Asysin2leads

If you want to pass the practical exam and its been a while since you certified, I would recommend taking the time and effort take a trip out to Sacramento and use a place called NCTI. For an extra fee, you can take a practice run the day before through all the stations and correct whatever mistakes you may make. Trust me when I say that given the expense of the NREMT exam and the difficulty in finding the practicals, its worth a flight and a day and night in Sacramento, California. Which is a really nice place, too. Hope that helps. PS I am not paid nor endorsed by the NCTI of Sacramento, although maybe they should, lol.

Hey all, long time no see. I'm happy to report I finally made the move and I'm here in beautiful British Columbia, and was able to get my paperwork through to sit for the Advance Care Paramedic exam. I've been hunkered down and studying pretty much everything for a while, and I even took an EMR course to get a feel for how things are done, but I'd really like to know from someone who's taken it fairly recently what kind of questions will be on it and what I can expect. I hope everyone is doing well, I see some regulars are still around.

At first I read this article and thought "Hmmm, good, a decision showing racism in any form won't be tolerated." Then I go and read comments like CB's, and whoever it was who basically said "Yeah, there's black firefighters because of the games they played, etc. etc." Hmmm, now why could minorities possibly feel discriminated against when attitudes like that abound? Gee, I wonder. Then on the other side of the equation, you have crochitymedic doing his blame the man routine. I read "Its because of the white owned banks" and all I can think is "Well, at least he didn't say Jew owned banks..." But you know what, its just as bad. At the end of the day, the only person you can blame for the position you are in is yourself. Anyway, this entire thread has really turned my stomach.

That's because you generally don't find deer lying dead in the forest of anything, any animal in the forest that is that weak will generally have been found, hunted down, and torn to smithereens like Mylie Cyrus in a pack of R. Kelly clones. Even if hunters don't have any effect on any population at all, even if there is no reason to hunt except for sport, doesn't mean hunters are doing any thing any worse than what happens every second of every minute of every day. I actively donate to the ASPCA but I think PETA is a bunch of loons. And I don't mean the sad sounding duck things.

Its weird, it seems the Rampart CRASH team seems to agree with diazepam. Must be an LA thing.

Yeah, the LAPD does have a long proud history of professionally dealing with people of color, after all. :-D In fact, I think the band 'Sublime' wrote a song about it at one point.

I can tell you with out a doubt that when the Inspector Generals office conducts a 'sting' operation on a public safety employee they go out of there way to make sure that the 911 system is not compromised, up to and including put a spare unit in service while the unit being investigated goes through with the operation. The Inspector General's office also does not just do this at random. For the Inspector General's office to go to such lengths, they usually will have a great deal of evidence prior to the operation. And yes, IMHO, an EMT STEALING $100 is a really bad thing.

Scott, in your opinion, in what ways does the "real world" differ from the "book world"? I mean, shouldn't a training program be all about applying didactic ("book knowledge") with the experience in the "real world"? I mean, wouldn't those hours spent getting "experience" at the basic and/or intermediate level be better spent in an environment where those experiences can be quantified with researched knowledge, rather than with the theory, conjecture, and legends that pass for knowledge in the "street"?

That's funny, I was going to be a fireman but unfortunately my nasty habit of putting my patients first got in the way. Go figure. I think that EMT-B experience can be useful, but not in the way most people think. I think that if you take a fresh out of school EMT-B, partner them with two quality paramedics, and let them guide their BLS skills, after a year or so you will have a fine candidate for paramedic school. The concept of "experience" is in itself, neutral. An EMT-B's experience can be very good, as the example I gave, or really rotten, learning all the bad habits and bending the rules tricks of the trade, and a mindset that will not help them later down the line. The best candidate for the paramedic core courses is similar to what someone before described, having a person, who in, the equivalent of one semester finishes A&P, Psychology, and either introductory chemistry or biology to get them on the scientific method path. If, over the next 8 to 9 months they then go work as an EMT-Basic, in a decent system, I believe that experience will help them when they go into paramedic school.

I'll break it down for you and make it very simple. 1. New Jersey's EMS system sucks beyond belief. I could give you a list of whats wrong with it but EMTCity has limited bandwidth. The working conditions suck, the pay is not comparable to the cost of living, and yes, indeed, the place is run by Bubba and Larry the volunteer EMS chief/captain/commodore. There are positions such as "1st Sergeant and 2nd Sergeant" on the volunteer squads and, interestingly enough, there are people who take those positions oh so seriously. If you'd like to get a glimpse into the NJ-BLS mentality, go over to the NJ's EMS website, look up "disciplinary actions", then read the one about the NJ EMT who ransacked a patient's house looking for drugs, proclaimed himself an "officer", and ordered a police officer (a real one) to handcuff and arrest everyone. That's about it in a nutshell. ON THE OTHER HAND 2. Its a recession. You can get a job there, and with a little luck and a lot of overtime, you can make ends meet, you do get health benefits and other perks, and that's more than a lot of people with a lot more qualifications than being paramedic can say in this economy. So if you can keep your head down, live simply, and avoid the bullshit, you can make ends meet until the job you really want comes along. That's, I think, all you need to know.

It could be worse, she could have 8 embryos implanted in her. And I hate to rain on anyone's parade, but teenage girls have been getting pregnant for many decades, even centuries, even when there were sock hops and drive-ins and men were men and women wore their letter jackets. Look at her. Her parents are probably in jail or dead, and she was probably raised by her grandparents. Its not because they read Dr. Spock rather than tannin' thar hides, its because they probably had her when they were her age or younger.

There's a reason presidential campaigns spend hundreds of millions of dollars on "image consultants". And its not because voters are looking for the most qualified candidate or who has the most on the inside. If I'm an employer, and my service depends on the patients having confidence in my employees, I will do everything to make sure that confidence is a the highest, and that includes considering the image of the employee. Believe me, I don't agree with it, I don't think its right, but it is the way it is. Ever notice the media tends to spend more time on you if you're attractive? Ever notice the guy who's "not a doctor, put plays one on TV" in the commercials has a little bit of distinguished grey along the temples? Ever wonder why there is a minimum age for the presidency? Its part of the trade off for being in a high visibility field. Image does matter, and youthfulness is not always a plus in the image of a provider.

I'm not sure what to say about this age thing any more. Even if age isn't an indicator of your performance, you'll find that employers and patients tend to think so. People want someone who is at least in their mid-20's working on them when they call 911. They don't really care if its someone from One Tree Hill arresting the bad guy or putting out the flames but when they're sick or hurt, and someone is approaching them with a sharp object and a bag full of drugs, they don't want someone who can't grow a mustache answering the call. Maybe its wrong. Maybe its unfair, but that is the way it is. So, if you want to stand in the middle of the street, and scream "Its not fair! I worked hard! I can do everything they can! I'm mature! I'm good!" and stomp your feet and throw yourself on the ground kicking and screaming, feel free.

My suggestion would be in your current situation to take the job in the hospital, and here are my reasons why. 1. 401k is as you said, a good thing. Start saving now. You can roll it over and as Albert Einstein said, there is no more powerful force in the universe than compound interest. 2. Even partial pay of tuition is a great thing. I'd check the clauses about how long you have to work for the employer and such, but getting grants to go to school is a beautiful thing. If they are offering you a loan, be sure to read the fine print about interest rates and make sure you can't get a better deal through the Department of Education's programs. 3. This is a biggie and most people don't take this into account. Working in EMS, particularly as an EMT-B, is inherently risky. At this point in your career, even a minor complication from work, be it legal, physical, heck even mental, can have major consequences in your career. Your back and your knees are very easy to injure and very hard to fix. Trust me. Anyway, you sound like a very intelligent person who has done some great research into your prospects, and I'm sure you will do well no matter what you decide.

Suprisingly, Medicare supposedly does a much better job managing people's insurance than most insurance companies do. Trust me, the gummint can't do a much worse job than these guys.

Well, there's one service who needs to increase their physical standards a little more...

Hey everyone, just got back from the NREMT practical. I actually did fine on the orals. Knocked them out of the park. I did them like I did a call and all was well with the world. That doesn't mean I passed completely. I have to retest on the pediatric IO, pediatric ventilation, and adult ventilatory management. Now, you may pause and ask yourself, "Is asysin2leads really such a doofus that after being a paramedic for five years that he still can't figure out how to intubate and how to do an IO?" The answer, I assure you, is NO. The other answer is yes, I did study the skill sheets. Approximately 8 hours a day for the past three weeks I have been reviewing. I am not sure why they failed me on the stations. I know it is nothing in any text-book, skill sheet, or CME I could get my hands on that I missed. I do know that the reason I failed the KED station the first time (told ya), is because I put the middle strap on first and not the top strap. Yeah, apparently in their neck of the woods, they put the top strap on first, not the middle strap, and that's reason enough to fail your sorry ass on the random basic skill if you put the middle strap on first. Yes, I know the manufacturers instructions actually say there's not really any order to put the straps on, but what can I say. Given that experience, I can only assume their was some BS local idiosyncracy that I wasn't doing on the other stations that failed me. I would also like to take this time to voice my opinion that if the goal of the NREMT is to provide a standardization of EMS throughout the country, they are not doing particularly well, as their skills testing still allows too much wiggle room for the testers to throw their own little interjections into the testing. For instance, if on your skill sheet, the criteria simply states "Secures the torso properly" and you never spell out what "securing the torso properly" really means, then it is up to the local testing agency to decide what that means. Now, if you are the paramedic student who has been training with said testers for the duration of their curriculum, knowing exactly what they want is not a particularly difficult goal to achieve. However, for the paramedic who comes in from a different area to do your testing, it presents a bit of a challenge to psychically mind read the testers to know exactly what they want. Yes, I am a little annoyed. Just a little. A smidgen.

