Ridryder 911

Never seen a manual that could hold enough emesis. Also, my hnads are too busy to squeeze, or perform suctioning, it is much easier to use a Yankuer tip or just the tubing & remove the chunks...... Be safe, R/R 911

New future EMT's if we don't change our education system soon.............. http://www.ebaumsworld.com/flash/bkingremix.html Merry Chrsitmas...! R/R 911

Howdy !.... Be safe, R/R 911

Insult to injury.......as my partner and I was getting our order from Wendy's the mgr. was making small chat.. (we were hoping for discount ...lol) he discussed he used to be a Paramedic for 9 yrs (really was) stated he could not afford it anymore..... wow! as he asked if we wanted fries with that ..... be safe, R/R 911

:protest: Actually there are 70% in 35 states has formal Paramedic training. This does not always include degree training or of those might be with associated business or vo-tech Paramedic programs that one might be able to transfer credit to a degree program later. ( * source U.S. EMS Survey 2003) http://www.emspi.org/Downloads/pdf/Rural_I..._EMS_Survey.pdf Please be reminded when comparing with Physical Therapist, they usually require a master degree level for therapist entry level and only allow a few in programs (fewer allowed than in medical school). Competition is fierce as well. They too have a lower level technician ( physical therapy aide/ associate degree level). I believe most are missing the main point... money $$$ As long as EMS only receiving up to 80% of reimbursement and with collection of average <70-80%, there will never be high salary either. If the money does not come in ... it will never go out. Government supplemental programs will never work and and with recent government cuts, I am sure EMS will not be receiving an increase but a decrease. Again, a re-vamp of the whole EMS system needs to occur. But, I doubt it will. Most of the true successful EMS financier's "will see that the pie is never cut" ...Keeping EMS managers ignorant in billing, coding, even keeping medics ignorant only saves money. Cold hard fact, but true.. Until we as a business, are able to truly recruit and supplement those who know how to manage health care and business, things will never change. But us as practitioners must also learn a few business things as well. Just as physician's had to suddenly change gears & start learning proper documentation to receive appropriate reimbursement and to be open to change certain treatment routines as well. Most medics do not give a damn on the financial aspect of the business. Compare this with the attitude of physicians & yes even the physical therapist. They get the picture...unless you know the rules of the game and learn how to use it.... you can never win at it! Again, this all goes hand in hand... increasing our knowledge (medical and general education) to be able have a bargaining factor as well, along with major a revamp of the whole system. I doubt this to change soon, there is too many making money on the way it is. And most medics really don't give a damn.. if they did they would had changed it. One way to change is by ensuring proper documentation is occurring so that the proper reimbursement can be achieved. It is then has to be properly coded. Money will never float down to the medics side until we fix the top..... as most older medics know, the top never cuts themselves. The bottom of the pool always get the ax first.... Unfortunately, I have seen most medics have a couple of similarities.... their ego and apathy... 2 amazing things... ](*,) For ones who are supposed to care so much for the "people"... can they justify maintaining a failing EMS system to the public? Is this not really a form of negligence to ourselves & our patients in about way ? Again, I'll stick my neck out... look at the posters that will reply... it will be basically the same ones... why? Because again, most EMT's really don't care about EMS...not enough to participate in change, write to State EMS Directors, lobby for EMS bills, or even study current events. Most are really stupid in about their profession....which is why we are in the situation we are in ...! My $1.00 worth.... R/R 911

We have a fleet of 12 Osage... the back end is okay. we just went with another vendor. Osage is bult tough, but the rides are pretty hard, but we haven't had much problems... I do llike them better than the new ones we are now going to... Be safe, R/R 911

I too agree with Dust.. Why buy the milk, when the cow is free"... Yes, there are areas where volunteers will always be needed and used. But, for the most part, cities that I have heard complain are usually over 30k to even a million people. Some even admitted that they use freight-liner ambulances and have 5 medics in the back of the rig.. ( I guess this is the reason for the big rig?) Then they try to tell me that the city can not afford professional EMS... Just like any other health care profession, we too have to progress and change. Just like all the others there will biting, gnashing of teeth, & clawing as we try to improve the system and the profession. Hopefully, we can learn of nursing profession and not take 150 years to change.... so far we have 40+ and still holding onto what we have. I have mentioned this before but really think about it... when Johnny & Roy ; Emergency was on t.v. 35+ yrs ago... they are doing more advanced EMS care than a lot of EMS units are still today.... now tell me, if that is not disappointing and SCARY ! I agree with Dust and had been almost crucified here long time ago, when I described that until we truly hit the public where it hits the most we will never be appreciated or treated like a profession. It took disasters for the fire department to receive attention for the public to appreciate their role in rescue. what will it take for EMS. Again, as long as someone will do it for free and there is at least someone there... no one cares...In most people eyes we are a luxury or "just there". There is no real deterrent foe not having ALS units other than death... with Police they are required of crime & dangers, with the F.D.they are required because of the I.S.O. ratings .. but EMS... try to justify us. Other than loosing a loved one, which usually is thought as "well, death happens"....don't believe me ? look at how many AED's versus fire extinguishers... now think how many full arrest you work in those same buildings versus the number of fire's they have.... Something to think about .... R/R 911

Haven't heard response form mine.... of course this is holiday week too... & we know how those Gov'.t employees are :wink: Be safe, R/R 911

Here in this area, there are so many Paramedic programs that "flood" the market every 16 weeks. Now there is still a shortage & the reason is most that get through the program & yes even pass the NREMT/P exam the first time are basically ...hmmmm shall I say VERY LACKING! No progressive service will hire them, because they do lack initiative and some gray matter. Unfortunately they wind up in the rural areas, where medical decision is more crucial than ever. Unfortunately, griping & whining here does not change anything. I do wish we had more contact with those involved in legislative and policy changes. I do wonder if any State, National EMS representatives ever bother reading what "real medics" are concerned with. As a former bureaucrat, I know that much are so out of touch with reality, and do not really care what goes on out in the field, only to be concerned what occurs in their ivory towers. If they read this, I challenge them to speak up!... let us know that they are concerned as much as we are. ... For some reason, I doubt I'll see a response. Since this will probably not occur I challenge, those on this forum at least e-mail them a link to this site to discuss this... I will. (Mine was my Paramedic preceptor) Attached is a link of the State EMS Directors... let us put money where our mouth is.. and see how many responses occur, I am sure we can set up a special thread for them.... . http://www.nasemsd.org/index.php?option=co...&Itemid=101 Good luck, R/R 911

I am not too worried about this problem. I just found out they are developing a trial program : "super EMT/I " (ETT. IV, Narcan, HHN nebulizer tx, epi; SQ) in my state to allow them to administer meds.... now this is supposed to be fill in at large metro' FD in lieu of Paramedics. Hmmm .... because they can administer med's until the EMS unit arrives?.... sounds fishy & looks fishy to me, especially it is endorsed by the Ambulance Operators. (Can we say cheap labor on the rise?) Again, those not directly involved with client care is making the decisions. Worse most field medics are not aware of this program nor do they care, as long as they get a check. The problem with the apathetic attitude is it will affect them, maybe not today, but later as the raises goes down and the need of Paramedics are all of sudden not needed. Since medicare does not recognize the difference between Intermediate care & Paramedic care, I have actually heard EMS administrator's describe it would be cheaper & about the same to deliver Intermediate care (IV, ETT advance only). In administrator's eyes the reimbursement is the same, with the costs of business drastically reduced. So the age question until we can get $$ changed in payment ratio, EMS administrators are not going to endorse any increasing in education . Why should they? More education should = more raises & higher salary, in which lies our problem. It is known fact that some of the larger companies prefer to have a turn-a-around of medics in less than 1-2 years, to prevent paying benefits. As most of you know I am definitely in favor of higher education of Paramedics to at least associate level as an entry point. However, until we change the "whole system" we are chasing our own tail. Reimbursement ratio should be increased to Paramedic Life Support, and with this distribution to medics for higher rate of pay. Then we can require educated Paramedics. But, for now we need to be careful and be sure "multiple levels" are not invented to short change & replace costly medics. This is not fair to the patients and to Paramedics as well as EMS system in whole. I know I am going to monitor the development of the "new program"... and be sure that it is truly warranted, and not a replacement in lieu of Paramedics. Be safe, R/R 911

