JPINFV

Did I say they did. What it needs to become is a team not a bunch of ego-maniacs running around thinking they are smarter then everyone else. Doctors , medic emt nurses police and fire. You are all there for the good of the community we should start acting like it.

1. Not everyone has the same intelligence. Unlike in grade school, not everyone in the real world is smart. It's not about egos, it's about education and ability.

2. Blindly following protocols (which was what I was trying to counter with using doctors as an example) is bad. Not every patient will happily follow how the local protocols are written. Innovation is good. Understanding what you are looking at and how to treat it (be it strictly following protocols or not) is good. Throwing up your hands and giving up because the patient isn't presenting how the protocols says the patient should is bad.

3. Very few people are in it only for the good of the community, if even for that.

I am not comparing the two medics have their role and emt have theirs. What I am saying is you cant assume everyone knows what is going on thats why there are protocols. Thats all its not difficult

As if doctors always know what is going on, yet they don't....

Oh, never mind.

Well, according to your article, the medic and the basic were developed at the same time and evolved out of intern doctors (which would be Post Graduate Year 1 following medical school). These doctors (they finished medical school and had earned the right to place an MD behind their names) are ALS providers. The ALS provider came before the BLS provider. Paramedics are the current ALS provider. Therefore, the history of the medic starts earlier then the history of the basic.

by cookbook you mean protocols? They are there for a reason, just like you as and RN dont make decisions without a doctors orders, or your standing protocols, If we didnt have a set guideline to follow we would have people running around doing whatever they wanted to.[like doctors?] Lets face you and rid are the exception to the rule not the norm. We cant assume all paramedics and emt's have competent and educated clinical judgement.

Lets face it, protocols have to start at some level, and above that level, the providers do what ever they want to (just checked by insurance and hospital privileges). Granted, 4 years of general, post-secondary education, followed by 4 years of applied education, followed by 3-4 years (assuming straight EM, not FP or a combined program) of on the job training is a lot more education then even the degreed medics have. Let's not compare this to the training basics get.

Not every patient follows the protocols. Should there be mandatory contact for the rare procedures (child birth, any thing involving needles but not veins, etc)? Sure. Should there be a base hospital available for those weird presentations? Sure. That said, a paramedic should be able to treat patients as they present, which may not be completely in line with protocols. Unfortunately, the amount of education required to do this is not achieved by the vast majority of basic schools.

Pyramids are fun!

Not much tolerence here either...but in a different way. The guy playing Jesus was middle eastern...

Which makes sense since Israel is in the middle East...

please tell me this wasn't a real call.

Hmm, "lividity" of the face and hands sounds more like cyanosis (calling captain obvious?). So, umm, are you [ems crew] getting good chest rise when bagging? Is he intubated (can someone say esophageal intubation?)?

lividity of the face?

How long has the patient been down?

What is the current rhythm?

What rhythms has the patient progressed through and what treatments have been preformed?

ETA to the nearest paramedic receiving center?

http://www.thefirestore.com/store/category.cfm?cID=761

http://www.officerstore.com/store/manufact..._chest_harness/

http://www.mooremfg.com/radioharness.htm

Google: Radio Chest Strap

Fenway on this board if EMT's are in anyway invovled in the system it must suck. This is a pro paramedic board where EMTs cant or shouldnt make any medical decision, they should be called paramedic helpers, and there paid way to much. Well they got one thing right most of the paramedics I meet defintley need help.

:roll:

I guess some of us just like to be able to provide our patients better care then oxygen and transport.

Besides, I've never gotten any flak for being a basic in any of the scenarios. Knowing and understanding the limits of 120 hours of training can be a little painful.

Is there an actual difference between having a "license" and having a "certificate?" Or is it just sematics in most cases? I'm a certified EMT-B, but a licensed Ambulance Attendent (You must have an EMT cert to be an Ambulance Attendent).

So, I guess I'm both certified and licensed, but I don't know any practical difference between the two...

43, second try. time for bed. try again in morning. brain no work after midnight (12:43am PDT)

If you read the earlier posts, I understand the survival rates all to well, But we do work arrests period until the protocols change, up till now they havent,

They have in some places, apparently. I know ALS in my area can terminate resuscitation after talking to med control (arrests are a mandatory contact anyways).

