Ridryder 911

Add another zero on that, then you have what I spent on textbooks for just this mini-semester alone...

So when I hear $350.00 .. I chuckle...

R/r 911

Also how about "none of the above" for those that really may know?....

Who is to say that it is not more than one person.. hmm maybe a couple?

R/r 911

Ironically, some of us do know who the Admin is when there was trouble on here a few years back. As well, I do remember when many of those acclaimed individuals joined EMT City, too bad the original "join" dates was changed when the web site changed a few years ago..

R/r 911

What calls sometimes throw you off or sometimes trip you up? This question mainly applies to the veteran Paramedics who have worked the streets 5-10 years. We ALL have our weaknesses,so what is yours and how do you handle it.

You call 5-10 being a veteran? Geez.. they just got their feet wet, veteran is after 25 years...

R/r 911

You guys are miracle workers. Oklahoma has been ignoring this for a long time. I got my EMT-Basic so I could volunteer and maybe prevent at least one small EMS provider from shutting down. The jury is still out on it.

Did this ever pass? I can't find it on the oklahoma.gov site.

Thanks!!!

Unfortunately, 1014 did not fail but did not make it either. Another bill (18? sorry, forgot the number) did pass allowing a small portion of funding for research and assistance. It's not much (a few million) but it is a start...

We will keep going at it, alike all states having a hard time, EMS must pull together as one and then fight later...lol

Here is a link to the OK EMS Coalation

http://www.ok-emscoalition.org/legislation

For every inch of a step we take forward, guys like KSEMT send us back back three yards. Thanks, buddy.

Always amazes me it is those without the education or even the license to tell us "how it should be".. as well that they are in favor for education, as long as one does not go to college or academics... Yeah, that makes sense too?

R/r 911

.

It is great if somebody doesn't pursue a degree, but the world doesn't stop and start with a degree. Some may argue the world is progressing that way, but in reality, it doesn't.

It does in medicine. Period. Sorry, medical field is considered a professional level, hence it requires college. You may do the same thing, but I have something to prove I went on and beyond and as well have proof of my educational level.

Technical training is designed for "blue collar", non-scientific workers. What is EMS or healthcare is not. This does not make anyone more superior, just usually more educated.

The only we are going to get payers such as Medicare, Insurance corporation to reimburse EMS is by increasing educational standards. What corporation is going to justify an EMS/ambulance for $500-$1200 with some personnel training is lower in hours than beautician? Kinda high for a taxi cab ride... and that is exactly what payers alike Medicare and Blue Cross & Blue Shield, AETNA, etc. is thinking.

Look at (Gasp! shall we say it? ) other medical professions. Look at how they increased their payment structures, and reimbursement rates. Remember the old saying... "what does not come in, can't go out".. For example look at Respiratory Therapy. A few years ago it was mainly OJT, then trade school (technology) and now a degree is required. Again, look at their salary range.. the same with physical therapy, roentogram (x-ray), etc..

Want more money, more respect, be considered a peer in the medical community? Then do what a professional has to do... get an education! (Not training).

Otherwise, suffer the consequences since you are part of the problem not part of the solution.

R/r 911

Education. No doubt it does no harm in expanding one's horizons and gaining a more in depth knowledge of a subject. Here is where I have a problem when people say education is the answer to everything.

I saw officers in the Marine Corps that made deciscions so stupid you had to ask yourself if they were serious, or just messing with you to see if you were dumb enough to do as they said. I have seen college graduates come into the fire service, pretty sure of themselves, thinking they have all the answers, and they have no knowledge or skills retention. I am an engine company officer, so I can say this with having seen this trend with my own eyes. It is sad. Some of the problem is the attitude of society in general as well. The younger generation seems to believe that they are owed something. Where did they ever come up with that idea?

That has nothing to do with education, rather that most are "trained" the way most EMT's are taught. Hence part of the problem, training and education is NOT the same. Unfortunately most in EMS are not educated enough to recognize this. Even those that usually teach EMS courses are not educated; again what do we expect in return? Little 5 year old Johnny teacher requires to have a formal education, but the teacher that instructs those that shock and administers medications does not... Do we not see a problem with this?

If you want to put college classes into the mix for medic, that is ok, but then I think we should keep them classes pertinent to the subject material at hand. A&P I agree with, as well as some biology, how about medical terminology. I am enrolled in the paramedic program at our local college, and so far, the medication administration has been pretty straight forward as far as I can tell. Seriously, the vast majority of them are somewhat along the lines of : X amount of drug in X amount of solution, per Kg of body weight (sometimes), over a certain period of time. This isn't rocket science. It is basic math. It is Jr high general math, dealing with fractions, and ratios; simple addition, multiplication, and division for pete sakes! Oh sure, when we deal with a dopamine drip we are talking micrograms but then again, the majority of the time we deal with a situation like that, we titrate in the field, and the pump is used in the hospital.

If your pharmacology class is that simple your school sucks. As well, don't come to work at my EMS, we have IV pumps for the trucks. Yes, IV NTG and a lot of other medications have to be on a pump to regulate the amount. Yes, I do require the Paramedics to know how to perform drip ratios as well. If I find out any of our Paramedic is just "titrating per effect" on any medication and does not know the dosage, I will recommend formal action. Medications are given by weight/dosage for a reason. Reaching the appropriate therapeutic level is the goal for all medications.

English Comp as a college course? I don't know. I mean seriously, we are talking about writing a few simple paragraphs detailing what you saw, what you did, what the outcome was, and a few other pertinents. Sounds simple yes, but we all know a good report is a little more than that. Honestly though, this is simple composition. Another high school skill that was taught to me 20 years ago. Where has it gone? Are we that in depth with "No child left behind" that we pass any kid that walks through the doors of a school? How about we spend a little more time on this subject in the class? Make people write reports on the skill scenarios they had in class; everyone one of them, this way, they can make the mistakes in class, and not lose a court case someday.

You do realize most Paramedic texts are only written at 10'th grade reading level? Look at the posts on EMS forums and tell me English should not be required! Most ePCR's are checked box configuration and very little is written in paragraph form, but this should NOT exclude a health care professional not having the BASIC EDUCATION. Technically you cannot even call yourself a professional without a degree. Yes more should be taught about patient care, hence the reason there should be more than one text book or "series". Each segment should have detailed education. Alike all other medical professions have.. Each text book should be written in detailed and specific to that area, and usually consist > than a 1000 pages in length. How can we proclaim to have knowledge in anything that is covered in a paragraph or chapter? Does your school not require outside study time, such as thesis projects and additional scenarios and lab time? Again, if they don't it sucks.

I am not sure that college is needed to be an EMT. Now I am talking a basic here, not an advanced EMT. Let's think about this for a second. Basic EMT's are trained to identify and intiate treatment in life threatening illnesses or injuries. The word basic describes their very training and skill level. ( No offense to the B's out there) They are not trained in AMLS, ACLS, or PALS, they are taught how to treat for bleeding, identify a patient that is in danger of going into shock, and how to package with out causing further harm. These people are generally volunteers. (I know, we have talked about that too, but let's leave paid vs vollie in the other forum) They not only need to be educated to be able to perform to their skill level, but be educated enough to say we need ALS, or we need to get moving quickly if ALS is not an option. Can this be done with out college? I think so. Remember, these responders are the first line of defense in circumventing death.(I know, talked this one over too.)

That is what first aid classes are for. Basically that is all EMT courses are... just a little more than advanced first aid. (again prove me wrong)

I do feel that the national registry needs to play a big role in this. Maybe the DOT needs to get involved and mandate that all states start to be on the same page, so that an EMT basic in FL is the same as SD, CA, MN, MO, NY, IA, or TX. Same would go for an advanced EMT, and Paramedics. This way we as an EMS community would be able to talk more clearly to one another for one thing. In this way it would be easier for us to talk to one another and identify problems, and hopefully solve a few of them.

They have and there is. NREMT is now requiring all Paramedic level educational institutions to be CoEMSP accredited by 2012. To be such, usually one is associated with a higher education system. In regards to being the same taught.. it is. It's called the National Curriculum which all states are supposed to be following. Something that has been out since the beginning of EMS. The National Highway Traffic Safety Administration (NHTSA) formerly known as DOT, oversees it. All EMT level text books are based and written upon it.

In a perfect world, we would all have as much education as possible on the subject of EMS, have 4 year degrees, and be the utmost professional paramedics, there would be no EMT's or vollies. (No offense guys, just trying to make some of the others feel good) Then again, in a perfect world, we would be out of business; be careful what you wish for.

B.S.! Too bad. Those types have prevented EMS from becoming a profession since its concept. Again, I can prove it. Every time a curriculum changes, there is wailing among those groups and the curriculum is watered down. Shame the patient has to pay for it.

Really the severity of the patient does not change because there is lack of knowledge by the provider. Can't do the care, get out. Someone will. As long as there is excuses then communities will use one.

I humbly believe that we can not be faulted for doing the very best we can with what we have and strive for improvement. I don't think that the problem will be solved overnight, nor in a matter of a few years. I also think that when we do set new goals, we have to be realistic as to what we are trying to accomplish, and who will be impacted by these new goals. Yes, of course the patient will be impacted, but so will the provider. Let's be careful on how we dish out the requirements, and make sure we don't get our egos in the way when we began talking about how good we are because of how many letters are behind our names. No offense to anyone with a bunch of letters and abbreviations. I am just a fire based ems provider anyway.

Ooh now I see the problem. Seriously, how many people dying does it take to change a system? It has been over 40 years worth, is that not enough?

You are right there is an ego problem.

It is not those of us with letters behind our names. It is those that acclaim that they are "doing something" which is correct. Their preventing EMS to progress. As well, those of us with those letters are tired of seeing needless deaths. Too many first aiders, too many levels of EMT (or substitute Paramedics) out there. Time we quit making excuses, and get on with being a real health care profession and having those that just have a 150 hour class does not cut it. Want to be in health care? Then meet the standards.

R/r 911

After reading in regards to a Paramedic stealing credit cards and other news worthy items, I see a slippery slope of our own. Yes, I realize some of it has always occurred, being one from the "Mother, Jugs & Speed" era. As with any other profession but in general outside looking in, would you say our professional demeanor, standards, and such better or worse in the past ten years?

If not what are some areas we can change, or remedy it? As well, we need to address the positive side to reinforce what we do have..

Wrong, but at least its a mistake.. look at one of our own did!

http://blog.cleveland.com/metro/2008/06/cl...caught_usi.html

If you read, .."stress has not been an associated contributor"... Ironically, pharmacists has one of the highest rates in the health care profession.. who would had thought?

R/r 911

I believe too many get think it is more than what it is. A horrible event. With that saying, it is a legal situation as well. Now since it is technically an assault, do we not ask or intervene with assault victims?

There is nothing wrong with dispatching what the caller stated that it was. How many times a day I respond to "unresponsive" never to find an altered mental status?

As far as keeping it limited, I believe we are doing the patient/victim injustice if we want to keep them quiet for our own personnel reasons to avoid court or be a witness. With that saying, I am not ensuing that a medic asks for great details either.

Paper work (PCR) can be limited to quotations of what the patient stated. I use generic terms such as.."Patient describes being sexually assaulted. Patient tearful, appears frightened by facial expressions and gestures. .."Patient stated he raped me". .. Detailed physical exam deferred at time, no gross trauma noted"... Treatment: reassurance, allowed patient to vent if wanted to... etc.

LEO will asks if she stated anything, and usually this is where one has to fill out those darn third party statement forms, for detail statements if they did say anything. Again, there are very few sexual assault cases I had to go to court for as a Paramedic. Most are transported by LEO.

R/r 911

Hmm.. sometimes about 48,000 people and 1200 square miles...

R/r 911

[blindly giving bicarb could be considered malpractice,

Good thing you are used to newer ACLS, as in the old ACLS guidelines NsHco3 was given routinely every 5 minutes as well as CaCl- for a EMD/PEA rhythm. I agree one has to be be extremely careful, hoever it is not unusual to administer to give a pre-loading dose as well as bicarb drip form in rhabo and other specific conditions such as some OD.'s without having prior baseline labs.

R/r 911

One does not have to have a degree to demonstrate compassion or have to have a degree to listen. It is called being a medical professional. As a Sexual Assault Nurse Examiner, I know one does not have to be or show indifference.

Remember it may not be what you said, but what you did not say or how your actions that may be everlasting.

As discussed, these paitents (yes, MEN & women) are emotionally traumatized, reactions can misinterperted and ask any survivor they can be life long memorie. Just remember your actions may speak louder than words....

I don't know what phyc is..?? physical educatin? You mean psych?

As others have described, usually one will take a patient to the hospital (its much easier) but there has been times, when after talking to medical control that they have denied me to transport (physician had seen patient earlier).

It sounds like other have pointed out, you may not have the full story. Yes, there are horrible Paramedics, but for the sake lets not assume that. Maybe the Sp02 was not accurate, eyes swollen shut? Having a reaction, allergies?... Did they already administer treatment such as Benadryl before arrival? Again, too many variables..

Not saying it is not 100% accurate, but really a RN (even a physician) cannot order me or any of my crew to do anything. It takes a physician going through my medical control to do so. This is where I wonder where the stories may be exaggerated...

R/r 911

Must have been a small deer...

Deer kills more people than lightning.. some of the worse trauma patients I have seen was from striking the Deer and it coming through the windshield.

I guess it depends on how venison you want?

R/r 911.

Yep, that is why God created firefighters..

R/r 911

Ditto to what others have said.. As well, I have had to repeat the decompression because they sometimes occlude off, with time and blood. I have even arrived in ED where they looked like a porcupine..

So yes, been there & done it ......unfortunately more than I would like to think of :roll:

Vent makes some very interesting points. I do not know any state that allows RN's to be taught by any thing less than a MSN. Yes, clinical adjuncts may do so and then most have to prove documentation that they are currently pursuing the MSN. Alike, most BSN programs usually require the Director or Chairperson to hold at the least a PhD or DNSc. level. As well, nursing shortages are well planned. Yes, instead of compromising the ..."quality versus quantity"... not alike EMS that will accept and take anything. Also the law of supply & demand is well used. Why flood the market and demand? Yes, control the amount that is needed to maintain salaries, job openings, etc. Again, where I have seen EMS make the serious mistake of flooding the market and need.

Yes, you are correct there is a demand for educators. This is one of my reasons for abandoning the NP route and pursuing the education route.

Just imagine that educators of EMS was that. Educators, not trainers. That true lesson plans with in-depth knowledge of different teaching techniques could be used. Correct pronunciation, grammar and usage of teaching materials would be expected. Course work could be more scientific using techniques as thesis and even ..(gulp!) true scientific research!... Unfortunately until we obtain that level, we will not be able to do so.

Doug.. you might want to stop while your ahead .. You are pointing out the need for more education in other areas of EMS than just the clinical area. Would you really want most of the Paramedics you have met, be in charge of a State Level EMS Authority? Joe Bob wearing his NREMT baseball cap, and please just read the postings on EMS forums. Now, this is the person you want representing your profession to the Legislature, Senate, Governor's and to Physician level professionals? I am and always will be a proponent that we should govern ourselves, but unfortunately until we have those that can present and be educated and professional, there is no reason to even to do so. It would be disastrous. Another valid point for higher education.

