678 Responding

I gotcha covered. Here is that link. Legal action against NJ EMS Services.

Hehe, this is like opening a can of worms. It all depends on what you want to know, some places are great to work, other are on the "less desirable" list. Basics and Medics usually make a lot more than the national average. The wages already stated here are pretty much on the money (no pun intended). There is a mix of volunteer and paid BLS squads all over the state, with ALS being 100% paid and from the hospitals. It has it's good and bad points obviously, but no system is perfect. All ALS is run by a hospital in that county or counties that has been given the right to operate a MICU, by state law. Yes, it does seem like a monopoly, but we can't escape the red tape of this state. You have heard of very laxed state EMS laws, but this is the total other end of the spectrum, TOO overregulated. Welcome to the Socialist Republic of New Jersey. Here is a list of NJ ALS Providers per County Most of the Volunteer BLS squads are governed by the First Aid Council (First Grade Council as we like to call it) but some are not, and feel that they shouldn't have to adhere to EMS laws and promote professional pre-hospital care. Those that are licenced by the state have to abide by specific laws and regulations that the volunteers do not, and are allowed to bill for their runs I feel the biggest step we need to make in this state is to outlaw volunteer EMS, disband the FAC, and allow more MICU projects while still keeping it 100% hospital based.

Cool, glad you got it. I'm going to tell you that most of the calls you are going to get are BS with the occasional stabbing and shooting. So you're pretty much a taxi ride since the hospital is in such close proximity that you really don't get to do much before you're pulling up to the ER. Good luck and have fun.

Yes, I've seen it, looks like a medieval torture device. I cringe at the thought of that going into my chest. I've never seen one used though, id rather have the standard IO put in my leg before that thing.

How about the next powerball lottery numbers?

Thanks a lot everyone for your input! I really appreciate it. I'm starting to understand it more and more each time I read the posts. I couldn't find the answers to save my life, thanks again!! I'm full of stumping questions, but the more difficult ones, everyone needs a little help once in a while. Hehe. Stay safe!

He might have been mistaken himself, but the next time I see him which should be next friday, I will definitely ask him about it and see what his explanation is. I myself am also confused over why he said this, as I can't seem to find a rational reason behind it. I also don't see a reason why not to use Beta Blockers. But I will keep everyone informed.

During a shift change the other day, one of our Medics stated that Beta Blockers should NOT be used to relieve symptomatic Tachycardia in a heart transplant patient, but rather a calcium channel blocker. I was unable to get a reason WHY because I had to run out on a call. I've been trying to research the reason but can not seem to find an answer. If you guys could help me out, that would be great. Thanks!! Stay Safe.

I work for Exceptional, anything you want to know? Oh, hope you have no points on your license, because there is a good chance they won't even allow you to drive a truck if you do.

In NJ, we are required regardless of service to have 2 ALS providers in the ambulance. Its usually up to the specific medical director, but Etomidate has been used for a while here, along with Versed. The state gives them a list of approved medications and lets the Doc decide which drugs he wants for RSI. CPAP has also been received quite nicely here, as your usual CHF patient can benefit much more from this than a tube. Intubation is always a last resort as we all know, so CPAP gives us a less aggressive option. The issue with Lasix is understandable, well when it comes to poory educated paramedics. We all know medics that hear "fluid in the lungs" but are unable to differentiate between pneumonia or CHF. This is an education problem that can only be changed with more class time. Since I live about 15 minutes from Philly, I get to communicate a lot with PA medics that also work in NJ. They welcome the new protocols, but are starting to feel like they are turning into NJ where everything has to be called in, rather than being a protocol driven system like PA is. I feel a compromise between the two would be best suited.

Who cares?

Because I wanted to explain it a little better so she understands the system more in depth to answer any questiosn that might come up, whats wrong with that? hmm?? Many people around here get confused with NREMT and testing, just wanted to clarify it better for her, rather than GO HERE.

