# Hat's off to EMT-B's



## trauma1534 (Nov 24, 2006)

I just thought it would be nice to recognize our EMT-B's for the great job they do everyday.  I myself am an ALS provider, but I have been down your road, and I know what you go through and take off of ALS providers alot of times.  You don't get the credit you deserve!  Thank you so much for always being there to help us, to save us in that truck, and for trying to be the very best that you can be!  

Again!  My hats off to you for everything you do!


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## fm_emt (Nov 25, 2006)

Wait a second, I thought you hated us! Did you get into the spiked eggnog again?


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## sarahharter (Nov 25, 2006)

it is finally nice to be appreciated. als around me think well, we call most of them paragods and to them we are nothing and can do nothing but vitals. i am an emt-b but i also am a medtech in the air force so i know how to do medic stuff and some of my medics know that and let me help if they can't get a stick or something but we have medics that are complete jerks to emt-s. so i thank you for your comment it is very much appreiciated.


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## jeepmedic (Nov 25, 2006)

Truama never said that she hated EMT-B's Read some of her other post.


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## jeepmedic (Nov 25, 2006)

By the way what is a Hatr's?


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## Stevo (Nov 25, 2006)

interesting way around a locked thread folks....


let's look at how ems is set up, shall we? everyone is aware of the continuity of care right? in a (redundant) nutshell this essentially means there is a line of communication from the trenches/troops on up.

what does a _good_ bls'er do? s/he effectively communicates well with the recieving als'er, which follows on up through the hiearchy all the way to the Doc.

as each trasnfere occurs, this is the resonsibility of the lesser trained element, yet for a good continued relationship it should not be a one way deal, should it?

again, a good bls'er is apt to have some clue as to what level(s) of care are to occur, or be needed next (most of you are keen to this on dispatch alone) 
this subsequently falls on the next ems'er in line to impart to his/her subordinates.

in other words, everyone in ems had their hand held at one point or another, we were offered explainations and rationales for that chain that we are

those who seek to break said chain not only do an injustice to the whole of what we are, they compromise patient care in doing so

~S~


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## trauma1534 (Nov 25, 2006)

Heck no I don't hate EMT-B's.  I spend most of my time taking up for ya'll.  Read some of my posts.  I think you all do one H*ll of a job!  I have no problem taking a stand for people who are out there giving thier time to help people when there are alot of other things they could be doing with thier time.  There is nothing wrong with EMT-B's for the most part.  Those who want to be the best at what they do have my hat's off.  

Don't even give place to those paragod's out there who want to put you down all the time.  Let me tell you a little story about EMT-B level.  There are alot of things that you CAN handle without even calling on us for anything.  What makes the difference in a good and bad provider at any level of training is knowing when you are at your limit in treatment and when to continue on at your level with that patient.  I have no problem with taking anything down the road to the ER in my truck.  I also know when I am up against the wall and need more on my truck.  I recently heard from a very good paramedic (hat's off to you and you know who you are) that people call flights in because they are scared to care for the patient.  While that may be true to alot of providers... that is definatly not the case with me.  When I call a flight in, it is because I know that is the very best for my patient.  I know that the recieving facility where I would normally take my patient is not equiped to handle the underlying problem with that patient.  That makes a good provider. 

Yes, EMT-B's can be agressive!  I know.  I was agressive as sh*t when I was an EMT-B.  I am highly agressive now.  Some have said I am too aggresive or cocky.  Nope, I'm not cocky, I just have learned to recognize what needs to be done, and I stay ahead of the game.  That's what every level needs to do.  If you think you will need ALS, call them.  You can always turn them around.  If you are ALS, and you think you will need to start a line, start it before it get's to that point.  

Now, I have worked for a combination of agancy's over the years.  I have worked under 3 different protocols in 12 years.  I have worked for that busy 20 calls in at 24 hour shift agancy.  That made me learn how quickly you had to get everything done... so it made me even more aggresive.  I could have everything done and drugs onboard within 10 min.  You have to be able to recognize the red flaggs.  EMT-B's are good at recognizing those flags.  I have volunteered for a squad that was full of Medics who had the "I'm better than you" mentality.  In that agency, is where most would feel like they were on egg shells, that is the exact agency that I tried to shine the most in.  I put my patient's first above anything else.  There is nothing better than to have a bad patient going down hill quick and have at good EMT-B setting across from me in that truck.  I am like prizenmedik, I'd rather have a good EMT-B in my truck with a bad patient, than to have the highest trained paramedic with a big head in my truck.  When it gets down to it, when you are zoned in on that patient condition, the last thing you need in your truck is ego.  I now work for a slower paced agancy where our transport time has been as much as 45 min. from the scene to the closest recieving facility.  The least eta we have is aprox. 25 min.  That type transport times seporate the men from the boys (or women from the girls).  Guess what?  In that department, we only have 1 paramedic, 4 EMT-Enhanced, 2 EMT-I's and about 10 EMT-B's and about 6 or seven drivers only with no certifications.  When I work, I am lucky to get just a driver.  The EMT-B's there have learned to be the best they can be.  Alot of times, they are not going to get anything any higher after hours when all of us are off work.  Let me tell you, for the most part, they kick azz!!!  

There is nothing I like to see any more than to see a fresh new EMT-B, or even a student get in the back with me on a bad call and see them hungry to do and learn!!!  Let me tell you!  I will teach them and help them as much as I can.  I will NEVER say anything against them for trying.  Hey!  It's the best that that county will get after hours!  Why not encourage them and help them be the best at thier level!!!  After all, we are in this for the patients, not ourselves!  Atleast that's why I am in it!  

I will say this in closing.  EMT-B's, always hold your head up!  Don't let those medics see ya sweat!!!  Learn and do all you can at your level.  If you don't want to go further, then be the best you can be at your level.  If you want to go to higher level, then take your time.  Learn all you can at each level.  BE THE BEST!!  I have only seen one Paramedic over the last 12 years who went from 0-to hero and made it work.  Guess who it was?  PRIZENMEDIC!  He is one of the very best paramedic's I know!  One of the other very best medics I ever had the priveledge of knowing and working with is FEDMEDIC!  JEEPMEDIC is awesome too!  We all came from the same original group.  They will always stand up for you guys!  They along with myself know that we could not be what we are without ya'll!  

Maybe prizenmedic has not made such a great impression on some people, and maybe Fedmedic and Jeepmedic have pissed some people off, but I share the same mentality as them, I'm sure they will agree when I say "Hat's off to EMT-B's"!  They and myself will always stand up for you guys, because we have not forgotten where we come from!  

Now EMT-B's, get out there and make it count!  Make your mark!  Thank you so much for all you do everyday!  Don't let anyone discourage you!!!  You are our backbone!!!  

I would also like to add one other thing.  We who are paid in this field sometimes over look the volunteers for what they sacrafice (I'm not the best speller lol), but I was watching the movie Pearl Harbor, and I remember one comment made on that movie that stand true and stuck with me... "There is nothing greater than the heart of a volunteer"!  That is so true.  Thanks again for all you do everday when you could be doing something else with your time!  You are always there when we need you!  God Bless you!!!


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## paraprincess (Nov 25, 2006)

some of my best partners have been emt-b's.. i have respect for everyone in our line of work.. its too bad we can't all stick together and have it for each other because lots of outsiders sure dont have respect.. i.e. when they call us ambulance drivers..or when they dont realize why we look so down and tired after some bad shifts.. 
anyway thanks to everyone in EMS especially the basics because thats where it all starts and its where we all started! .. BLS b4 anything else
:usa: as a team we can do it all!!


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## Stevo (Nov 25, 2006)

an apt post via an ems'er who came up through the ranks *trauma1534*

bravo!

people here do realize that ALS is a coveted and scarce resource in many parts of the rural contingent, yes?

in said areas, it is up to the basics to _sell the powers that be_ on ALS 

so you see, recognition is _everything_ from every point of view in ems

~S~


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## jeepmedic (Nov 25, 2006)

trauma1534 said:


> Heck no I don't hate EMT-B's.  I spend most of my time taking up for ya'll.  Read some of my posts.  I think you all do one H*ll of a job!  I have no problem taking a stand for people who are out there giving thier time to help people when there are alot of other things they could be doing with thier time.  There is nothing wrong with EMT-B's for the most part.  Those who want to be the best at what they do have my hat's off.
> 
> Don't even give place to those paragod's out there who want to put you down all the time.  Let me tell you a little story about EMT-B level.  There are alot of things that you CAN handle without even calling on us for anything.  What makes the difference in a good and bad provider at any level of training is knowing when you are at your limit in treatment and when to continue on at your level with that patient.  I have no problem with taking anything down the road to the ER in my truck.  I also know when I am up against the wall and need more on my truck.  I recently heard from a very good paramedic (hat's off to you and you know who you are) that people call flights in because they are scared to care for the patient.  While that may be true to alot of providers... that is definatly not the case with me.  When I call a flight in, it is because I know that is the very best for my patient.  I know that the recieving facility where I would normally take my patient is not equiped to handle the underlying problem with that patient.  That makes a good provider.
> 
> ...



