chbare

I'm very sorry. Good thoughts for you and your wife.

We all know and have probably all experienced long wait times. However, I wonder if a discussion about plausible solutions is warranted? The problem is not projected to improve and may significantly deteriorate as the nations transitions to "Affordable Care."

Are you looking at training, education or management? There are different focus areas. For example, if you are looking at management of scheduling, employee policy and procedures, AMLS instructor credentials may not be as helpful as say a business degree. Education and training are potentially different animals. Particularly if you are looking at collegiate derived education.

I would not call terbutaline worthless. If you look at the literature instead of anecdote, you will find that terbutaline is effective. A study in the mid 1990's compared pre-hospital terbutaline to albuterol. Quantatitive measurements of respiratory severity were similar between the two groups and both groups had improvement but the albuterol group reported "feeling" better. You have a case for albuterol being a better agent, but it would be difficult to call terbutaline worthless.

I completed EMT-B in the Army, therefore my experience is probably not applicable. However, the core material is not particularly difficult. Show up for lectures and labs, engage in the activities and ask questions for verification. Most people who are reasonably motivated and literate will be able to pass.

Some services utilise these medications, particularly flight crews and critical care transport crews. I'm not aware of widespread use of propofol for pre-hospital RSI but it is commonly used post intubation as a titrated infusion. Etimidate was particularly common when I started flying, but ketamine is becoming quite popular. States do much of the scope of practice regulation, so guidelines can change from place to place.

A CRNA is a nurse specialised in anaesthesia.

Looking back I'm ashamed: Who knew a precipitous drop in blood pressure would be harmful? It's nearly axiomatically true that doing so would be problematic, yet we did it and probably harmed many people in the process...

I used the Procardia capsules way back when I was a LPN at a nursing home. It was not uncommon for us to puncture the capsules and administer SL. I shutter at how things were done.

We all excel and struggle in different areas. Test anxiety can also be an issue. This will become quite obvious when you find yourself struggling at something when others appear to breeze right through it. They may not understand why you are struggling with said task. Additionally, CE may be a better option for people who have to look at a significant commute or taking days off to go and test. This is especially true if their employer provides CE or they struggle at test taking.

I suspect the registry will transition to an adaptive after they have had enough people go through the current AEMT questions and enough time has passed to properly pilot questions so they can have a good idea where the average student is testing in terms of overall score and performance on types of questions and specific questions. The AEMT is so new it will take a while to really put a good adaptive test in place. Even the psychomotor process has seen changes as a cardiac arrest/AED station was added to this testing process.

I will say that the AEMT exam dives into significantly more detail than the I/85 exam and really focuses on basic shock pathophysiology. Anecdotally, I liked the exam and think it requires an improved understanding of the human body. It also has allowed us to push through new pre-requisite courses such as a semester of A&P, English composition and a medical math class.

Not the AEMT exam. Currently, it's a straight 135 questions and a certain percentage of content from several sections will be included on the exam. It may end up being an adaptive test in the future. I outline the content areas and percentage of content found on the exam in the videos.

I noticed the same things as CHBARE noted with the nurses I flew with. I also noticed the same thing with the paramedics hired to fly.

In the area I'm currently living a two year nurse cannot get a job. Anywhere. The minimum education needed for hire locally is a BSN. And this is a pretty big local area.

This varies. The ADN has a big share of the nursing jobs in my area of the country. I think the biggest change that I've seen is that you can no longer expect a job wherever you want upon getting out of nursing school. As a new grad I was able to walk into an ER and I had several other offers around the country. Now, I think that kind of flexibility is limited even among four year nurses. As a two year nurse, there are jobs, but you will have to be willing to relocate and take a "less" desirable position. The same is true with LPN's. There is a market for the LPN but it's limited and you have to be willing to travel. The old glory days of nursing are over IMHO, but it's still a viable career pathway.

Edit: As somebody who has been a CNA, LPN, ADN and a BSN, I would strongly recommend people tough it out and get the BS degree. You will likely spend the same amount of time getting an ADN due to pre-requisites and waiting lists. You may as well find a decent, accredited four year programme and maximise your options in this economy.

I do not see two year nurses going anywhere. The BSN required in ten (years) statements have been around before I went to nursing school. There has been a bigger RN presence in contemporary times, but I suspect it is still somewhat limited to specialty transport. Nurses are not uncommon on flight teams and the assumption that they have massive amounts of experience and specialty certification is incorrect. In recent years, I've seen a change in the industry and now it's not uncommon to find RN's with 1-3 years of experience making the flight transition. Even when I started flying HEMS in 2006, I had over four years of ER experience and no specialty certifications aside from NREMT credentials. That changed when I started flying, but I still wanted to dispel the myth that all flight nurses have exceptional amounts of experience and extensive credential lists when they start flying.

I think admin basically wanted to put an end to the grammar and spelling police debate and as such we've probably beat said topic to death and we probably do not have much else to focus on in terms of productive dialogue?

Regarding online education, I can only see online activities and exercises continue to proliferate. Particularly with the success of people like Mr. Khan of the Khan Academy and the MIT Open course ware (OCW) and OCWx. I am starting to add online components to the classes I teach and the data collection and feedback over the past year has been encouraging. I am not confident a completely online course is possible for subjects involving significant use of psychomotor skills however. With that, I can see the "right" kind of student being able to complete didactic lectures online and showing up to a hybrid class that focuses the time spend in the classroom on psychomotor exercises, group work and problem solving and clinical labs/rotations.

States are pretty much free to define their own EMS levels as they see fit; however, most will follow the Department of Transportation guidelines regardless of what they may call their internal levels of providers. For example, New Mexico mandates NREMT Advanced EMT credentials but New Mexico still calls their "mid-level" EMS provider an EMT-Intermediate. I doubt every state will ever get on board with consistent names across the board. This is why maintaining NREMT credentials is so important, because it allows you to frequently apply for reciprocity as a provider in another state regardless of the naming issues and with NREMT credentials, everybody who has said credential is assured that they have met a minimal educational requirement regardless of state differences.

PERCOM has an online class, but you still have to do around 80 clinical hours. They offer AEMT and Paramedic as well. I am not particularly smitten with it, but have no data to indicate that it's better or worse than a traditional course. I completed a BS degree mostly online except for the research and a clinical rotation, and anecdotally, found it to have pros and cons, but not quite as terrible as I though it may have been.

Edit: However, both my AAS in nursing and AAS in respiratory were traditional "brick and mortar" community college degrees, so I went into the BS degree with a good foundation of traditional college credits already under my belt.

No worries bro. Even the old times like myself will occasionally post without searching.

Do not give up on your goal if you really believe Canada should be in your future. Some of us, my self included most likely, tend to remind people of the reality of the situation. In spite of the difficulty and challenges you face, your goals may not be impossible. They may be much more challenging and complex than you thought however.

We also must consider certain boundary conditions that exist in the United States. Primarily, that singling a person out in front of a group may be considered hostile work environment or some other related issue and said employee could take legal action. Often, we see these types of meeting occur behind closed doors and often with witnesses to minimise the potential legal consequences.

If a systemic culture and policy exists where people are comfortable with being singled out, I could see such a process working; however, this is something that would need a specific policy in place that has passed by the legal consultants and is part of the larger culture of a company. However, shoehorning something in is bound to lead to disastrous consequences, especially in companies that have a strong union presence and like involve union representatives and contractual obligations when it comes to these situations.

If a systemic issue is identified, then systemic changes can occur as they often do. However, these changes often involve dealing with all employees in an environment where no single person is singled out in front of their peers. Another helpful process that can occur is a medical director facilitated chart review where all names are removed and the call is reviewed for it's ability to promote productive dialogue, learning and change.

With that said, in a situation where somebody may make a sentinel event or error, it is your duty to do something about it. However, following an event or potential event, nothing good can come from finger pointing and singling people out in front of a large group of people.

A lack of practical learning in paramedic school reflects the particular curriculum of that school. As stated earlier, few real professions require experience at a lower level before moving on. Physicians do not have to be PA's prior to going to medical school, RN's do not have to be LPN's prior to nursing school, Registered Respiratory Therapists do not have to go to CRT school prior to completing RRT.

If you want to know about pharmacology and 12 leads, you need extensive foundational knowledge in anatomy and physiology and other subjects. Not an EMT-B add on module. Additionally, EMT-B experience has little to offer aside from picking something up here and there from other providers. That's somewhat like me thinking I can lean proper chemistry by hanging out with physical chemists and picking up a term here and a concept there.

If a school is pumping out subpar medics, the problem is with the school and should not be remedied by mandating arbitrary amounts of experience as a lower level provider. IMHO.

I did a three part series on the cognitive AEMT exam. I can only link two videos in one post but the third should be easy to find. I do not discuss specific questions however, and the onus is still on you to study:

http://youtu.be/P828MnPJA40

http://youtu.be/Zr-o_8TyuM4

http://youtu.be/ilC0PvqssE8

If only I could understand why bags with cool pouches and tonnes of gear you will probably not "legally" use continue to be so pervasive among the culture of EMS?

Are you talking about the psychomotor exam or the CBT?

I wonder if it wouldn't be better to consolidate the gun control discussion to the thread where it's currently being discussed and allow the original intent of this thread to remain intact?

I'm still not sure how that would have helped the situation in this thread as I do not think all the information about this guy is out. I am a little hesitant to start throwing out solutions with scant evidence. How about we let the people morn, use this thread in the purpose it was intended and start a new one about solutions when we have more evidence?