Ok here is my take on this all. New Jersey actually has something good going on here. Hospital based ALS is the way to go. If you look at it closely, their main objective (besides the absurd bill) is to provide maximum patient care Some of these municipal run ALS programs have nothing but politics and tax money in mind. With hospitals you get quality training, quality assurance, top notch equipment, and less of the politics/tax BS going on. Why fix something if it isn't broke. Only about 10-20% of calls are TRULY ALS treats. I'm not talking ALS DISPATCH, but treat. For example: BLS and ALS get dispatched to a residence for whatever reason, BLS arrives, does an assessment and decides ALS is NOT appropriate and to be recalled. This is the way the system is to work. BLS gets on location, does initial assessment, decides whether to keep ALS, if they aren't needed, they recall the medics and make them available for the next call. There are a lot of ALS dispatches, but only a few are legitimate treats. Where I live here in Camden County, I can have 3 different medic units at my house in about 6-7 minutes or less (provided they were all available). There is absolutely no need for every municipality in NJ to run an ALS program since it isn't tax effective and the quality of care is less than that of the current system. I know if I were the patient I'd feel more comfortable hearing "I'm one of the paramedics from the hospital" rather than XYZ fire department. As for Intermediates, I have to disagree with everyone here. In New Jersey there is no need for Intermediate level. Once again, if the patient is in need of drugs, advanced airway management, and EKG monitoring, you should have Paramedics in the first place. The Basic provider level does just that, provide basic care. If they need more advanced care they call for paramedics. So you get a patient, its a legit BLS patient, you as an intermediate decide to start a line and hang some fluids. Did you do anything to immediately make that patient any better than what the Basic couldn't have done, after all, it was a legit BLS call. No. If they needed the more advanced care, get a medic. These fire departments that want to start ALS care in NJ, its never ever ever going to happen. This would be a regress in standards. Cherry Hill lives in a fantasy world. But what is interesting in NJ is that if a Medic is running on a BLS ambulance and they get a call with ALS, and they transport with ALS, as long as the Medic that staffs the BLS ambulance also works for the same hospital as a medic as the ALS crew, its up to the ALS crews discretion, but the Medic on the BLS truck is allowed to treat as a paramedic. This is because he/shee is covered by their medical director. Now if they were from a different hospital, it wouldn't be allowed. Pretty wild.

It depends where you want to work. The NREMT is only a service that standardizes tests throughout the country, so that states do not have to come up with expensive testing systems, they just use the NREMT that has been doing a lot of it for a long time. The NREMT has no official status in states, only for standardized tests. The ultimate power comes from whether the state will give you credentials or not. Once you get your Paramedic training done, if you are in NJ (AND your training was in NJ), you will take the National Registry test, you will then be issued a NREMT-P card, and a MICP card from the state. NY on the other hand does NOT use NREMT and will issue their own test. So it pretty much comes down to this. Every state is different, they all don't use the NREMT. Some use it as their testing source, others don't but most do. When you apply to take a Paramedic exam in any particular state they will say whether you need to take the NREMT test or not. Hope that clears it up.

I couldn't have said it any better myself.

"EMT's" are mostly in the U.K., outside of there you won't find any, as most trucks are stocked with RNs. Like Zippy said, the Franco/German EMS is pretty much DOCTOR based. They work much differently than the British Dutch/Scandinavian systems, which is mostly Paramedic and RN staff. The Franco/German system bases it's care on bringing the ER to the patient, and do as much as possible before transporting. The British Dutch/Scandinavian system is pretty much just like the U.S. system, stabilize and transport, although a Doctor is much more available if needed for advanced trauma life support. I read an article in JEMS about the Italian system, which is also Franco/German based, and how they were trying to adopt more of the U.S. standards (Stabilize and Transport), mixed in with their own standards.

Come on!! When you ride, you gotta ride in style... MERCEDES!!! hahaha

I can see 100% where you are coming from. And I agree totally. It goes back to the whole government system. (Ex. state laws) But that doesn't mean that things can't be taken from this example and implemented as far as we could. Increasing educational requirements is a start.

And the Netherlands is even smaller than the state of Missouri. Don't forget, there are about 16 million people stuffed into a space about the size twice of New Jersey. So, take that and compare to what it would be per person. Approximately 1 EMS Nurse per 9000 inhabitants. Give or take. Now, take the amount of medics you have and compare that to your population. It's not that far off. Just the proportion is different. I can see where others are going to say about size of a country. If the standard is implemented across the board, along with the same policies and procedures in Alberta as it is in New Brunswick, size wouldn't matter.. why would it? You still have a single system overall. Like DustDevil and many others have said, EDUCATION is the key, NOT TRAINING. Rather than switching exclusively to nurses, we'd need to adapt the current system, INCREASE the educational requirement for a paramedic. Make it a mandatory 4 year Bachelor Degree program. As for the advantages of a national system, I think that benefits outweigh the negative aspects. I'd like to hear every ones view, what would a national system offer like the one in the article that we don't already have, and vice versa.

Ok, I didn't mean for the response to be inflammatory. When I'm talking about the advancements, I'm talking about standards, abilities, and staff. How many services do you know that can literally do amputations on a location with a surgeon and anesthesiologist within minutes? How about a chest tube? Also, compared to the United States and Canada, it's a NATIONAL system, with a national scope and standard. No differences between provinces that say one service is allowed to do this, and the other not. Budget is also controlled by a single entity, along with education. This is what everyone here has been screaming for, some kind of conformity. Possibly this could be a model to take after, to be able to understand how a true standardized national EMS system works. Same credentials across the board, same protocols, same scope. Nurses need ATLEAST a minimum of a "Bachelors Degree" to work in a hospital, which takes approximately 4 years, PLUS you need atleast 2- 3 years experience in anesthesia, intensive care or cardiac. THEN you need to take a pre-hospital course in order to work on the ambulance. Add it up. Average paramedic training in the U.S., approx 1 - 2 years. hmm. Nurses on every single truck is great, but like you said you were in systems that have Medics and Nurses. Think about how practical that really could be. It would be great for stabilization, but what about transporting? Someone has to drive the truck, the medic or the nurse? So you're still only getting one advanced provider taking care of the patient at once during the ride to the hospital. Another thing I like, is that they aren't going to get called to every stubbed toe, and hurting tooth. I've heard plenty of stories about these, and have experienced them myself as well as you have I'm sure also. None of that goes on, as patients are told directly to go visit a doctor as this would not constitute an emergency for which an ambulance is needed. This keeps the system for being tied up with nonsense calls. This wasn't intended to be a BASH, but yet a model in which everyone would like to take after. After all, everyone seems to want some kind of standardization and conformity in EMS in the US.

I just wanted to share the difference between EMS in Europe, particularly the Netherlands (where I'm from), and how much more advanced and organized the system is compared to the United States and even Canada. If you want to share other information, go right ahead, the more the better. Hopefully, we in the U.S. can learn and improve to get close to a level like this, but without drastic changes, it will NEVER happen. Here is the Link. EMS in the Netherlands

ok, would someone PLEASE like to explain what the F*** Canadian Tire money is? lol I can only imagine what you crazies up there do with something like that. :wink:

ACTUALLY, it is the law that states it needs to be run by a hospital system. The certificate of need can not be submitted by any other entity than a hospital system. Technically it could, but the application would NEVER get accepted. Also, the last time I checked, NJ has one of the highest paid medics in the nation. I know they make more up north, but down in the south of the state, they start around 20/hr which is still pretty sad.

I do know that AMR runs Children's Hospital SCTU transport service, as well as Temple uses AMR for various critical transports. As for 9-1-1 responses, AMR is very limited to none in the area, they're strictly interfacility transport. Hope this helps ya out a little.

Really? So, someone is unconscious/unresponsive due to an obvious narcotic OD, you need to call for orders first before narcan administration? I'm just curious, I figured it'd be standing as we do, as Canada is so progressive.