UMSTUDENT

Is the State Police the only providers of air evac there?

That saves the patients about $7000 based rates for flight services here in NC.

Yes, in Maryland the Maryland State Police Aviation Command is the only provider of emergency 9-1-1 air emergency medical services. 12 aircraft respond from eight strategic locations within the state. The expense is paid for almost entirely from a vehicle plate registration fee. Each aircraft is designated "Trooper 1-8." Each is staffed primarily by a civilian pilot and a sworn Trooper/Paramedic. Troopers complete a 26 week live-in state police academy and then enter into the aviation command for additional training. The aircraft also complete law enforcement and rescue (hoist, etc) missions.

Go to http://www.mspaviation.org/frames.asp to learn more about the system. Its really the vision of the late R Adams Cowley, MD and something most Marylanders are very proud of.

Yes, it does have its drawbacks and critics do abound, but the system is free. Its not hard for them to find people whose lives have been made better by the service. It comprises a significant part of our state EMS system. Private transfer air medical services are provided by several for-profit air medical entities such as STAT Medevac, Maryland Express Care (PHI), and DC MedSTAR.

I made the decision to go to med school right around the end of my paramedic training...

'zilla

How did you finish your prereqs for medical school? I'm about to finish my B.S., but still need to finish Organic Chemistry (8 credits) and Physics (8 Credits). I also may need to take another semester of English if I decide to pursue the DO route.

When I finish school, I'll probably start working a bit. I've heard that finishing at a university or enrolling in a formal post-bac program is what medical schools would like to see, but the local community colleges (who offer everything I need to take) are VERY cheap. Whats your take on this? I'm a good student, but money is an issue. One of my professors, who is an MD, states that medical schools don't care where they were taken so long as you did well. However, he did mention that the need for a composite letter of recommendation from your school pre-health committee is hard to acquire from community colleges.

Oh and thanks for the advice. It means a lot.

...

Good luck,

R/r 911

Thanks Rid. I especially appreciate exactly how you came to make the decisions you did.

I love education, but I also want a career and family. I'm at a crossroads. There are so many things that I feel I would enjoy to do in life, but feel only prepared to continue in medicine. Some people have suggested I work for awhile, but I fear that I may never be capable (financially and family-wise) to return to make an extensive full-time commitment as student.

A lot of people are like, "Be a paramedic for a while," but if my education has taught me anything it is that this field is hugely fragmented, mostly unstructured, and lacks little-if-any upward mobility. Plus the pay generally sucks.

I'm looking for some input from former paramedics who have continued their medical education at the graduate level. Specifically, I'd like to hear from paramedics who became nurse practitioners, physician assistants, or physicians. Individuals who sought other paths are welcome too.

What influenced you to choose the profession? How long were you a paramedic before?

You don't have to have been a paramedic, but I'd like to hear from people with prehospital experience.

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Seriously considering a move out of NYC the stress in EMS and politics are the worst. I'd like to stay on the east coast. Does anyone have the same problem and can share some ideas w/ me.....Thank you

If you don't mind a 18+ week academy in a fire-based system, Maryland and Northern Virginia has plenty of highly funded professional systems. Good pay and benefits.

Most places it is a semester but what we are saying is even a semester is pitiful. Many would like to see EMT be an Associates and Paramedic being a BS.

No, EMT is not an "entire" semester. 120 hours of didactic classroom time is equivalent to approximately 4 credits. Full time at most community colleges and universities is 12 credits or more. Most students take around 15 credits a semester.

The EMT-B curriculum does not require a degree of any sorts. Seriously, it is basically an upgraded first-aid. What does need to happen is the recognition that true EMS is provided by EMS professionals. In other words, paramedics educated at the collegiate level (AAS or BS).

Like working a shooting in a bar room you couldn't enter off duty, or delivering a premie in the projects, or dealing with a suicidal 40 yo father of 3 in the midst of a bad divorce? I agree some life experience beyond highschool and 120hrs is needed to perform adequately.