Like the old saying" he won't do that again".... that's for sure.... BE safe, R/R 911

Hell, I believe in bringing back public hangings.. with the picnics and all. There was a decline in crime then. Yes, given the scenario, I think we could raffle off tickets to see who get to push the syringe and help pay victims fund. Can you imagine how much money would be generated?..... LOL :shock: Be safe, R/R 911

After reading some posts and viewing the "chat room" I have seen a large percentage of non-EMT's and EMT's that are entering Paramedic school. I came across an article in JEMS, that I found very interesting and has very good ideas. The link is as posted, I did not copy due to possible copyright infractions. http://www.jems.com/educationandtraining/articles/13369/ I hope that all students or future students will read this article. As an instructor and working medic I am concerned of the future of our career. Main points I found interesting in this article was common basic thinking, although I am finding this is getting harder & harder to find daily. Like the author I find very few students takes the course (s) seriously. I find talking to a lot of EMS students, that the routine of studying is less than 6 hrs a week. When asked about library research or reading, I get a puzzled look. Would a student not study chemistry more than a couple of hours a week, would one think a class on administering medical care should not be as in-depth ? I am also concerned that we as instructors are not "challenging" our students. As some of the few medics on this forum site, will admit; although we may disagree with a response from another peer, we will respect their opinion. That is if they can properly explain or discuss it. The old saying there might be more than one way.... is never more true than in emergency medicine. However;I do not see majority of medic students recognizing this. The simplistic textbooks on the market appearantly are not providing enough challenge to the students. I know while I was in medic school, we were issued texts with conflicting literature on purpose. This was to make us research and develop "our own educated rationale". Yes there are of course core standards, and basic scientific understanding for all material, but most scientific data can always be challenged in some form. Should we not encourage EMS personal to challenge the educational standards and protocols? Understanding why, and how we are performing treatment is just as appropriate as accurately treating our clients. Just reciting protocols without knowing why or if there is something better out there is detrimental not only to our patients, but our profession as well. I refer to such common statements as "o2 @ high flow.... etc. The other portion of the article even addressed dressing for class. Which I found interesting and in total agreement. I am not endorsing suit & ties, but dressing for success should be part of the curriculum as well. When attending EMS conventions I can almost always identify EMT' in the crowd of multiple medical personal. I wonder sometimes, if medics own any clothing without any EMS or Fire logo's on them. Of course there has to be as many baseball style caps as well. Yes, I too have several hundred articles clothing of various conferences and services I worked at, but these are reserved for leisure activity. Emphasizing professionalism should start at the career of the EMT. Emphasizing reading journals, CEU's, behavior (off and on-duty) as well professional appearance needs to be addressed as well. As we have had plenty of discussion of curriculum changes, some of these could be performed internally without a national forum. So to start a discussion or debate, what else would you recommend a new student of EMS? Be safe, R/R

Well you know the old saying " I'll keep my eye out for it "..LOL...the person below, like to crossdress on week-ends and call themself "Pat on Saturdays & Sam on Sundays"... Be safe, R/R 911

