Scaramedic

Lots of issues being brought up here, so let me take them one at a time. #1 The crew are morons, revoke their field status, shave off their pubic hair and send them home to mommy. They have no place working in the field. #2 The issue here isn't whether or not we work asystole arrests. The issue is the above mentioned fact that this crew are morons. If anything this proves what we have said on other posts, termination of efforts is viable alternative with medical control. In this case ERDoc denied calling the patient, and the patient was transported, if the patient was truly not viable maybe ERDoc would have responded differently. I do not believe anyone on the other thread said med control should not be contacted for termination of efforts. Those efforts should include a couple rounds of the usual ACLS drugs, Airway management (ETI), CPR and a proper assessment, not just "he's blue can we stop now?" #3 I strongly agree we should have a Paramedic standard for every urban area/city in the nation. The Basic level should be reserved for First Responders, not transport. Except for, let me phrase a new term here, "extreme rural areas." The problem here might be geography, what you consider rural in New York or other states is not what we consider rural on the West coast or the Mountain states. There are towns out here with pops of 20-30 people, 1 1/2hrs from the nearest ALS service, and 30 minutes beyond them is another town of 20 people. These little mountain towns do have volly services that transport to an ALS intercept, but that intercept might take 30-60 minutes. These rural areas are in my opinion, the only exceptions to ALS transport, and then only to get a patient some basic level of treatment before they can meet up with an ALS transport unit. #4 Did I mention the crew in question was not all that bright? :sign3: Peace, Marty :joker:

Average teachers salary in Louisiana is $24,300. That's with a Bachelor's degree, seems like $35,000 for two years is pretty good pay to me. Peace, Marty :joker:

I agree totally Shane, but you still need a Basic/FR level response before the ALS intercept. That is what volly departments are good for getting on scene and giving the patient some level of medical care before ALS can get there. The idea of communities sharing the cost is awesome though. =D> Peace, Marty :joker:

Oh my God!!!! I am agreeing with Quint on this one. :banghead: :puke: Ok, first a little local geography. Grays River, Wa population like 300. The kids living in Grays River have to catch a bus about twenty five miles to a school in Nasselle, pop 400. The town is too small to have a school, yet they do have a volly fire department that does transport. The nearest hospital is about an hour away, east or west, nearest ALS service minimum 30 minutes. Were talking rural here, well as rural as you can get in Washington. So what are we to tell the residents of Grays River? You need to divide the cost of an ALS service between the 300 of you, ambulance, supplies, quarters, about 8 full time AAS degreed Paramedics. Ummm little math, carry the 2, yeah that is going to equal a buttload of money. I agree with Quint the rural providers cannot afford to run at the levels of urban areas. Yes teachers have to have degrees but podunk America doesn't even have schools, so that analogy is not valid. So what is the answer? I believe that in urban areas transport units should be staffed with Paramedics. Those Paramedics should have an AAS or above. Urban areas have the tax base to support ALS staff levels. Rural areas do not have the tax base to support ALS staff levels. It comes down to money, so unless we go to a socialized medical system we are stuck with it. Most of rural America relies on Basic level care, it is not possible to cover all of the rural areas with ALS without an increase in taxes, and we know people love to vote for new taxes. Rural providers are an important asset in BFE, even providing Red Cross first aid is something until an ALS intercept or ALS arrival can happen. It is better than the folks of Grays River, Wa having to wait 30+ minutes for an ambulance. In a perfect world ALS would be everywhere, we don't live in perfect, at least that's what the Walgreen's commercial says. Peace, Marty :joker:

Updated, changes made. Thanks for the info everyone. Peace, Marty :joker: P.S. AK be nice or I'll take your ass out to breakfast again.

Well she did marry me!! :wink: Peace, Marty :joker:

It is ironic that an increase in education does not always equal a rise in pay. My wife is looking into the NP program for Mental Health, an assload more school yet she won't make much more than she does as an RN. Now granted part of that is because its MH, but still you would think it would pay better. The upside I get free Mental Health, Wooohoo! Peace, Marty :joker:

I added the little green check mark to the states that license. There are others I just can't remember which ones, I'll look them up for you though. Peace, Marty :joker: P.S. I forgot that Oklahoma was a licensing state, but there it is on an old card, license number. :oops:

