asrnj77

I've seen numerous references to NREMT-B certification being a 120 hour class. How often does someone pass the NREMT-B written and practical tests with just those 120 hours. I passed the state NREMT-B practicals in March and the NREMT-B CBT in April - here's my hours spent pursuing it:

EMT-Basic class time - 120 hours

Study time in conjunction with class (book learning) - 120 hours

Emergency Department Clinicals - 50 hours

BLS / ALS Ambulance ride alongs - 40 hours

Practicals / NREMT-B CBT preparation - 50 hours

I did sign up for extra clinical and ride along shifts - the bare minimum was 5 patient contacts, which seemed way too light.

I probably estimated low on book learning and test prep times, which does not include time on EMTCity, etc.

Having said this, I have no illusions that this training comes close to NREMT-P training time commitments or skill sets, but I do wonder if people actually get NREMT-B certified and State licensed with just 120 hours of class time.

Feel free to detail your hours spent for whichever NREMT certification you wish.

Well you kind of answered your own question. The 120 hours is likely the minimum required by your state. They never factor in study time or prep time as it varies with the individual. You also increased the amount of clinicals and ride alongs. Like many professions a lot is learned on the job. A police officer is not proficient right out of the academy. They learn the basics in the academy and the "real" police work in the field just like a new EMT. You get the base line training in school and NR and many states have determined that 120hrs is enough base info for that skill set. This could be argued back and forth but just remember that the hours of actual experience in the field far outweighs classroom time.

Yeah I have reached out to some people. I may just have to buckle down and stop being lazy I need to spend some time with the 'ole powerpoint. I have taken practically every "tacti-kool" course out there. Some great, some not so great. This is more geared for operator/buddy aide. TQ, QuikClot, Sucking Chestwound, Airway control...

Certainly tragic and to be so young....I believe part of it is the allure that private contractors can present. I mean a local firefighter in Arkansas vs. private contractor in Iraq? Maybe 5 times the salary? Many also believe they will be safe because they will stay "on base". Certainly there is danger abound and safety can't be taken for granted. Especially over there

So I'm having problems locating a "train-the-trainer" type course. Basically I've been tasked with teaching my agency a 1-2 day "tactical first responder" course. I have a lot of ideas in my head but I would prefer to have somebody authorize me to use their instructional materials. I didn't want to make a powerpoint that is pieced together from other people's potentially copyrighted material. A lot of tactical medic companies aren't in the business of producing instructors but I have no intentions of teaching to anybody outside of my agency. I have been to CONTOMS, OEMS, CMAST, TCCC and Wilderness but like I said it would make my life easier to have a concise program already prepared with material. Basically immediate action treatment for the non-medical provider. Plus my co-workers always like a nifty little certificate that they can stick in their folder..please let me know if anybody has any ideas...thanks

Bang out one of those EMT-W that includes NR-Basic cert with a resume friendly Wilderness attachment (resume friendly debatable). They take a couple of weeks and you camp around the woods while getting the cert. With your experience I wouldn't sweat a basic course at all...

[web:7492d10974]http://www.nols.edu/wmi/courses/wemt.shtml[/web:7492d10974]

You can google more classes. I would avoid NY personally because they don't recognize National Registry and it makes transfering that much more difficult

Firstly: The whole concept of BULLETPROOF is a sham, as the shotgun is very effective tool for finding holes / chinks in lots of body armour and under the arm is a big cop killer, as are head shots. The whole idea is a misnomer and unless one is wearing a level 3 "ceramic plates" type BODY ARMOUR and a Kevlar Lid, so if you have one inkling to wear this level of protection working on a truck. Are you considering or subjecting oneself to a higher than "regular" threat level ? Just saying a bit of false sence of security. If one is working in a tactical support or combat role well that's a tad different and then it should not be issue it should be issue ! period.