And I will continue to work a pt if I feel it benefits their family members or the pt. within my protocols. Without regard for the studies and the journals or the fact that I might run up and upaid bill for a for profit hospital.

This scares me. Do you still practice fluid resuscitation for trauma patients? Do you still use MAST pants? How about leeches (yes, I know leeches are used for wound care post surgery, but it really isn't used that much)? There is a reason those aren't used anymore, and it is those studies that you are decrying. If EMS is going to be viewed seriously in the medical profession, then it needs to get its act together. We need to start using science to guide our treatments instead of giving into emotion.

When they stop allowing pts. on welfare to have elective plastic surgery. I will consider the fact that I might be wasting taxepayers money

I agree with no plastic surgery. Viagra should be a no-no too (except pulmonary HTN)

By the way who do you people transport you dont want to transport stub toes, or hand lacs, or non emergent pts. you dont want to transport arrest pts.

Different reasons why people don't want to transport. The stub toe isn't an emergency and can be taken POV or taxi to the hospital. The ambulance should be available for critical patients.

The arrest shouldn't be transported (generally speaking). Yes, work it till you get a pulse or asystole. Recognize that asystole is dead, though. The ambulance should be available for live patients.

you must have pretty slow days, to ponder all the research.

Or maybe some people are dedicated and take a little bit of time to gain a better picture of emergency medicine. We let science be our guide.

And yes emotion sometimes factors into my day, if it dosent for you your a liar, do I make decisions based on it maybe, but everyone is treated in the way I would want my loved one treated if they were in that situation, if you call that emotion too bad, if you dont like it too bad, if you got a problem with it too bad.

I don't want my loved one taken out of my home, abused, tubes shoved in every orifice, and left to die in some hospital where the staff would like nothing better then to get rid of my loved one so that they can actually treat someone who needs help. Furthermore, any system that transports every arrest forfeits the right to complain about holding the wall or being diverted away from a hospital. That extra bed that you're patient needs might just be holding that asystole arrest that was brought in earlier.

I dont work 14 yo arrests pts to be a hero, but I dont leave them laying in the street either.

I take a refresher every two years and when the protocols change I honor them, But I dont waste my time sitting there saying, well here they dont transport arrest pts, or there they get to do this or that, I went to school for a year I dont claim to be or try to be more then I am. And I sure as hell am not worried about a couple of paramedics who have a problem with the way I do my job. I dont have a cushy EMS job I can barely pay my bills half the time I dont sit on any boards or conduct any research, all I do is show up every day and try to leave it a little better then I found it.

I believe it is important to know what other places are doing. Maybe you can be the one that finds a new protocol and suggests it for implementation? The more you know, the better you can treat your patients. Just because I'm BLS doesn't mean that I can't limit myself to the questions and information learned in my 120+change basic class. While my treatment is limited, my understanding can be used as a guide of if I need medics, how much O2 should I give, etc. Just as an ALS provider can do the same.

Evidence based medicine beats emotion based medicine any day of the week and twice on Sundays.

A "save" isn't a "save" unless they are discharged with decent brain activity. Just because you got a pulse back doesn't make it a save. There is no need to waste resouces (EMS, hospital, etc) so you can play hero abusing a dead body. I volunteered a bit (about 6 months [i was in the program for 2 years, but on different units] and one during my EMT clinicals at a different hospital) in a local ER. I saw a relitivly fair number of dead (asystole) bodies come in being abused by paramedics. Every body that came in in asystole left in asystole.

OK, it seems that there has always been talk about different things that could be improved (pay, education, staffing, etc), but never a full layout. So...

If you were the leader/medical director of an EMS agency (your choice of type (fire ran, police ran, 3rd government agency, private, volly), how would you run things. What trade-offs would you make between on-line medical control/standing orders? Levels required to staff an ambulance? Education levels? Types of calls? Sources of money?

All are fair game to try to cover, but remember, money and degreed medics don't grow on trees.

If a specific plan sparks debate, please form a new thread. Questions for clarification on specific items are welcome.

