Ridryder 911

With EMS being placed under "new management". I was wondering what you would consider the "normal licensure" length should be. Most medical licensures, or certification is 2-3 yrs with cont ed. & other requirements. Board Certifications are usually 4-5 yrs, but have to either completely re-take the test/boards or several hundred hours of CME's.

Just a thought...?

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Ridryder 911

This should be fun ... =P~

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Ridryder 911

Before we discuss new changes, look at the whole picture. I just attended a roll-out on Emergency Cardiac Care for the 2005 standards. Lot of the talk is just that......talk. Even if it is in the print. There will be some differences in treatment & procedures than in the past. Also, dissecting between the common laymen & rescuer standards.

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Ridryder 911

Wonder if you use Vasopressin much ?

Come to the South....the love crank & Bar-B-Q, can cook it at the same time ! ( of -course they have no enamel on their teeth)

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Ridryder 911

Can you tell I have been working out lately ?

Chris... they are client's. In nursing school we are taught to address patients as clients, and document as such. This means you have a contractual obligation to that person.. paid or not. Many EMS education & EMS services that are progressive have "removed" the patient attitude & replaced it with client.. reflecting that they pay our salary, & we offer a service to them.

Now that being said, I too agree it is a shame that occurred. But, P.E is one of the hardest diagnosis to obtain.. approx 80% are missed, & that is on patients with history that co-relates to precursors.

For all those that posts, "Oh how could they " attitude, I work in a town with 3 correctional facilities. We see an average of at least 5-10 prisoners a day. I would say 50% are repeaters, & the other 49% are "want to get out of jail trip". So until you have been there, & seen the 20 year-old chest pains.. or really bad jock itch case, or the falls from the bottom bunk at 3:00 in the a.m., don't give me the bleeding heart story. They get treated & examined like every one else, except creditability on history is not respected.

Yes, she should have been examined more thoroughly.. would it had changed her treatment plan...probably no. Being incarcerated or not. I do not know a physician that is going to accept a non-paying teen age patient & perform a V-Q scan. At best, maybe a d-Dimer lab test.. then still no change in treatment, unless high indication of such.. recent trauma, stasis of legs etc.. Are you going to admit a teen ager with shortness of breath, with sats in the upper 90's.. CXR usually will not reveal Pulmonary Emboli.. even ABG's can mis-leading unless she is compensating.

We could all write a bleeding heart story on each & every case .. "as he attempted to defecate..beads of prespiration ran down his face.. his face flushed with engorged blood.. lips blue from bearing down.. he could feel his heart beat slowing..his anguish.."

Sounds like a journalist was contacted by the family, to increase the chance of litigation. Now the citizens will be on the "war" to change things.. & what are they going to change ? Send them a bill for 6-10 million dollars for needless medical care then the journalist can write another story of tax payers waste ?

My 2 cents worth...

Ridryder 911

You have to own up for yourself... take responsibility, good or bad. That is called maturity. Everybody has problems, to what degree they are interpreted & how a persons react & decide how to handle, is another thing. We can also show articles of success, of post incest, rape, warfare trauma. It is how you handle, what you what to do, with your scars, that makes the difference.

Be safe,

Ridryder 911

If there was a Federal mandate tomorrow, not allowing EMS to have lights, sirens. Disallowing EMS personal from wearing patches, pins, stickers etc.. & allowing EMT's only to identify themselves as "Health Care Provider" only.

Would you stay in EMS ?

Please, be honest.. I even prefer no comments

Thanks ,

Ridryder 911

As I IM you, I agree with you. Please remember National Registry DOES NOT make the standards ! They only test over them. So if medics want to gripe about the test, gripe about the standards... Yes they suck !

Until we raise the national reading level of EMT's & basic educational level not much can or will be done.

Have mot of the medics you know participated in local or national committees to review or change such, or do as most .. .gripe, & not be active. Medics are known not to be involved at the grass root level, & rather sideline criticize. Be active in your local association, still have certification level... why not licensure level ? Get active !

Here are some web sites that I found interesting :

The 1'st is the NREMT scoring process, explaining how test are graded & why ...

www.nremt.org/about/about_exams.asp#Understanding%20NREMT% 20Scores

2'nd is the national advocates of EMS who helped developed & currently developing changes in EMS curriculum & profession

www.advocatesforems.org/

Professionally,

Ridryder 911

I agree Phireman, we not need to lower standards. However, numbers are irreverent. I can write a test no one can make a 70% or have a test everybody can make a 90%. It is based upon criteria, & content. So when people throw up numbers on grades etc.. it really does not mean anything.

Maintaining standards and education level is important.

We must remember certifying examination ONLY test the MINIMAL acceptance criteria Therefore, only entry level knowledge is being examined.

Yes, I agree, have tougher standards, therefore the Registry CAN test on these. Don't blame the National Registry because our national standards are sub competent ! They can only test on the current standards & national curriculum. Let us raise the bar in level education, entry requirements & professionalism. But, at the same point don't whine & gripe about attending pre & co-requisite classes such in-depth science, English, math, & psychology.