In passing Combat small arms Schools are even teaching a different stance when confronting a shooter based on this evidence, well that's what I have been told and only when exchanging lead. :wink:

cheers

Well you are right about the change in stance but I think it goes against what you are saying. The traditional method for facing a threat was the weaver stance which is basically blading yourself with your dominant foot back. They found that this opens the weak side arm pit (as you mentioned) to gsw. The new stance is to face the threat directly so your body armor can provide it's maximum level of effectiveness. The vests can be bought off ebay for relatively cheap. Sure they have expiration dates but they have found that a lot of the expiration dates are like those on medications....you can extend the life by a few years. There have been many studies on this....just look it up. Some fabrics like zytel have been recalled after failing an unusual amount of times so research your material as well. Basically they are hot and uncomfortable but if you get shot then that will be the day you wish you'd worn it. Personal decision...been discussed plenty before

Paramedic Shortage Eased

Interesting article about how the metro DC area is recruiting medics. Even in some of the more rural jurisdictions starting pay can be 57k. I especially like when they call the paramedics "field doctors". Also keep in mind that I/99's and P's are called Paramedics in DC and Northern Virginia and the term refers to both in the article.

The card issue is irrelevant. As mentioned before, they have ground medical control. So you put the little headset on and speak with the md on the ground. They can't see what your little card says and the situation now calls for somebody to do what they are able to. If you tell the doctor that you are an EMT-B and don't know how to start a line but you think this person is having a stroke, then the doctor will authorize you to perform whatever they are comfortable with on their medical license. This may be 02 by non-rebreather and monitor. You can't expect a flight attendant to say "oh I see that you are a wilderness emt from Pennsylvania and since we are currently over some wilderness you can now go crazy with the furosemide and 16 gauge iv"

Hopefully the most qualified person or group of people will volunteer and explain their level of ability to the medical control and they will take it from there.

When I first started working Penn State football games I was on a medic unit dispatched to one of the parking lots for a 23 year old male unconscious. When we arrived we found this guy unconscious as dispatched. His friends all swore he only had two beers and there must be something really wrong with him. They also identified themselves as paramedics and nurses from a large city. I was skeptical about the two beers but decided to give them the benefit of the doubt. We loaded him into the truck but needed the police to keep them from getting into the truck. High flow oxygen, nasal airway, glucose check, IV and narcan but he was still unconscious. We arrived at the local community hospital two miles away and I gave the ER staff my report. A nurse looked at me and said "Why the hell did you do all that treatment. He's drunk." She went on to say the only thing I did by giving fluids was to lessen the hangover. Their treatment for drunks is to put them in a room with a pulse oximeter and let them sleep it off.

I don't quite comprehend that philosophy but it turned out the guy's BAC came back at 250. I wouldn't treat the guy any differently even after working the games for ten years but I now ask how large were the two beers!

Live long and prosper.

Spock

How did this nurse know that he was "just drunk"? Did the nurse expect you to do labs on the scene? Unconscious patient....sounds like you did everything right. I guess you could have left him knocked out and come back the next to pick up the body when he aspirates vomit. A bac of .25 is a solid buzz but everybody is different...I label this guy a buzz kill for making them call 911

This is taken from the association of national park ranger newsletter - just thought it was relevant...

"EMS Clinicals and Ride-Alongs — Unlike full-time EMTs and paramedics, most ranger/EMTs do not treat patients every day they go to work.

Some work at parks that are busy year-round, such as Great Smoky Mountains and Shenandoah, and see their share of sick and injured people. But often, the ranger/EMT is able to transfer patient care to ambulance personnel within five minutes of arriving on scene. Plus, they frequently bear scene safety, traffic direction and accident investigation responsibilities.

Others work at parks in remote settings where ambulance personnel may not have access to patients, such as Lake Mead and Glacier, in which cases the ranger/EMT usually is the primary care provider for extended durations. But oftentimes their EMS caseload is significant only during peak visitation periods, not year-round.

We are committed to providing the highest quality of treatment to our patients. The best way to achieve this is to maintain our skills. In turn, the best way to do this is to treat patients often. So, we have a quandary: How do we maintain our perishable EMS skills, thereby ensuring our patients receive the highest quality of care?

One answer lies in clinical rotations and ambulance ride-alongs. This means we immerse ourselves, several times a year if possible, into an environment where we are surrounded by full-time medical professionals, we observe them as they work, and we treat patients ourselves. Lots and lots of patients.

There are five arrangements available to most ranger/EMTs. Of course, each is contingent on an approved agreement among supervisors, the cooperating entity and park medical directors.

Emergency Room Clinicals. By far, spending time in a hospital ER is the most effective way to increase hands-on, face-to-face interaction with patients. Though not the best setting for improving field skills such as patient packaging, it cannot be surpassed in terms of patient volume and its wide spectrum of chief complaints, medical and trauma. Outstanding opportunities exist for conducting patient assessments (an imperative skill that is often glossed over), airway management, CPR and other procedures. For park medics, a 12-hour ER shift will usually yield six to 10 IVs and meds administrations. With every patient, lay a hand on their wrist, obtain vitals, listen to breath sounds and ask lots of questions. Spend time with patients and listen to them.

Operating Room Clinicals. In many cases, rangers can augment their ER time with time spent in the hospital’s OR. The primary — and often only — procedure rangers will perform in the OR is endotracheal intubation, and this will be limited to parkmedics, paramedics and possibly intermediates with advanced airway management training. Additionally, the OR is a sterile setting, and rangers can learn much about sterile fields simply by observing OR personnel at work. Though the scope of skills covered in the OR is more narrow than that of the ER, its value to ranger/parkmedics is indispensable: In several hours’ time, one can perform maybe a half-dozen intubations. For most ranger/medics, it’ll take a year or more to do the same number in the field.

Ground Ambulance Ride-Alongs. Second only to time in the ER in terms of overall value is time spent doing ride-alongs with a local ambulance service. Ranger/EMTs will not only contact a lot of patients, they’ll do so in a field environment, and they’ll usually be permitted to perform any skill they’re certified in. Additionally, they will acquire a fair amount of exposure to radio transmissions between paramedics and ER docs — again something most rangers do not do enough of. It’s amazing how much we can learn just by listening to the medic call in his or her patient assessment and to the physician’s questions and orders.

Air Ambulance Ride-Alongs. For parks close enough to an aeromedical ambulance service, conducting ride-alongs on flight missions is another medium in which rangers can expand their EMS experience. Often rangers are limited strictly to observation. However, much can be learned from watching, especially considering most incidents requiring air evacuation are serious in nature, and flight personnel are often the best of the best. And as a bonus, rangers will further their helicopter experience, which only serves to strengthen us as well.

Ski Patrol. Rangers volunteering as ski patrollers can also improve their EMS skills. Again, not all rangers work near ski areas, but for those who do, volunteering as a patroller provides an almost ideal setting, one that in many ways mimics some of the problems rangers face in backcountry EMS incidents, such as similar injuries, inclement weather, rugged terrain and possibly limited equipment.

We can never provide care for too many patients, and each one we treat increases our experience level and confidence. We have a responsibility to ourselves and, to a greater degree, our patients to remain as skilled rescuers. The above efforts will help us emerge as more competent EMS providers. Our patients deserve that much."

~ Kevin Moses, Big South Fork

IMHO...starting lines is not very difficult....I've seen junkies on the street that can get IV access in their own neck....even in paramedic school you practice on some manikin arms then each other and then during clinicals in your rotations. Why not have Basics in rural areas that can quickly give d50 or narcan? Maybe the pharmacology isn't all there but if there was ever a case for cookbook medicine here it is -

"He took three bags of heroin and now he is blue"

Also in the Army NREMT-B's are trained in I/O access during CMAST. It's about an hours worth of training. This isn't going to be narcotics, acls drugs, etc. It is life saving, easier to dose medications.

It is not a substitute for a paramedic...it is just enhancing the life saving capabilities of emergency medical technicians....I think this would work best in rural areas with sparse populations...just my opinion though

if for some reason the link doesn't work..just go manual

www.cottage-grove.org/ems.htm

Cottage Grove, Minnesota

read above...

IMHO....people like to start IVs because they feel like they are getting more or using their advanced medical training I feel that oral rehydration is the better way to go unless you can't keep it down...if you need vitamins drink some gookinaid or 50/50 gatorade h20 blend...

Something to consider...of course a ballistic vest can save your life but they also add an intense amount of trapped body heat so if you are a "hot" person expect to be 20 degrees warmer. (bear extra notice smelly/sweaty people) If you don't get it properly fitted it will ride up and choke you when you sit down or pinch your armpits. Puncture/stab resistant vests commonly used by correctional officers are hotter/thicker/less mobile than traditional vests.

Again, it's a decision. If you want protection it's an excellent option but like everything else it has it's ups and downs. Lastly vests have "lifespans" so make sure to check the date printed on them when purchasing used ones. That being said, even though they may be expired many tests have shown them to still be effective.

www.aecare911.org is associates in emergency care's website. They are listed in Dustdevil's post as being certified in MD but actually teach their classes in Northern Virginia. It's a 6 month class offered twice a year for $2000. Check the website for more info

If you would like to feel 100% at ease just pop into your local district attorneys office and ask them if the station would be justified in having a camera aimed at firefighter's beds or other areas where changing clothing is expected. I expect they will nearly pass out at the the mere thought that this may be occurring and quickly (and behind closed doors) confirm with the Fire Chief that this has not/will not occur. The last thing they want to hear is a government employee bringing up an issue that could cost the gov twice their annual budget.

I don't know about your area but we can go to the district (commonwealth around here) attorneys and and ask questions whenever we feel like it. Many places have a hotline or open office hours.

Was I supposed to decompress on this scenario...I know I didn't.

What are the other possible scenarios?

I believe everything is BLS...I know that throws people off but you may have just gone over the time limit like you said and therein lies the solution. Just memorize everything on the sheet and practice with a classmate and stopwatch.

http://www.nremt.org/downloads/Patient%20Trauma.pdf

That's good that NY is higher but last time I was in Manhattan at TGI Fridays a sandwich was $21.50 and $7.15 an hour is still less than 15k a year

The federal minimum wage will go up by $2.10 but over two years. Many states are higher. I'm not sure of the cost of living in your area but if you were/are making a little above minimum wage then that means you are making roughly $12,000 a year (without OT), full time which is at the poverty level. Of cousre nobody goes into EMS for the money but that is very low (at least to me). Would you make more money in the government sector? At least the benefits have to be better

3 step increase is scheduled as follows:

$5.85 - Summer of 2007

$6.55 - Summer of 2008

$7.25 - Summer of 2009

It's an herb, not a drug, despite its effects. .

Feeling irie, mon :kermit:

A slight twist to this topic although it is in the realm of public safety....in my old police department we had a fridge in the back where we would store confiscated (unopened of course) beer from minors, etc. When we got off shift we could take whatever we wanted for consumption when we got home. So of course you couldn't drink on duty but you could certainly store it there. They trusted that the officer would be reasonable and drink it off duty.

I saw in some posts people were shocked that they might have alcohol at a station for other purposes. I suppose they trust their employees/members. I mean it's not like you have morphine, fentanyl, amyl nitrate, or valium anywhere nearby

Figured I'd throw my 2 cents in here...as a wearer of a pump I know that it works in a basal/bolus mode. The basal mode is preset to your preferred settings - say maybe .9 units per hour delivered in a small drop maybe every three minutes. When preparing to eat you give an appropriate bolus - many pumps have a safety feature that won't let you give more than 16 units at a time. So perhaps it is possible that the pump has malfunctioned and is continually pushing insulin (never had this happen) and you would need to end/cancel/disconnect. But the minute amount of basal insulin that they are receiving while you are working on them shouldn't be too much of a factor.

If indeed the conversion works out to a BG of 72 then I think there is something else going on besides an insulin reaction. In my younger pre-pump days I could be rocking and rolling on a BG of 40 and few would be the wiser (although I would then eat something so they would continue not being the wiser) Point being I have never ever seen or heard of a diabetic having a severe reaction at 72. I would evaluate the patient - start a line - I guess you can give the dextrose to rule it out but would certainly be thinking something else is wrong especially if LOC. Just my humble opinion

Assrnj77: Do you even know what OPSEC means? Any professional soldier/cop/tactical medic avoids public attention for more than one reason. Why arent you applying your vast tactical medic knowlege in the GWOT?

You made it obvious that you watched BlackHawk Down. Your little "active shooter" scenario sounds unoriginal. If you understood TC3 (tactical combat casualty care, you'd realize that fire superiority takes priority over a groin wound. A medic will need to be a shooter first in this dynamic situation. Holding pressure makes little sense in your scenario even though it may be detrimental to the injured cop . If a tourniquet was required, you could apply it and leave the casualty behind as you continued your part of the mission...It takes little time to apply a tourniquet.

Again, SWAT cops need to be Tactical first responders as well as what their normal team assignments are.

Somedic Sends

unoriginal is my whole point - this stuff happens

First of all I thought your OPSEC (perhaps PERSEC would be better) would get a kick out of this :

http://www.aetv.com/dallas_swat/dswat_meet_teams.jsp

Second of all, in addition to running active shooter drills (thankfully haven't had a real one) I have taken TC3, CMAST, and the other cool acronym courses and what applies for the military in Iraq is not the same as what American SWAT teams are doing. As Doczilla said the majority of care is preventative and dealing with minor injuries. But if a situation does arise the same medic can handle a situation under duress. The "tactical" medic also gets training in dealing with less lethal devices like bean bags, tasers, CS and pepper spray. They are able to treat prisoners and police and may have additional protocols (like Maryland) that allow them to work with more flexibility than a civilian medic. Do I think that everybody wants tactical medic because it's kewl to be a "ninja"? Yes...but I also think that there is a real use for them and in my opinion, if they saved just one cop's life then it was worth all the arguing and fussing

(with the double posting - yeah that sucks but for some reason EMTCITY was acting funny on my computer)

Oh Dust did you have to?.....This walking, talking "one man pilot project" killing machine/medic Erik Carlsen must be one more bad ass. Why dont they just send him to the sand box for nocturnally emissive gun fights with all the bad guys over there?

My real hope is that these latest tactical medic bad asses really train as hard as they may have to fight because if they dont then they become another bunch of tactical wacker groupies that endanger themselves, patients and the real swat cops.

Minus 10 points to the PD and MAST for allowing a tactical medic"s name to be published all across the country...GREAT security guys he is already a target and hasnt got to kill anyone himself yet!!

Somedic sends.

Not sure why you think he needs the intense OPSEC...they also printed the name of his supervisor. SWAT team members are not undercover detectives (usually) so having their names in the paper probably isn't giving away much. Other than now the local hoodlums will pop the trunk of his crown vic in the driveway and take his AR, MP5, body armor and 50 mags

I also saw that you said you don't see a paramedic doing ALS duties until the scene is secured. Well I believe that is the point of the tactical medic. They get some training in team movement, safety, and accept the risk of working in a hostile environment. What about the active shooter scenario - You have 1 maybe more shooters in a public school (guess it could be private too and the team moves in - Officers prepare to move into a classroom and one officer takes a groin shot possibly nicking the femoral. Could another member apply a tq or pressure? Yes, but now you have one guy wounded and 1 or more (shooting team members) treating him. If you have a dedicated team medic - they can provide care while the members address the problem at hand - the shooter.

A lot of SWAT team medics spend them time addressing non-traumatic injuries like training injuries, dehydration, jock itch, and checking vitals before PT drills. Of course you could have a civilian medic doing this but the "team medic" or the dedicated "tactical medic" develops a bond between themselves and the team. Trust plays a big role and if they feel that you have taken the initiative to learn some tactical training it may further the team as a whole.