AnthonyM83

I believe it was only 1 page until very recently. Also, note how many rounds of epinephrine and atropine you can give prior to calling base and asking for orders: ONE. And can someone find how much albuterol you give a two year-old with wheezing? (Whoops)

Sir, your original post, which I originally quoted and was replying to, stated, "As a EMT ride along student, your primary responsibility is just to observe." I disagree with that idea and believe it contributes to under-education of EMTs. Primary responsibility should be to observe and perform directly supervised skills. This is especially important when most exam partners in EMT schools present healthy and in ideal circumstances with lower anxiety (in both examiner and examinee). I am not addressing whether a student can jump in and start doing what he wants during a ride-along. That was a separate topic within the same thread. Which is why I did not make that comparison. Instead, I compared a first year medical student with only A&P in specific body systems with very limited skills sessions doing screening exams at clinics with semi direct supervision with an EMT student, only as it applies to contesting the point that higher medical professions do not have students assess with incomplete education. As a side note, many medical students have not had intensive 4-year undergraduate education in biological sciences. Many are English, Psychology, Music (etc) majors who took only the basic prerequisites. Even many biology majors cannot tell you much about anatomy, as many undergrad programs place heavy emphasis on biochemical processes, genes, and even general animal physiology, but low emphasis on human anatomy. Freshman zoology, 4-6 years prior, might be the closest to an anatomy class a new medical student's biology undergrad required (provided he was even a science major). A bio undergrad can tell you all about the citric acid cycle and SN2 reactions, but not always how many ribs we have (depends on the program).

Heh, GIGGITY. Biochem wouldn't hurt for paramedic school, though for sake of understanding things like pharmacology and toxicology...but that would depend on how in-depth your chem and pharm lectures in school are. Scary. All of those terms and some of the basic accompanying formulas are covered at the local EMT-B school here, as some of them apply to understanding of the drugs they can assist with, such as NTG. Many of the "good" students have at least basic rudimentary understanding of them and use them when being quizzed on EMT pharm during their ride-alongs... Lisa, take the most in-depth A&P course you can find, provided that you meet the prerequisites and won't end up overwhelmed to the point it hurts what you gain from the class. Students with A&P or simply biology backgrounds assimilate the concepts much faster, as they have more "concept hooks" to integrate the new material with in their thinking. This makes it easier to remember the new EMT material. You'll be much more confident when you go to paramedic school, too. Instead of waiting until then to start understanding the underlying disease processes, you'll start at the EMT level. By the time you get to medic school, a lot of that info will already be second nature to you. Which will let you take away even more from each paramedic class session. It also lets you ask more intelligent questions of the other healthcare personnel you'll see at the ERs.

I imagine because it's implied that an ALS patient often (though not always) needs more complex assessments, procedures, and monitoring. They also have a higher chance of being unstable. In case it comes up, I don't think this he's asking whether the crew is ALS or BLS, versus what type of patient we classify them as.

Never, which is exactly why I'm confused about Daedelus's comment suggesting that an EMT who has completed the 110 hour course has such a better understanding of A&P, especially when A&P is commonly done toward the beginning of EMT class. Aside from that, the EMT should not just be prodding. The point of direct supervision is to guide their technique, in general, and specific to that patient. My EMT 'preceptor' asked me to show him what I was going to do first, then guided me through it with stable patients. That included deciding which patients I would not be doing the exams on. Again, I'm specifically saying that by the time they graduate, they have a great education. BUT by the time they do their first physical exams on patients (with mostly indirect supervision) they might not have most of that training. The example was the local school where they might only have 2 hours of abdomen exam skills lab before doing it on real patients (example: screening patients at clinics). This was in response to comparing to other professions that wouldn't allow practice of exams on patients with so little practice.

Things have started getting better, but a couple years ago it was ROUTINELY 2-6 hours (as the norm, sometimes less, sometimes more). You get stuck at a bad hospital during a busy time and your shift is "shot".

Why would they be doing it on their own accord? They should be doing it under your direction, since you're a part of their education. How is that different from your education as a working EMT? You've seen decompensation from the palpation or decompensation that naturally occurs? If the latter, then the palpation can help give you a sense of urgency and perhaps help you with transport priority decisions. Negative Vents, A&P is a not a prerequisite for medical school and many students have not taken it. The A&P they do get in school (depending on the school) may only be in specific systems by the time they start doing exams during 1st year preceptorships. Additionally, supervision is not always "direct" for all patient contacts. And their physical exam skills lab time may be limited to less than 10 hours (maybe 2 of abdomen). I've been present for all physical skills labs a local prestigious medical school. In the end they get great training, but with their first exams they have practice time similar to some EMT. Now, that doesn't invalidate the arguments made about needing better education before attempting skills.

For you it's not rocket science, because of the level of EMS provided here. Go work in more advanced systems were you actually have to do some thinking. Of course, you can get away with less (LA does), but doesn't mean you're providing the best service for your patients or citizens. It's a stepping stone job here, because that's the way the system is set up. There are people in other parts of the state and country who do private EMS because they care about EMS and patients. I honestly want THOSE guys responding when I'm in serious need. Says who, our medical directors? Talk to the patients who have mortality/morbidity because of faults in the system. It rarely gets back to those in charge. So, you're saying you cheat on your wife (and in effect your kids)? And you're saying this in order to get "standing" with us? That just shows how screwed up your mind is. You have low personal boundaries and decision-making skills, as well as ethics. That shows poor personal strength. To think your kids (you brought them into this conversation) are going to be imprinted off of your values, thought processes, and behaviors...

