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Any kid with with an effective enough foot can kick in my door and break into my house, but that does not make it right. Phones have GPS radios for many reasons. Communication is sophisticated business and there is still an expectation of privacy. Additionally, isn't this conversation about "big brother" watching us? I do not think we denying that fact, but rather discussing how far this watching should be taken. Again, if government drops the ball on things such as taxes and guns (IRS Scandal & Fast & Furious), can it be trusted to have access to our personal conversations, even if they swear they are only using meta data? Just like the gun control debates, this situation has opened up important discussions about where our country should and will go. Simply admitting that "big brother" watches us and going on with our lives is one action, but is it not important to pursue additional dialogue and really attempt to come to terms with where this could lead? I have not yet talked about constitutional law, but clearly past court decisions will play an important role as well as subsequent decisions. The ACLU has already filed suit and how things go should be of great interest to people who are not completely apathetic.

If I call my wife and talk about husband and wife stuff, that's nobodies business. If Osama figured out his phone was being monitored, then did the so called "moron" actually give anything secret away? I cannot fully condone his actions however. My biggest issue is that repeated incidents show that the government simply cannot be trusted with our personal data. Recent scandals have set a poor precedent and as much as I love to call conspiracy theorists out, I find my self in the uncomfortable position of having to come to their defence (on a few issues at least). Also, the government outright lies. Back on March 12th of this year, Mr. Clapper (Director of national intelligence) was directly asked during a congressional hearing, "does the NSA collect any type of data at all on millions or hundreds of millions of Americans?" Mr. Clapper replied, "No sir … not wittingly." Sorry brother, but the government has consistently used information to potentially harm it's citizens (IRS scandal anybody) and has lied about what it is doing. If I cannot trust the government with my taxes I am not confident that I can trust them not to take the whole meta data thing a bit further. I have done nothing criminal but I guarantee there is still very personal information that my wife and I discuss (especially when we have not seen each-other for a while) that in the wrong hands could cause me great embarrassment at the least. I know Obama has come out and said that the NSA are professionals and would never misuse or abuse their positions of power. However, I thought the IRS people were professionals as well? What about Mr. Clapper and his lies?

