paramedicmike

Philadelphia has a population of close to 1.5 million people. That's one ambulance for every 42,800 people. That is, it's one ambulance for almost 43000 people when they're all up and running. Once the 12 hour squads go down at night there are less ambulances on the street. Many of these ambulances do shift change out in front of the station with the out-going crew driving by on the way to a call. The out going crew jumps out, in coming crew jumps in and the shift begins. They are crazy busy running from the minute they get there until the minute they leave if they can get out on time. Given the demands on their time based simply on call volume, the care provided isn't known to be spectacular. This isn't to say there aren't good providers working in this system. There are. But they are so hampered by time constraints and stacked calls that they don't really get a lot of time to do even the most basic aspects of patient care. As a result of the call volume and limited resources, it is not uncommon to hear in the local news stories about extended waits for an ambulance resulting in the death of the patient waiting. It is more common to hear of extended delays in a wait for an ambulance not resulting in someone's death. Either way, having to wait 45 minutes or more is a glaring sign of a broken system. Have you looked at NJ? No. NJEMS isn't any better than Philly but it does answer your question. Also, please consider how many people get hired as a PFD medic only because they think it'll help them get into the suppression side faster than waiting on the hiring list. Do you really want your "medic partner", who is only there waiting to get his fire ticket punched, backing you up? Brand new? In training maybe. To follow your line of thinking, where else can you go where your supervisors don't support the line guys? Where else can you go to have your schedule completely overhauled in retaliation for city mandated, illegal work practices? (Specifically, PFD medics had to sue the city for years of unpaid overtime. The city lost the lawsuit. In return, the department completely overhauled scheduling for PFD medics and have worked to create what many medics are calling a hostile work environment where even the most minor of "infractions" results in a lengthy disciplinary action.) Spelling counts. So what you're saying is that PFD is moving into the sex industry? If you're really blinded by shiny things and bells and whistles then maybe PFD is the place for you. But if you're looking for a quality employer who will not only provide you the training you need to succeed but back you up when you need it PFD isn't the place to be. It is a broken system that has, and will continue to, cost people their lives. There is not a single accredited paramedic program in the Philadelphia area. As such, you take your chances with your training. Also, at least two of the places you've mentioned have been accused of being medic mills. Consider, too, that the same training (I can't call what they do education) can be obtained for thousands less elsewhere in the area. So you are correct is saying there are plenty of places. Unfortunately, you're not making the distinction between plenty of *quality* places.

What are you looking to do? If you're looking for 911 then look at Philly fire. They are the *only* 911 provider for the City of Philadelphia. They also do not hire EMTs to work the ambulance. They only hire medics for ambulance work. However, given how short staffed they are in terms of medics, they will pull FFs and stick them on an ambulance. (As a side note, the FFs hate it and it's visibly obvious in the lack of care provided.) There are some good people working for Philly fire as EMS providers. However, they are few and far between. PFD is an excellent example of how not to run a fire based EMS system... but that's a different discussion for a different thread. If you're looking for a transport company, well, good luck with that. There are quite a few transport agencies in the city. But most of them change names on a fairly regular basis. None of them are well reputed. Job stability with them is almost absent as there are dozens of applicants for each opening (i.e. individual staff are expendable). I would *strongly* advise you not to consider working for any of these organizations. If you're willing to consider outside of the City of Philadelphia, look to the surrounding counties. Delaware County, Chester County and Montgomery County are a little better developed in terms of EMS. Squads in those areas offer some better opportunity for web research as well. You also stand a better chance of getting hired as an EMT-B than you would in the city. You'd stand a much better chance if you were a medic, though. There's always the New Jersey side of the river, too. But I can't really recommend looking there, either. Hope this helps.

I don't know. I think he makes a valid point even with all the vitriolic rhetoric. HOWEVER(!), there are a couple things he's forgetting. The Towers collapsing created a scenario for which nobody could've been prepared. In the immediate response to the collapse, by all accounts, things got really crazy. Sometimes, in the heat of battle, basic safety precautions get thrown out the window out of necessity of either surviving or helping others survive. This says nothing of the guys who under normal circumstances wouldn't have been in the middle of the action (e.g. cops directing traffic outside the buildings) who suddenly found themselves surrounded by collapsing building and all that dust. In the aftermath and clean up these guys were told that the air was clean and safe to breathe. It's really hard to fault them for not using SCBA or respirators when they're told that there is no danger. Even with these exceptions in mind I do find the cavalier approach that many of these guys took with their own health a bit disturbing. It was a really dusty environment and there were respirators available for them to use. Even though they were told the air was clean I don't know that I'd want to work without some sort of respiratory protection from all the dust that was being kicked up. All this being said, it's easy to critique a situation from the comfort of 20/20 armchair hindsight. While that doesn't remove the possibility of an accurate assessment of events, it does create a situation where the reviewer should be a little more sensitive. The author of this letter to the editor certainly tossed any tact he may have had out the window. And he may have done that on purpose. I'm not saying I entirely agree with him. But I do think he makes a valid point.

Tape works to secure the device. It will also fit in a Thomas Tube Holder. If they don't bring this up in your training I would make sure to ask.

When you "inflate the balloon" there will be two inflations on the tube. The distal inflation secures the esophagus. The proximal fills the oropharynx above the glottic opening. The openings for ventilation purposes are between the two balloons so air/oxygen can be directed into the right spot. If, however, you use the wrong size or don't inflate the cuffs enough then there is a risk for gastric distention. Proper use of this device, though, should not result in a distention related problem. I think once you get your hands on the tube itself you'll get a better idea of how it works. If you google "King LT airway" and look at the images that come up you should get a better idea of how it sits and how the inflations work with patient anatomy. What else would you like to know? These things really are a good tool to have available. Just a word of caution. Once you put these into service make sure there are educational opportunities at your local receiving hospital(s) to make sure the docs know what they could be getting. The last thing you want is for some doc who has never seen one ripping it out with the cuffs still inflated.

This device does not insert into the trachea. It is a blind insertion airway device that is ridiculously easy to use. This is our backup airway device. I've used it on patients who, for a variety of issues, couldn't be intubated and have never had a problem with it doing exactly what it is designed to do. You asked about timing. If a provider can't place this device on their first attempt (i.e. mere seconds worth of time) then there are some larger issues at play. It really is that easy. Easier than a Combitube, even.

Gotta agree with Fiznat (again!). If you think a four degree will be a waste then you need to sit down and rethink your priorities. What options do you see available to an EMS provider with a degree in health care administration? What options would you like to see available for an EMS provider with a degree in health care administration? What options do you think you could create for yourself with that kind of degree? You're only limited by your imagination. If you can't imagine where you want to be in five or ten years then we can't help you. I can tell you that your degree won't be a waste. If you think it might be a waste then perhaps you're not in the right field of study. The degree you earn through the education you'll receive will take you much, much further than any career in EMS might.

There's no reason for an EMT-B to need such a high end scope. There's no need for a medic to need such a high end scope. If you're looking for a status symbol to hang around your neck earn your college degree. That'll take you more places than your $200 stethoscope will.

This. And for whom is this paper being written? Are you in school? What school? What program of study? Or are you a journalist creeping around looking to steal people's ideas and claim them as your own? (And before you get defensive about it, the answer to your question is yes. Journalists posing as, well, posers, have come here looking for a variety of information. So if we seem a little skeptical there's usually several good reasons behind that skepticism.)

Come on, people. This is false. Pay particular attention the last paragraph of the above linked page:

Why not post them here so that others may benefit?

Boston EMS is part of the Boston Public Health Commission. I'm not able to find any information regarding a "Boston Health and Hospitals Corporation". Boston FD does, in some circumstances, respond with EMS but is not in the routine business of providing EMS. This information is easily accessible.

I'm sorry... "Boston EMS Fraud"? You may not have committed a copyright violation by linking the article, but you did libel an entire organization who's name appeared nowhere in the linked story. Boston EMS conducts its own in-house training. As such, I'm willing to bet they had absolutely nothing to do with the people mentioned in the article. They certainly weren't mentioned in relation to the (now) defendants. Yes, some of the people mentioned and referred to in the article live in the greater Boston metro area. But that doesn't mean they worked for Boston EMS. To insinuate as much, with no evidence to support your position is well beneath your demonstrated standard of behaviour in these forums.

I'm in school now and have some thoughts on this. However, I've got several exams this week and can't really take much time to answer at the moment. If I don't post something here in the next couple days send me a PM and we can chat. -be safe

Yeah. Admin didn't remove it. Squint initially coloured it white so as to blend in and not be seen unless someone either quoted him (that's how I saw it) or highlighted everything he wrote.

JP turned when the tone towards him changed. However, I'm not going to defend him. He can do that himself. I think this is a fair question and bears an answer for the benefit of this conversation. I have been in this position... confronted by people who thought that the actions of military, and by default military members of my family, were condemnable. Circumstances were not completely similar (and not completely different) to what was presented in the news story or video. Although, the comments directed towards the military, and by default family members serving in the military, and to me for supporting them, were equally harsh. My honest reaction was that of pride. I was proud of the fact that these people were free to lawfully assemble and speak their mind without fear of retribution or recourse from the government. I was proud of the fact that I live in a society that tolerates and even promotes the difference of ideas and allows for a forum to air ideas. I was proud of my family members who have served to help protect and defend that right. My response to them was to wear a bigger smile knowing what I just outlined. I'll even admit to a secret joy in finding out that this pissed off the protesters even more. I was *not* offended by their protests or their comments. Nor did I say anything to them as it was neither the forum, time or place for confrontation. Besides, what good would it have done? Their protests, just as the ones in the video, demonstrated ignorance and stupidity on such a level that they didn't need anyone to make them look bad. They were doing a good job of that all on their own. I understand. Nor did I think this was about me or you or anyone else who has contributed. I think the difference here is that while you were upset by this, I can think of no better way to honour the sacrifice of those who died defending the freedoms we hold dear than to exercise those very freedoms. If we deny the right of people to exercise the freedoms that people have sacrificed their life to protect then we belittle, demean and completely invalidate the sacrifice made. That, I'm afraid, is a bigger crime than letting these boneheads hold their protest. -be safe

Seriously, Squint? I thought you were smarter than this. This type of response from you, especially your little hidden message at the bottom, seems very unlike the rest of your posts throughout this site. I understand you feeling passionately about this. I even understand why the protest upsets you. However, resorting to name calling and telling those who present a respectful counter argument what they can do with themselves is really beneath your usually astute replies. Did you really think people wouldn't notice? ETA: I have to agree with JP on this. This is the protest you were upset about? A small group of people making fools of themselves in a fenced off area away from the main ceremonies? Will you next ask for a limit to a free press because without them this little moronic demonstration wouldn't have received any air time?

Do you, who are arguing for a limit to free speech, honestly believe that there should be limits place on speech based on what is deemed "offensive"?

At least in the US this is specifically for whom freedom of speech was intended... even if the intent is to offend. Someone is *always* going to be offended by something someone has to say. One cannot limit speech to only what s/he finds acceptable or appropriate. If speech were limited based on what certain people found objectionable then no one would have the right to say anything. Once that freedom falls then others are soon to follow. Even if the sole purpose and intent is to offend, the right to speak cannot and should not be eclipsed. You are free to be offended. You are free to voice your offense. You are free to counter protest. You are free to ignore it. You are not free to limit the rights of the individuals involved. The actions may be despicable. The actions may be deplorable. They may be offensive and in egregiously poor taste. But they are protected. Because someday that may be you being called offensive who's actions are in poor taste. -be safe -edited for spelling

In the US at least, and this is the basis from which I can write, disruptive acts (as both you and JP have outlined) including burnings in effigy et cetera have been determined by the Supreme Court to be protected speech. They are physical actions and do not always include the spoken word. However, the expression is, and has been determined to be, protected speech and therefore permissible. If the laws are different in other countries then I am woefully ignorant and can't comment specific to them. Are free speech acts in Canada limited to just the spoken word? Or are actions included in free speech as well? -be safe -edited once for idea clarification

Yes, coming in late to the discussion. I've been reading intently, however. Just haven't been in a position to reply. This is an interesting thought. So if freedom of speech isn't an absolute, who limits speech? You? Someone who's offended by what you say? If you're willing to accept that someone may limit speech then why have it specifically protected as an inherent freedom? Why not remove it altogether? What happens then when someone decides to limit your speech because she doesn't like it? What's more, if someone destroys something important to me and I, in turn, destroy something important to him then I am no better a person than he is. That's a rather childish approach, isn't it? From the US side of things I think an avoidance of that type of behaviour is something that's helped us reach the point we're at now. If everyone responded in a tit-for-tat manner we'd all be dead. Freedom of speech isn't designed to protect speech with which we agree. It is specifically designed to protect speech with which we *disagree*. Remove that protection and we open up the proverbial slippery slope. I understand the argument regarding respect. But respect and freedom of speech are two different concepts. -be safe

To say "I appreciate" wouldn't begin to do justice to the sentiment.

Condolences and peace to you and your family, Herbie.

Well, first things first. Welcome to the City. You will find a lot of very knowledgeable people here with a wide breadth of experience. With regards to your post, I feel I should say this now because something tells me you might not get to the end. I think I see where you're headed with your thoughts. I'll even go so far as to say that I like what you're thinking. However, please tell me you haven't sent this yet. If I were to receive an email like this (if this is, in fact, exactly what you sent) I would delete it without a second thought. I probably wouldn't even have read it in its entirety. The grammar and spelling mistakes alone are enough to do away with any credibility this piece of correspondence may have had. There are also some very basic and fundamental construction issues that are blatantly absent. Without this foundation, anything you write is worthless. Before reading on just remember, you asked for feedback. You're asking for a complete restructuring of EMT certifications but you have not outlined why. You have failed to demonstrate there's a problem. By failing to demonstrate a problem you have essentially demonstrated to the reader that there is no point in reading further. All you have done is outline your resume which has absolutely nothing to do with asking for certification restructuring Really? This is news to me. Do you have any information to support this claim? How are diseases more complex? Why do patients need more than BLS care? How do you counter skeptics who have studies to back up their claims that EMS doesn't do a whole lot? If you do have resources to support your claim, failing to include your references pretty much removes any credence to any argument you may be trying to make. The reader is free to assume that you're just shooting from the hip and have *nothing* to back up anything you're saying. This is another reason to immediately delete what you've sent. Is this a problem in NY? Are skills being added with no formal training? How does that work? Since you've not cited any specific example to justify your claim why should anyone continue to take you seriously? What's more, why the concentration on skills? Medicine is not about skills. Medicine is about knowledge and skills are an add-on. Perhaps a focus on EMS education instead of EMS skills would help. Again, why? You have no argument presented nor do you have examples citing why you believe these changes are important. You started with something potentially useful by trying to compare nursing with EMS. Where you run into problems is comparing the two with no common link established as to why EMS should model nursing. Nor have you demonstrated *if* EMS should model nursing. You have failed to demonstrate why this is necessary. You have also failed to demonstrate why people should listen to you. What bridge from EMT to EMT-P? This is the first time you're mentioning this. How will obtaining a CCEMT-P certification help make the transition in health care easier? Again, you've provided no examples to support your point. Prerequisite courses? What prerequisite courses? You've mentioned nothing about how any degree program would offer prerequisite courses that would even come close to satisfying requirements for other degree programs. Do you plan on including all the schools that offer EMS education in your certification revamping process? What about, like Dwayne astutely noted, all the other outside interests that claim a stake in EMS? What about fire based EMS systems? What about municipal third services? What about all the private services that aren't going to want to pay a higher wage for a college educated paramedic? What idea? You've offered a half baked solution to a problem you haven't identified. What's more you haven't provided examples of why whatever it is you view as a problem is, in fact, a problem. Are you asking for a job? Did you send your resume with this letter? Before anyone can say I'm not offering any help, please consider the following: Dear Sir/Madam: (This would go even better if you had a contact name so it could be formally addressed.) Paragraph 1: Identify yourself and your experience. Paragraph 2: Identify the problem you see and how you came to see this particular issue as a problem. Paragraph 3: Cite *specific* examples that can be independently corroborated that support your claim that there's a problem. Paragraph 4: Identify your idea that would serve as a solution for the problem you've identified and supported by way of examples. Paragraph 5: Briefly outline details of your solution and how they would benefit the involved parties. Paragraph 6: (optional) Discuss potential pitfalls or roadblocks that would stand in the way of successful completion of your plan. Paragraph 7: Close by summing up everything you've outlined so far. Close by saying, "Thank you for your attention." Regards: Alex Woo Yes. This is a lot of work. But progress of the kind I think you're shooting for doesn't come easy. Good luck.

I like it.