Nope. EMT should be increased to something like at least the equivalent of a college semester. 120 hours is pitifully small.

Has anyone considered that the problem is that the curriculum for EMT-B is so easy that a 16 year old is able to pass it almost blindly...?

I was licensed as an EMT when I was 17 years old. I completed the class with a stellar understanding and little effort. Looking back I thought I could handle it, but now some years later, I feel as if the state was and still is totally wrong for allowing it.

It isn't the death that bothered me. I was placed in situations that, looking back on it, were not appropriate for a 17 year old to be in. I was in no place to make some of the decisions I had to make. Flat out EMS should be a field that is entered after extensive collegiate education....end of story.

Keep in mind cat' that not everyone does this fresh out of high school. Also keep in mind that many who do this still have occupations such as mechanics, farmers (in my area), truck drivers, etc. It is a field that does not segregate those who may not have the most spectacular resume. My best advice to you is to take the basic, attend all the trainings that you can, and enroll in the paramedic program, and you should be well on your way to landing yourself a job in EMS. You sound like you have a positive attitude and I encourage and welcome that in the new men and women coming into the field.

I wish you the best of luck. Keep us posted and feel free to ask questions.

Honestly, I wouldn't worry about a resume until you've successfully completed a paramedic program. In my opinion there is a huge step in the level of professionalism between the two job functions. A good paramedic program will boost your resume with a couple of key factors:

A) A degree (AAS or BS).

Clinical hours. Clerkship, Rotation, Internship, Externship...whatever your school calls it.

C) Membership to a professional "registry" of equally qualified individuals.

Add some volunteer hours in whatever you so choose and you're off to a good start. Remember, you'll be starting off new so don't expect to be gunning for an officer level position or time on a helicopter. Spend some time as a street paramedic and go from there.

As I've started looking for possible careers I've kept a couple of things in mind:

A) Competitive entry. If lots of people want to work for this employer, the package is probably fairly good.

Benefits, benefits, benefits...

C) Competitive Starting Salary. Look for bonuses for ALS qualifications in fire-based systems. This will depend on your area. I'd say 36,000+ is fairly decent in most of the country for a new paramedic. Where I'm at 45,000-50,000 is ideal.

D) Clearly defined advancement structure.

E) Respect for education and performance-based advancement.

F) Union Representation.

Go to your interviews in a suit, bring a copy of your resume, and be prepared to sell yourself...no not illegally.

Any particular reason you left off Ron Paul? He is the only one with a philosophy that is conducive to progressive EMS.

I originally had Ron Paul listed, along with several other individuals like Dennis Kucinich and Mike Huckabee.

It wouldn't allow me to include more than so many poll options, so I made a quick guess of candidates I felt people would be most familiar with (popularity, media attention, etc).

Elaborate a bit on Ron Paul Dust. He's one of the candidates that interest me.

So, the Iowa Caucus is about t-minus thirty days away. Most of the candidates have released their form of a plan for heath care, but I've yet to see anything extremely specific for public safety.

Which candidate do you feel would best support the interest of EMS? I don't care about the fire service or public safety in general...I want to know about EMS and the issues that face our profession.

See, this whole mess isn't a problem in my state.

We don't have nurses flying on our 'copters. One paramedic, one pilot.

And you don't lip off to the paramedic because he carries a gun and handcuffs.

Maryland State Police Aviation Division. Eight helicopters geographically deployed throughout the state. Maybe not the best model, but it works here...for the most part...

Millions of dollars? Yes. Overly used? Yes. Paid for? Tag and license fees.

We also have the GO team, which is basically a way of grabbing anesthesiologist and trauma surgeons from Shock Trauma to fly into the field for amputations, etc.

Ummm nice try. Anytime you use the word Neo-con your showing your ignorance by repeating what you heard on Air America. Global climate change is the term NOW preferred by proponents of global warming. They feel the public was getting confused by the talk of colder winters involved with global warming. The "neocons" you speak of just call it bullsh*t. But nice try to throw in a much repeated SP term.

