# Get paramedic cert online while at work!



## daedalus (Mar 27, 2009)

http://www.iafc.org/displayindustryarticle.cfm?articlenbr=27730



> In January, Orange County (Fla.) Fire Rescue will begin its second distance learning paramedic school, taught in-house and entirely on duty




This part makes me laugh


> "The actual patient contact hours and skills attained by the students in this e-learning program are phenomenal,” said Pat Brandt, lead instructor....every student in the first school got at least one field intubation


:sad:


----------



## Ridryder911 (Mar 27, 2009)

Instructor?. Unfortunately, they are not educators yet they probably do not understand such.

R/r 911


----------



## VentMedic (Mar 27, 2009)

> "The actual patient contact hours and skills attained by the students in this e-learning program are phenomenal,” said Pat Brandt, lead instructor....every student in the first school got at least one field intubation


 
This program was started just after this "outstanding" study was published:

http://www.pulmonaryreviews.com/may01/pr_may01_misplaced.html




> [SIZE=-1][FONT=Geneva, Arial, sans-serif][FONT=Geneva, Arial, sans-serif][SIZE=-1]*ORLANDO, FLA*—[/SIZE][/FONT][FONT=Geneva, Arial, sans-serif][SIZE=-1]Endotracheal tube misplacement by paramedics is more common than previously believed, suggests a study of the emergency medical services (EMS) system in Orange County, Florida.[1] Of the 108 intubated patients studied, *25% were found to have an improperly placed endotracheal tube when they arrived at the emergency department. *[/SIZE][/FONT][/FONT][/SIZE]
> [SIZE=-1][FONT=Geneva, Arial, sans-serif]
> [FONT=Geneva, Arial, sans-serif][SIZE=-1][FONT=Geneva, Arial, sans-serif][SIZE=-1]“That rate is alarmingly high,” said Jay L. Falk, MD, one of the study authors. “The medical literature places the occurrence of misplaced endotracheal tubes at around only 1% to 5%.” The high incidence in Orange County may reflect a ubiquitous problem, suggested Dr. Falk, who is the Academic Chairman of the Department of Emergency Medicine at Orlando Regional Medical Center in Florida. “I have presented this study around the country, and its results ring true with many colleagues,” he told P[SIZE=-2]ULMONARY[/SIZE] R[SIZE=-2]EVIEWS[/SIZE].[/SIZE][/FONT] [/SIZE][/FONT]
> [/FONT][/SIZE]


----------



## phabib (Mar 27, 2009)

VentMedic said:


> This program was started just after this "outstanding" study was published:
> 
> http://www.pulmonaryreviews.com/may01/pr_may01_misplaced.html



The study was from 1997. Still, this seems absurd. Just an way to get Medic's on your staff without having to give them time off to go to school.


----------



## triemal04 (Mar 27, 2009)

Daedalus- you do realize that the article you posted is over 5 years old, right?  Or did you not bother reading it?  I'm not trying to justify or condemn the program in any way, but I am curious, how did you find this?  Looking for something so you can complain about fire dept's?  Or are you going to head over to this thread http://www.emtlife.com/showthread.php?t=11697 and complain about the people who only need 1 live tube?  Or none?

Ventmedic-  you do realize that the article is over 5 years old, right?  And that the study you posted was published in *2001* 3 years before the program started, not "just after"?  And the stats were collected in *1997*, well before ETCO2 monitoring became commonplace prehospital?  Again, I'm not in any way trying to justify the program.

http://www.merginet.com/clinical/airway/MissedETRates.cfm
Study in Indiana, can't tell if what type of service though.  But even without detectors, the success rate was much better, and better still with detectors.

http://www.ncbi.nlm.nih.gov/pubmed/15855946?dopt=AbstractPlus
Even better...this is what happens with ETCO2 monitoring...and with 11 counties, I'm pretty damn sure some fire dept's where involved.

There's a couple more recent studies that I've found cited that had a success rate from 90-95% (still should be better), and yes, some did involve fire dept's.  Unfortunately, I can't access them, but there are a whole lot more studies of this type out there.  If you are able to post them...that'd be much appreciated.

