Stupid EMS Rules, Regulations, or Practices ................

[firedoc5]

What we need is to make the CPR recert more health care specific (and I don't mean AHA's or CRC or anyone's CPR-HCP) course such that it makes good CME. So rather than spending hours on the how boring everyone to death, spend the recert on the latest from ILCOR and the why. That would be a recert worth the few hours. Though I just sign my friend's card and he signs mine each year, since we're both instructors.

I've done the same. As an Instructor myself, if I get some guys that I work day in and day out with and have ran numerours "codes" with them, I'd just sign them off basically. The time that we are required to spend on that certain station, we'd just shoot the bull or tell jokes. I'm so ashamed. :oops:

[VentMedic]

I've done the same. As an Instructor myself, if I get some guys that I work day in and day out with and have ran numerours "codes" with them, I'd just sign them off basically. The time that we are required to spend on that certain station, we'd just shoot the bull or tell jokes. I'm so ashamed. :oops:

That would explain some of the bizzare questions you see on the forums about the basics CPR. Sometimes the logic also needs to be put forth and emphasized or some stagnate in ideas of the past and don't move on with new concepts or have little understanding of the whys.

As boring as it may seem to some, I try to learn something each time I recert even if it is reading a couple of research articles in the reference data as to why things have changed and how they arrived at their conclusions.

[WolfmanHarris]

You see Ventmedic, that's the type of recert I'm encouraging. The problem is the standard CPR-HCP recert doesn't provide any access to the research or references. It's taught entirely by rote and repetition which is only good the point of mastery of the physical skill. After that you need the background to make it the least bit relevant.

[firedoc5]

I was so relieved when I became an ACLS Instructor. There was always changes and new challenges. With basic CPR, how many years was it the exact same? And when they did have changes it was procedures that were used at one time, then "improved", then change back to the way it use to be.

It's been a long time since I taught a basic CPR class, but I hope it covers a lot more than it use to.

We had one veteran Instructor that always said that the CPR class should be a two day/night course. But he did try to cram what seemed to be two nights into one.

[WolfmanHarris]

Let me put it this way, CPR "C" Basic Rescuer (not sure if it's called the same in the US) was dumbed down so much they had to create a new level for Health Care Providers (CPR-HCP). The problem is while the procedures haven't been dumbed down at the HCP level, the teaching still has AND the instructors teaching it aren't necessarily knowledgeable enough to make it any more than that. Becoming a FA and CPR instructor is itself a two weekend merit badge process with no pre-requisites for many of the organizations.

[VentMedic]

With basic CPR, how many years was it the exact same? And when they did have changes it was procedures that were used at one time, then "improved", then change back to the way it use to be.

CPR has changed alot over the 35 years I have been taking it. It used to be 1- one thousand - 2- one thousand and the thing with the 4 stacked breaths. Personally, my tired back would love to so the very slow CPR again but I don't see it going back to that anytime in the future.

The research going into the compressions only or the breath rate has had some logic to it. Unfortunately you do still see EMT(P)s doing whatever rate and bagging away like the devil chasing them because they haven't gotten the message or retrained.

I always point out some of the things that are interesting for those that want to extend their knowledge with reading more. Even a class for the lay person can be interesting if there are those that want to learn more.

[firedoc5]

CPR has changed a lot over the 35 years I have been taking it. It used to be 1- one thousand - 2- one thousand and the thing with the 4 stacked breaths. Personally, my tired back would love to so the very slow CPR again but I don't see it going back to that anytime in the future.

The research going into the compressions only or the breath rate has had some logic to it. Unfortunately you do still see EMT(P)s doing whatever rate and bagging away like the devil chasing them because they haven't gotten the message or retrained.

I always point out some of the things that are interesting for those that want to extend their knowledge with reading more. Even a class for the lay person can be interesting if there are those that want to learn more.

I remember back when you were to do a chest compression, then compress on the upper abd. (aorta), and back and forth.

When they went with the 1 and 2 and 3 compressions it seemed more efficient, but tiring. But I'm talking about before EMS arrives. I have nothing against what is taught for CPR, for the general public or rescuers.

Sometimes I wondered if when they did make changes just to make changes.

But when ALS get's there, and I'm guilty of it. We rarely counted. We were too busy doing other things. If anyone was actually counting was the guy doing compression. Once the pt. was tubed, basically he was ventilated every 3-5 seconds, not going by the compression count. We liked it when PaO2 was 100+ when the labs first came in. Every now and then we'd have temp. doc working and he would be impressed when we brought in full arrest with a PaO2 was 95 or higher and their pH at close to 4.

Vent M, I know you know more about it than me, but what is wrong with not actually counting and bringing in a patient with those kinds of labs? I am by no means being sarcastic, it is a serious question.

[crotchitymedic1986]

I hear you -- i dont need a watch/clock to count a pulse and i can usually guess a pulse ox reading within 2% points by just assessing the patient. Which reminds me do any of you play the "guess" the patient while enroute to the call game --- we had it down to a science as to what kind of clothing they would be in, whether they would be amputee or not, time of onset of symptoms, which hospital they went to -- we could even guess how many teeth they had based on the trailer park we were responding too.

[VentMedic]

Sometimes I wondered if when they did make changes just to make changes.

But when ALS get's there, and I'm guilty of it. We rarely counted. We were too busy doing other things. If anyone was actually counting was the guy doing compression. Once the pt. was tubed, basically he was ventilated every 3-5 seconds, not going by the compression count. We liked it when PaO2 was 100+ when the labs first came in. Every now and then we'd have temp. doc working and he would be impressed when we brought in full arrest with a PaO2 was 95 or higher and their pH at close to 4.

Vent M, I know you know more about it than me, but what is wrong with not actually counting and bringing in a patient with those kinds of labs? I am by no means being sarcastic, it is a serious question.

The inattentiveness of some not to count was one of the reasons a few of the changes were made. Hyperventilating a patient to a dangerously high pH was as bad as the very low pH.

Throughout the years as more research became available or better methods to prove different concepts, medicine has changed its way of thinking may times.

The way we ventilate ARDS or a TBI patient has greatly changed throughout the years. Permissive hypercapnia is accepted in some situations as is the use of buffers now. Acceptable PaO2 levels have differed in acceptibility for ARDS, TBI, Sepsis and other disease processes. The limitations and benefits of the pulse oximeter has been defined and further understood as has the ETCO2 monitor. We now have many, many protocols driven by the disease and no longer make blanket statements. The use of oxygen in neonates has evolved into a different way of thinking for resuscitation in that population also. So many changes and some very exciting times to be more involved in medicine.

An interesting article about CPR and EMS:

http://www.jems.com/Images/CPR-Revived_tcm16-12259.pdf

[Just Plain Ruff]

I think it's stupid that we are certified to perform certain duties on the truck (IV, intubation, etc.), but we can't perform these duties in the ED because LPNs can't do them. What's even dumber, when one of the ED docs has to RSI and respiratory and anesthesia aren't available, who do they call? Yep, that's right, EMS!

actually, in the hospital I work at I am able to do everything that a nurse can do. The onlything I am unable to do is to spike blood but I can administer it.

I can do somethings that a nurse is unable to do such as needling the chest and also intubating.

it's a good place to work in .