Ridryder 911

Enjoy while you can... I feel a ban being started up. Of course, you will just troll away.. to find another site. Shame, one will get a section locked.

R/r 911

I would imagine the reason they can only transport to a physician facility is they (physicians) are the only ones licensed to practice medicine. Yes, there are plenty of NP/P.A. facility but in realistic terms those are usually considered stand-by ER's.

The same as an EMS transporting to a minor ER clinic, etc. Most States also have laws in place for EMS to be able to receive proper reimbursements.

R/r 911

Naw.. just tell her to keep the change.

Part of being a noobie is listening. You DON"T have the experience to have an informed opinion yet, just verbal statement. Can't stand the heat then get out of the kitchen. This is a business and attempting to be a profession is being informed. Chances are you were not taught 99% of the stuff needed in EMS.

You come to a site about EMS with a whopping experience of a few week course and want to be recognized as actually knowing about the profession? Alike Dust, do you have several thousand calls under your belt or education past that first aid level EMT cert? ... Yet, alike many others spouting they "know what is best" even though they do not know the "what" is yet.

Expertise is based upon education, experience for a reason. Before jumping to conclusions read what the context is rather than taking it personal. One usually finds it is to motivate and truly inform you past the poor information that was taught to you.

Sure, everyone starts out as a noobie but not everyone remains one. Alike being a basic most start out but prefer to grow...

R/r 911

Congrat's Rodney on a job well done!. Guess, I''ll be seeing you again in the legislative halls...

R/r 911

I feel they should not be worn in an MRI.

You know, its sad but somewhere ...late at night this has been attempted...at least once.

R/r 911

They should be prosecuted for murder!Sorry, just because someone had an active life and now a tragic event occurred, one can dismiss life immediately. Was this a terminal case, was there no brain function, or more an inconvenience?

Sure, spinal cord injuries are horrible and tragic in which none of us want to ever be directly involved in. Yet, there are those that have overcome to have a life and even a productive life (albeit limited role than the normal). Just because she was a athlete should have no influence.

Would we pull the plug on a patient that had became a cardiac crippled, that was a former tennis pro or runner?

How does one really know that this was not a maladaption process? That nearly everyone that is struck with this type of injury goes through the grieving process of wanting to die and end life.

I have a friend that received a spinal cord injury. He was your normal average Joe, very athletic, macho male.. He was dirt bike riding and flipped his bike receiving a C-5,6,7 fxr. Did he hate his life afterwards, you bet. He was engaged and broke it off, he was in a junior college (for 4 years) and dropped out. As is in his words, life sucked! Yet, with time and rehabilitation, things changed. Ironically, today he describes it as positive thing. Yes, he wished it would had never occurred yet ... he did go back to school and not only received his A.D. but his PhD. He now works as a University professor with other handicapped survivors. If you would had asked him the same question, he would had immediately answered the same thing.

I was a burn nurse for a few years. Was there horrible tragedies that one could had gave up on if allowed ... you bet! Some that I would had personally pulled the plug if allowed, yet I know of one that is now a very productive engineer and great husband and father. Yes, such extent of no pinna (ears) and nose, lost the right hand and only has two fingers on the other. Yet, successful in all rights as a human being.

Is there cases where we should allow patients to die. Yes. Those are well defined as terminal, no cognitive brain function(s), end stage diseases that have no chance of reversal or age dependent/ physically never heal or respond to therapy. Just asking a patient afterwards should not be considered that they have all the information needed to make a logical and informed consent.

Inconvenience is NOT one of the criteria.

R/r 911

Experience.... Higher for people in High volume services. Billy Bobs transfer service with runs to the nursing home to take Aunt Pootie back is not the same as 8-16 patients of varying acuities over a 12 hour shift.

R

Nor does those EMS that responds to those 12-15 calls in 12 hours. How much patient care was really performed and detailed assessment for such a quick turn around. Load and go, is no better than a transfer service.

R/r 911

Greater than 2 years, have to re-attend curriculum. Less than two, refresher and re-test. One still has to contact NREMT for clarification and information though.

R/r 911

My daughter was in one for a while, and I thought they asked for donations until she went back to public school. At least the money is going to books. It seemed that my daughter was selling chocolate bars, candy in tin boxes or high dollar cheap made candles going for who knows what?

R/r 911

I finally read all the comments. There was a article by Ludwig on tattoos in a JEMS rag a few months ago. Ironically, I used it to write the policy on tattoos last week. Basically, describing no visible tattoos while wearing a standard uniform, if there is, they must be covered at all times. Period. Further, no new tattoos must be received that can be visible or regarded as tasteless with sexual content or politically motivated.

