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I didn't see that you were American until nwoparamedics made his comment, glad I didn't make a hockey comment.

The way you wrote your comments makes it look like you were lumping everyone together. I am sorry if I misquoted you but that is how my crew and myself read it. Long live fire-based EMS.

Although you do have do have some good points to say that we provide the lowest form of service is wrong. Down here in the states there are places that suck at EMS, but to lump all fire-based services in one group is wrong. In fact, I would put the 19 paramedics that I work with against any other group of 19 medics working at one agency anywhere in the world. I work for a Washington department, and in my county, and the west coast in general is very progressive with EMS. In my county we have a very progressive QA/QI program to prevent lowest common denominator medics from surviving/ hiding in our system. We also have active protocol commitee that is constantly reviewing current methods and equipment ( and medications) to see how we can improve our service. Its too bad you have such a negative outlook on fire based EMS. While I am sure you can find whole organizations that would fit your model of poor practice, there are some absolutely phenominal paramedics and EMT's that you take credit from when you make such general statements. Perhaps if you worked for a fire based provider you could effect change in your area from the inside. Or you could move to the Pacific Northwest U.S. and see first hand what I am talking about.

Most West Coast fire departments provide EMS. Having worked in both sides, 3rd service and fire departments, I'd have to say it's not about what kind of department you work at but the type of people working in your department. I have seen EMT/medics that were great and sucked in both situations. I am a medic that is a firefighter too, and love it. If my district was covered by privates or 3rd service we would have 3 transport units spread out over 120 sq mi. as opposed to 5. I don't understand why people always have to talk down about firemedics or medics. We are all out for one thing, the better good of our citizens.

Look into ACLS fro EMT's, I think AAOS makes the book. Some of our EMT's went through the course to get a better understanding of what medics do in cardiovascular situations and loved it.

King County Medics at their best! Remember, they have the best system in the world, NOT!!!

I'm not anti-volunteer, I'm pro-career.

What kind of agency would allow that? Bad news, won't it be nice the next time they go on an EMS call in that neighborhood and someone takes pot shots at them. I think it's one thing to use fire/EMS units for cover in certain circumstances like they did in during the Columbine shootings, as long as it's not an unprotected person driving it (i.e. me), but this crap?

Remember to only use enough force to stop the attack, and always notify LE and document, document, document!

Good job, your boss needs to learn to treat the Pt not the pulse ox.

WEAR YOU F*&^% SEAT BELTS!!! Remember it's their emergency not yours.

I agree, peak-flow worthless. ETCO2 great.

I am the candy man, to a certain degree. Anyone of us who has been in Px understands how uncomfortable it can be, and why not do for others like you would want done for you. My requirements for how much to use are: 1) Keep em breathing 2) Keep em happy 3) Follow the protocol. A medicated Pt is a happy Pt, plus who said you have to knock off the Px in all situations, you can help take the edge off if that's all you can do.

Being an EMT-B is 90% being nice and 10% skills that get used. If you work for an agency that does inter facilities then being nice is most of you job.

I am currently working on getting my EMT-I Cert and I've been wondering what else can I do other then be a Ambulance jockey? Ambulances are fine and all but the hours and the pay both sorta suck. #1 WE ARE NOT AMBULANCE JOCKYS!!! I hate that term. We are professionals that sometimes get treated like crap because we are seen as second rate CNA's that just drive fast and mess things up. I went through a 1,600 hour education plus an extra four month FTO program after I had my PM cert to do my job. We do a lot of things a nurse does, and some things a nurse cannot do (i.e. tubes, crics, Cx decompression, etc). Until we get rid of terminology like "ambulance jocky," we won't get the respect we deserve. #2 Hours- find a system that has 8, 10 or 12 hour shifts if you don't like 24's. #3 Pay- I agree, if you wanna get rich find another job. If you want better pay become a PM, RN, PA, or something else; find a system that pays better like municipal government run systems (i.e. city/county). Or better yet sit in an office trying not to get paper cuts or hurt yourself with a stapler. And as for all the talk about the ER skills, I can understand a PM working their pushing drugs because of a better understanding of indications/contraindications but a EMT-B? What a liability, keep in mind I love EMT's because I was there once but with more training you understand some things you did before probably wasn't a good idea. If you want to push drugs, get more training to become a higher cert. Please don't take this the wrong way, but show some respect for this great profession.

When I work with another medic we alternate calls, if I'm driving I help him and he is in-charge and when he drives I'm in-charge. Now I say "in-charge" because who ever is responsible for Pt care is the boss. We work together and help each other out. The driver is the airway guy if needed and the PM is running the call. I know it's the same other places too.

ZOLL SUCKS!!! I have used both, but like the LP 12 due to ease of scrolling through the menus. The CO2 monitor does a better jog, it takes BP's better, easier to pace, easier to defib, 12-leads come out better, the screen is bigger, do I need to go on? I think LP12 is a west coast thing and Zoll is a east coast thing

I think it is more a matter of experience vs age. The youngest guy in my class was 22 but he already had four year in a busy system with lots of calls under his belt, was a great student and very professional. Remember BLS before ALS. As for older people, as long as they can do the job (i.e. lifting, riding around in a box for 12 hrs), go for it. Fitness is a big deal to, I'd rather have a 50 yo that is in good enough shape to do the job than a 23 year old that is out of shape and can't lift the 90 year old without throwing their back out.

I agree with Ryder, RSI is an important tool that is needed in certain cases. It all comes down to training and volume. If you don't use it you loose it; meaning if you work in a low call volume system and always need to go to the OR to recert, maybe RSI isn't a good choice. I think the main problem in EMS is people in other medical fields (i.e. MD's, RN's PA's, etc) don't think we are compitent. How many times have you been called an ambulance driver? EMS needs to be more vocal both with the public and other professionals about our real role. Pre-hospital care is a technical field, we have some of the same responsibilities as a doctor and a nurse. It's time to step up boys and girls and next time you get called an ambulance driver, professionally educate the person, just don't be an ass about it. The Gospel according to me. Stay safe brothers and sisters.

We premedicate with Atropine (kids) or Lido (head injuries) if indicated. Then sedate with Etomidate (.3 mg/kg) in head injuries or hemodynamically compromised Pt's. The other option is Versed (.1-.3 mg/kg) in kids or hemodynamically stable Pt's. Then use Succinycholine (1.5 mg/kg) if no contraindications or Rocuronium (.6 mg.kg) if you can't use succs. Contraindications are hyperkalemia, head injury, massive crush injury, penetrating eye injuries, skeletal muscle myopathies or Hx of malignant hyperthermia. For continued sedation we use Ativan or Versed, and for continues paralysis we use more Rocuronium. RSI is a great tool if used by a properly trained and educated medic. I think it is necessary to maintain CE to make sure your ready. Remember the ABC's, AIRWAY, AIRWAY, AIRWAY.