Ridryder 911

I agree with the others. If you can find an accredited program, the chances are they will have a high pass rate as well. Although, it is true, you must pass your test to practice, there is definitely more than the test. I have a couple of medics that I know, that had a horrible experience in medic school. They self taught themselves, and passed the NREMT/ P with high scores.. so do let the test intimidate you. Good luck, R/R 911

So do you have them take water with this as they swallow ?... I believe the right route would be inhalation. Be safe, R/R 911

Oh .. Oh.. are we tryin gto say there is a difference in V/q... ? LOL R/R 911

As other have posted, I would also consider contacting State EMS Director Offices. They should be able to direct you to the training director that will have the information in your area. Here is a link to state EMS directors http://www.nasemsd.org/ Good luck ! R/R 911

Hopefully, counseling and medical therapy will help. Maybe they will be able to find the problem either depression or organic. Good luck, & he will be in our prayers. R/R 911

As far as I know there is no requirement here even for formal EVOC training, usually it is required by the insurance carriers. However, my service requires either you have EVOC every 2 yrs. or every year, dependent on when the class is presented. Whenever, we have hire new people, we make the rest of crews take it again, for refresher (at least the serpentine and handling portion). Be safe, R/R 911

Okay I have to say this.. "I wonder if they have any positons left ?"....... R/R 911

Okay What the hell is street smart or street skills? Is that what the guys on highway maintenance use ? I have been a field medic for nearly 29 years and yet figured out this stupid expression. This is usually used by the guys that can't read above th 6'th grade level, and was promoted up from the "gopher" status. Should I inform the patients to seek other medical advice from the cardiologist because he "was not street smart" ?... Being a good medic is one that can learn and be educated in emergency medicine from both books and clinical areas, and then can adapt and place that knowledge to be effective in the field setting. Sorry, one can learn "bad habits and still be dumber than a rock & follow protocols" thus being street smart. Should I use the purple box, yellow box analogy ? If you are talking about being safe, knowing how to handle people, providing effective care in the field, you better know more than the street sense. Sorry, we provide medical care .. not street medicine. The days of John Wayne medicine died several years ago .. thank god ! Don't want to promote EMS as a profession so be it. Don't want to condone a National Standard test, or enforce education that would promote the EMT's or Paramedics with formal education so one can be licensed in any state, that is your choice. Might want to go back to the 70's... I heard they maybe re-making Mother Jugs & Speed ! R/R 911

I go to school with a couple of Exclusior graduates. They are sharp... they also will tell you that they had to study their anus off as well. Especially, the BSN program. Just like some say about Paramedics without experience of an EMT, the same with these nurses, they had to grab on learn faster and harder. Most will tell you that they wished they would had went through traditional programs for the clinical phase. It is not that it can't be done, just very difficult. If you think EMT or medic school was difficult, I would not suggest that type of program. Good luck, R/R 911

I can't speak for Dustdevil, but I believe what he was referring to is most medics believe that if they are good medics, this will automatically make them good nurses as well. That EMT was easy so will nursing ....Nurses (albeit they still have plenty of problems) actually finally gathered their priorities together and have a true set curriculum, testing and educational standards. Not like EMS. Why should the nursing honor any EMT program? They are 2 different professions. That is like saying x-ray tech should be able to audit out nursing school. Remember less than 10% of nursing has anything to do with emergency or critical care. Believe it or not folks, most nurses DO NOT WANT TO TAKE CARE OF EMERGENCY or CRITICAL CARE PATIENTS ! Sorry for the shouting, but most EMT's still assume that is what nursing is about...WRONG! EMS is too fragmented with way too many levels, (One EMS magazine stated > 150 acronyms) and no true set of standards of education or even a "true " national test. There are way too many ego's and not enough education in EMS. If our educator's and EMS administrators, governing bodies was required to have an education prior to their appointment then we would had seen some progressive changes. EMS is still way too "Mother, Jugs & Speed" style with certifications and EMS administrators and EMS Trainers being appointed to those positions because of their field knowledge, not their expertise in those areas. Forty years later and still things continue to be the same.... because the people in EMS refuse to mature and allow the profession to grow. I can assure you, if it was harder to become an EMT (education level, spending the time and money) like other health careers, there would not be as many leaving. It is too easy to become an EMT or Paramedic. Short and simple. Be safe, R/R 911

I think there is a deep subconscious thoughts of most EMT's wanting to be NASCAR drivers...... 8) R/R 911

