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I'm a Paramedic in Texas, at the 2 companies I work at (both municipal 911 only) our paramedics can RSI via standing orders. Protocols call for the consideration of Lidocaine and/or atropine obviously if indicated, followed by etomidate and succinylcholine, unless they are contraindicated in which case we have the option to do versed or valium with vecuronium. Big fan of the Ronc as well, we dont have it, wish we did... Have a good one man! Rob

I completely agree with you statement on the A&P, however my arguement is that anyone wishing to further their education and strive to provide the highest, most competent level of care to their patients has every availability to do so. I drove 3.5 hours recently to take a Stroke specific class. I wasn't on the clock, but the class was free so myself and a partner of mine rode together. Free CE classes are available constantly at every hospital and every decent EMS agency around. If worse comes to worse and you care about making a positive difference in the outcome of your patients, fork out a little cash and take the classes in your area you feel the need for improvement in. Thanks, Rob

I have worked at several agencies from rural to urban municipalities in Texas, and have never encountered anyone in my area with a protocol to treat vertigo in the field. I have to somewhat agree with the curiosity about an accurrate diagnosis prior to treatment and how one would come to that. Also, I feel like there would be a lot more calls from people with vertigo if we start hooking them all up with valium, etc... just playing devil's advocate a little, interesting question though. Same as the NY guy, we use Zofran or Phenergan in the nausea/vomitting protocol. Rob

I have worked with a ton of different paramedic partners, some of which have spent time at every level, and some who have went all the way through to paramedic without ever spending a day on the box. I am an EMS Instructor, as well as CPR/AED, and ITLS; and I give this same advice to my students. The best ones I have worked with spent time at every level. I spent over a year at every level before certification, and in between classes took smaller classes at higher knowledge levels to better prepare me for the next level, for example I took an emergency airway management class as an EMT- Basic, and a comprehensive 12 lead EKG class as an intermediate. Going straight through can make the test easier, but nothing can compare to experience in the field. How can you expect to perform a surgical airway when you have not put in an OPA? And one of the toughest problems you will encounter will be accurrate, confident assessment of your patients. All the drugs and procedures in the toolbox, but it takes you the whole ride to the ED to figure out which one you should have used. Plus, if you get on the box where you have good partners they will help to build your knowledge. Anytime we run a decent call I always recap the call with my partners, whether they're EMT's or 30 year paramedics, not only to help them, but to help myself and pick up anything I missed or could have recognized earlier. Those classes are not that expensive, and you can always take out small student loans or work weekends on the box to pay for them while in class, as I did through B, I, and P. Best of luck man! Rob -"Give me 6 hours to cut down a tree and I'll spend the first 4 sharpening the axe." -Abraham Lincoln It is possible, I usually don't recommend it because most people are not willing or capable of putting forth the effort it takes to do all of the studying; and it will require ALOT of studying. My best advice is to try to find a company where you can work as a Paramedic with a paramedic partner for a while, or that has a strenuous program where you ride 3rd out for a while (paid of course) until you are checked off in certain areas. I was a Paramedic Lieutenant at a small Fire Department based EMS, and have recently applied for a larger municipality. As a new hire I will have to sit for a 3 week classroom refresher, then ride 3rd out for ten 24 hour shifts, then spend a year with a paramedic mentor. Alot of the guys there worked for me part time at the other company where I was the Sup., but it goes to show how dedicated the service is to providing top medical care to the people in the response district. If you apply for a company willing to throw you on the box with an EMT partner the first day, be wary. Keep your nose in the book, you will only be as good as you allow yourself to be. Best of luck girl! Rob "Give me 6 hours to cut down a tree, and I'll spend the first 4 sharpening the axe." -Abraham Lincoln-