# Accelerated EMT – B Program in December (14 Days)



## Tom Perroni (Nov 3, 2011)

*Accelerated EMT – B Program*

*Dates: December 1st, 2011 – December 14th, 2011 (14 Days)*

Time: 9am-6pm 

*Location:* Commonwealth Criminal Justice Academy, 1380 Central 
Park Blvd, Suite # 208 Fredericksburg, Va. 22401

*Prerequisites:*

1. Student must be 16 years of age or older before the start of the course.

2. Hold an approved cardiopulmonary resuscitation (CPR) course at the beginning date of the course. This certification must also be current at the time of state testing. (CCJA will offer this training before this course for hose enrolled and paid who need this training at no cost.) 

*Cost: $1,200.00 (This does not include Books and State or National test fees)*

Coordinator: Charles A. Williams NREMT-P

Registration: Call (540) 322-3000 or e-mail ccjatraining@gmail.com 

*Books:* 

Required text:
Mosby's EMT-Basic Textbook Revised 2nd Edition Revised
W. Stoy, T. Platt, D. Lejeune and the Center for Emergency Medicine, published by Mosby

Required text:
Mosby's EMT-Basic Workbook 2nd Edition
W. Stoy, T. Platt, D. Lejeune and the Center for Emergency Medicine, published by Mosby.

*Program description:* 

Emergency Medical Technician – Basic (4 year certification)

The Emergency Medical Technician – Basic course is designed to provide training to prepare an individual to function independently in a medical emergency. This course provides the basic knowledge and skills needed to provide basic life support (BLS) care and is required to progress to more advanced levels of pre-hospital patient care. 

The course requires a minimum of 111 hours of classroom and skills instruction and 10 hours of Clinical/Field rotations for a total of 121 hours of training. 

Virginia Certification requires successful completion of a written and practical skills examination. This course is designed to train individuals to serve as a vital link in the chain of the health care team. 

Student will be eligible to set for Virginia EMT-Basic exam Note: reciprocity available to the take National Registry Exam after gaining Virginia certification. 

This includes all skills necessary to provide emergency medical care as an attendant-in-charge with a basic life support ambulance service or other specialized rescue service.

Upon successfully completion of the training program, the student will be capable of performing the following functions:

(1) Recognize the nature and seriousness of the patient’s condition or extent of injury to assess requirements for emergency care.

(2) Administer appropriate emergency care to stabilize the patient’s condition. 

(3) Lift, move, position and otherwise handle the patient in a way as to minimize discomfort and further injury.

The EMT-Basic curriculum will be based upon the DOT National Standard Curriculum for the EMT-Basic (1994 edition) and the 2002 Supplemental Airway Modules for the 1994 EMT-Basic National Standard Curriculum. The EMT-Basic will be trained and proficient in all skills described in the DOT National Standard Curriculum for the EMT-Basic (1994 edition) and the 2002 Supplemental modules for the EMT-Basic: National Standard Curriculum.

*This program has a 92% first time test pass rate!*

To register or for more information Contact: 

Tom Perroni (540) 322-3000 / (540) 846-7088 
ccjatraining@gmail.com 
www.ccjatraining.com

Recommended Hotel: 
Fredericksburg Hospitality House
www.fredericksburghospitalityhouse.com
2801 Plank Rd
Fredericksburg, VA 22401
(540) 786-8321
CCJA Training Rate: $70.00 per night single occupant. 


__________________
Tom Perroni
Doc "Gwedo"

"Trust me, I'm a medic"

The “State of the Art” in medicine is constantly changing –unlearn outdated medical training @ CCJA.


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## Tigger (Nov 4, 2011)

This is not to be construed as an attack on your training center. The college I currently attend has us taking one class at a time, 5 days a week, 3 hours+ classroom time per day, for 3.5 weeks. This schedule works fine, and the college is well regarded. I'm not going to throw stones over a 2 week basic class.

My question is in regards to price: why $1200? My class had 30 more hours and was half as much...Is there something I am missing here?


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## Tom Perroni (Nov 4, 2011)

I must be missing something.....:wacko:

5 days X 3 hours a day = 15 hours

15 hours X 3.5 weeks = 52.5 hours

My program is 121 hours of class room and clinical rotation and approved by Virginia OEMS.

George Washington University Charges $5,000.00 here for the same program however it is 1 semester long.  But if you call them looking for an accelerated program they will send students to us.

I would love to know the name of a college that would charge $600.00 for a 3.5 week course. I'm still paying off student loans

Have you completed the course yet? I am confused you said you are in class now but your avatar says EMT-Basic?


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## Tigger (Nov 4, 2011)

Tom Perroni said:


> I must be missing something.....:wacko:
> 
> 5 days X 3 hours a day = 15 hours
> 
> ...



You're only missing something because I was rather unspecific, sorry about that. The college I was talking about is where I am getting my undergrad done. It's a liberal arts college that teaches its academic classes on a block schedule. My point was that I don't see any issue with the "short but intense" model, you just have to know that it is right for you. My classes are a lot more than $1200, but please don't make me think of that. :sad:

I've been a basic for two years, I took the class over the course of a semester at my undergrad college. It was $600, and that's relatively high for the area, from what I understand. Just curious why your class is twice that. Before you ask, I went to a quality program with a great and competent instructor that had access to excellent equipment and clinical placement opportunities with a hospital network, 911 EMS provider, and 911 ALS FD.

Again, not an attack, just curiosity. 

Also, GW offering it for 5k? Really? That's not even comprehensible.


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## crazycajun (Nov 4, 2011)

Tom Perroni said:


> *Accelerated EMT – B Program*
> 
> *Dates: December 1st, 2011 – December 14th, 2011 (14 Days)*
> 
> ...



Sorry Tom but programs like yours are exactly why EMS needs an overhaul. 8 hours a day for two weeks is not near enough time to train any one. By the way our class is 152 hours classroom and 40 ride time. The cost is $700 including text and workbooks.


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## dstevens58 (Nov 4, 2011)

Curiosity asks, just what does $1,200 buy you other than the training? (books not included).  

Others may be adapted to this type of learning environment, but I wasn't.  I like my standard class structure.  It's intense (medic-level) with one day a week.


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## Tigger (Nov 4, 2011)

crazycajun said:


> Sorry Tom but programs like yours are exactly why EMS needs an overhaul. 8 hours a day for two weeks is not near enough time to train any one. By the way our class is 152 hours classroom and 40 ride time. The cost is $700 including text and workbooks.



Eight hours a day for two weeks is 112 hours. Eight hours a week for 14 weeks (close to a college semester, i.e. how most basic classes are taught) is also 112 hours. How is there not enough time to train someone in the accelerated model? 

The classroom time is the same. Surely you do not dispute this. Given this, why can someone not take it all at once? Is this program for everybody? No, everyone learns differently. But it might work for some.

The reason that I shy away from the accelerated courses is generally due to the reputation of the teaching institution and the patch factory style of instruction. But, if an accelerated program is held to the same academic standards as a "traditional" program, what is the difference?

Anecdotally, it is a very different way to learn, and I can speak to that having spent the last 2.5 years of my life learning in such a manner. If you like the material, its great. I love studying government, so to be able to study government for almost a month without worrying about other courses is awesome.


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## JPINFV (Nov 4, 2011)

Tom Perroni said:


> I would love to know the name of a college that would charge $600.00 for a 3.5 week course. I'm still paying off student loans



The EMT course I took several years ago was only $40 plus books. Unless there's something honestly special, I can't imagine paying more than a couple hundred dollars for an EMT course, little less over a thousand. 

http://www.coastlinerop.schoolloop.com/


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## Tom Perroni (Nov 4, 2011)

crazycajun said:


> Sorry Tom but programs like yours are exactly why EMS needs an overhaul. 8 hours a day for two weeks is not near enough time to train any one. By the way our class is 152 hours classroom and 40 ride time. The cost is $700 including text and workbooks.



This may not be for everyone! However we have a 92% state pass rate and a 100% NREMT-B pass rate.

In Virginia the course is 121 Hours......So If you take the class one night a week for months or everyday for weeks...... what is the problem. As long as the hours are satisfied.

We started this program for the Military and then expanded it for "Open Enrollment" we have been doing it for over 2 years now as an "Open Enrollment course" 4 years in general. I don't think we would still be in business if it did not work?

Not sure what the issue is we follow the same DOT guidlines as every other course? 

It is not for everyone and if you don't think it will work for you I understand!

But I don't think you can judge a program you haven't taken or blame the problems of EMS in general on My school. We have  what I think is a good pass rate...However we all know that the REAL learning comes from OJT.

When you go to a Doctor you have no idea if he/she was first in his/her class or last! 

When you get your NREMT-B card it does not have your score on it how do you know who is competant and who is not.

It all comes down to how they operate in the field.


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## JPINFV (Nov 4, 2011)

Tom Perroni said:


> Not sure what the issue is we follow the same DOT guidlines as every other course?



To be fair, the DOT guidelines are terrible. High on cook book, low on understanding what is actually being done. Hence things like the stupidity of the medical assessment practical requiring high concentration oxygen, or automatic failure. 



> But I don't think you can judge a program you haven't taken or blame the problems of EMS in general on My school.


True. Accelerated courses being feasible is just a symptom of very simplistic requirements. However...


> However we all know that the REAL learning comes from OJT.


2 issues.

1. If most of the "real learning" is on the job training, then what is deficient about the current curriculum requirements? Especially since there's nothing stopping your school from exceeding the minimum. 

2. Why are EMS education programs failing to lay down a proper foundation? If the "real learning" isn't happening in the classroom, then the program is simply building a house on sand. 

As an educator, the above two issues are squarely within your control. You don't have to follow the pack. 


> When you go to a Doctor you have no idea if he/she was first in his/her class or last!


Oh, can we please please please compare the rigors of medical school and EMT class? How many "accelerated physician" programs can you think of? Heck, I can't think of a single medical school in the US that bases it's curriculum on anything other than "years." Even still, there's only a couple of medical schools offering 3 year tracks (as in 2 or 3 out of well over a hundred), and those tracks are strictly limited to physicians entering primary care as well as removing basically all vacation time. You won't find any medical school saying, "Hey, look at us, we just meet the 4,000 hours (at least the statutory education requirement for California) required of us."

Heck, I don't even know, nor do I care, what the number of hours of instruction my current school provides. Why? Because it's irrelevant. 


Also, in medical school grades and licensing exam scores matter when it comes to residencies. Most students aren't looking to just squeak by.


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## TacEMT (Nov 5, 2011)

I personally don't see a problem with accelerated EMT programs. Theres actually a two week intesive EMT bootcamp course near where I am at and I know people that have went through the program and successfully completed the National registry and state requirements. An intensive course is not for everyone but I think it just comes down to the individuals themselves. If your really dedicated you will do fine regardless if its a 2 week, 10 week, 6 months, or 9 month. course. In fact I think intensive courses are better because when you do get tested, you will be tested on something you learned a few weeks or few days ago, rather then a few months ago. Then there is the problem if the students can actually absorb all that information in the short amount of time. EMT-B is not a easy by any means so hard work is required. Its up to the students to make sure they actually understand the information and not fall behind, since everything kinda builds off the basics. Intensive courses are good for people that don't have the time to make such a long comittment to school, such as they need the job right away. Also its good for those who let their license laspse and just need a good refresher for them to pass the national registry instead of a full course.


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## crazycajun (Nov 5, 2011)

Tom Perroni said:


> This may not be for everyone! However we have a 92% state pass rate and a 100% NREMT-B pass rate.
> 
> In Virginia the course is 121 Hours......So If you take the class one night a week for months or everyday for weeks...... what is the problem. As long as the hours are satisfied.
> 
> ...



Sorry if you are offended but you will never convince me that teaching 8 modules testing on each, practical skills and a final exam can be done efficiently in 14 days. Another problem is your comment about REAL learning comes from OJT. That is a ridiculous statement and again why EMS needs a serious overhaul. Stop worrying about the dollar in your pocket and start worrying about the quality of personnel we are putting in the streets. Also you keep stating percentage rates. Why don't you tell us exactly how many people have attended your program and how many have actually passed the test in REAL numbers. Then tell us how many actually took the NREMT and passed in real numbers.


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## abckidsmom (Nov 5, 2011)

There's a problem with study time, too.  If you spend 120 hours in class over 2 weeks, at what point are you studying to get this information permanently into your brain?


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## BrushBunny91 (Nov 5, 2011)

I am currently 12 weeks into my 16 week EMT program and I would not be the same EMT if I took an accelerated program. The amount of time and understanding to not only grasp but truly understand the concepts takes a lot longer then 14 days. 
Accelerated programs treat EMT like its just one of those obstacles you need to quickly complete and move on to paramedic school.
EMT should be taught and understood rather than just finish.


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## Tigger (Nov 6, 2011)

abckidsmom said:


> There's a problem with study time, too.  If you spend 120 hours in class over 2 weeks, at what point are you studying to get this information permanently into your brain?



The last two classes I took at school were chemistry classes with three hours of lecture and three hours of lab five days a week. 

It sucked, but if you suck it up for a month there is plenty of time to study and we have research showing that taking a single class in an "intense" format does not make one less likely to retain information compared to a student on a semester plan.


Sent from my out of area communications device.


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## crazycajun (Nov 6, 2011)

Tigger said:


> The last two classes I took at school were chemistry classes with three hours of lecture and three hours of lab five days a week.
> 
> It sucked, but if you suck it up for a month there is plenty of time to study and we have research showing that taking a single class in an "intense" format does not make one less likely to retain information compared to a student on a semester plan.
> 
> ...



You are talking about ONE subject for a month. We are talking about EIGHT modules which are basically separate subjects over 14 days. You still need to learn practicals, learn how to word assessments and somehow retain all of that information. Schools like this simply pump the answers to a test in you over and over again. You may very well pass but your actual knowledge of what a EMT actually does will not be sufficient. Furthermore Tom claims in his signature to be a "Medic" however nothing on his site states such.


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## Tom Perroni (Nov 6, 2011)

crazycajun said:


> You are talking about ONE subject for a month. We are talking about EIGHT modules which are basically separate subjects over 14 days. You still need to learn practicals, learn how to word assessments and somehow retain all of that information. Schools like this simply pump the answers to a test in you over and over again. You may very well pass but your actual knowledge of what a EMT actually does will not be sufficient. Furthermore Tom claims in his signature to be a "Medic" however nothing on his site states such.




Tigger,

I fear no matter what anyone says the "crazycajun" has made up his/her mind. No worries this course is not for everyone If you read between the lines It would appear that he/she is an EMT-I student and may have gone to a longer course and that may or may not have worked for him/her.


crazycajun,

In response to your question about my Medic status....I am a Virginia ALS provider and you can verify that here: 

http://www.vdh.virginia.gov/OEMS/index.htm

However my full name is Thomas J. Perroni

I am also an “ASHI” ACLS, PALS Instructor, ITLS Advanced Provider, USSOCOM TCCC/LTT Instructor, TEMS Instructor, I also teach RSI. Advanced Trauma Training …..etc.etc. but that isn’t on my web site either.

If you’re having problems in you’re I/85 or I/99 course let me know ...you are not too far away and I would allow you take the training for free. However all I ask in return is an AAR the good the bad the ugly.

I can assure you were are not teaching the test.

But come see for yourself ...However if you won't come check us out for free then don't talk carp about a program you have not taken nor have no knowledge of.

P.S. You don’t have to keep telling me you are sorry…I don’t mind having these discussions. Even after several years of doing this I am not so arrogant as to think I know everything, I am very open minded and willing to learn new things or a better way to do something.


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## Tigger (Nov 6, 2011)

crazycajun said:


> You are talking about ONE subject for a month. We are talking about EIGHT modules which are basically separate subjects over 14 days. You still need to learn practicals, learn how to word assessments and somehow retain all of that information. Schools like this simply pump the answers to a test in you over and over again. You may very well pass but your actual knowledge of what a EMT actually does will not be sufficient. Furthermore Tom claims in his signature to be a "Medic" however nothing on his site states such.



Are you serious? Chemistry is not just chemistry. There many, many different topics to study that are in many cases barely related to one another. I spent one week doing nothing but acid base reactions and then the next week working on thermo and electro chemistry. The two weeks were not at all related, yet it's still in the same class.

If the eight modules of EMT class are so different, how can they be taught as a single class? Let's face it, they are not.. Much of what is taught is interrelated throughout the class.

I applaud your desire to increase the education standards in EMS, and you know that I agree with you when it comes to furthering the minimum standard of ambulance based providers.

What you are doing here is *not* helping that. You are making completely baseless accusations about one program's quality of education. Furthermore, you are unilaterally declaring a proven system of education to be worthless to EMS, without providing any evidence what so ever. The opinion that you hold that these programs to produce subapar providers is perhaps anecdotally true, but you can prove it to be the case for this specific program.

I have no stake in this discussion. I have been to Virginia once, and have no knowledge of this institution. I just cannot stand when people get up on their high horse and declare something to be unworkable, despite having no experience or evidence to support such a claim. I know that this manner of education works, I'm living it. I can't say it works for anyone else though.


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## Cawolf86 (Nov 6, 2011)

Tom Perroni said:


> If you’re having problems in you’re I/85 or I/99 course let me know ...you are not too far away and I would allow you take the training for free. However all I ask in return is an AAR the good the bad the ugly.



Seems like a great offer.


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## crazycajun (Nov 7, 2011)

Tom Perroni said:


> Tigger,
> 
> I fear no matter what anyone says the "crazycajun" has made up his/her mind. No worries this course is not for everyone If you read between the lines It would appear that he/she is an EMT-I student and may have gone to a longer course and that may or may not have worked for him/her.
> 
> ...



Tom I am a current EMT-I and in a paramedic degree program. I have been in EMS for more than 20 years and have seen many "Accelerated Programs". With that said I would like to know the actual number of attendees and graduates from your program and how many actually took the State test and the NREMT test. I think this is a fair question if you are that sure of your program.


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## Tom Perroni (Nov 7, 2011)

You have made your position well known. I fear at this point we will just be talking in circles. I wish you luck in your training and hope that you do become a medic.

Good Luck!

Tom


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## Tigger (Nov 7, 2011)

Tom Perroni said:


> You have made your position well known. I fear at this point we will just be talking in circles. I wish you luck in your training and hope that you do become a medic.
> 
> Good Luck!
> 
> Tom



Sheesh talk about a cop out. If you're going to choose not to answer the question at least give a reason. I think crazycajun's question is reasonable, and can certainly help to better your program's reputation.


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## Fish (Nov 7, 2011)

OJT? Well that makes my skin crawl.


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## crazycajun (Nov 7, 2011)

Fish said:


> OJT? Well that makes my skin crawl.



Yeah Fish don't you know the best time to train a new EMT is when all hell is breaking loose at an MCI or when you have a PT in full Cardiac Arrest or when a ped PT is unresponsive? Geesh :rofl:


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## Tom Perroni (Nov 7, 2011)

Tigger said:


> Sheesh talk about a cop out. If you're going to choose not to answer the question at least give a reason. I think crazycajun's question is reasonable, and can certainly help to better your program's reputation.



Cop out?

My reason....I don't owe him any explanation. He said that the program would not work for him…..O.K. don't take the course. His question is reasonable?   It would better my programs reputation?

Please. I have neither the time nor the inclination to deal with him any longer.

I offered him to come see for himself free of charge! 

P.S. we teach Paramedic as well. 

I'm done.


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## Tom Perroni (Nov 7, 2011)

crazycajun said:


> Yeah Fish don't you know the best time to train a new EMT is when all hell is breaking loose at an MCI or when you have a PT in full Cardiac Arrest or when a ped PT is unresponsive? Geesh :rofl:



Let’s talk about OJT …since it makes some peoples skin crawl….

So I guess you were both so high speed low drag that you came out of EMT-Basic and could do everything perfect right?  I mean come on you were in class for so long I mean…well you didn’t even need to have a preceptor right?  You were in class so long that you went over ever possible scenario that could happen in the field right?

There is no way that anyone can leave any program and be 100% perfect.  You need OJT to mold you into what you will become in this field…And if you have a good preceptor your chances of being a good EMT are 10 fold.

My program is solid, my Instructors are solid, and my students are solid.

Baskin Robins has 31 flavors for a reason.

Tom


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## BandageBrigade (Nov 7, 2011)

Why do you refuse to give actual statistics (numbers not percentages) for your programs? I am not against or for programs such as yours, but this makes me think you are hiding something, such as the number of students actually taught ect.


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## JPINFV (Nov 7, 2011)

Tom Perroni said:


> Let’s talk about OJT …since it makes some peoples skin crawl….
> 
> So I guess you were both so high speed low drag that you came out of EMT-Basic and could do everything perfect right?  I mean come on you were in class for so long I mean…well you didn’t even need to have a preceptor right?  You were in class so long that you went over ever possible scenario that could happen in the field right?



1. Preceptors and clinicals are not the same as OTJ training. 

2. EMS all too often uses OTJ training as a bandaid to cover up deficient training standards.


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## BEorP (Nov 7, 2011)

If you don't mind me asking, how long is your paramedic program, Tom?


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## Tom Perroni (Nov 7, 2011)

BEorP said:


> If you don't mind me asking, how long is your paramedic program, Tom?



Classroom 12 weeks 40 hours per week= 480 hours 
Hospital clinicals are= 230 hours
Field clinicals (Ambulance) = 200

Total = 910 hours or 23 weeks

Tom


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## Tom Perroni (Nov 7, 2011)

JPINFV said:


> 1. Preceptors and clinicals are not the same as OTJ training.
> 
> 2. EMS all too often uses OTJ training as a bandaid to cover up deficient training standards.




:rofl:


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## JPINFV (Nov 7, 2011)

Tom Perroni said:


> :rofl:



By all means, feel free to provide a useful and professional reply instead of just an emoticon.

Edit:

Oh, and to expand on the "OTJ =  bandaid" motif, why is EMS the only health care field with the fetish for requiring prior experience? RNs don't have to be CNAs first. Physicians don't have to be PAs first.


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## Tom Perroni (Nov 8, 2011)

JPINFV said:


> By all means, feel free to provide a useful and professional reply instead of just an emoticon.
> 
> *I have neither the time nor the inclination to deal with you any longer.*
> 
> ...



