UMSTUDENT

1 gram of carbohydrate= 4 calories. Therefore 25 grams of 50% Dextrose is equivalent to roughly 100 calories. This isn't rocket science either; rather you can find it on the side of your cereal box. You're basically shoving an apple down someone's throat when you give them D50, minus the whole digestion thing.

I heard of a system recently that has a fairly innovative approach to handling their narcotics and drug box access problem. Apparently they've designed their system so that each individual paramedic has a unique access code that allows them to open up one of two doors to access the drug box. Then they have to radio dispatch on a unique channel, identify themselves somehow, and the dispatcher sends a special code through the digital signal back to the ambulance which opens the second door. I think it's pretty neat. Keeps accountability for who is in which drugs box. In an ideal world I'd say we could trust every provider, but hey...this isn't Perfect and your local ambulance service certainly isn't Walgreens.

Glad to see others have had the same experience. I agree that there needs to be a complete overhaul of how we test students. I'm personally more in favor of a mandatory internship where you are evaluated by medics in the field followed by an exam that more accurately test a student's knowledge. I've heard that the computer based exam I'm to take tomorrow is much harder than the test in the past. A few of our students have already taken the exam and reported it to be extremely difficult, but unfortunately still a little misrepresentative of a paramedic's true skill set. I was told that a lot of the exam is based on rare toxicological emergencies. Questions on snake bites, etc. We’ll see how it goes. We had a fairly detailed instruction on toxidromes, etc so I think I’m fairly prepared

Ah, thanks Dust! We disagree a lot (see certs argument), but I don't mind arguing with someone who knows their sh*t. To add to your comment: Something that I'm starting to see among graduating, college or university prepared paramedics is a shift away from being proud of your education. There is such a culture in EMS that is against the idea of going to some "stupid waste of money of a school" that less and less students are taking that route. A lot of people in the academic side, community college and university, seem to attribute it to the increasing cost of education throughout the country, but I disagree. I think it’s a combination of those two. The fire monkeys are doing a great job at discouraging going to school.

I would agree Dust had it not been trashed by someone who has rallied behind a country full of EMS providers desperately trying to understand "scientific-based medicine." 80% or more of EMS providers wouldn't know how to even begin analytically looking over one of his articles, let alone how to properly verify the sources. Mr. Bledsoe has NEVER himself done any legitimate research on the utility or usefulness of air medical helicopters. A simple literature review in one or two peer reviewed journals is simply that...a literature review! He draws broad conclusions based on some loosely related articles and facts. Do I agree with him on certain points? Yes. I believe that in most areas helicopters are used at an alarming rate, unnecessarily. Does this happen in Maryland? Sometimes. I think you'll find that in most states this is a problem because of the, and I quote, "hidden dragon which is competition." In Maryland, we have a state supported system. SYSCOM and the individual pilots make flight decisions, not managers looking at the bottom dollar. Oh, and Shock Trauma has an alarming save rate...over 96% of the trauma patients who arrive walk out the doors. That's what happens when you have a state sponsored, tax payer supported, primary adult trauma center solely devoted to treating and researching the disease of injury. Don't get me wrong, I agree with the guy on a lot of stuff, but I don't think he's absolutely correct on every issue. I didn't say the Golden Hour was a sound scientific principal. I don't necessarily agree with using air medical services at every drop of the hat either. I think Bledsoe's conclusions are valid to some extent, but to make broad sweeping generalities about an entire industry that is DRASTICALLY different from one part of the country to the next is fairly short sighted too.

I have problems taking too much advice from someone who has had their share of problems! I know you understand what I'm talking about... Regardless, if you know anything about Dr. Cowley you would know that the Golden Hour principal was purely political. Cowely himself didn’t purport that there was any specific scientific time where shock began to become irreversible, but it sure as heck was a good number to throw out to the governor and the people of Maryland. Who cares if it is an hour, an hour and twenty minutes, or three hours? The fact is simple: Quick, efficient transport of trauma patients with good prehospital care en route saves lives! To his credit, he developed the first, and still to this day, only state agency solely dedicated to EMS. Modern treatment of trauma patients is based on Cowley's revolutionary ideas and much of this nation's current methodology on trauma management still comes out of U of MD. Just because Texas and the Midwest have Baylor doesn't make it any better or worst. I would suggest reading the book Shocktrauma if you’d like to know the real story. While it is true that Maryland EMS is fairly archaic in protocol, I would not say it is a state overrun with volunteers. As one of the richest states in the US, it has some of the most well developed, most highly funded paid municipal and county systems in the entire country. Prince George's, Montgomery, Howard, and Baltimore Counties all have fully paid fire/EMS systems. Do they have volunteer stations? Yes, but they're really only there to allow the local community to interact with the fire departments. They DO NOT rely on them! These counties constitute over 80% of the state's population...easy. Many other, more rural counties have paid components that are more heavily supplemented with volunteer staff. Also, Maryland has the only comprehensive medevac system in the nation. 8 helicopters from 8 geographically located bases provide over 9,000 transports a year via the air to the state's 9 trauma centers. That is fairly good for such a small state.

As someone who just finished my 3rd year of a 4 year paramedic Bachelor's program, I'd have to agree with Rid. Is there a clear advantage in the level of knowledge between our students and most others? I'd say yes. Are we marketable? Questionable. The truth of the matter is that a card is a card, is a card, is a card.... In my adventures to seek employment I've found that most employers don't care where you've gotten your paramedic so long as you're competent enough to do the job. In fact, I've found mentioning my education can be a hazard. There are definitely some companies out there whose administration balk at the notion of a "four-year" paramedic education. Some of these people have advanced degrees, but seem intimidated by the possibility that you may be more qualified to handle their job. Instead of relying on the obvious advantage of their experience and education, they get worried.

So I successfully passed my practical examination. I take my CBT this week and hopefully I'll have my card fairly soon! One more year and I'll hopefully be a paramedic. What was interesting was the number of students who didn't pass the practical. I kind of realized that the entire thing is entirely dependent on the evaluator you get. Many, many well qualified, highly prepared students did not pass the exam. Many of the evaluators I had were very relaxed, some even going as far as to say that they knew if we were competent and were not there to fail me. Other students reported having total idiots who barely paid attention, or who obviously didn't care. It seemed that by the end of the day there was a definite correlation between what evaluator you had, for what station, and if you passed. After the exam there was some extensive discussion among the participants and it seems that some five students failed static cardiology over the same single strip and the treatment modality of that strip. Then, during retest, they were all given the same strips again. It sucks because they keep people in the dark during the exam by not allowing students to talk about testing for fear of failing. So no one really knows the inconsistencies until after the exam. Days like yesterday just seem to make the registry process seem like a joke. They get so called "experts" from the local area that are apparently familiar with the testing process. Some of them are very professional and others are just a joke. One of my evaluators seemed to be hearing impaired, stared out the window, and I had to prompt him to ask me a required question, which he said "not to worry about." Sure, I loved it, but it showed the blatant inconsistencies during the evaluation process. Several students made complaints during the day. There were a lot of complaints from students about unfamiliar equipment or equipment that was not even provided. None of the complaints seem to have been addressed, including blatant errors that evaluators made while grading. I passed, but I felt for a lot of my classmates. I noticed several things during the test that were fairly shady, but I tried to quickly adapt and think on my feet. I also quickly realized that if you kissed a$$, said sir and mam a lot, and were just generally polite that a lot of things would get written off. Granted, I realize these are things that are qualities of a good paramedic, but it is not what most of these students were prepared for by any means.

I remember being presented information that stated that, given clinical manifestations alone, EMS providers were only about 40% effective in differentiating between CHF and pneumonia. Physicians are only something like 60%. The exact numbers may be a little wrong, but the point is the same. Anyway, many hospitals treat CHF with high-dose nitro. Granted they have access to drips to tailor their results, but Lasix still seems to be falling out of favor for every incidence of CHF with pulmonary edema.

First off, I'd like to edit my last post: Tier...instead of tear. Duh. I don’t like this new 90 minutes to edit thing. Secondly, good point. I was just presenting what I've been told in instruction. There was a great crusade down here against Lasix during the last protocol roll out and it may be true that they pumped their chest a bit to give EMS providers a reason to hate it. I had rather forgot about the initial vasodilatory response. I did know that it does sometimes potentiate the effects of other PO antihypertensives.

What you say is interesting, because many of the veteran paramedics I've run into swear by Lasix in the rural prehospital environment. In MD, it is now like a 4th or 5th tear drug and only with medical direction. High-dose nitro sublingually is first line, followed by CPAP, transdermal nitro (Nitrobid), captopril, and then Lasix. What I was taught was that furosemide doesn't reach peak effect for over an hour and "should" show little effect in the prehospital environment. Clinically, I would say, most paramedics disagree.

As they say, "Look for horses before you go looking for zebras!"

Total cost of my education? I started at about 13,000 a year for tuition, room, and board. Now its more like 17,000 thanks to the incredible increase in education over the past four years. Add about 5,000 a year to that for cost of living in this horrendously expensive area. Plus add the odd expenses of being a paramedic student. Gas, registry fees, equipment, and uniforms...another grand or two. Total when its all said in done...about 85,000 US Dollars. Thank GOD for scholarships, grants, and tuition reimbursement. Oh and Federal and Private loans.

I must say that I often make the comments in class that I feel that they (nurses) practice an entirely different medicine. I just finished the majority of a rotation in a local hospital and was often surprised at how differently they viewed a disease process. My biggest problem with nursing is that they seem to perpetuate their reliance and subordinance to physicians. Even if they're intelligent and educated enough to know what is going on they'll literally create a giant mental wall to keep themselves from drawing conclusions. I can't even begin to explain the looks I get when I dare read a 12-lead and then talk to physician about it. That is entirely taboo. One of the things I've definitely noticed is that general nursing education seems to focus more on the long-term care of a disease process, often making them ill-equipped to handle the hear and now of emergency medicine. They say stuff sometimes this is entirely inappropriate or just flat chronologically wrong. An example: I recently was working under a nurse when a fairly critical patient came in. She presented hot, clammy and diaphoretic, obvious dypsnea...pretty much in extremis. She complained of generalized chest pain and trouble breathing...at least on paper. She was tachycardic (~150) on the pulse ox and so the nurse ordered me to get a 12-lead because they were probably going to have to "push a drug to temporarily stop her heart." Time! I'm already not impressed. My gut is not cardiac and just because her heart rate is 150 doesn't necessarily mean we’ll be pushing adenosine. So I do the 12-lead and of course there are obvious p-waves of normal morphology. It was a perfect sinus tachycardia with occasional unifocal PVCs, normal axis and no ST changes. Sure, it could be reentrant or inappropriate, but hey she’s obviously febrile (treat the cause). I went to the physician we were working under, handed him the print out and gave him the "look." He's a cool guy and treats his students like he would a resident or medical student. So he walks back with me and does a quick assessment. The nurse is running around asking about possible cardiac causes and freaking out about getting a PE study. She keeps rattling off about there being at risk for a PE...something about her age. Meanwhile the physician looks at me with the most disappointed look ever. He just seemed irritated. He listens to her lungs...totally junky. Patient is febrile and has severe trouble breathing. He orders a chest x-ray and CT that reveals a massive pneumonia. Consolidation in pretty much every lobe. The CT scan is pretty scary too. So he orders a gram of Vancomycin and Dexamethasone to open her up a bit. Now once he had her hang the drip and push the steroid she was right at home. Once she was out of the acute stage she was entirely comfortable with her situation. I’m not confident that the nursing model of education is superior to a good EMS education utilizing the medical model. I’m a huge proponent that ER care, and healthcare in general, would work a thousand times faster if nurses would be taught to think and interact with physicians as colleagues and not slaves. There just seems to be a huge mental block. Granted, doctors can be assholes, but they work with them every day. The most successful nurses I worked with knew this and adapted in the interest of efficiency and patient care. They’re just very rare.

Thats cool. I figure the best way to learn about Texas is to learn it from a Texan. I'm an east coast kid... The good news is I hear it's fairly easy to get a concealed weapons permit in Texas!

Damn university kids...LOL. Sam, from what I understand Austin-Travis is fairly progressive system with great benefits and starting pay. I could use an alumnus down there to put in a good word if I decide to apply.

I'm looking for info about Austin-Travis County EMS, specifically any type of personal experience with the organization. Dust and anyone else from Texas, please feel free to contribute. Also, anyone who has experience with Texas EMS please feel free to contribute. I'm interested in the demographics of the state's EMS system or lack thereof. Thanks!

So, I'm on the last leg of my journey to becoming a paramedic. One more year and I'll technically have graduated, taken my paramedic registry and be able to practice in a number of places and environments. As some of you may know, my education has been relatively unique and I spend the majority of my days with the same 10 or so students who were accepted into my program. My problem is that EMS organizations are horrible about recruiting. At my university we have TONS of local businesses and corporations vying for new graduates to employ. NSA, ExxonMobil, Legg Mason, Goldman Sachs, State, Federal government. They ALL send tons of recruiters. It seems that every industry besides the emergency services actively recruits for qualified, highly motivated applicants. It sucks. The people who do come to recruit often leave much to be desired. Most of the combo EMS/fire services seem to only be set-up to attract people who want an easy way to a pension and relative job security. Never do they talk about a "career" or a route for advancement. The private and county EMS services are interesting, some of them actually have very progressive systems, but they too lack in the realm of making you motivated to work for them. They talk of working in hospitals "under" nurses in your "down time." Horrible benefits, no pensions, crappy hours. They offer no incentive for individuals with an education and sometimes look down upon it. This had led me to desperately search for other job skills. Graduate school, which has always been a very high consideration, is looking more and more lucrative. The problem is that many of the schools I'm interested in want 2-5 years of work experience that is "career oriented." My question is this: Why doesn't our field do a better job of recruiting? Is the field saturated with people willing to work on the whootie-woo for nothing? What would you do? Thanks

Traffic violations are just a state's way to tax the middle class. Most people in law enforcement and the judicial system know this, IMHO. A 200 dollar find doesn't adversely affect someone making 70,000+ thousand dollars a year. Plus, you'll also notice that people who own a BMW, Mercedes, or other sport sedan can generally afford a very nice radar detector. Where I live and go to school commuting is everything. The old adage that speeding tickets effect insurance is generally BS too, because most states have laws limiting the ability of an insurance company to view your driving record. While it is true that speeding may adversely affect the insurance rates on a 2007 BMW 3 series or Porsche 911, these people are also in a better situation to handle the fee. Talk to any police officer and they'll tell you that speeders control the flow of traffic. If everyone went the same speed from a point of entry on a highway in rush hour, no one would get anywhere. For instance, where I'm at the State Police are one of the only groups that directly benefit from handing out tickets. They have quotas and it directly funds their retirement and pension. Get pulled over by a county mounty and the story is different. AKA more latent enforcement (visible police presence and less actual pulling over of cars). Should there be limits? Absolutely! I just disagree with a jurisdiction that enforces an absolute speed limit without consideration for the overall affect on the people they're ticketing. The people who need to be ticketed AND arrested are those who drive recklessly, drunk, or high. I've watched someone get pulled over doing 80 while some ass**** in a pickup truck weaves through 4 lanes at 95 MPH. The cop is so busy with his head down the laser sight that he doesn't see it! So the 16 year old driving the teeny bopper Honda Civic gets to go home with a ticket. I think the judge will look favorably on his position. Most people need to have a license, period. Where I'm at that's 12 points! The business executive whose making 200,000+ with stock options doesn't rely on his driving record. I think a fair and reasonable judge will be able to see a kid who wants to do some good and work, making relative crap, helping people.

I agree. Academia seems to be a challenging world for many people, especially those in EMS. I've found that many EMS personnel, including so-called "EMS educators," have no idea what it takes in order to recieve a certain degree. Many also do not understand accreditation or what entails a basic undergraduate education.

I understand a little of what you're speaking of. It is very sad how our culture views our profession, but unfortunately this is slightly our own doing. When I was a kid I can specifically remember my mother poking fun of the local firefighters as they washed the engines out front. She was specifically referring to the volunteer aspect of the profession and remarked of how "bored" they must be to wash "those damn fire trucks so often." She respected what they did, but her remarks were all but expected. When I joined my local ambulance squad later in life I realized where she got her attitude. It was seldom that they were called upon to working fires and the thick beards and ruff exterior didn't help much for professionalism. They were bored...After all, we expect people who work 8 hour days, 5 days a week to understand getting paid to sleep. She supported my decision to get involved in the field later life, but some of my friends and colleagues at college have not been so lucky. Many of their parents routinely question their decision to become involved in the field. Many of them see it as a "lowly profession" with little career opportunities. This is true to some degree unfortunately. EMS has a long way to go before the public truly respects them. Do what you want, but make sure you have a back-up. Education is always a plus!

Professors at most major universities have a decent gig going for them. Many professors, especially once they receive tenure, have liberal leave policies. Summers are fairly light too... Sabbaticals? I mean where else can you take an entire semester off to write a book and have your office, job, etc reserved for you when you return as if you never left? EMS professors seem to, in my book at least, have a unique gig going for them. Not only can they collect their paycheck, but their professorship gives them unprecedented credentials to go on the lecture circuit, write books, be expert witnesses, etc. Some of these guys travel a good bit on someone else's ticket. AND...on the side they can work a part-time job as a field medic depending on the area. Once you're done, you can go collect a check with some think-tank and make way more money in the private sector. This is especially true if you diversified your specialization into the realm of emergency management or some other subspecialty.

While in class today, my professor made a comment about the "approaching paramedic shortage." It equated to light at the end of the tunnel for a dozen or so individuals looking at getting into the leadership echelons of EMS. This guy is very well educated, is well credentialed, and works administratively for a nationally recognized flight service. He reads the literature and seemed realistic about many of the problems facing our profession. He's an adjunct instructor teaching a fairly specialized area of EMS. Cool guy! Do you think there is, or will be a paramedic shortage? He compared it to the nursing shortage in the late 80’s and early 90’s. He seemed to believe that pay increase, professional recognition and a decent living will shortly follow. He did mention higher education standards (seeing as he’s teaching at a university), but definitely put stock in the supply and demand theory. I’d like to hear everyone’s thoughts on the matter. What do you think? Is there a shortage in your area? Is it all smoke and mirrors?

I think it is about time for me to end this entire discussion by referencing my own post to envoke Godwin's Law. So long as you're not familar with Quirk's Exception this should work... Bassically, Godwin's Law states that: "As an online discussion grows longer, the probability of a comparison involving Nazis or Hitler approaches one." This Theory bassically means that once such a comparison has been made the thread is only bound to degenerate. Also, it serves as a type of cap on thread lengths, because in any heated discussion the Nazi's will almost certainly be used for comparison. So...thread over.