Wow! Level 5 .. LMAO R/R 911

I always wondered when you document should it be different ? Like you do for Doppler ?... R/R 911

Sorry, I have priced soap and water, it is not that expensive. Try catheterizing a female patient that has not bathed in at least 5 months... not because of illness, but because of no desire to take care of themselves. I had a gentleman, that I tried to remove his socks and could not... they had been on for over a month and a half.. and had started to embed into the skin. Again, these were not homeless, or so ill they could not perform measure, but have no desire to care for themselves, because they knew someone else would later. I have compassion for those that need it.. but to abuse yourself, and me because you are lazy.. geex. I have heard that .. I am poor, broke, etc.. song and dance routine so long, only to find cigarettes in the purse, and to respond to the Casino'son a call to see them plugging away. .. sorry for the tangent.. lot of F/F (frequent flyers) lately. R/R 911

Actually, there was one state that had a loop hole that apparently allowed a few to slip through. I believe it has changed now. I agree from what I know of, there is a minimum of at least an associate degree program. True, you can test out of some the long distance nursing programs, but you still have to have an associate degree. I know the NREMT used to allow RN's to test out for the Paramedic examination, but have changed their policy since. Just like any other profession, you will have those that can pass board exams showing that might have the minimum criteria. Again, they have some similarities, but are totally different professions and should be treated as such. Be safe, R/R 911

Unfortunately America neglects its elderly more than European countries. We place our elderly into nursing homes, care centers etc. I am not blaming or excusing either one. It is difficult to take care of an elderly person, and is a full time job as well. Yes, it can be done, but like I said it can be very difficult. From my years experience elderly people are placed into these homes for 2-3 reasons. One is to recuperate until illness is better and or arrangements can be made, the other is to place the patient in the facility to die. I place a lot of the blame on the physicians not addressing the situation of DNR's. Many are still uncomfortable of discussing with the immediate family or even the patient. If things were discussed in detail, patient and family members could make a better rationale decision. True many family member want to make the final decision, and unfortunately we are not allowed to carry out the wishes of the patient. True, we have an obligation to our patients. That service is to care for them, the best we can. Too many have the idea of DNR is not to treat, and I have seen more than my fair share of situations like that. As well I have a poor tolerance of not having the patient information prepared for treatment and transport. I do understand the difficulty of taking care or being responsible for 150 patients, but having the DNR status in hand should be easy enough. It appears that recently we are getting more and more apathetic medical providers. Maybe it is my age, or years of experience, but I will no longer tolerate such behavior. I now will call and discuss the matter with the D.O. N . or administrator if need be. More we allow or tolerate, the more it will occur. Be safe, R/R 911

I suggest performing a Google search.. most from what I remember it does induce seizure activity, have not found status but I am sure with the caffeine it would not be be impossible. For what I have read Wellbrutin has a lower mortality rate, than some other medications.There is not much documented time release capsules. I am sure it is all based upon the amount, absorption rate. etc as well with what else as taken. Two stimulants definitely would not be advisable. I hope things ge better and the outcome is positive. R/R 911