Maybe, we can persuade whomever the management of EMS will be, to re-design education criteria in the future.

Be safe,

Ridryder 911

Sorry, National Registry NEVER has been 80% to pass written examination. Since its conception in 1973, 70% of the "over-all" is all that has it has required.

The Paramedic written does require "certain" higher percentages on portions such as cardiac, respiratory etc.. where as such as communications, role & responsibilities has not had mandated portion of pass. These encompassed score are then added up for on over-all pass percentage.

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Ridryder 911

The U.S. Naval Medical Research Center has submitted to the U.S. Food and Drug Administration an investigational new drug application to conduct a two-stage clinical trial of Biopure Corp.’s oxygen therapeutic Hemopure for the out-of-hospital treatment of trauma patients.

Under a research agreement with Cambridge-based Biopure, the NMRC has primary responsibility for designing, seeking FDA acceptance of and directing the trial, entitled “Restore Effective Survival in Shock.â€

The objective of the trial is to assess the safety and efficacy of Hemopure, as compared to standard treatment, in reducing morbidity and mortality in severely injured patients experiencing hemorrhagic shock (acute blood loss) in situations where blood is not available for transfusion.

The trial represents a collaboration among scientists and clinicians from the military, academic hospitals, nonprofit organization and Biopure under the direction of the NMRC.

Congress has appropriated $18.5 million to the Navy and Army for the development of Hemopure for potential use in military and civilian trauma indications and to cover military administrative costs.

Biopure Corp. develops and manufactures intravenously administered pharmaceuticals, called oxygen therapeutics, that deliver oxygen to the body’s tissues

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Ridryder911

I haven't used medical telemetry except for a few months in the late '70's to receive a medical grant for equipment. Now I do consult with medical control occasionally if there is a difficult or peculiar case. We work on strictly standing protocols, with a very few exceptions.

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RIdryder911

Just to show you.. "blind justice has a greased palm"...

www.atomfilms.com/af/content/cop_feel

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Ridryder 911

Amen.. Budha

I was hoping with the curriculum change in the mid-'90's was supposed to have more competency's clinicals However, it seems (us) educators have failed implementing & demanding this.

We also need preceptors who want to teach. Just because they are a good medic, does not make them a good instructor ( or boss/supv). Some people feel uncomfortable teaching & should not have students.

I know some of the institutions now require EMS instructors to be on site at hospitals etc.. at some clinical sites. This has helped reduce clinical objective confusion as well as having a mediator to be sure the student is exposed to & has the ability to meet objectives.

So many EMT's do not understand the value of clinical exposures. Hour based clinicals with objective met criteria is the best. Just because you have an intubation clinical.. & stay there for 2 days & only intubate 3 patients is really not successful. The student should have a minimum number set criteria.. such as cardiac arrest, intubations, IV insertions etc.. This may mean more clinical time, but increased patient contact time. Also, EMT's are not aware, most medical students travel for specialty clinicals. For example I traveled 90 miles just to be able to do a pediatric burn rotation & 500 miles to do a trauma internship rotation. I know of physicians actually moving or traveling several hundred miles to work in a busy trauma center to get exposure.

If we required more, and students received more, can you imagine the skill level & feeling of competence our students would have. Also, I believe several would not have the feeling of leaving the field so easily, if time & money was placed into their career.

Respectfully,

Ridryder 911

It depends on the rescuer & the patient..I have successfully done this many times. As long as you can maintain an open airway ( I usually use a neck-roll) & be ventilate the patient. I prefer this method when performing PEEP using the BVM device.

Also, remember CPAP & patients on ventilators are in this position at times, & does not require the patient to be in a supine position.

Be safe,

Ridryder 911

Sorry, you are getting the impression that you can not make a living in EMS, here in the U.S.. It all depends on all of the location & region of where you want to be employed. You also have to remember we are a work driven society here. I know physicians that work part time to add to their income although they make over 1/2 a million a yr. Our work ethics are different here, we appear to live to work instead of working to live. Most health care professional work between 40-140 hrs a week, depending on the need or drive they have.

You also need to recognize our country is very diverse, & most countries is smaller than some of our states.

Actually, I am fortunate to be employed at a local EMS that pays Paramedics comparably to RN's. Some even make more than RN's for 10 shifts a month. .. & in our larger local city some are equal to middle to higher middle income. Yes, unfortunately, most EMS do not receive excellent pay. However; we are one of the few medical profession that does not go through the traditional education process (degree required) before employment.

Nothing against volunteers, but as long as a community or personal choose this avenue, EMS will never have a higher paying avenue. It makes no sense to pay a middle income to an applicant if you get someone for free (please, no dis-respect intended).

Yes, we have several issues & problems in EMS & especially in the U.S. But, lets at look who also invented the majority of equipment & technology. NASA who pioneered bio-telemetry, micro-monitoring, & medical advances to our military with their on-going research in trauma.

