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I am not precisely sure what you are trying to say- I think you are trying to get at the township is not an adequate entity to fund services. In many cases that is true, in others it is almost too big. Depends on the area. Where we are at, we are along a transition line (for now, it is growing fast). 10 miles east is basically Indianapolis, 10 miles west is almost purely farm land. There are too many operational municipalities within our county who do too good of a job to hand over their power to the county. Not to mention the county is about the most worthless entity we have. There are only 35 road deputies for our county and the commisioners don't have a clue why they want more deputies to cover the 420 square miles and 120,000 people. Townships are adequate in our area, as they grow they can afford the needs of the growing population. But for the next county over, it would be more difficult to not depend on some volunteer services, especially as a first response- regardless of whether or not the county would be the primary funding entity as there are too many miles to cover with too few people to justify enough ambulances to be within a 5 minute response.

I would say that if you have less than 5,000 people for a township (depending on the size of the township- as some will encompass several "towns"), it would be hard pressed to have the tax base for paid municipal service or the run load to attract a private service. My vollie agency is in the process of switching over, but we are well over 6,000 people now and it is over due. We are almost to a full time BLS bus and pretty much have full time ALS as well. A few years ago, it would have been almost impossible to do though.

Actually, I can think of a pretty darn good argument. The need for full time firefighters is very minimal, the need for full time EMS is critical. So, instead of hiring firefighter candidates- which anyone can be an average firefighter- hire EMS personnel and use them to staff transporting and rescue units full time, and to augment critical fire responses instead of what seems to be the standard with most departments that are transporting EMS fire departments, which is to use firefighters to run EMS and "cross train" them as paramedics or EMT's. This is basically instituting municipally or township ran EMS services- it is under the "fire" chief ultimately, but the dedication to EMS is there, it is not a stepchild by any stretch of the imagination. In the system I come from you cannot put in an application unless you are an EMT-B or higher. Several agencies have stopped recognizing the B level and require all their personnel to be EMT-I's just to be a firefighter. They will train you to be a firefighter, but they require you to show the capability to do EMS first. The aptitude tests are just that for the firefighting, but require you to pass a level appropriate approximation of the state EMS test in conjunction with the fire fighting aptitude test. This also fixes the problem of bad working conditions and inferior pay and benefits (theoretically). The EMS/firefighting personel are better paid than the cops and they have the 24 on/48 off shift rotation which allows them to work part time at private ambulance services or smaller fire departments (or wahtever they choose). Plus paramedics make a premium above all other personnel, in fact, if you are a paramedic and you can pass the PERF physical and the agility test, you pretty much have a job. If "fire based EMS" is done properly, it can work. The problem is there are too many people that focus on the firefighting even though it is secondary to all other emergency services endeavors. On the scene of a fire you are taught that rescue comes first (right after personal safety), so we are supposed to help the victim before we bother with fire suppression. So right there in firefigthing 101 we get our priorities taught to us, which should tell those departments who train for firefighting more than EMS that their priorities are way off. Competency in firefighting is easy to achieve with regular drilling, so the majority of training should be in EMS continuing/advancing education.

I only know that if you are going to have "fire based EMS" as some people call it, you need to make sure that firefighting is placed appropriately in order of priority. About 90% of our runs are EMS, rescue or service based, the other 10% make up fire runs. In our system, the FD is no longer a fire department, it is an EMS agency that also does firefighting. We have people that are strictly fire, but they are in the minority. We keep up on fire training but emphasize EMS and rescue training. There is no reason to treat EMS as the stepchild of the FD as too many systems do. It will be your bread and butter and it needs to be treated as such. Several officers must be dedicated to maintaining training, records, and affiliations. You need to staff based on ambulance coverage- any staffing must be dedicated to the bus first and should be able to only fill in as a truck company, but should not be treated as a dual engine/ambulance crew. You need to operate with the understanding that the ambulance crew is that unless there is a working structure fire and only then should the ambulance crew be delegated to a truck or other second due apparatus- at which time you need to call for ambulance coverage from mutual aid or other volunteers.

[web:dcf8b19ab9]http://www.thesmokinggun.com/archive/0307062sheep1.html[/web:dcf8b19ab9] couldn't resist :shock: :arrow: Just working on my veterinary EMS cert. The person below me has a blue hand after leaving the port-a-john...... and wet pockets

yes

I can only rebut #2- have you tried to change the sattelite channel with out a remote? Going from channel 6 to 354 takes so long you could go to the store and buy a new remote before you get to the channel manually.

I don't think they mean asking the victims, I think they mean asking the firefighters or EMT's. Once there are adequate resources there, stopping is just a hinderance not a help.

Dust- Upon further ponderance of the discussion, you are correct. "BLS" skills are based on treating signs, but these medications are administered to treat symptoms therefore you are 100% correct that it is no longer in the "BLS" realm wether or not our hospital ED lists it under "BLS" provider standing orders. And as for brain surgery, it really does not look that hard. Do they have depth guards on those little saws?