Looking Your Best for the Paramedics No woman wants to think about it: there you are, balanced precariously on the edge of your sofa, trying to nab that out-of-the-way cobweb, when suddenly you lose your footing and fall flat on your face. Three days later you awake in the hospital, and just catch the end of a cat chat among the nurses about how you were dressed "like trailer trash" when they found you. How humiliating! It doesn't have to turn out that way. Read on to learn what you can do to transform the unforeseen calamity into a beacon of admiration shining directly on you, the best-looking household injury in the neighborhood. Always dress up a notch You know how it is: you come home from work or a long afternoon of shopping, and all you want to do is get into your sweats. Resist the urge! Change if you want to, but into an ensemble fit for guests. Dressing well means that you're ready to face the unforeseen with fashion sense. Should you lose consciousness, for example, before you can writhe to your most flattering position on the kitchen floor, at least those attractive dividers and slightly daring fatuas are still working their magic. Remember: even drool won't look so bad when you're properly attired. This ground rule applies even if a household emergency never befalls you. We can't predict when the police might accidentally transpose the numbers of a suspected murderer's address, and land at your doorstep instead. And won't you look lovely as they handcuff you and drag you away to the police station for questioning. Always be freshly made up. The perfect outfit is all but useless if your makeup has worn off. It doesn't matter if you're hurling every five minutes from the Asian Bird Flu. The magic word you must make your mantra is, "Re-apply"! Carry a cell phone on your person at all times What if you're done writhing in the living room, and then remember that you haven't called 9-1-1 yet? Now you have to crawl to the phone, leaving an unsightly traffic pattern, and God knows what else, on your carpet. If you make it back home alive, you'll be greeted by that unsightly mess. But with a cell phone at your disposal, you can call first, then lose consciousness with the carefree confidence that any carpet damage has been limited to your writhing zone. Rehearse and rehearse again. If you want to look your best in an emergency, you need to be prepared. But don't put undue pressure on yourself to execute the perfect life-threatening accident without plenty of practice under your belt. You didn't get that quiche pastry right the first few times, either! Imagine, for example, that you were to faint while standing on a step ladder. How would you like to be arranged when that handsome paramedic comes charging into the room? Rehearse your fainting spell from a safer, lower step on the ladder until you master your fall and land in the most comely configuration for your body type. Let's say that you possess lovely, narrow ankles. We suggest landing on your side with your legs attractively scissored 4"- 6" apart below the knee, and your feet pointed slightly downward. Who wouldn't want to help such a fetching tableau of distress? Just to be safe, wear padding and head protection during rehearsals. By the way, there's never any shame in being caught with your practice gear on. If paramedics discover you "outfitted," their admiration for your dedication to feminine beauty will simply increase their efforts to bring you back to life all the sooner. Make your entryway sparkle. Remember that your home is an extension of you, and that the paramedics will traverse your entryway both coming and going. Be sure to apply daily spit and polish! You may also need to invest in basic renovations, such as vaulted ceilings and imported Italian marble statuary. It's difficult to put a price on a human life, but we think this comes pretty darn close to a reliable estimate. Oh, and don't forget the fresh flowers. Consider yourself armed with the basic skills for putting your own special beauty mark on almost any household emergency. author unknown

Methemoglobinemia due to incorrect use of benzocaine sprays By Feb 22, 2006, 07:28 Courtesy the EMS House of DeFrance http://www.defrance.org Benzocaine sprays are used in medical practice for locally numbing mucous membranes of the mouth and throat for minor surgical procedures or when a tube must be inserted into the stomach or airways. Their use is known to be occasionally associated with methemoglobinemia. However, cases of methemoglobinemia have also resulted from medication errors due to incorrect use of benzocaine sprays (e.g., longer duration or more frequent sprays than recommended.). On February 8, 2006, the Veterans Health Administration (VA) announced the decision to stop using benzocaine sprays for these purposes. The FDA is aware of the reported adverse events and is reviewing all available safety data, but at this time is not planning action to remove the drugs from the market. Up until now, the FDA has concluded that the number of reported adverse events with these sprays has been low and, when properly used, these products can help make important procedures less uncomfortable for patients. This advisory applies only to benzocaine sprays used in the mouth and throat, not to other benzocaine products or to benzocaine sprays applied to exterior skin. The FDA is again highlighting here safety information previously addressed by the Agency (see http://www.accessdata.fda.gov/scripts/cdrh...inter.cfm?id=40 ), and will make further announcements or take action as warranted by the ongoing review. At present, the FDA suggests considering the following points about the use of benzocaine sprays in procedures requiring that a tube be inserted in the larynx or pharynx (down the throat, windpipe, or gullet) or in minor surgical procedures performed in these locations. Considerations Benzocaine sprays used in the mouth and throat can result in potentially dangerous levels of methemoglobinemia. Patients who have breathing problems such as asthma, bronchitis, or emphysema, patients with heart disease, and patients who smoke are at greater risk for complications related to methemoglobinemia and may be candidates for other forms of therapy. Patients who may have greater tendency for elevated levels of methemoglobinemia, such as all children less than 4 months of age and older patients with certain in-born defects (such as glucose-6-phosphodiesterase (G-6-PD) deficiency, hemoglobin-M disease, NADH-methemoglobin reductase (diaphorase 1) deficiency, and pyruvate-kinase deficiency) may benefit from products with different active ingredients such as lidocaine. Patients who receive benzocaine sprays should be given the minimum amount needed, to reduce the risks associated with methemoglobinemia. Patients who receive benzocaine sprays should be carefully observed for signs of methemoglobinemia including pale, gray or blue colored skin, headache, lightheadedness, shortness of breath, anxiety, fatigue and tachycardia (rapid heart rate). Methemoglobinemia makes a standard device used to assess the amount of oxygen bound to hemoglobin (2-wavelength pulse oximetry) unreliable. If blood is drawn to check for the condition, a co-oximeter is needed to reliably detect methemoglobinemia. A characteristic color of the blood (chocolate-brown rather than blood-red) can be a danger sign, but these changes are a late sign of the condition. Patients suspected of having high levels of methemoglobinemia should be promptly treated. Methemoglobinemia is a condition where too much of the hemoglobin in red blood cells becomes unable to bind and carry oxygen. While there is treatment available, until the condition is reversed, oxygen is not effectively delivered throughout the patient’s body. Patients with methemoglobinemia can suffer effects ranging from headache to cyanosis (turning blue due to lack of oxygen) that can be life-threatening in the most severe cases. Patients with underlying breathing problems, such as asthma or emphysema, patients with heart disease, and those who smoke may be more susceptible to the problems from methemoglobinemia and may suffer from bad effects from this condition at lower levels of methemoglobin than healthy individuals. Similarly, some patients may lack or have reduced level of enzymes that help reverse the methemoglobinemia, and they are also more susceptible to risks associated with benzocaine sprays. The VA health system has announced its decision to remove benzocaine sprays from their practice because they believe other topical anesthetics are less likely to cause methemoglobinemia and because the procedures themselves might cause similar signs, suggesting that methemoglobinemia may occur but go unrecognized in some cases. The FDA has received adverse event reports involving benzocaine sprays together with symptoms that probably indicated methemoglobinemia in the patients. It is important to note also that these cases were received over a period of many years and this is an uncommon adverse event. The FDA is continuing to review all available safety information for these affected products. 1 In addition to benzocaine, Cetacaine® also contains butyl aminobenzoate and tetracaine as active ingredients. The contents, unless otherwise specified, are copyrighted by © EMS House of DeFrance. http://www.defrance.org and/or http://www.emshouse.com

