Ridryder 911

What did he eat? Did his dog get loose and did he pet him afterwards? ...

R/r 911

Rid, Humeral Head I/O was a skill we introduced at the begining of the year as an alternative insertion site to tiberal tuberosity. I will say that in most cardiac arrests we have been running here in Austin that an I/O is primary insertion point on more than a few of those cardiac arrests. There was talk for about 2 months about our system removing EJ cannulation as a skill. This is where the humeral head insertion point came in. The paramedics in the system have convinced all of our powers that be to let us keep the skill by demonstrating proficiency knowledge of when's, why's, and how's etc. However we were still left with the Humeral head as an insertion point for our EZ-I/O. When i am asking about securing the I/O cath we all know that things can be bumped during movement etc. and I am curious how easy this site is to maintain and keep patent with everything else going on up by the chest head and neck area. One of the things I like about the tibial tuberosity is the insertion point. It is a skill easily erformed because it is out of the way of chest compressions, airway management, and defibrillation

Wow! I thought Austin was smarter than that. Why would anyone even consider to remove a peripheral line access over an I/O route? Yes, they are wonderful but should never be thought as more than an alternative route. Yes, I have started my fair share too; but personally unless one has a pressure bag and large enough bore .. it is hard to still infuse at a decent rate. No matter what site is utilized. Again, peripheral (especially EJ) would be a much more preferred site not even thinking of the long term effects of I/O.

Sorry, misunderstood your comment on securing the I/O. That is about the only advantage FAST has that it does have a "dome" cover to help protect the site.

R/r 911

There are several previous numerous posts on the use of capnography. From the use of monitoring for air entrapment to side stream, to DKA. Might check search for the previous posts.

R/r 911

I'm also going to add here. Is anyone using EZ I/o humeral head insertion? We started doing it the begining of this year. I haven't done one yet because if I personally am up by that part of the body I am going to go EJ. I was wondering if people have had issues with securing the catheter, moving patient etc.

Why would you not establish an EJ instead of a EZ I/O ? I/O should be used as an alternative if there is not an ability to establish an venous IV. As well, you do understand the "catheter" per say is in the bone and securing it should NOT be a problem and if there is; you have not performed the I/O properly.

R/r 911

I do believe one of our major downfalls is the inadequacy of patient assessment skills. No matter what level we are discussing. Sorry, very few Paramedics actually know how and worse do not perform detailed neuro assessments when needed; most referring to the old PEARL. Which most know by now in comparison is really a farce. There are so much more that EMS personal can obtain by learning detailed assessment techniques and then applying them and using them appropriately.

Yes, one should be able to focus on the problem and perform a detailed assessment and history. So many are being taught.. " you don't need to know this or you don't use this or that in the field" Those that teach that is full of B.S. and should be considered poor instructors. One can master such assessment techniques and then develop related clinical understandings. After performing several; then one can modify and learn to "speed up" assessment techniques.

Yes, I listen for gallops and murmurs on cardiac patients .. (it takes < than aminute) .. yes, I check skin turgor, clubbing, even a brief overview of hair growth patterns (which can reveal circulatory problems). How many look at the conjuctiva on a hypotensive or GI bleed? .. All can be major indicators of related illnesses and injuries. Again, why not? Most of this is an automatic assessment, much occurs while approaching my patient.

I found it humerous a few months ago, while I had some EMS clinical students. I pointed out what what I could detect by just observing the feet alone. They were sticking out from the ED curtains at the time. The edema present, poor skin break down with the skin having an ash/flaky appearance, thick toe nails, ulcerations located in medial aspect of the legs/ankles and foot drop. Without even seeing the patient's chart or viewing above the ankles.. that I predicted that the patient was a long term care patient, a diabetic probably on Dyalisis and was septic. I have to admit the students were shocked to see that I was correct on all accounts; just by knowing disease process associated with observation of a patient....

My scene time is just as short in comparrision to others, but after practicing and developing my skill continously, one can master a thourough assessment in a brief period of time. It's not hard .. just have to study and practice repeatedly.

R/r 911

Here is a great link to understanding heart tones as a Paramedic and reference in EMS.

http://www.co.gaston.nc.us/gemshp/training/HeartTones.htm

R/r 911

Hard to get the taste of those feathers (crow) out your mouth .. huh? As others described welcome to the other side. Yes, it does get harder and along with it comes the responsibility, which many EMT's fail to recognize and you will as well.

Good luck in school and thank you for your declaration. It takes integrity to do so.

R/r 911

Although technically not free; I liked the presentations...

http://www.utsw.ws/guestquizindex.htm

I agree with you on that... but what if a member had a profile (be it myspace or even a non-pornographic dating site) and they identify the company they work with, as well as make it accessable to the public? Does that in any way demonstrate unbecoming? Sure we are all humans and entitled to our personal lives... but is there a point where even tasteful can be harmful in our proffesional lives?

You are very right. For example; I personally have some pics of friends and even a few scene pics (no patient data-even changed the vehicle color) along with some add ons of the usual EMS and RN glitter. By doing so, I have met and chatted with other Paramedics and RN's. In fact was able to be contacted by a fellow Paramedic graduate of my program I had not heard from in 27+ years (yes, remarkably we all are still some form of EMS still after > 27 yrs.)

Now, the bad side effect is I have seen medics making obscene gestures wearing companies uniform and even describing F.U. (you get the hint) to a Director. Of course, things get around and how would you expect them to feel? I as well as many administrators and boards feel that if you are wearing insignia, uniforms; you are representing the company, school, institution .. on duty or not. The moment one wears and displays the insignia, badge, patch, etc.. with that company, cities, state, whatever.. they are no longer just representing themselves but the company, employees, administration and even the patrons of the service.

So yes, everything that displays or that demonstrates that you are associated with a particular agency is fair game to their advantage. If you want personal freedom to be unprofessional, poor conduct and low moral stance.. You are welcomed to on your time, without any mention of your association or mention of that companies name.

It is not that hard to determine what is right or wrong. People know the difference; they are not stupid; rather they love to challenge to be different and be noticed. If you know that your administration would disagree or see harm in it.. then it is a high possibility that it is wrong.

R/r 911

There is a far cry from my space, Internet dating and then posting self or any porn. Unfortunately, people attempt to want to cross the line and dare others to challenge it. Once again we demonstrate how unprofessional this so called profession is.

I doubt there are many states with "conduct and professional standards" alike many of the true professions have (attorneys, physicians, engineers, and yes even nurses).

What people do on their day off is their business as long as it does not will not embarrass or display poor moral conduct. There was no reason to wear the Chief shirt.. and obviously he is a whacker in more than one way. Too bad our profession cannot literally "boot" him out. This was more than an EKG background or a few pics of EMS units and should not even be considered the same.

R/ r 911

i no longer get Jems, too frilly for me. Can you post a link for all of us.

I subscribe, but my rag is at work. So I thought I would check it out on-line and post a link. Apparently JEMS has changed their website. Now, it is similar to other professional journal web sites .... shame that their magazine is not.

R/r 911

I agree divorce can be brutal but nothing to loose your head about

Ruff-The four allergies you named are the 4 most common ones I see with my patients.

PCN is actually a allergy with at least 1 out of every 4 patients

Then you ask them what it does, they will say they have never taken it :shock: ...

Allergies is big clue as well as type of history they may have. Albeit substance abuse, treated for mental health, seizures, chronic pain, cancer, etc... similar to the medicine that are taking.

Just as important to know the allergies is what do they consider the allergy to present? Most are NOT true allergies rather are side effects of the medication.... i.e. Codeine=nausea, Lortab=vertigo,nausea..etc..

I stand by my statement. I took both CEN and CFRN. Neither certification changed my responsibilities as a nurse in the ER or in the transport environment. Just like taking ACLS, my responsibilities as a provider do not change. This is my point. However, I find other people think they are entitled to have intubation privileges after watching somebody do it at an ACLS class.

Take care,

chbare.

I understand what you are describing, but as well it may change your or increase your scope of practice. For example many states will not allow RN's to intubate, adminster RSI, deep sedation, EJ's; unless they have been through or demonstrated knowledge in that speciality. I know that it is a touchy subject in my state, and the state likes to see credentials such as CFRN, CCRN, CEN, CTRN, demonstrating that the have met the professional minimal standards. No, not a license rather a demonstration upon the individual has taken upon themselves to excel and focus in an area of expertise.

R/r 911

I'll stop whenever the general Paramedic curriculum has enough material that there could not be a differential made.

I don't think I will have to worry....

R/r 911

I notice Bob Page famous 12 lead book writer and instructor has the following after his name. AAS, NREMT-P, CCEMT-P, I/C

Bob is an active instructor for UMBC as well wrote the majority of UMBC cardiology portion and ... the cardiology portion of Bledsoe's CCP text.

I have talked to many instructors of the Critical Care Paramedic programs, Ohio, UMBC and even FP-C review courses, nearly all have stated there is few to no changes.. again, critical care is medicine and medicine is medicine. Can all improve ? Yes, but again most courses only teach what is minimal accepted.

R/r 911

Most of our systems (progressive) that have SCT have either adopted the UMBC or FP-C, or an internal one. The reason I am on a task force; attempting to develop regulations and guidelines. Yes, it is routine for most services either to charge for SCT if they meet the guidelines, (of course for interfacility transports) and some may not if there is not a CCEMT/P aboard rather a generic Paramedic. And yes, most programs in my state (I say most cautiously) teach above the general curriculum of the Paramedic. Again, most will not charge unless they can demonstrate that those individuals have met or successfully completed some form of a CCP course.

Even one of the largest EMS in the metro areas in my state will not transport a patient with a NTG drip unless they have one of their specialty care medics. The trick now is some hospitals realize that the ruling describes that the person trnasferring must be equal or higher trained and be familar with the treatment regime. Some are using helicopter EMS (HEMS) for such transports to meet the requirments.. a much more costly event than ground. Even most ground transports (Non SCT) 911 starts at a $1000 & up.. with speciality care at about $1500-$18000. HEMS starts about $6,000. I was shown by a patient a HEMS bill for $18,000 for a ER cardiac transfer that was flown < 25 miles, with only two IV drips..

Not trying to start another debate, but something else that needs to be investigated. That hospital based SCT can and will recieve a larger proportion than third party or private EMS. Many times a charge is placed under ICU/CCU that was performed by the SCT flight or ground crew. It does not matter where or whom performed rather the facility offered and performed the procedure/medication. No difference from the ICU or the HEMS ...

R/r 911

The OP was just a question asking what CCEMT-P stood for and what it meant. How did we get to the issues of billing? I understand that when submitting charges for services rendered, especially for insurance, you may have to list someone as a Paramedic to prove that paramedic services were provided. But do you get more money if you list someone as a Critical Care Paramedic as apposed to a "regular" Paramedic? Maybe some places you do, I don't know.

That is why it was being discussed. Yes, one can increase the charges if they are performing SCT that meet the criteria. Again, the only reason the CCEMT/P was even designed for.

R/r 911

Many may not be aware of a new OSHA requirement stating and mandating that those involved in working near or around Federal Hwy. must wear approved reflective vest. This will take effect soon Nov. 28, 2008. Even though, your state may not be an OSHA state it does receive Federal Highway funding and can loose funds if it does not participate. (so basically all will participate)

This law was placed a few years ago and a few states are challenging the types of vest ( tear away if working construction, etc) but over all; all agree it would be a safe measure. This also means LEO at MVC's, traffic stops, F/F, EMS and even tow truck [s:bb6b4c0bd8]drivers.[/s:bb6b4c0bd8] technicians.

http://edocket.access.gpo.gov/2006/E6-19910.htm

DEPARTMENT OF TRANSPORTATION

Federal Highway Administration

23 CFR Part 634

[FHWA Docket No. FHWA-2005-23200]

RIN 2125-AF11

Worker Visibility

AGENCY: Federal Highway Administration (FHWA), DOT.

ACTION: Final rule.

-----------------------------------------------------------------------

SUMMARY: Pursuant to Section 1402 of the Safe, Accountable, Flexible,

Efficient Transportation Equity Act: A Legacy for Users (SAFETEA-LU),

this final rule establishes a policy for the use of high-visibility

safety apparel. The FHWA establishes a new Part in title 23, Code of

Federal Regulations (CFR) that requires the use of high-visibility

safety apparel and provides guidance on its application. This

rulemaking applies only to workers who are working within the rights-

of-way of Federal-aid highways. The FHWA is taking this action to

decrease the likelihood of fatalities or injuries to workers on foot

who are exposed either to traffic (vehicles using the highway for

purposes of travel) or to construction vehicles or equipment while

working within the rights-of-way of Federal-aid highways.

DATES: Effective Date: This final rule is effective November 24, 2008.

The incorporation by reference of the publication listed in this

regulation is approved by the Director of the Office of the Federal

Register as of November 24, 2008.

My state is discussing taking action against EMS services not mandating and action against EMT's themselves if found not participating. As well, many may not know employers may be exempt from liability if the employee did not use such devices and they were injured or killed.

Personally, I much rather be seen than felt!

R/r 911

EMT = First Responder and First Responder = EMT. Doesn't matter which one the Fire Department chooses them to have.

Case closed.

R/r 911

Thanks for adding the additional language, I failed to do so. Yes, they are not for primary responses however; many services will charge for an ALS II for an emergency interfacility transport. Yes, they have to meet the requirements for SCT.. .yet many do and the EMS does not take advantage for services they provide. Aviation EMS and Speciality Transport teams are well abreast of this.... every time there is a interfacility transport..

This is a justified charge increase for services rendered. Again, most of those in EMS Administration have little to no formal business or health care administrative education, rather a "good ole boy" promotion. One of the multiple reasons EMS is drowning....

Mine is set up as a non-profit trust. They do receive a minor county 911 tax revenue (about $30,000 or so a year) as well as we have a membership that does not generate much anymore. The main payer is the usual billing which is Medicare/Medicaid and the usual Insurance payers. We have an above collection rate, especially in comparison being of the urban/rural setting.

I have to admit my administrator and the billing people try to stay abreast of the daily changes. It is hard to make it in EMS and most EMS Administrators lack healthcare administration education and background.

R/r 911

Personally I would probably not place "CCEMTP" behind my name. It is not a board certification/registration in the same way that being a NREMT-P is. It would be more akin to a emergency physician in a trauma center placing ATLS (advanced trauma life support) behind his name. Postnominals are generally limited to the most advanced degree you hold and any relevant board/registrations.

I feel that the registry should move as soon as possible to establishing a level of criteria for certification of such paramedics, but feel that there is greater need in studying the efficacy of an advanced-level paramedic practitioner.

Very good points. As well, NREMT is NOT a formal board either nor represent having formal education, rather a private testing firm; but people continue to place their titles as such.

Ironically, I find Bledsoe's post confusing. It was not not very long ago we had discussed the possibility of having a Critical Care Paramedic level and in fact he had discussed with me (per e-mail) that the Registry had been contacted but the costs for it were astronomical. Thus, the decision to possibly link to the FP-C for credentialing.

Again, Dr. Bledsoe is one of EMS best representatives in the business, and honestly a mentor for me and others. I can not speak enough and give enough praises of how his involvement has changed EMS. I do however; find the timing of this article strange when he has a new text "Success for the Critical Care Paramedic" coming out in a few weeks. I do wonder if this was a publisher timing.

R/r 911

I think there was a misunderstanding somewhere. We do bill for services, but don't have the need for increasing that cost to our taxpayers. We do have property tax, and have past a sales tax to start off setting that cost to the tax payers. I'm quite clear that it takes money to run an ambulance every year, but is there really a need to rake the residence we serve if there is other money out there? If so, are you really serving those residents as responsibly as possible? I have never believed that it was our job to keep the poor (that we tend to run on the most)....poor, but by continuously running on these people then hitting them with huge charges such as the ones discussed here, we are doing exactly that. Savvy? I call it irresponsible, but if thats how things need to be done at your service then so be it.

I believe there is a misunderstanding. How are you offsetting the costs by having a different level of charges? I bet, if you investigate you have ALS I or ALS II with multiple charges. As well, look into the billing.. speciality care is only charged when those calls are appropriate, not on every call.

The citizens will pay for it one way or another, personally I much rather charge it to those that required the services and not to the broad spectrum of tax payers.

R/r 911