Sure you have all the right to demonstrate your artistic right, freedom of speech .. on your time. While you are employed you are representing the company, not just yourself. The company is servicing the public and you are just providing the function (saving lives) of that company. Part of that profession or job is public image. The same as wearing the official uniform, keeping it clean, starched, and shoes shined. The same if someone that has poor hygiene and refuses to care for themselves describing it is their religion, artistic right not to bathe. If I wanted you to wear pink uniform shirts with yellow bow ties, so be it. You have a choice. Follow the guidelines and work at that employers or move on.

Remember, employers have rights as well. The right to only employ those that want to present themselves in regards to my customers/clients. Those are the ones that we serve, they pay our bills, and whom we are there for.

Remember, you are really there for the patient.. not that the patient is there for you!

R/r 911

Most medical care for disasters outside local coverage is provided by Medical Reserve Corps (MRC) or Disaster Medical Assistance Team (DMAT). Both are considered volunteer groups. MRC is usually composed of local area providers for the first wave of providers and within local regions where as DMAT is composed of Regional providers and deployed for a period of time (usually larger disaster where Federal Disaster has been declared).

Both have education and required entry levels, as well CEU that must be met.

Check out their web sites for more information.

R/r911

Wow! The Chiefs are really upset about a program that requires applicants to be based upon above the neck. Too bad they are such activists scare tactics instead of the real truth. How shameful and embarrassing it would be to be a fire fighter or chief to have my representation making excuses instead preparing and doing the right thing.

R/r 911

My point was to point out some things I felt was very basic points. First this technique is not new, it has been discussed and re-hashed for a couple of decades and probably will continue to do so.

What I hoped that others will learn off this that as a student you are there to learn the proper and approved way. Can one imagine as an EMT or Paramedic to have an EMS student attempt to go outside the normal scope of approved skills while on a clinical with you, and then chastise you for attempting to correct and teaching the proper method? Remembering as well, that you are a student and are allowed to work under their direct supervision, since it is their license. That any affect on care, treatment or procedures and blame will be placed upon you, not the student in which you were supposed to be supervising. Even if the so called instructors (note, not educators) are discussing this technique; this should not mean the student should attempt the technique unless approved by local EMS authority and Medical Director. I would hope most instructors would have clarified such.

Those that have read my posts, realize I am all in favor for advancing care and attempting new proven techniques. There is a place for this and its called clinical trial studies. There is NO room for cowboy medicine. This is where one is trying unproven methods of treatment. First it is illegal, and second how does one really know it does not place patients at risks?

Even in regards to reverse bevel theory. Do we really know that it is safe, or does it increase the risks of catheter shearing, laceration of the lumen of the wall, skin tear, etc. ? No one knows this unless it is scientifically studied under direct observation and under controlled studies. I feel that if this technique was so superior, then we would had read or heard about it from those that establish more cannulations than those in EMS. IV teams, ICU units, O.P. surgery units, all that routinely establish far more IV's in one hour than most EMS perform in one day. As well, there are those that do really study IV's, the techniques, the associated risks & complications that has far more education, experience, and speciality certifications than anyone on this forum in IV therapy. Surely they would had endorse this method as a normal procedure or to be used in extreme cases. IV therapy is NOT a new procedure.

Again, if I offended someone that was not the intent. The intent was to place the emphasis on the correct method of learning the procedures the correct way, knowing there is a better more way of representing yourself to the staff as a so called professional, that your role is a student while doing clinicals not to be "trying new techniques" before you have even mastered the correct methodology. I do ask, what would your schools medical director or even school liability insurance consider if they were to find out? I even doubt the instructor's would back one up or admit endorsing/teaching such technique if a complication resulted from the action.

There is always trick of the trade. Everyone does them. These should never increase or produce a risks to the patient. Until it is thoroughly proven, then it becomes is a standard procedure. Knowing the associated risks and when they are appropriate makes the difference.

R/r 911

haha there you go. I love our system

I bet you would love to trade me taxes though...

R/r 911

Do you folks charge for inter-facility transport?

You bet!! That is the biggest income generator in EMS in the U.S.

There are three bridge programs in my area for Paramedic to RN . Actually my area started this over 22 years ago. I myself, graduated from one 19 years ago with my ADN then went onward for my BSN, etc.

Here are the links:

Rose State College

http://www.rose.edu/students/hsdiv/ns_prog/progreq.asp

Oklahoma City Community College:

http://www.occc.edu/07-08-CoursePatterns.pdf#page=84

Oklahoma State University, OKC Branch:

http://www.osuokc.edu/health/paramedic.aspx

I know that all three had a very high pass rate on the NCLEX RN boards and have very respectable programs. Two have AD for Paramedic degree as well.