Fair points. As a matter of fact prior to watching my medic on a call I asked him to show me on the first day. I agree that our system is lacking in education and it should be changed. It has probably been asked and answered before but how do you start to overhaul the system. If we move towards a system similar to Canada will the country be willing to pay a fair wage. If we start requiring medics to have an education simmilar to a RN's in time, will we pay them a RN's wage?

(in no particular order)

1. Lobby

2. Organize (as much as I have a distaste for unions in general)

3. Get an education and get into leadership (note, just as education and training are different, leadership and management are different. A manager may not be able to dictate hiring standards. A leader should)

4. Be prepared to take one for the team (would you rather, A. Make 30k/yr running only 911 or make twice that amount running 911/interfacility combined. You've got to work to play, and, like it or not, interfacility is where the money is. Maybe 3rd government agencies should embrace it and reinvest the money into higher pay, more education, etc)

5. Become involved with PR (the FD and PD didn't become highly recognized overnight. EMS won't either. This goes with 1. We do need a catch phrase, though. If the PD is America's finest, and the FD is America's bravest, are those involved in EMS then America's Smartest?). Make your community know WHAT you do and ensure that they believe that you are worth every penny, plus some, that their tax dollars go to.

6. Fight Fires (hey, if the FFs can become crappy medics, can medics become crappy FFs for the extra money that being a FD would bring the system? We could send an ambulance to all fire calls just for shits and giggles.) /sarcasm.

7. Form partnerships with other local resources. (Maybe instead of having a paramedic teach A/P, have it taught at the local university There should already be a biochem, human physiology, human anatomy, neruobio, chem, physics classes at the university. Better yet, have the university run the program and have it become a degree-granting program)

I agree with the above. BUT, I will add this to it. The refusal of any specific treatment can only be made in addition to the above criteria. AFTER the provider has explained, the risks, benefits, consequences, complications, etc.. of this 'refusal'. ONLY THEN, will it be an appropriate and "INFORMED Refusal'.

Out here,

ACE844

On the flip side, you're technically supposed to do that for any procedure you preform so you can obtain informed consent too.

what noone has brought up in this situation is this---what is your recommendation if the patient is conscious and alert, and vehemently objects to being stripped?

Simple. Any action taken without consent is considered battery. IF the person is of sound mind and of age (state law dependent), they can refuse any treatment, assessment, or other action, including transport. If you feel that it is in the best interest of the patient, have no reason to believe that the patient can not make rational decisions, and the patient is refusing, then you document and move on.

Then here is an idea for you if you think basics are such a bad deal.........BECOME A PARAMEDIC, if we basics are so G'damn dangerous why are there still classes being taught? Why are certificates still being issued? There are enough medics out there that if basics were so dangerous they could get them wiped out.

I, actually, currently have a different path in mind. Why are their still classes? Because the FD wants to train people at a lower level and the IFTs can charge more then just sticking a gurney and an O2 tank in the back of a van and transporting that dialysis or discharge that way.

Good for you guys getting more education, but it is pretty damn ignorant of you to make the assumption that I have not furthered my education, I just simply choose to stay at the basic level rather than be lumped in with crappy attitudes that are displayed proudly on this site.

Good you you. The average basic is still under-educated. You have to talk about the average person, not the exceptions.

You had to have known when you went to EMT class what you were getting into, if not then the blame lays on you. If the PARAGODS want to get rid of basic's then do it, otherwise stop bellyaching and bashing on other levels and professions, this relates back to my you aren't professionals because of attitude.

I'm not going to apologize for trying to improve this profession at all levels. The only way to improve it is by increasing the amount of education to be considered competent to start. You have to know the faults before you fix them.

And BEorP I have no issue with being a driver but it's my choice not yours!

Um, what you do on scene is actually up to the person with the highest level of medical education. Hopefully, that will be at least a paramedic. Your only choice is to limit yourself by not embracing higher education for yourself or higher standards for your level.

What I'm saying is that giving a drug without understanding either why the patient needs it or what it does is stupid. EMT class teaches the how and when, but not the more important why.

Oh, and I'm a basic, so it's not some sort of "paragod" mentality with me. While I would love a larger scope of practice, the idea of basics who lack even a basic understanding of physiology also getting that same scope scare me to no end. Things like understanding why you need oxygen is, actually, so basic that it's taught to high school students. Personally, I want the people transporting me to have more then a high school understanding of biology. Unfortunately, too many providers lack even that. Because of this, the basic scope is so dumbed down that our indications for a nasal cannula is that the patient can't stand a non-rebreather (and the NRBs are dumbed down, as it is, so that we don't kill the patients if we don't connect it to oxygen).

The fact is that the EMT- B level of training is not enough to understand WHY we're doing what we're doing. This makes us dangerous, unloved, and, ultimately, unneeded in a 911 system.

One last point. I have no advanced training. I do have more education, though, then the average basic. There is a difference.

We are far from under educated, we are Basics plain and simple no two ways about it........you knew that when you took the course! If you want to be "advanced" go for it, your patch will then read "PARAMEDIC" which is how it should be! If you are lacking in skills or education you did not investigate what you were getting into, I am full aware of what is coming and I welcome it, because I love fired up people that's how Ca Ca gets accomplished, not by whining about it on a flippin internet site. you want advanced skills go to school and get a job as a Paramedic otherwise stick to the basics

Oh, really? You really think that 120 hours of basic first aid training that is just past what boy scouts get is really considered a proper education? Do you even understand most of the common diseases seen, even by a basic (CHF, a-fib, etc)? How much do you understand about psych disorders that are commonly seen (Schizoaffective versus Biopolar versus Schizophrenia). How much about the cardiovascular system did you really learn during those 120 hours? Of course, my personal favorite since oxygen IS the primary BLS drug. Do you even know why we need oxygen?

Rid I do not disagree with education and advanced care......I do disagree paying two paramedics for their skills when one of them has to be the driver (not much use for ALS skills behind a steering wheel, although I am sure dust will make an argument for that one). Why should a hospital trip get expensive just so you have an equal to talk to.

Open invite for you to come and educate me Dust!!!! And the last I heard from you was whining and complaining about not being on the same level with us lowly firemen when it comes to money and respect, considering fire is taking over EMS I am qualified to speak of how I am ramming you out of your "profession".

There are fire departments still? Can you really call an agency where the majority of their calls are for medical aid a 'fire department?'

The problem with fire fighter/paramedics is that they, on average, either became a fire fighter to be a paramedic or became a paramedic to be a fire fighter. They neither care, nor devoted to one of those roles, and generally suck. The only reason why fire fighting is more respected then EMS is because of age. Personally, I would rather have good fire fighters that fight fires and good paramedics that treat patients then a mediocre fire fighter/paramedic.

When Chuck Norris works the ambulance, telemetry calls HIM.

Okay, I'll stop...

Thats funny, I don't care who ya are. If you don't laught at that then you need to get out.

/Larry the cable guy

http://www.moller.com/skycar/

New ALS fly car?

Three things caught my attention.

First, you have the makings of an ugly battle over patient control here. Lets say a prehospital RN, PA, and paramedic all show up to render aid. No judgement is made over which is considered higher and all have been tested and shown that they can provide prehospital care (so it isn't some random SNF RN showing up here...). Who's in charge?

Second.

Has successfully completed the first year of an emergency

medicine residency program that satisfies subparagraph (i) and has

successfully completed programs approved by the department in

advanced cardiac life support, advanced trauma life support, and

advanced pediatric life support.

Are second year EM residents really advanced enough to allow total control (PH Physicans do not need to follow protocol) of patient care (granted, by the end of PGY1 they are licensed MDs...)? ERDoc or Doczilla?

Has successfully completed an anesthesia, family practice, internal

medicine, or general surgery residency program that is accepted by

either the State Board of Medicine or the State Board of

Osteopathic Medicine as providing the graduate medical training

the board requires for issuance of a physician license without

restriction, and has successfully completed programs approved by

the department in advanced cardiac life support, advanced trauma

life support, and advanced pediatric life support.

Two problems with this one. First, they just have had to completed a residency? No board cert?

Second, does anyone here really feel comfortable with a family or IM doctor providing emergency medical care just because they passed an ACLS, PALS, ATLS, and a skills test?

Of coruse House MD is based off the little known TV series, Walker, Texas Ranger Doctor. Chuck Norris doesn't do pericardial thump with his fist. He does it with a round house kick to the chest. This makes his ROSC surprisingly high/

Chuck Norris can shock asystole patients back to life.