Good info Asy. Etfink if you are seriously considering Israel, I would suggest a program with MDA like this... http://www.israelprograms.org/MagenDavidAdom.htm It will give you time in Israel to feel the culture and experience EMS in whatever city you choose, Hebrew is a must though. Peace, Marty :joker:

Updated. Thanks for the info everyone. Rid I only know of 2 right now I'll go back through when I have time. The little teacher guy indicates an AAS or above is required. Peace, Marty :joker:

There has been a lot of discussion about the certification levels available in each state on these boards. So since the weather is bad and I was bored I made up this list of the certs for each state. The information is from each states EMS website, if there are any mistakes please correct them in a post. Half a pack of smokes, six pack of diet Pepsi later and 3 hours down the drain, but here ya go. Alabama AMBULANCE DRIVER BASIC BASIC/DRIVER INTERMEDIATE - CREDENTIALED INTERMEDIATE NON-CREDENTIALED INTERMEDIATE/DRIVER - CREDENTIALED PARAMEDIC - CREDENTIALED PARAMEDIC NON-CREDENTIALED PARAMEDIC/DRIVER - CREDENTIALED Alaska ETT--Emergency Trauma Technician EMT I EMT II EMT III MICP Arizona Basic Intermediate Paramedic Arkansas EMT Basic EMT Ambulance EMT Intermediate EMT Paramedic California EMT-I (Basic) EMT-II (Intermediate) Paramedic Colorado NREMT Basic NREMT Intermediate/85 NREMT Intermediate/99 NREMT Paramedic Conneticut MRT EMT EMT-I Paramedic Delaware EMT EMT-C Paramedic District of Columbia EMT Intermediate Paramedic Florida EMT Paramedic Georgia Emergency Medical Technician-Basic Emergency Medical Technician- Intermediate/85 Paramedic Hawaii EMT-Basic Mobile Intensive Care Technician Idaho EMT-Basic EMT-Advanced EMT-Paramedic Illinois EMT-Basic EMT-Intermediate EMT-Paramedic Indiana First Responder EMT-Basic EMT-Basic Advanced EMT-Intermediate EMT-Paramedic Iowa EMT-Ambulance EMT-Defibrillation EMT-Basic EMT-Intermediate(1985) EMT-Paramedic EMT-Paramedic Specialist Critical Care Paramedic Kansas First Responder EMT EMT-Defib EMT-I Mobile Intensive Care Technician Kentucky EMT Paramedic Louisiana Basic Intermediate Paramedic Maine Ambulance Attendant EMT-Basic EMT-Intermediate EMT-Critical Care EMT-Paramedic Maryland EMT-Basic Cardiac Rescue Technician-Originally Licensed before July 1, 2001 Cardiac Rescue Technician-Originally Licensed after July 1, 2001 EMT-Paramedic Massachusetts Basic Intermediate Paramedic Michigan Basic Emergency Medical Technician Emergency Medical Technician - Specialist Paramedic Minnesota Basic Intermediate Paramedic Mississippi EMS-Driver EMT-Basic EMT-Intermediate EMT-Paramedic Missouri EMT-Basic Paramedic Montana Basic Intermediate Paramedic Nebraska Basic Intermediate Paramedic Nevada *State EMT Intermediate EMT Advanced EMT *Clark County Basic Paramedic New Hampshire Basic Intermediate Paramedic New Jersey EMT-Basic MICU-Paramedic New Mexico Basic Intermediate Paramedic New York First Responder EMT EMT-Intermediate Critical Care Technician Paramedic North Carolina EMT EMT-Intermediate EMT-Paramedic North Dakota Driver CPR First Responder EMT-B EMT-I 85 EMT-I 99 EMT-P LPN RN Ohio Basic Intermediate Paramedic Oklahoma Basic Intermediate Paramedic Oregon Basic Intermediate Paramedic Pennsylvania EMT Advanced EMT Paramedic PHRN PHPA Rhode Island EMT Basic EMT Intermediate EMT Cardiac EMT Paramedic South Carolina Basic Intermediate Paramedic South Dakota EMT-Basic EMT-Intermediate/85 EMT-Intermediate/99 EMT-Paramedic Tennessee EMT EMT IV EMT Paramedic Texas Emergency Care Attendant (ECA) EMT-basic EMT- Intermediate Paramedic Paramedic Licensed EMT I-69 Taught exclusively by Dustdevil, females only need apply preferably from Canada. Utah EMT Basic EMT Intermediate EMT Intermediate Advanced EMT IV Paramedic Vermont Emergency Care Attendant Basic Intermediate-90 Intermediate-03 Paramedic Virginia EMT-Enhanced EMT-Intermediate EMT-Paramedic Washington First Responder EMT-Basic IV Technician Airway Technician IV/AW Technician ILS Technician ILS/Airway Technician Paramedic West Virginia Emergency Medical Technician Basic Emergency Medical Technician Paramedic Emergency Medical Services Attendants RN, PA, FN, DO or MD Wisconsin EMT-Basic EMT-Intermediate Technician (1985) EMT-Intermediate (1999) EMT-Paramedic Wyoming Basic Intermediate Paramedic Licensed Degree Peace, Marty :joker: Edit: 06-04-06 Updated Edit: 06-05-06 Updated Again

Oh yeah! Well I guess in the Big City you do your brain surgery on the coffee table! Seriously though, I agree that termination of resuscitation protocols should be in place. This is coming from a Medic who had an amazing asystole save, 5 min response, No CPR, asystole on arrival, converted to Sinus and walked out of the hospital a week later. She was young (30 something) and got really lucky. There should be criteria for cessation of efforts though, age, medical history, etc. Not just 10 minutes and call the code. Like others have said, there is no reason to transport a corpse lights & sirens just to have the Doc call the pt in the ER. Peace, Marty :joker:

I have always loved that phrase "mechanism of action unknown/not fully understood. Damn near every analgesic has that phrase attached to it. Oh well at least the scientists are being honest, they could just make some shit up... Mechanism of action-MS causes dilation of the receptor sites thereby causing impotence of the pain impulse to achieve erection. Sounds good to me. :thumbright: Peace, Marty :joker:

They'll damn sure move for this QUINT.. This shark, swallow you whole. No shakin', no tenderizin', down you go. Peace, Marty :joker:

Yes mine have hung low in the past, but I had to get a jock strap, brass dragging on the ground makes a whole lotta noise! Peace, Marty :joker:

Why should we try to change it. Basic's like you will continue to overstep your education, kill a few patients and then the public will demand changes. Thank you for doing our work for us. Much appreciated. I have a name for Paramedics, since you are an EMT-Basic I suggest you call us Sir! After all I address my superiors, MD,s & RN's, with the respect they deserve, why don't you? Peace, Marty P.S. I agree with weasel 108, that truck is looking awful dirty.

Hmmmm... Because private companies like having a cheap "Paramedic Assistant/Driver" and because Fire Chiefs love sending FF's through a $400 EMT-Basic course, and then having them driving a $500,00 fire truck to a medical scene to build up their call volume. As far as getting rid of the Basic level, correct me if I'm wrong but isn't Canada doing that right now? The problem with the Basic level is systems are doing exactly what this thread is about. They are constantly trying to push the envelope of Basic skills without furthering the educational requirements. I'm sorry an 8hr course on med administration is not enough to be giving any kind of medication. Don't take it personally Basic's but there is no reason for a Basic to be giving meds. I'll say it again just because you can is not the same as you should. Peace, Marty :joker: P.S. The 'paragod' term is getting really old, please come up with something new!

I have heard good things about SWA also. I just could never get past that whole living in the desert thing. :? Peace, Marty :joker:

Really where? Many cities are finding out that does not work. The city of Portland tried that years ago with the Portland Fire Bureau. In the end the citizens of Portland voted it down. Why? Because not only was it going to cost the taxpayers a butt load more money in taxes but PFB was going to charge the same rates as AMR. Also from what I have read FDNY (Asysin2leads correct me if I'm wrong) is less than thrilled at running NYC EMS now. Even the hallmark of Fire EMS, Medic One is more of a hospital based system than a fire system, started and maintained by Harborview. So tell me Quint where is this great rush for Fire to "take over EMS?" I have another question for you Quint. Why is it if a company making widgets slowly over years of improvement starts selling less widgets they start downsizing their staff, yet fire departments continue to grow and spend more tax dollars even though the number of fires per station has gone down? Could it be because Chiefs are really good at finding ways to milk tax dollars from the naive citizens they serve? Hazmat, Confined Space Rescue, Whitewater Rescue, Marine Rescue, Doggy Rescue, Kitty Rescue, Playground Equipment Extrication Team, and EMS. Where is it going to stop? I get really nervous when I hear statements like "were taking over EMS" because they are never followed by an intelligent reason. It comes down to because we can (read into this "we need the money") not because it would be better for the patient or the community. Peace, Marty :joker:

It is amazing how that worked out on all of my arrests too. :wink: Another mystery is how come if you get a good nights sleep before a 24hr shift, you only run one or two calls, but if you stay up all night with the intention of sleeping during your shift you end up running 27 calls? Peace, Marty :joker:

I agree Dust, Let's take it a step beyond that. What is the number one injury for EMS personnel? Back injuries by far end more careers than anything else. How many times have you heard this? 45 yo male, C/C N/V, general malaise at 123 Anywhere street, 6th flr walk up, alpha response but were dispatching fire for lifting assistance down the stairs. There are a lot more dangers to us out there than knife wielding psychos. Be safe. Peace, Marty :joker:

From the "Field lab draws by ALS" thread. You bring up a point that made me think in a new direction. Should Paramedic students rotate through the lab? I worked in a lab at a level 1 trauma center for the last 4 years, so I am coming from a Paramedic/Lab Tech perspective. First off let me deal with the draw order does not matter issue. You perfectly highlighted the problems we had with staff draws in any unit in the hospital. The order of draws is extremely important, as well as the way the blood is drawn, it can skewer the test results. I have seen tests results that were far out of range, when investigating I found that the Nurse had drawn all the blood in a EDTA (purple) tube and then transferred it to the other tubes. I have seen severely hemolized blood because the staff had done a syringe draw and "pumped" the syringe to get the blood. The number of tests that we had to put disclaimers on is ridiculous. This is why our hospital as well as many others insist that blood is drawn by phlebotomists, not hospital staff. This is not a slam against hospital staff, its just we can keep phlebotomists up to date on draw techniques, it is hard to educate a whole hospital on proper technique. So this brings us to my question. Why not have Para students work in the lab during their rotations. It would give them exposure to draw techniques, but more importantly it would give them education in regards to what lab values represent and the underlying causes. Here's an example... You respond to a 76 yo female, C/C decreased LOC, pt is very confused, very weak, and non ambulatory. Pt is usually ambulatory and A&OX4. Family states history of NIDDM and Chronic Lymphocytic Leukemia (CLL). You check the blood sugar and find pts BSL is 134. How many of us know what CLL is? Do we know that CLL causes Hemolytic anemia? Do we know why this pts Hemoglobin level is low? The patient in this case was once again my mother her HGB was 4. This is something that a lab technician would know. This is not something taught in Para school. If Para students spent some time in a lab, studied the test results, and saw cells under a scope they might better understand the disease processes and therefore better understand what they see in the field. We have talked about Citrated (blue) top tubes for coag tests on this thread, but how many medics understand what a D-Dimer test is? Do we know about such things as Disseminated Intravascular Coagulation (DIC) or Venous ThromboEmbolism (VTE). Look these terms up, learn the underlying causes and it will give you another train of thought for what you might be seeing. I do not believe that every medic should know all this stuff (OK I do believe it but I won't go there) but a basic understanding would be a good thing. Lab exposure time would introduce them to a new equation to consider, altered blood values = s/s of a certain disease. It does not matter what the exact values are to the medic as long as they know the basics of how blood chemistry/make up can affect the patient. I believe that time in the lab, not shadowing a phlebotomist but bench time with the techs, would make them better medics. Am I completely goofy? Are some programs doing this? I would love to hear your opinions. Peace, Marty :joker:

So true, my favorite Houseism's.... Dr. Wilson: That smugness of yours really is an attractive quality. Dr. Gregory House: Thank you. It was either that or get my hair highlighted. Smugness is easier to maintain. Dr. Gregory House: Sorry, I missed that. White count's been down since the Ricky Martin concert. Some cholo kicked me in the head. Dr. Lisa Cuddy: I need you to wear your lab coat. Dr. Gregory House: I need two days of outrageous sex with someone obscenely younger than you. Like half your age. Dr. Lisa Cuddy: People talk. Dr. Gregory House: About how big your ass is getting? I've been defending you- you got back! Peace, Marty :joker:

The draft was kind of vague, is an Advanced EMT essentially an Intermediate? Peace, Marty :joker:

Hey AK, if you cross reference the dates in the story... With the dates from Acadian's site for the "National EMS Academy" EMT-Basic Class.... ...it looks to me like it's just another name for a Basic. Peace, Marty :joker: