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:

And who is can afford to go to school for 2 years to make 35,000 a year.

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:

Your teacher anaolgy just might provide the answer to the problem. In order to effectively staff the schools, they combine school districts together in one school to allow for degreed teachers rather then lowering the standards. Instead of telling your citizens that they need to absorb the entire cost, spread the cost among a district and provide a paramedic intercept response for a region instead of an isolated town. While this might not mean the paramedic is always available, the availability should be better than not having one at all within 30 minutes. But I suppose that all in all it comes down to what the citizens of any given area are willing to pay for and willing to accept as a standard level of service. Sometimes it's better for towns to combine resources in order to better serve the greater number of people.

Shane

NREMT-P

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.

How is being married free?

Most mental health providers that I have met have had their cheese slide a bit off the cracker.

Well she did marry me!! :wink:

Peace,

Marty

:joker:

Does this mean school teachers will start getting compensated to?.. There are many that have undergrad even grad, and PhD's that make similar wages as medics.

I agree, we should make more, and education definitely be part of the requirement, so should responsibility and increasing professionalism.

Be safe,

R/r 911

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:

As well, all of Oklahoma EMS levels are licensed. From Basic on up... I am sure there are others, and it might be difficult to locate. Nice to know though...

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

...if medicine didn't change occasionally, we would still be doing brain surgery on our kitchen tables.

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:

Another thing to consider in relation to why the "C" level is not taught on every drug, is possibly because the "C" level of knowledge is not known on every drug. I would even venture to say that the "C" level is not known for the majority of drugs. If you have ever read the CPS (or American equivalent) you will find that in most of the drug monographs under "Mechanism of action" there is a brief superficial description followed by "the mechanism of action is not fully understood".

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:

If you don't like what basic's are permitted to do CHANGE IT or accept the invite to shut up!!

Ditch the attitudes and I will give you a new name, but for now if the shoe fits...........

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.

if we basics are so G'damn dangerous why are there still classes being taught? Why are certificates still being issued?

If the PARAGODS want to get rid of basic's then do it

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:

considering fire is taking over EMS I am qualified to speak of how I am ramming you out of your "profession".

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:

Mystery # Two: WHEN YOU COMPLETE A CARDIAC ARREST CALL...THE DRUG ADMINISTRATION TIMES ALWAYS SEEM TO MATCH THE CURRENTLY ACLS ALGORITHM PERFECTLY i.e.: epinephrine 1:10,000 IVP @ 13:20, epinephrine 1:10,000 @ 13:25, epinephrine 1:10,000 @ 13:30 Hmmmmmmmm

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:

The most dangerous scene we consistently make, hands down, is the MVA. More of our brothers and sisters are seriously injured or killed by traffic than by any other scene danger. But when was the last time you were dispatched to an MVA with the warning to "stage for PD?" For that matter, how many times have you voluntarily waited for police to arrive and stop traffic before you made an MVA scene? Doesn't happen, does it? Why not? Why would you go playing in traffic, yet cower half a mile away from an overdose, waiting for police?

Use your head, folks. Failure to do so will land you here ---> http://www.emtcity.com/phpBB2/viewforum.php?f=39

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.

As far as technique and "accurate" blood draws or whatever, I'm in medic school right now and we do clinicals at the same level 2 facility I mentioned above. We do blood draws in the ER all the time as part of IV practice, and the instruction/technique is exactly the same as that performed in the field. I see no reason why EMS blood draws should be treated any differently than an ER blood draw as the technique (and equipment!) is exactly the same. Also, even in the ER I was never taught any specific order to fill the tubes, so I dont know how much that really matters...

Like I said, I'm just a medic student right now but I really dont see any good reason to deny EMS blood draws other than as an attempt to control who gets to charge for the service.

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:

I mean, after all, there's only one House M.D. and no one else can be him, so don't try.

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...

The three-month assistant medic class begins June 20th and is being offered in seven cities in Louisiana, including Lafayette, Baton Rouge, Lake Charles and Alexandria.

With the dates from Acadian's site for the "National EMS Academy" EMT-Basic Class....

EMT – Basic Classes

June 20: Alexandria, Baton Rouge, Covington, Houma, Lafayette, Lake Charles

...it looks to me like it's just another name for a Basic.

Peace,

Marty

:joker: