paramedicmike

To what are you referring when you say horse collar?

Welcome.

A former frequent contributor to this site recommended this place several years ago. He reported that he had used it several times to maintain his certification. Based on his recommendation I gave them a try and have now used them twice. It's not online learning. It's distance education consisting of an education packet you download, complete and return. You will need to do work to complete the program. You will need access to reference material. You will need to fully answer the questions. Instructors have been easily available if I have had questions. Hope this helps you.

I've used both the Glidescope and C-MAC. The C-MAC I found to use a lot of trained muscle memory with the versatility of the option of a more tranditional versus video laryngoscopy. It's the video laryngoscope of choice in my ER now. Interestingly enough, the anesthesiologists in my hospital use the Glidescope. I actually like the Glidescope and have had excellent success with it. The learning curve is certainly different as it's a different approach. I've found that some of the weaker intubators (yet another topic entirely) did not do so well with the Glidescope. Of course, there were plenty of other issues involved. Though, I think the different approach with the hardware and mechanics of the rigid stylet were problematic for those in question. I've not used the McGrath on a live patient. Practicing on a manikin, however, was easy and I did like it. Nice to see you back. edit: punctuation

A lot of people get into EMS and say they're going to go back to school. Very few of those people actually go back to school. The reasons why are varied. It is not impossible, however, to go back. 1) This doesn't sound like an unreasonable goal. Some of this will depend on what classes you'll have when you finish HS/associates work. 2) Can you do paramedic school at the same time as completing your premed requirements? This would save you the time in paramedic school after you finish your undergrad degree. What will you do if you run into two year paramedic programs? How much will that affect your timeline? 3) What's the goal of working as a paramedic on your local male dominated FD? Simply to be a woman breaking into the FD to leave in three years or less (if you stick to your med school plan of age 24)? If that's what you want to do who is anyone to tell you "no"? What happens if the hiring process for your local FD doesn't mesh with the timeline of your plans? If you're looking for (life) experience before going to medical school consider moving to an area that will better offer you a better chance to work as a medic. Make a plan. Stick with it. Be ready for the foreseeable pitfalls. Be ready for the unforeseeable pitfalls. Pick your battles wisely.

This story has popped up in a couple of my news feeds over the past few days. Thought it was interesting. Reuters link. Medscape link. (May require a log-in.) Essentially, the more cardiac arrests you run the better the survival rate. There were some limitations to the research. It's an observational study. It says survival to hospital discharge but I haven't seen anything about how neurologically intact any of them are. However, some of the findings they note were interesting. Years of experience as a paramedic didn't count. It was observed that the more often paramedics encountered an out of hospital arrest the less the chance of the paramedic deciding to work it. Eleven percent of the paramedics involved over the nine years of the study didn't encounter a single cardiac arrest (which makes me wonder who these folks were... admin, supervisors, people who retired/resigned early on... nothing I've seen goes into detail).

There are a few questions here. What is their mindset requiring an IV and monitor? What is their justification? Is your medical director on board? What does your medical director have to say about this? What answer were you given when you questioned why a suspected thumb fracture needed an IV and monitor? Knowing whether this constitutes upcoding and/or fraud will depend on their billing practices. Based only on what you've provided so far I don't think it's a straight forward answer. You can always contact CMS and ask. If this is something you're legitimately concerned about then quit and find a new PT gig. Take steps to protect yourself. Document everything. Keep us posted.

I jumped, too. Did not see that coming.

Here's the thing. Appearance matters. Image matters. It's important. It always has been. It always will be. This is true for all cultures, subcultures and underground movements. Dress for success. Dress and present yourself for the the job you want... not the job you have. It is better, in a business or interview setting, to be over dressed than under dressed. Image and appearance is what people notice first. Want to be taken seriously? Then present yourself in such a way so as to give others a reason to take you seriously. Employers are free to put whatever kind of restrictions they want on their employees. No tobacco policies, no drug policies, no visible tattoo policies and more are all well within the rights of employers to enact. These policies are not a violation of anyone's individual rights. Employers are free to present an image that makes their customers take them seriously. If that means no tats, no facial hair, no <fill in the blank> then it isn't a matter of the employer being unreasonable. Rather, it's more a matter of how badly the potential or current employee wants to work there.

Gotta agree with this. While we are moving towards more quantifiable measures of the care we provide, and being asked to provide documentation to verify that care, there are still simple physical exam findings that can and will demonstrate that interventions we're performing are working. Treat the patient not the number. If you have a number to additionally verify your interventions then use it. It will benefit, and may protect, you in the long run. But don't rely on nothing else except for the number. None of these things are independent of the other. It is all a part of the patient care package.

Why say something when it's not the idea you're really trying to convey?

Oh, I don't know. I think not ventilating and letting the patient die is far, far worse than ventilating without end tidal. At least then you can wind up with a live patient and a potentially correctable blood gas. Ideally, yes. We would do everything perfectly in every instance. Ideally, yes. We would have ETCO2 hooked up every single time we have to manage a patient's airway. Don't think for a second that I'm arguing not using it whenever possible. However, we work with what we have. We all know, especially in EMS, that this is a very uncontrolled environment. Inconsistent minute volumes and a live patient is far better than a zero minute volume and a dead patient.

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Welcome. A well prepared EMT student should have college level anatomy and physiology, math and writing/composition classes under his/her belt. Bonus points for history, psychology and sociology classes will be earned once you start dealing with patients. Hairstyle, grooming standards and personal hygiene requirements can vary from employer to employer. If you want to work for a specific organization that has grooming and physical appearance standards as a condition of employment be prepared to cut your hair. edit: double period fixed

Interestingly enough I was one of two paramedics in my PA school class. We had a few EMTs, one RT. The traditional applicant used to be a military medic/corpsman. That evolved into EMS providers. Today, however, it's lots of younger folks with limited life experience. I would love to see US EMS education mirror some of the educational programs in other countries. PAs with a solid EMS background would be ideally suited for community EMS programs as well as more critical care based programs (e.g. ground or air critical care transport). Unfortunately, that's not something we'll be getting anytime soon.

If appropriately staffed with a PA/NP level provider it'll be no different than people going to the ER for the same things they'd otherwise call 911. If staffed simply with a paramedic or EMT crew then there could be problems. In the ER there are more resources for referral available than what EMS providers have on the street. Put an appropriately educated provider into these types of community programs with the resources that s/he would have available in the ER, I agree that PA/NP would be ideal for this, and not only could you decrease inappropriate access of the 911 system but also, potentially, of the ER as well. This would likely be geographically dependent. It would certainly be interesting to study. Funding/billing would be difficult. I'm way more expensive as a PA than I am as a paramedic. To my knowledge (here in the States, anyway) CMS don't have a means to bill for these types of visits. In other countries there may be different financial structures in place. EMS provider education is a huge factor. Paramedic educational programs are not geared towards, nor do they provide an adequate base for, this type of medicine.

Welcome. That seems like an excellent question to pose to your command structure.

Then log out and log back in. Please don't try to post under another user name. It'll get confusing. Let Admin know and he can continue to troubleshoot.

PM sent.

Lots of abbreviations. No idea what any of them mean.

Ah yes. The Kingdom of Montgomery. Better than PG County anyway.

Welcome. I have heard/read of EMT programs offering a combination of online learning and hands on practice. I know very little about the quality of the programs, however. Most of the programs I've seen require at least a solid week for required hands on time. That may prove a challenge if your job is as difficult with your schedule as you make it sounds. The big question to ask is if a program like the one you're looking for will allow for state or national certification. It would be unfortunate to dump all that time and money into a program that won't leave you with anything tangible at the end. Online learning, though, isn't as easy or straight forward as one might think. I've taken several online classes and they were much more time consuming than traditional classes. Just something to keep in mind. In the end it comes down to how badly you want it. Research locally. Talk to your employer. See what you can work out.

Some interesting changes coming from AHA with their 2015 ACLS updates. For example, Vasopressin is out. Epinephrine is the first round drug of choice. Ultrasound is an option for ETT placement (likely more hospital based but interesting for any prehospital systems using u/s). In non-shockable rhythms give epi early. Lots of oxygen during CPR; if/when ROSC returns titrate as necessary. A hospital based intervention which I thought was interesting was ECMO in place of CPR if available. From an academic point of view it's interesting to trend the changes over time. It's interesting to watch the research. It'll be interesting to see what comes next.

Locally I've recently seen two cardiac arrest transports that were, on their face, questionable. One turned out to be a hunter, questionable hypothermia, and the crew kept getting a shockable rhythm. The other turned out to be a scene safety issue. It was reported that the family was less than reasonable and the situation deteriorated quickly. From a safety perspective they chose to grab and go and work en route. Otherwise, locally, which is an area that covers both rural and urban settings, the vast majority of cardiac arrest patients found on scene in cardiac arrest are not transported. Patients are worked on scene. If ROSC occurs then they're transported. If not a quick phone call for request to terminate resuscitation attempts is made and usually granted. There are occasions where transporting someone in cardiac arrest could be warranted. The hypothermia patient as previously discussed would be a good example. These exceptions, however, aren't particularly common no matter how often we tend to talk about them. I think the vast majority of cardiac arrest patients we see are dead well before we get there. Even if resuscitation is attempted on scene there is little value in transporting the vast majority of cardiac arrest patients we encounter. To be fair we need to talk about those zebras that might otherwise require we transport. But how often are those situations realistically encountered? Of course, this says nothing of the multiple safety considerations and interventional efficacy issues of working a cardiac arrest in the back of a moving ambulance. I have worked in rural, suburban and urban environments. Personally, I have no problem, if given the right circumstances, with working and terminating attempts in the field without transport regardless of the environment.

Still have NR? You can move to inactive status and maintain it that way. It's always a tough decision to let it lapse. I'm sure this is something you've considered pretty thoroughly.