Very well said young Padawan


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## trauma1534 (Nov 25, 2006)

paraprincess said:


> some of my best partners have been emt-b's.. i have respect for everyone in our line of work.. its too bad we can't all stick together and have it for each other because lots of outsiders sure dont have respect.. i.e. when they call us ambulance drivers..or when they dont realize why we look so down and tired after some bad shifts..
> anyway thanks to everyone in EMS especially the basics because thats where it all starts and its where we all started! .. BLS b4 anything else
> :usa: as a team we can do it all!!



Well said!!!  Thank you for holding these guys up!  They need all the encouragement they can get.  I'm surprized some of them havn't gotten tired of the negative attitude's of the higher ranks and just quit.  Trust me, they have been beat down pretty bad!  Let's all try to keep thier spirits up!  They obviously love what they do or they would be doing something for more money.  Thanks again!!!  Keep it comming!


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## trauma1534 (Nov 25, 2006)

jeepmedic said:


> Very well said young Padawan



Thank you ya old flunkie!!!  10 bucks says you didn't read my whole post in it's intirety!  LOL


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## Summit (Nov 25, 2006)

trauma1534 said:


> 10 bucks says you didn't read my whole post in it's intirety!  LOL



what i read was good... but it was just too long and my vision started to get blurry


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## jeepmedic (Nov 25, 2006)

You owe me ten bucks.


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## trauma1534 (Nov 25, 2006)

jeepmedic said:


> You owe me ten bucks.




How 'bout I buy you a happy meal for supper next week and we'll call it even!  LOL


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## jeepmedic (Nov 25, 2006)

Make it a Big Kids meal.


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## trauma1534 (Nov 25, 2006)

Do you want a toy for a boy or girl?


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## jeepmedic (Nov 25, 2006)

Girl Brianne has got to have somethng to play with.


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## jeepmedic (Nov 25, 2006)

Summit said:


> it was just too long and my vision started to get blurry



It needs to be short. She knows I have ADD. I did read it all. It just took a while. Had to go back several times.


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## fm_emt (Nov 25, 2006)

jeepmedic said:


> Truama never said that she hated EMT-B's Read some of her other post.



Clearly internet sarcasm is lost on you.  In other words, I was just kidding.


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## jeepmedic (Nov 25, 2006)

fm_emt said:


> Clearly internet sarcasm is lost on you.  In other words, I was just kidding.




ok you got me


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## Guardian (Nov 25, 2006)

Yea, Hatr's off to ya emt-b, what would we do without you.  It would be horrible, we would have all these highly trained paramedics with college level educations running around taking care of us.  Damn that, when I'm having an MI, I want a quick BP check and a ride.  I don't want no fancy morphine or 12 lead EKG either.  Just take me on over to Doc Brown's house so he can give me a tranquilizer.  I've just been tired lately and haven't been able to sleep, that's all it is.  It's not like we can afford those fancy paramedics anyway, you must think we live in the richest country in the world or something.  People just don't understand our way of life out in the rural parts, you need those paramedics to be close to the city, that way bettie-sue-joe-bobby-2-teeth-mary can take care of me.  She has been a CNA for years and bless her heart, she's just the sweetest thing.  She took that emt-b class down at the firehall and you know, they took out all that useless medical jargon.


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## ffemt8978 (Nov 25, 2006)

Admin note - corrected spelling in thread title.


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## fm_emt (Nov 25, 2006)

ffemt8978 said:


> Admin note - corrected spelling in thread title.



The apostrophe shouldn't be there either.  "Hat's" indicates possession.


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## trauma1534 (Nov 26, 2006)

ffemt8978 said:


> Admin note - corrected spelling in thread title.




Thank you!  I tried to go back and fix that, and I couldn't get it to change!


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## Ridryder911 (Nov 26, 2006)

I have worked with very outstanding basic EMT's that could run circles around any Paramedic. Worked with two that had graduate level in molecular biology and never wanted to "proceed" past the basic level. Although, I believe that was a waste, he could had offered so much to patients and EMS system. 

No, I don't hate or even dislike any Basic when we used to have basics, they preferred to ride with me, because I have always thought as a team approach. No matter, whom is in the back.. it is both EMS personal on the call, and both will go to court, if something wrong happens no matter whom is in the back. as long as both are patient conscious, the patient will have a great team.

In closing, all I will say is many will be surprised by the new 2008 EMT curriculum. 

R/r 911


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## trauma1534 (Nov 26, 2006)

Ridryder911 said:


> I have worked with very outstanding basic EMT's that could run circles around any Paramedic. Worked with two that had graduate level in molecular biology and never wanted to "proceed" past the basic level. Although, I believe that was a waste, he could had offered so much to patients and EMS system.
> 
> No, I don't hate or even dislike any Basic when we used to have basics, they preferred to ride with me, because I have always thought as a team approach. No matter, whom is in the back.. it is both EMS personal on the call, and both will go to court, if something wrong happens no matter whom is in the back. as long as both are patient conscious, the patient will have a great team.
> 
> ...



Thank you Ridryder!  You have surprized me on here!  You actually did not put them down.  What you said, was for the most part, well said!  

What is surprising about the 2008 curriculum?


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## Guardian (Nov 26, 2006)

emt-basics are great.  I work with a lot of emt-basics and think the world of them.  My girlfriend is an emt-b.  Currently, our ems system wouldn't work without emt-basics.  This is because of our failure to demand ALS in every ems system.  My last post was meant to show what we have now compared to what we could have.  As an als provider, wouldn't you rather an als provider take care of you or your family instead of a bls provider, all things being equal.

I'm going to be disappointed no matter how the new emt curriculum has changed.  Education won't increase, maybe they'll have a few new skills but that will only show that ems is dumbing down even more so that emt-basics can play a larger role in advanced care (without the proper education) and thus, there will be even fewer paramedics.  On the other hand, I can't imagine emt-basics losing any skills considering how few they have now but if that happens, it will just be sad.  Either way, the new curriculum is going to suck.


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## jeepmedic (Nov 26, 2006)

Ridryder911 said:


> In closing, all I will say is many will be surprised by the new 2008 EMT curriculum.
> 
> R/r 911




Any idea when the new curriculum will come out? I am planning to teach another class in the spring and wondering should I wait or just start anyway.


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## Stevo (Nov 26, 2006)

> In closing, all I will say is many will be surprised by the new 2008 EMT curriculum.



yes, i'm sure that book sales will soar, while everyone debates why the powers that be have feverently slaved away trying to fix what isn't broken 

~S~


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## Fedmedic (Nov 26, 2006)

Guardian said:


> emt-basics are great.  I work with a lot of emt-basics and think the world of them.  My girlfriend is an emt-b.  Currently, our ems system wouldn't work without emt-basics.  This is because of our failure to demand ALS in every ems system.  My last post was meant to show what we have now compared to what we could have.  As an als provider, wouldn't you rather an als provider take care of you or your family instead of a bls provider, all things being equal.
> 
> I'm going to be disappointed no matter how the new emt curriculum has changed.  Education won't increase, maybe they'll have a few new skills but that will only show that ems is dumbing down even more so that emt-basics can play a larger role in advanced care (without the proper education) and thus, there will be even fewer paramedics.  On the other hand, I can't imagine emt-basics losing any skills considering how few they have now but if that happens, it will just be sad.  Either way, the new curriculum is going to suck.



In our area it's not that the agencies don't want to hire paramedics, it's just that there aren't any to apply. For example, at the last agency I worked, when I started we were an all ALS agency with all paramedic/paramedic trucks. After a couple of years we slowing transitioning to a combination agency, now it's pretty much 50/50; paramedics and EMT's. But it wasn't the agencies fault or intent. For every 4 paramedic openings you would have 2 applications and of those 2; 1 was guaranteed to be any idiot. I know, I used to do new applicant assessments. 

I don't know about the rest of the country, but there is a large paramedic shortage in this state and the state beside us, where I used to work. I just think this day and time with so many choices to pick in college courses, most young people are going into something that is more lucrative. Most of the new paramedics were the ones who came up through the ranks, started out as a volley EMT somewhere and decided to get their medic. And these happened to be the better paramedics. So what is the answer? I don't know. It seems to be a double edged sword, do you shoot for more education and licensure? at the risk of having even a less number of paramedics to apply and hope the money goes up. And then will it become like nursing, making good money but still having a large shortage of providers. Or do you stay the same or lower the standards to try to generate more interest?


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## Ridryder911 (Nov 26, 2006)

Actually the curriculum review is being sent away as we discuss for initial evaluation. Rumor ( as usual) is there going to be a shift of giving basics more education in science and detailed assessment skills. 

Paramedic level will have more basic interaction, and as well have most of the CCEMT/P doctrines incorporated into the program. 

I do disagree adamantly that the system is not broke. Some of the Basic EMT texts are now only written at a 6'th grade level and many institutions are now having a hard time allowing college credit and other similar standards due to the lax educational standards. I agree dumbgrading is not the answer for replacing empty spots, actually quite the opposite. 

When and after review of curriculum changes, there will be a public review and critique to allow in-put. Please remember, we should maintain and request higher standards than we currently have. It should not matter if one is paid, volunteer, metro or rural... EMS and patient care should have continuity and diluting the education is not the answer to personnel problems.
Our patients and emergency medicine requires we increase the knowledge level to provide current medical care. 

I will post the site for reviews, as soon as I hear or receive information in regards to the new curriculum. 