This is very much a BLS topic- Knowing the contra-indications of medications that are considered within our scope of practice is critical. There are some areas that are considering even allowing BLS providers to carry Epi-pens and nitro spray. If we can administer it, we need to know what the potential harmful interactions are. This is a fairly new development in comparison to some B's cert date. We have a few old timers that were unaware of the dangers, and one was on a run with me and was ready to give nitro prior to taking blood pressure or asking about other medications. Remember that there are many men who purchase their meds online and are likely unaware that there may be deadly interactions. They see viagra, punch in the old credit card number, and don't read the warnings.

Us darn capitalists. Yes in the USA it is required to find out how you are going to get paid. We don't have any problems asking who is going to pay us.

That would be Gung ho! Or are you sick of spelling correctly as well?

Creating an image of professionalism and proficiency will contribute to a better pay rate quicker than the "need" created by fewer volunteers. I would rather have an older NUG that loves what he is doing than a young pay grabber that thinks they deserve what they are getting simply by their presence. If you love it, do it.

BLS level providers do have to remember that they are BLS level providers. I have personally met those "medic in training" who will frequently overstep their scope of practice. Unfortunately, some of them are on our department. They are dangerous to not only the patients but the EMS system as a whole. They will gladly tell the medic who catches up with them their diagnosis of the patient instead of their SAMPLE and vitals. Does this help the patient, or would it be more beneficial for the B to tell the medic all the pertinent information garnered from their SAMPLE and vitals. We are only trained in identifying signs and recording symptoms and taking BLS precautions and interventions. We need to be able to recognize what interventions to take when, and to that extent we are diagnosing, but to overstep our scope of practice by diagnosing what we are not trained to recognize is not good patient care. Our job is to make sure the patient makes it safely to the next level of care, hopefully that is definitve care from a hospital or, in lieu of that, a medic. I still say it is irresponsible to suggest undertrained B level providers overstep their scope of practice and try to diagnose internal problems definitively, which is the feeling I get from some. The fact is that while there are many intelligent and capable B's out there, many are at the B level because of limited time, resources, or intellect. The ones in the latter category are the ones who are dangerous, and suggesting to them that they are capable of anything beyond their scope of practice will greatly endanger their patients. We need to stay within our scope of practice as much as possible to ensure patient safety. Our scope of practice includes assesment, transport, ABCD interventions, and some Rx interventions. Knowing what to do when we observe certain signs is important, but asking a B to diagnose PAT would be a waste of time- instead recognizing the tachycardia and taking them to the appropriate facility and hopefully making contact with a medic because it is tachycardia is the correct course of action.

I am quite aware that "cookbook medicine" is not the way to handle a patient. I am also aware that we are taught to treat only what we can observe. As sad as that is, it is our scope of practice. Is that all we really do- no. My comment about observation and assesment and we don't diagnose- except, unless, but, etc. was meant to allude to doing as much diagnosing as possible, without "playing medic" which is one of the biggest problems in BLS care. You are right, we are limited in what we can do due to limited training. So to suggest that we are able to diagnose things when it is not within our scope of pracitce would be irresponsible. Do I diagnose, tentatively- I have to ensure the best possible care for my patient. I am usually correct, but would never presume to tell anyone what the diagnosis is, just give as much detail in my assesment findings as possible. My findings will usually steer my assesment to a more focused secondary. I simply do not want to make a statement that would lead someone to think it is OK to play medic. As for the O2 and diesel thing, I have seen much more detrimental things than that saying- such as infighting.

Yes, every patient gets a full assesment. I made the cardinal mistake here of assuming that you are going to do the assesment (never assume). My point though, is if you have ruled those things I covered out, you are fairly helpless without ALS. But ruling things out is part of our job. We do not diagnose- except, unless, but, etc. We are emergency detectives, and our powers of observation are paramount. We are just limited on what interventions and diagnoses we have. My assesment may assist the ED in determining if there is neurogenic shock, but there is little I can do at the B level other than O2 and diesel (and immobilization if needed). RID- diesel means transport, it has nothing to do with mode of transport. I have only transported one patient signal 10 (or code 3) because there was no ALS unit available. Usually there is a medic available, and they make the transport decision for those patients who are signal 10 candidates. My take is that the stress of emergent transport is more harmful than losing any time from an easy ride (yes, there are exceptions). It is merely lingo, a saying I heard a few years ago and see repeated alot "treat all things with O2 and diesel." In response to airway- again, my breaking of the cardinal rule, never assume. Airway, airway, airway- the lifesaving intervention across all level of practice, the O2 doesn't do much without it. Sometimes we are left to out in the cold and have to use what tools we do have as effectively as possible. But freaking out and driving like an idiot truly is the wrong way to treat any ailment. *DUE REGARD*

This is from a Sheriff's department that requires their deputies to be college educated (usually). They are actually very professional when dealing with the public, but this was late one cold night...... (Edward is the designator for the enforcement division) Control: Edward (insert unit #), dispatch Edward xx: Edward xx Control: Copy for an animal complaint Edward xx: Edward xx Control: xxxx county road xxx, 10-17 (complaintant) advises there is a cow out of the neighbors fence wandering through their yard and the road Edward xx: Edward xx is clear, see if you can locate the number of the owner in the livestock registration. Control: Clear ................................. Edward xx: Control, Edward xx is 10-60 (in the area) Control: Edward xx ... Edward xx: Control, Edward xx, I am unable to locate a cow Control: We have located the potential owner Edward xx: Clear .. Edward xx: Control, Edward xx, I have moo cow Control: Edward xx? Edward xx: Control, I will be out of the car with the property owner and a brown on white cow Control: Clear on moo cow

Lone Star, he said C-8? Did you send him an anatomy book? He could use his trainer certificate as a book mark for it.

For B's, our primary concerns are going to be diabetes, ETOH/narcotics, and hypoxemia. We can treat two of those (depending on the situation and protocols, etc.) and the other we need to know for personal safety. But as B's, we can only do baseline assesments and treat with O2 and diesel, so it is unlikely that we will be able to determine any other problems and even less likely be able to treat it. *****NEVER FORGET TO RULE OUT TRAUMA****** Even if the scene is safe and there are no apparent signs of trauma, do assesments as necessary to rule out trauma. Something to consider is hypovolemia, as internal bleeds are more common than you may think in older patients. Drug interactions also, make sure to get all medications and take them with you when the patient has more than one prescription- especially if one is new.

I signed up here= I am a whacker. I am addicted. I don't care. I have a habit, an addiction that I don't care to quit. There, I said it.

The best way to advance in any profession is to fully accept whatever consequences are handed out. Go in and say "yes sir, I forgot to report that. I apologize and understand that this was a potentially catastrophic issue, and I will be more diligent in the future." Do not report other people after the fact, but rather when you receive a discplinary action, be sure that everyone is aware of why you received it to ensure you are the example. If you were not at all involved, then this advice would not be pertinent. If you are asked a question, don't even fudge the truth. If you were only partly responsible, then accept as much responsibility as you can, mabye even more than your share. This is advice that I have heeded and has taken me far. People will respect you for this and you will get the benefit of the doubt in the future.

What rid said is correct- but to answer the original question with terminology and reasoning even us dumb old B's can understand, the heart is next to the lungs and the brain is closer to the heart and has much less resistance to the blood being pushed out of the heart. So these three very important organs will get theirs easier than the toes will get theirs. The best thing to do is practice proper depth and technique for compressions during CPR.

Every minute equals 10% is a good rule of thumb, but it is actually worse than that as it starts declining exponentially after about 8-10 minutes.

I hate this argument. It is so divisive. There are areas of the country that really do require volunteer squads, 30 runs for fire and EMS combined for a township is not likely to need paid personnel. There are vollies that cover counties almost as big as some of our smaller states with these run loads. Cities do require full time staffing. Period. It really does not matter if those people are paid or not, as long as they are within arms reach of their busses. That is if those volunteers approach it in the professional manner that is required. Professional does not mean paid, it means serious, dedicated, competent, and capable. I have 70 hours of EMS training this year (remember, it is only March) and more than 100 in fire training and I am a volunteer only (yes, I am already FF2/EMT-B/Hazmat ops). That is not as much EMS training as someone who is career EMS (if it is shame on you) but it is comparable with most career FD short bussers (I know- whole other can of worms). I am competent to provide BLS level care, and probably more. Would it make sense for me to be a medic- no, I would not be able to keep up with it, but it would be reasonable to get my intermediate cert. I will wait though until I we go paid and just get my medic, there is no point in getting the intermediate at this point.We are a growing township in a quickly growing county, and we are now in the process of pushing for a FD merger and territory, because we need full time bus and engine coverage instead of one or the other we currently have paid. So when we go paid many of these volunteers will become full time, then are they good enough? even thoght the run volume is the same. If the issue is with training, I tend to agree that the sense of obligation is not there in all people. But those that are truly professional should be commended. Those career people who show up just to get paid are just as much of a scourge as those volunteers who do not advance their training (notice the word advance, as opposed to just keeping up with). I noticed the argument of "volunteers pick and choose their runs"- sadly this is true, far too many volunteers will pick and choose and they should be run out of the service. I have gotten up from "relations" with my wife to go bus the suicidal idiot who had us out previously on Christmas eve searching in muddy fields for him when he was actually hiding in the house (told SD that he was losing conciousness in a tree line), and would do it again. But when the Box is toned out those choosers better get the hell out of my engine seat. :arrow: :!: :!: If the issue is response time, then there is still room for the second due to be volunteer, and that would allow for cost saving with fast first due response. If you feel there is no room for volunteers who are only half commited, then you are correct. If you think that cities and large towns should pay for public safety, you are also correct. If you feel that there is no room for volunteers, then you are sadly mistaken.