Savoy6

See, a rationale. But my question was not answered. Thanks for the offer of the info. See how this snide comment appears. you do not know me, nor my level of expertise, yet you take it upon yourself to enlighten me on what patient care is about. I do appreciate the offer. It is because of this that many providers I know leave this site. This stifles open discussions and drives folks away. We are a long way from a profession when discourse does become personal--"Furthermore, I would expect you as a long time member of this site to know better than to think this is about being X mins for a hospital and more about providing your patient with access to appropriate timely treatment as well as continuing care" if that isn't personal, what is it. i like to see if people can use rational thought and not emotional responses. Keeps discussions flowing, and I'm not trolling. Good bye. Good luck.

We've become spoiled with ALS, spoiled as in relying too much on it and spoiled as in ruined- no one other than 1person came up with a reason for ALS. 1 IV- As I said in my post , what is a crystalloid going to do. I do believe a rationale was asked for. Let's go back in time before the proliferation of ALS. BLS was it. Will a paramedic riding with this patient monitoring her have any different outcome from an EMT doing the same. put away the ego's and think. Look at outcome. And I hope that last post wasn't a personal attack regarding education stature. This is like brainstorming, there is no right or wrong. Don't jerk your knees, give it some thought.

Don't feel guilty. If it was an accidental OD or suicide, you couldn't have helped either. If it was intentional it may not have been anything that was occurring while you were partners. It may have been a sudden overwhelming event that caused it. I have lost friends to both types of overdoses, intentional(suicide) and unintentional (accident). They are different, don't lump them together. You still lost a partner. My advice though, do pay your respects to your late partner. Don't let a feeling of guilt override your compassion and your own feeling of loss. it will help you.

Without having seen before, I still say BLS I advocate letting Basics attend whenever possible. And this is one of those.

You can only go so far to remediate or change a person. They have to "want to change". Like the light bulb and the psychiatrist. Peer counseling in a positive way may do something, but if this is ingrained behavior, why waste your time. The test should not be used as a weeding out tool. We all know they may pass and get that card. If the employer won't do anything, you either cope or move on. Taking it into your hands or those of others can open the door to harrassment and that's counter-productive for all. You lose, and the object of change wins. Good Luck :?

What's the transport time? Has the bleeding been stopped prior to arival or is she actively bleeding? What are the capabilities of the on scene crew, if BLS will waiting for ALS be too long? Since starting an IV on this patient opens the chance of another bleeding site, why??If as you say, lotsa heparin. Plus What fluids and why?? What will a crystalloid accomplish and if too much, hey she has kidney problems, right?? A good BLS crew could transport this pt. O2 supine, monitor( I don't mean EKG or any other machine) the old fashioned clinical skill of monitoring a patient with your eyes, ears, nose. Cave man stuff

As a concept, ride alongs are a good thing. We had an explorer post with our Fire Dept. Some went on to EMT and even have had careers in the Fire Service/EMS now for almost 20 years. They were just observers not primary care givers. Of course when they encountered fatalities or high stress calls we were there to talk to them and make the process easier. This was before CISD,,dating myself. But it worked well for us. As with all good things comes the bad side. Liability concerns have made them disappear, as well as criminal behavior on the part of the folks supervising. The worst case involved the rape, sodomy and transmission of an STD to a ride along. There was a young girl from a northern state killed in an MVC of the tanker she was riding in. The driver had been drinking. We, in our state, had a medic expose himself to a ride along too. The list goes on. Now as observers this can serve many purposes; educational, awareness level increase, career possibilities. I am opposed to using anyone under 18 as a firefighter, EMS provider. It's no different than the worldwide problem of child soldiers. http://en.wikipedia.org/wiki/Child_soldier You are using children to do an adults job in a hazardous occupation. PERIOD! Also, if a city relies on that practice because adults won't do it or aren't available, SHAME ON THEM!!! History is full of children being placed in harms way. labor laws prevent this in most states, but other have this cultural allowance that makes this possible. Just my common sense, two cents 8)(Rookie title is because I haven't been in EMT city too long, trust me I'm no rookie)

1. I believe you may have missed my point. All people should be assessed. All should be suspected of not only having a weapon, but any underlying injuries or medical problems. It all goes together. BUT, emotion does not trump, as you say, the law or a person's rights. I'm not going to get in a pissing contest, but read case law against law enforcement. They can't search, just to search, but we can assess a patient, that is part of the job. But there has to be reasonableness in your actions. When studying searches read about looking for an elephant in a shoe box. Each situation is different as is your approach. That is what you are judged on. Simple fact. You can't strip people or cut everyone's clothes off and declare "scene safety". When you are brought up on a civil rights violation, it isn't so easy to just say it was for my safety. And to say it doesn't happen, it does. Civil right violations are a federal case, employers don't like to go there and you might be swinging alone. Oh, it sounds good, but it won't hold up in court. 2. A weapon is not just what you find on the person, but what is within their reach, including that stethoscope around your neck, that knife in your pocket, many things in your rig. Don't give them that opportunity either. Safety starts from the time you get the call until you are back in the station, or on your arrival at home, alive post shift. 3. Since this lock step teaching of this "scene safety" crap, (I use the term crap to describe the way it's taught, not the concept).students respond like Pavlov's dog or a parrot, 'scene safety"- Ask them to explain it and dollars to donuts they'll say, "I was trained to say it to pass the practical station". give them a scenario and when they say, "is the scene safe?", tell them, NO. See what happens, the train of thought derails. new students and refresher students should be taught actual cases, and rational, legal responses. if not you are at risk responding with a poorly trained partner or you are poorly trained and equipped. Case in point- patient spits in paramedics face, paramedic punches patient. legit?? Well, the patient was on a long-backboard, immobilized, and was 16. Defend that action

It happens, as feces does occur. An increased pucker factor is a good learning tool. As anything else, learn from the call. I used to teach assessment a different way than most instructors. I'd hide actual weapons on the patient. Bayonets, grenades, full size 92F. Got missed by the whole class. An assessment is not a search, it's meant to find problems not weapons.If you do find something,scene safety, right. Semantics, yes, but assessment is a tool we have to treat patients. Altered level of conciousness can hide a medical condition or injury. How you sell your assessment is the key. Let the caregiver in you take over, not the security guard. Bedside manner, schmooze. Once force takes over, as it does sometimes, that old slippery slope comes up. I knew a guy that stripped all AMS females under the guise of looking for weapons. Yeah, right. You use the amount for the situation, reasonableness is the key. I know i wandered off topic but you have to protect yourself on the scene and after the call. A search is a completly different topic. That darned 4th amendment (sarcasm)

TEMS is a specialty like haz mat and high angle rescue, it's not for everyone and not everyone can do it. You can't take one course and that's it, you have to train on all aspects. you can't expect an open arms reception from the law. you have to prove yourself. Your best bet is low profile. Any miitary medic or corpsman can tell you, you got to earn the right to be called "doc", it's not automatic.You do good, life is good. Screw up, well just guess. Shop for schools, if you can get into CONTOMS, more power to you. Look out though, there's folks that will sell you something that isn't TEMS. If there's a buck to be made they will. Join ITEMS, good place to get info and share ideas. Remember, TEMS main function is preventive medicine for the TEAM, and medical support of the TEAM, all else is incidental. Too many want the flash bangs and weapons. like the rest of EMS, The sexier the better. Making sure guys pee is clear and they are warm and dry isn't sexy or exciting. But is can be a lifesaver!

http://www.tems.org/ is the link

From a state perspective, and we've cussed and discussed this. There is no data, that i know of, that supports the belief that experience as an EMT makes a good paramedic. You get the basic, then the medic class levels the playing field. It sure does help to have a working knowledge, but the multi-tiered medic class, didactic, clinicals and field internship is what makes a medic. It's not a perfect system. Okay, bring me another dead horse to flog!

You are right. you need to stay safe your own bad self.

History refresher- The Britiish and the US both were involved in saturation bombing of cities as were the Germans. The Germans made it an art in Guernica, Spain. Factories make the tools of war, ie ball bearings, and fuel. The fire bombombing of Dresden had no strategic purpose other than demoralizing the germans. Terrorism??? Hiroshima and nagasaki too had no strategic importance either- The planned invasion of Japan would jave been a bloody affair that would habe made Normandy look like a walk in the park. Read the SF motto on their berets. They do more than train operatives and "hide in the civilian population". An A-team is more than killers. You are right though, war is bad, very bad. But, you can sit at your computer expressing this becasue a soldier, somehwere in time took up arms. Your freedoms are protected by the military. If this is a false statement, then why isn't California a Japanese state or New York run by the Germans. War is not courageous, the men(and women) who fight it are though. Oh and when you start referring to rules of war as an oxymoron, would you rather have all out unrestricted war? The barbarians are at the gate, want them to come in. An old saying, older than many reading this goes, "nobody likes a soldier until the enemy is at the gates". Well guess what, not only are they at the gate, they are inside now. Sleeep tight knowing this. I was never shot at in my career. but I did deal with terrorism and counter-terrorism. I've seen their work up close. See, in my job if everyone woke up in the morning and nobody has breached our security and all the planes could go on their mission, my job was done for that shift, then someone else took over. Warfare does not always mean shooting and going boom! Kind of preventive medicine. Only it's called making "hard targets". Equating Special Forces to terrorists does make the acid reflux come back. I'm only assuming here, but you never served, right?? And that's okay. it's easier to make those statements. And if you did that's okay too. I just think the views were a misguided but that's ok too.... Freedom of Speech, "AIN'T IT GRAND?"

That's old news. But it does give a good dose of reality. having been in force protection, I'd not hesitate to send them to their 72 virgins. But remember ,we have to play by the rules. Shortly after 9-11 there was a scare in the US regarding the same thing. Goes back even further, remember Passenger 57 with Wesley Snipes? 'member that stinker of a movie?? For the vets out there, we are all taught under LOAC(law of armed conflict) they lose their non-combatant status(if they ever had it to begin with) and become fair game. As always, stay low, check-six.

I was EMS supervisor for a Fire Department in an earlier life. I had an appointment at my attorney's and came by the station still in my navy blazer, gray slacks and tie. Dressed better than my lawyer! Well a new hire medic was on and the tones went out for a patient with chest pain, so the chief says go with and observe. All went well, got pt to ER. A car screeches up, out jumps mom screaming about her "little girl". So we go out, little girl is 17-18 in a bikini, a lifeguard and she's out, heat exhaustion going to heat stroke quick like. So we, the Fire guys, get her out and put her on gurney. In the process, her top comes up, oops. So ER doc is not there yet so my crew and I get things going, 02, IV, the whole shootin' match. I step out out and mom says, "doctor will she be okay". So I reach in to my inside blazer pocket and show my off duty badge and identified myself as the Chief Paramedic for the Fire Dept.. Mom flipped out! I think more because we saw what slipped out more than anything else. Of course, a full oral report was given the Fire Chief on our return. Of course we were both belly laughing throughout the debrief. Nothing more was said. More than 20 years and it's still makes me laugh. Same thing happened at a federal agency last week. I filed some papers for my kids, in a suit and tie. "Are you there attorney?" Nope, just the dad. amazing people's perceptions.

Here, Here, well put. It's funny when "the powers to be" want to control knowledge. "EMT's can't learn that" "Don't teach them that" The thought police belong in SCI-FI. As an EMT I had an opportunity to be trained by some of the best surgeons I've ever seen. What i could do in the military as an 18-22 year old was taboo in the civiilian world, but it was beneficial in my Paramedic school. I was taught assessment skills that far surpassed the initial EMT-P curicullum, but knowledge is power. I would rather have well trained EMT-B's in assessment than Paramedics who know less, but can do skills. Without assessment, skills are useless and or dangerous. Pigeon holes are for the birds, literally. We need EMT's and Paramedics. Not every patient needs a paramedic to care for them. use your resources wisely, train your people and then, educate them. if you have to ask the difference, go back to school.

Being the only paramedic in my high school class of 150+, let me make some observations. I have a dispoportionate number of lawyers, doctors and nurses in my class. How did they get there. I spent 6 years roaming as an EMT because at that time Paramedic was not available in the areas I lived in. While I'm honing my skills, these folks are in med school, nursing or law school, they graduate and now are in practice. Did they have X amount of cases before the bar for admission- nope Couple are OB/GYN- deliver X amount of babies first- nope The education process prepared them or weeded them out. Then they worked as externs, interns and resident.... Once again we focus on number of runs, years of experience. Give me solid data that proves that makes a better EMT or Paramedic. The focus should be aptitude to get in, and if you want physical requiremnts, make them task oriented, and be sure you can pass them too. A good leadership axiom, never ask the troops to do something you can't do yourself. Add physical fitness to a class. I did and it was fun. We led the group in PT and ran in the morning, no one was sleeping later. Oh yeah, liability! So's turning out sub-par EMS "professionals". Look around EMS, physical fitness is not a priority, but you send out of shape folks out everyday under stress and expect optimum performance. And you get terrbile results. A 5 k run. Why, I have an ambulance to drive me there. Anyone out ever had to run 5k to get to a patient. Were you able to work with your pulse racing and muscles hurting?? Read some studies of combat physiologly as far as focusing and fine motor skills. The skills EMS folks need. There needs to be a balancing act- not just a heartbeat and a check that doesn't bounce. Be careful on criminal backgrounds, you may be missing some folks. It should be case by case, relative and recency. OOPS another rant.

EMS is skills driven- No offense, but to use skills properly one must have training or education. As they say, "you can teach a monkey to do that", but does the monkey know when to do a skill and why? You are absolutely correct, "critical thinking", that is needed tp be taught from day one in EMS courses. It's not, know why, instructors were never taught it, so the incestuous cycle continues. If providers were taught that, many clinical complaints and investigations would not occur. Simply put, angel on right shoulder, devil on left. Who do you listen too?? and what are the consequences for your patient. Okay, forest vs trees, zebras vs horses. How about- If I did this would mommy be mad at me? I think the reliance on motor skills over cognitive is a mistake. Online does have a function. how one uses it is the key. As you know in MO we can use ditributive learning for 100% relicensure. An employer should, in a perfect world, be doing skills review and validation annually. I know it doesn't happen, but I can dream can't I. One advantage is for rural folks that cannot afford to travel to numerous classes, or none are available close by as is the norm in urban or suburban areas and may or may not be practicing. Or office bound admiinistrators(who me??) if a traiing coordinator at a service or facility is using "internet" as the sole source, why have that position??? Heck anyone with a checking account or credit card, an internet hookup and a computer can do that. Live training shoud be "live" Also people learn in various manners. Some cannot learn from a computer and others are bored by lackluster instructors rehashing the same crap every year, "because the state requires it". Continuing education- just the name gives it away,"CONTINUING". Not initial EMT or Paramedic. This is where the '94 EMT-B opened the door for the, dare I say, "nice to know" things EMS providers need. There are too many people that are locked in the box. All they teach is what they think that nebulous entity "the state" requires. Some states, not mine, dictate almost all aspects of training, taking creative thought and training away. " The man's a heretic!!!" Yep I am. darned proud of it too., just ask me. But hey, look at my profile I'm a "newbie", what do I know?? Sorry for the rant. too much coffee and House on USA last night. Hey Dr. House and i have the same first name! I see a pattern emerging here

Hey, where'd the heroin/Fentanyl go?? it was just starting to get good. We've had folks here in MO suck on the Fentanyl patch. Why add heroin? Just as fatal, let's stay focused here!,EMS does have it's share of ADD kids i guess.

Hey, I didn't mean to put a damper on the fun. No action in over 12 hours,what am I , "the big bad wolf". C'mon folks a little dialogue is good. Everyone on the right side of the forum, stand up. Now the left. hey we can do the wave!

Arrest records should not be used. CONVICTIONS are the key. You can be arrested for anything, and many times people are mistakenly or wrongly arrested. Angry spouses have their partners arrested and a trial may never occur, just an example. Convictions, on the other hand, you have gone through the legal system, and as our rules say, finally adjudicated. Now we have certain offenses that require notification within 72 hours of charges being filed. Public safety is a priority. That's Missouri. We've been doing background checks in one fashion or another for over 10 years. Our statutes and regulations can be found at www.dhss.mo.gov/EMS

Yeah, I do hang out in EMT city. Like to be the sheriff in an old west town, right the wrongs. As far as testing here is a short Primer: 1. From Course completion, meaning everything, you have 2 years to complete testing and get your NREMT 2. practical results are good for 1 year. After 1 year, you have to repeat the entire practical 3. if you go past that 2 year window, you start all over at square one. If you think MO EMS is bad, 'you ain't seen nothin". It can be a whole lot worse.I deal with EMT's, and candidates from other states every day. My offer still stands to come to Jeff City and spend a day watching our ops. Don't worry about getting in the way, we can have an office party in a booth at Ryan's. Just call ahead of time and I'll personally give you the "grand" tour. Missouri's hiring and employment is like many other states. It depends on the location of the state you are in. Willy Sutton, a 1930's bank robber was asked why he robbed banks. His response, "that's where the money is!" When I was a brand new paramedic, i had to move from Jefferson City to Excelsior Spring by Kansas City to get the job i wanted and the pay. That's only 150 miles. Some folks move out of state. You do what you have to do. Now regarding paramedic testing. we had a meeting in Jeff City Tuesday to discuss this. We are working on scheduling and procedural changes. if you have complaints or concerns e-mail me at Greg.Natsch@dhss.mo.gov Don't be afraid of the big bad state, we don't bite. But we're not lazy porch dogs either. We're more than happy to answer a question. it's better to ask first than ask how to get out of trouble. And I know some instructors don't give all the answers right or wrong, but I try to help.

Got it, read it, liked it.

A little known document, sarcasm noted, is the functional job analysis for EMT and Paramedic. This is a Dept of Labor/DOT document. Before emotion writes a check and your..., never mind. Familiarize yourself with this, especially if you are an instructor. You can find it in both the EMT-B and EMT-Paramedic National Standard Curriculum. States also have rules and regs regarding physical ability. Also, as noted earlier ADA doesn't give a blanket coverage. Reasonable is the key. Just a little light reading to keep you out of trouble.