NREMT-Basic

Dust- I know that its convenient to quote the 120 hours as Basic level training. I personally went through a program that was 176 hours. I know the difference may seem marginal to you, especially since you think Basics should be done away with, but generlizations never help anybody. Its hard for me to accept that someone as intelligent and well trained as you can continually find nothing to do but bash Basics. Like it or not, we are part of the EMS equation and arent going away. Please dont lump us all into one group...alot of us are poorly trained, but there are many of us who are not and who have trained to serve our communities in a BLS capacity. Its like if I constantly said all medics are arrogant arses who think they walk on water. True of alot of them, but not all. Demeaning and degrading members of the EMS community doesnt do anything. If you think Basics need more training, come back here and train us. I personally would be ecstatic to learn from you. When a person generalizes and bashes whole groups of people, they arent part of the solution but rather part of the problem.

I have two degrees...and the 30k in loans to show for it. I just hope to make enough over my EMS career to pay for it

ewww

Little thing called shock and disbelief, Dust.

In Illinois, we also have protocols for which patients get to take to the skies. Some of them are full thickness/eschar burns over a certain percentage of the body, amputations, falls from greater that 20 feet and extrications which take longer than 20 minutes. Usually we will talk to the fire captain at about 12 minutes in (and yes I carry a stopwatch which starts at the first cut) and find out if hes almost got them out and if he says its going to be awhile yet, the bird goes aloft. Our mantra out here is "we can always turn them around." We have the availability of 3 dedicated med-evac bk-117s and the State Police helo if needed. So I agree..when in doubt.... Also we have sort of established an unwritten rule that if a patient has resps and pulse but is non-responsive and must be extricated, we get the helo in the air immediate and set up and LZ. We are fortuate that we have several great pilots that will really attempt to put that thing down just about any place the rotors will clear...high school and mall parking lots, cornfields and, when necessary, in the middle of the interstate. The other thing out my way is that we have three major hospitals within a few miles of each other and then nothing for quite a ways. So if the patient is 45 miles away from the city, hes gonna come in by helo. I think of the fellow that got drunk at the wake after a funeral and fell on the ice and whacked his head on the bumper of his car...in the middle of nowhere...so he got a nice ride...of course he panicked up there so he got paralyzed and tubed.

My two cents on abandonment- legally its once you have made patient contact and you just walk away or leave without the patient and without a refusal. The other way is if you get them to the ED and wheel them into a bay, and just leave them there with no one signing for them, of equal or greater "rank" than yourself."

We actually try to avoid police escorts around here unless the patient belongs more to the police than he does to us. What we have found is that if you have to emergency vehicles--squad car and ambulance---running with the same siren patterns, its easy for people not to really recognize that both are there. If different sirens are used, it creates a great deal of confusion and i have been in one situation where traffic got all gummed up because the LEO stops in the intersection and traffic think he is trying to get through, then we come along and they are all in the way. We almost never do this here unless the patient, as I say, is going to need to be seen by the police while in hospital and usually then, the LEO rides along with us. I find police escorts just complicate things...we have lights and sirens and have a few guys that actually know when and where they should be used and when they shouldnt. No need for second set.

Congrats and welcome to the family. Go get em!

I am considering going Intermediate between basic and medic...can anyone tell the difference in the I-85 and the other intermediate exam? Im sure its bloody simply but Ive never known. Thanks.

These are fun. My father who recently retired after 36 years as a sheriffs deputy has a couple. He was called to an armed robbery in progress at a local quick mart. He responded and went in (thats when backup was an afterthought). He drew his service weapon and pointed it at the subject and promptly yelled "drop it or you will get shot" just as the man pulled the trigger and the barrel feel off followed by the cylinder, which he picked up and threw at my father. Attempted aggravated burglary and assault with a deady weapon on LEO. Also the barrel left a grease stain on dads shirt which the judge ordered the would be burglar to pay compensation for. A few years later, dad went in to break up a bar fight. As he went through the door, a man charged him with a broken bottle in his hand. Dad carried the largest maglight rather than a baton or nightstick, so he drew it an hit the guy on the head, knocking him to the ground and also breaking the head off of dads maglite. Charge: ADW on a LEO and destruction of county property. God Bless America!

One of my preceptors was a chicago fire medic. They are integrated and has been previously stated, they dont really do ride time. Also, these are the guys who stole the State Test for Illinois and have put us all through hell and contributed greatly to the poor quality of many EMTs and Medics here in the Land of Lincoln. Find yourself a good ambulance agency from one of the hospitals and ride with them.

To add to what AK most eloquently said, and I agree with every one of his points....In my system, we are told that in no case do we go more than 20 mph over the speed limit and we are advised to keep it at 10. 30+ over the limit is insane, stupid and here illegal for EMS. You are not in a high speed pursuit. And what happens to that patient waiting on the other end? Your partner blazing through traffic actually slows people down because they really dont know what to do to react and get out of the way and he is leaving them far to little time to do so. So what happens when your rig is on its side in an intersection because of your bonehead moron of a partner decides to play Indy race and that MI patient laying in their yard is decompensating? What happens when he takes you head first into a city bus injuring you, killing bus passengers while you, battered and bloody, reach for the mic to take yourself out of the service and transfer your call to another unit. And what about the units out of service to retrive his stupid a** from the wreckage of your rig, not to mention rescue squads, fire, extrication units. And if you both live, somebody's gonna ask why you didnt slow him the hell down. This guy should be out on his head. He is dangerous behind the wheel and that makes me think that he is also likely to be reckless in the care of his patients. If I were on the state EMS board and this were brought before me for review, he would have his license to practice pulled without a second thought for endangering his partner, the property of the service, everyone on the road and your crews patients. Next time he yanks you out from behind the wheel if you are ever cursed with him again, demand that he pull over and if he wont, grab the radio and request a supervisor intercept at a specific intersection due to the danger your partner is placing you in.

First of all, used to be a FTO means no longer is, so he should just unbunch his shorts. Since we basics are called "drivers" that puts the responsibility for driving and maneuvering decisions in our hands, as long as we are behind the wheel. ANYONE, including my medic partner, that reached over and changed my emergency apparratus by flipping on the sirens without ok'ing with me would be drawing back a bloody stump. Totally unacceptable. By your description, he put you in danger by flippng on the siren in the middle of traffic, which is also massively unacceptable, and should be written up for doing so. If he believes that his judgement is better than the one behind the wheel who is judging and adjusting speed, watching traffic, moving for traffic, then let him drive. But after having just finished EVOC, I would fail him if I were to judge his driving. Granted things vary service to service, but I was told in EVOC that you should have a working relationship with your non-driving partner such that if you want something changed about the way you were running, if you want callout over the PA, you will let him know, except in case of a changing road scenario, where he should check with you before he starts throwing switches. Barring that, he should sit there, call out traffic for you and enjoy the ride. He may be gung-ho. Gung ho gets people dead. He may be a medic, but he is mostly definately a rookie in action and a frigging siren junky. In my system, a W/D patient may get sirens but there must be circumstances like chest pain, cardiac/pulmonary history, CHF, COPD...something. And also here, unless the medic specifically requests a code three ride, the driving EMT makes that decision...and it is usually discussed. We have intercoms in our rigs that go from the box to the cabin. If the medic wants to go hot all of the sudden and tells me to punch it, he better hang on cause we're gonna go like hell at that point. I have one particular medic who will just shout, "he's crunkin" and I know to pull out all the bells and whistles as it were. Basically what he did was dangerous, reckless, stupid and is roughly equivalent to grabbing the wheel from the passengers seat. If I were you, I would request another partner because this one sounds like a dullard without the common sense god gave a horse. We have one EMT in our system who tapes a three by five card to the panel that reads "If I am driving, keep your hands in your lap." All due respect to Medics and the jobs they do, but if you aint drivin', youre a passenger. You may not want to get any bad blood going and working in a little inbred department myself i can totally understand that, but this guy, by throwing on sirens and stopping traffic when you are driving and then driving recklessly himself is going to end up killing someone, very possibly any and all occupants of your rig. As for his not letting you drive, we are assigned who will drive on a given day by the ops manager...so he wouldnt pull that around here. Sounds like he needs a little administrative attitude adjustment. He may well have been an FTO, but so was my father for the PD he worked for...in the 80's. I say again, used to be means isnt anymore so his comment about that means absolutely nothing except that he is trying yet another way to pull what he feels is rank. NOT ACCEPTABLE.

Goodness. Are they just wanting to know what preferable vital sign ranges are for a person of a certain age category or...? I usually just go by what I learned in my EMT classes and some common sense. Have you tried Tabers? I have the newest edition and thought I havent yet checked it for this, it has a great many charts and values graphs, etc. I dont know if that would be scholarly enough for the nurses you speak of or not. If they are so adament, there must be a purpose in them asking...do you know what it is, or is this some kind of Zen riddle they have given you? I know the AHA now says something like 116/78 instead of 120/80 as the gold standard, but what about things like skin warm and dry, pupils perrl, pulse/hr between 60-100, resps 12-20? I mean these come out of Brady but I have seen them cited other places as well. I am curious to hear what their reasoning is for demanding that you research this. certainly it cant be your experience and knowledge they question. Cant wait to see what you say. Good luck.

Youre right about the subpoena. In most places they are required to officially "compel" you to be deposed to make it all nice and neat in court.

Why is a subpoena not proper in your county. Most jurisdictions use them for depositions.

Ah stair chairs. What fond memories that conjures. I remember on the very first call I went on during my clinicals, we ran on a grand mal seizure. The gentleman was in the basement family room with stairs that were so steep that they practically ran straight up and down. Living in the midwest, there had originally been no stairs coming up from the "cellar." It was accessed from the outside by those big tornado doors. Sometime after the house was built, the cellar was turned into a finished basement and this staircase was added. So we get our patient in the stair chair, since the tornado doors had been sealed off with concrete and we couldnt get a stretcher in. As we were going up the stairs, the EMT went first moving the front of the chair and the medic was at the chairs back and I was behind the medic. I was proud of myself for following exactly what I was taught that I had my hand on his back and was calling out "step up, step up, step up." We got almost all the way to the top when I got the toe of my boot on the front of a stair and started to tumble backwards into the two LEOs that were behind me and sending us back down about 6 or 7 steps. When we managed to right ourlselves and the medic hollars down "everybody ok?" I look back at the LEOs, one of whom was the duty sergeant and he looks at me and says "step up." I have nightmares about stair chairs.

First, as a substitute teacher and someone who is put in all kinds of delicate situations with children (thank god I have never been accused of anything) I find it difficult to...justify this kind of behavior from anyone who holds the public trust. That being said... Human beings do weird and deviant things. You dont find many otters or antelope surfing the net picking up children. Humans have a dark side shared by little else in creation and some fall prey to it, cant control it. Some of the stuff I saw and heard about when working in criminal law haunts me to this day. However, I have also sat across the table from convicted pedophiles, rapists, murderers and serial killers. They dont really look any different from you and me. Im not excusing any kind of this behavior and it must be dealt with severly and quickly whether its in prison or in a mental health facility of some kind, and yes, there are people who are predators who shout not be allowed out in the world. But does that change what this man did as a medic? Did he ever touch a child on the job? Was his professional conduct anything but exceptional? The medics her turned out were top-knotch according to the original posting. Thats no mean feat. Its hard enough to turn out basics who dont smoke standing near the oxygen tank and dont blast the siren everytime they drive past their girlfriends house. But to turn out high quality, street ready medics...a herculian task. Hell, Im scared whitless to even think about medic school let alone that possibility that I might one day teach. Anybody willing to go up to their arms in blood and guts every day and try to figure out what meds to push in a 10 second window and get the patient to the ED alive, well thats a pretty special individual. Im surprised that more medics dont go off of one deep end or another into the dark hole. I lived for 2/3 of my life with a public servant...a wearer of the badge as many of you have read about. He was an outstanding police officer, served his community with nobility, compassion and dignity for 36 years. As a homicide detective for 25 of those years he brought closure to countless families by determining what happened to their loved ones and bring the responsible person to justice. He was awarded almost every citation available to him in IL. But his personal life....well...the job wore him down. He did alot of stupid things, dark things, that people wouldnt dream of doing in a million years if they didnt wade daily into the much and slime of human existance. Do the actions of such people deserve to be whitewashed. Absolutely not. Is pedophilia or child predation one of the worse crimes imaginable....from dealing with the minds and lives of these people for longer than I care to think about I can say that it absolutely is. But they are human beings. Do we strip them of everything else in their lives because of the dark side that they may or may not be able to control. OK. So i am a knee-jerk bleeding heart liberal. Glad to be called that. But somewhere, there has to be room for forgiveness and reconciliation. I hope that the people that learned from this man and are now out there getting it done dont feel as though they have screwed up, or worse, been dooped. I worked with a client once that I believed in whole heartedly. As far as I was concerned the prosecution was cooking up a case cause they need a predator conviction. And then they turned over his computer files during evidence discovery. I went to the trash can and vomited until my ribs were throbbing. But there is the job. In criminal defense, we chose the case to defend the rights, not the action as so many think. We defend the process. The human beings rights. So this guy slipped into the hell of that lifestyle. He still trained good medics and no one needs to worry that he wont pay for what he has done. I can tell you that no matter how light a sentence he may get, cell block justice will have its way and no deed goes unpunished in places like Joliet, Marionville, Menard, Statesville. These are the prisons you hear about as being the most hideous in the country. And they dont just exist in Illinois. Having been inside each and every one of them I can tell you that hall has nothing on them. Take the good, take the bad for what its worth and move on.

Im sure your right. It would appear that I have attributed an accepted maneuver and attributed to the partner I am used to. Thanks for enlightening me.

Actually in my city, we are sort of unofficially trying out the "stop and stay where you are and I will let you know if you need to move" strategy. All ambulance and PD vehicles have had the "curb right for sirens and lights" signs taken off of them. During my clinicals, I found that it often helped if people just stopped. At least then we can sort of see a pattern that we might be able to get through. Obviously stopping right in front of me or boxing me in is a no no. Oh and if youre in the right turn lane and it looks like that my be my route of travel, safely go on through and dont sit there. This has happened to me many times which is why one of my medic partners almost never uses turn lanes. A good way to get trapped. With a few exceptions if we are running hot (which we do to all calls, largely because we get "man down" or unknown pain calls) this particular partner will get himself into the intersection and make a wide looping turn to the right. He is an EVOC instructor and one of the few that I feel completely comfortable with. I dont have to reach for the OH Shite! handles at all. I have complete confidence that he will get us where we need to go expeditiously and safely, so I just sit back, call out traffic, move them with the PA if necessary and enjoy the ride.

Garcon! Two Yankauers to this mans table and put it on my tab. Have you tried EBay? I could always "acquire"you a couple if everything else craps out....kidding...sorta

Though we have gotten far off the original thread, I appreciate the level of informed discussion here, especially since this is an area that is so overlooked in terms of EMS. Just out of interest, I drug out my Brady Pre-Hospital Emergency Care text (Basic Level) which was the most current edition available at the time I took my course. Oddly, it mentions assault, battery and self defense by the EMT or Medic not at all in the Medical Legal Section, and in the chapter in Behavioral Emergencies shys away from the idea of self-defense in favor of the more politically correct notion of "human restraint." According to this admittedly non-legally based text, self-defense, in so far, as the EMT or Medic is concerned is defined as "the minimum amount of force required to affect humane restraint of the patient" and cautions that only methods which have no possibility of causing harm or further harm to the patient should be applied. Ironically, the accompanying illustrations, show the EMS crew getting involved with and EDP with a baseball bat. There are about 5 EMS members in these photos with no LEOs in sight. The crew is however, using decidely LEO techniques to obtain "humane restraint." In particular, they are using the wrist twist elbow thrust technique which if used by untrained personnel is likely to either break or severly injure the patients wrists and elbows. Whats next? The stiff arm bar across the throat. They also advocate packaging a combative patient face down, so long as his breathing is carefully monitored. I know that in the military pre-cursors to our modern EMS, such technique was often called a "sandwich case" in which two stretchers were lashed together with the patient in the middle, tight enough to allow the crew to flip him either face up or down depending on injuries. I also saw a documentary the other night on the Discovery Channel about police and EMS dealing with EDPs and they showed a EDP patient being handcuffed (covered in gravel after an obvious struggle) and restrained face down with his arms behind his back. Hmmmm. No wonder none of us know what to do to protect ourselves.

Brian- Im not sure what you mean by "issues with personal attacks" so perhaps you could delve further into that for me in a PM where I think that kind of stuff belongs. I appreciate your comments and if I disrespected anyone by statement or tone, I sincerely apologize. One of the things that I was trying to reinforce, is that in terms of assault, youre focusing on the word "threat." This can easily be tested by having an argument with your neighbor. If he hollars "Im going to shoot you" this is not assault. At worst it is disorderly conduct. If goes to the house and gets a gun, he has then escalated not only to assault, but aggravated assault with a deadly weapon. Perhaps more to the point, assigning assault to a verbal comment, regardless of what it may be, is useless. Are the police going to arrest a patient for saying he is going to hurt you. Nope. Are they if he says it and then goes for ya, You bet (if they are doing their job) because that element of furtherance exists there. A really good example of this is that you can stand toe to toe with a LEO and say Im goona whip your a** pal, blah blah blah and there really is nothing he can do under the law unless he wishes to site you for some breech of peace related offense. The moment you reach for him...assault...and aggravated assault because he is a LEO. It simply doesnt matter what the person says, if there is no follow up action of any kind. If so, we would have people getting arrested on freeways, etc everyday for assault. I followed this up with my LEO father and he confirmed (living as he does in Devine, TX) that an act in furtherance must follow up the threat in order to have a true and prosecutable charge of assault. After 36 years on the job, I trust his judgement and knowledge of the law. He now works in private security and trains LEOs in appropriate use of force to ward off an assault AS IT IS DEFINED BY LAW. I respect all opinions posted in this thread and defer to anyone with more experience than I have. My only "issues" with assault (and assault and attack are not the same thing) is that I have the legal experience to know what these definitions are and how they will be prosecuted and the personal experience of having been assaulted twice by two seperate patients. Again, I greatly respect those with more experience than I have. As for the "actually" comment...i think it can be hard to judge tones in these posts and I assure you that no offense was intended and if offense was taken I again humbly apologize. Thanks Brian, and I look forward to more discussions on the topic of EMS safety and self defense. PS- I think in your most recent post, you have the definitions of assault and battery reversed. There is no such thing as verbal battery. I assume that was a typo. I dont remember anything in the medical-legal section of NREMT exam about self defense or assault/battery. Would be most interested to see what they have to say. Not saying its not there, just saying medical legal on the Basic exam was about 5 questions about neglect and abandonment. It might also put things in perspective to acknowledge that the term "assault" is often used generally to mean a physical attack. Technically, its definition is the action leading up to the attack. Assault-Step 1 "I am going to knock your head off" Step 2 - I produce the baseball bat. Step 3- I swing it at you. If I miss, we have an aggravated assault with a weapon. If I make contact we have aggravated assault AND battery with great bodily harm, scarring or disfigurement. Two seperate charges. In Illinois, the assault portion would be a Class A misdemeanor and the battery, since a weapon and bodily harm is involved, would most likely be a Class 2 or Class 1 Felony.

Great Post and I think Jersey really has a great system.