on that tangent, and I'll leave my views on intermediates at that. FireEMT, like I said, there is a tremendous difference between an intermediate and a paramedic. And I'm not particular about protecting or sequestering the term "paramedic" for use only by ALS level providers, only about ensuring that the differences in the level of care are respected and recognized--whatever the terminology--because anything less disrespects and diminishes the vastly greater education paramedics hold and simplifies our entire profession into a question of who can do what skills; rather than focusing on what we know and what we've proven we know (or should know), which is the mentality we as EMS providers should be striving for, in my humble opinion.

A paramedic is not defined by the skills they can do, but by their knowledge and the level of education they have attained which, as inadequate as it tends to be in the majority of the United States, is still substantial compared to that obtained of an EMT-Intermediate. Now, I wouldn't complain if we abolished the term "EMT" and renamed it "paramedic" and clarified the level of care as an addendum to the title (if only among ourselves)--i.e. Basic Paramedic, Intermediate Paramedic, Advanced Paramedic, etc--but as it stands, the way we distinguish the two is with the classical nomenclature of EMT(- , (A)EMT-I, and (EMT-)Paramedic. Should there be noted differences between the two? Well, yes, because there ARE noted differences between the two. Sorry, man, an intermediate in your area may be able to perform all the same procedures as a paramedic, but they're not the same. I say this as someone who was once an EMT-B, an EMT-I and who is now a paramedic. The amount of education (at least around here, and granted, Kansas requires an Associates to become a paramedic but I don't believe we're light-years away from the rest of the country either) is on a completely different level. Like I said, I don't care if we rename all EMT's "paramedics" for ease of use and for the general public's sake, but to imply that there is no difference between two providers because they are allowed to do the same skills shows a complete lack of recognition for the fact that we are not what we can do--any monkey can perform the skills we do; hell, a child can intubate. We are what we know and what we have proven we know. Not trying to be a dick, man, and if I misunderstood something you said then please let me know and I'll redact my reply, but the impression I'm getting from you is that you think the ability to do the same skills makes an EMT-I the same as a paramedic, which couldn't be further from the truth.

Thanks for sharing that, Kiwi!