Sorry, but the conservative administration that currently controls most of our country's wounded poltical system is not the same as the conservatives Reagan was running around with in the 80's. It is a totally appropriate term, although I will agree that it is a term thrown around by the 24-hour news networks far too often.

To make you happy, I'll just call them "evil." Not quite as silly a term.

As far as Dust..., ugh whatever. Your from Texas, it makes sense. I'm not going to try and convince you otherwise.

Ha! They blinked!

What this means is that they got caught blowing smoke and dishonest hyperbole, so now they're retreating to what they think will be a safer position. Credibility: 0

Actually, credible scientist still call it global warming. "Global climate change" is a euphinism that the republican, neoconservative oil think-tanks developed to desensitize the American people into believing that New York City will still be above water in 80 years...

I'm sorry, I used to think global warming was a total bunch of junk. I was a big fan of the belief that these temperature increases were just normal variations in otherwise historical deviations of temperature and ocean levels. I've seen too much literature from too many respected, skeptical scientist saying otherwise. 7 billion people are producing billions of tons of carbon emissions..

Pessimism aside, while some of what UM is saying is true, it's not the final word by any means.

-be safe

My understanding is that you're a former disciple...

??

BTW- what does your roomate specifically do to make 'boatloads' for a private company ( what kind of company and approx. income?) Thanks for your input

My old roommate works for a private consulting/lobbying firm in DC. I'd say he's making in the range of 55,000-65,000 grand right now as a first year graduate. He acquired the job before he finished his Master's. I'll leave out details in the interest of discretion for his job and company.

Remember, MOST first-year college graduates make crap. I think a lot of EMS professionals forget this. Many young adults live for years on the poverty line. The fundamental difference is that most careers have a defined upward mobility based on experience that, given proper marketing, will produce a livable career. We're spoiled as paramedics because you can make 60,000-70,000 a year with OT. We forget two things:

1. This never goes up.

2. We're working horrendous overtime to accomplish it.

Seriously, just stay away from the northeast. Period. Look at the South and Midwest if you're looking for a fiscally responsible, performance oriented EMS organizations who will need your education. I work per diem at a local EMS organization to make some beer money. I was quickly assigned administrative duties/hours as part of my job.

The #1 remark I get is that I can:

1) Spell words correctly.

2) Utilize proper grammar and punctuation.

3) Use a word processor.

4) Use Excel.

Things I've learned in college have helped to some extent. I know fundamental research techniques and can read and interpret a peer-reviewed study. I can speak, intelligently, with professionals . I can write a technical memo. I know basic managerial skills, aka conflict resolution stuff...

Still, the first four have been seen as far more useful to my organization. Sad but true.

hi all, first time post

I am a 4 year volly EMT-B and f/f. I am in my 3rd year at a rather large, accredited college in western PA. I did my first 2 years of undergrad with pre-med in my mind. Decided it wasn't for me and I luckily enrolled in to my schools emergency medicine program. The junior year is getting NREMTP, and senior year is the 'degree' portion.

My question is.. what do you all know when it comes to 4-year EMS degrees and their monetary, etc, recognition in the field. Any services, states, or communities that look for this type of education and compensate 'somewhat' accordingly. I know in this immediate area, there is a relatively low demand for just EMT-P's, and time in/education doesn't change your pay as well. All advice/help is appreciated.

My main reason for posting is that as graduation comes close, I am seeing where I will be 'in demand' with my expensiveeee ass degree in the field and simply, where am i gonna go after i graduate (ohh wonderful indecision of the early twenties).

By the sound of the curriculum, I'd say you're at Pittsburgh. I informally interviewed there, but ended up choosing Maryland over it for a couple personal and academic reasons.

There is absolutely, IMHO, no market for Bachelor's prepared paramedics. None. In fact, depending on the department, it may disqualify you for a job. Fortunately, I've only found this in the northeast mostly. Systems like Wake County, NC embrace education. I read recently that all of the upper administration there has at least a bachelor's degree and many have upper-level graduate degrees.