FYI: Review http://www.merginet.com/index.cfm?pg=airway&fn=GEB Use of the Gum Elastic Bougie in the Difficult Prehospital Airway By Bryan E. Bledsoe, DO, FACEP December 2005, MERGINET—The gum elastic bougie (GEB) is an excellent tool for intubating patients who have a difficult airway. The GEB is common in operating rooms and emergency departments—but less so on ambulances. French researchers studied the use of GEBs in the prehospital setting. (Remember, though, in France the ambulances are usually staffed by a physician.) The study assessed the effectiveness of the GEB in difficult airway intubation occurring in the prehospital setting. After mannequin training to GEB usage, prehospital physicians were recommended to use the GEB as first alternative technique in case of difficult intubation. The intubating conditions and details of patients requiring GEB-assisted laryngoscopy were recorded for more than 30 months. Among the 1,442 prehospital intubations performed, 41 patients (3 percent) required GEB. The GEB allowed successful intubation in 33 cases (78 percent) while 8 patients sustained a second alternative technique. One patient was never intubated. Another required an emergency cricothyroidotomy. Twenty-four (60 percent) of GEB patients had associated factors for difficult intubation such as reduced or limited cervical spine mobility; morbid obesity; cervicofacial trauma; or an ears, nose and throat tumors. The success rate of GEB was 75 and 94 percent, respectively, depending on whether associated factors for difficult intubation are present or not. No adverse events associated to GEB use were noted. The GEB should be a part of every prehospital intubation kit. Also, the specialty courses (i.e., Street Level Airway Management [sLAM]) courses are excellent in terms of developing critical skills for the management of the difficult airway. Reference Jabre P. Combes X. Leroux B. et al. “Use of gum elastic bougie for prehospital difficult intubation.†The American Journal of Emergency Medicine. 2005:23(4):552-555. Be safe, R/R 911

Ironically, I have 2 medical licenses, and never took an oath. I agree, they are not patients, your duty to act is not to perform medical care, or nor the intent was for such. Be safe, R/R 911

Actually, some of the courses are held together, that way you can recieve credit for both. Be safe, R/R 911

Yes, very common.. epinephrine When you call a code it is BEST to turn-off the monitor! When one makes the decision of "calling it quits" then all machinery is turned off immediately. PEA may show up and can be interpreted that the patient may be viable from non-emergency personal. I also suggest codes not to be called with PEA situations as well, never know if perfusion might re-occur.... most common practice is Aystole in 2 leads .. ( seen that wording before) Far as travel & treat, actually the whole purpose & ideology of EMS was to stabilize prior to transport. Now, the important thing is deciding how much one can be stabilized prior to transport. This is where education, experience comes into play. Be safe, R/R 911

You should had been taught this in basic CPR, ad EMT course. The conclussive signs of death as you mentioned. You should also refer to your protocols and policies. Be safe, R/R 911

OMG I remember those damn suction units !... We had one that had the suction cannister unit that held about 15 cc of emesis... Be safe, R/R 911

Welcome to real EMS... where Paramedics are needed. Sound like it went well. You are also lucky, that you got to call the code... some rural places you would have to proceed with the arrest & continue CPR etc... yes, it is a lot different than the routine metro call. I wish you the best of luck.. ! Be safe, R/R 911

No I don't !.... Yes, you do !.... the person below me is very intilligent however; very non-diplomatic.... R/R 911

All of our "pysch" patients are routinely transported for evaluation per Sherrif or LEO, unless they require medical intervention enroute to another hospital. Emergency Oder of Detention (EOD) (pysch eval) patients are cuffed (always, no matter how safe they appear), and transported by uniformed officers to a mental health facility. Be safe, R/R 911

I contacted him & left a message, we will see if he will. Helpful hint* if he does... brush up on your organic chemistry, kinesiology, & pathology....( I am sure it will similar to the MCAT exam) if it is like the one we started writing earlier. Be safe, R/R 911

If the state would provide " fair & speedy trial.. then the cost could be down. I do not see the need for automatic appeal if was like I had given situation. Volunteer admission and videotape of murder. Cases like that should not be given the right for appeal. The guilty already have more rights than the victims they have killed... Be safe, R/R 911