Ridryder 911

Dependent on the extent of the ischemia and possible infarction. We routinely use TNKase, and usually we see immediate changes to changes within one hour after administration, some later again dependent on degree. R/R 911

American Heart Association whom is primary responsible for these programs regulate the courses. Both these courses are considered education courses. It is recommended that the participants have knowledge and experience in the course content. Being this, it is not recommended that is not at the level of the basic EMT. As an instructor for both, I do not recommend attendance. It involves materials most basic level have not been exposed to as well as clinical skills not in the realm of the basic level. I would recommend another course or placing the money in courses to expand your education. PEPP is one that I would recommend or PHTLS. Remember; attendance and passing these courses DOES NOT CERTIFY anyone, and does NOT allow them to perform any the skills. Good luck, R/R 911

Some Doc's do not prefer NTG post thrombolytic (especially IV form) since occlusion should be somewhat opened up. Since it should not be arterial spasm and partial occlusion, I am sure he was thinking of slow absorption nitrates, he might worried of transfusion enroute. I too am a fan of NTG drips, and still wonder why EMS has not became of age of even initiating them. Morphine definitely has its place, but in arterial spasms and some occlusion, I wonder why the hesitation of not the use in the field? Yes, closely monitored B/P etc.. which should be doene with any medication(s). I am surprised this has not been investigated further or researched in more detail. Please, the "glass bottles" how to monitor should be eliminated from discussion. There are far more dangerous objects that are carried in the units, and yes IV pumps have to be used. Therapeutic levels could be reached at a faster rate, and closely monitored. I am quite aware that many services are using NTG paste at this time, which is good, but definitely has a slower absorption rate. I did work at one EMS that did utilize NTG drips, but I have not seen it utilized very much prehospital wise. R/R 911

Geez... fogging up the mirror... didn't they do that in the 1800's ?... How about checking a pulse.. or EtCo2 ? R/R 911

Asysin2leads, you treated the patient in whole, the etiology of the problems. I refuse to work for services that will not allow me to be a practitioner, rather than a delegated monkey following protocols. It is nice to see a Paramedic using the cerebral contents and treat the patient appropriate .... many patients fall into categories of protocol, and so many needless procedures and treatments are performed accordingly but yet not appropriately. The gentleman with his outstanding history, and the "routine" tx. did not correct the situation, so you treated the etiology. Shame the physicians are not as well diverse, and I agree with Dust, thought it was unusual for someone to actually be thinking or as I have begin to see physicians are becoming more "cook-book" in tx modalities. Continue, the type of care and assessing skills Aysin2leads, EMS needs more that thinks outside the "box" .. who knows maybe you can start a new trend ?... R/R 911

Good luck ! .. Let us know how it goes... There are several good attorneys out there... be sure to protect yourself for the future... R/R 911

As I have always said " You may love EMS ; but EMS will NEVER love you ! I hope you can get into another career, and better yourself off. Sorry this occurred, from one old veteran to another..... R/R 911

Actually, NTG is on the national standard of treatment for CHF. Of course, eliminating or use in cation with Right sided infarcts... Be safe, R/R 911

