NREMT-Basic

Since Liver and Gall Bladder are Zang and Fu, mother and child, etc and his liver qi is deficient (xue) then he has an excess of qi of the gall bladder, which could cause pain in the hips, thighs, knees and ankles as well as the muscles of the lateral legs since the Gall Bladder meridian runs down this aspect of the patients leg. He should be given treatments which tonify the Liver so that it may draw qi back from the Gall Bladder. Also, treatments which sedate the gall bladder will help with this condition. What is the appearance of the patients tongue? It may be helpful to consult the Yellow Emperors Classic of Internal Medicine and also the Treatise of Cold Induced Disease.

Answers (as far as I know): 1. I dont believe a law governs uniforms. In IL..if you are responding on duty, you do, however have to have something visible...the volly service I am with issues photo ID's that clip onto our shirt collars. We also have an official copy of each providers DOPH/EMS license up in a prominant place in the station (right as you come in the pubic entrance) with our photos next to it. Our tags have our name, level and our call sign on them (all EMS in this county is Charlie or "C" and then a number.) 2. From working in labor law in a previous life, I dont believe OSHA really has anything regarding what a uniform must be worn. Mostly these are in the "equipment" section of our protocols. We dont require steel toe boots because their is a dispute among providers as to whether or not they are helpful or would cause further damage. i wear steel toed flight safety boots. 3. Yeah, i would think being sober would be a good thing. Though around here, if you respond off duty, you fall under the good samaritan law so you are much less likely to be sued. We arent like policemen who are required by state statutes to respond to a situation no matter whether on duty or not.

About the age of the incoming students....what do you think about raising the minimum age that is required for a person to enter the EMT course? Here it is 18, though I have heard some places it is as low as 16. I personally would like to see it go up to 21 and perhaps 25...maybe if youre not old enough to rent a car, they shouldnt trust you with a half million dollar vehicle.

Since there arent any Medic programs starting in my area in the next year, I am considering getting my Masters in Public Health, which I see alot of well qualified instructors and authors in the field of EMS have. Dust- whats your particular opinion about this? I would get the Masters, which would also include things like more advanced a and p, origins of disease, public healthcare during epidemic/pandemic situations, etc. Do you think this would be helpful when I finally do go to medic school? Thanks in advance for your input.

As I can testify from the difficult in finding gainful Basic work, there is no shortage of us running around out there since we are multiplying like rabbits and generally its the first guy in the door who gets the job. However, Ive done some research and I differ a little with the other posters. The median ages of people going into EMS is getting younger (in Illinois you have to be 18 and many people are going to EMT courses right after high school, as they would have CNA classes a few years ago) so there are lots of people out there with their EMT cards in their pockets, as Rid rightly said about medics, working at walmart and mcdonalds. However, in my home city of about 30,000 people and the next city of about 400,000, there are three hospitals offering Paramedic programs. I called them all three days ago and they either just finished a Medic school, or are finishing it up now. All three directors said the same thing...because of the educational level of many people coming out of high school (ie poor math and literacy skills, poor written and verbal communication, etc) alot of people do not look at going on to Medic school, or at least not right away. In the agency with which I did my clinicals, there were Basics who were my age (early 30s) and had been medics for 10 years. One of them has taken the NREMT-P twice and cannot pass it. If somehow this cross section of people do find their way into the paramedic arena, they will not be good and will not last long. Another factor to consider is the "greying of America": a significant part of our population is now living to be 90 or older...these folks tend to need a great deal more medical care. Finally, the Department of Labor anticipates that Paramedicine (and actually EMS in general) will be the fastest growing, non-physician medical careers through at least 2010. That being said, I have to reluctantly agree with other members of the City who say that the overall quality of EMS responders is going down. I was recently in a hospital after a volly run and heard one of the medics from a large midwestern service talking to his buddies...he had been a medic for about 18 months and as he said "got the chance" to do a needle crych. However, he couldnt manage it by the time he got to the ED. Now I will admit not being advanced enough yet to understand all of the ramifications, what he could do when this didnt work, etc...but its true that around the country, paramedics protocols are being limited because people simply are not willing to put in the thousands of hours of skill practice that is required. There may be no shortage of medics at the moment in the US, but there is a shortage of excellant medics. And honestly, in my area where there are enough services to make most transport times between 6-8 minutes, the medic often finds him/herself taking vitals, giving nitro/asa, starting a line and making his report to the receiving facility and thats about it. Wounds are bandaged on scene, usually by the Basic as is splinting and many people have figured out that they can often get a free check up by calling the ambulance and then signing the refusal form. What we must do in order to create a demand for good EMS providers of all levels, is to raise the standards and start developing more progressive EMS services...check out services like Acadian, the largest single private provider in the country. They build their own rigs, have bike crews, marine crews, etc...they are on the cutting edge of what the field can be and they have their own Medic academy. If the profession is to flourish, we must expect more from our responders and start to see more services that are owned by someone other than some guy with the money to buy a few rigs. We need to see services started and owned by the practitioners of EMS themselves, meeting the needs of their own communities.

Unfortunately, in labor law, there are two kinds of employment: contracted and at will. Contract specifies terms and duration of employment and usually the situations that could arise that would cause you to be let go. "At will" employment is just that. Your employer can let you go at any time, for any reason, or for no reason at all. It stinks, believe me I have been there. I dont think you should look at your paramedical education as a waste. It sounds like you are good at it an work consistantly to improve yourself as a medic. Maybe you will have to relocate, etc, but I am confident you will find a new situation. The thing is that if they want to give you a reference, thats fine. But also know that under US labor law, the only thing that they can tell a potential employer who might call them is to confirm how long you worked their, verify your hourly wages and tell the prospective new employer whether or not they would hire you again. They cant legally say anything else. They cant talk about your attitude or if you smelled funny. I would also be honest with any prospective employer during an interview and lay out the situation surrounding your termination. But, by the sounds of it, and as another poster put it, the word is probably out about them and how they treat their crews and new employers really do take that into consideration. I know its hard when you are out of work, but try to stay positive and since you were fired, you an apply for unemployment compensation, which can help keep food on the table until you land that next medic gig. Good Luck and keep your chin up.

Perhaps, just perhaps, you could run a paid ALS service this way. I doubt it. What I would like to see is where the magical problem solving numbers come from. It always make me doubt the accuracy when someone gives a statistic and says something like 'a friend told me.' Anyway, we are now all guilty of massively hijacking this thread. -15 to all those who participated in knocking this thread off the rails (including myself). Now if you'll excuse me, I just found .13 cents in the couch cushions...Im going to go start an ALS service.

You assume that everyone who gets into EMS wants to become a paramedic...the Paragod complex rears its head. Thats like saying that every person who goes to nursing school to work in an ER actually wants to be a trauma doctor. And you think a town/city of 20k can run one rig, staffed by two ALS providers for .13 cents a day. I live in a town of 30k and it takes two services running 5 rigs each to take care of the assistance load 24 hours a day. On rig and one crew dont work in a town of 20-30k and you know that to be true. Thats just a worthless suggestion. That would bring us back to 40 minute response times. And if you dont want to hurt you back and your neck, and if you cant handle some unpleasant memories, then be a florist. Thats what EMS is about. If you work in NYC or Dynamite Springs, BFE, these things are going to happen. Is your back any less hurt or your memories any less disturbing for 45k/year than for a lesser amount. Pheh! and minus 10 for faulty reasoning and figures not based on fact. The fact is that even you, in your "infinite wisdom" couldnt provide adequate service to a town of 20k with one rig...and its not like it wold be one crew running 24/7/365...you would probably need something more like 3 crews to covers time off, sick leave, family emergencies. The city of 30k I live in has 3 extra crews on each service just to cover such eventualities. And if you have that one rig and its on its way to say, an acute MI call, and it gets hit going through the intersection....how much cardiac muscle will your patient burn when there is no back up. There are enough holes in your plan to drive that rig through. And even if it worked...do you honestly think they are at the communities "beck and call." Double Pheh!

Unfortunately, you have once again presumed to prescribe a method that will work in all communities all of the time. The situation they have works for them, its an older community and as I believe I said, the nearest EMS/Fire responders outside of this town are 30-40 miles away...and as of the last time I checked they were working on a grant from Homeland Security to combine departments, but the wheels of the government grind slowly and exceedingly dumb. Im always surprised at the closed-mindeness of some of the Citys most experienced and voluminously posted "veterans." Do you think a town of 100 souls can afford $6200/month...of course not. But they found a situation which works for them, raised the money for one truck and one engine and they save lives and property. This is obviously a super-rural community...should they let a COPD patient weight 40 minutes for a rendezvous....should a house, farm and someones livelihood be allowed to burn to the ground while they wait. Again...my new favorite response...Pheh! Double Pheh!

Rid- I can understand where youre coming from, but I still think it doesnt hold water. I mean esentially your argument is something like, if the town can thrown a veterans day parade, they can afford to pay their volunteer fire/ems. Not so, and I think you know that. We have a town about a hundred miles from where I live. It has a population of 110 people. They have little town picnics, etc and I think a bus might run through their every few days. Until a few years ago, they had no fire/ems response locally at all with the nearest responders being 30 miles away. So, the people of the town got together, got a firetruck (forgive me for not using FF terminology) and one ambulance. Then before using it, they send 4 of the towns men to FF school and there are 2 women in this little burg that have gone to medic level. Thats their emergency response system. But they cant afford to pay them. They need things like road salt and to pay someone to keep the weeds by the side of the road cut down because the state says they have to. I would honestly like someone to show me a study that says that across the board, volunteer EMS is no good...that it somehow sacrificies the quality of the care that it provides the inhabitants of its community. Or what about the towns closer to me but next to that little one...they have a Fire-Rescue service, all volunteer, called Win-Bur-Sew Fire Rescue, for the names of the towns they serve. Their fire fighters and EMS personnel make no money at what they do. they leave their jobs in the middle of the day and their homes in the middle of the night to put out house fires, tend to patients having acute MIs and deliver babies, among the million other things they do every day. Do you really have the conceit to say that they are no good or that the towns they live in are slacking off because they cant afford to pay these dedicted folks. Not everplace is NYC or Chicago or LA...alot of communities really do have to make do...do you honestly believe that having no EMS is better than volunteer. Pheh! I say.

Besides...if everyone became a paramedic, who would paramedics blame their problems and screw ups on? Stupid idea. Doesnt cut it. But, it is good to see that Somedic still cant offer up a suggestion without having to bash others to make himself feel better about his own life. Atta boy, Somedic.

How many of those others do it for free? Well...I guess we could start with Doctors without Borders. The simple fact is that many communities can afford the equipment or the personnel but not both. I dont know where you live and work, but I have seen some pretty outstanding volunteers. Whenever you say "all" volunteers are bad, that they are terrible, that they are part of the problem and not part of the solution....you are making a generalization which doesnt stand up to scrutiny.

This morning, after reading this article my Andrew McIntosh of the Sacramento Bee, I was bothered enough to write him an email. Not because he said that some EMS personnel have drug problems, but because of the slanted way his article was written. He wrote me back, saying his article was "fair and balanced" (does he moonlight for FOX?) and had the following to say about EMS, and those who work in this field: "Dear Mr. KinCannon: Wow, can I ever feel the heat out of your key board. And Iike it. My newspaper does dozens of stories every year on the heroic deeds of paramedics and EMTs ( yes i know the difference, as you soon shall see) and guys like you never call to praise them or say, gee nice story. You guys like to live on a pedestal and you crave public worship. However, when we shed a little sunshine on a taboo issue in your world - one that is less flattering - you're jumping up and down and making groundless accusations. One of the cases I have reports that EMT partner went to work with a paramedic for 3 months and everyday she strongly smelled of alcohol? Did he report her? No. What's that about? Shame on me? Shame on you - for taking cheap shots at the messenger. .The state agency here says there's a problem. Are you saying they're full of it? Employers in your field prefer to fire or force people to resign rather than deal with employees with problems and get them help. Far from reckless, my article was comprehensive, fair and blanced. Dozens of your peers have written in to praise and celebrate it's groundbreaking scope. I' m not sure you went to our web site and looked at the entire package, either. Look at the case studies. A Lot of pain and suffering there. If it were my business, I'd be concerned. That said, I like to hear from guys like you. Keep em coming. Dialogue is good." regards, Andrew McIntosh Assistant City Editor, Investigations The Sacramento Bee

Yes, I think better pre-hospital education at all levels of EMS would be an excellant start. I am really an advocate for a more "police academy" style training, where things are most standardized. Even little things, like students, whether they be future basics or medics, wearing uniforms to classes. I have observed classes where students come in in street clothes and where they wear uniforms. I guess its a dress for success thing because the uniformed students seemed to have a better handle on information, took pride in their education and did better on practicals, ie patient assessment, megacodes, etc. As for the standardization of training, I do believe this would increase the level of professionalism. From physical fitness training to things like CPR training...some use AHA, some use National Safety Council, etc. I also think that a more "degree" style training would be better suited, in terms of expanding Basic school to 8 months instead of 4 or 5 and medic training to a full 2 years, both basic and medic having the possibility of being dropped if you dont meet performance and skills mastery benchmarks along the way. We are dealing with peoples lives and health here. You cant train too much, or be too educated.

What about across the board better education for Basics, including better, more qualified instructors. When I went through my classes, the instructor couldnt pronounce, let alone define elementary medical terminology and hadnt been on a call or in the field in more than 10 years. While bandaging is not THE most critical skill in the field, we never were even taught pressure bandaging, were lectured on but not demonstrated occlusive dressings for, say, neck or chest wounds. When I realized that we werent going to get this stuff, I got a friend of mine to get me a Marine Corps. "corpsmans" manual and taught myself. To a certain extent, I can understand the feeling that Bs are undertrained. We had a girl in my class who, even after being passed through her national practicals, couldnt hear BP sounds through a stethoscope, let along lung sounds, etc. So yeah...at the early on stages, I would say better instructors, better instruction and better training equipment...half of the stuff we were using was either so outdated or beat up that it was barely useable. It was hard for us to train for Combitubes, because the maniquins we were using had cracked "lungs" so you couldnt tell if you were getting any air in or not and we were just old in simulations "ok, assume you got the tube in the trachea." Kind of silly considering how frequently they end up in the esophagus. Still being a Basic myself, I really hope that this doesnt degenerate into the old standby medic vs. basic argument or the arguments that say that Basics are worthless and should be eliminated altogether. I think the author of this thread has that in mind as well. Im hoping for good posts from people with alot of EMS field time under their belts. Thanks and I cant wait to read what you all have to say. Thanks also to the threads author for sticking their neck out to discuss a topic which frequently becomes an argument. Plus 15 points for that.

I just took EVOC recently and they didnt mention the devices, so i am not familiar with them. I assume they are speed based and not stupid driving maneuvers based? On a related note, do many of you have governor's controlling the max speed on your rigs? Ours are set at 75mph.

This argument is like has more holes than a lace curtain. First of all, we are comparing pay scales in about 4 different countries, so its meaningless to be shocked by the comparison of what the American EMT vs the Aussie EMT makes..its a little thing called the exchange rate. And of course, if you have someone who has faithfully served as Basic with the same agency for 20 or 25 years here in the US vs someone who went EMT straight to Medic in a total of about a year and a half and when they get that job riding with that 25 year medic have months of road time to his 25 years, yes, experience matters. Longevity counts. And those longevity/seniority pay raises arent for nothing. That 25 year EMT has more real-time experience in the box, dealing with patients everyday, than that medic does, regardless of their skill set, scope of practice etc. That Basic knows the community he works in. He knows what areas have the highest level of violent crime calls for example and may well have been on multiple crime scene calls over his 25 years. He most likely has every bit of his area memorized like the back of his hand and knows every short cut to and from the hospital from anywhere in his service area. Ok. So he cant start a line, or drop an ET, but his mere experience, decades of it, have merit. He has real world, real time experience and just like older nurses with younger doctors, he may actually be able to simplify some calls, etc because he no longer rides around with his EMT handbook in his pocket consulting it for every patient. He knows the patients that call you everytime they have a bad day and get drunk and whats more, he knows how his service handles that individual person. And OzMedic, you make a huge assumption, and a totally groundless one, when you say that that 25 year EMT hasnt had one more hour of education or training since he got his cert. That is absolutely the height of egotism, and you know very well it isnt true. If nothing else, he has to maintain CEUs to keep his license. Do you suppose they had AED's 25 years ago when he started? Nope. So he has probably been uptrained to use one. How many times has CPR procedure changed in 25 years? By your fallacious reasoning, he would have just been allowed to ignore those changes and do things the way he did them 25 years ago. This is the problem with rash generalizations: it makes the assumption that because there are some EMTs or even Medics who are willing to to sit back, get most of the CEUs every four years by sitting in on classes, helping out with MCI days, etc. But there are those who constantly work to improve themselves at the level they have chosen to work and they deserve to be respected for it and their pay should reflect it. If nothing else, for doing the same job for 25 years with the same service, he deserves the pay and respect. What would you do? Have him making the same amount as he was making when he started. Its a ludicrous argument, based on ludicrous and outdated concepts. As has been said, deal with it or find another line of work. Experience and dedication to an employer matters and is, in most cases rewarded and there should be no cap on what an EMT or Medic makes just as a general across the board thing. If the owner of a service wants to give that EMT a 2.00/hr raise because he performed particularly well (called a merit increase) and that puts him at a higher rate than some 25 year old who just got his Medic cert, too bloody bad. When youve been a medic for 25 years and a new hire EMT makes more than you do, then and only then would you have something legitimate to whine about. Otherwise, get on with it. That EMT isnt taking money out of your pocket. Youre just griped because you have more initials after your name and he is making close to the same amount of money. If you got into EMS for the money, somebody sold you a great big bill of goods. Its about the patients and thats it. Not how much you make, or how much your EMT partner makes. Its about patient care and quality of service and the fact is that that old, tired but still working for his community EMT has more years of patient care and service than the new medic and that deserves to be rewarded. Ok, so he makes only a few cents less than you do or perhaps more. Wah Wah! Cry me a frigging river. Get over yourself and move on to take care of patients. That is all. We now return you to your regularly scheduled p*** and moan time.

I have to say that I think the Norwegian chap is one of the funniest youtubes I have seen in a long time. As for Paula Abdul's tox screen...take your pick.

I guess that begs my next question, which is in fact about the use of the Combitube. Given that the risk of soft tissue/cord damage is high, is it considered enough of a known complication/risk that if we do it we are going to be somewhat protected against litigation. And I make no claim that it speaks to anything other than my experience, but out of the three Combis I have dropped in the field, one actually went into the trachea and to be honest, since I saw no blood gushing into the airway, I have no idea what damage may or may not have been done, only that we achieved a patent airway (or a Combi-airway if you are of the mind that a patent airway can only be achieved with an ETT, which I say to allow for both sides of the debate and not to slam someone who feels one way or another).

Just as a point of interest and conversation: the med list for an Ontario PCP is identical to our EMT-B drug list with the exception of the last drug, which I readily admit not being familiar with. In IL we also include the obvious O2 as a "drug" allowed to be given with standing order.

In the interest of my own education... As an EMT-B, obviously ETTs are not of concern to me, except insofar as they involve whatever assistance I might give the medic. But consider if you will, the following for my edification: If we say that a truly patent/protected airway is one that is a)held by the patient or b)held by ETT, if we have a six minutes transport time from just about anywhere in my area to the nearest facility, what is the medics best and most viable option? Multiple pharyngeal airways? ETT? I guess what I am asking is if we are 6 minutes out, is it in the pts best interest to attempt an ETT given the information by another poster that most ETTs require at least 2 attempts? Notice I dont even bring up Combitubing. When I first got my EMT, I was very excited about the possibility that at my level of training, an instrument had been devised to allow me (not for reasons of prestige or ego)to "tube" a patient. After having done three in the field now, since my local volly department runs BLS, I see them as a "lube, cram and jam" procedure of last resort. I still hold that they are a wonderful asset, but as a last resort which is carries a very high risk of causing esophegeal and/or tracheal damage. I have also just about reached the conclusion that if I were to get a perfectly placed (ie tracheal) Combi, I would probably still trash the cords since Combitubing is blind. I would also be interested if someone had statistics on damage done by Combitubing in the field. So, if we take our old friend Combi out of the picture, what is the best option if an ETT is not plausible because of time, difficult intubation field, etc? Im hoping not to get trashed for asking this since it is a sincere question with no motive other than to educate myself. And I say hoping not to get trashed, because I have noticed an alarming trend of certain posters blasting anyone with whom they disagree even when the question is not intended to incite controversy. As a side bar, it would be really great if we could return to the days of yore when questions were just that...a means of education and not an invitation for a bare knuckled bar brawl. Thanks.

I havent followed football probably since the Bears won it all back in '85. The Colts used to be from Indianapolis, I think they are now from somewhere else. I just know I will be watching the Bears smear em on Superbowl Sunday.

Whats your beef with methadone clinics?

In what way would an EMT starting an IV take money out of the Paramedics pockets. Last time I checked, most services are volly, paid by call, paid by hour, or for some advanced paramedic positions, the medic receives a salary. I honestly dont see that having a Basic start an IV line is more expensive for the community, since if we Basics started IVs, it would probably become considered a BLS intervention and would hold down the cost to the commuity since BLS fees are less than ALS. Its not like the Medic gets paid for each IV he starts. The only time that the shear number of IVs you start makes a difference is when you are working that 1000 hours of clinical time in the ED or in a rig. Your argument really does not hold water or make any sense, nor does it seemed to be grounded in the realities of how EMS works. I now have a second license in Wisconsin and am being uptrained to start IVs. Tell me...how am I taking money away from my medic partner.

Dust- Hey Brother! Good to see that all your pieces parts are still where they were when you got there. How far down in the sand did you have to dig to get that SAW? And if you didnt, you really should stop cleaning it with a hershey bar. Now, tell me again how the boxes were going to be labeled when you send my Hummer one piece at a time... Keep your head down and your chin up.