I've done a good bit of research with our graduates and have found the following:

1. Most end up being absorbed into fire/EMS systems as would any other paramedic. There is about a 50/50 split from graduates. Some say the degree has helped them advance tremendously while others attribute any upper mobility to shear hard work. The good news is that most are supervisors/administration fairly quickly.

2. Many choose to progress to higher medicine. Nursing and Physician Assistant programs eat up a lot of these people. Nursing is a quick bridge in some areas. Depending on your program's prerequisite curriculum, you're practically set-up for admission to a PA program. Our program’s high # of clinical hours meets most of the "documented" clinical experience needed for admission.

3. Emergency Management. We've had a couple of guys/gals go into emergency management. One of my roommates works for a private consulting firm in DC making boatloads of cash. Another works for a local state emergency management agency.

4. Medical School. In the early 90s the degree was a ticket to an MD or DO. I think medical schools have been saturated with these kinds of applicants now. A lot of pre-med/paramedic students encounter the same difficulties as other students now with admission. Granted, the clinical experience still speaks wonders of the individual, but it’s still a difficult process. Plus, these programs seem to be extremely credit intensive. Most paramedic-track majors don't have enough available (manageable) credit hours to fit in the full year of organic chemistry and semester of physics/calculus. Unless you stay an extra year (too expensive), community college or a formal post-bac is your only route later in life. I think a lot of prospective medical school applicants get lost in the "real world."

I’m finishing my senior year now. I’m currently deciding on option 2 or 4.

I think the RBBB does account for a lot of the R, R' business in V1. Not sure how much evidence there really is for right ventricular hypertrophy, especially when there is a left axis deviation. Normally the axis will deviate towards hypertrophy and away from infarct, no? The LAD probably has more to do with the BBB I think, although in this elderly patient with such a significant history who knows.

I agree with your assessment on the R,R' in V1. Good point that I failed to think through.

I guess the next thing to do would be to look at the R-wave progression, which...ugh...I guess is fine. This is the problem with the 12-Lead ECG. So much of it may be irrelevant to your treatment of the patient. Physiologic finger prints...

Nothing substitutes a set of labs. 12-Lead is a good tool for early recognition of STEMI. It has also helped me make some other treatment decisions in the past, but in the end it is one diagnostic tool among many.

Where'd you take Intermediate, Maryland?

I'm afraid I cannot specifically answer your question, but I hope I can offer some help.

While you wait for recommendations here, you can call the schools in your area and see what you can find. Although, as discussed in another topic over the last few days, I to P transition classes are getting pretty hard to find.

Here's what a search of http://www.caahep.org/Find_An_Accredited_Program.aspx brings up for your area:

George Washington University Medical Center - Washington, DC

Website: www.gwumc.edu

EMT-Paramedic Program

2121 Eye Street, NW Suite 701

Washington , DC - 20052

Program Director: Keith Monosky MPM, EMT-P

Phone: (202) 741-2945

Anne Arundel Community College - Arnold, MD

Website: www.aacc.edu

Emergency Medical Technician-Paramedic Program

101 College Parkway

Arnold , MD - 21012

Program Director: Melanie Miller MSN, CCRN, NREMT-P

Email: mkmiller@aacc.edu

Phone: (410) 777-7385

Associates in Emergency Care Consortia - New Market, MD

Emergency Medical Technician-Paramedic Program

P.O. Box 490

Damascus , MD - 20872

Program Director: Sal Marini MA NREMT-P

Email: aecare911@aol.com

Phone: (301) 865-8880

Community College of Baltimore County - Essex Campus - Baltimore, MD

Website: www.ccbcmd.edu

Emergency Medical Technician-Paramedic Program

7201 Rossville Boulevard

Baltimore , MD - 21237

Program Director: Robert Henderson Jr. BS NREMTP

Email: rhenderson@ccbcmd.edu

Phone: (410) 780-6477

Howard Community College - Columbia, MD

Website: www.howardcc.edu

Emergency Medical Technician-Paramedic Program

10901 Little Patuxent Parkway

Columbia , MD - 21045

Program Director: Angel Burba MS NREMT-P

Email: aburba@howardcc.edu

Phone: (410) 772-4948

University of Maryland Baltimore County - Baltimore, MD

Website: www.umbc.edu or www.umbctrainingcenters.com

Emergency Medical Technician-Paramedic Program

1000 Hilltop Circle

Academic IV, Room 316

Baltimore , MD - 21250

Program Director: Dwight Polk MSW NREMT-P

Email: polk@umbc.edu

Phone: (410) 455-3782

Northern Virginia Community College - Annandale, VA

Website: www.nvcc.edu

Emergency Medical Technician-Paramedic Program

6699 Springfield Center Drive

Office 239

Springfield , VA - 22150

Program Director: Holly Frost MS NREMT-P

Email: hfrost@nvcc.edu

Phone: (703) 822-6560

There are others listed in VA, although none very close to the DC area.

Good luck!

As a Maryland resident:

All of the community colleges are good options. Most of them should let you integrate into their second year of classes given you've completed their listed prerequisites.

UMBC is not a good option unless you're willing to start from scratch and complete a four-year degree.

Montgomery County and Washington County both offer an I-P bridge for their volunteer/career employees.

Note: You must be certified as an NREMT-I'99. The I'85 curriculum is not accepted in MD.

I would say that one thing indicates right-ventricular involvement:

1. R-wave equal to or greater in size than the S-wave in V1.

R/O Right Ventricular Hypertrophy. Bundle Branch Block too...

Pathologic Left Axis Deviation.

Did your patient have a history of Digoxin use?

At 17 I'm not sure what level of education you're at. High school or college?

Though for me it doesn't really matter. Your teacher is responsible for much more than what comes out of their mouths. They are responsible to set a professional example for students. I don't care what level of education that falls under.

But that's just me...

Dwayne

Your answers are very good; however, they may be a little misguided depending on the university.

My experience has been that universities are EXTREMELY political machines with little interest in hearing you complain. Professors who act unprofessional are usually one of two things:

1. Part-time staff that were dragged or begged to teach in the first place. They aren't there because they want to teach, so much as because of beer money. This is especially true of professionals with terminal degrees only because it is required of their profession.

Ex: My roommates have had continuous problems with their accounting classes being taught by uncaring dicks. They're all CPAs.

2. Tenured professors. Tenure= untouchable. In most instances, outside of sexual harassment or flat murdering someone, these professors are not getting fired anytime soon. It takes a fairly large majority, or in some cases unanimous approval, from a group of peers within their respective college.

There are formal procedures within each school for dealing with unprofessional conduct, but be prepared to fight adults as an adult. You need to represent yourself as an adult, paying for an education. Also be willing to go above someone’s head if necessary.

Again, this is totally dependent on the university. I think it has a lot to do with why so very few students ever make formal complaints.

UMSTUDENT, I think I'm missing the part that is different...

Except for doing 'air' clinicals it sounds about the same as ours...We'll log a minimum of 800 clinical hours, or more depending on getting skills accomplished during preceptorship...

Are other school's clinicals set up so much differently?

Read past the first paragraph...I wrote it for a reason. Thanks.

I can offer a fairly educated opinion about an alternative way of conducting field internships since our school takes a fairly different approach to the clinical process.

I'm currently engaged in about 33-40 hours a week of clinical time. Our system operates by requiring a minimum hour requirement, minimal level of documented competencies, and required evaluations by EVERY preceptor we come in contact with. Our total clinical time, if done properly, amounts to approximately 1,000 hours over the course of our education.

Clinical time occurs in a variety of settings with exposure to many types of patient demographics. Clinical time is split roughly 40/60 hospital-to-field. Time is spent on a variety of hospital services and with physicians. Field time is organized across multiple EMS delivery types and geographic areas. Urban, suburban, rural, and sky.

