BillKaneEMT

I'm kind of on the fence about this one. My personal code is something along the lines of "do what you like as long as you don't hurt anyone else". The problem I foresee with the assisted suicide issue is the competence factor. Is the patient truly competent to make the decision? In many, perhaps most cases they will be. What happens when the patient is not though? What happens when an elderly patient is cajoled, guilted, or tricked into requesting assisted suicide by their greedy offspring? This is a tough issue. I think both sides of this discussion have raised valid points, I would probably lean toward the "pro" side of this debate myself but only if there were some way of preventing worthless pieces of shit from murdering the elderly for personal gain. If anyone thinks it wouldn't come to that I must respectfully disagree based on my own observations in our local nursing homes. So to clarify: I'd say yes, but with severe restrictions regarding competence of the patient, education pertaining to the patient's available choices, and extremely draconian penalties for violating those restrictions. Basically I'd prefer a system in which any violations of those rules change it from assisted suicide to murder. Because it will be. Please don't misunderstand. I'm very open to letting people make their own decisions. Whether I approve or not isn't really relevant. I don't want people telling me what to do so I try to afford the same courtesy to others. I smoke. I'm aware of the danger of smoking and I do it anyway. I'm FAR from perfect. Hell, I'm far from good sometimes. So yes, let people choose by all means. But I don't smoke if I'm around non smokers. Because then my choice hurts them which is unacceptable. I know of at least 2 cases in local homes in which, if assisted suicide were made legal, family members would attempt to browbeat their suggestible elderly relatives into taking it. You wouldn't believe some of the things I've overheard said to patients by "loved ones". Or perhaps you would. In any case, I could accept this if the rules governing it ensured that NO patient, EVER, would be tricked, intimidated, or harassed into losing their life for the enrichment or convenience of someone else. edit: Just as an fyi- reporting suspected elder abuse is both necessary and easy. You can do it anonymously if you like. Every state does it differently, as far as I know Indiana is the only state in which the Adult Protective Services program is a criminal justice function. Laws to protect those who are unable to protect themselves vary by state but most seem to include some variation on the following: (taken from IN.gov) Not trying to be preachy but seriously, if you're suspicious report it. They don't go off half cocked, they investigate. If you're wrong, oh well. If you're right you prevent physical/emotional pain and suffering and it costs you nothing. I'm not a violent man but physical or emotional abuse of people who can't defend themselves sets me off like nothing else.

I don't think hurt feelings are too big of an issue:) regarding other licensed healthcare provider (in the US) with less education or training than in EMS (in the US) our local CNA classes are 75 hours in length as opposed to the 182 of the emt class. Not that I'm excusing the lack of scope of our Basic classes, simply wanted to clarify. This is a fascinating debate. In an ideal world I suppose every rig would be crewed by 2 people of at least paramedic level of training and education. My assumption is that most basics would prefer to be medics. The 2 major problems involved in upgrading ones education, at least from my perspective, are cost and time. Medic school costs more than half of my yearly take home pay. The time factor occurs because I need to work at minimum 55 hours a week to meet my living expenses. When I start medic school that's no longer going to be an option. I'll probably need to take out a loan for tuition and cut it back to ramen noodles twice a day again. It's worth it to me because I picked this field and I'm damn well gonna stick with it but I'm not sure how many current basics will be willing to live like a monk for the better part of 2 years in order to provide better patient care. In a perfect world the answer would be "every last one of us" but I'm a little too old to believe in perfection. The current emt education system is sadly lacking, no one can deny that. Any fresh emt can figure that out shortly after he or she starts working. I attend every class that's offered by our medical director's hospital (because they're free for me) and several of them, in my opinion, would be fairly easy to fold into the current emt-b curriculum if they took the class from 5 months to 8 or 9. Hell, make it a year. and 2 years for medics. But companies will need to adjust to the new educational requirements as well. I.E. -pay more than McDonalds. @Kiwi: Kiwi, what do your first responders do? Work concerts/festivals and things like that, or is it more of a volunteer cert held by people with other jobs (teachers, sanitation, movie theater workers etc)? If it's a 16 hour training session then there's really no reason not to teach it to everyone who interacts with the public. That might be a helpful and fairly simple idea to implement over here. Does the class include AED/cpr too?

Interesting topic. Presumably you're suggesting that all ambulance personnel should be trained to medic level. Do you consider NREMT-P certification high enough or would you prefer a setup more similar to that of some other countries which require 4 year degrees? Additionally, have you considered the logistics? Given the (approximate number according to the best estimates I could find online) 40,000 ambulances operating in the US we would have to open up some more paramedic schools certainly. I'm honestly unsure of the percentages involved basics vs medics, but I think it's a safe assumption that basics are a significant majority given the faster (and much much cheaper) education required. The numbers I saw most frequently were 40000 ambulances and half a million 911 calls per day. Not sure if that's including services like mine in which 80% of our calls are medical and/or scheduled transfers for testing or treatments. Regarding 1: I agree to an extent. The public is certainly unaware of the variances between our certs. I'm not entirely sure that it matters to the majority of them though. I don't bother telling people outside the business anymore since doing so typically generates a blank stare and a shrug. I'm not sure about establishing a professional identity though. I need to give it some more thought, I honestly haven't considered the issue in any depth. Regarding 2: I'm sure the average joe(sephine) on the street doesn't appreciate our extremely varied levels of training but I'm also not sure how much it would matter to them. I understand that an ALS crew is able to provide a lot of treatments BLS crews can't, and certainly if I'm in serious trouble medically I'd be real happy to see that paramedic patch. I really prefer to avoid medical care altogether whenever possible, barring serious injury or a worse illness than I've ever had I will avoid hospitals at all costs. For myself obviously, not my patients. I have a couple regulars who call us once or twice a week for a ride to the ER. (Like triage much? *sad headshake*) Anyway, I've never been on a call in which the patient said or implied that I oughtta be a medic instead of a basic. I grant that it could happen though, particularly in pain management situations. "Morphine? Sorry, no can do. II have...errr... Baby aspirin and a bite stick?" Anyway, I once again need to crash, hopefully sleep will prove less elusive for me tonight. This is a great topic and I look forward to the lively debate that will doubtless ensue. I'd like to add as well, one of the reasons I'm getting prepared for medic school this fall is that I ~do~ feel my patients would be better served if I had a deeper medical background and education. Would I like to see everyone on the rigs a certified medic? Sure! Would I like to see everyone on the rigs granted the same level of autonomy as a New Zealand medic? Given proper education then absolutely! I'm just not sure how practical that would be given the current (and expected) call volume in the US. Again, great topic!

I can tell you that starting medics with their nremt-p make slightly over 12 dollars an hour at my company. Perhaps 13 or 13.50 at a few other places in this area (we're on the low end). Basics make 9 and a bit, which might be dropped soon. Wanna take a stab at how many hours you need to work at 9 bucks and change to make your mortgage payment? ;-D I get less than 60-70 per week (between both jobs) and I get evicted. Better hope no one cuts back the hours. And thank goodness I'm just renting, if I was stuck owning I'd be screwed. One of my coworkers just took his nremt-p practical in Iowa(there was no nremt-p practical in IN at the time), and apparently basics and medics make a significantly higher wage in Iowa than they do in Indiana. He's thinking about moving there. I may do so as well after I finish medic school. I like my company but I'd rather not go to school for 2 years (at 6 grand a year) and come out making 12 and change an hour. We shall see.

Kiwi, I was told that they've phased out the paramedic license in our state now. Unless medics were grandfathered in due to having their EMT-P cert prior to 2010 or 2011 you have to pass the NREMT-P written and practical to work in Indiana now. Some of our Illinois medics were grumbling about it just last week due to the fact that some IL programs run about 6 months and have fewer practical stations than the nremt-p and also have a much easier written. Or perhaps that only applies to medics from out of state. I dunno, I'm so damn tired and I can't sleep and I have to work in 5 hours:( Grahgh. So ridiculous.

Regarding the "Dr. T." link Chbare, I personally would be uncomfortable with the "3 hours of didactic training and 6 to 10 hours of practical training (on a manikin and then real patients" he suggests for advanced airway management. I dunno, I've only worked a half dozen als shifts thus far (typically the more experienced basics get those unless someone wants a day off or calls in sick) so I haven't seen medics working in the field to any great extent, but even if my instructor were some sort of superhuman medic I'd feel pretty nervous about trying to intubate someone after after 9-16 hours worth of practice and instruction. I don't feel qualified to determine how long medic school should be in the U.S., my area has multiple courses ranging from 8 months to 2 years. I will say that I'm going with one of the longer courses simply because I'd be more comfortable in the rig as a medic with closer to 2000 hours training than I would if I had 1060 hours. Again, I'm not saying it's impossible to train a qualified medic in 7 months. I personally haven't had the education as yet to make a reasonable case against it. I just don't plan to go that route. I've run into several random things on calls, a couple of which I discussed in chat here, in which I simply had no clue what the problem was, how it could be solved, what could have caused it... I'm all for more education. Particularly since our als shifts are typically one medic/one basic per rig. I truly have no desire to get to a patient and be completely at a loss as to how to treat said patient. I've seen a medic with that look on his face and it was a little scary. I'm about halfway through Marieb's Human Anatomy and Physiology right now and I plan to have it read cover to cover at least twice before August. Let me reiterate though, this is just me. I have to say, this is a very interesting topic. I checked it to find some helpful hints for myself for this fall but this sort of debate really makes one think. I've been searching for the types of studies you're looking for Chbare but the pickings are decidedly slim:/ Anyhow, I need to crash out soon since I'm working the early shift tomorrow. I look forward to checking this topic again though. Later folks.

I'm a pc gamer for preference though I did absolutely love Red Dead Redemption. On pc I tend to gravitate toward the old school adventure games. Old Lucas Arts and Sierra stuff plus all the indie games of the same type. Most of which are available for free since the companies have folded now. Gotta love the abandonware.

My company will accept either AHA or ARC. I asked my boss and she said as long as our medical director said it was OK there would be no problem with ASHI in our area but it is medical director's choice. Or rather, if your director approves it's the individual company's choice. Most companies around here have at least one instructor just to keep the emt's and medics current, typically you can go to a recert class around here from an AHA instructor for 40-50 bucks. Not a big outlay. My ARC for Pro lifesavers was 80 but it came with a nice portable mask with one way filter and O2 hookup. Plus it was the one recommended by my EMT class. I know the FF's around here used to go ARC and mostly go AHA now but for some reason most dental/doctor's office people still do ARC. Are you working anywhere else or just doing the volunteer squad?

From what I read it's accepted anywhere AHA is accepted within the United States. Bear in mind that it's possible what I read was false:) Should be fine I'd think, and if not the AHA and ARC classes take a whole day so it shouldn't be too bad:) Take care!

Ok. From what I've read ASHI is equivalent to AHA in all 50 states in the US as regards cert acceptance for professional lifesavers (CNA's, EMT's, Medics, and so forth). I'm currently working under an ARC cert but most of my coworkers are AHA certified simply because my company was based in Illinois and that's more common over there. I'm going to be taking the AHA instructor class in a couple months (it's free for us and our company needs another one so why not?:-D) and I've gone over the teaching materials already. As far as I can tell the ARC and AHA courses are identical. The only difference is the movies they show and those are just different actors and such as opposed to a different message. I haven't had anything to do with ASHI yet but let me paste this: My (admittedly limited) experience leads me to believe that these three certs are probably going to be identical in all but the most trivial ways. Most likely it's going to come down to personal preference of your medical director. If anyone else has some info I don't I'm sure it will be posted soon but I'd say the probability is that ASHI will work just fine. Have a good one! edit: Not sure why it does that, my font size seems to drop to the minimum when I post something in a quote box. Oh well, fixed to be readable:)

Not sure about the FF's level of training. In my area you can't get onto a non-volly fire department without an emt-p cert. Which really means an NREMT-P cert of course since that's the only one IN recognizes these days. Older FF's were grandfathered but word is nobody gets brought on now without NREMT-P and Fire 2 unless they get a special dispensation or something.

I grew up on Amelia Island off the coast of Jacksonville FL. We had Diamondbacks, Pygmies, Coral snakes, and Cottonmouths. I was bitten by a Pygmy when I was 9 and I was sick for a week. Didn't go necrotic, the thing bit me in the ankle after I stepped on it in the backyard. They gave antivenin at the hospital, ours stocked plenty, most of it for pygmies since they treated bites from those almost constantly. I don't remember how many doses I got, that whole week is pretty much gone for me. Fortunately my mom is an RN with plenty of experience with snakebites and she rushed me in without trying home venom extraction or a tourniquet. Do bear in mind that young snakes will nearly typically empty their venom in one bite while adult snakes will rarely do so, meaning the younger the snake the worse it will be. Typically, I'm sure there are exceptions, and that may not apply to snakes outside the US. (I've had zero experience with non US snakes.) You guys may have seen this before but I thought I'd share it:-D

Positive mental attitude Good luck, hope the interview goes well for you.