Now let's review back to the clinical arena. Wonder what Supervisors would be like if they were required to have a basic minimum education level at least an Associate or alike most healthcare supervisors a Baccalaureate. Can one imagine, if that position was based upon those that had some real management & human behavior courses, rather than the "good ole boys" syndrome? Wow! What type of profession this would be, what care could be expected? .. Something to think about...

Ok for the sake of arguement, let's say I agree that we need a degree. What level? An associates degree? Considering that our scope of practice often exceeds that of an RN in the pre-hospital setting it hardly seems enough, plus in many countries an associates degree is called an "Advanced Diploma" (hence my grade 13-14 comments earlier) hardly professional sounding.

I agree with Vent and furthermore:

How do you figure that? ..exceeds? Really, in what way? Seriously the skills are very, very simplistic and basic, the patient assessment level is nill to none, and the usual Paramedic pharmacology is a joke.. Hmmm advanced enough that all of that information can be contained in one single book? Yet, again that book is written at high school sophomore level.. Can we really say that is advanced?

Sure, the RN is NOT supposed to function in a prehospital arena. The same is true that they are not usually prepared to function in critical or emergency areas immediately after graduation either.. there is no requirements for teaching or being educated in that specialized area. So one cannot compare the new RN against a Paramedic that is supposed to be soley specialized in only one area... The same arguement if I was to place a new Paramedic on med-surg floor.

What I would like to be able to see is that the general education of the Paramedic to include general medicine. That our texts be specialized and have great detail, that our knowledge would be comparable to other health care practitioners. Our interventions would not be mandated from cookbook medicine rather be based upon the physical findings of the patient, along with diagnostic aids and of course from the knowledge the practitioner (Paramedic) that has developed this knowledge through education and clinical experience.

It is embarrassing that a so called professional is taught in chapter forms instead of texts. Seriously, my Pediatric text was over 2000 pages and Nursing Pyschology alone was over 3,000 pages long. The Paramedic that has to deal with the worse case scenario... uh, two paragraphs or maybe 15 pages at the most? Do we not see a problem here? How can one take care of problem if they do not know the norm.. we teach this philosophy to basics all the time.. yet, we ignore it through out our Advanced Programs.

Really, are we not tired of using other professions texts to teach out of? Just because ours is so watered down that any moron could meet such simplistic objectives? Yes, it is embarrassing, shameful to have to rely upon another professions text just to teach the basics out of.

If we want this so called profession to grow or worse to even stay around, then we will have to change the attitudes that the status quo is okay. Again, over & over it has been proven it is not. Again, you cannot fix what you do not acknowledge what is broken.

As well, I do not understand your 13'th & 14'th grade labeling. Grade levels such is usually left in high school arena. Alike clock hours is left to trade or blue collar training areas.

R/r 911

I thank you for your response, but here is where we may disagree. My protocols are only 30 pages long.. that's it for a Paramedic level. Yet, we are expected to perform as one would normally as in any advanced system.. why? Because, my medical director expects us to use those protocols as .."guidelines".. as protocols should be used. Ironically even physicians and EMS administrators are ignorant on the fact more protocols may only open them up to more litigation and "should had, could had" type scenarios.

If we had truly educated Paramedics, then again protocols would be used only as such as I described.. guidelines. One cannot expect to have more in-depth privileges, and less control with less recognized knowledge.

I am not attempting to .."appease" the other health care professionals, rather to appease our PATIENTS. Our patients deserve to have well educated personnel that can make clinical impressions (diagnosis) based upon a thorough, highly intense program, taught by only well educated professors with clinical professors to assure that they have met and been exposed to clinical environments. As other posts have demonstrated, one does not need anymore studies in medicine to prove that a formal education is needed.

At this time most Paramedic texts is written at a 10'th grade reading level, and the Basic at a elementary grade level.. Why? Because it has been determined that most Paramedics cannot read above such levels.. and we do not think this is not going to affect patient care?

One can only imagine if the our texts were written at a level that would ensure that Paramedics have been exposed to medicine rather than diluted science.

So does the paper of the Degree make one practice medicine better.. technically no. Definitely neither does NOT having it either. As well, we can assume that the individual have the drive to pursue to be better and have had the opportunities to be exposed to education rather than training. That they have met at least the minimum satisfaction in the building blocks of an education process such as reading, writing and mathematics. Something that a non- higher education institutions cannot fulfill.

Can one really legitimately say that having a profession that allows a non formal education be better for patient care? Obviously not, again look at our profession. Look at the other medical professions they did not remain stagnant. Also, can one actually believe without requiring a formal education that our profession can ensure quality care and be able to require the demanded increasing knowledge? Apparently not. After 40+ years, we still do not do such. Can we expect our profession to move forward, (again meaning our professions main goal is patient care) and to grow as a profession without a formal education? Again, forty years has proven to us it cannot.. and now one needs to compare us to other professions that have.

Yes, as much as those in EMS that are linked to non-medical institutions hate to admit it, EMS is medical. Therefore EMS will always be associated with the medical profession community and its peers. Since our profession is medical we should be expected to have the same entry education level, the same ideologies to promote patient care by competent and well educated professionals, and also be judged by our peers and also be able to judge them as well... something that cannot be done at this time.

We also cannot expect payers (Insurance/Medicare) in our system to recognize us as professionals. Sorry, the general definition in the work field for professional is to have a degree. Therefore we can never expect the pay to be above the technical or trade level. That is what we are classified at this time. Without the payers increasing reimbursement rates, pay structure will never increase, turnover can be expected and yes less attractable persons should be expected to enter the market. Do you think this is better for patient care? So one can associate education with direct patient care.

How do we fix it? Simple. Just alike all other health care professions before us did. Place current training programs into a collegiate level institution meeting their requirements. Employers demanding that their associations and legislators recognize us as professionals and start receiving and distributing the funding. Nurses did not always make the money they did, nor did RT, PT's, etc.. It has to start from the beginning.. the entry point and that is education.

R/r 911

NO! I can't just get along nor do I want to anymore! That is one of our major problems! We have got along way to long! Over 40+ years now, and still trying to attempt to make excuses for our piss poor profession. We all whine and bitch about things then we coddle and make excuses for each other. Seriously, there is NO reason that the entry level is not required to be at the least an Associate Degree!

Boo-hoo...sniff, sniff.. So sorry that we may enforce one to actually demonstrate that they have competency in English, Mathematics and basic Science.. and yes then attend a course taught by those with more than just ..."good ole boy" experience!

Give me any other reason than laziness..not to complete an degree program! Money, sorry pawn those lights & scanners or do alike the other 80% of the population and get a student loan. Why do you think you are so special? Maybe owing a little money will make you want others to take and consider your profession more serious!

Getting tired of reading 10'th grade level textbooks and magazines such as JEMS & EMS ? Containing articles that are so watered down one can expect to see a "seek & find" in the next issue?

C'mon folks this is not in-depth conversation, rather again attempts for those to "water down" the profession instead of promoting it upwards. How asinine to even make an innuendo that an education would be harmful or not even be needed? Really? Obviously the current system we use SUCKS! Maybe a time for a change?

It is ludicrous to even consider anything other than a higher education, in fact any thing else should be considered harmful to the profession and towards patient care. We are not talking 10 years out of someones life, just two years to start as a professional.. Much easier in comparison than other health care professions.

Sorry, if the truth hurts!

R/r 911

Maybe an alternative would be that the Basic Level would only be good for two years. After that it would expire or immediately be lowered to a MFR level; unless you were currently in a Paramedic program (good standing),

This would allow one to "work" in the field while obtaining experience, yet not procrastinate doing so and then increase our first responder ratio as common laymen for those that do not succeed or progress in the system.

The only exceptions allowed would be very remote areas and those associated with non-EMS as their primary functions.

R/r 911