R/r 911


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## Summit (Nov 26, 2006)

Fedmedic said:


> So what is the answer? I don't know. It seems to be a double edged sword, do you shoot for more education and licensure? at the risk of having even a less number of paramedics to apply and hope the money goes up. And then will it become like nursing, making good money but still having a large shortage of providers. Or do you stay the same or lower the standards to try to generate more interest?



I really don't think they can lower standards. They are already pretty low.

Note that the following sentence is fancifull:

I tend to think that if a national increase in standards for education and entry into BLS and ALS levels can be coupled with an increase in scope and a change at the state and federal level regarding reimbursement including classifying EMS as an essential service, then we will see an increase in quality of care, an increase in pay and benefits, and decreased attrition in providers.

That nasty runon sentence above is a hard thing to dream of accomplishing. One thing EMS has going for it is, at least around here, all EMS classes are affiliated with a university or community college even if taught off campus. That means that EMS education need not suffer the same fate as nursing did in many states when many nursing schools were unable or unwilling to join univerities and closed leading to a drastic decrease in slots. So ability to educate the same number of paramedics will not suffer. If attrition decreases, the available paramedics will increase because the profession is a workable one. One thing EMS doesn't have going for it that nursing did have was that nursing was already integrated into the hospital care system and therefor it was easier to adjust salaries.

Presently, for most providers in most places, EMS is not a feasible lifetime career. Canada has a good system going I thinik with PCP/ACP/CCP. Can you even imagine a 1 year program requirement for BLS?

I was going to write more but it is snowing. WOOHOO!


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## Airwaygoddess (Nov 26, 2006)

It is one thing to be taught, but it even means more to be taught well.  It is important to understand the theory that goes with the skills.  I have been on both sides of the desk along with being on both sides of the gurney, and let me tell you folks, being on both ends has taught me to how to be a good (and always work on getting better!) EMT and when the time comes, a good paramedic. (ditto!)  I often think about the folks that I have worked with and taught me about caring for the sick and injured, these folks were my first teachers, to this day I will say because of these great folks became my mentors.  The paramedics, emts, and nurses that have been  instructors in the various classes that I have taken through the years have not only taught me "whats in the book" but also their real life experience.  I strongly believe that is one of the best teaching tools that an instructor could have.  This website alone, has given me a chance to keep on learning from all aspects of EMS.    Two words for you all, THANK YOU!!!


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## Stevo (Nov 26, 2006)

> I do disagree adamantly that the system is not broke. Some of the Basic EMT texts are now only written at a *6'th grade level* and many institutions are now having a hard time *allowing college credit* and other similar standards due to the lax educational standards.



that's odd *R/r 911*, seems like the majority of ems personel i've worked with in the last 20 years didn't get into it to pursue college , or have even attended college at all....

seems they can articulate better than a 6th grade level too....

perhaps you should clarify your educational stance, if only for the many misfortunates that have been so woefully misled for so long

yrs

~S~


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## jeepmedic (Nov 26, 2006)

Stevo said:


> that's odd *R/r 911*, seems like the majority of ems personel i've worked with in the last 20 years didn't get into it to pursue college , or have even attended college at all....
> 
> seems they can articulate better than a 6th grade level too....
> 
> ...



I didn't get into EMS to pursue college but if I want to stay in it and do my pts. justice then I will need to. I hate the thought of going back to school but I study all the time anyways.
As far as the books this is true. I can read higher than a 6th grade level but  that does not mean the books were not writen higher than that.


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## Stevo (Nov 26, 2006)

*Jeepmedic imparts a revelation*



> I didn't get into EMS to pursue college



and ems was not created for it's bulk to pursue it either, _im(rarely humble)o_

so i ask in this forum (yet again, for the nth time) , do we wish to elevate ems to a profession that takes away from the proliferation of responders out there?

quality/quantity...._(as the dogs painted in velvet continue to cheat at poker....)_

extra credit Q~ what was the premis of ems's inception

~S (oh the humaity)tevo~


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## jeepmedic (Nov 26, 2006)

> so i ask in this forum (yet again, for the nth time) , do we wish to elevate ems to a profession that takes away from the proliferation of responders out there?



It is not what EMS started out to be but what it has evolved into. The first Nurses did not have to go to school they just studied under another nurse and we made one. Now as time passes It is hard to find just a RN program it is moving more and more toward a BSN is the standard in Nursing. 

To answer your question Yes we need and should wish to elevate EMS to a profession. But not one that leaves its roots behind. We do and will always need First Responders but the general public expects more and more out of an EMT-B and they do deserve more. You look at it now. In some states a RN only has to send money in to there state to keep there RN Lic. while an EMT at any level has to have a min. of 36 hours to keep there Cert. This by itself is making it harder and harder for most Vollys to keep there Cert. up. So yes you do need and should try move this profession foward. If you are not moving foward then you are only going to get left behind.


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## Stevo (Nov 26, 2006)

*Jeepmedic tries for the kewpie doll*



> but what it has evolved into


who or what factions are insiting we walk upright *Jeepmedic* ? Think about this for a moment, the spectre of $$$ looms very close to the heart of this statement.  



> Yes we need and should wish to elevate EMS to a profession. But not one that leaves its roots behind.



it's roots were (and by rights still are) community service, removing the availability of being able to do this creates an expense that the majority of the populance can't afford to fund

as in 45 million Americans who we turn our backs on every time we insist the ante' be upped...

~S~


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## jeepmedic (Nov 26, 2006)

Stevo said:


> *Jeepmedic tries for the kewpie doll*
> 
> 
> who or what factions are insiting we walk upright *Jeepmedic* ? Think about this for a moment, the spectre of $$$ looms very close to the heart of this statement.
> ...



You have a point.


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## Ridryder911 (Nov 26, 2006)

Surely you are not implicating we should not become more professional requiring at least above high school level equivalency for our profession. Again, medicine is changing and we have to keep up with it, there is no choice. As well responsibities of the EMT will be increasing as those with experience can attest to. These will only becoming more and more as the generation ages increase and hospitals become more taxed.  

Sorry, voluteer or paid that is really irrevelant.. the system should be about the patients sake not the rescuers ability to go to school or not. One does not see other professions maintianing status quo or regressing because the inabilty to attend school, etc. 

FYI many states are adopting CEU's for RN's and other health professions due to EMS personal has set an example, as well some are requesting they have to be currently employed or associated with a healthcare facility. P.A's has to take CEU's plus retake the whole board over every 6 years. 

The old "we won't have enough volunteers" should not even enter the subject, again if people are really interested then they will attend. This is why a competent, good qualified First Responders, and Basic levels are essential for those communities. 

Just because a physician, nurse, or any other health care provider decides to work in a rural or less populated area, does not excuse them from having to attend courses like the rest of their peers. One is expected to know, perform, and treat just like those that want to work in a high call volume, and in fact one has to be better prepared due to less exposure. There is not a difference in standards of one that gets a salary or volunteers, professionally and legally all are compared equally. 

People afford other healthcare, clinics, hospitilzation, even nursing homes so EMS should be able to maintain and have just as qualified individuals to provide for their care as well. All hospitals still require RN's, even nursing homes do, no matter where and how remote it is some how; they always find a way.. maybe we should look at see if there is a way for EMS to get substainal funding and support as well. 

Sorry, the only progression for EMS to become substainal to expect revenue and reimbursements for the betterment of the medical community is for the education level of the EMS personel to increase. We are one of the very few if not only healthcare profession that requires such a limited courses. 

We can only better ourselves off with increasing education, and as well as patients can expect to recieve better care.

R/r 911


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## oldschoolmedic (Nov 26, 2006)

I have a question, and unfortunately it will probably stir up a hornet's nest. What would happen if there were no more volunteer services? What if everything had to become paid/professional services? My reasoning is this... there are no volunteer nurses or doctors. Respiratory therapists and x-ray techs don't have volunteer services.

If we expect to be treated as healthcare professionals (that we are) then we must take our educational process seriously, that means college level education at a minimum, nothing less than an Associate's degree to start. This is the lowest acceptable degree for a RN. If it means cutting out the less intellectually inclined, so be it. And please no commentary on "The best paramedic I ever knew only got as far as third grade walking uphill both ways to school." We have enough rhetoric to go around.

Other aspects of healthcare are continuously raising the bar academically to meet the challenges of their field. On the other hand we (EMS) are willing to let our standards deteriorate to allow more people become certified, or because we are unwilling to hurt someone's feelings. This is the "meat in the seat" or "pulse and a patch" mentality we need to do away with. We as a profession need to stop being concerned with the alphabet courses which teach the "what", but not the "why" a procedure is performed. By raising the educational requirements we will eventually move past simply being technicians. With that being done, pay and respect will follow. No longer will you have to hear, "Hey, the ambulance guys are here..." Ok, maybe that last part is wishful thinking.

And please before anybody says anything I like EMTs, I like them enough that I married one. Even she agrees the educational requirements need to be raised.


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## jeepmedic (Nov 26, 2006)

Ok here goes I hope this comes out right.



> As well responsibities of the EMT will be increasing as those with experience can attest to.



This is true. As an EMT-A we could do less and had a longer class, and were tought more.



> People afford other healthcare, clinics, hospitilzation, even nursing homes so EMS should be able to maintain and have just as qualified individuals to provide for their care as well. All hospitals still require RN's, even nursing homes do, no matter where and how remote it is some how; they always find a way.. maybe we should look at see if there is a way for EMS to get substainal funding and support as well.



Look at medicad and medicare



> I have a question, and unfortunately it will probably stir up a hornet's nest. What would happen if there were no more volunteer services? What if everything had to become paid/professional services? My reasoning is this... there are no volunteer nurses or doctors. Respiratory therapists and x-ray techs don't have volunteer services.



This is becoming an increasing problem in all areas of the country. The county I live in which is the largest in VA with over 950 square miles has just hired a third party paid service to cover the calls that the Volunteer stations could not cover. And to add to this: How many volunteer police do you see now days? And they do not have to have any education past High School. They go to a 6 month class and bam They can write tickets, and shoot you.


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## Fedmedic (Nov 26, 2006)

oldschoolmedic said:


> I have a question, and unfortunately it will probably stir up a hornet's nest. What would happen if there were no more volunteer services? What if everything had to become paid/professional services? My reasoning is this... there are no volunteer nurses or doctors. Respiratory therapists and x-ray techs don't have volunteer services.
> 
> If we expect to be treated as healthcare professionals (that we are) then we must take our educational process seriously, that means college level education at a minimum, nothing less than an Associate's degree to start. This is the lowest acceptable degree for a RN. If it means cutting out the less intellectually inclined, so be it. And please no commentary on "The best paramedic I ever knew only got as far as third grade walking uphill both ways to school." We have enough rhetoric to go around.
> 
> ...



I think if the rest of the country adopted a philosophy similar to NC's if would help provide a better service to the community. I not 100% sure, but I am going to research it and get back to post what I found. But this is the way I think it is. Sometime in the 1970's, the state passed a law stating the each county must provide an ambulance service, just as they must provide law enforcement. By doing this, I think the entire state of NC has paid EMS, no matter how rural you can get an ambulance there within a reasonble amount of time. And the majority of the state is at the paramedic level. The only downside to this is they opened upon the paramedic program to most of the community colleges. Which sounds good in theory, because you can get your paramedic almost anywhere. The problem is most of these community college paramedic programs, for a lack of better words, really suck. I have always said, if you could take the best of NC and VA and combine them then you would have a top notch EMS system. VA has mostly volunteer agencies and  it may take an hour or more to get an ambulance to your house, but if it shows up with a paramedic, then you can rest assured you are in good hands. Up until about 3-4 years ago, there were only approximately 5 places in the state of VA to recieve your paramedic. And these the large teaching hospitals, such as MCV, UVA and College of Health Sciences. Now there are more paramedic programs, but even these are still regulated by the teaching hospitals with satellite programs. So you still have excellent paramedic programs.


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## trauma1534 (Nov 26, 2006)

oldschoolmedic said:


> I have a question, and unfortunately it will probably stir up a hornet's nest. What would happen if there were no more volunteer services? What if everything had to become paid/professional services? My reasoning is this... there are no volunteer nurses or doctors. Respiratory therapists and x-ray techs don't have volunteer services.
> 
> If we expect to be treated as healthcare professionals (that we are) then we must take our educational process seriously, that means college level education at a minimum, nothing less than an Associate's degree to start. This is the lowest acceptable degree for a RN. If it means cutting out the less intellectually inclined, so be it. And please no commentary on "The best paramedic I ever knew only got as far as third grade walking uphill both ways to school." We have enough rhetoric to go around.
> 
> ...




I must say that I (suprisingly enough) am dissappointed in the EMT curriculam today.  I sat in on an EMT-B class about a year ago, assisting with it, and I was shocked!  The instructor was just going through the book refuring to what they would need to know to pass thier state boards.  I was even more upset when they started doing thier ride time and I was precepting them.  They were not even 3 weeks from finnishing thier class and testing out and they were CLUELESS!!!  I really had nothing to precept, and believe me, I documented those things on thier precepting form accordingly.  Half of them didn't know how to take a simple blood pressure, they were unsure of how to detect lung sounds or what they were listening to.  They didn't know what to ask the patients during the assessments.  When it was time to load and lift the stretcher, they were clueless as to what the functions of the stretcher were.  And, my pet pieve, documentation.  They could not write a call report on thier patients.  These people were in no way ready for EMT-B test.  Well... they may have been ready to take the test, but they were not ready at all to become EMT-B's in the field.  The test site?  They were passing in and everything during the practicals.  As long as they placed thier hands on the sturnal area during compressions, it didn't matter if it was correct placement or not, they passed.  As long as they said I'm clear, you're clear, everybody clear, they passed.  They didn't have to have correct placement of the pads or anything.  That was just with the AED station.  

I said all that to say this.  I do think the EMT-B curriculam should be fine tuned.  I think they need to spend time learning how to be a good EMT-B in order to finnish the class.  

What ever it takes to make these EMT-B's ready for the field, that is what needs to happen.  As far as doing away with volunteers and making it an all paid thing, I think that would be a good thing.  However, like someone else said, if that happened here, we would have no one wanting to do it due to the pay.  

It is a hard thing to sort out.  But for now, we have to try to make the best of what we have.  That means we as experienced and seasoned providers need to take every opportunity we have to teach the new providers to be good.  I'm not saying that every EMT-B class is as much of a cluster as that particular one, there are some really good instructors out there who have passion for what they do and want thier students to come out as very good providers.  We just need to do the best we can to help eachother learn what they can.  I still am learning.  I will never stop learning.  I try to pick out something new from each call I run to learn and break down.  

So the fix to our problem?  It would be nice to snap our fingers and figure out the perfect fix.


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## Ridryder911 (Nov 26, 2006)

You hit the double edge sword.. must would not do it for the current pay... Without proper education, there is no justification of paying what most EMT's want and truly deserve as pay. 

It is a shame that most EMT's have to work 2 -3 jobs just to feed their children, and pay the electric bill. All just because they chose to "help" others. At the same time, one has to recognize there are very few to no profession one can enter the marketplace within less than 16 weeks (2 weeks if you go to a shake and bake program). 

Trauma you are right about current standards and students.. I renewed my EMS instructor last year after a hiatus of teaching flight nurses/medics. It was a shock to see, or rather not see what was taught or required. It probably was not the students was not ready for test, rather they were not taught at all. Not that the instructor was at fault the system has dropped down. For example, remember when AMI was an approved abbreviation, which is now recommended to use the word "heart attack" and those 6 types of fractures we all memorized are no longer even discussed. I guess my astonishment was the discussion of treating a "bee sting" as an impaled object ... What? Even in boy scouts they are taught to "scrape it off" to prevent further injections from occurring. Now, I ask how are you going to immobilize a stinger?.... We have lost reality in some of the way, and what we teach. 

As many of you are with EMS students, ask initially what the treatment of any injury and you will automatically get a robot response .. "scene safe, BSI, oxygen NRBM".. no thought, no process. Yes, I am aware we teach for testing and to protect them ... but rarely I see an introduction made or even reasoning of placing a nasal cannula in lieu of NRBM on a patient with active vomiting. A lot of this is common sense, which many times is not encouraged or practiced. 

At the same time, review most EMT instructors qualifications. No other medical profession would allow anyone to teach without a minimal B.S. degree or some form of formal adult education criteria. In comparison respiratory therapist requires at least a person with a B.S., in nursing the minimum is a master degree or higher, and so on. Although my fellow classmates in my EMS Instructor had a big heart, and well intentioned many lack experience, medical knowledge or expertise, and definitely an understanding on how adults learn. A 40 clock hour class cannot even begin to teach objective base teaching, or how to write objectives, key stem test questions for preparedness of state and national board examinations. 

These dilemmas are many of the tasks we as EMT's need to address and try to solve. Many of these again are related to poor participation in EMS organizations and basically apathy among most EMS workers. We all like to complain, but few what to change things. 

R/r 911


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## Stevo (Nov 26, 2006)

> Surely you are not implicating we should not become more professional requiring at least above high school level equivalency for our profession. Again, medicine is changing and we have to keep up with it, there is no choice. As well responsibities of the EMT will be increasing as those with experience can attest to. These will only becoming more and more as the generation ages increase and hospitals become more taxed.



The ABC's of ems have not changed have they?



> Sorry, voluteer or paid that is really irrevelant.. the system should be about the patients sake not the rescuers ability to go to school or not. One does not see other professions maintianing status quo or regressing because the inabilty to attend school, etc.


So in your opinion, patient care should NOT be based on acedemic ability?




> The old "we won't have enough volunteers" should not even enter the subject, again if people are really interested then they will attend. This is why a competent, good qualified First Responders, and Basic levels are essential for those communities.


 
1/2 correct, if the system creates enough obstacles, acedemic or not, the volly's eventually loose intrest due to lack of available time to donate



> Just because a physician, nurse, or any other health care provider decides to work in a rural or less populated area, does not excuse them from having to attend courses like the rest of their peers. One is expected to know, perform, and treat just like those that want to work in a high call volume, and in fact one has to be better prepared due to less exposure. There is not a difference in standards of one that gets a salary or volunteers, professionally and legally all are compared equally.



Did i bring up a difference in standards rural/metro here ? 



> People afford other healthcare, clinics, hospitilzation, even nursing homes so EMS should be able to maintain and have just as qualified individuals to provide for their care as well. All hospitals still require RN's, even nursing homes do, no matter where and how remote it is some how; they always find a way.. maybe we should look at see if there is a way for EMS to get substainal funding and support as well.



_Other Health care?_ is this like the other white meat? yeah they always find a way when the rest of the world turns them away all right, they call 911.  Are you suggesting Homeland Security foot their bill here?



> Sorry, the only progression for EMS to become substainal to expect revenue and reimbursements for the betterment of the medical community is for the education level of the EMS personel to increase. We are one of the very few if not only healthcare profession that requires such a limited courses.


 
Substaintial equates to renumeration to you? That's it? Please excuse me if i find this a rather prostituted mindset here because it insinuates those with the $$$ get better care than the many have nots out there (which are our fellow citizens btw)



> We can only better ourselves off with increasing education, and as well as patients can expect to recieve better care.



Doesn't seem to me we are in such serious dire straights, but i'll tell you this. I'd rather have a boy scout with a pen knife trying his best to extricate me instead of waiting for some sheepskin waving ems'er from afar, which would you prefer?

~S~


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## Ridryder911 (Nov 26, 2006)

I guess I rather have someone who has been educated, tested and performed clinically to perform any skill. I much rather have a "sheepskin" waiving person than a boy scout any day be my surgeon, physician, & EMS provider as well. (and yes, I am a triple silver palm Eagle Scout, so this is not derogatory remark) 

Has the ABC's changed?... Uh, yes they have actually. But, if EMS was only ABC's that would be simple, but it is not. It much more than such.. for example differential diagnosis, Left AMI versus anterior wall (such as administering NTG to a Left AMI can actually cause more damage even death). So if you were having the heart attack, would you not rather have someone knowing that before they gave you that nitroglycerin?

Personally, I could care less if those vollies lost interest. If they were truly in it for the patient sake, they would go to school and continue education. I do understand the conflict in proportion of keeping vollies and interference with maintaining staff. If the citizens are concerned enough, something will be designed and funding will come from somewhere. I bet they still have parks, LEO, and other so called required services. 

With proper funding from grants, tax revenue, and yes even billing patients properly EMS systems can work...difficult yes. I worked at some very poor rural cities with a total population of 6,000 and performed some of the most aggressive care, so size in this case does not matter...LOL Yes, it can be difficult and yes there needs to be more investigation and answers to solve these problems, but ignoring and keeping the status quo is not the answer.. it is not working now.. Do we think it would be better by ignoring the problem? 

Maybe, incorporating nearby professional services to assist and provide medical education to staff members would be helpful and more financially feasible. I am starting a program to do such, where once a month we have "Pizza and Education" night, for our local 1'st responders from neighboring communities. This gives them the needed education, and as well develops a better working relationship between everyone.

It is amazing many assume Homeland Security is the answer or lack of answer. In comparison EMS only received very few grants of Homeland Security monies, by far in comparison of fire services, and LEO. So no.. Homeland Security should not be involved, this is a health care, medical issue... remember we are Emergency MEDICAL Services, and as of such we should meet and supersede the rest of the medical criteria. 

Yes, unfortunately money does sometimes mean better care than those without. Hopefully, not in EMS, but cities that do not have proper funding does not always have available the staff, the equipment required to always function. Not that is right or fair, but that is they way it is sometimes. If your community does have the monetary revenue, why would they have to rely upon volunteers? 

No, I don't have the answers or even attempt to claim to, rather hopefully to spark interest in EMT's to become more interested in their profession and become active in change. No matter what your opinion, get involved.

Again, EMS is on life support in many areas, and it is not going to get better. In my state alone we have lost 3 EMS in the past 4 months, and personally just adopted another site. This is not because we really wanted to (since it is about 25 miles away), but someone has to be there. We are attempting to develop something for this small community, maybe a better first response unit, rendezvous Medic truck.. we will see by trial and error. Again, if it is really important to the community, something will be developed and funded.

When ER's do not have the beds needed to accommodate patients, EMS role will change (as it is currently being investigated) because the number of patients in comparison of beds is not there. Google how many people a day turn 60 and over... now compare this with the building and closing of hospitals. It is scary... 

Nothing more, at least this might get you discussing the problems among fellow EMT's and maybe someone will get involved.  

R/r 911


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## jeepmedic (Nov 27, 2006)

Like I said before I did not get into EMS to go to school. I hated school and still do. But if I want to keep up with the times then I need to go to school as much as possable because as Ridryder has said things change all the time. Pre-Hospital care is still a new field compaired to other medical profesions so things are changing at a rapid pace. 

Yes we are learning that things we did 10 years ago were not the right things to do. It may not have harmed the pt. right then but in the long run it did. Like Dopamine we used to just start it and when the BP came up we would titrate it to keep the BP above 100 systolic. We saved the pt. for now but blew out the Kidneys in the long run. We as ems providers did not know this because we had tunnel vision stayed in the box. All we cared about was "I got 'em to the ED alive." Today I have learned through education that I need to do the math and be more careful with the drugs I do have. 

When I took my EMT-A the only drug we could give was O2. Now EMT-B's are giving more and more. Some places EMT-B's can intubate, start IV's and give so called 1st round drugs in a cardiac arrest. And the EMT-B class is in no way as strong as the old EMT-A class was. I hope that the new standards will be stronger toward the why's and how's instead of just do this for this next. I am teaching a First Responder class and last night we went over shock the only thing the book says teach is S&S of shock and how to treat it. Does not say teach why it is happening. I think this is very inportant. How can you treat something if you don't know what is happening?

Some of my EMT-B's at the Fire Dept. can't tell me what the NTG does or how it helps the pt. but they know if a pt. has CP and there own NTG and a BP above 100 systolic give it to 'em. Some don't even know why you don't give it if the BP is below 100 systolic. Not there fault just wasn't taught to them. Thats why my EMT class takes longer to teach I try to teach them the how and why to what they will be doing in the field.


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## FFEMT1764 (Nov 27, 2006)

I have to agree with Rid also. Every month we are getting a new item into our protocol's. This month's item was CPAP. Who knows what we get next month. We all need to continue our education in some way. If you feel like you know everything or can't learn something new it's time to get out of this field before you KILL someone with ignorance. I enjoy learning as much as I can, and even though I am not doing it in a traditional sense (college, etc.) I am always reading new things in the various medical publications as well as here on the internet.


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## trauma1534 (Nov 27, 2006)

jeepmedic said:


> Like I said before I did not get into EMS to go to school. I hated school and still do.



Shucks!  I slept through most of it!!!


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## Guardian (Nov 27, 2006)

I hate most of the classes I'm taking right now...hell, most of the people I go to school with dream of sitting on a beach and doing nothing (I love that song banana's and blow by ween).  Not liking school is no excuse for not getting an education.


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## trauma1534 (Nov 27, 2006)

Guardian said:


> I hate most of the classes I'm taking right now...hell, most of the people I go to school with dream of sitting on a beach and doing nothing (I love that song banana's and blow by ween).  Not liking school is no excuse for not getting an education.



Those on here who know me, know that I am only kidding about sleeping through school!


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## jeepmedic (Nov 27, 2006)

trauma1534 said:


> Those on here who know me, know that I am only kidding about sleeping through school!



No you were not.


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## trauma1534 (Nov 27, 2006)

Don't tell all my secrets!!!  SHHHHHHHH!


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## Stevo (Nov 27, 2006)

> I guess I rather have someone who has been educated, tested and performed clinically to perform any skill. I much rather have a "sheepskin" waiving person than a boy scout any day be my surgeon, physician, & EMS provider as well. (and yes, I am a triple silver palm Eagle Scout, so this is not derogatory remark)




no offense intended Ryder, we'd all like 5 star service, but the qaulity/quanity point still stands, in reality we're not going to achieve both. Perhaps googling up Starve the Beast  would enlighten you as to why i've sided as i do.



> Has the ABC's changed?... Uh, yes they have actually. But, if EMS was only ABC's that would be simple, but it is not. It much more than such.. for example differential diagnosis, Left AMI versus anterior wall (such as administering NTG to a Left AMI can actually cause more damage even death). So if you were having the heart attack, would you not rather have someone knowing that before they gave you that nitroglycerin?



I don't belive the ABC's change even if your the dean of a medical college, in fact the greater % of all ems calls are basic abc calls, ....that simple to mitigate, where do you think the term _cabulance_ came from?

 Introducing _'what if'_ scare tactics is loosing it's umph, don't you think? Focus on the greatest good ems can do, as we are taught to triage, and the greatest percenatge of our populance benifits



> Personally, I could care less if those vollies lost interest. If they were truly in it for the patient sake, they would go to school and continue education. I do understand the conflict in proportion of keeping vollies and interference with maintaining staff. If the citizens are concerned enough, something will be designed and funding will come from somewhere. I bet they still have parks, LEO, and other so called required services.




It's a simple theory Ryder, there's safety in numbers.  And we already have continuing educational requirements that seem to work just fine. Now i'm all for education, but let's keep the advancement comprable to those who wish to be involved here. In fact, let's allow those within the system to create a reasonable menu  of advancement that is a personal elective , as opposed to another unfunded mandate.
You do realize here that we really have no viable 'from the streets' collective voice here right? Personally, i'm tired of being the subject of DOT bigwigs, ex-ems magazine publishers, as well as the pharmacabal in what WE do in the trenches they've either long forgotton, or sold out to lobbyists for.