R/r 911

Hmmm bad joo joo... Been in three long term relationships, two which ended up in marriage > 10 years and all three were EMS related. One a EMT became ER RN, second Paramedic and third a Flight Nurse. My new requirements is NOT to be active in any EMS activities.

Yes, it does help for those to understand our moodiness, but I have found as well most of us has A type personalities. Yes, the A stands for something else as well. Not that it can't work, just the personality itself is very competitive and we all know that most medics cannot turn off the switch alike some others, which in a relationship one has to do. Something I have learned with time. Too much of thing is bad..

When I first received my Paramedic degree, when had to attend an intro class. It had five married EMS couples and they gave advice on "how to make it work". Ironically, all five couples were divorced in three years.

R/r 911

If anyone uses the cost of the ambulance bill to be a aid to get a patient to refuse is out of line. I know it's never happened right?

I routinely do this. If the patent's condition warrants true emergency medical intervention then I will discourage discussion, placing life over costs. If the condition is not a true emergency and can be handled per taxi, non-urgent care centers then I will emphasize the costs. Never refusing care or treatment, rather informing them of their options.

R/r 911

Normally, I would agree that puppies are harmless. Tragically there was a recent strange event in my state. The puppy was a very small pup and appeared to be very gentle. There is more questions than answers..

Here is the AP report :

http://ap.google.com/article/ALeqM5gLyZs1w...12QOLAD9277N6G1

TULSA, Okla. (AP) — Police say a puppy has attacked and killed a 2-month-old boy who was left unattended in a swing.

Officer Jason Willingham said Monday the baby was mauled by the Labrador at the boy's home and died at the scene. He says the dog will most likely be destroyed.

Authorities have not yet released the infant's name.

Willingham says the baby's mother and grandmother were home, but nobody was in the room at the time.

Police are unsure why the dog attacked.

The child's body was taken to the Medical Examiner's office. Willingham says police will forward their investigation to the district attorney to determine whether criminal charges are warranted

Actually if the patient is on Medicare, they require one to inform the patient (especially those that do not require stretcher services or may not be covered). One is to as well have the patient sign a release stating that they realize they maybe be billed for such services. If one does not discuss prices how is the patient to know the costs? Why would the costs be hidden? Patients are supposed to be informed of all their options and risks.

In regards to non-paying patients in the ER, alike in EMS, we turn them over to a collection agency in 90 days if no payment has been received. In fact, in one of the ER I managed they were not able to receive their prescription unless some form of payment was made. Yes, assessment and initial treatment was given, so life threatening injuries and illnesses was corrected or determined. It did not matter the amount.. $3.00 to what ever also a discount was made for those with cash payment.

R/r 911

You are the one that posted and flaunted it, can't stand the heat get out of the kitchen. Really, don't care what article, or poor teaching you might be receiving.. that will not hold up in court as you are judged by your curriculum, the manufacture recommendations and other professional peers. Discussion of what might and doing is another principle. One can use D50w up the rectum; but that does not mean I have to try it.

If you want to go against the manufactures suggestions and I am sure standard procedures and protocols, that is fine but work on you own license and don't criticize others that are attempting to install proper procedures to students.

Yes, we all have tricks of the trade or short cuts that have not been medically validated but they should not be taught as part of the educational process.

R/r 911

Wow! Their monitor batteries must be better than mine. 38 times ? ..

R/r 911

Diploma nurse= go back to school to get degree.

ADN= go back to school to get BSN for promotion

BSN= Go back to school to get a position

MSN= Go back to school to get professional position and be the leader of your profession.

PhD/DNSc= Definitely not reimbursed enough for the education level in comparison ; also very few job opportunities in comparison.

Diploma nursing went out in the 80's. Yes, there are a few left.. (hint few). If you want to be recognized or ever considered for any promotion, better have the degree.

R/r 911

The reason the bevel is up is to prevent "tearing" the skin as it punctures as well as while introducing that catheter into the lumen you make a clean entry into the vein. Now, if I was the nurse, I would have failed you as well as not following proper techniques and instruction. Get into a debate with me over such, I'll send you home and attempt to not allow you to continue clinicals at that facility anymore. We need students that want to learn not debate. Remember, you don't even have the license yet and you are telling them how to do things? Wow.. your impressive. You just demonstrated you have no regards of performing a procedure properly. Yeah, working under her license and your upset that she wants you to perform it correctly... shame on her! Your whole purpose is to learn the correct method, not some tricks of the trade that might endanger a patient or one's career.

Wonder what your institutions and instructor will feel about explaining to the patients attorney if there was the catheter shear?

I agree your main purpose may not be assisting in their duties, but as well it demonstrates team work something everyone can work upon.

R/r 911