Actually I do believe volunteerism will be a thing in the past for most communities if they try to continue as they are. Exception will be those you mentioned in frontier and very rural areas. The Explorer posts days will soon be gone as well, due to high liability, HIPPA, and basically people expect to have educated professionals working on them. Yes, we will continue to have posts to promote the work force but actual patient care will be decreased or eliminated. The geriatric population will place such a demand, it will make it near impossible for the hours required to staff. The role of the EMS provider will soon be shifting from transporting all to triaging those will get to be transported. Many of those in EMS laughed at my prophecies, but so far I have been >90% right. The number of hospital beds, emergency department beds is in no way co-related to the expected number of patients in the next 5 years. ENA, ACEP etc.. has discussed this but media has not made notice. Of course fear would suddenly occur. It is very doubtful the hospitals will build or be able to keep up the the demand as well. Look at articles American Hospital Association (AHA) has referred to. The insurance companies are quite aware of this dilemma as well. I suggest everyone that has a real interest in the future of EMS look at this months JEMS magazine. For many years I have prophesied that EMS will be summoned as usual, but treatments that had not been routinely performed in the field after consultation with a physician will be accomplished. Physicians will increase their role in EMS as well to improve and broaden & expand the role of the Paramedic, in more of a mobile health care rather than just EMS. Emergency type patients routinely do not pay...where as medical patients have a higher percentage of re-reimbursement ratio. Insurance companies are quite aware that more be performed in the field rather than paying for an expensive taxi ride, and then the ultimate costs of admission(s) . Again, like it or not; it is simple economics... for example 1 chest pain patient: EMS bill $800.00 .. ER bill $2000-3000. ...ICU/Chest Pain Center to rule out $5-10K .. total roughly $9-10,000 in comparison of 1 EMS with physician that does a XII, lead with bedside enzyme(s), portable U/S ... and an HMO Cardiologist tele-video referral conference... $ 3-5,000... now multiply that time number of cardiac calls a day..... Now, if you were the insurance company what would you do ? If you were Medicare which would you rather pay, as well ? Think this is to futuristic ?... again read this months JEMS .. televideo from EMS to ER in Phoenix... Doc in the box.. future is not that far away. So how are the volunteers in metropolitan to compete and up-keep ?.. liability, education, etc.... they won't... the same as nursing years ago with the visiting nurse association or public health nursing.. that performed a lot of volunteer services. The demand became to high, technology became intense, and education more involved, that nursing actually became a profession requiring a college degree. Again, I don't say get rid of the volunteers, but again change their main emphasis and jobs. Emphasis should be placed in a highly trained first response system to accomodate, the EMS and mobile health care. Their role will be essential to prevent time delay in care and to perform BLS skills. The main difference is that role will not be the sole provider but the initial one. Ask fellow volunteers if they would mind performing the first 5-10 minute care, rather than be with the patient for the full course, I believe you would be surprised. More people would be attracted, and memberships would not dwell so if there was a decreased in time as well as need to have so many on call. Cities would defintely gain as well with reduction in costs, and increased in city healthcare. For those who might think I am over zealous with my predictions...look in your community of the population ratio and number of elderly housing/nursing homes now multiply that 5... is your community prepared ? Be safe, R/R 911

Ditto... I thought it was just me ! R/R 911

In Oklahoma, it is dependent on the medical directors discretion. The state does have a state protocol for those that do not have an active medical director or work upon individual protocols. I worked in the state as an bureaucrat and I can assure you the state has not a clue of each EMS services (200) protocols. They do go for review, but as long as it in within somewhat of normal reasons .... they are approved as long as you have an active medical director. I know of a ground service that (or at least last year) carried Fentyl. Be safe. R/R 911

We do not have volunteer EMS in my area. The volunteer EMS agencies was changed into paid systems, and now most that did volunteer is now within the volunteer fire departments. By doing such, they can respond as first responders as such role and provide initial care and assist the professional EMS. We are in the works of continuing our relations with the volunteers. I believe they are an asset, especially in rural areas that are not protected by paid professionals, and definitely can be an asset in aiding us in EMS. We are considering starting once a month or quarterly pizza night, by providing free food and CEU's to volunteers. This does not just provide us with good working relationship, but will also allow them to get CEU's , get familiar with our equipment and procedures as well. Like I described, most volunteers are having to spend more time away from home, and thus decreasing memberships and activities. There are very few members that want to work two professions and not get some compensation. By having a paid full time ALS EMS and having the responders assisting have decreased their time awaiting calls and at the scene. Hence, they go home faster... We also provide most of the major medical equipment and restock as necessary, since we are the only EMS provider. Basically a trade out situation... this has also decreased the costs of small local town city budgets... some of the responses are even 30 -35 miles away, so we depend on these responders to make initial contact and treatment. A dual Paramedic unit responds for further treatment and transport. Again, it would be foolish for cities to compete, and try to provide duplicate systems. By re-duplicating services, several things fail... the EMS system, the patient (because lack of funding/education/level of care), and personnel. As America has learned, each city, community cannot have or afford a hospital and they are soon finding out the same is true in EMS. Developing and improvising systems will have to occur. The predicted demand will be too much for most volunteer agencies. It will be better to have a first response system and utilize volunteers appropriately than to loose all help. I do believe volunteer agencies should be looking toward the future, and instead of trying to compete due to tradition, ego's, etc.. assist in developing funding for paid professional regional services with Paramedic capabilities. The end result would be better for the patient, the community, and even the volunteer agencies. R/R 911

I chuckle when I see comparisons of physicians, nurses, etc doing volunteer work and comparing it to EMS functions. First, I do volunteer my time as a nurse to free clinics, and medical missionary groups when possible, like so many others. When you look at the "make-up of the medical group however, you do not see volunteers that is their only exposure of medicine. These folks are either retired from professional medicine (where they did it paid full time) or they work in medicine full time. I have yet met (29 years) anyone that went to medical school/nursing school to donate their services all the time and never be compensated. I can assure you that the medical profession (hence.. profession) has never considered that its members not be reimbursed for its services. It would be nice that member of EMS could afford to be able to volunteer areas of the world that is lacking in health-care. Most I have found are not financially able to donate time due to working 2 to 3 jobs, to make ends meet as described. Again, I have not seen any professional describe to eliminate the volunteer, rather change the role of the volunteer to a first responder role. This has been performed in my area and has been very successful. Decreased time the volunteers have to spend on a call, education provided by professional EMS so certifications and CEU's can be obtained easier and less costly, and less financial burden on the system. This has actually helped the volunteer agencies and increased their memberships. We have developed a good working relationship with these agencies and have actually hired some to our professional service. As described volunteerism is diminishing, maybe a change in role and functions, they will be able to continue their services. R/R 911

I hope I don't get sick in your town either. If you knew anything about emergency medicine you would know you can't go to ALS without BLS first. I agree most BLS education is not much more than advanced first aid. Winning citations does not impress me, nor professionals that work in health care industry. Never seen any competition in saving lives, or should there be any awards. This is not a competition events, this is a division of emergency medicine and should be performed by college educated professionals. Point is made when medals or ribbons are handed out... I know the EMT curriculum and how it was diluted down so it would not compromise volunteer agencies membership. The last modification was performed in 1992 and the curricula was watered down so bad, that very little medical terminology was allowed or detailed anatomy or physiology was allowed. This is why most texts are written at a 6'th grade reading level. Do a comparison of First Responder and ARC First Aid, and the Basic EMT and you will find there are very few differences. Yes, the Basic EMT has a role, like any member of EMS. With the current curriculum level though, it is hard to justify to allow them to be the first response health care providers. R/R 911

Investigators know that they have to get a subpoena for information for the medical care that was provided. However; we need to careful that we don't try to behind HIPPA. HIPPA only pertains to the specific treatment and care that was given to the patient, It is simple enough for the D.A. to get a court order for release of information. Good luck, R/R 911

and yes the debate of professional soldier and reservists still goes on.......... With all the thought on how the well volunteer and the caring of so much.. if you really cared so much, would one want the BEST for the community and its residents ? ... This would be responders available for call immediately, (without any waiting for response) professional knowledge and requirements to be available for the citizens of the community. I wonder how many goes to a physician that only volunteers his/her services.. or would trust that individual. R/R 911

Years ago, I studied Fire Science and was very active in Fire Rescue, an became very discouraged when I realized that most Fires Services did not want anything to do with EMS. Department after department routinely told me the same thing , that they did not "want to be in the ambulance business, and sure did not want any pretend Dr.'s ". After, discouragement I focused my full attention into EMS and the medical side. It was not until a little over 10 years ago, that Fire Services started paying any attention to EMS. Most recognized the potential of public relations and productivity. Yes, there are more EMS calls in lieu of fire responses. With the decreased number of fire responses thus less productivity = less need of budget = less manpower. Now, after all these years, EMS becomes the savior and all interests are pointed towards EMS to save the Fire Service Systems. This are the same systems that a few years prior snubbed their nose to accept this services. Not only, they have found it is a public relations tool, but can be profitable business as well, actually maintaining itself and not "dipping into the budget". I believe there are very few Fire Services that have ever really wanted to provide EMS, rather felt it was either a non choice to again provide the needed verification for maintaining the fire service and its personnel or was EMS was dumped in their lap. This definitely is still seen in the attitudes across the nation from Fire/EMS services. With the world as it is now, and the need of prevention WMD, MCI and fires of different caliber, fire service is a specialty of its own. It is difficult to be proficient in every thing and EMS is one thing less they should have to worry about. Money, attention can only be focused on very few things, and as history has shown EMS will be treated as a step-child. EMS which is medical should be treated as such, There is no correlation of fire suppression, in EMS. The same would be like placing law enforcement in the fire service. EMS needs to recognize we are a health care profession that provide these services to the community outside the hospital setting. Some new keywords are even replacing the term EMS with Mobile Health care, which is more accurately showing the trend we are moving towards. We are not public servants, but provide a service to the public. As EMS matures, we need to encourage independence from fire services, and encourage private, or third party services. I used to recommend hospital based EMS, but with the restraints of reimbursements hospital EMS based services are short lived. Again, we are medical and should represent that in our studies, behavior, dress, and professional organizations. EMS should not and cannot be one of the many hats that someone wears.... Be safe, R/R 911

If you won the appeals.. why did they charge you for this ? Sounds odd. You were told this,by your instructor or was this more here say? It was your evaluation, he should had showed your clinical performance. If your school did you this wrong, you should had received your money back with an apology as well as program director discussing with preceptors service. This preceptor should not continue to be one. Was there no discussion during your clinical time(s) of your grades, performance level, etc.. seems odd that you would find out only at the end. I don't care about the size, sex, color, etc.. when they are a student ... I do know some that feels image is important and yes being obese in EMS can be a hindrance inside small units and movement. But, I would hope the sole basis of clinical performance would not be based upon looks alone. The same is true, I have not seen where clinicals was the majority portion of the grade was based upon clinical grades. R/R 911

Try this little test... hold your breath for that extra 3 minutes... now you can see the need for rapid response. Meanwhile, if your heart has arrhythmia's due to hypoxia or anoxia it shouldn't be that big a deal now should it ?... or if your laying there with 2'nd degree burns on your face, chest and arms.. or your mother or father starts having a CVA that extra 10-20 minutes for an ALS wouldn't be that bad either... Again most that are making assumptions are ones that are not educated in medicine. Does anyone else see a problem here, except for about 5 or 6 us ?..... Again prove me wrong .... R/R 911

Rescue that is my point .. yes, you do need a paid service, now I wonder why your community does not address this? Sounds definitely busy enough, andyou have a pool to gather the people from... good luck R/R 911

Sounds like some re-organization is needed. If there is a county that has and needs >250 volunteers then it is PLENTY of big enough to become professional. Does the county realize you would not probably need but about 30% of the 250 people to provide the service full time, thus remove the need of reimbursement of the additional 150 or more people to keep up their certs. Again, poor government management skills. Yet, I doubt there are very many rallying to change things either. That number is more than we have 3 full time fire departments and EMS with full time dual Paramedics FTE covering a county of 100,000. Unfortunately there are very few professional EMS advisers that can discuss with city managers, and county board officials, to improve systems and at the same time probably save the townships money. Setting up EMS correctly with proper billing services and if need be supplemental tax base, it can be definitely cheaper than volunteer services. R/R 911

You know, I see some truth in that ...LOL R/R 911

Yep, the old days of "You call, we haul" are over. That is what taxis are for. If the patient needs medical attention then we should provide such, but to charge people $800 for a taxi ride without need of care is not right for the patient or the system. R/R 911

I understand what you are saying, and actually used to have the same feelings. But we should not be public servants. We should medical professionals. With doing such we should not have the need or desire to "dress up" or be confused by the public of being of such. Like Dust describes do you see physicians wearing badges ? Whenever EMS finally understands what the abbreviations stands for Emergency Medical Services then maybe.. the public will too. R/R 911

Okay, I see.. it's all right for you to have to have an education for your job, but it's not okay for a medical field not to ?.... Hmm does that sound like it came from an educated person ?... Pay is not important to you... fine, let me find some volunteer to replace you at your profession.. I am sure we could find some retired business type... it is not like they are going to kill someone in that job or profession. Really, how important can your job really be to have to have just a B.A ? Yet again, you have audacity to be self righteous on the pay, but you would not work for it ...kinda a hypocritical statement. Again, I highlighted the "I's and me's in the posts .... do we still see a pattern ? Are we right by stating they are in it for themselves... prove me wrong ...... R/R 911