 If in fact there are so  many instructors (been one btw) who feel the constant ciric changes have disenfranchised ems, where is their voice?

to add, i would not wish the one entity on this earth with more compassion in it's pinky , than what could be _prositituted by $$$_ in a carear mans whole body to vanish...do you?



> With proper funding from grants, tax revenue, and yes even billing patients properly EMS systems can work...difficult yes. I worked at some very poor rural cities with a total population of 6,000 and performed some of the most aggressive care, so size in this case does not matter...LOL Yes, it can be difficult and yes there needs to be more investigation and answers to solve these problems, but ignoring and keeping the status quo is not the answer.. it is not working now.. Do we think it would be better by ignoring the problem?



I find no great wrong being done by the status quo in the field, in fact may i inquire who it is that feels it is so broken we require (constant) change?  i do find that the oversight of the entire gambit wishes to evolve not for the sake of the patient, but for the sake of the creation of more self serving bueracracy.  So i ask here in ernest, what stats are there to justify change? If we are in such need, there must be something relevant out there that would dictate such aside from trauma studies on pigs & our educational contingent fishing for further employment, yes?



> Maybe, incorporating nearby professional services to assist and provide medical education to staff members would be helpful and more financially feasible. I am starting a program to do such, where once a month we have "Pizza and Education" night, for our local 1'st responders from neighboring communities. This gives them the needed education, and as well develops a better working relationship between everyone.
> 
> It is amazing many assume Homeland Security is the answer or lack of answer. In comparison EMS only received very few grants of Homeland Security monies, by far in comparison of fire services, and LEO. So no.. Homeland Security should not be involved, this is a health care, medical issue... remember we are Emergency MEDICAL Services, and as of such we should meet and supersede the rest of the medical criteria.



Well Rider, i posted Homeland Insecurity as a joke, because it basically is one. Yes i would like prioritization for the benifit of the populance, instead of for the benifit of the top 1% in this country. But as it stands now the priorities don't favor the people Cost of War alone has precluded any viable benifit(s) that could be there.  So you see, EMS is left with the vistages of bugetary concerns, the triage of dollars squeezing the life out of vaible concerns.  
Operating for the reduced benifit of the whole, imho, trumps the favored benifit of the few....

Yes, unfortunately money does sometimes mean better care than those without. Hopefully, not in EMS, but cities that do not have proper funding does not always have available the staff, the equipment required to always function. Not that is right or fair, but that is they way it is sometimes. If your community does have the monetary revenue, *why would they have to rely upon volunteers?* 

Do you do have any idea how _incredibly caustic_ this remark is? You obviously need an update on vollies here, The greater portion of any rural contingent are vollies,in fact most small municipalities rely on vollies for everything. And they are involved, and not the perephrial entity you allude to here. We're your roots for gawd sake....



> No, I don't have the answers or even attempt to claim to, rather hopefully to spark interest in EMT's to become more interested in their profession and become active in change. No matter what your opinion, get involved.
> 
> Again, EMS is on life support in many areas, and it is not going to get better. In my state alone we have lost 3 EMS in the past 4 months, and personally just adopted another site. This is not because we really wanted to (since it is about 25 miles away), but someone has to be there. We are attempting to develop something for this small community, maybe a better first response unit, rendezvous Medic truck.. we will see by trial and error. Again, if it is really important to the community, something will be developed and funded.
> 
> When ER's do not have the beds needed to accommodate patients, EMS role will change (as it is currently being investigated) because the number of patients in comparison of beds is not there. Google how many people a day turn 60 and over... now compare this with the building and closing of hospitals. It is scary...



This is greatly due to our  Lambourgini of a health care system, within which most people drive Chevy's....

  Evolving, or insisting on greater acedemics means the cost of ems rises also. In essence this continues the cycle of alienation for the 45 million have nots (along with millions more that have little)

I'm not signing on to any more of the insanity that turns our backs to on it's own, sorry



~S~


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## Fedmedic (Nov 27, 2006)

Stevo said:


> no offense intended Ryder, we'd all like 5 star service, but the qaulity/quanity point still stands, in reality we're not going to achieve both. Perhaps googling up Starve the Beast  would enlighten you as to why i've sided as i do.
> 
> 
> 
> ...



Well said! Two thumbs up Stevo!!


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## Ridryder911 (Nov 27, 2006)

System not broke.. C'mon no ALS available in up to 30% of the time and it not broke?.. Sorry, even if ALS is only required 1% of the time it should be there. Just to think EMS has been popular for over 30 years and see still most areas without providing ALS, because there is always an excuse. This would be the same comparison of not having trauma centers due to less than 10% trauma patients do not require Level I Trauma Centers.. most patients do not really have poly-trauma or MOI that requires such. 

EMS systems going broke, no patient care in some places..EMT's on food stamps and the system is okay? Again, the old saying.. "why buy the cow, when you get the milk free" comes in mind 

Sorry, it appears to me many rather see EMS live in 60's with first-aid squads and maybe we can even go further go back to funeral homes. They even applied oxygen, splinting, and rapid transport and was a lot cheaper. 

I will maintain my position that as EMS personnel we should be considered health care professionals, and should meet the minimal standards. This should mean the minimal standards of reading, mathematics, and English, science should be at least high school to 14'th grade level. When in court, one of the evaluations is based upon education level, no matter volunteer, or paid. 

I agree we will have to agree to disagree and that's okay.. I do respect your opinion. Thanks for your responses.


p.s. there is a group of us field medics attempting to change things... 
www.fieldmedics.com

R/r 911


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## trauma1534 (Nov 27, 2006)

ridryder, uhhh.... there is a such thing as a silver palm eagle scout, however there is no such thing as a tripple silver palm!  And the palm does not change your rank!  Do you have the God and Country award?  Now that would change your rank.  Are you in the order of the arrow?  I'm married to an Eagle Scout, and my son is cub.


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## Fedmedic (Nov 27, 2006)

Ah yes, the Order of the Arrow, I was just looking at my sash the other day. Oh the fun times.


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## trauma1534 (Nov 27, 2006)

Fedmedic said:


> Ah yes, the Order of the Arrow, I was just looking at my sash the other day. Oh the fun times.



Dag man!  They let any old flunkie be a boy scout!  HA!


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## Fedmedic (Nov 27, 2006)

trauma1534 said:


> Dag man!  They let any old flunkie be a boy scout!  HA!



And I was an Eagle Scout, why do think I am such a good paramedic, I got my first aid merit badge and skill award.


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## fm_emt (Nov 27, 2006)

Fedmedic said:


> And I was an Eagle Scout, why do think I am such a good paramedic, I got my first aid merit badge and skill award.



That's basically how I started down this road.. the Boy Scouts! There was an ER doc teaching the First Aid merit badge stuff.

I would have made Eagle if I didn't move out of the country. :|


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## trauma1534 (Nov 28, 2006)

Fedmedic said:


> And I was an Eagle Scout, why do think I am such a good paramedic, I got my first aid merit badge and skill award.



Well cool!  I didn't know that!  I was a 4-H Honer Club Member myself! LOL  Didn't win a marit badge or anything, but I did learn how to use a canoo!  lol


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## fm_emt (Nov 28, 2006)

trauma1534 said:


> Didn't win a *marit* badge or anything, but I did learn how to use a *canoo*!  lol



You should have put the oars down and picked up a dictionary!

*bah-dum..ching!*

Thanks! I'll be here all week. Please be sure to tip your waitress. 


(Yes, I'm just playing with you.)


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## Fedmedic (Nov 28, 2006)

fm_emt said:


> You should have put the oars down and picked up a dictionary!
> 
> *bah-dum..ching!*
> 
> ...



Now I liked that...He gotcha there Trauma1534...that's what you get for leading with your jaw!


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## trauma1534 (Nov 28, 2006)

fm_emt said:


> You should have put the oars down and picked up a dictionary!
> 
> *bah-dum..ching!*
> 
> ...



huh?  a dictionary?  I don't know how to read them.  

Yep, ya got me!  I'll give you that one!  lol


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## trauma1534 (Nov 28, 2006)

Fedmedic said:


> Now I liked that...He gotcha there Trauma1534...that's what you get for leading with your jaw!



Now you being ugly!  Be pretty!


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## FFEMT1764 (Nov 28, 2006)

I see this is now a discussion on the Boy Scouts. I was a scout many moons ago. Got as far as Life before I became and EMT and started working full time EMS.  Scouting is a great thing, and it taught me alot about how to overcome things in stressful situations. As far as the whole EMS system being broken, I think it is in several ways. We don't get paid enough, and we aren't given the respect of our healthcare counterparts. Of course more money, and more education may fix that, but ultimately its the professionalism we all display that helps our case the most!


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## trauma1534 (Nov 28, 2006)

If you think it is broken, then help those under your level to get good.  That is how you are going to fix it.  Not by shutting them out!!!


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## oldschoolmedic (Nov 28, 2006)

The system is broken. We are over-regulated and under-educated. Have any of you ever been to court and been picked apart by a competent attorney? Even meeting the minimum standards to practice his profession has required him to earn a doctorate. Why is asking for the educational standards (to a minimum AS or BS) of EMS to be raised even considered exclusionary? Is it because it may reduce the amount of providers? In counterpoint to that it will raise the level of care and earning potential  provided by those who meet the standard. 