The NREMT Announces Plan to Incorporate the Revised AHA Guidelines on NREMT Exams by The NREMT recognizes that the EMS community is in a transition period as medical directors, EMS agencies, EMS educational programs, and States implement the 2005 American Heart Association Guidelines for CPR and Emergency Cardiovascular Care. In conjunction with this transition, the NREMT will be revising examinations as follows: After June 1, 2006 the NREMT will publish interim pencil-and-paper EMT-Basic and First Responder Exams. After September 1, 2006 the NREMT will publish interim Paramedic, EMT-Intermediate (85 and 99) Exams. The interim examinations will be constructed so that candidates will not be penalized for being trained over either 2000 or 2005 AHA Guidelines for CPR and Emergency Cardiovascular Care. After January 1, 2007 all NREMT cognitive and psychomotor exams will reflect 2005 American Heart Association Guidelines for Emergency Cardiovascular Care. During the transition period, practical exam skill sheets will continue to reflect 2000 guidelines; however instructions to examiners will be modified so that candidates correctly performing to 2005 guidelines are not penalized. This transition plan is predicated on assumption that the American Heart Association releases educational materials supporting the new guidelines as scheduled and may be modified if the AHA changes the scheduled release time for educational materials. Feb 22, 2006 source/courtesy of http://www.nremt.org

I see they changed the M on the EMT had the 3 line m...whenI used to work with a couple Tx guys, we would make a couple extra bars on the E to change it to S the M into H & I then T .. it spells out SH*T ..lol Be safe, R/R 911

That is most "nebies" fear. You wil find out that you are usually too busy or should be to notice the "gore". With more medical education, the "gore factor" leaves and you actually become more interested in situation. Good luck, R/R 911

Surely your joking after seeing these ...! http://www.ncems.org/patches/patchpg2.htm R/R 911

I can always tell the ones that have never had professional education with board exams. NREMT is an organization that administers TESTS ! That's it short & simple !. Take the test OR not take test.. it is up to you ! Want to move to 40 some other states, you might to have taken & pass the test. Some states will not recognize other states certifications or schools... some states will give you a license or certification immediately if you are CURRENTLY NREMT certified... thus less hassle, some won't. Don't blame the NREMT..blame the state. C'mon folks this is not rocket science. Thank god we don't have multiple testing organizations like respiratory or laboratory tech.'s have .. we would have to have it's own forum and web site ! Be safe, R/R 911

Yeah, most do not there are preferred ways in wearing the NREMT patch... i.e left shoulder, 1 1/2'' from the shoulder. They even have subdued for SWAT, military etc.. It also has a trade mark.. I get chuckles with my patch collection of mine. I have one of the original "charter" member then the NREMT/ ambulance, then the NATIONAL bar on top, etc.. hmm maybe someday I might have to sell them for retirement money ... :wink: