thbarnes

Grady is transitioning from a county authority to an independent non-profit, which will make it eligible for more external funding.

Grady EMS - Atlanta http://www.gradyhealthsystem.org/job_search.asp Rural Metro - North Fulton, South Fulton http://www.rmetro-ga.com MetroAtlanta - Cobb http://www.maas911.com/default.php AMR - Dekalb http://www.amr.net/careers/index.aspx Care Ambulance

Mary Wohlford, 80, of Decorah, Iowa, had the words “DO NOT RESUSCITATE” tattooed on her chest to make her medical wishes clear, but at least one doctor thinks that isn’t enough to stop medical personnel. Dr. Mark Purtle of the Iowa Methodist Medical Center in Des Moines told the Des Moines Register that state law defines when caregivers are permitted to end life-sustaining measures, and a tattoo isn’t enough. Wohlford noted that she also has a living will hanging on the side of her refrigerator. Complete Article

Georgia is talking about letting RNs staff ambulances after completing the airway, trauma, communications, ethics, and scene safety units of the Paramedic curriculum. They must also have ACLS and PHTLS/BTLS. This presents a problem in mind. Case 1: They are going to pay the ambulance-based RNs the same hourly rate as RNs receive in the ER or ICU, which is where they most likely moved over from. This wouldn't make sense, because there are already numerous EMT-P with their RN who don't receive the hourly rate as ER and ICU nurses. 2. They are going to pay the RNs on the ambulances the same hourly rate as Paramedics, many of whom also have their Bachelors. In which case, are these RNs total fuck ups?

And we are going to find these willing candidates, where?

A previous service I worked for had them, but I never got the opportunity to use them. My present service is getting them in October. The hold up? There's no check box in the billing system for them. See "Private Service Thread".

They may not be well aware of it right then, they might be feeling quite good actually (alcohol, pills, etc.) but they are going to be very well aware of the situation when they wake up in a noisy ER with a raging headache. The only thing you can do is be honest.

You will feel better when you do the hard work to pass again next time.

This is an original, ongoing work... You may have received an email or seen a local news report on "ICE". "ICE" was all the rage in 2005 but continues to crop up here are there. The concept behind ICE is that it's a number saved on your cellphone under the contact name "ICE", which stands for In Case of Emergency, which Paramedics can use to contact your loved ones in an emergency situation. I have news. I will never look through your phone to contact your next of kin unless you are dead and the police officer or coroner ask me to. If you are in a truly life-threatening emergency, the last thing I'm going to do is play with your phone, nor do I want to share the play-by-play with your blubbering family. I will be busy performing a rapid assessment to determine the extent of your illness or injury, obtaining vital signs, establishing vascular access, and providing supplemental oxygen and ventilation, if needed. If you were in an accident, I will be working hard to maintain your cervical spine. If you are a cardiac patient, I will be attaching and reading the ECG machine, measuring out precise medications, and monitoring your response. In other words, ICE is stupid. However, I do recommend the following: If you choose to down three six packs of beer, break into the YMCA pool, and decide to dive into the shallow end, please leave your car keys on the lifeguard's seat. I will return for your car after my shift is over. If you are diabetic and choose to skip your insulin for three days and eat seven boxes of Little Debbies instead, please leave your best recipe on a post-it note next to be bed, because we both know you like to eat, don't you? If you have a rare medical disorder, please make sure no one in your family knows what it's called. But do tell your family to call 911 periodically when you are sleeping to report "seizures". If you are planning on getting crazy on PCP today, please do us a favor and remove your clothes ahead of time, you're going to do it anyways, sometime between throwing the television at the police and them tazing you four times.

I am a new Paramedic, having passed my exams in September of 2006 and been hired right out of Paramedic school. When I was hired, the service who hired me was and continues to be desperately understaffed. I worked hard for them, because they needed help and I needed the money. I worked my first 24 hours shift my third day there, totally clueless, they just threw me in. Over the next 60 days, I averaged about 50 - 60 hours a week on grueling shifts in the busiest parts of town. I came in early and stayed late with no complaints, I gave it my all and had the best attitude. Then classes began at my University and I had to cut back on my hours, dramatically, because the service still utilizes the old 24-48 hour shifts and I can't work during the week. This was not a surprise for them, I had told them in my first interview that I would be returning to school in the Spring. A couple weeks later, out of nowhere, I was asked to come in and meet with the chiefs. I had not completed their "orientation program" on schedule ("What orientation program?" I thought to myself) and they would not have the time to complete it with me before my 90-day review now that I was going PRN and had classes at the university. They offered me the opportunity to work hard over the next 30 days with the Asst. Chief of Training, alongside my other classes, to memorize their protocols and improve my paperwork...I took it. Despite the Asst. Chief of Training's absence on most if not all of our scheduled days together, my documentation went from okay to stellar. I have also made a huge improvement in utilizing their awkward and sometimes backwards protocols. I actually had to go back and learn the old ACLS because they have not updated yet. I made dramatic improvements and many of my peers acknowledged this. So today they let me go. They did not feel I could finish "getting up to speed" before my 90-day review. They offered a good reference and a handshake but I am very, very disappointed. Why didn't they take me through the orientation program the first 60 days when I was available all day, every day? They certainly didn't have a problem throwing me out there the third day when they needed to cover that shift. I really feel taken advantage of. Why weren't any NRP, AMLS, or PHTLS classes offered for the entire months of November, December, and January? I know why the Asst. Chief didn't have any time for me, it's because they pile on so many other responsibilities onto him, but why not assign me to under-utilized FTOs (Field Training Officers). But now they are still understaffed. Since I was hired, they've let three other people go and hired no one new. And now I'm supposed to go get a job at, where? A fast food joint? I don't know what I'm going to do. I feel like my Paramedic training was a waste of time. I appreciate the reference, but a three-month stint does not look good on a resume.

Yeah, shift supervisor, lt, or capt...an extra $.25 an hour.

There has been much debate on requiring degrees for EMTs and Paramedics, especially Paramedics. We can look at other allied heath professionals and the 'degree inflation' their professions have seen, but it comes down to the fact that EMS is not a true meritocracy in most cases: degrees don't mean anything in EMS, until they mean something, not many are going to get them. In medicine, an MSN does not do the work of a CNA. An attending does not have to spend 80 hours at the hospital anymore, that's what residents do. They don't do these things not because of their experience, leadership skills, or other qualities, they do it because the have degrees plain and simple, no question. Today I worked with a paramedic of twenty years who possess a BSN and is pursuing his MNP, despite pursuing every opportunity afforded him, he's only a lieutenant in our service. Being the best paramedic I know, I don't know why he doesn't have 'chief' in his title. I took a patient to Emory the other day with a Paramedic with twelve years experience and two masters degrees, one in education and one in EMS leadership. He has no rank despite applying at every opportunity. Both of these medics I know make maybe two dollars more an hour than I do, a 21-year-old college student with a Paramedic certificate and not because of their degree, because they've stuck it out longer. It's a shame really that our profession while wanting to advance itself, shortchanges those individuals who take it upon themselves, on their own time and own dollar to do so.

My service responds either lights and sirens, or not, there is no in-between. If anything were to happen on the road and you didn't have both lights and sirens on, the driver could be personally liable.

Hey, that's the service I did my Medic clinicals with! Yeah, Yamacraw Village in Savannah, that's where I worked my first GSW, stabbing, and domestic assault. Pt was probably high on PCP or Meth. Been there, done that. I don't work in Savannah anymore.

Open ended topic starter. What mental illness do YOU suffer from? What diagnoses do you encounter most? What patients do you find the most interesting, obnoxious, etc.? ANNOUNCED TODAY - Study on Post Traumatic Stress among EMS Personnel http://www.tema.ca/news.php?news_id=9 Program helps cops respond to mental illness http://www.mysanantonio.com/news/metro/sto...NG.32042ed.html Poll shows campaign to reduce mental illness stigma is paying off http://www.theroyalgazette.com/apps/pbcs.d...OCEAN/110130160 Mental illness afflicts 30 million young Chinese http://english.people.com.cn/200610/11/eng...011_310680.html

The patient is already in cardiac arrest, it's not a good situation to start with. But yes, atropine would make the situation worse. Most services carry Atropine and Lidocaine in handy color-coded pre-filled syringes with the name of drug in big, bold letters on the side, I think to prevent this very thing from happening. Lidocaine is an antiarrhythmic Atropine is a parasympathetic blocker, essentially it accelerates the heart by blocking the brain's ability to slow it down and keep the heart rate in check You're not slowing the heart-rate down with the lidocaine per-se, but you are trying to correct the dysrhythmia, which is tachycardic in nature, and return control of the heart back to the SA node, returning the rhythm to normal sinus. Either way, the atropine is not the exact opposite of what you were going for, but it's not good, because it accelerates the heart rate and does nothing for the dysrhythmia. If the v-tach was caused by certain factors, such as muscle hypoxia or ischemia (in a heart attack for instance), then the atropine will increase the oxygen demand on the cardiac muscle, causing further damage. The most likely outcome I forsee and others may have their own opinion, is the v-tach degenerating into PEA or asystole, which has much less probable chance of positive outcome.

I've got all the shots the US State Department recommends for rural China...

Following my post 'I Passed', I've gotten a few requests for the resources I used in my test preparation. I've compiled the following list. This is hardly definitive, please add anything which helped you. About 300+ homemade flashcards with anatomy, signs/symptoms of disease processes, cardiac rhythms, and drugs Barron's How To Prepare for the EMT Paramedic Exam Out of the dozens of test books I ran across, this book has questions that most accurately reflect the style and breadth of the written exam (in my opinion). Unfortunately it is a little out of date in regards to the new ECC protocols, so stay sharp. You can get one of those books with 5,000 questions or you can get this one, which actually explains the answers in the back. About 100 questions in each of the written exam focus areas (medical, trauma, etc) and three full-length practice exams. Highly recommended. AHA's ECC 2005 Pocket Handbook Mosby's Intermediate/Paramedic Practice DVD Mosby's Paramedic Refresher and Review: A Case Studies Approach Streetmedic's Handbook by Traynor, Coonan, Rahilly, and Rubens Also a little outdated, but handy, more concise than your text book with more than your pocket guide. I have the 1995 edition, but I believe there was a subsequent edition circa 2001. Informed Emergency & Critical Care Pocket Guide Practice Tests In the weeks leading up to my exam, I took the hardest practice tests my instructor could dig up for me. I took about two a week and my grades were all over the place, so don't stress. I would make notes as I worked through the exam on areas I needed to go back and read up on, I'd do the same once my instructor graded my exam. I would then go home, read, make flashcards, and come back in and try again. Eventually you can fill in all the gaps.

I find it varies ambulance to ambulance. It's always funny to see people covering their ears when we scream by, I guess they have the right idea though. Does your jurisdiction's law enforcement enforce noise ordinances? Police officers in those that do often carry decible meters, you could borrow one and a do a rough study. If you were given ear plugs to wear (by OSHA standards), would you wear them? How about a headset?

And I would like to thank everyone for their posts. I really appreciate the advice. I did well on my exam and I am anxiously awaiting my results. I did have an interview today, which went great. I'm looking forward to moving up to Paramedic.

This definitely shows ignorance regarding ADD/ADHD on your part. But I'm going to give you the benefit of a doubt you're not very familiar with it. The problem is not knowing the material, it's about being able to mentally access it in my memory and staying focused on the question. Maybe you've been reading a book or something and gotten to a point where you realize that you haven't really been following the text, just 'eyeing' it, not really reading. That happens to me all the time, hundreds of times a day. It happens mid-sentence. It will happen to me ten times on the same page. But let me get up and pace around, rock, or fiddle with something in my hand, I know the material. Accomodations are not about making up for some inability, they adjust the situation for my disability. All I need is time and I can do just as well or better than someone without ADD/ADHD. Thanks Dr. obvious. I am actually very sensitive to stimulants and most ADD/ADHD drugs are stimulants, most of them are combinations of amphetamine. They work because they stimulate the pre-frontal cortex of the brain, the part of the brain which regulates attention. It's also the part of the brain that I severely injured as a child, injuries that show up on scans today. Straterra is different, it's a norepinephrine reuptake inhibitor, similar to SSRIs. It is indicated for adults and for those sensetive to stimulants. I'm going to discuss it with my Dr. soon. Again, I'm giving you the benefit of a doubt that you are not familiar with the true nature of ADD/ADHD. And I really don't think anyone trained to my level would forget 'what I'm doing' during an OPA insertion. Actually, EMS is one of those fields that seems to attract people with ADD/ADHD. During intense calls, a 'hyperfocus' is required, and most persons with ADD/ADHD have an incredibly ability to hyperfocus, it's paradoxic but proven. I ask you to please read up on ADD/ADHD before posting such insulting comments. And if you didn't mean to be insulting, your post was and you need to understand why.

Excelsior College https://www.excelsior.edu/ It is possible to sit for the NREMT-Paramedic exam as an RN after a two-week course. Many trauma hospitals sponsor these internally for their own ER and Flight Nurses. http://ems.creighton.edu/rnp.htm CEN http://www.ena.org/bcen/cen/CENdefault.asp CFRN http://www.ena.org/bcen/cfrn/ CCEMT-P http://ehs.umbc.edu/CE/CCEMT-P/

You could become an EMT, but then you do have a family. Wages vary based on geographic location, most range from $8 an hour in rural communities to as high as $15 in some metropolitan centers. It is also based on the type of service you are working for, private company, fire department, etc. Unlike nurses, of which there is a nationwide shortage, there is a glut of EMTs. I am not familiar with your family's position by any means, but you may need to consider the income you would be looking at as an EMT and the job market as a whole. If I were you, already enrolled in a nursing program, I would transfer to another nursing program. Once I had my RN, I would then sit for the Paramedic exam. Then you could move between the in-hospital and the pre-hospital settings with ease. If you earned your Certified Emergency Nurse (CEN) or Certified Flight Nurse (CFN), you would really have some great options anywhere in the country and could almost name your own price. I would stick with RN. Not to say EMT is below you or anyone, EMTs are great, but don't give up on nursing school! You could also see if Excelsior College would accept some of your credit so far, they are the online nationally recognized RN program I am aware of. You could complete your EMT-I, finish your RN through Excelsior, test Paramedic, get your CEN and CFN then. How does that sound?

Um...not looking for special advantages, just looking for advice from other EMTs or Paramedics who have struggled with exams in the past.

Believe it or not, I was not diagnosed with ADD (non-hyperactive) until late into my teens. I tried medication once, but couldn't tolerate the stimulant effects. I do well with meditation and to-do lists. Maybe one day I will give the non-stimulant medication a try. Unlike the SAT or many other standardized tests, the National Registry exam does not allow extended time or special provisions for those with ADD or any other LD, nor am I proposing they should. Are there any other EMTs or Paramedics who have difficulty taking exams with any advice regarding the National Registry exam in particular who have advice to offer ? Thanks. Moderators: Would you mind leaving this test-related question in the EMS Discussion folder for a bit? I know it would probably best fit in the Taking the Test folder, but I was hoping for a few responses before it's filled down there. Thanks.