Ridryder 911

Studies like this one provide insight into possible changes we could/need to make internationally in the prehospital environment if we want to get serious about improving decreasing mortality rates. Interesting what you are saying about ACLS drugs and lack of proven efficacy in traumatic arrests – this is one thing I certainly wasn’t aware of!

Most traumatic arrests (multi trauma) are not worked for a reason. They have very poor outcome as evidence based of survivalbility. I know of very few EMS that even have traumatic arrest protocols unless the cessation occured during after treatment had started, even then many have other measures to cease resuscitative efforts. If you are surprised by the lack of efficacy of medication therapy in trauma, then of course you should not be alarmed as the resuts and poor effects in non-trauma patients too.

Most traumatic arrests are decleared dead upon arrival and no resuscitation is attempted for a reason, as most have learned it is a futile attempt.

Agree that is poor judgement and bad parents but that is still no excuse to kill, mame and have sex with a corpse....

R/r 911

Take him to the woods, tie him to a tree and forget about him.

R/r 911

As one that just attended the test writers for the NREMT a few weeks ago, I can say that the NHTSA curriculum and as well as the medications found for the ECC in ACLS. All cardiac related questions are referred to those sources.

R/r 911

If they are going to pay reparations to the African American community then they had better pay reparations for the Native Americans.

Actually, we are paying for that too!... Way too much hand outs instead of hand ups... and we wonder why we have made them dependent upon the "system".

R/r 911

So has anyone used the CPAP system in EMS our medical director has opened up protocol to use it for COPD, CHF, asthma, ephazima in field. Disposable units run around 50 bucks but they are suppose to be O2 hogs. And the reusable systems are a lot better but run 1500 bucks. So is the system the whiz bang I have heard or just another nifty trinket.

There is several articles about CPAP; as it has been out in the EMS world for several years now as a well proven device. Yes, they are one of the best devices to treat pulmonary edema. Remember, it is not for all types of respiratory diseases. As well, one should be formally educated in respiratory diseases and the details of CPAP before utilizing them.

In reference to oxygen usage, yes they use more than the normal nonrebreather but who cares? It works. True medical devices that increase outcomes and reduce morbidity and mortality should not be referred as a trinket.

R/ 911

I am looking for any assistance in this issue. My TCC is requiring all BLS Instructors to also carry a provider card. This is not a problem for me, however some of the older instructors seem to be disturbed about it. I am trying to determine if this is a TCC requirement or an AHA requirement. Can anyone help???

I would want to know why they want duplicate cards. Appears they have an office jock; that don't seem to understand to instruct also means you met the standards as you passed the course. Just pay the $5 & give up trying to understand some people.

R/r 911

Well, alike t.v. channels don't come on by themselves. I am sure you had to actually enter EMT City. Don't like the posts.. guess what you can do? There are many FIre and EMS forums I don't visit because of the Fire drool and lack of understanding of medicine by vollies. Yet, I won't bitch because its focused upon those specific interest and is their site.

R/r 911

It was turning into the starts of an ALS and BLS debate for the mere facts of people placing the "do not diagnose and you are only a basic" concept within their posts. There was an undercurrent of BLS vs ALS or paragod syndrome in some posts.

Some people practice at EMT-B yet are in training for ILS or ALS also, so does the thought and mindset of trying to think with their new gained knowledge mean nothing. Perhaps it is different in different countries or areas, but here you are encouraged to think and learn, apart from when you get partnered up with ol wol who doesnt think A&P knowledge is essential in the prehospital arena.

Do you need a hug fiznet?

No, I doubt they do. It's hard to state someone with only a few hundred hours of training and no formal education as in not having a degree to state they make a diagnosis is being asinine. Even stating they can make a clinical impression is stretching it. I even have a hard time accepting most Paramedics as being able to make a good clinical impression can be wishful thinking.

There is no such thing as ALS or BLS except in EMS where they have had to differentiate because of training vs. education. Medical care is medical care, the assumption especially regarding in making a differential diagnosis is much farther advanced than just simplistic signs & symptoms.

