NYCEMS9115

Its a delicate matter and it will take years before something like Degree only Paramedic Programs. If there are changes; I hope its to the right direction. I know we all can agree on that...

Prmedc. Unfortunately, you experienced something that shouldn't be. It was the people involved not the degree. School only benefits a person. Its like saying a seasoned EMT or EMT-I can be a Paramedic based on experience. On paper the AS and BS in Paramedics is great. I have it in Paramedics. I've been Management since 2006. I was able to get a Management Position at a new company due to my degree and experience. That will seperate me from a Paramedic with just experience. It may not make better Medics but it makes the Medic able to transfer credits to other Science Degrees like Nursing. We insult the Paramedic. Referring us to drug addicts, blue collar, plumbers, etc. We are that if the individual is like that. They're some like myself who respect the job or profession. Its people who've made what EMS is. All the negative comments one has is because of bad experience. On paper the degree Paramedic is better. We can argue all points. Look at the RN, NP, CRNA with ASN, BSN, MSN, PhdN Degrees. It took hundreds of years for Nursing to be what it is today. If we don't fix or improve EMS; we will remain stagnant and considered a hobby. If you want to be a doctor; you have to get your BS/Pre Med, pass the MCATS, then get accepted into Medical School, Greduate, get into Internship Program, then to Chief Attending, finally to Fellow. This is a process established to become a Doctor. So Paramedics need to develop a process beyond a HS/GED. The Degree for the Paramedic only helps; it doesn't hurt. One without can hurt. If you want to be Director of EMS; most require a degree. If you want to be the Dean of an EMS Program; most if not all require a degree. If you want to be an Executive for Ambulance Company; many require a degree. Chief of EMS; most require a degree. Degrees don't make the profession; the person does but with the degree; that person's job is recognized as a profession. EMT-B/I/P's are not consider a profession; its a job. Degrees will change that. You may be gray when that happens. So keep working, pushing, striving to be the best Provider possible. Lobby and write to your elected officials. I know we all want EMS to reach unlimited success. I know I do....

Ridryder 911, I agree with almost everything you've said. I've been saying that for over a decade. That being said; I don't believe insurances will pay more: regardless of who's on the ambulance. They pay for the ride not the care. No itemized payments. The US HHS hasn't increase the Medicare and Medicaid rates in years. They've enacted policies to make it harder for ambulance services to get and retain money. On audits they'll take the money paid to the service if mileage, times, & signatures with printed names are not on the paperwork. That's why Managers like myself reprimand all who do not comply. They just passed a policy where the mileage must have the decimal tenth on the mileage too. If not; they'll round it down and take back partial reimbursements. I'm just saying...

I believe protocols need to reflect the needs of patients. We're hearing a lot on TBI and the NFL has big rules on Head Injuries and not allowing a player to come back until he's thoroughly examined and cleared. In NYS, we have a click it or tic-ket slogan to prevent MVA deaths; so why doesn't NYS/NYC push for helmet or ticket laws. We know the cost to treat TBI is staggering... I've heard from one MD; that's right, one MD who gave a CME lecture on TBI at NY Weill Cornell; he was the Chair of Neurology at NY Columbia Presby. He was surprised that we couldn't give Mannitol; he believes & studies have shown its a great edema reducer & for the TBI pt with increased ICP; it works wonders; it is a mainstream medication. This lecture was given 9/10. Also, reverse tredelenberg also helps to lower ICP. I've done 8hrs CME on TBI after that one and each one MD who gave the lecture said the same thing. I've relayed lectures from these CMEs to NYC REMSCO; they haven't responded neither. I requested Mannitol to be in our head injury protocol and the notation about placing the pt into a reverse trendelenberg for moderate to severe TBI pts. It has been 2 months since I've sent emails to the region. That being said; Mr. Woo, I hear you and I am also fustrated w/ NYC REMSCO. I agree that they do little to hear what providers say. Its a sad time in NYC EMS. See: http://emedicine.medscape.com/article/433855-overview Updated 11/1/2010, so its pretty current.. We as EMS providers can guessimate the CPP. We can formulate the MAP by: (2x diastolic + systolic) / 3.... If the MAP is low (normal 70-110) then the CPP will be low. MOI and S/S will let you know that there's a TBI. Mannitol must be given; it takes 2-8hrs to work. Dose is 0.25-1g/kg q 4-6hrs. Its pricey but so are the cost for TBI pts....

What I like to see change is; I can only speak for NYC, there must be brotherhood and sisterhood. There has and is still anamosity towards fellow EMS/PHC members. Why? We must get along, shared ideas, and co-exist. We don't have to break bread with one another but we must respect each other. Even on the forum; many do not respect each other. Its I'm better than you mentality. Do we need a disaster to honor each other? Let's get along. Let's respect thy fellow EMT... This is one of the things I would like to see changed in NYC EMS and EMS as a whole... Happy New Year, EMT City Members...

Unfortunately, medicine is a practice. You can never get everyone to agree on the same thing. I believe something; others may dispute. Science based studys are only thing that changes the practice of medicine. Ideas are things that starts a study. Every practice must use education, continuing education, protocols, guidelines, experience, & discussions to make medical disicions. This is what we all must do; sometimes it can be the wrong dicision. Mostly, due to the misunderstanding of the science. You will meet resistance and bias because you have ideas. Be prepared. See many posts; how members get rediculed because they have different ideas. Go for it. Good luck.

Yes, the snow was nice to watch with a cup of hot cocco, sitting by the fireplace.... I am a Manager at a Private Company in the Bronx, NY... I had to go in because I had several units stuck; lucky I have an X3.... Hospitals wanted patient discharged during the storm; demanded it.... I had a crew stcuk the whole night by Montefiore North.... Nothing anyone could do; I had another unit go with the shovel to try to dig them out; no luck.... Nothing was plowed; nothing.... I can't blame one person for this snow; other than mother nature.... The Mayor is to blame because he's the Mayor... If the allegations are true that the NYC Dept of Sanitation Brass ordered workers to start late, skip streets, take long breaks, etc because of labor disputes with the city; then those involved should be terminated; pension voided, and healthcare suspended, and all perks one receives when they leave sanitaion, gone. This was uncalled for; this explains why the street to my garage wasn't touch at all; not until 2 days later. Ridiculous ppl will do this for personal gain.... FDNY EMS kept calling for mutual aide during the storm... A call the day before; maybe I could have helped; not the night of.... This may change NYC/FDNY EMS's tune; to charge non FDNY EMS 911 Units $72,000 a tour come 1/1/2012... This and other reasons made me leave NYC. I live in Orange County NY; they had the streets done later that morning and afternoon.... Streets were drivable come Monday noon... The Bronx at that time was still buried. I had patient's street, sidwalk, walkways snowed covered. Their appts cancelled as a result. Thousands of dollars was lost due to the snow on that Monday alone. So kudos to NYC Dept of Sanitaion for the stunt they'd pulled to hurt everyone in NYC.... THANK YOU...

I totally agrre with the change.... I hate having to be on hold with the MD.... I concur; good luck with this....