I bring up nursing as an example because I am dearly familiar with several. In the seventies when nurses were becoming increasingly scarce due to increasing workloads, stagnated pay, and indifferent hospital management systems what did nurses do? Did they ease the educational requirements to put more nurses on the wards? No, they raised the educational requirements and lobbied congress for reforms, thus broadening their scope of practice to justify the concommitant increases in pay and reductions in patient loading they needed. Did it hurt them? Yes, in the short run it did, but in the long run it changed a profession. Now there are minimum staffing levels, and maximum patient to provider ratios, and a pay scale that is only limited by the ambition of the nurse. Nursing has been around far longer than EMS, and yet is far less hidebound and inflexible when it comes to change.

Let us now consider our brethren in the fire service. Does anyone believe they joined the department to run an ambulance or respond to the drunk behind the dumpster? Nope, they wanted to fight fire, period. The fire service has in effect almost legislated itself out of business by enforcing newer building codes and endorsing better, less flammable building materials. Now they are having to adapt their mission so that they may justify having all of their apparatus sitting on the bay floor not rolling while EMS is busting butt all day and night. Some people see it as the next logical expansion of the fire service, and it just may be.

As a profession EMS is all of thirty-five years old, we are the children of the public safety sector, and from what I see here we are acting like it too. I am an advocate of EMS. I have been since my dad was intubated on my living room floor by two guys in flannel shirts and blue jeans. We only had rescue squads in upstate NY at that time. Those guys did fine, and so did my dad. Twenty years and a lot of miles later I am still riding in a truck trying to help. I am pro-EMT, but at the same time recognize the limitations of their education, just as I acknowledge my own. 

I have grown disenchanted with the emphasis on the "alphabet" courses even while holding several instructor certs. When I precept students I ask them why we did a certain procedure and the standard answer is "protocols." No independent thought, or reflection needed, just a pat "because I was told to." I ask them to find me an answer to the question asked before I sign off on them. Hard, yes. Fair, probably not. Motivational definitely. I have my knee-jerk moments too, but those are mainly due to having my hands tied by the self-same protocols.

I want the next generation of providers to be smarter than we were. I believe if we relax our standards, or keep the bar set low just to keep the meat in the seat we are doing ourselves a bigger disservice than if we take the transient discomfort which will come with an elevation of our standards. We all know providers that we would let work on our family members in a heartbeat, but, by the same token we all know some we wouldn't let touch our hamsters on a bet. The majority of the time raising the bar is going help the former, and keep the latter out. Occasionally one will slip through, but they won't last. 

It is only our silence which allows substandard care to be rendered. The "What happens in the truck stays in the truck" and "It's all in how you write the run report" mentality needs to go away quickly. A true national educational standard (not the National Registry), licensing (not certification) with statewide regulation will go a long way to creating the foundation upon whch future EMS systems will be built.

I will now relinquish my soapbox. Thank you.


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## FFEMT1764 (Nov 28, 2006)

oldschoolmedic said:


> .
> We only had rescue squads in upstate NY at that time.


 
Seems like alot of people from PA and NY are moving here to SC. 

As for the thread, I think that in the next 5 years an AS will be required to be a paramedic, possibly even just to be an EMT. Of course there will be the arguement that its a bad thing to make people go to college/tech school to get certified, but guess what, nurses now get degrees to be nurses...its only a matter of time. LEO and FD personnel are even going to college and get degrees in their field, so why shouldnt EMS get the education too, at worst it will only make us better providers!


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## oldschoolmedic (Nov 28, 2006)

We're coming here because you don't have to shovel rain in the winter. Now if I could only find a decent pizza, I've been looking since 1989. None of what I found compares to NY style 'za.


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## FFEMT1764 (Nov 28, 2006)

What part of SC ya in old school?


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## trauma1534 (Nov 29, 2006)

FFEMT1764 said:


> Seems like alot of people from PA and NY are moving here to SC.
> 
> As for the thread, I think that in the next 5 years an AS will be required to be a paramedic, possibly even just to be an EMT. Of course there will be the arguement that its a bad thing to make people go to college/tech school to get certified, but guess what, nurses now get degrees to be nurses...its only a matter of time. LEO and FD personnel are even going to college and get degrees in their field, so why shouldnt EMS get the education too, at worst it will only make us better providers!



As far as nurses go, I can atest to this.  Nurses don't have to get a degree to be a nurse.  The trauma center where I work hires diploma nurses everyday.  Infact, my supervisor has her masters in nursing and she will tell you that a diploma RN makes a better clinical nurse any day than a degree nurse.  They are more hands on and they are not just pencil pushers or Dr. callers.  She says that they are taught to think on thier feet.  When it gets down to it, diploma nurses at the hospital I work at holds management positions, training positions, and anything else that the BSN's get.  They even start at the same level in pay as new BSN grads.  

I think we are all blowing this whole thing out of proportion.  We need to get back to discussions about the calls we run and chat about real life situations that we have been through and share and help eachother out with encouragement, not putting anyone down, or slamming or pissing matches.  Let's just get back to the basics of why we are in this field to start with.  Even paramedics are not in it to get rich.  We all knew when we got our certifications that it was one of the lowest paying jobs in health care.


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## jeepmedic (Nov 29, 2006)

> Hard, yes. Fair, probably not.



Oldschool. Great post. This is the only thing I disagree with though. It is hard and It is Fair to not only the provider you are training but also to the System you work for and the pts. that are in your response area. The provider needs to know why he/she is doing what they are doing and why the protocal are written the way they are.


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## Ridryder911 (Nov 29, 2006)

trauma1534 said:


> As far as nurses go, I can attest to this.  Nurses don't have to get a degree to be a nurse.  The trauma center where I work hires diploma nurses everyday.  In fact, my supervisor has her masters in nursing and she will tell you that a diploma RN makes a better clinical nurse any day than a degree nurse.  They are more hands on and they are not just pencil pushers or Dr. callers.  She says that they are taught to think on their feet.  When it gets down to it, diploma nurses at the hospital I work at holds management positions, training positions, and anything else that the BSN's get.  They even start at the same level in pay as new BSN grads.




Sorry, but if they are hiring diploma nurses they are hiring older experienced nurses and and that is the reason they are getting paid = to BSN, not because of their educational level. I can assure you as well, not all diploma nurses in general make the equivalency ,or have the ability to be promoted upward most of the time. I agree they are good technical nurses, but their career can be limited.

Many diploma schools closed after 1965, when the American Nurses' Association (ANA) published a position paper stating that all nursing education should take place in institutions of higher learning. The organization also recommended two levels of nursing practice: professional and technical; the professional nurse would have a baccalaureate or higher degree, the technical nurse would have an associate degree, and the technical nurse would work under the direct supervision of the professional nurse.

AAS or ADN has been required since 1990, to take the NLN,- RN test.  I could not find ANA approved nursing diploma schools. Many may call themselves private but are associated with some college or university to allow students to obtain the required degree.  

Yes, it is true no one expected to be "rich" but to be able to make a decent living without working > 40 hours in doing so. Most medics work in excess of 50-100 per week, not every 2 weeks. As well most are able to qualify for medicaid and food stamp programs. This is a disgrace for someone that has that much responsibility as well reflects upon on the profession. Now, do we really wonder why we get the type of applicants we are getting for EMT schools, and why many are leaving? 

Sorry, educational requirements and having such demands will equal higher pay in recognition than those that do not. It is the fact, not bragging or demeaning. The same as high school graduates to comparison of those that do not have degrees, to associate to bachelors degree to masters degree each approximately 5 to 10 thousand dollars salary differential.


This is real life discussion, much more than some other discussions. scenarios are great... but, we should all know how to perform and treat most of these by now. Yes, we can learn off strange and bizarre cases, but the typical AMI and chest pain is really pretty routine. There is really little treatment for trauma, except the usual immobilization, IV's and airway management, maybe a decompression if severe other than that, it's pretty mondaine.

I am glad to see more involvement on this forum lately. 

R/r 911


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## oldschoolmedic (Nov 29, 2006)

Living near Cola.

My mother is a diploma nurse, graduated in 1960. It was a three year course of study which involved them actually living on the hospital campus, attending classes by day, and working on the wards at night. They rolled bandages as punishment in their first year. Second-years were washing out test tubes, beakers, and hypodermic syringes. Third years, get this, resharpened needles and scalpels for use. She just attended her 46th reunion last month. There are only eight nurses from her class left. My mom still works full time as a home health nurse, even though she has already retired from a hospital after thirty five years of service.


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## jeepmedic (Nov 29, 2006)

oldschoolmedic said:


> Living near Cola.
> 
> My mother is a diploma nurse, graduated in 1960. It was a three year course of study which involved them actually living on the hospital campus, attending classes by day, and working on the wards at night. They rolled bandages as punishment in their first year. Second-years were washing out test tubes, beakers, and hypodermic syringes. Third years, get this, resharpened needles and scalpels for use. She just attended her 46th reunion last month. There are only eight nurses from her class left. My mom still works full time as a home health nurse, even though she has already retired from a hospital after thirty five years of service.



And you call yourself "Oldschool"

Thats great about your mom. Those are the folks we need to listen


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## trauma1534 (Nov 29, 2006)

Ridryder, I'm sorry, but you are wrong buddy.  We do have diploma nurses at MCV, and they hold management positions.  They do walk in the door with the same entry level pay scale as someone from the VCU BSN program.  Entry level RN is entry Level RN.  