We use the DCHART format: D: Dispatch information C: Chief complaint H: History (SAMPLE & OPQRST) A: Assessment: Physical exam, Labs & Vital Signs R: Rx: Treatment rendered and patient response T: Significant notes during transport Field impression at the end I have copied a fairly recent PCR that I did with some of the data removed or changed for obvious reasons: D: Dispatched to the scene of a 76 year old male or female with weakness C: 84 y/o male or female found sitting in chair at home with family at his/her side, pt reports “I think I feel alright,” family reports he/she has been very weak and breathing fast and they cannot get him/her out of his/her chair to get into the car to take him/her to the hospital, Pt contact made at 09:50 H: S: generalized weakness, tachypnoea A: NKA/NKDA M: Jalyn 0.5 mg PO q D, Megase oral PO Q day, mirtazapine 7.5 mg PO Q day, tamsuiosin 0.4 mg PO Q HS, temazepam 30 mg PO Q HS, Trazadone 50 mg PO Q HS, hydrocodone/APAP 5/325 PO PRN, lisinopril 1.25 mg PO Q D PmHx: HTN, BPH, Fall resulting in intracranial haemorrhage in December 2012 L: Last HS E: Family reports that the patient has recently been discharged from rehab following a fall resulting in a TBI but has been progressively weak and unable to perform ADS’s with s/s that have worsened over the past couple of days O: Last HS P: Denies pain or discomfort Q: Denies pain or discomfort R: Denies pain or discomfort S: Denies pain or discomfort T: As defined above A: HEENT: Sitting upright in chair, AO times 4 with movement in all extremities, atraumatic to exam, airway patent and self maintained with increased respiratory rate, pupils pinpoint and minimally reactive bilaterally, neck midline with flat jugular veins, Pt able to swallow without difficulty and smile w/o indication of facial droop, speech slow but non-slurred Cx: Atraumatic, unlaboured respirations, no accessory muscle use, clear lung sounds in all lobes, no c/o dyspnoea, no overt s/s of respiratory distress, but rapid and deep respirations at a rate of 24 noted with regular rhythm, irregular, faint heart tones noted at an elevated rate of 112-118, firm, round mass with a diameter of approximately 5 cm noted to lower right anterior chest wall, Pt reports “I have had that forever” Abd: Soft all quadrants, non tender to palpate, atraumatic to exam Pelvis/GU: Pelvis stable and intact, full GU exam deferred, Pt reports that he/she has been having “difficulty going pee” Ext: Movement in all extremities with weak bilateral hand-grips, atraumatic to exam, pale/cool/dry skin with decreased turgor, no indications of cyanosis or jaundice noted Neck/Back: Atraumatic, midline w/o step offs, Pt denies any c/o V/S: B/P- 60/40, P-118 & irregular, RR- 24 w/o overt indications of significant respiratory distress, SpO2-88% R/A, T-98 F, Wt~68 kg, Temp 97.1 F tympanic Rx: 1) Pt contact and full assessment, placed on portable pulse oximeter and BGL of 265 mg/dl noted, Pt placed on supplemental Oxygen at 2 L/min via nasal cannula @ 09:50 2) Pt carried out of his/her room and down a small hallway via transfer sheet and placed onto the EMS str into semi Fowlers position by EMS crew, Pt reports “feeling like I’m going to faint” upon being picked up, Pt properly secured onto EMS str w/o incident @ 09:55 3) Loaded and properly secured in EMS unit for transport w/o incident, Placed on monitor for continuous SPO2 monitoring and cardiac monitoring in lead II with q 5 min v/s reassessments and XII lead acquisition and transmission to General Hospital ER w/o incident, sinus tachycardia with frequent unifocal PVC’s w/o overt ST changes or indications of BBB noted @ 10:00 4) 20 ga IV placed to L AC times one attempt using aseptic technique w/o incident along with BGL check (123 mg/dl), fluids up at 1,000 ml 0.9% NS at wide open rate for volume expansion @ 10:02 5) Radio report called to General Hospital ER w/o incident @ 10:05 6) Discussed possibility of Zofran administration for c/o nausea with EMS preceptor; however, she/he does not want to administer it at this time d/t "short ETA to the hospital", Repeat VS reassessment @ 10:10: B/P- 72/40, RR-22-24 and non-laboured, SPO2-96% 2 L NC, P-112 irregular, lung sounds remain clear after 500 ml of fluids have been administered, 1,000 ml challenge continued T: Pt transported to General Hospital ER w/o incident or change in assessment or condition, bedside report and turnover to Dr Smith w/o incident @ 10:15 DDx: 1) Hypotension with possible tissue hypoperfusion a) Possible infectious pathology (Consider urinary and respiratory sources as high priority systems to assess) Possible toxicological etiology (Consider opiate toxicity with possible poly-pharmacy as a primary candidate) 2) Cannot rule out neurological event (TIA vs Stroke with possible increased ICP or intracranial mass effect) 3) Possible fluid volume deficit 4) Hypoxaemia with possible tissue hypoxia 5) Hypoglycaemia R/O with point of care BGL testing Please note this may be based on a patient encounter but it is not an actual chart and presented here as a training tool.

No worries, I figured I would have some explaining to do. Good luck with the bridge. You may even consider looking at the national registry Re-entry policy as a paramedic. It may save you a year.

I just happened to see the lapsed certification policy in a new brochure I received from the registry, though I'd quote it: "If your national EMS certification has lapsed within a two year period or you are currently state licensed...you must: 1. document successful completion of a state approved 48 hour refresher course...within the last two years 2. complete an online application and pay the application fee 3. successfully complete the...cognitive and psychomotor examination If your National EMS Certification has lapsed beyond a two year period and your state licensure has also expired, you must apply to re-enter...via the...Re-entry policy..." You can find this on the NREMT website as well.

Another potential consideration is something called the Mark King initiative. You may want to ask the registry about it if other options fail.

Thanks for the replies everybody! Scuba, it appears you are calling me out? I hoped this question would come up. Unfortunately, it appears that I'm a hypocrite. I completed a bridge programme. Allow me to explain. I was approached by my boss (EMS programme director) about doing a bridge transition. She made several points that revolved around my past experience as a transport nurse and EMT in addition to pointing out that I've taught every paramedic course and had been a clinical preceptor. These points certainly carry weight, but what made the change was that there exists scant evidence about the best way for a RN in my position to make the transition. My objections were based on pride and conformational bias. I did something very difficult, I changed my mind. I had significant input into the bridge and good support from my boss and our programme medical director. A programme was developed that included didactic, lab and clinical components. In addition, I had to take every block exam that the paramedic students have to take, but entirely new exams were developed so I had no idea what to expect. A hospital clinical rotation was required and I rode for many shifts with a paramedic service that runs dual medic crews where I took the place of one of the paramedics. The experience included about 400 hours of classroom and clinical experience. I am still not sure of the optimal programme length or duration, but I hope most people will find what I completed to be robust, fair and adequate.

I'm not sure. It shows up for me. Ill do another image on this post. I just finished a paramedic course and took national registry last week.

I'm reasonably satisfied with the results.

It's all outlined by the NREMT. You are in fact able to take advantage on an online option whete you fill in an online record of hours, mandatory credentials and so on. It's helpful to have your agence affiliated with the NREMT however. You should have an NREMT account. Spend some time learning about the process through their website and call for additional answers if you exhaust your other options for gathering information.

I cannot make a conclusion on scant, anecdote however. It may be the next great thing, but I must default to the null until compelled by the evidence.

Just received a call. A close family member was taken to the hospital experiencing intractable pain. A couple of months ago this person was diagnosed with pancreatic cancer with hepatic mets. For what I assume are a variety of reasons this person did not tell anybody and instructed their doctor to not even tell the spouse. To say the least, it was a shock to hear about this and to try to take in the fact that any hour from now I will be loosing a family member. My mother is probably suffering the most. There are no miracles, there is no hope and the most progressive, cutting edge science cannot reverse this situation. The one thing that my mother in particular is holding onto is the fact that the health care providers have treated the family and patient with nothing but compassion and respect. This family member is no longer in pain and the providers have taken time to discuss what is occurring and what is to be expected down to what to expect with the breathing, mottling and why their beloved one is so yellow in colour. Even though there are no miraculous recoveries when faced with this situation, health care providers are still able to touch people in profound and important ways that reverberate and resonate for years to follow. These are often simple gestures of human dignity, respect and compassion. My situation is not unique; however, and I imagine many people have similar stories to tell. Thank you for such thoughtful and profound posts Dwayne.

Possibly. I'd like to see significant literature before making up my mind. It very well may work, but I default to the null hypothesis until convinced otherwise. I will be happy to change my mind as the evidence pours in however.

I too would like to know the efficacy of this device when used for large, gaping or non-linear wounds and on wounds with a difficult to appreciate source of haemorrhage. It may work well under certain circumstances; however, I question it's general use on a broad range of injuries. I'm skeptical but certainly willing to change my mind.

The last thing I want is yet another rumour about the BSN/ADN argument. A registered nurse is just that. When you graduate your initial nursing educational programme you take the NCLEX-RN, not the NCLEX-BSN if you have a BSN and the RN if you have an ADN/AAS. It is true that many hospitals are pushing for BSN due to magnet credentials among many other things. However, I do not want somebody who doesn't know better to confuse RN and BSN.

Just to clarify, a BSN and an ADN are both Registered Nurses (RN) after they pass the NCLEX. RN does not mean ADN, it means RN and is a separate concept from the degree. I do not want people thinking differently as can be inferred from above.

You may want to look at National Ambulance. I know they accept credentials from the United States and many of the common wealth countries to include Canada. http://www.nationalambulance.ae/ Also be advised that from what I understand if you get hired, this is an actual job that requires you to move and live in the United Arab Emirates. It it not like a contracting gig where you take leave every few months.

Most of the medics I worked with in the United Arab Emirates were associated with a hospital. The major hospital based EMS service I worked with was Wellcare. An earlier thread on this topic: http://www.emtcity.com/topic/14404-paramedics-in-uae-abu-dhabi-dubai/

My experiences differ from yours. Unfortunately, anecdote is not particularly effective when making any big picture sort of assessment or decision.

Good on you mate! Keep us posted on your progress. Strong work.

Why start from scratch? What does the evidence say about medics who make the transition traditionally versus a hybrid or bridge programme? I will be honest and say I'm not sure. My decision would be based on the literature. Do these "bridge" nurses have comparable NCLEX pass rates, how about making the transition into practice and obtaining employment? In addition, what about rates of errors and overall long term job performance? I simply cannot definitively say with any degree of confidence beyond anecdote.

Congratulations man! Job well done, I have no doubt that it had to have been a difficult challenge. Thank you so much for sharing this wonderful accomplishment!

Perhaps, but I still cannot fault individuals for improving their personal situation. All the raw raw soap box speeches will not keep your kids fed or make the house and car payments. I agree with advancing the profession and that is one of the reasons I am in education. However, I cannot call somebody out for making honest decisions that could improve their overall life situation. This also goes for nurses who move to other professions such as physician assistant or respiratory therapists who move onto nursing, medicine or physician assistant. I could call all these people out for not supporting their professions, but personal choice and advancement is much more important IMHO.

It's a dichotomy for sure. Support for the overall advancement of a profession (big picture) or improving your personal situation. At the end of the day I would never fault somebody for choosing to improve their personal situation particularly if family, children and major life changes are involved. It's easy to preach big picture stuff when you are in a good place. I do it all the time as an educator and it certainly makes me a hypocrite. Also, nursing isn't the holy grail of job opportunities and higher educational standards that many people believe.

It was wonderful. I'm not sure what you all see with the awful weather, overpopulation and terribly crowded roads up there however. :-)