Advanced Cardiac Life Support manual, page 46-47 "For a cardiac arrest patinet in VF/VT who has hypothermia and a body temperature of <30 degree C (<86 degree F), a single defibrillation attempt is appropriate. If the patient fails to respond to the initial defibrillation attempt, defer subsequent defibrillation attempts and drug therapy until the core temperature rises above 30 degree C (86 degree F)... in cardiac arrest in the hospital should be aimed at rapid core rewarming. Got it. Shock once, rapid transport. Now how about active rewarming? Warm IV fluids or maintain body temperature en route? Decisions, decisions. Actually, the BLS is also the thing that scares me. Actually what scares me is the KED. In over 12 years of testing for EMS, I still can't get the damn thing to work when I'm being evaluated. I know all about it. Invented for rapid extrication of test pilots. My baby looks hot tonight. Middle bottom legs head top. Check neurologic status before and after application, I know how to feed the straps. I know how to roll the shoulders. I know how to place padding to prevent femoral artery occlusion. What I don't know is why, every single goddamn time I think I have the leg straps tight, when I move the patient, it all falls apart. I can only assume that God hates me. I fear the backboard because I know how I put the straps on, but that might not be acceptable to the tester. I fear bleeding control because I might sneeze and fail the sterility part. We're still at direct pressure, elevation, pressure point, and tourniquet, right? Hard to screw that up? But I think I might. I once had a traumatic arrest packaged, intubated, two large bore IVs, needle decompression, and transport initiated in 6 minutes and 37 seconds. I've treated bilateral above knee amputations, shootings and eviscerations, and MVA's and even a couple of helicopter crashes, and still, the thing I fear most is basic BLS skills evaluation. I think it says more about the tests than me. There has to be a better way. God help me if I get the 20 year EMT with the light bar and the tattoos who is looking to conclusively prove that book learnin' ain't what its about. God help me if I forget to fold something the right way. I wish the future of my career rested on more than a 1 page checklist. But it doesn't. Of the things I hate about this job the most, this is one of them.

Anyone taken the NREMT-P practical lately? I'm having stress-induced GI problems over it. My biggest problem is that where I am testing is no where near me, so I'll be doing it with strange people in a place I've never worked, and I am really afraid of tripping up over some idiosyncracy. Any one have any tips? Better yet, anyone know where I can find some practice materials so I at least have some heads up with what I'm facing? I have pretty much everything printed out from the NREMT possible, but I could always use more. Thanks for anything that helps.

I think its simpler than that. I think the problem was that too many uneducated, inexperienced providers were seeing some blood and tying a tourniquet when it wasn't necessary. Perhaps they were of the same conclusion that you and I came too, which is that the body has some excellent compensatory mechanisms for dealing with blood loss, and that the window for use of a tourniquet is actually quite small in the civilian arena. I have seen many amputations. The plate glass window guy was the first and since only that I could honestly say was in danger of exsanguination. That includes several mid-femur transections. I'm still not exactly sure what it is about glass cuts that make them so dangerous, but they really are bad.

Funny you should say that, the last guy I had who honestly needed a tourniquet also had a misshap with a plate glass window after tying one on. I think I even did a post about it discussing glass injuries and exsanguination. All I can say is that this guy had transected literally everything right down to the mid humerus. It looked like a beef roast.

I'm not sure exactly what the question here was. I'm not sure if you're asking why some experienced providers just seem to be going through the motions rather than being excited about the call. You'll have to understand, and for some people it is hard to understand that for some people, like myself, EMS is a job. Nothing more, nothing less. The point of a job is to do your job well, and to do your job well, you need to be focused. The "adrenaline rush", can actually be a real detriment to good patient care. To properly treat a patient, you need to think. Adrenergic reactions are well documented in the their abilities to produce "tunnel vision", to cloud judgement, and to react, not think. It makes your pulse stronger and quicker, which can lead to you feeling your own pulse instead of the patient's, and it can make your hands shake. In fact, this is so well documented, that some EMS texts even suggest regular cardiovascular exercise to increase the level at which your sympathetic nervous system kicks in for just these reasons. Now, there are, for sure, those providers who just don't care. I've worked with them. I don't like them, and I don't care how many years of experience you have, once you stop caring, you need to do something else. But for others, there are those who are merely focused, and for others, they may just be coping. For some people, they need to distance themselves from the call so it doesn't interefere with their emotional health. Dealing with your personal emotions is key to survival in EMS. We all deal with them differently. Maybe some of the providers you see aren't disinterested, but trying to do their job.

Well, since EMS can always use another mnemonic, and we all love mnemonics, rather than a broad based understanding of pathophysiology, I came up with this one while reviewing PALS. Ready? The phrase is "Helping Tykes Takes Courage", which leaves you with "HTTC", which stands for "Hypoxia, Toxins, Trauma, Congenital Abnormaility", which I think pretty much covers the categories for any pediatric emergency you can run into. Yes, I'm bored and taking a break from studying.

I saw a pic in the paper today of 4 burned out cars on the highway in your area, which I thought was pretty standard fare for a wildfire. Then I read a caption about how the cars were overtaken by the fire trying to drive away and all inside perished. That put it all into context for me. Great work Timmy, send my personal best to all those involved in the effort.