john_boston

I have zero tolerance for superstitious supernatural nonsense. Medicine comes from science and we should all respect that. I can understand having a little fun or pointing out bizarre coincidences but it never ceases to amaze me how little most Americans (btw I was raised in the US, went to American public schools) understand scientific methodology. It's actually quite embarrassing that a country that is on the cutting edge of scientific research, that benefits so much from the march of reason, is so muddled by primitive superstition. For example, America is home to some of the world's foremost biologists and yet we are the only country that has a sizable contingent of people who actually say things like "Evolution is just a theory" -- giving away their ignorance of not only what evolution is but also their misunderstanding of what a scientific theory is. How's that for opening up a can or worms?

Here's a few: 1) If a patient is complaining of 10/10 chest pain radiating to her lower back, describes the pain as "crushing" and "worse than anything [she's] ever felt", has a history of angina and a sense of impending doom, don't wait an hour and a half before you call an ambulance because you think she's faking her symptoms. 2) If a urosepsis patient has a GCS of 3 or 4, an irregular pulse, and a BP of 68/34, don't call it in as "high creatinine with increasing lethargy" and decline ALS. Call it in as full blown septic shock and ask for paramedics. They can at least get a monitor and IV going. 3) If the patient is DNR that doesn't mean you don't have to care for them. Also if you want me to honor the DNR/DNI, you should probably have the paperwork. I could go on but just thinking about this sort of thing drives me nuts.

Not to mention fellowships that are a requirement for most specialties after you finish your three years of residency. Even longer if you want to be a surgeon.

That was a fantastic article, MadAxe. Depressing but every word of it was true. Interesting to read that Mobile Intensive Care Units staffed by nurses were fairly common in the 1980's.

I should acknowledge that I do not believe private non-emergency transports are included under the umbrella of "EMS". They are clearly not. If I gave the impression that I believe that they are, I apologize for not being clear. It's a point with which I am in total agreement with you, Dust. Let me draw an analogy. African Americans are incarcerated in America at an overwhelmingly higher rate than any other ethnicity. If this fact lead me to an assumption that the majority of African Americans are criminals and therefore all African Americans deserve to be regarded and treated as such without regard to their status as individuals capable of making their own choices, any sane person would object. The accusation is a non sequitur, it just doesn't follow. The reason for this is that the issue is complex and as you correct observe about the many problems of EMS in this country, "it is much more of a systemic problem than a problem of individuals." In the case of African Americans and incarceration rates, questions of educational opportunity and access, social dynamics, recent American history and civil rights, and just good ole' fashioned American racism loom large in the discussion. It's a problem of plagued institutions, not bad people. Racism is indefensible because all individuals have integrity and deserve to be treated as such. I know it's a dramatic example but I feel like it's an analogous (albeit in a tenuous way) to this discussion; unskilled, uneducated EMS and private ambulance workers deserve to be treated respectfully as widely-varied individuals with many different goals and capabilities, despite the fact that there are massive systemic problems associated with their job and despite the "whacker"-ish tendency among many of our least qualified. I feel no no need to defend unskilled, incurious, uneducated, macho morons in any field, I just take offense at your tendency to dismiss the lot of us basics as people who seemingly by definition, are idiots because their are barely nonexistent educational requirements to begin working as an EMT. More later...have to go do a non-emergency transport now.

Sure, I know plenty of EMT-Bs who almost never work emergency responses, have little to no experience, and love to boast that they are a critical part of a system that saves lives. We all likely know people like that. They have star of life tattoos and don't know what the difference between lateral and medial. However, Dust, there are plenty of us who also take our jobs seriously without losing perspective on what we do, how valuable we are, and what we know. I think you have an unfortunate tendency to dismiss most EMTs as "wankers" who have "pathetic lives" because of the very real problems that plague the varied educational requirements and duties in all of the different systems in the US and around the world. Obviously there needs to be a hell of a lot more education required of people who wish to work in EMS. This has been discussed endlessly here and elsewhere. Obviously there are a lot of deluded and ignorant EMTs who love to blather about how vital and important they think they are. Why does this need to be emphasized endlessly at the expense of people like me who happen to be EMTs but who have a proper perspective and ambitious goals (I'm planning to be an ER nurse). Trust me, I take your point and you've obviously got loads of experience and I'm sure are a hell of an asset where ever you work. It's just such a shame your attitude is so rotten and condescending nearly all of the time. Re: transport vs. emergency responses. I work at a private service that does both routine non-emergent transports as well as emergency responses to nursing homes, rehab facilities, etc., AND backs up the city's busy 911 service. I would estimate that we do 60 percent responses, 40 percent uneventful transports. As a basic I recognize that our scope of practice is so limited as far as real interventions go that I suffer no delusions and do not romanticize my inability to actually save lives. However, if I can comfort a terminal cancer patient by holding her hand or getting her a pillow then I feel like my job is more meaningful and rewarding than serving fries. What's so awful about that? Why does that deserve berating condescension from people who have more education and experience? Sure, transports aren't exciting. Sure, I plan on getting a lot more education and experience so I can actually help critical patients. But for now I'm not going to be another one of those guys who feels the need to sh*t on the reputation of EMS workers (many of whom aren't complete idiots with no medical knowledge).

I might be wrong but I don't think the AAOS Emergency Care and Safety Institute Professional Rescuer CPR course is affiliated with the Red Cross at all. My card only says "American Academy of Orthopaedic Surgeons" and "American College of Emergency Physicians". I found this link on the ECS Institute site that says the card is valid for two years, so I guess I answered my own question.

My BLS/CPR card has a recommended renewal date one year from when I received it. I was wondering why it says "recommended" rather than "expires on". Is an AAOS BLS/CPR card valid for two years or one?

As an EMT newbie I just want to say thanks and that I appreciate all of the advice given in this thread. The few times I've been in an ER so far (on ride-alongs) have been exciting but made me incredible nervous.

All interesting posts, love reading this stuff. I'm a EMT-B in training and was wondering what percentage of calls are (in your opinion) dispatched as unsafe and how many turn out being unsafe (taking into account all calls)? I'm sure I didn't word that question well, just curious how often you encounter a scene where you realize "Oh jeez, I need to get the hell out of here!" Of course it all depends on where you work, but almost never? Fairly often?