Medical oversite through reading run reports doesn't mean crap if you're making up what you write on the run report. If hospital complaints rarely actually get to the medical director, rather just the paramedic crew themselves or the station captain. Think about it...how much could you get away with...people regularly do.

Dude, the LA medics can't even rip their own tape for IV's. They literally get upset if the EMT doesn't have tapes pre-ripped for him and handed to him, even if EMT is trying to do something else like putting on O2 or hooking the monitor up. I can't imagine what would happen if majority of our medics were translocated to a real EMS system. BTW, did you start medic school yet?

Wow, that's what contributes to crappy EMT education right there. You say their education is not enough to even practice skills on patients under direct supervision. So, what makes it okay for you and your coworkers to perform those skills on your own?

Since you're talking about urgency, what about buying the patient time by recognizing a potential AAA based on pulsation (38% is a pretty good stat, 1/3)? Especially since current literature is saying rupture from palpation isn't a danger. Also, as far as the 4 years of medical school comments...students are often palpating abdomens at under 4 or so months of school, in theory "supervised" but not always directly supervised. BLS also often gathers preliminary information for reporting purposes without the full knowledge to interpret it. Paramedics, often do the same. This idea isn't new...and one can never know enough, unless one goes to medical school (and even then apparently not full knowledge). Alright, still trying to catch up on the posts in this thread...

Do you have further details that I could provide to any potential prospects I might find? Length of course? How skills are practiced /tested? Any travel involved and length of stays? Is it accredited?

EMT's are still taught this, because it is the standard of care, thus it would negligent for an educational institution not to teach it. It most areas, it would also be negligent for a healthcare provider not to adhere to it without specific reason not to. It also concerns me that it surprised you that the EMT attempted to practice his assessment. It surprised you to the point that you had to yank on his hand. Palpation is part of the physical exam and can provide information that supports suspicion of a life-threatening condition. Please elaborate on the situation that occurred, you thinking, and why you assumed we'd all be on the same page with you about not teaching EMT's to palpate.

I don't forsee any major changes to EMS itself, but there will be continued implementation of the educational standards and other Agenda For the Future items. Things that field employees might not directly see effects of other than perhaps additional education requirements.

As far as the experience portion: It seems to work well on near syncope, positive orthostatic, weak/dizzy patients very well (depending on cause, of course). That's patient experience. For personal experience, I woke up from a shift extremely sick once, was dehydrated, and had sudden sweating, skin felt cool, (I'm sure I was pale), and head not quite hurt, but felt like worst hang over ever. I literally crawled to an O2 tank in supply room and received very quick relief from an NRB. It felt like life coming out of that thing. Felt so good to take those deep breaths of O2. After the episode itself passed I was fine.

My advice would be to stay away from California if you're seeking real EMS work, but if you do I suggest "NorCal" rather than "SoCal". I've heard San Diego is a really nice place to work and EMS is 'decent' for California, but pay is low. Stay away from Orange County and Los Angeles County...it's more pseudo-EMS. ALS is FD only with EMT's as ambulance drivers and "load em up" guys.

The features I like on a watch for work are digital, subdued backlight, plastic (for easy cleaning and fast drying after hand washes).

Alright, might be going both days. Anyone driving in from the Columbus direction who might be able to give myself and a friend from CA a lift to the conference?

I think I'm missing something in the setup. MedicOne units (which are part of FD?) run mostly critical calls? So, who runs the ALS calls on the "less critical" calls? Separate FD ALS ambulances? How long is their medic program? And if you ARE a medic, you said it's just an additional year of training to work there. Is that additional year for a medic who went to school anywhere? Or do they have a list of "approved" programs that they deem strong enough where they only give you the additional year (instead of making you take their entire program)? In other words, I heard one school say they were one of the few that MedicOne made special exceptions for. I don't know the exception was only making them train a year. Or if the one year training ins the standard, and thus medics coming out of certain schools would have less than a year training?

Because at least one AHA publication instructs one to do this during CPR. At least that's my reason...but nowhere near the top of my list of things to do...

It might then become easier, but depending on the blade, the little shelf it creates to one side also helps you visualize your tube better as it goes down. (Some more or less than others)

Thanks for the continuing replies. Addenum Question: Do you guys put the HEAD padding on the board before rolling patient onto it or after? I know some like to stick the disposable head padding (Head Wedges, Sta Blocks, etc) onto the board first, so you don't have to lift the head later. The downside you don't always know where the patient's going to land when you roll. Also, if you need to go down, then back up, the head sliding off the pad (bigger deal for thicker Sta Block pad than for thin Head Wedge pad). What's the correct way of doing it? Or what ways do people do it in?

Depends on how bad the place looks. What you described is very very common in much of my service area? It'd ba subjective decision. If the patient wanted to stay, I'm not going to intervene and make problems every time I saw that environment (I'd be doing it daily.) *BUT* if I thought it was just absolutely disgusting and thought elder abuse of some kind might be going on, I'd report it after the call, unless it seemed immediately life-threatening. In which case, we might have to call a social worker then and there (if patient wanted to stay and it was life threatening almost).

Just skimmed through this thread, but I'd recommend reading through the many journal articles explaining that pain meds don't usually hinder assessment and a number of articles actually stating they help the assessment. If she gripes about it again, you can have a conversation about said articles and how it's a common standard of care now. You might also ask around at other hospitals in the area and see if they agree (which would help prove your case to her, that it's a standard).