So yes, you can be a professional EMT or Paramedic, just dependent on what your obligations, desire, & drive is.

Respectfully,

Ridryder 911

Damn, Steven who needs a rig.. just call you next time...LOL

Be safe,

Ridryder 911

If you are asking how to change EMS it starts at State levels. Mandate requirements of entry level into EMT education (notice I did not say training). Almost all other health care programs require an entry level requirements. I believe it is way too easy to become a medic. If it was harder & even more costly, we would not have as many drop out of the profession.

Be sure your educators have an education & field experience. I really take annoyance "of those can't teach".. not, are like that. Just because you are a good medic does not represent being a good instructor or supervisor, administrator material. They should be monitored for pass rates. Education facilities should mandate assessment tests prior to students enrolling. As well, not everybody should be allowed to be in the EMT program. Many applicants have no desire to function at that level, and should be recommended to the first-responder program.

We (EMS) need to shift from the "training" set of mind; to true education, These programs should be held to accountable to the educational standards of adult teaching & curriculum development. Clinical time should have assigned preceptors, with number of clinical tasks that was performed & obtained, not length of clinical hours. I do not know how many "coffee clinicals" I have seen.

As some has had mentioned "think outside the box". The days of EMS as we know it, will soon be over. The number of baby-boomers becoming older & now also becoming more ill, the run volume is predicted to increase 20-40% in the next five-seven years. With this ED's will be full, & no place for the sick or injured, the EMS will have to become a mobile healthcare system. With the new technology invented everyday, who knows what the limits will be.

This is exciting times for the EMS provider.

Be safe,

Ridryder 911

I have been experimenting with the vacuum splint & so far works very well...

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Ridryder 911

Steven,

I know Brian personally, I can attest that he is pro-advocate for EMS at all levels especially Paramedics. The problem is the general consensus of the education level of the Paramedic.

Although you & I have the general opinion of what Paramedics & EMS education level should be, that is a different story of the publishers & national standards.

What most do not understand, (as was told by me Brian Bledsoe D.O.) is that most publishers has a cap on the reading level for EMS material. Most EMS books are written at the maximum of 11'th grade. This is from a series of research from the publishers at what level most EMT's reading level is rated at. Most Basic EMT manuals are at a 6'th grade level.

It is not most EMS educators (i.e. Dr. Bledsoe) does not what more informative & in-depth literature, it is they will not publish it. Even magazines (noticed I did not say " Journals") are even rated at no more than an 10'th or 11'th grade reading level. I have written for JEMS many years ago, getting published is not easy:after the query letter, & research, & review, most articles take up to 6-11 months before it is published.

Before, everybody gets upset about reading levels... compare the National Registry of EMT's pass rate on a board examination, on a mid-high rated reading & examination.... I believe a little more than 64 %..

Wow !

Maybe, we should test.. before applicants are allowed into EMS programs such as the Nelson Denny Reading test., A basic mathematics test with some pre-Algebra for pharmacology equations, & basic science & comprehension levels, and English & spelling for charting & documentation .

Then we can introduce scientific studies, true patho-physiology, gross anatomy, with a diagnostic approach. Until then, & with most apathetic attitude we will be stuck in our current status.

No, Stephen, I do not believe you will be taken serious for a sole author. They might consider you for to review, or if lucky chapter contributor. I have friends who are M.D. or D.O. with Board Certifications & all the titles associated, & have several years EMS field experience, who have tried to be published. It is a difficult thing to accomplish.

If you are able, feel free to contact me I will be glad to assist you in any way.

Respectfully,

Ridryder 911

It is illegal to display emergency lights on personal vehicles in my state. Only authorized vehicles owned by city/company etc. may exhibit & utilize such.

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Ridryder 911

Sorry wake up & smell the coffee... It happens everyday.. every ER, ICU, CCU, floor units etc.. physicians or even extenders.. make the call. Unless the family is really wanting the patient to be resuscitated with a hx. of long term illness (COPD/ Extensive Cardiac) with a terminal or pro-long hx. most resuscitation's efforts are little to none. I do not believe in them, but some hospitals have ... slow codes, or pharmacological efforts only where no compression & ventilation's, just meds pushed.

I know, now when patients have been attempted in the field, very little to no effort is made in ER if there has been no prior response. Also, after the second round of ACLS medications the arrest is called.

Decreasing prolong efforts & death with dignity has became more aware in emergency medicine.

Be safe,

Ridryder 911

How old was the patient ? Also neuro eval.. any deep brain function, lower limbic & mid brain function? The larger hospital may have consulted & informed them to check certain things, then make a decision. I know Down's syndrome have several congenital defects, which may leads them into a DNR category.

Does sound a little harsh though..if I was attending I send & let them decide to pull after CT, etc. Unless you didn't think he make the trip.

Be safe,

Ridryder 911