Hi everyone. So, for those of you who don't know, at my service we have a pretty rigid rank structure (stupid, but that's a debate for another time). Anyway, the gist of it is that every ambulance must have a lieutenant (2+ years FT, plus passing a test, interview, etc) or an acting lieutenant (paramedic in good standing, generally 18 mo FT exp.) on it. Because lieutenants and acting lieutenants must be paramedics, non-lieutenant paramedics ("techs") who cannot act as lieutenant also cannot work with part-timers or EMT's. Lieutenants (and acting lieutenants) are technically in charge of everything that happens on the truck; principally with regards to operations issues (i.e. in charge of running incident command during an MCI or multi-patient incident, figuring out what to do if something breaks, if there's a crash, ensuring adequate supplies, etc, etc), but also technically with regards to patient care as well (i.e. if something is about to go wrong, it's the lieutenant's responsibility to prevent it; and if something DOES go wrong, it's the lieutenant's fault for not preventing it). In theory, every truck in the service should have a lieutenant on it, and acting lieutenants should only be utilized when an LT is sick, on vacation, etc; in practice, we've had a moratorium on lieutenant promotions for almost a year (as we go through a ton of organizational changes) so we've ended up with a bunch of "dual tech" trucks with acting lieutenants running the show on them. Also, we've got so many people gone on any given shift (and numerous open positions), so people who can "act" are invariably shifted around to ensure adequate lieutenant/acting lieutenant coverage for all trucks. Anyway, long story short, the Biebs' time has finally come, and I am finally cleared to "act" as a lieutenant. What this basically means that from now on I am cleared to work with part-time paramedics, paramedics with less seniority than me, and EMT's. Being that my service is the way it is, I have never, ever worked with anyone other than a paramedic, nor have I ever worked with anyone with less seniority than me or a part-timer. Now that I can act, it means that my regular partner and I will be split up often so that they can use me to maintain adequate "lieutenant/acting lieutenant coverage". My partner is going to be acting captain (division supervisor; 2 per shift; ride around in Suburbans doing supervisory shit) this weekend and Friday and Saturday will be my first shifts acting. I'll be working with a part-time paramedic who was in the class after me, but looking ahead I'm also scheduled to work alongside an EMT next Tuesday (on a shift trade that I can now do, thanks to being cleared to act), and a couple more days (unknown who my partner will be yet) near the end of the month. So! Your mission, should you choose to accept it, is to share your thoughts, experiences, opinions, etc with me with regards to serving as the lead paramedic (if your service has such a thing) OR working with an EMT on a paramedic/EMT truck and on EMS ranking structure in general. First, tell me about your service. Are you let free to work with whoever in whatever capacity as soon as your paramedic cert is printed, or did you have to work alongside a senior paramedic initially? Who was your first partner? Medic? EMT? More or less experience than you? Do you have any sort of hierarchy on your trucks or are both crew members considered equal? What kind of system do you prefer? What is the certification level of your current partner? Personally, while I think that as a new paramedic it's helpful and probably good to work with a more senior paramedic initially, I strongly disagree with the notion of having one paramedic in charge of another. I feel that patient care should be a team effort, and that establishing "ranks" (even if in practice they're not utilized--usually) is not particularly the best thing. Dwayne knows all about my frustrations of being overruled by another paramedic--even on my own calls--as well as my frustrations with wanting to be "thrown to the wolves" so that I could make my own mistakes and learn from them, without being stiffened by a senior paramedic who may simply have disagreed with my treatment plan (regardless of whether or not it was correct or simply not the way they would have done things). But wait! Don't think I'm leaving the nurses, physicians and other healthcare practitioners out of this! I want to hear from you too! Tell us about the rank structure (if one exists) at your healthcare setting. Obviously an attending overrules an intern and a charge nurse overrules a nurse, but something tells me that you folks who actually work in that setting can elaborate on that a hell of a lot better than my meager simplification. Anyway, sorry about turning this into a novel. Please, let's hear from you!

It's happened to me before. A fluid bolus sometimes helps.

Sorry, but that one made me laugh. Is that what they're advertising now? 'Cause I recall watching a video, taking a test, and then driving an ambulance around some cones in a parking lot in about a day's time.

Question, then, why was a non-health professional sent to a medical call? Addendum: Not trying to be facetious, it's a legit question. I mean, you don't fight fires with an ambulance and you don't chase bad guys in a firetruck.

Thanks for the reply, Jim. Out of curiosity, is there any particular reason why you always transport on the cot? Is it a company policy? Thanks. Also, a question for everyone, how often do you utilize supplies from your bags on calls? Obviously we're all probably taking blood pressures, sugars, and ECG tracings on scene when appropriate, but what about other supplies? I know that the vast, vast majority of supplies in my box are never used 80-90% of the time. What about the rest of you?

Don't feel too bad, I'd've bailed out. "In other news today, a paramedic dies after jumping out of a moving ambulance. The ambulance was transporting a patient at the time, who stated that the patient made his suicidal escape after discovering a spider in the patient compartment... Later, ambuspiders, and what they mean for the future of mobile healthcare."

Going to see it today!

Around here, all of our firefighters are trained to the EMT level and as such as allowed to ventilate patients using a BVM. Perhaps the paramedic was keeping an eye on the monitor or managing some other aspect of patient care. Would I prefer to be bagging the patient? It depends on what other priorities are present and my own assessment of where I will be able to provide the most effective care. I get where you're coming from, and I share your sentiments about the IAFF, but unfortunately we can't know when we're going to be behind the camera lens and we've got to make decisions based on what our patients need, not necessarily what makes us look better than fire. Stressing the importance (IMHO) of EMS-based EMS comes later.