There is NO debating this. This is the way medicine is and yes we are division of medicine.

We all can learn no matter what the level but let's be realistic.

R/r 911

The program is licensed by the state, the courses have numbers assigned to them.

It is not an "online" course per se, it is a home study course.

You download the material, then fill it out by hand, then mail it in for review and grading. They are sticklers for full and complete answers, no shortcuts allowed.

In all honesty, I have gotten more out of these two refreshers than ones attended in person previously. I do not sit around listening to BS stories from other walks of life, I do not need to wait on idiots who have not kept up try to do so in that short week.

I get my packet and complete it. Completion requires utilizing many different resources. I spent several hours online doing research as well as consulted several different books. I also had to look up certain state statutes. Having to do all the research myself, led me to read many new articles I had not previously seen, it forced me to review certain things I had forgotten, otherwise I would not have the correct answer.

Overall it was a great review which is why I opted to utilize them again this year and do recommend them to others. It is inexpensive to sign up, you save gas, you save time. With the economy the way it is and everyone complaining about funds, here ya go.

I am not against such courses as long as they are credible. But you & I both know that is not always the case. I agree refreshers usually have a lot to be desired and if this was a viable option that is great.

Again the whole purpose of the refresher is to review areas and recognize those that one may have become rusty in. As long as it does it purpose.

R/r 911

We treat patients NOT numbers. As the previous posts described. Not all mid 20 year old as well may have a lower blood pressure all dependent upon the make-up of their body.

Realistically, and truthfully you will NOT know what their ideal blood pressure or even what a normal BP is unless you perform serial readings. Even then one has to be sure to take them about or near the same time of the day, activity, same arm and position.

One of my pit pees is to hear v.s. WNL. Really, you know what their normal limits are? Nope.

R/r 911

I have posted this before and I myself have recerted my state and NR twice with this refresher.

eeii.org

It is a home study refresher. Download the content, fill it out completely, should take 3 days to a week depending on how much time you put into it, mail it in to be graded and then you are mailed a certificate of completion.

As I said, the State of FL has accepted it twice as well as National Registry.

With the abundance of online EMT and Paramedic programs, why do you think a refresher would be hard to find and unapproved?

Just alike the scams of study questions on-line and test review crap that is out there one needs to be very careful. I know my state does not allow on-line refreshers. It has to have a certified authorized course number, and be pre-approved before it even occurs, as I know of many states also are reviewing many of those on-line courses.

There are very credible on-line courses but be sure they have met the credential of being Distributive Education with a CECBEMS approval rating; otherwise it maybe rejected.

Just because there is an abundance of online programs does not always mean each State will allow it within their own State. As one of the educators of a pilot program on-line Paramedic program within my State I will tell you not all programs are grandfathered in.

Alike online programs of those within the Nursing profession. There are States that are increasing additional education or may totally refuse to accept those licensed from another State. (Just because you have a license does not automatically guarantee permission). I am on a committee that will start reviewing such programs for EMS to ensure quality education, not just having completed a program.

Be aware of what your State will allow.

R/r 911

I don't know what "new" way of test you are discussing unless you are talking about the computer method that has been performing for three years now.

As well, as long as one completes a formal refresher that is authorized by their State and meets the qualifications of such as the NHTSA curriculum.

I would be very leery of any "guaranteed' thing. If one actually studied properly the NHTSA and AHA/ECC reference in regards to all cardiac/CVA/ ASCHD questions one should be prepared enough.

There is no..."trick" in questions or specific proportion in the questions. As one that just returned from NREMT a few weeks ago at a test writer meeting, I know and understand their idealogies.

Good luck,

R/r 911

This discussion is typical about what is wrong with EMS, everyone wants to bitch about the problem, but when it comes time to roll up your sleeves and do some work, everyone walks away. You do not have to buy brand-new, state of the art, triple chamber pumps to regulate what we need to regulate in EMS. There are many reputable companies that deal it refurbished pumps with a warranty. I have found several on the internet in the $400-1000.00 range. Maybe you can only buy one a quarter, or two annually, but you can afford to buy what you need. Maybe you can do a fundraiser, maybe you can talk your local hospital into donating some old ones, when they buy new ones (or sell them to you cheap).

I get tired of hearing the "we cant afford it" bullshit. You didnt budget for $5.00 a gallon diesel, but you managed somehow (because you were forced to). I promise you that if you would get your ass off myspace and facebook for 30 minutes, you could figure out a way to start buying some pumps for your service.

Sosayeththecrotch

So very true. As well, part of the problem is majority of EMS administrators are not properly educated in business nor the effects of the American way of payment .... Medicare.

Dependent upon the State you are located but Medicare has a special section for those that have to transport drips that require special education up and beyond the general NHTSA Paramedic curriculum (i.e. Lidocaine and Dopamine are the only two discussed) then a Speciality Care Transport charge can be added. Of course one should have the proper education and evidence to back this but the fee usually is increased and can actually off-set the equipment within a short period of time. Even known to be profitable.

R/r 911

Unless it is standard of practice where you are, then there is no certification on the line.

Actually, it is. Read the drug insert. If it describes it should or has to be per pump (i.e. Levophed, NTG) then you as a practitioner should had known and then you willingly administered the improper way. I know, as I have testified against an EMS that transported a medication that should had been per pump only.

Their defense was, they did not have one. The court & jury, stated that if that was the case they should had declined the transport or made other arangements. Do you take a NICU without a transport incubator or if the patient is on PEEP/Vent ... BVM them?

Doesn’t sound like you ever did it in NY, otherwise you’d know that 911 medic’s don’t carry IV pumps of any kind…

(IV drip sets yes, pumps no)

It’s all titrate to effect (within dose limits mcg/k/min).

-ntg

Ignorance does not make State standards correct. Weight/volume and toxicity does not equal in good patient care. Bolusing medications that were intentionally prescribed as a IV drip can land you & your medical director for review. I don't care how long, etc. Tell me when you see the immediate effects of Dopamine in the field and I will tell you probably have overdosed them. As EMS matures and is assumed to be responsible health care providers, part of the risks is we will be scrutinized by litigation cases that will point our faults.

Part of the problem of Paramedicine is we fail to teach and educate pharmokenetics properly. The only reason ..."desired effects" was ever taught was because most assume that Paramedics were too stupid to understand other dynamic parameters. Let's not reenforce their theory.

R/r 911

I am sure there are already thoughts of using specific Elephants parts....

Seems to me, all answers are right, it’s the scenario that changes, is it 911 / stat job / short transport to hospital.

Or a interfaculty transport / ICU to ICU / ER to Cath lab / etc.

One the patient is unstable and has not had a Dr’s evaluation / treatment, the goal is to get to definitive care, so the old “Titrate to effect” is what is needed and called for.

The other, is a “Stabilized” Patient who is on and has been on meds for a specific time and rate, where a therapeutic dose has been reached and just needs maintenance as per a prescription.

Or am I over simplifying?

IMHO

-w

I hope your not considering transporting Levophed or even NTG not on a pump. Even their manufacture informs that it has to be performed as such. Titrate to effect = I can't perform pharmacological equations. Sorry, that is like saying give Epi until it works or any other medication until you see your desired effect which may over or under dosing the patient. Many medications alike Dopamine are dose dependent that varies its actions dependent upon the dosage.

Does no one carry micro or mini drips anymore?

I have been an expert witness against Paramedics transporting even considered simple drips such as K+ or Heparin. Sorry, one cannot give a precise measurement then they do not need to be transporting and allow someone else that can. Remember as well, if you are not familiar with the equipment (i.e. hospitals pump) and there is failure or problems, you better be able to trouble shoot the device.

R/r 911

One as well need to recognize mean arterial pressure (MAP) to assess the depth of shock in addition to pulse pressure.

R/r 911

There are very few events that are time sensitive. In reality lights and sirens have not be proven to save time if so very little (that is if the they proceeded safely). Return in emergency status is very limited as well, again for time sensitive injuries and illnesses. Hence the reason you are supposed to have a medical professional in the back providing medical care, one should not have to respond back in emergency status.

Running in emergency status increases risks and jeopardizes all.

R/r 911

"Medicare paid for this"

EZIO will run you about $300+ for the driver, and $80 each for needles. BIG is self-contained and I get them for around $60 each.

Wow! I need your rep! It costs me $6200 for 6 drivers with four needles. Of course the newer model (short handle) was $15 more.

R/r 911

Just purchased some EZ I/O's today. They run about a grand a piece with a few needles. The cost is about $100 bucks a pop and $120 for the larger one. As well, you can insert manual if there is battery failure. Most rep.'s will give you an additional drill free as the money is made off the needles. I did not even consider BIG or FAST as I have heard horror stories and I have used FAST and was not impressed.

R/r 911

I do however disagree with the way the written test is put together. The test bank is derived from way to many sources. The pass/fail ratio of the paramedic exam and the cost of taking/retaking the test is likely why some people feel it is a scam. It's not a scam, but there is room for improvement.

If you can come off the $70.00, go ahead and get the certification. The basic exam is not that hard. I'm about to pay $110.00 for the paramedic exam, plus state fees, plus background check

Do you know the sources? Have you really investigated where or who they are? As one that just returned from the NREMT test writer meeting, I can assure the sources are very limited. That being they are only two things. The NHTSA Curriculum and cardiac material is from the AHA. All questions are reviewed and pilot tested and then restudied and re-critiqued. It is a very scientific process and one that has to be analyzed often for credibility. You can take Brady, Mosby, etc and study from them but the questions are verified to be in the official curriculum.

The costs is nominal in comparison to other professional tests. NREMT did not set the fee, Pearson/Vue costs is what caused the increase. Don't like it.. well I guess we could go back to scan tron grading and awaiting 6 weeks for results.

The pass/fail ratio is one of the highest for a medical examination, so in the real world it probably in comparison too easy of a test. Something most of us educators would like to see changed. Unfortunately, most use the NREMT as a screener to eliminate those that should had never passed any EMT course.

Go take another health professional test, then compare costs of the organization. Usually several hundred dollars are required every two to three years. Part of the problem it is too easy and too cheap to become a medic.

R/r 911

The degree is not what makes the person or the medic - it is the pursuit of education and professional attitude which define them.

True; but unless one can master the objectives and the way we measure the objectives in education by issuing of a degree. One could continue to pursue both and never achieve either. Having the education, knowing how to use what they have learned and applying it wisely will only demonstrate the proper attitude.

A truly educated clinician realizes continous learning and education is essential.

R/r911

Chill out homeboy, I to have a two year degree, I just don't think we need the registry to pursue higher standards in this field. As long as people volunteer EMS will never go anywhere. Fire departments are the least of our worries, Do I think that I need a glow in the dark patch to tell an employer I worth an extra 50 cents an hour, No my degree and experience whould give me an extra 50 cents an hour or what ever low paying wage I so choose to go for.

Again, NREMT has never been against education; quite the contrary and even promote professional development so I do not understand your anguish against an organization that would be promoting your ideas?

Look at it this way, each professional organization needs some continuity of assurance that it is meeting at least the minimal standards. I know of collegiate Paramedics that never attended a formal anatomy class because the Paramedic course was contracted out to a Career (Vo-Tech) Tech. They were awarded college credit for their courses that did not meet the usual collegiate level requirements. In reality. although an associate degree is great it is not the end all. Can you assure me that all program graduates have the same continuity or meet the minimal standards?

Would it not make sense the NREMT be pro for us in EMS, since they have not raised their rates in decades? Remember, the more professional we become the more successful they can be as well. I am assured they would love to see our profession grow in both education and in professional development. After being with them two weeks ago, I can personally say they are more pro EMS in way of professional development and also wanting the Paramedic to be compensated for such, than most of the other organizations out there.

Think about it. What other organization has changed or even to attempted to increase the education standards other than the NREMT? ....

Degree is a worthy thing, but it alone does not make the difference. Having the degree and meeting those standards to ensure public safety is the key point.

R/r 911