Well crap. I know some of the things I was taught are incorrect and I just learned a new one. I just found http://acutecaretest...tion_beneficial when I googled part of your post Bieber. Naturally I'm surprised but I'm even more surprised they haven't done more extensive studies on this! Ideally they should conduct a much larger study on this and if the numbers continue as it seems they will they need to change our protocols. I am a little hazy as to how the study would work though. Anyone ever taken part in this type of thing? I have the uneasy feeling that the family of any patient who dies during this sort of test will be suing like there's no tomorrow whether the patient got O2 or compressed air. If anyone has done this sort of study before, is it done by the hospital or EMS service on all their patients or do patients have to volunteer? long edit: Honestly it just seems as though learning something like that in a study would be widely publicized and maybe mentioned, at least once, in class. For our practical testing they demanded it go "Gloves on, scene safe?, Did anyone see what happened, Is that/Are you my only patient?, Partner, hold c-spine, Oxygen on." Then the call in, description, head to toe for trauma or call in, description, SAMPLE and so on for medical. Admittedly we were told things would be different when we started working (ain't that the truth) but in class they were adamant about giving high flow O2 to everyone except COPD patients for crying out loud. I don't break out the nrb mask unless someone seems to legitimately need it but for the first week or so on the job I was pretty nervous about it. We got a new guy in last week, just got his cert, and he's got that edgy look in his eye that I recognize from the mirror when I started. We chatted the other day about how different things are compared to the classroom and it seemed to ease his mind somewhat. I dunno, I just feel that the class does a great job getting you ready to test and a "meh" job getting you prepared for the field. Even as it is I read something on here once a week or so that is contrary to what they teach us and, often, our protocols. Then of course I read up on it and it always seems to be correct. They should print this site's URL on the back of our certs. Well, time for me to get some sleep. Working an ALS shift tomorrow morning (yay!) which means I get to help one of our guys study for his nremt-p. Which is helpful for me too. Nighters all.

Not sure about an EMS tat. I love body art, have 4 myself and will probably get more BUT, none of mine are visible when I'm clothed. Upper arms, shoulders, back, chest, those are the only places I, personally, will get inked. I don't have a problem with people who go for full sleeves or whatever, it's their body, that sort of thing isn't for me though. I think face and neck tats look a bit ridiculous but again, not my body, do what ya want. I wouldn't get an ems tattoo unless I found a design I really love. Even then It would be a back tattoo most likely and none of my patients would ever see it. We have a few medics and basics with sleeves and our company has no policy against it. To summarize: I most likely won't get an ems tat but if you want to; knock yourself out.

We see hep a fair amount, especially on Dialysis days, usually coupled with MRSA. A couple facilities in our area it seems like every other patient has MRSA :/. I've yet to run into a TB case but I've only been doing this a few months. Typically we stick with the regular glove routine and wipe every inch of the stretcher down with our super wipes once we get the patient to the hospital. We keep the full masks and gowns on the rig but I haven't used them yet personally. A buddy of mine sent me this article the other day. I can't vouch for it's veracity given the site but I did find it pretty interesting. http://www.cracked.c...e-are-real.html

Yar. It's not that I think 14 calls isn't workable in a shift, it's just that I doubt they're evenly distributed. If I have 7 calls on a slow day I might have 21 tomorrow. They just said a quarter mil a year and while that may be workable most times what happens on the 4th of July? That town goes nuts on Independence day and I can imagine what happens when they get 1500 calls in a shift. 30 calls in a day per rig? I'd be worried if I had to try it. We're never that busy here. I admire the guys that stick it out in a place like that. Obviously I have no inside info regarding the city budget or anything but it may be a good idea to look into buying some new rigs and adding some medics if they can. I saw that you said they've tried it and if it doesn't work then... I guess the police might have to keep doing gsw transports themselves if it's critical? Without a ground level view of the ems situation there I can't think of a useful solution. I wonder if their police have anything beyond first responder training? We have a number of EMT-B's and a few medics as well on our local and county departments. Maybe the city could offer free classes and an incentive for officers who get certs? Just tossin ideas around, I have no idea how practical that would be.

Ok. 50 rigs for the whole damn city with fewer at night? That seems low to me. I wonder if that's just PFD rigs or what. I could be off on that but with 50 rigs doing 250000 calls a year.... Hmmm. I guess... That would average out to 14 calls per day if every day was perfectly equal in call volume. Which it isn't. What do you guys think? I'm glad the patient and her baby lived and depending on the ETA I can't say I wouldn't have made the same call if I were that officer. As for the larger ramifications, maybe the city needs to buy some more rigs and hire more medics. My numbers may be wrong but I just think that sounds low.

My advice would be to put together a really nice resume. If you intend to go with a private service you should probably review everything to do with diabetic patients because most private services, at least near me, focus questions during the interview regarding patients with diabetic emergencies, both hyper and hypoglycemia, things of that nature. We seem to have more calls for diabetic emergencies than anything else, though that's anecdotal since I don't have the numbers. It's a common belief anyway:) If you plan on going into a fire service you'll be better off listening to one of the long time FF's that frequent this lovely site. More than anything else though, my advice would be this. Do not lose hope. It took me months to find a job in EMS after I got my cert. Some people can manage it quicker than others, particularly if you know some people in the field. Even if it takes you awhile, you will find a job. Might not be a well paying job, might not have the best conditions. But if you're lucky you'll wake up every day glad to be going in. I didn't start in this field til I was in my thirties. This is the first job I've ever had, EVER, in which I go to work with a smile on my face. I love it. Working at something I don't hate is a novelty to me, first time in 15 years. If you found this field at a young age, and you decide you enjoy it, don't take that enjoyment for granted. We spend a lot of time working, doing so at a job we love is a better benefit than any insurance or vacation plan. Congrats on passing your NREMT, and good luck. If I were you I'd apply here: But not here..... edit for pics:)

The reason I laughed at this is simply because it's true to life. I've had multiple calls over the last couple weeks for minor injuries. I don't begrudge people that, if they feel the need to call an ambulance I'll be happy to pick them up and take them to a hospital. What's funny is when someone with a shallow extremity laceration (which was mostly controlled by pressure before we even arrived) has us take him to the ER and expects to bypass all the other patients because he shelled out for a rig. Sorry friend, doesn't work that way. Not around our hospitals anyway. The caption may seem a little cold but it's a fairly accurate assessment of our ER's policy.

*flees*

I've been working a lot lately and between the job and continuing ed I just haven't been on the internet much. I just came across this thread and I have to say: This sort of debate is one of the reasons I love this place. I lean more toward Dwayne and Cap'n's side on this issue, at least temperamentally (never run into this in real life myself); but I can respect your perspective JP, particularly since you backed it up with real world court cases. If I ever find myself in this situation I'll do what I feel is right and deal with the consequences and now, thanks to this thread, I have a much better idea what those consequences would be. Hopefully I don't run into a case where I'm treating a patient and have to expose the patient in public without being able to sheet-shield or meat shield her/him. akflightmedic said: This has been my experience thus far, though I must point out that my experience is almost certainly the lowest in duration of anyone reading this thread. As I said, I'd rather not open myself up to legal consequences if I can possibly avoid it. I'l still make the call on the scene though, and thanks to this fascinating debate I have a better idea of the possible outcomes. Take care all.

MOUNT UNION, Pa. (WHTM) - A first responder, originally from the Midstate, was killed in the line of duty Saturday morning in Huntingdon County. 22-year-old Ethan Amsbaugh is from the Newville area and graduated from Boiling Springs High School. State police said he died when the ambulance he was riding in crossed the center line on Route 22 in Brady Township around 6:30. It then went off the road, causing the vehicle to flip onto the passenger side. Troopers said Amsbaugh was partially ejected and was not wearing his seat belt. He was a member of the Mount Union Fire Department. http://www.abc27.com/story/18684411/local-emt-killed-in-crash Regarding the comments following this article, I don't have the facts of the matter. I admit that I am rarely buckled in when working on a patient in the back during a call. Someone said he was in the front passenger seat but I have no idea whether he has firsthand knowledge or is simply making an assumption. Whatever the case may be my thoughts are with his family and friends now. Rest in peace.

Our family doctor is a DO. He is, by far, the best doctor we've ever had, which is why my entire extended family uses him as well. Over the last few years he went from treating me and my dad to my brothers, aunts, uncles, and 3 grandparents. And 13 or 14 cousins. Great guy.