*I'm not sure why don't you tell us?* *Now we are comparing RN's PA's and MD's to EMT- Basics?*

:rofl::rofl::rofl::rofl::rofl::rofl::rofl:


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## JPINFV (Nov 8, 2011)

Tom Perroni said:


> *I have neither the time nor the inclination to deal with you any longer.*



Strange. You've never offered a response to any of my posts, so since you've never 'dealt' with me before, you can't refuse to "deal" with me any longer. The only reason I can think of is because you have no actual valid response to the arguments that I am putting forth. 
*




			I'm not sure why don't you tell us?
		
Click to expand...

*


> *Now we are comparing RN's PA's and MD's to EMT- Basics?*
> 
> :rofl::rofl::rofl::rofl::rofl::rofl::rofl:



...because EMT is required to become a paramedic, and paramedics insist on being consider a profession. I reject the concept that EMTs lack the capability of making informed, professional decisions regarding their, albeit limited, interventions. Similarly, I reject the concept that someone can be trained to act and think with one mindset (follow the cookbookocol), and then turn around and teach them to think like professionals instead of technicians. 

Apparently, at least in your mind, paramedics can't be compared to real health care professions.


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## fast65 (Nov 8, 2011)

Well I was going to head to bed...but after reading this thread I feel as though I don't have the time nor the inclination for bed...please continue the conversation gentleman.


Sent from my iPhone using Tapatalk


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## Handsome Robb (Nov 8, 2011)

fast65 said:


> Well I was going to head to bed...but after reading this thread I feel as though I don't have the time nor the inclination for bed...please continue the conversation gentleman.
> 
> 
> Sent from my iPhone using Tapatalk



#watchingintently

Yup, I did it


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## BandageBrigade (Nov 8, 2011)

Tom, instead of ignoring my previous post completely could you at least reply?



On a different note, 900 hours total (classroom and clinicals) seems woefully inadequate for a paramedic program. We did more than that in clinicals alone.


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## BEorP (Nov 8, 2011)

Tom, I appreciate you staying on for what can hopefully be a productive discussion on various areas. I'm certainly interested in hearing your opinions, even if they differ from my own. It seems as though we have very different views of the profession. What are your thoughts on the paramedic degree programs that are becoming standard in places like Australia as the minimum to work on an ambulance? Would you agree that this increase in education requirements is what will ultimately help to push paramedicine to a true profession?


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## Fish (Nov 8, 2011)

Tom Perroni said:


> Let’s talk about OJT …since it makes some peoples skin crawl….
> 
> So I guess you were both so high speed low drag that you came out of EMT-Basic and could do everything perfect right?  I mean come on you were in class for so long I mean…well you didn’t even need to have a preceptor right?  You were in class so long that you went over ever possible scenario that could happen in the field right?
> 
> ...




OJT and being precepted are entirely different, you have supervision during your preception. OJT is not OJT EMS, it is called gaining experience. YOu recieve the knowledge needed in class and then go experience it in the field. You don't learn about DKA as it unfolds infront of you, you have already learned everything about it and now you can experience it.

Baskin Robins huh? Atleast all their Flavours are good. And the real number of flavours is somewhere in the 300s.


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## crazycajun (Nov 8, 2011)

Tom,
  You are ready to defend your program but cannot provide simple numbers to a valid question. Are you hiding something? You came to this site and offered your program but when it is questioned you have a problem with it. As for you comment on OJT, I spent 6 months in class when I began in the 80's. I then spent an additional 4 months as a third man and we were only allowed to observe for the first 2. This gave all of us time to settle in the field, see some real world scenario's and see how things are supposed to be done. Every time we get newbies from schools such as yours I get a sickening feeling deep inside my gut. Why? Because they have no clue what it means to be an EMT. Defend your program all you like but until we get a REAL training program mandated nationally we will never get over the high turn over, lack of knowledge group of EMT's that enter the field today. These young men and women deserve more than a $1200.00 2 week class. They deserve an education.


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## mikeward (Nov 9, 2011)

Wow, every time Tom announces a course he gets grief from those who think an accelerated EMT-Basic (8 hours a day, 5 days a week) is inappropriate, impossible or immoral.

I have absolutely NO ties to Tom's program, except to refer people to his program that need EMT-Basic RIGHT NOW.

EMT-Basic training is evaluated at a sophmore college level of comprehension difficulty (14th grade), based on the medical terms used.

If I remove the terminology, the 1984-era EMT-Basic falls into the 10th grade of comprehension.

For comparison, Firefighter I and II are around the 7th grade of comprehension.

Career fire departments, municipal/federal government, military and private entities teach 8 hour/day EMT courses all the time.

Back in the day (1982-1984) I ran the EMT-Basic program for a large county fire department.  Delivered 6 EMT-Basic classes to rookies and 4 EMT-Basics to in-service firefighters each year.  8 hours a day, five days a week.

A secret in certification training is that those that teach a lot of courses have a significantly higher student success rate that those that teach one course every two years.  

A not-so-secret reality in EMT training is that most instructors have not benefitted from additional education or training to become effective as medical or technical instructors. 

These instructors are dedicated, often donate their time to teach, and deeply care about EMS. But neither the state agency nor the sponsoring organization has the time or resources to help dedicated instructors improve their effectiveness as EMT instructors.

Those teaching "accelerated" EMT courses often have the resources and infrastructure to support instructors and improve student performances.

"crazycajun" -
I started as a volunteer EMT (1971), went full time four years later.
State EMT instructor in 1977
Became a Virginia Cardiac-EMT in 1978 and paramedic in 1982.

My experience is similar to yours.  Just because I learned it this way does not mean everyone else needs to as well.

The military does not have that much time to go from raw recruit to field medic.  Military basic training includes self and buddy care, including starting IVs and handling tourniquets.

From my perspective, following the physician education model, we can go from "zero" to Scope of Practice Paramedic without stopping at the EMT level ... and do it in a 8 hour a day/5 day a week format.

Mike


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## Martyn (Nov 9, 2011)

mikeward said:


> EMT-Basic training is evaluated at a sophmore college level of comprehension difficulty (14th grade), based on the medical terms used.
> 
> If I remove the terminology, the 1984-era EMT-Basic falls into the 10th grade of comprehension.
> 
> For comparison, Firefighter I and II are around the 7th grade of comprehension.


 
OK, changing the subject and at the risk of hijacking this thread, I rest my case your honor. Why send 7th graders out to a medical emergency when there are better educated 14th graders?   :rofl:


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## mikeward (Nov 9, 2011)

Martyn said:


> OK, changing the subject and at the risk of hijacking this thread, I rest my case your honor. Why send 7th graders out to a medical emergency when there are better educated 14th graders?   :rofl:



Because a 4th grader can operate an AED.


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## JPINFV (Nov 9, 2011)

Martyn said:


> OK, changing the subject and at the risk of hijacking this thread, I rest my case your honor. Why send 7th graders out to a medical emergency when there are better educated 14th graders?   :rofl:


[YOUTUBE]http://www.youtube.com/watch?v=ZIkEf2Wu9B4[/YOUTUBE]


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## JPINFV (Nov 9, 2011)

Hello Mr. Fossil Medic. It's always nice when one of the more well known people in EMS wonder through here. 



mikeward said:


> Wow, every time Tom announces a course he gets grief from those who think an accelerated EMT-Basic (8 hours a day, 5 days a week) is *inappropriate*, impossible or immoral.



Would you say that the current EMS standards meet the current educational (both foundational and applied education) demands placed upon providers, both in an operational context and the sense of a trade attempting to become a profession?

If not, do you feel that EMS educators and educational programs have a duty to surpass the minimum requirements and, at a minimum, prepare students to meet the operational demands placed on EMS providers (regardless the level)?

Again, if no to the first question, do you feel that "accelerated" programs provide enough time to attempt to surpass the minimum requirements, or are they essentially limited to teaching to the test? 




> From my perspective, following the physician education model, we can go from "zero" to Scope of Practice Paramedic without stopping at the EMT level ... and do it in a 8 hour a day/5 day a week format.
> 
> Mike



I think there's a very important difference between EMS programs and medical school. Accelerated medical school is 3 years, limits students to primary care (through agreement when entering the program), and basically removes all vacation time during that 3 year period (including Christmas and Summer breaks). It's also found in only a handful of schools. Similarly, while there are often statutory hour requirements (4000 hours in California), no program that I've seen discusses how many hours they provide because their goal is to produce competitive physicians. It's 4 years. If it's 4000, 5000, or somewhere in between, that's how long it is. 

Granted, another difference is the factor of graduate medical education (residency) has in pushing (undergraduate) medical school standards. Where, by and large, EMS training program grades, evaluations, and NREMT/state exam scores don't matter, residency programs will look at those when deciding who to rank for their program. As such, there's a market incentive for medical schools to produce competitive students. If students from bare minimum EMS education programs found the job market extra hard because of the school they graduated from, then there would be a direct incentive for students to not go there.


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## mikeward (Nov 9, 2011)

We need to separate EMT from Paramedic for this part of the discussion.

EMT, even under the new Educational Standards, remains a technical skill set under a pretty narrow scope of practice.

Some states require an "instructor-training" program that often covers the state requirements to run an EMT class and an overview/review of the publisher or state provided instructor manual.

Maybe a qualifying knowledge test / skill demonstration.

That is why the publishers spend so much time working on the instructor package for EMT (and Firefighter I/II).  EMT is a practitioner teaching skills and knowledge. There are no national minimum academic requirements for EMT instructors

"Duty" is a nice term, but it is not appropriate to expect a training program or certification process to meet all of the "operational needs" of a particular vocation.  

Did your EMT-Basic class include certification in operating an emergency vehicle?

PS - I taught EMT at a rural high school for a couple of years


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## crazycajun (Nov 9, 2011)

mikeward said:


> Wow, every time Tom announces a course he gets grief from those who think an accelerated EMT-Basic (8 hours a day, 5 days a week) is inappropriate, impossible or immoral.
> 
> I have absolutely NO ties to Tom's program, except to refer people to his program that need EMT-Basic RIGHT NOW.
> 
> ...



Mike,
  I simply asked for actual numbers which he has not provided. I don't think it is a difficult question. Now to the rest of your post. All of the resources in the world mean nothing if the average person entering one of these programs has no understanding whatsoever of basic medical skills. Furthermore I have seen quite a few guys go through these courses and and couldn't tell you the correct term for knee cap. These companies as well as other longer classes are not interested in teaching the true medical side of being a pre-hospital provider. They are simply interested in putting a dollar in their pocket. Sadly states that do not follow the NREMT standards will not change their training to the new standards further impeding said EMT from working in other states or improving the quality of service. I m all for 8 hours a day 5 days a week for 6 months. But 14 days is just not enough time to teach a quality program. Research has shown that the average student must study 2 hours for every hour spent in class. Based on that theory a 14 day program is impossible to be adequate. I understand some may learn quicker but we must look at the standard. More time needs to be spent on A&P, Biology, Chemistry, Trauma and medical illness in even the longer programs. We will never be recognized as anything more than Ambulance drivers if we don't make those changes and 14 day programs do nothing but hinder that process even further.


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## JPINFV (Nov 9, 2011)

mikeward said:


> We need to separate EMT from Paramedic for this part of the discussion.
> 
> EMT, even under the new Educational Standards, remains a technical skill set under a pretty narrow scope of practice.



As long as we (we = EMS as a whole) insist on requiring people to become EMTs before paramedics, I don't think we can. For me, the big sticking point is independent judgement. Technicians do X because the cookbook-ocol says so. Professionals do X because X is the right treatment. One can deviate, the other can't. As such, I don't see how it's valid to spend 120ish hours say, "Thou shalt do X for Y," and then turn around and say, "use your judgement and ignore everything we said about how to think during EMT training." To be, the perfect example of this is the fragmentation of "BLS before ALS" instead of treating it as a continuum. Sometimes the best answer isn't to provide a BLS intervention, and only after it fails move on to ALS. 

Additionally, I want EMTs to act like professionals in that same sense. Even with a much narrower scope of practice, the thought process of "ambulance = supplemental oxygen, trauma = spinal immobilization" strikes me as wrong. 




> Some states require an "instructor-training" program that often covers the state requirements to run an EMT class and an overview/review of the publisher or state provided instructor manual.
> 
> Maybe a qualifying knowledge test / skill demonstration.


Shouldn't the educational programs be taking the lead in ensuring that their instructors and educators are competent? 

What about single subject lecturers, or does this only apply to the instructor/coordinator? If you bring in an anatomist to teach anatomy, do they need to pass a skills demonstration or paramedic knowledge test? Do I need to know the finer points of inserting an IO or initiating CPAP to teach physiology? 




> "Duty" is a nice term, but it is not appropriate to expect a training program or certification process to meet all of the "operational needs" of a particular skill set.
> 
> Did your EMT-Basic class include certification in operating an emergency vehicle?



"Operational needs" probably was a bit broader than I meant, however a lot of things can be covered that doesn't necessarily require the resources needed to provide EVO course. 

Off the top of my head based on my EMT course and my discussions with other people,

How about a decent understanding of anatomy and physiology? How about covering some of the mechanism of action of interventions? I don't remember (granted, this was 6 years ago) Frank-Starling being mentioned in connection with trendelenburg. Heck, when I took a refresher, the RN teaching the course had some laughable concepts regarding trendelenburg to begin with (because placing a hypotensive stroke patient in semifowlers and shock position umm... does something beneficial?). 

How about basics of charting? Strange, all physicians graduate being able to write a SOAP note (we're tested on it on our licensing exam practical during Step 2), yet very little was taught in EMT course regarding documentation. 

Body mechanics, including sheet transfers and gurney/chair to bed transfers. On a side note, I view separating non-emergent transport from EMS as more of a priority than separating EMTs from paramedics in this discussion. 

Covering the basics of restraining patients, including a basic take down. 

A proper discussion of privacy laws besides, "Don't share anything or else the HIPPA (sic) monster will eat you." At a minimum, providers need to understand how "treatment, billing, and health care operations" are permitted uses. 

A proper discussion on decision making besides, "Call medical control" (which is really funny when you find out that the area you work in doesn't have online medical control for EMTs).


Now this is all off the top of my head. It's not everything, but how many EMS providers aren't going to need all of those sometime in their career, and most of them often? I'm never going to praise my EMT course because it wasn't that great. It also wasn't an accelerated course. At least with the courses that go for 3 months, 5 hours a week plus a handful of Saturdays, you could more easily tack on a day or two or an hour than one advertising that they can get you through an EMT course during winter break.


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## Fish (Nov 10, 2011)

mikeward said:


> Wow, every time Tom announces a course he gets grief from those who think an accelerated EMT-Basic (8 hours a day, 5 days a week) is inappropriate, impossible or immoral.
> 
> I have absolutely NO ties to Tom's program, except to refer people to his program that need EMT-Basic RIGHT NOW.
> 
> ...



You referenced back in the days and Fire Fighters wanting a quick EMTB course to much in this post, neither of which can be associated with good Medicene.


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## Tom Perroni (Nov 10, 2011)

Passion runs deep here in regards to EMS training and I'm glad to see that!

However a few points to consider:

I have been running this course for several years. If this course were not run correctly would the OMD sign off on it and would Virginia OEMS allow us to continue to run the program?  *The answer is NO!*

I resent the implication that we are here just for the money. I am in business to make money to feed my family however I have given away more free training and CEU's than I can count. I also run as an EMS  volunteer and teach at the Local High Schools EMT program for free as well as sponsoring Rescue stations that can not afford to send students to EMT training. In fact we have one free seat in every class.

We just recently hosted the Culpeper County Sheriffs office SWAT team and taught a EMT-B course for (1) deputy for free.

I am willing to put my money where my mouth is.........

I will offer (1) free slot in my December EMT-B class for someone from this forum. All you need to do is (1) send me an e-mail letting me know why you want this course. (2) When the course is complete you will need to write a day by day After Action Report of the class. the Good the Bad the Ugly.  “ccjatraining@gmail.com”

I teach this because I love what I do... My class size is limited to 12 students and we have 4 experienced ALS Instructors teaching as well as Sheldon Marks MD.

I can assure you that we teach well above the standard...However you may just have to see for yourself.

I can give you all the numbers in the world and you can twist them however you want to benefit your point….But I’m going way beyond that and saying for the last time….
Don’t talk carp about a program you have not taken…..You have no idea how I teach or who my Instructor cadre is……so come to class and find out for yourself.

I am willing to stand behind whatever the person who takes this free class says in the AAR. And hopefully we can all work together in furthering EMS education.

This class is not for everyone, however it can be for anyone who is willing to come to class to learn, study and most importantly have an OPEN MIND.

*P.S. If anyone would like to discuss this in person you can call me (540) 322-3000. *I do not feel that I can adequately convey via a forum post my passion for delivering quality EMS education. Moreover I will answer any legitimate questions you may have about our program.

Tom


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## Fish (Nov 10, 2011)

Most people on this forum agree that a Paramedic License should be the result of a degree, so naturally your going to meet resistance when talking about anything accellerated.


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## JPINFV (Nov 10, 2011)

Fish said:


> Most people on this forum agree that a Paramedic License should be the result of a degree, so naturally your going to meet resistance when talking about anything accellerated.



To be fair, we're talking about EMT training, and currently discussing making EMT training is as much pie in the sky as suggesting that paramedic training should be a bachelor of science degree. Long term? Sure, valid goals. Discussing it anywhere in the foreseeable future? Nope.


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## crazycajun (Nov 10, 2011)

Tom Perroni said:


> Passion runs deep here in regards to EMS training and I'm glad to see that!
> 
> I can give you all the numbers in the world and you can twist them however you want to benefit your point….But I’m going way beyond that and saying for the last time….
> Don’t talk carp about a program you have not taken…..You have no idea how I teach or who my Instructor cadre is……so come to class and find out for yourself.
> ...



Tom,
  You posted here claiming HIGH success rates and even put in bold print your 92% pass rate. All I am asking for is true numbers. This is a simple process.

1. Total of classes taught since inception
2. Total number of attendees
3. Total number of attendees that took the state test
4. Total number of attendees that passed
5. Total number of attendees that took and passed NRENT as you claim 100% pass rate.

I can get these numbers from any school in the country because they want you to know they are telling you facts. So if you don't want people talking CRAP about your program, provide some actual data. You keep stating that you will give away a free class but what does that matter? I can take a turd and paint it to look good and give it to you free. However it is still a turd.


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## Tom Perroni (Nov 10, 2011)

crazycajun said:


> Tom,
> You posted here claiming HIGH success rates and even put in bold print your 92% pass rate. All I am asking for is true numbers. This is a simple process.
> 
> 1. Total of classes taught since inception
> ...



*“I can take a turd and paint it to look good and give it to you free. However it is still a turd.”*

With comments like that…I will not give you any information so stop asking. You or anyone else can think what they want.

I think you like to act like your high and mighty on the internet. So this will be the last time I post to you.

If you’re so great why don’t you teach?  
If your not part of the solution you are the problem! So how are you going to fix the problems of EMS? Or are you all talk no action? 
It’s easy to sit behind a computer screen with anonymity and point out what you think is wrong with everyone and everything else!  But I don’t know who you are? I don’t know your background? So why should I prove myself to you?

If ANYONE on here who is a serious student has a question about our program call me and I will answer it.  (540) 322-3000 

As for giving you any further info not happening.


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## crazycajun (Nov 10, 2011)

Tom Perroni said:


> *“I can take a turd and paint it to look good and give it to you free. However it is still a turd.”*
> 
> With comments like that…I will not give you any information so stop asking. You or anyone else can think what they want.
> 
> ...



First of all YOU are advertising your school not me. 
How do you know I do not teach?
Due to my position I am not allowed just as many others here to disclose my identity as per county rules.
I could care less what you may or may not think of me. Again you came on here spouting off percentage of success in your program but refuse to show the actual numbers when requested. It seems you are the one with something to hide.

By the way you are not just proving this information to me but also to other potential candidates for your school.


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## BandageBrigade (Nov 10, 2011)

How hard is it to state number of students taught vs number that became certified?


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## medic417 (Nov 10, 2011)

The OP has been attacked and his method of teaching attacked by people ignorant to the facts.  Now because of it the OP has shut down any reasonable dialougue and who can blame him?  

As an educator and as a business man though my advice is develope thicker skin.  Sift thru the crap the ignorant pile on you and use there posts to actually make your point, which at time my include answering questions that they do not deserve the answer to but that others may be interested in knowing.  

OP consider this as a factual example.  I can say based on my last Paramedic course a 100% pass rate on NR.  Sounds good doesn't it.  But the fact is I gave 2 students course completions as the rest did not complete everything required.  Doesn't sound nearly as impressive.  So perhaps giving figures would help potential students to see better how your program is doing.

OP sorry you had to endure so many uneducated and rude attacks, really surprised the mods didn't lock or delete much of this topic.


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## JPINFV (Nov 10, 2011)

medic417 said:


> The OP has been attacked and his method of teaching attacked by people ignorant to the facts.  Now because of it the OP has shut down any reasonable dialougue and who can blame him?



On one hand, I agree. On the other hand, he choose to respond to those posts, ignored most of my posts (where I attacked the overall concept of making EMTs in 2 weeks and the system that allows it, instead of making it personal, either to him directly or his company), and when he did reply to me, he posted a laughing emoticon and offered no substantial reply. The hilarious part was when he said he was "done" with me despite never replying to one of my posts outside of posting said emoticon.

As such, I'm left to conclude that he has no actual response to my comments and commentary and would rather play with the mud slingers.


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## medic417 (Nov 10, 2011)

JPINFV said:


> On one hand, I agree. On the other hand, he choose to respond to those posts, ignored most of my posts (where I attacked the overall concept of making EMTs in 2 weeks and the system that allows it, instead of making it personal, either to him directly or his company), and when he did reply to me, he posted a laughing emoticon and offered no substantial reply. The hilarious part was when he said he was "done" with me despite never replying to one of my posts outside of posting said emoticon.
> 
> As such, I'm left to conclude that he has no actual response to my comments and commentary and would rather play with the mud slingers.



I believe based on a quick scan of the topic he was already at a point of frustration and had given up on the hope of a quality discussion and you just caught the frustrated response.


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## Handsome Robb (Nov 10, 2011)

My question is how can we expect to further our jobs into an actual profession with accelerated courses?

Not pointing the finger at you Tom, just at accelerated courses in general. Look at the rest of the world, most places require more education to be a BLS/ILS provider than the U.S. requires to be an ALS provider....There's something wrong with that. Furthermore, there is a national over-saturation of EMS providers, especially EMT-Basics except for the random rural area. Why continue to produce providers in such a short amount of time when there are already many more providers than jobs available?

Now, on to Mr. mikeward's comments:

You sir, seem to be in the profession of fighting fire, not practicing medicine. EMS = Emergency *Medical* Services. FD = Fire Department. As I said before about our education, we are one of the few countries in the world that still associates EMS with FD....Think about that one for a minute. Personally and *no offense to the fire guys on here*, if I lived in a place with fire based EMS it would take an act of God for me to call 911 for a medical problem. 

"Jack of all trades, master of none" gets even worse when you try to have dual role providers.


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## Tigger (Nov 11, 2011)

NVRob said:


> Personally and *no offense to the fire guys on here*, if I lived in a place with fire based EMS it would take an act of God for me to call 911 for a medical problem.
> 
> "Jack of all trades, master of none" gets even worse when you try to have dual role providers.



I guess I just don't get this attitude. Fire based EMS does not automatically equate to crappy medical care. Is there a lot of crappy medicine being practiced by fire based providers? Yes, but there is also plenty of equally bad medicine being practice by single role providers. 

There are good fire medics out there, and they're more common than it seems. Competent providers rarely make the news. Everyone has a horror story, and I do too, but I also have seen firsthand some excellent patient care provided by fire-based providers.

Being associated with fire department does not have to mean that the EMS provided is low quality. If EMS is not being delivered properly, we need to look at why, and not write it off as "oh, it's just fire based EMS being fire based EMS." That's not a real answer. If there are incompetent medics who are only medics so they could get a fire job, that is a systemic cultural problem within the department, and that the department has no business providing EMS. If the providers are still operating like it's 1982, that is a department problem and again, that department has no business providing EMS. 

The jack of all trades, master of one point is worth considering, but there are plenty of EMS agencies that provide more than just EMS, so by the above logic, they must not be very good either. Remember when there was the big argument over the FDNY/NYPD botched extrication and it was argued that extrication should be EMS centered? I'm not saying you agree with this line of thinking personally, but many do see EMS providers as able to provide more than just EMS.

My main point though is that you cannot judge the quality of care provided just by the type of service. Broadly stereotyping the fire service as unable to provide EMS in not a productive way to fix EMS, especially since the fire service is capable of providing first-rate quality EMS so long as the department and its culture are set up to do so.

EDIT: I realize this rather off-topic and I apologize, but I think the point still bears stating.


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## STXmedic (Nov 11, 2011)

Tigger said:


> I guess I just don't get this attitude. Fire based EMS does not automatically equate to crappy medical care. Is there a lot of crappy medicine being practiced by fire based providers? Yes, but there is also plenty of equally bad medicine being practice by single role providers.
> 
> There are good fire medics out there, and they're more common than it seems. Competent providers rarely make the news. Everyone has a horror story, and I do too, but I also have seen firsthand some excellent patient care provided by fire-based providers.
> 
> ...



I like you. 

Gotta agree here. I work for both, and agree that fire has some :censored::censored::censored::censored:ty medics, but also some GREAT ones, as does stand-alone EMS.

Might add more later, but this fire medic is freakin' tired after being woken up to give exceptional care to a chest pain patient.


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## Handsome Robb (Nov 11, 2011)

I should have worded that better. Agreed there are definitely exceptional firemedics out there just like there are exceptionally :censored::censored::censored::censored:ty single roll medics. 

I was doing a terrible job of trying to direct that towards EMS that is taken over by a FD, forcing providers and FFs alike to become dual roll, in most cases.


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## systemet (Nov 11, 2011)

It doesn't seem like 14 day EMT programs or 900 hour paramedic programs are good for the potential growth of EMS into a profession.
I think that if you run one of those programs, you should expect to have to defend it from time to time. This doesn't appear to have been an effective marketing exercise.


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## mikeward (Nov 11, 2011)

NVRob said:


> Now, on to Mr. mikeward's comments:
> 
> You sir, seem to be in the profession of fighting fire, not practicing medicine. EMS = Emergency *Medical* Services. FD = Fire Department. As I said before about our education, we are one of the few countries in the world that still associates EMS with FD....Think about that one for a minute. Personally and *no offense to the fire guys on here*, if I lived in a place with fire based EMS it would take an act of God for me to call 911 for a medical problem.
> 
> "Jack of all trades, master of none" gets even worse when you try to have dual role providers.



Hi NVRob, nice to meet you.  

While my first career was with a large county fire department, I am an assistant professor of emergency medicine at a private university in Washington DC.  (Yeah, that is pretty scary!)

Wow, there are few urban areas that do not run a fire-administered ambulance service or have fire company ALS 1st responders. You have used a very broad brush to make an emotional response.

So let me briefly share nuggets picked up by studying urban ems systems in the United States:


The biggest indicator of clinical excellence is an active and involved physician medical director ... regardless of who is administering the EMS service ... fire, police, ems or a corporation.

Most of our assumptions about "good" patient care crumble when we look at patient outcomes.  What things should we do to increase the number of patients who can walk out of the hospital with most of their facilities intact?

Both the 8:59 minute response of an ALS ambulance and staffing fire companies with dual role paramedic/firefighters are expensive and ineffective ways to improve patient outcomes.

Retrospective studies in Seattle and Los Angeles have shown no change in the survival rate of witnessed VF in 25 years. Improvement in community response (public access AED, police as part of 9-1-1 ems response, aggressive compression-only civilian rescue response, pre-positioned response people in high-rises) will probably make a bigger difference in outcomes. 

But this thread is about the value of a compressed EMT-Basic training program.

A well-supervised system can deliver superior clinical care by "non-caring" firefighters than a non-supervised system filled with compassionate ems caregivers.

It is not about attitude, but the competent completion of tasks within a clinical directive. 

You know, ems stinks at charting. Within the same worker demographic those that become police officers learn how to "chart" criminal activity as a competent officer of the legal system.  Maybe because the captain and the district attorney provides feedback and incentives?

The nursing profession has grown, even while there were mom-and-pop diploma programs similar to accelerated EMT programs.  

We share the same challenge of nursing in developing appropriately credentialed educators, researchers and leaders to support the growth of the profession.

Mike


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## JPINFV (Nov 11, 2011)

mikeward said:


> Most of our assumptions about "good" patient care crumble when we look at patient outcomes.  What things should we do to increase the number of patients who can walk out of the hospital with most of their facilities intact?




Is that the only metric that matters? How many people does pain management save? How many people does prehospital albuterol save? 
Is increasing survival to discharge always the goal, or just the easiest metric to measure? Where does relieving pain and suffering come into play?


> Retrospective studies in Seattle and Los Angeles have shown no change in the survival rate of witnessed VF in 25 years. Improvement in community response (public access AED, *police as part of 9-1-1 ems response*, aggressive compression-only civilian rescue response, pre-positioned response people in high-rises) will probably make a bigger difference in outcomes.


Emphasis added. 

You know, it's amazing and sad how many people balk about that, even if it's simply "train them in CPR, give them an AED, and only dispatch to cardiac arrests."

However, are cardiac arrests the best metric for EMS, or just the easiest to measure? How many cardiac arrests are beyond saving by the time EMS is even summoned? 



> But this thread is about the value of a compressed EMT-Basic training program.
> 
> A well-supervised system can deliver superior clinical care by "non-caring" firefighters than a non-supervised system filled with compassionate ems caregivers.



It's too bad that having both are too much to ask for. Personally, my opinion has evolved from "Boo on Fire" to "I'll support the first delivery model that will actually requires providers to have a proper foundation and think like professionals (in contrast to technicians)."

As far as the physician issue, with the recent acceptance of EMS as a proper sub-specialty of emergency medicine (much like cardiology is a sub-specialty of internal medicine), I think that the next few decades is going to see more and more physicians engaged in running the EMS system.  


> It is not about attitude, but the competent completion of tasks within a clinical directive.



I'd argue it is about attitude. I want someone taking care of me that is thinking past a cookbook-ocol and who isn't afraid to make tough decisions based on his/her education and training. After all, with out both the willingness to make decisions and the education and training, how do we decide which interventions and procedures needs to be done? If EMS is just about competent completion of tasks as assigned by a cookbook-ocol, then paramedic training can be distilled down to a few months of teaching individual skills as well. 




> Maybe because the captain and the district attorney provides feedback and incentives?


Police officer fails at charting and bad guy goes free. EMS fails at charting, and often little happens provided billing is taken care of. Of course billing can always be ran down after the fact and the worst that happens to the individual provider enters his or her name into the malpractice lawsuit lottery, and most likely his or her number won't be called, even if it's a dozy when it does get called.


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## Fish (Nov 11, 2011)

PoeticInjustice said:


> I like you.
> 
> Gotta agree here. I work for both, and agree that fire has some :censored::censored::censored::censored:ty medics, but also some GREAT ones, as does stand-alone EMS.
> 
> Might add more later, but this fire medic is freakin' tired after being woken up to give exceptional care to a chest pain patient.



Yes, but I bet those stand alones are private services. I don't know of one third service EMS department that struggles clinically. I knw of plenty Private and Fire.


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## STXmedic (Nov 11, 2011)

Fish said:


> Yes, but I bet those stand alones are private services. I don't know of one third service EMS department that struggles clinically. I knw of plenty Private and Fire.



I wasn't referring to an entire service. I was referring to individual medics. But if you want to go there, I DO know of several third services that are a joke as a whole.


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## mikeward (Nov 11, 2011)

JPINFV:

*Measurement metrics:*

_*"What things should we do to increase the number of patients who can walk out of the hospital with most of their facilities intact?"*_ is not the only metric.

But in discussion with some of those engaged and involved physician medical directors, it was a question that drove a discussion that continues to rattle in my diesel exhaust pickled brain when considering EMS system design.

And one that is appropriate when talking about EMT level caregivers.

Pain management is an underserved area in prehospital paramedic care.  Maybe one day EMTs can administer Nitrous Oxide.

*CPR resuscitation as a valid system performance indicator*

CPR survival rates have been claimed by some as an indicator of EMS system performance over a wider range of services.  I do not agree, but it remains a measurement.  

The U. S. Metropolitan Municipalities’ Medical Directors issued a statement: “Evidence Based Performance Measures for Emergency Medical Service Systems: A Model for Expanded EMS Benchmarking” was published in the April/June 2008 issue of Prehospital Emergency Care.  [Prehospital Emergency Care 2008;12:141–151]

In that statement they eliminated any ALS response standard. The "Eagles" noted that much of the clinical research used to establish acceptable ALS response time intervals was conducted prior to the widespread dissemination of AEDs and at a time in which the compression component of CPR was not emphasized as it is now. 

As a result, the consensus group proposed that EMS systems not focus response time measurement on ALS ambulances, but rather pay greater attention to first response/BLS response time to measure what it called the “most important predictive elements for optimal outcome: time elapsed until initiation of basic chest compressions and time elapsed until defibrillation attempts.”


Rochester, MN achieved the same 43% witnessed VF survival rate as Seattle/King County by dispatching AED equipped police officers on life-threatening incidents.  

That was a follow-up to this presentation:   Mickey Eisenberg. The C. J. Shanaberger Lecture: The Evolution of Prehospital Cardiac Care: 1966–2006 and Beyond. Prehospital Emergency Care October-December 2006  10(4) 411-417

Ventricular fibrillation in King County, Washington: a 30-year perspective.
Becker L. Gold LS. Eisenberg M. White L. Hearne T. Rea T.
Resuscitation. 79(1):22-7, 2008 Oct.

A population-based investigation of public access defibrillation: role of emergency medical services care.
Rea TD. Olsufka M. Bemis B. White L. Yin L. Becker L. Copass M. Eisenberg M. Cobb L.
Resuscitation. 81(2):163-7, 2010 Feb.

*Competence over attitude*

I will disagree about attitude.  At the EMT level it is the competent completion of tasks within a clinical directive.


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## Fish (Nov 11, 2011)

PoeticInjustice said:


> I wasn't referring to an entire service. I was referring to individual medics. But if you want to go there, I DO know of several third services that are a joke as a whole.



Name some(so that I never apply there if I ever decide to move)


Copy, I thought you were referring to the services. I know one(private) that surrounds your department that is a no good service. You know what I am talkin bouts!


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## emt junkie (Nov 12, 2011)

crazycajun said:


> Due to my position I am not allowed just as many others here to disclose my identity as per county rules.



This strikes a curosity in me.   Why would county rules prohibit someone from dislosing who they are?   The only reason I can come up with is they might be afraid if they new who you were with them it might come off as they are associated with your position on topics and might not be. 

Could someone who has these rules please expand on this a bit?


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## crazycajun (Nov 12, 2011)

emt junkie said:


> This strikes a curosity in me.   Why would county rules prohibit someone from dislosing who they are?   The only reason I can come up with is they might be afraid if they new who you were with them it might come off as they are associated with your position on topics and might not be.
> 
> Could someone who has these rules please expand on this a bit?



Our county is specific regarding social media and county association. Due to the fact that anyone can search a name within the DHEC system and see what service they work for my utilization of this site along with my real name would violate county policy. This is a great site but not worth my job.


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## systemet (Nov 13, 2011)

A few points:

* Yes, ALS probably makes little to no difference in cardiac arrest survival.  Anyone who can get CPR and a defibrillator to a person in arrest quickly is improving their survival.

* This doesn't mean ALS isn't beneficial in other situations, e.g. pain control, respiratory distress patients, 12-lead prenotification / ER-bypass / field 'lytics, etc.

* In many other settings, the fact that there's no evidence to support ALS intervention is as more often a reflection of a lack of research than the presence of studies showing an absence of benefit.   

* If the DOT, or any other governing body sets a minimum standard for our field, why do we as a community accept teaching only to that minimum standard?  Why don't we demand that the bar be raised, and recognise that this will only benefit us in the long term?  

* I've worked in systems where EMTs can give nitrous oxide.  It's better than not giving nitrous oxide, but it's not that much better.  It's just not that effective an analgesic in most of the population when given as a 50% / 50% oxygen mix.  It's contraindicated in a lot of patients, causes a lot of dysphoria / nausea, is cumbersome, and often has to be discontinued at the receiving facility, which results in a period of pain until a physician is able to administer narcotic analgesia.  Given the frequency with which pain control is indicated, and how often our patients are undermedicated, it makes sense to do it right from the start (my opinion, just anecdote).


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