Our clinical evaluation is HEAVILY based on number of hours completed and is VERY patient assessment based. The idea is to expose students to types of patients rather than just skills and drills. For instance, NICU time is arranged specifically so that students may be exposed to a variety of neonatal problems.

I prefer this type of learning; however, I feel that EMS still suffers from skills obtainment issues. For instance, significant competition exist among classmates to obtain certain types of skills. I feel that FISDAP is actually a big cause of this. The idea of simple competency through a magic "number" is somehow silly to me, although I understand the need to measure statistical markers.

Problems:

Some clinical sites serve better as educational opportunities, rather than opportunities to practice. It can be frustrating spending 12 hours at a clinical site and having never done any type of skill. While often mentally exercising, there are certain skills that must be maintained.

Yes sir, however you are talking about testing for I-99 after completing a certain amount of a paramedic course. That is not terribly uncommon. In fact, there are some RN schools set up for their students to test for LVN licensure halfway through. But what I believe this discussion to be about is taking a freestanding EMT-I course that is not an integrated portion of a complete paramedic programme, and then maybe trying to finish up paramedic education later. The former isn't a bad idea. The latter is a horrible idea.

Agreed, but unfortunately what you talk about does still exist within our state in many of the county academies. I have a friend who is currently taking his EMT-I this way.

The program spends about 2-4 weeks on anatomy and then goes straight into the intermediate curriculum. Later, these students will "bridge" over to paramedic by completing a couple more months of 2 day-a-week classes, complete the minimum clinical time for registry standard, and test for their Registry Paramedic. They're called cook-book programs around here.

Most of these classes are filled with career firefighters striving for the extra 3-4 grand a year that comes with holding a paramedic card.

From what I can tell, there is an excellent chance that you will not find a paramedic school to recognise your Intermediate training at all. It's just becoming rarer and rarer everyday to find a school that is set up for that disjointed continuum. Back in the 70's it was pretty common to progress from EMT to EMT-I to EMT-P, but not anymore. It's just not a good way to go, and the schools recognise that. Not to mention that it simply isn't cost effective to set up two completely different educational paths for the same ultimate goal. A school has to totally change the normal flow of educational objectives in order to accommodate Intermediate students, and then -- unless you were educated at that school for Intermediate -- they really have no way to validate what you already know. They can't just assume that you know the stuff you were supposed to have learned in I school, because then they are the ones that look stupid when you graduate their P programme with insufficient knowledge for competent practice. Consequently, unless you stay out in the really rural areas where volunteer whacker EMS is the norm, it's just hard to find the Intermediate level integrated into the paramedic educational process anymore. Then you're going to end up like all the other guys who come here whining about having to get "all that book learnin" over again when they already had it once. Of course, if it comes to that, take it like a man and just do it. None of us are so damn good that we can't use a review.

Are you a volunteer, or is this your profession? If this is your profession, then just forget the Intermediate nonsense. It is counterproductive to good education. You will literally learn less and learn harder by going that route. Get into a college programme and knock a complete paramedic education out in a single sitting. Everything flows together so much more completely and naturally that way, and there is a palpable difference in the quality of medic that is turned out.

Today, Intermediate is just a half-arse level for volunteers and hobbyists who don't have the time, money, or professional commitment to devote to being a quality medical provider. If that isn't you, then do yourself and the profession a favour and just skip it.

Best of luck in whatever you do!

Dust,

In Maryland, many of the community colleges and UMBC require that you obtain your I-'99 prior to testing for paramedic. At UMBC most of our paramedic education occurs during our junior year. One full academic year of medical didactic curriculum, 6-8 hours a day. During the second semester students complete ~180 hours of clinical time before testing for their I-'99. During the senior year students complete approximately 900 hours of clinical time while completing classes in EMS management and seminars designed to refresh complex skills or knowledge.

Depends on the area.