We do have about 3 diploma programs here in the area as well.  They are not related to a college.  They are hospital based and the nurses comming from one of those programs in particular are awesome.  

I am actually considering enrolling into that program myself.  It is based out of a small hospital in Petersburg.  These nurses are the best nurses I've ever seen to just come out of school.  They are agressive as most grads lack.  Infact, most nurses weather fresh grads or years of experience depending on thier background are not agressive at all!  But these are.


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## Flight-LP (Nov 29, 2006)

What does aggressiveness remotely have to do with the level of quality a nurse provides?


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## oldschoolmedic (Nov 29, 2006)

*The gray in my hair begs to differ*

Jeep, the name oldschool got hung on me by a partner I had who was younger in years than the length of time I had been a emt. I did one of those "no tourniquet on a little old lady taking coumadin ivs" and he said I was so old school I probably remember when tourniquets were invented. He also witnessed the blown lightbulb in the laryngoscope intubation with the maglite held between my shoulder and ear. Told me, " I bet it was harder by candlelight." Smarta$$ kids. First ambulance I rode in had an eight-track player in the dash, and we only had one tape.

To me old school refers to the way I was trained, but says I've been here long enough to know things have to change. The senior paramedic who trained me, my emt and paramedic instructors, and most of my early supervisors have all RETIRED. They got their thirty and out, just like I will in 11 more years, Waaaaaa-hooooooooo!!!!!!!


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## Anomalous (Nov 29, 2006)

While it would be great to have all ALS 24/7 with a crew sitting at the station, not at home, that's still some way off.  Kind of like the way the 911 system started out. It will happen but it just takes time.  
Education should be appropriate to the level of certification desired.  A MFR doesn't need to know acid/base balance. If I want to get a license to drive a moped, there is no reason for me to study for a CDL license.  I don't need to know that you might need to downshift before you are going down a 6% grade at 80 mph. An EMT-B doesn't need to know the landmarks to perform a needle thoracotomy. An EMT-I doesn't need to know how to perform a pericardial centesis (sp?).  An MFR  needs to know what to do until the EMT-B arrives. The EMT-B needs to know everything required of a EMT-B in the National Curriculum to treat until an EMT-I or a EMT-P arrives or they get to the hospital and so on up the line. That's why there are different levels. Even if we had all ALS 24/7 there would probably be a need for the other levels. 
That being said... shoot for training above your level.  Everyone in the class might be smarter than you but you will probably learn more from that one class than they did.


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## Ridryder911 (Nov 29, 2006)

After more research I do stand corrected, you are correct there are still a very few diploma programs left. Most are attempting to be associated with at least an ADN program, mainly due to federal funding and ability of students obtaining student loans. It is considered a dying method, again due to few hospitals have the capabilities to teach full time. 

I agree they are prepared for patient care (yes, I work with several and agree they are great at that level) over all they are not recruited for administrative duties and are still are considered for "technical nursing level". (That is a direct quote from AACN). This is not a slam.. just the hierarchy of nursing, which I am very familiar with on a national level. 

One needs to be careful categorizing medical education and certification based upon local policy and employment in ones local market area. Each region has specific programs that are considered good and marketable, but one needs to be aware of the national trends, for future growth, and careers. For example many medics are now running to the Exclusiveor (NY Regents) for the RN, only to find out some states do not even recognize that as an approved nursing program (external degree).Some states do not recognize those that have attended that program. (When one applies for state license, you must present where you obtained your education). The same being on some Paramedic programs fail short on class and clinical hours in many states (for example my state requires Intubation for the EMT/I (85) and does not recognize the I/99). So my advice is to be very cautious on any educational programs.

If direct patient care is your main goal; that would be an excellent route and plan. However; if one is considering management, educational, or advance nurse levels in the future I highly recommend attending a formal BSN program to start with. The prestigous Magnet Status, and JCAHO all recommends percentage of administrative staff to have those credentials. As well advance level nursing must have at least that or equivelant level for entry requirements.  


Old school.. you are still a young one...LOL I will have my 30 next year, my goal is to make the Registry print a 50 year certificate...LOL I received my 20 year several years ago... there are not many of us left huh? ...

Sorry for the rant... 

R/r 911


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## jeepmedic (Dec 5, 2006)

Ridryder and oldschool you are both just OLD!!!! I got 20 years in but only 6 as a medic. But I started at a young age. like 10 or so


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## jeepmedic (Dec 5, 2006)

OH I almost forgot you Fedmedic you are really OLD to. You were intubating when I was just a First Responder.


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## trauma1534 (Dec 5, 2006)

jeepmedic said:


> OH I almost forgot you Fedmedic you are really OLD to. You were intubating when I was just a First Responder.



Yeah, he teaches EMT now in the nursing home where he resides.  He has really done alot there.  He set up an in house first responder program.  He has set up a program to educate the nurses on emergencys.  I do miss him being able to ride the truck with us now though.  He can't help it that he is old and gray now though!  HA HA!  Fed, you know we love ya suga!!  HA HA HA HA HA H!!!!!


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## jeepmedic (Dec 5, 2006)

He does look kinda funny with that back board on his wheel chair. 

Everyone thinks he drives an ambulance but he really drives a wheel chair.


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## trauma1534 (Dec 5, 2006)

jeepmedic said:


> He does look kinda funny with that back board on his wheel chair.
> 
> Everyone thinks he drives an ambulance but he really drives a wheel chair.



Have you seen that new scooter power chair he got?  It is cool!  He has a drug box, IV supplies, and an AED on it too!  tahehe!


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## jeepmedic (Dec 5, 2006)

Pops is going to be mad at us.


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## trauma1534 (Dec 5, 2006)

jeepmedic said:


> Pops is going to be mad at us.



We just showing that old fart some love!  HA!


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## Ridryder911 (Dec 5, 2006)

Hey ! There is nothing wrong with a magnifying glass on a walker, it helps me find a vein...

R/r 911


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## trauma1534 (Dec 5, 2006)

Ridryder911 said:


> Hey ! There is nothing wrong with a magnifying glass on a walker, it helps me find a vein...
> 
> R/r 911



What style power chair do you have ryder?  Fed's is pretty and black with heated leather seats!  Real cool!  Did I mention that he has a red strobe light on the front of it so he can get to the nursing home codes real fast!  Oh, and a little squeaky horn!!  it goes... booka booka!


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## Fedmedic (Dec 5, 2006)

Yeah, yall are so funnnnnnyyyyyyyyyy!! Yall should go on the road and do a comedy tour.....not!!!

Remember, payback is hell!


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## trauma1534 (Dec 6, 2006)

Fedmedic said:


> Yeah, yall are so funnnnnnyyyyyyyyyy!! Yall should go on the road and do a comedy tour.....not!!!
> 
> Remember, payback is hell!



I'm frightened!!!  Big time!!!!  Smile suga, we just playin!


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## trauma1534 (Dec 6, 2006)

Fedmedic said:


> Yeah, yall are so funnnnnnyyyyyyyyyy!! Yall should go on the road and do a comedy tour.....not!!!
> 
> Remember, payback is hell!



Since I am so funny, get this one.  I was riding down the road this past weekend and I saw Jeepmedic riding his 3 year old daughter's bike, which is pink, with a little purple basket on the front, and yes he has a state of the art booka booka horn too, fed!  But my God!  You should have seen his knees when he was peddleing, it looked like they were going to hit his face eveytime his knees went up.  And did I mention that he had a McDonalds cap on?  And he has a strobe light on the front!  I believe he was trying his best to get to that dang fire call!!!

Jeep, I didn't want to leave you out!  I still luz ya sugas!  HA HA HA HAHA HAHA!!!


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## jeepmedic (Dec 6, 2006)

just go get your diaper changed


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## trauma1534 (Dec 6, 2006)

jeepmedic said:


> just go get your diaper changed



I ran out!  Would you pick some up for me while you are out joyridding on your daughter's bike?


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## Firechic (Dec 6, 2006)

How old are these "old" folks you're making fun of??!!


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## jeepmedic (Dec 6, 2006)

She is just mad she is still in diapers. Lets see I remember $0.50 a gal. gas. and When I could buy a pack of smokes and a Dr. Pepper for a buck and still get change.

And hey trauma you forgot the Barbie Radio on the front.


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## Ridryder911 (Dec 6, 2006)

Well, I just put it this way.. my first Registry Patch had NREMT/Charter member.. yes, my number was less than 10,000. I would watch Johnny & Roy on TV (while the series was on the first time) between EMS calls, & I was a Paramedic even then. My first NREMT/P number was 3 digits long... and I recieved my 20 year continous Paramedic certificate from NREMT several years ago.. if that gives you a hint.

R/r 911


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## oldschoolmedic (Dec 6, 2006)

My brother and I would walk to the store and each buy a 16 oz Dr. Pepper in a glass bottle for a dime (oh yeah, no twist off caps either). The bottles had a nickel deposit on them, so we would take the two nickels and buy another one to split, then pocket the third nickel until the next day. It's when my Doc habit started, 1972.


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## fm_emt (Dec 7, 2006)

Oh yeah? Well, I strapped Thog to a stone tablet with some Stegosaurus entrails one time!


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## Airwaygoddess (Dec 7, 2006)

Can anyone say BEE GEES.......EEK!!


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