My point is twofold, one, that using an outdated study that did not incorporate current practices is not smart, and two, if you are going to complain about a fire dept...get all the fact's in order, there's enough problems that you shouldn't need to tweak the truth.


----------



## VentMedic (Mar 27, 2009)

triemal04 said:


> Ventmedic- you do realize that the article is over 5 years old, right? And that the study you posted was published in *2001* 3 years before the program started, not "just after"? And the stats were collected in *1997*, well before ETCO2 monitoring became commonplace prehospital? Again, I'm not in any way trying to justify the program.


 
The article dated January 15, 2004 is about the *SECOND* program. It also took them a couple of years to get the first program approved. With state accreditation standards and budget factors, it doesn't just happen over night. 

In January, Orange County (Fla.) Fire Rescue will begin its *second *distance learning paramedic school,



triemal04 said:


> http://www.merginet.com/clinical/airway/MissedETRates.cfm
> Study in Indiana, can't tell if what type of service though. But even without detectors, the success rate was much better, and better still with detectors.


 
Indiana? No where near Orlando. Yes, ETCO2 detectors make a difference. However, it is getting those who  have access to them to be consistent in their use that can be the problem. Remember the RSI articles from Texas last year? 



triemal04 said:


> http://www.ncbi.nlm.nih.gov/pubmed/15855946?dopt=AbstractPlus
> Even better...this is what happens with ETCO2 monitoring...and with 11 counties, I'm pretty damn sure some fire dept's where involved.


 
CONCLUSION: No unrecognized misplaced intubations were found in patients for whom paramedics used continuous ETCO2 monitoring. *Failure to use continuous ETCO2 monitoring was associated with a 23% unrecognized misplaced intubation rate.*



triemal04 said:


> There's a couple more recent studies that I've found cited that had a success rate from 90-95% (still should be better), and *yes, some did involve fire dept's. Unfortunately*, I can't access them, but there are a whole lot more studies of this type out there. If you are able to post them...that'd be much appreciated.


 
What are you trying to start against FDs? In Florida, we are Fire Based EMS and in this state there is ALS service in all parts of the state. So, enough already if you want to bash FDs. 

Of course there are positive studies. But there are also a large number of studies that aren't which is why ETI is now in question and have been pulled from some services throughout the country. 



triemal04 said:


> My point is twofold, one, that using an outdated study that did not incorporate current practices is not smart, and two, if you are going to *complain about a fire dept...*get all the fact's in order, there's enough problems that you shouldn't need to tweak the truth.


 
The study was *specific to the history of Orange Country* and the time at which they decided to start the program. 


You are the one that wants to complain about the FD by your earlier commment. So, don't start bashing the FDs of Florida with me.


----------



## triemal04 (Mar 27, 2009)

VentMedic said:


> The article dated January 15, 2004 is about the *SECOND* program. It also took them a couple of years to get the first program approved. With state accreditation standards and budget factors, it doesn't just happen over night.
> 
> In January, Orange County (Fla.) Fire Rescue will begin its *second *distance learning paramedic school,
> 
> ...


I know it's the second program.  I don't know when the first one took place; the article doesn't say.  Could have been the year before for all I know; if it was several years before then I was wrong about that part.  Do you know?  It doesn't change the fact that, in the study you referenced, the stats where collected in *1997* when ETCO2 monitoring was not available, or only rarely so if that.  There are more recent studies that could have been used, and even ones that where closer to the date of the article if you had really wanted to be technical.  I know that one was specific to Orange County, but what is their practice now?  Do they use ETCO2?  What is their success rate now/when the article came out?  Using that info would have been much more accurate than what you did.  Clear enough?

The point with the 2 links is to basically show what I said above; with the implementation of ETCO2, success rates and detection of misplaced tubes have changed.  Citing current studies (or studies that were current when the article was written) would have been much more accurate than citing an outdated one.  Doesn't matter if the article and the study have to do with the same county if the study is talking about things that have changed.  And I'm betting that between 1997 and 2001 and 2004 there were at least a couple of changes. 

I'm not trying to start anything against fire dept's.  I'd rather prevent it.  And both daedalus and you to one extent or another will complain about fire dept's.  If you are going to do that, as I said, get the facts in order, don't tweak them by using old, outdated info.  Clear enough?


----------



## VentMedic (Mar 27, 2009)

triemal04 said:


> you to one extent or another will complain about fire dept's. If you are going to do that, as I said, get the facts in order, don't tweak them by using old, outdated info. Clear enough?


 
I seriously take offense to that and you know very well I will since that is where my retirement is coming from. We've been over that before. So don't even start to bash me or FDs either on the forums or by PM. 

The point to the original post was to show that we have a variety of paramedic programs in this country that will make it difficult to establish higher educational standards. That has been the theme of the last few threads. This is not an article only about ETI. He was merely highlighting some points in the article that showed where somethings are lacking.

I posted the ETI article because it was done just before this training program was initiated. If they use the equipment they have, they should have little problem with confirming placement. However, if they are only getting 5 tubes in school total with only one in the field, that is pathetic. The studies also don't always tell us how many attempts it took before ETCO2 could be confirmed.

If you want to talk about just ETI, start another thread or read Bledsloe's latest article.

This article has more potential. I am not against FDs but I am against them taking the Paramedic programs out the the colleges.


----------



## daedalus (Mar 27, 2009)

Whoa! Triemal, I do not know how to respond to your comments because I do not understand the position you are taking. I have no position on this fire department, I posted the article knowing it was older. I really hope that intubation is kept in the paramedic SOP, and it is something I want to have in my toolbox in the future, but getting only one intubation in school is really just us making the the case against ourselves to remove it. Education, not ETI, was the focus of my post.


----------



## Epi-do (Mar 27, 2009)

triemal04 said:


> http://www.merginet.com/clinical/airway/MissedETRates.cfm
> Study in Indiana, can't tell if what type of service though.  But even without detectors, the success rate was much better, and better still with detectors.



Just FYI, since the article doesn't say - the study took place in Indianapolis.  I know this for a fact because 1) it is the only place in the state with 2 level 1  adult trauma centers (and they are less than 2 miles, and quite possibly less than 1, from each other.  We also have a level 1 pediatric trauma center.), and 2) although I wasn't a medic at the time, so I don't know the specifics for inclusion in the study, I do remember it being carried out.  Depending upon which township within Marion County you live in, EMS is provided by either a hospital based service, FD based EMS, or contracted private service.  All of the services within Marion County that participated in the study were 911 services.  However, I cannot remember if every township within the county participated.


----------



## Sasha (Mar 27, 2009)

I've ridden with OCFD. Half their medics are compassionless idiots in EMS for the pretty lights. Kinda like the blind leading the blind to train their medics in house.


----------



## triemal04 (Mar 27, 2009)

Ventmedic, I don't care where part of your retirement comes from.  I don't care if you used to work for a fire dept.  What bothers me, and what I do care about, is how much you complain about fire depts, sometimes with justification, and others without a bit of it.  You can take offence to that all you want, but it doesn't change the fact that you do it plenty.  It get's really old after awhile, especially with your propensity for twisting things and not being entirely accurate in your comments.  I have no idea what daedalus's point was...maybe it was to show how varied paremedic education could be...or maybe it was to show his contempt for fire dept's...I don't know, but I can make a pretty accurate guess.

And again...the stats for the study were collected in 1997...when was the first class?  Was it in 2001 when the study was published?  Before?  After that?  What kind of equipment were they using when it started?  I could be wrong; maybe there were no changes betwee 1997 and whenever the first class started and none between then and 2004...but I can't say right now due to lack of info.  Can you?


----------



## VentMedic (Mar 27, 2009)

triemal04 said:


> Ventmedic, I don't care where part of your retirement comes from. I don't care if you used to work for a fire dept. What bothers me, and what I do care about, is how much you complain about fire depts, sometimes with justification, and others without a bit of it. You can take offence to that all you want, but it doesn't change the fact that you do it plenty. It get's really old after awhile, especially with your propensity for twisting things and not being entirely accurate in your comments. I have no idea what daedalus's point was...maybe it was to show how varied paremedic education could be...or maybe it was to show his contempt for fire dept's...I don't know, but I can make a pretty accurate guess.


 
Show me a post where I have complained about the FDs because they are FDs. 

Those that know me on this forum know I will not participate in FD bashing unless it is for a good reason. Collier County was an example of a good reason since they had a good EMS system in place. I discuss things I know well and put up the links to back it up. If a system is worth discussing to learn something from, who cares what or where if there is worthiness to the discussion. 


You spout off stuff but rarely post links to your information. Or, when you do, they are not relevant to what is being discussed because you haven't read them. 

I can tell I struck a nerve because you didn't proof read or spellcheck your post. 

You also want to start crap with daedalus although his post is a good discussion. But, you want to hijack this thread just to bash daedalus and me. 


> maybe it was to show his contempt for fire dept's


 
You're not worth the trouble and don't bother filling my PM box with more profanity.  That's getting rather old too.


----------



## triemal04 (Mar 28, 2009)

VentMedic said:


> Show me a post where I have complained about the FDs because they are FDs.
> 
> Those that know me on this forum know I will not participate in FD bashing unless it is for a good reason. Collier County was an example of a good reason since they had a good EMS system in place. I discuss things I know well and put up the links to back it up. If a system is worth discussing to learn something from, who cares what or where if there is worthiness to the discussion.
> 
> ...


My god you're pathetic.  Your attitude as it relates to fire dept's comes through quite clear...and no, it's not always for a "good" reason.  The things that you discuss that you know "quite well" are not always completely accurate or completely related to whichever topic is being gone over...as can be seen here.  (again, if I'm wrong about that, all you need to do is tell me when the first class started...hopefully it was sometime around 1997 when the stats were collected...please, prove me wrong)

Which links aren't relevant?  Surely not the ones here, since I posted links to some studies that were more current (both current to todays date and when the original article was written in 2004) that showed a very different result in intubation success when ETCO2 and other detectors were used.  If you can't see the relevance to that you need some help.  But if you really want I will explain it...again.

Um...I rarely if ever spellcheck my posts.  You'll notice that often the same word will be spelled incorrectly the same way repeatedly in multiple posts...bad habit I have unfortunately.  Far as proof reading...don't know where you got that...is this more smoke that you're blowing because...oh...I don't know...you screwed up...again?

What's this about filling your PM box?  There's been 1 string of PM's between the 2 of us (and all were answered by you...odd) and they contained no profanity and continued an arguement that was started in a thread.  I'd be happy to post them and your responces here if you don't care.  Really, you can twist things around as you always do, you can omit facts or blatantly lie if it suits you...but doesn't it ever get to you how disgusting that is that you have to do that?


----------



## VentMedic (Mar 28, 2009)

triemal04 said:


> My god you're pathetic. Your attitude as it relates to fire dept's comes through quite clear...and no, it's not always for a "good" reason. The things that you discuss that you know "quite well" are not always completely accurate or completely related to whichever topic is being gone over...as can be seen here. (again, if I'm wrong about that, all you need to do is tell me when the first class started...hopefully it was sometime around 1997 when the stats were collected...please, prove me wrong)


 
Oh no, you're pouting. Didn't find any posts of me bashing FDs? 
If some of my information was incorrect, why didn't you jump in at that time with evidence of it being otherwise? 

I posted one article, which I didn't write, about Orange County and you come up with these accusations? Don't complain to me if you don't think the data in that article is incorrect. Write the authors of the study. You probably don't even know where Orange County, FL is. 

1997 is not that long ago for those of us who grew up with EMS. Yes, it may seem like a long time ago to you since you were only about 12 at the time. History repeats itself especially when some don't learn from their mistakes. 



triemal04 said:


> Which links aren't relevant? Surely not the ones here, since I posted links to some studies that were more current (both current to todays date and when the original article was written in 2004) that showed a very different result in intubation success when ETCO2 and other detectors were used. If you can't see the relevance to that you need some help. But if you really want I will explain it...again.


 
Read the thread. I wasn't the only one with a comment about your links. 



triemal04 said:


> Um...I rarely if ever spellcheck my posts. You'll notice that often the same word will be spelled incorrectly the same way repeatedly in multiple posts...bad habit I have unfortunately. Far as proof reading...don't know where you got that...is this more smoke that you're blowing because...oh...I don't know...you screwed up...again?


Is this a paragraph of some sorts?



triemal04 said:


> What's this about filling your PM box? There's been 1 string of PM's between the 2 of us (and all were answered by you...odd) and they contained no profanity and continued an arguement that was started in a thread. I'd be happy to post them and your responces here if you don't care. Really, you can twist things around as you always do, you can omit facts or blatantly lie if it suits you...but doesn't it ever get to you how disgusting that is that you have to do that.


 
I've deleted at least 50 messages over the past couple of years, many of which contained profanity. When I attempted to answer your questions, I got something similiar to this post as a reply.

Now if all I have been doing is telling lies, there are many others on this forum and others much smarter with more experience than you that can engage in questioning the validity of my responses without profantiy or rude remarks. I am usually able to clarify my comments, provide links or in a couple of cases admitted misinformation. 

All I see in some of your posts is a jealous little boy who has anger issues. 
Maybe you didn't get that FD job you wanted.


----------



## ffemt8978 (Mar 28, 2009)

Play nice or play elsewhere.


----------



## triemal04 (Mar 28, 2009)

VentMedic said:


> Oh no, you're pouting. Didn't find any posts of me bashing FDs?
> If some of my information was incorrect, why didn't you jump in at that time with evidence of it being otherwise?
> I didn't even bother looking.  And I have jumped in before...strange...it always ends with you making insults and complaining for some reason...
> 
> ...


Wow...this is fun.

Edit:  I've said this before, but perhaps it bears repeating.  You have lot's of great medical knowledge, and it's great when you share it, by all means keep that up.  But, that does not mean that you are always right; yes, even you make mistakes and say things that aren't really right.  This is not "the world according to ventmedic," it's reality.  You need to come to grips with that, and realize that everyone screws up sometimes, including you.  Please, get over it, and yourself.  You could be an even better resource here if you'd realize that.  When you are wrong, admit it, learn from it, and move on...happens to everyone.  Hell, I've asked you a couple times to show that I'm wrong here...you just can't, and ignore those requests to continue to argue.  It's pointless after awhile.


----------



## VentMedic (Mar 28, 2009)

triemal04 said:


> Wow...this is fun.
> 
> Edit: I've said this before, but perhaps it bears repeating. You have lot's of great medical knowledge, and it's great when you share it, by all means keep that up. But, that does not mean that you are always right; yes, even you make mistakes and say things that aren't really right. This is not "the world according to ventmedic," it's reality. You need to come to grips with that, and realize that everyone screws up sometimes, including you. Please, get over it, and yourself. You could be an even better resource here if you'd realize that. When you are wrong, admit it, learn from it, and move on...happens to everyone. Hell, I've asked you a couple times to show that I'm wrong here...you just can't, and ignore those requests to continue to argue. It's pointless after awhile.


 
Again, you are just coming off as a jealous little kid. If you can not form a proper debate with facts, then don't criticize those who can. When you can not get your point across, you resort to profanity. The same goes when someone questions you. Some of your posts are just anger and little else. If you don't believe me, read this thread. So no, I don't bother to question you because your responses are always the same. 

All this anger from you is from one article I posted. Nothing else. You don't seem to understand that I didn't write that article. I just posted it in a response to another article which was relevant to the time line of that program and a comment made. It was relevant for the that time and the time the program was initiated. Their new data may not be available or published yet since it takes a few years to get it into the journals. There is so much you need to learn before you start bashing people. You have yet to call me on a lie. You can not call this a lie because it is just an article from the same time the program was initiated. How many times do you want me to repeat that? What part do you not understand? 

You seem to think 1997 is in the prehistoric times. I do not Unfortunately, EMS as not advanced much since you were in diapers 12 years ago.

Do you not know what a lie is? 

You are one of the reasons why people on these don't give their true identity. You never know when someone is a stalker or has serious psych issues on a public forum even if it pertains to EMS. You don't seem know when you've crossed the line and your statements start to read more like threats. I've seen your behavior on a couple of different forums and there is a pattern. You are just an angry person.  You can criticize others but can't take it yourself. 

Take some anger management classes.


----------



## AJ Hidell (Mar 28, 2009)

VentMedic said:


> Show me a post where I have complained about the FDs because they are FDs.


Maybe he got you and I confused.  It often happens.


----------



## triemal04 (Mar 28, 2009)

VentMedic said:


> Again, you are just coming off as a jealous little kid. If you can not form a proper debate with facts, then don't criticize those who can. When you can not get your point across, you resort to profanity. The same goes when someone questions you. Some of your posts are just anger and little else. If you don't believe me, read this thread. So no, I don't bother to question you because your responses are always the same.
> 
> All this anger from you is from one article I posted. Nothing else. You don't seem to understand that I didn't write that article. I just posted it in a response to another article which was relevant to the time line of that program and a comment made. It was relevant for the that time and the time the program was initiated. Their new data may not be available or published yet since it takes a few years to get it into the journals. There is so much you need to learn before you start bashing people. You have yet to call me on a lie. You can not call this a lie because it is just an article from the same time the program was initiated. How many times do you want me to repeat that? What part do you not understand?
> 
> ...


There isn't much of a debate to be had here...no, 1997 was not that long ago, but there are things in use today (such as ETCO2 detectors that really work) that were not used then...so citing a study that used stats from then while referencing a program that started at a later date (and exactly what that later date is stills seems unclear; guess you don't actually know either) when equipment was being used that hadn't been during the study is not the best choice.  Geez, I think I've said that, and explained why several times now.  It really can't be that hard to grasp, can it?  I've also said that I very well may be wrong; if there was no change in how intubations were confirmed in OC between 1997 and whenever the program started and 2004 when the article was written, then I am wrong; you just need to show that.

What profanity?  You seem to be caught up in that for some reason.  There's none to be seen here...none in the "50" PM's that I sent you (what a joke)...odd.  Far as anger goes...not really.  It really is more of a feeling of disgust that this is what you have to resort to in this type of situation.

Lies...um...just see the part where you were talking about PM's...that's easy to find.  More often what you do is, as I said, misrepresent something, omit certain facts, and like a good politician (don't worry that's a joke) spin spin spin!  As can be seen with the study you cited.  I've allready explained why, and, once again, if I am wrong, then you just need to show that. 

Now we get to the more serious parts.  Threats?  Where have I said anything that is even close to a threat?  This is a bit more serious; if that's the case then you need to immedietly report me to the mod's and I should be banned.  Permanently.  As should anyone that does something like that.  Of course, that's not really the case so, it would appear, that once again, you've resorted to insults and complaining because that is the only recourse you have in this.  

Strange...for almost everything you've accused me of doing, or I've asked, it would be really easy for you to show that I have done that, or even answer the questions I asked.  I've done the best I can o my part, but you...not even close, which is what often happens.  Why?

You can do better than this.

Edit:  Ventmedic...if what you are saying about the PM's and "threats" was even remotely close to true, all you need to do is complain to the mods and I'd pretty much gaurentee that I'd get banned.  You know...I'll do it for you...mods, please look into these accusations...if they are true then take whatever action is appropriate.  The fact that you haven't done this is a bit telling about how accurate what you are saying is...and the type of person you are.


----------



## VentMedic (Mar 28, 2009)

AJ Hidell said:


> Maybe he got you and I confused. It often happens.


 
You could have a point.  Sometimes we could be mistaken for kin by a few of our posts.


----------



## medic417 (Mar 28, 2009)

VentMedic said:


> You could have a point.  Sometimes we could be mistaken for kin by a few of our posts.



Now that is just scary.^_^


----------



## ffemt8978 (Mar 28, 2009)

Last warning...

Stay on topic and keep the accusations off of the forums.  If you've got an issue with a forum member, you need to take it up with them or the Community Leaders in private.


----------

